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Byline: Jitin. Bajaj, Sarat. Chandra, Bhargavi. Ramanujam, Heri. Subianto, Shabari. Girishan, Ramesh. Doddamani, Mohit. Agrawal, Raghu. Samala, Rekha. Dwivedi, Kapil. Chaudhary, Ajay. Garg, Madhavi. Tripathi, C. Bal, Ashima. Nehra, Mehar. [...]

Byline: Ramesh. Doddamani, Heri. Subianto, Jitin. Bajaj, Shabari. Girishan, Raghu. Samala, Mohit. Agrawal, Bhargavi. Ramanujam, Manjari. Tripathi, Poodipedi. Chandra Background: Patients with temporal lobe epilepsy are subjected to standard temporal [...]

Byline: Hitesh. Rai, Jyotsna. Singh, Manmohan. Singh, Jaskaran. Singh, Asheesh. Gupta, Raghu. Samala, Pavana. Veerabhadaraiah, Aruna. Nambirajan Meningiomas are benign intracranial neoplasms arising from arachnoid cap cells. High grade meningiomas [...]

Byline: Ramesh. Doddamani, P. Chandra, Raghu. Samala, Bhargavi. Ramanujan, Madhavi. Tripathi, C. Bal, Ajay. Garg, Shailesh. Gaikwad, Manjari. Tripathi Background: Hemispheric disconnection represents a challenging and major epilepsy surgical procedure. [...]

Byline: Ramesh. Doddamani, Raghu. Samala, Heri. Subianto, Bhargavi. Ramanujam, Manjari. Tripathi, Poodipedi. Chandra Background: Stereoelectroencephalography (SEEG) has become an integral part of epilepsy surgery, often used in the localization of [...]

Byline: Ramesh. Doddamani, Raghu. Samala, Mohit. Agrawal, Rohit. Verma, Nand. Kumar, Poodipedi. Chandra Background: Bilateral anterior cingulotomy (BAC) constitutes the most commonly performed procedure for treatment of refractory OCD. Evolution [...]

Byline: Poodipedi. Chandra, Raghu. Samala, Mohit. Agrawal, Ramesh. Doddamani, Bhargavi. Ramanujam, Manjari. Tripathi Background: Vagal nerve stimulation (VNS) is a form of neuromodulation for patients with drug-refractory epilepsy (DRE), in [...]

Byline: Kanwaljeet. Garg, Raghu. Samala, Mohit. Agrawal, Roopa. Rajan, Manmohan. Singh Background: Deep brain stimulation (DBS) is currently the preferred surgical treatment for various movement disorders. Pallidotomy is an effective [...]

Byline: Ramesh. Doddamani, Mohit. Agrawal, Raghu. Samala, Bhargavi. Ramanujam, Poodipedi. Chandra, Manjari. Tripathi Epilepsy surgery currently offers the best treatment for patients with drug-refractory epilepsy (DRE). Resective surgery, in the [...]

Byline: Jasmine. Parihar, Mohit. Agrawal, Raghu. Samala, P. Chandra, Manjari. Tripathi The choice of neuromodulation techniques has greatly increased over the past two decades. While vagal nerve stimulation (VNS) has [...]

Byline: Ramesh. Doddamani, Manjari. Tripathi, Raghu. Samala, Mohit. Agrawal, Bhargavi. Ramanujam, Jitin. Bajaj, Shabari. Girishan, Madhavi. Tripathi, C. Bal, Ajay. Garg, P. Chandra Background: The management of hypothalamic hamartomas (HH) [...]

Byline: Ramesh. Doddamani, Manjari. Tripathi, Raghu. Samala, Mohit. Agarwal, Bhargavi. Ramanujan, Sarat. Chandra The posterior quadratic epilepsy (PQE) is a form of a multilobar epilepsy, involving the temporal-parietal and occipital [...]

Byline: Raghu. Samala, Sachin. Borkar, Ravi. Sharma, Ajay. Garg, Ashish. Suri, Deepak. Gupta, Shashank. Kale Background: The goal of surgery in case of a large vestibular schwannoma is complete excision [...]

Background and Objective: Hemispherotomy surgery in adults is shrouded in doubts regarding the functional outcome. The age at surgery alone should not be the deciding factor for surgery. Language paradigms were used in functional magnetic resonance imaging (fMRI) to confirm the role played by the age at the onset of seizures to predict the postoperative functional outcome. The objective of the study was to formulate an optimal strategy for patient selection for the left-sided hemispherotomy in adults, based on functional outcome analysis.Materials and Methods: A retrospective analysis of 20 participants (age at surgery 1-26 years) who underwent left hemispherotomy (over a 5-year period) was conducted. The language and motor functional assessments of 18 participants (13 pediatric and five adult participants; attrition of participants- two) were recorded at presentation and during follow-up visits. After approval was obtained from the Institutional Ethics Committee, 13 cooperative participants (eight pediatric and five adult participants) underwent language fMRI. Motor fMRI with both active and passive paradigms was done in 16 participants.Results: All 18 participants with a mean follow-up of 24 months had class I seizure-free outcome. Of these 18, five were adults (mean age = 21 years, range: 18-22 years) and 13 were in the pediatric age group (mean age = 8 years, range: 2-15 years). Postoperatively, four adults retained both verbal fluency and language comprehension at a mean follow-up period of 38 months (range: 24-48 months). Their pre- and post-op language fMRI showed word generation and regional activations for semantic comprehension in the right hemisphere. The motor area activations were seen in the right hemisphere in two and in the left hemisphere in two participants. Among the pediatric participants, four (group I [n = 4/13]) who had good language outcome showed activations in the right hemisphere. In two participants (group II [n = 2/13]) who deteriorated postoperatively, the activations were in the left hemisphere. Five participants (group III [n = 5/13]) who retained the telegraphic language postoperatively had bilateral activations of semantic comprehension areas in fMRI. All 13 pediatric participants had motor area activations seen in the left hemisphere, similar to controls.Conclusion: Left hemispherotomy can be advised to adults with comparably good postoperative language and motor outcome as in the pediatric age group, provided the weakness is acquired perinatally or below the age of 7 years. The fMRI is a valuable tool to aid in patient selection. [ABSTRACT FROM AUTHOR]

Background: Patients with perinatal hypoxia (PH) and drug-refractory epilepsy (DRE) often have bilateral parieto-occipital gliosis. Surgical management of such patients is a dilemma.Objective: To identify preoperative determinants for unilateral disconnection vs callosotomy, and analyze the surgical outcome in such patients.Methods and Material: This was a retrospective analysis of patients with DRE and history of PH, with MRI abnormalities restricted to bilateral posterior quadrants. Preoperative semiology, epilepsy duration and seizure frequency were recorded. Based on the concordance between the results of non-invasive tests, patients underwent either posterior quadrant disconnection (PQD) or corpus callosotomy (CC). Preoperative variables were analyzed and corelated to the postoperative seizure freedom.Results: Fourteen patients were identified, 6 underwent PQD and 8 underwent CC. At follow up of 39.17 ± 23.75 months, 66.66% of patients (4/6) in the PQD subgroup had an ILAE Class I outcome. While none in the CC group attained seizure freedom, 87.5% (7/8) had more than 50% reduction in seizure frequency (follow up: 42 ± 27.31 months). Patients with a poor outcome had significantly greater seizure frequency (P = 0.05) and history of drop attacks (P = 0.04) in both the groups. Magnetoencephalography (MEG) accurately localized the epileptogenic zone in all of the patients with good outcome (P = 0.015). Concordance with single photon emission tomography (SPECT) was also a predictor of favorable outcome (P = 0.041).Conclusions: A history of drop attacks with high seizure frequency is associated with poor postoperative seizure outcome. Unilateral PQD is feasible and leads to superior seizure-free outcomes, even in cases with widespread and bilateral imaging and electrical abnormalities, provided the other preoperative investigations are concordant in localizing the epileptogenic zone. [ABSTRACT FROM AUTHOR]

Vagal nerve stimulation (VNS) is US Food and Drug Administration approved treatment for drug refractory epilepsy and major depression. In vivo research showed that VNS has anti-inflammatory properties and has a role in inflammatory conditions such as inflammatory bowel disease, rheumatoid arthritis, sepsis, lung and bowel injuries, and in patients with head injury. It is also shown that VNS can restore the homeostasis between the sympathetic and parasympathetic systems. This property is made use of in heart failure, angina, and peripheral arterial disease. Cluster headache and migraine are the other conditions. In this review, we describe the indications along with the mechanisms in various clinical conditions other than epilepsy and the associated outcomes. [ABSTRACT FROM AUTHOR]

Vagal nerve stimulation (VNS) is a proven effective modality of treatment for drug refractory epilepsy and major depression. Recently, the indications have been expanded to various other non-neural indications. The key to a successful surgery includes identification of the vagus nerve and proper application of the device. Meticulous dissection and proper handling of the nerve leads to maximizing therapeutic effect and minimizing complications. In the current article, we describe the technical aspects of performing VNS, focusing on the anatomical variants and intraoperative adjuncts to identify the vagus nerve accurately. [ABSTRACT FROM AUTHOR]