Browsing by Author "Menon, Girish"

Now showing 1 - 12 of 12
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    A single institution series of cavernomas of the brainstem
    (JOURNAL OF CLINICAL NEUROSCIENCE, 2011)
    We retrospectively analyzed a series of patients with brainstem cavernomas of the medulla, pons, or midbrain to attempt to define the natural history, indications for surgery, and outcome after surgical resection. Between 1993 and 2008, 52 patients with cavernomas of the brainstem presented to our institute and were managed either surgically or conservatively. Twenty-three patients underwent surgical excision using standard skull base approaches. Outcomes were correlated to the number of preoperative hemorrhages, location of the cavernoma, timing of surgery in relation to the hemorrhage and the preoperative neurological status. Nine patients improved after surgery, 12 deteriorated and two died. In the conservatively managed group, 15 patients had a good outcome, 11 deteriorated and one died. Multiple hemorrhages, poor preoperative neurological status and surgery during the acute phase were predictive of the surgical outcome. Excision of brainstem cavernomas should be considered in patients with symptomatic hemorrhages whose lesions approach the pial surface. Patients with minimal stable neurologic deficits without recurrent bleeds should be managed conservatively. (C) 2011 Elsevier Ltd. All rights reserved.
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    Acute subdural hematoma after transsphenoidal surgery
    (JOURNAL OF CLINICAL NEUROSCIENCE, 2009)
    We report the case of a 48-year-old male who developed an acute subdural hematoma after transsphenoidal decompression of a pituitary adenoma followed by lumbar drain to conservatively manage postoperative cerebrospinal fluid rhinorrhoea. An attempt is made to discuss the risk factors. The need for constant monitoring, early imaging and prompt treatment is stressed. (C) 2008 Elsevier Ltd. All rights reserved.
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    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.
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    Aneurysm of the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: two case reports and review of literature
    (BRITISH JOURNAL OF NEUROSURGERY, 2009)
    Aneurysms arising from anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) variant are exceedingly rare. We report two cases of distal AICA-PICA variant aneurysms and discuss their surgical management with emphasis on the higher risk for perforator artery injury. The etiopathogenesis of these rare aneurysms at non-branching sites remains elusive.
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    Changing signal intensity of a craniopharyngioma
    (NEUROLOGY INDIA, 2010)
    Craniopharyngiomas can present as suprasellar cystic lesion with varied imaging appearance. In magnetic resonance imaging using T1-weighted sequence, the cyst can show hypointense, isointense or hyper intense signals depending on the cyst content. We report a case where the T1 signal intensity of a craniopharyngioma changed over time. The hypointense lesion had become hyper intense in the follow-up scan after six months. Such change in signal intensity is described with Rathke's cleft cyst but has not been reported with craniopharyngioma. The possible reason for this change in signal intensity is discussed.
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    Choroid plexus tumors: An institutional series of 25 patients
    (NEUROLOGY INDIA, 2010)
    Purpose: Choroid plexus tumors (CPT) are rare neoplasms that pose considerable treatment challenges. This study reviews a single institute's experience with 25 patients of CPT and attempts to contribute to the general body of knowledge on CPT. Materials and Methods: A retrospective analysis of the case records of 25 patients operated for CPT since January 1998 and having a minimum of 1 year follow-up. Results: The study group included 12 (48%) cases of choroid plexus papilloma (CPP), 09 (36%) cases of choroid plexus carcinoma (CPC) and 4 cases of atypical CPP. The mean age at presentation was 18.6 years (range, 6 months to 54 years; SD, 18.7) and a male preponderance was noted (17: 8). Raised intracranial pressure was the commonest presenting symptom (72%). The tumors were distributed as follows: lateral ventricle (16; 64%), fourth ventricle (5; 20%), fourth ventricle with cerebellopontine angle extension (3; 12%), and third ventricle (1; 4%). A complete surgical excision was achieved in 11 cases of CPP and 8 cases of CPC. Operative complications include pneumocephalus (40%), focal deficits (36%), subdural effusion (32%), and persistent hydrocephalus requiring shunt (24%). All patients with CPP had a good outcome at the end of a mean follow-up of 5.4 years, whereas the median survival for patients with CPCs who underwent a subtotal resection with adjuvant therapy was 36 months. Conclusion: CPTs include a spectra ranging from CPP to CPC. Radiologic and histologic characterization of these tumors is difficult and newer immunohistochemical and genetic studies should be done to differentiate them from each other. Total excision offers a good prognosis and should be attempted for all forms of CPTs. CPPs carry a good prognosis, and adjuvant therapy is not indicated even after partial excision. CPCs and atypical CPCs carry a poor prognosis, and adjuvant therapy improves survival marginally after total excision. Spinal drop metastases are common for CPC and screening of the spine for possible metastasis should be part of the routine preoperative and postoperative investigation protocol.
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    Intracranial hypertension with polyradiculopathy - early CSF diversion to optimize neurological recovery
    (BRITISH JOURNAL OF NEUROSURGERY, 2012)
    Cerebral venous sinus thrombosis (CVST) and idiopathic intracranial hypertension (IIH) are common considerations in young patients presenting with isolated intracranial hypertension. We report two patients with progressive visual failure and polyradiculopathy with arefl exic quadriparesis, secondary to raised intracranial pressure (ICP). Both underwent cerebrospinal fl uid diversion with complete recovery. Such a fulminant presentation of raised ICP with an excellent outcome has rarely been reported in the literature.
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    Mesencephalothalamic Giant Virchow-Robin Space Causing Obstructive Hydrocephalus
    (NEUROSURGERY QUARTERLY, 2011)
    Virchow-Robin (VR) spaces are well-defined, normal pialined spaces along the walls of perforating arteries as they course in the brain parenchyma. These spaces are <2mm in size and are similar to cerebrospinal fluid (CSF) intensity on all pulse sequences. Dilated VR spaces are part of normal aging process. When VR spaces assume large bizarre, multicystic configuration, they are called as giant perivascular spaces and can be mistaken for other intracranial cystic space occupying lesions. When located in the mesencephalon-thalamic region, they produce acute hydrocephalus, which necessitates CSF diversion. We report a rare case of giant VR space in the mesencephalon-thalamic region causing symptoms related to obstruction of CSF flow due to aqueduct compression.
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    Non-surgical management of cystic prolactinomas
    (JOURNAL OF CLINICAL NEUROSCIENCE, 2009)
    Cystic prolactinomas are considered not amenable to dopamine agonist therapy. We present the results of dopamine agonist therapy in six patients with cystic prolactinomas. The inclusion criteria of patients were: (i) cystic macroadenomas with the cyst occupying more than 50% of the turnout volume: (ii) a serum prolactin value more than 150 ng/mL. All patients were males with a mean age of 35 years. The clinical presentations were erectile dysfunction in 66.6%, Visual deficits in 50% and headache in 50% of patients. All patients were treated with bromocriptine only except one who was treated with both bromocriptine and cabergoline. The mean duration of follow up was 57.1 months. At the final follow-up 50% of patients had hormonal Cure, 50% had radiological cure and 50% had reduction in the size of the turnout. Hence, it is appropriate to consider dopamine agonist therapy in patients with cystic prolactinomas before considering surgery. (C) 2009 Elsevier Ltd. All rights reserved.
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    Rosai-Dorfman disease mimicking chronic subdural hematoma
    (JOURNAL OF CLINICAL NEUROSCIENCE, 2008)
    Rosai-Dorfman disease (RDD) otherwise known as simus histiocytosis with massive lymphadenopathy is an uncommon benign systemic histio-proliferative disease characterised by massive lymphadenopathy particularly in the head and neck region and is often associated with extra-nodal involvement. We report a case in which RDD was mistaken for a chronic subdural hematoma and surgery was attempted. (C) 2007 Elsevier Ltd. All rights reserved.
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    Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following foramen magnum decompression for Chiari malformation Type I
    (JOURNAL OF NEUROSURGERY, 2011)
    Symptomatic subdural hygroma due to foramen magnum decompression for Chiari malformation Type I is extremely rare. The authors present their experience with 2 patients harboring such lesions and discuss treatment issues. They conclude that the possibility of subdural hygromas should be considered in all patients presenting with increased intracranial tension following foramen magnum decompression for Chiari malformation Type I. Immediate neuroimaging and appropriate surgical intervention provides a good outcome. (DOI: 10.3171/2010.8.JNS10413)
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    Variant origin of superior thyroid artery, occipital artery and ascending pharyngeal artery from a common trunk from the cervical segment of internal carotid artery
    (SURGICAL AND RADIOLOGIC ANATOMY, 2006)
    We report a case of variant origin of superior thyroid artery (STA), occipital artery (OA) and ascending pharyngeal artery (APA) from the cervical segment of internal carotid artery (ICA) in a 63-year-old male patient, who presented with acute subarachnoid hemorrhage. Four-vessel angiography showed asymptomatic occlusion of ICA giving origin to the anomalous branches. There was common origin of the STA and the OA. The APA originated from the OA. We did not find any other description in the literature on variant origin of STA from the cervical segment of ICA in the presence of a well-developed external carotid artery.