Women in leadership positions in European neurosurgery - Have we broken the glass ceiling?

Introduction: The proportion of male neurosurgeons has historically been higher than of women, although at least equal numbers of women have been entering European medical schools. The Diversity Committee (DC) of the European Association of Neurosurgical Societies (EANS) was founded recently to address this phenomenon. Research question: In this cross-sectional study, we aimed to characterize the status quo of female leadership by assessing the proportion of women heading European neurosurgical departments. Material and methods: European neurosurgical departments were retrieved from the EANS repository. The gender of all department chairs was determined via departmental websites or by personal contact. The proportion of females was stratified by region and by type of hospital (university versus non-university). Results: A total of 41 (4.3%) female department chairs were identified in 961 neurosurgery departments in 41 European countries. Two thirds (68.3%) of European countries do not have a female neurosurgery chair. The highest proportion of female chairs was found in Northern Europe (11.1%), owing to four female chairs in a relatively small number of departments (n = 36). The proportions were considerably smaller in Western Europe (n = 17/312 (5.5%)), Southern Europe (n = 14/353 (4.0%)) and Central and Eastern Europe (n = 6/260 (2.3%)) (p = 0.06). The distribution of female chairs in university (n = 19 (46.3%)) versus non-university departments (n = 22 (53.7%)) was even. Discussion and Conclusion: There is a significant gender imbalance with 4% of all European neurosurgery departments headed by women. The DC intends to develop strategies to support equal chances and normalize the presence of female leaders in European neurosurgery.

Distal Posterior Cerebral Artery Ruptured Aneurysm: A Rare Case Report and Review of Literature.

Distal posterior cerebral artery aneurysms consist of a rare vascular entity whose treatment approach remains challenging. Few studies exist scarcely in the literature reporting cases of P4 ruptured aneurysms. In this study, we present the case of a 49-year-old female patient who was admitted to our Neurosurgery Department with the World Federation of Neurological Surgeons grade IV, Fischer grade IV subarachnoid hemorrhage due to a right distal posterior cerebral artery aneurysm. She successfully underwent surgery via a posterior occipital interhemispheric approach. The patient recovered well from surgery, and the following days, she was successfully extubated and had a significant neurological improvement. However, she died during her rehabilitation due to sepsis and severe acute respiratory distress syndrome.

Sinus Bradycardia after Extensive Neck Dissection and Total Thyroidectomy in a Pediatric Patient: A Case Report.

Postoperative complications after total thyroidectomy with extensive neck dissection in thyroid malignancies are well documented in the current literature. However, sinus bradycardia as a postthyroidectomy complication is a rare phenomenon and, to the best of our knowledge, few studies have identified it as a perioperative condition. In our study, we report a case of 9-year-old boy with papillary thyroid carcinoma, who underwent total thyroidectomy and bilateral neck dissection. Postoperatively, the surgery was complicated by initial vocal cord paresis and chyle leak. The patient also suffered from asymptomatic sinus bradycardia which self-resolved. Although causative factors cannot be determined by a single case, hypothyroidism, carotid sinus hypersensitivity, and bilateral damage to the middle cervical sympathetic ganglion could play a significant role in this uncommon pathophysiological condition.

Posterior Circulation Ischemic Stroke Secondary to High-Grade Glioma: A Rare Case Report and Review of the Literature.

Neurological deterioration or new focal deficits in patients with primary brain tumors are usually related to intratumoral hemorrhage, disease progression, seizures (Todd paralysis) and, rarely, ischemic stroke. Ischemic strokes in this group of patients are usually a postoperative complication, a long-term result of radiation vasculopathy, embolic due to hypercoagulability and, less commonly, caused by vessel occlusion by an adjacent brain tumor. We report a rare case of ischemic stroke secondary to a newly diagnosed high-grade glioma and the possible mechanisms that resulted in this medical condition.

Sporadic Pituitary Stalk Hemangioblastoma: A Rare Case Report and Review of the Literature.

Supratentorial hemangioblastomas have rarely been described in the literature. Pituitary stalk hemangioblastomas are extremely rare and almost always are associated with von Hippel Lindau disease. Herein, we report a sporadic case of pituitary stalk hemangioblastoma in a 36-year-old male and review the current literature regarding this pathology. In our case, complete resection of the lesion was achieved using the transglabellar approach.

A Coexisting Pilocytic Astrocytoma and a Prolactinoma: A Case Report of Collision Tumors and Literature Review.

Pituitary adenomas and gliomas constitute two of the most common primary intracranial tumors. However, their coexistence as collision tumors is relatively rare and few similar reports could be identified in the literature. In this study, we report a case of a 64-year-old male patient with a prolactinoma and a pilocytic astrocytoma in collision. The patient underwent both an endoscopic transsphenoidal approach and a subfrontal craniotomy, achieving a gross total resection of the concomitant lesions in the sellar and suprasellar regions. Postoperatively, the patient's preoperative bitemporal hemianopsia resolved and no new deficits occurred. At his six-month follow-up, he remained free of neurologic deficits. Although causative factors are yet to be determined for these tumors in collision, their nonsyndromic coexistence could point to a common genetic linkage which will help to shed light on their natural history of occurrence.

Suitability study of current endovascular aortic repair devices based on real-life anatomic data.

BACKGROUND: There are a number of stent-grafts in the market, designed to handle difficult anatomies during endovascular aortic repair. The aim of this study is to determine which stent-graft is the most appropriate to accommodate the majority of infra-renal aortic aneurysms cases. An additional aim is to determine what stent-graft characteristics influence the suitability of the stent-graft. RESEARCH DESIGN AND METHODS: Retrospective cohort study on the suitability of available stent-grafts for infrarenal aneurysm (AAA) repair based on real-life anatomic data. The anatomical characteristics of 235 AAA were measured manually using specialized software. All measurements were compared to the official instructions-for-use (IFU) using a purpose-specific server-side script. The proper function of the script was additionally confirmed. RESULTS: The highest suitability rate was achieved by Medtronic Endurant. The majority of stent-grafts failed to meet the respective AAA anatomy by one IFU characteristic. Stent-grafts that failed by only one IFU characteristic by ≥80% of unsuitable cases tend to have higher suitability rates. Neck dimensions and CIA diameter are the two characteristics significantly influencing the suitability rate. CONCLUSIONS: Any stent-graft with high suitability rates should be available off-the-shelf in any vascular department in order to cover the majority of cases. For challenging cases, special advantages of the stent-grafts should be taken under consideration.

Intranasal insulin in Alzheimer's dementia or mild cognitive impairment: a systematic review.

BACKGROUND AND AIMS: Due to common pathophysiological findings of Alzheimer's disease (AD) with diabetes mellitus (DM), insulin has been suggested as a possible treatment of AD or mild cognitive impairment (MCI). A safe alternative of IV insulin is intranasal (IN) insulin. The aim of this systematic review is to investigate the effects of IN insulin on cognitive function of patients with either AD or MCI. METHODS: A literature search of the electronic databases Medline, Scopus and CENTRAL was performed to identify RCTs investigating the effect of IN insulin administration on cognitive tasks, in patients with AD or MCI. RESULTS: Seven studies (293 patients) met our inclusion criteria. Most studies showed that verbal memory and especially story recall was improved after IN insulin administration. Sometimes the effect was restricted for apoe4 (-) patients. Intranasal insulin did not affect other cognitive functions. However, there were some positive results in functional status and daily activity. Data suggested that different insulin types and doses may have different effects on different apoe4 groups. In addition, the effects of treatment on Αß levels differed from study to study. Finally, IN insulin resulted in minor adverse effects. CONCLUSIONS: Intranasal insulin improved story recall performance of apoe4 (-) patients with AD or MCI. Other cognitive functions were not affected, but there were some positive results in functional status and daily activity. Since IN insulin is a safe intervention, future studies should be conducted with larger doses and after proper selection of patients and insulin types.

Atrial fibrillation and cognitive function in patients with heart failure: a systematic review and meta-analysis.

Cognitive impairment and dementia are established complications of heart failure (HF) in adult patients and impair medication adherence and self-care. Atrial fibrillation (AF) is suggested to play an independent role in the cognitive decline in patients with HF. The objective of this systematic review was to assess the effect of AF on cognitive function in these patients. Medline (PubMed), Scopus, and the CENTRAL databases were queried from their inception up to April 30, 2016. The search included primary research articles evaluating the effect of AF on cognition in HF patients. There were five eligible studies, including a total of 1670 patients with HF; of these, 449 (26.9%) had AF. Different AF types were studied, including persistent, paroxysmal, or permanent. Four cognitive tests were used to assess cognitive function (Mini-Mental State Examination, Short Portable Mental Status Questionnaire, Modified Mini-Mental Examination, and Montreal cognitive assessment tool). Using the inverse variance method and a random effects model, we observed that presence of AF was significantly associated with increased risk of cognitive impairment in HF patients (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.30-2.87), although with significant heterogeneity (I 2  = 39%). This heterogeneity can be attributed to the different populations and types of AF studied as well as to varying cognitive assessment methods. Concomitant AF may exacerbate cognitive dysfunction in HF patients. However, data are sparse and heterogeneous. Well-designed, prospective studies are needed to (a) establish a causative link and (b) identify the underlying mechanism in order to design appropriate interventions to attenuate risk of cognitive impairment in patients with HF.