Nepal Journal of Neuroscience https://nepjol.info/index.php/NJN <p>Official journal of the Nepalese Society of Neurosurgeons (NESON). Also available on its own site at <a title="NESON" href="http://neson.org/" target="_blank" rel="noopener">http://neson.org/</a></p> <p>The Nepal Journal of Neuroscience is now accepting online submissions. Please <a href="/index.php/NJN/user/register">register</a> with the journal and select the author role to be able to submit your manuscript using the 5 step submission process.</p> en-US njns2004@yahoo.com (Dr Resha Shrestha) sioux.cumming@ubiquitypress.com (Sioux Cumming) Thu, 07 Jul 2022 07:25:44 +0000 OJS 3.3.0.6 http://blogs.law.harvard.edu/tech/rss 60 A case of Artery of Percheron infarct caused by Dengue virus encephalitis https://nepjol.info/index.php/NJN/article/view/44609 <p>In this communication, we describe a patient with dengue virus encephalitis who presented with fever and sudden onset bilateral oculomotor nerve involvement with left side hemi paresis, MRI showing bilateral thalamus and midbrain involvement (artery of Percheron infarct).</p> Archana Verma, Pragati Garg, Ashutosh Kumar Mishra Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/44609 Thu, 07 Jul 2022 00:00:00 +0000 Spinal epidural Cavernous Hemangioma mimicking Schwannoma: Case report and review of literature https://nepjol.info/index.php/NJN/article/view/43608 <p>Pure epidural spinal cavernous hemangiomas are encountered rarely in clinical practice. These lesions are more commonly found in the thoracic region and present with features of myelopathy. Presentation is usually insidious due to slow growth of these tumors, however, acute neurological deterioration is possible in cases with intra-lesional hemorrhage. Surgery is the treatment of choice with patients having good outcomes after complete resection. Due to high vascularity there may be excessive blood loss intra-operatively which might limit complete resection. It is for these reasons that these lesions should be considered in the differential diagnosis of spinal epidural lesions. Literature on these lesions reveals that these tumors are pre-operatively misdiagnosed as schwannomas. We report a case of an elderly male who presented with features of myelopathy and an epidural lesion in the thoracic region. A diagnosis of spinal epidural schwannoma with paravertebral extension was made pre-operatively on the basis of imaging characteristics. However, the lesion was found to be highly vascular during surgery and post-resection histopathology revealed a cavernous hemangioma.&nbsp; &nbsp;</p> Abhinav Debanath, Subir Dey Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/43608 Thu, 07 Jul 2022 00:00:00 +0000 Lipomatous Cystic Meningioma Mimicking High Grade Glioma: A Rare Case Report with Brief Review of Literature https://nepjol.info/index.php/NJN/article/view/43460 <p>Lipomatous meningioma is rare variant of meningioma. A 34 year old male was presented with intermittent headache, dizziness, slurring of speech and right hand numbness and weakness since 15days. Patient came at OPD with Computed Tomography (CT) scan and it reported that a well defined thick walled heterogeneous mass. Brain magnetic resonance imaging (MRI) was done where it reported that large (6.3 x 6.5 x 4.7 cm) T1 hypo-intense and T2 hyer-intesne enhancing mass with non-enhancing cystic lesion and surrounding edema in left parietal lobe suggesting high grade glioma. Left parietal craniotomy and total excision of mass was performed. Histopathology diagnosis was a rare Lipomatous Meningioma.</p> Mohan Karki, Yam Bdr Roka Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/43460 Thu, 07 Jul 2022 00:00:00 +0000 Multidisciplinary approach in the management of neurotrauma and its sequelae https://nepjol.info/index.php/NJN/article/view/43733 <p>It is well known that traumatic brain injury (TBI) can long-term consequences of major public health concern. It can be said that wide spectrum and distinct lesions resulting in variable clinical consequences make the process of post-TBI rehabilitation challenging. A patient who sustains TBI can have variable outcome ranging from complete recovery to persistent vegetative state. Between these two there is a spectrum of TBI related sequel which may be disturbed levels of consciousness, post-traumatic agitation, post-traumatic paroxysmal sympathetic hyperactivity, posttraumatic hydrocephalus, and posttraumatic neuroendocrine dysfunctions all these requiring different rehabilitation programmes and rehabilitation approaches.&nbsp;</p> Amit Agrawal Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/43733 Thu, 07 Jul 2022 00:00:00 +0000 Neuromonitoring in Neurosurgery : An imperative redemption https://nepjol.info/index.php/NJN/article/view/45614 <p>With the refinement in biomedical gadgetry, it has been a modern day requisite to safeguard the indigenous neuro-architecture and henceforth foretell the postoperative neurological outcome. The intraoperative neuro-physiological monitoring (IONM) comes as no surprise to be the only credible paradigm which can cluethe standing of neural pathway directly during general anesthesia. By engaging with the IONM appliance, the operating surgeon can acknowledge the risk of injury to critical neural structure while dealing with the pathology within its vicinity. Based on the province of the encephalon, a disparate methods of IONM such as MEP, SSEP, ABR, VEP, BCR, AMR etc have unfolded over time.</p> <p> </p> <p>Intraoperative monitoring of motor evoked potentials (MEPs) has been believed to be advantageousin preventing postoperative motor dysfunction while coping up with aneurysmal surgery involving the internal carotid artery (ICA) and middle cerebral artery (MCA) and resection of tumor near sensorimotor areas or corticospinal tract.<sup>3–6</sup>The fundamental essence of MEP monitoring is based on the detection of a pyramidal tract insult expressed as a decrease of the amplitude of the waveform elicited by electrical stimulation.</p> <p>Conversely, Somatosensory evoked potentials (SSEPs) embraces a series of wave forms that emulate sequential activation of neural structures along the somatosensory pathways.<sup>7</sup> The representative stimulation sites classically used for clinical diagnostic in the course of SSEPs studies are the median nerve at the wrist, the common peroneal nerve at the knee, and the posterior tibial nerve at the ankle. Over and above that, SSEPs have been used as an indicator of cerebral ischemia during CEA, although far less commonly and as a surrogate alternative to EEG. SSEPs primarily gauge the integrity of the dorsal (sensory) column of the spinal cord. It furnishes with the real-time examination of spinal tracts at risk during surgical manipulation of the spinal cord such as spinal tumor and pedicle screw instrumentation.</p> <p>Likewise, Auditory brainstem response (ABR) is a test which can assess the brain wave activity and diagnose dysfunctions of the auditory pathways within the auditory nerve and brainstem that occurs in response to an stimuli with clicks or certain tones.<sup>8</sup>This is notably useful in the surgery of CP angle tumor such as vestibular schwannoma, Microvascular decompression for hemifacial spasm and trigeminal neuralgia.</p> <p>In any neurosurgical endeavour, where a visual field impairment is contemplated during the intraoperative period, the monitoring of flash visual evoked potential (VEP) comes as a rescue to evaluate the state of visual function.<sup>9</sup>This manoeuvre is explicitly virtuous while performing tumorectomy at the optic chiasm of pituitary adenomas, craniopharyngiomas, tuberculum sellae meningiomas, and other tumors; the removal of brain tumors from the optic pathway and structures in its vicinity such as the optic nerve, optic radiation, and occipital lobe; and clip ligation of aneurysm involving the internal carotid artery, which strike a pose of risking injury and impeding blood flow to the ophthalmic artery.<sup>9</sup> Monitoring intraoperative flash visual evoked potentials (VEPs) estimate the functionality of the optic pathway from the retina to the visual cortical area, and hence allows visual impairment to be avoided or minimized.</p> <p>The bulbocavernosus reflex (BCR) is anillustrious somatic reflex that is convenient in gaining information about the state of the sacral spinal cord segments.<sup>10</sup> When present, it is indicative of an intact spinal reflex arcs (S2–S4 spinal segments) with afferent and efferent nerves through the pudendal nerve. BCR is of the greatest utility for the monitoring of sacral function in detethering of the tethered cord syndrome.<sup>11</sup> A surface electrode is used to electrically stimulate the pudendal afferent fibers at the clitoris or penis and recording of the analogous triggered EMG in external anal sphincter using a subdermal needle electrode.</p> <p>The abnormal muscle response (AMR), which is also known as lateral pread response, is adopted in the microvascular decompression (MVD) for hemifacial spasm.<sup>12</sup>A complete disappearance of AMR after a convincing MVD from root exit zone implicate a postoperative disappearance of the hemifacial spasm. Nonetheless, the persistence of the AMR does not mean incomplete MVD.</p> <p> </p> Pritam Gurung Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/45614 Thu, 07 Jul 2022 00:00:00 +0000 Minimally invasive short segment pedicle screw fixation for Thoraco-Lumbar Trauma: Where we stand? https://nepjol.info/index.php/NJN/article/view/41429 <p><strong>Background &amp; Overview of Literature: </strong><span style="font-weight: 400;">Use of MISS or Percutaneous pedicle screws for thoracolumbar trauma has shown</span><span style="font-weight: 400;">&nbsp;superiority in terms of postoperative pain, blood loss, operating time, hospital stay and incision size</span><span style="font-weight: 400;"> as compared to open surgical method. The use of MISS in thoracolumbar trauma has been limited due to the high cost and lack of posterolateral fusion. There is conflicting evidence for and against the use of MISS in AO spine A3/A4 fractures without any neurological deficit and maybe managed conservatively as well. </span><strong>Purpose: </strong><span style="font-weight: 400;">To establish efficacy and safety of MISS, short segment pedicle screw fixation in patients of thoraco-lumbar fractures but without any neurological deficit. </span><strong>Study Design:</strong><span style="font-weight: 400;"> Retrospective case reports of 2 years in which 20 patients of thoraco-lumbar trauma that underwent minimally invasive short segment spine fixation were included. </span><strong>Material &amp; Methods: </strong><span style="font-weight: 400;">Retrospective analysis of 20 patients of thoraco-lumbar spine fractures that were operated from 2017 to 2019 at Government Medical College &amp; Hospital, Chandigarh. Patients included were in the age group of 23-70 years, operated within one week of trauma, AO type A3 and A4, and operated using short segment fixation. Our exclusion criteria were trauma more than one week old, multiple levels of fractures and non-traumatic fractures. Clinical and radiological data were collected and tabulated. </span><strong>Results: </strong><span style="font-weight: 400;">Most patients (8 out of 20) had fracture of D12 vertebra. 18 out of 20 patients were involved in a road traffic accident. The mean blood loss was 25.78 mL. Cobb’s angle was used to measure focal deformity and the average gain in Cobb’s angle after surgery was 10.9°. Mean loss in correction was 2.35°. All patients were pain-free after 6 months as measured on the VAS score. The average time taken in getting back to work after surgery was 26 days. </span><strong>Conclusion: </strong><span style="font-weight: 400;">MISS is the ideal treatment of choice in patients of thoraco-lumbar spine trauma without any neurological deficit. MISS provides higher safety, early mobilization, </span><span style="font-weight: 400;">less blood loss during surgery, shorter recovery time, and less post-operative pain.</span></p> Vipin Kumar Gupta, Arvind malhora, Ashwani kumar Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/41429 Thu, 07 Jul 2022 00:00:00 +0000 Outcome of microsurgical clipping of ruptured intracranial aneurysms: An early experience https://nepjol.info/index.php/NJN/article/view/40583 <p><strong>Introduction: </strong>Rupture of intracranial aneurysm is a catastrophic event with a mortality rate of 25% to 50%. Despite recent advances in endovascular techniques, microsurgical clipping is the standard modality of treatment due to its relative low cost and feasibility. We prospectively analyzed the cases of microsurgically clipped aneurysms with an aim to evaluate the overall outcome and the pretreatment variables predicting outcomes.</p> <p><strong>Materials and methods: </strong>This is the prospective study of 15 consecutive microsurgical clippings of ruptured intracranial aneurysms conducted in the Department of Neurosurgery at College of Medical Sciences Teaching Hospital, Chitwan, Nepal from April 2018 to March 2020. Patients were followed up for at least three months and assessed according to modified Rankin Scale (mRS).</p> <p><strong>Results: </strong>The mean age of patients was 55.47 years with female predominance. The most common location of aneurysms was Middle cerebral artery bifurcation (53%). Favorable outcome (mRS score 1 to 3) was achieved in 60% of patients whereas 40% had unfavorable outcome (mRS score 4 to 6). Poor Hunt and Hess at presentation and presence of vasospasm/infarction were associated with poor outcome. Overall mortality rate was 27%. Three patients required VP shunt whereas three patients each had vasospasm/Delayed ischemic neurological deficit (DIND) and intra-operative rupture.</p> <p><strong>Conclusion: </strong>Microsurgical clipping of aneurysms is a standard treatment modality with good results despite recent advances in endovascular techniques. Favorable outcome can be achieved in patients with good Hunt and Hess grade at presentation and without clinical vasospasm/DIND.</p> Somraj Lamichhane, Sabin Tripathee, Ruchi Dev Bhandari Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/40583 Thu, 07 Jul 2022 00:00:00 +0000 An eminent rendezvous with a series of cranial vault remodeling for Craniosynostosis https://nepjol.info/index.php/NJN/article/view/42999 <p>In defiance with the meager tally of craniosynostosis, the surgical treatment of non syndromic craniosynostosis is one of the most common stratagem detained by craniofacial surgeon. By dint of the onerous anatomy secondary to the imperfection in embryogenesis, a long haul of drill is required to obtain perfection in surgical sequel.<sup>1</sup>&nbsp;</p> <p>With the advancement in neurosurgical gadgetry and improvement in agility of neurosurgical authority, a multitude of strategy has evolved over time with the eminent intent to bring forth the supreme aftermath.</p> <p>Browsing through the archives of craniofacial reconstruction discloses vault remodeling techniques evolving over time with disparate modification tactics to the inception of state-of-the-art strategies like endoscopic suturectomy, spring treatment and cranial vault distraction osteogenesis.<sup>2</sup></p> <p>Regardless of all these alternatives, we still resort to the standard cranial vault remodeling with a fairly approving outcome. We herein attempt to disclose our result of vault remodeling in a series of patients with craniosynostosis.</p> Bishal Shrestha, Pritam Gurung, Jessica Kayastha, Aditi Agarwal, Resha Shrestha, Samir Acharya, Sudan Dhakal, Pravesh Rajbhandari, Pranaya Shrestha, Basant Pant Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/42999 Thu, 07 Jul 2022 00:00:00 +0000 Brain arteriovenous malformation involving a persistent primitive olfactory artery https://nepjol.info/index.php/NJN/article/view/45417 <p>The incidence of a persistent primitive olfactory artery is extremely rare. This anomaly may be involved in the development of aneurysms due to hemodynamic stress. We report a patient with a brain arteriovenous malformation mainly fed by a persistent primitive olfactory artery. A 40-year-old healthy man experienced transient numbness around the left side of his mouth. Magnetic resonance imaging incidentally disclosed flow voids inside and at the medial part of the pre-central gyrus of the left frontal lobe with dilation of the cortical veins. A left internal carotid artery angiogram revealed that a left persistent primitive olfactory artery with a proximal hair-pin turn fed an anterior component of the nidus. A right internal carotid artery angiogram showed that the right bihemispheric anterior cerebral artery fed a posterior component of the nidus. There was no aneurysm in the nidus or on the feeding vessel. The diagnosis was asymptomatic arteriovenous malformation (Spetzler-Martin grade 3). The patient developed systemic exanthema with facial edema after diagnostic angiography. We ruled out target embolization followed by stereotactic radiosurgery and placed him under close conservative outpatient observation. We suspect that the arteriovenous malformation was due to the presence of a pre-exiting persistent primitive olfactory artery. In patients with a persistent primitive olfactory artery, structural fragility and hemodynamic stress may elicit aneurysms at the apex of the hairpin curve of the persistent primitive olfactory artery.</p> Minoru Ideguchi, Kyongsong Kim, Shushi Kominami, Akio Morita Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/45417 Thu, 07 Jul 2022 00:00:00 +0000 Factors predicting leaving against medical advice in Neurosurgery: A prospective observational study from Nepal https://nepjol.info/index.php/NJN/article/view/43168 <p><strong>Introduction</strong>: Though leave against medical advice (LAMA) is a common healthcare problem in low-income countries, there is paucity of studies exploring this aspect of care from Nepal. Our study aims to find out the prevalence of LAMA, its reasons and any differences that exist among patients in neurosurgery versus other specialties.</p> <p><strong>Methods:</strong> A prospective, cross-sectional study was carried out among patients discharged against medical advice from September 2020 through February 2021 at Gandaki Medical College, Pokhara. </p> <p><strong>Results:</strong> A total of 150 patients were included, 29.3% (n=44) from neurosurgery and 70.7% (n=106) from other departments. The overall rate of LAMA was 5.68%; 16.73% from neurosurgical service. In the neurosurgical cohort, mean age was 61.41±18.72 years and majority of patients were males (65.9%). Most patients were Hindu by religion (97.7%), illiterate (59.1%), married (93.2%), with history of substance abuse (63.6%), admitted directly to the ICU (88.6%) and lacked insurance (79.5%). Financial insufficiency (40.9%) followed by expected poor prognosis of the disease (25%) were reported as major reasons for LAMA. Statistically significant differences (p&lt;0.05) were observed in neurosurgical patients when compared to patients from other departments in terms of age, gender, educational status, history of substance abuse, place of in-patient admission, treatment modality recommended, status of mechanical ventilation and insurance status. In-patient admission to the ICU and proposal of surgical intervention were predictive of LAMA among neurosurgical patients.</p> <p><strong>Conclusions:</strong> The rate of LAMA was high in neurosurgery. Educating general public about neurosurgical care and widespread implementation of health insurance seem important policy-implications.</p> Shabal Sapkota, Mitesh Karn, Bhoj Raj Neupane, Bandana Gurung, Chandika Pandit, Tirtha Upadhyay, Brihaspati Sigdel, Dipendra Kandel Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) http://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/43168 Thu, 07 Jul 2022 00:00:00 +0000 Prediction of Quality of Life by Helsinki CT Scoring System in Patients with Traumatic Brain Injury https://nepjol.info/index.php/NJN/article/view/42293 <p><strong>Introduction: </strong><span style="font-weight: 400;">Traumatic brain injury (TBI) is an alteration in normally maintained homeostasis and function of the brain owing to any external forces. It is one of the major causes leading to increased disability and morbidity among patients suffering trauma. Hence, we aim to study the association between Helsinki computed tomography CT score on admission to patient’s Quality of Life (QoL) following traumatic brain injury in Dhulikhel Hospital, Nepal. </span></p> <p><strong>Methods and Materials </strong></p> <p><span style="font-weight: 400;">A prospective observational study was conducted among 44 patients who suffered traumatic brain injury. Eligible patients over 18 years of age diagnosed with traumatic brain injury which is confirmed with a computed tomography scan on admission were included. Outcomes were assessed using the quality of life scale “Project for the Epidemiological Analysis of Critical Care Patients scale (PAEEC)”. </span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Among 44 participants suffering from TBI owing to various modes of injury, male to female ratio was 2.3:1. The mean age among participants was 41.07 years with standard deviation of ± 20.13 (Range 18 – 90 years). Correlation analysis showed that QoL, up to 6 months post-TBI, was significantly associated with Helsinki CT classification. Group 1 and group 2 encompassed subjects who sustained TBI and are in their scheduled 3 monthly and 6 monthly follow up. And significant correlation was noted between two variables r</span><span style="font-weight: 400;">1</span><span style="font-weight: 400;"> = 0.536, p-value = 0.027 and r</span><span style="font-weight: 400;">2</span><span style="font-weight: 400;"> = 0.565, p-value = 0.001 respectively. </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">The present study showed that patients with TBI experience significant quality of life deterioration up to 3-6 months post-TBI. And such deterioration can be predicted by use of Helsinki CT score on admission.</span></p> Bibhusan Shrestha, Robin Man Karmacharya, Narendra Shalike Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/42293 Thu, 07 Jul 2022 00:00:00 +0000 Comparative study of diffuse midline glioma and glioblastoma: Magnetic Resonance Imaging (MRI) in the characteristics and demography https://nepjol.info/index.php/NJN/article/view/43724 <p><strong>Introduction:</strong> Diffuse midline glioma and glioblastoma are classified as grade IV CNS tumors (WHO). The entity ‘diffuse midline glioma, H3 K27 mutant’ was introduced in the 4<sup>th</sup> revised edition of the 2016 WHO classification of brain tumors; however, there are only a few reports on Magnetic Resonance Imaging of these tumors. Thus, we conducted a retrospective study focused on Magnetic Resonance Imaging features of diffuse midline glioma compared to glioblastoma. This study aims to evaluate and compare the demographic characteristics, anatomic location of lesions, and MRI characteristics of diffuse midline glioma and glioblastoma.</p> <p><strong>Methods:</strong> We histologically confirmed 30 patients with diffuse midline glioma and 70 patients with glioblastoma were enrolled in this retrospective study.</p> <p>Pretreatment MRI of each patient was reviewed by a neuroradiology issuing physician and neuroradiology reporting physician for MRI characteristics of tumors. Comparative analysis was performed of the imaging pattern to show differences between diffuse midline glioma and glioblastoma with the p-value.<strong> </strong></p> <p><strong>Results:</strong> The age of patients with diffuse midline glioma (mean age =24.7 ±10.4) was significantly lower than in those with glioblastoma (mean age =48.2 ±1). The majority of patients with diffuse midline glioma (56.7%) and glioblastoma (51.4%) were ≤ 25 and ≥ 50 years age group respectively. The most common location of diffuse midline glioma and glioblastoma were the thalamus (73.3%) and frontal lobe (37.1%) respectively. The presence of hydrocephalus, edema, and invasion were statistically significantly differences in patients with diffuse midline glioma (hydrocephalus = 46.7%, edema = 53.3%, and invasion =30%) than in those with glioblastoma (hydrocephalus = 12.9%, edema = 88.6%, and invasion =5.7%) <em> </em>(<em>P </em>&lt; 0.05 each).</p> <p><strong>Conclusions: </strong>Despite having similar imaging features, diffuse midline glioma exhibited marked differences in age, edema, invasion, and hydrocephalus in MRI compared to Glioblastoma.</p> Sabendra Joshi, Yuan-Kui Wu, Yi-Kai Xu, Xiao-Min Liu, Hao Zhang Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/43724 Thu, 07 Jul 2022 00:00:00 +0000 Hospital Course and Outcome of Patients Admitted to Critical Care Unit with Cerebral Venous Sinus Thrombosis https://nepjol.info/index.php/NJN/article/view/45448 <p><strong>Introduction</strong>: Cerebral venous sinus thrombosis (CVST) is a potentially serious neurological condition. Yet, non-specific clinical and radiological features of cerebral venous sinus thrombosis, making it delay in the diagnosis and subsequent management. This study aims to find the hospital course and outcome of patients.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was done in patients with diagnosis of cerebral venous sinus thrombosis confirmed by computed tomography or by magnetic resonance imaging with magnetic resonance venography. Demography, clinical features, hospital course and outcome at hospital discharge were recorded and analysed.</p> <p><strong>Results:</strong> A total of nine patients included in the study. Mean age of patient was 33.22 ± 9.24 years with male to female ratio of 1:2. Headache was the most common presenting symptom found in eight patients. GCS at admission of all of the patients were 15 except for 2 patients. Surgical intervention was required in two patients. Good outcome with mRS score of 0 was found in eight patients at hospital discharge. No mortality was observed in this study.</p> <p><strong>Conclusions:</strong> Favorable outcome was found in most of the patients at hospital discharge. Nonetheless, complications can occur during the hospital course which might require surgical intervention.</p> Bidur KC Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/45448 Thu, 07 Jul 2022 00:00:00 +0000 Delta-like factor 1 negatively regulates angiogenesis as a target gene of miR-126-5p after indirect revascularization surgery in patients with moyamoya disease https://nepjol.info/index.php/NJN/article/view/43886 <p>Promoting endothelial cell (EC) proliferation and angiogenesis after indirect revascularization surgery is crucial for decreasing the stroke rate in moyamoya patients. However, the role of delta-like factor 1 (DLK1) in regulating EC proliferation in chronically ischaemic brains and the specific mechanisms remain unclear. Therefore, we compared the expression levels of DLK1 in the dura mater (DM) tissues of &nbsp;patients with moyamoya disease and patients with aneurysms, and dual luciferase reporter and RNA binding protein immunoprecipitation assays were conducted to determine whether DLK1 is a target gene of miR-126-5p. The effect of DLK1 on EC proliferation and the interaction between DLK1 and miR-126-5p were explored in vitro. Then, we established an animal model of two-vessel occlusion together with encephalo-myo-synangiosis (2VO+EMS). The temporalis muscles (TMs) of the animals were transfected with DLK1 lentiviral RNA (Lv-DLK1) and short hairpin RNA (sh-DLK1) to compare the DLK1 expression, angiogenesis (CD31 count), and numbers of vacuoles and impaired tight junctions in the ECs of TM-covered chronically ischaemic brains as well as the cognitive improvement in each group. DLK1 expression was lower in the DM tissues of moyamoya patients than in those of the aneurysm patients, and DLK1 was identified as a target gene of miR-126-5p. In vitro, DLK1 inhibited EC proliferation, migration and angiogenesis and exerted effects opposite those of miR-126-5p. In 2VO+EMS rats, compared to the control transfection, the TM transfection of Lv-DLK1 induced significantly higher DLK1 expression and worse angiogenesis in the TM-covered ischaemic brain as well as less extensive cognitive improvement, while the transfection of sh-DLK1 into the TM had the opposite effects. In summary, DLK1, a target gene of miR-126-5p, negatively regulates angiogenesis in chronically ischaemic brains and is expected to be a new target to improve the efficacy of indirect revascularization surgery and the prognosis of moyamoya patients.</p> Yang Yang, Cong Ling, Shuangqi Gao, Chao Li, Robin Bhattarai, Hui Wang, Chuan Chen Copyright (c) 2022 Nepalese Society of Neurosurgeons (NESON) https://creativecommons.org/licenses/by-nc/4.0 https://nepjol.info/index.php/NJN/article/view/43886 Thu, 07 Jul 2022 00:00:00 +0000