Madhusudan Reddy

Expansile cranioplasty for massive occipital encephalocele

ObjectiveThis report highlights the management of infrequently encountered massive occipital encephaloceles with herniation of large amount of apparently functional cortex into the encephalocele sac.Materials and methodsTwo children with giant occipital encephaloceles with herniation of significant brain parenchyma into the encephalocele sac were managed with expansile cranioplasty and reconstruction of the calvarial defect with autologus bone graft harvested from the adjacent parietal region.ConclusionsGiant occipital encephaloceles with significant brain parenchyma in the encephalocele sac can be considered for preservation of the herniated parenchyma and expansile cranioplasty.

Apnea during awake epilepsy surgery: an unusual cause for a rare complication.

gradually within a week following intervention. Hyperperfusion of cerebral circulation was thought to be responsible for these symptoms. Our patient had a high-flow CCF with significant steal in the middle cerebral artery and anterior cerebral artery territories. The most probable cause of nausea and vomiting was the increase in intracranial pressure following normal perfusion pressure breakthrough. This explanation is further supported by gradual reduction in symptoms over the period of 5 days, which correlates with the time when the cerebral vasculature adapts to the change in regional cerebral blood flow. With this report it has been emphasized that the episodes of nausea and vomiting could be a manifestation of normal perfusion pressure breakthrough. Hence, appropriate management with this regard should be initiated in patients presenting with persistent nausea and vomiting following balloon occlusion of CCF.

Non-awakening from anesthesia following posterior fossa surgery due to skull pin-induced tension pneumocephalus.

Neurology India | Jul-Aug 2011 | Vol 59 | Issue 4 the surgical procedure. The histological diagnosis of the biopsy samples was primary B-cell central nervous system lymphoma. He was started on intrathecal methrotexate treatment. Two weeks after discharge the patient was readmitted with altered consciousness, severe headache, expressive aphasia, and increase in right crural weakness. Physical examination revealed a dehiscent incision scar with necrotic tissue and a scalp defect above the burr hole. Brain computerized tomography (CT) scan and MRI showed massive ventricular and subarachnoid pneumocephalus, both “Mount Fuji” and the “Air Bubbles” signs were present. There were no changes in the previous lesions [Figure 2]. CSF examination was normal. The wound was debrided and closed under local anesthesia. The wound healed completely. The patient’s symptoms gradually resolved and was discharged 2 weeks after the admission. Repeat CT scan and MRI showed an expanded brain and complete reabsorption of the pneumocephalus.

In reply: is dexmedetomidine really superior to propofol?

1. Banik S, Prabhakar H. Is dexmedetomidine really superior to propofol? J Anesth. 2015. doi:10.1007/s00540-015-2005-0. 2. Sriganesh K, Reddy M, Jena S, Mittal M, Umamaheswara Rao GS. A comparative study of dexmedetomidine and propofol as sole sedative agents for patients with aneurysmal subarachnoid hemorrhage undergoing diagnostic cerebral angiography. J J Anesth. 2014. doi:10.1007/s00540-014-1952-1. 3. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35:121–6. 4. Noordzij M, Tripepi G, Dekker FW, Zoccali C, Tanck MW, Jager KJ. Sample size calculations: basic principles and common pitfalls. Nephrol Dial Transpl. 2010;25:1388–93. To the Editor: We thank Drs. Banik and Prabhakar for their comments [1] on our paper [2]. Based on the parameters we studied in 60 patients with subarachnoid hemorrhage (SAH), we found dexmedetomidine to be a better choice for sedation compared to propofol in spontaneously breathing patients for cerebral angiography. They opine that sample size calculation based on an earlier study might not hold well for our study. We differ with their observation. The study we used was closest to our design. The calculation of sample size depends on whether the outcome variable is quantitative or qualitative [3]. When qualitative parameters are used, sample size required is larger. It also depends on degree of difference the investigators wishes to accept between study and control groups. There are many formulas for different types of data and study designs. It is important that the parameter used for estimating the sample size should be one that measures treatment effects that we consider clinically relevant. In most studies, investigators use standard deviation from a pilot study or from published data [4]. Although previous studies have differences with the current study, such as dissimilar eligibility criteria

NIBP monitoring as a cause for intraoperative hypotension and postoperative monoparesis in a patient undergoing lumbar laminectomy.

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