Sampath Somanna - Academia.edu (original) (raw)

Papers by Sampath Somanna

Research paper thumbnail of Case Reports Ipsilateral Hemichorea-hemiballism in a Case of Postoperative Stroke

Background: Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on ... more Background: Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion.

Research paper thumbnail of Diagnostic Utility of CUSA Specimen in Histopathological Evaluation of Tumors of Central Nervous System

Neurology India, 2020

Introduction: Cavitron Ultrasonic Surgical Aspirator (CUSA) is a technique used for the surgical ... more Introduction: Cavitron Ultrasonic Surgical Aspirator (CUSA) is a technique used for the surgical treatment of tumors that aids the surgeon in highly selective tumor sampling with minimal injury to surrounding tissues. The utility of the tissue obtained from CUSA for histopathological diagnosis of central nervous system tumors is not as well-known as its surgical benefits. Even though a few studies have evaluated the diagnostic accuracy of CUSA specimen, these have dealt with very few cases. Methodology: In this study, we nil analysed 73 cases of CNS tumors (glial and non-glial) where CUSA specimen was available for histopathological examination and compared with findings on conventional samples as gold standard. Results: Most frequent types of artefacts induced by CUSA included tissue breakdown resembling necrosis, empty spaces in tissues, and crush artefacts particularly in cellular tumors, that interfered with interpretation. CUSA samples were found optimal for diagnosis of non-gl...

Research paper thumbnail of ”Tailored” far lateral approach to anterior foramen magnum meningiomas – The importance of condylar preservation

Neurology India, 2019

Introduction: Anterior and anterolaterally situated foramen magnum meningiomas are a technically ... more Introduction: Anterior and anterolaterally situated foramen magnum meningiomas are a technically complex subgroup of meningiomas. The need for an extensive exposure and bone work and their complex anatomy make them a difficult and challenging group of tumors to resect. The bone work has ranged from an extensive condylar resection to condylar preserving exposures. In this paper, we present our experience with condylar preserving or minimal condylar resection based approaches to these tumors. Materials and Methods: All patients who underwent surgical resection of anterior and anterolaterally situated foramen magnum meningiomas were included in the analysis. The study period was more than 10 years from 2005 to 2015 at our institute; a tertiary referral centre in India. The records along with demographic profile, clinico-radiological features, surgical strategies, outcomes as well as mortality and morbidity were analysed. Results: There were a total of 20 patients (9 males and 11 female...

Research paper thumbnail of Cranial and Spinal Malignant Peripheral Nerve Sheath Tumor: A Pathological Enigma

Journal of Neurosciences in Rural Practice, 2021

Objective Malignant peripheral nerve sheath tumor (MPNST) arises from nerve sheaths, mostly seen ... more Objective Malignant peripheral nerve sheath tumor (MPNST) arises from nerve sheaths, mostly seen in peripheral nerves but rare in craniospinal nerves. The information available in the literature to build up treatment strategy and improve clinical outcomes is scarce. We are reviewing cases from our institute, with emphasis on radiological features for early differentiation from its benign variants. Methods We analyzed pathologically diagnosed cases retrospectively from January 2007 to December 2018 at our institute. Clinicoradiological details and treatment parameters were collected from medical records for evaluation. Each case was contacted telephonically for final clinical follow-up at the time of writing the manuscript. Results A total of seven cases of MPNST were diagnosed in the last 10 years. It included four intracranial and three spinal cases. The mean age for the cohort was 34.3 years, with five females. We could achieve gross total resection (GTR) and subtotal resection in...

Research paper thumbnail of Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature

Journal of Neurosciences in Rural Practice, 2020

Background Posterior inferior cerebellar artery (PICA) is a tortuous, variable, and uncommon site... more Background Posterior inferior cerebellar artery (PICA) is a tortuous, variable, and uncommon site for aneurysms. Surgical management of PICA aneurysms involves careful selection of approach based on the location of the aneurysm and meticulous dissection of the neurovascular structures and perforators. Materials and Methods We did a retrospective review of all the PICA aneurysms operated at our institute in the past 10 years along with the site, presentation, and approach used for the same. Preoperative World Federation of Neurosurgical Society scores and follow-up modified Rankin scores (mRS) were also evaluated. During the same period, data for intervention cases of PICA aneurysm were also collected with follow-ups for a comparative analysis. Results A total of 20 patients with 21 PICA aneurysms were reviewed. All the reviewed cases presented with subarachnoid hemorrhage, and the most common location was the lateral medullary segment and vertebral artery (VA)–PICA junction. Midline...

Research paper thumbnail of Multiple-site neural tube defects: embryogenesis with complete review of existing literature

Neurosurgical Focus, 2019

OBJECTIVEMultiple-site neural tube defects (MNTDs) are very uncommon, with the predominant number... more OBJECTIVEMultiple-site neural tube defects (MNTDs) are very uncommon, with the predominant number of cases being reported in developing countries. The classic theory of neural tube closure fails to explain the occurrence of these defects. Multisite closure theory, first proposed in 1995, explains most of the occurrences with a few modifications specific to a few defects. In this paper, the authors endeavor to explain all the defects, along with their genetic and embryological bases, and to review the available literature and discuss their own experience in the management of these complex cases.METHODSThe authors retrospectively reviewed the data of all the patients treated surgically for MNTDs over that past 14 years. All possible demographic data, clinical details, and radiological imaging data were reviewed. In addition, surgical parameters, complications, and status at follow-up of more than 12 months were evaluated. All previously reported cases of MNTD were analyzed, and compar...

Research paper thumbnail of Needle in a haystack: migration of ventriculoperitoneal shunt into scrotum of infant

Egyptian Journal of Neurosurgery, 2018

Background: Ventriculoperitoneal shunt malpositions are known complications which tend to increas... more Background: Ventriculoperitoneal shunt malpositions are known complications which tend to increase the morbidity and recovery time of an elegant procedure. Distal malpositions into subcutaneous space due to improper closure or positioning can lead to shunt failure. Migration to the scrotum due to a patent processus vaginalis is, however, reported only in a handful of cases and, thus, needs to be highlighted and reported. Results: We report a case of congenital hydrocephalus that underwent shunting at the age of 3 months and reported to be 9 months later with the shunt tube being felt in the scrotum. Repositioning along with herniotomy was performed. Conclusions: A rare occurrence, scrotal migration, needs to recognized and reported. Potential preventive measures include truncation stiches and laproscopic assisted insertion.

Research paper thumbnail of Intracranial Germ Cell Tumors: Spectrum of Disease in an Indian Cohort and Management Strategies

Journal of neurosciences in rural practice

Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West,... more Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West, whereas in Asia, they constitute between 8% and 15% of pediatric brain tumors. We retrospectively studied all patients with intracranial GCT managed at our institute from January 1998 to December 2013. The clinical data and radiological data were analyzed. Forty-eight patients with intracranial GCT including 36 males and 16 females formed the cohort. The proportion of GCT in our study was 0.29%. The mean age was 16.5 ± 2.5 years. Germinomas constituted 56.3% and nongerminomatous GCTs constituted 43.7% of all the tumors. The most common location was posterior third ventricle (58.3%) followed by suprasellar (22.9%). Histopathological diagnosis was obtained in almost all patients (96%). Surgical procedures included tumor decompression (71.7%), stereotactic biopsy (13%), and endoscopic third ventriculostomy and biopsy (15%). Patient's age, location of the tumor, and histology did not in...

Research paper thumbnail of {"__content__"=>"Wolf in Sheep's clothing: Intracranial actinomycosis masquerading as meningioma.", "i"=>{"__content__"=>"en-plaque"}}

Surgical neurology international, 2018

is a gram-positive non-acid-fast bacterium and is the most common causative agent of actinomycosi... more is a gram-positive non-acid-fast bacterium and is the most common causative agent of actinomycosis. It usually presents as a brain abscess via a secondary spread from the cervicofacial region or lungs. However, presentation as an lesion with bone involvement out of proportion to brain parenchyma is rare and needs to be acknowledged. We report a case of intracranial lesion in a 47-year-old female with restriction of mouth opening and right third nerve palsy for 1 year. Imaging showed hyperostosis of the maxilla, temporal base, sphenoid, and zygoma with dural thickening suggestive of a meningioma. Surgical decompression yielded a granulomatous lesion along with empirical antitubercular therapy. However, patient succumbed to the infection and final histopathology revealed actinomycosis infection. Adequate knowledge along with clinical suspicion are the pillars to treating this unfortunate disease. Cheek swelling with bone involvement should be actively sought as risk factors. This case...

Research paper thumbnail of Rare Cranial Nerve Schwannomas: A Retrospective Review of Nontrigeminal, Nonvestibular Cranial Nerve Schwannomas

Journal of neurosciences in rural practice

Intracranial schwannomas arising from non-trigeminal and non-vestibular sources are extremely rar... more Intracranial schwannomas arising from non-trigeminal and non-vestibular sources are extremely rare constituting <0.8% of all schwannomas. In this article, we have analyzed our experience in the management of these rare tumors over a 10-year period. There were a total of 16 cases, with 11 of them undergoing microsurgical resection and 5 undergoing stereotactic radiosurgery (SRS). There were no fresh neurological deficit in any of these patients and two patients underwent postoperative SRS for residual tumor. One patient died due to postoperative septicemia. Knowledge of these lesions along with their clinicoradiological profile is essential to maintain a high index of suspicion and understand the nuances of treatment.

Research paper thumbnail of Abscess within a Glioblastoma: Mimicking a Matryoshka Doll

World neurosurgery, 2018

Abscess coexisting within a brain tumor is rare. Case reports in the literature primarily consist... more Abscess coexisting within a brain tumor is rare. Case reports in the literature primarily consist of sellar pathology and parenchymal lesions, including meningioma, glioma, and metastases. We report a case of glioblastoma with an intratumoral abscess in a middle-aged patient with no prior invasive procedure or systemic focus of infection. A 45-year-old woman presented with new-onset generalized seizures and rapidly progressive left hemiparesis. Imaging showed a right frontal necrotic lesion with a peripherally enhancing wall and solid component posteriorly. There was no diffusion restriction within the lesion. She was afebrile, and there was no systemic focus of infection. With provisional diagnosis of malignant glioma, she underwent surgical resection of the lesion. A differential diagnosis of abscess was considered preoperatively because of the rapid increase in size of the lesion. At surgery, there was a pus-filled cavity with a few areas of grayish, soft, flimsy wall and thrombo...

Research paper thumbnail of Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery

Journal of neurosciences in rural practice, 2017

Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressi... more Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressing the fourth ventricle. Symptoms related to HCP are expected to alleviate after resection of the tumor and decompression of the cerebrospinal fluid (CSF) pathways. However, some patients may require permanent cerebrospinal diversion even after surgery due to persistent HCP. In this study, the authors try to find out the factors associated with the requirement of CSF diversion after vestibular schwannoma surgery in cases of persistent HCP. This was a retrospective study involving 193 cases of vestibular schwannoma operated between 2010 and 2013 in our institute. Cases that underwent ventriculoperitoneal (VP) shunts before surgery were compared to cases which were operated directly. In cases where vestibular schwannomas were operated without prior VP shunts, factors which were associated with persistent postoperative HCP were analyzed. Comparing the group who underwent direct surgery to t...

Research paper thumbnail of Evaluation of Factors Affecting Outcome in Growth Hormone–Secreting Pituitary Adenomas

Indian Journal of Neurosurgery, 2017

Introduction Management of functioning pituitary adenomas is challenging as they can present with... more Introduction Management of functioning pituitary adenomas is challenging as they can present with features of an intracranial mass, systemic effects, or a combination of both. In this series, one of the largest in available literature from our country, we have analyzed our experience with surgical management of growth hormone (GH)-secreting pituitary adenomas and factors influencing their hormonal remission. Materials and Methods The data of all functional pituitary adenomas operated at our institute from January 2002 to December 2011 were obtained from the case files of these patients. This was studied for various clinical-radiologic features, management stratagems, and clinical and hormonal outcomes. Results Ninety-three patients of GH-secreting pituitary adenomas with a mean age of 32.7 years were included in the study. Fifty-three (57%) patients had headache at presentation; 46 (49%) had visual complaints, whereas menstrual irregularity was seen in majority of females. Mean GH l...

Research paper thumbnail of Isolated brainstem tuberculomas

Acta Neurochirurgica, 2017

Research paper thumbnail of Isolated Sphenoid Sinus Lesions: Experience with a Few Rare Pathologies

Journal of Neurosciences in Rural Practice, 2017

Introduction: The sphenoid sinus is often neglected because of its difficult access. The deep pos... more Introduction: The sphenoid sinus is often neglected because of its difficult access. The deep position of the sphenoid sinus hinders early diagnosis of pathologies in that location. Delayed diagnosis can cause serious complications due to proximity to many important structures. Objectives: The aim of this study is to demonstrate different pathologies which can affect the sphenoid sinus and elucidate the findings. Methods: Cases of isolated sphenoid sinus lesions encountered in the neurosurgical setting which had rare pathologies are discussed. Pathologies such as Langerhans cell histiocytosis, solitary plasmacytoma, chordoma, pituitary adenoma, leiomyosarcoma, fungal infection, and mucocele which appeared primarily in sphenoid sinus are discussed along with their imaging features and pathological findings. Conclusion: Multitude of different pathologies can occur in sphenoid sinus. Detailed preoperative imaging is very helpful, but transnasal biopsy and histological study are require...

Research paper thumbnail of Ruptured blebs and racing hearts: autonomic cardiac changes in neurosurgeons during microsurgical clipping of aneurysms

British Journal of Neurosurgery, 2016

In this study, we intend to evaluate the autonomic changes occurring in neurosurgeons and thus th... more In this study, we intend to evaluate the autonomic changes occurring in neurosurgeons and thus the stress during microsurgical clipping of aneurysms. The aim of the current study is to evaluate the heart rate variability (HRV) of the neurosurgeons during microsurgical clipping of aneurysm by using continuous real time monitoring of the ECG intraoperatively. Lead II ECG was recorded using Bioharness(®) (Zephyr Technologies, Annapolis, MD) in 4 healthy neurosurgeons who performed 29 microsurgical clipping of aneurysms. ECG from 21 surgeries was analysed (LabChart(®) software, ADInstruments, Dunedin, New Zealand) across five stages: Baseline (BL), sylvian fissure dissection (SFD), perianeurysmal dissection (PAD), clipping of the aneurysm (CLIP) and haemostasis (HEMO). There was a reduction in TP and an increased LF/HF ratio in spite of suppression of both LF and HF powers. Contrary to the common understanding that the sympathetic limb of the autonomic system mostly mediates responses during stress and anxiety, we found that there was a significant contribution of the parasympathetic system too.

Research paper thumbnail of Differential expression levels of collagen 1A2, tissue inhibitor of metalloproteinase 4, and cathepsin B in intracranial aneurysms

Neurology India

Intracranial aneurysms (IAs) express a variety of differentially expressed genes when compared to... more Intracranial aneurysms (IAs) express a variety of differentially expressed genes when compared to the normal artery. The aim of this study was to evaluate the expression level of a few genes in the aneurysm wall and to correlate them with various clinicoradiological factors. The mRNA level of collagen 1A2 (COL1A2), tissue inhibitor of metalloproteinase 4 (TIMP4), and cathepsin B (CTSB) genes were studied in 23 aneurysmal walls and 19 superficial temporal arteries harvested from 23 patients undergoing clipping of IAs, by real-time polymerase chain reaction method. The mean fold change of COL1A2 gene between the aneurysm sample and the superficial temporal artery (STA) sample was 2.46 ± 0.12, that of TIMP4 gene was 0.31 ± 0, and that of CTSB gene was 31.47 ± 39.01. There was a positive correlation of TIMP4 expression level with maximum diameter of aneurysm (P = 0.008) and fundus of aneurysm (P = 0.012). The mean fold change of CTSB of patients who had preoperative hydrocephalus in the...

Research paper thumbnail of Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations

Journal of Neurosciences in Rural Practice, 2016

Background: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (A... more Background: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (AVM). Very few studies have addressed the concern of radiation injury to the brain and its attendant adverse effects on cognitive function. Materials and Methods: This prospective study included all patients who underwent gamma knife radiosurgery (GKRS) at our institute for cerebral AVM between 2006 and December 2008 (n = 34). All patients underwent neuropsychological evaluation before the procedure. Neuropsychological evaluation was repeated in eighteen patients 2 years following GKRS. Clinical outcome, AVM obliteration, and factors influencing outcome were analyzed in these eighteen patients. Results: Before GKRS, more than 50% had significant impairment of neuropsychological functions compared to normal population norms. 66.6% achieved the excellent radiosurgical outcome. At 2 years follow-up, patients showed varied improvement in neuropsychological function in various categories. Pret...

Research paper thumbnail of Therapy Resistance and Survival in Glioblastoma-The Role of STAT-1

Research paper thumbnail of Malignant nodular hidradenoma of scalp

Journal of Neurosciences in Rural Practice, 2014

ABSTRACTMalignant nodular hidradenoma (MNH) is a rare tumor of sweat gland known by many names in... more ABSTRACTMalignant nodular hidradenoma (MNH) is a rare tumor of sweat gland known by many names in the literature. Scalp is a known and yet uncommon site of occurrence. We describe two patients with scalp MNH with brain parenchymal invasion. Both tumors recurred in spite of total excision and radiotherapy.

Research paper thumbnail of Case Reports Ipsilateral Hemichorea-hemiballism in a Case of Postoperative Stroke

Background: Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on ... more Background: Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion.

Research paper thumbnail of Diagnostic Utility of CUSA Specimen in Histopathological Evaluation of Tumors of Central Nervous System

Neurology India, 2020

Introduction: Cavitron Ultrasonic Surgical Aspirator (CUSA) is a technique used for the surgical ... more Introduction: Cavitron Ultrasonic Surgical Aspirator (CUSA) is a technique used for the surgical treatment of tumors that aids the surgeon in highly selective tumor sampling with minimal injury to surrounding tissues. The utility of the tissue obtained from CUSA for histopathological diagnosis of central nervous system tumors is not as well-known as its surgical benefits. Even though a few studies have evaluated the diagnostic accuracy of CUSA specimen, these have dealt with very few cases. Methodology: In this study, we nil analysed 73 cases of CNS tumors (glial and non-glial) where CUSA specimen was available for histopathological examination and compared with findings on conventional samples as gold standard. Results: Most frequent types of artefacts induced by CUSA included tissue breakdown resembling necrosis, empty spaces in tissues, and crush artefacts particularly in cellular tumors, that interfered with interpretation. CUSA samples were found optimal for diagnosis of non-gl...

Research paper thumbnail of ”Tailored” far lateral approach to anterior foramen magnum meningiomas – The importance of condylar preservation

Neurology India, 2019

Introduction: Anterior and anterolaterally situated foramen magnum meningiomas are a technically ... more Introduction: Anterior and anterolaterally situated foramen magnum meningiomas are a technically complex subgroup of meningiomas. The need for an extensive exposure and bone work and their complex anatomy make them a difficult and challenging group of tumors to resect. The bone work has ranged from an extensive condylar resection to condylar preserving exposures. In this paper, we present our experience with condylar preserving or minimal condylar resection based approaches to these tumors. Materials and Methods: All patients who underwent surgical resection of anterior and anterolaterally situated foramen magnum meningiomas were included in the analysis. The study period was more than 10 years from 2005 to 2015 at our institute; a tertiary referral centre in India. The records along with demographic profile, clinico-radiological features, surgical strategies, outcomes as well as mortality and morbidity were analysed. Results: There were a total of 20 patients (9 males and 11 female...

Research paper thumbnail of Cranial and Spinal Malignant Peripheral Nerve Sheath Tumor: A Pathological Enigma

Journal of Neurosciences in Rural Practice, 2021

Objective Malignant peripheral nerve sheath tumor (MPNST) arises from nerve sheaths, mostly seen ... more Objective Malignant peripheral nerve sheath tumor (MPNST) arises from nerve sheaths, mostly seen in peripheral nerves but rare in craniospinal nerves. The information available in the literature to build up treatment strategy and improve clinical outcomes is scarce. We are reviewing cases from our institute, with emphasis on radiological features for early differentiation from its benign variants. Methods We analyzed pathologically diagnosed cases retrospectively from January 2007 to December 2018 at our institute. Clinicoradiological details and treatment parameters were collected from medical records for evaluation. Each case was contacted telephonically for final clinical follow-up at the time of writing the manuscript. Results A total of seven cases of MPNST were diagnosed in the last 10 years. It included four intracranial and three spinal cases. The mean age for the cohort was 34.3 years, with five females. We could achieve gross total resection (GTR) and subtotal resection in...

Research paper thumbnail of Surgical Management and Outcomes of Aneurysms of Posterior Inferior Cerebellar Artery: Location-Based Approaches with Review of Literature

Journal of Neurosciences in Rural Practice, 2020

Background Posterior inferior cerebellar artery (PICA) is a tortuous, variable, and uncommon site... more Background Posterior inferior cerebellar artery (PICA) is a tortuous, variable, and uncommon site for aneurysms. Surgical management of PICA aneurysms involves careful selection of approach based on the location of the aneurysm and meticulous dissection of the neurovascular structures and perforators. Materials and Methods We did a retrospective review of all the PICA aneurysms operated at our institute in the past 10 years along with the site, presentation, and approach used for the same. Preoperative World Federation of Neurosurgical Society scores and follow-up modified Rankin scores (mRS) were also evaluated. During the same period, data for intervention cases of PICA aneurysm were also collected with follow-ups for a comparative analysis. Results A total of 20 patients with 21 PICA aneurysms were reviewed. All the reviewed cases presented with subarachnoid hemorrhage, and the most common location was the lateral medullary segment and vertebral artery (VA)–PICA junction. Midline...

Research paper thumbnail of Multiple-site neural tube defects: embryogenesis with complete review of existing literature

Neurosurgical Focus, 2019

OBJECTIVEMultiple-site neural tube defects (MNTDs) are very uncommon, with the predominant number... more OBJECTIVEMultiple-site neural tube defects (MNTDs) are very uncommon, with the predominant number of cases being reported in developing countries. The classic theory of neural tube closure fails to explain the occurrence of these defects. Multisite closure theory, first proposed in 1995, explains most of the occurrences with a few modifications specific to a few defects. In this paper, the authors endeavor to explain all the defects, along with their genetic and embryological bases, and to review the available literature and discuss their own experience in the management of these complex cases.METHODSThe authors retrospectively reviewed the data of all the patients treated surgically for MNTDs over that past 14 years. All possible demographic data, clinical details, and radiological imaging data were reviewed. In addition, surgical parameters, complications, and status at follow-up of more than 12 months were evaluated. All previously reported cases of MNTD were analyzed, and compar...

Research paper thumbnail of Needle in a haystack: migration of ventriculoperitoneal shunt into scrotum of infant

Egyptian Journal of Neurosurgery, 2018

Background: Ventriculoperitoneal shunt malpositions are known complications which tend to increas... more Background: Ventriculoperitoneal shunt malpositions are known complications which tend to increase the morbidity and recovery time of an elegant procedure. Distal malpositions into subcutaneous space due to improper closure or positioning can lead to shunt failure. Migration to the scrotum due to a patent processus vaginalis is, however, reported only in a handful of cases and, thus, needs to be highlighted and reported. Results: We report a case of congenital hydrocephalus that underwent shunting at the age of 3 months and reported to be 9 months later with the shunt tube being felt in the scrotum. Repositioning along with herniotomy was performed. Conclusions: A rare occurrence, scrotal migration, needs to recognized and reported. Potential preventive measures include truncation stiches and laproscopic assisted insertion.

Research paper thumbnail of Intracranial Germ Cell Tumors: Spectrum of Disease in an Indian Cohort and Management Strategies

Journal of neurosciences in rural practice

Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West,... more Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West, whereas in Asia, they constitute between 8% and 15% of pediatric brain tumors. We retrospectively studied all patients with intracranial GCT managed at our institute from January 1998 to December 2013. The clinical data and radiological data were analyzed. Forty-eight patients with intracranial GCT including 36 males and 16 females formed the cohort. The proportion of GCT in our study was 0.29%. The mean age was 16.5 ± 2.5 years. Germinomas constituted 56.3% and nongerminomatous GCTs constituted 43.7% of all the tumors. The most common location was posterior third ventricle (58.3%) followed by suprasellar (22.9%). Histopathological diagnosis was obtained in almost all patients (96%). Surgical procedures included tumor decompression (71.7%), stereotactic biopsy (13%), and endoscopic third ventriculostomy and biopsy (15%). Patient's age, location of the tumor, and histology did not in...

Research paper thumbnail of {"__content__"=>"Wolf in Sheep's clothing: Intracranial actinomycosis masquerading as meningioma.", "i"=>{"__content__"=>"en-plaque"}}

Surgical neurology international, 2018

is a gram-positive non-acid-fast bacterium and is the most common causative agent of actinomycosi... more is a gram-positive non-acid-fast bacterium and is the most common causative agent of actinomycosis. It usually presents as a brain abscess via a secondary spread from the cervicofacial region or lungs. However, presentation as an lesion with bone involvement out of proportion to brain parenchyma is rare and needs to be acknowledged. We report a case of intracranial lesion in a 47-year-old female with restriction of mouth opening and right third nerve palsy for 1 year. Imaging showed hyperostosis of the maxilla, temporal base, sphenoid, and zygoma with dural thickening suggestive of a meningioma. Surgical decompression yielded a granulomatous lesion along with empirical antitubercular therapy. However, patient succumbed to the infection and final histopathology revealed actinomycosis infection. Adequate knowledge along with clinical suspicion are the pillars to treating this unfortunate disease. Cheek swelling with bone involvement should be actively sought as risk factors. This case...

Research paper thumbnail of Rare Cranial Nerve Schwannomas: A Retrospective Review of Nontrigeminal, Nonvestibular Cranial Nerve Schwannomas

Journal of neurosciences in rural practice

Intracranial schwannomas arising from non-trigeminal and non-vestibular sources are extremely rar... more Intracranial schwannomas arising from non-trigeminal and non-vestibular sources are extremely rare constituting <0.8% of all schwannomas. In this article, we have analyzed our experience in the management of these rare tumors over a 10-year period. There were a total of 16 cases, with 11 of them undergoing microsurgical resection and 5 undergoing stereotactic radiosurgery (SRS). There were no fresh neurological deficit in any of these patients and two patients underwent postoperative SRS for residual tumor. One patient died due to postoperative septicemia. Knowledge of these lesions along with their clinicoradiological profile is essential to maintain a high index of suspicion and understand the nuances of treatment.

Research paper thumbnail of Abscess within a Glioblastoma: Mimicking a Matryoshka Doll

World neurosurgery, 2018

Abscess coexisting within a brain tumor is rare. Case reports in the literature primarily consist... more Abscess coexisting within a brain tumor is rare. Case reports in the literature primarily consist of sellar pathology and parenchymal lesions, including meningioma, glioma, and metastases. We report a case of glioblastoma with an intratumoral abscess in a middle-aged patient with no prior invasive procedure or systemic focus of infection. A 45-year-old woman presented with new-onset generalized seizures and rapidly progressive left hemiparesis. Imaging showed a right frontal necrotic lesion with a peripherally enhancing wall and solid component posteriorly. There was no diffusion restriction within the lesion. She was afebrile, and there was no systemic focus of infection. With provisional diagnosis of malignant glioma, she underwent surgical resection of the lesion. A differential diagnosis of abscess was considered preoperatively because of the rapid increase in size of the lesion. At surgery, there was a pus-filled cavity with a few areas of grayish, soft, flimsy wall and thrombo...

Research paper thumbnail of Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery

Journal of neurosciences in rural practice, 2017

Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressi... more Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressing the fourth ventricle. Symptoms related to HCP are expected to alleviate after resection of the tumor and decompression of the cerebrospinal fluid (CSF) pathways. However, some patients may require permanent cerebrospinal diversion even after surgery due to persistent HCP. In this study, the authors try to find out the factors associated with the requirement of CSF diversion after vestibular schwannoma surgery in cases of persistent HCP. This was a retrospective study involving 193 cases of vestibular schwannoma operated between 2010 and 2013 in our institute. Cases that underwent ventriculoperitoneal (VP) shunts before surgery were compared to cases which were operated directly. In cases where vestibular schwannomas were operated without prior VP shunts, factors which were associated with persistent postoperative HCP were analyzed. Comparing the group who underwent direct surgery to t...

Research paper thumbnail of Evaluation of Factors Affecting Outcome in Growth Hormone–Secreting Pituitary Adenomas

Indian Journal of Neurosurgery, 2017

Introduction Management of functioning pituitary adenomas is challenging as they can present with... more Introduction Management of functioning pituitary adenomas is challenging as they can present with features of an intracranial mass, systemic effects, or a combination of both. In this series, one of the largest in available literature from our country, we have analyzed our experience with surgical management of growth hormone (GH)-secreting pituitary adenomas and factors influencing their hormonal remission. Materials and Methods The data of all functional pituitary adenomas operated at our institute from January 2002 to December 2011 were obtained from the case files of these patients. This was studied for various clinical-radiologic features, management stratagems, and clinical and hormonal outcomes. Results Ninety-three patients of GH-secreting pituitary adenomas with a mean age of 32.7 years were included in the study. Fifty-three (57%) patients had headache at presentation; 46 (49%) had visual complaints, whereas menstrual irregularity was seen in majority of females. Mean GH l...

Research paper thumbnail of Isolated brainstem tuberculomas

Acta Neurochirurgica, 2017

Research paper thumbnail of Isolated Sphenoid Sinus Lesions: Experience with a Few Rare Pathologies

Journal of Neurosciences in Rural Practice, 2017

Introduction: The sphenoid sinus is often neglected because of its difficult access. The deep pos... more Introduction: The sphenoid sinus is often neglected because of its difficult access. The deep position of the sphenoid sinus hinders early diagnosis of pathologies in that location. Delayed diagnosis can cause serious complications due to proximity to many important structures. Objectives: The aim of this study is to demonstrate different pathologies which can affect the sphenoid sinus and elucidate the findings. Methods: Cases of isolated sphenoid sinus lesions encountered in the neurosurgical setting which had rare pathologies are discussed. Pathologies such as Langerhans cell histiocytosis, solitary plasmacytoma, chordoma, pituitary adenoma, leiomyosarcoma, fungal infection, and mucocele which appeared primarily in sphenoid sinus are discussed along with their imaging features and pathological findings. Conclusion: Multitude of different pathologies can occur in sphenoid sinus. Detailed preoperative imaging is very helpful, but transnasal biopsy and histological study are require...

Research paper thumbnail of Ruptured blebs and racing hearts: autonomic cardiac changes in neurosurgeons during microsurgical clipping of aneurysms

British Journal of Neurosurgery, 2016

In this study, we intend to evaluate the autonomic changes occurring in neurosurgeons and thus th... more In this study, we intend to evaluate the autonomic changes occurring in neurosurgeons and thus the stress during microsurgical clipping of aneurysms. The aim of the current study is to evaluate the heart rate variability (HRV) of the neurosurgeons during microsurgical clipping of aneurysm by using continuous real time monitoring of the ECG intraoperatively. Lead II ECG was recorded using Bioharness(®) (Zephyr Technologies, Annapolis, MD) in 4 healthy neurosurgeons who performed 29 microsurgical clipping of aneurysms. ECG from 21 surgeries was analysed (LabChart(®) software, ADInstruments, Dunedin, New Zealand) across five stages: Baseline (BL), sylvian fissure dissection (SFD), perianeurysmal dissection (PAD), clipping of the aneurysm (CLIP) and haemostasis (HEMO). There was a reduction in TP and an increased LF/HF ratio in spite of suppression of both LF and HF powers. Contrary to the common understanding that the sympathetic limb of the autonomic system mostly mediates responses during stress and anxiety, we found that there was a significant contribution of the parasympathetic system too.

Research paper thumbnail of Differential expression levels of collagen 1A2, tissue inhibitor of metalloproteinase 4, and cathepsin B in intracranial aneurysms

Neurology India

Intracranial aneurysms (IAs) express a variety of differentially expressed genes when compared to... more Intracranial aneurysms (IAs) express a variety of differentially expressed genes when compared to the normal artery. The aim of this study was to evaluate the expression level of a few genes in the aneurysm wall and to correlate them with various clinicoradiological factors. The mRNA level of collagen 1A2 (COL1A2), tissue inhibitor of metalloproteinase 4 (TIMP4), and cathepsin B (CTSB) genes were studied in 23 aneurysmal walls and 19 superficial temporal arteries harvested from 23 patients undergoing clipping of IAs, by real-time polymerase chain reaction method. The mean fold change of COL1A2 gene between the aneurysm sample and the superficial temporal artery (STA) sample was 2.46 ± 0.12, that of TIMP4 gene was 0.31 ± 0, and that of CTSB gene was 31.47 ± 39.01. There was a positive correlation of TIMP4 expression level with maximum diameter of aneurysm (P = 0.008) and fundus of aneurysm (P = 0.012). The mean fold change of CTSB of patients who had preoperative hydrocephalus in the...

Research paper thumbnail of Impact on cognitive functions following gamma knife radiosurgery for cerebral arteriovenous malformations

Journal of Neurosciences in Rural Practice, 2016

Background: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (A... more Background: Radiosurgery is an alternative to surgical resection of arteriovenous malformation (AVM). Very few studies have addressed the concern of radiation injury to the brain and its attendant adverse effects on cognitive function. Materials and Methods: This prospective study included all patients who underwent gamma knife radiosurgery (GKRS) at our institute for cerebral AVM between 2006 and December 2008 (n = 34). All patients underwent neuropsychological evaluation before the procedure. Neuropsychological evaluation was repeated in eighteen patients 2 years following GKRS. Clinical outcome, AVM obliteration, and factors influencing outcome were analyzed in these eighteen patients. Results: Before GKRS, more than 50% had significant impairment of neuropsychological functions compared to normal population norms. 66.6% achieved the excellent radiosurgical outcome. At 2 years follow-up, patients showed varied improvement in neuropsychological function in various categories. Pret...

Research paper thumbnail of Therapy Resistance and Survival in Glioblastoma-The Role of STAT-1

Research paper thumbnail of Malignant nodular hidradenoma of scalp

Journal of Neurosciences in Rural Practice, 2014

ABSTRACTMalignant nodular hidradenoma (MNH) is a rare tumor of sweat gland known by many names in... more ABSTRACTMalignant nodular hidradenoma (MNH) is a rare tumor of sweat gland known by many names in the literature. Scalp is a known and yet uncommon site of occurrence. We describe two patients with scalp MNH with brain parenchymal invasion. Both tumors recurred in spite of total excision and radiotherapy.