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1.  Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series 
Introduction and Aim:
The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.
Materials and Methods:
We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.
In 6 cases the PFAC was located in the midline. In the 7th case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.
We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.
PMCID: PMC4352631  PMID: 25767579
Cysto-peritoneal shunt; endoscopic excision of cyst; excision of arachnoid cyst; intracranial arachnoid cysts; posterior fossa arachnoid cysts
2.  Long Term Outcome of Non-Dysraphic Intramedullary Spinal Cord Lipomas in Adults: Case Series and Review 
Asian Spine Journal  2014;8(4):476-483.
Study Design
It is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature.
The purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas.
Overview of Literature
Non-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013.
Here we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases.
Review of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status.
Earlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit.
PMCID: PMC4149991  PMID: 25187865
Spinal lipomas; Intramedullary tumors; Spinal cord tumor; Lipomas
3.  Posterior Epidural Migration of Sequestrated Cervical Disc Fragment: Case Series 
Asian Spine Journal  2011;5(4):220-227.
Study Design
A retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse.
To present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management.
Overview of Literature
Non-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature.
Detailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery.
T1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated.
We opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome.
PMCID: PMC3230649  PMID: 22164316
Sequestrated cervical disc prolapse; Epidural cervical disc; Magnetic resonance imaging; Epidural cervical disc; Anterior cervical corpectomy
4.  Therapeutic potential of melatonin and its analogs in Parkinson’s disease: focus on sleep and neuroprotection 
Sleep disorders constitute major nonmotor features of Parkinson’s disease (PD) that have a substantial effect on patients’ quality of life and can be related to the progression of the neurodegenerative disease. They can also serve as preclinical markers for PD, as it is the case for rapid eye movement (REM)-associated sleep behavior disorder (RBD). Although the etiology of sleep disorders in PD remains undefined, the assessment of the components of the circadian system, including melatonin secretion, could give therapeutically valuable insight on their pathophysiopathology. Melatonin is a regulator of the sleep/wake cycle and also acts as an effective antioxidant and mitochondrial function protector. A reduction in the expression of melatonin MT1 and MT2 receptors has been documented in the substantia nigra of PD patients. The efficacy of melatonin for preventing neuronal cell death and for ameliorating PD symptoms has been demonstrated in animal models of PD employing neurotoxins. A small number of controlled trials indicate that melatonin is useful in treating disturbed sleep in PD, in particular RBD. Whether melatonin and the recently developed melatonergic agents (ramelteon, tasimelteon, agomelatine) have therapeutic potential in PD is also discussed.
PMCID: PMC3187674  PMID: 22010042
agomelatine; insomnia; light therapy; melatonin; oxidative stress; Parkinson’s disease; ramelteon; REM sleep behavior disorder; tasimelteon

Results 1-4 (4)