Cytological features in pilomyxoid astrocytoma: A case report with summary of prior published cases.

Pilomyxoid astrocytoma is a subtype of pilocytic astrocytoma that is described as a grade 1 tumour in the 2022 WHO classification of central nervous system tumours. It occurs predominantly in the hypothalamic region in infants. Although the histological features of pilomyxoid astrocytomas are well documented, few reports are available in the literature regarding cytological findings. Here we describe the squash cytological features of a case of pilomyxoid astrocytoma along with a summary of prior published cases. Smears for this type of tumour tend to be more cellular, with piloid cells arranged in an angiocentric pattern without Rosenthal fibres or eosinophilic granular bodies. A blue myxoid substance may be present in the background.

Suprameatal Extension of Retrosigmoid Approach in Microvascular Decompression for Trigeminal Neuralgia with Petrous Endostosis: Case Report and Literature Review.

Petrous endostosis or prominent suprameatal tubercle is a rare entity which may prevent adequate microscopic exposure of the trigeminal nerve root entry zone during microvascular decompression (MVD) for trigeminal neuralgia. We present a rare case of trigeminal neuralgia (TN) with petrous endostosis, which was managed adequately by partial removal of the prominent suprameatal tubercle to improve the obscured site of neurovascular conflict and enabled complete MVD. Through this manuscript, we additionally discuss the nuances involved in this extension of the standard retrosigmoid approach in light of the published literature. Petrous endostosis encountered during MVD for TN can impose an operative challenge. Suprameatal extension of the standard retrosigmoid approach improves exposure at the site of neurovascular conflict but requires utmost care and attention to avoid complications. We emphasize recognizing this anatomical variation in the preoperative period to predict an operative difficulty, ensure appropriate patient counselling, and avoiding surgical complications.

Guidelines for Preoperative Testing for Neurosurgery in Coronavirus Disease 2019 (COVID-19) Era: Indian Viewpoint Amidst Global Practice.

Preoperative testing and evaluation for coronavirus disease 2019 (COVID-19) have been an enigmatic challenge for the neurosurgical community during the pandemic. Since the beginning of the pandemic, laboratory diagnostic methods have evolved substantially, and with them has been the necessity for readily available, fast, and accurate preoperative testing methods. In this article, we provide an overview of the various laboratory testing methods that are presently available and a comprehensive literature review how various institutes and neurosurgical communities across the globe are employing them to ensure safe and effective delivery of surgical care to patients. Through this review, we highlight the guiding principles for preoperative testing, which may serve as a road map for other medical institutions to follow. In addition, we provide an Indian perspective of preoperative testing and share our experience in this regard.

Preparedness and guidelines for neurosurgery in the COVID-19 era: Indian perspective from a tertiary care referral hospital.

The COVID-19 pandemic has severely impacted healthcare systems globally. The need of the hour is the development of effective strategies for protecting the lives of healthcare providers (HCPs) and judicious triage for optimal utilization of human and hospital resources. During this pandemic, neurosurgery, like other specialties, must transform, innovate, and adopt new guidelines and safety protocols for reducing the risk of cross-infection of HCPs without compromising patient care. In this article, the authors discuss the current neurosurgical practice guidelines at a high-volume tertiary care referral hospital in India and compare them with international guidelines and global consensus for neurosurgery practice in the COVID-19 era. Additionally, the authors highlight some of the modifications incorporated into their clinical practice, including those for stratification of neurosurgical cases, patient triaging based on COVID-19 testing, optimal manpower management, infrastructure reorganization, evolving modules for resident training, and innovations in operating guidelines. The authors recommend the use of their blueprint for stratification of neurosurgical cases, including their protocol for algorithmic patient triage and management and their template for manpower allocation to COVID-19 duty, as a replicable model for efficient healthcare delivery.

Tumor-induced Osteomalacia due to a Phosphaturic Mesenchymal Tumor in the Cervical Spine: A Case Report and Literature Review.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome of certain mesenchymal tumors which secrete fibroblast growth factor-23 (FGF-23) responsible for causing features of hypophosphatemia and osteomalacia in these patients. Most of them involve the appendicular skeleton and occasionally the craniofacial regions. Involvement of spine is exceedingly rare. Through this paper, the authors present a rare case of a 71-year-old male with TIO due to a lesion in the cervical spine (right C2 lamina) which was proven to be a phosphaturic mesenchymal tumor-mixed connective tissue type on histopathology. This is the fifth reported case of TIO localized to the cervical spine. The patient underwent a hemilaminectomy and gross total resection of the tumor following which he made a gradual but steady recovery and does not have any recurrence 24 months after surgery. The authors not only provide a comprehensive literature review of all 18 spinal cases reported till date but also discuss the management of these patients in light of the published literature.

Symptomatic Diffuse Vasospasm After Resection of Temporal Ganglioglioma: Review of the Literature with Case Illustration.

BACKGROUND: Symptomatic cerebral vasospasm may occur in the setting of aneurysmal subarachnoid hemorrhage, traumatic brain injury, or after anterior skull base surgery, but its occurrence is extremely rare in the background of glioma surgical resection. CASE DESCRIPTION: We present a rare case of symptomatic diffuse vasospasm, which is the fourth reported case of symptomatic vasospasm after temporal lobectomy and the third in the setting of a glial tumor. This patient, a 10-year-old boy, developed bilateral, progressive cerebral infarcts because of diffuse vasospasm after anteromesial temporal lobectomy for a left temporal ganglioglioma leading to significant morbidity. CONCLUSIONS: The risk factors, likely pathogenesis and the importance of early diagnosis and timely institution of treatment, in such cases are discussed in the background of relevant literature. The current case represents the first report of symptomatic diffuse vasospasm occuring after surgical resection of intracranial ganglioglioma in the Western literature.