Sailesh Gaikwad - Academia.edu (original) (raw)

Uploads

Papers by Sailesh Gaikwad

Interventional Neuroradiology, Mar 1, 2001

Stroke Research and Treatment, 2011

Journal of NeuroInterventional Surgery, Jul 1, 2012

Introduction/Purpose Retrospective study of spinal angiography and management of spinal arterio-v... more Introduction/Purpose Retrospective study of spinal angiography and management of spinal arterio-venous malformations, at the department of Neuroradiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India, between 1989 and June 2011. Materials and Methods 190 patients were analyzed. 17 were negative angiograms. Four had spinal tumors. Arterio-venous spinal malformation was diagnosed in 169 patients. Results Among these 169 patients, 51 (30.2%) had spinal dural arteriovenous fistulae (SDAVFs), 48 (28.4%) had spinal cord arteriovenous malformations (SCAVMs), 58 (34.3%) had spinal cord arteriovenous fistulae (SCAVFs), 9 (5.3%) had epidural arteriovenous fistulae and 3 (1.8%) miscellaneous lesions. Overall preponderance of males (75%) was observed. SCAVF was the most common vascular lesion in our series. 90% of SDAVF patients were male. Most had progressive symptoms of motor weakness (96%), sensory deficits (90%) and sphincter disturbances (88%). Dorso-lumbar (D6–L2) location common, except one fistula at foramen magnum. In four patients, there were two fistulae each, two of them metachronous and two of them synchronous. Mean time to diagnosis in SDAVF was 12.9 months. 34 SDAVF patients were treated by surgery which improved or stabilized the clinical status in 88.5% & 3 (11.5%) deteriorated after surgery. Embolization was successful in 58% patients attempted & all improved with no recurrence. SCAVFs (58) outnumbered SCAVMs (48). Macro SCAVFs were preferentially treated by embolization and all except one improved. 60% Micro-AVFs treated by embolization and 93% of them improved. On the other hand 33% Micro-AVFs worsened after surgery. Three out of seven radicular fistulae treated by embolization improved clinically. Surgery was preferred for filar fistulae and 90% improved. Mean age of presentation for SCAVM was 25 years and 31.25% of them were younger than 20 years. 33% had acute however MR evidence of haematomyelia was seen in only 10%. 75% were Glomus type, 16.5% Multimyelomeric and four (8.5%) had Metameric malformations. 56% focal cord lesions occurred in dorso-lumbar region. Conus AVMs were between 21 and 30 years. Three out of four metameric lesions involved cervical segments. Venous ectasia, pial venous reflux and arteriovenous micro-fistulae were dominant angiographic features in SCAVMs. Aneurysm or pseudo-aneurysms were observed in 31.25% of cases. Out of 35 SCAVMs, 29 (83%) were treated by embolization with improvement or stabilization in 86%. 90% or more nidus obliteration could be achieved in 13 (44.83%), 80-90% in 7 (24.14%), 60-80% in 5 (17.24%) and 40%–60% in 4 (13.79%). Surgery improved or stabilized five out of six SCAVMs and one deteriorated. Six epidural AVMs and three vertebra-venous (VVF) fistulae were treated by embolization with cure of VVFs. Epidural AVMs typically required multiple sessions. Two spinal artery aneurysms in collateralized spinal artery were treated by coiling. Conclusion Endovascular treatment is effective in treating majority of spinal vascular lesions. Surgery can be reserved for selective situations like filar AVFs, lesions with unfavorable for endovascular embolizations and failed embolizations. Competing interests None.

Advances in Ophthalmology and Optometry, Aug 1, 2022

American Journal of Roentgenology, Nov 1, 1997

Journal of Clinical Neuroscience, Oct 1, 1998

Journal of Neuro-oncology, Aug 1, 2005

Skeletal Radiology, Jul 27, 1998

Interventional Neuroradiology, Feb 18, 2021

Basilar artery fenestration aneurysms are very rare and endovascular management of large and comp... more Basilar artery fenestration aneurysms are very rare and endovascular management of large and complex aneurysms is extremely challenging. Most of these type of cases are managed with stent assisted coiling, dual flow diverters (FD) and single FD with additional coiling of aneurysm and occlusion of one of the vertebral artery. Here, we report a case of large complex basilar artery fenestration aneurysm successfully treated with single FD using novel technique called “crossing flow diverter technique” without any additional coiling of aneurysm or occlusion of vertebral artery. Using this technique cost of procedure and procedural complexity inherent with other above mentioned techniques can be significantly reduced.

$Research paper thumbnail of Feasibility of Tailored Unilateral Disconnection vs Callosotomy for Refractory Epilepsy in Patients with Bilateral Parieto-Occipital Gliosis Following Perinatal Insult$

Neurology India, Jul 23, 2022

Background: Patients with perinatal hypoxia (PH) and drug-refractory epilepsy (DRE) often have bi... more Background: Patients with perinatal hypoxia (PH) and drug-refractory epilepsy (DRE) often have bilateral parieto-occipital gliosis. Surgical management of such patients is a dilemma. Objective: To identify preoperative determinants for unilateral disconnection vs callosotomy, and analyze the surgical outcome in such patients. Methods and material: This was a retrospective analysis of patients with DRE and history of PH, with MRI abnormalities restricted to bilateral posterior quadrants. Preoperative semiology, epilepsy duration and seizure frequency were recorded. Based on the concordance between the results of non-invasive tests, patients underwent either posterior quadrant disconnection (PQD) or corpus callosotomy (CC). Preoperative variables were analyzed and corelated to the postoperative seizure freedom. Results: Fourteen patients were identified, 6 underwent PQD and 8 underwent CC. At follow up of 39.17 ± 23.75 months, 66.66% of patients (4/6) in the PQD subgroup had an ILAE Class I outcome. While none in the CC group attained seizure freedom, 87.5% (7/8) had more than 50% reduction in seizure frequency (follow up: 42 ± 27.31 months). Patients with a poor outcome had significantly greater seizure frequency (P = 0.05) and history of drop attacks (P = 0.04) in both the groups. Magnetoencephalography (MEG) accurately localized the epileptogenic zone in all of the patients with good outcome (P = 0.015). Concordance with single photon emission tomography (SPECT) was also a predictor of favorable outcome (P = 0.041). Conclusions: A history of drop attacks with high seizure frequency is associated with poor postoperative seizure outcome. Unilateral PQD is feasible and leads to superior seizure-free outcomes, even in cases with widespread and bilateral imaging and electrical abnormalities, provided the other preoperative investigations are concordant in localizing the epileptogenic zone.

Intracranial tuberculomas constitute 0.15 to 4 % of all intracranial space occupying lesions6,12 ... more Intracranial tuberculomas constitute 0.15 to 4 % of all intracranial space occupying lesions6,12 but used to account for 30-50 % of intracranial space occupying lesions before the advent of antitubercular chemotherapy.5 Isolated intra-

SSRN Electronic Journal, 2020

Mechanisms of Ageing and Development, 2020