Intraoperative assessment of STA-MCA bypass patency using near-infrared indocyanine green video-angiography: a preliminary study.

BACKGROUND: Bypass patency is critical for patients undergoing superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. Near-infrared indocyanine green video-angiography (ICGA) is an excellent method to assess vessels during cerebrovascular surgery. OBJECTIVE: The aim of the present study is to analyze the effectiveness of ICGA in patients undergoing STA-MCA anastomosis for moyamoya disease. MATERIALS AND METHODS: This study was a retrospective review of case records and operation records of patients who underwent STA-MCA bypass for moyamoya disease at our institute. Concordance of ICGA with intraoperative micro-Doppler and postoperative angiography, whenever available, was assessed. RESULTS: In all, 22 STA-MCA anastomoses were performed in 13 patients. ICGA was used to assess patency in 14 surgeries (10 patients). No patient required revision of anastomosis following ICGA. Postoperative angiography was done in five anastomoses (three patients) at three months follow-up and correlated well with ICGA findings in all cases. CONCLUSION: ICGA is an effective technique to assess bypass patency during cerebrovascular surgery. Routine use of ICGA in cerebral bypass surgery improves graft patency and minimizes complications due to graft occlusion.

Central nervous system cladosporiosis: an account of ten culture-proven cases.

BACKGROUND: Central nervous system (CNS) cladosporiosis is a rare infection caused by Cladophialophora bantiana. It has varied presentation and poor outcome. Most of the available data in the literature are reviews of individual case reports. OBJECTIVE: To describe the clinical, radiological and mycological features of 10 cases of C. bantiana managed at a single tertiary center. To analyze the various treatment options, factors associated with outcome and to review the relevant literature. MATERIALS AND METHODS: This is a retrospective study of 10 patients with CNS cladosporiosis managed at National Institute of Mental Health and Neurosciences from 1979 to 2006. It is a descriptive study. The case records were reviewed for clinical presentation, radiological features, management and outcome. Only those patients in whom the fungus could be isolated on culture were included in the study. RESULTS: The age of the patients ranged from three to 42 years. Nine patients presented with features of space-occupying lesion and one patient with chronic meningitis. There were no specific clinical or radiological features. None of patients had impaired immune status. This infection presented as two pathomorphological forms - diffuse meningoencephalitis and focal abscesses. Burr hole tapping and excision are the surgical options. Both patients with burr hole tapping required excision of abscess subsequently. Two out of seven patients with abscess expired compared to all three patients with diffuse meningoencephalitis who expired. Recurrences occurred in four of the five patients following excision of the abscess. Combination antifungal treatment had better result than monotherapy. The outcome was poor with survival of only 50%. CONCLUSIONS: Thorough microbiological examination is required to diagnose CNS infection caused by C. bantiana. The outcome is better in patients with abscess. Excision of the abscess followed by combination antifungal therapy results in better outcome. Close follow-up is required due to high risk of recurrence.

Third ventricular colloid cysts in children.

INTRODUCTION: Colloid cysts of the 3rd ventricle are relatively rare intracranial tumours, more so in children. They are benign tumours with excellent prognosis if diagnosed and treated early. METHODS: A retrospective analysis of 18 cases of colloid cysts in children below 18 years, operated in our institution between September 1998 and November 2003 (5 years) was made. Clinical presentation, radiological findings, surgical approaches and outcome were analysed. RESULTS: Age ranged from 7 to 18 years. The male-to-female ratio was 12:6. Headache and vomiting were the most common symptoms. Papilloedema was the most common clinical sign. Pre-operative CT showed a hyperdense non-enhancing lesion in the majority. Twelve patients underwent a transcallosal, 2 a transcortical and 4 an endoscopic approach. Ventriculoperitoneal shunts were done in 5 patients. Postoperatively 2 patients developed epidural haemorrhage which required evacuation. One patient was re-explored for symptomatic residue. A mean follow-up of 10.2 months was available in 9 patients; the majority were asymptomatic. CONCLUSION: Colloid cysts though rare are increasingly detected in children. Their early recognition and treatment give excellent results.