Clinical and immunohistochemical prognostic factors in adult glioblastoma patients.

Objective: Glioblastomas are the commonest and the most malignant of all adult brain tumors, characterized by genetic instability, intratumoral histopathological variability, and unpredictable clinical behavior. The utility of tumor markers that reflect their underlying biology is becoming increasingly important with respect to patient prognostication and their potential role as molecular targets of therapy is being recognized. In this study, we aimed to identify the clinical factors and some immunohistochemical markers that could have an effect on patient survival in supratentorial glioblastomas.

Efficacy of stereotactic aspiration in deep-seated and eloquent-region intracranial pyogenic abscesses.

Object: Intracranial abscesses located deep in the cerebral parenchyma and in eloquent regions are often difficult to manage surgically. The authors have attempted to analyze the efficacy of stereotactic aspiration in the management of these abscesses.

Methods: Cases involving 22 patients (including 9 children) with deep-seated and/or eloquent-region intracranial abscesses who underwent CT- or MR imaging-guided stereotactic aspiration between January 1995 and July 2001 were analyzed.

Pediatric intracranial meningiomas--do they differ from their counterparts in adults?

Aim: Meningiomas are very rare in children comprising only 0.44.1% of pediatric age tumors and only 1.

Intensive care management of head injury patients without routine intracranial pressure monitoring.

Background: Head injury contributes significantly to mortality and morbidity in India. Evaluation of the available trauma care facilities may help improve outcome.

Aim: To evaluate the factors influencing the mortality of patients with head injury who had intensive care management and evolve strategies to improve outcome.

Posterior fossa extradural hematoma: our experience and review of the literature.

Background: Posterior fossa EDH is an uncommon entity, accounting for only 4% to 12.9% of all EDHs It has a characteristic clinical presentation, which if detected can be life-saving.

Methods: We sought to study the demographic features of patients with PFEDH and assess the clinical and radiologic predictors of the outcomes of as well as evaluate the various treatment modalities for this disease.

Endoscopic options in management of posterior third ventricular tumors.

Objective: A spectrum of both radiosensitive and radio-resistant lesions occurs in the region of the posterior third ventricle (PTV). Most of these are associated with hydrocephalus requiring a cerebrospinal fluid diversion procedure. The present study aims to assess the effectiveness of endoscopic biopsy and third ventriculostomy (ETV) in these patients.

Pediatric infratentorial subdural empyema: analysis of 14 cases.

Object: Pediatric cases of infratentorial subdural empyema (SDE) are both rare and associated with high rates of morbidity and mortality. The goal of this study was to report patient characteristics, treatment, and outcome in an exclusively pediatric series of SDE cases.

Methods: A series of 14 pediatric cases of infratentorial SDE was retrospectively analyzed.

Treatment options for Dandy-Walker malformation.

Object: The aim of this study was to assess the efficacy of various treatment options available for children with Dandy-Walker malformation (DWM) and to evaluate the role of endoscopic procedures in the treatment of this disorder.

Methods: The authors conducted a retrospective review of 72 children who underwent surgical treatment for DWM during a 16-year period. All patients underwent computed tomography scanning, and 26 underwent magnetic resonance (MR) imaging.

Expansile cranioplasty for massive occipital encephalocele.

Objective: This report highlights the management of infrequently encountered massive occipital encephaloceles with herniation of large amount of apparently functional cortex into the encephalocele sac.

Materials And Methods: Two children with giant occipital encephaloceles with herniation of significant brain parenchyma into the encephalocele sac were managed with expansile cranioplasty and reconstruction of the calvarial defect with autologus bone graft harvested from the adjacent parietal region.

Conclusions: Giant occipital encephaloceles with significant brain parenchyma in the encephalocele sac can be considered for preservation of the herniated parenchyma and expansile cranioplasty.

Third ventricular colloid cysts in children.

Introduction: Colloid cysts of the 3rd ventricle are relatively rare intracranial tumours, more so in children. They are benign tumours with excellent prognosis if diagnosed and treated early.

Methods: A retrospective analysis of 18 cases of colloid cysts in children below 18 years, operated in our institution between September 1998 and November 2003 (5 years) was made.

Spontaneous intraoperative hypothermia and cerebral protection in aneurysmal subarachnoid hemorrhage.

Background: In patients with aneurysmal subarachnoid hemorrhage (SAH), a trend towards cerebral protection has been demonstrated with intraoperative mild hypothermia. Mild to moderate spontaneous hypothermia occurs intraoperatively if no active measures are taken to warm the patient. The present study investigated the cerebral protective role of such spontaneous intraoperative hypothermia in patients with aneurysmal SAH.

Expression of p53, EGFR, pRb and bcl-2 proteins in pediatric glioblastoma multiforme: a study of 54 patients.

Pediatric glioblastoma multiforme (GBM) tumors, which have been established as 'de novo' neoplasms, are known to differ from their adult counterparts in terms of biology, genetics and ultimately survival of patients. In order to evaluate the utility of markers of tumor biology for refining prognostic assessment, we retrospectively analyzed 54 pediatric GBMs (age range 9 months to 15 years) occurring at different anatomical sites in the brain, operated at our institute between 1995 and 2001. The expression of p53, epidermal growth factor receptor (EGFR), bcl-2 and retinoblastoma proteins (pRb) was analyzed by immunohistochemistry and the results were compared with the clinical profile, MIB-1 labeling index (LI) and patient survival.

Intracranial fungal granuloma: analysis of 40 patients and review of the literature.

Objective: To describe the characteristics of patients diagnosed with intracranial fungal granuloma (IFG) in the largest reported series to date (to our knowledge).

Methods: A 22-year retrospective, multi-institutional review of 40 patients, aged 16 to 62 years (mean, 40.2 years), was performed in patients with histopathologically confirmed IFG.

Does volume of extradural hematoma influence management strategy and outcome?

Aims: To evaluate the management strategy of extradural hematomas (EDH), particularly with respect to its volume.

Methods And Materials: Two hundred and three patients with EDH and no other significant intracranial injuries were treated over a period of three years.

Results: The factors influencing management strategy and outcome were the Glasgow coma scale (GCS), volume of extradural hematoma (EDHV) and its location.

Prognosis in children with head injury: an analysis of 340 patients.

Background: The outcome in children with head injury is distinctive because of the different biophysical properties of the child's skull and brain, and their reaction to injury.

Methods: In this retrospective study of three hundred and forty children with head injury, managed from January 1993 to December 1998, at NIMHANS, the factors influencing outcome were analyzed.

Results: On admission there were 40 children in GCS 3-5, 55 children in GCS 6-8, 96 in GCS 9-12 and 152 children in GCS 13-15.

Failed endoscopic third ventriculostomy in children: management options.

Endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus has a failure rate of 20-50% in various series. The present study analyzes ETV failures in 72 patients over a 2-year period and attempts to outline a management plan. Of the 72 patients who underwent ETV, it failed in 13.

Peritumoural oedema in meningiomas : a radiological and histological correlation.

One hundred and six patients with intracranial meningiomas were evaluated retrospectively, and the degree of peritumoural oedema as noticed on CT, was correlated with the histological features and site and size of the tumour. 89 of the tumours which were 4.5 cms or more and all angioblastic and haemangiopericytic subtypes were associated with significant peritumoural oedema.

Neuro-endoscopic fenestration of occluded foramen of Monro causing unilateral hydrocephalus.

An uncommon case of unilateral hydrocephalus due to membranous occlusion of the ipsilateral foramen of Monro is presented. The patient successfully underwent neuroendoscopic fenestration of the occluded foramen of Monro along with septum pellucidum fenestration.

Prognosis in contre-coup intracranial haematomas--a clinical and radiological study of 63 patients.

The clinical and radiological profiles of 63 patients with contre-coup haematomas were studied. The overall mortality was 53%. The mortality in patients with contre-coup haematomas alone was only half of that found in patients with associated coup injury (80%).

[Fluorotic cervical spinal cord disease].

Skeletal fluorosis was reported as a disease endemic to an area in the Madras Presidency of Indian in 1937 and prior to this, it was known as an occasional disease. There are two endemic areas in India, one in Punjab and the other in Andhra Pradesh State. This disease is also endemic in some parts of China and Africa.

Recurrences in meningioma after surgery.

123 cases of meningioma operated upon between 1975 and 1984 were reviewed. There were 13 cases of symptomatic tumour recurrence and 15 cases of tumour progression. Both, recurrence and progression of the tumour were seen twice as often in males.