Sumit Sinha - Academia.edu (original) (raw)

Papers by Sumit Sinha

Indian Journal of Neurosurgery

Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow distur... more Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow disturbances and adhesive loculations can cause cord compression and traction on roots causing the symptoms. The surgical treatment of this condition is often considered a limited option, because of the high chances of recurrence of symptoms and adhesions, often considered as surgical failure. Here, we report a patient with extensive lumbar–sacral adhesive arachnoiditis successfully treated with limited adhesiolysis under neuromonitoring and cystoperitoneal shunt placement.

Indian Journal of Neurotrauma, 2021

The development of endoscopy, microscopy, and image guidance system provided the impetus for the ... more The development of endoscopy, microscopy, and image guidance system provided the impetus for the adoption of minimally invasive surgery (MIS) techniques in the management of spinal trauma patients. The underlying drive has been an attempt to achieve the functional and biomechanical goals inherent to trauma care but through MIS techniques. Broadly the MIS techniques for spinal trauma can be divided into two categories—fusion and nonfusion methods. Fusion methods include mini-open or keyhole approaches that allow for discectomy and/or corpectomy and cage reconstruction via an anterior/lateral/posterior operative corridor. The nonfusion methods primarily include percutaneous pedicle screw fixation, kyphoplasty, and vertebroplasty, all without placement of bone graft or other attempts at inducing arthrodesis. In this review article, we have stratified the MIS techniques based on the operative corridor used and briefly described the decision-making process, technical nuances, pros, and c...

Interdisciplinary Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Indian Journal of Neurotrauma, 2019

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.

International Orthopaedics, 2011

Background Traumatic spondyloptosis is defined as greater than 100% of traumatic subluxation of o... more Background Traumatic spondyloptosis is defined as greater than 100% of traumatic subluxation of one vertebral body in the coronal or sagittal plane which usually causes the complete transaction of spinal cord. It is a rare but severe injury of the vertebral column. We present four unusual cases of traumatic spondyloptosis causing complete spinal cord transaction, which were operated upon successfully. Methods We reviewed the imaging findings of four patients with traumatic thoraco-lumbar spondyloptosis from our radiology database, who presented to our trauma centre from August 2008 to September 2008. Four patients were identified with ages ranging from ten to 27 years. All patients had sustained high-energy closed spinal injuries. All patients underwent plain radiography, CT and MR imaging. Results Three patients had sagittal plane spondyloptosis and one patient had coronal plane spondyloptosis. Complete cord/cauda eqina transection was present in all patients. One patient had low lying cord with complete cord transection. All patients underwent surgery. Reduction of displacement with pedicle screw and rod fixation was carried out to realign the vertebral column. None of the patients recovered neurological function postoperatively. Conclusions To conclude, traumatic thoraco-lumbar spondyloptosis is very rare and radiology plays an important role in the diagnosis and management of traumatic spondyloptosis. Surgical reconstruction and stabilisation allows for rehabilitation.

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.

Neurospine, 2019

This study presents the results of a systematic literature review conducted to determine most up-... more This study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques. Methods: A literature search was performed for articles published during the last 10 years. Results: The natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease. Conclusion: The natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.

International Journal of Advances in Medicine, 2017

Background: Endothelial dysfunction (ED) is an early phenomenon in atherosclerosis and often prog... more Background: Endothelial dysfunction (ED) is an early phenomenon in atherosclerosis and often progresses to structural changes and clinical manifestations. Brachial artery flow mediated dilatation (BAFMD) has recently emerged as a reliable tool for assessment of ED. Carotid artery intima media thickness (CCAIMT) is an established tool for the detection of early structural atherosclerosis. This study was done to assess the reliability of BAFMD as a surrogate marker of atherosclerosis by comparing it to CCAIMT.Methods: Seventy-one subjects were divided in to Group I (n = 42, patients with overt cardiovascular disease; abnormal resting ECG or history of myocardial infarction/angina or an abnormal coronary angiogram), Group II (n = 17, apparently healthy individuals, with risk factors, but no overt cardiovascular disease) and Group III (n = 12, control, healthy individuals without risk factors). Ischemia induced BAFMD and CCAIMT were studied using ultrasound imaging along with presence o...

Indian Journal of Neurosurgery, 2017

Traumatic bilateral epidural hematomas (EDHs) are uncommon and are mostly found in the frontal re... more Traumatic bilateral epidural hematomas (EDHs) are uncommon and are mostly found in the frontal region because of extension of fracture across the midline and tear of venous sinus. Authors report two cases of mirror image biparietal extradural hematoma after sustaining a high-velocity motor vehicle accident. Both were adult males and had a very low admission GCS of less than 8. Emergency hematoma evacuation was performed bilaterally and good outcomes were achieved in both. Mean follow-up duration was 9 months. The pathophysiologic mechanisms are different from solitary EDH as are the clinical features and outcomes. The rarity of these lesions and surgical nuances are highlighted.

Journal of Neurosurgery, 2016

Indian Journal of Neurosurgery, 2016

Cervical facet dislocations represent a severe form of cervical spine injury and can be present u... more Cervical facet dislocations represent a severe form of cervical spine injury and can be present unilaterally or bilaterally. They are invariably associated with neurological compromise, with complete spinal cord injury seen in 65 to 87% and the incomplete injury seen in 13 to 25% of the cases. The facet dislocations represent hyperflexiondistraction injuries and are classified as type B in the AO classification system. These are unstable injuries and necessitate some form of surgical stabilization. A variety of surgical procedures can be performed to effect the reduction of the locked facets which can be performed anteriorly, posteriorly, and by combined approaches. The article focuses on the indications, contraindications, and on the surgical management and the techniques used in the reduction of unilateral or bilateral locked facets.

Indian Journal of Neurosurgery, 2016

Indian Journal of Neurosurgery, 2016

Medulloepithelioma of the central nervous system (CNS) is a rare primitive neuroectodermal tumor ... more Medulloepithelioma of the central nervous system (CNS) is a rare primitive neuroectodermal tumor (PNET) usually occurring in early childhood. It is a highly aggressive tumor with poor outcomes despite aggressive treatment. The ideal treatment appears to be gross total surgical resection, followed by radiation therapy. We report a case of a cerebral medulloepithelioma in a child with an aggressive tumor growth despite the gross total resection, who is surviving 1 year after diagnosis.

Indian Journal of Neurosurgery, 2016

Spinal cord injury (SCI) is any injury resulting from an insult to the spinal cord that disrupts ... more Spinal cord injury (SCI) is any injury resulting from an insult to the spinal cord that disrupts its major functions, either completely or incompletely, and it can be caused by both traumatic and nontraumatic events. The number of SCI patients has been continuously increasing due to increasing number of motor vehicles and average age of patients is constantly decreasing. After SCI, nerve cells located at the injured site are severely damaged and eventually die, and these dead cells are cleared away by the immune system and in turn a cavity remains. Unfortunately, till date no effective treatment strategy exists ensuring functional recovery after SCI. There is an imperative need for the development of therapies to reduce the enormous physical and financial burdens of people afflicted with SCI. The surgical treatment has been known to aid in rehabilitation, but cannot substantially improve neurologic and functional outcome after SCI. The stem cell-based therapy has been proposed as a promising treatment strategy for SCI. Many of the current strategies for treatment of SCI involve replacing the cells lost to injury with cells derived from alternative sources, such as Schwann cells, oligodendrocyte precursor cells, and neural stem cells. This review discusses the present status of various cell-based therapies, which are being used for treating SCI.

Journal of Neurosurgery, 2016

OBJECTIVE There has been increased interest in the potential importance of biochemical parameters... more OBJECTIVE There has been increased interest in the potential importance of biochemical parameters as predictors of outcome in severe traumatic brain injury (sTBI). METHODS Of 107 patients with sTBI (age 18–65 years with a Glasgow Coma Scale score of 4–8 presenting within 8 hours after injury) who were randomized for a placebo-controlled Phase II trial of progesterone with or without hypothermia, the authors serially analyzed serum biomarkers (S100-B, glial fibrillary acidic protein [GFAP], neuron-specific enolase [NSE], tumor necrosis factor–α, interleukin-6 [IL-6], estrogen [Eg], and progesterone [Pg]). This analysis was performed using the sandwich enzyme-linked immunosorbent assay technique at admission and 7 days later for 86 patients, irrespective of assigned group. The long-term predictive values of serum biomarkers for dichotomized Glasgow Outcome Scale (GOS) score, functional independence measure, and survival status at 6 and 12 months were analyzed using an adjusted binary ...

Turkish neurosurgery, 2008

Aneurysmal bone cyst is a benign fibro-osseous lesion usually described in the long bones. Intrao... more Aneurysmal bone cyst is a benign fibro-osseous lesion usually described in the long bones. Intraorbital aneurysmal bone cyst is a rare clinical entity with an entirely different outcome and prognosis as compared to the usual pediatric orbital tumors. The authors report magnetic resonance imaging (MRI) features of an orbital mass lesion in a 4-year-old child who presented with painless proptosis of right eye. Characteristic MRI findings led to a suspicion of an aneurysmal bone cyst that was totally excised via a right frontotemporal craniotomy. Appreciation of characteristic MRI features can be of extreme help for appropriate diagnosis and management of this rare entity.

Indian Journal of Neurosurgery, 2017

the patient outcomes after anoxic injury associated with cardiac arrest; [5,6] however, its benef... more the patient outcomes after anoxic injury associated with cardiac arrest; [5,6] however, its benefits in traumatic brain injury (TBI) are uncertain. The concept that hypothermia may be beneficial in improving the outcomes after TBI evolved with the discovery that the final neuronal injury pattern after an ischemic event could be lessened by cooling the brain. [7] Several subsequent animal studies and clinical trials have now been conducted, which have led the Brain Trauma Foundation to issue a Level III recommendation for the use of primary therapeutic hypothermia in the management of TBI in 2007. [8] MECHANISM OF NEUROPROTECTION Cerebral metabolic rate decreases by about 6-7% for every 1°C drop in temperature, [9] thereby reducing the oxygen demand, preserving the phosphate compounds and energy stores, preventing lactate production and development of acidosis. [10,11] Immediately after TBI, hypothermia is known to improve the brain glucose utilisation. [12] Cerebral blood flow decreases commensurately with cerebral oxygen consumption during hypothermia, suggesting preservation of autoregulation. [10] The major acute effect of hypothermia on cerebral blood

Surgical Neurology International, 2014

Background: Spinal angiolipomas are rare tumors consisting of mature adipose tissue and abnormal ... more Background: Spinal angiolipomas are rare tumors consisting of mature adipose tissue and abnormal vascular elements. Intradural location is very rare, and till now, only seven cases have been reported in literature. Authors report a case of an intradural intramedullary (subpial) angiolipoma located in the thoracic cord. Case Description: A 26-year-old patient presented with features of progressive myelopathy of relatively short duration. Imaging showed a heterogeneous fat-containing intradural lesion at D5-D9 level, which enhanced on contrast enhanced fat saturation sequences. Subtotal excision was performed and patient had partial recovery of his neurological deficits. Histopathology was suggestive of angiolipoma. Conclusions: Intradural angiolipomas are very rare. Complete excision often leads to neurological deficits. Hence, safe maximal decompression would suffice leading to long-term recurrence-free periods.

Indian Journal of Neurosurgery, 2013

Air contained within the spinal canal is termed as pneumorrhachis. There are only few previously ... more Air contained within the spinal canal is termed as pneumorrhachis. There are only few previously reported cases in the literature about pneumorrhachis. We herein report a case of pneumorrhachis associated with tension pneumocephalus in a patient with severe head injury.

Indian Journal of Neurosurgery, 2013

Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or ... more Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or posterior approaches. The aim of study was to analyze the surgical outcomes of MS-CSM treated by either anterior cervical discectomy with fusion and cervical plating (ACDF) or cervical laminoplasty (LP). Sixty-five patients with MS-CSM (two or more levels) underwent either ACDF (n=13) or LP (n=52). ACDF was performed in patients having these criteria: (i) three or less levels involved, (ii) myeloradiculopathy, (iii) pre-dominant anterior compression radiologically, (iv) <50 years age. LP was chosen in: (i) more than three levels involved (ii) posterior compression radiologically, (iii) >50 years age. Patients were evaluated pre- and post-operatively on the basis of modified Japanese Orthopedic Association (mJOA) scoring and Hirabayashi formula. Thirty-five patients were followed up (8 in ACDF group and 27 in LP group). The mean follow-up period was 37.5 months (12.5-54 months). The...

Indian Journal of Neurosurgery

Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow distur... more Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow disturbances and adhesive loculations can cause cord compression and traction on roots causing the symptoms. The surgical treatment of this condition is often considered a limited option, because of the high chances of recurrence of symptoms and adhesions, often considered as surgical failure. Here, we report a patient with extensive lumbar–sacral adhesive arachnoiditis successfully treated with limited adhesiolysis under neuromonitoring and cystoperitoneal shunt placement.

Indian Journal of Neurotrauma, 2021

The development of endoscopy, microscopy, and image guidance system provided the impetus for the ... more The development of endoscopy, microscopy, and image guidance system provided the impetus for the adoption of minimally invasive surgery (MIS) techniques in the management of spinal trauma patients. The underlying drive has been an attempt to achieve the functional and biomechanical goals inherent to trauma care but through MIS techniques. Broadly the MIS techniques for spinal trauma can be divided into two categories—fusion and nonfusion methods. Fusion methods include mini-open or keyhole approaches that allow for discectomy and/or corpectomy and cage reconstruction via an anterior/lateral/posterior operative corridor. The nonfusion methods primarily include percutaneous pedicle screw fixation, kyphoplasty, and vertebroplasty, all without placement of bone graft or other attempts at inducing arthrodesis. In this review article, we have stratified the MIS techniques based on the operative corridor used and briefly described the decision-making process, technical nuances, pros, and c...

Interdisciplinary Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Indian Journal of Neurotrauma, 2019

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.

International Orthopaedics, 2011

Background Traumatic spondyloptosis is defined as greater than 100% of traumatic subluxation of o... more Background Traumatic spondyloptosis is defined as greater than 100% of traumatic subluxation of one vertebral body in the coronal or sagittal plane which usually causes the complete transaction of spinal cord. It is a rare but severe injury of the vertebral column. We present four unusual cases of traumatic spondyloptosis causing complete spinal cord transaction, which were operated upon successfully. Methods We reviewed the imaging findings of four patients with traumatic thoraco-lumbar spondyloptosis from our radiology database, who presented to our trauma centre from August 2008 to September 2008. Four patients were identified with ages ranging from ten to 27 years. All patients had sustained high-energy closed spinal injuries. All patients underwent plain radiography, CT and MR imaging. Results Three patients had sagittal plane spondyloptosis and one patient had coronal plane spondyloptosis. Complete cord/cauda eqina transection was present in all patients. One patient had low lying cord with complete cord transection. All patients underwent surgery. Reduction of displacement with pedicle screw and rod fixation was carried out to realign the vertebral column. None of the patients recovered neurological function postoperatively. Conclusions To conclude, traumatic thoraco-lumbar spondyloptosis is very rare and radiology plays an important role in the diagnosis and management of traumatic spondyloptosis. Surgical reconstruction and stabilisation allows for rehabilitation.

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.

Neurospine, 2019

This study presents the results of a systematic literature review conducted to determine most up-... more This study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques. Methods: A literature search was performed for articles published during the last 10 years. Results: The natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease. Conclusion: The natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.

International Journal of Advances in Medicine, 2017

Background: Endothelial dysfunction (ED) is an early phenomenon in atherosclerosis and often prog... more Background: Endothelial dysfunction (ED) is an early phenomenon in atherosclerosis and often progresses to structural changes and clinical manifestations. Brachial artery flow mediated dilatation (BAFMD) has recently emerged as a reliable tool for assessment of ED. Carotid artery intima media thickness (CCAIMT) is an established tool for the detection of early structural atherosclerosis. This study was done to assess the reliability of BAFMD as a surrogate marker of atherosclerosis by comparing it to CCAIMT.Methods: Seventy-one subjects were divided in to Group I (n = 42, patients with overt cardiovascular disease; abnormal resting ECG or history of myocardial infarction/angina or an abnormal coronary angiogram), Group II (n = 17, apparently healthy individuals, with risk factors, but no overt cardiovascular disease) and Group III (n = 12, control, healthy individuals without risk factors). Ischemia induced BAFMD and CCAIMT were studied using ultrasound imaging along with presence o...

Indian Journal of Neurosurgery, 2017

Traumatic bilateral epidural hematomas (EDHs) are uncommon and are mostly found in the frontal re... more Traumatic bilateral epidural hematomas (EDHs) are uncommon and are mostly found in the frontal region because of extension of fracture across the midline and tear of venous sinus. Authors report two cases of mirror image biparietal extradural hematoma after sustaining a high-velocity motor vehicle accident. Both were adult males and had a very low admission GCS of less than 8. Emergency hematoma evacuation was performed bilaterally and good outcomes were achieved in both. Mean follow-up duration was 9 months. The pathophysiologic mechanisms are different from solitary EDH as are the clinical features and outcomes. The rarity of these lesions and surgical nuances are highlighted.

Journal of Neurosurgery, 2016

Indian Journal of Neurosurgery, 2016

Cervical facet dislocations represent a severe form of cervical spine injury and can be present u... more Cervical facet dislocations represent a severe form of cervical spine injury and can be present unilaterally or bilaterally. They are invariably associated with neurological compromise, with complete spinal cord injury seen in 65 to 87% and the incomplete injury seen in 13 to 25% of the cases. The facet dislocations represent hyperflexiondistraction injuries and are classified as type B in the AO classification system. These are unstable injuries and necessitate some form of surgical stabilization. A variety of surgical procedures can be performed to effect the reduction of the locked facets which can be performed anteriorly, posteriorly, and by combined approaches. The article focuses on the indications, contraindications, and on the surgical management and the techniques used in the reduction of unilateral or bilateral locked facets.

Indian Journal of Neurosurgery, 2016

Indian Journal of Neurosurgery, 2016

Medulloepithelioma of the central nervous system (CNS) is a rare primitive neuroectodermal tumor ... more Medulloepithelioma of the central nervous system (CNS) is a rare primitive neuroectodermal tumor (PNET) usually occurring in early childhood. It is a highly aggressive tumor with poor outcomes despite aggressive treatment. The ideal treatment appears to be gross total surgical resection, followed by radiation therapy. We report a case of a cerebral medulloepithelioma in a child with an aggressive tumor growth despite the gross total resection, who is surviving 1 year after diagnosis.

Indian Journal of Neurosurgery, 2016

Spinal cord injury (SCI) is any injury resulting from an insult to the spinal cord that disrupts ... more Spinal cord injury (SCI) is any injury resulting from an insult to the spinal cord that disrupts its major functions, either completely or incompletely, and it can be caused by both traumatic and nontraumatic events. The number of SCI patients has been continuously increasing due to increasing number of motor vehicles and average age of patients is constantly decreasing. After SCI, nerve cells located at the injured site are severely damaged and eventually die, and these dead cells are cleared away by the immune system and in turn a cavity remains. Unfortunately, till date no effective treatment strategy exists ensuring functional recovery after SCI. There is an imperative need for the development of therapies to reduce the enormous physical and financial burdens of people afflicted with SCI. The surgical treatment has been known to aid in rehabilitation, but cannot substantially improve neurologic and functional outcome after SCI. The stem cell-based therapy has been proposed as a promising treatment strategy for SCI. Many of the current strategies for treatment of SCI involve replacing the cells lost to injury with cells derived from alternative sources, such as Schwann cells, oligodendrocyte precursor cells, and neural stem cells. This review discusses the present status of various cell-based therapies, which are being used for treating SCI.

Journal of Neurosurgery, 2016

OBJECTIVE There has been increased interest in the potential importance of biochemical parameters... more OBJECTIVE There has been increased interest in the potential importance of biochemical parameters as predictors of outcome in severe traumatic brain injury (sTBI). METHODS Of 107 patients with sTBI (age 18–65 years with a Glasgow Coma Scale score of 4–8 presenting within 8 hours after injury) who were randomized for a placebo-controlled Phase II trial of progesterone with or without hypothermia, the authors serially analyzed serum biomarkers (S100-B, glial fibrillary acidic protein [GFAP], neuron-specific enolase [NSE], tumor necrosis factor–α, interleukin-6 [IL-6], estrogen [Eg], and progesterone [Pg]). This analysis was performed using the sandwich enzyme-linked immunosorbent assay technique at admission and 7 days later for 86 patients, irrespective of assigned group. The long-term predictive values of serum biomarkers for dichotomized Glasgow Outcome Scale (GOS) score, functional independence measure, and survival status at 6 and 12 months were analyzed using an adjusted binary ...

Turkish neurosurgery, 2008

Aneurysmal bone cyst is a benign fibro-osseous lesion usually described in the long bones. Intrao... more Aneurysmal bone cyst is a benign fibro-osseous lesion usually described in the long bones. Intraorbital aneurysmal bone cyst is a rare clinical entity with an entirely different outcome and prognosis as compared to the usual pediatric orbital tumors. The authors report magnetic resonance imaging (MRI) features of an orbital mass lesion in a 4-year-old child who presented with painless proptosis of right eye. Characteristic MRI findings led to a suspicion of an aneurysmal bone cyst that was totally excised via a right frontotemporal craniotomy. Appreciation of characteristic MRI features can be of extreme help for appropriate diagnosis and management of this rare entity.

Indian Journal of Neurosurgery, 2017

the patient outcomes after anoxic injury associated with cardiac arrest; [5,6] however, its benef... more the patient outcomes after anoxic injury associated with cardiac arrest; [5,6] however, its benefits in traumatic brain injury (TBI) are uncertain. The concept that hypothermia may be beneficial in improving the outcomes after TBI evolved with the discovery that the final neuronal injury pattern after an ischemic event could be lessened by cooling the brain. [7] Several subsequent animal studies and clinical trials have now been conducted, which have led the Brain Trauma Foundation to issue a Level III recommendation for the use of primary therapeutic hypothermia in the management of TBI in 2007. [8] MECHANISM OF NEUROPROTECTION Cerebral metabolic rate decreases by about 6-7% for every 1°C drop in temperature, [9] thereby reducing the oxygen demand, preserving the phosphate compounds and energy stores, preventing lactate production and development of acidosis. [10,11] Immediately after TBI, hypothermia is known to improve the brain glucose utilisation. [12] Cerebral blood flow decreases commensurately with cerebral oxygen consumption during hypothermia, suggesting preservation of autoregulation. [10] The major acute effect of hypothermia on cerebral blood

Surgical Neurology International, 2014

Background: Spinal angiolipomas are rare tumors consisting of mature adipose tissue and abnormal ... more Background: Spinal angiolipomas are rare tumors consisting of mature adipose tissue and abnormal vascular elements. Intradural location is very rare, and till now, only seven cases have been reported in literature. Authors report a case of an intradural intramedullary (subpial) angiolipoma located in the thoracic cord. Case Description: A 26-year-old patient presented with features of progressive myelopathy of relatively short duration. Imaging showed a heterogeneous fat-containing intradural lesion at D5-D9 level, which enhanced on contrast enhanced fat saturation sequences. Subtotal excision was performed and patient had partial recovery of his neurological deficits. Histopathology was suggestive of angiolipoma. Conclusions: Intradural angiolipomas are very rare. Complete excision often leads to neurological deficits. Hence, safe maximal decompression would suffice leading to long-term recurrence-free periods.

Indian Journal of Neurosurgery, 2013

Air contained within the spinal canal is termed as pneumorrhachis. There are only few previously ... more Air contained within the spinal canal is termed as pneumorrhachis. There are only few previously reported cases in the literature about pneumorrhachis. We herein report a case of pneumorrhachis associated with tension pneumocephalus in a patient with severe head injury.

Indian Journal of Neurosurgery, 2013

Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or ... more Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or posterior approaches. The aim of study was to analyze the surgical outcomes of MS-CSM treated by either anterior cervical discectomy with fusion and cervical plating (ACDF) or cervical laminoplasty (LP). Sixty-five patients with MS-CSM (two or more levels) underwent either ACDF (n=13) or LP (n=52). ACDF was performed in patients having these criteria: (i) three or less levels involved, (ii) myeloradiculopathy, (iii) pre-dominant anterior compression radiologically, (iv) <50 years age. LP was chosen in: (i) more than three levels involved (ii) posterior compression radiologically, (iii) >50 years age. Patients were evaluated pre- and post-operatively on the basis of modified Japanese Orthopedic Association (mJOA) scoring and Hirabayashi formula. Thirty-five patients were followed up (8 in ACDF group and 27 in LP group). The mean follow-up period was 37.5 months (12.5-54 months). The...