B Anandh

National Institute of Mental Health and Neuro Sciences, Bengalore, State of Karnataka, India

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Publications (21)33.19 Total impact

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    ABSTRACT: Low-grade diffuse astrocytoma (DA) is considered benign tumor (World Health Organization [WHO] grade II), but it has an inherent tendency for malignant progression, which is quite variable. To identify malignant progression in an individual case of DA, we studied the clinico-radiological and immunohistochemical factors and correlated with progression of DA at a dedicated tertiary level neurosciences centre NIMHANS, Bangalore, India. Consecutive adult patients who had undergone tumor decompression for lobar supratentorial DA at our institute from 1994 to 1998 were retrospectively selected and followed up for clinico-radiological progression. The clinico-radiological and histomorphological features were studied. With the use of immunohistochemistry, proliferation index [MIB-1 labeling index (LI)], p53 protein expression, microvessel density (MVD) count [assessed using anti-CD34 antibody] were analyzed and correlated with progression-free survival (PFS) Results: There were 13 patients. Mean age was 34 years. The most common presenting symptom was seizures. The median follow-up was 54 months. There were four recurrences, with median interval of 75 months. Eight patients received radiotherapy. Younger patients (<40 years), seizure as the presenting symptom and postoperative radiotherapy were associated with longer PFS, while gemistocytic morphology (>20% gemistocytic cells), MVD value >20 correlated with shorter PFS, albeit statistically insignificant. MIB1 LI did not correlate with recurrence pattern. Moreover, p53 LI > 10% correlated with early progression (P = 0.04). Our study highlights some of the clinical, histological and immunohistochemical parameters that predict progression on DA. Validation on a larger sample may be useful to plan appropriate treatment in an individual case.
    Neurology India 01/2011; 59(2):248-53. · 1.04 Impact Factor
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    ABSTRACT: Glioblastomas are the commonest and the most malignant of all adult brain tumors, characterized by genetic instability, intratumoral histopathological variability, and unpredictable clinical behavior. The utility of tumor markers that reflect their underlying biology is becoming increasingly important with respect to patient prognostication and their potential role as molecular targets of therapy is being recognized. In this study, we aimed to identify the clinical factors and some immunohistochemical markers that could have an effect on patient survival in supratentorial glioblastomas. We evaluated 54 cases of adult supratentorial glioblastomas operated over a span of 1 year, with respect to clinical features such as age, Karnofsky performance score (KPS), extent of resection, adjuvant therapy, and immunohistochemical expression of p53, EGFR (Epidermal Growth Factor Receptor) and PTEN (Phosphatase and Tensin homolog). Radiotherapy and KPS at presentation were significant predictors of outcome in both univariate and multivariate analyses. Among immunohistochemical variables; loss of PTEN expression in association with over-expression of EGFR showed a trend towards poorer survival, in univariate analysis. Over-expression of EGFR and/or p53 emerged as significant predictors of poor outcome on multivariate analysis, despite failing to prognosticate on univariate analysis. Our study shows that EGFR and p53 overexpression along with loss of PTEN expression are important adjuncts to clinical variables in prognosticating glioblastoma patients.
    Clinical neuropathology 01/2009; 28(5):362-72. · 1.34 Impact Factor
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    ABSTRACT: Cerebral abscess commonly occurs secondary to trauma, hematogenous spread from distant infection, or otitis media. Pulmonary AVF is an uncommon cause of recurrent cerebral abscess and is often overlooked. We report 3 cases of cerebral abscesses secondary to pulmonary AVF. A 20-year-old man who presented with fever, headache, and vomiting of short duration was diagnosed as having right parietal abscess and underwent burr hole and tapping and antibiotic treatment. He later presented with many episodes of cerebral abscess at various locations involving both sides and required multiple surgical procedures. The routine workup for the source did not reveal any etiology. His hematological examination revealed polycythemia. A pulmonary angiogram was performed, which revealed pulmonary AVF. He underwent embolization of the fistula and had no further recurrence. Two other adult men were treated surgically for cerebral abscess. One patient had polycythemia and hypoxemia, and another had clubbing. Both patients were investigated with CT of the chest and were diagnosed as having pulmonary AVF. None of them had features of HHT. Pulmonary AVF is an unusual cause of cerebral abscess. Patients with multiple recurrences of cerebral abscess, signs of pulmonary disease, and hypoxia should be investigated for pulmonary AVF.
    Surgical Neurology 03/2008; 71(2):241-4; discussion 245. · 1.67 Impact Factor
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    ABSTRACT: The pineal parenchymal tumors are rare, comprising 15-30% of all tumors of pineal region. Their histological classification alone has been found to be inadequate for prognostication. Hence, we correlated their immunohistochemical profile with the prognosis. A retrospective analysis of 33 pineal parenchymal tumors treated from 1990-2004 was performed. The histological features of the tumors were reviewed and immunohistochemical staining for neurofilament protein (NF), MIB-1, synaptophysin and GFAP were performed. Results were correlated with the patients' survival. The study comprised 6 pineocytomas (PC), 17 pineoblastomas (PB) and 10 pineal parenchymal tumors with intermediate differentiation (PPT-ID) which included 3 mixed PC/PB. The histological diagnosis was obtained from microsurgical biopsy/decompression, stereotactic or endoscopic biopsy. Adjuvant therapy was advised based on histology. All pineocytomas stained positive for NF. Most pineoblastomas (13/16) failed to show any immunoreactivity with NF. The mean MIB-1 labeling index in pineocytomas, PPT of ID and pineoblastomas were 1.58, 16.1 and 23.52 respectively (p < 0.001). All the tumors stained positive for synaptophysin, although the intensity of the staining varied. NF-positive tumors had a higher chance of disease-free state, irrespective of histological subgroup (p = 0.0036). The median disease-free survival in pineoblastomas with negative NF staining was 5 months, which was less than that of pineoblastomas with positive NF staining (32 months). Neurofilament immunoreactivity indicates better prognosis in pineal parenchymal tumors. The MIB-1 labeling index can be utilized as an additional tool to differentiate pineal parenchymal tumors into various subgroups.
    Clinical neuropathology 01/2008; 27(5):325-33. · 1.34 Impact Factor
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    ABSTRACT: Accurate localization of cerebrospinal fluid (CSF) fistula in a patient with CSF rhinorrhea is challenging and often involves multiple imaging studies with associated expense and patient discomfort. Intrathecal contrast-enhanced computed tomography (CT) and unenhanced magnetic resonance (MR) cisternography using constructive interference in steady state (CISS-3D) sequences are currently being used in attempt to localize the leakage site but with varying degrees of success. Our purpose is to evaluate the utility of intrathecal gadolinium-enhanced MR cisternography (GdMRC) in patients with CSF rhinorrhea. Ten consecutive patients of CSF rhinorrhea (five spontaneous, four post-traumatic, and one post-operative) were evaluated with GdMRC. Nine of the patients underwent intrathecal contrast CT and CISS-3D examinations in addition. Each of studies was reviewed independently by three neuroradiologists blinded to results of other modalities. Surgery was planned after consensus and surgical correlation obtained in nine cases. The fistulous site was clearly demonstrated by using GdMRC in eight patients, CISS-3D in six, and intrathecal CT in three patients. The site of leakage was confirmed surgically in all the patients. One patient was found to be false negative both by intrathecal CT and GdMRC, and in one patient no fistulous site was demonstrated by any of the modalities and surgery was not offered. No adverse reaction was seen in any of the patients. GdMRC is a novel method of confirmation and localization of CSF fistula with potential for routine clinical application. Diagnosis and localization of fistulous site is better demonstrated due to its high-contrast resolution, absence of bony artifacts, and direct multi-planar imaging.
    Journal of Neurotrauma 11/2007; 24(10):1570-5. · 4.30 Impact Factor
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    ABSTRACT: Involvement of nervous system by toxocariasis is rare and can produce a spectrum of pathology that includes eosinophillic meningoencephalitis, meningomyelitis, space occupying lesions, vasculitis causing seizures or behavioral abnormalities posing diagnostic dilemmas. We describe a 38-year-old man who presented with multiple intracranial and intramedullary abscesses caused by visceral larva migrans. Neurohelminthiasis as a cause of multiple abscesses, though rare, should be entertained as a differential diagnosis particularly in tropical South-east Asian countries where helminthiasis is still an epidemiological concern prevalent in the pediatric age group.
    Neuropathology 09/2007; 27(4):371-4. · 1.91 Impact Factor
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    ABSTRACT: A total of 40 human brain tumor samples were analyzed for tumor-specific alterations at the RB1 gene locus. Gliomas were more prevalent in younger males and meningiomas in older females. Southern blot analysis revealed loss of heterozygosity (LOH) at the intron 1 locus of RB1 gene in 19.4% of informative cases and this is the first report showing LOH at this locus in human brain tumors. Levels of RB1 mRNA and protein, pRb, and the percentage of hyperphosphorylated form of pRb were also analyzed in these tumors. Normal human fibroblast cell line WI38 was used as control in northern and western analysis. Normal sized RB1 mRNA and protein were present in all the tumor samples. Majority of the gliomas had 2.0-fold or higher levels of RB1 mRNA and most meningiomas had less than 2.0-fold of RB1 mRNA compared to control WI38 cells. The total pRb levels were 2.0-fold or higher in all the tumor samples compared to control. More than 50% of pRb existed in hyperphosphorylated form in all gliomas except two. However, six out of 13 meningiomas had less than 50% of total pRb in the hyperphosphorylated form. These results indicate that the increased percentage of hyperphosphorylated form of pRb in gliomas could provide growth advantage to these tumors. Presence of LOH at the RB1 gene locus and the increased levels of RB1 RNA and protein and increased percentage of hyperphosphorylated form of pRb are indicative of an overall deregulation of pRb pathway in human brain tumors.
    Molecular and Cellular Biochemistry 09/2007; 302(1-2):67-77. · 2.33 Impact Factor
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    ABSTRACT: Tumor-specific alterations at the p53 gene locus were analyzed in 40 human brain tumor samples. Gliomas were more prevalent in young males and meningiomas in old females. Structural changes at the intron 1 region of the p53 gene were analyzed in these tumors by Southern blotting. Among the 40 tumors, 33 were informative and 21 of these (63.6%) informative cases showed loss of heterozygosity (LOH). This is the first report showing LOH at the intron 1 region of p53 gene in human brain tumors. The level of p53 mRNA, p53 protein and Ser 392 phosphorylated p53 protein were also analyzed in all tumor samples. Normal sized p53 mRNA and protein were present in all the tumor samples; however, their levels were 1.5- to 4-fold higher compared to the control suggesting deregulated p53 pathway in these tumors. No correlation was found between LOH status and the levels of p53 mRNA and protein. In all high-grade glioblastomas majority of the p53 protein existed as Ser 392 phosphorylated form as compared to low-grade gliomas. In addition, the percentage of Ser 392 phosphorylated form of p53 protein was lower in meningiomas and other brain tumor types irrespective of tumor grade. These results suggest involvement of Ser 392 phosphorylated form of p53 protein during the later stages of glioma development. These results also indicate that deregulation of p53 gene could occur at various steps in p53 pathway and suggest an overall deregulation of p53 gene in most brain tumor types.
    Molecular and Cellular Biochemistry 07/2007; 300(1-2):101-11. · 2.33 Impact Factor
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    Neurology India 10/2005; 53(3):358-60. · 1.04 Impact Factor
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    Journal of Neurology Neurosurgery &amp Psychiatry 02/2005; 76(1):24. · 4.92 Impact Factor
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    Neurology India (ISSN: 0028-3886) Vol 53 Num 3. 01/2005;
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    ABSTRACT: Pediatric glioblastoma multiforme (GBM) tumors, which have been established as 'de novo' neoplasms, are known to differ from their adult counterparts in terms of biology, genetics and ultimately survival of patients. In order to evaluate the utility of markers of tumor biology for refining prognostic assessment, we retrospectively analyzed 54 pediatric GBMs (age range 9 months to 15 years) occurring at different anatomical sites in the brain, operated at our institute between 1995 and 2001. The expression of p53, epidermal growth factor receptor (EGFR), bcl-2 and retinoblastoma proteins (pRb) was analyzed by immunohistochemistry and the results were compared with the clinical profile, MIB-1 labeling index (LI) and patient survival. p53 immunoreactivity was noted in 53.7% of cases, predominantly in thalamic (75%) and cerebral lobar (62.2%), followed by brainstem tumors (30%). It was absent in cerebellar tumors. p53-positive tumors had a higher MIB-1 LI, compared to p53-negative tumors (p=0.003). EGFR and bcl-2 overexpression was observed in 25.9% and 33.3% of cases, respectively, and loss of pRb expression was evident in only 7.4% of cases, indicating that loss of this gene function is not significantly involved in pediatric GBMs. p53 and bcl-2 expression were maximally noted in patients with poorer outcome. Our results indicate that p53 expression status is noted in a significant number of pediatric supratentorial neoplasms. p53 with bcl-2 overexpression is more often associated with ominous prognosis. Further molecular characterization would provide newer insights into the biology of these neoplasms and form a basis for future therapeutic decision making.
    Pediatric Neurosurgery 01/2005; 41(6):292-9. · 0.42 Impact Factor
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    ABSTRACT: CASE REPORT: Four cases of medulloblastoma with extensive nodularity (MBEN) are described. The patients were 3 years of age or younger at diagnosis. Cranial CT scan disclosed multiple coalescing nodules with peculiar 'grape-like' architecture in three patients. A near total excision of the tumour was performed in all four patients. The patients are currently receiving radiation and chemotherapy. Histologically, the tumours were characterized by extreme nodularity with intranodular uniformity and low proliferative index. The internodular zones were extremely cellular, composed of undifferentiated, mitotically active cells. Bcl-2 protein expression was observed in the cellular zones but was distinctly absent within nodules. DISCUSSION: MBEN represents a variant that occurs in very young children but has a good prognosis. The favourable outcome is probably related to its spontaneous neurocytic differentiation. The pattern of Bcl-2 immunoreactivity in MBENs indicates that this protein could be a key player in the regulation of neuronal differentiation in medulloblastomas.
    Child s Nervous System 02/2004; 20(1):55-60. · 1.24 Impact Factor
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    ABSTRACT: To study intracranial cestodal cysts using in vivo proton magnetic resonance spectroscopy ((1)H MRS) in an effort to identify metabolite(s) that may help in recognizing the parasitic etiology and, perhaps, viability of such tapeworm cysts. Cestodal infestations of the human central nervous system (CNS)-cysticercosis and hydatidosis-are not rare. Identification of a scolex is considered diagnostic of cysticercosis on imaging. In its absence, however, the features are non-specific. Three patients with intracranial hydatid cysts and 13 patients with intracranial cysticercal cysts (four intraventricular, seven parenchymal, and two subarachnoid racemose cysts) were studied on a 1.5-T MR system. In vivo (1)H MRS was performed by multivoxel two-dimensional hybrid chemical shift imaging technique (TE = 135 msec). In vitro (1)H NMR and mass spectroscopy (matrix assisted laser desorption/ionization [MALDI]) were performed on excised cysticercal and hydatid cyst fluid. MALDI spectra for pyruvate and succinate were also obtained. Alanine, pyruvate, and acetate were seen in all the three hydatid cysts. Lactate was seen in racemose cysticercal cysts. A large resonance at 2.4 ppm, confirmed as pyruvate at mass spectroscopy, was seen in 13 cestodal cysts. Pyruvate was not seen in one each of racemose, intraventricular, and parenchymal cysticercal cysts. Pyruvate is the predominant metabolite in cestodal cysts infesting the human CNS. It may be a marker of parasitic etiology and perhaps that of viability of such intracranial cysts.
    Journal of Magnetic Resonance Imaging 01/2004; 18(6):675-80. · 2.57 Impact Factor
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    ABSTRACT: During our initial experience with endoscopic third ventriculostomies, we observed intraoperative bradycardia and postoperative hyperkalemia. The present study was carried out to verify the consistency of these initial observations. Intraoperative heart rate (HR) changes and postoperative serum K + changes were studied prospectively in 20 patients of endoscopic third ventriculostomy. Another 6 patients who underwent endoscopic procedures other than ventriculostomy acted as controls. The anaesthetic technique and intraoperative and postoperative fluid regimen were similar in all patients. Serum K + concentrations were measured intraoperatively and once a day for the next 5 days. The third ventriculostomy group exhibited a significant slowing of the heart rate during the fenestration of the floor of the third ventricle (112 +/- 26 to 101 +/- 28 bpm, p < 0.001) and also at the time of the reversal of the neuromuscular block at the end of surgery (104 +/- 29 to 96 +/- 33 bpm, p < 0.01). The control group did not exhibit similar changes in the heart rate. The postoperative increase in serum K + values in the ventriculostomy group (0.82 +/- 0.55 mmol/L) was higher than that in the control group (0.10 +/- 0.44 mmol/L) (p < 0.01). Endoscopic third ventriculostomy is associated with a significant bradycardia at the time of fenestration and at the time of reversal of the neuromuscular block. The procedure is also associated with a postoperative increase in serum K + values. We propose a mechanism involving distortion of the posterior hypothalamus, which accounts for the bradycardia and postoperative hyperkalemia.
    min - Minimally Invasive Neurosurgery 10/2002; 45(3):154-7. · 0.62 Impact Factor
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    ABSTRACT: Various surgical approaches to treat intraventricular cysticercosis have been practiced over the years. We now present our experience with the use of the endoscope in the removal of intraventricular cysticercal cysts in patients with intraventricular cysticercal lesions associated with hydrocephalus. From 1995 to 1998, we have excised intraventricular cysticercal cysts from 9 patients. They were located in lateral ventricle in 4, in the third ventricle in two and in the fourth ventricle in three patients. A Gaab's rigid neuroendoscope system was used to enter and excise cysts in the lateral and third ventricle. The flexible fiberoptic scope was used for excising cysts in the fourth ventricle, through a transaqueductal route. In all cases a precoronal frontal burr hole was used for entry. All have been treated with albendazole in the postoperative period. All the cysts were removed successfully using endoscopic neurosurgery alone. One patient had a superficial injury to the rigid side of the aqueduct with a postoperative deficit, which improved. Three septal perforations, three third ventriculostomies, and one aqueductoplasty were done in the same sitting after cyst removal for CSF diversion. None of the nine cases required further surgery up to date. The follow-up period varied from 12 to 45 months with a median of 18 months. Endoscopic neurosurgery is a minimally invasive technique enabling removal of intraventricular cyticercal cysts from all locations, avoiding major craniotomies/posterior fossa explorations and shunts.
    min - Minimally Invasive Neurosurgery 01/2002; 44(4):194-6. · 0.62 Impact Factor
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    ABSTRACT: Stereotactic biopsies for diagnosing intracranial tuberculomas are often reported to be inconclusive, being confirmatory in only 28% of cases. We analyzed the role and diagnostic efficacy of stereotactic biopsies in the management of intracranial tuberculomas. Twenty patients diagnosed with intracranial tuberculomas based on neuroimaging procedures underwent computerized tomography (CT) guided stereotactic biopsies for histological confirmation. In 10 patients (Group A), biopsies were obtained from the center of the lesion; in the other 10 (Group B), biopsies were obtained from both the enhancing rim and the isodense center and examined separately. The tissues were processed for paraffin sections and hematoxylin eosin staining. In addition, in the first five patients a squash smear from a small portion of the biopsy was prepared, and the cytological features of the cells were examined. All the patients received antitubercular medication and CT scans were repeated 4 months posttreatment. Histopathological features of the paraffin sections in 17 patients (Group A: 8, Group B: 9) were diagnostic of tuberculoma, whereas the other three revealed only chronic nonspecific inflammation. Based on the cytological features in squash smears, diagnosis could be made in one of five. In two, although the smear was not diagnostic, the histological section from the same specimen confirmed the tuberculous pathology. There was no procedural morbidity or mortality. One patient had a small asymptomatic hematoma at the biopsy site. Three patients died during the follow-up period, due to secondary complications of tuberculosis. Repeat CT scans during follow-up after antituberculous treatment confirmed the reduction in the size of the lesion in 15/17 patients. The high positive yield of stereotactic biopsies in diagnosing tuberculomas argues for their inclusion in the management protocol for tuberculous mass lesions.
    Surgical Neurology 10/1999; 52(3):252-7; discussion 257-8. · 1.67 Impact Factor
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    ABSTRACT: Intracranial tuberculous abscesses are uncommon clinical entities, even in countries where tuberculosis is endemic. Surgical excision and antituberculous treatment is the treatment of choice. The role of stereotactic aspiration in the management of these lesions is highlighted in this communication. Three patients, all receiving treatment for pulmonary tuberculosis, presented with symptoms of raised intracranial pressure and neurological deficits. Computed tomography (CT) scans revealed cystic lesions with enhancing rim in the thalamus in two patients and multiple coalescing cystic lesions in the deep temporal region in another. Stereotactic aspiration of the cyst and biopsy of the cyst wall were performed in all. In two, the pus revealed acid fast bacilli (AFB). In another, though the pus did not reveal any AFB, the wall showed tuberculous granuloma. Antituberculous treatment was continued in all the patients. Follow-up CT revealed resolution of the lesions in all patients. Stereotactic aspiration is an useful alternative modality of management of tuberculous abscesses in a selected group of patients.
    Surgical Neurology 05/1999; 51(4):443-6; discussion 446-7. · 1.67 Impact Factor
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    ABSTRACT: Acquired fourth ventricular outlet obstruction, an uncommon entity, has been conventionally managed by ventriculoperitoneal shunt placements or excision of the obstructing membranes. The role of endoscopic third ventriculostomy is highlighted in the present communication. Three patients presenting with symptoms of raised intracranial pressure were diagnosed to have fourth ventricular outlet obstruction by neuroimaging studies and underwent endoscopic third ventriculostomy. All the patients had relief of their symptoms in the postoperative period. Neuroimaging studies performed at follow-up revealed decrease in ventricular size in all. Endoscopic third ventriculostomy is a useful alternative in the management of acquired fourth ventricular outlet obstruction.
    min - Minimally Invasive Neurosurgery 04/1999; 42(1):18-21. · 0.62 Impact Factor
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    ABSTRACT: An uncommon case of contralateral massive subdural collection developing acutely after a neuroendoscopic third ventriculostomy is presented. The patient developed a cardiorespiratory arrest in the recovery room where he could be successfully resuscitated. He made a complete recovery following aspiration of the subdural collection.
    min - Minimally Invasive Neurosurgery 07/1997; 40(2):59-61. · 0.62 Impact Factor

Publication Stats

241 Citations
33.19 Total Impact Points


  • 2007
    • National Institute of Mental Health and Neuro Sciences
      • Department of Neuroimaging & Interventional Radiology
      Bengalore, State of Karnataka, India
  • 1999–2004
    • Dharwad Institute of Mental Health and Neurosciences
      Hubli, Karnātaka, India