Virtual pedagogy in neurosurgery during the COVID-19 pandemic: Perspectives from university hospital in Nepal.

Objectives: Since the onset of the COVID-19 pandemic many large institutions have turned towards virtual education. Neurosurgery in our institute, recognizing its benefits, readily embraced the virtual learning experience using Zoom Inc (San Jose, California) beginning on May 21, 2020. The result of this form of educational experience may not be apparent readily. Hence, nearing the end of one year of monthly Zoom meetings, an effort was undertaken to assess the feasibility and the barriers of effective virtual teaching learning activity in neurosurgery among the participants. Methods: The participants consisted of neurosurgeons and trainees from department of neurosurgery Tribhuvan University Teaching Hospital in Nepal, neurosurgeons based in Seattle, United States of America and neurosurgeons based in Sweden, who have been regularly attending the monthly virtual education organized by Dr. Wohns. At the end of one-year experience of monthly Zoom teaching and learning activities between the participants a questionnaire comprising objective questions related to their experience of virtual education in neurosurgery was distributed to the participants and answers were collected and analyzed. Results: A total of 18 persons out of 25 responded to the questionnaire. Majority of participants responded favorably to virtual education. A few responders faced disturbance in internet connectivity affecting the quality of video and sound during the presentations. None of the participants faced inconvenience due to time difference. Most responders preferred to continue virtual education even after the pandemic. Conclusions: Overall most participants responded favorably to virtual education which has helped them increase their participation and hence broaden their knowledge in the field. Most participants look forward to continuing this form of education even in future. Thus, this form of education may be incorporated at least in part in the future of neurosurgical training.

Effect of high altitude on the visual evoked responses in humans on Mt. Everest.

Cerebral visual evoked potentials (VEPs) were collected over a 1-year period from the summer of 1983 through the summer of 1984 from 16 members of the American Ultima Thule Everest Expedition at sea level and at altitudes of 7,100 ft, 16,800 ft, and 21,300 ft. VEPs in response to 100 unilateral LED flashes were processed by a modified Nicolet CA-1000 computer of average transients with an analysis time of 250 ms and were recorded by an X-Y plotter. Readings of oxygen saturation, tetrapolar impedance pulmonary plethysmography, and clinical signs and symptoms of acute mountain sickness (AMS) were recorded. The latency of the major waves of the VEPs increased on initial arrival at higher altitude and returned toward base line over time with acclimatization. There were more acute latency changes in individuals who suffered from symptoms of AMS, which reversed with amelioration of symptoms.

Transient ischemic attacks at high altitude.

The precise etiology of transient neurologic deficits at high altitude is unclear, particularly since the subjects are not investigated as they would be had the events occurred in an urban environment. This report describes two subjects who experienced transient ischemic attacks (TIAs) while ascending the northeast ridge route of Mt. Everest during the Ultima Thule Everest Expedition, and a third subject with TIAs during three separate high-altitude climbs. Possible etiologies and treatment for TIAs at high altitude are suggested.

Phenytoin and acute mountain sickness on Mount Everest.

Twenty-one climbers who were members of the American Ultima Thule Everest Expedition participated in a double-blind, randomized clinical trial of phenytoin prophylaxis for acute mountain sickness during the approach to the northeast ridge of Mount Everest. The study was carried out between Beijing and base camp at 16,800 feet. Time spent ascending from Beijing to base camp averaged 13 days. High-altitude symptom questionnaires were filled out beginning in Lhasa at 11,800 feet and in Xigatse at 12,000 feet, in Xegar at 14,000 feet, and at base camp. Computer analysis of the questionnaire answers performed by an impartial analyst revealed that climbers who took phenytoin were less likely to have headaches at base camp. No other statistically significant differences were observed, but the power of the sample size was low.

Cerebral etiology of acute mountain sickness: a case report.

The authors report a case of acute mountain sickness (AMS) experienced by a support member of the Ultima Thule Everest Expedition. The subject arrived at the 17,000-ft base camp by truck and then developed the symptoms of AMS over the following 72 hours. Flash-induced visual evoked responses (VERs), tetrapolar impedance pulmonary plethysmography, and oxygen saturation measurements were performed. These changed from normal before the onset of his symptoms to abnormal during the height of the symptoms and reverted to normal after treatment. This is the first reported case of AMS monitored with VERs. It has been postulated that AMS may be an early form of cerebral edema, and this report corroborates this hypothesis.

Chlorpromazine treatment for neurogenic pulmonary edema.

A patient with neurogenic pulmonary edema was successfully treated with the alpha-blocking agent, chlorpromazine. A pathophysiologic basis for this drug's efficacy is discussed.

The role of dilantin in the prevention of pulmonary edema associated with cerebral hypoxia.

Twenty-five mongrel dogs were subjected to isolated cerebral hypoxia or noncerebral systemic hypotension to create the congestive pulmonary lesions of the shock lung syndrome (SLS). Eleven of the experimental dogs were pretreated with 5, 5-diphenylhydantoin (DPH). Prophylactic DPH protects the lung from the injury that is a consequence of hypoxic cerebral perfusion in the dog, but does not afford protection from pulmonary damage caused by isolated, noncerebral systemic hypotension. DPH confers this protection on the brain; there is no evidence that DPH exerts this protective effect by an action on the pulmonary parenchyma directly or on other tissue in the body.

Spinal epidural neoplasia. A 15-year review of the results of surgical therapy.

The outcome following decompressive laminectomy and spinal irradiation has been evaluated in 104 consecutive patients with epidural metastatic neoplasia, using broad criteria for successful outcome. Of patients so treated, 33% were benefited, while 23% became worse. Both tumor histology and the preoperative neurological status were important factors in determining the response to this therapy. The authors review the surgical and radiotherapeutic literature in the treatment of this condition, and conclude that there is no clearly established superiority of laminectomy followed by irradiation over radiotherapy alone. Specific indications for surgery exist if prior histological confirmation of malignancy is lacking, if there is neurological deterioration during radiotherapy, or if there are recurrent symptoms referable to a previously irradiated metastasis. Surgery is also indicated if facilities for prompt administration of radiotherapy are unavailable.

Prophylactic phenytoin in severe head injuries.

We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had a 50% incidence of epilepsy. These data from a highly selected group of patients with severe head injuries confirm the bias that treatment with phenytoin decreases the incidence of posttraumatic epilepsy.

Osteomyelitis following translumbar aortography.

Osteomyelitis of the lumbar spine occurred in a patient following translumbar aortography. Treatment included surgical drainage and systemic antibiotic therapy. Fever and progresive neurological dysfunction were relieved. There is controversy about the safety and efficacy of translumbar versus percutaneous transfemoral aortography. The translumbar route, is not the primary approach, is a reasonable alternative; bleeding complications are infrequent and infection is rare.