A K Mahapatra

All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India

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Publications (488)521.81 Total impact

  • Sumit Bansal, Ashish Suri, Bhawani S Sharma, Ashok Kumar Mahapatra
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    ABSTRACT: Introduction: Jugular foramen schwannomas are rare. Only a couple of series involving a large number of cases have been reported. Methods: In the present study we aimed to analyse the clinical characteristics, management plan (surgery or radiosurgery), surgical approaches used to treat and outcome of paediatric patients (≤20 years of age) undergoing treatment for Jugular foramen schwannomas via retrospective analysis of departmental records. Data for 5 patients (≤20 years of age) treated for Jugular foramen schwannomas in the Department of Neurosurgery at All India Institute of Medical Sciences, New Delhi, India, a tertiary level referral institution between January 2001 and December 2010 were analysed. Results: Most patients presented with the duration of symptoms ranging from 1 month to 13 months. Four patients were managed with surgery and one patient was managed with primary Gamma knife. Of the patients for whom radiological follow-up data were available, complete tumour excision was achieved in 3 cases. Follow- up ranged from 11 months to 49 months. There was no mortality. Conclusions: Jugular foramen schwannomas are best treated by total surgical resection. Partial resection is appropriate for tumours with adhesions to the brainstem and in medically unfit patients. Radiosurgery can be planned for small residual tumor later.
    The 25th Annual Conference of Indian Society for Pediatric Neurosurgery (IndSPNCON 2014); 10/2014
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    ABSTRACT: Growing skull fractures are rare complications of traumatic skull fractures in children. The authors aim to share their experience in management of such lesions and analyse clinicoradiological features, surgical management and outcome in addition to prognostication factors.
    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 09/2014;
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    ABSTRACT: Background. Arachnoid cysts account for 1% of intracranial mass lesions. Quadrigeminal cistern arachnoid cysts are even rarer lesions. We report 18 cases of quadrigeminal cistern arachnoid cysts treated at our institute from 2002 to 2012. Methods. We retrospectively analysed 18 patients with quadrigeminal cistern arachnoid cyst for clinical presentation, demographic profile, management and outcome. The age of the patients ranged from 29 days to 50 years (mean 17 years). The cysts were classified into 3 subtypes based on MRI findings. Surgical intervention was carried out in all the patients. Results. Two patients had Type 1 cysts, 4 had Type 2 cysts and 12 had Type 3 cysts. Two patients (Type 1) underwent endoscopic third ventriculostomy (alone). Craniotomy and cyst wall excision along with ventriculocystostomy and cystocisternostomy were done in 4 patients with Type 2 cysts, and endoscopic fenestration of cysts to the sub-arachnoid space or the ventricles and endoscopic third ventriculostomy were done in 7 patients with Type 3 cysts. Two patients with Type 3 cysts underwent only endoscopic ventriculocystostomy and cystocisternostomy without endoscopic third ventriculostomy, while three patients underwent ventriculoperitoneal shunt. The follow- up period ranged from 6 months to 48 months (mean 23.7 ± 12.3 months). Conclusion. Quadrigeminal plate arachnoid cysts are generally symptomatic and require some form of surgical intervention. We believe that endoscopic fenestration of the cyst with cystocisternostomy or cystoventriculostomy, when combined with third ventriculostomy, is the procedure of choice for such patients. We do not recommend the placement of a ventriculoperitnoeal shunt alone. Operative re-exploration should be planned only after obtaining proper clinico-radiological correlation and not on the basis of imaging findings alone, as sometimes the cysts fail to regress but the symptoms improve.
    British Journal of Neurosurgery 09/2014; · 0.86 Impact Factor
  • Ashis Patnaik, Ashok Kumar Mahapatra
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    ABSTRACT: Background: Intraosseous collections of air are rare in comparison to the extra-osseous collection. Pneumoceles are rare entities defined as enlarged pneumatized air sinuses or air cells, with focal or diffuse thinning of the surrounding bony walls. They may affect mastoid air cells and any of the paranasal sinuses. Case Description: We report a rare case of extensive mastoid pneumatisation in a young male patient. Patient was completely asymptomatic with swelling as the main complaint. Short history of development raised suspicion for a malignant lesion. Cholesteatoma was also taken as a differential diagnosis. However, computed tomography (CT) scan showed gross expansion of mastoid air cells with no lesion inside it. The walls of mastoid were markedly thinned out, making the diagnosis as pneumocele. In spite of a large swelling, conservative treatment was adopted in view of no symptoms and was advised follow-up regularly to detect any possible complications. Conclusion: Our case was interesting in that rare mastoid pneumoceles can be totally asymptomatic and can be large enough to raise concern for a malignant lesion. Literature shows that such mastoid pneumocele are symptomatic and require active intervention. Our asymptomatic mastoid pneumocele is a rare instance requiring no surgical procedure and was followed-up. Overall, such lesions should be treated as normal variants of physiological mastoid.
    Surgical Neurology International 08/2014; · 1.18 Impact Factor
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    ABSTRACT: Background: Since the end of last century, technology has taken a front seat in dispersion of medical education. Advancements of technology in neurosurgery and traditional training methods are now being challenged by legal and ethical concerns of patient safety, resident work-hour restriction and cost of operating-room time. To supplement the existing neurosurgery education pattern, various e-learning platforms are introduced as structured, interactive learning system. Materials and Methods: This study focuses on the concept, formulation, development and impact of web based learning platforms dedicated to neurosurgery discipline to disseminate education, supplement surgical knowledge and improve skills of neurosurgeons. 'Neurosurgery Education and Training School (NETS), e-learning platform' has integration of web-based technologies like 'Content Management System' for organizing the education material and 'Learning Management System' for updating neurosurgeons. NETS discussion forum networks neurosurgeons, neuroscientists and neuro-technologists across the globe facilitating collaborative translational research. Results: Multi-authored neurosurgical e-learning material supplements the deficiencies of regular time-bound education. Interactive open-source, global, free-access e-learning platform of NETS has around 1) 425 visitors/month from 73 countries; ratio of new visitors to returning visitors 42.3; 57.7 (2); 64,380 views from 190 subscribers for surgical videos, 3-D animation, graphics based training modules (3); average 402 views per post. Conclusion: The e-Learning platforms provide updated educational content that make them "quick, surf, find and extract" resources. e-Learning tools like web-based education, social interactive platform and question-answer forum will save unnecessary expenditure of time and travel of neurosurgeons seeking knowledge. The need for free access platforms is more pronounced for the neurosurgeons and patients in developing nations.
    Neurology India 07/2014; 62(4):352-361. · 1.04 Impact Factor
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    ABSTRACT: Background Hypoglossal schwannomas are rare intracranial neoplasms. Microsurgical resection with the goal of cure is the aim of management but is associated with a high rate of postoperative morbidity. Objective The objective of the study was to outline the clinical presentation, radiologic characteristics, surgical techniques, postoperative morbidity, and long-term follow-up results for hypoglossal schwannomas. Methods Patients treated for hypoglossal schwannoma at the Department of Neurosurgery of a tertiary-level referral institution from January 2001 until December 2010 were analyzed retrospectively using hospital records. Results There were 14 patients who were treated in the study period. Tongue atrophy and swallowing difficulties were the most common presenting symptoms. Surgery done in 12 patients using a variety of approaches (retromastoid retrosigmoid suboccipital in 9, midline suboccipital in 2, and far lateral in 1). Five patients having small residual tumors received gamma knife (GK) subsequently. two patients received primary GK stereotactic radiosurgery. Three patients had permanent morbidity in the form of cranial nerve paresis. Immediate postoperative complications like cerebrospinal fluid leak and pneumonia were present in three patients. Conclusion Complete microsurgical resection is often associated with a high rate of morbidity. Subtotal and near-total resection followed by stereotactic radiosurgery or observation now offers an alternative approach.
    Skull Base 06/2014; 75(3):159-64. · 0.66 Impact Factor
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    ABSTRACT: Aims and objective To assess and compare surgical outcome of brain contusions treated by Decompressive craniotomy with or without lobectomy or contusectomy. Methods 156 patients of severe TBI, operated for brain contusions from January 2009 through December 2010 were reviewed. The patients with brain contusions >20 cm3 in volume were included in study. In group A, decompressive craniotomy with lax duraplasty was done; in group B decompressive craniotomy with lax duraplasty along with excision of brain contusion or lobectomy was performed. Results There were 101 patients in group A and 55 in group B. Both groups were compared for demographic data, CT findings, GCS, time from injury to surgery, duration of surgery, blood loss, hospital stay, mortality and Glasgow outcome scale. Contusions were larger in group B (p = 0.0001). Pupillary reaction was worse in group B (p = 0.037). The time from injury to presentation to casualty (p = 0.0033) and time from injury to surgery (p = 0.0008) was longer in group B. Blood loss (p = 0.0001) and duration of surgery (p = 0.0013) were higher in group B. Rest other parameters were not significantly different. In group A, mortality rate was 63% and 50% in group B (p = 0.131). 28% patients in group A and 42% in group B had good outcome (p = 0.073). Conclusions Adequate contusectomy or lobectomy is useful in severe TBI with contusions. The results of present series suggest that one should be very aggressive in managing brain contusions to achieve better outcomes.
    The Indian Journal of Neurotrauma. 06/2014;
  • Ashis Patnaik, Ashok Kumar Mahapatra
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    ABSTRACT: Cerebral contusions are common lesions in context of traumatic brain injury and are often associated with other lesions such as subdural hematoma, subarachnoid hemorrhage, extradural hematoma, etc., However, contusion due to severe shock wave without physical trauma is quite peculiar and has never been reported in the literature. We report one such rare case.
    Neurology India 05/2014; 62(2):207-8. · 1.04 Impact Factor
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    ABSTRACT: Objective. Isolated abducens nerve palsies associated with intracranial aneurysms have rarely been reported. The purpose of the study was to study the patients with bilateral abducens nerve palsy in association with subarachnoid hemorrhage (SAH). Methods. All patients admitted and managed at our center with a diagnosis of SAH and had bilateral abducens nerve palsy were included in the study. The demographic and clinical details, radiological findings, treatment data, and outcome of these patients were retrieved from the computerized database of our hospital. Results. Nine patients, with a mean age of 49.4 years, met the inclusion criteria. Male to female ratio of 1.25:1). Average duration of symptoms before presentation was 2.6 days (ranging from 1 to 4 days). Third nerve palsy in addition to bilateral abducens nerve palsy was present in 4 patients (44%). DSA demonstrated aneurysms in 7 patients; 4 had posterior circulation aneurysms and 3 had aneurysms of anterior circulation. Two patients had angionegative SAH. The abnormality resolved in all but one patient over a time period of 4-9 weeks, and one patient died due to unrelated cause. Conclusions. Bilateral abducens nerve palsy in association with SAH is rarely described. Proposed mechanisms include direct compression of the bilateral abducens nerves, vasospasm of the pontine branches of the basilar artery and hydrocephalous. Most of the patients in our series showed resolution of the symptoms over a period of 4-9 weeks.
    British Journal of Neurosurgery 05/2014; · 0.86 Impact Factor
  • Neurology India 05/2014; 62(3):329-35. · 1.04 Impact Factor
  • Ashutosh Khandelwal, Noufal Basheer, Ashok K Mahapatra
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    ABSTRACT: Intracerebral abscess are rare in neonates and infants. We present a rare case of 4-month-old immunocompetent infant with multiple intracranial fungal abscess. Right frontoparietal craniotomy was done with excision of multicystic mass containing 200cc of dirty colored fluid. Biopsy and culture of abscess came as Aspergillus fumigates. Patient received parental amphotericin B. An immunocompetent infant with intracranial aspergillosis is rare. We advocate combination of surgical excision with parental amphotericin B as best way to achieve good result.
    Journal of Pediatric Neurosciences 05/2014; 9(2):159-61.
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    ABSTRACT: To evaluate clinical presentation and microsurgical outcome of giant pituitary adenomas (GPAs) in pediatric age. All patients <18 years, who were operated on at our center for GPA (tumor >40 mm in maximum diameter) were included in study. Clinical features, hormonal profile, radiology, surgical approach, results and complications were analysed. A total of 12 children with GPA were managed microsurgically. Visual deterioration (73 %) was most common presentation. Functioning adenomas were found in 83 % patients, with prolactinomas being most common. Twelve patients underwent a total of 16 microsurgical procedures, with a single surgery done in eight (75 %) patients. Out of the 12 primary surgeries, eight (67 %) were performed trans-sphenoidally. A near-total excision (>90 % tumor removal) could be achieved in six (50 %) patients. Visual improvement was observed in 44 % patients. However, there was no improvement in those where the eye was negative to perception of light prior to surgery. At the last follow-up, all the patients with functioning adenomas were in hormonal remission, and there was no residual/recurrent tumor in patients with non-functional adenomas. 25 % experienced single or multiple perioperative or postoperative complications. There was one perioperative death (8 %). GPAs are very rare in the pediatric population, with majority being functional and more aggressive in nature as compared to in adults. However, most of them can be approached trans-sphenoidally. The combination of surgery and radiotherapy, as well as medical therapy with bromocriptine, achieves good tumor control, despite a high rate of residual tumor and tumor recurrence.
    Child s Nervous System 04/2014; · 1.24 Impact Factor
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    ABSTRACT: The aim was to calculate, in monetary terms, total cost incurred by a Level I trauma center in providing in-patient care to brachial plexus injury patients during their preoperative and the postoperative stay.
    Asian journal of neurosurgery. 04/2014; 9(2):89-92.
  • Vivek Tandon, Kanwaljeet Garg, Ashok Kumar Mahapatra, Sachin A Borkar
    The Indian Journal of Pediatrics 02/2014; · 0.72 Impact Factor
  • Ashis Patnaik, Ashok Kumar Mahapatra
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    ABSTRACT: Craniopharyngiomas continue to be a challenge to manage, due to difficulty in complete excision and frequent recurrences. The management protocol remains controversial. They have a tendency to invade the normal brain tissues around them and due to their position in suprasellar region in close relationship with vital structures like optic apparatus, pituitary-hypothalamic axis, complete removal is often not feasible without causing serious morbidity and mortality. In this scenario, sub-total excision seems to be a better alternative, which is plagued by early and frequent recurrences. Radiotherapy has been used for increasing the progression free survival and to improve the overall quality of life. Recently Gamma knife radiosurgery has evolved as a promising technique of radiating the residual or recurrent tumor in a single session with great accuracy and precision. This helps in maximizing the radiation dose to the tumor with steep dose fall off to the surrounding tissue, and hence there is better control of the tumor and minimal radiation exposure to surrounding normal, vital brain tissues. We discuss the current strategies of Gamma knife treatment for craniopharyngioma and review the literature.
    Indian Journal of Neurosurgery. 01/2014; 2(3):256-261.
  • Ashis Patnaik, Ashok Kumar Mahapatra
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    ABSTRACT: Subarachnoid hemorrhage (SAH) is the bleeding into the subarachnoid space containing cerebrospinal fluid. The most common cause of SAH is trauma. Rupture of aneurysms, vascular anomalies, tumor bleeds and hypertension are other important etiologies. SAH in the setting of pituitary tumor can result from various causes. It can be due to intrinsic tumor related pathology, injury to surrounding the vessel during the operative procedure or due to an associated aneurysm. We discuss the pathological mechanisms and review relevant literature related to this interesting phenomenon. Early and accurate diagnosis of the cause of the SAH in pituitary tumors is important, as this influences the management.
    The Indian journal of Neurosurgery. 01/2014; 2(3):240-247.
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    ABSTRACT: Bilateral thalamic tumors are rare. Pediatric bilateral thalamic glioblastomas are even rarer, only five cases reported in the English literature till date. The clinical presentation, natural history, and prognosis of pediatric thalamic tumors are still relatively obscure. In this article, we report an 8-year-old patient with large bilateral thalamic glioblastomas and briefly discuss its clinical presentation, possible modalities of management, and prognosis, in the light of available literature.
    Journal of Pediatric Neurosciences 01/2014; 9(1):76-8.
  • Nishant Goyal, Bhawani Shankar Sharma, Ashok Kumar Mahapatra
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    ABSTRACT: Colloid cysts are uncommon lesions, which most commonly occur in the fourth through seventh decade. The authors hereby report a series of colloid cysts in the pediatric age group. MATERIAL and A retrospective study was conducted on all patients of colloid cyst that underwent surgery at our institute over a period of seven years (2005 to 2011). Patients above the age of 20 were excluded from the study. All eight patients presented with the features of raised intracranial pressure. All these patients had the characteristic radiological features of a colloid cyst. Of these eight pediatric patients, endoscopic removal was attempted in four. In one of these four, the colloid cyst could not be removed endoscopically and had to be converted into transcortical transventricular excision. In one more patient, transcortical transventricular excision was used, while transcallosal approach was performed in three patients. Of the three patients who underwent endoscopy, one patient additionally underwent septostomy and one patient additionally underwent septostomy along with third ventriculostomy. One of the patients succumbed to ventriculitis. Colloid cysts in the young are thought to be more aggressive clinically and radiologically and therefore, early surgical intervention is indicated.
    Turkish neurosurgery 01/2014; 24(1):1-7. · 0.58 Impact Factor
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    ABSTRACT: Intracranial aneurysms in children are not as common as in adults and there are many differences in the etiology, demographic variables, aneurysm location, aneurysm morphological characteristics, clinical presentation, and outcome in pediatric and adult intracranial aneurysms. All children (≤18 years) suffering from intracranial aneurysm managed at our center from July 2001 through June 2013 were included in the study, and the details of these patients were retrieved from the computerized database of our hospital. A total of 62 pediatric patients were treated for 74 aneurysms during the study period and constituted 2.3 % of all intracranial aneurysms treated during the same period. The mean age at presentation was 13.5 years. Headache (82 %) was the commonest presenting feature; other symptoms included seizures (21 %), ictal loss of consciousness (27 %), and motor/cranial nerve deficits (22.6 %). Computed tomogram revealed subarachnoid hemorrhage in 58 % of patients. Eighty-two percent of aneurysms were in anterior circulation. Sixty-seven percent of aneurysms were complex aneurysms. Fifty-eight percent of patients underwent surgical intervention while 30 % underwent endovascular procedures. Twenty-one percent of the patients developed vasospasm. There was no postoperative mortality. Favorable outcome was seen in 72 % of the patients. Pediatric intracranial aneurysms are uncommon as compared to in adult patients. Seizures and cranial nerve involvement are seen more often as the presenting features in children. Posterior circulation aneurysms are more common in children, as are the internal carotid artery bifurcation aneurysms. There is high incidence of giant, posttraumatic, and mycotic aneurysms in children.
    Child s Nervous System 12/2013; · 1.24 Impact Factor
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    ABSTRACT: The purpose of the study was to analyze the surgical outcomes in children (≤18 years) with brachial plexus injury operated between April 2008 and March 2012 at our center. All children <18 years of age admitted to our center and surgically treated with a diagnosis of posttraumatic brachial plexus injury were included in the study. The demographic details of these patients were retrieved from the computerized database of our hospital. The results were analyzed in terms of the mode of injury, type of injury, surgical procedure performed, and motor recovery after the surgery (MRC Grading). Motor recovery with MRC >3/5 was termed as good outcome. A total of 33 patients were surgically treated. The mean age at presentation was 15.1 (range 4-18) years. Boys constituted 79 % (n = 26) of our patient population. High-velocity injury was the commonest mode of injury. Panbrachial injury was the commonest seen in 82 % (n = 27) of patients. Mean duration between injury and surgical intervention was 6 (range 2-13, SD ± 2.6) months. Majority of patients underwent neurotization procedure. Mean follow-up was 32 (range 6-51) months. High-velocity trauma is the most common mode on injury. Global palsy involving all the plexal elements was present in 82 % of the children. Neurotization was the most commonly performed surgical procedure. Good motor outcome (MRC grade ≥3/5) was seen in 62 % of patients.
    Child s Nervous System 11/2013; · 1.24 Impact Factor

Publication Stats

2k Citations
521.81 Total Impact Points


  • 2014
    • All India Institute of Medical Sciences Bhubaneswar
      Bhubaneswar, Orissa, India
  • 1985–2014
    • All India Institute of Medical Sciences
      • • Department of Neurosurgery
      • • Department of Pathology
      • • Department of Biochemistry
      • • Department of Medical Oncology
      New Dilli, NCT, India
  • 2013
    • Postgraduate Institute of Medical Education and Research
      Chandigarh, Chandīgarh, India
  • 1995–2013
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India
  • 2007–2012
    • Sanjay Gandhi Post Graduate Institute of Medical Sciences
      • Department of Neurosurgery
      Lucknow, Uttar Pradesh, India
  • 2003–2004
    • Philadelphia ZOO
      Philadelphia, Pennsylvania, United States
  • 2000–2003
    • Khoula Hospital
      Masqaţ, Masqaţ, Oman