Search

Background: Despite a recent surge in keyhole approaches to aneurysm clipping, only few studies have compared these approaches, and none have laid any foundation or roadmap for surgeons newly venturing into these procedures. Objectives: To report a single surgeon's experience of multiple keyhole approaches to these aneurysms, and to highlight the case selection algorithm, technical nuances, and surgical results. Material and Methods: Twenty-four patients (25 aneurysms) underwent aneurysm clipping using either a mini-pterional approach (MPA), lateral supraorbital approach (LSO), or a supraorbital keyhole approach (SOKHA). Intraoperative premature rupture, adequacy of clipping, and immediate postoperative and long-term functional outcomes were recorded. Results: All but five patients presented with ruptured aneurysms (Hunt and Hess grade 1 in 12 patients, grade 2 in 5 patients, and grade 3 in 2 patients). The anterior communicating artery (A-Comm; n = 14, 56%) was most frequently involved with aneurysms. The MPA was most frequently employed (n = 11, 45.8%), followed by the LSO (n = 9, 37.5%) and the SOKHA (n = 4, 16.7%). An intraoperative rupture (total n = 5, 20.8%) was most frequently seen in the SOKHA group (50%) and the only case of inadequate aneurysm clipping resulted from inadequate clipping ergonomics during the SOKHA for A-Comm aneurysm. Major complications occurred in the supraorbital approaches (one each in the LSO and SOKHA). Irrespective of the approach used, the long-term outcomes were excellent. Conclusion: In properly selected patients, keyhole approaches--particularly the MPA and the LSO--can provide excellent surgical outcomes. The learning curve in the SOKHA is steeper. A pragmatic case selection algorithm is proposed. Keywords: Aneurysm, interhemispheric keyhole, mini craniotomy, mini-pterional approach, subarachnoid hemorrhage, supraorbital approach, Author(s): Kuntal K. Das (corresponding author) [1]; Anant Mehrotra [1]; Awadhesh K. Jaiswal [1]; Vipin Sahu [1]; Preetham Dange [1]; Priyadarshi Dikshit [1]; Sanjeev Pattankar [1]; Pawan K. Verma [1]; [...]

Background: Pediatric posterior fossa tumors (pPFTs) may present acutely with features of increased intracranial pressure that need urgent intervention or with stable symptoms requiring elective management. In this article, we have analyzed the outcomes of pPFTs managed under three arms: (1) emergency tumor resection (A), (2) elective tumor resection (B), and (3) pre-resection cerebrospinal spinal fluid (CSF) diversion followed by elective tumor resection (C). Materials and Methods: We retrospectively reviewed our database from July 2012 to March 2020 for pediatric patients (age ≤16 years) with PFTs. The patients were classified into three groups based on the timing and type of intervention. Their result was assessed as the primary (postoperative complications) and secondary outcomes (post-resection CSF diversion, CSF diversion failure, residual tumor, and survival). A P value < 0.05 was considered significant (SPSS version 22.0, IBM, New York). Results: A total of 154 patients (M:F 2.42:1) were included with a mean age of 8.1 (SD ± 4.2)-years (range 1-16). Group B (n 72/46.8%) had a significantly higher number of patients as compared to the group A (n 40/26%) and group C (n 42/27.3%) (χ[sup.2] test, P value 0.02). The primary outcomes were comparable between group A and group B. A higher incidence of preoperative external ventricular drain insertion and post-resection CSF diversion failure was noted in group A as compared to group B (P value < 0.01). Group C had a significantly higher proportion of patients with residual tumor (n 19/48.7%) as compared to group A (n 11/29.7%, P value 0.09) and group B (n 20/ 29.4%,P value < 0.05). The post-resection CSF diversion failure rate was significantly higher in group C than in the other two groups (P value < 0.05). Conclusion: The pre-resection CSF diversion subgroup had a poorer outcome as compared to elective and emergency tumor resection. The outcomes of elective and emergency resection of pPFTs were comparable, except for the higher risk of shunt failure in the emergency cohort. Keywords: Elective, emergency, external ventricular drain, pediatric posterior fossa tumors, pre-resection CSF diversion, Author(s): Ashutosh Kumar [1]; Suyash Singh [2]; Aanchal Datta [1]; Kamlesh Singh Bhaisora [1]; Jayesh Sardhara [1]; Priyadarshi Dikshit [1]; Ved Prakash Maurya [1]; Pawan Kumar Verma [1]; Kuntal Kanti [...]

Byline: Soumen. Kanjilal, Kuntal. Das, Arun. Srivastava, Anant. Mehrotra, Kamlesh. Bhaisora, Awadhesh. Jaiswal, Raj. Kumar Meningiomas based on the anterior clinoid process, also called clinoidal meningiomas (CMs), are daunting tumors, [...]

Byline: Kavindra. Singh, Kamlesh. Bhaisora A 20-month-old girl child was brought to our outpatient department with complaints of inappropriate laughter and crying since the age of 2 weeks. On evaluation, [...]

Byline: Kuntal. Das, Amanjot. Singh, Prabhakar. Mishra, Deepak. Khatri, Balachandar. Deivasigamani, Aanchal. Datta, Kamlesh. Bhaisora, Anant. Mehrotra, Arun. Srivastava, Awadhesh. Jaiswal, Sanjay. Behari, Raj. Kumar Background: Studies on insular gliomas [...]

Byline: Nazrin. Hameed, Ravi. Manogaran, Abhishek. Dubey, Govind. Bhuskute, Kanika. Arora, Amit. Keshri, Anant. Mehrotra, Awadhesh. Jaiswal, Kuntal. Das, Kamlesh. Bhaisora, Arun. Srivastava, Raj. Kumar, Ramandeep. Virk The lateral recess [...]

Byline: Ashutosh. Kumar, Arun. Srivastava, Shashwat. Mishra, Kamlesh. Bhaisora, Kuntal. Das, Pawan. Verma, Awadhesh. Jaiswal, Sanjay. Behari Objective: This article aims to discuss the surgical nuances and major adjustments necessary [...]

Byline: Ashutosh. Kumar, Kamlesh. Bhaisora, Kamlesh. Rangari, Prabhakar. Mishra, Vandan. Raiyani, Jayesh. Sardhara, Ved. Maurya, Pawan. Verma, Kuntal. Das, Anant. Mehrotra, Arun. Srivastav, Awadhesh. Jaiswal, Raj. Kumar, Sanjay. Behari Objective: [...]

Proximal or A1 segment anterior cerebral artery (ACA) aneurysms are rare aneurysms. They have certain unique properties when compared to all other intracranial aneurysms. They are smaller and prone to an early rupture. Thus, they need an aggressive intervention even when they are less than 7 mm in size. The technical difficulties that arise in their management are based on their location along the length and circumference of the ACA. Accordingly, they have been variously classified in literature. Their intimate relationship to the medial lenticulostriate perforators and the recurrent artery of Heubner is the prime factor in determining the surgical or endovascular strategy and outcome. These aneurysms are commonly associated with vascular anomalies, needing a thorough interpretation of preoperative angiograms. Though there are many series reporting the clinical features and management outcome of proximal ACA aneurysms, all are limited by a small sample size due to the rarity of the pathology. In this article, the pertinent literature related to the surgical nuances associated with dealing with A1 segment aneurysms is reviewed. The clinical presentation, associated anatomical characteristics, microsurgical management, role of endovascular therapy, and outcome are discussed. [ABSTRACT FROM AUTHOR]

Byline: Gagandeep. Attri, Suyash. Singh, G. Kumar, Jeena. Joseph, Kamlesh. Bhaisora, Arun. Srivastava, Sushila. Jaiswal, Sanjay. Behari Sir, Spinal drop metastasis is common sequelae in high-grade like glioblastoma. However drop [...]

Background: The ruptured anterior communicating artery aneurysm is the most frequent intra-cranial aneurysm treated at any neurosurgical department. These aneurysms arise from either the A1-A2-Acom artery junction or Acom artery. The surgical outcome depends on the age of the patient, time duration between ictus and surgery, and Hunt and Hess grade at admission. In this article, we intend to analyze the surgical outcome based on our proposed classification with our overall experience of Acom aneurysm. Methods: A retrospective review of our surgical database with 250 patients of ruptured Acom was done, and the location, morphology, and direction of aneurysm, along with other clinical parameters including the demographic profile, radiological findings, and intra-operative details, were studied. We classified the Acom based on both site of origin and morphology (Type I, junctional on the dominant side; Type II, fusiform with an ill-defined neck and branching pattern; Type III, saccular true Acom A) and secondarily as described in the literature on the basis of the direction of fundus (Type A-E). The clinical parameters were compared among the above groups using Fischer-exact and one-way analysis of variance test. Results: A total of 250 patients (M: F =113:137) were included (mean age 52.1 ± 11.5 standard deviation years). 55.2% patients had left A1 dominance. Type I Acom A was commonly found on the left dominant circulation (P = 0.00). The difference in aspect ratio of Type I (2.0 ± 0.8) and Type II (1.8 ± 0.52) aneurysms was insignificant (P = 0.28). However, a significant difference in post-operative vasospasm among different types of aneurysms was found (P < 0.05). The Type I Acom A were anteriorly directed, while Type II and III were posteriorly directed (P = 0.001). The mean follow-up of the study was 44.4 ± 25.7 months, with age (P = 0.007) and Hunt and Hess grade (P = 0.001) at admission correlating with surgical outcome. Conclusion: Classifying the Acom A pre-operatively based on site and morphology, location, and direction of fundus helps in surgical planning and prognosis. The junctional 'Type IA aneurysms' are most common and possess a high intra-operative rupture rate. The anteriorly directed aneurysms have a better prognosis, and visual complaints are usually associated with anterior-inferiorly directed aneurysms. [ABSTRACT FROM AUTHOR]

Byline: Kuntal. Das, Arun. Srivastava, Kamlesh. Bhaisora, Balachandar, Awadhesh. Jaiswal, Sanjay. Behari Background: Anterior clinoidectomy for aneurysm clipping is generally performed intradurally. Despite obvious advantages, accidental drill slippage or indirect [...]

Byline: Kuntal. Das, Bhawan. Nangarwal, Jaskaran. Gosal, Kamlesh. Bhaisora, Rahul. Srinivasan, Arun. Srivastava Background and Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a [...]