A K Mahapatra

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (298)309.77 Total impact

  • G Lakshmi Prasad · Sumit Sinha · Ashok Kumar Mahapatra ·

    Pediatric Neurosurgery 10/2015; DOI:10.1159/000371892 · 0.33 Impact Factor
  • G Lakshmi Prasad · Deepak Kumar Gupta · Ashok Kumar Mahapatra · Bhawani Shankar Sharma ·
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    ABSTRACT: Introduction: Literature remains sparse regarding decompressive craniectomy (DC) in traumatic brain injury (TBI) in very young children. This study analysed the indications, complications and outcome of young children undergoing DC for TBI at our institute. Study design: Retrospective. Observations: The total number of patients was 71. Mean age was 1.6 years. Mean duration from injury to surgery was 11.9 hours (range = 3-80 hours). Around 50% had severe head injury. Intracranial pressure (ICP) monitoring was done in 33 patients. Mean ICP was 22.2 mm Hg (range = 9-50 mm Hg). The threshold ICP for surgery was 15 mm Hg. Perioperative mortality was 50% each for severe TBI (18/36) and diffuse cerebral edema (7/14), and 58% for infants (4/7). Ninety per cent of expired patients had ICP > 20 mm Hg. Mean follow-up duration was 19.6 months (range = 2-42 months). Except one, all survivors had good-to-excellent outcomes (Glasgow outcome scale extended; GOS-E = 7-8). Conclusions: Decompressive craniectomy offers a survival advantage in almost 50% of young children with severe TBI and should be used judiciously. The highest mortality was within the 1st week of surgery. The cut-off limit of 20 mm Hg for surgical decompression might not be applicable to young children and a low threshold ICP needs to be considered. Factors associated with increased mortality are high opening ICP (>20 mm Hg), GCS <8, diffuse cerebral oedema and infant age group. Timing of DC remains crucial. Further prospective studies are necessary to optimize the timing and ICP limit for surgical decompression.
    Brain Injury 09/2015; DOI:10.3109/02699052.2015.1075146 · 1.81 Impact Factor
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    Ashok Mahapatra ·

    International Journal of Surgery (London, England) 09/2015; 13 Suppl 1:105. DOI:10.1016/j.ijsu.2015.08.044 · 1.53 Impact Factor
  • G Lakshmi Prasad · Deepak Kumar Gupta · Bhawani Shankar Sharma · Ashok Kumar Mahapatra ·
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    ABSTRACT: Introduction: Traumatic posterior fossa extradural hematomas (PFEDH) are rare lesions constituting Materials and Methods: We conducted a retrospective analysis of pediatric patients (≤18 years) admitted with a diagnosis of traumatic PFEDH from January 2008 to February 2014. Results: Of 22 patients, 16 were managed surgically (group 1) and 6 conservatively (group 2); 1 failed conservative treatment (due to an increased EDH volume). Mean age was 11.7 years (range 2-18 years). Falls were the most common cause of injury. Vomiting and loss of consciousness were the most frequent presenting features. There were 18 mild, 2 moderate and 2 severe head injuries. The mean volume of EDH was 37.1 ml (range 18-100 ml) and 10.3 ml (8-16 ml) in the operative and conservative subgroups, respectively. Occipital bone fracture was seen in 16 cases with supratentorial extension in 11. Four complications were noted in 3 cases. Mean follow-up duration was 25.1 months (range 3-34 months). Except for 1 patient, all had excellent outcomes. There was no mortality. Conclusions: Traumatic pediatric PFEDHs are rare. Both the clinical status of the patient and the volume of the hematoma need to be assessed before deciding on surgery. Most cases have associated occipital bone fractures and around half have supratentorial extension; these need to be carefully assessed preoperatively. Torrential venous bleeding can be a major problem due to rupture of the adjacent sinuses. Timely intervention is crucial for achieving good outcome, keeping in view a low threshold for surgical evacuation. Although not innovative, this second-largest case series provides additional data and contributes to the existing literature on such lesions in pediatric patients.
    Pediatric Neurosurgery 08/2015; 50. DOI:10.1159/000438488 · 0.33 Impact Factor
  • Sumit Bansal · Ashok Kumar Mahapatra ·
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    ABSTRACT: Terminal myelocystocele (TMC) is a rare form of spinal dysraphism. They constitute approximately 5% of skin covered lumbosacral masses. The TMC is composed of a low-lying conus medullaris with cystic dilatation of caudal central canal and a surrounding meningocele that extends from the conus to the skin. A 2-year-old female child presented with a large lumbosacral mass and weakness of both lower limbs since birth. Magnetic resonance imaging revealed a giant TMC. The child was operated on successfully. This is an interesting and rare case of "giant" TMC with partial sacral agenesis.
    08/2015; 10(4):350-352. DOI:10.4103/1793-5482.162730
  • Raj Kumar · Vivek Vaid · Samir Kalra · Ashok Mahapatra ·
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    ABSTRACT: Intracranial aneurysms are extremely uncommon in children (≤ 18 years old) and their incidence increases with age. Their epidemiology is poorly understood and certain features like location, morphology and presentation make them unique in comparison to adults. The internal carotid artery bifurcation is the most frequent site for aneurysm in this age group. We report a case of an 8-year-old boy with history of sudden unconsciousness followed by generalized tonic clonic seizures. The computerized tomography scan revealed subarachnoid hemorrhage with blood seen in the left Sylvian fissure, along tentorium cerebelli and posterior falx. There was focal intracerebral hematoma in the left temporal lobe abutting the Sylvian fissure and blood could also be seen in the fourth, third and both lateral ventricles with mild ventriculomegaly. The digital subtraction angiography revealed a large intracranial aneurysm arising from the left proximal anterior cerebral artery just distal to left internal carotid artery bifurcation. The aneurysm was clipped using standard microsurgical techniques. The child did well postoperatively. Intracranial aneurysms are rare in childhood and proximal artery anterior cerebral artery aneurysms are amongst the rarer sites. This report highlights one such rare case.
    Journal of pediatric neurology: JPN 07/2015; 06(01):077-080. DOI:10.1055/s-0035-1557430
  • Raj Kumar · Nitu Das · Ashok Mahapatra ·

    Journal of pediatric neurology: JPN 07/2015; 05(04):357-359. DOI:10.1055/s-0035-1557404
  • Raj Kumar · Vivek Vaıd · Samir Kalra · Ashok Mahapatra ·
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    ABSTRACT: Situs inversus (also called situs transversus) is a rare congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. The association of spinal dyraphism with situs inversus totalis is rare and only few cases have been reported till date. The authors report an infant who presented with meningomyelocele, with split cord malformation type-1 and situs inversus totalis. It is hypothesized that defects of the midline and laterality defects (e.g., situs inversus) are etiologically related and determining genetic locus or implicating various chemical agents that are known to produce situs inversus independently, as the causative factor for spinal dysraphism would further enhance our understanding about the pathogenesis of the above conditions and hence help in better management. A thorough physical examination supplemented by imaging studies of the entire neuraxis with a high index of suspicion for associated developmental abnormalities in a patient with congenital spinal abnormality is necessary.
    Journal of pediatric neurology: JPN 07/2015; 06(03):269-272. DOI:10.1055/s-0035-1557465
  • Raj Kumar · Namit Singhal · Rabi Sahu · Samir Kalra · Kumudini Sharma · Ashok Mahapatra ·

    Journal of pediatric neurology: JPN 07/2015; 06(03):287-292. DOI:10.1055/s-0035-1557460
  • Raj Kumar · Samir Kalra · Nitu Das · Banani Poddar · Ashok Mahapatra ·
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    ABSTRACT: Grisel's syndrome is a rare condition characterized by atlantoaxial subluxation following an inflammatory process in the head and neck region. It occurs more commonly in children and usually presents with cervical pain and torticollis, in addition to symptoms of the primary infection. A case of Grisel's syndrome is discussed here who suddenly developed quadriplegia with severe respiratory compromise and ultimately diagnosed as reducible atlantoaxial subluxation with hematomyelia. Hematomyelia was extending from medulla to the third cervical vertebrae level of cord. The case was managed successfully by posterior fusion. Though the clinical improvement occurred following posterior fusion, but there was no optimum radiological reduction of the reducible atlantoaxial subluxation. This case emphasizes the importance of posterior fusion in Grisel's syndrome where an offending posterior indentation of upper cervical cord by dislocated posterior arch, if dealt with; the clinical improvement can be achieved even without sufficient anterior reduction of subluxation. The reasons of hematomyelia and nonreduction atlantoaxial subluxation are discussed here.
    Journal of pediatric neurology: JPN 07/2015; 06(03):265-268. DOI:10.1055/s-0035-1557463
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    ABSTRACT: We report our initial experience to optimize neurosurgical procedures using high field strength intraoperative magnetic resonance imaging (IOMRI) in 300 consecutive patients as high field strength IOMRI rapidly becomes the standard of care for neurosurgical procedures. Three sequential groups (groups A, B, C; n=100 each) were compared with respect to time management, complications and technical difficulties to assess improvement in these parameters with experience. We observed a reduction in the number of technical difficulties (p<0.001), time to induction (p<0.001) and total anesthesia time (p=0.007) in sequential groups. IOMRI was performed for neuronavigation guidance (n=252) and intraoperative validation of extent of resection (EOR; n=67). Performing IOMRI increased the EOR over and beyond the primary surgical attempt in 20.5% (29/141) and 18% (11/61) of patients undergoing glioma and pituitary surgery, respectively. Overall, EOR improved in 59.7% of patients undergoing IOMRI (40/67). Intraoperative tractography and real time navigation using re-uploaded IOMRI images (accounting for brain shift) helps in intraoperative planning to reduce complications. IOMRI is an asset to neurosurgeons, helping to augment the EOR, especially in glioma and pituitary surgery, with no significant increase in morbidity to the patient. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Clinical Neuroscience 06/2015; 22(8). DOI:10.1016/j.jocn.2015.02.027 · 1.38 Impact Factor
  • Ashis Patnaik · Ashok Kumar Mahapatra · Menka Jha ·
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    ABSTRACT: Neurological complications following lightning are rare and occur in form of temporary neurological deficits of central origin. Involvement of peripheral nervous system is extremely rare and only a few cases have been described in the literature. Isolated unilateral pan-brachial plexus neuropraxia has never been reported in the literature. Steroids have long been used for treatment of neuropraxia. However, their use in lightning neural injury is unique and requires special mention. We report a rare case of lightning-induced unilateral complete flaccid paralysis along with sensory loss in a young patient. Lightning typically causes central nervous involvement in various types of motor and sensory deficit. Surprisingly, the nerve conduction study showed the involvement of peripheral nervous system involvement. Steroids were administered and there was significant improvement in neurological functions within a short span of days. Patients' functions in the affected limb were normal in one month. Our case was interesting since it is the first such case in the literature where lightning has caused such a rare instance of unilateral pan-brachial plexus lesion. Such cases when seen, raises the possibility of more common central nervous system pathology rather than peripheral involvement. However, such lesions can be purely benign forms of peripheral nerve neuropraxia, which can be managed by steroid treatment without leaving any long-term neurological deficits.
    Surgical Neurology International 04/2015; 6(Suppl 2):S110-2. DOI:10.4103/2152-7806.153650 · 1.18 Impact Factor
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    ABSTRACT: We report an uncommon case of posterior circulation stroke in a young patient due to occlusion of posterior cerebral artery with reducible atlantoaxial dislocation (AAD). Plain dynamic radiography showed reducible AAD and intra-arterial digital subtraction angiography demonstrated occlusion of left posterior cerebral artery. Patient underwent stabilization of craniovertebral junction by occipito cervical fixation using occipit-C2/C3 lateral mass screws and rod fixation and has since experienced no recurrent symptoms. Vertebrobasilar insufficiency is a known entity in a patient with reducible AAD; however, isolated involvement of posterior cerebral artery is very rare. So this condition should be kept in mind, and necessary interventions must be undertaken at the earliest to avoid further irreversible brain damage.
    Journal of Pediatric Neurosciences 04/2015; 10(2):149-52. DOI:10.4103/1817-1745.159186
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    ABSTRACT: Background: Ganglioglioma is a tumour commonly asociated with seizures. The goal of this study was to observe the postoperative outcome in patients with gangliogliomas. Material and Methods: A total 24 patients with gangliogliomas who underwent surgery at our institute from 2008 to 2011 were included. There were 13 males (54%) in our study. A retrospective analysis for the demographic profile, surgery and outcome was performed using STATA software. Literature on this subject was also reviewed, MEDLINE and PUBMED databases were searched. Observations: Sixteen patients presented with signs and symptoms of raised intracranial pressure and 12 patients had seizure disorder. Average age at surgery was 20 years (range 7-50 years). Twelve each were located in the temporal lobe and extra-temporal location. Intra-operative electrocorticography (ECoG) alone in three and image guidance alone were used in two patients, respectively. Both ECoG and image guidance were used in one patient and none of them was used in 18 patients. Gross total resection was achieved in 17 patients. After a mean follow-up of 1.6 years (range 3 months to 2.5 years), out of 12 patients with preoperative seizures, 10 (83.3%) were seizure free (Engel class-I) and 2 (16.6%) belonged to Engel class-II. None of the factors, including age at surgery, seizure duration prior to surgery, type of seizures, use of intra-operative ECoG and image guidance, extent of tumor resection, and surgical strategy proved to have significant correlation with postoperative seizure outcome. Conclusions: Surgical treatment is effective and safe for patients with gangliogliomas. Neither intra-operative ECoG nor image guidance necessarily leads to better seizure control, although they are useful adjunct for achieving safe and complete tumor resection.
    03/2015; DOI:10.4103/1793-5482.153500
  • Vikas Naik · F U Ahmed · Aditya Gupta · Ajay Garg · Chitra Sarkar · Bhawani Sharma · Ashok Kumar Mahapatra ·
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    ABSTRACT: Fungal granulomas of the central nervous system are rare, and have high mortality and morbidity irrespective of treatment. The authors report their experience of managing 66 patients over 15 years and discuss the clinical, radiological, surgical and pathological findings. This is among the largest reported series. A retrospective analysis was performed on patients with intracranial fungal granulomas (ICFGs), treated in our institution, between January 1997 and May 2011. Only mass forming histopathologically proven ICFG were included in this study. The age of the patients ranged from 7 years to 67 years (mean= 32.3 yrs) and most patients were in the third and fourth decades of life. The study population had 47 males and 19 females. The most common symptom was headache (41 patients), followed by vomiting (16 patients) and blurring of vision (16 patients). Only 3 patients had fever as a presenting feature. The duration of symptoms was less than 6 months in all cases and less then 3 months in 39 cases. Anterior cranial fossa and frontal lobe was involved in 35 cases (54.5%), followed by middle cranial fossa in 20 cases (30.3%).Three cases had granulomas in CP angle. Three cases had multi-compartmental involvement and four multi-lobar involvement. Nine patients had predisposing factors for fungal infection Based on clinical and imaging data, preoperative diagnosis of a possible fungal lesion was made in 44 (some had only CT imaging) patients. All the patients were treated surgically, followed by antifungal treatment with amphotericin-B and/ fluconazole/ itraconazole for a period of six weeks. Eight patients had symptomatic recurrence of lesions 3-12 weeks after treatment and were re-operated. Six patients were lost to follow up. Nine patients died in the post-operative period (within 30 days postoperatively). Fifteen patients died during follow up due to recurrent lesions, repeat surgery, renal failure and unrelated causes. Overall mortality was 24 (36.3%). Poor neurological status before surgery, emergency craniotomy, severe brain edema with mass effect and opening of ventricles during surgery was associated with poor outcome. Aspergillus species were the causative organism in an overwhelming majority of patients (n=52) followed by Mucor in 7 cases, Cladiosporium in 3 cases, Eumycetoma in 2 cases, Maduramycosis and Blastomycosis in 1case each. ICFG have high morbidity and mortality rates. Early diagnosis, radical surgery and antifungal treatment for 6 weeks may improve outcome. Poor neurological status of patients at the time of presentation, immunocompromised state, contamination of ventricular CSF during surgery and renal failure (due to amphotericin-B) are associated with poor outcome. Copyright © 2015 Elsevier Inc. All rights reserved.
    World Neurosurgery 02/2015; 83(6). DOI:10.1016/j.wneu.2015.01.053 · 2.88 Impact Factor
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    Swagata Tripathy · Ashok Kumar Mahapatra ·
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    ABSTRACT: Targeted temperature management (TTM) for neuroprotection involves maintaining the temperature of the brain at predetermined levels by various techniques. It is aimed at avoiding the harmful effects of hyperthermia on the brain and at exploiting the protective effects of lower tissue temperature. There has been an explosion in the use of TTM for neuroprotection in a variety of clinical scenarios apart from the commonly accepted fields of resuscitation and ischaemic, hypoxic encephalopathy. This review briefly discusses the evidence base for TTM. The focus is on various areas of application for neuroprotection, the practical issues pertaining to TTM implementation, the recent data that support it and the present areas of controversy.
    Indian journal of anaesthesia 02/2015; 59(1):9-14. DOI:10.4103/0019-5049.149442
  • Guru Dutta Satyarthee · A.K. Mahapatra ·
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    ABSTRACT: The ventriculo-peritoneal (VP) shunt surgery in resource constrained centre still remains, most common form of treatment for hydrocephalus. The V. P. shunt complications can occur along entire course of shunt, distal complications are obstruction of catheter, cerebrospinal fluid ascites, abscess and ulceration of skin. However, total cranial migration and getting coiled in subgaleal space, of peritoneal catheter end is very rare occurrence and is reported in only seven cases as isolated case- report in western literature, further more rare is associated extrusion of ventricular catheter and rarer is subgaleal coiling of both peritoneal and ventricular end. Author reports a rare and unique case of complete migration of peritoneal catheter into subgaleal space in a 2-year old boy associated, with partial extrusion of ventricular end, the child was also given electric stimulation by untrained physiotherapist along the shunt tract, which might have facilitated cranial migration of distal catheter in our case. Pertinent literature is briefly reviewed
    01/2015; 29(2). DOI:10.1515/romneu-2015-0028
  • SachinA Borkar · AK Mahapatra · Avijit Sarkari ·

    01/2015; DOI:10.4103/1793-5482.150002
  • Amol Raheja · Guru Dutta Satyarthee · Ashok Kumar Mahapatra ·
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    ABSTRACT: Occurrence of chronic subdural hematoma (CSDH) in leukemia is rare, and most reported cases occurred in relation with acute myeloid leukaemia; however, occurrence is extremely rare in accelerated phase of chronic myelogenous leukaemia (CML). Seizure as presentation of SDH development in CML cases is not reported in literature. Authors report an elderly male, who was diagnosed as CML, accelerated phase of developing SDH. Initially presented to local physician with seizure; urgent CT scan head was advised, but ignored and sensorium rapidly worsened over next day and reported to our emergency department in deeply comatose state, where imaging revealed chronic subdural hematoma with hypoxic brain injury with fatal outcome. Seizure, progressive worsening of headache, vomiting and papilloedema are harbinger of intracranial space occupying lesion and requires CT head in emergency medical department for exclusion, who are receiving treatment of haematological malignancy
    01/2015; 29(2). DOI:10.1515/romneu-2015-0029
  • Guru Dutta Satyarthee · A.K. Mahapatra ·
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    ABSTRACT: Cerebellar liponeurocytoma (LNC) is a very rare neuroepithelial tumor. About thirty eight cases have been reported, in literature till date, mostly in the form of isolated case reports due to rarity of the occurrence. Authors report interesting case in 27-year old male presented with headache and cerebellar signs. MRI imaging revealed posterior fossa mass. He underwent sub occipital ctraniectomy with gross total resection of lesion. Histopathological report of specimen was consistent with liponeurocytoma with range of MIb index less than three. He is under regular follow-up. However he was not advised any adjuvant therapy. Diagnosis of LNC requires high index of suspicion and neuroimaging with typical MRI findings may be help to confirm the diagnosis. The tumor needs to be differentiated from medulloblastoma, which is far more common and aggressive and requires post-operative chemo-radiation and carries poor prognosis Management and pertinent literature will be reviewed
    01/2015; 29(2). DOI:10.1515/romneu-2015-0026

Publication Stats

2k Citations
309.77 Total Impact Points


  • 1984-2014
    • All India Institute of Medical Sciences
      • • Department of Neurosurgery
      • • Department of Medical Oncology
      New Dilli, NCT, India
  • 2007-2013
    • Sanjay Gandhi Post Graduate Institute of Medical Sciences
      • Department of Neurosurgery
      Lakhnau, Uttar Pradesh, India
  • 1995-2011
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India
  • 2003-2004
    • Philadelphia ZOO
      Philadelphia, Pennsylvania, United States
  • 1999-2003
    • Khoula Hospital
      Masqaţ, Muḩāfaz̧at Masqaţ, Oman