Neurosurgical Department Research Articles

‘It is the child with the big head’ – Primary healthcare providers’ perceptions of paediatric hydrocephalus in Blantyre, Malawi: A qualitative study

ABSTRACT Children in Africa are disproportionately burdened by the neurosurgical condition hydrocephalus. In Blantyre, Malawi, paediatric hydrocephalus represents the majority of surgical procedures performed in the neurosurgical department at Queen Elizabeth Central Hospital. To reduce morbidity and mortality, timely detection followed by referral from surrounding primary health centres is crucial. Aiming to explore perceptions and identify enablers and barriers to detection and referral, we conducted a qualitative study among primary healthcare providers (n = 30) from ten health centres in Blantyre district. Using a semi-structured interview-guide, we audio-recorded and transcribed the interviews before conducting a thematic analysis. One main finding is that there is a potential to improve detection through head circumference measurements, which is the recommended way to detect hydrocephalus early, yet healthcare providers did not carry this out systematically. They described the health passport provided by the Malawian Ministry of Health as an important tool for clinical communication. However, head circumference growth charts are not included. To optimise outcomes for paediatric hydrocephalus we suggest including head circumference growth charts in the health passports. To meet the need for comprehensive management of paediatric hydrocephalus, we recommend more research from the continent, focusing on bridging the gap between primary care and neurosurgery.

Women in leadership positions in European neurosurgery - Have we broken the glass ceiling?

IntroductionThe proportion of male neurosurgeons has historically been higher than of women, although at least equal numbers of women have been entering European medical schools. The Diversity Committee (DC) of the European Association of Neurosurgical Societies (EANS) was founded recently to address this phenomenon. Research questionIn this cross-sectional study, we aimed to characterize the status quo of female leadership by assessing the proportion of women heading European neurosurgical departments. Material and methodsEuropean neurosurgical departments were retrieved from the EANS repository. The gender of all department chairs was determined via departmental websites or by personal contact. The proportion of females was stratified by region and by type of hospital (university versus non-university). ResultsA total of 41 (4.3%) female department chairs were identified in 961 neurosurgery departments in 41 European countries. Two thirds (68.3%) of European countries do not have a female neurosurgery chair. The highest proportion of female chairs was found in Northern Europe (11.1%), owing to four female chairs in a relatively small number of departments (n = 36). The proportions were considerably smaller in Western Europe (n = 17/312 (5.5%)), Southern Europe (n = 14/353 (4.0%)) and Central and Eastern Europe (n = 6/260 (2.3%)) (p = 0.06). The distribution of female chairs in university (n = 19 (46.3%)) versus non-university departments (n = 22 (53.7%)) was even. Discussion and ConclusionThere is a significant gender imbalance with 4% of all European neurosurgery departments headed by women. The DC intends to develop strategies to support equal chances and normalize the presence of female leaders in European neurosurgery.

Predictors of lethal outcome in young patients with hemorrhagic stroke

To evaluate the predictors of the lethal outcome of hemorrhagic stroke in young people. A retrospective analysis of cases of non-traumatic hemorrhagic stroke was carried out in 60 young patients hospitalized in the neurosurgical department in the Ufa Clinical Emergency Hospital. By gender, the male predominated. The mean age of the patients was 37.4±5.1 years. Lethal outcome was in 18 (30%) patients. Data analysis revealed a relationship between the lethal outcome of hemorrhagic stroke and certain clinical, somatic, laboratory and instrumental factors. As a result, a significant model (p<0.001) of the probability of a lethal outcome in young patients was developed. The identified predictors of the probability of death from stroke can serve as the basis for adequate management of young patients with hemorrhagic stroke.

Эффективность рентгенологических методов диагностики нестабильности позвоночно-двигательного сегмента в шейном отделе

Introduction. Standard spine radiography is the basic method of radiodiagnosis, used for screening. X-ray imaging allows you to assess the anatomy of spinal motion segments in the cervical spine, determine the period of osteochondrosis and the tactics of further examination and treatment. Various types of dislocation of vertebrae are much more common than can be determined by spinal radiography in standard projections; as a result of dislocation, a pain syndrome occurs. Aim. To study the effectiveness of conventional methods for diagnosis of instability in the spinal motion segment (SMS) in the cervical spine. Materials and methods. We observed 50 patients (mean age 50.6 ± 2.19 years) who were admitted to the Clinic of the Irkutsk Scientific Center for Surgery and Traumatology (Neurosurgical Department) with a diagnosis Adult osteochondrosis of spine (ICD-10 code – M42.1). Conventional methods were used to diagnose SMS instability: plain radiography in anteroposterior and lateral projections, functional cervical spine radiography. Results. It was stated that the most common changes are characteristic of II and III periods of osteochondrosis: straightening of cervical lordosis – in 48 patients (96%), decrease in intervertebral disc height – in 46 patients (92%), anterior wedging of vertebral bodies – in 48 patients (96%), endplate sclerosis – in 37 patients (74%), presence of marginal osteophytes – in 45 patients (90%). In maximum flexion and extension, the CII–CVI vertebrae were involved in the formation of pathological mobility of the intervertebral segments, while the CI and CVII vertebrae remained stable. Instability in one cervical vertebra was revealed in 15 patients (30%). Most often, excessive mobility of 2 vertebrae was observed – in 22 people (44%), less often of 3 vertebrae – in 5 patients (10%). The dislocation of 4 vertebrae was quite rare – in 2 patients (4%). When analyzing the data of functional cervical spine radiography, we have found that the SMS instability in patients with intervertebral disc degeneration develops most often in the following segments: CII–CIII – 13 people (26%), СIII–СIV – 34 people (70%), CIV–CV – 29 people (58%), СV–СVI – 12 people (24%). Conclusion. The SMS instability still remains an urgent problem in neurology and neurosurgery. Plain radiography reveals only indirect signs of SMS instability. Diagnosis by functional spondylography made it possible to verify the SMS instability only in 36% of cases.

Differences in intraoperative sampling during meningioma surgery regarding CNS invasion – Results of a survey on behalf of the EANS skull base section

Introductionand Research Question: Invasive growth of meningiomas into CNS tissue is rare but of prognostic significance. While it has entered the WHO classification as a stand-alone criterion for atypia, its true prognostic impact remains controversial. Retrospective analyses, on which the current evidence is based, show conflicting results. Discordant findings might be explained by different intraoperative sampling methodologies. Material and methodsTo assess the applied sampling methods in the light of the novel prognostic impact of CNS invasion, an anonymous survey was designed and distributed via the EANS website and newsletter. The survey was open from June 5th until July 15th, 2022. ResultsAfter exclusion of 13 incomplete responses, 142 (91.6%) datasets were used for statistical analysis. Only 47.2% of participants’ institutions utilize a standardized sampling method, and 54.9% pursue a complete sampling of the area of contact between the meningioma surface and CNS tissue. Most respondents (77.5%) did not change their sampling practice after introduction of the new grading criteria to the WHO classification of 2016. Intraoperative suspicion of CNS invasion changes the sampling for half of the participants (49.3%). Additional sampling of suspicious areas of interest is reported in 53.5%. Dural attachment and adjacent bone are more readily sampled separately if tumor invasion is suspected (72.5% and 74.6%, respectively), compared to meningioma tissue with signs of CNS invasion (59.9%). Discussion and conclusionsIntraoperative sampling methods during meningioma resection vary among neurosurgical departments. There is need for a structured sampling to optimize the diagnostic yield of CNS invasion.

Impact of Location on Resectability and Neurological Outcome in Spinal Cutaneous Inclusion Tumors

Background: Spinal cutaneous inclusion tumors are extremely rare, accounting for less than 1% of intraspinal tumors. The existing literature is scarce; in last two decades, only eight case series have documented more than 10 patients. We tried to figure out if intramedullary and extramedullary locations have an impact on outcomes in terms of extent of resection and neurological recovery. Materials and Methods: A retrospective review of intraspinal epidermoid and dermoid tumors operated at our Neurosurgical Department, between May 2006 and May 2021, was made. McCormick grading was used to evaluate the neurological status of all patients at presentation, after surgery, and at the follow-up visit in the outpatient clinic. The neurological status at the last follow-up was taken as final. Results: Of 15 cases, eight (53.3%) were males with the age at presentation ranging from 7 to 60 years (mean = 24.4 years). Spinal dysraphism was associated in four patients. The proportion of region involved in descending order was lumbar (46.6%), thoracic/thoracolumbar/lumbosacral (13.3% each) and cervicothoracic/sacrococcygeal (6.6% each) with 11 gross total resections (73.3%) and four subtotal resections (all intramedullary). Two-tailed Fischer’s exact test showed a significant correlation between location, extent of resection, and neurological recovery, whereas histological subtype and region had no significant impact on the outcome. Conclusions: To the best of our knowledge, this is the eighth largest study in the last two decades, reporting 15 cases with long-term follow-up. We attempt to bring clarity to the notion of location having no effect on resectablity by specifying location in terms of spinal compartment involved and describing spinal level as region. Overall, our gross total resection rate was lower (73.3%) than other contemporary studies (86.6%–92%), but a subgroup analysis with regard to the location of tumor revealed the intramedullary location to be the primary determinant of the extent of resection.

PS-R02-2: HEART FAILURE AS A PRESENTING FEATURE OF CUSHING'S DISEASE: A CASE REPORT

Cushing's disease is an endocrine disorder in which the pituitary gland releases too much adrenocorticotropic hormone, resulting in excess synthesis and secretion of cortisol by the adrenal glands. Cushing's disease associated heart failure is rare in clinic and can be misdiagnosed with initial presentation of heart failure. Symptoms of heart failure are caused by structural and functional alterations in the heart. The disturbances of cardiac structure and function may be recovered by eucortisolaemia. A 30-year-old man with a medical past of hypertension and history of smoking presented to the outpatient department with global heart failure. The left ventricular ejection fraction (LVEF) was estimated as 31% and the blood pressure (BP) was above 180/100 mmHg. After 1 months of optimal pharmacological treatment for systolic heart failure, there was obvious improvement of LVEF of 42%. Clinical features were suspicious for Cushing's disease. Initially, the patient could not have an MRI because of metal sheet in the body. After removal of metal sheet, the pituitary imaging were suggestive of Cushing's disease. The patient was referred to the neurosurgical department and the adenoma was successfully removed. Approximately one year after his initial hospitalization, his cardiac structure and function had nearly returned to normal and there were no high BP and signs of Cushing's syndrome.

Demography and Outcome of Pediatric Traumatic Brain Injury; Experience from a University Teaching Hospital in Nepal

Introduction: Traumatic brain injury (TBI) is one of the significant causes of disability and death. It is a common cause of emergency neurosurgical consultation. Due to differences in physiology and management strategy, outcomes of pediatric TBI are different. This study purposes to describe the demography, clinical-radiological characteristics, and outcome of patients with pediatric TBI. Methods: A retrospective study of 112 children of age up to 18 years admitted to the Neurosurgical Department in Tribhuvan University Teaching Hospital following TBI from August 2021 to July 2022 was conducted. Variables analyzed were the demographics, clinical characteristics, imaging findings, management strategies, and outcome. Results: Median age was 5.5 years. The male-to-female ratio was 2.3:1. Falls followed by road accidents (RTA) were the most common mode of injury. A significant number of patients (62, 55.3%) presented after 24 hours of injury. Vomiting (67, 59.8%) was the commonest symptom followed by loss of consciousness (60, 53.6%). Post-traumatic seizure was observed in 13 (11.6%) of the children; however, had no association with the outcome. Mild, moderate, and severe TBI were seen in 80.3%, 17.8%, and 1.7% respectively. Extra-axial hematomas (40%) were the most common findings followed by skull fractures (33.9%). Intensive care was required in 13 (11.6%) and 34 (30%) required surgery. Craniotomy (30.3%) was the most common procedure. Good outcome at discharge was seen in 107 (95.5%) of patients. Conclusion: Falls and RTAs were the commonest causes of pediatric TBI. In our study, a significant number of the patients presented after 24 hours of injury. Craniotomy was the most common managment and most of the children had good outcomes at discharge.

Implementation of a three-dimensional (3D) robotic digital microscope (AEOS) in spinal procedures

Three-dimensional exoscopes have been designed to overcome certain insufficiencies of operative microscopes. We aimed to explore the clinical use in various spinal surgeries. We performed surgery on patients with different spine entities in a neurosurgical department according to the current standard operating procedures over a 4-week period of time. The microsurgical part has been performed with Aesculap AEOS 3D microscope. Three neurosurgeons with different degree of surgical expertise completed a questionnaire with 43 items based on intraoperative handling and feasibility after the procedures. We collected and analyzed data from seventeen patients (35% male/65% female) with a median age of 70 years [CI 47–86] and median BMI of 25.8 kg/m2 [range 21–33]. We included a variety of spinal pathologies (10 degenerative, 4 tumor and 3 infectious cases) with different level of complexity. Regarding setup conflicts we observed issues with adjustment of the monitor position or while using additional equipment (e.g. fluoroscopy in fusion surgery) (p = 0.007/p = 0.001). However image resolution and sharpness as well as 3D-depth perception were completely satisfactory for all surgeons in all procedures. The utilization of the exoscopic arm was easy for 76.5% of the surgeons, and all of them declared a significant improvement of the surgical corridor. The 3D-exoscope implementation appears to achieve very satisfactory results in spinal procedures especially with minimally invasive approaches.

A clinical case of a combined approach to restoring post-traumatic deformation of the bones of the arch and base of the skull, bones of the middle zone of the face

Background. The article is extremely relevant due to growing traumatism, current condition of craniofacial traumatology, debatable and incomplete tactics of restoring traumatic defects and deformations of bones of the skull and face. Plastic surgery of the skull defects has developed from simple defect closure to restoring an aesthetically attractive area of the skull, which shape repeats the individual structure of the area lost due to trauma or surgical treatment (trepanation surgery, osteoplastic trepanation, treatment of a depressed skull fracture, etc.). To restore the defects specialists use auto‑ and allografts. In recent years, materials to manufacture implants are simulated using a 3D‑shape.Aims. To describe the clinical case of a combined approach for the restoration of post‑traumatic deformation of the bones of the arch, base of the skull and bones of the middle zone of the face. To show the importance of multidisciplinary teams in providing assistance to this group of patients, as well as the use of individual 3D simulated titanium plates for reconstructive operations. Emphasize the need to perform reconstructive operations as soon as possible.Materials and methods. Patient Sh., 43 years old, was admitted to the neurosurgical department of the City Clinical Emergency Hospital (Minsk), in the long term severe traumatic brain injury, with defects of the arch and base of the skull and deformation of the bones of the facial skull on the left. Titanium implants were modeled on a 3D printer, which were used during the operation performed by a multidisciplinary team consisting of a neurosurgeon, maxillofacial surgeon and ophthalmologist‑surgeon. Us for closing defects in the cranial vault, the bottom wall of the orbit and in eliminating deformation skeleton midface line. Titanium implants are made by specialists of Medbiotech SP LLC, Minsk, Republic of Belarus.Results. The late postoperative period proceeded without peculiarities, the wounds healed by primary tension. Post-operative CT showed that the condition of the implants is satisfactory.Conclusion. This clinical observation demonstrated the need for a multidisciplinary approach, as well as the priority in using 3D simulated titanium implants to restore post‑traumatic deformation of the bones of the arch and base of the skull and midline bones.

Simulator training in aneurysm clipping

Abstract Due to an increased number of patients with aneurysms treated endovascularly, a resident does not have enough opportunities to come across such a complex procedure as surgical clipping. There have been many types of training methods designed for traditional surgical aneurysm treatment so far. A brief report regarding the helpfulness of vascular simulator AneurysmBox at our Neurosurgical Department is presented.

The effects of surgical clipping on the outcomes of patients with ruptured middle cerebral artery aneurysms A multi center study

The objective of the study: To determine the statistical importance of each predicted factor in terms of prognosis for patients with ruptured MCAAs, we focus on those who have had surgical treatment for their aneurysms. Materials and methods: A total of 104 patients with ruptured MCAAs were examined in this retrospective analysis, which covered the years 2018 through 2020 and was conducted by the Neurosurgical Department at MMC Hosptial Mardan , pakistan . Patient characteristics (age, sex, comorbid conditions), aneurysm location (proximal, bifurcation, or distal), aneurysm dome size (small, large, or giant), aneurysm size at the time of surgery (ultra-early, early, or delayed), and Intracerebral Hemorrhage (ICH) volume are all assessed as potential predictors. Mean, standard deviation, covariance, and correlation were determined for each parameter (through the linear regression model). Results: The World Federation of Neurological Surgeons (WFSN) grading system was used to evaluate each patient's clinical status; a score of 5 indicated excellent quality in 37 (35.3%), while a score of 4 indicated a fair rate in the remaining 28 patients.

The role of messaging services in day-to-day practice in pediatric neurosurgery, advantages of a bubble network, and an international survey.

Messaging services (MS) are used widely worldwide. The implications of MS usage in daily hospital patient care have not been investigated. In this study, we discuss the extensive usage of MS in our Pediatric Neurosurgical Department, introduce our bubble algorithm, and provide additional input from an international survey. WhatsApp activity in the department of pediatric neurosurgery at Dana Children's Hospital, Tel Aviv, Israel, was analyzed. We designed a graphic representation of the content of the different conversation bubbles and how they interact. We also described a survey evaluating MS use in daily neurosurgical practice was sent to 25 neurosurgeons around the world. Collected data included details on the usage of MS, the type of information being transferred, and the participants' opinion of the potential risks and benefits of these systems. We began collecting messaging data November 2018, before the COVID pandemic era. We continued to collect data over the course of almost 3years. We identified a bubble network structure that reflects a logical method of communication between different segments of pediatric neurosurgical care in our institution. Additionally, we analyzed 22 survey responses, received from 14 different countries. The vast majority of centers with "department groups" use messaging services to transfer multimedia files of patient-related data. Nineteen responders believe that MS significantly improve overall patient care. MS has revolutionized and improved the patterns of communication in our department. The great benefits of quick, simple access to information strongly outweigh formality and the potential for medicolegal disadvantages (e.g., HIPAA).

A look at the global impact of COVID-19 pandemic on neurosurgical services and residency training

BackgroundThe COVID-19 pandemic has left an indelible effect on healthcare delivery and education system, including residency training. Particularly, neurosurgical departments worldwide had to adapt their operating model to the constantly changing pandemic landscape. This review aimed to quantify the reduction in neurosurgical operative volume and describe the impact of these trends on neurosurgical residency training. MethodsWe performed a comprehensive search of PubMed and EMBASE between December 2019 and October 2022 to identify studies comparing pre-pandemic and pandemic neurosurgical caseloads as well as articles detailing the impact of COVID-19 on neurosurgery residency training. Statistical analysis of quantitative data was presented as pooled odds ratio (OR) and 95% confidence intervals (CI). ResultsA total of 49 studies met the inclusion criteria, of which 12 (24.5%) were survey-based. The case volume of elective surgeries and non-elective procedures decreased by 70.4% (OR=0.296, 95%CI 0.210–0.418) and 68.2% (OR=0.318, 95%CI 0.193–0.525), respectively. A significant decrease was also observed in functional (OR=0.542, 95%CI 0.394–0.746), spine (OR=0.545, 95%CI 0.409–0.725), and skull base surgery (OR=0.545, 95%CI 0.409–0.725), whereas the caseloads for tumor (OR=1.029, 95%CI 0.838–1.263), trauma (OR=1.021, 95%CI 0.846–1.232), vascular (OR=1.001, 95%CI 0.870–1.152), and pediatric neurosurgery (OR=0.589, 95%CI 0.344–1.010) remained relatively the same between pre-pandemic and pandemic periods. The reduction in caseloads had caused concerns among residents and program directors in regard to the diminished clinical exposure, financial constraints, and mental well-being. Some positives highlighted were rapid adaptation to virtual educational platforms and increasing time for self-learning and research activities. ConclusionWhile COVID-19 has brought about significant disruptions in neurosurgical practice and training, this unprecedented challenge has opened the door for technological advances and collaboration that broaden the accessibility of resources and reduce the worldwide gap in neurosurgical education.

External validation of the Ruptured Arteriovenous Malformation Grading Scale (RAGS) in a multicenter adult cohort

PurposeWhile Ruptured Arteriovenous Malformation Grading Scale (RAGS) has recently been validated in children, the literature lacks validation on adults exclusively. Therefore, we aimed to determine the validity of RAGS on the external multicenter adult cohort and compare its accuracy with other scales.MethodsA retrospective analysis was performed in five neurosurgical departments to extract patients who presented with the first episode of acute brain arteriovenous malformation (bAVM) rupture between 2012 and 2019. Standard logistic regression and area under the receiver operating curve (AUROC) calculations were performed to determine the value of the following scales: intracerebral hemorrhage (ICH), AVM-associated ICH (AVICH), Spetzler-Martin (SM), Supplemented SM (Supp-SM), Hunt and Hess (HH), Glasgow Coma Scale (GCS), World Federation of Neurological Surgeons (WFNS), and RAGS to predict change in categorical and dichotomized modified Rankin Scale (mRS) across three follow-up periods: within the 6 months, 6 months to 1 year, and above 1 year.ResultsSixty-one individuals with a mean age of 43.6 years were included. The RAGS outperformed other grading scales during all follow-up time frames. It showed AUROC of 0.78, 0.74, and 0.71 at the first 6 months, between 6 and 12 months, and after 12 months of follow-up, respectively, when categorized mRS was applied, while corresponding values were 0.79, 0.76, and 0.73 for dichotomized mRS, respectively.ConclusionThe RAGS constitutes a reliable scale predicting clinical outcomes following bAVM rupture among adults. Furthermore, the RAGS proved its generalizability across medical centers with varying treatment preferences.

Intradural extramedullary cervical metastasis from Merkel cell carcinoma: a case report and literature review

BackgroundMerkel cell carcinoma (MCC) is a rare aggressive primary skin carcinoma with an incidence of 44 cases per 100,000.The natural course of MCC often results in rapid growth and early metastasis. On the other hand, the spinal cord is rarely affected and frequently features the end stage of the disease. The aim of this paper was to clarify the management of patients with spine metastasis from a skin lesion and showed a case-based update.Case presentationA 73-year-old female was admitted to the Neurosurgical Department in December 2021 for a sudden right hemiparesis with bladder dysfunction and a history of cutaneous Merkel cell carcinoma. A magnetic resonance imaging (MRI) of the central nervous system (CNS) showed an intradural-extramedullary right-sided C6–C7 tumor with mass effect and edema of the cervical cord. The patient underwent a C6–C7 laminectomy with microsurgical total resection of the intradural extramedullary lesion. The neuropathological examination identified a metastasis from Merkel cell carcinoma. Nowadays, evidence for spinal metastasis from malignities skin cancer is generally lacking, probably because they are extremely rare. The exact time of life expectancy is controversial, and some clinicians use a cutoff of 3 months to determine whether surgical intervention should be offered, while others advocate at least 6 months of life expectancy.ConclusionsTo the best of our knowledge, we showed the first case of solitary intradural extramedullary cervical spine metastasis from MCC. We recommend to consider metastasis of MCC in the differential diagnosis of spinal metastasis.

Analysis of the type of course of arteriovenous malformations of the brain on the basis of the evaluation of the personalized features of angioarchitectonics of venous drainages

Background. Arteriovenous malformations of the brain are a rare congenital vascular pathology. At the moment, the study of the venous component of arteriovenous malformations is a hot topic of many studies. Most authors believe that the angioarchitectural features of the venous link of arteriovenous malformations can have a significant impact on assessing the natural course of the pathology and determining the tactics of treating these patients. Objective. In our work, we conducted a assessment and compared the personalized features of venous drainage of arteriovenous malformations of the brain with the type of clinical course. Design and methods. We analyzed the results of a survey of 61 adult patients with arteriovenous malformations of the brain, observed in the neurosurgical department No. 3 of the RNSI n. a. prof. A. L. Polenov in the period from 2014 to 2021. Gender and age characteristics and neuroimaging data, as well as features of the venous outflow of arteriovenous malformations were analyzed. Groups of patients were composed according to the type of the course of the disease and a personalized analysis was carried out with the characteristics of the venous outflow, as well as their features. The male/female ratio was 1.5/1 (37/24). Patients under 45 years of age prevailed (77.1 %). By types of clinical course: hemorrhagic type — 18 cases (29.5 %); epileptic type — 24 patients (39.3 %); torpid type — 19 patients (31.2 %). Results. A correlation was found between the deep location of the body of the malformation, as well as drainage exclusively into the deep vein system, and the hemorrhagic type of course (p = 0.034), while the male gender and superficial localization of the malformation were more characteristic of the epileptic type (p = 0.01). The torpid flow type did not have significant relationships with the studied features. Conclusion. According to our data, an analysis of the personalized characteristics of venous drainage of cerebral arteriovenous malformations can help in assessing the clinical course, which will improve the treatment outcomes of these patients.

Effect of Irrigation Fluid Temperature on Recurrence in the Evacuation of Chronic Subdural Hematoma

The effect of a physical property of irrigation fluid (at body vs room temperature) on recurrence rate in the evacuation of chronic subdural hematoma (cSDH) needs further study. To explore whether irrigation fluid temperature has an influence on cSDH recurrence. This was a multicenter randomized clinical trial performed between March 16, 2016, and May 30, 2020. The follow-up period was 6 months. The study was conducted at 3 neurosurgical departments in Sweden. All patients older than 18 years undergoing cSDH evacuation during the study period were screened for eligibility in the study. The study participants were randomly assigned by 1:1 block randomization to the cSDH evacuation procedure with irrigation fluid at room temperature (RT group) or at body temperature (BT group). The primary end point was recurrence requiring reoperation within 6 months. Secondary end points were mortality, health-related quality of life, and complication frequency. At 6 months after surgery, 541 patients (mean [SD] age, 75.8 [9.8] years; 395 men [73%]) had a complete follow-up according to protocol. There were 39 of 277 recurrences (14%) requiring reoperation in the RT group, compared with 16 of 264 recurrences (6%) in the BT group (odds ratio, 2.56; 95% CI, 1.38-4.66; P < .001). There were no significant differences in mortality, health-related quality of life, or complication frequency. In this study, irrigation at body temperature was superior to irrigation at room temperature in terms of fewer recurrences. This is a simple, safe, and readily available technique to optimize outcome in patients with cSDH. When irrigation is used in cSDH surgery, irrigation fluid at body temperature should be considered standard of care. ClincalTrials.gov Identifier: NCT02757235.

Features of thermo- and electromyography in patients with vertebrogenic pain syndrome

Thermography and electroneuromyography parameters were studied in 34 patients with vertebrogenic pain syndrome associated with lumbar spine stenosis. All patients were treated in the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology. We determined the changes in temperature values in the lumbar spine and lower extremities under the condition of disorder in peripheral nerves functional state.Purpose of the study: to evaluate the parameters of thermography and electroneuromyography in patients with lumbar spine stenosis.Materials and methods. The article presents the results of thermography and electroneuromyography of 34 patients with severe pain syndrome associated with degenerative stenosis of the lumbar part of spinal canal in preoperative period. Thermal-imaging study was carried out using a thermovision camera SVIT-004, the study of the peripheral nerves function of the lower extremities was carried out using the Neuromian-1-04 neuromyoanalyzer. The skin temperature recording points corresponded to the projection of stimulating and pickup ENMG electrodes on the spinous processes of the LIV, LV, SI vertebrae and paravertebrally.Results. Thermography parameters in patients with degenerative lumbar spine stenosis on the pain side were higher than on the intact side at all measurement points by 1–2 °C. At the same time, electroneuromyographic parameters in these patients indicated a decrease in the activity of the peripheral and central motor apparatus.Conclusion. The change in thermography parameters in patients with lumbar spine stenosis in the lumbar part and the area of pain irradiation in the lower extremities occurs alongside with the disorder of the peripheral nerves functional state.

Neurosurgical research in Southeast Asia: A bibliometric analysis

ObjectivesBibliometric analysis can provide insight into the growth, development and dissemination of research in neurosurgery. Little work has been done to examine the role of country-specific characteristics affecting research productivity. We aimed to characterize andcompare the research productivity among SEA countries in terms of bibliometric indicesand determine associations with country-specific factors. MethodsWe performed a systematic search of all articles by authors affiliated with a neurosurgical department in any of the Southeast Asian countries, indexed in 3 databases from inception to June 10, 2020. Bibliometric indices – number of publications, number of citations, average citations per publication, h-index, and the i-10-index – were computed for each country. Correlations between the indices and country-specific characteristics (population size, GDP per capita, percentage of GDP allocation to research and development (R&D), number of neurosurgeons, number of neurosurgeons per capita, and number of collaborations with non-SEA authors) were determined. ResultsThe number of publications showed an increasing trend up to 2019. Most studies were cohort studies (37%) or case reports or series (37%). Of the country-specific factors analyzed, only percentage of the GDP allocated to R&D was positively correlated with number of publications (p = 0.0004), total citations (p < 0.0001), H-index (p < 0.0001), and i(10)-index (p < 0.0001). Number of collaborations also positively correlated with the same indices. ConclusionOur bibliometric analysis showed increasing contribution by neurosurgeons in the SEA region. Correlational analysis support the view that increased R&D budget allocation and international collaboration can improve neurosurgical research capacity and productivity.