People Against Brain Attack
Dr Anil Karapurkar Dr. Anil Karapurkar

Dr Anil Karapurkar completed his training in Neurosurgery from KEM Hospital, Seth GS Medical College, Mumbai in 1975. He subsequently worked as Tutor, Asst. Prof., Assoc. Prof and Prof. in Neurosurgery at the above institutions.

He took voluntary retirement and joined Indraprastha Apollo Hospital, New Delhi where he worked from 1996 to 2002. In 2002 he returned to Mumbai and has been working in various hospitals. He started performing endovascular procedures in 1978 along with his colleagues Dr Sunil Pandya and Dr R D Nagpal at the KEM Hospital.

He was performing endovascular procedures with Prof Ravi Ramakantan, Prof. of Radiology, KEM Hospital. In 1980-81 he received training in endovascular procedures under Prof Luc Picard, the doyen of Neurointervention, in Nancy, France. Subsequently he received further fellowships from Govt of France for training under Prof Picard and Prof Jaques Moret of Fondation Opthalmique de Rothschilde, Paris, France. He has been the past president of AAFITN ( Asian & Australasian Federation Of Interventional Neuroradiology). He has been on the Advisory Board of WFITN. ( World Federation Of Interventional Neuroradiology). For the last 8 years he has completely given up Neurosurgery and devoted himself to this new medical speciality of Interventional Neuradiology or Endovascular Neurosurgery. He has trained several Neurologists, Neurosurgeons and Radiologists in this exciting speciality.

Prof. Karapurkar over the years has treated thousands of patients with neurovascular diseases such as aneurysms, brain arterio-venous malformations and fistulas, (AVM and AVF), neoplasms such as meningiomas, glomus tumours and paragangliomas, acute arterial ischemic stroke with thrombolysis or angioplasty and stenting, prevent stroke with angioplasty and stenting of carotid and vertebral arteries in the neck and intracranial arteries, avute venous stroke with thrombolysis, spinal cord AVMs and AVFs, spinal neoplasms, vertebroplasty for compression fractures and neoplasms etc.

Aneurysms have been treated with simple coiling with single or double catheters, , coiling with the help of single or double balloons, stent assisted coiling with single and double stents, covered stents for giant and inoperable aneurysms. Giant aneurysms gave been treated by occlusion of the parent artery proximal to the aneurysm if the patient has passed the balloon occlusion test. Posterior circulation and intracranial giant aneurysms have been treated by “inside out occlusion” with some coils inside aneurysm and then coils being backed into the parent artery to occlude it. Peripheral intracranial and spinal aneurysms have been treated with injection of glue.

Brain AVMs have been treated by embolization and radiosurgery (SRS) using the X-Knife. Embolization was earlier done with Histoacryl, a glue which hardens rapidly when it comes in contact with blood. For the last 3 years most AVMs have been treated by Onyx alone and the cure rate with embolization alone has gone upto about 50% for large AVMs and 100% for small AVMs. Residual AVM is treated by SRS with the X-Knife. Dural and pial AVF need careful planning. The cure rate for AVF has been 100% with virtually no complications. Spinal cord AVM is treated with glue ( Histoacryl).

For ischemic stroke thrombolysis with Urokinase, rTPA have been done. If required balloon angioplasty and stenting have been done in the acute setting. Stenting for focal stenosis of the extracranial and intracranial arteries has been done with complication rate of less than 1%. Extracranial stenosis is stented under local anesthesia and intracranial under General Anesthesia. So far self-expanding carotid stents are used for extracranial carotid stenosis and balloon mounted coronary stents are used for intracranial and distal stenosis. For venous sinus thrombosis thrombo-lysis has been done by cannulating the occluded sinsus and injecting urokinase.

For intra-, juxta-cranial and spinal neoplasms, embolization is done to facilitate surgery and reduce blood loss. It is done with particles injected through a microcatheter or by filling the tumour bed with glue ( Histoacryl).

For spinal fractures and neoplasms vertebroplasty with bone cement is done.

Dr Nishant Aditya Dr. Nishant Aditya

Dr. Nishant Aditya trained as an Interventional Neuroradiologist  in the Division of Interventional Neuroradiology,KEM Hospital , Mumbai, Maharashtra(which as a tertiary zonal reference center caters patients from all parts of Maharashtra and adjacent states like Gujarat, Madhya Pradesh ,Andhra Pradesh and Karnataka).
He took his training as a Radiologist in the Department of Radiodiagnosis ,Gujarat Cancer and Research Institute, Ahmedabad, Gujarat (which as a tertiary zonal reference center caters patients from all parts of Gujarat and adjacent states like Rajasthan, Madhya Pradesh and Uttar Pradesh). During post graduate tenure he was trained in Interventional Radiology and became a part of team. This  department has a separate segment for Intervention Radiology where he was exposed to various vascular intervention viz.: Diagnostic angiography (cerebral, pulmonary, mapping of CNS AVM),  Embolization of: AVM and angiofibroma; bronchial artery embolization, percutaneous AVM embolization- with various types of embolic materials (e.g. coils, PVA particles, alcohol),  GI Vascular Intervention: In management of GI bleed (Vasopressin infusion especially for lower GI bleed and particulate embolization in upper GI bleed), embolization of giant hepatic hemangioma, portal vein embolization (bland embolization and with chemotherapeutic agents), hepatic artery infusion with chemotherapeutic agents for Hepatocellular Carcinoma,  Biliary tract intervention (biliary tract decompression),  Percutaneous nephrostomy.

After post graduation he joined KEM Interventional Neuroradiology (INR) team as a fellow and spent about three years under guidance of Dr. Uday Limaye.On regular basis following procedures are done in which fellows are allowed to observe, assist, perform under guidance and perform independently :Carotid Angiograms, Spinal Angiograms, Cerebral aneurysm coiling ,Aneurysm coiling with neck remodeling ,Cerebral AVM / AVF embolization, AVM embolization with Onyx, Embolization of Dural AVF, Embolization of scalp AVM / AVF,Spinal AVM / AVF embolization, Extra cranial Carotid stenting, Intra-cranial carotid stenting, Basilar artery Stenting, Vertebral artery stenting, Preoperative embolization of skull base tumor, Embolization of vertebral hemangioma, Arterial thrombolysis, Venous thrombolysis, Angioplasties/chemical plasty for post-SAH vasospasm, Balloon occlusion tests, Permanent occlusion of the Artery, Sclerotherapy of cranio-facial malformations and Embolization of Carotico cavernous fistula.

RESEARCH AND PUBLICATION:-Dissertation Thesis - Role of spiral CT in Pediatric liver tumor. Publications- 1. Co-Author of ?Case Report: Pseudoaneurysm from gastroduodenal artery associated with chronic pancreatitis, an unusual complication.? published in Indian Journal of Radiology and Imaging, Vol. 13, August 2003.2. Co-Author of ?Case Report: Giant Basilar artery aneurysm? to be published in Gujarat Medical Journal.3. Co-Author of "Case Report: Endodermal Sinus Tumor of Vagina" Ind J Radiol Imag 2005 15:2:259-262.

Ongoing Research-1.Pathology of Giant Fusiform (Serpentine) Intracranial Aneurysms.

2.An Institute Experience In Treatment : Two Case Series of Vein Of Galen Aneurysmal Malformation & Giant Fusiform (Serpentine) Intracranial Aneurysms .

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