Biomedical subjects
Publications and source records attributed to A Goel.
A case is reported where after resection of a large cervical spinal intradural schwanomma a direct plate and screw fixation of the adjacent vertebral bodies was performed. The issue of instability after spinal tumour resection and the merits of the fixation technique described are discussed.
A case of extra-axial fungal (Blastomyces dermatitidis) granuloma in the region of the lower clivus is presented. The lesion simulated a meningioma both on radiological examination and on the macroscopic appearance at operation.
A 37-year-old female presented with a rare case of intradural, extraaxial Blastomyces dermatitidis granuloma involving a large part of the skull base. She had the principal complaint of worsening vision, but was otherwise healthy. The lesion mimicked an en-plaque meningioma on radiological examination and in gross appearance during surgery. This is a very unusual presentation for a blasto-mycosis granuloma.
A 15-year-old boy with von Recklinghausen's disease presented with two very rare symptomatic cervical intramedullary schwannomas manifesting as slowly progressive weakness. The tumors were totally resected and he made a complete recovery.
A 26-year-old male presented with a trigeminal neurinoma manifesting as pathological laughter. After resection of the large tumor, the symptom disappeared completely. Pathological laughter sometimes precedes other manifestations of tumors around the brainstem and may be a useful localizing sign.
A simple method of thoracic laminoplasty using spinous processes is described. The procedure involves reshaping the spinous processes which have been removed during laminectomy and suturing these back into position to provide a cover for the dura. The procedure was carried out in five patients with good results. Laminoplasty using spinous processes appears to be a simple and safe alternative, using otherwise discarded tissue and requiring no sophisticated instrumentation, prosthetic material, or technically complex maneuvers.
A 30-year-old male and a 40-year-old female presented with Aspergillus fungal granuloma in the cerebral locations involving the gasserian-ganglion and its divisions in one case and was densely adherent to the lateral dural wall of the cavernous sinus in the other. Both patients were otherwise healthy with no evidence of immuno-suppression. The lesions resembled benign tumor on preoperative imaging and intraoperative consistency and vascularity. The lesions were successfully and completely resected. Both patients developed major cerebral arterial territory infarcts in the postoperative phase, remote from the site of operation, leading to crippling neurological deficits in one patient and death in the other. The unusual location and the unusual and similar clinical course suggests that awareness of the possibility of ischemic complications after surgical resection of intracranial aspergillomas is necessary.
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The present study was envisaged to investigate the protective effects of zinc treatment on the activities of various drug metabolizing enzymes, reduced glutathione content, and extent of lipid peroxidation in the livers of male albino rats subjected to long-term carbontetrachloride (CCl4) toxicity. It was observed that the activities of cytochrome P450, cytochrome b5, NADPH-cytochrome-c-reductase, and glutathione concentrations were significantly depressed following treatment with CCl4 for 6 weeks. At the same time, a marked elevation was seen in the extent of NADPH-dependent lipid peroxidation after CCl4 toxicity. Moreover, significantly depressed concentrations of zinc (Zn2+) were observed in both serum and liver after 6 weeks of the CCl4 administration. However, simultaneous zinc treatment to CCl4-intoxicated rats resulted in significant improvement in the activities of most of the drug metabolizing enzymes as well as the glutathione levels. Similarly, zinc treatment also normalized the CCl4-induced increase in the extent of NADPH-dependent lipid peroxidation. We conclude that zinc supplementation considerably attenuates the liver injury induced by chronic CCl4 treatment to rats.
In 6 patients with chordoma and 1 patient with a chondrosarcoma in the petroclival region, the internal carotid artery (ICA) showed a rather interesting relationship. The striking finding was the marked anterior (ventral) displacement of the adjacent segments of the ICA by the tumour. Complete encasement of the artery was not seen despite the massive size of the tumour. Narrowing of the caliber of ICA was seen in 1 case. The displacement of the ICA pointed toward the origin of the tumour and the pattern of its spread suggested pre-operatively the pathological diagnosis. Pre-operative recognition of the carotid artery neoplasm relation helped to better protect the ICA during surgery on these formidable lesions.
A modified lateral subtemporal, transpetrous apex and sub-Gasserian ganglion approach was found to be most suitable for clival chordomas. The approach selection was based on the typical anatomical relationship of chordomas in terms of site of origin, pattern of growth and neural and vascular displacements. The approach was suitable to deal with tumour anterior and lateral to the brain stem, the clival part of the tumour and its sub-cavernous sinus extensions. The carotid artery was under control. The approach had the advantage of being simple and relatively quick and of its familiarity to general neurosurgeons. The tumour could be excised radically and extension of anterior, posterior and inferior exposure was possible.
A small craniectomy in the infratemporal fossa incorporating the foramen ovale was used to resect 4 large trigeminal neurinomas. The tumour extended from the posterior cranial fossa and involved Meckel's cave and the lateral wall of the cavernous sinus in each instance. The dural sheath around the mandibular nerve and Gasserian ganglion was opened to expose the entire lesion. The head position and the surgeon's view of the tumour were modified to obtained a basal view. The craniectomy at this strategic site provided an avenue for control of the carotid artery at the petrous apex, avoided the need for brain retraction and permitted safe and complete resection of the tumours. The approach appears to be ideal for selected cases of trigeminal neurinomas.
An extended subgaleal fascia pericranial flap based on the temporalis muscle is described. The flap receives its vascular nourishment from the arteries supplying the temporalis muscle and from the superficial temporal artery. The long length of the flap and the ease of its rotation was used effectively to close anterior skull basal defects.
In this report an interhemispheric transfalcine approach for contralateral hemispheric tumours is described. This surgical approach was successfully employed for 4 tumours situated in the parafalcine region. The approach provided direct access to the tumour avoiding the need to retract oedematous brain on the tumour affected side. The possible indications and advantages of such an operation are discussed.
A modification of the previously described transcochlear approach to extra- and intradural petroclival and clival lesions is described in this report. It is an approach from the middle cranial fossa. It involves unroofing and depression of the external ear canal, removal of the glenoid cavity of the temporo-mandibular joint, exentration of the middle ear ossicles, posterior mobilization of labryrinthine and tympanic segments of the facial nerve, and drilling of the petrous bone from an entirely lateral perspective. An extensive and low exposure of the petroclival region, posterior aspect of the cavernous sinus, upper and mid clivus and the cerebellopontine angle is obtained. The anterior surface of the brain stem upto the pontomedullary junction is exposed with minimal or no retraction of the temporal lobe of the brain. The vein of Labbe and sigmoid sinus drainage is unhampered. Anterior and posterior extension of the exposure is possible. Only a limited mastoidectomy and labyrinthectomy, necessary to facilitate exposure and mobilization of the facial nerve is necessary. The inferior limit of the exposure is set by the dome of the jugular bulb. Hearing is sacrificed. The technique and merits of the procedure are discussed in this report. The study is based on surgical experience of 4 cases.
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