An Official publication of The Asian Congress of Neurological Surgeons (AsianCNS)

Search Article
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Advertise Subscribe Contacts Reader Login Facebook Tweeter
  Users Online: 350 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2014| January-March  | Volume 9 | Issue 1  
    Online since April 19, 2014

  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach
Kentaro Mori
January-March 2014, 9(1):14-20
DOI:10.4103/1793-5482.131059  PMID:24891885
The keyhole concept in neurosurgery is designed to minimize the craniotomy needed for the access route to deep intracranial pathologies. Such keyhole surgeries cause less trauma and can be less invasive than conventional surgical techniques. Among the various types of keyhole mini-craniotomy, supraorbital or lateral supraorbital mini-craniotomy is the standard and basic keyhole approaches. The lateral supraorbital keyhole provides adequate working space in the suprasellar to parasellar areas and planum sphenoidale area including the anterior communicating artery complex. Despite the development of neuro-endoscopic techniques and intra-operative assistant methods, the limited working angle to manipulate and observe deeply situated pathologies is a major disadvantage of the keyhole approaches. Neurosurgeons should understand that keyhole mini-craniotomy surgeries aim at "minimally invasive neurosurgery" but still carry the risks of malpractice unless we understand the advantages and disadvantages of these keyhole concepts and strategies.
  7,826 1,004 17
Microgravity environment and compensatory: Decompensatory phases for intracranial hypertension form new perspectives to explain mechanism underlying communicating hydrocephalus and its related disorders
Zamzuri Idris, Muzaimi Mustapha, Jafri M Abdullah
January-March 2014, 9(1):7-13
DOI:10.4103/1793-5482.131058  PMID:24891884
The pathogenesis underlying communicating hydrocephalus has been centered on impaired cerebrospinal fluid (CSF) outflow secondary to abnormal CSF pulsation and venous hypertension. Hydrodynamic theory of hydrocephalus fares better than traditional theory in explaining the possible mechanisms underlying communicating hydrocephalus. Nonetheless, hydrodynamic theory alone could not fully explain some conditions that have ventriculomegaly but without hydrocephalus. By revisiting brain buoyancy from a fresher perspective, called microgravity environment of the brain, introducing wider concepts of anatomical and physiological compensatory-decompensatory phases for a persistent raise in intracranial pressure, and along with combining these two concepts with the previously well-accepted concepts of Monro-Kellie doctrine, intracranial hypertension, cerebral blood flow, cerebral perfusion pressure, brain compliance and elasticity, cerebral autoregulation, blood-brain and blood-CSF barriers, venous and cardiopulmonary hypertension, Windkessel phenomenon, and cerebral pulsation, we provide plausible explanations to the pathogenesis for communicating hydrocephalus and its related disorders.
  3,418 531 2
Brown tumor as an unusual but preventable cause of spinal cord compression: Case report and review of the literature
Hakan Tayfun, Orakdögen Metin, Somay Hakan, Berkman Zafer, Aker Fügen Vardar
January-March 2014, 9(1):40-44
DOI:10.4103/1793-5482.131074  PMID:24891890
Brown tumor (BT), also known as osteoclastoma, may appear in the context of primary and secondary hyperparathyroidism. Spinal cord compression due to the BT is extremely rare. We present here an unusual case of BT involving thoracal spine and mandible. A 26-year-old woman, who had been on hemodialysis for chronic renal failure for over 6 years, got admitted with dorsal pain and progressive weakness in her lower extremities and gait disturbances. Neurological examination revealed spastic paraparesis and symmetrically hyperactive tendon reflex in the lower extremities. She had hypoesthesia under T10 level. On physical examination, a swelling on the left side of her jaw was also detected. Magnetic resonance imaging (MRI) showed cord compression due to an extradural mass lesion at T8 level. A computerized tomography (CT) scan showed that this expansile lytic lesion was caused by the collapse of vertebra corpus (T8) at that level. CT of the mandible revealed an expansile lytic lesion on left arm of the mandible. Laboratory findings were nearly normal except parathormone level elevation to 1289 pg/mL (normal 30-70 pg/mL). Ultrasound examination showed enlargement of the parathyroid glands. The patient underwent an emergency decompression and stabilization surgery. The lesion was fragile and reddish in appearance and was easy to aspirate. The tumor was reported as "BT." Her weakness in the lower extremities improved in the early postoperative period. Following surgical intervention, the patient was transferred to nephrology clinic for additional medical treatment.
  2,628 421 11
Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors
Anup P Nair, Anant Mehrotra, Kuntal Kanti Das, Arun K Srivastava, Rabi Narayan Sahu, Raj Kumar
January-March 2014, 9(1):21-28
DOI:10.4103/1793-5482.131060  PMID:24891886
Background: Cervicomedullary junction (CMJ) intramedullary tumors comprise of tumors that often pose a surgical challenge even in the present era. Though classified under brainstem glioma CMJ tumors are well amenable for surgical resection and have a good outcome. Various factors are involved in the outcome of these patients following surgery and a proper pre-operative assessment is often required to reduce the morbidity and mortality. Materials and Methods: Patients admitted in the Department of Neurosurgery with a diagnosis of CMJ intramedullary tumors from January 2001 to January 2010 were included in the study. Patients were analyzed retrospectively regarding their symptomatology, clinical findings, radiology and outcome after surgery. All patients underwent pre-operative magnetic resonance imaging (MRI) and post-operatively all were managed in the neurosurgery intensive care unit for days to weeks or as dictated by the clinical condition of the patient. Results: A total of 32 patients were included in the present study. The number of males was 21 (65.6%) and females were 11 (34.4%) respectively. The mean age of presentation was 22.97 ± 9.8 years and the mean duration of pre-operative symptoms was 13.3 ± 12.9 months. The tumor had extension from the CMJ into the cervical region in 17 (53.1%) and into the medullary region in 14 (43.8%) patients. Tumor decompression was done in 9 (28.1%) patients and gross near total excision done in 23 (71.87%) patients. Conclusions: Cervicomedullary tumors are a subset of tumors quite distinct from the usual brainstem tumors. Patients having predominant cervical involvement present early and have less post-operative deficits. Those with predominantly more medullary involvement present late, hence have a much more morbid outcome. Though closely related to vital neural structures, surgery forms the mainstay of treatment. Adequate pre-operative planning and preparation of the patient along with intense post-operative monitoring and ventilatory assistance as and when required helps in a good surgical outcome.
  2,574 443 5
Use of pipeline flow diverting stents for wide neck intracranial aneurysms: A retrospective institutional review
Abhishek Agarwal, Sankalp Gokhale, Jagan Gupta, Roman Raju, Shahid Nimjee, Tony Smith, Gavin W Britz
January-March 2014, 9(1):3-6
DOI:10.4103/1793-5482.131057  PMID:24891883
Background: Intracranial aneurysms (ICA) if inadequately treated may result in serious morbidity and mortality. Wide-neck; large/giant, fusiform, and dissecting aneurysms are not well treated using the conventional coil embolization technique. Recent advance in endovascular treatment and technology has introduced flow diverter devices including pipeline embolization devices (PED) and Silk stents that have been shown to be more effective in treating these more complicated aneurysms. Flow Diverter devices offer a more physiologic approach to ICA treatment. Methods: We conducted a retrospective chart review of 23 adult patients who underwent aneurysm treatment utilizing the pipeline stent at Duke University Medical Center from July 2011 to March 2013. Results: Majority of patients (19, 82.7%) showed angiographic evidence of complete obliteration of aneurysm at 6 months follow-up, with sustained clinical improvement on modified Rankin scale score. All of the patients tolerated the procedure well with no intra-operative hemorrhage or intra-operative thromboembolic complications. Conclusions: Our experience shows that use of PED offers a safe and effective strategy for treatment of complex ICA. Larger prospective studies are needed to confirm these observations.
  2,396 508 2
Cognitive and sexual functions in patients with traumatic brain injury
Firdous A War, R Jamuna, A Arivazhagan
January-March 2014, 9(1):29-32
DOI:10.4103/1793-5482.131061  PMID:24891887
Background: Traumatic brain injury (TBI) has an immense psychosocial impact on an individual as well as on the close relatives. Sexuality is one among the functions which are usually found compromised post injury. The aim of present study was to examine cognitive and sexual functions post TBI. The objective of the study was to explore these domains and their relationship with each other. Tools: The tools used were sociodemographics record sheet, Edinburg handedness inventory, brief sexual function inventory, depression anxiety stress scales-21 and NIMHANS head injury battery. The sample consisted of 30 patients with mild-to-moderate TBI. All the subjects were tested individually in their regional language. Results: On cognitive domain, patients performed inadequately on all the tests; however, the percentage was higher in mental speed (43.3%), sustained attention (26.7%), verbal working memory (30%), response inhibition (36.7%), verbal memory (immediate and delayed) (43%) and visual (immediate, 23.3% and delayed, 26.7%). On the domain of sexual functions, all the four domains (sexual drive, erection, ejaculation and problem assessment) were affected however overall satisfaction (93.3%) was adequate. Among the four domains higher percentage of involvement was noted on problem assessment (70%), ejaculation (56.7%), and erection (46.7%). Significant correlation was found between mental speed, verbal working memory, planning, and visual memory with sexual drive, erection, ejaculation and overall satisfaction domains of sexual functioning. Negative correlation was found between motor speed and sustained attention with sexual drive, erection and ejaculation. Conclusion: Both cognitive and sexual functioning were found effected post TBI. However less emphasis is given to sexual functioning by the professionals. Educational intervention is needed to sensitize professional about this area and to include this area for better management.
  2,481 386 7
Intramedullary melanocytoma of thoracic spine: A rare case report
Pranav Dorwal, Ishani Mohapatra, Dheeraj Gautam, Aditya Gupta
January-March 2014, 9(1):36-39
DOI:10.4103/1793-5482.131068  PMID:24891889
Melanocytomas are present in leptomeninges and arise from neural crest during early embryonic development. They are a rare entity and usually occur in the thoracic spine and infratentorial region. We report a 32-year-old female with meningeal melanocytoma of D9-10. Magnetic resonance imaging revealed an intramedullary spinal tumor at D9-D10. Intraoperatively, the tumor was greyish-black in color with moderate vascularity, and was adherent to the cord. The clinical differential diagnoses included cavernoma and melanocytoma. On microscopic examination, the lesion showed sheets of cells with marked pigment deposition, which was obscuring the cellular morphology. The pigment was confirmed to be melanin by Masson's Fontana stain. Immunohistochemistry was performed, which showed positivity for HMB-45, S-100, Vimentin and Melan-A. The cells were negative for cytokeratin, epithelial membrane antigen, Glial fibrillary acidic protein and neuron-specific enolase. Mib-1 labeling index was less than 1%. In view of the lack of nuclear atypia, mitoses, necrosis and low Mib-1-labeling index along with immunohistochemistry profile, the diagnosis of Melanocytoma was made. Melanocytomas are rare pigmented tumors of the spinal cord and posterior cranial fossa. They are benign in nature, but can also be locally aggressive. Melanocytic lesions of the nervous system are to be differentiated from metastatic melanomas and also tumors showing melanin pigment deposition like schwanomma, paraganglioma, medulloblastoma and various gliomas.
  2,238 343 5
Rapid ventricular pacing assisted hypotension in the management of sudden intraoperative hemorrhage during cerebral aneurysm clipping
Shariq Ali Khan, Miles Berger, Abhishek Agrawal, Mary Huang, Isaac Karikari, Shahid M Nimjee, Ali R Zomorodi, David L McDonagh
January-March 2014, 9(1):33-35
DOI:10.4103/1793-5482.131066  PMID:24891888
Sudden intraoperative hemorrhage during intracranial aneurysm surgery from vascular injury or aneurysmal rupture has been known to dramatically increase the associated morbidity and mortality. We describe the first reported use of rapid ventricular pacing (RVP) assisted hypotension to control sudden intraoperative hemorrhage during intracranial aneurysm surgery where temporary arterial occlusion was not achievable.
  2,175 377 8
Fluidity of the body
Manu Kothari, Atul Goel, Abhidha Shah
January-March 2014, 9(1):1-2
DOI:10.4103/1793-5482.131056  PMID:24891882
  2,076 278 -
Atypical medulloblastoma: A case series
Ali Meshkini, Amir Vahedi, Mohammad Meshkini, Hossein Alikhah, Mohammad Naghavi-Behzad
January-March 2014, 9(1):45-47
DOI:10.4103/1793-5482.131077  PMID:24891891
Medulloblastoma is common in children as a tumor of midline posterior fossa, which arises from vermis and appears as a homogenously enhancing hyperdense mass on computed tomography scan and is associated with the clinical picture of posterior fossa syndrome. This unique clinic-radiological pattern in considered "typical" medulloblastoma, but medulloblastomas does not follow the typical clinic-radiological pattern in a significant number of children and adult cases. We review here the previous reports of atypical or uncommon features of medulloblastoma and add our very rare atypical cases of medulloblastomas to this list. Medulloblastoma should be considered in all midline posterior fossa tumors, hemisphere and cerebellopontine angle despite having clinical and radiological features suggestive of other tumors. Definitive diagnosis requires histologic confirmation in all cases.
  1,875 364 2
Giant cell tumor of the clivus with presence of epithelioid histiocytes
Amit Agrawal, Rajsekhar Gali, Vissa Shanthi, Baddukonda Appala Ramakrishna, Kuppili Venkata Murali Mohan
January-March 2014, 9(1):48-49
DOI:10.4103/1793-5482.131078  PMID:24891892
Giant cell tumor (GCT) is a benign neoplasm but locally aggressive tumor that uncommonly involves the skull bone. We report a case of a 62-year-old male presented with increasing headache and diplopia. Investigations were suggestive of an expanding mass lesion of the clivus. Histopathology was suggestive of diagnosed with GCT with abundant histiocytes.
  1,865 247 3