Neurosurgical Equipment Research Articles

Challenges and Progress in Neurosurgery: A Comprehensive Assessment of the Landscape in Nepal.

A large portion of the global population lacks access to essential surgical care, despite surgical conditions contributing significantly to the overall burden of disease worldwide. This burden is heaviest in developing countries like Nepal, where disparities in access to surgery for neurosurgical disorders stem from health system failures including an inadequate neurosurgical workforce, lack of requisite neurosurgical equipment, and challenges in perioperative care. By bibliometric analysis of neurosurgery-related publications in Nepal through PubMed search using the search terms "Neurosurg* AND Nepal", we have found a total of 528 articles with a notable increase in the number of such publications from 14 to 25 between 2015 and 2016, with over 300 published in 2021, 2022, and 2023. Nepal has also seen a drastic increase in neurosurgeon density from 0.166 per 100,000 population in 2016 to 0.377 per 100,000 population in 2023 compared to 0.780in China, 0.274in India, 0.130in Bhutan, and 0.092per 100,000 population in Bangladesh in 2023. This study underscores the pressing need for enhanced neurosurgical capacity and improved health equity in Nepal.

MNGA-08 SKULL BASE TUMOR RESECTION IN LOW-RESOURCE SETTINGS: A REVIEW OF THREE CASES AT THE KENYATTA NATIONAL HOSPITAL

Abstract Skull-based tumors are challenging to treat surgically due to their proximity to vital structures and the risk of complications. In low-resource settings, the availability of advanced neurosurgical equipment and expertise is limited, which may affect the outcomes of these patients. We report the outcomes of three patients with skull base tumors who underwent surgery at the Kenyatta National Hospital, Kenya. We retrospectively reviewed the medical records and followed up with three patients who underwent surgery for skull base tumors between October and November 2023. We collected data on their demographic characteristics, clinical presentation, imaging findings, surgical procedures, histopathological diagnosis, and postoperative course. The three patients were male, aged 42, 40, and 36 years. The common presentation was with headache, but dizziness and other cerebellar deficits were common. Imaging revealed defined lesions in the posterior fossa, involving the cerebellum and brainstem. The differential diagnosis included hemangioblastoma and meningioma. The surgical approach with anatomically-specified craniotomy with resection of the tumor and decompression. The postoperative course was uneventful for the first and third patients, who showed improvement in their neurological symptoms and signs. The second patient had repeat surgery. Skull base tumor surgery in a low-resource setting can achieve favorable outcomes with careful patient selection, meticulous surgical technique, and multidisciplinary care. However, the challenges of limited resources and high complication rates remain. Further studies are needed to evaluate the long-term outcomes and quality of life of these patients.

Systematic Review of Recent Developments Related to Microergonomics of Surgical Instruments

Researches are now being conducted on redesign as well as micro ergonomic interventions. Most micro-surgical tool designs concentrate on the manipulation of targeted tissue instead of the surgeon's hand, and this presents a new research opportunity for better fitting the equipment to the surgeon's hand. So the objective is to examine the advancements made in the last few years and provide a framework for ergonomic intervention framework regarding manufacturing systems. With the use of words like ergonomic design, intervention, and evaluation," the titles and abstracts of ergonomics publications were filtered to find relevant research. The paper describes the way that the concept of micro-ergonomics can enhance the design of the micro-instruments. Finally, an application of a new surgical instrument is stated as a pen needle holder designed by SOLIDWORK 22 which creating a wide range of possible uses for futuristic technology. In future, neurosurgical equipment design will incorporate concepts from surgical tool design together with penization, microergonomics, and electronics.

Needs, Roles, and Challenges of Young Latin American and Caribbean Neurosurgeons

Barriers to neurosurgery training and practice in Latin American and Caribbean countries (LACs) have been scarcely documented. The World Federation of Neurosurgical Societies Young Neurosurgeons Forum survey sought to identify young neurosurgeons' needs, roles, and challenges. We present the results focused on Latin America and the Caribbean. In this cross-sectional study, we analyzed the Young Neurosurgeons Forum survey responses from LACs, following online survey dissemination through personal contacts, social media, and neurosurgical societies' e-mailing lists between April and November 2018. Data analysis was performed using Jamovi version 2.0 and STATA version16. There were 91 respondents from LACs. Three (3.3%) respondents practiced in high-income countries, 77 (84.6%) in upper middle-income countries, 10 (11%) in lower middle-income countries, and 1 (1.1%) in an unclassified country. The majority (77, or 84.6%) of respondents were male, and 71 (90.2%) were younger than 40. Access to basic imaging modalities was high, with access to computed tomography scan universal among the survey respondents. However, only 25 (27.5%) of respondents reported having access to imaging guidance systems (navigation), and 73 (80.2%) reported having access to high-speed drills. A high GDP per capita was associated with increased availability of high-speed drills and more time dedicated to educational endeavors in neurosurgery, such as didactic teaching and topic presentation (P<0.05). This survey found that neurosurgery trainees and practitioners of Latin America and the Caribbean face many barriers to practice. These include inadequate state-of-the-art neurosurgical equipment, a lack of standardized training curricula, few research opportunities, and long working hours.

Burr hole as a management for extra axial hematomas in a low-resource setting

Introduction and importanceIn a low-resource setting, the availability of neurosurgeons and neurosurgical equipment for neurosurgery has proved to be a challenge for the management of extra-axial hematomas hence general surgeons perform burr hole surgeries for emergencies. Case presentationWe share our experience with three patients who presented with extra-axial hematomas and managed successfully in our institute with craniostomy as the surgical approach. Clinical discussionTraumatic brain injury is a major global health burden as it is a leading cause of death among the middle-aged population. Mortality associated with brain injury is highest in low- and middle-income countries. From our experience, we had good outcome in terms of improved Glasgow Coma Scale and overall clinical status in those who underwent burr hole surgery for extra axial hematoma. ConclusionThe need for neurosurgeons in sub-Saharan Africa is high but training comes at a cost hence general surgeons can perform life-saving emergency procedures with good outcomes.

401 Global Neurosurgery Advances from Trenches to Bedside: Lessons from Neurosurgical Care in War, Humanitarian Assistance, and Disaster Response

INTRODUCTION: War has influenced the development of neurosurgery. Armed conflict and mass casualty events, including Humanitarian Assistance Disaster Relief (HADR) missions, require military surgeons to innovate to meet extreme demands. Neurosurgeons serving in the military have provided a pragmatic template for global neurosurgeons to emulate in humanitarian disaster responses METHODS: We performed a narrative review of the literature examining the influence of wars and mass casualty disasters on contemporary global neurosurgery practices. RESULTS: Wartime innovations that influenced global neurosurgery include the development of triage systems and modernization with airlifts, implementation of ambulance corps, early operation on cranial injuries in hospital camps near the battlefield, use of combat body armor, and the rise of damage control neurosurgery. Workforce shortages during wars and disasters have promoted task-shifting and task-sharing in low-resource settings that catalyzed the establishment of the physician associate profession in the United States (US). Neurosurgical care has been utilized by the US as a form of "soft power" during natural and humanitarian disasters. Low-and middle-income countries (LMICs) face similar challenges in developing trauma systems and obtaining advanced technology, including neurosurgical equipment like battery-powered computed tomography scanners. These challenges— ubiquitous in low-resource settings— have underpinned innovations in triage and wound care, rapid evacuation to tertiary care centers, and minimizing infection risk. CONCLUSIONS: War and mass casualty disasters have catalyzed significant advancements in neurosurgical care both in the pre-hospital and inpatient settings. Most of these innovations originated in the military with subsequent spread to the civilian sector as military neurosurgeons and civilian neurosurgeons, who are military reservists, returned from the battlefront or other low-resource locations. LMICs have, by necessity, responded to challenges arising from resource shortages by developing innovative, context-specific care paradigms and technologies.

Neurosurgery equipment donation in Africa: a scoping review

Abstract A common tactic to alleviate current gaps is to donate medical equipment to low-resource areas, however, there is a dearth of recorded experience and evaluation. Providing accessible equipment to low- and middle-income countries (LMICs) is a crucial component of the attempts to improve access to neurosurgery in African nations; yet, the necessity of promoting neurosurgical equipment in Africa and the effects of these programs have not yet been assessed. Therefore, our goal was to evaluate the extent, advantages and sustainability of the gift of neurosurgical equipment in Africa. A scoping review covering both scholarly and gray literature was used. Selected databases from the time of inception to September 2022 were searched using a search strategy customized for the study title. All studies that addressed the donation of neurosurgical equipment to Africa were given special attention, along with any factors that increased the likelihood of donations and included, but not limited to, agreements signed during the donation. Finally, participating authors also reviewed articles randomly selected to ensure homogeneity. Donating equipment positively impacts neurosurgical units in LMICs, growing their practices while also enhancing safety, quality and affordability. Collaborations between LMICs and HICs (High Income Countries) also make it more likely that the donated neurosurgical equipment will be used to satisfy recipients' needs. Lastly, to guarantee the most advantage, proper follow-up, consideration of equipment durability, maintenance requirements and increased assistance for repairs should be prioritized.

A Scoping Review of the Use of Improvised External Ventricular Drains in Africa.

Poor access to neurosurgical equipment is one of the problems limiting service delivery in Africa. Improvised surgical devices have long been used in Africa as replacements for high-cost standard versions. In this study, we aimed to see if improvised external ventricular drains (EVD) are being used, how these devices are made, and what their outcomes are. The PRISMA extension for scoping reviews was used in conducting this study. A search was conducted from inception to July 2022. PubMed, Ovid Embase, and African Journal Online were searched. Three studies were identified and used. The methods of making the EVD devices were compared and the incidence proportions of improvised EVD-related infections were calculated. The standard ventricular catheter was replaced by cheaper alternatives like a size 6/8 feeding tube or a 14-gauge central line catheter. The connecting tube had low-cost alternatives, and in a study, was replaced by a fluid infusion set. Aggregated outcomes from the three identified studies show that just over half of the sample survived post-EVD insertion (54%). The incidence proportion of EVD-related infections was 24%. This study describes the experience of African centers with an improvised version of the EVD devices and their outcomes. This will serve as a baseline for more research into the use of improvised EVD devices in low-resource settings.

Neurosurgical Equipment Donations: A Qualitative Study.

IntroductionNeurosurgical equipment donation from high-income countries (HICs) to low-and-middle income countries (LMICs) exists. However, there is currently no published literature on whether there is a need for neurosurgical equipment donations or how to design equipment donation programmes that meet the needs of LMIC neurosurgeons. The primary aims of this study were to explore: (1) the need for the donation of neurosurgical equipment from the UK and Ireland to LMICs within the African continent, and (2) the ways through which neurosurgical equipment donations could meet the needs of LMIC neurosurgeons.MethodsThis was a qualitative study using semi-structured, one-on-one, audio-recorded interviews. Purposive sampling was used to recruit and interview consultants or attending neurosurgeons from Ireland, the UK and LMICs in Africa in a continuous process until data saturation. Interviews were conducted by members of the Association of Future African Neurosurgeons during March 2021. Qualitative analysis used a thematic approach using open and axial coding.ResultsFive HIC and 3 LMIC neurosurgeons were interviewed. Five overarching themes were identified: (1) inequality of access to neurosurgical equipment, (2) identifying specific neurosurgical equipment needs, (3) importance of organisations, (4) partnerships between LMIC and HIC centres, and (5) donations are insufficient in isolation.ConclusionThere is a need for greater access to neurosurgical equipment in LMICs. It is unclear if neurosurgical equipment donations are the optimal solution to this issue. Other solutions that are not linked to dependency need to be explored and executed. Collaborative relationships between LMICs and HICs better ensures that neurosurgical equipment donations meet the needs of the recipients. These relationships may be best created within an organisation framework that has the logistical capabilities of coordinating international equipment donation and providing a quality control measure.

Autopsy assessment of pediatric head injury: a proposal for aerosol mitigation during the COVID-19 pandemic.

During the Corona Virus Disease-19 (COVID-19) pandemic, there is still a requirement for post-mortems to continue, including those examinations performed in the context of medico-legal investigations. Currently, very little is known about how long this coronavirus can survive in deceased human bodies or whether un-embalmed human cadavers can be contagious to people who handle them. Therefore, it would appear to be prudent to consider implementation of additional safety measures for all necessary post-mortem procedures. During the post-mortem examination of babies and young children, it is important to open the calvarium to enable visualization of the brain and its coverings, particularly in cases where a head injury is likely to have occurred. Since October 2013, the use of neurosurgical equipment to open the calvarium during infant and young child autopsies has become routine practice in our unit. Both the neurosurgical craniotome and a standard oscillating mortuary saw produce particulate matter consisting of bone and body fluids (including blood) which can become aerosolized. Within this paper, we discuss the use of a transparent plastic tent whilst opening the calvarium during pediatric post-mortems, to reduce the spread of aerosols into the mortuary environment.

Robotic Surgical Assistant (ROSA™) Rehearsal: Using 3-Dimensional Printing Technology to Facilitate the Introduction of Stereotactic Robotic Neurosurgical Equipment.

The use of frameless stereotactic robotic technology has rapidly expanded since the Food and Drug Administration's approval of the Robotic Surgical Assistant (ROSA™) in 2012. Although the safety and accuracy of the ROSA platform has been well-established, the introduction of complex robotic technology into an existing surgical practice poses technical and logistical challenges particular to a given institution. To better facilitate the integration of new surgical equipment into the armamentarium of a thriving pediatric neurosurgery practice by describing the use of a three-dimensional (3D)-printed patient model with in situ 3D-printed tumor for presurgical positioning and trajectory optimization in the stereotactic biopsy of a pontine lesion in a pediatric patient. A 3D model was created with an added silicone mock tumor at the anatomical position of the lesion. In a preoperative rehearsal session, the patient model was pinned and registered using the ROSA platform, and a mock biopsy was performed targeting the in Situ silicone tumor. Utilization of the 3D-printed model enabled workflow optimization and increased staff familiarity with the logistics of the robotic technology. Biopsy trajectory successfully reached intralesional tissue on the 3D-printed model. The rehearsal maneuvers decreased operative and intubation time for the patient and improved operative staff familiarity with the robotic setup. Use of a 3D-printed patient model enhanced presurgical positioning and trajectory planning in the biopsy of a difficult to reach pontine lesion in a pediatric patient. The ROSA rehearsal decreased operative time and increased staff familiarity with a new complex surgical equipment.

Advanced needle neuroendoscopy technique in the treatment of pineal cyst

Modern neurosurgical equipment and techniques, neuroendoscopy in particular, allow performing complex operations even in the deep and narrow anatomical structures of the brain without injuring vessels or soft tissue and consequently lowers risk of postoperative complications. The surgical treatment includes classical open microsurgical and mini-invasive neuroendoscopic cystoventriculostomy or cystocysternostomy depending on the cyst localization. In this work, we present a case of surgical treatment of a pineal cyst of a 1 year 6 months old boy with a semi-rigid neuroendoscope under neuronavigation and ultrasound guidance and provide the advantages of this technique. The good clinical and radiological improvement observed in our patient is the result of the use of triple intraoperative monitoring including a semi-rigid needle neuroendoscope, neuronavigation, ultrasound and, thus, the neurosurgeon has the entire picture of the delicate structures that allows carry our surgical intervention (endoscopic cyst fenestration) with the greatest precision and safety.

Doing More with Less: A Minimally Invasive, Cost-Conscious Approach to Stereoelectroencephalography

Stereoelectroencephalography (SEEG) is a commonly used technique for mapping the epileptogenic zone before epilepsy surgery. Many SEEG depth electrode implantation techniques involve the use of extensive technological equipment and shaving of the patient's entire head before electrode implantation. Our goal was to evaluate an SEEG depth electrode implantation technique that used readily available cost-effective neurosurgical equipment, was minimally invasive in nature, and required negligible hair shaving. Data on demographic characteristics, operative time, hemorrhagic complications, implantation complications, infection, morbidity, and mortality among patients who underwent this procedure were reviewed retrospectively. Between April 2016 and March 2018, 23 patients underwent implantation of 213 depth electrodes with use of this technique. Mean (SD) operative time was 123 (32) minutes (range, 66-181 minutes). A mean (SD) of 9.3 (1.4) electrodes were placed for each patient (range, 8-13 electrodes). Two of the 213 electrodes (0.9%) were associated with postimplantation asymptomatic hemorrhage. One of the 213 electrodes (0.5%) was placed extradurally or incorrectly. None of the 213 electrodes was associated with symptomatic complications. No patients experienced infectious complications at any point in the preoperative, perioperative, or postoperative stages. This minimally invasive, cost-effective technique for SEEG depth electrode implantation is a safe, efficient method that uses readily available basic neurosurgical equipment. This technique may be useful in neurosurgery centers with more limited resources. This study suggests that leaving the patient's hair largely intact throughout the procedure does not pose an additional infection risk.

Controlled biodegradation of metallic biomaterials by plasma polymer coatings using hexamethyldisiloxane and allylamine monomers

Abstract Plasma enhanced chemical vapor deposition is a promising process for the generation of tailor-made polymer coatings on medical devices in order to improve their implant/ host interaction. The ultra-thin coatings can fulfil a variety of purposes, depending on the monomers used, the process conditions and the location of the coated implants in the human body. In addition, even complex geometries can be coated easily and without the application of solvents. Particularly hydrophilic and hydrophobic plasma polymer coatings can improve biocompatibility, especially in blood contact. Furthermore, the selection of the monomers used enables the generation of specific functional groups for further surface immobilization of drugs, such as proteins, by chemical crosslinking. The release of toxic residues from polymeric implants, such as monomers, additives or degraded components, can also be avoided. The aim of our investigation was the generation of plasma polymer films, their characterization and application as coatings for biodegradable metallic biomaterials in order to retard the degradation process. Metallic biomaterials, in various forms are frequently used in orthopaedics, dentistry, cardiovascular and neurosurgical equipment, because of their tensile strength, fracture toughness, fatigue strength and electrical conductivity. Plasma polymerization was performed using the monomers hexamethyldisiloxane and allylamine. The resulting plasma polymers were analysed in an accelerated degradation test. Both plasma polymers appear to be promising, while polyHMDSO appears to degrade over time and polyallylamine indicates to be stable.

Transpalpebral approach in skull base surgery: how I do it.

Keyhole surgery has been actively developing in the last two decades. Modern neuroimaging, preoperative individual planning, and innovative neurosurgical equipment allow us to operate through mini craniotomy with minimization of approach-related complications. Preoperative planning is very critical. After the patient positioning, skin incision, craniotomy, and dura incision are performed. Intradural lesion is reached with standard microneurosurgical technique. A watertight dura closure is important. Transpalpebral approach can be good alternative to traditional, extended fronto-lateral craniotomies with excellent cosmetic and functional outcomes. Adequate selection of patients is important.

Neurosurgical Care: Availability and Access in Low-Income and Middle-Income Countries.

An estimated 5 billion people worldwide lack access to basic surgical care. In particular, the vast majority of low-income and middle-income countries (LMICs) currently struggle to provide adequate neurosurgical services. Significant barriers exist, including limited access to trained medical, nursing, and allied health staff; lack of equipment; and availability of services at reasonable distance and at reasonable cost to patients. An accurate assessment of current neurosurgical capacity in LIMCs is an essential first step in tackling this deficit. To quantify the neurosurgical operational capacity and assess access to neurosurgical services in LMICs, by taking into account the location of workforce and services. A total of 141 LMICs were contacted and asked to report the number of currently practicing neurosurgeons, access to computed tomographic and magnetic resonance imaging, and availability of neurosurgical equipment (microscope, endoscope, bipolar diathermy, high-speed neurosurgical drill). A proposed World Federation of Neurosurgeons classification was used to stratify cities based on the level of neurosurgical care that could be provided. The data were geocoded and analyzed in Redivis (Redivis Inc.) to assess the percentage of the population covered within a 2-hour travel time of a city offering differing levels of neurosurgical care. 68 countries provided complete data (response rate, 48.2%). Eleven countries reported having no practicing neurosurgeons. The average percentage of the population with access to neurosurgical services within a 2-hour window is 25.26% in sub-Saharan Africa, 62.3% in Latin America and the Caribbean, 29.64% in East Asia and the Pacific, 52.83% in South Asia, 79.65% in the Middle East and North Africa, and 93.3% in Eastern Europe and Central Asia. There are several challenges to the provision of adequate neurosurgical services in low-resource settings. This study used mapping techniques to determine the current global neurosurgical workforce capacity and distribution. We have used our findings to identify areas for improvement. These include increasing and improving neurosurgical training programs worldwide, recruiting students and young physicians into the field, and retaining existing neurosurgeons within their home countries.

Pediatric endocrine surgery development

Отделение детской хирургии на базе ФГБУ “Эндокринологический научный центр” функционирует около двух лет. За время работы хирургическое лечение получили более 500 пациентов с различной эндокринной патологией. В статье обсуждаются современные диагностические подходы и выбор хирургической тактики при заболеваниях, входящих в круг интересов нового направления детской хирургии – эндокринной хирургии детского возраста. В рамках дискуссии обсуждаются варианты радикального лечения болезни Грейвса у детей, рассматриваются положительные и отрицательные стороны хирургического лечения и радиойодтерапии. Приводится собственная статистика послеоперационного гипопаратиреоза. Предлагается оптимизация алгоритма действий при выявлении узлового зоба у детей. При первичном гиперпаратиреозе делается акцент на сложностях послеоперационного ведения пациентов, связанных с особенностями детского возраста, определяющими остроту реакции на водно-электролитные нарушения. Отдельно рассмотрены данные литературы по заболеваниям надпочечников у детей, демонстрируются собственные клинические случаи, потребовавшие хирургического вмешательства. Освещаются возможности современной нейрохирургической техники, применяемой в Эндокринологическом научном центре при операциях на гипофизе у детей. Пациентам различных возрастных групп проводится трансназальное транссфеноидальное удаление опухолей хиазмально-селлярной области с применением эндоскопической ассистенции. В статье также приведены данные исследований в области изучения болезней поджелудочной железы и их хирургического лечения. Большое внимание уделяется гендерному разделу эндокринной хирургии детского возраста. Обсуждается тактика при нарушениях формирования пола, опухолях половых желез у детей, заболеваниях молочных желез. В заключение обрисовываются перспективы развития эндокринной хирургии детского возраста.

МЕТОДИКА ВИКЛИКАНИХ СЛУХОВИХ ПОТЕНЦІАЛІВ ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ ПУХЛИН МОСТОМОЗОЧКОВОГО КУТА

У даній статті представлено огляд літератури, що присвячений пухлинам мостомозочкового кута, анатомії та фізіології вестибулярного нерва, інтраопераційному нейрофізіологічному моніторингу та методиці реєстрації викликаних слухових потенціалів. Зважаючи на розвиток технічного обладнання в нейрохірургії у наш час, стає можливим виконувати оперативні втручання, зберігаючи функціонально значимі структури і таким чином поліпшувати якість життя пацієнта в післяопераційному періоді.Мета дослідження – продемонструвати ефективність використання та методику інтраопераційного нейрофізіологічного моніторингу в модальності викликаних слухових потенціалів для збереження функції кохлеарного нерва під час оперативного втручання з приводу пухлин мостомозочкового кута. Об’єктом дослідження є функція кохлеарного нерва, а предметом дослідження виступають викликані слухові потенціали.Матеріали і методи. Викликані слухові потенціали (від англ. Auditory Evoked Potentials) відображають весь чутливий шлях вестибуло-кохлеарного нерва. В нашій клініці використовували апарат Medtronik Xomed Nim Eclipse з нейрофізіологіним блоком на 32 канали. Імпульси рухаються по провідному шляху слухового аналізатора: перший нейрон – біполярні клітини – спіральний ганглій, другий нейрон – вентральні та дорзальні ядра в оливах ромбоподібної ямки, третій нейрон – нижні горбики чотиригорбкової пластинки, четвертий нейрон – медіальні колінчасті тіла – звивина Гешля. На екрані монітору ми отримуємо сім хвиль, які позначаються римськими цифрами І, ІІ, ІІІ, ІV, V, VI, VII. Оцінка даних амплітуди та латентності всіх хвиль дає можливість проаналізувати функціональну цілісність провідного шляху слуху на всіх його ланках. Дана методика дає можливість нейрохірургу володіти даними функціонального стану нерва.Результати досліджень та їх обговорення. В обласному клінічному центрі нейрохірургії та неврології м. Ужгород було прооперовано за період з лютого 2016 до серпня 2017 р. 35 (100 %) пацієнтів із пухлинами мостомозочкового кута. З них у 30 (85,7 %) хворих втрачений слух на доопераційному етапі, у 5 (14,3 %) пацієнтів слух знижений, порівняно з нормою, збережений. Викликані слухові потенціали не зареєстровані на початку основного етапу в групі пацієнтів із відсутнім слухом на доопераційному рівні. При цьому розмір новоутворення складав переважно більше 25 мм. У всіх хворих із збереженим слухом діаметр новоутворення складав менше 25 мм.Висновки. Визначено кореляцію між клінічними проявами на доопераційному етапі (збережений слух) та розмірами новоутворення. Використання даної методики для пухлин мостомозочкового кута діаметром до 25 мм ефективне.

Evaluating the Effectiveness and the Impact of Donated Neurosurgical Equipment on Neurosurgical Units in Low- and Middle-Income Countries: The World Federation of Neurosurgical Societies Experience.

Surgical practice highly depends on the availability of surgical equipment; this is particularly relevant to low- and middle-income countries (LMICs), where resources are limited. A key part of the efforts to improve surgical provision globally include providing affordable equipment to LMICs; however, the effectiveness and the impact of these initiatives have not yet been assessed. We aimed to evaluate the World Federation of Neurosurgical Societies neurosurgical equipment program in this context. Recipients were identified from the World Federation of Neurosurgical Societies records; contact details were gathered. An online survey was used to collect data on equipment, including its current use, any malfunctioning issues, suitability, reliability, serviceability, and the impact it has had on the unit. Responses were received from 16 units, totaling 28 pieces of equipment. A total of 75% of the equipment is still in use; of this, 57% is fully functioning, and 43% is used despite some malfunction. We found that 25% of the equipment is broken and unusable; high-maintenance items, such as high-speed drills, feature in this category (100% broken, n= 3). Units reported an increase in number of operation performed in 74% cases, improved surgery quality in 78%, and breadth of operations in 44%. Satisfaction, equipment suitability, reliability, and serviceability scored highly, with median values of 9 for all fields on a 10-point scale. Equipment donation positively impacts neurosurgical units in LMICs by allowing expansion of neurosurgical practice, improved safety and quality, and affordability. Adequate follow-up, considerations regarding equipment durability and maintenance needs, and improved support for repairs should be prioritized to ensure maximal benefit.

Morphological and morphometric analysis of the distal branches of the rat brachial plexus

The rat brachial plexus has gained interest recently in neuro-regenerative research due to the advancement of neurosurgical equipment and techniques, but moreover in that it provides a model that can closely resemble the common peripheral nerve injuries seen in humans. The aim of this study was to provide a systematic baseline quantification for fibre type and morphology of the major terminal nerve branches of the rat brachial plexus (radial, ulnar and median) at four surgically accessible sites, through the forelimb. We applied a microstructural and immunohistological analysis of 12 rat brachial plexuses using three forms of micro-visualisation: electron microscopy; whole mount; and immunohistology. The three distal nerves studied showed a similar patterning in terms of the number and size of myelinated fibres, with all proportionally decreasing when moving distally. The fibre types of both the median and ulnar nerve appeared to be homogenously mixed throughout their trajectory, while the radial nerve had a more distinct patterning, especially distal to the elbow, with the entire nerve’s main branch appearing to consist of sensory fibres only. Our microstructural analysis of the rat brachial plexus provides important normative reference data for future peripheral nerve research using the forelimb of the rat.