bluuebunny/crossref_metadata_2025 huggingface dataset:
A comprehensive overview on sandfly fever
Authors: Dehghani Rouhullah , Kassiri Hamid , Khodkar Iman , Karami Saina
Published: July 2021

Sandfly fever is a febrile emerging arboviral illness which is a huge threat posed to public health. Sandfly fever viruses (Sicilian, Naples, and Toscana) are endemic to the Mediterranean region. Evidence suggests an increase in the activity of sandfly-borne phleboviruses and their extension to other places. The infection is relatively benign but may cause severe clinical manifestations and complications. Sandfly fever viruses belongs to the genus Phlebovirus (family Bunyaviridae), and the four main serotypes include sandfly fever Sicilian virus, sandfly fever Naples virus, sandfly fever Cyprus virus, and Toscana virus. Sandfly fever has flu-like symptoms such as fever, headache, photophobia, malaise, myalgia, and retro-orbital pain. The incubation period of the disease is 4-8 days, and the patient usually recovers within a week. The first infection provides the host with immunity. Sandfly fever viruses are transmitted through the bites of infected female sandflies, thus, the epidemiology of sandfly fever is closely related to the presence and activity of sandfly species that act as the vectors for transmission. Cases and outbreaks of the disease have been reported worldwide for more than 100 years. All in all, this disease is important for non-endemic countries because it is a travel-related and/or imported illness.
Predictive value of serum lactate dehydrogenase in diagnosis of septic shock in critical pediatric patients
Authors: Algebaly HebatAllah Fadel , Abd-Elal Ahmed , Kaffas Rasha El , Ahmed Elshymaa Salah
Published: July 2021

Objectives:

To determine the predictive value of lactate dehydrogenase (LDH) in diagnosis of septic shock and its association with other prognostic scores in critical pediatric patients.

Methods:

A cross-sectional study was performed at Children's Hospital of Cairo University between June 2019 and December 2019. A total of 200 pediatric patients were divided into the septic shock group [100 critically ill patients with septic shock from the pediatric intensive care unit (PICU)] and the control group (100 patients with only sepsis). LDH was determined in the first 24 hours of admission. The sensitivity and specificity of LDH in diagnosis of septic shock were assessed; the levels of related indicators of patients with different etiologies were compared; correlations between LDH, Paediatric Index of Mortality Π, and Pediatric Sequential Organ Failure Assessment (PSOFA) were analyzed.

Results:

LDH was 512 μL (406.50-663.00) in the septic shock group and was significantly higher than that (190 μL, range 160.00-264.50) in the control group (P<0.001). Besides, median LDH in children with chest infecion was higher than that in children with other diagnoses (P=0.047). A good positive correlation was found between PSOFA and LDH (r=0.503, P<0.001).

Conclusions:

LDH could be a potential inflammatory marker in diagnosis of septic shock and is valuable for PICU admission decisions.
Effect of exchange blood transfusion on oxygen saturation of neonates with severe neonatal jaundice by pulse oximetry
Authors: Shakur Abubakar Muhammed , Garba Nuhu Abubakar , Ahmadu Ibrahim , Apollos Daniel , Wada Aminu , Abdullahi Safiya Garba , Mohammed Abdulsalam , Asani Mustafa O. , Aliyu Ibrahim
Published: July 2021

Objective:

To determine if there was any difference in SpO2 readings during exchange blood transfusion (EBT).

Methods:

A prospective cross-sectional study of neonates with severe neonatal jaundice requiring EBT was conducted. Oxygen saturation was recorded before, immediately and 15 minutes after EBT by using a pulse oximeter.

Results:

This study included 30 neonates with 20 males and 10 females. The age ranged from 1 to 12 days with a mean of (5.4 ±2.9) days. Pre-EBT SpO2 ranged from 90% to 98% with a mean value of (94.3 ± 2.2)%; SpO2 in the end of EBT ranged from 85% to 99% with a mean value of (94.1 ± 3.2)%; SpO2 at 15 minutes after EBT ranged from 77% to 99% with a mean value of (94.8 ± 4.1)%. There was no significant difference between SpO2 values at onset of EBT and either immediately or 15 minutes after EBT (P=0.770 and 0.422, respectively). SpO2 showed no significant difference between neonates who were infused with blood of different storage times (<24 h or ≥24 h) at the onset of EBT (P=0.584), immediately (P>0.999) and 15 minutes after EBT (P=0.887). Besides, SpO2 values were compariable in neonates with hematocrit <45% or ≥45% at the onset of EBT (P=0.284), immediately (P=0.118) and 15 minutes after EBT (P=0.868).

Conclusions:

EBT does not affect SpO2 in neonates.
Detection of oqxA and oqxB efflux pump genes among nosocomial coliform bacilli
Authors: Gabr Basant Mostafa , Zamzam Afaf Sayed Ahmed , Eisa Eman Ahmed , El-Baradey Ghada Foad , Eldeen Maii Atef Shams
Published: July 2021

Objectives:

To identify and test the antibiotic susceptibility of nosocomial coliform bacilli and investigate the presence of oqxA and oqxB genes among the multidrug-resistant (MDR) phenotypes.

Methods:

One hundred and twenty different healthcare-associated infection samples were collected. Coliform bacilli were isolated, identified by conventional methods, and then antibiotic susceptibility tests were done using the VITEK2 system and disk diffusion methods. OqxAB operon was identified using a conventional PCR-based technique. oqxA and oqxB genes were compared between MDR Klebsiella pneumonia (K. pneumonia) phenotypes and MDR Escherichia coli (E. coli) phenotypes. Besides, oqxAB operons were compared between phenotypes of K. pneumonia and E. coli isolates.

Results:

Seventy coliform bacilli were isolated with the predominance of K. pneumonia and E. coli. Besides, 82.1% of K. pneumonia strains and 53.3% of E. coli isolates were MDR phenotypes. Significant more oqxB genes alone were found in MDR E. coli than that in MDR K. pneumoniae phenotypes (χ2=10.160, P=0.003). OqxAB operon was significantly more in MDR phenotypes of E. coli than that in the susceptible phenotypes (P<0.001). There was significantly less of this operon in susceptible E. coli isolates than that in susceptible K. pneumoniae isolates (P<0.001). OqxAB positive isolates that were also resistant to fluoroquinolones, tetracycline, trimethoprim, and chloramphenicol, most probably suggested functional pumps.

Conclusions:

MDR coliform bacilli are strongly implicated in healthcare-associated infection. Attention should be paid to the presence of oqxAB pump, as an important mechanism in the development of resistance against many antimicrobials because it contributes to co-resistance with other categories; therefore, this pump could be a good target for efflux pump inhibitors.
Diffuse unilateral subacute neuroretinitis in children
Authors: Nik-Nurfarhana Nik Mohd Noor , Azima Ahmad Shahrudin , Ismaeel-Mohamed Khonji , Zunaina Embong
Published: July 2021

Rationale:

Diffuse unilateral subacute neuroretinitis is a form of posterior uveitis and has a few clinical presentations according to the onset of presentation.

Patients’ concern:

A girl (5-year-old) and 2 boys (both 12-year-old) were included in this report. Upon presentation, the visual acuity ranges from 6/12 to 6/60. All three cases had different symptoms (case 1: floaters; case 2: eye redness and pain; case 3: central scotoma). All of them had variable posterior uveitis features (case 1: vitritis and focal retinitis; case 2: subretinal larva track; case 3: choroiditis).

Diagnosis:

Diffuse unilateral subacute neuroretinitis.

Intervention:

All 3 patients were treated with oral albendazole.

Outcome:

All patients showed remarkable resolution of inflammatory reactions of the eye and also improvement of vision.

Lesson:

High index of suspicion should be made for children and young adults who are previously healthy but presented with suddenly onset of reduced vision with clinical features of posterior uveitis of variable degree. Clinical features together with a full blood picture can help to diagnose the problem when other parameters are negative.
Marchiafava-Bignami disease
Authors: Gupta Monica , Garg Swati , Gaba Saurabh , Gupta Rekha
Published: July 2021

Rationale:

Clinicians encounter multiple alcohol-related illnesses in practice, and Marchiafava-Bignami disease is a rare and devastating entity among them. It is a toxic-demyelinating disease and seen in chronic alcoholics, although it may be occasionally observed in chronically malnourished teetotalers. The clinical presentations are diverse. The symptoms and signs are non-specific, and the onset can be acute or chronic.

Patient's concerns:

A 45-year-old right-handed patient suffered from alcohol use disorder with multiple non-specific neuropsychiatric manifestations.

Diagnosis:

Marchiafava-Bignami disease.

Interventions:

Thiamine, folate, vitamin B12, and steroid therapy.

Outcome:

The patient's behaviour was significantly improved but dysarthria and pyramidal signs persisted. He was left with permanent cognitive impairment.

Lessons:

Though prompt therapy may halt the demyelinating process in this disease, the treatment remains a challenge in clinical practice. The recognition of the neuro-radiologic features is crucial to establish an early diagnosis.
Chronic myeloid leukaemia presenting as acute small bowel gangrene
Authors: Pandiaraja Jayabal , Shalini Arumugam
Published: July 2021

Rationale:

Chronic myeloid leukaemia is a myeloproliferative disorder due to clonal hyperproliferation of myeloid cells within the bone marrow. It can present both pro- and anti-thrombotic states. CML has different presentations within the gastrointestinal tract.

Patient's concern:

A 40-year-old non-diabetic and non-hypertensive male complained of abdominal pain with nausea and emesis for 1 day. Besides, he had a history of abdominal distension and fever for 1 day.

Diagnosis:

Acute small bowel gangrene due to chronic myeloid leukaemia.

Intervention:

A limited resection of small intestine with ileostomy and mucus fistula.

Outcome:

After 3 months following surgery the patient underwent stoma closure. The patient was followed up for more than 3 years postoperatively. During the follow-up, the patient was asymptomatic without any recurrence of the disease.

Lesson:

Chronic myeloid leukaemia should be considered as one of the causes for small intestine gangrene when there is increased leukocyte count, splenomegaly without evidence of atherosclerotic occlusion or systemic emboli from the heart.
Surgical management of multi-level cervical spine synovial chondromatosis
Authors: Mirza Farhan , Vasquez Raul
Published: July 2021

Cervical synovial chondromatosis is a benign condition which most commonly affects the knee joint. The involvement of the spinal column is rare, with only a few reports in the literature describing surgical treatment for compressive spinal lesions. Given the rarity of this condition, the best treatment methodology is yet to be established. We describe the case of a 38-year-old female who presented with progressively worsening myeloradicular symptoms localizing to the cervical spinal cord. Imaging revealed a multilevel osseous and epidural lesion involving the subaxial cervical spine. A computed tomography-guided biopsy was performed to obtain a diagnosis to aid further treatment planning. Subsequently, surgical decompression and stabilization were performed after which the patient made an excellent recovery. She continues to do well at 2 years follow-up. Cervical synovial chondromatosis is a rare condition which can present with pain, radiculopathy, and/or myelopathy. Surgical treatment should focus on complete resection, decompression, and stabilization with arthrodesis and fusion to prevent recurrence. We propose that the lack of motion provided by stabilization and fusion after gross total resection prevents disease recurrence.
Spontaneous resolution of postoperative giant frontal pseudomeningocele
Authors: Tran Duc , Dinh Thi , Nguyen Quoc , Mai Dang , Truong Van
Published: July 2021

Cranial pseudomeningoceles are abnormal extradural collections of cerebrospinal fluid. Postoperative giant cranial pseudomeningoceles have been rarely reported in the literature and have no specific treatment guidelines. The optimal management strategy for this condition differs among authors, varying from conservative approach to surgical intervention. A spontaneous resolution of postoperative giant frontal pseudomeningocele is reported. A 41-year-old female presented a pseudomeningocele 3 weeks after a right frontal meningioma surgical resection. The pseudomeningocele progressed during the first 1.5-month postoperatively despite percutaneous aspiration and compressive bandage, it then shrank spontaneously and was completely resolved at the 15th month since the surgery. Nonoperative treatment with a close follow-up could be a good option for asymptomatic giant pseudomeningoceles, resulting in a spontaneous resolution.
Correlation of intraoperative neurophysiological parameters and outcomes in patients with intramedullary tumors
Authors: Ruschel Leonardo , Aragão Afonso , Oliveira Matheus , Milano Jerônimo , Neto Mauricio , Ramina Ricardo
Published: July 2021

Introduction: Intramedullary spinal cord tumors (IMSCT) account for about 2%–4% of all central nervous system tumors. Surgical resection is the main treatment step, but might cause damage to functional tissues. Intraoperative neuromonitoring (IONM) is an adopted measure to decrease surgical complications. Below, we describe the results of IMSCT submitted to surgery under IONM at a tertiary institution. Methods: The sample consisted of consecutive patients with IMSCT admitted to the Neurological Institute of Curitiba from January 2007 to November 2016. A total of 47 patients were surgically treated. Twenty-three were male (48.9%) and 24 were female (51.1%). The mean age was 42.77 years. The mean follow-up time was 42.7 months. Results: Neurological status improved in 29 patients (62%), stable in 6 (13%), and worse in 12 (25%). Patients who presented with motor symptoms at initial diagnosis had a worse outcome compared to patients with sensory impairment and pain (P = 0.026). Patients with a change in electromyography had worse neurological outcomes compared to patients who did not show changes in monitoring (P = 0.017). Discussion and Conclusion: No prospective randomized high evidence study has been performed to date to compare clinical evolution after surgery with or without monitoring. In our sample, surgical resection was well succeeded mainly in oligosymptomatic patients with low preoperative McCormick classification and no worsening of IONM during surgery. We believe that microsurgical resection of IMSCT with simultaneous IONM is the gold standard treatment and achieved with good results.
Algorithm of traumatic brain injury in pregnancy (Perspective on neurosurgery)
Authors: Darlan Ditto , Prasetya Galan , Ismail Arif , Pradana Aditya , Fauza Joandre , Dariansyah Ahmad , Wardana Gigih , Apriawan Tedy , Bajamal Abdul
Published: July 2021

Background: The maternal deaths due to obstetrical cases declined, but the maternal deaths that caused by nonobstetrical cases still increase. The study reported that traumatic cases in pregnancy are the highest causes of mortality in pregnancy (nonobstetrical cases) in the United States. Another study reported that 1 in 12 pregnant women that experienced traumatic accident and as many as 9.1% of the trauma cases were caused by traumatic brain injury (TBI). The female sex hormone has an important role that regulates the hemodynamic condition. Anatomical and physiological changes during pregnancy make the examination, diagnosis, and treatment of TBI different from non-pregnant cases. Therefore, it is very important to lead the algorithm for each institution based on their own resources. Case Series: A 37-year-old woman with a history of loss of consciousness after traffic accident. She rode a motorbike then hit the car. She was referred at 18 weeks' gestation. Glasgow Coma Scale (GCS) E1V1M4, isochoric of the pupil, reactive to the light reflex, and right-sided hemiparesis. The non-contrast head computed tomography (CT) scan revealed subdural hematoma (SDH) in the left frontal-temporal-parietal region, SDH of the tentorial region, burst lobe intracerebral hemorrhage, and cerebral edema. There was not a fetal distress condition. The next case, a 31 years old woman, in 26 weeks gestation, had a history of unconscious after motorcycle accident then she fell from the height down to the field about 3 m. GCS E1V1M3, isochoric of the pupil, but the pupil reflex decreased. Noncontrast CT scan revealed multiple contusion, subarachnoid hemorrhage, and cerebral edema. She had a good fetal condition. Discussion: We proposed the algorithm of TBI in pregnancy that we already used in our hospital. The main principle of the initial management must be resuscitating the mother and that also the maternal resuscitation. The primary and secondary survey is always prominent of the initial treatment. Conclusion: The clinical decision depends on the condition of the fetal, the surgical lesion of the intracranial, and also the resources of the neonatal intensive care unit in our hospital.
Clinical improvement of patients with endovascular treatment in the traumatic carotid-cavernous fistula
Authors: Permana Galih , Suroto Nur , Al Fauzi Asra
Published: July 2021

A carotid-cavernous sinus fistula (CCF) is a clinical condition when there is an abnormal communication between the internal carotid artery, external carotid artery (ECA), or any of their branches to the cavernous sinus. Traumatic CCF (TCCF) is the most common type of all CCFs. This study aims to find clinical improvement of traumatic carotid-cavernous fistulas (TCCF) after endovascular treatment. We predict the degree of clinical recovery in an attempt to make the treatment of TCCF safe and effective. This study reported a series of 28 patients with TCCFs undergoing coiling and ballooning in a period of 3 years, i.e., from December 2014 to December 2017. This is a novel case report about CCF in our country, Indonesia, especially in Surabaya. We performed clinical, angiographical, and radiological assessments before and at regular time periods after the procedure until 6 months. All patients had a partial and complete occlusion of the fistula. Angiographic occlusion of fistula, visualization of the ophthalmic artery, and disappearance of bruit predicted a good clinical outcome. All patients made a recovery at different times, depending on the degree of fistulas and treatment. Improvement in clinical symptoms had a direct correlation with the degree of occlusion. Treatment was divided into coiling and ballooning depending on patient's condition and angiographic examination. Trans femoral cerebral angiography is still very important diagnostic tool in the diagnosis and treatment of TCCFs.
Endotracheal tube obstruction experienced during an anterior cervical discectomy and fusion
Authors: Aoyama Masahiro , Hara Masahito , Maejima Ryuya , Kinoshita Tomoko , Aoyama Hiroko , Kurokawa Shuji , Hashimoto Atsushi , Ito Hiroshi , Sato Yuko , Fujiwara Yoshihiro , Miyachi Shigeru
Published: July 2021

During anterior cervical discectomy and fusion (ACDF), endotracheal tube difficulties are anticipated at the operative level but are unexpected elsewhere in the airway. We report the case of a 66-year-old woman who underwent C4/C5 ACDF to treat adjacent segment disease following a previous anterior cervical fixation surgery. Shortly after her lower jaw was elevated and the fusion cage was inserted, a rise in airway pressure was observed, indicating impaired breathing. Subsequent examination revealed a bent endotracheal tube in the oral cavity as the cause of the respiratory impairment. During anterior cervical surgery, elevating the lower jaw can cause the tongue root to press against the endotracheal tube. Reinforced endotracheal tubes, with a spiral-wound wire in the inner wall, would effectively prevent this issue. In the unlikely event of impaired breathing during such an operation, the oral cavity should be inspected for confirmation of an open airway.
Local balloon-assisted navigation of a microcatheter into an aneurysm during intracranial aneurysmal coiling: A dunk shot technique
Authors: Ohshima Tomotaka , Kawaguchi Reo , Matsuo Naoki , Miyachi Shigeru
Published: July 2021

Objectives: Various endovascular approaches have been reported for patients with intracranial aneurysms. However, the safety of navigating a microcatheter into the aneurysm remains debatable. In this study, we evaluated a novel method “dunk shot technique,” in which a proximal balloon and a local balloon are used for navigation of a microcatheter into an aneurysm under challenging situations. Materials and Methods: We have reported two cases of unruptured internal carotid artery–superior hypothalamic artery aneurysm. An 8-F balloon-attached catheter was used as the guiding catheter. A local balloon catheter for neck remodeling and a microcatheter for coil insertion were navigated around the aneurysmal neck region. When it seemed difficult to navigate a microcatheter into an aneurysm, both the guiding balloon and a local balloon catheter were used for assistance. After inflation of the guiding balloon, the local balloon was inflated partially to negotiate the tip of the microcatheter. Results: The uncontrollable tip of the microcatheter could be intentionally moved by the local balloon. Conclusions: We evaluated the effectiveness of the balloon-assisted technique for the navigation of a microcatheter in cases with challenging anatomy. A little bit of direct effect to the tip of the microcatheter by a local balloon could produce effective outcomes under the proximal flow arrest.
Predictors of outcome following interventions for ruptured intracranial aneurysms in an emerging health institution in West Bengal: A 6-year experience
Authors: Uche Enoch , Matthew Mesi , Meher Sujeet , Tripathy Laxmi , Mezue Wilfred , Jain Harsh , Basu Sunandan , Chikani Mark , Onyia Ephraim , Iloabachie Izuchukwu
Published: July 2021

Background: Microsurgical clipping and endovascular coiling have remained over the past half-century, the main options for definitive treatment of ruptured intracranial aneurysms. However, recent advances in endovascular techniques have broadened their application stimulating much debate regarding the usefulness of microsurgical options. For locations with limited capacity or evolving endovascular service, however, microsurgical treatment offers not only cost-effective and durable options but also oftentimes the only option available for most patients. Materials and Methods: This was a single institution questionnaire-based retrospective study from West Bengal India. It was performed on patients with aneurysmal rupture managed from June 2010 to October 2016. Data analysis was performed with SPSS for Windows, version 21. Results: One hundred and ten patients were studied. The mean age was 50.8 years (standard deviation [SD] ±13.5) for females and 50.2 (SD ± 12.4) for males (P = 0.8112, t-test). Ninety (81.8%) patients received microsurgical clipping. Microsurgical options such as wrapping, bypass, and excision were performed for 9 (8.2%) patients. Coiling was performed for 11 (10%) patients. ACOM was the most common site for ruptured aneurysm. Ictus-intervention interval (χ2 = 10.034, P = 0.007) and multiple surgical procedures (χ2 = 8.9341, P = 0.003) were the significant outcome determinants. Overall, 72.7% of those treated had a good outcome (Glasgow Outcome Score of 4 and 5). The good outcome was higher among microsurgery groups (73.7%) compared to the coiling group (63.6%) but this difference did not achieve statistical significance (χ2 = 0.46 P = 0.4976). Conclusion: Microsurgical options achieved good outcomes in the management of ruptured aneurysms in our series. Their availability makes them first-line options for low-income settings.
Strategies to offer uninterrupted neurosurgical care at a tertiary center in Makka amid COVID-19 pandemic
Authors: Azab Mohammed
Published: July 2021

Background: Globally, there is a shooting pandemic that affected many healthcare systems. Healthcare facilities had to set up logistics to avoid being drained while facing a catastrophic health problem. There are currently no available vaccines or perfect therapies and also no certified immunity against that disease. Therefore, it is probable that healthcare systems will face it for an exceptionally long period. That will have a grave effect on the strategy of daily practice of different specialties' services at healthcare centers. Impossible decisions in usual workdays are now forcibly adopted for the sake of patients, care providers, and health resources. Methods: We try in a simple way to share tertiary center expertise in managing neurosurgical cases amid a dreadful healthcare crisis. Healthcare workers' safety and patient safety were typical priorities for neurosurgical service at King Abdullah Medical City. We expose the lines of management, triaging cases, the methods of handling confirmed and suspected neurosurgical patients, and strategies for discharging and following up patients. We identified hospital admission and discharge records starting from March 2020 till July to track the neurosurgical case burden and the state of service offered and the rate of infection among healthcare workers who participated in surgeries. Results: At the peak time of the COVID-19 pandemic in Makka starting from March till July, we have admitted 250 neurosurgical patients. About 210 (84%) of them did surgeries according to the triaging protocol described in the article. About 155 (62%) of those who did surgeries were urgent and the rest were borderline or semi-urgent. About 10 (4%) were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and three of them died due to acute respiratory distress syndrome. Only two mortality cases were reported due to a neurological complication and not related to SARS-CoV-2 infection. The rest of the cases (98%) were discharged for follow-up without grave complications after they were offered the service. No neurosurgeons or anesthesia staff involved in offering the service were infected with SARS-CoV-2. Successful uninterrupted neurosurgical care was available for patients during that health crisis without any healthcare worker being infected. Conclusion: Following the suggested strategies, any center can provide the healthcare service amid any pandemic happening now or in the future without dismantling the normal health system, especially for life-saving cases in a critical specialty as neurosurgery.
Primary spinal extradural extraosseous primitive neuroectodermal tumor/Ewing's sarcoma: A critical analysis and review
Authors: Patil Akshay , Gupta Prasheelkumar , Iratwar Sandeep
Published: July 2021

Primary spinal extradural Ewing's sarcoma/primitive neuroectodermal tumor (PNET) is rare malignant tumor of childhood and early adulthood. The World Health Organization classifies PNET as an undifferentiated round cell tumor arising from primitive neuroepithelial cell. It can be central or peripheral PNET depending on site of presentation. Usually, the presenting symptoms are chronic back pain and myelopathy. Overall prognosis and survival are dismal in spite of total surgical resection and adjuvant therapy. Because of the rarity and malignant behavior, definite management of spinal PNET has never been described. After review of medical record at Acharaya Vinoba Bhave Rural Hospital, Sawangi, India, we identified four patients of spinal PNET and were included in our study. Age at diagnosis ranging from 15 to 26 years old with mean age of 20 years old. All four cases were epidural in location, two of which were of Askin type tumor with spinal cord compression. Rural population with low literacy and financial constraints were the key reasons of late presentations at our hospital. Counseling and proper education regarding the disease are a must for early case detection and early treatment of those living in rural areas and suffers from financial constraints. Due to rarity of the disease and its poor prognosis, a well-organized multicentric controlled trial is required to formulate a standard guidelines in the management of this disease.
Peripheral neurectomy for trigeminal neuralgia: A report of seventeen cases and review of the literature
Authors: Nagy Mohamed , Mahmoud Bokhary
Published: July 2021

Background: Surgical intervention for trigeminal neuralgia (TN) is indicated if there is a failure of the medical treatment. Peripheral neurectomy is one of the oldest surgical procedures for TN. Objective: The aim is to evaluate the clinical outcome and the recurrence rate following peripheral neurectomy for the management of TN. Patients and Methods: This was a retrospective cohort study of 17 patients with classical TN treated by peripheral neurectomy. The visual analogue scale (VAS) was used for pain assessment preoperatively and during the follow-up period. The outcome of surgery was graded as a marked, moderate, or mild improvement. Kaplan–Meier analysis was used for the time to recurrence to predict the probability of recurrence at any given time following the procedure. Results: The mean pain-free interval was 29.3 ± 16.3 months. At 2 and 5 years of the follow-up period, the mean VAS improved significantly (P < 0.001 and P = 0.042 respectively). Thirteen patients had marked improvement of pain. There was recurrence of pain in 4 patients (23.5%). By Kaplan–Meier analysis, the survival rate without recurrence at 2, 3, 4, and 5 years following the procedure were 92.9%, 79.6%, 59.7%, and 29.8%, respectively. The mean preoperative Hospital Anxiety and Depression Scale-Anxiety and Depression scores significantly improved on the last follow-up visit following the procedure (P < 0.001 for both). Conclusion: Peripheral neurectomy provides short to medium-term good pain control for patients with TN. The preoperative severity of pain, anxiety, and depression levels improved markedly after the procedure.
A rare variant of meningioma: Case report and review of literature
Authors: Joseph Elizabeth , Abraham Rojin , Koshy Sujin , John John
Published: July 2021

Meningioma is a morphologically heterogeneous tumour arising from meningothelial cells that has been classified by the World Health Organization into 15 different histological types and graded into three types groups (Grade I, II, and III) based on the biological behavior. Metaplastic meningioma is a rare subtype of meningioma characterized by focal or widespread mesenchymal differentiation in the form of bone, cartilage, fat, or xanthomatous tissue elements. Xanthomatous meningioma is a subclass of metaplastic meningioma which is exceedingly rare. Only a few cases have been reported in the literature. Here, we report the case of a 44-year-old man, who presented with left sided weakness and was diagnosed as a case of xanthomatous meningioma.
Outcome of decompressive craniectomy for traumatic brain injury: An institutional-based analysis from Nepal
Authors: Shah Damber , Paudel Prakash , Joshi Sumit , Karki Prasanna , Sharma Gopal
Published: July 2021

Objective: Decompressive craniectomy (DC) is one of the commonly used treatment modalities for refractory intracranial hypertension after traumatic brain injury. The objective of this study is to assess the functional outcome following DC in closed traumatic brain injury based on Glasgow Outcome Scale (GOS). Materials and Methods: This is a retrospective study conducted at Nepal Mediciti Hospital, Nepal, from September 2017 to October 2019. Data of the patients who had undergone DC for closed traumatic brain injury were reviewed from medical record files. Patients who had DC for nontraumatic causes were excluded from the study. Functional outcome was assessed using GOS at 3 months of follow-up. Results: Of the 52 decompressive craniectomies, 46 were included in the study. The majority was male (71.7%). The mean age and the mean Glasgow Coma Scale (GCS) score at presentation were 41.87 (standard deviation [SD] ± 15.29) and 7.59 (SD ± 2.97), respectively. The most common mode of injury was road traffic accident (76.1%). 60.9% had GCS score ≤8 while 39.1% had >8 GCS on admission. 34.8% had both the pupils reactive while 58.7% were anisocoric. Majority had Marshall IV and above grade of injury (67.4%). Sixteen (34.8%) had inhospital mortality. Favorable outcome was seen in 39.1%. GCS score >8 at presentation (72.2%, P < 0.001), bilaterally intact pupillary reflexes (75%, P < 0.001), Marshall grade injury ≤3 on computed tomography scan (90%, P < 0.001), and age <50 years (50%, P = 0.039) were significantly associated with favorable outcome. Procedure-related complications were seen in 36.9%. Conclusion: Favorable outcome was seen in 39.1%. Age <50 years, higher GCS score at presentation (>8), intact pupillary reflexes, and lower Marshall grade injuries were associated with favorable outcome. We recommend a larger prospective study to assess the long-term functional outcome after DC using extended GOS.
A case of nonapoplectic pituitary adenoma presenting with isolated oculomotor nerve palsy
Authors: Yokoyama Kunio , Ikeda Naokado , Sugie Akira , Yamada Makoto , Tanaka Hidekazu , Ito Yutaka , Kawanishi Masahiro
Published: July 2021

We report a rare case of nonapoplectic pituitary adenoma that did not invade the cavernous sinus and was associated with isolated oculomotor nerve palsy. A 61-year-old male was admitted to our hospital due to diplopia that had gradually worsened from 6 months to presentation. He was diagnosed with right oculomotor nerve palsy, and brain magnetic resonance imaging (MRI) showed a mass lesion within the sella. The tumor was homogeneously enhanced on contrast-enhanced MRI. However, no findings suggestive of pituitary apoplexy were found. Brain computed tomography revealed the tumor to have eroded the right side of the posterior clinoid process by gradual expansion. Endoscopic transsphenoidal surgery was used for complete resection of the tumor. Intraoperative findings showed that the tumor did not invade the cavernous sinus. The histological diagnosis was pituitary adenoma, and symptom improvement was observed from the early postoperative stage onward. Surgical treatment is essential because oculomotor nerve palsy caused by the enlargement of pituitary adenoma is not expected to resolve if treated conservatively, unlike that caused by pituitary apoplexy.
Landscape, presentation, and characteristics of brain gliomas in Zimbabwe
Authors: Jokonya Luxwell , Musara Aaron , Esene Ignatius , Mduluza-Jokonya Tariro , Makunike-Mutasa Rudo , Rothemeyer Sally , Ntenge Kalangu Kazadi , Mduluza Takafira , Naicker Thajasvarie
Published: July 2021

Introduction: Gliomas are tumors of the supporting cells of the central nervous system. They have great heterogeneity in their clinical and pathological features as well as prognosis. There is paucity of glioma epidemiology data in Zimbabwe. We carried out a study to determine the landscape, presentation, and characteristics of brain gliomas in Zimbabwe. Materials and Methods: A prospective cross-sectional study was conducted in Zimbabwe over a 2 years period to determine descriptive epidemiological data with regards to demographic distribution, presentation, and tumor characteristics. Consecutive patients from across the country with brain gliomas were recruited in the study. Results: A total of 112 brain tumors were diagnosed histologically. Of these 43.8% (n = 49) were gliomas and hence recruited in the study. The mean age of study participants was 40.3 years (standard deviation = 23.1 years), range 3–83 years. Male to female ratio (M:F) was 1:1. The study population consisted of 14% caucasians (n = 7), 83.7% black (n = 41), and 2% (n = 1) were of mixed race. Eighty-six percent (n = 42) of participants were from urban areas. The most common presenting complaint was headache in 87.8% (n = 43). The majority (61.2%) presented with a Karnofsky score ≥70%. Astrocytomas were the most common gliomas constituting 57.1% (n = 28), followed by ependymomas and oligodendrogliomas being 8.1% (n = 4) each. There was no statistical difference in the hemisphere of the brain involved (P = 0.475). Eight percent of the population were HIV positive (n = 4). Age above 60 years has an adjusted odds ratio of 13 for presenting with high-grade tumors. Conclusion: There is a disproportionately high number of gliomas among Caucasians, urban dwellers, and those gainfully employed. The prevalence of HIV in glioma patients is less than that of the general population.
Spinal nerve root extradural melanocytoma progressing to malignant melanoma: A case report with review of literature
Authors: Shaikh Salman , Gupta Gaurav , Mohanty Chandan , Deopujari Chadrashekhar
Published: July 2021

Melanocytomas are rare benign pigmented tumors arising from the leptomeninges with a very remote chance of progressing to malignant melanoma. They have a predilection for occurring in the posterior fossa or in the intradural extramedullary region of the cervical spine. We report the first case of malignant transformation of a nerve root (extradural) melanocytoma wherein immunotherapy has been added for its treatment. Only four such cases of malignant transformation of central nervous system melanocytoma have been reported in the literature. Definite diagnosis in such cases is based on immunohistochemistry evaluation. Surgical resection with adjuvant radiotherapy and immunotherapy is the recommended treatment.
Benchmarking of neurosurgery training in Pakistan
Authors: Ali Noor-Ul-Ain , Ali Syed , Sharif Salman , Amin Faridah
Published: July 2021

Introduction: Neurosurgery is a challenging field of surgery. A neurosurgeon has to be trained with the finest skills, knowledge, and competencies necessary to provide high-quality patient care. Maintaining postgraduate training standards is a challenge in Pakistan due to low budget allocation to the health sector. This study aims to assess the difference in parameters among different institutes in different sectors and provinces offering neurosurgery training in Pakistan. Methods: A nationwide survey was conducted by the Neurosurgery Department at Liaquat National Hospital Karachi, from November 2019 to February 2020. Data were collected through a questionnaire from neurosurgery trainees from all over the country. The questionnaire was divided into the following sections: Sociodemographics and infrastructure of training site, clinical skills training and exposure, knowledge-based education, and workload. The data were kept confidential and institutional names were not inquired or disclosed. Results: The response rate was 85.3% (151/177), with more males (80%) than females. The total number of trainees was higher in government than private institutions (P < 0.005). The frequency (P = 0.030) and number of trainees (P < 0.005) inducted per cycle was more among government institutions. Participation in international conferences was higher among trainees in private sector (P = 0.006). The frequency of clinics was significantly higher in private institutions (P < 0.005), though the number of patients seen per clinic was lower than in government sector (P < 0.005). At a provincial level, there was a significant difference in gender distribution (P = 0.020), total number of trainees (P < 0.005), number of residents per induction (P < 0.005), frequency of mortality and morbidity meetings (P < 0.005), morning meetings (P < 0.005), number of calls per week (P < 0.005), number of workshops attended (P < 0.005), exposure to radiation (P = 0.003), frequency of outpatient departments (OPDs) attended per week (P = 0.002), and number of patients seen per OPD (P 0.02). Conclusion: This study reported variability in the quality of neurosurgery training programs within public and private sector with even greater differences between the four provinces of Pakistan. We recommend continuous assessments and re-accreditation of these training programs through subject experts and health-care educationists to improve the quality of training programs; hence the quality of service and patient care.
MR venography in gamma knife radiosurgery for parasagittal meningiomas: A technical note with the rationale of venous protection and a review of literature
Authors: Sahoo Sushanta , Ahuja Chirag , Dhandapani Sivashanmugam , Madan Renu , Tomar Parsee , Kumar Sushil , Kaur Manjeet
Published: July 2021

Postradiosurgery symptomatic brain edema may be seen with parasagittal meningioma owing to its proximity to major venous sinuses and cortical veins. Venous preservation radiosurgery planning is less described. Here, we discuss a new method of tumor volume contouring on postcontrast magnetic resonance venogram (CEMRV) images safely excluding the adjacent cortical veins and sinuses. Six cases of parasagittal meningiomas where Gamma Knife radiosurgery was planned on CEMRV sequence were studied in detail. A double-contrast injection method was used to obtain CEMRV images. The differential contrast enhancement showed the displaced and compressed sinuses and cortical veins in the vicinity of meningioma. Tumor was contoured on both contrast magnetic resonance imaging (CEMRI) and MRV image for comparative analysis. 15 Gy at 50% marginal isodose was prescribed and quantitative assessment showed reduced exposure to the adjacent veins and sinuses on the MRV plan as compared to the CEMRI plan. All patients remain asymptomatic at a mean follow-up of 34.2 months. Postcontrast MRV is a simple sequence and can delineate the adjacent venous structures in parasagittal meningiomas. Tumor contouring directly on this sequence guides the surgeon to prescribe adequate radiation dose while sparing cortical veins and sinuses in radiosurgery planning.
Recurrent papillary tumor of pineal region misdiagnosed as pineocytoma 9-years ago
Authors: Mehta Nirav , Gupta Gaurav , Shaikh Salman
Published: July 2021

Primary tumors of the pineal gland occur infrequently with a preponderance of either parenchymal tumors or germ cells tumors. Papillary tumor of the pineal region is a rare neuroepithelial lesion that arises exclusively in the pineal region. They have been designated as either Grade II or Grade III lesions as per the 2016 WHO classification of central nervous system tumors. Clinically, they usually present with obstructive hydrocephalus and visual disturbance. On imaging, these tumors are solid-cystic, heterogeneously enhancing, and show T2 hyperintensity. Pathologically, they can closely resemble a Grade I pineocytoma and immunohistochemistry is essential to differentiate the two. No definite guidelines exist to confirm the ideal protocol of treatment. Evidence regarding the role of radiation after surgery is limited to case reports and series. Adjuvant therapy is usually recommended for tumors with subtotal excision, high proliferative/mitotic index, or proven metastasis. We describe a case of a 29-year-old male with a recurrent papillary tumor of the pineal region, 9 years after primary surgery where it was misdiagnosed as a pineocytoma. The tumor was effectively controlled with surgical excision, cerebrospinal fluid diversion, and adjuvant radiation for 8 years before showing two recurrences within a span of 6 months with a rising proliferation index.
Optimal use of temporary clip application during aneurysm surgery – In search of the holy grail
Authors: Kumar Sanjeev , Sahana Debabrata , Menon Girish
Published: July 2021

Temporary clips are invaluable safety tools during the clipping of an aneurysm. Controversies regarding maximum permissible duration and safety, however, remain unanswered. This descriptive narrative attempts to review the literature to provide valuable insights on controversies clouding the use of temporary clips among neurosurgeons. Popular databases, including Pub Med, Medline/Medscape, Scopus, Cochrane, Embase, Google Scholar, were searched to find available literature on temporary clips. The searched MeSH terms were “Temporary Clip,” “Temporary Clipping,” “Cerebral Aneurysm,” and “Aneurysm.” Temporary clips have been in use since 1928 and have undergone considerable structural and technical modifications. A temporary clip's optimal safety limit is not yet defined with literature evidence ranging from immediate to 93 min. It is not yet definite whether temporary clips application aggravates vasospasm, but emergency temporary clips application, especially in poor-grade aneurysmal subarachnoid hemorrhage patients, is associated with poor outcomes. A temporary clip needs to be applied with caution in patients treated earlier by endovascular technique and having indwelling stents. Nitinol Stent is feasible, while a Cobalt-Chromium alloy stent does not get occluded and gets deformed under the closing pressure of a temporary clip. Although a temporary clip application is a fundamental strategy during the clipping of an aneurysm; the exact safe duration remains to be decided in randomized control trials. Their utility for the shorter duration is beneficial under un-conclusive evidence of neuroprotective agents and intraoperative monitoring. Neurosurgeons need to consider all aspects of their pros and cons for optimal use.
Pathological diversity in schwannomas of the orofacial region
Authors: Urs Aadithya , Kumar Priya , Augustine Jeyaseelan , Malhotra Rewa , Jot Kiran
Published: July 2021

Schwannoma is a slow-growing, encapsulated benign tumor of the neuroectodermal origin arising from the perineural Schwann cells. This study aims to elucidate the clinicoradiographical and histopathological features of orofacial schwannomas through a case series of seven cases. The patients' aged ranged from 13 to 45 years, with a male predilection in the ratio of 5:2. One intraosseous case presented as a radiolucent lesion. All the cases exhibited Antoni A and Antoni B type of microscopic patterns in varying amounts. One case of ancient schwannoma showed degenerative features. The tumor cells showed diffuse positive immunohistochemical reaction for S-100 protein. Our study suggests that intraosseous schwannoma should be considered in the differential diagnosis of the intraosseous jaw lesions. Histopathologically, it is important to recognize the findings of ancient schwannoma and to avoid misdiagnosing it as a malignant lesion.
Cortical blindness after cervical spine surgery in supine position – A rare case report and review of the literature
Authors: Mulukutla Raghav , Yelamarthy Phani , Vadapalli RamMohan
Published: July 2021

We report the first case of perioperative visual loss due to cortical blindness after supine cervical spine surgery. A 46-year-old female presented with severe right-sided brachialgia of 1½ years' duration. Her magnetic resonance imaging (MRI) (cervical spine) showed severe right foraminal stenosis at C5–6. She underwent C5–6 anterior cervical discectomy and fusion. Nine hours after surgery, during a routine postoperative round, the patient complained of complete bilateral visual loss. The fundus examination and pupillary light reflex were normal. MRI of the brain showed the posterior cerebral artery infarct with hypoplasia of the left vertebral artery. She was transferred to the neurointensive care unit where antiplatelet treatment was started along with heparin. Her vision slowly began to improve, and at the end of 1 year, she had a reasonable visual acuity in both eyes. It is now standard practice in our institution to check patients' vision immediately after surgery.