Frameless Gamma Knife Radiosurgery with Leksell ICON: Initial Experience.

Gamma knife radiosurgery saw the light of the day when the Swedish physician "Lars Leksell" postulated the salient first principles of stereotactic radiosurgery. Prior to being realized in its new 'avatar' "The ICON", Leksell Gamma Knife (LGK) "Perfexion" has been the most practiced model and is still in practice in most of the centers in India. The Gamma Knife ICON (the sixth generation model) utilizes the concept of the Cone-Beam Computed Tomography (CBCT) module, thus allowing non-invasive immobilization of the skull employing frameless treatments without jeopardizing accuracy to sub-millimeters.

Simplifying Tumor Volume Estimation from Linear Dimensions for Intra-Cranial Lesions Treated with Stereotactic Radiosurgery.

Aims: This study aims to derive simple yet robust formula(s) for the calculation of cranial tumor volume using linear tumor dimensions in anterioposterior (AP), mediolateral (ML) and craniocaudal (CC) directions and also propose a reproducible methodology for tumor dimension measurements.

Materials And Methods: Magnetic resonance images (MRI) of 337 patients planned for Gammaknife Stereotactic Radiosurgery for different types of brain tumors were analyzed using Leksell Gamma Plan (LGP) software. Tumor volume in three dimensional was outlined and maximum tumor diameters were measured in three orthogonal directions AP, ML, and CC on the MRI.

Microvascular Clipping of A1 Segment Aneurysms.

Background: Aneurysms arising from the proximal segment (A1) of the anterior cerebral artery (ACA) are relatively rare. Because of their small size, abnormal location in relation to the parent artery and the risk of damage to the surrounding perforators, their surgical management is a big challenge. We present our experience with 7 patients of A1 segment aneurysms.

Optic Tract Edema: A Rare Entity in Pituitary Macroadenoma.

Pituitary tumors are relatively common tumors accounting for almost 15% of all primary brain tumors. Pituitary macroadenomas cause mass effect on the optic apparatus causing a myriad of visual deficits. On imaging generally the anterior visual pathway is involved which may be compressed by the mass lesion.

Impact on Cognitive Improvement Following Burr Hole Evacuation of Chronic Subdural Hematoma: A Prospective Observational Study.

Objective: Patients of Chronic subdural haematoma can present with only subtle cognitive impairment without any motor deficit. It is hence imperative for the treating clinician to be aware of this entity. The aim of the study was to identify any statistically significant improvement of cognitive functions following burr hole evacuation of Chronic SDH especially in the elderly patients.

Spastic quadriparesis due to pathological fracture of odontoid secondary to carcinoma prostate: A rare presentation.

Prostate carcinoma presenting as symptomatic metastases to atlantoaxial spine is extremely rare. Spastic quadriparesis due to pathological fracture of odontoid as the only initial manifestation without symptoms of primary malignancy is rarer still. We report a 64-year-old male who presented with progressive spastic quadriparesis along with urinary retention of 3 weeks duration.

Nelson's syndrome presenting as bilateral oculomotor palsy.

Nelson's syndrome refers to a clinical spectrum arising from progressive enlargement of pituitary adenoma and elevated adrenocorticotrophic hormone after total bilateral adrenalectomy for Cushing's disease comprising of hyperpigmentation, visual field defects which can be life threatening. We report here a 50-year male presenting with rapid onset of Nelson's syndrome with an unusual finding of bilateral oculomotor palsy mistakenly treated as ocular myasthenia.

Post-traumatic cervical pneumorrhachis--a rare entity.

Pneumorrhachis(PR) is a rare phenomenon and post traumatic PR even more so. Presentation can vary from asymptomatic to significant neurological deficit and so the management has to be individualised. We present a case of post-traumatic cervical PR.

Primary spinal pleomorphic xanthoastrocytoma.

Pleomorphic xanthochromic astrocytoma primarily of the spinal cord is a rare entity. The case is possibly the fifth such report. Complete surgical excision is the essential requirement for good survival.