Browsing by Author "Abraham, M."

Now showing 1 - 6 of 6
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    Multifocal desmoplastic noninfantile astrocytoma
    (JOURNAL OF NEURORADIOLOGY, 2008)
    This is a report of a case of multifocal desmoplastic astrocytoma in an 11-year-old child in which we describe the MRI findings and discuss the possible mechanism of its development. The MRI appearances in our case support the view that the tumor is primarily of teptomeningeal or superficial cortical origin, with cystic formation secondary to entrapment of cerebrospinal fluid. The question of whether or not the lesions are metastases or metachronous lesions is also discussed. Desmoplastic astrocytoma at a noninfantile age is extremely rare: only four cases have been reported in the literature so far. Even more unusual is the presence of this lesion in multiple locations at the initial presentation. (C) 2008 Elsevier Masson SAS. All rights reserved.
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    Precoronal, Paramedian Minicraniotomy: A Minimal Access Approach for Microsurgical, Transcallosal, Transforaminal Removal of Colloid Cysts of the Third Ventricle
    (MINIMALLY INVASIVE NEUROSURGERY, 2008)
    Objective: Microsurgical excision of colloid cysts of the third ventricle is accomplished along the transcallosal or the transfrontal routes. In the transcallosal approach, venous tributaries of the superior sagittal sinus can often act as an impediment to entry into the interhemispheric fissure for accessing the corpus callosum. We propose a paramedian minicraniotomy anterior to the coronal suture for removing colloid cysts via the transcallosal approach as veins are relatively rare in this area.Methods: A triangular minicraniotomy was designed with each side measuring 3 cm based on the midline in the precoronal area of the frontal bone on the right side. Nineteen cases of symptomatic colloid cysts of the third ventricle whose diagnoses were proven by CT and/or MRI were subjected to microsurgery in the period from June 2004 to May 2007. Following the minicraniotomy the cysts were removed utilizing the transcallosal transforaminal route.Results: Venous tributaries crossing the inter-hemispheric fissure were seen in 2 patients and these could be avoided to access the corpus callosum. Complete excision could be achieved in all cases. All patients had a good outcome although one patient had transient left lower limb weakness. The mean operating time was 163 minutes, while the mean duration of stay in the intensive care unit and hospitalization were 1.35 days and 3.73 days, respectively.Conclusion: The pre-coronal, paramedian minicraniotomy is safe and effective for the total excision of colloid cysts of the third ventricle. As a minimal access approach, it needs only a short duration of postoperative hospitalized care.
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    Rasmussen's encephalitis: Experience from a developing country based on a group of medically and surgically treated patients
    (SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2009)
    Purpose: To describe the attributes of patients with Rasmussen's encephalitis (RE) seen in a tertiary epilepsy referral center in southern India and to enquire factors helpful in predicting responsiveness to immunotherapy.Methods: We diagnosed RE based on the European consensus criteria. To assess the factors that Could potentially predict the natural course and therapeutic Outcome, we subcategorized our patients according to age at onset ( 6 years), duration from onset to presentation ( 2 years), immunotherapy versus surgery, and early (<= 2 years from the onset) versus late Surgery.Results: The median age at disease onset of 19 patients was 6.0 years (range 2.3-13 years). Epilepsia partialis continua (EPC) and hemiparesis were noted in 14 (73.6%) and 16 (84.2%) patients, respectively. One patient, who presented with clysarthria due to tongue EPC, did not have hemiparesis despite having had the disease for over 15 years. The MRI findings in majority conformed to stage 3 of Bien classification. While 9/10 patients treated by surgery achieved seizure-freedom, only 1/11 patients who received immunotherapy did so. One patient expired due to subsequent development of contralateral hemispheric disease following successful hemispherectomy. None of the factors Such as age at onset, age at presentation, presence/absence of antecedents, seizure burden, MRI stage predicted responsiveness to immunotherapy.Conclusion: This study from a developing country, in addition to Substantiating the well known characteristics of RE, noted the following unusual findings: isolated lingual EPC abolished by focal cortical resection, bilateral RE, putaminal atrophy and absence of hemiparesis despite long standing disease. (C) 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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    Telovelar approach: technical issues for large fourth ventricle tumors
    (CHILDS NERVOUS SYSTEM, 2007)
    Objects Fourth ventricle is conventionally accessed via resection of the part of the vermis for total excision of the tumors at the expense of significant morbidity. Numerous avenues have been identified to minimize the morbidity; some of which include transforaminal, subtonsillar, telovelar approaches, etc. These approaches are devised on the basis that accurate dissection along the natural avascular planes will avoid injury to the important structures in this area minimizing morbidity. We attempt to emphasize the technique of telovelar approach and the problems encountered while employing this technique for excision of large fourth ventricle tumors.Material and methods Fifteen patients with fourth ventricle tumors were operated during January to September 2005 at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. Fourteen of these cases were medulloblastomas, and one was ependymoma. All the patients were operated in prone oblique position via telovelar approach.Conclusion Clear understanding of the normal anatomy will help in meticulous dissection and will result in reduced morbidity. Significant incidence of postoperative ataxia and mutism is seen with this approach in large tumors, and this can be avoided by staged dissection of the uvulotonsillar cleft.