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Category : Brain & Nerves
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Sep08
Management of pediatric colloid cysts of anterior third ventricle-A review of 5 cases
Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated.

Material and methods:
Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment.
Results:
Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died four hours after the admission. On follow up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances.
Conclusion:
Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared to the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
Key words: Colloid cyst, pediatric, transcallosal-transforaminal, anterior third ventricle, disconnection syndrome.


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Sep08
multiple burhole surgery as a treament for moyamoya disease
Objective: To re-emphasize that indirect revascularization surgery alone, where multiple burr holes and arachnoid openings are made over both cerebral hemispheres, is beneficial in the treatment of moyamoya disease in children.
Clinical presentation:
We report a 10 year old boy presenting with complaints of episodic headache for the last five years. At the peak of his headache he had visual disturbances and acute onset weakness of left sided limbs, recovering within a few minutes. He had no focal neurological deficits. Radiological investigations revealed abnormal findings, demonstrating the features of moyamoya disease.
Surgical management:
He underwent bilateral multiple burr holes, dural and arachnoid opening over the frontal, parietal and temporal regions of each hemisphere. The elevated periosteal flap was placed in contact with the exposed brain through each burr hole.
Results:
On six months follow up he had only one episode of TIA. Post operative four vessel angiogram demonstrated excellent cerebral revascularization around the burr hole sites, and SPECT imaging showed hypoperfusion in the right temporo-occipital area suggestive of an old infarct with no other perfusion defect in the rest of the brain parenchyma.
Conclusion:
In children with moyamoya disease this relatively simple surgical technique is effective and safe, and can be used as the only treatment without supplementary revascularization procedures. This procedure can be done in a single stage, on both sides, and the number of burr holes made over each hemisphere depends on the extent of the disease.

Key words: indirect revascularization, multiple burr holes, moyamoya disease, children.


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Jul01
Adult Lead Encephalopathy
Authors: Dr Aaron de Souza
Dr KPS Narvencar, Dr PK Desai, Dr Z D'Costa, Dr G Nilajkar

Journal: Neurological Research, In Press, 2012


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Jul01
Asymmetric Blepharospasm with bilateral curtain sign
Authors: Dr Aaron de Souza, Dr S K Bhonsle

Journal: European Journal of Neurology, In Press, 2012.
[official journal of the European Neurological Society]


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Jul01
Acute generalised chorea in the diabetic nonketotic hyperosmolar state.
Authors: Dr Aaron de Souza
Dr Shyam Babu C, Dr P K Desai

Journal: Journal of Clinical Neuroscience, In Press, 2012


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Jul01
Wernicke’s encephalopathy following hyperemesis gravidarum: a case series.
Authors: Dr Aaron de Souza, Dr K V Krishna

Journal: The Neuroradiology Journal, 2012 In Press.


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Jul01
Delayed chorea after recovery from a symmetric parkinsonian syndrome due to striatal myelinolysis
Authors: Dr Aaron de Souza, Dr P K Desai

Journal: Journal of Clinical Neuroscience 19 (2012) 1165–1167 epub June 7, 2012


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Jul01
More often striatal myelinolysis than pontine? A consecutive series of patients with osmotic demyelination syndrome.
Authors: Dr Aaron de Souza, Dr P K Desai
Type of study: Original Research, case series

Journal: Neurological Research 2012 Apr;34(3):262-71. Epub 2012 Mar 5


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Jul01
Wrapping up a diagnosis of Creutzfeldt-Jakob disease with the cortical ribbon.
Authors: Dr Aaron de Souza
Dr Paresh K Desai, Dr Varun R Pai Kakode

Journal: Basal Ganglia epub 14 January 2012, ISSN 2210-5336, 10.1016/j.baga.2011.11.005.


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Jul01
Effect of Perilesional Gliosis around Solitary Cerebral Parenchymal Cysticerci on Long-Term Seizure Outcome: a Prospective Study using Serial Magnetisation Transfer Imaging
Authors: Dr Aaron de Souza,
Dr Atchayaram Nalini, Dr Jerry M. E. Kovoor, Dr Gangappa Yeshraj, Dr Hanumanthaiah S. Siddalingaiah, and Dr Kandavel Thennarasu

Type of Study: Original Research, propsective randomised controlled study of clinical outcome dependent on an imaging parameter

Journal: Epilepsia 2011 Oct;52(10):1918-27
[official journal of the International League against Epilepsy]


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