bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Intracranial Germ Cell Tumors
Authors: Sahay Ayushi , Epari Sridhar , Chinnaswamy Girish , Chatterjee Abhishek , Goda Jayant Sastri , Patil Vijay , Moyiadi Aliasgar , Shetty Prakash , Singh Vikas , Sahu Arpita , Choudhary Amit , Janu Amit , Gupta Tejpal 
Published: August 2023

Background and Objective:
Primary intracranial germ cell tumors (ICGCTs) are rare and are histologically classified as germinomas and non-germinomatous with distinctive prognostic and therapeutic implications. ICGCTs, essentially due to the inherent difficulty of surgical access, pose different challenges and management connotations than their extracranial counterparts. This is a retrospective analysis of histologically verified ICGCTs, which was undertaken to evaluate various clinicopathological features and their implications on patient management.

Materials and Methods:
Eighty-eight histologically diagnosed cases (over 14 years) of ICGCT at our institute formed the study cohort and were classified into germinoma and non-germinomatous germ cell tumors (NGGCTs). Additionally, germinomas were further subdivided on the basis of 1) tumor marker (TM) levels, as germinoma with normal TM, mildly elevated TM, and markedly elevated TM and 2) radiology features, as germinomas with typical radiology and atypical radiological features.

Results:
ICGCT with age ≤6 years (P = 0.049), elevated TM (P = 0.047), and NGGCT histology (P < 0.001) showed significantly worse outcomes. Furthermore, germinomas with markedly elevated TM and certain atypical radiological features showed prognosis akin to NGGCT.

Conclusions:
Analysis of our largest single cancer center Indian patient cohort of ICGCT shows that inclusion of age ≤6 years, raised TM, and certain radiological features may assist clinicians in overcoming the limitations of surgical sampling, with better prognostication of histologically diagnosed germinomas.
fMRI Analysis of Dissociative Convulsions
Authors: Garg Harshit , Sharan Pratap , Kumaran Senthil S , Bhargava Rachna , Patra Bichitra N , Tripathi Manjari 
Published: August 2023

Background and Objectives:
Dissociative convulsions represent complex biopsychosocial etiopathogenesis and have semiological similarities with epilepsy, which leads to delays in definitive diagnosis as well as treatment. We explored the neurobiological underpinnings of dissociative convulsions using a functional magnetic resonance imaging (fMRI) design targeting cognitive, affective, and resting state characteristics in our subjects.

Materials and Methods:
Seventeen female patients with dissociative convulsions without any co-morbid psychiatric or neurological illness and 17 matched healthy controls underwent standardized task-based (affective and cognitive) and resting state fMRI. Blood oxygen level-dependent (BOLD) activation results were compared across the groups, and correlation with the severity of dissociation was measured.

Results:
Patients with dissociative convulsions had lower activation in the left cingulate gyrus, left paracentral lobule, right middle and inferior frontal gyrus, right caudate nucleus, and right thalamus. There was increased resting state functional connectivity (FC) between the left posterior superior temporal gyrus and left superior parietal lobule; left amygdala and Default Mode Network (DMN) of right lateral parietal cortex; right supramarginal gyrus and left cuneus in the patient group. Patients also had decreased FC between the anterior cingulate cortex (ACC) and left thalamus; ACC and right central opercular cortex; DMN of PCC, posterior cingulate gyrus, and right middle temporal lobe.

Conclusions:
Patients with dissociative convulsions have significant deficits in the areas associated with the processing of emotional, cognitive, memory, and sensory-motor functions. There is a significant correlation between dissociative severity and the functioning of areas involving the processing of emotions, cognition, and memory.
Role of Nerve Conduction Studies in Hansen's Disease
Authors: Chaudhary Sarvesh K , Kalita Jayantee , Misra Usha K 
Published: August 2023

Background and Objective:
To report the role of nerve conduction study (NCS) in diagnosis, monitoring, and prognosis of Hansen's disease (HD).

Materials and Methods:
In a hospital-based prospecive observational study, the patients with HD as per World Health Organization (WHO) criteria were included; muscle wasting power, reflexes, and sensations were recorded. Motor NCS of median, ulnar, and peroneal nerves and sensory NCS of ulnar, median, and sural nerves were recorded. Disability was graded using WHO grading scale. The outcome was assessed after 6 months using modified Rankin scale.

Results:
In the present study, 38 patients with a median age of 40 (15–80) years and five females were included. The diagnosis was tuberculoid in seven, borderline tuberculoid in 23, borderline lepromatous in two, and borderline in six patients. The disability was grade 1 and 2 in 19 patients each. Out of 480 nerves studied, NCS was normal in 139 sensory (57.4%) and 160 (67.2%) motor nerves. NCSs were axonal in seven sensory and eight motor nerves, demyelinating in three nerves, and mixed in one in seven patients who had lepra reaction. NCS findings did not correlate with disability (p = 1.0) or outcome (0.304) and provided additional information in 11 nerves (seven patients). Peripheral nerves were enlarged in 79. NCSs were normal in 32 (29.90%) in thickened nerves.

Conclusion:
In HD, NCS abnormalities correlated with respective sensory or motor abnormality but related with neither disability nor the outcome.
Preventing Postoperative Apoplexy in Giant Pituitary Adenomas using Combined Trans-Sphenoidal and Cranial Surgery
Authors: Baldia Manish , Rajshekhar Vedantam 
Published: August 2023

Background:
Combined surgery consisting of endoscopic trans-sphenoidal surgery (ETSS) and transcranial (TC) surgery for giant pituitary adenomas (GPAs) has been recommended to prevent lethal postoperative apoplexy. Based on our experience, we attempt to rationalize the indications for such surgery.

Materials and Methods:
We report the magnetic resonance (MR) characteristics of the tumor and the outcomes in patients with GPAs who underwent ETSS only and combined surgery. Total tumor volume (TTV), tumor extension volume (TEV), and suprasellar extension of tumor (SET) were calculated based on the lines drawn on MR images and compared between those who underwent ETSS only and those who underwent combined surgery.

Results:
Of 80 patients with GPAs, eight (10%) underwent combined surgery (seven in the same sitting and one had staged surgery). All eight patients (100%) who underwent combined surgery had tumors with multilobulations, extensions, and encasement of the vessels in the circle of Willis (COW). Of 72 patients who underwent ETSS alone, 21 (29.1%) had a multilobulated tumor, 26 (36.2%) tumors had anterior/lateral extensions, and 12 (16.6%) had encasement of the COW. The mean TTV, TEV, and SET for the combined surgery group were significantly higher than those in the ETSS group. None of the patients who underwent combined surgery suffered postoperative residual tumor apoplexy.

Conclusion:
Patients with GPAs in whom there are significant lateral intradural or subfrontal tumor extensions should be considered for combined surgery at the same sitting to avoid devastating postoperative apoplexy in the residual tumor, which can occur when ETSS alone is performed.
Magnetic Resonance Imaging Brain Findings in Chikungunya Virus (CHIKV) Infection with Neurological Complication during Epidemic Outbreak
Authors: Sethi Kanika Sekhri , Aryan Abhay Kumar , Ganeshan Prem Kumar 
Published: August 2023

Background and Objective:
The Chikungunya virus is an alphavirus RNA of the family Togaviridae transmitted by the Aedes mosquito. We aim to report magnetic resonance imaging (MRI) brain findings for neurological complications at our institute during epidemic outbreak.

Materials and Methods:
A total of 43 seropositive cases of Chikungunya infection underwent MRI brain.

Results:
Out of 43 patients, 27 (63%) had discrete and confluent supra-tentorial T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) hyper-intense white matter foci. A total of 14 patients (33%) showed multiple foci/areas of diffusion restriction, and four of these patients had infra-tentorial T2 & FLAIR hyper-intense foci with restricted diffusion. In three pediatric age group patients including two neonates, the pattern of involvement was diffuse white matter changes with restricted diffusion. In 30% cases, MRI was normal.

Conclusions:
Detection of focal or confluent white matter hyper-intense foci with restricted diffusion on MRI in patients presenting with fever and neurological symptoms has potential to conclude the diagnosis of Chikungunya encephalitis, especially in epidemic settings.
The Journey and Progress of the Department of Neurosurgery at the University College of Medical Sciences and Guru Teg Bahadur Hospital
Authors: Sarma Pragyan 
Published: August 2023

Background:
Guru Teg Bahadur Hospital (GTBH) associated with the University College of Medical Sciences (UCMS) is one of the largest hospitals associated with a medical college in the National Capital of Delhi, India. The Department of Neurosurgery was initially established here in 1997, but since its inception, has made rapid strides in terms of infrastructure and quality of patient care.

Objective:
The main objective of this article is to depict the history and path of progress of the Neurosurgery Department, from its inception to its present status, along with the inherent and existing challenges in running the department.

Materials and Methods:
A retrospective analysis from the time the department was established to its present status was done. The improvement of infrastructure, increase in patient inflow over the years, the number of procedures related to different subspecialties, and existing challenges along with the scope of further improvement were analyzed.

Results:
There has been a significant upgradation of infrastructure more so in the last 5 years. Both indoor and outdoor patient attendance has increased over the years along with steady significant growth of the number of elective and emergency procedures. However, despite the progress, significant challenges hampering optimal patient care still remain to be overcome.

Conclusion:
The department right now is providing satisfactory patient care with absolutely no financial burden to the patients. Neurosurgery academic residency has recently resumed, and a wide range of neurosurgical conditions are being successfully treated. If the existing challenges are addressed in a timely manner, the coming years hold a bright future for the department.
Volume of Aneurysmal Subarachnoid Hematoma Measured Quantitatively by 3D Slicer to Predict Symptomatic Cerebral Vasospasm
Authors: Yanming Huang , Xiaoyan Lai , Celin Guan , Xiaolong Qi , Huihua Li , Xin Lin , Shuanglin Que 
Published: August 2023

Background and Objectives:
Aneurysmal subarachnoid hemorrhage is strongly associated with symptomatic cerebral vasospasm. This study aims to investigate whether a quantitative measure of aneurysmal subarachnoid hematoma by 3D Slicer is more valuable for vasospasm risk prediction compared with modified Fisher scale and the new scale by Eagles.

Materials and Methods:
We performed a retrospective research of Digital Imaging and Communications in Medicine format (DICOM) in aneurysmal patients treated at our institution from 2019 to 2020. Association between vasospasm and hematoma volume by 3D Slicer was explored by univariate and multivariate analyses. Value of risk prediction was compared through area under the receiver operator characteristic curve (AUC) among the modified Fisher scale, the new scale by Eagles, and hematoma volume by 3D Slicer.

Results:
Hematoma volume by 3D Slicer had a significant relationship with vasospasm both by one-way analysis of variance (ANOVA; F = 19.37, P < 0.001) and a binary logistic regression analysis (odds ratio [OR] = 1.05, P = 0.016). Hematoma volume by 3D Slicer had a significantly higher AUC (0.708; 95% confidence interval [CI]: 0.618–0.798, P < 0.001) than the modified Fisher scale and the new scale by Eagles. The optimal diagnostic threshold for hematoma volume by 3D Slicer was 15.98 ml, and the sensitivity and specificity were 73.5% and 58.6%, respectively.

Conclusions:
Volume of aneurysmal subarachnoid hematoma measured quantitatively by 3D Slicer can improve the predictive value for symptomatic cerebral vasospasm.
Acute Toxic Encephalopathy in Occupational Exposure with Polyvinyl Chloride (PVC) Fumes
Authors: Verma Rajesh , Chakraborty Rajarshi , Giri Prithvi 
Published: August 2023

Background:
Toxic encephalopathy is a spectrum of central nervous system disorders caused by exposure to toxins, especially from occupational workplace. Polyvinylchloride (PVC) is a synthetic chemical polymer that is used widely in daily activities of living. PVC is produced by polymerization of monomer units of vinyl chloride. Its manufacturing requires multiple procedures and additives for heat and light stabilization involving heavy metals.

Objective:
In this novel case series, we present the diverse clinical presentation of 10 patients, working in plastic recycling factory having inhalational exposure to PVC fumes, manifesting as acute toxic encephalopathy.

Materials and Methods:
All the patients were screened for the causes of acute encephalopathy including heavy metals, methanol poisoning, and organotins along with arterial blood gas analysis, brain imaging, and electroencephalogram. Memory loss, confusion, vertigo, headache, and nausea were complained in all the patients while seizure occurred in three patients. Neurocognitive status was grossly impaired in all the patients. Metabolic acidosis in presence of hyponatremia and/or hypokalemia was observed in nine cases. Five of the patients were having evidence of white matter involvement in brain imaging. The screening for heavy metal, methanol, and organotin were negative. Hemodialysis was done in six patients. Recovery was good in everyone and the average discharge was by 10.8 days (range: 2–25 days). All the patients were symptom-free at 3-months follow-up.

Conclusion:
Early suspicion and aggressive management can have favorable outcome in PVC toxic encephalopathy. Occupational hazards due to PVC toxicity are increasing in the present industrial era but it is very less identified.
Cervical Discometry
Authors: Yu Long , Cui Xu , Bao Da 
Published: August 2023

Background and Objectives:
Anterior cervical discectomy and fusion (ACDF), which is widely used in the treatment of cervical spondylosis, may cause complications such as adjacent segment degeneration (ASD). However, such studies on complications are limited, and quantitative evidence is still lacking. To evaluate the clinical value of cervical discometry combined with adjacent intraoperative intradiscal pressure in cervical vertebral surgery through clinical explorations.

Materials and Methods:
In this retrospective study, 100 patients who were treated with anterior decompression, reconstruction, and internal fixation, were enrolled. Among them, 50 patients received ACDF combined with perioperative pressure adjustment of the adjacent segments to ensure that the pressure difference was less than 5 mmHg. The other 50 patients who had only simple ACDF were considered as the control group. Patient information, radiographic changes, axial symptoms (AS), and the occurrence of ASD were recorded in the study.

Results:
The degree of lordosis (D values) at postoperative of all cases were positive. The D value of the two groups of patients immediately after the operation and at the last follow-up were significantly higher than that before the operation (P < 0.05). The incidence of AS was significantly lower in the experimental group than that in the control group (P < 0.05). Besides, there were only 10 patients in the experimental group during the five-year follow-up period, which was significantly lower than the 19 patients in the control group (P < 0.05).

Conclusions:
The intraoperative intervertebral disc pressure measurement could effectively monitor the vertebral body distraction strength and reduce the incidence of postoperative AS and ASD.
Diagnostic Cerebral Angiography Through Distal Transradial Access
Authors: Bhatia Vikas , Kesha Meghashyam , Kumar Ajay , Prabhakar Anuj , Chauhan Rajeev , Singh Apinderpreet 
Published: August 2023

Background and Objective:
Over the last few years, there has been considerable interest in the neurointervention community to use transradial approach for diagnostic and therapeutic neurointerventions. Distal radial approach has been postulated as an effective technique with reduced risk of hand ischemia. Our objective was to assess the safety and feasibility of distal transradial access (DTRA) to perform diagnostic cerebral angiography.

Materials and Methods:
A retrospective evaluation of 25 patients who were taken for DTRA through the anatomical snuff box from December 2021 to March 2022 was done.

Results:
Twenty-five diagnostic cerebral angiographies were attempted with DTRA in 25 patients (age, 23–70 years; mean age, 45.4 years; 10 (40%) females). The right distal radial artery mean diameter was 2.09 mm. The procedure was successful in 21 (84%) procedures. Failure was seen in four cases, with three being converted to the proximal transradial approach without any need for redraping and one was converted to the transfemoral approach. The reason for access conversion was a severe spasm in three cases and dissection in one case. Selective catheterization of the cranial vessels through a distal transradial approach was achieved in 92 (96.8%) of 95 vessels. No significant access site complications were seen in the study cohort.

Conclusion:
DTRA is a promising approach for diagnostic cerebral angiography. Interventionists should get accustomed to this approach by overcoming the initial learning curve.
Rivastigmine for Cognitive Impairment in Multiple Sclerosis
Authors: Gotur Amrita J , Prasad Kameshwar , Bhatia Rohit , Srivastava Achal K , Tripathi Manjari , Goyal Vinay , Pandit Awadh K , Vibha Deepti , Rajan Roopa , Padma Srivastava MV 
Published: August 2023

Background and Objective:
Nearly 40–65% patients with MS develop cognitive impairment during the disease. There is no treatment clearly effective in improving the cognitive deficits. To evaluate the efficacy and safety of Rivastigmine in cognitively impaired MS patients.

Materials and Methods:
This was a parallel group randomized open label study with blinded end-point assessment. The patient allocation to treatment and control arm was done by telephonic contact with an independent statistician who used a computer to generate a random sequence of allocation using permuted block randomization (varying block size of 4 and 6) in 1:1 ratio. The outcome assessor was blinded to this allocation. A total of 60 patients were in included in the study (30 in each arm). Primary outcome was improvement in memory functions (using logical memory subset of Wechsler Memory Scale III, India) assessed after 12 weeks. Secondary outcomes included fatigue, depression, and safety.

Results:
In modified intention to treat analysis (N = 22), treatment arm showed statistically significant improvement in memory function with mean difference of 7.56 [95% CI (0.67,14.46), p 0.032] as compared to control arm. There was no statistically significant difference in outcomes such as fatigue and depression. Vomiting was the most common side effect. No major adverse events were observed in either group.

Conclusion:
Rivastigmine is safe and effective in improving memory functions in cognitively impaired MS patients. However, our study has a small sample size and tested only a single domain. Larger studies with a validated single comprehensive neuropsychological test are needed.
Modified Nasoseptal Flap Technique to Prevent the Recurrence of Rathke's Cleft Cyst
Authors: Joshua Shejoy P. , Sundar Shyam S. , Viswam Vineeth , Panikar Dilip 
Published: August 2023

Background:
Rathke's cleft cysts (RCCs) are benign epithelial lesions arising from the Rathke's pouch remnants that fail to regress during embryogenesis. Some RCCs become symptomatic and require treatment. Cyst fenestration and drainage of its contents is the preferred procedure to treat symptomatic cases but carries a risk of recurrence. We propose the use of a novel modified nasoseptal flap technique to partially line the cyst wall to avoid recurrence.

Methods:
This was a prospective, observational study that included all RCC patients admitted to the Department of Neurosurgery, Aster Medcity, from April 2015 to May 2018. The modified nasoseptal flap technique was performed in all patients. They underwent preoperative and postoperative ophthalmological, endocrine, endoscopic, and MRI evaluations to look for recurrence.

Results:
Ten patients underwent the modified nasoseptal flap technique. The median follow-up was 36 months. Postoperatively, all patients were relieved from headaches. Moreover, their visual fields and pituitary functions normalized. None of the patients developed recurrence of RCC on follow-up brain MRI. On endoscopic examination, all patients had retained patency of the fenestra. The longest follow-up was 72 months.

Conclusions:
The modified nasoseptal flap technique maintains patency and avoids recurrence of RCCs on long-term follow-up.
Alberta Stroke Program Early CT Score can Predict Severity of Spasticity and Functional Outcome in Ischemic Stroke Survivors
Authors: Krishnan Reshma K. V. , Sankaran Ravi 
Published: August 2023

Background:
Post-stroke spasticity is common and an early predictor of the severity of spasticity can help track recovery trajectory helping to modify rehabilitation plans.

Objectives:
We explored the utility of the Alberta Stroke Program Early CT Score (ASPECTS) to predict functional motor capacity in patients after acute ischemic stroke.

Methods:
One hundred and one patients (mean age of 58.6 ± 7.6 years; M:F = 72: 29) with the first documented acute ischemic stroke were followed up for three to twelve months after the stroke. Cerebral lesions within the territory of the middle cerebral artery were evaluated using the ASPECTS. Spasticity was assessed using the Modified Ashworth Score (MAS) and walking with Timed Up and Go test (TUG). The associations between severity of spasticity and size/extent of infarct as derived from ASPECTS and between spasticity and functional walking in post-stroke survivors were analyzed.

Results:
Among the patients studied, 61.3% (n = 62) had infarct in the region of supply of the left middle cerebral artery (MCA) and 38.7% (n = 39) had infarct in the region supplied by the right MCA. Three percent (n = 3) had a low ASPECTS, 53.6% (n = 54) had an intermediate score and 44.4% (n = 44) had a high score. The majority of patients with no to mild spasticity had high ASPECTS. Worse spasticity was significantly associated with low ASPECTS (P = 0.001). High scores in Timed Up and Go test (TUG) were associated with low ASPECTS (P < 0.001). Patients with high ASPECTS had the propensity to have subcortical infarcts (P < 0.001) when compared to those with moderate ASPECTS, who had a mix of cortical and subcortical infarcts.

Conclusion:
ASPECTS at admission in patients with acute ischemic stroke is a good predictor of post-stroke spasticity and functional walking. Low ASPECTS is associated with higher spasticity and lower functional walking status on follow-up after stroke.