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1.
Childs Nerv Syst ; 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38644384

RESUMO

Dural sinus malformation (DSM) is a rare vascular malformation characterized by the dilatation of a dural venous sinus with or without an anomalous jugular bulb. Its presentation with venous-reflux-related secondary proptosis is anecdotal, with only six such cases reported so far. We report a 17-month-old boy who presented with a progressive proptosis of the right eye secondary to a DSM of the transverse sinus and torcula. Following endovascular embolization of the arterio-venous fistula, complete thrombosis of the venous lake and improvement in proptosis was noted at 6-month follow-up. Prognosis of this rare malformation is variable and dependent on specific angio-architectural features.

4.
World Neurosurg ; 179: 66-67, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37611803

RESUMO

A 34-year-old man presented with a 2-year history of medically refractory Holmes tremor in the right upper limb. Magnetic resonance imaging revealed a large, nonenhancing, multiseptate cystic lesion of cerebrospinal fluid intensity in the left thalamopeduncular region causing brainstem compression and hydrocephalus. A diagnosis of giant tumefactive perivascular spaces was made after a biopsy ruled out an infectious or neoplastic etiology. Significant clinicoradiologic improvement was noted following a ventriculoperitoneal shunt. Giant tumefactive perivascular spaces should be included as one of the rare differentials of a large, nonenhancing cystic lesion situated along the course of perforator vessels. Treatment options include cerebrospinal fluid diversion with or without cyst fenestration.


Assuntos
Hidrocefalia , Tremor , Masculino , Humanos , Adulto , Tremor/diagnóstico por imagem , Tremor/etiologia , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Imageamento por Ressonância Magnética/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Biópsia/efeitos adversos
7.
Childs Nerv Syst ; 39(7): 1957-1962, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36932253

RESUMO

It is very unusual for a primary intracranial malignancy to present as a chronic subdural hematoma. This case report describes one such case in a 3-year-old girl who presented with raised intracranial pressure following a mild head injury. Imaging of her brain revealed bilateral chronic subdural hematomas with an enhancing subdural mass and multiple nodular lesions infiltrating the brain parenchyma. She underwent a craniotomy, drainage of the subdural collections and resection of the subdural mass. Histopathology revealed an undifferentiated sarcoma, and she was referred for adjuvant therapy. This case underlines the importance of evaluating paediatric subdural collections for a possible underlying malignancy, even in the background of a preceding head injury. The cause-effect relationship of sarcomas with subdural collections remains unclear because of the scarcity of available literature on the subject.


Assuntos
Neoplasias Encefálicas , Hematoma Subdural Crônico , Sarcoma , Humanos , Criança , Feminino , Pré-Escolar , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Sarcoma/cirurgia , Craniotomia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Tomografia Computadorizada por Raios X
9.
Neurol India ; 70(6): 2357-2365, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36537416

RESUMO

Introduction: Quality of life (QOL) assessment is increasingly being recognized as an important parameter while evaluating outcomes after endoscopic endonasal transsphenoidal surgery (EETS). There has been no study that has evaluated this in the Indian context. Objectives: We aimed to analyze sinonasal and overall QOL before and after EETS for non-functioning pituitary adenomas (NFPAs), and to evaluate possible correlations between changes in QOL and various clinicoradiological, hormonal, and surgical factors. Methods: This prospective observational study included 62 patients who underwent EETS for NFPAs. The Anterior Skull Base Nasal Inventory-12 (ASK-12) and Short Form-12 (SF-12) were used to assess QOL. Changes in QOL were recorded at 2 weeks, 3 months, and 1-year follow-up periods. Results: While the nasal crusting and nasal discharge components of the ASK-12 worsened 2 weeks after EETS, the headache component demonstrated significant improvement (P < 0.05). The overall ASK-12 score (6.69+/-7.98) did not change significantly at follow-up. The SF-12 physical component summary (PCS) score (42.14+/-8.54) improved progressively after surgery, while the SF-12 mental component summary (MCS) score (42.48+/-7.95) improved 1 year later. The SF-12 PCS correlated with visual field improvement at 3-month follow-up (P = 0.04). Conclusions: EETS affects some components of the ASK-12 without affecting the overall sinonasal QOL in patients with NFPAs. These patients demonstrate progressive postoperative improvement in physical well-being, while their mental functioning improves only a year later. Improvement in physical functioning correlates with visual field improvement at a 3-month follow-up. Hormonal dysfunction and surgical factors do not have any impact on QOL in these patients.


Assuntos
Neoplasias Hipofisárias , Humanos , Neoplasias Hipofisárias/cirurgia , Qualidade de Vida , Resultado do Tratamento , Nariz , Endoscopia/métodos
10.
Neurol India ; 70(6): 2449-2451, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36537434

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is an unusual neurological condition known to occur in the setting of various risk factors such as acute hypertension, renal failure, sepsis, multiorgan failure, autoimmune disease, and immunosuppression. Twenty cases of PRES have been previously reported in neurosurgical literature, almost all of which were attributed to either hypertension or chemotherapeutic drugs. Herein, we report a case of PRES in a neurosurgical patient in the absence of the commonly described risk factors for the syndrome. The patient was a 9-year-old boy who underwent uneventful transcranial resection of a suprasellar craniopharyngioma. His postoperative clinical course was complicated by hepatic failure and hypothalamic dysfunction, both of which were managed conservatively. Ten days after the onset of these complications, he developed clinical and radiological features suggestive of PRES which eventually resolved at follow-up. We discuss the pathogenesis of this unusual neurological syndrome in our patient in the light of a literature review.


Assuntos
Craniofaringioma , Hipertensão , Neoplasias Hipofisárias , Síndrome da Leucoencefalopatia Posterior , Masculino , Humanos , Criança , Fatores de Risco , Hipertensão/complicações , Neoplasias Hipofisárias/complicações , Progressão da Doença
11.
Neurol India ; 70(Supplement): S211-S217, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412371

RESUMO

Introduction: There is conflicting data on the risk factors for recurrent lumbar disc herniation (rLDH). Most of the predictors for rLDH identified so far are acquired risk factors or radiological factors at the level of the herniation. Whole lumbar spine (WLS) morphometry has not been evaluated as a possible predictor of rLDH. Objectives: We aimed to evaluate if preoperative spinal morphometry can predict the occurrence of rLDH requiring revision surgery. Methods: This retrospective case-control study on 250 patients included 45 patients operated for rLDH, 180 controls without rLDH who had previously undergone microdiscectomy for a single level lumbar disc prolapse, and a holdout validation set of 25 patients. Morphometric variables related to the WLS were recorded in addition to previously identified predictors of rLDH. Logistic regression (LR) analysis was performed to identify independent predictors of rLDH. Results: LR yielded four predictors of which two were WLS morphometric variables. While increasing age and smoking positively predicted rLDH, increasing WLS interfacet distance and WLS dural-sac circumference negatively predicted rLDH. The LR model was statistically significant, χ2 (4) =15.98, P = 0.003, and correctly classified 80.3% of cases. On validation, the model demonstrated a fair accuracy in predicting rLDH (accuracy: 0.80, AUC: 0.70). Conclusions: Larger mean lumbar bony canals and dural sacs protect from the occurrence of symptomatic rLDH. These WLS morphometric variables should be included in future risk stratification algorithms for lumbar disc disease. In addition to the previously recognized risk factors, our study points to an underlying developmental predisposition for rLDH.


Assuntos
Discotomia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Humanos , Estudos de Casos e Controles , Discotomia/métodos , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/cirurgia , Microcirurgia , Recidiva , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco
12.
Neurol India ; 70(4): 1417-1426, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36076638

RESUMO

Background: Controversies exist regarding the ideal surgical approach for tumors in posterior third ventricular region (PTV). Objective: To evaluate the results of occipital interhemispheric transtentorial (OITT) approach for tumors in PTV. Materials And Methods: Thirty-three patients underwent surgery via OITT approach for PTV tumors at Sri Sathya Sai Institute of Higher Medical Sciences during the study period of 5 years (June 2011-May 2016). Ideal trajectory for OITT approach was determined by neuronavigation. Endoscope was used for removing any residual lesion at the blind spots. Results: Postoperative magnetic resonance imaging (MRI) performed in all the patients revealed gross total or near-total (>95%) excision of tumor in 31 patients (93.9%). Preoperative neurological deficits improved either completely or significantly following excision of the tumor in 73.3% (11/15) of the patients. Outcome was good (modified Rankin scale ≤2) at discharge in 93.9% (31/33) and at a final follow-up of 3 months or more in 96.8% (30/31) of the patients. None of the patients died during the postoperative period. Complications included upgaze palsy (transient- 6.1% [2/33], persisting- 3% [1/33]), visual field defects (transient- 3% [1/33], persisting- 3% [1/33]), transient third nerve paresis (1/33-3%), transient hemiparesis (1/33-3%), operative site hematoma (1/33-3%), small posterior cerebral artery (PCA) territory infarct (1/33-3%), and small venous infarct (1/33-3%). At least one follow-up MRI could be performed in 23 patients. Final follow-up MRI revealed no recurrence or increase in the size of the residual lesion compared to postoperative images in 20 patients (20/23-87%) and large recurrence in 3 patients (3/23-13%) with high-grade lesions. Conclusion: Gross total/near-total excision can be performed in majority of the PTV tumors through OITT approach with minimal morbidity and mortality.


Assuntos
Neoplasias Meníngeas , Meningioma , Glândula Pineal , Terceiro Ventrículo , Humanos , Infarto/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Glândula Pineal/patologia , Terceiro Ventrículo/cirurgia
13.
Asian J Neurosurg ; 17(1): 68-73, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35873854

RESUMO

Background Monomelic amyotrophy (Hirayama disease) has been established to have accompanied biomechanical abnormalities such as flexion hypermobility and sagittal imbalance. Paraspinal muscles, the major contributor to cervical biomechanics, have, however, not been comprehensively evaluated in the disease. The objective of this study was to compare the morphology of the subaxial cervical paraspinal musculature in patients with and without Hirayama disease. Materials and Methods A retrospective case-control study of 64 patients with Hirayama disease and 64 age- and sex-matched controls was performed . Cross-sectional areas (CSAs) of the superficial and deep flexors and extensors from C3 to C7 were measured on T2-weighted magnetic resonance imaging sequences. Student's t -test was used to compare differences between the paraspinal muscle CSAs in the study and control groups. Results Compared with controls, patients with Hirayama disease were found to have larger flexors and smaller extensors at all levels. The overall subaxial muscle area values for superficial flexors and deep flexors were significantly larger ( p < 0.0001) in patients, while the corresponding superficial extensor and deep extensor area values were significantly smaller than in controls ( p = 0.01 and < 0.0001, respectively). The patient group demonstrated stronger subaxial deep flexor-deep extensor, superficial flexor-superficial extensor, and total flexor-total extensor ratios ( p < 0.0001). Conclusion Patients with Hirayama disease have morphometric alterations at all levels of their subaxial cervical paraspinal musculature. These patients have abnormally large flexors and small extensors compared with controls. This flexor-extensor muscle disparity could be utilized as a potentially modifiable factor in the management of the disease.

15.
Clin Neuropathol ; 41(2): 66-73, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35034688

RESUMO

Paraganglioma that involves the CNS may mimic clinico-radiologically many other commoner entities. The current study presents a wide view of the clinical, radiological, and histomorphological spectrum along with rare associations that can occur concurrently with this lesion. The most common site of infliction in CNS is the spine and, in the current series, involvement of the lumbar spine was most frequent. Both clinical and radiological features point towards other more common differentials, including neurofibroma/schwannoma and ependymoma. Some studies suggest rich vascularity (cap sign) and salt pepper appearance in T2-weighted images to serve as soft pointers towards diagnosing it on magnetic resonance imaging, however, in our series we did not encounter the same.


Assuntos
Ependimoma , Neurilemoma , Paraganglioma , Ependimoma/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Neurilemoma/patologia , Paraganglioma/diagnóstico , Paraganglioma/patologia , Centros de Atenção Terciária
16.
World Neurosurg ; 157: e497-e505, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34710575

RESUMO

BACKGROUND: Two-dimensional (2D) morphometric measures have been previously used to diagnose Chiari I malformation (CMI) and distinguish patients from healthy subjects. There is, however, a paucity of literature regarding whether morphometric differences exist across the range of CMI disease severity. We evaluated whether 2D morphometrics demonstrate significant changes across standardized grades of CMI severity in adults. METHODS: This retrospective observational study comprised 76 patients with symptomatic CMI with or without syringomyelia. Patients matched for age, sex, and body mass index were selected from each of the 3 severity grades of the Chiari Severity Index (CSI). The study used 17 2D craniocervical and posterior fossa morphometric variables that were previously found to differentiate patients with CMI from healthy subjects. The measurements were performed on midsagittal T1-weighted magnetic resonance imaging sequences using 2 custom in-house software tools, MorphPro and CerePro, and compared across CSI grades. RESULTS: Analysis of variance showed that none of the 17 morphometric variables were significantly different across the 3 CSI grades (P > 0.003). Bayes factor 10 scores ranged from 0.11 to 0.82. Of variables, 9 had Bayes factor 10 scores between 0.10 and 0.30, while 8 had scores between 0.30 and 1. None of the Bayes factor 10 scores provided support for the alternative hypothesis that the morphometric measures differed across the CSI grades. CONCLUSIONS: Our study indicated that 2D morphometrics are not reflective of CMI disease severity as indicated by the CSI grading system. The findings of our study support the need for further investigation into whether non-2D morphometric variables can be used as markers of disease severity.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Índice de Gravidade de Doença , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
17.
J Neurosci Rural Pract ; 12(4): 642-651, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34737497

RESUMO

Background The optimal management and the role of surgery in monomelic amyotrophy, also known as Hirayama disease (HD), remain controversial. In the largest series of patients with HD managed by cervical duraplasty (CD), this study compares the outcomes between conservative and surgical management. Methods A retrospective case-control study was performed on 60 patients with HD. The cases consisted of 30 patients who underwent CD, and 30 age- and sex-matched controls who managed with long-term collar wear. Clinical improvement was recorded using two patient-reported outcome measures-the Odom's scale and a self-rated hand grip strength score. Median and ulnar compound muscle action potential (CMAP) amplitudes and various magnetic resonance imaging parameters were recorded. Results None of the controls experienced clinical improvement at follow-up; 90% remained status quo at 24.33 ± 9.38 months. Seventy-six percent of the operated patients demonstrated clinical improvement at 29.61 ± 12.78 months, and a majority of them reported moderately better grip strength. The preoperative anteroposterior diameter (APD) of the surgical group improved from 0.74 ± 0.13 to 0.86 ± 0.21 ( p = 0.01), and the cord demonstrated a significant decrease in forward migration on flexion (0.20 ± 0.11 and 0.03 ± 0.07 preoperatively and at follow-up, respectively, p < 0.0001). Patients with clinical improvement demonstrated significantly better mean APD and median and ulnar CMAP values than those who did not improve ( p < 0.0001). The mean cervical alignment did not change significantly at follow-up ( p = 0.13). Conclusions This study shows that CD can significantly alter the clinical course of patients with progressive symptoms of HD. This approach successfully arrests the forward migration of the cervical cord on flexion and promotes morphological recovery of the cord. A majority of the patients undergoing CD demonstrate clinical and electrophysiological improvement at mid-term follow-up.

18.
J Neurosci Rural Pract ; 12(2): 302-307, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33935447

RESUMO

Background Cardiogenic brain abscess (CBA) is the commonest noncardiac cause of morbidity and mortality in cyanotic heart disease (CHD). The clinical diagnosis of a CBA is often delayed due to its nonspecific presentations and the scarce availability of computed tomography (CT) imaging in resource-restricted settings. We attempted to identify parameters that reliably point to the diagnosis of a CBA in patients with Tetralogy of Fallot (TOF). Methods From among 150 children with TOF treated at a tertiary care institute over a 15-year period from 2001 to 2016, 30 consecutive patients with CBAs and 85 age- and sex-matched controls without CBAs were included in this retrospective case-control study. Demographic and clinical features, laboratory investigations, and baseline echocardiographic findings were analyzed for possible correlations with the presence of a CBA. Statistical Analysis Variables demonstrating significant bivariate correlations with the presence of a CBA were further analyzed using multivariate logistic regression (LR) analysis. Various LR models were tested for their predictive value, and the best model was then validated on a hold-out dataset of 25 patients. Results Among the 26 variables tested for bivariate associations with the presence of a CBA, some of the clinical, echocardiographic, and laboratory variables demonstrated significant correlations ( p < 0.05). LR analysis revealed elevated neutrophil-lymphocyte ratio and erythrocyte sedimentation rate values and a lower age-adjusted resting heart rate percentile to be the strongest independent biomarkers of a CBA. The LR model was statistically significant, (χ 2 = 23.72, p = <0.001), and it fitted the data well. It explained 53% (Nagelkerke R 2 ) of the variance in occurrence of a CBA, and correctly classified 83.93% of cases. The model demonstrated a good predictive value (area under the curve: 0.80) on validation analysis. Conclusions This study has identified simple clinical and laboratory parameters that can serve as reliable pointers of a CBA in patients with TOF. A scoring model-the 'BA-TOF' score-that predicts the occurrence of a CBA has been proposed. Patients with higher scores on the proposed model should be referred urgently for a CT confirmation of the diagnosis. Usage of such a diagnostic aid in resource-limited settings can optimize the pickup rates of a CBA and potentially improve outcomes.

19.
J Pediatr Neurosci ; 16(2): 163-164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35018188

RESUMO

We report a rare cause of paraparesis in a 2-year-old girl. Along with lower limb weakness, she presented with a neurogenic bladder and lower limb deformities. Her magnetic resonance imaging showed multiple dorsolumbar segmentation defects and a dysgenetic spinal cord segment between T10 and S1. A thin septum connected the lower end of the normal cord to a bulky conus at S1-2. These features were suggestive of type 1 segmental spinal dysgenesis. The findings were confirmed at surgery, and the child was referred for supportive care.

20.
World Neurosurg ; 146: e313-e322, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33096283

RESUMO

OBJECTIVE: To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the results of transoral odontoidectomy and posterior fusion (TOO+PF) with only posterior fusion (PF) in patients with irreducible AAD/BI. METHODS AND RESULTS: All 94 patients with congenital CVJ anomalies with AAD/BI operated on during the 3-year study period (June 2013-May 2016) were included. Of these patients, 55 had irreducible AAD/BI and the remaining 39 had reducible AAD/BI. TOO+PF was restricted to patients (34/94; 36.2%) with irreducible AAD/BI when reduction and realignment by intraoperative C1-C2 facet joint manipulation were considered technically difficult and risky. The remaining patients with irreducible AAD/BI and all the patients with reducible AAD/BI (60/94; 63.8%) were managed with only posterior fusion. Poor preoperative Nurick grade, preoperative dyspnea/lower cranial nerve deficits, and syringomyelia were associated with significantly higher incidence of postoperative pulmonary complications. Follow-up ≥3 months (final follow-up) was available for 87 patients. Good outcome (Nurick grade 0-3) at final follow-up was noted in 90% (45/50) of the patients with irreducible AAD/BI and 91.9% (34/37) of the patients with reducible AAD/BI. Preoperative poor Nurick grade (4-5) was the only factor associated with poor outcome. No significant difference in perioperative complications, outcome, and fusion was noted between patients who underwent TOO+PF or only PF for irreducible AAD/BI. CONCLUSIONS: Many of the patients with congenital AAD/BI showed remarkable recovery after surgery. Preoperative poor Nurick grade (4-5) is associated with poor outcome. TOO+PF is a safe alternative treatment option for irreducible AAD/BI when only PF techniques are technically difficult/risky.


Assuntos
Articulação Atlantoaxial/anormalidades , Articulação Atlantoaxial/cirurgia , Luxações Articulares/cirurgia , Platibasia/cirurgia , Fusão Vertebral/tendências , Adolescente , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Platibasia/diagnóstico por imagem , Cuidados Pré-Operatórios/tendências , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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