Open Neural Tube Defects in COVID-19 Pandemic: An Analysis of 26 Neonatal Patients in a Tertiary Care Center.

Coronavirus disease-2019 (COVID-19) pandemic has severely affected and disrupted medical practice all over the world since December 2019 till date. This has affected the pediatric surgical practice in general and neurosurgical practice in particular. An analysis of 26 neonatal patients with open neural tube defects who underwent surgery in the neurosurgery department at the King Edward VII Memorial Hospital (KEM), Mumbai during the period of March 2020 till December 2020 is presented.

Split Cord Malformation Type 1 (Bony Spur) Excision Using Microrongeur.

Split cord malformation is well documented and reported in various case series and reports in the literature. The excision of bony spur in type 1 split cord malformation is challenging due to the intricate pathologic anatomy. The standard method advocated is to excise the bony spur with the help of a high-speed microdrill and a forward cutting punch.

Sitting Position for Posterior Fossa Tumor in Infants: A Technical Report.

Surgery for posterior fossa tumors in sitting position is performed in very few neurosurgical centers all over the world. It carries the potential risk of air embolism with consequent related morbidity. However, posterior fossa surgery in the sitting position is still performed in neurosurgical centers with considerable expertise including neurosurgeons and neuroanesthesiologists.

Endoscopic anatomy of distal biceps tendon insertion and bicipitoradial bursa: a cadaveric study.

Background: Distal biceps endoscopy has emerged as a minimally invasive alternative to open procedures for distal biceps tendon (DBT) pathology. The purpose of this study was to systematically describe the static and dynamic appearance and variations of the DBT insertional region using a standardized endoscopic technique and dissection in healthy cadaveric elbows.

Methods: Endoscopic assessment of the DBT insertional region was performed using a standard proximal parabiceps portal in 20 fresh frozen cadaveric upper extremities.

Cadaveric Study of Insertional Anatomy of Distal Biceps Tendon and its Relationship to the Dynamic Proximal Radioulnar Space.

Purpose: To quantify and assess the relationship between the insertional dimensions of the distal biceps tendon (DBT) and radioulnar space (RUS) in 3 rotational positions. We hypothesized that in all positions RUS would be adequate for the DBT and would remain adequate even after an incremental increase (1 to 3 mm) in tendon thickness.

Methods: Eleven fresh-frozen cadaveric elbows were dissected; DBT dimensions and bicipital tuberosity measurements were performed and insertional footprints were quantified using a distal biceps footprint index.

Arthroscopic Reduction and Stabilization of Chronic Perilunate Wrist Dislocations.

An acute perilunate wrist injury that is unreduced for more than 6 weeks results in severe disability, and even open reduction with stabilization through wide dorsal and volar approaches is technically challenging. This report describes an arthroscopic technique for reduction and percutaneous wire stabilization of a chronic perilunate wrist dislocations. The technique involves initial radiocarpal and midcarpal access through the 6R and 3-4 portals, and these portals are used for synovectomy and debridement of capsular flap tears.

Endoscopic Distal Biceps Repair: Endoscopic Anatomy and Dual-Anchor Repair Using a Proximal Anterolateral "Parabiceps Portal".

Distal biceps rupture is associated with significant functional disability, and surgical treatment involves open or endoscopic-assisted repair of the ruptured tendon through an anterior incision. This report describes an endoscopic approach that is performed with 2 portals for visualization and instrumentation. Preoperative sonography is used to identify bony and soft-tissue landmarks.

Cadaveric study of anterior and posterior elbow endoscopy portals for endoscopic distal biceps repair: comparative anatomy-at-risk.

Purpose: The purpose of this study was to describe neurovascular structures-at-risk during establishment of five portals for access to distal biceps tendon (DBT) in cubital fossa, and to establish relative safety of these portal sites for such access. We hypothesized that all five portals are safe for endoscopic DBT exploration.

Methods: Ten fresh frozen cadaveric elbows were dissected after placement of portals at five potential sites (four anterior, one posterior).

A study of clinical presentations and complications of foreign body in the bronchus - own experience.

Objectives: In this study, we studied varied clinical presentations and complications of a foreign body in the airway and complications of bronchoscopy, if carried out.

Methods: A prospective observational clinical study in a tertiary care centre from June 2010 to May 2012 included 46 paediatric patients aged less than 12 years, with suspected foreign body aspiration, all of whom underwent rigid bronchoscopy under general anaesthesia. All the patients were subjected to history taking, clinical examination, and investigations (pre- and post-op chest X-ray and CT virtual bronchoscopy, if required).

The "double-barrel" knot: a new sliding knot for arthroscopic soft tissue fixation using single-pulley and double-pulley techniques.

The double-barrel knot is a new arthroscopic sliding knot for soft tissue reconstruction and repair procedures in arthroscopic and open shoulder surgery. The double-barrel knot is a modified sliding hitch, and is formed using 2 sutures from a single double-loaded anchor (single-pulley technique) or 2 sutures from 2 adjacent anchors (double-pulley technique). This paper describes the method of double-barrel knot formation, and its variations; in addition, single-pulley and double-pulley techniques for anterior glenoid labral repair are presented.

Iatrogenic perforation of upper pouch in pure esophageal atresia: a rare complication and review of literature.

Iatrogenic perforation of the neonate's pharynx and esophagus with normal anatomy was first described by Eklöf et al in 1968. It typically occurs in severely premature neonates who have undergone repeated traumatic attempts at endotracheal intubation or passage of orogastric tubes. It may also mimic esophageal atresia (EA).

Surgical correction of the "Popeye biceps" deformity: dual-window approach for combined subpectoral and deltopectoral access and proximal biceps tenodesis.

"Popeye biceps" deformity represents the appearance of a distally retracted biceps muscle resulting from either a traumatic long biceps tendon (LBT) rupture or an iatrogenic LBT tenotomy. Cosmetic and functional problems associated with the deformity may necessitate surgical correction, and surgical exposure using multiple incisions is recommended. The technique presented here describes a novel mini-open approach using a single 1-in incision that provides access to 3 peripectoral anatomical zones.

Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability.

Purpose: Combined occurrence of humeral avulsion of glenohumeral ligament (HAGL) lesion and a significant glenoid bone defect is an unusual and previously undescribed association in traumatic anterior shoulder instability. The purpose of this study was (1) to report a retrospective case series of seven anterior bony instability patients who were diagnosed with this unusual association and (2) to evaluate the results of a modified Latarjet procedure and simultaneous HAGL repair using a new subscapularis-sparing approach.

Methods: A retrospective review of the records of 64 anterior shoulder instability patients who underwent bony stabilization surgery was performed, and patients who underwent a combined reconstruction for significant glenohumeral bone defects (glenoid loss >20 %) and an associated HAGL lesion were identified.

Orthogonal radiographic technique for radiographic visualization of coracoid process fractures and pericoracoid fracture extensions.

Radiographic visualization of coracoid process fractures is difficult due to the complex and variable 3-dimensional orientation of coracoid pillars. Failure to suspect an injury on preliminary radiographs has been described as a major reason for suboptimal management of these fractures. We describe a standardized method of patient positioning and radiographic beam angulation (orthogonal radiographic technique), to provide two roentgenographic views (Bhatia views) for visualization of individual coracoid pillars.

Orthogonal biplanar fluoroscopy-guided percutaneous fixation of a coracoid base fracture associated with acromioclavicular joint dislocation.

Coracoid process fractures that involve the coracoid base (inferior pillar) without a concomitant rupture of the coracoclavicular ligaments can destabilize the acromioclavicular joint with its subsequent dislocation; prophylactic or therapeutic operative treatment involving open reduction and internal fixation has been traditionally recommended. This report presents a new technique of percutaneous reduction and stabilization of the coracoid fracture with indirect acromioclavicular joint reduction under fluoroscopic guidance; biplanar visualization of coracoid process anatomy is obtained using 2 specific radiographic/fluoroscopic-beam angulations (Bhatia views), and this permits a guided placement of screws for controlled reduction of this dual injury. The technique is based on the author's original work on coracoid process anatomy and development of radiographic views for orthogonal visualization of coracoid pillars in their entirety.

Dual-window subscapularis-sparing approach: a new surgical technique for combined reconstruction of a glenoid bone defect or bankart lesion associated with a HAGL lesion in anterior shoulder instability.

Combined bankart lesion and humeral avulsion of glenohumeral ligament lesion (HAGL) is a well-described pathologic complex in anterior shoulder instability; open surgical approaches with and without arthroscopic assistance have been suggested for simultaneous 1-stage repair of these lesions. Presence of a significant glenoid bone defect (inverted-pear glenoid) adds to the complexity of the problem and necessitates a bony reconstruction procedure. Open surgical approaches described for management of this combined lesion complex in anterior shoulder instability necessitate a subscapularis-cutting approach; suboptimal healing of the tenotomized subscapularis and subsequent delayed rehabilitation predisposes to late subscapularis dysfunction, and this compromises clinical outcomes.

Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control.

Background: Oral cleansing with chlorhexidine decreases the incidence of nosocomial pneumonia in patients after cardiac surgery. However, evidence of its benefit in ICU patients is conflicting.

Methods: Patients admitted to the ICU of an Indian tertiary care teaching hospital were randomized to twice-daily oropharyngeal cleansing with 0.

Interdural cavernous sinus epidermoid cyst.

We report a patient with an uncommon interdural epidermoid tumor, located within the confines of dural layers of the lateral wall of the cavernous sinus. The tumor was resected by a basal subtemporal extradural-interdural approach. Following the surgery, the 45-year-old female patient recovered completely from her symptoms of atypical neuralgic facial pains.

Petroclival mixed meningioma.

We present a 47-year-old lady with a large dumb-bell petroclival-cavernous sinus meningioma. The tumour was of mixed histopathology; the anterior part, in relationship to the cavernous sinus, was a syncitial meningioma and the posterior part in the petroclival region was a transitional meningioma. The two histological subtypes of meningioma within the same tumour displayed remarkable differences in their radiological features, nature of extensions, relationship with the adjoining structures and consistency.