Papers by Kanna Gnanalingham
Child's Nervous …, Jan 1, 2005
Ventriculo-peritoneal (VP) shunt malfunction is usually due to blockage of the ventricular cathet... more Ventriculo-peritoneal (VP) shunt malfunction is usually due to blockage of the ventricular catheter and this is typically apparent as enlarged ventricles on a CT scan of the brain. We describe a less common radiological finding in an infant with a blocked shunt. A male infant presenting with hydrocephalus in the neonatal period underwent insertion of a VP shunt. He represented at 17 months of age with the clinical features of raised intracranial pressure. A CT scan of the brain revealed that the ventricles were smaller compared with his previous scan, but X-rays taken as part of the shunt series revealed diastasis of the sagittal, coronal and lambdoid sutures. The shunt was explored and the ventricular catheter was found to be blocked and was replaced. Post-operatively there was complete resolution of the symptoms and the suture diastasis. Suture diastasis with small ventricles on a CT scan of the brain is an unusual radiological finding in an infant with a blocked shunt. Suture diastasis in this patient suggests raised intracranial volume and this may be due to the transependymal absorption of CSF into the white matter.
Journal of Neurology, Jan 1, 2001
Acta …, Jan 1, 2009
Visual disturbance in hydrocephalus is typically due to raised intracranial pressure. We describe... more Visual disturbance in hydrocephalus is typically due to raised intracranial pressure. We describe a patient who presented with marked loss of peripheral visual fields, but without features suggestive of raised intracranial pressure. MR scan showed an enlarged third ventricle and a downward displacement of the optic chiasm, Chiari II malformation. These radiological changes and the visual field deficits reversed after endoscopic third ventriculostomy and foramen magnum decompression. These observations support the view that the treatment of the hydrocephalus in such patients can help to reverse the change in the position of the optic chiasm and the visual field deficits.
British Journal of …, Jan 1, 2011
Objective. Extra-ventricular neurocytoma (EVN) is rare, mainly described within the cerebral hemi... more Objective. Extra-ventricular neurocytoma (EVN) is rare, mainly described within the cerebral hemispheres or spinal cord. We report a case of sellar neurocytoma presenting with chiasmal compression. Clinical presentation. A 50-year-old woman presented with decreasing vision and a bitemporal eld de cit. CT and MRI demonstrated an enhancing invasive sellar lesion extending into the sphenoid sinus and left cavernous sinus, with speckled calci cation and compression of the optic chiasm. Pituitary function was normal apart from a mildly elevated prolactin level consistent with stalk e ect. Intervention. Endoscopic trans-sphenoidal resection of the lesion was performed revealing a rm, vascular tumour. Some residual tumour was left within the left cavernous sinus. Histology revealed a neurocytic tumour with nests, islands and strands of neuropil. Di use synaptophysin, chromogranin, neuro lament protein and CD56 positivity was seen. A histological diagnosis of EVN, WHO grade II was made and adjuvant radiotherapy was given for the residual tumour. Conclusion. This is only the second case of neurocytoma of the sella reported. It should be considered in the di erential diagnoses of sellar lesions that appear radiologically atypical for pituitary adenomas.
…, Jan 1, 2010
R osai-Dorfman disease (also known as sinus histiocytosis with massive lymphadenopathy) is an unc... more R osai-Dorfman disease (also known as sinus histiocytosis with massive lymphadenopathy) is an uncommon benign histiocytic proliferative disorder of unknown origin. 1-7 It predominantly affects the lymph nodes but can also be found extranodally in other organs and usually presents with other constitutional symptoms such as fever, malaise, weight loss, and raised inflammatory markers. 1-7 Nervous system involvement is rare and most cases intracranial. We describe the management of a 24-year-old man who presented with thoracic back pain and paraparesis secondary to an isolated thoracic extradural lesion, which was histologically confirmed to be Rosai-Dorfman disease.
Acta neurochirurgica, Jan 1, 2010
Low-grade CSF leaks in endoscopic transsphenoidal pituitary surgery: efficacy of a simple and ful... more Low-grade CSF leaks in endoscopic transsphenoidal pituitary surgery: efficacy of a simple and fully synthetic repair with a hydrogel sealant 1 2 3 Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your work, please use the accepted author's version for posting to your own website or your institution's repository. You may further deposit the accepted author's version on a funder's repository at a funder's request, provided it is not made publicly available until 12 months after publication.
British journal of …, Jan 1, 2005
Page 1. CASE REPORTS Anterior cervico-thoracic osteophytes: an unusual cause of dysphagia JANE NG... more Page 1. CASE REPORTS Anterior cervico-thoracic osteophytes: an unusual cause of dysphagia JANE NG, KANNA K GNANALINGHAM, OLIVER STOKES, ANOUSHKA SINGH & ADRIAN CASEY Department of Neurosurgery ...
Clinical radiology, Jan 1, 2001
Primitive`neuroectodermal' tumours (PNETs) are central nervous system tumours of poorly dierentia... more Primitive`neuroectodermal' tumours (PNETs) are central nervous system tumours of poorly dierentiated neuroepithelial cells that may dierentiate into glial, neuronal and mesenchymal cells [1±4]. In the new World Health Organization classi®cation of brain tumours, PNETs include cerebellar medulloblastomas and neoplasms that are histologically indistinguishable from medulloblastomas, but located at sites other than the cerebellum . PNETs account for between 20±25% of primary brain tumours in children, but less than 1% of those in adults, and carry a generally poor prognosis. In all age groups, the cerebellum is most commonly aected, although spinal cord and systemic metastases are known . Supratentorial PNETs, either as primary lesions or metastases from cerebellar medulloblastomas are uncommon, especially in adults . The neuroradiological features of PNETs, in particular supratentorial lesions, are poorly characterized .
Acta …, Jan 1, 2009
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Ambulatory Surgery, Jan 1, 1998
In selected patients, day case herniorrhaphy has a similar clinical outcome but is more economica... more In selected patients, day case herniorrhaphy has a similar clinical outcome but is more economical than in-patient care. Herniorrhaphy may be performed under local (LA) or general anaesthesia (GA). GA requires an anaesthetist and greater post-operative nursing care. A survey of 75 patients awaiting open hernia repair revealed that when allowed to make an 'informed choice', 91% of patients who were fit for GA or LA preferred day case surgery. Whilst 20% did not express a preference for the type of anaesthesia, 33% had a strong preference for LA and 47% for GA. Preference for GA was associated with previous adverse experiences with LA and an assumed feeling of anxiety if awake during surgery. Measures are needed to improve patient acceptability of day case hernia repair, especially under LA, which makes clinical and economic sense.
Pituitary, Jan 1, 2009
Cardiac arrhythmias are rare during transsphenoidal surgery and is often secondary to stimulation... more Cardiac arrhythmias are rare during transsphenoidal surgery and is often secondary to stimulation of the trigeminal nerve endings that supply the nasal passages and cavernous sinus walls. Authors report a patient with Acromegaly, who developed transient asystole, during the dissection of the adenoma extending into the left cavernous sinus wall. In such cases, the use of prophylactic atropine may help to avoid such a complication.
European Spine Journal, Jan 1, 2006
Spinal arachnoiditis can rarely occur following irritation from foreign body substances, includin... more Spinal arachnoiditis can rarely occur following irritation from foreign body substances, including certain oil based contrast agents used for myelography. We describe a patient with thoracic arachnoiditis, arachnoid cyst and syringomyelia, 30 years following a myelogram with Myodil. A 62-year-old female presented with chronic thoraco-lumbar back pain, a spastic paraparesis and sphincter disturbance. She had undergone a myelogram with Myodil, 30 years previously for investigation of back pain. A MRI scan revealed evidence of arachnoiditis, thoracic syringomyelia (T6–T8) and an anteriorly placed, extramedullary, arachnoid cyst at T10–T12, compressing the cord. At surgery, T7–T10 thoracic laminectomies were carried out and syringo- and cysto-subarachnoid shunts were inserted. At 12 months follow-up, the sphincter disturbance, lower limb weakness and mobility problems had almost resolved. Although, the use of oil based contrast agents such as Myodil has been discontinued, the present case illustrates some of the rare sequelae of its use, manifesting decades later. Aggressive surgical intervention produced symptomatic benefit.
Pediatric …, Jan 1, 2003
Posterior fossa tumours in children predispose to hydrocephalus, although the natural history is ... more Posterior fossa tumours in children predispose to hydrocephalus, although the natural history is unclear and the need for drainage of the ventricles is controversial. We report on the natural history of ventriculomegaly and tonsillar herniation, as seen on serial MRI scans in children with posterior fossa tumours. Eighty-nine children with posterior fossa tumours were reviewed retrospectively. Overall, 18 (20%) patients required permanent cerebrospinal fluid (CSF) drainage in the form of a ventriculoperitoneal shunt (n = 15) or third ventriculostomy (n = 3). On pre-operative MRI scan, the ventricular size was assessed by measurement of the ventricular index (VI) and 59 patients (66%) had a VI greater than 0.4. There was a progressive decrease in the mean VI from pre-operative to post-operative MRI scans and beyond 3-9 months after surgery, the mean VI was less than 0.4 (p = 0.0001). Patients requiring permanent CSF drainage had a greater VI pre-operatively and at 3-9 months post-operatively (p < 0.05). On pre-operative MRI scan, 75 patients (84%) had greater than 5 mm herniation of the cerebellar tonsils below the level of the foramen magnum. There was a progressive decrease in the mean tonsillar herniation from pre-operative to post-operative MRI scans, with time (p = 0.0001), although this did not relate to the need for CSF drainage. On multivariate analysis, the need for permanent CSF drainage was associated with pre- and intra-operative CSF drainage (odds ratio = 23.3; p = 0.0001) and incomplete surgical excision of tumour (odds ratio = 7.7; p = 0.006). Hydrocephalus and tonsillar herniation are common in children with posterior fossa tumours, although post-operatively there is a natural tendency for it to resolve and only a fifth of the patients needed permanent CSF drainage. We recommend selective drainage of CSF in children with posterior fossa tumours. Patients at risk are those with severe symptoms at presentation, needing peri-operative CSF drainage and those with subtotal resection of tumour.
Spine, Jan 1, 2004
To describe the management of a patient presenting with intraosseous MPNST of the thoracic spine ... more To describe the management of a patient presenting with intraosseous MPNST of the thoracic spine causing cord compression. Malignant peripheral nerve sheath tumors (MPNST) are uncommon tumors of cells of peripheral nerve sheath origin. MPNST typically present as an enlarging mass originating from a peripheral nerve root in the trunk, extremities, and head and neck region. METHODS.: A 59-year-old woman presented with midthoracic back pain, paraparesis, and a T4 sensory level. Magnetic resonance image scan revealed a large enhancing and destructive lesion at the T3 level with cord compression. Decompressive laminectomies, tumor debulking, and instrumentation was performed from a posterior approach. At surgery, the lesion was noted to originate from the T3 vertebral body, and separate from the dura and spinal nerve roots. Surgical excision was incomplete and the spine was stabilized with a Ti frame. MPNST was confirmed histologically. Despite adjuvant radiotherapy, she developed metastatic deposits in the spine and femur. Intraosseous MPNST causing spinal cord compression has not been described as yet and should be added to the differential diagnosis of primary bone tumors causing cord compression. Prognosis with MPNST can be poor, especially in patients with large tumors, undergoing subtotal surgical resection and in association with neurofibromatosis.
Arthritis Res …, Jan 1, 2009
Introduction Matrix metalloproteinases (MMPs) are known to be involved in the degradation of the ... more Introduction Matrix metalloproteinases (MMPs) are known to be involved in the degradation of the nucleus pulposus (NP) during intervertebral disc (IVD) degeneration. This study investigated MMP-10 (stromelysin-2) expression in the NP during IVD degeneration and correlated its expression with proinflammatory cytokines and molecules involved in innervation and nociception during degeneration which results in low back pain (LBP).
Spine, Jan 1, 2006
Study Design. Clinical outcome study comparing the Short Form-36 (SF-36) and Short Form-12 (SF-12... more Study Design. Clinical outcome study comparing the Short Form-36 (SF-36) and Short Form-12 (SF-12) assessment scales in patients with cervical spondylotic myelopathy (CSM).
Journal of …, Jan 1, 2002
Sarcomatous change is a rare complication of postoperative radiotherapy for pituitary adenomas. T... more Sarcomatous change is a rare complication of postoperative radiotherapy for pituitary adenomas. The authors report on what they believe to be the first case in which fibrosarcoma and, later, osteosarcoma developed during a 14-year period following surgery and radiotherapy for a nonsecreting pituitary macroadenoma.
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Papers by Kanna Gnanalingham