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Chandrakiran C, Ishwarya R, Rakshitha R, Luckose R, Khanapure K, Patil SB, Reddy HN, Surya Prakash DR. Retrospective Analysis of Transnasal Endoscopic CSF Rhinorrhea Repair in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2022; 74:1328-1333. [PMID: 36452772 PMCID: PMC9702216 DOI: 10.1007/s12070-021-02462-7] [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: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022] Open
Abstract
To analyse the outcome of transnasal endoscopic repair of CSF Rhinorrhea in a tertiary care centre. This is a retrospective study conducted on 81 patients who underwent CSF Rhinorrhea repair in a tertiary care hospital for a period of 11 years. Following confirmation of diagnosis using bio-chemical and radiological investigations, all patients underwent transnasal endoscopic repair of CSF Rhinorrhea using a multilayer graft. Patients were followed up for 6 months. The most common etiology in our study was spontaneous CSF rhinorrhea (60.49%) and subjects with BMI > 25.5 kg/m2 were more prone to it. Cribriform plate was found to be the most frequent site of leak in our study (58.02%), followed by fovea ethmoidalis (12.35%). Overall success rate was 96.30%. Transnasal endoscopic approach for cerebrospinal fluid rhinorrhea repair shows good success rate and also offers the advantages of better visualization and identification of site of leak, less complications, rapid postoperative recovery, and low recurrence rate. Transnasal endoscopic CSF Rhinorrhea repair has shown good results in terms of low recurrence rates and high patient satisfaction among other advantages. Hence this approach should be commonly used for CSF rhinorrhea repair by surgeons.
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Affiliation(s)
- C. Chandrakiran
- Department of ENT, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
| | - R. Ishwarya
- Department of ENT, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
| | - R. Rakshitha
- Department of ENT, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
| | - Rini Luckose
- Department of ENT, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
| | - Kiran Khanapure
- Department of Neurosurgery, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
| | - Sanjay B. Patil
- Department of ENT, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
| | - Harshavardhan N Reddy
- Department of ENT, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
| | - D. R. Surya Prakash
- Department of ENT, M.S. Ramaiah Medical College, M.S. Ramaiah nagar, Mathikere, Bangalore, 560054 India
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Basu B, Bhaskar N, Barui S, Sharma V, Das S, Govindarajan N, Hegde P, Perikal PJ, Antharasanahalli Shivakumar M, Khanapure K, Tekkatte Jagannatha A. Evaluation of implant properties, safety profile and clinical efficacy of patient-specific acrylic prosthesis in cranioplasty using 3D binderjet printed cranium model: A pilot study. J Clin Neurosci 2021; 85:132-142. [PMID: 33581784 DOI: 10.1016/j.jocn.2020.12.020] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023]
Abstract
There exists a significant demand to develop patient-specific prosthesis in reconstruction of cranial vaults after decompressive craniectomy. we report here, the outcomes of an unicentric pilot study on acrylic cranial prosthesis fabricated using a 3D printed cranium model with its clinically relevant mechanical properties. METHODS The semi-crystalline polymethyl methacrylate (PMMA) implants, shaped to the cranial defects of 3D printed cranium model, were implanted in 10 patients (mean age, 40.8 ± 14.8 years). A binderjet 3D printer was used to create patient-specific mould and PMMA was casted to fabricate prosthesis which was analyzed for microstructure and properties. Patients were followed up for allergy, infection and cosmesis for a period of 6 months. RESULTS As-cast PMMA flap exhibited hardness of 15.8 ± 0.24Hv, tensile strength of 30.7 ± 3.9 MPa and elastic modulus of 1.5 ± 0.1 GPa. 3D microstructure of the semi-crystalline acrylic implant revealed 2.5-15 µm spherical isolated pores. The mean area of the calvarial defect in craniectomy patients was 94.7 ± 17.4 cm2. We achieved a cranial index of symmetry (CIS -%) of 94.5 ± 3.9, while the average post-operative Glasgow outcome scale (GOS) score recorded was 4.2 ± 0.9. CONCLUSIONS 3D printing based patient-specific design and fabrication of acrylic cranioplasty implant is safe and achieves acceptable cosmetic and clinical outcomes in patients with decompressive craniectomy. Our study ensured clinically acceptable structural and mechanical properties of implanted PMMA, suggesting that a low cost 3D printer based PMMA flap is an affordable option for cranioplasty in resource constrained settings.
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Affiliation(s)
- Bikramjit Basu
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India; Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Nitu Bhaskar
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Srimanta Barui
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Vidushi Sharma
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Soumitra Das
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Nikhil Govindarajan
- Department of Metallurgical and Materials Engineering, National Institute of Technology, Surathkal, Mangaluru 575025, Karnataka, India
| | - Pranoy Hegde
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
| | - Parichay J Perikal
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
| | | | - Kiran Khanapure
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
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Mehta A, Mahale R, Khanapure K, Jagannatha AT, Acharya P, Srinivasa R. Acute Hydrocephalus in a Case of Mumps Meningoencephalitis: A Rare Occurrence. J Pediatr Neurosci 2020; 15:34-37. [PMID: 32435304 PMCID: PMC7227755 DOI: 10.4103/jpn.jpn_58_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Mumps is an acute viral illness, which presents with glandular and/or nervous system involvement. The most common central nervous system manifestations of mumps include aseptic meningitis and meningoencephalitis. Mumps meningoencephalitis, which is characterized by fever, vomiting, nuchal rigidity, and altered sensorium, usually develops at least 3-10 days after mumps parotitis. Acute hydrocephalus secondary to mumps meningoencephalitis is rare. Here we report a child who developed acute hydrocephalus following mumps meningoencephalitis and who was treated with external ventricular drainage following which he showed exceptional recovery.
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Affiliation(s)
- Anish Mehta
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India,Address for correspondence: Dr. Rohan Mahale, Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru 560054, Karnataka, India. E-mail:
| | - Kiran Khanapure
- Department of Neurosurgery, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anirudh T Jagannatha
- Department of Neurosurgery, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Khanapure K, Joshi KC, Jagannatha AT, Perikal PJ, Quryshi SA, Srikantha U, Verma RG, Hegde AS. Supraorbital Craniotomy for Large Anterior Skull Base Meningiomas: A Technical Note. Asian J Neurosurg 2019; 14:767-772. [PMID: 31497100 PMCID: PMC6703076 DOI: 10.4103/ajns.ajns_40_19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Supraorbital craniotomy (SOC) has brought a paradigm shift in approaching anterior skull base lesions. With better understanding of relevant anatomy, the indications are being stretched from highly selected, small-to-moderate-sized tumors to large and complex anterior skull base lesions. Objective: We share our experience and discuss the nuances of surgery for large anterior skull base meningiomas using the SOC. Methods: This is a single institute study using prospectively collected retrospective data from seven cases of large anterior skull base meningiomas (>3 cm) using the SOC. We reviewed the indications, safety, and procedural complications in these cases. Results: Simpson's Grade 2 excision was achieved in all these seven cases, with faster postoperative recovery. Follow-up clinical outcome and cosmesis were satisfactory. Conclusion: SOC is a safe alternative for the standard skull base approaches in treating large anterior skull base meningiomas. The SOC can be effectively used to treat selected large anterior skull base meningiomas.
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Affiliation(s)
- Kiran Khanapure
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Krishna Chaitanya Joshi
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka, India.,The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | | | - Parichay J Perikal
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Syed Aezaz Quryshi
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Umesh Srikantha
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka, India.,Department of Neurosurgery, Institute of Neurosciences, Aster Hospital, Bengaluru, Karnataka, India
| | - Ravi Gopal Verma
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka, India.,Department of Neurosurgery, Institute of Neurosciences, Aster Hospital, Bengaluru, Karnataka, India
| | - Alankar S Hegde
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka, India
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Perikal PJ, Srikantha U, Jagannath AT, Khanapure K, Varma RG, Hegde AS. Rare manifestation of common disease with an unique method of minimally invasive spine stabilization: Cervical 2-3 facet lesion. J Craniovertebr Junction Spine 2018; 9:209-211. [PMID: 30443143 PMCID: PMC6187890 DOI: 10.4103/jcvjs.jcvjs_69_18] [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: 11/04/2022] Open
Abstract
Cervical granulomatous infections of the posterior elements are very rare, it is often difficult to diagnose due to rarity and variable presentation of symptoms. Any cervical surgical procedure carries a certain morbid risk to the patient. We present a case of cervical 2-3 facet joint lesion which was managed by a minimally invasive technique with a favorable outcome.
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Affiliation(s)
- Parichay J Perikal
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Umesh Srikantha
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Aniruddha T Jagannath
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Kiran Khanapure
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Ravi Gopal Varma
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India
| | - A S Hegde
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
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Perikal PJ, Srikantha U, Joshi KC, J AJ, Khanapure K, Varma RG, Hegde SA. Minimally Invasive Augmented Fixation for Anatomical Reduction of Grade 2 and Grade 3 Listhesis in Patients with Osteoporosis. Asian Spine J 2018; 12:887-892. [PMID: 30213172 PMCID: PMC6147869 DOI: 10.31616/asj.2018.12.5.887] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/05/2018] [Indexed: 11/25/2022] Open
Abstract
Study Design A retrospective study. Purpose To study the efficacy of augmented fixation for anatomical reduction of grade 2 and grade 3 listhesis in patients with osteoporosis. Overview of Literature Spondylolisthesis in osteoporotic patients requiring spinal fixation are associated with complications such as loss of surgical construct stability, screw pulling out, and screw loosening. Augmented fixation is a novel strategy to achieve necessary construct integrity. Methods Thirteen consecutive patients with grade 2 or grade 3 listhesis, with proven osteoporosis on dual energy X-ray absorptiometry (DEXA) scan, and who underwent augmented fixation for reduction of listhesis were retrospectively analyzed. In all patients, surgical access was achieved with a fixed 22 mm tubular retractor. A modified technique of bilateral, sequential, transforaminal decompression and discectomy, followed by reduction of listhesis using unilaterally placed augmented screws was employed in all the cases. Patients were followed up with plain X-rays at regular intervals to assess for implant stability and fusion status. All patients were started on medical treatment for osteoporosis. Results The mean age of the patients was 52.46 years, with 12 females and one male. The median T-score on DEXA scan was −3.0. Of the 13 patients, listhesis was at L4–L5 in five and at L5–S1 in eight. Nine patients had grade 2 listhesis, while four patients had grade 3 listhesis. Complete reduction was achieved in 10 patients. The median duration of follow-up was 18 months. Postoperative outcomes were satisfactory in all cases. Conclusions Augmented fixation is a useful technique for achieving anatomical reduction of listhesis in patients with osteoporosis.
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Affiliation(s)
- Parichay J Perikal
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Umesh Srikantha
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, India
| | - Krishna C Joshi
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Aniruddha Jagannath J
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Kiran Khanapure
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
| | - Ravi Gopal Varma
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, India
| | - Sathyaranjandas Alanga Hegde
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
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Parichay PJ, Khanapure K, Aniruddha TJ, Mahendra JV, Joshi KC, Furtado SV, Hegde AS. Curious Case of a Medullary Lesion following Pontine Cavernoma Resection. JMSH 2017. [DOI: 10.46347/jmsh.2017.v03i02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Parichay PJ, Khanapure K, Joshi KC, Aniruddha TJ, Sandhya M, Hegde AS. Clinical and radiological assessment of cerebral hemodynamics after cranioplasty for decompressive craniectomy - A Clinical study. J Clin Neurosci 2017; 42:97-101. [PMID: 28457859 DOI: 10.1016/j.jocn.2017.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/15/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To find the correlation between radiologically proven improvement in cerebral hemodynamics with clinical improvement in patients undergoing cranioplasty. MATERIAL AND METHODS The study is a prospective observational study of 10 cases, in M S Ramaiah Institute of Neurosciences, involving patients treated by a decompressive craniectomy for intractable intra cranial hypertension either due to trauma or stroke and afterwards underwent cranioplasty. RESULTS Of the 10 patients, 70% patients showing significant improvement in motor functions on Barthel index scale, 60% patients showed improvement in speech, mean duration from date of decompressive craniectomy to cranioplasty being 122.4days. Cerebral perfusion was remarkably better after cranioplasty, as demonstrated decrease in the Pulsatility index on the ipsilateral side of decompression on Trans cranial Doppler (<0.73 mean). This data also favored improved cerebral blood flow and permeability on the CT perfusion with increase in cerebral blood flow (CBF), Cerebral Blood Volume (CBV) and decrease in Time to Peak (TTP) and a positive outcome when correlated with Barthel index with P-values of 0.093, 0.017 and 0.001 respectively. CONCLUSION Cranioplasty influences the cerebral hemodynamics after cranioplasty and has a positive correlation on the functional outcome and cerebral blood flow in the MCA territory.
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Affiliation(s)
- Perikal J Parichay
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India.
| | - Kiran Khanapure
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
| | - Krishna C Joshi
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
| | - T J Aniruddha
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
| | - M Sandhya
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - A S Hegde
- Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road, Bangalore 54, India
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Joshi KC, Khanapure K, Hegde N, Ravindra N, Jagannatha AT, Hegde AS. Angioglioma of the Spinal Cord. World Neurosurg 2016; 96:610.e5-610.e8. [PMID: 27641267 DOI: 10.1016/j.wneu.2016.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Angiogliomas are rare low-grade glial tumors with significant vascular components. These tumors are usually seen in the brain, and spinal cord angiogliomas have not been reported in the literature until now. CASE DESCRIPTION We report the case of a 15-year-old boy with an angioglioma of the medulla and cervicodorsal spine, which was completely excised through a combined suboccipital craniotomy and cervicodorsal laminotomy. The patient experienced excellent clinical recovery after the surgery, and follow-up contrast magnetic resonance imaging showed complete excision of the tumor. CONCLUSION The fact that increased vascularity in a glioma does not always indicate a higher grade is confirmed by the unique histology of angiogliomas. These tumors can present with intratumoral bleeding. Awareness of these entities is extremely important. Complete excision can be attempted, and the postoperative prognosis is very good.
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Affiliation(s)
| | - Kiran Khanapure
- Department of Neurosurgery, M. S Ramaiah Medical College, Bangalore, India
| | - Nishchit Hegde
- Department of Neurosurgery, M. S Ramaiah Medical College, Bangalore, India
| | | | | | - Alangar S Hegde
- Department of Neurosurgery, M. S Ramaiah Medical College, Bangalore, India
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Abstract
PURPOSE Ventriculoperitoneal (VP) shunt is one of the most commonly performed procedures by a neurosurgeon. It is occasionally fraught with the most bizarre complications. Understanding the pathophysiology of these complications can help us make the procedure safe and more effective. METHODS The authors report a case of 8-year-old boy, previously operated for lumbar myelomeningocele and hydrocephalus with an intra diploic migration of shunt tube and shunt dysfunction, and discuss the pathophysiology, diagnosis, and surgical strategy. RESULTS After diagnosis of shunt malfunction, shunt revision was done with placement of new system and removal of the old apparatus. Patient had a remarkable recovery after the surgery. CONCLUSION Intradiploic migration is an extremely rare cause of shunt malfunction and has never been reported in literature before. Possible mechanism is that prolonged pressure on the valve due to recumbent head position in a paraplegic child might have led to new bone formation and subsequent intradiploic migration of the valve. Careful planning the position of shunt valve in relation to head position, especially in children who are recumbent due to paraplegia might avoid this untoward complication.
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Affiliation(s)
| | - Kiran Khanapure
- M. S. Ramaiah Medical College, New BEL Road, Bangalore, 560055, India.
| | | | - Ravi Gopal Varma
- M. S. Ramaiah Medical College, New BEL Road, Bangalore, 560055, India.
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Abstract
Congenital occipital dermal sinus with an underlying dermoid is a rare, benign lesion of embryological origin and may occur anywhere along the neuraxis. We present a case of a 15-year-old girl with a vermian dermoid and an occipital dermal sinus. Gross total resection of the lesion was done and post-operative period was uneventful. A detailed review of the literature is also covered.
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Affiliation(s)
- Umesh Srikantha
- Department of Neurosurgery, M S Ramaiah Medical Teaching Hospital, Bangalore, Karnataka, India
| | - Kiran Khanapure
- Department of Neurosurgery, M S Ramaiah Medical Teaching Hospital, Bangalore, Karnataka, India
| | - S. Nirmala
- Department of Neurosurgery, M S Ramaiah Medical Teaching Hospital, Bangalore, Karnataka, India
| | - Ravi Gopal Varma
- Department of Neurosurgery, M S Ramaiah Medical Teaching Hospital, Bangalore, Karnataka, India
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Venkatesh MS, Pandey P, Devi BI, Khanapure K, Satish S, Sampath S, Chandramouli BA, Sastry KVR. Pediatric infratentorial subdural empyema: analysis of 14 cases. J Neurosurg Pediatr 2006; 105:370-7. [PMID: 17328260 DOI: 10.3171/ped.2006.105.5.370] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECT Pediatric cases of infratentorial subdural empyema (SDE) are both rare and associated with high rates of morbidity and mortality. The goal of this study was to report patient characteristics, treatment, and outcome in an exclusively pediatric series of SDE cases. METHODS A series of 14 pediatric cases of infratentorial SDE was retrospectively analyzed. All patients were treated between 1994 and 2004. Sixty-four percent of the patients were boys; the majority of cases occurred during the summer months. Clinical features included headache, fever, vomiting, meningism, and otorrhea. Cerebellar signs were found only in 21% of patients. In 85.7% of the cases, the patients presented with a depressed level of consciousness (Glasgow Coma Scale Scores 11-15). In 79.6%, pus collection was seen over the cerebellar convexity; interhemispheric and tentorial collections were also observed in some cases. Hydrocephalus was present in 92.9% of patients. Five patients required external ventricular drainage during surgery or postoperatively. Shunt placement was required in 21% of cases. All patients were treated with antibiotic therapy and surgery (bur holes in 21% of the cases, craniectomy in 79%). Pus cultures demonstrated microbial infection in 71.4%, and polymicrobial infection in 21%. Four patients required repeated surgery for reaccumulation of pus. Minor postoperative complications developed in three patients. All 14 patients survived. At follow up, the Glasgow Outcome Scale scores were 4 or 5 in all cases. CONCLUSIONS Early diagnosis and prompt surgical treatment are crucial in cases of SDE. With appropriate surgery, antibiotic therapy, and management of hydrocephalus, good outcome can be expected.
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Affiliation(s)
- Madhugiri S Venkatesh
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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