Saudi women pioneers in neurological surgery: Insights into progress and inclusion.

Forty years ago, General Professor Dr. Khalaf Al-Mouteary established the first neurosurgical department in the Kingdom of Saudi Arabia. Here, we explored various pieces of evidence on the progress and inclusion of Saudi female pioneers in the neurosurgical workforce of the Kingdom of Saudi Arabia. We gathered information data on the inclusion of women in neurological surgery retrieved from open-resource online documentation of the Ministry of Health and direct communication with Saudi Commission for Health Specialties (SCFHS) administrative services. Furthermore, regional neurosurgery program directors, four active registered consultants, were either interviewed live or through offline communications. Data on the current number of board-certified, active female neurosurgeons in either the government or private sectors, along with the number of current neurosurgery postgraduate residency program trainees, were obtained from the registered database of the SCFHS. Since 2002, 18 women (29 %) have graduated from the Saudi Neurosurgical Residency Training Program (SNRTP), in contrast,71 % of the graduates were male. The SNRTP is now training more than 34 females (30 %), who are progressing in their neurosurgical training across the country. The first Saudi woman to pursue neurosurgery was Dr Samia Abdel-Rahim Maimani, while the first woman to pass the Saudi Neurosurgery Board was Dr Aisha Al-Hajjaj in 2002. In 2021, board-certified female neurosurgeons in Saudi Arabia will represent approximately 3 % of all practicing neurosurgeons.

Successful magnetic resonance-guided focused ultrasound treatment of tremor in patients with a skull density ratio of 0.4 or less.

OBJECTIVE: The use of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of tremor-related disorders and other novel indications has been limited by guidelines advocating treatment of patients with a skull density ratio (SDR) above 0.45 ± 0.05 despite reports of successful outcomes in patients with a low SDR (LSDR). The authors' goal was to retrospectively analyze the sonication strategies, adverse effects, and clinical and imaging outcomes in patients with SDR ≤ 0.4 treated for tremor using MRgFUS. METHODS: Clinical outcomes and adverse effects were assessed at 3 and 12 months after MRgFUS. Outcomes and lesion location, volume, and shape characteristics (elongation and eccentricity) were compared between the SDR groups. RESULTS: A total of 102 consecutive patients were included in the analysis, of whom 39 had SDRs ≤ 0.4. No patient was excluded from treatment because of an LSDR, with the lowest being 0.22. Lesioning temperatures (> 52°C) and therapeutic ablations were achieved in all patients. There were no significant differences in clinical outcome, adverse effects, lesion location, and volume between the high SDR group and the LSDR group. SDR was significantly associated with total energy (rho = -0.459, p < 0.001), heating efficiency (rho = 0.605, p < 0.001), and peak temperature (rho = 0.222, p = 0.025). CONCLUSIONS: The authors' results show that treatment of tremor in patients with an LSDR using MRgFUS is technically possible, leading to a safe and lasting therapeutic effect. Limiting the number of sonications and adjusting the energy and duration to achieve the required temperature early during the treatment are suitable strategies in LSDR patients.

Endolymphatic sac tumor at the cerebellopontine angle: A case report and review of literature.

INTRODUCTION: Endolymphatic sac tumors may present as sporadic or may be associated with Von Hippel-Lindau disease. Patients generally present with hearing loss, tinnitus and vertigo. The tumor is highly vascular which may lead to erosion of the adjacent bony and vascular structures, resulting in heavy bleeding during surgery. PRESENTATION: A twenty-five year-old female presented with a five year history of chronic ear discharge, left sided facial weakness, and recent onset of ataxia. DISCUSSION: The unusual clinical presentation made management challenging, in large part due to profuse bleeding. Pre-operative embolization of the vessels supplying the tumor may reduce blood loss during surgical excision. Radiotherapy could be considered for any residual tumor. CONCLUSION: The patient was diagnosed with an endolymphatic sac tumor of sporadic origin which presented at the cerebellopontine angle and was managed with a multidisciplinary approach.

Peripontomedullary hydatid cyst: Case report and literature review.

INTRODUCTION: Hydatid cyst represents the parasitic infection by Genus Echenococcus Granulosis. This disease usually involves liver followed by lungs and rarely the CNS. The CNS involvement by the Hydatid Cyst is present in 1-2% of all hydatidosis. Even when it is found in the Brain it presents usually in the supratentorial compartment. However this case was unique in having the Hydatid cyst within the infratentorial fossa. With multiple small cysts, causing mass effect and challenging for surgical resection. PRESENTATION: A 44 years female presented with headache, diplobia and bulbar symptoms, followed by ataxia. Full examination, proper investigations showed the peripontomedullary hydatid cysts. Surgical management is illustrated. DISCUSSION: It is still challenging for the neurosurgeons to operate on these lesions in spite of modern technologies and fancy approaches due to its delicate nature, associated risk of allergic reaction, cyst's material dissemination and irreversible injury of multiple neurological structure due to prolonged compression of cranial nerves crossing the cerebellopontine angle. CONCLUSION: In this case report we are presenting a rare case of Multiple Hydatid cysts involving a rare location in the brain; peripontomedullary area and extending all the way down to the foramen magnum. Supported with a literature review in relation to disease etiology, epidemiology, clinical presentation and management.