Maruti Nandan, A. Patnaik, R. Sahu, Yashveer Singh, V. Maurya, K. Das, S. Behari
Abstract The rosette-forming glioneuronal tumor (RGNT) is an uncommon entity and carries a special character because of its mixed glial and neuronal composition in the histomorphological appearance. These lesions have a benign character and carry a good outcome if undergoes gross total resection. Over the past 15 years, there have been a significant change in their nomenclature depending upon the location to histological composition. Herein, we report an interesting case of a 26-year-old lady who was diagnosed to have the lesion at the septum pellucidum with significant symptoms in the form of headache and seizure episodes. A gross total resection was achieved and she made an uneventful recovery. We discuss the literature on the incidence, location, and histological characteristics of the RGNT in various age groups.
{"title":"Rosette-Forming Glioneuronal Tumor at Septum Pellucidum: Insights Gained from a Common Tumor at Rare Location","authors":"Maruti Nandan, A. Patnaik, R. Sahu, Yashveer Singh, V. Maurya, K. Das, S. Behari","doi":"10.1055/s-0042-1743397","DOIUrl":"https://doi.org/10.1055/s-0042-1743397","url":null,"abstract":"Abstract The rosette-forming glioneuronal tumor (RGNT) is an uncommon entity and carries a special character because of its mixed glial and neuronal composition in the histomorphological appearance. These lesions have a benign character and carry a good outcome if undergoes gross total resection. Over the past 15 years, there have been a significant change in their nomenclature depending upon the location to histological composition. Herein, we report an interesting case of a 26-year-old lady who was diagnosed to have the lesion at the septum pellucidum with significant symptoms in the form of headache and seizure episodes. A gross total resection was achieved and she made an uneventful recovery. We discuss the literature on the incidence, location, and histological characteristics of the RGNT in various age groups.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"32 1","pages":"180 - 183"},"PeriodicalIF":0.2,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78244735","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}
M. Ora, N. Soni, A. Nazar, A. Mehrotra, P. Mishra, S. Gambhir
Abstract Background and Purpose [18F]Fluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has a promising role in the workup and management of carcinoma of unknown primary (CUP). We have evaluated the effect of whole-body FDG PET/CT in assessing the patients presented with suspected brain metastasis (CUP-BM) on brain magnetic resonance imaging (MRI) or computed tomography (CT). Materials and Methods This retrospective study included FDG PET/CT of 50 patients (24 males, mean: 58 ± 12.2 years old) with a CUP-BM diagnosis based on MRI and CT imaging. The final diagnosis of primary brain neoplasm (BP) or brain metastases (BM) was based on FDG PET/CT findings and/or histopathology (HPE). Results On FDG PET/CT, 52% (26/50) of patients did not have any systemic lesion apart from a brain lesion. Out of these, 50% (13/26) had HPE confirmation of primary brain neoplasm (BP). FDG PET/CT identified multiple systemic lesions apart from brain lesions in the remaining 48% (24/50) of patients. They were categorized as the brain metastases (BM) group. The primary lesions were located in the lungs ( n = 20), kidneys ( n = 1), prostate ( n = 1), esophagus ( n = 1), and tongue ( n = 1). Conclusion FDG PET/CT could suggest a diagnosis of BM based on the presence of systemic lesions. It also provides an easily accessible peripheral site for biopsy and systemic disease burden in a single scan. FDG PET/CT's up-front use in suspected CUP-BM on CT and/or MRI could differentiate the BM from BP in most cases and avoid brain biopsy in the BM group.
{"title":"Effect of Whole-body [18F]Fluoro-2-deoxy-2-d-glucose Positron Emission Tomography in Patients with Suspected Brain Metastasis","authors":"M. Ora, N. Soni, A. Nazar, A. Mehrotra, P. Mishra, S. Gambhir","doi":"10.1055/s-0042-1743398","DOIUrl":"https://doi.org/10.1055/s-0042-1743398","url":null,"abstract":"Abstract Background and Purpose [18F]Fluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has a promising role in the workup and management of carcinoma of unknown primary (CUP). We have evaluated the effect of whole-body FDG PET/CT in assessing the patients presented with suspected brain metastasis (CUP-BM) on brain magnetic resonance imaging (MRI) or computed tomography (CT). Materials and Methods This retrospective study included FDG PET/CT of 50 patients (24 males, mean: 58 ± 12.2 years old) with a CUP-BM diagnosis based on MRI and CT imaging. The final diagnosis of primary brain neoplasm (BP) or brain metastases (BM) was based on FDG PET/CT findings and/or histopathology (HPE). Results On FDG PET/CT, 52% (26/50) of patients did not have any systemic lesion apart from a brain lesion. Out of these, 50% (13/26) had HPE confirmation of primary brain neoplasm (BP). FDG PET/CT identified multiple systemic lesions apart from brain lesions in the remaining 48% (24/50) of patients. They were categorized as the brain metastases (BM) group. The primary lesions were located in the lungs ( n = 20), kidneys ( n = 1), prostate ( n = 1), esophagus ( n = 1), and tongue ( n = 1). Conclusion FDG PET/CT could suggest a diagnosis of BM based on the presence of systemic lesions. It also provides an easily accessible peripheral site for biopsy and systemic disease burden in a single scan. FDG PET/CT's up-front use in suspected CUP-BM on CT and/or MRI could differentiate the BM from BP in most cases and avoid brain biopsy in the BM group.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"21 1","pages":"147 - 154"},"PeriodicalIF":0.2,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85297801","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}
E. Gandham, B. Patel, V. Mathew, Krishnaprabhu Raju
Background and Purpose Intracranial space-occupying lesions are a sine qua non for neoplastic lesions; however, occasionally non-neoplastic lesions mimic neoplastic lesions, leading to diagnostic dilemmas. We report our experience with three patients who presented with a progressive hemispheric syndrome and the diagnostic considerations involved in the cases. Materials and Methods In this retrospective study, we included three patients with primary angiitis of central nervous system (PACNS) who underwent craniotomy and biopsy, suspecting it to be mass lesions. Demographic features, clinical features, radiological features, histopathology, treatment, and clinical outcomes were studied. Results Majority were males. The male:female ratio was 2:1. Lobar involvement was common. MR brain with contrast showed features of high-grade glioma. Despite hemispheric involvement, there was no mass effect. Perilesional edema was seen in all cases. All underwent craniotomy and biopsy; histopathology was consistent with PACNS. All patients were treated with corticosteroids and cyclophosphamide. Rituximab was used in addition to cyclophosphamide in one patient. At 2 years follow-up, two patients were in disease remission and one patient died due to disease progression. Conclusion PACNS has a protean clinical manifestation. A high index of suspicion is required in cases with atypical clinical presentations, radiological features, and normal angiograms. Early histological diagnosis and aggressive immunotherapy with high-dose corticosteroids combined with intravenous cyclophosphamide yields favorable outcomes.
{"title":"Primary Central Nervous System Angiitis Mimicking a Space-Occupying Lesion","authors":"E. Gandham, B. Patel, V. Mathew, Krishnaprabhu Raju","doi":"10.1055/s-0042-1743263","DOIUrl":"https://doi.org/10.1055/s-0042-1743263","url":null,"abstract":"\u0000 Background and Purpose Intracranial space-occupying lesions are a sine qua non for neoplastic lesions; however, occasionally non-neoplastic lesions mimic neoplastic lesions, leading to diagnostic dilemmas. We report our experience with three patients who presented with a progressive hemispheric syndrome and the diagnostic considerations involved in the cases.\u0000 Materials and Methods In this retrospective study, we included three patients with primary angiitis of central nervous system (PACNS) who underwent craniotomy and biopsy, suspecting it to be mass lesions. Demographic features, clinical features, radiological features, histopathology, treatment, and clinical outcomes were studied.\u0000 Results Majority were males. The male:female ratio was 2:1. Lobar involvement was common. MR brain with contrast showed features of high-grade glioma. Despite hemispheric involvement, there was no mass effect. Perilesional edema was seen in all cases. All underwent craniotomy and biopsy; histopathology was consistent with PACNS. All patients were treated with corticosteroids and cyclophosphamide. Rituximab was used in addition to cyclophosphamide in one patient. At 2 years follow-up, two patients were in disease remission and one patient died due to disease progression.\u0000 Conclusion PACNS has a protean clinical manifestation. A high index of suspicion is required in cases with atypical clinical presentations, radiological features, and normal angiograms. Early histological diagnosis and aggressive immunotherapy with high-dose corticosteroids combined with intravenous cyclophosphamide yields favorable outcomes.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"561 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72541037","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}
K. Multani, A. Balasubramaniam, B. Rajesh, K. Kumar, Nitin Manohar, Anjani D Kumar
Abstract Introduction Pituitary adenomas (PAs) although benign, are difficult to resect intracranial tumors and their residues are associated with morbidity and reduced quality of life. Thus, gross total resection (GTR) is the goal for all PAs. Role of various modalities for better intraoperative visualization and thus improve resection of adenoma have been tested and each have their pros and cons. The aim of this paper is to analyze adjunctive benefit of high-field 3 Tesla intraoperative magnetic resonance imaging (iMRI) in PAs resection by endoscopic transnasal transsphenoidal surgery (eTSS). Materials and Methods A total of 50 patients who underwent iMRI-guided eTSS were included. MRI findings in preoperative, intraoperative, and 3 months postoperative stage were compared. Adjunctive value of iMRI in improving resection rates of adenoma, postoperative endocrinological outcomes, need for adjuvant radiotherapy, and postoperative cerebrospinal fluid leak rates was assessed. Results High-field 3 Tesla iMRI helped us to detect residues in 24 (48%) patients and iMRI-guided second look surgery increased our GTR rates from initial 52 to 80% and also helped us to identify and achieve 100% GTR in intrasellar residues and parasellar residues that were medial to medial carotid tangential line. With better resection rates, need for adjuvant radiotherapy was also reduced and only 2% received adjuvant radiotherapy. Average increase in surgical time with the use of iMRI was 38.78 minutes without any side effects pertaining to prolonged surgery. Conclusion High-field iMRI is a useful adjunct in assessment and improvement in extent of resection of PA by endoscopic transsphenoidal surgery. Also, it was found beneficial in preserving normal anatomical gland and, thus, reducing the need for postoperative adjuvant hormonal and radiation therapy.
{"title":"Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma","authors":"K. Multani, A. Balasubramaniam, B. Rajesh, K. Kumar, Nitin Manohar, Anjani D Kumar","doi":"10.1055/s-0042-1743267","DOIUrl":"https://doi.org/10.1055/s-0042-1743267","url":null,"abstract":"Abstract Introduction Pituitary adenomas (PAs) although benign, are difficult to resect intracranial tumors and their residues are associated with morbidity and reduced quality of life. Thus, gross total resection (GTR) is the goal for all PAs. Role of various modalities for better intraoperative visualization and thus improve resection of adenoma have been tested and each have their pros and cons. The aim of this paper is to analyze adjunctive benefit of high-field 3 Tesla intraoperative magnetic resonance imaging (iMRI) in PAs resection by endoscopic transnasal transsphenoidal surgery (eTSS). Materials and Methods A total of 50 patients who underwent iMRI-guided eTSS were included. MRI findings in preoperative, intraoperative, and 3 months postoperative stage were compared. Adjunctive value of iMRI in improving resection rates of adenoma, postoperative endocrinological outcomes, need for adjuvant radiotherapy, and postoperative cerebrospinal fluid leak rates was assessed. Results High-field 3 Tesla iMRI helped us to detect residues in 24 (48%) patients and iMRI-guided second look surgery increased our GTR rates from initial 52 to 80% and also helped us to identify and achieve 100% GTR in intrasellar residues and parasellar residues that were medial to medial carotid tangential line. With better resection rates, need for adjuvant radiotherapy was also reduced and only 2% received adjuvant radiotherapy. Average increase in surgical time with the use of iMRI was 38.78 minutes without any side effects pertaining to prolonged surgery. Conclusion High-field iMRI is a useful adjunct in assessment and improvement in extent of resection of PA by endoscopic transsphenoidal surgery. Also, it was found beneficial in preserving normal anatomical gland and, thus, reducing the need for postoperative adjuvant hormonal and radiation therapy.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"90 1","pages":"051 - 058"},"PeriodicalIF":0.2,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74206263","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}
M. Darwish, Walid Nanous, Khalaf Hamead, M. Ismail
Abstract Background Intraoperative cerebrospinal fluid (CSF) leak is not uncommon with endoscopic transsphenoidal surgical excision of pituitary macroadenomas. How to seal the defect and prevent postoperative leak is still a matter of debate. Objectives In patients with CSF leak, we tried to figure out which is more important in preventing postoperative leak, is it the sellar fat packing, is it tight repair of the sellar floor, or do we need to combine them both? Patients and Methods Over 5 years, in patients with evident intraoperative CSF leak, with growing experience supported by positive postoperative results, we shifted gradually from intrasellar packing using combined fat graft and bioabsorbable materials (SURGICEL FIBRILLAR/Gelfoam) (group A, n =15) to only bioabsorbable materials (group B, n = 18), either of which is followed by tight repair of the sellar floor. Results Postoperative clinical assessment did not differ significantly between both groups at early, midterm, and long-term follow-up intervals. We did not have any patients with delayed postoperative CSF leak or symptomatic empty sella syndrome (ESS). Conclusion There is no difference in the incidence of postoperative CSF leak and clinical ESS among both groups, indicating that tight sellar floor repair is more important than packing the sellar cavity with or without fat graft.
{"title":"Sellar Floor Reconstruction with and without Intrasellar Fat Packing after Endoscopic Resection of Large Pituitary Macroadenomas with Evident Intraoperative CSF Leak","authors":"M. Darwish, Walid Nanous, Khalaf Hamead, M. Ismail","doi":"10.1055/s-0042-1742475","DOIUrl":"https://doi.org/10.1055/s-0042-1742475","url":null,"abstract":"Abstract Background Intraoperative cerebrospinal fluid (CSF) leak is not uncommon with endoscopic transsphenoidal surgical excision of pituitary macroadenomas. How to seal the defect and prevent postoperative leak is still a matter of debate. Objectives In patients with CSF leak, we tried to figure out which is more important in preventing postoperative leak, is it the sellar fat packing, is it tight repair of the sellar floor, or do we need to combine them both? Patients and Methods Over 5 years, in patients with evident intraoperative CSF leak, with growing experience supported by positive postoperative results, we shifted gradually from intrasellar packing using combined fat graft and bioabsorbable materials (SURGICEL FIBRILLAR/Gelfoam) (group A, n =15) to only bioabsorbable materials (group B, n = 18), either of which is followed by tight repair of the sellar floor. Results Postoperative clinical assessment did not differ significantly between both groups at early, midterm, and long-term follow-up intervals. We did not have any patients with delayed postoperative CSF leak or symptomatic empty sella syndrome (ESS). Conclusion There is no difference in the incidence of postoperative CSF leak and clinical ESS among both groups, indicating that tight sellar floor repair is more important than packing the sellar cavity with or without fat graft.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"13 1","pages":"047 - 050"},"PeriodicalIF":0.2,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85169091","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}
Abstract Astroblastoma is an uncommon neuroepithelial primary brain neoplasm with speculative histopathological origin and unpredictable clinical behavior. They can be easily misdiagnosed, as they are rarely encountered in clinical practice and share common radiological and histopathologic appearances with other glial neoplasms. Herein, we report a case of high-grade astroblastoma in a 27-year-old female with complaints of seizures and loss of consciousness, which was misdiagnosed as atypical meningioma on neuroimaging, due to its rarity and superficial cortical location appearing as extra-axial mass. Although intraoperative findings were also of an extra-axial tumor, the histology and immunophenotype was of an astroblastoma; thus, highlighting the role of histopathology and immunohistochemistry.
{"title":"High-Grade Astroblastoma in a Young Female: An Enigma with a Rare Cautionary Tale","authors":"Mukta Meel, A. Gandhi, A. Jindal, Mukesh Kumar","doi":"10.1055/s-0042-1742476","DOIUrl":"https://doi.org/10.1055/s-0042-1742476","url":null,"abstract":"Abstract Astroblastoma is an uncommon neuroepithelial primary brain neoplasm with speculative histopathological origin and unpredictable clinical behavior. They can be easily misdiagnosed, as they are rarely encountered in clinical practice and share common radiological and histopathologic appearances with other glial neoplasms. Herein, we report a case of high-grade astroblastoma in a 27-year-old female with complaints of seizures and loss of consciousness, which was misdiagnosed as atypical meningioma on neuroimaging, due to its rarity and superficial cortical location appearing as extra-axial mass. Although intraoperative findings were also of an extra-axial tumor, the histology and immunophenotype was of an astroblastoma; thus, highlighting the role of histopathology and immunohistochemistry.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"103 1","pages":"086 - 089"},"PeriodicalIF":0.2,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73871664","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}
Abstract Background The supplementary motor area (SMA) is involved in planning of voluntary motor activities. Tumors in SMA usually present with seizures and, rarely, motor deficits. Postoperatively, these patients may develop SMA syndrome. Patients with SMA tumors usually undergo awake craniotomy along with neuromonitoring for maximal safe resection, and some of these patients tend to have residual tumor. Objective To completely excise the SMA region tumors under general anesthesia without causing any permanent neurological deficits. Methods We operated upon four patients with SMA region tumor under general anesthesia (GA) with direct electrocortical stimulation (DES). Motor-evoked potential was used to monitor corticospinal tracts through corkscrew or strip electrodes. Intraoperative MRI was done to assess the tumor excision. Results All four patients had complete resection of tumor and, postoperatively, all four developed SMA syndrome. All of them recovered completely over a period of time. Conclusion SMA tumors can be excised completely under GA with DES, thereby increasing progression-free survival.
{"title":"Role of Asleep Surgery for Supplementary Motor Area Tumors","authors":"Krishna Kumar G, Chandrasekhar Chigurupalli, A. Balasubramaniam, BJ Rajesh, Nitin Manohar","doi":"10.1055/s-0042-1743266","DOIUrl":"https://doi.org/10.1055/s-0042-1743266","url":null,"abstract":"Abstract Background The supplementary motor area (SMA) is involved in planning of voluntary motor activities. Tumors in SMA usually present with seizures and, rarely, motor deficits. Postoperatively, these patients may develop SMA syndrome. Patients with SMA tumors usually undergo awake craniotomy along with neuromonitoring for maximal safe resection, and some of these patients tend to have residual tumor. Objective To completely excise the SMA region tumors under general anesthesia without causing any permanent neurological deficits. Methods We operated upon four patients with SMA region tumor under general anesthesia (GA) with direct electrocortical stimulation (DES). Motor-evoked potential was used to monitor corticospinal tracts through corkscrew or strip electrodes. Intraoperative MRI was done to assess the tumor excision. Results All four patients had complete resection of tumor and, postoperatively, all four developed SMA syndrome. All of them recovered completely over a period of time. Conclusion SMA tumors can be excised completely under GA with DES, thereby increasing progression-free survival.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"35 1","pages":"132 - 136"},"PeriodicalIF":0.2,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72798147","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}
Background Surgical clipping has been a gold standard procedure for management of intracranial aneurysms. Outcome studies of surgical clipping at institutional level are important to identify modifiable factors and further improve the results. These are even more important in areas where resources are limited, and patient presents late due to ignorance and lack of education. This study is a review of our institutional experience in microsurgical clipping of ruptured intracranial aneurysms. Methods A retrospective study of patients who underwent surgical clipping for ruptured intracranial aneurysms from January 2014 to February 2020. The medical records of patients were reviewed for demographic data, clinical presentation, radiological investigations, surgery performed and neurological outcome. Outcome at discharge and outcome at follow-up were measured by modified Rankin scale (mRS). Results In this study of 289 patients, 194 patients (67.13%) had good outcome at discharge (mRS0–2), while 95 patients (32.87%) had poor outcome at discharge (mRS 3–6) and 50 patients (17.30%) expired during hospital stay. Out of 289 patients, 208 patients (71.97%) were admitted after more than 3 days of ictus. Significant factors affecting outcome were neurological status determined by Glasgow coma scale (GCS) score, World Federation of Neurosurgical Societies (WFNS) grade or Hunt and Hess Grade, time interval from onset of subarachnoid hemorrhage to admission, and time interval from admission to surgery. Conclusion The present study identifies factors for improving outcome in patients of ruptured aneurysm at institutional and community level. Time from ictus to admission and admission to surgery are important modifiable factors in our study.
背景手术夹闭一直是治疗颅内动脉瘤的金标准方法。在机构层面对手术夹持的结果进行研究对于确定可改变的因素和进一步改善结果是重要的。在资源有限、患者因无知和缺乏教育而迟到的地区，这一点尤为重要。本研究回顾了我院显微外科手术治疗颅内动脉瘤破裂的经验。方法回顾性分析2014年1月至2020年2月行颅内动脉瘤破裂手术夹持的患者。对患者的医疗记录进行了人口统计数据、临床表现、放射学调查、手术和神经学结果的审查。采用改良Rankin量表(mRS)测量出院时和随访时的预后。结果289例患者出院时预后良好(mr50 - 2) 194例(67.13%)，出院时预后不良(mr3 - 6) 95例(32.87%)，住院期间死亡50例(17.30%)。289例患者中，208例(71.97%)患者入院时间超过3天。影响预后的重要因素是由格拉斯哥昏迷量表(GCS)评分、世界神经外科学会联合会(WFNS)分级或Hunt and Hess分级、从蛛网膜下腔出血开始到入院的时间间隔以及从入院到手术的时间间隔确定的神经状态。结论本研究在机构和社区层面确定了改善动脉瘤破裂患者预后的因素。在我们的研究中，从发作到入院和入院手术的时间是重要的可改变因素。
{"title":"Surgical Clipping of Ruptured Intracranial Aneurysm: Experience of a Tertiary Centre in Western India","authors":"Vijay Kumar, M. Agrawal, Vinod Sharma, D. Purohit","doi":"10.1055/s-0042-1743400","DOIUrl":"https://doi.org/10.1055/s-0042-1743400","url":null,"abstract":"\u0000 Background Surgical clipping has been a gold standard procedure for management of intracranial aneurysms. Outcome studies of surgical clipping at institutional level are important to identify modifiable factors and further improve the results. These are even more important in areas where resources are limited, and patient presents late due to ignorance and lack of education. This study is a review of our institutional experience in microsurgical clipping of ruptured intracranial aneurysms.\u0000 Methods A retrospective study of patients who underwent surgical clipping for ruptured intracranial aneurysms from January 2014 to February 2020. The medical records of patients were reviewed for demographic data, clinical presentation, radiological investigations, surgery performed and neurological outcome. Outcome at discharge and outcome at follow-up were measured by modified Rankin scale (mRS).\u0000 Results In this study of 289 patients, 194 patients (67.13%) had good outcome at discharge (mRS0–2), while 95 patients (32.87%) had poor outcome at discharge (mRS 3–6) and 50 patients (17.30%) expired during hospital stay. Out of 289 patients, 208 patients (71.97%) were admitted after more than 3 days of ictus. Significant factors affecting outcome were neurological status determined by Glasgow coma scale (GCS) score, World Federation of Neurosurgical Societies (WFNS) grade or Hunt and Hess Grade, time interval from onset of subarachnoid hemorrhage to admission, and time interval from admission to surgery.\u0000 Conclusion The present study identifies factors for improving outcome in patients of ruptured aneurysm at institutional and community level. Time from ictus to admission and admission to surgery are important modifiable factors in our study.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"111 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90079965","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}
M. Fayaz, K. Kareem, A. Wani, A. Ramzan, N. Malik, Sabia Rashid
Background Digital subtraction angiography (DSA) is a fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a “pre-contrast image” or mask from subsequent images, once the contrast medium has been introduced into a structure, hence the term “Digital subtraction angiography.” Indocyanine green video angiography (ICG-VA) is a safe and practical method of real-time delineation of microvasculature used in the surgical management of intracranial aneurysms, arteriovenous malformations, and other vascular lesions. Intraoperative ICG-VA is used as an adjunct in addition to intraoperative or postoperative DSA, and in other cases, it is used as the sole method to confirm the complete obliteration of clipped intracranial aneurysm. The only limitation of ICG-VA is the nonvisibility of vessels that are not in the operative field. Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA. Methods ICG angiography was done during the surgery and the findings of intraoperative ICG angiography were compared with postoperative DSA that was done between 6 and 12 weeks. DSA was done to see any compromise of lumen of parent vessel by clip, any residual aneurysm. Results In our study, intraoperative ICG complete aneurysm obliteration was present in all 30 (100%) patients, while in postoperative DSA complete aneurysm obliteration was diagnosed in 27 (90.0%) patients. Parent vessel patency was present in all 30 (100.0%) patients in both intraoperative ICG-VA and postoperative DSA. In intraoperative ICG distal branch patency was present in 26 (86.7%) patients, while in postoperative DSA distal branch patency was diagnosed in 27 (90.0%) patients. Conclusion We compared the intraoperative ICG finding and postoperative DSA finding and found that DSA is more sensitive than ICG in depicting residual aneurysm neck, hence reducing the risk of rupture of the aneurysm in future. Intraoperative ICG has high special resolution reflex feedback, intraoperative repositioning time is less and thus critical ischemia time is reduced. In a developing country like ours where DSA facilities are limited, ICG can be optimal investigation to delineate the vascular anatomy and confirmation of clip position thus reducing mortality.
{"title":"Comparison between Digital Subtraction Angiography and Indocyanine Green Video Angiography in the Operative Management of Aneurysmal Subarachnoid Hemorrhage","authors":"M. Fayaz, K. Kareem, A. Wani, A. Ramzan, N. Malik, Sabia Rashid","doi":"10.1055/s-0041-1735378","DOIUrl":"https://doi.org/10.1055/s-0041-1735378","url":null,"abstract":"\u0000 Background Digital subtraction angiography (DSA) is a fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a “pre-contrast image” or mask from subsequent images, once the contrast medium has been introduced into a structure, hence the term “Digital subtraction angiography.” Indocyanine green video angiography (ICG-VA) is a safe and practical method of real-time delineation of microvasculature used in the surgical management of intracranial aneurysms, arteriovenous malformations, and other vascular lesions. Intraoperative ICG-VA is used as an adjunct in addition to intraoperative or postoperative DSA, and in other cases, it is used as the sole method to confirm the complete obliteration of clipped intracranial aneurysm. The only limitation of ICG-VA is the nonvisibility of vessels that are not in the operative field. Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA.\u0000 Methods ICG angiography was done during the surgery and the findings of intraoperative ICG angiography were compared with postoperative DSA that was done between 6 and 12 weeks. DSA was done to see any compromise of lumen of parent vessel by clip, any residual aneurysm.\u0000 Results In our study, intraoperative ICG complete aneurysm obliteration was present in all 30 (100%) patients, while in postoperative DSA complete aneurysm obliteration was diagnosed in 27 (90.0%) patients. Parent vessel patency was present in all 30 (100.0%) patients in both intraoperative ICG-VA and postoperative DSA. In intraoperative ICG distal branch patency was present in 26 (86.7%) patients, while in postoperative DSA distal branch patency was diagnosed in 27 (90.0%) patients.\u0000 Conclusion We compared the intraoperative ICG finding and postoperative DSA finding and found that DSA is more sensitive than ICG in depicting residual aneurysm neck, hence reducing the risk of rupture of the aneurysm in future. Intraoperative ICG has high special resolution reflex feedback, intraoperative repositioning time is less and thus critical ischemia time is reduced. In a developing country like ours where DSA facilities are limited, ICG can be optimal investigation to delineate the vascular anatomy and confirmation of clip position thus reducing mortality.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"53 22","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72367986","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}
J. Baek, M. Kim, S. Pyo, Youn-Jung Heo, S. Kim, Cheol Ahn, Jeong-Gu Kim
Abstract Objective The incidence of aneurysms coexisting with arteriovenous malformations (AVMs) ranges between 2.7% and 16.7%. The anatomical relationship between AVM and aneurysm is critical in deciding the best management. Methods Between October 1994 and August 2017, gamma knife surgery (GKS) was performed in six patients with AVMs and associated aneurysms. The patients consisted of four men and two women with a mean age of 37.8 years (range, 18−57 years). The mean follow-up was 34.2 months (range, 13−84 months). The mean maximal dose was 35.9 Gy and the mean margin dose to AVM was 18 Gy. Coil embolization was performed in one of the aneurysms prior to GKS. In our study, GKS was performed in six AVM-associated aneurysms. Of the six aneurysms, four were intranidal and two were pedicular. The mean volume of AVMs was 3.6 cm 3 (range, 1.6−6.5 cm 3 ). Results The locations of aneurysms are as follows: four on posterior cerebral artery (PCA), one on posterior inferior cerebellar artery (PICA), and one on middle cerebral artery (MCA). Sublocation sites were MCA M3 above, PCA P3 above, and PICA distal. There were no GKS-related complications. Complete obliteration of AVM and aneurysm was documented in all four patients with intranidal aneurysm-associated AVMs. Both the aneurysm and AVM were completely obliterated in the two patients with proximal pedicular aneurysms. Conclusion GKS is a possible treatment for AVM with associated intranidal or pedicular aneurysms located above P3 or M3, etc., in which there is less turbulent flow and jet flow.
摘要目的动脉瘤并发动静脉畸形(AVMs)的发生率为2.7% ~ 16.7%。动静脉畸形与动脉瘤之间的解剖关系是决定最佳治疗的关键。方法1994年10月至2017年8月，对6例AVMs及相关动脉瘤患者进行伽玛刀手术治疗。患者包括4男2女，平均年龄37.8岁(范围18 ~ 57岁)。平均随访时间为34.2个月(13 ~ 84个月)。平均最大剂量为35.9 Gy，平均边缘剂量为18 Gy。在GKS之前对其中一个动脉瘤进行了线圈栓塞。在我们的研究中，对6例avm相关动脉瘤进行了GKS。6个动脉瘤中，4个在膜内，2个在椎弓根。avm的平均体积为3.6 cm 3(范围1.6 ~ 6.5 cm 3)。结果4例动脉瘤位于大脑后动脉(PCA)， 1例位于小脑后下动脉(PICA)， 1例位于大脑中动脉(MCA)。亚位部位为MCA M3以上，PCA P3以上，PICA远端。无gks相关并发症。在所有4例与膜内动脉瘤相关的动静脉畸形患者中，均记录了动静脉畸形和动脉瘤的完全闭塞。两例近端椎弓根动脉瘤患者的动脉瘤和动静脉均被完全切除。结论GKS是治疗AVM合并膜内动脉瘤或椎弓根动脉瘤位于P3或M3以上的一种可能的治疗方法，这些动脉瘤的湍流和射流较少。
{"title":"Case Series for Gamma Knife Surgery for Arteriovenous Malformation Associated Intracranial Aneurysms","authors":"J. Baek, M. Kim, S. Pyo, Youn-Jung Heo, S. Kim, Cheol Ahn, Jeong-Gu Kim","doi":"10.1055/s-0040-1718239","DOIUrl":"https://doi.org/10.1055/s-0040-1718239","url":null,"abstract":"Abstract Objective The incidence of aneurysms coexisting with arteriovenous malformations (AVMs) ranges between 2.7% and 16.7%. The anatomical relationship between AVM and aneurysm is critical in deciding the best management. Methods Between October 1994 and August 2017, gamma knife surgery (GKS) was performed in six patients with AVMs and associated aneurysms. The patients consisted of four men and two women with a mean age of 37.8 years (range, 18−57 years). The mean follow-up was 34.2 months (range, 13−84 months). The mean maximal dose was 35.9 Gy and the mean margin dose to AVM was 18 Gy. Coil embolization was performed in one of the aneurysms prior to GKS. In our study, GKS was performed in six AVM-associated aneurysms. Of the six aneurysms, four were intranidal and two were pedicular. The mean volume of AVMs was 3.6 cm 3 (range, 1.6−6.5 cm 3 ). Results The locations of aneurysms are as follows: four on posterior cerebral artery (PCA), one on posterior inferior cerebellar artery (PICA), and one on middle cerebral artery (MCA). Sublocation sites were MCA M3 above, PCA P3 above, and PICA distal. There were no GKS-related complications. Complete obliteration of AVM and aneurysm was documented in all four patients with intranidal aneurysm-associated AVMs. Both the aneurysm and AVM were completely obliterated in the two patients with proximal pedicular aneurysms. Conclusion GKS is a possible treatment for AVM with associated intranidal or pedicular aneurysms located above P3 or M3, etc., in which there is less turbulent flow and jet flow.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"45 1","pages":"265 - 268"},"PeriodicalIF":0.2,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90733678","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}
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