Background In management of patients with traumatic brain injury, intracranial pressure holds an important place. Any untoward rise in intracranial pressure portends dreaded complications. Hence, any delay in detecting the issue is considered unacceptable. Objective This study focuses on analyzing the correlation between ultrasound derived optic nerve sheath diameter and intracranial pressure values derived from invasive intracranial pressure monitoring system in a neurosurgical patient with severe traumatic brain injury. Method A prospective observational study was performed using a convenience sample technique including all adult patients with traumatic brain injury who had invasive intracranial monitors placed as part of their clinical care. Ocular ultrasound was performed with 5 - 7.5 MHz linear probe of ACUSON X300 ultrasound system while simultaneous intracranial pressure readings were obtained directly from an invasive intracranial pressure monitoring system. The association between optic nerve sheath diameter and invasive intracranial pressure reading was assessed with the Pearson’s correlation coefficient and a receiver operator characteristic curve was created to determine the optimal optic nerve sheath diameter cutoff to detect intracranial pressure > 15 cm H2O. Result One hundred and fifteen ocular ultrasounds were performed on 30 individual patients. The mean age of the population involved in this study is 42.13 years ± 1.89 with male preponderance in the ratio of 6:1. Pearson’s correlation coefficient of optic nerve sheath diameter and intracranial pressure was found to be 0.844 (p < 0.000) demonstrating a significant positive correlation. The area under the receiver operating characteristic curve was found to be 0.961 (95% confidence interval = 0.93 to 0.99). Based on analysis of the receiver operating characteristic curve, optic nerve sheath diameter > 4.85 mm performed best to detect intracranial pressure > 15 cm H2O with a sensitivity of 93.5% and specificity of 83%. Conclusion Optic nerve sheath diameter is a dependable screening tool to evaluate for elevated intracranial pressure among patients with traumatic nerve injury.

Central Pontine Demyelination is a neurological disease caused by rapidly fl uctuating serum osmolality resulting in severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area of pons. This condition is associated with electrolyte disorders, especially severe hyponatremia and its rapid correction. Its clinical course is characterized by alterations in the mental status to debilitating neurological status i.e. coma. Chronic hyponatremia and its correction, with or without evaluating safe limit could result in pontine demyelination. Demyelination might also occur with normal sodium levels, and even if serum sodium levels are corrected within safe limits. The objective of this case report is to give a broad perspective on Central Pontine Demyelination and to discuss about the different factors contributing to the demyelination and the various causes, pathophysiology and the management of this condition. Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 99-101

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Introduction: The main aim of this study is to determine the anterior commissure-posterior commissure (AC-PC) distance in Nepalese cohort and has comparison of intercommissural distance of Nepalese cohort with some other races. Materials and Methods: The 47 patients, with mean age of 50 years, included in the study had undergone DBS or lesioning (Pallidotomy). Data were collected through the magnetic resonance imaging under DBS protocol and the manipulation, marking of AC and PC was done in Inomed Planning Software (IPS). Results: The data revealed average AC-PC distance of Nepalese cohort to be 24.86 ± 2.08 mm, ranging from 16 mm to 30 mm. The study among 29 males and 18 females illustrated male to have longer AC-PC as compared to female (25.38 mm male and 24.02 mm female). The results also confirmed age related changes in AC-PC distance which was linearly increasing with the age. Conclusion: Comparison of data from other studies revealed Nepalese cohort to have almost similar AC-PC distance with Asian population, while that was longer in Caucasian and shorter in Hispanic Population.

Background: Craniopharyngioma, an epithelial tumor believed to arise from the remnants of Rathke’s pouch, portray approximately 1.2%-4.4% of all intracranial tumors. Due to its inherent domain in the skull base and its liaison with indispensable neurovascular structure, it has still remained an intimidating contest despite an improved dexterity among the neurosurgeons and refinement in neurosurgical gadgetry.Surgical corridor to come down in favor for is elected by the position of optic chiasm, extension of tumor and development of ACoM or ACA (A1). Methods: A retrospective series study was conducted at Annapurna Neurological Institute and Allied Sciences between January 2016 and August 2021. A total of 20 patients who underwent surgery for histopathologically proven craniopharyngioma was enrolled. Majority of the surgery was performed via a pterional approach while two cases were addressed with a supra ciliary approach and one with a trans nasal trans septal transsphenoidal approach. Result: The age of presentation among our study group ranged from 5 years to 46 years with a mean age of 28.2 years.The most frequent mode of presentation was headache associated with visual disturbances (visual acuity and visual field). Histopathological analysis disclosed an admantinomatous variant 15 cases and a papillary type in 5 cases. The use of Ommaya reservoir in few selective cases was escorted by the cystic ingredient of the lesion. An endeavor to aggressive surgical approach was accomplished, amidst, excision of tumor was subtotal in 9 %, near total in 36 % and gross total in 45 %. Diabetes insipidus was seen in 36%. We had to endure a case of mortality, who lamentably had a massive sub-arachnoid hemorrhage with a colossal PCA territory infarction on arrival. Post operatively, the mass effect evolved on account of PCA territory infarction. Conclusion: The magnitude of resection of the tumor is affected by the extension of tumor, consistency of the lesion and position of optic chiasm. Even with an extensive resection, the prospect of recurrence is inordinately high.