Telemedicine in Follow-up after Spine Surgery: Need of the Hour.

 There is an acute shortage of neurosurgeons and spine surgeons especially in rural areas of low- and middle-income countries including India. Patients of spine surgery need to travel long distances for follow-up at tertiary care hospitals. This study was done to evaluate role and success rate of telemedicine in follow-up after spine surgery based on patients' diagnosis and demographic features and to identify barriers to successful telemedicine consultations.

Optochiasmatic Cavernomas: Updated systematic review and proposal of a novel classification with surgical approaches.

Cavernomas are histologically benign vascular malformations found at different sites in the brain. A rare site for such cavernomas, however, is the anterior optic pathway, comprising the optic nerve, chiasma, and optic tract-called optochiasmatic cavernomas (OCC). These lesions usually present with sudden onset or progressive vision loss, headache, and features mimicking pituitary apoplexy.

Clear Cell Meningioma with Tyrosine Crystals: a Case Report with Review of Literature.

Introduction Or Background: Clear cell meningioma is a rare WHO grade 2 tumour and runs an aggressive course. Tyrosine crystals are very uncommon in meningioma.

Case Presentation: We present a case of a 43-year female with right middle and posterior cranial fossa space occupying lesion (SOL) diagnosed as clear cell meningioma with presence of numerous tyrosine crystals.

Multiple Symptomatic Spinal Intradural Arachnoid Cysts: A Case Report.

A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in multiples is even rarer.

Setting Up a Department of Neurosurgery in a Government Hospital in an LMIC: Jodhpur, India.

Background: The number of government institutes offering affordable super specialty and tertiary healthcare in India has traditionally not been able to keep pace with the growth in population, most of whom are too poor to be able to afford private healthcare services. To meet this mandate, 6 new institutes built on the template of the premier institute of the country-the All India Institute of Medical Sciences, New Delhi-were founded and began operations in 2012. Using the progress of our department as an example, the aim of this report is to outline the principles that were followed to set up the department of neurosurgery.

Skull base dural reflection models: tool for teaching neuroanatomy at resource-scarce centers.

Skull base dural reflections are complex, and along with various ligaments joining sutures of the skull base, are related to most important vessels like internal carotid arteries (ICA), vertebral arteries, jugular veins, cavernous sinus, and cranial nerves which make surgical approaches difficult and need thorough knowledge and anatomy for a safe dissection and satisfactory patient outcomes. Cadaver dissection is much more important for the training of skull base anatomy in comparison to any other subspecialty of neurosurgery; however, such facilities are not available at most of the training institutes, more so in low- and middle-income countries (LMICs). A glue gun (100-Watt glue gun, ApTech Deals, Delhi, India) was used to spread glue over the superior surface of the bone of the skull base over desired area (anterior, middle, or lateral skull base).

Chondrosarcoma Skull Base: A Case Report.

Introduction: Chondrosarcomas are primary malignant bone tumor that rarely occurs in the head and neck region. Squash cytology of skull base neoplasm shows atypical chondrocytes and myxoid stroma, which suggests many possibilities like chordoma, chordoid glioma, chordoid meningioma and chondrosarcoma. Isocitrate dehydrogenase gene (IDH) mutations have been reported in 50% to 60% of the head and neck region chondrosarcoma.

Handmade models for aneurysm surgery: A useful tool for training.

Background: Aneurysm surgery is considered difficult by young and trainee neurosurgeons. This is due to difficulty in understanding orientation of aneurysm complex (proximal and distal vessels, aneurysm neck, and fundus) in relation to the surrounding structures (skull, brain, vessels, and nerves) after head is rotated, extended, and fixed on the head frame. Virtual three-dimensional (3D) imaging studies and 3D-printed models help young neurosurgeons but are not accessible to most of the centers due to need for resources (human and equipment).

Ultrastructural Changes in Autopsy Tissues of COVID-19 Patients.

Introduction: The COVID-19 pandemic resulted in substantial morbidity and mortality across the world. The prognosis was found to be poor in patients with co-morbidities such as diabetes, hypertension, interstitial lung disease, etc. Although biochemical studies were done in patient samples, no study has been reported from the Indian subcontinent about ultrastructural changes in the vital organs of COVID-19 patients.

The Yin and Yang of Operating on a Posterior Fossa Meningioma: The Schmahmann Syndrome.

The cerebellum is classically linked with control of motor function, such as coordination, balance, and regulation of movement. There is an increasing awareness, now, of the non-motor functions of the cerebellum, and the occurrence of behavioral anomalies with cerebellar disorders. We present the first report of Schmahmann syndrome (cerebellar cognitive affective syndrome [CCAS]) occurring secondary to posterior fossa meningioma excision.

Cerebral Ptosis: A Revisit.

Ptosis, unilateral or bilateral, partial or complete, occurring in cases of cerebral ischemic or hemorrhagic stroke, trauma or tumor without involvement of brainstem or oculo-sympathetic mechanism can be termed as cerebral ptosis. Such eyelid dysfunction can occur with hemispheric involvement of either side. It is associated with higher frequency of gaze preference to side of lesion as well as upgaze limitation compared to patients without cerebral ptosis.

Efficacy of Hyaluronidase in the Mannitol Extravasation Induced Compartment Syndrome-A Case Report and Review of Literature.

Mannitol is one of the indispensable drugs in neurosurgery to manage the raised intracranial pressure. Though considered safe, extravasation of mannitol into the tissues can cause considerable morbidity with the consequent development of compartment syndrome. We report a case of a 50-year-old female who developed forearm compartment syndrome due to mannitol extravasation after undergoing surgery for frontal glioma under general anaesthesia.

Methylmethacrylate Inter-Facetal and Inter-Vertebral Body Spacers for Cranio-Vertebral Junction and Various Spine Surgeries: Technical Note.

Study Design: Prospective.

Purpose: Over past one and half decade, ready-to-use magnetic resonance imaging (MRI) compatible spinal implants have changed the clinical practice and economics of spinal surgery. These are beyond reach of majority of population of developing countries like India due to financial reasons and also availability in remote areas.

Volume Rendering Technique (VRT) for Planning and Learning Cranio-Vertebral Junction (CVJ) Surgeries: Technical Note.

Aim: To present the application of volume rendering technique (VRT) of computed tomography (CT) scan in cranio-vertebral junction (CVJ) surgeries.

Material And Methods: The authors used VRT images of CT scan in patients of congenital CVJ anomalies who were subjected to various surgeries through midline posterior approach. The screw entry points and courses of vertebral arteries were identified in relation to various landmarks on the VRT images, preoperatively and intra-operatively.

Simulation of surgery for supratentorial gliomas in virtual reality using a 3D volume rendering technique: a poor man's neuronavigation.

Objective: Different techniques of performing image-guided neurosurgery exist, namely, neuronavigation systems, intraoperative ultrasound, and intraoperative MRI, each with its limitations. Except for ultrasound, other methods are expensive. Three-dimensional virtual reconstruction and surgical simulation using 3D volume rendering (VR) is an economical and excellent technique for preoperative surgical planning and image-guided neurosurgery.

Modified Taylor Retractor in Unilateral Subperiosteal Lumbar Microdiscectomy: A Frugal Alternative to the Tubular Retractor.

Objective: To do a comparative surgical outcome and cost-benefit analysis of our simple modified Taylor retractor with both open and tubular techniques in lumbar discectomy.

Methods: We retrospectively divided 52 lumbar disc patients operated by 2 different techniques between January 2019 and June 2020 into 2 groups- group 1 (n = 20): standard open macrodiscectomy (4-5 cm incision); group 2 (n = 32): unilateral translaminar microdiscectomy using our modified Taylor retractor with a small incision (18-20 mm, comparable to the tubular retractor). We compared both groups in terms of surgical outcomes and cost-benefit analysis.

Endoscopic Third Ventriculostomy in Failed Ventriculoperitoneal Shunt in Pediatric Population.

Introduction: Ventriculoperitoneal (VP) shunt malfunction is common in pediatric age group patients. There is a high complication rate and revision rate of VP shunt. Endoscopic third ventriculostomy (ETV) can alleviate these complications and can act as an effective alternative for the treatment of hydrocephalus in this age group of patients.