Anatomy and physiology of cisternostomy

Cisternostomy is defined as opening the basal cisterns to atmospheric pressure. This technique helps to reduce the intracranial pressure in severe head trauma as well as other conditions when the so-called sudden "brain swelling" troubles the surgeon. We elaborated the surgical anatomy of this procedure as well as the proposed physiology of how cisternostomy works. This novel technique may change the current trends in neurosurgery

Wasting of Extensor Digitorum Brevis as a Decisive Preoperative Clinical Indicator of Lumbar Canal Stenosis: A Single‑center Prospective Cohort Study

Background: The dilemma in managing patients with low back ache lies in  differentiating radiculopathy from lumbar canal stenosis. This has a huge bearing in patients being planned for surgical intervention as underperforming leads to failed back syndrome whereas over‑doing leads to instability. There still remains a loophole in clinically diagnosing lumbar canal stenosis.Aim: We opt to utilize a simple bedside clinical examination in routinely assessing patients presenting with low back ache in ruling out underlying canal stenosis.Subjects and Methods: We performed a prospective study on 120 consecutive  patients presenting with low back ache in the spine clinic. Each of them was neurologically examined and thoroughly assessed for wasting of extensor digitorum brevis (EDB) muscles. These were then correlated with the radio‑imaging and the intraoperative findings.Results: Lumbar canal stenosis was mostly observed in the age group of 50–60 years. Diagnosis for L3/4 canal stenosis was made in 44/120 (36.6%), L5‑S1 in 52/120 (43.3%), and L3/L4/L5 level in 48/120 (40%) of patients. EDB wasting was seen unilaterally in 72/120 (60%) and bilaterally in 36/120 (30%) of the study group.Conclusion: This study appraises the clinical implication of observing for the wasting of EDB muscle so as to aid in the diagnosis of lumbar canal stenosis. This simple bedside clinical pearl can help us in predicting the need of further imaging studies and also in taking right therapeutic decision.Keywords: Extensor digitorum brevis, Lumbar canal, Stenosi

Appraisal of Burden of Caregivers to Chronically Rehabilitated Patients with Spinal Cord Injuries in a Tertiary Neurological Center in Nepal

The care of a patient with a spinal cord injury is part of healthcare systems. It causes a substantial physical and emotional drain on the caretakers who often are in short supply and thus may lack adequate training, preparation, and support. Long hours of assisting a chronically handicapped patient with activities of daily living and exercises decrease the rehabilitator’s quality of life and take a psychological toll that increases a risk of burnout syndrome. The present study found a significant caregiving burden among care providers of chronically dependent patients with spinal cord injuries. Additionally, financial drain escalates the issue in this rather neglected health and quality of life aspect concerning caregivers. For the situation to improve, there must be a paradigm shift in care taking toward the motivative patient’s participation in the rehabilitative process. Provisions for social support and educational programs focusing on the patients and their families need to be reappraised