Indunil Karunarathna

McCune-Albright syndrome (MAS) is a rare genetic disorder characterized by the triad of polyostotic fibrous dysplasia, precocious puberty, and café-au-lait spots, along with various endocrine disorders such as hyperthyroidism, acromegaly, phosphate wasting, and Cushing syndrome. This review explores the etiology, presentation, evaluation, and management of MAS, highlighting the importance of a multidisciplinary approach. The disorder arises from a somatic activating mutation of the GNAS gene, leading to increased intracellular cAMP signaling. Diagnosis is primarily clinical, supported by imaging and laboratory evaluations. Management includes the use of aromatase inhibitors, antithyroid medications, GH receptor antagonists, and surgical interventions for fibrous dysplastic lesions. The prognosis varies depending on disease severity, with potential complications including bone pain, fractures, and decreased adult stature. Effective care involves coordinated efforts among pediatric specialists, emphasizing personalized patient management and ongoing monitoring of endocrinopathies.

The fields of neuroanaesthesia and neurocritical care have undergone substantial advancements, significantly enhancing patient outcomes and procedural efficiency. This review explores key developments, including the resurgence of ketamine for improving cerebral perfusion pressure, the adoption of dexmedetomidine for opioid-free anaesthesia, and the strategic use of adenosine and rapid ventricular pacing in neurovascular procedures. Innovations in awake craniotomies and spinal surgeries, along with the expanding role of regional anaesthesia, are highlighted. The review also discusses functional neurosurgery techniques, advanced anaesthetic management for neuronavigation and intraoperative MRI, and the implementation of enhanced recovery after surgery (ERAS) protocols. Furthermore, it addresses the evolving management strategies for stroke patients undergoing mechanical thrombectomy, traumatic brain injury, and advanced neuromonitoring techniques such as multimodal monitoring and telemetric ICP monitoring. These advancements collectively contribute to improved patient care and procedural outcomes, underscoring the importance of ongoing research and technological innovations in neuroanaesthesia and neurocritical care.