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Biomedical subjects

M C Vasudevan

Publications and source records attributed to M C Vasudevan.

11 recordsLinked to original sources
PubMed2004

Posttraumatic total dislocation of the upper thoracic spine.

BACKGROUND: Difficulty in proper visualization of the upper thoracic spine in plain radiographs allows for injuries at this level to be missed, especially in a busy trauma center. This window of error is increased when the patient presents with no symptoms or signs of neurologic or spinal involvement, as upper thoracic dislocations commonly present early. CASE DESCRIPTION: The authors report a 19-year-old girl who developed progressive paraparesis 18 hours following initial presentation with a scalp avulsion injury. Imaging revealed a complete dislocation at T1-T2, with cord compression. Emergency surgical decompression and reconstruction of her spinal column was performed with a 360-degree stabilization. There was immediate neurologic improvement and on follow-up the patient is neurologically normal. CONCLUSIONS: The case highlights the difficulty in visualization of the upper thoracic spine in routine radiographs taken in a casualty setting. Treating physicians should have a low threshold for investigation of cervico-thoracic dislocations. The possibility of a delayed progressive dislocation should be kept in mind when dealing with injuries with a potential for spinal injury.

Adult↗
PubMed2004

Idiopathic chronic hypertrophic pachymeningitis causing thoracic cord compression.

Chronic idiopathic pachymeningitis is a rare cause of compressive myelopathy, especially of the thoracic spinal cord. The hypertrophic dura causes symptoms either by pressure on the spinal cord or by vascular compromise. The authors report the diagnostic dilemmas in a 48-year-old lady who presented with progressive spastic paraparesis of 4 months duration. MRI showed an extradural hypointense band, surrounding and flattening the thoracic cord in the anteroposterior direction, extending from C7 to T11. Neither the CT scan nor the myelogram provided any clue to the diagnosis. A T1-T10 laminectomy was performed. The dura was hypertrophied and found compressing the cord. The posterior dura was excised and the spinal cord was decompressed. The histopathology showed hypertrophic pachymeningitis. The patient improved neurologically. She was started empirically on anti-tubercular chemotherapy, though she was serologically negative for all known causes of pachymeningitis.

Chronic Disease↗
PubMed2001

Giant invasive spinal schwannomas: definition and surgical management.

OBJECT: Confusion exists regarding the term giant spinal schwannoma. There are a variety of nerve sheath tumors that, because of their size and extent, justify the label "giant schwannoma." The authors propose a classification system for spinal schwannomas as a means to define these giant lesions. The classification is confined to tumors that are essentially intraspinal, with or without extraspinal components. Lesions that erode the vertebral bodies (VBs) and extend posteriorly and laterally into the myofascial planes are classified as giant "invasive" spinal schwannomas. METHODS: The records of patients with giant invasive spinal schwannoma were analyzed. The radiological features, operative approaches, and intraoperative findings were noted. Ten patients with giant invasive tumors were surgically treated over the last 8 years. Six patients were male. Erosion of the posterior surface of the VBs was the diagnostic finding demonstrated on plain x-ray films. Magnetic resonance imaging delineated the extent of the tumors and helped in preoperative planning. Radical excision of the tumors in multiple stages was possible in eight of the 10 patients. Dural reconstruction was required in four patients. All patients required fusion, and an additional stabilization procedure was undertaken in three patients. CONCLUSIONS: The authors conclude that giant invasive schwannomas are uncommon lesions and propose a new classification system. Because of their locally "invasive" nature and extension in all directions, careful preoperative planning of the surgical approach is very important. Although radical excision is possible and promises good results, recurrences may occur and multiple surgical procedures may be required.

Adolescent↗
PubMed2001

Surgery for ossification of the posterior longitudinal ligament of the cervical spine.

The authors present their surgical experience with fifty seven cases of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, operated between January 1992 and January 1999. Continuous OPLL was seen in the majority of patients (40/57). Posterior decompressive surgery was performed in 18 patients, a median corpectomy and excision of the OPLL in 28 and anterior segmental decompression in 11 patients. One patient had a transient weakness of muscles supplied by the C5 myotome following a C4-C5 corpectomy. 84.2% of the patients showed improvement by at least one grade at the time of discharge. 92.8% of patients who underwent a corpectomy improved in the immediate post-operative period as compared to 90.9% of those who underwent an anterior segmental decompression and 83.3% of those who underwent a posterior decompressive procedure. 97.7% of the 44 patients followed-up between one and five years showed neurological improvement. Thirty-two patients (72.7 %) had regained normal or near normal neurological function and returned to their jobs. Good results were obtained when the surgical approach and the procedure adopted were individualised.

Adult↗
PubMed1999

Isolated eccentric syrinx of the conus medullaris simulating a tumour.

There are many reasons for the formation of cavities in the spinal cord. A focal cavitation is distinguished from syringomyclia by the absence of an ependymal lining in the former as opposed to the latter. The authors report a case of an isolated eccentrically placed syringomyelia of the conus medullaris, which caused a cauda equina syndrome and resembled a tumour on MRI.

Cauda Equina↗
PubMed1999

Magnetic resonance imaging artifact following acoustic neurofibroma surgery--case report.

Metallic artifacts in magnetic resonance (MR) imaging occur mostly in patients who have received an implant at surgery. Similar artifacts are now increasingly recognized in patients in whom high-speed drills have been used. A 15-year-old male with neurofibromatosis 2 had undergone excision of acoustic neurofibroma on the left 1.5 years prior to the present admission. MR imaging to evaluate the acoustic neurofibroma on the right showed a metallic artifact at the site of the previous surgery. Computed tomography did not show any evidence of metal debris. The artifact was probably caused by metallic dust or debris from a high-speed drill during the first surgery. We suggest that care should be taken to prevent deposition of such debris in the operative field to prevent this complication.

Adolescent↗
PubMed1998

Limited unilateral approach for extramedullary spinal tumours.

Traditionally, spinal extramedullary tumours are approached by a wide multilevel laminectomy and a midline dural incision. This exposure may result in immediate or delayed instability of the spine, and exposes the spinal cord to the possibility of inadvertent injury during surgery. To avoid these complications the authors have, in 27 patients, used a limited unilateral approach to remove extramedullary tumours. The approach entails bone removal which is limited to the lateral half of the lamina on the side of the tumour and may or may not include the medial part of the facet joint. A lateral dural flap exposes the tumour without exposing the cord. Extraspinal extensions of the lesion may be approached by extending the laminectomy further laterally to the facet joint. This technique has been used in the cervical, thoracic and the lumbar spine to radically remove the lesion in all cases. There were no complications. The authors conclude that extramedullary lesions of the spine can be removed radically by this approach which allows direct access without cord or root retraction, and with little disturbance to the normal anatomy.

Adult↗
PubMed1995

Cystic meningiomas.

BACKGROUND: Meningiomas are generally solid tumors and are easily diagnosed by CT scans and MRI scans. Rarely are these tumors associated with cysts that can cause a confusion in the pre- and intraoperative diagnosis. Cysts associated with meningiomas may be intratumoral or peritumoral. METHODS: The authors conducted a retrospective study of the seventeen meningiomas, out of a total number of 232, which were associated with cysts. The cysts were classified based on their relationship to the tumor. The patients' sex, age group, location of the tumor, and pathological type of tumor were also analyzed. RESULTS: The 17 cases of cystic meningioma formed 7.3% of the meningiomas seen between 1984 and 1993. Eleven of these were intratumoral and 6 peritumoral. One case had both intra- and peritumoral cysts. The tumors were found mostly in the fourth and fifth decades of life. Histologically, all the peritumoral cysts except one were associated with meningotheliomatous meningiomas. Tumors with peritumoral cysts were more common in males. Intratumoral cysts, more common in females, were angioblastic or meningotheliomatous on histopathology. Only one case was an anaplastic meningioma. CONCLUSION: Cysts associated with meningiomas, although uncommon, are certainly not rare. The peritumoral and the intratumoral cysts form distinct subtypes needing separate consideration. Cystic meningiomas are only rarely malignant.

Adult↗
PubMed1993

The changing face of tuberculomas.

Tuberculomas of the brain continue to be prevalent in all the developing countries of Asia, Africa, South American and Europe and seem to be making a comeback in the richer nations of the West. They pose a challenge to the neurosurgeon, in spite of the advances that have been made in the diagnosis of these lesions and in the available therapeutic regimes. During the last decade, computed tomographic (CT) scan has facilitated early diagnosis of tuberculomas at a stage when the lesions are small and antituberculous therapy (ATT) has been found beneficial in the majority of patients. Those lesions that do not respond need change in the ATT regimen and addition of steroids. Some lesions tend to disappear by themselves after a few weeks and probably are not tuberculous in nature. Some continue to grow in spite of ATT, probably due to drug resistance and require surgery, and some turn out to be gliomas. As it is not possible to differentiate between glioma or tuberculoma from CT morphology alone, and as stereotactic biopsy can be expensive, it is worth a trial with ATT, reserving surgery only to those which continue to grow inspite of ATT.

Humans↗
PubMed1986

Changing concepts in the treatment of tuberculomas of the brain.

Tuberculomas of the brain in children constitute 5% to 8% of intracranial space-occupying lesions in developing countries. These have in the past been treated with antituberculous drugs and with excision of large masses when the intracranial tension was high. Computed tomography (CT) has modified this approach. CT has resulted in earlier diagnosis and has been of help in monitoring the results of medical treatment of tuberculomas in children. With such monitoring there has been less need for surgical excision. At the same time, it has been realised that some caution is required towards our dependence on CT, as the image morphology of a tuberculoma could simulate other lesions like a glioma, and surgical excision needs to be carried out when in doubt or when there is no appreciable improvement in CT appearances with medical treatment.

Antitubercular Agents↗