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Abstract Background Temporary occlusion of the proximal vessel is being increasingly used as an adjunct during aneurysm surgery for safer dissection, evacuation of the aneurysm, and to prevent intraoperative rupture. The guidelines regarding its practice are ambiguous. One of the major concerns is the safe time limit for temporary occlusion. Studies done so far have failed to reach a consensus on this issue. This study is an attempt to provide a practical, safe time period of intermittent occlusion of an artery in the anterior circulation, irrespective of vascular territory. Patients and Methods A total of 68 patients in whom elective, intermittent, temporary clipping of the proximal vessel was employed during aneurysm surgery were prospectively studied. They were divided into two groups, Group I with an occlusion period of less than 7 minutes and Group II with occlusion period of 10 minutes and above per episode. The incidence of complications in both groups, their relationship to the number of intermittent clippings, and the total duration of clipping were analyzed. Results The incidence of complications was more in Group II (23.5 vs. 8.8%). There was a reduction in the incidence of complications when the duration of occlusion per episode was reduced; this, however, was not reflected statistically (p = 0.1). The total duration of temporary occlusion, when compared, was significantly longer in Group II (p = 0.000). The total duration of clipping, however, was not significantly different between those who developed complications and those who did not (p = 0.86). The occurrence of complications did not correlate with the vascular territory, number of intermittent clippings, or the total duration of occlusion within their respective groups. Conclusion Our study supports the view that the proximal vessel can be safely occluded during aneurysm surgery. The total occlusion period could be safely prolonged when employed in an intermittent fashion with periods of reperfusion to attain the objective of safe dissection. The reduction in duration of each episode of occlusion, though resulted in fewer complications, did not reach statistical significance.

This research article discusses the challenges faced by the Network-on-Chip (NoC) architecture due to increased integration density and proposes a novel fault-tolerant multi-application mapping approach called ”FANC.” The approach is based on Machine Learning (ML) and can provide solutions for unseen graphs and topologies without prior training. The proposed technique uses an ML-based model to extract relevant information from the search data and incorporate it into the search process. This results in a more robust model with a higher convergence rate and solution quality. The approach is evaluated using a variety of simulation parameters, such as communication cost, network latency, throughput, and power usage. Static simulations are performed in a Python programming environment, while dynamic simulations are performed with a SystemC-based cycle-accurate NoC simulator and the Orion2.0 Power tool. The results show that FANC reduces communication costs by 266%. It also improves network latency by 9%, throughput by 1%, and power consumption by 7%. The approach also simplifies and minimizes the search area in the design exploration process and can be used as an auxiliary component for other optimization algorithms.

Abstract Background Pneumocephalus is a common complication presented as air in the cranial cavity after cranial surgery. We present a very rare case of isolated new onset aphasia due to pneumocephalus after evacuation of subdural hematoma (SDH). Tension pneumocephalus presenting as isolated aphasia has not been reported earlier although associated paresis has been reported. Case presentation We present the case of a 13-year-old male child with a history of fall before the onset of symptoms like headache and vomiting. The immediate MRI of the brain showed left-sided frontotemporoparietal subacute SDH with significant midline shift and subfalcine herniation. The child was subsequently managed with craniotomy and evacuation of hematoma with duraplasty. The patient developed aphasia on second-day post-surgery which progressed from moderate to severe aphasia by day 4. Computed tomography (CT) scan revealed pneumocephalus and an increase in the pneumocephalus in imaging on post-op day 4 with no other abnormalities. The condition was then managed by removing the subgaleal drain and administering high flow oxygen of 10 l/min. Conclusion This case signifies the importance of proper diagnosis of new-onset neurological deficits after evacuation of subdural hematoma for the better outcome.

Supratentorial ependymomas are rare and are usually intra axial in location. We report a case of extra axial supra tentorial ependymoma in a girl which mimicked a falcine meningioma. Imaging, pathological features and management are described in this case report along with review of the literature. The possible origin of these tumors is discussed.

Intrasellar location of schwannoma is extremely uncommon and 18 cases are documented in the literature till now. This report describes intrasellar schwannoma in a patient in whom the neuroimaging features were suggestive of a pituitary adenoma.