Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives.

The global demand for hospital care, driven by population growth and medical advances, emphasizes the importance of optimized resource management. Enhanced Recovery After Surgery (ERAS) protocols aim to expedite patient recovery and reduce health care costs without compromising patient safety or satisfaction. Its principles have been adopted in various surgical specialties but have not fully encompassed all areas of neurosurgery, including craniotomy.

Sequential mechanical thrombectomies in acute bilateral middle cerebral artery strokes: A case report and review of literature.

Simultaneous occlusion of both middle cerebral arteries (MCAs) is very rare and usually devastating. Few case reports are available in the literature where bilateral thrombectomy was done simultaneously to remove the clot. High NIH stroke scale with a low level of consciousness can be a clue for the diagnosis.

A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm.

Introduction: To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm.

Methods: An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals.

Initial Results of a Direct Aspiration First-Pass Technique to Treat Acute Ischemic Stroke Patients in Nepal.

 Endovascular therapy has become the mainstay of treatment of acute ischemic stroke (AIS) due to large vessel occlusion. A direct aspiration first-pass technique (ADAPT) using large bore aspiration catheters has been introduced as a rapid, simple method for achieving good revascularization and good clinical outcomes. The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to large-vessel occlusion in the Nepali patient population.

Peripheral Nerve and Plexus Blocks for Hip Surgery in a Nonagenarian with Severe Cardiac Disease.

The hemodynamic alterations and stress response associated with anesthesia and surgery are often poorly tolerated by elderly patients. Regional anesthesia techniques are useful in the elderly as they provide excellent perioperative analgesia with minimal hemodynamic perturbations. We report the case of a 90-year-old man with valvular heart disease and severe left ventricular systolic dysfunction, who underwent dynamic hip screw fixation of fractured femur neck under combined pericapsular nerve group block, lumbar plexus block, and para-sacral sciatic nerve block.

Effect of Tranexamic Acid on Blood Loss and the Quality of Surgical Field in Transsphenoidal Pituitary Surgeries: Double-Blind Placebo-Controlled Randomized Control Trial.

Background And Aims: Pituitary adenomas are common intracranial neoplasms and several cases require surgery, radiotherapy or radiosurgery. Transsphenoidal access to the pituitary gland is the commonest surgical approach. In microscopic or endoscopic approach to the pituitary, even modest bleeding can significantly worsen the surgical field for the neurosurgeon, lengthen intra-operative time and lead to potentially catastrophic complications.

Post-traumatic Pseudoaneurysm of the Internal Carotid Artery with Intractable Epistaxis: A Case Report.

Epistaxis is a common otorhinolaryngology emergency. There are several treatment modalities for epistaxis, but bleeding from the internal carotid artery necessitates a particular treatment technique. We report a case of a 22-years old man who presented to us recurrent episodes of epistaxis and blurry vision in the right eye for one month.

Mucormycosis: An unanticipated progeny of COVID-19.

The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection.

Rational Use of Oxygen in COVID-19 Pandemic - Are We Doing Enough?

During the episodes of large case surge of COVID-19, the health care system of many nations have struggled, more so in nations with resource limitations. Recently, Nepal and the neighboring nation India are being hit hard by the pandemic. Management of patients with moderate and severe COVID-19 remains largely supportive, with oxygen therapy being the cornerstone of the management.

The First Successful Endovascular Management of Posterior Fossa Arteriovenous Malformations in Nepal: Case Series.

Posterior fossa arteriovenous malformations represent 7-15% of all intracranial AVMs. They carry a higher risk of rupture than supratentorial AVMs and are associated with considerable rates of morbidity and mortality. Available treatment options include conservative management, microsurgical resection, radiosurgery, endovascular embolization, or combinations of these modalities.

Middle cerebral artery occlusion due to cardiac tissue following catheter ablation in Wolff-Parkinson-White syndrome.

Catheter ablation is a commonly performed procedure in patients with Wolff-Parkinson-White syndrome. A 56-year-old man developed an acute ischemic stroke immediately after undergoing radiofrequency catheter ablation of the left-sided accessory pathway. Neuroimaging revealed complete occlusion of the proximal middle cerebral artery.

Transsellar trans-sphenoidal encephalocele with cleft lip, cleft palate and agenesis of corpus callosum.

Basal encephalocele is a rare congenital malformation. Among basal encephaloceles, the transsellar, trans-sphenoidal encephalocele is the least common subtype. We present the case of a newborn female, who presented to us with cleft lip and cleft palate.

Anesthesiology and Critical Care Response to COVID-19 in Resource-Limited Settings: Experiences from Nepal.

It is difficult to predict the future course and length of the ongoing COVID-19 pandemic, which has devastated health care systems in low- and middle-income countries. Anesthesiology and critical care services are hard hit because many hospitals have stopped performing elective surgeries, staff and scarce hospital resources have been diverted to manage COVID-19 patients, and several makeshift COVID-19 units had to be set up. Intensive care units are overwhelmed with critically ill patients.

Management of Stroke During COVID-19 Pandemic: The Challenges in Nepal.

The COVID-19 pandemic has significantly affected health care delivery globally. COVID-19 is associated with varied neurological manifestations including acute ischemic stroke. In densely populated South Asian nations like Nepal that have suboptimal baseline health care systems, we foresee unique challenges during this pandemic to ensure effective stroke management as well as the safety of health care workers involved in the management of stroke patients.

Successful Treatment of Giant Intracranial Aneurysm Using Flow-Diverter Device: First Experience in Nepal.

Giant intracranial aneurysms are defined as aneurysms that measure over 25 mm in the greatest dimension. They are rare vascular lesions that preferentially involve regions with high-velocity blood flow, such as the cavernous and supraclinoid segments of the internal carotid artery, the middle cerebral artery, the vertebrobasilar region, and the basilar apex. The treatment of giant aneurysms is challenging and associated with high rates of morbidity and mortality.

Giant Cerebral Tuberculoma Masquerading as Malignant Brain Tumor - A Report of Two Cases.

Giant cerebral tuberculoma is an uncommon but serious form of tuberculosis. We report two patients who had a single, large lesion on magnetic resonance imaging (MRI) of the brain. Both patients underwent neurosurgery for the excision of the mass lesion as neuroimaging findings were suggestive of a brain tumor.

Perspective of Doctors for COVID-19 Pandemic Readiness in Government Hospitals of Nepal.

Background: The study assesses the perspective of doctors working in government hospitals of Nepal regarding hospital preparedness for infection prevention measures, isolation services provisions, critical care service readiness, and training of staff for COVID-19 pandemic management.

Methods: This cross-sectional study was done in central, provincial, and local level health centers of the Government of Nepal to assess the perspective of medical doctors regarding COVID-19 pandemic readiness in their facility. Nonprobability sampling was used to collect 56 responses from doctors working in different hospitals of Nepal.

Mechanical Thrombectomy for Basilar Artery Occlusion Stroke: A Case Report.

Posterior circulation strokes are potentially devastating events that carry a significant risk of morbidity and mortality. Acute basilar artery occlusion stroke is a rare posterior circulation stroke that needs emergent management. We report the case of a 67-year-old woman who developed an acute basilar artery occlusion.

Endovascular treatment of complex vertebrobasilar junction aneurysms: A report of two cases.

Introduction: Vertebrobasilar junction (VBJ) aneurysms are uncommon posterior circulation aneurysms. The treatment of VBJ aneurysms is challenging and in most cases, endovascular management is preferred over neurosurgery.

Presentation Of Case: We describe two patients with VBJ aneurysms who underwent successful neuro-interventional procedures.

Effect of Stellate Ganglion Block on Intraoperative Propofol and Fentanyl Consumption in Patients with Complex Regional Pain Syndrome Undergoing Surgical Repair of Brachial Plexus Injury: A Randomized, Double-blind, Placebo-controlled Trial.

Introduction: Stellate ganglion block (SGB) is commonly performed to treat chronic painful conditions, such as complex regional pain syndrome (CRPS) and postherpetic neuralgia. However, whether it is effective in reducing anesthesia and analgesia requirement during surgery (acute pain) is not known.

Materials And Methods: Sixty American Society of Anesthesiologists (ASA) physical status I and II patients with CRPS type II undergoing surgery for repair of brachial plexus injury were randomized (1:1) to receive SGB with either 10 mL of 0.

Ankle Surgery in a Patient with Acute Subdural Hematoma Under Combined Lumbar Plexus and Proximal Sciatic Nerve Block - A Case Report.

Acute subdural hematoma (aSDH) is commonly encountered in the emergency department in patients with traumatic injuries. If the hematoma is small, non-expanding and asymptomatic, it is managed conservatively. However, other injuries sustained during trauma may warrant surgical intervention, during which anesthetic management becomes challenging.

Pericapsular Nerve Group Block: An Excellent Option for Analgesia for Positional Pain in Hip Fractures.

Fractures in and around the hip are common presentations in the emergency department. It is commonly seen in the elderly as a result of osteoporotic changes. However, younger age groups are also affected, especially as a result of high velocity trauma.

Effect of dexmedetomidine on dynamic cerebral autoregulation and carbon dioxide reactivity during sevoflurane anesthesia in healthy patients.

Background: There are conflicting opinions on the effect of dexmedetomidine on cerebral autoregulation. This study assessed its effect on dynamic cerebral autoregulation (dCA) using a transcranial Doppler (TCD).

Methods: Thirty American Society of Anesthesiologists physical status I and II patients between 18 and 60 years, who underwent lumbar spine surgery, received infusions of dexmedetomidine (Group D) or normal saline (Group C), followed by anesthesia with propofol and fentanyl, and maintenance with oxygen, nitrous oxide and sevoflurane.