Ketan Desai

King Edward Memorial Hospital, Mumbai, Mahārāshtra, India

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Publications (43)51.54 Total impact

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    ABSTRACT: This study is a retrospective analysis of 60 surgically treated patients with 64 peripheral nerve sheath tumors (PNSTs) at the second cervical (C-2) nerve root. The anatomical subtleties of these tumors and their implications for surgical strategy when compared with other spinal PNSTs and other tumors in the foramen magnum region are reviewed. Sixty patients with C-2 PNSTs treated surgically in the Department of Neurosurgery at King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College between 1992 and 2006 were studied. All patients underwent magnetic resonance imaging. Tumors were divided into 3 groups depending on their anatomical location identified during surgery. Those tumors located within or extending into the spinal dural tube were called Type A, those located within the dural tube of the C-2 ganglion were labeled as Type B, and tumors extending laterally into the paraspinal region were labeled as Type C. Follow-up durations ranged from 6 months to 15 years (mean 64 months). There were 38 male and 22 female patients in the study, who ranged in age from 6 to 62 years (mean 28 years). Nine patients had clinical features indicative of neurofibromatosis (NF). The mean duration of symptoms at the time of presentation was 27 months (range 4 days-5 years). Two patients had no specific symptoms related to the C-2 PNST, 6 patients had only local symptoms such as neck pain or stiffness, and 52 patients had symptoms of varying degrees of myelopathy. There were 5 solely Type A tumors, 7 Type A + B tumors, 31 Type B tumors, and 21 Type B + C tumors. All Type A, A + B, and B tumors were totally resected. Seven of 21 Type B + C tumors were partially resected, and the remainder were completely resected. All patients postoperatively reported varying improvement in their preoperative symptoms. Except for patients with NF who were disabled by other tumors, the rest of the patients resumed their normal life style. There have been no cases of symptomatic tumor recurrence. The majority of PNSTs located at the C-2 level in these patients probably arose from the large C-2 ganglion and are limited within the dural confines or are interdural in location. In contrast to other spinal PNSTs, the location of C-2 PNSTs is in most cases posterior to the lateral mass of the atlas and axis and the atlantoaxial joint and is exposed to the posterior without any bone cover. Radical tumor resection is safe, resolution of clinical symptoms is rapid, and recurrence rates are extremely low. In a selected number of cases, bone work for tumor exposure and resection can be entirely avoided.
    Journal of Neurosurgery Spine 03/2008; 8(2):129-34. · 1.98 Impact Factor
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    ABSTRACT: A 10-month-old male child with severe congenital hydrocephalus due to aqueduct stenosis presented with cranial migration of the entire ventriculo-peritoneal (VP) shunt. The complete shunt assembly, including the shunt chamber, was noted in the dilated ventricles. The migrated shunt was left in situ. A VP shunt was performed on the opposite side. The complete intraventricular migration of a VP shunt is a rare complication. This complication may be avoided by firm anchoring of the connector sites to the periosteum, and avoidance of large burr holes and dural openings. The possible mechanisms of such an event and the relevant literature are discussed.
    Journal of Clinical Neuroscience 02/2007; 14(1):92-4. · 1.25 Impact Factor
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    ABSTRACT: A 32-year-old woman was diagnosed with chronic bilateral frontoparietal and interhemispheric subdural haematomas (SDH). Abdominal ultrasonography revealed chronic renal failure due to bilateral large cystic kidneys. Brain MRI demonstrated Dandy-Walker malformation associated with hypoplastic vermis, in addition to the chronic subdural haematomas. This association of polycystic kidneys with Dandy-Walker malformation has been referred to as Goldston or cerebrorenal syndrome. The case is rare and is the first to be reported in an adult patient. The relevant literature is reviewed.
    Journal of Clinical Neuroscience 11/2006; 13(8):875-7. · 1.25 Impact Factor
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    ABSTRACT: A 52-year-old man presented with low backache, paraesthesiae and spasticity of both lower limbs. He had urinary retention and constipation. Investigations revealed a vascular intradural cauda equina-conus tumor. MRI scan demonstrated an enhancing mass at the second and third lumbar vertebral levels. There were multiple dilated and tortuous veins draining from both poles of the tumor. Digital subtraction spinal angiogram showed the tumor to be supplied mainly by the radiculo-medullary artery from first lumbar artery and dural branches of the second and third lumbar arteries. At surgery, after pre-operative embolization, a well-defined tumor with an orange hue and fleshy consistency was encountered arising from the filum terminale. The tumor was excised en bloc. A sporadic hemangioblastoma arising from the filum terminale should be considered as a rare cause of back pain and sciatica. Total excision of the tumor offers cure.
    Journal of Clinical Neuroscience 03/2006; 13(2):285-8. · 1.25 Impact Factor
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    ABSTRACT: A retrospective analysis of clinical features and management strategy in 24 cases of epidermoids in the pineal region is done. Long-term outcome of radical surgical resection is analyzed. Twenty-four patients having epidermoids in the pineal region were surgically treated in our department during an 11-year period (1992 up to 2003). These cases were retrospectively analyzed. The average duration of follow-up was 5.2 years. The age at the time of presentation ranged from 13 to 51 years (mean, 29.2 years). There were 15 male and 9 female patients. The average duration of complaints was 7 months. Headache and ataxia were the commonest symptoms. The infratentorial-supracerebellar approach and the interhemispheric posterior parietooccipital route were used to excise the epidermoids in 20 and 3 patients, respectively. In one patient, the tumor was removed in 2 stages, first by the infratentorial-supracerebellar approach and subsequently by the interhemispheric posterior parietooccipital surgical approach. Total excision of the solid part of the tumor and the capsule was achieved in 6 patients. In 13 cases, the solid part of the tumor was completely resected, but at least, a part of the tumor capsule was left behind. In 5 cases, a part of the solid portion of the tumor was either deliberately or inadvertently left behind. Incomplete tumor resection was primarily due to adhesions of the capsule to large veins in the region, dissection around which was considered hazardous, and extensive and invasive nature of extension of the tumor. During the period of follow-up, one patient had asymptomatic growth of the residual tumor after 6 years of surgery. One patient with residual tumor continued to get generalized seizures. All patients are leading active lives. Radical surgery for pineal region epidermoid tumors is associated with an excellent immediate postoperative and long-term outcome.
    Surgical Neurology 03/2006; 65(2):124-9. · 1.67 Impact Factor
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    ABSTRACT: A massive supratentorial torcular meningioma was completely resected in a 50-year-old woman. On the tenth postoperative day she presented with spontaneous cerebrospinal fluid (CSF) rhinorrhea. The site of the CSF leak was through the region of the cribriform plate, remote from the site of surgery. The possible cause of the leak and the relationship with the massive meningioma are analyzed.
    Journal of Clinical Neuroscience 02/2006; 13(1):118-21. · 1.25 Impact Factor
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    ABSTRACT: A rare case of an oligodendroglioma of the cerebellum in an 18-year-old male is presented. Radical surgical excision and craniospinal radiotherapy appear to be the treatment options for these potentially malignant lesions.
    Journal of Clinical Neuroscience 10/2005; 12(7):837-8. · 1.25 Impact Factor
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    ABSTRACT: A 34-year-old man presented with progressive diminution of vision in the left eye for 7 years. He had suffered left hemicranial headache associated with left retro-orbital pain and diplopia for 3 months. Magnetic resonance (MR) imaging revealed a pituitary tumor located in the sella and extending into the right cavernous sinus. After transsphenoidal surgery, the vision improved drastically but the diplopia persisted. Postoperative MR imaging showed residual tumor in the right cavernous sinus. Follow-up examination after 3 years showed the diplopia had completely recovered and the residual tumor in the cavernous sinus had disappeared. Spontaneous resolution of a large intracavernous sinus residue of a pituitary adenoma may occur due to tumor necrosis.
    Neurologia medico-chirurgica 07/2005; 45(6):315-7. · 0.49 Impact Factor
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    ABSTRACT: We describe 2 patients with segmental costovertebral malformation, a form of spondylocostal dysostosis, associated with tethering of the conus to a lipomyelomeningocoele. Such an association is rare. In both these patients the defects occurred sporadically. The relevant literature is reviewed.
    Journal of Clinical Neuroscience 07/2005; 12(5):599-601. · 1.25 Impact Factor
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    ABSTRACT: A 30-year-old male presented complaining of a six-month history of progressive weakness and paraesthesia in all four limbs. Symptoms occurred following moderately severe neck trauma. Investigations revealed ossification of the ligamentum flavum (OLF) between the atlas and axis, with marked cord compression. The patient showed remarkable neurological recovery following excision of the OLF. OLF causing cord compression is rare and has never been reported in the atlantoaxial region.
    Journal of Clinical Neuroscience 06/2005; 12(4):486-9. · 1.25 Impact Factor
  • Neurologia Medico-chirurgica - NEUROL MED-CHIR. 01/2005; 45(6):315-317.
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    ABSTRACT: We report a case of a 12-year-old male child who presented with a gradual onset exopthalmos involving the left eye. The plain radiographs of the skull showed hyperostosis of the left orbital roof. The computerized tomography (CT) scan revealed an intradiploic orbital roof tumor with expansion of both the tables of the orbital roof. The tumor was completely excised by an extradural route using a basal frontal craniotomy. The histopathological diagnosis of the tumor was a psammomatous meningioma. A split calvarial frontal bone graft was used to reconstruct the orbital roof. The pathogenesis, radiological features and surgical technique involved in the management of intradiploic orbital roof meningioma are discussed and the relevant literature is reviewed.
    Neurology India 10/2004; 52(3):380-2. · 1.04 Impact Factor
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    ABSTRACT: A 40-year-old male presented with hemangiopericytoma in the lateral ventricle manifesting as headaches persisting for 6 months associated with vomiting and visual obscurations for one month. Computed tomography and magnetic resonance imaging of the brain showed a large tumor in the trigone of the right lateral ventricle. The highly vascular tumor was completely excised. The histological diagnosis was hemangiopericytoma. Hemangiopericytoma is rarely located in the lateral ventricle and is difficult to differentiate from meningioma by neuroimaging methods.
    Neurologia medico-chirurgica 10/2004; 44(9):484-8. · 0.49 Impact Factor
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    ABSTRACT: A 11-year-old boy presented with complaints of diminution of vision in the left eye for three months. On examination, the vision in this eye was reduced to only perception of light. Magnetic resonance imaging revealed a thickened left intracranial optic nerve. The lesion was explored by a pterional craniotomy. At surgery, the left optic nerve was diffusely thickened. The biopsy of a fleshy mass along the optic nerve showed that it was a germinoma on histopathology. Isolated optic nerve germinomas are extremely rare. Exclusive primary involvement of the intracranial portion of the optic nerve by a germinoma has not been reported in the literature. This rare case is discussed and the relevant literature has been reviewed.
    Journal of Clinical Neuroscience 07/2004; 11(5):559-61. · 1.25 Impact Factor
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    ABSTRACT: The aim of the study is to analyze the nature, extensions, and dural relationships of hormonally inactive giant pituitary tumors. The relevance of the anatomic relationships to surgery is analyzed. There were 118 cases of hormonally inactive pituitary tumors analyzed with the maximum dimension of more than 4 cm. These cases were surgically treated in our neurosurgical department from 1995 to 2002. Depending on the anatomic extensions and the nature of their meningeal coverings, these tumors were divided into 4 grades. The grades reflected an increasing order of invasiveness of adjacent dural and arachnoidal compartments. The strategy and outcome of surgery and radiotherapy was analyzed for these 4 groups. Average duration of follow-up was 31 months. There were 54 giant pituitary tumors, which remained within the confines of sellar dura and under the diaphragma sellae and did not enter into the compartment of cavernous sinus (Grade I). Transgression of the medial wall and invasion into the compartment of the cavernous sinus (Grade II) was seen in 38 cases. Elevation of the dura of the superior wall of the cavernous sinus and extension of this elevation into various compartments of brain (Grade III) was observed in 24 cases. Supradiaphragmatic-subarachnoid extension (Grade IV) was seen in 2 patients. The majority of patients were treated by transsphenoidal route. Giant pituitary tumors usually have a meningeal cover and extend into well-defined anatomic pathways. Radical surgery by a transsphenoidal route is indicated and possible in Grade I-III pituitary tumors. Such a strategy offers a reasonable opportunity for recovery in vision and a satisfactory postoperative and long-term outcome. Biopsy of the tumor followed by radiotherapy could be suitable for Grade IV pituitary tumors.
    Surgical Neurology 06/2004; 61(5):436-45; discussion 445-6. · 1.67 Impact Factor
  • Ketan I Desai, Trimurti D Nadkarni, Atul Goel
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    ABSTRACT: Tuberculomas involving the hypophysis cerebri are extremely rare lesions, and these may occur even in the absence of systemic tuberculosis. This report presents the clinical data of 5 patients harbouring tuberculomas of the pituitary gland. Sellar tuberculomas commonly mimic pituitary adenoma. Histological diagnosis of a sellar lesion is mandatory irrespective of the clinical presentation and radiological findings. A history of extracranial tuberculosis in the past associated with radiological findings like leptomeningeal enhancement, parenchymatous brain tuberculomas or a thickened pituitary stalk on contrast MRI, are indicative of the possibility of a sellar tuberculoma. The aim of surgery is tissue diagnosis and tumour debulking. The response to long-term antituberculous chemotherapy is excellent. There is often a complete resolution of the granuloma and a satisfactory recovery of visual and endocrinological function.
    Journal of Clinical Neuroscience 10/2003; 10(5):562-6. · 1.25 Impact Factor
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    ABSTRACT: A 32-year-old male presented with a paranasal sinus Aspergillus fungal infection. The nasal infection was cleared by endoscopic sinus surgery and the patient was treated with antifungal agents. The patient was otherwise healthy with no evidence of immunosuppresion. Five months later, the patient had to undergo excision of the left frontal intracranial infection for symptoms of raised intracranial pressure and seizures. Within 48hours of surgery, the patient developed basilar artery thrombosis with infarction of the cerebellum and midbrain. The patient succumbed to this vascular catastrophe, which developed at a site distal to that from surgery. The pathophysiology of ischaemic complications after surgical resection of intracranial aspergilloma is discussed.
    Journal of Clinical Neuroscience 08/2003; 10(4):500-2. · 1.25 Impact Factor
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    ABSTRACT: An extremely unusual case demonstrating rare behaviour of an ependymoma is presented. The tumour spread in an en-plaque fashion and involved the ependymal lining of the entire ventricular system. The patient, a 56-year-old male, presented with symptoms of raised intracranial pressure and truncal ataxia. The management issues are analyzed on the basis of a brief literature survey.
    Journal of Clinical Neuroscience 04/2003; 10(2):262-4. · 1.25 Impact Factor
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    ABSTRACT: Segmental spinal dysgenesis (SSD) is a rare congenital abnormality in which a segment of the spine and spinal cord fails to develop properly. We report a case of a 4-year-old female child who was born prematurely with a permanent neurological deficit in the lower limbs and sphincter incontinence. Radiological investigations revealed segmental agenesis of the thoracic spinal cord (D8-D11 vertebral levels) with an associated vertebral bony anomaly. The pathogenesis of this rare form of SSD syndrome is discussed and the relevant literature is briefly reviewed.
    Pediatric Neurosurgery 03/2003; 38(2):102-6. · 0.42 Impact Factor
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    ABSTRACT: An 18-year-old male presented with severe proptosis and blindness in the right eye. Neuroimaging revealed a large and hypervascular tumor in the right retrobulbar region and a large tumor in the left cavernous sinus. Angiography showed the right tumor was extensively vascular, fed by a hypertrophic ophthalmic artery, and the left tumor was moderately vascular, fed by a large middle meningeal artery. Following embolization of the feeder vessels, the right retrobulbar hemangiopericytoma and the left cavernous sinus schwannoma were uneventfully and successfully resected. Such combinations of different pathological lesions present unusual therapeutic challenges.
    Neurologia medico-chirurgica 02/2003; 43(1):47-50. · 0.49 Impact Factor

Publication Stats

577 Citations
51.54 Total Impact Points

Institutions

  • 2000–2007
    • King Edward Memorial Hospital
      Mumbai, Mahārāshtra, India