An Online Model for Neurosurgical Research in Developing Countries: A One-Year Experience in Mexico and Latin America.

BACKGROUND: Mexico is under-represented in global neurosurgical research. High-income countries represent roughly 10% of the world's population but utilize about 90% of the research funding for medical research, highlighting the need for promoting research initiatives in low- and middle-income countries. We present an online-based research initiative in Mexico that aims to reduce the research gap in neurosurgery. METHODS: Implemented in early 2023, our online-based research initiative included weekly modules covering study types, statistical analysis, meta-analysis, and scientific writing. The first cohort of 22 students completed the 12-week program and then served as tutors for subsequent cohorts. The research model was promoted via word of mouth and social media platforms to medical students, graduates, and specialists across Latin America. Post-program, tutors and the author conducted weekly planning sessions to assist with project planning, analysis, and article writing. RESULTS: From 833 registrations, over 800 students completed at least 1 training module. The program published 7 articles and presented 12 abstracts at major international neurosurgical meetings. We performed a bibliographic analysis in PubMed and found that from 2021 to 2022, 33,637 neurosurgical articles were published, with 197 involving collaboration from Mexico (0.5%). From 2023 to 2024, 24,121 articles were published, with 205 involving collaboration from Mexico (0.8%), a significant increase (P < 0.001). Our collaboration contributed to 3.4% of these, representing a significant addition in 2023-2024 (P = 0.026). CONCLUSIONS: This online-based neurosurgical model contributed to 3.4% of the neurosurgical research productivity in Mexico. Our findings suggest that this model can effectively bridge the research gap and enhance scientific contributions in developing countries.

Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

SUMMARY: Intracranial aneurysm is a common cerebrovascular disease with high mortality. Neurosurgical clipping for the treatment of intracranial aneurysms can easily lead to serious postoperative complications. Studies have shown that intraoperative monitoring of the degree of cerebral ischemia is extremely important to ensure the safety of operation and improve the prognosis of patients. Aim of this study was to probe the application value of combined monitoring of intraoperative neurophysiological monitoring (IONM)-intracranial pressure (ICP)-cerebral perfusion pressure (CPP) in craniotomy clipping of intracranial aneurysms. From January 2020 to December 2022, 126 patients in our hospital with intracranial aneurysms who underwent neurosurgical clipping were randomly divided into two groups. One group received IONM monitoring during neurosurgical clipping (control group, n=63), and the other group received IONM-ICP-CPP monitoring during neurosurgical clipping (monitoring group, n=63). The aneurysm clipping and new neurological deficits at 1 day after operation were compared between the two groups. Glasgow coma scale (GCS) score and national institutes of health stroke scale (NIHSS) score were compared before operation, at 1 day and 3 months after operation. Glasgow outcome scale (GOS) and modified Rankin scale (mRS) were compared at 3 months after operation. All aneurysms were clipped completely. Rate of new neurological deficit at 1 day after operation in monitoring group was 3.17 % (2/63), which was markedly lower than that in control group of 11.11 % (7/30) (P0.05). Combined monitoring of IONM-ICP-CPP can monitor the cerebral blood flow of patients in real time during neurosurgical clipping, according to the monitoring results, timely intervention measures can improve the consciousness state of patients in early postoperative period and reduce the occurrence of early postoperative neurological deficits.

El aneurisma intracraneal es una enfermedad cerebrovascular común con alta mortalidad. El clipaje neuroquirúrgico para el tratamiento de aneurismas intracraneales puede provocar complicaciones posoperatorias graves. Los estudios han demostrado que la monitorización intraoperatoria del grado de isquemia cerebral es extremadamente importante para garantizar la seguridad de la operación y mejorar el pronóstico de los pacientes. El objetivo de este estudio fue probar el valor de la aplicación de la monitorización combinada de la monitorización neurofisiológica intraoperatoria (IONM), la presión intracraneal (PIC) y la presión de perfusión cerebral (CPP) en el clipaje de craneotomía de aneurismas intracraneales. Desde enero de 2020 hasta diciembre de 2022, 126 pacientes de nuestro hospital con aneurismas intracraneales que se sometieron a clipaje neuroquirúrgico se dividieron aleatoriamente en dos grupos. Un grupo recibió monitorización IONM durante el clipaje neuroquirúrgico (grupo de control, n=63) y el otro grupo recibió monitorización IONM-ICP-CPP durante el clipaje neuroquirúrgico (grupo de monitorización, n=63). Se compararon entre los dos grupos el recorte del aneurisma y los nuevos déficits neurológicos un día después de la operación. La puntuación de la escala de coma de Glasgow (GCS) y la puntuación de la escala de accidentes cerebrovasculares de los institutos nacionales de salud (NIHSS) se compararon antes de la operación, 1 día y 3 meses después de la operación. La escala de resultados de Glasgow (GOS) y la escala de Rankin modificada (mRS) se compararon 3 meses después de la operación. Todos los aneurismas fueron cortados por completo. La tasa de nuevo déficit neurológico 1 día después de la operación en el grupo de seguimiento fue del 3,17 % (2/63), que fue notablemente inferior a la del grupo de control del 11,11 % (7/30) (P 0,05). La monitorización combinada de IONM-ICP-CPP puede controlar el flujo sanguíneo cerebral de los pacientes en tiempo real durante el corte neuroquirúrgico; de acuerdo con los resultados de la monitorización, las medidas de intervención oportunas pueden mejorar el estado de conciencia de los pacientes en el período postoperatorio temprano y reducir la aparición de problemas postoperatorios tempranos y déficits neurológicos.

Morphometric analysis of the foramen magnum in the Peruvian population.

Background: The foramen magnum, as an anatomical structure, holds clinical and functional significance due to its strategic location in the craniovertebral transition. A detailed understanding of its dimensions and shapes is crucial for better comprehension of related pathologies and for enhancing neurosurgical techniques within a specific population. The objective is to measure precise morphometric reference points of the foramen magnum in individuals of Peruvian ancestry, aiming to establish specific anatomical patterns and potential variations within this population. Methods: The study was conducted on 17 unidentified skulls donated to the NeuroZone3D Research Center, utilizing an inelastic and soft measuring tape as the tool. Our report considered direct anthropometric measurement techniques with data collection performed by a single researcher. Results: Distinct morphometric characteristics were observed in the foramen magnum of the Peruvian population compared to other studies. The average measurements of the skull base revealed a foramen magnum with a mean length of 33.80 mm and a width of 28.70 mm, along with right condyles measuring 25 mm in length and 14.10 mm in width, and left condyles measuring 23.80 mm in length and 13.90 mm in width. Conclusion: The morphometric analysis of the foramen magnum in the Peruvian population provides valuable insights into specific anatomical features within this ethnic group. These findings could have significant implications across various medical and surgical disciplines, from interpreting diagnostic images to designing more precise therapeutic interventions tailored to this population.

Pituitary Metastasis of Clear Cell Renal Carcinoma Mimicking Pituitary Macroadenoma ­ Case Report / Metástase de carcinoma renal de células claras em sela túrcica simulando macroadenoma hipofisário ­ Relato de caso

Introduction Pituitary tumors account for 25% of all primary brain tumors and for 15% of overall intracranial expansive masses. Pituitary metastases, in contrast, are a rare condition, estimated as 1.8% of all resected sellar lesions. We present here a rare case of clear cell renal carcinoma metastasis to the pituitary gland. Case Report A 65-year-old patient with holocranial headache and diplopia, whose physical examination showed right eye abduction palsy and ipsilateral anisocoria. Magnetic resonance imaging (MRI) of the pituitary revealed a heterogeneous mass in T1 weighted imaging with mild peripheral contrast enhancement and considerable growth during follow-up. Prolactin levels were high and dropped to normal after use of cabergoline, but remained normal even after the medication was halted. Biopsy was compatible with clear cell renal carcinoma. After surgery, the patient underwent radiotherapy, which was effective in reducing the volume of the lesion. Discussion Only 25 cases of pituitary metastasis arising from the kidney were reported in the literature between the years of 1957 and 2018. Metastases can reach the pituitary through hematogenous spread, cerebrospinal fluid, and contiguous bony lesions. Clinical presentation varies from vague complaints such as fatigue or headache to more specific signs like polyuria and polydipsia, and 60% of cases have clinical manifestations. Conclusion Case reports of pituitary metastases are low worldwide, with only 25 case reports of kidney metastases in over a 60-year period. The rarity of the lesions and hormonal alterations due to pituitary stalk compression can mislead diagnosis, and some patients may even never be diagnosed regarding their lower life span. In this report, radiotherapy was effective postresection, and accounts for a treatment option. All these issues account for the relevance of these case reports.

Introdução Os tumores hipofisários representam 25% de todos os tumores cerebrais primários e 15% das massas expansivas intracranianas totais. As metástases hipofisárias, por outro lado, são uma condição rara, estimada em 1,8% de todas as lesões selares ressecadas. Apresentamos aqui um caso raro de metástase de carcinoma renal de células claras para a glândula pituitária. Relato de caso Paciente de 65 anos com cefaleia holocraniana e diplopia, cujo exame físico mostrou paralisia de abdução do olho direito e anisocoria ipsilateral. A ressonância magnética (RM) da hipófise revelou uma massa heterogênea na imagem ponderada em T1 com leve realce periférico de contraste e crescimento considerável durante o acompanhamento. Os níveis de prolactina estavam altos e caíram para o normal após o uso de cabergolina, mas permaneceram normais mesmo após a interrupção da medicação. A biópsia foi compatível com carcinoma renal de células claras. Após a cirurgia, o paciente foi submetido à radioterapia, que foi eficaz na redução do volume da lesão. Discussão Apenas 25 casos de metástase hipofisária originada do rim foram relatados na literatura entre os anos de 1957 e 2018. As metástases podem atingir a hipófise por meio de disseminação hematogênica, líquido cefalorraquidiano e lesões ósseas contíguas. A apresentação clínica varia de queixas vagas, como fadiga ou dor de cabeça, a sinais mais específicos, como poliúria e polidipsia, e 60% dos casos têm manifestações clínicas. Conclusão Os relatos de casos de metástases hipofisárias são baixos em todo o mundo, com apenas 25 relatos de casos de metástases renais em um período de mais de 60 anos. A raridade das lesões e alterações hormonais devido à compressão do pedúnculo hipofisário podem enganar o diagnóstico, e alguns pacientes podem nunca ser diagnosticados em relação à sua menor expectativa de vida. Neste relato, a radioterapia foi eficaz após a ressecção e representa uma opção de tratamento. Todas essas questões são responsáveis pela relevância desses relatos de caso.

Neurosurgical simulation models developed in Latin America and the Caribbean: a scoping review.

Simulation training is an educational tool that provides technical and cognitive proficiency in a risk-free environment. Several models have recently been presented in Latin America and the Caribbean (LAC). However, many of them were presented in non-indexed literature and not included in international reviews. This scoping review aims to describe the simulation models developed in LAC for neurosurgery training. Specifically, it focuses on assessing the models developed in LAC, the simulated neurosurgical procedures, the model's manufacturing costs, and the translational outcomes. Simulation models developed in LAC were considered, with no language or time restriction. Cadaveric, ex vivo, animal, synthetic, and virtual/augmented reality models were included for cranial and spinal procedures. We conducted a review according to the PRISMA-ScR, including international and regional reports from indexed and non-indexed literature. Two independent reviewers screened articles. Conflicts were resolved by a third reviewer using Covidence software. We collected data regarding the country of origin, recreated procedure, type of model, model validity, and manufacturing costs. Upon screening 917 studies, 69 models were developed in LAC. Most of them were developed in Brazil (49.28%). The most common procedures were related to general neurosurgery (20.29%), spine (17.39%), and ventricular neuroendoscopy and cerebrovascular (15.94% both). Synthetic models were the most frequent ones (38.98%). The manufacturing cost ranged from 4.00 to 2005.00 US Dollars. To our knowledge, this is the first scoping review about simulation models in LAC, setting the basis for future research studies. It depicts an increasing number of simulation models in the region, allowing a wide range of neurosurgical training in a resource-limited setting.

Worldwide Research Trends on Transvenous Embolization of Brain Arteriovenous Malformations: A Bibliometric and Visualized Study.

BACKGROUND: Transvenous embolization (TVE) of brain arteriovenous malformations (bAVMs) is an emerging endovascular technique that has shown high cure rates in selected cases. The rationale of our study was to determine authorship and worldwide institutional trends and contributions to the knowledge in this topic. METHODS: Web of Science database was used. A total of 63 articles were included based on predefined inclusion criteria, which were manually reviewed. The bibliometric analysis involved the use of quantitative bibliometric indicators and network analysis with co-authorship and co-occurrence of terms, which were performed using the bibliometrix package in R and VOSviewer, respectively. RESULTS: The first article was published in 2010, with the largest number of articles published in 2022 (10 articles). The average number of citations per document was 11.38, and the annual growth rate was 14.35%. The top 10 authors with the most scientific production on TVE of bAVMs were from France, and the most cited study was published by Iosif C in 2015, followed by Consoli A in 2013, and Chen CJ in 2018. Journal of Neurointerventional Surgery was the journal with the most articles published. The most commonly used keywords were dural arteriovenous fistula, Onyx, vascular disorders, and neurological surgery around 2016, and intervention around 2021. CONCLUSIONS: TVE of bAVMs is an emerging technique. Our search identified some scientific articles, without randomized clinical trials, but many case series from single institutions. French and German institutions are the pioneers in the field, and further research is required in specialized endovascular centers.

Lipotransferencias en defectos estéticos post neuroquirúrgicos / Lipotransferences in post neurosurgical aesthetic defects

Introducción y objetivo: Existen numerosos procedimientos en los cuales más allá de la adecuada manipulación del músculo temporal y del cierre craneal, los pacientes pueden presentar defecto óseo, muscular por atrofia y asimetría facial consecuente, provocando un malestar psicológico y deterioro funcional. Nuestro equipo decidió aunar los conocimientos de cirugía plástica y aplicarlos a reconstrucciones craneales con lipotranferencias en pacientes post neuroquirúrgicos. El objetivo del siguiente trabajo consiste en presentar los resultados en una serie de pacientes donde se aplicó la mencionada técnica. Materiales y métodos: Durante 2022 se realizaron 45 procedimientos de lipotransferencias para corrección de defectos craneofaciales, de los cuales 29 fueron femeninos y 16 masculinos. Todos presentaban el antecedente quirúrgico de craneotomías pterionales y sus variantes, abordajes orbitocigomáticos y transcigomáticos, con el consiguiente déficit de volumen. Resultados: El procedimiento se realizó de manera ambulatoria, con anestesia local y en un tiempo promedio de 30 a 40 minutos. Se utilizó como zona donante la región hemiabdominal inferior; procesamiento de la grasa mediante técnica de decantación e inyección en la zona receptora a nivel craneo facial. Los pacientes toleraron el procedimiento adecuadamente sin complicaciones intraoperatoria ni eventos sobreagregados. Conclusión: La lipotransferencia constituye una técnica mínimamente invasiva, con baja morbilidad y altas tasas de efectividad en cuanto al resultado estético y a la satisfacción por parte del paciente. Es una herramienta que todo neurocirujano debería considerar ante un defecto secundario a un abordaje anterolateral a la base del cráneo(AU)

Background: There are numerous procedures in which, beyond adequate manipulation of the temporalis muscle and cranial closure, patients may present bone and muscle defects due to atrophy and consequent facial asymmetry, causing psychological discomfort and functional deterioration. Our team decided to combine the knowledge of plastic surgery and apply it to cranial reconstructions with fat transfers in post neurosurgical patients. The objective of the following work is to present the results in a series of patients where the aforementioned technique was applied. Methods: During the year 2022, 45 fat transfer procedures were performed for the correction of craniofacial defects, of which 29 were female and 16 male. All had a surgical history of pterional craniotomies and their variants, orbitozygomatic and transzygomatic approaches, with the consequent volume deficit. Results: The procedure was performed on an outpatient basis, with local anesthesia and in an average time of 30 to 40 minutes. The lower hemiabdominal region was used as the donor area, processing the fat using the decantation technique and injection into the receptor area at the craniofacial level. The patients tolerated the procedure adequately without intraoperative complications or superadded events. Conclusion: Fat transfer is a minimally invasive technique, with low morbidity and high rates of effectiveness in terms of aesthetic results and patient satisfaction. It is a tool that every neurosurgeon should consider when faced with a defect secondary to an anterolateral approach to the skull base(AU)

The Hibiscus Model: A Feasible Cadaveric Model Using Continuous Arterial Circulation for Intracranial Bypass Training and Its Validation.

OBJECTIVE: The frequency of intracranial bypass procedures has declined. Thus it is difficult for neurosurgeons to develop the necessary skills for this complex procedure. We present a perfusion-based cadaveric model to provide a realistic training experience with high anatomic and physiological fidelity, as well as instantaneous assessment of bypass patency. Validation was assessed by evaluating the educational impact and skill improvement of the participants. METHODS: Fourteen participants attended a hands-on revascularization course with 7 cadaveric models connected to a continuous arterial circulation system pumping a red-colored solution through the entire cranial vasculature, mimicking blood circulation. The ability to perform a vascular anastomosis was evaluated initially. Further, a questionnaire on prior experience was provided. At the end of the 36-hour course, the ability to perform an intracranial bypass was reexamined and the participants completed a self-assessment questionnaire. RESULTS: Initially, only 3 attendees were able to perform an end-to-end anastomosis within the time limit, and only 2 of these anastomoses showed adequate patency. After having accomplished the course, all participants were able to complete a patent end-to-end anastomosis within the time limit, thus demonstrating a significant improvement. Further, both overall educational gain and surgical skills were regarded as remarkable (n = 11 and n = 9). CONCLUSIONS: Simulation-based education is considered an important aspect of medical and surgical development. The presented model is a feasible and accessible alternative to the prior models used for cerebral bypass training. This training may serve as a helpful and widely available tool to improve neurosurgeons' development irrespective of financial resources.

Características clínicas e histopatológicas de niños peruanos con craneofaringioma

Introducción: Los craneofaringiomas son tumores benignos, de los cuales hasta el 50% ocurren en niños. Sin embargo, no hay estudios en niños peruanos. Objetivo: describir las características clínicas e histopatológicas de niños con craneofaringioma hospitalizados en el Hospital Nacional Edgardo Rebagliati Martins entre agosto de 2019 y mayo de 2021. El estudio: El diseño es transversal y la fuente de los datos fueron las historias clínicas. Se recolectó información sobre el sexo, edad, cirugías y características relacionadas a la primera cirugía de resección tumoral. Hallazgos: Incluimos 12 pacientes. El 83.3% fueron varones, al momento del diagnóstico la mediana de edad fue de 6 años y predominaron los síntomas visuales, todos tuvieron deficiencias hormonales luego de la primera cirugía de resección. Conclusión: tres recibieron radioterapia, uno desarrolló transformación maligna y otro falleció. Es necesario realizar a futuro estudios prospectivos.

Introduction: Craniopharyngiomas are benign tumors, of which up to 50% occur in children. However, there are no studies in Peruvian children. Objective : to describe the clinical and histopathological characteristics of children with craniopharyngioma hospitalized at the Edgardo Rebagliati Martins National Hospital between August 2019 and May 2021. The study: The design is cross-sectional and the data source were medical records. Information on sex, age, surgeries and characteristics related to the first tumor resection surgery were collected. Findings: We included 12 patients. 83.3% were male, at the time of diagnosis the median age was 6 years and visual symptoms predominated, all had hormonal deficiencies after the first resection surgery. Conclusions: three received radiotherapy, one developed malignant transformation and one died. Future prospective studies are necessary.

Pandemic impact on aneurysmal subarachnoid hemorrhage in Peru's high COVID-19 lethality setting: A public institutional experience.

Background: The COVID-19 pandemic in 2020 profoundly impacted healthcare worldwide, and Peru was particularly affected, experiencing the highest COVID-19 case fatality rate globally. Methods: We conducted a retrospective comparative study of patients presenting with aneurysmal subarachnoid hemorrhage (SAH) at a public Peruvian national referral center specializing in cerebrovascular diseases. Two study periods were considered, one during the first wave of the COVID-19 pandemic and a second identical period in 2019. Variables included patient demographics, comorbidities, COVID-19 infection status, clinical presentation, treatment approaches, and hospital outcomes. Results: We analyzed 114 patients with aneurysmal SAH, 65 (57.0%) treated in 2019 and 49 (43.0%) in 2020. The mean time from emergency admission to the day of definitive treatment during 2019 and 2020 was 2.72 and 1.93 days, respectively. Likewise, the mean time from symptom onset to the date of definitive treatment was 6.71 and 7.70 days, respectively. We identified significant associations between complications such as sepsis, respiratory failure, acute kidney failure, and hospital mortality. The proportion of fatalities was significantly higher in 2020 compared to 2019 (36.7% vs. 15.4%, respectively). Interestingly, there was no statistically significant association between COVID-19 infection status and mortality during the 2020 period. Conclusion: Patients with aneurysmal SAH treated during the pandemic had a higher proportion of sepsis, respiratory failure, acute kidney failure, and mortality compared to the pre-pandemic period. Reallocating healthcare resources to prioritize COVID-19 patients may have inadvertently neglected or delayed care for patients with other emergency conditions, such as aneurysmal SAH. This highlights the importance of maintaining adequate care for non-infectious emergencies during a pandemic.

Lipotranferences in post neurosurgical esthetic defects.

Background: There are numerous procedures in which, beyond adequate manipulation of the temporalis muscle and cranial closure, patients may present bone and muscle defects due to atrophy and consequent facial asymmetry, causing psychological discomfort and functional deterioration. The objective of our work is to combine the knowledge of plastic surgery and apply it to cranial reconstructions with fat transfers in post-neurosurgical patients, analyzing its results. Methods: During the year 2022, 45 fat transfer procedures were performed for the correction of craniofacial defects, of which 29 were female and 16 were male. All had a surgical history of pterional craniotomies and their variants, orbitozygomatic and transzygomatic approaches, with the consequent volume deficit. Results: The procedure was performed on an outpatient basis, with local anesthesia, and in an average time of 30-40 min. The lower hemiabdominal region was used as the donor area, processing the fat using the decantation technique and injecting it into the receptor area at the craniofacial level. The patients tolerated the procedure adequately without intraoperative complications or superadded events. Conclusion: Fat transfer is a minimally invasive, effective, and cost-effective technique that plastic surgery offers us to implement in post-neurosurgical patients, as it achieves natural results that stand the test of time.

Protocol of a Nerve Neurotmesis Sciatic Repair using Polyvinyl Alcohol Biofilm in Wistar Rats / Protocolo de reparação de uma neurotmese do nervo ciático utilizando o biofilme de álcool polivinílico em ratos Wistar

Background Animal models are commonly used to assess the efficacy of new materials to be employed in the surgical repair of a nerve injury. However, there is no published surgical repair protocol for sciatic nerve neurotmesis in rats. Objective To produce and evaluate a protocol for the tubing technique using a polyvinyl alcohol biofilm after sciatic nerve neurotmesis. Methods Eighteen rats were randomized into 3 groups (n » 6 per group): control group - CG, neurotmesis group - NG, and neurotmesis biofilm group - NBG. The NG and NBGanimals were submitted to neurotmesis of the sciatic nerve at 60 days of life, followed by suture of the nerve stumps; in the NBG, the animals had the suture involved by polyvinyl alcohol biofilm. A descriptive evaluation of the surgical technique was performed after the experimental period. The Shapiro-Wilk normality test was used for body weight, and analysis of variance (ANOVA) with Bonferroni posthoc (p < 0.05) was applied. Results All groups showed good repair of the skin and muscle sutures; however, 33.30% of the CG presented disruption of skin points. Furthermore, 16.70% of the stumps were not structurally aligned and 33.30% had neuromas in the NG, while in the NBG, all stumps were aligned and none of them had neuroma. Conclusions The present study was able to produce a protocol with high reproducibility in view of the mechanical stability, targeting of the nerve stumps, muscle healing, the low frequency of skin breakage and the low complexity level of the technique, and it can be used in future studies that aim to evaluate other biomaterials for nerve repair in rats.

Introdução Modelos animais são comumente utilizados para avaliar a eficácia de novos materiais a ser empregados no reparo cirúrgico de lesões nervosas. No entanto, não há protocolo de reparo cirúrgico publicado para neurotmese do nervo ciático em ratos. Objetivo Produzir e avaliar um protocolo para a técnica de tubulização usando um biofilme de álcool polivinílico após uma neurotmese do nervo ciático. Métodos Dezoito ratos foram randomizados em três grupos (n » 6 por grupo): grupo controle - GC, grupo neurotmese - GN e grupo neurotmese biofilme - GNB. Os animais do GN e do GNB foram submetidos à neurotmese do nervo ciático aos 60 dias de vida, seguida de sutura dos cotos do nervo; no GNB, os animais tiveram a sutura envolvida por biofilme de álcool polivinílico. Após o período experimental, foi realizada avaliação descritiva da técnica cirúrgica. Para o peso corporal, foi utilizado o teste de normalidade Shapiro-Wilk e aplicada a análise de variância (ANOVA) com posthoc de Bonferroni (p < 0,05). Resultados Todos os grupos apresentaram bom reparo de suturas de pele e musculares; porém, 33,30% do GC apresentou rompimento dos pontos da pele. Além disso, 16,70% dos cotos não estavam estruturalmente alinhados e 33,30% apresentavam neuromas no GN, enquanto todos os cotos estavam alinhados e nenhum apresentava neuroma no GNB. Conclusões O presente estudo foi capaz de produzir um protocolo com alta reprodutibilidade tendo em vista a estabilidade mecânica, direcionamento dos cotos nervosos, cicatrização muscular, a baixa frequência de rompimento da pele e o baixo nível de complexidade da técnica, podendo ser utilizado em estudos futuros que avaliem outros biomateriais para reparo de nervo em ratos.

Spontaneous intracranial hypotension: from cerebral venous thrombosis to neurosurgical treatment: a case series experience from a Brazilian tertiary health care center / Hipotensão intracraniana espontânea: de trombose venosa cerebral ao tratamento cirúrgico: uma série de casos de um centro terciário de saúde brasileiro

Abstract Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods Review of the medical files of three patients and description of clinical and surgical outcomes. Results Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed tomography (CT) myelography could determine an identifiable cerebrospinal fluid (CSF) leak in only one patient. One patient received a conservative approach, and the other two were submitted to open surgery with lamino-plasty. Both of them had uneventful recovery and remission in surgery follow-up. Conclusion The diagnosis and management of SIH are still a challenge in neurology practice. We highlight in the present study severe cases of incapacitating SIH, complication with CVT, and good outcomes with neurosurgical treatment.

Resumo Antecedentes Hipotensão intracraniana espontânea (HIE) é uma causa secundária de cefaleia e uma doença subdiagnosticada. A apresentação clínica pode ser muito variável. Tipicamente, se apresenta com queixas isoladas de cefaleia ortostática clássica, porém pode evoluir com complicações significativas como trombose venosa cerebral (TVC). Objetivo Relatar 3 casos de diagnóstico de hipotensão intracraniana espontânea manejados em uma enfermaria de neurologia de nível terciário. Métodos Revisão dos prontuários de três pacientes e descrição dos resultados clínicos e cirúrgicos. Resultados Três pacientes do sexo feminino com média de idade de 25.6 ± 10.0 anos. As pacientes apresentavam cefaleia ortostática e uma delas apresentou sonolência e diplopia devido a TVC. A ressonância magnética (RM) do encéfalo varia de achados normais até achados clássicos de HIE como realce paquimeníngeo e deslocamento inferior das tonsilas cerebelares. A RM da coluna mostrou coleções anormais de líquido epidural em todos os casos e a mielografia por tomografia computadorizada (TC) foi capaz de determinar fístula liquórica identificável em apenas uma paciente. Uma paciente recebeu abordagem conservadora e as outras duas foram submetidas a cirurgia aberta com laminoplastia. Ambas tiveram recuperação e remissão sem intercorrências no seguimento cirúrgico. Conclusão O diagnóstico e manejo da hipotensão intracraniana ainda são desafios na prática neurológica. Destacamos no presente estudo casos graves, complicação com TVC e bons resultados com tratamento neurocirúrgico.

Minimally invasive craniotomies for lesions of the anterior and middle fossa.

Minimally invasive craniotomies are the subject of increasing attention over the last two decades in neurosurgery, following the current trend of attempting to increase patient safety by providing surgeries with less tissue disruption, blood loss, and decreased operative time. However, a significant information overlap exists among the various keyhole approaches regarding their indications and differences with more invasive techniques. Therefore, the present study aims to comprehensively review, illustrate, and describe the potential benefits and disadvantages of minimally invasive techniques to access the anterior and middle fossa, including the mini-pterional, mini orbito-zygomatic, supraorbital, lateral supraorbital, and extended lateral supraorbital approaches while comparing them to classic, more invasive approaches.

Técnica de clonación 3D aplicada en planificación quirúrgica para craneosinostosis sagital en Latinoamérica-Perú: reporte de caso

La craneosinostosis sagital es el cierre prematuro de la sutura sagital, ocasionando alteraciones funcionales y estructurales. El tratamiento es quirúrgico, y actualmente se cuenta con diversas técnicas, las cuales requieren de una planificación y entrenamiento para lograr óptimos resultados. Se presenta el caso de un varón de 1 año presenta crecimiento anteroposterior anormal del cráneo, indicándose tomografía cerebral sin contraste evidenciando una sinostosis sagital. Se realiza la planificación quirúrgica de la técnica a desarrollar mediante modelo 3D personalizado a escala real. Paciente cursa con buena evolución y es dado de alta. Finalmente, la tecnología de clonación 3D esencial para la educación y desarrollo neuroquirúrgico permitiendo acceder a modelos táctiles de alta precisión y bajo costo que mejoran la calidad del manejo de craneosinostosis.

Sagittal craniosynostosis is the premature closure of the sagittal suture, causing functional and structural alterations. The treatment is surgical, and there are currently various techniques, which require planning and training to achieve optimal results. We present the case of a 1-year-old male with abnormal anteroposterior growth of the skull, indicating brain tomography without contrast, showing sagittal synostosis. Surgical planning of the technique to be developed is carried out using a real-scale personalized 3D model. The patient progresses well and is discharged. Finally, essential 3D cloning technology for neurosurgical education and development allows access to high-precision, low-cost tactile models that improve the quality of craniosynostosis management.

Neurosurgery Research Productivity in Latin American and Caribbean Countries: A Bibliometric and Visualized Study.

OBJECTIVES: Determine the bibliometric characteristics of scientific articles that address the subject of neurosurgery in Latin America and the Caribbean. METHODS: A bibliographic search of original articles published in the Web of Science database up to 2021 was performed, without language restrictions. The terms included in the search strategy were Neurosurgery, neurosurgical procedures, and neurological surgical procedure. Articles according to the inclusion criteria in the Rayyan application were included. Subsequently, a quantitative bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer. RESULTS: We identified 882 articles published in 271 journals. The first publication was in 2006, the highest number of publications was in 2021, the annual percentage growth rate was 25.9, and the average number of citations per document was 11.2. The author with the highest number of publications was Teixeira MJ (41 articles), and the University of Sao Paulo had the highest number of articles on this topic. WORLD NEUROSURGERY was the journal with the most publications (120 articles), and the study by Carney et al (2017) was the most cited (1175 citations). The country of corresponding authors with the most publications and the greatest number of total citations was Brazil. Surgery, and Management were the most used keywords plus; however, in the most recent articles Simulation and Guidelines were used. CONCLUSIONS: In the past decade, there has been an increase in articles on neurosurgery in Latin America and the Caribbean. Scientific production in neurosurgery must continue to increase in order to promote evidence-based medicine.

L1 cell adhesion molecule high expression is associated with poor prognosis in surgically resected brain metastases from lung adenocarcinoma.

OBJECTIVES: Accurate prognosis assessment across the heterogeneous population of brain metastases is very important, which may facilitate clinical decision-making and appropriate stratification of future clinical trials. Previous studies have shown the L1 Cell Adhesion Molecule (L1CAM) is potentially involved in human malignancies of multiple different samples and unfavorable survival. However, no data of L1CAM are available for the brain metastases from lung adenocarcinoma, especially for the one with neurosurgical resection. METHOD: The authors investigated the L1CAM expression in cranial metastatic lesions for patients with brain metastases from lung adenocarcinoma after neurosurgical resection using tissue microarrays that were obtained from the Department of Neurosurgery at the Cancer Hospital of the Chinese Academy of Medical Sciences. Furthermore, the relationship between L1CAM expression and clinic-pathological parameters, including overall survival time, was analyzed to assess the prognostic value of L1CAM. RESULTS: L1CAM high expression was found in 62.30% of brain metastases from lung adenocarcinoma and significantly correlated with brain metastasis number (p = 0.028) and Lung-molGPA score (p = 0.042). Moreover, L1CAM expression was an independent predictor of survival for brain metastases after neurosurgical resection in a multivariate analysis. Patients with L1CAM high expression had unfavorable overall survival time (p = 0.016). In addition, the multivariate analysis also showed age and extracranial transfer were also the independent prognostic factors for this type of patient with brain metastases. CONCLUSIONS: A subset of brain metastases from lung adenocarcinoma aberrantly expresses L1CAM. L1CAM is a novel independent prognostic factor for brain metastasis from lung adenocarcinoma after neurosurgical resection.

Alterações neurológicas e psiquiátricas crônicas devido à Covid-19 / Chronic neurological and psychiatric alterations due to Covid-19

Desde os primeiros relatos do novo coronavírus na China em 2019, houve uma disseminação rápida e severa desta patologia, acarretando milhões de mortes. Dessa forma, ao longo deste período, um dos principais focos de toda a comunidade científica foi o estudo das implicações da Covid-19 no organismo humano em curto, médio e longo prazo. Dessas pesquisas, surgiram diversas descobertas relacionas à implicação no vírus no sistema nervoso central e sistema nervoso periférico, principalmente a longo prazo, e não associadas apenas a questões neurológicas, mas também psiquiátricas e neurocirúrgicas. Entre as alterações mais relatadas, vemos: cefaleia, ageusia, anosmia, alteração de consciência, AVE, convulsão, meningite, depressão, ansiedades, transtorno de humor, entre muitas outras. Tendo em vista esta vasta gama de patologias, o estudo sistemático e padronizado das implicações se faz imprescindível e é desenvolvido neste artigo de revisão.

Ever since the first reports of the new coronavirus in China in 2019, there has been a fast and severe dissemination of this pathology, leading to millions of deaths. Throughout this period, one of the main cornerstones of the scientific community has thus been the study of COVID-19 implications to the human body in the short, medium, and long term. From this research, various discoveries have emerged regarding the implication of the virus in the central and peripheral nervous systems, especially in the long term; these are not only associated with neurological issues but also to psychiatric and neurosurgical ones. Among the most commonly reported alterations are headaches, ageusia, anosmia, altered states of consciousness, strokes, seizures, meningitis, depression, anxiety, mood disorders, and others. Considering this wide range of pathologies, a systematic and standardized study of these implications is thus indispensable and is carried out in this review article.

Safety and Feasibility of Nucleus Accumbens Surgery for Drug Addiction: A Systematic Review.

BACKGROUND: Substance addiction encompasses the incapacity to discontinue urgent drug use; many severely disabled patients might be considered appropriate candidates for surgery due to the high rates of relapse despite conservative treatment. A crucial finding in the brain of these patients is increased extracellular concentrations of dopamine in the nucleus accumbens (NAcc). OBJECTIVES: To determine the efficacy and safety of NAcc surgery for the treatment of substance dependence. MATERIALS AND METHODS: Adhering to PRISMA guidelines, we performed a systematic review to identify all original studies in which NAcc surgery was performed to treat relapsing drug addiction with a minimum follow-up of six months. From database inception to April 10, 2020, we searched PubMed, Scopus, and LILACS. Two reviewers independently selected studies and extracted data. The main outcome was the relapse rate. The GRADE methods were applied to evaluate the quality of evidence. This study was registered with PROSPERO CRD42020177054. RESULTS: Fifteen studies involving 359 participants met inclusion criteria; eight (56%) included NAcc deep brain stimulation (DBS) in 13 patients with addiction for alcohol (N = 6, 46.1%), opioid (N = 4, 30.7%), and nicotine (N = 3, 15.3%); seven studies (N = 346, 44%) performed NAcc radiofrequency (RF) ablation for opioid (N = 334) and alcohol (N = 12) dependence. Relapse rates were 38.4% for DBS and 39% for RF ablation. CONCLUSIONS: Despite available studies reporting a benefit in the treatment of drug addictions with NAcc surgery, this systematic review stresses the need for carefully planned prospective studies in order to further address the efficacy and indications.

Serious and infrequent neurological complications in hospitalized patients with COVID19.

BACKGROUND: SARS-CoV-2 virus infection may affect other organs including the nervous system with variable neurological manifestations, even some research has reported that SARS-CoV-2 can be found in the brain parenchyma and / or in the cerebrospinal fluid (CSF). Although these reports of neurological involvement secondary to COVID-19 has increased, the clinical manifestations and the forms of neurological invasion is not fully understood. OBJECTIVES: In this paper, we report a case series of patients with SARS-CoV-2 infection with involvement of the nervous system and its neurological complications. In addition, a bibliographic review was developed in different databases with the aim of expanding information on neurological complications and the pathophysiological mechanisms of invasion to the nervous system. CASE REPORT: Case 1, a 79 year old male developed an infarct of the head of the caudate nucleus and thrombosis of the superior longitudinal sinus. Case 2, a 62 year old female developed an intraparenchymal hemorrhage in the left parietal lobe while hospitalized and COVID19 encephalitis was diagnosed. Case 3, a 59 year old healthy male developed a Fisher IV subarachnoid hemorrhage by aneurysmal origin of the right middle cerebral artery and right temporal intraparenchymal hematoma, due to rapid and severe neurological impairment new brain images was performed showing a right cerebellar ischemic stroke leading to compression of the cistern and brainstem. CONCLUSIONS: In these cases, the surgery goal was relieved symptoms, neurologic functional recovery, and life survival. We considered its diffusion and knowledge as imperative for all practitioners involved in the care of this patient.