OBJECTIVEThe utility of telemedicine (TM) in neurosurgery is underexplored, with most of the studies relating to teletrauma or telestroke programs. In this study, the authors evaluate the cost-effectiveness of TM consultations for follow-up care of a large population of patients who underwent neurosurgical procedures.METHODSA decision-analytical model was used to assess the cost-effectiveness of TM for elective post–neurosurgical care patients from a predominantly nonurban cohort in West Bengal, India. The model compared TM care via a nodal center in West Bengal to routine, in-person, per-episode care at the provider site in Bangalore, India. Cost and effectiveness data relating to 1200 patients were collected for a 52-month period. The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations, as well as patient-perceived utility values for overall experience of the type of health care access that they received. Incremental cost-effectiveness ratio (ICER) analysis was done using the 4-quadrant charting of the cost-effectiveness plane. One-way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change.RESULTSThe overall utility for the 3 TM scenarios was found to be higher (89%) than for the utility of routine care (80%). TM was found to be more cost-effective (Indian rupee [INR] 2630 per patient) compared to routine care (INR 6848 per patient). The TM strategy “dominates” that of routine care by being more effective and less expensive (ICER value of -39,400 INR/unit of effectiveness). Sensitivity analysis revealed that cost-effectiveness of TM was most sensitive to changes in the number of TM patients, utility and success rate of TM, and travel distance to the TM center.CONCLUSIONSTM care dominates the in-person care strategy by providing more effective and less expensive follow-up care for a remote post–neurosurgical care population in India. In the authors’ setting, this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful. The viability of TM as a cost-effective care protocol is attributed to a combination of factors, like an adequate patient volume utilizing TM, patient utility, success rate of TM, and the patient travel distance.

Intracranial dermoids are rare congenital lesions of the brain that account for < 1% of all intracranial tumors. Even though they are rare, typical computed tomography (CT) scan and magnetic resonance imaging (MRI) features along with location allow radiological diagnosis in the majority of patients. Radiologically, dermoid cysts typically appear as nonenhancing low-density masses on CT scan and are hyperintense on T1-weighted (T1-W) MRI sequences with variable signal on T2-W sequences. We describe two cases of dermoid with unusual imaging appearance with the presence of mural nodule in both the cases. The recognition of atypical radiological features can avoid diagnostic pitfalls and is clinically relevant for overall surgical management.

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Knowledge of the microvascular anatomy is indispensable and it is mandatory to be aware of the possible variations in the anomalies to minimize morbidity.

Music is said to affect the brain in different ways. To the best of our knowledge, research works on the effect of passive listening to different melodic scales of Indian music on Electroencephalogram (EEG) power spectrum is rare to find. In this randomized control trial, 137 healthy subjects were randomly divided into 4 groups (A to D, n~32 in each group), of which A (raga Ahir Bhairav), B (raga Kaunsi Kanada), C (raga Bhimpalas) received music intervention while group D was the control arm. Nineteen channel scalp EEG was recorded for 30 minutes [10 min for each condition, before (BI), during (DI) and after intervention (AI)] and conducted power spectral analysis of waveforms in standard frequency bands. Two-way ANOVA was performed across conditions and groups, to determine the scalp regions showing significant changes, for each frequency band separately. Across conditions, significant change in BI alpha and AI theta, beta1, beta2 bands, while between groups, group B had significant change in alpha and group C in beta1 power, mostly involving frontal regions was seen. Mid Frontal PSA exhibited an increased theta power in group C and D (AI), while alpha and beta1 power increased in group B and C (in group C, beta2 increased significantly). Temporal trend analysis (2-minute segments), showed that there was a significant fall in frontal alpha DI in group B; while in A, C and D groups, the drop seen BI reduced DI and AI. Similarly, the beta1 drop reduced DI and AI in group C and D, while it increased in group B (DI) and group A (AI). Music caused relaxation effect with scales B and C causing maximal effect. In line with existing literature, it may be concluded that listening to these melodic scales was associated with mind wandering effect and probable visual imagery/recall.