Abstract: Spinal dural arteriovenous fistulas are a reversible cause of progressive thoracic myelopathy, for which definitive treatment requires complete disconnection of the pathological arteriovenous shunt. We demonstrate microsurgical clip occlusion and disconnection of a right T4 spinal dural arteriovenous fistula using indocyanine green (ICG) videoangiography and intraoperative neuromonitoring. Following T4–T5 laminectomy, the fistulous point was identified near the right T4 nerve root exit zone, with ICG confirming arterialized venous drainage. A clip was placed immediately adjacent to the dural fistulous point, and repeat ICG demonstrated obliteration of the shunt. The draining vein was subsequently coagulated and divided, with stable somatosensory and motor evoked potentials throughout the procedure. Precise angiographic localization and disconnection as close as possible to the dural fistulous point are critical to minimize residual shunting, vascular recruitment, and recurrence. ICG videoangiography and neuromonitoring provide valuable intraoperative confirmation for safe and definitive microsurgical treatment.
Abstract Anti-3-hydroxy-3-methylglutaryl-CoA reductase (anti-HMGCR) antibody-associated myopathy is a rare form of immune-mediated necrotizing myopathy most commonly reported in patients exposed to statins. However, its occurrence in statin-naïve individuals is increasingly recognized but remains underreported. We describe two unusual cases of statin-naïve anti-HMGCR myopathy presenting with severe rhabdomyolysis, leading to acute kidney injury in one patient and dropped head syndrome in another, emphasizing that anti-HMGCR IMNM should be suspected even in statin-naïve individuals presenting with unexplained myopathy, rhabdomyolysis-associated AKI, or axial muscle weakness such as dropped head syndrome, as early immunotherapy may significantly improve outcomes.
Abstract Anterior clinoidectomy (AC) is a critical step in the surgery of complex aneurysms and tumors of the parasellar region. However, anatomical variations of the anterior clinoid process (ACP) present unique surgical challenges, often mandating specific operative considerations. A unique anatomical variation, namely the carotico-clinoidal foramen (CCF), poses specific challenges in this context. We present the surgical steps and rationale of the “extra-intradural” technique for ACP removal as a means of safely managing the CCF, with an illustrative case of a thrombosed right-sided superior hypophyseal artery aneurysm in a 59-year-old lady. This technique is safe and specifically suited for AC in the presence of CCF, aimed at avoiding the potential complications while retaining the advantages of a complete AC.
Abstract: Tectal plate gliomas are rare, indolent lesions that present unique surgical challenges. They are approached via the occipital transtentorial or supracerebellar infratentorial corridors. We describe a 38-year-old male with a tectal plate pilocytic astrocytoma with progressive increase in the size of the lesion. While the endoscope has been used to improve visualisation and check completeness of resection, we present a video of a pure endoscopic Krause approach, discussing the operative steps, and the advantages of using the endoscope. A purely endoscopic supracerebellar infratentorial approach was performed via a small suboccipital craniotomy in sitting position using both 0-degree and 30-degree endoscopes, excising the lesion. In this case, the purely endoscopic supracerebellar infratentorial approach was a useful adjunct, enhancing illumination and visualisation.
Abstract Background: Stroke affects older women and is associated with greater severity in women than in men. Stroke characteristics differ between high- and low-and-middle-income countries. Hence, the aim of this study was to explore if these gender differences hold true for Ludhiana population-based stroke registry. Materials and Methods: This study was a part of the Ludhiana Urban population-based Stroke Registry. Data were collected using the WHO STEPS method. All patients aged ≥18 years of age, who developed stroke (ischemic or hemorrhagic) between March 26, 2011 and March 25, 2013, were included. Data on demographic details, clinical features, and risk factors were collected. Outcome was assessed at 28 days using the modified Rankin Scale. The statistical analyses performed included descriptive statistics, Chi square test, Fischer’s exact test, and the independent t -test. Results: A total of 2948 were included in the final analysis, of whom 1811 (61.4%) were men. Women were older (≥75 years) [283 (16%) vs. 234 (21%), P = 0.001], were more illiterate [132 (13%) vs. 195 (32%), P < 0.0001], and had more ischemic strokes [1134 (68%) vs. 756 (73%), P < 0.01], hypertension [907 (79%) vs. 599 (84%), P = 0.003], hyperlipidemia [194 (17%) vs. 153 (23%), P = 0.008], and rheumatic heart disease (RHD) [26 (2%) vs. 32 (5%), P = 0.005]. Conclusion: Stroke was more common among men. However, gender differences were noted. Women were older and had a higher incidence of ischemic stroke, hypertension, RHD, and hyperlipidemia. Both men and women had comparable short-term outcomes.
