Introduction: Vestibular schwannomas constitute 8% of all intracranial tumors. A majority of vestibular schwannomas are sporadic and unilateral. Giant vestibular schwannomas are seen in our country due to the late diagnosis and long duration of symptoms before diagnosis. These giant schwannomas are challenging to manage as most of the patients are having brainstem compression. Materials and Methods: Twelve cases of a giant vestibular schwannoma were operated in our department between May 2011 and December 2012. Vestibular schwannomas with a maximal diameter of more than 4 cm were defined as a giant vestibular schwannoma. All the patients had a unilateral vestibular schwannoma. Performance status of all the patients were graded as per the Karnofsky performance score. Pre-operative assessment of 5 th , 7 th , 8 th and lower cranial nerve status was done in all cases. Ventriculoperitoneal shunting was done pre-operatively in all cases. All patients were operated through retromastoid suboccipital craniectomy and retrosigmoid approach. These patients were operated in two stages in two consecutive days with overnight elective ventilation in ICU. Ultrasonic aspirator and nerve monitoring techniques were not used. Results: Giant acoustic schwannomas can be safely resected completely by a staged resection on two consecutive days without any increased morbidity or mortality. This technique may be employed to achieve complete resection of such lesions without deterioration of facial nerve function in institutions which do not have advanced facilities like nerve monitoring or ultrasonic aspirator.
Introduction:Vestibular schwannomas constitute 8% of all intracranial tumors. A majority of vestibular schwannomas are sporadic and unilateral. Giant vestibular schwannomas are seen in our country due to the late diagnosis and long duration of symptoms before diagnosis. These giant schwannomas are challenging to manage as most of the patients are having brainstem compression.Materials and Methods:Twelve cases of a giant vestibular schwannoma were operated in our department between May 2011 and December 2012. Vestibular schwannomas with a maximal diameter of more than 4 cm were defined as a giant vestibular schwannoma. All the patients had a unilateral vestibular schwannoma. Performance status of all the patients were graded as per the Karnofsky performance score. Pre-operative assessment of 5th, 7th, 8th and lower cranial nerve status was done in all cases. Ventriculoperitoneal shunting was done pre-operatively in all cases. All patients were operated through retromastoid suboccipital craniectomy and retrosigmoid approach. These patients were operated in two stages in two consecutive days with overnight elective ventilation in ICU. Ultrasonic aspirator and nerve monitoring techniques were not used.Results:Giant acoustic schwannomas can be safely resected completely by a staged resection on two consecutive days without any increased morbidity or mortality. This technique may be employed to achieve complete resection of such lesions without deterioration of facial nerve function in institutions which do not have advanced facilities like nerve monitoring or ultrasonic aspirator.
Interbody fusions are routinely used in deformity surgery to achieve both coronal and sagittal correction and attain increased fusion rates. Minimally invasive interbody techniques, including the prepsoas approach, are being utilized to decrease tissue disruption, blood loss, and patient morbidity with similar outcomes compared to traditional surgery. The prepsoas oblique lateral interbody fusion, accesses the spine between the iliac arteries or aorta and psoas muscle, and allows for exposure of the lumbar spine while avoiding some complications commonly seen with a direct lateral approach. Navigation can assist the surgeon for surgical planning, ensuring appropriate placement of the interbody graft, and with placement of posterior pedicle screws. In correctly selected patients, these minimally invasive procedures can achieve excellent deformity correction and outcomes.
Backdrop: Nutritional status has been proven to affect surgical outcome in various studies worldwide. Accurate nutritional assessment tools can help the clinician in taking appropriate steps at the right time in order to improve the surgical outcome. This is especially relevant in neurosurgical cases because of the long hospital stay and high incidence of complications. In the present study we aim to find out the prevalence of severe malnutrition in the patients admitted to NICU and the correlation of the same with mortality. We also intend to find out the best predictor of mortality amongst the malnutrition parameters. Materials and Methods: This is a prospective observational study conducted at Bangur Institute of neurosciences (BIN), Kolkata on 50 patients who were admitted in NICU for more than 5 days. Various nutritional paramaters like SGA, albumin and transferrin values were studied. Statistical Analysis was performed with help of Epi Info (TM) 3.5.3. Chi-square test was used to find the associations. Odds Ratio (OR) with 95% confidence interval (CI) was calculated to find the risk factors. Results: Glioma and meningioma were the most common clinical conditions in the study populations followed by space occupying lesions of the CP angle and aneurysm, PF SOL and pituitary adenoma. Nearly 42% (21/50) were severely malnourished, 36% (18/50) were moderately malnourished whereas 22% (11/50) had a normal nutritional status. CP angle SOLs were most commonly associated with severe malnutrition followed by PF SOL and pituitary adenoma. Association of various parameters namely SGA, serum albumin and serum transferrin with mortality was found to be statistically significant. This association was found to be the strongest with severe malnutrition by SGA ) as compared to serum transferrin and serum albumin levels (odds ratio of 4.37 (1.29-14.77) and 6.95 (0.80-60.13) respectively. Conclusion: In countries like India where malnutrition is very high in general and in critically ill patients, SGA is a potential tool for categorising patients with high risk of mortality at the time of admission. An early nutritional intervention thereafter might help in improving the outcome of such patients and might reduce the economic burden on part of the healthcare setting and the individual.
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