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2014| July-August | Volume 62 | Issue 4
Online since
September 19, 2014
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ORIGINAL ARTICLES
Rhinocerebral mucormycosis: Pathology revisited with emphasis on perineural spread
Tumuluri Sravani, Shantveer Gurulingappa Uppin, Megha Shantveer Uppin, Challa Sundaram
July-August 2014, 62(4):383-386
DOI
:10.4103/0028-3886.141252
PMID
:25237943
Aims and objectives:
To study the histopathological features with particular emphasis on perineural invasion in invasive rhinocerebral mucormycosis.
Materials and Methods:
Tissue sections from 30 patients with invasive rhinocerebral mucormycosis were included in the study. Demographic features, predisposing conditions, and clinical features were obtained from medical records. Tissue sections were reviewed with hematoxylin and eosin (H and E), Gomori's methenamine silver (GMS), and periodic acid Schiff (PAS) stains for (i) the presence and type of inflammation (suppurative/granulomatous; sparse/absent), (ii) invasion into soft tissues, and (iii) type of spread (angio/perineural) and presence of infarction/necrosis and fungal morphology.
Results:
The study material included 20 males and 10 females with age ranging from 15-84 years. The clinical syndromes included rhino-orbital in 15, rhinocerebral in 6, and rhino-orbito-cerebral in 9 patients. On histopathological examination, inflammation was suppurative with predominance of neutrophils in 25 biopsies. Suppurating granuloma with neutrophils, lymphocytes, and foreign body giant cells was seen in 3 biopsies. Invasion into soft tissues, muscles, and adipose tissues was seen in 20 biopsies. Angioinvasion was noted in 25 and soft tissue invasion in 20 biopsies. Peripheral nerves were identified in 19 and perineural spread was identified in 15 biopsies. In all, biopsies with perineural invasion, angioinvasion, and soft tissue invasion were seen.
Conclusions:
Perineural invasion is one of the important histological features of invasive rhinocerebral mucormycosis and it indicates advanced the extent of invasion.
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REVIEW ARTICLE
Tale of two diseases: Amyotrophic lateral sclerosis and frontotemporal dementia
Ashok Verma
July-August 2014, 62(4):347-351
DOI
:10.4103/0028-3886.141174
PMID
:25237937
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) were independently described in clinical and pathological details more than a century ago. Recent breakthrough discoveries identifying common genes that are causal to either ALS or FTD or an overlapping ALS-FTD syndrome have dramatically transformed our view regarding their pathogenesis. Most recently, a massive hexanucleotide (GGGGCC) repeat expansion mutation in C9orf72 gene has been linked to the majority of familial ALS, FTD and mixed ALS-FTD cases. C9orf72 and other genes causal to ALS and FTD are consistently associated with the formation of cellular RNA inclusions and protein aggregates. This article summarizes the recently reported ALS-FTD-linked genes and the emerging common unifying mechanism in the pathogenesis of ALS-FTD spectrum disorders along with a comment on the potential new therapeutic targets in these hitherto incurable diseases.
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TECHNICAL REVIEW
Free-access open-source e-learning in comprehensive neurosurgery skills training
Payal Jotwani, Vinkle Srivastav, Manjul Tripathi, Rama Chandra Deo, Britty Baby, Natesan Damodaran, Ramandeep Singh, Ashish Suri, Martin Bettag, Tara Sankar Roy, Christoph Busert, Marcus Mehlitz, Sanjeev Lalwani, Kanwaljeet Garg, Kolin Paul, Sanjiva Prasad, Subhashis Banerjee, Prem Kalra, Subodh Kumar, Bhavani Shankar Sharma, Ashok Kumar Mahapatra
July-August 2014, 62(4):352-361
DOI
:10.4103/0028-3886.141208
PMID
:25237938
Background:
Since the end of last century, technology has taken a front seat in dispersion of medical education. Advancements of technology in neurosurgery and traditional training methods are now being challenged by legal and ethical concerns of patient safety, resident work-hour restriction and cost of operating-room time. To supplement the existing neurosurgery education pattern, various e-learning platforms are introduced as structured, interactive learning system.
Materials and Methods:
This study focuses on the concept, formulation, development and impact of web based learning platforms dedicated to neurosurgery discipline to disseminate education, supplement surgical knowledge and improve skills of neurosurgeons. 'Neurosurgery Education and Training School (NETS), e-learning platform' has integration of web-based technologies like 'Content Management System' for organizing the education material and 'Learning Management System' for updating neurosurgeons. NETS discussion forum networks neurosurgeons, neuroscientists and neuro-technologists across the globe facilitating collaborative translational research. Results: Multi-authored neurosurgical e-learning material supplements the deficiencies of regular time-bound education. Interactive open-source, global, free-access e-learning platform of NETS has around 1) 425 visitors/month from 73 countries; ratio of new visitors to returning visitors 42.3; 57.7 (2); 64,380 views from 190 subscribers for surgical videos, 3-D animation, graphics based training modules (3); average 402 views per post.
Conclusion:
The e-Learning platforms provide updated educational content that make them "quick, surf, find and extract" resources. e-Learning tools like web-based education, social interactive platform and question-answer forum will save unnecessary expenditure of time and travel of neurosurgeons seeking knowledge. The need for free access platforms is more pronounced for the neurosurgeons and patients in developing nations.
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ORIGINAL ARTICLES
A1-segment aneurysms: Management protocol based on a new classification
Kamlesh Singh Bhaisora, Sanjay Behari, Guru Prasadh, Arun K Srivastava, Anant Mehrotra, Rabi N Sahu, Awadhesh K Jaiswal
July-August 2014, 62(4):410-416
DOI
:10.4103/0028-3886.141284
PMID
:25237948
Background:
Aneurysms of proximal (A1)-segment of anterior cerebral artery (ACA) constitute <1% of all intracranial aneurysms.
Aim:
Management dilemmas of A1-segment aneurysms were studied utilizing a new classification based upon their location on the longitudinal and circumferential axis of A1-segment.
Setting and Design:
Tertiary care referral center.
Materials and Methods:
This is a retrospective analysis of 14 patients (0.98%; mean age: 38.02 ± 15.74 years) with A1-segment aneurysms. The data collected included clinical features, computed tomography (CT) scan and CT-angiography (CTA)/digital subtraction angiography (DSA) findings, modified Hunt and Hess (H and H) grade, surgical steps and difficulties encountered.
Results:
The modified Hunt and Hess (H and H) grades in the 14 patients were: grade I in two, grade II in two, grade III in four, grade IV in five and grade V in 1. The mean ictus-admission duration was 5.07 ± 2.30 days (range: 1-10 days). Multiple aneurysms were two. Thirteen patients underwent clipping and one, wrapping. Bilateral lateral ventricle hemorrhage occurred in 8 (66%) patients and frontal intracerebral hematoma in 2 (16.66%) patients. In one patient, the aneurysm could only be detected following the third angiogram. A1-aneurysms were classified as proximal (n = 6), distal (n = 7), and mid-segment (n = 1); and, anterior (n = 2), posterior-inferior (n = 7) and posterior-superior (n = 5). Follow-up (range: 6 months-10 years, mean: 2.9 years) recovery (assessed using Modified Rankin's score or mRS) correlated with preoperative status. The preoperative H and H grade and follow-up mRS status were as follows: H and H I (n = 2): mRS 0 (asymptomatic, n = 2); H and H II (n = 2): mRS 1 (minor symptoms without disability, n = 2); H and H III (n = 4):mRS 1 (n = 2) and mRS 2 (slight disability but performing unassisted activities of daily living, n = 1); H and H IV (n = 5): mRS 3 (moderate disability, requiring help for daily living but unassisted walking, n = 2) and mRS 4 (moderately severe disability, requiring help for daily living and walking, n = 2). One patient each from H and H grade III, IV and V died (mRS 6) during treatment due to severe vasospasm, pneumonitis and septicemia.
Conclusions:
A1-segment aneurysms have unique properties: rupturing of small-sized aneurysms; multiplicity; undetectable on initial imaging; frontal lobar/intraventricular bleeding; origin from main trunk and not bifurcating points; neck obscuration by A1-trunk; close proximity to perforators; and, associated A1-segment and ACA anomalies. A new classification identifies surgical difficulties inherent in different sites of origin of A1-aneurysms.
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Spinal angiolipoma: Experience of twelve patients and literature
Bo Wang, Zhijun Yang, Jun Yang, Guihuai Wang, Yulun Xu, Pinan Liu
July-August 2014, 62(4):367-370
DOI
:10.4103/0028-3886.141232
PMID
:25237940
Purpose:
To summarize our experience in treating patients with spinal angiolipomas.
Materials and Methods:
We conducted a retrospective review of the case records of patients with spinal angiolipoma who underwent surgery between March 1992 and March 2013.
Results:
Of the 12 patients seen during the study period, 10 patients had total removal of the lesion and 2 patients had sub-total removal. The postoperative course was uneventful, and the outcomes were good in patients who underwent total excision of the lesion. No patient received adjuvant radiation even in the patients with sub-total excision.
Conclusion:
In patients with spinal angiolipoma, total excision should be achieved and is associated with good outcomes.
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Characterizing brain mineral deposition in patients with Wilson disease using susceptibility-weighted imaging
Xiang-Xue Zhou, Hao-Lin Qin, Xun-Hua Li, Hai-Wei Huang, Ying-Ying Liang, Xiu-Ling Liang, Xiao-Yong Pu
July-August 2014, 62(4):362-366
DOI
:10.4103/0028-3886.141221
PMID
:25237939
Aims:
The aim of this study was to evaluate the feasibility of characterizing the brain-mineral deposition in patients with Wilson disease (WD) using susceptibility-weighted imaging (SWI).
Materials and Methods:
The study enrolled 30 WD patients and 20 age-matched healthy controls. Neurological symptoms were scored using the modified Young Scale. The hepatic function indices, serum and urinary copper content, and serum iron content were determined. All study objects received the magnetic resonance imaging (MRI) and SWI test of the brain. The values of corrected phase (CP) were calculated on SWI. The relationship between CP values and the clinical status were evaluated.
Results:
The serum iron content of WD patients was higher than the normal. The CP values of substantia nigra, caudate nucleus, and globus pallidus of WD were lower than the normal values, while the CP value of substantia nigra was the lowest. No correlations were determined between the CP values and the iron and copper parameters. There was negative correlation between the scores of dysarthria and the CP values of the globus pallidus. There was negative correlation between the scores of tremor and the CP values of caudate nucleus. Some regions, which had high signals on T2-weighted image, had low signals on SWI.
Conclusions:
There might be abnormal iron metabolism in patients with WD. The decreased CP values might reflect a deposition of both copper and iron. SWI may be more sensitive than the ordinary MRI. The mineral deposition may contribute to the neural symptoms.
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Subarachnoid hemorrhage with blister aneurysms: Endovascular management
Swati Dayanand Chinchure, Vipul Gupta, Gaurav Goel, Aditya Gupta, Ajayanand Jha
July-August 2014, 62(4):393-399
DOI
:10.4103/0028-3886.141262
PMID
:25237945
Blister aneurysms of are rare lesions representing a real challenge for diagnosis and management. They typically show small size, hemispherical shape, fragile wall, broad neck, and are arising from non-branching sites of intracranial arteries. Materials and Methods: We retrospectively reviewed all aneurysms treated at our institution. Seventeen patients (6 male, 11 female) with 17 blister aneurysms were identified (mean age 53.3, range 41-63 years). Clinical, procedural, angiographic data as well as follow up data were evaluated. Results: All patients presented with aneurysmal subarachnoid hemorrhage. Majority of the blister aneurysms were located in ICA while 1 was located at posterior cerebral artery, 1 at vertebral and 1 involving basilar artery. All patients were treated using single or overlapping stents and if possible additional coiling. There was no intra-operative rupture. Good outcome (mrs 0-2) was seen in 14 patients. Poor clinical outcome (mrs 3-5) was seen in 2 patients due to vasospasm induced ischemic deficits at discharge, both of them improved on follow up (mrs 1 on follow up). There were 3 mortalities, One patient died of rebleeding while other 2 died due to SAH induced complications. Follow-up angiography was available in 16 patients (one patient died before follow up angiogram) and revealed complete or near complete aneurysm occlusion in 11, incomplete obliteration in 1 and no change in 2 cases. Two cases showed post-treatment angiographic aneurysm recurrence. Both cases were managed with repeat coiling and overlapping stent placement. Conclusion: Endovascular management using single/overlapping stent and if possible coil placement is technically safe and feasible in blister aneurysms. Overlapping stents lead to better aneurysm occlusion than a single stent. Blister aneurysm in dorso-medial ICA showed higher tendency of continued growth/recurrence, higher incidence of clinical vasospasm and in these cases early angiographic follow-up is advisable. Repeat treatment should be considered promptly if necessary.
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NEUROIMAGES
Bithalamic T2 hypointensity: A diagnostic clue for Sandhoff's disease
Devendra Kumar, Subramaniyan Ramanathan, Maneesh Khanna, Yegu Palaniappan, Devendra Kumar, Subramaniyan Ramanathan, Maneesh Khanna, Yegu Palaniappan
July-August 2014, 62(4):481-482
DOI
:10.4103/0028-3886.141311
PMID
:25237979
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ORIGINAL ARTICLES
Endoscopic anterior decompression in cervical disc disease
Yad Ram Yadav, Vijay Parihar, Shailendra Ratre, Yatin Kher
July-August 2014, 62(4):417-422
DOI
:10.4103/0028-3886.141287
PMID
:25237949
Background:
Although microscopic anterior cervical discectomy with or without fusion are common surgical procedures for treatment of cervical herniated discs, loss of disc height, pseudarthrosis, and adjacent disc degeneration are some of the problems associated with it. This study is aimed to evaluate results of endoscopic microforaminotomy in cervical disc diseases.
Materials and Methods:
A prospective study of 50 patients of mono segmental soft or hard disc causing myeloradiculopathy was undertaken. A visual analogue scale (VAS) for neck and arm pain and functional outcomes using the Nurick grading system were assessed. There were 28, 12, 8, and 2 patients at C5-6, C6-7, C4-5, and C3-4 levels disc diseases, respectively. Patients with two or more level disc, instabilities, disc extending more than half vertebral body height, and previous operation at the same segment were excluded.
Results:
Age ranged from 21 to 67 years. Average postoperative reduction in disc height, operating time, and blood loss was 1.1 mm, 110 minutes, and 30 ml, respectively. Average pre-operative VAS score for arm pain and Nurick grading was 7.6 and 2.7, which improved to 1.9 and 0.82, respectively. All patients improved; 1, 2, 3 grade improvement was seen in 10, 27, and 10 patients, respectively. There was no significant complication or any mortality.
Conclusion:
Although longer follow up of large number of patients is required, endoscopic microforaminotomy is a safe and an effective alternative to microscopic anterior discectomy with or without fusion.
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Balloon dilatation and thrombus extraction for the treatment of cerebral venous sinus thrombosis
Shao-Feng Shui, Teng-Fei Li*, Xin-Wei Han, Ji Ma, Dong Guo
July-August 2014, 62(4):371-375
DOI
:10.4103/0028-3886.141241
PMID
:25237941
Background and Purpose:
This study aimed to investigate the efficacy and safety of balloon dilatation and thrombus extraction for the treatment of cerebral venous sinus thrombosis (CVST).
Materials and Methods:
Twenty-six cases of digital subtraction angiography-confirmed CVST were treated with balloon dilatation and thrombus extraction. Active treatment of primary disease was carried out after cerebral venous sinus recanalization, and the subsequent anticoagulant therapy lasted for 6 months.
Results:
Recanalization of the cerebral venous sinus was achieved in all 26 patients, and no endovascular treatment-related complications occurred during or after the procedure. At discharge, the Glasgow Coma Scale (GCS) of the patients had improved from an average of 12.3 points to 15 points, and clinical symptoms were improved in 100% of the patients. Follow-up times ranged from 12-62 months (mean follow-up time of 42.3 months) and no thrombus re-formation or new neurological deficits occurred during that time.
Conclusion:
Based on our small study population, balloon dilatation and thrombus extraction appears to be a safe and effective treatment for cerebral venous sinus thrombosis. However, further research is needed to confirm this.
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Evaluation of 1p and 14q status, MIB-1 labeling index and progesterone receptor immunoexpression in meningiomas: Adjuncts to histopathological grading and predictors of aggressive behavior
Sawan Kumar, Aanchal Kakkar, Vaishali Suri, Anupam Kumar, Utkarsh Bhagat, Mehar Chand Sharma, Manmohan Singh, Ashish Suri, Chitra Sarkar
July-August 2014, 62(4):376-382
DOI
:10.4103/0028-3886.141248
PMID
:25237942
Background:
Meningiomas are benign central nervous system tumors; however, significant fraction recurs, irrespective of histological grade.
Materials and Methods:
We performed fluorescence in-situ hybridization for 1p36 and 14q32, and immunohistochemistry for progesterone receptor (PR), p53 and MIB-1 on 84 meningiomas.
Results and Conclusion:
Sixty-four were convexity tumors (30 grade I, 21 grade II, 13 grade III) and 20 petroclival (grade I; 10 with gross total resection (GTR), 10 with subtotal resection (STR)). Isolated 1p36 deletion was seen in 20% grade I, 28.6% grade II and 30.8% grade III convexity meningiomas, and isolated 14q deletion in one grade III convexity tumor. 1p/14q co-deletion was seen in none of grade I, 28.5% grade II and 30% grade III convexity meningiomas. PR immunoreactivity was less frequent in grade III tumors. Petroclival tumors did not show isolated deletion. However, 1p/14q co-deletion was seen in 20% of petroclival tumors with STR and in none with GTR. Frequency of chromosomal alterations and MIB-1 labeling index both increase with tumor grade. 1p/14q co-deletion is characteristic of grade II/III meningiomas, while PR immunoreactivity inversely correlates with grade, suggesting their use as surrogate markers for grading. Identification of 1p/14q co-deletion in grade I petroclival tumors with STR suggests that unresectable petroclival meningiomas are biologically more aggressive than their grade I convexity counterparts.
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LETTERS TO EDITOR
Upper limbs spread of orthostatic tremor following hip replacement surgery
Philip B Adebayo, Aysegul Gunduz, Meral E Kiziltan, Gunes Kiziltan, Philip B Adebayo, Aysegul Gunduz, Meral E Kiziltan, Gunes Kiziltan
July-August 2014, 62(4):462-463
DOI
:10.4103/0028-3886.141280
PMID
:25237968
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ORIGINAL ARTICLES
Effect of radiation dose on the outcomes of gamma knife treatment for trigeminal neuralgia: A multi-factor analysis
Xinjie Zhang, Peng Li, Shizhen Zhang, Feilong Gong, Sen Yang, Wei Wang
July-August 2014, 62(4):400-405
DOI
:10.4103/0028-3886.141272
PMID
:25237946
Aim:
To analyze the effect of different radiation variables on the outcomes of treatment for trigeminal neuralgia (TN).
Materials and Methods:
Seventy-three patients with refractory TN were treated with a maximum dose of 75-90 Gy using either one (n = 41) or two (n = 32) isocenters and were intensively followed up. The integrated dose delivered to the trigeminal nerve root within the prepontine cistern and the nerve root volume was calculated using the Gamma-Plan system. Relationships between the clinical outcomes and radiation variables were statistically analyzed using a combination of Fisher's exact test and multivariate analyses.
Results:
At their last follow up, 21 patients (28.8%), 22 patients (30.1%), 19 patients (26%), 6 patients (8.2%), and 5 patients (6.8%) had Grade I-V pain outcomes, respectively, and the average mean dose delivered to the trigeminal nerve root, average integrated dose (mJ) and nerve root volume in prepontine cistern were 45.29 Gy, 4,26 mJ, and 98.47 mm
3
, respectively. The pain relief rate was not significantly improved by a higher amount of integrated dose received by the trigeminal nerve root in prepontine cistern, however, incidence of trigeminal nerve toxicity was increased (P = 0.005).
Conclusions:
Our limited results suggested that a higher integrated dose might increase the incidence of trigeminal nerve toxicity with no significant benefits in pain relief when the maximal doses were within 75-90 Gy. The protocol for increasing radiation variables such as longer nerve exposure length and higher maximal dose is not recommended as a routine approach and more randomized studies with large number of cases would be required to verify the best treatment strategy of gamma knife radiosurgery for TN.
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EDITORIAL
Intramedullary spinal cord cavernous angiomas: To treat or not to treat?
Deepak Agrawal, Sanjay Behari
July-August 2014, 62(4):345-346
DOI
:10.4103/0028-3886.141172
PMID
:25237936
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ORIGINAL ARTICLES
Association of -1382A>G CCL11 gene variant with ischemic stroke, its subtypes and hemorrhagic stroke in a South Indian population
Sitara Roy, Satrupa Das, Anjana Munshi, Subhash Kaul, Akka Jyothy
July-August 2014, 62(4):387-392
DOI
:10.4103/0028-3886.141259
PMID
:25237944
Background:
CCL11 (Eotaxin-1) is an important inflammatory cytokine belonging to the CC family of chemokines associated with a number of infection or inflammation-related diseases such as atherosclerosis and stroke. We investigated the association of CCL11 gene polymorphism rs4795895-1382A>G with ischemic and hemorrhagic stroke.
Materials and Methods:
Six hundred and twenty ischemic stroke patients, 620 age- and sex-matched healthy controls, and 220 hemorrhagic stroke patients, 220 age- and sex-matched healthy controls were included in the present study. The CCL11 gene polymorphism rs4795895-1382A>G was determined using PCR-RFLP technique.
Results:
We found a statistically significant difference in the genotypic distribution between ischemic stroke patients and controls (For GG vs. AA, χ
2
= 7.604; P < 0.001, Odds ratio = 2.793; 95% CI = 1.308-5.9). For GG vs. AA + AG, χ
2
= 44.8, P < 0.001, Odds ratio = 2.382 (95% CI = 1.842-3.081). A significant difference was observed in the frequency of G and A alleles in patients and controls (For G vs. A, χ
2
= 43.26; P < 0.001, Odds ratio = 2.127; 95% CI = 1.693-2.672). Statistically significant difference was observed in the genotypic distribution between hemorrhagic stroke patients and controls (For GG vs. AG, χ
2
= 26.78; P = 0.001, Odds ratio = 3.5; 95% CI = 2.162-5.824). A significant difference was observed in the frequency of G and A alleles in patients and controls (For G vs. A, χ
2
= 41.98; P = 0.001, Odds ratio = 4.1; 95% CI = 2.61-6.44).
Conclusion:
The results of the present study show that the GG genotype is a significant risk factor for ischemic as well as hemorrhagic stroke. Further, the frequency of the GG genotype was observed to be higher in hemorrhagic stroke patients in comparison with ischemic stroke. Evaluating the association with ischemic stroke subtypes, a significant association was observed with intracranial large artery atherosclerosis and lacunar stroke.
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Epithelial cell transformation sequence 2 is a potential biomarker of unfavorable survival in human gliomas
Yung-Sheng Cheng, Chin Lin, Yen-Po Cheng, Yi-Lin Yu, Chi-Tun Tang, Dueng-Yuan Hueng
July-August 2014, 62(4):406-409
DOI
:10.4103/0028-3886.141278
PMID
:25237947
Background:
High-grade primary gliomas are invasive and have poor outcome. The identification of biomarkers predictive of outcome in patients with gliomas is crucial for clinical follow-up. Epithelial cell transformation sequence 2 (ECT2) modulates cancer invasion, progression, metastasis and cell cycle regulation. However, its role in determining the clinical outcome of human gliomas warrants further elucidation.
Materials and Methods:
This study hypothesized that ECT2 is over-expressed in human gliomas. We analysis de-linked data (GDS1815/219787_s_at/ECT2) in primary high-grade glioma, and exclude 23 sheets of data without detailed information. An additional database (GDS1962/234992_x_at/ECT2) was also included to evaluation ECT2 gene expression in each pathologic grading.
Results:
Analysis of the Gene Expression Omnibus (GEO) profile showed that ECT2 mRNA expression level was higher in WHO grade IV (n = 81) than in grade II (n = 7, P = 0.0126) gliomas and non-tumor controls (n = 23; P = 1.65 Χ 10
-8
). Kaplan-Meier analysis showed unfavorable survival in patients with high ECT2 mRNA levels (n = 10) than in those with low ECT2 expression (n = 67) (median survival, 106 vs. 46 weeks, P < 0.0001, by log-rank test, Hazard ratio: 0.07850, 95% CI: 0.02402-0.2565).
Conclusions:
ECT2 expression is positively correlated with WHO pathologic grading and unfavorable survival, suggesting that ECT2 may be a potential therapeutic candidate in human gliomas.
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LETTERS TO EDITOR
Cervical spinal cord compression caused by X-linked hypophosphatemic rickets with a novel PHEX mutation
Fei Xie, Zhi-dong Cen, Li-li Chen, Wei Luo, Fei Xie, Zhi-dong Cen, Li-li Chen, Wei Luo
July-August 2014, 62(4):457-459
DOI
:10.4103/0028-3886.141271
PMID
:25237965
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CASE REPORTS
Intracranial Ewings Sarcoma/peripheral primitive neuroectodermal tumor
R Amita, S Sandhyamani, Suresh Nair, TR Kapilamoorthy, R Amita, S Sandhyamani, Suresh Nair, TR Kapilamoorthy
July-August 2014, 62(4):432-433
DOI
:10.4103/0028-3886.141300
PMID
:25237951
Central nervous system primitive neuroectodermal tumours (CNS PNET) are aggressive embryonal tumours composed of undifferentiated or poorly differentiated neuroepithelial cells seen in the pediatric age group. This is rare and only a handful of cases of ES/pPNET in CNS are reported. We report such a case in a 3 year old child. Reporting of more such cases is needed to better define these rare tumours of the dura.
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LETTERS TO EDITOR
Brainstem hemorrhage secondary to evacuation of chronic subdural hematoma
Luis Mariano Rojas-Medina, Atul Goel, Luis Mariano Rojas-Medina, Atul Goel
July-August 2014, 62(4):435-437
DOI
:10.4103/0028-3886.141222
PMID
:25237953
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3,943
68
4
Bilateral thalamic gliomas: Report of two cases with review of literature
Bi-Wu Wu, Yi Zhang, Wen-Gang Li, Zhi-Qi Li, Bi-Wu Wu, Yi Zhang, Wen-Gang Li, Zhi-Qi Li
July-August 2014, 62(4):444-446
DOI
:10.4103/0028-3886.141247
PMID
:25237959
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[PubMed]
3,765
89
3
A new differential diagnosis for acquired demyelinating neuropathy: Copper deficiency
Geysu Karlikaya, Dilaver Kaya, Geysu Karlikaya, Dilaver Kaya
July-August 2014, 62(4):434-435
DOI
:10.4103/0028-3886.141219
PMID
:25237952
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3,758
77
2
ORIGINAL ARTICLES
Surgical management of intramedullary cavernous angiomas and analysis pain relief
Huang Si Qing, Gong Shuhui, Liu Jiagang
July-August 2014, 62(4):423-428
DOI
:10.4103/0028-3886.141477
PMID
:25241760
Objective:
The objective of this study was to conduct a retrospective analysis of the clinical characteristics of 20 individuals with intramedullary cavernous angiomas (ICA) presented with serious pain complaints. This study was to investigate the efficacy of short- and long-term pain relief following surgical resection.
Materials and Methods:
Between 2006 and 2012, 55 patients with ICA were surgically managed in our institution. Of these 20 (36.4%) patients presented with serious pain as a unique clinical feature. Numerical pain scores (NPS: 0-10) were used to assess the patients' pain levels preoperatively, as well as at 1 month and 1 year postoperatively. All the patients had magnetic resonance imaging (MRI) preoperatively and during follow-up. IBM SPSS Statistics 19.0 was used to analysis the outcomes.
Results:
Of the 20 patients with ICA, 9 (45%) required cervical and 11 (55%) thoracic surgery. Seven (35%) patients presented with radicular pain and 13 (65%) presented with central pain. Pain improved from a total mean preoperative score of 8.60 to total mean score of 2.95 (
P
< 0.01) at one month and 3.35 (
P
< 0.01) at one year post-surgery. However, the pain symptoms completely disappeared in the long-term follow-up only in three (15%) patients. Five (25%) patients reported new pain symptoms with no lesion reoccurrence postoperatively.
Conclusion:
Pain is the common complaint in patients with ICA. Surgery is effective in providing short- and long-term pain relief. However, long-term follow-up measures on postoperative pain levels show that the pain does recur in the months following surgery.
[ABSTRACT]
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3,737
81
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CASE REPORTS
Olfactory schwannoma: A report of two cases and literature review
Zheng Wang, Wei Zhang, Gan You, Jiangfei Wang, Guilin Li, Zhixian Gao, Jian Xie, Zheng Wang, Wei Zhang, Gan You, Jiangfei Wang, Guilin Li, Zhixian Gao, Jian Xie
July-August 2014, 62(4):429-431
DOI
:10.4103/0028-3886.141289
PMID
:25237950
Intracranial schwannoma is a kind of benign intracranial tumors, derived from neuron myelin sheath, growing slowly and curable. Olfactory schwannoma is an exceedingly rare kind of schwannoma, whose origin is still uncovered. Although several theories have been put up for pathogenesis of olfactory schwannoma, till now, none of these hypotheses has been widely accepted and acknowledged officially. Up to date, only 46 cases of olfactory schwannoma were reported across numerous institutes worldwide. Here we gathered two cases from Department of Neurosurgery in Beijing Tiantan Hospital across two years collection.
[ABSTRACT]
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3,717
86
6
NEUROIMAGES
Retrograde thromboembolic vertebrobasilar artery infarct due to right cervical rib
Nilesh G Kinge, Vimal Kumar Paliwal, Zafar Neyaz, Rohitash Sharma, Nilesh G Kinge, Vimal Kumar Paliwal, Zafar Neyaz, Rohitash Sharma
July-August 2014, 62(4):479-480
DOI
:10.4103/0028-3886.141310
PMID
:25237978
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[PubMed]
3,706
59
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LETTERS TO EDITOR
Diffusion MRI in transient global amnesia
Harikiran Reddy, Keerthiraj Bele, ZK Misri, Santosh P.V Rai, Harikiran Reddy, Keerthiraj Bele, ZK Misri, Santosh P.V Rai
July-August 2014, 62(4):463-465
DOI
:10.4103/0028-3886.141283
PMID
:25237969
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[PubMed]
3,172
50
2
Brain metastasis from cardiac angiosarcoma
Roberto Bezerra Vital, Pedro Tadao Hamamoto Filho, Newton Moreira Lima Neto, Jose Candido Caldeira Xavier, Daniela Cristina Santos, Flavio Ramalho Romero, Marco Antonio Zanini, Roberto Bezerra Vital, Pedro Tadao Hamamoto Filho, Newton Moreira Lima Neto, Jose Candido Caldeira Xavier, Daniela Cristina Santos, Flavio Ramalho Romero, Marco Antonio Zanini
July-August 2014, 62(4):451-452
DOI
:10.4103/0028-3886.141261
PMID
:25237962
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[PubMed]
3,128
46
5
Peri-ictal pseudoprogression [pipg] in an operated case of right frontal glioma; case report and review of literature
Boby Varkey Maramattom, Dilip Panikar, Boby Varkey Maramattom, Dilip Panikar
July-August 2014, 62(4):467-469
DOI
:10.4103/0028-3886.141291
PMID
:25237971
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[PubMed]
3,070
63
2
Malignant infiltration of peripheral nerves: As initial presenting manifestation of lymphoreticular malignancies
Meena Angamuthu Kannan, Megha Shantiveer Uppin, Sheik Afshan Jabeen, Rukmini K Mridula, Sundaram Challa, Rupam Borgohain, Meena Angamuthu Kannan, Megha Shantiveer Uppin, Sheik Afshan Jabeen, Rukmini K Mridula, Sundaram Challa, Rupam Borgohain
July-August 2014, 62(4):465-467
DOI
:10.4103/0028-3886.141288
PMID
:25237970
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[PubMed]
3,054
59
1
Vasospasm causing reversible cortical deafness in subarachnoid hemorrhage
Raghvendra Ramdasi, Aadil Chagla, Amit Mahore, Raghvendra Ramdasi, Aadil Chagla, Amit Mahore
July-August 2014, 62(4):469-470
DOI
:10.4103/0028-3886.141292
PMID
:25237972
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[PubMed]
3,067
44
1
Pipeline stents for partially thrombosed posterior circulation aneurysms: A word of caution!
Ashish Kumar, Victor Yang, Leodante Dacosta, Ashish Kumar, Victor Yang, Leodante Dacosta
July-August 2014, 62(4):455-457
DOI
:10.4103/0028-3886.141268
PMID
:25237964
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[PubMed]
2,882
47
2
Lingual epilepsia partialis continua as the presenting manifestation of herpes simplex encephalitis: Uncommon presentation of a common disease
Rajesh Shankar Iyer, Tiruppur Chinnappan Ramalingam Ramakrishnan, Rajesh Shankar Iyer, Tiruppur Chinnappan Ramalingam Ramakrishnan
July-August 2014, 62(4):439-441
DOI
:10.4103/0028-3886.141230
PMID
:25237955
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[PubMed]
2,796
69
4
Hypoventilation: An aid to the neurosurgeon
Karen Ruby Lionel, Georgene Singh, Rosen Roy Mathew, Ranjith K Moorthy, Vedantam Rajshekhar, Karen Ruby Lionel, Georgene Singh, Rosen Roy Mathew, Ranjith K Moorthy, Vedantam Rajshekhar
July-August 2014, 62(4):441-443
DOI
:10.4103/0028-3886.141239
PMID
:25237957
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2,728
77
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Calcifying pseudoneoplasm of the cerebellomedullary cistern: A case report and review of the literature
Aydemir Fatih, Cekinmez Melih, Kardes Ozgur, Sarica B Feyzi, Tufan Kadir, Kayaselcuk Fazilet, Aydemir Fatih, Cekinmez Melih, Kardes Ozgur, Sarica B Feyzi, Tufan Kadir, Kayaselcuk Fazilet
July-August 2014, 62(4):449-451
DOI
:10.4103/0028-3886.141255
PMID
:25237961
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[PubMed]
2,759
28
4
Endoscopic cure for post-traumatic pneumocephalus: When air hits the brain, treatment may not be the same
Ishtyaque Ansari, Sameer Shankar Futane, Ashfaque Ansari, Ishtyaque Ansari, Sameer Shankar Futane, Ashfaque Ansari
July-August 2014, 62(4):459-460
DOI
:10.4103/0028-3886.141274
PMID
:25237966
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[PubMed]
2,700
76
1
Role of diffusion-weighted MR imaging in diagnosis of spinal cord stroke following aorto-iliac bypass: Case report and review of literature
Anuradha Singh, Chandan J Das, Anita Dhar, AK Gupta, Anuradha Singh, Chandan J Das, Anita Dhar, AK Gupta
July-August 2014, 62(4):471-472
DOI
:10.4103/0028-3886.141294
PMID
:25237973
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2,695
61
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Central nervous system Erdheim Chester disease presenting with raised intracranial pressure and cerebellar signs mimicking neurosarcoidosis with secondary cerebral venous thrombosis
Shanthi Viswanathan, Nurulanissa Abdul Kadir, Ang Chong Lip, Mohammad Hanip Rafia, Shanthi Viswanathan, Nurulanissa Abdul Kadir, Ang Chong Lip, Mohammad Hanip Rafia
July-August 2014, 62(4):446-448
DOI
:10.4103/0028-3886.141250
PMID
:25237960
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2,651
54
3
BOOK REVIEW
Clinical Practice of Multiple Sclerosis
M Madhusudanan, M Madhusudanan
July-August 2014, 62(4):483-484
DOI
:10.4103/0028-3886.141306
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2,615
64
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LETTERS TO EDITOR
Hemangiopericytoma of pineal region: Case report and review
Tanmoy Kumar Maiti, MN Nagarjun, Arivazhagan Arimappamagan, Anita Mahadevan, Paritosh Pandey, Tanmoy Kumar Maiti, MN Nagarjun, Arivazhagan Arimappamagan, Anita Mahadevan, Paritosh Pandey
July-August 2014, 62(4):460-462
DOI
:10.4103/0028-3886.141277
PMID
:25237967
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[PubMed]
2,556
81
2
Vertex epidural hematoma and triplegia
Ulas Cikla, Bora Gürer, Ilker Coskun, Ulas Cikla, Bora Gürer, Ilker Coskun
July-August 2014, 62(4):443-444
DOI
:10.4103/0028-3886.141245
PMID
:25237958
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[PubMed]
2,567
42
1
Primary cerebellopontine angle choroid plexus papilloma in a child: A rare occurrence
G Lakshmi Prasad, Rajinder Kumar, Vaishali Suri, G Lakshmi Prasad, Rajinder Kumar, Vaishali Suri
July-August 2014, 62(4):438-439
DOI
:10.4103/0028-3886.141226
PMID
:25237954
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2,534
48
1
Hematomyelia as a cause of brown-sequard's syndrome in a hypofibrinogenemic patient
BK Madhusudhan, JV Mahendra, Sandya , M Rohan, R Srinivasa, BK Madhusudhan, JV Mahendra, Sandya , M Rohan, R Srinivasa
July-August 2014, 62(4):473-473
DOI
:10.4103/0028-3886.141296
PMID
:25237974
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2,400
52
3
CORRESPONDENCE
Authors reply
Vivek Gupta, Navin Mulimani, Ajay Kumar, Chirag Ahuja, SN Mathuria, N Khandelwal, Vivek Gupta, Navin Mulimani, Ajay Kumar, Chirag Ahuja, SN Mathuria, N Khandelwal
July-August 2014, 62(4):476-476
DOI
:10.4103/0028-3886.141305
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2,410
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Endovascular treatment of ruptured proximal PICA aneurysms: A single-center 5-year experience
Sim Sai Tin, Viroj Wiwanitkit, Sim Sai Tin, Viroj Wiwanitkit
July-August 2014, 62(4):476-476
DOI
:10.4103/0028-3886.141302
PMID
:25237976
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2,344
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Endovascular treatment of acute ischemic stroke: Not yet a panacea for all troubles
R Rajan, D Khurana, R Rajan, D Khurana
July-August 2014, 62(4):474-474
DOI
:10.4103/0028-3886.141298
PMID
:25237975
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2,318
55
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LETTERS TO EDITOR
Suprasellar tuberculoma associated with unilateral moyamoya phenomenon: Case report
Nupur Pruthi, Shrithi Karanth, MN Nagarjun, Paritosh Pandey, Nupur Pruthi, Shrithi Karanth, MN Nagarjun, Paritosh Pandey
July-August 2014, 62(4):453-455
DOI
:10.4103/0028-3886.141264
PMID
:25237963
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2,291
72
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Elevated serum creatine kinase due to nocturnal seizure
Hiroshi Nawashiro, Hiroshi Nawashiro
July-August 2014, 62(4):441-441
DOI
:10.4103/0028-3886.141234
PMID
:25237956
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2,309
45
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NEUROIMAGES
CT angiography demonstration of ongoing intraventricular hemorrhage from actively bleeding posterior communicating artery aneurysm
Hiroshi Yokota, Yuki Ida, Hiroshi Yokota, Yuki Ida
July-August 2014, 62(4):477-478
DOI
:10.4103/0028-3886.141308
PMID
:25237977
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2,270
44
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CORRESPONDENCE
Authors reply
V Huded, R De Souza, RK Nagarajaiah, SM Zafer, R Nair, H Acharya, V Huded, R De Souza, RK Nagarajaiah, SM Zafer, R Nair, H Acharya
July-August 2014, 62(4):474-475
DOI
:10.4103/0028-3886.141301
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2,224
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