Ventriculoperitoneal shunt infection due to Listeria monocytogenes.
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Aged↗
Biomedical subjects
A A Patil
Publications and source records attributed to A A Patil.
Electromagnetic field focusing instrument augments resection of meningiomas.
The electromagnetic field focusing (EFF) surgical instrument creates an oscillating electromagnetic field that induces eddy currents in the tissue, which converge at the point of contact. This energy creates a focal spark capable of vaporizing tissue. The EFF instrument was used to resect 17 meningiomas in 14 patients. The effectiveness of the EFF probe in resecting tumor tissue was compared with that of the Cavetron ultrasonic surgical aspirator (Model 100) in 11 patients. The EFF system was superior to the Cavetron ultrasonic surgical aspirator in tumor excision in all but two cases, in which the EFF grounding tip was poorly tuned. Surgical time and blood loss were reduced by subjective analysis in all but these two cases, especially in the rubbery or calcified meningiomas resistant to aspiration. No complications were directly attributable to use of the EFF. Drawbacks encountered with the EFF system include buildup of "char" on the tip, requiring scraping, and intense heat at the tip, which occasionally melted the insulating sheath, requiring replacement.
Adult↗
Electroconvergent cautery.
A new cautery system known as the electroconvergent cautery system is described. This cautery system uses a radiofrequency current of 13.56 MHz. The current is passed through an amplifier, an impedance matching system, and a loading and tuning coil into a probe. After the probe tip is touched to the tissue, the mismatch of impedance between the probe tip and the generator is minimized to almost zero, resulting in high-current density at the probe tip, which causes pinpoint heating of the tissue at the point where it is touched by the probe without spread of heat to the surrounding tissue. This heat can cut and vaporize tissue and coagulate vessels. The probe can also be used to coagulate vessels with standard surgical forceps. Because convergence of energy is used for tissue heating, a grounding pad is not needed. The system can also be used under cerebrospinal fluid or saline.
Astrocytoma↗
Role of brachytherapy in the management of the skull base meningioma. Treatment of skull base meningiomas.
BACKGROUND: The treatment of primary and recurrent skull base meningiomas presents a formidable surgical problem. METHODS: Fifteen patients with primary and recurrent skull base meningiomas were treated by means of interstitial irradiation with iodine 125 (125I) seed implantation. The physical characteristics of 125I enabled the authors to administer a minimum tumor dose ranging from 100 to 500 Gy at a low dose rate of 0.05-0.25 Gy per hour. RESULTS: All 15 patients are alive at a median follow-up of 29 months. Of the 15 patients, 2 with calcification and 2 without calcification achieved only partial responses. The remaining 11 patients achieved a complete response. No early or late complications were observed. CONCLUSIONS: From these data, the authors conclude that interstitial irradiation with 125I seeds is an effective, safe, and simple method in the treatment of both recurrent and primary skull base meningiomas.
Adult↗
Continuous low dose rate brachytherapy with high activity iodine-125 seeds in the management of meningiomas.
The purpose of this study was to evaluate if meningiomas can be effectively treated with brachytherapy using permanent implantation of high activity I-125 seeds. Thirteen patients with intracranial meningiomas were treated by means of permanent stereotactic implantation of one or more high-activity I-125 seeds. The physical characteristics of I-125 enabled us to deliver a minimum tumor dose ranging from 100 Gy to 500 Gy at a low dose rate of 5 cGy to 25 cGy per hr. Indications for this procedure included recurrence after initial surgery or as primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 25 months. Nine of 13 patients achieved complete resolution of the tumor and in the remaining four, more than 50% reduction in tumor volume was noted at the last follow-up. No late complications were observed. We conclude from this initial data that localized high dose irradiation delivered at a low dose rate using I-125 permanent implantation is an effective, safe, and simple method in the treatment of both recurrent and primary intracranial meningiomas.
Adult↗
Intracranial skip metastasis from parotid and facial skin tumors: mechanism, diagnosis, and treatment.
Perineural and endoneural tumor spread is a form of metastatic disease in which the primary tumors spread along neural pathways and gain access to noncontiguous regions. Although rare, this type of skip metastasis into the cranial cavity occurs from tumors of the parotid gland and facial skin. Recognition of this process, evaluation of the patient with proper diagnostic procedures, and its treatment are presented.
Brachytherapy↗
Bourneville's tuberous sclerosis associated with double outlet right ventricle and infundibular pulmonary stenosis.
The cardiac manifestation usually associated with tuberous sclerosis is rhabdomyoma of the heart. We report a rare association with cyanotic congenital heart disease in the form of double outlet right ventricle with infundibular pulmonary stenosis.
Child↗
Stereotactic external beam irradiation system.
Stereotactic localization is of vital importance in treating small intracranial lesions either with interstitial or external beam irradiation. This article describes a simple, fast, accurate, and verifiable system that can be used with a standard computerized axial tomography (CAT) scanner and linear accelerator for stereotactic external beam irradiation.
Brachytherapy↗
Free-standing, stereotactic, microsurgical retraction technique in "key hole" intracranial procedures.
Free-standing, stereotactic, microsurgical retraction technique involves integration of a standard image-guided stereotaxis, an operating microscope and free-standing micro-retractors, data acquisition from computed tomography (CT) images, trajectory determination, and obtaining tumor configuration "in line" with the trajectory using standard CT computer program. The free-standing stereotactic micro-retractors are directed to the lesion using the stereotactic frame. The remainder of the procedure is carried out independent of the stereotactic frame. The technique allows unobstructed access to deep lesions through a "key-hole" opening with excellent visualization of the lesions, and accurate retractor placement. Independent retractor movement also allows visualization of the different corners of the wound. Experience with the first 15 consecutive procedures for stereotactic excision of deep lesions using the Patil frame is reported. Based on this preliminary experience, this technique is free of obstruction, accurate and safe.
Adolescent↗
Axial herniation with brain stem deformity as a cause of sleep apnea.
A patient with an intracerebral hematoma and associated edema in the high right hemisphere parasagittal convexity had several episodes of apnea at night and during the day when she was asleep. On computed tomography (CT) scan, the hematoma demonstrated no evidence of brainstem compression. Sagittal magnetic resonance image (MRI), revealed the hematoma and edema mass resulted in central herniation with axial deformity of the brainstem. This is believed to be the cause of the apneic episodes. Treatment with mannitol and steroids promptly relieved the symptom.
Brain Edema↗
Stereotactic approach to skull-base lesions.
With improved knowledge of the anatomy and increased collaboration between the neurosurgeon and the otolaryngologist, successful surgical resection of skull-based tumors is being achieved with reduced mortality and morbidity. In spite of this, there remains a group of patients in whom an alternate surgical approach of stereotaxis may be indicated. This group of patients includes those in whom only biopsy is required, or those in whom brachytherapy using high-intensity (125)I is planned because the patients' general condition is not good enough to undergo open surgical resection of the tumor or the tumor is unresectable or the patient refuses open surgery. This article presents a preliminary report on stereotactic approach to skull base lesions with special emphasis on the technique.
Journal Article↗
Accuracy of thalamotomy target determination using axial images only.
The target point for thalamotomy is generally determined in relationship to the intercommissural line. Standard axial computed tomography (CT) images can show both the anterior and posterior commissures. However, these commissures may not always be visible on the same axial image, as the plane in which the two commissures are located may not be the same as the plane of scanning. Mathematical calculations were performed to determine the degree of error that would occur if the target point determination was performed using axial images alone, even when the two commissures were not in the same plane as the CT images. The degree of error was found to be directly proportional to the distance between the plane of scanning for the two commissures. For each millimeter separation of these planes an error of approximately 0.11 mm in the z-coordinate (caudo-cephaled distance) and 0.04 mm in the y-coordinate (antero-posterior distance) was observed. These errors were felt to be negligible, especially since the final target point determination is based on physiological responses.
Humans↗
Intraoperative calibration of the Patil stereotactic system during computed tomography (CT) guided stereotactic procedures--a technical note.
A method for intraoperative calibration of the Patil stereotactic system is described. After adjusting the z and y coordinates, a marker is placed in the pivot block and a CT scan is obtained. The presence of the marker in the indicator block on the same horizontal line as the target, on the image of the target, would indicate that the y and z coordinates adjustments are accurate. After the arc is attached with the x coordinate adjusted, a CT scan is obtained with the arc vertical and the probe holder at zero angle (from the vertical) position. The presence of the middle of the probe holder in the same vertical line as the target would indicate accurate x coordinate adjustment. This technique, which can be applied also to other stereotactic systems, allows the surgeon to check not only the accuracy of the system but also the accuracy of the procedure prior to inserting the probe into the brain.
Brain↗
Brachytherapy: a viable alternative in the management of basal meningiomas.
Thirteen patients with intracranial meningiomas of the skull base were treated with one or more high-activity iodine-125 seeds. In 11 patients, the seeds were implanted stereotactically under local anesthesia. A minimum dose of 100 to 500 Gy was delivered to the tumor at a dose rate of 5 to 25 cGy/h. Indications for this procedure included recurrence after initial surgery or as the primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 15 months. Nine of 11 patients (82%) without calcification in their meningiomas achieved complete response. The remaining 4 patients-2 with calcification and 2 without--achieved partial response. No early or late complications were observed. We conclude from our experience that both recurrent and primary meningiomas of the skull base can be treated effectively with permanent iodine-125 brachytherapy.
Adult↗
Intraventricular neurocytoma: a report of two cases.
Intraventricular neurocytoma is a rare clinicopathological entity that has been recently recognized. Previous reports have not described the magnetic resonance imaging findings of this tumor. This paper describes two patients with neurocytoma in which serpiginous flow voids and isointensity with cortex were distinctive features on the magnetic resonance imaging scan. Immunohistochemical studies showed reactivity for neuron-specific enolase, Leu-7, and S-100 protein.
Adult↗
Survival of patients with glioblastoma multiforme treated by intraoperative high-activity cobalt 60 endocurietherapy.
The authors report their initial treatment results in 49 patients with glioblastoma multiforme (GM) who received intraoperative endocurietherapy (ECT) with high-activity cobalt 60 (60Co) probe. Thirty poor prognosis (unresectable tumor) patients (Group I) with newly diagnosed GM were treated by either biopsy or subtotal excision, followed by 20.00-Gy single-fraction 60Co probe ECT, and 60.00-Gy external-beam radiation therapy (EXRT) (80.00 Gy total tumor dose). Nineteen patients (Group II) with recurrent, previously resected and externally irradiated GM were retreated with 20.00-Gy single-fraction 60Co probe ECT alone. The authors' initial experience with intraoperative ECT of GM is discussed.
Adolescent↗
Radiosurgery with the linear accelerator.
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Brain Diseases↗
Permanent high-activity iodine-125 in the management of petroclival meningiomas: case reports.
Two cases of petroclival meningiomas are reported wherein the tumors were completely destroyed without surgical resection or external-beam irradiation by means of permanent stereotactic implantation of one or two high-activity iodine-125 seeds.
Aged↗