Context:Hypothalamic hamartomas (HH) are ectopic masses of neuronal and glial tissue most commonly presenting with medically refractory gelastic seizures with evolution to other seizure types. They are also associated with cognitive and behavioral problems to varying extent. Surgery has been found to improve quality of life in more than 50% of patients.Aim:To evaluate the clinical characteristics and long-term outcome of surgery in children with HH and refractory epilepsy.Materials and Methods:A retrospective analysis of presurgical, surgical, and postsurgical data of six children who underwent surgery for HH and had at least 3 years follow-up was performed.Results:Six children (male: female = 5:1) aged 3-16 years (at the time of surgery) underwent surgical resection of HH for refractory epilepsy. At last follow-up (range 3-9 years), three children were in Engel's class I, two in Class II, and one in class III outcome. Significant improvement in behavior, quality of life was noted in four children; while the change in intelligence quotient (IQ) was marginal.Conclusions:Medically refractory epilepsy associated with behavioral and cognitive dysfunction is the most common presentation of HH. Open surgical resection is safe with favorable outcome of epilepsy in 50% with significant improvement in behavior and marginal change in cognitive functions.

Background:The effect of heat in endoscopic instruments used for laparoscopy and hysteroscopy has been well-studied. Reports of thermal injury from nasal endoscopes have also been reported. However, there are no experimental studies, which have objectively documented and provided recommendations for safe use of endoscopes in neurosurgery.Objectives:To study the heat generated at the tip of the endoscope and the subsequent thermal damage caused to a cotton drape placed in proximity, by varying the intensity of light delivered through different optical cables, ambient (operating room) temperatures and working distances.Materials and Methods:The study was carried out in the operation theater using a 300 watt xenon light source connected to the endoscope with 3.5 mm and 4.8 mm optical cables. A digital thermometer was used to record the heat generated at the tip of the endoscope.Results:The heat generated at the tip of the endoscope reached its peak in the first 6 min and attained a plateau at 15 min after turning on a light source of 60% intensity. Thermal injury to the cotton drape took a longer time with a 3.8 mm cable compared with 4.8 mm cable. The heat generated at the tip of the endoscope, and thereby the thermal injury caused was found to be lower when the ambient temperature was close to 20°C.Conclusions:Complications related to thermal injuries caused by heat generated at the tip of an endoscope can be reduced by using a smaller diameter cable, light intensity of 60%, increasing the working distance (as permissible), reducing the time spent for dissection while keeping the endoscope very close to the target and lowering the ambient temperature to 20°C.

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A systematic groundwater analysis was carried out in six villages of Narsampet in Warangal district and two villages of Narketpally in Nalgonda district of Telangana in India. These water samples were collected from respective areas and evaluated under four different categories viz. physico-chemical parameters (such as pH, Electric Conductivity (EC), Total Dissolved Solids (TDS), Turbidity, Alkalinity, Hardness, Chloride, Nitrates, Sulphates, Fluoride, Iron content) as per standard methods, behavioral changes i.e. measurement of learning and memory ability of rats (Rectangular maze, Morris water maze, Locomotor activity tests), various biochemical tests for both brain homogenate (Ellaman’s, DPPH, H2O2 Catalase activity assay) and serum (GOD-POD end point Assay, Uricase/POD end point Assay, Modified Biuret end point Assay) and histopathological studies of brain and bones. The results of physico-chemical tests were compared with WHO, BIS standards and the fluoride content of all the water samples was found to be higher than the standards. The results of behavioral tests and biochemical tests indicate the decrease in antioxidant activity and acetylcholine levels in rat brains due to high fluoride induced oxidative stress and increase in the cholinesterase activity. The biochemical tests for assessing bone toxicity reveal an increase in blood glucose and uric acid levels accompanied by decrease in protein levels indicating damage to bones. Histopathological studies indicate damage to the hippocampus region of the brain, nucleus and endoplasmic reticulum of femur bone.

Purpose: To study the 6D correction efficacy on dose to the target due to infrared(IR) body marker localization for stereotactic radiotherapy(SRT) patients Methods: Commercially available laboratory skull phantom, made of plastic is used in this study.It is filled with physiotherapy wax and a provision is made to insert CC13 ion‐chamber(0.13cc). The dose at a point in skull phantom is measured by CC13 ion‐chamber.An ordinary thermoplastic mould is prepared for skull phantom and 5 infrared body markers are placed at different places for localization as shown in figA. CT scan of the phantom is obtained using Siemens PET‐CT scanner with and without ion‐chamber. Treatment Planning is done on images which are without ion chamber .In the absence of ion chamber to fill the cavity a wax insert is inserted during the CT scan. 3mm slice thickness are obtained and imported to Eclipse treatment planning system(TPS) for contouring and planning.Treatment plans of 3D CRT/IMRT are planned in Eclipse on skull phantom images with isocenter placed at the chamber sensitive volume.The plan is exported to Exactrac imaging system for localization and verification. After setup of skull phantom imaging is done with exactrac stereoscopic imaging system and the 6D shifts (Vertical,logitudenal,lateral,yaw,pitch,roll) are applied. The focus to skin distance(FSD) is noted‐Table1.The radiation dose is delivered in Varian Novalis Tx.The charge collected /dose in CC13 ion chamber is noted from the DOSE1 electrometer‐Table2.The planned FSD and dose are noted from TPS. Results: The mean difference between planned and measured FSD and Dose are 0.55cm and 2.7% respectively. The mean SD of FSD and Dose are 0.383 and 1.58% respectively. Conclusion: Even though Exactrac‐6D couch shifts introduce change in FSD by 1–1.5cm the dose difference is within the range of 3% and is reasonable to treat frame less SRT treatments with IR body markers with ordinary mask.