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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
Abstract Schwannomas are one of the most common primary spinal tumors representing 30% of all intraspinal lesions. Intramedullary schwannomas constitutes 0.3% of all intraspinal tumors and approximately 1% of spinal cord schwannomas. Majority of the tumors are seen in the cervical (58%), followed by thoracic (32%) and lumbar (10%) regions. Very few are reported at the level of conus medullaris. The important radiologic features of intramedullary schwannoma are predominant extramedullary component, intramedullary spinal tumor with a thickened and enhancing spinal nerve root, absent syrinx, enhancing well with contrast, and sharp margins. The aim of surgery in intramedullary spinal schwannomas is total removal whenever possible. Diagnosing intramedullary schwannoma preoperatively needs high index of suspicion. We are reporting the 10th case of intramedullary schwannoma in the conus region.
{"title":"Spinal Intramedullary Schwannoma of the Conus","authors":"J. Tp, Sekar Chinnamuthu","doi":"10.1055/s-0043-1768065","DOIUrl":"https://doi.org/10.1055/s-0043-1768065","url":null,"abstract":"Abstract Schwannomas are one of the most common primary spinal tumors representing 30% of all intraspinal lesions. Intramedullary schwannomas constitutes 0.3% of all intraspinal tumors and approximately 1% of spinal cord schwannomas. Majority of the tumors are seen in the cervical (58%), followed by thoracic (32%) and lumbar (10%) regions. Very few are reported at the level of conus medullaris. The important radiologic features of intramedullary schwannoma are predominant extramedullary component, intramedullary spinal tumor with a thickened and enhancing spinal nerve root, absent syrinx, enhancing well with contrast, and sharp margins. The aim of surgery in intramedullary spinal schwannomas is total removal whenever possible. Diagnosing intramedullary schwannoma preoperatively needs high index of suspicion. We are reporting the 10th case of intramedullary schwannoma in the conus region.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78903717","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}
Nidhi Rai, Rupi Jamwal, B. Singh, Jyoti Gupta, K. Shankar, Sufiyan Zaheer
Abstract Introduction Brain tumors remain a significant cause of morbidity and mortality around the globe. Preoperative estimation of tumor vascularity is of great significance for a neurosurgeon. Aim of our study was to correlate tumor blood flow (TBF) using arterial spin labeling perfusion imaging (ASL-PI) with microvessel density (MVD), tumor grade, and preoperative prognostication of brain tumors. Materials and Methods This was a prospective observational cross-sectional study conducted in 63 patients of primary brain tumors already referred for magnetic resonance imaging. Absolute and relative mean and maximum TBF were calculated using ASL-PI and correlated with tumor grade and MVD at 10x and 40x magnificantion; thereby stydying the role of ASL-PI in brain tumor prognostication. Results The mean of maxTBF values (mL/min/100 g) in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 147.15, 251.55, 96.43, 43.3, and 578.3, respectively. The median of maxTBF value in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 131.5, 158.63, 94.5, 43.4, and 578.3, respectively. Discussion Significant correlation between meanTBF and MVD at 10X magnification ( p -value < 0.001, rho =0.88) and a positive correlation between meanTBF and MVD at 40X magnification ( p -value < 0.001) were seen. Significant correlation was also seen between maxTBF and MVD at 10X magnification ( p -value < 0.001, rho = 0.91) and between maxTBF and MVD at 40X magnification. TBF in case of the hemangioblastoma was higher than other types of brain tumors (gliomas, meningiomas, and schwannomas). HighTBF value was seen in high-grade gliomas compared with low-grade gliomas with worse prognosis. TBF was high in typical meningiomas whereas low in atypical meningioma. Conclusion TBF by ASL-PI can be considered a noninvasive in vivo marker in predicting the grade of brain tumors and further assist in envisaging prognosis of the patients with brain tumors.
{"title":"Brain Tumor Vascularity Estimation by Arterial Spin Label Perfusion MRI—A Preoperative Tool for Patient Prognostication","authors":"Nidhi Rai, Rupi Jamwal, B. Singh, Jyoti Gupta, K. Shankar, Sufiyan Zaheer","doi":"10.1055/s-0043-1761604","DOIUrl":"https://doi.org/10.1055/s-0043-1761604","url":null,"abstract":"Abstract Introduction Brain tumors remain a significant cause of morbidity and mortality around the globe. Preoperative estimation of tumor vascularity is of great significance for a neurosurgeon. Aim of our study was to correlate tumor blood flow (TBF) using arterial spin labeling perfusion imaging (ASL-PI) with microvessel density (MVD), tumor grade, and preoperative prognostication of brain tumors. Materials and Methods This was a prospective observational cross-sectional study conducted in 63 patients of primary brain tumors already referred for magnetic resonance imaging. Absolute and relative mean and maximum TBF were calculated using ASL-PI and correlated with tumor grade and MVD at 10x and 40x magnificantion; thereby stydying the role of ASL-PI in brain tumor prognostication. Results The mean of maxTBF values (mL/min/100 g) in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 147.15, 251.55, 96.43, 43.3, and 578.3, respectively. The median of maxTBF value in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 131.5, 158.63, 94.5, 43.4, and 578.3, respectively. Discussion Significant correlation between meanTBF and MVD at 10X magnification ( p -value < 0.001, rho =0.88) and a positive correlation between meanTBF and MVD at 40X magnification ( p -value < 0.001) were seen. Significant correlation was also seen between maxTBF and MVD at 10X magnification ( p -value < 0.001, rho = 0.91) and between maxTBF and MVD at 40X magnification. TBF in case of the hemangioblastoma was higher than other types of brain tumors (gliomas, meningiomas, and schwannomas). HighTBF value was seen in high-grade gliomas compared with low-grade gliomas with worse prognosis. TBF was high in typical meningiomas whereas low in atypical meningioma. Conclusion TBF by ASL-PI can be considered a noninvasive in vivo marker in predicting the grade of brain tumors and further assist in envisaging prognosis of the patients with brain tumors.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86115462","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}
Nishtha Yadav, Ambuj Kumar, Kavita Sachdeva, S. Asati
Abstract Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion ( n = 3), vascular narrowing ( n = 3), and pseudoaneurysm ( n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.
{"title":"Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis","authors":"Nishtha Yadav, Ambuj Kumar, Kavita Sachdeva, S. Asati","doi":"10.1055/s-0043-1764351","DOIUrl":"https://doi.org/10.1055/s-0043-1764351","url":null,"abstract":"Abstract Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion ( n = 3), vascular narrowing ( n = 3), and pseudoaneurysm ( n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.","PeriodicalId":53938,"journal":{"name":"Indian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82053301","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}
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