The Current State of Neurosurgery in Iceland.

BACKGROUND: Although surgical conditions account for 32% of the global burden of diseases, approximately 5 billion people worldwide lack access to timely and affordable, surgical and anesthetic services. Disparities in access to surgical care are most evident in low- and middle-income countries, often resulting from a lack of surgical infrastructure. However, the establishment of surgical infrastructure, particularly for specialty surgical services including neurosurgery, is challenging in countries with small populations, irrespective of income classification, due to the distribution of high costs among a lesser number of individuals. One such nation is Iceland. Despite high-income status, high quality of life, literacy, and educational attainment, the population of Iceland has often lacked access to local neurosurgical care, with the establishment of the domestic neurosurgical system in 1971 and continued externalization of complex neurosurgical procedures to neighboring nations and neurosurgeons. METHODS: A narrative review was conducted. RESULTS: This article provides the first-ever examination of neurosurgery in Iceland. We discussed the history and the social, political, and economical contexts in Iceland. We examined the history of neurosurgery in Iceland, which provided brief biographic sketches of pioneers who have catalyzed the establishment of neurosurgical care and training in Iceland, and characterize the current state of neurosurgery in Iceland. CONCLUSIONS: Recommendations derived from the experiences of Icelandic neurosurgeons may guide the international community in future initiatives.

[The incidence of sinus thrombosis in Iceland 2008-202].

BACKGROUND: Cerebral venous sinus thrombosis (CSVT) is the cause of 0.5%-1% of all strokes. CSVT can cause haemorrhage, cerebral infarction and increased intracranial pressure. Due to a variety of symptoms, CSVT can be difficult to diagnose. The purpose of this study was to examine the incidence of CSVT in Iceland 2008-2020, risk factors, symptoms, treatment and outcome. METHODS: A retrospective reviewing of medical records of those diagnosed with CSVT from 1. January 2008 to 31. December 2020, was performed. Sex, age at diagnosis, symptoms, known risk factors, imaging results, treatment and outcome were studied. Statistical processing was performed with Excel and Rstudio. RESULTS: Overall, 31 patients were diagnosed with CSVT (22 women). The mean incidence was 0.72/100.00 per year. The mean age was 34.3 years (14-63 years). The most common symptom was headache (87%), other symptoms included focal symptoms and seizures. The most common risk factor was the use of oral contraceptives (73%). Four patients had no risk factor. The most commonly affected sinus was the transverse-sinus (74%). All patients were treated with anticoagulants. Most received heparin or low-molecular-weight heparin then succeeded by warfarin or NOACs. Three months after diagnosis, 87% of the patients scored 0-2 on the modified Rankin Scale. One patient died as a result of CSVT. DISCUSSION: The incidence of CSVT in Iceland is in accordance with other studies. Headache was the most common symptom and oral contraceptives the most common risk factor among women. Most patients made a good recovery, which suggests a timely diagnosis and appropriate treatment for CSVT in Iceland.

Rare SLC13A1 variants associate with intervertebral disc disorder highlighting role of sulfate in disc pathology.

Back pain is a common and debilitating disorder with largely unknown underlying biology. Here we report a genome-wide association study of back pain using diagnoses assigned in clinical practice; dorsalgia (119,100 cases, 909,847 controls) and intervertebral disc disorder (IDD) (58,854 cases, 922,958 controls). We identify 41 variants at 33 loci. The most significant association (ORIDD = 0.92, P = 1.6 × 10-39; ORdorsalgia = 0.92, P = 7.2 × 10-15) is with a 3'UTR variant (rs1871452-T) in CHST3, encoding a sulfotransferase enzyme expressed in intervertebral discs. The largest effects on IDD are conferred by rare (MAF = 0.07 - 0.32%) loss-of-function (LoF) variants in SLC13A1, encoding a sodium-sulfate co-transporter (LoF burden OR = 1.44, P = 3.1 × 10-11); variants that also associate with reduced serum sulfate. Genes implicated by this study are involved in cartilage and bone biology, as well as neurological and inflammatory processes.

Intraventricular Vancomycin Treatment for Shunt-related Ventriculitis Caused by Methicillin-resistant Staphylococcus Aureus in a Preterm Infant: A Case Report.

Posthemorragic hydrocephalus is a relatively common condition in prematures, often requiring ventriculoperitoneal shunts. We report a case of methicillin-resistant Staphylococcus aureus infection of a ventriculoperitoneal shunt in a premature neonate which failed conventional intravenous treatment. Despite the absence of published guidelines, we used available data and expert advice to treat the patient with intraventricular vancomycin. The treatment was successful in eradicating the infection without observed toxicity. This case highlights the need for international guidelines on intraventricular treatment for neonates.

Preparation and Culturing of Human Primary Vascular Cells.

Cerebral amyloid angiopathy (CAA) results from amyloid accumulation within arteries of the cerebral cortex and leptomeninges. This condition is age-related, especially prevalent in Alzheimer's disease (AD), and the main feature of certain hereditary disorders (i.e., HCHWA-I). The vascular smooth muscle cells (VSMCs) appear to play a vital role in the development of CAA, which makes them well suited as an experimental model to study the disease and screen for possible remedies. We describe two different methods for isolating and culturing human VSMCs: First, using the human umbilical cord as an easy source of robust cells, and secondly, using brain tissue that provides the proper cerebral VSMCs, but is more problematic to work with. The umbilical cord also provides human umbilical vascular endothelial cells (HUVEC), useful primary cells for vascular research. Finally, the maintenance, preservation, and characterization of the isolated vascular cells are described.

Sequence variant at 8q24.21 associates with sciatica caused by lumbar disc herniation.

Lumbar disc herniation (LDH) is common and often debilitating. Microdiscectomy of herniated lumbar discs (LDHsurg) is performed on the most severe cases to resolve the resulting sciatica. Here we perform a genome-wide association study on 4,748 LDHsurg cases and 282,590 population controls and discover 37 highly correlated markers associating with LDHsurg at 8q24.21 (between CCDC26 and GSDMC), represented by rs6651255[C] (OR=0.81; P=5.6 × 10-12) with a stronger effect among younger patients than older. As rs6651255[C] also associates with height, we performed a Mendelian randomization analysis using height polygenic risk scores as instruments to estimate the effect of height on LDHsurg risk, and found that the marker's association with LDHsurg is much greater than predicted by its effect on height. In light of presented findings, we speculate that the effect of rs6651255 on LDHsurg is driven by susceptibility to developing severe and persistent sciatica upon LDH.

[Cerebral arteriovenous malformations - overview].

UNLABELLED: Cerebral arteriovenous malformations (AVMs) are uncommon but can cause intracerebral hemorrhage with grave disability or death. AVMs can even cause focal neurological symptoms, seizures and headache. The treatment of AVMs is complex. The most common treatment forms are microsurgery, stereotactic radiotherapy and endovascular embolization. The best treatment in each case can include a combination of the mentioned treatment forms. New studies indicate that no intervention is the best option in unruptured AVMs. In this article we discuss the epidemiology, diagnosis and treatment of cerebral AVMs. KEY WORDS: cerebral arteriovenous malformations, intracerebral hemorrhage, seizures, headache, surgery, radiation, endovascular embolization. Correspondence: Olafur Sveinsson, olafur.sveinsson@karolinska.se.

[Spontaneus intracerebral haemhorrhage--review]. / Sjálfsprottin heilavefsblæding--yfirlitsgrein.

Spontaneous intracerebral hemorrhage occurs when a blood vessel within the brain parenchyma ruptures without a near related trauma. It is the second most common form of stroke, accounting for approximately 10% to 15% of new strokes. The 30 day mortality is very high (25-50%). Hypertension is the most common cause. Unfortunately, surgery has not proven to be helpful except in certain exceptions such as in large cerebellar hemorrhage. Nonetheless, it is very important that patients with ICH are admitted to an intensive care or a stroke unit with close surveillance of consciousness, focal neurologic symptoms, blood pressure and fluid balance.

[Brain abscess - overview]. / Heilaigerd - yfirlitsgrein.

Brain abscess is a life threatening illness, demanding rapid diagnosis and treatment. Its development requires seeding of an organism into the brain parenchyma, often in an area of damaged brain tissue or in a region with poor microcirculation. The lesion evolves from a cerebritis stage to capsule formation. Brain abscesses can be caused by contiguous or haematogenous spread of an infection, or by head trauma/ neurosurgical procedure. The most common presentation is that of headache and vomiting due to raised intracranial pressure. Seizures have been reported in up to 50% of cases. Focal neurological deficits may be present, depending on the location of the lesion. Treatment of a brain abscess involves aspiration or excision, along with parenteral antibiotic therapy. The outcome has improved dramatically in the last decades due to improvement in diagnostic techniques, neurosurgery, and broad-spectrum antibiotics. The authors provide an overview of the pathogenesis, diagnosis and management of brain abscesses.

Preparation of cultured human vascular cells.

Cerebral amyloid angiopathy (CAA) results from amyloid accumulation within arteries of the cerebral cortex and leptomeninges. This condition is age-related, especially prevalent in Alzheimer's disease (AD), and the main feature of certain hereditary disorders (i.e., HCHWA-I). The vascular smooth muscle cells (VSMCs) appear to play a vital role in the development of CAA, which makes them well suited as an experimental model to study the disease and screen for possible remedies. We describe two different methods for isolating and culturing human VSMCs. First, using the human umbilical cord as an easy source of robust cells, and secondly, using brain tissue that provides the proper cerebral VSMCs, but is more problematic to work with. The umbilical cord also provides human umbilical vascular endothelial cells (HUVECs), useful primary cells for vascular research. Finally, the maintenance, preservation, and characterization of the isolated vascular cells are described.

[Spontaneous subarachnoid haemorrhage--review]. / Sjálfsprottin innanskúmsblæding--yfirlitsgrein.

Spontaneous subarachnoid hemorrhage is a bleeding in to the subarachnoid space without trauma. Aneurysms are the underlying cause in 80% of the cases. Among other causes are: arteriovenous malformations, anticoagulation, vasculitis or brain tumor. Spontaneous subarachnoid hemorrhage is a serious disease, where up to half of the patients die. Of those who survive, only half return to work and many have a reduced quality of life. To prevent rebleeding the aneurysm is closed either with endovascular coiling or neurosurgical clipping.

Isolation and culturing of human vascular smooth muscle cells.

Cerebral amyloid angiopathy (CAA) results from amyloid accumulation within arteries of the cerebral cortex and leptomeninges. This condition is age-related, especially prevalent in Alz-heimer's disease (AD), and the main feature of certain hereditary disorders (i.e., HCHWA-I). The vascular smooth muscle cells (VSMCs) appear to play a vital role in the development of CAA, which makes them well-suited as an experimental model to study the disease and screen for possible remedies. We describe two different methods for isolating and culturing human VSMCs. First, using the human umbilical cord as an easy source of robust cells, and secondly, using brain tissue that provides the proper cerebral VSMCs, but is more problematic to work with. Finally the maintenance, preservation, and characterization of the isolated VSMCs are described.