Giant craniocervical junction schwannoma: A case report and review of the literature

Background: Giant schwannomas are tumors that measure more than 2.5 cm or span more than two vertebral body levels. They are benign peripheral nerve sheath tumors that can be associated with neurofibromatosis type 2. These giant tumors rarely occur at the craniocervical junction; when they do, giant schwannoma pose a significant surgical challenge in terms of choice of approach.

Objective: To present a case of giant craniocervical junction schwannoma successfully excised.

Case description: We present the case of a 68-year-old male patient with a giant craniocervical mass. The tumor was excised in one seating through a far lateral approach, and histology confirmed a schwannoma. The patient made a good recovery as seen in the improvement of his Nurick grade immediately postoperatively. We reviewed the current literature on giant craniocervical junction schwannoma.

Conclusion: Management of giant craniocervical junction schwannoma is challenging but careful planning and the choice of the correct approach will assist the patient have a good outcome.

Keywords: Giant schwannoma, craniocervical junction, spinal tumor, neurofibromatosis, Nurick grade

Bilateral extradural hematoma: a case report, review and treatment strategy

Introduction: Bilateral EDH (Extradural Hematoma) is rare consequence of closed head injury and is mainly seen in young population.  Patients with bilateral  EDH less frequently have a lucid interval, have a lower GCS, lateralization is frequently absent and deteriorate more often than individuals with unilateral hematomas. therefore needs to be managed on emergency basis by surgery. Literature suggests for bilateral simultaneous craniotomy for evacuation for bilateral EDH.  We report here a case of bilateral EDH which was managed by one side craniotomy.

Case presentation: A 35 year old male was admitted with history of hit to the left side of his head by a wooden stick. History of loss of consciousness and nasal bleed was present. On local examination there was open wound over left parietal region. Glasgow Coma Scale (GCS) was E4V2M6., Pupils were bilaterally 3mm and were reacting. Non contrast computed tomography (NCCT) scan head  showed linear fracture of both parietal and left frontal bone. An EDH of 17mm in maximum thickness in left parietal and frontal region with another EDH in right high parietal region with maximum thickness of 6.3mm was present. Intraoperatively subgaleal hematoma was present. Linear fracture was present in the left frontal and parietal bone. Left fronto parietal craniotomy was done and EDH was evacuated. Post operative period was uneventful. NCCT head was done which showed no increase in size of right high parietal EDH with adequate evacuation of left side EDH. The patient was discharged on post operative day 5.The clinical, radiological features of this rare entity are presented.

Conclusion: Bilateral EDH is a rare condition and has different management strategy as compared to unilateral EDH. Clinically, the patient may be intact and lateralising signs are often absent. Serial CT scans are necessary and surgical threshold should be low.

Keywords: Extradural hematoma, Bilateral, GCS, Head injury

Current and future use of virtual and augmented reality in neurosurgery: a literature review

Background: For many years the same model has been applied to neurosurgical education; and unfortunately with the shift of healthcare to political and socioeconomic areas, it forced many surgical residents and fellows to limit their OR exposure only to certain cases. With limited resources given to graduate medical education facilities, now a more optimal approach to surgical education has to be adopted. There is a need for modern hands-on, yet safe approach to crucial neurosurgical procedures. A Virtual Reality/Augmented Reality technology can provide an optimal solution to any neurosurgeon who seeks to improve his/her OR skills on demand, without compromising patient safety, wasting OR time and most importantly cost efficiently for the hospital.

Methods: We performed online search of the Google Scholar and PubMed databases for the following keywords “virtual reality,” “neurosurgery,” “spine surgery,” “augmented reality,” separately as a single word and as a phrase. Our search strategy included publications from early 2000s to 2019 years respectively.
Results: A unique combination of 3D VR/AR technology allows neurosurgeons to get a precise planning before the actual procedure, additionally, visualize a roadmap for possible complications during the surgery. Some critical tasks of complex procedures could be segmented and rehearsed before the surgery for optimal outcome. One who immerses in 3D VR can easily explore the area of interest from any possible angle.

Conclusion: Integration of VR/AR technology in the preoperative and operative fields, allows neurosurgeons to maximize efficiency, technique and even provide an educational benefit for the patients undergoing neurosurgical procedure.

 Keywords: augmented reality, neurosurgery, virtual reality