Papers by Manish Kolakshyapati
Pediatric Neurosurgery
Purpose: The T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign was previously reported... more Purpose: The T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign was previously reported as a diagnostic indicator of diffuse astrocytoma, isocitrate dehydrogenase-mutant, and 1p/19q noncodeletion. Subsequently, it was reported that the same findings were observed in diffuse intrinsic pontine glioma (DIPG). We investigated the clinical significance of T2-FLAIR mismatch sign in DIPG. Methods: Twenty-one patients with DIPG (Male: Female = 12:9) were treated at our institute between 2004 and 2019. All patients were treated with local radiotherapy of 54 Gy/30 fractions. The positive T2-FLAIR mismatch sign was defined if it fulfilled the following criteria: (1) T2-FLAIR mismatch volume was >50% of T2 high volume at nonenhanced area, (2) the FLAIR low lesion is not associated with gadolinium enhancement (inside of enhancement or just outside of enhancement defined as edema), and (3) signal-intensity of FLAIR lowest lesion at tumor is lower than the normal cerebellar cortex. Re...
T2-FLAIR mismatch sign in dysembryoplasticneuroepithelial tumor
European Journal of Radiology
Corrigendum to “T2-FLAIR mismatch sign in dysembryoplastic neuroepithelial tumor” [Eur. J. Radiol. 126 (2020) 108924]
European Journal of Radiology
Perfusion Computed Tomography Parameters Are Useful for Differentiating Glioblastoma, Lymphoma, and Metastasis
World Neurosurgery
Usefulness of Preoperative Simulation in Skull Base Approach: A Case Report
Journal of Neurological Surgery Part B: Skull Base
Skull base approach is a neurosurgical challenge requiring dexterity of the operating surgeon for... more Skull base approach is a neurosurgical challenge requiring dexterity of the operating surgeon for good postoperative outcome. In addition to the experience of the operating surgeon, adequate preoperative information of the tumor is necessary to ensure better outcome. In clinoid meningioma, it is sometimes difficult to determine its relationship with the surrounding structure and the feeding artery. Previously, preoperative simulation has been utilized to determine the intracranial course of the compressed nerves in relation to the petroclival meningioma. We report a case of clinoid meningioma where preoperative fusion of three dimensional computed tomography angiography (3D-CTA) and 3T-fast imaging employing steady-state acquisition (FIESTA) images was useful in determining the exact location of the feeding artery to devascularize the tumor and aid in surgery. Preoperative simulation with three-dimensional digital subtraction angiography (3D-DSA) and 3T-FIESTA fusion images can be a...
HGG-21. Imaging and Immunohistochemical Characteristics of H3 G34R-MUTANT Gliomas -A Report of Two Cases
Neuro-Oncology
Neuro-Oncology
NEURO-ONCOLOGY • JUNE 2018 anterior pituitary failure. CONCLUSION: Pituitary failures are a major... more NEURO-ONCOLOGY • JUNE 2018 anterior pituitary failure. CONCLUSION: Pituitary failures are a major long-term risk of CNS MMGCTs. 60% of patients treated with 54 Gy prescribed RT dose to pituitary area, had anterior pituitary failure at follow-up, compared with 19% treated with 0/30 Gy. Reduction of RT dose to pituitary area where possible should be an aim of future treatment strategies for MMGCTs. (supported in part by German Cancer Aid) GERM-13. PITUITARY FAILURES IN CNS GERMINOMA.
Primary and recurrent growing teratoma syndrome in central nervous system non-germinomatous germ cell tumors: case series and review of the literature
World Neurosurgery
Bevacizumab for optic pathway glioma with worsening visual field in absence of imaging progression: 2 case reports and literature review
Child's Nervous System
Cancer Medicine
This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Usefulness of histogram-profile analysis in ring-enhancing intracranial lesions
World Neurosurgery
Grande Medical Journal
The updated 2016 World Health Organization (WHO) classification of central nervous system (CNS) t... more The updated 2016 World Health Organization (WHO) classification of central nervous system (CNS) tumors has incorporated the molecular markers together with histological parameters in defining and diagnosing various tumor entities. This has led to major changes and revision of the classification. A number of new entities are classified based on clinical, diagnostic, and prognostic relevance and those without such relevance have been removed. Major changes are incorporated in diffuse glioma, medulloblastoma, pediatric gliomas, and other embryonal tumors. These new requisites make molecular testing a basic requirement for CNS tumor diagnosis and treatment. New treatment protocols are designed and targeted based on the genetic alteration involved in the tumor entity. The update aims to achieve accurate diagnosis, determine precise prognosis and ensure better patient treatment all through facilitating better categorization of clinical and experimental trials. The multidisciplinary team o...
Neurosurgical Focus
OBJECTIVEElderly patients are particularly at risk for severe morbidity following surgery. Among ... more OBJECTIVEElderly patients are particularly at risk for severe morbidity following surgery. Among the various risk factors, age and skull base location of meningioma are known to be poor prognostic factors in meningioma surgery. The authors conducted this study to analyze significant preoperative risk factors in elderly patients with skull base meningioma.METHODSA total of 265 elderly patients (≥ 65 years old) with meningioma were surgically treated at the authors’ institute and affiliated hospitals between 2000 and 2016, and these cases were reviewed. Among them, 57 patients with skull base meningioma were evaluated. Among the various risk factors, the authors analyzed age, sex, Karnofsky Performance Scale (KPS) score, American Society of Anesthesiologists score, and tumor size, location, and pathology. Body mass index (BMI) and serum albumin were investigated as the frailty factors. The authors also reviewed 11 surgical studies of elderly patients ≥ 60 years old with meningioma.RES...
A Case of Holocord Leptomeningeal Dissemination from Cerebellar Hemangioblastoma without von Hippel-Lindau Disease
Hiroshima journal of medical sciences, 2017
Hemangioblastoma disseminated along leptomeninges from the solitary cranial lesion without von Hi... more Hemangioblastoma disseminated along leptomeninges from the solitary cranial lesion without von Hippel-Lindau (VHL) disease is a quite rare instance with 23 cases reported in 40 years. We add a new case and discuss these rare instances. A 55-year-old female underwent surgery for total removal of cerebellar hemangioblastoma. Twenty months later, magnetic resonance (MR) images of the spinal cord revealed a tumor compressing the thoracic cord at T3-4 level which was removed en bloc by emergent spinal surgery. However, paraplegia and bowel bladder dysfunction recurred 5 months after the spinal surgery. Spine MR images showed diffuse enhancement of subarachnoid space. Exploratory surgery disclosed that the enhanced lesion was disseminated hemangioblastoma. After whole spinal irradiation, she was transferred to a palliative care hospital. Even after complete removal, possibility of leptomeningeal dissemination demands continuous follow-up. The mechanism of seeding of hemangioblastoma remai...
Neurospine, 2018
Central nervous system tuberculosis is a devastating complication of systemic tuberculosis. Intra... more Central nervous system tuberculosis is a devastating complication of systemic tuberculosis. Intradural extramedullary (IDEM) tuberculoma at the foramen magnum is rare, and mimics en plaque meningioma. We report the case of a 53-year-old woman who presented with dysesthesia of the tongue and lower cranial nerve (CN) palsy, with onset 4 months prior to admission. The neurologic examination revealed left upper-limb weakness and hypoesthesia on the sole and dorsum of the left foot. Other physical examinations revealed no features of tubercular infection. Laboratory investigations likewise showed no signs of infection or inflammation. Magnetic resonance imaging of the brain showed an IDEM mass originating from the left intradural surface at the foramen magnum extending to the C2 segment and compressing the brainstem and upper cervical cord. The mass was isointense/hypointense on T1- and T2-weighted images and homogeneously-enhanced on postcontrast images. The lesion also exhibited the du...
Occult community acquired Klebsiella pneumoniae purulent meningitis in an adult: A case report
Medicine, 2018
Klebsiella pneumonia (K. pneumonia), primarily a hospital-acquired pathogen, can cause a variety ... more Klebsiella pneumonia (K. pneumonia), primarily a hospital-acquired pathogen, can cause a variety of deep-seated infections with significant morbidities. However, in the current scenario of global rise in antibiotic abuse, unexpected infection could be caused by K. pneumoniae. A 56-year-old male who presented with intermittent headache and low fever was admitted, he had transsphenoidal surgery for pituitary adenoma 3 years ago. Routine laboratory tests revealed an elevated WBC count of 10.12 × 10/L and C-reactive protein (CRP) 12.9 mg/L. computed tomography (CT) revealed the sellar region with suspicious hemorrhage. The patient was initially diagnosed with acute residual tumor hemorrhage. But the consequent diagnose of Klebsiella pneumoniae purulent meningitis was made based on the cerebrospinal fluid lab test and cerebrospinal fluid (CSF) and blood culture, and CT scan. Lumbar puncture examination was made and the antibiotics were adjusted to meropenem and vancomycin according to th...
Proton Magnetic Resonance Spectroscopy Detection of High Lipid Levels and Low Apparent Diffusion Coefficient Is Characteristic of Germinomas
World neurosurgery, 2018
The differentiation of germinoma from other tumors by conventional magnetic resonance imaging (MR... more The differentiation of germinoma from other tumors by conventional magnetic resonance imaging (MRI) can be very difficult. The purpose of our study was to determine whether diffusion-weighted imaging (DWI) and single-voxel proton magnetic resonance spectroscopy (1H-MRS) could provide additional useful information for a definitive diagnosis of germinomas. Our hospital's Institutional Review Board approved this retrospective study. We reviewed imaging studies of 26 patients with histologically confirmed germinomas who were treated at our hospital between 2003 and 2016. We also studied 25 patients with pineal tumors, which included 14 nongerminomatous germ cell tumors (NGGCTs), 9 pineal parenchymal tumors (PPTs; including 3 pineocytomas, 4 PPTs of intermediate differentiation [PPTID], and 2 pineoblastomas) and 2 meningiomas. Patients underwent conventional MRI and advanced MRI, including DWI and/or 1H-MRS. The germinoma group comprised 24 males and 2 females, ranging in age from 9....
RELA fusion-positive anaplastic ependymoma: molecular characterization and advanced MR imaging
Brain tumor pathology, Jan 11, 2017
Neuro-Oncology
Protein intake reduces FET activity uptake in healthy appearing brain by 29 %. A slight increase ... more Protein intake reduces FET activity uptake in healthy appearing brain by 29 %. A slight increase was found in the routine FET-PET tumour metrics after modest protein intake, while high protein intake might not be clinically acceptable. These preliminary results indicate that a FET-PET scanning may be valid after moderate accidental protein intake in clinical routine use. Further results will be presented.
Neuro-Oncology
NEURO-ONCOLOGY • NOVEMBER 2016 irradiation was postponed to evaluate response to systemic treatme... more NEURO-ONCOLOGY • NOVEMBER 2016 irradiation was postponed to evaluate response to systemic treatment. After two cycles of etoposide/cisplatin, agents with poor CNS penetration in the absence of blood-brain barrier breakdown, the patient exhibited modest but significant clinical improvement. Her repeat imaging showed near-complete resolution of insular involvement and marked reduction in the extent of T2/ FLAIR cortical hyperintensities without any signs of necrosis. At the same time FDG-PET exhibited reduced number of hypermetabolic lesions and improved generalized cortical metabolism. Our findings perhaps represent imaging evidence of network-wise recovery in the setting of paraneoplastic syndrome treated with systemic chemotherapy.
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Papers by Manish Kolakshyapati