International Journal of Neurology and Neurosurgery

Objective : Aim of this study is to correlate final outcome with the extent of surgical removal of cerebellopontine angle epidermoid, in term total or near total resection, recurrence and morbidity. Being a benign nature,
neurosurgically shown a great concern because of close proximity and adherence to the cranial nerves, intracranial vessels and brain stem. Methods: We use our data from 21 consecutive patients of cerebellopontine epidermoid that were surgically treated in our institute from 1995-2012 were reviewed and the final outcome were assessed with emphasis on outcome after surgery, long term follow up results and anatomic relationship between the tumor and surrounding neurovascular structures. Results: The average age of patients were 33.14 years at onset of symptom and 36.33 years at the time of operation. The mean duration from onset of symptoms to surgery was 3.1 years. Of 21, 12 were female and 9 were male. Headache was present in 9 patients most common presentation followed by hearing impairmentin 7 patients. Most of them confined to cerebellopontine angle, hypodense non-enhancing lesion in 8 patients, 3 have supratentorial extension. Retromastoid approach in 14 and supine in 12 patients rest all in sitting position. Total removal done in 16 patients. After total removal transient cranial nerve palsy in 9 patients which were improved in 7 patients. Cerebrospinal fluid leak in 2 patients improved by repeated lumber puncture. Pulmonary embolism in1 patient. 18 were followed over mean period of 60 month, range from 1-11 years. 3 had recurrence ,two in near total excision, one in sub-total excision and 2 had persistent cranial nerve paresis. Conclusion : -Approach needed to be conservative in whom capsule is adherent to brain stem and neurovascular structures. Aggressive removal had transient but significant short term cranial nerve and brain stem dysfunction.
Total removal of cerebellopontine angle epidermoids does not result in significantly increased long term morbidity and mortality and should be the goal of surgical treatment .

Keywords: Epidermoid Tumor ; Cerebellopontine and Reteromastoid Approach.
 

Introduction: Standard surgical technique is the posterior approach discectomy. The use of an endoscope allows the same entry port and surgical technique used on vertebral canal and disc while at the same time reducing the skin incision. Aims: Aimed to studyendoscopic lumbar discectomy for a surgeon naive to endoscopic surgery but trained in open microdiscectomy. Materials and methods: This was a prospective study done in department of neurosurgery in patients who had acute onset of symptoms like low back pain with sciatica which is unilateral and whose clinical examination showed signs of definitive radiculopathy and MRI showing sequestered disc prolapse at that corresponding level.We have done 40 cases of endoscopic discectomy using a conical freehand working channel . We divided the 40 cases into 20 each, the first 20 cases represent learning curve and the next 20 post learning curve. Results: Patients who had undergone endoscopic discectomy were 40 among them 26 patients were male and 14 patients were females. All patients were between 20-65 years of age and the mean was 39.57.The most common level operated was L4-L5(31) followed by L5-S1(08). We have operated double level in one patient at L4-L5 and L5-S1. Initial 20 cases the mean duration was 58.8 minutes and it was significantly reduced to 31.55 minutes in our last 20 cases. The mean duration for all 40 cases in our series was 45.17minutes. Mean blood was 18.1ml. Mean hospital stay in our first 20 cases was 3.75 days and in our last 20 cases it was 3 days. The mean hospital stay taking in to account of all 40 cases in our series was 3.37 days or 80.8 hours.our study the mean duration to return to work was 19 days.10% of cases had complications, among them one patient had nerve root injury, 2 patient had Dural tear, and in 1 patients pain dint subside and he underwent redo open laminectomy. In our study 85% patients had excellent outcome and 2.5 patients had poor outcome. Conclusions: Endoscopic discectomy is a minimally invasive procedure with less tissue disruption to achieve the results of the traditional surgery.

Keywords: Lumbar disc prolapses; Endoscopic discectomy; Mean blood loss.
 

Context- Occipital encephaloceles are one of the less commonly seen herniation deformities of central nervous system. Management of this entity has been an uphill task and this study touches all aspects and dimensions of this complex entity along with its outcome. Aim- To study the epidemiological, clinical, radiological features, perioperative issues,
post surgical results and outcome. Settings and Design- A retrospective study comprising of 39 patients of occipital encephaloceles admitted from January 2013 to March 2019 in the Department of Neurosurgery at King George’s Medical University(KGMU), Lucknow was performed. Materials and Methods Data records containing demographic, clinical and radiological details as well as intraoperative and post surgical details and follow up were analyzed. Results- In this study of 39 patients (24 male and 15 female), age ranged from 2 months-14 years. Hydrocephalus was seen in 20 patients (51%) cases and Corpus callosum abnormality was seen in 10 patients (24%). Five patients
were having ruptured encephalocele (11%). Excision of sac along with its contents and water tight dural repair was done in all cases. Shunt surgery was done in 25 cases (64%). Mortality was recorded in seven patients (18%). Wound infection was the commonest complication seen in this study. Mean follow up was of 48 months. 47% of the patients
had no neurological deficits while 53% had moderate neurological deficits. Conclusion- Occipital encephalocele pose a surgical challenge though better outcomes have been achieved with multidisciplinary team approach. Giant size sac with significant brain tissue is a bad prognostic indicator for the outcome.

Keywords: Occipital Encephalocele; Giant Encephalocele; Surgery; Outcome.
 

Introductions:- The traumatic Brain injury (TBI) is an important and large clinical problem worldwide which can lead to severe sequel like cognitive deficits and movement obstacles etc. Cognitive function disorders (CFDS) are group of disorders characterized by one or more of the cognitive domains. CFDs are major Neuro cognitive disorders, which includes three group of disorders1. All these three are characterized by an important cognition (as in memory, language or attention) 2 Overall these functions are of paramount importance and are essential for carrying out day to day activities. Homotaurine is a close structural analogue of the natural amino acid gamma-aminobutyrid acid (GABA) an endogenous neurotransmitter present within the central nervous system. This new compound is used in present study, showing improvement is post TBI cognitive functions related to memory, arousal and aggression. Material and methods:- This study was conducted in the neurosurgery unit of Gandhi Medical College & Associated Hamidia Hospital Bhopal from April 2017 to April 2019, A total number of 76 patients included in the study who had post TBI cognitive functions disturbance. Aim and Objects: To evaluate the effectiveness and safety of Homoturine in the patients suffering from cognitive function disturbance following Traumatic Brain injury. Result:- Homotaurine 100mg TDS for 4 weeks and 50mg TDS for 8 weeks and 50mg BD for
12 weeks appears to be an effective and safe for improving the memory and reducing the irritability and aggression among patients with TBI. Further none of the available treatment option for cognitive disorders affords definitive resolution of symptoms.Conclusion: Our study concludes that the usage of Homotaurine therapy can be safe and useful in traumatic Brain injury in terms of post TBI cognitive and functional outcome with beter recovery though the sympathetic and supporting role of family and friends help in Quick recovery.

Keyword: Cognitive function disorders; Traumatic Brain injury; TBI Homotaurine; Memory; Aggression.
 

Objectives: Neurocysticercosis (NCC) is currently considered the most common parasitic disease of the CNS, affecting thousands of individuals living in developing countries and in industrialised nations with a high index of immigration of people from endemic areas. It is one of the most common causes of acquired epilepsy in the developing world especially in India. In this study we present our experience in the surgical management of NCC, complications arising following of the procedures and the lessons learnt at a tertiary care centre in Southern India. Methods: In this study,the records of 69 cases of NCC were prospectively and retrospectively analysed. Eleven patients underwent surgical intervention due to the complications arising out of the infection. Patients were followed up for a period of one year and the short term outcome of the interventions were evaluated. Results: Six (54.5%) patients presenting with hydrocephalus were treated with VP shunt, two (18.2%) patients presented as fourth ventricular SOL and underwent posterior fossa craniotomy and excision, while three (27.3%) had supratentorial lesions who underwent craniotomy and excision. One patient developed pseudomeningocele with CSF leak another developed wound infection which improved on conservative management. Conclusion: Cysticercosis is considered as a “biological marker” of social and economic development. It is a global health problem and developing countries, like India, bear most of the disease burden. In the present study the short term prognosis was good.HoweverNCC being a chronic disease these patients require prolonged follow up to understand the long term complications and
their impact on the overall outcome and survival of the patient.

Keywords: Neurocysticercosis; Hydrocephalus; Fourth Ventricular SOL.
 

Overview: Head injuries are among the leading cause of morbidity and mortality across the world. Adequate, expeditious assessment and early intervention is of utmost importance for favorable outcome in patients with head injury. GCS and FOUR score are the widely accepted tool to quickly assess the severity in head injury patients and prognosticate, albeit with limitations. The objective of this study was to test the adequacy of FOUR-P score, as an alternative tool, to assess the severity and prognosticate the patients with head injury in poly trauma patients. Methods and Materials: This was a comparative study, conducted on 100 patients of poly trauma admitted to the trauma ward of Madras Medical College, Chennai. For all these patients, FOUR and FOUR-P score and GCS were calculated at the time of presentation and at 1st hour, 6th hour, 24th hour. The predictive value of FOUR-P score as well as its correlation with FOUR score and GCS was studied. Results: A statistically significant assessment and prognostication could be made using FOUR-P score when compared to FOUR score and GCS. Also FOUR-P was able to furnish better details about the neurological status of poly trauma patients. Conclusion: As per the results, it can be concluded that the FOUR-P score can be applied as an ideal tool for initial evaluation and prognostication in patients with poly trauma. It can be used as the ideal replacement for FOUR score and GCS. Further studies needed.

Keywords: FOUR and FOUR-P score; GCS; Poly trauma; Head injury.
 

Objective: The purpose of this study was to analyse 5 years data on incidence of mechanism of injury, pattern of injury and other variables of pediatric spine injuries at a tertiary care centre in India. Methods: We retrospectively reviewed the medical records, a total of 78 patients were identified over 5 years period. Patients were divided into 3 age groups, 0-9, 10-14 and 15-18 years. Results: There were 13 patients in 0-9 year, 15 in 10-14 year and 50 in 15-18 year age groups.The mean age was 12 ± 2.5 years (range 3 to 18 years). Incidence of spine injury increased
with age. Boys were 4.5 times more injured compared to girls. Fall from height was most common mechanism of injury (45%), followed by road traffic accidents (35%). Cervical spine was most commonly involved spinal segment. Fractures with subluxation was most common pattern of injury, observed in 49% patients, followed by fractures 22%. Incidence of pure subluxation and spinal cord injury without radiographic abnormality (SCIWORA) was equally documented, 13% patients in each. Younger children more likely had incomplete spinal cord injury. Forty two percent patients were managed surgically by various decompression and stabilization procedures. At the time of discharge, 9% patients had one to two grades improvement in their neurological status. Conclusion: Our findings suggest predominant involvement of cervical spine. The incidence of SCIWORA was similar to other studies. Complication rates were higher in polytrauma and in complete spinal cord injury patients. Young children had good recovery rate compared to older children.

Keywords: Pediatric; Spine Injury; SCIWORA.