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- 저자 : Anant Mehrotra (검색결과 3 건)
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Kamlesh Rangari,Kuntal Kanti Das,Suyash Singh,Krishna G. Kumar,Kamlesh Singh Bhaisora,Jayesh Sardhara,Anant Mehrotra,Arun Kumar Srivastava,Awadhesh Kumar Jaiswal,Sanjay Behari 대한척추신경외과학회 2021 Neurospine Vol.18 No.1
Objective: Posterior fossa decompression is the treatment of choice in type 1 Chiari malformation (CM-1) without bony instability. Although surgical fixation has been recommended by a few authors recently, comparative studies to evaluate these treatment strategies using objective outcome tools are lacking. Methods: Seventy-three patients with pure CM-1 (posterior fossa bony decompression [PFBD], n=21; posterior fossa bony and dural decompression [PFBDD], n=40; and posterior fixation [PF], n=12) underwent a postoperative outcome assessment using Chicago Chiari Outcome Score (CCOS). Logistic regression analysis detected predictors of an unfavorable outcome. Results: Minimally symptomatic patients generally underwent a PFBD while most of the clinically severe patients underwent a PFBDD (p=0.049). The mean CCOS score at discharge was highest in the PF (12.0±1.41) and lowest in PFBDD group (10.98±1.73, p=0.087). Patients with minimal preoperative clinical disease severity (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.29–16.31) and PFBDD (AOR, 7.56; 95% CI, 1.70–33.68) represented risks for an unfavorable short-term postoperative outcome. Though long-term outcomes (CCOS) did not differ among the 3 groups (p=0.615), PFBD group showed the best long-term improvements (mean follow-up CCOS, 13.71±0.95), PFBDD group improved to a comparable degree despite a poorer short-term outcome while PF had the lowest scores. Late deteriorations (n=3, 4.1%) occurred in the PFBDD group. Conclusion: Minimally symptomatic patients and PFBDD predict a poor short-term postoperative outcome. PFBD appears to be a durable procedure while PFBDD group is marred by complications and late deteriorations. PF does not provide any better results than posterior fossa decompression alone in the long run.
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Suyash Singh,Arun Kumar Srivastava,Jayesh Sardhara,Kamlesh Singh Bhaisora,Kuntal Kanti Das,Anant Mehrotra,Awadhesh Kumar Jaiswal,Manas Kumar Panigrahi,Sanjay Behari 대한척추신경외과학회 2021 Neurospine Vol.18 No.1
Objective: Joint manipulation for craniovertebral junction instability is often hindered by the C2-ganglion (C2G). Our study aims to compare the surgical outcome among patients with or without C2G preservation and discuss the technical nuances. Methods: We did a prospective, bicentric study and included all the operated patients with craniovertebral junction anomaly. The outcome was assessed by the Pain Numeric Rating Scale, Patient Satisfactions Score, and Stony Brook Scar Evaluation Scale. The fusion was assessed using Lenke fusion grade. Results: One hundred seventy-one patients (88 in group A and 83 in group B) were included. The most common symptom was spastic quadriparesis (n=165, 96.5%) with median Nurick grade 3.3. Thirteen patients had suboccipital numbness and 12 patients had paraesthesia. Mean blood loss in group A was 490±96.2 mL and group B was 525±45.7 mL; median operative time was 217.9 and 162.2 minutes in the groups A and B, respectively (p<0.05). At the follow-up (median, 46.8 months), Lenke fusion grade A was achieved in 92.4% and grade B in 7.6%. A trend suggesting better functional outcomes (numbness, parestheisa, scar outcome, and postoperative ulcer formation) in group A was seen with all 6 patients, who underwent O-C2 fixation, developed pressure sore. Conclusion: Our results support ganglion preservation, especially in the subset of patients where occipital plating is required. Although the study fails to show any statistical significance, we suggest that one should always start with an ‘intent’ of preservation as the functional outcome is better.
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A Universal Craniometric Index for Establishing the Diagnosis of Basilar Invagination
Jayesh Sardhara,Sanjay Behari,Suyash Singh,Arun K. Srivastava,Gaurav Chauhan,Hira Lal,Kuntal K. Das,Kamlesh Singh Bhaisora,Anant Mehrotra,Prabhakar Mishra,Awadhesh K. Jaiswal 대한척추신경외과학회 2021 Neurospine Vol.18 No.1
Objective: The conventional criteria for defining the basilar invagination (BI) focus on the relationship of odontoid tip to basion and opisthion, landmarks that are intrinsically variable especially in presence of occipitalised atlas. A universal single reference line is proposed that helps in unequivocally establishing the diagnosis of BI, may be relevant in establishing both Goel types A and B BI, as well as in differentiating a ‘very high’ from ‘regular’ BI. Methods: Study design – case-control study. In 268 patients (group I with BI [n=89] including Goel type A BI [n=66], Goel type B BI [n=23], and group II controls [n=179]), the perpendicular distance between odontoid tip and line subtended between posterior tip of hard palate-internal occipital protuberance (P-IOP line) was measured. Logistic regression analysis determined factors influencing the proposed parameter (p<0.05). Results: In patients with a ‘very high’ BI (n=5), the odontoid tip intersected/or was above the P-IOP line. In patients with a ‘regular’ BI (n=84), the odontoid tip was 6.56±3.9mm below the P-IOP line; while in controls, this distance was 12.53±4.28 mm (p<0.01). In Goel type A BI, the distance was 7.01±3.78 mm and in type B BI, it was 5.07±4.19 mm (p=0.004). Receiver-operating characteristic curve analysis identified 9.0 mm (8.92–9.15 mm) as the cut-point for diagnosing BI using the odontoid tip-P-IOP line distance as reference. Conclusion: The odontoid tip either intersecting the P-IOP line (very high BI) or being <9 mm below the P-IOP line (Goel types A and B BI) is recommended as highly applicable criteria to establish the diagnosis of BI. This parameter may be useful in establishing the diagnosis in all varieties of BI.
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