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Lumbar disc degeneration (LDD) is a multifactorial disorder caused by genetic and environmental factors. Polymorphisms in several structural and inflammatory genes like collagens, aggrecan, matrix metalloproteinases are associated with the risk of disc degeneration. In this study, we analyzed the role of a few important single nucleotide polymorphisms in cartilage intermediate layer protein (CILP), collagen 9A2 (COL9A2) and matrix metalloproteinase 3 (MMP3) genes in LDD from an Indian population. Two hundred patients with LDD and 200 healthy controls were recruited for the study. Genotyping was performed by allelic discrimination assay. The rs2073711 polymorphism (CILP gene - GG genotype) was associated with reduced risk of LDD in the Indian population (OR = 0.43, p = 0.016). The rs591058 polymorphism (MMP3 gene - TT genotype) is found to be associated with lower risk among women (OR = 0.34, p = 0.041). No significant association was found between COL9A2 polymorphism rs7533552 and the risk of LDD. We conclude that the CILP gene polymorphism (rs2073711) is associated with a lower risk of LDD, the MMP3 (rs591058) gene polymorphism is associated with LDD among women, and the TT genotype confers a lower risk of LDD.

Chordoid meningioma is a rare variant of meningioma, with a higher incidence in the young and a supposed association with Castleman’s syndrome. They have an aggressive clinical course, and are assigned as WHO grade II meningiomas. To the best of our knowledge, 284 chordoid meningiomas have been reported in the literature. This series reporting 33 cases is the third largest series in published literature from a single Institution. We reviewed Clinico-pathological characteristics of 33 patients diagnosed with chordoid meningioma between 2001 and 2015 in our institution. Forty-one specimens were available for review of histopathological and immunohistochemical characteristics. There were 15 men and 18 women with mean age of 36.8 years (median 36 years, range 9–62 years) at diagnosis with three cases occurring in pediatric age group. The majority were supratentorial in location with 11 convexity, 1 falcine, 5 parasagittal, 1 intraventricular, skull base involvement in 12 with 4 being petroclival location and 3 had spinal lesions. Lymphoplasmacytic infiltrates were seen in 23 cases with majority being T cells. MIB index varied from 1 to 14%. Five patients received radiotherapy for residual lesion. Two patients died (recurrence-1, post-operative complication-1). Three patients were lost to follow up after surgery. The mean post-operative follow up period for the remaining was 55.3 months. Seven patients had recurrence of which three had it twice. This study adds to the pool of available data for better understanding of this variant of meningioma. These meningiomas occur in middle age; spinal lesions and pediatric cases are not uncommon. We did not find any association between surgery, post-operative radiotherapy and histopathological features with recurrence and survival. Small number of cases may be responsible for this statistical insignificance.

•Interleukin 18 Receptor Accessory Protein (IL18RAP) plays a role in lumbar disc degeneration.•Genotyping of two IL18RAP polymorphisms (rs1420106 and rs917997) and IL18RAP plasma levels was studied in LDD patients.•CT genotype of rs917997 was associated with lower risk of LDD in women. Lumbar disc degeneration (LDD) is a common musculoskeletal disorder. Interleukin 18 Receptor Accessory Protein (IL18RAP) gene is involved in disc degeneration and inflammatory processes like matrix degeneration. Hence, this study was performed to understand the role of 2 IL18RAP (rs1420106 and rs917997) polymorphisms and IL18RAP plasma levels in lumbar disc degeneration (LDD) in Indian population. 200 LDD patients and 200 healthy controls were recruited for the study. Genotyping was performed using allelic discrimination assay. IL18RAP levels were measured by ELISA. rs1420106 polymorphism did not follow Hardy Weinberg equilibrium, so it was not considered for association analysis. There was a significant association among females in CT genotype of rs917997 in LDD (p = 0.041). Also, among subjects with no history of alcohol consumption, CT allele was found to be significantly associated and had a protective effect (OR = 0.61). The plasma levels of IL18RAP were also measured. There was no significant difference in IL18RAP levels between patients and controls. Overall, rs917997 polymorphism did not show any significant difference between patients and controls (p = 0.77). However, it showed a protective role in females and patients with no history of alcohol consumption in Indian population and there was no association between polymorphisms and IL18RAP plasma levels.

Background Aneurysmal subarachnoid hemorrhage is a life- threatening condition with high rate of disability and mortality. Apolipoprotein E ( APOE ) and Factor XIIIA ( F13A ) genes are involved in the pathogenetic mechanism of aneurysmal subarachnoid haemorrhage (aSAH). We evaluated the association of promoter methylation status of APOE and F13A gene and risk of aSAH. Methods For evaluating the effect of hypermethylation in the promoter region of these genes with risk of aSAH, we conducted a case -control study with 50 aSAH patients and 50 healthy control. The methylation pattern was analysed using methylation specific PCR. The risk factors associated with poor outcome after aSAH was also analysed in this study. The outcome was assessed using Glasgow outcome score (GOS) after 3 months from the initial bleed. Results The frequency of APOE and F13A methylation pattern showed insignificant association with risk of aSAH in this study. Gender stratification analysis suggests that F13A promoter methylation status was significantly associated with the risk of aSAH in male gender. Age, aneurysm located at the anterior communicating artery and diabetes mellitus showed significant association with poor outcome after aSAH. Conclusion There was no significant association with APOE promoter methylation with the risk as well as outcome of patients after aSAH. F13A promoter methylation status was significantly associated with risk of aSAH in male gender, with no significant association with outcome after aSAH.

Background The rupture of a brain aneurysm causes bleeding in the subarachnoid space and is known as aneurysmal subarachnoid haemorrhage (aSAH). In our study, we evaluated the association of factor XIII polymorphism and the risk of Aneurysmal subarachnoid haemorrhage (aSAH) in South Indian population. Methods The study was performed in 200 subjects with aSAH and 205 healthy control subjects. Genotyping of rs5985(c.103G > T (p.Val35Leu)) and rs5982(c.1694C > T (p.Pro564Leu)) polymorphism was performed by Taqman® allelic discrimination assay. Results In our study, Val/Leu genotype frequency was higher in control subjects (18%) compared to aSAH patients (9%).The Val/Leu genotype was associated with lower risk of aSAH (OR = 0.48, 95%CI = 0.26–0.88, p  = 0.02). When compared with Val allele, Leu allele was significantly associated with lower risk of aSAH (OR = 0.55, 95%CI = 0.32–0.95, p  = 0.03). In subtyping, we found a significant association of Leu/Leu genotype with the Basilar top aneurysm (OR = 3.59, 95%CI = 1.11–11.64, p  = 0.03). In c.1694C > T (p.Pro565Leu) variant, Pro/Pro Vs Pro/Leu genotype (OR = 2.06, 95%CI = 1.10–3.85, p  = 0.02) was significantly associated with higher risk of aSAH. The 564Leu allelic frequency in aSAH patients (36%) was higher when compared with that in healthy controls (30%) in our study. When allele frequency (Pro Vs Leu) was compared, 564Leu allele was found to be significantly associated with higher aSAH risk (OR = 1.36, 95%CI = 1.01–1.83, p  = 0.04). (OR = 1.36, 95%CI = 1.01–1.83, p  = 0.04). Regarding rs5985 and rs5982, significant association was found in the log-additive model (OR = 0.57, 95%CI = 0.33–0.97, p  = 0.034; OR = 1.32, 95%CI = 1.00–1.72, p  = 0.043). Conclusion These results suggest that 34Leu allele was a protective factor for lower risk of aSAH whereas 564Leu allele was associated with higher risk of aSAH in South Indian population.

In an international trial involving 450 patients with acute subdural hematoma, craniotomy (bone flap replaced) and decompressive craniectomy (bone flap left out) yielded similar disability-related outcomes at 12 months.

Initially, it was endoscope-assisted microscopic surgery, which soon transformed into purely endoscopic surgery. [...]dawned a new era of pituitary surgery. Let us be clear that in these days of heightened patient awareness, widespread availability of a wealth of information from the internet, the veracity of which cannot always be vouched for, it becomes all the more reason for the competitive neurosurgeon to be abreast with the latest know-how in the professional frontDriving force of market and training programs. In few years or decade from now, the word “learning curve” will become obsolete in endoscopic surgery; just like we never hear about “learning curve” for hand/eye coordination for using microscopes in neurosurgery. Along with all these exciting changes going on, with better resolution cameras, vetting of sophisticated instruments, and with the ethos of patient safety, comfort along with best clinical outcomes prime in mind of every dynamic neurosurgeon, endoscopic pituitary surgery may be the next revolutionary evolution in neurosurgery akin to microscopic surgery is seen in the latter half of the 20th century.

[...]at present, there are no methods to simulate and study the entire human body in health and disease using the in vitro techniques. Refinement: Improving all aspects of experiment and care so that the animal suffers the least; Reduction: Use as minimum number of animals as possible without compromising the scientific validity; and, Replacement: Avoid using animals if non-animal models like cell and tissue cultures and computer models are available. All these result in a failure of the energy-dependent cellular homeostatic mechanisms leading to cytotoxic edema, endothelial wall damage causing nitric oxide/nitric oxide synthase pathway disruption, oxidative stress, endothelin activation, and the release of many proinflammatory cytokines. The failure of clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1 trial); and, the failure of patients to show any improvement in mortality and morbidity following clazosentan administration despite reversal of large artery vasospasm in aSAH has been attributed to the biochemical and inflammatory changes which were not reversed by the drug.

Brain relaxation is an important requirement in intracranial neurosurgical procedures and optimal brain relaxation improves the operating conditions. Optic nerve sheath diameter (ONSD) is a non-invasive bedside surrogate marker of intracranial pressure (ICP) status. Elevated ICP is often associated with marked autonomic dysfunction. There is no standard measure to predict intraoperative brain condition non-invasively, considering both anatomical displacement and physiological effects due to raised ICP and brain oedema. This study was aimed to determine the usefulness of heart rate variability (HRV) parameters and ONSD preoperatively in predicting intraoperative brain relaxation in patients with supratentorial tumors undergoing surgery.This prospective observational study was conducted in a tertiary care centre. 58 patients with supratentorial brain tumors undergoing elective surgery were studied. Preoperative clinical presentation, computed tomography (CT) findings, ONSD and HRV parameters were assessed in determining intraoperative brain condition. Intraoperative hemodynamic parameters and brain relaxation score after craniotomy were studied. There was significant difference in CT grade, ONSD and HRV parameters in patients between lax and tight brain. A receiver operating curve was constructed to determine the cut off to predict intraoperative brain bulge. A CT grade more than 2, ONSD of greater than 0.63 cms and ratio of low frequency to high ratio (LF/HF) of more than 1.8 were good predictors of brain bulge. The changes in ONSD and HRV parameters, with the CT findings can be used as surrogate markers of increased ICP to help predict intraoperative brain condition.

Vertebral artery dolicoectasia (VAD) can cause brainstem compression and dysfunction. Reports of pyramidal tract involvement by brainstem compression and the surgical benefits and its long-term results are sparsely reported. We hereby report three cases of medullary compression by VAD causing pyramidal weakness. Two patients with bilateral compression with quadriparesis did not want surgical treatment and were still disabled at 58 months and 50 months of follow-up, respectively. One patient with unilateral medullary compression with hemiparesis underwent microvascular decompression using Teflon sling retraction. This patient was relieved of symptoms and is asymptomatic at 14-month follow-up. This report emphasizes the need of surgical decompression in cases of brainstem compression by VAD with caution about appropriate case selection.