Browsing by Author "Krishnakumar, K."
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Item Adult medulloblastoma: Clinical profile and treatment results of 18 patients(JOURNAL OF CLINICAL NEUROSCIENCE, 2008)The objective of this article is to examine the clinicoradiological features and surgical outcomes of adult patients (>16 years) with medulloblastoma. An attempt was made to identify the predictors of poor outcome and assess patterns of relapse and to compare these with pediatric medulloblastoma. Retrospective case record analyses were performed on 18 adults (> 16 years) and 79 children (< 16 years) operated upon after January 1990, who had at least 5 years of follow-up. The following variables were assessed by bivariate analyses: age, location of the lesion, brainstem invasion, extent of excision and histological subtype. Statistical analysis was performed using chi-square test, Fischer's exact test and Student's t-test. Results revealed there was no gender preference. The tumor was located in the vermis in 12 patients (66.6%) and in the cerebellar hemisphere in six (16.6%). Calcification was observed in two cases (11.1%) and hydrocephalus was seen in six (33.3%). MRI evidence of brainstem infiltration was seen in three patients (16.6%). Total excision was achieved in 13 cases (72.2%), near total excision in four (22.2%) and subtotal excision in one. Major complications included fresh cranial nerve deficits in four patients (22.2%), hemiparesis and gait unsteadiness in three (16.6%), mutism in one and meningitis in two. All patients underwent adjuvant radiotherapy in the form of craniospinal irradiation with a posterior fossa boost. On follow-up, 11 patients (61.1%) were observed to have recurrence and all were located in the posterior fossa. All 11 subsequently underwent chemotherapy. Two patients had reoperation for residual/recurrent lesions causing raised intracranial symptoms. Five-year follow-up data showed that 10 patients (55.5%) were alive, five (27.7%) had died while three (16.6%) were lost to follow-up. In spite of recent advances in management, patients with medulloblastoma still have a poor prognosis. However, adults fared better than children. Vermian location had a better outcome in adults, but not in children. Desmoplastic variant histology was not observed to be a significant prognostic factor in the adult group while brain stem invasion carried a poor prognosis. (c) 2007 Elsevier Ltd. All rights reserved.Item Bilateral thalamic lesions(BRITISH JOURNAL OF NEUROSURGERY, 2010)Objective. Bilateral thalamic lesions are rare and relatively obscure neoplasms. We present our experience with nine cases of bilateral thalamic lesions and attempt to analyse them in the background of available literature.Materials and methods. Retrospective analyses of the case records of 9 cases of bilateral thalamic lesions treated in our department since January 2002, which have a minimum of 1 year follow-up.Results. The study group included four males and five females with a mean age of 14.6 years (5 years to 29 years). Seven of these patients had radiological evidence of bilateral thalamic lesions at presentation and 2 patients had involvement of the opposite thalamus at a later stage of the disease. All patients except one presented with raised intracranial pressure symptoms. Focal motor deficits (4/9), behavioral and memory disturbances (3/9) were the other major presenting symptoms. Biopsy confirmation was possible in six patients and histopathology was suggestive of low grade fibrillary astrocytoma in all six patients. Seven patients required CSF diversion procedure for associated hydrocephalus. Eight of our nine patients underwent radiotherapy. On last follow-up, 3 patients were clinically stable with images suggestive of arrested disease, four patients had evidence of progressive disease both clinically and radiologically and there were two recorded cases of mortality.Conclusion. Primary bilateral thalamic lesions have characteristic neuroradiological properties and are distinct from unilateral thalamic tumours with bilateral progression. Almost all of these lesions on histology prove to be gliomas but decompressive surgery is seldom feasible. Surgical intervention is limited to biopsy and CSF diversion for hydrocephalus. Bilateral thalamic lesions remain unresponsive to adjuvant therapy and generally carry a poor prognosis.Item Dissecting intracranial aneurysms presenting as subarachnoid haemorrhage: report of two cases and review of literature(BRITISH JOURNAL OF NEUROSURGERY, 2008)Subarachnoid haemorrhage due to intracranial non-traumatic dissecting aneurysms is rare. Most of the published reports refer to dissecting aneurysms in the vertebrobasilar territory. Anterior circulation dissecting aneurysms are rare and their pathogenesis, clinical features, angiographic findings and management are a matter of debate. Management of patients with intracranial arterial dissection is unclear. Unlike the well-established proximal occlusion and trapping approaches to vertebral artery dissections, choices of interventions for anterior circulation and basilar dissecting aneurysms are limited, and most reports have been limited to wrapping techniques for arterial wall reinforcement. The role of anticoagulation therapy in the presence of subarachnoid haemorrhage is also a matter of debate. As no clear-cut guidelines are available, treatment should be tailored to the individual patient. We describe two cases of intracranial dissecting aneurysms, which presented as subarachnoid haemorrhage (SAH) and discuss the management issues.Item Meningiomas of the Lateral Ventricle-A Report of 15 cases(BRITISH JOURNAL OF NEUROSURGERY, 2009)Lateral ventricular meningiomas are rare tumours that pose considerable surgical challenge. This study attempts to analyse some of the important clinical features of these tumours and review technical considerations in surgery for lateral ventricular meningiomas. A retrospective analysis of the case records of patients with lateral ventricular meningiomas operated in our institute since 1998 with a minimum of one year follow up was done. The variables analysed included age, sex, clinical presentation, imaging characteristics, histopathology and operative details. Outcome was analysed using the Glasgow outcome score (GOS). Fifteen patients with a mean age of 40.6 years formed the study group. A female preponderance was observed (M:F 5:10). Raised intracranial pressure was the predominant symptom at presentation (10/15; 66%) followed by visual field deficits (6/15; 40%) and contralateral motor deficits (5/15; 33.3%). One patient presented with evidence of intratumoural bleed. The tumour was on the right side in 7 patients and on the left side in 8 patients. The lesion was located in the trigone of the lateral ventricle in 13 patients and in the body of the ventricle in two. The tumours were excised through a parietooccipital approach in 11 (73.33%) patients and through a middle temporal gyrus approach in 4 (26.66%).The tumour recurred in 2 patients, both tumours being histologically fibroblastic variants. Fresh operative complications included motor deficits in 3, contralateral homonymous hemianopia in 2, dysphasia in 1, refractory seizures in 2 and loculated hydrocephalus in one. We had no operative mortality. At last follow-up for 10 patients were in GOS 5, two were in GOS 4 and three in GOS 3. Lateral ventricular meningiomas are difficult tumours to operate. Total surgical excision through a superior parietal lobule or middle temporal gyrus approach is possible in most cases with minimal morbidity.Item Subfrontal gangliocytoma masquerading as olfactory groove meningioma(BRITISH JOURNAL OF NEUROSURGERY, 2009)We describe a rare case of an unusually located gangliocytoma. The conventional magnetic resonance imaging (MRI) appearance was suggestive of an olfactory groove meningioma. However, advanced MRI sequences (diffusion-weighted imagingDWI; perfusion MRI; susceptibility-weighted imagingSWI; MR spectroscopyMRS) revealed features more consistent with a glial neoplasm.