Six-year longitudinal prospective comparative study between preoperative and postoperative heart rate variability indices in congenital craniovertebral junction anomalies.

Background: Craniovertebral junction (CVJ) anomalies involve mosaic interaction of multifaceted neurovascular and bony elements. Most of them present late in the course of illness usually as acute presentations following trivial trauma. Knowing subclinical autonomic dysfunction in such anomalies when managed medically can not only indicate progression but also provide en route to early intervention for better outcomes, especially in relatively asymptomatic patients.

A comparative study between preoperative and postoperative conventional autonomic functions in congenital craniovertebral junction anomalies.

Background: Autonomic nervous system (ANS) is invariably affected by craniovertebral junction (CVJ) anomalies. The usual presentation is sudden after trivial trauma. When symptomatic, most of this autonomic dysfunction is clearly elicited clinically with bedside tests.

Patients with Invasive Tumors and Gene Polymorphisms with Subarachnoid Hemorrhage Tend to Have Poorer Prognosis.

 Endothelial nitric oxide synthase ( gene polymorphisms are found to predict predisposition to aneurysmal rupture and development of vasospasm in a patient of subarachnoid hemorrhage (SAH). gene polymorphisms are also found to predict invasiveness of malignant cells. Studies are not available in literature to describe the effect of gene polymorphisms and correlation between aneurysm and carcinoma.

Vertebral artery dissection in acute cervical spine trauma.

Objective: The aim of this study was to study mechanism, risk factors, and prognosis of patients with vertebral artery dissection (VAD) from acute cervical spine trauma (CST).

Methods: A total of 149 consecutive patients were chosen from 2014 to 2019 from our institute data base, and their records were retrospectively studied. Morphology of fracture and subluxation were studied in detail with respect to the presence or absence of VAD.

Effect of remote ischemic preconditioning on cerebral vasospasm, biomarkers of cerebral ischemia, and functional outcomes in aneurysmal subarachnoid hemorrhage (ERVAS): A randomized controlled pilot trial.

Background: Cerebral vasospasm can complicate aneurysmal subarachnoid hemorrhage (aSAH), contributing to cerebral ischemia. We explored the role of remote ischemic preconditioning (RIPC) in reducing cerebral vasospasm and ischemia and improving outcomes after aSAH.

Materials And Methods: Patients with ruptured cerebral aneurysm undergoing surgical clipping and meeting the trial criteria were randomized to true RIPC ( = 13) (inflating upper extremity blood pressure cuff thrice to 30 mmHg above systolic pressure for 5 min) or sham RIPC ( = 12) (inflating blood pressure cuff thrice to 30 mmHg for 5 min) after ethical approval.

Altered MicroRNA Expression in Intracranial Aneurysmal Tissues: Possible Role in TGF-β Signaling Pathway.

The molecular mechanisms behind the rupture of intracranial aneurysms remain obscure. MiRNAs are key regulators of a wide array of biological processes altering protein synthesis by binding to target mRNAs. However, variations in miRNA levels in ruptured aneurysmal wall have not been completely examined.

DREZotomy in the management of post brachial plexus root avulsion neuropathic pain: fMRI correlates for pain relief.

Background: Deafferentiation pain following brachial plexus root avulsion has been documented to be severe enough to affect activities of daily living in patients. Microsurgical DREZotomy is known to alleviate the symptoms by decreasing the afferent signals transmitted from the spinal cord to sensory cortex.

Objectives: To document and analyse the effectiveness of DREZotomy and to evaluate the role of 'sensory cortex' in the cause and relief of dysesthetic pain, using fMRI.

Circulating MicroRNAs as Potential Molecular Biomarkers for Intracranial Aneurysmal Rupture.

Introduction: Diagnosis of the rupture of an intracranial aneurysm (IA) relies on sophisticated neuro-imaging studies, and molecular biomarkers to identify an IA or predict its rupture are still unavailable.

Objective: Our objective was to determine the plasma microRNA (miRNA) expression profile in patients with ruptured IA presenting as aneurysmal subarachnoid hemorrhage (aSAH) and identify potential biomarkers of aneurysmal rupture.

Methods: Plasma miRNA profiling was carried out using quantitative real-time polymerase chain reaction (qRT-PCR) in 20 patients with aSAH and 20 age- and sex-matched healthy controls.

Estrogen receptor alpha gene variant, PvuII (rs2234693), as a potential pharmacogenetic biomarker for aneurysmal subarachnoid hemorrhage in postmenopausal women.

Aneurysmal subarachnoid hemorrhage (aSAH) occurs more often in postmenopausal women than in men. Estrogen plays an important role in vascular homeostasis. Our aim was to elucidate whether a drop in circulating estradiol in conjunction with variants of estrogen receptor genes have a role in female gender susceptibility to aSAH.

Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years.

Objective: Intracranial fungal granuloma (IFG) remains an uncommon entity. The authors report a single-institute study of 90 cases of IFG, which is the largest study until now.

Methods: In this retrospective study, all cases of IFG surgically treated in the years 2001-2018 were included.

Novel Findings in Obstetric Brachial Plexus Palsy: A Study of Corpus Callosum Volumetry and Resting-State Functional Magnetic Resonance Imaging of Sensorimotor Network.

Background: The response of the brain to obstetric brachial plexus palsy (OBPP) is not clearly understood. We propose that even a peripheral insult at the developmental stage may result in changes in the volume of white matter of the brain, which we studied using corpus callosum volumetry and resting-state functional magnetic resonance imaging (rsfMRI) of sensorimotor network.

Objective: To study the central neural effects in OBPP.

Surgically Managed Pediatric Intracranial Aneurysms: How Different Are They from Adult Intracranial Aneurysms?

Purpose: Intracranial aneurysms in children are rare compared to those in adults, and their causes, presentations, and outcomes also vary. Thus, they need to be studied intricately and as an independent entity.

Methods: We retrospectively reviewed intracranial saccular aneurysms in 44 children of <19 years of age who had been surgically treated during the last 30 years at our institute.

Growing Skull Fracture and the Orbitocranial Variant: Nuances of Surgical Management.

Aims: Growing skull fracture (GSF) is a rare complication resulting from diastatic enlargement of a pediatric skull fracture. Orbitocranial GSF is a distinct variant with more complex management issues due to the displacement of the globe. This study aims to discuss surgical considerations in the management of GSF, with particular reference to orbitocranial variants.

Craniofacial injuries in professional cricket: no more a red herring.

The issue of head injury in a noncontact sport like cricket is a matter of great debate and it carries more questions than answers. Recent incidents of fatal head injuries in individuals wearing a helmet have caused some to question the protective value of the helmet. The authors discuss the pattern, type of injury, incidents, and location of cranio-facio-ocular injuries in professional cricket to date.

Occipitocervical Fetus in Fetu with Extracalvarial Extension: A Case Report.

Fetus in fetu (FIF) is an extremely rare congenital anomaly in the pediatric age group. It is defined by the presence of an axial skeleton and well-formed internal organs in a fetiform mass. Only about 15 cases of intracranial FIF have been reported in the literature worldwide.

Unusual Complication of Neglected Hydrocephalus: Spontaneous Rupture with Growing Skull Fracture.

Timely management of hydrocephalus in infants is critical as the initial treatment can have lifelong implications for survival and neurological outcome. In the developing countries, grossly enlarged heads are still not an uncommon occurrence. In extreme cases, there may be a spontaneous rupture of hydrocephalus either externally or internally, depending on the status of the sutures.

Lack of IDH1 mutation in astroblastomas suggests putative origin from ependymoglial cells?

Astroblastomas are extremely rare neuroepithelial tumors of uncertain histogenesis, affecting children and young adults, and constitute a new addition to the WHO 2000 classification of CNS tumors. We report the largest series of nine cases diagnosed in a single institute over the last 13 years and review published literature. Mean age at presentation was 12.

Correlation between plasma total nitric oxide levels and cerebral vasospasm and clinical outcome in patients with aneurysmal subarachnoid hemorrhage in Indian population.

Context: Cerebral vasospasm remains a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Reduced bioavailability of nitric oxide has been associated with the development of cerebral vasospasm after aSAH. Such data is not available in Indian population.

Dermoid cysts of the posterior fossa--morbid associations of a benign lesion.

Dermoid cysts of posterior fossa are uncommon benign lesions. They differ from other lesions found in the infra tentorial compartment by virtue of their associated conditions. Due to their association with dermal sinus tracts, intracranial infection is a potential threat following infection of the cyst.

Cortical reorganization following neurotization: a diffusion tensor imaging and functional magnetic resonance imaging study.

Background: Following successful intercostal-musculocutaneous nerve (ICN-MCN) neurotization for brachial plexus injuries (BPIs), patients initially show a synkinetic movement of elbow flexion during inspiration. Later they are able to flex the elbow, independent of respiratory activity.

Objective: To demonstrate cortical reorganization following ICN-MCN coaptation in BPI through functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI).

Isolated cranio-spinal involvement of Rosai-Dorfman disease: case report.

Rosai-Dorfman disease is a rare non-neoplastic lymphoproliferative condition. It commonly affects individuals between third and fifth decades, most common presentation being in the form of massive painless cervical lymphadenopathy with fever, weight loss and malaise. Isolated intracranial involvement is rare seen in less than 5% of patients with extranodal involvement.

Aneurysms from extracranial, extradurally originating posterior inferior cerebellar arteries: a rare case report.

Background: Aneurysms arising from the PICA are infrequent and those arising from an extracranially originating PICA in the extracranial intradural region are even rare. We report a case of bilaterally extracranial extradurally originating PICAs, each of which had an aneurysm, both being situated below the foramen magnum. This to the best of our knowledge is the first of its kind to be reported.