Gender Differences in Perceived Stress among Neurosurgeons: A Cross-Sectional Study.

Purpose: Surgeons are subjected to enhanced levels of work-related stress and women are likely to face unique challenges due to sub-optimal representation. The present study was conceived with a primary objective to study the gender differences faced by surgeons and neurosurgeons in particular. The secondary objective was to assess the correlation between the various stress inducers and busters of normal working and daily life and the mental state of neurosurgeons. Methods: The study was a cross-sectional, multi-centric study in which a structured questionnaire was sent to neurosurgeons through various neurosurgical forums of the country. A total of 93 complete responses were included in the study. The questions were broadly divided into four themes, demographic working data, stress inducers, stress busters, and questions to reflect the mental state of the respondent. Results: There were 74 males and 19 females in the study, with an average age of 39.34 ± 8.57 years. Statistically significant gender differences were noted in rating the out-patient department (OPD) hours, lectures and seminars, performing and assisting surgeries, attending conferences and working in the intensive care unit (ICU), with women scoring lower than men for these activities. There were no significant gender differences in the mental state of the respondents. A strong correlation was found between scoring for performance and assisting of surgery and the mental state questions, and a strong negative correlation was noted between music, playing games, going to the gym, practicing yoga and the mental state questions, indicative of a protective effect. Conclusions: There was no significant gender differences in the perceived stress levels among neurosurgeons. Women appeared more comfortable with certain normal activities of working. A strong negative correlation was reported for activities such as music, playing games, yoga, and going to the gym, indicating a protective effect.

Minimally invasive bone-saving orbitotomy for removal of optic nerve cysticercosis.

A 32-year-old man previously being managed for multiple neurocysticercosis presented with a reduction in vision and pain on eye movement. Fundus examination revealed disc edema with venous dilatation. MRI showed a localized hypointensity on T1 weighted images and hyperintensity on T2 weighted images suggestive of a cyst in the optic nerve sheath. Medical therapy with albendazole and steroids did not improve vision. Surgical removal of the cyst was achieved by a modified lateral orbital exploration using a lateral canthal incision without bone removal, with full recovery of vision. Histopathological examination confirmed cysticercosis.

Minimal invasive transcaruncular optic canal decompression for traumatic optic neuropathy.

Traumatic optic neuropathy is a cause of loss of vision associated with head injuries. Treatment options include observation, steroids and decompression of the optic canal. We report a case where the optic canal decompression was performed using a transcaruncular approach under a regional block. The incision was made through the caruncle and the dissection was carried down to the periosteum down to the orbital apex where the optic nerve was seen exiting through the optic canal posterior to the posterior ethmoidal artery. The optic nerve was decompressed with good visualization. Hemostasis and wound closure was achieved using fibrin glue. Postoperatively visual acuity improved with minimal inflammation enabling early rehabilitation.

Botulinum toxin A in the treatment of pthiriasis palpebrarum.

Treatment of pthiriasis palpebrarum is usually difficult and prolonged, involving the use of anticholinesterase eye ointments, yellow oxide of mercury, or fluorescein. The most effective treatment, however, remains direct removal of all the lice and nits from the lashes. We report the use of topical application of botulinum toxin A in 6 children with pthiriasis palpebrum to facilitate complete removal.

Perceptual Learning for Rehabilitation in Traumatic Optic Neuropathy.

Traumatic optic neuropathy is a cause of sudden irreversible visual loss due to optic nerve damage following trauma. Reports of improvement have been noted after observation alone, treatment with corticosteroids, and surgical decompression. However, final visual acuity may not be predictable, with individual patients having little improvement in visual function despite therapy. Perceptual learning improves visual functions by improving the neural processing so as to allow image perception at low signal-to-noise ratios. The case report describes the beneficial effect of perceptual learning in traumatic optic neuropathy, the first to describe the use of perceptual learning in an optic neuropathy. A larger case-controlled study of the effect of perceptual learning in optic neuropathies is required to substantiate the beneficial effect and elaborate the scale of improvement that may be possible with this form of therapy.

Optic Canal Decompression and Direct Ophthalmic Artery Fibrinolysis for Traumatic Optic Neuropathy With Central Retinal Artery Occlusion.

Central retinal artery occlusion is a rare association of traumatic optic neuropathy. Superselective fibrinolytic therapy is a management option for central artery occlusion that reduces systemic side effects of thrombolysis. A rare case of posttraumatic central retinal artery occlusion is described where optic nerve decompression was performed followed by restoration of central retinal flow by direct puncture of ophthalmic artery and institution of fibrinolytic therapy.