Browsing by Author "Nair, Suresh"

Now showing 1 - 15 of 15
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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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    Alanine peak in central neurocytomas on proton MR spectroscopy
    (NEURORADIOLOGY, 2007)
    Introduction We present three consecutive patients with central neurocytoma in whom proton MRS demonstrated the presence of alanine.Materials and methods Three patients in the age range 24 to 30 years underwent MRI and proton MRS using a 1.5-T system. MRS was performed with the multivoxel PRESS sequence. All three patients underwent surgery and the diagnosis of central neurocytoma was established by histopathological examination and immunostaining.Results With an echo time of 135 ms glycine, high choline, small NAA and alanine were observed in all three patients.Conclusion Alanine may be observed in central neurocytomas as it is in meningiomas. Other spectral peaks such as those for glycine and NAA should help to identify this tumor correctly.
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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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    Cerebellar Low-Grade Oligoastrocytoma Presenting with Subarachnoid Haemorrhage
    (TURKISH NEUROSURGERY, 2012)
    Subarachnoid haemorrhage (SAH) associated with intra-axial tumours is extremely uncommon and is usually seen in association with intratumoural bleed. Tumours located near the ventricle or subarachnoid spaces have a higher propensity for SAH compared to intraparenchymal lesions. Low-grade tumours rarely demonstrate any evidence of bleed on imaging. Oligoastrocytomas of the posterior fossa are rare tumours in adults and their presentation with intratumoural haemorrhage and SAH is unknown. We report a unique case of cerebellar low-grade oligoastrocytoma that mimicked a tentorial-based extraaxial lesion on imaging and presented with SAH. Susceptibility-weighted magnetic resonance imaging is a useful imaging modality to demonstrate blood within and outside the tumour.
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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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    Epidermoid Cyst of the Brainstem in Children: Case-Based Update
    (JOURNAL OF CHILD NEUROLOGY, 2012)
    Epidermoid cysts are rare, slow growing, space-occupying lesions of early adulthood. Among the various locations, involvement of the brainstem is quite exceptional. In children, these tumors are extremely uncommon; only 4 purely intrinsic brainstem epidermoids are reported in the literature. The pathogenesis of true intraaxial brainstem epidermoid is unclear and is usually not considered in the preoperative differential diagnosis of brainstem tumors. We report 2 additional cases of brainstem epidermoid cysts occurring in children, underlining their clinical characteristics, the difficulties faced in the diagnostic work-up, and the surgical treatment adopted. These tumors pose a surgical challenge and attempts at aggressive removal of the cyst wall are fraught with increased risks of morbidity and mortality. On the other hand, cases treated more conservatively show good or excellent results with minimal complications. Neurosurgical judgment at the time of surgery is warranted to ensure maximum resection while minimizing postoperative neurologic deficits.
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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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    Neurenteric Cyst of the Cerebellopontine Angle With Fetal-type Posterior Circulation
    (NEUROSURGERY QUARTERLY, 2010)
    Intracranial neurenteric cysts are rare congenital tumors, which are located largely in the posterior fossa. The benign nature of the lesion allows them to attain large proportions before they are diagnosed. Histopathogenesis of neurenteric cysts is controversial and they are thought to develop during the third week of gestation as a result of endodermal dysgenesis. This is also the period during which the fetal cerebral circulation develops. The transformation from fetal-type to adult-type circulation begins from the eighth week, and theoretically, any disturbance during this process may lead to persistent fetal-type posterior cerebral circulation. We report a unique case of neurenteric cyst in the posterior fossa with bilateral full fetal-type posterior circulation. To the best of our knowledge, there has been no reported case of a congenital cyst in the posterior fossa associated with fetal-type posterior circulation. As angiography for such benign cystic lesions in the posterior fossa is not routinely practiced, the incidence of their association with persistent fetal circulation is not known. We postulate that congenital lesions in the posterior fossa can affect the normal vascular development leading to known arterial variations.
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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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    Posterior reversible encephalopathy syndrome in a case of postoperative spinal extradural haematoma: case report and review of literature.
    (Asian spine journal, 2011)
    A 14-year-old girl presented with progressive paraparesis and paresthesia of one-year duration. Magnetic resonance imaging revealed a T6 vertebral hemangioma with epidural compression on the spinal cord. Following angiography and embolization, she underwent dorsal laminectomy and excision of the soft tissue component compressing the cord. In the postoperative period she had rapid worsening of lower limb power and imaging demonstrated an epidural haematoma at the operative site. The patient was taken up for urgent re-exploration and evacuation of haematoma. Postoperatively the patient complained of visual failure, headache and had multiple episodes of seizures. An magnetic resonance imaging brain showed characteristic features of posterior reversible encephalopathy syndrome (PRES) and the patient improved gradually after control of hypertension. This is the first documented case of PRES following spinal cord compression in a patient without any known risk factors. We postulate the possible mechanism involved in its pathogenesis.
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    Primary Ewing's sarcoma of the spine presenting as acute paraplegia.
    (Journal of pediatric neurosciences, 2012)
    Ewing's sarcoma is a primary bone malignancy with the highest incidence in the second decade of life. Although it mostly affects the metaphyseal region of long growing bones, involvement of spine is not very uncommon especially the sacrum. Nonsacral spinal Ewing's sarcoma is rarer and often mimics a benign condition before spreading extensively. They present with neurologic deficits due to spinal cord compression, but acute onset paraplegia has not been previously reported. A high index of clinical suspicion can clinch the diagnosis early in the course of the disease. A prompt intervention is required to keep neurological damage to a minimum, and a correct combination of surgery, chemotherapy, and radiotherapy is required for better long-term patient outcome. We report a 16-year-old female who presented with acute paraplegia and had an excellent postoperative outcome after radical excision of a D9 Ewing's sarcoma.
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    Spontaneous cervical epidural hematoma of idiopathic etiology: Case report and review of literature
    (JOURNAL OF SPINAL CORD MEDICINE, 2012)
    Context: Spontaneous spinal epidural hematoma (SSEH) is a rare idiopathic condition that leads to acute onset of neurological deficits, which if not recognized early can have catastrophic consequences. The definition and pathophysiology of this condition remain controversial. High index of suspicion followed by T2-weighted gradient echo sequences are particularly useful in early diagnosis. Management consists of prompt surgical decompression of the hematoma though a recent trend is toward non-surgical treatment.Findings: A 70-year-old man presented with acute onset neck pain with a radicular component and rapidly progressive quadriparesis. Magnetic resonance imaging revealed a posteriorly located cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery to near normal function occurred within 24 hours of surgery.Conclusion: SSEH in its true idiopathic form is a rare pathologic entity. Because of the high risk of poor outcome without treatment, SSEH should be a diagnostic possibility when presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma leads to a favorable neurological outcome, whereas delay in treatment can be disastrous. The role of conservative management needs to be proven and should be tailored on an individual basis.
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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)