Sandeep Moolchandani - Academia.edu (original) (raw)

Uploads

Papers by Sandeep Moolchandani

Research paper thumbnail of Cervical Nerve Root Cavernoma – Case Report and Literature Review

International Clinical Neuroscience Journal, 2023

Spinal cavernous angiomas are uncommon vascular malformations in the spine accounting for 5%-12% ... more Spinal cavernous angiomas are uncommon vascular malformations in the spine accounting for 5%-12% of all spinal vascular lesions. When present in an intradural extra-medullary location, these usually present with radicular pain and neurological deficits due to mass effect (myelopathy). Herein, we present an atypical presentation of cavernous angioma in a 54-year-old man with tinnitus, headache and sensorineural hearing loss. We have also reviewed 51 cases of intradural extramedullary cavernous angiomas including our case with respect to demographic and clinical profile. A 54-year-old man presented with tinnitus in the left ear and occipital headache with neck pain and slight weakness of left-hand grip along with atrophy of thenar muscles. His pure tone audiometry (PTA) test reveled mild left sensorineural hearing loss. Magnetic resonance imaging (MRI) of cervical spine showed T2WI heterogeneously hyperintense left intradural extramedullary lesion at C7 vertebral body level. It was avidly enhancing with contrast. The patient underwent C7 laminectomy with a midline durotomy and complete excision of the lesion under neuromonitoring with sacrifice of the C8 sensory root. His symptoms improved following the surgery. The diagnosis of a cavernoma in an unusual location in the presence of cranial nerve dysfunction needs a high degree of diagnostic suspicion. Most of these cavernomas have a nerve root origin or attachment. The optimal treatment is microsurgical en bloc resection which leads to an effective resolution of both the symptoms.

Research paper thumbnail of Terminal ileal stricture caused by eosinophilic gastroenteritis: a postoperative histopathological finding

International Surgery Journal, 2016

Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic inf... more Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic infiltration of one or more segments of gastrointestinal tract. Stricture formation is one of the uncommon occurrences seen in the muscular and serosal type of the disease. Stricturing disease of oesophagus, pylorus and proximal small bowel has been reported earlier. We report a rare case of 48 year old male presenting with intestinal obstruction due to stricture formation in the terminal ileum. CECT of abdomen showed a segmental stricture of terminal ileum. Intraoperatively multiple dense adhesions were seen around ileocaecal junction along with a strictured segment in the terminal ileum. Initially the diseased ileal segment was resected followed by an end ileostomy with a distal mucous fistula. The histopathological examination of the resected sample revealed ulcerated and edematous ileal mucosa with dense inflammatory cells rich in eosinophils infiltrating lamina proparia, muscularis proparia and serosal layer. After a month of the first surgery, a right hemicolectomy with end to end ileotransverse anastomoses was done as a definitive procedure. Patient was put on oral glucocorticoid regimen. He has been asymptomatic during the follow up period of 6 months.

Research paper thumbnail of Dialysis Dysequilibrium Syndrome in A Case of Hemorrhagic Stroke with Chronic Kidney Disease: Bermuda Triangle of Neurocritical Care

Interdisciplinary Neurosurgery, Sep 1, 2020

Abstract Background Chronic renal failure in neurosurgical patients is not uncommon especially in... more Abstract Background Chronic renal failure in neurosurgical patients is not uncommon especially in the setting of hemorrhagic stroke. However, unfamiliarity with the syndrome of increased ICP during dialysis in these cases can lead a novice into the Bermuda Triangle. neurosurgeons prognosticating a patient with an ICH are often left in a state of ambiguity when the baseline blood reports reveal a deranged kidney function profile. To compound matters, Dialysis Disequilibrium syndrome presents with symptoms of raised intracranial pressure like nausea, headache, and vomiting and may even fatal in such cases. Case description We describe a 64 yr old gentleman with right basal ganglia bleed who also had chronic kidney failure at presentation. An ICP monitor was placed in this case and dialysis was carried out along with anti-edema measures such as Mannitol with input-output and serum electrolyte monitoring. The ICP monitor showed a sudden rise in ICP during the dialysis sessions and this was reproducible over 3 such sessions. Eventually, further such sessions were stopped and the patient was managed with osmotic diuretics, antiepileptics. The eventual CT scan also did not show any sign of increased hematoma or mass effect thus pointing to a different mechanism of increase of the same. Conclusion Too often neurosurgeons are faced with cases that may demand knowledge of a disease that may affect the neurological outcome. Avoiding high urea gradients during the procedure, minimizing the dialysis dose and isolated ultrafiltration may be the ideal approach.

Research paper thumbnail of Demonstration of Brain Expansion in Cases of Chronic SDH during Admission Leads to Decreased Rates of Recurrence

Indian Journal of Neurotrauma

While being considered a simple procedure among the wide spectrum of neurosurgical procedures, th... more While being considered a simple procedure among the wide spectrum of neurosurgical procedures, the surgical management of chronic subdural hematoma (SDH) still possesses a degree of variability. Present concepts of production versus absorption of chronic SDH fluid has led to practitioners differing in the use of drains, the treatment of inner membrane, the flushing of the subdural cavity, and the perioperative decision making for cases with comorbidities and a history of anticoagulant/antiplatelet usage. In this article, we present the management of chronic SDH over a period of 15 months using the principles followed at our center. In 60 patients of chronic SDH, with the use of drains, we waited for radiological demonstration of brain expansion before drain removal and discharge. In our experience, this has led to better prognostication and very low recurrence rates, particularly in patients with comorbidities and on anticoagulant/ antiplatelet medication.

Research paper thumbnail of Epidemiological and clinical patterns of presentation of surgical oncological emergencies of abdomen at a tertiary institution

International Surgery Journal, 2017

Background: Oncological surgical emergencies of abdomen pose a typical problem for surgeons with ... more Background: Oncological surgical emergencies of abdomen pose a typical problem for surgeons with respect to the choice of curative and palliative treatments and procedures in absence of opportunity for proper evaluation and support of multidisciplinary approach. For appropriate management, it is important to understand the epidemiological and clinical profile of this disease complex.Methods: A prospective analysis of abdominal emergencies encountered in emergency surgery department was done over a period of two years at a single institution and the malignancies were studied with respect to the pattern of clinical presentation and epidemiological characteristics.Results: At our centre, the incidence of intraabdominal oncological emergencies requiring surgery was found to be 6.56% of total emergent presentations excluding abdominal trauma cases. The overall mortality for study duration was 29% and the perioperative mortality within 30 days was 24%. Colonic malignancies (62%) and gastr...

Research paper thumbnail of Terminal ileal stricture caused by eosinophilic gastroenteritis: a postoperative histopathological finding

Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic inf... more Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic infiltration of one or more segments of gastrointestinal tract. Stricture formation is one of the uncommon occurrences seen in the muscular and serosal type of the disease. Stricturing disease of oesophagus, pylorus and proximal small bowel has been
reported earlier. We report a rare case of 48 year old male presenting with intestinal bstruction due to stricture formation in the terminal ileum. CECT of abdomen showed a segmental stricture of terminal ileum. Intraoperatively multiple dense adhesions were seen around ileocaecal junction along with a strictured segment in the terminal ileum. Initially the diseased ileal segment was resected followed by an end ileostomy with a distal mucous fistula. The histopathological examination of the resected sample revealed ulcerated and edematous ileal mucosa with dense inflammatory cells rich in eosinophils infiltrating lamina proparia, muscularis proparia and serosal layer. After a month of the first surgery, a right hemicolectomy with end to end ileotransverse anastomoses was done as a definitive
procedure. Patient was put on oral glucocorticoid regimen. He has been asymptomatic during the follow up period of 6 months.

Research paper thumbnail of Cervical Nerve Root Cavernoma – Case Report and Literature Review

International Clinical Neuroscience Journal, 2023

Spinal cavernous angiomas are uncommon vascular malformations in the spine accounting for 5%-12% ... more Spinal cavernous angiomas are uncommon vascular malformations in the spine accounting for 5%-12% of all spinal vascular lesions. When present in an intradural extra-medullary location, these usually present with radicular pain and neurological deficits due to mass effect (myelopathy). Herein, we present an atypical presentation of cavernous angioma in a 54-year-old man with tinnitus, headache and sensorineural hearing loss. We have also reviewed 51 cases of intradural extramedullary cavernous angiomas including our case with respect to demographic and clinical profile. A 54-year-old man presented with tinnitus in the left ear and occipital headache with neck pain and slight weakness of left-hand grip along with atrophy of thenar muscles. His pure tone audiometry (PTA) test reveled mild left sensorineural hearing loss. Magnetic resonance imaging (MRI) of cervical spine showed T2WI heterogeneously hyperintense left intradural extramedullary lesion at C7 vertebral body level. It was avidly enhancing with contrast. The patient underwent C7 laminectomy with a midline durotomy and complete excision of the lesion under neuromonitoring with sacrifice of the C8 sensory root. His symptoms improved following the surgery. The diagnosis of a cavernoma in an unusual location in the presence of cranial nerve dysfunction needs a high degree of diagnostic suspicion. Most of these cavernomas have a nerve root origin or attachment. The optimal treatment is microsurgical en bloc resection which leads to an effective resolution of both the symptoms.

Research paper thumbnail of Terminal ileal stricture caused by eosinophilic gastroenteritis: a postoperative histopathological finding

International Surgery Journal, 2016

Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic inf... more Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic infiltration of one or more segments of gastrointestinal tract. Stricture formation is one of the uncommon occurrences seen in the muscular and serosal type of the disease. Stricturing disease of oesophagus, pylorus and proximal small bowel has been reported earlier. We report a rare case of 48 year old male presenting with intestinal obstruction due to stricture formation in the terminal ileum. CECT of abdomen showed a segmental stricture of terminal ileum. Intraoperatively multiple dense adhesions were seen around ileocaecal junction along with a strictured segment in the terminal ileum. Initially the diseased ileal segment was resected followed by an end ileostomy with a distal mucous fistula. The histopathological examination of the resected sample revealed ulcerated and edematous ileal mucosa with dense inflammatory cells rich in eosinophils infiltrating lamina proparia, muscularis proparia and serosal layer. After a month of the first surgery, a right hemicolectomy with end to end ileotransverse anastomoses was done as a definitive procedure. Patient was put on oral glucocorticoid regimen. He has been asymptomatic during the follow up period of 6 months.

Research paper thumbnail of Dialysis Dysequilibrium Syndrome in A Case of Hemorrhagic Stroke with Chronic Kidney Disease: Bermuda Triangle of Neurocritical Care

Interdisciplinary Neurosurgery, Sep 1, 2020

Abstract Background Chronic renal failure in neurosurgical patients is not uncommon especially in... more Abstract Background Chronic renal failure in neurosurgical patients is not uncommon especially in the setting of hemorrhagic stroke. However, unfamiliarity with the syndrome of increased ICP during dialysis in these cases can lead a novice into the Bermuda Triangle. neurosurgeons prognosticating a patient with an ICH are often left in a state of ambiguity when the baseline blood reports reveal a deranged kidney function profile. To compound matters, Dialysis Disequilibrium syndrome presents with symptoms of raised intracranial pressure like nausea, headache, and vomiting and may even fatal in such cases. Case description We describe a 64 yr old gentleman with right basal ganglia bleed who also had chronic kidney failure at presentation. An ICP monitor was placed in this case and dialysis was carried out along with anti-edema measures such as Mannitol with input-output and serum electrolyte monitoring. The ICP monitor showed a sudden rise in ICP during the dialysis sessions and this was reproducible over 3 such sessions. Eventually, further such sessions were stopped and the patient was managed with osmotic diuretics, antiepileptics. The eventual CT scan also did not show any sign of increased hematoma or mass effect thus pointing to a different mechanism of increase of the same. Conclusion Too often neurosurgeons are faced with cases that may demand knowledge of a disease that may affect the neurological outcome. Avoiding high urea gradients during the procedure, minimizing the dialysis dose and isolated ultrafiltration may be the ideal approach.

Research paper thumbnail of Demonstration of Brain Expansion in Cases of Chronic SDH during Admission Leads to Decreased Rates of Recurrence

Indian Journal of Neurotrauma

While being considered a simple procedure among the wide spectrum of neurosurgical procedures, th... more While being considered a simple procedure among the wide spectrum of neurosurgical procedures, the surgical management of chronic subdural hematoma (SDH) still possesses a degree of variability. Present concepts of production versus absorption of chronic SDH fluid has led to practitioners differing in the use of drains, the treatment of inner membrane, the flushing of the subdural cavity, and the perioperative decision making for cases with comorbidities and a history of anticoagulant/antiplatelet usage. In this article, we present the management of chronic SDH over a period of 15 months using the principles followed at our center. In 60 patients of chronic SDH, with the use of drains, we waited for radiological demonstration of brain expansion before drain removal and discharge. In our experience, this has led to better prognostication and very low recurrence rates, particularly in patients with comorbidities and on anticoagulant/ antiplatelet medication.

Research paper thumbnail of Epidemiological and clinical patterns of presentation of surgical oncological emergencies of abdomen at a tertiary institution

International Surgery Journal, 2017

Background: Oncological surgical emergencies of abdomen pose a typical problem for surgeons with ... more Background: Oncological surgical emergencies of abdomen pose a typical problem for surgeons with respect to the choice of curative and palliative treatments and procedures in absence of opportunity for proper evaluation and support of multidisciplinary approach. For appropriate management, it is important to understand the epidemiological and clinical profile of this disease complex.Methods: A prospective analysis of abdominal emergencies encountered in emergency surgery department was done over a period of two years at a single institution and the malignancies were studied with respect to the pattern of clinical presentation and epidemiological characteristics.Results: At our centre, the incidence of intraabdominal oncological emergencies requiring surgery was found to be 6.56% of total emergent presentations excluding abdominal trauma cases. The overall mortality for study duration was 29% and the perioperative mortality within 30 days was 24%. Colonic malignancies (62%) and gastr...

Research paper thumbnail of Terminal ileal stricture caused by eosinophilic gastroenteritis: a postoperative histopathological finding

Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic inf... more Eosinophilic gastroenteritis is a rare disease of unknown cause characterised by eosinophilic infiltration of one or more segments of gastrointestinal tract. Stricture formation is one of the uncommon occurrences seen in the muscular and serosal type of the disease. Stricturing disease of oesophagus, pylorus and proximal small bowel has been
reported earlier. We report a rare case of 48 year old male presenting with intestinal bstruction due to stricture formation in the terminal ileum. CECT of abdomen showed a segmental stricture of terminal ileum. Intraoperatively multiple dense adhesions were seen around ileocaecal junction along with a strictured segment in the terminal ileum. Initially the diseased ileal segment was resected followed by an end ileostomy with a distal mucous fistula. The histopathological examination of the resected sample revealed ulcerated and edematous ileal mucosa with dense inflammatory cells rich in eosinophils infiltrating lamina proparia, muscularis proparia and serosal layer. After a month of the first surgery, a right hemicolectomy with end to end ileotransverse anastomoses was done as a definitive
procedure. Patient was put on oral glucocorticoid regimen. He has been asymptomatic during the follow up period of 6 months.