Cameron A. Rawanduzy, E. R. Earl, Jaden B. Brooks, Majid Khan, N. Dadario, M. Sughrue, M. Karsy
Abstract The emerging field of connectomics has provided an improved understanding of the structural and functional organization of the human brain into large-scale brain networks. Recent studies have helped define the canonical neurological networks and outline how considering their presence may aid in surgical decision-making in brain tumor patients. Gliomas represent one of the most common types of brain tumor and often involve displacement and/or infiltration of neurological pathways, suggesting an opportunity to use connectomic maps to improve patient morbidity and mortality based on oncofunctional goals. This review aims to provide a working knowledge of important neurological networks, examine the use of networks in surgical planning, and describe the current literature discussing the impact of these networks on clinical outcomes in glioma resection.
{"title":"Connectomic Networks and Their Impact on Clinical Outcomes in Glioma Treatment: A Review","authors":"Cameron A. Rawanduzy, E. R. Earl, Jaden B. Brooks, Majid Khan, N. Dadario, M. Sughrue, M. Karsy","doi":"10.1055/s-0043-1771214","DOIUrl":"https://doi.org/10.1055/s-0043-1771214","url":null,"abstract":"Abstract The emerging field of connectomics has provided an improved understanding of the structural and functional organization of the human brain into large-scale brain networks. Recent studies have helped define the canonical neurological networks and outline how considering their presence may aid in surgical decision-making in brain tumor patients. Gliomas represent one of the most common types of brain tumor and often involve displacement and/or infiltration of neurological pathways, suggesting an opportunity to use connectomic maps to improve patient morbidity and mortality based on oncofunctional goals. This review aims to provide a working knowledge of important neurological networks, examine the use of networks in surgical planning, and describe the current literature discussing the impact of these networks on clinical outcomes in glioma resection.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"54 1","pages":"116 - 131"},"PeriodicalIF":0.2,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73526153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 5-year-old girl tripped while carrying a bowl of rice and plastic chopsticks. One of the plastic chopsticks penetrated the medial aspect of the right upper eyelid. In the emergency room, she was fully conscious and without any evident neurological damage. From a computed tomography (CT) study ( ► Fig. 1A and B ) and three-dimensional reconstruction ( ► Fig. 1C ), the chopstick was found to be passing through the right superior orbital fi ssure into the cranium. No hematoma was found and an angiogram showed no vascular injury. Under general anesthesia, the chopstick was withdrawn without dif fi culty in one piece ( ► Fig. 1D ) and the patient remained well without any complications. Immediate postoperative CT scan showed no evidence of neural damage or intracranial hemorrhage ( ► Fig. 1E and F ). Postoperative prophylactic antibiotics were administered to prevent infections. 1 – 4 Pre-and postoperative ophthalmological examination revealed normal visual acuity and intact ocular movements. The patient was discharged home 5 days after the operation. At a 3-month follow-up, there were no neurological/ ophthalmological de fi cits or intracranial infections. Among all head injuries, penetrating transorbital intracranial injury accounts for a small percentage. 1 – 4 Additionally, such injuries can result in ophthalmoplegia, blindness, brainstem damage, and intracerebral hemorrhage. 1 – 4 The management of these types of injuries is complex and the delay in treatment can result in a poor prognosis. 1,2,4
{"title":"Transorbital Intracranial Injury by a Chopstick","authors":"R. Darwazeh, Xiaochuan Sun","doi":"10.1055/s-0043-1770907","DOIUrl":"https://doi.org/10.1055/s-0043-1770907","url":null,"abstract":"A 5-year-old girl tripped while carrying a bowl of rice and plastic chopsticks. One of the plastic chopsticks penetrated the medial aspect of the right upper eyelid. In the emergency room, she was fully conscious and without any evident neurological damage. From a computed tomography (CT) study ( ► Fig. 1A and B ) and three-dimensional reconstruction ( ► Fig. 1C ), the chopstick was found to be passing through the right superior orbital fi ssure into the cranium. No hematoma was found and an angiogram showed no vascular injury. Under general anesthesia, the chopstick was withdrawn without dif fi culty in one piece ( ► Fig. 1D ) and the patient remained well without any complications. Immediate postoperative CT scan showed no evidence of neural damage or intracranial hemorrhage ( ► Fig. 1E and F ). Postoperative prophylactic antibiotics were administered to prevent infections. 1 – 4 Pre-and postoperative ophthalmological examination revealed normal visual acuity and intact ocular movements. The patient was discharged home 5 days after the operation. At a 3-month follow-up, there were no neurological/ ophthalmological de fi cits or intracranial infections. Among all head injuries, penetrating transorbital intracranial injury accounts for a small percentage. 1 – 4 Additionally, such injuries can result in ophthalmoplegia, blindness, brainstem damage, and intracerebral hemorrhage. 1 – 4 The management of these types of injuries is complex and the delay in treatment can result in a poor prognosis. 1,2,4","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"148 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85012088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 62-year-old male presented to our emergency room intubated, with posttraumatic seizures and compound left femur fracture after suffering a road traffic accident. Glasgow Coma Scale (GCS) prior to seizure onset was 15. The computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain on admission were normal and the patient was taken up for emergency wound exploration and fixation of femur fracture. Postoperatively, sensorium did not improve on weaning sedation and GCS was E2VtM4. Initial noncontrast head CT showed no evidence of any infarcts or bleeds. Repeat MRI showed multiple punctate areas of diffusion restriction and corresponding punctate T2 hyperintensities in the subcortical white matter cerebellum and brainstem suggestive of cerebral fat embolism syndrome. These areas showed a diffusion restriction on diffusion-weighted imaging (DWI) sequences (►Fig. 1). Gradient recalled echo /susceptibility-weighted imaging (SWI) did not show microareas of blooming in the same distribution. Diffuse axonal injury was ruled out in our patient owing to normal MRI brain at admission. Early DWI in a typical case of Cerebral Fat embolism Syndrome (CFS) shows “starfield” appearance as multiple foci of high signal scatter predominantly in the border zones and deep gray nuclei bilaterally, similar to that seen in our case. In the subacute phase, DWI shows confluent bilateral symmetric periventricular and subcortical white matter cytotoxic edema and diffusion restriction. Microhemorrhages are seen as blooming foci in the white matte in T2 sequences but are better appreciated on SWI, theyare pathogenic of CFs. Up to one-third of all fat embolism casesmay showblooming on SWI, it was not seen in our case. MR spectroscopy shows the presence of lipid peaks within the lesions, a finding related to the nature of the emboli or associated necrosis.1–4 Fig. 1 (A) Magnetic resonance imaging brain axial image, T2weighted, showing multiple areas of hyperintensities in the cerebellum and the brainstem, corresponding to the diffusion restriction in the diffusion-weighted imaging (DWI). (B) Magnetic resonance imaging brain axial image, T2-weighted, showing multiple areas of hyperintensities in the subcortical white matter, corresponding to the diffusion restriction in the DWI. (C) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the cerebellum and brainstem. (D) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the subcortical white matter, in a “starfield” pattern. The diffusion restriction is seen predominantly in the border zones and deep gray nuclei bilaterally.
{"title":"Imaging in a Case of Cerebral Fat Embolism Syndrome","authors":"Harsh Jain, J. Nair, K. Ganesh","doi":"10.1055/s-0043-1770909","DOIUrl":"https://doi.org/10.1055/s-0043-1770909","url":null,"abstract":"A 62-year-old male presented to our emergency room intubated, with posttraumatic seizures and compound left femur fracture after suffering a road traffic accident. Glasgow Coma Scale (GCS) prior to seizure onset was 15. The computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain on admission were normal and the patient was taken up for emergency wound exploration and fixation of femur fracture. Postoperatively, sensorium did not improve on weaning sedation and GCS was E2VtM4. Initial noncontrast head CT showed no evidence of any infarcts or bleeds. Repeat MRI showed multiple punctate areas of diffusion restriction and corresponding punctate T2 hyperintensities in the subcortical white matter cerebellum and brainstem suggestive of cerebral fat embolism syndrome. These areas showed a diffusion restriction on diffusion-weighted imaging (DWI) sequences (►Fig. 1). Gradient recalled echo /susceptibility-weighted imaging (SWI) did not show microareas of blooming in the same distribution. Diffuse axonal injury was ruled out in our patient owing to normal MRI brain at admission. Early DWI in a typical case of Cerebral Fat embolism Syndrome (CFS) shows “starfield” appearance as multiple foci of high signal scatter predominantly in the border zones and deep gray nuclei bilaterally, similar to that seen in our case. In the subacute phase, DWI shows confluent bilateral symmetric periventricular and subcortical white matter cytotoxic edema and diffusion restriction. Microhemorrhages are seen as blooming foci in the white matte in T2 sequences but are better appreciated on SWI, theyare pathogenic of CFs. Up to one-third of all fat embolism casesmay showblooming on SWI, it was not seen in our case. MR spectroscopy shows the presence of lipid peaks within the lesions, a finding related to the nature of the emboli or associated necrosis.1–4 Fig. 1 (A) Magnetic resonance imaging brain axial image, T2weighted, showing multiple areas of hyperintensities in the cerebellum and the brainstem, corresponding to the diffusion restriction in the diffusion-weighted imaging (DWI). (B) Magnetic resonance imaging brain axial image, T2-weighted, showing multiple areas of hyperintensities in the subcortical white matter, corresponding to the diffusion restriction in the DWI. (C) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the cerebellum and brainstem. (D) Magnetic resonance imaging brain axial image, diffusion-weighted sequence, showing multiple punctuate areas of diffusion restriction in the subcortical white matter, in a “starfield” pattern. The diffusion restriction is seen predominantly in the border zones and deep gray nuclei bilaterally.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"116 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81308756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abhijit Acharya, S. Senapati, Sumirini Puppala, A. Mahapatra
Abstract Background India is home to almost 19% of the world's children. The burden of diseases in the pediatric age group is quite high and is just the tip of the iceberg. In India, there are very few neurosurgeons who deal with cases in the pediatric age group. Most parents avoid surgical management for their child due lack of confidence in the expertise of the neurosurgeon in handling pediatric cases. Many challenges are encountered in the pediatric population during the pre-, intra- and post-operative period. Objectives The aim of this study is to study the demographic profile and respective outcomes of pediatric neurosurgical cases (below 18 years of age). Methods A retrospective study of cases over a period of 1.5 years in the Department of Neurosurgery, Institute of Medical Sciences and Sum Hospital was done. The variables analyzed were age group, sex, diagnosis, elective or emergency, neurological examination, and outcome. Data analysis was done using Version 3.0.2; 2013-09-25 for Statistical Computing (IBM Corporation's SPSS programme, version 27.0, 2020). Literature review was done through the NCBI PubMed, Scopus, Embase, and Google Scholar databases. Quality of life was assessed by the disability-adjusted life years (DALY) score approved by the World Health Organization. Results The majority of the patients had significant improvement in achieving milestones with reduced morbidity and one case of mortality. Conclusion To conclude, we have managed all cases of pediatric age group in a general neurosurgery department with utmost skill and meticulous surgery, with less than 0.1% mortality. In the cases that pertain to low resourced centers, areas, and countries where general neurosurgeons are mandated and obliged to perform pediatric neurosurgical procedures, we general neurosurgeons should take it as a challenge to manage these pediatric cases as our study showed appreciable results although the need for specialized pediatric neurosurgical care cannot be overemphasized.
{"title":"Outcomes of Pediatric Neurosurgical Cases Managed by General Neurosurgeons: A Retrospective Study from Eastern India","authors":"Abhijit Acharya, S. Senapati, Sumirini Puppala, A. Mahapatra","doi":"10.1055/s-0043-1770098","DOIUrl":"https://doi.org/10.1055/s-0043-1770098","url":null,"abstract":"Abstract Background India is home to almost 19% of the world's children. The burden of diseases in the pediatric age group is quite high and is just the tip of the iceberg. In India, there are very few neurosurgeons who deal with cases in the pediatric age group. Most parents avoid surgical management for their child due lack of confidence in the expertise of the neurosurgeon in handling pediatric cases. Many challenges are encountered in the pediatric population during the pre-, intra- and post-operative period. Objectives The aim of this study is to study the demographic profile and respective outcomes of pediatric neurosurgical cases (below 18 years of age). Methods A retrospective study of cases over a period of 1.5 years in the Department of Neurosurgery, Institute of Medical Sciences and Sum Hospital was done. The variables analyzed were age group, sex, diagnosis, elective or emergency, neurological examination, and outcome. Data analysis was done using Version 3.0.2; 2013-09-25 for Statistical Computing (IBM Corporation's SPSS programme, version 27.0, 2020). Literature review was done through the NCBI PubMed, Scopus, Embase, and Google Scholar databases. Quality of life was assessed by the disability-adjusted life years (DALY) score approved by the World Health Organization. Results The majority of the patients had significant improvement in achieving milestones with reduced morbidity and one case of mortality. Conclusion To conclude, we have managed all cases of pediatric age group in a general neurosurgery department with utmost skill and meticulous surgery, with less than 0.1% mortality. In the cases that pertain to low resourced centers, areas, and countries where general neurosurgeons are mandated and obliged to perform pediatric neurosurgical procedures, we general neurosurgeons should take it as a challenge to manage these pediatric cases as our study showed appreciable results although the need for specialized pediatric neurosurgical care cannot be overemphasized.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"3 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84325184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Pai, Devaprasad Sathyanarayanan, Harsha Manjarambath Haridas
Abstract Background Lumbar discal cysts are rare intraspinal extradural lesions presenting as lumbar radiculopathy. The rarity of the lesion is sufficient to evoke interest in its diagnosis. The hitherto unsolved etiopathogenesis prompted us to look into these areas in this study. Objectives 1) To review the literature and summarize the clinicoradiological and histopathological features of the discal cyst. 2) To investigate possible mechanisms in the etiopathogenesis of discal cysts. Materials and Methods Three patients presented with features suggestive of lumbar disc prolapse and were diagnosed with discal cyst over 1.5 years and were included in this study. All patients underwent lumbar spine magnetic resonance imaging (MRI) and were subsequently treated by cyst excision. The final diagnosis of the discal cyst was based on histopathological features. Results Out of three patients, two had a discal cyst with disc prolapse, and one had a discal cyst alone. Discal cyst patient underwent excision of cyst alone. Discal cyst patients with disc prolapse underwent discectomy in addition to excision of the discal cyst. One patient had an L2–L3 level discal cyst with disc prolapse, which is uncommon. Conclusions Lumbar discal cysts, although rare, form an important differential diagnosis in patients with lumbar radiculopathy. They have a distinctive MRI appearance, and because discal cyst and disc prolapse shared similar etiopathological features, we hypothesize that discal cyst is a part of the degenerative disc disease spectrum. We also conclude that discal cyst excision should be coupled with discectomy when LDC is associated with disc prolapse.
{"title":"Lumbar Discal Cyst: Is it a Rare Consequence in Lumbar Disc Disease Spectrum? Short Case Series with Review of Literature and Hypothesis Regarding Etiopathogenesis","authors":"U. Pai, Devaprasad Sathyanarayanan, Harsha Manjarambath Haridas","doi":"10.1055/s-0042-1743396","DOIUrl":"https://doi.org/10.1055/s-0042-1743396","url":null,"abstract":"Abstract Background Lumbar discal cysts are rare intraspinal extradural lesions presenting as lumbar radiculopathy. The rarity of the lesion is sufficient to evoke interest in its diagnosis. The hitherto unsolved etiopathogenesis prompted us to look into these areas in this study. Objectives 1) To review the literature and summarize the clinicoradiological and histopathological features of the discal cyst. 2) To investigate possible mechanisms in the etiopathogenesis of discal cysts. Materials and Methods Three patients presented with features suggestive of lumbar disc prolapse and were diagnosed with discal cyst over 1.5 years and were included in this study. All patients underwent lumbar spine magnetic resonance imaging (MRI) and were subsequently treated by cyst excision. The final diagnosis of the discal cyst was based on histopathological features. Results Out of three patients, two had a discal cyst with disc prolapse, and one had a discal cyst alone. Discal cyst patient underwent excision of cyst alone. Discal cyst patients with disc prolapse underwent discectomy in addition to excision of the discal cyst. One patient had an L2–L3 level discal cyst with disc prolapse, which is uncommon. Conclusions Lumbar discal cysts, although rare, form an important differential diagnosis in patients with lumbar radiculopathy. They have a distinctive MRI appearance, and because discal cyst and disc prolapse shared similar etiopathological features, we hypothesize that discal cyst is a part of the degenerative disc disease spectrum. We also conclude that discal cyst excision should be coupled with discectomy when LDC is associated with disc prolapse.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"224 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80033994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Operative Manual of Neurosurgery: A Step by Step Pictorial Atlas, published by Jaypee Brothers and authored byDr. Balaji Pai and his team comprising Asima Banu and Sandesh Khandelwal, is a two-volume visual delight. This twovolume operative atlas of neurosurgery is the sweet product of Dr. Balaji Pai’s “labor of intense fascination and love for thefine art of neurosurgery.”Dr. Balaji, in his preface, highlights that the focus of this venture is to teach neurosurgery through photographs and illustrations rather than through theory. This step-by-step pictorial operative atlas of neurosurgery hits the mark, and the editorial team can certainly be complimented for a goal well accomplished. The book is virtually an illustrated guided tour through all aspects of neurosurgery starting from basic technique to recent advances in neurosurgery. The book has 2 volumes comprising 21 sections with 155 chapters spread over a total of 1,684 pages, with each chapter authored by subject experts (►Fig. 1). Volume I includes preoperative planning, basic techniques, surgery for trauma and tumors, skull base surgery, and cerebrovascular surgery. Volume II concentrates on neuroendoscopy, orbital surgery, functional neurosurgery, pediatric neurosurgery, craniovertebral junction surgery, and spine surgery including spinal endoscopy and minimally invasive spine surgery. Chapters are organized in a systematic manner, starting with a brief introduction and details about positioning followed by a step-by-step operative documentary supplemented by operative photographs and radiological images. The icing on the cake is the pearls of wisdom provided at the end of each chapter. Singling out chapters for special comment would be invidious. In addition to often-discussed chapters on trauma, tumors, and vascular surgery, there are chapters that deal with newer concepts such as neuroendoscopy and minimally invasive spine surgery, which makes this book a comprehensive, go-to reference atlas for any neurosurgeon in evolution. In addition, for a practicing neurosurgeon, it is an easy ready reckoner, which he/she can brush through and revise just before scrubbing up for any surgery. The production aspect of the atlas is excellent considering the fact that this is a book based exclusively on camera photographs, endoscopic views, and highquality microscopic images. Expecting uniformly highquality images from the over hundred authors who have contributed to this book is difficult. Moreover, photographs obtained through the operation microscope vary considerably in clarity and glare often obscures crucial features. Yet, the illustrations are clear and the quality of the print, text, and images provides a smoothening read to the eyes. The annotations of the images and brief and detailed captions make for an easy reference. The text content in each chapter has been reduced to a minimum, and there is an average of 15 illustrations per chapter. Yes, one concern is the physical bulk of the two v
{"title":"Operative Manual of Neurosurgery: A Step by Step Pictorial Atlas —A Review","authors":"G. Menon","doi":"10.1055/s-0043-1769898","DOIUrl":"https://doi.org/10.1055/s-0043-1769898","url":null,"abstract":"Operative Manual of Neurosurgery: A Step by Step Pictorial Atlas, published by Jaypee Brothers and authored byDr. Balaji Pai and his team comprising Asima Banu and Sandesh Khandelwal, is a two-volume visual delight. This twovolume operative atlas of neurosurgery is the sweet product of Dr. Balaji Pai’s “labor of intense fascination and love for thefine art of neurosurgery.”Dr. Balaji, in his preface, highlights that the focus of this venture is to teach neurosurgery through photographs and illustrations rather than through theory. This step-by-step pictorial operative atlas of neurosurgery hits the mark, and the editorial team can certainly be complimented for a goal well accomplished. The book is virtually an illustrated guided tour through all aspects of neurosurgery starting from basic technique to recent advances in neurosurgery. The book has 2 volumes comprising 21 sections with 155 chapters spread over a total of 1,684 pages, with each chapter authored by subject experts (►Fig. 1). Volume I includes preoperative planning, basic techniques, surgery for trauma and tumors, skull base surgery, and cerebrovascular surgery. Volume II concentrates on neuroendoscopy, orbital surgery, functional neurosurgery, pediatric neurosurgery, craniovertebral junction surgery, and spine surgery including spinal endoscopy and minimally invasive spine surgery. Chapters are organized in a systematic manner, starting with a brief introduction and details about positioning followed by a step-by-step operative documentary supplemented by operative photographs and radiological images. The icing on the cake is the pearls of wisdom provided at the end of each chapter. Singling out chapters for special comment would be invidious. In addition to often-discussed chapters on trauma, tumors, and vascular surgery, there are chapters that deal with newer concepts such as neuroendoscopy and minimally invasive spine surgery, which makes this book a comprehensive, go-to reference atlas for any neurosurgeon in evolution. In addition, for a practicing neurosurgeon, it is an easy ready reckoner, which he/she can brush through and revise just before scrubbing up for any surgery. The production aspect of the atlas is excellent considering the fact that this is a book based exclusively on camera photographs, endoscopic views, and highquality microscopic images. Expecting uniformly highquality images from the over hundred authors who have contributed to this book is difficult. Moreover, photographs obtained through the operation microscope vary considerably in clarity and glare often obscures crucial features. Yet, the illustrations are clear and the quality of the print, text, and images provides a smoothening read to the eyes. The annotations of the images and brief and detailed captions make for an easy reference. The text content in each chapter has been reduced to a minimum, and there is an average of 15 illustrations per chapter. Yes, one concern is the physical bulk of the two v","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"145 1","pages":"186 - 187"},"PeriodicalIF":0.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86984925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Nitheesha Reddy, K. Nagarajan, V. Midhusha Reddy, A. Ramesh
Abstract Neurovascular conflicts are common in the posterior fossa and basal cisterns due to coexistence of important neural and vascular structures. Neurovascular conflict arising from compression of the cranial nerves by pulsatile flow in the adjacent atherosclerotic arteries is well known and is associated with conditions like trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. The medulla is known to be affected by dilated tortuous (dolichoectatic) vertebrobasilar arteries in the elderly or hypertensive. The vertebral artery causing the compression can be dolichoectatic or normal dominant vertebral artery or an elongated tortuous artery. Very few cases of medullary compression by non-dolichoectatic elongated tortuous or dominant vertebral artery were reported in the literature. In this article, we report three cases of medullary compression by the dominant and angulated vertebral artery. Magnetic resonance (MR) imaging with MR angiography showed indentation of the anterolateral aspect of the inferior medulla by the vertebral artery. The patients are managed conservatively and on regular follow-up.
{"title":"Vascular Compression of Medulla Oblongata by Non-Dolichoectatic Vertebral Artery","authors":"V. Nitheesha Reddy, K. Nagarajan, V. Midhusha Reddy, A. Ramesh","doi":"10.1055/s-0043-1769899","DOIUrl":"https://doi.org/10.1055/s-0043-1769899","url":null,"abstract":"Abstract Neurovascular conflicts are common in the posterior fossa and basal cisterns due to coexistence of important neural and vascular structures. Neurovascular conflict arising from compression of the cranial nerves by pulsatile flow in the adjacent atherosclerotic arteries is well known and is associated with conditions like trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. The medulla is known to be affected by dilated tortuous (dolichoectatic) vertebrobasilar arteries in the elderly or hypertensive. The vertebral artery causing the compression can be dolichoectatic or normal dominant vertebral artery or an elongated tortuous artery. Very few cases of medullary compression by non-dolichoectatic elongated tortuous or dominant vertebral artery were reported in the literature. In this article, we report three cases of medullary compression by the dominant and angulated vertebral artery. Magnetic resonance (MR) imaging with MR angiography showed indentation of the anterolateral aspect of the inferior medulla by the vertebral artery. The patients are managed conservatively and on regular follow-up.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"7 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74291969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Singh, Kshitij Sinha, R. Singh, V. Chand, ArunD Singh
Abstract Introduction Degenerative spondylolisthesis (DS) is usually seen at lumbo-sacral region. Lumbarization of S1 is seen in less than 2% of the population and to have spondylolisthesis in this segment is even rarer. The purpose is to report a rare case of DS at S1-S2 level. Case Report A 52-year-old male, a farmer by profession, presented to Neurosurgery outpatient department with complaint of low back ache for 4 years, which was insidious and progressive. The pain radiated to both lower limbs with more on right than left side. Radiological evaluation with anteroposterior and lateral roentgenogram of lumbo-sacral spine revealed anterolisthesis of S1-S2 (Meyerding's grade 2). Magnetic resonance imaging reported S1-S2 disk bulge with bilateral foraminal stenosis. The patient underwent S1 laminectomy along with S1-S2 discectomy with bilateral S1 and S2 pedicle screws and rod fixation with transforaminal lumbar interbody fusion. Result Postoperative recovery was good with improvement in back pain along with power on postoperative day 1. Conclusion The prevalence of lumbarization is less than 2% and getting spondylolisthesis in this segment is even rarer. As this is one of the first of its kind of case, further case series or longitudinal studies of such cases may help understand better the pathomechanics related to spondylolisthesis at this level.
{"title":"Degenerative Spondylolisthesis of Lumbarized S1-S2 Vertebrae: A Case Report","authors":"D. Singh, Kshitij Sinha, R. Singh, V. Chand, ArunD Singh","doi":"10.1055/s-0043-1768640","DOIUrl":"https://doi.org/10.1055/s-0043-1768640","url":null,"abstract":"Abstract Introduction Degenerative spondylolisthesis (DS) is usually seen at lumbo-sacral region. Lumbarization of S1 is seen in less than 2% of the population and to have spondylolisthesis in this segment is even rarer. The purpose is to report a rare case of DS at S1-S2 level. Case Report A 52-year-old male, a farmer by profession, presented to Neurosurgery outpatient department with complaint of low back ache for 4 years, which was insidious and progressive. The pain radiated to both lower limbs with more on right than left side. Radiological evaluation with anteroposterior and lateral roentgenogram of lumbo-sacral spine revealed anterolisthesis of S1-S2 (Meyerding's grade 2). Magnetic resonance imaging reported S1-S2 disk bulge with bilateral foraminal stenosis. The patient underwent S1 laminectomy along with S1-S2 discectomy with bilateral S1 and S2 pedicle screws and rod fixation with transforaminal lumbar interbody fusion. Result Postoperative recovery was good with improvement in back pain along with power on postoperative day 1. Conclusion The prevalence of lumbarization is less than 2% and getting spondylolisthesis in this segment is even rarer. As this is one of the first of its kind of case, further case series or longitudinal studies of such cases may help understand better the pathomechanics related to spondylolisthesis at this level.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"14 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74763478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Posttraumatic low ulnar nerve injuries develop claw hand and poor hand function. Transferring the opponens pollicis branch of the thenar branch at the palm to the terminal division of the deep branch of the ulnar nerve is an effective distal nerve transfer to restore pinch in low ulnar nerve injuries. The author describes the surgical technique for a 4-month-old low ulnar nerve injury in a 25-year-old man with inconclusive electrodiagnostic findings and no clinical findings of distal nerve recovery. The intraoperative electrical stimulation of the nerve in the palm is a simple method to ensure the reinnervation of the ulnar nerve in a claw hand and muscle wasting. Therefore, all postcut injuries with a low ulnar nerve palsy with claw hands may not need a distal nerve transfer. However, performing distal nerve exploration in the palm is vital in cases of doubtful nerve recovery in a low ulnar nerve palsy with a claw hand.
{"title":"Distal Nerve Exploration in the Palm Avoids Nerve Transfer in a Posttraumatic Ulnar Nerve Injury with a Claw Hand","authors":"J. Terrence, J. Jerome, Indian J Neurosurg","doi":"10.1055/s-0043-57031","DOIUrl":"https://doi.org/10.1055/s-0043-57031","url":null,"abstract":"Abstract Posttraumatic low ulnar nerve injuries develop claw hand and poor hand function. Transferring the opponens pollicis branch of the thenar branch at the palm to the terminal division of the deep branch of the ulnar nerve is an effective distal nerve transfer to restore pinch in low ulnar nerve injuries. The author describes the surgical technique for a 4-month-old low ulnar nerve injury in a 25-year-old man with inconclusive electrodiagnostic findings and no clinical findings of distal nerve recovery. The intraoperative electrical stimulation of the nerve in the palm is a simple method to ensure the reinnervation of the ulnar nerve in a claw hand and muscle wasting. Therefore, all postcut injuries with a low ulnar nerve palsy with claw hands may not need a distal nerve transfer. However, performing distal nerve exploration in the palm is vital in cases of doubtful nerve recovery in a low ulnar nerve palsy with a claw hand.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"72 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78790362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Neuronavigation is a system composed of advanced intraoperative equipment where a virtual link is created between digital images and anatomical structures such that intra-axial lesions are precisely located and removed safely and efficiently. Thus, neuronavigation has enormously increased the success rate of brain and spinal cord surgery compared to the era in which it did not exist. This article takes a look at and emphasizes, as a reminder, the benefits of neuronavigation, equipment used, equipment setup, tips and tricks on preoperative preparation of patients' images, and future perspectives on neuronavigation and equipment, aspects that are very rare in literature. A commonly used neuronavigation system is described, with regard to its parts, setup, instructions, and tips and tricks. This narrative review allows the reader to grasp the main aspects of neuronavigation, the functions of all the aspects, and what to expect during brain surgery. Although training with neuronavigation is a given in most developed parts of the world, in underdeveloped and developing countries the lack of equipment does not allow most neurosurgeons to have a first-hand experience. This article has aimed to ease the learning curve for neurosurgeons that are unfamiliar with neuronavigation.
{"title":"Neuro-navigation: Equipment, Tips, and Tricks on Brain Navigated Surgery","authors":"E. N. Kingsly, Ismail Bozkurt, B. Chaurasia","doi":"10.1055/s-0043-1764456","DOIUrl":"https://doi.org/10.1055/s-0043-1764456","url":null,"abstract":"Abstract Neuronavigation is a system composed of advanced intraoperative equipment where a virtual link is created between digital images and anatomical structures such that intra-axial lesions are precisely located and removed safely and efficiently. Thus, neuronavigation has enormously increased the success rate of brain and spinal cord surgery compared to the era in which it did not exist. This article takes a look at and emphasizes, as a reminder, the benefits of neuronavigation, equipment used, equipment setup, tips and tricks on preoperative preparation of patients' images, and future perspectives on neuronavigation and equipment, aspects that are very rare in literature. A commonly used neuronavigation system is described, with regard to its parts, setup, instructions, and tips and tricks. This narrative review allows the reader to grasp the main aspects of neuronavigation, the functions of all the aspects, and what to expect during brain surgery. Although training with neuronavigation is a given in most developed parts of the world, in underdeveloped and developing countries the lack of equipment does not allow most neurosurgeons to have a first-hand experience. This article has aimed to ease the learning curve for neurosurgeons that are unfamiliar with neuronavigation.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":"20 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89018934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：