DOI https://doi.org/ 10.1055/s-0042-1757119 ISSN 2277-954X Lower back problems are increasing worldwide due to changing lifestyle, prolonged use of digital technology, and increased use of diagnostic modalities such as Xrays, computed tomography (CT) scan, and magnetic resonance imaging. Increased diagnostic yield has led to increase in spine surgery. The conventional surgery for spine diseases are gradually shifting to minimal invasive spine surgery (MISS) using endoscope or microscope considering its advantages over surgery with big incision and massive muscle dissection. The biggest advantage is same day discharge unlike many neurosurgical procedures. This helps in cutting the cost of treatment to a major extent, less infection, resuming the work early, and above all, a person can go home same day, as “Home is oasis.” The microscopic surgery for disc can be done even with the same length of incision as the MISS; however, the muscle dissection and detachment from spinous process in microscopic surgery with conventional retraction of muscle make it a maximal invasive surgery. MISS needs basic understanding of spine anatomy. As the MISS is emerging as superior surgical procedure for majority spinal pathologies, young neurosurgeon would not have much exposure of detailed spinal anatomy as many anatomical structures in MISS use tactile sensations to localize unlike maximal invasive surgery where visual perception dominates. This would require cadaveric dissections, simulators or anatomy can be understood by cases subjected to open maximal invasive dissections not suitable for minimal exposure. However, use of intraoperative Carms, navigation with ultrasound, CT scan, and/or robots will be the future to understand the bony details of spine. Navigation and robotic has increased the accuracy of spinal instrumentation and success rate of MISS. After reading and analyzing the articles by Kumar et al and Dubey and Agrawal,1,2 it seems the skills and advancement in spinal surgery has made day care surgery possible especially for disc surgery. The other day care procedures for spine are ozone nucleolysis, nucleoplasty, etc.3 For complete extruded disc where disc acts as extradural mass, it might be difficult to identify the relation of root with the disc in MISS which can be overcome to some extent by transforaminal disc injection of methylene blue with iodine containing dye (omnipaque) into the disc before giving incision. This makes disc blue and easily distinguishable. Kumar et al described basics of MISS using tubular retractor, nuances, and technique for beginners.1 Dubey and Agrawal2 used posterolateral transforaminal approach for tumor removal, and ultrasound has been used to localize the foramen along with C-arm. Use of tracked ultrasound technology in spine if substantially recognized, the radiation dose can be reduced to all working in the operation room. Use of standalone ultrasound should be cautiously done in spine localization, however, it is
{"title":"Day Care Neurosurgery: Skill and Technical Advancement","authors":"A. Jagetia","doi":"10.1055/s-0042-1757119","DOIUrl":"https://doi.org/10.1055/s-0042-1757119","url":null,"abstract":"DOI https://doi.org/ 10.1055/s-0042-1757119 ISSN 2277-954X Lower back problems are increasing worldwide due to changing lifestyle, prolonged use of digital technology, and increased use of diagnostic modalities such as Xrays, computed tomography (CT) scan, and magnetic resonance imaging. Increased diagnostic yield has led to increase in spine surgery. The conventional surgery for spine diseases are gradually shifting to minimal invasive spine surgery (MISS) using endoscope or microscope considering its advantages over surgery with big incision and massive muscle dissection. The biggest advantage is same day discharge unlike many neurosurgical procedures. This helps in cutting the cost of treatment to a major extent, less infection, resuming the work early, and above all, a person can go home same day, as “Home is oasis.” The microscopic surgery for disc can be done even with the same length of incision as the MISS; however, the muscle dissection and detachment from spinous process in microscopic surgery with conventional retraction of muscle make it a maximal invasive surgery. MISS needs basic understanding of spine anatomy. As the MISS is emerging as superior surgical procedure for majority spinal pathologies, young neurosurgeon would not have much exposure of detailed spinal anatomy as many anatomical structures in MISS use tactile sensations to localize unlike maximal invasive surgery where visual perception dominates. This would require cadaveric dissections, simulators or anatomy can be understood by cases subjected to open maximal invasive dissections not suitable for minimal exposure. However, use of intraoperative Carms, navigation with ultrasound, CT scan, and/or robots will be the future to understand the bony details of spine. Navigation and robotic has increased the accuracy of spinal instrumentation and success rate of MISS. After reading and analyzing the articles by Kumar et al and Dubey and Agrawal,1,2 it seems the skills and advancement in spinal surgery has made day care surgery possible especially for disc surgery. The other day care procedures for spine are ozone nucleolysis, nucleoplasty, etc.3 For complete extruded disc where disc acts as extradural mass, it might be difficult to identify the relation of root with the disc in MISS which can be overcome to some extent by transforaminal disc injection of methylene blue with iodine containing dye (omnipaque) into the disc before giving incision. This makes disc blue and easily distinguishable. Kumar et al described basics of MISS using tubular retractor, nuances, and technique for beginners.1 Dubey and Agrawal2 used posterolateral transforaminal approach for tumor removal, and ultrasound has been used to localize the foramen along with C-arm. Use of tracked ultrasound technology in spine if substantially recognized, the radiation dose can be reduced to all working in the operation room. Use of standalone ultrasound should be cautiously done in spine localization, however, it is","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"49 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84873590","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":"Progress on Folate Supplementation and Spina Bifida Prevention","authors":"N. Zanon","doi":"10.1055/s-0042-1757118","DOIUrl":"https://doi.org/10.1055/s-0042-1757118","url":null,"abstract":"","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"607 ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72495375","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}
R. Sihag, Rajkumar Pannem, Ridham Khanderia, R. Arora
The intramedullary lesions affecting cervical cord usually present with signi fi cant neurological de fi cits and the differentials on magnetic resonance imaging (MRI) can be neoplastic, infective, vascular, or demyelinated. 1 We are providing imaging description of an isolated cervical intramedullary cysticercosis, which is very rare, with only 24 cases reported to date. A 21-year-old male patient presented with complaints of neck pain of 3-month duration followed by asymmetric spastic quadriparesis (power ⅕ in both upper limbs, 4 þ /5 in lower limbs), along with graded sensory loss below C4 dermatome, and bladder and bowel involvement of 2-month duration; Modi fi ed Japanese Orthopedic Association (mJOA) score at presentation was 8. Preoperative MRI revealed a well-circumscribed
{"title":"Cysticercosis Presenting as an Isolated Cervical Intramedullary Lesion: A Rare Benign Condition at a Dangerous Location","authors":"R. Sihag, Rajkumar Pannem, Ridham Khanderia, R. Arora","doi":"10.1055/s-0042-1750741","DOIUrl":"https://doi.org/10.1055/s-0042-1750741","url":null,"abstract":"The intramedullary lesions affecting cervical cord usually present with signi fi cant neurological de fi cits and the differentials on magnetic resonance imaging (MRI) can be neoplastic, infective, vascular, or demyelinated. 1 We are providing imaging description of an isolated cervical intramedullary cysticercosis, which is very rare, with only 24 cases reported to date. A 21-year-old male patient presented with complaints of neck pain of 3-month duration followed by asymmetric spastic quadriparesis (power ⅕ in both upper limbs, 4 þ /5 in lower limbs), along with graded sensory loss below C4 dermatome, and bladder and bowel involvement of 2-month duration; Modi fi ed Japanese Orthopedic Association (mJOA) score at presentation was 8. Preoperative MRI revealed a well-circumscribed","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"13 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82739736","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 Normal pressure hydrocephalus (NPH) is the most frequently occurring form of hydrocephalus among adults. It is characterized clinically by the classical triad, called Hakim's triad, comprising gait issues, cognitive impairment, and urinary problems. NPH may be primary or idiopathic (iNPH) or secondary. Characteristic neuroimaging features occur, which are vital to diagnosis. Diagnostic criteria in the form of Japanese guideline and Congress of Neurological Surgeons 2005 guidelines have been devised, and broadly, are based on a constellation of clinical and neuroimaging features, in association with cerebrospinal fluid (CSF) testing. CSF tap test, extended lumbar drainage, and CSF infusion tests are invasive diagnostic tests. CSF tap test and extended lumbar drainage are used to demonstrate clinical reversibility with CSF drainage, and patients who demonstrate this are candidates for CSF shunting. However, due to the low negative predictive value of these tests, potential response to shunting cannot be negated among patients who do not respond to CSF drainage. Various shunting procedures are used for treatment, including ventriculoperitoneal, lumboperitoneal, and ventriculoatrial shunts. Endoscopic third ventriculostomy has also been attempted with limited success. Among the clinical features, gait abnormalities are most responsive to shunting. Persistent long-term response to shunting has been reported. Patients need to be meticulously followed up after the shunting procedure, to assess clinical and neuroimaging response, and detect possible shunt-related complications, especially CSF over-drainage. Early treatment is associated with better prognosis, and it is crucial to recognize and treat this condition before the development of severe symptoms.
{"title":"Addressing the Devil Within: Normal Pressure Hydrocephalus—A Narrative Review","authors":"D. Garg, N. Chaudhry","doi":"10.1055/s-0042-1753475","DOIUrl":"https://doi.org/10.1055/s-0042-1753475","url":null,"abstract":"Abstract Normal pressure hydrocephalus (NPH) is the most frequently occurring form of hydrocephalus among adults. It is characterized clinically by the classical triad, called Hakim's triad, comprising gait issues, cognitive impairment, and urinary problems. NPH may be primary or idiopathic (iNPH) or secondary. Characteristic neuroimaging features occur, which are vital to diagnosis. Diagnostic criteria in the form of Japanese guideline and Congress of Neurological Surgeons 2005 guidelines have been devised, and broadly, are based on a constellation of clinical and neuroimaging features, in association with cerebrospinal fluid (CSF) testing. CSF tap test, extended lumbar drainage, and CSF infusion tests are invasive diagnostic tests. CSF tap test and extended lumbar drainage are used to demonstrate clinical reversibility with CSF drainage, and patients who demonstrate this are candidates for CSF shunting. However, due to the low negative predictive value of these tests, potential response to shunting cannot be negated among patients who do not respond to CSF drainage. Various shunting procedures are used for treatment, including ventriculoperitoneal, lumboperitoneal, and ventriculoatrial shunts. Endoscopic third ventriculostomy has also been attempted with limited success. Among the clinical features, gait abnormalities are most responsive to shunting. Persistent long-term response to shunting has been reported. Patients need to be meticulously followed up after the shunting procedure, to assess clinical and neuroimaging response, and detect possible shunt-related complications, especially CSF over-drainage. Early treatment is associated with better prognosis, and it is crucial to recognize and treat this condition before the development of severe symptoms.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"4 1","pages":"195 - 201"},"PeriodicalIF":0.2,"publicationDate":"2022-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73177046","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. Giridharan, C. T. Unais Mohammed, M. Saranraj, M. Balamurugan
Abstract Introduction Pituicytoma is a rare form of primary benign tumor of the neurohypophysis and infundibulum. There have been 140 reported cases in world literature that could be found in our search. Here we discuss about the presentation, radiological features, treatment, histopathology, and immunohistochemical markers of two cases, along with a brief review of literature. Materials and Methods A 48-year-old female presented with headache and painless visual loss for 4 years. Examination revealed bitemporal hemianopia and normal fundus. Hormonal profile was normal. Magnetic resonance imaging (MRI) showed 2.6 × 2.8 × 3.3 cm, thin-walled, cystic sellar and suprasellar lesions stretching the optic chiasm superiorly. Endoscopic transnasal, transsphenoidal gross total excision was done. Histopathological examination (HPE) and immunohistochemistry (IHC) were suggestive of pituicytoma. A 55-year-old male presented with intermittent headache and vomiting for 3 months. Examination was unremarkable. Hormonal profile was normal. MRI showed lobulated mass of size 1.4 × 1.9 × 2.0 cm, arising from anterior pituitary and extending to the suprasellar cistern. Lesion was hyperintense in T1-weighted and heterointense in T2-weighted images, and Fluid attenuated inversion recovery images (FLAIR) with homogenous contrast enhancement pushed the optic chiasm superiorly. Endoscopic transnasal partial excision of the lesion was done. HPE and IHC were suggestive of pituicytoma. Results Total number of cases was 142, of which 71 were males (50%) and 71 were females (50%). Age ranged between 7 and 83 years (mean 49.2, median 48). Brain imaging was available in 110 cases. Size of the lesion varied from 4 to 72 mm (mean 27 mm). Location was either pure sellar (24.3%) or with extension into the suprasellar cistern (34.3%) and/or the cavernous sinuses (7.1%). Lesions in MRI were solid (84%) with few areas of cystic changes, while contrast enhancement of solid portion was in 92% (homogenous in 80% and heterogeneous in 20%) of the cases. One case showed features of hemorrhage while no case showed calcification. Treatment was primarily surgical (120 out of 130 cases): transsphenoidal excision in 70% of the cases and craniotomy and excision in 30%. Preoperative embolization of arterial feeders was done in two cases and postoperative radiation was given in one case. Gross total resection was done in 46.3%, subtotal resection in 40%, partial resection in 12.6%, and biopsy was done in 1.1% of the cases in the study. Follow-up ranged from 2 to 134 months (average 31.2, median 19). Recurrence or regrowth was documented in 23 patients, treatment in 18 patients, and resurgery was done in 12 cases, followed by radiotherapy in 5. In six cases, radiotherapy was used in isolation. Improvement in the visual deficit was seen in 26 patients, and remained unchanged in 3. Among the patients with preoperative endocrine dysfunction, 10 improved while 11 suffered a worsening. Ten patients had
{"title":"Pituicytoma: A Report of Two Cases and Literature Review","authors":"K. Giridharan, C. T. Unais Mohammed, M. Saranraj, M. Balamurugan","doi":"10.1055/s-0042-1750740","DOIUrl":"https://doi.org/10.1055/s-0042-1750740","url":null,"abstract":"Abstract Introduction Pituicytoma is a rare form of primary benign tumor of the neurohypophysis and infundibulum. There have been 140 reported cases in world literature that could be found in our search. Here we discuss about the presentation, radiological features, treatment, histopathology, and immunohistochemical markers of two cases, along with a brief review of literature. Materials and Methods A 48-year-old female presented with headache and painless visual loss for 4 years. Examination revealed bitemporal hemianopia and normal fundus. Hormonal profile was normal. Magnetic resonance imaging (MRI) showed 2.6 × 2.8 × 3.3 cm, thin-walled, cystic sellar and suprasellar lesions stretching the optic chiasm superiorly. Endoscopic transnasal, transsphenoidal gross total excision was done. Histopathological examination (HPE) and immunohistochemistry (IHC) were suggestive of pituicytoma. A 55-year-old male presented with intermittent headache and vomiting for 3 months. Examination was unremarkable. Hormonal profile was normal. MRI showed lobulated mass of size 1.4 × 1.9 × 2.0 cm, arising from anterior pituitary and extending to the suprasellar cistern. Lesion was hyperintense in T1-weighted and heterointense in T2-weighted images, and Fluid attenuated inversion recovery images (FLAIR) with homogenous contrast enhancement pushed the optic chiasm superiorly. Endoscopic transnasal partial excision of the lesion was done. HPE and IHC were suggestive of pituicytoma. Results Total number of cases was 142, of which 71 were males (50%) and 71 were females (50%). Age ranged between 7 and 83 years (mean 49.2, median 48). Brain imaging was available in 110 cases. Size of the lesion varied from 4 to 72 mm (mean 27 mm). Location was either pure sellar (24.3%) or with extension into the suprasellar cistern (34.3%) and/or the cavernous sinuses (7.1%). Lesions in MRI were solid (84%) with few areas of cystic changes, while contrast enhancement of solid portion was in 92% (homogenous in 80% and heterogeneous in 20%) of the cases. One case showed features of hemorrhage while no case showed calcification. Treatment was primarily surgical (120 out of 130 cases): transsphenoidal excision in 70% of the cases and craniotomy and excision in 30%. Preoperative embolization of arterial feeders was done in two cases and postoperative radiation was given in one case. Gross total resection was done in 46.3%, subtotal resection in 40%, partial resection in 12.6%, and biopsy was done in 1.1% of the cases in the study. Follow-up ranged from 2 to 134 months (average 31.2, median 19). Recurrence or regrowth was documented in 23 patients, treatment in 18 patients, and resurgery was done in 12 cases, followed by radiotherapy in 5. In six cases, radiotherapy was used in isolation. Improvement in the visual deficit was seen in 26 patients, and remained unchanged in 3. Among the patients with preoperative endocrine dysfunction, 10 improved while 11 suffered a worsening. Ten patients had","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"15 1","pages":"174 - 179"},"PeriodicalIF":0.2,"publicationDate":"2022-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82012552","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}
W. Wani, Heena Samad, Shaam Bodeliwala, A. Jagetia, Daljit Singh
Abstract One of the first procedures that a neurosurgical resident/trainee assists and performs is the placement of a ventriculoperitoneal shunt, the commonest being the Chhabra shunt system. However, no modification has been done or proposed in performing this procedure keeping in mind the position of the chamber of the Chhabra shunt system. As the tunneller has to pass through the subcutaneous plane having tight adhesions, it is essential to have a proper and adequate space for the chamber. Utilization of instruments such as artery forceps or Penfield dissectors for the same results in the creation of inappropriate or a roughly estimated space, which is either inadequate, causing kinking of tubing, or too roomy that results in the peri-catheter collection of cerebrospinal fluid with the risk of infection. We propose a novel method of utilizing a modified tunneller with a distal “Capsule” that provides just enough space both, at the appropriate distance and for adequate length, for the chamber to fit snugly and thus avoid procedure-related risks and complications as well as reduce the total duration of surgery, thereby decreasing the chances of infection.
{"title":"Modified Tunneling (Capsule Modification Technique) for Subcutaneous Placement of Ventriculo-Peritoneal Shunt in Patients with Hydrocephalus: Technical Note","authors":"W. Wani, Heena Samad, Shaam Bodeliwala, A. Jagetia, Daljit Singh","doi":"10.1055/s-0042-1744252","DOIUrl":"https://doi.org/10.1055/s-0042-1744252","url":null,"abstract":"Abstract One of the first procedures that a neurosurgical resident/trainee assists and performs is the placement of a ventriculoperitoneal shunt, the commonest being the Chhabra shunt system. However, no modification has been done or proposed in performing this procedure keeping in mind the position of the chamber of the Chhabra shunt system. As the tunneller has to pass through the subcutaneous plane having tight adhesions, it is essential to have a proper and adequate space for the chamber. Utilization of instruments such as artery forceps or Penfield dissectors for the same results in the creation of inappropriate or a roughly estimated space, which is either inadequate, causing kinking of tubing, or too roomy that results in the peri-catheter collection of cerebrospinal fluid with the risk of infection. We propose a novel method of utilizing a modified tunneller with a distal “Capsule” that provides just enough space both, at the appropriate distance and for adequate length, for the chamber to fit snugly and thus avoid procedure-related risks and complications as well as reduce the total duration of surgery, thereby decreasing the chances of infection.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"4 1","pages":"280 - 283"},"PeriodicalIF":0.2,"publicationDate":"2022-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85935350","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}
Shrithi Karanth, Shilpa Rao, A. Savardekar, Aravinda Hr, N. Pruthi, Arimapamagan Arivazhagan, D. Bhat, Dwarakanath Srinivas, B. Devi, S. Somanna, A. Mahadevan
Abstract Background Vascular malformations (VMs) of the central nervous system comprise a variety of lesions that could affect the arteries, veins, or capillaries. Materials and Method s We analyzed the histopathological features of all the VMs diagnosed at our centre over a decade. Results Intracranial VM included arteriovenous malformation (AVM) (53%), cerebral cavernous malformations (CCMs) (45%), capillary telangiectasia (2%), venous angioma (0.5%), and arteriovenous fistula (AVF) (0.5%). In spinal VMs, capillary telangiectasia (40%) were the most common, followed by cavernomas (34%), AVF (16%), and AVMs and venous angiomas (5%). Clinical presentation varied from focal deficit to features of raised intracranial tension. Conclusion Imaging and histopathology plays an important role in the diagnosis and management of VMs. Histopathological examination is essential for characterization of the VMs, which influences the prognosis.
{"title":"Pathological Spectrum of Vascular Malformations of the Central Nervous System: A Single Institution Experience of a Decade","authors":"Shrithi Karanth, Shilpa Rao, A. Savardekar, Aravinda Hr, N. Pruthi, Arimapamagan Arivazhagan, D. Bhat, Dwarakanath Srinivas, B. Devi, S. Somanna, A. Mahadevan","doi":"10.1055/s-0042-1749141","DOIUrl":"https://doi.org/10.1055/s-0042-1749141","url":null,"abstract":"Abstract Background Vascular malformations (VMs) of the central nervous system comprise a variety of lesions that could affect the arteries, veins, or capillaries. Materials and Method s We analyzed the histopathological features of all the VMs diagnosed at our centre over a decade. Results Intracranial VM included arteriovenous malformation (AVM) (53%), cerebral cavernous malformations (CCMs) (45%), capillary telangiectasia (2%), venous angioma (0.5%), and arteriovenous fistula (AVF) (0.5%). In spinal VMs, capillary telangiectasia (40%) were the most common, followed by cavernomas (34%), AVF (16%), and AVMs and venous angiomas (5%). Clinical presentation varied from focal deficit to features of raised intracranial tension. Conclusion Imaging and histopathology plays an important role in the diagnosis and management of VMs. Histopathological examination is essential for characterization of the VMs, which influences the prognosis.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"37 1","pages":"064 - 070"},"PeriodicalIF":0.2,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79312239","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}
Neurosurgery is a rapidly ever evolving, challenging, and young specialty. We are in a race toward technological advancement to achieve excellence in postoperative outcome, avoiding and anticipating complications. Skull base neurosurgery has moved signi fi cantly forward with pioneering contributions from eminent neurosurgeons to enrich neuroanatomical knowledge, promoting safe and innovative surgical approaches.
{"title":"Predicting the Position of the Internal Landmarks of Middle Cranial Fossa Using the Zygomatic Root: An Attempt to Simplify Its Complexity","authors":"C. Kaliaperumal","doi":"10.1055/s-0042-1750297","DOIUrl":"https://doi.org/10.1055/s-0042-1750297","url":null,"abstract":"Neurosurgery is a rapidly ever evolving, challenging, and young specialty. We are in a race toward technological advancement to achieve excellence in postoperative outcome, avoiding and anticipating complications. Skull base neurosurgery has moved signi fi cantly forward with pioneering contributions from eminent neurosurgeons to enrich neuroanatomical knowledge, promoting safe and innovative surgical approaches.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90720160","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}
Santosh Sharma, K. Mathur, A. Mittal, Meel Mukta, A. Jindal, Mukesh Kumar
Abstract Introduction In consonance with current the World Health Organization (WHO) classification of the central nervous system (CNS) tumors (2016), histological diagnosis of gliomas should be reinforced by molecular information. This study was performed to determine the frequency of isocitrate dehydrogenase 1 (IDH1), α thalassemia/intellectual disability syndrome X-linked (ATRX), p53, and BRAF V600E mutations in different grade astrocytomas and oligodendrogliomas. Methods Seventy-seven cases of astrocytoma and oligodendroglioma (7 pilocytic astrocytomas, 15 diffuse astrocytomas [DA], 4 anaplastic astrocytomas [AA], 29 glioblastomas [GBM], and 22 oligodendrogliomas) were analyzed using immunohistochemistry for IDH1 mutant protein, ATRX, p53, and BRAF as well as their clinicopathological features assessed. Results All pilocytic astrocytoma and primary glioblastoma cases were negative for an IDH1 mutation. IDH1 mutation was detected in 66.7% (10/15) of DA, 50% (2/4) of AA, 20.7% (6/29) of glioblastomas, and 81.8% (18/22) of oligodendroglioma cases. Loss of nuclear ATRX expression was found in 86.7% (13/15), 75% (3/4), and 34.5% (10/29) of DA, AA, and GBM cases, respectively. All oligodendroglioma cases showed retained ATRX expression. Both markers were found statistically significant in the above tumors ( p <0.05). BRAF V600E mutation was detected in a single case of pilocytic astrocytoma and pleomorphic xanthoastrocytoma as well as both cases of epithelioid glioblastoma. Conclusions IDH1 and ATRX mutations are very common in diffuse astrocytoma and anaplastic astrocytoma, while they are rare in pilocytic astrocytoma and glioblastoma. Immunohistochemistry for IDH1 and ATRX can successfully characterize the diffuse gliomas into molecularly defined groups in the majority of the cases. BRAF V600E mutation is rare in astrocytic tumors in the Indian population.
{"title":"Study of Surrogate Immunohistochemical Markers IDH1, ATRX, BRAF V600E, and p53 Mutation in Astrocytic and Oligodendroglial Tumors","authors":"Santosh Sharma, K. Mathur, A. Mittal, Meel Mukta, A. Jindal, Mukesh Kumar","doi":"10.1055/s-0042-1743265","DOIUrl":"https://doi.org/10.1055/s-0042-1743265","url":null,"abstract":"Abstract Introduction In consonance with current the World Health Organization (WHO) classification of the central nervous system (CNS) tumors (2016), histological diagnosis of gliomas should be reinforced by molecular information. This study was performed to determine the frequency of isocitrate dehydrogenase 1 (IDH1), α thalassemia/intellectual disability syndrome X-linked (ATRX), p53, and BRAF V600E mutations in different grade astrocytomas and oligodendrogliomas. Methods Seventy-seven cases of astrocytoma and oligodendroglioma (7 pilocytic astrocytomas, 15 diffuse astrocytomas [DA], 4 anaplastic astrocytomas [AA], 29 glioblastomas [GBM], and 22 oligodendrogliomas) were analyzed using immunohistochemistry for IDH1 mutant protein, ATRX, p53, and BRAF as well as their clinicopathological features assessed. Results All pilocytic astrocytoma and primary glioblastoma cases were negative for an IDH1 mutation. IDH1 mutation was detected in 66.7% (10/15) of DA, 50% (2/4) of AA, 20.7% (6/29) of glioblastomas, and 81.8% (18/22) of oligodendroglioma cases. Loss of nuclear ATRX expression was found in 86.7% (13/15), 75% (3/4), and 34.5% (10/29) of DA, AA, and GBM cases, respectively. All oligodendroglioma cases showed retained ATRX expression. Both markers were found statistically significant in the above tumors ( p <0.05). BRAF V600E mutation was detected in a single case of pilocytic astrocytoma and pleomorphic xanthoastrocytoma as well as both cases of epithelioid glioblastoma. Conclusions IDH1 and ATRX mutations are very common in diffuse astrocytoma and anaplastic astrocytoma, while they are rare in pilocytic astrocytoma and glioblastoma. Immunohistochemistry for IDH1 and ATRX can successfully characterize the diffuse gliomas into molecularly defined groups in the majority of the cases. BRAF V600E mutation is rare in astrocytic tumors in the Indian population.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"46 1","pages":"137 - 146"},"PeriodicalIF":0.2,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75536619","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}
Long insular artery (LIA) infarct can occur after insular glioma surgery. LIA infarct after extracranial-intracranial (EC-IC) bypass is very rare, and so far, it is not reported in EC-IC bypass. Here, we report a case of high-flow EC-IC bypass, where postoperatively, the patient developed isolated LIA infarct. A 65-year-old female presented with recurrent severe headache along with altered sensorium. Computed tomography (CT) scan and CT angiography (CTA) of the brain showed ruptured large left internal carotid artery (ICA) fusiform aneurysm. She underwent left-sided, high-flow EC-IC bypass involving upper trunk of left middle cerebral artery (MCA) and ICA ligation at neck at its origin. Postoperatively, the patient developed right sided hemiplegia. Postoperative MRI of the brain showed left-sided external capsular infarct, extending up to the corona radiata resulted from LIA infarct. By the end of 6 months after operation, she could walk with support but her left upper limb remained more severely affected and magnetic resonance angiogram (MRA) showed almost disappearance of aneurysm with functioning bypass.
{"title":"Post-operative Corona Radiata Infarct in a High-flow EC-IC Bypass: Report of Unusual Complication","authors":"F. Chowdhury, M. Haque","doi":"10.1055/s-0042-1742477","DOIUrl":"https://doi.org/10.1055/s-0042-1742477","url":null,"abstract":"Long insular artery (LIA) infarct can occur after insular glioma surgery. LIA infarct after extracranial-intracranial (EC-IC) bypass is very rare, and so far, it is not reported in EC-IC bypass. Here, we report a case of high-flow EC-IC bypass, where postoperatively, the patient developed isolated LIA infarct. A 65-year-old female presented with recurrent severe headache along with altered sensorium. Computed tomography (CT) scan and CT angiography (CTA) of the brain showed ruptured large left internal carotid artery (ICA) fusiform aneurysm. She underwent left-sided, high-flow EC-IC bypass involving upper trunk of left middle cerebral artery (MCA) and ICA ligation at neck at its origin. Postoperatively, the patient developed right sided hemiplegia. Postoperative MRI of the brain showed left-sided external capsular infarct, extending up to the corona radiata resulted from LIA infarct. By the end of 6 months after operation, she could walk with support but her left upper limb remained more severely affected and magnetic resonance angiogram (MRA) showed almost disappearance of aneurysm with functioning bypass.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76586791","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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