Neurosurgical Research Articles

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa.

The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

Hyperosmolar Therapy in Elderly Neurosurgical Patients: Comparison of the Effect of Mannitol (20%) and Hypertonic Saline (3%) on Advanced Cardiovascular Parameters Using Transesophageal Echocardiography: A Preliminary Randomized Controlled Trial

Osmotherapeutic agents increase the intravascular volume by withdrawing water from the brain followed by relative hypovolemia due to diuresis leading to significant changes in systemic hemodynamics which might have adverse consequences in the elderly. We studied the effect of mannitol (20%) and hypertonic saline (3%) on left ventricle outflow tract velocity-time integral (LVOT-VTI) and cardiac output in elderly patients undergoing supratentorial neurosurgical procedures using transesophageal echocardiography. We recruited twenty-eight patients aged above 65 years undergoing supratentorial craniotomy who received equiosmolar solutions of 5.35 ml/kg of 3% hypertonic saline (Group HS, n=14) or 5 ml/kg of 20% mannitol (Group M, n=14). LVOT-VTI was recorded at baseline, 15, 30, 45, 60 and 90 minutes post-infusion and cardiac output (CO) was derived. We also recorded heart rate, blood pressure, fluid balance, brain relaxation, vasopressor use, complications and neurological outcome. We found a significant decrease in LVOT-VTI at 45, and 60 mins in Group M as compared to Group HS [mean(SD), 16.76(1.81) v/s 20.78(1.87), P <0.001, 17.4(2.38) v/s 19.16(2), P = 0.044, respectively]. We also found a corresponding significant fall in CO [3863.16(845.87) v/s 4745.59 (1209.33) ml/min, P = 0.034] and systolic blood pressure (P = 0.039), at 45 mins in Group M. Urine output was higher in Group M (P <0.001). All other parameters were comparable. Hypertonic saline appears to be associated with better systemic hemodynamics (LVOT-VTI, CO) while providing equivalent brain relaxation as mannitol in elderly patients. A future larger study is required to confirm our preliminary findings.

1136 Risk Factors for Postoperative Urinary Retention After Deep Brain Stimulation Surgery: The Role of the Subthalamic Nucleus

INTRODUCTION: Deep brain stimulation (DBS) is a widely used neurosurgical procedure for treating Parkinson's disease (PD) and essential tremor (ET). Lower urinary tract dysfunction is a common complication in PD, and this study examines the risk factors for postoperative urinary retention (POUR) after DBS surgery in PD and ET patients to improve patient outcomes. METHODS: This retrospective study analyzed data from patients who underwent DBS surgery for PD and ET at the University of Florida between 2010 and 2021. Data on patient characteristics and surgical details were collected and analyzed using univariate and mixed-linear models. RESULTS: 350 patients underwent 1086 DBS or IPG surgeries, with 153 of them having PD and 197 having ET. The rate of POUR was 79/477 (16.6%), 19/295 (5.2%), and 1/246 (0.4%) for Part 1, Part 2, and IPG replacement. Optimal mixed linear modeling revealed history of urinary retention (OR = 10.2, p = .002), Part 1 surgery (OR = 3.6 compared to Part 2, p &lt; .0003), male sex (OR = 2.5, p = .011), having an electrode placed or connected for the first time (OR = 1.8, p = .046), surgical time (OR 1.5 for each 30 min increase, p &lt; .0001), CCI (OR = 1.4 per comorbidity, p= .006), and preoperative opioid use (OR 1.4 for each additional 10 MME, p = .022) to be significant risk factors for POUR. Having an electrode in STN was found to be protective of POUR (OR = 0.4, p = .030). CONCLUSIONS: While most identified risk factors for POUR in DBS are non-modifiable, they remain important for preoperative planning. Reducing opioid use and minimizing surgical time may help mitigate POUR risk. Targeting the STN during DBS may lead to decreased POUR rates, indicating the potential benefits of STN-targeted DBS for PD and ET patients.

Opiate-reduction protocol for common outpatient spinal procedures: a long-term feasibility study and single-center experience.

The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence in the neurosurgical landscape, the authors' institution implemented opioid-prescribing guidelines for common outpatient spinal procedures in 2017, subsequently demonstrating a significant reduction in the narcotics prescribed. However, the ability to maintain the results garnered from such guidelines long term has not been described. The objective of this study was to evaluate postoperative opioid utilization at a high-volume quaternary referral center 5 years after the initial implementation of an opioid-reduction protocol for common outpatient spinal procedures. From the electronic medical records, authors collected data on the number of tablets and total morphine equivalent dose (MED) prescribed, acute postoperative readmissions for pain concerns, refill requests, and conversion to long-term opiate use in the 5 years following implementation of an opioid-reduction protocol for common outpatient spinal procedures. These procedures, undertaken in opiate-naive patients, included 1- or 2-level anterior cervical discectomy and fusion, 1- or 2-level cervical disc replacement, and 1- or 2-level laminectomy, laminotomy, or foraminotomy (cervical or lumbar). The total quantity of narcotics was reduced by 37.0 tablets per patient after protocol implementation and over the 5-year period thereafter. Generally, patients were discharged with an average of 23.3 tablets, concurrent with the initial goal of 24 tablets, set forth in 2017. These results confirm an ongoing reduction in opiate quantities prescribed and overall morphine equivalent totals at the time of discharge over the course of 5 years after initial protocol implementation. A standardized discharge protocol for postoperative outpatient spinal procedures can lead to long-term reductions in opioid discharge quantity, without compromising patient safety or increasing the utilization of hospital resources through readmissions, refill requests, or clinic phone calls. This study provides an example of a feasible and effective discharge prescription regimen that may be generalizable to common outpatient neurosurgical procedures with long-term evidence that a small intervention can lead to ongoing reduced quantities of postoperative opioids at the time of discharge.

330 Accuracy and Clinical Significance of Neurosurgical Patient Safety Indicator Events Reported by Centers for Medicare Services

INTRODUCTION: Data on patient safety indicator (PSI) events are used by Center for Medicare Services (CMS) for determining reimbursement to hospitals, and public quality reporting. It is unclear whether the process used by CMS to detect PSI events is accurate, and whether PSI events affect clinical outcomes in neurosurgical patients. METHODS: We reviewed CMS reported PSI events in neurosurgical patients at our hospital from July 1, 2018, through December 31, 2019. Discharge billing codes were reviewed in order to assess whether CMS criteria for PSI were met. Charts were reviewed by experienced clinicians in order to assess the accuracy and clinical significance of CMS reported PSI events. For deep venous thrombosis/pulmonary embolism (DVT/PE) PSI events, chart reviews were performed in order to assess whether standard of care prophylaxis was administered. RESULTS: 14 PSI events were reported in 11 patients, representing 1.3% of neurosurgical procedures in fee for service medicare patients. 7 patients underwent spinal surgery and 4 underwent cranial surgery. PSI events included DVT/PE (n = 6), postoperative hematoma (n = 2), postoperative respiratory failure (n = 5), and iatrogenic pneumothorax (n = 1). Only 10/14 PSI events (71%) met CMS criteria based on discharge billing codes, and only 8/14 PSI events (57%) met CMS criteria based on chart review. All PSI events that were confirmed based on chart review required specific medical or surgical treatment, but only 5 (63%) led to increased length of stay, and no patients had residual adverse effects at hospital discharge. 5/6 patients with chart confirmed DVT/PE (83%) received standard of care DVT prophylaxis. CONCLUSIONS: CMS-reported PSI events have significant rates of inaccuracy. PSI events may not correlate with meaningful adverse clinical outcomes. DVT/PE PSI events were not associated with breaches in standard of care.

Ventricular Access Utilizing Cutaneous Reference Points: Statistical Analysis and Proposal of a New Ventricular Entry Point

Perform radiological measurements and analysis of normal brain CT scans; delineate a new ventricular entry point from cutaneous landmarks, highlighting the potential surgical implications of these findings. 6 radiological distances (AR; BR; AL; BL, C and D) were measured in normal brain CT scans using Horos software. Statistical analysis of the measurements was performed with minitab18 software based on age, sex and side. 132 brain CT scans were analyzed, yielding the following mean results: AR distance: 2.1cm; BR distance: 7 cm; AL distance: 2.1 cm; BL distance: 7.1 cm; C distance: 12.4 cm; D distance: 7 cm; new ventricular entry point: 12.4 cm posterior to the nasion and 2.1 cm lateral to the midline. The freehand technique for accessing the lateral ventricles is a common neurosurgical procedure but is often accompanied by complications. To address this, we suggest a novel entry point for ventricular access, determined by cutaneous reference points. This point is situated 12.4 cm posterior to the nasion along the midline, and 2.1cm lateral to the midline. Although our findings may play a role in presurgical planning for ventricular pathologies, future prospective studies are warranted.

Evaluating the efficacy of standardized pressure ulcer management protocols in the prevention of pressure injuries among patients undergoing neurosurgical procedures.

Pressure injuries are a significant concern for patients undergoing neurosurgical procedures due to prolonged immobility and the complexity of care. This study evaluates the efficacy of standardized pressure ulcer management protocols in preventing pressure injuries and enhancing patient care in a neurosurgical context. A comprehensive retrospective analysis was conducted at a single institution from December 2020 to December 2023, comparing 50 patients who received standardized pressure ulcer management (intervention group) with 50 patients who received conventional care (control group). The study assessed the incidence of pressure ulcers, patient comfort levels using the Kolcaba Comfort Scale and sleep quality using the Richards-Campbell Sleep Questionnaire (RCSQ). Statistical analysis was performed using SPSS software, version 27.0, applying t-tests and chi-square tests as appropriate. The intervention group exhibited a significantly lower incidence of pressure ulcers at all measured time points post-surgery compared to the control group. Patient comfort levels in the intervention group were consistently higher across psychological, environmental, physiological and socio-cultural domains. Sleep quality metrics, including sleep depth, latency to sleep onset and overall sleep quality, were significantly improved in the intervention group. The implementation of standardized pressure ulcer management protocols in neurosurgical care significantly reduces the incidence of pressure injuries, enhances patient comfort and improves sleep quality. These findings highlight the importance of adopting structured care protocols to improve postoperative outcomes and patient well-being in neurosurgical settings.

478 Single-Neuron and Columnar Computations in the Human Prefrontal Cortex Underlying Transformations From Conscious Visual Perception to Speech Production

INTRODUCTION: The basic functional unit of the mammalian neocortex is the cortical column. It consists of a vast diversity of circuit elements and interconnected layers supporting a range of computations for cognitive functions. While much progress has been made in our understanding of its functional architecture in animal models, its role in complex, uniquely human cognitive processes remain unknown. METHODS: We utilized a new columnar recording approach in humans participating of cognitive tasks, while undergoing awake neurosurgical procedures. The novelty of this approach hinged on utilizing state-of-the-art Neuropixels probes for our recordings, a silicon-based electrophysiology recording electrodes with high channel count and recording site density. This technology allows us to measure neural activity with single cell resolution throughout the neocortical column and its layers, and at a scale that is far beyond the capabilities of current clinically-approved devices. The participants performed a naturalistic visual priming-based sentence production task that provided them with pictorial representations of events that had to be articulated in specific form and order. RESULTS: We observed distinct spatiotemporal activity dynamics throughout the cortical column in the language-dominant prefrontal cortex that encoded a preparatory mode for speech generation, as well as visual perception and sentence construction processing stages during natural speech. Furthermore, we observed the emergence of this columnar activity pattern with optimal visual inspection of presented images (by high resolution eye and pupil tracking) and associated improved performance during the task. CONCLUSIONS: These results highlight a functional organization of the cortical column in the human prefrontal cortex subserving sensory-motor transformations for visual conscious perception and speech production, with profound implications for future brain machine interfaces that aim to restore complex human cogntive functions.

879 Comparison of Perioperative and Long-Term Outcomes Following PEEK and Autologous Cranioplasty: A Single Institution Experience

INTRODUCTION: Cranioplasty is a common neurosurgical procedure to correct congenital or acquired skull defects. Three-dimensionally (3D) printed polyether-ether-ketone (PEEK) implants are a relatively novel option for cranioplasty that has gained popularity in recent years. However, there is ongoing debate with respect to this material’s efficacy and safety compared to autologous bone grafts. The purpose of this study was to offer our institution’s experience and add to the growing body of literature on the topic. METHODS: A single-institution retrospective analysis of patients undergoing cranioplasties between 2016 and 2021 was performed. Patients were divided into PEEK and autologous cranioplasty cohorts. Parameters of interest included patient demographics as well as perioperative (&lt;3 months postoperative) and long-term outcomes (&gt;3 months postoperative). A p-value &lt;0.05 was considered statistically significant. RESULTS: A total of 31 patients met inclusion criteria (PEEK: 15, Autologous: 16). Mean age of the entire cohort was 51.7 years (range 19-81 years). Baseline demographics using the modified frailty index (mFI) revealed greater rate of comorbidities in the autologous group (p = 0.073), which was accounted for in statistical analyses. Multiple logistic regression model revealed a significantly higher rate of surgical site infection during the immediate postoperative period in the autologous cohort (31.3% vs. 0%, p = 0.011). Otherwise, perioperative and long-term complication profiles were similar between groups. Additionally, a generalized linear model demonstrated that both cohorts had similar mean hospital length of stay (LoS) (autologous: 16.1 vs. PEEK: 10.7 days). CONCLUSIONS: PEEK cranioplasty implants may offer a more favorable perioperative complication profile with similar long-term complication rates and hospital LoS compared to autologous bone implants. Future studies are warranted to confirm our findings in larger series, and further examine the utility of PEEK in cranioplasty.

430 Academic Productivity of Neurosurgical Trainees Is Associated With Productivity of Gender Concordant Faculty

INTRODUCTION: Mentorship disparity is a commonly cited barrier to female neurosurgery trainees. The extent to which gender concordance with faculty impacts trainees’ academic productivity is underexplored. METHODS: The website of each ACGME accredited neurological surgery residency program was queried to identify the name and gender of all current (2022-2023) neurosurgical residents and academic faculty. Academic productivity, defined as the number of publications per person between 2021-2023 in 15 neurosurgery journals, was compiled into an original database. For each program, the average number of publications per female and male faculty and resident were recorded. Pearson correlation coefficients were calculated. RESULTS: A total of 959 faculty (female: 121, 12.6%) and 790 residents (female: 179, 22.7%) across 112 programs were identified. Forty (38%) programs had no female faculty; 32% had no female residents. The absence of female faculty was not statistically associated with the absence of female residents. In programs with only male faculty, academic productivity of male attendings was negatively associated with that of female residents (-0.47, p 0.0104). CONCLUSIONS: Academic productivity of male faculty correlates with productivity of male residents in their program; this relationship is not observed between faculty and residents of opposite genders. In programs with only male faculty, faculty productivity is inversely correlated with productivity of female residents. These findings reveal limited collaboration between residents and faculty of the opposite gender as a potential barrier to academic productivity. Furthermore, efforts to promote effective cross-sex collaboration could increase productivity for all members of neurosurgery divisions.

819 Pre-residency Research Output Amongst U.S. Neurological Surgery Residents

INTRODUCTION: Research productivity is often used in evaluating candidates for neurosurgery residency. Official Match data report successful candidates have on average ∼25 pre-residency research products; however, average number of indexed publications, the highest-valued research product, is not reported separate from other research products. METHODS: A list of all US neurosurgery residents who successfully matched between 2017-2021 was generated and narrowed to US MD seniors who applied to the authors’ institution. Each resident’s pre-residency publication quantity was extracted using Scopus. Additional variables were extracted from residency applications. RESULTS: 93.2% of all matched neurosurgery applicants from 2017 through 2021 were captured. Distribution of publication quantity was right skewed. Mean ± SD total, neuroscience-specific, and first-author pre-residency publications for applicants who matched in 2021 were 8.1 ± 10.0, 6.6 ± 8.7, and 2.3 ± 3.8 respectively. Median (IQR) total, neuroscience-specific, and first-author pre-residency publications were 5.0 (2.0, 11.0), 4.0 (1.5, 9.0), and 1.0 (0.0, 3.0) respectively. There was a statistically significant increase in average total, neuroscience-specific, and first-author publications from 2017 to 2021 (p &lt; 0.001). Multivariable analysis demonstrated an independent, positive association between class year and publication quantity (1.07 (0.71-1.42), p &lt; 0.001). CONCLUSIONS: Indexed publications constitute a small portion of total research products successful neurosurgery candidates apply with. A high number of publications is not necessary to match with approximately 50% of all applicants who successfully matched having fewer than five publications and 25% having fewer than two. That said, average pre-residency publication quantity is increasing over time at a rate of approximately one publication per year.

Letter to the Editor Regarding “Impact of Fellowship Training on Research Productivity in Academic Neurological Surgery”

Letter to the Editor Regarding “Impact of Fellowship Training on Research Productivity in Academic Neurological Surgery”

322 A Cost Analysis of Medical Students Applying to Neurological Surgery Residency: An Analysis of the Texas STAR Database

INTRODUCTION: Medical Students applying to competitive residencies such as neurosurgery incur substantial costs associated with interviews, away rotations, and application fees. Researchers in the past have examined the sources of expenses during the residency application cycle, but few studies have compared the expenses prior to and during the COVID-19 pandemic. METHODS: The TEXAS STAR database was surveyed for applicants of neurosurgical residency programs during the COVID-19 pandemic (2021) and post-pandemic (2022). In total, 66 applicants for the 2021 application cycle and 50 applicants for the 2022 application cycle completed the survey. We compared the application fees, away rotations cost, interview cost, and total expenses as reported by the neurosurgery applicants of the 2021 and 2022 application cycle. A Shapiro-Wilk test was used to test for data normality, and a Mann-Whitney U-Test was used to compare costs during the 2021 and 2022 neurosurgery application cycle. RESULTS: There was a statistically significant reduction in total expenses in 2021 vs 2022 ($3,934 vs $9,860). Interview expenses and away rotation expenses were also decreased in 2021 vs 2022 (interview expenses $786 vs $4511, away rotation $1,083 vs $3,000, p &lt; 0.001). Application fee expenses were not different between the 2021 and 2022 application cycle. Regional stratification revealed the greatest reduction in cost, an $11,908 savings, in the South region for the year of 2021. CONCLUSIONS: Our study revealed that the COVID-19 pandemic caused a significant reduction in the total fees associated with the neurosurgical residency application. The use of virtual platforms in place of in-person interviews could lessen the financial burden on applicants and alleviate socioeconomic barriers in the neurosurgical application process even after COVID-19.

724 Population Per State Served by a Neurosurgery Resident: A National Review

INTRODUCTION: Neurosurgery residency remains challenging, with 7-years of post-graduate training offered at only 116 locations. It's typically the longest route to board certification of all surgical and medical specialties, yet its programs often consist of the smallest cohorts. Furthermore, the breadth of pathology and populations served by each neurological residency varies significantly. METHODS: Doximity residency “navigator” was used to query total residency programs that entered the 2022-2023 match cycle. U.S. state populations were collected from World Population Review Census January 2023. States were arranged from highest to lowest by census population. Each state population was divided by the NS resident positions in that state. The population per resident (PPR) were compared. RESULTS: California and Wyoming contained the largest and smallest state populations, respectively at 40,223,504 and 580,817. Vermont was the smallest state to contain a NS program with a population of 648,279 and 7 residency positions or roughly 92,611 PPR. California comparatively contained 151 positions or 266,381 PPR. Interestingly, New York and Florida each contain roughly 21 million people, yet they respectively contained 115,527 and 354,909 PPR. In total 65% of residents served between 127,920 to 306,528 people depending on the state. CONCLUSIONS: There is a wide range in the number of people served by each NS resident throughout the USA. Neurological Surgery residencies are not located uniformly by population and patients are free to travel across state boundaries. Currently the ACGME determines program expansion and creation by uniform specialty specific standards. Our data presents a new lens for discussing maximization of training opportunities across the continental United States.

491 Scalp Incisions With Stairstep Pericranial Edges to Minimize Sequalae of Poor Wound Healing in Supratentorial Brain Tumor Surgery

INTRODUCTION: Wound healing problems are especially prevalent in craniotomies for intra-axial brain tumors as patients often require radiation, chemotherapy, and chronic steroids. All surgeons have postoperative patients with poor skin healing (i.e., excessive scabbing) at follow up, some of whom progress to infections that may involve the bone graft or hardware. While newer techniques like minimally invasive approaches and routine vancomycin powder use have helped overall complication rates, poor skin healing remains a frustratingly persistent cause of morbidity. METHODS: Ninety-one consecutive patients underwent supratentorial, intra-axial brain tumor surgery with a single surgeon at a single institution using this technique. Patient demographics, pathology, adjuvant interventions, and other independent risk factors were analyzed. RESULTS: No wound-related complications requiring readmission, intravenous antibiotics, or reoperation were encountered at a median 3-month follow up. There were also no surgical site infections, dehiscences, or CSF leaks. Fifty-one patients (57.3%) had postoperative radiotherapy, eighty-five patients (93.4%) had perioperative steroids, and fifty-six patients (61.5%) had postoperative chemotherapy. Six patients (6.5%) had concerns for poor initial scalp healing at routine follow up and were placed on a short course of oral antibiotics prophylactically. None (0%) of these individuals progressed to infection or required further intervention. One other patient developed a shunt infection in this interval that required removal unrelated to the craniotomy site. CONCLUSIONS: Here we outline the principles and demonstrate the execution of stairstep pericranial edges in supratentorial brain surgery. This technique, designed with plastic surgeons, provides an intact, vascularized layer of pericranium beneath the incision and over the bone graft/hardware to optimize wound healing and prevent morbid sequelae in inevitable cases of poor initial skin healing.

Advancements and Challenges in Robot-Assisted Bone Processing in Neurosurgical Procedures.

Practical applications of nerve decompression using neurosurgical robots remain unexplored. Our ongoing research and development initiatives, utilizing industrial robots, aim to establish a secure and efficient neurosurgical robotic system. The principal objective of this study was to automate bone grinding, which is a pivotal component of neurosurgical procedures. To achieve this goal, we integrated an endoscope system into a manipulator and conducted precision bone machining using a neurosurgical drill, recording the grinding resistance values across 3 axes. Our study encompassed 2 core tasks: linear grinding, such as laminectomy, and cylindrical grinding, such as foraminotomy, with each task yielding unique measurement data. In linear grinding, we observed a proportional increase in grinding resistance values in the machining direction with acceleration. This observation suggests that 3-axis resistance measurements are a valuable tool for gauging and predicting deep cortical penetration. However, problems occurred in cylindrical grinding, and a significant error of 10% was detected. The analysis revealed that multiple factors, including the tool tip efficiency, machining speed, teaching methods, and deflection in the robot arm and jig joints, contributed to this error. We successfully measured the resistance exerted on the tool tip during bone machining with a robotic arm across 3 axes. The resistance ranged from 3 to 8 Nm, with the measurement conducted at a processing speed approximately twice that of manual surgery performed by a surgeon. During the simulation of foraminotomy under endoscopic grinding conditions, we encountered a -10% error margin.

Impaired creative cognition after surgery for an IDH-mutated glioma: A proof-of-concept study

Assessment of high cognitive functions, such as creativity, is often overlooked in medical practice. However, it is crucial to understand the impact of brain tumors, specifically low-grade gliomas, on creative cognition, as these tumors predominantly affect brain regions associated with cognitive creativity. In this study, we investigated creative cognition using the Alternative Uses Task (AUT) and the Combination of Associates Task (CAT) in a cohort of 29 patients who underwent brain surgery for a low-grade glioma, along with 27 control participants. While the group of patients did not exhibit deficits in clinical neuropsychological assessments, our results revealed significant impairment in generating original and creative ideas compared to the control group. Furthermore, when analyzing the specific brain regions affected by the tumors, patients with lesions overlapping the left rostro-lateral prefrontal cortex, a critical region for creativity, displayed more pronounced impairments in the CAT compared to patients with lesions outside this region. These findings provide proof of concept that patients can experience impaired creative cognition following surgery for low-grade glioma, highlighting the importance of assessing higher-order cognitive functions, including creativity, in neurosurgical patients. Moreover, beyond its clinical relevance, our study contributes to advancing our understanding of the neuroscience of creativity.

Microcurrent wave alleviates mouse intracranial arterial dolichoectasia development

Intracranial arterial dolichoectasia (IADE) is associated with the interaction of hypertension and inflammation, and microcurrent can be effective in hypertension. Therefore, this study aimed to investigate the therapeutic effect of microcurrent electrical stimulation in a mouse IADE model. This study randomly categorized 20 mice into five groups: group 1-C (healthy control), group 2-D (IADE model), group 3-M + D (microcurrent administration before nephrectomy and until brain surgery), group 4-D + M (microcurrent administration for 4 weeks following brain surgery), and group 5-M (microcurrent administration for 4 weeks). Cerebral artery diameter and thickness and cerebral arterial wall extracellular matrix components were assessed. Among the five groups, group 2-D showed significantly higher cerebral arterial wall diameter (117.79 ± 17.05 µm) and proportion of collagen (42.46 ± 14.12%) and significantly lower arterial wall thickness (9.31 ± 2.26 µm) and proportion of smooth muscle cell (SMC) and elastin in the cerebral arterial wall (SMC: 38.05 ± 10.32%, elastin: 11.11 ± 6.97%). Additionally, group 4-D + M exhibited a non-significantly lower diameter (100.28 ± 25.99 µm) and higher thickness (12.82 ± 5.17 µm). Group 5-M demonstrated no evidence of toxicity in the liver and brain. The pilot study revealed that microcurrent is effective in preventing IADE development, although these beneficial effects warrant further investigation.

Telemedicine for Potential Application in Austere Military Environments: Neurosurgical Support for a Decompressive Craniectomy.

The main goal of this study was to assess the feasibility of a head-mounted display (HMD) providing telemedicine neurosurgical support during a decompressive craniectomy by a military surgeon who is isolated from readily available neurosurgical care. The secondary aim was to assess the usability perceived by the military surgeon and to evaluate technical aspects of the head-mounted display. After a standard concise lecture, 10 military surgeons performed a decompressive craniectomy on a AnubiFiX-embalmed post-mortem human head. Seven military surgeons used a HMD to receive telemedicine neurosurgical support. In the control group, three military surgeons performed a decompressive craniectomy without guidance. The performance of the decompressive craniectomy was evaluated qualitatively by the supervising neurosurgeon and quantified with the surgeons' operative performance tool. The military surgeons rated the usability of the HMD with the telehealth usability questionnaire. All military surgeons performed a decompressive craniectomy adequately directly after a standard concise lecture. The HMD was used to discuss potential errors and reconfirmed essential steps. The military surgeons were very satisfied with the HMD providing telemedicine neurosurgical support. Military surgeons in the control group were faster. The HMD showed no hard technical errors. It is feasible to provide telemedicine neurosurgical support with a HMD during a decompressive craniectomy performed by a non-neurosurgically trained military surgeon. All military surgeons showed competence in performing a decompressive craniectomy after receiving a standardized concise lecture. The use of a HMD clearly demonstrated the potential to improve the quality of these neurosurgical procedures performed by military surgeons.

Emergent Coronary Thrombectomy for Acute Myocardial Infarction Immediately Following Craniotomy with Tumor Resection.

The management of perioperative acute myocardial infarction (AMI) following oncologic neurosurgery requires balancing competing risks of myocardial ischemia and postoperative bleeding. There are limited human data to establish the safest timing of antiplatelet or anticoagulation therapy following neurosurgical procedures. For patients with malignancy experiencing AMI in the acute postoperative period, staged percutaneous coronary intervention (PCI) with upfront coronary aspiration thrombectomy followed by delayed completion PCI may offer an opportunity for myocardial salvage while minimizing postoperative bleeding risks. CYP2C19 genotyping and platelet aggregation studies can help confirm adequate platelet inhibition once antiplatelet therapy is resumed.