Feasibility of Conducting a Virtual Exit Exam in Neurosurgery During the SARS-COV19 Pandemic.

BACKGROUND: Skills assessment forms an integral part of the exit examination in neurosurgical training programs. The established method of evaluating trainees for their clinical knowledge and surgical proficiency in the operating room is not feasible in the current time of SARS-COV19 pandemic. OBJECTIVE: The feasibility of conducting such an assessment using case modules on an online meeting platform is discussed. METHODS: Six candidates were evaluated on two consecutive days with two internal examiners located at the examination site and two external examiners situated at their own institutions elsewhere in the country. Clinical details, including images and videos of patients managed at our institute were recorded and provided to the candidates as case modules. Four sessions were conducted in the form of long and short cases, operative neurosurgery, neuroradiology, and neuropathology and a general viva-voce using "Zoom" (Zoom-Video-Communications, Inc. USA) platform. Feedback from the examinee and the examiners were obtained for any modification in the current format. RESULT: The online platform worked well without any interruption except for slight lag in the audio-visual system and occasional difficulty in using microphone and screen simultaneously. Trainees were able to interpret the clinical details and rated this format close to actual clinical evaluation. The examiners uniformly agreed that the online format for assessment was satisfactory and made some suggestions for improvement. CONCLUSION: Clinical and surgical skill evaluation is feasible using case modules and online meeting platforms. Use of original patient's data, images, videos demonstrating clinical signs, and operative procedures makes this assessment more objective.

Arachnoid cyst masquerades as late onset obsessive-compulsive disorder.

Literature evidence suggests that onset of obsessive-compulsive disorder (OCD) at a later age is usually associated with brain lesions. However, none of previous reports suggest an association between arachnoid cyst and OCD. In this report, we present a case of OCD, starting at the age of 40 years, in which the obsessive symptoms were characteristically associated with fluctuating insight. Investigation revealed an arachnoid cyst, in the area of left fronto-parietal region, with broad base towards the falx.

Analysis of homing potential of marrow-derived mononuclear cells in an experimentally-induced brain stroke mouse model.

PRIMARY OBJECTIVE: To analyse the efficacy of bone marrow-derived mononuclear cells (MNCs) in traversing the blood-brain barrier (BBB) in an experimental model of stroke. METHODS AND PROCEDURES: The middle cerebral artery occlusion (MCAo) mouse model was established and behavioural and histological analysis was performed, subsequently the carboxyfluorescein diacetate (CFDA)-labelled MNCs were transplanted through the tail vein immediately after 23 hours of reperfusion. The fluorescence microscopic analysis of the brain sections was analysed in both acute and sub-acute phases of transplantation. RESULTS: The neurological deficit was confirmed by TTC staining and contra lateral turning behaviour. After 2 and 7 days of transplantation, the CFDA-labelled MNCs were observed in the infarcted regions along the line of cortex. CONCLUSION: The presence of the CFDA-labelled cells in the ischaemic injured brain lesions proved homing of the implanted MNCs in the infarcted regions of the brain. The successful homing of MNCs may pave way for future clinical trials using MNC in stroke.