White Fiber Correlates of Amygdalohippocampectomy Through the Middle Temporal Gyrus Approach.

OBJECTIVE: The white fiber and gross anatomy relevant for performing amygdalohippocampectomy through the middle temporal gyrus approach for mesial temporal sclerosis has been depicted by white fiber dissection. METHODS: Three previously frozen and formalin fixed cerebral hemispheres were studied. The Klingler method of fiber dissection was used to study the anatomy. The primary tools used were hand-made wooden spatulas, forceps, and microscissors. The anatomy of the amygdala and hippocampus and the landmarks for performing the disconnection during epilepsy surgery are presented. The white fibers at risk during the middle temporal gyrus approach were studied. RESULTS: The white fiber tracts at risk during the middle temporal gyrus approach for epilepsy surgery are the fibers of the inferior frontooccipital fasciculus, temporal extension of the anterior commissure, Meyer loop of the optic radiation, and uncinate fasciculus. On the basis of our anatomic dissections, we present a novel entry point into the temporal horn, potentially minimizing injury to the fibers of the sagittal stratum. We also propose novel landmarks to perform the amygdala disconnection in mesial temporal sclerosis. CONCLUSIONS: The middle temporal gyrus is a commonly used approach to perform temporal lobectomy and amygdalohippocampectomy for patients with mesial temporal sclerosis. The anatomy relevant to the approach as presented will aid while performing epilepsy surgery.

Hangman's fracture: a clinical review based on surgical treatment of 15 cases.

This is a retrospective analysis of cases with hangman's fracture. The subject of 'hangman's fracture' has been elaborately evaluated in the literature. The authors propose an alternative format of surgical treatment that is based on modification of existing classification schemes. During the period 2015 to March 2020, 15 patients having hangman's fracture were identified and were surgically treated. The clinical condition was classified on the basis of American Spinal Injury Association scale (ASIA scale) and VAS parameters. The patients were classified into 4 groups depending on the presence (or absence) of atlantoaxial and/or C2-3 instability. Surgical decisions were guided by the proposed classification. Clinical evaluation and dynamic CT scan were done at follow-up visits. During the average follow-up of 26 months, all patients are essentially asymptomatic. There was marginal restriction of extent of neck movements in all cases. There was solid bone fusion in all cases. The proposed novel classification scheme based on the presence of atlantoaxial and C2-3 instability assisted in directing the treatment strategy of hangman's fracture.

Clinical outcome following multisegmental cervical spinal fixation in patients who recovered partially following injury.

OBJECTIVE: The clinical outcome following multilevel stabilization in patients who suffered cervical spinal injury and developed severe neurological deficits and then gradually partially recovered is evaluated. The basis of the surgical concept was that cervical spinal degeneration is a result of single or multilevel spinal instability and that spinal trauma exaggerates the instability. MATERIALS AND METHODS: During the period 2015-2020, 14 patients who suffered severe cervical spinal injury and could be included in the classification of spinal cord injury without computed tomography evidence of trauma were surgically treated. There were 11 males and 3 females. The ages ranged from 45 to 67 years, average being 53 years. Cervical canal stenoses related to degenerative spinal changes were observed in all patients. All patients suffered severe neurological deficits and within few days or weeks had shown significant but incomplete neurological recovery. The identification of the levels of unstable spinal segments was done on the basis of radiological and clinical parameters and direct observation of spinal instability in adjoining spinal segments. Transarticular fixation was done by Camille's transarticular fixation technique. Using ASIA score, modified JOA score, and Goel Clinical Grading Scale, the clinical course of the patients was monitored. RESULTS: All patients showed recovery in the neurological status. Recovery started in the immediate postoperative period and the improvement progressed during the period of follow-up. CONCLUSIONS: Surgery for spinal stabilization can be indicated even in cases that improve in the neurological function.

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. The cumulative experience and challenges encountered in the comprehensive management of these cohort of patients in the difficult period of the pandemic is discussed in accordance with relevant literature on the subject.

Report of two cases with omovertebral bone and Klippel-Feil syndrome with craniovertebral junction instability.

We present a report of two patients having the association of omovertebra, Sprengel's deformity of the shoulder and Klippel-Feil abnormality with craniovertebral junctional instability. Our literature survey did not locate any report of such association. Significance of bone alterations is analyzed. Two young patients presented with neck pain, torticollis, webbed neck, and spastic quadriparesis. In both patients, the investigations revealed basilar invagination, Klippel-Feil abnormality and Sprengel's deformity of the shoulder. Apart from these relatively common associations, both the patients had omovertebral bone that extended from the transverse process of C5 vertebra to scapula. Following atlantoaxial stabilization surgery, the patients rapidly recovered from all symptoms. Musculoskeletal abnormalities at the craniovertebral junction that include Klippel-Feil abnormality, Sprengel's shoulder, and omovertebra are secondary alterations to primary atlantoaxial instability.

Supracerebellar Approach for Clival Chordomas: Technical Note.

BACKGROUND: The conventional retrosigmoid and lateral supracerebellar approach was used for surgery in 5 select cases of large chordomas. METHODS: Patients were treated during 2011 and 2019. Location of the tumor in the depth from surface, wide tumor extensions, and intimate relationships with critical neural and vascular lesions made the approach selection a formidable challenge. RESULTS: The discussed approach provided a satisfactory and wide exposure that permitted circumferential dissection of the tumor. Maneuvering the angulation of microscope provided access to the part of tumor that extended in the region of cavernous sinus. CONCLUSIONS: Radical resection of all the tumors was achieved.

Ossified Anterior Foramen Magnum Meningioma: Report of Long-Term Surgical Outcome.

BACKGROUND: Technical surgery-related issues for large ossified/calcified meningioma that encased one or both vertebral arteries located anterior to brainstem in the region of foramen magnum are discussed. Relatively long-term outcome of successful surgery is reported. CASE DESCRIPTION: Three women were operated on for symptoms of progressive quadriparesis. Investigations revealed ossified meningioma located anterior to the brainstem. One or both vertebral arteries were encased within the confines of the tumor. Large size, bone-hard consistency, location anterior to the brainstem, and intimate vascular relationship made the surgery a formidable surgical problem. A midline posterior suboccipital approach was used to resect these tumors. Radical tumor resection was achieved in all cases successfully. Tumor drilling or heavy tumor breaking instruments were not necessary to debulk the tumor. Histologic examination in all 3 cases revealed psammomatous meningioma. During the follow-up period that ranged from 2 to 12 years, all 3 patients were leading a normal life, and there has been no documented recurrence in any case. CONCLUSIONS: Successful resection of "ossified" meningioma is associated with satisfactory long-term clinical outcome.