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Nishant S. Yagnick, Manjul Tripathi, and Sandeep Mohindra

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Sandeep Mohindra and Kanchan Kumar Mukherjee

✓ The authors report a case of primary brainstem tethering, a component of a spinal dysraphic state, occurring in a 13-year-old girl. This patient also had associated hydrocephalus, a low-lying tethered cord, and a syrinx in her conus medullaris. The significance of imaging surveys of the craniospinal region and head in a case involving a low-lying tethered cord is highlighted. The insertion of a ventriculoperitoneal shunt, leading to traction on the tethered brainstem, proved nearly fatal for this patient. In cases involving a multiple-level tethered cord, the sequence of detethering should be decided on with caution. It seems prudent to detether the vital neural structure first, so as to minimize the traction force on that structure. All four previously reported cases of secondary tethered brainstem and cerebellar vermis in the literature are reviewed and compared with the present case of primary brainstem tethering. The literature describing brainstem dysfunction caused by ventricular drainage is also reviewed.

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Nishant S. Yagnick, Harsh Deora, Manjul Tripathi, Aman Batish, and Sandeep Mohindra

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Sandeep Mohindra, Rahul Gupta, Suresh Narain Mathuriya, and Bishan Dass Radotra

✓The authors report on two patients with intramedullary tumors complicated by abscess formation. Both patients experienced abrupt onset of neurological deterioration and poor surgical outcome. An intratumoral abscess developed in one, whereas the other had a tumor-associated syrinx in which an intramedullary abscess developed. Such a conversion of a syrinx into an abscess has not been reported earlier. It is septicemia that underlies all such catastrophic complications; therefore, rapid neurological deterioration should always be looked on with caution and investigated with contrast-enhanced magnetic resonance imaging. Despite poor neurological outcome in such patients, urgent surgical intervention is mandatory.

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Ravi Bharatbhai Chauhan, Ayusman Satapathy, Sandeep Mohindra, Manjul Tripathi, Aman Batish, and Sumit Dave

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Harsh Deora, Manjul Tripathi, Manish Modi, Sandeep Mohindra, Aman Batish, Jenil Gurnani, and Abhinav Agrahari

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Sushanta K. Sahoo, Sivashanmugam Dhandapani, Apinderpreet Singh, Chandrashekhar Gendle, Madhivanan Karthigeyan, Pravin Salunke, Ashish Aggarwal, Navneet Singla, Raghav Singla, Manjul Tripathi, Rajesh Chhabra, Sandeep Mohindra, Manoj Kumar Tewari, Manju Mohanty, Hemant Bhagat, Arunaloke Chakrabarti, and Sunil Kumar Gupta

OBJECTIVE

COVID-19 has affected surgical practice globally. Treating neurosurgical patients with the restrictions imposed by the pandemic is challenging in institutions with shared patient areas. The present study was performed to assess the changing patterns of neurosurgical cases, the efficacy of repeated testing before surgery, and the prevalence of COVID-19 in asymptomatic neurosurgical inpatients.

METHODS

Cases of non–trauma-related neurosurgical patients treated at the Postgraduate Institute of Medical Education and Research (PGIMER) before and during the COVID-19 pandemic were reviewed. During the pandemic, all patients underwent a nasopharyngeal swab reverse transcription–polymerase chain reaction test to detect COVID-19 at admission. Patients who needed immediate intervention were surgically treated following a single COVID-19 test, while stable patients who initially tested negative for COVID-19 were subjected to repeated testing at least 5 days after the first test and within 48 hours prior to the planned surgery. The COVID-19 positivity rate was compared with the local period prevalence. The number of patients who tested positive at the second test, following a negative first test, was used to determine the probable number of people who could have become infected during the surgical procedure without second testing.

RESULTS

Of the total 1769 non–trauma-related neurosurgical patients included in this study, a mean of 337.2 patients underwent surgery per month before COVID-19, while a mean of 184.2 patients (54.6% of pre–COVID-19 capacity) underwent surgery per month during the pandemic period, when COVID-19 cases were on the rise in India. There was a significant increase in the proportion of patients undergoing surgery for a ruptured aneurysm, stroke, hydrocephalus, and cerebellar tumors, while the number of patients seeking surgery for chronic benign diseases declined. At the first COVID-19 test, 4 patients (0.48%) tested were found to have the disease, a proportion 3.7 times greater than that found in the local community. An additional 5 patients tested positive at the time of the second COVID-19 test, resulting in an overall inpatient period prevalence of 1%, in contrast to a 0.2% national cumulative caseload. It is possible that COVID-19 was prevented in approximately 67.4 people every month by using double testing.

CONCLUSIONS

COVID-19 has changed the pattern of neurosurgical procedures, with acute cases dominating the practice. Despite the fact that the pandemic has not yet reached its peak in India, COVID-19 has been detected 3.7 times more often in asymptomatic neurosurgical inpatients than in the local community, even with single testing. Double testing displays an incremental value by disclosing COVID-19 overall in 1 in 100 inpatients and thus averting its spread through neurosurgical services.