Vascular injuries during pituitary surgery are feared as they can lead to serious disability and can be life threatening. We are describing a case of severe intractable epistaxis following endoscopic transnasal transsphenoidal surgery for pituitary tumour due to a sphenopalatine artery pseudoaneurysm which was successfully managed using endovascular embolisation techniques. Very few cases of sphenopalatine artery pseudoaneurysm following endoscopic nasal surgery have been described. A middle aged male patient with a pituitary macroadenoma underwent endoscopic transsphenoidal pituitary surgery and returned to us after 3 days of discharge with severe epistaxis. Digital subtraction angiography showed contrast leakage and left sphenopalatine artery pseudoaneurysm. Glue embolisation of the distal sphenopalatine branches and pseudoaneurysm was done. Good occlusion of pseudoaneurysm was seen. Such a diagnosis for epistaxis following endoscopic transnasal surgery should be borne in mind, so prompt treatment can be planned to avoid life threatening complications.

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Background Data: Kyphoscoliosis in conjunction with tethered cord is a rare and challenging spinal deformity to treat. The availability of intraoperative monitoring in recent times has helped reduce the incidence of operative neurological complications in spine deformity corrective surgery. The present case report underlines the value and utility of intraoperative neuromonitoring in corrective surgery for kyphoscoliosis. Study Design: Case report. Purpose: To report the importance of intraoperative neuromonitoring in the release of tethered cord along with deformity correction. Case Report: A 14-year-old male patient presented with a one-month history of progressive weakness in both lower extremities. Radiographs showed that he had thoracic kyphoscoliosis with a 30-degree scoliotic curve together with a 70-degree kyphotic curve with an apical vertebra of T12. The preoperative MRI and CT showed that the spinal cord was entrapped by the apical vertebra and a butterfly vertebra was noted at T12. This resulted in the right half being smaller in size, with the resultant convexity to the left side. The conus was low-lying and tethered at the L3 level. The patient underwent detethering of the cord with corrective surgery for kyphoscoliosis in the same setting under intraoperative neuromonitoring. Results: Scoliosis was corrected to 20 degrees and kyphosis was corrected to 40 degrees. The motor evoked potentials (MEPs) that previously showed very feeble tracings now showed persistent positive potentials. The SSEPs remained constant and the same as baseline throughout. The patient's spinal cord function improved from Frankel C to Frankel D. A good trunk balance was evident at the two-month follow-up. Conclusion: Intraoperative neuromonitoring allowed safe and effective detethering and maintained correction of the kyphoscoliosis. (2021ESJ234)

Background: Hernia surgery has undergone tremendous refinement in technique of various methods have been advocated by different authors but each has got its own merit. Laparoscopic Trans-abdominal Pre-Peritoneal inguinal meshplasty (TAPP) is a newer technique which results in less post-operative pain, better cosmetic result, improves recovery time. The aim of the study was to compare cost effectiveness and duration of hospital stay that occurs from both laparoscopic TAPP repair and Lichtenstein repair in patients of inguinal hernia.Methods: The present study comprises 25 cases underwent open Lichtenstein mesh repair and 25 cases underwent laparoscopic (TAPP) repair. After surgery all patients were monitored carefully for pain, infection, cost effectiveness and hospital stay.Results: In present study, Group A is having significantly more cost of treatment than Group B in unilateral. The hospital stay was significantly low in group A than Group B.Conclusions: TAPP repair is more expensive compared to Lichtenstein’s meshplasty, TAPP repair is associated with faster recovery as compared to open Lichtenstein meshplasty, hospital stay is lesser in TAPP as compared to open inguinal meshplasty.

Falcotentorial meningiomas are rare and comprise only 0.3-1.1% of all meningiomas. The choice of surgical strategy for such lesions is not straightforward. 46 year old female came to our institute with complaints of gradually intensifying headache since 3 months which had aggravated over a period of 5 days. MRI Brain with contrast was done which showed a large, well circumscribed, lobulated, midline, extra-axial lesion attached to the posterior third of the falx and the anterior lip of the tentorium. The surgical plan was to excise the infra tentorial portion, for which a Steins (supra cerebellar infra tentorial) approach was deployed. Attempts to approach the supratentorial portion by incising the tentorium were unsuccessful as the required trajectory was far too acute. The supra tentorial portion would have to be approached by a more cranial trajectory, and hence it was decided to tackle that portion at a second stage. Some tumors may not be amenable to total excision in a single sitting. This case is being reported to underline the importance of a delayed 2 stage approach to excise this complex genre of Falcotentorial meningiomas which invade the supra and infra tentorial compartments.