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  Citation statistics : Table of Contents
   2015| September-October  | Volume 63 | Issue 5  
    Online since October 6, 2015

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Navigated intraoperative ultrasound for resection of gliomas: Predictive value, influence on resection and survival
Aliasgar V Moiyadi, Sadhana Kannan, Prakash Shetty
September-October 2015, 63(5):727-735
DOI:10.4103/0028-3886.166549  PMID:26448233
Background: Navigable ultrasound (NUS) is a useful adjunct for controlling resection in intra-axial brain tumors. We investigated its role in predicting residual disease and thereby in influencing the intraoperative decision regarding additional resection as also its influence on survival in glioblastoma patients. Methods: A prospectively maintained database was accessed to retrieve the data regarding consecutive histologically verified gliomas operated using the NUS. We documented the number of times US images were obtained, the surgeon's impression of each scan and the subsequent decision regarding further resection. Survival (progression-free and overall) was calculated for patients with a glioblastoma, and univariate and multivariate analyses performed. Results: The NUS was used for resection control in 88 gliomas. In 66 cases, intermediate scans were performed resulting in further resection in 60 of them. Radiological gross total resection was obtained in 46 cases (44%). The US correctly predicted postoperative residue in 83% cases (sensitivity and specificity of 87 and 78% respectively; positive and negative predictive values of 82 and 84%). There were 9 false positives and 6 false negative cases. When the US was false positive, the resolution was more often good (7 of 9 cases); whereas when there were false negatives, it was more likely to be less than optimal (4 of 6). Morbidity was 17% and this was not related to the additional resections. In the subset of glioblastoma patients (n = 28) use of NUS was associated with significantly better progression-free as well as overall survival rates. Conclusions: NUS is a useful intraoperative adjunct in controlling resections. It positively and decisively influences the intraoperative course of the surgery. Understanding its correct technique and limitations, along with experience in image interpretation can help in maximizing its accuracy without compromising functional outcomes. Optimally utilized, it can improve survival.
  5 1,922 69
Clinical and imaging characteristics of 16 patients with autoimmune neuronal synaptic encephalitis
N Kamble, M Netravathi, J Saini, A Mahadevan, R Yadav, A Nalini, PK Pal, P Satishchandra
September-October 2015, 63(5):687-696
DOI:10.4103/0028-3886.166532  PMID:26448226
Objectives: Autoimmune neuronal synaptic encephalitis (AIE) encompasses a heterogeneous group of disorders characterized by immune-mediated neuronal cell destruction. In this study, we aim to study the clinical features, imaging profile and treatment outcome of patients with AIE. Methods:This is a chart review of 16 (M: F-3:13) patients with AIE from 2011 to 2015. Results:Among the patients, 10 had anti-NMDA, 4 had anti-TPO, and 2 had anti-VGKC antibody positivity. Cognitive impairment and seizures were the predominant symptoms present in nearly all patients, followed by psychiatric disturbances (87.5%), mutism (62.5%), movement disorders (62.5%), myoclonic jerks (37.5%) and visual hallucinations (18.75%). Magnetic resonance imaging (MRI) of the brain was available in 15 patients; it was abnormal in 53.3% patients. Abnormalities were seen in all patients with anti-VGKC positivity; and, 60% of patients with anti-NMDA positivity. Imaging was normal in 26.7% of the patients (3: anti-NMDA; and, 1: anti-TPO positivity); and, diffuse cerebral atrophy was noted in rest of the 20% (3: anti-TPO positivity) patients. All patients improved gradually with immunomodulation. Conclusions: All patients with anti-VGKC, anti-NMDA and anti-TPO antibody positivity presented with a triad of behavioral changes, impaired cognition and seizures. Mutism was a predominant symptom in patients with an anti-NMDA antibody positivity, which may help in the early identification of this disorder. MRI brain showed changes restricted to limbic structures in anti-NMDA and anti-VGKC antibody positivity. An early diagnosis and treatment of autoimmune encephalitis is essential for a better outcome and for prevention of long-term sequel.
  4 5,707 210
Basal ganglia infarction due to mild trauma in a case of mineralizing angiopathy: A rare entity
Abhishek J Arora, Himabindu Bolla, Richa Arora, Subash Kaul, Jyotsna Yarlagadda
September-October 2015, 63(5):771-772
DOI:10.4103/0028-3886.166566  PMID:26448238
  2 3,020 79
An unusual case of neurobrucellosis presenting with stroke-like episodes
Ester Reggio, Luisa Vinciguerra, Giorgia Sciacca, Giuseppa Fiuman˛, Carmelo Iacobello, Mario Zappia
September-October 2015, 63(5):776-778
DOI:10.4103/0028-3886.166548  PMID:26448241
  2 1,642 49
Teflon granuloma: A rare cause of recurrent trigeminal neuralgia
Garima Sharma, Arti Chaturvedi, Dinesh Kapoor
September-October 2015, 63(5):803-804
DOI:10.4103/0028-3886.166554  PMID:26448256
  2 3,059 48
History of neurology at All India Institute of Medical Sciences
Madakasira Vasantha Padma Srivastava, Deepa Dash
September-October 2015, 63(5):751-761
DOI:10.4103/0028-3886.166553  PMID:26448236
All India Institute of Medical Sciences (AIIMS), New Delhi is considered as the apex healthcare institute of the country. The Department of Neurology was established in the 1960's and continues to be a leader in the country, in providing quality health care, in teaching, and also in conducting cutting edge research. The article traces the history of the Department of Neurology at AIIMS from its inception to the present day.
  2 9,901 131
Presurgical epileptogenic network analysis: A way to enhance epilepsy surgery outcome
Aparna Banerjee Dixit, Jyotirmoy Banerjee, Manjari Tripathi, P Sarat Chandra
September-October 2015, 63(5):743-750
DOI:10.4103/0028-3886.166546  PMID:26448235
Accurate localization of the “epileptogenic zone (EZ)” is an important issue in epilepsy surgery. The EZ is not discrete and focal; in fact, the epileptogenic networks can spread ictal activity to different regions of the brain. Changes in network characteristics and functional connectivity are shown to be associated with epilepsy. Seizures are thought to represent a hyper-synchronous state and presumable changes in synchronization between different brain regions underlie the mechanisms of seizure spread. Although presurgical evaluation of the epileptogenic network analysis can be carried out using existing investigative techniques like electroencephalogram (EEG), video-EEG, magnetic resonance imaging, single-photon emission computed tomography, and magnetoencephalography, advanced imaging techniques such as optical intrinsic spectroscopy, auto-fluorescence imaging, voltage sensitive dye imaging, and calcium imaging have the advantage of better spatiotemporal resolution over a large area of cortex. Understanding the wide-scale dynamic networks by analyzing the changes in the synchronization patterns using advanced imaging techniques will be instrumental in the presurgical analysis of the epileptogenic network and better localization of the EZs in the future.
  2 2,672 132
Outcome after revascularization surgery for moyamoya disease: An anesthesiologist’s perspective
Pragati Ganjoo
September-October 2015, 63(5):654-655
DOI:10.4103/0028-3886.166578  PMID:26448218
  1 1,464 56
Andersen-Tawil syndrome: A review of literature
Sachin Suresh Babu, Gaurav Bhaskar Nigam, C Sudhir Peter, C Shobhna Peter
September-October 2015, 63(5):772-774
DOI:10.4103/0028-3886.166530  PMID:26448239
  1 2,663 73
Tapia's syndrome secondary to metastatic prostate cancer
Zahide Yilmaz, Gokhan Duygulu, Sehnaz Kiliš, Rabia Terzi
September-October 2015, 63(5):782-783
DOI:10.4103/0028-3886.166531  PMID:26448244
  1 1,658 42
Multiple mirror aneurysms: Does the embryological perspective merit a special mention?
Tanmoy Kumar Maiti, Subhas Konar, Anil Nanda
September-October 2015, 63(5):784-785
DOI:10.4103/0028-3886.166557  PMID:26448245
  1 1,551 38
Co-occurrence of trifid and bifid median nerves in a patient with bilateral carpal tunnel syndrome
Seyed Mansoor Rayegani, Leyla Sedighipour, Seyed Ahmad Raeissadat, Fatemeh Hojjati, Hamid Reza Aghayousefi, Farivar Lahiji, Morteza Sanei Taheri
September-October 2015, 63(5):788-789
DOI:10.4103/0028-3886.166535  PMID:26448247
  1 1,834 36
Compressive cervical myelopathy secondary to totally extradural spinal arteriovenous fistula
Manish K Kasliwal, Sumeet G Dua, Erwin Z Mangubat, Demetrius K Lopes
September-October 2015, 63(5):790-792
DOI:10.4103/0028-3886.166542  PMID:26448248
  1 1,481 44
Corpus callosal lipoma with extracranial extension as a scalp swelling
Survendra Kumar Rai, Vithal Rangarajan, Abhidha Shah, Atul Goel
September-October 2015, 63(5):796-797
DOI:10.4103/0028-3886.166565  PMID:26448251
  1 1,550 40
Cervical pneumorrhachis secondary to a basal skull fracture
Mehdi Bellil, Khaled Hadhri, Anis Tebourbi
September-October 2015, 63(5):800-801
DOI:10.4103/0028-3886.166536  PMID:26448253
  1 1,453 47
Anesthetic factors and outcome in children undergoing indirect revascularization procedure for moyamoya disease: An Indian perspective
Sabina Jagdevan, Kamath Sriganesh, Paritosh Pandey, Madhusudan Reddy, GS Umamaheswara Rao
September-October 2015, 63(5):702-706
DOI:10.4103/0028-3886.166575  PMID:26448228
Background: Moya Moya disease (MMD) is one of the most common cerebro-vascular diseases in children resulting in stroke. Surgical revascularization aims at improving the perfusion to the 'at-risk' ischemic brain. Several factors including peri-operative anesthetic related ones, affect the outcome in these children. This study was performed with the aim to explore the role of anesthetic techniques, pharmacological agents and perioperative management strategies on the neurological outcome following an indirect revascularization procedure for the treatment of MMD. Materials and Methods: This was a retrospective chart review of pediatric indirect revascularization procedures for MMD during a three year period at a tertiary neurosciences hospital in southern India. Demographic details, disease characteristics and variables related to anesthetic management were obtained from the patient's charts and analyzed. The main outcome measure was occurrence of postoperative new neurological complications; and, the secondary outcome was length of hospital stay after surgery. Results: Twenty-two children underwent thirty indirect revascularization procedures, of which four patients had new postoperative neurological complications. One child died due to bilateral cerebral infarcts following bilateral surgery as a single stage under the same anesthesia. Female gender and a higher opioid dose were associated with occurrence of postoperative neurological deficits. Younger age, prolonged anesthetic duration and occurrence of postoperative neurological deficits were associated with prolonged postoperative hospital stay. However, none of these factors were predictive of either an adverse neurological outcome or a prolonged hospital stay. Conclusion: In this study, anesthetic techniques or medications did not influence the occurrence of postoperative neurological deficits or prolonged hospital stay after an indirect revascularization procedure in children with MMD.
  1 2,686 84
Novel classification for surgical approach of petroclival meningiomas: A single-surgeon experience
Manas Panigrahi, Sudhindra Vooturi, Mohan Rao Patibandla, Dilip Kulkarni
September-October 2015, 63(5):718-722
DOI:10.4103/0028-3886.166551  PMID:26448231
Background: Management of petroclival meningiomas (PCMs) is a surgeons' challenge. Planning the surgical approach and extent of excision play a vital role. The current study discusses a novel grading system that may help to choose the surgical approach. Materials and Methods: We prospectively analyzed 76 patients operated after selecting the surgical approach through a novel grading system based on the extent of dural attachment of PCM in the posterior fossa. Results: The mean age of the study group was 39.74 ± 13.38 years and 51% of the patients were women. Gross total resection (GTR) was achieved in 59 (77.6%) patients. Among patients who underwent subtotal resection (STR), the mean sagittal diameter of the tumor was greater than axial (4.6 ± 0.9 mm vs. 3.4 ± 1.3 mm; P = 0.01) and coronal diameters (4.6 ± 0.9 mm vs. 3.8 ± 1.4 mm; P < 0.01). The complication rate was 34.2%. The most frequent complication was cerebrospinal fluid leak in 10 (13.1%) patients. In patients where STR was done, the sagittal diameter of the tumor was higher in patients without complications (4.5 ± 0.9 mm vs. 3.9 ± 1.1 mm; P = 0.02). At 6 years follow-up, 6 patients where STR was performed, developed tumor progression. Conclusion: The proposed grading is helpful in achieving higher rates of GTR with minimal complications in surgical excision of PCMs. The role of sagittal diameter in planning the extent of excision needs further research.
  1 3,075 141
Reshaping the zygomatic complex: A “small step” in frontotemporal craniotomy and a “big leap” in exposure
Shashwat Mishra, Arun K Srivastava, Hitesh Kumar, Bhawani S Sharma
September-October 2015, 63(5):723-726
DOI:10.4103/0028-3886.166540  PMID:26448232
Context: Pterional or fronto-temporal craniotomy, developed by Prof. M. G. Yasargil, is among the most familiar skull base surgery techniques. The cranio-orbito zygomatic (COZ) approach evolved to address the significant limitations of the pterional exposure in excising some parasellar lesions. Although extremely versatile, the COZ technique involves extensive dissection of the cranio-facial soft tissue and reconstruction towards the end of the procedure. The zygomatic reshaping is a minor modification of the pterional approach, which enhances the exposure possible through the classical approach and often circumvents the need for an orbito-zygomatic osteotomy. Aims: To demonstrate the technique of reshaping of the zygomatic complex for an optimum surgical exposure and cosmetic results. Materials and Methods: Between April 2013 and December 2014, 8 patients with various middle and anterior skull base lesions were operated using this technique. These patients form the clinical material for this study. The clinical details, radiological images and follow-up data of these patients were collected for this clinical series. Results: No mortality or significant morbidity were noted in this series. The post-operative cosmetic results were also acceptable. Conclusions: A quick and easy modification of the classical pterional approach through zygomatic reshaping has the potential to provide a significantly enhanced surgical exposure for parasellar lesions. Using this approach, it might be possible to avoid an extensive orbito-zygomatic osteotomy in suitable lesions.
  1 2,228 82
Current trends in the management of acute ischemic stroke
Srinivasan Paramasivam
September-October 2015, 63(5):665-672
DOI:10.4103/0028-3886.166547  PMID:26448223
Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT) head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV) recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS). Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly improved outcome in stroke patients.
  1 5,322 342
Are Indian neuroscience clinicians perishing without publishing?
George C Vilanilam, BJ Sudhir, K Krishna Kumar, Mathew A Abraham, Suresh N Nair
September-October 2015, 63(5):807-808
DOI:10.4103/0028-3886.166564  PMID:26448258
  - 1,611 74
Author's reply
Venkatesh S Madhugiri
September-October 2015, 63(5):808-809
  - 859 48
Publication performance and research output of neurology and neurosurgery training institutes in India: The true picture of King George's Medical University
Praveen Kumar Sharma, Hardeep Singh Malhotra, Ravindra Kumar Garg
September-October 2015, 63(5):810-811
DOI:10.4103/0028-3886.166562  PMID:26448259
  - 1,477 71
Author's reply
Venkatesh S Madhugiri
September-October 2015, 63(5):811-813
  - 817 49
Bangur Institute of Neurosciences: One of the premier neurology/neurosurgery teaching institutes of the country
Atanu Biswas, Shyamal Kumar Das
September-October 2015, 63(5):813-814
DOI:10.4103/0028-3886.166567  PMID:26448260
  - 4,320 86
Authors' reply
Venkatesh S Madhugiri
September-October 2015, 63(5):814-815
  - 845 43
Postoperative diabetes insipidus in craniopharyngiomas: Effective management by adherence to a strict protocol
Kiyoshi Saito
September-October 2015, 63(5):659-660
DOI:10.4103/0028-3886.166572  PMID:26448220
  - 1,953 74
Management of diabetes insipidus in craniopharyngiomas
Deepu Banerji
September-October 2015, 63(5):661-662
DOI:10.4103/0028-3886.166576  PMID:26448221
  - 3,629 96
Craniopharyngiomas: Postoperative assessment of fluid and electrolyte disturbances
Preeti Dabadghao
September-October 2015, 63(5):663-664
DOI:10.4103/0028-3886.166577  PMID:26448222
  - 3,117 101
Petroclival meningioma: Resisting the Siren’s song
Anil Nanda, Subhas Konar
September-October 2015, 63(5):656-658
DOI:10.4103/0028-3886.166579  PMID:26448219
  - 2,637 75
Autoimmune encephalitis - The evolving spectrum: An Indian case series
Saiju Jacob
September-October 2015, 63(5):647-649
DOI:10.4103/0028-3886.166556  PMID:26448215
  - 4,241 256
Neuromodulation in chronic headache
Manmohan Singh
September-October 2015, 63(5):650-651
DOI:10.4103/0028-3886.166559  PMID:26448216
  - 1,938 86
Giant cell arteritis (temporal arteritis) revisited
Satish K Sai, Sanjeev V Thomas
September-October 2015, 63(5):652-653
DOI:10.4103/0028-3886.166571  PMID:26448217
  - 1,853 87
Arteriovenous malformation at the corpus callosum with an intraventricular aneurysm
Masaru Honda, Takeo Anda, Toshiaki Kamei
September-October 2015, 63(5):792-794
DOI:10.4103/0028-3886.166558  PMID:26448249
  - 1,704 41
C1-2 ganglioneuroma in a patient with neurofibromatosis type-1
Hrushikesh Kharosekar, Shonali Valsangkar, V Velho
September-October 2015, 63(5):794-796
DOI:10.4103/0028-3886.166550  PMID:26448250
  - 1,656 42
New onset syringomyelia: An uncommon presentation of ventriculo-peritoneal shunt dysfunction following treatment of hydrocephalus in the young
VR Roopesh Kumar, Prasad Krishnan
September-October 2015, 63(5):785-788
DOI:10.4103/0028-3886.166561  PMID:26448246
  - 1,583 40
Transient oculomotor synkinesis in a case of ophthalmoplegic migraine
Subasree Ramakrishnan, Pradeep Kallollimath, Girish B Kulkarni, Veerendrakumar Mustare
September-October 2015, 63(5):778-780
DOI:10.4103/0028-3886.166537  PMID:26448242
  - 1,646 54
Carotid dissection as a manifestation of granulomatosis with polyangiitis
Golnaz Yadollahikhales, Zahra Habibagahi, Anahid Safari, Afshin Borhani-Haghighi
September-October 2015, 63(5):780-782
DOI:10.4103/0028-3886.166541  PMID:26448243
  - 1,535 37
Dyke-Davidoff-Masson syndrome: A classical case with additional skeletal findings
Sanjay Pandey, Shruti Jain
September-October 2015, 63(5):774-776
DOI:10.4103/0028-3886.166545  PMID:26448240
  - 3,954 94
Infraoptic course of the anterior cerebral artery associated with anterior communicating artery and distal anterior cerebral artery aneurysms
Arun Sadashiva Rao, Narayanam Anantha Sai Kiran, Zarina Abdul Assis, Alangar S Hegde
September-October 2015, 63(5):797-799
DOI:10.4103/0028-3886.166563  PMID:26448252
  - 1,648 41
Tension arachnoid cyst with transtentorial herniation: A rare entity
Ankit Balani, Anjani D Kumar, Sapna S Marda, Surendar Alwala
September-October 2015, 63(5):801-802
DOI:10.4103/0028-3886.166544  PMID:26448254
  - 1,981 49
Recurrent facial paralysis for 12 years
Jinqiong Chen
September-October 2015, 63(5):803-803
DOI:10.4103/0028-3886.166560  PMID:26448255
  - 1,759 48
Ponticulus posticus: An anatomical curiosity with clinical implications
Prasad Krishnan, Rajaraman Kartikueyan, Sachinkumar Maheshbhai Patel, Sayan Das
September-October 2015, 63(5):805-806
DOI:10.4103/0028-3886.166555  PMID:26448257
  - 2,906 77
The Cover Page

September-October 2015, 63(5):643-643
  - 1,365 65
Let us promote bio-banking in India for translational research
SK Shankar
September-October 2015, 63(5):644-646
DOI:10.4103/0028-3886.166573  PMID:26448214
  - 2,788 116
A 7-year-old girl with recurrent episodes of abdominal pain, seizures, and loss of vision: Primary diffuse leptomeningeal primitive neuroectodermal tumor masquerading as chronic meningitis
Aruna Nambirajan, Vaishali Suri, Mehar Chand Sharma, Ranjith Kumar, Ajay Garg, Sheffali Gulati, Vivek Tandon
September-October 2015, 63(5):736-742
DOI:10.4103/0028-3886.166552  PMID:26448234
  - 1,972 61
A summary of some of the recently published seminal papers in Neuroscience
K Sridhar, Anant Mehrotra, Sanjay Pandey
September-October 2015, 63(5):762-770
DOI:10.4103/0028-3886.166580  PMID:26448237
  - 1,668 79
Dr. Sanjiv Sinha (8th September 1956 -7th August 2015)
Daljit Singh
September-October 2015, 63(5):816-817
  - 2,439 70
Giant cell arteritis in India: Report from a tertiary care center along with total published experience from India
Aman Sharma, Vinay Sagar, Mahesh Prakash, Vikas Gupta, Niranajan Khaire, Benzeeta Pinto, Varun Dhir, Amanjit Bal, Ashish Aggarwal, Susheel Kumar, Kusum Sharma, Manish Rathi, Ashim Das, Ramandeep Singh, Surjit Singh, Amod Gupta
September-October 2015, 63(5):681-686
DOI:10.4103/0028-3886.166543  PMID:26448225
Objectives: Giant cell arteritis (GCA) is a granulomatous large vessel vasculitis with very scarce data from India. The purpose of this study was to present a comprehensive data of all published Indian cases along with our experience from North India. Materials and Methods: This was a retrospective study of all patients diagnosed to be having GCA according to the American College of Rheumatology criteria at a large tertiary care hospital. The demographic data, clinical, investigations, treatment details, and outcomes were noted. Details of all case series and case reports published from India were pooled along with our experience in order to generate a cumulative data of all cases from India. This was then compared with several large published case series from South America, Europe, and Asia. Results: A total of 72 patients (17 patients in the present series and another 55 patients from other Indian case series and case reports) were identified. The findings of our study are similar to the studies published from other parts of the world, except for the onset of the disease a decade earlier, a male predilection, a lower temporal artery biopsy positivity, and a higher incidence of ophthalmic complications. Conclusions: Indian patients with GCA have an earlier age of onset, male preponderance, and higher ophthalmic complications.
  - 2,560 131
The effect of citicoline on stroke: A comparative study from the Eastern part of India
Saikat Ghosh, Somak Kumar Das, Tanusree Nath, Kartik Chandra Ghosh, Ramesh Bhattacharyya, Gouranga Prosad Mondal
September-October 2015, 63(5):697-701
DOI:10.4103/0028-3886.166538  PMID:26448227
Background: Citicoline is a novel neuroprotective agent used in acute stroke with a significantly favorable outcome. Materials and Methods: A hundred patients who suffered from either an ischemic and hemorrhagic stroke and who presented to the hospital within 48 h of stroke onset were enrolled for the study. Of these 100 patients (age- and sex-matched), 50 patients were treated with citicoline along with the standard stroke management and considered as 'cases'. The other 50 patients who were administered the standard stroke treatment were considered as 'controls.' The baseline parameters of the patients was assessed using the National Institute of Health Stroke Scale. The patients were reassessed at follow up at the end of the 1st and 3rd month of the commencement of the therapy and their outcome was evaluated by the Barthel Index score (BI). Results: The mean BI scores of all categories at the 1st and 3rd month were significantly higher in the citicoline treatment group (P < 0.001 at the 1st month and P = 0.002 at the 3rd month). An analysis of the categorized BI score showed that there was a significant difference in the number of patients in the categorized BI score (85–100) (at the 1st month follow-up: 0% in control vs. 7% in case group [P < 0.05]; and, at the 3rd month follow-up: 10% in control vs. 36% in citicoline case group [P < 0.05]). In the subgroup analysis, both patients suffering from either ischemic and hemorrhagic stroke (including all categories of BI score) in the citicoline treatment group showed a significantly higher mean BI score at the 1st month (ischemic: P = 0.003, hemorrhagic: P =0.04) and also at the end of the 3rd month (ischemic: P = 0.03, hemorrhagic: P = 0.03). An analysis of the categorized BI score (85–100) at the end of the 3rd month in both the hemorrhagic as well as the ischemic subgroups showed a significant incidence of improvement in the citicoline group compared with the control group (hemorrhagic-- control: 6.66% vs. case: 31.81%, P < 0.05 and ischemic-- control: 11.41% vs. case: 35.71%, P < 0.05). Conclusion: In patients suffering from stroke and presenting within 48 h of onset, treatment with citicholine increases the probability of complete recovery and a favorable outcome at the 1st month and at the end of the 3rd month in all the stroke groups.
  - 6,287 266
Neuromodulation as a last resort option in the treatment of chronic daily headaches in patients with idiopathic intracranial hypertension
Andrew B Shaw, Mayur Sharma, Ammar Shaikhouni, Evan S Marlin, Daniel S Ikeda, John M McGregor, Milind Deogaonkar
September-October 2015, 63(5):707-711
DOI:10.4103/0028-3886.166534  PMID:26448229
Objective: To determine the feasibility and efficacy of occipital nerve stimulation (ONS) in patients with refractory headaches secondary to idiopathic intracranial hypertension (IIH). Background: IIH is a syndrome characterized by elevated intracranial pressures in the absence of a mass lesion. These patients typically present with chronic and intractable headaches. Cerebrospinal fluid (CSF) diversion fails in relieving the headache in a significant proportion of this population. ONS has been shown to be effective in medically refractory headaches and to our knowledge, has not been attempted as a therapeutic modality in this population. Methods: Four patients with occipital predominant chronic daily headaches and IIH who failed medical management underwent bilateral ONSs. Octopolar percutaneous electrodes were implanted in the defined area of pain. Visual Analog Scale (VAS) was used as an outcome measure. Patient demographics and surgical complications were also reviewed in this retrospective study. Following the trial period, all patients had >50% pain reduction resulting in permanent implantation. Results: All 4 patients had an average improvement of their VAS scores by 75%, with 85% spatial coverage and the remainder of the uncovered region being frontal. Sustained benefits were seen up to 3 years of follow-up. One patient had a lead erosion requiring removal followed by delayed re-implantation and another lost treatment efficacy at 2 years resulting in explantation. One patient required CSF diversion due to visual threat during the follow-up period but maintained sustained benefit from her ONS. Conclusions: Bilateral ONS may be a useful treatment option in the management of selected patients with IIH, after standard surgical interventions have been attempted. Bilateral ONS may provide therapeutic option for management of residual headaches in these complicated patients.
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Evaluation of a protocol-based treatment strategy for postoperative diabetes insipidus in craniopharyngioma
Ravindran Pratheesh, Diane M. A Swallow, Mathew Joseph, Damodaran Natesan, Simon Rajaratnam, KS Jacob, Ari G Chacko
September-October 2015, 63(5):712-717
DOI:10.4103/0028-3886.166533  PMID:26448230
Background: Postoperative diabetes insipidus (DI) is a significant cause of morbidity in craniopharyngiomas (CP) and its effective management improves outcome. Objective: The objective was to determine the efficacy of a treatment protocol in the management of early postoperative DI in CP. Materials and Methods: The quality of postoperative DI control in a prospective cohort of 26 patients treated utilizing a strict protocol (Group 1) was compared with a retrospective cohort of 34 patients (Group 2) managed without a protocol. A 6-h urine output more than 4 ml/kg/h or serum sodium (Na+) more than 145 mEq/L was diagnosed as DI. The quality of DI control was assessed by determining the incidence of serum Na+ values above 150 mEq/L or below 130 mEq/L and the incidence of wide (>10 mEq/L) intra-day fluctuations of serum Na+ levels. Results: The occurrence of high and low serum Na+ levels was significantly lower in Group 1(P = 0.032). The incidence of serum Na+ exceeding 150 mEq/L on postoperative days 2 and 3 was significantly higher in Group 2 as compared with those in Group 1 (25% vs. 7.6%, P = 0.0008). Hyponatremia was more frequent in Group 2 and tended to occur on postoperative days 6, 7, and 8 (14.2% vs. 3.2%; P = 0.004). The same patients who had hypernatremia in the early part of the week later developed hyponatremia. Although the incidence of wide intra-day fluctuations (>10 mEq/L) was higher in Group 2, it did not reach statistical significance. Conclusion: A strict protocol based management results in better control of postoperative DI in CP.
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Endoscopic transnasal approach to anterior and middle cranial base lesions
Sien Hui Tan, Yves Brand, Narayanan Prepageran, Vicknes Waran
September-October 2015, 63(5):673-680
DOI:10.4103/0028-3886.166539  PMID:26448224
We present our experience in managing pathologies involving the anterior and middle cranial base using an endoscopic transnasal approach, highlighting the surgical technique, indications, and complications. The different types of endoscopic approaches used include the transtuberculum/transplanum, transcribiform, transsellar, and cavernous sinus approaches. The common indications include repair of cerebrospinal fluid leaks (both spontaneous and post traumatic) and excision of pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, and other malignancies of the anterior cranial base. Careful reconstruction is performed with the multilayer technique utilizing fat, fascia lata, and fibrin sealant. The endoscopic transnasal approach, coupled with the present-day sophisticated neuronavigation systems, allows access to lesions in the midline extending from the cribriform plate to the craniovertebral junction. However, preoperative planning and careful selection of cases with evaluation of each case on an individual basis with regard to the lateral extension of the lesion are imperative.
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Online since 20th March '04
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