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   2018| March-April  | Volume 66 | Issue 2  
    Online since March 15, 2018

 
 
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GUEST COMMENTARY
Deceased organ donation and transplantation in India: Promises and challenges
Aneesh Srivastava, Anil Mani
March-April 2018, 66(2):316-322
DOI:10.4103/0028-3886.227259  PMID:29547145
Organ transplantation has improved the lives of hundreds of thousands of patients all the world. The total organ donation shortage of the country can be met with if even 5 to 10% of the victims involved in fatal accidents serve as organ donors. The challenges include an interplay of sociocultural factors, beliefs and superstitions, lack of communication and organizational support, and negative views by the media. Several initiatives to encourage deceased organ donation include the Indian Network for Organ Sharing, a subdivision of the National Organ and Tissue Transplant Organization, the Transplantation of Human Organ Act (THOA), as well as the Transplantation of Human Organs and Tissue Rules. There are stringent criteria instituted for the retrieval, preservation and transportation of donor organs. This article reviews the ongoing efforts being implemented to encourage organ transplantation.
  15,874 377 -
Brain death revisited
K Ganapathy
March-April 2018, 66(2):308-315
DOI:10.4103/0028-3886.227287  PMID:29547144
Until six decades ago, death was considered to be a specific point in time, referring to the moment at which life ends. With the availability of ventilators, even determining when death has occurred is becoming difficult, as cessation of life functions is often not simultaneous across organ systems. With increasing accessibility to intensive care units (ICUs) even in Tier II and Tier III cities, and the government making it mandatory to notify brain death to facilitate cadaveric organ transplants, it behooves the neurosurgeon and neurologist to totally understand the minutiae of brain death. The author reflects on his personal experience in certifying brain death, over two decades, in a quaternary care hospital. Knowing the pathophysiology of brain stem dysfunction will help the clinician better understand the rationale of the mandatory clinical tests prescribed. The necessity for an early diagnosis and the pitfalls in the clinical diagnosis of brain death, the limitations of the so-called confirmatory tests, and the concerns and ethical issues will be highlighted. Review of the world literature demonstrates that there is no international consensus even on what constitutes brain death. An individual could be considered legally dead in one country but not in another!
  12,226 776 -
NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY
Six decades of Neurology at NIMHANS: A historical perspective
M Netravathi, Nitish Kamble, P Satishchandra, M Gourie-Devi, Pramod Kumar Pal
March-April 2018, 66(2):459-495
DOI:10.4103/0028-3886.227272  PMID:29547172
The Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka has a long tradition of excellence in education, teaching, research, and patient care. Its exceptional alumni, as well as current and past faculty members, have made considerable contributions to the development of neurological services throughout the world. The six decades of its existence have seen a momentous growth in clinical, investigative, and community Neurology. As a result of the immense scientific individual as well as collaborative contributions of the faculty members in various departments, the Institute has had the honour of attaining the status of an autonomous 'Institute of National Importance' under the Ministry of Health, Government of India, through a novel concept of collaboration and partnership of central and state governments. This article traces the dedicated pursuit of members of the Department of Neurology, NIMHANS, in managing neurologic diseases through compassionate patient-centred care, transformative research and education.
  12,845 155 -
REVIEW ARTICLES
Sepsis-associated encephalopathy: A review of literature
Levente Molnar, Béla Fülesdi, Norbert Németh, Csilla Molnár
March-April 2018, 66(2):352-361
DOI:10.4103/0028-3886.227299  PMID:29547154
Sepsis is a leading cause of death in medical and surgical intensive care units (ICUs). Disturbance of consciousness of varying severity is an early warning sign of developing sepsis in the majority of cases. Sepsis-associated encephalopathy (SAE) is the most frequent type of encephalopathy in the ICU and is defined as a state of diffuse cerebral dysfunction caused by the inflammatory response of the body to various infections, where the inflammatory process does not affect the central nervous system (CNS) directly and the primary symptom is a disturbed level of consciousness. The aim of this comprehensive review was to collect the latest scientific knowledge regarding the epidemiology, clinical aspects, pathogenesis, diagnosis, and possible prevention strategies related to SAE.
  8,338 147 -
LETTERS TO EDITOR
Acute ischemic stroke on apixaban: What next?
Konark Malhotra, Santosh R Ramanathan
March-April 2018, 66(2):525-526
DOI:10.4103/0028-3886.227300  PMID:29547181
  5,111 44 -
NI FEATURE: THE EDITORIAL DEBATE III-- PROS AND CONS
Current approach to meningiomas of the medial sphenoid wing and the cavernous sinus
Laligam N Sekhar, Zeeshan Qazi
March-April 2018, 66(2):335-341
DOI:10.4103/0028-3886.227292  PMID:29547151
  4,305 85 -
ORIGINAL ARTICLES
Development of neuropsychological evaluation screening tool: An education-free cognitive screening instrument
Sakshi Chopra, Harsimarpreet Kaur, Ravindra M Pandey, Ashima Nehra
March-April 2018, 66(2):391-399
DOI:10.4103/0028-3886.227304  PMID:29547160
Background: Due to the paucity of quick, cognitive screening tools available in India that are independent of cultural and educational influences, a 6-item paper and pencil test, covering areas of memory, executive functioning, attention, and visuospatial ability domains – the Neuropsychological Evaluation Screening Tool (NEST) was developed. Aim and Method: NEST was administered to 84 healthy controls to analyze, revise, and review items. In the second phase, 408 patients, above 16 years of age, with their educational level ranging from being illiterate to having greater than 25 years of education, with various neurological and psychiatric conditions were independently administered NEST, Hindi Mental State Examination (HMSE), and a detailed cognitive evaluation using PGI Memory Scale (PGIMS). Results: Using receiver operating characteristics analysis for 341 patients, ≥3 was identified as the optimum cut-off for NEST. NEST could correctly classify 87.9% of the patients with an impaired vs. an intact cognition. The diagnostic characteristics of NEST with PGIMS were sensitivity (95% CI): 94.78% (91.1, 97.3); specificity (95% CI): 60.31% (51.3, 68.7); positive predictive value (95% CI): 80.74% (78.1, 93.0); and negative predictive value (95% CI): 86.81% (75.6, 85.3). NEST had an 82.5% agreement (95% CI: 78.1, 86.2) with PGIMS. On the other hand, the diagnostic characteristics of HMSE with PGIMS were sensitivity (95% CI): 73.79% (67.5, 79.3); specificity (95% CI): 82.44% (74.8, 88.5); positive predictive value (95% CI): 88.02% (82.5, 92.2); and negative predictive value (95% CI): 64.3% (56.5, 71.5). HMSE had a 76.95% (95% CI: 72.2, 81.1) agreement with PGIMS. Conclusions: NEST has better sensitivity compared to HMSE for detecting cognitive impairment when compared to a detailed evaluation at all educational levels.
  4,222 102 -
REVIEW ARTICLES
Can oral microbial infections be a risk factor for neurodegeneration? A review of the literature
Rajeev Ranjan, Arra Abhinay, Monalisa Mishra
March-April 2018, 66(2):344-351
DOI:10.4103/0028-3886.227315  PMID:29547153
Neurodegenerative diseases, e.g., Alzheimer's and Parkinson's disease, etc., are serious life-threatening diseases, which involve degeneration of the neurons with time. Numerous studies have discussed the role of microbes in neurodegeneration. Oral cavity being the primary site of infection acts as a gateway for gigantic population of microbes to the human body. Oral infection is known to be associated with neurodegeneration. The current review summarizes various mechanisms due to which the oral microbiome can cause neurodegeneration.
  4,103 63 -
NI FEATURE - COMMENTARY: TIMELESS REVERBERATIONS
Reminiscences of Neurosurgery training at AIIMS, New Delhi
Sureswar Mohanty
March-April 2018, 66(2):298-300
DOI:10.4103/0028-3886.227296  PMID:29547141
  3,989 84 -
NI FEATURE: NORMATIVE DATA - ORIGINAL ARTICLE
Morphometric analysis of cervical spinal canal diameter, transverse foramen, and pedicle width using computed tomography in Indian population
Binit Sureka, Aliza Mittal, Mahesh K Mittal, Kanhaiya Agarwal, Mukul Sinha, Brij Bhushan Thukral
March-April 2018, 66(2):454-458
DOI:10.4103/0028-3886.227277  PMID:29547171
Background: Accurate and detailed measurements of spinal canal diameter (SCD) and transverse foraminal morphometry are essential for understanding spinal column-related diseases and for surgical planning, especially for transpedicular screw fixation. This is especially because lateral cervical radiographs do not provide accurate measurements. Aim: This study was conducted to measure the dimensions of the transverse foramen sagittal and transverse diameters (SFD, TFD), SCD, and the distance of spinal canal from the transverse foramina (dSC-TF) at C1–C7 level in the Indian population. Materials and Methods: The study population comprised 84 male and 42 female subjects. The mean age of the study group was 44.63 years (range, 19–81 years). A retrospective study was conducted, and data were collected and analyzed for patients who underwent cervical spine computed tomography (CT) imaging for various reasons. Results: One hundred and twenty-six patients were included in the study. Detailed readings were taken at all levels from C1–C7 for SCD, SFD, TFD, and dSc-TF. Values for male and female subjects were separately calculated and compared. For both the groups, the widest SCD were measured at the C1 level and the narrowest SCD at the C4 level. The narrowest SFD was measured at C7 for both male and female subjects on the right and left sides. The widest SFD was measured at C1 both for male and female subjects on the right and left side. The narrowest TFD on the left side was measured at C7 for male and at C1 for female subjects. The narrowest mean distance of dSC-TF was found to be at C4 for both male and female subjects on both left and right side. Conclusion: The computed tomographic (CT) imaging is better than conventional radiographs for the preoperative evaluation of cervical spine and for better understanding cervical spine morphometry. Care must be taken during transpedicular screw fixation, especially in female subjects, more so at the C2, C4, and C6 levels due to a decrease in the distance of dSC-TF.
  3,798 62 -
NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS
Infantile spasms: The quest for the most effective medical management
Rashmi Kumar
March-April 2018, 66(2):332-334
DOI:10.4103/0028-3886.227280  PMID:29547150
  3,776 77 -
ORIGINAL ARTICLES
Clinical characterization of neck pain in migraine
Sunil Pradhan, Surjyaprakash S Choudhury
March-April 2018, 66(2):377-384
DOI:10.4103/0028-3886.227302  PMID:29547158
Introduction: Several extracranial symptoms, including somatic pain syndormes, are known to occur in migraine. Though neck pain has been occasionally described with migraine, its precise association and nature is not yet clear. Objective: To study the incidence and characteristics of neck pain in migraine with particular emphasis on its occurrence as a trigger or a part of the symptom complex of migraine, as well as its association with different phases of the migraine attack. Materials and Methods: We interviewed 391 migraine patients for 18 months. All patients who reported neck pain anytime during the migraine phase were analyzed for their demographic profile, headache and neck pain characteristics, the associated conditions, and other clinical features. Results: One hundred and sixty-six (42.5%) patients reported neck pain anytime during the attack (61.5% were female patients and the mean age was 35.8 years). A total of 82.7% patients had migraine without aura and 75.3% had episodic migraine at the onset. In 53 patients (32%), neck pain was a trigger, and in the rest (n = 113, 68%), neck pain was a part of migraine symtomatology. Fifty-seven patients (34.3%) noticed neck pain before the onset of headache; 148 patients (89.2%) reported neck pain at the onset of headache, and 46 patients (27.7%) experienced neck pain after the resolution of headache. The characteristic feature of migraine, such as the unilateral side shifting type of headache, was seen in only 54.2% of the patients, and the throbbing pain quality was seen in 75.2% of the patients. There was no significant difference in the nonheadache symptoms (P = 0.587) and cranial autonomic symptoms (P = 0.596) between the neck pain triggered migraine patients and those having neck pain as a part of the attack. Conclusion: These data indicate that neck pain is a very common feature of migraine attacks and is likely to be either a trigger or a part of the migraine attack. Contrary to the established concept, however, neck pain as a prodromal or postdromal migraine symptom was less common. Careful history taking is required to diagnose neck pain as a feature of migraine and to differentiate it from secondary headache due to a cervical pathology for avoiding unnecessary imaging or other investigations.
  3,625 96 -
Aggressive management of vasospasm with direct intra-arterial nimodipine therapy
Vinayak Narayan, Hima Pendharkar, Bhagavatula Indira Devi, Dhananjaya I Bhat, Dhaval P Shukla
March-April 2018, 66(2):416-422
DOI:10.4103/0028-3886.227295  PMID:29547164
Background: The conventional medical management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is associated with uncertainty of outcome and complications. Aims and Objectives: To examine the effect of direct intra-arterial nimodipine therapy on outcome in patients with delayed cerebral ischemia (DCI). Settings and Design: The retrospective observational study was conducted at a single neurosurgical unit and interventional neuroradiolgy suite of a center managing SAH. Materials and Methods: Data analysis of SAH managed surgically during the period from January 2014 through October 2015 was performed. Any decline in the neurological status on clinical examination, such as consciousness, motor and speech deficits, without other identifiable causes such as hydrocephalus, hyponatremia, seizure, intracranial hematoma, or infection, was used to define the presence of DCI. Patients with suspected DCI underwent computed tomography (CT) scan of the head followed by angiography. When vasospasm was detected in the absence of any major arterial territory infarct, the patients were managed with intra-arterial nimodipine therapy. The outcome at discharge was assessed. Statistical Analysis: Mid-P exact, two-tailed P value was used for categorical variables. Results: A total of 106 patients underwent surgical clipping of an aneurysm following SAH. DCI was diagnosed in 26 (24.5%) patients. Twenty three (88.5%) patients underwent intra-arterial nimodipine therapy. Angiographic response was seen in 22 (95.7%) patients and clinical response in 20 (87%) patients. At discharge, 19 patients (73.1%) with vasospasm had a favorable outcome. There was no significant difference in the outcome of patients with or without vasospasm. Conclusions: Aggressive management with intra-arterial nimodipine therapy is effective in preventing disability caused by DCI.
  3,564 78 -
REVIEW ARTICLES
Patterns of care and survival outcomes in patients with an extraventricular neurocytoma: An individual patient data analysis of 201 cases
Supriya Mallick, Rony Benson, Goura K Rath
March-April 2018, 66(2):362-367
DOI:10.4103/0028-3886.227262  PMID:29547155
Introduction: Extraventricular neurocytoma is a rare neuronal tumor arising outside the ventricles. However, because of its rarity, its optimum treatment remains undefined. Materials and Methods: We intended to perform an individual patient data analysis to examine the patterns of care and prognostic factors involved in the treatment of extraventricular neurocytomas. PubMed, SCOPUS, and Google Scholar were searched with the following MeSH terms: “Neurocytoma, Extra ventricular neurocytoma, Spinal neurocytoma AND treatment, Survival” to find all possible publications pertaining to EVN. Results: From 108 publications, we retrieved 201 patients of extraventricular neurocytoma. Their median age was 30 years (range: 0.6–78 years). Sixty seven patients were in the pediatric (age ≤20 years) age group. There was a bimodal age distribution. Surgical details were available for 132 cases, and 51.5% underwent a gross total resection whereas 41.7% underwent a subtotal resection. Adjuvant radiation was used in 40% cases. For the entire cohort, the median progression free survival was 77 months (53.3–100.7). However, we could not find an impact of any of the prognostic factors on survival. Conclusion: An extraventricular neurocytoma is a very rare disease with varied presentations and different sites of origin. Gross total resection remains the standard of care. Adjuvant radiation may be used for salvage. However, radiation therapy after subtotal resection of an atypical neurocytoma may be administered.
  3,485 31 -
CASE REPORT
Surgical nuances in the separation of craniopagus twins - Our experience and a follow up of 15 years
Muralidhar Pai K, R Chandrasekhar Naidu, A Raja, YS Rai, Niranjan Kumar, Anand Kini, Santhosh Joseph, Vinod Hegde, HS Ballal, Ramoorthi Rao, Saroja V Sharma, Vinay Kumar Valakatte
March-April 2018, 66(2):426-433
DOI:10.4103/0028-3886.227289  PMID:29547166
Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2– 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10–20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis. Surgical separation of these cases can be an elective procedure or an emergency, mandated by the death of one of the twins. Surgical separation of craniopagus twins is a complex exercise needing detailed evaluation and planning. For the successful management of these twins, a multi-disciplinary approach involving neurosurgeons, plastic surgeons, anesthetists, radiologists, pediatric critical care specialists and ancillary staff is mandatory. We present a case of partially successful elective separation of partial angular craniopagus twins performed in 2002.The surviving twin was managed conservatively for a cerebrospinal fluid leak. The patient subsequently developed a pseudomeningocele, necessitating re-exploration, excision of the gliotic tissue, and repair of the dura and the overlying scalp flap. The patient has a skull defect for which cranioplasty has been deferred. The child is neurologically intact. The post-operative evaluation and the detailed periodic neurological assessment till date (with a follow up of 15 years) have been presented in this study.
  3,385 67 -
ORIGINAL ARTICLES
Addition of pyridoxine to prednisolone in the treatment of infantile spasms: A pilot, randomized controlled trial
Vedavathi Kunnanayaka, Puneet Jain, Suvasini Sharma, Anju Seth, Satinder Aneja
March-April 2018, 66(2):385-390
DOI:10.4103/0028-3886.227281  PMID:29547159
Background: West syndrome is a catastrophic epilepsy syndrome characterized by infantile spasms, hypsarrhythmia, and developmental arrest or regression. Aim: The aim of this study was to explore the role of pyridoxine in the management of infantile spasms. Setting and Design: This was a pilot, randomized, open-label trial conducted at a tertiary level hospital from November 2012 to March 2014. Materials and Methods: Children aged 3 months to 3 years presenting with infantile spasms in clusters (at least 1 cluster/day) with hypsarrhythmia or its variants on electroencephalogram (EEG) were enrolled. The study participants were randomized to receive either oral prednisolone (4 mg/kg/day) alone or 30 mg/kg/day of pyridoxine with oral prednisolone. The primary outcome measure was the proportion of children who achieved spasm freedom for 48 h on day-14 after treatment initiation, as per parental reports, in both the groups. The adverse effects were also monitored. The study was registered with clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT01828437). Results: Sixty-two children were randomized into the two groups with comparable baseline characteristics. The proportion of children with spasm cessation on day-14 was similar in the two groups (39 vs. 37%, P = 0.98). The adverse effects were comparable in both the groups. Conclusions: The combination of pyridoxine with oral prednisolone was not found to be a beneficial therapy as compared to prednisolone alone in the treatment of infantile spasms in this pilot study. However, high dose pyridoxine may be safe in children with infantile spasms.
  3,351 60 -
Corticosteroids in the management of lymphocytic hypophysitis: Case series
Manas Panigrahi, Manoranjitha Kumari, Sudhindra Vooturi
March-April 2018, 66(2):400-404
DOI:10.4103/0028-3886.227293  PMID:29547161
Background: The diagnosis of lymphocytic hypophysitis (LYH) is a clinical challenge. Medical management with steroids may result in complete resolution of the symptoms and radiological features. We report our approach to the diagnosis and treatment of LYH. Materials and Methods: Retrospective analysis of data of nine consecutive patients of LYH from August 2013 to August 2015 was done. The average age of the study population was 38.4 ± 19.8 years, with five (55.5%) women. Presumptive diagnosis of LYH was made in six patients who were treated with steroids. Among the medical intervention group, one patient developed progressive ocular symptoms involving the third cranial nerve, which required surgical intervention. Out of the five remaining patients under medical treatment, four patients showed improvement in clinical symptoms and resolution of radiological features and one patient showed recurrence of the lesion. In the surgical group, the diagnosis was made after the histopathological confirmation. Results: In the surgical group, the diagnosis was made after the histopathological confirmation in all patients except one. All the patients in this group presented with optic nerve compression requiring surgical decompression. All the patients in this group showed symptomatic improvement postoperatively. Symptoms for deficiency of hormones required supplementation dose of steroids. Conclusion: Steroids should be considered as the first line of management in LYH. Surgical resection should be considered in the presence of optic nerve and/or chiasmal compression and for lesions nonresponsive to medical management.
  3,202 60 -
COMMENTARY
Diagnosis and management of lymphocytic hypophysitis: A synopsis on current perspective
Anil Nanda, Amey R Savardekar, Devi Prasad Patra
March-April 2018, 66(2):405-406
DOI:10.4103/0028-3886.227282  PMID:29547162
  3,095 42 -
NI FEATURE - COMMENTARY: THE FIRST IMPRESSION
The cover page

March-April 2018, 66(2):297-297
DOI:10.4103/0028-3886.227261  PMID:29547140
  3,064 65 -
NI FEATURE: THE QUEST - COMMENTARY
Standardization of the technique of silicon injection of human cadaveric heads for opacification of cerebral vasculature in Indian conditions
Parkinson Soubam, Shashwat Mishra, Ashish Suri, Renu Dhingra, Sankat Mochan, Sanjeev Lalwani, TS Roy, Ashok K Mahapatra
March-April 2018, 66(2):439-443
DOI:10.4103/0028-3886.227303  PMID:29547168
A surgeon's understanding of the surgical anatomy can be greatly enhanced by the dissection of preserved cadaveric specimens. A reliable and inexpensive biological model for testing and standardization of dye injection concentrations is proposed utilizing the goat's head as a biological model. The first phase was concerned with standardization of the dye by titrating its concentration and injecting various amounts into cerebral vessels of a goat's head until an optimal concentration had been ascertained. In the second phase, this optimum concentration of the dye was injected into four human cadaveric heads following the same technique standardized using the goat's head. Upon dissecting the four cadaveric human heads which were injected with silicon dyes and preserved in 10% formalin, the vessels were all well-opacified and the brain was of near normal consistency and good for dissection, without showing any features of putrefaction. The goat model, having similar color, texture, and the handling as the cadaveric head, offers an opportunity to test indigenously manufactured polymerizing dyes in the future. This biological model, therefore, has the potential to considerably reduce the cost of cadaver preparation.
  3,078 51 -
COMMENTARY
Vasospasm following aneurysmal subarachnoid hemorrhage: The search for the elusive wonder-drug
Girish Menon
March-April 2018, 66(2):423-425
DOI:10.4103/0028-3886.227285  PMID:29547165
  3,026 87 -
LETTERS TO EDITOR
Osmotic demyelination syndrome in the setting of hypernatremia
Neeraj Jain, Rajendra V Phadke, Gaurav Chauhan, SP Ambesh
March-April 2018, 66(2):559-560
DOI:10.4103/0028-3886.227332  PMID:29547197
  3,066 43 -
NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS
Role of pyridoxine in the management of infantile spasms
Sangeeta Ravat, Mansi Shah
March-April 2018, 66(2):330-331
DOI:10.4103/0028-3886.227278  PMID:29547149
  3,055 49 -
LETTERS TO EDITOR
Subdural hemorrhage of infancy: Is it spontaneous?
Ananthanarayanan Kasinathan, Naveen Sankhyan, Ashish Aggarwal, Pratibha Singhi
March-April 2018, 66(2):557-558
DOI:10.4103/0028-3886.227329  PMID:29547196
  3,020 28 -
NI FEATURE: CENT (CONCEPTS, ERGONOMICS, NUANCES, THERBLIGS, SHORTCOMINGS) - COMMENTARY
Endoscopic partial corpectomy using anterior decompression for cervical myelopathy
Yad Ram Yadav, Shailendra Ratre, Vijay Parihar, Amitesh Dubey, Mashoo N Dubey
March-April 2018, 66(2):444-451
DOI:10.4103/0028-3886.227270  PMID:29547169
Symptomatic ventral cervical cord compressions have been treated by anterior discectomy with fusion, anterior corpectomy and fusion, discectomy with an artificial disc, and minimally invasive techniques. There are complications associated with the fusion procedure, especially when a long segment fusion is undertaken. Partial removal of the vertebral body without fusion could help in avoiding fusion and its associated complications. We are describing the detailed surgical technique, indications, limitations, and early results of endoscopic partially corpectomy. The detailed endoscopic technique of how to remove minimal portion of the anterior and middle part of the vertebra with the removal of compressing posterior portion is described. To the best of the author's knowledge, this procedure has not been described in the literature till date. This technique has the advantages of preservation of most of the vertebral body and disc. The stability of the spine is maintained without the patient having to undergo the additional procedure of spinal fusion. There is a shorter length of hospital stay. The technique can also be used in special conditions, such as when a migrated disc behind the vertebral body or any bony compression opposite the vertebral body is encountered. It avoids injury to the longus colli muscles and damage to most of the annulus fibrosis. It preserves motion segments at the operated and adjacent segments without any significant decrease in the disc and vertebral height. A relatively short follow-up and the experience in a relatively small number of patients till now, are the limitations to the widespread use of this technique. Although long-term follow-up of this procedure in a large number of patients is not currently available, endoscopic partial corpectomy seems to be an effective and an alternative method for dealing with anteriorly located cervical compression. Long-term follow-up in a large number of patients is required to assess for the safety and effectiveness of the procedure.
  2,970 44 -
GUEST COMMENTARY
'Stance' in epilepsy - our stance on the current classification of seizures
Sunil Pradhan, Madhura Mulmuley
March-April 2018, 66(2):323-325
DOI:10.4103/0028-3886.227274  PMID:29547146
  2,883 85 -
NEUROIMAGES
Cerebral achromatopsia secondary to ischemic stroke
Chenguang Zhou, Yuanhong He, Xiangying Li
March-April 2018, 66(2):573-575
DOI:10.4103/0028-3886.227322  PMID:29547203
  2,845 20 -
NI FEATURE: JOURNEY THROUGH THE EONS
Founders of Indian Neurosciences: Professor Autar Singh Paintal and Professor Darab Kersasp Dastur
Prakash N Tandon
March-April 2018, 66(2):301-303
DOI:10.4103/0028-3886.227288  PMID:29547142
  2,816 38 -
COMMENTARY
Walter Edward Dandy (1886-1946): The epitome of adroitness and dexterity in Neurosurgery
Kalyan B Bhattacharyya
March-April 2018, 66(2):304-307
DOI:10.4103/0028-3886.227266  PMID:29547143
Walter Edward Dandy did pioneering work in Neurosurgery in the early part of the 19th century. He worked all his life at the Johns Hopkins Hospital in USA and contributed extensively to research in hydrocephalus, the physiology of the cerebrospinal fluid and devised the technique of pneumoencephalography, apart from performing the first clipping operation in cerebral aneurysm and the division of the trigeminal nerve in neuralgic pain. This article summarizes his immense contributions in the field of Neurosurgery.
  2,770 79 -
LETTERS TO EDITOR
Atypical sporadic Creutzfeldt–Jakob disease presenting as progressing schizophrenia
Suk-Won Ahn, Moo-Seok Park, Su-Hyun Han, Byung-Nam Yoon, Je-Young Shin
March-April 2018, 66(2):529-531
DOI:10.4103/0028-3886.227321  PMID:29547184
  2,804 22 -
Nasu–Hakola disease (polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy): First report from India
Ramesh Chepuru, Afshan Jabeen Shaik, Swetha Reddy Tandra, Padmaja Gaddamanugu, Suvarna Alladi, Subhash Kaul
March-April 2018, 66(2):538-541
DOI:10.4103/0028-3886.227319  PMID:29547188
  2,790 36 -
ORIGINAL ARTICLES
Structural correlates of mild cognitive impairment: A clinicovolumetric study
R Sheelakumari, C Kesavadas, VS Lekha, Sunitha Justus, P Sankara Sarma, Ramshekhar Menon
March-April 2018, 66(2):370-376
DOI:10.4103/0028-3886.227298  PMID:29547157
Context: Annually 10–12% of patients with mild cognitive impairment (MCI) are likely to progress to Alzheimer's Disease (AD). The morphometric profile in stable non-converters has not been adequately characterized. Aims: To determine the structural differences between amnestic MCI and early AD using volumetric magnetic resonance imaging (MRI) and its correlation with neuropsychological test performances. Settings and Design: This was a hospital-based case-control study. Materials and Methods: Twenty-four patients classified as having “non-progressor” MCI, 13 as having an early AD, and 25 controls, and assessed using neuropsychological evaluation, and three-dimensional T1-weighted 1.5T magnetic resonance maging (MRI) were included in the study. We used both voxel-based morphometry and automated regional volumetry to assess the topographical patterns of volume loss. Statistical Analysis Used: Post-hoc analysis of variance was done for comparison between means, and partial correlation analysis was done for correlating volumetric and cognitive measures. Results: Consistently, significant atrophy of the superior temporal gyrus, left hippocampus, and mesial frontoparietal regions were identified in patients with MCI in comparison to controls. Increased atrophy in the limbic regions, temporal neocortex, and precuneus was identified in patients with early AD in comparison to patients with MCI. While differences in retention and recall scores between the groups were independent of age and volumetric variables, significant correlations were observed between the learning and recall scores and the volume of hippocampus in patients with MCI as well as temporal neocortex in patients with AD. Atrophy of the superior temporal gyrus and mesial neocortical regions represents the structural correlate of amnestic MCI parallel to the development of hippocampal atrophy. Conclusions: Identification of the pattern of volumetric abnormalities in patients with amnestic MCI in addition to atrophy of the medial temporal lobes necessitates a close follow up to continuously assess these patients for their progression to early AD.
  2,775 48 -
NEUROIMAGES
Simultaneous bilateral hypertensive thalamic hemorrhage: A rare event
Aditya Choudhary, Manoj K Goyal, Rajveer Singh
March-April 2018, 66(2):575-577
DOI:10.4103/0028-3886.227323  PMID:29547204
  2,771 24 -
ORIGINAL ARTICLES
Mobilization of the outer cavernous membrane decreases bleeding and improves resection in spheno-clinoidal meningiomas without cavernous sinus extension: A randomized controlled trial
Ahmed Hegazy, Hieder Al-Shami, Mohammed Fathy Adel Ali, Mohamad Fathallah, Ahmed Salah, Hashim Mohamed, Emad Ibrahim Ahmed, Haytham Hussien Mohammed Osman, Arundhati Biswas
March-April 2018, 66(2):407-415
DOI:10.4103/0028-3886.227306  PMID:29547163
Objective: The aim of this study was to determine whether adding mobilization of the outer cavernous sinus membrane as a part of the approach, in large spheno-clinoidal meningiomas without cavernous sinus extension, would reduce bleeding and increase the extent of resection. Methods: This prospective randomized controlled trial was held between February 2016 and April 2017 at Cairo University Hospitals. The study recruited 94 patients with spheno-clinoidal meningiomas without cavernous sinus involvement. Patients were randomly assigned (by a computer based randomization system) into two groups; the treatment group, in which the patients received mobilization of the outer layer of the lateral wall of the cavernous sinus, prior to opening of the dura; and, the control group, in which the patients were operated by a direct opening of the dura without cavernous sinus dissection. The primary outcome of this study was the difference in the amount of blood lost during surgery between both groups of patients. The secondary outcome variables were the estimated blood loss (EBL) calculated according to Mercurelli's formula, the extent of tumor resection and the amount of blood transfused. Results: The amount of blood loss and estimated blood loss (EBL) were significantly less in the “with mobilization group” with the P value being 0.00 and 0.013, respectively. Additionally, the amount of residual tumor was compared between both the groups and it showed that the group of patients who have received mobilization of the outer cavernous sinus membrane had a higher rate of radical resection as expressed by a lower volume of residual tumor (P value 0.005). Conclusion: In large spheno-clinoidal meningiomas without cavernous sinus involvement, routine mobilization of the outer cavernous sinus membrane reduces bleeding. This helps in a better visualization of cranial nerves in a relatively avascular field as it enables the performance of neurovascular dissection in an earlier phase of surgery. It also enables a more radical resection.
  2,752 32 -
LETTERS TO EDITOR
Stoneman syndrome: A rare clinical entity
Bhawna Sharma, Ashok Panagariya, Madhuparna Paul, Kishor Kumar
March-April 2018, 66(2):531-534
DOI:10.4103/0028-3886.227313  PMID:29547185
  2,709 43 -
NEUROIMAGES
Chikungunya encephalitis presenting as a brainstem syndrome and “boomerang” sign
Rajendra Singh Jain, Ibraheem Khan, Kapil Khandelwal, Pankaj Kumar Saini, Reenu Chaudhary
March-April 2018, 66(2):578-580
DOI:10.4103/0028-3886.227269  PMID:29547206
  2,697 34 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Severe polyradiculoneuritis associated with the combination of ipilimumab and pembrolizumab in a lung cancer patient
Hsiao-Shan Cho, Kang-Yun Lee, Chaur-Jong Hu, Chen-Chih Chung
March-April 2018, 66(2):509-511
DOI:10.4103/0028-3886.227311  PMID:29547174
  2,652 19 -
LETTERS TO EDITOR
Extreme delta brushes in a 14-year old girl with anti-NMDAR encephalitis
Puneet Jain, Robyn Whitney, Cristina Go
March-April 2018, 66(2):536-538
DOI:10.4103/0028-3886.227316  PMID:29547187
  2,624 37 -
NI FEATURE: PATHOLOGY PANORAMA - COMMENTARY
Central nervous system lesions in scrub typhus rediscovered: An autopsy report
Kirti Gupta, Chirag K Ahuja, Awadh K Pandit, Manisha Biswal, MR Shivaprakash
March-April 2018, 66(2):434-438
DOI:10.4103/0028-3886.227309  PMID:29547167
While neurological manifestations in scrub typhus have been well described both in clinical and radiological reports in the literature, neuropathological features are rarely reported. They range from subtle “typhus nodules” to more widespread capillaritis. Familiarity with pathological features is essential for correct interpretation. We describe the clinical, imaging, and histological findings in an autopsy case of scrub typhus, which was pre-terminally superimposed by fungal meningoencephalitis. Interestingly, the autopsy revealed morphological evidence of both etiologies.
  2,615 45 -
LETTERS TO EDITOR
Walking with the ventilator: A rare case of Pompe's disease with a review of literature
Neetu Ramrakhiani, Khusboo Agarwal, Ankit Bansal
March-April 2018, 66(2):545-547
DOI:10.4103/0028-3886.227264  PMID:29547191
  2,591 39 -
NI FEATURE: THE FOURTH DIMENSION - COMMENTARY
A summary of some of the recently published, seminal papers in neuroscience
Mazda K Turel, Manjul Tripathi, Ravi Yadav, PR Srijithesh, Aastha Takkar, Sahil Mehta, Chirag K Ahuja, Anant Mehrotra, Kuntal K Das
March-April 2018, 66(2):496-508
DOI:10.4103/0028-3886.227331  PMID:29547173
  2,580 50 -
LETTERS TO EDITOR
Tuberculosis masquerading as isolated hypoglossal nerve palsy: A rare presenting scenario
Subhransu S Jena, Satya S Mohapatra, Debahuti Mohapatra, Seemanchana Mahanta
March-April 2018, 66(2):568-571
DOI:10.4103/0028-3886.227271  PMID:29547201
  2,569 28 -
Chronic eosinophilic meningitis as a manifestation of isolated spinal neurocysticercosis: A rare case and a review of literature
Abhinith Shashidhar, Amey R Savardekar, Ravindranadh C Mundlamuri, M Netravathi, A Nalini, Yasha T Chickabasaviah, A Arivazhagan, Malla Bhaskar Rao
March-April 2018, 66(2):561-564
DOI:10.4103/0028-3886.227297  PMID:29547198
  2,533 30 -
NI FEATURE: THE EDITORIAL DEBATE I-- PROS AND CONS
Differentiating mild cognitive impairment from normal cognition and frank dementia utilizing structural changes observed on magnetic resonance imaging
Shyamal Kumar Das, Souvik Dubey
March-April 2018, 66(2):328-329
DOI:10.4103/0028-3886.227276  PMID:29547148
  2,512 47 -
LETTERS TO EDITOR
Charcot Marie Tooth disease 2F and a novel mutation from India
Malay K Ghodasara, Charulata S Sankhla, Nitin S Lovhale, Sandip T Borse
March-April 2018, 66(2):528-529
DOI:10.4103/0028-3886.227317  PMID:29547183
  2,520 38 -
Giant anterior interhemispheric fissure amoebic abscess: A rare case
AK Kothiwala, HI S Rai, Kanwaljeet Garg, Manmohan Singh, Pankaj Singh, BS Sharma, R Sood
March-April 2018, 66(2):548-551
DOI:10.4103/0028-3886.227320  PMID:29547192
  2,529 26 -
Diffuse cerebellar hypometabolism in 18FDG PET-CT in two long-term followed patients with diagnosis of nonprogressive congenital ataxia
Don-Kyu Kim, Si Hyun Kang, Kyung Mook Seo
March-April 2018, 66(2):534-536
DOI:10.4103/0028-3886.227314  PMID:29547186
  2,522 19 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Low tension of the dural sac as a cause of unsuccessful myelography in spontaneous intracranial hypotension: Evidence from computed tomographic-guided myelography
Jiaqi Xu, Jin Wang, Xiangyang Gong
March-April 2018, 66(2):518-520
DOI:10.4103/0028-3886.227307  PMID:29547178
  2,525 13 -
NEUROIMAGES
A “cure”ttable cause of secondary headache
Deepak Menon, Biji Bahuleyan, Shamim Ahammed, Annie Belthazar
March-April 2018, 66(2):577-578
DOI:10.4103/0028-3886.227333  PMID:29547205
  2,489 18 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Pseudoaneurysm as a late complication of gamma knife surgery for trigeminal neuralgia
Stella Pak, David Cha, Damian Valencia, Yusuf Askaroglu, Jody Short, Peter Bouz
March-April 2018, 66(2):514-515
DOI:10.4103/0028-3886.227291  PMID:29547176
  2,472 28 -
COMMENTARY
Extra-ventricular neurocytoma: An enigmatic tumor
C Komal Prasad
March-April 2018, 66(2):368-369
DOI:10.4103/0028-3886.227286  PMID:29547156
  2,469 30 -
NI FEATURE: THE EDITORIAL DEBATE I-- PROS AND CONS
MR volumetry in mild cognitive impairment (MCI) – A useful marker to predict progression
Ellajosyula Ratnavalli
March-April 2018, 66(2):326-327
DOI:10.4103/0028-3886.227284  PMID:29547147
  2,456 42 -
LETTERS TO EDITOR
Solitary facet joint osteochondroma of the upper thoracic spine: An unusual cause of cord compression in the pediatric age group
Swaminathan Ganesh, Gandham E Jonathan, Bimal Patel, Krishna Prabhu
March-April 2018, 66(2):555-556
DOI:10.4103/0028-3886.227328  PMID:29547195
  2,464 29 -
Aplasia cutis congenita: A report
H Ibrahim Sun, F Kaan Aras, Can Anarat, Mustafa Güdük
March-April 2018, 66(2):542-543
DOI:10.4103/0028-3886.227325  PMID:29547189
  2,464 17 -
“Dancing eye, dancing feet” in cerebral malaria: A rare association
Dharmesh Bhalodiya, Chaturbhuj Rathore, Varun Gupta, Sanjay Prakash, Kamal Pathak
March-April 2018, 66(2):543-545
DOI:10.4103/0028-3886.227326  PMID:29547190
  2,433 34 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Cavernous malformation induced by stereotactic radiosurgery: A report and literature review
Qiguang Wang, Si Zhang, Xuhui Hui
March-April 2018, 66(2):515-518
DOI:10.4103/0028-3886.227308  PMID:29547177
  2,445 20 -
NI FEATURE: CENT (CONCEPTS, ERGONOMICS, NUANCES, THERBLIGS, SHORTCOMINGS) - COMMENTARY
Endoscopic partial cervical corpectomy – Opening a new door to create a wider window
Mazda K Turel, Ari G Chacko
March-April 2018, 66(2):452-453
DOI:10.4103/0028-3886.227263  PMID:29547170
  2,414 37 -
NEUROIMAGES
Isolated striatal lesions: A rare imaging finding of neurofibromatosis type I
Lokesh Saini, Prashant Jauhari, Biswaroop Chakrabarty, Atin Kumar, Sheffali Gulati
March-April 2018, 66(2):572-573
DOI:10.4103/0028-3886.227305  PMID:29547202
  2,407 26 -
LETTERS TO EDITOR
Giant pericallosal lipoma presenting with psychosis
Yaxiong Li, Xin Wang, Fengshi Fan
March-April 2018, 66(2):553-555
DOI:10.4103/0028-3886.227327  PMID:29547194
  2,408 15 -
NEUROIMAGES
Lumbosacral nerve root lesion with malignant lymphoma
Haruo Nishijima, Tomoaki Akagi, Tatsuya Ueno, Tomoya Kon, Rie Haga, Yukihisa Funamizu, Akira Arai, Chieko Suzuki, Jin-ichi Nunomura, Masayuki Baba, Masahiko Tomiyama
March-April 2018, 66(2):580-581
DOI:10.4103/0028-3886.227301  PMID:29547207
  2,401 20 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Not a refugee, nasogastric tube in the brain: Modes of prevention and controversies in management
Saswat K Dandpat, Manjul Tripathi, Nagesh Varshney, Aman Batish, Sandeep Mohindra
March-April 2018, 66(2):523-524
DOI:10.4103/0028-3886.227265  PMID:29547180
  2,392 29 -
Distal cervical carotid artery pseudoaneurysm after carotid endarterectomy:Inflated?
Masaru Honda, Hajime Maeda
March-April 2018, 66(2):512-513
DOI:10.4103/0028-3886.227312  PMID:29547175
  2,398 17 -
LETTERS TO EDITOR
Commentary: Theranostics for stroke: Precision medicine is about tailoring therapy to the mechanism of ischemia
David S Liebeskind
March-April 2018, 66(2):526-528
DOI:10.4103/0028-3886.227260  PMID:29547182
  2,383 22 -
An unusual presentation of intracranial meningioma in Hajdu–Cheney syndrome
Wei Liu, Jie Tang, Zhen Wu, Junting Zhang
March-April 2018, 66(2):566-568
DOI:10.4103/0028-3886.227310  PMID:29547200
  2,383 20 -
NI FEATURE: FACING ADVERSITY…TOMORROW IS ANOTHER DAY! - LETTERS TO EDITOR
Remote contralateral side cerebral venous thrombosis following intracranial surgery: A rare complication in an unusual setting
A Arivazhagan, Ravindranadh Chowdary Mundlamuri, AS Shreedhara, Rose Dawn Bharath, Anita Mahadevan, Sanjib Sinha, Malla Bhaskara Rao, P Satishchandra
March-April 2018, 66(2):520-522
DOI:10.4103/0028-3886.227318  PMID:29547179
  2,364 33 -
CORRESPONDENCE
Vintage trans-sternal approaches: Consigned to the graveyard!
J K B C Parthiban
March-April 2018, 66(2):585-586
DOI:10.4103/0028-3886.227283  PMID:29547212
  2,357 17 -
Author's Reply: Standard of care for Duchenne muscular dystrophy in children
A Nalini
March-April 2018, 66(2):582-583
DOI:10.4103/0028-3886.227273  PMID:29547208
  2,346 24 -
LETTERS TO EDITOR
Occipital condyle syndrome due to tuberculosis: An uncommon cause unearthed by an unconventional approach
Prasad Krishnan, Sayan Das, Pravin Salunke
March-April 2018, 66(2):551-553
DOI:10.4103/0028-3886.227324  PMID:29547193
  2,340 26 -
Distant supratentorial recurrence of craniopharyngioma
Ananth Egoor, Alugolu Rajesh, Megha S Uppin, MV Saradhi
March-April 2018, 66(2):564-566
DOI:10.4103/0028-3886.227330  PMID:29547199
  2,335 13 -
NI FEATURE: THE EDITORIAL DEBATE III-- PROS AND CONS
Surgery for spheno-clinoidal meningiomas : The advantages and technical challenges of mobilizing the outer wall of the cavernous sinus
Dilip Panikar
March-April 2018, 66(2):342-343
DOI:10.4103/0028-3886.227275  PMID:29547152
  2,319 28 -
CORRESPONDENCE
Bias in randomized trials
Sunil K Raina
March-April 2018, 66(2):583-584
DOI:10.4103/0028-3886.227290  PMID:29547210
  2,326 20 -
Establishing the natural history of disease
KR Sunil
March-April 2018, 66(2):582-582
DOI:10.4103/0028-3886.227294  PMID:29547209
  2,322 16 -
Author's Reply: Progesterone with or without hypothermia in patients with acute severe traumatic brain injury
Sumit Sinha
March-April 2018, 66(2):584-585
DOI:10.4103/0028-3886.227279  PMID:29547211
  2,287 17 -
BOOK REVIEW
Sandhyarani N: Thumbe Hoo… Biography of Dr. G. N. Narayana Reddy
Sunil Pandya
March-April 2018, 66(2):592-593
DOI:10.4103/0028-3886.227267  
  816 19 -
NI FEATURE - BOOKS FROM MY SHELF - COMMENTARY
Russel Brain: Doctors past and present
Sunil Pandya
March-April 2018, 66(2):587-591
DOI:10.4103/0028-3886.227268  
  610 24 -
Online since 20th March '04
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