Prof. B. Ramamurthi - A Glimpse into his Contributions to Neuroscience.

Prof B Ramamurthi was a pioneer of Indian neurosurgery and a major force in the development of Indian neuroscience. Founding the Madras Institute of Neurology and later the A Lakshmipathi Neurosurgical Centre (ALNC), both at Madras (or Chennai as it is now called), he developed centres of excellence in his career that spanned over five decades. During this period of time he made Madras, a destination for neurosurgery and neuroscience. Along with his colleagues a large number of publications were produced which influenced the world. Notable among his contributions were those in Stereotaxy for movement disorders, epilepsy, pain and psychiatric illness. He also had notable contributions in brain tumours especially acoustic neurinomas and pituitary tumours. His papers on the low incidence of aneurysms is still quoted widely. Head injuries formed a major part of the neurosurgical work and major contributions were made in that field too. As a developing country with socio-economic issues, infections of the nervous system were seen commonly. His publications on tuberculomas of the brain are noteworthy. He was intrigued by the neurophysiological basis of consciousness. He writings on the subject reflect his attempt to bring together ancient eastern thoughts and concepts of consciousness and life and western science. In the later part of his career he spoke on ethics in and the changing milieu of neurosurgery. While contributions to spinal surgery were not seen in the first half of his career, he along with his colleagues from ALNC published original articles on spinal surgery especially tumours and OPLL. Prof B Ramamurthi, has not only influenced, taught and mentored, during his lifetime, a great many neuroscientists, but he also continues to do so through his publications which continue to be relevant in todays world. A glimpse into his contributions show us how without the technology of today a lot was achieved - and we need to see that, to inspire us to achieve more and to strive for greater heights.

Vestibular Schwannoma Resection in a Consecutive Series of 502 Cases via the Retrosigmoid Approach: Technical Aspects, Complications, and Functional Outcome.

OBJECTIVE: Outcome in vestibular schwannoma (VS) surgery has improved enormously over the last decades. Surgical positioning remains a matter of discussion. A standardized protocol for diagnostics and management has been applied and evaluated for complications and functional outcome. METHODS: We examined 502 VS tumors in 483 patients (227 men and 256 women) between 2005 and 2016. According to our patient selection and treatment algorithm, 488 operations (97%) were performed in the semi-sitting position, and 14 (3%) were in the supine position. Auditory and facial functions were analyzed before and after surgery as were perioperative complications. RESULTS: There were 182 patients (36%) with small tumors (Hannover classification T1-T3A) and 320 (64%) large tumors (T3B or T4). Of the patients, 14% were neurofibromatosis type 2 cases. Complete tumor resection was achieved in 96.4%. Hearing preservation occurred in 44% of patients with small tumors and 23% of those with large tumors (Hannover classification), and correlated significantly with tumor size (P < 0.001). Facial palsy (House Brackmann grades II-VI) was present in 63 patients before and in 185 patients after surgery. Useful facial function (House Brackmann grades I-III) early after surgery was maintained in 86% of patients with small tumors and in 77% of patients with large tumors. Intraoperative complications included air embolism in 45 cases (9%), sinus injury in 3 cases, cerebrospinal fluid leakage in 46 cases (9%), and local hemorrhage in 19 cases (4%). Surgical revision was indicated in 31 cases (6%). CONCLUSIONS: In a standardized setting, the semi-sitting position allowed a safe approach. This setting offers the advantage of bimanual tumor nerve handling by the surgeon and an optimal visualization of important functional structures.

Subtemporal "Interdural" Surgical Approach for "Giant" Facial Nerve Neurinomas.

OBJECTIVE: The management issues of 15 cases of giant and dumbbell-shaped facial neurinomas that extended both in the middle and posterior cranial fossa are reported. MATERIAL AND METHODS: During the period 2002 to June 2017, we surgically treated 15 cases of giant and dumbbell shaped facial neurinomas: 10 males and 5 females ranging from 17-59 years (average 34.2 years). Average duration of facial nerve weakness before seeking surgical relief was 49.46 months. Fourteen patients had varying degrees of hearing disturbance. Seven patients had ataxia. The sizes of the tumor ranged from 5.2-8 cm (average being 6.2 cm). The tumors were in an "interdural" location, both in the middle and in the posterior cranial fossa. An extradural subtemporal "interdural" approach was used to resect the tumor in both compartments. The dural cover of the tumor provided a well-defined surgical plane of dissection. Tumor recurrence was observed in 3 cases. The tumor was interdural even at the time of recurrence. CONCLUSIONS: Understanding the fact that the facial nerve neurinomas are interdural in nature and soft and necrotic in character can allow quick and safe surgery with a relatively small surgical exposure.

Facial Nerve Monitoring in Patients Under The Low Level Of Neuromuscular Blockade During Resection Of acoustic Neurinomas / 中国神经精神疾病杂志

Objective To perform facial nerve monitoring in patients under the low level of neuromuscular blockade during resection of acoustic neurinomas.Methods Twenty-eight patients with large,or medium acoustic neuroma underwent the surgery of acoustic neurinomas resection. During the operation,TOF and EEG monitoring were performed in order to detect the degree of muscle relaxation and the depth of anesthesia. Neuromuscular relaxation was maintained at T_4/T_1=25%～50% by adjusting doses of muscle relaxant and aneasthetic. Free-run EMG and Triggered EMG of orbicularis oris, orbicularis oculi, masseter and trapezius were recordered to monitor the function of the facial, trigeminal and accessory nerves, respectively. The function of the facial nerve was evaluated at first week and half year postoperatively according to House-brackmann classification.Results The facial never was successfully identified and mapped by neurominitoring in all 28 patients. successfully, tThe electrical stimulation was 0.1 mA-0.3 mA and no any involuntary body movement was observed in all patients ne of patients have moved during operation. The preservation of the facial nerve function following surgery was good. Five patients had a HB grade I, 13 a HB grade II, 8 a grade III and 2 a HB grade IV The facial nerve function was HB Grade Ⅰin 5 of 28 patients, HB GradeⅡ in 13, HB Grade Ⅲ in 8 and HB Grade Ⅳ in 2 immediately after operation. Six months after surgery, 10 casespatents showed demonstrated a HB GradeⅠof facial never function, 12 cases exhibited a slight palsy (HB Grade II) , and 5 cases exhibited a HB Grade III palsy and . Another 1 cases a exhibited severe palsy (HB Grade IV).Conclusions Facial nerve monitoring in patients under the low level of neuromuscular blockade can ensure the surgical safety and preserve the facial never function.

Linear Accelerator-Based Stereotactic Radiosurgery for Acoustic Neurinomas / 대한암학회지

No abstract available