bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome Following Surgical Revascularization in Patients of Moyamoya Disease with Focus on Graft Patency and Angiographic Changes
Authors: Gupta Sunil K , Narayanan Rajashekhar , Aggarwal Ashish , Mohanty Manju , Ahuja Chirag , Verma Nidhi , Praneeth Kokkula , Agarwal Vivek 
Published: December 2021

Background:
Surgical revascularization is the mainstay of treatment in symptomatic patients of moyamoya disease (MMD).

Objective:
The present study analyzed the postoperative angio-architecture in pediatric and adult patients of moyamoya disease.

Material and Methods:
Patients with MMD, both ischemic and hemorrhagic, were subjected to surgery. A superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was attempted in all. It was augmented by an encephalo-duro-myo-synangiosis), this was labelled as the combined surgical group. In patients where a direct bypass was not possible encephalo-duro-arterio-myo-synangiosis (EDAMS) was performed and these patients were put in the indirect surgery group. In the postoperative period, MRA was performed in all patients to look for (a) graft patency, (b) regression of moyamoya vessels, and (c) degree of surgical neovascularization (as quantified on adapted Matsushima and Inaba grading system).

Results:
Eighty-two patients underwent 131 surgical revascularization procedures. A combined surgery (STA-MCA bypass and EDAMS) was performed in 100 hemispheres and indirect surgery (EDAMS) on 31 sides. In children less than 5 years of age, STA-MCA anastomosis was possible in more than 50% of patients. Clinical improvement was seen in 85.4% of patients. Postoperative MRA demonstrated a patent bypass graft in 97% of cases. Regression of moyamoya vessels was seen in half of the cases and good surgical revascularization (type A and B) was seen in more than 80% of hemispheres in the combined surgery and indirect surgery group.

Conclusions:
Revascularization procedures led to a regression of moyamoya collaterals, appearance of surgical neo angiogenesis, and a graft patency rate of 97%. Surgical group with combined revascularization had a trend towards better collateral development.
Pediatric to Adult Hydrocephalus
Authors: Hong Manilyn A , Sukumaran Arvind , Riva-Cambrin Jay 
Published: December 2021

Abstract

Introduction:
Pediatric patients treated for hydrocephalus, regardless of etiology, require continuous access to care to address the long-term sequelae from the disease progression itself and from the interventions undertaken. The challenge for all pediatric neurosurgeons is providing comprehensive and coordinated care for these patients in order to achieve a smooth and seamless transition into adult health care.

Methods:
A review of the literature was conducted regarding the overall concept of pediatric patients with chronic conditions transitioning to adult care. We also specifically reviewed the pediatric hydrocephalus literature to investigate the barriers of transition, models of success, and specific elements required in a transition policy.

Results:
The review identified several barriers that hamper smooth and successful transition from pediatric to adult care within the hydrocephalus population. These included patient-related, cultural/society-related, healthcare provider-related, and healthcare system-related barriers. Six elements for successful transitions were noted: transition policy, tracking and monitoring, transition readiness, transition planning, transfer of care, and transition completion stemming from the Got Transition center.

Conclusions:
A successful patient transition from pediatric neurosurgical care to adult neurosurgical care is very center-specific and depends on the available resources within that center's hospital, health system, and geo-economic environment. Six recommendations are made for transition policy implementation in resource-poor environments, including beginning the process early, preferably at age 14 years.
Genetics and Molecular Pathogenesis of Human Hydrocephalus
Authors: Garcia-Bonilla Maria , McAllister James P , Limbrick D Limbrick 
Published: December 2021

Abstract
Hydrocephalus is a neurological disorder with an incidence of 80–125 per 100,000 live births in the United States. The molecular pathogenesis of this multidimensional disorder is complex and has both genetic and environmental influences. This review aims to discuss the genetic and molecular alterations described in human hydrocephalus, from well-characterized, heritable forms of hydrocephalus (e.g., X-linked hydrocephalus from L1CAM variants) to those affecting cilia motility and other complex pathologies such as neural tube defects and Dandy–Walker syndrome. Ventricular zone disruption is one key pattern among congenital and acquired forms of hydrocephalus, with abnormalities in cadherins, which mediate neuroepithelium/ependymal cell junctions and contribute to the pathogenesis and severity of the disease. Given the relationship between hydrocephalus pathogenesis and neurodevelopment, future research should elucidate the genetic and molecular mechanisms that regulate ventricular zone integrity and stem cell biology.
Mathematical Modelling in Hydrocephalus
Authors: Kazimierska Agnieszka , Ziółkowski Arkadiusz , Kasprowicz Magdalena , Lalou Afroditi , Czosnyka Zofia , Czosnyka Marek 
Published: December 2021

Abstract

Background:
Various studies highlight the significance of alterations in cerebrospinal fluid (CSF) and cerebral blood flow (CBF) dynamics in the pathogenesis of hydrocephalus and suggest the role of mathematical modeling in studying these complex interactions.

Objective:
This narrative review discusses mathematical models of CSF and CBF dynamics, including Marmarou's compartmental model of CSF spaces and a model of cardiac changes in cerebral arterial blood volume. The diagnostic utility of CSF compensatory parameters is described along with current information on secondary model-based indices of cerebral hemodynamics in hydrocephalus.

Conclusions:
Compensatory parameters derived from the model of CSF circulation have long been used in the diagnosis and management of hydrocephalus patients. However, recent studies using mathematical models of cerebral circulation also show alterations in CBF dynamics, and model-based indices of cerebral hemodynamics, which can be calculated non-invasively using transracranial Doppler ultrasonography, can be used as a complementary source of information about the state of the cerebrospinal space.
Evaluation and Management of Patients with Hydrocephalus in Craniosynostosis
Authors: Grant Jaime , Jagadeesan Jagajeevan , Gallo Pasquale , Rodrigues Desiderio 
Published: December 2021

Abstract

Background:
Hydrocephalus in presence of craniosynostosis, though relatively rare, occurs in 4%–10% cases, with an increased incidence in syndromic craniosynostosis. The optimum management in these patients is unknown.

Materials and Methods:
A search was performed on the departmental craniofacial database to identify all patients with craniosynostosis and hydrocephalus from January 2000 to December 2020. Diagnosis was confirmed by a meticulous review of the notes and previous imaging. These patients were grouped into two groups based on the primary treatment they received: either a cerebrospinal fluid (CSF) diversion procedure or a calvarial remodeling procedure. By analyzing the outcomes for each group, we endeavor to rationalize and outline our management strategy for this complex cohort of patients.

Results:
Sixty-four of 989 patients were confirmed to have hydrocephalus. Of these, 55 patients underwent calvarial expansion while nine had CSF diversion as a primary procedure. Our study demonstrates that the complication rate is lower in the primary calvarial expansion group. Furthermore, the need for a CSF diversion procedure was avoided in a significant number of these patients as a direct result.

Conclusion:
In the vast majority of patients with craniosynostosis and hydrocephalus, calvarial expansion surgery should be the preferred primary management option.
Idiopathic Intracranial Hypertension - Challenges and Pearls
Authors: Rohit Wadikhaye , Rajesh Alugolu , Mridula Rukmini , Jabeen Shaik A 
Published: December 2021

Abstract
Idiopathic intracranial hypertension (IIH) is defined as a syndrome of raised intracranial pressure with normal imaging of the brain and cerebrospinal fluid (CSF) composition. There is a rising incidence and prevalence of this disease related to the increased prevalence of obesity. It typically affects women of working age, and headache is the predominant morbidity in over 90%. The disease is also more prevalent in young males. There are many controversies and myths that surround IIH. There are currently few treatment options for IIH, management is typically medical with those experiencing progressive visual loss undergoing surgical procedures. Weight loss and venous sinus stenting are a few therapies directed at the etiology.
Prenatal Ventriculomegaly – Diagnosis, Prognostication and Management
Authors: Krishnan Vivek , Sharma Akshatha , Ramamurthy Rachita , Elayedatt Rinshi , Ramamurthy B S 
Published: December 2021

Abstract
Fetal ventriculomegaly (VM) refers to the abnormal enlargement of one or more ventricles of the brain in-utero. The enlargement may or may not be related to ventricular obstruction and increased intracranial pressure; therefore, the term “hydrocephalus” is not used. VM is diagnosed usually in the mid-trimester when the atrial diameter (AD) of the lateral ventricle is more than 10 mm on one or both sides. A thorough workup is then required to identify the cause as the etiology is diverse. Fetal magnetic resonance imaging (MRI) may yield additional information. Serial ultrasound follow-up would be required to assess its progression with advancing gestation. The prognosis and long-term outcomes greatly depend upon the etiology, the severity at diagnosis, progression, and associations. This article reviews the definitions, diagnosis, and workup of fetal VM, discusses follow-up protocols and prognosis, and examines the role of fetal therapy, including fetoscopic surgery in its prenatal management.
A comparison of Adult and Pediatric Hydrocephalus
Authors: Deopujari Chandrashekhar , Mohanty Chandan , Agrawal Harshal , Jain Sonal , Chawla Pawan 
Published: December 2021

Abstract
Hydrocephalus is a common clinical problem encountered in neurosurgical practice. With greater subspecialisation, pediatric neurosurgery has emerged as a special discipline in several countries. However, in the developing world, which inhabits a large pediatric population, a limited number of neurosurgeons manage all types of hydrocephalus across all ages. There are some essential differences in pediatric and adult hydrocephalus. The spectrum of hydrocephalus of dysgenetic origin in a neonate and that of normal pressure hydrocephalus of the old age has a completely different strategy of management. Endoscopic third ventriculostomy outcomes are known to be closely associated with age at presentation and surgery. Efficacy of alternative pathways of CSF absorption also differs according to age. Managing this disease in various age groups is challenging because of these differences in etiopathology, tempo of the disease, modalities of investigations and various treatment protocols as well as prognosis.
Management of Complex Hydrocephalus
Authors: Gabbita Abhirama Chandra , Raju Subodh 
Published: December 2021

Abstract

Background:
Management of complex/multiloculated/septated hydrocephalus is challenging. Neuroendoscopy has been well-established when compared to multiple shunt placements in management of multiloculated hydrocephalus (MH). The main aim of neuroendoscopy is to convert multiple locules into a single locule and drain it by either third ventriculostomy or ventriculoperitoneal shunt.

Objective:
The objective is to reduce the number of surgical procedures and improve the quality of life. Neuroendoscopy avoids multiple shunt placement and need for revision of shunt.

Methods:
Literature review regarding natural history, pathogenesis, classification and management of complex/uni/multiloculated hydrocephalus was extensively done and our minimal experience with these cases has been taken into consideration.

Conclusion:
Neuroendoscopy when combined with frameless neuronavigation is reliable, accurate, and extremely useful in maintaining orientation and localizing the appropriate fenestration site in MH where anatomical landmarks are grossly distorted.
Trans-Sylvian Resection of Giant Left Insular Glioma
Authors: Agrawal Rati , Arumulla Sivasai , Manjunath Nivedita , Meena Rajesh , Doddamani Ramesh , Singh Pankaj Kumar , Chandra Sarat P. 
Published: December 2021

Abstract

Background:
Insular glioma was considered a nonsurgical entity due to resection-associated morbidities. The advancement in neurosurgical techniques and adjuncts used in the last two decades made the resection of insular gliomas simpler for neurosurgeons with the maximum extent of resection and acceptable morbidity rates. The complex anatomy of this region remains a challenge for neurosurgeons and requires expertise. The key factors to achieve complete resection in the insular region are the thorough knowledge of surgical anatomy and meticulous microsurgical techniques. Intraoperative adjuncts such as image guidance along with cortical and subcortical mapping assist in excellent outcomes.

Objective:
In this study, we describe the operative technique and application of trans-Sylvian approach to do the compartmental dissection done by the senior author, along with challenges faced, with the hope to highlight the efficacy of the approach to achieve maximal resection of this entity without compromising patient's safety.

Materials and Methods:
A 32-year-old right-handed gentleman presented with episodes of excessive salivation, tingling sensation on the right side of the body along with nausea that lasted for 15–20 s for the last 8 months and one episode of speech arrest without any loss of consciousness and motor or sensory deficit. CEMRI of the brain was suggestive of left insular glioma. The patient underwent left pterional craniotomy, and gross total resection of the tumor was done using compartmental dissection.

Results:
At follow-up after 1 month, the patient is seizure-free without any speech difficulty and motor or sensory deficit.

Conclusion:
Compartmental dissection of insular glioma is a safe and efficacious technique to achieve gross total resection of the tumor in this complex region without morbidity.
Neuroendoscopy in the Surgical Management of Lateral and Third Ventricular Tumors
Authors: Deopujari Chandrashekhar E , Karmarkar Vikram S. , Shaikh Salman T. , Mohanty Chandan B. , Sharma Vikas , Tadghare Jitendra , Thareja Varun 
Published: December 2021

Abstract

Background:
Intraventricular tumors pose a surgical challenge because of the difficulty in reaching their deep location through safe corridors and their adherence or proximity to vital neurovascular structures. Although microneurosurgery is the mainstay of surgical management, neuroendoscopy aided by adjuncts, namely, navigation and ultrasonic aspirators, has made a great contribution to improving surgical results.

Objective:
This article reviews the experience of a neurosurgical unit with endoscopic procedures for intraventricular tumors. The current indications, benefits, and complications of neuroendoscopy are described.

Materials and Methods:
This is a retrospective, observational study of lateral and third ventricular tumors tackled either purely with an endoscope or with its assistance over 19 years in a single unit at Bombay Hospital Institute of Medical Sciences, Mumbai.

Results:
Of a total of 247 operated patients with intraventricular tumors, 85 cases operated using an endoscope were included. The majority of the patients had a tumor in the third ventricle (n = 62), whereas 23 patients had tumor in the lateral ventricle. The most common pathologies were colloid cyst and arachnoid cyst (n = 18). An endoscope was used for microsurgical assisted excision of tumors in 31 cases, biopsy in 24, cyst fenestration in 23, and pure endoscopic excision in seven cases.

Conclusion:
Microsurgery remains the gold standard for the removal of giant, vascular intraventricular tumors. However, endoscopic fenestration or excision of cysts and biopsy have become better alternatives in many cases. Endoscope-assisted microsurgery affords safety and helps in achieving a more complete excision.
Incidence of and Risk Factors for Emergence Delirium and Postoperative Delirium in Neurosurgical Patients- A Prospective Cohort Study
Authors: Bharadwaj Suparna , Kamath Sriganesh , Chakrabarti Dhritiman , Shetty Prajwal 
Published: December 2021

Abstract

Background:
Delirium after surgery is a spectrum of clinical syndrome constituting emergence delirium (ED) and/or postoperative delirium (POD).

Objectives:
The primary objective of this study was to evaluate the incidence of ED and POD in patients after neurosurgical procedures. The secondary objectives were to examine the relationship between ED and POD and identify perioperative risk factors of ED and POD.

Materials and Methods:
This is a prospective cohort study conducted at the National Institute of Mental Health and Neurosciences. After obtaining the ethics committee approval, consecutive adult patients scheduled for elective neurosurgical procedures from February 2018 to November 2018 were included. We excluded children, patients with preoperative Glasgow Coma score <15, and patients with preoperative delirium. ED was assessed using Riker's Sedation-Agitation Score and POD was assessed using Confusion Assessment Method. Data collection included patient demographics, details of anesthetics and analgesics, and neurosurgical details.

Results:
The incidence of ED and POD was 41% (N = 82/200) and 20% (N = 40/200), respectively. The occurrence of ED and POD coexisting as a continuous spectrum was 15%. Patients undergoing spine surgeries were found to have 44% less risk of ED than after cranial surgeries (P = 0.032). Presence of ED was associated with 1.8 times higher risk of POD (P < 0.001) and male gender was associated with 2.5 times higher risk of POD (P = 0.005).

Conclusions:
Incidences of ED and POD are higher after neurosurgery as compared with that reported in nonneurosurgical population previously.
Assessment of Collaterals Using Multiphasic CT Angiography in Acute Stroke
Authors: Adhithyan Rajendran , Kannath Santhosh , Thomas Bejoy , Jayadevan Enakshy , Sylaja PN , Kesavadas Chandrasekharan 
Published: December 2021

Abstract

Background and Purpose:
The aim of the research was to compare the efficiency of multiphase and single-phase computed tomography (CT) angiography in assessing the leptomeningeal collaterals and in predicting the long-term clinical outcome as well as the risk of hemorrhagic transformation.

Materials and Methods:
A prospective study was conducted from October 2016 to May 2018 in consecutive patients who presented within 8 hours of the onset of acute anterior circulation ischemic strokes, with NIHSS (National Institutes of Health Stroke Scale) scores ≥5. They underwent triple-phase cerebral CT angiography, and the collaterals were assessed separately using both single-phase and multiphase techniques. The ability of the collaterals to predict the 24-hour CT ASPECTS (Alberta Stroke Program Early CT score), risk of cerebral hemorrhagic transformation, and 90-day clinical outcome was assessed.

Results:
Fifty-six patients, which included 42 with an involvement of the middle cerebral artery and 14 with mixed occlusions, were assessed. In the multivariate logistic analysis, multiphase CT angiography collateral grading is one of the independent predictors of favorable outcomes. Area under the curve (AUC) was 0.853 (95% confidence interval [CI; 0.73, 0.97]) for multiphase CT collateral scoring in predicting the long-term functional independence, whereas single-phase CT (sCT) scoring displayed an AUC value of only 0.609 (95% CI [0.43, 0.78]). Eighty-two percent of the patients with good multiphase CT collaterals were functionally independent. CT ASPECTS at 24 hours was significantly better in patients with a good multiphase CT collateral score than in those with a good single-phase score. None of the patients with good collaterals in multiphase CT angiography had a significant hemorrhagic transformation. Good multiphase CT collaterals demonstrated 78% sensitivity, 81% specificity, and 80% accuracy in predicting the functional outcome.

Conclusion:
Multiphase CT collateral system was superior to single-phase angiography in predicting the long-term functional outcomes. Prediction of the hemorrhagic transformation risk was also observed to be better for multiphase CT.
Segmental Agenesis of External Carotid Artery from Common Carotid Artery with Anomalous Reformation through Occipital Artery Anastomoses
Authors: Furtado Sunil V , Quryshi Syed A , Jagannatha Aniruddha T , Hegde Alangar S 
Published: December 2021

Abstract
Anomalous origin of extracranial and intracranial carotid system is subject to permutations of embryonal regression of the developing primitive embryonal vasculature. We present a case of segmental agenesis of left external carotid artery from the cervical carotid circulation. The entire left external carotid artery was supplied by the vertebral artery through muscular branches via the occipital artery. This anomaly of proximal external carotid agenesis with the entire vascular tree dependent on the posterior circulation via occipital artery muscular collaterals is unique and has not been described before. We discuss this anomaly with its embryology, clinical implications, and its relationship to a Proatlantal artery.
Impact of Pre-Stroke Antiplatelet Use on 3-Month Outcome After Ischemic Stroke
Authors: Sylaja PN , Nair Sruthi S , Pandian Jeyaraj , Khurana Dheeraj , Srivastava M V Padma , Kaul Subhash , Arora Deepti , Sarma P Sankara , Singhal Aneesh B 
Published: December 2021

Abstract

Background:
Pre-stroke anti-platelet (PAP) therapy can potentially influence the severity and outcome after ischemic stroke.

Methods:
We analyzed data from the prospective multicenter Indo–US collaborative stroke project for the impact of PAP therapy. Outcome measures included the admission National Institute of Health Stroke Scale (NIHSS) score, 3-month modified Rankin scale (mRS) score, and rates of in-hospital mortality and post-ischemic intracerebral hemorrhage.

Results:
Among 2048 of 2066 patients (M:F = 2:1) with known pre-stroke medication status, 336 (16.3%) were on PAP therapy. As compared to the non-PAP group, the PAP group had significantly higher mean age (62.2 vs 57.4 years, P < 0.001) and significantly more men, vascular risk factors, cerebral microbleeds (12.8% vs 6.2%, P = 0.001) and intravenous thrombolysis treatment (17% vs. 10.6%, P = 0.001). Cardioembolic strokes were significantly more in the PAP group (P < 0.001), but not large artery atherosclerosis. No significant differences were observed in the median NIHSS score (9 vs. 10, P = 0.274), 3-month mRS (score 0-2,51.4% vs. 49.0%, P = 0.428), in-hospital mortality (8.6% vs. 7.8%, P = 0.592), or symptomatic post ischemic intracerebral haemorrhage (12.2% vs. 10.6%, P = 0.382). The PAP group had more stroke recurrence (6.6% vs. 2.9%, P = 0.002) which was not significant (P = 0.065) after multivariate regression analysis adjusting for age, sex and vascular risk factors. PAP therapy was not an independent predictor of initial stroke severity or stroke outcome.

Conclusion:
PAP therapy has no significant effect on initial stroke severity, rates of post-ischemic hemorrhage with or without thrombolysis, in-hospital mortality, stroke recurrence, and 3-month outcome after ischemic stroke.