Background and Importance: Spinal epidural hematoma (EDH) is a rare clinical condition that occurs spontaneously in patients with a spine injury. Most patients require laminectomy and evacuation of spinal EDH. Magnetic resonance imaging (MRI) of the spine with magnetic resonance angiography is the chosen radiological investigation. This study aims to review cases with spinal EDH and discuss its etiology, pathogenesis, investigations, and various management strategies.
Case Presantation: This is a retrospective analysis study of five spinal EDH cases admitted at our institute from August 2020 to August 2021. Four patients underwent laminectomy and evacuation, while one was managed conservatively because of rapid clinical improvement. The patients’ functional outcomes were assessed by using American spinal cord injury association impairment scale (AIS) before and after treatment. Four of the five patients who participated in this study had significant neurological improvement. One of the patients who presented late to us had poor neurological recovery despite the surgical intervention.
Conclusion: Surgical evacuation of spinal EDH within 48 hours of the onset of symptoms ensures good clinical recovery. Spontaneous resolution is possible in some cases if patients have an improvement in their neurological status early in the course of the disease. Hence, we conclude that prompt treatment in spinal EDH patients ensures maximum functional recovery. Patients with spinal EDH need close follow-up and periodical neurological examination.

Background and Aim: Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by paroxysmal and transient episodes of fever, tachypnea, tachycardia, hypertension, diaphoresis, and dystonia following non-noxious stimuli. It is a rare clinical condition and is seen
in patients with acquired brain injury (trauma, meningitis, encephalitis, and stroke). Paroxysmal sympathetic hyperactivity-assessment measure (PSH-AM) is a clinical tool for diagnosing PSH. This study aims to describe the clinical characteristics and the outcomes of PSH.
Case Presentation: Of the 412 patients admitted to the neurosurgery intensive care unit at PSGIMSR, Coimbatore, India, 11 (2.6%) patients were diagnosed to have PSH according to the PSH-AM scale. Trauma (72%) was the leading cause of the development of PSH. All patients
(100%) had developed at least two PSH episodes per day that persisted for at least 3 consecutive days. Tachycardia and tachypnea were the most common symptoms noted in all PSH patients. The Glasgow Outcome Score (GOS) was less than 3 in 72% of PSH cases at the time of discharge, indicating a poor outcome.
Conclusion: Traumatic brain injury remained the leading cause of PSH. The duration of hospitalization was increased in patients with PSH. Along with the prompt treatment of the primary disease, appropriate medications to overcome sympathetic hyperactivity ensure better recovery for these patients. Patients with PSH had relatively poor GOS at the time of discharge.

Background and Aim: We assessed surgical cases with giant epidural hemorrhages that have a significant influence on therapeutic as well as clinical prognosis.
Methods and Materials/Patients: A total of 112 cases underwent surgery for epidural hemorrhage in an Emergency Neurosurgical Department of the Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India (a rural hospital), between January 1, 2022, and March 31, 2023. We defined giant epidural hemorrhage as a quantity of more than 80 cc. The therapeutic and prognostic features of 15 people with giant epidural hemorrhage with a hematoma volume of 80 cc were studied further.
Results: The most prevalent age group was between 20 and 40 years (53.33%). M2 response (60%) represented the most frequent motor movement among giant epidural hemorrhage victims who underwent surgery. The majority of them (86.66%) suffered from serious brain damage. The Glasgow Coma Scale (GCS) score on admission, pupil alterations, and motor movement were all associated with the prognosis of giant epidural hemorrhage surgery.
Conclusion: Giant epidural hemorrhage > 80 cc performs badly. The GCS on admission, pupil alterations, and motor movement are all markers of the operative prognosis of a large epidural hemorrhage.
 

Background and Aim: Numerous prognostic factors for spontaneous intracerebral hemorrhage have been advocated; however, only a few studies have specifically addressed basal ganglia bleed prognosis and management. Regarding basal ganglia bleeding, this study determines the predictors
of functional outcomes and predictors of severe disability or death in surgically treated cases.
Methods and Materials/Patients: This was a one-time follow-up study of 271 spontaneous basal ganglia bleed patients undergoing surgical intervention over 3 years. An electronic hospital database was used to collect data regarding clinical and radiological parameters and functional outcomes according to the glasgow outcome scale (GOS) three months after the hemorrhage.
Results: We analyzed 271 cases, with a mean age of 50.8±13.57 years. At the end of 3 months, 53.87% of patients had favorable outcomes (GOS=4, 5), 9.59% had poor outcomes (GOS=2, 3) and mortality was 37.75% (GOS=1) at the end of 3 months. Independent predictors of poor outcome were age (odd ratio [OR]=1.81, 95% CI, 1.09%, 3.02%, GCS OR=6.93, 95% CI, 1.52%, 31.51%), hematoma volume more than 60 mL (OR=12.73, 95% CI, 3.29%, 49.23%, midline shift (OR=2.78, 95% CI, 1.64%, 4.73%), the left side of bleed (OR=1.81, 95% CI, 1.11%, 2.94%), intraventricular hemorrhage (OR=2.94, 95% CI, 1.72%, 5.02%) and intraventricular hemorrhage associated with hydrocephalus (OR=22.30, 95% CI, 6.35%, 78.27%). There was a significant association between these factors and poor outcomes (P<0.05).
Conclusion: Almost half of the patients with large basal ganglia hemorrhage survivors were severely disabled or died within three months after the event. Basal ganglia hemorrhage was associated with severe disability or death among patients aged over 60 years with left-side bleeding, low
GCS on admission, preoperative computed tomography scan showing midline shift of more than 5mm with the presence of intraventricular hemorrhage or associated hydrocephalus and a large hematoma volume.

Background and Aim: Intramedullary spinal cord tumors (IMSCTs) are rare tumors of the spine. The study aims to analyze the clinical profile and surgical management of IMSCTs.
Methods and Materials/Patients: This is a retrospective study to review the IMSCTs operated between January 2007 to December 2021. Myxopapillary ependymomas were excluded from the study.
Results: There were twenty-seven operated cases of IMSCTs. The Mean±SD age was 39±22 years. Fifteen (55.5%) were males and 12(44.5%) were female patients. There were 6(22%) cervical, 7(26%) cervicodorsal, 9 (33%) dorsal, and 5(19%) dorsolumbar IMSCTs. The Mean±SD duration of symptoms was 10±14 months. Ten (37%) patients had spinal cord syrinx. Motor weakness and pain were the most common symptoms. Intraoperative gross total resection (GTR) was achieved in 12(44.4%) patients, near-total resection in 4(14.8%) patients, subtotal resection in 2(7.4%) patients, decompression in 7(26%) patients, and biopsy in 2(7.4%) patients. Eighteen (66.6%) patients had neurological status same as preoperative status. Four (14.8%) patients had improvement and 5(18.5%) patients had deterioration in neurological status. Ependymoma was the most common histological type of IMSCT (40.5%). Other lesions are glioma, hemangioblastoma, lipoma, schwannoma, lymphoma, capillary hemangioma, arachnoid cyst, and epidermoid cyst with spinal dysraphism. Ependymomas had well-defined margins compared to other gliomas. Duration of stay in the hospital was 9±3.5 days. Conclusion: Dorsal spine is the most common location of IMSCTs and ependymoma is the most common histological type. It is the surgeon’s intraoperative decision regarding the extent of resection of the tumor based on the spinal cord infiltration and tumor type. GTR is possible in the majority of ependymomas and some other histological tumors like schwannoma, arachnoid cyst, and epidermoid cyst.

Background and Aim: Transcranial endoscopic surgeries are mainly limited to intraventricular lesions. This study aims to elaborate on the various benefits of transcranial endoscopic surgeries in extraventricular regions of the brain.
Methods and Materials/Patients: It is a retrospective study of transcranial extraventricular endoscopic surgeries (TEESs) operated between June 2022 to May 2023. The authors described the surgeries done for brain lesions other than intraventricular lesions as extraventricular surgeries. Access to the intracranial region was obtained through the transcranial approach. The transnasal rigid endoscope was used for the surgeries. The surgery was performed as either pure endoscopic surgery or endoscopic-assisted microscopic surgery.
Results: The authors have performed 6 microvascular decompressions using an endoscope. Three pineal tumors, 3 craniopharyngiomas, 1 cerebellopontine angle epidermoid cyst, and 1 petrous neurenteric cyst were excised using an endoscope by transcranial approach. One internal carotid artery bifurcation aneurysm was clipped using an endoscope. All patients improved in the postoperative period. Surgeries were done using the 0-degree and 30-degree endoscopes. The endoscopic eye was able to reach the deep-seated area of surgical interest and authors were able to visualize the structures in a wide panoramic view with good illumination and magnification. There was no misinterpretation of structures.
Conclusion: Endoscope can reach the deep-seated extraventricular areas of the brain with a narrow corridor, giving good illumination and magnification at the site of surgery. An endoscope can reach beyond the obstructing anatomical structure and visualize the area behind it. It is used as a complimentary to microscope to access the microscopic invisible areas. It has increased the ease of doing surgery, decreased tissue dissection, decreased complications, and improved surgical results. TEES improves the hand-eye coordination of surgeons in transcranial surgeries and it will help in adapting to exoscope easily

Background and Aim: Traumatic Brain Injury (TBI) is often described as a “hidden epidemic.” Various biochemical markers reflecting cerebral damage can be used to correlate the patient's prognosis and the development of secondary lesions. We studied human Superoxide dismutase (SOD) in the serum to evaluate its role in the outcome of TBI.
Methods and Materials/Patients:
 This observational study was conducted in patients with severe TBI who presented to a tertiary care hospital in India. A total of 40 patients with severe TBI were enrolled, with 40 healthy people taken as controls. Serum samples were assayed for serum SOD using the ELISA technique.
Results:
 The most common age group was 28-37 years. Of 40 patients, 28 were male (70%), and 12 were female (30 %). The most common mode of injury was road traffic accident (70%), followed by fall from height (12.5%), physical assault (12.5%) and sports injury (5%). The most common CT finding was intra-cerebral haematoma (55%), followed by sub-arachnoid haemorrhage (SAH) (10 %), skull fracture (10 %), subdural haemorrhage (SDH) (7.5%) and extradural haemorrhage (EDH) (5%). The mean serum SOD value in the severe TBI group was 23.23 U/ml, and in the control group, it was 135.93 U/ml, which was statistically significant. Out of 40 patients, 24 (60%) had a good Glasgow Outcome Scale (GOS) at the time of discharge, and 16(40%) had poor outcomes. There was a significant improvement in outcome after six months compared to GOS at discharge.
Conclusion:
The results obtained in the study are preliminary, and more extensive prospective studies are needed to reach a definitive conclusion. A handful of studies on protein degradation products are available and need to be more comprehensive. In conclusion, with more extensive studies and continued exploration SOD can become a reliable tool in TBI and can be integrated into standard care protocols.
 

Background and Importance: Neurenteric cysts (NCs) account for 0.7 to 1.3% of all spinal tumors and are most commonly present during the first three decades of life. Only two cases have been reported in individuals in their 7th and 8th decades of life. This study described a rare case of an NC in a septuagenarian (70 – 79 years of age) who presented with atypical features of the disease.
Case Presentation: A 77-year-old female patient presented with acute onset paraparesis. Magnetic resonance imaging revealed a 13.6 × 14.1 × 15.4 mm intradural extramedullary cystic lesion, which was anteriorly located at the C7-D1 level. It was T1 hypointense, T2 hyperintense, and showed faint contrast enhancement at the junction between the cyst and the spinal cord. At surgery, a cyst with a greyish-white thin wall was noted in the spinal canal, displacing the spinal cord posteriorly. The cyst wall was partially excised, and a small portion adhering to the spinal cord was left behind. The histopathology report was consistent with an NC. At the 2-week follow-up, the patient’s lower limb strength had improved.
Conclusion: Although rare, NCs can present in the seventh decade of life. Magnetic resonance imaging may reveal unusual findings, like T1 hypointensity and faint contrast enhancement of the cyst wall. In elderly patients, a portion of the cyst wall may be left behind if it adheres to the spinal cord to avoid the risk of neurological deterioration.