Adjunct role of liquid absolute alcohol intralesional sclerotherapy during the surgical management of spinal primary aneurysmal bone cyst in a child: a technical case report.

BACKGROUND: Aneurysmal bone cyst is composed of variable -sized cystic blood-filled spaces separated by connective tissue septae. First-line surgical resection of spinal aneurysmal bone cyst in a child with limited total blood volume can lead to massive intraoperative bleeding, thus limiting extent of resection. Our Centre's has good experience of using absolute alcohol as an effective immediate devascularizing agent during vertebral hemangioma surgery in children. MATERIAL AND METHODS: We report the first case of pediatric lumbar primary aneurysmal bone cyst in which completely blood-less piecemeal total resection of the lesion was performed after intraoperative absolute alcohol intralesional sclerotherapy. RESULTS: Completely blood-less piecemeal total resection of the lumbar aneurysmal bone cyst was performed after intraoperative absolute alcohol intralesional sclerotherapy. CONCLUSION: Intraoperative absolute alcohol intralesional sclerotherapy is a very effective devascularizing adjunct for complete piecemeal resection of spinal aneurysmal bone cyst in children with limited blood volume.

Understanding anterior communicating artery aneurysms: A bibliometric analysis of top 100 most cited articles.

Bibliometric analysis is of paramount importance in assessing the research impact wherein studies are ranked on the basis of citations received. It also brings out the excellent contribution of authors and journals in adding evidence for future research. This study aimed at evaluating the top 100 most cited articles on anterior communicating artery (ACoA) Aneurysms. Scopus database was searched using title specific search for the aneurysm of ACoA and top 100 most cited articles along with their authors, author IDs, affiliated institutions, countries and funding bodies were identified. Search yielded 841 articles and top 100 articles were identified to include in this analysis which secured 5615 citations. Citations per year was also calculated to minimize the risk of bias. Maximum citations by any article were 242. The United States was the major contributor to the number of articles while Kessler Institute for Rehabilitation became the highest contributing institution. DeLuca J proved to be a pioneer in this specialized area as he penned 6 studies being first author in 4 of them, making him the most frequent author. National Institutes of Health and the U.S. Department of Health and Human Services were the main funding bodies. Subcategory analysis revealed, 50% studies provided evidence for the treatment and the surgical outcome of the aneurysm. Studies like these can aid in better neurological and neurosurgical management in decision making of ACoA aneurysm.

Role of Gamma Knife radiosurgery in trigeminal neuralgia - Its long term outcome and prediction using Artificial neural Network model.

PURPOSE: We aimed to study the long-term efficacy, prognostic factors and complications associated with the GKRS for trigeminal neuralgia. METHODS AND MATERIALS: Prospectively created database was analyzed for these patients. We created an Artificial neural Network - using Multilayer perceptron model in SPSS 23 by including all variables whose p value were<0.5 in univariate analysis. RESULTS: A total of 36 patients were included in the study. Patients pain free at 6 months were 25(69.44%), which reduced to 6(40 %) at 6 years. Median time to pain relief was 18.5 days. Only 5(13.88%) of them developed new onset or worsened numbness post Gamma Knife radio surgery. Median radiation dose was 80 Gy (prescribed at 100 percent isodose line). 1st GKT (P value < 0.05) and post GKT numbness (P value < 0.05) were the only factors favouring good outcome. Prior history of MVD was associated with poor pain relief post GKRS although p value was not significant (p = 0.136). ANN model could predict with 90.0 percent accuracy the favourable or unfavourable response on 11 Tested cases. In ANN model, a greater number of Pre GKT medications, previous MVD history, V2 dermatome involvement and negative history of post GKT numbness were negative prognostic factors. CONCLUSIONS: Lesser number of pre GKRS drugs used, involvement of V1 dermatome, post GKT numbness are favourable prognostic factors. Also, history of failed MVD for trigeminal neuralgia is associated with poor outcome. Repeat GKRS failed to show improvement in BNI grades.

Applications of Machine Learning in Pediatric Hydrocephalus: A Systematic Review.

INTRODUCTION: Annually, hydrocephalus affects nearly 7 children per 10,000 live births around the world. It significantly impairs the quality of life of such children and is associated with increased morbidity and mortality The high cost of treatment and post-intervention complications add to the burden of disease. Deployment of machine learning (ML) models in actual clinical settings have led to improved outcomes. OBJECTIVE: The aim of this systematic review is to analyze the utility as well as acknowledge the achievements of AI/ML in HCP decision making. METHODOLOGY: PubMed and Cochrane databases were used to perform a systematic search with proper terminology to include all the relevant articles up to May 2021. RESULTS: Fifteen studies that described the use of ML models in the diagnosis, treatment, and prognostication of pediatric hydrocephalus were identified. The median accuracy of prediction by the ML model in various tasks listed above was found to be 0.88. ML models were most commonly employed for ventricular segmentation for diagnosis of hydrocephalus. The most frequently used model was neural networks. ML models attained faster processing speeds than their manual and non-ML-based automated counterparts. CONCLUSION: This study attempts to evaluate the important advances and applications of ML in pediatric hydrocephalus. These methods may be better suited for clinical use than manual methods alone due to faster automated processing and near-human accuracy. Future studies should evaluate whether the use of these models is feasible in the future for patient care and management in field settings.