Background: Alexander disease (AxD) is a rare, progressive and fatal neurological disorder characterized by degeneration of the white matter of the brain accompanied by the formation of Rosenthal fibers, distinct cytoplasmic inclusion within astrocytes (non-neuronal cells) in the brain. The disease phenotype is commonly identified to be associated with heterozygous de novo variation in the Glial Fibrillary Acidic Protein (GFAP) gene. Rare instances of familial AxD have also been reported with genetic anticipation. Methods and result: The study aimed to determine the genetic cause of a clinically diagnosed case of juvenile AxD from India with macrocephaly and psychomotor delay, followed by regression, spastic paraparesis, and feeding difficulties. DNA was extracted from peripheral blood sample and was taken for whole-exome-sequencing. Two pathogenic heterozygous missense variations were identified in GFAP, the potential candidate for AxD (c.626G > A leading to p.R209Q and c.983 T > C leading to p.L328P), notably, p.L328P is being reported here first time. The karyotype of the proband revealed no chromosomal anomalies. Following confirmation by Sanger sequencing, variants including their cumulative effect in Double Mutant were characterized in silico for prediction of pathogenicity, protein stability, physiochemical analysis, molecular simulation, principal component analysis and molecular docking. Collectively, these findings reveal both compensatory and synergistic effects that may influence intermediate filament dynamics and related signaling pathways. Conclusion: This altered GFAP protein gets accumulated in the cytoplasm of the astrocyte cells, leading to the formation of Rosenthal fibers, which impairs cell function. While in silico analysis supports the pathogenic nature of the studied variants, which is consistent with the observed AxD pathophysiology in the current study.

Introduction:Traumatic brain injury (TBI) is a leading cause of global mortality and morbidity. Posttraumatic hydrocephalus (PTH) often occurs in patients recovering from TBI surgery, but its diagnosis is challenging due to limited clinical features and accurate scales. Aims:This study aims to identify the risk factors associated with PTH, particularly the inflammatory estimates, systemic inflammatory response index (SIRI), and systemic immune inflammation index (SII) in PTH and its association with outcome following treatment for TBI. Materials and Methods:This retrospective study included TBI surgery patients recruited during intensive care unit (ICU) recovery and followed for 2 years for PTH occurrence. Baseline demographic, blood, and biochemical data were collected at admission, and patients were monitored from discharge to PTH onset or death. Risk factors for PTH and outcome associations were analyzed using univariate and multivariable logistic regression models. Conclusion:A total of 12.42% ( n  = 55) from a cohort of 443 patients developed PTH. The univariate regression showed factors like decompressive craniectomy, postoperative meningitis, Glasgow Coma Scale (GCS), hospital stay, SIRI, and SII to be associated with PTH. SIRI and SII show high statistical significance ( p  < 0.001). The best-fit multivariate model determined that preadmission GCS ( p  < 0.003), length of ICU stay ( p  < 0.003), and GCS at discharge ( p  < 0.025) and SII ( p  < 0.001) were significantly associated with PTH. Elevated SIRI and SII levels were strongly associated with PTH occurrence. Determining the incidence of risk factors, in a larger cohort may establish the association of SIRI and SII as potential inflammatory surrogate markers in the risk of PTH development that can improve earlier detection and effective treatment for PTH management.

Background:Diffuse axonal injury (DAI) is a frequent and devastating form of traumatic brain injury (TBI) that requires prolonged intensive care and carries high morbidity and mortality. Early magnetic resonance imaging (MRI) lesion topography may offer crucial prognostic information to guide clinical management and family counseling. Objective:The objective of this is to evaluate the prognostic value of early MRI-based lesion location in DAI using the novel KASHI Classification and to correlate lesion topography with acute neurological severity, in-hospital mortality, and long-term functional recovery. Materials and Methods:In this single-center prospective cohort study, 91 patients with DAI (from 734 TBI admissions) underwent standardized MRI (T1, T2, FLAIR, diffusion-weighted imaging, gradient echo  ±  diffusion tensor imaging) on Day 1 postinjury. Lesions were graded 1-3C according to the KASHI schema based on their anatomical distribution. Clinical severity was assessed by the Glasgow Coma Scale (GCS) at admission, and outcomes included in-hospital mortality, duration of post-traumatic amnesia (PTA), and 6-month functional status measured by Glasgow Outcome Score and Rancho Los Amigos Scale. Results:Higher KASHI grades were strongly associated with worse acute and long-term outcomes. Grade 3C lesions (pontine, medullary, cerebellar peduncle, or intraventricular hemorrhage) corresponded to the lowest mean GCS scores and a 68 % in-hospital mortality rate. Lesions of the thalamus and basal ganglia independently predicted prolonged PTA and poorer 6-month functional recovery. The KASHI Classification demonstrated high interrater reliability and outperformed total lesion volume models in early prognostication. Conclusion:Early MRI lesion topography, as stratified by the KASHI Classification, provides a simple, reliable framework for predicting neurological severity and recovery in DAI. Its application in acute TBI care can enhance prognostic accuracy and inform clinical decision-making. Further multicenter validation and integration with automated imaging analytics are warranted.

Background and aim Thoracolumbar spine surgeries involve physiological stress that may influence hepatic and renal parameters. This study aimed to compare the effects of propofol-based anaesthesia with sevoflurane-based anaesthesia on liver function tests (LFTs), renal function tests (RFTs) and early postoperative recovery parameters in patients undergoing elective thoracolumbar spine surgery. Materials and methods This prospective randomised comparative study included 56 adult patients classified as American Society of Anesthesiologists (ASA) physical status I-II, who were randomly allocated into two groups (n = 28 each). Group P received intravenous (IV) propofol infusion (100-200 µg/kg/minute), while Group S received inhalational sevoflurane (0.8-1.5 minimum alveolar concentration {MAC}). Primary outcomes included serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatinine, measured preoperatively, immediately after extubation and at 24 hours postoperatively. Secondary outcomes included intraoperative hemodynamic stability, Ramsay Sedation Scale (RSS) scores and the incidence of postoperative nausea and vomiting (PONV). Results Both groups maintained stable intraoperative hemodynamics, with no significant differences (p > 0.05). At 24 hours, Group S demonstrated significantly higher AST, ALT and creatinine levels compared to Group P (p < 0.001). The incidence of PONV was also significantly higher in Group S (66.7% versus 33.3%; p = 0.029), while sedation scores remained comparable. Conclusion Propofol-based anaesthesia was associated with better early postoperative hepatorenal preservation and a lower incidence of PONV compared to sevoflurane, with similar intraoperative hemodynamic stability.

Introduction: Spinal arachnoid cysts are rare fluid-filled sacs that develop within the spine’s protective layer, known as the arachnoid membrane. These cysts were first described by British neurologist George Spiller in 1903. The arachnoid cyst gets its name from the arachnoid membrane, one of the three layers of the meninges that surround and protect the brain and spinal cord. This membrane is responsible for producing cerebrospinal fluid, which acts as a cushion and shock absorber for the brain and spinal cord. Case discussion: A 21-year-old female with no known medical conditions presented with a history of weakness and numbness in both lower limb for the past 1 years. Clinical examination and routine workup done with radiological investigation. An MRI of the spine showed a well-defined cystic lesion in the spinal canal measuring 22cm x 10.7cm x 8.2 cm, extending from the middle of the T11 to L3 vertebrae segment. After careful consideration, it was decided that surgery is necessary to relieve her symptoms and prevent further damage to her spinal cord. Discussion: Spinal arachnoid cysts, although rare, are a fascinating and often misunderstood condition. Usually seen in patients between the ages of 30-50 years with a slight female predominance, their exact cause is still unknown. Diagnosis of spinal arachnoid cysts can be challenging, as the symptoms may mimic those of other spinal conditions. Treatment options for spinal arachnoid cysts depend on the severity of symptoms and the size and location of the cyst. Conclusion: Spinal arachnoid cysts are rare but potentially debilitating conditions that can occur at any age and in any region of the spine. While their exact cause is unknown, advances in imaging technology have made it easier to diagnose and manage these cysts. Keywords: Spinal arachnoid cyst, extradural arachnoid cyst, arachnoid cyst.

Objective  Chronic subdural hematoma (CSDH) is a common neurological problem with significant recurrence after surgery. Risk considerations can vary, ranging from patient-related factors to those related to the surgical procedure. This study explores the association between preoperative eosinophil count and systemic immune inflammation (SII) with CSDH recurrence. Materials and Methods  We conducted a prospective analysis of 105 patients with equal numbers of CSDHs who underwent surgery for CSDH between January 2023 and January 2024. The preoperative eosinophil counts, along with other differential leukocyte counts, were measured. The SII index was calculated using the standard formula (SII = neutrophil count  ×  platelet count/lymphocyte count). Multivariate and univariate regression analyses were performed to assess the association between risk factors and CSDH recurrence. Results  The preoperative eosinophil count showed a significant correlation with recurrence ( p  < 0.001). The SII index was significantly higher in patients with recurrent CSDH ( p  = 0.003). Neutrophils were found to be significantly associated with CSDH recurrence ( p  = 0.038). Age ( p  < 0.001) and SII ( p  = 0.005) were found to be independent predictors of CSDH recurrence, whereas hematoma volume ( p  < 0.001) and the antiplatelet regimen were a significant predictor of CSDH recurrence ( p  = 0.047). Variables like male gender, diabetes mellitus, anticoagulants, and hematoma volume were associated with eosinophil-rich or eosinophil-poor status. Conclusion  Preoperative eosinophil count, neutrophils, and the SII index may serve as potential predictors of CSDH recurrence. Further studies with larger sample sizes are needed to validate these findings.

Background The posterior cranial fossa (PCF) and the foramen magnum (FM) are the critical anatomical components of the craniovertebral junction region, which comprise and transmit numerous vital neurovascular structures. So, a fundamental knowledge of the basic radiological anatomy of PCF and FM is of paramount importance in the evaluation of associated pathologies and approaching these areas surgically. The aim of this study is to describe different linear and angular craniometric parameters of PCF, FM and surrounding territory based on reconstructed computed tomography (CT) images. Material and methods This study was conducted in our tertiary care hospital in northern India from the period of January 2023 to June 2023 on 120 patients, and CT screening was done for the head and spine region following a history of head injury. Results In this study, 120 patients were included, of whom 50.83% ( n = 61) were females and 49.17% ( n = 59) were males. Age ranged from 18 to 70 years with mean age of 43.5 ± 14.08 years. The mean values for linear craniometric parameters of PCF were statistically nonsignificant for different age groups. Statistically significant differences were found for twinning line (TL) ( p < 0.0001), McRae’s line (< 0.0001), clivus length (< p < 0.0001), internal occipital protuberence -opisthion line ( p = 0.01), Klaus’ index ( p < 0.0001), height of posterior fossa (h) ( p < 0.0001), h/TL ( p = 0.028), when these values were compared for the genders. The measurements of FM transverse diameter, anteroposterior diameter and area were 27.12 ± 1.42 mm (range 23.6–30.1 mm), 30.99 ± 2.23 mm (range 27.6–35.8 mm) and 691.32 ± 30.35 mm 2 (range 632.7–777.7 mm 2 ). The values of clivus canal angle ( p = 0.038) and clivoodontoid angle ( p = 0.012) were statistically significant when compared for different age groups. The values of Boogard’s angle ( p = 0.021) and tentorial slope ( p = 0.031) were statistically significant when these were compared for the genders. Conclusions This study described almost all the linear and angular craniometric parameters used in the morphometric analysis of PCF and FM. The findings of this study provide valuable data regarding linear and angular craniometric parameters of PCF and FM which can redefine reference values.

Objective  Intraoperative neuromonitoring (IONM) is an acknowledged tool for real-time neuraxis assessment during surgery. Somatosensory evoked potential (SSEP) and transcranial motor evoked potential (MEP) are commonest deployed modalities of IONM. Role of SSEP and MEP in intradural extramedullary spinal cord tumor (IDEMSCT) surgery is not well established. The aim of this study was to evaluate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and transcranial MEP, in detection of intraoperative neurological injury in IDEMSCT patients as well as their postoperative limb-specific neurological improvement assessment at fixed intervals till 30 days. Materials and Methods  Symptomatic patients with IDEMSCTs were selected according to the inclusion criteria of study protocol. On modified McCormick (mMC) scale, their sensory-motor deficit was assessed both preoperatively and postoperatively. Surgery was done under SSEP and MEP (transcranial) monitoring using appropriate anesthetic agents. Gross total/subtotal resection of tumor was achieved as per IONM warning alarms. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP were calculated considering postoperative neurological changes as "reference standard." Patients were followed up at postoperative day (POD) 0, 1, 7, and 30 for convalescence. Statistical Analysis  With appropriate tests of significance, statistical analysis was carried out. Receiver-operating characteristic curve was used to find cutoff point of mMC for SSEP being recordable in patients with higher neurological deficit along with calculation of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP for prediction of intraoperative neurological injury. Results  Study included 32 patients. Baseline mean mMC value was 2.59. Under neuromonitoring, gross total resection of IDEMSCT was achieved in 87.5% patients. SSEP was recordable in subset of patients with mMC value less than or equal to 2 with diagnostic accuracy of 100%. MEP was recordable in all patients and it had 96.88% diagnostic accuracy. Statistically significant neurological improvement was noted at POD-7 and POD-30 follow-up. Conclusion  SSEP and MEP individually carry high diagnostic accuracy in detection of intraoperative neurological injuries in patients undergoing IDEMSCT surgery. MEP continues to monitor the neuraxis, even in those subsets of patients where SSEP fails to record.

Objective:The main purpose of our case reports and literature review is to make individuals aware about possible catastrophic events which may be associated with some particular Yoga asanas, which result too much straining on craniovertebral junction and cervical spine, particularly in individuals with congenital anomalies of craniovertebral junction and cervical spine as well as osteoporotic and degenerative weakness of this region. Method:We presented our two case reports and literature review of case reports of compressive myelopathy and vascular accidents of this region associated with various Yoga asanas .Results: Both of the patients in our case reports had Os odontoideum, one was taking steroid for bronchial asthma and they were practicing Sirsasana (Headstand) and Halasana (plow pose).In review of literature we found four cases of compressive myelopathy, two cases were associated with multilevel cervical spondylosis and other two cases were associated with osteoporosis.Three of these patients were practicing Sirsasana (Headstand) and one Halasana (plow pose).We also found three cases of vascular accidents at craniovertebral junction.Two cases related to vertebral artery and one related to basilar artery while practicing Setubandha (Bridge pose), Sarvangasana (Shoulder stand) and Sirsasana (Headstand) respectively. Conclusion:Though yoga practices are considered safe and without harmful effects, some yoga asanas, resulting significant strain on craniovertebral junction and cervical spine, may land up individuals in catastrophic complications such as quadriparesis, stroke and respiratory paralysis with ventilator dependency.Individuals wishing to commence these asanas should have prior proper assessment osteoligametous structures of this region to rule out underlying osteoporosis, any osseous pathology, congenital osseous malformations, basilar invagination, vascular malformations etc.

AbstractBackgroundAlexander disease is a rare neurological ailment caused by the degeneration of the white matter of the brain accompanied with the formation of Rosenthal fibers, a unique cytoplasmic inclusion within astrocytes (non-nerve tissue) in the brain. Till to date only heterozygousde novomutation in Glial Fibrillary Acidic Protein (GFAP) gene is found to be associated for the disease phenotype.Methods and Resultthe aim of our study was to determine the genetic basis of an Indian-origin juvenile AxD patient with pathological symptoms of macrocephaly and psychomotor delay followed by regression, spastic parapresis and feeding difficulty. The patient was screened for mutation in candidate gene for AxD by Whole Exome Sequencing and the detected variants were further reconfirmed by Sanger sequencing. The clonicopathological feature were investigated and two heterozygous missence variants (c.983T>C and c. 626G>A) were indentify in GFAP gene of the patient. Familial screenings of both of these variants were predicted to be pathogenic or damaging by variousin silicomethods and prediction tools.ConclusionThis altered GFA protein get accumulated in cytoplasm of the astroglial cells, leading to formation of Rosenthal fibers, which impairs cell function. Future study, however, would be helpful to understand the functional mechanism of these variant in formation of Rosenthal fibers leading to AxD pathophysiology.

AIM: To establish the diagnosis of basilar invagination (BI) on the basis of specific bony landmarks Klaus' index (KI), perpendicular distance between the tip of the odontoid process and palato internal occipital protuberance (PI) line. MATERIAL and METHODS: Forty-nine patients were analysed, who underwent surgery for BI, between July 2020 and June 2023. Radiological assessment was done in all the patients using reconstructed midsagittal images on computed tomography scans. RESULTS: Mean age was 34.82 +/- 10.52 years with male preponderance (67.35%) in patients with BI. We also analysed randomly selected 120 control subjects (male: female = 59:61) with mean age 43.5 +/- 14.08 years. The mean distance of tip of the odontoid process from PI line in patients with BI was 3.39 +/- 3.09 mm. The mean value of KI in the patients with BI was 28.57 +/- 1.68 mm. Receiver operating characteristic (ROC)curve was used for analysing the distance of the tip of the odontoid process from PI line in the patients with BI which produced area under curve(AUC) of 0.97 (confidence interval [CI] -0.931 to 0.990, p<0.0001). Cut-off point of 7.5 mm was identified for the distance of tip of odontoid process from PI line with sensitivity of 89.8% and specificity of 97.5% having 95.27% diagnostic accuracy for BI. ROC curve analysis of value of KI for the diagnosis of BI produced AUC of 1(CI: 0.978 to 1.000, p<0.0001). Cut-off value of 33.2 mm for KI was identified for diagnosing BI with 100% accuracy. CONCLUSION: The distance of tip of the odontoid process from PI line <7.5 mm and value of KI <33.2 mm, both of these parameters can diagnose BI with comparable accuracy to most widely used conventional radiological methods.

Background Alexander disease is a rare neurological ailment caused by the degeneration of the white matter of the brain accompanied with the formation of Rosenthal fibers, a unique cytoplasmic inclusion within astrocytes (non-nerve tissue) in the brain. Till to date only heterozygous de novo mutation in Glial Fibrillary Acidic Protein ( GFAP ) gene is found to be associated for the disease phenotype. Methods and Result the aim of our study was to determine the genetic basis of an Indian-origin juvenile AxD patient with pathological symptoms of macrocephaly and psychomotor delay followed by regression, spastic parapresis and feeding difficulty. The patient was screened for mutation in candidate gene for AxD by Whole Exome Sequencing and the detected variants were further reconfirmed by Sanger sequencing. The clonicopathological feature were investigated and two heterozygous missence variants (c.983T>C and c. 626G>A) were indentify in GFAP gene of the patient. Familial screenings of both of these variants were predicted to be pathogenic or damaging by various in silico methods and prediction tools. Conclusion This altered GFA protein get accumulated in cytoplasm of the astroglial cells, leading to formation of Rosenthal fibers, which impairs cell function. Future study, however, would be helpful to understand the functional mechanism of these variant in formation of Rosenthal fibers leading to AxD pathophysiology. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee, Institute of Science, Banaras Hindu University, Varanasi, Ref No. I.Sc./ECM-XII/2021-22 Ethics committee, Institute of science, Banaras Hindu University, Varanasi, Uttar Pradesh, Ref No. I.Sc./ECM-XII/2021-22 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors All data produced in the present work are contained in the manuscript

Abstract Introduction Decompressive craniectomy [DC] is one of the leading armaments to lower refractory intracranial pressure. Post-DC hydrocephalus [PDCH] occurs in 11.9–36% of patients undergoing DCs for TBIs. Various theories have been given regarding pathophysiological mechanism of PDCH but remain dubious. Risk factors predicting PDCH still under research. Exact timeline regarding developmental process of PDCH remains undefined. Method This retrospective study was conducted on 422 patients who underwent DCs in our tertiary care trauma center over the period of one year. 60 patients out of 422 who developed PDCH were analyzed with respect to demographic variables and preoperative and postoperative risk factors. A total of 20 randomly selected patients, who underwent DCs but did not develop hydrocephalus, were selected and compared with patients who developed PDCH. Outcome analysis was done by dichotomizing the groups into independent and dependent groups. Results Among 422 patients undergoing DC, 14.21%[n = 60] developed PDCH. Younger [34.2 y vs 43.3 y, p = 0.0004] male age group was predominant in our study. Age [p = 0.021, multivariate analysis] and midline shift [p = 0.008, multivariate analysis] were significant preoperative predicting risk factors for PDCH. Interhemispheric hygroma [p = 0.031], brain bulge [ p = 0.008], and blood in postoperative scan [p = 0.029] were significant postoperative risk factors. Lower GCS score at admission [p = 0.0003], postoperative day 10 and at the time of establishment of PDCH were significantly predicted surgery to hydrocephalus time. Midline shift [p = 0.007] and thickness of interhemispheric hygroma [p = 0.021] were associated with poor outcome in patients with PDCH. Conclusion Younger age group and presence of midline shift are significant preoperative predictors of PDCH. Blood in postoperative scan, interhemispheric hygroma and brain bulge in postoperative period are significant predictors for PDCH. Deterioration in GCS score in postoperative period following DC should be taken as high index of suspicion for developing PDCH.

Abstract Background Decompressive craniectomy (DC) is a neurosurgical procedure, frequently used in lowering the refractory intracranial pressure (ICP) following traumatic brain injuries. Post-traumatic hydrocephalus (PTH), a debilitating complication in the patients with traumatic brain injuries, occurs in 11.9–36% patients undergoing DCs. Sunken flap syndrome (SFS) is a rare entity, following DCs or cerebrospinal fluid (CSF) diversion procedures for PTH after DCs and leads to neurological deterioration of the patients. Literature regarding risk factors associated with SFS in the patients undergoing ventriculoperitoneal shunt procedures for hydrocephalus following DCs is scarce. The aim of this study is to determine the incidence of SFS and to establish a relationship between several clinico-radiological features and SFS in patients undergoing shunt procedures for PTH. Results This retrospective study was conducted in a tertiary care trauma centre upon 60 patients who underwent shunt procedures for PTH. Intraventricular haemorrhage (P < 0.0001), communicating-type hydrocephalus (P = 0.0006), and modified frontal horn index (P < 0.0001) were significantly associated with development of SFS. MFHI > 43 was a significant risk factor in development of SFS. Conclusions SFS is the common complication following shunt procedures for PTH after DCs. MFHI is significant risk predictor for SFS. MFHI > 43 is associated with higher chances of developing SFS following shunt insertion in PTH. Early cranioplasty following DCs might prevent development of SFS.

Neural tube defects (NTDs) are serious congenital deformities of the nervous system that occur owing to the failure of normal neural tube closures. Genetic and non-genetic factors contribute to the etiology of neural tube defects in humans, indicating the role of gene-gene and gene-environment interaction in the occurrence and recurrence risk of neural tube defects. Several lines of genetic studies on humans and animals demonstrated the role of aberrant genes in the developmental risk of neural tube defects and also provided an understanding of the cellular and morphological programs that occur during embryonic development. Other studies observed the effects of folate and supplementation of folic acid on neural tube defects. Hence, here we review what is known to date regarding altered genes associated with specific signaling pathways resulting in NTDs, as well as highlight the role of various genetic, and non-genetic factors and their interactions that contribute to NTDs. Additionally, we also shine a light on the role of folate and cell adhesion molecules (CAMs) in neural tube defects.

Penetrating spine injuries are second most common spine injury after blunt trauma. Stab wounds and, gunshot wounds are two common types of penetrating injuries. Surgery has a signicant role in penetrating spine injury in cases of cord transection, cord compression by foreign body/ bony and soft tissue fragment, bony instability and in CSF leak. Stab wounds have comparatively better prognosis. Moreover, surgery plays a much larger role. Retained foreign objects should be removed after a stab injury, whereas bullet fragments may be left in place if it is not causing any role in neurological compression. Penetrating spine injuries are the second leading cause of spinal cord injuries. There is high rate of complications in surgical intervention for penetrating spine injuries to the spine. Very few literatures are available showing data on Penetrating spine injuries to the spine in India. Approximately 38 cases over the last 3 years have been recorded, with unusual presentation and neurological recovery. We tried to ll this gap in data, by reviewing cases of Penetrating spine injuries to spine presenting at a tertiary care hospital. A Retrospective cohort Methods study, in which Patients of all ages who presented to the emergency department of IMS BHU, with Penetrating spine injuries between October 2019 and April 2022 were included in the study. Neurological examinations were done and data were collected. American Spinal Injury Association score (ASIA) was used for the initial and follow-up neurological assessment. Extent of cord transection, motor and sensory decits were also recorded. The patients were grouped into patients with cord transaction and those with cord contusion with cord compression by foreign body or by bony and soft tissue fragment, CSF leak, and intact spinal cord and having fractures with bony instability. All patients were then followed and the outcomes were recorded. A total of 38 patients were identied. The mean ± Results SD of patients age was (30.9 ± 9.5) years. Of the 38patients with Penetrating spine injuries 36 were gunshot wounds, 2 had sharp weapon penetrating spinal cord injury.35 patients were managed surgically and conservative management done in 3 patients. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, dorsal spine was the most commonly injured region. Of the 38 patients with medical imaging performed at our institute, 27 (71.05%) having cord contusion, 6(15.78%) were having cord compression by foreign body, 3(7.89%) were having bony instability without cord contusion and 2(5.26%) having CSF leak. Conclusion The prognosis of Penetrating spine injuries to the spine depends on whether the spinal cord is intact or transected and on presence of bony instability. Above inference will help healthcare providers to plan the further management of the patient and counsel them accordingly.

Introduction: Chlorpromazine belongs to the category of typical antipsychotics or neuroleptics, also known as FirstGeneration Antipsychotics (FGAs). It is found to be effective in hiccup management by its action as dopamine antagonist in the hypothalamus. Olanzapine act as an antagonist at postsynaptic serotonergic receptors which augment phrenic motoneuronal activity and play a role in the generation of hiccups. Aim: To compare the effectiveness of combination therapy (Olanzapine plus Chlorpromazine) with monotherapy (Chlorpromazine) in Traumatic Brain Injury (TBI) patient admitted to trauma Intensive Care Unit (ICU). Material and Methods: The present study was a control trial which was conducted between November 2020 to October 2021 on patients aged 18-65 years diagnosed with intracranial injury due to trauma. A total of 100 patients (50 in each group) were randomised into Group 1 (patients receiving chlorpromazine 25 mg thrice daily for five days) and Group 2 (patients receiving chlorpromazine 25 mg thrice daily and olanzapine 5 mg once daily for five days). The primary outcome measure was to compare cessation or reduction in the frequency of hiccups. Various laboratory parameters were investigated and compared between both the groups on day zero and day five. The secondary outcome was side-effects of the drugs. Results: In the present study, the distributions of age and gender were similar in both groups with mean age of patients being 39.16±13.88 years and 43.30±12.51 years in group 1 and 2, respectively. Cessation of hiccups were found in 29 (58%) of the patients in group 2 as compared to 27 (54%) patients in group 1, which was not statistically significant. However, improvement in the status of patients was observed in 18 (36%) in group 2, as compared to 10 (20%) in group 1 (p<0.05). No serious adverse events were documented in either groups. Conclusion: A better outcome was observed with combination of chlorpromazine and olanzapine than chlorpromazine alone, in treating hiccups due to TBI. The present trial has established the role of drugs for managing hiccups caused after TBI.

Background Ventriculoperitoneal (VP) shunt insertion is routinely performed for the treatment of hydrocephalus due to different indications like congenital, infective, tumor, posttraumatic, and normal pressure hydrocephalus (NPH). A lot of common and rare complications following this procedure have been reported. Objectives To analyze the clinical profile, indications, anesthetic, and postoperative complications for VP shunt surgery in our center. Materials and Methods This prospective clinical review study was conducted in the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, between October 2018 to January 2020 and included 454 cases of hydrocephalus who underwent VP shunt surgery. The data was compiled and analyzed. Results A total of 454 patients with male predominance were studied. Pediatric and adolescent patients were 48.9% (222/454). Obstructive hydrocephalus due to tumors was the etiology of 48.7% (221/454) cases. The incidence of overall shunt complications was 9.7% (44/454), of which obstruction and infection was 5.9% (27/454) and 3.1% (14/454), respectively. Factors associated with increased shunt complications include redo and infective etiology and cases having higher protein in perioperative cerebrospinal fluid (CSF) analysis. Neuronavigation, antibiotic-impregnated shunt and biventricular shunt are associated with lower complications. Conclusion Obstructive hydrocephalus due to tumors happened to be the most common cause of VP shunt, and shunt obstruction is most common complication, especially in infective and redo cases.

Background: Chronic subdural hematoma (CSDH) is a well-known entity and common surgical disorder managed by the neurosurgeon and, if not recognized and treated timely, may prove fatal. It can be non-traumatic or post-traumatic and all of them need urgent attention irrespective of aetiology. It manifests with a progressive neurologic deficit that occurs >3 weeks following head injury. The principal techniques used in the treatment of CSDHs presently are burr hole, twist drill craniostomy, craniectomy and craniotomy. Objective: The aim of this study was to assess clinical outcome in unilateral chronic subdural hematoma patients treated by single or double burr-hole drainage. This prospective study was carried out at the Department of Neurosurgery, IMS, BHU, Varanasi from September 2016 to August 2018. A total of 60 patients with their age ranged from 22to 88 years with GCS 6 to 15 & hematoma thickness 10mmc were included in this study and randomly divided into two groups using random allocation software. In group A, patients with chronic subdural hematoma (CSDH) were managed with single burr-hole drainage. In group B, patients were managed with double burr-hole drainage. Clinical outcome was measured on the1st postoperative day, 3rd postoperative day and 7th postoperative day by GCS and at 1month follow-up by measuring the Glasgow outcome scale (GOS). Result: In this study double burr-hole drainage and single burr-hole drainage surgery shows equal success in the management of CSDHs with single burr hole taking less operative time.