Nishtha Yadav, Ambuj Kumar, Kavita Sachdeva, S. Asati
Abstract Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion ( n = 3), vascular narrowing ( n = 3), and pseudoaneurysm ( n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.
{"title":"Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis","authors":"Nishtha Yadav, Ambuj Kumar, Kavita Sachdeva, S. Asati","doi":"10.1055/s-0043-1764351","DOIUrl":"https://doi.org/10.1055/s-0043-1764351","url":null,"abstract":"Abstract Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion ( n = 3), vascular narrowing ( n = 3), and pseudoaneurysm ( n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"54 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82053301","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}
Nidhi Rai, Rupi Jamwal, B. Singh, Jyoti Gupta, K. Shankar, Sufiyan Zaheer
Abstract Introduction Brain tumors remain a significant cause of morbidity and mortality around the globe. Preoperative estimation of tumor vascularity is of great significance for a neurosurgeon. Aim of our study was to correlate tumor blood flow (TBF) using arterial spin labeling perfusion imaging (ASL-PI) with microvessel density (MVD), tumor grade, and preoperative prognostication of brain tumors. Materials and Methods This was a prospective observational cross-sectional study conducted in 63 patients of primary brain tumors already referred for magnetic resonance imaging. Absolute and relative mean and maximum TBF were calculated using ASL-PI and correlated with tumor grade and MVD at 10x and 40x magnificantion; thereby stydying the role of ASL-PI in brain tumor prognostication. Results The mean of maxTBF values (mL/min/100 g) in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 147.15, 251.55, 96.43, 43.3, and 578.3, respectively. The median of maxTBF value in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 131.5, 158.63, 94.5, 43.4, and 578.3, respectively. Discussion Significant correlation between meanTBF and MVD at 10X magnification ( p -value < 0.001, rho =0.88) and a positive correlation between meanTBF and MVD at 40X magnification ( p -value < 0.001) were seen. Significant correlation was also seen between maxTBF and MVD at 10X magnification ( p -value < 0.001, rho = 0.91) and between maxTBF and MVD at 40X magnification. TBF in case of the hemangioblastoma was higher than other types of brain tumors (gliomas, meningiomas, and schwannomas). HighTBF value was seen in high-grade gliomas compared with low-grade gliomas with worse prognosis. TBF was high in typical meningiomas whereas low in atypical meningioma. Conclusion TBF by ASL-PI can be considered a noninvasive in vivo marker in predicting the grade of brain tumors and further assist in envisaging prognosis of the patients with brain tumors.
{"title":"Brain Tumor Vascularity Estimation by Arterial Spin Label Perfusion MRI—A Preoperative Tool for Patient Prognostication","authors":"Nidhi Rai, Rupi Jamwal, B. Singh, Jyoti Gupta, K. Shankar, Sufiyan Zaheer","doi":"10.1055/s-0043-1761604","DOIUrl":"https://doi.org/10.1055/s-0043-1761604","url":null,"abstract":"Abstract Introduction Brain tumors remain a significant cause of morbidity and mortality around the globe. Preoperative estimation of tumor vascularity is of great significance for a neurosurgeon. Aim of our study was to correlate tumor blood flow (TBF) using arterial spin labeling perfusion imaging (ASL-PI) with microvessel density (MVD), tumor grade, and preoperative prognostication of brain tumors. Materials and Methods This was a prospective observational cross-sectional study conducted in 63 patients of primary brain tumors already referred for magnetic resonance imaging. Absolute and relative mean and maximum TBF were calculated using ASL-PI and correlated with tumor grade and MVD at 10x and 40x magnificantion; thereby stydying the role of ASL-PI in brain tumor prognostication. Results The mean of maxTBF values (mL/min/100 g) in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 147.15, 251.55, 96.43, 43.3, and 578.3, respectively. The median of maxTBF value in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 131.5, 158.63, 94.5, 43.4, and 578.3, respectively. Discussion Significant correlation between meanTBF and MVD at 10X magnification ( p -value < 0.001, rho =0.88) and a positive correlation between meanTBF and MVD at 40X magnification ( p -value < 0.001) were seen. Significant correlation was also seen between maxTBF and MVD at 10X magnification ( p -value < 0.001, rho = 0.91) and between maxTBF and MVD at 40X magnification. TBF in case of the hemangioblastoma was higher than other types of brain tumors (gliomas, meningiomas, and schwannomas). HighTBF value was seen in high-grade gliomas compared with low-grade gliomas with worse prognosis. TBF was high in typical meningiomas whereas low in atypical meningioma. Conclusion TBF by ASL-PI can be considered a noninvasive in vivo marker in predicting the grade of brain tumors and further assist in envisaging prognosis of the patients with brain tumors.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"70 1","pages":"155 - 162"},"PeriodicalIF":0.2,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86115462","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 Schwannomas are one of the most common primary spinal tumors representing 30% of all intraspinal lesions. Intramedullary schwannomas constitutes 0.3% of all intraspinal tumors and approximately 1% of spinal cord schwannomas. Majority of the tumors are seen in the cervical (58%), followed by thoracic (32%) and lumbar (10%) regions. Very few are reported at the level of conus medullaris. The important radiologic features of intramedullary schwannoma are predominant extramedullary component, intramedullary spinal tumor with a thickened and enhancing spinal nerve root, absent syrinx, enhancing well with contrast, and sharp margins. The aim of surgery in intramedullary spinal schwannomas is total removal whenever possible. Diagnosing intramedullary schwannoma preoperatively needs high index of suspicion. We are reporting the 10th case of intramedullary schwannoma in the conus region.
{"title":"Spinal Intramedullary Schwannoma of the Conus","authors":"J. Tp, Sekar Chinnamuthu","doi":"10.1055/s-0043-1768065","DOIUrl":"https://doi.org/10.1055/s-0043-1768065","url":null,"abstract":"Abstract Schwannomas are one of the most common primary spinal tumors representing 30% of all intraspinal lesions. Intramedullary schwannomas constitutes 0.3% of all intraspinal tumors and approximately 1% of spinal cord schwannomas. Majority of the tumors are seen in the cervical (58%), followed by thoracic (32%) and lumbar (10%) regions. Very few are reported at the level of conus medullaris. The important radiologic features of intramedullary schwannoma are predominant extramedullary component, intramedullary spinal tumor with a thickened and enhancing spinal nerve root, absent syrinx, enhancing well with contrast, and sharp margins. The aim of surgery in intramedullary spinal schwannomas is total removal whenever possible. Diagnosing intramedullary schwannoma preoperatively needs high index of suspicion. We are reporting the 10th case of intramedullary schwannoma in the conus region.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"37 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78903717","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}
Thara Tunthanathip, Sakchai Sae-heng, T. Oearsakul, Anukoon Kaewborisutsakul, Chin Taweesomboonyat
Abstract Background Excessive requests for preoperative packed red cell (PRC) preparation have been noted, resulting in waste of blood products and higher costs in brain tumor surgery. The objectives of the present study were as follows: (1) the primary objective was to assess the effectiveness index of blood preparation and utilization; (2) the secondary objective was to explore factors associated with intraoperative PRC transfusion; and (3) the third objective was to identify the prevalence and analyze risk factors of massive transfusion. Methods A retrospective cohort study was done on patients who had undergone brain tumor operations. The effectiveness indexes of preoperative PRC preparation and intraoperative utilization were calculated as follows: the crossmatch to transfusion (C/T) ratio, transfusion probability (Tp), and transfusion index (Ti). Additionally, factors associated with intraoperative PRC transfusion and massive transfusion were analyzed. Results There were 1,708 brain tumor patients and overall C/T, Tp, and Ti were 3.27, 45.54%, and 1.10, respectively. Prevalence of intraoperative PRC transfusion was 44.8%, and meningioma, intraosseous/skull-based tumor, and tumor size were linked with massive transfusion. Conclusion Unnecessary preoperative blood component preparation for brain tumor surgery was noticed in routine practice. Exploring intraoperative transfusion variables has been challenged in optimizing crossmatch and actual use.
{"title":"Effectiveness of Preoperative Red Cell Preparation and Intraoperative Massive Transfusion in Brain Tumor Operation","authors":"Thara Tunthanathip, Sakchai Sae-heng, T. Oearsakul, Anukoon Kaewborisutsakul, Chin Taweesomboonyat","doi":"10.1055/s-0043-1768066","DOIUrl":"https://doi.org/10.1055/s-0043-1768066","url":null,"abstract":"Abstract Background Excessive requests for preoperative packed red cell (PRC) preparation have been noted, resulting in waste of blood products and higher costs in brain tumor surgery. The objectives of the present study were as follows: (1) the primary objective was to assess the effectiveness index of blood preparation and utilization; (2) the secondary objective was to explore factors associated with intraoperative PRC transfusion; and (3) the third objective was to identify the prevalence and analyze risk factors of massive transfusion. Methods A retrospective cohort study was done on patients who had undergone brain tumor operations. The effectiveness indexes of preoperative PRC preparation and intraoperative utilization were calculated as follows: the crossmatch to transfusion (C/T) ratio, transfusion probability (Tp), and transfusion index (Ti). Additionally, factors associated with intraoperative PRC transfusion and massive transfusion were analyzed. Results There were 1,708 brain tumor patients and overall C/T, Tp, and Ti were 3.27, 45.54%, and 1.10, respectively. Prevalence of intraoperative PRC transfusion was 44.8%, and meningioma, intraosseous/skull-based tumor, and tumor size were linked with massive transfusion. Conclusion Unnecessary preoperative blood component preparation for brain tumor surgery was noticed in routine practice. Exploring intraoperative transfusion variables has been challenged in optimizing crossmatch and actual use.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88123211","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}
Austin S. Gamblin, Al-Wala Awad, M. Karsy, J. Guan, M. Mazur, E. Bisson, Orhan Bican, A. Dailey
Abstract Objective The accuracy of intraoperative neuromonitoring (IONM) during surgery for cervical spondylotic myelopathy (CSM) to detect iatrogenic nervous system injuries while they are reversible remains unknown. We evaluated a cohort of patients who had IONM during surgery to assess accuracy. Methods Patients who underwent surgical treatment of CSM that included IONM from January 2018 through August 2018 were retrospectively identified. A standardized protocol was used for operative management. Clinical changes and postoperative neurological deficits were evaluated. Results Among 131 patients in whom IONM was used during their procedure, 42 patients (age 58.2 ± 16.3 years, 54.8% males) showed IONM changes and 89 patients had no change. The reasons for IONM changes varied, and some patients had changes detected via multiple modalities: electromyography ( n = 25, 59.5%), somatosensory-evoked potentials ( n = 14, 33.3%), motor evoked potentials ( n = 13, 31.0%). Three patients, all having baseline deficits before surgery, had postoperative deficits. Among the 89 patients without an IONM change, 4 showed worsened postoperative deficits, which were also seen at last follow-up. The sensitivity of IONM for predicting postoperative neurological change was 42.86% and the specificity was 68.55%. However, most patients (124, 94.7%) in whom IONM was used showed no worsened neurological deficit. Conclusions IONM shows potential in ensuring stable postoperative neurological outcomes in most patients; however, its clinical use and supportive guidelines remain controversial. In our series, prediction of neurological deficits was poor in contrast to some previous studies. Further refinement of clinical and electrophysiological variables is needed to uniformly predict postoperative neurological outcomes.
{"title":"Efficacy of Intraoperative Neuromonitoring during the Treatment of Cervical Myelopathy","authors":"Austin S. Gamblin, Al-Wala Awad, M. Karsy, J. Guan, M. Mazur, E. Bisson, Orhan Bican, A. Dailey","doi":"10.1055/s-0043-1764455","DOIUrl":"https://doi.org/10.1055/s-0043-1764455","url":null,"abstract":"Abstract Objective The accuracy of intraoperative neuromonitoring (IONM) during surgery for cervical spondylotic myelopathy (CSM) to detect iatrogenic nervous system injuries while they are reversible remains unknown. We evaluated a cohort of patients who had IONM during surgery to assess accuracy. Methods Patients who underwent surgical treatment of CSM that included IONM from January 2018 through August 2018 were retrospectively identified. A standardized protocol was used for operative management. Clinical changes and postoperative neurological deficits were evaluated. Results Among 131 patients in whom IONM was used during their procedure, 42 patients (age 58.2 ± 16.3 years, 54.8% males) showed IONM changes and 89 patients had no change. The reasons for IONM changes varied, and some patients had changes detected via multiple modalities: electromyography ( n = 25, 59.5%), somatosensory-evoked potentials ( n = 14, 33.3%), motor evoked potentials ( n = 13, 31.0%). Three patients, all having baseline deficits before surgery, had postoperative deficits. Among the 89 patients without an IONM change, 4 showed worsened postoperative deficits, which were also seen at last follow-up. The sensitivity of IONM for predicting postoperative neurological change was 42.86% and the specificity was 68.55%. However, most patients (124, 94.7%) in whom IONM was used showed no worsened neurological deficit. Conclusions IONM shows potential in ensuring stable postoperative neurological outcomes in most patients; however, its clinical use and supportive guidelines remain controversial. In our series, prediction of neurological deficits was poor in contrast to some previous studies. Further refinement of clinical and electrophysiological variables is needed to uniformly predict postoperative neurological outcomes.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88248969","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}
Ankur Bajaj, R. Ansari, Somil Jaiswal, C. Srivastava, B. Ojha, Imran Rizvi, T. Chandra
Abstract Objective Medulloblastoma is the most common central nervous system embryonal tumor and the most common malignant brain tumor of childhood. This study aims to find out the incidence of the ABO-Rh blood group in medulloblastoma patients of northern India to assess the utility of the blood group as a preclinical non-modifiable risk factor. Materials and Methods The study cohort consisted of 87 pediatric patients (age up to 18 years) who were diagnosed after histopathological examination with medulloblastoma at a university hospital in Lucknow between 2014 and 2019. Hundred random pediatric individuals from the same population who were admitted to the same hospital between 2014 and 2019 for non-tumor cases were selected as the control group. Data concerning characteristics including age, sex, ABO blood group, and Rh factor were collected from hospital records. The distribution of ABO-Rh blood groups in the study population was compared with the general population using the χ 2 test. Statistical analysis of the ABO-Rh blood groups in the study population was done using the IBM SPSS statistics version 24.0. Results Data analysis revealed that blood group A was significantly associated with medulloblastoma cases (odds ratio [OR] = 2.93; 95% confidence interval [CI]: 1.35–6.34). We find that the classical subtype was prevalent with the blood group A (43.8%), while the desmoplastic subtype was associated with the blood group O (38.5%). Conclusions Blood group A has a higher risk for the development of medulloblastoma while blood group O has the least risk. These findings suggest that blood group antigen should be considered as a non-modifiable preclinical risk factor for developing medulloblastoma.
{"title":"Medulloblastoma and ABO-Rh Blood Group: Evidence of an Association between the Distribution of Blood Group Antigens and Medulloblastoma","authors":"Ankur Bajaj, R. Ansari, Somil Jaiswal, C. Srivastava, B. Ojha, Imran Rizvi, T. Chandra","doi":"10.1055/s-0042-1744244","DOIUrl":"https://doi.org/10.1055/s-0042-1744244","url":null,"abstract":"Abstract Objective Medulloblastoma is the most common central nervous system embryonal tumor and the most common malignant brain tumor of childhood. This study aims to find out the incidence of the ABO-Rh blood group in medulloblastoma patients of northern India to assess the utility of the blood group as a preclinical non-modifiable risk factor. Materials and Methods The study cohort consisted of 87 pediatric patients (age up to 18 years) who were diagnosed after histopathological examination with medulloblastoma at a university hospital in Lucknow between 2014 and 2019. Hundred random pediatric individuals from the same population who were admitted to the same hospital between 2014 and 2019 for non-tumor cases were selected as the control group. Data concerning characteristics including age, sex, ABO blood group, and Rh factor were collected from hospital records. The distribution of ABO-Rh blood groups in the study population was compared with the general population using the χ 2 test. Statistical analysis of the ABO-Rh blood groups in the study population was done using the IBM SPSS statistics version 24.0. Results Data analysis revealed that blood group A was significantly associated with medulloblastoma cases (odds ratio [OR] = 2.93; 95% confidence interval [CI]: 1.35–6.34). We find that the classical subtype was prevalent with the blood group A (43.8%), while the desmoplastic subtype was associated with the blood group O (38.5%). Conclusions Blood group A has a higher risk for the development of medulloblastoma while blood group O has the least risk. These findings suggest that blood group antigen should be considered as a non-modifiable preclinical risk factor for developing medulloblastoma.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84056639","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}
Sarah Basindwah, A. Hawsawi, Amjad Alduhaish, Abdulrazag M. Ajlan
Abstract Background Although histologically benign, colloid cysts have been an entity of interest to neurosurgeons due to the wide array of possible presentations ranging from asymptomatic to high ICP symptoms to sudden death. It is estimated that colloid cysts represent 0.3 to 2% of all brain tumors. 1 As they are typically located in the third ventricle, multiple approaches have been adapted and developed for the maximum resection with the least complications given the sensitive anatomy in the area. 1 2 The interhemispheric transcallosal approach can be safely performed to fully resect a third ventricle colloid cyst with close to zero recurrence rate and minimal to none permanent deficits. 3 This video is an educational illustration of the surgical technique and the related anatomy for the interhemispheric transcallosal approach and how to provide best chances of a benign postoperative course. Case Description In this surgical video, we present a case of a 20-year-old male, a known case of hypertension and un-controlled diabetes type-1, presented to our hospital with on and off headache, dizziness, and diplopia that gradually progressed. His neurological exam was unremarkable including memory function. CT and MRI scans demonstrated a rounded sharply demarcated lesion at the at the roof of the third ventricle, measuring 1 × 1 cm in size. The patient underwent an anterior inter-hemispheric transcallosal approach, with gross total resection of the cyst. In the follow-up office visit, the patient headache has resolved, and he had no seizures with preserved memory functions. Conclusion When removal of the colloid cyst is indicated, the interhemispheric transcallosal approach can be performed safely with gross total resection and minimal neurological deficit. This is a surgical demonstration of the transcallosal approach showcasing the surgical corridors and related anatomy.
{"title":"Anterior Inter-hemispheric Transcallosal Approach for Resection of Colloid Cyst: A Video Abstract","authors":"Sarah Basindwah, A. Hawsawi, Amjad Alduhaish, Abdulrazag M. Ajlan","doi":"10.1055/s-0042-1759887","DOIUrl":"https://doi.org/10.1055/s-0042-1759887","url":null,"abstract":"Abstract Background Although histologically benign, colloid cysts have been an entity of interest to neurosurgeons due to the wide array of possible presentations ranging from asymptomatic to high ICP symptoms to sudden death. It is estimated that colloid cysts represent 0.3 to 2% of all brain tumors. 1 As they are typically located in the third ventricle, multiple approaches have been adapted and developed for the maximum resection with the least complications given the sensitive anatomy in the area. 1 2 The interhemispheric transcallosal approach can be safely performed to fully resect a third ventricle colloid cyst with close to zero recurrence rate and minimal to none permanent deficits. 3 This video is an educational illustration of the surgical technique and the related anatomy for the interhemispheric transcallosal approach and how to provide best chances of a benign postoperative course. Case Description In this surgical video, we present a case of a 20-year-old male, a known case of hypertension and un-controlled diabetes type-1, presented to our hospital with on and off headache, dizziness, and diplopia that gradually progressed. His neurological exam was unremarkable including memory function. CT and MRI scans demonstrated a rounded sharply demarcated lesion at the at the roof of the third ventricle, measuring 1 × 1 cm in size. The patient underwent an anterior inter-hemispheric transcallosal approach, with gross total resection of the cyst. In the follow-up office visit, the patient headache has resolved, and he had no seizures with preserved memory functions. Conclusion When removal of the colloid cyst is indicated, the interhemispheric transcallosal approach can be performed safely with gross total resection and minimal neurological deficit. This is a surgical demonstration of the transcallosal approach showcasing the surgical corridors and related anatomy.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"7 1","pages":"188 - 189"},"PeriodicalIF":0.2,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86908284","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}
Arteriovenous malformations (AVMs) are the most common intracranial vascular malformation that we encounter in our clinical practice. Patientsmay present with either headaches, seizures, or bleed. There are several classification systems described in literature to aid in management. Most of them look into the size of the nidus and the status of the draining veins. Any nidus which is compact, superficial, and in a surgically safe area are offered surgery. Most of the other AVMs aremanaged by radiosurgery or embolization either as a single treatment modality or in combination. The largest series of 258 cases with histopathology of the vascular malformations including AVMs were studied in detail and published by Karanth et al.1 It is well documented that AVMs form a conglomerate of arteries, veins, and arterialized veins. The vessel wall has varying degree of hyalinization and calcification with the intervening parenchyma showing gliotic changes and signs of hemosiderin and inflammation. This issue of the journal has interesting read on AVM. Hunugundmath et al2 documented the outcome of linear accelerator (LINAC)-based single fraction radiosurgery of AVMs on 35 patients with a median follow-up of 7 years. The median modified AVM score was 1.47. Nearly 40% of the patients had undergone embolization pre-radiosurgery. Obliteration rate observed was around 71%, and 6% of the patients had bleed post-radiosurgery. At our institute we use gamma knife radiosurgery (GKRS) for appropriate sized AVMs since 1997. The new Gamma knife ICON model enables us to use frameless stereotactic radiosurgery for indicated cases. The protocol is similar to what authors have described in their paper for LINAC, but it is a daycare procedure. The patient comes on the day of GKRS and undergoes contrast-enhanced magnetic resonance imaging (MRI) brain along with time of flight sequence imaging of brain and digital subtraction angiography (DSA). The planning is done on the GammaPlan software. The most crucial part of the planning, I believe, is delineating the nidus. We generally prefer to deliver 22 Gy (18–25 Gy) to the nidus. We may opt for volume staging or dose staging of the nidus depending on the volume and location and both have shown good results. The single fraction definitely gives a better result but may be associatedwith radiation-induced changes (RICs) depending on the nidus angio-architectural complexity. The patients are called for follow-up MRI brain annually for the first 2 years and then once in 2 years. The follow-up DSA is done in the 4th year of treatment. DSA is essential in case MRI shows residual nidus but may not necessarily be donewhenMRI reveals complete obliteration. It is good to see that in their series the authors observed only three patients developing transient neurological deficits and no mortality. I would like to remind my authors that at times radiation complications can be life threatening. The RICs usually sets in first 6 months and may be cl
{"title":"Radiosurgery for Cerebral Arteriovenous Malformations","authors":"Shweta Kedia","doi":"10.1055/s-0043-1767743","DOIUrl":"https://doi.org/10.1055/s-0043-1767743","url":null,"abstract":"Arteriovenous malformations (AVMs) are the most common intracranial vascular malformation that we encounter in our clinical practice. Patientsmay present with either headaches, seizures, or bleed. There are several classification systems described in literature to aid in management. Most of them look into the size of the nidus and the status of the draining veins. Any nidus which is compact, superficial, and in a surgically safe area are offered surgery. Most of the other AVMs aremanaged by radiosurgery or embolization either as a single treatment modality or in combination. The largest series of 258 cases with histopathology of the vascular malformations including AVMs were studied in detail and published by Karanth et al.1 It is well documented that AVMs form a conglomerate of arteries, veins, and arterialized veins. The vessel wall has varying degree of hyalinization and calcification with the intervening parenchyma showing gliotic changes and signs of hemosiderin and inflammation. This issue of the journal has interesting read on AVM. Hunugundmath et al2 documented the outcome of linear accelerator (LINAC)-based single fraction radiosurgery of AVMs on 35 patients with a median follow-up of 7 years. The median modified AVM score was 1.47. Nearly 40% of the patients had undergone embolization pre-radiosurgery. Obliteration rate observed was around 71%, and 6% of the patients had bleed post-radiosurgery. At our institute we use gamma knife radiosurgery (GKRS) for appropriate sized AVMs since 1997. The new Gamma knife ICON model enables us to use frameless stereotactic radiosurgery for indicated cases. The protocol is similar to what authors have described in their paper for LINAC, but it is a daycare procedure. The patient comes on the day of GKRS and undergoes contrast-enhanced magnetic resonance imaging (MRI) brain along with time of flight sequence imaging of brain and digital subtraction angiography (DSA). The planning is done on the GammaPlan software. The most crucial part of the planning, I believe, is delineating the nidus. We generally prefer to deliver 22 Gy (18–25 Gy) to the nidus. We may opt for volume staging or dose staging of the nidus depending on the volume and location and both have shown good results. The single fraction definitely gives a better result but may be associatedwith radiation-induced changes (RICs) depending on the nidus angio-architectural complexity. The patients are called for follow-up MRI brain annually for the first 2 years and then once in 2 years. The follow-up DSA is done in the 4th year of treatment. DSA is essential in case MRI shows residual nidus but may not necessarily be donewhenMRI reveals complete obliteration. It is good to see that in their series the authors observed only three patients developing transient neurological deficits and no mortality. I would like to remind my authors that at times radiation complications can be life threatening. The RICs usually sets in first 6 months and may be cl","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"115 1","pages":"001 - 002"},"PeriodicalIF":0.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88910082","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 Maintaining the transoral approach in the armamentarium of surgical approaches to clival chordomas mainly as a complimentary procedure to endonasal endoscopic approach in selected cases is advantageous. Lateral extension of the disease is a limitation to both approaches and is addressed by transcranial approaches. Especially for extensive lesions the simultaneous combination of approaches is based upon the predicted blind spots for each approach and certain technical nuances need to be considered.
{"title":"Time to Modify Rather than Discard the Transoral Approach to Selected Cases of Clival Chordomas at the Craniocervical Junction","authors":"R. Kirollos, R. Pillay","doi":"10.1055/s-0043-1768239","DOIUrl":"https://doi.org/10.1055/s-0043-1768239","url":null,"abstract":"Abstract Maintaining the transoral approach in the armamentarium of surgical approaches to clival chordomas mainly as a complimentary procedure to endonasal endoscopic approach in selected cases is advantageous. Lateral extension of the disease is a limitation to both approaches and is addressed by transcranial approaches. Especially for extensive lesions the simultaneous combination of approaches is based upon the predicted blind spots for each approach and certain technical nuances need to be considered.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"60 1","pages":"010 - 014"},"PeriodicalIF":0.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77237578","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 Astroblastoma is a rare neuroepithelial tumor of unknown origin, usually seen in children and young adults. It is usually localized to the cerebral hemisphere. Computed tomography and magnetic resonance imaging show a well-demarcated, contrast-enhancing mass with a cystic area. Characteristic histological findings are perivascular pseudorosette formation and frequent vascular hyalinization. The presented case is a 3.7-month-old female patient diagnosed with high-grade astroblastoma. Case Presentation We report the case of a 3.7-year-old female patient admitted to the neurosurgery clinic with strabismus for 25 days. Magnetic resonance imaging revealed a contrast-enhancing mass that contained cystic and necrotic areas. The tumor mass has been totally resected and histological examination combined with immunohistochemical study confirmed the diagnosis of high-grade astroblastoma.
{"title":"A Rare Pediatric Tumor: Supratentorial High-Grade Astroblastoma Presenting as a huge Mass","authors":"D. Sürmeli, Boran Urfalı, T. Özgür","doi":"10.1055/s-0042-1744245","DOIUrl":"https://doi.org/10.1055/s-0042-1744245","url":null,"abstract":"Abstract Background Astroblastoma is a rare neuroepithelial tumor of unknown origin, usually seen in children and young adults. It is usually localized to the cerebral hemisphere. Computed tomography and magnetic resonance imaging show a well-demarcated, contrast-enhancing mass with a cystic area. Characteristic histological findings are perivascular pseudorosette formation and frequent vascular hyalinization. The presented case is a 3.7-month-old female patient diagnosed with high-grade astroblastoma. Case Presentation We report the case of a 3.7-year-old female patient admitted to the neurosurgery clinic with strabismus for 25 days. Magnetic resonance imaging revealed a contrast-enhancing mass that contained cystic and necrotic areas. The tumor mass has been totally resected and histological examination combined with immunohistochemical study confirmed the diagnosis of high-grade astroblastoma.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"36 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88446529","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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