Neurosurgical Institute Research Articles

Impact of Perioperative Acetylsalicylic Acid (ASA) Administration on Postoperative Intracranial Hemorrhage (pICH) and Thromboembolic Events in Patients with Intracranial Meningiomas.

Background: In routine medical practice, patients are increasingly using ASA for primary and secondary prevention. Although many of these patients discontinue ASA prior to elective intracranial surgery, there are limited data to support whether perioperative ASA use raises the risk of postoperative hemorrhage. This study aimed to investigate the implications of continuing or stopping ASA around the time of surgery in patients with intracranial meningiomas, focusing on postoperative hemorrhage and thromboembolic events. Methods: For this purpose, medical records and radiological images of 1862 patients who underwent cranial neurosurgical procedures for brain tumors over a decade at our neurosurgical institute were retrospectively analyzed. The risk of postoperative hemorrhage was evaluated by comparing meningioma patients who received ASA treatment with those who did not. Furthermore, we investigated other factors that influence postoperative hemorrhage and thromboembolic events, particularly in patients receiving ASA treatment. Results: A total of 422 patients diagnosed with meningiomas underwent surgical intervention. Among the patients who received ASA preoperatively, 4 out of 46 (8.69%) experienced postoperative hemorrhage requiring surgical intervention, whereas the same complication occurred in only 4 out of 376 patients (1.06%) in the non-ASA group (p = 0.007). There was no significant difference in the incidence of thromboembolic events between the two groups. Conclusions: Our analysis revealed an increased risk of postoperative hemorrhage in patients using ASA.

Criteria for predicting the development of recurrent peripheral nerve sheas tumors

Peripheral nerve sheaths tumors (PNST) account for about 8 % of all nervous system cancers. The relapse rate ranges from 17.3 to 26.4 %, showing an upward trend. The causes and provoking factors for the development of relapses of PNST have not been fully studied. Purpose of the study: to establish criteria for predicting recurrence of PNST. Material and Methods. The study included 122 patients who were treated at the Department of Spine and Peripheral Nerve Surgery of A.I. Polenov Russian Research Neurosurgical Institute from 2009 to 2021. Among them, there were 87 (71.3 %) patients with primary PNST and 35 (28.7 %) patients with recurrent PNST. All patients underwent MRI and ENMG both before and after surgery. An immunohistochemical study of Ki67 and SO X10 markers was performed. Results. The majority of relapses occured within 1 year after surgery. In cases with radical removal of PNST, the risk of relapse was: 28.6 % for schwannomas 28.6 %, 37.1 % for neurofibromas and 34.3 % for MP NST 34.3 % (p≥0.05). The risk of developing relapse of PNST was 2.9 times higher in patients aged ≥49 years than in patients aged ≤48 years (p<0.004). The larger the initial size of the tumor, the higher the risk of relapse in the late postoperative period. The risk of developing relapse of MP NST was 8.79 times higher in patients with tumor size of greater than 11.5 cm than in patients with smaller tumor size (p<0.02). The of Ki67 level above 4.85 % in schwannomas and above 5.17 % in neurofibromas can predict relapse of PNST (p<0.05). Loss of SO X10 protein expression was associated with an increase in histological anaplasia of the tumor, which causes a high risk of relapse and an unfavorable clinical course of the disease. Conclusion. Despite radical (total) resection of PNST, the risk of relapse remains high. The pathological type of tumor, its size, levels of SO X10 and Ki67 markers, patient’s age, degree of preoperative neurological deficit and extent of surgery are significant criteria for predicting the development of relapse of PNST.

Intracranial angioleiomyoma: a case series of seven patients and review of the literature

PurposeAngioleiomyoma, predominantly arising from the extremities, is a benign soft tissue tumor. Reports on its intracranial location are rare. We assessed clinical, radiological, and pathological features of intracranial angioleiomyoma (iALM) treated at our neurosurgical institution.MethodsWe consecutively enrolled all patients with neuropathologically confirmed iALM treated at a single neurosurgical institution between 2013 and 2021. Clinical and imaging data were collected, and histological tissue sections were analyzed. A review of the literature on iALM was conducted.ResultsSeven patients with iALM (four female) with a median age of 45 years (range: 32–76 years) were identified. In three cases, the lesion was found incidentally. In magnetic resonance imaging (MRI), all tumors were hypo- to isointense on T1-weighted, hyperintense on T2-weighted sequences, and gadolinium-enhancing. A strong FLAIR signal was seen in six patients. Surgery consisted of gross total resection in all cases without perioperative complications. Neuropathological staining was positive for smooth muscle actin (SMA) in all lesions. Mature smooth muscle cells arranged around blood vessels were typically observed. The Ki-67 index was ≤ 3%. The patients were discharged after a median of 6 days (range: 4–9 days). During a median follow-up time of 14 months (range: 4–41 months), no tumor recurrence occurred. In the current literature, 42 additional cases of iALM were identified.ConclusionIntracranial angioleiomyoma is a benign soft tissue tumor treated by gross total resection. Tumor morphology and positive staining for SMA lead to the neuropathological diagnosis.

Impact of frailty on survival glioblastoma, IDH-wildtype patients.

Frailty increases the risk of mortality among patients. We studied the prognostic significance of frailty using the modified 5-item frailty index (5-mFI) in patients harboring a newly diagnosed supratentorial glioblastoma, IDH-wildtype. We retrospectively reviewed records of patients surgical treated at a single neurosurgical institution at the standard radiochemotherapy era (January 2006 - December 2021). Inclusion criteria were: age ≥ 18, newly diagnosed glioblastoma, IDH-wildtype, supratentorial location, available data to assess the 5-mFI index. A total of 694 adult patients were included. The median overall survival was longer in the non-frail subgroup (5-mFI < 2, n = 538 patients; 14.3 months, 95%CI 12.5-16.0) than in the frail subgroup (5-mFI ≥ 2, n = 156 patients; 4.7 months, 95%CI 4.0-6.5 months; p < 0.001). 5-mFI ≥ 2 (adjusted Hazard Ratio (aHR) 1.31; 95%CI 1.07-1.61; p = 0.009) was an independent predictor of a shorter overall survival while age ≤ 60 years (aHR 0.78; 95%CI 0.66-0.93; p = 0.007), KPS score ≥ 70 (aHR 0.71; 95%CI 0.58-0.87; p = 0.001), unilateral location (aHR 0.67; 95%CI 0.52-0.87; p = 0.002), total removal (aHR 0.54; 95%CI 0.44-0.64; p < 0.0001), and standard radiochemotherapy protocol (aHR 0.32; 95%CI 0.26-0.38; p < 0.0001) were independent predictors of a longer overall survival. Frailty remained an independent predictor of overall survival within the subgroup of patients undergoing a first-line oncological treatment after surgery (n = 549) and within the subgroup of patients who benefited from a total removal plus adjuvant standard radiochemotherapy (n = 209). In newly diagnosed supratentorial glioblastoma, IDH-wildtype patients treated at the standard combined radiochemotherapy era, frailty, defined using a 5-mFI score ≥ 2 was an independent predictor of overall survival.

A Practical Guide to Train the Side-to-side Anastomosis: Tips, Tricks and Technical Nuances

Microanastomosis presents a challenge in neurosurgical procedures, requiring specialized skills. Regular practice outside the operating room is crucial. This study aims to provide a detailed description of the side-to-side anastomosis technique and analyze its advantages in preventing failures compared with other variations. We examined the technique, characteristics, and outcomes of side-to-side bypass procedures for complex aneurysms in the anterior cerebral artery territory at our institution over the past decade. We compared our technique with those described in the literature by other groups. The Far East Neurosurgical Institute (FENI) technique was used in 15 patients, with 17 side-to-side anastomoses performed. The average anastomosis time was 27.5 minutes, with 100% patency in follow-up. Our technique demonstrated safety and effectiveness in treating intracranial aneurysms, yielding satisfactory short- and long-term functionality outcomes. We highlight the importance of maintaining a curvilinear arteriotomy shape, at least 3 times the diameter of the artery, and utilizing an interrupted suturing technique on the anterior wall. This paper presents the first comprehensive description of the side-to-side anastomosis technique, supported with images and videos for training and replicability. Our technique enhances flow dynamics and reduces the risk of acute thrombus formation. Training in simulators and microsurgery practice centers outside the operating room is essential for acquiring and refining microsurgical skills.

Ophthalmic segment internal carotid artery aneurysms endovascular treatment

Aim. To estimate the nearest and distant angiographic results of endovascular occlusion of aneurysms of the internal carotid artery ophthalmic segment using non‑reconstructive treatment methods.Materials and methods. The results of endovascular treatment of 75 patients with aneurysms of the ophthalmic segment of the internal carotid artery admitted to the Neurosurgical Department No. 3 of the V. L. Polenov Russian Research Neurosurgical Institute, from January 1, 2013 to December 31, 2016 were analyzed.Results. Of 75 aneurysms, 52 (69.3 %) were radically occluded from the blood flow (Type A) and 23 (30.7 %) were sub‑totally (Type B). When isolated occlusion with detachable coils was used, radical result was achieved in 13 (59.1 %) out of 22 cases, subtotal occlusion – in 9 (40.9 %). During balloon‑assisted occlusion 39 (73.6 %) out of 53 aneurysms were shut off from the blood flow totally, 14 (26.4 %) – sub‑totally. Partial aneurysm occlusion (Type C) was not achieved in any of the observations. Recurrence was observed in 3 (30 %) out of 10 cases on control angiography after isolated occlusion with detached spirals, and 2 (20 %) required repeated surgical intervention. From 38 aneurysms operated on using balloon‑assistence, 9 (23,7 %) recurred on control angiography, 6 of them (15,8 %) required repeated surgical intervention.Conclusion. Nonconstructive surgical interventions for occlusion of aneurysms of the internal carotid artery ophthalmic segment are still urgent and effective method of treatment of patients in acute period of aneurysm rupture combined with somatic status; however, they are inferior to reconstructive surgeries concerning radica lity in the long‑term period.

Pediatric neurosurgery in Ukraine in 2001-2020. Availability, workforce, performance indicators

Objective: to analyze the development dynamics of pediatric neurosurgical care in Ukraine in 2001-2020. Materials and methods. The number of pediatric neurosurgical beds, pediatric neurosurgeons, hospitalization rates and surgical treatment of children in neurosurgical departments of Ukraine in 2001‒2020 were analyzed. Data for the years 2014-2020 were unavailable for departments located in temporarily non-government-controlled territories. Results. In 2020, there were 22 pediatric neurosurgery departments in Ukraine, with a total of 290 pediatric neurosurgical beds, representing a 26.6% increase compared to 2001. Pediatric neurosurgical departments or pediatric units with neurosurgical beds were operational in almost all regions. The distribution of pediatric neurosurgical beds in Ukraine did not statistically differ from countries with high-income levels (p=0.9987). The increased number of beds contributed to more than doubling the provision of neurosurgical beds per child population. In 2001, there were 17 beds per 1 million children, compared to 38 beds in 2020. In 2020, the number of pediatric neurosurgeons in Ukraine doubled compared to 2001 reaching 58 in 2020 (9.2% of the total number of neurosurgeons in Ukraine and 2.5% of the total number of pediatric neurosurgeons globally). The provision of pediatric neurosurgeons in Ukraine increased more than threefold from 2001 to 2020, reaching 7.7 per 1 million children, meeting the Ministry of Health of Ukraine's standard (7.5). Consequently, the workload per pediatric neurosurgeon decreased almost fourfold, with one specialist per 129,895 children. In 2020, the number of children hospitalized in neurosurgical departments was 9,045, operated on ‒ 3,144, representing a 15.8% decrease and a 3.3% increase, respectively compared to 2001. Per 1 million child population, the hospitalization rate increased by 53, 8% (1201 and 781), the surgery rate increased by 88.7% (417 and 221).Despite the decrease in the number of operated patients over 20 years, surgical activity in neurosurgical institutions of the country increased from 28.3% in 2001 to 34.8% in 2020 (by 23%), postoperative lethality during this period decreased from 2,1 to 1.0% (by 52%).Significant fluctuations in hospital morbidity (HM) rate of children for general neurosurgical pathology and its individual types were recorded during the studied period. In 2020, an increase in these indicators was noted compared to 2001: HM for pediatric neurosurgical pathology in general increased by 53.7% (from 781 to 1,201 cases per 1 million child population), for acute craniocerebral trauma - by 17,5% (from 595 to 699), for hydrocephalus - 5.1 times (from 29 to 149), for neuro-oncological diseases - 3.2 times (from 31 to 100), for congenital anomalies of the nervous system - 4 times ( from 15 to 60), for vascular lesions of the nervous system - 5.1 times (from 5 to 26), for acute spinal trauma - twice (from 9 to 18). Conclusions. Ukraine is a country with high availability of pediatric neurosurgical care. Over the past 20 years, there has been an increase in the provision of pediatric neurosurgery beds and pediatric neurosurgeons. In the first 13 years of the 21st century the trend towards a significant increase in both absolute and relative rates of hospitalization and surgery for children with neurosurgical pathology in subsequent years as a result of the annexation of Crimea, military actions in Donbas and the coronavirus epidemic has changed to a trend towards a decrease in these rates. However, in general, only the absolute number of hospitalized children decreased over 20 years, while the absolute number of operated on and the level of hospitalization and operated on increased. Surgical activity also increased accompanied by a decrease in postoperative lethality.

Growth kinetics of benign neuroepithelial brain tumors in children with relapse

The problem of treating children with recurrent cerebral tumors cannot be solved without effective prediction of recurrent blastomatous growth. The main question will be, in addition to the possible risks of tumor recurrence, when should regrowth of the neoplasm be expected in time? In our opinion, one of the probable ways to solve this problem is to study the kinetics of tumor growth and create a mathematical model for it. The aim of the study was to analyze the kinetic features of the continued growth of benign neuroepithelial brain tumors in children after surgical treatment. The study included the results of an MRI of a 32 patients under the age of 17 years. All patients underwent brain tumor resection for the first time in the Department for Children Polenov Neurosurgical Institute (Almazov National Medical Research Centre). All patients had a relapse/continued tumor growth, as well as a benign nature of the neoplasm, which was confirmed pathomorphologically. To construct the kinetic curves, volumetric indicators of tumors obtained by virtual 3D-modeling were used. Depending on the histotype, the tumor growth rate was determined by the formula: v = (VT-VO)/T, and a graphical assessment of changes in the volume of the neoplasm was carried out – the construction of kinetic curves. Further, the most typical kinetic curves for each histological type of benign neuroepithelial tumors were identified.

Physical Activity and Exercise in Patients with Epilepsy: a Single-Centre Uncontrolled Retrospective Cohort Study

INTRODUCTION. For a long time, persons with epilepsy have been told to stay away from physical activity and sports to prevent seizure triggers. However, in recent years, evidence has accumulated to the contrary, suggesting that sports may help with preventing seizures.&#x0D; AIM. To examine the level of physical activity and sports among patients of the Russian Epileptology Center.&#x0D; MATERIALS AND METHODS. We conducted a study on physical activity in patients with childhood epilSepsy and in patients currently suffering from epilepsy in 2018–2019 at Polenov Neurosurgical Institute. They answered 3 blocks of questions: first block — physical activity and sporting activity during the school years, second block — current assessment of motor activity, third block — effect of physical activity on the course of the disease (triggering/reduction of seizure frequency.&#x0D; RESULTS. Fifty patients with a verified diagnosis of epilepsy were enrolled in the study. According to study findings, 30 % of patients with childhood-onset epilepsy were not allowed to participate in physical activity when they were in school, and the majority of them were forced to give up their sports after developing epilepsy. It was also found that when the seizures were controlled, the children tried to match their peers in terms of physical activity and participated in classes despite being exempted from physical education and some continued to play sports. The results showed that in 70 % of the cases physical activity did not have negative effect on the course of the disease and in 26 % of the cases the patients reported a positive effect of regular physical activity on the course of the disease.&#x0D; CONCLUSION. Therefore, patients continued to exercise despite severe limitations in the compensated course of the disease, as physical activity with the right type and level of sport has a positive effect on the somatic and psychological state of patients with epilepsy and physical activity is chosen.

Early Detection of hyperemia with Magnetic Resonance Fluid Attenuation Inversion Recovery Imaging after Superficial Temporal Artery to Middle Cerebral Artery Anastomosis.

Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

Effect of Intraoperative Mixed-Reality use on Nonsurgical Team Members in the Neurosurgical Operating Room: An Explorative Study

Mixed-reality (MxR) implementation in the neurosurgical operating room (OR) is emerging, but the impact of this technology on the nonsurgical OR staff has not been investigated yet. The purpose of this study is to evaluate the nonsurgical OR team's perception of the impact of intraoperative MxR use. The evaluation occurred in a neurosurgical institution implementing MxR perioperatively on a daily basis for 15 months. The questionnaire measuring the impact of MxR consisted of 5 binary questions and 4 subquestions measured on a 7-point Likert scale. Fifteen nonsurgical staff members of a neurosurgical OR team were interviewed. Most (85%) of the cohort stated that MxR changed their perception of the surgery, improving understanding of the spatial orientation (median 6, interquartile range 5-7) and of the pathology dimensions (6, 5.5-7). One participant (7%) was of the opinion that MxR disrupted the OR workflow. The majority (60%) stated that use of the holograms improved efficiency in the OR. The participants were neutral about the potential role of MxR to improve communication among different OR team members (4, 2-5) and overall teamwork (4, 2-5). The use of 3-Dimensional interactive holograms of neurosurgical cases in the nonsterile intraoperative phase was not perceived as distractive, and neither was OR flow disruption by members of the nonsurgical OR staff. MxR was considered an adjunct to improve OR efficiency. A thorough understanding of the impact of MxR's implementation on the nonsurgical staff could lead to targeted improvement of the MxR use and, potentially, to increasing the quality of the teamwork.

Analysis of surgical treatment of drug-resistant epilepsy in Ukraine for the period 2014—2020

The aim of the study is analysis of surgical care for epilepsy patients in Ukraine from 2014 to 2020. The results of the surgical treatment of epilepsy patients in three leading neurosurgical institutions of Ukraine, which regularly perform epilepsy surgery were analyzed. They are Romodanov neurosurgery institute (Kyiv), Regional Clinical Center of Neurosurgery and Neurology (Uzhhorod) and Dnipropetrovsk Clinical Psychiatric Hospital (Dnipro). A questionnaire was used to obtain information on the quantity and types of surgical operations carried out in the aforementioned institutions between 2014 and 2020. From 2014 to 2018, surgical treatment was performed on 320 patients, in 2019 — 112 patients, and in 2020 — 61. The etiology of seizures was analyzed, where mesial temporal sclerosis overall years had an advantage over other causes of drug-resistant epilepsy. Accordingly, amygdalohypocampectomy accounted for the majority of surgical interventions in all years, however, other etiological factors and types of surgical treatment were also analyzed in detail. The number of patients who require surgical treatment is increasing. It is necessary to carefully refine the stages of preoperative preparation of patients in order to provide the patient with full-fledged medical care and to be able to perform a detailed analysis of surgical treatment. To achieve this goal, it was decided to develop a registry of epilepsy patients who received surgical treatment, which will allow to fully structure all the information received, track postoperative patients, and clearly evaluate the effectiveness of this type of treatment. Key words: drug-resistant epilepsy, epilepsy surgery, register

Early and long-term results of endovascular treatment of cerebral aneurysms

Introduction. Postoperative angiographic examinations after endovascular treatment of cerebral aneurysms may demonstrate unstable results, both in the form of recurrence formation, and in the form of increased degree of occlusion with initially incomplete occlusion of the aneurysm sac. Cerebral aneurysm recurrences represent an important medical and social problem comparable in terms of hemorrhage risks with nonoperated aneurysms.Aim. To estimate the early and long‑term results of endovascular treatment of patients with cerebral aneurysms ope rated on using different endovascular techniques. Materials and methods. The present study included 167 patients (48 men and 119 women) with 195 cerebral aneurysms aged from 18 to 75 years who were operated on using endovascular techniques at the neurosurgical department No. 3 of the Russian Research Neurosurgical Institute named after Prof. A. L. Polenov from 2013 to 2016. The average age of the patients was 52 ± 12 years, the minimum age was 18 years, and the maximum age was 75 years. The choice of endovascular treatment method in the patients included in the study was based on anatomico‑topographic and morphometric features of aneurysm, as well as taking into account the period of aneurysmal disease course.Results. The study of data of control angiographic examinations after endovascular treatment of patients with cerebral aneurysms showed that in the remote postoperative period the degree of aneurysm occlusion may differ from that initially achieved. The probability of aneurysm recurrence after its isolated occlusion with coils may reach 13.1 % already in 6 months after surgical treatment, 31.7 % after 12 months and 22.3 % after 36 months, averaging 22.5 % (p &lt; 0.05).Conclusion. The personalized approach in choosing optimal surgical tactics for the treatment of patients with cerebral aneurysms allows to achieve stable radical aneurysm occlusion, to decrease the incidence of postoperative complications and aneurysm recurrences in the long‑term postoperative period.

Construct validity of the Hungarian Version of the Patient-Reported Outcomes Measurement Information System-29 Profile Among Patients with Low Back Pain

We aim to evaluate the psychometric properties of the Hungarian version of the patient-reported outcomes measurement information system (PROMIS)-29 profile domains among patients with chronic low back pain. We used a convenience, cross-sectional sampling of patients recruited at our neurosurgical institution. The participants completed paper-pencil version of the PROMIS-29 profile in addition to validated legacy questionnaires, including the Oswestry disability index, Research and Development Corporation 36-item short-form survey, 7-item general anxiety disorder scale, 9-item patient health questionnaire. Reliability was evaluated by calculating the internal consistency (Cronbach's α). Test-retest reliability was assessed using the intraclass correlation coefficient. The structural validity of PROMIS-29 was assessed using a confirmatory factor analysis. Construct validity was assessed by evaluating convergent and discriminant validity using Spearman's rank correlation. To further corroborate the construct validity, we also performed known-group comparisons. The mean age of the 131 participants was 54 ± 16 years. Of the 131 patients, 62% were women. The internal consistency of each PROMIS domain was high (Cronbach's α >0.89 for all). The test-retest reliability was excellent (intraclass correlation >0.97). The confirmatory factor analysis showed good structural validity (comparative fit index >0.96; standardized root mean square residual <0.026 for all domains). All measured PROMIS scores correlated strongly with the scores obtained using the corresponding primary legacy instrument, indicating excellent convergent validity. The known-group comparisons demonstrated differences as hypothesized. We present data supporting the validity and reliability of the Hungarian PROMIS-29 profile short forms for patients with low back pain. This instrument will be useful for research and clinical applications in spine care.

Telemedical Support Using Smartphones for Spine Surgery in Low- and Middle-Income Countries.

Objective: Low- and middle-income countries (LMICs) face many challenges compared to industrialized nations, most notably in regard to the health care system. Patients often have to travel long distances to receive medical care with few reliable transportation mechanisms. In time-critical emergencies, this is a significant disadvantage. One specialty that is particularly affected by this is spine surgery. Within this field, traumatic injuries and acutely compressive pathologies are often time-critical. Increasing global networking capabilities through internet access offers the possibility for telemedical support in remote regions. Recently, high-performance cameras and processors became available in commercially available smartphones. Due to their wide availability and ease of use, this could provide a unique opportunity to offer telemedical support in LMICs. Methods: We conducted a feasibility study with a neurosurgical institution in east Africa. To ensure telemedical support, a commercially available smartphone was selected as the experimental hardware. Preoperatively, resolution, contrast, brightness, and color reproduction were assessed under theoretical conditions using a test chart. Intraoperatively, the image quality was assessed under different conditions. In the first step, the instrumentation table was displayed, and the mentor surgeon marked an instrument that the mentee surgeon should recognize correctly. In the next evaluation step, the surgical field was shown on film and the mentor surgeon marked an anatomical structure, and in the last evaluation step, the screen of the X-ray machine was captured, and the mentor surgeon again marked an anatomical structure. Subjective image quality was rated by two independent reviewers using the similar modified Likert scale as before on a scale of 1-5, with 1 indicating inadequate quality and 5 indicating excellent quality. Results: The image quality during the video calls was rated as sufficient overall. When evaluating the test charts, a quality of 97% ± 5 on average was found for the chart with the white background and a quality of 84% ± 5 on average for the chart with the black background. The color reproduction, the contrast, and the reproduction of brightness were rated excellent. Intraoperatively, the visualization of the instrument table was also rated excellent. Visualization of the operative site was rated 1.5 ± 0.5 on average and it was not possible to recognize relevant anatomical structures with the required confidence for surgical procedures. Image quality of the X-ray screen was rated 1.5 ± 0.9 on average. Conclusion: Current generation smartphones have high imaging performance, high computing power, and excellent connectivity. However, relevant anatomical structures during spine surgery procedures and on the X-ray screen in the operating room could not be identified with reliability to provide adequate surgical support. Nevertheless, our study showed the potential in smartphones supporting surgical procedures in LMICs, which could be helpful in other surgical fields.

The Beneficial Effect of Preoperative Exercise on Postoperative Clinical Outcome, Quality of Life and Return to Work after Microsurgical Resection of Spinal Meningiomas.

While outcomes of surgical treatment for spinal meningiomas are well-described within the literature, factors affecting early return to work as well as long-term health related quality of life remain unclear. In this retrospective study, patients with spinal meningioma and surgical treatment from two university-level neurosurgical institutions between 2008 and 2021 were analyzed. Time to return to work, physical activities and long-term health related quality of life (assessed by telephone interviews using the EQ-5D-5L health status measure and visual analogue scale (EQ VAS) were analyzed. We identified a total of 196 patients who underwent microsurgical resection of spinal meningioma between January 2008 and December 2021. Of those, 130 patients of working age were included and analyzed. The median follow-up time was 96 months. All included patients returned to work. The median time of return to work was 45 days for the whole cohort. Patients who preoperatively performed physical activity returned to work significantly earlier compared to patients who did not (p < 0.001). Furthermore, younger age (p = 0.033) and absence of obesity (p = 0.023) correlated significantly with earlier return to work. Significant differences were also observed in all 5 EQ-5D-5L dimensions between patients with and without preoperative physical activity. Despite the benign nature of spinal meningioma preoperative physical activity and physiological body weight are associated with favorable postoperative outcome, higher quality of life and early return to work.

Comorbid emotional disturbances in drug-resistant epilepsy in neurosurgical patients during the preoperative and postoperative periods

Background. Pharmacoresistant epilepsy, i.e. failure to achieve adequate seizure control with antiepileptic drugs develops in 30–40 % of patients. The surgical treatment for these patients are of particular importance. The relevance of studying the emotional sphere of neurosurgical patients with drug-resistant epilepsy stems from the high incidence of this pathology and its impact on patients’ quality of life.Objective. To investigate comorbidity indicators: depression and anxiety in neurosurgical patients with drug-resistant epilepsy during the preoperative and postoperative periods of epilepsy treatment.Design and methods. In 2019–2020, Polenov Neurosurgical Institute studied comorbid affective pathology in 46 neurosurgical patients with drug-resistant epilepsy in 2 groups: Group 1 — preoperative and Group 2 — postoperative patients, using HADS for screening.Results. The study included 46 patients in 2 groups. Group1 — 56.5 %, Group2 — 43.5 %. The mean age of the participants in the study was 30.8 ± 1.1 years. The sex ratio in the cohort was 1.7 males to 1 female. In the cohort, no anxiety was observed in 71.7 % and depression in 84.8 %, severe anxiety in 13 % and depression in 8.7 %.Conclusion. Among the neurosurgical patients with drug-resistant epilepsy, patients without symptoms of anxiety and depression predominated. There is a need to expand the sample and investigate further.

Seven bypasses simulation set: description and validity assessment of novel models for microneurosurgical training.

Microsurgical training remains indispensable to master cerebrovascular bypass procedures, but simulation models for training that accurately replicate microanastomosis in narrow, deep-operating corridors are lacking. Seven simulation bypass scenarios were developed that included head models in various surgical positions with premade approaches, simulating the restrictions of the surgical corridors and hand positions for microvascular bypass training. This study describes these models and assesses their validity. Simulation models were created using 3D printing of the skull with a designed craniotomy. Brain and external soft tissues were cast using a silicone molding technique from the clay-sculptured prototypes. The 7 simulation scenarios included: 1) temporal craniotomy for a superficial temporal artery (STA)-middle cerebral artery (MCA) bypass using the M4 branch of the MCA; 2) pterional craniotomy and transsylvian approach for STA-M2 bypass; 3) bifrontal craniotomy and interhemispheric approach for side-to-side bypass using the A3 branches of the anterior cerebral artery; 4) far lateral craniotomy and transcerebellomedullary approach for a posterior inferior cerebellar artery (PICA)-PICA bypass or 5) PICA reanastomosis; 6) orbitozygomatic craniotomy and transsylvian-subtemporal approach for a posterior cerebral artery bypass; and 7) extended retrosigmoid craniotomy and transcerebellopontine approach for an occipital artery-anterior inferior cerebellar artery bypass. Experienced neurosurgeons evaluated each model by practicing the aforementioned bypasses on the models. Face and content validities were assessed using the bypass participant survey. A workflow for model production was developed, and these models were used during microsurgical courses at 2 neurosurgical institutions. Each model is accompanied by a corresponding prototypical case and surgical video, creating a simulation scenario. Seven experienced cerebrovascular neurosurgeons practiced microvascular anastomoses on each of the models and completed surveys. They reported that actual anastomosis within a specific approach was well replicated by the models, and difficulty was comparable to that for real surgery, which confirms the face validity of the models. All experts stated that practice using these models may improve bypass technique, instrument handling, and surgical technique when applied to patients, confirming the content validity of the models. The 7 bypasses simulation set includes novel models that effectively simulate surgical scenarios of a bypass within distinct deep anatomical corridors, as well as hand and operator positions. These models use artificial materials, are reusable, and can be implemented for personal training and during microsurgical courses.

Is surgical resection predict overall survival in frail patients with glioblastoma, IDH-wildtype?

PurposeWe assessed the impact of frailty on surgical outcomes, survival, and functional dependency in elderly patients harboring a glioblastoma, isocitrate dehydrogenase (IDH)-wildtype. MethodsWe retrospectively reviewed records of old and frail patients surgical treated at a single neurosurgical institution between January 2018 to May 2021. Inclusion criteria were: (1) neuropathological diagnosis of glioblastoma, IDH-wildtype; (2) patient≥65years at the time of surgery; (3) available data to assess the frailty index according to the 5-modified Frailty Index (5-mFI). ResultsA total of 47 patients were included. The 5-mFI was at 0 in 11 cases (23.4%), at 1 in 30 cases (63.8%), at 2 in two cases (4.2%), at 3 in two cases (4.2%), and at 4 in two cases (4.2%). A gross total resection was performed in 26 patients (55.3%), a subtotal resection was performed in 13 patients (27.6%), and a biopsy was performed in 8 patients (17.1%). The rate of 30-day postoperative complications was higher in the biopsy subgroup and in the 5-mFI=4 subgroup. Gross total resection and age≤70years were independent predictors of a longer overall survival. Sex, 5-mFI, postoperative complications, and preoperative Karnofsky Performance Status score did not influence overall survival and functional dependency. ConclusionIn patients≥65years harboring a glioblastoma, IDH-wildtype, gross total resection remains an independent predictor of longer survival and good postoperative functional recovery. The frailty, assessed by the 5-mFI score, does not influence surgery and outcomes in this dataset. Further confirmatory analyses are required.

Role and mechanism of autophagy in the occurrence and development of meningothelial meningioma

This paper aims to investigate the role and mechanism of autophagy in meningioma. A total of 182 meningiomas which diagnosed in the ultrastructural pathology department of Beijing Neurosurgical Institute, Beijing Tiantan Hospital from 1993 to 2021. Light microscope, electron microscope, western blotting and immunohistochemical staining were used. 182 meningiomas, 104 males and 78 females. There were 174 WHO grade 1 benign meningiomas, including 62 meningothelial types, 39 fibrous type, 58 transitional types, 15 angiomatous types, 6 WHO grade 2 cases, including 4 clear cell types and 2 atypical types, 2 WHO grade 3 anaplastic types. Transmission electron microscopy (TEM) showed that the incidence of autophagosomes as a high expression in 27 cases, most of which were meningothelial meningiomas. Immunohistochemical markers EMA, PR, Vimentin, SSTR-2, Ki67, and CD34 were positively expressed in most of the tumors, GFAP, S-100, desmin, C-erbB-2 expression were negative. Western blotting was used to detect the up-regulated proteins of LC3, Beclin1, and down-regulated proteins of Bax, Caspase3, mTOR, PI3K, Akt, S6 and 4EBP1in meningothelial meningiomas compared with the none –meningothelial control group.Autophagy is induced by down-regulating PI3K/Akt/mTOR signaling pathway molecules in meningothelial meningiomas, which can inhibit tumor apoptosis and promote tumorigenesis.