Commencement and Monitoring: Microbiological Surveillance in Operation Theaters at a Tertiary Care Center in North India.

INTRODUCTION: Preserving sterility and safety in hospital operation theaters (OTs) is vital. We have implemented a comprehensive microbiological surveillance program for OTs, encompassing both commencement and ongoing monitoring. This study assesses the prevalence of microorganisms, identifies their types, and detects contamination on surfaces and in the air. METHODS: Commencement and monitoring samples were collected from October 2021 to July 2023, from nine OTs. OTs were cleaned with soap and water, disinfected, and fogged with quaternary ammonium compounds. After sealing the OTs overnight, samples were collected aseptically. Air was sampled using the settle plate method, and surfaces were swabbed. Six surfaces, namely, the floor, wall, table, light, anesthesia workstation, and door handle, were swabbed. Samples were transported immediately to the institution's microbiology laboratory. RESULTS: During OT commencement, 247 swabs from nine OTs yielded 19 (7.29%) positives for bacterial growth. These microorganisms were primarily non-pathogenic, including aerobic spore-forming bacilli and Micrococcus, with an average bioload of 9.5 colony-forming units (CFU)/m3 of air. During OT monitoring, swab positivity was 10.79% (23/213). The General Surgery OT and Obstetrics and Gynecology OT showed the highest bacterial growth (5/23). Surface sampling revealed prevalent methicillin-resistant coagulase-negative staphylococci (MRCoNS) (9/23), followed by methicillin-sensitive Staphylococcus aureus (MSSA) (4/23) and methicillin-sensitive coagulase-negative staphylococci (MSCoNS) and aerobic spore-forming bacilli (ASB) (3/10). The General Surgery, Obstetrics and Gynecology, and ENT OTs displayed elevated air bioloads of 53, 49, and 47 CFU/m3, respectively. CONCLUSION: In newly constructed non-operational OTs, non-pathogenic organisms prevailed. However, as the OTs became functional, pathogenic organisms became more prevalent. Sampling emphasized contamination in areas with high patient loads, such as General Surgery, Obstetrics and Gynecology, and ENT OTs. Notably, OT tables and OT walls exhibited higher pathogenic microorganism presence. By combining both initial commencement and ongoing monitoring, the institution has effectively managed the microbial environment within its OTs.

Perception of robotic-assisted surgery (RAS) among medical students: a systematic review and meta-analysis.

INTRODUCTION: Robotic surgery, also known as robotic-assisted surgery (RAS), involves a camera and a small surgical instrument attached to a robotic arm. A trained surgeon operates the robot from a viewing screen while being in the same room. METHODOLOGY: This review was prepared following Cochrane collaboration guidelines and reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Two authors independently searched and appraised the studies published in PubMed, cumulative index to nursing and allied health literature (CINAHL), Embase, Clinical Key, and Google Scholar. Pooled data analyzed and reported in RevMan software version-5.4. RESULTS: This systematic review and meta-analysis comprised 1400 medical students, from 8 studies. The participants' age ranged from 23 to 49 years. Similarly, the sample size ranged from 25 and 300. The pooled prevalence of the existing studies revealed that 29.8% of medical students, were favorable towards RAS. Effect size (ES), 95% confidence intervals (CI) and heterogeneity (I2) [ES = 29.8, 95% CI 16.4-43.2, I2 = 95.1%, P < 0.00]. About 40% of Australian medical students' positive opinion on RAS [ES = 40.4, 95% CI 25.7-55.2]. Similarly, 34.2% of students from Saudi Arabia [ES = 29.8, 95% CI 22.4-90.8, I2 = 99.3%, P < 0.00], 27.8% students from Canada [ES = 27.8, 95% CI 15.9-39.6], 24.8% from USA [ES = 24.8, 95% CI 6.9-42.7, I2 = 77.3%, P < 0.00] and 24% [ES = 24, 95% CI 18-30] from India favorable towards RAS. DISCUSSION: Medical students from developed nations display favorable attitudes towards RAS. However, implementing of revised curriculum at the beginning of the graduation level sparks medical students' attitude towards robotic surgery.

Factors predicting seizure outcome after surgical excision of meningioma: SOLID-C guideline for prophylactic AED.

BACKGROUND: Seizures are commonly seen among meningioma patients and may cause impaired quality of life. These patients can be effectively treated with surgery. Still, many patients have persistent seizure episodes after surgery. The factors which are associated with worsening of seizure episodes remain critical in improving the quality of life for such patients. In this study, we aim to analyze the clinical and histopathological factors to predict the post excision seizure-outcome in meningioma and need of antiepileptic prophylaxis for these patients. METHODS: Adult patients who underwent primary resection of meningioma at our institute between 2007 and 2020 were included in the study. Eligibility criteria were as follows: (i) Surgery for newly-diagnosed biopsy proven meningioma, (ii) Presence of pre-operative seizure (iii) A follow-up period ≥ 12 months. RESULTS: Of the 1145 patients in this series, 333 patients were recruited in study. The major determinants of prophylactic anti-epileptic were tumour size (S), Oedema (O), location (L), inclusion body (I), antiepileptic drugs (D) and surgical complication (C). The factors independently associated with poor seizure control after surgical resection were presence of brain parenchyma invasion (p < 0.001), pre-operative use of > 2 antiepileptics (p = 0.016) and presence of intranuclear inclusion bodies (p = 0.001). CONCLUSIONS: The identification and consideration of factors associated with prolonged seizure control after surgery may help us to guide treatment strategies aimed at improving the quality of life for patients with meningiomas. Authors have proposed a SOLID-C guideline to avoid the blanket approach of prophylactic AED in patients undergoing for meningioma resection.

Circularly polarized printed dual port MIMO antenna with polarization diversity optimized by machine learning approach for 5G NR n77/n78 frequency band applications.

In this communication, a planar dual port multiple input multiple output antenna of size 1.2λ0 × 0.6λ0 × 0.008λ0 with LHCP/RHCP features is reported for the fifth-generation new radio n77/n78 sub-6 GHz wireless applications band. The single unit of the proposed design consists of a modified L-shape rectangular radiator with Z-shape slot loaded DGS. The defected ground structure is optimized through machine learning algorithms to achieve the maximum ARBW (output) by Right Shifting (RS) and left shifting (LS) the DGS and obtaining input features. The performance metric for ANN with ADAM optimizer was found to be optimal with MSE and R2 of 0.99 and 0.82, respectively. ANNs can leverage gradient information to guide the optimization process. This enables faster convergence towards optimal solutions compared to popular GAs and PSO, which are often gradient-free optimization methods. The MIMO configuration is achieved by creating a mirror image of the single unit about the x-axis. The salient features of the proposed design are (a) Impedance bandwidth (IBW) of 3.0-4.2 GHz covering the n77/n78 band, (b) 3-dB axial ratio bandwidth (ARBW) of the 2.6-3.9 GHz (c) Port-1 is generating RHCP while Port-2 is generating LHCP, results in polarization diversity. Different diversity performance parameters (ECC < 0.005, DG ~ 9.99 dB, and MEG < 3 dB) are in the optimum range confirming the proposed configuration as a suitable design for a MIMO radiator.

Novel tumor localization model and prediction of ablation zone using an intertwined helical antenna for the treatment of hepatocellular carcinoma.

Hepatocellular carcinoma has been the leading cause of death in recent centuries and with the advent of newer technologies, several thermal and cryo-ablation techniques have been introduced in the recent past. In this regard, microwave ablation has developed into a promising method for thermal ablation technique. However, due to clinical obligations, in-vivo analysis is not feasible and ex-vivo analysis is inaccurate due to changes in the electrical and thermal properties of the tissue. Therefore, in this study, temperature-dependent permittivity, electrical conductivity, and thermal conductivity along with phase change effect due to temperature reaching above 100°C are incorporated using finite element method model. Further, using an intertwined normal mode helical antenna ablation probe, a change in resonant frequency (Δf) and reflection coefficient (ΔS11 ) from the actual value (antenna parameter in the air at 5 GHz) is modeled using second-order polynomial curve fitting to predict the surrounding permittivity in the range of 30-70. A maximum deviation of 0.8 value in permittivity from the actual value is observed. However, to obtain a generalized methodology, XG Boost and CAT Boost algorithms are used. Further, since ablation diameter plays a crucial role in achieving optimal tumor ablation, an artificial neural network (ANN) algorithm with three different optimizers is incorporated to predict ablation diameter using five critical parameters. Such an ANN algorithm which can predict the transversal and axial ablation zone may provide optimal ablation outcomes.

Seizure-outcome after surgery of low-grade epilepsy associated neuro-epithelial tumors.

BACKGROUND: Most patients with glioneuronal tumors present with seizures. Although several studies have shown that greater extent of resection improves overall patient survival, few studies have focused on postoperative seizure outcome after resection of these tumors. The aim of this study was to characterize seizure control rates in patients undergoing glioneuronal tumor resection and evaluate the association between poor seizure outcome and tumor recurrence or progression. METHODS: The study population included patients who had undergone resection of glioneuronal tumors between 2014 and 2019 at our institution. Seizure outcome was assessed using Engel grading. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed. RESULTS: Twenty-six patients (N.=16, temporal lobe; N.=6, frontal lobe; N.=4, parietal lobe) with mean seizures duration of 56.9-months, were assessed. Histopathologically, N.=15 dysembryoplastic neurepithelial tumor, N.=7 ganglioglioma and N.=4 Diffuse lepto-meningeal neuroepithelial tumor. There were 2 cases of complex DNET and one case of DLMNT had associated cortical dysplasia. At mean follow-up of 49.7 months, N.=20 Engel 1, N.=4 Engel 2 and N.=2 had Engel 3 outcome. N.=20 underwent gross total excision (N.=18 Engel 1 and N.=2 Engel 2) and N.=6 sub-total excision. Among the 4 patients who needed re-surgery, two were in Engel 2 and another two were in Engel 3. CONCLUSIONS: Good seizure-outcome is likely associated with extent of resection. Younger age of patient, less than one-year of seizure duration and absence of generalization of seizure are good prognostic indicators. The best seizure-control can be achieved by early surgical intervention.

Insular glioblastoma: surgical challenges, survival outcomes and prognostic factors.

BACKGROUND: Insular gliomas are unique, challenging and evoke a lot of interest amongst neurosurgeons. Publications on insular glioma generally focus on the surgical intricacies and extent of resection pertaining to the low-grade gliomas. Insular glioblastomas (iGBM) have not been analysed separately before. METHODS: Histologically proven WHO grade IV gliomas involving the insula over a 9-year period were studied. Their clinical presentation, radiological features, surgical findings and survival outcomes were assessed. Statistical methods were used to determine the favourable predictors of survival. RESULTS: Out of 27 patients (M:F = 2.9:1), 18 (66%) patients had a tumour extension beyond the insula, 10 (37%) of whom had basal ganglia involvement. Total, near total and subtotal excisions were performed in 7 (26%), 9 (33%) and 11 (40.7%) patients, respectively. Twenty-three patients had glioblastoma, while four had gliosarcoma. IDH mutation was negative in six of the seven patients where it was done. Median overall survival was 5 months. Multivariate analysis showed that a female gender (p = 0.013), seizures in the preoperative period (p = 0.048) and completion of adjuvant therapy (p = 0.003) were associated with a longer survival. CONCLUSION: Insular glioblastomas have a poor prognosis. Insular location and certain tumour characteristics often limit the extent of resection of iGBMs. Moreover, postoperative complications sometimes negate the advantages of a radical resection. A female gender, presentation with seizures and completion of adjuvant chemoradiotherapy appear to be good prognostic factors.

Impact of Postoperative ABG Analysis and ICU Weaning Protocol in Surgical Outcome of Atlanto-Axial Dislocation: It's not the Towering Sail, but the Unseen Wind that Moves the Ship.

Background: The outcome in patients of atlanto-axial dislocation (AAD) depends on multiple factors like preoperative optimization, intraoperative distractio and cord manipulation. Certain unfocussed factors such as respiratory reserve and compensatory acclimatization to hypoxia warrant consideration. Aims: The purpose of this study is to find the association of postoperative arterial blood gas (ABG) analysis and respiratory reserve in patients of AAD with clinical outcome. Study Design: We retrospectively analyzed the available records of patients, operated for AAD, at our institute (n = 66), from January 2014 to November 2018. Materials and Methods: Preoperative pulmonary function test (PFT) and the postoperative ABG analysis was noted. Timing of extubation, duration of intensive care unit (ICU) stays, and clinical outcomes (Nurick grade) were noted from the inpatient record and the last outpatient follow up. An independent t-test and analysis of variance were used to find significance. Results: In total, 41% (n = 27) patients had body mass index of less than 18.5, and 50% (n = 33) had breath holding time of less than 20 minutes. There was improvement in mean Nurick grade from 3.17 ± 0.8 to 2.76 ± 0.7 in follow up. A trend suggesting that patients with poor preoperative PFT has more ICU duration and worse outcome. In patients with mild acid-base disorders, extubation was possible within 24 hours. Out of 26 patients with ICU duration less than 2 days, 23 patients had "good" outcome, whereas ten out of 40 patients with ICU duration of more than or equal to 2 days had "bad" outcome (P = 0.00). Conclusion: Patients having moderate to severe primary or mixed acid-base disorder have a probability of re-intubation or delayed extubation. A strong correlation was seen with the novel grading system (grade >6 had worse outcome).

Cerebellopontine Angle Epidermoids: Comparative Results of Microscopic and Endoscopic Excision Using the Retromastoid Approach".

Background Densely packed neurovascular structures, often times inseparable capsular adhesions and sometimes a multicompartmental tumor extension, make surgical excision of cerebellopontine angle epidermoids (CPEs) a challenging task. A simultaneous or an exclusive endoscopic visualization has added a new dimension to the classical microscopic approaches to these tumors recently. Methods Eighty-six patients (age: 31.6 ± 11.7 years, M:F = 1:1) were included. Nineteen patients (22.1%) had a multicompartmental tumor. Tumor extension was classified into five subtypes. Sixty-two patients underwent a pure microscopic approach (72%) out of which 10 patients (16%) underwent an endoscope-assisted surgery (11.6%) and 24 patients (28%) underwent an endoscope-controlled excision. Surgical outcomes were retrospectively analyzed. Results Headache (53.4%), hearing loss (46.5%), and trigeminal neuralgia (41.8%) were the leading symptoms. Interestingly, 21% of the patients had at least one preexisting cranial nerve deficit. Endoscopic assistance helped in removing an unseen tumor lobule in 3 of 10 patients (30%). Pure endoscopic approach significantly reduced the hospital stay from 9.2 to 7.3 days ( p = 0.012), and had a statistically insignificant yet a clearly noticeable lesser incidence of subtotal tumor excision (0 vs. 10%, p = 0.18) with comparable cranial nerve deficits but with a higher postoperative cerebrospinal fluid (CSF) leak rate (29% vs. 4.8%, p = 0.004). Conclusion Endoscope assistance in CPE surgery is a useful addition to conventional microscopic retromastoid approach. Pure endoscopic excision in CPE is feasible, associated with a lesser duration of hospital stay, better extent of excision in selected cases, and it has a comparable cranial nerve morbidity profile albeit with a higher rate of CSF leak.

Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art.

Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis ( n = 2) and postoperative bony defects leading to contour defects of the scalp ( n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

Paraclinoid Segment Aneurysms of the Internal Carotid Artery: Surgical Clipping.

BACKGROUND: Paraclinoid segment aneurysms arise from the internal carotid artery (ICA) between the distal dural ring and the origin of the posterior communicating (PComm) artery. OBJECTIVE: This pictorial study presents videos showing clipping of paraclinoid segment aneurysms. MATERIALS AND METHODS: The various subtypes of these aneurysms, the nuances in the technique of clinoidectomy, and methods of proximal control are presented. RESULTS: Cavernous ICA is designated as C4, clinoidal segment (between the proximal and distal dural rings) as C5, and supraclinoid segment (between the distal dural ring up to the PComm artery as C6 segment. The techniques used for clipping various aneurysms are based upon their subtypes and location. In the first case, in a giant superior hypophyseal artery aneurysm directed toward the suprasellar region, an intradural clinoidectomy helped in accessing the neck of the aneurysm encroaching into the clinoidal segment of ICA. In the second case, concurrent bilateral "kissing" paraclinoid segment aneurysms were clipped using a unilateral approach. In the third case, clipping of a dissecting paraclinoid segment aneurysm is demonstrated. CONCLUSIONS: Surgery still represents the most definitive form of treatment. It may also be used to evacuate an intracerebral hematoma, with an extremely tortuous proximal vessel or in an aneurysm with complex anatomy, with blister aneurysms, or following aneurysm regrowth following a failed endovascular procedure. Assessing the three-dimensional anatomy of various segments of ICA is an important step.

Seizure Outcome after Lesionectomy With or Without Concomitant Anteromedial Temporal Lobectomy for Low-Grade Gliomas of the Medial Temporal Lobe.

BACKGROUND: Mesial temporal lobe epilepsy attributed to low-grade glioma is known for intractable seizures and choice of surgery range from lesionectomy (Lo) to lesionectomy with anteromesial temporal resection (L0 + AMTR) is still debatable. We intend to analyze the seizure outcome after lesionectomy alone or with AMTR. SUBJECTS AND METHODS: Retrospective analyses of patients operated for medial low-grade temporal lobe tumors with seizures were included in the study. Preoperative records include video-electroencephalographic, magnetic resonance imaging (epilepsy protocol), and neuropsychological evaluation for language, memory, and dominance were assessed. Two groups (Lo [Group I] and Lo + AMTR [Group II]) were assessed after surgery by the international league against epilepsy (ILAE) seizure outcome scale. RESULTS: A total of 39 patients underwent Lo (n = 20) and Lo + AMTR (n = 19) with a mean age of 26.92 ± 12.96 months, and mean duration of seizures was 36.87 46.76 months. A total of 23 patients had long-term intractable seizures for >1 year despite >2 drugs(Group I [n = 10], Group II [n = 13]); remaining 16 had frequent seizures of <1-year duration. In the postoperative period, on a mean follow-up of 49.72 ± 34.10 months, the ILAE outcome scale shown a significant difference (P = 0.05) in seizure outcome between two groups. Four (40%) patients out of 10 having refractory seizures in Group I and 8 (80%) from the Group II out of 10 patients could achieved ILAE Class 1 outcome after surgery. Histopathology analysis includes low-grade astrocytoma (n = 29) and in two patients there were associated CA1 neuronal loss in hippocampus, one patient had mesial temporal sclerosis from Group II attributed to its intractability in seizures. CONCLUSION: For the mesial temporal low-grade glioma presenting with seizures, the seizure outcome by lesionectomy with AMTR is superior than lesionectomy only.

Does Socioeconomic Status Have an Association with Cranio-vertebral Anomalies: A Step Toward Healing the Curse!

BACKGROUND: The etiological or causal factors of pediatric craniovertebral junction anomalies (CVJA) are still unknown. The disease bears a major proportion of economic and social burdens over a developing country like ours. This article aims to highlight an important modifiable factor that may prove to have a critical causal relationship with disease incidence. MATERIALS AND METHODS: This is a cross-sectional, single-institutional study, wherein the socioeconomic status (SES) of all the operated pediatric patients of CVJA, between 2014 and 2019, was studied. Variables including the patient's age, sex, residence status (rural or urban), perioperative data, length of stay, follow-up, and the time between revision surgery (if required) and clinical presentation were noted. Data regarding average household and type of family (nuclear or joint) were also enquired. RESULTS: Sixty-six patients (M:F 56:10) with a mean age of 13.14 ± 3.44 years were included. The mean annual family income was 11.1 ± 12.1 thousands. 43.9% belonged to joint family; according to Kuppuswami and Prasad scale, 42.4% of patients belong to lower class, while 20 patients belong to lower middle class, and 14 patients belong to the below poverty line category. Neither the SES of patient nor rural-urban background affected the surgical outcome. The mean follow-up of patients in our study was 42.3 ± 23.0 months and 83.3% had a good outcome. DISCUSSION: Patients operated for CVJ anomaly in the authors' institution mainly come from the lower socioeconomic groups. The present study raises several important questions like nutritional deficiencies in reproductive age group females leading to a cascade of events as a causal factor.

Efficacy of Silicone Conduit in the Rat Sciatic Nerve Repair Model: Journey of a Thousand Miles.

BACKGROUND: A lot of options have been tried for bridging the two ends of the injured nerves. Researchers have used decellularized nerve grafts, artificial materials and even nerve growth factors to augment functional recovery. These materials are either costly or inaccessible in developing world. OBJECTIVE: The study aimed to evaluate the efficacy of the silicone conduit in a rat sciatic nerve injury model. MATERIALS AND METHODS: 24 healthy Sprague-Dawley (SD) rats (250-300 grams; 8-10 weeks) were used and right sciatic nerve was exposed; transected and re-anastomosed by two different methods in 16 rats. In control group, n = 8 (Group I) the sciatic nerve was untouched; Group II (reverse nerve anastomosis, n = 8): 1-centimeter of nerve was cut and re-anastomosed by using 10-0 monofilament suture; Group III (silicone conduit, n = 8) 1-centimeter nerve segment was cut, replaced by silicone conduit and supplemented by fibrin glue]. Evaluation of nerve recovery was done functionally (pain threshold and sciatic functional index) over 3 months and histologically and electron microscopically. RESULTS: Functional results showed a trend of clinical improvement in Group III and II but recovery was poor and never reached up to normal. Histopathological and electron microscopic results showed an incomplete axonal regeneration in Groups II and III. Psychological analyses showed that no outwards signs of stress were present and none of the rats showed paw biting and teeth chattering. CONCLUSION: The silicone conduit graft may be an economical and effective alternative to presently available interposition grafts, however for short segments only.

C3 segmental vertebral artery and its surgical implication in craniovertebral junction anomalies: Insights from two cases.

A spectrum of vertebral artery (VA) anomalies have been described with or without an associated congenital craniovertebral junction (CVJ) anomalies. C3 segmental VA, where the VA enters the dura at the level of C2/3 intervertebral foramen is an extremely rare anomaly. We report two cases of congenital CVJ anomaly (irreducible in one with C2/3 fusion and reducible in the other; without any subaxial fusion but with articular agenesis at C2/3 joint on the anomalous artery side). Computed tomographic angiography revealed intraspinal intradural entry of VA through the C2/3 intervertebral foramen on the right side with the contralateral artery found crossing the atlanto-axial joint. Both the patients underwent posterior approach and C2 was spared from instrumentation in both cases. Postoperatively, the patient with irreducible dislocation recovered well while the patient with reducible dislocation expired, possibly secondary to the thrombosis of the dominant VA from C2/3 foraminal encroachment. C3 segmental VA may be advantageous in aggressively exposing the C1/2 joint but instrumentation of C2 or C3 needs caution in view of the possibility of VA injury. Our experience shows that VA may be endangered even while exposing and protecting the artery. For such cases, we recommend posterior decompression of the C2/3 neural foramen during instrumentation in the absence of associated C2/3 fusion, as an abnormal joint morphology of C2/3 indicates a C2/3 instability.

Type I Chiari Malformation Without Concomitant Bony Instability: Assessment of Different Surgical Procedures and Outcomes in 73 Patients.

OBJECTIVE: Posterior fossa decompression is the treatment of choice in type 1 Chiari malformation (CM-1) without bony instability. Although surgical fixation has been recommended by a few authors recently, comparative studies to evaluate these treatment strategies using objective outcome tools are lacking. METHODS: Seventy-three patients with pure CM-1 (posterior fossa bony decompression [PFBD], n = 21; posterior fossa bony and dural decompression [PFBDD], n = 40; and posterior fixation [PF], n = 12) underwent a postoperative outcome assessment using Chicago Chiari Outcome Score (CCOS). Logistic regression analysis detected predictors of an unfavorable outcome. RESULTS: Minimally symptomatic patients generally underwent a PFBD while most of the clinically severe patients underwent a PFBDD (p = 0.049). The mean CCOS score at discharge was highest in the PF (12.0 ± 1.41) and lowest in PFBDD group (10.98 ± 1.73, p = 0.087). Patients with minimal preoperative clinical disease severity (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.29-16.31) and PFBDD (AOR, 7.56; 95% CI, 1.70-33.68) represented risks for an unfavorable short-term postoperative outcome. Though long-term outcomes (CCOS) did not differ among the 3 groups (p = 0.615), PFBD group showed the best long-term improvements (mean follow-up CCOS, 13.71 ± 0.95), PFBDD group improved to a comparable degree despite a poorer short-term outcome while PF had the lowest scores. Late deteriorations (n = 3, 4.1%) occurred in the PFBDD group. CONCLUSION: Minimally symptomatic patients and PFBDD predict a poor short-term postoperative outcome. PFBD appears to be a durable procedure while PFBDD group is marred by complications and late deteriorations. PF does not provide any better results than posterior fossa decompression alone in the long run.

Resistant Temporal Lobe Epilepsy: Initial Steps into a Bigger Epilepsy Surgery Program.

Background Among the patients of drug-resistant epilepsy, a subset which has focal impaired seizures localizes to the temporal lobe region (TLE). A majority of these cases are surgically amenable with anterior-medial temporal lobe resection or "lesionectomy." Objective In India, there is scarcity of "specialized centers" providing "comprehensive epilepsy care" and this dearth is further worse in populous states. In this article, we share our single center, observational, and retrospective experience of TLE in background of limited resources and utmost requirement. Methodology Our study is a retrospective analysis medically refractory epilepsy patients (2016-2019). Patients with medically refractory epilepsy were selected based upon our noninvasive protocol (clinical semiology, interictal scalp electroencephalography (EEG), long-term video EEG monitoring data, and magnetic resonance injury [MRI]). The follow-up was noted from the last out-patient visit record or through telephonic conversation (International League Against Epilepsy score). Results Of 23 cases of TLE ( n = 7, mesial temporal sclerosis; n = 16 temporal lobe like cavernomas, tumors, or arterio-venous malformations). Single photon emission computed tomography/positron emission tomography (SPECT/PET) was performed in five cases (three cases of ictal/interictal SPECT and two cases of PET scan) where there was discordance between EEG/clinical and MRI. The median follow-up was of 19 months with 18 cases being seizure free. Five cases were fully off the antiepileptic drug (AEDs) while in 15 cases, the AEDs dosages or the number were reduced. Average number of AEDs reduced from 2.9 in preoperative period to 1.2 postoperatively. Two cases had quadrantanopia and one case of cerebrospinal fluid leak. Conclusion A multidisciplinary and holistic approach is required for best patient care. The results of our initial surgical experience are encouraging.