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Introduction: Pedicle screw placement plays a crucial role in treating various cases such as fractures, scoliosis, degenerative spine issues, and kyphosis, reinforcing all three spinal columns simultaneously. While three-dimensional navigation-assisted pedicle screw placement is considered superior, the freehand technique relies on anatomical landmarks and tactile feedback, with observed low complication rates. MATERIALS AND METHODS: This was a prospective single-center study conducted over a period of 3 years. It included all patients of dorsal, lumbar, and sacral spinal instability of myriad etiology. Previously operated patients and sick obtunded patients were excluded from the study. Results: In our study, we included 102 patients including 62 (60.7%) males and 40 (39.2%) females. More than half of patients were young in the age group of 20–50 years. Our study population had a varied etiology with 43.1% of patients having vertebral column instability due to trauma. The other etiologies were spondylolisthesis and lumbar canal stenosis (39.2%), Pott’s spine (11.7%), tumors (2.9%), and osteoporotic fractures (2.9%). Majority of patients (44.1%) presented with lower backache with radiculopathy. All the transpedicular screws inserted were evaluated by C-arm to assess for screw fixation. In the first year of our study, an average of 4 anteroposterior (AP) and 4 lateral C-arm X-ray shots were taken per screw placement. In the next year, an average of 3 AP and 3 lateral shots and finally in the last year of our study only 2 AP and 2 lateral C-arm X-ray shots were taken per screw placement. Out of 650 screws placed, 4 screws were identified to cause breach with maximum breaches in the lumbar spine fixation. In dorsal spine fixation, there was 1 lateral breach at D10. In lumbar spine fixation, there were 3 breaches: two medial one each at L4 and L5 and one anterior at L2 level. The various complications include wound infection, temporary and permanent neurological deficit, screw breakage, screw misplacement, cerebrospinal fluid leaks, nonunion, and spinal epidural hematoma. Conclusions: Our study has provided strong encouragement to persist with the freehand technique in transpedicular fixation surgeries after a certain number of cases given the minimal breaches and complications observed. There are subtle technical nuances as we increase the number of cases with less exposure of anatomical landmarks and X-rays. Success hinges on experience, adherence to technique, and thorough preoperative planning. Further research and extended follow-up periods are necessary to firmly establish this technique as the gold standard.

Background Digital subtraction angiography (DSA) is a fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a “pre-contrast image” or mask from subsequent images, once the contrast medium has been introduced into a structure, hence the term “Digital subtraction angiography.” Indocyanine green video angiography (ICG-VA) is a safe and practical method of real-time delineation of microvasculature used in the surgical management of intracranial aneurysms, arteriovenous malformations, and other vascular lesions. Intraoperative ICG-VA is used as an adjunct in addition to intraoperative or postoperative DSA, and in other cases, it is used as the sole method to confirm the complete obliteration of clipped intracranial aneurysm. The only limitation of ICG-VA is the nonvisibility of vessels that are not in the operative field. Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA.

Abstract Background A ventriculoperitoneal (VP) shunt is a cerebral shunt that diverts excess cerebrospinal fluid (CSF).Obstruction in the normal outflow or decreased absorption of the fluid is the usual cause. Hydrocephalus is treated by cerebral shunts.In paediatric patients, untreated hydrocephalus can be lethal and leads to many adverse effects including increase irritabilities, chronic headaches, learning difficulties, visual disturbances, and, in more advanced cases, severe mental retardation. Malfunction of the shunt with excess CSF accumulated can increase the intracranial pressure resulting in cerebral oedema and ultimately herniation. Objective To study and evaluate the mechanical causes of shunt failure and their surgical remedies and reduce the preventable morbidity, cost and mortality associated with shunt failure. Methods We conducted a prospective observational study including 70 patients who developed pure mechanical shunt failure for the first time from 2017 to 2020 in the Department of Neurosurgery Sher-i-kashmir Institute of Medical Sciences. Patients with previous shunt surgeries which include VP shunting and shunt revision or failure and shunt infections were excluded. Identity of all the patients has been kept anonymus. Written informed consent was obtained from all patients or their guardians in case of minors. Shunt malfunction was in the form of catheter misplacement, kinking, displacement from the ventricle or peritoneal cavity, disconnection, migration,inadvertent suturing of the catheter, air in shunt bulb. Results We found kinking at the proximal end in 25 (35%) patients as the most common cause of shunt failure. It was mostly as a result of inadequate and less spacious tunnelling made for the reservoir. Inadvertant suturing of shunt while closing abdomen in 7 (10%), shunt disconnection in 6 (8.5%), air in shunt bulb in 2 (2.8%), wrong placement at ventricular end in 10 (14.2%), shunt migration into the brain parenchyma in 5 (7.1%), shunt migration through the anal canal in 1(1.4%), pseudomeningocele around catheter valve in 3 (4.2%), placement of lower end into the preperitoneal space in 4 (5.7%) patients. Conclusions Shunt surgery is seemingly a straightforward operation for neurosurgeons. But considering the incidence of shunt failure and its associated morbidity and mortality, it should always be done with trepidation and extreme caution. Exclusive mechanical shunt malfunction is a major concern and leads to great deal of morbidity in the shunt operations. However, there are trivial remedies and technical nuances which needs to be followed during surgery to avoid these complications.

Key Clinical Message Timely diagnosis, multidisciplinary surgical intervention, and appropriate imaging are crucial in managing transorbital‐penetrating intracranial injuries (TOPIs), minimizing morbidity, and optimizing patient outcomes. Abstract Transorbital‐penetrating intracranial injuries (TOPIs) are rare occurrences with potential for severe neurological complications and high mortality rates. Prompt diagnosis and management are essential to mitigate adverse outcomes. Understanding injury patterns and employing appropriate imaging modalities are crucial for effective surgical planning and patient care. We present a case of a 22‐year‐old male mechanic who sustained a TOPI involving bilateral frontal lobes with evisceration of the right eye following a workplace accident with a metal cutter. Upon arrival at the emergency department, the patient exhibited vision loss in the right eye, proptosis, and a dilated pupil. Imaging studies revealed the trajectory of a metal arrow through the right orbital roof, necessitating surgical intervention. A multidisciplinary team performed bifrontal craniectomy with duroplasty to remove the foreign body and address associated injuries. Postoperatively, the patient received broad‐spectrum antibiotics and anticonvulsants, leading to full recovery and discharge on postoperative day 10. TOPIs present unique challenges due to their rarity and potential for devastating consequences. Our case highlights the importance of timely diagnosis, meticulous surgical planning, and multidisciplinary collaboration in achieving favorable outcomes. Radiological imaging plays a crucial role in guiding treatment decisions and optimizing patient care. This report underscores the significance of early surgical intervention, antimicrobial therapy, and prophylactic measures in reducing morbidity and mortality associated with TOPIs.

Abstract Background Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. Aims and objectives To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Material and methods Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. Results A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. Conclusions EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ‘’Benign extradural haemorrhages’’.

Background: Spinal meningiomas, originating from arachnoid cap cells, primarily manifest in the intradural extramedullary region, commonly favouring the thoracic area, albeit occurrences in the cervical, lumbar, and exceptionally rare sacral regions have been noted. Among tumours in this location, meningiomas, neurofibromas, and schwannomas prevail. MRI serves as the preferred imaging modality due to its ability to often reveal the distinctive dural origin of meningiomas. Microdissection and resection stand as the established gold standard for treating spinal meningiomas. Materials and methods: This study, conducted at the Sheri-Kashmir Institute of Medical Sciences Soura Srinagar in Jammu and Kashmir, India, spanned approximately 10 years from August 2009 to July 2017 retrospectively and August 2017 to July 2019 prospectively. It encompassed patients diagnosed with spinal meningiomas, evaluated through comprehensive history-taking, clinical examinations, biochemical assessments, and radiological studies. Surgical interventions predominantly involved laminectomy, aiming for gross total or subtotal tumour resection using a posterior approach. Postoperative complications, such as CSF leaks and wound infections, were monitored, and the duration of hospitalization was recorded from the surgery date to discharge. Results: The results showed a mean patient age of 44 years, with the youngest being 16 years old and the eldest 70 years old. Most patients (40.90%) fell within the 41-50 age group, with 22.72% in the 51-60 age bracket. Among the 22 patients, females comprised 68.18%, resulting in a female-to-male ratio of 2.1:1. The most prevalent symptoms were pain (77%) and weakness (63%), followed by bladder dysfunction (27%). Tumors were primarily located in the thoracic region (68%), with other occurrences in the cervicothoracic (18%), thoracolumbar (9%), and cervical (4.54%) areas. Posterior surgical approaches were utilized in 91% of cases, with the remaining 9% employing an anterior approach. Tumour sizes varied, with 22.72% smaller than 2 cm and 77.27% larger, having a mean greatest diameter of 2.9 cm. Postoperative complications were observed in 9.09% of patients, with CSF leaks and wound infections being the major concerns, while 91% experienced no complications. Conclusions: In conclusion, this study illustrates spinal meningiomas as slow-growing tumors with a subtle onset, typically appearing in the 4th to 5th decade, and exhibiting a female predominance with a 2:1 ratio. Pain emerges as the most prevalent presenting symptom. Surgery stands as the primary treatment, albeit accompanied by potential postoperative complications such as wound infections, CSF leaks, or bowel and bladder dysfunctions. Adjuvant radiotherapy might be considered for recurrent or advanced disease to offer palliative relief.

The Jammu-Srinagar National Highway is the critical road connection between Kashmir valley and the rest of India. It passes through extremely steep slopes and high mountains prone to mass movements, particularly landslides and rockslides. Most mountainous roads are constructed on fragile and rocky slopes, and any natural (e.g., precipitation) or human-triggered disturbance (e.g., heavy traffic) can cause a fatal and devastating landslide under the influence of gravity. Many landslide-prone sites along the Highway are responsible for the continuous blockade almost throughout the year but peaking particularly during winters. As a result, it has a high toll on the state's economy and is responsible for many human casualties yearly. The present study aims to characterize various factors and their threshold values responsible for triggering a landslide. Through extensive field surveys, we evaluated different geotechnical parameters of soils at the most landslide-prone site along the Highway and augmented it with the satellite remote sensing datasets to determine the threshold values that trigger a landslide and assess the probability of occurrence of landslide events in the future using Autoregressive Moving Average (ARIMA) model and IBM SPSS Forecasting Model. This work shall help devise countermeasures for managing the landslides in the study area locally and shall serve as the guiding framework for using artificial intelligence and machine learning techniques for hazard management in the Himalayas.

Landslides are critical natural disasters characterized by a downward movement of land masses. As one of the deadliest types of disasters worldwide, they have a high death toll every year and cause a large amount of economic damage. The transition between urban and rural areas is characterized by highways, which, in rugged Himalayan terrain, have to be constructed by cutting into the mountains, thereby destabilizing them and making them prone to landslides. This study was conducted landslide-prone regions of the entire Himalayan belt, i.e., National Highway NH-44 (the Jammu–Srinagar stretch). The main objectives of this study are to understand the causes behind the regular recurrence of the landslides in this region and propose a landslide early warning system (LEWS) based on the most suitable machine learning algorithms among the four selected, i.e., multiple linear regression, adaptive neuro-fuzzy inference system (ANFIS), random forest, and decision tree. It was found that ANFIS and random forest outperformed the other proposed methods with a substantial increase in overall accuracy. The LEWS model was developed using the land system parameters that govern landslide occurrence, such as rainfall, soil moisture, distance to the road and river, slope, land surface temperature (LST), and the built-up area (BUA) near the landslide site. The developed LEWS was validated using various statistical error assessment tools such as the root mean square error (RMSE), mean square error (MSE), confusion matrix, out-of-bag (OOB) error estimation, and area under the receiver operating characteristic (ROC) curve (AUC). The outcomes of this study can help to manage landslide hazards in the Himalayan urban–rural transition zones and serve as a sample study for similar mountainous regions of the world.