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   2016| October-December  | Volume 11 | Issue 4  
    Online since July 7, 2016

 
 
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REVIEW ARTICLES
Chronic subdural hematoma
Yad R Yadav, Vijay Parihar, Hemant Namdev, Jitin Bajaj
October-December 2016, 11(4):330-342
DOI:10.4103/1793-5482.145102  PMID:27695533
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule. Contrast-enhanced CT or MRI could detect associated primary or metastatic dural diseases. Although definite history of trauma could be obtained in a majority of cases, some cases may be secondary to coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., Recurrent bleeding, increased exudates from outer membrane, and cerebrospinal fluid entrapment have been implicated in the enlargement of CSDH. Burr-hole evacuation is the treatment of choice for an uncomplicated CSDH. Most of the recent trials favor the use of drain to reduce recurrence rate. Craniotomy and twist drill craniostomy also play a role in the management. Dural biopsy should be taken, especially in recurrence and thick outer membrane. Nonsurgical management is reserved for asymptomatic or high operative risk patients. The steroids and angiotensin converting enzyme inhibitors may also play a role in the management. Single management strategy is not appropriate for all the cases of CSDH. Better understanding of the nature of the pathology, rational selection of an ideal treatment strategy for an individual patient, and identification of the merits and limitations of different surgical techniques could help in improving the prognosis.
  6,581 2,938 15
Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
Yad R Yadav, Vijay S Parihar, Mina Todorov, Yatin Kher, Ishwar D Chaurasia, Sonjjay Pande, Hemant Namdev
October-December 2016, 11(4):325-329
DOI:10.4103/1793-5482.145100  PMID:27695532
Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM). It can be purely obstructive, purely communicating, or due to combinations of obstruction in addition to defective absorption of cerebrospinal fluid (CSF). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. ETV in TBM hydrocephalus can be technically very difficult, especially in acute stage of disease due to inflamed, thick, and opaque third ventricle floor. Water jet dissection can be helpful in thick and opaque ventricular floor patients, while simple blunt perforation is possible in thin and transparent floor. Lumbar peritoneal shunt is a better option for communicating hydrocephalus as compared to VP shunt or ETV. Intraoperative Doppler or neuronavigation can help in proper planning of the perforation to prevent neurovascular complications. Choroid plexus coagulation with ETV can improve success rate in infants. Results of ETV are better in good grade patients. Poor results are observed in cisternal exudates, thick and opaque third ventricle floor, acute phase, malnourished patients as compared to patients without cisternal exudates, thin and transparent third ventricle floor, chronic phase, well-nourished patients. Some of the patients, especially in poor grade, can show delayed recovery. Failure to improve after ETV can be due to blocked stoma, complex hydrocephalus, or vascular compromise. Repeated lumbar puncture can help faster normalization of the raised intracranial pressure after ETV in patients with temporary defect in CSF absorption, whereas lumbar peritoneal shunt is required in permanent defect. Repeat ETV is recommended if the stoma is blocked. ETV should be considered as treatment of choice in chronic phase of the disease in obstructive hydrocephalus.
  3,218 3,448 4
Posttraumatic delayed tension pneumocephalus: Rare case with review of literature
Vivek Kumar Kankane, Gaurav Jaiswal, Tarun Kumar Gupta
October-December 2016, 11(4):343-347
DOI:10.4103/1793-5482.180904  PMID:27695534
Pneumocephalus is commonly seen after head and facial trauma, ear infections, and tumors of the skull base or neurosurgical interventions. In tension pneumocephalus, the continuous accumulation of intracranial air is thought to be caused by a “ball valve” mechanism. In turn, this may lead to a mass effect on the brain, with subsequent neurological deterioration and signs of herniation. Tension pneumocephalus is considered a life-threatening, neurosurgical emergency burr-hole evacuation was performed and he experienced a full recovery. However, more invasive surgery was needed to resolve the condition. Delayed tension pneumocephalus is extremely rare and considered a neurosurgical emergency. Pneumocephalus is a complication of head injury in 3.9–9.7% of the cases. The accumulation of intracranial air can be acute (<72 h) or delayed (≥72 h). When intracranial air causes intracranial hypertension and has a mass effect with neurological deterioration, it is called tension pneumocephalus. We represent a clinical case of a 30-year-old male patient with involved in a road traffic accident, complicated by tension pneumocephalus and cerebrospinal fluid rhinorrhea on 1 month after trauma and underwent urgent surgical intervention. Burr-hole placement in the right frontal region, evacuation of tension pneumocephalus. Tension pneumocephalus is a life-threatening neurosurgical emergency case, which needs to undergo immediate surgical intervention.
  3,412 459 5
ORIGINAL ARTICLES
Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management
Nissar Shaikh, MA Rhaman, Ali Raza, Adel Shabana, Mahommad Faisal Malstrom, Ghanem Al-Sulaiti
October-December 2016, 11(4):427-432
DOI:10.4103/1793-5482.146394  PMID:27695550
Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole. Endotracheal suctioning and positioning of HSCI patients were significant provocative factors for prolonged bradycardia; hypotension on admission, pneumonia and tracheostomy were the risk factors for the development of prolonged bradycardia in these patients.
  2,543 216 -
High incidence of neural tube defects in Northern part of India
Sunil Kumar Rai, Royana Singh, Sharad Pandey, Kulwant Singh, Neeraj Shinde, Sangita Rai, Rajniti Prasad, Satya Narayan Shama
October-December 2016, 11(4):352-355
DOI:10.4103/1793-5482.175628  PMID:27695536
Background: In the absence of primary care and prevailing associated social stigma, many patients of neural tube defects (NTDs) from remote areas die without getting any treatment. The high number of such untreated cases and unregistered deaths in these areas made us ponders to the fact that tertiary care center-based studies do not represent the true incidence of NTDs. Materials and Methods: We did a population-based survey for NTDs births of rural areas from Jaunpur to Ghazipur district in Eastern Uttar Pradesh. These districts are among the least developed areas of Northern India in Uttar Pradesh among other 17. Results: The data show an incidence of 7.48 per 1000 live births. Conclusion: Besides of unawareness regarding periconceptional folate supplementation, intensive effort is required to design adequately powered studies to search other key factors responsible for high prevalence of NTDs.
  2,313 299 1
Learning neuroendoscopy with an exoscope system (video telescopic operating monitor): Early clinical results
Vijay Parihar, YR Yadav, Yatin Kher, Shailendra Ratre, Ashish Sethi, Dhananjaya Sharma
October-December 2016, 11(4):421-426
DOI:10.4103/1793-5482.145551  PMID:27695549
Context: Steep learning curve is found initially in pure endoscopic procedures. Video telescopic operating monitor (VITOM) is an advance in rigid-lens telescope systems provides an alternative method for learning basics of neuroendoscopy with the help of the familiar principle of microneurosurgery. Aims: The aim was to evaluate the clinical utility of VITOM as a learning tool for neuroendoscopy. Materials and Methods: Video telescopic operating monitor was used 39 cranial and spinal procedures and its utility as a tool for minimally invasive neurosurgery and neuroendoscopy for initial learning curve was studied. Results: Video telescopic operating monitor was used in 25 cranial and 14 spinal procedures. Image quality is comparable to endoscope and microscope. Surgeons comfort improved with VITOM. Frequent repositioning of scope holder and lack of stereopsis is initial limiting factor was compensated for with repeated procedures. Conclusions: Video telescopic operating monitor is found useful to reduce initial learning curve of neuroendoscopy.
  2,138 300 4
Spinal epidural angiolipomas: Clinical characteristics, management and outcomes
Sofiene Bouali, Nidhal Maatar, Asma Bouhoula, Khansa Abderrahmen, Imed Ben Said, Adnen Boubaker, Jalel Kallel, Hafedh Jemel
October-December 2016, 11(4):348-351
DOI:10.4103/1793-5482.180901  PMID:27695535
Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated.
  2,093 320 2
Intracranial abscesses: Retrospective analysis of 32 patients and review of literature
David O Udoh, Emmanuel Ibadin, Mojisola O Udoh
October-December 2016, 11(4):384-391
DOI:10.4103/1793-5482.150007  PMID:27695542
Background: Intracranial abscess collections, though uncommon, are dreaded complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Combining surgical evacuation with the appropriate antibiotic therapy is the effective treatment for intracranial abscesses. However, literature on surgical treatment is replete with several procedures which, on their own, may not determine outcome. Objectives: To determine the epidemiology and outcomes (of various treatment modalities) of intracranial abscesses in our institution, a major referral center for neurosurgical conditions in the midwestern region of Nigeria. Materials and Methods: This is a retrospective analysis of demographic data as well as indications, treatment modalities, and outcomes of various surgical procedures for evacuation of intracranial abscesses between September 2006 and December 2011. Results: We carried out 40 procedures in 32 (23 male and 9 female) patients with various intracranial abscesses. These represented approximately 5.6% of all operative neurosurgical procedures in our unit since inception. Most abscesses [16, i.e. 50%] occurred in the second decade. In the first decade, there were 7 (22%), and after the age of 30 years, there were 4 (12.5%). The most susceptible single year of life was infancy with 4 (12.5%) cases of intracranial abscesses. None of the infants had features of congenital heart disease. The predisposing factors were mostly otolaryngologic (9) or posttraumatic (6). Most abscesses (41%) were located in the frontal region, and intraparenchymal (i.e. intracerebral or intracerebellar) (50%) lesions were commoner than extradural, subdural, or intraventricular lesions. The commonest procedure performed (50%) was burr hole evacuation. Four patients (12.5% of cases) died. Prognosis appears to worsen with meningitis as the predisposing infection, ventriculitis, multiple abscesses especially in infants, and immunosuppression. Conclusion: The relative rarity of intracranial abscesses and the frequent delays in making the diagnosis render the condition a significant challenge to the clinician. A high index of suspicion, close interaction between the neurosurgeon and infectious disease specialist, with early treatment by adequate abscess drainage and appropriate antimicrobial treatment are important in their management.
  2,071 279 1
CASE REPORTS (ONLINE ONLY)
Baastrup's disease in the pediatric spine
Suryapratap Singh
October-December 2016, 11(4):446-447
DOI:10.4103/1793-5482.145153  PMID:27695557
Baastrup's disease is an uncommon entity in the elderly spine and it is very rare in the pediatric age group. There are only few case reports in the literature containing Baastrup's disease in pediatric spine. Baastrup's disease is also known as kissing spine because the posterior spinous processes touch or “kiss” one another, characterized by enlarged posterior spinous projections with normal neuroforamina and normal spinal disk height. There are various pathological and etiological hypotheses behind Baastrup's disease. Backache is one of the most common causes of morbidity in these patients and but sometimes patient can be asymptomatic with or without swelling on the back. Here, we present a case of 10-year-old female child with silent swelling on low back region diagnose as Baastrup's disease.
  2,186 150 -
Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali
GB Mahadewa Tjokorda, Golden Nyoman, Maliawan Sri, Mizuno Junichi
October-December 2016, 11(4):453-454
DOI:10.4103/1793-5482.145122  PMID:27695567
This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome.
  2,071 215 -
Peripheral nerve lipoma: Case report of an intraneural lipoma of the median nerve and literature review
Alisson Roberto Teles, Guilherme Finger, Marcelo N Schuster, Pedro Luis Gobbato
October-December 2016, 11(4):458-458
DOI:10.4103/1793-5482.181118  PMID:27695575
Adipose lesions rarely affect the peripheral nerves. This can occur in two different ways: Direct compression by an extraneural lipoma, or by a lipoma originated from the adipose cells located inside the nerve. Since its first description, many terms have been used in the literature to mention intraneural lipomatous lesions. In this article, the authors report a case of a 62-year-old female who presented with an intraneural median nerve lipoma and review the literature concerning the classification of adipose lesions of the nerve, radiological diagnosis and treatment.
  2,105 169 2
Traumatic bilateral basal ganglia bleed: A report of rare two cases and review of the literature
Vivek Kumar Kankane, Tarun Kumar Gupta, Gaurav Jaiswal
October-December 2016, 11(4):457-457
DOI:10.4103/1793-5482.175646  PMID:27695573
Traumatic basal ganglia hemorrhage (TBGH) is relatively uncommon. Bilateral basal ganglia hematoma after trauma is extremely rare and is limited to case reports. We report two cases of traumatic bilateral basal ganglia hemorrhage and review the literature in brief. Both cases were managed conservatively. The general incidence of TBGH is reported between 2.4% and 3% of closed head injury. However, the incidence is higher in postmortem studies (9.8%). Bilateral traumatic basal ganglia hematoma is extremely rare. Descriptions are limited to case reports.
  2,085 184 1
ORIGINAL ARTICLES
Factors affecting outcome in poor grade subarachnoid haemorrhage: An institutional study
Sannepaneni Kranthi, Barada P Sahu, Purohit Aniruddh
October-December 2016, 11(4):365-371
DOI:10.4103/1793-5482.149991  PMID:27695539
Context: Poor grade subarachnoid hemorrhage (SAH) is usually associated with unfavorable outcomes and optimal management is deemed complicated. Most centres follow an expectant management strategy or a less aggressive approach till patients improve to good clinical grades. This approach has been associated with higher mortality and morbidity. However, not all patients with poor clinical condition fare badly. Identification and early aggressive management of this select group of patients may lead to favorable outcomes. Settings and Design: Prospective non-randomized study. Materials and Methods: We prospectively analyzed 19 cases presented in WFNS grade 4 and 5 and factors affecting their outcome at a tertiary care centre in south India. This study was aimed at identifying those few poor grade patients who are probable candidates for a good outcome. Statistical Analysis Used: All the variables were analyzed for possible correlations with the SPSS version 13 software. The Chi-square test with a P < 0.05 was taken as statistically significant. Results: Of 19 cases, 13 were operated and good outcome was seen in 53.8% of the patients who underwent surgery and aggressive management. All 7 patients who were managed conservatively died. 15.8% of the patients had low density changes (P = 0.625). Absence of such changes was associated with a good long term outcome (P = 0.004). 9 patients had intraventricular hemorrhage at presentation and 5 patients having hydrocephalus underwent extra-ventricular drainage. Statistically significant factors precluding good outcome were the presence of infarcts and thick SAH in the cisterns. Conclusions: Poor grade (WFNS 4 and 5) SAH patients with or without ICH, IVH, if operated within 3 days can give rise to favorable outcome in around 50%. However, presence of patchy infarcts associated with thick subarachnoid blood (Fisher grade 3) precludes long term survival or meaningful recovery. Hence, aggressive management is unlikely to alter the natural history of such patients.
  1,948 275 2
Facial functional outcome in monitored versus not-monitored patients in vestibular schwannomas surgery
Graziano Taddei, Alfonso Marrelli, Donatella Trovarelli, Alessandro Ricci, Renato J Galzio
October-December 2016, 11(4):402-406
DOI:10.4103/1793-5482.144208  PMID:27695545
Objective: Even though advances in surgical techniques have improved facial nerve outcomes, functional preservation is still an issue because injury to the facial nerve has significant physical and psychological consequences for the patient. We retrospectively review our data in VS surgery to compare the facial outcome in intraoperative facial monitored versus not-monitored patients. Materials and Methods: 51 consecutive patients with unilateral vestibular schwannoma in the period from 2005 to 2010 were treated in our Institution. In according to the type of neurophysiological tool used during surgical procedures, two patients groups were identified: Group 1 (facial stimulator only) and Group 2 (stimulator and facial monitoring). Statistical comparison of the two groups was made with the t- test, and facial function results were evaluated with the Fisher's exact test. Results: In the Group 1, of the 22 patients with anatomically preserved facial nerves, 3 (13.6%) showed excellent facial nerve function, 14 (63.6%) showed intermediate function, and 5 (22.7%) showed poor function. In the Group 2, all the 27 patients got anatomically preserved facial nerves, and 18 (66.7%) showed excellent facial nerve function, 9 (33.3%) showed intermediate function, and no one showed poor function. Conclusions: We found that retrosigmoid approach associated with continuous EMG facial monitoring combined with the use of bipolar stimulation is a safe and effective treatment for vestibular schwannomas.
  1,888 226 -
CASE REPORTS (ONLINE ONLY)
Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy
Hayri Kertmen, Bora Gürer, Erdal Resit Yilmaz, Zeki Sekerci
October-December 2016, 11(4):450-450
DOI:10.4103/1793-5482.145119  PMID:27695562
Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac.
  1,839 249 2
ORIGINAL ARTICLES
Ganglioglioma: Single-institutional experience of 24 cases with review of literature
Vivek Tandon, Sumit Bansal, P Sarat Chandra, Ashish Suri, Manjari Tripathi, Mehar C Sharma, Avijit Sarkari, Ashok K Mahapatra
October-December 2016, 11(4):407-411
DOI:10.4103/1793-5482.153500  PMID:27695546
Background: Ganglioglioma is a common seizure associated tumor. The goal of this study was to observe the postoperative outcome in patients with gangliogliomas. Material and Methods: A total 24 patients with gangliogliomas who underwent surgery at our institute from 2008 to 2011 were included. There were 13 males (54%) in our study. A retrospective analysis for the demographic profile, surgery and outcome was performed using STATA software. Literature on this subject was also reviewed, MEDLINE and PUBMED databases were searched. Observations: Sixteen patients presented with signs and symptoms of raised intracranial pressure and 12 patients had seizure disorder. Average age at surgery was 20 years (range 7-50 years). Twelve each were located in the temporal lobe and extra-temporal location. Intra-operative electrocorticography (ECoG) alone in three and image guidance alone were used in two patients, respectively. Both ECoG and image guidance were used in one patient and none of them was used in 18 patients. Gross total resection was achieved in 17 patients. After a mean follow-up of 1.6 years (range 3 months to 2.5 years), out of 12 patients with preoperative seizures, 10 (83.3%) were seizure free (Engel class-I) and 2 (16.6%) belonged to Engel class-II. None of the factors, including age at surgery, seizure duration prior to surgery, type of seizures, use of intra-operative ECoG and image guidance, extent of tumor resection, and surgical strategy proved to have significant correlation with postoperative seizure outcome. Conclusions: Surgical treatment is effective and safe for patients with gangliogliomas. Neither intra-operative ECoG nor image guidance necessarily leads to better seizure control, although they are useful adjunct for achieving safe and complete tumor resection.
  1,871 172 2
Localized reversible high signal intensities on diffusion-weighted MRI in hypoglycemia: A study of 70 cases
Masahito Katoh, Masami Yoshino, Takeshi Aoki, Takeo Abumiya, Hiroyuki Imamura, Toshimitsu Aida
October-December 2016, 11(4):412-415
DOI:10.4103/1793-5482.144196  PMID:27695547
Introduction: It is well-known that localized reversible high signal intensities in the splenium of the corpus callosum or the basal ganglia appear on diffusion-weighted MRI in the presence of hypoglycemia. The aim of this study was to clarify the incidence and significance of such high signal intensity lesions. Results: We analyzed 70 cases of hypoglycemia with consciousness disturbance referred to our outpatient office. Localized reversible high signal intensities on diffusion-weighted MRI were noted in 6 cases (8.6%). They were at the splenium of the corpus callosum in four cases (5.7%), and right frontal cortex and bilateral frontal white matter in one each. Convulsions were noted in five cases, and right hemiparesis was noted in three. None of the three cases of hemiparesis showed localized reversible high signal intensities on diffusion-weighted MRI. These lesions are reversible if the patients undergo treatment without delay. Conclusion: The significance of these lesions is still unclear. However, when a high signal intensity lesion that is not reasonable for the symptom is detected on diffusion-weighted MRI, an immediate check of the blood sugar level is mandatory.
  1,915 113 -
Comparison of computational fluid dynamics findings with intraoperative microscopy findings in unruptured intracranial aneurysms- An initial analysis
Sandeep Talari, Yoko Kato, Hanbing Shang, Yasuhiro Yamada, Kei Yamashiro, Daisuke Suyama, Tsukasa Kawase, Vladimir Balik, Wu Rile
October-December 2016, 11(4):356-360
DOI:10.4103/1793-5482.180962  PMID:27695537
Context: The increase in the detection of unruptured cerebral aneurysms has led to management dilemma. Prediction of risk based on the size of the aneurysm is not always accurate. There is no objective way of predicting rupture of aneurysm so far. Computational fluid dynamics (CFDs) was proposed as a tool to identify the rupture risk. Aims: To know the correlation of CFD findings with intraoperative microscopic findings and to know the relevance of CFD in the prediction of rupture risk and in the management of unruptured intracranial aneurysms. Settings and Design: A prospective study involving nine cases over a period of 6 months as an initial analysis. Subjects and Methods: Both males and females were included in the study. Preoperative analysis was performed using computed tomography angiogram, magnetic resonance imaging in all cases and digital substraction angiogram in some cases. Intraoperatively microscopic examination of the aneurysm wall was carried out and images recorded. The correlation was done between microscopic and CFD images. Results: Seven cases were found intraoperatively to have a higher risk of rupture based on the thinning of the wall. Two cases had an atherosclerotic wall. All cases had low wall shear stress (WSS).Only two cases with atherosclerotic wall had a correlation with low WSS. Conclusions: While the pressure measured with CFD technique is a good predictor of rupture risk, the WSS component is controversial. Multicentric trials involving a larger subset of population are needed before drawing any definite conclusions. On-going development in the CFD analysis may help to predict the rupture chances accurately in future.
  1,767 227 4
CASE REPORTS (ONLINE ONLY)
Nocardia farcinica abscess of the cerebellum in an immunocompetent patient: A case report and review of the literature
María Pascual-Gallego, Pedro Alonso-Lera, Ana Arribi, Juan A Barcia, Javier Marco
October-December 2016, 11(4):454-455
DOI:10.4103/1793-5482.145179  PMID:27695569
Nocardial brain abscesses are uncommon and rarely occur in patients without predisposing factors. They may be mistaken for gliomas or necrotic metastases, and surgical intervention may be required to make the diagnosis. We report the first case of Nocardia farcinica cerebellar abscess in a patient without immunosuppression. He presented to us with headache and instability beginning a week before. Brain magnetic resonance imaging (MRI) revealed a cystic lesion located at the right cerebellar hemisphere, hypointense in T1 and hyperintense in T2, with a fine wall that enhanced after injection of gadolinium. Image tests also showed a cavitated lesion at the upper lobule of the right lung. The patient underwent craniotomy and drainage of the cerebellar abscess. Initial post-operative treatment with linezolid produced a limited response. He was re-operated and vancomycin, imipenem and ciprofloxacin were added with an excellent outcome of the cerebellar and lung lesions.
  1,863 126 1
Primary non-Hodgkin's lymphoma of the skull with extra and intracranial extension presenting with bulky scalp mass lesion
Manish Jaiswal, Ashok Gandhi, Devendra Purohit, Shashi Singhvi, Radhey Shyam Mittal
October-December 2016, 11(4):444-444
DOI:10.4103/1793-5482.145093  PMID:27695553
Primary non-Hodgkin's lymphoma (NHL) of the cranium with extra- and intracranial extension without systemic or skeletal manifestation in a non-immunocompromised patient is extremely rare. These lesions are most of the time misdiagnosed because they mimic other conditions like meningioma. Here, we report a case presented with huge bulky scalp mass which on magnetic resonance imaging (MRI) brain showed involvement of scalp, cranial vault, meninges, and the brain parenchyma, mimicking a meningioma. After gross total resection, biopsy and CD marker study revealed primary non-Hodgkin's diffuse large B-cell lymphoma (DLBCL). Malignant NHL should be considered in differential diagnosis of bulky scalp mass lesion.
  1,802 164 1
Coexistent dysembryoplastic neuroepithelial tumour and pilocytic astrocytoma
Jitendra G Nasit, Payal Shah, Himanshu Zalawadia
October-December 2016, 11(4):451-451
DOI:10.4103/1793-5482.145352  PMID:27695565
Dysembryoplastic neuroepithelial tumour (DNET) is an uncommon mixed glioneuronal tumour. DNET is classified as Grade I neoplasm in revised World Health Organization classification of tumors of the nervous system. DNET is commonly seen in the temporal lobe of children and young adults with features of pharmacoresistant complex partial seizures. Tumors arising in association with DNETs are rare. Only two cases of pilocytic astrocytoma (PA) arising in DNETs are reported. Surgical excision is the only successful management with favourable prognosis. The development of recurrence and malignancy after subtotal or even after complete excision challenges the premise of stability and highlights the importance of close clinical follow up. Here, a case of DNET with area of PA is described which helps in understanding the pathogenesis and biological behavior of DNET.
  1,846 117 3
ORIGINAL ARTICLES
Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India
Vishal Kumar, Amarjeet Singh, Manoj K Tewari, Sukhpal Kaur
October-December 2016, 11(4):372-377
DOI:10.4103/1793-5482.144190  PMID:27695540
Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study:
  • To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultants
  • To evaluate the quality of life of these patients
  • To know the problems faced by these patients at home.
Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of physical, emotional, cognitive, behavioral, and social problems, which may result in difficulties for both patients and their family caregivers. Provision of mechanism of prioritized follow-up care to the operated bedridden neurosurgery patients should be made.
  1,835 117 -
CASE REPORTS (ONLINE ONLY)
Spontaneous recovery of post-traumatic acute bilateral facial and abducens nerve palsy
Pravin Salunke, Karthigeyan Madhivanan, Nasib Kamali, Ravi Garg
October-December 2016, 11(4):446-446
DOI:10.4103/1793-5482.145056  PMID:27695556
Bilateral abducens and facial palsy following head injury are extremely rare. We present a patient with post-traumatic bilateral facial and abducens palsy. There were bitemporal fractures that did not correspond with the facial canal. Despite complete facial palsy with axonal degeneration and > 90% facial muscle degenervation, conservative management helped. This report highlights the importance of conservative management in post-traumatic complete facial palsy especially when the fracture line does not correspond with the facial canal.
  1,825 124 -
ORIGINAL ARTICLES
Sellar repair with autologous muscle and composite septal cartilage grafts for treatment of cerebrospinal fluid leakage following trans-sphenoidal pituitary surgery
Ayman A El Shazly, Mohammed A El Wardany, Tamer A Abo El Ezz
October-December 2016, 11(4):433-439
DOI:10.4103/1793-5482.144157  PMID:27695551
Context: Many reconstructive techniques have been proposed to prevent postoperative cerebrospinal fluid (CSF) leakage after trans-sphenoidal pituitary surgery. However, no total agreement has been reached to the best technique. Aim: Assessment of the efficacy of sellar repair with autologous muscle and composite septal cartilage grafts for treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain. Study Design: This is a retrospective case series study, level IV evidence. Materials and Methods: Twenty three patients were involved in this study. Seventeen patients had intraoperative CSF leakage and were treated immediately by our technique. Six patients had postoperative CSF rhinorrhea and had delayed treatment with our technique after failure of conservative measures and external lumbar CSF drainage for more than three days. The technique involved intradural placement of autologous muscle graft supplemented with extradural composite septal cartilage graft, composed of a piece of the posterior cartilaginous septum with its covering mucoperichondrium on one side only to fit into the sellar defect as a double layer button. Results: CSF leak was of grade 1 in 6 patients (26.1%), grade 2 in 10 patients (43.5%) and grade 3 in 7 patients (30.4%). None of the patients in our study had postoperative CSF leak after the use of our technique during the follow up period (mean 24 ± 10.47 standard deviation months). None of the patients developed treatment-related complications. All the patients had well developed mucosal covering of the sellar defect after two months. Conclusion: Our technique of sellar repair by using autologous muscle and composite septal cartilage grafts is effective in treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain even in the high-output CSF leaks.
  1,794 142 2
CASE REPORTS (ONLINE ONLY)
Papillary tumor of pineal region: A rare entity
Meena Patil, Manjiri Karandikar
October-December 2016, 11(4):453-453
DOI:10.4103/1793-5482.145373  PMID:27695568
Pineal tumors comprise 0.4 - 1.0% of intracranial space-occupying lesions in adults. Papillary tumor of pineal region (PTPR) is a very rare entity. It has been newly described in WHO 2007 classification of brain tumors. Only a few case reports are available in the literature. We report a case of a 60 year-old female presenting with headache, giddiness and reduced vision. Imaging studies showed a pineal mass with areas of hemorrhage. All ventricles were normal. There was a past history of a pineal gland tumor excised 2 years ago. This case is being reported for its rarity and aggressiveness in the form of recurrence. Limited/available immunohistochemistry workup has been done.
  1,721 184 3
Anal extrusion of migrated ventriculo-peritoneal shunt catheter: An unusual complication and review of literature
Avijit Sarkari, Sachin A Borkar, AK Mahapatra
October-December 2016, 11(4):459-459
DOI:10.4103/1793-5482.150002  PMID:27695576
Authors present an unusual case of anal extrusion of peritoneal end of ventriculo-peritoneal shunt in a 2-year-old male child. Pertinent literature is reviewed regarding this rare complication of a very commonly performed neurosurgical procedure.
  1,725 160 -
ORIGINAL ARTICLES
Wall-to-lumen ratio of intracranial arteries measured by indocyanine green angiography
Daichi Nakagawa, Masaaki Shojima, Masanori Yoshino, Taichi Kin, Hideaki Imai, Seiji Nomura, Toki Saito, Hirofumi Nakatomi, Hiroshi Oyama, Nobuhito Saito
October-December 2016, 11(4):361-364
DOI:10.4103/1793-5482.175637  PMID:27695538
Background: The wall-to-lumen ratio (WLR) is an important parameter in vascular medicine because it indicates the character of vascular wall as well as the degree of stenosis. Despite the advances in medical imaging technologies, it is still difficult to measure the thin-walled normal intracranial arteries, and the reports on the WLR of normal intracranial artery are limited. It might be possible to calculate the WLR using the indocyanine green (ICG) angiography, which is used to observe intracranial vessels during microsurgery. Purpose: To evaluate the WLR of normal intracranial arteries using ICG angiography. Materials and Methods: From the three cases in which ICG angiography was recorded with a ruler during microsurgery, 20 measurement points were chosen for the analysis. The ICG was injected intravenously with a dose of 0.2 mg/kg, and the vessels were inspected at high magnification using an operating microscope equipped with near-infrared illumination system. The vessel outer diameter and the luminal diameter were measured using the images before and after the ICG arrival based on the pixel ratio method using a ruler as reference, respectively. The WLR was calculated as 0.5 × (vessel outer diameter − vessel luminal diameter). Results: The WLR (mean ± standard deviation) of normal intracranial arteries was 0.086 ± 0.022. The WLR tended to be high in small arteries. Conclusion: The WLR of normal intracranial arteries calculated using ICG angiography was consistent with the WLR reported in the previous reports based on human autopsy.
  1,714 164 -
CASE REPORTS (ONLINE ONLY)
Lymphoplasmacyte-rich meningioma with invasion of bone: A case report and review of literature
Dhruba J Kurmi, Achal Sharma, RS Mittal, Shashi Singhvi
October-December 2016, 11(4):448-449
DOI:10.4103/1793-5482.145084  PMID:27695559
Lymphoplasmacyte-rich (LPR) meningioma is a rare variant of meningioma, which is characterized by conspicuous infiltration of plasma cells and lymphocytes and a variable proportion of meningothelial elements, and is classified as a grade I tumor in World Health Organization (WHO) classification of tumors of central nervous system. The origin and biological behavior of this rare variant of meningioma is still not clear. Till date, very few cases of LPR meningioma have been reported globally. Here, we are presenting a case of right parietal convexity LPR meningioma with invasion of bone in a 32-year-old male patient, who presented to us with complaints of focal seizures and weakness in left upper limb.
  1,717 133 -
Osteoblastic meningioma with turtle shell: Different entity from calcified meningioma
Pravin Salunke, Ashish Aggarwal, Sameer Futane, Ritambhara Nada, Debasis Gochhait
October-December 2016, 11(4):450-451
DOI:10.4103/1793-5482.145151  PMID:27695563
Bone formation within meningioma is secondary to metaplasia of the meningothelial cells into osteoblastic cells. This needs to be differentiated form the commonly seen calcification. We describe a rare case of osteobalstic meningioma in which bony trabeculae were seen within meningothelial cells.
  1,716 123 1
ORIGINAL ARTICLES
Role of effective canal diameter in assessing the pre-operative and the post-operative status of patients with bony cranio-vertebral anomalies
Anant Mehrotra, Arun Srivastava, Rabi N Sahu, Raj Kumar
October-December 2016, 11(4):396-401
DOI:10.4103/1793-5482.144149  PMID:27695544
Introduction: The effective canal diameter (ECD) for the cranio-vertebral junction is measured from the posterior surface of the dens to the nearest posterior bony structure (foramen magnum or the posterior arch of the atlas). The ECD is the space which is occupied by the buffer space (which can be compromised without producing any signs or symptoms) and the cord itself. We intend to study the role of the ECD (especially in patients with markedly reduced ECD) in producing the symptoms and also the outcome of surgery in patients with bony cranio-vertebral junction (CVJ) anomalies. Materials and Methods: A total of 67 consecutive patients from the period of January 2009 through June 2010 were prospectively included in the study. These patients were operated by a single experienced surgeon (the senior author) at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The ECD and the pre-operative Kumar and Kalra score (K and K score) (4) was calculated for all patients. The K and K score was also calculated at the time of discharge, at three months and six months follow-up. The patients were divided into three groups based on the ECD into 5 mm to 10 mm group, 10 mm to 15 mm group, and >15 mm group. Results: There were 53 male (79.1%) patients and 14 female patients (20.9%) with mean age of presentation 27.10 years (±15.01 years) with range of 4-59 years. The duration of symptoms in our series varied from 1-120 months with mean of 23.79 months. The mean effective canal diameter was 9.027 mm (±2.23 mm) with range of 5-16 mm. The mean pre-operative K and K score was 19.27 (±4.19). There were 39 patients who had an ECD between 5 mm to 10 mm, 24 patients with ECD between 10 mm to 15 mm, and 4 patients with ECD more than 15 mm. The correlation coefficients between the effective canal diameter and the pre-operative and the post-operative Kumar and Kalra score at the time of discharge, 3 months and 6 months were 0.404 (P < 0.001), 0.320 (P < 0.008), 0.0302 (P < 0.013), and 0.284 (P < 0.020), respectively. The ECD and the pre-operative score were most significantly and strongly related to each other in patients with ECD between 5-10 mm. Conclusion: The ECD is significantly related to the pre-operative status (K and K score) of the patient. This correlation was strongest in the group with ECD of 5-10 mm. It was also observed that as the follow-up increased, the correlation between the ECD and the post-operative K and K score became less stronger though they remained significantly related to each other.
  1,696 138 -
CASE REPORTS (ONLINE ONLY)
Primary aneurysmal bone cyst of the petrous temporal bone: A case report and review of literature
Mayur Sharma, Vernon Velho, Hrushikesh Kharosekar
October-December 2016, 11(4):444-445
DOI:10.4103/1793-5482.145327  PMID:27695554
Aneurysmal bone cyst (ABC) arising in the petrous portion of the temporal bone is a rare entity with only five such reported cases in the literature. We report the case of a 28-year-old man who presented with a tender swelling in the right preauricular region with right ear discharge and conductive hearing loss of 4 years' duration. Computed tomography and Magnetic Resonance imaging showed a destructive lesion in the right petrous bone with cavitation consistent with the diagnosis of ABC. Gross total resection of the lesion was achieved and diagnosis was confirmed histologically. The patient had no recurrence at 12 months of follow-up. This report presents the unusual location of an uncommon bony tumor with a review of its clinical, radiological, and histopathological features as well as the treatment modalities available.
  1,678 135 1
Recurrence of spinal schwannoma: Is it preventable?
Satya B Senapati, Sudhansu S Mishra, Manmath K Dhir, Ashis Patnaik, Souvagya Panigrahi
October-December 2016, 11(4):451-452
DOI:10.4103/1793-5482.145060  PMID:27695564
Spinal schwannomas account for about 25% of primary intradural spinal cord tumors in adult. The prognosis for spinal schwannomas is excellent in most cases. Complete resection is curative. However following subtotal removal, recurrence develops after several years. We describe a case of recurrent spinal schwannoma who had been operated twice before for same disease. The possible cause of recurrence and difficulties in reoperation are discussed.
  1,695 111 3
ORIGINAL ARTICLES
Traumatic tentorial hematoma in two-wheeler riders: Correlation with helmet use
Deepak Agrawal, Pankaj Dawar
October-December 2016, 11(4):392-395
DOI:10.4103/1793-5482.144182  PMID:27695543
Background: Tentorial hematoma is frequently seen in traumatic brain injury (TBI) patients, especially in motorized two-wheeler riders following head injury. However its relevance and prognostic significance are not known. Objective: To evaluate patients of TBI with tentorial hematoma using a simple grading system and attempt to correlate this grading with factors like helmet use and neurological outcome. Materials and Methods: This prospective study over a 1-year period included patients with TBI who had tentorial hematoma in the initial plain head. Patients were divided into three grades based on the initial CT findings: Grade I: Isolated tentorial hematoma, grade II: tentorial hematoma with midline shift but open cisterns and grade III: Tentorial hematoma with effaced cisterns. Clinical and radiological records of patients including admission GCS and GOS at discharge were assessed in all cases. Observations: A total of 1786 patients of TBI were admitted during the study period. Of these, 106 (5.9%) patients had tentorial hematoma. 84.9% (n = 90) were male and 15.1% (n = 16) were female with the mean age being 36.5 years (range 2-66 years). The mean admission GCS was 13, 11 and 8 in patients with grade I, II and III tentorial hematoma respectively. 43.4% (n = 46) of the patients had grade I, 32.1% (n = 34) had grade II and 24.5% (n = 26) patients had grade III tentorial hematoma. Seventy-one patients (84.5%) were riding motorized two wheelers with 63 (89%) wearing helmets. The majority of the patients wearing helmets (58.8%) had grade I hematoma with 35% (n = 22) having grade II hematoma and only 6.3% (n = 4) having grade III hematoma. Overall, there were 20 deaths. 50% (n = 10) of the deaths were in patients with grade III hematoma and 40% (n = 8) of the deaths were in patients with grade II hematoma. There were two (10%) deaths in patients with grade I hematoma (both unrelated to head injury). The mean GOS at the time of discharge was 5, 4.1 and 2.2 in patients with grade I, II and III tentorial hematoma, respectively. Conclusions: Tentorial hematomas are very common in two-wheeler riders with TBI and could be a marker for indirect forces such as rotational forces experienced while wearing helmets.
  1,647 129 -
CASE REPORTS (ONLINE ONLY)
A case of symptomatic synchronous cervical and cerebellar metastasis after resection of thoracal metastasis from temporal glioblastoma multiforme without any local recurrence
Yasar Karatas, Sahika Liva Cengiz, Mehmet Erkan Ustun
October-December 2016, 11(4):452-452
DOI:10.4103/1793-5482.145047  PMID:27695566
Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults and it is usually occurs between the age of 40 and 60 years. It is local invasive and recurrent tumor and hence that has a poor prognosis. However, recent advances in tumor surgery, irradiation and chemotherapeutic agent permit long survival and metastasis which is symptomatic. Previously studies reported spinal metastasis, but we report a first case of synchronous symptomatic cerebellar and cervical spinal metastasis after resection of symptomatic thoracic spinal metastasis from temporal GBM without any recurrence of excision areas.
  1,659 106 1
ORIGINAL ARTICLES
Primary spinal tumors in childhood: A single institution 15 year experience
Po-Cheng Hung, Chieh-Tsai Wu, Tang-Her Jaing, Jiunn-Ming Sheen, Ming-Liang Chou, Kuang-Lin Lin
October-December 2016, 11(4):440-443
DOI:10.4103/1793-5482.144148  PMID:27695552
Background: Pediatric primary spinal tumors (PST) are fairly uncommon, with little available data regarding incidence and outcomes. Materials and Methods: We conducted a retrospective review of the 22 consecutive patients less than 18 years old diagnosed with PST between March 1997 and May 2011 and treated at Chang Gung Children Hospital. All patients had undergone magnetic resonance imaging (MRI) for pre-operative evaluation and operations for PST. The extent of tumor removal was assessed by surgical report by the neurosurgeon or by post-operative MRI if available. Results: Ten of them had intramedullary tumors and 12 had intradural extramedullary tumors. All patients were treated with surgery to the primary site. A total of 15 patients underwent gross total tumor resection and seven patients received post-operative radiotherapy. Five patients received adjuvant chemotherapy for their primary tumor. Fourteen patients (64%) survived from study entry without tumor progression. Conclusions: PST encompassed a diverse group of pathologic entities that differ markedly based on the location and age of the children. Total resection of pediatric PST in children could be performed with acceptable risk and satisfactory long-term results.
  1,622 137 -
CASE REPORTS (ONLINE ONLY)
Calvarial tubercular osteomyelitic abscess in an elderly
Bhavanam Hanuma Srinivas, Megha Shantveer Uppin, Sateesh Killi, Malladi Venkata Surya Subbalaxmi, Madhusudan Patil, Alugolu Rajesh
October-December 2016, 11(4):445-445
DOI:10.4103/1793-5482.145334  PMID:27695555
Tuberculous osteomyelitis of skull is very rare, even in areas where tuberculosis is endemic. We herein describe an elderly woman who was apparently immunocompetent and presented with left frontal scalp swelling and right cervical lymphadenopathy. CT scan showed irregular bony destruction of the frontal bone. MRI revealed a large extradural, multiseptate, solid-cystic lesion with peripheral enhancement. FNAC from the lesion showed granulomas with caseation suggestive of tuberculosis. The lesion was debrided and she was started on anti-tubercular therapy. Deterioration of liver parameters led to change from primary drugs to liver-friendly, anti-tubercular agents. Though anti-tubercular therapy is the mainstay of calvarial tuberculosis, surgical debridement reduces the bacterial burden and probably hastens recovery.
  1,639 119 -
ORIGINAL ARTICLES
A cost effectiveness based safety and efficacy study of resterilized intra-parenchymal catheter based intracranial pressure monitoring in developing world
Deepak Kumar Gupta, Ajay Bisht, Priyam Batra, Purva Mathur, Ashok Kumar Mahapatra
October-December 2016, 11(4):416-420
DOI:10.4103/1793-5482.165785  PMID:27695548
Background: The management of traumatic brain injury (TBI) aims to maintain the normal cerebral perfusion in spite of the mass lesions that may occur (haematoma, contusion, and oedema). The monitoring of the intracranial pressure (ICP) is a step in that direction. The intra-parenchymal catheters have the lowest incidence of infection compared to intra-ventricular/subdural catheters with reliable and accurate pressure recordings. The major disadvantage of the intra-parenchymal catheters is the cost, especially in developing nations. Hypothesis: Resterilized intra-parenchymal strain gauge catheters can be used safely for ICP monitoring without any added risk of meningitis. The reusage of catheters can bring down the costs. Resterilized catheters/equipment have been approved for usage in cardiac usage, but such study on ICP catheters has not been carried out so far in any part of the world. Methodology: A total of 100 consecutive cases of severe TBI receiving ICP monitoring at a level 1 trauma center of a developing nation were prospectively studied (34 cases had fresh catheters, and 66 had resterilized [using ethylene oxide] catheters). Observations: The use of reused resterilized catheters was not associated with increased incidence of meningitis or fever (the surrogate marker for infection in this study). Also, there was concordance between the pressure recording of reused catheters and operative finding/subsequent computed tomography scans. These catheters after sterilization could be reused 2–4 times and reliably recorded the ICP (insignificant drift) with no increase in the incidence of meningitis. Conclusions: Usage of resterilized intra-parenchymal ICP catheters is feasible, safe, efficacious, and cost effective and brings down the cost of monitoring significantly.
  1,587 157 4
Evaluation of modified Kumar and Kalra myelopathy scoring system in sub-axial spinal pathologies
Anant Mehrotra, Arun Srivastava, Rabi N Sahu, Raj Kumar
October-December 2016, 11(4):378-383
DOI:10.4103/1793-5482.144150  PMID:27695541
Background: Various pathologies affect the spine, but these lesions present with more or less similar clinical profile. The present functional scoring systems are inadequate and insensitive to changes in neurological status of the patient. Objective: Our study aims to assess the modified Kumar and Kalra (K and K) scoring system in patients with pathologies in the sub-axial spine. Materials and Methods: A total of 78 consecutive patients from the period of January 2009 to June 2010 were prospectively included in the study. These patients were operated by the senior author at our institute. The mean Modified Japanese Orthopaedic Association (MJOA) score and the mean modified K and K score were calculated in the preoperative, at the time of discharge (post-surgery), and at 3 months and 6 months follow-up. Results: There were 57 male (73.01%) patients and 21 female patients (26.92%), with the mean age of presentation of 39.20 years (±14.12 years) and a range of 9-75 years. Out of the total 78 patients, 60 patients had pathology in the cervical spine (sub-axial spine) and 18 patients had pathology in the dorsal spine. Majority of the patients had motor and sensory symptoms. The mean preoperative modified K and K score was 17.38 (±3.18) and the mean preoperative MJOA score was 11.21 (±2.12). The K and K score was able to predict the correct outcome in 70 patients (89.74%), whereas the MJOA score was able to predict correctly in 62 patients (79.49%). Conclusion: The modified K and K score has a better predictive value than the MJOA score.
  1,634 103 -
CASE REPORTS (ONLINE ONLY)
Solitary fibrous tumor of the sellar region treated with adjuvant radiation therapy
Puja Sahai, Geetika Singh, Dodul Mondal, Vaishali Suri, Pramod Kumar Julka
October-December 2016, 11(4):449-449
DOI:10.4103/1793-5482.145186  PMID:27695561
The solitary fibrous tumor of central nervous system is rare. Herein, a case of solitary fibrous tumor arising from sellar region is described. A 60-year-old man underwent subtotal excision of the tumor because of extensive infiltration of optical and vascular structures. In view of the presence of residual tumor, he was treated with adjuvant radiation therapy. After a follow-up period of 1 year, there was no progression of the lesion evident on magnetic resonance imaging of the brain. Solitary fibrous tumor should be considered as one of the differential diagnosis of a mass lesion arising in sellar region. Immunohistochemistry with CD34 is valuable for discerning the diagnosis. Complete surgery should be the goal of treatment and adjuvant radiation therapy may be considered for residual or recurrent disease.
  1,621 114 1
Delayed intracerebellar hemorrhage secondary to lumboperitoneal shunt insertion
Uygur Er, Çetin Akyol, Murad Bavbek
October-December 2016, 11(4):447-447
DOI:10.4103/1793-5482.145068  PMID:27695558
Aim of this paper is to present and discuss a case of a delayed cerebellar parenchymal hemorrhage developing after L/P shunt placement with a NPH patient. A hypertensive patient admitted to our clinic with a diagnosis of NPH. The patient was placed a pressure adjustable L/P shunt without any surgical complication. He was discharged with an uneventful period. The patient was admitted to the emergency clinic of our hospital with a 1.5 × 1.5 cm diameter hematoma at the left cerebellar hemisphere on 2 days after his discharge. CSF drainage by an L/P shunt can generate intracerebellar hemorrhages especially in hypertensive patients.
  1,608 97 1
Solid cystic trigeminal schwannoma with intraorbital extension causing proptosis and vision loss
Pankaj Gupta, Arvind Sharma, Jitendra Singh
October-December 2016, 11(4):456-456
DOI:10.4103/1793-5482.181142  PMID:27695572
Schwannomas are slowly growing, well capsulated, benign tumors. Involvement of vestibular nerve is most commonly followed by trigeminal nerve. Trigeminal schwannoma is rare entity, and cystic degeneration with intraorbital extension of trigeminal schwannoma is even rarer. These tumors occur in fourth and fifth decades of life and patients have variable presentation depending on which cranial compartment is involved. Orbital schwannoma usually presents with proptosis with or without vision loss. We are reporting such a rare case of solid cystic trigeminal schwannoma with intraorbital extension through superior orbital fissure that was removed surgically.
  1,579 112 -
Ganglioglioma of conus medullaris in a patient of neurofibromatosis type 1: A novel association?
Ilangovan Vijay Sundar, Manish Jaiswal, Devendra Purohit, RS Mittal
October-December 2016, 11(4):455-455
DOI:10.4103/1793-5482.145088  PMID:27695570
Ganglioglioma of the conus region is quite rare with only 12 reported cases. Ganglioglioma shares biologic features with neurofibromatosis leading to suggestions that the co-existence of the two diseases may be more than coincidental. We report a case of ganglioglioma of the conus medullaris in a patient of neurofibromatosis and explore the possible association of the two diseases.
  1,539 109 -
Primary central nervous system teratoma with sarcomatous transformation in a young girl: Report of a rare case
Gautam Kumar Mandal, Indranil Das, Rahul Paul, Saunak Mitra Mustafi
October-December 2016, 11(4):458-459
DOI:10.4103/1793-5482.181117  PMID:27695574
A 13-year-old girl presented with chief complaints of severe headache and vomiting followed by hemiparesis. Radiological examination suggested a space occupying lesion in the right parietal lobe. Craniotomy and debulking of the tumor mass were done. Histopathological and subsequent immunohistochemical examination showed a tumor composed of fascicle of atypical spindle cells which revealed reactivity to vimentin with interspersed areas of well-differentiated cartilage tissue. Hence, the diagnosis of teratoma with sarcomatous transformation was given. Detailed discussion including review of literature has been made regarding different aspect of the tumor.
  1,501 99 -
Resolution of aspergillosis in neuroimaging of an immunocompromised patient with pulmonary and cerebral lesions
Mohsen Meidani, Atousa Hakamifard, Amir Hossein Sarrami
October-December 2016, 11(4):456-457
DOI:10.4103/1793-5482.175644  PMID:27695571
Central nervous system (CNS) aspergillosis is uncommon and considered the most lethal form of aspergillosis. Indeed, current therapeutic strategies such as combination antifungal regimen, neurosurgical resection of infected tissue, and removal of infection source fail to improve the unsatisfactory prognosis of CNS aspergillosis in the majority of the patients. The authors describe a case of chronic pulmonary aspergillosis with concomitant CNS lesions that dramatically responded to antifungal therapy and the CNS lesions resolved in follow-up imaging.
  1,486 109 1
Late onset of subdural hematoma after bifrontal contusion
Bora Gürer, Hayri Kertmen, Habibullah Dolgun, Zeki Sekerci
October-December 2016, 11(4):448-448
DOI:10.4103/1793-5482.145115  PMID:27695560
Cerebral cortical contusions are one of the most common computed tomography findings in head-injured patients and common sequel of traumatic brain injury. These contusions tend to show a progressive increase in mass effect on repeated imaging, most small contusions do not require surgical evacuation. However, progression to subdural hematoma (SDH) in a late aspect is unique. Here we present a 71-year-old man with bifrontal contusion, who deteriorated 43 days after initial trauma with sudden onset of acute SDH. This unusual case suggests that neurosurgeons should be alert for the possibility of very late onset of acute SDH after bifrontal contusions.
  984 62 -
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