Human amniotic membrane as a dural substitute in neurosurgery: A systematic review.

Background: Several studies have highlighted the use of human amniotic membrane (HAM) in neurosurgical procedures as an effective dural substitute. HAM has inherent antifibrotic and anti-inflammatory properties and exhibits immunomodulatory effect that makes it an ideal dural substitute. Other advantages including easy availability, low cost of procurement, and storage also render it a promising dural substitute especially in low- and middle-income countries. Methods: A systematic literature search was performed using PubMed, Scopus, and Google Scholar databases, using the search terms "human amniotic membrane," "dural repair," and "neurosurgery." To be eligible for inclusion in our review, papers had to report primary data, be published in English language and report dural repair on humans with human amniotic membrane. Eligibility assessment was conducted by two independent reviewers with qualitative analysis on the basis of surgical utility, postoperative complications, and histological analysis. Results: Eight articles met the predefined inclusion criteria, including three randomized control trials and five cohort studies. We evaluated the use of HAM grafts in dural repair for elective cranial surgery (four studies), trauma surgery (three studies), and elective spine surgery (one study). Cases with postoperative cerebrospinal fluid (CSF) leak were reported by two studies. Other postoperative complications including meningitis, hydrocephalus, pseudomeningocele, CSF collection in subdural space, and subacute subdural hematoma were reported by one study each. Postsurgical histological analysis was reported by three studies highlighting the antiadhesive and integrative properties of HAM. Conclusion: The current review of evidence suggests that in terms of postsurgical outcomes, HAM is comparable with commercially available dural substitutes.

Multifocal oligodendroglioma with callosal and brainstem involvement.

Background: Oligodendrogliomas are generally low-grade glial neoplasms commonly occurring in a cortical or subcortical location and frequently contain coarse calcifications. Tumors with 1p and 19q codeletions behave atypically and are more likely to have ill-defined margins and tend to have calcification. Very rarely, diffuse pattern and gliomatosis type of infiltrative nature of oligodendrogliomas have been described in sporadic case reports. Case Description: In this article, we present a case of a 31-year-old male who had diffuse multifocal oligodendroglioma with rare features of extensive callosal and brainstem involvement on imaging. Conclusion: Rare cases of oligodendrocytic gliomatosis cerebri or oligodendrogliomatosis with diffuse white matter spread of these tumors usually lead to a detrimental course of neurological status and a poor prognosis in these patients.

Case report: Primary ependymoma of the trigeminal nerve presenting as trigeminal neuralgia.

Background: Ependymomas are usually found in the posterior fossa originating from the fourth ventricle. Primary ependymomas arising from cranial nerves are rare with only a handful of reported cases. Trigeminal neuralgia (TN) is rarely due to space occupying lesions. Case Description: A 20-year-old female presented with TN with a rare presentation of a pure extra-axial ependymoma involving the right trigeminal nerve in the cerebellopontine angle. Conclusion: It is essential to explore the possibility of a mass arising from the trigeminal nerve when investigating the cause of TN.

Deep learning applications in neuro-oncology.

Deep learning (DL) is a relatively newer subdomain of machine learning (ML) with incredible potential for certain applications in the medical field. Given recent advances in its use in neuro-oncology, its role in diagnosing, prognosticating, and managing the care of cancer patients has been the subject of many research studies. The gamut of studies has shown that the landscape of algorithmic methods is constantly improving with each iteration from its inception. With the increase in the availability of high-quality data, more training sets will allow for higher fidelity models. However, logistical and ethical concerns over a prospective trial comparing prognostic abilities of DL and physicians severely limit the ability of this technology to be widely adopted. One of the medical tenets is judgment, a facet of medical decision making in DL that is often missing because of its inherent nature as a "black box." A natural distrust for newer technology, combined with a lack of autonomy that is normally expected in our current medical practices, is just one of several important limitations in implementation. In our review, we will first define and outline the different types of artificial intelligence (AI) as well as the role of AI in the current advances of clinical medicine. We briefly highlight several of the salient studies using different methods of DL in the realm of neuroradiology and summarize the key findings and challenges faced when using this nascent technology, particularly ethical challenges that could be faced by users of DL.

Management of symptomatic disc herniation in pregnancy: A case report and literature review.

BACKGROUND: Lower back pain with radiculopathy due to a disc herniation occurs in about 0.01% of pregnant females. Surgical intervention is seldom required unless there is intractable pain, and for a significant neurological deficit. Further, the use of intraoperative ionizing radiation may adversely affect the developing fetus. CASE DESCRIPTION: A 25-year-old female, 17-weeks pregnant, presented with right lower extremity sciatica due to a L4-5 unilateral disc herniation. She underwent a microdiscectomy that required just one intraoperative C-arm fluoroscopic image. Postoperatively, her leg pain resolved, and she delivered a healthy baby at term. CONCLUSION: Using single-image C-arm fluoroscopy in a pregnant female undergoing an emergent lumbar discectomy, employing as low as reasonably achievable/shielding, did not adversely impact the developing fetus.

Acute cerebellitis successfully managed with temporary cerebrospinal fluid diversion using a long tunnel external ventricular drain: a long-term radiological follow-up of two cases.

Acute cerebellitis (AC) is a rare inflammatory childhood disorder. Although there is no consensus on standard treatment for cerebellitis, its outcome is usually favourable. We report two cases of AC in the paediatric age group, successfully managed with long tunnel external ventricular drain (EVD). The first patient was an 8-year-old boy with a history of fever and headache. Sequential MRI showed diffuse cerebellar swelling with tonsillar herniation and resulting hydrocephalus. The second patient was a 6-month-old boy who presented with high-grade fever associated with chills. CT scan of the head showed triventricular hydrocephalus with obliteration of cerebrospinal fluid spaces and cisterns. Both patients underwent immediate emergency right-sided long tunnel EVD insertion. The EVD was removed on the 9th day in the first patient and the 10th day in the second patient; the patients showed no neurological deficits at a follow-up of 2 years and 1 year, respectively.

Splenic injury after blunt abdominal trauma: an unusual presentation.

BACKGROUND: The spleen is the most commonly injured viscus in blunt abdominal trauma. Abdominal pain with left upper quadrant tenderness or signs of peritonitis in a patient with history of trauma is the most common presentation of this condition. OBJECTIVE: To describe an unusual presentation of splenic rupture in a patient with history of motor vehicle crash and blunt abdominal trauma. CASE REPORT: A young man was brought to the Emergency Department with a history of being in a motor vehicle crash 10 h earlier. He experienced gradually worsening difficulty breathing while sitting or lying down for the previous 4 h, although he was asymptomatic in the upright position. He was transported to the hospital standing upright, supported by two men, on the open back of a vehicle normally used to transport cattle. The patient was found to have left upper quadrant abdominal tenderness on examination and free fluid in the pelvis on the focused abdominal sonography for trauma examination done while the patient was standing. A grade III splenic injury with hemoperitoneum was diagnosed on computed tomography scan and the patient was treated with splenectomy. CONCLUSION: We report an unusual presentation of a splenic injury in a young man who had symptoms only in the supine position.

Surgically treated rectal prolapse: experience at a teaching hospital.

OBJECTIVE: To analyze our results regarding the surgical treatment of complete rectal prolapse performed at the Aga Khan University Hospital, from January 1988 to December 2003. METHODS: Files were retrieved from our medical records and data was reviewed for all adult patients admitted and operated upon for complete rectal prolapse during our study period. Long-term follow-ups were obtained through these files and also by contacting patients through telephone and letters. Data was recorded in a standardized two-page proforma and analysis was carried out between different variables using SPSS 10.0. RESULTS: A total number of twenty surgeries (n = 20) were performed. All patients had the presenting complaint of something coming out of anus, 70% (n = 14) patients complained of some bleeding per rectum, 30% (n = 6) had anal pain and 20% (n = 4) had faecal incontinence. Chronic constipation was found in 50% (n = 10) patients, obstructive uropathy in 30% (n = 6), weight loss, chronic cough and mental illness, each in 10 % (n = 2) of patients. Primary procedure was carried out in 70% patients. Mean operative time was 178 minutes; mean length of stay was 7 days with a mean follow-up of 25 months. Early complications were noted in 5% (n = 1) patients, and late complications in 30% (n = 6). Based on this data, comparative analysis was carried out between different variables. CONCLUSIONS: Surgery is the only treatment for rectal prolapse in adults. Several procedures are done suggesting that there is no standard treatment for this ailment. The number of male patients was higher, chronic constipation was the most common risk factor, abdominal rectopexy was the favored procedure, perineal procedures were associated with shorter operative time, hospital stay, and were done more often in females and elderly. Revision surgery was associated with longer operative time and hospital stay.