1
|
Kudva A, Suryanarayan RK, Menon G, Varshney S. Use of the Smith's Spreader as a Self-Retaining Retractor in the Direct Approach to Clival Tumours - A Technical Note. Indian J Otolaryngol Head Neck Surg 2024; 76:1476-1477. [PMID: 38440652 PMCID: PMC10908718 DOI: 10.1007/s12070-023-04292-1] [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: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 03/06/2024] Open
Abstract
The traditional Le Fort level 1 osteotomy has proven to be an effective in approaching central skull base lesions. The challenge being - stabilization of the down-fractured maxilla in an amenable position for tumour resection. The authors describe a simple technique to overcome the task of stabilizing the down-fractured maxilla.
Collapse
Affiliation(s)
- Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Ramya K. Suryanarayan
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Surbhi Varshney
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka India
| |
Collapse
|
2
|
Sadhasivam S, Menon G, Abraham M, Arora RK, Nair SN. The influence of tumor topography on the surgical outcome of craniopharyngiomas. J Neurosurg 2023; 139:1247-1257. [PMID: 37119112 DOI: 10.3171/2023.3.jns222302] [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: 10/08/2022] [Accepted: 03/06/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Various topographical classifications for craniopharyngioma have been proposed based on their relationship with optic chiasm and the third ventricular floor. There is a paucity of literature evaluating the surgical outcome based on tumor topography. This study aims to compare the surgical outcomes of retrochiasmatic craniopharyngiomas (RCPs) and nonretrochiasmatic craniopharyngiomas (non-RCPs). METHODS This retrospective study includes newly diagnosed patients with craniopharyngioma who underwent surgery between January 2000 and December 2015. Clinical features, the extent of resection (EOR), surgical outcomes, tumor recurrence, and progression-free survival (PFS) of craniopharyngiomas were compared with respect to their relationship to the optic chiasm and third ventricular floor. RESULTS The authors identified RCPs in 104 and non-RCPs in 33 patients. RCPs were significantly larger and more associated with hydrocephalus than were non-RCPs (p < 0.001) at the time of diagnosis. Puget grade 2 hypothalamic involvement was more frequent with RCPs. EOR and PFS following either subtotal resection (p = 0.07) or gross-total resection (p = 0.7) were comparable between RCPs and non-RCPs. There was no significant difference in the postoperative visual outcome. Resection of RCPs resulted in higher postoperative hypopituitarism (64% vs 42%, p = 0.01) and hypothalamic dysfunction (18% vs 3%, p = 0.02). Location of the tumor, either retrochiasmatic (HR 0.5; 95% CI 0.14-2.2; p = 0.4) or nonretrochiasmatic (HR 1.3; 95% CI 0.3-5.5; p = 0.6), did not show association with recurrence. RCPs with extra- and intraventricular components (type 3b) had a higher incidence of postoperative hypothalamic morbidities (p = 0.01) and tumor recurrence (36% vs 19%; p = 0.05) during follow-up than the extraventricular (type 3a) RCP. Between prechiasmatic and infrachiasmatic/intrasellar craniopharyngiomas, EOR (p = 0.7), postoperative diabetes insipidus (p = 0.4), endocrinological outcome (p = 0.7), and recurrence (p = 0.1) were comparable. The patients with complex multicompartmental tumors had a lower rate of gross-total resection (25%, p = 0.02) and a higher incidence of tumor recurrence (75%, p = 0.004) than the rest. CONCLUSIONS The tumor topography can influence the postoperative outcome. RCPs can be associated with a higher incidence of hypopituitarism and hypothalamic morbidities postoperatively. The influence of topography on EOR and tumor recurrence is controversial. However, this study did not find a significant difference in EOR and tumor recurrence between RCPs and non-RCPs. PFS and overall mortality are also comparable.
Collapse
Affiliation(s)
- Saravanan Sadhasivam
- 1Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand; and
| | - Girish Menon
- 2Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Mathew Abraham
- 2Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Rajnish Kumar Arora
- 1Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand; and
| | - Suresh Narayanan Nair
- 2Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| |
Collapse
|
3
|
Nair R, Nayal B, Beedkar S, Menon G. "A tumour registry initiative". World Neurosurg X 2023; 20:100227. [PMID: 37456693 PMCID: PMC10344826 DOI: 10.1016/j.wnsx.2023.100227] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Published literature on epidemiological profile of paediatric brain tumours in India is limited. Aim: To present a retrospective analysis of the histological spectrum of 158 paediatric age group central nervous system tumours operated in a single tertiary care hospital in Coastal South India between January 2015 and December 2021. Material and methods Retrospective analysis of the data regarding frequencies of various primary brain tumours among 158 paediatric patients (<18 years of age). The tumours were categorised according to the revised 4th edition of World Health Organization (WHO) classification of tumours of the Central Nervous system. Results Paediatric CNS constituted 8.5% of total intracranial tumours (158/1860) operated in the study period. The mean age of the patients was 10.2 years and a definite male predominance was noted (1.54:1) Astrocytomas, glioneuronal tumours, and neuronal tumours constituted the majority (72/158; 45.6%) followed by embryonal tumours (31/158; 19.6%) and craniopharyngiomas(24/158; 15.4%).Of the glial neoplasms majority were pilocytic and other astrocytic tumours(41.6%), followed by mixed neuroglial tumours (19.4%), diffuse high grade astrocytomas (Grade III/IV) (11.1%), diffuse low -grade astrocytomas (Grade II) (9.7%) and ependymomas (13.8%). Our series also included six meningiomas (3.8%), five germ cell tumours (3.16%), four nerve sheath tumours (2.53%), two choroid plexus tumours (1.26%), two pineal parenchymal tumours (1.26%) and one metastasis from a soft tissue sarcoma from the thigh. Supratentorial tumours (58.2%) were more common than posterior fossa (34.6%) and spinal tumours (7.6%) and visual pathway gliomas accounted for 5.6% of all our tumours. Conclusions Paediatric central nervous system tumours are more common in boys and in the second decade of life. Astrocytomas are the most common paediatric brain tumours followed by medulloblastomas and craniopharyngiomas. Pediatric tumours affect the supratentorial compartment more often than the infratentorial compartment. The profile of paediatric brain tumours in our series is similar to that reported from other Indian centres as well as most western literature.
Collapse
Affiliation(s)
- Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Bhavna Nayal
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Saurabh Beedkar
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
4
|
Srinivasan S, Hegde A, Nair R, Menon G. Medulloblastoma with Subcutaneous Spread: A Rare Entity. Asian J Neurosurg 2023; 18:698-700. [PMID: 38152545 PMCID: PMC10749860 DOI: 10.1055/s-0043-1774822] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Medulloblastoma is the most common malignant pediatric brain tumor. Histological subclassification and adjuvant therapy have improved prognostication and outcome. Extraneural metastasis remains a poor prognostic factor and subcutaneous seeding is rarely encountered and reported in the pediatric population. We report a 3-year-old child who rapidly presented with subcutaneous seeding a month following gross total resection of his tumor.
Collapse
Affiliation(s)
- Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
5
|
Onkarappa S, Prasad GL, Pai A, Menon G. A 2-Year Prospective Study of Complication Rates After Cranioplasty: Is 8 Weeks' Interval Associated with Increased Complications? World Neurosurg 2023; 176:e569-e574. [PMID: 37270098 DOI: 10.1016/j.wneu.2023.05.104] [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: 05/15/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The commonly observed complications after cranioplasty include infections, intracranial hemorrhage, and seizures. The timing of cranioplasty after decompressive craniectomy (DC) is still under debate, with literature available for both early and delayed cranioplasties. The objectives of this study were to note the overall complication rates and more specifically compare complications between 2 different time intervals. METHODS This was a 24-month, single-center, prospective study. Since timing is the most debated variable, the study cohort was divided into 2 groups (≤8 weeks and >8 weeks). Furthermore, other variables such as age, gender, etiology of DC, neurologic condition, and blood loss were correlated with complications. RESULTS A total of 104 cases were analyzed. Two thirds were traumatic etiology. The mean and median DC-cranioplasty intervals were 11.3 weeks (range 4-52 weeks) and 9 weeks, respectively. Seven complications (6.7%) were observed in 6 patients. There was no statistical difference observed between any of the variables and complications. CONCLUSIONS We observed that performing cranioplasty within 8 weeks of the initial DC surgery is safe and noninferior to cranioplasty performed after 8 weeks. Therefore if the general condition of the patient is satisfactory, we are of the opinion that an interval of 6-8 weeks from the primary DC is safe and a reasonable time frame for performing cranioplasty.
Collapse
Affiliation(s)
- Sandesh Onkarappa
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
6
|
Reddy V, Pradhan A, Prasad GL, Menon G. Clinical outcomes and prognostic factors of traumatic basal ganglia hematomas: A 4-year single-center study. Surg Neurol Int 2023; 14:251. [PMID: 37560578 PMCID: PMC10408632 DOI: 10.25259/sni_411_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Traumatic basal ganglia hematomas (TBGH) are rare entities. They are situated in the deep cerebral parenchyma and have also been termed as intermediate coup contusions. Available literature is sparse with regards to the characteristics and prognosis of TBGH. We aim to share our experience in the management, outcomes, and prognostic factors of TBGH. METHODS A 4-year retrospective study which included all cases of TBGH, except dot contusions (<2 mL) and those with coagulopathies. Admission variables were correlated with Glasgow Outcome Scale score at discharge and 12 months. RESULTS Thirty-two patients were analyzed. The mean age was 39.2 years. Two-thirds were due to road traffic accidents. Around 60% were severe head injuries. The mean Glasgow coma scale (GCS) score at presentation was 8.5. Twenty patients had moderate-to-severe hemiparesis. The mean hematoma volume was 18.1 mL. Associated traumatic intracranial lesions were seen in 28 cases. Only 7 patients (22%) underwent surgery. The mean follow-up was 17.4 months (range 14-34 months). The mortality rate was 12.5% (n = 4). Among the survivors, only 39% (n = 11) had good outcomes at discharge which showed modest improvement to 54% (n = 15) at 12 months. CONCLUSION Our study noted that poor admission GCS scores, poor motor response, presence of significant hemiparesis, and larger hematoma volumes (>20 mL) correlated with poor outcomes at 12 months. The overall outcomes have been mostly unfavorable as observed in majority of studies due to deeper location of these hematomas, high proportion of severe head injuries, and high proportion of residual weakness in survivors.
Collapse
Affiliation(s)
| | | | - G. Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | |
Collapse
|
7
|
Menon G, Macharla A, Srinivasan S, Santosh S, Pai A, Nair R, Hegde A. Spontaneous Intracerebral Hemorrhage in the Young: An Institutional Registry Analysis. Ann Indian Acad Neurol 2023; 26:502-506. [PMID: 37970280 PMCID: PMC10645210 DOI: 10.4103/aian.aian_76_23] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 11/17/2023] Open
Abstract
Background Spontaneous intracerebral hemorrhage (SICH) accounts for about 10-15% of all strokes. Generally, it is a disease of the elderly; worldwide, the incidence of SICH in the young is showing an increasing trend, especially in India and the Asian continent. An attempt is also made to analyze the presence of factors, which may predict the risk of SICH among young hypertensives. Methods A six-year retrospective review of patients aged below 50 years who presented with SICH was included in the study. Patients with bleeds secondary to an identifiable cause such as tumor, trauma, vascular malformations, and coagulopathy-induced bleeds were excluded from the study. The outcome was measured at 90 days using the modified ranking scale, and predictors of outcome (good outcome modified ranking score (mRS): 0-3; poor outcome mRS: 4-6) were analyzed. Results SICH in the young accounted for 28.4% of all intracerebral hemorrhage (ICH) patients admitted during the study period (344/1210). The mean age of our male-dominant (78.5%) cohort was 42.9 ± 6.24 years, and the median Glasgow coma score (GCS) on presentation was 11 (IQR: 8-14). A prior history of hypertension (HTN) was obtained in 51.2% (176), and left ventricular hypertrophy (LVH) was documented in 237 (68.9%) patients. The basal ganglia was the most common location of the bleed (62.2%). At 90 days, 200 patients (58.1%) had good outcome and 144 (41.9%) had poor outcome with an overall mortality of 75 (21.8%). Independent predictors of poor outcome were poor GCS, larger volume, and high serum creatinine values. Conclusion The incidence of SICH among the young accounts for nearly 30% of admitted ICH. Poor outcome and mortality are high with HTN being the single most important modifiable risk factor in the cohort.
Collapse
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Aparna Macharla
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sonin Santosh
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
8
|
Shenoy N, Srinivasan S, Menon G, Kurupath R. Surgical treatment of epilepsy - Initial experience from a comprehensive epilepsy program in coastal South India. J Neurosci Rural Pract 2023; 14:488-494. [PMID: 37692803 PMCID: PMC10483204 DOI: 10.25259/jnrp_116_2023] [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: 03/02/2023] [Accepted: 05/18/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives The objectives of this study were to share our initial experience with epilepsy surgery and provide an overview on the surgical treatments of epilepsies. Materials and Methods This was a retrospective analysis of the demographics and clinical and investigative features of patients who underwent epilepsy surgery between January 2016 and August 2021. Postoperative seizure outcome was categorized according to modified Engel's classification, and the minimum period of follow-up was 1 year. Results The study group included 30 patients with an age ranging from 6 years to 45 years (mean: 22.28 years, median: 20 years) and a male: female ratio of 20:10. The epilepsy duration before surgery ranged from 3 years to 32 years (median: 7 years). Majority of our patients underwent resective surgeries (28/30 = 93.3%), and disconnection procedures were done in two patients. This included one functional hemispherotomy and one posterior quadrantic disconnection. Temporal lobe resective surgery was the most common procedure (16/30 = 53.3%), followed by eight frontal lobe and two parietal lobe surgeries. Among resective surgeries, majority were lesional surgeries and the pathologies included mesial temporal sclerosis (4), dysembryoplastic neuroepithelial tumor (8), ganglioglioma (6), cavernoma (4), focal cortical dysplasia (2), gliosis (1), and one case of hypothalamic hamartoma. Intraoperative electrocorticography was used in all cases for optimizing surgical resection/disconnection. Nearly two-thirds of our patients (66.6%) had an Engel's Class I outcome, five patients had Engel's Class II outcome, three patients had Class III outcome, and one patient did not have any worthwhile improvement. Temporal lobe surgery patients had a better seizure outcome compared to extratemporal surgeries (84% vs. 74%). Overall, complications were minimal and short lasting, and comprised meningitis in three patients (5.6%) and transient worsening of hemiparesis following hemispherotomy in two patients. There was no mortality or long-lasting major morbidity in our patients. Conclusion In carefully selected patients with drug-resistant epilepsy, surgery offers an excellent chance of becoming seizure-free with significant improvement in overall quality of life. Majority of the common epilepsy surgery procedures can be performed through a multidisciplinary approach even in centers with limited resources.
Collapse
Affiliation(s)
- Nisha Shenoy
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Radhakrishnan Kurupath
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| |
Collapse
|
9
|
Hegde A, Srinivasan S, Menon G. Extraventricular Neurocytoma of the Posterior Fossa: A Case Report Written by ChatGPT. Cureus 2023; 15:e35850. [PMID: 37033498 PMCID: PMC10076908 DOI: 10.7759/cureus.35850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
ChatGPT (Chat Generative Pre-trained Transformer) is the latest artificial intelligence (AI) tool that has taken the internet by storm. A large language model-based AI tool, ChatGPT is used to generate natural prose-like answers learning from a large database of text. A lot is being written and spoken about the future of academic writing using this tool.We attempt to generate a short case report of a brain tumour labelled extraventriuclar neurocytoma (EVN) which is a rare tumour of the central nervous system. When posed with a set of questions on this uncommon topic, ChatGPT did well with relevant but not very specific answers. Validation of the information is an issue like with most machine learning solutions. This case report is an attempt to summarise EVN and its management. Q: Summarise extraventricular neurocytoma. ChatGPT: EVN is a rare and benign tumor that typically occurs in the brain. It often causes no symptoms, but as it grows, it can cause headaches, seizures, and changes in vision or balance. Surgery is usually curative, but there is a lack of studies to know the best treatment options. The prognosis is generally good with high rates of long-term survival and low rates of recurrence. Text italicised in the article is generated by ChatGPT.
Collapse
|
10
|
Menon G, Srinivasan S, Pai A, Hegde A. Mini anterior interhemispheric approach for A3 segment distal anterior cerebral artery aneurysms. Clin Neurol Neurosurg 2023; 226:107598. [PMID: 36706678 DOI: 10.1016/j.clineuro.2023.107598] [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: 11/21/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Aneurysms of the A3 segment of the distal anterior cerebral artery (DACA), in relation to the genu of the corpus callosum, are specific sub-group which pose unique surgical challenges due to their discrete anatomical location. We describe a mini-anterior interhemispheric approach which can be safely utilised to clip these aneurysms rather than the traditional bifrontal approach. METHODS Retrospective analysis of the clinical and radiological data of ruptured DACA-A3 aneurysms operated between 2014 and 2021 at our institute. A curvilinear scalp incision within the hairline followed by raising small, unilateral, free frontal bone flap, avoiding the opening of frontal sinus. Superior sagittal sinus is displaced medially, inter-hemispheric dissection carried out with posterior trajectory and small callosotomy is performed. DACA is skeletonised, proximal control is established, and the A3 aneurysm is dissected and clipped. RESULT Our cohort of 18 patients had a definite female preponderance (F:M::2:1) with mean age of 55.6 years. On admission three patients were categorized as WFNS Grade I, thirteen in Grade II, and two in Grade III for subarachnoid haemorrhage. All the patients had evidence of blood in the interhemispheric fissure; intraparenchymal haemorrhage was seen in seven, with intraventricular haemorrhage in six patients. Within the A3 segment six aneurysms were infragenu (inferior), eight were at the genu (anterior) and four were supragenu (superior). Two (11.1%) elderly patients succumbed post-surgery following ischemic infarcts and associated complications. At the time of follow-up at 3 months of the remaining sixteen (72.2%) patients, thirteen had a good outcome (mRS 0-3) and three (16.7%) had a poor outcome (mRS > 3). CONCLUSION The mini anterior interhemispheric is an effective minimally invasive alternative for A3 segments aneurysms and helps to avoid the complications of the conventional bifrontal interhemispheric approach.
Collapse
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India.
| |
Collapse
|
11
|
Menon S, Nair S, Kodnani A, Hegde A, Nayak R, Menon G. Retinal nerve fiber layer thickness and its correlation with visual symptoms and radiological features in pituitary macroadenoma. J Neurosci Rural Pract 2023; 14:41-47. [PMID: 36891116 PMCID: PMC9943945 DOI: 10.25259/jnrp_18_2022] [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: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of the study was to evaluate the association of the thickness of retinal nerve fiber layer (RNFL) with (i) visual symptoms and (ii) suprasellar extension defined by magnetic resonance imaging (MRI) in patients with pituitary macroadenoma. Materials and Methods RNFL thickness of 50 consecutive patients operated for pituitary macroadenoma between July 2019 and April 2021 were compared with standard visual examination findings and MRI measurements such as optic chiasm height, distance between the optic chiasm and adenoma, suprasellar extension, and chiasmal lift. Results The study group included 100 eyes of 50 patients operated for pituitary adenomas with suprasellar extension. RNFL thinning predominantly involved the nasal (84.26 ± 16.43 μm) and temporal quadrants (70.72 ± 14.80 μm) and correlated well with the visual field deficit (P < 0.001). Patients with moderate-to-severe deficit in visual acuity had a mean RNFL thickness <85 μm and patients with severe disc pallor had extremely thin RNFLs (<70 μm). Suprasellar extension defined as Wilsons Grade C, D, and E and Fujimotos Grades 3 and 4 were significantly associated with thin RNFLs <85 μm (P < 0.01). Chiasmal lift more than 1 cm and tumor chiasm distance of <0.5 mm were associated with thin RNFL (P < 0.002). Conclusion RNFL thinning correlates directly with the severity of visual deficits in patients with pituitary adenoma. Wilsons Grade D and E, Fujimoto Grade 3 and 4, chiasmal lift more than 1 cm, and chiasm tumor distance <0.5 mm are strong predictors of RNFL thinning and poor vision. Pituitary macro adenoma and other suprasellar tumors need to be excluded in patients with preserved vision but having obvious RNFL thinning.
Collapse
Affiliation(s)
- Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Soumya Nair
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Anuj Kodnani
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| |
Collapse
|
12
|
Paulson K, Logie N, Han G, Tilley D, Menon G, Menon A, Nelson G, Phan T, Murray B, Ghosh S, Pearcey R, Huang F, Wiebe E. Adjuvant Radiotherapy in Stage II Endometrial Cancer: Selective De-intensification of Adjuvant Treatment. Clin Oncol (R Coll Radiol) 2023; 35:e94-e102. [PMID: 36150980 DOI: 10.1016/j.clon.2022.08.034] [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: 02/11/2022] [Revised: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023]
Abstract
AIMS Risk stratification, including nodal assessment, allows for selective de-intensification of adjuvant radiotherapy in stage II endometrial cancer. Patterns of treatment and clinical outcomes, including the use of reduced volume 'mini-pelvis' radiotherapy fields, were evaluated in a population-based study. MATERIALS AND METHODS All patients diagnosed with pathological stage II endometrial cancer between 2000 and 2014, and received adjuvant radiotherapy in a regional healthcare jurisdiction were reviewed. Registry data were supplemented by a comprehensive review of patient demographics, disease characteristics and treatment details. The Charlson Comorbidity Score was calculated. Survival and recurrence data were analysed. RESULTS In total, 264 patients met the inclusion criteria. Most patients had endometrioid histology (83%); 41% of patients had International Federation of Gynecologists and Obstetricians grade 1 disease. Half (49%) had surgical nodal evaluation; 11% received chemotherapy. Most patients (59%) were treated with full pelvic radiotherapy fields ± brachytherapy. Seventeen per cent of patients received mini-pelvis radiotherapy ± brachytherapy, whereas 24% received brachytherapy alone. Five-year recurrence-free survival was 87% for the entire cohort, with no significant difference by adjuvant radiotherapy approach. Only one patient receiving mini-pelvis radiotherapy ± brachytherapy recurred in the pelvis but outside of the mini-pelvis field. Recorded late toxicity rates were highest for full pelvis radiotherapy + brachytherapy. CONCLUSION Risk stratification in a real-world setting allowed for selective de-intensification of adjuvant radiation with equivalent outcomes for stage II endometrial cancer. Mini-pelvis radiotherapy combined with brachytherapy is effective in highly selected patients, with the potential to decrease toxicity without compromising local control. Brachytherapy should be considered in low-risk stage II patients.
Collapse
Affiliation(s)
- K Paulson
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - N Logie
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - G Han
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - D Tilley
- Cancer Control, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada
| | - G Menon
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - A Menon
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - G Nelson
- Cancer Control, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada
| | - T Phan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - B Murray
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - S Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - R Pearcey
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - F Huang
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - E Wiebe
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
13
|
Choudhary D, Mohan V, Varsha AS, Hegde A, Menon G. Neurosurgical emergencies during pregnancy - Management dilemmas. Surg Neurol Int 2023; 14:151. [PMID: 37151438 PMCID: PMC10159311 DOI: 10.25259/sni_1076_2022] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Background Neurosurgical emergencies in the obstetric setting pose considerable challenges. Decision-making involves deliberations on the gestational age, critical nature of the illness, timing of surgery, maternal positioning during neurosurgery, anesthesiologic strategies, monitoring of the pregnancy during surgery, and the mode of delivery. The present study discusses the management and ethical dilemmas encountered during the management of six obstetric patients with neurosurgical emergencies. Methods A retrospective review of all neurosurgical operations performed between January 2016 and December 2022 were included in the study. Results This study includes a series of six pregnant women who presented with neurosurgical emergencies, secondary to freshly diagnosed pathologies in the period 2016-2022. The mean maternal age was 31.33 years. Four of the six patients were in the third semester and two were in the second trimester. The underlying etiologies were as follows: spontaneous intracerebral hypertensive hemorrhage (1), obstructive hydrocephalus due to shunt malfunction (1), brain tumor (02), and compressive spinal cord myelopathy due to tumors (02). Three patients who were near term underwent lower cesarean section followed by emergency neurosurgical procedure in the same sitting. Two second trimester patients continued their pregnancy after the emergency neurosurgical operation. In one patient, in whom a brain tumor was diagnosed near term, underwent neurosurgery 1 week after successful cesarean section. All the six mothers and fetus recovered well, ex3cept two patients who have persisting residual deficits. Conclusion Treatment of neurosurgical emergencies during pregnancy needs to be customized depending on the clinical condition of the pregnant woman, prognosis of the disease, gestational age and the status of the pregnancy. With careful planning, timely intervention, consultative decision making and it is possible to achieve the ultimate goal - which is to protect and safeguard the mother and preserve and deliver a viable fetus.
Collapse
Affiliation(s)
| | | | | | | | - Girish Menon
- Corresponding author: Girish Menon, Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India.
| |
Collapse
|
14
|
Ibrahim S, Reddy V, Menon G. Intra-Parenchymal Cerebellar Metastasis—A Rare Presentation of Castration-Resistant Prostate Cancer. J Neurosci Rural Pract 2022; 13:558-560. [PMID: 35946005 PMCID: PMC9357486 DOI: 10.1055/s-0042-1745819] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AbstractIntracranial metastases from prostate carcinoma are uncommon and usually manifest as dural secondaries in the supratentorial compartment. We present an unusual case of intra-parenchymal posterior fossa prostatic metastasis in a 61-year-old gentleman and discuss the diagnostic and management challenges involved. A 61-year-old hypertensive, diabetic man presented with gait unsteadiness for 1-month duration and no other neurological deficits. He had previously undergone bilateral orchiectomy for prostate carcinoma with multiple osseous metastases. Magnetic resonance imaging showed a well-defined lobulated, intraventricular, peripherally enhancing lesion in the fourth ventricle with obstructive hydrocephalus. He underwent sub-occipital craniectomy and decompression, and histological examination was consistent with metastatic prostate adenocarcinoma. Although cerebellar secondaries are atypical, a suspicion of metastasis should be upheld in all patients with the history of prostate carcinoma, regardless of their location and radiological characteristics of the intracranial lesion.
Collapse
Affiliation(s)
- Sufyan Ibrahim
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Vyjayanth Reddy
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| |
Collapse
|
15
|
Chakrabarty J, Cutinho M, Menon G. Knowledge on risk factors and warning signs of stroke in Udupi. Muller J Med Sci Res 2022. [DOI: 10.4103/mjmsr.mjmsr_4_20] [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: 11/04/2022] Open
|
16
|
Abraham M, Sadashivam S, Menon G, Nair S. Analysis of Prognostic Factors, Extent of Resection, and Long-Term Outcome of Craniopharyngioma in Adults and Children. Neurol India 2022; 70:2021-2030. [DOI: 10.4103/0028-3886.359154] [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: 11/06/2022]
|
17
|
Menon G, Pai A. History of trepanation and the Indian connection. Arch Med Health Sci 2022. [DOI: 10.4103/amhs.amhs_96_22] [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: 11/04/2022] Open
|
18
|
Menon G, Srinivasan S, Nair R, Hegde A, Nair S. Spinal intramedullary tumors. Arch Med Health Sci 2022. [DOI: 10.4103/amhs.amhs_263_22] [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: 12/24/2022] Open
|
19
|
Onkarappa S, Nayak R, Menon G. Intratumoral Hemorrhage in Vestibular Schwannoma: An Unusual but Alarming Clinical Entity. Neurol India 2021; 69:1492-1493. [PMID: 34747863 DOI: 10.4103/0028-3886.329608] [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)
- Sandesh Onkarappa
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| |
Collapse
|
20
|
Kumar S, Sahana D, Menon G. Optimal Use of Temporary Clip Application during Aneurysm Surgery - In Search of the Holy Grail. Asian J Neurosurg 2021; 16:237-242. [PMID: 34268145 PMCID: PMC8244713 DOI: 10.4103/ajns.ajns_465_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/29/2021] [Indexed: 11/04/2022] Open
Abstract
Temporary clips are invaluable safety tools during the clipping of an aneurysm. Controversies regarding maximum permissible duration and safety, however, remain unanswered. This descriptive narrative attempts to review the literature to provide valuable insights on controversies clouding the use of temporary clips among neurosurgeons. Popular databases, including Pub Med, Medline/Medscape, Scopus, Cochrane, Embase, Google Scholar, were searched to find available literature on temporary clips. The searched MeSH terms were "Temporary Clip," "Temporary Clipping," "Cerebral Aneurysm," and "Aneurysm." Temporary clips have been in use since 1928 and have undergone considerable structural and technical modifications. A temporary clip's optimal safety limit is not yet defined with literature evidence ranging from immediate to 93 min. It is not yet definite whether temporary clips application aggravates vasospasm, but emergency temporary clips application, especially in poor-grade aneurysmal subarachnoid hemorrhage patients, is associated with poor outcomes. A temporary clip needs to be applied with caution in patients treated earlier by endovascular technique and having indwelling stents. Nitinol Stent is feasible, while a Cobalt-Chromium alloy stent does not get occluded and gets deformed under the closing pressure of a temporary clip. Although a temporary clip application is a fundamental strategy during the clipping of an aneurysm; the exact safe duration remains to be decided in randomized control trials. Their utility for the shorter duration is beneficial under un-conclusive evidence of neuroprotective agents and intraoperative monitoring. Neurosurgeons need to consider all aspects of their pros and cons for optimal use.
Collapse
Affiliation(s)
- Sanjeev Kumar
- Department of Neurosurgery, DKS Postgraduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Debabrata Sahana
- Department of Neurosurgery, DKS Postgraduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
21
|
Huang F, Schultz B, Menon S, Vawda N, Nijjar Y, Rose B, Dickey M, Trenka K, Zimmer J, Gadbois K, Heikal A, Burke B, Baldwin L, Cuartero J, Wiebe E, Menon G. PO-0172 Towards real-world quality cervical brachytherapy: how convergence met complexity, taxing capacity. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06331-3] [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: 11/24/2022]
|
22
|
Menon G, Long B, Petit R, Zimmer J, Gadbois K, Niatsetski Y, Wiebe E, Cuartero J, Huang F, Yip E. PO-0214 Investigation of obstructions in ring applicators during pulsed dose rate cervix brachytherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06373-8] [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: 12/01/2022]
|
23
|
Mandava P, Hegde A, Sandesh O, Menon G. Abstract P421: Google Auto ML Based Prediction of Outcomes in Intracerebral Hemorrhage - Bringing Machine Learning to Clinicians. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p421] [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: 11/16/2022]
Abstract
Background:
Application of Machine Learning (ML) techniques in the prediction of Neurological Disorders has been growing rapidly. ML techniques require novel computer programming skills along with domain knowledge to produce a useful tool. We used Google Auto ML and Google ML Tables, a Cloud based front-end tools to develop, validate and deploy a prognostic model for Intracerebral Hemorrhage (ICH) without a single line of programming code.
Methods:
Data from Kasturba Medical College (KMC) Hospital ICH Stroke Registry between January 2015 and May 2019 was accessed. Google Auto ML Tables splits the dataset into training, validation and testing sets. 80% of the dataset was used for training, 10% for validation, and 10% for testing.
Cramers V
correlation statistic (
ϕ
c
) between 30 variables and outcome was used to select 20 variables to predict the dichotomous outcome of good (mRS 0-3) vs bad outcome (mRS 4-6). The ML model generated was evaluated using Area Under the Curve (AUC) and Receiver Operating Characteristic (ROC) measures and by confusion/error matrix. Logistic Regression model was developed in parallel using Wizard Pro with the same set of 20 variables.
Results:
1000 patients from KMC Registry were analysed.
Cramers V
correlation was highest for Glasgow Coma Scale (GCS) on admission (
ϕ
c
=0.6), followed by hematoma volume (
ϕ
c
=0.57). The AUC ROC of the model for good and bad outcome was 0.89 with an accuracy of 85.6%. Confusion matrix predicted 84% patients with good outcome and 87% with poor outcome. Feature importance chart showed that GCS had the highest relative importance at 25.7, followed by hematoma volume and age. A similar model created with simple logistic regression yielded a ROC of 0.87 with comparable results to the machine learning platform.
Conclusion:
Useful ML models can be easily developed and implemented by clinicians possessing domain expertise using Google Auto ML without computer programming experience.
Collapse
Affiliation(s)
| | - Ajay Hegde
- Neurology, Kasturba Med College, Manipal, India
| | | | - Girish Menon
- Neurosurgery, Kasturba Med College, Manipal, India
| |
Collapse
|
24
|
Menon S, Reddy V, Poduval AR, Menon G. Optimising surgical approaches to the orbit — a retrospective analysis of a series of forty orbital tumours. Ophthalmol J 2021. [DOI: 10.5603/oj.2021.0023] [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
|
25
|
Nayak R, Menon G, Rathod S. Cerebellar mutism following the posterior fossa tumour excision. BMJ Case Rep 2020; 13:13/12/e239969. [PMID: 33370958 DOI: 10.1136/bcr-2020-239969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Raghavendra Nayak
- Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karanataka, India
| | - Girish Menon
- Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karanataka, India
| | - Sanjeev Rathod
- Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karanataka, India
| |
Collapse
|
26
|
Abstract
Background
Adult primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke that is poorly understood. The study attempts to define the clinical profile, yield of diagnostic cerebral angiography, and prognosis of patients with PIVH.
Patients and Methods
Retrospective data analysis of all patients with PIVH admitted between February 2015 and February 2019 at a tertiary care center. Outcome was assessed using the modified Rankin scale (mRS) at 6 months.
Results and Discussion
Our study group of 30 patients constituted 3.3% (30/905) of our spontaneous intracerebral hemorrhage (SICH) patients in the study period. The mean Glasgow Coma Score on admission was 11 ± 3.33 and the mean IVH Graeb score was 5.2±2.4. All patients underwent angiography. Angiography detected moyamoya disease in four patients (13.3%) and aneurysms in two patients (6.6%) and these patients were managed surgically. Extraventricular drainage with intraventricular instillation of Streptokinase was performed in five patients. The rest of the patients was managed conservatively. At 6-month follow-up, 25 patients (83.33%) achieved favorable outcome (mRS score of 0.1 or 2), whereas five (16.66%) patients had a poor outcome (mRS score of 3 or more. Three patients succumbed to the illness. IVH Graeb score and presence of hydrocephalus have significant correlation with poor outcome.
Conclusion
PIVH is an uncommon entity but carries a better long-term prognosis than SICH angiography helps in diagnosing surgically remediable underlying vascular anomalies and is indicated in all cases of PIVH.
Collapse
Affiliation(s)
- Aswin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
27
|
Menon G. Facial Nerve Preservation During Temporal Exposure- Search for an Optimal Strategy. Neurol India 2020; 68:1321-1322. [PMID: 33342861 DOI: 10.4103/0028-3886.304079] [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: 06/12/2023]
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
28
|
Menon G, Johnson SE, Hegde A, Rathod S, Nayak R, Nair R. Neutrophil to lymphocyte ratio - A novel prognostic marker following spontaneous intracerebral haemorrhage. Clin Neurol Neurosurg 2020; 200:106339. [PMID: 33183885 DOI: 10.1016/j.clineuro.2020.106339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/14/2020] [Revised: 10/21/2020] [Accepted: 10/25/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inflammation plays a role in secondary brain injury after intracerebral haemorrhage (ICH). Peripheral biomarkers of inflammation especially the neutrophil-to-lymphocyte ratio (NLR) have been shown to influence outcome following ischemic stroke and traumatic brain injury. Role of NLR in outcome prognostication following haemorrhagic stroke has not yet been conclusively established. This study analyses the prognostic significance of admission neutrophil to lymphocyte ratio on mortality and 90-day outcome in patients admitted with acute SICH. MATERIAL AND METHODS A total of 851 patients with spontaneous ICH were retrospectively investigated. Admission haematological parameters were retrieved from our hospital laboratory systems and NLR was then calculated using the formula ANC/ALC. (Absolute neutrophil count/Absolute lymphocyte count) Clinical outcome was assessed by modified Rankin Scale at 90 days. Logistic regression was performed to identify independent risk factors of mortality and 90-day outcome. Receiver operator curve (ROC) test was used to determine the predictive value of NLR for 30-day death. RESULTS A total of 851 patients enrolled in the study. Our 30 day and 90 day mortality were 125 (17.7 %) and 244 (28.7 %) respectively. The mean NLR in the entire cohort was 9.03 ± 7.6. NLR was significantly higher in the mortality group compared to the survivors (11.98 ± 9.91 vs 8.52 ± 7.05) P < 0.001. NLR in patients with a good outcome at 90 days (7.21 ± 6.06) was a lower in comparison to patients with poor outcome(10.66 ± 8.48).(p=<0.001). NLR was dichotomised at 8.2 which was computed based on ROC curve. Mortality and poor outcome were higher in the NLR > 8.2 group at 140 (40.1 %) and 23 (67.8 %) respectively (p < 0.001). Age, GCS < 8, Volume of Hematoma, Intra ventricular extension of hematoma and NLR > 8.2 were found to be independent predictors of outcome. GCS < 8 had a greater predictive value (5.236) compared to NLR.8.2 (1.78). CONCLUSION Elevated levels of admission NLR were independently related to poor mortality and 90-day outcome after ICH. NLR is a novel, easily available and cost effective prognostic biomarker following ICH.
Collapse
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| | - Sarah Estar Johnson
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India; Institute of Neurological Sciences, Glasgow, United Kingdom.
| | - Sanjeev Rathod
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| | - Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| |
Collapse
|
29
|
Menon G. Angionegative Subarachnoid Hemorrhage: Need for Consensus Guidelines. J Neurosci Rural Pract 2020; 11:517-518. [PMID: 33144784 PMCID: PMC7595779 DOI: 10.1055/s-0040-1715082] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, India
| |
Collapse
|
30
|
Abstract
OBJECTIVE Implication of the tumor size on oncological and functional outcomes of craniopharyngioma is inconsistently reported. The aim of this study is to assess the postoperative outcome of giant craniopharyngiomas (> 4 cm in diameter) and to elucidate the impact of tumor size on various outcome parameters and survival. MATERIAL AND METHODS Forty-four patients (children aged ≤ 18 years: 25; adults: 16) with giant craniopharyngioma, operated between January 2001 and December 2015, were included in this study. Various outcomes, progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Gross total resection (GTR) was achieved in 17 (39%) and subtotal resection (STR) in 27 (61%) patients. Eleven patients (25%) received radiotherapy (RT) after STR. Postoperatively, new cranial nerve and motor deficits were noted in 12 (27%) and 9 (20%) patients, respectively. Tumor recurrence following GTR and STR without adjuvant RT was diagnosed in 3 (17%), and 5 (38%) patients, respectively. Following STR with RT, one (9%) experienced recurrence. PFS at 5-, and 10- year following GTR, STR, and STR + RT was 80.8%, 45.4%, and 90%, respectively. At 5- and 10- year, OS was 86.5%, 77.9% and 100% following GTR, STR, and STR + RT, respectively. The rate of GTR was significantly lower in patients with giant tumors (39% vs. 62%; Chi-square test, p value 0.008). Postoperatively, neurological deficit (20%), hypopituitarism (95%) and hypothalamic dysfunction (26%) were significantly higher for giant craniopharyngiomas. Hazards of recurrence were not significant between giant and non-giant tumors (hazard ratio 1.86; 95% CI 0.94-3.68; p 0.07). There was no significant difference in OS between the patients with giant and non-giant tumors (log-rank test 2.1; p value 0.14). CONCLUSION Tumor size should be considered as an important predictor of the postoperative functional outcome. Although the rate of GTR is less than that of small tumors, the recurrence rate, progression-free survival, and overall survival of the patients with giant tumor are comparable to non-giant tumors.
Collapse
Affiliation(s)
- Saravanan Sadhasivam
- Department of Neurosurgery, All India Institute of Medical Science, Veerbhadra Road, Rishikesh, Uttarakhand, 249203, India.
| | - Girish Menon
- Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Mathew Abraham
- Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Suresh Narayanan Nair
- Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| |
Collapse
|
31
|
Hegde A, Prasad GL, Menon G. Decompressive Craniectomy in Spontaneous Intracerebral Hemorrhage: A Comparison with Standard Craniotomy Using Propensity-Matched Analysis. World Neurosurg 2020; 144:e622-e630. [PMID: 32916353 DOI: 10.1016/j.wneu.2020.09.016] [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: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage carries a poor prognosis with a 30-day mortality rate of 35%-52%. There is no standardized surgical technique for treatment of spontaneous intracerebral hemorrhage. While minimally invasive techniques are popular, there has been renewed interest in decompressive craniectomy (DC). We compared surgical and functional outcomes of standard craniotomy and DC, both with hematoma evacuation, in the surgical treatment of supratentorial spontaneous intracerebral hemorrhage. METHODS This 4-year retrospective study compared outcomes of 2 surgical techniques: standard craniotomy in group A (n = 78) and DC in group B (n = 54). To minimize bias in case selection, propensity matching was performed to match preoperative Glasgow Coma Scale score and hematoma volume (group C). RESULTS Hematoma evacuation was performed in 132 patients. Mean age of patients was 53.3 years, 50.5 years, and 52.06 years in groups A, B, and C, respectively. Median preoperative Glasgow Coma Scale score was 9, 7, and 8 (P = 0.01; P = 0.45), and mean hematoma volume was 46.21 mL, 50.91 mL, and 49.90 mL. Overall mortality was 26.5%; 62.9% (n = 22) of deaths were in group A, and 37.1% (n = 13) were in group B (P = 0.69). Median modified Rankin Scale score was similar in both groups, both at discharge and at 3 months. After determining propensity scores, mortality and outcomes of matched groups remained similar. CONCLUSIONS DC with hematoma evacuation does not appear to provide a significant advantage over standard craniotomy with regard to functional outcomes and mortality. DC may overcome the need for subsequent surgery in accommodating postoperative mass effect in residual bleeds and rebleeds but is associated with greater blood loss and longer operative duration.
Collapse
Affiliation(s)
- Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India; Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| |
Collapse
|
32
|
Abstract
Background Spheno-orbital meningiomas (SOMs) constitute a rare cause for orbital proptosis and visual impairment. This study aims to share our outcome experience with regard to vision and exophthalmos following the surgical management of 17 patients with SOM. Methods Retrospective analysis of the case records of all surgically treated SOMs in the last 10 years. Exophthalmos index (EI) was calculated based on preoperative magnetic resonance imaging/computed tomography imaging. Vision was assessed using the Snellen's chart and Goldman's perimeter. Orbital volume was calculated using three-dimensional volume rendering assisted region-of-interest computation. Preoperative duration of symptoms and extent of surgery were the other predictors analyzed. Results Patients' age ranged from 17 to 72 years (mean, 50.57 y; median, 50.0 years). Women represented 13 (76.4%) of the entire study group. Proptosis (14/17; 82.4%) and visual impairment (14/17; 82.3%) were the two most common presenting complaints followed by headache (12/17; 70.1%). Gross total resection (GTR) was achieved in only 2 of the 17 patients (11.8%). Majority of the tumors were benign World Health Organization Grade I meningiomas (14/17; 84%). Mean follow-up time for the entire cohort was 56 months. Postoperatively, proptosis improved in nine (64.3%) and remained static in the rest five (35.7%) of patients. Four patients (28.6%) improved in vision following surgery. Vision remained static in eight patients (57.1%). Vision deteriorated in two (14.3%) patients who had severe preoperative visual deficits. New onset oculomotor palsy, trigeminal dysfunction, and mechanical ocular motility restriction were noticed in three (17.6%), two (11.2%), and six (35.3%) patients, respectively. The mean preoperative orbital volume was 21.68 ± 3.2 cm 3 and the mean postoperative orbital volume was 23.72 ± 3.4 cm 3 . Orbital volume was inversely related to EI. Optic canal (OC) deroofing and extensive orbital wall decompression facilitated visual improvement and proptosis reduction. None of the variables including orbital volume proved to be statistically significant in predicting outcome. Conclusion SOMs constitute a rare subgroup of skull base meningiomas that pose considerable surgical challenges. A surgical strategy aimed at safe maximal resection rather than aggressive GTR provides favorable outcome with less morbidity. Adequate bony decompression of the orbital walls and OC provides satisfactory improvements in proptosis and vision. Residual disease is common, but the risk of symptomatic recurrence is low especially when combined with adjuvant radiotherapy. Visual outcome is likely to be poor in patients presenting with severely compromised vision.
Collapse
Affiliation(s)
- Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal, India
| | - Sandesh O
- Department of Neurosurgery, Kasturba Medical College, Manipal, India
| | - Debish Anand
- Department of Neurosurgery, Kasturba Medical College, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, India
| |
Collapse
|
33
|
Menon G. Outcome Assessment Following Aneurysmal Subarachnoid Hemorrhage - Need for a Comprehensive Tool. Neurol India 2020; 68:108-110. [PMID: 32129257 DOI: 10.4103/0028-3886.279711] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| |
Collapse
|
34
|
Litvak P, Medikonda J, Menon G, Mandava P. Abstract TP458: High Accuracy of Predictive Models for SAH Using Different Machine Learning Approaches. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp458] [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: 11/16/2022]
Abstract
Background:
Patients suffering from subarachnoid hemorrhage (SAH) have poor long-term outcomes. There are predictive models for ischemic and hemorrhagic stroke. However, there is paucity of models for SAH. Machine learning concepts were applied to build multi-stage Neural Networks (NN), Support Vector Machines (SVM) and Keras/Tensor Flow models to predict SAH outcomes.
Methods:
A database of ~800 aneurysmal SAH patients from Kasturba Medical College was utilized. Baseline variables of World Federation of Neurosurgeons 5-point scale (WFNS 1-5), age, gender, and presence/absence of hypertension and diabetes were considered in Stage 1. Stage 2 included all Stage 1 variables along with presence/absence of radiologic signs vasospasm and ischemia. Stage 3 includes earlier 2 stages and discharge Glasgow Outcome Scale (GOS 1-5). GOS at 3 months was predicted using 2-layer NN/SVM/Keras-TensorFlow models on the five point categorical scale as well as dichotomized to dead/alive and favorable (GOS 4-5) or unfavorable (GOS 1-3). Prediction accuracy of models was compared to the recorded GOS.
Results:
Prediction accuracy shown as percentages (See Table) for all three stages was similar for SVM, NN and Keras/TensorFlow models. Accuracy was remarkably higher with dichotomization compared to the complete five point GOS categorical scale.
Conclusions:
SVM, NN, and Keras-TensorFlow based machine learning models can be used to predict SAH outcomes to a high degree of accuracy. These powerful predictive models can be used to prognosticate and select patients into trials.
Collapse
Affiliation(s)
| | - Jeevan Medikonda
- Biomedical Engineering, Manipal Institute of Technology, Manipal, India
| | | | | |
Collapse
|
35
|
Hegde A, Menon G, Kumar V, Lakshmi Prasad G, Kongwad LI, Nair R, Nayak R. Clinical Profile and Predictors of Outcome in Spontaneous Intracerebral Hemorrhage from a Tertiary Care Centre in South India. Stroke Res Treat 2020; 2020:2192709. [PMID: 32411342 PMCID: PMC7204327 DOI: 10.1155/2020/2192709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3-month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0-3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4-5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (p = <0.001, OR 4.806, 95% CI 3.064-7.54), admission GCS <8 (p = <0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (p = <0.001, OR 2.45, 95% CI 1.626-3.691). Intraventricular haemorrhage was an additional poor outcome predictor (p < 0.015, CI 1.105-2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.
Collapse
Affiliation(s)
- Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
- Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, UK
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Vinod Kumar
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - G. Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Lakshman I. Kongwad
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
36
|
Nair R, Anand D, Menon G, Kiran Acharya KV, Shastri BA. Compressive myelopathy – An unusual presentation of extramedullary hematopoiesis in a known patient of thalassemia major. Arch Med Health Sci 2020. [DOI: 10.4103/amhs.amhs_97_20] [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: 11/04/2022] Open
|
37
|
Menon S, Menon G, Vyjayanth R, George N, Jagdish V. Clinical presentation and outcome of patients with optic pathway gliomas: A series of twenty patients. Kerala J Ophthalmol 2020. [DOI: 10.4103/kjo.kjo_43_20] [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: 11/04/2022] Open
|
38
|
Mahmood A, Solomon JM, English C, Bhaskaran U, Menon G, Manikandan N. Measurement of adherence to home-based exercises among community-dwelling stroke survivors in India. Physiother Res Int 2019; 25:e1827. [PMID: 31880059 DOI: 10.1002/pri.1827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To develop an adherence questionnaire specific to stroke and measure the level of adherence to home-based exercises among community-dwelling stroke survivors. METHODS We developed and validated the "Stroke-Specific Measure of Adherence to Home-based Exercises" (SS-MAHE). We measured the exercise adherence among 92 community-dwelling stroke survivors in a cross-sectional study. RESULTS The SS-MAHE has two sections covering (a) the dosage of prescribed exercises and (b) dosage of actual exercises done by the participants. It was found to be reliable with ICC score of 0.81 (95% CI, 0.44, 0.94, p = .001.) Adherence was measured by comparing prescribed exercises to the actual exercises performed at home. We rated participants as "adherent" if they were following more than 70% of the prescribed exercise dosage. In our sample of 92 stroke survivors, only 28% of participants were adherent to prescribed home-based exercises. CONCLUSION SS-MAHE is a practical and reliable tool to measure adherence to home-based exercises after a stroke. Exercise adherence among stroke survivors is less than ideal. There is a need for strategies to specifically target exercise adherence in stroke survivors.
Collapse
Affiliation(s)
- Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - John Michael Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, India
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Unnikrishnan Bhaskaran
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Natarajan Manikandan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
39
|
Affiliation(s)
- Pranav Rai
- Neurosurgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Raghavendra Nayak
- Neurosurgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Debish Anand
- Neurosurgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Girish Menon
- Neurosurgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| |
Collapse
|
40
|
Abstract
Microvascular decompression (MVD) is a novel surgical procedure predominantly performed for treating trigeminal neuralgia (TN) and hemifacial spasm (HS). Multiple studies have proven the long-term success of MVD for both these conditions. The most common complications of MVD reported include chemical meningitis, facial hypesthesia, cerebrospinal fluid leak, facial paresis, and hearing loss. Delayed facial palsy (DFP) is an uncommon complication mostly noted in MVD for HS and after the removal of acoustic tumors. We report two cases of DFP occurring after performing MVD, one each for HS and TN. This is also the first case of DFP to be reported after MVD for TN. Both were young females who developed DFP 2 weeks after surgery. They were managed with oral steroids and acyclovir for 2–3 weeks and achieved excellent outcome at an average of 4.5 weeks from the onset. We conclude that although majority of the cases improve spontaneously, steroids and acyclovir might assist in faster recovery.
Collapse
Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Vinod Kumar
- Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| |
Collapse
|
41
|
Pargaonkar R, Kumar V, Menon G, Hegde A. Comparative study of computed tomographic scoring systems and predictors of early mortality in severe traumatic brain injury. J Clin Neurosci 2019; 66:100-106. [DOI: 10.1016/j.jocn.2019.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/07/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022]
|
42
|
Hegde A, Menon G, Kumar V. Surgery for spontaneous intracerebral hemorrhage - A comparative study with medical management in moderate to large sized hematomas. Clin Neurol Neurosurg 2019; 184:105415. [PMID: 31323546 DOI: 10.1016/j.clineuro.2019.105415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/07/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Intracerebral Hemorrhage (ICH) is a devastating form of stroke and accounts for 10-15% of all cases. The management of ICH has predominantly been directed towards medical management. Multiple trials have failed to prove the superiority of surgical evacuation over conservative methods. However, surgery in a carefully selected set of patients is beneficial in reducing mortality and limiting disability. In this article, we retrospectively analysed our ICH register to compare the outcomes of surgical and conservative management of patients <70 years having a clot volume above 30 ml. PATIENTS AND METHODS We retrospectively analysed patients with ICH admitted at our centre between January 2015 and December 2017. A total of 119/624 patients with supratentorial hematoma volume >30 ml, GCS ≥ 5 and age less than 70 were included in this study. RESULTS The group was dichotomised into two groups A & B based on the management. Seventy-two (60.5%) patients underwent surgical intervention in group A and the remaining 47 (39.5%) were managed by best possible conservative methods in group B. The mean age in Group A was 51.01 years and 55.89 years in group B (P = 0.012). The volume of hematoma in the surgical group was 46.5 ± 14.9 ml in comparison to 38.53 ± 10.84 ml in the medically managed group (p = 0.002). Mortality at 90 days was 27/47 (57.44%) in the medically managed group while 23/72 (31.9%) in the surgical group (p = 0.006). Median mRS at discharge and 90 days were nearly identical and there was no significant difference in the dichotomized outcome among the two different management cohorts (p > 0.05). Mortality was the highest in the 30-50 ml medically managed group and >51 ml surgical group (p = 0.024). Age of the patient, GCS on presentation and medical management were independent predictors of mortality on logistic regression. The Cox Regression survival analysis of the two groups showed a clear survival advantage in the surgically managed group adjusting for age and GCS (p = 0.002) at 90 days. CONCLUSION Surgical Evacuation of spontaneous intracerebral haemorrhage has a survival advantage at 90 days in moderate to large sized hematomas. It, however, did not demonstrate any quantifiable improvement in functional outcome. Surgical evacuation of moderate-sized hematomas reduces mortality caused by delayed perihematomal oedema.
Collapse
Affiliation(s)
- Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India; Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United kingdom.
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India.
| | - Vinod Kumar
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India.
| |
Collapse
|
43
|
Hegde A, Prasad GL, Menon G, Jaiprakash P. Spontaneous orbital haemorrhage secondary to cavernous haemangioma - a case summary and review of literature. J Clin Neurosci 2019; 67:272-275. [PMID: 31221581 DOI: 10.1016/j.jocn.2019.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/31/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Orbital haemangiomas are common orbital tumors known for their slow growth. Acute presentation with haemorrhage into the tumor is a rare occurrence with only nine cases reported in literature. METHODS The authors present a case of an elderly female with sudden onset of proptosis and swelling of the eye. There was a transient relief of symptoms with steroids with residual proptosis and ptosis at two weeks. Magnetic resonance imaging revealed an intraconal soft tissue mass in the inferolateral quadrant of the left orbit with a differential diagnosis of haemangioma with bleed or metastasis. RESULTS Patient underwent a lateral orbitotomy and tumour excision and histopathological examination revealed a cavernous haemangioma with a thrombus. The patient had complete symptomatic recovery following surgery. CONCLUSION Orbital haemangiomas presenting with haemorrhage is rare and should be differentiated from orbital venous anomalies prior to surgery.
Collapse
Affiliation(s)
- Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India; Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Padmapriya Jaiprakash
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
44
|
Pettitt A, Kalakonda N, Cicconi S, Murphy C, Menon G, Coupland S, Oates M, Lin K, Pocock C, Jenkins S, Schuh A, Wandroo F, Rassam S, Duncombe A, Cervi P, Paneesha S, Aldouri M, Fox C, Knechtli C, Hamblin M, Turner D, Hillmen P. BRIEF CO-ADMINISTRATION OF IDELALISIB MAY IMPROVE THE LONG-TERM EFFICACY OF FRONTLINE CHEMOIMMUNOTHERAPY IN CHRONIC LYMPHOCYTIC LEUKAEMIA: 3-YEAR FOLLOW-UP FROM THE RIALTO TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.32_2630] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A. Pettitt
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - S. Cicconi
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - C. Murphy
- CR-UK Liverpool Cancer Trials Unit; University of Liverpool; Liverpool United Kingdom
| | - G. Menon
- Liverpool Clinical Laboratories; Haemato-Oncology Diagnostic Service; Liverpool United Kingdom
| | - S.E. Coupland
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - M. Oates
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - K. Lin
- Liverpool Clinical Laboratories; Department of Blood Sciences; Liverpool United Kingdom
| | - C. Pocock
- Department of Haematology; Kent & Canterbury Hospital; Canterbury United Kingdom
| | - S. Jenkins
- Russells Hall Hospital; Haematology Unit; Dudley United Kingdom
| | - A. Schuh
- Department of Oncology; University of Oxford; Oxford United Kingdom
| | - F. Wandroo
- Department of Haematology; Sandwell Hospital; Birmingham United Kingdom
| | - S. Rassam
- Department of Haematology; Maidstone Hospital; Maidstone United Kingdom
| | - A.S. Duncombe
- Department of Haematology; University Hospital Southampton; Southampton United Kingdom
| | - P. Cervi
- Department of Haematology & Blood Transfusion; Southend Hospital; Southend United Kingdom
| | - S. Paneesha
- Department of Haematology; Heartlands Hospital; Birmingham United Kingdom
| | - M. Aldouri
- Department of Haematology; Medway Maritime Hospital; Gillingham United Kingdom
| | - C. Fox
- Department of Clinical Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - C. Knechtli
- Department of Clinical Haematology; Royal United Hospital; Bath United Kingdom
| | - M. Hamblin
- Department of Haematology; Colchester General Hospital; Colchester United Kingdom
| | - D. Turner
- Oncology Unit; Torbay Hospital; Torquay United Kingdom
| | - P. Hillmen
- Faculty of Medicine and Health; University of Leeds; Leeds United Kingdom
| |
Collapse
|
45
|
Korfi K, Araf S, Bewicke-Copley F, Kumar E, Cummin T, Ashton-Key M, Barrans S, Van Hoppe S, Burton C, Elshiekh M, Rule S, Crosbie N, Clear A, Calaminici M, Menon G, Sha C, Bentley M, Nagano A, Davies A, Painter D, Smith A, Okosun J, Gribben J, Naresh K, Westhead D, Wang J, Johnson P, Fitzgibbon J. LONGITUDINAL ANALYSES OF DIAGNOSTIC-RELAPSE BIOPSIES OF DIFFUSE LARGE B CELL LYMPHOMA SUGGEST THAT RELAPSE IS MEDIATED BY DISTINCT MECHANISMS IN ABC AND GCB LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.100_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- K. Korfi
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - S. Araf
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - F. Bewicke-Copley
- Centre for Molecular Oncology; Barts Cancer Institute; London United Kingdom
| | - E. Kumar
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - T. Cummin
- Cancer Research UK Centre; University of Southampton; Southampton United Kingdom
| | - M. Ashton-Key
- Cellular Pathology; University Hospital Southampton NHS Foundation Trust; Southampton United Kingdom
| | - S. Barrans
- HMDS; Leeds Teaching Hospitals NHS Trust; Leeds United Kingdom
| | - S. Van Hoppe
- HMDS; Leeds Teaching Hospitals NHS Trust; Leeds United Kingdom
| | - C. Burton
- HMDS; Leeds Teaching Hospitals NHS Trust; Leeds United Kingdom
| | - M. Elshiekh
- Cellular & Molecular Pathology; Imperial College NHS Trust & Imperial College London; London United Kingdom
| | - S. Rule
- Department of Haematology; Derriford Hospital, University of Plymouth; Plymouth United Kingdom
| | - N. Crosbie
- Department of Haematology; University Hospitals Plymouth NHS Trust; Plymouth United Kingdom
| | - A. Clear
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - M. Calaminici
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - G. Menon
- Haemato-Oncology Diagnostic Service; Liverpool Clinical Laboratories; Liverpool United Kingdom
| | - C. Sha
- School of Molecular and Cellular Biology; University of Leeds; Leeds United Kingdom
| | - M. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds United Kingdom
| | - A. Nagano
- Centre for Molecular Oncology; Barts Cancer Institute; London United Kingdom
| | - A. Davies
- Cancer Research UK Centre; University of Southampton; Southampton United Kingdom
| | - D. Painter
- Epidemiology and Cancer Statistics Group; University of York; York United Kingdom
| | - A. Smith
- Epidemiology and Cancer Statistics Group; University of York; York United Kingdom
| | - J. Okosun
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - J. Gribben
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - K.N. Naresh
- Cellular & Molecular Pathology; Imperial College NHS Trust & Imperial College London; London United Kingdom
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds United Kingdom
| | - J. Wang
- Centre for Molecular Oncology; Barts Cancer Institute; London United Kingdom
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton United Kingdom
| | - J. Fitzgibbon
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| |
Collapse
|
46
|
Menon G, Hegde A, Kongwad LI, Omkarappa S. Primary Thalamic Haemorrhage – Clinical Profile and Prognostic Predictors from a Series of 117 Cases. Open Neurol J 2019. [DOI: 10.2174/1874205x01913010076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Studies on isolated primary thalamic hematomas are limited. This study analyses 117 patients with primary thalamic hematomas and attempts to identify the various prognostic factors influencing the outcome.
Materials and Methods:
A retrospective analysis of the case records was carried out to analyse the following prognostic parameters - GCS on admission, comorbidities like systemic hypertension and diabetes mellitus, side and site of hematoma, volume of the clot, presence of intraventricular haemorrhage (IVH), development of hydrocephalus, and the role of surgical intervention. A Chi-square test was used to compare categorical variables, and Student t-test and Mann Whitney test were applied to calculate the P-value for continuous variables for univariate statistics. Binary Logistic regression was used for multivariate analysis.
Results and Discussion:
This study group comprised 67 men and 50 women with a mean age of 62.05±11.71years. The mean GCS on admission in the study group was 11.56±3.28. The mean clot volume was 13±9.5ml and majority (89.74%) of the patients had clots with a volume of less than 20 ml. An intraventricular extension was noted in 98 patients. Craniotomy and surgical evacuation were performed in only two patients while external ventricular drainage with urokinase instillation was performed in 23 patients. Of the 117 patients, 3 had anterior thalamic clots, 19 had posterior thalamic clots, 13 had medial clots, 53 had lateral thalamic bleeds and 29 had global clots. The overall three-month mortality with thalamic bleeds was 28.2%. At the end of three months, 59 patients (50.42%) had a favourable outcome (mRS < 4). On univariate analysis, male sex, dominant side bleed, preoperative GCS of less than 8 (p < 0.001), presence of hydrocephalus (p< 0.004) and a need for EVD (p<0.012) were found to be significantly associated with mortality and poor outcome. Similarly, clot volume less than 20 ml, right-sided bleed and surgical evacuation were associated with a favourable outcome (p < 0.001). On multiple logistic regression, age, volume of hematoma and GCS on admission were predictors for mortality and volume of hematoma was a significant predictor of poor outcome.
Conclusion:
Thalamic hematomas include a spectrum of clots of varying dimensions at different locations and the outcomes need not be uniformly poor. Isolated thalamic hemorrhages are generally small in volume preferentially located in the lateral thalamus. Patients with right-sided bleeds and small clot volume perform well. Male sex, poor GCS on admission, clot volume above 20 ml, intraventricular extension and a need for external ventricular drainage adversely influence the outcome.
Collapse
|
47
|
Jukkarwala A, Baheti NN, Dhakoji A, Salgotra B, Menon G, Gupta A, Prakash S, Rathore C. Establishment of low cost epilepsy surgery centers in resource poor setting. Seizure 2019; 69:245-250. [PMID: 31121549 DOI: 10.1016/j.seizure.2019.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/01/2019] [Revised: 04/25/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To prospectively assess the feasibility of establishing low cost epilepsy surgery programs in resource poor settings. METHOD We started epilepsy surgery centers in Tier 2 and Tier 3 cities in India in private hospitals. This model is based on the identifying and operating ideal epilepsy surgery candidates on the basis of clinical history, interictal and ictal video-EEG data, and 1.5 T MRI without other investigations and without regular involvement of other specialists. Trained epileptologists formed the fulcrum of this program who identified ideal candidates, offered them counseling, and read video-EEG and MRI. We also spread epilepsy awareness among locals and physicians and established focused epilepsy clinics. The expenses were subsidized for deserving patients and policies were devised to keep video-EEG duration and staff requirement to minimum. Difficult epilepsy surgery cases were referred to established centers. Initial surgeries were performed by invited epilepsy surgeons and subsequently by local neurosurgeons. RESULTS A total of 125 epilepsy surgeries were performed at three centers since 2012. This included 81(64.8%) temporal lobe resections, 26 (20.8%) extratemporal focal resections, and 13 (10.4%) hemispherotomies. Of the 93 patients with more than 1 year of postoperative followup, 86 (92.5%) had Engel class IA outcome. There were minor complications in 5% patients. Average cost of presurgical evaluation and surgery was Rs. 92,707 (USD 1,324). CONCLUSIONS It is possible to establish successful epilepsy surgery programs in resource poor setting with reasonable costs. This low cost model can be replicated in other parts of world to reduce the surgical treatment gap.
Collapse
Affiliation(s)
- Anis Jukkarwala
- Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Neeraj N Baheti
- Department of Neurology, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Amit Dhakoji
- Department of Neurology, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India; Department of Neurosurgery, Sahyadri Super Speciality Hospital, Pune, Maharashtra, India
| | - Bhagwati Salgotra
- Department of Neurosciences, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Aditya Gupta
- Department of Neurosurgery, Artemis Hospital, Gurugram, Haryana, India
| | - Sanjay Prakash
- Department of Neurosciences, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Chaturbhuj Rathore
- Department of Neurosciences, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India.
| |
Collapse
|
48
|
Cohen I, Zhao D, Menon G, Nakayama M, Koseki H, Zheng D, Ezhkova E. 287 Polycomb repressive complex 1 (PRC1) preserves epidermal tissue integrity independently of PRC2. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.363] [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: 11/16/2022]
|
49
|
Menon G, Menon S, Hegde A. Does Universal Bypass before Carotid Artery Occlusion Obviate the Need for Balloon Test Occlusion: Personal Experience with Extracranial-Intracranial Bypass in 23 Patients. J Neurosci Rural Pract 2019; 10:194-200. [PMID: 31001004 PMCID: PMC6454976 DOI: 10.4103/jnrp.jnrp_381_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim Carotid artery ligation carries a potential risk of ischemic complications even in patients with good collaterals and adequate cross-circulation. Preoperative assessment through balloon test occlusion (BTO) is technically challenging and not feasible in all patients. We analyze our experience with universal bypass without performing detailed cerebrovascular reserve (CVR) studies in 23 patients before carotid artery ligation. Patients and Methods This was a retrospective analysis of the case records of 23 patients who underwent cervical carotid artery ligation for various indications since January 2009. Results The study included 21 patients with cavernous carotid aneurysms, one patient with a large fusiform petrous carotid aneurysm, and one patient with recurrent glomus jugulare encasing the cervical internal carotid artery. The initial 12 patients underwent preoperative BTO with hypotensive challenge. All patients underwent a bypass procedure followed by carotid artery ligation irrespective of the BTO findings. Patients who successfully completed a BTO underwent a low-flow superficial temporal artery to middle cerebral artery bypass. A high-flow extracranial-intracranial bypass using a saphenous vein graft from external carotid artery to middle cerebral artery was done in all patients who either failed the BTO or did not undergo BTO. We had two operative mortalities and one poor outcome. All the other patients had a good recovery with a Glasgow outcome score of 5 at the last follow-up. Graft patency rates were 81.1% in both the low-flow and high-flow groups. Conclusion Universal high-flow bypass is safe, effective, and should be preferred in all patients before carotid artery ligation. It obviates the need for detailed CVR assessment, especially in centers with limited resources.
Collapse
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| |
Collapse
|
50
|
Menon S, Ghosh S, Vawda N, Menon G, Roumeliotis M, Doll C, Wiebe E, Huang F. EP-1509 "Young adult" and "geriatric" locally advanced cervix cancer in Alberta: same but different? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31929-2] [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: 11/28/2022]
|