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Biomedical subjects

P K Pillay

Publications and source records attributed to P K Pillay.

At least 19 recordsLinked to original sources
PubMed2000

Computer-aided/image-guided and video-endoscopic resection of pituitary tumors.

Endoscopic pituitary surgery is a minimally invasive method which allows simple transnasal transphenoidal surgical access without retractors, and has been used by our team in 536 patients from 1993 to 1999. In 326 of these patients, computer-aided image-guided techniques (CAN) were used in conjunction with endoscopy. We found that CAN techniques and endoscopy allow accurate and precise minimal access to small, deep/lateral microadenomas and enable a more complete resection of large pituitary tumors especially those which are firm/fibrous in nature. Overall results were better than conventional pituitary surgery with a lower morbidity and shorter hospital stays. However, special training and expertise is needed for surgeons to carry out these procedures with acceptable results.

Adenoma↗
PubMed1997

The Brain Bench: virtual tools for stereotactic frame neurosurgery.

We present a suite of neurosurgery supporting tools developed around (i) the Virtual Workbench, a productive environment for the control of 3-D data, in which delicate work can be performed for hours on end without strain, and (ii) the Electronic Brain Atlas, integrating the major print brain atlases in day-to-day clinical use. We describe in detail the Brain Bench, a surgical planning system for stereotactic frame neurosurgery. Its objective is to prepare faster plans; have a better and more accurate choice of target points; improve the avoidance of sensitive structures; have fewer sub-optimal frame attachments and speedier, more effective planning and training. If validated by a clinical study now under way, this will improve medical efficacy and reduce costs.

Brain↗
PubMed1997

Video-endoscopic and mini-endoscopic sympathectomy for hyperhidrosis.

Video-endoscopic sympathectomy (VES) is currently the method of choice for the minimally invasive treatment of hyperhidrosis involving the palms, armpit and facial areas. Over a 7-year period from 1991 to 1997 our technique of performing VES has evolved during the performance of 800 endoscopic sympathectomies from the use of 3 ports to a single 10-mm port to finally a 3-mm port using a mini-endoscope. In comparison to standard VES, mini-endoscopic sympathectomy is simpler, less invasive, causes less postoperative discomfort and consistently allows patients to return home the same day.

Adult↗
PubMed1996

Endoscopic management of cerebrospinal fluid fistulae and traumatic cephalocoele.

The excellent visualisation and atraumatic surgical techniques of endoscopic sinus surgery were applied to the management of 5 patients with cerebrospinal fluid (CSF) fistulae in the anterior skull base. The CSF fistula was iatrogenic in three patients, post-traumatic in one patient and primary in another patient. The role of endoscopes in the diagnosis and management of CSF rhinorrhoea is discussed. These five case reports illustrate the use of rigid transnasal endoscopy for diagnosis and management of CSF fistulae. The use of endoscopes allowed us to accurately localise and repair CSF fistulae. Our technique and results of endoscopic management of CSF fistulae are discussed. Using the endoscopic transnasal approach and minimally invasive techniques the fistulae were successfully repaired in all 5 patients.

Adult↗
PubMed1995

Endoscopic anatomy of the sphenoid sinus and sella turcica.

An endoscopic study of the sphenoid sinus was carried out, on 30 cadavers, to understand the important anatomical relationships of the sphenoid sinus, and the sella turcica. The aim was to study the endoscopic anatomy and the variants, and to determine if endoscopic instrumentation and techniques, could play a beneficial role in endoscopic management of sellar lesions. The results of this study are discussed, with particular reference to the important surgical anatomical features of the sphenoid sinus. A surgical technique for the endoscopic transsphenoid approach to the sella turcica was developed. Anatomical variants can be identified endoscopically, and endoscopic techniques have the advantages of improved visualization, magnification, angled vision, and a panoramic perspective of the intrasphenoid anatomy, compared to currently employed methods of pituitary/sellar surgery, using the operating microscope.

Adult↗
PubMed1995

Endoscopic management of lesions of the sella turcica.

The excellent visualization and minimally invasive surgical technique of endoscopic sinus surgery was applied to the management of 40 patients with sellar lesions. Endoscopic management of sellar lesions offers, not only the advantage of improved visualization, but also magnification, and a panoramic perspective of the important relationships of the sella turcica. In the past year, we have managed 40 subjects with sellar lesions, endoscopically: 38 patients had pituitary adenomas and two a craniopharyngioma. At our hospital, the endoscope has replaced the operating microscope for surgery for pituitary adenomas and other sellar lesions. The endoscopic approach to the sphenoid sinus and the sella is performed by an ENT surgeon and the ablative surgery performed by a neurosurgeon. Our experiences, using the endoscope to perform surgery on sellar and parasellar lesions, are reported and the advantages, over the operating microscope, which is traditionally used are discussed. The technique for endoscopic management of sellar lesions is described.

Adenoma↗
PubMed1994

Functional anatomy of the human supplementary sensorimotor area: results of extraoperative electrical stimulation.

Electrical stimulation studies have demonstrated that a "supplementary motor area" (SMA) exists in humans. However, its precise functional organization has not been well defined. We reviewed the extraoperative electrical stimulation studies of 15 patients with intractable epilepsy who were evaluated with chronically implanted interhemispheric subdural electrodes. SMA-type positive motor responses were elicited not only from the mesial portion of the superior frontal gyrus but also from its dorsal convexity, and from the paracentral lobule, cingulate gyrus, and precuneus. Sensory symptoms, that could not be attributed to stimulation of the primary sensory area, were elicited from the superior frontal and cingulate gyri in addition to the precuneus. Therefore, human SMA, as defined by electrical stimulation, is not always confined to the mesial portion of the superior frontal gyrus as described previously. It is also not strictly "motor" but "sensorimotor" in representation. We propose referring to this region as the "supplementary sensorimotor area" (SSMA). We observed a somatotopic organization within the SSMA with an order of lower extremity, upper extremity, and head from posterior to anterior. Sensory representation in an individual was either anterior or posterior to the positive motor representation but never both. There was a supplementary eye field within the head representation. A supplementary negative motor area was noted at the anterior aspect of the SSMA. No language area was demonstrated within the SSMA. The physiologic significance of the SSMA and functional consequences of its resection must be addressed in further studies.

Adolescent↗
PubMed1994

Thoracoscopic ganglionectomy for hyperhidrosis.

Thoracoscopic sympathectomy for the treatment of hyperhidrosis has been carried out with techniques that involve either monopolar coagulation or laser injury to the T2 ganglion. Although this has the advantage of being minimally invasive, it has not been established whether these techniques are superior to complete ganglion excision, as carried out during open surgery. A new technique of complete T2 ganglion excision for palmar hyperhidrosis (with T3 ganglionectomy for axillary sweating) was developed using thoracoscopic techniques. Sixteen patients were treated with thoracoscopic T2 ganglion excision on the right side, and simple coagulation (Nd-YAG laser or monopolar) on the left side. Results were excellent with no posttreatment differences between hands at 1 year follow-up. However, long-term follow-up of these patients will be carried out to determine whether differences exist between these two techniques.

Adult↗
PubMed1993

Minimally invasive brain surgery.

Minimally invasive brain surgery refers to technological advances refining surgical access that have enabled neurosurgeons to reduce the morbidity and improve the accuracy and quality of neurosurgical procedures. These advances include computer-assisted stereotaxis, intraoperative ultrasound, brain mapping and neuroendoscopy. Computer-assisted stereotaxis includes not only smaller and accurate craniotomies but precision radiotherapy with radiosurgery and interstitial brachytherapy.

Brain Diseases↗
PubMed1993

Epilepsy surgery in children and adults.

Epilepsy surgery is now accepted as a treatment modality for medically intractable epilepsy. A careful and detailed evaluation of patients is required by a trained epilepsy team which includes neurosurgeons, neurologists, neuroradiologists, psychologists and psychiatrists. For intractable complex partial seizures of temporal lobe origin, epilepsy surgery offers an 80% success rate.

Adult↗
PubMed1993

Acute necrotising myopathy in association with carcinoma of the tongue.

Acute necrotising myopathy (ANM) is a rare complication of carcinoma. The myopathy is proximal, rapidly progressive, associated with rhabdomyolysis and usually fatal. We report an unusual case of acute necrotising myopathy in a woman with squamous cell carcinoma of the tongue who is alive, without tumour recurrence two years after diagnosis. This association of ANM with head and neck cancer is unique.

Biopsy↗
PubMed1992

Bilateral MRI-guided stereotactic cingulotomy for intractable pain.

As a treatment of patients with intractable cancer and noncancer pain, bilateral radiofrequency cingulotomy was performed in 10 patients. The technique involved stereotaxis using magnetic resonance guidance and local anesthesia, with the placement of a radiofrequency lesion (75 degrees, 60s). Of the 10 patients, 8 had metastatic lesions with musculoskeletal (6) or neurogenic (2) pain. Pain relief was judged excellent (4 patients), fair (1), poor (2) and excellent for 6 months poor in the last patient. The two benign lesions were neurofibromatosis with neurogenic pain and thalamic pain from an old stroke. Pain relief (with 1 year follow-up) in this group was judged excellent in one and poor in the other (thalamic pain).

Adult↗
PubMed1992

MRI-guided stereotactic placement of depth electrodes in temporal lobe epilepsy.

Electrodes placed stereotactically in mesial temporal lobe structures may be useful for determining laterality, and extent of the epileptogenic zone in temporal lobe epilepsy. We present and compare our experience with the use of two stereotactic arcs, the Brown-Roberts-Wells (BRW) and Cosman-Roberts-Wells (CRW) for magnetic resonance imaging guided placement of multicontact electrodes in the amygdala, anterior and posterior hippocampus. Out of 101 electrodes, 28 were placed in 6 and 17 patients using the BRW and CRW arcs, respectively. The target-centered design of the CRW arc eliminated the need for trajectory calculations, used uniform 'depth' measurements, and allowed greater operative flexibility and a shortened operating time. The use of depth electrode recording allowed 14 of the 23 patients to be selected for temporal lobectomy.

Brain↗
PubMed1991

Surgical management of syringomyelia: a five year experience in the era of magnetic resonance imaging.

We summarize our experience with 59 consecutive surgically managed cases of syringomyelia (SM) over a 5 year period. All cases had magnetic resonance imaging (MRI) preoperatively and postoperatively. Twenty-eight patients presented with SM and the adult Chiari (Chiari I) malformation (SM-ACM), 6 patients had post traumatic syrinxes, 14 patients had syrinxes associated with an intramedullary neoplasm, 3 patients had syringomyelia associated with spinal arachnoiditis and 8 patients had idiopathic syringomyelia. Holocord syrinxes were more often associated with SM-ACM, while focal syrinxes were associated with posttraumatic, spinal arachnoiditis and neoplastic conditions. In all cases with neoplasms the MRI revealed parenchymal intramedullary signal abnormalities in addition to the syrinx cavity. Posterior fossa decompression with obex plugging (the Gardner operation) was the procedure of choice for SM-ACM and for idiopathic holocord syringomyelia. Exploration and drainage of the syrinx with or without shunting was carried out mainly for focal syrinxes associated with trauma and neoplasm. Patients with SM-ACM responded well to posterior fossa decompression with satisfactory results in 24/28 patients. Idiopathic SM is probably a forme fruste of SM-ACM and when treated with the Gardner procedure showed good results in all 8 patients. Posttraumatic and neoplastic SM had the least predictable results with surgery. The disappearance of the syrinx on postoperative MRI correlated well with a good surgical outcome.

Adolescent↗
PubMed1991

Brain tumor resection aided with markers placed using stereotaxis guided by magnetic resonance imaging and computed tomography.

In the operative resection of brain tumors, defining and locating edges of deep-seated tumors or those with indistinct color and consistency can be difficult. This report presents a simple yet precise, alternative method, using the basic Brown-Roberts-Wells or Cosman-Roberts-Wells stereotactic frame, for placement of visual markers to aid in tumor resections. The method can also be extended to the Leksell system. Using routine computed tomographic scanning or magnetic resonance imaging after stereotactic frame application, multiple points along tumor edges were used as target points. In the operating room, standard techniques were used for the skin incision, removal of the bone flap, and opening the dura. At each target point, after opening the dura and using stereotactic coordinates and equipment, a microbiopsy forceps was used to place "micropatties" (each with a string tail) or small catheters with pledgets or catheter tips located at tumor edges. After removing the arc, the tumor resection was accomplished in a conventional nonstereotactic manner by simply following string tails or catheters to the tumor. Gross tumor edges were determined from positions of actual patties or catheter tips. These simple but accurate techniques offer the possibility of tumor resections under stereotactic guidance with equipment readily available to most neurosurgeons. The fidelity of marker placement is also maintained in relation to tumor edges despite shifts in the tumor and/or brain as cystic areas are drained or large amounts of the tumor are resected.

Adult↗