A Systematic Review on the Impact of the COVID-19 Pandemic on Neurosurgical Practice and Indian Perspective.

OBJECTIVE: The study objective was to systematically review the impact of the current pandemic on neurosurgical practice and to find out a safe way of practicing neurosurgery amid the highly infectious patients with COVID-19. MATERIALS AND METHODS: A review of the PubMed and EMBASE databases was performed. The literature was systematically searched using keywords such as "COVID-19" and "Neurosurgery." RESULTS: Among the 425 records, 128 articles were found to be eligible for analysis. These articles described the perspectives of the neurosurgical departments during the pandemic, departmental models, and organizational schemes for triaging emergent and nonemergent neurosurgical cases for the optimal utilization of limited resources, and solutions to continue academic and research activities. Triaging systems help us to optimally utilize the limited resources available. Guidelines have been developed for safe neurosurgical practice and for the continuation of clinical and academic activities during this pandemic by various national and international neurosurgical societies. Key changes in the telemedicine regulatory guidelines would help us to continue to provide neurosurgical care. Videoconferences, online education programs, and webinars could help us to overcome the disadvantages brought upon the neurosurgical education by the social-distancing norms. CONCLUSION: In an unprecedented time like this, no single algorithm is going to clear the ethical dilemma faced by us. Individual patient triage is a way for maintaining our ethical practice and at the same time, for efficiently utilizing the limited resources. As the pandemic progresses, new guidelines and protocols will continue to evolve for better neurosurgical practice.

Dorsal spine osteoblastoma.

Benign osteoblastoma is a rare primary neoplasm comprising less than 1% of primary bone tumors.[1] We report a case of a 20-year-old female patient presenting with progressive paraparesis over one year and back pain over the dorsal spine gradually increasing in severity over a year. Computerised tomomography (CT) of the spine revealed a well-defined 3.5 × 3.0 cm mass heterodense expansile bony lesion arising from the lamina of the D12 vertebra, having lytic and sclerotic component and causing compromise of the bony spinal canal. D12 laminectomy and total excision of the tumor was done.

Craniovertebral junction melanocytoma: a case report.

Melanocytomas are rare melanocytic tumors of the central nervous system and its presence at the foramen magnum is extremely rare. We report a case of a 55-year-old male presenting with progressive quadriparesis over one year. Imaging showed a well-defined intradural extramedullary lobulated mass at craniovertebral junction towards the left side and extending to left C2-3 neural foramina. Patient was operated through foramen magnum approach with near total excision of tumor. On a ten-month follow up, he was ambulatory with normal motor power on right side of body and left lower limb and with motor power of 4-/5 in left upper limb. Histopathology and immunohistochemistry confirmed the lesion to be a melanocytoma.

Traumatic bilateral basal ganglia hematoma: A report of two cases.

Traumatic Basal ganglia hemorrhage is relatively uncommon. Bilateral basal ganglia hematoma after trauma is extremely rare and is limited to case reports. We report two cases of traumatic bilateral basal ganglia hemorrhage, and review the literature in brief. Both cases were managed conservatively.

Breast tuberculosis--a case report.

Breast tuberculosis is a rare disease. It usually mimics carcinoma breast in its presentation both clinically as well as radiologically. Since breast conservation is possible in tuberculous mastitis and it may be a presenting feature of HIV, it is important to recognise this condition. One case of a 50-year female despite strong clinical suspicion of malignancy though could not be histologically proven is reported here. Following a breast conserving surgery, Langhans' giant cells were seen on histopathology. Patient was started on antituberculous therapy and responded well.

Hypersexuality following subthalamic nucleus stimulation for Parkinson's disease.

Subthalamic nucleus (STN) stimulation is an established surgical treatment for Parkinson's disease (PD). Though the motor benefits of STN stimulation are well understood, its cognitive and behavioral effects are still not fully understood. Manic psychosis, hypersexuality, pathological gambling and mood swings are associated with advanced PD. There have been reports to suggest improvement or worsening in these symptoms following STN deep brain stimulation (DBS). We report two cases as the sole behavioral side-effects of STN stimulation despite good clinical improvement on long-term follow-up. These patients and literature review suggests the complex role of STN stimulation in motor and behavioral control.

Wound infection after metronidazole infiltration.

In state-run hospitals in India, pre-existing malnutrition and anaemia with late presentation, septicaemia and gross peritoneal contamination lead to a very high wound infection rate despite the use of systemic antibiotics. We studied the wound infection rate of subcutaneous infiltration of metronidazole (group B) versus irrigation with saline (group A) in patients undergoing exploratory laprotomy for perforation peritonitis with pyoperitoneum. The study included 30 patients in group A and 30 in group B. In group A 66.6% of the patients developed wound infection, whereas in group B 26.6% only developed wound infection. This difference is found to be statistically significant at a level of P < 0.01. There was no local complication attributable to infiltration of metronidazole in group B. Thus, we concluded that local infiltration of metronidazole at the incision is a safe and effective measure to control wound infection in cases of perforation peritonitis with pyoperitoneum.