Sanjay Behari

Christian Medical College Vellore, Vellore, State of Tamil Nadu, India

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Publications (142)186.75 Total impact

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    ABSTRACT: Increased glycine concentration in the brain is associated with altered metabolism in cancer and can be detected by using in vivo MR spectroscopy. This has been proposed as a marker for grade IV gliomas; however, little is known about the potential significance and frequency of in vivo glycine observation. The purpose of this study was to examine the rate of occurrence and spatial distribution of glycine observation with respect to other MR imaging parameters. Data from volumetric whole-brain MR spectroscopic imaging of 59 subjects with glioma were analyzed with glycine included in the spectral model. The associations of the signal amplitude and spatial distributions of glycine with findings from contrast-enhanced T1, perfusion, and diffusion MR imaging were then examined. Glycine was detected in 24% of all studies, though with a wide range of signal amplitude and extent of the spatial distributions. While more commonly seen in grade IV tumors (42% of studies), relatively large concentrations were also detected in grade II and III gliomas. Coanalysis with other metabolites indicated a strong association with choline and that glycine was frequently seen to be overlapping with, and adjacent to, areas of high lactate concentration. Increased glycine was always associated with contrast enhancement and areas of increased cerebral blood flow, but without any clear association with other image parameters. Detection of increased glycine in gliomas appears to identify a subgroup of tumors and areas of increased proliferation.
    American Journal of Neuroradiology 01/2014; · 3.17 Impact Factor
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    ABSTRACT: Studies of brain tumors have identified altered tissue metabolism and water diffusion in MRI normal appearing tissue regions. In this retrospective study the relationship of these imaging measures with tumor grade in gliomas was investigated. MR spectroscopic imaging of whole brain and mean diffusivity (MD) measurements were obtained in subjects with untreated glioma and from normal control subjects. Mean metabolite values for N-acetylaspartate (NAA), total creatine (Cre), and total choline (Cho) were obtained in gray- and white-matter regions for the hemisphere contralateral to the tumor location, and MD values were obtained from contralateral normal-appearing white matter. Analyses tested for differences in mean values between subject groups while accounting for age. Analysis demonstrated increased NAA/Cre and MD, and decreased Cho/NAA for all tumor grades relative to control values. Differences between tumor grades were also observed for NAA, NAA/Cre, and Cho/NAA. Abnormal values of water diffusion were also observed, but with only a weak association between alterations in diffusion and tissue metabolites. This study supports previous observations of altered tissue metabolism and water diffusion in normal-appearing white matter while additionally finding differences of metabolite values in gray matter and an association with tumor grade.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 11/2013; · 3.36 Impact Factor
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    ABSTRACT: To modify the generalized tracer kinetic model (GTKM) by introducing an additional tissue uptake leakage compartment in extracellular extravascular space (LTKM). In addition, an implicit determination of voxel-wise local arterial input function (AIF) Cp (t) was performed to see whether these changes help in better discrimination between low- and high-grade glioma using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). The modified model (LTKM) was explored and fitted to the concentration-time curve C(t) of each voxel, in which the local AIF Cp (t) could be estimated by a time invariant convolution approximation based on a separately measured global AIF Ca (t). A comparative study of tracer kinetic analysis was performed on 184 glioma patients using DCE-MRI data on 1.5T and 3T MRI systems. The LTKM analysis provided more accurate pharmacokinetic parameters as evidenced by their relative constancy with respect to the length of concentration-time curve used. In addition, LTKM with local AIF resulted in improved discrimination between low-grade and high-grade gliomas. LTKM with local AIF provides more accurate estimation of physiological parameters and improves discrimination between low-grade and high-grade gliomas as compared with GTKM. J. Magn. Reson. Imaging 2013;38:677-688. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 09/2013; 38(3):spcone. · 2.57 Impact Factor
  • Acta Neurochirurgica 06/2013; · 1.55 Impact Factor
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    ABSTRACT: BACKGROUND: This prospective study attempts to study the clinico-radiological differences between patients with syndromic AAD (SAAD), non-syndromic AAD (NSAAD), and AAD with Klippel-Feil anomaly (AADKFA) that may impact management. METHODS: In 46 patients with AAD [SAAD (including Morquio, Down, Larson and Marshall syndrome and achondroplasia; n = 6); NSAAD(n = 20); and, AADKFS (n = 20)], myelopathy was graded as mild (n = 17, 37 %), moderate (15, 32.5 %) or severe (14, 30.5 %) based on Japanese Orthopaedic Association Score modified for Indian patients (mJOAS). Basilar invagination (BI), basal angle, odontoid hypoplasia, facet-joint angle, effective canal diameter, Ishihara curvature index, and angle of retroversion of odontoid and vertebral artery (VA) variations were also studied. STATISTICS: Clinico-radiological differences were assessed by Fisher's exact test, and mean craniometric values by Kruskal-Wallis test (p value ≤ 0.05 significant) RESULTS: Incidence of irreducible AAD in SAAD (n = 0), NSA AD (11.55 %) and AADKFS (n = 18.90 %) showed significant difference (p = 0.01). High incidence of kyphoscoliosis (83 %) and odontoid hypoplasia (83 %) in SAAD, and assimilated atlas and BI in NSAAD and AADKFA groups were found. In AADKFA, effective canal diameter was significantly reduced(p = 0.017) with increased Ishihara index and increased angle of odontoid retroversion; 61 % patients had VA variations. Thirty-five patients underwent single-stage transoral decompression with posterior fusion (for irreducible AAD) or direct posterior stabilization (for reducible AAD). Postoperative mJOAS evaluation often revealed persistent residual myelopathy despite clinical improvement. CONCLUSIONS: Myelopathy is induced by recurrent cord trauma due to reducible AAD in SAAD, and compromised cervicomedullary canal diameter in NSAAD and AADKFA. SAAD in children may be missed due to incomplete odontoid ossification or coexisting angular deformities. In AADKFA, decisions regarding vertebral levels to be included in posterior stabilization should take into consideration intact intervening motion segments and compensatory cervical hyperlordosis. Following VA injury, endovascular primary vessel occlusion/stenting across pseudoaneurysm preempts delayed rehemorrhage.
    Acta Neurochirurgica 05/2013; · 1.55 Impact Factor
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    ABSTRACT: PURPOSE: To modify the generalized tracer kinetic model (GTKM) by introducing an additional tissue uptake leakage compartment in extracellular extravascular space (LTKM). In addition, an implicit determination of voxel-wise local arterial input function (AIF) C(p) (t) was performed to see whether these changes help in better discrimination between low- and high-grade glioma using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). MATERIALS AND METHODS: The modified model (LTKM) was explored and fitted to the concentration-time curve C(t) of each voxel, in which the local AIF C(p) (t) could be estimated by a time invariant convolution approximation based on a separately measured global AIF C(a) (t). A comparative study of tracer kinetic analysis was performed on 184 glioma patients using DCE-MRI data on 1.5T and 3T MRI systems. RESULTS: The LTKM analysis provided more accurate pharmacokinetic parameters as evidenced by their relative constancy with respect to the length of concentration-time curve used. In addition, LTKM with local AIF resulted in improved discrimination between low-grade and high-grade gliomas. CONCLUSION: LTKM with local AIF provides more accurate estimation of physiological parameters and improves discrimination between low-grade and high-grade gliomas as compared with GTKM. J. Magn. Reson. Imaging 2013;. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 02/2013; · 2.57 Impact Factor
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    ABSTRACT: INTRODUCTION: Accurate grading of cerebral glioma using conventional structural imaging techniques remains challenging due to the relatively poor sensitivity and specificity of these methods. The purpose of this study was to evaluate the relative sensitivity and specificity of structural magnetic resonance imaging and MR measurements of perfusion, diffusion, and whole-brain spectroscopic parameters for glioma grading. METHODS: Fifty-six patients with radiologically suspected untreated glioma were studied with T1- and T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, diffusion tensor imaging, and volumetric whole-brain MR spectroscopic imaging. Receiver-operating characteristic analysis was performed using the relative cerebral blood volume (rCBV), apparent diffusion coefficient, fractional anisotropy, and multiple spectroscopic parameters to determine optimum thresholds for tumor grading and to obtain the sensitivity, specificity, and positive and negative predictive values for identifying high-grade gliomas. Logistic regression was performed to analyze all the parameters together. RESULTS: The rCBV individually classified glioma as low and high grade with a sensitivity and specificity of 100 and 88 %, respectively, based on a threshold value of 3.34. On combining all parameters under consideration, the classification was achieved with 2 % error and sensitivity and specificity of 100 and 96 %, respectively. CONCLUSION: Individually, CBV measurement provides the greatest diagnostic performance for predicting glioma grade; however, the most accurate classification can be achieved by combining all of the imaging parameters.
    Neuroradiology 02/2013; · 2.70 Impact Factor
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    ABSTRACT: Nerve sheath myxoma (neurothekeoma) are rare benign nerve sheath tumors, usually arising in the skin of the head and neck region and upper extremities in young females. To the best of author's knowledge only two cases of intracranial neurothekeoma have been published in the English literature. These tumors were located in the parasellar area and in middle cranial fossa. This is the first case report of cerebellopontine angle neurothekeoma and third case report of intracranial neurothekeoma. This patient, a 45-year-old female, presented to us with complaints of right side progressive hearing loss for 12 months and swaying during walking for 8 months. Histologically the tumor had lobular appearance with spindle or stellate cells embedded in abundant myxoid background. The tumor cells were diffusely positive for S100. The patient was symptom free at eight month follow up.
    Turkish neurosurgery 01/2013; 23(1):113-6. · 0.58 Impact Factor
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    ABSTRACT: We report a rare case of a post-traumatic subdural hygroma occurring with a giant frontotemporal arachnoid cyst in a 6-year old child and discuss its pathogenesis and management implications. Awareness regarding the association of a subdural hygroma associated with an arachnoid cyst is of immense clinical importance as the former may precipitate intracranial hypertension in a previously asymptomatic arachnoid cyst and yet may remain undetectable on a CT scan.
    The Indian Journal of Neurotrauma. 01/2013;
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    ABSTRACT: Choroid plexus tumors are intraventricular tumors derived from choroid plexus epithelium. To study the choroid plexus tumors with reference to their clinical, radiological, and pathological features. The study was performed by the retrospectively reviewing the clinical, radiological, and pathological records of patients of choroid plexus tumors. A total of 23 cases (11 males, 13 females) of choroid plexus tumor were diagnosed from 1997 to 2009. Fourteen patients were below 15 years of age. Raised intracranial pressure was the main presenting feature in all the cases. Tumor was located in lateral ventricle (n = 14; in 3 cases tumor was going into third ventricle), fourth ventricle (n = 7), and cerebellopontine angle (n = 2). Total tumor excision was achieved in 21 cases. The histopathology was suggestive of choroid plexus papilloma (n = 19), atypical choroid plexus papilloma (n = 1), and choroid plexus carcinoma (n = 2). Clears cell areas were noted in three cases. Other histopathological features observed were foci of calcification (n = 5), Psammoma bodies (n = 2), hemorrhage (n = 5), hyalinization (n = 2), and oncocytic changes (n = 1). Choroid plexus tumors are intraventricular tumors arising from choroid plexus epithelium. The predominant clinical presentation is raised intracranial pressure. Surgery is the mainstay of treatment; histopathologically, they include choroid plexus papilloma, atypical choroid plexus papilloma, and choroid plexus carcinoma.
    Asian journal of neurosurgery. 01/2013; 8(1):29-35.
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    ABSTRACT: BACKGROUND: Hyperproteinorrhachia associated with vestibular schwannomas (VSs) may influence visual status independent of the effect caused by raised intracranial pressure. The role of cisterna magna CSF protein levels (CMCP) in determining visual outcome in patients with large to giant vestibular schwannomas (VSs) was prospectively investigated. METHODS: The mean CMCP levels in VSs and control group; and, levels in VSs with or without visual deterioration were compared. Spearman's rank correlation coefficient tested for relationships between CMCP level with symptom duration and tumour volume (Kawamoto's method). Vision was regarded as normal when visual acuity was >6/18; and, deteriorated when it was between 6/18 and PL negative in the worse eye. Papilloedema (n = 26)/secondary optic atrophy (n = 6) and hydrocephalus (based on Evan's ratio, mild to moderate: n = 22; none: n = 18) were also recorded. The analysis of factors predicting diminished vision was done using logistic regression analysis (p < 0.05 significant). FINDINGS: There was a significant difference (p < 0.001) in mean CMCP levels between VS (456.3 SD 213.6 mg/dl) and control groups (96.3 SD 74.3 mg/dl). The mean CMCP levels in the VS group were also markedly higher than the ventricular mean protein levels. The CMCP levels in patients with visual diminution (<6/18 to PL negative; n = 23) was 561.4 SD 186.9 mg/dl and those without visual loss (n = 17) was 314.2 SD 160.8 mg/dl (p < 0.001). Their grade of visual diminution had a positive correlation with mean CMCP levels (p < 0.001). There was a negative correlation between total duration of symptoms and CMCP levels (p < 0.015). Logistic regression analysis using five independent factors (symptom duration, papilloedema/secondary optic atrophy, tumour volume, hydrocephalus and mean CMCP level) revealed that only CMCP level had a significant association with visual diminution. CONCLUSION: Elevated cisternal CSF proteins may play an important role in determining visual outcome in large to giant VSs. Ventricular CSF analysis is often unable confirm the presence of VS-associated cisternal hyperproteinorrhachia. High CMCP levels may influence decision-making while instituting a permanent CSF diversion for postoperative hydrocephalus or recalcitrant pseudomeningocoele.
    Acta Neurochirurgica 11/2012; · 1.55 Impact Factor
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    ABSTRACT: In this study, three primary central nervous system tumors of different histological cell types occurring together without neurofibromatosis are reported. These included a sellar pituitary adenoma with apoplexy, a large torculo-tentorial meningioma in the posterior fossa, and a cervical spinal intramedullary schwannoma. Displacement of primitive multipotent cells in different central nervous system compartments or the oncogenic effects of activated signaling of growth factor receptors are the proposed pathophysiological mechanisms for the simultaneous genesis of different types of tumors. There was associated tonsillar herniation, cervicodorsal syringomyelia, and hydrocephalus. The radiological features and treatment strategy of these rare synchronous tumors are highlighted.
    Indian Journal of Surgery 10/2012; 74(5):420-421. · 0.09 Impact Factor
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    ABSTRACT: Intraoperative consultation is an important component in the surgical management of brain tumors. This study was undertaken to describe the cytomorphological features of central neurocytoma (CN) in squash smears. Squash smear of five CNs were reviewed. One to two millimeters of the biopsy material was crushed between two glass slides to make a thin film that was fixed in 95% alcohol and stained with haematoxylin and eosin (H&E). Cytological diagnoses were correlated with clinical and radiological data and finally with histopathological findings in the tumor. We had 5 cases (4 males, 1 female; age, 19-61 years; mean, 32 years). All tumors were located in the lateral ventricle. The smears were highly cellular displaying monomoprhic round tumor cells, round to oval nuclei with evenly distributed finely granular chromatin and ill-defined cytoplasmic borders within fibrillar matrix. Focal rosette formation is also noted. A capillary network was identified in between tumor cells in all the cases. One case had calcification with numerous psamomma bodies identified in the squash smear. The differential diagnosis is discussed. On squash smears, CN can be diagnosed when cytomorphological features are correlated with clinical and radiological finding.
    Diagnostic Cytopathology 08/2012; 40(8):678-83. · 1.49 Impact Factor
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    ABSTRACT: Large epidermoids of the quadrigeminal cistern (LEQCs) of more than 4 cm in size are benign intracranial tumours and present with diverse clinical manifestations. Fifteen cases of LEQC have been treated in our institute over last 10 years. This is a retrospective study of the 15 LEQCs treated in our institute from January 2001 to May 2011. We classified these epidermoids into three types, based on the location of the major bulk of the epidermoid, to tailor surgical approaches to these tumours. Fifteen patients (age range 14-45 years, mean age 27.2 years) were operated upon after clinicoradiological evaluation. Eight were females and seven were males. The mean duration of symptoms was 9.2 months. Symptoms of raised intracranial pressure were present in ten patients. Surgical approaches included infratentorial-supracerebellar approach in nine cases, the occipital transtentorial approach in five cases and subtemporal approach one case. Complete excision was possible in ten (66.6 %) cases, near total in four (26.6 %) and subtotal excision in one case. Six patients underwent cerebrospinal fluid (CSF) diversion by ventriculoperitoneal (VP) shunt. Twelve patients improved with surgery and are functionally active. One patient developed hemiparesis. There were two deaths in our series. LEQC may present with hydrocephalus, unlike epidermoids at other intracranial locations. Complete surgical excision is possible in most of the patients and it helps in re-establishing the CSF pathway. Early surgery in these patients prevents postoperative shunt dependence. Most of the patients improve after surgery.
    Acta Neurochirurgica 06/2012; 154(8):1391-8. · 1.55 Impact Factor
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    ABSTRACT: Squash cytology description of subependymal giant cell astrocytoma (SEGA) is poorly described in the literature. Objective of this study is to study the cytomorphological features of SEGA in squash smears. Introperative squash smear preparations of four patients of SEGA diagnosed from 2004 to 2010 were reviewed. One to two millimetres of the biopsy material was crushed between two glass slides to make a thin film and fixed in 95% alcohol and stained by haematoxylin and eosin (H&E). Smear cytology diagnoses were correlated with clinical, radiological data and finally with histopathological findings of the tumor specimen. We had four cases (all males; age range 11-15 years; mean age 12.5 years). All tumors were located in the lateral ventricles. The cytological smears in all four cases were cellular and display pleomorohic binucleate to multinucleate tumor cells disposed in cohesive clusters, groups or lying singly. Elongated spindle shaped and strap cells with long thick cell processes were also identified. On squash smears, SEGA can be diagnosed when cytomorphological features are correlated with clinical and radiological finding. The distinct cytomorphological features are cellular smears comprising of pleomorohic binucleate to multinucleate tumor cells with round to polygonal eccentrically placed mildly anisomorphic nuclei, prominent nucleoli, and abundant eosinophilic glassy cytoplasm. Astrocytic fibrillary background, endothelial proliferation, mitosis, and necrosis are lacking.
    Diagnostic Cytopathology 04/2012; 40(4):333-6. · 1.49 Impact Factor
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    ABSTRACT: Cytology has been shown to be of great value in intraoperative consultations of central nervous system (CNS) pathology. Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery.The current study was undertaken to assess the accuracy and utility of intraoperative consultations for cytomorphological diagnosis by smear technique and correlate with histopathological diagnosis.A retrospective study of 326 cases of CNS intraoperative consultations was performed. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing and stained by the Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with final histopathological diagnosis.Concordance between the intraoperative diagnosis and the final diagnosis was seen in 83.7% of cases. We demonstrated >95% accuracy for glioblastomas and >89% accuracy for mennigiomas and schwannomas. A reduction of diagnostic accuracy was seen in oligodendrogliomas (60%) and anaplastic oligodendrogliomas (57.2%).Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible, and cost effective tool to diagnose brain tumors. Smear cytology is of great value in intraoperative consultation of CNS pathology. Diagn. Cytopathol. 2011. © 2010 Wiley Periodicals, Inc.
    Diagnostic Cytopathology 01/2012; 40(2):104 - 112. · 1.49 Impact Factor
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    ABSTRACT: Alveolar soft part sarcoma is a rare tumor affecting mainly adolescent and young children. It presents as a slowly growing tumor and is usually overlooked due to lack of symptoms. Early metastasis is a characteristic feature of this tumor and, in a good number of cases, metastasis to the lung or brain is the first manifestation of the disease. In this report, we present a case of alveolar soft part sarcoma predominantly located in the right frontal bone with dural breach and contiguous right frontal lobe involvement in a 17-year-old girl without any evident primary or other secondaries. A brief review of literature is also presented.
    Journal of Pediatric Neurosciences 01/2012; 7(1):36-9.
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    ABSTRACT: Haemorrhage is a rare complication of meningiomas that can occur spontaneously, after embolization, stereotactic radiation and perioperatively. Our first case was a 16 year old male, admitted with spastic quadriparesis, and retention of urine. Magnetic Resonance Imaging (MRI) revealed anteriorly placed cervical intradural extramedullary mass. Patient underwent emergency surgery following sudden worsening of neurological symptoms and intratumoral bleed was noted peroperatively. Tumor was labeled as angiomatous meningioma with hemorrhage. The second case was of a 45 year female who presented with history of sudden onset weakness in right upper and lower limb followed by unconsciousness. MRI revealed heterogeneous lesion in left parasagittal area with intratumoral bleed. Left frontal craniotomy with tumour decompression was performed. Tumour was labelled as meningothelial meningioma with haemorrhage. Meningiomas with hemorrhagic onset remain rare, and pathophysiology is still incompletely understood. Prevention and outcome of intratumoral haemorrhage highly depends on early diagnosis and adequate treatment.
    Journal of cancer research and therapeutics 01/2012; 8(1):145-7. · 0.83 Impact Factor
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    ABSTRACT: Posterior inferior cerebellar artery (PICA) aneurysms are associated with multiple anatomical variations of the parent vessel. Complexities in their surgical clipping relate to narrow corridors limited by brain-stem, petrous-occipital bones, and multiple neurovascular structures occupying the cerebellomedullary and cerebellopontine cisterns. The present study focuses on surgical considerations during clipping of saccular PICA aneurysms. Tertiary care, retrospective study. In 20 patients with PICA aneurysms, CT angiogram/digital substraction angiogram was used to correlate the site and anatomical variations of aneurysms located on different segments of PICA with the approach selected, the difficulties encountered and the final outcome. Comparison of means and percentages. ANEURYSMS WERE LOCATED ON PICA AT: vertebral artery/basilar artery (VA/BA)-PICA (n=5); anterior medullary (n=4); lateral medullary (n=3); tonsillomedullary (n=4); and, telovelotonsillar (n=4) segments. The Hunt and Hess grade distribution was I in 15; II in 2; and, III in 3 patients (mean ictus-surgery interval: 23.5 days; range: 3-150 days). Eight patients had hydrocephalus. Anatomical variations included giant, thrombosed aneurysms; 2 PICA aneurysms proximal to an arteriovenous malformation; bilobed or multiple aneurysms; low PICA situated at the foramen magnum with a hypoplastic VA; and fenestrated PICA. The approaches included a retromastoid suboccipital craniectomy (n=9); midline suboccipital craniectomy (n=6); and far-lateral approach (n=5). At a follow-up (range 6 months-2.5 years), 13 patients had no deficits (modified Rankin score (mRS) 0); 2 were symptomatic with no significant disability (mRS1); 1 had mild disability (mRS2); 1 had moderately severe disability (mRS4); and 3 died (mRS6). Three mortalities were caused by vasospasm (2) and, rupture of unclipped second VA-BA junctional aneurysm (1). PICA aneurysms may present with only IV(th) ventricular blood without subarachnoid hemorrhage. PICA may have multiple anomalies and its aneurysms may be missed on CT angiograms. Surgical approach is influenced by VA-BA tortuosity and variations in anatomy, location of the VA-BA junction and the PICA aneurysm relative to the brain-stem, and the pattern of collateral supply. The special category of VA-PICA junctional aneurysms and its management; and, the multiple anatomical variations of PICA aneurysms, merit special surgical considerations and have been highlighted in this study.
    Asian journal of neurosurgery. 01/2012; 7(1):2-11.
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    ABSTRACT: Bone formation in pituitary adenoma is an extremely rare finding. Only five previous cases have been published. This is the sixth case report of an ossifying pituitary adenoma and the first case report of a pituitary adenoma with bone formation coexisting with WHO grade II astrocytoma. MRI imaging revealed an unusual eggshell cap-like calcified structure surrounding the tumor. Histologically, the adenoma contained irregularly anastomosing trabeculae with well-formed lacunae and osteoblasts along the margins. Our second case concerns a 25-year-old male patient who presented with complains of off and on headache for 12 months. MRI (head) revealed a 4x3cm well defined rounded lesion in the sella and suprasellar extension that was isointense in T1, hyperintense on T2 with cystic areas and homogenous contrast enhancement. On morphological examination, a cellular tumor admixed with foci of large ganglion cells embedded in a neuropil stroma was noted. On immunohistochemistry, tumor cells were focally positive for pancytokeratin, growth hormone and synaptophysin; and ganglion cells were positive for neurofilament and synaptophysin. No GFAP positive cells were seen. The Ki67 index was < 1%. Based on these findings, a diagnosis of gangliocytoma associated with pituitary adenoma was considered.
    Turkish neurosurgery 01/2012; 22(1):127-33. · 0.58 Impact Factor

Publication Stats

769 Citations
186.75 Total Impact Points

Institutions

  • 2013
    • Christian Medical College Vellore
      • Department of Pathology
      Vellore, State of Tamil Nadu, India
    • Indian Institute of Technology Kanpur
      • Department of Mathematics and Statistics
      Kānpur, Uttar Pradesh, India
  • 1996–2012
    • Sanjay Gandhi Post Graduate Institute of Medical Sciences
      • • Department of Pathology
      • • Department of Neurosurgery
      Lucknow, Uttar Pradesh, India
  • 2008
    • Nizam's Institute of Medical Sciences
      Bhaganagar, Andhra Pradesh, India