Stent-assisted coil embolization of MCA aneurysm via a trans-posterior communicating artery access

External carotid artery (ECA) to internal carotid artery (ICA) bypass is a well-established procedure for the treatment of chronic ischemic diseases of the carotid artery. Rarely de novo aneurysms can develop at the site of anastomosis. The treatment of these aneurysms can be very challenging due to various factors, including the presence of graft, previous craniotomy, atherosclerotic vessels, and lack of direct access. In this video the authors report and discuss the management of a right middle cerebral artery (MCA) wide-necked de novo aneurysm by stent-assisted coiling through a retrograde trans-posterior communicating artery access.

The video can be found here: https://youtu.be/MBKolPvOErU.

Endovascular management of basilar artery occlusion secondary to fusiform aneurysm with intraluminal thrombus

Acute basilar artery occlusion is one of the most devastating subtypes of ischemic stroke with an extremely high morbidity and mortality rate. The most common causes include embolism, large-artery atherosclerosis, penetrating small-artery disease, and arterial dissection. The heart and vertebral arteries are the main source of emboli in embolic basilar occlusions. The authors present an uncommon acute basilar occlusion secondary to a fusiform aneurysm with intraluminal thrombus. The patient underwent a mechanical thrombectomy with successful recanalization, but persistent intraluminal thrombus. The authors discuss the management dilemma and describe their choice for placement of flow diverter stents.The video can be found here: https://youtu.be/XzBdgxJPSWQ.

Minimally Invasive Augmented Fixation for Anatomical Reduction of Grade 2 and Grade 3 Listhesis in Patients with Osteoporosis

Study Design

A retrospective study.

Purpose

To study the efficacy of augmented fixation for anatomical reduction of grade 2 and grade 3 listhesis in patients with osteoporosis.

Overview of Literature

Spondylolisthesis in osteoporotic patients requiring spinal fixation are associated with complications such as loss of surgical construct stability, screw pulling out, and screw loosening. Augmented fixation is a novel strategy to achieve necessary construct integrity.

Methods

Thirteen consecutive patients with grade 2 or grade 3 listhesis, with proven osteoporosis on dual energy X-ray absorptiometry (DEXA) scan, and who underwent augmented fixation for reduction of listhesis were retrospectively analyzed. In all patients, surgical access was achieved with a fixed 22 mm tubular retractor. A modified technique of bilateral, sequential, transforaminal decompression and discectomy, followed by reduction of listhesis using unilaterally placed augmented screws was employed in all the cases. Patients were followed up with plain X-rays at regular intervals to assess for implant stability and fusion status. All patients were started on medical treatment for osteoporosis.

Results

The mean age of the patients was 52.46 years, with 12 females and one male. The median T-score on DEXA scan was −3.0. Of the 13 patients, listhesis was at L4–L5 in five and at L5–S1 in eight. Nine patients had grade 2 listhesis, while four patients had grade 3 listhesis. Complete reduction was achieved in 10 patients. The median duration of follow-up was 18 months. Postoperative outcomes were satisfactory in all cases.

Conclusions

Augmented fixation is a useful technique for achieving anatomical reduction of listhesis in patients with osteoporosis.

Clinical and radiological assessment of cerebral hemodynamics after cranioplasty for decompressive craniectomy - A Clinical study

OBJECTIVES

To find the correlation between radiologically proven improvement in cerebral hemodynamics with clinical improvement in patients undergoing cranioplasty.

MATERIAL AND METHODS

The study is a prospective observational study of 10 cases, in M S Ramaiah Institute of Neurosciences, involving patients treated by a decompressive craniectomy for intractable intra cranial hypertension either due to trauma or stroke and afterwards underwent cranioplasty.

RESULTS

Of the 10 patients, 70% patients showing significant improvement in motor functions on Barthel index scale, 60% patients showed improvement in speech, mean duration from date of decompressive craniectomy to cranioplasty being 122.4days. Cerebral perfusion was remarkably better after cranioplasty, as demonstrated decrease in the Pulsatility index on the ipsilateral side of decompression on Trans cranial Doppler (<0.73 mean). This data also favored improved cerebral blood flow and permeability on the CT perfusion with increase in cerebral blood flow (CBF), Cerebral Blood Volume (CBV) and decrease in Time to Peak (TTP) and a positive outcome when correlated with Barthel index with P-values of 0.093, 0.017 and 0.001 respectively.

CONCLUSION

Cranioplasty influences the cerebral hemodynamics after cranioplasty and has a positive correlation on the functional outcome and cerebral blood flow in the MCA territory.

Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases

OBJECTIVE

Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion.

MATERIALS

Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases. Clinical cases included patients with reducible atlantoaxial instability and undisplaced or minimally displaced odontoid fractures. The surgical technique is illustrated in detail.

RESULTS

Among the cadaveric specimens, all C-1 lateral mass screws were in the correct position and 2 of the 8 C-2 screws had a vertebral canal breach. Among clinical cases, all C-1 lateral mass screws were in the correct position. Only one C-2 screw had a Grade 2 vertebral canal breach, which was clinically insignificant. None of the patients experienced neurological worsening or implant-related complications at follow-up. Evidence of rib graft fusion or C1–2 joint fusion was successfully demonstrated in 4 cases, and flexion-extension radiographs done at follow-up did not show mobility in any case.

CONCLUSIONS

Minimally invasive atlantoaxial fusion is a safe and effective alternative to the conventional approach in selected cases. Larger series with direct comparison to the conventional approach will be required to demonstrate clinical benefit presumed to be associated with a minimally invasive approach.

Juglone and Lawsone as Acid-Base Indicators

Juglone and lawsone, both acid-base indicators, obtained from natural sources and give pink and red colours with aqueous alkalies, respectively. Their transition ranges are found to be pH 7.4–8.2 and 2.6–3.4. To establish the transition intervals, a buffer series ranging in the pH values from 2.0–2.2–2.4–2.6–2.8–3.0–3.2–3.4–3.6–3.8–4.0–4.2–4.4–4.6–4.8–5.0–5.2–5.4–5.6–5.8–6.0–6.2–6.4–6.6–6.8–7.0–7.2–7.4–7.6–7.8–8.0–8.2–8.4–8.6–8.8–9.0 has been used. Juglone can be used for the titrations of strong acids with strong bases and weak acids with strong bases and lawsone can be used for the titration of strong acids with weak bases only. Permanancy of the colours at the end point is one of their advantages.

Extractives from Heartwoods: Part II. Isolation of Gmelinol and n-Octacosanol from Gmelina arborea

From the aqueous extract of the heartwood of Gmelina arborea (N.O.: Verbenaceae), a lignan has been isolated and identified as gmelinol on the basis of its chemical and spectral analysis. From the benzene extract of the same heartwood, n-octacosanol has been isolated as one of the constituents.

Repeated hydrocephalus in recurrent intraventricular neurocysticercosis: An uncommon presentation

A rare case of a 42-years old man presented with repeated hydrocephalus due to the neurocysticercosis cyst (NCC) in the lateral ventricle. Patient was operated previously 2½ years back for a similar lesion at same site. Both times he was treated endoscopically with removal of the cyst. Interestingly there was no parenchymatous lesion at any stage of follow up. Isolated recurrent intraventricular NCC is a rare condition that has never been reported in the literature.

Spectral shift due to source correlation in conventional spectroradiometric measurements

Keeping in view the recent findings of the spectral shift due to source correlation during propagation of light, a study has been undertaken to analyze the errors which may be introduced in spectroradiometric measurements.