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Background As the COVID-19 pandemic completes one year, it is prudent to reflect back upon the challenges faced and the management strategies employed to tackle this overwhelming healthcare crisis. We undertook this study to validate our institutional protocols which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. Methods All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anaesthesia techniques, patient demographics as well as COVID-19 status was analysed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). Results Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P <0.001); and the same was attributable to a significant reduction in elective spine surgeries (P < 0.001). However no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the two time periods (P = 0.482). There was an increased incidence in the use of monitored anaesthesia care (MAC) techniques during emergency and essential neurosurgical procedures by the anaesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality amongst those subjected to general anaesthesia vis-a-vis MAC (p = 0.014). Conclusions Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared to the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favourable. The employment of monitored anaesthesia care techniques like awake craniotomy, and regional anaesthesia; facilitate a better outcome in the COVID-19 era.

The prevalence of anti-speno antibodies was assessed in 100 patients of male factor infertility. Majority of the patients were in 30·35 years age group. 18% of these patients had anti-speno antibodies in their seminal fluid and 16% in their serum. MJAFI 1999; 55 : 206-208

Brainstem glioma usually carries a poor prognosis and prolonged survival is very infrequent. In a detailed Pubmed, Medline search for prolonged survival, authors could got a longest survival only up to seventeen years, reported by Umehara et al, who was subjected to gamma knife therapy and got symptomatic, MRI brain reveled large tumor growth during pregnancy necessitating emergency surgery and histopathological diagnosis was pilocytic astrocytoma. Authors report an interesting case of midbrain glioma diagnosed 21 years back, who underwent gross resection in the year 1993, histopathology was pilocytic astrocytoma, WHO grade I, and received gamma knife surgery for residual subsequently and he presented with sudden onset left sided hemiplegia on the current admission. The cranial MRI imaging revealed an infarct involving right hemi midbrain, contrast MRI brain revealed no residual glioma. To the best knowledge of authors such prolonged survival is not reported with a case of brainstem glioma survived twenty- one years with non residual tumor on the last imaging study represents first case of its kind in the western literature and probably developed hemiplegia due to bleed, highlighting bleed as delayed complication following gamma knife therapy for cranial tumors

Background: Spinal ependymomas constitute approximately 2%–8% of primary adult central nervous system tumors. Authors analyzed demographic, clinical, radiological, surgical, and histopathological factors which correlated with the postoperative neurological outcome of patients who underwent surgery for conus and filum ependymoma (CFE). Materials and Methods: A retrospective analysis of 31 patients regarding clinical feature, imaging study, surgical management, and McCormick grading system for assessing functional neurological status was carried out, who underwent surgical management for CFE between January 2009 and April 2014. Final neurological outcome at follow-up period was correlated with various factors in search to find out probable prognostic factors affecting final neurological outcome following surgical management. Results: The myxopapillary ependymoma was observed in 55% of cases ( n = 17), while 39% cases ( n = 12) had Grade II ependymoma and rest 6% ( n = 2) cases had anaplastic ependymomas. The mean age was 30 years (range 7–60 years) with male to female ratio of 1:0.82. Patients predominantly presented with pain (80.65%); mean duration of symptoms was 28.61 months. Only, the preoperative McCormick grade was found to be the statistically significant prognostic factor ( P = 0.045), affecting neurological outcome however, the age, sex, duration of symptoms, location of the tumor, extent of the tumor, extradural spread, degree of surgical excision, vascularity of tumor, and histopathological World Health Organization grades were not found to be significant prognostic factors in the current study. Conclusion: The preoperative McCormick score was found to be the only statistically significant factor predicting the functional and neurological outcome after surgery, so surgical treatment should be offered early in the course of the disease to provide chance of preservation and good neurological recovery.