Browsing by Author "Sudhir, J"

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    Colloid Cyst: Institutional Experience of 293 Cases
    (13TH ASIAN-AUSTRALASIAN CONGRESS OF NEUROLOGICAL SURGEONS (AACNS), 2012) Nair, S; Menon, G; Easwer, HV; Abraham, M; Vikas, V; Krishnakumar; Gopalakrishnan, CV; George, V; Sudhir, J
    Aim: To analyze the clinical presentation, surgical outcome of 293 cases of colloid cysts surgically managed over a period of 32 years beginning January 1980 to September 2011. Methods: Age range was between 9 to 66 years. Raised ICP headache was the most common initial presenting symptom in 74% followed by visual blurring in 7%, memory disturbance in 5.3%, intermittent headaches in 7.6%, drop attacks, gait unsteadiness in 3.4% and incidental in five patients (2%). Imaging with CT scan done showed the cyst to be hyperdense in 69%, isodense in 28% and hypodense in 4% of patients. Shorter duration of symptoms correlated with MRI T2W hyperintensity changes. While an interhemispheric transcallosal approach was used in 271, it was trans-cortical in 22 (endoscope assisted in 6 & endoscopically in 2). Results: Out of the 271 patients operated through the transcallosal approach, the cyst was removed through transforaminal route in 226, interforniceal rote in 24, subchoroidal in 14 and suprachoroidal in seven. Twenty-two patients underwent emergency surgery. Twenty-eight patients had CSF diversionary procedure (14 patients referred with preoperative shunt done elsewhere and 14 required postoperative CSF diversions). Complications included impaired memory in 35, hemiplegia/ hemiparesis in 8 and seizures in twelve. There was an operative mortality of 1% (3 cases). Eight patients had symptomatic recurrence of which 6 had total excision at first surgery. Conclusions: These potentially life threatening lesions can be removed safely through the interhemispheric transcallosal approach. Periodic follow-up with MR imaging is necessary as recurrence can occur even after apparent total excision.
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    MALIGNANT MCA STROKE: EARLY OUTCOMES WITH AND WITHOUT DECOMPRESSIVE HEMICRANIECTOMY
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Shetty, K; Sreedharan, SE; Sudhir, J; Menon, D; Nair, S; N, SP
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    Moyamoya disease: A comparison of long term outcome of conservative and surgical treatment in India
    (JOURNAL OF THE NEUROLOGICAL SCIENCES, 2014) Sundaram, S; Sylaja, PN; Menon, G; Sudhir, J; Jayadevan, ER; Sukumaran, S; Sreedharan, SE; Sarma, S
    Background: Revascularization surgery (RS) is the therapy of choice in moyamoya disease (MMD). Due to rarity of disease and ethical concerns, randomized controlled trials about the treatment options are lacking. Very little information is available on the long-term outcome of conservatively treated moyamoya patients. Aim: We compared the long-term outcome of moyamoya patients treated conservatively to those who underwent RS. Methods: Our study population included all patients with moyamoya disease/syndrome from 2002 to 2012. The demographic, clinical characteristic and imaging details were reviewed. The outcome was obtained prospectively. Results: Of the 36 patients, 26 (72.2%) had MMD and 10 (27.8%) had moyamoya syndrome. The median age at onset of symptoms was 17.5 years (range, 10 months-55 years). Fifteen patients belonged to pediatric group and 21 were adults. All the pediatric patients had ischemic events at onset and 10 (47.6%) of the adults presented with hemorrhage. Twenty (55.6%) patients received conservative treatment and 16 (44.4%) underwent revascularization procedures. The median duration of follow-up was 28 months (range, 3-90 months). Three (18%) of the surgically treated patients had recurrent ischemic events on follow-up, but none of the conservatively treated patients had events. An excellent outcome (Modified Rankin Scale of <= 2) was seen in 12 (75%) surgically treated and 16 (94%) conservatively treated patients (p = 0.17). Conclusion: Compared to East Asians, our patients had a lower stroke recurrence rate and good functional outcome even with conservative treatment. Future studies should focus on clinical and imaging predictors of progression to select moyamoya patients for RS. (C) 2013 Elsevier B.V. All rights reserved.