Displaying publications 1 - 20 of 32 in total

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  1. Ganesan D, Puthucheary SD, Waran V
    Br J Neurosurg, 2003 Dec;17(6):568-71.
    PMID: 14756491
    Central nervous system melioidosis is an unusual infection in humans. This article reports a case of melioidosis presenting as an acute spinal epidural abscess. A discussion of this case and its management together with a brief review of melioidosis of the central nervous system is presented.
  2. Tan BH, Sockalingam S, Ganesan D
    Br J Neurosurg, 2023 Jun 22.
    PMID: 37345453 DOI: 10.1080/02688697.2023.2225611
    OBJECTIVES: Posterior cervical foraminotomy is a surgical procedure used to treat unilateral cervical radiculopathy. It provides direct decompression of the nerve root without the necessity of fusion while maintaining cervical mobility. With the advancement in image-guidance technology and minimal access techniques, intra-operative CT has provided a safer, more accurate instrumentation placement with less radiation exposure to operative staff and provides better anatomical visualization quality compared to traditional intra-operative imaging techniques. This case series aims to address the applications of advanced image guidance in posterior cervical foraminotomy and describe the nuances.

    METHOD: A technical report on a series of seven cases on intraoperative CT navigation for posterior cervical foraminotomy surgery. Posterior cervical foraminotomy was performed in all patients under CT guided navigation system without an image intensifier. In one case after the foraminotomy, the extruded disc was carefully removed by gentle retraction.

    RESULT: From 1 January 2020 to 31 December 2021, a total of seven patients with nine cervical foraminotomy procedures were performed using the aid of CT-guided navigation. The series comprised five women and two men whose mean age was 50.6 years. In all cases, the radiculopathy symptoms were diminished significantly. There were no cases of instability on the dynamic cervical radiograph. There were no complications during the surgical procedure.

    CONCLUSION: The navigation also allows the surgeon to localise the index level accurately and appraise the adequacy of the intended decompression in three planes of the CT scan image. The ability to perform accurate spine navigation would be the precursor for robotic spinal surgery.

  3. Chong SY, Danaee M, Ganesan D
    Asian Spine J, 2023 Jun;17(3):538-548.
    PMID: 36740928 DOI: 10.31616/asj.2022.0293
    STUDY DESIGN: Validation of a novel retrospective comparative questionnaire to obtain post-intervention outcome data in patients with lumbar degenerative spinal disease.

    PURPOSE: Acquiring prospective outcome data for spinal intervention is not frequently feasible in resource-depleted units in certain developing countries. Therefore, a novel retrospective instrument is being validated for clinical use, which can act as a standard method to describe outcomes when data are retrospectively collected.

    OVERVIEW OF LITERATURE: The standard method of collecting outcome data after a spinal intervention has been prospective, including the Oswestry Disability Index, Roland-Morris Questionnaire, and Short Form-36. The process of content validation and reliability of the novel retrospective spinal questionnaires is highlighted.

    METHODS: Questionnaire items were created based on a literature review, followed by a process of content validation by experts and modification based on expert opinions to achieve an acceptable content validity index (CVI, 0.70-1.00). To calculate factor loadings for each question, a pilot test was subsequently conducted from a pool of patients who underwent lumbar spine surgeries for degenerative spine diseases.

    RESULTS: All items achieved a CVI of >0.85 for both relevancy and clarity and were successfully validated after appropriate corrections were made before the second validation phase. Except for Q9 and Q10, which showed low-loading factors in the pooled sample, the remainder of the items had acceptable loading factors across different subgroups, indicating that the passage of time did not affect the results of the exploratory factor analysis.

    CONCLUSIONS: The retrospective questionnaire that encompasses the general well-being and lumbar-specific symptoms is a valid and reliable instrument to provide an impression of the outcome after intervention in a patient with a degenerative lumbar spinal disease. A summative score will indicate the overall outcome.

  4. Ramachandran T, Valayatham V, Ganesan D
    Asian J Neurosurg, 2022 Dec;17(4):676-679.
    PMID: 36570764 DOI: 10.1055/s-0042-1757223
    Intracranial arachnoid cyst is the most common cystic congenital anomaly in the brain. In this study, we discuss a pregnancy that had serial fetal ultrasound scans throughout the pregnancy and a fetal anomaly scan at 24 weeks of gestation that was normal. The child was born healthy with normal development, but 12 months onward the head began to enlarge. The magnetic resonance imaging of the brain showed a large posterior fossa arachnoid cyst with hydrocephalus. We discuss the postulation to explain this pathogenesis of the cyst. This case highlights that not all symptomatic arachnoid cysts are congenital despite the manifestation being as early as infancy.
  5. Hariri F, Rahman ZA, Mahdah S, Mathaneswaran V, Ganesan D
    J Craniofac Surg, 2015 Nov;26(8):e740-4.
    PMID: 26594993 DOI: 10.1097/SCS.0000000000002174
    Rigid external distraction device is often indicated for superior midfacial advancement in pediatric syndromic craniosynostosis patients. Even though the technique is proven reliable to treat the functional issues related to the craniofacial deformity, major complications associated with its fixation, such as intracranial pin perforation and migration have been reported. We report a novel technique of using a customized headgear to prevent intracranial pin perforation over a very thin temporal bone region in an 8-month-old infant with Crouzon syndrome who underwent monobloc Le Fort III distraction osteogenesis using a combination of bilateral internal and a rigid external distraction device. The customized headgear provides a protective platform at the temporal region thus preventing intracranial pin perforation and allows stable fixation during the early phase of consolidation period to prevent central component relapse. The headgear can be used short term when rigid external distractor is indicated in infant patient but requires close monitoring because of risks of skin necrosis and temporal region indentation.
  6. Fadzli F, Ramli NM, Rahmat K, Ganesan D
    Childs Nerv Syst, 2013 Jan;29(1):159-62.
    PMID: 22996826 DOI: 10.1007/s00381-012-1923-5
    Intraventricular haemorrhage is the most common cause of hydrocephalus in a pre-term baby and may require surgical intervention depending on severity.
  7. Al-Edrus SA, Mohamed Mukari SA, Ganesan D, Ramli N
    Spine J, 2011 Aug;11(8):796-7.
    PMID: 21724472 DOI: 10.1016/j.spinee.2011.05.013
  8. Narverud SF, Ramli NB, Chandran H, Ganesan D
    Eur Spine J, 2013 May;22 Suppl 3:S443-9.
    PMID: 23233216 DOI: 10.1007/s00586-012-2610-7
    In this article, we review the English literature of calcified pseudomeningoceles in the lumbar region.
  9. Leong BK, Mazlan M, Abd Rahim RB, Ganesan D
    Disabil Rehabil, 2013 Aug;35(18):1546-51.
    PMID: 23294408 DOI: 10.3109/09638288.2012.748832
    This study aims to describe the presence and severity of extracranial concomitant injuries in traumatic brain injury (TBI) patients and to ascertain their effect on long-term functional outcome.
  10. Foo LL, Chaw SH, Chan L, Ganesan D, Karuppiah R
    Rev Bras Anestesiol, 2016 09 28;67(6):655-658.
    PMID: 27692367 DOI: 10.1016/j.bjan.2015.09.006
    Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.
  11. Tan SH, Mun KS, Chandran PA, Manuel AM, Prepageran N, Waran V, et al.
    Childs Nerv Syst, 2015 Jul;31(7):1165-9.
    PMID: 25712744 DOI: 10.1007/s00381-015-2667-9
    This paper reports an unusual case of a transsphenoidal encephalocele and discusses our experience with a minimally invasive management. To the best of our knowledge, we present the first case of a combined endoscopic transnasal and transoral approach to a transsphenoidal encephalocele in an infant.
  12. Guan TK, Pancharatnam D, Chandran H, Hooi TK, Kumar G, Ganesan D
    J Med Case Rep, 2013;7:87.
    PMID: 23537099 DOI: 10.1186/1752-1947-7-87
    Cystic meningiomas are rare variants of meningiomas; they can pose a radiological diagnostic dilemma.
  13. Waran V, Bahuri NF, Narayanan V, Ganesan D, Kadir KA
    Br J Neurosurg, 2012 Apr;26(2):199-201.
    PMID: 21970777 DOI: 10.3109/02688697.2011.605482
    The purpose of this study was to validate and assess the accuracy and usefulness of sending short video clips in 3gp file format of an entire scan series of patients, using mobile telephones running on 3G-MMS technology, to enable consultation between junior doctors in a neurosurgical unit and the consultants on-call after office hours.
  14. Ramli N, Khairy AM, Seow P, Tan LK, Wong JH, Ganesan D, et al.
    Eur Radiol, 2016 Jul;26(7):2019-29.
    PMID: 26560718 DOI: 10.1007/s00330-015-4045-0
    OBJECTIVES: We evaluated the feasibility of using chemical shift gradient-echo (GE) in- and opposed-phase (IOP) imaging to grade glioma.

    METHODS: A phantom study was performed to investigate the correlation of (1)H MRS-visible lipids with the signal loss ratio (SLR) obtained using IOP imaging. A cross-sectional study approved by the institutional review board was carried out in 22 patients with different glioma grades. The patients underwent scanning using IOP imaging and single-voxel spectroscopy (SVS) using 3T MRI. The brain spectra acquisitions from solid and cystic components were obtained and correlated with the SLR for different grades.

    RESULTS: The phantom study showed a positive linear correlation between lipid quantification at 0.9 parts per million (ppm) and 1.3 ppm with SLR (r = 0.79-0.99, p 

  15. Veeramuthu V, Hariri F, Narayanan V, Tan LK, Ramli N, Ganesan D
    J Oral Maxillofac Surg, 2016 Jun;74(6):1197.e1-1197.e10.
    PMID: 26917201 DOI: 10.1016/j.joms.2016.01.042
    The aim of the present study was to establish the incidence of maxillofacial (MF) injury accompanying mild traumatic brain injury (mTBI) and the associated neurocognitive deficits and white matter changes.
  16. Tan SH, Ganesan D, Rusydi WZ, Chandran H, Prepageran N, Waran V
    Eur Spine J, 2015 Dec;24(12):2776-80.
    PMID: 26210311 DOI: 10.1007/s00586-015-4153-1
    PURPOSE: Osteoradionecrosis (ORN) is a rare yet well-recognized complication following radiotherapy to the head and neck. We illustrate the only case of a spontaneous extrusion of the sequestered C1 arch through the oral cavity and discuss our experience with a combined endoscopic transnasal and transoral approach for cervical ORN.

    METHODS: A 56-year-old female presented with a 3-month history of blood-stained nasal discharge. She had been treated with radiotherapy for nasopharyngeal carcinoma 25 years earlier. Flexible nasal endoscopy demonstrated an exposed bone with an edematous posterior nasopharyngeal mass. Computed tomography showed a pre-vertebral mass with destruction of C1 and C2. She underwent occipito-cervical fusion followed by a combined transnasal and transoral endoscopic debridement of non-viable bone in the same perioperative setting. Healing of the raw mucosa was by secondary intention and reconstruction was not performed.

    RESULTS: Histopathological examination reported ulcerated inflamed granulation tissue with no evidence of malignancy. During follow-up, she remained neurologically intact with no recurrence.

    CONCLUSION: Using both nasal and oral spaces allows placement of the endoscope in the nasal cavity and surgical instruments in the oral cavity without splitting the palate. Hence, the endoscopic transnasal and transoral approach has vast potential to be effective in carefully selected cases of cervical ORN.

  17. Ponnampalam SN, Kamaluddin NR, Zakaria Z, Matheneswaran V, Ganesan D, Haspani MS, et al.
    Oncol Rep, 2017 Jan;37(1):10-22.
    PMID: 28004117 DOI: 10.3892/or.2016.5285
    The aims of the present study were to undertake gene expression profiling of the blood of glioma patients to determine key genetic components of signaling pathways and to develop a panel of genes that could be used as a potential blood-based biomarker to differentiate between high and low grade gliomas, non-gliomas and control samples. In this study, blood samples were obtained from glioma patients, non-glioma and control subjects. Ten samples each were obtained from patients with high and low grade tumours, respectively, ten samples from non-glioma patients and twenty samples from control subjects. Total RNA was isolated from each sample after which first and second strand synthesis was performed. The resulting cRNA was then hybridized with the Agilent Whole Human Genome (4x44K) microarray chip according to the manufacturer's instructions. Universal Human Reference RNA and samples were labeled with Cy3 CTP and Cy5 CTP, respectively. Microarray data were analyzed by the Agilent Gene Spring 12.1V software using stringent criteria which included at least a 2-fold difference in gene expression between samples. Statistical analysis was performed using the unpaired Student's t-test with a p<0.01. Pathway enrichment was also performed, with key genes selected for validation using droplet digital polymerase chain reaction (ddPCR). The gene expression profiling indicated that were a substantial number of genes that were differentially expressed with more than a 2-fold change (p<0.01) between each of the four different conditions. We selected key genes within significant pathways that were analyzed through pathway enrichment. These key genes included regulators of cell proliferation, transcription factors, cytokines and tumour suppressor genes. In the present study, we showed that key genes involved in significant and well established pathways, could possibly be used as a potential blood-based biomarker to differentiate between high and low grade gliomas, non-gliomas and control samples.
  18. Hariri F, Abdul Rahman ZA, Bahuri NFA, Azmi MN, Abdullah NA, Ganesan D
    J Oral Maxillofac Surg, 2018 03;76(3):646.e1-646.e12.
    PMID: 29268076 DOI: 10.1016/j.joms.2017.11.029
    Crouzon syndrome (CS) is the most common craniosynostosis syndrome and requires a comprehensive management strategy for the optimization of care and functional rehabilitation. This report presents a case series of 6 pediatric patients diagnosed with CS who were treated with distraction osteogenesis (DO) to treat serious functional issues involving severe orbital proptosis, an obstructed nasopharyngeal airway, and increased intracranial pressure (ICP). Three boy and 3 girls were 8 months to 6 years old at the time of the operation. The mean skeletal advancement was 16.1 mm (range, 10 to 27 mm) with a mean follow-up of 31.7 months (range, 13 to 48 months). Reasonable and successful outcomes were achieved in most patients as evidenced by adequate eye protection, absence of signs and symptoms of increased ICP, and tracheostomy tube decannulation except in 1 patient. Complications were difficult fixation of external stabilizing pins in the distraction device (n = 1) and related to surgery (n = 4). Although DO can be considered very technical and can have potentially serious complications, the technique produces favorable functional and clinical outcomes in treating severe CS.
  19. Veeramuthu V, Narayanan V, Ramli N, Hernowo A, Waran V, Bondi MW, et al.
    World Neurosurg, 2017 Jan;97:416-423.
    PMID: 27751922 DOI: 10.1016/j.wneu.2016.10.041
    OBJECTIVE: To compare the extent of persistent neuropsychological impairment in patients with complicated mild traumatic brain injury (mTBI) and those with uncomplicated mTBI.

    METHODS: Sixty-one patients with mTBI (Glasgow Coma Scale score 13-15) were recruited prospectively, categorized according to baseline computed tomography findings, and subjected to neuropsychological assessment at initial admission (n = 61) as well as at a 6-month follow-up (n = 30). The paired t test, Cohen's d effect size calculation, and repeated-measures analysis of variance were used to establish the differences between the 2 groups in terms of neuropsychological performance.

    RESULTS: A trend toward poorer neuropsychological performance among the patients with complicated mTBI was observed during admission; however, performance in this group improved over time. In contrast, the uncomplicated mTBI group showed slower recovery, especially in tasks of memory, visuospatial processing, and executive functions, at follow-up.

    CONCLUSIONS: Our findings suggest that despite the broad umbrella designation of mTBI, the current classification schemes of injury severity for mild neurotrauma should be revisited. They also raise questions about the clinical relevance of both traumatic focal lesions and the absence of visible traumatic lesions on brain imaging studies in patients with milder forms of head trauma.

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