bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffuse intrinsic pontine gliomas in adults
Authors: Kandregula Sandeep , Konar Subhas , Sadashiva Nishanth , Nagesh Madhusudhan , Kalahasti Sathya Rao , Krishna Uday , Saini Jitender , Shukla Dhaval , Santosh Vani 
Published: August 2023

Background:
Brainstem gliomas (BSG) constitutes very small proportion in adults brain tumors with pons as most common location. There is significant paucity in literature for adult diffuse intrinsic pontine gliomas (DIPG).

Objective:
In this study, we attempt to review the outcomes of DIPG in single institute.

Methods:
We performed a retrospective chart review of adult DIPG from last 8 years (2010-2018) in a tertiary institute. DIPG was defined as expansile lesions involving more than 50% of the greatest diameter in the pons.

Results:
We found a total 46 patients with the diagnosis of adult BSG. Based on the definition, 23 patients with adult DIPG qualified to be included in the study. The median age was 32 years (IQR: 22-41), with a sex ratio of 16/7 (M/F). Cranial palsies were found in 17 (73%) patients. The median duration of symptoms was 6 months. On magnetic resonance imaging (MRI), contrast enhancement was found in seven (30%) patients. Biopsy was done in five patients. Median follow up was 11 months (IQR: 7-15). Median overall survival (OS) was 15 months (95%, CI 8.3-21.6). Fourteen patients had succumbed to death at the latest follow-up, and seven patients were alive. Median OS for the patients with age less than 40 years and more than 40 years was 7 and 22 months, respectively (p = 0.016). Rest of the variables did not effect OS significantly.

Conclusion:
Adult DIPG's significantly differs from pediatric counterparts in clinical characteristics, as well as OS. Age was the only factor which was significantly associated with survival in our study. Long-term studies with molecular profiling may help in further characterizing these lesions.
Feasibility of Tailored Unilateral Disconnection vs Callosotomy for Refractory Epilepsy in Patients with Bilateral Parieto-Occipital Gliosis Following Perinatal Insult
Authors: Agrawal Mohit , Chandra Sarat P. , Doddamani Ramesh S. , Samala Raghu , Garg Ajay , Gaikwad Shailesh , Sharma Ravi , Ramanujan Bhargavi , Tripathi Madhavi , Bal Chandrashekar , Tripathi Manjari 
Published: August 2023

Background:
Patients with perinatal hypoxia (PH) and drug-refractory epilepsy (DRE) often have bilateral parieto-occipital gliosis. Surgical management of such patients is a dilemma.

Objective:
To identify preoperative determinants for unilateral disconnection vs callosotomy, and analyze the surgical outcome in such patients.

Methods and Material:
This was a retrospective analysis of patients with DRE and history of PH, with MRI abnormalities restricted to bilateral posterior quadrants. Preoperative semiology, epilepsy duration and seizure frequency were recorded. Based on the concordance between the results of non-invasive tests, patients underwent either posterior quadrant disconnection (PQD) or corpus callosotomy (CC). Preoperative variables were analyzed and corelated to the postoperative seizure freedom.

Results:
Fourteen patients were identified, 6 underwent PQD and 8 underwent CC. At follow up of 39.17 ± 23.75 months, 66.66% of patients (4/6) in the PQD subgroup had an ILAE Class I outcome. While none in the CC group attained seizure freedom, 87.5% (7/8) had more than 50% reduction in seizure frequency (follow up: 42 ± 27.31 months). Patients with a poor outcome had significantly greater seizure frequency (P = 0.05) and history of drop attacks (P = 0.04) in both the groups. Magnetoencephalography (MEG) accurately localized the epileptogenic zone in all of the patients with good outcome (P = 0.015). Concordance with single photon emission tomography (SPECT) was also a predictor of favorable outcome (P = 0.041).

Conclusions:
A history of drop attacks with high seizure frequency is associated with poor postoperative seizure outcome. Unilateral PQD is feasible and leads to superior seizure-free outcomes, even in cases with widespread and bilateral imaging and electrical abnormalities, provided the other preoperative investigations are concordant in localizing the epileptogenic zone.
Endoscopic Endonasal Excision of a Meckel's Cave Dermoid Cyst
Authors: Patel Biren K , Darshan HR , Binu Anand , George Tobin , Easwer HV , Nair Prakash 
Published: August 2023

Background:
Meckel's cave dermoid cyst is an extremely rare and a technically challenging lesion. The objective of the study is to show that endoscopic endonasal approach (EEA) has recently emerged as a better alternative to transcranial approach for this formidable tumor, owing to minimal retraction-related morbidity.

Method:
A 52-year-old male presented with numbness over the right side of the face and temporal area for the last 3 years. On examination, there was decreased sensation to touch, pain, and temperature over the right V1, V2, and V3 areas with an absent right corneal reflex. Imaging revealed a heterogenous extra-axial lesion in the right Meckel's cave. The tumor was resected by an extended endonasal transpterygoid approach.

Results:
The patient had improvement in his symptoms with no endocrine complication.

Conclusion:
This case demonstrates the surgical techniquenof endoscopic endonasal transpterygoid resection of a Meckel's cave dermoid cyst.
Preoperative 3D Image Evaluation of EC–IC Bypass by 3D Visualization Analysis Software Amira®
Authors: Tanaka Riki , Liew Boon Seng , Yamada Yasuhiro , Okubo Mai , Katayama Tomoka , Sasaki Kento , Miyatani Kyosuke , Komatsu Fuminari , Kato Yoko , Hirose Yuichi 
Published: August 2023

Background:
Careful evaluation of the preoperative imaging for extracranial–intracranial bypass performed for conditions like intracranial stenosis and Moya disease is important. The traditional use of 2D imaging has a significant limitation for neurosurgeons, primarily to determine the optimal location of the recipient artery for performing the surgical bypass. Therefore, many neurosurgeons use 3D angiograms more frequently to overcome these shortcomings.

Materials And Methods:
We performed the preoperative evaluation of the possibility of performing an anastomosis between the superficial temporal artery and the middle cerebral artery (STA–MCA) bypass by synthesizing images of computerized tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) using Amira® of 3D visualization analysis software (Thermo Scientific Co.).

Results:
The 3D images prepared before surgery using this software showed good agreement with the intraoperative findings.

Conclusion:
Preoperative image processing using tools like Amira provide optimal information for good planning and communication for performing STA–MCA bypass and may become a helpful tool.
Gamut of Orbital Lesions in a Tertiary Neurocenter—A Clinicopathological Study of Lesions Seen Over a Period of One Decade
Authors: Bhatt Anusha S , Nandeesh Bevinahalli N , Mhatre Radhika , Mahadevan Anita , Santosh Vani , Yasha T Chickabasaviah 
Published: August 2023

Background:
The orbital region is an anatomically complex area comprising crucial contiguous/adjacent structures. Since the eye has a neuroectodermal basis of embryogenesis, many of the lesions may be similar to those arising in the central nervous system.

Objective:
To record and describe the clinicopathological spectrum of orbital lesions presenting to a neurology center.

Study Setting:
The retrospective study included biopsy/resected specimens of patients with orbital/ophthalmic lesions referred to the Department of Neuropathology, between February 2007 and February 2018.

Materials and Methods
: The demographic, clinical, and radiological details were retrieved from the departmental archives and the slides were reviewed.

Results:
There were 99 cases in the period of the study (2007–2018) with a peak in fourth and fifth decades (age range: 5 months to 68 years; mean: 37.2 years; M: F =1.06: 1). Eighty-six (86.8%) cases had epicenter in the orbit, whereas 13 (13.13%) cases were extraorbital with orbital extension. The benign neoplasms predominated (50/99, 50.5%) followed by malignant neoplasms (24/99, 24.24%), infective conditions (11/99, 11.11%) and tumor like conditions (7/99, 7.07%). The most common benign tumor was vascular tumor (17/50, 34%) followed by meningioma (12/50, 24%), while epithelial malignant tumor (6/24, 25%) was the most common malignancy. Fungal infection was the most frequent infective condition (6/11, 54.5%).

Conclusion:
The spectrum of ocular-orbital lesions varies with the geographic area and the nature of the institute catering to the needs of patients. The spectrum of lesions that we encountered from a neurological institute was vastly different from that reported from ophthalmic centers with very low frequency of retinoblastomas.
Factors Predicting Poor Surgical Outcome in Patients with Thoracic Ossified Ligamentum Flavum – Analysis Of 106 Patients in a Tertiary Care Hospital in South India
Authors: Ramesh Chandra Venkata Vemula , M Prasad Bodapati C , Rajesh Paradesi , Agarwal Sudharsan , Krishna Mohana Murali 
Published: August 2023

Background:Ossified ligamentum flavum (OLF) is the major cause of thoracic myelopathy in our locality. Surgical outcomes and their related factors for patients with thoracic OLF (T-OLF) remain unclear because of the few studies on this condition.Objectives:The present study aimed to examine the factors predicting poor surgical outcomes and the effectiveness of decompressive laminectomy and OLF resection in patients with T-OLF.Material and Methods:A total of 106 patients with T-OLF operated at our institute from 2007 to 2018 were included. The mJOA score was used in neurological assessment preoperatively and during the follow-up. Multiple regression analysis was conducted to know the best correlation between factors and surgical outcomes.Results:The mean mJOA score was 5.67 ± 2.13 preoperatively and 7.50 ± 2.60 postoperatively at the end of follow-up. The recovery rate was 43.29 ± 30.55%. After decompressive laminectomy, the mean mJOA score, modified Nurick score, and Ashworth's grade showed significant improvement (P< 0.001). Multiple regression analysis showed that the age of the patient, associated trauma, OLF level, tuberous type OLF, intramedullary signal change on T2WI, preoperative severity of myelopathy, pre-op mJOA score, and pre-op Nurick grade were significantly correlated with the surgical outcome (P< 0.001). No correlation was identified with the duration of symptoms, dural ossification, dural tear, and CSF leak (P> 0.05).Conclusion:It is important to identify preventable risk factors for poor surgical outcomes for T-OLF. Age of the patient, associated trauma, OLF level, tuberous type OLF, intramedullary signal change on T2WI, preoperative severity of myelopathy, preoperative mJOA score, and Nurick grade were important predictors of surgical outcome in our study series.
‘White Cord Syndrome’
Authors: Goyal Nishant , Chaturvedi Jitender , Kandwal Pankaj , Gupta Priyanka , Kaushal Ashutosh , Kumar Mritunjai 
Published: August 2023

Background:
'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's neurology and MRI reveals signal changes in spinal cord in absence of cord compression. We wish to report a case of 'white-cord syndrome' following a 'routine' ACDF.

Case Description:
A 39-year-old woman with paresthesias and spastic quadriparesis was found to have C5-C6 PIVD on MRI. ACDF was performed at C5-C6, after which worsening of quadriparesis was noted, for which intravenous high-dose steroids were started. An urgent MRI was done, which revealed findings of white-cord syndrome, without compression on underlying cord. With conservative management, her ASIA grade improved from C to D and the features of white-cord syndrome disappeared on follow-up imaging.

Conclusion:
It is important for surgeons and patients to be aware of this rare but potentially catastrophic entity as this needs to be discussed while taking consent for surgery.
Transplantation of NEP1-40 and NT-3 Gene-Co-Transduced Neural Stem Cells Improves Function and Neurogenesis after Spinal Cord Injury in a Rat Model
Authors: Chen Feng , Zhang Zhuang , Wang Lin-nan , Yang Xi , Zhou Chun-Guang , Zhu Ce , Wang Lei , Liu Li-min , Song Yue-ming 
Published: August 2023

Background:
Spinal cord injury (SCI) generally results in necrosis, scarring, cavitation, and a release of inhibitory molecules of the nervous system, which lead to disruption of neurotransmission and impede nerve fiber regeneration. This study was intended to evaluate the therapeutic efficacy rates of the transplantation of NEP
1–40- and NT-3 gene-co-transduced neural stem cells (NSCs) in a rat model of SCI.

Methods:
Ninety Sprague–Dawley rats were subdivided randomly into six groups: sham-operated, SCI model, SCI + NSCs-NC, SCI + NEP1-40-NSCs, SCI + NT-3-NSCs, and SCI + NEP1-40/NT-3-NSCs. Motor function at different time points was evaluated using the Basso, Beattie, and Bresnahan locomotor activity scoring system (BBB). At 8 weeks post-transplantation, histological analysis, a terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay, immunofluorescent assay, immunocytochemical staining, and cholera toxin subunit B (CTB) retrograde tracing were performed.

Results:
BBB scores of the co-transduction group significantly surpassed those of other transplantation groups and of the SCI-model group after 2 weeks post-transplantation. The apoptotic rate of neurocytes was significantly lower in the co-transduction group than in other experimental groups. Expression of NF-200, MBP, and ChAT was significantly higher in the SCI + NEP1-40/NT-3-NSCs group than in other transplantation groups, whereas the expression of GFAP and GAD67 was the second lowest after the sham-operated group. CTB retrograde tracing showed that CTB-positive neural fibers on the caudal side of the hemisected site were more numerous in the SCI + NEP1-40/NT-3-NSCs group than in other experimental groups.

Conclusion:
Transplantation of NEP
1–40- and NT-3-gene-co-transduced NSCs can modify the protein expression following acute SCI and promote neuron formation and axonal regeneration, thus having a neuroprotective effect. Furthermore, this effect surpasses that of transplantation of single-gene-transduced NSCs. Transplantation of NEP
1–40- and NT-3-gene-co-transduced NSCs is effective at the neural recovery of the rat model of SCI and may be a novel strategy for clinical treatment of SCI.
Post-Vaccination/Post-COVID Immune-Mediated Demyelination of the Brain and Spinal Cord
Authors: Mahajan Ashima , Nayak Manoj K , Gaikwad Shailesh B. , Sharma Kalyan , Padma Srivastava M Vasantha , Anand Pooja , Oinam Rahul , Mishra Biswa Mohan 
Published: August 2023

Introduction:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which not only produces respiratory symptoms but is known to involve almost every system, and its neuroinvasive properties have been well demonstrated throughout the pandemic. Also, to combat the pandemic, there was rapid development and induction of various vaccination drives, following which many adverse events following immunization (AEFIs) have been reported, which include neurological complications as well.

Method:
We present a series of three cases, post vaccination, with and without a history of COVID illness that showed remarkably similar findings on magnetic resonance imaging (MRI).

Result:
A 38-year-old male presented with complaints of weakness of the bilateral lower limbs with sensory loss and bladder disturbance a day after receiving his first dose of ChadOx1 nCoV-19 (COVISHIELD) vaccine. A 50-year-old male with hypothyroidism characterized by autoimmune thyroiditis and impaired glucose tolerance experienced difficulty in walking 11.5 weeks after being administered with COVID vaccine (COVAXIN). A 38-year-old male presented with subacute onset progressive symmetric quadriparesis 2 months after their first dose of a COVID vaccine. The patient also had sensory ataxia, and his vibration sensation was impaired below C7. All three patients had typical pattern of involvement of the brain and spine on MRI with signal changes in bilateral corticospinal tracts, trigeminal tracts in the brain, and both lateral and posterior columns in the spine.

Conclusion:
This pattern of brain and spine involvement on MRI is a novel finding and is likely a result of post-vaccination/post-COVID immune-mediated demyelination.
The Legal Void Outside Brain Death in India
Authors: Deora Harsh , Yagnick Nishant S. , Gupta Ayan , Tripathi Manjul , Gupta Sanjay Kumar , Mohindra Sandeep , Ganapathy Krishnan 
Published: August 2023

Objective:
The legal definitions of brain death are tantamount for legal dogmas and sometimes criminal intimidation of the treating doctors. The tests for brain death are only applicable to patients planned for organ transplantation. We intend to discuss the necessity of the “Do Not Resuscitate (DNR)” legislature in cases of brain death patients and applicability of tests for brain death irrespective of the intention for organ donation.

Methods:
A comprehensive review of the literature was performed till May 31, 2020 from the MEDLINE (1966 to July 2019) and Web of Science (1900 to July 2019). Search criteria included all publications with the MESH terms: “Brain Death/legislation and jurisprudence”[Mesh] OR “Brain Death/organization and administration”[Mesh] AND “India” [Mesh]. We also discuss the different opinions and implications of brain death versus brain stem death in India with the senior author (KG) who was responsible for South Asia's first multi-organ transplant after certifying brain death. Additionally, a hypothetical scenario of a DNR case is discussed in the current legal paradigm of India.

Results:
The systematic search yielded only five articles reporting a series of brain stem death cases with an acceptance rate of organ transplant among brain stem deaths being 34.8%. The most common solid organs transplanted were the kidney (73%) and liver (21%). A hypothetical scenario of a DNR and possible legal implications of the same under the current 'Transplantation of Human Organs Act (THOA)' of India remains unclear. A comparison of brain death laws in most Asian countries shows a similar pattern regarding the declaration of brain death and the lack of knowledge or legislature regarding DNR cases.

Conclusion:
After the determination of brain death, discontinuation of organ support requires the consent of the family. The lack of education and the lack of awareness have been major impediments in this medico-legal battle. There is also an urgent need to make laws for cases that do not qualify for brain death. This would help in not only realistic realization but also better triage of the health care resources while legally safeguarding the medical fraternity.
Efficacy and safety of rituximab in treatment of systemic sclerosis: A retrospective study
Authors: Singh Anupama , Udayan Uday Kumar , Tiwary Pankaj Kumar , Prasad Gopal , Jha Abhijeet Kumar , Zeeshan Md. , Singh Shivangi 
Published: August 2023

Background:
Conventional treatment of systemic sclerosis with drugs for symptom control and broad-spectrum immunosuppression has remained unsatisfactory. Depletion of B-lymphocytes, which are a crucial element in pathogenesis, with rituximab (RTX) has produced encouraging results.

Objective:
This study aimed to retrospectively analyze the safety and efficacy of RTX in systemic sclerosis.

Materials and Methods:
Baseline, 6- and 12-month follow-up data of 13 systemic sclerosis (11 diffuse and 2 limited) patients (10 adult and 3 adolescent) who received 4 infusions of 500 mg RTX at 2-weekly intervals was accessed and retrospectively analyzed.

Results:
Modified Rodnan Skin Score progressively improved from a baseline of 22.2 ± 7.97 to 17.7 ± 7.95 at 6 months (P < 0.05) and 14 ± 7.12 at 12 months (P < 0.05 vs. baseline and 6-month), and mouth opening increased from 2.23 ± 0.44 fingers to 3.5 ± 0.52 fingers at 12 months (P < 0.05). Pruritus and melanoderma improved in all those affected. Raynaud’s phenomenon improved in 12/13, whereas digital ulcers improved significantly in 9/12 patients. Arthritis remitted in the six affected patients, and percentage predicted forced vital capacity improved from a baseline of 70 ± 9.09 to 76.54 ± 7.5 at 12 months (P < 0.05). There were no serious adverse effects.

Conclusion:
RTX showed good outcome in cutaneous, joint, and pulmonary features of systemic sclerosis without any significant adverse event.
Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy in a multi-institutional cohort of Indian patients
Authors: Sharma Gopal , Shah Milap , Ahluwalia Puneet , Bhandari Mahendra , Ahlawat Rajesh , Rawal Sudhir , Sivaraman Ananthakrishnan , Thyavihally Yuvaraja B. , Gautam Gagan 
Published: August 2023

ABSTRACT

Introduction:
The literature on studies reporting trifecta or pentafecta outcomes following robot-assisted partial nephrectomy (RAPN) in Indian patients is limited. The primary aim of this study was to report and evaluate the factors predicting trifecta and pentafecta outcomes following RAPN in Indian patients using the multicentric Vattikuti collective quality initiative (VCQI) database.

Methods:
From the VCQI database for patients who underwent RAPN, data for Indian patients were extracted and analyzed for factors predicting the achievement of trifecta and pentafecta following RAPN. Trifecta was defined as the absence of complications, negative surgical margins, and warm ischemia period shorter than 25 min or zero ischemia. Pentafecta covers all the trifecta criteria as well as >90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease at 12 months.

Results:
In this study, among 614 patients, the trifecta was achieved in 374 patients (60.9%) and pentafecta was achieved in 24.2% of the patients. Patients who achieved trifecta had significantly higher mean age (54.1 vs. 51.0 years, P = 0.005), body mass index (BMI) (26.7 vs. 26.03 kg/m2, P = 0.022), and smaller tumor size (38.6 vs. 41.4 mm, P = 0.028). The preoperative eGFR (84.2 vs. 91.9 ml/min, P = 0.012) and renal nephrometry score (RNS) (6.96 vs. 7.87, P ≤ 0.0001) were significantly lower in the trifecta group. Comparing patients who achieved pentafecta to those who did not, we noted a statistically significant difference between the two groups for tumor size (36.1 vs. 41.5 mm, P = 0.017) and RNS (6.6 vs. 7.7, P = 0.0001). On multivariate analysis, BMI and RNS were associated with trifecta outcomes. Similarly, only RNS was identified as an independent predictor of pentafecta.

Conclusions:
RNS and BMI were independent predictors of the trifecta. At the same time, RNS was identified as an independent predictor of pentafecta following RAPN.
Prepubic inflammatory liposarcoma presenting as urosepsis
Authors: Khattar Manish , Singh Prabhjot , Nayak Brusabhanu , Khan Shah Alam , Kumar Venkatesan Sampath 
Published: August 2023

ABSTRACT
Inflammatory well-differentiated liposarcoma is a rare soft-tissue tumor which is predominantly retroperitoneal in origin. We report a 72-year-old male without co-morbidities with suspected urosepsis and an obstructing ureteric calculus. Despite adequate diversion and broad-spectrum antimicrobials, the leukocytosis persisted. Further imaging revealed a locally infiltrating prepubic mass which was suspicious of a lymphoid malignancy and was found to be a high-grade liposarcoma on biopsy. He underwent open wide local resection of the tumor and the histopathology revealed an inflammatory well-differentiated liposarcoma with areas of neutrophilic abscess and necrosis. A dramatic response to the surgical resection was seen and the leukocytosis resolved within a few days.