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Background: Autonomic nervous system (ANS) is invariably affected by craniovertebral junction (CVJ) anomalies. The usual presentation is sudden after trivial trauma. When symptomatic, most of this autonomic dysfunction is clearly elicited clinically with bedside tests. Nonetheless, ANS functionality in relatively less symptomatic or asymptomatic patients is not known as no studies exist. Methodology: We performed a longitudinal prospective study of 40 less symptomatic patients who underwent surgery with conventional autonomic function tests (AFT) in pre- and post-operative periods. Correlation of its association with such anomalies is studied. Results: All 40 had both pre- and post-operative clinical follow-up, pre-operative AFT, whereas only 22 patients had follow-up AFT. The mean age for the group was 32 years and male: female ratio was 2.3:1. Mean Nurick's grade was 1.8, whereas Barthel's index was 83.75%. Clinical improvement was seen in almost 98% at follow-up. Orthostatic test showed a significant association with Nurick's grade. Barthel's index was significantly associated with degree of compression. The mean follow-up was 17.4 months. Most conventional AFTs were significantly decreased in the preoperative period (P ≤ 0.01). Both parasympathetic and sympathetic tone improved on follow-up with better improvement later. Overall clinical involvement of ANS was seen in 22.5% whereas subclinical involvement in the form of AFT impairment was seen in 100%. Conclusion: There is a definite involvement of subclinical ANS in all patients of CVJ anomalies irrespective of their symptomatology. Knowing the extent of involvement in the preoperative period can help prognosticate, prioritize regarding surgery as well as correlate with the extent of improvement.

Background: Fibrin glue as an adjunct in peripheral nerve injuries has gained recent popularity. Whether fibrosis and inflammatory processes which are the major hindrances in repair reduce with fibrin glue has more of theoretical support than experimental. Methodology: A prospective nerve repair study was conducted between two different species of rats as donor and recipient. Four comparison groups with 40 rats were outlined with or without fibrin glue in immediate post-injury period with fresh or cold preserved grafts were examined based on histological, macroscopic, functional, and electrophysiological criteria. Results: There was suture site granuloma along with neuroma formation and inflammatory reaction and severe epineural inflammation in allografts with immediate suturing (Group A), whereas suture site inflammation and epineural inflammation were negligible in cold preserved allografts with immediate suturing (Group B). Allografts with minimal suturing and glue (Group C) had less severe epineural inflammation with less severe suture site granuloma and neuroma formation as compared to first two groups. Continuity of nerve was partial in later group as compared to other two. In fibrin glue only group (Group D), suture site granuloma and neuroma were absent, with negligible epineural inflammation, but continuity nerve was partial to absent in most of the rats with some showing partial continuity. Functionally, microsuturing with or without glue demonstrated significant difference with better SLR and toe spread (p = 0.042) as compared with only glue. Electrophysiologically, NCV was maximum in Group A and least in Group D at 12 weeks. We report significant difference in CMAP and NCV between microsuturing group vs. only glue group (p < 0.05) and also between microsuturing with glue group vs. only glue group (p < 0.05). Conclusion: There may be more data required with proper standardization for adept usage of fibrin glue. Though our results have shown partial success, it nonetheless highlights the lack of sufficient data for widespread glue usage.