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Introduction:The sella turcica (ST) is a vital structure located in the median position within the middle cranial fossa and is frequently utilized in cephalometric for assessing craniofacial features. However, there is limited literature available regarding cephalometry of the ST in Nepal. Consequently, this study aimed to establish the normal dimensions of the ST in the Nepalese population and explore the potential difference in radio-morphometric measurement among sexes. Materirals and Methods: This study encompassed a descriptive, cross-sectional chart review conducted at the Upendra Devkota Memorial National Institute of Neurological and Allied Sciences over a three-month period. Morphometric assessment of the ST was performed using computed tomography scans. A single radiologist employed an EV Insite DICOM viewer to measure and record the length, depth, and antero-posterior diameter of the ST. Independent-Samples t-test was employed to compare the means between sexes, and a significance level of p < 0.05 was considered statistically significant. Results:Among the 385 cases analyzed, 199 were male (51.8%) and 185 were female (48.2%), resulting in a male-to-female ratio of 1.07:1. The age range of the patients was 20 to 87 years, with a mean age of 44.5 ± 18.5 years. The mean dimensions of the sella turcica were determined as 9.32 mm for length, 7.07 mm for depth, and 10.29 mm for the antero-posterior diameter. Conclusions:The findings of this study indicate that the ST dimensions in the Nepalese population are relatively smaller compared to those reported in various other countries. Additionally, no statistically significant differences were observed in ST dimensions between males and females within the Nepalese population. These results emphasize the importance of considering populationspecific variations when utilizing cephalometric measurements and provide valuable reference standards for future studies and accurate assessment of craniofacial morphology in the Nepalese population. [ABSTRACT FROM AUTHOR]

Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH) is a devastating condition with high mortality and morbidity. Significant factors influencing the prognosis of aneurysmal subarachnoid hemorrhage (SAH) include the severity at presentation of the disease and delayed cerebral ischemia (DCI). Methods: This is a prospective study conducted in Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Bansbari, Kathmandu, Nepal among patients who underwent clipping of aneurysm for subarachnoid hemorrhage. Various clinical and radiological prognostic factors were registered on admission and during the intensive care stay. Outcome was recorded. GOS>3 was considered good outcome and GOS ≤3 was considered poor outcome. Results: Seventy-two patients with ruptured aneurysm were surgically clipped. Good outcome was observed in 51 (70.83%) patients while poor outcome was seen among 21 (29.17%) patients including death among 16 (22.2%) patients. In univariate analysis, WFNS>2, Fisher grade >2, EVD placement for hydrocephalus and delayed cerebral ischemia (DCI) were found to have statistically significant in poor outcome. On Multivariate logistic regression model showed delayed cerebral ischemia was statistically significant predictor of poor outcome at p= 0.032 (OR= 7.34; 95% CI=1.280 to 17.702). Conclusion: WFNS >2, Fisher grade>2, EVD placement and DCI were found to have statistical significance in poor outcome while only DCI was an independent predictor of poor outcome following aneurysmal Subarachnoid Hemorrhage (aSAH). [ABSTRACT FROM AUTHOR]

Pituitary apoplexy (PA) is caused by a sudden increase in pressure in the pituitary region due to acute hemorrhage, infarction or necrosis. PA can also be caused by restricting blood supply to the nerve due to compression of the internal carotid artery. Acute third cranial nerve palsy (third CN) secondary to PA is a rare medical emergency caused by bleeding within a growing mass within the sella turcica. We presented two cases of PA with isolated third CN palsy treated with transsphenoidal pituitary decompression. PA is therefore an important differential diagnosis to consider in patients with isolated third nerve palsy. The prognosis for isolated third nerve palsy in PA appeared successful, with variable recovery from medical and surgical intervention. [ABSTRACT FROM AUTHOR]

Introduction: Incidence of diffuse axonal injury has been estimated at 40-50% of hospitalizations. Recently, much interest has been directed towards the potential of newer imaging sequences of magnetic resonance imaging to investigate diffuse axonal injury (DAI) and to prognosticate the outcome. In this study, we correlated the magnetic resonance imaging grades of diffuse axonal injury with clinical outcome in terms of Glasgow Outcome Scale (GOS). Methods and Materials: A hospital based observational study was carried out at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Kathmandu in 69 patients of diffuse axonal injury between November 2017 to November 2018. Data was collected on patient and trauma characteristics, as well as neurological assessment and MRI findings. Outcome was assessed as favourable and unfavourable GOS for various MRI grades of diffuse axonal injury. Results: There were 21.74%, 42.03% and 36.23% of cases with grade I, II and III diffuse axonal injury respectively. There were 0 (0%), 2 (11.8%) and 15 (88.2%) cases of MRI grade I, II and III diffuse axonal injury in favourable GOS group and 15 (28.8%), 27 (51.9%) and 10 (19.2%) cases of MRI grade I, II and III diffuse axonal injury in unfavourable GOS group (p=0.00). Conclusion: This study showed that there was a significantly higher chance of unfavourable outcome with increasing MRI grades of diffuse axonal injury. [ABSTRACT FROM AUTHOR]

Biopsy is mandatory for histological diagnosis of non-resectable brain tumors. Of various techniques, neuronavigation guided biopsy provides intraoperative real-time reference and allows biopsy from multiple trajectories. The aim of this study is to assess the efficacy and accuracy of frameless neuronavigation biopsy. We retrospectively reviewed the medical archives of patients with intracranial space occupying lesion who underwent frameless neuronavigation biopsy at our institute between 2016 to 2018. All operations were performed under general anesthesia. Data were analyzed by SPSS version 20. P value of <0.05 was considered significant. There were 46 patients who underwent neuronavigation guided biopsy over the period of two years. Median age of patients was 46.5 years. Supratentorial tumors accounted for 95.8% of cases. Mean tumor diameter was 3.35 cm. Accuracy was 89.1%. More than half were glial tumors. Histopathology was inconclusive in 10.9% cases. Complication rate was 4.3%: one tract hematoma and one new neurological deficit. Frameless neuronavigation guided biopsy of intracranial space occupying lesion is safe and efficacious procedure with high diagnostic yield. [ABSTRACT FROM AUTHOR]