Awadhesh Kumar Jaiswal

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lakhnau, Uttar Pradesh, India

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Publications (87)84.05 Total impact

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    ABSTRACT: The authors present a case of 15 years male child who presented with neck pain and progressive ascending quadriparesis. Magnetic resonance imaging showed lytic mass involving C5 and C6 vertebra with soft tissue extension. Surgical excision of mass done using anterior cervical approach. Postoperatively, patient showed improvement in spasticity and power. Histopathological examination of mass was suggestive of juvenile xanthogranuloma (JXG). At 6 months follow-up, patient was improving without any evidence of recurrence. Only 12 cases of JXG of spine have been reported till date including only four cases involving the cervical spine and among these four cases only two were of pediatric age group.
    01/2015; 10(1):57. DOI:10.4103/1793-5482.151525
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    ABSTRACT: An 11-year-old boy presented with holocranial headache associated with vomiting and heaviness in right paranasal region. On examination, he had left sided upper motor neuron type facial palsy along with a subtle ipsilateral hemiparesis (grade 4/5 Medical Research Council). Magnetic resonance imaging brain revealed a contrast enhancing large well-defined extra-axial mass lesion in right middle cranial fossa with extension into the infratemporal fossa. The mass was excised in two stages. Histopathology was suggestive of clear cell meningioma (CCM). Supratentorial pediatric CCM is a rare entity. The case is discussed along with review of literature on this rare clinico-pathological entity.
    01/2015; 10(1):53. DOI:10.4103/1793-5482.151520
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    ABSTRACT: Trends in pre- and postoperative fluid, electrolyte and osmolarity changes, and incidence of diabetes insipidus (DI) were assessed in pediatric patients with anterior visual pathway gliomas (AVPGs). Thirty-three patients with AVPGs (age < 16 years) were divided into two groups: (1) no hypothalamic involvement [NHI; n = 17 (51.5 %) including optic (5, 15.2 %); chiasmal (5, 15.2 %); and optico-chiasmal (7, 21.2 %)] and (2) hypothalamic involvement [HI; n = 16 (48.5 %) including chiasmal-hypothalamic (12, 36.4 %) and optico-chiasmal-hypothalamic (4, 12.1 %)]. Frontotemporal transylvian decompression/biopsy was undertaken in 32 patients, while one patient (with severe diencephalic syndrome) was treated conservatively. Their endocrinal and fluid/electrolyte balance, serum osmolarity, and DI status were noted. Chi-square test compared clinical/endocrinological parameters, and unpaired T test evaluated mean daily water/electrolyte changes (p value < 0.05: significant). Significant visual deterioration (perception of light (PL) positive (left: n = 4; right: n = 4) and PL negative (left: n = 5; right: n = 5) was encountered due to optic atrophy. Larger lesions (>3 cm), hydrocephalus [(NHI: n = 7, 41.18 %; HI: n = 12, 75 %), endocrinopathies (p = 0.047), Na(+)/K(+) derangements, and preoperative DI (n = 8, p = 0.004)] were present in the group HI. Increased postoperative urine output (almost double in those with hypothalamic involvement) and hypernatremia/hyperkalemia were seen in group HI until the sixth postoperative day (p < 0.05). Two patients with progressive hypernatremia without increased urine output showed dehydration on central venous pressure monitoring and improved with vasopressin administration. Five patients [NHI: n = 4 (23.5 %); HI: n = 1 (6.3 %)] had neurofibromatosis types I and 3 (NHI: n = 1, 5.9 %; HI: n = 2, 12.5 %) had a diencephalic syndrome. Hypothalamic infiltration significantly increases the incidence of DI and fluid and electrolyte disturbances. Strict vigilance over postoperative fluid balance is mandatory during the first postoperative week. Rapidly rising serial serum sodium values without increased urine output mandates immediate central venous pressure measurement to detect DI associated with dehydration.
    Child s Nervous System 12/2014; 31(3). DOI:10.1007/s00381-014-2606-1 · 1.16 Impact Factor
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    ABSTRACT: Surgical management of foramen magnum (FM) tumors is challenging by virtue of their location and vital neurovascular relationships. The ideal approach to anterior/anterolateral tumors continue to evoke controversy even in the modern era. In this article, we present and discuss our experience in the surgical management of these tumors. This retrospective study includes 29 consecutive patients (mean age 36.6 years, M: F = 2.63:1) of extramedullary tumors at the surgical foramen magnum, operated at our center, between 2007 and 2012. Their mean duration of symptoms was 14. 6 months. A majority of the patients presented with motor symptoms (quadri/paraparesis, n = 21, 72.4%), neck pain with/without suboccipital radiation (n = 16, 55.2%) and sensory symptoms like tingling/numbness (n = 16, 55.2%). There were nine extradural (31%) and 20 intradural tumors (69%). Most of the tumors were located posterolateral to the neuraxis (n = 13, 44.8%). Nerve sheath tumors (n = 11, 38%) and meningiomas (n = 5, 17.2%) were the most commonly encountered histologies in our series. The standard posterior approach was the most frequently employed surgical approach (n = 20, 69%). Operative mortality and morbidity were 3.4 and 18.9%, respectively. At a mean follow-up of 27.3 months, 13 out of the 18 available patients improved. A majority of the foramen magnum tumors are amenable to excision via the standard posterior approach. Small anterior dural-based meningiomas/recurrent tumors may require a lateral approach like the far lateral approach.
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    ABSTRACT: Background:In some cases of spontaneous subarachnoid hemorrhage (SAH), the cause of bleed remains obscure on initial evaluation. These patients may harbor structural lesions. We aim to determine the utility of repeat angiogram in these subsets of patients.Methods:In this prospective study, patients with SAH with a negative computed tomographic angiogram (CTA) and digital subtraction angiogram (DSA) were included. A repeat angiogram was done after 6 weeks of initial angiogram. Patients were divided into perimesencephalic SAH (PM-SAH) and diffuse classic SAH (Classic-SAH) groups. Outcome was determined by modified Rankin score (mRS).Results:A total of 22% (39/178) of all SAH were angio-negative. A total of 90% (n = 35) of these were in Hunt and Hess grade 1-3. A total of 22 patients had PM-SAH and 17 had a Classic-SAH. Repeat angiogram did not reveal any pathology in the PM-SAH group, whereas two patients with Classic-SAH were found to have aneurysms. At 6 months follow-up, 95% patients of PM-SAH and 83.3% of Classic-SAH had mRS of 0.Conclusion:Repeat angiogram is probably not necessary in patients of PM-SAH and they tend to have better outcome. Classic-SAH pattern of bleed is associated with fair chances of an underlying pathology and a repeat angiogram is recommended and these cases and they have poorer outcome.
    Surgical Neurology International 08/2014; 5:125. DOI:10.4103/2152-7806.138367 · 1.18 Impact Factor
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    ABSTRACT: Background: Aneurysms of proximal (A1)-segment of anterior cerebral artery (ACA) constitute <1% of all intracranial aneurysms. Aim: Management dilemmas of A1-segment aneurysms were studied utilizing a new classification based upon their location on the longitudinal and circumferential axis of A1-segment. Setting and Design: Tertiary care referral center. Materials and Methods: This is a retrospective analysis of 14 patients (0.98%; mean age: 38.02 ± 15.74 years) with A1-segment aneurysms. The data collected included clinical features, computed tomography (CT) scan and CT-angiography (CTA)/digital subtraction angiography (DSA) findings, modified Hunt and Hess (H and H) grade, surgical steps and difficulties encountered. Results: The modified Hunt and Hess (H and H) grades in the 14 patients were: grade I in two, grade II in two, grade III in four, grade IV in five and grade V in 1. The mean ictus-admission duration was 5.07 ± 2.30 days (range: 1-10 days). Multiple aneurysms were two. Thirteen patients underwent clipping and one, wrapping. Bilateral lateral ventricle hemorrhage occurred in 8 (66%) patients and frontal intracerebral hematoma in 2 (16.66%) patients. In one patient, the aneurysm could only be detected following the third angiogram. A1-aneurysms were classified as proximal (n = 6), distal (n = 7), and mid-segment (n = 1); and, anterior (n = 2), posterior-inferior (n = 7) and posterior-superior (n = 5). Follow-up (range: 6 months-10 years, mean: 2.9 years) recovery (assessed using Modified Rankin's score or mRS) correlated with preoperative status. The preoperative H and H grade and follow-up mRS status were as follows: H and H I (n = 2): mRS 0 (asymptomatic, n = 2); H and H II (n = 2): mRS 1 (minor symptoms without disability, n = 2); H and H III (n = 4):mRS 1 (n = 2) and mRS 2 (slight disability but performing unassisted activities of daily living, n = 1); H and H IV (n = 5): mRS 3 (moderate disability, requiring help for daily living but unassisted walking, n = 2) and mRS 4 (moderately severe disability, requiring help for daily living and walking, n = 2). One patient each from H and H grade III, IV and V died (mRS 6) during treatment due to severe vasospasm, pneumonitis and septicemia. Conclusions: A1-segment aneurysms have unique properties: rupturing of small-sized aneurysms; multiplicity; undetectable on initial imaging; frontal lobar/intraventricular bleeding; origin from main trunk and not bifurcating points; neck obscuration by A1-trunk; close proximity to perforators; and, associated A1-segment and ACA anomalies. A new classification identifies surgical difficulties inherent in different sites of origin of A1-aneurysms.
    Neurology India 07/2014; 62(4):410-416. DOI:10.4103/0028-3886.141284 · 1.08 Impact Factor
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    ABSTRACT: Surgical excision of rare, large-to-giant posterior third ventricular (PTV) meningiomas [including velum-interpositum meningiomas (VIM; postero-superior venous complex displacement; without falco-tentorial attachment) and falco-tentorial meningiomas (FTM; falco-tentorial attachment; displacing major veins antero-inferiorly)] is extremely challenging. To study the management nuances in the excision of large-to-giant PTV meningiomas. Tertiary care referral center. Four patients with large (>3 cm; n = 2) and giant (>5 cm; n = 2) meningiomas (FTM = 2; VIM = 2, mean tumor size = 4.9 cm) underwent occipital transtentorial approach (OTT) for tumor excision. One also underwent a second-stage supracerebellar infratentorial (SCIT) approach. The side of approach was determined by lateral tumor extension and venous displacement (right = 3, left = 1). Near-total removal or subtotal excision (<10% remaining) with radiotherapy was performed in 2 patients each, respectively. At follow-up (mean: 14.75 months), clinical improvement without tumor recurrence/re-growth was achieved. Extent of excision was determined by position of great vein of Galen; tumor attachment to falco-tentorium or major veins; its consistency; its lateral and inferior extent; and, presence of a good tumor-neuraxial arachnoidal plane. OTT is the preferable approach for large-to-giant meningiomas as it provides a wider corridor and better delineation of tumor-neurovascular arachnoidal interface.
    Neurology India 05/2014; 62(3):290-5. DOI:10.4103/0028-3886.136934 · 1.08 Impact Factor
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    ABSTRACT: Intracranial dural metastasis presenting as chronic subdural hematoma is a relatively rare clinical scenario. There are different theories explaining the formation of subdural hematoma in such cases. In this report we present a case of chronic subdural hematoma in a 44-yearold lady who did not have any clinical evidence of primary tumour anywhere in the body. This lady died in spite of two emergency surgeries. During second surgery, the subdural membrane was sent for histopathological examination which revealed presence of metastatic tumour. We discuss the case along with a review of literature and recommend subdural membrane biopsy in all cases of chronic subdural hematoma.
    Turkish neurosurgery 01/2014; 24(6):992-5. DOI:10.5137/1019-5149.JTN.9708-13.0 · 0.53 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.
    12/2013; DOI:10.1016/j.ijnt.2013.11.003
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    ABSTRACT: A wide variety of congenital anomalies are observed around the craniovertebral junctional area. However, hypertrophied unilateral lateral mass of atlas in association with chiari-1 malformation leading to myelopathy is extremely uncommon. Herein we report a case of 28-year-old female who presented to us with a high cervical compressive myelopathy. Imaging revealed bony hypertrophy involving right sided C1 lateral mass along with chiari malformation-type 1. She underwent transoral as well as posterior decompression followed by occipito-cervical fusion. The authors discuss their case in light of other such reported cases and present a review of the literature.
    Journal of craniovertebral junction and spine 07/2013; 4(2):73-5. DOI:10.4103/0974-8237.128534
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    ABSTRACT: Osteoblastoma (OB) is a rare bony neoplasm constituting around 1% of all primary bone tumors. Although the vertebrae and long bones are the most common sites affected by OB, skull remains a relatively uncommon site of occurrence. Aggressive variant of OB is histologically intermediate between an indolent conventional OB and a malignant osteosarcoma. To the best of our knowledge, aggressive osteoblastoma (AO) affecting the craniovertebral junction has not been previously described in the literature. In this report, we present a 34-year-old gentleman who presented with a mass involving the left side of the neck and oral cavity along with ipsilateral lower cranial nerve paresis. Computed tomography and magnetic resonance imaging scans of the craniovertebral junction revealed a heterogeneously enhancing expansile lesion with areas of destruction involving the clivus, left sided jugular foramen and left side of first two cervical vertebras. Angiography showed distortion of the V3 segment of the left vertebral artery and shift of the ipsilateral internal carotid artery. The tumor was maximally excised through far lateral approach. Histopathologic examination revealed a diagnosis of AO. The patient was referred for radiotherapy for the residual tumor and was doing well at 5 months follow-up.
    Journal of craniovertebral junction and spine 07/2013; 4(2):69-72. DOI:10.4103/0974-8237.128533
  • Acta Neurochirurgica 06/2013; 155(8). DOI:10.1007/s00701-013-1776-z · 1.79 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; 155(7). DOI:10.1007/s00701-013-1717-x · 1.79 Impact Factor
  • Neurology India 05/2013; 61(3):315-7. DOI:10.4103/0028-3886.115082 · 1.08 Impact Factor
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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.
    03/2013; 8(1):29-35. DOI:10.4103/1793-5482.110277
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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; 155(1). DOI:10.1007/s00701-012-1529-4 · 1.79 Impact Factor
  • Kuntal Kanti Das, Awadhesh K Jaiswal, Sanjay Behari
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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. DOI:10.1007/s12262-012-0463-2 · 0.27 Impact Factor
  • Sushila Jaiswal, Mukul Vij, Awadhesh Kumar Jaiswal, Sanjay Behari
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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. DOI:10.1002/dc.21593 · 1.52 Impact Factor
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    ABSTRACT: Giant cell glioblastoma is a histological variant of glioblastoma that accounts for less than 1% of intracranial tumors and to 5% of glioblastoma. They occur at any age and are likely to affect the younger as well the older age group unlike the conventional glioblastoma multiforme (GBM). They are often located subcortically in the temporal and parietal lobes. Cytological descriptions of giant cell glioblastoma are extremely rare. We describe squash cytomorphology of giant cell glioblastoma of left posterior frontal region in 35-year-old male. The squash smears were moderately cellular displaying malignant astrocytic tumor cells disposed in cohesive clusters and dispersed population on a necrotic background. Most striking feature was numerous multinucleated giant cells. We also discuss the differential diagnosis in light of relevant literature.
    Diagnostic Cytopathology 05/2012; 40(5):440-3. DOI:10.1002/dc.21648 · 1.52 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 04/2012; 7(1):36-9. DOI:10.4103/1817-1745.97621

Publication Stats

343 Citations
84.05 Total Impact Points


  • 2007–2014
    • Sanjay Gandhi Post Graduate Institute of Medical Sciences
      • Department of Neurosurgery
      Lakhnau, Uttar Pradesh, India
  • 2000–2005
    • All India Institute of Medical Sciences
      • • Neurosciences Centre
      • • Department of Neurosurgery
      New Dilli, NCT, India