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Publisher: Medknow Publishers   (Total: 429 journals)

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Showing 1 - 200 of 429 Journals sorted alphabetically
Acta Medica Intl.     Open Access   (SJR: 0.101, CiteScore: 0)
Advanced Arab Academy of Audio-Vestibulogy J.     Open Access  
Advanced Biomedical Research     Open Access  
Advances in Human Biology     Open Access   (Followers: 3)
Advances in Skeletal Muscle Function Assessment     Open Access  
African J. for Infertility and Assisted Conception     Open Access  
African J. of Medical and Health Sciences     Open Access   (Followers: 2)
African J. of Paediatric Surgery     Open Access   (Followers: 7, SJR: 0.25, CiteScore: 1)
African J. of Trauma     Open Access   (Followers: 1)
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)
Alexandria J. of Pediatrics     Open Access  
Ancient Science of Life     Open Access   (Followers: 5)
Anesthesia : Essays and Researches     Open Access   (Followers: 10)
Annals of African Medicine     Open Access   (Followers: 1, SJR: 0.258, CiteScore: 1)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Cardiac Anaesthesia     Open Access   (Followers: 14, SJR: 0.308, CiteScore: 1)
Annals of Indian Academy of Neurology     Open Access   (Followers: 3, SJR: 0.434, CiteScore: 1)
Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery     Open Access  
Annals of Indian Psychiatry     Open Access  
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: 9, SJR: 0.352, CiteScore: 1)
Annals of Saudi Medicine     Open Access   (SJR: 0.238, CiteScore: 1)
Annals of Thoracic Medicine     Open Access   (Followers: 6, SJR: 0.524, CiteScore: 1)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 13, SJR: 0.152, CiteScore: 0)
Annals of Tropical Pathology     Open Access  
Apollo Medicine     Open Access  
APOS Trends in Orthodontics     Open Access  
Arab J. of Interventional Radiology     Open Access  
Archives of Cardiovascular Imaging     Open Access   (Followers: 1, SJR: 0.187, CiteScore: 0)
Archives of Intl. Surgery     Open Access   (Followers: 10, SJR: 0.302, CiteScore: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Medicine and Surgery     Open Access  
Archives of Pharmacy Practice     Open Access   (Followers: 6, SJR: 0.102, CiteScore: 0)
Archives of Trauma Research     Open Access   (Followers: 3, SJR: 0.37, CiteScore: 2)
Asia Pacific J. of Clinical Trials : Nervous System Diseases     Open Access  
Asia-Pacific J. of Oncology Nursing     Open Access   (Followers: 4)
Asian J. of Andrology     Open Access   (Followers: 1, SJR: 0.856, CiteScore: 2)
Asian J. of Neurosurgery     Open Access   (Followers: 2)
Asian J. of Oncology     Open Access   (Followers: 1)
Asian J. of Transfusion Science     Open Access   (Followers: 1, SJR: 0.35, CiteScore: 1)
Asian Pacific J. of Reproduction     Open Access   (SJR: 0.227, CiteScore: 1)
Asian Pacific J. of Tropical Biomedicine     Open Access   (Followers: 2, SJR: 0.491, CiteScore: 2)
Asian Pacific J. of Tropical Medicine     Open Access   (Followers: 1, SJR: 0.561, CiteScore: 2)
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  
Biomedical and Biotechnology Research 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)
Canadian J. of Rural Medicine     Full-text available via subscription   (SJR: 0.202, CiteScore: 0)
Cancer Translational Medicine     Open Access   (Followers: 2)
Cardiology Plus     Open Access  
Chinese Medical J.     Open Access   (Followers: 10, SJR: 0.52, CiteScore: 1)
CHRISMED J. of Health and Research     Open Access   (Followers: 2)
Clinical Cancer Investigation J.     Open Access  
Clinical Dermatology Review     Open Access   (Followers: 2)
Clinical Trials in Degenerative Diseases     Open Access  
Clinical Trials in Orthopedic Disorders     Open Access  
Community Acquired Infection     Open Access  
Conservation and Society     Open Access   (Followers: 10, SJR: 0.811, CiteScore: 2)
Contemporary Clinical Dentistry     Open Access   (Followers: 4, SJR: 0.353, CiteScore: 1)
Current Medical Issues     Open Access   (Followers: 1)
CytoJ.     Open Access   (Followers: 2, SJR: 0.543, CiteScore: 1)
Delta J. of Ophthalmology     Open Access  
Dental Hypotheses     Open Access   (Followers: 3, SJR: 0.152, CiteScore: 0)
Dental Research J.     Open Access   (Followers: 11, SJR: 0.416, CiteScore: 1)
Dentistry and Medical Research     Open Access  
Digital Medicine     Open Access  
Drug Development and Therapeutics     Open Access  
Education for Health     Open Access   (Followers: 6, SJR: 0.242, CiteScore: 0)
Egyptian J. of Bronchology     Open Access  
Egyptian J. of Cardiothoracic Anesthesia     Open Access  
Egyptian J. of Cataract and Refractive Surgery     Open Access   (Followers: 1, SJR: 1.799, CiteScore: 2)
Egyptian J. of Chest Diseases and Tuberculosis     Open Access   (Followers: 3, SJR: 0.155, CiteScore: 0)
Egyptian J. of Dermatology and Venerology     Open Access   (Followers: 1)
Egyptian J. of Haematology     Open Access   (Followers: 1)
Egyptian J. of Internal Medicine     Open Access   (Followers: 1)
Egyptian J. of Neurology, Psychiatry and Neurosurgery     Open Access   (Followers: 1, SJR: 0.127, CiteScore: 0)
Egyptian J. of Obesity, Diabetes and Endocrinology     Open Access   (Followers: 1)
Egyptian J. of Otolaryngology     Open Access   (Followers: 2)
Egyptian J. of Psychiatry     Open Access   (Followers: 2)
Egyptian J. of Surgery     Open Access   (Followers: 1)
Egyptian Nursing J.     Open Access  
Egyptian Orthopaedic J.     Open Access   (Followers: 2)
Egyptian Pharmaceutical J.     Open Access  
Egyptian Retina J.     Open Access  
Egyptian Rheumatology and Rehabilitation     Open Access  
Endodontology     Open Access  
Endoscopic Ultrasound     Open Access   (SJR: 0.822, CiteScore: 2)
Environmental Disease     Open Access   (Followers: 3)
Eurasian J. of Pulmonology     Open Access  
European J. of Dentistry     Open Access   (Followers: 2, SJR: 0.749, CiteScore: 2)
European J. of General Dentistry     Open Access   (Followers: 1, SJR: 0.12, CiteScore: 0)
European J. of Prosthodontics     Open Access   (Followers: 3)
European J. of Psychology and Educational Studies     Open Access   (Followers: 11, SJR: 0.113, CiteScore: 0)
Fertility Science and Research     Open Access  
Formosan J. of Surgery     Open Access   (SJR: 0.112, CiteScore: 0)
Genome Integrity     Open Access   (Followers: 2, SJR: 0.153, CiteScore: 0)
Glioma     Open Access  
Global J. of Transfusion Medicine     Open Access   (Followers: 1)
Gynecology and Minimally Invasive Therapy     Open Access   (SJR: 0.311, CiteScore: 1)
Hamdan Medical J.     Open Access  
Heart and Mind     Open Access  
Heart India     Open Access   (Followers: 1)
Heart Views     Open Access   (Followers: 2)
Hepatitis B Annual     Open Access   (Followers: 3)
Ibnosina J. of Medicine and Biomedical Sciences     Open Access  
IJS Short Reports     Open Access  
Imam J. of Applied Sciences     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: 7, SJR: 0.478, CiteScore: 1)
Indian J. of Burns     Open Access   (Followers: 1)
Indian J. of Cancer     Open Access   (Followers: 1, SJR: 0.361, CiteScore: 1)
Indian J. of Cerebral Palsy     Open Access   (Followers: 1)
Indian J. of Community Medicine     Open Access   (Followers: 2, SJR: 0.37, CiteScore: 1)
Indian J. of Critical Care Medicine     Open Access   (Followers: 3, SJR: 0.604, CiteScore: 1)
Indian J. of Dental Research     Open Access   (Followers: 4, SJR: 0.266, CiteScore: 1)
Indian J. of Dental Sciences     Open Access  
Indian J. of Dentistry     Open Access   (Followers: 1)
Indian J. of Dermatology     Open Access   (Followers: 2, SJR: 0.468, CiteScore: 1)
Indian J. of Dermatology, Venereology and Leprology     Open Access   (Followers: 4, SJR: 0.445, CiteScore: 1)
Indian J. of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian J. of Drugs in Dermatology     Open Access   (Followers: 1, SJR: 0.791, CiteScore: 1)
Indian J. of Endocrinology and Metabolism     Open Access   (Followers: 4, SJR: 0.568, CiteScore: 1)
Indian J. of Health Sciences     Open Access   (Followers: 2)
Indian J. of Medical and Paediatric Oncology     Open Access   (SJR: 0.425, CiteScore: 1)
Indian J. of Medical Microbiology     Open Access   (Followers: 1, SJR: 0.503, CiteScore: 1)
Indian J. of Medical Research     Open Access   (Followers: 4, SJR: 0.656, CiteScore: 1)
Indian J. of Medical Sciences     Open Access   (Followers: 2, SJR: 0.102, CiteScore: 0)
Indian J. of Multidisciplinary Dentistry     Open Access   (Followers: 1)
Indian J. of Nephrology     Open Access   (Followers: 2, SJR: 0.347, CiteScore: 1)
Indian J. of Nuclear Medicine     Open Access   (Followers: 2, SJR: 0.23, CiteScore: 0)
Indian J. of Occupational and Environmental Medicine     Open Access   (Followers: 3, SJR: 0.225, CiteScore: 1)
Indian J. of Ophthalmology     Open Access   (Followers: 4, SJR: 0.498, CiteScore: 1)
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: 8, SJR: 0.392, CiteScore: 1)
Indian J. of Otology     Open Access   (Followers: 1, SJR: 0.199, CiteScore: 0)
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: 0.454, CiteScore: 1)
Indian J. of Pathology and Microbiology     Open Access   (Followers: 2, SJR: 0.276, CiteScore: 1)
Indian J. of Pharmacology     Open Access   (SJR: 0.412, CiteScore: 1)
Indian J. of Plastic Surgery     Open Access   (Followers: 12, SJR: 0.311, CiteScore: 0)
Indian J. of Psychiatry     Open Access   (Followers: 3, SJR: 0.408, CiteScore: 1)
Indian J. of Psychological Medicine     Open Access   (SJR: 0.368, CiteScore: 1)
Indian J. of Public Health     Open Access   (Followers: 1)
Indian J. of Radiology and Imaging     Open Access   (Followers: 4)
Indian J. of Research in Homoeopathy     Open Access  
Indian J. of Respiratory Care     Open Access  
Indian J. of Rheumatology     Open Access   (SJR: 0.119, CiteScore: 0)
Indian J. of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2, SJR: 0.34, CiteScore: 0)
Indian J. of Social Psychiatry     Open Access   (Followers: 2)
Indian J. of Transplantation     Open Access  
Indian J. of Urology     Open Access   (Followers: 3, SJR: 0.434, CiteScore: 1)
Indian J. of Vascular and Endovascular Surgery     Open Access   (Followers: 2)
Indian Spine J.     Open Access  
Industrial Psychiatry J.     Open Access   (Followers: 2)
Intervention     Open Access   (Followers: 1)
Intl. Archives of Health Sciences     Open Access  
Intl. J. of Abdominal Wall and Hernia Surgery     Open Access   (Followers: 1)
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 Clinicopathological Correlation     Open Access  
Intl. J. of Community Dentistry     Open Access  
Intl. J. of Critical Illness and Injury Science     Open Access   (Followers: 1, SJR: 0.192, CiteScore: 0)
Intl. J. of Educational and Psychological Researches     Open Access   (Followers: 4)
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: 3, SJR: 0.142, CiteScore: 0)
Intl. J. of Growth Factors and Stem Cells in Dentistry     Open Access  
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: 6)
Intl. J. of Mycobacteriology     Open Access   (SJR: 0.535, CiteScore: 1)
Intl. J. of Noncommunicable Diseases     Open Access  
Intl. J. of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4, SJR: 0.17, CiteScore: 0)
Intl. J. of Oral Health Sciences     Open Access   (Followers: 2)
Intl. J. of Orofacial Biology     Open Access   (Followers: 1)
Intl. J. of Orofacial Research     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: 0.623, CiteScore: 1)
Intl. J. of Shoulder Surgery     Open Access   (Followers: 5, SJR: 0.653, CiteScore: 1)
Intl. J. of the Cardiovascular Academy     Open Access   (SJR: 0.105, CiteScore: 0)
Intl. J. of Trichology     Open Access   (SJR: 0.4, CiteScore: 1)
Intl. J. of Yoga     Open Access   (Followers: 15)
Intl. J. of Yoga : Philosophy, Psychology and Parapsychology     Open Access   (Followers: 6)

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Journal Cover
Asian Journal of Neurosurgery
Number of Followers: 2  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1793-5482 - ISSN (Online) 2248-9614
Published by Medknow Publishers Homepage  [429 journals]
  • The effect of stents in cerebral aneurysms: A review

    • Authors: Kenan Alkhalili, Jack Hannallah, Mary Cobb, Nohra Chalouhi, Jessica L Philips, Angela B Echeverria, Pascal Jabbour, M Haithem Babiker, David H Frakes, L Fernando Gonzalez
      Pages: 201 - 211
      Abstract: Kenan Alkhalili, Jack Hannallah, Mary Cobb, Nohra Chalouhi, Jessica L Philips, Angela B Echeverria, Pascal Jabbour, M Haithem Babiker, David H Frakes, L Fernando Gonzalez
      Asian Journal of Neurosurgery 2018 13(2):201-211
      The etiology of up to 95% of cerebral aneurysms may be accounted for by hemodynamically-induced factors that create vascular injury. The purpose of this review is to describe key physical properties that stents have and how they affect cerebral aneurysms. We performed a two-step screening process . First, a structured search was performed using the PubMed database. The following search terms and keywords were used: “Hemodynamics,” “wall shear stress (WSS),” “velocity,” “viscosity,” “cerebral aneurysm,” “intracranial aneurysm,” “stent,” “flow diverter,” “stent porosity,” “stent geometry,” “stent configuration,” and “stent design.” Reports were considered if they included original data, discussed hemodynamic changes after stent-based treatment of cerebral aneurysms, examined the hemodynamic effects of stent deployment, and/or described the geometric characteristics of both stents and the aneurysms they were used to treat. The search strategy yielded a total of 122 articles, 61 were excluded after screening the titles and abstracts. Additional articles were then identified by cross-checking reference lists. The final collection of 97 articles demonstrates that the geometric characteristics and configurations of deployed stents influenced hemodynamic parameters such as aneurysmal WSS, inflow, and pressure. The geometric characteristics of the aneurysm and its position also had significant influences on intra-aneurysmal hemodynamics after treatment. In conclusion, changes in specific aneurysmal hemodynamic parameters that result from stenting relate to a number of factors including the geometric properties and configurations of deployed stents, the geometric properties of the aneurysm, and the pretreatment hemodynamics.
      Citation: Asian Journal of Neurosurgery 2018 13(2):201-211
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.175639
      Issue No: Vol. 13, No. 2 (2018)
       
  • Craniofacial trauma in pediatric patients following winnowing blade
           injury-review of literature

    • Authors: Harsha Huliyappa, Balakrishna Ojha, Anil Chandra, Sunil Kumar Singh, Chhitij Srivastava
      Pages: 212 - 216
      Abstract: Harsha Huliyappa, Balakrishna Ojha, Anil Chandra, Sunil Kumar Singh, Chhitij Srivastava
      Asian Journal of Neurosurgery 2018 13(2):212-216
      In developing countries, during the harvest season, winnower blade injuries occur very frequently in children and results in lifelong disability. Nine children were managed during 1 month, all resulting due to winnower blade induced craniofacial trauma. PubMed search for “fan blade injury” showed two case series and three case reports. In our study, 88% had compound depressed fracture; brain matter leak in 56%, cerebrospinal fluid (CSF) leak alone in 22%. 66.7% had injury involving the frontal bone. Two patients had eye injury with visual loss. Seven underwent debridement craniectomy, five augmentation duroplasty and three contusectomy. All had vegetable material, sand particles. Complications in 66.6% with two cases of CSF leak settled with lumbar drain, one case of CSF otorrohea, 22.2% of wound infection, 44.4% wound dehiscence requiring redebridement and suturing in five patients. Two patients had postoperative seizures, two patients had hemiparesis both improved. Two low Glasgow Coma Scale remained so on postoperative period. One case of subdural empyema needed debridement and duroplasty with glue. No mortality noted. These findings were consistent with previous reports. Follow-up at 1.5 months showed good functional recovery. Early surgery debridement, steps to minimize postoperative infections, identifying putative risk factors early in the management are the principles of a successful treatment regimen.
      Citation: Asian Journal of Neurosurgery 2018 13(2):212-216
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.180880
      Issue No: Vol. 13, No. 2 (2018)
       
  • Endoscopic versus microscopic pituitary adenoma surgery: An institutional
           experience

    • Authors: Hanuman Prasad Prajapati, Shashi Kant Jain, Virendra D Sinha
      Pages: 217 - 221
      Abstract: Hanuman Prasad Prajapati, Shashi Kant Jain, Virendra D Sinha
      Asian Journal of Neurosurgery 2018 13(2):217-221
      Aim: The aim of this study was to compare the efficacy of endoscopic versus microscopic excision of pituitary adenoma, and to evaluate the merits and demerits of each approach. Materials and Methods: Prospective data were collected and patients were surgically treated for pituitary adenoma at SMS Hospital, Jaipur, Rajasthan, India. Patients consent was obtained. Age, sex, presenting symptoms, length of hospital stay, pre- and post-operative hormone status, extent of resections of tumors, and intra- and post-operative complication were noted. Results: A total of thirty patients with pituitary adenoma were operated transsphenoidally. Seventeen patients were operated by endonasal endoscopic transsphenoidal surgery and 13 patients were operated by microscopic transsphenoidal surgery. In an endoscopic group, complete tumor excision was achieved in 11 (64.71%) patients, and in microscopic group, it was achieved in 6 (46.15%) patients. In endoscopic group, mean operative time was 111.29 ± 21.95 min (ranged 80–135 min), and in microscopic group, it was 134.38 ± 8.33 min (ranged 120–145 min). In endoscopic group, mean blood loss was 124.41 ± 39.64 ml (60–190 ml), and in microscopic group, it was 174.62 ± 37.99 (100–220 ml). Postoperative sinusitis was present in 1 (5.88%) patient in endoscopic group and in 2 (15.38%) patients in microscopic group. Conclusion: Endoscopic approach provides a wide surgical field and broad lateral vision making easier distinction of tumor tissues. Thus, there is less blood loss, greater extent of tumor removal and it had less operative time, less postoperative complication, and early discharge from the hospital.
      Citation: Asian Journal of Neurosurgery 2018 13(2):217-221
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_160_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Depressed fractures of skull: An institutional series of 453 patients and
           brief review of literature

    • Authors: Anand Prakash, Viraat Harsh, Utkarsh Gupta, Jayendra Kumar, Anil Kumar
      Pages: 222 - 226
      Abstract: Anand Prakash, Viraat Harsh, Utkarsh Gupta, Jayendra Kumar, Anil Kumar
      Asian Journal of Neurosurgery 2018 13(2):222-226
      Background: There has been a substantial increase in the number of cases with head injuries in the past two decades which has simultaneously led to increase in the annual incidence of depressed fractures of skull. Most of these skull fractures are associated with considerable morbidity and mortality of patients and an unavoidable financial burden on the family members. However, many changes have been undertaken directed toward improved management of patients with head injuries and skull fractures in the past 20 years. Objective: To study and compare the patterns of occurrence of the depressed fractures of skull and examine the factors which may influence the surgical outcome of patients with reference to similar case series from the past literature. Patients and Methods: We reviewed patient records of 453 patients admitted with depressed skull fractures in Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi, India, during the period of March 2004 through July 2009. Results: The incidence of depressed skull fracture was highest (56%) in the age group of 16–45 years. There was a predominance of male cases over females with a ratio of 7:1. The most common mode of injury was noted to be alleged assault (36%) and the parietal region (34%) being the most common site. Most cases had mild injury (62%) with Glasgow Coma Scale score of 13–15. The percentage of pure depressed fractures was 57% and the rest 42% were associated with intracranial lesion, of which the most common was contusion (25%). Superficial wound infection was observed in 38% of the patients. Of all the 453 patients, 91% were operated and most of them were operated within 24 h with overall mortality rate of 17%. Conclusions: Our study revealed the increased incidence of mortality in the age group of 16–45 years, which can guide our focus of management on them with strategic planning at individual as well as community level. Primary surgical repair of depressed skull fractures is safe, feasible, and associated with good outcomes. There was no significant association between tear in dura and an increase in the complications and, also, no substantial data to support the use of prophylactic antibiotics in patients to reduce chances of infection with it.
      Citation: Asian Journal of Neurosurgery 2018 13(2):222-226
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_168_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Traumatic posterior fossa extradural hematoma: Experience at level I
           trauma center

    • Authors: Satish Kumar Verma, Sachin Anil Borkar, Pankaj Kumar Singh, Vivek Tandon, Hitesh Kumar Gurjar, Sumit Sinha, Guru Dutta Satyarthee, Deepak Gupta, Deepak Agarwal, Bhawani Shankar Sharma
      Pages: 227 - 232
      Abstract: Satish Kumar Verma, Sachin Anil Borkar, Pankaj Kumar Singh, Vivek Tandon, Hitesh Kumar Gurjar, Sumit Sinha, Guru Dutta Satyarthee, Deepak Gupta, Deepak Agarwal, Bhawani Shankar Sharma
      Asian Journal of Neurosurgery 2018 13(2):227-232
      Introduction: Posterior fossa extradural hematoma (PFEDH) is rare among the traumatic brain injury and represent about 4–7% cases of all EDHs. This rare condition is rapidly fatal unless identified and intervened timely. Because of limited space in posterior fossa, comparatively small volume can cause clinical deterioration. Early diagnosis by cranial computed tomography and emergent evacuation is vital for a good outcome. Materials and Methods: This study was conducted at Level I trauma center at All India Institute of Medical Sciences, New Delhi, India. Hospital medical records were reviewed from September 2007 to June 2015. There were 856 cases of acute EDHs and of these 69 cases had PFEDHs. Records of patients with PFEDHs were reviewed for the mode of injury, Glasgow Coma Scale (GCS) at admission, imaging, type of intervention, outcome, and follow-up. GCS was assessed at 6 months and 12 months follow-up. Pertinent literature is reviewed. Results: Of these 69 patients, 51 were males and 18 females. The mean age of patients was 28.6 years (range 4–43 years). Forty-three patients had GCS 15 at admission, and only 4 of them had admission GCS <8. Mean EDH volume was 29.2 ml. Sixty-six patients were operated, three managed conservatively. Sixty-seven patients were discharged, of which, 56 (81.1%) had GCS 15. Two patients died. Most common associated injuries were long bone fractures (18, 26.1%) followed by blunt injury thorax (11, 15.9%). Mean follow-up duration was 69.2 months (range 6–94 months). At 6 months follow-up, 61 (88.4%) patients had good recovery (Glasgow Outcome Score [GOS] 5) and at 12 months, 62 (89.8%) had GOS 5. Conclusion: PFEDH are rare. They are usually associated with occipital bone fractures and may also have a supratentorial hematoma. It may be rapidly fatal due to the expansion of hematoma and compromise of the posterior cranial fossa space leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early diagnosis and emergent evacuation lead to good outcome.
      Citation: Asian Journal of Neurosurgery 2018 13(2):227-232
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228536
      Issue No: Vol. 13, No. 2 (2018)
       
  • Neurosurgical interventions for occipital encephalocele

    • Authors: Lal Rehman, Ghulam Farooq, Irum Bukhari
      Pages: 233 - 237
      Abstract: Lal Rehman, Ghulam Farooq, Irum Bukhari
      Asian Journal of Neurosurgery 2018 13(2):233-237
      Aims and Objectives: The aim of this study is to find the outcome of repair and resection of the occipital encephalocele. Study Design: Case series. Materials and Methods: The clinical data of fifty consecutive occipital encephalocele patients were retrieved from medical records including operative notes, postoperative follow-up visits, and postsurgical complications were noted for analysis from November 2009 to November 2013 at the Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. All patients were assessed by computed tomography scan, magnetic resonance imaging brain, and ultrasound when needed. Physician's assessment, physical examination, and his/her questions to the family at follow-up were used as a tool to determine if there was a developmental delay rather than quantitative analysis like hydrocephalus questionnaires. Patients who developed complications and delayed milestone were regarded as no improvement and those who did not develop complications and achieved appropriate milestone were regarded as improved at 18 months follow-up. Results: Of 50 patients, 17 were males and 33 were females. The average age at presentation was 2.4 months. 16 (32%) patients had increased head circumference and hydrocephalus, 2 (4%) had associated Dandy–Walker cyst, 3 (6%) developed developmental delays, and 8 (15%) had a seizure disorder. None of our patients had neurological deficits. The size of the sac ranged from 2 cm × 3 cm to 27 cm × 15 cm. 9 (18%) patients were admitted with the complication of sac rupture and 2 (4%) patients sac ruptured after admission. Only one patient (2%) had a cerebrospinal fluid leak postoperatively that was repaired primarily without patch graft or dura seal while 4 (8%) developed hydrocephalus after repair of the sac which was treated with placement of ventriculoperitoneal shunt. One (2%) patient did not recover from anesthesia and expired. Conclusion: Encephalocele is commonly seen in the practice of neurosurgery in the world as well as in Pakistan. Modern neuroimaging, neurosurgical techniques, and neonatal neurological intensive care have greatly improved morbidity and mortality in the care of encephalocele.
      Citation: Asian Journal of Neurosurgery 2018 13(2):233-237
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228549
      Issue No: Vol. 13, No. 2 (2018)
       
  • Spinal cerebrospinal fluid drainage for prevention of vasospasm in
           aneurysmal subarachnoid hemorrhage: A prospective, randomized controlled
           study

    • Authors: Sachin Anil Borkar, Manmohanjit Singh, Shashank Sharad Kale, Ashish Suri, Poodipedi Sarat Chandra, Rajender Kumar, Bhawani Shankar Sharma, Shailesh Gaikwad, Ashok Kumar Mahapatra
      Pages: 238 - 246
      Abstract: Sachin Anil Borkar, Manmohanjit Singh, Shashank Sharad Kale, Ashish Suri, Poodipedi Sarat Chandra, Rajender Kumar, Bhawani Shankar Sharma, Shailesh Gaikwad, Ashok Kumar Mahapatra
      Asian Journal of Neurosurgery 2018 13(2):238-246
      Introduction: Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of mortality and morbidity. Despite various treatment modalities, the optimal management of vasospasm remains elusive. In this regard; we undertook a prospective, randomized controlled study to evaluate the effectiveness of lumbar cerebrospinal fluid drainage (LCSFD) for prevention of cerebral vasospasm and its sequelae. Materials and Methods: Patients with aneurysmal SAH who met the inclusion criteria were randomized into two groups – Group I (30 patients) underwent LCSFD whereas Group II (30 patients) did not undergo LCSFD. All patients underwent aneurysmal clipping. Both the groups received standard neurosurgical treatment except for LCSFD. The outcome was measured in terms of (1) clinically evident vasospasm; (2) vasospasm-related cerebral infarction; (3) condition of the patient at the time of discharge; and (4) Glasgow outcome score (GOS) at 1- and 3-month follow-up. Results: LCSFD conferred a statistically significant benefit reducing the incidence of clinical vasospasm from 63% (in non-LCSFD group) to 30% (in LCSFD group) (P = 0.01) and incidence of vasospasm-related cerebral infarction from 53% (in non-LCSFD group) to 20% (in LCSFD group) (P = 0.007). Incidence of vasospasm was quantitatively lower in LCSFD group across all Hunt and Hess grades; however, it was statistically significant in SAH Grade III (P = 0.008). Mean duration of hospital stay was slightly lower in LCSFD group compared to non-LCSFD group; however, it did not reach statistical significance. A higher incidence of meningitis in LCSFD group was not statistically significant. A higher GOS was observed in LCSFD group at 1- and 3-month follow-up as compared to non-LCSFD group. Conclusion: Drainage of CSF through a lumbar drain following aneurysmal SAH caused a statistically significant reduction in the incidence of clinical and radiological vasospasm and its sequelae. It also shortens the overall duration of hospital stay and improves the outcome as evidenced by a better GOS score at 1- and 3-month follow-up. The results of this prospective, randomized study establish the efficacy of LCSFD in prevention of vasospasm following aneurysmal SAH.
      Citation: Asian Journal of Neurosurgery 2018 13(2):238-246
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228512
      Issue No: Vol. 13, No. 2 (2018)
       
  • Neurological outcome following surgical treatment of spinal metastases

    • Authors: Abdelaal Abdelbaky, Hazem Eltahawy
      Pages: 247 - 249
      Abstract: Abdelaal Abdelbaky, Hazem Eltahawy
      Asian Journal of Neurosurgery 2018 13(2):247-249
      Background: Spinal metastases lead to bony instability and spinal cord compression resulting in intractable pain and neurological deficits which affect ambulatory function and quality of life. The most appropriate treatment for spinal metastasis is still debated. Objective: The aim of this study is to evaluate clinical outcome, quality of life, complications, and survival after surgical treatment of spinal metastases. Methods: Retrospective review of patients with spinal metastases surgically treated at our facility between March 2008 and March 2013 was performed. Evaluations include hospital charts, initial and interval imaging studies, neurological outcome, and surgical complications. Follow-up examinations were performed every 3 months after surgery. Results: Seventy patients underwent surgical intervention for treatment of spinal metastasis in our institution. There were 27 women and 43 men. The preoperative pain was reported in 65 patients (93%), whereas postoperative complete pain relief was reported in 16 patients (24%), and pain levels decreased in 38 patients (58%). Preoperative 39 patients were ambulant and 31 patients were nonambulant. Postoperative 52 patients were ambulant and 18 patients were nonambulant. Postoperative complications were experienced in 10 (14.2%) patients, and the patient survival rate was 71% (50 patients) at 3 months, 49% (34 patients) at 1 year. The postoperative 30-day mortality rate was 4.2%. Conclusion: Surgical decompression for a metastatic spinal tumor can improve the quality of life in a substantially high percentage of patients with acceptable complications rate.
      Citation: Asian Journal of Neurosurgery 2018 13(2):247-249
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_43_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • The organisms and factors affecting outcomes of external ventricular
           drainage catheter-related ventriculitis: A penang experience

    • Authors: Jo Ee Sam, Chee Loon Lim, Priya Sharda, Nasser Abdul Wahab
      Pages: 250 - 257
      Abstract: Jo Ee Sam, Chee Loon Lim, Priya Sharda, Nasser Abdul Wahab
      Asian Journal of Neurosurgery 2018 13(2):250-257
      Introduction: Ventriculostomy-related infection (VRI) from external ventricular drain (EVD) insertion is a common complication and carries a high mortality rate. Choice of empiric antibiotics depends on the institutions common causative organisms and their susceptibility. We determined risk factors for mortality in patients with VRI, the common organisms causing VRI, and the rate of EVD-related VRI at our institution. Methods: Medical records and operative data of patients with cerebrospinal fluid positive cultures with an EVD inserted from 2012 to 2015 were traced. Forty-five patients with EVD-related VRI were included in the study. Results: The overall rate of VRI was 6.3%, and the overall mortality rate due to VRI was 48.9%. Acinetobacter baumannii was the most common organism causing VRI (14 patients, 29.2%) with a mortality rate of 64.3%. Only 14.3% of A. baumannii are sensitive to meropenem and imipenem. We found that patients that had a decompressive craniectomy (DC) had a lower mortality rate (P = 0.042) and patients with a longer duration of the EVD being in place before the diagnosis of VRI had poor outcome (P = 0.040). Multivariate logistic regression was performed and we found that the use of steroid (P = 0.014), Pseudomonas aeruginosa infection (P = 0.010), multiple organism infection (P = 0.017), lower Glasgow Coma Scale (P = 0.043), and a longer duration the EVD was in place before the diagnosis of VRI (P = 0.008) were related with higher mortality. Conclusion: VRI mortality rate is high with an alarming resistance pattern seen in Acinetobacter VRI. EVDs should be removed as soon as feasible, and DC may be offered to patients with severe ventriculitis or meningitis.
      Citation: Asian Journal of Neurosurgery 2018 13(2):250-257
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_150_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Modern microsurgical resection of olfactory groove meningiomas by
           classical bicoronal subfrontal approach without orbital osteotomies

    • Authors: Ghulam Farooq, Lal Rehman, Irum Bokhari, Syed Raza Hussain Rizvi
      Pages: 258 - 263
      Abstract: Ghulam Farooq, Lal Rehman, Irum Bokhari, Syed Raza Hussain Rizvi
      Asian Journal of Neurosurgery 2018 13(2):258-263
      Background: The olfactory groove meningioma has always been surgically challenging. The common microscopic surgical procedures exercised involve modification of pterional or sub-frontal approaches with or without orbital osteotomies. However, we believe that orbital osteotomies are not mandatory to achieve gross total resection. Hence, this study was performed to evaluate the surgical outcomes of olfactory groove meningioma with bicoronal sub frontal approach but without orbital osteotomies. Materials and Methods: The study was performed by reviewing the medical charts, neuroimaging data, and follow-up data of 19 patients who were treated micro surgically for olfactory groove meningioma without orbital osteotomies in our department. Mean overall follow up period of our study was 5 years. Statistical analysis was done by means of IBM SPSS Software version 19. Results: Nineteen patients (1 male and 18 female patients, with an age range of 35-67 years; average age of patients' 51±7.5 years) of OGM were managed in our department. All patients were evaluated by MRI Brain with and without Gadolinium, CTA, CT Scan both axial and Coronal sequences. Most common symptom reported was head ache (80%), others include; urinary incontinence (26%), seizures (78%), decreased visual acuity (79%), papilledema (74%), personality changes (68%) and olfactory loss was reported in 57% of the patients. Post-operative complications include; CSF accumulation (5%), hematoma at tumor bed (10%), skin infection (5%) and mild post-operative brain edema (26%). Mortality rate was 5%. During 5 years of follow-up, we recorded one recurrence which was after 26 months and successfully removed in reoperation. Conclusion: Bi-coronal sub frontal approach appears to be an excellent technique for Olfactory Meningioma removal as practiced by most neurosurgeons. Nevertheless, it is not mandatory to carry out orbital osteotomy to acquire optimal surgical outcome as is advocated by some
      Authors .
      Citation: Asian Journal of Neurosurgery 2018 13(2):258-263
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_66_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Adult versus pediatric tethered cord syndrome: Clinicoradiological
           differences and its management

    • Authors: Mukesh Shukla, Jayesh Sardhara, Rabi Narayan Sahu, Pradeep Sharma, Sanjay Behari, Awadesh Kumar Jaiswal, Arun Kumar Srivastava, Anant Mehrotra, Kuntal Kanti Das, Kamlesh Singh Bhaisora
      Pages: 264 - 270
      Abstract: Mukesh Shukla, Jayesh Sardhara, Rabi Narayan Sahu, Pradeep Sharma, Sanjay Behari, Awadesh Kumar Jaiswal, Arun Kumar Srivastava, Anant Mehrotra, Kuntal Kanti Das, Kamlesh Singh Bhaisora
      Asian Journal of Neurosurgery 2018 13(2):264-270
      Background: Dysraphic lesions in adults, presenting clinically as tethered cord syndrome (TCS), are relatively rare, and their optimal management remains controversial. Patients and Methods: We performed a retrospective analysis of our pediatric database over a period of last 7 years to focus on the adult TCS. Our aim was to determine the clinicoradiological and etiopathological differences between adult and pediatric patients as well as to determine the results of surgery in adult TCS. Results: Adult spinal dysraphisms constituted 15.4% of our patients (20 out of 130). Motor weakness, sphincteric dysfunction, and backache (n = 13, 65.0% each) predominated in adults unlike children who presented with subcutaneous swellings (n = 74, 67.6%) followed by motor weakness (n = 40, 46.4%), backache being reported by only three patients. The different pathologic substrates underlying adult dysraphisms were lipomeningocele (n = 8), split cord malformation (total = 7; Type 1: n = 5; Type 2: n = 2), dermal sinus (n = 2), and fatty filum (n = 3). On the other hand, meningomyelocele/meningocele (61, 54.9%) followed by split cord malformation Type 1 and 2 (n = 29, 26.1%) predominated in children. The radiological differences between the two groups were a higher incidence of vertebral body defects (hemivertebrae and butterfly vertebrae) and lack of intracranial anomalies in adults. At a mean follow-up of 20.5 months, the most common symptoms to improve following detethering were pain (11 out of 13, 84.6%) followed by motor weakness (six out of 13, 56.2%) and sphincteric control (7 out of 13, 53.8%). Conclusion: Most common symptoms to improve following detethering in adult TCS were pain followed by motor weakness. The major radiological differences between these two groups were a higher incidence of vertebral body defects (hemivertebrae and butterfly vertebrae) and lack of intracranial anomalies in adults.
      Citation: Asian Journal of Neurosurgery 2018 13(2):264-270
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228566
      Issue No: Vol. 13, No. 2 (2018)
       
  • Morphometric analysis of dose-dependent effect of progesterone on
           experimental vasospasm-induced rat femoral arteries

    • Authors: Metin Kasap, Huseyin Canaz, Gokhan Canaz, Mehmet Tokmak, Alper Bingul, Ibrahim Alatas
      Pages: 271 - 276
      Abstract: Metin Kasap, Huseyin Canaz, Gokhan Canaz, Mehmet Tokmak, Alper Bingul, Ibrahim Alatas
      Asian Journal of Neurosurgery 2018 13(2):271-276
      Objective: Our aim of this study was to determine effective doses of progesterone which has a vasodilatory effect during the early stage of vasospasm. Cerebral vasospasm (CV) is a predominant cause of morbidity and mortality which develops following subarachnoidal hemorrhage (SAH). Etiopathogenesis of CV is multifactorial. Despite many previously performed studies on this issue, the mechanism by which blood and blood products in the subarachnoidal space induce CV has not been clarified yet. Materials and Methods: In our study, we used “Rat Femoral Artery Vasospasm Model” introduced by Okada et al. Thanks to easy procurement and maintenance of rats. Rats were divided into four groups as: Group 1 (n = 8; control group), Group 2 (n = 8; vasospasm group), Group 3 (n = 8; vasospasm + 3 mg/kg progesterone group), and Group 4 (n = 8; vasospasm +15 mg/kg progesterone group). Progesterone which is an endogenously synthesized natural steroid was preferred in our study. Progesterone increases the production of vasodilatory epoxyeicosatrienoic acid by acting on its binding sites termed as pregnane X receptor. It decreases the intracellular influx of Ca2+ by blocking the functioning of L-type channels in smooth muscle cells. It manifests another vasodilatory effect by decreasing expression of TxA2 receptor. In our study, at the end of the 7th day, where the most intense vasospasm is seen, 1 cm pieces were excised from the femoral arteries and histopathologically examined under light microscope. Results: Vascular walls of three vasospasm-induced groups were relatively thicker when compared with the control group. Drug-treated groups were not different from each other. Vascular walls of the groups treated with lower and higher doses of the drug were thinner when compared with the vasospasm group without any statistically significant difference between groups (P > 0.05). Luminal cross-sectional areas of the drug-treated groups did not differ from each other. Mean luminal cross-sectional areas of the control and the drug-treated groups were larger than that of the vasospasm group without any statistically significant intergroup difference (P > 0.05). Conclusion: Based on the results of our study, progesterone did not exert protective effects on vascular wall thickness, while histopathological examination of luminal cross-sectional areas revealed its vasodilatory effects without any statistically significant difference between groups. Starting from the study results obtained, we think that its potential use as a preventive agent against the development of post-SAH CV requires conduction of multicentered, placebo-controlled, randomized, and double-blind studies.
      Citation: Asian Journal of Neurosurgery 2018 13(2):271-276
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228567
      Issue No: Vol. 13, No. 2 (2018)
       
  • Coccygectomy for coccygodynia: A single center experience over 5 years

    • Authors: Arif Hussain Sarmast, Altaf Rehman Kirmani, Abdul Rashid Bhat
      Pages: 277 - 282
      Abstract: Arif Hussain Sarmast, Altaf Rehman Kirmani, Abdul Rashid Bhat
      Asian Journal of Neurosurgery 2018 13(2):277-282
      Introduction: Coccygodynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity. The pain is usually provoked by sitting or rising from sitting. Several studies have reported good or excellent results after coccygectomy especially in patients who are refractory to conservative treatment. Aims and Objectives: This study aims to evaluate the role and effectiveness of coccygectomy in chronic refractory coccygodynia. Materials and Methods: Between January 2011 and January 2015, 16 consecutive patients (4 males and 12 females) who underwent surgical coccygectomy were enrolled prospectively in the study. All patients suffered from treatment-resistant coccygodynia and had exhausted conservative therapeutic options for at least 6 months before undergoing surgery. The same surgeon performed a complete coccygectomy on all patients. Postoperative outcomes included measurements of pain relief and degree of patient satisfaction with the procedure's results. Results: The average age of patient was 37.93 years (range: 25–53 years), and the male to female ratio was 1:3. The median duration of patient-reported symptoms prior to surgery was 24 months. The most common cause of coccygodynia was direct or indirect trauma, recorded in 11 patients (68.75%). Idiopathic coccygodynia was five cases (31.25%). The number of patients with outcomes rated as “excellent,” “good,” “fair,” and “poor” were 12, 2, 1, and 1, respectively. The favorable result (excellent or good) was 87.5%. The self-reported visual analog scale (VAS) was significantly improved by surgery. The mean VAS preoperatively was 9.62, and postoperatively it was 2.25 (P < 0.001). There were two infections (12.5%) among the 16 patients which were managed conservatively. Conclusions: Coccygectomy for chronic intractable coccygodynia is simple and effective, with a low complication rate.
      Citation: Asian Journal of Neurosurgery 2018 13(2):277-282
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228568
      Issue No: Vol. 13, No. 2 (2018)
       
  • Radiofrequency and methylprednisolone in treatment of lower back pain
           caused by facet joint syndrome: Comparison of the outcomes

    • Authors: Dagistan Yasar, Okmen Korgun, Dagistan Emine
      Pages: 283 - 287
      Abstract: Dagistan Yasar, Okmen Korgun, Dagistan Emine
      Asian Journal of Neurosurgery 2018 13(2):283-287
      Introduction: In this trial we have discussed the outcomes of radiofrequency ablation and methylprednisolone treatment in cases diagnosed with facet syndrome; and effects of treatment modality on quality of life is evaluated by visual analogue scale and Oswestry Disability Index. Materials and Methods: This prospective, study was conducted with 100 patients with diagnosis of facet joint syndrome. Patients, benefited from diagnostic block, were separated into two groups, with 50 cases in each. In Group 1, 40 mg of methylprednisolone acetate were injected into each level. In Group 2, radiofrequency needle was used to apply RF to the facet joint. Results: Demographic characteristics of patients were similar (P > 0.05). VAS values of the patients in Group 1 were significantly lower than the values prior to treatment (P < 0.05). Similarly, VAS values of the patients in Group 2 were also significantly lower than the values prior to treatment (P < 0.05). When VAS scores of the patients in Group 2 at 3rd and 6th months were compared with scores of the patients in Group 1, significant differences were also observed (P < 0.01).ODI results of the patients in Group 1 were significantly lower than the values prior to treatment (P < 0.05). Additionally ODI scores of the patients in Group 1 on 9th and 12th months are recorded as significantly lower. Conclusion: We consider that the steroid injection should be used as the first choice of treatment before the RF methods to be used in patients with back pain, caused by facet articulation pathology, if there are no contraindications.
      Citation: Asian Journal of Neurosurgery 2018 13(2):283-287
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228569
      Issue No: Vol. 13, No. 2 (2018)
       
  • Extraosseous primary intracranial ewing sarcoma/peripheral primitive
           neuroectodermal tumor: Series of seven cases and review of literature

    • Authors: Amit Kumar Singh, Arun Kumar Srivastava, Lily Pal, Jayesh Sardhara, Rajan Yadav, Shalini Singh, Kamlesh Singh Bhaisora, Kuntal Kanti Das, Anant Mehrotra, Rabi Narayan Sahu, Awadhesh Kumar Jaiswal, Sanjay Behari
      Pages: 288 - 296
      Abstract: Amit Kumar Singh, Arun Kumar Srivastava, Lily Pal, Jayesh Sardhara, Rajan Yadav, Shalini Singh, Kamlesh Singh Bhaisora, Kuntal Kanti Das, Anant Mehrotra, Rabi Narayan Sahu, Awadhesh Kumar Jaiswal, Sanjay Behari
      Asian Journal of Neurosurgery 2018 13(2):288-296
      Background: The Ewing sarcoma peripheral PNET (ES-pPNET) is very rare small round cell tumour that involves the CNS as either a primary dural neoplasm or by direct extension from contiguous bone or soft tissue. Materials and Methods: Biopsy proven cases of intracranial ES/pPNET with orbital involvement operated during Jan 2010-Jan 2014 were retrospectively included and their clinical data, operative and histological findings were reviewed from institutional oncology register. Results: seven patients (4 males; 3 female) were studied with mean age at presentation of 13 years. Six patients had orbital involvement in one or other form. Surgical excision was gross total in five, near total in one, and subtotal in one patient. All patients received adjuvant therapy, only chemotherapy in 2, only Radiotherapy in four, both in one. MRI characteristics were studied in six patients. Four patients died with average survival of 33.2 months and three patients are having Progression free survival of average 23.3 months. Conclusions: The EWS-pPNET is very rare tumour and very poorly described in literature. These tumours are showing special predilection for the frontotemporal dura and erode through the flat bone of cranium like orbital roof and lateral wall of the orbit. These tumours are aggressive, multi compartmental, vascular and very rapidly growing, so missing or overlooking the primary symptoms of dural stretching/bony involvement leads to delay in management and poor outcome.
      Citation: Asian Journal of Neurosurgery 2018 13(2):288-296
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228570
      Issue No: Vol. 13, No. 2 (2018)
       
  • Adjuvant radiation therapy and temozolomide in gliosarcoma: Is it enough?
           case series of seven patients

    • Authors: Himanshu Srivastava, Abhinav Dewan, Surender Kumar Sharma, Preety Negi, Ajay Kumar Dewan, Sunil Pasricha, Krati Mehrotra
      Pages: 297 - 301
      Abstract: Himanshu Srivastava, Abhinav Dewan, Surender Kumar Sharma, Preety Negi, Ajay Kumar Dewan, Sunil Pasricha, Krati Mehrotra
      Asian Journal of Neurosurgery 2018 13(2):297-301
      Objective: We present our experience of gliosarcoma (GSM) in oncology tertiary care center over the last 5 years. Materials and Methods: We carried out a retrospective analysis of seven patients with GSM diagnosed between April 2008 and December 2012. Demographic data, clinicopathological data, treatment strategies employed, details of recurrence, and survival patterns were reviewed. Results: The median age at diagnosis was 54 years, ranging between 34 and 63 years with a female predominance (57.1% females). Headache and neurological deficit were the most common symptoms with parietal region being the most common site of lesion. Subtotal resection followed by concurrent chemoradiation therapy was delivered to six patients. The results following completion of planned schedule of concurrent chemoradiotherapy were quite disappointing with two patients having no evidence of disease, one patient was lost to follow-up, and other three had progressive disease. One patient with progressive disease subsequently received eight cycles of bevacizumab on a clinical trial protocol. Fifteen-month posttreatment, she had stable disease on follow-up. Conclusions: Our experience suggests that despite treatment, the diagnosis of GSM portends a poor prognosis and the use of bevacizumab could represent a treatment approach to improve outcome in these patients. Although the role of targeted therapy in GSM remains unclear because of paucity of experience, the treatment decision should be according to patient's performance status, ability, and willingness to receive additional treatment.
      Citation: Asian Journal of Neurosurgery 2018 13(2):297-301
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_151_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Role of diffusion tensor imaging in brain tumor surgery

    • Authors: Amitesh Dubey, Rashim Kataria, Virendra Deo Sinha
      Pages: 302 - 306
      Abstract: Amitesh Dubey, Rashim Kataria, Virendra Deo Sinha
      Asian Journal of Neurosurgery 2018 13(2):302-306
      Object: The objective is to evaluate the role of diffusion tensor imaging (DTI) in intra-axial brain tumor cases (gliomas and metastasis). To preoperatively assess the integrity and location of white matter (WM) tracts and plan the surgical corridor to cause least damage to the WM tracts with minimum postoperative new neurological deficits. Materials and Methods: A total of 34 patients were included in this study. Pre-operative contrast-enhanced magnetic resonance imaging and DTI scans of the patients were taken into consideration. Pre- and post-operative neurological examinations were performed and the outcome was assessed. Results: Preoperative planning of surgical corridor and extent of resection were planned so that maximum possible resection could be achieved without disturbing the WM tracts. DTI indicated the involvement of fiber tracts. A total of 21 (61.7%) patients had a displacement of tracts only and they were not invaded by tumor. A total of 11 (32.3%) patients had an invasion of tracts by the tumor, whereas in 4 (11.7%) patients the tracts were disrupted. Postoperative neurologic examination revealed deterioration of motor power in 4 (11.7%) patients, deterioration of language function in 3 (8.82%) patients, and memory in one patient. Total resection was achieved in 11/18 (61.1%) patients who had displacement of fibers, whereas it was achieved in 5/16 (31.2%) patients when there was infiltration/disruption of tracts. Conclusion: DTI provides crucial information regarding the infiltration of the tract and their displaced course due to the tumor. This study indicates that it is a very important tool for the preoperative planning of surgery. The involvement of WM tracts is a strong predictor of the surgical outcome.
      Citation: Asian Journal of Neurosurgery 2018 13(2):302-306
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_226_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Prognostic implications of histological clear cells in high-grade
           intracranial ependymal tumors: A retrospective analysis from a tertiary
           care hospital in Pakistan

    • Authors: Fauzan Alam Hashmi, Hamid Hussain Rai, Muhammad Faheem Khan, Muhammad Ehsan Bari
      Pages: 307 - 313
      Abstract: Fauzan Alam Hashmi, Hamid Hussain Rai, Muhammad Faheem Khan, Muhammad Ehsan Bari
      Asian Journal of Neurosurgery 2018 13(2):307-313
      Background: Clear cell variant in ependymal tumors is rare. We aimed to compare the features and outcome of the World Health Organization (WHO) Grade 3 ependymal tumors with clear cells to the WHO Grade 3 classic anaplastic ependymoma (AE). Materials and Methods: A retrospective cohort study conducted at the Department of Neurosurgery, Aga Khan University, Pakistan, from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. The analysis was done on SPSS 20. Results: Nine cases of clear cell variant and 23 cases of classic AE were found, both of which combined equated to 4% of the total tumor burden in 11 years. The median age of clear cell ependymoma (CCE) and AE were 49 and 37 years, respectively. Presenting symptoms included headache in 66% of CCE and 63% in AE, raised intracranial pressure accounting for 33% of CCE and 54% of AE, dizziness in 22% CCE and 39% AE, while seizures presented equally in both. Supratentorial location was observed in 77% CCE and 48% AE. Both showed hypointense signals on T1-weighted images of magnetic resonance imaging (MRI) while T2-weighted images showed hyperintensity in all cases of CCE but only 80% of AE. MRI characteristics such as the presence of cystic component were found in 89% of CCE and 68% of AE, necrosis in 33% CCE, and 22% AE, hemorrhagic in 22% CCE and 9% AE, and equivalent contrast enhancement. Gross total resection was achieved in 5 (55%) patients of CCE, compared to 6 (26%) patients in AE. Subtotal resection was done in 4 (44%) patients of CCE and 15 (65%) patients of AE. Radiotherapy was given to 5 (55%) patients of CCE and 12 (52%) patients of AE. Recurrence was observed in 77% cases of CCE and 70% of AE, with metastasis in 29% of AE and in only one patient of CCE. Repeat surgery was done in 3 (33%) cases of CCE and 8 (35%) cases of AE. Median progression-free survival and overall survival were 9 and 13 months, respectively, in CCE while 14 and 18 months, respectively, for AE. Conclusion: Clear cells in the WHO Grade 3 ependymal tumors are found mainly in a comparatively older adult population with a predilection for supratentorial location and are more aggressive in behavior with poorer outcome than AE.
      Citation: Asian Journal of Neurosurgery 2018 13(2):307-313
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_280_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Decompressive craniectomy in diffuse traumatic brain injury: An industrial
           hospital study

    • Authors: Niraj Kumar Choudhary, Rinku Bhargava
      Pages: 314 - 318
      Abstract: Niraj Kumar Choudhary, Rinku Bhargava
      Asian Journal of Neurosurgery 2018 13(2):314-318
      Context: High intracranial pressure is the most frequent cause of mortality and disability after severe traumatic brain injury (TBI) which is treated by first-line therapeutic measures. When these measures fail, second-line therapies are started. Among second-line therapies, decompressive craniectomy (DC) has been used. It improves the functional outcome in these patients. Aim: This study aims to analyze the clinicoradiological factors associated with the prognosis of severe TBI in patients undergoing DC. Settings and Design: It was a retrospective case series study from April 2014 to March 2016. Subjects and Methods: A total of 85 patients (admitted at Tata Main Hospital, Jamshedpur) with severe diffuse TBI with clinical and radiological evidence of intracranial hypertension who were refractory to first-tier therapies and required DC were included in our study. Cases excluded were patients with age <10 years and polytrauma patients. Results: Out of 85 cases, 55 were males, and thirty were females (male:female = 1.8:1) with the age ranging from 17 to 68 years. Road traffic accident was the leading cause of injury in 69.5% cases. A total of 49 (58%) patients were of Glasgow coma scale (GCS) 4–6 whereas 36 (42%) patients had GCS 7–8. Computed tomography (CT) scan brain was classified as per Marshall CT classification. Bifrontotemporal DC was done in 29% cases, and unilateral frontotemporoparietal craniectomy was done in 71%. Conclusions: Patients with younger age, early surgical intervention, better preoperative GCS score, and with low Marshall CT score have better prognosis.
      Citation: Asian Journal of Neurosurgery 2018 13(2):314-318
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_281_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Management of chronic subdural hematoma: Burr hole versus twist drill
           – A prospective study

    • Authors: Ram Kumar Goyal, Biswaranjan Nayak, Rajiv Maharshi, Debadulal Das Bidhar, Sunil Panchal, Harish Chandra Pathak
      Pages: 319 - 323
      Abstract: Ram Kumar Goyal, Biswaranjan Nayak, Rajiv Maharshi, Debadulal Das Bidhar, Sunil Panchal, Harish Chandra Pathak
      Asian Journal of Neurosurgery 2018 13(2):319-323
      Introduction: Incidence of chronic subdural hematoma (CSDH) is about 5/100,000/year in the general population and still rising. Two surgical techniques, namely, burr-hole evacuation (BHE) versus twist-drill evacuation (TDE) are commonly used to manage such patients but the preferred surgical method continues to attract debate, and the time for an evidence-based approach is now overdue. In vogue with recent trends, a minimally invasive surgical approach is considered as best; therefore, we tried to establish the hypothesis that TDE is as safe and as effective as BHE for CSDH treatment. Materials and Methods: A prospective, randomized, controlled study including forty patients was conducted. The primary outcome variable studied was clinically significant recurrence rate. The secondary outcome variables in postoperative period and follow-up assessment of the patients include Glasgow coma scale (GCS), Markwalder grade, postoperative complication, and operative mortality rate. Results: In our study, results of BHE seem to be superior than TDE in terms of recurrence rate (5% vs. 15%), complication rate (15% vs. 20%), and mean Markwalder neurological grading score and mean GCS at time of discharge (0.16 vs. 0.45 and 14.95 vs. 14.65, respectively). TDE seems to be better than BHE in terms of duration of hospital stay (7.4 vs. 8.05). However, these differences were not statistically significant. TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and least invasive. Overall results were comparable across both techniques without any significant difference. Conclusion: Although both techniques appear to be similar in respect of their primary and secondary outcome variables, but TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and small incision.
      Citation: Asian Journal of Neurosurgery 2018 13(2):319-323
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_99_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Meningioma consistency: Correlation between magnetic resonance imaging
           characteristics, operative findings, and histopathological features

    • Authors: Mahmoud Alyamany, Mohammad M Alshardan, Abdullah Abu Jamea, Nahid ElBakry, Lahbib Soualmi, Yasser Orz
      Pages: 324 - 328
      Abstract: Mahmoud Alyamany, Mohammad M Alshardan, Abdullah Abu Jamea, Nahid ElBakry, Lahbib Soualmi, Yasser Orz
      Asian Journal of Neurosurgery 2018 13(2):324-328
      Introduction: Intracranial meningiomas account for 30% of all primary intracranial tumors. Surgical resection remains the mainstay of the treatment for meningiomas. The magnetic resonance of intracranial meningiomas has been largely discussed in many reports of the radiological and neurosurgical literature. To date, a few studies have been attempted to differentiate the tumor characteristics of meningiomas based on magnetic resonance imaging (MRI) studies. Objective: The objective of the study is to evaluate the relationship between MRI signal characteristics of intracranial meningiomas and consistency of tumor using objective measures. Materials and Methods: A prospective study included all the patients who were admitted for surgery with an MRI finding suggestive of meningioma. All patients were subjected to routine radiological investigations. Surgical resection was performed for patients eligible for surgery using cavitron ultrasonic aspirator (CUSA). The relationship and correlation between the radiological, intraoperative measurements and the histopathological diagnosis were studied. The tumor consistency was measured using mean CUSA level. Intensity on T2, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) was measured using circular regions of interest (ROI) on the MRI. Multiple ROIs were placed initially on the lesions avoiding the obvious blood vessels, if any, then on the brain cortex to avoid the vasogenic edema. The mean ROI (mROI) results from the lesion were subtracted from the mean ROI from the brain cortex for each lesion to achieve normalized ratio. The results of lesion mROI-cortex mROI were compared to the operative and histopathology results using Pearson's correlation test and linear regression test. Results: The total number of patients was seventy. The mean age of the patients was 51 ± 14.8, with 72% of them being females and 28% males. There was a strong statistically significant (P = 0.046) and (P = 0.003) correlation between mean CUSA and FLAIR mROI difference or T2 mROI difference, respectively. On the other hand, there was an inversely proportional relationship between mean CUSA and FLAIR mROI difference and mean CUSA and T2 mROI difference. The value of the regression test (r) shows that there was a slight linear relationship between FLAIR mROI difference or T2 mROI difference and mean CUSA values, in which the mean CUSA value = 50.1 + (−0.088) × FLAIR mROI difference (r = −0.273, P = 0.046) or mean CUSA value = 50.8 + (−0.055) × T2 mROI difference (r = 0.4, P = 0.003). There was no statistical significance in the relation between CUSA values and tumor histological subtypes, DWI values, age, or gender. Conclusion: This study presents a new objective method to measure the consistency of intracranial meningiomas based on a simple algorithmic formula. Such information will aid in planning surgery and assessing the resectability of the tumor. To date, this is the first objective measurement of meningioma consistency based on MRI studies and objective intraoperative evaluation.
      Citation: Asian Journal of Neurosurgery 2018 13(2):324-328
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228515
      Issue No: Vol. 13, No. 2 (2018)
       
  • Maximum surgical blood order schedule for elective neurosurgery in a
           University Teaching Hospital in Northern Thailand

    • Authors: Ananchanok Saringcarinkul, Siriwan Chuasuwan
      Pages: 329 - 335
      Abstract: Ananchanok Saringcarinkul, Siriwan Chuasuwan
      Asian Journal of Neurosurgery 2018 13(2):329-335
      Context: Preoperative blood bank testing should optimize the trade-off between intraoperative transfusion delay and blood wastage. Aims: This study aims to develop a maximal surgical blood order schedule (MSBOS) for elective neurosurgery. Settings and Design: Prospective data in University Teaching Hospital, Northern Thailand. Subjects and Methods: Blood transfusion data were collected on all adult patients satisfying inclusion/exclusion criteria in 2015. Patients were assigned to ten procedure groups (G): vascular: (1) Aneurysm/arteriovenous malformation, (2) Cerebrovascular bypass; tumor resection: (3) Meningioma, (4) Other, (5) Cerebellopontine angle, (6) Pituitary/craniopharyngioma, (7) Endoscopic pituitary; and miscellaneous: (8) Cranioplasty, (9) Spine, (10) Other. The crossmatch-transfusion ratio (C/T), transfusion probability (%T), and transfusion index (Ti) were calculated. MSBOS was generated by applying published criteria, subjected to clinical neurosurgical judgment. Statistical Analysis Used: Statistical Package for the Social Sciences, Vision 20. Results: Of 377 patients, 95% underwent preoperative cross-and-match (C and M) testing for 1422 red blood cell (RBC) units, while 3% had no type and screen (T and S) nor C and M, and 2% had T and S only. Overall C/T was 6.6, with range from 4 for G3-53 for G8. Intraoperative %T was 27%. Intraoperative Ti was 0.6. Our MSBOS recommended T and S only for G2, G7, G8, G9, G10; C and M of 2 RBC units for G1, G4, G5, G6; and C and M 2-to-4 for G3. If this were followed in 2015, intraoperative blood needs would have been satisfied for ≥82% of patients, and substantial reductions achieved in blood banking fees. Conclusions: Our MSBOS may help optimize blood ordering and serve as an example for similar efforts for other surgical specialties.
      Citation: Asian Journal of Neurosurgery 2018 13(2):329-335
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_104_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Solitary fibrous tumors of the orbit and central nervous system: A case
           series analysis

    • Authors: Marisa Brum, Hip&#243;lito Nzwalo, Edson Oliveira, Maria Rita Pelej&#227;o, Pedro Pereira, Jo&#227;o Paulo Farias, Jos&#233; Pimentel
      Pages: 336 - 340
      Abstract: Marisa Brum, Hipólito Nzwalo, Edson Oliveira, Maria Rita Pelejão, Pedro Pereira, João Paulo Farias, José Pimentel
      Asian Journal of Neurosurgery 2018 13(2):336-340
      Introduction: Solitary fibrous tumor (SFT) is rarely diagnosed in clinical practice. Since its initial descriptions in the central nervous system (CNS) and the orbits, very few case reports and small case series have expanded their clinical and pathological characterization. We sought to describe a cases series of SFT from a single laboratory of neuropathology belonging to a tertiary university hospital. Methods: Retrospective clinical and histopathological description of eight cases of CNS and orbital SFT diagnosed over a 21-year period of time. Results: Median age was 47.3 years and four were males. Clinical presentation was related to local mass effect in all. Tumors occurred in the orbits (5/62.5%), intracranial dura attached (2), and the spinal medulla (1). The neuropathology showed the presence of hemangiopericytoma type (2), classic type (3), and mixed type (3). Histological anaplasia was present in two cases. Widespread/total immunoreactivity for vimentin, CD34, and Bcl-2 was present in all. Gross total removal was conducted in the majority (6/75%) and subtotal removal in 2 (25%). Three patients were submitted to adjuvant treatment (radiosurgery and radiotherapy). Recurrence occurred in four patients, 13–120 months after surgical intervention. Anaplasia was present in one case of recurrence. Conclusion: Our case series confirms the clinical and neuropathological diversity of CNS and orbital SFTs. Studies with longer follow-up periods are necessary to better understand the clinical behavior and prognosis of the SFT in the CNS and orbits.
      Citation: Asian Journal of Neurosurgery 2018 13(2):336-340
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_111_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Analysis of factors influencing outcome of depressed fracture of skull

    • Authors: Ritesh S Satardey, Srikant Balasubramaniam, Jayashree S Pandya, Rajesh C Mahey
      Pages: 341 - 347
      Abstract: Ritesh S Satardey, Srikant Balasubramaniam, Jayashree S Pandya, Rajesh C Mahey
      Asian Journal of Neurosurgery 2018 13(2):341-347
      Context: The outcome of patients with depressed fracture varies and depends on multiple factors. There has been no previous study on the significance of these factors on the outcome of depressed fracture of the skull and hence this study. Aims: The primary aim of our study is to find the factors affecting the outcome in cases of depressed skull fracture (DSF). This will help us improve outcomes and give more accurate prediction of long-term outcomes. Settings and Design: Prospective observational study. Subjects and Methods: Institutional Ethics Committee approval was taken for doing this observational study. This was conducted in a tertiary care institute by collecting data of fifty cases of DSFs in 2 years, between January 2012 and December 2013. The study included patients who were diagnosed with DSFs admitted to our tertiary care public hospital. Patients with comorbidity involving injury to other organs or medical disorders and pediatric patients were excluded from our study. Statistical Analysis Used: Chi-square test and Fisher exact test. Results: There was a statistically significant impact on age, sex, Glasgow Coma Scale (GCS) score at presentation, type of DSF, and site of DSF in the long-term outcome of patients. The patients with GCS score of 13 or more fared well with good long-term outcome as against those with GCS score below it. Any additional brain injury in the form of hematomas, etc., has a significant negative impact on long-term outcome of the patient and warrant urgent surgical intervention. Complications such as dural tear, cerebral contusions, wound infections, and seizures have adverse effect on the recovery. Conclusions: Our observation suggests that patients brought to hospital with minimal delay, with GCS score between 13 and 15, with simple DSF and normal brain parenchyma without dural tear, have the best outcome.
      Citation: Asian Journal of Neurosurgery 2018 13(2):341-347
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_117_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Diagnostic and prognostic capability of newer magnetic resonance imaging
           brain sequences in diffuse axonal injury patient

    • Authors: Mayank Bansal, Virendra Deo Sinha, Juhi Bansal
      Pages: 348 - 356
      Abstract: Mayank Bansal, Virendra Deo Sinha, Juhi Bansal
      Asian Journal of Neurosurgery 2018 13(2):348-356
      Objectives: Diffuse axonal injury is one of the major causes of unconsciousness, profound neurologic deficits and persistent vegetative state after head trauma. In recent years, MR imaging has been gaining popularity as an adjunctive imaging method in patients with DAI. Our study aims to assess the relative diagnostic and prognostic capability of various MRI sequences. Patients and Methods: Retrospective observational study done in 1 year duration on 30 DAI patients. Clinical assessment done with GCS at admission and GOS at 6 month.MRI Brain FLAIR, DWI, T2*GRE AND SWI sequences taken. DAI grade were evaluated for different MRI sequences .Prognosis was correlated to total number of lesion/locations and DAI grade of patients. Statistical analysis was done using SPSS Statistical software (ver.20.0.0) and XL-Stat and ANOVA one way test, post hoc test (Turkey test) and Chi square test. Result: We studied 30 male patients,mean age 32.57±8.72 ranges. The commonest mode of injury is RTA-80%, fall-16% followed by assault-3.33%.Out of 30 patients, 17 patients (56.67%) had GCS
      Citation: Asian Journal of Neurosurgery 2018 13(2):348-356
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_229_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Bone turnover in vertebral fractures: Does it effect the decision of
           surgery?

    • Authors: Zeki Serdar Ataizi, Hasan Emre Aydin, Evin Kocat&#252;rk, Ahmet &#199;erezci, &#304;brahim &#214;zkan Alatas
      Pages: 357 - 362
      Abstract: Zeki Serdar Ataizi, Hasan Emre Aydin, Evin Kocatürk, Ahmet Çerezci, İbrahim Özkan Alatas
      Asian Journal of Neurosurgery 2018 13(2):357-362
      Background and Aim: Instrumentation is commonly used in spinal surgery to stabilize the fracture. In the present study, we aimed to compare the early and late changes seen in bone production and degradation products in patients with traumatic spinal fracture who had been treated surgically or conservatively. Materials and Methods: Forty-three patients were admitted to the Neurosurgery Department with thoracolumbar or lumbar fracture in this prospective study. Patients were divided into two groups of surgically treated (n = 23) and nonsurgically/conservatively treated (n = 20) patients. The early and late changes seen in bone production and degradation products were compared in patients with traumatic spinal fracture who had been treated surgically or conservatively. Results: In conservatively treated patients, although osteocalcin level was slightly increased and deoxypiridinoline (DPD)/creatinine was slightly decreased after the treatment, the difference was not statistically significant (P = 0.08 and P = 0.539, respectively). There is no significant difference between admission time, posttreatment late period osteocalcin level, and DPD/creatinine ratio between the two group of patients (P = 0.215 and P = 0.236, respectively). Conclusion: We suggest that the healing and fusion processes in fractured vertebrae not only followed by the radiological examination but also by noninvasive biochemical changes seen in the serum levels of bone formation and resorption markers.
      Citation: Asian Journal of Neurosurgery 2018 13(2):357-362
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_137_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Anatomical variability of the posterior communicating artery

    • Authors: Sandhya Arvind Gunnal, Mujibuddin S Farooqui, Rajendra N Wabale
      Pages: 363 - 369
      Abstract: Sandhya Arvind Gunnal, Mujibuddin S Farooqui, Rajendra N Wabale
      Asian Journal of Neurosurgery 2018 13(2):363-369
      Objective: Although posterior communicating artery (PCoA) is a smaller branch of the internal carotid artery, it gives the main contribution in the formation of circle of Willis (CW) by communicating with the internal carotid arterial system and the vertebro-basilar arterial system. The size of PCoA varies frequently. The present work aims to study the PCoA regarding its morphology, morphometry, and symmetry. Materials and Methods: This study was conducted on 170 human cadaveric brains. Brains were dissected carefully and delicately to expose all components of CW, especially PCoA. Morphological variations of PCoA were noted along with its morphometry and symmetry. Results: Morphological variations of PCoA were aplasia (3.52%), hypoplasia (25.29%), fenestration (0.58%), and persistent fetal pattern (16.47%). In the present study, we found the five different types of terminations of PCoA. Type I termination was the most common type, seen in 92.94% of cases, Type II termination was seen in 1.17%, Type III and Type IV terminations both were seen in 0.58%, and Type V was seen in 1.17%. The mean length of PCoA was 15.9 mm and 15.3 mm on the right and left sides, respectively. The mean diameter of PCoA was 2.1 mm and 1.9 mm on the right and left sides, respectively. Symmetry of PCoA was seen in 65.29% and asymmetric PCoA was seen in 34.70% of cases. Conclusion: The present study provides the complete description of PCoA regarding its morphology, symmetry, and morphometry. Awareness of these anatomical variations is important in neurovascular procedures.
      Citation: Asian Journal of Neurosurgery 2018 13(2):363-369
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_152_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Effectiveness of goreisan in preventing recurrence of chronic subdural
           hematoma

    • Authors: Shunsaku Goto, Kyozo Kato, Taiki Yamamoto, Shinji Shimato, Tomotaka Ohshima, Toshihisa Nishizawa
      Pages: 370 - 374
      Abstract: Shunsaku Goto, Kyozo Kato, Taiki Yamamoto, Shinji Shimato, Tomotaka Ohshima, Toshihisa Nishizawa
      Asian Journal of Neurosurgery 2018 13(2):370-374
      Background: Burr-hole irrigation surgery is now recognized as a widespread simple technique for the treatment of chronic subdural hematoma (CSDH). However, recurrence of CSDH is sometimes experienced after initial surgery. Recently, it has been reported that goreisan is effective in preventing CSDH recurrence. Materials and Methods: We studied patients with CSDH who received burr-hole irrigation at our hospital between January 2011 and December 2014. We divided these patients into three groups. The first group was given goreisan during the early phase after burr-hole irrigation. The second group was given goreisan when there was a visual tendency of recurrence, as observed in the course of computed tomography imaging for outpatients. The third group was not given any drug. Results: The recurrence rate was compared between each group. The recurrence rate was significantly lower in the early goreisan administration group (5% vs. 12%, P = 0.046). There was a decreased tendency of recurrence in the goreisan-administered group compared with the group that was not administered any drug, but this was not statistically different (6.1% vs. 12%, P = 0.082). The recurrence period in the goreisan-administered group was longer than that in the group that was not administered any drug (39.9 ± 12.1 vs. 27.45 ± 8.5, P = 0.017). Conclusions: Goreisan is effective in preventing recurrence of CSDH after burr-hole irrigation.
      Citation: Asian Journal of Neurosurgery 2018 13(2):370-374
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_174_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Disappearance of intracranial extradural hematomas: Role of diastatic
           cranial fracture and intracranial pressure - An institutional experience

    • Authors: Abdul Rashid Bhat, Altaf Rehman Kirmani, Mohammed Afzal Wani
      Pages: 375 - 379
      Abstract: Abdul Rashid Bhat, Altaf Rehman Kirmani, Mohammed Afzal Wani
      Asian Journal of Neurosurgery 2018 13(2):375-379
      Context: The intracranial extradural hematoma (EDH) occupies space and creates a mass effect on the brain but the tenacious-adhesions of dura to the inner table of skull counters this effect. The intracranial pressure also pushes the hematoma back while it is held by dural tensile-force. Aims: The exploitation of a diastatic fracture, overlying an EDH, by the intracranial pressures to decompress a hematoma out of extradural space into subgaleal/subperiosteal space without surgical intervention. Settings and Design: In a period of 15 years, a group of 11 patients among 729 EDHs were managed conservatively. Materials and Methods: The retrospective study of 11 EDH patients was conducted in the Department of Neurosurgery from January 2000 to December 2014 in 15 years. Statistical Analysis Used: The statistical law of variance was used as applicable. Results: Analysis of spontaneous disappearance of intracranial EDH among 11 patients revealed that only 1.5% (11/729) EDHs resolved conservatively. The most cases (63.6%) were children and the youngest being 9 months old. All the patients had a diastatic fracture overlying-EDH and were fully conscious. The cause of head injury in most was the fall from height. The hospital stay ranged from 2 to 4 days. All the patients had a good recovery at the time of discharging. Conclusion: The trial of the conservative or spontaneous disappearance of an EDH through a diastatic fracture into the subgaleal space is similar to burr-hole drainage without surgical intervention but depends upon the neurological status, the intracranial pressure of the patient, and the availability of all the modern neurosurgical gadgets.
      Citation: Asian Journal of Neurosurgery 2018 13(2):375-379
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228577
      Issue No: Vol. 13, No. 2 (2018)
       
  • A novel application of the integra camino bolt for the drainage of chronic
           subdural hematoma: A technical note

    • Authors: Ninh B Doan, Ha Nguyen, Karl Janich, Andrew Montoure, Patel Mohit, Saman Shabani, Michael Gelsomino, Wade M Mueller, Shekar Kurpad
      Pages: 380 - 382
      Abstract: Ninh B Doan, Ha Nguyen, Karl Janich, Andrew Montoure, Patel Mohit, Saman Shabani, Michael Gelsomino, Wade M Mueller, Shekar Kurpad
      Asian Journal of Neurosurgery 2018 13(2):380-382
      Background: Chronic subdural hematoma (cSDH) is a common neurosurgical pathology associated with older age and complicated by antiplatelet/anticoagulant therapies. With improving medical care in an aging population, the incidence of cSDH will likely increase over the next 25 years, placing a burden on health care costs. Aims: A simple and inexpensive treatment option for cSDH is desirable. Material and methods: We report a basic, but novel, technique to drain cSDH with an Integra Camino bolt. Results: This technique was employed in two patients, where the significant resolution of cSDH and associated clinical symptoms were observed without complications. Conclusions: Our technique is simple and effective. It incorporates readily available materials, which reduces costs. Such characteristics are necessary, given the increasing incidence of cSDH.
      Citation: Asian Journal of Neurosurgery 2018 13(2):380-382
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228518
      Issue No: Vol. 13, No. 2 (2018)
       
  • Chalkstick fracture: A catastrophic injury

    • Authors: Suryapratap Singh Tomar
      Pages: 383 - 385
      Abstract: Suryapratap Singh Tomar
      Asian Journal of Neurosurgery 2018 13(2):383-385
      Cervical spine region is known as very prone for injury because it is great mobility. Hyperflexion or hyperextension may create life-threatening injury to ankylosed cervical spine vertebra and spinal cord. The posttrauma result can range from neurological damage to the death. We present a case of a 52-year-old male patient, came to the emergency department with a history of road traffic accident induced quadriplegia and shock. The final diagnosis was chalkstick fracture of spine with complete cord transaction.
      Citation: Asian Journal of Neurosurgery 2018 13(2):383-385
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_167_13
      Issue No: Vol. 13, No. 2 (2018)
       
  • Widespread intra-abdominal carcinomatosis from a rhabdoid meningioma after
           placement of a ventriculoperitoneal shunt: A case report and review of the
           literature

    • Authors: Jun Jie Ng, Kok Ann Teo, Asim Shabbir, Tseng Tsai Yeo
      Pages: 386 - 393
      Abstract: Jun Jie Ng, Kok Ann Teo, Asim Shabbir, Tseng Tsai Yeo
      Asian Journal of Neurosurgery 2018 13(2):386-393
      Intra-abdominal metastasis (IAM) of central nervous system (CNS) tumors through ventriculoperitoneal shunt (VPS) is rare but has been previously reported (e.g., germinomas and medulloblastomas). However, there has been no previous reports in literature involving meningiomas. A case of primary rhabdoid meningioma with widespread intra-abdominal carcinomatosis after placement of a VPS in a 36-year-old man is described. The patient underwent preoperative angioembolization of the tumor, craniotomy, and surgical excision, followed by postoperative gamma knife radiosurgery. Five months later, he underwent a decompressive craniectomy and surgical excision for tumor recurrence causing raised intracranial pressure and communicating hydrocephalus, necessitating placement of a VPS. One month after placement of the VPS, the patient developed abdominal distension and confusion. He was treated for a VPS infection and the shunt was explanted. He continued to deteriorate with high output from the peritoneal drain placed at the time of shunt explantation. An exploratory laparotomy revealed multiple diffuse peritoneal and omental nodules which had the same histopathological and immunohistochemical morphology as the primary tumor. We reviewed the current literature on IAM of primary CNS tumors through VPS, which revealed that patients belonging to the pediatric age group of the male gender and with a primary intracranial germinoma or medulloblastoma have a higher incidence of IAM. The majority of IAM occurred within 2 years of VPS placement, and patients most commonly present with abdominal distension and ascites. Treatment after diagnosis is varied, and the prognosis is poor, with more than half of the patients dying within a year. It is vital for clinicians to maintain a high index of suspicion for similar patients as early intervention could potentially improve patient outcomes and patient expectations managed more effectively.
      Citation: Asian Journal of Neurosurgery 2018 13(2):386-393
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_42_15
      Issue No: Vol. 13, No. 2 (2018)
       
  • Pseudo primary abscess of the cavum septum pellucidum due to pus
           entrapment: A rare case report

    • Authors: Ahmed Ansari, Ashok Gandhi, RS Mittal, Achal Sharma
      Pages: 394 - 395
      Abstract: Ahmed Ansari, Ashok Gandhi, RS Mittal, Achal Sharma
      Asian Journal of Neurosurgery 2018 13(2):394-395
      The cavum septum pellucidum (CSP) is defined as a crevice-like space of variable width between the left and right transparent septum. In this report, a rare case of pseudo primary abscess formed in the CSP due to ventriculitis is presented.
      Citation: Asian Journal of Neurosurgery 2018 13(2):394-395
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228514
      Issue No: Vol. 13, No. 2 (2018)
       
  • Good outcomes with the intraventricular vancomycin therapy in a patient
           with ruptured brain abscesses

    • Authors: Ninh Doan, Ha Nguyen, Li Luyuan, Saman Shabani, Michael Gelsomino, Vijay Johnson
      Pages: 396 - 399
      Abstract: Ninh Doan, Ha Nguyen, Li Luyuan, Saman Shabani, Michael Gelsomino, Vijay Johnson
      Asian Journal of Neurosurgery 2018 13(2):396-399
      Brain abscesses are associated with high morbidity and mortality rates. In particular, patients with intraventricular rupture of brain abscess (IVROBA) exhibit mortality rates up to 85%. Treatment options are lacking for IVROBA, once patients become refractory to intravenous antibiotics and surgical drainage. Limited data exist regarding the risks and benefits of intraventricular therapy in such a scenario. We report a patient with IVROBA, who deteriorated while on systemic antibiotics; once intraventricular vancomycin was employed, the patient demonstrated remarkable improvement without perceivable side effects. This case suggests that intraventricular vancomycin may be a safe, effective, and viable option for the treatment of IVROBA, especially for patients becoming refractory to systemic antibiotics.
      Citation: Asian Journal of Neurosurgery 2018 13(2):396-399
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.185065
      Issue No: Vol. 13, No. 2 (2018)
       
  • Tectal tuberculoma: An unusual cause of Parinaud&#39;s Syndrome

    • Authors: Pravin Tukaram Survashe, Sachin Guthe, Vernon Velho, Harish Naik
      Pages: 400 - 402
      Abstract: Pravin Tukaram Survashe, Sachin Guthe, Vernon Velho, Harish Naik
      Asian Journal of Neurosurgery 2018 13(2):400-402
      Introduction: Parinaud's Syndrome is an inability to move the eyes upwards which is caused by damage to the tectal plate of midbrain. Commonest causes implicated are the Pineal tumors in children, Multiple Sclerosis in adults and stroke in elderly patients. We present a rare case of Tectal plate tuberculoma leading to Parinaud's Syndrome. Discussion: Parinaud's syndrome is caused by damage to the tectal plate or posterior commissure of midbrain. Our patient presented with upward gaze paresis and was diagnosed to have tuberculoma involving the midbrain region. He was managed conservatively and responded to the treatment. Conclusion: Tectal plate tuberculoma though a rare possibility, warrants proper diagnostic workup in order to prevent unnecessary brainstem surgery.
      Citation: Asian Journal of Neurosurgery 2018 13(2):400-402
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_86_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Twiddler&#39;s syndrome: A rare hardware complication in spinal
           cord stimulation

    • Authors: Byung-chul Son, Jin-gyu Choi, Sang-woo Ha
      Pages: 403 - 406
      Abstract: Byung-chul Son, Jin-gyu Choi, Sang-woo Ha
      Asian Journal of Neurosurgery 2018 13(2):403-406
      Twiddler's syndrome is an uncommon hardware complication involving the lead and pulse generators in cardiac pacemakers and defibrillators, deep brain stimulators, and vagal nerve stimulators. However, until very recently, it had not been reported in spinal cord stimulation (SCS). Considering the incidence of hardware complications of spinal cord stimulation, there may be an underreporting of Twiddler's syndrome due to lack of awareness. Two cases of Twiddler's syndrome as a hardware complication of SCS were identified between 2005 and 2015. One patient with hardware failure due to Twiddler's syndrome refused to have a revision surgery. The other patient who had a lead migration associated with coiling of the lead and twisting of pulse generator needed a revision surgery. Twiddler's syndrome in patients treated with SCS is an uncommon but important adverse event. Awareness of characteristic presentation and radiologic finding is essential in the identification of Twiddler's syndrome in SCS.
      Citation: Asian Journal of Neurosurgery 2018 13(2):403-406
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_147_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Cerebrospinal fluid egress from the quadripolar deep brain stimulation
           electrode for anterior nucleus of the thalamus for refractory epilepsy

    • Authors: Byung-chul Son, Jin-gyu Choi, Sang-woo Ha
      Pages: 407 - 410
      Abstract: Byung-chul Son, Jin-gyu Choi, Sang-woo Ha
      Asian Journal of Neurosurgery 2018 13(2):407-410
      Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an effective treatment for refractory epilepsy. Due to the unique location of ANT in the thalamus facing the lateral and third ventricles, transventricular DBS lead placement is an essential part of ANT DBS. However, there is no report regarding hardware problems including impedance variability in transventricular ANT DBS due to limited experience. A 45-year-old male patient with previously effective, bilateral ANT DBS presented with increasing seizure frequency and a shortened battery longevity within 2 years. Magnetic resonance imaging showed that the left-sided DBS lead was in the third ventricle leaning on the medial wall of ANT. Electrode revision was performed. Upon disconnecting the proximal lead from the extension connection, cerebrospinal fluid egress through fine gaps between the metallic electrode contacts, and electrode spacing was observed. This case raises a concern about the transventricular approach for ANT lead placement because the currently available DBS electrode lead is not waterproofed. A careful, longitudinal follow-up of DBS impedance for ANT DBS is warranted.
      Citation: Asian Journal of Neurosurgery 2018 13(2):407-410
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_148_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • C1–C2 transverse foramen decompression by anterolateral approach as
           an alternative treatment in Bow Hunter's Syndrome

    • Authors: Serdar Cevik, Salim Katar, Hakan Han&#305;mo&#487;lu
      Pages: 411 - 413
      Abstract: Serdar Cevik, Salim Katar, Hakan Hanımoǧlu
      Asian Journal of Neurosurgery 2018 13(2):411-413
      Bow hunter's syndrome (BHS) is characterized with repeating paroxysmal vertigo, nystagmus and ataxia caused by mechanical compression of the vertebral arteries. There is no definite diagnostic and treatment protocol. 26-year-old female patient admitted to the outpatient clinic with complaints of dizziness and seldom falls. Stenosis in the right vertebral artery at the level of C1 and C2 was discovered by the diagnostic modalities. In our patient, we first performed hemilaminectomy by posterior approach. But the symptoms of the patient did not recede, thus we performed decompression with the anterolateral approach by opening the foramens atlas and axis without disrupting the dynamics of the vertebrae and without the need for stabilization. The symptoms of the patient disappeared after this intervention. The patient had complete relief of symptoms at the first year follow up. Surgery must be planned to preserve the life quality of the patient and relieve complaints of the patients. To achieve these goals anterolateral approach must be tried before attempting posterior stabilization.
      Citation: Asian Journal of Neurosurgery 2018 13(2):411-413
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_338_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • IDH1 mutation in brain stem glioma: Case report and review of literature

    • Authors: Seyed Amirhossein Javadi, Christian Hartmann, Gerhard Franz Walter, Roozbeh Banan, Amir Samii
      Pages: 414 - 417
      Abstract: Seyed Amirhossein Javadi, Christian Hartmann, Gerhard Franz Walter, Roozbeh Banan, Amir Samii
      Asian Journal of Neurosurgery 2018 13(2):414-417
      The role of isocitrate dehydrogenase 1 (IDH1) mutation in brain stem glioma is not clear. To the best of our knowledge, six cases of brain stem gliomas carrying IDH1/2 mutations are currently reported in the literature. One case of diffuse brain stem glioma with IDH1 mutation, which was followed for 2 years, is presented and compared with IDH1 negative tumors. A 22-year-old lady was referred with diplopia and left arm palsy. Neuroimaging detected a nonenhancing, nonhomogeneous diffuse infiltrating brain stem tumor extending from pons to medulla. Microsurgical debulking was performed. Microscopic evaluation of the tissue specimen and immunohistochemistry revealed an astrocytoma WHO Grade II with proliferation rate of 3% and glial fibrillary acidic protein (GFAP)-positive tumor cells. Interestingly, the tumor cells expressed mutated IDH1 R132H protein. The patient underwent adjuvant radiation and chemotherapy. The primary and 2 years' clinical/radiological characteristics did not indicate any significant difference from other cases without IDH1 mutation. the prognostic value of IDH1/2 mutation in brain stem glioma is unclear. Brain stem biopsies may allow determination of a tissue-based tumor diagnosis for further investigations.
      Citation: Asian Journal of Neurosurgery 2018 13(2):414-417
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228540
      Issue No: Vol. 13, No. 2 (2018)
       
  • Choroidal type of vein of galen aneurysmal malformation in adult patient
           with unusual presentation of orthostatic headache

    • Authors: Kapil Pareek, Trilochan Shrivastava, Virendra Deo Sinha
      Pages: 418 - 420
      Abstract: Kapil Pareek, Trilochan Shrivastava, Virendra Deo Sinha
      Asian Journal of Neurosurgery 2018 13(2):418-420
      Vein of Galen aneurysmal malformations (VGAMs) are rare vascular malformations occurring commonly in the pediatric age group. They comprise only 1% of all intracranial vascular malformations, but in pediatric population, they represent 30% of all intracranial vascular malformations. They are of two types-mural and choroidal. Choroidal type of VGAM is more primitive and most severe form of disease. It usually causes high cardiac output failure in newborn period because of multiple high flow fistulas. Adult presentation of choroidal type VGAM is very rare, and only few cases have been reported in literature so far. A 21-year-old female patient presented with an orthostatic headache. Neuroimaging showed the choroidal type of VGAM. Staged embolization was planned through transarterial route. Partial embolization was done in the first stage. Patient's symptoms were disappeared thereafter. As per our knowledge, orthostatic headache has not been described previously in literature. With a very few existing case reports of adult true vein of Galen malformations, we believe that this case can help in understanding the natural history of vein of Galen malformations and the pathophysiology of its development.
      Citation: Asian Journal of Neurosurgery 2018 13(2):418-420
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228542
      Issue No: Vol. 13, No. 2 (2018)
       
  • Primary extradural meningioma of posterior fossa associated with acquired
           chiari malformation: A short review

    • Authors: Guru Dutta Satyarthee
      Pages: 421 - 424
      Abstract: Guru Dutta Satyarthee
      Asian Journal of Neurosurgery 2018 13(2):421-424
      Generally, meningioma is considered intracranial lesion occurring in the intradural compartment. However, meningioma can also occur and usually confined in the extradural compartment called as primary extradural meningioma (PEM). PEM represents a special subgroup of meningioma constitute about 1% of all meningioma. PEM arises outside the subdural compartment and usually contains neither connection underlying subdural structures nor extends into with subdural compartment. It is commonly located in the paranasal sinus, middle ear, rarely in the intradiploic spaces of calvarial bone such as temporal, frontal, and parietal bone and orbit but extremely uncommonly in the occipital and sphenoid bones.
      Authors did detailed Pubmed search for posterior fossa, occipital bone extradural, ectopic intraosseous meningioma which yielded only four publications in the form of isolated case report analyzing only five case of PEM.
      Authors report a rare case extradural meningioma in a 40-year-old male, who presented with progressive headache and gait imbalance. Magnetic resonance imaging study of brain revealed the presence of PEM of posterior fossa associated with acquired Chiari malformation. The patient was managed successfully surgically with excision of meningioma and release of associated acquired tonsiallar descent was carried out.
      Authors are analyzing total of five cases including four cases from published literature and one our current case. PEM of the posterior fossa tends to have equal predilection in male and female (3:3), with a mean age of 48 years (range 25–64 years). All cases were surgically and underwent gross total surgical excision. The clinical features, imagings, and management of this rare entity along with the pertinent literature are briefly discussed.
      Citation: Asian Journal of Neurosurgery 2018 13(2):421-424
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_28_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Spastic quadriparesis and communicating hydrocephalus as late sequel of
           Rosai–Dorfman disease: A case report and review of literature

    • Authors: Ankur Kapoor, Pravin Salunke, Chirag K Ahuja, Debjyoti Chatterjee
      Pages: 425 - 427
      Abstract: Ankur Kapoor, Pravin Salunke, Chirag K Ahuja, Debjyoti Chatterjee
      Asian Journal of Neurosurgery 2018 13(2):425-427
      Rosai–Dorfman disease (RDD) predominantly affects cervical lymph nodes and presents with fever and pancytopenia. Central nervous system involvement though uncommon is often reported. Hydrocephalus and paraparesis as a consequence of RDD is an extremely rare entity. We present a 58-year-old male, diagnosed and treated for RDD with cervical lymphadenopathy, who now presented with spastic paraparesis and on evaluation was found to have communicating hydrocephalus that resolved after ventriculoperitoneal shunt surgery.
      Citation: Asian Journal of Neurosurgery 2018 13(2):425-427
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_30_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Meningioma in fourth ventricle of brain: A case report and literature
           review

    • Authors: Firooz Salehpour, Javad Aghazadeh, Amir Mohammad Bazzazi, Farhad Mirzaei, Amir Taha Eftekhar Saadat, Seyed Ahmad Naseri Alavi
      Pages: 428 - 430
      Abstract: Firooz Salehpour, Javad Aghazadeh, Amir Mohammad Bazzazi, Farhad Mirzaei, Amir Taha Eftekhar Saadat, Seyed Ahmad Naseri Alavi
      Asian Journal of Neurosurgery 2018 13(2):428-430
      Meningiomas are benign tumors origin from central nervous system. They usually involve cephalic, paravertebral soft tissues, skin and in rare cases in the ear, temporal bone, mandible, foot, lung, and mediastinum. In this case, we report an unusual case of meningioma which placed in the fourth ventricle. A 14-year-old man with seizure and headache referred to our ward. The magnetic resonance imaging reported bilateral acoustic neuroma and fourth ventricle meningioma. The patient was scheduled for total tumor resection and the histopathology revealed psammomatous type of meningioma. The patient discharged with good general status.
      Citation: Asian Journal of Neurosurgery 2018 13(2):428-430
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228551
      Issue No: Vol. 13, No. 2 (2018)
       
  • Venous air embolism during endoscopic third ventriculostomy

    • Authors: Renu Bala, Mihir P Pandia
      Pages: 431 - 432
      Abstract: Renu Bala, Mihir P Pandia
      Asian Journal of Neurosurgery 2018 13(2):431-432
      Neuroendoscopic procedures are increasingly performed nowadays due to the significant technological improvement of endoscopic instrumentation. It carries various advantages such as speed, simplicity, avoidance of implants, and no brain dissection or retraction. Although considered to be safe, it is associated with a host of complications. We hereby report a case of venous air embolism in an infant who was undergoing endoscopic third ventriculostomy. The complication occurred at the completion of surgery when surgeons were withdrawing the endoscope. The successful management of this uncommon event is being discussed.
      Citation: Asian Journal of Neurosurgery 2018 13(2):431-432
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.185072
      Issue No: Vol. 13, No. 2 (2018)
       
  • Penetrating injury to cauda equina from a missile fragment, completely
           recovered after delayed surgical removal of ballistic fragment

    • Authors: Kamble Jayaprakash Harsha, Anu Thomas
      Pages: 433 - 435
      Abstract: Kamble Jayaprakash Harsha, Anu Thomas
      Asian Journal of Neurosurgery 2018 13(2):433-435
      Penetrating injuries to cauda equina due to missile fragment are rare. The mechanism of injury may be more complex due to thermal effect of missile fragment, apart from mechanisms described in penetrating gunshot injuries or stab injuries. We report a case of a 42-year-old male with penetrating missile injury to cauda equina, improved completely after delayed surgical exploration and removal of ballistic fragment. Furthermore, his bowel and bladder dysfunction improved completely within 1 week of neurosurgical exploration. Although early neurosurgical intervention is recommended for penetrating injuries of the cauda equina, delayed intervention may also be beneficial in selected patients. Computed tomography (CT) scan and CT myelogram are extremely useful in surgical planning when magnetic resonance imaging contraindicated due to impregnated metal fragments.
      Citation: Asian Journal of Neurosurgery 2018 13(2):433-435
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228565
      Issue No: Vol. 13, No. 2 (2018)
       
  • Aspergilloma mimicking olfactory groove meningioma

    • Authors: Pradeep Sharma, Kamlesh S Bhaisora, Satyadeo Pandey, Arun Kumar Srivastava, Krushna C Pani, Jayesh Sardhara, Kuntal K Das, Anant Mehrotra, Rabi Narayan Sahu, Awadhesh K Jaiswal, Sanjay Behari
      Pages: 436 - 439
      Abstract: Pradeep Sharma, Kamlesh S Bhaisora, Satyadeo Pandey, Arun Kumar Srivastava, Krushna C Pani, Jayesh Sardhara, Kuntal K Das, Anant Mehrotra, Rabi Narayan Sahu, Awadhesh K Jaiswal, Sanjay Behari
      Asian Journal of Neurosurgery 2018 13(2):436-439
      Central nervous system aspergillosis is rare with reported mortality rate of 13–50% involving foci in paranasal sinuses and even higher mortality rates (80–100%) in patients of immune-compromised status. Modern day imaging offers an opportunity for early diagnosis, but findings are minimal. A typical finding is that of a space occupying mass lesion with iso-hypointense signal on T1-weighted sequences and extreme hypointense appearance on T2-weighted. This results from the concentration of ferromagnetic substances (iron/zinc/magnesium/manganese) within the lesion. Gadolinium enhancement pattern varies from homogeneous to peripheral ring enhancement. The immune-competent hosts present with homogeneous enhancement while those with immune compromise bear more variable radiological appearance. Due to such radiological appearance, meningioma or tuberculoma is considered in differential earlier than fungal granuloma, if not for the hypointense appearance on T2-weighted sequences which strongly points to fungal granuloma. Through this case report, we attempt to highlight the unusual radiological presentation of the entity.
      Citation: Asian Journal of Neurosurgery 2018 13(2):436-439
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228571
      Issue No: Vol. 13, No. 2 (2018)
       
  • Pneumorrhachis following chest injury: A rare entity

    • Authors: Shivender Sobti, S Bhaskar, Rajesh K Sharma, Ajay Choudhary
      Pages: 440 - 441
      Abstract: Shivender Sobti, S Bhaskar, Rajesh K Sharma, Ajay Choudhary
      Asian Journal of Neurosurgery 2018 13(2):440-441
      Pneumorrhachis (PR) – the phenomenon of intraspinal air – is a rare radiological finding. The presence of intraspinal air is usually after epidural injections, spinal manipulations, synovial cysts, degenerative disc disease, and epidural abscess. PR is mostly asymptomatic but can also be symptomatic. We report a case with PR after chest trauma and attempt to explain its development.
      Citation: Asian Journal of Neurosurgery 2018 13(2):440-441
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_81_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Occipital neuralgia from C2 cavernous malformation

    • Authors: Sang-woo Ha, Jin-gyu Choi, Byung-chul Son
      Pages: 442 - 445
      Abstract: Sang-woo Ha, Jin-gyu Choi, Byung-chul Son
      Asian Journal of Neurosurgery 2018 13(2):442-445
      A unique case is presented of chronic occipital neuralgia (ON) caused by cavernous malformation (CM) in the intramedullary C2 spinal cord and subsequent pain relief and remodeling of allodynic pain following dorsal root rhizotomy. A 53-year-old male presented with a 30-year history of chronic allodynic, paroxysmal lancinating pain in the greater and lesser occipital nerves. Typically, the pain was aggravated with neck extension and head movement. Magnetic resonance imaging showed a CM in the right posterolateral side of the intramedullary C2 cord. Considering potential risks associated with removal of the lesion, intradural C1-3 dorsal root rhizotomy with dentate ligament resection was performed. The paroxysmal lancinating pain of ON was significantly alleviated, and the remodeling of the extent of allodynic pain was noted after C1-3 dorsal root rhizotomy. These changes gradually occurred during the second postoperative month, and this effect was maintained for 24 months postoperatively. Significant reduction in chronic allodynic pain of secondary ON caused by cervicomedullary CM involving central sensitization in the trigeminocervical complex was observed with reduction of irritating, afferent input with C1-C3 dorsal root rhizotomy.
      Citation: Asian Journal of Neurosurgery 2018 13(2):442-445
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.181131
      Issue No: Vol. 13, No. 2 (2018)
       
  • Silent migration of ventriculoperitoneal shunt per anus in a child:
           Management and review of literature

    • Authors: Sachin Parshuram Guthe, Survashe Pravin, Poonam Darade, Vernon Velho
      Pages: 446 - 448
      Abstract: Sachin Parshuram Guthe, Survashe Pravin, Poonam Darade, Vernon Velho
      Asian Journal of Neurosurgery 2018 13(2):446-448
      The aim of this paper is to report a case of ventriculoperitoneal (VP) shunt tube coming out through the anus in a 6-year-old boy, who had undergone shunt revision surgery for the malfunctioning of the peritoneal end 6 months back. Among the complications of VP shunt surgery, such unusual migration of peritoneal end of the VP shunt is very rare. The possible factors responsible for this complication, in our case, were abdominal adhesions and thin bowel wall in the children. Although this complication has been previously reported, it remains an exceedingly rare case. Risk factors and possible mechanisms of migration are discussed.
      Citation: Asian Journal of Neurosurgery 2018 13(2):446-448
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228559
      Issue No: Vol. 13, No. 2 (2018)
       
  • Hemispheric infarct following a cerebellar hematoma: A rare coincidence

    • Authors: R Girish Menon, Vinod Kumar, IK Laskhman, Rajesh P Nair
      Pages: 449 - 452
      Abstract: R Girish Menon, Vinod Kumar, IK Laskhman, Rajesh P Nair
      Asian Journal of Neurosurgery 2018 13(2):449-452
      Concomitant cerebral infarction developing soon after a parenchymal intracerebral hemorrhage is a rare occurrence. Usually, these remote site changes follow tumor decompression and are associated with hemorrhagic changes rather than infarcts. We report a case of a fatal malignant internal carotid territory infarct in a hospitalized patient being conservatively managed for a vermian hematoma and discuss the probable pathophysiology. Stroke physicians need to be aware that spontaneous intracerebral hematoma patients have a potential threat of developing large vessel occlusion with malignant cerebral infarcts, especially after surgical decompression. Although the exact pathogenesis is unknown, size of the clot, intraventricular hemorrhage, hydrocephalus, and aggressive reduction of blood pressure appear to be predictive factors.
      Citation: Asian Journal of Neurosurgery 2018 13(2):449-452
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_227_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Traumatic supra- and infra-tentorial extradural hematoma: Case series and
           literature review

    • Authors: Yunus Kuntawi Aji, Tedy Apriawan, Abdul Hafid Bajamal
      Pages: 453 - 457
      Abstract: Yunus Kuntawi Aji, Tedy Apriawan, Abdul Hafid Bajamal
      Asian Journal of Neurosurgery 2018 13(2):453-457
      Traumatic supra- and infra-tentorial extradural hematoma (TSIEDH) is a rare lesion constituting <2% of all extradural hematomas. There are only a few published articles about TSIEDH. This study included three patients with TSIEDH who were treated and operated at Dr. Soetomo General Hospital, Surabaya, Indonesia, from August 2015 to July 2016. Two patients sustained injuries in traffic accidents and one patient was injured by fall. The male to female ratio was 1:2. Glasgow Coma Scale (GCS) score ≤8 was present in one and GCS score of 9–12 was present in two patients. The brain computed tomography scan verified linear fracture of occipital bone in one and linear fracture of occipital bone with lambdoid suture separation in two patients. Early diagnosis and early surgical intervention of TSIEDH are imperative because the deterioration of TSIEDH is sudden and quick. We presented our experience in treating patients with TSIEDH in Dr. Soetomo General Hospital, Surabaya, Indonesia.
      Citation: Asian Journal of Neurosurgery 2018 13(2):453-457
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_282_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Rapidly developing subdural empyema in an adult with sinusitis: A
           neurosurgical threat alert

    • Authors: Kabilan Chokkappan, Rahul Lohan
      Pages: 458 - 461
      Abstract: Kabilan Chokkappan, Rahul Lohan
      Asian Journal of Neurosurgery 2018 13(2):458-461
      Subdural empyema (SDE) is collection of pus in the potential space between the dura and arachnoid layers of the meninges. Leading causes of SDE are sinonasal and otomastoid infections. Commonly affecting patients in the second and third decades, SDE could have a fulminant course with immediate complications and delayed morbidities including hydrocephalus, focal deficits, and epilepsy.
      Citation: Asian Journal of Neurosurgery 2018 13(2):458-461
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_97_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Transcranial and epidural approach for spontaneous cerebrospinal fluid
           leakage due to meningoencephalocele of the lateral sphenoid sinus

    • Authors: Ryosuke Shintoku, Masahiko Tosaka, Tatsuya Shimizu, Yuhei Yoshimoto
      Pages: 462 - 464
      Abstract: Ryosuke Shintoku, Masahiko Tosaka, Tatsuya Shimizu, Yuhei Yoshimoto
      Asian Journal of Neurosurgery 2018 13(2):462-464
      We experienced a case of sphenoid sinus type meningoencephalocele manifesting as severe cerebrospinal fluid (CSF) rhinorrhea. A 35-year-old man became aware of serous nasal discharge 1 year previously, which had gradually worsened. The nasal discharge was diagnosed as CSF rhinorrhea. Head computed tomography (CT) showed several small depressions in the bone of the left middle cranial fossa, and the largest depression extended through the bone to the lateral sphenoid sinus. Head magnetic resonance imaging revealed that the meningoencephalocele projected to the lateral sphenoid sinus, through this small bone defect of the middle cranial fossa. We performed a combined craniotomy and epidural approach without intradural procedures using neuronavigation. Multiple meningoencephaloceles protruded into small depressions in the middle skull base. The small protrusions not passing through the sphenoid sinus were coagulated. The largest protrusion causing the CSF leakage was identified by neuronavigation. This meningoencephalocele was cut. Both the dural and bone sides were closed with double layers to prevent CSF leakage. The CSF rhinorrhea completely stopped after the surgery. In our case, identification of the leak site was easy with neuronavigation based on bone window CT. The epidural approach also has significant advantages with double layer closure, including both the dural and bone sides. If the site of CSF leakage is outside the foramen rotundum (as with the most common type of lateral sphenoid sinus meningoencephalocele), we recommend the epidural approach using neuronavigation for surgical treatment.
      Citation: Asian Journal of Neurosurgery 2018 13(2):462-464
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228579
      Issue No: Vol. 13, No. 2 (2018)
       
  • Dural ectasia and cauda equina syndrome: A rare complication of
           long-standing fusion

    • Authors: Vrushali D Bachhav, Sumeet G Dua, Miral D Jhaveri
      Pages: 465 - 467
      Abstract: Vrushali D Bachhav, Sumeet G Dua, Miral D Jhaveri
      Asian Journal of Neurosurgery 2018 13(2):465-467
      The clinicoradiological combination of cauda equina syndrome (CES) and dural ectasia is rare and has been described in a few of patients with ankylosing spondylitis (AS). Simultaneous occurrence of these entities in the absence of AS and in patients with long-standing spinal fusion is extremely rare. We present a case of dural ectasia and CES occurring as a long-term complication of instrumented spinal fusion and discuss the pathogenesis, imaging findings, and management options of this elusive disease process.
      Citation: Asian Journal of Neurosurgery 2018 13(2):465-467
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_113_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • A rare case of spinal extradural arachnoid cyst with cord compression

    • Authors: Lee Chun Lin, R Jason
      Pages: 468 - 470
      Abstract: Lee Chun Lin, R Jason
      Asian Journal of Neurosurgery 2018 13(2):468-470
      Spinal extradural arachnoid cysts are rare lesions which typically involve the thoracic spine and are an asymptomatic condition of unknown origin. They may also produce symptoms by compressing the spinal cord or nerve roots. Surgery is the treatment of choice in such lesions, but asymptomatic patients can be managed conservatively. We present a case of symptomatic, probable traumatic origin, spinal arachnoid cyst at our center in Hospital Kuala Lumpur, Malaysia. Magnetic resonance imaging spine showed well-defined, nonenhancing extradural cystic lesion from T5 to T6 vertebrae level compressing spinal cord anteriorly. The patient underwent T5, T6 laminoplasty, T4 partial laminectomy and excision of the cyst. Histologically, the cyst wall comprised of collagen and meningothelial cells. This surgical intervention achieved neurological improvement in terms of motor power in our follow-up of this patient.
      Citation: Asian Journal of Neurosurgery 2018 13(2):468-470
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_310_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Awake craniotomy with noninvasive brain mapping by 3-Tesla functional
           magnetic resonance imaging for excision of low-grade glioma: A case of a
           young patient from Pakistan

    • Authors: Atta Ul Aleem Bhatti, Nasir Khan Jakhrani, Maria Adnan Parekh
      Pages: 471 - 474
      Abstract: Atta Ul Aleem Bhatti, Nasir Khan Jakhrani, Maria Adnan Parekh
      Asian Journal of Neurosurgery 2018 13(2):471-474
      The past few years have seen increasing support for gross total resection in the management of low-grade gliomas (LGGs), with a greater extent of resection correlated with better overall survival, progression-free survival, and time to malignant transformation. There is consistent evidence in literature supporting extent of safe resection as a good prognostic indicator as well as positively affecting seizure control, symptomatic relief in pressure symptoms, and longer progression-free and total survival. The operative goal in most LGG cases is to maximize the extent of resection for these benefits while avoiding postoperative neurologic deficits. Several advanced invasive and noninvasive surgical techniques such as intraoperative magnetic resonance imaging (MRI), fluorescence-guided surgery, intraoperative functional pathway mapping, and neuronavigation have been developed in an attempt to better achieve maximal safe resection. We present a case of LGG in a young patient with a 5-year history of refractory seizures and gradual onset walking difficulty. Serial MRI brain scans revealed a progressive increase in right frontal tumor size with substantial edema and parafalcine herniation. Noninvasive brain mapping by functional MRI (fMRI) and sleep-awake-sleep type of anesthesia with endotracheal tube insertion was utilized during an awake craniotomy. Histopathology confirmed a Grade II oligodendroglioma, and genetic analysis revealed no codeletion at 1p/19q. Neurological improvement was remarkable in terms of immediate motor improvement, and the patient remained completely seizure free on a single antiepileptic drug. There is no radiologic or clinical evidence of recurrence 6 months postoperatively. This is the first published report of an awake craniotomy for LGG in Pakistan. The contemporary concept of supratotal resection in LGGs advocates generous functional resection even beyond MRI findings rather than mere excision of oncological boundaries. This relatively aggressive approach is only possible with an awake craniotomy, which ensures preservation of functional status and thus less postoperative morbidity and better outcomes. Noninvasive mapping for intracranial space-occupying lesions, including fMRI and blood-oxygen-level dependent (BOLD) imaging modality, is an essential tool in a resource-limited setting such as Pakistan.
      Citation: Asian Journal of Neurosurgery 2018 13(2):471-474
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_144_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • A rare extra-axial midline tentorial adult medulloblastoma with dural-tail
           sign mimicking a meningioma

    • Authors: Ninh Ba Doan, Mohit Patel, Ha Son Nguyen, Karl Janich, Andrew Montoure, Saman Shabani, Michael Gelsomino
      Pages: 475 - 477
      Abstract: Ninh Ba Doan, Mohit Patel, Ha Son Nguyen, Karl Janich, Andrew Montoure, Saman Shabani, Michael Gelsomino
      Asian Journal of Neurosurgery 2018 13(2):475-477
      Medulloblastomas are categorized as the World Health Organization Grade IV neoplasms. Only 33 cases have been reported of extra-axial, mostly in the cerebellar pontine angle and lateral cerebellar hemisphere, medulloblastomas in the current literature. Our study showcases the first case of an extremely rare presentation of an extra-axial midline tentorial adult medulloblastoma with the dural-tail sign mimicking a meningioma. To achieve the best possible outcome, a high index of suspicion for medulloblastoma is critical especially in young patient with an atypical posterior fossa mass as treatment regimens drastically different between a medulloblastoma and a meningioma.
      Citation: Asian Journal of Neurosurgery 2018 13(2):475-477
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228563
      Issue No: Vol. 13, No. 2 (2018)
       
  • Intramedullary melanocytoma of the cervicothoracic cord: Case report and
           review of literature

    • Authors: Amitesh Dubey, Rashim Kataria, Vimal R Sardana
      Pages: 478 - 481
      Abstract: Amitesh Dubey, Rashim Kataria, Vimal R Sardana
      Asian Journal of Neurosurgery 2018 13(2):478-481
      Melanocytoma is rare pigmented tumor of the leptomeninges which arise from the neural crest. Intramedullary location of the tumor is extremely rare, and only a few case reports are available in the literature. We report a case of 35-year-old female with the entity who had a near total removal of the intramedullary tumor with good postoperative outcome. The available literature is reviewed.
      Citation: Asian Journal of Neurosurgery 2018 13(2):478-481
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228560
      Issue No: Vol. 13, No. 2 (2018)
       
  • Suction decompression during anterior clinoidectomy for direct clipping of
           paraclinoid aneurysm involving the anterior clinoid process

    • Authors: Naoki Otani, Kojiro Wada, Terushige Toyoka, Kentaro Mori
      Pages: 482 - 484
      Abstract: Naoki Otani, Kojiro Wada, Terushige Toyoka, Kentaro Mori
      Asian Journal of Neurosurgery 2018 13(2):482-484
      Surgical clipping of paraclinoid aneurysms involving the anterior clinoid process (ACP) can present great challenges because strong adhesion may hinder dissection of the surrounding anatomical structures from the aneurysm dome. On the other hand, retrograde suction decompression (RSD) through direct puncture of the common carotid artery is a useful adjunct technique for clipping of these aneurysms. The present case illustrates that direct clipping of paraclinoid aneurysms involving the ACP can be achieved safely and less invasively using RSD during anterior clinoidectomy. Postoperatively, her clinical course was uneventful. RSD is a useful technique during anterior clinoidectomy in direct clipping of paraclinoid aneurysms involving the ACP.
      Citation: Asian Journal of Neurosurgery 2018 13(2):482-484
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_153_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Safe use of tissue plasminogen activator in conjunction with the integra
           camino bolt for the drainage of chronic subdural hematoma

    • Authors: Ninh B Doan, Mohit Patel, Ha Son Nguyen, Hayley Doan, Andrew Montoure, Saman Shabani, Michael Gelsomino, Karl Janich
      Pages: 485 - 486
      Abstract: Ninh B Doan, Mohit Patel, Ha Son Nguyen, Hayley Doan, Andrew Montoure, Saman Shabani, Michael Gelsomino, Karl Janich
      Asian Journal of Neurosurgery 2018 13(2):485-486
      Chronic subdural hematoma (CSDH) is a relatively common condition encountered in a neurosurgical practice. There have been increased efforts in creating different treatment regimens for CSDH to improve patients' outcomes, including the addition of tissue plasminogen activator (tPA) in drains to reduce recurrences. Here, we present the first case report of the safe use of tPA in conjunction with an Integra Camino bolt for maximized drainage of CSDH with a successful neurological recovery and the complete resolution of the hematoma.
      Citation: Asian Journal of Neurosurgery 2018 13(2):485-486
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_230_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Ruptured distal anterior choroidal artery aneurysm presenting as isolated
           intraventricular hemorrhage: Case report and comprehensive review of the
           literature

    • Authors: Chi Hau Tan, Leon T Lai, Ronil V Chandra
      Pages: 487 - 491
      Abstract: Chi Hau Tan, Leon T Lai, Ronil V Chandra
      Asian Journal of Neurosurgery 2018 13(2):487-491
      Distal anterior choroidal artery (AChA) aneurysms are infrequent. We discuss the case of a 59-year-old patient who presented with an isolated intraventricular hemorrhage (IVH) secondary to a ruptured distal AChA aneurysm. Initial noninvasive cerebral computed tomography angiography revealed no evidence of an underlying vascular pathology. The patient underwent further digital subtraction cerebral angiography, which revealed an aneurysm arising from the distal AChA segment. The aneurysm was successfully treated with surgical clip ligation. The current study highlights the importance of considering a ruptured distal AChA aneurysm as a potential source of isolated IVH.
      Citation: Asian Journal of Neurosurgery 2018 13(2):487-491
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_256_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Capsuloganglionic germinoma: A rare site for uncommon childhood tumor

    • Authors: Kuntal Kanti Das, Jeena Joseph, Amit Kumar Singh, Pradeep Sharma, Jayesh Sardhara, Kamlesh Singh Bhaisora, Anant Mehrotra, Arun Kumar Srivastava, Sushila Jaiswal, Rabi Narayan Sahu, Awadhesh Kumar Jaiswal, Sanjay Behari
      Pages: 492 - 495
      Abstract: Kuntal Kanti Das, Jeena Joseph, Amit Kumar Singh, Pradeep Sharma, Jayesh Sardhara, Kamlesh Singh Bhaisora, Anant Mehrotra, Arun Kumar Srivastava, Sushila Jaiswal, Rabi Narayan Sahu, Awadhesh Kumar Jaiswal, Sanjay Behari
      Asian Journal of Neurosurgery 2018 13(2):492-495
      Germ cell tumors (GCTs) are rare intracranial tumors with a strong predilection for children. Commonly, these tumors arise either in the suprasellar or the pineal region. The basal ganglia-thalamus complex represents a rare site of nonmidline intracranial GCTs. Such basal ganglionic GCTs have been reported to produce certain interesting clinico-radiological features, the knowledge of which may provide important diagnostic clues preoperatively. We present the case of a 9.5-year-old boy who presented with right hemiparesis and precocious puberty. Imaging revealed a heterogeneously enhancing mass involving the left capsuloganglionic region, sparing the thalamus. There was little perilesional edema and midline shift. Because of the deep location of the mass and a lack of mass effect, a neuronavigation-guided tumor biopsy was performed which unraveled a pure germinoma. The child was referred for adjuvant radiotherapy following an uneventful postoperative course. At the time of writing the report, the child was on radiotherapy and doing well.
      Citation: Asian Journal of Neurosurgery 2018 13(2):492-495
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_284_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Intraoperative rupture cerebral aneurysm and computational flow dynamics

    • Authors: Ilya Senko, Anton Shatokhin, Ishu Bishnoi, Yasuhiro Yamada, Riki Tanaka, Daisuke Suyama, Tukasa Kawase, Yoko Kato
      Pages: 496 - 498
      Abstract: Ilya Senko, Anton Shatokhin, Ishu Bishnoi, Yasuhiro Yamada, Riki Tanaka, Daisuke Suyama, Tukasa Kawase, Yoko Kato
      Asian Journal of Neurosurgery 2018 13(2):496-498
      Intraoperative aneurysmal rupture (IAR) is the most fearsome complication of aneurysm surgery. IAR associates with high morbidity and mortality. In recent years, we have many studies regarding using computational fluid dynamics (CFD) in aneurysm surgery. CFD helps in calculating the velocity of blood flowing in the aneurysm sac, the pressure in the aneurysm sac, and wall shear stress (WSS). CFD also helps in predicting nature of aneurysm wall and thus may warn about different intraoperative microscopy findings in aneurysms. Using its application, surgeon may become more careful in doing microsurgical sharp dissection. A 40-year-old female admitted with diagnosis of unruptured anterior communicating artery aneurysm. CFD analysis demonstrated high intra-aneurysmal pressure and divergent WSS in dome. During sharp dissection, there was intraoperative rupture aneurysm twice which was managed with cotton tamponade and glue and temporary clipping aneurysm. Indocyanine green video angiography showed working parent arteries and nonfunctioning aneurysm. After operation, the patient recovered fully and had a modified Rankin score of 1. This case demonstrated importance of preoperative planning of aneurysm surgery using CFD analysis. IAR is associated with an increased risk for an unfavorable outcome. Accurate preoperative planning with studying flow dynamics and structure of aneurysm may help in use sharp microsurgical dissection more cautiously.
      Citation: Asian Journal of Neurosurgery 2018 13(2):496-498
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_359_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Venous malformation (Cavernous Hemangioma) of the supraorbital nerve

    • Authors: Jung-hoon Kim, Jin-gyu Choi, Byung-chul Son
      Pages: 499 - 502
      Abstract: Jung-hoon Kim, Jin-gyu Choi, Byung-chul Son
      Asian Journal of Neurosurgery 2018 13(2):499-502
      Cavernous hemangiomas are not true vascular tumors, but rather are slow-flow venous malformations (VMs). They are present at birth as nonproliferating vascular birthmarks composed of anomalous ectatic venous channels. VMs have often been incorrectly called cavernous hemangiomas and cavernous angiomas. These terms have for a long time lead to confusion with the more common proliferating or true hemangioma of infancy. VM has been reported to arise at all sites including skin and subcutaneous layers of the head and neck, face, extremities, liver, gastrointestinal tract, and even the thymus. Although VMs are common intraocular tumors and are involved within intracranial, extraaxial cranial nerves within the cavernous sinus has been sporadically reported, and less often in the supraorbital nerve, an extraocular and extracranial division of the trigeminal nerve has not been reported. The authors present an extremely rare occurrence of VM involving the supraorbital nerve in an 80-year-old female.
      Citation: Asian Journal of Neurosurgery 2018 13(2):499-502
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_166_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Endoscopic management of a fourth ventricular cyst

    • Authors: Saba Jafarpour, Morteza Faghih Jouibari, Leila Aghaghazvini, Vafa Rahimi-Movaghar
      Pages: 503 - 506
      Abstract: Saba Jafarpour, Morteza Faghih Jouibari, Leila Aghaghazvini, Vafa Rahimi-Movaghar
      Asian Journal of Neurosurgery 2018 13(2):503-506
      We report a case of a 12-year-old boy with previously shunted congenital hydrocephalus, presenting with a progressive headache, nausea, vomiting, and lethargy. In the brain magnetic resonance imaging, a large cyst was seen in the superior recess of the fourth ventricle extending through the cerebral aqueduct toward the third ventricle. Endoscopic dual fenestration of the cyst was performed successfully using the posterior suboccipital approach through the foramen of Magendie, which resulted in the relief of symptoms without any complications, and the patient was symptom-free in the subsequent follow-up visits for 4 years.
      Citation: Asian Journal of Neurosurgery 2018 13(2):503-506
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228533
      Issue No: Vol. 13, No. 2 (2018)
       
  • Language mapping in awake surgery: Report of two cases with review of
           language networks

    • Authors: Liang Hooi Lim, Zamzuri Idris, Faruque Reza, Wan Mohd Nazaruddin Wan Hassan, Laila Abd Mukmin, Jafri Malin Abdullah
      Pages: 507 - 513
      Abstract: Liang Hooi Lim, Zamzuri Idris, Faruque Reza, Wan Mohd Nazaruddin Wan Hassan, Laila Abd Mukmin, Jafri Malin Abdullah
      Asian Journal of Neurosurgery 2018 13(2):507-513
      The role of language in communication plays a crucial role in human development and function. In patients who have a surgical lesion at the functional language areas, surgery should be intricately planned to avoid incurring further morbidity. This normally requires extensive functional and anatomical mappings of the brain to identify regions that are involved in language processing and production. In our case report, regions of the brain that are important for language functions were studied before surgery by employing (a) extraoperative methods such as functional magnetic resonance imaging, transmagnetic stimulation, and magnetoencephalography; (b) during the surgery by utilizing intraoperative awake surgical methods such as an intraoperative electrical stimulation; and (c) a two-stage surgery, in which electrical stimulation and first mapping are made thoroughly in the ward before second remapping during surgery. The extraoperative methods before surgery can guide the neurosurgeon to localize the functional language regions and tracts preoperatively. This will be confirmed using single-stage intraoperative electrical brain stimulation during surgery or a two-stage electrical brain stimulation before and during surgery. Here, we describe two cases in whom one has a superficial lesion and another a deep-seated lesion at language-related regions, in which language mapping was done to preserve its function. Additional review on the neuroanatomy of language regions, language network, and its impairment was also described.
      Citation: Asian Journal of Neurosurgery 2018 13(2):507-513
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_176_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • Giant occipital intradiploic epidermoid cyst

    • Authors: Arun Oommen, Jayasree Govindan, Devan Surendran Peroor, C Roshan Azeez, R Rashmi, Muhammed Jasim Abdul Jalal
      Pages: 514 - 517
      Abstract: Arun Oommen, Jayasree Govindan, Devan Surendran Peroor, C Roshan Azeez, R Rashmi, Muhammed Jasim Abdul Jalal
      Asian Journal of Neurosurgery 2018 13(2):514-517
      Intraparenchymal or intradiploic epidermoid cysts are very rare. Most of these cysts, when present, tend to involve the frontal and temporal lobes, and occasionally, the pineal gland or the brain stem. Here, we report a 45-year-old female, who presented with localized occipital headache and a tender occipital swelling, gradually increasing in size. She was hemodynamically and neurologically stable and did not have any focal neurological deficits. Whole skull and brain imaging revealed a well-demarcated expansile lytic lesion in the right occipital bone, which was hypointense on T1-weighted and hyperintense on both T2-weighted imaging and diffusion-weighted imaging without any contrast enhancement. The patient underwent a right occipital craniotomy and total excision of the intradiploic space occupying lesion. Histopathological examination confirmed the lytic bone lesion over occipital bone as intradiploic epidermoid cyst.
      Citation: Asian Journal of Neurosurgery 2018 13(2):514-517
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.181146
      Issue No: Vol. 13, No. 2 (2018)
       
  • Neurocysticercosis in Japan

    • Authors: Victor Kwasi, Kunihiko Kodama, Toshiya Uchiyama, Yoshikazu Kusano, Toshiyuki Shimizu, Kazuo Tokushige, Toshiki Takemae
      Pages: 518 - 521
      Abstract: Victor Kwasi, Kunihiko Kodama, Toshiya Uchiyama, Yoshikazu Kusano, Toshiyuki Shimizu, Kazuo Tokushige, Toshiki Takemae
      Asian Journal of Neurosurgery 2018 13(2):518-521
      Neurocysticercosis is a condition rarely reported in Japan, and therefore, the specific route of infestation in our set up has not been conclusively elucidated. Preoperative diagnosis remains difficult to make with certainty due to the slowly evolving nature of the disease and the fact that there are no typical characteristic clinical findings particularly associated with the disease. The hematological, serological, serum biochemistry, stool, and radiological tests were nonspecific for neurocysticercosis. The characteristic neuro-imaging findings were demonstrated in this case, and histopathology confirmed Taenia solium parenchymal infestation.
      Citation: Asian Journal of Neurosurgery 2018 13(2):518-521
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228561
      Issue No: Vol. 13, No. 2 (2018)
       
  • Intracerebral hemorrhage with multiple intracranial arterial stenoses in a
           synthetic cannabinoid “Spice” user

    • Authors: Seckin Aydin, Odhan Yuksel, Aysegul Esen Aydin, Osman Kizilkilic, Suat Erol Celik
      Pages: 522 - 524
      Abstract: Seckin Aydin, Odhan Yuksel, Aysegul Esen Aydin, Osman Kizilkilic, Suat Erol Celik
      Asian Journal of Neurosurgery 2018 13(2):522-524
      Synthetic cannabinoids (spice), which are used frequently worldwide, are more potent than herbal compounds and also have more side effects in comparison. A 23-year-old male was admitted to the emergency unit with altered consciousness. There was no sign of trauma, and his medical history did not reveal any chronic illness. Computed tomography revealed a large frontal hematoma extending to the ventricular system. The outcomes of cerebral angiography were consistent with multiple intracranial arterial stenoses (MIAS) which can also be seen after cannabis usage. The patient made a good recovery with treatment, and during the follow-up, his medical condition was stable. In addition to the psychological symptoms, encephalopathy, ischemia, and seizures have also been described as side effects of synthetic cannabinoids. This paper reports an intracerebral hematoma due to synthetic cannabinoids and its association with MIAS.
      Citation: Asian Journal of Neurosurgery 2018 13(2):522-524
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/ajns.AJNS_48_16
      Issue No: Vol. 13, No. 2 (2018)
       
  • A case of vago-glossopharyngeal neuralgia caused by choroid plexus

    • Authors: Ali Akay, Mete R&#252;k&#351;en, Serta&#231; &#304;&#351;lekel
      Pages: 525 - 527
      Abstract: Ali Akay, Mete Rükşen, Sertaç İşlekel
      Asian Journal of Neurosurgery 2018 13(2):525-527
      Vascular compression has been reported to be the most common reason for vago-glossopharyngeal neuralgia (VGN). The treatment may include medications, ganglion blockade with a radiofrequency ablation, and microvascular decompression (MVD). A review of the literature reveals that VGN may develop due to choroid plexus compression, and the number of reported cases is very limited. The current case is the fifth in the relevant literature. In this paper, choroid plexus compression has been shown intraoperatively during the treatment of rare idiopathic VGN using MVD. Complaints of the patient have been resolved following the choroid plexus excision.
      Citation: Asian Journal of Neurosurgery 2018 13(2):525-527
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.180890
      Issue No: Vol. 13, No. 2 (2018)
       
  • Do we need to include “Elevated Skull Fractures” in skull
           fracture classification?

    • Authors: Amit Agrawal
      Pages: 528 - 528
      Abstract: Amit Agrawal
      Asian Journal of Neurosurgery 2018 13(2):528-528

      Citation: Asian Journal of Neurosurgery 2018 13(2):528-528
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228553
      Issue No: Vol. 13, No. 2 (2018)
       
  • Can pediatric bispectral index sensor replace adult bispectral index
           sensor for depth of anesthesia monitoring?

    • Authors: Indu Kapoor, Hemanshu Prabhakar, Charu Mahajan
      Pages: 529 - 530
      Abstract: Indu Kapoor, Hemanshu Prabhakar, Charu Mahajan
      Asian Journal of Neurosurgery 2018 13(2):529-530

      Citation: Asian Journal of Neurosurgery 2018 13(2):529-530
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228572
      Issue No: Vol. 13, No. 2 (2018)
       
  • The overview of the second annual winter seminar of cerebrovascular
           diseases in Banbuntane Hotokukai Hospital

    • Authors: Dilshod Mamadaliev, Yoko Kato, Sandeep Talari, Tushit Mewada
      Pages: 531 - 533
      Abstract: Dilshod Mamadaliev, Yoko Kato, Sandeep Talari, Tushit Mewada
      Asian Journal of Neurosurgery 2018 13(2):531-533

      Citation: Asian Journal of Neurosurgery 2018 13(2):531-533
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228574
      Issue No: Vol. 13, No. 2 (2018)
       
  • &#8220;Sinking Bone&#8221; flap presenting as reversible
           postural hemiparesis

    • Authors: Prasad Krishnan, Rajaraman Kartikueyan, Sachinkumar Maheshbhai Patel, Sayan Das
      Pages: 534 - 535
      Abstract: Prasad Krishnan, Rajaraman Kartikueyan, Sachinkumar Maheshbhai Patel, Sayan Das
      Asian Journal of Neurosurgery 2018 13(2):534-535

      Citation: Asian Journal of Neurosurgery 2018 13(2):534-535
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228513
      Issue No: Vol. 13, No. 2 (2018)
       
  • Bony tumors of the cranial base: One size does not fit all

    • Authors: Maysam Alimohamadi
      Pages: 536 - 537
      Abstract: Maysam Alimohamadi
      Asian Journal of Neurosurgery 2018 13(2):536-537

      Citation: Asian Journal of Neurosurgery 2018 13(2):536-537
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228576
      Issue No: Vol. 13, No. 2 (2018)
       
  • Commentary on - Management of orbitocranial non-missile wounds

    • Authors: Abbas Amirjamshidi, Kazem Abbassioun
      Pages: 538 - 538
      Abstract: Abbas Amirjamshidi, Kazem Abbassioun
      Asian Journal of Neurosurgery 2018 13(2):538-538

      Citation: Asian Journal of Neurosurgery 2018 13(2):538-538
      PubDate: Mon,26 Mar 2018
      DOI: 10.4103/1793-5482.228556
      Issue No: Vol. 13, No. 2 (2018)
       
 
 
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