Faculty Bibliography

Tubercular meningitis and intracranial tuberculomas are the two frequent manifestations of neurotuberculosis with their variable incidence in different countries. Brain stem tuberculomas are even more unusual, accounting for 2.5-8% of all intracranial tuberculomas. We present here six paediatric cases of brain stem tuberculosis, where well-formed tuberculomas were demonstrated in five symptomatic cases; however, only a hypodense ill-defined lesion was found in the brain stem of one child who presented with features of tubercular meningitis. Three of these children had other associated tuberculomas in their brain parenchyma as well. All the six cases, however, showed the involvement of 3rd, 6th & 7th cranial nerves, in various combinations, at the time of initial presentation. Only two children developed hydrocephalus and required CSF diversion. All responded well to anti-tubercular chemotherapy, though two children developed toxicity to the therapy, which recovered with drug manipulation for about 2 months. Recovery was full without residual deficit in all the cases. Surgical excision of brain stem granulomas was not indicated in any case.

Association of syringomyelia with retrocerebellar arachnoid cysts is rare. A case of 14 year old female is being reported, who presented with hydrocephalus caused by a large midline retrocerebellar infravermal arachnoid cyst leading to obstruction of the outlet foramina of the fourth ventricle. There was associated syringomyelia. The pathogenesis of syringomyelia is discussed. The need to evaluate cervical spinal cord by taking T1 weighted sagittal sections in all the patients of large posterior fossa mass lesions causing obstruction to the outlet foramina of the fourth ventricle has been stressed, in order to detect associated syringomyelia.

Glioblastoma multiforme is one of the commonest primary malignant tumours of the brain with rare incidence of extracranial metastases. Systemic dissemination via the CSF or CSF diversionary shunt procedures is also rare. The reported 9-year-old child was a case of thalamic glioblastoma with hydrocephalus who underwent biventriculoperitoneal shunting before tumour decompression and radiotherapy. The child developed incapacitating ascites 8 months following surgical decompression and 9 months after the shunt diversion which was found to be caused by CSF dissemination of the glioblastoma via the ventriculoperitoneal shunt. The child ultimately succumbed to his disease.