Publications by authors named "Dhananjaya Ishwar Bhat"

20 Publications

  • Page 1 of 1

Effect of remote ischemic preconditioning on cerebral vasospasm, biomarkers of cerebral ischemia, and functional outcomes in aneurysmal subarachnoid hemorrhage (ERVAS): A randomized controlled pilot trial.

Brain Circ 2021 Apr-Jun;7(2):104-110. Epub 2021 May 29.

Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Background: Cerebral vasospasm can complicate aneurysmal subarachnoid hemorrhage (aSAH), contributing to cerebral ischemia. We explored the role of remote ischemic preconditioning (RIPC) in reducing cerebral vasospasm and ischemia and improving outcomes after aSAH.

Materials And Methods: Patients with ruptured cerebral aneurysm undergoing surgical clipping and meeting the trial criteria were randomized to true RIPC ( = 13) (inflating upper extremity blood pressure cuff thrice to 30 mmHg above systolic pressure for 5 min) or sham RIPC ( = 12) (inflating blood pressure cuff thrice to 30 mmHg for 5 min) after ethical approval. A blinded observer assessed outcome measures-cerebral vasospasm and biomarkers of cerebral ischemia. We also evaluated the feasibility and safety of RIPC in aSAH and Glasgow Outcome Scale-Extended (GOSE).

Results: Angiographic vasospasm was seen in 9/13 (69%) patients; 1/4 patients (25%) in true RIPC group, and 8/9 patients (89%) in sham RIPC group ( = 0.05). Vasospasm on transcranial Doppler study was diagnosed in 5/25 (20%) patients and 1/13 patients (7.7%) in true RIPC and 4/12 patients (33.3%) in sham RIPC group, ( = 0.16). There was no difference in S100B and neuron-specific enolase (NSE) levels over various time-points within groups ( = 0.32 and 0.49 for S100B, = 0.66 and 0.17 for NSE in true and sham groups, respectively) and between groups ( = 0.56 for S100B and = 0.31 for NSE). Higher GOSE scores were observed with true RIPC ( = 0.009) unlike sham RIPC ( = 0.847) over 6-month follow-up with significant between group difference ( = 0.003). No side effects were seen with RIPC.

Conclusions: RIPC is feasible and safe in patients with aSAH and results in a lower incidence of vasospasm and better functional outcome.
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http://dx.doi.org/10.4103/bc.bc_13_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191538PMC
May 2021

Altered MicroRNA Expression in Intracranial Aneurysmal Tissues: Possible Role in TGF-β Signaling Pathway.

Cell Mol Neurobiol 2021 Jun 29. Epub 2021 Jun 29.

Department of Pathology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, 560069, India.

The molecular mechanisms behind the rupture of intracranial aneurysms remain obscure. MiRNAs are key regulators of a wide array of biological processes altering protein synthesis by binding to target mRNAs. However, variations in miRNA levels in ruptured aneurysmal wall have not been completely examined. We hypothesized that altered miRNA signature in aneurysmal tissues could potentially provide insight into aneurysm pathophysiology. Using a high-throughput miRNA microarray screening approach, we compared the miRNA expression pattern in aneurysm tissues obtained during surgery from patients with aneurysmal subarachnoid hemorrhage (aSAH) with control tissues (GEO accession number GSE161870). We found that the expression of 70 miRNAs was altered. Expressions of the top 10 miRNA were validated, by qRT-PCR and results were correlated with clinical characteristics of aSAH patients. The level of 10 miRNAs (miR-24-3p, miR-26b-5p, miR-27b-3p, miR-125b-5p, miR-143-3p, miR-145-5p, miR-193a-3p, miR-199a-5p, miR-365a-3p/365b-3p, and miR-497-5p) was significantly decreased in patients compared to controls. Expression of miR-125b-5p, miR-143-3p and miR-199a-5p was significantly decreased in patients with poor prognosis and vasospasm. The target genes of few miRNAs were enriched in Transforming growth factor-beta (TGF-β) and Mitogen-activated protein kinases (MAPK) pathways. We found significant negative correlation between the miRNA and mRNA expression (TGF-β1, TGF-β2, SMAD family member 2 (SMAD2), SMAD family member 4 (SMAD4), MAPK1 and MAPK3) in aneurysm tissues. We suggest that miR-26b, miR-199a, miR-497and miR-365, could target multiple genes in TGF-β and MAPK signaling cascades to influence inflammatory processes, extracellular matrix and vascular smooth muscle cell degradation and apoptosis, and ultimately cause vessel wall degradation and rupture.
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http://dx.doi.org/10.1007/s10571-021-01121-3DOI Listing
June 2021

DREZotomy in the management of post brachial plexus root avulsion neuropathic pain: fMRI correlates for pain relief.

Br J Neurosurg 2021 Jan 19:1-10. Epub 2021 Jan 19.

Department of NeuroImaging and Interventional Radiology (NIIR), NIMHANS, Bengaluru, Karnataka, India.

Background: Deafferentiation pain following brachial plexus root avulsion has been documented to be severe enough to affect activities of daily living in patients. Microsurgical DREZotomy is known to alleviate the symptoms by decreasing the afferent signals transmitted from the spinal cord to sensory cortex.

Objectives: To document and analyse the effectiveness of DREZotomy and to evaluate the role of 'sensory cortex' in the cause and relief of dysesthetic pain, using fMRI.

Materials And Methods: This was a prospective study conducted between 2010 and 2016 and included all patients who underwent DREZotomy for dysesthetic pain following traumatic brachial plexus injury (TBPI). Patients were evaluated both preoperatively and postoperatively with Visual Analogue Scale(VAS), Hospital Anxiety and Depression score (HADS) and SF36 questionnaire and effectiveness of surgery was assessed. Functional magnetic resonance imaging (fMRI) of the brain in resting state was performed before and after surgery and was also compared with controls. Patients underwent standard microsurgical DREZotomy from C5 to D1. Postoperative assessment was done at 6 weeks and 6 months following surgery.

Results: Our series had 18 patients aged between 22 and 63 years. RTA was the most common cause of injury. There was significant decrease in pain at 6 months follow up compared to pre-operative values as assessed by VAS, HADS, SF36 questionnaire. fMRI analysis revealed cluster activations in the sensory, motor cortex and in the right cingulate gyrus in the preoperative group which was higher than in normal controls. In the postoperative group, the size of the resting state activation was significantly reduced.

Conclusion: DREZotomy is an effective procedure for TBPI patients. We hypothesize that these fMRI findings reflect the cortical reorganization that occurs not only after injury but also following successful surgery which explains the cause and relief of dyesthetic pain.
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http://dx.doi.org/10.1080/02688697.2021.1872769DOI Listing
January 2021

Circulating MicroRNAs as Potential Molecular Biomarkers for Intracranial Aneurysmal Rupture.

Mol Diagn Ther 2020 06;24(3):351-364

Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560029, India.

Introduction: Diagnosis of the rupture of an intracranial aneurysm (IA) relies on sophisticated neuro-imaging studies, and molecular biomarkers to identify an IA or predict its rupture are still unavailable.

Objective: Our objective was to determine the plasma microRNA (miRNA) expression profile in patients with ruptured IA presenting as aneurysmal subarachnoid hemorrhage (aSAH) and identify potential biomarkers of aneurysmal rupture.

Methods: Plasma miRNA profiling was carried out using quantitative real-time polymerase chain reaction (qRT-PCR) in 20 patients with aSAH and 20 age- and sex-matched healthy controls. Eight differentially expressed miRNAs were validated by qPCR in a larger cohort of 88 patients with aSAH and 110 healthy controls. A receiver operating characteristic (ROC) curve was constructed to evaluate the overall performance of the miRNA-based assay. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was used to determine the potential pathway of miRNA-target genes.

Results: The miRNA profiles were clearly distinct in patients compared with controls. Validation studies showed that three upregulated miRNAs (miR-15a-5p, miR-34a-5p, miR-374a-5p) and five downregulated miRNAs (miR-146a-5p, miR-376c-3p, miR-18b-5p, miR-24-3p, miR-27b-3p) could distinguish patients with aSAH from healthy controls with high predicted probability (0.865 and 0.995, respectively). Further, the expression levels of the eight candidate miRNAs were significantly dysregulated only in aSAH cases and not in patients with SAH due to other causes. Plasma miR-146a-5p and miR-27b-3p were associated with clinical outcomes in patients with aSAH. Functional analysis of the eight differentially expressed miRNA showed that the target genes involved in signaling pathways were related to inflammation.

Conclusions: Our study determined the plasma miRNA signature of ruptured IAs and identified eight candidate miRNAs that could be useful biomarkers for this condition. We hypothesize that these differentially expressed miRNAs may play pivotal roles in IA pathology.
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http://dx.doi.org/10.1007/s40291-020-00465-8DOI Listing
June 2020

Estrogen receptor alpha gene variant, PvuII (rs2234693), as a potential pharmacogenetic biomarker for aneurysmal subarachnoid hemorrhage in postmenopausal women.

Pharmacogenomics J 2020 10 4;20(5):655-663. Epub 2020 Feb 4.

Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560029, India.

Aneurysmal subarachnoid hemorrhage (aSAH) occurs more often in postmenopausal women than in men. Estrogen plays an important role in vascular homeostasis. Our aim was to elucidate whether a drop in circulating estradiol in conjunction with variants of estrogen receptor genes have a role in female gender susceptibility to aSAH. A total of 709 subjects were enrolled (349 aSAH patients, 360 controls) and genotyped for rs2234693 or PvuII (intron 1, T>C) in the ESR1 gene and rs4986938 or AluI (exon 8, 1730G>A) of ESR2 gene by PCR-RFLP. Serum estradiol was estimated by ELISA. Estrogen receptor gene expression was studied by qRT-PCR. Logistic regression analysis indicated a significant recessive effect of the T allele of PvuII on aSAH in females, and this association remained statistically significant even after adjusting for confounders (OR 1.702, CI 95% 1.062, 2.726, P value = 0.027). ESR1 gene expression was significantly reduced (P value = 0.0089) in subjects carrying PvuII T allele. In postmenopausal women with TT genotype and low serum estradiol, the odds for developing aSAH were found to be 3.5-fold increase compared with premenopausal women (CI 95% 1.424-8.828, P value = 0.0074). However, this variant showed no significant association with aSAH in men. No significant difference was found in genotype and allelic distribution of AluI polymorphism in ESR2 gene, between patients and controls. We propose that the PvuII T allele could be a potential pharmacogenetic marker for strategizing personal medicine for preventing aSAH in postmenopausal women with low circulating estradiol. Further larger studies in other population are warranted.
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http://dx.doi.org/10.1038/s41397-020-0155-4DOI Listing
October 2020

Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years.

Neurosurg Focus 2019 08;47(2):E14

Departments of1Neurosurgery.

Objective: Intracranial fungal granuloma (IFG) remains an uncommon entity. The authors report a single-institute study of 90 cases of IFG, which is the largest study until now.

Methods: In this retrospective study, all cases of IFG surgically treated in the years 2001-2018 were included. Data were obtained from the medical records and the pathology, microbiology, and radiology departments. All relevant clinical data, imaging characteristics, surgical procedure performed, perioperative findings, and follow-up data were recorded from the case files. Telephonic follow-up was also performed for a few patients to find out their current status.

Results: A total of 90 cases consisting of 64 males (71.1%) and 26 (28.9%) females were evaluated. The mean patient age was 40.2 years (range 1-79 years). Headache (54 patients) was the most common presenting complaint, followed by visual symptoms (35 patients), fever (21 patients), and others such as limb weakness (13 patients) or seizure (9 patients). Cranial nerve involvement was the most common sign (47 patients), followed by motor deficit (22 patients) and papilledema (7 patients). The mean duration of symptoms before presentation was 6.4 months (range 0.06-48 months). Thirty patients (33.3%) had predisposing factors like diabetes mellitus, tuberculosis, or other immunocompromised status. A pure intracranial location of the IFG was seen in 49 cases (54.4%), whereas rhinocerebral or paranasal sinus involvement was seen in 41 cases (45.6%). Open surgery, that is, craniotomy and decompression, was performed in 55 cases, endoscopic biopsy was done in 30 cases, and stereotactic biopsy was performed in 5 cases. Aspergilloma (43 patients) was the most common fungal mass, followed by zygomycosis (13 patients), chromomycosis (9 patients), cryptococcoma (7 patients), mucormycosis (5 patients), and candida infection (1 patient). In 12 cases, the exact fungal phenotype could not be identified. Follow-up was available for 69/90 patients (76.7%). The mean duration of the follow-up was 37.97 months (range 3-144 months). The mortality rate was 52.2% (36/69 patients) among the patients with available follow-up.

Conclusions: A high index of suspicion for IFG should exist for patients with an immunocompromised status and diabetic patients with rhinocerebral mass lesions. Early diagnosis, aggressive surgical decompression, and a course of promptly initiated antifungal therapy are associated with a better prognosis.
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http://dx.doi.org/10.3171/2019.5.FOCUS19252DOI Listing
August 2019

Novel Findings in Obstetric Brachial Plexus Palsy: A Study of Corpus Callosum Volumetry and Resting-State Functional Magnetic Resonance Imaging of Sensorimotor Network.

Neurosurgery 2018 11;83(5):905-914

Departments of Neuroimaging and In-terventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.

Background: The response of the brain to obstetric brachial plexus palsy (OBPP) is not clearly understood. We propose that even a peripheral insult at the developmental stage may result in changes in the volume of white matter of the brain, which we studied using corpus callosum volumetry and resting-state functional magnetic resonance imaging (rsfMRI) of sensorimotor network.

Objective: To study the central neural effects in OBPP.

Methods: We performed an MRI study on a cohort of 14 children who had OBPP and 14 healthy controls. The mean age of the test subjects was 10.07 ± 1.22 yr (95% confidence interval). Corpus callosum volumetry was compared with that of age-matched healthy subjects. Hofer and Frahm segmentation was used. Resting-state fMRI data were analyzed using the FSL software (FMRIB Software Library v5.0, Oxford, United Kingdom), and group analysis of the sensorimotor network was performed.

Results: Statistical analysis of corpus callosum volume revealed significant differences between the OBPP cohort and healthy controls, especially in the motor association areas. Independent t-test revealed statistically significant volume loss in segments I (prefrontal), II (premotor), and IV (primary sensory area). rsfMRI of sensorimotor network showed decreased activation in the test hemisphere (the side contralateral to the injured brachial plexus) and also decreased activation in the ipsilateral hemisphere, when compared with healthy controls.

Conclusion: OBPP occurs in an immature brain and causes central cortical changes. There is secondary corpus callosum atrophy which may be due to retrograde transneuronal degeneration. This in turn may result in disruption of interhemispheric coactivation and consequent reduction in activation of sensorimotor network even in the ipsilateral hemisphere.
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http://dx.doi.org/10.1093/neuros/nyx495DOI Listing
November 2018

Surgically Managed Pediatric Intracranial Aneurysms: How Different Are They from Adult Intracranial Aneurysms?

Pediatr Neurosurg 2017 29;52(5):313-317. Epub 2017 Aug 29.

Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.

Purpose: Intracranial aneurysms in children are rare compared to those in adults, and their causes, presentations, and outcomes also vary. Thus, they need to be studied intricately and as an independent entity.

Methods: We retrospectively reviewed intracranial saccular aneurysms in 44 children of <19 years of age who had been surgically treated during the last 30 years at our institute. We analyzed presentation, characteristics, size, multiplicity, cause, and eventual outcome, and compared these to the adult cases of aneurysms operated on during the same period.

Results: The commonest site of aneurysm was the internal carotid artery (ICA), in 47.7%. Follow-up was available for 38 (86.4%) children. The median duration of follow-up was 14 months (range 1-89 months). A favorable outcome was seen in 31 cases (81.6%) and an unfavorable outcome (including 1 death) in 7 (18.4%).

Conclusion: Intracranial aneurysms in children present with subarachnoid hemorrhage in a good grade. ICA bifurcation aneurysms are the commonest sites of occurrence. Surgery is safe and effective, and children seem to have a better outcome.
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http://dx.doi.org/10.1159/000477815DOI Listing
June 2018

Growing Skull Fracture and the Orbitocranial Variant: Nuances of Surgical Management.

Pediatr Neurosurg 2017 21;52(3):161-167. Epub 2017 Apr 21.

Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.

Aims: Growing skull fracture (GSF) is a rare complication resulting from diastatic enlargement of a pediatric skull fracture. Orbitocranial GSF is a distinct variant with more complex management issues due to the displacement of the globe. This study aims to discuss surgical considerations in the management of GSF, with particular reference to orbitocranial variants.

Methods: We conducted a retrospective analysis of 7 children operated for GSFs at our institute from 2008 to 2015.

Results: Four boys and 3 girls were operated during this period. The mean age at initial trauma was 2 years, and most of them sustained falls. The most frequent symptoms of GSF were progressive scalp swelling and proptosis. The most common location was the orbitofrontal region. Duraplasty with cranioplasty was performed in 5 patients, while duraplasty alone was only required in 2 patients. A postoperative complication was noted in 1 patient and managed successfully. Good cosmetic results were obtained in all of the cases.

Conclusions: Duraplasty is essential in the repair of GSF and should be followed by cranioplasty to prevent recurrent leptomeningeal herniation. We recommend the use of autologous bone from the surgical site for cranioplasty. Orbital roof repair is advisable for good visual and cosmetic outcome in orbitocranial variants of GSF.
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http://dx.doi.org/10.1159/000464295DOI Listing
May 2018

Craniofacial injuries in professional cricket: no more a red herring.

Neurosurg Focus 2016 Apr;40(4):E11

Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India.

The issue of head injury in a noncontact sport like cricket is a matter of great debate and it carries more questions than answers. Recent incidents of fatal head injuries in individuals wearing a helmet have caused some to question the protective value of the helmet. The authors discuss the pattern, type of injury, incidents, and location of cranio-facio-ocular injuries in professional cricket to date. They evaluate the history of usage of the helmet in cricket, changes in design, and the protective value, and they compare the efficacy of various sports' helmets with injury profiles similar to those in cricket. The drop test and air cannon test are compared for impact energy attenuation performance of cricket helmets. A total of 36 cases of head injuries were identified, of which 5 (14%) were fatal and 9 (22%) were career-terminating events. Batsmen are the most vulnerable to injury, bearing 86% of the burden, followed by wicketkeepers (8%) and fielders (5.5%). In 53% of cases, the ball directly hit the head, while in 19.5% of cases the ball entered the gap between the peak and the faceguard. Ocular injuries to 3 wicketkeepers proved to be career-terminating injuries. The air cannon test is a better test for evaluating cricket helmets than the drop test. Craniofacial injuries are more common than popularly believed. There is an urgent need to improve the efficacy and compliance of protective restraints in cricket. A strict injury surveillance system with universal acceptance is needed to identify the burden of injuries and modes for their prevention.
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http://dx.doi.org/10.3171/2016.2.FOCUS15341DOI Listing
April 2016

Occipitocervical Fetus in Fetu with Extracalvarial Extension: A Case Report.

Pediatr Neurosurg 2016 18;51(2):87-92. Epub 2015 Dec 18.

Department of Neurosurgery, National Institute of Mental Health and Neurological Sciences, Bangalore, India.

Fetus in fetu (FIF) is an extremely rare congenital anomaly in the pediatric age group. It is defined by the presence of an axial skeleton and well-formed internal organs in a fetiform mass. Only about 15 cases of intracranial FIF have been reported in the literature worldwide. We report a case of temporo-occipitocervical FIF. This 7-month-old female child presented to us with occipital swelling that she had had since birth. A soft swelling was palpable in the retroauricular region with extension into the neck. A few bony parts were palpable in the swelling. Imaging was suggestive of a multiseptate mass lesion in the right occipital region with intracranial, intraspinal and extracranial components. The patient underwent exploration and excision of the extracranial mass and retromastoid suboccipital craniectomy and decompression of the intracranial component. Different parts, such as a terminal ileum, cecum, appendix, femur, humerus and vertebral body, were identified within the mass. This case meets Willis' criteria as well as 4/5 criteria stated by Spencer for the diagnosis of this condition. To the best of our knowledge, this is the first reported case of temporo-occipitocervical FIF with a well-defined embryological spectrum. This also supports Spencer's hypothesis of abnormal twinning.
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http://dx.doi.org/10.1159/000441035DOI Listing
December 2016

Unusual Complication of Neglected Hydrocephalus: Spontaneous Rupture with Growing Skull Fracture.

Pediatr Neurosurg 2015 9;50(5):281-5. Epub 2015 Sep 9.

Timely management of hydrocephalus in infants is critical as the initial treatment can have lifelong implications for survival and neurological outcome. In the developing countries, grossly enlarged heads are still not an uncommon occurrence. In extreme cases, there may be a spontaneous rupture of hydrocephalus either externally or internally, depending on the status of the sutures. Here, the successful management of a rare complication of spontaneous rupture of hydrocephalus in an infant is discussed. The management of the present case provides a novel approach to deal with this dreaded complication. Though the neurological outcome remains guarded in such cases, they need to be tackled cautiously to address the hydrocephalus and esthetic appearance of the infant.
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http://dx.doi.org/10.1159/000438795DOI Listing
July 2016

Lack of IDH1 mutation in astroblastomas suggests putative origin from ependymoglial cells?

Neuropathology 2015 Aug 18;35(4):303-11. Epub 2015 Mar 18.

Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India.

Astroblastomas are extremely rare neuroepithelial tumors of uncertain histogenesis, affecting children and young adults, and constitute a new addition to the WHO 2000 classification of CNS tumors. We report the largest series of nine cases diagnosed in a single institute over the last 13 years and review published literature. Mean age at presentation was 12.8 years (range: 22 months to 27years). Seven out of nine cases were supratentorial (frontal/frontoparietal - three, parieto-occipital - three, parafalcine - one), one was intraventricular and another was optochaismatic/suprasellar. Five cases were high grade (anaplastic) astroblastomas with Ki-67 labeling index of 8-10%. Immunohistochemical and ultrastructural evidence suggesting origin from cells intermediate between ependymocytes and astrocytes is presented. The histogenetic origin of these tumors remains speculative. But the lack of Isocitrate dehydrogenase 1 (IDH1) mutation as detected by immunohistochemistry in this study, which is similar to ependymomas supports putative origin from ependymoglial cells. Out of the nine cases, recurrence was noted in one case, 12 months after gross total resection with progression to high grade in the recurrent tumor. There is no recommended treatment protocol due to the rarity of this entity and prognostic factors are yet to be established.
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http://dx.doi.org/10.1111/neup.12194DOI Listing
August 2015

History of Neurosurgery at National Institute of Mental Health and Neurosciences: an epitome of steady growth.

Neurol India 2015 Jan-Feb;63(1):91-5

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.

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http://dx.doi.org/10.4103/0028-3886.152663DOI Listing
May 2015

Correlation between plasma total nitric oxide levels and cerebral vasospasm and clinical outcome in patients with aneurysmal subarachnoid hemorrhage in Indian population.

J Neurosci Rural Pract 2014 Nov;5(Suppl 1):S22-7

Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.

Context: Cerebral vasospasm remains a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Reduced bioavailability of nitric oxide has been associated with the development of cerebral vasospasm after aSAH. Such data is not available in Indian population.

Aims: The objective of the study was to measure the plasma total nitric oxide (nitrite and nitrate-NO x ) level in aSAH patients and healthy controls treated at a tertiary hospital in India and to investigate a possible association between plasma total nitric oxide level and cerebral vasospasm and clinical outcome following treatment in patients with aSAH.

Settings And Design: A case-control study of aSAH patients was conducted. Plasma total NO x levels were estimated in aSAH patients with and without vasospasm and compared the results with NO x levels in healthy individuals.

Materials And Methods: aSAH in patients was diagnosed on the basis of clinical and neuro-imaging findings. Plasma total NO x levels in different subject groups were determined by Griess assay.

Results: Plasma total NO x level was found to be significantly decreased in patients with aSAH when compared to controls. Plasma total NO x level in the poor-grade SAH group was lower than that in the good-grade SAH group. Plasma total NO x level further reduced in patients with angiographic (P < 0.05) and clinical vasospasm.

Conclusions: Reduced plasma NO x level is seen in aSAH patients as compared to normal individuals. In aSAH patients reduced levels are associated with increased incidence of cerebral vasospasm and poor outcome. Plasma total NO x level could be used as a candidate biomarker for predicting vasospasm and outcome for this pathology.
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http://dx.doi.org/10.4103/0976-3147.145196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271376PMC
November 2014

Partially thrombosed distal orbitofrontal artery aneurysm mimicking an A1 segment aneurysm.

J Neurosci Rural Pract 2014 Oct;5(4):436-7

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.

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http://dx.doi.org/10.4103/0976-3147.140017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173257PMC
October 2014

Dermoid cysts of the posterior fossa--morbid associations of a benign lesion.

Br J Neurosurg 2013 Dec 26;27(6):765-71. Epub 2013 Mar 26.

Department of Neurosurgery, National Institute of Mental Health and Neurosciences , Bangalore , India.

Dermoid cysts of posterior fossa are uncommon benign lesions. They differ from other lesions found in the infra tentorial compartment by virtue of their associated conditions. Due to their association with dermal sinus tracts, intracranial infection is a potential threat following infection of the cyst. Due to their embryologic origin, these cysts may also be associated with other congenital anomalies. In this article we detail our eleven-year-experience with posterior fossa dermoid cysts in fifteen patients. Despite the morbid presentation with severe life-threatening complications, the overall outcome was excellent. Implications of the various associations are discussed.
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http://dx.doi.org/10.3109/02688697.2013.776667DOI Listing
December 2013

Cortical reorganization following neurotization: a diffusion tensor imaging and functional magnetic resonance imaging study.

Neurosurgery 2012 May;70(5):1305-11; discussion 1311

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.

Background: Following successful intercostal-musculocutaneous nerve (ICN-MCN) neurotization for brachial plexus injuries (BPIs), patients initially show a synkinetic movement of elbow flexion during inspiration. Later they are able to flex the elbow, independent of respiratory activity.

Objective: To demonstrate cortical reorganization following ICN-MCN coaptation in BPI through functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI).

Methods: Thirty adult patients underwent ICN-MCN coaptation for BPI. The controls were age and sex matched. All patients had Sunderland 3 or 4 degree of injury. Patients underwent fMRI and DTI (pre- and postoperatively) with electromyography of the biceps. Maps of neural activity within the motor cortex were generated in the paralyzed and control arms and center of maximum activity was calculated. Fractional anisotropy and apparent diffusion coefficient were generated from fMRI and DTI over the motor cortex and comparison was made between the paralyzed and control arms.

Results: Median deinnervation interval was 6 months. Seventeen patients improved from grade 0 to grade 3 or more. There was no significant difference between the coordinates for maximum activity, when the cortical activity following elbow flexion of the patients who improved was compared with the control arm activity. There was reduction in FA and ADC values in patients who have improved following surgery when compared to controls. Fractional anisotropy and apparent diffusion coefficient values of the postoperative patients revealed no significant difference from the controls or preoperative patients.

Conclusion: Cortical plasticity following ICN-MCN transfer in BPI does occur. There was no correlation between the degree of improvement either with the transposition of activity on the motor cortex from the chest to the elbow area, or the amount of activity on the motor cortex representing the elbow area.
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http://dx.doi.org/10.1227/NEU.0b013e318241017dDOI Listing
May 2012

Isolated cranio-spinal involvement of Rosai-Dorfman disease: case report.

Br J Neurosurg 2011 Apr 8;25(2):297-9. Epub 2010 Sep 8.

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.

Rosai-Dorfman disease is a rare non-neoplastic lymphoproliferative condition. It commonly affects individuals between third and fifth decades, most common presentation being in the form of massive painless cervical lymphadenopathy with fever, weight loss and malaise. Isolated intracranial involvement is rare seen in less than 5% of patients with extranodal involvement. We present a patient with isolated contiguous cranio-spinal involvement who presented to us with remitting symptoms.
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http://dx.doi.org/10.3109/02688697.2010.508849DOI Listing
April 2011

Aneurysms from extracranial, extradurally originating posterior inferior cerebellar arteries: a rare case report.

Surg Neurol 2009 Oct 14;72(4):406-8. Epub 2009 Jan 14.

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.

Background: Aneurysms arising from the PICA are infrequent and those arising from an extracranially originating PICA in the extracranial intradural region are even rare. We report a case of bilaterally extracranial extradurally originating PICAs, each of which had an aneurysm, both being situated below the foramen magnum. This to the best of our knowledge is the first of its kind to be reported.

Case Description: A 35-year-old woman presented with giddiness and headache of 2-day duration. CT scan head revealed blood in the 4(th) ventricle. 4 vessel angiogram revealed bilateral extracranial, extradural origin of PICAs from the vertebral arteries between C1 and C2 vertebrae. Both PICAs were associated with a saccular aneurysm each, both of which were extracranial. She underwent a midline suboccipital craniectomy, C1 arch excision, and clipping of both aneurysms.

Conclusions: We report a very rare case of bilateral extracranial PICA aneurysms from an aberrantly originating PICA (ie, extracranial and extradural).
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http://dx.doi.org/10.1016/j.surneu.2008.09.021DOI Listing
October 2009
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