Perspective Chapter: Glioblastoma of the Corpus Callosum

Glioma is the most common malignant tumour of the brain, in which glioblastoma (GBM) is the most aggressive form which infiltrates through the white fibre tracts. Corpus callosum (CC) is most invaded by GBM, it carries poor prognosis as mostly these tumours are not touched upon due to the belief of post operative cognitive decline, or there is incomplete resection leading to tumour recurrence. However current advancement in technology, operative techniques and better understanding of nature of CC-GBM, maximal safe resection is being carried out with better outcomes in comparison with the GBM without infiltration of CC

Spinal Shock: Clinical Pearls

Spinal shock is a clinical manifestation following injury to the spinal cord resulting from multiple mechanisms. It is a complex phenomenon with flaccid paralysis, absent anal wink, and bulbocavernosus reflex. Management strategy for such patients includes rapid evaluation and treatment strategies to minimize the impact of secondary spinal cord injury. The advanced trauma life support (ATLS) guidelines provide the basis for rapid assessment and stabilization of A (Airway), B (Breathing), and C (Circulation) before dealing with the neurological deficits under the primary survey. The emergence of better radiological investigations has been pivotal in categorizing spinal syndromes and reaching a precise diagnosis. Early initiation of treatment measures results in better neurological and functional recovery with minimal residual deficits. The role of steroids in spinal shock has been a highly debated topic, and the timing of surgery is variable, intending to eliminate the secondary injury. Clinical differentiation between neurogenic and hypovolemic shock is vital, enhancing the quality of care with realistic outcome expectations

Airway management in neurotrauma care: Basic considerations

The predictability of the airway compromise affects the decision for tracheal intubation. Associated specific injuries, clinical presentation, and expected deterioration are the deciding factors regarding the need for securing the airway. Emergent or semi-urgent intubations are straightforward in the majority of patients. Airway management in trauma patients aims to improve tissue oxygenation, ensure ventilatory exchange, stabilize other injuries and prevent aspiration. Airway management in the trauma and emergency room is challenging as the emergency team has limited time for full airway assessment unlike pre-anaesthesia check-up clinic/operative room. The airway cart must be checked routinely in the emergency room for the working condition of the equipment and its availability. All trauma patients must be considered to have cervical spine injuries unless ruled out. The airway management for trauma patients is best done using a team approach including emergency medicine physicians, anesthesiologists, surgeons, and trained paramedical staff. Regardless of the emergency room setting, airway management of a trauma patient requires effective communication and efficient teamwork

Diagnostic and prognostic role of magnetic resonance imaging in cases of moderate to severe traumatic brain injury

Moderate to severe traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Timely diagnosis and accurate prognostication play a key role in informed clinical decision-making. Though magnetic resonance imaging (MRI) is a superior anatomical scan compared to computerized tomography (CT), the latter remains the current investigation of choice in the clinical setting of TBI due to some of the former’s inherent deficiencies in imaging bone/blood, limited access, cost, etc. Nevertheless, the fact that MRI is a valuable adjunct in evaluating the TBI patients with clinical findings disproportionate to the CT scan substantiates its possible complementary/supplementary diagnostic and prognostic role in TBI. MRI scan is ideally placed on demonstrating the shear/diffuse axonal injury (DAI), non-haemorrhagic intraparenchymal lesions, and brain stem lesions poorly delineated by a CT scan. The currently available literature demonstrates that DAI and caudal brainstem lesions are indicators of poorer outcomes. However, the prognostic value of MRI, in addition to that of CT, remains an area of active investigation. We have tried to present the evidence-based use of MRI in moderate to severe TBI. Advances in newer MRI sequences like susceptibility-weighted imaging (SWI), diffusion tensor imaging (DTI), functional MRI (fMRI), and magnetic encephalography (MEG) have the potential to revolutionize the current role of MRI in TBI. 

Emerging Role of Autophagy in Governing Cellular Dormancy, Metabolic Functions, and Therapeutic Responses of Cancer Stem Cells

Tumors are composed of heterogeneous populations of dysregulated cells that grow in specialized niches that support their growth and maintain their properties. Tumor heterogeneity and metastasis are among the major hindrances that exist while treating cancer patients, leading to poor clinical outcomes. Although the factors that determine tumor complexity remain largely unknown, several genotypic and phenotypic changes, including DNA mutations and metabolic reprograming provide cancer cells with a survival advantage over host cells and resistance to therapeutics. Furthermore, the presence of a specific population of cells within the tumor mass, commonly known as cancer stem cells (CSCs), is thought to initiate tumor formation, maintenance, resistance, and recurrence. Therefore, these CSCs have been investigated in detail recently as potential targets to treat cancer and prevent recurrence. Understanding the molecular mechanisms involved in CSC proliferation, self-renewal, and dormancy may provide important clues for developing effective therapeutic strategies. Autophagy, a catabolic process, has long been recognized to regulate various physiological and pathological processes. In addition to regulating cancer cells, recent studies have identified a critical role for autophagy in regulating CSC functions. Autophagy is activated under various adverse conditions and promotes cellular maintenance, survival, and even cell death. Thus, it is intriguing to address whether autophagy promotes or inhibits CSC functions and whether autophagy modulation can be used to regulate CSC functions, either alone or in combination. This review describes the roles of autophagy in the regulation of metabolic functions, proliferation and quiescence of CSCs, and its role during therapeutic stress. The review further highlights the autophagy-associated pathways that could be used to regulate CSCs. Overall, the present review will help to rationalize various translational approaches that involve autophagy-mediated modulation of CSCs in controlling cancer progression, metastasis, and recurrence

Clinicoradiological Features and Treatment Outcome of Supratentorial Intraparenchymal Epidermoid Cyst: A Report of Five Cases and Literature Review

Objectives Intraparenchymal epidermoid cysts (IECs) are rare lesions. They represent less than 1% of the intracranial epidermoid cysts. The supratentorial IEC is a clinically and prognostically distinct subset. Given the rarity, most of the articles are case reports. We present a series of five cases of supratentorial IEC to characterize their clinical presentation and outcome, with emphasis on the surgical features. Materials and Methods We searched our database for all cases of intracranial epidermoid cysts operated between January 2005 and January 2020. Five patients were identified having IEC from the hospital information system and the neurosurgical operation record book. Standard craniotomy and decompression of the lesion were performed in all these patients. Standard postoperative care includes computed tomography scan of head on the day of surgery and magnetic resonance imaging of brain after 6 weeks to look for the residual lesion, if any. Subsequent follow-up visits in outpatient department to look for resolution of the presurgical symptoms. Results The mean age of the patients in our series was 28.8 years (range: 28–40 years.). All the five patients were male. Four patients had IEC involving frontal lobe and one in parietal lobe with a small occipital lobe extension. Seizure was the most common presenting complaint followed by headache. Complete excision was achieved in all the cases. All the three patients with seizure attained seizure freedom postlesionectomy. Focal neurological deficits resolved gradually in postoperative period. There was no recurrence of lesion during follow-up. Conclusion Supratentorial IEC most commonly affects young males, involve frontal lobe and present clinically with seizure. Complete surgical excision offers best outcome in the form of remission of seizure disorder