Browsing by Author "Rao, RM"

Now showing 1 - 7 of 7
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    BEYOND THE LEARNING CURVE IN EPILEPSY SURGERY: THE INSTITUTIONAL AND INDIVIDUAL PERSPECTIVE
    (EPILEPSIA, 2011) Vilanilam, GC; Abraham, M; Menon, G; Rao, RM; Nair, S; Radhakrishnan, K
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    Electro-clinical characteristics and postoperative outcome of medically refractory tumoral temporal lobe epilepsy
    (NEUROLOGY INDIA, 2005)
    Background: Very few studies have specifically addressed surgical treatment and outcome of patients with tumor-related temporal lobe epilepsy (TLE). Aim: To define the postoperative seizure outcome and the factors that influenced the outcome of patients with tumor-related TLE. Materials and Methods: We selected patients whose surgical pathology revealed a temporal lobe neoplasm and who had completed >= 1 year of postoperative follow-up. We reviewed the clinical, EEG, radiological and pathological data, and the seizure outcome of these patients and assessed the factors that influenced the outcome. Results: Out of the 409 patients who underwent surgery for refractory TLE during the 8-year study period, there were 34 (8.3%) patients with temporal lobe neoplasms. The median age at surgery was 20 years and the median duration of epilepsy prior to surgery was 9.0 years. MRI revealed tumor in the mesial location in 21 (61.8%) patients. Interictal and ictal epileptiform EEG abnormalities were localized to the side of th lesion in the majority. Mesial temporal lobe structures were included in the resection, if they were involved by the tumor; otherwise, lesionectomy alone was performed. During a median follow-up of 4 years, 27 (79%) patients were completely seizure-free. The only factor that predicted long-term seizure-free outcome was being seizure-free during the first two postoperative years. Conclusions: Our results emphasize the fact that in patients with tumoral TLE, when the seizures are medically refractory, surgery offers potential for cure of epilepsy in the majority.
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    Gender influence on selection and outcome of deep brain stimulation for Parkinsons disease
    (ANNALS OF INDIAN ACADEMY OF NEUROLOGY, 2014) Chandran, S; Krishnan, S; Rao, RM; Sarma, SG; Sarma, PS; Kishore, A
    Background: Gender differences exist in Parkinsons disease (PD), both in clinical manifestations and response to medical treatment. We investigated whether gender differences occur in the clinical characteristics of patients selected for bilateral subthalamic nucleus deep brain stimulation (STN DBS) or in the outcome when resource limits influence treatment choices made by patients. Materials and Methods: Fifty-one consecutive patients were evaluated 1 month before, and 12 months after bilateral STN DBS. All patients were rated using Unified Parkinsons Disease Rating Scale, Parkinsons Disease Quality of Life (PDQL) Scale, Addenbrookes Cognitive Examination and Beck Depression Inventory. Results: Pre-operative characteristics did not differ between the genders except for lower doses of drugs (P = 0.03), worse emotional scores in PDQL (P = 0.01) and worse depression (P = 0.03) in women. There was no gender difference in the surgical outcome, except a lesser reduction of dopaminergic drugs in women. Depression and quality of life (QOL) improved equally well in women and men. Conclusion: Bilateral STN DBS is equally efficacious in both genders as a treatment for motor complications of PD and for improving QOL. Women are likely to be undertreated because of more severe dyskinesia and may experience less emotional well-being, and could therefore potentially benefit from earlier surgical treatment.
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    Gender influence on selection and outcome of deep brain stimulation for Parkinson’s disease
    (Annals of Indian Academy of Neurology, 2014-12) Chandran, S; Syam, K; Rao, RM; Sarma, SG; Sarma, PS; Kishore, A
    BACKGROUND: Gender differences exist in Parkinson's disease (PD), both in clinical manifestations and response to medical treatment. We investigated whether gender differences occur in the clinical characteristics of patients selected for bilateral subthalamic nucleus deep brain stimulation (STN DBS) or in the outcome when resource limits influence treatment choices made by patients. MATERIALS AND METHODS: Fifty-one consecutive patients were evaluated 1 month before, and 12 months after bilateral STN DBS. All patients were rated using Unified Parkinson's Disease Rating Scale, Parkinson's Disease Quality of Life (PDQL) Scale, Addenbrooke's Cognitive Examination and Beck Depression Inventory. RESULTS: Pre-operative characteristics did not differ between the genders except for lower doses of drugs (P = 0.03), worse emotional scores in PDQL (P = 0.01) and worse depression (P = 0.03) in women. There was no gender difference in the surgical outcome, except a lesser reduction of dopaminergic drugs in women. Depression and quality of life (QOL) improved equally well in women and men. CONCLUSION: Bilateral STN DBS is equally efficacious in both genders as a treatment for motor complications of PD and for improving QOL. Women are likely to be undertreated because of more severe dyskinesia and may experience less emotional well-being, and could therefore potentially benefit from earlier surgical treatment.
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    Middle Cerebral Artery Aneurysms An Institutional Experience in a South Indian Population
    (NEUROSURGERY QUARTERLY, 2008) Khursheed, N; Bhattacharya, RN; Nair, S; Menon, G; Rao, RM
    Background: Middle cerebral artery aneurysms (MCAAs) account for about 20% of intracranial aneurysms. These are commoner in females and have various other special features. Aim: To study the demographic features in a subset of South Indian Population and to assess the clinical and radiologic parameters of outcome. Patients and Methods: Retrospective analysis of 99 patients with diagnosis of symptomatic MCAAs admitted to Sri Chitra Tirunal Institute for Medical Sciences find Technology, Trivandrum, India from 2000 to 2004 was performed. Clinical features and radiologic parameters were analyzed and correlation with outcome was evaluated. Fishers exact test and Pearson analysis was used for statistical analysis. Results: Seizures and hemiparesis were common clinical findings. Hydrocephalus was less often seen and aneurysms pointing laterally had high incidence of parenchymal hematomas. Mirror, giant, and multiple aneurysms were often seen. Conclusions: MCAAs have higher association of multiple aneurysms, incidence of angiographic vasospasm is very high. and it si significantly influences outcome besides preoperative World Federation of Neurological Surgeon and future directions to improve the Surgical results should be aimed to better deal with the vasospasm and its sequelae.
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    Petroclival Meningiomas: Institutional Experience of 119 cases
    (13TH ASIAN-AUSTRALASIAN CONGRESS OF NEUROLOGICAL SURGEONS (AACNS), 2012) Nair, S; Gopalakrishnan, CV; Vikas, V; Abraham, M; Rao, RM; Menon, G; George, V; Easwer, HV; Sudhir, JK; Amit, D
    A retrospective analysis of 119 cases of petroclival-premeatal meningiomas surgically managed in their institute from 1st Jan 1990 till 14th November 2011 was carried out to see the outcome with various approaches. While the tumor resection was carried through an anterolateral/ lateral route in 32(27%), it was through a combined posterior subtemporal /pre or trans-sigmoid (posterior petrosal) in 24(20%) & retrosigmoid supra-paracerebellar route in 55 cases (46%). In three cases with extra cranial extension to infratemporal area, a modified Fisch approach was used. Five patients who were in poor clinical condition had only a CSF diversionary procedure. The percentage of these tumors operated by conventional retrosigmoid route has increased in the later part of the series thus proving that in many of these tumors without significant middle fossa extension, it is not necessary to use complex and time consuming skull base approaches which in themselves can cause morbidity. The tumor could be radically removed in 79 patients (66%), subtotally in 26 (22%) and decompression only in 9). Six patients had tumor excision in two stages. There was an operative mortality of 8.4% (10 cases). Out of the 85 patients on long term follow up 56 are independent. Six out of the eight patients who had symptomatic recurrence were re-operated.
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    Primary yolk sac tumor of the paracavernous region
    (ACTA NEUROCHIRURGICA, 2010) Radhakrishnan, N; Rao, RM; Kapilamoorthy, TR; Radhakrishnan, VV