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Byline: Jitin. Bajaj, Sarat. Chandra, Bhargavi. Ramanujam, Heri. Subianto, Shabari. Girishan, Ramesh. Doddamani, Mohit. Agrawal, Raghu. Samala, Rekha. Dwivedi, Kapil. Chaudhary, Ajay. Garg, Madhavi. Tripathi, C. Bal, Ashima. Nehra, Mehar. [...]

Post-decompressive craniectomy syndrome (PDCS) is a complication following decompressive craniectomy (DC). PDCS or also known as trephine or sunken skin flap syndrome has an indirect relationship with traumatic brain injury (TBI). The mechanism of PDCS is not yet fully understood and the clinical manifestations are diverse, causing PDCS to often be underdiagnosed. In this study, the authors aim to create a systematic review of PDCS following TBI including a discussion of incidence, clinical and radiological manifestations, management and outcome. This systematic review is conducted based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline. The literature search included electronic databases PubMed, Cochrane, JNS and EMBASE. All studies included were available in English and full-text format. In this research, 42 case reports were obtained. The population was predominantly male (72%) with a mean population age of 44.7 ± 17.3 years. The mean interval for onset and cranioplasty procedure was 80.17 ± 77.34 days and 92.05 ± 77.06, respectively. The most common clinical manifestations were sunken skin flap in the defect area (74%) and decreased consciousness (64%). Paradoxical herniation (74%) was the most common radiological manifestation. There was no connection between the occurrence of PDCS and the size of the defect. Cranioplasty remains the mainstay of management with clinical improvement in 96% of cases. PDCS should be suspected in every patient with symptoms of new neurological deficits after DC. Early management must be carried out to prevent further deterioration. [ABSTRACT FROM AUTHOR]

Byline: Ramesh. Doddamani, Heri. Subianto, Jitin. Bajaj, Shabari. Girishan, Raghu. Samala, Mohit. Agrawal, Bhargavi. Ramanujam, Manjari. Tripathi, Poodipedi. Chandra Background: Patients with temporal lobe epilepsy are subjected to standard temporal [...]

Byline: Ramesh. Doddamani, Raghu. Samala, Heri. Subianto, Bhargavi. Ramanujam, Manjari. Tripathi, Poodipedi. Chandra Background: Stereoelectroencephalography (SEEG) has become an integral part of epilepsy surgery, often used in the localization of [...]

• Some of piriformis syndrome intractable with conservative treatment. • Surgery was indicated for intractable piriformis syndrome. • Piriformis resection can be a feasible option for intractable piriformis syndrome. • Piriformis resection decrease visual analog scale in intractable piriformis syndrome. Piriformis syndrome (PS) is an uncommon neuromuscular condition characterized by buttock pain radiating to the leg. Although the goal of PS treatment is symptom relief, it is difficult in some patients using conservative treatment alone. A 72-year-old male underwent piriformis resection after failed sequential steroid injection of the piriformis. The patient ultimately underwent surgery for resection of the piriformis muscle and experienced satisfactory pain relief (pain reduction > 75% according to visual analog scale for at least 12 months) following surgery and in the 3-year follow-up period. Conservative treatment is first-choice treatment for managing PS. Surgery was indicated when the patient did not achieve satisfactory pain relief with conservative treatment. Surgical resection of the piriformis muscle has been shown to be effective and feasible. Piriformis resection is effective and can be a feasible option for the treatment of PS following failure of appropriate conservative treatment(s). [ABSTRACT FROM AUTHOR]

• Stereotactic hematoma evacuation can be performed without anticoagulant agent. • Stereotactic evacuation of intracerebral hematoma can be adopted in any center. • Stereotactic evacuation of intracerebral hematoma is a safe procedure. • Stereotactic surgery can minimize brain injury. Minimally invasive techniques such as stereotactic aspiration of spontaneous intracerebral hematoma (SICH) evacuation can minimize brain tissue damage due to surgery. We share our experience of adopting stereotactic aspiration of SICH in our center without compromising safety. Three stereotactic aspiration procedures for SICH immediately after 24 h of onset are reported. All cases showed good results. Level of consciousness of all the patient returned to normal. Two patients could carry out routine activities independently. One patient has left hemiparesis. Stereotactic aspiration of SICH has been newly implemented at our center with acceptable results achieved. Patient selection has an important role in determining the choice of technique. The procedures were done without anticoagulant agent. Stereotactic aspiration of SICH is associated with limited brain tissue damage, shorter duration of surgery, reduced length of stay, faster postoperative healing, and better functional improvement. Stereotactic aspiration of SICH is a minimally invasive defined strategy for hematoma evacuation without compromising safety. [ABSTRACT FROM AUTHOR]

Since it was first introduced, a variety of modification techniques to block the impar ganglion appear such as transsacrococcygeal ligament technique, sacrococcygeal transdiscal approach, paramedian approach, and a two-needle technique using fluoroscopy or computed tomography scan. For therapeutic purposes, a combination of steroid and local anesthetic, neurolysis agents such as alcohol, phenol, cryolesioning, and heat lesioning using radiofrequency thermocoagulation could be used. Here, we reported a successful outcome in treating chronic perineal pain in a 65-year-old patient using combination of neurolysis agent which was alcohol 96% and radiofrequency thermocoagulation. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) implantation is a neurosurgical procedure in which electrodes are implanted in the brain. Complications that may occur include wound infection, issues with the DBS hardware, and others. This case report presents a patient who suffered ear numbness following DBS implantation. A 50-year-old man presented with resting tremors in both hands. He reported that his handwriting had worsened and his movements had slowed. Physical examination revealed rigidity and postural instability. The patient was diagnosed with Parkinson's disease and a bilateral subthalamic nucleus DBS implantation was scheduled combined with the patient's medication all this time. Patient's symptoms showed improvement after the procedure. However, the patient complained of ear numbness and occasional pain in the area around his ear. We observed the patient over the next 3 months and the symptoms eventually resolved without any medication and intervention. Ear numbness is a rare complication that occasionally occurs after DBS implantation. This complication occurs because the tunneling track's proximity to the great auricular nerve and the lesser occipital nerve can result in accidental damage to either one or both of these nerves during subcutaneous tunneling. We suggest a simple procedure to avoid neural injury while maintaining the course of the tunneling in which the tunnel is created below the periosteum rather than at the subcutaneous level. • Ear numbness is a rare complication after DBS. • The likely cause is neural damage during subcutaneous tunneling. • In DBS implantation, tunneling below the periosteum can prevent this complication. [ABSTRACT FROM AUTHOR]

Management of hypothalamic hamartoma (HH) with intractable gelastic epilepsy remains challenging. We performed robotic (ROSA) guided radiofrequency ablation for the treatment of HH with intractable gelastic epilepsy in a child of 6 months age. During the surgery, intracranial depth electrode implanted to the hamartoma to identify the ictal onset. Planning for surgery was performed under ROSA assistance with MRI guided targeting and radiofrequency ablation of the hypothalamic hamartoma was performed to achieve disconnection effects. No intraoperative complications occurred. The present study was primarily aimed at verifying the feasibility of using robotic guided radiofrequency disconnection technique in terms of safety, short surgical duration in younger patients to prevent further secondary epileptogenesis from hypothalamic hamartomas. [ABSTRACT FROM AUTHOR]

Abdominal dystonia is very rare. To our knowledge, no clinical study has reported its specific treatment. Stereotactic therapy has been used to treat several movement disorders, including focal and general dystonia. We investigated the use of internal globus pallidum (GPi) pallidotomy for abdominal dystonia after failed oral medication. A 48-year-old man presented with abdominal dystonia and complaints of involuntary undulating and contraction movements of his left abdominal wall for 5 years. Treatment with oral medication for 4 years was ineffective. Lesioning of the right GPi successfully relieved his symptoms. The symptoms recurred at 3 months and right GPi pallidotomy was repeated with complete resolution of symptoms after the second procedure. There was no recurrence or focal deficit at the 2-year follow-up. GPi pallidotomy is feasible and effective for the treatment of abdominal dystonia that is resistant to standard medical therapy. [ABSTRACT FROM AUTHOR]

Introduction Treatment options for hypothalamic hamartoma (HH) include microvascular surgery, stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy, or Gamma Knife surgery. During SRT, thermographic monitoring cannot be performed and therefore highly accurate placement of electrode and confirmation of its position are required. We have used robotic guidance (ROSA) and coregistered it with O-arm for performing ablation of hamartoma. Methods Five patients with HH and gelastic seizures underwent SRT. Robotic guidance (ROSA) was used for placement of electrodes. An O-arm was used for coregistering and confirming the robotic trajectory with real-time intraoperative imaging. Intraoperative computed tomography was merged with preoperative magnetic resonance imaging to confirm the exact position and trajectory of the electrode. Ablation was performed using a radiofrequency generator (70°C for 60 seconds). Multiple target sites were ablated to achieve proper ablation and disconnection. Results Most patients (4/5) had International League Against Epilepsy class I outcome. One patient 2 sittings of lesioning. All but 1 electrode could be placed in the planned trajectories. One electrode was detected to have a medial deviation, and it had to be revised. No permanent complication was observed. Conclusions SRT is a cost-effective method of treating HH when compared with laser interstitial thermal therapy. With the use of a robotic arm we have demonstrated accurate placement of electrodes. Intraoperative computed tomography acquired using an O-arm can be merged with preoperative magnetic resonance imaging. This confirms electrode location and trajectory on a real-time basis by performing intraoperative imaging. This method is safe and can be used for radiofrequency ablation of HH. [ABSTRACT FROM AUTHOR]