bluuebunny/crossref_metadata_2025 huggingface dataset:
Trigeminal Neuralgia Secondary to Meckel's Cave Meningoencephaloceles
Authors: Martínez Jaime L , Domingo Ricardo A , Rowland Nathan C , Vandergrift William A
Published: August 2023

Background:

The culprit of trigeminal neuralgia (TGN) may occur at any point between the nerve's root entry zone (REZ) and Meckel's cave. Meckel's cave meningoencephaloceles are rare middle cranial fossa defects that usually remain asymptomatic but may contain prolapsed trigeminal nerve rootlets and result in TGN. Their management and surgical outcomes remain poorly understood.

Objectives:

To perform a systematic review of clinical presentation and surgical outcomes of middle fossa defects presenting with trigeminal nerve-related symptoms.

Materials and Methods:

A systematic review was conducted in accordance with the PRISMA guidelines for all reports of middle cranial fossa defects causing trigeminal nerve-related symptoms. The pathophysiology, presentation, surgical management, and outcomes are discussed and illustrated with a case.

Results:

Initial search from inception to March 2021 identified 33 articles for screening. After applying inclusion and exclusion criteria, 6 articles were included representing a total of 8 cases in addition to our case (n = 9). All 9 patients were females and 33.3% (n = 3) presented with classic trigeminal neuralgia. “Empty sella” syndrome and radiologic signs of intracranial hypertension were present in 40%–62%. No patient presented with cerebrospinal fluid leak. The preferred treatment modality was surgical with subtemporal extradural repairs using combinations of autologous fat and muscle grafts and synthetic dura. Postoperative outcomes were only available in 55.5% (n = 5) of the cases, and nearly all reported complete symptom resolution, except for one case in which the meningoencephalocele wall was incised, along with trigeminal rootlets adhered to it. Our patient had immediate and durable symptom relief after a 4-year follow-up.

Conclusions:

MEC containing prolapsed trigeminal nerve rootlets can cause typical trigeminal neuralgia from chronic pulsatile stress. This supports the hypothesis that the compressive or demyelinating culprit can locate more ventrally on the course of the trigeminal nerve. Subtemporal extradural surgical repairs can be safe, effective, and durable. Incising the MEC wall should be avoided as it may have trigeminal rootlets adhered to it.
A Comprehensive Stemness Gene Expression Analysis Signifies the Role of ABC Transporters and Molecular Chaperons in Determining the Fate of Human Neural Precursor Cells
Authors: Vishwakarma Sandeep Kumar , Bardia Avinash , B Fathima Syeda Sumaiya , Basha Paspala Syed Ameer , Khan Aleem Ahmed
Published: August 2023

Background and Aim:

The major aim of this study was to identify the most common stemness genes across different stem cell types and further validate them in human fetal subventricular zone-derived primary and cultured neural precursor cells (NPCs). This study involved the use of a unique method of stemness meta-analysis (SMA) for investigating comprehensive upregulation and downregulation of differentially expressed genes (DEGs) among different stem cell populations.

Materials and Methods:

A total of 55 mouse and human data sets targeting crucial genes identified in seven different types of stem cells population were screened and subjected to independent DEGs analysis using SMA. Identified 30 meta-gene signatures were subjected to functional enrichment analysis based on their biological processes and molecular functions. Validation of enriched meta-gene signatures was performed using RT-qPCR. Cellular localization of ABCB1 and ABCG2 was identified using immunofluorescence staining, whereas functional assessment was performed using western-blot.

Results:

SMA analysis revealed that among 52 commonly expressed genes, 30 genes were either upregulated or downregulated in at least two stem cell populations. Further gene enrichment analysis showed nine genes (ABCB1, ABCG2, HSPA4, HSPA9, HSPA14, Nestin, Sox-2, Oct-4, and Notch-2) with the highest combined scores among 30 meta-gene signatures. RT-qPCR demonstrated that all the enriched gene signatures were significantly upregulated in primary NPCs and further downregulated during NPCs lineage differentiation in culture except HSPA4, HSPA9, and HSPA14 gene transcripts.

Conclusions:

The stemness meta-gene signatures were abundantly expressed in human NPCs population which categorically suggest the involvement of these genes/pathways in pluripotency maintenance and molecular switches for lineage differentiation while HSP-70 had a neuroprotective effect.
Pituitary Involvement as a Primary Manifestation of Granulomatosis with Polyangiitis
Authors: Koc Emine R , Gullu Gizem , Guner Altug , Tolunay Sahsene , Ozpar Rifat , Dalkilic Huseyin E
Published: August 2023

Granulomatosis with polyangiitis is a systemic necrotizing granulomatous vasculitis that can predominantly affect systemic small- and medium-sized vessels. Isolated pituitary gland involvement at the onset of the disease is extremely rare in granulomatosis with polyangiitis and usually associated with other organ involvement, especially upper and lower respiratory tract and kidneys. This report highlights granulomatosis with polyangiitis -related pituitary dysfunction with clinical, radiological, and laboratory findings.
Quality of Communication Life (QoCL) In Persons with Expressive Aphasia With And Without Communication Intervention – A Comparative Study
Authors: Preetha Udayakumar Madhu , Perumal Radhakrishnan Chella
Published: August 2023

Background:

Communication difficulties in aphasia can result in social isolation, challenges with interpersonal relationships, emotional changes, inability to return to work, and lack of independence. Therefore, intervention is essential particularly in the context of functional communication for persons with aphasia (PwAs). Studies have also indicated that quality of communication life (QoCL) is a valid measure of the impact of communication difficulty on quality of life.

Objective:

To estimate the relationship between communication intervention and QoCL in individuals with expressive aphasia.

Methods and Material:

Twenty PwAs were divided into two groups: group I individuals had undergone at least 3 months of speech and language intervention whereas group II individuals did not have any formal communication intervention. Tamil version of the QoCL scale was administered for all participants. Statistical analysis was carried out using Mann–Whitney U test and Spearman's rho correlation coefficient.

Results:

Individuals with speech and language intervention in group I had higher scores in overall QoCL domains as well as in overall QoL when compared to group II. The results of correlation analysis indicated that individuals with greater therapy duration had significantly high scores.

Conclusions:

The results prove that communication intervention is necessary for PwAs to improve QoCL and can be used to raise awareness of its importance. The findings can also guide treatment planning, counseling the PwA, and caregivers. It also indicates the importance of using patient-related outcome measures during the intervention process.
Risk Factors for and Outcomes of Postoperative Entrapped Temporal Horn in Trigone Meningiomas
Authors: Liu Shuang , Liu Xueyou , Wang Meng , Wang Zhengfeng
Published: August 2023

Background:

Meningioma in the ventricle triangle area is a benign tumor that can be cured by surgery, but postoperative entrapped temporal horn may seriously affect the patient's quality of life and even require a second operation. Currently, there are few reports on this complication.

Objective:

The risk factors and prognosis of postoperative ETH in trigone meningiomas were investigated.

Material and Methods:

A retrospective analysis of the clinical data of 87 patients with trigone meningioma from 2010 to 2018 was performed, and univariate and multivariate analyses were used to assess the risk factors associated with postoperative ETH. The degree of ETH was evaluated using the modified ventriculocranial ratio.

Results:

The incidence of postoperative ETH in trigone meningioma was 29.9% (26/87). Preoperative ETH [odds ratio (OR): 4.826, 95% confidence interval (CI): 1.820–12.796, P = 0.002] and postoperative meningitis (OR: 12.811, 95%CI: 1.615–101.605, P = 0.016) are independent risk factors for postoperative ETH. Of the 18 patients with ETH syndrome, 12 improved after medical treatment, and finally, a total of 6 patients received ETH surgery. The mean duration from tumor resection to the appearance of ETH syndrome was 3.1 ± 1.9 months (range: 9 days–7 months). Patients with ETH grade II and III are more prone to clinical symptoms.

Conclusions

: The incidence of postoperative ETH for trigone meningiomas is high, and clinical symptoms generally appear delayed after surgery. Reducing postoperative infections can reduce the occurrence of postoperative ETH. Patients with symptoms of ETH who have failed medical treatment have clear indications for surgery.
Inflammatory Myositis in a Child due to Anti-NXP2 Antibody, First Case Report from India
Authors: Reddy Taallapalli Ashok V , Shivaram Sumanth , Gupta Manisha , Nashi Saraswati , Vengalil Seena , Kulkarni Girish B , Alladi Suvarna , Nalini Atchayaram
Published: August 2023

We present a case of a 10-year-old boy with 1-month history of proximal more than the distal weakness of all four limbs with myalgias, contractures, and bulbar symptoms on a background history of exertional myalgias for 2 years. His power was grade two-three. Investigations showed elevated creatine phosphokinase (CPK). His auto-antibody profile showed anti- nuclear matrix protein 2 (NXP2) antibody positivity. Muscle magnetic resonance imaging (MRI) showed extensive T2 fat-saturated hyperintense signal changes in the glutei, thigh, and leg muscles suggestive of active myositis. He improved significantly with immunomodulation with steroids, intravenous immunoglobulins (Iv Ig), and mycophenolate mofetil (MMF). He was continued on monthly pulse steroids and MMF. He is on regular follow-up. This is a rare case of anti-NXP2 antibody-mediated inflammatory myositis and the first report from India.
Factors Associated with Outcomes in Patients with Chronic Subdural Hematoma who Underwent 'Burr Hole Craniotomy'
Authors: Allahdini Faramarz , Rahmani Khaled , Afkhamzadeh Abdorrahim
Published: August 2023

Background and Objective:

Chronic subdural hematomas (CSDH) is frequently encountered in neurosurgical practice. The aim of this study was to investigate the factors associated with the outcome of Burr Hole Craniotomy.

Methods:

This study was conducted on 116 patients with CSDH in Be'sat Hospital, an educational hospital, in Kurdistan province, Iran. We used Glasgow outcome scale (GOS) at times of discharge and 1 month after stitch removal as favorable outcome. Student t-test or corresponding nonparametric test (Mann–Whitney U test) and logistic regression were used to assess the relationship between investigated variables and favorable outcome.

Results

: The results indicated that the chance of success after surgery in patients with CSDH was different based on several variables. The chance of cure after surgery among CSDH male patients (OR = 12.5), patients who have no atrophy (OR = 25.0), patients with no cardiovascular diseases (OR = 7.14), patients who had no medical complications after surgery (OR = 2.08), and patients with higher GCS score at the time of hospitalization (OR = 1.31) was higher.

Conclusions:

Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.

s:

Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.
Telomerase Reverse Transcriptase Promoter Mutations in A Cohort Of Adult Gliomas – Clinicopathological Correlates
Authors: Balakumar Shailaja , Pai Rekha , Chacko Ari G , Patel Bimal , Nancy Rachel , Balakrishnan Rajesh , Sarkar Sauradeep , Sampath Gowri , Chacko Geeta
Published: August 2023

Background:

Introduction: Gliomas were previously classified histologically, although now the latest WHO classification incorporates several molecular markers to classify these. Detection of TERT promoter mutations is assuming increased importance due to its relevance to prognostication.

Objective

: The aim of this study was to determine the frequency of TERT promoter mutations, association of TERT promoter mutations with other molecular alterations and to assess the role of TERT promoter mutations in overall survival and progression-free survival in relation to histological and molecular glioma subtypes.

Materials and Methods:

This study analyzed a cohort of 107 adult patients with diffuse gliomas, WHO grades II and III and glioblastoma, by immunohistochemistry for IDH and ATRX mutations, FISH for 1p/19q co-deletions and PCR sequencing for TERT promoter mutation. Further, five glioma molecular sub-groups were derived using three molecular alteration and included the sub-groups with: i) IDH mutations only, ii) IDH and TERT mutations only, iii) IDH and 1p/19q co-deletion only, iv) Triple negative, and v) Triple positive.

Results:

IDH mutations and 1p/19q co-deletions were individually and significantly associated with an improved progression free (P = 0.001 and P = 0.002, respectively) and overall survival (P = 0.000 and P = 0.005, respectively) in the present cohort of gliomas. TERT promoter mutations occurred frequently in anaplastic oligodendrogliomas (94%), oligodendrogliomas (87.5%) and glioblastomas (54%). Sub-division into molecular sub-groups showed that the triple-positive tumors carried the best prognosis, followed by IDH only, triple negative and finally the TERT mutation only tumors (P < 0.000).

Conclusion

: This indicates that sub-classification using these molecular markers separates tumors into prognostically relevant categories.
A Rare Case Report of C1 Posterior Arch and C2 Laminae Hypertrophy Causing Cervical Myelopathy
Authors: Venkatesan Ravi , Pammi Srinath
Published: August 2023

Cervical canal stenosis, localized to upper cervical spine, is very rare which can be developmental or acquired. Hypertrophic osteoarthritis accompanied by dens hypertrophy, hypertrophy of the osodontoideum, ossification of the transverse atlantal ligament, aplasia or developmental defect of the posterior arches of Atlas, and unilateral lateral mass hypertrophy are some of the rare reported conditions causing cervical myelopathy. Localized upper cervical canal stenosis due to hypertrophied C1 posterior arch and C2 laminae hypertrophy as an isolated cause of cervical myelopathy has not been reported earlier to our knowledge. We report a case of cervical myelopathy in a 52-year-old gentleman due to the hypertrophied posterior arch of atlas and laminae of axis. C2 laminectomy along with removal of the posterior arch of Atlas and decompression is the treatment. No adjuvant radiotherapy or chemotherapy is needed. The knowledge of such an entity will avoid surprises in the diagnosis and facilitates the management.
Needle Electromyography in the Acute Phase of Stroke
Authors: Silva Bitencourt Ana Carolina , Fernandes Thiago Dias , Bazan Rodrigo , Luvizutto Gustavo José
Published: August 2023

Background:

After the stroke, the development of the second motor neuron degeneration can reduce muscle strength and functional capacity.

Objective:

The aim of this study was to describe the electro-myographic findings in the acute phase of stroke and to correlate them with the severity and muscle strength.

Material and Methods:

Twenty patients were studied in the first 72 hours after stroke. The severity of the lesion was assessed using the National Institutes of Health Stroke Scale (NIHSS), and muscle strength was assessed using the Medical Research Council Scale (MRC). Sensory conduction and motor conduction were studied to exclude peripheral polyneuropathy, radiculopathies, or other neuro-muscular diseases, and electro-myography (EMG) was performed with co-axial needle electrodes in the deltoid, carpal radial extensor, vastus lateralis, and anterior tibialis at rest, slight effort and maximum effort. The associations between qualitative and quantitative variables were studied using the Chi-square test and Fisher's exact test.

Results:

Among the patients, 40% had abnormal EMG [positive sharp waves (PSWs), fibrillation, fasciculations, and abnormal patterns in maximum effort]. Positive correlations were found between NIHSS and PSW (p = 0.005; r = 0.65) and abnormal EMG (p = 0.017; r = 0.72), and negative correlations were found between MRC and PSW (p = 0.041; r = -0.83) and abnormal EMG (p = 0.027; r = -0.81).

Conclusion:

It was concluded that the main EMG findings in the acute phase of stroke were the presence of the denervation process and polyphasic motor unit potentials. These changes in EMG were correlated with stroke severity and lower muscle strength.
Retinal Changes in Parkinson's Disease
Authors: Mailankody Pooja , Battu Rajani , Lenka Abhishek , Mohammed Shereef PM , Thennarasu K , Yadav Ravi , Pal Pramod Kumar
Published: August 2023

Background:

There is definite evidence for the involvement of retina in Parkinson's disease (PD). However, a specific pattern has not been clear due to the cross-sectional nature of the majority of the previous studies.

Objective:

The aim of this work was to study the pattern of changes in the retinal layers in patients with PD on longitudinal follow-up.

Materials and Methods:

Twelve patients with PD (23 eyes) were evaluated at baseline with complete history, clinical examination, Unified Parkinson's Disease Rating Scale (UPDRS) motor part, visual acuity, and retinal imaging with spectral-domain Optical Coherence Tomography. After a mean duration of 3.7 ± 0.46 years, patients were re-evaluated.

Results:

The Central Macular Thickness (CMT) of the right eye was found to be significantly thicker during the follow-up (P = 0.002). The outer retinal layer in the temporal quadrant at 0.5 centimeters from the fovea of the left eye was found to be significantly thinner (P = 0.001).

Conclusion:

The serial evaluation of the retinal layers in patients with PD suggests a progressive loss of thickness of the outer retinal layer. The involvement of non-dopaminergic mechanisms, especially glutamatergic pathways, may be responsible for these changes.
Dengue Associated Demyelinating Disorders – A Report of 2 Cases
Authors: Ganguly Mimi , Giri Prabhas P , Mukherjee Mausumi , Jagwani Harshita , Banerjee Arundhati
Published: August 2023

Dengue is a common viral infection worldwide, though its neurological manifestations are infrequent (2%–11% in recent years) and can be varied as the Dengue virus per se is a non-neurotropic virus. Neurological manifestations of Dengue usually result from multisystem dysfunction which may be secondary to vascular leak or it can be due to direct virus invasion (dengue encephalitis) or an immunological phenomenon which is triggered by dengue infection (demyelinating disorders). Here we present two cases of dengue fever associated demyelinating disorders in two pediatric patients aptly depicting the two spectra of the disease. One of them is a case of fatal acute hemorrhagic leukoencephalopathy (AHLE) in a 3-year-old girl, that developed severe neurological sequelae while the other one is a case of an Acute disseminated Encephalomyelitis (ADEM) in a 3-year-old boy who had recovered with timely immunomodulatory therapy and appropriate management.
Clinical and Molecular Spectrum of Degenerative Cerebellar Ataxia
Authors: Balakrishnan Surya , Aggarwal Shagun , Muthulakshmi Mayandi , Meena Angamuthu Kanikannan , Borgohain Rupam , Mridula Kandadai Rukmini , Yareeda Sireesha , Ranganath Prajnya , Dalal Ashwin
Published: August 2023

Background:

Cerebellar ataxia is a disabling neurological symptom with extreme clinical and etiological heterogeneity.

Objective:

To study the clinical and molecular characteristics in patients with degenerative cerebellar ataxia.

Materials and Methods:

In this study, 150 South-Indian patients with degenerative cerebellar ataxia underwent a phenotype guided, sequential tiered testing. Phenotypic features studied included cerebellar symptoms, pyramidal and extrapyramidal features, and ophthalmic and systemic findings. Tier one included conventional tests such as short PCR/fragment analysis for spinocerebellar ataxia (SCA) subtypes 1, 2, 3, 6, 7, 8, 12, 17, and 36 and TP-PCR for Friedreich ataxia (FA). Tier two testing comprised next-generation sequencing (NGS)-based strategies reserved for select undiagnosed cases.

Results:

The clinical features were highly overlapping and had limited specificity, except in autosomal recessive ataxias and SCA 34. The overall diagnostic yield of our study was 49.3%. SCA 1, 2, and 3 were noted in 13 (12.6%), 12 (11.6%) and 14 (13.5%), respectively, out of the 103 tested, and FA was noted in 17/55 (30.9%) patients. SCA subtypes 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. Targeted Sanger sequencing and NGS revealed some rare diagnoses in 17 among the 18 patients tested. Whole exome sequencing uncovered a novel genotype-phenotype association in a sibling-pair with ataxia, dysmorphism, and retinopathy.

Conclusion:

SCA 1, 2, 3 and FRDA were the most common causes of ataxia. SCA 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. NGS testing revealed several rare forms of ataxia. Clinical features based testing is cost-effective, achieves good genotype-phenotype correlation, and prioritizes variants for further studies.
Development and Validation of a Multivariable Model to Predict Surgical Outcome in Patients with Chiari malformations
Authors: Kumar Shishir , Chandrachari Komal P. , Mariswamappa Kiran , Pillai Shibu V. , Vijayendra Vishwas H. , Lale Sathyanarayana , Hegde Thimappa
Published: August 2023

Background:

Surgical outcome predictive models for Chiari malformations (CM) which are applicable to all age groups and simple enough to use on outpatient basis are lacking.

Objective:

The aim of this study was to develop and validate a preoperative index for predicting long-term outcomes in Chiari 1 (CM1) and Chiari 0 (CM0) malformations.

Materials and Methods:

It was a single-institution, ambidirectional, cohort study from 2014 to 2019, having patients between 5 to 70 years. Outcome was assessed using Chicago Chiari outcome score (CCOS) over 2 years follow-up. Preoperative clinical and radiological factors were analyzed using Chi-square test and Mann Whitney U test, in relation to CCOS and those attaining P value ≤0.05, were used to develop model - Chiari Outcome Predictive Index (COPI). COPI was internally validated using 10-fold cross-validation and c-statistic for discrimination.

Results:

A total of 88 patients (66 in development and 22 in validation cohort) were included in the study. Outcome was negatively associated with presence of motor, sensory or cranial nerve symptoms, poor functional status, basilar invagination, and tonsillar descent. It was positively associated with shorter duration of presenting symptom (<9 months) and syrinx diameter <6 mm. COPI predicted CCOS with 91.1% accuracy (10-fold cross-validation). It had excellent discrimination for improved outcome (c = 0.968 in development and 0.976 in validation cohort), at threshold index of -1.

Conclusions:

COPI is simple tool that can be administered in outpatient setting. It can facilitate evidence-based preoperative counseling of patients, to help them develop reasonable expectations regarding surgical outcomes.
A Review of the Diagnostic Features of Posteriorly Migrated Lumbar Discs with Reports of Two Cases
Authors: Ayyappan Unnithan Ajaya Kumar
Published: August 2023

Background:

The radiological features of posteriorly migrated intervertebral discs mimic tumors, hematoma, and abscess.

Objective:

The aim is to analyze two cases of posteriorly migrated lumbar discs.

Cases:

Two males had features of cauda equina syndrome. Both had posterior lesions at L4/5 level in magnetic resonance imaging. The mass of the 41-year-old man had peripheral rim enhancement with gadolinium. The epidural mass was excised. The histopathology showed fibrocartilaginous disc. The 67-year-old man had mass with moderate enhancement. The mass had thinned the dura to appear as intradural tumor. The histopathology showed a fibrocartilaginous disc. Immunohistochemistry was negative for neoplasm.

Conclusion:

A migrated disc should be considered in the case of a posterior extramedullary mass. The granulation tissue around the disc produces peripheral enhancement with gadolinium. Thin enhancement is common. Thick enhancement is also reported. Neoplasms have intense enhancement and inflammatory changes are seen in abscess.
Prospective Study of Sinonasal Outcome Following Endoscopic Skull Base Surgery
Authors: Gohil Jaypalsinh A , Stanley Antony , Jamaluddin Mohamed A , Singh Arvind K , Shah Shreykumar , George Tobin , Rangnekar Ranjit D , Nair Prakash , Abraham Mathew
Published: August 2023

Background:

Endoscopic endonasal surgery (EES) requires wide sinonasal dissection to achieve adequate visualisation of anatomical landmarks. This can also result in nasal sequelae like crusting, nasal discharge, and anosmia.

Aim:

To use the sinonasal outcome test (SNOT) 22 questionnaire to study the postoperative sinonasal morbidity and its recovery in patients who have undergone EES.

Materials and Method:

Prospective study conducted from November 2017 to May 2018. SNOT-22 questionnaire was administered on patients operated between before EES and then re-administered during outpatient visits at 1 month, 3 months, and 6-12 months following surgery.

Results:

Results of 46 patients were analyzed. The mean duration of follow-up was 11.8 months. The mean preoperative SNOT-22 score was 2.69 ± 4.95. SNOT-22 score at 1 month was 5.52 ± 6.77, at 3 months follow-up was 0.39 ± 1.02, and after 6 months was 0.30 ± 1.00. In 32 patients with a nasoseptal flap, mean preoperative score was 3.34 ± 5.68 (P = 0.18), one month following surgery it was 6.68 ± 6.88 and at 3 and 6 months following surgery it was 0.56 ± 1.19 and 0.38 ± 1.15. The mean preoperative nasal domain score was 1.022 (±2.13), the postoperative 1 month score was 2.3 ± 3.7, at 3 months following surgery was 0.22 ± 0.82 and after 6 months of surgery was 0.28 ± 0.96.

Conclusion:

Patients undergoing EES experienced transient worsening of SNOT 22 scores in the first month following surgery and recovered within 3 months of surgery. The improvement was sustained in follow-up visits beyond 6 months of surgery.
Medicolegal Priorities for a Neurosurgeon/Neurologist in the COVID Era
Authors: Vilanilam George C , Gohil Jaypalsinh
Published: August 2023

Vulnerable moments, panic, and uncertainties are the hallmarks of pandemic outbreaks. Medicolegal challenges add further injury to the public health chaos. Although containing the pandemic is of prime concern, medicolegal and ethical uncertainties further complicate ideal standards of medical care. Constraints in the provision of medical care, resource limitations, infectivity risks, burgeoning costs, and pandemic control laws, create extremely precarious medicolegal situations. Ethics and medical negligence laws may, at times, be trampled upon by the overwhelming urgencies of the pandemic. Hence, we attempt to review basic ethical and medicolegal principles that are put to test by pandemic urgencies. We aim to study these vulnerable medicolegal moments in neurosurgeons'/neurologists' clinical and research practices during the COVID-19 times from our own practice and contemporary literature on COVID practices, medicolegal sciences, and pandemic healthcare directives. We also review supportive measures and safeguards to brace these vulnerable moments effectively. We compile medicolegally sound and ideal practice parameters, including the basic principles for a restructured informed surgical consent ensuring a medicolegally and ethically sound practice. Several ethical and medicolegal exigencies are part of medical practice during a pandemic. Special care should be taken to avoid violations of medicolegal and ethical proprieties during the urgencies of medical care and research. Restructuring of contracts like the informed consent would also count as an ideal practice modification in a pandemic.
Microsurgery versus stereotactic radiosurgery for small petroclival meningiomas presenting with intractable trigeminal neuropathy
Authors: Hegazy Ahmed , Al-Shami Hieder A , Arundhati Biswas , Negida Ahmed , A Hafez Raef F , Fahmy Osama M , Ragab Omar A , Elkatatny Amr M , Amin Sameh M , Ali Mohammed F A
Published: August 2023

Background:

Data on the outcomes of microsurgical resection (SR) and stereotactic gamma knife radiosurgery (GKRS) in patients with trigeminal neuralgia associated with small petrous apex meningiomas are scarce.

Objective:

We conducted this study to evaluate the pain relief, tumor control, and procedure costs following SR and GKRS for small petroclival meningiomas (less than 3 cm in maximal diameter) using real-world data from our center in Egypt.

Material and Methods:

We conducted a retrospective cohort study of 47 patients with small petrous apex meningiomas presenting with intractable trigeminal nerve pain (SR: n = 22 and GKRS: n = 25). Data regarding pain relief on Barrow Neurological Institute (BNI), procedure cost, and tumor control were retrieved and analyzed using appropriate statistical tests.

Results:

Patients who underwent SR had lower median BNI pain intensity scores compared to those patients who underwent GKRS, and a significantly higher proportion of patients in the SR group had good BNI scores compared to those in GKRS group (P < 0.05); however, the total costs of SR were significantly less than GKRS (30,519$ vs. 92,372$, respectively).

Conclusion:

Both SR and GKRS provide pain relief and tumor control in patients with trigeminal neuralgia associated with petrous apex meningioma. However, in the present study, SR achieved better pain control and was more affordable than GKRS.
iCT Navigation for Transpedicular Screw Fixation in the Thoracolumbar Spine
Authors: Payer Michael , Wiesli Markus , Woernle Christoph
Published: August 2023

Background:

Various guidance techniques have been developed for optimal pedicle screw placement. We present our initial experience with intraoperative CT (iCT) navigation for transpedicular screw fixation in the thoracolumbar spine.

Objective:

This study aimed to describe the accuracy and reliability of iCT navigation for transpedicular screw fixation.

Material and Methods:

One hundred consecutive patients underwent thoracolumbar pedicle screw fixation under iCT navigation. After iCT registration of the local bony anatomy with a firmly attached spinous process tracker, pedicle screw placement was performed under navigation with an infrared camera and infrared reflectors on insertion instruments. Screw trajectories of the intraoperative verification CT were matched against the navigation paths. Radiological and clinical follow-up was prospectively documented and retrospectively analyzed. The study included 47 women and 53 men with a mean age of 66 years. Indications for thoracolumbar pedicle fixation were degenerative instability with stenosis, cyst or disc herniation (82), spondylolytic instability (9), scoliosis with stenosis (6), and traumatic fractures (3). A total of 443 pedicle screws were inserted: 22 in the thoracic spine, 371 in the lumbar spine, and 50 in S1.

Results and Conclusions:

Four hundred thirty-five out of 443 screws (98%) were correctly placed. Misplacement was explained by loosened infrared reflectors on pedicle awl or probe, or by the displacement of the spinous process tracker; misplaced screws were re-inserted intraoperatively and showed correct placement on the second verification CT. Based on our first 100 cases, iCT navigation for transpedicular screw fixation in the thoracolumbar spine seems to be very accurate and reliable.
A New Surface Technique for Phrenic Nerve Conduction Study
Authors: Pradhan Sunil , Anand Sucharita
Published: August 2023

Objective:

To report a new patient friendly and convenient technique for phrenic nerve conduction with alternative sites of stimulation and recording.

Methods:

Phrenic nerve conduction was performed in forty volunteers and ten patients of peripheral neuropathy. Active recording electrode was placed in tenth intercostal space 2.5 cm away from para-spinal muscles (mid-scapular line), reference electrode in eighth intercostal space just medial to subcostal margin with ground between stimulating and recording electrode. Stimulation was done at the level of crico-thyroid space near or under the posterior margin of sternocleidomastoid muscle. This new method was compared with existing ones.

Analysis:

Data was analysed using SPSS 23 version. Correlation between height, weight, body mass index, age, and chest expansion was done using bi-variate correlation. Mean latency and amplitude of the study method were compared with other methods using MANNOVA test.

Results:

Total of forty subjects were studied. Thirty-seven were male subjects. Mean age was 28.03 ± 9.63 years, height 168.0 ± 9.60 cm and chest expansion 3.53 ± 0.64 cm. Right sided phrenic nerve mean latency was 5.99 ± 0.629 ms and amplitude 1.088 ± 0.178 mV. Left sided phrenic nerve conductions showed mean latency of 6.02 ± 1.82 ms, amplitude of 1.092 ± 0.2912 mV. These standard deviations were smaller than what were observed with other methods suggesting increased consistency of our results. There was no correlation between phrenic nerve conduction with age, height, gender or chest expansion.

Conclusion:

This study method gave a better as well as consistent morphology, higher amplitude and required lower amount of current strength. It was superior to previously reported methods in consistency of normative data.
Transoral Vertebroplasty of C2 Aggressive Hemangioma
Authors: Murodzhon Kosimshoev , Yuliy Kubetskiy , Jamil Rzaev
Published: August 2023

The article describes a clinical case of surgical treatment of a patient with aggressive C2 vertebral hemangioma by vertebroplasty with a transoral approach.
Analysis of Nanohydroxyapatite/Polyamide-66 Cage, Titanium Mesh, and Iliac Crest in Spinal Reconstruction of the Patients with Thoracic and Lumbar Tuberculosis
Authors: Zhong Dian , Lin Lu , Liu Yang , Ke Zhen-Yong , Wang Yang
Published: August 2023

Background:

The standard recommended and common reconstruction method for spinal tuberculosis is titanium mesh bone graft and autogenous iliac crest. However, these methods have their own disadvantages.

Objective:

To evaluate the clinical efficacy of one-stage posterior debridement with iliac bone graft, titanium mesh bone graft, or nanohydroxyapatite/polyamide-66 cage in thoracic and lumbar tuberculosis.

Materials and Methods:

Between January 2013 and December 2018, 57 patients with thoracic or lumbar tuberculosis were treated by interbody bone graft combined with posterior internal fixation after debridement. Thirteen patients were treated with iliac bone graft to construct the stability of the vertebral body, 26 patients were treated with titanium mesh bone graft, and 18 patients were treated with nanohydroxyapatite/polyamide-66 cage bone graft. The main clinical results were evaluated by intervertebral height, cage subsidence, operation time, operative blood loss, postoperative hospitalization, postoperative complications, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, and bone graft fusion time. All the outcomes were recorded and analyzed by statistical methods.

Results:

The mean follow-up time was 24.5 months. Neurologic function was improved in most patients at the last follow-up. There were significant differences in ESR, CRP, and VAS score between preoperative and postoperative values; however, there were no significant differences in ESR, CRP, and VAS score among the three groups. There were no significant differences in operation time, blood loss, postoperative hospitalization, and postoperative complications among the three groups at discharge. There was no significant difference in ASIA grade among the three groups at the last follow-up. Nanohydroxyapatite/polyamide-66 cage group had a lower cage subsidence (P= 0.013). The bone graft fusion time of the nanohydroxyapatite/polyamide-66 cage group was significantly shorter than the iliac bone graft group and the titanium mesh bone graft (P< 0.05).

Conclusions:

The follow-up outcomes showed that the method involving one-stage posterior debridement and internal fixation, interbody graft, and fusion is an effective and safe surgical method for patients with thoracic and lumbar tuberculosis. The incidence rate of cage subsidence was less and the bone graft fusion time was shorter with nanohydroxyap atite/polyamide 66 cage when compared with iliac bone graft and titanium mesh bone graft in the surgical treatment of thoracic and lumbar tuberculosis. Nanohydroxyapatite/polyamide-66 cage has a promising application prospect to be a new bone graft material.
Double Anchoring Technique of Occipito-Cervical Fixation Using Innovative Occipital Plate
Authors: Singh Deepak K. , Pathak Vipul V. , Singh Neha , Kaif Mohammad , Yadav Kuldeep , Kumar Rakesh
Published: August 2023

Background:

Occipito-cervical fixation (OCF) provides immediate rigid fixation to cranio-vertebral junction (CVJ); however, in current practice, the optimal occipito-cervical fixation method is arguable.

Aim:

The aim of this study was to test the safety and efficacy of a newly designed inside-outside occipital (OC) plate system for the treatment of cranio-vertebral junction instability.

Material and Methods:

Thirty-two patients of CVJ instability were treated using this new OC plate system. Safety and efficacy of this new OC plate was evaluated radiologically and clinically.

Results:

Follow-up period ranged from 9 to 23 months. During the follow-up, no implant failure, recurrent subluxation, or newly developed instability at adjacent levels occurred, except in one patient in whom C2 screw pullout occurred due to trauma. All patients showed a satisfactory fusion at three months follow-up examination.

Conclusions:

These preliminary results suggest that this OC plate system is a simple, safe, and effective method for providing immediate internal rigid fixation of the CV junction. Long-term results are needed to determine the superiority of this OC plate over other methods of occipital fixation.
Efficacy of Non-Fusion Surgeries in the Management of AO Type C Injuries of the Thoracic and Thoracolumbar Spine
Authors: Murugan Chandhan , Shetty Ajoy P. , Kavishwar Rohit , Krishnan Vibhu , Kanna Rishi M. , Rajasekaran Shanmuganathan
Published: August 2023

Background:

The initial descriptions of successful management of non-fusion surgeries in the management of unstable burst injuries of the thoracic and thoracolumbar spine (TTLS) were published by Osti in 1987 and Sanderson in 1999. These were further supported by prospective studies and meta-analyses establishing comparable results between fusion and non-fusion surgeries. However, there is a paucity of literature regarding the efficacy of non-fusion surgeries in the management of AO type C injuries.

Objective, Materials and Methods:

The study aims to determine the efficacy of open posterior instrumented stabilization without fusion in AO type C injuries of the TTLS. Patients with AO type C injuries of the TTLS (T4-L2 levels) with normal neurology who underwent open, posterior, long segment instrumented stabilization without fusion between January 2015 and June 2018 were included. The regional kyphotic angle, local kyphotic angle, AP (anterior and posterior wall) ratio, and cumulative loss of disc space angle were assessed on radiographs. Functional outcome was assessed using Oswestry Disability Index (ODI) and the AO Spine patient-reported outcome spine trauma (PROST) instrument.

Results and Conclusion:

The study included 35 patients with AO type C injury of the TTLS and a normal neurology who underwent open posterior instrumented stabilization and had a mean follow-up of 43.2 months (range 24–60 months). The mean preoperative regional kyphotic angle decreased from 19.8 ± 13.7° to 6.6 ± 11.3° after surgery but showed an increase to 9.21 ± 10.5° at final follow-up (P= 0.003). The cumulative loss of disc space angle was significant at final follow-up (2.4 ± 5° [P= 0.002]). Twenty-eight out of 35 patients had minimal while seven had moderate disability on the ODI score. The AO Spine PROST revealed that patients regained 95.7 ± 4.2% of their pre-injury functional status at final follow-up. Posterior instrumented stabilization without fusion in the management of AO type C injuries of the TTLS gives satisfactory results with acceptable functional and radiological outcomes.
Preoperative Heart Rate Variability Predicts Postinduction Hypotension in Patients with Cervical Myelopathy
Authors: Boyle Sarah L , Moodley Alastair , Al Azazi Emad , Dinsmore Michael , Massicotte Eric M , Venkatraghavan Lashmi
Published: August 2023

Background:

Autonomic dysfunction, commonly seen in patients with cervical myelopathy, may lead to a decrease in blood pressure intraoperatively.

Objective:

The aim of our study is to determine if changes in Heart rate variability (HRV) could predict hypotension after induction of anesthesia in patients with cervical myelopathy undergoing spine surgery.

Methods and Material:

In this prospective observational study, 47 patients with cervical myelopathy were included. Five-minute resting ECG (5 lead) was recorded preoperatively and HRV of very low frequency (VLF), low frequency (LF), and high frequency (HF) spectra were calculated using frequency domain analysis. Incidence of hypotension (MAP <80 mmHg, lasting >5 min) and the number of interventions (40 mcg of phenylephrine or 5 mg of ephedrine) required to treat the hypotension during the period from induction to surgical incision were recorded. HRV indices were compared between the hypotension group and the stable group.

Results:

The incidence of hypotension after induction was 74.4% (35/47) and the median (IQR) interventions needed to treat hypotension was 2 (0.5–6). Patients who experienced hypotension had lower HF power and higher LF–HF ratios. A LF/HF >2.5 indicated postinduction hypotension likely. There was a correlation between increasing LF–HF ratio and the number of interventions that needs to maintain the MAP above 80 mmHg.

Conclusion:

HF power was lower and LF-HF ratio was higher in patients with cervical myelopathy who developed postinduction hypotension. Hence, preoperative HRV analysis can be useful to identify patients with cervical myelopathy who are at risk of post-induction hypotension.
Lumbar Facet Effusions and Other Degeneration Parameters and Its Association with Instability
Authors: Bendersky Damián , Asem Martín , Navarrete Oscar
Published: August 2023

Background:

Controversy exists in the literature about whether facet effusions and other degeneration parameters are associated with instability.

Objective:

To assess the association between facet effusions and other lumbar degeneration parameters and segmental instability.

Material and Methods:

In this study, 207 L4–L5 and L5–S1 levels in 104 patients were assessed. We divided the spinal levels into two groups: the small facet effusions (SFE) group in whom facet effusions were <1.5 mm or non-effusions were found, and the large facet effusions (LFE) group in whom they were ≥1.5 mm. The association between other degeneration parameters and instability was also assessed, such as disc degeneration, Modic changes (MC), spondylolisthesis, facet orientation and tropism, facet subchondral sclerosis, and facet cartilage degeneration. Furthermore, we subdivided the levels into subgroups to evaluate the association of LFE and instability within each one.

Results:

The main analysis comparing the presence of instability in SFE and LFE groups showed a non-statistically significant association between LFE and instability. The presence of MC type 1 and the existence of L4–L5 spondylolisthesis had a statistically significant association with instability. In the subset of 43 levels with L4–L5 degenerative spondylolisthesis, the presence of LFE and the existence of MC type 1 reached a significant association with instability.

Conclusion:

The presence of LFE and/or MC type 1 may act as red flags in patients with L4–L5 degenerative spondylolisthesis to suspect segmental instability.
Quantifying Neurological Examination in 21st Century
Authors: Yilmaz Murat , Ilbay Gul , Yilmaz Huriye E , Ertem Onder , Erbayraktar Serhat , Ilbay Konuralp M
Published: August 2023

Background:

Current methods used to measure the muscle strength required to achieve plantar flexion may yield highly variable results depending on the perception of the physician conducting the examination because these tests involve subjective and qualitative evaluation.

Objective:

To describe and evaluate the efficacy of a novel examination technique that can quantitatively measure plantar flexion in L5–S1 disc herniation.

Materials and Methods:

A total of 32 patients (average age: 49.4 years, range: 23–78) with L5–S1 disc herniations were included. The patient to be tested stood next to a table on which they could lean with their hands. The leg closer to the table was fully flexed at the knee, and the other foot was brought to maximum plantar flexion on the toes. At this point, a stopwatch was started to measure the time that passed until the muscles fatigued and the heel fell. The differences between the right and left plantar flexion times were noted. In addition, three different physicians graded muscle strength by using the classical “The Medical Research Council of the United Kingdom” method.

Results:

The time until fatigue in right and left plantar flexion was measured using the proposed method, and each test underwent a video recording. The Yilmaz–Ilbay plantar flexion test yielded the correct classification for all cases.

Conclusion:

We suggest that the proposed method “Yilmaz–Ilbay plantar flexion test” can serve as a useful, practical, and effective test to detect quantitative evaluation of plantar flexion in L5–S1 herniation.