Awake brain mapping by direct cortical stimulation; technical note to get higher resection rate and low morbidity in low-grade glioma patients.

Introduction: Direct cortical stimulation has been used for brain mapping and localization of eloquent areas in awake patients. This simplified technique is to provide the positive areas, which can be preserved if the tumor or lesions are involved eloquent areas. Objective: The main objective of this study is to determine whether direct cortical stimulation in awake brain mapping for low-grade glioma patients increases the rate of resection or not. Method: The authors present a retrospective study between 2020 to 2022 that includes 35 cases in a single center, to get higher resection rate, and their consequences in awake craniotomy in low-grade glioma patients. Here, two neurosurgeons were involved and the minimum follow-up was 12 months. Results: The authors achieved 80% removal of tumors. To get higher resection rate we emphasized negative mapping with prior anatomical analysis to understand functional realignment. Stimulation-related complications will be thoroughly discussed with a potential future direction to minimize the issues. The authors used PROMIS score to measure patients physical and mental health status and kernofsky score to measure performance status before and after successful surgery. The authors found three cases of transient deficit in repetitive stimulation. Repeated stimulation to identify the eloquent areas with low voltage frequency is a good option. Numbness in the face related to stimulation may continue for 6 weeks. Conclusion: Functional realignment in shifted brain and edema can be seen while doing cortical and subcortical stimulation. Most of the stimulation from low to high for language mapping may vary from patient to patient. For safe removal of low-grade glioma a steep learning curve is needed to find out the negative areas, though the authors emphasize positive mapping of areas to secure the maximum eloquence.

The use of facial nerve fasciculus motor evoked potential (MEP) as intraoperative neurophysiological monitoring modality in a child with a diffuse intrinsic pontine glioma: A case report.

BACKGROUND: Intraoperative neurophysiological monitoring (IONM) has improved the diagnosis and surgical treatment of brainstem and posterior fossa tumors. Several modalities are available for IONM such as electroencephalography, brainstem mapping (BSM), cranial nerves evoked potentials), somatosensory evoked potentials (SEP), motor evoked potentials (MEP), brainstem auditory evoked potentials (BAEPs), nerve conduction, and electromyography (EMG) signals. Though motor evoked potential (MEP) and brainstem mapping are the most common IONM modalities used for surgical management of brainstem gliomas, cranial nerve potentials can also be of great help. CASE DESCRIPTION: This article describes a 10-year-old child with diffuse intrinsic pontine glioma (DIPG) who presented with gradual progressive crossed hemiparesis. His brain images carried a range of potential differential diagnoses. Her underwent a successful brainstem biopsy via using motor evoked potential for facial nerve without injuring nearby structures. CONCLUSION: Motor evoked potential of the facial nerve can be used solely for biopsy taking in cases of DIPG.

Robotic surgery in Asia.

The percentage of robot-assisted radical cystectomy (RARC) is comparatively low in Asia compared to other continents [11]. Few studies showed, RARC with intracorporeal urinary diversion causes less bleeding and hospital stay compared with extracorporeal urinary diversion.

Endoscopic third ventriculostomy in children: problems and surgical outcome: analysis of 34 cases.

BACKGROUND: Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid (CSF) or reclosure of ventriculostomy stoma or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors. METHODS: Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively. The patients' age limit was between 2.5 months and 14 years. This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018. Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study. RESULTS: The mean age of all patients was 51.25 ± 53.90 months and the mean follow-up period was 50.47 ± 20.84 months. Of 34 surgeries, the success rate was 79% and the failure rate was 21%. Within 2 years, the success rate was 68.42% and above 2 years' success rate was 93.33%. In this series, 7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases, the presence of the second membrane in re-exploration 2 cases, and presence of inflammatory arachnoid membrane in re-exploration 2 cases. The use of dexamethasone around the stoma in inflammatory stoma was useful, having no recurrence. In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt. CONCLUSIONS: Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, remnants of the second membrane inside the stoma, CSF absorption failure, infection/high protein in CSF and inappropriate patient selection.

Magnetic Resonance Spectroscopy for Prediction of Grades of Diffusely Infiltrating Intracranial Astrocytomas.

Objective Gliomas, the most frequent primary brain tumors, have various grades, among which grade II, III, and IV are diffusely infiltrating astrocytomas. As therapeutic approaches and outcome differ considerably, depending on the grade of these tumors, prediction is important regarding outcome. Magnetic resonance spectroscopy (MRS) can be of help in understanding of the biochemical changes of pathological state to study, monitor, predict grading and outcome of gliomas. Materials and Methods All the 30 patients in the study with intracranial diffusely infiltrating astrocytoma had MRS study using 1.5 Tesla MR scanner. The study population was divided into three groups on the basis of the grades of the tumor according to histopathology. Mean height of choline (Ch), N-acetyl aspartate (NAA), creatine (Cr) peak, and choline/creatine (Ch/Cr) ratio was documented. Mean value of each variable among three grades was analyzed and compared with analysis of variance (ANOVA) test (F-test). Results There was positive relationship regarding Ch/Cr ratio among astrocytomas grade II to IV and the result was significant ( p = 0.047). A positive relationship of Ch peak was also observed for grade II to IV astrocytoma, though the result was not significant ( p = 0.578). The result was nonsignificant for NAA ( p = 0.696) and Cr ( p = 0.740) peak also. Conclusion We recommend Ch/Cr ratio to be considered as a dependable MRS data to comment on low- or high-grade astrocytomas. MRS can be done as a routine investigation in the developing countries for astrocytomas where other facilities are less accessible for reliable prediction and counseling.

A Conceptual Model of Dyadic Coordination in HIV Care Engagement Among Couples of Black Men Who Have Sex with Men: A Qualitative Dyadic Analysis.

Among Black men who have sex with men (MSM), HIV incidence is disproportionately high and HIV care engagement is disproportionately low. There may be important opportunities to leverage the primary relationship to improve engagement in HIV care and treatment among Black MSM couples. Using dyadic qualitative analysis of semi-structured, one-on-one interviews, we explored dyadic aspects of HIV care engagement among 14 Black MSM couples in which at least one partner was HIV-positive and identified as a Black cisgender man. Findings showed that men varied in how involved they were in their HIV-positive partner's care and treatment, and in how they reciprocated their partner's involvement. Patterns of dyadic HIV care engagement supported a conceptual model of dyadic coordination that describes Black MSM relationships in terms of two conceptual dimensions of dyadic HIV care engagement, and guides future intervention designs with Black MSM couples.

Mobile Technology for Healthy Aging Among Older HIV-Positive Black Men Who Have Sex with Men: Qualitative Study.

BACKGROUND: People living with HIV are living longer in the United States as a result of antiretroviral therapy. Black men who have sex with men (MSM) are disproportionally affected by HIV and have low rates of engagement in HIV care and treatment. Mobile technology holds promise as an intervention platform; however, little is known regarding its use among older black MSM living with HIV. OBJECTIVE: The goal of this study was to explore mobile technology use and narratives of aging with HIV among older black MSM to inform mobile health intervention development. METHODS: A total of 12 black MSM living with HIV, aged 50 years or older, completed in-person, semistructured interviews exploring the issues of aging, HIV care engagement, and mobile technology use. The interviews were audiotaped, transcribed, and analyzed using qualitative research methods. RESULTS: Men appreciated having survived the AIDS epidemic, but some expressed discomfort and ambivalence toward aging. Men described various levels of engagement in HIV care and treatment; challenges included social isolation and need for support that was not focused on HIV. Almost all described using mobile technology to engage in health care, whereas some referenced important barriers and challenges to technology use. CONCLUSIONS: Findings highlighted a high level of interest toward a mobile technology-based intervention targeting older black men but also identified barriers and challenges to using mobile technology for health care engagement. Mobile technology is well incorporated into older black MSM's lives and shows potential as an intervention platform for addressing aging issues to enhance engagement in HIV care and treatment.

The Use of Mobile Health Applications Among Youth and Young Adults Living with HIV: Focus Group Findings.

The objective of this study was to conduct focus groups with youth (18-29 years old) living with HIV (YLWH) to better understand preferences for mobile applications in general and to inform the design of a mobile health application aimed at improving retention and engagement in healthcare and adherence to antiretroviral therapy. We conducted four focus groups with YLWH to elicit the names and characteristics of applications that they commonly used, reasons they deleted applications, and the features of an ideal mobile health application. A diverse sample of youth (N = 17) with a mean age of 25 years, 88.2% male, and 29.4% African American participated in four focus groups. Positive attributes of applications included informative, simple, allowing for networking, timely updates, little overlap with other applications, unlimited access to entertainment, and with ongoing advancement. Participants identified several reasons for deleting applications, including engaging in excessive behaviors (e.g., spending money), for hook ups only, too many notifications or restrictions, occupied too much space on device, or required wireless connectivity or frequent updates. Participants suggested that a mobile health application that they would find useful should have the ability to connect to a community of other YLWH, readily access healthcare providers, track personal data and information (such as laboratory data), and obtain health news and education. Privacy was a key factor in a mobile health application for all participants. Researchers can use the information provided by focus group participants in creating mobile health applications for YLWH.

Double migration of a schwannoma of thoracic spine.

Mobile intraspinal tumours have rarely been reported. In most cases, mobile tumours such as schwannomas or ependymomas were located in the cauda equina. Perusal of the literature revealed only two reports of mobile schwannomas in the cervical and thoracic regions. We report a case of thoracic schwannoma which migrated twice in successive operations resulting in negative exploration in the expected area. The aim of this report is to remind the surgeons about the possibility of migration of intradural-extramedullary tumour.

Doctors and the nurse endoscopist issue in New Zealand.

AIM: Training and recruitment of Nurse Endoscopists (NEs) is currently actively debated in medical circles. The aim of this survey was to obtain the views of doctors regarding the role of NEs in New Zealand (NZ). METHODS: A web-based, self-administered questionnaire was sent to 84 endoscopists currently working in 25 public hospitals across all the 20 District Health Boards. The survey period was July 2011. Data was analysed using descriptive statistics. RESULTS: The response rate was 47.5%. Fifty percent of the respondents worked in tertiary hospitals. Only 30% had a positive attitude towards the introduction of NEs in NZ. The majority (62%) believed that doctors would deliver better quality of endoscopy services than NEs. Only 37% thought that the introduction of NEs will reduce the cost of services. Forty-one percent thought it was inappropriate for the NEs to be enrolled in the Bowel Cancer Screening Programme and only 6 doctors (18%) thought that NEs should be allowed to perform therapeutic endoscopic procedures. CONCLUSION: Only a minority of doctors had a positive attitude towards the role of NEs. The majority considered doctors to deliver 'higher' quality of service and only a minority thought that the introduction of NEs will lower the cost of services.