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Gobbur N, K Konar S, Birua GJS, Shashidhar A, A A. Mirror movements associated with cervical limited dorsal myeloschisis: a unique case study. Childs Nerv Syst 2024:10.1007/s00381-024-06389-6. [PMID: 38609721 DOI: 10.1007/s00381-024-06389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
Mirror movements, characterized by involuntary symmetrical movements in contralateral body parts during intentional movements, have been associated with various neurological conditions. Limited dorsal myeloschisis (LDM), a rare form of spinal dysraphism, is defined by a focal closed midline defect and a fibro-neural stalk connecting the skin lesion to the underlying cord. We present a unique case of a 4-year-old girl with cervical LDM exhibiting mirror movements. The patient underwent surgical exploration, skin tag excision, fibrous tract removal, and cervical spinal cord detethering. Post-operatively, there was a partial improvement in mirror movements and a complete resolution of hand grip weakness.
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Affiliation(s)
- Nishant Gobbur
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Subhas K Konar
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gyani J S Birua
- National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | | | - Arivazhagan A
- National Institute of Mental Health and Neurosciences, Bengaluru, India
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Birua GJS, Sadashiva N, Konar S, Shashidhar A, Beniwal M, Vazhayil V, Shukla D. Surgical Outcome of Torcula Herophili Meningioma: An Institutional Experience. World Neurosurg 2024; 184:e765-e773. [PMID: 38354772 DOI: 10.1016/j.wneu.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Resection of meningiomas (THMs) at the torcular Herophili poses challenges to surgeons due to complex regional anatomy. The current study aims to evaluate factors affecting the extent of resections, progression-free survival, and the role of radiation. METHODS We did a retrospective study of all the THM patients treated at our institute between May 1987 and June 2022. The demographic data, signs and symptoms, surgical notes, postoperative details, and radiotherapy were gathered retrospectively. Survival analysis was done with Kaplan-Meier tests along with predictors of the extent of resection as well as recurrence. RESULTS A total of 39 patients qualified to be included in the study, with 10 male patients (male:female 1:2.9) and an average age of 50.8 years. The average follow-up duration was 75.9 months. Simpson's grade 2 excision was achieved in 19 (48.7%) patients, followed by Simpson's grade 3 excision in 17 patients (43.6%). Progression-free survival in subtotal resection was 60 months, and 100 months in gross total resection. Statistically, the extent of the resection was determined by the involvement of sinuses/torcula and the number of quadrants involved around torcula. A total of 16 patients received radiosurgery for the residual or small reccurrence of the lesion. Follow-up revealed reccurrence in 5 cases. CONCLUSIONS Torcular meningiomas are relatively uncommon, described in few reports, and represent a therapeutic dilemma. Though some experts recommend complete removal of tumor and reconstruction of the sinus, others suggest maximum safe resection, followed by radiosurgery. The present study reflects reasonable control of the residual lesion with radiosurgery after maximum safe resection.
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Affiliation(s)
- Gyani J S Birua
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Ahmed S, Saini J, Gorantla P, Kulanthaivelu K, Shashidhar A, Deora H, Holla VV, Arora A. An Illustrative Review of the Pathomechanisms of Symptomatic Developmental Venous Anomalies. J Comput Assist Tomogr 2023; 47:940-950. [PMID: 37948370 DOI: 10.1097/rct.0000000000001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Symptomatic developmental venous anomalies (DVAs) are rare. Here, we illustrate the varied clinicoradiologic profiles of symptomatic DVAs and contemplate the mechanisms that render these (allegedly) benign entities symptomatic supported by a review of literature. METHODS Institutional databases were searched to identify cases of symptomatic DVAs. Clinical and imaging (angiographic and cross-sectional) data of 9 cases with 11 neurovascular symptoms consequent to inflow/outflow perturbations and mechanical obstruction that manifested because of the strategic topography of underlying DVAs were analyzed. A review of the existing literature on DVAs in agreement with our case series was performed on publications retrieved from the PubMed database. RESULTS Symptoms secondary to venous hypertension arising from flow-related perturbations were broadly divided into those arising from restricted outflow and increased inflow. Restricted outflow occurred because of collector vein stenosis (n = 2) and collector vein/DVA thrombosis (n = 3), whereas the latter pathomechanism was initiated by arterialized/transitional DVAs (n = 2). A mechanical/obstructive pathomechanism culminating in moderate supratentorial ventriculomegaly was noted in 1 case. One patient was given a diagnosis of hemorrhage associated with a cavernoma. CONCLUSIONS Awareness and contextualization of potential flow-related perturbations and mechanical insults that render DVAs symptomatic aid in accurate diagnosis, management, and prognostication.
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Affiliation(s)
- Sabha Ahmed
- From the Departments of Neuroimaging and Interventional Radiology
| | - Jitender Saini
- From the Departments of Neuroimaging and Interventional Radiology
| | | | | | - Abhinith Shashidhar
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harsh Deora
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vikram V Holla
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ankit Arora
- From the Departments of Neuroimaging and Interventional Radiology
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Bisanalli S, Balachander B, Shashidhar A, Raman V, Josit P, Rao SP. The beneficial effect of early and prolonged kangaroo mother care on long-term neuro-developmental outcomes in low birth neonates - A cohort study. Acta Paediatr 2023; 112:2400-2407. [PMID: 37543716 DOI: 10.1111/apa.16939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
AIM Kangaroo mother care (KMC) has immense short-term benefits, but data on long-term outcomes are scarce. Hence, this study aimed to compare the neurodevelopmental outcomes at 12 months of corrected age (CA) in infants <2000 g receiving early and prolonged KMC to a control group. METHODS This was a cohort study that was conducted from January 2017 to November 2018. All neonates<2000 g were eligible for the study. Neonates that received early initiation (<72 h of life) and prolonged KMC comprised the intervention group and were compared to neonates without the intervention. Bayley Scales of Infant and Toddler Development, Third edition (BSID-III) was done at 12 months of CA, and this was analysed using t-test and multi-linear regression analysis. RESULTS There were 75 neonates in the intervention and 69 in the control group. Baseline characteristics were comparable. We found higher composite scores for cognition (110.38 ± 9.89 vs. 105.44 ± 8.77, p value = 0.023), language (107.51 ± 10.72 vs. 101.05 ± 12.06, p value = 0.014) and adaptive behaviour (87.97 ± 9.97 vs. 80 ± 9.1, p value<0.001) in the early and prolonged KMC group in comparison to the control group. CONCLUSION Infants with early and prolonged KMC have better neurodevelopmental outcomes in terms of cognition, language and adaptive behaviour at 12 months of CA.
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Affiliation(s)
- Shridevi Bisanalli
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - A Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Vijaya Raman
- Department of Psychiatry, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Pavitra Josit
- St.John's Research Institute, Bangalore, Karnataka, India
| | - Suman Pn Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
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Kulkarni AV, Shashidhar A, Malla BR, Saini J. Giant, lamellated colloid cyst: 'Russian-Doll' appearance. Br J Neurosurg 2023:1-4. [PMID: 37779360 DOI: 10.1080/02688697.2023.2263080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Colloid cysts (CCs) are usually small, benign lesions located at the foramen of Monro. They usually grow to a size of 1-3 cms. We have described here a giant colloid cyst of size 6 x 5.2 x 4.4 cm with a unique radiological appearance of multiple concentric layers with different intensities which has not been described before. This unusual appearance is most probably due to the variation of hydration between the different layers with gradually decreasing concentration of protein from centre to periphery, which correlated well with intraoperative and histopathological findings.
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Affiliation(s)
- Akshay V Kulkarni
- Department of Neurosurgery Mazumdar Shaw Medical Center, Bengaluru, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bhaskara Rao Malla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health And Neurosciences, Bengaluru, India
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Prabhuraj AR, Mehta S, Sadashiva N, Pruthi N, Arima A, Rao KN, Vazhayil V, Beniwal M, Shashidhar A, Birua GJS, Somanna S. Factors predicting recurrence in benign spinal nerve sheath tumors: A retrospective study of 457 patients from a single institution. J Clin Neurosci 2023; 114:158-165. [PMID: 37441931 DOI: 10.1016/j.jocn.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Benign Nerve sheath tumors (NST) comprise almost one-third of primary spinal tumours. The majority are sporadic. They have low rates of recurrence but an occasional recurrence may need re-surgery. The present study was designed to identify the variables that can predict the risk of their recurrence. METHODS A retrospective chart review was done including all the histologically proven benign spinal NSTs operated between 2001 and 2019 in our institute. Demographic, operative and postoperative follow-up data were recorded. Recurrence was defined as local reappearance after definite surgical excision or symptomatic increase in size of a residual tumour on follow-up imaging studies. Statistical analysis was done to determine the significant variables associated with local recurrence. RESULTS 457 patients with a median age of 38 years operated for 459 NSTs qualified for the study. The most frequent location of occurrence of tumours was found to be Low Cervical level (C3-C7 levels). Majority of Schwannoma were located intradurally while Neurofibroma were dumb-bell shaped and extradural. Most of the tumours had solid consistency. Post operatively, 7.7% patients developed complications. 7.8% tumours developed local recurrence after median period of 12 months. The patients developing recurrence were younger compared to nonrecurring tumors. On univariate analysis, male gender, Low cervical and Cervicothoracic junction location were associated with higher recurrence. On multivariate analysis, location at Cervicothoracic junction reached significance. CONCLUSION Overall recurrence risk among all NST was 7.8% with a median progression free survival of 36 months. The location of tumour at cervicothoracic location was the significant risk factors for recurrence of tumour in our study.
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Affiliation(s)
- A R Prabhuraj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Sarthak Mehta
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Arivazhagan Arima
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Kannepalli Narasingha Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Gyani Jail Singh Birua
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India
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Mishra RK, Sriganesh K, Surve RM, Sangeetha R, Chakrabarti D, Shashidhar A, Anju JL. Comparison of Perioperative Characteristics and Clinical Outcomes of COVID-19 and non-COVID-19 Patients Undergoing Neurosurgery—A Retrospective Analysis. J Neuroanaesth Crit Care 2022. [DOI: 10.1055/s-0042-1749144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Abstract
Background Patients with coronavirus disease 2019 (COVID-19) presenting for neurosurgery are not rare. Considering the lack of literature informing the outcomes in this subset, present study was conducted to compare perioperative management and postoperative outcomes between COVID-19 and non-COVID-19 neurosurgical patients.
Methods After ethics committee approval, data of all patients with COVID-19 along with an equal number of age and diagnosis matched non-COVID-19 patients undergoing neurosurgery between April 2020 and January 2021 was analyzed retrospectively. Predictors of poor outcome were identified using multivariate logistic regression analysis.
Results During the study period, 50 COVID-19 patients (28 laboratory confirmed (group-C) and 22 clinicoradiological diagnosed [group-CR]) underwent neurosurgery and were compared with 50 matched non-COVID-19 patients. Preoperatively, clinicoradiological diagnosed COVID-19 patients had higher American Society of Anesthesiologists (ASA) grade (p = 0.01), lower Glasgow Coma Scale (GCS) score (p < 0.001), and more pulmonary involvement (p = 0.004). The duration of intensive care unit stay was significantly longer in laboratory confirmed patients (p = 0.03). Poor clinical outcome (in-hospital mortality or discharge motor-GCS ≤ 5) did not differ significantly between the groups (p = 0.28). On univariate analysis, younger age, higher ASA grade, lower preoperative GCS, and motor-GCS, higher intraoperative blood and fluid administration and traumatic brain injury diagnosis were associated with poor outcome. On multivariable logistic regression. only lower preoperative motor-GCS remained the predictor of poor outcome.
Conclusions The concomitant presence of COVID-19 infection did not translate into poor outcome in patients undergoing neurosurgery. Preoperative motor-GCS predicted neurological outcome in both COVID-19 and non-COVID-19 neurosurgical patients.
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Affiliation(s)
- Rajeeb K. Mishra
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kamath Sriganesh
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rohini M. Surve
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R.P. Sangeetha
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhritiman Chakrabarti
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Janaki L Anju
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Deora H, Mishra A, Gupta R, Konar S, Vazhayil V, Shashidhar A, Dwarakanath S. Paediatric chronic subdural haematoma: what are the predisposing factors and outcomes in management of these cases? Childs Nerv Syst 2022; 38:123-132. [PMID: 34487204 DOI: 10.1007/s00381-021-05341-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Chronic subdural hematoma (cSDH) is a disease of the elderly population. Incidence in paediatric population is relatively uncommon. Child abuse, birth trauma, coagulopathy and shunt surgeries represent major causes. Major impact of the disease on life of patient due to recurrence and repeat surgical procedure is significant, not to mention the burden on health care system. MATERIAL AND METHODS We retrospectively reviewed our institute data for chronic sub-dural cases for the past 10 years (2008-2018) and collected data on the demography, clinical features, metabolic workup, mode of treatment, recurrence rates, predisposing factors, laterality, hematoma characteristics and factors associated with recurrence in all cases with less than or equal to 18 years of age. RESULTS A total of 30 such cases were found in a period of 10 years (2008-2018). The mean patient age was 7.3 years (range 2 months-17 years), with 20 males (66.67%) and 10 females (33.33%). Raised intracranial pressure (n = 9) was the commonest presenting symptom in 30% of cases followed by seizures in 26.67% (n = 8). The previous shunt was the commonest predisposing factor seen in 43.33% (n = 13). cSDHs were unilateral in 56.67% cases (n = 17) and bilateral in 43.33% (n = 13). Burr hole craniostomy was done in 27 cases (90%), and conservative management was done in three cases (10%). Follow up was available for 27 cases (90%) with a mean follow up duration of 24 months. Recurrence rate was 30% (n = 9). Shunt surgery contributed to 77% of bilateral disease (p = 0.009). Child abuse was not reported in our series. CONCLUSION Presence of paediatric cSDH is alarming, and the physician should be alerted to look for underlying cause and rule out child abuse. Detailed metabolic, skeletal workup is required. Treatment of primary pathology should be the goal as CSF diversion is not the solution to all problems, but can definitely be the cause of all the problems.
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Affiliation(s)
- Harsh Deora
- Neurosurgery, NIMHANS, Hosur Road, Bangalore, Karnataka, India
| | - Ajit Mishra
- Neurosurgery, NIMHANS, Hosur Road, Bangalore, Karnataka, India
| | - Rahul Gupta
- Neurosurgery, NIMHANS, Hosur Road, Bangalore, Karnataka, India
| | - Subhas Konar
- Neurosurgery, NIMHANS, Hosur Road, Bangalore, Karnataka, India
| | - Vikas Vazhayil
- Neurosurgery, NIMHANS, Hosur Road, Bangalore, Karnataka, India
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Kandregula S, Shashidhar A, Rao S, Beniwal M, Shukla D, Srinivas D, Saini J, Mahadevan A, Santosh V, Arimappamagan A. Granular Cell Tumor and Spindle Cell Oncocytoma of the Pituitary Gland: Imaging and Intraoperative Cytology Diagnostic Dilemmas and Management Challenges. J Neurol Surg A Cent Eur Neurosurg 2021; 83:442-450. [PMID: 34911085 DOI: 10.1055/s-0041-1740264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Tumors arising from the posterior pituitary gland are rare and closely resemble pituitary adenoma in presentation and imaging. Most of them come as a histopathologic surprise. We have analyzed the posterior pituitary tumors managed in our institute and have discussed the dilemmas in imaging, challenges in intraoperative squash cytology, and surgical management. METHODS We retrospectively reviewed our operative database of pituitary tumors over the past 10 years, which included five posterior pituitary tumors (three granular cell tumors [GCTs] and two spindle cell oncocytomas [SCOs]). Clinical, imaging, and endocrine characteristics; intraoperative details; histopathologic features; and postoperative outcomes were collected and analyzed. RESULTS The mean age of the patients was 47 years. All patients presented with varying degrees of vision loss. Radiology revealed a sellar / suprasellar lesion with the pituitary gland seen separately in two of three GCTs, whereas a separate pituitary gland could not be identified in both the SCOs. Pituitary adenoma was a radiologic diagnosis in only two of five cases. Three patients underwent a transsphenoidal surgery, whereas two underwent surgery by the transcranial approach. Intraoperative cytology was challenging, though a possibility of posterior pituitary tumor was considered in three of four cases, whereas one was considered meningioma. All the tumors were very vascular and influenced the extent of resection. CONCLUSIONS GCTs and SCOs are relatively uncommon tumors that are difficult to diagnose on preoperative imaging. Intraoperative squash cytology too can pose challenges. A preoperative suspicion can prepare the surgeon for surgery of these hypervascular tumors. The transcranial approach may be necessary in cases of uncertainty in imaging.
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Affiliation(s)
- Sandeep Kandregula
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
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Nadeem M, Deora H, Shashidhar A, Bhaskara Rao M. Image guided repair of spontaneous CSF rhinorrhoea secondary to double skull base defect – Case report and review of literature. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kulanthaivelu K, Siddiqui SM, Prasad C, Shashidhar A. Traumatic Pseudoaneurysm of Middle Meningeal Artery with Delayed Presentation as Intracerebral Hematoma: A Report with Review of Literature. Neurol India 2021; 69:1820-1823. [PMID: 34979698 DOI: 10.4103/0028-3886.333471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Post-traumatic pseudoaneurysm of the middle meningeal artery is a rare entity. We report an atypical case of a delayed presentation as parenchymal hemorrhage due to a ruptured middle meningeal artery pseudoaneurysm. Case Description A 22-year-old man with an alleged history of cranial trauma following a road traffic accident presented 10 days later with a new right temporal intraparenchymal hemorrhage. The CT revealed a differentially hypodense circumscribed structure in the anterior temporal location eccentrically in the hematoma. The cerebral angiogram depicted a pseudoaneurysm arising from the middle meningeal artery. The patient underwent craniotomy and excision of the aneurysm. On follow up, the patient was asymptomatic and had no focal neurological deficits. Conclusion Despite its rare occurrence, meningeal artery pseudoaneurysm should be considered as a possible etiology of a post-traumatic delayed presentation as an intracerebral hematoma. Prompt diagnosis and management are warranted in view of the mortality and morbidity.
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Affiliation(s)
- Karthik Kulanthaivelu
- Department of Neuroimaging, Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shahyan Mohsin Siddiqui
- Department of Neuroimaging, Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Chandrajit Prasad
- Department of Neuroimaging, Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Hande VH, Gunasekaran H, Hegde S, Shashidhar A, Arimappamagan A. Role of Clinical Neuropsychologists in Awake-Craniotomy. Neurol India 2021; 69:711-716. [PMID: 34169874 PMCID: PMC7613143 DOI: 10.4103/0028-3886.319237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Awake craniotomy encompasses surgical resection of focal zone of neurological impairment, using intraoperative functional zone mapping. The strength of the procedure is maximum retention of functionally significant zones to ensure better function and quality of life outcomes in patients. A clinical neuropsychologist plays a vital role in profiling the patient’s cognitive and psychosocial functioning as well as increasing the efficacy of functional zone mapping procedures. Objective Aim of this article is to summarize the literature on the role of clinical neuropsychologists in awake craniotomy and underscoring the need for establishing standardized operating procedures for neuropsychologists in awake craniotomy highlighting experiential anecdotes from a tertiary care facility. Materials and Methods A review of articles that elucidate the role of clinical neuropsychologists was done and summarized to highlight the role of clinical neuropsychologists. An attempt was made to explain the implementation of this role in regular clinical practice at a tertiary care facility. Results The role of a clinical neuropsychologist is highly crucial at pre-/during and postawake craniotomy, and has a significant bearing on the overall psychological outcome of the individual. The need for a standardized protocol to unify practice and increase the efficacy of the awake-craniotomy procedure is put forth. Recommendations for future directions in research to increase the scope of neuropsychologists in awake craniotomy have also been made.
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Affiliation(s)
- Vasudha H Hande
- Clinical Neuropsychology and Cognitive Neuro Science Center, Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harini Gunasekaran
- Clinical Neuropsychology and Cognitive Neuro Science Center, Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shantala Hegde
- Clinical Neuropsychology and Cognitive Neuro Science Center, Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Shashidhar A, Arimappamagan A, Madhusudhan N, Narasinga Rao KVL, Bhat D, Shukla D, Arvinda HR, Srinivas D, Indira Devi B, Somanna S. Transcranial approach for pituitary adenomas - An evaluation of surgical approaches over two decades and factors influencing peri-operative morbidity. Clin Neurol Neurosurg 2020; 200:106400. [PMID: 33341089 DOI: 10.1016/j.clineuro.2020.106400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Transcranial surgery(TCS) for pituitary adenoma(PA) is mostly reserved for lesions with widespread extensions. We sought to analyse the intraoperative challenges, morbidity and the factors associated with morbidity of transcranial approaches, in a large series from a tertiary neurosurgical institute. METHODS We retrospectively evaluated 137 patients who underwent TCS for PA in our institute. The details of their clinical features, imaging, operative and peri-operative events and complications were collected and analysed. The factors associated with morbidity were evaluated. RESULTS The mean age of the cohort was 40.86 ± 13.35 years. 21 (15.3%) patients developed significant post-operative hematoma, out of which 7 patients (5.1%) required re-exploration. Post-operative diabetes insipidus was noted in 45 patients (32.84%), while SIADH was noted in 10 patients (7.35%). Other complications were cranial nerve palsy in 14 patients (10.2%), visual deterioration in 7 patients (5.1%). Neither tumour characteristics nor the choice of approach was associated with occurrence of post op hematoma. SIADH was significantly associated with patients with tumours involving cavernous sinus (p = 0.019) and subfrontal extension (p = 0.031). Patients with post-operative hematoma had significantly higher incidence of post-op DI (57.1% vs 28.7%; p = 0.021), while similar correlation was not noticed with SIADH (4.7 vs 7.8%). CONCLUSION TCS plays a distinct, albeit a small role in surgical management of pituitary adenoma. Tumour related or approach related factors are not significantly associated with the incidence of hematoma. Post-operative hematoma significantly influences the incidence of DI. A proper and judicious selection of approach and meticulous surgical technique should result in a reduction in associated morbidity and mortality.
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Affiliation(s)
| | | | - N Madhusudhan
- Department of Neurosurgery, NIMHANS, Bengaluru, India
| | | | | | - Dhaval Shukla
- Department of Neurosurgery, NIMHANS, Bengaluru, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, Bengaluru, India
| | | | - B Indira Devi
- Department of Neurosurgery, NIMHANS, Bengaluru, India
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Arumalla K, Deora H, Rao S, Shashidhar A, Rao MB. Spinal extradural hemangioblastoma: A systematic review of characteristics and outcomes. J Craniovertebr Junction Spine 2020; 11:254-261. [PMID: 33824554 PMCID: PMC8019116 DOI: 10.4103/jcvjs.jcvjs_112_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/20/2020] [Indexed: 12/02/2022] Open
Abstract
Extradural spinal nerve root hemangioblastoma is a rare entity with very few cases reported in the literature. A comprehensive picture of the treatments and outcomes of the same is thus not available. A systematic search was done according to PRISMA guidelines. Search criteria included terms: spinal extradural hemangioblastoma, extradural hemangioblastoma, and spinal root hemangioblastoma. The parameters considered were treatment, motor, and sensory outcome, association with von-Hippel-Lindau (VHL) syndrome. Twenty-two studies (19 full text articles) were available for the review. A total of 39 cases of extradural spinal nerve root hemangioblastoma have been reported. These cases had a median age of 44 years with male predominance (2:1) and up to 48% occur in the thoracic level, similar to our case. Thirty-six percent of patients were associated with VHL syndrome. Surgical resection was the primary modality of treatment with embolization used in selected cases (20%). They had mean follow-up of 23 (±11) months. The prognosis was better than the intradural counterpart with no motor deficit and sensory deficit in only 9%. Preoperative identification of the extradural nature of this pathology and complete excision at the first surgery offers excellent outcomes compared to intradural lesion. Targeted embolization may be used in cases anticipated with high blood loss.
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Affiliation(s)
- Kirit Arumalla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Malla Bhaskara Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Tyagi G, Singh V, Shashidhar A. An unusual case of penetrating skull injury. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Prashantha YN, Shashidhar A, Balasunder BC, Kumar BP, Rao PNS. Onsite mentoring of special newborn care unit to improve the quality of newborn care. Indian J Public Health 2020; 63:357-361. [PMID: 32189658 DOI: 10.4103/ijph.ijph_419_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background It has been possible to set up special newborn care units (SNCUs) and to improve the survival of newborns in India. However, several challenges remain affecting their effective functioning. Different approaches have been attempted and several policies have also been implemented to address this issue. Objectives To evaluate the feasibility of implementing best practices in neonatal care by onsite mentoring in an SNCU over 4 months. Methods The mentoring team was from a tertiary care hospital in Karnataka. The SNCU was functioning at the district hospital, catering to approximately 3500 live births per year. Onsite mentoring was carried out from August 2016 to November 2016. This was a prospective implementation research. Framework focused on infection control, preterm care, care at birth, advocacy for infrastructure and resources, and facility-based refresher training. Results A total of 16 visits were done by the mentoring team and 2 weeks of in-house residency. There were improvements in hand hygiene compliance from 0% to 87.5%, in cleaner IV site (from 50% to 100%), decreased unnecessary oxygen administration (from 75% to 33.3%), decreased antibiotic usage (from 70.5% to 35.5%), decrease in the number of babies receiving >5 days of antibiotics (from 41.6% to 0%), and increased kangaroo mother care initiation rate from 0% to 41.6%. The facility got level IIA accreditation by the end of the intervention period. Conclusions Onsite mentorship program of SNCU is feasible and planning should be contextual. With the problems being uniform across most facilities, the model could be replicated across the country.
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Affiliation(s)
- Y N Prashantha
- Assistant Professor, Department of Neonatology, St. John's Medical College, Bengaluru, Karnataka, India
| | - A Shashidhar
- Associate Professor, Department of Neonatology, St. John's Medical College, Bengaluru, Karnataka, India
| | - B C Balasunder
- Senior Specialist (Pediatrics), S.N.R. District Hospital, Kolar, Karnataka, India
| | - B Pradeep Kumar
- Consultant, Department of Pediatrics, SSNMC, Bengaluru, Karnataka, India
| | - P N Suman Rao
- Professor and Head, Department of Neonatology, St. John's Medical College, Bengaluru, Karnataka, India
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Arshad F, Rao S, Kenchaiah R, Prasad C, Shashidhar A. Intraventricular neurocysticercosis presenting as Bruns’ syndrome: An uncommon presentation. Egypt J Neurol Psychiatry Neurosurg 2020. [DOI: 10.1186/s41983-020-00187-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Though parenchymal neurocysticercosis is common and a major contributor to burden of seizures in most parts of the world, intraventricular neurocysticercosis (IVNCC) comprises 10–20% of cases and poses a diagnostic challenge to the clinician.
Case presentation
We report an adult female presenting with intermittent occipital headache, used to be worse in lying down position, and aggravated with head movements, and there was mild relief in the sitting position. Her physical examination was unremarkable, and laboratory tests were within normal limits. Her multimodal neuroimaging showed cystic lesion in the fourth ventricle suggestive of neurocysticercosis. Patient underwent neuroendoscopic removal of the cyst, and the final diagnosis was confirmed on histopathology. Post removal of cyst patient had complete resolution of her symptoms.
Discussion
Intraventricular neurocysticercosis can present as acute hydrocephalus which may clinically manifest as Bruns’ syndrome in which sudden attacks of headache vertigo and nausea or vomiting are precipitated by abrupt head movements which was observed in our patient. Multimodal neuroimaging supported by histopathology helped in confirmation of the diagnosis, thus averting an inadvertent use of unnecessary medications in such patients. Furthermore, neuroendoscopy has evolved as minimally invasive technique for extirpation of fourth ventricular cysts.
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Shashidhar A, Bharath RD, Satishchandra P, Rao MB, Arimappamagan A. Dissecting Aneurysm of the Basilar Artery-A Rare Complication of Bacterial Meningitis in a Postoperative Case of CSF Rhinorrhea. Neurol India 2020; 68:173-175. [PMID: 32129272 DOI: 10.4103/0028-3886.279691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Basilar artery dissections are rare events which present with subarachnoid hemorrhage (SAH), brain ischemia, and usually have a fatal outcome. Few case reports of mycotic dissections are published in literature. We report a case of a young male who underwent surgical treatment for post-traumatic CSF rhinorrhea. He presented 3 years later with signs of bacterial meningitis. During medical management with antibiotic therapy, he developed basilar artery aneurysm in a span of 2 days, had subarachnoid hemorrhage and deteriorated. CSF culture grew alpha hemolytic streptococci. Despite medical management, he developed brain stem infarcts and succumbed. This report highlights a rare fatal complication of mycotic dissecting aneurysm of the basilar artery following meningitis, which developed acutely in hospital, while on treatment. Antibiotic therapy had not altered the course of disease. It is advisable to investigate for presence of ruptured mycotic aneurysms or dissection in cases of bacterial meningitis leading to SAH.
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Affiliation(s)
- Abhinith Shashidhar
- Department of Neurosurgery, Neuroimaging and Interventional, NIMHANS, Bengaluru, Karnataka, India
| | | | | | - Malla Bhaskara Rao
- Department of Neurosurgery, Neuroimaging and Interventional, NIMHANS, Bengaluru, Karnataka, India
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Shashidhar A, Prashantha YN, Suman Rao PN. Author reply: therapeutic hypothermia as standard care in India: a local innovation meets the challenge. Paediatr Int Child Health 2019; 39:306-307. [PMID: 30328390 DOI: 10.1080/20469047.2018.1531592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Shashidhar
- Department of Neonatology, St. John's Medical College , Bangalore , India
| | - Y N Prashantha
- Department of Neonatology, St. John's Medical College , Bangalore , India
| | - P N Suman Rao
- Department of Neonatology, St. John's Medical College , Bangalore , India
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Prashantha YN, Suman Rao PN, Nesargi S, Chandrakala BS, Balla KC, Shashidhar A. Therapeutic hypothermia for moderate and severe hypoxic ischaemic encephalopathy in newborns using low-cost devices - ice packs and phase changing material. Paediatr Int Child Health 2019; 39:234-239. [PMID: 30109814 DOI: 10.1080/20469047.2018.1500805] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Different methods have been used for therapeutic hypothermia for neonates with moderate-to-severe hypoxic ischaemic encephalopathy (HIE). As standard cooling devices are expensive, there is a need to establish the safety and efficacy of low-cost devices such as ice packs (IP) and phase changing material (PCM). Aim: To assess the efficacy and safety of therapeutic hypothermia (TH) and the clinico-laboratory profile of neonates who underwent cooling with IP or PCM. Methods: The study was retrospective. TH for moderate-to-severe HIE was initiated with IP between 2012 and 2014 and with PCM (MiraCradleTM) from September 2014. A standard protocol for inclusion and management during TH was used for all newborns. All data were collected by means of a local cooling registry. Results: Sixty-two cooled newborns (IP 29, PCM 33) were included in the study. Mean gestational age was 38.6 (1.7) weeks and mean birthweight 2920.6 g (450.7); 66.1% were inborn and 91.9% had moderate encephalopathy. Mean (SD) core temperature during cooling was 33.47°C (0.33) for PCM and 33.44°C (0.34) for IP. Adverse events observed during TH were thrombocytopenia (54.8%), coagulopathy (30.6%), shock (30.6%), skin changes (12.9%) and persistent pulmonary hypertension (8.1%). Forty-nine infants were discharged, two died and 11 were discharged against medical advice. TH was prematurely stopped in seven newborns with serious adverse events such as disseminated intravascular coagulation (DIC), gangrene and arrhythmia (IP 5, PCM 2). Conclusion: Low-cost devices are safe and effective alternatives for maintaining TH in low-resource settings with adequate monitoring. Abbreviations: DAMA, discharged against medical advice; DIC, disseminated intravascular coagulation; HELIX, Hypothermia for Encephalopathy in Low- and Middle-Income Countries Trial; HIE, hypoxic ischaemic encephalopathy; IP, ice packs; LMIC, low- and middle-income countries; NICHD, National Institute of Child Health and Human Development; PCM, phase changing; TH, therapeutic hypothermia (TH); TOBY, total body hypothermia for neonatal encephalopathy.
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Affiliation(s)
- Y N Prashantha
- Department of Neonatology, St John's Medical College , Bengaluru , India
| | - P N Suman Rao
- Department of Neonatology, St John's Medical College , Bengaluru , India
| | - Saudamini Nesargi
- Department of Neonatology, St John's Medical College , Bengaluru , India
| | - B S Chandrakala
- Department of Neonatology, St John's Medical College , Bengaluru , India
| | | | - A Shashidhar
- Department of Neonatology, St John's Medical College , Bengaluru , India
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Shashidhar A, Sadashiva N, Prabhuraj A, Narasingha Rao K, Tiwari S, Saini J, Shukla D, Devi BI. Ruptured intracranial dermoid cysts: A retrospective institutional review. J Clin Neurosci 2019; 67:172-177. [DOI: 10.1016/j.jocn.2019.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022]
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Yeole U, Malla BR, Arivazhagan A, Shashidhar A, Deora H, Mundalamuri RC, Raghvendra K, Bharath RD, Sinha S. Intra-operative, spontaneous subarachnoid hemorrhage during anterior temporal lobectomy for mesial temporal sclerosis: Video evidence and literature review. Neurol India 2019; 67:862-866. [PMID: 31347568 DOI: 10.4103/0028-3886.263215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ujwal Yeole
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bhaskara Rao Malla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - A Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - K Raghvendra
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Balla KC, Rao SPN, Arul C, Shashidhar A, Prashantha YN, Nagaraj S, Suresh G. Decreasing Central Line-associated Bloodstream Infections Through Quality Improvement Initiative. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1374-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Balla KC, Rao SP, Arul C, Shashidhar A, Prashantha YN, Nagaraj S, Suresh G. Decreasing Central Line-associated Bloodstream Infections Through Quality Improvement Initiative. Indian Pediatr 2018; 55:753-756. [PMID: 30345978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the impact of a quality improvement (QI) initiative using care bundle approach on Central-line associated bloodstream infections (CLABSI) rates. METHODS A QI team for infection control in NICU was formed in a tertiary-care neonatal intensive care unit (NICU) from June 2015 to August 2016. Baseline data were collected over first 3 months followed by the intervention period of 1 year. Measures with respect to strengthening hand hygiene and central line bundle care were implemented during the intervention period. Audits assessing the compliance to hand hygiene and CLABSI bundle protocols were used as process indicators. Multiple PDSA cycles were used to strengthen the practices of proposed interventions, documentation of data and audits of the processes during the study period. RESULTS The QI initiative achieved a 89% reduction in CLABSI from the baseline rate of 31.7 to 3.5 per 1000 line-days. The blood stream Infections reduced from 7.3 to 2.3 per 1000 patient-days. The overall mortality showed a reduction from 2.9% to 1.7% during the intervention period. There was a significant improvement in compliance with hand hygiene protocol and compliance with CLABSI protocols. CONCLUSION This study demonstrated that simple measures involving hand hygiene and strengthening of the care bundle approach through quality improvement could significantly reduce the blood stream Infections and CLABSI rates.
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Affiliation(s)
| | - Suman Pn Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India. Correspondence to: Dr Suman PN Rao, Department of Neonatology, St John's Medical College Hospital, Sarjapur Road, Koramangala, Bangalore 560 034, Karnataka, India.
| | - Celine Arul
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - A Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Y N Prashantha
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Savitha Nagaraj
- Hospital Infection Control Committee, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Gautham Suresh
- Baylor College of Medicine and Texas Children's Hospital, Houston, USA
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Ram Mohan G, Shashidhar A, Chandrakala BS, Nesargi S, Suman Rao PN. Umbilical cord milking in preterm neonates requiring resuscitation: A randomized controlled trial. Resuscitation 2018; 130:88-91. [PMID: 29981817 DOI: 10.1016/j.resuscitation.2018.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/03/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the effect of cord milking on short term morbidity and hematologic parameters at 6 weeks in preterm neonates requiring resuscitation. METHODS This trial randomized preterm infants requiring resuscitation to milking group and no milking group. Multiple pregnancy, Rh negative mothers, hydrops, cord abnormalities were excluded. The primary outcome was hemoglobin and serum ferritin at 6 weeks of life. Secondary outcomes were common preterm morbidities and mortality. RESULTS 60 neonates were included in the study. Infants in the milking group had higher hemoglobin (10.07 g/dl vs 8.9 g/dl; p 0.003) and higher serum ferritin level (244.8 ng/ml vs 148.5 ng/ml; p 0.04) compared to no milking group. CONCLUSIONS In preterm neonates requiring resuscitation, umbilical cord milking results in higher hemoglobin and ferritin at 6 weeks of life. It can be a used as a placental transfusion strategy in preterm neonates requiring resuscitation with no significant adverse effects. CLINICAL TRIAL REGISTRATION Clinical trials registry -India CTRI/2015/01/005436, www.ctri.nic.in.
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Affiliation(s)
- G Ram Mohan
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - A Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - B S Chandrakala
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - S Nesargi
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - P N Suman Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India.
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Shashidhar A, Bharath RD, Rao MB, Arivazhagan A. Clival Lesion in a Young Girl: Neoplastic or Inflammatory? Pediatr Neurosurg 2018; 53:280-281. [PMID: 29860248 DOI: 10.1159/000489011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, NIMHANS, Bangalore, India
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Savardekar A, Shashidhar A, Mundlamuri R, Netravathi M, Nalini A, Chickabasaviah Y, Arivazhagan A, Rao M. Chronic eosinophilic meningitis as a manifestation of isolated spinal neurocysticercosis: A rare case and a review of literature. Neurol India 2018; 66:561-564. [DOI: 10.4103/0028-3886.227297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rodrigues L, Nesargi SV, Fernandes M, Shashidhar A, Rao SPN, Bhat S. Analgesic Efficacy of Oral Dextrose and Breast Milk during Nasopharyngeal Suctioning of Preterm Infants on CPAP: A Blinded Randomized Controlled Trial. J Trop Pediatr 2017; 63:483-488. [PMID: 28369634 DOI: 10.1093/tropej/fmx017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Continuous positive airway pressure (CPAP) requires nasopharyngeal suctioning for airway patency, which is painful. Other procedures have used breast milk and 25% dextrose as analgesics. We aimed to compare their analgesic efficacy during nasopharyngeal suctioning in preterm neonates on CPAP. In this blinded randomized controlled trial, babies received 25% dextrose or breast milk orally. Pain before, during and after was assessed using the Premature Infant Pain Profile (PIPP) score. Analysis was done for 40 babies. The mean PIPP score in the 25% dextrose group during the procedure was 11.25 ± 2.73 and 13.2 ± 2.55 (p = 0.02) with the intervention and without. In the breast milk group the PIPP score during the procedure was 11.35 ± 3.05 and 13.45 ± 3.27 (p = 0.04); this difference persisted even after the procedure. There was no significant difference between the interventions. Both interventions significantly reduce pain. The analgesic effect of breast milk was sustained.
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Affiliation(s)
- Luvena Rodrigues
- Department of Paediatrics, Goa Medical College and Hospital, Bambolim, Goa 403202, India
| | - Saudamini V Nesargi
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Maneka Fernandes
- Department of Paediatrics, Goa Medical College and Hospital, Bambolim, Goa 403202, India
| | - A Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Suman P N Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Swarnarekha Bhat
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
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Shashidhar A. Serum Phenobarbitone Levels in Neonates with Seizures: Some Clarifications. Indian Pediatr 2016; 53:842. [PMID: 27771659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- A Shashidhar
- Department of Neonatology, St. Johns Medical College, Bangalore, Karnataka, India.
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Kumar V, Sushil G, Tarangini D, Shashidhar A, Prakash A. Rare presentation of a rare bleeding disorder. Pediatric Hematology Oncology Journal 2016. [DOI: 10.1016/j.phoj.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Fetus exists in a complex, dynamic, and yet intriguing symbiosis with its mother as far as fuel metabolism is concerned. Though the dependence on maternal fuel is nearly complete to cater for its high requirement, the fetus is capable of some metabolism of its own. The first half of gestation is a period of maternal anabolism and storage whereas the second half results in exponential fetal growth where maternal stores are mobilized. Glucose is the primary substrate for energy production in the fetus though capable of utilizing alternate sources like lactate, ketoacids, amino acids, fatty acids, and glycogen as fuel under special circumstances. Key transporters like glucose transporters (GLUT) are responsible for preferential transfers, which are in turn regulated by complex interaction of maternal and fetal hormones. Amino acids are preferentially utilized for growth and essential fatty acids for development of brain and retina. Insulin, insulin like growth factors, glucagon, catecholamines, and letpin are the hormones implicated in this fascinating process. Hormonal regulation of metabolic substrate utilization and anabolism in the fetus is secondary to the supply of nutrient substrates. The knowledge of fuel homeostasis is crucial for a clinician caring for pregnant women and neonates to manage disorders of metabolism (diabetes), growth (intrauterine growth restriction), and transitional adaptation (hypoglycemia).
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Affiliation(s)
- P. N. Suman Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - A. Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - C. Ashok
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
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Ansari M, Shashidhar A, Srivastava V. 404. Prognosis in Incidentally Diagnosed Gallbladder Cancer. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ansari M, Shashidhar A, Srivastava V, Kumar A. 403. Diagnostic Laparoscopy- an Important Tool in Evaluation of Gallbladder Cancer. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kalyana P, Shashidhar A, Meghashyam B, Sreevidya KR, Sweta S. Stain removal efficacy of a novel dentifrice containing papain and Bromelain extracts--an in vitro study. Int J Dent Hyg 2011; 9:229-33. [PMID: 21356017 DOI: 10.1111/j.1601-5037.2010.00473.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the in vitro stain removal efficacy of a novel commercially available dentifrice. MATERIALS AND METHODS Twenty four human molar teeth (12 in test and 12 in control group) were cut to obtain enamel specimens approximately 9 mm(2) and placed on a microscopic slide using mounting adhesive. They were cycled in human saliva, staining model and dried for brushing regimen using a customized brushing apparatus. Lightness values were recorded at baseline, after staining and after brushing regimen using Adobe Photoshop software. Stain removal efficacy was tested using the either of the two dentifrice slurries for 2 one minute brushing cycles. RESULTS The mean lightness increment for test and control after brushing regimen was 13.7 ± 6.35 and 3.16 ± 1.29 respectively. There was statistically significant difference in percentage removal of stains for test and control groups (66.99 ± 9.57 and 25.89 ± 16.2 P < 0.001). CONCLUSION There was significant stain removal with new whitening dentifrice when compared with control. Further clinical trials are recommended to evaluate this significant difference.
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Affiliation(s)
- P Kalyana
- Department of Community Dentistry, Manipal College of Dental Sciences, Manipal, India.
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