Dr. Sunil Malagi- Brain and Spine Surgeon

01/12/2023

Neurenteric cysts of the central nervous system are cystic congenital lesions that may occur anywhere along the neural tube. They are most common in the spinal region, in the lower part of cervical and upper thoracic region. Intracranial cysts are rare and there are only small series of patients published in literature worldwide. Surgery is the treatment choice. Here we are presenting a case of posterior fossa neurenteric cyst with surgical management. The complexity of this case lies in the location in which the lesion lies where it is surrounded by very important and must be preserved neurovascular structures without scope for any injury. Brain stem region constitutes a very important part of the brain which is difficult to access and tolerates very little damage as it can lead to severe morbidity and mortality when injured. Special and sincere thanks to Dr. Nishchith S, consultant neurosurgeon, SDMCSH for the expert assistance in doing the case.

Neurenteric cysts (NCs) of the central nervous system (CNS) are cystic congenital lesions that may occur anywhere along the neural tube. hey are most common ...

12/09/2021

A 56 year old gentleman rolled into OPD on a wheelchair with inability to walk due to weakness of right side of the body, headache, left eye complete vision loss and right eye progressive deterioration of vision. The patient presented significantly late due to fear of COVID until his symptoms became quite severe. The MRI Brain of the patient showed a large tumor in one of the difficult areas of the brain to operate that too in the dominant half of the brain. The lesion was further complicated in the fact that it was completely encasing the artery supplying the majority of left side of the brain (internal carotid artery) and also encasing the origins of the 2 most important branches of it ( anterior cerebral artery and middle cerebral artery). Diagnosis of a large left clinoidal meningioma was made. The injury to these blood vessels would have made the patient bedridden and dependent and unconscious for the rest of his life. The patient underwent left fronto-temporal craniotomy and excision of the lesion and complete preservation of all the major blood vessels encased by the tumor and also the optic nerves and chiasm. One of the most complex and the longest surgery done till date by me. Complex surgery with excellent results. Patient on follow-up is back to his routine activities and doing well and his follow up MRI shows a good surgical outcome.

25/07/2021

A 59 year old lady presented with the history of headache since 6 months, gradually progressive with increase in severity and frequency. Her CT and MRI Brain showed a lesion (tumor) in the posterior one third of the falx (midline fibrous structure separating two halves of the brain) extending to both sides and also attached to the tentorium (another fibrous structure separating cerebrum from cerebellum) at the origin of the straight sinus from the inferior sagittal sinus and the vein of Galen. These veins and sinuses are important drainage systems for deeper important structures of the brain which needs to be preserved with utmost care to avoid significant morbidity. Patient was advised surgery and she underwent bilateral parieto-occipital craniotomy with superior sagittal sinus exposure with bilateral inter-hemispheric approach and excision of the lesion. Patient tolerated the procedure well and made complete recovery without any deficits in the post-op period. Histopathology report showed a grade 1 transitional meningioma. Post-op scan showed no residue and on 3 months follow-up MRI there is no residue or recurrence and no injury to the venous sinuses. Patient is leading a normal life with no deficits.

18/07/2021

A 9 year old boy presented with the history of headache since 1 month associated with episodes of vomiting and blurring of vision. One day prior to presentation to the hospital, the severity of headache increased with multiple episodes of vomiting and the boy lapsed into altered sensorium (altered level of consciousness). Evaluation with CT Brain showed a lesion (tumor) in the ventricular system (fluid filled cavities within in the brain) with hydrocephalus (increase in the fluid within the cavity leading to increased pressure within the skull). The boy underwent VP shunt (procedure to drain the fluid) on emergency basis for life saving. Once the patient condition improved he was evaluated with a MRI Brain, which showed a lesion in the region of Foramen of Munro with extension into right lateral and third ventricle. The patient relatives were then advised surgery for the excision of the lesion and he underwent Right Frontal Para-sagittal Craniotomy Inter-hemispheric Transcallosal approach and excision of the lesion. The patient tolerated the procedure well and there were no deficits in the post-op period. Post-op scan shows complete excision and follow-up scan at 3 months shows no lesion or hydrocephalus. The boy is leading a normal life and is free of the disease at 8 months follow-up. In removing tumors of this location, it is important to preserve the veins (blood vessels) which are quite delicate and small, but the damage of which can lead to catastrophic complications.

11/07/2021

A 19-year-old male patient presented with a history of seizures (fits) since 2 years for which he was evaluated in a tertiary govt hospital in Bangalore where he was found to have small lesion (tumor) in the region of left motor cortex (part of the brain which controls movements of the opposite side of the body). Patient was started on antiepileptics (medications to stop fits) and told to be on follow up for assessment of size of the lesion. Patient was then lost to follow-up. He presented to our hospital with complaints of one episode of seizure followed by persistent right upper and lower limb weakness (paralysis) since 20 days. Patient was evaluated with an MRI brain which showed a large solid cystic lesion (tumor) in the region of the left motor cortex with significant mass effect. Patient was advised surgery and plan was made for awake craniotomy in order to identify the motor cortex and preserve it. Awake craniotomy is a procedure where in the patient is kept awake throughout the duration of surgery in order to stimulate and identify the areas of the brain in and around the tumor which are associated with important functions and preserve it so as to maintain or improve quality of life. The patient underwent Left Fronto-parietal awake craniotomy and total excision of the lesion. The patient was monitored throughout the procedure with all attempts to preserve the motor functions and complete excision was achieved. Patient tolerated the procedure well with completely preserved motor functions. Post-op scan showed complete excision and On one year follow-up patient has no deficits and is leading a normal life with no residue or recurrence on scan and is free of the disease . The procedure of awake craniotomy requires an excellent and skilled anaesthetic management. Sincere thanks to the anaesthetic team headed by Dr. Sameer Desai. The other anaesthetists in the team were Dr. Asif, Dr. Anwar and Dr. Ram.

04/07/2021

A 57-year-old male patient presented with the history of loss of consciousness lasting 5 minutes. Once the patient woke up, he had severe persistent headache which gradually came down over few days. Meanwhile, patient was evaluated with a CT Brain which showed bleed in the cisterns and sulci suggestive of sub-arachnoid bleed. Patient was evaluated further with CT angiogram which showed an Anterior communicating artery complex aneurysm. Patient was advised surgery and he underwent left fronto-temoral craniotomy trans-sylvian approach and clipping of the aneurysm. The procedure was uneventful and patient recovered well from surgery without any neurological deficits. Post-op scan showed clips in situ with no infarcts, edema or hydrocephalus. At 3 months follow-up, patient is leading a normal active life.