This issue is dedicated to Cerebrovascular diseases which are one of the common non-communicable mortality. A series of articles have been contributed by experts in the field, covering the various aspects which will provide a comprehensive review of the current status on the management of common cerebrovascular diseases.

Adjuvants used in peripheral nerve blocks prolong duration of analgesia without prolonging motor blockade or causing systemic side effects. The current study was conducted to evaluate the efficacy of buprenorphine as an adjuvant to bupivacaine in supraclavicular brachial plexus block.

Microsurgical clipping of aneurysms is a challenging procedure for any neurosurgeon. It requires in depth knowledge of microanatomy, microsurgical skills, experienced neuro anaesthetists and dedicated specialised postoperative care. We present our experience in aneurysmal clipping.

Arteriovenous malformations(AVM) are the most commonly seen surgical vascular lesions. It accounts for about 0.68 per 100000 person-years. Mean age of presentation is about 33-45 years with no sex predisposition. Approximately half of the patients suffer from intracranial haemorrhage (ICH) during their lifetime. Inspite of many treatment options available for AVM, surgery is the gold standard treatment though it poses a great challenge. Here we present one such case.

Ischemic stroke is a major devastating neurological problem which may result in severe disability and can lead to mortality at times. It is frequently associated with diabetes mellitus, hypertension, hyperlipidemias and cardiac diseases. The advent of acute thrombolysis and endovascular interventions1 is showing good results in the outcome of acute stroke. There is a limited time window for acute intervention as ischemic tissue may not be salvageable if irreversible damage to the ischemic region sets in. Hence time is very precious in acute management; the concept of “Brain attack”, like heart attack is gaining popularity to stress emergency treatment.

He established Neurosurgery as a speciality in India, when very little was known about brain tumours and other surgical conditions of nervous system. He started Stereotactic and Functional Neurosurgery in Madras, along with his team comprising Drs. V. Balasubramaniam, S. Kalyanaraman, T. S. Kanaka and his Neurology colleagues Drs. G. Arjundas and K. Jagannathan. Madras Institute of Neurology became one of the major centers for Stereotactic Surgery and several pioneering original work was done here, which have won international acclaim.

Aneurysmal subarachnoid hemorrhage is one of the significant causes of major morbidity and mortality throughout the world. Early diagnosis and management have considerably reduced the mortality. American Heart Association and American Stroke Association have recently compiled the guidelines for the management of aneurysmal subarachnoid hemorrhage. This article gives a brief overview on the management of aneurysmal subarachnoid hemorrhage, based on the above guidelines.

Aneurysms of the cranial vessels are more prevalent (3% - 4%)1 than it was thought before (1% -2%)2,3. They are mostly asymptomatic until they rupture4 and unruptured aneurysms are increasingly detected in clinical practice as use of CT and MRI is becoming more common. The risk of aneurysm rupture is about 1% (0.05%-2%) per year and may vary with location, size, and shape5 . The aneurysm rupture account for about 80–85% of non-traumatic subarachnoid hemo rrhages6 and can also cause intraparenchymal and intraventricular hemorrhage. Most aneurysms in both ruptured and unruptured setting are managed by endovascular means. We review here the current role of endovascular management of intracranial aneurysms.

A ruptured intra-cranial aneurysm and the ensuing subarachnoid haemorrhage have a dramatic clinical presentation and are associated with high morbidity and mortality. The diagnosis and perioperative management of this condition extending from the intensive care unit to the neurosurgical OT or catheterization laboratory (for surgical clipping or endovascular coiling) are discussed in detail. Recent recommendations in the anaesthetic management of this condition are also covered in this review article.

Intra cranial aneurysms are abnormal outpouchings of vessel wall occurring at major vessel bifurcations. Majority of them occur in the anterior circulation and most commonly present with sub arachnoid hemorrhage. Various radiological investigations are presently available to accurately localize the aneurysm and identify the morphology. The 2 major treatment modalities are surgical clipping and endovascular coiling and each have their own merits and demerits. While the treatment mainly focuses on exclusion of the aneurysm from the circulation to prevent recurrent bleed, the other major goal of management is treatment of cerebral vasospasm associated with subarachnoid hemorrhage. Little is known about the pathophysiology of vasospasm and thus the treatment remains mainly symptomatic by raising the blood pressure and adequately hydrating the patient during the peak period of vasospasm. While the surgical clipping of aneurysms is standardized, the endovascular coiling techniques continue to evolve and may be the mainstay of management in the future. Microsurgery would be restricted to a small cohort of patients requiring vascular bypasses. The long term outcome of coiling is a matter of concern as recanalization of previously coiled aneurysms is an issue which has to be worked upon.

A 39 years aged young male with hypertension and ischemic heart disease of 4 years duration on medical management, presented with lumbar canal stenosis involving L3-L4 and L4-L5 levels for surgical decompression. Routine preoperative assessment including cardiac evaluation revealed regional wall motion abnormality in the echocardiogram with LVEF of 56%. He had moderate effort tolerance and was planned for surgery under ASA grade II. The patient was adequately fasted and pre-medicated with a benzodiazapine and H2-antagonist.

Multiple myeloma is a B-cell malignancy caused by monoclonal proliferation of plasma cells which secrete immunoglobulins leading to a “M” protein spike on immunoelectrophoresis and lytic bone lesions or renal involvement or anaemia or hypercalcaemia and is not associated with organomegaly.Here we present a case with non-secretory multiple myeloma with lymphadenopathy and hepatosplenomegaly with review of literature.