Kumar R

All India Institute of Medical Sciences,Rishikesh,India · Department of Neurosurgery

This presentation showcases an endoscopic minimally invasive spine surgery (MISS) technique for lumbar interbody fusion. Significantly expanding the scope of Destandau’s system within MISS, it serves as a pivotal link to unilateral biportal endoscopy (UBE) for endofusion. The method involves minimally invasive transforaminal lumbar interbody fusion...

Introduction: The supraorbital keyhole approach (SOKHA) has been a less invasive alternative for anterior and middle skull base lesions. We aimed to review our data and understand the advantages and limitations of the approach. Methods: We analyzed our data and reviewed 89 consecutive cases who underwent the SOKHA. We included the clinico-radiologi...

Transarticular screw provides rigid C1 C2 fixation. It is associated with robust implant construct and high fusion rates. Combining sublaminar wiring provides rigid three point fixation. This technique can be safely considered in reducible AAD where a wide C2 isthmus along with a normal Vertebral artery course is present. Authors describe the techn...

Purpose To assess the accuracy of freehand cervical C1 C2 screws placement by knock and drill (K and D) technique in craniovertebral anomalous bony anatomy. Materials and Methods From January 2017 to December 2022, 682 consecutive C1 C2 screws in 215 patients with craniovertebral junction (CVJ) anomalies were enrolled. All patients underwent poste...

This video article presents the why and how of an extradural skull‑base approach to anterior clinoid meningiomas. This technique is indispensable for any neurosurgeon venturing into the parasellar area.

The extradural hematoma (EDH) of the posterior fossa is a rare clinical condition in head injury cases. The posterior fossa extradural hematoma (PFEDH) contributes to not more than 4 to 8% of all the EDH encountered in traumatic brain injury. The limited volume of the posterior fossa leads to early clinical deterioration and, if not subjected to ti...

Minimally invasive spine surgery is rapidly gaining popularity owing to its versatile nature. Traditionally prolapsed disc has been the most common pathology targeted using this technique. However, its utility for various other pathologies has also been shown in studies. Here we present our experience of using this technique for various spinal path...

Objectives Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by...

Purpose While extensive research with accurate classification has been done in mycoses of the paranasal sinuses and anterior skull base, a similar understanding of lateral skull base fungal pathologies is lacking due to relative rarity and diagnostic difficulties. We introduce a series of eleven cases and two different invasive entities of Aspergil...

Background: Studies on insular gliomas (IGs) generally focus on the oncological endpoints with a relative scarcity of literature focusing on the seizure outcomes. Objectives: To study the predictors of long-term postoperative seizure control in IG and propose a novel risk scoring system. Methods: Histopathologically proven, newly diagnosed adu...

Objective To study the etiological and anatomical factors in pathophysiology of invasive fungal rhinosinusitis affecting the skull base. Design Retrospective clinical study over 5 years. Setting Single-center tertiary referral hospital. Materials and Methods All cases of invasive fungal rhinosinusitis with clinicoradiological and/or operative evide...

Background: Arachnoid Cysts (AC) are developmental anomalies formed by splitting the arachnoid membrane's layers. ACs contribute around 2% of all intracranial space-occupying lesions. ACs are more prevalent in children. Because of varied clinical presentation, there has been a constant need for clinico-radiological risk stratification with a possi...

Benign parotid tumors follow an indolent course and present as slow-growing painless swelling in the pre-and-infra-auricular areas. The treatment of choice is surgery. Though the gold standard technique is Superficial Parotidectomy, Extracapsular Dissection (ECD) is an alternative option with the same outcome and decreased complications. This study...

Supratentorial intracerebral hematoma is a rare complication after posterior fossa tumor surgery in prone positioning. Although rare, its occurrence may cause significant impact on survival of the patient. We had described this rare complication and their possible pathophysiology in this report. A 52-year-old male with fourth ventricle epidermoid t...

Background and Purpose Altered levels of consciousness resulting from a vascular insult to the brain can vary from confusion to coma. A disruption in the function of the brain stem reticular activating system in the brain stem or both cerebral hemispheres and thalami causes coma. This study is aimed at finding the effect of transcranial direct curr...

Background: Posterior fossa midline epidermoid tumors (PFMETs) include the epidermoid tumors of the cisterna magna (CM) and fourth ventricle (FV). Objective: To report tumor epicenter-based classification of PFMETs and its clinical and surgical implications with outcome. Methods: On retrospective analysis of operated cases of intracranial epid...

Objective: We aim to find the temporal trend of incidence of post-resection cerebrospinal fluid (CSF) diversion (ventriculoperitoneal [VP] shunt/endoscopic third ventriculostomy [ETV]) in pediatric posterior fossa tumor (pPFT) patients with no pre-resection CSF diversion and the possible clinical predictors. Methods: We reviewed 108 operated chi...

Objectives Prevailing techniques of dural closure in endoscopic spine surgery (ESS) for intradural extramedullary (IDEM) tumor excision increase the steep learning curve and operative time. We aimed to assess the efficacy of augmented duroplasty with artificial dura and share our initial experience of ESS for IDEM excision. Materials and Methods W...

Injuries claim approximately 4.4 million lives annually worldwide, according to World Health Organization data in March 2021. With its 1.4 billion population, India has a large share of this. About four hundred fifteen people are killed daily in India following road traffic accidents, and about 0.15 million people sustain injuries daily (2019). Sur...

Objective The aim of this study was to evaluate the clinical and radiological outcomes analysis of craniovertebral junction (CVJ) anomalies cases. Materials and Methods Retrospective analysis of 43 CVJ anomalies cases, which were surgically managed at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India, from period be...

This video article demonstrates the technique of translabyrinthine approach to acoustic neuromas

Glioblastoma multiforme (GBM) of cerebellar hemisphere is a rare entity and constitutes less than 1% of all the GBMs. The rarity of occurrence leads to significant challenge in differentiating morphologically from other subtypes of glioma in the posterior fossa. Previous studies have suggested that cerebellar GBM occurs in the younger age group as...

Objective Traumatic brain injury leads to the activation of sympathetic nervous system and elevation in serum catecholamine levels. The aim of this study was to determine whether catecholamine level obtained within 24 hours of traumatic brain injury provides a reliable prognostic marker for outcome. Materials and Methods This study was a prospectiv...

Introduction Pineal tumours (PTs) are rare and histologically variable. Serum melatonin is a well-known product of this gland, albeit with uncertain clinical implications vis-à-vis its utility as a potential tumour marker. In particular, the temporal profile of serum melatonin during the disease course remains unclear and infrequently studied. Met...

Aim The exact cause of bleeding in non-aneurysmal sub-arachnoid hemorrhage (SAH) is yet to be established. The present study intends to evaluate the morphological variants of deep cerebral venous drainage, especially basal veins of Rosenthal (BVR), and to correlate if such a venous anomaly is associated with increased incidence of non-aneurysmal SA...

Background & Objective: Traumatic brain injury and cerebrovascular accidents can result in altered levels of consciousness. This study is aimed at finding the effect of transcranial direct current stimulation (tDCS) on the level of consciousness in these patients. Methods: A total of 100 patients admitted to the neurological ICU of the hospital wer...

Giant paraclinoid internal carotid artery (ICA) aneurysms are surgically challenging, mainly due to the lack of adequate working space and distortion of the regional anatomy. Anterior clinoidectomy is a vital surgical technique in such cases, allowing optic nerve decompression, and exposure of the proximal ICA outside the arachnoid confines. While...

This study aimed to determine the patient demographics, risk factors, which include comorbidities, medications used to treat COVID-19, and presenting symptoms and signs, and the management outcome of COVID-19-associated invasive fungal sinusitis. A retrospective, propensity score-matched, comparative study was conducted at a tertiary care center, i...

Objective: To see the effects of Raj Nirwan Bati (RNB) on the hematobiochemical parameters, coagulation tests, and histopathological changes in the lungs, liver, kidneys and spleen and also to evaluate the immunomodulatory activity of RNB in Wistar rats. Methods: A total of 24 adult albino Wistar rats (of bodyweight 200-250 g) of either sex were di...

Objective The aim of the present study was to investigate the psychiatric distress, including stress, anxiety and depression level among COVID-19 positive patients, who were admitted between 01 July 2020 to 31 August 2020 in the COVID-19 isolation ward of the Uttar Pradesh University of Medical Sciences, Saifai, Etawah India. Participants were 100...

Background The identification of neurosurgical causes of craniomegaly and early institution of therapy requires for better clinical and functional outcomes. Aims and Objectives The aim of this study was to evaluate the neurosurgical causes, managements, and outcomes of craniomegaly in neonate and infants. Materials and Methods The cases with a hist...

Neural Tube Defects are the most typical congenital malformations, with almost 300,000 cases annually worldwide. The incidence varies amongst geographical ranges from 0.2 to up to 11 per 1000 live births. In India, incidence is reportedly higher in north than south and can be attributable to diet and genetic variances. Etiology is multifactorial. S...

As of August 16, 2021, there have been 207,173,086 confirmed cases and 4,361,996 deaths due to the coronavirus disease (COVID-19), and the pandemic remains a global challenge. To date, no effective and approved drugs are available for the treatment of COVID-19. Angiotensin-converting enzyme 2 (ACE2) plays a crucial role in the invasion into host ce...

Background: The present pandemic of COVID-19 has created a huge pressure on the current health system of the world as the burden is increasing exponentially day by day. Study evaluated the effect of the novel allo-vedic formulation named Raj Nirwan Bati (RNB) on the clinical symptoms, microbiological, bio-chemical, haematological and radiological p...

Background: The COVID-19 pandemic is still spreading throughout the world along with its strange and frightening mutations, and the World Health Organization (WHO) has declared it as a global pandemic. Objective: The present investigation aims to evaluate the effect of SARS-CoV-2 infection on mother and newborn outcomes and the vertical transmissio...

With the sudden outbreak of coronavirus disease of 2019 (COVID-19) pandemic, the Health Care Workers (HCWs) have claimed varying echelons of stress, anxiety and insomnia. This is the first write up ever reported describing the numerous studies conducted globally to determine the mental health issues in HCWs throughout in COVID-19 pandemic. Herein w...

The Ayurveda is the traditional system of medicine which is been used by Indian's. The science of life is the basic meaning of the word Ayurveda. The method of practicing had been a trusted and tested method in treating the illness. Abhrak Bhasma, an amorphous powder drug, is prepared by treating biotite (mica) with the juices of a number of recons...

According to the World Health Organization (WHO), there are 37,704,153 cases and 10,79,029 deaths due to COVID-19 till the 13th October 2020 in the world. Day by day, rise in the number of COVID-19 deaths has created great pressure on health facilities, governmental bodies, and health workers. There is a need for knowledge regarding lifecycle, tran...

Abhrak bhasma (AB) is a type of bhasma prepared from repeated incineration of mineral mica with decoctions of about 72 herbs. The particle size of Abhrak bhasm has been shown to be in the range of 29-88 nanometers and Fe, Ca, Si, Mg and K are found to be as major constituent. Many drugs developed to treat Central Nervous System (CNS) disorders are...

The article's abstract is not available.

The world is grappling for US FDA-approved therapies for Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). It is the virus that has caused Coronavirus Disease 2019 (COVID-19). Several pharmacological drugs are under various phases of clinical trials, and their current clinical use is primarily based on the in vitro activity against SAR...

Coronavirus is known to cause various systemic infections both in human and animal which are mostly mild in nature. However, recent years have seen major pandemics caused by coronavirus which are very invasive and virulent in nature. The recent SARS-CoV2 is a new addition to this list of coronavirus pandemics. So the present study was done to syste...

Background Head injury is an important public health problem nowadays. Traumatic brain injury (TBI) results from external force that leads to damage to brain tissue. Main causes of TBI are motor vehicle collisions and fall from height. One of the primary symptoms after TBI is impaired word retrieval. Therefore, this study was undertaken to assess m...

Background: Traumatic brain injuries (TBIs) are the leading cause of morbidity, mortality, disability, and socioeconomic losses globally, but of more concern, in India and other developing countries. The Mini mental state examination (MMSE) and clock drawing test (CDT) are the two mostly adapted methods for cognitive impairment screening. Therefor...

ABSTRACT Worldwide pandemic of Covid- 19 has a great concern because everyone in the world is facing its impact on his/her life directly or indirectly. This has resulted in the substantial change in the inter-personal & social interactions. Globally, up to 17 July 2020, there have been 13,616,593 confirmed cases of COVID-19, including 5,85,727 deat...

Background and Objective The novel Coronavirus pandemic surfaced in Wuhan, China in December 2019 and spread rapidly across the globe. In recent available literature, most of the studies were done to estimate the burden of psychiatric problems among general population due to this pandemic, Therefore, this study was planned to assess depression, anx...

With a total of 5,370,375 cases worldwide and a death toll of 344,454, as on the 26 th of May 2020, the COVID-19 pandemic has affected humankind in profound ways. Originating from the city of Wuhan, the disease has gripped, till now, 216 countries and territories. 1 The mode of transmission is most evidently via aerosols and affects different peopl...

Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary c...

Specialty of surgery was quite popular in the Buddhist era, and it evolved up to an extent. Various known and unknown physicians (chikitsaks) performed different types of operations to cure different surgical diseases. Jivaka was a pioneer surgeon of that time who performed different operations including surgery of brain. As many as 11 types of dis...

Corona viruses are a large family of viruses that cause illness ranging from the common cold to more severe diseases. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. On 30 January 2020, the WHO Director-General declared the novel corona virus (COVID-19) outbreak a public health emergency of internationa...

Background Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belonging to the coronavirus family. The primary target of SARS-CoV-2 is peripheral mucosal cells of respiratory tract. Recent days have seen few cases where virus has affected extrapulmonary organ such as nervous...

Background: Stroke is a major cause of disability and mortality often associated with secondary complications which can postpone or prevent recovery. Early intervention by mobilization averts such negative effects and promotes the recovery. Purpose: To compare between Erigo robotic tilt table exercises and Traditional exercises in rehabilitation of...

Back ground & Purpose: Many countries in Asia as well as developed countries like England, Australia and USA were attacked by the rampant COVID-19.This observational study was conducted to analyze the rate of transmission, death to case ratio, doubling time, role of temperature and other preventive measures on these variables. Methodology: Data of...

Today the whole world is facing a pandemic attack of COVID-19. It started in December 2019, in China. Many nations are facing economical and medical crisis because of spread of COVID-19. Even the developed countries where there are sophisticated health care facilities are facing death trolls. As a result of this pandemic attack, many countries have...

Background Angiocentric glioma (AG) is a relatively uncommon clinico-pathological entity that presents in childhood. Angiocentric glioma displays various histopathological features which resemble cortical ependymoma, astroblastoma, and pilomyxoid astrocytoma and schwannoma. The astrocytes in angiocentric glioma appear peculiarly elongated, bipolar...

Background: Mucormycosis of the central nervous system is an uncommon infection caused by saprophytic or parasitic fungi of the subphylum Mucormycotina and order Mucorales viz. Rhizopus, Mucor, and Rhizomucor. Isolated, chronic involvement of the central nervous system is a rare occurrence. To the best of our knowledge, isolated chronic ventricula...

Introduction: With improvements in overall and progression‐free survival in gliomas, current focus in neurosurgical oncology has largely shifted to the issue of quality of life (QOL) after treatment. There are not too many prospective studies evaluating QOL in these patients. We prospectively analyzed the health related quality of life (HRQOL) usin...

BACKGROUND: Iniencephaly is an extremely rare congenital neural tube defect (NTD) involving the occipital region with rachischisis of the cervico- thoracic spine and fixed retroflexion deformity of the head. It affects an esti- mated 0.1e10 out of 10,000 pregnancies and carries a dismal prognosis. Most affected children are either stillborn or peri...

Traumatic brain injury (TBI) is known as “silent epidemic” because of lack of knowledge about it and its delayed symptoms of memory and cognitive problems. The incidence is approximately 1.4 million per year in the United States, and in the developing countries, it is approximately 341 per 100,000. In the United States, the annual productivity loss...

Subaxial posttraumatic spondyloptosis is a rare entity with management dilemma in the literature. Various approaches have been discussed, but few reports focused on management plan and rationale. The authors reviewed the literature and reported a case of a 30-year-old woman presented with posttraumatic spastic quadriparesis. The patient had C6–7 sp...

Background Preauricular transzygomatic surgical approach (PTZA) can be used to approach and resect tumors of infratemporal fossa (ITF) and surrounding skull base lesion. Various modifications in this approach can be used to approach various critical areas such as cavernous sinus, sphenoid sinus. Materials and Methods Clinical charts were reviewed t...

The histiocytic disorders are pathological diagnosis and rarely affects spine. The spinal involvement is characterized by lytic lesions and painful symptoms. Isolated intradural extramedullary involvement is rare presentation. A 15-year-old female patient presented with nontraumatic cervical compressive myelopathy and was operated electively with p...

Neurosciences in Buddhist era was mainly based on power of mind and thoughts. It emphasized mainly about the power of mind, control of thoughts, purification, and modifications of erroneous thought process, which should result in truthful and correct practices and subsequent actions by human beings to remain happy. Buddhism believes that most disea...

Cortical ependymomas (CE) are rare subset of supratentorial ependymoma which are located in the peripheral cortical rim without any connection to the ventricular lining. With limited cases previously reported, current knowledge on diagnosis and management of tumors is lacking. We present the largest single center experience on CE reported so far an...

Background Split cord malformation (SCM) remains an important cause of tethered cord syndrome. SCM type 1, wherein a bony spur separates the two dural sacs, represents a challenging condition to treat. The management can be further complicated by the other associated dysraphic states in the same patient. The bony spur at the level of split cord has...

Background: Intracranial peripheral primitive neuroectodermal tumors (pPNETs) are rare lesions, accounting for only 1% of all pPNETs, and usually arise from bone and soft tissue. These tumors primarily affect young patients (<30 years old) and rarely affect older patients. The common intracranial locations of these lesions are frontal dura and ten...

Background: Paragangliomas of the head and neck region are not only rare but also unique in that they are derived from the parasympathetic system and are nonsecretory. Orbit represents 1 of the least common sites for head and neck paragangliomas. Orbital paraganglioma remains predominantly a disease of adults, and it has never been reported in inf...

Objectives To evaluate the facial nerve in inferior and lateral (transmastoid) approaches to the jugular foramen and/or petrous apex. Design Retrospective study of 11 consecutive patients operated for lesions in the jugular foramen/petrous apex via an inferior or lateral transpetrosal approach. Setting Tertiary care superspecialty referral center....

Pineal gland or “spiritual third eye” is regarded as the gateway of spiritual life as per ancient concepts about the soul. Recently, modern neuroscience has proven that pineal gland is not only the melatonin-secreting neuroendocrine organ which controls the circardian rhythm, but it also has mystical and energetic associations with spirituality. It...

Lipomeningomyelocele (LMMC) with Jarcho-Levin syndrome (JLS) is extremely rare. The syndromic association is one of LMMC with JLS is one of phenotype of spondylocostal dysostosis (SCD). SCD is an autosomal-recessive disorder characterized by defects in the vertebrae and abnormalities of the ribs in the form of segmental fusion, malalignment, or abs...

Background Pleomorphic xanthoastrocytomas are rare tumors of glial origin comprising <1% of all astrocytic tumors of brain. These tumors are rare in the infratentorial compartment and were not known to arise from the middle cerebellar peduncle. Case Description We discuss the case of a 16-year-boy who presented with altered sensorium and features...

Background Primary extramedullary tumors involving multiple compartments around the spine are a technically demanding group of tumors whose extent traverses beyond the normal confines of those anatomical regions which fall in the common domain of neurosurgeons. In the following series, we present 12 patients who were diagnosed with primary spinal e...

ABSTRACT Glioblastoma in children, when compared with adults, is relatively rare. Despite this rarity, it is apparent from the limited number of publications that pediatric glioblastoma is quite distinct from their adult counterparts. The differences pertain to the molecular genetics, effectiveness of the adjuvant therapies, and possibly the progno...

Purpose: Identify factors affecting constipation and post surgical improvement in patients of myelopathy. Methods: Sixty-four patients with myelopathy due to extradural spine pathologies (47 cervical; 17 thoracic spine, male:female-5.4:1 with mean age 46.16) underwent evaluation including Bristol stool scale (BSS), PFT and uroflowmetry. All case...

Background: Although extensively studied, few papers have specifically addressed the surgical implications of horizontal and vertical tumor extensions in falcine meningioma (FM). The currently available classification systems do not address these tumor extensions and thus do not characterize FM in entirety. Objective: To determine the influence...

Background: Superior hypophyseal artery (SHA) aneurysms form a unique subgroup of paraclinoid aneurysms having a propensity to grow to a large size in the suprasellar region resulting in compression of the optic nerve, chiasma, and/or tract. Aim: A new classification of SHA aneurysms is proposed that helps in identifying the surgical issues encount...

Background: Anterior spinal artery aneurysms (ASAA) are extremely rare. While these aneurysms are very well known to cause spinal subarachnoid haemorrhage/hematomyelia secondary to sudden rupture, presentation with chronic myelopathy remains extremely rare. Case report: A 50-year-old gentleman presented with chronic upper thoracic myelopathy for 1...

Background: Intraventricular and subarachnoid forms represent the relatively complex albeit uncommon manifestations of the central nervous system involvement by the cysticercal cysts. Cysticercal encystationinsidethe Blake's pouch remnant of mega cisterna magna remainsan extremely rare clinical scenario and to the best of our knowledge, has not be...

Teratomas are one of the most common tumors in newborn with excellent prognosis arises from totipotent primordial germ cells harboring two or three germ cell layers. The tumor has been titled “Great masquerade.” The teratomas of sacrococcygeal region present with lower limb weakness, urinary or bowel obstruction, and swelling at lower back or intra...