Nepal Journal of Neuroscience <p>Official journal of the Nepalese Society of Neurosurgeons (NESON). Also available on its own site at <a title="NESON" href="" target="_blank" rel="noopener"></a></p> <p>The Nepal Journal of Neuroscience is now accepting online submissions. Please <a href="/index.php/NJN/user/register">register</a> with the journal and select the author role to be able to submit your manuscript using the 5 step submission process.</p> Nepalese Society of Neurosurgeons (NESON) en-US Nepal Journal of Neuroscience 1813-1948 Music in the operating theatre: to listen or not to listen remains a question? <p>Not available.</p> <p>&nbsp;</p> Yam Bahadur Roka ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 1 2 10.3126/njn.v16i1.24422 Review in The Management of Post-Craniotomy Pain <p>Pain can lead to increase in the sympathetic stimulation and thereby cause hypertension and rebleed in the operative site. The ideal management of pain in these circumstances is a topic of debate worldwide. The standard algorithm for pain management is usually with nonsteroidal anti-infl ammatory drugs (NSAIDS) with or without opioids. Good pain management helps to reduce not only the pain but also shortens hospital stay and cost and leads to early recovery but overenthusiastic use of drugs can lead to sedation, mydriasis, respiratory depression which could increase the intracranial pressure or obtundation of deteriorating neurological signs. There is thus no Gold Standard drugs or algorithm to manage post craniotomy pain and this review aims to discuss the common availability of medicine and review the various options available for successful management of post craniotomy pain (PCP). Each neurosurgical centre must have a protocol and guidelines regarding PCP management which will be easier for the juniors and nurses to follow. Multimodality treatment can achieve best results and further controlled trials with the different medications alone or in combination, studies in cannabinoid derivatives in future can help to formulate and ideal PCP management algorithm.</p> Yam Bahadur Roka ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 3 9 10.3126/njn.v16i1.24423 The surgical approach for clipping anterior communicating artery Aneurysm <p>Anterior communicating artery (ACoA) aneurysm, accounts for 30%-35% of all the aneurysm making it one of the most common intracranial aneurysms. Although the Pterional approach is considered as the safe and appropriate method in ACoA aneurysm surgery, temporalis atrophy and injury to a frontal branch of the facial nerve are few inexorable complications. With the advancement of minimally invasive surgery several modified approaches, such as the supraorbital eyebrow incision approach, the minipterional approach, the mini-supraorbital approach, and the lateral supraorbital approach has been recently introduced and has been used as an alternative.</p> Robin Bhattarai Chuan Chen Chao Feng Liang Teng Chao Huang Hui Wang Cong Ling Ying Guo ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 10 20 10.3126/njn.v16i1.24424 Surgical Outcome of Isolated Extradural Hematomas Operated in a Teaching Hospital in Western Nepal <p>The aim of this determine the causes, frequency, location of isolated extradural hematomas in patients presenting with head injury and to find out the outcome of surgery in such patients. This is prospective observational study was conducted in the Neurosurgery Unit of Manipal Teaching Hospital from January 2012 to January 2017. All patients who presented with headinjury and had isolated extradural hematomas were included in the study. Total number of patients admitted with diagnosis of extradural hematomas during that time period was 169 among which 94 patients underwent surgical treatment. Descriptive statistics data including age, gender, causes of injury, severity of head injury and Glasgow outcome scale were&nbsp;studied. Results in proportion and percentages were calculated by using Microsoft Excel 2013.</p> <p>There were 169 patients who had isolated extradural hematomas. Among them, 75 patients were managed conservatively and 94 underwent craniotomy for evacuation of hematoma. This group of 94 patients who operative treatment was taken for this study. Male: female ratio was 1.6:1. Mean age was 23 years. Most of patients were in 20-40 age groups. Causes of extradural hematomas included motor vehicle accidents, falls and assaults. Mild and moderate head injury was present in 53 (56.38%) and 32 (34.0%) patients. Seventy nine patients (84.05%) of patients had good recovery while 3 (3.19%) patients expired.</p> Balgopal Karmacharya Nikunja Yogi Benju Pun ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 21 24 10.3126/njn.v16i1.24425 Clinical Experience with Frameless Neuronavigation Guided Biopsy for Intracranial Space Occupying Lesion <p>Biopsy is mandatory for histological diagnosis of non-resectable brain tumors. Of various techniques, neuronavigation guided biopsy provides intraoperative real-time reference and allows biopsy from multiple trajectories. The aim of this study is to assess the efficacy and accuracy of frameless neuronavigation biopsy.</p> <p>We retrospectively reviewed the medical archives of patients with intracranial space occupying lesion who underwent frameless neuronavigation biopsy at our institute between 2016 to 2018. All operations were performed under general anesthesia. Data were analyzed by SPSS version 20. P value of &lt;0.05 was considered significant.</p> <p>There were 46 patients who underwent neuronavigation guided biopsy over the period of two years. Median age of patients was 46.5 years. Supratentorial tumors accounted for 95.8% of cases. Mean tumor diameter was 3.35 cm. Accuracy was 89.1%. More than half were glial tumors. Histopathology was inconclusive in 10.9% cases. Complication rate was 4.3%: one tract hematoma and one new neurological deficit.</p> <p>Frameless neuronavigation guided biopsy of intracranial space occupying lesion is safe and efficacious procedure with high diagnostic yield.</p> Suraj Thulung Suresh Bishokarma Subash Lohani Dinuj Shrestha Binit Aryal Munu Napit ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 25 28 10.3126/njn.v16i1.24427 Ischemic Stroke in Young Adults: Study of the Subtypes, Risk factors and Predictors of Poor Outcomes <p>The aim of this study is to show the subtype, risk factors and predictors of poor outcomes in young ischemic stroke patients.</p> <p><strong>Materials and Methods</strong>: It is a prospective study where only young onset ischemic stroke patients are analyzed.</p> <p>8% of total ischemic stroke sufferers were young adults; more prevalent in female (57.1%), with risk factors of smoking (47.6%) subtype cardio embolic (42.9%) was common. High NIHSS score was related to new event and correlation to mortality. Three month follow up showed MRS 2.86 ± 1.02. 57.1% of cases had significant disability (defined as MRS ≥ 3). There was a positive correlation of the cardio embolic subtype and the unclassified subtype to all three forms of poor outcomes, along with a positive correlation of the large artery atherothrombotic subtype to new events Recurrence of events&nbsp;(new stroke, sudden increase in symptoms and new TIAs) was observed in 14.3 %. Death was reported in 9.5% of cases.&nbsp;&nbsp;</p> <p>Etiological diagnosis can be reached in majority of cases if an aggressive approach is maintained. This small scale study has provided an overview of the distribution of subtypes, risk factors and poor outcomes and their predictors. Cardiac diseases (esp. valvular disease) need to be taken more seriously to prevent cardio embolic strokes, while addressing other traditional risk factors to prevent the atherothrombotic subtypes.</p> Reema Rajbhandari Parmatma Prajuli K K Oli ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 29 34 10.3126/njn.v16i1.24428 Outcome of Posterior Fossa Decompression for Chiari Type I Malformation with Syringomyelia <p>There are various treatment approaches for treating Chiari type I malformation with syringomyelia. Despite various choices, consensus for one particular approach is lacking. The objective of this study is to find out the clinical and radiological outcome of standard posterior fossa decompression incorporating removal of C1 arch with lax duroplasty in such cases.</p> <p>A retrospective study based on data acquired&nbsp;from a single tertiary center were analyzed. All cases who underwent posterior fossa decompression incorporating removal of C1 arch with lax duroplasty over a period of five years were included and their clinical and radiological progress were recorded during OPD follow up at 6 months.</p> <p>Out of 21 cases, occipital headache with nape of neck pain was the predominant complaint accounting to 71% followed by sensory symptoms and motor weakness, 61% and 33% respectively. Pain resolved in 93%, weakness in 71% and sensory symptoms in 69% of the cases. Only one patient developed hydrocephalus requiring shunting. Radiological improvement of syringomyelia were documented in 76.1% of the patients. There was no mortality.</p> <p>Posterior fossa decompression incorporating removal of C1 arch and lax duroplasty is a safe approach with good outcome in patients with Chiari I malformation with syringomyelia.</p> Sagar Koirala Suresh Bishokarma Dinesh Nath Gongal Henry Thomas Marsh ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 35 38 10.3126/njn.v16i1.24429 Bilobed Thoracic Meningomyelocele: A Case Report with Literature Review <p>Neural tube defects (NTDs) arethe most common congenital malformations affecting the brain and spinal cord. Furthermore,&nbsp;meningomyelocele (MMC) is said to be one of the commonest NTDs. Multiple MMC is uncommon and bilobed sac is even rarer, comparatively. In literature, only few such cases have been reported. Here, we present a rare case of bilobed thoracic MMC operated successfully in our department.</p> Dipendra Shrestha Binod Rajbhandari Sushil Krishna Shilpakar ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 39 41 10.3126/njn.v16i1.24430 Combining Internal Carotid Artery Occlusion with Intermediate-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: Case Report and Review of Literature <p>We summarize the treatment effectiveness and experience of a patient who underwent internal carotid balloon occlusion combined with Intermediate-flow bypass as a treatment for large-giant cavernous sinus segment internalcarotid artery (CS ICA) aneurysms.</p> <p>A 62-year-old woman presented with a large aneurysm on the right side of the cavernoussinus with dizziness for about two years and Oculomot or nerve palsy. An extra cranial intracranial (EC-IC) Intermediate-flow by pass using a radial artery bypass graft (RABG) and proximal balloon occlusion of the Right ICA were performed. The patient experienced no new neurologic deficit after this treatment. Follow up radiologic evaluations using Computed Tomography Angiography revealed complete aneurysm occlusion.</p> <p>For patients with large-giant CS ICA aneurysms, treatment of ICA occlusion combined with Intermediate-flow superficial temporal artery-Radial artery-middle cerebralartery bypass surgery was an effective and safe surgical strategy.</p> Robin Bhattarai Chuan Chen Chao Feng Liang Teng Chao Huang Hui Wang Ying Guo ##submission.copyrightStatement## 2019-06-12 2019-06-12 16 1 42 47 10.3126/njn.v16i1.24431 Situs Inversus Totalis with Hydrocephalus in an Adult: A Rare Case Report <p>Situs in versus is a rare anomaly where there is reversal of the visceral organ location and usually associated with Kartagener syndrome and digestive, circulatory and respiratory diseases abnormalities. The lateralization of visceralorgans to a side is a feature of vertebrates and humans are externally symmetrical but internally asymmetrical. Normal anatomy imparts the heart to left and the liver to the right which is found not only in humans but also other animals. This case showed aqueduct stenos is with hydrocephalus with normal corpus callosum. The association of situs in versus with ciliary abnormalities and therefore is rarely associated with hydrocephalus, polycystic disease or retinal degeneration. PubMed search for situs in versus total is with hydrocephalus showed only 7 results with 3 of them in animal studies, one was not relevant and the rest in human. Hydrocephalus was present in only two studies, one of them cadaveric finding. The association with hydrocephalus is very rare and we present such a case report.</p> Yam Bahadur Roka Mohan Karki Ashish Jung Thapa Narayani Roka ##submission.copyrightStatement## 2019-06-13 2019-06-13 16 1 48 50 10.3126/njn.v16i1.24434 Unusual Complication of the Foramen Magnum Decompression <p>The pathophysiology of Chiari-Imalformation lies with the abnormal CSF flow across Foramen magnum and Foramen magnum decompression (FMD) restores this flow. However, recent data suggests that FMD itself can alter the CSF dynamics in an abnormal fashion resulting in raised intracranial pressure. We report such a case where FMD has led to the development of subdural hygroma and hydrocephalus. Patient was managed with VP shunt after a failed trial of re-exploration and burr hole drainage. The mechanism behind this complication is not clearly understood despite several hypotheses being proposed. Once established, management has to be individualized, based upon the clinical condition and location of CSF collection.</p> Sridhara Narayana Ramesh Teegala ##submission.copyrightStatement## 2019-06-13 2019-06-13 16 1 51 54 10.3126/njn.v16i1.24435 Solitary Intracranial Plasmacytoma in an Unusual Location – A Case Report <p>Plasmacytoma is rare form of plasma cell dyscrasias, where there is malignant proliferation&nbsp; of plasma cells. Solitary plasmacytoma developsin isolation without systemic manifestations of multiple myeloma (MM). We report a case of cerebellopontine angle (CPA) plasma cytoma, which masqueraded as a schwannoma with multiple cranial nerve involvement and review a literature pertaining to the same pathological entity.</p> Suresh Bishokarma Shikher Shrestha Kajan Ranabhat Rajesh Panth ##submission.copyrightStatement## 2019-06-13 2019-06-13 16 1 55 57 10.3126/njn.v16i1.24436 Isolated Intraspinal Neurenteric Cyst, Mimicking Arachnoid Cyst: A Case Report <p>Neurenteric cysts account for 0.7-1.3% of spinal axis tumors. These uncommon lesions results from the inappropriate partitioning of the embryonic notochordal plate and presumptive endoderm during the third week of human development. Heterotopic nests of epithelium reminiscent of gastrointestinal and respiratory tissue lead to eventual formation of compressive cystic lesions of the pediatric and adult spine. We report a 40-year-old male&nbsp; presenting with slow-progressive myelopathic manifestation and ovoid non-enhancing cysticintradural extramedullary lesion at C7 level on MRI, mimicking intraspinal arachnoid cyst, who underwent successful surgical excision. The histopathological examination prove it to be neurenteric cyst.</p> Puspa Raj Koirala Suman Phuyal Gopal Sedain Sushil Krishna Shilpakar ##submission.copyrightStatement## 2019-06-13 2019-06-13 16 1 58 61 10.3126/njn.v16i1.24437 Endoscopic Retrieval of Intraventricular Migrated Whole Ventriculoperitoneal Shunt: A Case Report <p>Ventriculoperitoneal shunt is associated with different complications. Mechanical complications like blockage, disconnection and distal migration are relatively common. Distal migration of shunt is well documented. But proximal migration of the shunt into the ventricles is very rare with only a few cases reported in literature. Proximal migration of entire shunt in the ventricle, none of them have been proven. In comparison to frontal burr hole, occipital burr hole could facilitate migration due to relatively straight pathway.</p> Muhammad Tariq Diggaj Shrestha ##submission.copyrightStatement## 2019-06-13 2019-06-13 16 1 62 64 10.3126/njn.v16i1.24438 Giant Thrombosed "Divine Clipped" Vertebral Artery Aneurysm Presenting with Severe Vertigo <p>Not available.</p> Yam Bahadur Roka ##submission.copyrightStatement## 2019-06-13 2019-06-13 16 1 65 66 10.3126/njn.v16i1.24439