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   2016| November-December  | Volume 64 | Issue 6  
    Online since November 11, 2016

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Valsalva maneuver: Its implications in clinical neurosurgery
Rudrashish Haldar, Ankur Khandelwal, Devendra Gupta, Shashi Srivastava, Amit Rastogi, Prabhat K Singh
November-December 2016, 64(6):1276-1280
DOI:10.4103/0028-3886.193832  PMID:27841199
Valsalva maneuver is associated with diverse physiological changes. These changes are used in various diagnostic and therapeutic clinical settings. Valsalva maneuver is also employed during various phases of neurosurgical procedures to achieve specific targets and confirm intraoperative findings. In this article, we attempt to describe the various clinical applications of the Valsalva maneuver within the realms of clinical neurosurgery. The associated complications of this act have also been discussed.
  10,966 153 -
Tropical ataxic neuropathy – A century old enigma
Archana B Netto, Clare M Netto, Anita Mahadevan, Arun B Taly, JB Agadi
November-December 2016, 64(6):1151-1159
DOI:10.4103/0028-3886.193755  PMID:27841178
Tropical ataxic neuropathy, which is prevalent in the tropics causes significant disability as well as increased mortality and remains an enigmatic disease with no effective treatment or cure, even a century after its identification. The syndrome, first described in Jamaica in 1897 and christened as tropical ataxic neuropathy in 1959, is a constellation of bilateral optic atrophy, bilateral sensory neural deafness, predominant posterior column involvement and pyramidal tract myelopathy, with ataxic polyneuropathy. The exact etiopathogenesis remains unresolved, and several factors have been proposed including malnutrition, vitamin B deficiencies, malabsorption, poor protein consumption, chronic cyanide, and nitrile toxicity, with a strong geospatial endemic prevalence in areas of cassava cultivation. In this review, we summarize the history, epidemiology, clinical features, and controversies regarding the pathogenesis and differential diagnosis of the disease and identify the potential areas for further research concerning this debilitating disorder that is common in the tropics. Its multifactorial etiopathogenesis provides potential opportunities for research and international collaboration to identify novel avenues for treatment.
  4,655 236 -
Craniovertebral junction anomalies: When is resurgery required?
Pavaman Sindgikar, Kuntal Kanti Das, Jayesh Sardhara, Kamlesh Singh Bhaisora, Arun Kumar Srivastava, Anant Mehrotra, Awadhesh Kumar Jaiswal, Rabi N Sahu, Sanjay Behari
November-December 2016, 64(6):1220-1232
DOI:10.4103/0028-3886.193781  PMID:27841190
Background: Craniovertebral junction (CVJ) abnormalities, such as atlantoaxial dislocation (AAD) with or without basilar invagination (BI), with or without associated Chiari malformation (CM), may cause a high cervical myelopathy. Occasionally, mechanical factors such as inadequate canal decompression, torticollis, and/or scoliosis may lead to lack of improvement following the primary surgery. Furthermore, implant-related factors, requiring implant revision/removal, or the presence of surgical site infections may cause the patient to undergo resurgery. Aims: This study was aimed at highlighting the underlying etiopathogenesis of resurgery following the primary surgery undertaken in CVJ abnormalities. Setting and Design: This was a retrospective study from a tertiary care referral institute focusing on 414 operated cases of CVJ anomalies. Materials and Methods: The data of 55 patients who underwent resurgery included their clinicoradiological assessment and operative records. The inclusion criteria included failed primary procedure, repeat procedure for construct failure, infection at the surgical site, or wound dehiscence. Pure CM patients without bony anomalies were excluded from the study. Results: A total of 137 procedures were performed in 55/414 (13%) patients. Causes of resurgery could be divided into ventral [redo or denovo transoral decompression (TOD) or wound-related complications, n = 33, 40.2%] and dorsal causes (implant-related factors/wound infections, n = 49, 59.8%). De novo TOD was done in persisting myelopathy following posterior fusion (PF) with C1-2 distraction (n = 15,18.3%,). Redo TOD was done for residual anterior bony compression [n = 8, 9.6%, OR 0.61; [CI = 0.20-1.86]. Causes for oral wound reexplorations (n = 10, 12.2%) included velopharyngeal insufficiency, wound resuturing, oral bleeding, and cerebrospinal fluid (CSF) leak. Dorsal causes included: (A) Implant factors (n = 27, 32.7%) and (B) neck wound reexplorations (n = 22, 26.8%). Presence of subaxial spine scoliosis, torticollis, and asymmetric joints increased the incidence of reexploration. Occipitocervical fusion rather than C1-2 fusion was more prone towards construct loosening. Conclusions: Patients undergoing distraction with PF may require transoral surgery due to persisting myelopathy, especially in the presence of torticollis, scoliosis, and symmetrical joints. Single stage TOD+PF increases the chances of implant infection due to tissue contamination, bacteremia, or transfacetal migration of microbes. Chronic/recurrent sinus is usually a harbinger of deeper infection and can be cured with implant removal.
  4,476 183 2
Clinical Neuropsychology at Neurosciences Centre, All India Institute of Medical Sciences, New Delhi: A story of metamorphosis
Ashima Nehra
November-December 2016, 64(6):1281-1284
DOI:10.4103/0028-3886.193822  PMID:27841200
The services of clinical psychology (neuro) were established in 1969 under the tutelage of Dr. Surya Gupta. The unit has now established itself as a core group in the Neurosciences Centre, providing services to various other departments. The research and clinical services in Clinical Neuropsychology have substantially expanded since 2005. Research initiatives are underway toward better and more sophisticated systems of assessment and neuropsychological rehabilitation, aimed at facilitating patient care and in providing value-added services for the patients and their families.
  4,448 75 -
Neurosurgical training and evaluation – Need for a paradigm shift
Ajit K Banerji
November-December 2016, 64(6):1119-1124
DOI:10.4103/0028-3886.193841  PMID:27841168
  4,317 134 1
Levetiracetam as an antiepileptic, neuroprotective, and hyperalgesic drug
JL Cortes-Altamirano, A Olmos-Hernández, H Bonilla-Jaime, C Bandala, A González-Maciel, A Alfaro-Rodríguez
November-December 2016, 64(6):1266-1275
DOI:10.4103/0028-3886.193801  PMID:27841198
The main purpose of this review was to expound upon the mechanism of action of Levetiracetam (LEV) as an antiepileptic, neuroprotective, and hyperalgesic drug. LEV is a second-generation anti-epileptic drug (AED) that is approved for clinical use as monotherapy and may also be used for adjunctive treatment of patients with seizures. Several researchers have recommended LEV as a treatment option in different diseases causing neuronal damage, and recently, LEV has been used as an antihyperalgesic drug. LEV exhibits favorable characteristics, including a low potential for interaction, a short elimination half-life, and has neither active metabolites nor major negative effects on cognition. This has generated many new research avenues for the utilization of this drug. However, the precise mechanism of action of LEV has not been fully elucidated. In this review, a search was conducted on PubMed, ProQuest, EBSCO, and the Science Citation index for studies evaluating the effects of LEV as an antiepileptic, neuroprotective, and hyperalgesic drug. A total of 32 studies related to the use of LEV suggested different mechanisms of action, such as binding to the synaptic vesicle glycoprotein 2A (SV2A) protein, inhibition of Ca2+ N-type channels, and its presence as a neuromodulator. These studies concluded that the pharmacodynamics of LEV should be viewed as a single pathway, and should not be based on specific molecular targets that depend on the physiological or pathological conditions prevalent at that time.
  4,287 136 -
Acute disseminated encephalomyelitis: A clinical and neuroradiological profile of pediatric patients
Prabhas Prasun Giri, Sukanta Bhattyacharya, Dipankar Das, Swapan Mukhopadhaya
November-December 2016, 64(6):1187-1192
DOI:10.4103/0028-3886.193808  PMID:27841184
Objectives: To discuss the clinical and neuroradiological profile of pediatric patients with acute disseminated encephalomyelitis (ADEM). Design: Prospective observational study Settings: Children with clinico-radiological diagnosis of ADEM admitted in the pediatric ward of the Institute of Child Health between July 2009 to Sepetember 2014 were included. Materials and Methods: Clinical and neuroradiological parameters of children suffering from ADEM were noted. Results: A total of 36 children were included in the study, among whom approximately 50% had a history of either a preceding viral infection or the administration of a vaccination; and, 92% of them presented with some form of neurological deficits. Encephalopathy was present in 92% children at the time of admission. Seizures were present in 42% of children. The cerebrospinal fluid (CSF) study was non-contributory and magnetic resonance imaging (MRI) was diagnostic in most of the cases. The lesions were usually asymmetrically placed. All of them were treated with steroids and had a good prognosis, with complete neurological recovery in 75% of the children. Conclusion: Although it is perceived as a rare disease, ADEM is fairly common in the pediatric population, Most often, it is misdiagnosed as a meningoencephalitis. An early neuroradiological identification of the demyelinating lesions and treatment with steroid therapy leads to an excellent outcome.
  4,235 170 1
Cyproheptadine-dependent chronic serotonin syndrome
Sanjay Prakash, Chaturbhuj Rathore
November-December 2016, 64(6):1319-1321
DOI:10.4103/0028-3886.193796  PMID:27841211
  3,905 77 1
CT and MRI findings in a case of infantile form of GM2 gangliosidosis: Tay-Sachs disease
Puneet Mittal, Ranjana Gupta, Punita Garg, Amit Mittal, Harkirat Kaur, Sharad Gupta
November-December 2016, 64(6):1372-1373
DOI:10.4103/0028-3886.193818  PMID:27841233
  3,861 74 1
Harvey William Cushing: The father of modern Neurosurgery (1869–1939)
Kalyan B Bhattacharyya
November-December 2016, 64(6):1125-1128
DOI:10.4103/0028-3886.193810  PMID:27841169
  3,755 150 -
Recurrent isolated abducens nerve palsy – unusual manifestation of a known syndrome: Report of two cases
Rohan Mahale, Anish Mehta, Kiran Buddaraju, Abhinandan K Shankar, Mahendra Javali, Purushottam Acharya, Rangasetty Srinivasa
November-December 2016, 64(6):1313-1316
DOI:10.4103/0028-3886.193807  PMID:27841208
  3,525 49 -
Biotin thiamine responsive basal ganglia disease–A potentially treatable inborn error of metabolism
Karthik Muthusamy, Alka V Ekbote, Maya M Thomas, Sanjith Aaron, Vivek Mathew, Anil B Patil, Ajith Sivadasan, AT Prabhakar, Sangeetha Yoganathan, Mathew Alexander
November-December 2016, 64(6):1328-1331
DOI:10.4103/0028-3886.193797  PMID:27841215
  3,350 117 1
Visual outcome in 2000 eyes following microscopic transsphenoidal surgery for pituitary adenomas: Protracted blindness should not be a deterrent
Pinaki Dutta, Tenzin Gyurmey, Reema Bansal, Ashis Pathak, Sivashanmugam Dhandapani, Ashutosh Rai, Anil Bhansali, Kanchan Kumar Mukherjee
November-December 2016, 64(6):1247-1253
DOI:10.4103/0028-3886.193829  PMID:27841194
Objective: To study the visual outcome after surgery for pituitary adenomas with visual deficits. Materials and Methods: All patients with pituitary adenoma, who presented from 2003-2014 in a tertiary care institute, were included in the study. Surgical outcome was measured in terms of difference in visual acuity, visual fields and optic fundus parameters documented before surgery, immediate post-operatively and at the third, and twelfth months following surgery. Results: At the initial presentation, visual involvement was seen in 87.2% patients. One year after surgery, 93.2% patients having abnormal vision had improvement in visual acuity and visual fields; whereas visual parameters were static in 5.2%. Visual deterioration occurred only in 1.3% patients. Moreover, five-percent of those who did not even have perception of light at presentation experienced significant improvement in vision after surgery. The shorter the duration of visual symptoms, the more was the percentage of patients having faster recovery in the early postoperative period. Conclusion: Post-operative visual outcome was directly proportional to the pre-operative visual acuity. Though the visual outcome was good in the long run irrespective of the duration of symptoms, the speed of recovery was proportional to the duration of visual deficits. However, presence of long-standing visual symptoms should not deter us to subject the patient to surgery. Even patients who are completely visually impaired for years should be subjected to surgery as early as feasible.
  3,322 82 2
Accuracy of the ice test in the diagnosis of myasthenic ptosis
Byju Natarajan, Kondanath Saifudheen, V Abdul Gafoor, James Jose
November-December 2016, 64(6):1169-1172
DOI:10.4103/0028-3886.193780  PMID:27841180
Background: Diagnosis of myasthenia gravis is difficult, especially when the disease is restricted to ocular muscles. It is a well-known observation that myasthenic ptosis improves with cold and based on this, the ice pack test has been used as a tool in its differential diagnosis. The aim of the study is to investigate the diagnostic value of ice pack test as a preliminary test in the differential diagnosis of myasthenia and to find out the percentage of positivity and negativity of the ice pack test. Materials and Methods: The study included patients seeking treatment for ptosis in a tertiary care center in Kerala. All patients were subjected to the ice pack test. Evaluation of patients was made by recording the marginal reflex distance (MRD). MRD was recorded before and after the application of ice pack, and an improvement of more than 2 mm was considered positive. Patients were divided into two groups: (1) those who had ptosis and features suggestive of myasthenia; and, (2) those who had ptosis but no features of myasthenia. Patients of both groups were subjected to relevant investigations and the diagnosis of myasthenia was established. Results: Ice cold test was positive in 48 (96%) patients and negative in two patients of the myasthenia group. In the control group, 6 (12%) patients had a false positive ice cold test and in the remaining 44 patients (88%), ice cold test was negative. Conclusion: Ice pack test has a high specificity and sensitivity in the differential diagnosis of myasthenic ptosis.
  3,153 127 3
Demographic characteristics of epilepsy patients and antiepileptic drug utilization in adult patients: Results of a cross-sectional survey
Sanket Newale, Deepak S Bachani
November-December 2016, 64(6):1180-1186
DOI:10.4103/0028-3886.193806  PMID:27841183
Background: Through this cross-sectional study, we examined the demographic parameters, comorbidities, and antiepileptic drug (AED) utilization in patients with epilepsy. Materials and Methods: We collected data of 973 adult patients with epilepsy and analysed AED utilization according to the epilepsy type, age group and gender. Results: The study included 973 patients (males, 61.3%) with a mean age of 35.6 years. Only 3.6% patients were not educated whereas 45.3% patients were employed. Only 1.2% patients had a history of brain injury. The mean frequency of seizures during the previous 6 months was 24.0 ± 49.1 whereas the mean duration of epilepsy was 5.8 ± 5.8 years. Electroencephalogram was the most common (59.7%) investigation performed. A total of 109 (11.2%) patients had comorbid medical illness, with hypertension being observed in 3.3% patients. Levetiracetam was used in 583 (59.9%) patients whereas valproate, clobazam, and phenytoin were used in 16.3%, 14.8%, and 13.6% patients, respectively. Effectiveness and safety/tolerability profile were the two most important considerations for selecting the AED. A total of 924 (95%) patients had seizure control with the current therapy during the previous 6 months whereas the mean seizure-free interval was 7.1 ± 4.1 months. Levetiracetam was used in 34.9%, 45.7%, and 61.1% patients and valproate in 15.2%, 10.9%, and 4.6% patients in the age group of 18–30, 31–50 and 51–75 years, respectively. Levetiracetam was used in 57.7% and 63.4% whereas valproate was used in 19% and 12.2% male and female patients, respectively. The adverse event rate was only 0.1%. Conclusion: Epilepsy is common in adult patients. Hypertension is the most common comorbidity. Levetiracetam is the most commonly used AED across all studied age groups and both genders. Control of epilepsy with current treatment is satisfactory with no major adverse events.
  3,083 169 1
Ice test in the diagnosis of myasthenic ptosis
Meena Gupta
November-December 2016, 64(6):1173-1174
DOI:10.4103/0028-3886.193763  PMID:27841181
  3,169 75 1
Extracranial temporal cavernous hemangioma: Differential diagnosis, and a review of literature
Mazda K Turel, Tim-Rasmus Kiehl, Fred Gentili
November-December 2016, 64(6):1347-1351
DOI:10.4103/0028-3886.193800  PMID:27841223
  3,163 43 -
Molecular screening of intellectually disabled patients and those with premature ovarian failure for CGG repeat expansion at FMR1 locus: Implication of combined triplet repeat primed polymerase chain reaction and methylation-specific polymerase chain reaction analysis
Srinivasan Muthuswamy, Deepika Delsa Dean, Sarita Agarwal
November-December 2016, 64(6):1175-1179
DOI:10.4103/0028-3886.193786  PMID:27841182
Background: Fragile X syndrome (FXS) is also a leading cause of intellectual disability along with Down's syndrome. It is caused by the expansion of CGG triplet repeat at 5' untranslated region of the fragile X mental retardation 1 (FMR1) gene. Since the prevalence rate is quite high in the general population, molecular diagnosis is important to establish the cause and the prenatal diagnosis. At present, there are a number of methods available with their own merits and demerits. Aim and Methods: Molecular screening of intellectually disabled patients and those with premature ovarian failure with combined triplet repeat primed polymerase chain reaction (TP-PCR) and methylation-specific polymerase chain reaction (MS-PCR) for establishing the diagnosis of FXS. Results: The specificity of the method has been validated with archived previously genotyped samples, facilitating the application of this method in the screening procedure. The combined TP-PCR and MS-PCR approach identified six (10%) of the intellectually disabled cases as full mutation positive, one (4%) of the premature ovarian failure cases as premutation positive, and one (out of two) of the prenatal samples as premutation positive. Conclusion: The present study concludes that a combined usage of TP-PCR and MS-PCR will be a useful alternative approach to diagnose patients suffering from fragile X syndrome.
  3,015 77 1
Effects of endovascular therapy on acute ischemic stroke:An updated meta-analysis of randomized controlled trials
Chao Pan, Na Liu, Lifei Lian, Feng Xu, Suiqiang Zhu, Zhouping Tang
November-December 2016, 64(6):1160-1168
DOI:10.4103/0028-3886.193792  PMID:27841179
Objects: To clarify the effects of endovascular therapy (ET) for acute ischemic stroke (AIS) patients, we conducted an updated meta-analysis using data from randomized controlled trials (RCTs). Methods: We searched major electronic databases for RCTs comparing ET with intravenous thrombolysis (IVT) or other standard treatments for AIS patients. Eligible and high-quality RCTs were included in the meta-analysis. The overall estimates were demonstrated as an odds ratio (OR) with 95% confidence interval (CI) and P value. Results: Thirteen high-quality trials met the inclusion criteria and were analyzed. Patients treated by ET were more likely to have good functional outcomes (OR, 1.70; 95% CI, 1.32–2.19; P< 0.0001) and lower mortality rates (OR, 0.77; 95% CI, 0.60–0.98; P = 0.03) at 90 days than patients treated by IVT or standard treatment. There was no significant difference in the rate of symptomatic intracerebral hemorrhage [sICH] (OR, 1.18; 95% CI, 0.73–1.91; P = 0.50). Conclusions: ET is superior to both IVT and standard treatment in providing functional improvement and reducing the mortality rate at 90 days, while not increasing the risk of sICH for the treatment of AIS.
  2,684 93 -
Multiple nerve abscesses: An unusual manifestation of lepra reaction in a patient with borderline leprosy
Ravindra Kumar Garg, Hardeep Singh Malhotra, Vijay Kumar, Amita Jain, Madhumati Goel, Ved Prakash, Sukriti Kumar, Neera Kohli
November-December 2016, 64(6):1326-1328
DOI:10.4103/0028-3886.193787  PMID:27841214
  2,693 71 -
Bridging the treatment gap in epilepsy-is there an emerging trend in the use of newer antiepileptic drugs?
Ashalatha Radhakrishnan
November-December 2016, 64(6):1140-1142
DOI:10.4103/0028-3886.193773  PMID:27841173
  2,556 142 -
Microsurgical treatment of distal anterior cerebral artery aneurysms: A 25 year institutional experience
Dhaval Shukla, Dhananjaya I Bhat, Dwarkanath Srinivas, Sampath Somanna, Paritosh Pandey, BA Chandramouli, K. V. R. Sastry, BS Das
November-December 2016, 64(6):1204-1209
DOI:10.4103/0028-3886.193827  PMID:27841188
Introduction: We present a retrospective study of distal anterior cerebral artery (DACA) aneurysms operated at our institute. Material and methods: From 1988 to 2013, a total of 132 DACA aneurysms were managed surgically. The retrospective data of these patients was collected and analysed. Results: They comprised 6.2% of all 2137 aneurysms operated during the same period. The mean age at presentation was 48.3 years (range: 24–77 years) and the male: female ratio was 1:2. The notable symptom in 114 (86.4%) patients was headache, in 94 (71.2%) was loss of consciousness, in 25 (18.9%) was seizures, and in 17 (12.9%) was limb weakness. There were 99 (75%) patients in World Federation of Neurosurgical Societies (WFNS) grade <3 at admission. On plain computed tomography (CT) scan, intracerebral hemorrhage was seen in 49 (37.1%) and intraventricular hemorrhage in 23 (17.4%) patients. The most common site of aneurysm was the pericallosal (A3 segment) artery noted in 65 (49.2%) patients. Multiple aneurysms were observed in 16 (12.1%) cases. The mean timing of surgery from the first ictus was 17.8 days. The delay was due to a late referral, poor general condition, recurrent bleeding, and worse WFNS grade at presentation. Aneurysms were operated through the following approaches: parasaggital craniotomy in 61 (46.2%), bifrontal craniotomy in 64 (48.5%), and frontotemporal craniotomy in 7 (5.3%). Aneurysms could be successfully clipped in 93.2% of the cases. Postoperative mortality was 8 (6%). The follow-up data was available for 83 (62.9%) patients. The mean duration of follow-up was 15.1 months (1–70 months), with more than 41 (31%) patients having a follow-up of more than 6 months. A favorable outcome (good recovery or moderate disability) was seen in 71 (85.5%) cases. Conclusions: A meticulous attention to the surgical technique provides gratifying results in DACA aneurysms even in patients who present initially in a compromised clinical status.
  2,517 98 1
Meningitis retention syndrome: An unusual complication of viral meningitis
Irfan Ahmad Shah, Ravouf P Asimi, Yuman Kawoos, Mushtaq A Wani, Maqbool A Wani, Sheikh Nawaz, Atif Rasool, Adnan Raina
November-December 2016, 64(6):1307-1309
DOI:10.4103/0028-3886.193811  PMID:27841204
  2,435 54 -
Professor Umesh Sawalaram Vengsarkar – A genius neurosurgeon (27th September, 1934 - 5th July, 2016)
Dattatraya Muzumdar
November-December 2016, 64(6):1422-1424
DOI:10.4103/0028-3886.193775  PMID:27841254
  2,432 53 -
Headphone sign: Metronidazole-induced encephalopathy
Yeeshu S Sudan, Arun Garg, Rajiv Gupta, Atma R Bansal
November-December 2016, 64(6):1374-1376
DOI:10.4103/0028-3886.193788  PMID:27841235
  2,315 111 1
Organized Neurosurgery
Chandrashekhar Eknath Deopujari
November-December 2016, 64(6):1129-1135
DOI:10.4103/0028-3886.193779  PMID:27841170
Organized neurosurgery in India started in 1951 with the formation of the Neurological Society of India (NSI). Essentially, this society was the first superspecialty group in medicine comprising of clinical neuroscientists of India. The character of the Society has changed over the years with the formation of the Indian Academy of Neurology as well as separate groups with multiple specialty doctors in Neurosurgery also starting their own societies. The present mandate of the organization is to promote educational opportunities for residents, young members, and practicing neurosurgeons.
  2,247 74 -
Rhombencephalosynapsis: A rare cerebellar malformation associated with aqueductal stenosis and obstructive hydrocephalus
Umesh Kalane, Ashish Atre
November-December 2016, 64(6):1381-1383
DOI:10.4103/0028-3886.193837  PMID:27841240
  2,225 36 -
Distal anterior cerebral artery aneurysms: Current trends
Rajesh Chhabra, Sunil Kumar Gupta
November-December 2016, 64(6):1149-1150
DOI:10.4103/0028-3886.193782  PMID:27841177
  2,115 102 -
Surgical treatment of hemorrhagic brainstem cavernous malformations
Si Zhang, Hao Li, Wenke Liu, Xuhui Hui, Chao You
November-December 2016, 64(6):1210-1219
DOI:10.4103/0028-3886.193825  PMID:27841189
Context: Microsurgery is considered to be the optimal treatment for brainstem cavernous malformations (BCMs); however, the high surgery-related morbidity requires further assessment of therapeutic protocols. Aims: The surgical experience and the optimal surgical strategy for the management of brainstem cavernous malformations is discussed. Materials and Methods: From September 2007 to August 2014, a total of 120 patients with BCMs underwent surgical treatment in our hospital. The clinical features and neurological outcome of these patients were retrospectively analysed, and our institutional surgical strategy was discussed. Results: The preoperative annual hemorrhage and rehemorrhage rates were 4.2% and 42.9%, respectively. Gross total resection was achieved in 116 patients (96.7%) and subtotal resection in 4 (3.3%). After a mean follow-up of 50.7 ± 26.5 months (range: 18–90 months), the neurological status showed improvement in 71 patients (67.0%) and remained stable in 24 (22.6%). The postoperative new-onset or worsened symptoms occurred in 53 cases. During the follow-up period, 58.5% of these symptoms improved and 32.1% remained stable. The mean modified Rankin score (mRS) score was 2.51 ± 0.90 preoperatively, 2.73 ± 0.83 postoperatively, and 1.71 ± 0.98 at the recent follow-up. The surgery-related mortality was 1.7% (n = 2), and two patients suffered from recurrence during the follow-up period. The preoperative mRS was considered to be an independent predictive factor of the neurological outcome (P = 0.003). Conclusions: Safe resection and a favourable outcome can be achieved via a standardized surgical strategy based on appropriate surgical indications, optimal selection of safe trajectories, and application of advanced supplementary techniques in the surgical treatment of BCMs.
  2,161 56 2
Acute disseminated encephalomyelitis in children
Vimal K Paliwal
November-December 2016, 64(6):1193-1194
DOI:10.4103/0028-3886.193783  PMID:27841185
  2,118 65 -
Effects of white matter microstructure lesions on language and memory function in magnetic resonance imaging-negative temporal lobe epilepsy determined by diffusion tensor imaging
Buren Narenmandula, Xiaojun Zhou, Youcheng Li, Dongpei Tu, Yixin Bao, Rongyuan Zheng, Huiqin Xu
November-December 2016, 64(6):1233-1242
DOI:10.4103/0028-3886.193839  PMID:27841191
Objectives: This study was conducted to investigate the associations between white matter lesions and language and memory dysfunctions in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy. Materials and Methods: This study included 26 patients with temporal lobe epilepsy, who did not have significant findings on conventional MRI scanning, and 17 healthy subjects as control. Diffusion tensor imaging data was obtained with a 3Tesla (T) MRI scanner. Neuropsychological scores of language and memory functions were measured. One-way analysis of variance was used to analyze abnormal fractional anisotropy and mean diffusivity values. Correlations were performed to evaluate the relationship between fractional anisotropy/mean diffusivity of each fiber tract and neuropsychological measures. Regression analysis was performed to determine the contribution of each fiber tract to cognitive performance. Results: Our data showed significantly decreased neuropsychological scores in the left and right temporal lobe epilepsy groups compared with control; it however, failed to show a statistical difference between the two groups. For the left temporal lobe epilepsy group, the mean diffusivity of the left parahippocampal and cingulate cortex, right arcuate fasciculus, and left fornix were significantly higher than control. Fractional anisotropy of the right fornix and mean diffusivity of the left uncinate fasciculus were significantly related to confrontational naming scores. There were significant correlations between the fractional anisotropy of the left fornix and verbal delayed memory scores and between the fractional anisotropy of the left fornix and nonverbal delayed memory scores. The mean diffusivity of left fractional anisotropy and the fractional anisotropy of the left uncinate fasciculus were significantly related to confrontational naming and verbal fluency scores, and seizure frequency was significantly related to nonverbal delayed memory scores. Conclusions: Language and memory function impairment was correlated with white matter structural integrity.
  1,987 42 1
Wolfram (DIDMOAD) syndrome with ventral central pontine hyperintensity without brainstem atrophy
Kamble J Harsha, K Parameswaran
November-December 2016, 64(6):1310-1312
DOI:10.4103/0028-3886.193793  PMID:27841206
  1,967 40 1
A new diagnostic algorithm for an early diagnosis of patients with fragile X syndrome
Rama S Dwivedi
November-December 2016, 64(6):1136-1137
DOI:10.4103/0028-3886.193774  PMID:27841171
  1,893 66 -
The Cover Page

November-December 2016, 64(6):1117-1118
DOI:10.4103/0028-3886.193840  PMID:27841167
  1,844 76 -
Neuropsychological implications of white matter microstructural lesions determined by diffusion tensor imaging in magnetic resonance imaging-negative temporal lobe epilepsy
Manas K Panigrahi, V Sudhindra, Sita Jayalakshmi
November-December 2016, 64(6):1243-1244
DOI:10.4103/0028-3886.193764  PMID:27841192
  1,823 48 -
Three sporadic cases of endolymphatic sac tumor
Devimeenal Jegannathan, Gopinathan Kathirvelu, Alamelu Mahalingam
November-December 2016, 64(6):1336-1339
DOI:10.4103/0028-3886.193816  PMID:27841219
  1,816 55 1
Distal anterior cerebral artery aneurysms: Surgical tips
Vijendra K Jain
November-December 2016, 64(6):1147-1148
DOI:10.4103/0028-3886.193766  PMID:27841176
  1,764 73 -
CGG repeat expansion at FMR1 locus – A new molecular diagnostic algorithm in fragile X syndrome
Neeraj Kumar, Hardeep Singh Malhotra, Ravindra Kumar Garg
November-December 2016, 64(6):1138-1139
DOI:10.4103/0028-3886.193771  PMID:27841172
  1,746 59 1
Spontaneous resolution of Chiari malformation and associated syringomyelia
Arun K Mazumder, Sayan Das, Prasad Krishnan
November-December 2016, 64(6):1335-1336
DOI:10.4103/0028-3886.193819  PMID:27841218
  1,738 47 -
Informed refusal – A gray area in informed consent
George C Vilanilam, Gopalakrishnan M Sasidharan
November-December 2016, 64(6):1393-1395
DOI:10.4103/0028-3886.193834  PMID:27841247
  1,731 51 -
Limbic encephalitis associated with anti-leucine-rich glioma-inactivated-1 protein antibodies in a child
Faruk Incecik, Ozlem M Hergüner, Seyda Besen, Mustafa Yılmaz, Sakir Altunbasak
November-December 2016, 64(6):1321-1323
DOI:10.4103/0028-3886.193776  PMID:27841212
  1,725 41 -
Stroke and POEMS syndrome: More than a chance association
Roopa Rajan, Vinny Wilson, Biplab Das, Paramjeet Singh, Jasmina Ahluwalia, Sahil Mehta, Vivek Lal
November-December 2016, 64(6):1318-1319
DOI:10.4103/0028-3886.193842  PMID:27841210
  1,716 47 -
Pediatric intraparenchymal meningioma: A review of literature
Chinmaya Dash, Ambuj Kumar, Ramesh S Doddamani, Madhu Rajeshwari, Mehar C Sharma, Bhawani S Sharma
November-December 2016, 64(6):1351-1354
DOI:10.4103/0028-3886.193795  PMID:27841224
  1,689 48 -
Is cervicocephalic dissection a part “postpartum vasculopathy” spectrum? A case of postpartum posterior reversible encephalopathy syndrome, bilateral petrous carotid artery dissections, and stroke
Kamble J Harsha, K Parameswaran
November-December 2016, 64(6):1305-1307
DOI:10.4103/0028-3886.193794  PMID:27841203
  1,688 35 -
Rare case of non-neoplastic aqueductal stenosis due to web in a patient with neurofibromatosis type-1
Prerna Garg, KM Shruthi, V Maheshwaran, B Devanand
November-December 2016, 64(6):1384-1387
DOI:10.4103/0028-3886.193836  PMID:27841242
  1,680 37 -
Commentary: Wolfram (DIDMOAD) syndrome: A progressive disorder with nonsynchronized clinical and imaging features
Guru Dutta Satyarthee
November-December 2016, 64(6):1312-1313
DOI:10.4103/0028-3886.193809  PMID:27841207
  1,663 46 -
Conventional MRI demonstration of thalamic internal medullary laminae and a few nuclei in a case of multifocal glioma
Kamble J Harsha
November-December 2016, 64(6):1377-1378
DOI:10.4103/0028-3886.193799  PMID:27841237
  1,653 40 -
Perilymph fistula of oval window presenting as otogenic dizziness
Venkatraman Indiran
November-December 2016, 64(6):1383-1384
DOI:10.4103/0028-3886.193805  PMID:27841241
  1,655 33 -
Recurrent skull base rhabdoid meningioma in an adolescent patient
Ranajoy Ghosh, Dilip Dutta, Shatavisha Dasgupta, Uttara Chatterjee, Sandip Chatterjee, Manoj K Chaudhuri
November-December 2016, 64(6):1365-1369
DOI:10.4103/0028-3886.193817  PMID:27841231
  1,638 43 -
Elucidating the utility of neuro-navigation in reducing malposition rates in Ommaya reservoir placement: 23-year operative experience at the Louisiana State University
Andreas Filis, Piyush Kalakoti, David E Connor, Anil Nanda
November-December 2016, 64(6):1195-1201
DOI:10.4103/0028-3886.193798  PMID:27841186
Objectives: Variability exists with the use of neuro-navigation in the placement of Ommaya reservoir. In the setting of recent healthcare reforms in the United States that are focused on cost-containment strategies, we discuss from our experience at the Louisiana State University, Shreveport, if the use of high-cost stealth-guided navigation technique reduces malposition rates over free-hand placement. Patients and Methods: A retrospective cohort analyses on 146 patients that underwent placement of Ommaya reservoir between 1991 and 2014 using free-hand and neuro-navigated technique was performed. Primary endpoint was to evaluate the differences in rates of malposition across these two placement techniques. Results: The mean age of our cohort was 44.85 ± 15.05 years and 45% patients were female. We did not find any statistical differences for complications rates including infections (8.3% vs 9.2%; P = 1.000), hemorrhage (0.0% vs 3.1%; P = 0.551), and repositioning (6.3% vs 8.2%; P = 1.000) across patients that underwent placement of Ommaya reservoir using neuro-navigation and free hand technique. Conclusion: Although placement of Ommaya reservoir is a relatively easier technique as compared to other neurosurgical procedures, based on our experience and literature, we found lower rates of complications in patients who underwent placement via the stealth-guided neuro-navigational approach. Despite not having found any statistical difference in malposition rates between navigated and free-hand implantation of Ommaya reservoirs in our series, it is plausible that the number of technical complications in the neuronavigational group in the early years of acquisition could possibly be attributed to the learning curve, rather than their occuring purely by chance. Nevertheless, considering the increased cost of hospitalization associated with the use of navigational technology, future studies are recommended to weigh the cost-benefit ratio of preferring the neuro-navigational techniques for placement of Ommaya reservoir over the free-hand placement techniques.
  1,643 38 -
Hypoglossal palsy in a case of cavernous sinus thrombosis
Gopal C Ghosh, Brijesh Sharma
November-December 2016, 64(6):1316-1318
DOI:10.4103/0028-3886.193802  PMID:27841209
  1,620 51 -
Rosai–Dorfman disease: An unusual isolated cavernous sinus lesion
Rajinder Kumar, Kanwaljeet Garg, Chinmaya Dash, Mehar C Sharma
November-December 2016, 64(6):1331-1332
DOI:10.4103/0028-3886.193820  PMID:27841216
  1,621 48 -
Visual outcome after pituitary adenoma surgery
Sacit B Omay, Theodore H Schwartz
November-December 2016, 64(6):1254-1255
DOI:10.4103/0028-3886.193770  PMID:27841195
  1,601 47 1
Sports induced femoral neuropathy: Review of literature
Jayantee Kalita, Usha K Misra, Rajesh K Singh, Sanjeev K Bhoi
November-December 2016, 64(6):1303-1304
DOI:10.4103/0028-3886.193823  PMID:27841202
  1,608 39 -
Surgery for distal anterior cerebral artery aneurysm
B Ravi Mohan Rao
November-December 2016, 64(6):1145-1146
DOI:10.4103/0028-3886.193762  PMID:27841175
  1,581 64 -
Fluorescence in situ hybridization for chromosome 14q deletion in subsets of meningioma segregated by MIB-1 labelling index
Noopur Gupta, Geeta Chacko, Ari G Chacko, Vedantam Rajshekhar, Muyilil Jayprakash
November-December 2016, 64(6):1256-1263
DOI:10.4103/0028-3886.193768  PMID:27841196
Aim: To correlate histopathological grading of meningiomas segregated into subgroups based on the MIB-1 labelling index (MIB-1 LI) with chromosomal loss of 14q using fluorescence in situ hybridization (FISH). Settings and Design: Retrospective study conducted in a tertiary hospital. Methods and Material: Forty-six cases from January to December 2011 were segregated into 5 categories based on the MIB-1 LI. Slides were reviewed to ascertain the grade. Immunohistochemical staining for MIB-1 was performed using a Ventana Benchmark XT autostainer. Commercially available FISH paraffin pretreatment kit and SpectrumOrange fluorophore labelled probe were used. The Statistical Package for the Social Sciences version 16.0 for Windows was used for statistical analysis. Results: There were 21 World Health Organisation (WHO) grade I, 24 grade II, and 1 grade III meningiomas. There was a statistically significant difference between the mean duration of symptoms, maximum dimension, and the MIB-1 LI of grade I and grade II meningiomas. 33.3% grade I cases showed 14q deletion, compared to 84% of grade II and III meningiomas. Histologically, hypercellularity, small cell formation, prominent nucleoli, and sheet-like growth were significantly associated with 14q deletion. All brain invasive meningiomas had 14q deletion. As MIB-1% increased, the prevalence of deletions was significantly higher. The mean MIB-1 of the 7 grade I meningiomas that had 14q deletions was 8.86 ± 1.95% when compared to 4.14 ± 1.35% for those without 14q deletions. Conclusions: A strong association existed between histologic grade, MIB-1 LI, and the presence of chromosome 14q deletion. Association of high MIB-1 LI with 14q deletions, even in meningiomas with a Grade I histology, defines a distinct subset of benign meningiomas.
  1,590 49 -
Intradural benign epithelioid schwannoma of the lumbar spine
Joshua T Wewel, Erwin Z Mangubat, Jyothi Patil, Kurian P Abraham, Sepehr Sani
November-December 2016, 64(6):1340-1341
DOI:10.4103/0028-3886.193803  PMID:27841220
  1,583 29 -
Cervical cord compression secondary to epidural fibrous scar tissue around the spinal cord stimulation electrode
Sayoa de Eulate-Beramendi, Elena Santamarta-Liébana, Ramon Fernandez-De Leon, Antonio Saiz-Ayala, Fernando J Seijo-Fernandez
November-December 2016, 64(6):1363-1365
DOI:10.4103/0028-3886.193812  PMID:27841230
  1,550 29 -
A summary of some of the recently published, seminal papers in neuroscience
K Sridhar, Mazda K Turel, Manjul Tripathi, Ravi Yadav, Aastha Takkar, Kuntal Kanti Das, Anant Mehrotra, Hardeep S Malhotra
November-December 2016, 64(6):1285-1302
DOI:10.4103/0028-3886.193784  PMID:27841201
  1,485 56 -
Ommaya reservoir placement: The focus on using neuronavigational guidance
Manish Singh Sharma
November-December 2016, 64(6):1202-1203
DOI:10.4103/0028-3886.193767  PMID:27841187
  1,472 51 -
Cited heavily, taken lightly, matters hardly
George C Vilanilam, MS Gopalakrishnan, Satyajeet Misra, Nilay Chatterjee
November-December 2016, 64(6):1396-1398
DOI:10.4103/0028-3886.193833  PMID:27841249
  1,482 41 -
Vascular decompression for trigeminal neuralgia - Past, present and future
Markus F Oertel
November-December 2016, 64(6):1390-1391
DOI:10.4103/0028-3886.193814  PMID:27841245
  1,471 39 -
Primary spinal extradural inflammatory myofibroblastic tumor: A rare cause of paraparesis
Dipanker Singh Mankotia, Kanwaljeet Garg, Aruna Nambirajan, Vaishali Suri, Vivek Tandon, Rajinder Kumar, Ashish Suri, Shashank S Kale, Bhawani S Sharma
November-December 2016, 64(6):1333-1335
DOI:10.4103/0028-3886.193804  PMID:27841217
  1,455 43 -
Role of ICP monitoring in children with head injuries: Some thoughts
Sandip Chatterjee
November-December 2016, 64(6):1419-1421
DOI:10.4103/0028-3886.193790  PMID:27841253
  1,446 51 -
Rotational translational injury at the thoracolumbar junction
Manjul Tripathi, K. V. L. Narasinga Rao, Vikas Vazhayil, Dwarakanath Srinivas, Somanna Sampath
November-December 2016, 64(6):1369-1371
DOI:10.4103/0028-3886.193778  PMID:27841232
  1,439 46 -
Adult post-varicella small vessel vaculopathy mimicking hypertensive basal ganglia hemorrhage with coexisting infarcts
Kamble J Harsha, K Parameswaran
November-December 2016, 64(6):1323-1326
DOI:10.4103/0028-3886.193777  PMID:27841213
  1,431 41 -
Atypical presentation of primary spinal amyloidoma mimicking a giant cell tumor
Devi P Patra, Harsimrat Bir Singh Sodhi, Rajesh Chhabra, Bishan D Radotra
November-December 2016, 64(6):1361-1363
DOI:10.4103/0028-3886.193826  PMID:27841229
  1,427 38 -
Ectasia of transverse and sigmoid sinuses with vein of Galen malformation
Pankaj Kumar, Vinayak Rastogi, Shaam Bodeliwala, Vikas Kumar, Hukum Singh, Daljit Singh
November-December 2016, 64(6):1373-1374
DOI:10.4103/0028-3886.193791  PMID:27841234
  1,424 41 -
Author's reply: Surgical approaches to trigeminal neuralgia
Vengalathur Ganesan Ramesh
November-December 2016, 64(6):1392-1393
DOI:10.4103/0028-3886.193765  PMID:27841246
  1,424 37 -
Author's reply: Highest cited papers published in Neurology India for the years 1993–2014: The revised list
Paritosh Pandey, Venkatesan Subeikshanan, Venkatesh S Madhugiri
November-December 2016, 64(6):1400-1419
DOI:10.4103/0028-3886.193756  PMID:27841251
  1,402 56 -
The butterfly mystery
Soumya Sharma, Anu Gupta, Gulab Soni, Ravindra K Saran, Arvind K Srivastava, Vinod Puri
November-December 2016, 64(6):1376-1377
DOI:10.4103/0028-3886.193835  PMID:27841236
  1,380 46 -
Highest cited papers in Neurology India
Vedantam Rajshekhar
November-December 2016, 64(6):1400-1400
DOI:10.4103/0028-3886.193838  PMID:27841252
  1,366 55 -
Diffuse large B-cell lymphoma of the testis presenting as a pontine syndrome
Karim M Mahawish
November-December 2016, 64(6):1358-1359
DOI:10.4103/0028-3886.193828  PMID:27841227
  1,369 34 -
Spinal dysraphism masking the presentation of spinal dural arteriovenous fistula: A serendipitous development or a congenital predisposition to an early-onset variant of spinal dural arteriovenous fistula?
Anirudh Srinivasan, Neeteesh K Roy, Mandeep S Ghuman, Ajay Kumar, Sivashanmugam Dhandapani
November-December 2016, 64(6):1380-1381
DOI:10.4103/0028-3886.193830  PMID:27841239
  1,353 41 1
Densly calcified cystic extraventricular neurocytoma: Radiological–pathological correlation
Oktay Gurcan, Atilla Kazanci, Ahmet G Gurcay, Serdar Balci, Halil C Kucukyildiz, Omer F Turkoglu, Murad Bavbek
November-December 2016, 64(6):1355-1358
DOI:10.4103/0028-3886.193824  PMID:27841226
  1,353 31 -
Intrathecal baclofen pump in spinocerebellar degeneration
R Ramnarayan, Simon Herculus
November-December 2016, 64(6):1354-1355
DOI:10.4103/0028-3886.193789  PMID:27841225
  1,332 38 -
Transcorporeal excision of cervical intradural lesions: Two cases and a literature review
Santhosh Rajagandhi, Akshay Hari, Murali Krishna, Rajakumar V Deshpande
November-December 2016, 64(6):1341-1345
DOI:10.4103/0028-3886.193785  PMID:27841221
  1,323 45 -
Volume of hemorrhage in aneurysmal subarachnoid hemorrhage
Aaron Mohanty
November-December 2016, 64(6):1388-1389
DOI:10.4103/0028-3886.193758  PMID:27841243
  1,332 34 -
Hypertropic and exotropic strabismus fixus following neurotoxic snake bite
Kasturi Nirupama, Srinivasan Renuka
November-December 2016, 64(6):1309-1310
DOI:10.4103/0028-3886.193831  PMID:27841205
  1,331 32 -
Diffusion tensor imaging: Opening new possibilities in temporal lobe epilepsy
Abbas Ali Saifee, Renu Khamesra, Ravinder Kumar Kundu
November-December 2016, 64(6):1245-1246
DOI:10.4103/0028-3886.193769  PMID:27841193
  1,313 38 -
Thoracic intramedullary spinal metastasis from carcinoma ex pleomorphic adenoma of the submandibular gland
PY Waghmare, K Abhaya
November-December 2016, 64(6):1359-1361
DOI:10.4103/0028-3886.193821  PMID:27841228
  1,313 31 -
Author's reply: The right to refusal: The patient's prerogative
Daljit Singh
November-December 2016, 64(6):1395-1396
DOI:10.4103/0028-3886.193759  PMID:27841248
  1,286 33 -
Commentary: Surgery for pure midline ventral spinal intradural lesions
Dattatraya Muzumdar
November-December 2016, 64(6):1345-1347
DOI:10.4103/0028-3886.193815  PMID:27841222
  1,262 39 -
Genomic characterization of meningiomas: Fluorescence In-situ hybridization analysis for chromosome 14q deletion in subsets of meningiomas in a cohort of Indian patients
Vernon Velho, Harish Naik
November-December 2016, 64(6):1264-1265
DOI:10.4103/0028-3886.193761  PMID:27841197
  1,238 43 -
Nationwide survey of the antiepileptic used: A much needed study but is it truly representative?
G Arjundas
November-December 2016, 64(6):1143-1144
DOI:10.4103/0028-3886.193772  PMID:27841174
  1,217 53 -
An unusual cause of severe headache: Spontaneous dorsal cerebrospinal fluid leakage
Serkan Aribal, Onur L Ulusoy, Ersin Ozturk, Ayhan Mutlu, Sadık Server
November-December 2016, 64(6):1378-1379
DOI:10.4103/0028-3886.193813  PMID:27841238
  1,214 34 -
Author's reply: Cited heavily, taken lightly, matters hardly: What constitutes “Best science?”
Paritosh Pandey, Venkatesan Subeikshanan, Venkatesh S Madhugiri
November-December 2016, 64(6):1399-1400
DOI:10.4103/0028-3886.193757  PMID:27841250
  1,203 41 -
Author's reply: Correlation of volume of hemorrhage in aneurysmal subarachnoid hemorrhage with overall outcome
Di Zhao
November-December 2016, 64(6):1389-1390
DOI:10.4103/0028-3886.193760  PMID:27841244
  1,166 31 -
Online since 20th March '04
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