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Objectives: The determinants of progression-free survival (PFS) and overall survival (OS) for higher-grade meningiomas have not been clearly established and to summarize the long-term clinical outcome for patients with grade 2 or 3 meningioma and assess the PFS and OS factors. Materials and Methods: The study included all individuals, who had undergone surgical removal of cerebral meningiomas between 2005 and 2020 and whose histological results suggested a World Health Organization (WHO) grade 2 or grade 3 diseases. Kaplan-Meier curves are plotted to examine tumor control and OS after the follow-up. The reverse Wald logistic regression and Mantel-Cox test were used in multivariate analysis for tumor recurrence and mortality. Results: There were 94 individuals enrolled with 82 having WHO grade 2 tumors and 12 having WHO grade 3 lesions. Gross total resection of the tumor was present in 73 patients (78%), and adjuvant radiotherapy (RT) was administered to 43 (45.7%) individuals. During the course of the study, 17 patients died. The WHO grade of the tumor, the extent of resection, and the absence of bone involvement were all independent predictors of better survival in a multivariate analysis. Furthermore, whereas adjuvant RT after surgery enhanced survival, it was not statistically significant (hazard ratios [95% confidence interval CI] = 1.91 [0.15-23.52] [P = 0.61]). Conclusion: The degree of tumor excision is the strongest predictor of PFS and OS. In the event of a recurrence, rather than opting for upfront radiation, a second surgery with the goal of maximum safe resection should be performed. [ABSTRACT FROM AUTHOR]

Objectives: Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by doing less in the form of STB for the patients of doubtful intracranial lesions treated over the past 5 years. We also want to highlight the technique of performing the procedure under scalp block, which can be used as a versatile tool in many clinical scenarios. Stereotactic biopsies may be planned even in rural district-level health facilities. One-time investment to procure instruments and avail existing imaging can lead to establishing definitive diagnoses in many doubtful cases. This will result in lesser cost and early establishment of treatment. Independent risk factors determining the outcome, such as deep-seated lesions, associated edema, and intraoperative hypertension, were studied. Establishing the diagnosis helped in prognosticating the disease, explaining the natural progression of symptoms, and starting adjuvant therapy. This tissue biopsy would also help secure samples for research and molecular analysis. Materials and Methods: Twenty patients underwent STBs at our institution between January 2018 and December 2022. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including the diagnostic value and surgery-related complications. These patients were followed up, and their progression-free and overall survival were analyzed. The need for adjuvant treatment was noted and analyzed. All procedures were performed using Cosman Roberts Wells® stereotactic frame. Pre-procedure magnetic resonance scans were performed at the time of admission. Contrast-enhanced computerized tomography (CT) scan after frame application was performed to identify targets and calculate the coordinates. A post-procedure CT scan was done to confirm the accessibility of the targeted lesion. Results: The most common location of the tumor was a deep-seated thalamic lesion. A definitive diagnosis was established in 19 patients (95%) at the first STB. The diagnoses were glioma in 55% of cases, primary central nervous system lymphoma, tuberculosis, and demyelinating disorders in 10% of each, and a metastatic brain tumor in 1 (5%). The post-operative complications were all transient except in one patient with deterioration of motor weakness. The follow-up was noted, and modes of adjuvant treatment needed in these patients were recorded. Conclusion: Stereotactic biopsy is a useful and effective method for achieving a definitive diagnosis and aiding in treating multifocal or small deep-seated lesions in or around eloquent regions. [ABSTRACT FROM AUTHOR]

Background The identification of neurosurgical causes of craniomegaly and early institution of therapy requires for better clinical and functional outcomes. Aims and Objectives The aim of this study was to evaluate the neurosurgical causes, managements, and outcomes of craniomegaly in neonate and infants. Materials and Methods The cases with a history of head enlargement from neonatal period were included in this study. Their causes, managements, and outcomes were recorded retrospectively during the period of January 2010 to February 2013, in neurosurgery department at SGPGIMS Lucknow, and June 2018 to June 2020, at UPUMS, Saifai, Etawah, UP, India. Results Out of 41 cases, there were 30 (73.14%) cases of hydrocephalus, 4 (9.76%) Dandy-Walker malformation, 2 (4.88%) subdural collection, 2 (4.88%) arachnoid cyst, 1 (2.44%) craniosynostosis, and 2 (4.88%) with tubercular meningitis. The age range of our cases was 18 to 178 days and the mean age was 102.54 ± 50.73. Preoperative head circumference range was 39 to 62 cm (mean: 55.27 ± 6.58cm). Majority of the cases (n = 32, 78.05%) were managed with ventriculoperitoneal shunt surgeries. Out of 41 cases, 33(80.49%) had improved outcomes, 7 (17.07%) stabilized, and mortality occurred in 1 (2.44%) case. Postoperatively, there was improvement in the head circumference (range: 39–60 cm and mean: 46.15 ± 5.83 cm) on 6 to 24 months (mean: 17.85 ± 5.18 months) of follow-up. Conclusion Hydrocephalus was the commonest neurosurgical cause of head enlargement in neonate and infants. Shunt surgery was the most common form of management of these cases. Early detection, institution of therapy, and periodic follow-up program for diagnosing and treating complications were the key to successful outcomes in these patients. [ABSTRACT FROM AUTHOR]

Objectives: Prevailing techniques of dural closure in endoscopic spine surgery (ESS) for intradural extramedullary (IDEM) tumor excision increase the steep learning curve and operative time. We aimed to assess the efficacy of augmented duroplasty with artificial dura and share our initial experience of ESS for IDEM excision. Materials and Methods: We retrospectively analyzed 18 (n = 18) consecutive patients of IDEM tumors operated by ESS using Destandau's endoscopic system. The pre-operative, post-operative, and at the latest follow-up clinical status were recorded in terms of Nurick's grades and the Oswestry Disability Index. Immediate post-operative complications and intraoperative findings were noted from hospital information system and patient records. Results: The mean (± SD) age of patients was 40.3 ± 14.9 (range 19-64) years, with M: F ratio of 2:1. All the lesions were intradural and present at lumber (n = 6), thoracic (n = 9), and cervical (n = 3) regions. The average duration of surgery, blood loss, hospital stay, and duration of follow-up were 157 ± 45.3 (90-240) min, 168.8 ± 78.8 (30-300) mL, 4.29 ± 1.4 (2-7) days, and 19.3 ± 7.2 (7-36) months, respectively. There were no CSF leaks, wound-related complications, or material-induced adverse events. Conclusion: In endoscopic IDEM excision, dural closure with artificial dura is efficient in preventing CSF leak. It shortens the steep learning curve and improves the surgical outcome due to technical ease. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the clinical and radiological outcomes analysis of craniovertebral junction (CVJ) anomalies cases. Materials and Methods Retrospective analysis of 43 CVJ anomalies cases, which were surgically managed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India, from period between June 2015 and June 2019. They were analyzed for age, sex, clinical characteristics, radiological diagnosis, and treatment given. Patient's clinical and radiological status was assessed pre- and postoperatively during time of discharge and at 6 months of follow-up. For clinical assessment we used visual analogue scale (VAS) and Nurick grading system. Radiological assessment was done by atlantodental interval (ADI), craniobasal angle, and craniometric lines. Overall outcomes were depicted as favorable, stabilized, and mortality at 6 to 18 months (mean 12.69 ± 3.77) of follow-up. Results The age range of our cases was 7 to 71 years (mean 29.93 ± 17.39). Male-to-female ratio was 2.91:1. Majority of the cases were presented with neck pain (n = 38; 88.37%), motor weakness (n = 35; 81.40%), and sensory deficits (n = 25; 58.14%). Congenital atlantoaxial dislocation (n = 31; 72.09) was the most common CVJ anomaly. Clinically, there were significant improvements in VAS (p = 0.001) and Nurick grade (p = 0.007) postoperatively. Radiologically, ADI (p = 0.003) had decreased, clivus canal angle (p = 0.005) become less acute, and odontoid process (p = 0.003 for McRae's line) goes downwards in postoperative period. Bony fusion was achieved in 41 (95.35%) cases. Out of 43, 73% cases had favorable outcomes, 21% were stabilized, and mortality was seen in 2.33% cases at 6 months (mean ± standard deviation = 12.69 ± 3.77) of follow-up. Conclusion Proper preoperative evaluation and selection of individualized surgical technique was the key for excellent clinical and radiological outcomes with minimal complications. [ABSTRACT FROM AUTHOR]

Objective Traumatic brain injury leads to the activation of sympathetic nervous system and elevation in serum catecholamine levels. The aim of this study was to determine whether catecholamine level obtained within 24 hours of traumatic brain injury provides a reliable prognostic marker for outcome. Materials and Methods This study was a prospective observational cohort study on 36 moderate-to-severe traumatic brain injury. Plasma epinephrine (E), norepinephrine (NE), and dopamine (DA) levels were measured by using computed tomography enzyme-linked immunosorbent assay test and compared with Glasgow coma scale (GCS) that was obtained concurrently. Neurological outcome was determined by GCS at day 7 of treatment and by Glasgow outcome scale at mean follow-up of 9.73 ± 2.26 months. Results Patients with GCS 3 to 4 had markedly increase in baseline mean E (771.5 ± 126.0), NE (2,225.0 ± 215.4), and DA (590.2 ± 38.8) levels as compared with control, while patients with better GCS (11–12) had mildly elevated levels. Patients with GCS 5 to 10 had intermediate values. Cases with markedly elevated baseline E, NE, and DA level were either died or remained in poor GCS (3 or 4) at day 7 of treatment and remained in persistent vegetative state at mean follow-up of 9.73 ± 2.26 months. Cases with only mildly elevated E, NE, and DA level were improved to better GCS on treatment and had good recovery on follow-up. Conclusion These data indicate that a markedly elevated catecholamine level was an excellent endogenous and readily quantifiable marker that appears to reflect the extent of brain injury and predict the likelihood of recovery. [ABSTRACT FROM AUTHOR]

Background and Objective  The novel Coronavirus pandemic surfaced in Wuhan, China in December 2019 and spread rapidly across the globe. In recent available literature, most of the studies were done to estimate the burden of psychiatric problems among general population due to this pandemic, Therefore, this study was planned to assess depression, anxiety, and sleep disturbance among Coronavirus disease-2019 (COVID-19) patients. Materials and Methods  A hospital-based, cross-sectional study was done from June 2020 to August 2020 among 100 COVID-19 patients who were admitted and fulfilled the inclusion criteria. Assessment of depression, anxiety, and sleep disturbance were done by patient health questionnaire-9 (PHQ-9) scale, generalized anxiety disorder-7 (GAD-7) scale and Pittsburg sleep quality index (PSQI), respectively. Results  In this study, 73% were males and 27% were females. The mean age of the patients in present study was 42.90 ± 16.33 years. This study reveals that depression was in 27%, anxiety in 67%, and sleep disturbance in 62% of patients. Depression and anxiety were found significantly associated with presence of comorbidity and severity of illness (p < 0 0.05). The association of sleep disturbance with severity of illness was also found statistically significant (p < 0.05). Conclusion  The risk of psychological stress is high in COVID-19 patients. The psychological problems among COVID-19 patients are commonly related to the consequences of disease, and severity and contagiousness of the disease. Therefore, in this present pandemic situation, it is more important to identify these psychological problems among COVID-19 patients, so that better care and timely interventions can be done with respect to psychological issues. [ABSTRACT FROM AUTHOR]

Background  Lesions involving the skull base can be approached by a variety of surgical corridors and extended frontobasal approach is one of them. It provides quite a wide exposure to lesions in the midline of anterior skull base, paranasal sinuses, and sphenoclival region. Objective  To share our experience, and list the merits and demerits, of this approach for anterior skull base lesions. Methods  A total of six cases were operated using extended frontobasal approach. Four of them were skull base tumors with extensive involvement of paranansal sinuses and extension into sellar, parasellar, and clival region. Fronto-orbital and sphenoethmoidal osteotomy provided adequate surgical access, thereby facilitating their excision. Two cases of frontonaso-orbital encephalocele with large bone defect at anterior skull base were also operated upon. Skull base repair was performed using autologous bone graft, pericranium, and fibrin glue. Results  Gross total excision was achieved in four cases of skull base tumors with good cosmesis as transfacial access was obviated. Excision, repair, and reconstruction of two patients with frontonaso-orbital encephalocele were also done with acceptable cosmesis. Conclusion  The extended frontobasal approach is an excellent alternative for extensive anterior skull base tumors (up to posterior skull base), and also for the repair of large malformative lesions of the anterior skull base. [ABSTRACT FROM AUTHOR]

Background  Head injury is an important public health problem nowadays. Traumatic brain injury (TBI) results from external force that leads to damage to brain tissue. Main causes of TBI are motor vehicle collisions and fall from height. One of the primary symptoms after TBI is impaired word retrieval. Therefore, this study was undertaken to assess memory impairment in TBI patients following treatment to asses a residual memory status to declare them apt for official works if improved enough. Objectives  The purpose of this study was to assess memory impairment in TBI patients to assess the residual memory status following treatment. Materials and Methods  The study was conducted in Outpatient Department (OPD) of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh. The TBI patients were assessed by predesigned memory assessment questionnaire during their follow-up following discharge from hospital. Results  A total of 65 patients with TBI were assessed, of which 21 (32.3%) cases had frontal lobe injuries with 9 of 21 having memory loss (42.9% cases). The temporoparietal lobe was affected in 10 (15.4%) cases out of which 5 developed memory loss, that is, 50% cases. The multiple lobes were involved in 24 (36.9%) cases, out of which memory impairment occurred in 9 cases, that is, 37.5%. Four of total five cases (80%) of diffuse axonal injury had memory loss. Further, 16.9% (n = 11) TBI patients were unable to perform digit span test (immediate memory test), 44.6% (n = 29) cases could not perform three-word recall at 5 minutes (short-term memory test), and 15.4% (n = 10) cases could not perform (long-term memory test). Conclusion  The study showed that memory assessment is required in TBI patients for instituting proper rehabilitation measures and to allow them for sensitive memory-related work following discharge from hospital. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injuries (TBIs) are the leading cause of morbidity, mortality, disability, and socioeconomic losses globally, but of more concern, in India and other developing countries. The Mini mental state examination (MMSE) and clock drawing test (CDT) are the two mostly adapted methods for cognitive impairment screening. Therefore, it is necessary to establish a robust evaluation system exclusively for post-TBI cognitive impairment. Materials and Methods: One hundred and thirty-four cases treated previously at the health facility for TBIs were evaluated for cognitive functions during the follow-up period ranging from 3 weeks to 6 months in the out-patient department. All cases underwent mini-mental score examination (MMSE) and CDT to assess their cognitive performances. The data were analyzed statistically using Chi-square and ANOVA tests of significance. Results: Statistically significant association (P < 0.001) between the cognitive status of patients on the basis of overall MMSE score and the site of brain injury was observed. It was noted that 76 (56.7%) of the cases had cognitive impairment (MMSE score <24) with majority 44 (32.8%) patients having frontal lobe injuries, followed by 14 (10.1%) having brain injuries in the temporal lobe. On the other hand, using CDT score, it was observed that 102 (76.1%) of the cases had cognitive impairment (CDT score <5) with the majority 49 (36.6%) cases having frontal lobe injury followed by 19 (14.2%) having brain injury in the parietal lobe. Conclusion: The CDT was able to access cognitive function disruption in those patients, in whom the mini-mental score examination was not able to assess the same, and this difference in detection capabilities of both the tests was statistically found significant. [ABSTRACT FROM AUTHOR]

Background  Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belonging to the coronavirus family. The primary target of SARS-CoV-2 is peripheral mucosal cells of respiratory tract. Recent days have seen few cases where virus has affected extrapulmonary organ such as nervous system. Materials and Methods  The present study was a narrative review done using techniques of systemic review, that is, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases such as PubMed (Medline) and Google Scholar were searched systematically for published article from December 1, 2019 to June 5, 2020. A total of 189 articles were initially selected by the authors. A final list of 17 articles was prepared and following information were extracted from selected studies: study design, main result, and limitations of the study. Results  Majority of these article were descriptive studies describing spectrum of signs and symptoms among admitted patients. In majority of these studies, patients have developed symptoms suggestive of neurological involvement. Most common central nervous system symptoms reported were headache, followed by dizziness and confusion. Similarly, the most common peripheral nervous system involvement was loss of taste and smell. Conclusion  The present study concludes that there are enough evidences to prove that SARS-CoV-2 infection affects both central and peripheral nervous system. Various mechanisms are proposed to explain the pathophysiology of neurological manifestations in COVID-19-positive patients that needs to be established and verified. [ABSTRACT FROM AUTHOR]

Transmission of Coronavirus Disease 2019 (COVID-19) infection can occur to health care workers while providing treatment. It is vital to ensure the safety and to avoid any undue exposure of health care workers, leading to collapse of the entire health care system. As the world is facing this grave threat due to COVID-19, a proper protocol should be there. Daily updates and modifications are being made available by the Ministry of Health & Family Welfare and the ministry advises that protocols be tailored as per prevailing local conditions. We are trying to lay down guidelines based on available literature, data, and guidelines to take the procedures of neurosurgery and neurosciences. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is known as "silent epidemic" because of lack of knowledge about it and its delayed symptoms of memory and cognitive problems. The incidence is approximately 1.4 million per year in the United States, and in the developing countries, it is approximately 341 per 100,000. In the United States, the annual productivity loss due to TBI and its delayed effects is more than $56 billion. TBIs occur mainly due to traffic accidents and falls. All the age groups are affected, but the rates are higher in men than in women. The causes vary as per the age groups as traumas affect mainly children and elderly, and traffic accidents and violence affect more of adolescents and young adults. Data from various studies indicate wide variation in the incidence and prevalence of psychiatric disorders after TBI, but they are definitely higher as compared with general population. We also noted different psychiatric disorders in post head injury cases during follow-up at our university hospital, which included depression, behavioral disorders, cognitive disorders, memory impairment, anxiety disorders, stress-related headache, vertigo, irritability and sleep disorders, etc. Therefore, this review was undertaken to assess the psychosocial impact of brain injury on an individual. [ABSTRACT FROM AUTHOR]

Subaxial posttraumatic spondyloptosis is a rare entity with management dilemma in the literature. Various approaches have been discussed, but few reports focused on management plan and rationale. The authors reviewed the literature and reported a case of a 30-year-old woman presented with posttraumatic spastic quadriparesis. The patient had C6–7 spondyloptosis and was operated by anterior-only approach. There was improvement in both motor and sensory neurologic status. Surgical goals include vertebral realignment and stabilization. The authors conclude that anterior approach may be good enough if performed properly even if all three columns are involved. [ABSTRACT FROM AUTHOR]

Pineal gland tumors are rare tumors. According to World Health Organization (WHO) classification (2016) of the central nervous system, pineal parenchymal tumors of intermediate differentiation (PPTID) occupied their position between pineocytoma and pineoblastoma. It is either grade II or III. There are small numbers of reported cases, so its classification is still a matter of controversy. Here, we report a case of a 35-year-old man who presented with complaints of headache, nausea, vomiting, and focal weakness for 1 year. Computed tomography revealed an enhancing mass lesion in the region of pineal gland along with hydrocephalus. Following operation, histopathology of excised specimen was done, and it showed cellular tumor. Cells were having larger nuclei, vesicular chromatin pattern, ample cytoplasm, focal neuropil-like stroma along with moderate atypia, 3 to 5 mitotic figures per 10 hpf (high-power field), marked vascular proliferation, and pseudo rosette. Immunohistochemistry was found strongly positive for glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE), variable for synaptophysin, and negative for neurofilament and epithelial membrane antigen (EMA). These findings confirmed the diagnosis. As this tumor is rare with uncertain behavior following available treatment, the case report of PPTID grade III large cell type may enrich the existing data and is being presented because of its rarity. [ABSTRACT FROM AUTHOR]

Pineal gland or "spiritual third eye" is regarded as the gateway of spiritual life as per ancient concepts about the soul. Recently, modern neuroscience has proven that pineal gland is not only the melatonin-secreting neuroendocrine organ which controls the circardian rhythm, but it also has mystical and energetic associations with spirituality. It acts as a tremendous coordinator between molecular, hormonal, physiological, and chemical rhythmic orchestra. Thus, in this article, by highlighting the relation between ancient Indian methodology and modern chronomedicine, the author describes the odyssey of antiquity to modern science. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the facial nerve in inferior and lateral (transmastoid) approaches to the jugular foramen and/or petrous apex. Design Retrospective study of 11 consecutive patients operated for lesions in the jugular foramen/petrous apex via an inferior or lateral transpetrosal approach. Setting Tertiary care superspecialty referral center. Participants Eleven consecutive patients of jugular foramen/petrous apex lesions operated over a period of 18 months. Main Outcomes Measures Extent of tumor resection, surgical technique used, and recovery of facial nerve function postoperatively. Conclusion Approach to these lesions needs to be tailored to the extent of disease, possible histology and relation to the facial nerve. Meticulous surgery and adequate postoperative care permit a satisfactory recovery of facial nerve function following rerouting procedures. [ABSTRACT FROM AUTHOR]

Background: Primary extramedullary tumors involving multiple compartments around the spine are a technically demanding group of tumors whose extent traverses beyond the normal confines of those anatomical regions which fall in the common domain of neurosurgeons. In the following series, we present 12 patients who were diagnosed with primary spinal extramedullary tumors with multicompartmental extension, and whose surgical management was facilitated by a combined multidisciplinary approach involving surgeons of other superspecialties. This multidisciplinary assistance from the inception to the culmination of surgical management helped in achieving a better surgical removal, thereby resulting in better surgical outcomes. Materials and Methods: Twelve consecutive patients who fulfilled the inclusion criteria in the 5-year period (January 2010 to January 2015) were included in the series based on the radiological and pathological characteristics of the tumor. Depending on the site of the spine involved by the lesion, radiologists and surgeons were involved from the planning phase of the surgical management, and their assistance in procedures such as preoperative embolization/ureteric stenting was sought whenever was deemed necessary. The extent of resection and total blood loss was recorded meticulously. Regular follow-up (3, 6, and 12 months and 2 and 5 years) of the patients was done after the initial follow-up at 6 weeks and their disability scores were recorded. Results: Of the 12 cases (6 males and 6 females), sacrum was the most common location of the tumors (6). Histopathologically, giant-cell tumors, schwannomas, and chondrosarcomas (3 each) were most common followed by Ewing's sarcoma (2) and malignant peripheral nerve sheath tumor (1). Eight patients had functional status of McCormick scale 1 and two patients had a functional status of 2. One patient was lost to follow-up and one patient died during surgery. Conclusion: Judicious involvement of access surgeons and adjunct therapies along with careful preoperative planning can help in improving surgical outcome in multicompartmental spinal tumors. [ABSTRACT FROM AUTHOR]

We report a case of dissecting aneurysm of the right posterior cerebral artery presenting with sudden onset headache and altered behavior during labor. A 26-year-old P1001 with uncomplicated antenatal period, except history of headache off and on since 32 weeks of pregnancy, developed sudden onset headache and altered behavior during 3rd stage of labor. She had vaginal delivery and a live born male baby was delivered with good Apgar score. The CT was suggestive of subarachnoid hemorrhage and DSA was suggestive of dissecting aneurysm of the right P2 segment with hypoplasia of right P1 segment and A1 segment of posterior and anterior cerebral artery, respectively. The patient was managed conservatively. At 4-month follow-up, the patient was doing well. We discuss about the rare association of a dissecting aneurysm and pregnancy, especially dissection of the posterior cerebral artery. [ABSTRACT FROM AUTHOR]

Primary melanocytic tumours of the central nervous system (CNS) are rare. According to the WHO classification (2007), these tumours include diffuse leptomeningeal melanosis, melanomatosis, melanocytoma, and primary CNS melanoma. Meningeal melanocytoma, most commonly seen in the infratentorial compartment and cervical spinal cord, is a benign primary melanocytic neoplasm. Primary CNS melanoma, on the other hand, represents the malignant end of the spectrum. Intermediate grade melanocytoma is a rare histological subtype of primary meningeal tumours and is characterised by the clinicopathological features between the two extremes. Neurocutaneous melanosis (NCM) is a rare phacomatosis characterised by melanotic lesions on the skin and leptomeninges. Leptomeningeal manifestation in NCM may be observed either in the form of diffuse leptomeningeal melanosis or primary CNS melanoma. Melanocytomas are focal lesions and their association with NCM is extremely rare. In this report, we present an unusual case of NCM accompanied by right frontal intermediate grade melanocytoma with intratumoral bleeding in a 17-year-old boy. A brief literature review is also presented. [ABSTRACT FROM AUTHOR]

Introduction: The effective canal diameter (ECD) for the cranio-vertebral junction is measured from the posterior surface of the dens to the nearest posterior bony structure (foramen magnum or the posterior arch of the atlas). The ECD is the space which is occupied by the buffer space (which can be compromised without producing any signs or symptoms) and the cord itself. We intend to study the role of the ECD (especially in patients with markedly reduced ECD) in producing the symptoms and also the outcome of surgery in patients with bony cranio-vertebral junction (CVJ) anomalies. Materials and Methods: A total of 67 consecutive patients from the period of January 2009 through June 2010 were prospectively included in the study. These patients were operated by a single experienced surgeon (the senior author) at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The ECD and the pre-operative Kumar and Kalra score (K and K score) (4) was calculated for all patients. The K and K score was also calculated at the time of discharge, at three months and six months follow-up. The patients were divided into three groups based on the ECD into 5 mm to 10 mm group, 10 mm to 15 mm group, and >15 mm group. Results: There were 53 male (79.1%) patients and 14 female patients (20.9%) with mean age of presentation 27.10 years (±15.01 years) with range of 4-59 years. The duration of symptoms in our series varied from 1-120 months with mean of 23.79 months. The mean effective canal diameter was 9.027 mm (±2.23 mm) with range of 5-16 mm. The mean pre-operative K and K score was 19.27 (±4.19). There were 39 patients who had an ECD between 5 mm to 10 mm, 24 patients with ECD between 10 mm to 15 mm, and 4 patients with ECD more than 15 mm. The correlation coefficients between the effective canal diameter and the pre-operative and the post-operative Kumar and Kalra score at the time of discharge, 3 months and 6 months were 0.404 (P < 0.001), 0.320 (P < 0.008), 0.0302 (P < 0.013), and 0.284 (P < 0.020), respectively. The ECD and the pre-operative score were most significantly and strongly related to each other in patients with ECD between 5-10 mm. Conclusion: The ECD is significantly related to the pre-operative status (K and K score) of the patient. This correlation was strongest in the group with ECD of 5-10 mm. It was also observed that as the follow-up increased, the correlation between the ECD and the post-operative K and K score became less stronger though they remained significantly related to each other. [ABSTRACT FROM AUTHOR]

Background: Various pathologies affect the spine, but these lesions present with more or less similar clinical profile. The present functional scoring systems are inadequate and insensitive to changes in neurological status of the patient. Objective: Our study aims to assess the modified Kumar and Kalra (K and K) scoring system in patients with pathologies in the sub-axial spine. Materials and Methods: A total of 78 consecutive patients from the period of January 2009 to June 2010 were prospectively included in the study. These patients were operated by the senior author at our institute. The mean Modified Japanese Orthopaedic Association (MJOA) score and the mean modified K and K score were calculated in the preoperative, at the time of discharge (post-surgery), and at 3 months and 6 months follow-up. Results: There were 57 male (73.01%) patients and 21 female patients (26.92%), with the mean age of presentation of 39.20 years (±14.12 years) and a range of 9-75 years. Out of the total 78 patients, 60 patients had pathology in the cervical spine (sub-axial spine) and 18 patients had pathology in the dorsal spine. Majority of the patients had motor and sensory symptoms. The mean preoperative modified K and K score was 17.38 (±3.18) and the mean preoperative MJOA score was 11.21 (±2.12). The K and K score was able to predict the correct outcome in 70 patients (89.74%), whereas the MJOA score was able to predict correctly in 62 patients (79.49%). Conclusion: The modified K and K score has a better predictive value than the MJOA score. [ABSTRACT FROM AUTHOR]

A 40-year-old male patient presented to us with a history of road traffic accident, followed by loss of consciousness and vomiting. Noncontrast computed tomography (NCCT) scan revealed frontal bone defect along with multiple "mosaic pattern" homogenously hyperdense foreign bodies of nearly similar size in the right frontoparietal region within the extradural space. Debridement craniectomy was done, and multiple pieces of glass were retrieved. The extremely unique radiologic finding and probably first in the English literature prompted us to report this interesting case. Unfortunately, the patient died of myocardial infarction 3 days after the injury. Further, this new "mosaic pattern" radiologic finding on NCCT of the head may help in determining the mechanism of injury due to tempered glass-related head trauma. Window glass may not be always safe as it is thought by commuters. [ABSTRACT FROM AUTHOR]

Introduction and Methods: We retrospectively analyzed 111 patients with spinal tumors operated over a period of 9 years to observe the relative frequency of different lesions, their clinical profile, functional outcome and prognostic factors. 30/111 (27%) were extradural, 40/111 (36.1%) were intradural extramedullary (IDEM) and 41/111 (36.9%) were intramedullary spinal cord tumors (IMSCTs). Mean age at surgery was 30.81 years (range 1-73 years). The average preoperative duration of symptoms was 16.17 months (15 days to 15 years). Major diagnoses were ependymomas and astrocytomas in IMSCT group, schwanommas and neurofibromas in IDEM group, and metastasis, lymphoma in extradural group. The common clinical features were motor weakness in 78/111 (70.27%), sensory loss in 55/111 (49.54%), pain 46/111 (41.44%), and sphincter involvement in 47/111 (42.43%) cases. Results: Totally, 88/111 (79.27%) patients had improvement in their functional status, 17/111 (15.31%) remained same, and 6/111 (5.4%) were worse at time of their last follow up. The mean follow up was 15.64 months (1.5 m-10 years). Totally, 59 out of 79 patients, who were dependent initially, were ambulatory with or without the aid. Most common complication was persistent pain in 10/111 (9%) patients and nonimprovement of bladder/bowel symptoms in 7/111 (6.3%). One patient died 3 months after surgery. Conclusions: (1) Congenital malformative tumors like epidermoids/dermoids (unrelated to spina bifida) occur more frequently, whereas the incidence of spinal meningioma is less in developing countries than western populations. (2) The incidence of intramedullary tumors approaches to that of IDEM tumors. Intramedullary tumors present at a younger age in developing countries. (3) Rare histological variants like primitive neuroectodermal tumors should also be considered for histological differential diagnosis of spinal tumors. (4) Preoperative neurologic status is the most important factor related to outcome in spinal tumors. [ABSTRACT FROM AUTHOR]

Neurosciences in Buddhist era was mainly based on power of mind and thoughts. It emphasized mainly about the power of mind, control of thoughts, purification, and modifications of erroneous thought process, which should result in truthful and correct practices and subsequent actions by human beings to remain happy. Buddhism believes that most diseases of human body are secondary to mind and that these can be healed by controlling the erroneous thoughts and practices of Dhamma. Though the treatment for neurologic disorders such as headache, stress, and anxiety was primitive, it was mainly based on purification of mind and righteous pathway of Dhamma followed by medicines, modification in dietary and other living habits, etc. Enough evidence (including operated case-based commentary) shows that cranial surgery was also performed following appropriate diagnosis. The concept of diagnosis, preoperative evaluation, explanation to the patient, operative procedure, perioperative care, and follow-up was also present in that era. [ABSTRACT FROM AUTHOR]

Head enlargement (macrocephaly) is not an uncommon neurosurgical condition in infants presenting to outpatient department and emergency departments of neurosurgery/gynecology/pediatrics. We conducted a prospective and retrospective study of head enlargement in infants requiring neurosurgical care, to establish etiology, imaging findings, clinical profile, and outcome, with emphasis on management. Over a period of 24 months, 65 cases presented with head enlargement. All had a history of cranial expansion from neonatal period. Of 65 patients, 30 could match the inclusion criteria and were selected for this study. Age group ranged from 151 to 180 days, consisted maximum numbers (n = 10; 33.3%) of cases; of 30 23 (76.7%) patients were males. Of 30, 21 (70%) patients were diagnosed to have hydrocephalus, 4 (13.3%) had Dandy-Walker malformation, 2 (6.7%) had subdural effusion, and 3 cases (10%) had other causes as primary diagnoses. All were offered standard treatment as described in literature according to their clinical conditions and stage of diseases which included shunts (ventriculoperitoneal--unilateral, biventricular, and cystoventriculoperitonal), Ommaya placement, craniotomy, burr holes, and conservative. Four shunts required revision during follow-up period. The postoperative follow-up period ranged from 1 to 24 months. One child with the diagnosis of intracranial tumor died in postoperative period that is 1 month after the surgery due to disease-related morbidities. Thus, there are various causes of head enlargement in neonates where neurosurgical intervention may be required, the most common being the hydrocephalus, Dandy-Walker malformation followed by subdural effusion. The treatment depends on the diagnosis. Benign conditions such as subdural effusion do not require surgical intervention usually. [ABSTRACT FROM AUTHOR]

The morphometry of atlas is very important for surgeries in the occipitocervical region. There are studies explicitly differing in the results concerning some key anatomic measurements, mandating an additional evaluation of anatomic landmarks of atlas. Therefore, this study was aimed to evaluate the various dimensions of the atlas quantitatively relevant for various surgeries. A total of 30 adult atlas vertebrae of Indian origin were studied. The distances were measured by digital vernier calliper. The transverse diameter and maximum anteroposterior dimension of vertebral canal of atlas had a mean of 27.31 ± 2.74 and 29.44 ± 2.54 mm, respectively. The vertebral artery groove thickness on atlas is 3.79 ± 1.08 mm on right and 4.05 ± 00.86 mm on left, respectively. The mean distance from sagittal midline to the innermost edge of the vertebral artery groove is 10.73 ± 2.92 mm on right side and 09.72 ± 2.56 mm on left side. Overall, 74% of superior articular facets were found to be oval in shape and 26% in kidney shape. On the basis of these findings, we concluded that the thickness of the vertebral artery groove is satisfactory for surgical fixation techniques and the dissection on the posterior arch of atlas can be extended to 12 mm from the midline through the posterior approach. [ABSTRACT FROM AUTHOR]

The humankind is facing one of the worst nightmares in the form of the ongoing Corona crisis. The pandemic has spread all across the globe and we are struggling to deal with its might. All nations have made their own strategies to deal with this situation and mainly a phase of lockdown has been the savior in most countries, especially India, where it was enforced early and well in time. After a successful lockdown, there is a phase of unlocking, which is equally important. One should exercise caution in that this should be done gradually and phased, with all the precautions in place and without any complacency. Neurosurgeons are faced with a situation pertaining to those afflicted by posterior fossa lesions with hydrocephalus. They are treated with ventriculoperitoneal shunt, but sometimes they develop reverse tentorial herniation. This needs prompt evaluation and intervention and carries a poor prognosis if untreated. Another situation is where bifrontal contusions need decompressive surgery; some patients develop encephaloceles and extradural hematomas following successful surgery and complicate the prognosis. Both situations emerge due to sudden decompression, leading to quick changes in brain pressure and perfusion. The solution is slow and careful decompression, with all precautions in place despite the temptation of eureka moments. A similar response could be desirous over the course of our unlocking period. Hope this wisdom brings us good results in these Corona times. [ABSTRACT FROM AUTHOR]

We report a case of giant aneurysm causing subarachnoid hemorrhage in a pregnant female. A 25-year-old female presented with sudden onset of severe headache and vomiting with altered sensorium and right hemiplegia. On investigation, she had a giant supraclinoid segment internal carotid artery (ICA) aneurysm. She was planned for digital substraction angiography, but during the procedure she deteriorated neurologically and went into spontaneous labor. The baby was a male child with weight of 1.1 kg. She was taken up for surgery and aneurysm was clipped. We discuss the rare occurrence of intracranial hemorrhage in pregnancy due to a giant ICA aneurysm. [ABSTRACT FROM AUTHOR]

Primary intracranial rhabdomyosarcoma (PIRMS) is a rare neoplasm, which affects infants and young children. We report a rare case of a primary embryonal rhabdomyosarcoma of the cerebellopontine angle in a 7-year-old boy with clinical and radiological features mimicking a vestibular schwannoma. The patient underwent definitive surgery and radiotherapy and is recurrence free at 6 months. PIRMS commonly occur in parameningeal locations or metastasize to the brain from an extracranial primary. Gross total tumor resection followed by adjuvant radiotherapy remains the current standard of treatment; however, chemotherapy has also been tried with favorable results. The overall prognosis continues to remain poor. [ABSTRACT FROM AUTHOR]

We are spending our days today in a nationwide lockdown. The government should be lauded for taking a firm stand and announcing this lockdown well in time. Perhaps the benefits of social distancing cannot be more emphasized to prevent the spread of the dreaded coronavirus as witnessed by some of the developed nations who missed out by announcing it very late. In this lockdown period when we are primarily confined to our home, people face this dilemma of what to do and what lies ahead. Suddenly people find themselves in a situation where they are forced to stay at home and there is fear and turmoil all around. The mindset in this situation quickly becomes negative and as is well known "empty mind is devil's workshop." The need of the hour is to get constructively active and keep the positive vibes going. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a well-known endemic in developing countries. However calvarial TB is quiet rare even in such endemic areas. The most common sites affected are the frontal and parietal bones with destruction of both the inner and outer table. We hereby report a young male presenting to us with scalp swelling in the right temporal region with pus discharging sinus after an episode of tooth extraction for dental infection. Radiology revealed a loculated swelling within the right temporalis muscle and an associated bony defect in the right parietal bone. The patient was operated upon and the biopsy was suggestive of tubercular pathology. The patient improved on antitubercular therapy. The rare presentation of calvarial TB occurring secondary to dental infection along with relevant literature is discussed here. [ABSTRACT FROM AUTHOR]