Clinical Experience of Fluroscopy Guided Percutaneous Transpedicular Biopsy of Spinal Lesion.

INTRODUCTION: The diagnosis of the spinal lesions often puts the clinician in dilemma. The definite diagnosis is obviously needed for the proper management of the disease. The wrong diagnosis not only imposes the adverse effects, but sometimes may lead to the disabling conditions and even prove to be life threatening. This study is aimed at evaluating the need of fluoroscopy guided percutaneous transpedicular biopsy for establishing the proper diagnosis and find the diagnostic yield. METHODS: This is the descriptive cross-sectional study conducted over the period of 10 years in the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences among the patients who underwent transpedicular biopsy for various spinal lesions. RESULTS: Among the 77 cases, 38 (49%) of the lesions on MRI were single level whereas 39 (51%) of the lesions were multiple. Most of the lesions were diagnosed as the non-tubercular infection 30 (42%), followed by the osteoporotic fractures and malignancy in 18 (25%) and 15 (21%) respectively. The sensitivity and specificity of the radiology with the background of clinical scenario was 79.5% and 90.9% respectively. The diagnostic yield of the biopsy was 93.5%. CONCLUSIONS: The transpedicular biopsy of the spinal lesion is the must for the proper diagnosis and treatment plan of such cases. The change in the diagnosis after biopsy is often possible which will drastically alter the treatment plan.

Morphometric Measurement of Cranial Vault Thickness: A Tertiary Hospital Based Study.

INTRODUCTION: The skull's main function is to protect the brain. Total skull bone thickness is the total thickness of diploe and the external and internal tables. The measurement of the human skull based on CT images results are of great practical value in the fields of anatomy, clinical medicine, biomechanics study and head injury analysis. There are few literatures about imaging assisted measurement of the cranial vault thickness while sparse literature among Nepalese population. In this study, we aim to measure the thickness of calvarian bones of and find the difference between gender and ethnic groups. METHODS: This was a descriptive cross-sectional study conducted in our center during a period of 6 months. Patient of age 15 to 50 years with normal CT finding were included in the study. Using the axial view of brain CT, the thickness of cranial vault was measured and recorded in millimeter. RESULTS: Among 100 patients, 51 were male and 49 were female. Mean thickness of frontal bone, parietal, temporal and occipital bone were 8.02±1.97 mm, 7.04±1.43 mm, 4.71±1.34 mm and 7.98±2.47 mm respectively. CONCLUSIONS: There was no significant difference in cranial vault thickness among sex or ethnical groups in patients of a hospital.

Venture in 101 Cranial Punctures: A Comparative Study between Frame-based versus Frameless Biopsy of 101 Intracranial Space Occupying Lesion.

BACKGROUND: Presumptive diagnosis based solely on the clinical picture and imaging is not sufficient to provide appropriate treatment with certainty and hence histopathological confirmation of intracranial space occupying lesion (ICSOL) is essential. Needle biopsy via stereotactic frame-based or frameless neuronavigation technique is efficient procedure. The objective of this study is to compare their accuracy and efficacy and safety. METHODS: This is a retrospective comparative study conducted among 101 biopsies of ICSOL. Patients data were retrieved from medical record. Data were analyzed in SPSS ver. 20. P value of <0.05 was considered significant. RESULTS: Out of 101 patients, Frame-based stereotactic biopsy was done among 55 patients (54.4%) while 46 patients (45.6%) underwent frameless stealth neuronavigation guided biopsy. Male to female ration was 2.1:1. Age ranged from 5 to 82 years. 54.5% (55 patients) have deeper location of tumor while 45.5% (46 patients) have lobar location of tumor. Frontal (16.8%) and Thalamic (13.8%) were the common site. Mean size of tumor was 3.09±0.85cms. There was statistically significant difference in operative duration among study groups. Overall Diagnostic yield was 89.1%. Glioma was the most common (50.5%) diagnosis. Glioblastoma WHO Grade IV was 37.6% followed by lymphoma (12.8%). CONCLUSION: Needle biopsy via stereotactic frame-based or neuronavigation frameless technique is a safe and efficient procedure having high diagnostic yield. Reasons for negative biopsy could be missed target or retrieval of gliotic tissue.

Clinical Experience with Frame Based Stereotactic Biopsy for Intracranial Space Occupying Lesion.

INTRODUCTION: Preoperative diagnosis of intracranial space occupying lesion based solely on clinical and neuroimaging evaluation may not be sufficient to institute treatment plan without histopathological certainty. Frame based stereotactic biopsy is a technique of retrieving biopsy specimen to determine the histopathology. The aim of this study is to assess the efficacy and accuracy of frame based technique. METHODS: This is a cross-sectional study conducted among 80 patients who underwent computed tomography guided frame based stereotactic biopsy during a period of 6 years. All operations were performed under local anesthesia. Histopathology reports were retrieved and accuracy of biopsy technique analyzed. RESULTS: Out of 80 patients, 58 were male with male to female ratio of 2.6:1. Median age of patients were 50 years with range from 16 to 75 years. Most lesions were in deeper location 49 (61.3%). Most common location was Parietal, 15 (18.8%) followed by Thalamic, 12 (15%). Mean size of lesion was 2.88±0.71cms ranged from 2 to 5cms. Biopsy was accurate to retrieve target in 74 (92.5%) patients. Histopathology revealed glial tumor in 41 (51.2% ) of cases. Overall morbidity was observed in 3 (5.5%) patients. There is no procedure related mortality in this study during study period. CONCLUSIONS: Frame based biopsy of intracranial space occupying lesion is safe and efficacious procedure with high diagnostic yield.

Transcranial doppler ultrasonography cerebral blood flow dynamics study of neurosurgical patients in peri-agonal period with fixed dilated or non-reacting pupils.

INTRODUCTION: Fixed dilated and unreactive pupils are a harbinger of imminent death in neurosurgical patients, signifying that the brainstem is not functioning. Transcranial Doppler (TCD) ultrasonography is a noninvasive, bedside method of determining the flow velocities in the basal cerebral arteries, used extensively in various neurosurgical conditions. AIMS AND OBJECTIVES: To study the cerebral blood flow dynamics of neurosurgical patients in peri-agonal period with fixed dilated or non reacting pupils using TCD. MATERIALS AND METHODS: Repeated TCD studies were done in patients with fixed dilated or unreactive pupils in a tertiary care, neurosurgical hospital over a year, recording the various waveforms and indices as Pulsatility Index (PI), Resistivity Index, Peak systolic flow velocity (PSV), End diastolic flow velocity (EDV), Mean cerebral blood flow velocity (MCBFV) of their middle cerebral artery in their peri-agonal period. The subsequent change in the indices as the patients died or improved was analyzed. RESULTS: A total of 104 TCD studies were done on 57 patients. Mean initial PI and MCBFV in the patients that died were 1.52 ± 0.76 and 28.55 ± 14.92 cm/sec respectively; and in the patients that showed neurosurgical recovery was 1.11 ± 0.28 and 36.52 ± 8.56 cm/sec respectively. Four out of 57 patients showed neurosurgical recovery and all of them had an initial PI less than 1.4 and they showed decrement in PI and increment in MCBFV on subsequent TCD study. The specificity and positive predictive value of the TCD waveform in predicting death was 100%, however, it had low sensitivity (47.17%) and negative predictive value (12.5%). CONCLUSION: The various indices and waveforms of TCD can be useful in assessing the cerebral blood flow dynamics in patients with various traumatic and non-traumatic ailments in the peri-agonal period; and hence help in their management as well as in the confirmation of brainstem death.

Chorea-acanthocytosis: a case report.

Neuroacanthocytosis is a group of rare disorders. We report a 36-year-old right-handed female who presented with gradually progressive abnormal facial movements, generalized weakness, and lower-lip biting starting 4 years ago. On examination, she had lower-lip ulcer, orofacial dyskinesias, and peripheral neuropathy. Her peripheral blood smears showed acanthocytosis and magnetic resonance imaging revealed atrophied head of caudate nuclei and putaminal hyperintensities on T2-weighted and fluid attenuated inversion recovery images. Work-up for autoimmune and metabolic causes was negative. She was diagnosed with chorea-acanthocytosis, an entity under neuroacanthocytosis syndrome and the patient was offered symptomatic treatment.