Course Of Neurosurgery Research Articles

The Neurovascular Disease Management Course: A Medical Student Opportunity for Early Exposure and Technical Development in Vascular Neurosurgery

As endovascular neurosurgery techniques continue to evolve, medical students in the United States have widely varying exposures to the field, particularly with respect to opportunities for hands-on experiences. Current medical school curricula could benefit from a novel and adaptive course on vascular neurosurgery to increase student exposure earlier in their training. We launched a yearly hands-on vascular neurosurgery course for medical students and residents. The day-long course is a combination of lectures focused on neurovascular disease and management accompanied by hands-on sessions where students practiced fundamental microsurgery and angiography techniques using real microscopes and angiography simulators. We surveyed the students before and after each of the 2 courses. The survey following the second annual course included quiz questions the students had not previously seen. Over 2 courses, we had 149 attendees, 71.8% of which were first and second-year medical students representing fifteen institutions. The average survey completion rate was 41.4% for the 4 surveys across the 2 courses. Attendees' interest in pursuing a surgical specialty (t=1.815, P= 0.039) along with their comfort with neuroanatomy (t=8.780, P ≤ 0.001) and neurosurgical disease (t=6.133, P ≤ 0.001) was significantly elevated after the completion of the second course. Responses to the post-survey showed a good grasp of the fundamentals with 68% of attendees answering 70% of the quiz questions correctly. An interactive course on vascular neurosurgery may be an effective vehicle to provide medical students with exposure to the field and the opportunity to learn the fundamentals.

Celebrating 20 Years of Excellence: Latin American Pediatric Neurosurgery Course LACPN (2004-2024)

Two decades ago, a visionary initiative was launched in Latin America with the aim of advancing pediatric neurosurgery education and expertise across the region. Today, as we mark the 20th anniversary of the Latin American Pediatric Neurosurgery Course (LACPN), it is an opportune moment to reflect on its journey, celebrate its achievements, and chart a course for its continued success. The LACPN was established with a clear mission: to provide a platform for knowledge exchange, skill development, and collaboration among neurosurgeons dedicated to caring for children with neurological conditions. Designed to cover the major fields in Pediatric Neurosurgery, the scientific program is divided into annual courses over a 3-year cycle, with each biannual course is based on a four-day program divided in the morning sessions; lectures and case discussion an afternoon session; lectures, video session, "hand-on", and "solve a case". Following the ESPN post-graduate course and Asian-Australasian Course in Pediatric Neurosurgery program. At the heart of the LACPN's success lies its unwavering commitment to education and training, a culture of continuous learning and mentorship, the LACPN has not only raised the standard of care but also inspired a new generation of neurosurgeons dedicated to pediatric neurosurgery in the past 20 years. Over the past 18 years of LACPC more than 350 different trainees (from Brazil, Argentina, Chile, Colombia, Uruguay, Mexico, Venezuela, Bolivia, Cuba, Paraguay, and others) and 73 faculty invitees (from Brazil, Argentina, Chile, Mexico, USA, France, Italy, Costa Rica, Colombia, Turkish, Singapore, Spain, UK, and Australia, South Africa) have attended the course. In 2024, the LACPN become an official course of the Latin American Association for Pediatric Neurosurgery (ASOLANPED). This year the course was held in Pilar, Buenos Aires, Argentina, with the brilliant direction of Dr. Ramiro delRio and Dr. Sebastian G. Jaimovich. As we reflect on the past 20 years, it is evident that the LAPNC has made a profound impact on the field of pediatric neurosurgery in Latin America. Its legacy extends far beyond the confines of the operating room, encompassing a legacy of excellence, collaboration, and compassion that will continue to shape the future of pediatric neurosurgery for generations to come. As we celebrate this significant milestone, we are reminded that our work is far from complete. Challenges remain, ranging from disparities in access to care to the need for continued innovation and research. As we look ahead to the next 20 years and beyond, let us recommit ourselves to the pursuit of excellence, the advancement of knowledge, and the relentless pursuit of better outcomes for the children and families we serve.LACPN is a unique course! Friendship, collaboration and opportunities for everyone are the pillars of this course. In closing, we extend our heartfelt gratitude to all those who have contributed to the success of the Latin American Pediatric Neurosurgery Course over the past two decades – the organizers, faculty, participants, sponsors, and supporters. Your dedication, passion, and commitment have made this journey possible, and we look forward to continuing our shared mission of advancing pediatric neurosurgery in Latin America and beyond. Here's to 20 years of excellence, and to many more years of innovation, collaboration, and impact. See you in Rio de Janeiro 2024!!

Neurosurgical Education Using Cadaver-Free Brain Models and Augmented Reality: First Experiences from a Hands-On Simulation Course for Medical Students.

Background and Objectives: Neurosurgery has been underrepresented in the medical school curriculum. Advances in augmented reality and 3D printing have opened the way for early practical training through simulations. We assessed the usability of the UpSurgeOn simulation-based training model and report first experiences from a hands-on neurosurgery course for medical students. Materials and Methods: We organized a two-day microneurosurgery simulation course tailored to medical students. On day one, three neurosurgeons demonstrated anatomical explorations with the help of life-like physical simulators (BrainBox, UpSurgeOn). The surgical field was projected onto large high-definition screens by a robotic-assisted exoscope (RoboticScope, BHS Technologies). On day two, the students were equipped with microsurgical instruments to explore the surgical anatomy of the pterional, temporal and endoscopic retrosigmoid approaches. With the help of the RoboticScope, they simulated five clipping procedures using the Aneurysm BrainBox. All medical students filled out a digital Likert-scale-based questionnaire to evaluate their experiences. Results: Sixteen medical students participated in the course. No medical students had previous experience with UpSurgeOn. All participants agreed that the app helped develop anatomical orientation. They unanimously agreed that this model should be part of residency training. Fourteen out of sixteen students felt that the course solidified their decision to pursue neurosurgery. The same fourteen students rated their learning experience as totally positive, and the remaining two rated it as rather positive. Conclusions: The UpSurgeOn educational app and cadaver-free models were perceived as usable and effective tools for the hands-on neuroanatomy and neurosurgery teaching of medical students. Comparative studies may help measure the long-term benefits of UpSurgeOn-assisted teaching over conventional resources.

Neurosurgical Education in Tanzania: The Dar es Salaam Global Neurosurgery Course

Postgraduate neurosurgical training is essential to develop a neurosurgical workforce with the skills and knowledge to address patient needs for neurosurgical care. In Tanzania, the number of neurosurgeons and neurosurgical services offered have expanded in the past 40 years. Training opportunities within the country, however, are not sufficient to meet the needs of residents, specialists, and nurses in neurosurgery, forcing many to train outside the country incurring associated costs and burdens. We report on the Dar es Salaam Global Neurosurgery Course, which aims to provide local training to neurosurgical health care providers in Tanzania and surrounding countries. We report the experience of the Global Neurosurgery Course held in March 2023 in Dar es Salaam, Tanzania. We describe the funding, planning, organization, and teaching methods along with participant and faculty feedback. The course trained 121 participants with 63 faculty-42 from Tanzania and 21 international faculty. Training methods included lectures, hands-on surgical teaching, webinars, case discussions, surgical simulation, virtual reality, and bedside teaching. Although there were challenges with equipment and Internet connectivity, participant feedback was positive, with overall improvement in knowledge reported in all topics taught during the course. International collaboration can be successful in delivering topic-specific training that aims to address the everyday needs of surgeons in their local setting. Suggestions for future courses include increasing training on allied topics to neurosurgery and neurosurgical subspecialty topics, reflecting the growth in neurosurgical capacity and services offered in Tanzania.

Ailing neurosurgical services in rural Africa

Ailing neurosurgical services in rural Africa

Pilot application of Lecture-Panel-Discussion Model (LPDM) in global collaborative neurosurgical education: a novel training paradigm innovated by the Swedish African Neurosurgery Collaboration.

BackgroundDisruptions in global surgery educational routines by the COVID-19 pandemic have elicited demands for alternative formats for rendering qualitative neurosurgical education. This study presents application of a novel model of online neurosurgical course, the Lecture-Panel-Discussion Model (LPDM).MethodsThis is a cross-sectional survey of participants who attended the Swedish African Neurosurgery Collaboration (SANC)-100A course. Participants evaluated the course through an online self-administered questionnaire using a 5-point Likert scale ranging from very poor—1, poor—2, average (fair)—3, good—4, to excellent—5. SANC-100A comprises a tripod of Lectures, Panel review, and interactive case Discussion. This model (LPDM) was innovated by SANC and applied at the Enugu International Neurosurgery course in February 2021.ResultsThere were 71 attendees, 19 were course faculty, while 52 were participants. Thirty-five attended from Nigeria, 11 from Sweden, 3 from Malawi, 2 from Senegal, and 1 from the UK. Among 44 participants who completed the questionnaire, there were 9 fellows and 35 residents. The overall median course Likert rating was 4.65 ± 0.1. The median overall rating for course events was similar between day 1 (Likert score = 4.45) and day 2 (Likert score = 4.55), U = 55, Z score = 1.10, P = 0.27. The median rating for lectures was 4.50 ± 0.2 and varied from 4.40 on day 1 to 4.55 on day 2. The median rating for panel review was 4.60 ± 0.1 and varied from 4.55 on day 1 to 4.65 on day 2. Interactive case discussions were rated 4.80 on both course days. There was a significant variability in the rating profiles of the course tripod: U = 24.5, P = 0.03. Fifty-one (98%) participants believe LPDM was COVID-19-compliant, while 90% believe the course was beneficial to training and practice.ConclusionInitial application of LPDM is rewarded with both high acceptance and high rating among participants.

Student Survey Results of a Virtual Medical Student Course Developed as a Platform for Neurosurgical Education During the Coronavirus Disease 2019 Pandemic

BackgroundBefore the coronavirus disease 2019 (COVID-19) pandemic, medical students training in neurosurgery relied on external subinternships at institutions nationwide for immersive educational experiences and to increase their odds of matching. However, external rotations for the 2020–2021 cycle were suspended given concerns of spreading COVID-19. Our objective was to provide foundational neurosurgical knowledge expected of interns, bootcamp-style instruction in basic procedures, and preinterview networking opportunities for students in an accessible, virtual format.MethodsThe virtual neurosurgery course consisted of 16 biweekly 1-hour seminars over a 2-month period. Participants completed comprehensive precourse and postcourse surveys assessing their backgrounds, confidence in diverse neurosurgical concepts, and opinions of the qualities of the seminars. Responses from students completing both precourse and postcourse surveys were included.ResultsAn average of 82 students participated live in each weekly lecture (range, 41–150). Thirty-two participants completed both surveys. On a 1–10 scale self-assessing baseline confidence in neurosurgical concepts, participants were most confident in neuroendocrinology (6.79 ± 0.31) and least confident in spine oncology (4.24 ± 0.44), with an average of 5.05 ± 0.32 across all topics. Quality ratings for all seminars were favorable. The mean postcourse confidence was 7.79 ± 0.19, representing an improvement of 3.13 ± 0.38 (P < 0.0001).ConclusionsFeedback on seminar quality and improvements in confidence in neurosurgical topics suggest that an interactive virtual course may be an effective means of improving students' foundational neurosurgical knowledge and providing networking opportunities before application cycles. Comparison with in-person rotations when these are reestablished may help define roles for these tools.

On the occasion of the 90th anniversary of the founder of the Odessa School of Neurosurgeons Professor Aleksandr P. Korol

Honored Worker of Science and Technology of Ukraine, Doctor of Medical Sciences, Professor Alexander Pavlovich Korol was born on July 18, 1930, in Gaisin, Vinnytsia region. In 1953, Alexander Pavlovich graduated with honors from the Lviv Medical Institute and was recommended for scientific work at the Kiev Institute of Neurosurgery, where he worked until 1961. In 1961, the young scientist headed the department of neurosurgery at the Odessa Psychoneurological Institute. In 1964, A.P. Korol organized a course of neurosurgery at the Odessa Medical Institute, which he headed until 1999.Alexander Pavlovich Korol is the author of more than 300 scientific papers, 14 inventions, was a member of the Academic Council of the Odessa Medical Institute and the specialized Scientific Council of the Kiev Research Institute of Neurosurgery, the chairman of the Association of Neurosurgeons of the Odessa Region, the chief neurosurgeon of the regional health department, a member of the board of the Ukrainian Association of Neurosurgeons, a member of the editorial boards of a number of scientific journals. Under the guidance of prof. A.P. Korol for the first time in Odessa, operations were performed under controlled hypothermia and hypotension. A.P. Korol is a pioneer in the use of hyperbaric oxygenation in the treatment of patients with severe traumatic brain injury in Ukraine. Professor Korol is rightfully the founder of the Odessa School of Neurosurgeons. A prominent neurosurgeon and organizer, he was able to create and educate a scientific and practical team of neurosurgeons, create a neurosurgical center in the South of Ukraine, and his initiatives are continued and implemented by his followers and students.He passed away on December 7, 2003, at the age of 74, in Odessa.

Prof. James Tait Goodrich 1946 - 2020+

James Tait Goodrich was born on April 16, 1946 in Portland, Oregon, United States, the son of Richard Goodrich and Gail (Josselyn) Goodrich. Dr. Goodrich served as a Marine officer during the Vietnam War, during which time he decided his next step would be to pursue a medical career. Not only was he an elite surgeon, but over the years he was also a generous mentor and teacher who shared his craft with many young surgeons who wanted to follow in his footsteps. During the Tet Offensive, he spotted a Vietnamese surgeon in a medical tent opening up a soldier’s head. “Cool,” he thought. “I want to do that” (1). Upon return to the USA, Jim married Judy Loudin on December 27, 1970, the love of his life who gave him the confidence and support to pursue his dreams. Dr. Goodrich completed his undergraduate work at the University of California, Irvine and his graduate studies at the School of Arts and Sciences of Columbia University (1972), receiving his Masters and Doctor of Philosophy degrees in 1978 and 1980, respectively. He received his Medical Degree from Columbia University College of Physicians and Surgeons. After an internship at Columbia- Presbyterian Medical Center (1980-1981), he completed his residency training at the Presbyterian Hospital in New York City and the New York Neurological Institute (1981-1986). He also holds the rank of Professor Contralto of Neurological Surgery at the University of Palermo in Palermo, Italy. He was Director of the Division of Pediatric Neurosurgery at the Children’s Hospital of Montefiore Health System and he served as a Professor of Clinical Neurological Surgery, Pediatrics, Plastic and Reconstructive Surgery at the Albert Einstein College of Medicine since 1998 (2). Dr. James T. Goodrich dedicated his life to saving children with complex neurological conditions. He had a particular interest in the treatment of craniofacial abnormalities. He was a pioneer in this field and developed a multi-stage approach for separating craniopagus twins who have their brain and skull conjoined. In 2016, he famously led a team of 40 doctors in a 27-hour procedure to separate the McDonald twins. Throughout his distinguished career, he became known as the world’s leading expert on this lifesaving procedure. He has been consulted on hundreds of cases, and he routinely traveled the world sharing his vast knowledge and expertise with colleagues (3,4). In Brazil, Dr. Goodrich played a very important role in leading the processes to successfully separate craniopagus sets in Ribeirao Preto (2017-2018), and in Brasilia (2019). A classical multistage surgery was performed to separate the Ribeirao Preto conjoined twins, and Dr. Goodrich participated on all the neurosurgical procedures as a great mentor. In the final operation, on October 28, 2019, some members of Montefiore Hospital medical staff (Dr. Oren Tepper, plastic surgeon, Dr. Carlene Broderick, pediatric anesthesiologist and Kamilah A. Dowling, nurse) also worked alongside Jim and the Brazilian team. An extraordinary and humble man, his words after the first surgical step, during an interview for a TV channel, were that in “this particular surgery we were able to do more than we expected because the anatomy was very good and the team had exceptional skills that made the difference”. Dr. Goodrich was a chief supporter of the Latin American Pediatric Neurosurgery Course (LACPN), having participated in all editions since 2004. In these events, he did not hesitate to share his knowledge during the hands-on sessions and, likewise, his wonderful conferences. Prof. Goodrich was officially honored by the Brazilian Society for Pediatric Neurosurgery during the “XII Brazilian Congress of Pediatric Neurosurgery”, in Florianopolis, Brazil. Dr. Goodrich was a gentle and truly caring man. He did not crave the limelight and was beloved by his colleagues and staff. He has authored numerous book chapters and articles on Pediatric Neurosurgery and is known worldwide as a prominent lecturer in this field. Outside his work, he was also known for his passion for historical artifacts, travelling, wine, and surfing. Dr. Goodrich was an incredible human being. In March 30th, 2020, he passed away after complications due to Covid-19 (5). In that day the world has become a little less bright without Jim. Our sympathy and prayers go to his wife Judy, his three sisters, and all those who were close to him

Non-rigid registration of 3D ultrasound for neurosurgery using automatic feature detection and matching.

The brain undergoes significant structural change over the course of neurosurgery, including highly nonlinear deformation and resection. It can be informative to recover the spatial mapping between structures identified in preoperative surgical planning and the intraoperative state of the brain. We present a novel feature-based method for achieving robust, fully automatic deformable registration of intraoperative neurosurgical ultrasound images. A sparse set of local image feature correspondences is first estimated between ultrasound image pairs, after which rigid, affine and thin-plate spline models are used to estimate dense mappings throughout the image. Correspondences are derived from 3D features, distinctive generic image patterns that are automatically extracted from 3D ultrasound images and characterized in terms of their geometry (i.e., location, scale, and orientation) and a descriptor of local image appearance. Feature correspondences between ultrasound images are achieved based on a nearest-neighbor descriptor matching and probabilistic voting model similar to the Hough transform. Experiments demonstrate our method on intraoperative ultrasound images acquired before and after opening of the dura mater, during resection and after resection in nine clinical cases. A total of 1620 automatically extracted 3D feature correspondences were manually validated by eleven experts and used to guide the registration. Then, using manually labeled corresponding landmarks in the pre- and post-resection ultrasound images, we show that our feature-based registration reduces the mean target registration error from an initial value of 3.3 to 1.5mm. This result demonstrates that the 3D features promise to offer a robust and accurate solution for 3D ultrasound registration and to correct for brain shift in image-guided neurosurgery.

The Importance of Student Leagues on Medical Training in Neurosurgery and Residency Choice

Introduction Neurological and neurosurgical disorders are highly prevalent in Brazil. The initial management is performed by general practitioners, showing the importance of theoretical and practical studies of neurology and neurosurgery during undergraduate medical courses. Objective Describe the choices of medical specialty by members of a neurosurgery student league and investigate the existence and composition of neurology and/or neurosurgery courses and neuro-leagues in medical schools in Brazil. Methods We surveyed, in person or through social networks, all medical students who were members of the Neurosurgery Student League of Escola Paulista de Medicina (EPM) from 2007 to 2015 on the completion of their course and residency chosen. An online form was also submitted to all the medical schools registered with the Federal Council of Medicine (Conselho Federal de Medicina [CFM]) Results and Discussion Fifty-seven medical graduates had participated in the Neurosurgery Student League of EPM. Out of these, 45 have completed their undergraduate courses; 6 have undergone neurosurgery and 5 neurology. We obtained responses from 128 out of the 173 medical schools affiliated with the CFM. A total of 91% of the schools responded that they have a structured neurology course. These courses are divided as into: 32 exclusively theoretical, with 12 addressing neurosurgery and 84 are theoretical-practical, with 51 addressing neurosurgery. Structured neurosurgery courses were only present in 19% of the faculties, half of which are theoretical only. Neurosciences leagues were present in 66% of the universities. Conclusions It was noted that neurology and neurosurgery student leagues in 66% of the medical schools in Brazil is, many times, used to supplement theoretical-practical content that should have been addressed at undergraduate level. Unfortunately, only 9.5% of the medical schools include a theoretical-practical neurosurgery course in their curriculum, a fact that is concerning due to the high prevalence of neurologic diseases in the Brazilian population.

Recommendations of 5th-grade Medical Faculty students about clinical anatomy course

Objective: The data gathered objectively, and the information which is evidence-based is essential in evaluating both the sufficiency and the efficiency of medical education. Especially the feedback of students insights and suggestions is a good guidance for management of medical training. In this context, in the present study, it has been aimed to determine the thoughts and recommendations of 5th-grade Medical Faculty Students about Clinical Anatomy Course (CAC) by using a questionnaire which is consist of 12 questions. Method: A hundred and forty-four student (81 female and 63 male) volunteered to participate the study and took the questionary. Results: While 86.8 % of the students mentioned that it would be more necessary to take Clinical Anatomy Course during Orthopedics Course, 87.5 % of the student showed their preference for Neurosurgery Course. 75.7 % of the students suggested that it would also be beneficial to add CAC into the Eye Diseases and Otorhinolaryngology Practise in addition to those practices mentioned above. While the allotted time for CAC in the Clinical Practice was found sufficient to only 39.6 % of the student, 31.9 % asked for an increase in duration of CAC. According to 71.5 % of the students, the information should be solidified after the theoretical lectures by practices in which bones, manikins, and cadavers are used effectively. Giving attendance is not favored by 50 % of the students, and almost same amount of the participants (51.4 %) thinks the exam at the end of the class or the course is unnecessary. Conclusions: It has been understood from the positive feedback of the students that CAC which is currently taken during Orthopedics and Neurosurgery Courses facilitates the understanding Clinical Practise topics and it increases the overall success of the students in Clinic. While preparing the medical training curriculum, adding the CAC into the clinical training curriculums when needed may help to increase the overall quality of the medical education.

From Russian Refugee to Iowa's First Neurosurgeon and Pioneer of Cranial Hemostasis: The Legacy of Anatole Kolodny (1892-1948).

After immigrating to the United States from Russia in the wake of the First World War, Anatole Kolodny became the first surgeon in Iowa to specialize in neurological surgery. Kolodny was vital to the initial practice of neurosurgery in the state of Iowa and to the specific development of academic neurosurgery at the University of Iowa. In an effort to improve his surgical outcomes, Kolodny invented a hemostat that bears his name and is still used for cranial hemostasis. He also provided early outcomes of myelomenigocele repair and wrote extensively on bone sarcoma. Kolodny's achievements brought favorable attention to the university and altered the course of neurosurgery at the University of Iowa. Of significant importance, Kolodny influenced and trained Iowa's second neurosurgeon, Olan Hyndman, and this action led the way to the eventual recruitment of the university's first division head of neurosurgery. The purpose of this manuscript is to shed light on Kolodny's important contributions to the development of neurosurgery not only at Iowa, but also in the profession as a whole.

Impact of a Vascular Neurosurgery Simulation-Based Course on Cognitive Knowledge and Technical Skills in European Neurosurgical Trainees

To assess microsurgical and diagnostic cerebral angiography modules and their corresponding objective assessment scales as educational tools for European neurosurgical residents at the European Association of Neurosurgical Societies Resident Vascular Neurosurgery course, which was held in Prague, Czech Republic, on September 2013. Microsurgical skills and cerebral angiography are fundamental skills in vascular neurosurgery. There is a need to develop a simulation-based curriculum focusing on these skills for neurosurgical trainees worldwide. The course consisted of 2 modules: microanastomosis and diagnostic cerebral angiography. In addition to an initial screening survey, each module was divided into 3 components: 1) a before didactic cognitive knowledge and technical skills testing, 2) a didactic lecture, and 3) an after didactic cognitive knowledge and technical skills testing. We compared the trainees' cognitive and technical scores from the before and after testing phases. Wilcoxon sum rank test was used to test statistical significance. The knowledge test median scores increased from 63% and 68% to 80% and 88% (P < 0.01) on the microanastomosis and cerebral angiography modules, respectively. The practical hands-on simulation assessment median scores increased from 42% and 50% to 50.5% and 68% (P < 0.01) on the microanastomosis and cerebral angiography modules, respectively. Our course suggests that a simulation-based vascular neurosurgery curriculum is feasible and may enhance resident knowledge and technical proficiency.

Cognitive impairments in clinical practice and analyzing the work of a memory room in Yaroslavl (an outpatient reception)

The early diagnosis and treatment of cognitive impairments (CIs) are presently one of the most relevant and sociomedical problems. Since 2012, a memory room that performs an outpatient reception of patients complaining of diminished memory has been working at the Department of Neurology and Medical Genetics with Course of Neurosurgery, Yaroslavl State Medical Academy. The main goals of this subdivision are to make a diagnosis and differential diagnosis of CI, to manage patients with higher brain dysfunctions, to improve quality of life, and to elaborate rehabilitation programs. Objective: to assess the first results of work of a memory room and to study CIs in patients complaining of diminished memory at the time of their asking for medical advice. Patients and methods. The two-year data obtained in examining the work of the memory room were analyzed. In January 2012 to January 2014, a total of 250 patients (31% men and 69% women) (mean age 52.4 years (18 to 87 years)) visited the memory room. CIs were rated using the Schulte test, studying short-term visual memory, its volume, and accuracy by mnestic tests and numbers memory tests recording the number of errors; the hospital anxiety and depression Scale and SF-36 questionnaire to estimate quality of life were applied. The efficiency of vinpocetine therapy was investigated in 20 patients (13 women and 7 men) aged 45 to 59 years (mean age 56.3±1.7 years) with moderate CIs of vascular genesis. Results and discussion. Varying degrees of CIs were identified in 96% of the patients during their first visit to the room. The findings could estimate the approximate incidence and prevalence of CIs in the patients during different pathological processes. There was a preponderance of patients with dementia, the main cause of which was Alzheimer's disease among those who were seeking for medical advice for complaints of amnestic disorders. Vascular processes are a cause of the majority of non-dementia CIs. There are preliminary data on the association between CIs and other neuropsychiatric disorders.

Neurosurgical rotations or clerkships in US medical schools

Medical student exposure to neurosurgery is limited. To improve the educational interactions between neurosurgeons and medical students as well as neurosurgical medical student rotations or clerkships (NSCs) we must first understand the current status. Two questionnaires were sent, one to every neurosurgery course coordinator or director at each US neurosurgery residency program (99 questionnaires) and one to the associated parent medical school dean's office (91 questionnaires), to assess the current status of NSCs and the involvement of neurosurgeons at their respective institutions. We received responses from 86 (87%) of 99 neurosurgery course coordinators or directors and 64 (70%) of 91 medical school deans' offices. Most NSCs do not have didactic lectures (53 [62%] of 86 NSCs), provide their medical students with a syllabus or educational handouts (53 [62%] of 86), or have a recommended/required textbook (77 [90%] of 86). The most common method of evaluating students in NSCs is a subjective performance evaluation. Of 64 medical school deans, 38 (59%) felt that neurosurgery should not be a required rotation. Neurosurgical rotations or clerkships are primarily offered to students in their 4th year of medical school, which may be too late for appropriate timing of residency applications. Only 21 (33%) of 64 NSCs offer neurosurgery rotations to 3rd-year students. There is significant room for improvement in the neurosurgeon-to-medical student interactions in both the NSCs and during the didactic years of medical school.

Operative skills in neurosurgery

The operative skills in neurosurgery course is run at the Royal College of Surgeons of England and is convened by Ian Sabin, consultant neurosurgeon at the Royal London Hospital and tutor in neurosurgery at the college’s Raven Department of Education. It has been established for a decade and was previously known as essential or core skills in neurosurgery. The aim of the course is to introduce basic operative neurosurgical techniques required by trainees entering neurosurgery. The course is designed primarily for specialty trainees in years 1-3 and with membership of the Royal College of Surgeons who wish to gain thorough hands-on exposure to common cranial and spinal procedures in a mentored environment. A mixture of specialty trainees from years 1 to 4 attended, including some from overseas. Although I had already had an opportunity to use powered drills and perform many of the procedures taught, I did the course to gain exposure to operative anatomy and neurosurgical techniques in a relaxed and mentored environment free from the time constraints …

The European Course of Neuroradiology (ECNR) Goes Diagnostic and Interventional

The European Course of Neuroradiology (ECNR) was set up in 1983 under the aegis of the European Society of Neuroradiology (ESNR) founded in 1969. Besides the major aim of educating young doctors to become neuroradiologists, this course was also necessary to adhere as much as possible to the European regulations for academic education programs with the precise aim of being recognized as a sub-speciality within the European Union of Medical Specialists (UEMS). It was meant to be a dynamic initiative flanking the existing European Course of Neurosurgery (ECNS) thereby creating a true European neuroradiological profile. During the past years, our speciality has undergone many changes, the most obvious of which being that neuroradiology is nowadays widely accepted as both a diagnostic and interventional speciality. Guidelines for training and practice were established and specifically targeted the above-mentioned dual aspects of neuroradiology. Since March 2008 our goal of becoming a subsection within the UEMS has been rea-ched, further stressing the need to provide a European Course of Neuroradiology that adheres more obviously to our training guidelines which are both diagnostic and interventional. Under the directorate of Prof. Radu from Basel who organized the 8th and 9th cycles of the ECNR with huge success in Basel during the past four years, the first steps towards the dual aspect of the ECNR had been undertaken. With the 10th cycle we plan to continue on this path and even further stress our “interventional” educational mission with the ECNR being the course of the European Society for both diagnostic and interventional neuroradiology. The scientific content of the 10th Cycle will provide unique material and will take into very close account the standards and guidelines for residency training in clinical neuroradiology (diagnostic and interventional) included in the European Charter on Training of Medical Specialists in the European Union (EU), a document needed by the European Commission with the principal aim of standardizing training programs in the countries of the EU and associated member states. Different from the usual “refresher courses”, the 10th Cycle is mainly directed toward in-training or established neuroradiologists and has the following main scientific objectives and characteristics: 1) Impart teaching-based lectures and workshops, rather than academic-type conferences in order to transmit rather than deliver information. 2) Provide the students with scientific and conceptual lectures, which they are unlikely to obtain in their own countries, or from general radiology courses or textbooks. 3). Acquire basic neuroscience and clinical core knowledge. 4) Provide theoretical bases of present and future clinical practices and research in diagnostic and interventional neuroradiology. 5) Impart highly interactive diagnostic, interventional and mixed-type neuroradiological workshops. The interventional topics are chosen in close collaboration with the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) to assure the highest academic standards and to adhere to the Training Path of Interventional Neuroradiology consisting basic and theoretical knowledge, practical experience, and skill training. All topics are discussed by the board of the European Course of Neuroradiology comprising the course directors, the EBNR and ten established diagnostic and interventional neuroradiologists from Europe. Because of the broad coverage of interventional and diagnostic neuroradiology, the 10th cycle has also been approved by the European Society of Radiology (ESR) as being a modular part of the European School of Radiology (ESOR), further emphasizing its role as the European Course of Neuroradiology. The following topics have been chosen for each of the four courses to be covered in six full days of lectures and workshops: 1) Embryology/Anatomy/Malformations/Genetics (Tarragona, Spain October, 2008). 2) Tumours (Rome, Italy March, 2009). 3) Vascular Diseases (Tarragona, Spain October, 2009). 4) Trauma/Degenerative/Me-tabolic/ Inflammatory Diseases (Rome, Italy March 2010). The didactic credits provided for the course are intended to comply with the regulations of academic education programs. The cycles are structured in four modules held over two years. At the end of each module a certificate reporting CME credits is issued after completing a written test. Upon completion of all four modules (one entire cycle) participants can apply to take a final oral examination. If they pass, a certification as a qualified neuroradiologist (European Qualification in Neuroradiology EQNR) will be issued jointly by ESNR and EBNR. This EQNR is part of the European Qualification, as required by the UEMS for Specialities. We hope that with the 10th cycle we will be able to step into the large footsteps of the past courses and add our own marks to the education of future neuroradiologists. We look forward to meeting you in Tarragona and in Rome.

The European Course of Neuroradiology (ECNR) Goes Diagnostic and Interventional

The European Course of Neuroradiology (ECNR) was set up in 1983 under the aegis of the European Society of Neuroradiology (ESNR) founded in 1969. Besides the major aim of educating young doctors to become neuroradiologists, this course was also necessary to adhere as much as possible to the European regulations for academic education programs with the precise aim of being recognized as a sub-speciality within the European Union of Medical Specialists (UEMS). It was meant to be a dynamic initiative flanking the existing European Course of Neurosurgery (ECNS) thereby creating a true European neuroradiological profile. During the past years, our speciality has undergone many changes, the most obvious of which being that neuroradiology is nowadays widely accepted as both a diagnostic and interventional speciality. Guidelines for training and practice were established and specifically targeted the above-mentioned dual aspects of neuroradiology. Since March 2008 our goal of becoming a subsection within the UEMS has been rea-ched, further stressing the need to provide a European Course of Neuroradiology that adheres more obviously to our training guidelines which are both diagnostic and interventional. Under the directorate of Prof. Radu from Basel who organized the 8th and 9th cycles of the ECNR with huge success in Basel during the past four years, the first steps towards the dual aspect of the ECNR had been undertaken. With the 10th cycle we plan to continue on this path and even further stress our “interventional” educational mission with the ECNR being the course of the European Society for both diagnostic and interventional neuroradiology. The scientific content of the 10th Cycle will provide unique material and will take into very close account the standards and guidelines for residency training in clinical neuroradiology (diagnostic and interventional) included in the European Charter on Training of Medical Specialists in the European Union (EU), a document needed by the European Commission with the principal aim of standardizing training programs in the countries of the EU and associated member states. Different from the usual “refresher courses”, the 10th Cycle is mainly directed toward in-training or established neuroradiologists and has the following main scientific objectives and characteristics: 1) Impart teaching-based lectures and workshops, rather than academic-type conferences in order to transmit rather than deliver information. 2) Provide the students with scientific and conceptual lectures, which they are unlikely to obtain in their own countries, or from general radiology courses or textbooks. 3). Acquire basic neuroscience and clinical core knowledge. 4) Provide theoretical bases of present and future clinical practices and research in diagnostic and interventional neuroradiology. 5) Impart highly interactive diagnostic, interventional and mixed-type neuroradiological workshops. The interventional topics are chosen in close collaboration with the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) to assure the highest academic standards and to adhere to the Training Path of Interventional Neuroradiology consisting basic and theoretical knowledge, practical experience, and skill training. All topics are discussed by the board of the European Course of Neuroradiology comprising the course directors, the EBNR and ten established diagnostic and interventional neuroradiologists from Europe. Because of the broad coverage of interventional and diagnostic neuroradiology, the 10th cycle has also been approved by the European Society of Radiology (ESR) as being a modular part of the European School of Radiology (ESOR), further emphasizing its role as the European Course of Neuroradiology. The following topics have been chosen for each of the four courses to be covered in six full days of lectures and workshops: 1) Embryology/Anatomy/Malformations/Genetics (Tarragona, Spain October, 2008). 2) Tumours (Rome, Italy March, 2009). 3) Vascular Diseases (Tarragona, Spain October, 2009). 4) Trauma/Degenerative/Me-tabolic/ Inflammatory Diseases (Rome, Italy March 2010). The didactic credits provided for the course are intended to comply with the regulations of academic education programs. The cycles are structured in four modules held over two years. At the end of each module a certificate reporting CME credits is issued after completing a written test. Upon completion of all four modules (one entire cycle) participants can apply to take a final oral examination. If they pass, a certification as a qualified neuroradiologist (European Qualification in Neuroradiology EQNR) will be issued jointly by ESNR and EBNR. This EQNR is part of the European Qualification, as required by the UEMS for Specialities. We hope that with the 10th cycle we will be able to step into the large footsteps of the past courses and add our own marks to the education of future neuroradiologists. We look forward to meeting you in Tarragona and in Rome.

Pharmacology and electrophysiology of a synchronous gaba-mediated potential in the human neocortex

Spontaneous synchronous field potentials of negative polarity (duration = 200–700 ms, interevent interval= 9.1 ± 2.9 s; n = 27slices) were recorded, during application of 4-aminopyridine (50 μM), from the superficial/middle layers of slices of human neocortex obtained in the course of neurosurgery for the relief of intractable seizures. The negative-going field potential corresponded to an intracellular long-lasting (duration = 200–1600 ms) depolarization that could be preceded by an excitatory postsynaptic potential-hyperpolarizing inhibitory postsynaptic potential sequence and followed by a long-lasting hyperpolarization. This synchronous activity continued to occur following blockade of excitatory synaptic transmission by excitatory amino acid receptor antagonists, but was greatly reduced and eventually disappeared during application of the GABA A receptor antagonist bicuculline methiodide. Simultaneous extracellular recordings from three sites in the slice located along an axis parallel to the pia showed that successive synchronous field potentials could originate from any of the three areas. They invaded the other two sites in c. 35.5% of the cases, while propagation to another site only or no propagation at all was observed, respectively, in 44.4% and 20% of instances. The velocity of lateral propagation of the synchronous field potential was 7.9 ± 2.5mm/s(range= 4.5−11.8mm/s, n = 6). The modalities of origin and propagation remained the same after blockade of excitatory amino acid receptors. Under these conditions, however, there was a higher incidence of non-propagation and the velocity was significantly lower than in control ( 5.6 ± 1.9mm/s;range= 2.8–7.7mm/s, n = 6). These data indicate that, in the human neocortex, 4-aminopyridine can reveal a synchronous field potential that correlates with an intracellular long-lasting depolarization and is mainly due to the activation of postsynaptic GABA A receptors. The action of excitatory amino acid receptors is not necessary for the generation and propagation of these GABA-mediated potentials. We propose that this potential represents a novel mechanism for synchronization and spread of neuronal activity, including seizure-like discharges in the human neocortex.