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Background:Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Limited incision techniques for carpal tunnel release are gaining popularity. The main advantages of these techniques are less scar load, less pillar pain, shorter recovery, and return-to-work time. However, the completeness of release, and risk of neurovascular injury are always a concern. We devised a method of limited incision release with two mini-incisions and use of nasal speculum and a probe. We aimed to evaluate the clinical and neurological outcome of this technique.Materials and Methods:Twenty seven cases (9 male and 18 female, age 28–56 years) of isolated CTS cases were enrolled in the study. A total of 33 hands (six bilateral) underwent limited incision carpal tunnel release. In this study, two mini-incisions were used and release was done with the help of nasal speculum. Evaluation preoperatively and in 6 months and at 1-year postoperatively was done, namely, (a) clinical status examination, (b) motor testing using grip and pinch dynamometer, and (c) neurological outcome measure using nerve conduction study.Results:All the patients had good clinical and neurological outcome with no recurrence during followup. The first symptom to get relieved was night pains, with a mean of 4.5 days (range 2–14 days). Compared to pain, improvement of sensory symptoms was delayed; the mean duration was 42.8 days (range 30–90 days). Scar tenderness was present only for a mean duration of 9 days (range 7–21 days). The mean duration for patients to resume their daily activities was12 days (range 7–28 days) and to work was 32 days (range 21–90 days). The hand grip showed mean values of 45.12 ± 16.16 g/mm2 preoperatively, 62.45 ± 18.86 g/mm2 at 6 months postoperatively, and 74.87 ± 20.35 g/mm2 at 1-year postoperatively. The key pinch showed mean values of 11.27 ± 3.51 g/mm2 preoperatively, 20.181 ± 3.94 g/mm2 at 6 months postoperatively, and 27.96 ± 94.42 g/mm2 at 1-year postoperatively. The tip pinch showed mean values of 8.88 ± 2.39 g/mm2 preoperatively, 15.393 ± 3.25 g/mm2 at 6 months postoperatively, and 19.27 ± 4.81 g/mm2 at 1-year postoperatively. The palmar pinch showed mean values of 14.42 ± 2.92 g/mm2 preoperatively, 19.303 ± 3.62 g/mm2 at 6 months postoperatively, and 22.97 ± 4.08 g/mm2 at 1-year postoperatively.Conclusion:Limited incision carpal tunnel release can be considered a feasible alternative to traditional open release and endoscopic release.

Angioleiomyoma of the hand is a rare differential diagnosis of painful soft tissue nodule in the extremity. It arises from smooth muscle of the blood vessels and the most common symptom is pain. Imaging with magnetic resonance imaging shows characteristic features like a hypodense peripheral capsule with linear or branching internal hyperdensities on T2-weighted images, and post-contrast diffuse homogenous enhancement with a vessel leading up to the lesion. Histopathological examination shows well circumscribed fascicles of mature smooth muscle cells surrounding vascular lumina, lined by normal appearing endothelium without elastic lamina present. These cells stain positive for smooth muscle actin, desmin, vimentin, type IV collagen and S100, but stain negative for HMB-45 and ER. Angioleiomyoma is amenable for surgical resection. We report a case of painful subcutaneous nodule of hand, with radiological and histopathological findings suggestive of angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for painful nodule of extremity.

Purpose To study the demography, incidence, symptoms, histopathology, postoperative complications and recovery in operated patients of spinal tumor. Overview of Literature Primary spinal cord tumors (SCT) are an uncommon entity. According to their location, spinal tumors are conveniently classified as extradural (ED) and intradural (ID), although some can be both inside and outside the dura. ID tumors can be intradural extramedullary (IDEM) or intramedullary SCT (IMSCT). Methods This is a retrospective study of 122 patients with spinal tumors who were surgically treated at the department of neurosurgery from 2014 to 2019 over a period of 5 years. Study Design This is a retrospective study. Results Out of 122 patients, there were 19 patients with ED tumor, 73 had IDEM, and 30 had IMSCT. As many as 73 patients were males and the rest of the 49 patients were females. Mean age at time of surgery was 40.79 years. The thoracic region of spinal canal was most frequently involved (64; 52.4%). The common clinical symptom was motor weakness (90 cases; 73.77%). Majority of the patients had symptoms for duration of 6 to 12 months. Schwannomas were the most common tumor among IDEM and extradural location. Ependymomas were the most common type in IMSCT. We observed significant improvement in most of our cases. Four patients deteriorated at 3 months follow- up. Conclusions There was a higher male:female ratio for all spinal cord tumors except meningiomas. There was also a higher proportion of nerve sheath tumors, and a lower proportion of meningiomas and neuroepithelial tumors. These results are similar to other studies from Asian countries.

Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the dural membrane. Contact-related skull deformation causes inbending or fracturing of cranium or both, leading to separation of the dura mater from inner table. This injures the dural arteries, veins, venous sinus, or diploid channels, producing EDH. They usually occur as a result of direct impact injuries to the head, ipsilateral to impact side. Incidence of epidural hematoma is 1 to 3% of all head injuries. Contrecoup EDH cases are rare. and because of its rarity, we present a case report of a 17-year-old boy with contrecoup EDH who sustained head injury due to road traffic accident. Computed tomography of the brain showed left occipital bone fracture and large contrecoup extradural hematoma in right frontal region associated with pneumocephalus and hemorrhagic contusional edema beneath it. The EDH was operated on, and the patient was discharged uneventfully.

Introduction: The superficial circumflex iliac artery perforator (SCIP) flap has gained in popularity due to its thinness and superior donor site scar. However, there exist inconsistencies in the description of the surgical anatomy of the SCIP flap. The aim of this quantitative review was to provide a summary of published evidence to the surgical approach to such flaps. Methodology: A literature review of the MEDLINE® and Cochrane databases was conducted. Articles were assessed by two reviewers using predefined data fields and selected using specific inclusion criteria. The two authors independently reviewed the literature and discrepancies were resolved by consensus. Results: Included for evaluation were 39 articles. Of these, 30 fulfilled the criteria for surgical dissection, 16 for surgical anatomy and nine for preoperative imaging. The arterial anatomy of the groin perforator flap is variable and in 0.9 per cent of cases the pedicle originates from the superficial inferior epigastric artery rather than the superficial circumflex iliac artery (SCIA). The flap pedicle length is probably dependent on patient build and the course of the source vessel, rather than which groin perforator it is based on. CT is the gold standard preoperative imaging and should be used given the anatomical unpredictability. Lymphatics under the inguinal ligament and medial to the femoral artery should be preserved. Conclusion: This quantitative study provides a guide to safe groin perforator flap harvest and surgical pearls to consider for surgical planning. The usage of this flap remains novel and further long-term outcomes have yet to be established.

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Introduction Extradural hematoma diagnosed more than 14 days after head injury is classified as a chronic extradural hematoma (CEDH). In the present study, we presented a series of 8 patients with CEDH in a span of 6 months. Materials and Methods In this article, we reported 8 cases of CEDH who presented to Nil Ratan Sircar Medical College, Kolkata, West Bengal, India, within a span of 6 months. Discussion Extratemporal epidural hematomas (EDHs) are often due to venous bleeding from the diploic veins or dural sinuses or to delayed rupture of a middle meningeal pseudoaneurysm. In these cases, cerebrospinal fluid may redistribute from the lateral ventricles and thus allowing room for the enlarging hematoma producing vague neurological symptoms and signs. The incidence rate of CEDH reported in the literature ranges from 3.9 to 30% of all EDHs. Computed tomography (CT) scan in CEDH often shows a low-density center surrounded by a high-density margin. Calcification of the displaced dura mater may also occur. Some are identified incidentally, whereas others are diagnosed when investigating for persistent and/or progressive neurological symptoms. Symptomatic CEDH should be surgically evacuated and has an excellent outcome the earlier it is done. In patients with no or mild symptoms, normal neurological status, and a small-sized CEDH spontaneous resolution may be expected. Conclusion In the post-CT era, it is always said that CEDH is a rare entity. However, in developing countries we still encounter a large number of such cases and the question arises whether CEDH is still a rare entity.