Biomedical subjects

K K Kalia

Publications and source records attributed to K K Kalia.

8 recordsLinked to original sources

PubMed1994

Cranial base approaches to intracranial aneurysms in the subarachnoid space.

The use of cranial base approaches to aneurysm surgery is illustrated by means of patient examples. Over a 9-year period, cranial base approaches were used to expose and treat 38 aneurysms involving the anterior communicating artery complex, proximal internal carotid artery, basilar artery, or vertebral artery. The approaches included orbital osteotomy, orbitozygomatic osteotomy, petrous apicectomy, presigmoid petrosectomy, and extreme lateral transcondylar methods. Complications related to the approaches included one partial ptosis and two cerebrospinal fluid leaks, which resolved with treatment. The technique of three-dimensional computed tomographic angiography was useful in delineating the vascular anatomy and its relation to the cranial base structures. This helped the surgeon plan the appropriate approach to the aneurysm. Cranial base approaches, used selectively, can provide improved exposure of deep-seated aneurysms and large or giant aneurysms, while minimizing brain retraction.

Aneurysm, Ruptured↗

PubMed1994

Infiltration of the carotid artery by cavernous sinus meningioma.

Intracranial meningiomas are known to infiltrate surrounding structures such as the calvaria and dural sinuses, and the brain itself. The issue of whether meningiomas invade major intracranial arteries is of clinical importance, particularly in the case of meningiomas of the cavernous sinus. If a meningioma has not invaded the carotid artery wall, complete tumor removal may be accomplished with careful dissection from the carotid artery; however, if the tumor has infiltrated the wall of the carotid artery, complete removal may require sacrifice of the artery. To determine whether cavernous sinus meningiomas invade the carotid artery, the authors retrospectively reviewed the histopathology of 19 consecutively treated individuals whose carotid artery was sacrificed during removal of a meningioma involving the cavernous sinus. Patients were selected for carotid artery resection based on preoperative magnetic resonance imaging studies demonstrating complete encasement of the artery. Reconstruction of the carotid artery was planned depending on the results of preoperative balloon test occlusion with blood flow determinations. None of the 19 patients had pathological evidence of malignant tumor. Eight individuals (42%) were found to have infiltration of the carotid artery by meningioma. In five cases, focal involvement of the adventitia of the carotid artery wall was noted and, in three, the vessel was infiltrated up to the tunica muscularis. In no case was the tunica muscularis invaded by tumor. Thus, meningiomas of the cavernous sinus do infiltrate the internal carotid artery and, in order to completely resect these lesions and effect a surgical cure, it may be necessary to sacrifice the carotid artery with or without reconstruction.

Carotid Arteries↗

PubMed1993

An aggressive approach to massive middle cerebral artery infarction.

OBJECTIVE: We report favorable outcome after surgical decompression, or strokectomy, guided by xenon-enhanced computed tomographic studies of cerebral blood flow in the setting of potentially fatal swelling from massive cerebral infarction. DESIGN: Retrospective analysis with 3 months to 3 years of follow-up. SETTING: University of Pittsburgh (Pa) Medical Center, a tertiary care university referral center. PATIENTS: Four patients, aged 14 to 46 years, presented with focal neurologic deficits appropriate for a massive middle cerebral artery infarction (two dominant and two nondominant). In spite of medical therapy, all patients deteriorated to at least a decreased level of consciousness. INTERVENTION: Using xenon-enhanced computed tomographic studies of cerebral blood flow in three patients, areas of severely ischemic (blood flow, < 5 mL/100 g per minute), nonviable brain were identified and resected. OUTCOME MEASURE: Outcome was measured by survival and ability to perform activities of daily living. RESULTS: Postoperatively, all patients recovered rapidly (< 6 hours) to the level of function at admission and were able to perform the activities of daily living with minimal or no assistance. CONCLUSION: Despite deficits appropriate to the area of infarction, prompt management of life-threatening postinfarction swelling by surgical decompression can yield favorable outcome.

Activities of Daily Living↗

PubMed1993

Carpal tunnel release complicated by acute gout.

We report a patient who suffered an acute attack of gout in the wrist after surgical release for carpal tunnel syndrome. The postoperative management of this patient and a brief review of this complication of carpal tunnel release are discussed.

Acute Disease↗

PubMed1993

Assessing brain stem function.

Intraoperative neurophysiologic monitoring provides objective measures of nervous system function that are of value when operating in proximity to the brain stem. Real-time measurements of function can be correlated to operative manipulations in order to reduce the risk of damage in critically important regions. Techniques for evaluating brain stem function clinically and electrophysiologically are presented along with their applications during surgery of the brain stem.

Brain Diseases↗

PubMed1992

A partially thrombosed, fenestrated basilar artery mimicking an aneurysm of the vertebrobasilar junction: case report.

We report a patient with a subarachnoid hemorrhage in whom a partially thrombosed, fenestrated basilar artery mimicked an aneurysm of the vertebrobasilar junction on preoperative angiography. Intraoperatively, no aneurysm was detected; instead, the patient was found to have partial thrombosis of one limb of the fenestrated basilar artery. The nodular appearance of the residual lumen of the vessel corresponded exactly to the angiographic findings. To our knowledge, no similar case has been reported.

Adult↗

PubMed1991

Multiple arterial fenestrations, multiple aneurysms, and an arteriovenous malformation in a patient with subarachnoid hemorrhage.

We report the case of a 49-year-old, right-handed man with multiple vascular pathologies, including a fenestrated anterior communicating artery and middle cerebral artery, an aneurysm of the anterior communicating artery, multiple aneurysms of the middle cerebral artery, and an arteriovenous malformation. Diagnoses were made through computed tomography, cerebral angiography, magnetic resonance imaging, and intraoperative dissection. The lesions were managed surgically in stages with satisfactory results. Congenital and hemodynamic factors may have combined to manifest in the anomalies present in this unique case. We believe that no similar combination of vascular pathology has been reported previously.

Humans↗

PubMedDate not supplied

Multiple epidural hematomas following ventriculoperitoneal shunt.

Although extra-axial hematomas are a well-known complication of ventricular shunting, epidural hematomas are uncommon in this setting. We report an unusual case of multiple epidural hematomas in a patient with hydrocephalus treated by ventriculoperitoneal shunt. The patient became symptomatic 5 days after shunting and required craniotomy for evacuation of one of the hematomas. The literature is reviewed and treatment discussed.

Adolescent↗