Hydrocortisone dose and postoperative diabetes insipidus in patients undergoing transsphenoidal pituitary surgery: a prospective randomized controlled study

We report the results of a prospective randomized controlled trial, which looked at the incidence of postoperative diabetes insipidus (DI) following the use of three different hydrocortisone protocols, and the results of a study, on the incidence of DI and cortisol response in patients not given hydrocortisone. In study 1, 114 patients with pituitary macroadenoma were randomized into three groups: conventional dose (inj. hydrocortisone 100 mg IV 6-hourly for 3 days); intermediate dose (inj. hydrocortisone 100 mg IV 6-hourly on day 1, 100 mg IV 8-hourly on day 2, and 100 mg IV 12-hourly on day 3); low dose protocol (inj. hydrocortisone 25 mg IV 6-hourly on day 1, 25 mg IV 8-hourly on day 2 and 25 mg IV 12-hourly on day 3). Radical excision was achieved in 92 patients. The incidence of DI with the conventional dose was 52%, intermediate dose, 36% and low dose, 24% (p = 0.025). Study 2 included 16 consecutive patients with Hardy's grade A & B pituitary adenoma. These patients were randomized to receive (Group I) or not receive (Group II) hydrocortisone. Patients in Group II demonstrated normal cortisol response intraoperatively and no patient developed features of hypocortisolism; the incidence of DI in this group was 14%. The low dose hydrocortisone protocol reduced the incidence of DI by 46% when compared with the conventional dose hydrocortisone protocol. In patients with grade A and B tumour with normal preoperative cortisol levels, the use of perioperative hydrocortisone can be avoided.     

Syndrome of recurrent meninigitis due to congenital perilymph fistula with two different clinical presentations

Recurrent meningitis secondary to a congenital labyrinthine anomaly is a rare clinical entity, diagnosis of which is dependent upon certain clinical, radiological and intraoperative features. In the following report we describe two children with congenital labyrinthine fistula and recurrent meningitis whose clinical presentation, radiological features and intraoperative findings were dissimilar and thus, illustrative of two different ways of presentation of this rare disorder. While one had a classical Mondini defect and unilateral hearing loss, the other had normal audiometric and radiographic findings. The fistulae were successfully closed via a tympanotomy approach in both the patients.     

The calcified intracorporeal vacuole: an aid to the pathological diagnosis of solitary cerebral cysticercus granulomas

Fifty four cases of single small (<20 mm) enhancing CT lesions (SSECTLs) of the brain that were excised between 1987 and 1995 were reviewed histologically. In 28 cases the entire cysticercus or its parts were found. In the remaining 26 cases, most had a histological picture suggestive of a parasitic granuloma. In six of these 26 cases, small ovoid masses corresponding in morphology to the intracorporeal vacuoles of a cysticercus were seen lying free in the cavitary space of the granuloma. This lends further strength to the contention that SSECTLs of the brain are caused by cysticercus, and that in the event of a surgical excision, absence of obvious parasitic parts should necessitate a closer search, as calcareous residues of the parasite might be the only evidence of the cysticercal aetiology in the granuloma.     

Utility of the cysticercus immunoblot in a patient with an atypical solitary cerebral cysticercus granuloma

The value of the enzyme linked immunotransfer blot (EITB) assay in avoiding an invasive diagnostic procedure in a patient with an atypical solitary cerebral cysticercus granuloma is presented.     

Peripheral Neurectomy: Minimally Invasive Surgical Modality for Trigeminal Neuralgia in Indian Population: A Retrospective Analysis of 20 Cases

Objective

To evaluate the efficacy of peripheral neurectomy in 20 cases of trigeminal neuralgia as minimally invasive surgical treatment modality.

Materials and methods

Twenty (12 males and 8 females) patients with trigeminal neuralgia aged between 35 and 68 years (mean 48 years), who had undergone peripheral neurectomy, were retrospectively analyzed for relief of pain, complications, recurrence of pain, and any additional procedure required to treat recurrence, in a follow-up period of 36 months postoperatively.

Results

There was no significant intra-operative and post-operative complications. There was recurrence of pain in two patients (10 %) in 24 and 28 months post-operative follow-up respectively, whereas, rest of the 18 patients were symptom free during 36 months follow-up.

Conclusion

Peripheral neurectomy is one of the minimally invasive and expeditious forms of surgical modality for the treatment of trigeminal neuralgia. This treatment option is cost effective and provides long term relief from neuralgic pain.