Dr. Bhawan nangarwal | Sanjay Gandhi Postgraduate Institute of Medician Sciences, Lucknow (original) (raw)

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Papers by Dr. Bhawan nangarwal

Research paper thumbnail of A clinico-pathological and neuro-radiological study of angiomatous meningioma: Aggressive look with benign behaviour

Journal of Clinical Neuroscience, 2021

Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts ... more Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.

Research paper thumbnail of An Institutional Experience and Literature Review on Iatrogenic Major Vascular Injury in Neurosurgery: Proposal of a Management Algorithm

Research paper thumbnail of Microneurosurgery for Spinal Dural Arteriovenous Fistula- Operative Video

Neurology India, Mar 11, 2022

Background and Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare but curable con... more Background and Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a highly effective and readily affordable treatment modality. Objective: We present a surgical video of SDAVF to demonstrate the operative nuances involved. Surgical Technique: A 53-year-old wheelchair-bound man with spastic paraparesis for 1.5 years was found to have a SDAVF at L1/2 level with a single fistula point. During surgery, a L1-L2 laminectomy and durotomy revealed a dilated vein accompanying the nerve root exiting L1/2 foramen that showed early filling on indocyanine green (ICG) video angiography. This vein was occluded, and a segment of this vein was removed during surgery, which led to resumption of normal spinal cord perfusion. Results: The patient showed gradual recovery of lower limb motor power and improved to assisted ambulation after 3 months. Conclusions: Surgery is a simple, effective, and cost-effective treatment option in SDAVF.

Research paper thumbnail of Adrenal myelolipoma :Incidentally discovered mass

International Journal of Surgery and Medicine, 2017

Introduction: Myelolipoma is a rare benign tumour of the adrenal gland, usually asymptomatic, uni... more Introduction: Myelolipoma is a rare benign tumour of the adrenal gland, usually asymptomatic, unilateral and nonfunctioning. It is composed of a variable mixture of mature adipose tissue and hematopoietic elements. Widespread use of imaging modalities has increased the frequency of detection. Case presentation: We report a case of adrenal myelolipoma in a 55-years-old male of Indian origin, who presented with pain in the right flank. Physical examination revealed an intra-abdominal mass. Contrast-enhanced computed tomography (CECT) scan of the abdomen showed a well-defined, round lesion in right suprarenal region with heterogeneous attenuation. The patient was subjected to right adrenalectomy, and postoperative course was uneventful. The histopathological examination of the mass confirmed this as adrenal myelolipoma. Conclusion: Mostly adrenal lipoma is discovered as "incidentaloma" but warrants thorough diagnostic study. Imaging and biochemical assay are useful for planning best treatment modality in a particular case to minimise postoperative complications and assuring fast recovery.

Research paper thumbnail of Penile gangrene following condom catheter urinary drainage : A case report

International Journal of Surgery and Medicine, 2017

External urine collecting devices have been a boon to patients of urinary incontinence since thei... more External urine collecting devices have been a boon to patients of urinary incontinence since their invention in late 90s. They have replaced the need for uncomfortable indwelling catheters in these patients. As safe as they may be, ghastly complications have occurred infrequently, mostly due to their inappropriate application. Such penile and urethral complications add to the morbidity of the patients significantly. They can be easily avoided by following few simple steps of catheter care, thus emphasizing the need to aware clinicians and health care workers about the correct application methods. Here we discuss a case of 60 year old male who developed penile skin necrosis and urethral fistula due to chronic use of condom catheter.

Research paper thumbnail of Intraventricular papillary glioneuronal tumor with high proliferation index and CD117 positivity: Report of an atypical case and review of literature

Journal of Cancer Research and Therapeutics

Research paper thumbnail of Salivary Duct Carcinoma: A Case Report

Journal of Evolution of Medical and Dental Sciences, 2016

A Salivary Duct Carcinoma (SDC) is an uncommon high grade, aggressive malignant with high rate of... more A Salivary Duct Carcinoma (SDC) is an uncommon high grade, aggressive malignant with high rate of recurrence having frequent perineural and lymphovascular invasion. Salivary duct carcinoma accounts for 1% to 3% of all malignant salivary gland tumours. About 200 cases have been reported in the English literature. Histologically SDC is similar to a breast ductal carcinoma. Due to rarity of this malignancy, no consistent therapeutic concept and protocol is available in literature. However, total parotidectomy with neck dissection and adjuvant radiotherapy appear to be appropriate treatment for a salivary duct carcinoma.

Research paper thumbnail of A clinicopathological and neuroradiological study of paediatric meningioma from a single centre

Journal of Clinical Neuroscience, 2011

Paediatric meningiomas are rare intracranial neoplasms representing 0.4% to 4.1% of tumours in pa... more Paediatric meningiomas are rare intracranial neoplasms representing 0.4% to 4.1% of tumours in paediatric patients and 1.5% to 1.8% of all intracranial meningiomas. The goal of this study was to determine the epidemiology, clinical presentation, radiological features, morphological spectrum and treatment outcome of paediatric meningiomas. All evaluable reports of meningioma in children from 1 January 1999 to 31 December 2009 were retrieved from the database of our Department of Pathology and were assessed retrospectively. This study describes 12 patients (nine males, three females; age range, 4-18 years; mean, 12.8 years). Their age and sex distribution, presenting symptoms, neurological findings, location, neuroradiological and histopathological findings were reviewed and the results were compared with published reports. Atypical and malignant meningiomas seem to be more common in childhood and adolescence than in adulthood.

Research paper thumbnail of Gravity Assisted Retraction Less Occipito Transtentorial and Trans-Splenial Approach for Posterior Third Ventricular Dermoid

Research paper thumbnail of How important is to know the psychosocial performance in an operated child of meningioma? Devil is in the details

Journal of Pediatric Neurosciences

Research paper thumbnail of TRISS score A guide for survival in trauma patients

International journal of scientific research, 2017

Research paper thumbnail of Anterior Skull Base Meningioma: Surgical approach and complication avoidance

Journal of Neurological Surgery Part B: Skull Base

Background: Endoscopic endonasal approach (EEA) and keyhole transcranial approaches are being inc... more Background: Endoscopic endonasal approach (EEA) and keyhole transcranial approaches are being increasingly used in anterior skull base meningioma (ASBM) surgery. Objective: We compare tumor resection rates and complication profiles of EEA and supraorbital key hole approach (SOKHA) against conventional transcranial approaches (TCA). Methods: Fifty-four patients with ASBM [olfactory groove (OGM), n=19 and planum sphenoidale/tuberculum sellae (PS/TSM), n=35) operated at a single centre over 7 years were retrospectively analyzed. Results: The overall rate of GTR was higher in OGM (15/19, 78.9%) than PS-TSM group (23/35, 65.7%, p=0.37). GTR rate with OGM was 90% and 75% with TCA and EEA. Death (n=1) following medical complication (TCA) and CSF leak requiring re-exploration (n=2, one each in TCA and EEA) accounted for the major complications in OGM. For the PS/TSM group, the GTR rates were 73.3% (n=11/15), 53.8% (n=7/13) and 71.4% (n=5/7) with TCA, EEA and SOKHA respectively. Seven patien...

Research paper thumbnail of Autoimmune pancreatitis : An entity difficult to diagnose

International Journal of Surgery and Medicine

Research paper thumbnail of Fibroadenoma in an Ectopic Breast Tissue

Journal of Evolution of Medical and Dental Sciences

Ectopic breast tissue may be affected by the same diseases and alterations that affect topical br... more Ectopic breast tissue may be affected by the same diseases and alterations that affect topical breast tissue. Nevertheless, reports of fibroadenoma of the axilla are rare. OBJECTIVE To describe a case of fibroadenoma in an axillary ectopic breast tissue. CASE REPORT A 21 yrs. old woman presented with mass in left axilla since 1 yr., which was gradually increasing in size and not associated with menstrual cyclical disturbance. O/E: Lump of size 4×3 present in left axilla, mobile and non-tender. Breast USG and mammography was reported normal. HPE revealed findings consistent with fibroadenoma.

Research paper thumbnail of A clinico-pathological and neuro-radiological study of angiomatous meningioma: Aggressive look with benign behaviour

Journal of Clinical Neuroscience, 2021

Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts ... more Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.

Research paper thumbnail of An Institutional Experience and Literature Review on Iatrogenic Major Vascular Injury in Neurosurgery: Proposal of a Management Algorithm

Research paper thumbnail of Microneurosurgery for Spinal Dural Arteriovenous Fistula- Operative Video

Neurology India, Mar 11, 2022

Background and Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare but curable con... more Background and Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a highly effective and readily affordable treatment modality. Objective: We present a surgical video of SDAVF to demonstrate the operative nuances involved. Surgical Technique: A 53-year-old wheelchair-bound man with spastic paraparesis for 1.5 years was found to have a SDAVF at L1/2 level with a single fistula point. During surgery, a L1-L2 laminectomy and durotomy revealed a dilated vein accompanying the nerve root exiting L1/2 foramen that showed early filling on indocyanine green (ICG) video angiography. This vein was occluded, and a segment of this vein was removed during surgery, which led to resumption of normal spinal cord perfusion. Results: The patient showed gradual recovery of lower limb motor power and improved to assisted ambulation after 3 months. Conclusions: Surgery is a simple, effective, and cost-effective treatment option in SDAVF.

Research paper thumbnail of Adrenal myelolipoma :Incidentally discovered mass

International Journal of Surgery and Medicine, 2017

Introduction: Myelolipoma is a rare benign tumour of the adrenal gland, usually asymptomatic, uni... more Introduction: Myelolipoma is a rare benign tumour of the adrenal gland, usually asymptomatic, unilateral and nonfunctioning. It is composed of a variable mixture of mature adipose tissue and hematopoietic elements. Widespread use of imaging modalities has increased the frequency of detection. Case presentation: We report a case of adrenal myelolipoma in a 55-years-old male of Indian origin, who presented with pain in the right flank. Physical examination revealed an intra-abdominal mass. Contrast-enhanced computed tomography (CECT) scan of the abdomen showed a well-defined, round lesion in right suprarenal region with heterogeneous attenuation. The patient was subjected to right adrenalectomy, and postoperative course was uneventful. The histopathological examination of the mass confirmed this as adrenal myelolipoma. Conclusion: Mostly adrenal lipoma is discovered as "incidentaloma" but warrants thorough diagnostic study. Imaging and biochemical assay are useful for planning best treatment modality in a particular case to minimise postoperative complications and assuring fast recovery.

Research paper thumbnail of Penile gangrene following condom catheter urinary drainage : A case report

International Journal of Surgery and Medicine, 2017

External urine collecting devices have been a boon to patients of urinary incontinence since thei... more External urine collecting devices have been a boon to patients of urinary incontinence since their invention in late 90s. They have replaced the need for uncomfortable indwelling catheters in these patients. As safe as they may be, ghastly complications have occurred infrequently, mostly due to their inappropriate application. Such penile and urethral complications add to the morbidity of the patients significantly. They can be easily avoided by following few simple steps of catheter care, thus emphasizing the need to aware clinicians and health care workers about the correct application methods. Here we discuss a case of 60 year old male who developed penile skin necrosis and urethral fistula due to chronic use of condom catheter.

Research paper thumbnail of Intraventricular papillary glioneuronal tumor with high proliferation index and CD117 positivity: Report of an atypical case and review of literature

Journal of Cancer Research and Therapeutics

Research paper thumbnail of Salivary Duct Carcinoma: A Case Report

Journal of Evolution of Medical and Dental Sciences, 2016

A Salivary Duct Carcinoma (SDC) is an uncommon high grade, aggressive malignant with high rate of... more A Salivary Duct Carcinoma (SDC) is an uncommon high grade, aggressive malignant with high rate of recurrence having frequent perineural and lymphovascular invasion. Salivary duct carcinoma accounts for 1% to 3% of all malignant salivary gland tumours. About 200 cases have been reported in the English literature. Histologically SDC is similar to a breast ductal carcinoma. Due to rarity of this malignancy, no consistent therapeutic concept and protocol is available in literature. However, total parotidectomy with neck dissection and adjuvant radiotherapy appear to be appropriate treatment for a salivary duct carcinoma.

Research paper thumbnail of A clinicopathological and neuroradiological study of paediatric meningioma from a single centre

Journal of Clinical Neuroscience, 2011

Paediatric meningiomas are rare intracranial neoplasms representing 0.4% to 4.1% of tumours in pa... more Paediatric meningiomas are rare intracranial neoplasms representing 0.4% to 4.1% of tumours in paediatric patients and 1.5% to 1.8% of all intracranial meningiomas. The goal of this study was to determine the epidemiology, clinical presentation, radiological features, morphological spectrum and treatment outcome of paediatric meningiomas. All evaluable reports of meningioma in children from 1 January 1999 to 31 December 2009 were retrieved from the database of our Department of Pathology and were assessed retrospectively. This study describes 12 patients (nine males, three females; age range, 4-18 years; mean, 12.8 years). Their age and sex distribution, presenting symptoms, neurological findings, location, neuroradiological and histopathological findings were reviewed and the results were compared with published reports. Atypical and malignant meningiomas seem to be more common in childhood and adolescence than in adulthood.

Research paper thumbnail of Gravity Assisted Retraction Less Occipito Transtentorial and Trans-Splenial Approach for Posterior Third Ventricular Dermoid

Research paper thumbnail of How important is to know the psychosocial performance in an operated child of meningioma? Devil is in the details

Journal of Pediatric Neurosciences

Research paper thumbnail of TRISS score A guide for survival in trauma patients

International journal of scientific research, 2017

Research paper thumbnail of Anterior Skull Base Meningioma: Surgical approach and complication avoidance

Journal of Neurological Surgery Part B: Skull Base

Background: Endoscopic endonasal approach (EEA) and keyhole transcranial approaches are being inc... more Background: Endoscopic endonasal approach (EEA) and keyhole transcranial approaches are being increasingly used in anterior skull base meningioma (ASBM) surgery. Objective: We compare tumor resection rates and complication profiles of EEA and supraorbital key hole approach (SOKHA) against conventional transcranial approaches (TCA). Methods: Fifty-four patients with ASBM [olfactory groove (OGM), n=19 and planum sphenoidale/tuberculum sellae (PS/TSM), n=35) operated at a single centre over 7 years were retrospectively analyzed. Results: The overall rate of GTR was higher in OGM (15/19, 78.9%) than PS-TSM group (23/35, 65.7%, p=0.37). GTR rate with OGM was 90% and 75% with TCA and EEA. Death (n=1) following medical complication (TCA) and CSF leak requiring re-exploration (n=2, one each in TCA and EEA) accounted for the major complications in OGM. For the PS/TSM group, the GTR rates were 73.3% (n=11/15), 53.8% (n=7/13) and 71.4% (n=5/7) with TCA, EEA and SOKHA respectively. Seven patien...

Research paper thumbnail of Autoimmune pancreatitis : An entity difficult to diagnose

International Journal of Surgery and Medicine

Research paper thumbnail of Fibroadenoma in an Ectopic Breast Tissue

Journal of Evolution of Medical and Dental Sciences

Ectopic breast tissue may be affected by the same diseases and alterations that affect topical br... more Ectopic breast tissue may be affected by the same diseases and alterations that affect topical breast tissue. Nevertheless, reports of fibroadenoma of the axilla are rare. OBJECTIVE To describe a case of fibroadenoma in an axillary ectopic breast tissue. CASE REPORT A 21 yrs. old woman presented with mass in left axilla since 1 yr., which was gradually increasing in size and not associated with menstrual cyclical disturbance. O/E: Lump of size 4×3 present in left axilla, mobile and non-tender. Breast USG and mammography was reported normal. HPE revealed findings consistent with fibroadenoma.