International Journal of Neurology and Neurosurgery

Wide margin en bloc resection is becoming the trend for the treatment of primary spinal tumors. However, only few cases in the literature describeen bloc tumor resection including dural resection. We here describe a case of wide en bloc resection of a spinal osteosarcoma using spondylectomyanddural flap resection, followed by duraplasty repair. This was followed by adjuvant chemotherapy. At forty-two-monthsof followup, the patient was stable neurologically and free of disease radiologically. The clinical presentation, operative technique and related literature are reviewed.

Keywords: En Bloc; Spondylectomy; Dural Resection; Duraplasty.

Background: Tuberculosis is a common disease across the world and India alone accounts for 24% of global burden of the disease. Tuberculosis involving vertebral column is one of the commonest presentations in the extra-pulmonary tuberculosis. It is associated with significant morbidity. Therefore, social burden of the spinal tuberculosis is high, especially in the developing countries. The condition needs medical management and surgical intervention to achieve relief of cord compression, correction of deformities and stabilization when necessary. Aim: Present study aimed to analyse both short and long term follow up of the spinal tuberculosis patients who underwent surgical stabilisation using implants. Methods: All the patients with spinal tuberculosis treated in the Department of Neurosurgery, Gandhi Hospital, Secunderabad between January 2009 and December 2014 who underwent surgical stabilization using implant were included in the study. The study was taken up on both prospective and retrospective basis. Total 52 patients were included in the study. Preoperative and post operative status was analyzed in reference to the clinical symptoms and radiological evaluation. Their kyphotic angle regressions are specifically recorded during follow-up imaging. Parameters like time for mobilisation, duration of hospital stay, persistence of lesions and ESR trends and return to previous activity of the patient were followed. Results: The risk of neurological deterioration was reported following surgical intervention which is minimised with sound techniques of surgery and advent of better imaging and instrumentation. Duration and severity of neurological involvement prior to surgery is an important factor determining the final outcome. The patients undergoing surgery involving implant stabilisation were mobilised as early as second postoperative day and could be discharged very early. Total hospital stay has been reduced significantly. Rapid neurological improvement helps in early rehabilitation. Patients could go back to their previous work earlier compared to the medical management group as reported in the past. Follow up clinical evaluation and imaging was encouraging without problems like recrudescence or morbidity or need for prolongation of chemotherapy instead there was good union rate with normal ESR trends by end of three months. Conclusion: This study aimed to assess the outcome and benefits of surgical stabilisation using implants for TB spine patients with neurological deficits and instability. There was significant advantage for the patients allowing reduction of hospitalisation, early mobilisation and recovery such that they are able to attend their previous work.

Keywords: Tuberculosis of Spine; Surgical Management; Spinal Implants. 

One of the most common disorders that affect brain is epilepsy. More than 30% of epileptic patients have to undergo long term therapy with antiepileptic drugs (AED). Studies show an increase in mortality in symptomatic epileptic patients due to ischemic heart disease and acute cardiac failure. The mechanism behind the role of AEDs on cardiovascular diseases needs investigation. Hence the present study was designed to study the long term effect of AEDs on vascular risk factors like serum lipid profile, C-reactive protein (CRP), carotid intima media thickness (CIMT) in epileptic patients in comparison with control subjects. The study also correlated duration of the AEDs with CIMT. The results showed that carbamazepine and phenobarbitone therapies significantly increased serum total cholesterol, LDL-cholesterol and CRP but not HDL-cholesterol, Triglyceride and BMI. Patients on phenytoin and sodium valproate increased BMI but no significant change on lipid and CRP levels were observed. All the antiepileptic drugs in this study significantly increased CIMT.

Keywords: Epilepsy; Antiepileptic Drugs; Atherosclerosis; Lipids; CIMT. 

Background: There are yet to simplify some aspects regarding the surgical indications and surgical procedures that are at choice for treating intracranial arachnoid cysts. The purpose of this retrospective analysis is to contribute to the continuing debate on the most suitable management. Materials and Methods: We included in the study 66 patients, operated for intracranial arachnoid cysts during the period January 2008 to December 2017. The surgical methods were either a craniotomy or cyst shunting. The information regarding these patients was retrospectively assessed based on their clinical and imaging records. Treatment efficiency was evaluated considering postoperative clinical status, imaging appearance and postoperative complications. Results: 84.1% of the patients reported postoperative disappearance or reduction of symptoms, while 13.6% had the same complaints as prior surgery. Only 2 patients experienced worsening of symptoms. Follow-up imaging showed cyst disappearance in 29.5% patients and cyst reduction in 61.4% patients. 9.1% had no change in cyst volume. Craniotomy correlated with a better imaging appearance (p=0.02). There was no correlation between improved clinical status and cyst fluidreduction (p=0.6). 14 patients (21.21%), all with temporal cysts, experienced postoperative complications, and 10 of them (15.1%) needed surgery. There was no severe or permanent dysfunction in any of the patients. 42.8% of the cyst shunting patients suffered postoperative complications, whereas only 10% of the craniotomy patients did. Conclusion: Cyst decompression results in significant clinical improvement and it can be performed with little risk for severe complications. Craniotomy seems to be a better surgical treatment option than cystoperitoneal shunt, with a better neuroimaging appearance and a lower complications rate.

Keywords: Arachnoid Cyst; Cysto-Peritoneal Shunt; Craniotomy; Marsupialization. 

Aim: To determine the non-motor symptoms and to assess the stage and duration of the disease in patients above 50 years, with idiopathic Parkinson’s disease. To analyse the correlation of non-motor symptoms of Parkinson’s disease with the severity and duration of disease. Materials and Methods: Following the institutional ethical committee approval 105 patients who attended the Neurology department between July 2013 and July 2014 with Idiopathic Parkinson’s Disease as outpatient and inpatient were studied in a tertiary care referral medical college hospital in Chennai. Motor symptoms were assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) and stage of the disease with the Hoehn and Yahr staging. Non-motor Symptoms Questionnaire (NMS QUEST) which contains 30 items was used to determine the non-motor features and to correlate with the severity and duration of the illness was studied. Observation and Results: Among 105 patients studied, sixty seven belonged to the age group between 50 – 60 years, thirty patients belonged to age group between 61-70 years and eight patients were aged more than 70 years. Seventy five patients had the disease duration between 0 – 5 years, eighteen had duration of 5 – 10 yrs and twelve had the disease for more than 10 years. Upon observation 22.9% of the study population belonged to Hoehn and Yahr stage 1 and 1.5, 37.1% of the patients belonged to stage 2 and 2.5. Amid the rest, 32.2% had Stage 3 and stage 4 consisted of 7.6% of the study group respectively. The number of Non-motor Symptoms in Stages 1 and 1.5 were in the range of 2 to 5, Stages 2 and 2.5 were in the range of 3 to 9, Stages 3 were 6 to 11 and in stage 4 between 11 and 12. This study also revealed a higher occurrence of NMS like Nocturia (60%), urgency (44.8%) and constipation (52.4%), dizziness (43.8%), anxiety (34.3%), depression (34%), memory (37.1%), dreams (24.8%), sleepiness (22.9%) and hallucinations (24.8%). Conclusion: The most prevalent Non-motor symptoms are Autonomic dysfunction like Constipation, Nocturia, urgency and sweating, followed by insomnia, depression and memory disturbances followed by dizziness, drooling, falls and unexplained pains. NMS also shows an increase during the progression of the disease as the highest incidence was in the stages 3 and stage 4 (Hoehn and Yahr).

Keywords: Parkinson‘s Disease; Non-Motor Symptoms; Hoehn and Yahr Staging; Unified Parkinson’s Disease Rating Scale (UPDRS); Autonomic Symptoms; Cognitive Symptoms and Behavioural Symptoms. 

Introduction: Craniopharyngiomas are benign neoplasms of the sellar/suprasellar region. Management of these lesions always poses a challenge to neurosurgeons. Methods: Between 2012 and 2016, a total of 27 paediatric patients (8-16 year age) underwent surgery for craniopharyngiomas with a goal of total surgical removal without neurological risk. All patients were operated via frontopterional approach under operating microscope. Radiotherapy was offered to 7 patients in which partial decompression and excision was done. Results: Majority of the cases (21/27) 77% were large tumours with suprasellar extension and both supradiaphragmatic and infradiaphragmatic components. Complete resection was achieved in 13/27 (48%) of the cases. Neuropsychological sequele were seen in six children. Three children had memory deficits and behavioural problems (aggressiveness and lack of attention) and 3 had change in personality. Conclusion: We conclude that radical resection of craniopharyngiomas with perseveration of the pituitary stalk should be the goal of surgery. However; one should not be overly aggressive in approach for these tumors as radiotherapy also has a proven role in their management.

Keywords: Paedriatic Craniopharyngioma; Resection; Radiotherapy. 

Background: Ocular myasthenia gravis (OMG) is the most common focal form of myasthenia gravis (MG) characterized by variable weakness and fatigability of extraocular muscles (EOMs), levator, and orbicularis oculi. Most of the OMG patients will subsequently progress to develop more disabling and life threatening generalized myasthenia gravis (GMG). No definitive laboratory tests are available for the diagnosis of OMG. Hence, we aimed at characterizing the clinical profile of ocular myasthenia gravis in Indian population. Methods: We evaluated 30 suspected cases of ocular myasthenia referred from various parts of country (India) under the Department of Neurology, NIMHANS, Bangalore from October 2010 to October 2013. Detailed demographic and clinical data was extracted in a systematic manner using a predetermined proforma. All patients were investigated with neostigmine test, icepack test, Repetitive Nerve Stimulation (RNS), serum acetylcholine receptor (AChR) antibody assay and Single Fiber Electromyography (SFEMG). Results: Twenty of 30 patients were recruited. Among these twenty patients, 18 patients fulfilled SFEMG criteria (SFEMG ADHOC committee criteria, 1994) and remaining 2 patients (who were not willing for SFEMG) had clinical features of OMG and showed positive results in other tests.Among those, 17 (85%) were male and 3 (15%) were female. Ptosis was the most common symptom and was seen in 19 (95%) patients. Diplopia, the second commonest symptom was seen in 12 (60%). Eighty five percent (85%) ptosis and 75% of diplopia had shown diurnal variation. Shifting ptosis was observed in 20%. Conclusion: Systematic elicitation of clinical signs and symptoms has very important role in the diagnosis of OMG. Variable and fatigable ptosis and diplopia with diurnal variations are the diagnostic symptoms of OMG. Shifting ptosis and Coganýÿs lid twitch sign are the very important signs of OMG.

Keywords: Eextraocular Muscles; Ptosis; Fatigable Weakness; Acetylcholine Receptor; Neostigmine.