AbstractBurst frontal lobe or frontal lobe contusion is commonly seen in road traffic accidents (RTA) or assault. Chronic subdural hematomas are seen in elderly patients with history of nonsteroidal anti-inflammatory drugs use, chronic alcohol intake, and antithrombotic and/or anticoagulant therapy. Extradural and acute subdural hematomas are often seen in young patients following RTA or trauma. The coexistence of all the above-mentioned conditions, that is, lobar contusion, acute-on-chronic subdural hematoma (SDH), and acute extradural hematoma (EDH), in a patient is rare. Based on the Glasgow Coma Scale and imaging findings, early surgical intervention was planned in our patient. Early surgical evacuation of contusion, acute-on-chronic SDH, and EDH, as was done in our patient, will lead to early recovery. Avoiding alcohol intake and use of helmets while riding motorcycles will lead to reduction of such RTA in future.

AbstractAttention and memory deficits are frequently observed in individuals suffering from mild traumatic brain injury (MTBI), particularly in those exhibiting neurostructural abnormalities, commonly referred to as complicated mild traumatic brain injury (C-MTBI). The present case series employed customized cognitive retraining interventions and compensatory techniques designed to enhance attention, memory, and activities of daily living (ADL) of C-MTBI patient. Scores on Glasgow Coma Scale (GCS) and neuroimaging abnormalities detected via computed tomography (CT) or magnetic resonance imaging (MRI) were used to categorize the cases as C-MTBI. All four cases in the present case series were selected using purposive sampling technique. Cognitive dysfunction of the cases was evaluated utilizing the PGI Battery of Brain Dysfunction (PGI-BBD), while assessment of ADL was measured through the Hindi version of the Cognitive Symptom Checklist (CSC). Patients with C-MTBI underwent cognitive rehabilitation (CR) specifically tailored to address the unique requirements and characteristics of their nature of cognitive deficits. Cognitive retraining sessions were systematically organized on a biweekly basis, complemented by an additional weekly session focused on compensatory strategies, which were conducted face to face or through telephonic/video conferencing. All four cases completed CR sessions and after competition of the CR sessions, cognitive functions and ADL were reassessed using the PGI-BBD and CSC, respectively. The present case series highlights the effectiveness of CR program combining cognitive retraining and compensatory strategies in improving attention, memory, and ADLs of C-MTBI patients. All four cases demonstrated significant improvements in cognitive functioning and ADL measures following the CR program, supporting its applicability and therapeutic value.

Abstract Objective Patients with traumatic brain injury (TBI) often continue to have symptoms of neuropsychological dysfunction. Studies have demonstrated cerebral perfusion (CP) deficits following TBI. There is limited literature on the association between CP and neuropsychological outcomes following TBI. This study aimed to analyze the correlation between neuropsychological outcome and CP in patients with mild to moderate TBI. Materials and Methods Patients with mild to moderate TBI and computed tomography (CT) scan suggestive of diffuse axonal injury underwent CT perfusion scan within 48 hours of injury. All patients were evaluated with various neuropsychological tests at 3 months of follow-up. The correlation between CP and neuropsychological outcome was assessed. Results Forty patients (21 with TBI mild and 19 with moderate TBI) were enrolled. Among 21 patients with mild head injury, 14 (66.7%) showed evidence of hypoperfusion in the right frontal lobe and 12 (57.1%) in the right parietal lobe. Among 19 patients with moderate head injury, 12 (63.1%) patients showed hypoperfusion in the right frontal lobe and 7 (36.8%) in the right parietal lobe. CP in the bilateral frontal and left temporal lobe white matters showed a statistically significant negative correlation with the number of mistakes committed in the Stroop A, B, and C tests. Perfusion in the left temporal white matter showed a negative correlation with the trail making test (parts A and B) and a positive correlation with the animal fluency test. The right parietal and left frontal lobes also showed a positive correlation with the AFT. Conclusion We found a significant correlation between CP of the white matter of different lobes during the acute phase of TBI and neuropsychological performance at 3 months after TBI.

Abstract Background White fiber dissection is a method in acquiring in-depth neuroanatomical understanding for surgical practice. Collection of brain specimen during autopsy and preparation of the brain specimen without any disruption in anatomy are essential steps as cadaveric brain dissection is an important part of neuroanatomical teaching, and it further provides an initiative of how kind and precise the dissection must be during live surgery. Objective The aim of the study was to explain the stepwise technique of the preparation of the brain specimen for white fiber dissection as relevant to neuroanatomical and neurosurgical teaching. Materials and Methods The brain removal procedure is performed on the human brain during the conventional autopsy process. Results Various consecutive and typical steps are recommended for the removal and preparation of the specimen. Photographs accompany each relevant step for better understanding of the procedure. Conclusion In this article, we describe the technique and step-by-step guidelines to effectively remove the brain and to prepare the brain specimen for white fiber dissection. Avoiding common errors during this intricate procedure saves time and brain specimens.

Abstract Background Trauma is a leading cause of hospitalization worldwide, with spinal injuries resulting from traumatic events having severe and lasting repercussions. The high incidence of these injuries places a significant burden on families and health care systems. Disparities in epidemiological findings often occur due to the location- or culture-specific factors. This study aims to address the inadequate attention given to morphological patterns and their impact on neurological damage severity, which affects functional outcomes over time. Objectives The main objective of this study was to identify the injury patterns and detect associated spinal or extraspinal injuries in traumatic spine injury (TSI) patients who visited a level 1 trauma care facility in eastern India. Additionally, it aimed to establish a correlation between the severity, morphology, and grades of neurological damage with demographic characteristics. Materials and Methods This retrospective cross-sectional study was conducted at the neurosurgery unit of the trauma and emergency department (TED) at a level 1 trauma center in eastern India. It involved TSI patients admitted between March 15, 2023, and March 14, 2024. Data were collected from paper-based records and compiled into a structured Excel format. The study included adult patients admitted to the TED with traumatic spinal cord injuries and excluded those from outpatient departments or those with incomplete data. Data analysis utilized the Muller AO classification, Injury Severity Score (ISS), and ASIA classification, with statistical analysis performed using IBM SPSS version 19.0. Results Out of 320 patients, 309 met the inclusion criteria. The majority were males (263) with a median age of 39 years. Falling from a height (43.7%) was the most common mechanism of injury, followed by road traffic accidents (37.9%). Polytrauma was present in 73% of patients, with multilevel injuries more severe than single-region injuries. Type A fractures were most common (53.4%), and 67.6% of patients underwent surgery. A significant correlation was found between the ISS and ASIA scores. Conclusion The study revealed differences in spinal injury epidemiology in eastern India compared to other regions, with multiple vertebral level injuries being more common. The findings highlight the need for government health care strategies focused on treatment and rehabilitation, especially for the younger age group that is predominantly affected. Preventive measures should also be strictly enforced to reduce the incidence of such injuries.

AbstractIntracranial hypertension (IH) is a critical condition in neurocritical care and needs effective management to avoid severe outcomes like brain herniation and cerebral ischemia. External ventricular drains, although effective in reducing intracranial pressure, pose risks of infection, hemorrhage, and malfunction. This technical note present the transdiploic cerebrospinal fluid (CSF) diversion device, an alternative technique for CSF diversion utilizing the parietal diploic venous system.

Abstract Introduction Brachial plexus injury (BPI) is often associated with a neuropathic pain that usually is managed with analgesics; however, in up to 10% of the patients, it may be associated with a severely disabling chronic pain that does not respond to even maximal medical therapy. Materials and Methods This retrospective analysis included all the patients undergoing microscissors DREZotomy (MDZ) by a single surgeon (D.A.) for post-BPI brachialgia over 4 years (excluding 1.5 years of the COVID-19 pandemic) between 2018 and 2024 at our institution. Pain was quantified using the visual analog scale (VAS) between 0 and 10. Results A total of 32 patients underwent MDZ, of whom 3 patients had a redo DREZotomy. There were no complications and 65.7% patients showed an excellent response to pain with a VAS score of less than 3/10, which was statistically significant (p < 0.001). About 25.1% patients showed a good improvement in the VAS score of between 3 and 5. Conclusion MDZ is a very safe and highly effective technique to relieve the chronic refractory neuralgia in BPI. This technique can be performed with ease even in resource-limited conditions.

AbstractThe drainage of chronic subdural hematoma is a very frequently performed neurosurgical procedure. The management often requires subdurostomy with catheter placement for hematoma drainage. Sometimes, the catheter misplacement can lead to complications that could be catastrophic. This technical note introduces the Moscote–Agrawal guiding device, a tool designed to enhance the accuracy and safety of catheter placement during subdurostomy. We hope that this concept can be adapted by neurosurgeons around the world to minimize procedural risks, improve outcomes, and ensure the safety of neurosurgical practices.

AbstractContralateral formation and expansion of hemorrhagic contusion is a significant and rare complication following decompressive craniectomy. Decompressive craniectomy is an important surgical tool for management of raised intracranial hypertension secondary to various pathologies including trauma. These uncommon events are reported in the literature along substantive explanations and theories. We present two cases of road traffic accident (RTA) who following decompressive craniectomy developed expansion of contralateral hematoma. In this article, we are focus on the appearance and expansion of contralateral intraparenchymal contusion following decompressive craniectomy with a deep dive into the existing literature.

Abstract Objective In this study, a high-impact trauma (HIT) device was used for inducing moderate traumatic brain injury (TBI) in Drosophila melanogaster. Mechanical injuries in flies caused by rapid acceleration and assertion produce symptoms characteristics of TBI in humans. Materials and Methods Docking studies were carried out to check the binding affinity of the drug toward the receptors. Various oxidative stress parameters, catalase level, glutathione level, superoxide dismutase (SOD) level, malondialdehyde (MDA), and nitric oxide levels, were measured. The mortality index and neuroprotective potential were carried out in TBI in D. melanogaster models. Results In the current study, there was an increase in oxidative stress following TBI as evidenced by a significant decrease in the catalase, glutathione, and SOD levels and increase in the level of MDA and nitric oxide after 24 hours. Antioxidant enzymes, catalase and glutathione peroxidase, have a dominant role in TBI. Docking studies were carried out on estrogen receptor 1 (pdb: 1TVO and 1UOM) and NDMA receptor (pdb: 3QEL) as agonist showing the binding affinity of the drug toward the receptors. In comparison to the vehicle-treated group, there was a dose-dependent significant increase in the SOD level and percentage climbing along with a decrease in the MDA level and total protein content. The mortality index was also observed at three concentrations of ranolazine (1, 2, and 4 mg/mL) in D. melanogaster homogenate. These findings suggest that ranolazine has a good neuroprotective potential in the treatment of TBI in the D. melanogaster model. Conclusion Present study concluded the scientific evaluation of neuroprotective potential of ranolazine in the treatment of TBI in the D. melanogaster model.

AbstractFrontal depressed fracture generally results from high-speed motor vehicle accidents. The frontal fractures can be closed or open depending upon the involvement of the overlying skin. Frontal fracture can be comminuted if the bone is broken in at least two or more places. Because of the proximity of the frontal bone to critical structures like the frontal sinus, frontal dura with underlying brain parenchyma, and orbit with its content, an injury resulting in a frontal depressed fracture can result in a multitude of clinical symptoms. If not addressed promptly with an experienced team, these fractures can result in cerebrospinal fluid leak, osteomyelitis of the frontal bone, meningitis, and ocular and olfactory dysfunction with poor cosmetic outcomes. Thus, repairing the frontal depressed fracture should be considered a priority. The standard practice is to elevate the depressed fracture and repair any dural defect. In case of a comminuted fracture, elevation is not possible, and we generally remove the fracture pieces and repair the defect using titanium mesh. In this case report, we propose a novel technique of repair of the defect using a split calvarial graft, which is fashioned after separating the outer table from the inner table of the posterior frontal bone. This technique reduces the theoretical risk of infection and is cost-effective as our procedure does not require any external implant in cranioplasty.

Abstract Background Prognosis of traumatic brain injury (TBI) significantly depends on the incidence of progressive hemorrhagic injury (PHI). The present study was conducted to assess whether D-dimer/fibrinogen ratio can predict PHI among the patients with TBI. Materials and Methods A total of 150 patients were included in this retrospective study; among them 72 had PHI and 78 did not have PHI. Demographic, clinical, radiological, and laboratory parameters including plasma D-dimer and plasma fibrinogen levels and subsequently D-dimer/fibrinogen ratio were evaluated. Independent t-test, Mann–Whitney U test, chi-square test, Fisher's exact test, and multivariate logistic regression were used for statistical analysis. Results Age, injury time, first computed tomography time, Glasgow Coma Scale scores, unreactive pupils, abnormal cisterns, midline shift above 5 mm, skull base fracture, epidural hematoma, subdural hematoma, intraventricular hemorrhage, cerebral hematoma, brain contusion, plasma D-dimer concentration, plasma fibrinogen concentration, and D-dimer/fibrinogen ratio vary significantly between PHI and non-PHI groups (p < 0.05). Multivariate logistic regression showed that the Glasgow Coma Scale score (odds ratio [OR], 0.531; 95% confidence interval [CI], 0.436–0.648; p = 0.004) and D-dimer/fibrinogen ratio (OR, 3.784; 95% CI, 2.086–6.867; p = 0.027) were the two independent predictors for PHI. Conclusion D-dimer/fibrinogen ratio is a useful parameter in predicting the incidence of PHI among the patients with TBI.

Abstract Objective In patients with mild traumatic brain injuries (mTBIs), with Glasgow Coma Scale (GCS) scores of 13 to 15, isolated subdural hematomas (iSDHs) are identified as a prevalent category of intracranial hemorrhage. The primary objective of our research was to investigate the relationship between the characteristics of iSDHs, as revealed through computed tomography (CT) scans on patient admission, and the consequent necessity for neurosurgical intervention. Materials and Methods This was a 1-year study, employing a prospective observational design at our institution. We enrolled adult trauma patients diagnosed with mTBIs and concurrent iSDHs, intent on documenting the hemorrhages' quantitative parameters such as maximum length and thickness, among other related variables. The eventual execution of neurosurgical procedures constituted our primary outcome, aiming to establish a decisive correlation between CT scan metrics of iSDHs upon admission and the imperative for subsequent surgical intervention. Results A total of 50 patients were included in our study: 14 patients received a neurosurgical intervention and 36 patients did not. The neurosurgical intervention group had a mean maximum SDH length and thickness that were 38 mm longer and 9.6 mm thicker than those of the non-neurosurgical intervention group (p < 0.001 for both). Conclusion In this study, we evaluated the odds of a neurosurgical intervention based on hemorrhage characteristics on CT, in patients with an iSDH and mTBI. Once validated in a second population, these data can be used to evaluate the necessity of interhospital transfers and to better inform patients and families of the risk of future neurosurgical intervention and prognosis.

Abstract Background The existence of a sleep cycle in deeply unconscious patients with severe traumatic brain injury (TBI) remains unknown. Evaluating the sleep patterns of these patients may provide insights into their consciousness and help predict functional recovery. Aims and Objectives This prospective observational study aimed to assess the usefulness of monitoring the sleep cycle in the prognostication of unconscious TBI patients. Materials and Methods A purposive sampling technique was employed to include 39 patients with severe TBI (Glasgow Coma Scale [GCS] ≤ 8). The average GCS score at admission was (5.76 ± 1.65). Sleep was monitored using an actigraphy smartwatch for 4 consecutive days, (3.15 ± 2.49) days postbrain injury. Sleep cycle monitoring tool and unconscious patient outcome monitoring tool were employed. An outcome assessment was done based on the GCS score. Results Severe TBI patients exhibit intact sleep cycle (i.e., deep sleep, light sleep, and rapid eye movement sleep) despite being deeply unconscious, even in the acute stage. Total sleep duration was found to be significantly higher at a mean of 19.97 hours as compared to the mean of 8 hours as per the smartwatch reference value for normal individuals. Patients with improved sleep cycles had a higher likelihood of GCS improvement (p < 0.05). Conclusion This study is the first of its kind to demonstrate that the sleep cycle is a reliable prognostic factor for the recovery of consciousness in the acute phase of severe TBI among unconscious patients, with improvement in the sleep cycle mirroring neurological improvement.

Abstract Introduction Brain injuries from blasts are increasingly common in both civilian and war settings. The impact of blast injuries at different pressure levels remains unclear, and their long-term effects are not well understood. This study investigates how varying blast pressures affect the rat brain over time. Materials and Methods Forty adult Sprague-Dawley rats were randomized into four groups of 10. Three groups were exposed to blasts, while one served as a control and was only subjected to blast sounds. Each group received a single blast at different pressures, followed by neuropsychological tests. After 28 and 84 days, the rats were sacrificed to measure tau protein and acetylcholine esterase levels and to conduct histological examinations of brain tissues. Results A single blast exposure did not significantly impact visuospatial memory or recall. Despite the lack of noticeable cognitive deficits, histopathological and biochemical analyses revealed reduced tau protein levels, indicating ongoing neuronal damage. Conclusion While a single blast did not significantly impair visuospatial memory or recall in this rat model, there were decreases in tau protein and acetylcholine esterase levels, along with histological signs of neuronal damage.

Abstract Background Foreign bodies of neck are a common occurrence after trauma and road traffic accidents. Foreign bodies can get lodged in the neck especially after open wound. These could range from a piece of glass, wood, pebble pieces, or the part of tool used for trauma. Case Presentation We report a case of an unusual foreign body in the neck. Posttrauma, patient had mandibular fracture with dislodgement of teeth in the neck masquerading as foreign body. Patient required surgical intervention for removal of teeth from the neck via an external incision and recovered uneventfully. Conclusion The aim of the article was to highlight the importance of complete clinical and radiological examination in a patient of trauma. Missing teeth especially in cases of mandibular fracture must be searched for carefully.

Abstract Introduction Comprehensive rehabilitation is essential to enhance the quality of life and cognitive performance of traumatic brain injury (TBI) survivors. Virtual reality (VR) has emerged as a promising tool for TBI rehabilitation due to its ability to provide an engaging and tailored environment. Materials and Methods This was a randomized comparative study conducted at tertiary hospital and included individuals aged between 18 and 60 with mild-to-moderate cognitive impairment due to TBI. The participants were divided into a case group receiving intensive VR rehabilitation and a control group receiving standard care. Cognitive assessments were conducted before and after treatment, and during follow-up. Results VR rehabilitation demonstrated significant improvements in cognitive function. The VR group exhibited remarkable progress in the Montreal Cognitive Assessment (MoCA), Tower of London (TOL), and Trail Making Test (TMT) scores. Baseline MoCA, TOL, and TMT scores (mean value) of case group 16.5, 11.75, and 14.05 and for control group 17, 10, and 13 were respectively. All the parameters of case group improved at the time of discharge (MoCA: 24.3, TOL: 22, TMT: 27.5) and in follow-up (MoCA: 28.5, TOL: 32.5, TMT: 42.07) as compared with control group at discharge (MoCA: 19, TOL: 13, TMT: 17) and in follow-up (MoCA: 21, TOL: 15, TMT: 19), which shows significant improvement in case group (p < 0.001) as compared with control group. Conclusion VR rehabilitation significantly improves cognitive outcomes in TBI patients. It has the potential to be a significant tool in TBI rehabilitation.