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Spinal cavernous angiomas are lesions formed by vessels lined by closely clustered endothelial cells. They are common in the vertebral body and less common in an intradural location. However, these are very rare in the extra-osseous and epidural region. Less than 100 cases have been reported. Here, we report a case of dorsal spinal extradural cavernous angioma in a 52-year-old man who presented with back pain and difficulty in walking. Magnetic resonance imaging brain showed D7-D8 (thoracic) extradural spinal lesion, enhancing homogeneously on contrast administration. He underwent D7-D8 hemilaminectomy and tumor decompression. The tumor was extradural, tightly adherent to the dura, and highly vascular. He recovered completely after surgical removal with no recurrence 2 years after removal. He was not administered adjuvant radiotherapy. In this article, we review the literature regarding clinical features, imaging findings, and outcome of spinal epidural cavernous angioma.

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BACKGROUND: Benign intradural extramedullary (IDEM) tumours in children are usually neural sheath derivatives or are dura based. Total resection of these benign tumours is the primary surgical goal. A management issue related to their occurrence in the growing paediatric spine is a higher propensity for the development of postlaminectomy kyphosis, especially in the upper cervical spine, than what is seen in adults. METHODS: A retrospective study was performed on 22 patients to analyse the incidence, presentation and management of postoperative kyphotic deformities in children who underwent laminotomy and tumour excision for benign cervical IDEM tumours. RESULTS: The incidence of postoperative kyphosis was 13%. All these patients underwent subsequent posterior fusion following reduction of the deformity with good results. CONCLUSION: Following excision of cervical intradural lesions, paediatric patients need to be followed up regularly to rule out the development of postsurgical deformities especially in the upper cervical spine region. Various biomechanical, surgical and tumour-related factors which influence the development of deformities are reviewed.

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A cytohistological correlation with determination of accuracy rate of smear preparation result was done in a retrospective study of 306 cases of intracranial tumors. Cytomorphology of few new entities of CNS tumors are described. The cytological features and WHO grading of the tumors were described on smear preparation. The cases with discrepancy in cytological and histological diagnosis were reviewed again and a final possible diagnosis on smear preparation which should have been given is discussed. The clinical details like the age, sex, and site of the tumors were analyzed. The age range of the patients was from 3 years to 63 years with male:female ratio of 1.5:1. Of the total 306 cases, a cytohistological correlation was seen in 93% cases. Twenty-two (7.3%) cases showed discrepancy between the crush preparation diagnosis and final histopathological diagnosis. Majority of the tumors were located in the cerebral hemisphere (56%) and the most frequently diagnosed tumor was astrocytoma, in particular, pilocytic astrocytoma (18.5%) followed by meningioma (11.9%), medulloblastoma (7.3%), anaplastic oligodendroglioma (5%), ependymoma (4.3%), pituitary adenoma (3.3%), schwannoma (3.3%), etc. A few rarer tumors, in central nervous system like differentiating neuroblastoma, pineocytoma, atypical choroid plexus papilloma, piloxmyxoid astrocytoma, rosette forming glioneuronal tumor, etc. are also described, Smear/crush preparation is a very effective, simple, rapid and reliable technique for the diagnosis and WHO grading of central nervous system tumors. Diagnostic accuracy of cytology with final histopathological report is established with accuracy rate of 93%.

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A giant spinal arachnoid cyst is an unusual cause of progressive epidural compressive syndrome. The authors describe 4 cases of a "complex" subtype of this lesion and discuss aspects of surgical management. The patients presented with progressive spastic paraparesis and were found to harbor extensive spinal extradural arachnoid cysts with multiple septations and significant paraspinal extensions. Extensive laminotomy and excision of the cyst along with its extensions were performed in all cases. Compared with previously indexed cases of surgically managed extensive spinal extradural arachnoid cysts, the cases reported here are unique because of their complex nature. Curative treatment consists of radical excision inclusive of the paraspinal extensions as well as closure of a dural defect, if found. A laminotomy or laminoplasty should be performed to avoid postoperative instability related to the extensive exposure. Extended follow-up and instrumentation may be required in select cases.

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Oligodendrogliomas constitute 4-7% of primary intracranial gliomas in adult and 1% of primary central nervous system tumours in children. The authors report two unusual pediatric cases of anaplastic oligodendroglioma occurring in the cerebellum. The patient with a well-circumscribed lesion with 1p/19q co-deletion had a favorable outcome in comparison with the patient with a diffuse lesion and intact 1p/19q. The discussion elucidates the surgical outcome of such pediatric cerebellar anaplastic oligodendrogliomas in relation to their radiological findings.

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We report an unusual case of a recurrent fourth ventricular anaplastic ependymoma with prominent chondroid metaplasia in a 16-year-old male. On initial presentation, the patient had a WHO Grade II tumor. However, at recurrence 1 year later, the tumor progressed to WHO Grade III tumor with more cellularity, necrosis and brisk mitotic activity. Chondroid metaplasia was present in both the initial and recurrent tumors.

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We report an unusual patient with a primary malignant ganglioglioma, World Health Organization (WHO) grade III, of the spinal cord at the D11-L1 level in an 11-year-old boy. The patient presented with low backache and progressive paraparesis. A MRI scan revealed a well-defined conus lesion extending from D11 to L1, which was predominantly isointense on T1- and T2-weighted images and enhanced with contrast. On histopathological evaluation, the tumor was found to be comprised of two different components. One of the components revealed typical ganglioglioma with dysmorphic ganglion cells, positive for synaptophysin on immunohistochemistry. The other component was cellular with a high mitotic activity, giant tumor cells and glial fibrillary acidic protein (GFAP) positivity. The MIB-1 labeling index was ≥ 75% in the latter component. We emphasize the role of the MIB-1 labeling index to predict the prognosis and further management in these rare occurrences.

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Paradoxical embolism through a patent foramen ovale or atrial septal defect is increasingly recognized in association with embolic strokes, with the advent of modern echocardiography. The authors describe two neurosurgical cases with such an anomaly that suffered nonfatal embolic stroke in the cerebellum. The patients developed posterior inferior cerebellar artery infarcts, which were managed conservatively and had no neurological deficits. They evaluate possible factors for emboli to occur in a perioperative neurosurgical setting and provide a brief review of literature on preoperative management of patients with this cardiac defect. Closure of cardiac shunts is warranted before non-emergent neurosurgical operations. During emergency craniotomies, proper precautions should be taken to reduce the incidence of venous air embolism and paradoxical embolism.

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Isolated intracranial Rosai Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is rare. We present a 26-year-old male who presented with left focal motor seizures becoming secondarily generalized of one-year duration. Clinically and radiologically patient was diagnosed to have a right parietal convexity meningioma. However on histopathological examination a final diagnosis of intracranial Rosai Dorfman disease was rendered.

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