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Byline: Kuntal. Das, Amanjot. Singh, Prabhakar. Mishra, Deepak. Khatri, Balachandar. Deivasigamani, Aanchal. Datta, Kamlesh. Bhaisora, Anant. Mehrotra, Arun. Srivastava, Awadhesh. Jaiswal, Sanjay. Behari, Raj. Kumar Background: Studies on insular gliomas [...]

Carotid endarterectomy (CEA) is effective in treating carotid artery stenosis to prevent stroke. Historically, this operation has been performed utilizing loupe magnification with or without the operating microscope (OM). However, there remains a need for continued improvement in operative visualization and surgical ergonomics. Recently, newly developed digital 'exoscope' has provided the surgeon with unique lighting and magnification as well as improvements in surgical ergonomics and working angle. We sought to review our cumulative experience using a novel 4K high-definition (4K-HD) 3-dimensional (3D) exoscope (EX) for CEA surgery. All CEA surgery cases at our institution between 2013 and 2019 using the 4K-HD 3D EX were reviewed. Operative parameters, patient outcome and operator's assessment of the EX compared to OM-assisted cases was conducted. 28 patients were treated, 10 of which were operated using the EX. All procedures were performed without perioperative complications, or significant differences in operative parameters (blood loss <20 cm3 and 164 ± 49.5 minutes) compared to OM-assisted cases. Operators reported improved level of comfort performing 'high' bifurcation surgery and improved visualization and posture during inspection of the distal ICA lumen as primary advantages of EX-assisted CEA over OM-assisted CEA. The ORBEYE EX, albeit a learning curve necessitating a short period of the OR team, provided safety and outcome comparable to OM-assisted surgery. Potential advantages noted were improved visualization and ergonomics specifically for when extreme working angles were required. Our experience suggests that the exoscope may become a valuable alternative to standard magnification tools in CEA surgery. [ABSTRACT FROM AUTHOR]

Byline: Jaskaran. Gosal, Deepak. Khatri, Kuntal. Das, Sanjog. Gajbhiye, Anant. Mehrotra, Awadhesh. Jaiswal, Sanjay. Behari Background: 'Thirteen-and-a-half' is a newly described clinical syndrome characterized by the combination of the one-and-a-half [...]

Potential seed size in many crops including major cereals is determined during early seed developmental stages. However, the stage at which final seed size is determined in soybean (Glycine max [L.] Merr.) under field conditions is not known. Hence, this study was conducted with the main objective to assess seed growth dynamics under controlled and increased assimilate supply conditions during different seed filling periods using two maturity group soybean cultivars. Treatments consisted of a control, and a de-podding (pod removal) treatment at weekly intervals after the beginning of the seed filling stage up until physiological maturity. Only four to six pods were maintained per plant in de-podding treatments in order to provide a higher assimilate supply to remaining seeds. A higher assimilate supply until around the mid-seed filling stage increased unit seed weight in both the cultivars, indicating that the maximum seed size in soybean crops is determined during the mid-seed filling stage. The increase in seed weight under higher assimilate supply was associated with an extended seed filling duration and a uniform seed filling rate over a longer period. The results also suggested a possible source limitation during the early seed filling stage in soybean, indicating opportunities to improve its yield using supplemental inputs and other improved crop cultivation practices. [ABSTRACT FROM AUTHOR]

Introduction: Woven EndoBridge (WEB) is a new endovascular treatment option for wide necked bifurcation aneurysms. Results from the WEB-IT trial showed a 0% risk of thromboembolic complications within 30 days post-op but the rate reported in the literature is as high as 10%. We are exploring potential risk factors associated with immediate thromboembolic complications in patients treated with the WEB device. Methods: Retrospective study of forty-two patients with intracranial aneurysms who were treated with WEB at a single center from 2019–2021. Data was collected on patient demographics, comorbidities, aneurysm characteristics, procedural details, and hospital course. Bivariate analyses were performed to compare patients who experienced a periprocedural ischemic stroke to those who did not. Multiple logistic regression modeling was performed to identify independent risk factors for thromboembolic complications. Results: Of the 42 patients that were treated with WEB, 6 suffered an ischemic stroke (AIS). These patients were more likely to have an underlying diagnosis of arrythmias (p value = 0.007). Furthermore, they had a median angle of 32.0° in the true neck view on diagnostic angiogram compared to 19.5° (p value = 0.046). Lastly, they had a longer procedure length of 228 min compared to 178 min (p value = 0.002). Patients with thromboembolic complications had a longer length of stay in the hospital and worse outcomes at three months follow up. On logistic regression modeling, these risk factors did not reach statistical significance. Conclusion: Risk factors of thromboembolic complications after WEB placement include cardiac arrythmias, acute aneurysmal angle in the true neck view and a longer procedure length. [ABSTRACT FROM AUTHOR]

Byline: Arun. Srivastava, Suyash. Singh, Deepak. Khatri, Awadhesh. Jaiswal, Ravi. Sankar, Vimal. Paliwal, Zafar. Neyaz, Kumudini. Sharma, Sanjay. Behari Background: Progressive vision loss is a dismal sequelae of idiopathic intracranial [...]

Byline: Deepak. Khatri, Jaskaran. Gosal, Kuntal. Das, Kamlesh. Bhaisora Peter plus syndrome (PPS) is a rare, hereditary (autosomal recessive) disorder characterized by a mutation in the beta-1,3-galactosyltransferase-like gene (chromosome 13q12), [...]

Byline: Arun. Srivastava, Deepak. Khatri, Kamlesh. Bhaisora, Kuntal. Das, Ved. Maurya, Sanjay. Behari The surgery for intramedullary tumors (IMTs) has always been challenging. Mild to moderate neurological deficits with functional [...]

Byline: Deepak. Khatri, Awadhesh. Jaiswal, Kuntal. Das, Satyadeo. Pandey, Kamlesh. Bhaisora, Raj. Kumar Introduction: With improvements in overall and progression-free survival in gliomas, current focus in neurosurgical oncology has largely [...]

Intercostal nerves (ICN) are often utilized as donors for various neurotization procedures in brachial plexus injuries. ICN to musculocutaneous nerve (MCN) transfer is usually a standard in pan brachial plexus injuries, in order to restore flexion at the elbow. A tensionless co-aptation of the donor-recipient nerves often necessitates either a distal dissection of the ICNs where the number of fascicles is rather low or a proximal dissection, often at the cost of dissection of the serratus anterior digitation with a risk of later fibrosis and adhesion. We report two cases of pan brachial plexus injuries where ICN-MCN transfer was performed to restore elbow function. These patients underwent clinical and electrodiagnostic evaluation before surgery. We used the standard technique of harvesting ICNs 3-5, with our technical modification of "undercutting of rib" for increasing the donor length. The procedure was applied in two patients with pan brachial plexus injury (mean age = 23). Mean duration since the injury to surgery was ten months. Both patients underwent tensionless anastomosis with a combination of suture and fibrin glue co-aptation. While one patient had some improvement in elbow flexion, another one was under active rehabilitation protocol during follow-up. We found that undercutting of the ribs near serratus digitations can allow mobilization of the ICN from its groove, which in turn lengthens the donor nerve length without violating the serratus anterior digitations and without too anterior dissection of the nerve. It can be a viable option when a tensionless co-aptation at the axilla is otherwise not feasible intraoperatively. [ABSTRACT FROM AUTHOR]

Insular gliomas are unique, challenging and evoke a lot of interest amongst neurosurgeons. Publications on insular glioma generally focus on the surgical intricacies and extent of resection pertaining to the low-grade gliomas. Insular glioblastomas (iGBM) have not been analysed separately before. Histologically proven WHO grade IV gliomas involving the insula over a 9-year period were studied. Their clinical presentation, radiological features, surgical findings and survival outcomes were assessed. Statistical methods were used to determine the favourable predictors of survival. Out of 27 patients (M:F = 2.9:1), 18 (66%) patients had a tumour extension beyond the insula, 10 (37%) of whom had basal ganglia involvement. Total, near total and subtotal excisions were performed in 7 (26%), 9 (33%) and 11 (40.7%) patients, respectively. Twenty-three patients had glioblastoma, while four had gliosarcoma. IDH mutation was negative in six of the seven patients where it was done. Median overall survival was 5 months. Multivariate analysis showed that a female gender (p = 0.013), seizures in the preoperative period (p = 0.048) and completion of adjuvant therapy (p = 0.003) were associated with a longer survival. Insular glioblastomas have a poor prognosis. Insular location and certain tumour characteristics often limit the extent of resection of iGBMs. Moreover, postoperative complications sometimes negate the advantages of a radical resection. A female gender, presentation with seizures and completion of adjuvant chemoradiotherapy appear to be good prognostic factors. [ABSTRACT FROM AUTHOR]