bluuebunny/crossref_metadata_2025_split huggingface dataset:
Craniospinal MRI Findings in Neuromelioidosis
Authors: Naik Suprava , Bhoi Sanjeev Kumar , Jha Menka , Kumar Mukesh 
Published: August 2023

Background:
Melioidosis is a bacterial infection caused by Burkholderia pseudomallei that is endemic in Southeast Asia, northern Australia, and Africa. Neurological involvement is rare and reported in 3–5% of total cases.

Objective:
The purpose of this study was to report a series of cases of melioidosis with neurological involvement and a brief review of the literature.

Materials and Methods:
We collected the data from six melioidosis patients having neurological involvement. Clinical, biochemical, and imaging findings were analyzed.

Result:
All patients in our study were adults (age range 27 to 73 years). The presenting symptoms were fever of varying duration (range 15 days to 2 months). Altered sensorium was noted in five patients. Four cases had brain abscess, one had meningitis, and one had a spinal epidural abscess. All cases of brain abscesses were T2 hyperintense with an irregular wall showing central diffusion restriction and irregular peripheral enhancement. The trigeminal nucleus was involved in one patient, but there was no enhancement of the trigeminal nerve. Extension along the white matter tract was noted in two patients. Magnetic resonance (MR) spectroscopy done in two patients showed increased lipid/lactate and choline peak in both of them.

Conclusion:
Melioidosis can present as multiple micro-abscesses in the brain. Involvement of the trigeminal nucleus and extension along the corticospinal tract may raise the possibility of infection by B. pseudomallei. Meningitis and dural sinus thrombosis, although rare, can be presenting features.
An Analysis of Temporal Trend of Incidence of Post-Resection Cerebrospinal Fluid Diversion in Pediatric Posterior Fossa Tumor Patients and the Predictive Factors
Authors: Kumar Ashutosh , Bhaisora Kamlesh Singh , Rangari Kamlesh , Mishra Prabhakar , Raiyani Vandan , Sardhara Jayesh , Maurya Ved Prakash , Verma Pawan Kumar , Das Kuntal Kanti , Mehrotra Anant , Srivastav Arun Kumar , Jaiswal Awadhesh , Kumar Raj , Behari Sanjay 
Published: August 2023

Objective:
We aim to find the temporal trend of incidence of post-resection cerebrospinal fluid (CSF) diversion (ventriculoperitoneal [VP] shunt/endoscopic third ventriculostomy [ETV]) in pediatric posterior fossa tumor (pPFT) patients with no pre-resection CSF diversion and the possible clinical predictors.

Methods:
We reviewed 108 operated children (age ≤16 years) with PFTs, from 2012 to 2020, at a tertiary care center. Patients with preoperative CSF diversion (n = 42), lesions within cerebellopontine cistern (n = 8), and those lost to follow-up (n = 4) were excluded. Life table, Kaplan–Meier curve, univariate and multivariate analyses were used to determine CSF-diversion-free survival and independent predictive factors, with significance defined as P < 0.05.

Results:
The median (IQR) age was 9 (7) years (M: F: 2.5:1). Mean (±SD) duration of follow-up was 32.43 ± 21.3 months. 38.9% of patients (n = 42) needed post-resection CSF diversion. Of these, 64.3% (n = 27) were done in early (≤ 30 days), 23.8% (n = 10) in intermediate (>30 days to ≤6 months), and 11.9% (n = 5) in late (≥6 months) postoperative period (P-value < 0.001). Preoperative papilledema (HR: −5.8, 95%CI: 1.7–5.8), periventricular lucency (PVL) (HR: 6.2, 95%CI: 2.3–16.6), and wound complication (HR: 3.8, 95%CI: 1.7–8.3) were found on univariate analysis as significant risk factors for early post-resection CSF diversion. On multivariate analysis, PVL on preoperative imaging (HR: −4.2, 95%CI: 1.2–14.7, P = 0.02) was identified as an independent predictor. Preoperative ventriculomegaly, raised intracranial pressure and intraoperative visualization of CSF egress from the aqueduct were not found to be significant factors.

Conclusion:
Significantly high incidence of post-resection CSF diversion in pPFTs occurs in early (≤30 days) postoperative period, with preoperative papilledema, PVL, and wound complication being its significant predictive factors. Postoperative inflammation, causing edema and adhesion formation can be one of the important factors for post-resection hydrocephalus in pPFTs.
Outcome of COVID-19–Associated Acute Stroke
Authors: Chaudhuri Jaydip Ray , Sharma Vijay K , Mridula K Rukmini , Anjanikumar Darapureddy , Bandaru Srinivasarao VCS 
Published: August 2023

Background and Objective:
Coronavirus 2019 (COVID-19) infection is prevalent worldwide. COVID-19 infection can lead to various neurological disorders including acute stroke. We investigated the functional outcome and its determinants among our patients with acute stroke associated with COVID-19 infection in the present setup.

Materials and Methods:
This study is a prospective study in which we recruited acute stroke patients with COVID-19 positivity. Data on duration of COVID-19 symptoms and type of acute stroke were recorded. All patients underwent stroke subtype workup and measurement of D-dimer, C-reactive protein (CRP), lactate-dehydrogenase (LDH), procalcitonin, interleukin-6, and ferritin levels. Poor functional outcome was defined by modified Rankin score (mRS) ≥3 at 90 days.

Results:
During the study period, 610 patients were admitted for acute stroke, of whom 110 (18%) tested positive for COVID-19 infection. Majority (72.7%) were men with a mean age of 56.5 years and mean duration of COVID-19 symptoms for 6.9 days. Acute ischemic and hemorrhagic strokes were observed in 85.5% and 14.5% patients, respectively. Poor outcome was observed in 52.7%, including in-hospital mortality in 24.5% patients. COVID-19 symptoms ≤5 days (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.20–2.99), CRP positivity (OR: 1.97, 95% CI: 1.41–4.87), elevated levels of D-dimer (OR: 2.11, 95% CI: 1.51–5.61), interleukin-6 (OR: 1.92, 95% CI: 1.04–4.74), and serum ferritin (OR: 2.4, 95% CI: 1.02–6.07), and cycle threshold (Ct) value ≤25 (OR: 8.8, 95% CI: 6.52–12.21) were independent predictors of poor outcome.

Conclusion:
Poor outcomes were relatively higher among acute stroke patients with concomitant COVID-19 infection. In the present study, we established the independent predictors of poor outcome to be onset of COVID-19 symptoms (<5 days) and elevated levels of CRP, D-dimer, interleukin-6, ferritin, and Ct value ≤25 in acute stroke.
Hypophysitis – A Review of Fourteen Cases
Authors: Chatterjee Sudip , Chatterjee Sandip , Bhartiya Sankalp 
Published: August 2023

Background:
Primary hypophysitis is a rare condition, usually diagnosed retrospectively after surgery for a suspected pituitary adenoma. Improved awareness of the condition and better imaging have resulted in more patients being diagnosed without surgery.

Objective:
A retrospective chart analysis study of hypophysitis from a single secondary endocrine and neurosurgical referral center in eastern India was conducted between 1999 and 2021 to assess the diagnostic and therapeutic challenges posed by these patients.

Methods and Material:
Fourteen patients presented to the center between 1999 and 2021. All patients had an MRI of the head with contrast and a full clinical workup. Twelve patients had headache, of whom one had progressive visual impairment. One patient had severe weakness, attributed later to hypoadrenalism and one had sixth nerve palsy.

Results:
Six patients had glucocorticoids as their primary treatment, four refused treatment, and one was on glucocorticoid replacement. One patient had decompressive surgery because of progressive visual loss, and two had surgery because of a presumptive diagnosis of pituitary adenoma. There was no difference between the patients who had glucocorticoids and those who did not.

Conclusions:
Our data suggest that it is possible to identify most patients with hypophysitis on clinical and radiological grounds. In the largest published series on this subject and in ours, glucocorticoid treatment did not alter the outcome.
Anesthetic Concerns during Gamma-Knife Radiosurgery
Authors: Tripathi Manjul , Chauhan Rajeev , Luthra Ankur , Sadashiva Nishanth , Deora Harsh , Batish Aman , Kaur Rupinder , Madan Renu , Mohindra Sandeep 
Published: August 2023

Background:
Gamma-knife radiosurgery (GKRS) has emerged as one of the mainstream modalities in the treatment of many neurosurgical conditions. The indications for Gamma knife are ever-increasing and presently more than 1.2 million patients have been treated with Gamma knife worldwide.

Objective:
A neurosurgeon usually leads the team of radiation oncologists, medical physicists, nursing staff, and radiation technologists. Seldom, help from anesthetist colleagues is required in managing patients, who either require sedation or anesthesia.

Methods:
In this article, we try to elucidate anesthetic considerations in Gamma-knife treatment for different age groups. With the collective experience of authors involved in Gamma-Knife Radiosurgery of 2526 patients in 11 years with a frame-based technique, authors have tried to elucidate an effective and operational management strategy.

Results:
For pediatric patient (n = 76) population and mentally challenged adult patients (n = 12), GKRS merits special attention given its noninvasive nature but problems of frame fixation, imaging, and claustrophobia during radiation delivery become an issue. Even among adults, many patients have anxiety, fear, or claustrophobia, who require medications either to sedate or anesthetize during the procedure.

Conclusion:
A major goal in treatment would be a painless frame fixation, avoid inadvertent movement during dose delivery, and a fully wake, painless, and smooth course after frame removal. The role of anesthesia is to ensure patient immobilization during image acquisition and radiation delivery while ensuring an awake, neurologically accessible patient at the end of the radiosurgery.
Gamma Knife Stereotactic Radiosurgery for Giant Intracranial Tumors – A Series of 70 Patients
Authors: Verma Satish Kumar , Agrawal Deepak , Santhoor Hemanth Amardeep , Singh Manmohan , Kale Shashank Sharad 
Published: August 2023

Background and Objective:
Surgery remains the primary option in large intracranial tumors, but significant number of patients may not be amenable for surgery. We explored the role of stereotactic radiosurgery as an alternative to external beam radiation therapy (EBRT) in such patients. Our study objective was to assess the clinicoradiological outcomes of large intracranial tumors (volume ≥20 cm3) managed with gamma knife radiosurgery (GKRS).

Materials and Methods:
This was a single-center, retrospective study conducted from January 2012 to December 2019. Patients with intracranial tumor volume ≥20 cm3 who received GKRS and had a minimum of 12 months of follow-up were included. Clinical, radiological, and radiosurgical details and clinicoradiological outcomes of the patients were obtained and analyzed.

Results:
Seventy patients who had a pre-GKRS tumor volume ≥20 cm3 with >12 months of follow-up were included. The mean age of the patients was 41.9 ± 13.6 (range 11–75) years. Majority (97.1%) received GKRS in a single fraction. Mean pretreatment target volume was 31.9 ± 15.1 cm3. At a mean follow-up of 34.2 ± 17.1 months, tumor control was achieved in 91.4% (n = 64) of the patients. Adverse radiation effects were observed in 11 (15.7%) patients, but were symptomatic in only one (1.4%) patient.

Conclusion:
The present series defines “large intracranial lesions” for GKRS and demonstrates excellent radiological and clinical outcomes in these patients. GKRS may be considered as the primary option in such large intracranial lesions in which surgery carries significant risk based on patient-related factors.
Correlation Based on the WHO Grading with Tumor Control and Clinical Outcome Following Gamma Knife Radiosurgery in Meningiomas
Authors: Naik Vikas , Pahwa Bhavya , Singh Manmohan , Kale Shashank , Agrawal Deepak 
Published: August 2023

Background and Aim:
The aim of this study was to study the effect of Gamma Knife (GK) on meningiomas based on the World Health Organization's (WHO) grading system in terms of tumor control and final clinical outcome.

Methodology:
This retrospective study included clinicoradiological and GK characteristics of patients who had undergone GK for meningiomas at our institute from April 1997 until December 2009.

Results:
Of 440 patients, 235 underwent secondary GK for residual/recurrent lesion and 205 received primary GK. Of the 137 patients whose biopsy slide could be reviewed, 111 patients had grade I, 16 had grade II, and 10 had grade III meningiomas. Good tumor control rates were seen in 96.3% of grade I meningioma patients, 62.5% of 16 grade II, and 10% of grade III meningioma patients at median follow-up of 40 months. Age, sex, Simpson's grade of excision, and increasing peripheral dose of GK did not affect the response to radiosurgery (P > 0.05). Multivariate analysis showed that high-grade tumor and radiotherapy prior to GK were important negative predictors for progression of tumor size after GK radiosurgery (GKRS) (P < 0.05). In patients with WHO grade I meningioma, radiation therapy prior to GKRS and repeat surgery were predictors for poorer outcome.

Conclusion:
In WHO grades II and III meningiomas, no factors affected tumor control except the histology itself.
Proton Radiosurgery
Authors: Rosa Alonso La , Wroe Andrew , Fellows Zachary , Kotecha Rupesh 
Published: August 2023

Introduction:
Stereotactic radiosurgery (SRS) is highly conformal, high-dose radiation therapy delivered in 1–5 fractions, and is considered the standard of care for several central nervous system (CNS) indications. Particle therapies, such as protons, have physical and dosimetric advantageous properties compared to photons. However, proton SRS (PSRS) is not widely performed given the few particle therapy facilities, high-cost, and limited outcomes research as a sole modality and in comparative studies. The data available differs from each pathology. For AVMs, especially those with deep or eloquent locations, PSRS obliteration rates outcomes appear favorable and superior. For meningiomas, PSRS has been used for grade 1 alone, and for higher grades a PSRS boost has been considered. For vestibular schwannoma, PSRS seems to have favorable control rates with modest toxicity outcomes. For pituitary tumors, data shows excellent results with PSRS for functional and non-functioning adenomas. For brain metastasis, moderate doses of PSRS achieves high local control rates with low rates of radiation necrosis. For uveal melanoma, dedicated eyeline PSRS (4–5 fractions) are associated with very high tumor control and eye retention rates.

Conclusions:
PSRS is effective and safe for various intracranial pathologies. Limited data, usually retrospective and single institution series exist. There are numerous advantages of protons over photons, so it is important to understand limitations with further studies. Published clinical outcomes and widespread adoption of proton therapy will be key to unlocking the potential benefits of PSRS.
Hypo-fractionated Gamma Knife Radiosurgery for Intra-cranial Pathologies
Authors: Tripathi Manjul , Kumar Narendra , Sreenivasan Sanjeev A , Ahuja Chirag K , Jani Parth , Bhatta Rajkumar , Kaur Rupinder , Mohindra Sandeep , Chauhan Rajeev 
Published: August 2023

Background:
Single-session stereotactic radiosurgery (SRS) is a proven and effective treatment modality for various benign, malignant, and functional intra-cranial pathologies. In certain situations, single-fraction SRS is limited because of lesion size and location. Hypo-fractionated gamma knife radiosurgery (hfGKRS) is an alternative approach for such unconventional indications.

Objective:
To evaluate the feasibility, efficacy, safety, and complication profile of hfGKRS with evaluation of different fractionation schemes and dosing patterns.

Methodology:
The authors prospectively evaluated 202 patients treated with frame-based hfGKRS over a 9-year period. GKRS was administered fractionated because of either a large volume (>14 cc) or an inability to spare neighboring organs at risk from permissible radiation in single-session GKRS. The inter-fraction interval was kept at 24 hours, and the dose calculation was performed with linear quadratic equations. Patients with more than 3 years of clinical and radiological follow-up were included in prospective analysis. At pre-decided follow-up criteria, treatment effects and side effects were documented on objective scales.

Results:
A total of 169/202 patients met inclusion criteria. 41% patients received treatment in three fractions, whereas 59% received two-fraction GKRS. Two patients of giant cavernous sinus hemangiomas were treated with 5 Gy in the five-fraction regimen. In patients with more than 3 years of follow-up, the obliteration rate was 88% for complex arteriovenous malformations (AVMs) treated with hfGKRS because of eloquent locations, whereas it was 62% for Spetzler–Martin grade 4-5 AVMs. For non-AVM pathologies (meningiomas, schwannomas, pituitary adenomas, paragangliomas, hypothalamic hamartomas, etc.), the 5-year progression free survival was 95%. Tumor failure was noted in 0.05% patient population. Radiation necrosis developed in 8.1% patients, and radiation-induced brain edema developed in 12% patients. It was resistant to treatment in 4% patients. No patient developed radiation-induced malignancy. Hypo-fractionation did not provide any hearing improvement in giant vestibular schwannomas.

Conclusion:
hfGKRS is a valuable standalone treatment option for candidates unsuitable for single-session GKRS. The dosing parameters need to be tailored as per the pathology and neighboring structures. It provides comparable results to single-session GKRS with an acceptable safety and complication profile.
Adaptive Staged-Dose Gamma Knife Radiosurgery for the Treatment of Large Brain Metastases
Authors: Crisà Francesco M , Leocata Filippo , Arienti Virginia M , Picano Marco , Berta Luca , Brambilla Maria G , Mainardi Hae S , Monti Angelo F , Cenzato Marco , Palazzi Mauro , La Camera Alessandro 
Published: August 2023

Background:
Brain metastases are the most common brain tumors, being one of the most frequent neurological complications of systemic cancer and an important cause of morbidity and mortality. Stereotactic radiosurgery is efficacious and safe in the treatment of brain metastases, with good local control rates and low adverse effects rate. Large brain metastases present some issues in balancing local control and treatment-related toxicity.

Objective:
Demonstrating adaptive staged-dose Gamma Knife radiosurgery (ASD-GKRS) being a safe and effective treatment for large brain metastases.

Materials and Methods:
We retrospectively analyzed our series of patients treated with two-stage Gamma Knife radiosurgery for large brain metastases in [BLINDED], between February 2018 and May 2020.

Results:
Forty patients with large brain metastases underwent adaptive staged-dose Gamma Knife radiosurgery, with median prescription dose of 12 Gy and a median interval between stages of 30 days. At three-month follow-up, the survival rate was 75.0% with a local control rate of 100%. At six-month follow-up, the survival rate was 75.0% with a local control rate of 96.7%. The mean volume reduction was 21.81 cm3 (16.76–26.86; 95% CI). The difference between baseline volume and six-month follow-up volume was statistically significant.

Conclusions:
Adaptive staged-dose Gamma Knife radiosurgery is a safe, non-invasive and effective treatment for brain metastases, with a low rate of side effects. Large prospective trials are needed to strengthen data obtained about the effectiveness and safety of this technique in managing large brain metastases.
Role of Stereotactic Radiosurgery for Cavernous Sinus Hemangiomas - An Individual Patient Data-Based Meta-Analysis
Authors: Mishra Sandeep , Kumar Akshay Ganesh , Garg Kanwaljeet , Phalak Manoj , Tripathi Manjul , Agrawal Deepak , Singh Manmohan , Kale Shashank Sharad 
Published: August 2023

Context:
Cavernous sinus haemangiomas (CSHs) are rare vascular malformations arising from the micro-circulation of the cavernous sinus. The current treatment options are micro-surgical excision of CSH, stereotactic radiosurgery (SRS), and fractionated radiation therapy (FRT).

Aims:
We conducted a meta-analysis assessing the effect and complications of SRS in CSH and compared the pooled results after surgical excision of CSH. The aim of the study is to provide valuable insight into the role of SRS in the treatment of CSHs.

Materials and Methods:
The literature search revealed a total of 21 articles with 199 patients who met our inclusion criteria, and these were analyzed for this study.

Results:
There were 138 (69.3%) female and 61 (30.7%) male patients. The mean age at the time of radiosurgery was 48.4 ± 14.9 years. The mean tumor volume at the time of SRS was 17.4 cm3 (range 0.3–138 cm3). Fifty (25%) patients had undergone surgery before SRS, whereas 149 (75%) patients received standalone SRS. A total of 186 (93.5%) patients were treated by gamma knife radiosurgery (GKRS), whereas 13 got treated by Cyberknife. The mean tumor volume in CK-F, GKRS, and GKRS-F groups was 36.6 ± 26.3, 15.4 ± 18.4, and 86.0 ± 19.5 cm3, respectively. The mean marginal dose was 21.8 ± 2.9 Gy, 14.0 ± 1.9 Gy, and 25 ± 0.0 Gy in CK-F, GKRS, and GKRS-F groups, respectively. The mean marginal dose of SRS was 14.6 ± 2.9 Gy. The mean follow-up period after SRS was 35.8 ± 31.6 months. Significant clinical improvement was seen in 106 patients out of 116 (91.4%) after SRS with remarkable shrinkage, 22 patients out of 27 (81.5%) with minimal shrinkage, and nine patients out of 13 (69.2%) with stationary tumor shrinkage. The sixth cranial nerve (CN6) was the most commonly involved nerve in 73 patients (36.7%). 30/65 (89%) experienced an improvement in the abducent nerve function following SRS. 115/120 (95.8%) patients primary treated with SRS experienced clinical improvement, whereas the rest of the five patients remained clinically stable.

Conclusion:
Radiosurgery SRS is a safe and effective option in patients with CSHs and resulted in more than 50% decrease in tumor volume in 72.4% of the patients.
Magnetization Transfer Contrast – Is it Sensitive Enough to Differentiate Demyelination from Axonal Loss?
Authors: Chaganti Joga , Woodford Hannah , Taylor Michael , Chaganti Sai Sivananda , MacDonald Alexandra Louise , Garrick Raymond 
Published: August 2023

Background and Objective:
Magnetization transfer contrast imaging (MTC) exploits the principle of exchange of energy between the bound and free protons and was shown to be pathologically informative. There is, however, controversy as to whether it correlates with axonal loss (AL), demyelination (DM), or both. This study addresses the pathophysiological process that underlies the white matter injury using the metric derivative of MTC, magnetization transfer ratio (MTR), and defines the role of MTR in identifying the different stages of inflammation, that is, edema, DM, and AL, using optic nerve as the model.

Materials and Methods:
One hundred and forty-two patients with a single, unilateral episode of optic neuritis (ON) were included in the study. Patients were divided into three groups – those with AL, those with DM, and those who were clinically optic neurites but without any electrophysiological changes suggestive of either AL or DM. MTR and electrophysiological studies were performed in the post-acute stage of ON and the results were compared to those obtained from the unaffected optic nerve.

Results:
MTR was significantly reduced in the optic nerves of both DM and AL groups when compared to that in normal optic nerves (P < 0.001). The difference in MTR between the AL and DM groups did not reach statistical significance. Patient group with acute ON did not show any change in the MTR values compared to the normal controls.

Conclusions:
MTR is a sensitive technique to identify neuronal injury, whether it is DM or AL. It, however, cannot differentiate these two pathological processes. MTR is not sensitive to identify acute ON.