Neurology India最新文献

Background: Despite a recent surge in keyhole approaches to aneurysm clipping, only few studies have compared these approaches, and none have laid any foundation or roadmap for surgeons newly venturing into these procedures.

Objectives: To report a single surgeon's experience of multiple keyhole approaches to these aneurysms, and to highlight the case selection algorithm, technical nuances, and surgical results.

Material and methods: Twenty-four patients (25 aneurysms) underwent aneurysm clipping using either a mini-pterional approach (MPA), lateral supraorbital approach (LSO), or a supraorbital keyhole approach (SOKHA). Intraoperative premature rupture, adequacy of clipping, and immediate postoperative and long-term functional outcomes were recorded.

Results: All but five patients presented with ruptured aneurysms (Hunt and Hess grade 1 in 12 patients, grade 2 in 5 patients, and grade 3 in 2 patients). The anterior communicating artery (A-Comm; n = 14, 56%) was most frequently involved with aneurysms. The MPA was most frequently employed (n = 11, 45.8%), followed by the LSO (n = 9, 37.5%) and the SOKHA (n = 4, 16.7%). An intraoperative rupture (total n = 5, 20.8%) was most frequently seen in the SOKHA group (50%) and the only case of inadequate aneurysm clipping resulted from inadequate clipping ergonomics during the SOKHA for A-Comm aneurysm. Major complications occurred in the supraorbital approaches (one each in the LSO and SOKHA). Irrespective of the approach used, the long-term outcomes were excellent.

Conclusion: In properly selected patients, keyhole approaches-particularly the MPA and the LSO-can provide excellent surgical outcomes. The learning curve in the SOKHA is steeper. A pragmatic case selection algorithm is proposed.

Spontaneous dorsal cord herniations are very rare, with only 3 reported cases published in the literature. We report a case of a 15-year-old girl, presenting with progressive symptoms of myelopathy, diagnosed with dorsal cord herniation. She was managed surgically. The herniated arachnoid forming the cyst wall was opened to find a dorsally herniated mass of the dorsal spinal cord. The dura was opened above and below the herniation and then around it to free the herniating nodule of the spinal cord. The nodule was not reducible and was partially amputated for biopsy, and to facilitate dural closure. The patient's post-operative course was uneventful with no fresh deficits. Lower limb weakness improved to 5/5 power with normal gait at 3 months follow-up. We speculate, after a literature review, that the dorsal cord herniation is a 'dorsal trans-dural appendage of the spinal cord' possibly resulting from (a) abnormal migration of neural crest cells during formation of dorsal meninges; or (b) abnormal differentiation of neural crest cells; or (c) abnormal signaling by the neural crest cells.

Migraine, a common neurological condition, is characterized by a chronic and recurring headache that affects numerous people globally. Several drugs are available for the treatment and prophylaxis of migraine with their shortfalls. Zinc could play a role in migraine management because of its anti-inflammatory and antioxidant properties. This study was planned to systematically review the scientific databases to gather evidence regarding the role of zinc in the management of migraine. The protocol was registered with the PROSPERO (CRD42023398478). Three databases PubMed, The Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched with the keywords "migraine", "migraine disorders" and "zinc". A literature search led to the retrieval of 35 studies; of these five studies (2 clinical trials and 3 observational studies) were comprised in a systematic review. Clinical trials' risk of bias assessment is low. The review suggested a positive role of zinc in managing migraine however, the evidence requires further strengthening. The available clinical literature on the effectiveness of zinc in migraines is limited; hence, more robust and large clinical trials are required to support the role of zinc in migraines.