-
[show abstract]
[hide abstract]
ABSTRACT: Trigeminal schwannomas (TS), though the second most common intracranial schwannomas, represent only 0.8 to 8% of all Schwannomas. Advancement in imaging and microsurgical techniques has led to a remarkable improvement in the outcome of these benign tumors. Multicompartmental TS, though extensive, have an excellent outcome after surgery. In this article, we present our experience in the management of multicompartmental TS (types middle/posterior [MP], middle/extracranial [ME], and middle/posterior and extracranial [MPE]) and outcome in this rather uncommon group of tumors. This retrospective study included all the cases of multicompartmental TS operated at our institute from 1999 to 2009. The medical data were analyzed retrospectively. The demographic profile, clinical features, radiological findings, management strategies, postoperative complications, length of hospitalization, and outcome were noted. Follow-up data were collected from outpatient department records. The range and average duration of follow-up were noted. There were a total of 43 patients with TS operated over this period. Among them, 4 were type B, 5 type C, 11 type D, 18 type E, and 5 type F. The study included 26 patients (4 type B, 18 type E, and 4 type B). A variety of approaches were used to approach the tumor. Of 26, 23 patients had a gross total or near-total excision while 2 patients were lost to follow-up. Among the three patients who had a near-total excision and follow-up magnetic resonance imaging showed a small residual tumor, two are on close follow-up with no increase in the size of the tumor over a follow-up period of 3 years, the other patient is a 5-year-old boy who is too young for radiosurgery and is on follow-up. There was no mortality while four patients have had fresh permanent postoperative deficits. Multicompartmental TS are a rare, complex but eminently treatable group of tumors. A variety of surgical approaches can be used to excise the tumor. The choice of approach needs to be individualized with total excision providing excellent results.
Skull Base 11/2011; 21(6):351-8. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Malignant peripheral nerve-sheath tumours (MPNST) with a rhabdomyomatous component are referred to as malignant triton tumours. Cervical tritons are rare, with only one previous report. We present a 28-year-old male patient with a malignant triton tumor involving the cervical spine with neurofibromatosis Type 1 presenting with symptoms of rapidly progressive cord compression. Radiology was suggestive of a MPNST with hemorrhage at the C2-C3 level. He underwent surgery with decompression of the intradural, and a small part of the extradural, component. To our knowledge this is the first report of a cervical triton tumor presenting with an intratumoral bleed.
Journal of Clinical Neuroscience 03/2011; 18(5):721-3. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Triple neural tube defects (NTDs) are rare; only 1 case exists in the available literature. There has been a divergent view on the etiogenesis of NTDs, and 2 main theories have been postulated: the more widely held orderly closure theory and the less accepted multisite closure theory. In this article the authors present 2 cases of patients with triple NTDs, and they examine the embryological basis of NTDs with special reference to the multisite closure theory. The patient in Case 1 had a 2-level myelomeningocele (MMC) along with an encephalocele; the patient in Case 2 had a 3-level MMC. To the authors' knowledge, this paper outlines only the second and third cases described in world literature of triple NTDs including the first case of a triple MMC. The embryogenesis of triple NTDs can be better explained by the multisite closure theory. However, it fails to adequately explain the triple MMC in Case 2, given that the closure has to proceed in an orderly manner. The authors thus propose an additional closure site to explain this.
Journal of Neurosurgery Pediatrics 03/2008; 1(2):160-3. · 1.53 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cerebellar abscesses are common neurosurgical emergencies in developing countries, and have a distressingly high mortality rate of 10 to 15% even today. There is still no consensus on the standard approach to these lesions, and controversy persists over whether these lesions should be treated with primary excision or aspiration.
The authors retrospectively analyzed 82 cases of cerebellar pyogenic abscesses in children treated at their institution over a period of 10 years. This represents the largest such series being described in literature. All lesions except 1 were otogenic in origin. The clinical and radiological features are discussed.
Primary excision was undertaken in 66 patients (80%) and aspiration in 16 patients (20%). Five patients in whom the abscesses were initially treated with aspiration subsequently underwent elective excision. Nine (12.6%) of 71 patients in whom the abscesses were excised had residual abscesses on postoperative imaging; in those who had undergone aspiration as the primary treatment, 6 (54.5%) of 11 patients had recurrent abscesses. There were no deaths among the patients who underwent excision of the abscess. Also, excision of posterior fossa abscesses required fewer repeated procedures with lower recurrence rates, and statistically lower rate of complications.
Compared to primary aspiration, the authors found that primary excision is the preferred method for treating cerebellar abscesses.
Journal of Neurosurgery Pediatrics 02/2008; 1(1):31-4. · 1.53 Impact Factor
-
Neurology India (ISSN: 0028-3886) Vol 54 Num 2.
-
[show abstract]
[hide abstract]
ABSTRACT: Meningitis is the most dreaded cause of morbidity and mortality in neurosurgical patients. The reported incidence of postoperative meningitis is quite varied 0.5-8%.
The study cohort included all the patients who underwent neurosurgery at the department of neurosurgery, National Institute of Mental Health and Neurological Sciences, Bangalore, India over a period of seven years (2001 - 2007). Patients with culture positive meningitis were included for analysis. The incidence of postoperative meningitis was analyzed depending on the type of surgery performed and the microbiological profile of the organisms, and their sensitivity pattern.
Of the 18,092 patients who underwent neurosurgical procedures during the study period, 415 patients developed infection. The overall incidence of meningitis was 2.2%. The incidence of meningitis was high (7.7%) in patients who had a pre-existing infection like post-pyogenic meningitis or tuberculosis hydrocephalus. The procedure mainly performed in this subgroup was shunt. The most common organisms causing meningitis were non-lactose fermenting Gram-negative bacillus followed by Pseudomonas and Klebsiella species. The methicillin-resistant Staphylococcus aureus strains were isolated in 2.6% of the patients. Ninety-one strains were multi-drug resistant, among which four strains were resistant to all antibiotics tested. The overall mortality in patients with meningitis was 5%.
Meningitis remains one of the most dreaded complications of neurosurgical procedures and is common in patients with preexisting infection. Gram-negative organisms are the most common causative pathogens of postoperative meningitis.
Neurology India 59(2):195-8. · 0.96 Impact Factor
