Janam Shrestha - Academia.edu (original) (raw)

Papers by Janam Shrestha

Research paper thumbnail of An Audacious Voyage during COVID-19 Pandemic in Management of Patients with Aneurysmal Subarachnoid Hemorrhage at Annapurna Neurological Institute and Allied Sciences

Annapurna Journal of Health Sciences

Introduction: Aneurysmal Subarachnoid Hemorrhage(SAH) is a neurosurgical emergency for which test... more Introduction: Aneurysmal Subarachnoid Hemorrhage(SAH) is a neurosurgical emergency for which testing for COVID PCR was not an option and was unlikely to change the management of the case. Hence, all surgeries were performed without COVID PCR and Rapid Diagnostic Test (RDT) at our center for the welfare of the patient despite risks involved for the surgeons and supporting staff. Methods: Data were collected retrospectively of all cerebral aneurysm patients who received treatment at Annapurna Neurological Institute and Allied Sciences during the covid pandemic between February 2020 to May 2021. Their demographic profile, clinical and imaging characteristics, treatment decision, postoperative complication, postoperative functional status in terms of Modified Rankin Scale were taken into consideration and analyzed. Result: 63 patients were enrolled in study with patient age ranging from 9 years to 81 years. Male to female ratio was 1:3. Amongst them, 28% had hypertension. 82% underwent ...

Research paper thumbnail of Engineering and Innovations in Neurosurgery

Annapurna Journal of Health Sciences

Introduction: Modern technology engineered and developed with artificial intelligence have signif... more Introduction: Modern technology engineered and developed with artificial intelligence have significantly improved the nature of diagnosis and treatment of patients. Healthcare facility has changed significantly in the past few decades because of technological developments. Neurosurgery has been able to practise and enjoy a lot of technologically advanced tools in the past few decades. In context of Nepal, technologically sophisticated devices and tools ranging from neuro navigation, high speed cutting drills, intra operative neuro monitoring, deep brain stimulation, to high resolution magnetic resonance imaging are already introduced. In this paper, the literature review on currently available technologies used in neurosurgery, their significance in delivering a better health care and their usage in Nepal has been discussed.

Research paper thumbnail of A Case of Dorsal Spine Rhabdomyosarcoma in a 2 years old Child

Annapurna Journal of Health Sciences

Rhabdomyosarcoma is highly aggressive malignant form of mesenchymal tumor arising from skeletal m... more Rhabdomyosarcoma is highly aggressive malignant form of mesenchymal tumor arising from skeletal muscle cells rhabdomyoblast, that have failed to fully differenciate. It is most commonly seen in the children before 12 year of age. Primary spinal rhabdomyosarcoma is very rare. A 2 year old girl presented with mass over right upper back and inability to move lower limb. Patient underwent dorsal laminectomy and excision of the mass. Histology and molecular pathology helps in definite diagnosis and further need of chemotherapy or radiotherapy.

Research paper thumbnail of Venture of a Tertiary Care Neurosurgical Center in Course of COVID-19 Lockdown without RT-PCR

Asian Journal of Neurosurgery

"I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, na... more "I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient." Obliged by the aforementioned oath, no medical practitioner shall sit in a moral judgment on any patient but will treat their illness to the best of their ability whatever the circumstances. A clear concord was yet to be authorized after the World Health Organization (WHO) declared the global pandemic of severe acute respiratory syndrome coronavirus 2infection. As a diagnostic modality, WHO recommended real-time reverse transcription-polymerase chain reaction (RT-PCR) as a reliable test; however, its availability in a deprived nation like ours became a major restraining factor. Despite an asset of having high specificity, RT-PCR for coronavirus disease 2019has its own liability of having low sensitivity. Henceforth, as time passed by, the validity of the rapid diagnostic tests was put into question. In later months, a few centers around our periphery started conducting RT-PCR, but the time taken to obtain the result was long-drawn-out process and the patient who needed urgent neurosurgical intervention at Annapurna Neurological Institute and Allied Sciences had to wait. We would like to share our expedition through peaks and valleys of managing 215 patients during the vicious circle of lockdown and global pandemic.

Research paper thumbnail of Surgical Management among Patients with Spontaneous Supratentorial Intracerebral Haemorrhage Admitted in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association

Introduction: Spontaneous intracerebral haemorrhage is the second most common form of stroke and ... more Introduction: Spontaneous intracerebral haemorrhage is the second most common form of stroke and the most deadly one. An understanding of changing trends in the epidemiology of intracerebral haemorrhage prevalence, its risk factors, current practice in management, case fatality, and long-term outcome is essential to measure the effectiveness of stroke prevention and various treatment efforts. The objective of this study was to find out the prevalence of surgical management among patients with spontaneous supratentorial intracerebral haemorrhage in a tertiary centre. Methods: A descriptive cross-sectional study was conducted in the Department of Neurosurgery from January 2017 to December 2019. Ethical approval was obtained from the Institutional Review Committee (Reference number: 06/2020/IRC-ANIAS). A convenience sampling method was used. Data of the patients were retrieved from online medical records. Point estimate and 95% Confidence Interval were calculated. Results: Among 221 pa...

Research paper thumbnail of Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures

Kathmandu University medical journal, 2021

Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know t... more Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.

Research paper thumbnail of Locally Engineered Detachment System Rescuing Aneurysm Coiling when Regular Balt Coil Release Device Used to Detach Balt Coils Had a Technical Error

International Journal of Current Science Research and Review, 2022

While performing posterior communicating aneurysm coiling, the framing of the aneurysm was perfor... more While performing posterior communicating aneurysm coiling, the framing of the aneurysm was performed but the coil detachment device was having an error which was only known when the coil was released into the aneurysm. The biomedical engineer within the operating room created a twelve voltage power supply circuit which was used to detach all the coils, thus rescuing the situation and saving the patient.

Research paper thumbnail of A case of intradural lumbar disc herniation

Lumbar disc herniation into the dural space is a rare phenomenon of degenerative lumbar disc dise... more Lumbar disc herniation into the dural space is a rare phenomenon of degenerative lumbar disc disease and its pathogenesis remains unclear. Intraoperative ultrasonography and histopathological examination of resected specimen aids in diagnosis of intradural disc herniation.Prompt surgery is recommended as postoperative outcome of the patient at our setting was favourable.

Research paper thumbnail of Anthropometric Study of Cervical Spine in Adult Nepalese

The Journal of Spinal Surgery, 2017

Introduction: Anterior cervical discectomy with fusion (ACDF) and cervical corpectomies are commo... more Introduction: Anterior cervical discectomy with fusion (ACDF) and cervical corpectomies are commonly performed procedures in the neurosurgery and orthopedic units across the world. The size of the graft or prosthesis used is variable on individual basis. Also, geographical variations seem to play one of the vital roles in determining the size of the cervical vertebral body and intervertebral disk dimensions. Objective: To study dimension of C3 to C7 vertebral body and C2/3 to C7/T1 intervertebral disk. Inclusion criteria: Nepalese nationality aged between 18 to 60 year old and those with normal cervical spine Magnetic resonance imaging. Exclusion criteria: Traumatic cervical spine and any pathological lesion, such as infection/tumor, destructing the normal morphology of cervical vertebra.

Research paper thumbnail of Central pontine myelinolysis in association with Hodgkin's lymphoma

Postgraduate Medical Journal, 1981

Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymp... more Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymphoma. Clinically he had developed a progressive peripheral sensory deficit, ataxia, quadriparesis, dysarthria, incontinence and drowsiness. This is the fifth case reported in the British literature. The pathogenesis and aetiology of this primary demyelinating disease are considered.

Research paper thumbnail of Remote Cerebellar Hemorrhage after Removal of Large Convexity Meningioma

Nepal Journal of Neuroscience, 2020

Remote cerebellar hemorrhage is a rare postoperative complication. It can occur after infratentor... more Remote cerebellar hemorrhage is a rare postoperative complication. It can occur after infratentorial or supratentorial craniotomies, later being more common. Remote cerebellar hemorrhage is considered to be a self-limited and benign condition. The exact pathophysiology of remote cerebellar hemorrhage remains unclear, but reports have suggested an association with excessive loss of cerebrospinal fluid. We report a case of remote cerebellar hemorrhage after supratentorial craniotomy for large convexity meningioma without excessive loss of cerebrospinal fluid.

Research paper thumbnail of An Audacious Voyage during COVID-19 Pandemic in Management of Patients with Aneurysmal Subarachnoid Hemorrhage at Annapurna Neurological Institute and Allied Sciences

Annapurna Journal of Health Sciences

Introduction: Aneurysmal Subarachnoid Hemorrhage(SAH) is a neurosurgical emergency for which test... more Introduction: Aneurysmal Subarachnoid Hemorrhage(SAH) is a neurosurgical emergency for which testing for COVID PCR was not an option and was unlikely to change the management of the case. Hence, all surgeries were performed without COVID PCR and Rapid Diagnostic Test (RDT) at our center for the welfare of the patient despite risks involved for the surgeons and supporting staff. Methods: Data were collected retrospectively of all cerebral aneurysm patients who received treatment at Annapurna Neurological Institute and Allied Sciences during the covid pandemic between February 2020 to May 2021. Their demographic profile, clinical and imaging characteristics, treatment decision, postoperative complication, postoperative functional status in terms of Modified Rankin Scale were taken into consideration and analyzed. Result: 63 patients were enrolled in study with patient age ranging from 9 years to 81 years. Male to female ratio was 1:3. Amongst them, 28% had hypertension. 82% underwent ...

Research paper thumbnail of Engineering and Innovations in Neurosurgery

Annapurna Journal of Health Sciences

Introduction: Modern technology engineered and developed with artificial intelligence have signif... more Introduction: Modern technology engineered and developed with artificial intelligence have significantly improved the nature of diagnosis and treatment of patients. Healthcare facility has changed significantly in the past few decades because of technological developments. Neurosurgery has been able to practise and enjoy a lot of technologically advanced tools in the past few decades. In context of Nepal, technologically sophisticated devices and tools ranging from neuro navigation, high speed cutting drills, intra operative neuro monitoring, deep brain stimulation, to high resolution magnetic resonance imaging are already introduced. In this paper, the literature review on currently available technologies used in neurosurgery, their significance in delivering a better health care and their usage in Nepal has been discussed.

Research paper thumbnail of A Case of Dorsal Spine Rhabdomyosarcoma in a 2 years old Child

Annapurna Journal of Health Sciences

Rhabdomyosarcoma is highly aggressive malignant form of mesenchymal tumor arising from skeletal m... more Rhabdomyosarcoma is highly aggressive malignant form of mesenchymal tumor arising from skeletal muscle cells rhabdomyoblast, that have failed to fully differenciate. It is most commonly seen in the children before 12 year of age. Primary spinal rhabdomyosarcoma is very rare. A 2 year old girl presented with mass over right upper back and inability to move lower limb. Patient underwent dorsal laminectomy and excision of the mass. Histology and molecular pathology helps in definite diagnosis and further need of chemotherapy or radiotherapy.

Research paper thumbnail of Venture of a Tertiary Care Neurosurgical Center in Course of COVID-19 Lockdown without RT-PCR

Asian Journal of Neurosurgery

"I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, na... more "I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient." Obliged by the aforementioned oath, no medical practitioner shall sit in a moral judgment on any patient but will treat their illness to the best of their ability whatever the circumstances. A clear concord was yet to be authorized after the World Health Organization (WHO) declared the global pandemic of severe acute respiratory syndrome coronavirus 2infection. As a diagnostic modality, WHO recommended real-time reverse transcription-polymerase chain reaction (RT-PCR) as a reliable test; however, its availability in a deprived nation like ours became a major restraining factor. Despite an asset of having high specificity, RT-PCR for coronavirus disease 2019has its own liability of having low sensitivity. Henceforth, as time passed by, the validity of the rapid diagnostic tests was put into question. In later months, a few centers around our periphery started conducting RT-PCR, but the time taken to obtain the result was long-drawn-out process and the patient who needed urgent neurosurgical intervention at Annapurna Neurological Institute and Allied Sciences had to wait. We would like to share our expedition through peaks and valleys of managing 215 patients during the vicious circle of lockdown and global pandemic.

Research paper thumbnail of Surgical Management among Patients with Spontaneous Supratentorial Intracerebral Haemorrhage Admitted in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association

Introduction: Spontaneous intracerebral haemorrhage is the second most common form of stroke and ... more Introduction: Spontaneous intracerebral haemorrhage is the second most common form of stroke and the most deadly one. An understanding of changing trends in the epidemiology of intracerebral haemorrhage prevalence, its risk factors, current practice in management, case fatality, and long-term outcome is essential to measure the effectiveness of stroke prevention and various treatment efforts. The objective of this study was to find out the prevalence of surgical management among patients with spontaneous supratentorial intracerebral haemorrhage in a tertiary centre. Methods: A descriptive cross-sectional study was conducted in the Department of Neurosurgery from January 2017 to December 2019. Ethical approval was obtained from the Institutional Review Committee (Reference number: 06/2020/IRC-ANIAS). A convenience sampling method was used. Data of the patients were retrieved from online medical records. Point estimate and 95% Confidence Interval were calculated. Results: Among 221 pa...

Research paper thumbnail of Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures

Kathmandu University medical journal, 2021

Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know t... more Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.

Research paper thumbnail of Locally Engineered Detachment System Rescuing Aneurysm Coiling when Regular Balt Coil Release Device Used to Detach Balt Coils Had a Technical Error

International Journal of Current Science Research and Review, 2022

While performing posterior communicating aneurysm coiling, the framing of the aneurysm was perfor... more While performing posterior communicating aneurysm coiling, the framing of the aneurysm was performed but the coil detachment device was having an error which was only known when the coil was released into the aneurysm. The biomedical engineer within the operating room created a twelve voltage power supply circuit which was used to detach all the coils, thus rescuing the situation and saving the patient.

Research paper thumbnail of A case of intradural lumbar disc herniation

Lumbar disc herniation into the dural space is a rare phenomenon of degenerative lumbar disc dise... more Lumbar disc herniation into the dural space is a rare phenomenon of degenerative lumbar disc disease and its pathogenesis remains unclear. Intraoperative ultrasonography and histopathological examination of resected specimen aids in diagnosis of intradural disc herniation.Prompt surgery is recommended as postoperative outcome of the patient at our setting was favourable.

Research paper thumbnail of Anthropometric Study of Cervical Spine in Adult Nepalese

The Journal of Spinal Surgery, 2017

Introduction: Anterior cervical discectomy with fusion (ACDF) and cervical corpectomies are commo... more Introduction: Anterior cervical discectomy with fusion (ACDF) and cervical corpectomies are commonly performed procedures in the neurosurgery and orthopedic units across the world. The size of the graft or prosthesis used is variable on individual basis. Also, geographical variations seem to play one of the vital roles in determining the size of the cervical vertebral body and intervertebral disk dimensions. Objective: To study dimension of C3 to C7 vertebral body and C2/3 to C7/T1 intervertebral disk. Inclusion criteria: Nepalese nationality aged between 18 to 60 year old and those with normal cervical spine Magnetic resonance imaging. Exclusion criteria: Traumatic cervical spine and any pathological lesion, such as infection/tumor, destructing the normal morphology of cervical vertebra.

Research paper thumbnail of Central pontine myelinolysis in association with Hodgkin's lymphoma

Postgraduate Medical Journal, 1981

Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymp... more Central pontine myelinolysis was found histologically in a young man who died with Hodgkin's lymphoma. Clinically he had developed a progressive peripheral sensory deficit, ataxia, quadriparesis, dysarthria, incontinence and drowsiness. This is the fifth case reported in the British literature. The pathogenesis and aetiology of this primary demyelinating disease are considered.

Research paper thumbnail of Remote Cerebellar Hemorrhage after Removal of Large Convexity Meningioma

Nepal Journal of Neuroscience, 2020

Remote cerebellar hemorrhage is a rare postoperative complication. It can occur after infratentor... more Remote cerebellar hemorrhage is a rare postoperative complication. It can occur after infratentorial or supratentorial craniotomies, later being more common. Remote cerebellar hemorrhage is considered to be a self-limited and benign condition. The exact pathophysiology of remote cerebellar hemorrhage remains unclear, but reports have suggested an association with excessive loss of cerebrospinal fluid. We report a case of remote cerebellar hemorrhage after supratentorial craniotomy for large convexity meningioma without excessive loss of cerebrospinal fluid.