ABSTRACT
Background: Access to high-quality neurosurgery online learning is limited in low- and middle-income countries, and Iraq is part of this category. The need for collaboration and connection of people worldwide to exchange ideas and experiences in neurosurgery is a challenge. Surgical Neurology International® (SNI)/SNI Digital stimulated the establishment of the joint effort to bring the discussion about the best experiences in neurosurgery from the United States and Iraq together in an internet meeting format. Methods: An online survey was formulated and distributed to the attendees of the SNI-Baghdad neurosurgery meetings. The survey investigates the last 14 consecutive meetings for the period May/2021-April/2022. The online survey was designed utilizing Google Forms. The survey outline includes demographics, general aspects of the meetings, research aspects, surgical anatomy, neuroradiology, and capacity-building aspects. All these sections of the survey used a 5-point Likert scale. Results: The total number of participants was 84 out of 115 sent, with a response rate of 73.1%. The participants were diverse as they ranged from medical students to attending neurosurgeons. The male-to-female ratio was 1:1. Most attendees were from Baghdad (n = 66 [77.6%]) and the highest number of the responders was from the University of Baghdad (n = 46 [54.1%]). Conclusion: The targeted online collaborative meetings, SNI-Baghdad neurosurgery meeting as an example, give an insight into the effectiveness of such methods in providing a mutually beneficial educational experience between people of different parts of the world, as assessed by a survey initiated and performed by the attendees.
ABSTRACT
Background: Education by lectures has been standard for 100 years or more. Given the 21st century technology, people can connect with others around the world instantly, electronically. With the pandemic, teaching changed to one-way information transfer with the loss of interpersonal learning experience. SNI® and now SNI Digital™ have been experimenting with different forms of communication to transfer information. Methods: Using an interactive education model, a meeting for neurosurgeons in Baghdad was held for students, residents, and neurosurgeons, the first in Iraq for a number of years because of the disruption from the war there. A national and international faculty participated. Results: This 15th meeting of the series was described by 42 out of 60 participants as "The best conference I have ever attended." That significant response highlights the importance of such meetings and how they can be at the highest level possible and be a recipe for success. Conclusion: The 15th meeting provides a focused analysis of the underlying characteristics leading to its success so that it can be duplicated.
ABSTRACT
BACKGROUND: In regard to scientific information, are we effectively reaching the universe of physicians in the 21st century, all of whom have different backgrounds, practice environments, educational experiences, and varying degrees of research knowledge? METHODS: A comparison of the top nine neurosurgery journals based on various popular citation indices and also on the digital metric, Readers (Users)/month, was compiled from available metrics and from internet sources. RESULTS: Major differences in the ranking of the Readers (Users)/month metrics compared to ranking of the various citation indices were found. It is obvious that the citation indices do not measure the number of readers of a publication. Which metric should be used in judging the value of a scientific paper? The answer to that question relates to what the interest of the reader has in the scientific information. It appears that the academic scientist may have a different reason for reading a scientific publication than a physician caring for a patient. CONCLUSIONS: There needs to be more than one type of metric that measures the value and "Impact" of a scientific paper based on how physicians learn.
ABSTRACT
The Second Amendment of the USA Constitution states: "A well-regulated Militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed." Today around the USA and the world some people are advocating the removal of guns from the citizens, called "Gun Control," as the solution to violent crime that they associate with guns in the hands of the public, contrary to what the Second Amendment states. This review provides a factual background to the debate about the issues surrounding the arguments for and against "Gun Control." The paper documents many factors that lead to violent crimes committed by people. The means used to cause violent crimes cover the history of human civilization. They include weapons of all types, bombs, toxic substances, vehicles of many kinds, and planes, all to cause the death of others. Some who commit or threaten violent crime against others are emotionally disturbed and in many cases are known to the police through screening systems. Family dysfunction, alcohol and drug abuse, an incessant stream of media and entertainment featuring gun violence, and an educational system that does not equip the young with the proper civic and ethical principles to deal with life's challenges all contribute to violent behavior using guns and other lethal means. With this background of multiple factors leading to the commission of violent crimes against others, the focus has been concentrated on banning firearms from public ownership rather than understanding the reasons for this criminal behavior. Why? There is the overwhelming evidence that disarming the public from using firearms will not reduce violent crimes and will render people defenseless. Other facts indicate that allowing citizens to carry arms will prevent or reduce violent crimes. The debate over Gun Control has become politicized and emotionally based, because the real goal is not stated. In respected scientific journals and in the Media, factual information about the causes and prevention of violent deaths has been misrepresented or is blatantly false. Using censorship, the medical press and the mass media have refused to publish articles or print opposing opinions such as those supporting the rights of citizens to bear arms. There is evidence that tax-exempt foundations and wealthy individuals are financially supporting Gun Control efforts with the goal of disarming the public to establish a centrally controlled government and to eliminate the US Constitution. It is obvious that in the rapidly changing world we need to find answers to the many factors behind Violent Crime in which guns are used. That will take time and patience. In the meantime, is there a gray area for compromise in the Guns and Violence issue? Yes, logically, from all the evidence presented in this review, citizens should be encouraged to carry arms for self, family, and fellow citizen protection, and as a check on government, a right guaranteed by the constitution and endowed by our God-given natural right. The challenges facing us are multifaceted. Is Gun Control really about People Control?
ABSTRACT
BACKGROUND: Vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) is a complex disease entity in which the dual goals of preventing future rebleeding and maintaining perfusion of the lateral medulla must be considered. We present an illustrative case and review the literature surrounding treatment strategies. CASE DESCRIPTION: We report a patient presenting with extensive subarachnoid hemorrhage due to rupture of an intracranial VADA involving the PICA origin. After consideration of the patient's cerebral vasculature and robustness of collaterals, a flow-diverting stent was placed with angiographic resolution of the lesion and maintenance of antegrade PICA flow. Ultimately, the patient experienced a contralateral intraparenchymal hemorrhage leading to death. Review of the literature identified 124 cases of VADA involving the PICA origin described over the past decade. The methods of surgical and endovascular treatment of these cases were reviewed, with particular focus on the rationale of treatment, outcomes, and complications. CONCLUSION: Numerous treatment options for VADA involving PICA have been reported with different risk and benefit profiles. Flow-diverting stents appear to offer the most favorable balance of securing the aneurysm and avoiding medullary infarction, but the risks and optimal anti-thrombotic treatment strategy are incompletely understood. In select cases, in which the surgical risk is low or in which the anatomy is favorable (e.g., nondominant parent vessel or robust collateral circulation in the involved territories), parent artery trapping with or without microsurgical revascularization can be considered.
ABSTRACT
We have reviewed the English literature published in the last 70 years on Diseases of the Vertebral Basilar Circulation, or Posterior Circulation Disease (PCD). We have found that errors have been made in the conduct and interpretation of these studies that have led to incorrect approaches to the management of PCD. Because of the difficulty in evaluating the PC, the management of PCD has been incorrectly applied from anterior circulation disease (ACD) experience to PCD. PCD is a common form of stroke affecting 20-40% patients with stroke. Yet, the evidence is strong that the Anterior Circulation (AC) and Posterior Circulations (PC) differ in their pathology, in their clinical presentations, in the rapidity of development of symptoms, in optimal imaging methods, and in available treatments. There appears to be two categories of patients who present with PCD. The first, acute basilar artery occlusion has a more rapid onset. The diagnosis must be made quickly and if imaging proves a diagnosis of Basilar Artery Occlusion (BAO), the treatment of choice is Interventional removal of the basilar artery thrombosis or embolus. The second category of PCD and the most commonly seen PCD disease process presents with non-specific symptoms and early warnings of PCD that now can be related to ischemic events in the entire PC vessels. These warning symptoms and signs occur much earlier than those in the AC. IA angiography is still the gold standard of diagnosis and is superior in definition to MR and CT angiography which are commonly used as a convenient screening imaging tool to evaluate PCD but are both inferior to IA angiography in definition for lesions below 3-4 mm. In at least two reported studies 7T MR angiography appears superior to other imaging modalities and will become the gold standard of imaging of PCD in the future. Medical treatments applied to the ACD have not been proven of value in specific forms of PCD. Interventional therapy was promising but of unproven value in Randomized Controlled Trials (RCT) except for the treatment of Basilar Artery Occlusion (BAO). Surgical revascularization has been proved to be highly successful in patients, who are refractory to medical therapy. These studies have been ignored by the scientific community basically because of an incorrect interpretation of the flawed EC-IC Bypass Trial in 1985 as applying to all stroke patients. Moreover, the EC-IC Bypass Study did not include PCD patients in their study population, but the study results were extrapolated to patients with PCD without any scientific basis. This experience led clinicians to an incorrect bias that surgical treatments are of no value in PCD. Thus, incorrectly, surgical treatments of PCD have not been considered among the therapeutic possibilities for PCD. QMRA is a new quantitative MR technique that measures specific blood flow in extra and intracranial vessels. QMRA has been used to select those patients who may benefit from medical, or interventional, or surgical treatment for PCD based on flow determinations with a high success rate. QMRA accurately predicts the flows in many large and small vessels in the PC and AC and clearly indicates that both circulations are intimately related. From medical and surgical studies, the longer one waits for surgical treatment the higher the risk of a poor outcome results. This observation becomes obvious when the rapidity of development of PCD is compared with ACD. Recent advances in endovascular therapy in the treatment of acute basilar thrombosis is a clear sign that early diagnosis and treatment of PCD will reduce the morbidity and mortality of these diseases. In this review it is evident that there are multiple medical and surgical treatments for PCD depending upon the location of the lesion(s) and the collateral circulation demonstrated. It is clear that the AC and PC have significant differences. With the exception of the large population studies from Oxford England, the reported studies on the management of PCD in the literature represent small selected subsets of the universe of PC diseases, the information from which is not generalizable to the universe of PCD patients. At this point in the history of PCD, there are not large enough databases of similar patients to provide a basis for valid randomized studies, with the exception of the surgical studies. Thus, a high index of suspicion of the early warning symptoms of PCD should lead to a rapid individual clinical assessment of patients selecting those with PCD. Medical, interventional, and/or surgical treatments should be chosen based on knowledge presented in this review. Recording the results in a national Registry on a continuing basis will provide the data that may help advance the management of PCD based on larger data bases of well documented patient information to guide the selection of future therapies for PCD treatments. It is also clear that the management of patients within the complex of diseases that comprise PCD should be performed in centers with expertise in the imaging, medical, interventional and surgical approaches to diseases of the PCD.
