Normative parameters of the Evans Index using Computer Tomography in the Saudi population.

OBJECTIVES: To calculate The Evans Index (EI) in normal Individuals. Ventricular enlargement is referred to as hydrocephalus. Computer tomography (CT) scans are commonly used to investigate such intracranial pathologies. The EI is an important parameter for diagnosing hydrocephalus. METHODS: We included all patients who underwent Computer tomography (CT) scan of the brain that was reported as normal. The mean EI was calculated for the whole sample stratified by age, gender, and ethnicity. Patients with an initial report indicating any intracranial pathology, such as hydrocephalus, tumors, hemorrhages, or neurodegenerative disorders, were excluded. RESULTS: A total of 1,330 brain CT scans carried out at our institution were reviewed retrospectively from August 2021 to December 2021. A total of 423 CT scans were screened after excluding 25 patients with abnormal imaging findings and 14 repeated images for the same patients. A total of 384 patients were included. The mean EI for the entire sample was 0.2550±0.0277. There was a minimal but statistically significant difference based on gender, with a mean EI of 0.2588±0.0274 for males and 0.2517±0.0276 for females (p=0.012). There was no statistically significant difference between Saudi and non-Saudi patients. EI increased progressively with age in both genders. CONCLUSION: Our EI values were similar to many of those reported in other countries, which supports the use of the 0.3 cutoff for the diagnosis of hydrocephalus, regardless of gender, age, or ethnicity.

Outcomes after laser interstitial thermal ablation for temporal lobe epilepsy: a systematic review and meta-analysis.

Epilepsy is a common condition that affects approximately 1% of the world's population, with about one-third being refractory epilepsy. Temporal lobe epilepsy is the most common type of drug-resistant epilepsy, and laser interstitial thermal therapy (LITT) is an innovative treatment. In this systematic review and meta-analysis, we aimed to summarize the current evidence on outcomes after LITT, including seizure freedom rate, complication rate, and neurocognitive outcome. PubMed and OVID Medline search engines were systematically searched for all indexed publications in the English language up to July15, 2023. The search was limited to human studies. Proportions and 95% confidence interval (CI) values were calculated for seizure, neurocognitive outcome, and complication rate. A total of 836 patients were included. Overall seizure outcomes, regardless of the pathology, included Engel I outcome in 56% (95% CI, 52.4-59.5%), Engel II outcome in 19.2% (95% CI, 15.4-23.6%), Engel III outcome in 17.3% (95% CI, 13.5-21.8%), and Engel IV outcome in 10.5% (95% CI 6.3-17%) of the patients. The overall decline in verbal and visual memory regardless of laterality was 24.2 (95% CI 8.6-52%) and 25.2% (8.3-55.8%). For naming, the decline was 13.4% (6.6-25.4%). The results of the pooled analysis in comparison with available data in the literature showed that seizure outcomes after LITT were slightly inferior to published data after temporal lobectomy. Data on cognitive outcomes after LITT are scarce and heterogeneous.

The Impact of Nursing Education on Emergency Bedside External Ventricular Drain Insertion for Patients With Acute Hydrocephalus.

Objectives Acute hydrocephalus is a neurosurgical emergency that requires immediate intervention. With emergency external ventricular drain (EVD) insertion and management, such rapid intervention can be a safe bedside procedure. Nurses play an integral role in patient management. Thus, this study aims to assess the knowledge, attitudes, and practices of nurses from different departments regarding bedside EVD insertion in patients with acute hydrocephalus. Methods EVD and intracranial pressure (ICP) monitoring competency checklists were developed, and a quasi-experimental, single-group, pre/post-test study was conducted at a university hospital in Jeddah, Saudi Arabia, in January 2018 during an educational program. The neurosurgery team determined program efficacy using pre/post-questionnaires. All attendees who agreed to fill in the pre- and post-survey and whose data were complete were included in the study. Results Of the 140 nurses who participated in the study, the data of 101 were analyzed. Knowledge level improved significantly between the pre- and post-test; for example, when asked about administering antibiotics before EVD insertion, the pre-test correct response rate of 65% increased to 94% in the post-test (p<0.001), and 98% considered the session informative. However, the attitude toward bedside EVD insertion did not change after the teaching sessions. Conclusion This study emphasizes the importance of ongoing nursing education, hands-on training, and strict adherence to an EVD insertion checklist to achieve successful bedside management of patients with acute hydrocephalus.

Programmable Versus Differential Pressure Ventriculoperitoneal Shunts for Pediatric Hydrocephalus: A 20-Year Single-Center Experience From Saudi Arabia.

Background Shunt malfunction is the most common complication after ventriculoperitoneal shunt (VPS) insertion for pediatric hydrocephalus. The incidence of shunt malfunction and the need for VPS revision may be related to the type of valve used in the shunt. Therefore, we aimed to compare the outcome of VPS in the pediatric age group stratified by differential pressure valves (DPV) and programmable shunt valves (PSV). Materials and methods This ethics-approved retrospective study was conducted at a tertiary care hospital in Saudi Arabia. We included 175 children with congenital hydrocephalus who underwent a shunt insertion or revision between 2003 and 2018 and followed them up to December 2022. The VPS complication and revision rates were compared with the patient's demographics and shunt valve types. The Kaplan-Meier method, log-rank test, and univariate and multivariate Cox proportional hazards regression were used to analyze several variables and subsequent shunt revisions. Results Females represented 52% of the study participants, and the mean age of the patients was 21.7 ± 38.4 months. The main indication for VPS was congenital hydrocephalus due to aqueductal stenosis (40%). The differential shunt valve was used in 78.9% and the PSV in 21.1% of the patients. Surgical complications occurred in 33.7% of the patients. Shunt malfunction and infection occurred in 16% and 11.4% of the patients, respectively. The VPS revision rate was significantly lower when PSV was used (odds ratio = 0.39, P < 0.05). Conclusion Overall, one-third of the studied pediatric cohort required shunt revision at some point during the 15-year follow-up. However, children with PSV had fewer revision rate-related complications compared to children with DPV during the first five years of follow-up.

Outcome of Anterior and Posterior Endoscopic Procedures for Cervical Radiculopathy Due to Degenerative Disk Disease: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: Cervical spine endoscopic discectomy and decompression have gained popularity in the last decade. This review aimed to shed light on the current outcomes of cervical spine endoscopic procedures for degenerative disc disease (DDD) and to calculate a pooled estimate of various outcome measures. METHODS: We retrieved articles published in English related to endoscopic cervical spine procedures from 3 central databases from inception until September 2020. A subgroup analysis based on the anterior versus the posterior approach was performed. RESULTS: Thirty-one articles fulfilled the eligibility criteria and included 1,410 patients. A successful outcome was observed in 91.3% (88.6-93.4%, P = 0.000). This percentage was lower for the anterior approach (89.6% [85.8-92.5%], P = 0.000) than for the posterior approach (94.2% [90.4-96.5%], P = 0.000). A higher percentage of poor outcomes was reported for the anterior approach (5.7% [3.2-10.1%], P = 0.000 vs. 2.3% [1-5.5%], P = 0.000 for the posterior approach). The overall complication rate was 7.2% (5.2-9.8%, P = 0.000). There was a slightly higher complication rate for the anterior approach (7.9% [4.5-13.3%], P = 0.000) than for the posterior approach (6.7% [4.4-10%], P = 0.000). The revision rate was 4.2% (2.6-6.8%, P = 0.000); and 4.2% (1.8-9.7%, P = 0.000) for the anterior approach and 4.00% (2.2-7.4%, P = 0.000) for the posterior approach. CONCLUSIONS: There is a higher success rate and lower complication rate with the posterior approach than with the anterior approach. However, high-quality randomized controlled trials are vital to evaluate the efficacy of these procedures.

Accuracy of Pedicle Screw Placement Using Intraoperative CT-Guided Navigation and Conventional Fluoroscopy for Lumbar Spondylosis.

Background Transpedicular screws are a common adjunct for lumbar spine fusion. Accurate screw placement to prevent neurological injury has been the subject of many studies. The adoption of spine neuronavigation has shown a significant decrease in screw malposition morbidity. We aim to evaluate the accuracy of pedicle screw insertion using intraoperative CT-guided navigation in lumbar spondylosis. Methods We reviewed a prospective registry-based cohort study. This included patients who underwent transpedicular screws insertion for lumbar spondylosis under intraoperative CT-guided navigation (iCT-Nav) and compared it to another group operated using conventional fluoroscopy (FS) over one year. In addition, the correlation between clinical outcome using the visual analog scale (VAS) and short 12 physical component scores (SF-12 PCS) and hospital stay was reported. Results Fifteen patients were included in the iCT-Nav group compared to 42 patients in the FS group. The median age of the iCT-Nav group was 59.3 years old (27-76 years) versus 45 years old (20-60 years) in the FS group. The number of screws was 98 in the iCT-Nav group and 252 screws in the FS group. Based on more than 2-mm breach increments measured on CT images, lumbar pedicular screw placement accuracy was 100% in the iCT-Nav group and 86.9% in the FS group. None of the patients in the iCT-Nav group had to undergo any postoperative revisions. On the other hand, two patients of the FS group developed new postoperative symptoms related to displaced screws and required readmission and revision surgery. Conclusion In a commonly performed pedicular fixation in lumbar spondylosis, iCT-Nav has been shown to improve the accuracy of pedicle screw placement, hospital stay, and functional outcomes compared to FS.

Clinical manifestation of central nervous system tumor.

Tumors of the brain and spinal cord (central nervous system, CNS) are rare when compared with other sites and other diseases that can affect the length of an individual's life. However, about 20,000 new cases of primary CNS tumors are diagnosed in the United States each year, not an insignificant number. The CNS is "locked" inside a rigid and nonexpandable calvarium (except in newborns and young children); therefore, any new growths (primary or secondary) can only grow at the expense of the structures already inside the skull or spinal column. The symptoms and signs or clinical manifestations of CNS tumors depend on the location and the growth rate of these tumors. Symptoms include general nonlocalizing and focal symptoms and signs. General signs, which reflect the increase in intracranial pressure, include drowsiness, confusion, headache, nausea, vomiting, sixth nerve palsy, papilledema, generalized seizures, and cognitive impairment. Focal signs and symptoms reflect the effect of the tumor on specific structures. Special imaging techniques (such as computed tomography, magnetic resonance imaging, and positron emission tomography) are essential for the localization of the lesion and for image-guided brain biopsies. The handling of these tiny biopsies often presents significant diagnostic challenges, especially at the time of frozen section examination.

Prevalence of complementary and alternative medicine use in brain tumor patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

OBJECTIVES: To determine the prevalence and types of complementary and alternative medicine (CAM) being utilized and the possible factors that prompted the use of CAM in patients with brain tumors. Methods: The study conducted was a questionnaire-based, cross-sectional study of patients diagnosed with brain tumors at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia from January 2011 to May 2018. Patients with primary and secondary brain tumors, were included. Our questionnaire was conducted via phone interviews after obtaining patient consent.  Results: A total of 72 patients were included. The mean age of the participants was 45.89 (±16.52) years. We found that education level significantly affected the use of CAM. Fewer users of CAM held bachelor's degree and patients with lower degrees used CAM more frequently (p=0.027). The most frequent types of CAM were Zamzam (holy water) and Ruqya (Quran reading). Family members were the most frequent source of information about the use of CAM (81.6%).  Conclusion: Education level has a significant effect on CAM use. Gender plays a role in the type of CAM used. Future research should focus on the adverse effects of some CAM therapies, how effective CAM therapies are, and the effect CAM may play in delaying patients from seeking medical advice.

The longitudinal impact of COVID-19 pandemic on neurosurgical practice.

OBJECTIVE: This observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice. METHODS: We included 29 participating neurosurgeons in centers from all geographical regions in the Kingdom of Saudi Arabia. The study period, which was between March 5, 2020 and May 20, 2020, was divided into three equal periods to determine the longitudinal effect of COVID-19 measures on neurosurgical practice over time. RESULTS: During the 11-week study period, 474 neurosurgical interventions were performed. The median number of neurosurgical procedures per day was 5.5 (interquartile range [IQR]: 3.5-8). The number of cases declined from 72 in the first week and plateaued at the 30's range in subsequent weeks. The most and least number of performed procedures were oncology (129 [27.2 %]) and functional procedures (6 [1.3 %]), respectively. Emergency (Priority 1) cases were more frequent than non-urgent (Priority 4) cases (178 [37.6 %] vs. 74 [15.6 %], respectively). In our series, there were three positive COVID-19 cases. There was a significant among-period difference in the length of hospital stay, which dropped from a median stay of 7 days (IQR: 4-18) to 6 (IQR: 3-13) to 5 days (IQR: 2-8). There was no significant among-period difference with respect to institution type, complications, or mortality. CONCLUSION: Our study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post pandemic health-care system intolerable overload.

Neurosurgical Procedures and Safety During the COVID-19 Pandemic: A Case-Control Multicenter Study.

OBJECTIVE: Quantitative documentation of the effects of outbreaks, including the coronavirus disease 2019 (COVID-19) pandemic, is limited in neurosurgery. Our study aimed to evaluate the effects of the COVID-19 pandemic on neurosurgical practice and to determine whether surgical procedures are associated with increased morbidity and mortality. METHODS: A multicenter case-control study was conducted, involving patients who underwent neurosurgical intervention in the Kingdom of Saudi Arabia during 2 periods: pre-COVID-19 and during the COVID-19 pandemic. The surgical intervention data evaluated included diagnostic category, case priority, complications, length of hospital stay, and 30-day mortality. RESULTS: A total of 850 procedures were included, 36% during COVID-19. The median number of procedures per day was significantly lower during the COVID-19 period (5.5 cases) than during the pre-COVID-19 period (12 cases; P < 0.0001). Complications, length of hospital stay, and 30-day mortality did not differ during the pandemic. In a multivariate analysis comparing both periods, case priority levels 1 (immediate) (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.24-2.67), 1 (1-24 h) (OR, 1.63; 95% CI, 1.10-2.41), and 4 (OR, 0.28; 95% CI, 0.19-0.42) showed significant differences. CONCLUSIONS: During the early phase of the COVID-19 pandemic, the overall number of neurosurgical procedures declined, but the load of emergency procedures remained the same, thus highlighting the need to allocate sufficient resources for emergencies. More importantly, performing neurosurgical procedures during the pandemic in regions with limited effects of the outbreak on the health care system was safe. Our findings may aid in developing guidelines for acute and long-term care during pandemics in surgical subspecialties.