Sudheer Ambekar - Academia.edu (original) (raw)

Papers by Sudheer Ambekar

Research paper thumbnail of Contents Vol. 5, 2016

Interventional Neurology, 2016

Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/ine_issues

Research paper thumbnail of Thecoperitoneal Shunt Migration through Anus–A Rare Presentation

Indian Journal of Neurosurgery, 2020

The thecoperitoneal (TP) shunt is a cerebrospinal fluid (CSF) diversion technique. It is a common... more The thecoperitoneal (TP) shunt is a cerebrospinal fluid (CSF) diversion technique. It is a commonly used technique in many neurosurgical conditions, and many complications are associated with it. This is a case of TP shunt migration through the anus. It is an uncommon and rare presentation of one of the complications associated with the TP shunt. Caregivers should keep this in mind about this complication, as it leads to devastating complications like meningitis and suffering for the patient.

Research paper thumbnail of Anterior Cranial Fossa Meningioma

Research paper thumbnail of Flow Diversion for Giant Intracranial Aneurysms: Problem or Panacea?

Neurology India, 2020

Although giant intracranial aneurysms (GIAs) represent only 2–7% of all IAs, they are one of the ... more Although giant intracranial aneurysms (GIAs) represent only 2–7% of all IAs, they are one of the most difficult lesions to treat.[1] Large sizes (>2.5 cm) causing mass effect, the presence of calcification, thrombus, their incorporation of parent, and/or branch arteries make treatment challenging. The surgical techniques that are used in the management of GIAs include microsurgical clip reconstruction, parent artery ligation, and trapping with bypass.

Research paper thumbnail of Inflammation and aneurysms

Research paper thumbnail of Modified Far Lateral Approach for Posterior Circulation Aneurysms: An Institutional Experience

World neurosurgery, 2016

The modified far lateral approach is a modified version of the far lateral approach without drill... more The modified far lateral approach is a modified version of the far lateral approach without drilling of the condyle. This approach can be used for accessing aneurysms anterior and anterolateral to the brainstem and craniovertebral junction. We describe the surgical outcome and complications of the modified far lateral approach for vertebrobasilar, proximal posterior inferior cerebellar artery, and vertebral artery aneurysms. The records of 26 patients with vertebrobasilar aneurysms who underwent surgery using the modified far lateral approach from 1994 to 2015 were retrospectively reviewed to analyze the clinical outcomes. Mean age of patients was 61 years (range, 38-84 years), and 18 patients were women. The most common presenting symptoms were sudden-onset headache (77%) and dizziness (35%). Of patients, 21 (81%) had saccular aneurysms, and 5 (19%) had fusiform aneurysms. The modified far lateral approach was used in 16 patients with posterior inferior cerebellar artery aneurysms,...

Research paper thumbnail of Cerebral aneurysm treatment in India: Results of a national survey regarding practice patterns in India

Neurology India, 2016

The management of intracranial aneurysms (IAs) varies widely depending upon a number of factors. ... more The management of intracranial aneurysms (IAs) varies widely depending upon a number of factors. To understand the variations in practice patterns in the treatment of IAs in India. The survey consisted of 23 questions. Two group emails were sent to members of the Neurological Society of India and the Neurological Surgeons Society of India. Uni- and multivariate analysis was performed where appropriate. The response rate was 10.13% (150/1480). Fifty percent of the respondents used steroids in subarachnoid hemorrhage and 64% initiated triple-H therapy prophylactically. There was no significant difference in the use of steroids, antifibrinolytics, mannitol, or hypertonic saline and the choice of therapeutic intervention (clipping or endovascular therapy [EVT]) for anterior circulation aneurysms between physicians working at teaching and nonteaching hospitals. However, physicians in teaching and government hospitals were less likely to choose EVT for middle cerebral artery aneurysms as the first line of treatment (odds ratio [OR] 0.6 and 0.1, respectively). Physicians working at private hospitals were more likely to have EVT facilities than those working in government-owned hospitals. On multivariate analysis, physicians working in teaching hospitals preferred surgical clipping to EVT for posterior circulation aneurysms (OR = 0.7) and physicians at teaching hospitals performed >50 cases/year. Our study demonstrates the prevailing practice patterns in the management of IAs in India. Surgical clipping is the preferred treatment of choice for anterior circulation aneurysms and EVT for aneurysms along the posterior circulation. Corticosteroids and prophylactic "triple-H" therapy are still used by a large proportion of physicians.

Research paper thumbnail of Incidence, hospital costs and in-hospital mortality rates of epidural hematoma in the United States

Clinical neurology and neurosurgery, 2015

This study provides the first United States (US) national data regarding frequency, cost and mort... more This study provides the first United States (US) national data regarding frequency, cost and mortality rate of epidural hematoma (EDH) and determines the factors affecting the morbidity and deaths in the patients with EDH undergoing surgical evacuation. A retrospective analysis was performed by searching the Nationwide Inpatient Sample (NIS) from 2003 to 2010, the largest all payer database of non-federal community hospitals in the US. All cases of EDH were indentified using ICD-9 codes. A total of 5189 admissions were identified in the NIS database, and incidence was highest in the second decade (33.4%). The median length of stay in the hospital was about 4 days in each year (2003-2010) without significant difference. The percent of discharge disposition other than home was about 2-3% in the entire cohort, with the highest in 2009 (3%). The average cost per admission increased significantly (80%) from 45,850in2003to45,850 in 2003 to 45,850in2003to82,800 in 2010. The inhospital mortality and complication rat...

Research paper thumbnail of A to Z in neurointerventional surgery: A primer for residents

Neurology India

Neurointerventional surgery has evolved rapidly over the last two-and-a-half decades. It is now t... more Neurointerventional surgery has evolved rapidly over the last two-and-a-half decades. It is now the treatment of choice for many neurovascular conditions, and its techniques and indications are rapidly expanding. It is the need of the hour that residents in training programs should familiarize themselves with the basic concepts of neurointerventional surgery. There are no set guidelines regarding neuroendovascular training of residents in India. The current article provides an insight into the basic concepts of neurointerventional surgery for residents in training.

Research paper thumbnail of Clinical and Radiologic Outcome of Gamma Knife Radiosurgery on Nonfunctioning Pituitary Adenomas

Journal of Neurological Surgery Part B: Skull Base, 2015

Objective To elucidate the role of Gamma Knife radiosurgery (GKRS) in the management of nonfuncti... more Objective To elucidate the role of Gamma Knife radiosurgery (GKRS) in the management of nonfunctioning pituitary adenomas (NFAs). Materials and Methods A retrospective review of 57 consecutive patients spanning 2000 to 2013 with NFAs was performed. Of 57 patients, 53 patients had recurrent or residual tumors after microsurgical resection. The study population was evaluated clinically and radiographically after GKRS treatment. The median follow-up time was 45.57 months. Results GKRS in pituitary adenomas showed significant variations in tumor growth control (decreased in 32 patients [56.1%], arrested growth in 21 patients [36.1%], and increased tumor size in 4 patients [7%]). Progression-free survival after GKRS at 3, 7, and 10 years was 100%, 98%, and 90%, respectively. The neurologic signs and symptoms were significantly improved after GKRS (14% versus 107%) compared with pretreated signs and symptoms (p < 0.0001). Five patients (8.8%) required additional treatment. Conclusion Recent follow-up revealed that GKRS offers a high rate of tumor control and preservation of neurologic functions in both new and recurrent patients with NFAs. Thus GKRS is an effective treatment option for recurrent and residual as well as newly diagnosed patients with NFAs.

Research paper thumbnail of Pubmed Result

Research paper thumbnail of Occipitocervical Fusion Surgery: Review of Operative Techniques and Results

Journal of Neurological Surgery Part B: Skull Base, 2015

Objective Varying types of clinicoradiologic presentations at the craniovertebral junction (CVJ) ... more Objective Varying types of clinicoradiologic presentations at the craniovertebral junction (CVJ) influence the decision process for occipitocervical fusion (OCF) surgery. We discuss the operative techniques and decision-making process in OCF surgery based on our clinical experience and a literature review. Material and Methods A total of 49 consecutive patients who underwent OCF participated in the study. Sagittal computed tomography images were used to illustrate and measure radiologic parameters. We measured Wackenheim clivus baseline (WCB), clivus-canal angle (CCA), atlantodental distance (ADD), and Powers ratio (PR) in all the patients. Results Clinical improvement on Nurick grading was recorded in 36 patients. Patients with better preoperative status (Nurick grades 1-3) had better functional outcomes after the surgery (p ¼ 0.077). Restoration of WCB, CCA, ADD, and PR parameters following the surgery was noted in 39.2%, 34.6%, 77.4%, and 63.3% of the patients, respectively. Complications included deep wound infections (n ¼ 2), pseudoarthrosis (n ¼ 2), and deaths (n ¼ 4). Conclusion Conventional wire-based constructs are superseded by more rigid screwbased designs. Odontoidectomy is associated with a high incidence of perioperative complications. The advent of newer implants and reduction techniques around the CVJ has obviated the need for this procedure in most patients.

Research paper thumbnail of Impact of elective versus emergent admission on perioperative complications and resource utilization in lumbar fusion

Clinical Neurology and Neurosurgery, 2015

Background: The notion of higher complication rate and mortality in emergency surgeries is well e... more Background: The notion of higher complication rate and mortality in emergency surgeries is well established. There is a paucity of literature demonstrating the impact of emergent versus elective admissions for spinal surgery on the perioperative outcomes. We aim to evaluate the influence of the type of admission (elective or emergent) and day of surgery (same day versus other days within the emergent group) on the incidence, pattern of perioperative complications and hospital charges in the patients undergoing lumbar fusion for degenerative spine disease. Methods: Data was obtained from the Nationwide Inpatient Sample (NIS) database between 2002 and 2011. We performed multivariate analysis to evaluate the impact of admission type and day of surgery on perioperative outcomes. Results: A total of 266439 patients were identified. The majority of the admissions were elective (92.6%). Emergent admission comprised 7.4% of the total admission. Mean Charlson comorbidity index (CCI) was significantly higher in emergent and 'other days' (<0.001) groups. Emergent admission and surgery performed on the 'other days' were the independent risk factors for the higher incidence of the venous thromboembolic events, surgical site infection and wound dehiscence. The patients in the emergent and 'other days' surgery groups had a longer stay in the hospital (P < 0.001). The mean total hospital charges were higher in the emergent admission and 'other days' surgery groups (P < 0.001). Conclusions: 'Emergent admission' and surgery performed on the 'other days' in lumbar fusion are independent risk factors for the higher incidence of perioperative complications. Complicated hospital course and longer stay of the patients in the emergent admission and 'other days' group seems to be associated with higher total hospital charges.

Research paper thumbnail of Angioseal™ as a hemostatic device for direct carotid puncture during endovascular procedures

Interventional Neuroradiology, 2015

Introduction Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy a... more Introduction Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy and peripheral vascular disease when the peripheral arteries are not available for vascular access. Manual compression is the only method of achieving hemostasis following DCP and, till date, the use of a closure device for DCP has been reported in only one patient. In this study we sought to analyze our experience with the use of closure device for DCP. Methods This is a retrospective study of patients in whom Angioseal™ was used following DCP for neuroendovascular procedures. Medical charts and imaging of these patients was reviewed for any abnormalities pertaining to the use of the closure device. Results A total of eight patients were included in the study. Angioseal™ was used in all the patients. There were no complications related to the use of the closure device in any of the eight patients. Immediate post-procedure angiography done in one patient did not show any structural or hem...

Research paper thumbnail of Need for brain aneurysm treatment registry of India: How effectively are we treating intracranial aneurysms in India?

Research paper thumbnail of Factors Affecting Discharge Dispositions in NF2 Patients Following Surgery for Acoustic Neuroma: A U.S. Nationwide Inpatient Data Sample Study (2005-2009)

Journal of Neurological Surgery Part B: Skull Base, 2013

Research paper thumbnail of The Relevance of Microsurgical Management of Non-Basilar Posterior Circulation Aneurysm in the Current Era of Endovascular Management

Journal of Neurological Surgery Part B: Skull Base, 2013

Research paper thumbnail of Factors predictive of improved overall survival following stereotactic radiosurgery for recurrent glioblastoma

Neurosurgical review, Jan 14, 2015

The currently accepted standard of care for primary glioblastoma (GBM) consists of maximal surgic... more The currently accepted standard of care for primary glioblastoma (GBM) consists of maximal surgical resection followed by fractionated external beam radiotherapy (EBRT) with concomitant temozolomide chemotherapy. The role of stereotactic radiosurgery (SRS) in the treatment of GBM is not well defined, but SRS has typically been applied as a salvage therapy for GBM recurrence. This paper reviews our single institution experience using gamma knife radiosurgery (GKRS) for the treatment of GBM. Thirty-six patients treated with GKRS for pathologically proven GBM at LSU Health in Shreveport from February 2000 to December 2013 were identified and analyzed. Patient characteristics, treatment variables, and survival were correlated. Seven patients received GKRS in the immediate postoperative period for an average tumor volume of 10.9 cm(3), and 29 patients were treated for a recurrent average tumor volume of 11.4 cm(3) with a prescribed dose ranging from 10 to 20 Gy at the 50 % isodose line. ...

Research paper thumbnail of Clinical outcome and complications of gamma knife radiosurgery for intracranial arteriovenous malformations

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, Jan 31, 2015

We sought to evaluate the outcome of intracranial arteriovenous malformation (AVM) treated with g... more We sought to evaluate the outcome of intracranial arteriovenous malformation (AVM) treated with gamma knife radiosurgery (GKRS) (Elekta, Stockholm, Sweden) as a primary treatment as well as an adjunct therapy. GKRS has emerged as an important treatment option for intracranial AVM. However, the long term outcome of GKRS on AVM is not well understood. We performed a retrospective review of 85 patients with AVM from 2000-2012 who received GKRS. Out of 85 patients, 13 had undergone prior embolization. The study population was monitored clinically and radiographically after GKRS treatment. Outcome following GKRS for intracranial AVM showed significant variations in nidus obliteration (obliteration in 67 [79%] patients and increase of nidus size on MRI in 18 [21%] patients). The median time to nidus obliteration was 31 months. Overall two (2.3%) patients had intracranial bleeding and the annual bleeding risk was 1.6% after GKRS. Predictive factors for obliteration of the nidus in patients...

Research paper thumbnail of Dorello's Canal and Gruber's Ligament: Historical Perspective

Journal of neurological surgery. Part B, Skull base, 2012

Wenzel Leopold Gruber and Primo Dorello were great anatomists and researchers during the 19th and... more Wenzel Leopold Gruber and Primo Dorello were great anatomists and researchers during the 19th and 20th centuries. Their contributions to neuroanatomy-namely the Gruber's (petrosphenoidal) ligament and Dorello's canal, respectively-have come to be important structures in various approaches through the middle fossa. These structures have also helped provide us with an understanding of the mechanism of sixth nerve paresis in various pathological conditions, such as raised intracranial pressure and Gradenigo syndrome. Their numerous publications have stood as a reference to anatomical researchers. Gruber's description of internal mesogastric hernia and the Meckel-Gruber anastomosis are also widely known in medical literature. The following article is an attempt to reflect upon the life and works of Gruber and Dorello and the importance of their research.

Research paper thumbnail of Contents Vol. 5, 2016

Interventional Neurology, 2016

Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/ine_issues

Research paper thumbnail of Thecoperitoneal Shunt Migration through Anus–A Rare Presentation

Indian Journal of Neurosurgery, 2020

The thecoperitoneal (TP) shunt is a cerebrospinal fluid (CSF) diversion technique. It is a common... more The thecoperitoneal (TP) shunt is a cerebrospinal fluid (CSF) diversion technique. It is a commonly used technique in many neurosurgical conditions, and many complications are associated with it. This is a case of TP shunt migration through the anus. It is an uncommon and rare presentation of one of the complications associated with the TP shunt. Caregivers should keep this in mind about this complication, as it leads to devastating complications like meningitis and suffering for the patient.

Research paper thumbnail of Anterior Cranial Fossa Meningioma

Research paper thumbnail of Flow Diversion for Giant Intracranial Aneurysms: Problem or Panacea?

Neurology India, 2020

Although giant intracranial aneurysms (GIAs) represent only 2–7% of all IAs, they are one of the ... more Although giant intracranial aneurysms (GIAs) represent only 2–7% of all IAs, they are one of the most difficult lesions to treat.[1] Large sizes (>2.5 cm) causing mass effect, the presence of calcification, thrombus, their incorporation of parent, and/or branch arteries make treatment challenging. The surgical techniques that are used in the management of GIAs include microsurgical clip reconstruction, parent artery ligation, and trapping with bypass.

Research paper thumbnail of Inflammation and aneurysms

Research paper thumbnail of Modified Far Lateral Approach for Posterior Circulation Aneurysms: An Institutional Experience

World neurosurgery, 2016

The modified far lateral approach is a modified version of the far lateral approach without drill... more The modified far lateral approach is a modified version of the far lateral approach without drilling of the condyle. This approach can be used for accessing aneurysms anterior and anterolateral to the brainstem and craniovertebral junction. We describe the surgical outcome and complications of the modified far lateral approach for vertebrobasilar, proximal posterior inferior cerebellar artery, and vertebral artery aneurysms. The records of 26 patients with vertebrobasilar aneurysms who underwent surgery using the modified far lateral approach from 1994 to 2015 were retrospectively reviewed to analyze the clinical outcomes. Mean age of patients was 61 years (range, 38-84 years), and 18 patients were women. The most common presenting symptoms were sudden-onset headache (77%) and dizziness (35%). Of patients, 21 (81%) had saccular aneurysms, and 5 (19%) had fusiform aneurysms. The modified far lateral approach was used in 16 patients with posterior inferior cerebellar artery aneurysms,...

Research paper thumbnail of Cerebral aneurysm treatment in India: Results of a national survey regarding practice patterns in India

Neurology India, 2016

The management of intracranial aneurysms (IAs) varies widely depending upon a number of factors. ... more The management of intracranial aneurysms (IAs) varies widely depending upon a number of factors. To understand the variations in practice patterns in the treatment of IAs in India. The survey consisted of 23 questions. Two group emails were sent to members of the Neurological Society of India and the Neurological Surgeons Society of India. Uni- and multivariate analysis was performed where appropriate. The response rate was 10.13% (150/1480). Fifty percent of the respondents used steroids in subarachnoid hemorrhage and 64% initiated triple-H therapy prophylactically. There was no significant difference in the use of steroids, antifibrinolytics, mannitol, or hypertonic saline and the choice of therapeutic intervention (clipping or endovascular therapy [EVT]) for anterior circulation aneurysms between physicians working at teaching and nonteaching hospitals. However, physicians in teaching and government hospitals were less likely to choose EVT for middle cerebral artery aneurysms as the first line of treatment (odds ratio [OR] 0.6 and 0.1, respectively). Physicians working at private hospitals were more likely to have EVT facilities than those working in government-owned hospitals. On multivariate analysis, physicians working in teaching hospitals preferred surgical clipping to EVT for posterior circulation aneurysms (OR = 0.7) and physicians at teaching hospitals performed &amp;amp;amp;amp;amp;amp;amp;amp;gt;50 cases/year. Our study demonstrates the prevailing practice patterns in the management of IAs in India. Surgical clipping is the preferred treatment of choice for anterior circulation aneurysms and EVT for aneurysms along the posterior circulation. Corticosteroids and prophylactic &amp;amp;amp;amp;amp;amp;amp;amp;quot;triple-H&amp;amp;amp;amp;amp;amp;amp;amp;quot; therapy are still used by a large proportion of physicians.

Research paper thumbnail of Incidence, hospital costs and in-hospital mortality rates of epidural hematoma in the United States

Clinical neurology and neurosurgery, 2015

This study provides the first United States (US) national data regarding frequency, cost and mort... more This study provides the first United States (US) national data regarding frequency, cost and mortality rate of epidural hematoma (EDH) and determines the factors affecting the morbidity and deaths in the patients with EDH undergoing surgical evacuation. A retrospective analysis was performed by searching the Nationwide Inpatient Sample (NIS) from 2003 to 2010, the largest all payer database of non-federal community hospitals in the US. All cases of EDH were indentified using ICD-9 codes. A total of 5189 admissions were identified in the NIS database, and incidence was highest in the second decade (33.4%). The median length of stay in the hospital was about 4 days in each year (2003-2010) without significant difference. The percent of discharge disposition other than home was about 2-3% in the entire cohort, with the highest in 2009 (3%). The average cost per admission increased significantly (80%) from 45,850in2003to45,850 in 2003 to 45,850in2003to82,800 in 2010. The inhospital mortality and complication rat...

Research paper thumbnail of A to Z in neurointerventional surgery: A primer for residents

Neurology India

Neurointerventional surgery has evolved rapidly over the last two-and-a-half decades. It is now t... more Neurointerventional surgery has evolved rapidly over the last two-and-a-half decades. It is now the treatment of choice for many neurovascular conditions, and its techniques and indications are rapidly expanding. It is the need of the hour that residents in training programs should familiarize themselves with the basic concepts of neurointerventional surgery. There are no set guidelines regarding neuroendovascular training of residents in India. The current article provides an insight into the basic concepts of neurointerventional surgery for residents in training.

Research paper thumbnail of Clinical and Radiologic Outcome of Gamma Knife Radiosurgery on Nonfunctioning Pituitary Adenomas

Journal of Neurological Surgery Part B: Skull Base, 2015

Objective To elucidate the role of Gamma Knife radiosurgery (GKRS) in the management of nonfuncti... more Objective To elucidate the role of Gamma Knife radiosurgery (GKRS) in the management of nonfunctioning pituitary adenomas (NFAs). Materials and Methods A retrospective review of 57 consecutive patients spanning 2000 to 2013 with NFAs was performed. Of 57 patients, 53 patients had recurrent or residual tumors after microsurgical resection. The study population was evaluated clinically and radiographically after GKRS treatment. The median follow-up time was 45.57 months. Results GKRS in pituitary adenomas showed significant variations in tumor growth control (decreased in 32 patients [56.1%], arrested growth in 21 patients [36.1%], and increased tumor size in 4 patients [7%]). Progression-free survival after GKRS at 3, 7, and 10 years was 100%, 98%, and 90%, respectively. The neurologic signs and symptoms were significantly improved after GKRS (14% versus 107%) compared with pretreated signs and symptoms (p < 0.0001). Five patients (8.8%) required additional treatment. Conclusion Recent follow-up revealed that GKRS offers a high rate of tumor control and preservation of neurologic functions in both new and recurrent patients with NFAs. Thus GKRS is an effective treatment option for recurrent and residual as well as newly diagnosed patients with NFAs.

Research paper thumbnail of Pubmed Result

Research paper thumbnail of Occipitocervical Fusion Surgery: Review of Operative Techniques and Results

Journal of Neurological Surgery Part B: Skull Base, 2015

Objective Varying types of clinicoradiologic presentations at the craniovertebral junction (CVJ) ... more Objective Varying types of clinicoradiologic presentations at the craniovertebral junction (CVJ) influence the decision process for occipitocervical fusion (OCF) surgery. We discuss the operative techniques and decision-making process in OCF surgery based on our clinical experience and a literature review. Material and Methods A total of 49 consecutive patients who underwent OCF participated in the study. Sagittal computed tomography images were used to illustrate and measure radiologic parameters. We measured Wackenheim clivus baseline (WCB), clivus-canal angle (CCA), atlantodental distance (ADD), and Powers ratio (PR) in all the patients. Results Clinical improvement on Nurick grading was recorded in 36 patients. Patients with better preoperative status (Nurick grades 1-3) had better functional outcomes after the surgery (p ¼ 0.077). Restoration of WCB, CCA, ADD, and PR parameters following the surgery was noted in 39.2%, 34.6%, 77.4%, and 63.3% of the patients, respectively. Complications included deep wound infections (n ¼ 2), pseudoarthrosis (n ¼ 2), and deaths (n ¼ 4). Conclusion Conventional wire-based constructs are superseded by more rigid screwbased designs. Odontoidectomy is associated with a high incidence of perioperative complications. The advent of newer implants and reduction techniques around the CVJ has obviated the need for this procedure in most patients.

Research paper thumbnail of Impact of elective versus emergent admission on perioperative complications and resource utilization in lumbar fusion

Clinical Neurology and Neurosurgery, 2015

Background: The notion of higher complication rate and mortality in emergency surgeries is well e... more Background: The notion of higher complication rate and mortality in emergency surgeries is well established. There is a paucity of literature demonstrating the impact of emergent versus elective admissions for spinal surgery on the perioperative outcomes. We aim to evaluate the influence of the type of admission (elective or emergent) and day of surgery (same day versus other days within the emergent group) on the incidence, pattern of perioperative complications and hospital charges in the patients undergoing lumbar fusion for degenerative spine disease. Methods: Data was obtained from the Nationwide Inpatient Sample (NIS) database between 2002 and 2011. We performed multivariate analysis to evaluate the impact of admission type and day of surgery on perioperative outcomes. Results: A total of 266439 patients were identified. The majority of the admissions were elective (92.6%). Emergent admission comprised 7.4% of the total admission. Mean Charlson comorbidity index (CCI) was significantly higher in emergent and 'other days' (<0.001) groups. Emergent admission and surgery performed on the 'other days' were the independent risk factors for the higher incidence of the venous thromboembolic events, surgical site infection and wound dehiscence. The patients in the emergent and 'other days' surgery groups had a longer stay in the hospital (P < 0.001). The mean total hospital charges were higher in the emergent admission and 'other days' surgery groups (P < 0.001). Conclusions: 'Emergent admission' and surgery performed on the 'other days' in lumbar fusion are independent risk factors for the higher incidence of perioperative complications. Complicated hospital course and longer stay of the patients in the emergent admission and 'other days' group seems to be associated with higher total hospital charges.

Research paper thumbnail of Angioseal™ as a hemostatic device for direct carotid puncture during endovascular procedures

Interventional Neuroradiology, 2015

Introduction Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy a... more Introduction Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy and peripheral vascular disease when the peripheral arteries are not available for vascular access. Manual compression is the only method of achieving hemostasis following DCP and, till date, the use of a closure device for DCP has been reported in only one patient. In this study we sought to analyze our experience with the use of closure device for DCP. Methods This is a retrospective study of patients in whom Angioseal™ was used following DCP for neuroendovascular procedures. Medical charts and imaging of these patients was reviewed for any abnormalities pertaining to the use of the closure device. Results A total of eight patients were included in the study. Angioseal™ was used in all the patients. There were no complications related to the use of the closure device in any of the eight patients. Immediate post-procedure angiography done in one patient did not show any structural or hem...

Research paper thumbnail of Need for brain aneurysm treatment registry of India: How effectively are we treating intracranial aneurysms in India?

Research paper thumbnail of Factors Affecting Discharge Dispositions in NF2 Patients Following Surgery for Acoustic Neuroma: A U.S. Nationwide Inpatient Data Sample Study (2005-2009)

Journal of Neurological Surgery Part B: Skull Base, 2013

Research paper thumbnail of The Relevance of Microsurgical Management of Non-Basilar Posterior Circulation Aneurysm in the Current Era of Endovascular Management

Journal of Neurological Surgery Part B: Skull Base, 2013

Research paper thumbnail of Factors predictive of improved overall survival following stereotactic radiosurgery for recurrent glioblastoma

Neurosurgical review, Jan 14, 2015

The currently accepted standard of care for primary glioblastoma (GBM) consists of maximal surgic... more The currently accepted standard of care for primary glioblastoma (GBM) consists of maximal surgical resection followed by fractionated external beam radiotherapy (EBRT) with concomitant temozolomide chemotherapy. The role of stereotactic radiosurgery (SRS) in the treatment of GBM is not well defined, but SRS has typically been applied as a salvage therapy for GBM recurrence. This paper reviews our single institution experience using gamma knife radiosurgery (GKRS) for the treatment of GBM. Thirty-six patients treated with GKRS for pathologically proven GBM at LSU Health in Shreveport from February 2000 to December 2013 were identified and analyzed. Patient characteristics, treatment variables, and survival were correlated. Seven patients received GKRS in the immediate postoperative period for an average tumor volume of 10.9 cm(3), and 29 patients were treated for a recurrent average tumor volume of 11.4 cm(3) with a prescribed dose ranging from 10 to 20 Gy at the 50 % isodose line. ...

Research paper thumbnail of Clinical outcome and complications of gamma knife radiosurgery for intracranial arteriovenous malformations

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, Jan 31, 2015

We sought to evaluate the outcome of intracranial arteriovenous malformation (AVM) treated with g... more We sought to evaluate the outcome of intracranial arteriovenous malformation (AVM) treated with gamma knife radiosurgery (GKRS) (Elekta, Stockholm, Sweden) as a primary treatment as well as an adjunct therapy. GKRS has emerged as an important treatment option for intracranial AVM. However, the long term outcome of GKRS on AVM is not well understood. We performed a retrospective review of 85 patients with AVM from 2000-2012 who received GKRS. Out of 85 patients, 13 had undergone prior embolization. The study population was monitored clinically and radiographically after GKRS treatment. Outcome following GKRS for intracranial AVM showed significant variations in nidus obliteration (obliteration in 67 [79%] patients and increase of nidus size on MRI in 18 [21%] patients). The median time to nidus obliteration was 31 months. Overall two (2.3%) patients had intracranial bleeding and the annual bleeding risk was 1.6% after GKRS. Predictive factors for obliteration of the nidus in patients...

Research paper thumbnail of Dorello's Canal and Gruber's Ligament: Historical Perspective

Journal of neurological surgery. Part B, Skull base, 2012

Wenzel Leopold Gruber and Primo Dorello were great anatomists and researchers during the 19th and... more Wenzel Leopold Gruber and Primo Dorello were great anatomists and researchers during the 19th and 20th centuries. Their contributions to neuroanatomy-namely the Gruber's (petrosphenoidal) ligament and Dorello's canal, respectively-have come to be important structures in various approaches through the middle fossa. These structures have also helped provide us with an understanding of the mechanism of sixth nerve paresis in various pathological conditions, such as raised intracranial pressure and Gradenigo syndrome. Their numerous publications have stood as a reference to anatomical researchers. Gruber's description of internal mesogastric hernia and the Meckel-Gruber anastomosis are also widely known in medical literature. The following article is an attempt to reflect upon the life and works of Gruber and Dorello and the importance of their research.