Indian Journal of Neurosurgery最新文献

{"title":"Exoscopic Minimally Invasive Excision of Intradural Extramedullary Tumor","authors":"Debabrata Sahana, Lavlesh Rathore, Sanjeev Kumar, Rajiv Sahu","doi":"10.1055/s-0044-1782667","DOIUrl":"https://doi.org/10.1055/s-0044-1782667","url":null,"abstract":"Spinal tumors extending up to two levels can be removed using minimally invasive techniques. A microscope is traditionally used as a visualization tool with the tubular-retractor system. An exoscope is a newer optical tool with improved digital resolution, panoramic view, and better ergonomics for surgery. A 36-year-old who presented with paraparesis was diagnosed with intradural extramedullary tumor in the T7-T8 region. A complete tumor resection was possible using tubular retractors and exoscope. The patient recovered clinically. We document our surgical experience and present an edited video of the surgery. The key steps and nuances are described in the audio timeline. The authors acknowledge the feasibility of performing this surgery via a minimally invasive method using an exoscope.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141016766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Patterns for Managing Recurrent Glioblastoma Multiforme","authors":"J. Bajaj, Shweta Kedia, Arvind Sharma, Pankaj Gupta, Mohammad Ansari, Harsh Deora, K. Garg, Chinmaya Dash, V. S. Madhugiri, K. Das, M. Tripathi, Deepak K. Singh, Subodh Raju, A. Jagetia, Vikas Vazhayil, Manmohan Singh, R.S. Mittal, Subhash Gupta, Y. Yadav, A. Ramzan, Alok Umredkar, D. K. Jha, A.K. Mahapatra","doi":"10.1055/s-0043-1776359","DOIUrl":"https://doi.org/10.1055/s-0043-1776359","url":null,"abstract":"\u0000 Introduction Glioblastoma multiforme (GBM) is a devastating form of cancer with a poor prognosis despite available treatments. Managing recurrent GBM remains challenging and lacks guidelines. This study aims to provide practice patterns for managing recurrent GBMs in India.\u0000 Methods A panel of experts was assembled to develop practice patterns using the Delphi technique. Their responses were analyzed anonymously to ensure impartiality and generate recommendations. The statements were intended to be nonbinding and focused on promoting best practices in the field, without legal or regulatory authority.\u0000 Results A total of 23 experts participated in the study, providing their opinions on various aspects of managing recurrent GBM. Consensus was achieved on individualized and multidisciplinary management as the preferred approach. Surgery in combination with other treatments was found to impact survival in patients older than 65 years, with re-surgery and adjuvant radiation and chemotherapy being the preferred options. Gadolinium-enhanced magnetic resonance imaging (MRI) brain with spectroscopy and diffusion-weighted imaging was favored. Molecular profiling was considered significant, with O6-methylguanine DNA methyltransferase methylation being most relevant. Surgery was recommended for recurrent GBMs, primarily based on Karnofsky's performance score (KPS). Surgical adjuncts such as neuronavigation and intraoperative MRI were considered valuable. Radiation therapy, specifically stereotactic radiosurgery, was recommended for selected cases, while opinions on re-chemotherapy were divided. Palliative care was deemed important.\u0000 Conclusion This study presents practice patterns for managing recurrent GBM in India, providing standardized recommendations for practice. By implementing these, clinicians can make informed decisions, leading to improved patient outcomes and reduced variability in the management of recurrent GBM.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140414154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Uncommon Cases of Pediatric Transethmoidal–Transnasal Encephaloceles with a Review of Literature","authors":"Abhijit Acharya, S. Senapati, Souvagya Panigrahi, R. Deo, A. Mahapatra","doi":"10.1055/s-0043-1777348","DOIUrl":"https://doi.org/10.1055/s-0043-1777348","url":null,"abstract":"Encephaloceles are defined as the herniation of brain matter beyond the confines of the skull bone through a defect on the cranium or face. The encephaloceles are classified into different categories as per onset as congenital or traumatic, as per contents as meningocele, meningoencephalocele, and hydromeningoencephalocele, and as per anatomical location into frontoethmoid, basal, occipital, and cranial vault. Transethmoidal encephalocele is a rare type of encephalocele with a very few patients reported in the literature to date. We are presenting two cases of transethmoidal–transnasal encephalocele in the pediatric age group with one being congenital and other traumatic in onset. The first child presented with a mass visible inside the nasal cavity since birth with nasal obstruction. The second child presented with a history of trauma 5 years back followed by occasional cerebrospinal fluid leak, fever, and nasal stuffiness. Both patients underwent craniotomy and excision of the encephalocele with repair of the defect in the cribriform plate. These two uncommon cases highlight the different onsets of the disease successfully managed surgically.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140411805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Thoracolumbosacral Myelomeningocele: A Case Report","authors":"Abhijit Acharya, Souvagya Panigrahi, R. Deo, S. Senapati, A. Mahapatra","doi":"10.1055/s-0044-1780520","DOIUrl":"https://doi.org/10.1055/s-0044-1780520","url":null,"abstract":"Neural tube defects are a broad spectrum of congenital developmental anomalies that include cranial defects and open and closed spinal dysraphism. Myelomeningocele is a common form of spinal dysraphism most commonly seen in the lumbosacral region. Giant myelomeningoceles are rare occurrences. We hereby present the case of a 7-month-old infant with a history of large swelling over the thoracic lumbar region (circumference of 42 cm and diameter of 12.5 cm) that was progressively increasing in size with occasional cerebrospinal fluid (CSF) leakage from the swelling. There was associated progressive increasing size of the head size circumference (51 cm) as well for the past 6 months. There was no movement of both lower limbs since birth without any sensation up to the groin. On evaluation, the infant was found to have gross hydrocephalous. The Evans index was 0.4 with Chiari 2 malformation and a giant thoracolumbosacral myelomeningocele. The patient underwent a low-pressure ventriculoperitoneal (VP) shunt on the right side, followed by the repair of the giant myelomeningocele. The post-op period was uneventful with no CSF leakage or skin necrosis. The infant was discharged on day 5. Giant myelomeningoceles are quite a challenge for neurosurgeons due to the high risk of skin edge necrosis, CSF leaks, meningoencephalitis, etc. Here we managed our case with utmost intraoperative surgical skills and postoperative management due to which our patient was discharged in a satisfactory condition without any complication. This case is supposed to be largest myelomeningocele in the world literature to date.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140436258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphometry of Superior Sagittal Sinus and Its Clinical Significance","authors":"Grace Suganya, Ariharan Krishnaraj, Raveendranath Veeramani, Dinesh Kumar, Nagarajan Krishnan","doi":"10.1055/s-0043-1777276","DOIUrl":"https://doi.org/10.1055/s-0043-1777276","url":null,"abstract":"The position of the superior sagittal sinus (SSS) in the midline along the sagittal suture is still a debate among neurosurgeons. The aim of the study is to evaluate the diameter and deviation of the SSS at various landmarks in the midline. We evaluated 100 computed tomography venography images. The mean diameter of SSS between nasion and bregma was 2.6 ± 0.7 mm and it was 3.7 ± 0.9 at bregma. Between bregma and lambda and at lambda, the mean diameters were 5.1 ± 1.2 and 5.7 ± 1.04, respectively. Deviation of SSS toward the right side was seen in approximately 77% of cases, while left deviation and no deviation were seen in 11 and 12%, respectively, between nasion and bregma. At bregma, 62, 10, and 28% deviation was seen toward the right side, left side, and in midline, respectively. In other three segments between bregma and lambda, at lambda and beyond lambda the right and left deviation of SSS were found in 68, 70, 71% and 11, 9, 11% respectively. While in these three segments there was no deviation in SSS in 21(between bregma and lambda), 21(at lambda) and 18% (beyond lambda). Further, we compared our data between genders and age groups. A statistically significant difference in diameter of SSS between genders was noted at the level of bregma and a significant difference in deviation of SSS between genders was noted in the segment between nasion and bregma. Thus, the findings of this study would serve as the crucial surgical data for the neurosurgeons in placing the burr holes in craniotomies and in the interhemispheric approach for midline tumors.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Bilateral Emergence of the Ophthalmic Arteries from the Cavernous Segment of the ICA in a Patient with Multiple Intracranial Aneurysms","authors":"Francesco Giuseppe Marchetta-Cruz, Daniel Juárez-Rebollar, Mª del Rosario Sosa-Martínez, G. G. Broc-Haro","doi":"10.1055/s-0043-1778131","DOIUrl":"https://doi.org/10.1055/s-0043-1778131","url":null,"abstract":"","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139606295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Presentations of Sellar and Suprasellar Space Occupying Lesion: Our Institutional Experience","authors":"Ramalingam Giridharan, Nirmal Kumar, J. Srisaravanan","doi":"10.1055/s-0043-1778130","DOIUrl":"https://doi.org/10.1055/s-0043-1778130","url":null,"abstract":"A pituitary abscess (PA) is a rare intracranial lesion. It is a critical disorder caused by an infectious process where purulent material accumulates inside the sella turcica. It occurs either as a primary disease or because of an infection and is associated with poor prognosis. In this article, we share our experience with PA. At our institution, we operated on five cases of pituitary abscess since 2016. All the cases presented with bitemporal hemianopia and headache. None of them had fever. Pituitary hormones were normal except in two patients with a previous history of hypothyroidism. Magnetic resonance imaging (MRI) of the brain showed pituitary macroadenoma. They underwent the endoscopic transnasal transsphenoidal approach. Postoperatively their vision has improved. Endocrine functions were normal in all the patients following surgery. Culture sensitivity was sterile in all the patients. Diagnosis of pituitary abscess is highly difficult before surgery. Hence, the diagnosis should be considered when a patient presents with fever, headache, and signs of pituitary dysfunction and meningeal inflammation. Surgical and medical management leads to a lower mortality rate and a higher probability of hormone function recovery.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139606693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranial Migration of a VP Shunt—A Routine Procedure with a Rare Complication!","authors":"Aman Singh, Awadhesh Yadav, Pritesh Yadav, B. Ojha","doi":"10.1055/s-0043-1777279","DOIUrl":"https://doi.org/10.1055/s-0043-1777279","url":null,"abstract":"Abstract Ventriculoperitoneal shunt is one of the commonest neurosurgical procedures associated with a high-rate complication. Moreover, the variety of complications are nonetheless astonishing. Shunt malfunction is considered the most common complication of this procedure, but a cranial migration of shunt leading to malfunction is extremely rare. We present a case of a 6-month-old male child who was initially managed with a right-sided medium-pressure ventriculoperitoneal shunt for aqueductal stenosis with hydrocephalus at the age of 3 months and presented to us with features of shunt malfunction owing to a cranial migration of the shunt assembly. Cranial migration of a ventriculoperitoneal shunt is an extremely rare complication. Its possible mechanism includes a large subgaleal space for the chamber, larger size burr hole, inadequate anchorage of the shunt assembly, and excessive neck movements of the child in the postoperative procedure.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139157074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ruptured Cerebral Aneurysms and Dissecting Aneurysms in Patients with COVID-19: A Case Series and Literature Review","authors":"Daisuke Wajima, Rin Shimozato, Tomonori Takeshita, T. Nagamine","doi":"10.1055/s-0043-1777055","DOIUrl":"https://doi.org/10.1055/s-0043-1777055","url":null,"abstract":"Abstract Background  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a hypercoagulable state and ischemic stroke. However, aneurysmal subarachnoid hemorrhage (SAH) due to SARS-CoV-2 infection is uncommon. Here, we report a case series of SAH caused by ruptured cerebral aneurysms or dissecting aneurysms (DAs) in patients with coronavirus disease 2019 (COVID-19) and discuss the potential relationships between them. Case Description  Four of the six patients had a history of COVID-19, ranging from 2 to 9 days, one had COVID-19 pneumonia for 1 month, and one had SARS-CoV-2 positivity on admission. Plain head computed tomography revealed diffuse SAH in all cases, while angiography revealed a DA in the right posterior cerebral artery (P2 portion) in patient 1, DA in the right vertebral artery (VA) in patients 2 and 6, anterior communicating artery aneurysm in patient 3, blister aneurysm in the right internal cerebral artery (ICA) (C2 portion) in patient 4, and DAs in the right VA and extracranial portion of the right ICA in patient 5. Treatment comprised internal trapping for patients 1, 2, and 6; neck clipping for patient 3; stent-assisted coiling for patient 4; and internal trapping and flow diversion for patient 5. All the patients' postoperative courses were uneventful. Conclusion  The present cases alone do not provide clear evidence on whether SARS-CoV-2 infection causes ruptured cerebral aneurysms or DAs. Therefore, accumulation of more cases and further studies are needed to clarify the relationship between SARS-CoV-2 infection and these aneurysm conditions.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138948084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Intraventricular Migration of Ventriculoperitoneal Shunt: Once in a Blue Moon Phenomenon of Shunt Surgery","authors":"Vikrant Yadav, Ravi Shankar Prasad","doi":"10.1055/s-0043-1777278","DOIUrl":"https://doi.org/10.1055/s-0043-1777278","url":null,"abstract":"Abstract Shunt surgery is a very common neurosurgical procedure for hydrocephalus. It is associated with numerous complications, and intraventricular shunt migration is one of rarest. Various mechanisms have been described to explain this rare entity. Hereby we present an index case of this rare complication of shunt surgery in which patient presented with tuberculous meningitis with hydrocephalus having intraventricular shunt migration and will discuss possible mechanisms responsible for it. A 1-year old male infant, previously diagnosed case of tuberculous meningitis with hydrocephalus with right-sided ventriculoperitoneal shunt in situ, presented to the emergency department with bulging fontanelles secondary to shunt malfunction. Left-sided ventriculoperitoneal shunt was inserted. After few months, patient turned up again with left-sided shunt malfunction and right-sided intraventricular migrated shunt. Endoscopy-assisted removal of intraventricular migrated shunt and simultaneous third ventriculostomy was done. Patient improved in postoperative period. Being an extremely uncommon complication, intraventricular migration of shunt described as “once in a blue moon” phenomenon. It can be avoided by proper surgical technique with adequate-sized burr hole. Removal of shunt is preferred for prevention of infection.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138949550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}