Percutaneous femoral access: Stuck guide wire, decannulation difficulty due to unravelling and knotting.

Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting.

Adult transsphenoidal meningoencephalocele: Clinical image.

Background: Encephalocele is herniation of cranial contents through a skull defect, classified according to their contents and location, and is usually seen in pediatric age group. The transsphenoidal type represents <5% of all basal meningoencephaloceles. Of them, the presentation in adulthood is even rarer. Case Description: A 19-year-old female complaining of breathing difficulties during sleep and exertional dyspnea was diagnosed with a transsphenoidal meningoencephalocele, likely representing patent craniopharyngeal canal. On exploration through bifrontal craniotomy, the defect was identified in the sellar floor after completely reducing the contents into the cranial cavity and was repaired. She had immediate symptomatic relief and an uneventful postoperative course. Conclusion: There can be significant symptomatic relief with minimal postoperative morbidity after transcranial repair of such large transsphenoidal meningoencephaloceles, through traditional skull base approaches.

Sellar colloid cyst: Peculiar radiological characteristics of a common lesion at an uncommon location.

Background: Colloid cysts, common benign lesions of the third ventricle, have rarely been reported in uncommon extraventricular locations such as the pituitary fossa. Even in the sellar region, it is usually seen between the anterior and posterior pituitary lobes (pars intermedia). Case Description: Here, we report a case of a female patient, who was incidentally diagnosed with a sellar colloid cyst, while being evaluated for nonspecific holocranial headache. On imaging, there was a lesion located in the anterior sellar region, compressing the whole pituitary gland posteriorly (first reported case to the best of our knowledge), that was found to be a colloid cyst intraoperatively during microsurgical excision through transnasal transsphenoidal route. Conclusion: This rare entity should be kept in mind while considering lesions of the pituitary region, as evident by typical radiological features, in spite of being located in a less likely site.

Gender Differences in Perceived Stress among Neurosurgeons: A Cross-Sectional Study.

Purpose: Surgeons are subjected to enhanced levels of work-related stress and women are likely to face unique challenges due to sub-optimal representation. The present study was conceived with a primary objective to study the gender differences faced by surgeons and neurosurgeons in particular. The secondary objective was to assess the correlation between the various stress inducers and busters of normal working and daily life and the mental state of neurosurgeons. Methods: The study was a cross-sectional, multi-centric study in which a structured questionnaire was sent to neurosurgeons through various neurosurgical forums of the country. A total of 93 complete responses were included in the study. The questions were broadly divided into four themes, demographic working data, stress inducers, stress busters, and questions to reflect the mental state of the respondent. Results: There were 74 males and 19 females in the study, with an average age of 39.34 ± 8.57 years. Statistically significant gender differences were noted in rating the out-patient department (OPD) hours, lectures and seminars, performing and assisting surgeries, attending conferences and working in the intensive care unit (ICU), with women scoring lower than men for these activities. There were no significant gender differences in the mental state of the respondents. A strong correlation was found between scoring for performance and assisting of surgery and the mental state questions, and a strong negative correlation was noted between music, playing games, going to the gym, practicing yoga and the mental state questions, indicative of a protective effect. Conclusions: There was no significant gender differences in the perceived stress levels among neurosurgeons. Women appeared more comfortable with certain normal activities of working. A strong negative correlation was reported for activities such as music, playing games, yoga, and going to the gym, indicating a protective effect.

Posterior ischemic optic neuropathy with acute monocular vision loss following clipping of anterior communicating artery aneurysm. A case report and review of literature.

BACKGROUND: The acute postoperative monocular vision loss following anterior communicating artery aneurysm clipping secondary to posterior ischemic optic neuropathy (PION) a rare presentation. CASE DESCRIPTION: A 32-year old patient presented with a spontaneous holocranial thunderclap headache for 7 days, associated with vomiting. The SAH was diagnosed with a tiny saccular aneurysm arising from the anterior communicating artery. A left pterional craniotomy and clipping of aneurysm were done. On the 3rd postoperative day, he complained of left-sided complete blindness, and on the 5th postoperative day, his GCS dropped to E4V1M5 with right-sided hemiplegia. MRI brain showed normal optic apparatus with bilateral ACA and left MCA territory infarct. CONCLUSION: The PION must be kept in the differential diagnosis of post-clipping sudden visual deterioration, especially following anterior communicating artery aneurysm rupture.