Neurosurgical Department Research Articles

Pediatric Cerebral Meningioma: A Single-Center Study with 10 Children Not Associated with Neurofibromatosis Type 2 and Literature Review

Introduction: Pediatric meningiomas (PMs) are rare tumors; they differ from their adult counterparts by their atypicality of location, higher rates of malignant change, male preponderance, recurrence, and sometimes, their association with neurofibromatosis. This case series analyzes the clinical behavior, pathological presentation, location, and its association with neurofibromatosis type 2 (NF2). Methods: This case series consists of pediatric patients between the ages of 4 and 16 years who were hospitalized in the neurosurgical department of our hospital from 2012 to 2021 with different neurological symptoms and a literature review using the PubMed/MEDLINE database. Results: Sixty percent of the patients were males, while 40% were females. The most common neurological manifestations were signs of increased intracranial pressure. NF2 was absent in all patients. The predominant histopathology subtypes are atypical and WHO grade II, representing 30% and 40%, respectively. Conclusion: This study supports the relationship between NF2 and pediatric cerebral meningioma but at a lower concomitant rate from 0 to 13%, taking into consideration our original data and the literature review, contrasting some reported cases, which suggest rates as high as 33%, 50%, and 100% in a very small number of patients. Gross total resection without postoperative radiation therapy for nonmalignant and non-NF2-associated PM proved to be a sufficient and a good treatment option.

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study.

ObjectivePilocytic astrocytomas (PAs) are relatively benign tumors, usually enhancing on post-contrast MRI and often characterized by a mural nodule within a cystic component. Surgical resection represents the mainstay of treatment, and extent of resection (EOR) is associated with improved survival. In this study, we analyzed the effect of sodium fluorescein (SF) on the visualization and resection of these circumscribed astrocytic gliomas.MethodsSurgical databases at two neurosurgical departments (Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy and Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany) were retrospectively reviewed to identify the cohort of patients with pilocytic astrocytoma who had undergone fluorescein-guided tumor resection at any of the centers between March 2016 and February 2022. SF was intravenously injected (5 mg/kg) immediately after the induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW 560 filter (Carl Zeiss Meditec, Oberkochen, Germany).ResultsForty-four patients (25 males and 19 females; 26 pediatric patients, mean age of 9.77 years, range 2 to 17 years; and 18 adult patients, mean age of 34.39 years, range 18 to 58 years) underwent fluorescein-guided surgery. No side effects related to SF occurred. In all tumors, contrast enhancement on preoperative MRI was correlated with intense, heterogeneous yellow fluorescence with bright fluorescent cystic fluid. Fluorescein was considered helpful in distinguishing tumors from viable tissue in all cases except three patients due to faint fluorescein enhancement. Biopsy was intended in two operations, and partial resection was intended in three operations. Gross total resection was achieved in 24 cases out of 39 patients scheduled for tumor removal (61.54%), in five cases a minimal residual volume was highlighted by postoperative MRI despite the intraoperative subjective evaluation of complete tumor removal (12.82%); in the other 10 cases, the resection was subtotal with fluorescent residual spots to avoid neurological worsening (25.64%).ConclusionsThe use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of Pas, suggesting a possible role in improving the extent of resection of these lesions.

Some Results From the Sociological Survey of Neurosurgeons on Neurosurgical Care Problems in Mongolia

Introduction: Up to date, no scientific research has been undertaken in Mongolia highlighting problems of neurosurgical care from the perspective of providers of medical services – neurosurgeons. Objective: To identify the key problems and priority areas for optimizing neurosurgical care in Mongolia from the perspective of providers of medical services – neurosurgeons. Methods of Research: Sociological, statistical methods. Results: According to neurosurgeons, key problems of organization of neurosurgical care in Mongolia are as follows: depletion of stocks of instruments and equipment, insufficient educational base for the training of qualified specialists, and monopoly position of neurosurgical departments. Priority areas of optimization of neurosurgical care are improvement of neurosurgical care organization, including its centralization and structural reorganization, as well as staffing and resource provision. Conclusions: 1. The results of the study revealed that 13.8% of neurosurgeons in Mongolia rated neurosurgical care organization as unsatisfactory and 15.7% of respondents rated organization of the work of neurosurgical (surgical) departments as unsatisfactory. 2. More than a quarter of respondents (27.5%) rated the quality of tools in the operating room as unsatisfactory, while most respondents (80.4%) noted the lack of tools in the operating room. 3. According to 64.7% of neurosurgeons, neurosurgical (surgical) departments need major repairs and 25.5% of respondents noted that cosmetic repairs of departments’ are needed. 4. The key problems in the organization of neurosurgical care in Mongolia are shortage of tools and equipment, insufficient educational base for the training of qualified specialists, and the monopoly position of neurosurgical departments. 5. Priority areas of optimization of neurosurgical care, according to neurosurgeons, are improving of neurosurgical care organization, including its centralization and structural reorganization, as well as staffing and resource provision.

Dynamics in the Neurotrauma Catchment Area of a German University Hospital during the COVID-19 Pandemic.

Objective: At the beginning of 2020, the COVID-19 pandemic enforced a rapid reallocation of healthcare resources. Our neurosurgical department is located in the German county of Marburg–Biedenkopf, about 80 km from the nearest major city. We were able to maintain our previously established open-door policy after the emergence of COVID-19. Here, we report on dynamics in the catchment area for neurotrauma patients at our department during the pandemic. Methods: 763 consecutive neurotrauma cases admitted to our department between 1 January 2018 and 31 December 2021 were analyzed retrospectively. Patients’ age, gender, origin, diagnoses, and outcomes were recorded. The number of patients hospitalized with a COVID-19 infection in Germany (PHCG) were retrieved from the Robert Koch Institute (RKI). We defined calendar weeks with >1000 PHCG as high COVID-19 caseload weeks (HCLW). Chi-square and Fisher’s exact served as statistical tests. Results: In 2020 and 2021, we observed a significantly increased number of neurotrauma patients who, with primary residence outside of our district, were admitted to our hospital compared to 2018 and 2019 (p < 0.001), while there were no significant differences in in-house mortality. During HCLW, a significantly increased number of neurotrauma patients with primary residence in the densely populated southwestern margin (SWM) of the contiguous part of our catchment area were referred to us compared to the time prior to the pandemic and between HCLW (p = 0.003). In neurotrauma patients admitted from the SWM during HCLW, there was no tendency towards higher in-house mortality. Conclusion: An open-door policy may moderate the risk of involuntarily triaging neurotrauma patients during a pandemic.

Utility of a Pilot Neurosurgical Operative Skills Boot Camp in Medical Student Training

The neurosurgical sub-internship is a crucial step for prospective neurosurgeons. However, the expectations for sub-interns, particularly the technical skills required by residents and attendings, often are unclear. We present survey data on what medical students, residents, and attendings believe are important procedural proficiencies for neurosurgical sub-internships. We incorporated these tasks into a pilot skills-based craniotomy workshop, and here we report on the impact of the session on the neurosurgical training of medical students. A 1-day craniotomy lab using cadaveric cranial specimens was conducted for medical students. Surveys querying important competencies for sub-internships were answered by residents and attendings at affiliated hospitals. Pre- and postlab surveys querying interest in and perceptions of neurosurgery, self-assessment of skills, and important competencies for sub-internship preparation were answered by attendees. Medical students, residents, and attendings agreed that burr-hole placement, bone replating, and galea and skin closure were of high importance for sub-interns. There was significant disagreement on the importance of dural opening and closure, establishing a craniotomy, and neuronavigation. The workshop altered perceptions of neurosurgery, with significant changes in recognizing the value of peer mentorship. Students also expressed increased confidence in technical skills, with significant improvements shown in understanding of neurosurgical high-speed drill use (P < 0.001). Although the expectations for sub-interns may be heterogeneous, there is general agreement that proficiency in the initial and final steps of craniotomies, as well as minor procedures, is recommended. Cadaveric labs can improve student engagement in neurosurgery, facilitate interactions with neurosurgical departments, and enhance technical skills.

Recurrent lumbar intraspinal epidermoid cyst presenting as lower back pain, a case report.

IntroductionIntraspinal Epidermoid Cyst (IEC) is a very-rare, yet one of the most benign tumors of the Central Nervous System (CNS). Very few cases of IEC were reported world-wide. Presentations depend on the location of the tumor with pain being the most common presenting symptom.Case presentationA-35-year-old patient presented to the neurosurgical department for a regular follow up. Her history dates back to four years ago, when she first presented with back pain, which was later accompanied with fecal and urinary incontinence. Magnetic Resonance Imaging (MRI) showed a tumor at the level of L4-L5 which was surgically removed. Three years later, the patient presented to the clinic with similar symptoms. A repeat MRI showed a mass at L4-L5, which was surgically removed. Histological findings of both surgeries showed findings consistent with IEC. Currently the patient has no complaints.Clinical discussionIEC has various presentations. Our case presented with back pain, and urinary and fecal incontinence. Diagnosis depends on imaging and histology. MRI is the imaging modality of choice for those tumors in the CNS. Surgical removal is associated with high recurrence as a result of the suboptimal resection due to the strong adhesions between the capsule and the spinal cord.ConclusionPain is the most common presenting symptom for IEC. Adjuvant radiotherapy, which should be implemented in the standard of care, is associated with a lesser degree of recurrence, in addition to regular follow-ups.

Nonpharmacological treatment of cognitive impairment: cognitive training guidelines

Important aspects of the treatment of cognitive impairments are their early detection, prevention and timely prescription of drug therapy. The method of non-drug prevention and, at the same time, the treatment of cognitive impairment is cognitive training. There are cognitive training, cognitive stimulation and cognitive rehabilitation. The content of cognitive training should be determined by the type and severity of the patient’s cognitive impairment; effectiveness depends, among other things, on the duration of the sessions and on the commitment of patients to cognitive training. At the Department of Nervous Diseases and Neurosurgery of Sechenov University, guidelines have been developed that allow cognitive training for patients with mild and moderate cognitive impairments. The effectiveness of methodological recommendations has been confirmed by studies; they were introduced into the work of the neurological and neurosurgical departments of the clinic of nervous diseases of the Sechenov University. Taking into account the development of modern technologies, it seems interesting and important to create methods of cognitive training that will allow the patient to study using a smartphone, tablet or computer, and the doctor to remotely monitor the well-being and track the results of the patient’s therapy. In the fall of 2022, the Health Formula program will be launched on the basis of the My Health app, designed specifically to support patients with cognitive impairments. Health Formula is an online service for remote communication between a doctor and a patient, the purpose of which is to increase patient compliance and the effectiveness of the treatment itself. The application will contain a set of cognitive exercises to complement the prescribed drug therapy. At the initial stage, the course will be a balanced selection of video exercises, which will later be included in the global interactive program for patients with CI.

The best neurosurgical non-required required reading: Social media

Social media is an increasingly important communication modality for the community of academic medicine in general, and neurosurgery in particular, providing rich resources in a accessible, efficient, and convenient format.[1] Approximately 70% of neurosurgeons utilize social media for professional activities [2,3], neurosurgical departments and journals with active social media accounts reportedly have more impactful academic metrics than those without [4,5], and specialized social media teams for peer-reviewed journals increase engagement [6,7].

CLINICAL SIGNIFICANCE OF PROGRESSIVE TRAUMATIC INTRACRANIAL HEMATOMAS IN ACUTE PERIOD OF TRAUMATIC BRAIN INJURY

This work is devoted to one of the topical issues of neurosurgery, namely, craniocerebral injuries, in particular, intracranial hematomas. Timely diagnosis of traumatic intracranial hematomas and the choice of a correct treatment strategy are the main factors of patient’s recovery.&#x0D; The purpose of the study was to monitor intracranial hematomas and their changes using neuroimaging of brain structures, and to evaluate brain CT and MRI efficacy in a hospital setting.&#x0D; Materials and Methods. The authors analyzed 2255 medical records of patients treated in the neurosurgical departments of Ulyanovsk Regional Clinical Center for Specialized Types of Medical Care named after E.M. Chuchkalov and Central City Clinical Hospital, 61 reports of forensic autopsies and 373 surgical reports. Surgical procedures were performed in 2015.&#x0D; Results. Intracranial hematomas were diagnosed in 198 patients (8.7 %). According to the time factor, the hematomas were distributed as follows: 150 acute (75.8 %); 35 subacute (17.7 %); 8 chronic (4.0 %). In five cases (2.5 %), the authors identified hematomas that were not registered in the existing classification. Such hematomas have not been adequately investigated yet. Such hematomas were called “progressive”, due to their increase in case follow-up.&#x0D; Conclusion. The peculiarities of “progressive” intracranial hematoma development necessitates clinical suspicion. In this regard, the pathology requires a more detailed study in order to create a system of clinical and neuroimaging monitoring and develop management guidelines.

Evaluation of theTherapeutic Effect of the Hybrid Operation on Patients with Aneurysms Associated with Cerebral Arteriovenous Malformations with different Redekop Classifications

BackgroundIntracranial aneurysms associated with cerebral arteriovenous malformations (AVMs) are a rare condition in the clinic, and treatment is very difficult due to their particular anatomical features. We present our experience in the treatment of intracranial aneurysms with AVMs and evaluate the effectiveness and safety of endovascular treatment combined with microsurgical resection (the hybrid operation). MethodsThis was a single-center retrospective study in our neurosurgical department from January 2015 to January 2021. We collected clinical data from 48 patients with intracranial aneurysms associated with AVMs and categorized them according to Redekop classifications according to the results of cerebral imaging examination to compare the therapeutic effects of endovascular embolization and the hybrid operation. ResultsCompared to nonaneurysmal AVMs, intracranial aneurysms with AVMs more often presented with intracranial hemorrhage (P<0.05). Massive hematoma and severe neurological impairment were more often found in patients with intracranial aneurysms with AVMs (P<0.05). For flow-related aneurysms, the hybrid surgery had a higher one-stage cure rate than endovascular embolization alone (P<0.05). Both treatment methods had similar effects on intranidal aneurysms (P>0.05). There were no significant differences in prognostic indicators between the two treatments. However, the recurrence rate of AVMs with proximal flow-related aneurysms was lower in patients who underwent the hybrid operation (P<0.05). ConclusionThe hybrid operation was safe and effective for patients with intracranial aneurysms associated with AVMs. For flow-related aneurysms, the one-stage cure rate was higher and the recurrence rate was lower with the hybrid operation than with endovascular embolization alone.

Positive impact of the pandemic: the effect of post-COVID-19 virtual visit implementation on departmental efficiency and patient satisfaction in a quaternary care center.

The coronavirus disease 2019 (COVID-19) pandemic has significantly changed clinical practice across US healthcare. Increased adoption of telemedicine has emerged as an alternative to in-person contact for patient-physician interactions. The aim of this study was to analyze the impact of telemedicine on workflow and care delivery from January 2019 to December 2021 in a neurosurgical department at a quaternary care center. Prospectively captured data on clinic appointment utilization, duration, and outcomes were queried. Visits were divided into in-person visits and telemedicine appointments, categorized as follow-up visits of previously surgically treated patients, internal consultations, new patient visits, and early postoperative returns after surgery. Appointment volume was compared pre- and postpandemic using March 2020 as the pandemic onset. Clinical efficiency was measured by time to appointment, rate of on-time appointments, proportion of appointments resulting in surgical intervention (surgical yield), and patient-reported satisfaction, the latter measured as the proportion of patients indicating "high likelihood to recommend practice." A total of 54,562 visits occurred, most commonly for follow-up for previously operated patients (51.8%), internal new patient referrals (24.5%), and external new patient referrals (19.8%). Total visit volume was stable pre- to postpandemic (1521.3 vs 1512, p = 0.917). However, in-person visits significantly decreased (1517/month vs 1220/month, p < 0.001), with a nadir in April 2020, while telemedicine appointment utilization increased significantly (0.3% vs 19.1% of all visits). Telemedicine utilization remained stable throughout the 1st calendar year following the pandemic. Telemedicine appointments were associated with shorter time to appointment than in-person visits both before and after the pandemic onset (0-5 days from appointment request: 60% vs 33% vs 29.8%, p < 0.001). Patients had on-time appointments in 87% of telemedicine encounters. Notably, telemedicine appointments resulted in surgery in 31.8% of internal consultations or new patient visits, a significantly lower rate than that for in-person visits (51.8%). After the widespread integration of telemedicine, patient satisfaction for all visits was higher than before the pandemic onset (85.9% vs 88.5%, p = 0.027). Telemedicine use significantly increased following the pandemic onset, compensating for observed decreases in face-to-face visits. Utilization rates have remained stable, suggesting effective integration, and delays between referrals and appointments were lower than for in-person visits. Importantly, telemedicine integration was not associated with a decrease in overall patient satisfaction, although telemedicine appointments had a lower surgical yield. These data suggest that telemedicine smoothened the impact of the pandemic on clinical workflow and helped to maintain continuity and quality of outpatient care.

Травмы зрительного анализатора при различной локализации краниоорбитального повреждения

Purpose. To assess the influence of the localization of cranio-orbital injuries (COI) on the frequency and level of damage to the visual analyzer. Material and methods. In the emergency neurosurgical department of the FFRCEMC, we observed 115 patients with COP aged 18 to 70 years (men – 92, women – 23). The main causes of injuries were: traffic accidents – 46 (40 %), domestic injury 21 (18.2 %), criminal situation 34 (29.5 %). All patients studied history, performed a comprehensive ophthalmological examination: visometry (with optimal correction), refractometry, biomicroscopy, ophthalmoscopy, tonometry, perimetry. Results. Concussion was diagnosed in 51 (44.3 %) patients. Brain contusions were found in 50 (43.4 %) patients, with a predominant lesion of the frontal lobes – in 35 (30.4 %) patients. Epidural, subdural hematomas – in 31 (26.9 %) patients. Intracerebral hematomas were detected in 12 (10.4 %) patients. Conclusion. It is possible to predict the results of treatment of damage to the optic nerve only when the nature and severity are established. Severe cranioorbital damage, tear, rupture, detachment of the optic nerve, unfortunately, has a very unfavorable prognosis - from a significant degree of vision loss to complete loss of vision and the eye as an organ. Keywords: optic nerve, orbital fracture, visual analyzer contusion.

EPIDEMIOLOGICAL, THERAPEUTIC AND EVOLUTION ASPECTS OF HYDROCEPHALUS IN CHILDREN IN MADAGASCAR

Hydrocephalus is a disorder of the hydrodynamics of the CSF resulting in an increase in the volume of CSF in the cranial cavity. Hydrocephalus is frequent in Madagascar. We conducted a multicenter and retrospective study of operated hydrocephalic children in 3 neurosurgical departments in Madagascar over a 3-year period. We report 71 cases of hydrocephalus in operated children. Infants predominated in 90.1% of cases. Postmeningeal etiology was found in 42.3%. Ventriculo-peritoneal shunting was undertaken in 92.9% of cases. After the operation, the evolution was favourable in 84.5% of cases. Complications were reported. After discharge from hospital, 59.1% of the children were lost to follow-up within the first month. Hydrocephalus in children predominates in infants. Meningitis remains the most frequent etiology. Ventriculo-peritoneal shunting is the technique most commonly used in Madagascar. The result is favourable in the majority of cases.

Compound elevated skull fractures: a retrospective descriptive study

Background Traumatic skull fractures have been traditionally classified into those that involve the base or vault with distinct entities linear or depressed. Compound elevated skull fracture is a newer entity with scanty reports in the literature. Objective To describe the clinical presentation, neuro-radiology findings by development of a classification system, medical and surgical management, and complications of patients with compound elevated skull fractures at a tertiary referral neurosurgical department. Methods Medical records of consecutive patients admitted from January 2005 to December 2018 with compound elevated skull fractures at the single neurosurgical referral hospital were retrospectively evaluated. Data was analyzed for demographics, clinical presentation, mechanisms of injury, neuro-radiology findings, management and outcomes. Results Eighteen patients were included in this series with a median age of 28 years, median admission Glasgow Coma Scale was 12. Ten patients presented with focal neurological deficits which included hemiparesis [n = 8, 44%] and unilateral afferent pupil deficit [n = 2, 11%]. Intra-cerebral haematoma was the most common associated neuro-radiological finding [n = 10, 55%] followed by acute extradural haematoma [n = 4, 22%]. Three distinct neuro-radiological subtypes were identified: Type 1 – fractured segment with minimal loss of contact with rest of cranial vault, Type 2 – fractured segment with partial loss of contact with rest of cranial vault, Type 3 – fractured segment with complete loss of contact with rest of cranial vault. All patients underwent surgical debridement and of which 11 [61%] required duroplasty and 10[55%] re-placement of elevated bone flap. Septic complications included meningitis [n = 5, 27%], brain abscess [2, 11%] and surgical site infection [n = 1, 5%]. Seventeen patients had favourable outcomes at discharge (Glasgow Outcome Scale 4 or 5). Conclusion Compound elevated skull fracture is an additional subtype of skull vault fracture. Prompt neurosurgical management with appropriate operative management of dura and elevated bone fragment reduces morbidity from septic complications.

Occurrence of adjacent segment fractures after surgical treatment of an osteoporotic vertebral fracture: a retrospective comparison between two different treatment methods

IntroductionOsteoporotic vertebral fractures are a major healthcare problem. Vertebral cement augmentation (VCA) is frequently used as a minimally invasive surgical approach to manage symptomatic fractures. However, there is a potential risk of adjacent segment fracture (ASF), which may require second surgery. The addition of transcutaneous screw-fixation with cement augmentation superior and inferior to the fracture [Hybrid transcutaneous screw fixation (HTSF)] might represent an alternative treatment option to reduce the incidence of ASF.Materials and methodsWe retrospectively compared surgery time, hospital stay, intraoperative complication rate and the occurrence of ASF with the need for a surgical treatment in a cohort of 165 consecutive patients receiving either VCA or HTSF in our academic neurosurgical department from 2012 to 2020. The median follow-up was 52.3 weeks in the VCA-group and 51.9 in the HTSF-group.ResultsDuring the study period, 93 patients underwent VCA, and 72 had HTSF. Of all patients, 113 were females (64 VCA; 49 HTSF) and 52 were males (29 VCA; 23 HTSF). The median age was 77 years in both groups. Median surgery time was 32 min in the VCA-group and 81 min in the HTSF-group (p < 0.0001). No surgery-related complications occurred in the VCA-group with two in the HTSF-group (p = 0.19). ASF was significantly higher in the VCA-group compared to HTSF (24 [26%] vs. 8 [11%] patients; p < 0.02). The proportion of patients requiring additional surgery due to ASF was higher in the VCA-group (13 vs. 6%), but this difference was not statistically significant (p = 0.18). Median hospital stay was 9 days in the VCA-group and 11.5 days in the HTSF-group (p = 0.0001).ConclusionsBased on this single-center cohort study, HTSF appears to be a safe and effective option for the treatment of osteoporotic vertebral compression fractures. Surgical time and duration of hospital stay were longer in the HTSF-group, but the rate of ASF was significantly reduced with this approach. Further studies are required to ascertain whether HTSF results in superior long-term outcomes or improved quality of life.

Gender disparity in German neurosurgery.

Despite the rising number of women in higher education and leadership positions, the proportional rise of female neurosurgeons still lags behind these fields. This study evaluates the gender distribution in German neurosurgical departments across all career levels, and is aimed at heightening the awareness of gender disparity and the need for improving gender equality and its related opportunities. Data on gender distribution across all professional levels in German neurosurgical departments were obtained from departmental websites as well as by email and telephone request. Results were additionally analyzed in reference to hospital ownership type of the neurosurgical departments. A total of 140 German neurosurgical departments employing 2324 neurosurgeons were evaluated. The analysis revealed a clear preponderance of men in leadership positions. Only 9 (6.3%) of 143 department heads were women, and there were only 1 (2.4%), 17 (14.5%), and 4 (12.5%) women among 42 vice-directors, 117 chief senior physicians, and 32 managing senior physicians, respectively. Senior physicians not holding a leadership position were female in 23.1%, whereas board-certified neurosurgeons not holding a senior physician position and residents were female in 33.6% and 35.0%, respectively. Of note, the highest proportion of female department heads (15.6%) was found in private hospitals. The number of women in leadership positions in German neurosurgical departments is dramatically low, and with increasing leadership status gender disparity increases. Mentorship, recruitment, the perception of benefits offered by diversity and programs facilitating gender equality, job sharing, parental leave policies, and onsite childcare programs are needed to turn German neurosurgical departments into modern medical departments reflecting the gender profile of the general patient population.

Results of Resection of Giant Pituitary Adenomas through Endoscopic Endonasal Approach

Background/Objective: A minimally invasive surgical method is in use to create endoscopic transsphenoidal surgery. Because of the intricate dissection of the sellar region, surgical treatment of large pituitary adenomas is challenging. The study focused to determine the frequency of complications after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas.&#x0D; Materials and Methods: A descriptive case series study was conducted at the Neurosurgical Department of Lahore General Hospital, Lahore. A total of 70 patients fulfilling the selection criteria were enrolled. Major vascular injury was noted when there is an injury to the internal carotid artery or cavernous sinus. After discharge, patients were followed-up in OPD for 3 months. After 3 months, patients were evaluated for CSF leak and vision. The presence of complications was recorded. During surgery, operative time was noted.&#x0D; Results: Mean age of patients was 55.7 ± 6.5 years. 45.71% of patients were male while the remaining 54.29% of patients were female Total of 41.43% of patients had disease &lt; 2 years, whereas the duration of surgery was ? 3 hours in 64.3% of patients. A total 15.71% had complications which included diabetes insipidus (8.57%), infections (5.71%), pituitary dysfunction (4.29%), CSF leak (2.8%) and vascular injury (1.43%). The mortality rate was 1.43%.&#x0D; Conclusion: The complication rate after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas was high.&#x0D; Keywords: Endonasal Endoscopic, Transsphenoidal Resection, Pituitary Macroadenomas, Complications

Experience in the treatment of spinal tumors complicated by compression of the spinal cord and its roots

Objective: Improvement of the results of treatment of vertebral tumors with neural compression by means of analyzing the authors’ experience.Material and methods: The study included 151 patients with primary and metastatic vertebral tumors, operated in the neurosurgical departments of three large medical institutions from 01.01.2014 to 31.12.2020.Results: Most of the patients underwent palliative interventions. Radical surgery (marginal or wide resection of the tumor) was performed in 8 (5%) patients. Surgical treatment as the only method of treatment was used in 75 (50%) cases, combined treatment was used in 42 (28%) people, complex treatment – in 34 (22%). The immediate results of treatment of 91% of patients were characterized by the absence of negative dynamics in the neurological status and in 50% of cases by positive dynamics in the functional state. Among patients with malignant tumors and a traced catamnesis, the one-year survival rate was 66%, three-year – 52%, five-year – 47%. The median overall survival rate was 12.8 months, the median event-free survival rate was 12.55 months.Conclusion: The use of non-radical interventions in the surgery of vertebral tumors with neural compression expands the possibilities of minimizing surgical trauma, while maintaining the neurological and improving the functional status of the patient.

Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis

Operations for lumbar spinal stenosis is the most often performed surgical procedure in the adult lumbar spine. This study reports the clinical outcome of the 3 most commonly used minimally invasive posterior decompression techniques. To compare the effectiveness of 3 minimally invasive posterior decompression techniques for lumbar spinal stenosis. This randomized clinical trial used a parallel group design and included patients with symptomatic and radiologically verified lumbar spinal stenosis without degenerative spondylolisthesis. Patients were enrolled between February 2014 and October 2018 at the orthopedic and neurosurgical departments of 16 Norwegian public hospitals. Statistical analysis was performed in the period from May to June 2021. Patients were randomized to undergo 1 of the 3 minimally invasive posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy, and spinous process osteotomy. Primary outcome was change in disability measured with Oswestry Disability Index (ODI; range 0-100), presented as mean change from baseline to 2-year follow-up and proportions of patients classified as success (>30% reduction in ODI). Secondary outcomes were mean change in quality of life, disease-specific symptom severity measured with Zurich Claudication Questionnaire (ZCQ), back pain and leg pain on a 10-point numeric rating score (NRS), patient perceived benefit of the surgical procedure, duration of the surgical procedure, blood loss, perioperative complications, number of reoperations, and length of hospital stay. In total, 437 patients were included with a median (IQR) age of 68 (62-73) years and 230 men (53%). Of the included patients, 146 were randomized to unilateral laminotomy with crossover, 142 to bilateral laminotomy, and 149 to spinous process osteotomy. The unilateral laminotomy with crossover group had a mean change of -17.9 ODI points (95% CI, -20.8 to -14.9), the bilateral laminotomy group had a mean change of -19.7 ODI points (95% CI, -22.7 to -16.8), and the spinous process osteotomy group had a mean change of -19.9 ODI points (95% CI, -22.8 to -17.0). There were no significant differences in primary or secondary outcomes among the 3 surgical procedures, except a longer duration of the surgical procedure in the bilateral laminotomy group. No differences in clinical outcomes or complication rates were found among the 3 minimally invasive posterior decompression techniques used to treat patients with lumbar spinal stenosis. ClinicalTrials.gov Identifier: NCT02007083.

Gender Equality in Neurosurgery and Strategic Goals Toward a More Balanced Workforce.

The Women in Neurosurgery (WINS) and the American Association of Neurological Surgeons published a white paper in 2008 setting an ambitious goal for women to comprise 20% of neurosurgery residents by 2012 and 20% of practicing neurosurgeons by 2020. Although there has been steady progress, we have fallen short of these benchmarks. We take this opportunity to look back at the accomplishments made over the past decade and provide an update on our present status. We evaluate current barriers toward progress and propose new goals, highlighting the systemic changes necessary to accomplish them. We propose the following updated recommendations to recruit and retain diverse talent into the neurosurgical workforce. (1) Neurosurgical departments and societies should provide diverse, early formal mentorship opportunities for medical students, residents, and junior faculty members. (2) Parental leave policies must be delineated, promoted, and enforced for all neurosurgeons, with greater awareness of internal discrimination and normalization of the discussion surrounding this topic. (3) We need to strive for compensation equity, with transparency in compensation mechanisms and regular assessment of compensation metrics. (4) Departments and institutions must have a zero-tolerance policy for sexual harassment and discrimination and establish a safe reporting structure. Finally, we propose attainable benchmarks toward achieving gender balance in the neurosurgical workforce, with a goal for women to comprise 30% of the entering residency class by 2030 and to comprise 30% of practicing neurosurgeons by 2038. We hope that this will guide further progress toward our future of building a balanced workforce.