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Publisher: Medknow Publishers   (Total: 355 journals)

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Showing 1 - 200 of 355 Journals sorted alphabetically
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advances in Human Biology     Open Access   (Followers: 1)
African J. for Infertility and Assisted Conception     Open Access  
African J. of Business Ethics     Open Access   (Followers: 6)
African J. of Medical and Health Sciences     Open Access   (Followers: 1)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.269, h-index: 10)
African J. of Trauma     Open Access  
Ain-Shams J. of Anaesthesiology     Open Access   (Followers: 3)
Al-Azhar Assiut Medical J.     Open Access  
Al-Basar Intl. J. of Ophthalmology     Open Access   (Followers: 1)
Ancient Science of Life     Open Access   (Followers: 6)
Anesthesia : Essays and Researches     Open Access   (Followers: 7)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.331, h-index: 15)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 13, SJR: 0.408, h-index: 15)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.308, h-index: 14)
Annals of Maxillofacial Surgery     Open Access   (Followers: 6)
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 7, SJR: 0.441, h-index: 10)
Annals of Saudi Medicine     Open Access   (SJR: 0.24, h-index: 29)
Annals of Thoracic Medicine     Open Access   (Followers: 4, SJR: 0.388, h-index: 19)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15, SJR: 0.148, h-index: 5)
APOS Trends in Orthodontics     Open Access   (Followers: 1)
Arab J. of Interventional Radiology     Open Access  
Archives of Intl. Surgery     Open Access   (Followers: 9)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Pharmacy Practice     Open Access   (Followers: 5)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 3)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.879, h-index: 49)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 1)
Asian J. of Transfusion Science     Open Access   (Followers: 2, SJR: 0.362, h-index: 10)
Astrocyte     Open Access  
Avicenna J. of Medicine     Open Access   (Followers: 1)
AYU : An international quarterly journal of research in Ayurveda     Open Access   (Followers: 6)
Benha Medical J.     Open Access  
BLDE University J. of Health Sciences     Open Access  
Brain Circulation     Open Access  
Bulletin of Faculty of Physical Therapy     Open Access   (Followers: 1)
Cancer Translational Medicine     Open Access   (Followers: 1)
CHRISMED J. of Health and Research     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 1)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 1)
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 12, SJR: 0.82, h-index: 12)
Contemporary Clinical Dentistry     Open Access   (Followers: 4)
Current Medical Issues     Open Access   (Followers: 1)
CytoJ.     Open Access   (Followers: 2, SJR: 0.339, h-index: 19)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 3, SJR: 0.131, h-index: 4)
Dental Research J.     Open Access   (Followers: 9)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 5, SJR: 0.205, h-index: 22)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1)
Egyptian J. of Dermatology and Venerology     Open Access   (Followers: 1)
Egyptian J. of Haematology     Open Access  
Egyptian J. of Internal Medicine     Open Access   (Followers: 1)
Egyptian J. of Neurology, Psychiatry and Neurosurgery     Open Access   (Followers: 1, SJR: 0.121, h-index: 3)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access  
Egyptian J. of Otolaryngology     Open Access   (Followers: 1)
Egyptian J. of Psychiatry     Open Access   (Followers: 2)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Orthopaedic J.     Open Access  
Egyptian Pharmaceutical J.     Open Access  
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access  
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.473, h-index: 8)
Environmental Disease     Open Access  
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.496, h-index: 11)
European J. of General Dentistry     Open Access   (Followers: 1)
European J. of Prosthodontics     Open Access   (Followers: 2)
European J. of Psychology and Educational Studies     Open Access   (Followers: 7)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.107, h-index: 5)
Genome Integrity     Open Access   (Followers: 4, SJR: 1.227, h-index: 12)
Global J. of Transfusion Medicine     Open Access   (Followers: 1)
Heart India     Open Access   (Followers: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
IJS Short Reports     Open Access  
Indian Anaesthetists Forum     Open Access  
Indian Dermatology Online J.     Open Access   (Followers: 3)
Indian J. of Allergy, Asthma and Immunology     Open Access   (Followers: 1)
Indian J. of Anaesthesia     Open Access   (Followers: 8, SJR: 0.302, h-index: 13)
Indian J. of Burns     Open Access   (Followers: 1)
Indian J. of Cancer     Open Access   (SJR: 0.318, h-index: 26)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.618, h-index: 16)
Indian J. of Critical Care Medicine     Open Access   (Followers: 2, SJR: 0.307, h-index: 16)
Indian J. of Dental Research     Open Access   (Followers: 4, SJR: 0.243, h-index: 24)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.448, h-index: 16)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 3, SJR: 0.563, h-index: 29)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4)
Indian J. of Health Sciences     Open Access   (Followers: 2)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.292, h-index: 9)
Indian J. of Medical Microbiology     Open Access   (Followers: 1, SJR: 0.53, h-index: 34)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.716, h-index: 60)
Indian J. of Medical Sciences     Open Access   (Followers: 2, SJR: 0.207, h-index: 31)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 1, SJR: 0.233, h-index: 12)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.213, h-index: 5)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 4, SJR: 0.203, h-index: 13)
Indian J. of Ophthalmology     Open Access   (Followers: 5, SJR: 0.536, h-index: 34)
Indian J. of Oral Health and Research     Open Access  
Indian J. of Oral Sciences     Open Access   (Followers: 1)
Indian J. of Orthopaedics     Open Access   (Followers: 9, SJR: 0.393, h-index: 15)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.218, h-index: 5)
Indian J. of Paediatric Dermatology     Open Access   (Followers: 2)
Indian J. of Pain     Open Access   (Followers: 1)
Indian J. of Palliative Care     Open Access   (Followers: 5, SJR: 0.35, h-index: 12)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 1, SJR: 0.285, h-index: 22)
Indian J. of Pharmacology     Open Access   (SJR: 0.347, h-index: 44)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.303, h-index: 13)
Indian J. of Psychiatry     Open Access   (Followers: 3, SJR: 0.496, h-index: 15)
Indian J. of Psychological Medicine     Open Access   (Followers: 1, SJR: 0.344, h-index: 9)
Indian J. of Public Health     Open Access   (Followers: 1, SJR: 0.444, h-index: 17)
Indian J. of Radiology and Imaging     Open Access   (Followers: 4, SJR: 0.253, h-index: 14)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Rheumatology     Open Access   (SJR: 0.169, h-index: 7)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.313, h-index: 9)
Indian J. of Social Psychiatry     Open Access   (Followers: 2)
Indian J. of Urology     Open Access   (Followers: 3, SJR: 0.366, h-index: 16)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Industrial Psychiatry J.     Open Access   (Followers: 2)
Intl. J. of Academic Medicine     Open Access  
Intl. J. of Advanced Medical and Health Research     Open Access  
Intl. J. of Applied and Basic Medical Research     Open Access  
Intl. J. of Clinical and Experimental Physiology     Open Access   (Followers: 1)
Intl. J. of Critical Illness and Injury Science     Open Access   (Followers: 1)
Intl. J. of Educational and Psychological Researches     Open Access   (Followers: 3)
Intl. J. of Environmental Health Engineering     Open Access   (Followers: 1)
Intl. J. of Forensic Odontology     Open Access   (Followers: 1)
Intl. J. of Green Pharmacy     Open Access   (Followers: 4, SJR: 0.229, h-index: 13)
Intl. J. of Health & Allied Sciences     Open Access   (Followers: 3)
Intl. J. of Health System and Disaster Management     Open Access   (Followers: 3)
Intl. J. of Heart Rhythm     Open Access  
Intl. J. of Medicine and Public Health     Open Access   (Followers: 7)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.239, h-index: 4)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4)
Intl. J. of Oral Health Sciences     Open Access   (Followers: 1)
Intl. J. of Orthodontic Rehabilitation     Open Access  
Intl. J. of Pedodontic Rehabilitation     Open Access  
Intl. J. of Pharmaceutical Investigation     Open Access   (Followers: 1)
Intl. J. of Preventive Medicine     Open Access   (Followers: 1, SJR: 0.523, h-index: 15)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 7, SJR: 0.611, h-index: 9)
Intl. J. of Trichology     Open Access   (SJR: 0.37, h-index: 10)
Intl. J. of Yoga     Open Access   (Followers: 15)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 6)
Iranian J. of Nursing and Midwifery Research     Open Access   (Followers: 2)
Iraqi J. of Hematology     Open Access  
J. of Academy of Medical Sciences     Open Access  
J. of Advanced Pharmaceutical Technology & Research     Open Access   (Followers: 4, SJR: 0.427, h-index: 15)
J. of Anaesthesiology Clinical Pharmacology     Open Access   (Followers: 8, SJR: 0.416, h-index: 14)
J. of Applied Hematology     Open Access  
J. of Association of Chest Physicians     Open Access   (Followers: 2)
J. of Basic and Clinical Reproductive Sciences     Open Access   (Followers: 1)
J. of Cancer Research and Therapeutics     Open Access   (Followers: 4, SJR: 0.359, h-index: 21)
J. of Carcinogenesis     Open Access   (Followers: 1, SJR: 1.152, h-index: 26)
J. of Cardiothoracic Trauma     Open Access  
J. of Cardiovascular Disease Research     Open Access   (Followers: 3, SJR: 0.351, h-index: 13)
J. of Cardiovascular Echography     Open Access   (SJR: 0.134, h-index: 2)
J. of Cleft Lip Palate and Craniofacial Anomalies     Open Access   (Followers: 2)
J. of Clinical and Preventive Cardiology     Open Access   (Followers: 1)
J. of Clinical Imaging Science     Open Access   (Followers: 1, SJR: 0.277, h-index: 8)
J. of Clinical Neonatology     Open Access   (Followers: 1)
J. of Clinical Ophthalmology and Research     Open Access   (Followers: 2)
J. of Clinical Sciences     Open Access  
J. of Conservative Dentistry     Open Access   (Followers: 4, SJR: 0.532, h-index: 10)
J. of Craniovertebral Junction and Spine     Open Access   (Followers: 4, SJR: 0.199, h-index: 9)
J. of Current Medical Research and Practice     Open Access  
J. of Current Research in Scientific Medicine     Open Access  
J. of Cutaneous and Aesthetic Surgery     Open Access   (Followers: 1)
J. of Cytology     Open Access   (Followers: 1, SJR: 0.274, h-index: 9)
J. of Dental and Allied Sciences     Open Access   (Followers: 1)
J. of Dental Implants     Open Access   (Followers: 7)
J. of Dental Lasers     Open Access   (Followers: 2)
J. of Dental Research and Review     Open Access   (Followers: 1)
J. of Digestive Endoscopy     Open Access   (Followers: 3)
J. of Dr. NTR University of Health Sciences     Open Access  
J. of Earth, Environment and Health Sciences     Open Access   (Followers: 1)
J. of Education and Ethics in Dentistry     Open Access   (Followers: 5)
J. of Education and Health Promotion     Open Access   (Followers: 5)
J. of Emergencies, Trauma and Shock     Open Access   (Followers: 9, SJR: 0.353, h-index: 14)
J. of Engineering and Technology     Open Access   (Followers: 6)
J. of Experimental and Clinical Anatomy     Open Access   (Followers: 2)
J. of Family and Community Medicine     Open Access   (Followers: 2)
J. of Family Medicine and Primary Care     Open Access   (Followers: 10)

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Journal Cover Asian Journal of Neurosurgery
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 1793-5482 - ISSN (Online) 2248-9614
   Published by Medknow Publishers Homepage  [355 journals]
  • Trigeminal neuralgia

    • Authors: Yad Ram Yadav, Yadav Nishtha, Pande Sonjjay, Parihar Vijay, Ratre Shailendra, Khare Yatin
      Pages: 585 - 597
      Abstract: Yad Ram Yadav, Yadav Nishtha, Pande Sonjjay, Parihar Vijay, Ratre Shailendra, Khare Yatin
      Asian Journal of Neurosurgery 2017 12(4):585-597
      Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.
      Citation: Asian Journal of Neurosurgery 2017 12(4):585-597
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_67_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Organized chronic subdural hematomas treated by large craniotomy with
           extended membranectomy as the initial treatment

    • Authors: Mustafa Balevi
      Pages: 598 - 604
      Abstract: Mustafa Balevi
      Asian Journal of Neurosurgery 2017 12(4):598-604
      Objective: The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). Materials and Methods: We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Results: Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Conclusion: Large craniotomy and extended membrane excision for OSDH still carry a high rate of mortality and morbidity in elderly patients. TP, RSH, and postoperative seizures are frequently seen complications in elderly patients.
      Citation: Asian Journal of Neurosurgery 2017 12(4):598-604
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_8_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Endoscopic third ventriculostomy in normal pressure hydrocephalus and
           symptomatic long-standing overt ventriculomegaly

    • Authors: Mustafa Balevi
      Pages: 605 - 612
      Abstract: Mustafa Balevi
      Asian Journal of Neurosurgery 2017 12(4):605-612
      Objectives: The aim of this study is to define the role and effectiveness for an endoscopic third ventriculostomy (ETV) in patients with seconder normal pressure hydrocephalus(SNPH), idiopathic normal pressure hydrocephalus (INPH) and symptomatic longstanding overt ventriculomegaly (SLOVA). Materials and Methods: 3 patients with SLOVA, 3 patients with INPH and 3 patients with SNPH underwent ETV were studied retrospectively. The patients had a follow-up of 1-6 years. Preoperative CT or/and MRI of the brain was done in all cases.Tap test was done in all cases. Clinical examination finding were classified according to the by Japanese Committee for Scientific Research (JCSS) on intractable Hydrocephalus. Patients were studied to evaluate of the patency of ventriculosthomy and aqueduclus slyvius by a Cine PC MR and CSF_DRİVE T2 Sequence MRI after 1-6 years. Results: Headache, gait disturbance and pollakiuria improved in three patients with SNPH underwent ETV, but dementia didn't improve in one patient. Pollakiuria and headache improved in three patients with INPH underwent ETV but preoperative gait disturbance grade three remained unchanged in one patient. Headache improved in three patients with SLOVA underwent ETV. Preoperative gait disturbance grade 3 remained unchanged in one patient, but improved pollakiuria. We confirmed the patency of a third ventriculostomy and decreasing degrees of CSF flow into the aquaductus sylvius. Conclusions: In properly selected patients with SNPH, SLOVA and INPH who had headache ,slight gait disturbance and pollakiuria , mainly those with a short duration of symptoms, ETV may provide good results.
      Citation: Asian Journal of Neurosurgery 2017 12(4):605-612
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_54_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Formulation and characterization of nanomedicine (solid lipid
           nanoparticle) associate with the extract of Pterospermum acerifolium for
           the screening of neurochemicals and neuroendocrine effects

    • Authors: Ankur Choubey, Ritu Gilhotra, Santosh Kumar Singh, Gopal Garg
      Pages: 613 - 619
      Abstract: Ankur Choubey, Ritu Gilhotra, Santosh Kumar Singh, Gopal Garg
      Asian Journal of Neurosurgery 2017 12(4):613-619
      Background: Nanotechnology has given the likelihood of conveying medications to particular cells utilizing nanoparticles. Nanosystems can convey the dynamic constituent at an adequate fixation amid the whole treatment time frame, guiding it to the fancied site of activity. Traditional medications do not meet these necessities. The fundamental motivation behind creating elective medication conveyance advancements is to expand effectiveness of medication conveyance and security during the time spent medication conveyance and give more accommodation to the patient. Objectives: Pterospermum acerifolium, basic plant in India, is viewed as carminative, stimulant, and emmenagogue. The improvement of control discharge conveyance systems could prompt huge preferences in the clinical employments of these medications to diminish the toxicities. The point of this study was to figure another conveyance framework for impacts of neurochemicals by the joining of concentrate of P. acerifolium into strong lipid nanoparticles (SLNs). Methods: SLN formulations were prepared by Ethanolic extract, lipid layer was liquefied by warming at 5°C above liquefying purpose of the lipid. After that, SLNs were separated and dried. Shape and surface morphology of the SLNs were pictured by checking scanning electron microscopy. Particle size and size distribution were dictated by photon connection spectroscopy. Results and Discussion: The change of molecule charge was contemplated by zeta potential estimations. Treatment with SLN with concentrate was found to altogether diminish the serum levels of adrenocorticotropic hormone (ACTH), corticosterone and-endorphin and in addition the cerebrum and serum level of norepinephrine. Moreover, SLN with concentrate could essentially turn around the constant anxiety by diminishing the cerebrum and serum levels of the monoamine neurotransmitters dopamine, 5-hydroxytryptamine. Conclusion: The outcomes got from this study recommended that the memory-improving impact of SLN with concentrate was interceded through directions of neurochemical and neuroendocrine frameworks.
      Citation: Asian Journal of Neurosurgery 2017 12(4):613-619
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_2_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Outcomes of minimally invasive surgery compared to open posterior lumbar
           instrumentation and fusion

    • Authors: Low Yong Lee, Zamzuri Idris, Tan Boon Beng, Teo Yian Young, Wong Chung Chek, Jafri Malin Abdullah, Wong Sii Hieng
      Pages: 620 - 637
      Abstract: Low Yong Lee, Zamzuri Idris, Tan Boon Beng, Teo Yian Young, Wong Chung Chek, Jafri Malin Abdullah, Wong Sii Hieng
      Asian Journal of Neurosurgery 2017 12(4):620-637
      Introduction: Degenerative spine disease is increasingly common. There are many spinal fusion techniques used to treat degenerative spine disease. This study aims to compare the functional outcome of open versus minimally invasive surgery (MIS) technique in posterior lumbar instrumentation and fusion in degenerative spine disease and to evaluate the perioperative outcome and complications between MIS and open surgery. Materials and Methods: This is an observational cross-sectional study conducted on all degenerative spine disease patients who underwent both methods of posterior lumbar instrumentation and fusion from 2010 to 2014 by the Orthopedic and Neurosurgery Department, Sarawak General Hospital. The analyzed variables were method of surgery and the levels involved, demographic data, estimated blood loss, duration of operation, length of hospitalization, visual analog scale of back pain and radicular pain preoperative, postoperative 1 month, 3 months, 6 months, 1 year, and functional outcome. Results: One hundred and twenty-two patients underwent posterior lumbar instrumentation and fusion from 2010 to 2014. Seventy patients were subjected to MIS transforaminal lumbar interbody fusion (TLIF) and 52 open TLIF. Total 89 patients underwent single level of lumbar fusion with sixty patients in MIS group and 29 in open surgeries. MIS TLIF has less estimated blood loss and shorter hospitalization and longer operation time compared to open TLIF, which were statistically significance. MIS TLIF has statistically significance better functional outcome based on Oswestry disability index, Modified NASS score, and RAND 36-item Health Survey 1.0 score. Complications such as infection, new onsets of neurological, and dural tear are equal in both methods of surgery. Conclusion: This study concluded that MIS has better functional outcome compared to open TLIF with shorter hospitalization, faster return to work, and less estimated blood loss.
      Citation: Asian Journal of Neurosurgery 2017 12(4):620-637
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_331_16
      Issue No: Vol. 12, No. 4 (2017)
       
  • Intraoperative anatomical and hemodynamic analysis of intracerebral
           arteriovenous malformations by semi-quantitative color-coded indocyanine
           green videoangiography

    • Authors: Yoko Kato, Yasuhiro Yamada, Akiyo Sadato, Mohsen Nouri, Iype Cherian, Teppei Tanaka, Joji Inamasu
      Pages: 638 - 643
      Abstract: Yoko Kato, Yasuhiro Yamada, Akiyo Sadato, Mohsen Nouri, Iype Cherian, Teppei Tanaka, Joji Inamasu
      Asian Journal of Neurosurgery 2017 12(4):638-643
      Objective and Background: To evaluate possible roles for indocyanine green (ICG)-based FLOW 800 software in surgical treatment of cerebral arteriovenous malformations (AVMs). Methods: We perform ICG videoangiography several times for each step of AVM resection to elucidate feeders, drainers, and cerebral perfusion. Results: Since 2010, 22 AVM surgeries in our department have been conducted using FLOW 800 intraoperatively. We demonstrated ICG angiograms, color-coded images, and semi-quantitative curves for AVMs. By reviewing all these modalities, we would define vascular structure of the AVM, proceed with resection, and finally recheck for any remnant. Conclusions: ICG FLOW 800 software helps the surgeon to recognize feeding and draining vessels of an AVM intraoperatively. Further studies to evaluate semi-quantitative acquired data regarding blood flow and tissue perfusion are warranted.
      Citation: Asian Journal of Neurosurgery 2017 12(4):638-643
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_62_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Predictive value of motor evoked potential monitoring during surgery of
           unruptured anterior circulation cerebral aneurysms

    • Authors: Yasuhiro Yamada, Yoko Kato, Mohsen Nouri, Tsukasa Ganaha, Motoki Oheda, Kohei Ishihara, Shigeta Moriya, Akiyo Sadato, Joji Inamasu, Yuichi Hirose
      Pages: 644 - 647
      Abstract: Yasuhiro Yamada, Yoko Kato, Mohsen Nouri, Tsukasa Ganaha, Motoki Oheda, Kohei Ishihara, Shigeta Moriya, Akiyo Sadato, Joji Inamasu, Yuichi Hirose
      Asian Journal of Neurosurgery 2017 12(4):644-647
      Objective and Background: Surgery of unruptured aneurysms is always a great challenge to neurovascular surgeons because no postoperative neurological deficits should be expected postoperatively as the patients are fully asymptomatic before the surgery. Here, we present our experience with selective motor evoked potential (MEP) monitoring of our patients in a 2-year time window. Patients and Methods: From 2012 to 2014, 27 patients with unruptured intracranial aneurysms were operated in our institute with the help of MEP monitoring. All patients underwent endoscope-assisted microsurgery with pre- and post-clipping indocyanine green angiography. Results: In this period, no mortality was observed, but 18.5% of the patients developed postoperative deficits which showed good recovery in all cases. Overall, MEP showed about 90% accuracy in predicting postoperative deficits. Conclusions: MEP as a part of multimodality monitoring of aneurysm surgeries is a valuable tool to improve the outcome. However, we should know its limitations as its results are not always consistent with the outcome.
      Citation: Asian Journal of Neurosurgery 2017 12(4):644-647
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_135_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Contributing factors for coagulopathy in traumatic brain injury

    • Authors: Ajit Shrestha, Ramesh Man Joshi, Upendra Prasad Devkota
      Pages: 648 - 652
      Abstract: Ajit Shrestha, Ramesh Man Joshi, Upendra Prasad Devkota
      Asian Journal of Neurosurgery 2017 12(4):648-652
      Context: In traumatic brain injury patients, coagulation disorder causes secondary brain injury, thereby increasing mortality and morbidity. Aims: The aim of this study is to identify the factors responsible for coagulopathy in traumatic brain injury. Settings and Design: This prospective longitudinal study from June 2012 included 100 patients with moderate and severe head injury presenting to National Institute of Neurological and Allied Sciences, Kathmandu, over 1-year period. Subjects and Methods: Patients were evaluated for the development of coagulopathy, defined as collectively three abnormal hemostatic parameters, and associated risk factors for coagulopathy. They were then analyzed for correlation with coagulopathy. Statistical Analysis Used: SPSS version 16 was used for the analysis of data. For identification of contributing factors, a stepwise logistic regression analysis was performed, including the factors with P < 0.05 from the analysis. Results: Among the 100 patients, coagulopathy was present in 63% of cohort. Forty-three patients had severe head injury, and 76.7% (n = 33) of them had coagulopathy compared to 52.7% (n = 30) in 57 patients with moderate head injury (P = 0.013). Statistically significant correlation with coagulopathy was present with polytrauma, severity of head injury, blood transfusion, surgical intervention, and Marshall's classification of CT of the head; however, stepwise logistic regression analysis showed that blood transfusion, surgical intervention, polytrauma, and severity of head injury were significant independent variables responsible for the development of coagulopathy. Conclusions: Traumatic brain injury is complicated with coagulopathy in up to 63% of patients. Blood transfusion, surgical intervention, polytrauma, and severity of head injury are significant independent variables responsible for coagulopathy.
      Citation: Asian Journal of Neurosurgery 2017 12(4):648-652
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_192_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Profiling cognitive deficits in intra-axial and extra-axial tumors using
           addenbrooke's cognitive examination as a screening tool: An Indian
           experience

    • Authors: Sandhya Cherkil, Dilip Panikar, Deepak Kuttikkattu Soman
      Pages: 653 - 658
      Abstract: Sandhya Cherkil, Dilip Panikar, Deepak Kuttikkattu Soman
      Asian Journal of Neurosurgery 2017 12(4):653-658
      Background: Tumors of the brain, whether intra- or extra-axial, results in cognitive deficits. The aim of the present study was to profile cognitive deficits using Addenbrooke's Cognitive Examination-Malayalam (ACE-M) as a screen and to determine the sensitivity and specificity of the same. Methods: Seventy-four drug naïve patients diagnosed to have brain tumors were assessed for cognitive functioning using ACE-M before surgery. Results: Patients with high-grade intra-axial tumors showed a significant association on the cognitive domains of registration (0.04), recall (0.01), and visuospatial functioning (0.02). Gender showed an association between registration (0.02) and verbal fluency (0.02) with females performing better while education was significantly associated with retrograde or remote memory (0.00) with college-educated sample performing better. Significance was assumed at P < 0.05. In extra-axial tumors, laterality had a single association with recall (0.02). Males showed a significant cognitive decline on the cognitive domains of attention (0.02), recall (0.05), naming (0.02), and language functions (0.01). College educated group performed better on registration (0.01), recall (0.09), naming (0.00), and visuospatial functioning (0.00). The area under the receiver operating characteristic curve was estimated as 0.75, which indicates fairly good discriminative ability with a cut off of 71/100; sensitivity at 77.3 and specificity fixed at 67. Conclusions: ACE-M is capable of bringing out cognitive deficits along with a number of cognitive domains in patients with intra- and extra-axial tumors in the capacity of a screen, with fairly good levels of sensitivity and specificity.
      Citation: Asian Journal of Neurosurgery 2017 12(4):653-658
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_34_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Comparison between ventriculosubgaleal shunt and extraventricular drainage
           to treat acute hydrocephalus in adults

    • Authors: Low Siaw Nee, Rahmat Harun, Pulivendhan Sellamuthu, Zamzuri Idris
      Pages: 659 - 663
      Abstract: Low Siaw Nee, Rahmat Harun, Pulivendhan Sellamuthu, Zamzuri Idris
      Asian Journal of Neurosurgery 2017 12(4):659-663
      Context: Hydrocephalus, due to subarachnoid or intraventricular hemorrhage (IVH), meningitis, or tumor compression, is usually transient and may resolve after treatment. There are several temporary methods of cerebrospinal fluid (CSF) diversion, none of it is superior to the other, and the decision is based on its various etiologies and factors. Ventriculosubgaleal shunt (VSGS) is one of those temporary measures, which is a simple and rapid CSF decompression method without causing electrolyte and nutritional losses. Aims: The aim is to study the efficacy of VSGS for temporary CSF diversion, compared to extraventricular drainage (EVD) in adult hydrocephalus patients; to evaluate the outcome in terms of avoiding a permanent shunt, and to look for incidences of their complications. Settings and Design: This was a retrospective observational study. Subjects and Methods: The data were acquired from case notes of fifty patients with acute hydrocephalus: 26 secondary to IVH, 10 from aneurysm rupture, 8 posttrauma, and 6 from infection. All these patients had undergone CSF diversion in Hospital Queen Elizabeth II, Sabah, Malaysia, between 2013 and 2015. The patients were followed up from the date of treatment until the resolution of hydrocephalus, where parameters such as shunt dependency and complications were documented. Statistical Analysis Used: All analyses were carried out using Statistical Packages for the Social Sciences Version 22.0. Chi-squared test or Fisher's exact test is used for univariate analysis of categorical variables. Results: A total of 21 (42%) patients underwent EVD insertion and 29 (58%) underwent VSGS insertion. Thirty-seven (74%) patients did not require a permanent shunt; 24 (64.8%) of them were from the VSGS group (P = 0.097). EVD had more intracranial complications (44.1%) compared with VSGS (23.5%), with a statistically significant P = 0.026. Conclusions: VSGS is a safe and viable option for adult hydrocephalus patients, with the possibility of continuation of the treatment for such patients in nonneurosurgical centers, as opposed to patients with EVDs. Furthermore, even though this method had no statistical difference in avoiding a permanent ventriculoperitoneal shunt, VSGS has statistically significant less intracranial complications compared with EVD.
      Citation: Asian Journal of Neurosurgery 2017 12(4):659-663
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_122_16
      Issue No: Vol. 12, No. 4 (2017)
       
  • Comparison of stereotactic and ultrasound-guided biopsy of solid
           supratentorial tumor: A preliminary report

    • Authors: Guru Dutta Satyarthee, P Sarat Chandra, Bhawani S Sharma, VS Mehta
      Pages: 664 - 669
      Abstract: Guru Dutta Satyarthee, P Sarat Chandra, Bhawani S Sharma, VS Mehta
      Asian Journal of Neurosurgery 2017 12(4):664-669
      Introduction: The computed tomography (CT) guided stereotactic biopsy (STB) is considered as method of choice for biopsy of intracranial mass lesions. However, it's disadvantages are frame fixation, time requirement for transportation between CT scan suit to the operation theater with added much higher equipment cost in the relatively resource scarred developing country. Ultrasound-guided biopsy (USGB) is relatively simpler, economical, less time consuming, and real-time procedure. Clinical Materials and Methods: Thirty-seven consecutively admitted patients with supratentorial brain tumors, who underwent biopsy of the lesion using CT compatible stereotactic and ultrasound-guided (USGB) procedure formed cohort of the study. Based on location and size of the lesions, the cases were divided into two groups, superficial and deep. Twenty-two patients underwent ultrasound-guided biopsy and 15 with STB. Results: The diagnostic yield of STB was 93% and 91% for ultrasound-guided biopsy. The mean operation time of STB group was 149.00 min and 94 min for USGB, which was statistically significant. Two cases in each group developed hematoma; however, one case in USGB group needed surgical evacuation. The real-time monitoring detected two hematoma intraoperatively, which were further also confirmed on postoperative CT scan head. Conclusions: The ultrasound-guided biopsy procedure (USGB) was simple, relatively shorter time-consuming procedure and equally efficacious and utilizing economical equipment and can act as a safer alternative to CT STB process for biopsy of the intracranial mass lesion. Furthermore, USGB also provided intra-operative real-time monitoring, which provided clue for close monitoring in the postoperative period after completion of biopsy to look for development of fresh hematoma development not only at the biopsy site but also along the biopsy track and adjoining area. Perhaps, a longer period of ultrasonic monitoring following the procedure would be of greater help to detect hematoma formation, which is one of the most common complications of the biopsy procedure.
      Citation: Asian Journal of Neurosurgery 2017 12(4):664-669
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.215765
      Issue No: Vol. 12, No. 4 (2017)
       
  • Factors correlated with unfavorable outcome after carpal tunnel release
           surgery

    • Authors: Fakhr Fakhouri, Rana Alnasser Alsukhni, Bashar Altunbi, Zakaria Hawoot, Rasha Dabbagh
      Pages: 670 - 673
      Abstract: Fakhr Fakhouri, Rana Alnasser Alsukhni, Bashar Altunbi, Zakaria Hawoot, Rasha Dabbagh
      Asian Journal of Neurosurgery 2017 12(4):670-673
      Objectives: Carpal tunnel release surgery has excellent results. The aim of this study was to identify which baseline clinical and demographic factors could predict a good outcome from surgery. Understanding the impact of prognostic factors will enable surgeons to indicate surgical intervention better, provide appropriate preoperative counseling, and manage expectations postoperatively. Materials and Methods: A prospective, observational study included 620 carpal tunnel syndrome patients (age 42.38 ± 11.18 years; mean ± standard deviation). After the diagnosis had been confirmed by electrodiagnostic studies, patients underwent open carpal tunnel release surgery. Patients were evaluated initially after 2 weeks and eventually after 6 months. Surgical outcome was compared with presurgical findings. Results: Response to surgery was good in 89.4% and 94.2% after 2 weeks and 6 months, respectively. Factors correlated significantly with unfavorable outcome of surgery included old age, longer duration of symptoms, negative Phalen's test, abnormal two-point discrimination test, and weakness of abductor pollicis brevis muscle. Gender, retrograde radiation, and nocturnal symptoms did not correlate with surgical outcome. Conclusion: Elderly patients with longstanding disease, neurological deficits, and negative Phalen's test may not respond to surgery as others. This should be kept in mind in preoperative counseling and postoperative expectations.
      Citation: Asian Journal of Neurosurgery 2017 12(4):670-673
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_3_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Multicompartmental primary spinal extramedullary tumors: Value of an
           interdisciplinary approach

    • Authors: Guruprasad Bettaswamy, Paurush Ambesh, Raj Kumar, Rabi Narayan Sahu, Kuntal Kanti Das, Awadhesh Kumar Jaiswal, Arun Kumar Srivastava, Sanjay Behari
      Pages: 674 - 680
      Abstract: Guruprasad Bettaswamy, Paurush Ambesh, Raj Kumar, Rabi Narayan Sahu, Kuntal Kanti Das, Awadhesh Kumar Jaiswal, Arun Kumar Srivastava, Sanjay Behari
      Asian Journal of Neurosurgery 2017 12(4):674-680
      Background: Primary extramedullary tumors involving multiple compartments around the spine are a technically demanding group of tumors whose extent traverses beyond the normal confines of those anatomical regions which fall in the common domain of neurosurgeons. In the following series, we present 12 patients who were diagnosed with primary spinal extramedullary tumors with multicompartmental extension, and whose surgical management was facilitated by a combined multidisciplinary approach involving surgeons of other superspecialties. This multidisciplinary assistance from the inception to the culmination of surgical management helped in achieving a better surgical removal, thereby resulting in better surgical outcomes. Materials and Methods: Twelve consecutive patients who fulfilled the inclusion criteria in the 5-year period (January 2010 to January 2015) were included in the series based on the radiological and pathological characteristics of the tumor. Depending on the site of the spine involved by the lesion, radiologists and surgeons were involved from the planning phase of the surgical management, and their assistance in procedures such as preoperative embolization/ureteric stenting was sought whenever was deemed necessary. The extent of resection and total blood loss was recorded meticulously. Regular follow-up (3, 6, and 12 months and 2 and 5 years) of the patients was done after the initial follow-up at 6 weeks and their disability scores were recorded. Results: Of the 12 cases (6 males and 6 females), sacrum was the most common location of the tumors (6). Histopathologically, giant-cell tumors, schwannomas, and chondrosarcomas (3 each) were most common followed by Ewing's sarcoma (2) and malignant peripheral nerve sheath tumor (1). Eight patients had functional status of McCormick scale 1 and two patients had a functional status of 2. One patient was lost to follow-up and one patient died during surgery. Conclusion: Judicious involvement of access surgeons and adjunct therapies along with careful preoperative planning can help in improving surgical outcome in multicompartmental spinal tumors.
      Citation: Asian Journal of Neurosurgery 2017 12(4):674-680
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_54_13
      Issue No: Vol. 12, No. 4 (2017)
       
  • A method for reconstruction of severely damaged spinal cord using
           autologous hematopoietic stem cells and platelet-rich protein as a
           biological scaffold

    • Authors: Ahmed Sabry Ammar, Yasser Osman, Ahmed Taher Hendam, Mohammed Ahmed Hasen, Fatma Abdullah Al Rubaish, Danya Yaagoub Al Nujaidi, Faisal Mishal Al Abbas
      Pages: 681 - 690
      Abstract: Ahmed Sabry Ammar, Yasser Osman, Ahmed Taher Hendam, Mohammed Ahmed Hasen, Fatma Abdullah Al Rubaish, Danya Yaagoub Al Nujaidi, Faisal Mishal Al Abbas
      Asian Journal of Neurosurgery 2017 12(4):681-690
      Introduction: There have been attempts to alter the prognosis of severe spinal cord injury in different centers, but none of which have reliably altered the outcome. Some trials use stem cells (SCs) that produced widely differing results. We hereby add our experience in our center of a surgical reconstruction of the damaged spinal cord using a mixture of SCs and Platelet-Rich Protein (PRP) with fibrin coated as a biological scaffold. Materials and Methods: Four cases of severely damaged spinal cord have been operated for neurolysis and reconstruction of the spinal cord using SCs and platelet-rich protein (PRP) with fibrin coated harvested from the peripheral circulation of the patient. PRP serves to maintain the position of the SCs. One milliliter suspension contains an average of 2.8 × 106 of autologous hematopoietic SCs. Patients were intraoperatively monitored by somatosensory evoked potential, motor evoked potentials, and delta wave. They are clinically followed postoperatively and electromyogram was repeated every 2 weeks. Magnetic resonance imaging (MRI) was repeated regularly. The patients are followed up for a period between 2 and 3 years. Results: One patient demonstrated motor and objective sensory improvement (P = 0.05), two other patients reported subjective sensory improvement, and the fourth one remained without any improvement (P = 0.1). None of these patients demonstrated any sign of deterioration or complication either on the surgery or on implanting of the SCs. MRI clearly proved that the inserted biological scaffold remained in place of reconstruction. Conclusion: SCs may play a role in restoring spinal cord functions. However, the unsolved problems of the use of SCs and related ethical issues should be addressed.
      Citation: Asian Journal of Neurosurgery 2017 12(4):681-690
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_351_16
      Issue No: Vol. 12, No. 4 (2017)
       
  • Intraoperative magnetic resonance imaging for cranial and spinal cases
           using preexisting “C” shaped three side open 0.2 tesla
           magnetic resonance imaging

    • Authors: Vinod Kumar Tewari, Ravindra Tripathi, Subodh Aggarwal, Mazhar Hussain, Hari Kishan Das Gupta
      Pages: 691 - 694
      Abstract: Vinod Kumar Tewari, Ravindra Tripathi, Subodh Aggarwal, Mazhar Hussain, Hari Kishan Das Gupta
      Asian Journal of Neurosurgery 2017 12(4):691-694
      Background: The existing Intraoperative MRI (IMRI) of developed countries is too costly to be affordable in any developing country and out of the reach of common and poor people of developing country at remote areas. We have used the pre-existing (refurbished) 3 side open “C” shaped 0.2 Tesla MRI for IMRI in a very remote area. Materials and Methods: In this technique the 0.2 Tesla MRI and the operating theatre were merged. MRI table was used as an operation table. We have operated 36 cases via IMRI from November 2005 to till date. First case operated was on 13th nov 2005. Results: Low (0.2) Tesla open setup costs very low (around Rs 40 lakhs) so highly affordable to management and thus to patients, used for diagnostic and therapeutic purposes both, the equipments like Nitrous, oxygen and suction is outside the MRI room so no noise inside operative room, positioning the patient didn't take much time due to manual adjustments, no special training to nurses and technicians required because of low (0.2) Tesla power of magnet and same instruments and techniques, sequencing took only 1.31 mints per sequence and re registration is not required since we always note down the two orthogonal axis in x and y axis in preoperative imaging and we were able to operate on posterior fossa tumors as well because of no head fixation except with leucoplast strap. Moreover the images we got intraoperative are highly acceptable. Conclusion: Three side open 0.2 Tesla MRI system, if used for intraoperative guidance, is highly affordable and overcomes the limitations of western setup of IMRI. Postoperative MRI images were highly acceptable and also highly affordable too.
      Citation: Asian Journal of Neurosurgery 2017 12(4):691-694
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.181144
      Issue No: Vol. 12, No. 4 (2017)
       
  • Pneumocephalus presenting as sudden thunderclap headache

    • Authors: Vivek S Guleria, Ajay Sharma, Chetan Sharda, Virendra Kumar
      Pages: 695 - 697
      Abstract: Vivek S Guleria, Ajay Sharma, Chetan Sharda, Virendra Kumar
      Asian Journal of Neurosurgery 2017 12(4):695-697
      Pneumocephalus is a rare condition characterized by the presence of gas within the cranial cavity. This gas arises either from a trauma, tumor, surgical procedure, or occasionally from infection. Pneumocephalus secondary to chronic otitis media is an extremely rare phenomenon. We describe here a 70-year-old male, a known case of chronic suppurative otitis media who presented with sudden onset severe thunderclap headache and was eventually diagnosed as pneumocephalus.
      Citation: Asian Journal of Neurosurgery 2017 12(4):695-697
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_25_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Intradural eosinophilic granuloma invading skull: Case report and review
           of the literature

    • Authors: Kavita Mardi, RC Thakur, Lalita Negi
      Pages: 698 - 700
      Abstract: Kavita Mardi, RC Thakur, Lalita Negi
      Asian Journal of Neurosurgery 2017 12(4):698-700
      Eosinophilic granuloma is a localized form of Langerhans cell histiocytosis, most commonly involving the skeletal system. Their origin from the dura is rare with only a handful of cases on record. We present one such rare case of an eosinophilic granuloma originating from the dura mater with secondary osseous invasion in an 11-year-old female child who presented with a swelling in the right parietal region. Magnetic resonance imaging demonstrated an enhancing mass with a wide dural attachment with a lytic lesion in the overlying skull. Right parietal extended craniotomy was done with the excision of mass from the dura. Histopathological features of mass were characteristic of eosinophilic granuloma which was confirmed by positive immunohistochemical staining for CD1a.
      Citation: Asian Journal of Neurosurgery 2017 12(4):698-700
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_47_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Unruptured internal carotid artery aneurysm associated with functional
           pituitary adenoma: A true association

    • Authors: Guru Dutta Satyarthee, Amol Raheja
      Pages: 701 - 704
      Abstract: Guru Dutta Satyarthee, Amol Raheja
      Asian Journal of Neurosurgery 2017 12(4):701-704
      Detection of incidental intracranial aneurysm on neuroimaging can be associated with pituitary adenoma; however, such association is extremely rare. However, aneurysm with extension into the sella is extremely rare, and increases the risk of inadvertent intraoperative rupture, if trans-sphenoidal decompression is attempted either using endoscopic or microscopic surgical approach. Hanak et al. in a literature review of intrasellar noniatrogenic aneurysms over PubMed search in 2012 could only collect 31 studies, of which only eight cases had pituitary adenoma associated with aneurysm extending into sella.
      Authors report an interesting case of 52-year-old male diagnosed as case of acromegaly, was put on dopamine agonist, bromocriptine and responding well to therapy, however the magnetic resonance imaging raised suspicion of vascular pathology, and underwent digital subtraction angiography at our center revealed presence of right supracliniod internal carotid aneurysm, which was coiled using endovascular technique with resultant good outcome.
      Citation: Asian Journal of Neurosurgery 2017 12(4):701-704
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.215760
      Issue No: Vol. 12, No. 4 (2017)
       
  • Lhermitte&#8211;Duclos disease: A rare cause of cerebellar ataxia

    • Authors: Sanjay Pandey, Neelav Sarma
      Pages: 705 - 706
      Abstract: Sanjay Pandey, Neelav Sarma
      Asian Journal of Neurosurgery 2017 12(4):705-706
      The aim of this study is to describe a case of Lhermitte–Duclos disease (LDD), which is an extremely rare cause of cerebellar ataxia. LDD is an extremely rare type of benign cerebellar mass and usually manifest as features of raised intracranial pressure and cerebellar dysfunction. Patients may remain asymptomatic for many years, and detection of tumor may be by chance on routine magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). A 29-year-old female presented to the outdoor patient department with 18 months history of a headache, which was moderate to severe in intensity, throbbing in nature, localized to the right side of the head, and associated with nausea and photophobia. On examination, she had mild cerebellar dysfunction, and MRI/MRS finding was consistent with LDD. LDD is a rare cause of headache and cerebellar dysfunction in younger age group. Treatment may be individualized, and conservative management with regular follow-up may be a better approach if symptoms are mild and nonprogressive in nature.
      Citation: Asian Journal of Neurosurgery 2017 12(4):705-706
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_190_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Conus medullaris arachnoid cyst presenting as cauda equina syndrome

    • Authors: Salman Sharif, Afifa Afsar, Mohsin Qadeer
      Pages: 707 - 709
      Abstract: Salman Sharif, Afifa Afsar, Mohsin Qadeer
      Asian Journal of Neurosurgery 2017 12(4):707-709
      Intradural arachnoid cysts are a rare cause of spinal cord and nerve root compression. Primarily, they are present in the thoracic region posteriorly. We report a 25-year-old man who had an intradural arachnoid cyst at the level of conus medullaris presenting with cauda equina syndrome, which is very rare.
      Citation: Asian Journal of Neurosurgery 2017 12(4):707-709
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_36_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Open C2 vertebroplasty: Case report, technique, and review of literature

    • Authors: Sathwik Raviraj Shetty, Praveen Mahadev Ganigi, Bopanna Kanjithanda Mandanna
      Pages: 710 - 714
      Abstract: Sathwik Raviraj Shetty, Praveen Mahadev Ganigi, Bopanna Kanjithanda Mandanna
      Asian Journal of Neurosurgery 2017 12(4):710-714
      Osteolytic lesions of C2 are challenging pathologies to manage. Vertebroplasty, a minimally invasive technique has been widely used in lytic lesions of thoracic and lumbar spine. However, there has been limited experience with percutaneous vertebroplasty at C2, and the procedure is technically difficult. We describe a safer alternative technique of open vertebroplasty for lytic lesions involving the axis. Methods: The procedure was performed in a 49-year-old male with a metastatic lytic lesion involving the body and dens of C2 using an anterior cervical approach. The patient had an immediate reduction in pain with complete pain relief at 2 weeks and good stability at 3-month follow-up. The patient did not have any perioperative or postoperative complications. The anterior cervical approach open C2 vertebroplasty is a safe and effective option in the management of C2 osteolytic lesions.
      Citation: Asian Journal of Neurosurgery 2017 12(4):710-714
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_46_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • A rare case of isolated conus medullaris neurenteric cyst

    • Authors: Senthil Kumar Aiyappan, Vivakaran Thanga Thirupathi Rajan, Volga Harikrishnan
      Pages: 715 - 717
      Abstract: Senthil Kumar Aiyappan, Vivakaran Thanga Thirupathi Rajan, Volga Harikrishnan
      Asian Journal of Neurosurgery 2017 12(4):715-717
      Spinal neurenteric cysts are very rare congenital anomalies and are commonly associated with other spinal malformations. They are usually located in intradural, extramedullary location. We report a rare case of intramedullary conus medullaris neurenteric cyst without any associated spinal malformation diagnosed preoperatively by magnetic resonance imaging.
      Citation: Asian Journal of Neurosurgery 2017 12(4):715-717
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_92_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Vertex extradural hematoma: A diagnostic dilemma

    • Authors: Jayendra Kumar, Anand Prakash, Viraat Harsh, Anil Kumar
      Pages: 718 - 720
      Abstract: Jayendra Kumar, Anand Prakash, Viraat Harsh, Anil Kumar
      Asian Journal of Neurosurgery 2017 12(4):718-720
      Extradural hematomas (EDHs) of vertex are rarely seen and form a small percentage of all EDH. Usual cause of an EDH located at the vertex is tearing of the superior sagittal sinus. A 35-year-old male patient was admitted to our department, with history of fall and lucid interval. Imaging studies showed contusion in the right frontal region with midline shift and bilateral EDH located at vertex which was misinterpreted as artifact or subdural hematoma. We present this rare case and briefly review the literature regarding its etiopathology and associated clinico-radiological findings. The principles of management of this rare entity are also discussed.
      Citation: Asian Journal of Neurosurgery 2017 12(4):718-720
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.215758
      Issue No: Vol. 12, No. 4 (2017)
       
  • Solitary giant extradural plasmacytoma

    • Authors: H Raghavendra, M Dilip Kumar, Manas Panigraghi, Shailaja M Reddy
      Pages: 721 - 723
      Abstract: H Raghavendra, M Dilip Kumar, Manas Panigraghi, Shailaja M Reddy
      Asian Journal of Neurosurgery 2017 12(4):721-723
      Solitary plasmacytoma of the skull is very rare, and only a few cases have been reported in the literature. It remains controversial whether solitary plasmacytoma of the skull is essentially identical with solitary plasmacytoma of bone or not. Solitary plasmacytoma of bone including solitary plasmacytoma of the skull is characterized by a radiologically solitary bone lesion, neoplastic plasma cells in the biopsy specimen, fewer than 5% plasma cells in bone marrow, <2.0 g/dl monoclonal protein in the serum when present and negative urine test for Bence Jones protein (monoclonal light chain). We report one case of a 70-year-old woman who referred to our hospital because of a progressive left parietal swelling. On clinical examination, a painless large soft mass in the right parietal region was observed. Computed tomography revealed an extra-axial mass in the in the left frontoparietal region. The lesion was totally excised despite the bleeding tendency. Histology disclosed the presence of a plasmacytoma. On follow-up examination, 7 months later no tumor recurrence or evidence of multiple myeloma was detected.
      Citation: Asian Journal of Neurosurgery 2017 12(4):721-723
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.215764
      Issue No: Vol. 12, No. 4 (2017)
       
  • Evisceration of brain: An unusual case report of bear mauling from eastern
           India

    • Authors: Bikash Ranjan Behera, Sanjib Mishra, Deepak Das, Rajesh Gantayat
      Pages: 724 - 726
      Abstract: Bikash Ranjan Behera, Sanjib Mishra, Deepak Das, Rajesh Gantayat
      Asian Journal of Neurosurgery 2017 12(4):724-726
      Even if human beings are the most intelligent among all living beings, they are still not immune to attack from wild animals. Human contact with bears has become more frequent as their habitat is being endangered by frequent deforestation. The sloth bear is one of the few bear species found in India, especially in the hilly areas of Southern Odisha. Bears are highly intelligent and omnivorous animals with long claws coupled with powerful shoulder. Here, we describe the tale of a poor tribal male's encounter with a sloth bear resulting in critical injuries to face, scalp, skull bone, with brain matter fungating-out of the skull. We immediately went for debridement of the, bulged-out contused brain matter and opted for delayed repair of scalp defect with antero-lateral thigh free-flap to save him from fatality along with an acceptable cosmetic repair of the defect.
      Citation: Asian Journal of Neurosurgery 2017 12(4):724-726
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_31_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Tumor recurrence in a glioblastoma patient after discontinuation of
           prolonged temozolomide treatment

    • Authors: Wei-Lung Tseng, Hsu-Hsien Hsu, Yun Chen, Sheng-Hong Tseng
      Pages: 727 - 730
      Abstract: Wei-Lung Tseng, Hsu-Hsien Hsu, Yun Chen, Sheng-Hong Tseng
      Asian Journal of Neurosurgery 2017 12(4):727-730
      There is no consensus regarding the duration of temozolomide (TMZ) treatment for glioblastoma multiforme (GBM). We report a 53-year-old woman who had a left frontal GBM. The tumor showed good response to TMZ treatment, which was discontinued after 5.5 years with recurrence of tumor at the posterior fossa 6 months later, although there was no definite tumor recurrence in the left frontal region. The tumor failed to respond to the reinstitution of TMZ therapy. Continuous TMZ treatment may be necessary in GBM patients on prolonged TMZ treatment despite improved neurological condition and imaging studies revealing marked tumor regression.
      Citation: Asian Journal of Neurosurgery 2017 12(4):727-730
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_39_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Occipital intraparenchymal myxopapillary ependymoma: Case report and
           literature review

    • Authors: Tushit Bharat Mewada, Ishu Hetram Bishnoi, Hukum Singh, Daljit Singh
      Pages: 731 - 734
      Abstract: Tushit Bharat Mewada, Ishu Hetram Bishnoi, Hukum Singh, Daljit Singh
      Asian Journal of Neurosurgery 2017 12(4):731-734
      Myxopapillary ependymoma (MPE) is a histological variant of ependymoma found in the conus medullaris or filum terminale region. Intracranial occurrence of the tumor is a rarity. The most characteristic histological feature of myxopapillary tumors is the abundance of intercellular and perivascular mucin and the arborizing vasculature, which tends to form papillae. We are reporting a 14-year-old patient presented with seizures caused by the right occipital region intraparenchymal lesion. Histopathology confirmed it to be MPE. Lesion was excised completely. Literature reviews on the topic are discussed regarding the histological findings, natural history, and outcome of surgically treated MPE. This is the fifth reported case of cerebral intraparenchymal primary MPE.
      Citation: Asian Journal of Neurosurgery 2017 12(4):731-734
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_45_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Redo microvascular decompression in a patient of resistant
           cochleovestibular nerve compression syndrome

    • Authors: Ishu Bishnoi, Tushit Mewada, Daljit Singh, Hukum Singh
      Pages: 735 - 737
      Abstract: Ishu Bishnoi, Tushit Mewada, Daljit Singh, Hukum Singh
      Asian Journal of Neurosurgery 2017 12(4):735-737
      Cochlea-vestibular nerve compression syndrome (CVCS) may present as recurrent attacks of vertigo, dizziness, imbalance, etc. Those patients who do not respond to medical management, are usually managed by “microvascular decompression (MVD) of cochlea-vestibular nerve.” The success rate of MVD is not 100% and few patients present with the recurrence of symptoms. We are reporting management of one such resistant case of CVCS. A 40-year-old female patient who was a known case of CVCS, was managed by medical and surgical (MVD) management. She had no relief of symptoms. We did redo MVD of cochlea-vestibular nerve after full evaluation of symptomatology. Patient had complete relief in her symptoms. In failed MVD cases, redo MVD can be performed if patient is still having e/o nerve compression, adhesions on magnetic resonance imaging.
      Citation: Asian Journal of Neurosurgery 2017 12(4):735-737
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_48_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • Scrotal migration of tubing: An unusual complication after
           ventriculo-peritoneal shunt

    • Authors: Monika Bawa, Saurabh Garge, Ravi Garg, Katragadda Lakshmi Narasimha Rao
      Pages: 738 - 740
      Abstract: Monika Bawa, Saurabh Garge, Ravi Garg, Katragadda Lakshmi Narasimha Rao
      Asian Journal of Neurosurgery 2017 12(4):738-740
      Scrotal migration of peritoneal end of ventriculo-peritoneal (VP) shunt into the patent processus vaginalis (PPV) is a rare complication. Its exact incidence is not mentioned in the literature till date. This may be because of the rarity of this complication, and also because all previous articles related to the complication were case reports. We, in our series, had an incidence of 0.9%. This prospective study has been conducted on 437 patients in the age group of 1 month–3 years who underwent VP shunt for hydrocephalus over a period of 5 years from 2007 to 2011. The incidence of a hernia manifesting after shunt insertion has been reported to be around 16.8%. The average age of patients at the time of insertion of the shunt was 27.25 months (3–48 months). All our patients presented with swollen right sided scrotum after an average of 4 months (3–5 months) after shunt insertion. Shunt migration was more common on the right which is consistent with the incidence of hernias in children. The proper management of such cases includes repositioning of the catheter with the proper closure of the PPV. Usually, shunt revision is not required. We discuss the etiology, treatment and preventive measures of this rare entity.
      Citation: Asian Journal of Neurosurgery 2017 12(4):738-740
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.215783
      Issue No: Vol. 12, No. 4 (2017)
       
  • Tree-in-bud appearance in the brain: Fungal granuloma on contrast magnetic
           resonance imaging

    • Authors: Sunitha P Kumaran, Zarina Abdul Aziz, Sanjaya Viswamitra, Sai Kiran Narayanam, Nandita Ghosal
      Pages: 741 - 742
      Abstract: Sunitha P Kumaran, Zarina Abdul Aziz, Sanjaya Viswamitra, Sai Kiran Narayanam, Nandita Ghosal
      Asian Journal of Neurosurgery 2017 12(4):741-742
      We describe a case of dural-based homogenously enhancing fungal granuloma in a 29-year-old male who presented with 3 months history of headache. The peculiarity of the case was that there were streaky areas of enhancement around the lesion in the brain parenchyma which resembled tree-in-bud like appearance. The patient underwent surgery and histopathological analysis revealed numerous Aspergillus hyphae. To the best of our knowledge, this is the first case report of a fungal granuloma with atypical parenchymal enhancement pattern.
      Citation: Asian Journal of Neurosurgery 2017 12(4):741-742
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_89_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • An adult with atrial septal defect presenting with a brain abscess

    • Authors: Bijesh Ravindran Nair, Edmond Jonathan, Ranjith Krishna Moorthy, Vedantam Rajshekhar, Oommen George
      Pages: 743 - 745
      Abstract: Bijesh Ravindran Nair, Edmond Jonathan, Ranjith Krishna Moorthy, Vedantam Rajshekhar, Oommen George
      Asian Journal of Neurosurgery 2017 12(4):743-745
      The common heart diseases resulting in a brain abscess are associated with a right to left shunt and include tetralogy of Fallot and transposition of great vessels. Atrial septal defect (ASD) is almost always associated with the left to right shunt and therefore is not a commonly considered risk factor for brain abscess. We report the case of a 29-year-old male, with no symptoms of cardiac disease, who presented with the left posterior frontal pyogenic abscess which led to the detection of a silent ASD. Our case emphasizes the need for a careful evaluation of the source of infection in patients with a brain abscess.
      Citation: Asian Journal of Neurosurgery 2017 12(4):743-745
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_194_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Subependymal giant cell astrocytoma: Associated hyperproteinorrhachia
           causing shunt failures and nonobstructive hydrocephalus - Report of
           successful treatment with long-term follow-up

    • Authors: Ekkehard Kasper, Yosef Laviv, Mohammed-Adeeb E Sebai, Ning Lin, William Butler
      Pages: 746 - 750
      Abstract: Ekkehard Kasper, Yosef Laviv, Mohammed-Adeeb E Sebai, Ning Lin, William Butler
      Asian Journal of Neurosurgery 2017 12(4):746-750
      Subependymal giant cell astrocytomas (SEGAs) are histologically benign tumors most frequently associated with tuberous sclerosis complex (TSC). Despite their benign histopathological appearance, they may cause unfavorable outcomes due to their intraventricular location. Rarely, SEGA may be associated with hyperproteinorrhachia (high levels of proteins in the cerebrospinal fluid [CSF]), which causes malresorptive, communicating hydrocephalus; certainly, this scenario makes shunt obstruction likely in this patient population. In this report, we illustrate the case of hyperproteinorrhachia in an SEGA patient with known TSC, who presented repeatedly with shunt failure from proteinaceous shunt obstruction. Subsequent surgical resection of the main intraventricular lesion resulted in a dramatic drop in the CSF protein levels and has since prevented further shunt failures. Different treatment concepts and possible pathophysiology are discussed and the pertinent literature is reviewed.
      Citation: Asian Journal of Neurosurgery 2017 12(4):746-750
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_231_16
      Issue No: Vol. 12, No. 4 (2017)
       
  • Contrecoup extradural hematoma with coronal suture diastasis

    • Authors: Pratap Chandra Nath, Sudhansu Sekhar Mishra, Manmath Kumar Dhir, Rama Chandra Deo, Bikash Ranjan Behera, Sitansu Kumar Rout
      Pages: 751 - 753
      Abstract: Pratap Chandra Nath, Sudhansu Sekhar Mishra, Manmath Kumar Dhir, Rama Chandra Deo, Bikash Ranjan Behera, Sitansu Kumar Rout
      Asian Journal of Neurosurgery 2017 12(4):751-753
      Extradural hematoma (EDH) generally occurs in the site of impact, that is, coup injury site. EDH is associated with fracture of skull in many a times due to direct impact. However, EDH in counter coup site is a rare occurrence. Hardly, yet, 12 cases have been reported including this case. Here, we reported a case of a 22-year-old male of contrecoup acute EDH who had sustained head injury due to fall from bike. Physical examination revealed direct impact at the left occipito-parietal region with laceration of scalp and bruise with transient loss of consciousness at the time of injury. There was no evidence of impact on the right side of his head. Computed tomography scan revealed an EDH in the right fronto-temporal region without any bone fracture on bone windows. On intraoperative exploration, it is found that there was coronal suture diastasis with small subgaleal hematoma and right fronto-temporal extradural hematoma. The evacuation of EDH was done. The patient discharged on 3rd postoperative day. It can be concluded that direct impact on head causes exactly opposite hit of brain, and compensatory rebound causes a negative pressure in between the layers causing disruption of vessels and potential accumulation of blood. This mechanism mostly favors for acute subdural hematoma due to compact attachment of dura with cranium. However, in this case, diastasis of coronal suture due to transmitted force is the cause of accumulation of blood extradurally in relatively loosely adhered dura in fronto-temporal region where a potential negative pressure space is created by contrecoup injury.
      Citation: Asian Journal of Neurosurgery 2017 12(4):751-753
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_12_15
      Issue No: Vol. 12, No. 4 (2017)
       
  • A case of occipital rudimentary cephalocoele

    • Authors: Saurabh Garge, Prema Menon, Sumeet Aggarwal, Kln Rao
      Pages: 754 - 756
      Abstract: Saurabh Garge, Prema Menon, Sumeet Aggarwal, Kln Rao
      Asian Journal of Neurosurgery 2017 12(4):754-756
      We report a case of a 1-month-old boy with a cystic swelling in the occipital region without intracranial communication, called atretic cephalocoele. We discuss clues to the diagnosis of atretic cephalocoeles. We also discuss common clinical findings and a possible mechanism by which these lesions develop.
      Citation: Asian Journal of Neurosurgery 2017 12(4):754-756
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.215759
      Issue No: Vol. 12, No. 4 (2017)
       
  • Thrombosed giant “True” posterior communicating artery
           aneurysm treated by trapping and thrombectomy

    • Authors: Yuichi Mochizuki, Akitsugu Kawashima, Koji Yamaguch, Yoshikazu Okada
      Pages: 757 - 759
      Abstract: Yuichi Mochizuki, Akitsugu Kawashima, Koji Yamaguch, Yoshikazu Okada
      Asian Journal of Neurosurgery 2017 12(4):757-759
      Giant “true” posterior communicating artery (PCOM) aneurysms are rare and the best surgical treatment for them is unclear. We present a case of 85-year-old woman with this type of lesion, 35 mm in diameter, successfully treated by trapping and thrombectomy via pterional approach without complications. There were no perforating arteries originating from the aneurysmal wall. The patient had an uneventful postoperative course. The key for successful treatment for such lesions is preservation of perforators, as trapping may result in ischemic complications. However, our case indicates that trapping and thrombectomy might have relatively low risks for development of such complications, supposing that the thrombosis within the giant “true” PCOM aneurysm induced spontaneous obliteration of perforators, arising from the aneurysmal dome, and that collateral flow from the posterior cerebral artery already compensated the corresponding territories.
      Citation: Asian Journal of Neurosurgery 2017 12(4):757-759
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.215757
      Issue No: Vol. 12, No. 4 (2017)
       
  • Frontal mucocele mimicking a frontal subcutaneous tumor

    • Authors: Ellath Valappil Bijith, Shaju Mathew, Krishnaswamy Mahadevan
      Pages: 760 - 762
      Abstract: Ellath Valappil Bijith, Shaju Mathew, Krishnaswamy Mahadevan
      Asian Journal of Neurosurgery 2017 12(4):760-762
      Mucoceles are chronic, expanding, mucosa lined pathology of the paranasal sinuses. Frontal mucocele usually presents with the visual complaints such as diplopia, diminution of vision, visual field defect, ptosis, orbital swelling, retro-orbital pain, displacement of eye globe, and proptosis. Very rarely, it can be present as a subcutaneous swelling. This article presents a 58-year-old male patient presenting with an asymptomatic periorbital swelling and a painless forehead mass of 3 years duration. There was a partial ptosis, and an elongated, soft, subcutaneous mass over the forehead. Surgical excision of the mass confirmed the diagnosis of a mucocele. Postoperatively, the patient was asymptomatic. A subcutaneous soft-tissue mass may be the presenting complaint of a frontal mucocele. Careful examination of the surrounding skin may suggest the diagnosis of sinus-related disease and thus direct appropriate investigations.
      Citation: Asian Journal of Neurosurgery 2017 12(4):760-762
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.180908
      Issue No: Vol. 12, No. 4 (2017)
       
  • Combined use of intraoperative indocyanine green and dynamic angiography
           in rotational vertebral artery occlusion

    • Authors: Nauman Chaudhry, Brandon Gerard Gaynor, Sudheer Ambekar, Mohamed Samy Elhammady
      Pages: 763 - 765
      Abstract: Nauman Chaudhry, Brandon Gerard Gaynor, Sudheer Ambekar, Mohamed Samy Elhammady
      Asian Journal of Neurosurgery 2017 12(4):763-765
      Rotational vertebral artery occlusion (RVAO) is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. We report a case of RVAO in which intraoperative indocyanine green angiography (ICGA) was used to confirm adequate surgical decompression of the VA. A 57-year-old female who presented with multiple episodes of syncope provoked by turning her head to the right. Rotational dynamic angiography revealed a dominant right VA that became occluded at the level of C5/6 with head rotation to the right. The patient underwent successful surgical decompression of the VA via an anterior cervical approach. ICGA demonstrated VA patency with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To the best of our knowledge, we present the first use of ICG combined with intra-operative dynamic rotational angiography to document the adequacy surgical decompression of the VA in a patient with RVAO.
      Citation: Asian Journal of Neurosurgery 2017 12(4):763-765
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.180910
      Issue No: Vol. 12, No. 4 (2017)
       
  • A rare case of aggressive, huge primary orbital lymphoma with intracranial
           extension and bone invasion

    • Authors: Prabu Rau Sriram
      Pages: 766 - 768
      Abstract: Prabu Rau Sriram
      Asian Journal of Neurosurgery 2017 12(4):766-768
      Primary orbital lymphoma is a rare entity with only 1% of extranodal lymphomas. They usually present to ophthalmologist and surgical reserved for biopsy or tissue diagnosis. We present a patient who was referred to neurosurgery for a rapid growing orbital lymphoma. It grows from a small nodule in the eyelid to a huge, aggressive, disfiguring lesion invading bone and dura with intracranial extension within 3 months. The patient was treated with total surgical excision followed by systemic chemotherapy.
      Citation: Asian Journal of Neurosurgery 2017 12(4):766-768
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.185055
      Issue No: Vol. 12, No. 4 (2017)
       
  • Calvarial-orbital metastasis of prostate carcinoma which was diagnosed
           with sixth cranial nerve palsy

    • Authors: Z&#252;ht&#252; Ozbek, Emre &#214;zkara, Deniz Arik, Metin Atasoy Ant
      Pages: 769 - 771
      Abstract: Zühtü Ozbek, Emre Özkara, Deniz Arik, Metin Atasoy Ant
      Asian Journal of Neurosurgery 2017 12(4):769-771
      Sixth nerve palsy is frequently due to infectious orbital lesions, trauma, elevated intracranial pressure, brainstem lesions, and vasculopathies. Here, we describe a rare cause of sixth cranial nerve (CN) palsy secondary to calvarial and orbital metastasis of prostate carcinoma. The diagnosis of the prostate carcinoma with sixth CN palsy is a very rare condition. A 66-year-old male patient presented with complaints of blurred vision, double vision, and inability to move outward in the right eye for 3 weeks. Magnetic resonance imaging revealed a right orbitocalvarial mass and the mass surgically removed completely. Pathologic findings were compatible with prostate adenocarcinoma metastasis. After surgical removal, significant improvement in sixth CN palsy was observed.
      Citation: Asian Journal of Neurosurgery 2017 12(4):769-771
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.180933
      Issue No: Vol. 12, No. 4 (2017)
       
  • Pneumocephalus following dorsal laminectomy: An unusual complication

    • Authors: Brajesh Kumar, Chirantan Banerjee, Samarendra Nath Ghosh
      Pages: 772 - 773
      Abstract: Brajesh Kumar, Chirantan Banerjee, Samarendra Nath Ghosh
      Asian Journal of Neurosurgery 2017 12(4):772-773
      A 16-year-old male presented at Bangur Institute of Neurosciences Neurosurgery Outpatient Department with history of gradually progressive paraparesis for 5 months associated with stiffness, urinary hesitancy, and urge incontinence for last 2 months. Magnetic resonance imaging spine was done which showed cystic intradural extramedullary space occupying lesion at D4/D5 to D9. Patient had 2 episodes of generalized tonic–clonic seizure on the day 4. Computed tomography scan showed pneumocephalus. Histopathological examination report was that of nonspecific inflammatory cyst.
      Citation: Asian Journal of Neurosurgery 2017 12(4):772-773
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.185059
      Issue No: Vol. 12, No. 4 (2017)
       
  • Concurrent multilevel spinal intra-medullary with extensive intracranial
           tuberculomas: A rare case report

    • Authors: Shyam Sundar Krishnan, Bhavinkumar Rameshchandra Patel, Madabushi Chakravarthy Vasudevan
      Pages: 774 - 778
      Abstract: Shyam Sundar Krishnan, Bhavinkumar Rameshchandra Patel, Madabushi Chakravarthy Vasudevan
      Asian Journal of Neurosurgery 2017 12(4):774-778
      Disseminated tuberculomas in the brain and spinal cord are rare. To the best of our knowledge, only nine cases of spinal intra-medullary tuberculomas with cranial involvement have been reported till date. However, involvement of all levels in the spinal cord, brain stem with pan lobar involvement of the cerebrum and cerebellum has not been reported so far. We present such a case of a 12-year-old boy with history of pulmonary tuberculosis, who presented with gradual onset of quadriparesis and generalized seizures. We have discussed the unusual clinical presentation and the temporal changes in magnetic resonance imaging features along with clinical response to treatment. In cases reported so far, the plan of surgical versus medical management has been opted for variably, in cases of spinal intra-medullary involvement with acute neurological deficit. The decision is even more difficult in multilevel spinal intra-medullary tuberculomas. Our patient showed good clinico-radiological improvement with medical management.
      Citation: Asian Journal of Neurosurgery 2017 12(4):774-778
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.185073
      Issue No: Vol. 12, No. 4 (2017)
       
  • Giant cell glioblastoma in a child with clinical and family history of
           neurofibromatosis

    • Authors: Ishita Pant, Wajid Nazir, Vinita Ujjawal, Sujata Chaturvedi
      Pages: 779 - 782
      Abstract: Ishita Pant, Wajid Nazir, Vinita Ujjawal, Sujata Chaturvedi
      Asian Journal of Neurosurgery 2017 12(4):779-782
      We report a case of giant cell glioblastoma (GCG) in a 13-year-old child with clinical features and family history of neurofibromatosis type 1 (NF1). To the best of our knowledge, only two cases of GCG have been reported in a scenario of NF1, and only one of that was in a pediatric age group. A report on our case is presented here along with a review of literature.
      Citation: Asian Journal of Neurosurgery 2017 12(4):779-782
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.181119
      Issue No: Vol. 12, No. 4 (2017)
       
  • A case of high-dose adenosine usage for anterior communicating artery
           aneurysm clip ligation: What is the dose limit for a resistant response?

    • Authors: Shahid M Nimjee, David L McDonagh, Abhishek Agrawal, Gavin W Britz
      Pages: 783 - 786
      Abstract: Shahid M Nimjee, David L McDonagh, Abhishek Agrawal, Gavin W Britz
      Asian Journal of Neurosurgery 2017 12(4):783-786
      Intraoperative adenosine is used to induce asystole to facilitate clip ligation of intracranial aneurysms. Typically, 5–10 mg doses are used per administration and approximately 30 mg is used for a given case. An obvious concern with using adenosine is that the patient can remain in asystole or that prolonged hypotension can result in cerebral or cardiovascular ischemia. The upper limit of adenosine administration remains unclear. We present a case of a patient with a large anterior communicating artery aneurysm requiring large doses of adenosine, far exceeding previously reported cases. The patient received a 90 mg dose of adenosine to achieve 5 s of asystole as well as 30 s of hypotension that facilitated vessel dissection and clip application. Moreover, in order to successfully clip his aneurysm, he received a total of 744 mg of adenosine. After each administration of adenosine, his heart rate and blood pressure returned to baseline without the need for chest compressions or other interventions. He tolerated the procedure and had a good neurological outcome. This case is the first report of using such a high dose of adenosine in intracranial aneurysm surgery and suggests that more aggressive administration of adenosine during aneurysm clipping is feasible. Transient hypotension, as seen in this report, can provide surgeons the crucial moments they need to safely secure an aneurysm from circulation.
      Citation: Asian Journal of Neurosurgery 2017 12(4):783-786
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.181145
      Issue No: Vol. 12, No. 4 (2017)
       
  • Axillary nerve schwannoma: A rare case report

    • Authors: Prem A Kumar, Biju Islary, Ramya Ramachandra, Thippeswamy Naik
      Pages: 787 - 789
      Abstract: Prem A Kumar, Biju Islary, Ramya Ramachandra, Thippeswamy Naik
      Asian Journal of Neurosurgery 2017 12(4):787-789
      Primary tumors of the brachial plexus are a rare cause of an axillary swelling. Schwannomas are benign tumors arising from Schwann cells. Most of the schwannomas occur in the head and neck region and in the flexor aspect of the limbs. We present a case of a 60-year-old female who presented with pain in the left axilla radiating to the left upper limb since 2 years and a painful swelling in her left axilla for 3 months. The diagnosis is made by fine needle aspiration cytology and magnetic resonance imaging, and confirmed by histopathological examination as schwannoma.
      Citation: Asian Journal of Neurosurgery 2017 12(4):787-789
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.181147
      Issue No: Vol. 12, No. 4 (2017)
       
  • Endoscopic three-surgeon six-handed transorbital transnasal technique for
           excision of Juvenile Nasopharygeal Angiofibroma: New frontier explored

    • Authors: Trichy Narayanan Janakiram, Palak Parekh, Hanish Haneefa, Sivaswamy Karthik Prasad
      Pages: 790 - 793
      Abstract: Trichy Narayanan Janakiram, Palak Parekh, Hanish Haneefa, Sivaswamy Karthik Prasad
      Asian Journal of Neurosurgery 2017 12(4):790-793
      Endoscopic endonasal transorbital approach has been described for the removal of orbital lesions located anteromedially in temporal fossa. The same has been observed to be a versatile approach to the anterior and middle cranial fossa only in laboratory studies. This is the first clinical report of combined transorbital transnasal endoscopic approach to the cavernous sinus, superior orbital fissure, and middle cranial fossa in a case of recurrent nasopharyngeal angiofibroma using the three-surgeon six-handed technique.
      Citation: Asian Journal of Neurosurgery 2017 12(4):790-793
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.181148
      Issue No: Vol. 12, No. 4 (2017)
       
  • Intracranial hypotension-associated cerebral swelling following
           cranioplasty: Report of two cases

    • Authors: Masashi Nomura, Takahiro Ota, Mitsugu Ishizawa, Shinsuke Yoshida, Takayuki Hara
      Pages: 794 - 796
      Abstract: Masashi Nomura, Takahiro Ota, Mitsugu Ishizawa, Shinsuke Yoshida, Takayuki Hara
      Asian Journal of Neurosurgery 2017 12(4):794-796
      Cranioplasty is a comparatively simple neurosurgical procedure, and fatal complications are rare. This report describes two cases of critical brain swelling after otherwise uneventful cranioplasty. Both cases had subarachnoid hemorrhage and extremely similar clinical courses. They underwent decompressive craniotomy and clipping in the acute phase and had cranioplasty in the chronic phase, resulting in serious cerebral swelling and death. Deep venous sinus thrombosis was revealed in the autopsy for one case. Although no venous occlusion was identified in the other case, radiological findings suggested venous congestion. In both cases, intraoperative cerebrospinal fluid leakage was massive and was prolonged by a drain; therefore, we hypothesized that intracranial hypotension (IH) caused stagnation of venous flow. Neurosurgeons should be aware that fatal venous congestion induced by IH may occur after cranioplasty. To avoid this, tight dural closure should be obtained, and avoidance of the use of subcutaneous drains should be considered.
      Citation: Asian Journal of Neurosurgery 2017 12(4):794-796
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.185070
      Issue No: Vol. 12, No. 4 (2017)
       
  • Pure intra-optic canal schwannoma: Report of two cases

    • Authors: Sayuru Miyamura, Satoshi Yamaguchi, Masaaki Takeda, Takafumi Mitsuhara, Masahiro Hosogai, Kazuhiko Sugiyama, Kaoru Kurisu
      Pages: 797 - 800
      Abstract: Sayuru Miyamura, Satoshi Yamaguchi, Masaaki Takeda, Takafumi Mitsuhara, Masahiro Hosogai, Kazuhiko Sugiyama, Kaoru Kurisu
      Asian Journal of Neurosurgery 2017 12(4):797-800
      We report two cases of “pure intra-optic-canal schwannoma.” The first patient was a 67-year-old female who presented with a visual field defect and visual impairment in the right eye, and the second patient was a 17-year-old female with progressive visual impairment. Both patients underwent tumor resection through frontotemporal craniotomy combined with extradural anterior clinoidectomy and unroofing of the optic canal. The tumors were not attached to the optic nerve (ON) and were located exclusively inside the optic canal. In both cases, the histological diagnosis was schwannoma. Although the origin of pure intra-optic-canal schwannoma is controversial, intra-operative findings suggested that in these cases, the tumors arose from the sympathetic nerve around the ON.
      Citation: Asian Journal of Neurosurgery 2017 12(4):797-800
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.185071
      Issue No: Vol. 12, No. 4 (2017)
       
  • Agenesis of the internal carotid artery with transcavernous anastomosis
           associated with anterior communicating artery aneurysms

    • Authors: Kosuke Kumagai, Satoru Takeuchi, Naoki Otani, Masaki Komiyama, Kentaro Mori
      Pages: 801 - 803
      Abstract: Kosuke Kumagai, Satoru Takeuchi, Naoki Otani, Masaki Komiyama, Kentaro Mori
      Asian Journal of Neurosurgery 2017 12(4):801-803
      Agenesis of the internal carotid artery (ICA) is a rare congenital anomaly. Recently, several cases of ICA agenesis have been associated with cerebral aneurysms. We present the seventh case of ICA agenesis with transcavernous anastomosis associated with cerebral aneurysms. A 47-year-old man presented with transient numbness of his left hand. Magnetic resonance angiography indicated the presence of anterior communicating artery (ACoA) aneurysms. Digital subtraction angiography revealed two ACoA aneurysms, absence of the left ICA, and an anomalous collateral vessel connecting the cavernous portions of both internal carotid arteries, which was considered to be a transcavernous anastomosis. Head bone window computed tomography with contrast medium revealed the absence of the petrous carotid canal on the left suggesting the diagnosis of left ICA agenesis. The ACoA aneurysms were clipped successfully, and the postoperative course was uneventful.
      Citation: Asian Journal of Neurosurgery 2017 12(4):801-803
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.181125
      Issue No: Vol. 12, No. 4 (2017)
       
  • Intracranial hemorrhage in dengue: Where is it?

    • Authors: Viroj Wiwanitkit
      Pages: 804 - 804
      Abstract: Viroj Wiwanitkit
      Asian Journal of Neurosurgery 2017 12(4):804-804

      Citation: Asian Journal of Neurosurgery 2017 12(4):804-804
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/ajns.AJNS_66_14
      Issue No: Vol. 12, No. 4 (2017)
       
  • Carotid endarterectomy: A video demonstration

    • Authors: Yoko Kato, Mohsen Nouri, Motoki Oheda
      Pages: 805 - 805
      Abstract: Yoko Kato, Mohsen Nouri, Motoki Oheda
      Asian Journal of Neurosurgery 2017 12(4):805-805

      Citation: Asian Journal of Neurosurgery 2017 12(4):805-805
      PubDate: Tue,3 Oct 2017
      DOI: 10.4103/1793-5482.181143
      Issue No: Vol. 12, No. 4 (2017)
       
 
 
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