Introduction: The insular glioma is a rare condition in neurosurgical practice. The treatment of insular glioma lacks a distinct approach. This study aims to review the outcomes of insular glioma surgery and discuss strategies to minimise the risk in adults who have undergone initial or repeat resection of insular gliomas of all grades. Methods: An observational study was done among 50 patients with insular gliomas who were admitted to the Department of Neurosurgery of a tertiary care centre during January 2015-August 2025. The treatment decisions and neurosurgical outcomes of the patients with insular glioma were analysed. All patients were assessed with either computed tomography, magnetic resonance imaging, or both. Results: Among the admitted patients, the youngest patient was 25 years, and the oldest was 76 years, while there were 30 males and 20 females. Most of the patients, 42 (84%), presented with headache and 32 (64%) presented with seizures of sudden onset. Right-sided insular gliomas were observed in 27 (54%) patients, but 23 (46%) patients had left-sided tumours, and 27 (57%) patients were operated on with the Transylvanian approach and 20 (42%) patients with the transcortical approach. Extent of resection above 90% or above was achieved in 52% of cases, and EOR of 70-90% in 48% of cases. Conclusion: The surgical approach for insular gliomas requires technical mastery of intraoperative technologies to minimise postoperative morbidity.
Background: Chordoma is a rare malignant bone tumour derived from notochordal remnants, characterised by slow growth and aggressive local behaviour. Although distant metastases are increasingly recognised, dural metastasis remains exceptionally rare. Case description: We describe the case of a 72-year-old female patient with a history of a suprasellar chordoma, initially resected 8 years ago. The patient presented with tumour recurrence at the original site and a newly identified frontal dural metastasis. Imaging revealed growth of the residual clival tumour along with a well-circumscribed dural-based lesion in the frontal convexity. Surgical management consisted of resection of the recurrent clival lesion and complete excision of the frontal dural metastasis. The procedures were well tolerated, and postoperative recovery was uneventful, with resolution of preoperative neurological symptoms. Histopathological analysis confirmed the diagnosis of recurrent chordoma and dural metastasis. Conclusion: Dural metastasis of chordoma is an uncommon but important diagnostic entity that should be considered in patients with a history of chordoma presenting with new dural-based lesions. Early recognition is crucial to avoid misdiagnosis and guide appropriate management.
We present the case of a 47-year-old woman diagnosed with breast cancer who underwent surgery and, 35 months later, was diagnosed with multiple brain metastases. She was treated surgically, followed by Whole Brain Radiation Therapy and chemotherapy. Clinical and imaging follow-up revealed no tumour recurrence after more than 5 years.
Tension pneumocephalus is a rare and potentially fatal neurological disease. To avoid deadly consequences, it demands urgent and rapid intervention. The most prevalent cause of tension pneumocephalus is a head injury. Air can enter the cranium by a fracture affecting the paranasal sinus or the middle ear cavity, or even more rarely, through a complex depressed fracture of the skull vault. Its treatment consists of a simple twist drill and aspiration of intracranial air with or without the insertion of an underwater seal. 100% oxygen should be delivered using a non-breathable mask that hastens air resorption. The authors provide a series of five examples with post-traumatic tension pneumocephalus, focusing on its treatment and review of literature.
Midbrain contusions are uncommon in civilian trauma and rarely present with isolated cranial nerve deficits. We present a rare case of a conscious 40-year-old male who developed bilateral ptosis, right medial rectus palsy, and left upgaze palsy following a motor vehicle accident. NCCT brain revealed multiple contusions in the midbrain, bilateral frontal, and right parietal lobes. The patient was managed conservatively. The constellation of neuro-ophthalmic signs correlated with damage to the midbrain tegmentum and dorsal structures. This case underlines the importance of careful neuro-ophthalmic examination in head injury and highlights rare presentations of traumatic midbrain injury.
