Publications by authors named "Dattatraya Muzumdar"

81 Publications

A Treatise on Pediatric Meningiomas: Single-center Retrospective Cohort Experience and Review of Literature.

J Pediatr Neurosci 2020 Jul-Sep;15(3):238-244. Epub 2020 Nov 6.

Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India.

Background: Pediatric meningiomas are infrequently encountered in clinical practice. In comparison to adults, they have a distinct pathophysiology and clinical presentation. They are benign but locally aggressive tumors. Radical excision often culminates in good outcome.

Aim: The aim of this study was to study the demographic profile, clinico-radiological features, pathophysiology, and surgical outcome of childhood meningiomas.

Materials And Methods: The case records of patients <18 years of age operated for meningiomas in our institute from 1985 to 2015 were retrieved. The demographic profile, clinical and radiological features, surgical approach, extension of resection, and surgical outcome were recorded and subsequently analyzed.

Results: Among 37 patients, 20 were males and 17 were females. The mean age was 13 years. Predisposing etiologies such as neurofibromatosis and radiation exposure were identified in 20% of the study population. There were 31 intracranial and 6 spinal meningiomas. Headache associated with vomiting was the most common presenting complaint. Majority were supratentorial tumors. A safe maximal excision was attempted in each case. Recurrence was noted in five patients. Average follow-up was approximately 24 months. Two patients succumbed to the illness. Approximately, 30% of patients were rendered morbid.

Conclusion: Although rare, pediatric meningiomas are biologically different from their adult counterparts. They have a male predominance, common in intraventricular region and cystic in nature. Radical excision is associated with good prognosis. Although benign, they are aggressive in nature and have a tendency to recur. The response to adjuvant therapy is modest. Further molecular research and genetic studies are necessary to understand the biology of pediatric meningiomas, which will help in the identification of targeted molecular therapy.
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http://dx.doi.org/10.4103/jpn.JPN_102_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847124PMC
November 2020

Sitting Position for Posterior Fossa Tumor in Infants: A Technical Report.

J Pediatr Neurosci 2020 Jul-Sep;15(3):169-170. Epub 2020 Nov 6.

Department of Neurosurgery, Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai-400012, Maharashtra, India.

Surgery for posterior fossa tumors in sitting position is performed in very few neurosurgical centers all over the world. It carries the potential risk of air embolism with consequent related morbidity. However, posterior fossa surgery in the sitting position is still performed in neurosurgical centers with considerable expertise including neurosurgeons and neuroanesthesiologists. In older children and young adults, the sitting position is given with the appropriate modifications in the operating surgical table and the head fixation system. In infants, due to the small size of the baby and delicate physiology, the sitting position using standard protocol is challenging. A custom designed chair and its suitability for sitting position in infants is described. The chair assembly is secured to the operating surgical table. It is meant to align the infant in sitting position in an appropriate manner. The relevant surgical details including the advantages and limitations are discussed.
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http://dx.doi.org/10.4103/jpn.JPN_252_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847122PMC
November 2020

COVID-19. The Missing Link.

J Pediatr Neurosci 2020 Apr-Jun;15(2):69-71. Epub 2020 Jun 27.

Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial hospital, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/jpn.JPN_158_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519743PMC
June 2020

Utility of CISS imaging in the management of tethered cord syndrome.

Childs Nerv Syst 2021 Jan 15;37(1):217-223. Epub 2020 Aug 15.

Department of Neurosurgery, King Edward Memorial Hospital, Mumbai, India.

Objective: To compare the utility of constructive interference in steady-state (CISS) sequence over T2-weighted (T2W) sequence in the accurate delineation of the tethering element on magnetic resonance (MR) imaging in patients of tethered cord syndrome (TCS) and correlation with intraoperative findings.

Methods: MR findings of fifty-six consecutive patients with operative findings of TCS were studied. The intraoperative findings of all patients were studied and compared with the preoperative imaging findings on T2W imaging and CISS images.

Results: CISS images provided more information than T2W imaging. The overall sensitivity of CISS in MR evaluation of patients with TCS was higher (99.17%) as compared with the T2W sequence (71.48%) especially in the detection of precise position/extent of tethered cord, assessment of filum terminale thickening, detection of a fibrous spur in cases of split cord malformation, detection of dorsal dermal sinus, and evaluation of its precise extent and ramifications. The area under the ROC curve was higher with CISS (0.99) than with T2W sequence (0.85) which reflects its good predictive value as a screening test. This information was useful to the operating surgeon.

Conclusion: CISS sequence for imaging TCS can help enhance the overall surgical outcome of the patients ensuring completeness of the surgery. CISS should be routinely performed in the work-up of patients with tethered cord syndrome.
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http://dx.doi.org/10.1007/s00381-020-04789-yDOI Listing
January 2021

Does Tc-99m ECD ictal brain SPECT have incremental value in localization of epileptogenic zone and predicting postoperative seizure freedom in cases with discordant video electroencephalogram and MRI findings?

Nucl Med Commun 2020 Sep;41(9):858-870

Departments of Nuclear Medicine.

Objective: Localization of epileptogenic focus in drug-refractory epilepsy using Tc-99m ethylene cystine dimer (ECD) brain single photon emission computed tomography (SPECT) is less studied in patients with discordant findings on video electroencephalogram (VEEG) and MRI. The study was done to evaluate brain SPECT for epileptogenic focus localization and postoperative seizure freedom.

Methods: Epilepsy patients with discordant VEEG and MRI findings underwent brain SPECT at ictal and interictal phases. Various groups unilateral/bilateral mesial temporal sclerosis (MTS), solitary and multifocal lesional, nonlesional epilepsy were studied for localization of epileptogenic focus and postoperative seizure freedom (>2 years) using Engels classification. Reasons for nonoperability was evaluated in nonoperated group.

Results: SPECT could localize epileptogenic focus in 49/67 (73.13%) and guided surgery in 19/33 (57.57%) patients in operated group. SPECT was useful in 12 (46.12%) of unilateral (2)/bilateral (10) MTS. Postoperative seizure freedom of Engels Class I and II in 22 (66.67%), III in six (18.2%) and IV in one patient based on SPECT findings (P = 0.0086). Overall sensitivity and specificity were 79.3% and 85.7%, respectively. SPECT could localize epileptogenic focus in 23/34 (67.64%) patients in nonoperated group; 10 (29.41%) patients refused for surgery and no epileptogenic focus was localized in the rest of 14 (41.2%).

Conclusion: Ictal SPECT showed incremental value and was found necessary for epileptogenic focus localization and subsequent surgery in unilateral/bilateral MTS in this study. Seizure freedom in patients undergoing epilepsy surgery based on ictal SPECT assistance was comparable to the surgical group not requiring ictal SPECT.
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http://dx.doi.org/10.1097/MNM.0000000000001240DOI Listing
September 2020

Postoperative pneumoventricle following posterior fossa tumor surgery in sitting position: Plugging the aqueduct.

J Pediatr Neurosci 2020 Jan-Mar;15(1):1-4. Epub 2020 Mar 19.

Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Parel, Maharashtra, India.

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http://dx.doi.org/10.4103/JPN.JPN_35_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227758PMC
March 2020

Chiari 1 malformation: Revisited.

J Pediatr Neurosci 2019 Oct-Dec;14(4):179. Epub 2019 Dec 3.

Professor, Department of Neurosurgery, Seth G.S. Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/jpn.JPN_146_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935982PMC
December 2019

Shunt Care: More than What Beats the Eye.

J Pediatr Neurosci 2019 Jul-Sep;14(3):113. Epub 2019 Sep 27.

Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/jpn.JPN_114_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6798278PMC
September 2019

Emerging Trends in Publishing and Publication in the Current Era: Restoring the Balance.

J Pediatr Neurosci 2019 Jan-Mar;14(1)

Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/jpn.JPN_84_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601114PMC
July 2019

ISNO consensus guidelines for practical adaptation of the WHO 2016 classification of adult diffuse gliomas.

Neurol India 2019 Jan-Feb;67(1):173-182

Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India.

Introduction: Recent advances in the molecular biology of adult diffuse gliomas have brought about a paradigm shift in their diagnostic criteria, as witnessed in the World Health Organization (WHO) 2016 guidelines for central nervous system tumors. It is now mandatory to perform several molecular tests to reach a definitive integrated diagnosis in most of the cases. This comes with additional cost and higher turnaround time, which is not always affordable in developing countries like India. In addition, the non-uniform distribution of advanced research and diagnostic testing centers adds to the difficulty.

Methods: The Indian Society of Neuro-oncology (ISNO) multidisciplinary expert panel consisting of neuropathologists, neurosurgeons, and radiation/medical oncologists convened to prepare the national consensus guidelines for approach to diagnosis of adult diffuse gliomas.

Results: Algorithms for arriving at an integrated diagnosis of adult diffuse gliomas predominantly using immunohistochemistry and with minimum possible additional molecular testing were agreed upon, thus addressing the problems of cost, accessibility, and turnaround time. Mandatory and optional tests were proposed for each case scenario.

Conclusion: This document represents the consensus of the various neuro-oncology disciplines involved in diagnosis and management of patients with adult diffuse gliomas. The article reflects a practical adaptation of the WHO recommendations to suit a resource constrained setup.
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http://dx.doi.org/10.4103/0028-3886.253572DOI Listing
December 2019

Attenuation of Tumor Suppressive Function of FBXO16 Ubiquitin Ligase Activates Wnt Signaling In Glioblastoma.

Neoplasia 2019 01 5;21(1):106-116. Epub 2018 Dec 5.

National Centre for Cell Science (NCCS), SP Pune University Campus, Ganeshkhind, Pune, 411007, India. Electronic address:

Glioblastoma (GBM) is one of the most aggressive and lethal types of brain tumor. Despite the advancements in conventional or targeted therapies, median survival of GBM patients is less than 12 months. Amongst various signaling pathways aberrantly activated in glioma, active Wnt/β-catenin signaling pathway is one of the crucial oncogenic players. β-catenin, an important mediator of Wnt signaling pathway, gets phosphorylated by GSK3β complex. Phosphorylated β-catenin is specifically recognized by β-Trcp1, a F-box/WD40-repeat protein and with the help of Skp1 it plays a central role in recruiting phosphorylated β-catenin for degradation. In GBM, expression of β-TrCP1 and its affinity for β catenin is reported to be very low. Hence, we investigated whether any other members of the E3 ubiquitin ligase family could be involved in degradation of nuclear β-catenin. We here report that FBXO16, a component of SCF E3 ubiquitin ligase complex, is an interacting protein partner for β-catenin and mediates its degradation. Next, we show that FBXO16 functions as a tumor suppressor in GBM. Under normal growth conditions, FBXO16 proteasomally degrades β-catenin in a GSK-3β independent manner. Specifically, the C-terminal region of FBXO16 targets the nuclear β-catenin for degradation and inhibits TCF4/LEF1 dependent Wnt signaling pathway. The nuclear fraction of β-catenin undergoes K-48 linked poly-ubiquitination in presence of FBXO16. In summary, we show that due to low expression of FBXO16, the β-catenin is not targeted in glioma cells leading to its nuclear accumulation resulting in active Wnt signaling. Activated Wnt signaling potentiates the glioma cells toward a highly proliferative and malignant state.
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http://dx.doi.org/10.1016/j.neo.2018.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288984PMC
January 2019

Rupture of spinal dermoid cyst with intracranial dissemination.

Neurol India 2018 Jul-Aug;66(4):1200

Department of Neurosurgery, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/0028-3886.237017DOI Listing
February 2020

Special Annual Issue on CNS Infections.

Childs Nerv Syst 2018 10 19;34(10):1847-1848. Epub 2018 Jul 19.

Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.

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http://dx.doi.org/10.1007/s00381-018-3916-5DOI Listing
October 2018

Subdural empyema in children.

Childs Nerv Syst 2018 10 16;34(10):1881-1887. Epub 2018 Jul 16.

Department of Pediatric Neurosurgery, Bai Jerbai Wadia hospital for Children, Parel, Mumbai, India.

Background: Subdural empyema denotes the collection of purulent material in the subdural spaceand is commonly seen in infants and older children. In infants, the most common cause is bacterialmeningitis. In older children, sinusitis and otitis media are usually the source for subdural empyema. Theclinical symptomatology is varied and has a wide range including prolonged or recurrent fever, seizures,meningeal irritation, and raised intracranial pressure. It can mimic as well as complicate meningitis and aheightened clinical awareness is therefore paramount.

Aims And Objectives: The clinical profile, etiopathogenesis, imaging features and management of subdural empyema in children is discussed and the relevant literature is reviewed.

Conclusion: Subdural empyema is a neurosurgical emergency and rapid recognition and treatment canavoid life-threatening complications. In most cases, surgical decompression through burr hole or craniotomyis warranted. Near complete evacuation of the purulent material and appropriate long-term intravenous antibiotics are necessary for a gratifying outcome.
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http://dx.doi.org/10.1007/s00381-018-3907-6DOI Listing
October 2018

Tuberculosis of the central nervous system in children.

Childs Nerv Syst 2018 10 5;34(10):1925-1935. Epub 2018 Jul 5.

Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Marine Lines, Mumbai, India.

Background: Central nervous system tuberculosis (CNS TB) in children is still a socioeconomic problem in developing countries. It has varied manifestations, symptoms are nonspecific, diagnosis can be challenging, and treatment may be difficult. It is often missed or overlooked. Among the various pathological entities, tuberculous meningitis is the most common and devastating manifestation. The resultant vasculitis, infarction, and hydrocephalus can be life-threatening. It can have grave cognitive, intellectual, and endocrine sequelae if not treated in time resulting in handicap, especially in resource constraint countries. Early diagnosis and treatment of tuberculous meningitis is the single most important factor determining outcome. Tuberculous hydrocephalus needs to be recognized early, and cerebrospinal fluid diversion procedure needs to be performed in adequate time to prevent morbidity or mortality in some cases. Tuberculous pachymeningitis and arachnoiditis are rare in children. Tuberculous abscess can mimic pyogenic abscess and requires high index of suspicion. Calvarial tuberculosis is seen in children and responds well to antituberculous chemotherapy. Drug-resistant tuberculosis is a formidable problem, and alternate chemotherapy should be promptly instituted.

Aim: The pathogenesis, clinical features, diagnosis, and management of central nervous system tuberculosis in children are summarized.

Conclusion: Heightened clinical suspicion, early diagnosis, appropriate antituberculous treatment, and surgery in relevant situation are essential for a gratifying outcome and preventing complications.
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http://dx.doi.org/10.1007/s00381-018-3884-9DOI Listing
October 2018

Management of brain abscesses: where are we now?

Childs Nerv Syst 2018 10 3;34(10):1871-1880. Epub 2018 Jul 3.

Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.

Introduction: Brain abscesses affect all age groups and are not peculiar to a particular country, race, or geographical location. It is a disease that, in the past, carried a high morbidity and mortality. With improvements in medical technology and expertise, outcomes have improved tremendously. The causative organisms vary vastly and have evolved with time. Treatment of brain abscesses is primarily with antimicrobial therapy but surgery plays a vital role in achieving better outcomes.

Content: In this article, we review the literature to find out how the epidemiology of this disease has changed through the years and re-visit the basic pathological process of abscess evolution and highlight the new research in the biochemical pathways that initiate and regulate this process. We also highlight how magnetic resonance imaging and its various modalities have improved diagnostic accuracy. Finally, we discuss the pros and cons of traditional open surgery versus newer minimally invasive methods.
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http://dx.doi.org/10.1007/s00381-018-3886-7DOI Listing
October 2018

Hydatid disease (Echinococcus) of the central nervous system.

Childs Nerv Syst 2018 10 30;34(10):1967-1971. Epub 2018 Jun 30.

Department of Neurosurgery, King Edward VII Memorial hospital, Parel, Mumbai, India.

Hydatid disease of the central nervous system is rare and comprises about 2-3% of all the hydatid cyst cases reported in the world. Spinal hydatid is still rare. It is endemic in sheep and cattle-raising regions, seen mainly in Mediterranean countries including Turkey and Syria. Pediatric neurosurgeons in nonendemic countries face a challenge when they are encountered with hydatid cyst of the central nervous system due to lack of awareness and diagnostic dilemmas. It is also a mammoth economic problem in developing countries due to improper hygiene and lack of dedicated veterinary practice. The clinical features are largely nonspecific. However, with the advent of MR imaging, the diagnostic accuracy has increased. Intact removal of the cyst without causing any spillage is the goal and key to cure. In this manuscript, the current literature on hydatid cyst of the brain and spine is reviewed to understand the epidemiological, diagnostic accuracy and advances in therapeutics. A heightened clinical suspicion about hydatid disease, role of MR imaging and improving surgical strategies is discussed. A nationwide prevention of the disease is the ultimate goal.
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http://dx.doi.org/10.1007/s00381-018-3883-xDOI Listing
October 2018

Spinal model for teaching and training.

Neurol India 2017 Nov-Dec;65(6):1448-1449

Department of Neurosurgery, King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/0028-3886.217961DOI Listing
June 2019

Angiogenic Gene Signature Derived from Subtype Specific Cell Models Segregate Proneural and Mesenchymal Glioblastoma.

Front Oncol 2017 11;7:146. Epub 2017 Jul 11.

National Centre for Cell Science (NCCS), SP Pune University Campus, Pune, India.

Intertumoral molecular heterogeneity in glioblastoma identifies four major subtypes based on expression of molecular markers. Among them, the two clinically interrelated subtypes, proneural and mesenchymal, are the most aggressive with proneural liable for conversion to mesenchymal upon therapy. Using two patient-derived novel primary cell culture models (MTA10 and KW10), we developed a minimal but unique four-gene signature comprising genes vascular endothelial growth factor A (VEGF-A), vascular endothelial growth factor B (VEGF-B) and angiopoietin 1 (ANG1), angiopoietin 2 (ANG2) that effectively segregated the proneural (MTA10) and mesenchymal (KW10) glioblastoma subtypes. The cell culture preclassified as mesenchymal showed elevated expression of genes VEGF-A, VEGF-B and ANG1, ANG2 as compared to the other cell culture model that mimicked the proneural subtype. The differentially expressed genes in these two cell culture models were confirmed by us using TCGA and Verhaak databases and we refer to it as a minimal multigene signature (MMS). We validated this MMS on human glioblastoma tissue sections with the use of immunohistochemistry on preclassified (YKL-40 high or mesenchymal glioblastoma and OLIG2 high or proneural glioblastoma) tumor samples ( = 30). MMS segregated mesenchymal and proneural subtypes with 83% efficiency using a simple histopathology scoring approach ( = 0.008 for ANG2 and  = 0.01 for ANG1). Furthermore, MMS expression negatively correlated with patient survival. Importantly, MMS staining demonstrated spatiotemporal heterogeneity within each subclass, adding further complexity to subtype identification in glioblastoma. In conclusion, we report a novel and simple sequencing-independent histopathology-based biomarker signature comprising genes VEGF-A, VEGF-B and ANG1, ANG2 for subtyping of proneural and mesenchymal glioblastoma.
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http://dx.doi.org/10.3389/fonc.2017.00146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504164PMC
July 2017

Ictal asystole: A rare cardiac manifestation of temporal lobe epilepsy, treated with epilepsy surgery.

Ann Indian Acad Neurol 2017 Jan-Mar;20(1):55-57

Department of Neurology and Neurosurgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India.

Seizures are associated with fascinatingly varied cardiac and autonomic manifestations, of which ictal tachycardia is common, and asystole and bradycardia are rare. Ictal asystole (IA), an often unsought autonomic phenomenon, occurs most commonly with temporal followed by frontal lobe seizures. Prolonged IA may lead to cerebral anoxic ischemia. As the mysteries of sudden unexplained death in epilepsy are unraveled, it is quite possible that the key to it lays within these seizure-induced cardiac rhythm abnormalities. We present a case of a young male with temporal lobe epilepsy due to left mesial temporal sclerosis with prolonged IA, which was successfully managed with epilepsy surgery.
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http://dx.doi.org/10.4103/0972-2327.199916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341269PMC
March 2017

Epilepsy surgery in the developing world: Facts and challenges.

Int J Surg 2016 12 29;36(Pt B):403-404. Epub 2016 Nov 29.

Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, 400012, India. Electronic address:

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http://dx.doi.org/10.1016/j.ijsu.2016.11.131DOI Listing
December 2016

Commentary: Surgery for pure midline ventral spinal intradural lesions.

Neurol India 2016 Nov-Dec;64(6):1345-1347

Department of Neurosurgery, King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/0028-3886.193815DOI Listing
November 2018

Mesial temporal lobe epilepsy - An overview of surgical techniques.

Int J Surg 2016 Dec 20;36(Pt B):411-419. Epub 2016 Oct 20.

Department of Neurology, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Mumbai, India.

Mesial temporal lobe epilepsy is one of the commonest indications for epilepsy surgery. Presurgical evaluation for drug resistant epilepsy and identification of appropriate candidates for surgery is essential for optimal seizure freedom. The anatomy of mesial temporal lobe is complex and needs to be understood in the context of the advanced imaging, ictal and interictal Video_EEG monitoring, neuropsychology and psychiatric considerations. The completeness of disconnection of epileptogenic neural networks is paramount and is correlated with the extent of resection of the mesial temporal structures. In the Indian subcontinent, a standard but extended anterior temporal lobectomy is a viable option in view of the diverse socioeconomic, cultural and pathological considerations. The maximum utilization of epilepsy surgery services in this region is also a challenge. There is a need for regional comprehensive epilepsy care teams in a tertiary care academic hospital to form centers of excellence catering to a large population.
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http://dx.doi.org/10.1016/j.ijsu.2016.10.027DOI Listing
December 2016

Solitary pyogenic brainstem abscess.

Neurol India 2016 May-Jun;64(3):572-4

Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/0028-3886.181544DOI Listing
November 2018

Surgical outcomes in patients with intraoperative Electrocorticography (EcoG) guided epilepsy surgery-experiences of a tertiary care centre in India.

Int J Surg 2016 Dec 15;36(Pt B):420-428. Epub 2016 Feb 15.

Department of Neurosurgery, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India. Electronic address:

Introduction: The Comprehensive Epilepsy Surgery Program was started in 2001 at K.E.M. Hospital, Mumbai with the aim of performing epilepsy surgeries at highly concessional rates. We have started using intraoperative Electrocorticography (EcoG) since 2009 in patients with tumors, Mesial Temporal Sclerosis (MTS) plus and focal cortical dysplasia (FCD). This study highlights our experience with EcoG and it's utility in epilepsy surgery.introduction METHODS: 51 patients with drug resistant epilepsy due to temporal and extra-temporal tumors, MTS plus and FCD underwent pre-surgical evaluation and ECoG guided epilepsy surgery through our program. The surgical procedures employed included intraoperative EcoG guided lesionectomy or a lesionectomy with Anterior Temporal Lobectomy (ATL). Postoperative MRI and EEG were done. Seizure freedom was categorized as per Engel's classification.

Results: At a mean follow up of 33 months (range: 14-69 months), 43 out of 51(84.31%) patients were completely seizure free post-surgery (Engel's Class I). Among the patients who were not seizure free, 3 patients were in Engel's Class II and 5 patients were in Engel's Class III. Presence of a residual lesion on postoperative MRI (p < 0.001), abnormal postoperative EEG (p < 0.001) and persistent spikes on post-resection EcoG (p < 0.05) had a significant statistical association with poor seizure freedom post-surgery.

Conclusion: The success of epilepsy surgery depends upon accurate localization and complete resection of the epileptogenic tissue, both of which are aided by intraoperative EcoG.Thus, intraoperative EcoG is a useful adjunct in epilepsy surgery to achieve optimal seizure freedom in cases of MTS plus, focal cortical dysplasia and tumors. Even the patients who are not seizure free can achieve worthwhile improvement post surgery.
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http://dx.doi.org/10.1016/j.ijsu.2016.02.047DOI Listing
December 2016

Surgery for multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament.

Neurol India 2016 Jan-Feb;64(1):16-8

Department of Neurosurgery, King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/0028-3886.173630DOI Listing
October 2018

Vestibular schwannoma and tuberculoma occurring In collision in the posterior fossa: A case report.

Int J Surg Case Rep 2016 11;19:75-7. Epub 2015 Dec 11.

Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India.

Introduction: Though acoustic schwannoma is the most common primary tumour in the cerebello-pontine angle, its occurrence with tuberculoma has never been reported.

Presentation Of Case: A case of a vestibular schwannoma and tuberculoma occurring as collision tumors in the posterior fossa in a 46 years old female is reported. She presented with chronic raised intracranial pressure manifesting as headache, occasional diplopia, speech disturbance, and unsteady gait. Magnetic resonance imaging of the brain demonstrated a vestibular schwannoma and tuberculoma in the right cerebello-pontine angle. The lesions were resected through retro sigmoid route. The caudal mass was vestibular schwannoma while the rostral and medial portion was tuberculoma.

Discussion: The occurrence of a vestibular schwannoma and tuberculoma in collision has hitherto never been reported. The pathogenesis, surgical challenges and management of such a rare entity is discussed and the relevant literature is briefly reviewed.

Conclusion: The association of vestibular schwannoma and tuberculoma is rare. Surgical excision of lesions occurring in collision can be formidable. They require careful planning and strategy.
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http://dx.doi.org/10.1016/j.ijscr.2015.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756082PMC
February 2016

Memory outcomes in mesial temporal lobe epilepsy surgery.

Int J Surg 2016 Dec 30;36(Pt B):448-453. Epub 2015 Nov 30.

Department of Neurology, Seth G.S. Medical College and King Edward Memorial (K.E.M) Hospital, Parel, Mumbai 400012, India. Electronic address:

Introduction: Decline in verbal memory after dominant mesial temporal lobe surgery is a concern. Outcomes primarily reported by group data analysis do not address issues of practice effects and measurement errors and also do not provide information about individual meaningful change after surgery. Reliable Change Indices (RCI's) are regarded to be robust statistical methods for reporting individual change and have not been hitherto derived in patient populations in India.

Aim: Report memory outcomes for patients after surgery using group data as well as RCI score analyses using RCI scores derived in a control patient population.

Method: Retrospective data analysis of 106 selected patients who underwent Anterior Temporal Lobectomy (ATL) surgery. RCI scores derived from a control group of 44 non-operated patients. Outcomes based on score shifts on the various measures of two verbal and visual memory tests.

Results: Group mean score analysis revealed no significant shifts in verbal or visual memory scores after left ATL, but significant improvements in verbal memory after right ATL. RCI score analysis revealed decline and improvements in a small percentage of patients for both left and right ATL groups. Percentage of patients showing decline was much less than reported in western literature although percentage improved was comparable.

Discussion: Differences in decline percentage may be due to RCI scores and clinical characteristics of our sample (impaired pre-operative functioning, majority seizure free post surgery, moderate hippocampal sclerosis, early onset, long duration of seizures).

Conclusion: Group analyses mask individual change. Therefore, to report memory outcomes and counsel patients about relative risk-benefits of surgery, RCI scores derived from our patient populations should be used.
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http://dx.doi.org/10.1016/j.ijsu.2015.11.037DOI Listing
December 2016

Clinical characteristics, surgical and neuropsychological outcomes in drug resistant tumoral temporal lobe epilepsy.

Int J Surg 2016 Dec 19;36(Pt B):436-442. Epub 2015 Oct 19.

Dept of Neurology, Seth GSMC & KEM Hospital, Parel, Mumbai 400012, India. Electronic address:

Introduction: Glioneuronal tumors are found in nearly one third patients who undergo surgery for pharmacoresistant epilepsy with temporal lobe being the most common location. Few studies, however have concentrated on the neurological and neuropsychological outcomes after surgery, hitherto none from India.

Methods: We studied 34 patients with temporal lobe tumors and drug resistant epilepsy. These patients underwent anterior temporal lobectomy or lesionectomy based on the involvement of the hippocampus and mesial temporal structures. The clinical history, EEG, neuropsychology profile and MRI were compared. Seizure outcome was categorized using Engel's classification.

Results: At a mean follow up of 62 months, 85.29% of the patients were seizure free (Engel's Class I). All 8 patients with intraoperative electrocorticography (ECoG) guided resection were seizure free.

Discussion: Presence of a residual lesion was significantly associated with persistence of seizures post surgery (p = 0.002). Group analysis revealed no significant shifts in IQ and memory scores postoperatively. There was a significant improvement in the quality of life scores (total and across all subdomains) in all patients (p < 0.001). Postoperative EEG abnormalities predicted unfavorable ​seizure outcome.

Conclusion: Surgery for temporal lobe tumors and refractory epilepsy offers complete seizure freedom in majority. Complete surgical excision of the epileptogenic zone is of paramount importance in achieving seizure freedom. Intraoperative electrocorticography (EcoG) is a useful adjunct to ensure complete removal of epileptogenic zone, thus achieving optimal seizure freedom. There is a significant improvement in the quality of life scores (p < 0.001) with no negative impact of surgery on memory and intelligence. Even the patients who are not seizure free can achieve worthwhile improvement post surgery.
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http://dx.doi.org/10.1016/j.ijsu.2015.10.015DOI Listing
December 2016

Surgical outcomes with non-invasive presurgical evaluation in MRI determined bilateral mesial temporal sclerosis: A retrospective cohort study.

Int J Surg 2016 Dec 25;36(Pt B):429-435. Epub 2015 Sep 25.

Dept. of Neurology, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India. Electronic address:

Background & Objective: Epilepsy surgery for bilateral hippocampal sclerosis continues to pose a challenge and outcomes even with invasive evaluations have not been very promising. Very few studies have analyzed surgery outcomes for patients with MRI determined, bilateral mesial temporal sclerosis (MTS) after non-invasive pre-surgical evaluation.

Material And Methods: We studied 35 patients with bilateral MTS who underwent anterior temporal lobectomy (ATL) after non-invasive pre-surgical evaluation. Clinical history, EEG, neuropsychology profile and symmetry of MTS on MRI were reviewed in the groups of 'seizure free' and 'not seizure free' patients.

Results: At an average follow up of 44 months (range 12-110 months), 26 out of 35 patients (74%) were seizure free. Unilateral interictal discharges were seen in 57% patients. 94% patients had unilateral ictal EEG onset. Bilateral interictal discharges were significantly associated with 'not seizure free' outcome (p = 0.02). Pre-operatively, 24 (71%) patients had bilateral (verbal and visual) memory impairment while 10 (28%) patients had unilateral (verbal or visual) memory impairment and 1 patient had a normal memory profile. Overall, no significant decline in memory was seen in left or right surgery groups post-operatively. There was significant improvement in Quality of Life scores in all patients (p = <0.0005).

Conclusion: Patients with bilateral MTS on MRI can be unilateral on electro physiology and neuropsychology, and can have a very good surgical outcome. In a setting of limited resources, a noninvasive pre-surgical protocol can be used. With proper patient selection, the outcomes may be comparable to those reported with invasive pre-surgical protocols. Patients with unilateral interictal and ictal EEG have the best outcome. Up to 50% patients with bilateral interictal discharges can have a seizure free outcome. Patients with bilateral independent seizure onset have a less favourable prognosis. Patients who are not seizure free can still attain worthwhile improvement in seizure frequency without significant decline in memory and some improvement in quality of life.
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http://dx.doi.org/10.1016/j.ijsu.2015.09.006DOI Listing
December 2016