Dural arteriovenous fistulas at the craniocervical junction: a systematic review and meta-analysis.

BACKGROUND: The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management. METHODS: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes. RESULTS: We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2-64.5), 58.8 years (95%CI: 48.4-69.2), and 63.8 years (95%CI: 60.1-67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3-88.2%) in the microsurgery group and 54.9% (95%CI:30.7-77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7-34.5%) in the embolization group, 11.6% (95%CI:3.8-30.4%) in the microsurgery group, and 7.7% (95%CI:1.1-39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1-80.8%), embolization: 51.9% (95%CI:30.8-72.4%), and conservative: 11.6% (95%CI:4.4-27.4%)]. CONCLUSIONS: In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics.

Single session versus multisession stereotactic radiosurgery for the management of intracranial meningiomas: a systematic review and meta-analysis.

PURPOSE: To compare the efficacy, outcomes, and complications of single session (SS-SRS) and multisession (MS-SRS) stereotactic radiosurgery in the treatment of intracranial meningiomas. METHODS: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane. A systematic review and meta-analysis of treatment protocols and outcomes were conducted. After the selection process, 20 articles describing 1483 cases were included. RESULTS: A total of 1303 patients who underwent SS-SRS and 180 patients who underwent MS-SRS for the management of their intracranial meningioma were reported in the included studies. SS-SRS and MS-SRS had comparable one-year (SS-SRS: 98% vs. MS-SRS: 100%, p > 0.99) and five-year (SS-SRS: 94% vs. MS-SRS: 93%, p = 0.71) tumor control rates. The groups also had comparable tumor volume reduction/tumor regression rates (SS-SRS: 44% vs. MS-SRS: 25%, p = 0.25), tumor volume stability rates (SS-SRS: 51% vs. MS-SRS: 75%, p = 0.12), and tumor progression rates (SS-SRS: 4% vs. MS-SRS: 4%, p = 0.89). SS-SRS and MS-SRS yielded similar complication rates (10.4% vs. 11.4%, p = 0.68) and comparable functional improvement rates (MS-SRS: 44% vs. SS-SRS: 36%, p = 0.57). However, MS-SRS was used for significantly larger tumor volumes (MS-SRS: 23.8 cm3 vs. SS-SRS: 6.1 cm3, p = 0.02). CONCLUSION: SS-SRS and MS-SRS resulted in comparable tumor control, tumor volumetric change, and functional outcomes despite significant biases in selecting patients for SS- or MS-SRS.

Dolichoectatic vertebrobasilar aneurysms: a systematic review and meta-analysis of management strategies and outcomes.

OBJECTIVE: The aim of this study was to describe the efficacy, clinical outcomes, and complications of open cerebrovascular surgery, endovascular surgery, and conservative management of dolichoectatic vertebrobasilar aneurysms (DVBAs). METHODS: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane databases according to PRISMA guidelines. A meta-analysis was conducted for clinical presentation, treatment protocols, and clinical outcomes-good (improved or stable clinical status) or poor (deteriorated clinical status or death)-and mortality rates. RESULTS: The 9 identified articles described 41 cases (27.5%) of open cerebrovascular surgery, 61 endovascular procedures (40.9%), and 47 cases (31.5%) of conservative management for DVBAs. The total cohort had a good outcome rate of 51.9% (95% CI 28.3%-74.6%), a poor outcome rate of 45.5% (95% CI 23.0%-70.1%), and a mortality rate of 22.3% (95% CI 11.8%-38.0%). The treatment groups had comparable good clinical outcome rates (open cerebrovascular surgery group: 24.7% [95% CI 2.9%-78.2%]; endovascular surgery group: 69.0% [95% CI 28.7%-92.5%]; conservative management group: 57.7% [95% CI 13.0%-92.5%]; p = 0.19) and poor outcome rates (open vascular surgery group: 75.3% [95% CI 21.8%-97.1%]; endovascular surgery group: 27.2% [95% CI 5.6%-0.70.2%]; conservative management group: 39.9% [95% CI 9.1%-81.6%]; p = 0.15). The treatment groups also had comparable mortality rates (open vascular surgery group: 39.5% [95% CI 11.4%-76.8%]; endovascular surgery group: 15.8% [95% CI 4.4%-43.0%]; conservative management group: 19.2% [95% CI 6.8%-43.5%]; p = 0.23). CONCLUSIONS: The current study of DVBAs illustrated poor outcomes and high mortality rates regardless of the treatment modality. The subgroup analysis showed heterogeneity among the subgroups and advice for personalized management.

The lasting impact of COVID-19 on surgical training from the perspective of surgical residents and consultants in Saudi Arabia: a nationwide cross-sectional study.

BACKGROUND: Since the start of the COVID-19 pandemic, many precautionary measures have been set to curb the transmission of the virus. That has led to changes, most notably in surgical education, like lack of surgical exposure and clinical activities. However, the question aiming at the impact of changes made by the COVID-19 pandemic on surgical education and its extent remains unanswered. MATERIALS & METHODS: An electronic survey was distributed among surgical residents and consultants from all over Saudi Arabia, starting from the 6th till the 21st of July, 2021. Descriptive statistics were presented using counts and proportions (%). Study subjects were compared with the different perspectives during the COVID-19 pandemic by using Chi-square test. A p-value cut-off point of 0.05 at 95% CI was used to determine statistical significance. RESULTS: A total of 243 out of 500 surgical residents and consultants responded to the survey, giving a response rate of 48.6%. The majority were general surgeons (50.5%) and cardiothoracic surgeons (21.8%). Nearly 66% of surgeons, both residents and consultants, strongly agreed on the importance of training for infectious disease outbreaks. 44.7% of the consultants and 48% of the residents showed their willingness to respond to the pandemic regardless of its severity. Over 70% of surgeons agreed that developing clinical skills was compromised by the COVID-19 pandemic, and 40% expected a negative impact of the COVID-19 on their operative skills. Simulation was ranked best for disaster medicine training by over 77% of the respondents. The most common concern among surgeons during the COVID-19 pandemic was their family's health and safety. Regarding virtual curriculum components, online practice questions and surgical videos were preferred by the surgical consultant and resident, respectively. CONCLUSIONS: Although the COVID-19 pandemic has impacted surgical education, it has highlighted the alarming need for adopting new components. For surgical training programs, we recommend improving the virtual curriculum, incorporating disaster medicine training, providing psychological services, and prioritizing immunization and treatment access for surgeons' families.

Prevalence and predictors of nomophobia among the general population in two middle eastern countries.

BACKGROUND: Nomophobia is a psychological condition caused by a fear of disconnecting from others through mobile phones. AIM: This study aims to determine the prevalence of and predictors of nomophobia and anxiety symptoms among the general population in Saudi Arabia and Jordan. METHODS: This study was an observational cross-sectional study using a web-based online survey distributed in two middle eastern countries (Saudi Arabia and Jordan) between Jun 24 and Jul 20, 2021. A convenience sample was used to recruit the study participants. Categorical variables were identified as frequencies and percentages. In addition, a binary logistic regression analysis was used to determine the factors associated with nomophobia symptoms. The Statistical Package for Social Science (SPSS) software, version 27 (IBM Corp, Armonk, NY, USA), analyzed the data. RESULTS: A total of 5,191 responded to the online survey. Around (26.5%) reported that they suffer from an anxiety problem or use a treatment for anxiety. The median daily time spent using a mobile phone (IQR) (minutes) was around 210 min per day. About half of the study sample (51.2%) are diagnosed with dependence syndrome. The binary logistic regression analysis revealed that those within the age group of 30-49 years and 50 years and above) are less likely to have mobile phone dependence compared to those less than 30 years old. Females were 16% at lower risk of developing mobile phone dependence compared to males Married participants were less likely to have mobile phone dependence compared to single participants (OR: 0.62 (95% CI 0.56-0.70)), while divorced participants were at a 46% higher risk of developing mobile phone dependence. CONCLUSION: Nomophobia prevalence among Saudi Arabia and Jordon's population is 51.2%. Several factors may predict mobile phone dependence including age, gender, marital status, and previous history of anxiety.

Prevalence and factors associated with burnout among nurses in Jeddah: a single-institution cross-sectional study.

BACKGROUND: Health care workers, especially nurses, experience significantly elevated levels of emotional and social stressors in the work environment. Therefore, nurses develop high levels of burnout as the stress persists for prolonged periods. The main purpose of this paper is to measure burnout levels amongst nurses and find a relation between burnout levels and demographic factors. METHODS: This descriptive cross-sectional study was held from the 23rd of May till the 6th of September 2021 in King Abdulaziz Medical City of National Guard Health Affairs (KAMC-JD) in Jeddah. Data had been collected voluntarily from the nurses through electronic surveys that included demographic data and the Maslach Burnout Inventory (MBI) that measures three dimensions of burnout which are emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). The association between demographic variables and burnout had been studied using the Fisher Exact test and binary logistic regression. RESULTS: Out of the 1300 nurses working in KAMC-JD, 250 completed the survey. Burnout had been detected in 112 nurses (44.8%). Out of the 250 nurses, 26.4% were found to be at a high risk of burnout, which means they have high or moderate scores of EE and DP, with low ones in PA. The majority of the participants had high burnout levels in each of burnout components, and 99.6% of them scored high in at least one of the three dimensions. Level of burnout was significantly correlated to certain demographic factors which were the nationality (p-value = 0.01) and working unit (p-value = 0.02). On the other hand, there was no significant association between burnout and age, gender, or marital status. CONCLUSION: This study proves that a high percentage of nurses fell victims to burnout with a strong association between certain demographic data namely nationality as well as working unit and burnout levels. Taking into consideration the negative impact of burnout on both nurses and patients, conducting more studies about burnout among nurses, its effect on them, and the risk factors behind it is needed. Early treatment and management are also recommended to avoid the undesirable outcomes.

Neurosurgery Residents' Satisfaction Toward Their Saudi Training Program: Insights from a National Survey.

BACKGROUND: Given the high-stakes nature of their work, neurosurgery residents face constant pressure and require high-quality training to succeed. We aim to investigate the satisfaction levels of residents with their Saudi Neurosurgery Residency Training Program (SNRTP) and its influential factors. METHODS: This is a nationwide, cross-sectional study that employed a questionnaire, structured based on the relevant literature, which was disseminated to neurosurgery residents, commencing from December 2021 and culminating in September 2022. RESULTS: A total of 70 out of 143 neurosurgery residents were included, giving a response rate of 48.9%. Most participants (62.9%) aged 24-28 years old, 55.7% were males, and 40.0% were from the Central region of Saudi Arabia. The residents were further divided into juniors (R1-R3; 64.3%) and seniors (R4-R6; 35.7%). Approximately 13.3% of the juniors were satisfied with the SNRTP, whereas only 8.0% of the seniors were satisfied. Dissatisfaction rates over the SNRTP were significantly higher in the seniors (68.0%) compared to the juniors (28.9%; P = 0.006). The frequency of operating room sessions per week and presence of protected research time were the only 2 factors significantly associated with the junior and senior residents' satisfaction, respectively. CONCLUSIONS: The SNRTP has a vision to provide the society with elite competent neurosurgeons. However, we found a degree of dissatisfaction among the residents, indicating a need for improving the SNRTP's policies. We recommend incorporating more hands-on training opportunities, implementing a mentorship model, setting tailored teaching sessions, and establishing resident wellness programs. We hope this study initiate dialogue on promoting residents' satisfaction and overall well-being.

Surgical intervention ≤ 24 hours versus > 24 hours after injury for the management of acute traumatic central cord syndrome: a systematic review and meta-analysis.

OBJECTIVE: The objective was to evaluate the efficacy, outcomes, and complications of surgical intervention performed within 24 hours (≤ 24 hours) versus after 24 hours (> 24 hours) in managing acute traumatic central cord syndrome (ATCCS). METHODS: Articles pertinent to the study were retrieved from PubMed, Scopus, Web of Science, and Cochrane. The authors performed a systematic review and meta-analysis of treatment procedures and outcomes according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines. RESULTS: Seven articles comprising 488 patients were included, with 188 (38.5%) patients in the ≤ 24-hour group and 300 (61.5%) in the > 24-hour group. Significant differences were not found between groups in terms of demographic characteristics, injury mechanism, spinal cord compression level, neuroimaging features, and the American Spinal Injury Association (ASIA) motor score at admission. Both groups had a similar approach to surgery and steroid administration. The surgical complication rate was significantly higher in the > 24-hour group (4.5%) compared to the ≤ 24-hour group (1.2%) (p = 0.05). Clinical follow-up duration was similar at 12 months (interquartile range 3-36) for both groups (p > 0.99). The ≤ 24-hour group demonstrated a not statistically significant greater improvement in ASIA motor score, with a mean difference of 12 (95% CI -20.7 to 44.6) compared to the > 24-hour group. CONCLUSIONS: The present study indicates potential advantages of early (≤ 24 hours) surgery in ATCCS patients, specifically in terms of lower complication rates. However, further research is needed to confirm these findings and their clinical implications.

Orbital Exenteration for Craniofacial Lesions: A Systematic Review and Meta-Analysis of Patient Characteristics and Survival Outcomes.

BACKGROUND: The outcomes of orbital exenteration (OE) in patients with craniofacial lesions (CFLs) remain unclear. The present review summarizes the available literature on the clinical outcomes of OE, including surgical outcomes and overall survival (OS). METHODS: Relevant articles were retrieved from Medline, Scopus, and Cochrane according to PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management, and outcomes. RESULTS: A total of 33 articles containing 957 patients who underwent OE for CFLs were included (weighted mean age: 64.3 years [95% CI: 59.9-68.7]; 58.3% were male). The most common lesion was squamous cell carcinoma (31.8%), and the most common symptom was disturbed vision/reduced visual acuity (22.5%). Of the patients, 302 (31.6%) had total OE, 248 (26.0%) had extended OE, and 87 (9.0%) had subtotal OE. Free flaps (33.3%), endosseous implants (22.8%), and split-thickness skin grafts (17.2%) were the most used reconstructive methods. Sino-orbital or sino-nasal fistula (22.6%), flap or graft failure (16.9%), and hyperostosis (13%) were the most reported complications. Regarding tumor recurrences, 38.6% were local, 32.3% were distant, and 6.7% were regional. The perineural invasion rate was 17.4%, while the lymphovascular invasion rate was 5.0%. Over a weighted mean follow-up period of 23.6 months (95% CI: 13.8-33.4), a weighted overall mortality rate of 39% (95% CI: 28-50%) was observed. The 5-year OS rate was 50% (median: 61 months [95% CI: 46-83]). The OS multivariable analysis did not show any significant findings. CONCLUSIONS: Although OE is a disfiguring procedure with devastating outcomes, it is a viable option for carefully selected patients with advanced CFLs. A patient-tailored approach based on tumor pathology, extension, and overall patient condition is warranted.

Assessment of Quality of Life (QoL) of Colorectal Cancer Patients using QLQ-30 and QLQ-CR 29 at King Abdulaziz Medical City, Jeddah, Saudi Arabia.

Objective: We aimed to assess the quality of life (QoL) and its predictors in colorectal cancer (CRC) patients at King Abdulaziz Medical City, Jeddah. Methods: A total of 118 CRC patients at King Abdulaziz Medical City, a tertiary hospital in Jeddah, participated in this study. The participants were provided with the online questionnaire via WhatsApp by trained researchers and data collectors in February 2021. All participants were required to answer the three-section questionnaire comprising of (a) demographic data and a validated Arabic version of the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires, (b) a general version (QLQ-30), and (c) a CRC-specific version (QLQ-CR29). Results: Statistical analysis revealed that the most common comorbidity among the participants was diabetes mellitus (42.4%). In addition, the mean global health status was 63.91 ± 24.75. For the global health tool QLQ-C30, results exhibited that physical functioning [62.94 (30.04)] and social functioning [63.56 (31.95)] scored below the threshold, while the cognitive functioning scale scored the highest [74.86 (25.11)]. In addition, on the QLQ-C30 scales, fatigue and insomnia were distressing, with fatigue scoring the highest. For the disease-specific tool QLQ-CR29, it was found that for the symptom scale, urinary frequency and embarrassment scored the highest. Conclusion. The participants reported high global quality of life on both the EORTC QLQ-30 and QLQ-CR29 scales. This study identifies the factors and predictors that affect the quality of life of CRC patients in Saudi Arabia. Recognizing these factors and predictors may empower those patients to maintain positive perception towards the impact of colorectal cancer and improve their survival.

Level and predictors of breast cancer awareness among Saudi women: A nationwide study.

BACKGROUND: Breast cancer occurs when abnormal breast cells grow rapidly and uncontrollably. Early detection and intervention have been established to significantly decrease mortality rates. OBJECTIVE: There is a lack of focused research investigating the degree of breast cancer awareness among Saudi women. Thus, this study aimed to fill this gap by conducting a nationwide survey on a large pool of women. DESIGN: A cross-sectional web-based nationwide study. METHODS: This study targeted Saudi women from all regions of the country and was conducted from 20 August to 3 September 2021. The study used the Breast Cancer Awareness Measure questionnaire to measure breast cancer awareness. This study was approved by the King Abdullah International Medical Research Center institutional review board. RESULTS: Overall, poor breast cancer awareness scores were demonstrated by 71% of the participants. Unemployed women were more likely to have poor breast cancer awareness. CONCLUSION: Our study reports an alarmingly high level of poor overall breast cancer awareness in Saudi women. Interventions should be implemented to combat this lack of awareness.

Determinants of Post-COVID-19 Conditions among SARS-CoV-2-Infected Patients in Saudi Arabia: A Web-Based Cross-Sectional Study.

Background: Large numbers of people infected with COVID-19 developed acute symptoms. Post-COVID-19 conditions have been reported after recovery or discharge from the hospital. However, little is known about the prevalence and possible risk factors of post-COVID-19 conditions in the Saudi community. Here, we describe the incidence of post-COVID-19 conditions among the general population of Saudi Arabia. Methods: We conducted a cross-sectional, nationwide study using an online survey in Saudi Arabia from 1 September 2021 to 28 February 2022. The survey was distributed using social media platforms, such as Twitter, WhatsApp, and Facebook. Patients with SARS-CoV-2 infection were included in the questionnaire adapted from published studies. Result: The study enrolled 7520 individuals who were previously infected with SARS-CoV-2. Most patients in our study were symptomatic and their acute symptoms may persist for more than six days. On the other hand, long-term complications may develop and continue for an extended period (post-COVID-19 conditions). Most of these complications are respiratory, neurological, psychological, or skin related. The proportion of long-term complications reported in this study is 36% among SARS-CoV-2-infected individuals. In addition, being female, old age, number of chronic complications, long-term medication, length of stay in hospital and intensive care unit, and duration of acute symptoms may be significant predictors of post-COVID-19 symptoms. Conclusion: In conclusion, the incidence of post-COVID-19 conditions among the Saudi population was high, which urges further investigation into the risk factors associated with post-COVID-19 symptoms.