Background: Cisternostomy incorporates micro-neurosurgery to unfold the brain, allowing wider access to optico-carotid window. The Cisterns are drained after opening the membrane of Lillequest, significantly reducing the intra-parenchymal pressures due to CSF-Shift edema occurring in the setting of moderate to severe traumatic brain injury. It is important to consider the time of intervention following brain trauma, which determine the surgical procedure undertaken for best outcomes.

Methodology: A retrospective study was conducted to obtain data for 50 patients undergoing Cisternostomy between January to September 2018, with a presenting GCS of less than 8, as the primary surgical management for decreasing intra-parenchymal pressures secondary to severe traumatic brain injury. Outcomes were assessed at a 2 months follow-up using Glasgow Outcome Scale. All data was entered and analyzed using SPSS Software.

Results: Out of 50 patients, 70% were males and 30% females.  38% patients belonged to ages between 21 to 40 years. Out of 50 patients with GCS less than 8, 4 patients had bilaterally non-reactive pupils. In almost all patients (n=48), bone flap was replaced after complete brain relaxation was achieved. Post-operative CT scans showed opening of suprasellar cisterns (n=45).  The average ICU days and ventilator days were approximately 3 and 2, respectively. Follow-up on 2 months using GOS showed a good recovery (n= 38), moderate disability (n= 4), severe disability (n=3) and dead (n=5)

Conclusion: Cisternostomy provides promising outcomes in severe brain injuries by effectively decreasing intraparenchymal pressures and preventing axonal injury which manifest as a later sequel in brain trauma.

Background: Spina bifida is a congenital abnormality in neural tube that frequently occurs in the lumbosacral region and rarely occurs in the cervical region. Abnormality of the neural tube is one of the most common congenital disorders in the worldwide, with a prevalence ranging from 0.5 to more than 10 per 1,000 pregnancies. Meningocele at the cervical junction is a very rare congenital disorder. Our knowledge of this condition is very limited due to small retrospective case series and the limited number of case reports.

Case presentation: A 4-month-old boy with a mass in craniovertebral area covered with normal skin, measuring 6 cm in diameter, with semi-solid consistency. The CT scan of the head found hydrocephalus and type 1 Chiari malformation accompanied by fluid-filled cysts in the subcutaneous tissue in the craniovertebral area which has consistent findings with meningocele. The patients underwent Ventriculoperitoneal shunt and surgical excision to repair the meningocele. Postoperatively, no complications occurred and reported during both procedures, and the patient had no additional deficits.

Conclusion: Meningocele at the craniovertebral junction remains a rare case of congenital abnormalities. A comprehensive excisional operation is the first choice, and resulted in satisfactory outcome. Although there were no neurological abnormalities, we need to perform surgery as early as possible in these cases to prevent the occurrence of neurological disorders in the future.

Keywords: Chiari malformation, craniovertebral junction, hydrocephalus, meningocele, spina bifida

Introduction: Various anomalies occure in the jugular foramen. The most common lesion within the jugular foramen is the hypervascular glomus jugulare tumour followed by neurogenic tumors, predominantly schwannoma. Jugular foramen schwannoma can also be vascularized and frequently mimics paraganglioma.

Case presentation: We present a case of a 36-year-old woman who presented with 8 to 10 months history of  giddiness and vertigo, slowly progressive sensorineural hearing loss in left ear,  gradually progressive left facial weakness (House Brackman grade III at the time of admission) and gait ataxia. A magnetic resonance imaging showed an avidly enhancing extra axial left cerebello-pontine angle space occupying lesion extending through the jugular foramen into the petrous temporal bone on the left side with prominent central flow voids. Paraganglioma was suspected and Digital Subtraction Angiography was done which showed tumour blush with arteriovenous fistula supplied by stylomastoid artery, which is branch of occipital artery. Surprisingly, histopathology after surgical resection revealed schwannoma.

Conclusion: Prominent central vascularity and arteriovenous fistula with arterial supply from stylomastoid branch of occipital artery can be an unusual presentation for jugular foramen schwannomas. We describe architecture of vascualrity of jugular schwannoma and identify stylomastoid branch of occipital artery as its prime feeder.

Keywords: jugular foramen schwannoma, paraganglioma