ABSTRACT:The cerebral ventricles are fluid-filled cavities within the cerebral hemispheres and contain cerebrospinal fluid. Historically, the structure and presumed functions of the cerebral ventricles were often associated with the soul, intellect, memory, or mind. A comprehensive understanding of their true anatomy and functions emerged only through the application of scientific methods, including dissection, experimental research, and the correlation of structure with function. Many eponyms are reused to describe the anatomy of the cerebral ventricles. The aim of this study is to examine the historical development of the conceptualization of the ventricles and their interconnections, to elucidate their functions, and to investigate the origins of the eponyms commonly used in their anatomical description. The study was conducted as a scoping review in accordance with the PRISMA-ScR guidelines. PubMed, Web of Science, Scopus, and Google Scholar were searched. Data extraction and quality assessment were performed according to pre-established guidelines. The anatomical description of the cerebral ventricles can be traced back to Herophilus, Erasistratus, and Hippocrates and was further advanced by Galen (129-200). In the modern era, anatomical insight into the ventricles was refined through experimental research. Pioneering scholars such as Leonardo da Vinci (1452-1519), Andreas Vesalius (1514-1564), Franciscus de la Boe Sylvius (1614-1672), Alexander Monro (1733-1817), Domenico Cotugno (1736-1822), François Magendie (1783-1855), and Hubert von Luschka (1820-1875) made significant contributions to the field. An understanding of the historical emergence of eponymous terms and the processes by which anatomical structures were discovered is of considerable value in medical education.
BACKGROUND:Because of their location and vascularity, cavernous sinus hemangiomas (CSH) are uncommon, benign vascular diseases that present considerable surgical problems. Even if stereotactic radiosurgery (SRS) is being used more often, surgical excision is still essential for big lesions. One of the large single-center surgical series on CSH utilizing transcavernous microsurgical techniques, and interdural splitting is presented in this work. METHODS:A retrospective review of 15 patients who underwent surgery between January 2023 and April 2025 and had CSH confirmed by radiological and histological means was carried out. Analyses were conducted on the following data: Surgical technique, intraoperative blood loss, tumor volume, clinical presentation, demographics, amount of resection, and complications. Additionally included were qualitative observations from the surgeon's reflections and the operation notes. SPSS 24.0 was used for statistical analysis. RESULTS:Gross total resection (GTR) was achieved in 80% (n = 12) of patients, and near-total resection (NTR) was achieved in 20% (n = 3). The mean intraoperative blood loss was significantly lower in the GTR group (1133.3 ± 427.7 mL) compared to the NTR group (1766.7 ± 208.2 mL; P = 0.03). Larger tumor volume positively correlated with higher intraoperative blood loss (r = 0.52, P = 0.04). At 6-month follow-up, 66.7% (n = 10) of patients showed symptomatic improvement. Postoperative cranial nerve deficits occurred in 13.3% (n = 2), with no mortality. The extent of resection was not significantly associated with short-term functional outcome (P = 0.58). CONCLUSION:The interdural and transcavernous approach is a safe and effective microsurgical technique for resection of gCSH, enabling high rates of total resection with minimal morbidity. Although larger tumor size increases intraoperative bleeding risk, GTR can still be achieved with proper anatomical planning and technique. In select cases, NTR may be a reasonable alternative without compromising short-term neurological outcomes.
Abstract: A detailed understanding of the dural anatomy of the trigeminal nerve, particularly the Meckel’s cave, and the petrous apex is essential to accomplish an interdural approach in dumbbell-shaped trigeminal schwannomas (TSs) from the middle fossa side. A 34-year-old gentleman with left hemifacial pain and masseter weakness on examination was found to have a dumbbell-shaped TS around the petrous apex occupying the adjacent middle cranial fossa, posterior fossa, and the cavernous sinus. We performed an extended middle fossa approach (EMFA), taking an interdural route, and with the addition of an extradural anterior petrosectomy (AP), the tumor was completely resected. Postoperative imaging revealed a complete tumor excision, and the patient has been doing well at follow-up examinations. An EMFA with tailored AP provides an excellent control of the posterior fossa component of TS due to improved angulation and blind spot visualization.
BACKGROUND:Classical trigeminal neuralgia (TN) is a severe facial pain disorder most commonly caused by neurovascular conflict (NVC) at the trigeminal root entry zone. Microvascular decompression (MVD) provides durable pain relief by addressing the underlying vascular compression. However, Indian data evaluating predictors of failure, early relapse, redo surgery, and the role of adjunct nerve combing (MVD-plus) remain limited. OBJECTIVE:To evaluate functional outcomes after MVD for classical TN and identify predictors of early failure, pain relapse, redo surgery, and the role of MVD-plus. METHODS:A retrospective analysis was performed on 108 consecutive patients who underwent MVD for classical TN at a tertiary neurosurgical center in India between August 2018 and July 2025. Demographic characteristics; trigeminal division involvement; laterality; NVC grade; offending vessel; operative technique (Teflon alone vs. Teflon with adjunct nerve combing); complications (Ibañez classification); preoperative, immediate postoperative, and long-term Barrow Neurological Institute (BNI) pain scores; pain relapse; redo MVD; and history of dental or tooth extraction were analyzed. Kaplan-Meier survival analysis was used to assess pain-free survival. RESULTS:The mean age at surgery was 51.39 years, with right-sided involvement in 62% of patients. V2-V3 involvement was the most frequent trigeminal division pattern (22.1%). Severe preoperative pain was universal (BNI IV-V). Ten patients (9.3%) underwent MVD-plus (Teflon with adjunct nerve combing), including six patients (5.6%) undergoing redo MVD for early failure or relapse. At a mean follow-up of 22.7 months, outcomes were BNI I in 41 patients (37.9%), BNI II in 57 (52.8%), and BNI III in 10 (9.3%), yielding a 90.7% pain-free rate (BNI I-II). Severe NVC (Grades 2-3) and arterial compression correlated with superior outcomes, while venous compression and early postoperative residual pain predicted relapse (P < 0.05). The overall complication rate was 18.5%, predominantly minor, with no mortality. CONCLUSION:MVD is a safe and highly effective treatment for classical TN. NVC severity, offending vessel type, and early postoperative pain relief significantly influence outcomes. MVD-plus is valuable in cases where unfavorable anatomy does not allow adequate vascular decompression, redo surgery, and early failure.
Abstract: Sciatic nerve injuries result in profound motor and sensory deficits, and when direct repair is not feasible, autologous sural nerve grafting remains the gold standard for reconstruction. In this context, distal sciatic neuroma excision followed by sural nerve autografting illustrates the surgical nuances and technical challenges of bridging large distal nerve gaps. The procedure involves careful neuroma excision and reconstruction of the tibial and peroneal divisions using multiple reversed sural nerve cable grafts, with tension-free epineural coaptation performed under magnification to optimize outcomes. Although long grafts are associated with limited recovery, meticulous microsurgical technique and prioritization of the tibial division can enable meaningful functional restoration. Thus, autologous sural nerve grafting continues to provide a practical and viable solution for complex sciatic defects, underscoring its role in challenging reconstructions.
BACKGROUND:Endolymphatic sac tumors (ELSTs) are rare, locally aggressive tumors often associated with von Hippel-Lindau disease. Due to their location and hypervascularity, complete surgical excision is challenging, and recurrence is common. Gamma knife radiosurgery (GKRS) has emerged as a potential noninvasive treatment modality, particularly in recurrent or inoperable cases. METHODS:A retrospective analysis of five patients with radiologically diagnosed ELSTs treated with GKRS at our institution between 2012 and 2023 was performed. Patients who had received either upfront or adjuvant GKRS with a minimum of 1 year follow-up were included. Treatment planning involved frame-based MRI and GKRS delivery using the Leksell GammaPlan system. Clinical and radiological outcomes were assessed through clinical review and follow-up imaging. RESULTS:Of the five patients, two received primary GKRS, and three received secondary GKRS following surgical resection. Marginal doses ranged from 20 to 25 Gy. At follow-up, MRIs showed stable disease with no increase in tumor size. Clinically, patients remained stable, with no worsening or emergence of new neurological symptoms. No procedure-related or radiation-induced complications, including radiation necrosis, were observed, and none required corticosteroid therapy. CONCLUSIONS:GKRS is a safe and effective treatment modality for the management of ELSTs, particularly in residual or recurrent disease. Our experience suggests that GKRS offers excellent radiological control and symptom stabilization, supporting its role as both a primary and adjunctive treatment option.
BACKGROUND:The suprasellar cistern containing major neurovascular structures is accessible by various microscopic and endoscopic approaches. While literature strengthening the case for skull-base endoscopic management of neoplastic sellar-suprasellar lesions abounds, a straightforward algorithm for endoscopically managing sellar/suprasellar arachnoid cysts (SAC) has not been set forth. This is likely due to their low incidence and the wide variation in both nomenclature and surgical management described in the literature. METHODS:All (10) cases of SAC managed at our institution over the past 5 years have been analyzed and included in this retrospective study. All cases underwent endoscopic surgery as deemed appropriate by the managing teams. All studies published after 2010 describing endoscopic management of six or more SAC cases were reviewed. RESULTS:Endoscopic fenestration of the cyst with wall biopsy was done in all cases. Wide cysto-cisternostomy was done in all large suprasellar cysts. This was performed via the endonasal route in cases with a large(r) sellar + suprasellar component (anterior to the dorsum sellae) or via transventricular endoscopy in cases with a large(r) premesencephalic/prepontine (retrosellar) component. Postoperatively, all patients in our series experienced relief of symptoms with no complicating CSF leaks or evidence of recurrence at last follow-up. Literature review revealed gross inconsistencies in the nomenclature of each cyst type while largely describing successful endoscopic management. We encountered three main types of cysts and found that the most useful method of grouping SACs to aid surgical approach selection is based on their predominant cisternal location. Therefore, we suggest that they be organized into the intrasellar, sellar-suprasellar, and premesencephalic/prepontine types. CONCLUSION:Reorganizing SACs based on their anatomical extent simplifies academic communication and aids in choosing the surgical approach. In our experience treating these rare cysts, transventricular as well as transnasal endoscopic surgery has proven safe and efficient.
Abstract: Migraine is increasingly recognized as a cyclical brain state disorder rather than an isolated vascular or nociceptive condition. Its clinical phases may reflect dynamic reorganization of interacting neural circuits involved in sensory processing, homeostasis, pain modulation, and cognition. This review aims to synthesize current evidence and propose a stage-specific neural circuit dynamic model of migraine, linking each clinical phase to distinct patterns of circuit dysfunction and recovery. A narrative review of studies published between January 2010 and December 2024 was conducted using PubMed, Web of Science, and Embase. Controlled vocabulary and free-text terms were combined, and the article selection process was documented numerically to improve transparency. Evidence from human neuroimaging, electrophysiology, preclinical circuit manipulation, and neuromodulation studies was qualitatively integrated according to migraine phase and circuit domain. The interictal phase is characterized by vulnerable homeostasis, with heightened cortical excitability, impaired sensory gating, and weakened descending inhibition. During the prodromal phase, hypothalamic involvement and altered limbic-reward signaling may contribute to attack-related network priming. The ictal phase involves trigeminovascular activation, thalamocortical amplification, and engagement of pain and sensory networks; in migraine with aura, cortical spreading depression may contribute to these processes. Attack resolution may involve endogenous reset mechanisms engaging brainstem and hypothalamic modulatory systems, whereas chronic migraine may reflect maladaptive circuit plasticity and more persistent network reconfiguration. A stage-specific circuit framework can integrate fragmented evidence on migraine pathophysiology and may support circuit-based biotyping, biomarker development, and targeted neuromodulatory or pharmacological interventions.
BACKGROUND:Time to treatment, baseline stroke severity, blood pressure, age, atrial fibrillation, and imaging findings are known determinants of outcome after thrombolysis. Their combined effect has not been well quantified. METHODS:We conducted a cross-sectional study of 150 acute ischemic stroke patients treated with intravenous alteplase. We developed the TASBAC score (Time + Age + Stroke Severity + Blood Pressure + Atrial fibrillation + CT findings). Neurological improvement was defined as the change in NIHSS (NIHSSDIF) within 72 hours post treatment. Nonparametric (Spearman) and parametric (Pearson) correlations were used; significance was set at P < 0.05. RESULTS:The mean age was 62.7 ± 10.4 years; 57.3% were male. Onset-to-needle time, door-to-needle time, baseline NIHSS, and diastolic BP were negatively correlated with NIHSSDIF (rₛ = -0.202, P = 0.013; -0.438, P < 0.001; -0.464, P < 0.001; -0.477, P < 0.001, respectively). Dense MCA sign was associated with lower NIHSS improvement (mean 0.04 vs. 2.09). TASBAC score showed a strong negative correlation with NIHSS improvement (r = -0.761, P < 0.001). CONCLUSIONS:TASBAC quantifies cumulative risk and robustly predicts early neurological recovery after thrombolysis. It may help in clinical stratification and decision-making.
ABSTRACT:Autoimmune encephalitis (AE) is a heterogeneous group of immune-mediated disorders of the central nervous system characterized by neuropsychiatric symptoms, seizures, cognitive decline, and movement abnormalities. Timely recognition and initiation of immunotherapy are critical to improving outcomes. We report three cases of AE presenting with varied clinical phenotypes from the Neurology department of Madras Medical College. The first, a 44-year-old male, presented with altered sensorium, action tremor, and myokymia, and was diagnosed with LGI1 and CASPR2 antibody-positive AE. The second, a 16-year-old girl, presented with seizures, progressive cognitive decline, behavioral disturbance, and focal weakness, confirmed as anti-NMDAR encephalitis. The third, a 14-year-old boy, developed seizures and behavioral changes following herpes simplex encephalitis and was later confirmed to have anti-NMDAR antibody-positive AE with features of Kluver-Bucy syndrome. All patients received first-line immunotherapy (steroids, IVIg), with escalation to rituximab in resistant cases.
OBJECTIVE:This study aims to share a single surgeon's experience among patients with primary and secondary trigeminal neuralgia (TGN) managed with microvascular decompression (MVD), detailing immediate and last follow-up results and identifying the prognostic factors associated with various outcomes and recurrences. METHODS:A retrospective observational analysis of 136 consecutive patients (78.2% primary, 21.8% secondary TGN) managed with MVD between June 2018 and January 2025, with at least 3 months of follow-up, was conducted. Surgical results, complications, and recurrence rates were reviewed along with factors affecting these outcomes. RESULTS:A total of 101 patients were analyzed with a mean preoperative duration of symptoms of 4 years. V2V3 segment was the most common pain-harboring region. Superior cerebellar artery was the most common conflicting vessel. Immediate complete pain relief was achieved in 94.8% of cases (94.7% in primary and 95.2% in secondary TGN groups). At a mean latest follow-up of 266 (range: 10-2250 days) days, 84.2% of primary TGN and 95.2% of secondary TGN patients had experienced persistent pain relief (Barrow Neurological Institute [BNI] I). Poor immediate pain relief correlated strongly with poor outcomes at both first and final follow-up (P < 0.001). The most frequent complication was facial hypoesthesia (19.6%). The recurrence rate at last follow-up was 31.6%. Redo MVD stood out as the most efficient treatment modality. CONCLUSION:MVD still enjoys being the most coherent management strategy for drug-resistant TGN, with age being no bar. Favorable outcomes with shorter preoperative duration prompt the need for increasing patient awareness, improving multidisciplinary communications, and expeditious referral to a neurosurgical unit to amplify the patient's welfare. A duration of preoperative symptoms of more than 4 years, >2 vessels in conflict, and lack of immediate postoperative relief in symptoms herald the increased risk of pain recurrence.
BACKGROUND/OBJECTIVE:Acute cholecystitis (AC) can occur as a potentially fatal complication in critically ill patients, with multiple risk factors such as old age, male sex, diabetes mellitus, and history of cardiovascular disease reported. Recently, a history of cerebrovascular disease (CVD) has been suggested as a risk factor for the development of a complication in which vascular disease pathogenic factors, including atherosclerosis and ischemia, may play a role. However, little has been reported about the occurrence of AC in patients who have experienced CVD. This study aimed to investigate the incidence and clinical details of AC after CVD. METHODS:This was a retrospective review performed at a single institution. The records of all patients hospitalized with CVD were examined. In addition to the incidence of AC, atherosclerotic factors as well as previously reported risk factors were reviewed and then compared with those in patients with traumatic brain injury (TBI). RESULTS:AC was identified in 4/156 (2.6%) patients with CVD and 1/135 (0.7%) patients with TBI, which was not a statistically significant difference ( P = 0.233). In addition, factors were comparable, except for hypertension, fever, and nonambulant status, which were found significantly more often in CVD patients. Notably, three of the four patients developed AC after recurrent CVD. CONCLUSIONS:AC can occur as a potentially fatal complication in CVD patients. In addition to nonspecific clinical findings, consciousness disturbance with neurological deficits may lead to delayed diagnosis. A prospective study with a larger cohort is warranted to clarify the relationship between AC development and CVD.
