Browsing by Author "Rajesh, B. J."
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Item Anomalous origin of the callosomarginal artery from the A1 segment with an associated saccular aneurysm(AMERICAN JOURNAL OF NEURORADIOLOGY, 2006)Although anatomic variations are well known in the A1 segment of the anterior cerebral artery (ACA), anomalous origin of a cortical artery from the A1 segment is extremely rare. The only reported cortical branch to arise from the A1 segment is the fronto-orbital artery. We report a case of anomalous origin of the callosomarginal artery (CMA) in association with a saccular aneurysm from the A1 segment of the left ACA in a 35-year-old man who presented with intracerebral hemorrhage. To our knowledge, this is the first report of anomalous origin of the CMA from the A1 segment.Item Clinicopathological study of cerbral aneurysms.(SCTIMST, 2001)Item Intracranial infectious aneurysm: Presentation, management and outcome(JOURNAL OF THE NEUROLOGICAL SCIENCES, 2007)Background: Intracranial infectious aneurysms (IA) are infrequent, but can be fatal.Objectives: To compare the clinical profile of IAs associated with intravascular/systemic infection like infective endocarditis with that associated with local infections like meningitis, orbital cellulitis and cavernous sinus thrombosis.Methods: We analysed all cases of IA, treated in this Institute from 1976 to 2003, in order to identify prognostic factors.Results: There were 25 persons (mean age 24.8 +/- 17.3 years, males 17) with 29 IA (carotid circulation 19, vertebrobasilar circulation 10). Headache (83%) and fever (67%) were the most common presenting symptoms. In contrast to noninfectious aneurysms, intracerebral haemorrhage (60%) and focal signs were more common than subarachnoid haemorrhage (7%) with [A. Sources of infection were cardiac (10), meningitis (12), orbital cellulitis (2) or uncertain (I). Infective agents included bacteria (18), fungi (4), and tubercle bacilli (3). Fifteen]A were distal and 14 were proximal. IAs associated with meningitis were proximal (75%) while those associated with cardiac diseases preferentially involved carotid territory and were distal (p=0.013). The overall mortality was 32%. Survivors were younger than those who expired (p=0.015). Of the sixteen patients treated medically, seven recovered (44%), others (56%)) had treatment failure (three died and six required surgery later). Another five patients underwent early Surgery (one died). Mortality of IA was significantly higher with meningitis, fungal aetiology and vertebrobasilar location.Conclusions: IAs associated with local infections like meningitis had different clinical profile as compared to IAs associated with intravascular/systemic infections like infective endocarditis. (C) 2007 Elsevier B.V. All rights reserved.Item 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.