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1.
Neurosurg Focus ; 53(6): E4, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36455267

RESUMEN

OBJECTIVE: In adult patients, an increasing group of neurosurgeons specialize entirely in the treatment of highly eloquent tumors, particularly gliomas. In contrast, extensive perioperative neurophysiological workup for pediatric cases has been limited essentially to epilepsy surgery. METHODS: The authors discuss radio-oncological and general oncological considerations based on the current literature and their personal experience. RESULTS: While several functional mapping modalities facilitate preoperative identification of cortically and subcortically located eloquent areas, not all are suited for children. Direct cortical intraoperative stimulation is impractical in many young patients due to the reduced excitability of the immature cortex. Behavioral requirements also limit the utility of functional MRI and magnetoencephalography in children. In contrast, MRI-derived tractography and navigated transcranial magnetic stimulation are available across ages. Herein, the authors review the oncological rationale of function-guided resection in pediatric gliomas including technical implications such as personalized perioperative neurophysiology, surgical strategies, and limitations. CONCLUSIONS: Taken together, these techniques, despite the limitations of some, facilitate the identification of eloquent areas prior to tumor surgery and radiotherapy as well as during follow-up of residual tumors.


Asunto(s)
Glioma , Neurocirugia , Adulto , Humanos , Niño , Neurofisiología , Procedimientos Neuroquirúrgicos , Neurocirujanos , Glioma/diagnóstico por imagen , Glioma/cirugía
3.
Neurol India ; 70(5): 1896-1900, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36352584

RESUMEN

Background: This pilot survey aims to provide an insight into the variations of corticosteroid prescription among health care professionals across the Indian subcontinent and serve as a prerequisite for the future development of corticosteroid therapy guidelines in brain tumor patients. Materials and Methods: Participants of this anonymized online questionnaire-based survey included health care professionals involved in treating brain tumor patients. Unique links were electronically mailed to health care professionals from a database populated from professional associations. Descriptive statistical analysis, Chi-square test, and/or exact test were used for data analysis. Results: Seventy-three percent of the respondents were radiation oncologists followed by neurosurgeons (23%), medical oncologists (2%), and other specialties (2%). Raised intracranial pressure (90%) was the commonest indication for prescribing corticosteroids. Fifty percent of neurosurgeons preferred corticosteroids to be given routinely for all patients undergoing surgery for brain tumors while 64% of the radiation oncologists would prescribe based on imaging findings and/or on appearance of neurologic symptoms. Most of the respondents (90%) used a flat dosage pattern for determining the starting dose of corticosteroids. Emerging data about the long-term use of corticosteroids having a negative impact on the survival of brain tumor patients were not known by 52% of the respondents. The majority of the practitioners (94%) agreed regarding the formulation of evidence-based guidelines for prescribing corticosteroids in brain tumor patients. Conclusion: In view of the wide variations of corticosteroid therapy practices among health care professionals across various parts of the world, our pilot survey provides significant information which can act as a suitable benchmark to form uniform practice guidelines.


Asunto(s)
Neoplasias Encefálicas , Pautas de la Práctica en Medicina , Humanos , Encuestas y Cuestionarios , Corticoesteroides/uso terapéutico , Neurocirujanos , Neoplasias Encefálicas/tratamiento farmacológico
4.
Neurol India ; 70(5): 2205-2206, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36352644
5.
No Shinkei Geka ; 50(6): 1323-1331, 2022 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-36426532

RESUMEN

Pediatric suprasellar tumors are difficult to treat. Their sellar-suprasellar location frequently results in compression of the adjacent critical neurovascular structures, making them a challenging surgical entity. Our surgical strategy emphasizes on radical resection of the tumor without compromising visual or cognitive functions. In recent years, the endoscopic endonasal approach has been increasingly used for pediatric suprasellar tumors. We have adopted a "4-hand technique by two neurosurgeons" during endoscopic endonasal surgery to resect aggressive tumors safely. Posterior clinoidectomy and upper clivectomy are useful additional procedures to resect intra-3rd-ventricle and retrochiasmatic suprasellar tumors. Here, we present our surgical management strategy and tips for endonasal resection of pediatric suprasellar tumors.


Asunto(s)
Endoscopía , Neoplasias , Niño , Humanos , Ventrículos Cerebrales , Cognición , Neurocirujanos
6.
J Clin Neurosci ; 106: 159-165, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36343499

RESUMEN

OBJECTIVES: Bibliometric analysis can provide insight into the growth, development and dissemination of research in neurosurgery. Little work has been done to examine the role of country-specific characteristics affecting research productivity. We aimed to characterize andcompare the research productivity among SEA countries in terms of bibliometric indicesand determine associations with country-specific factors. METHODS: We performed a systematic search of all articles by authors affiliated with a neurosurgical department in any of the Southeast Asian countries, indexed in 3 databases from inception to June 10, 2020. Bibliometric indices - number of publications, number of citations, average citations per publication, h-index, and the i-10-index - were computed for each country. Correlations between the indices and country-specific characteristics (population size, GDP per capita, percentage of GDP allocation to research and development (R&D), number of neurosurgeons, number of neurosurgeons per capita, and number of collaborations with non-SEA authors) were determined. RESULTS: The number of publications showed an increasing trend up to 2019. Most studies were cohort studies (37%) or case reports or series (37%). Of the country-specific factors analyzed, only percentage of the GDP allocated to R&D was positively correlated with number of publications (p = 0.0004), total citations (p < 0.0001), H-index (p < 0.0001), and i(10)-index (p < 0.0001). Number of collaborations also positively correlated with the same indices. CONCLUSION: Our bibliometric analysis showed increasing contribution by neurosurgeons in the SEA region. Correlational analysis support the view that increased R&D budget allocation and international collaboration can improve neurosurgical research capacity and productivity.


Asunto(s)
Investigación Biomédica , Neurocirugia , Humanos , Bibliometría , Neurocirujanos , Eficiencia , Asia Sudoriental
8.
Acta Neurochir (Wien) ; 164(12): 3071-3074, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36264367

RESUMEN

BACKGROUND: The ongoing war in Ukraine leads to the destruction of critical infrastructure and the displacement of millions of civilians while the necessity for neurosurgical care has increased tremendously. The consequences of this armed conflict on the practice of neurosurgery are uncertain to date. METHODS: A cloud-based questionnaire including 10 single- and multiple-choice questions was sent through the email distribution list of the Ukrainian Neurosurgical Society and the Association of Neurosurgeons of Ukraine. RESULTS: Between June 2022 and July 2022, a link to the online survey was distributed to a total of 134 (100%) departments of neurosurgery across Ukraine. After 21 days of being available, a total of 96 questionnaires (72%) returned. CONCLUSIONS: The survey highlights the field of activity as well as the severe impact on professional and personal life of Ukrainian neurosurgeons during the ongoing war.


Asunto(s)
Neurocirujanos , Neurocirugia , Humanos , Ucrania , Procedimientos Neuroquirúrgicos , Encuestas y Cuestionarios
10.
Neurosurg Focus ; 53(3): E14, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-36052616

RESUMEN

Ralph B. Cloward (1908-2000) was the sole neurosurgeon present during the Japanese attack on Pearl Harbor on December 7, 1941. Cloward operated on 42 patients in a span of 4 days during the attacks and was awarded a commendation signed by President Franklin D. Roosevelt in 1945 for his wartime efforts. During the attacks, he primarily treated depressed skull fractures and penetrating shrapnel wounds, but he also treated peripheral nerve and spine injuries in the aftermath. His techniques included innovative advancements such as tantalum cranioplasty plates, electromagnets for intracranial metallic fragment removal, and the application of sulfonamide antibiotic powder within cranial wounds, which had been introduced by military medics for gangrene prevention in 1939 and described for penetrating cranial wounds in 1940. Despite the severity of injuries encountered, only 2 soldiers died in the course of Cloward's interventions. As the sole neurosurgeon in the Pacific Theater until 1944, he remained in Honolulu through World War II's duration and gained immense operative experience through his wartime service. Here, the authors review the history of Cloward's remarkable efforts, techniques, injury patterns treated, and legacy.


Asunto(s)
Neurocirugia , Traumatismos Vertebrales , Heridas Penetrantes , Humanos , Masculino , Neurocirujanos , Neurocirugia/historia , Procedimientos Neuroquirúrgicos
11.
Neurosurg Focus ; 53(3): E13, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-36052619

RESUMEN

Neurosurgery has benefited from innovations as a result of military conflict. The volume and complexity of injuries sustained on the battlefield require medical teams to triage, innovate, and practice beyond their capabilities in order to treat wartime injuries. The neurosurgeons who practiced in the Pacific Command (PACOM) during World War II, the Korean War, and the War in Vietnam built upon field operating room knowledge and influenced the logistics of treating battle-injured patients in far-forward environments. Modern-day battles are held on new terrain, and the military neurosurgeon must adapt. War in the PACOM uniquely presented significant obstacles due to geographic isolation, ultimately accelerating the growth and adaptability of military neurosurgery and medical evacuation. The advancements in infrastructure and resource mobilization made during PACOM conflicts continue to inform modern-day practices and provide insight for future conflicts. In this historical article, the authors review the development and evolution of neurosurgical care, forward surgical teams, and mobile field hospitals with surgical capabilities through US conflicts in the PACOM.


Asunto(s)
Medicina Militar , Personal Militar , Neurocirugia , Humanos , Neurocirujanos , Neurocirugia/historia , Estados Unidos , Segunda Guerra Mundial
12.
Neurosurg Focus ; 53(3): E16, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-36052624

RESUMEN

Operation Desert Storm (ODS) was an astounding success for combat arms and logistical units of the US Military. In contrast, Department of Defense (DOD) medical units struggled to keep pace with combat operations and were fortunate that casualty estimates for a Cold War-era battle failed to materialize. The medical support plan included a large contingent of active-duty and reserve neurosurgeons in anticipation of care requirements for more than 500,000 deploying service members engaged in a large-scale combat operation. Here, the authors review the clinical experience and operational challenges encountered by neurosurgeons deployed in support of this conflict and discuss legacies of ODS for both surgeons and the military medical system.


Asunto(s)
Medicina Militar , Personal Militar , Guerra del Golfo , Humanos , Neurocirujanos , Guerra
13.
Neurosurg Focus ; 53(3): E7, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-36052633

RESUMEN

The benefit of antibiotic irrigation for prophylaxis against wound infections, not only for traumatic cranial injuries but also in elective neurosurgical care, has recently been called into question. Several articles have cast doubt on the utility of topical antibiotics, and recently, bacitracin irrigation was made unavailable in some US markets. The pervasive nature of antibiotic irrigation, considering the lack of evidence supporting its use, led the authors to question when and how neurosurgeons started using antibiotic irrigation in cranial neurosurgery. Through a review of historical literature, they highlight the adoption of antibiotic irrigation as it began in battlefield surgical practice, gradually leading to the modern concept of antibiotic prophylaxis in civilian and military care.


Asunto(s)
Antibacterianos , Personal Militar , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/prevención & control
14.
Neurosurg Focus ; 53(3): E17, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-36052625

RESUMEN

The tenets of neurosurgery worldwide, whether in the civilian or military sector, espouse vigilance, the ability to adapt, extreme ownership, and, of course, an innate drive for developing a unique set of technical skills. At a time in history when the complexity of battlefield neurotrauma climaxed coupled with a chronic shortage of military neurosurgeons, modernized solutions were mandated in order to deliver world-class neurological care to our servicemen and servicewomen. Complex blast injuries, as caused by an increased incidence of improvised explosive devices, yielded widespread systemic inflammatory responses with multiorgan damage. In response to these challenges, the "NeuroTeam," originally a unit of two neurosurgeons as deployed during Operation Desert Storm, was redesigned to instead pair a neurosurgeon with a neurointensivist and launched itself during two specialized missions in Operations Iraqi Freedom and Enduring Freedom. Representing a hybridized version of present-day neurocritical care teams, the purpose of this unit was to optimize neurosurgical care by focusing on interdisciplinary collaboration in an Echelon III combat support hospital. The NeuroTeam provided unique workflow capabilities never seen collectively on the battlefield: downrange neurosurgical capability by a board-certified neurological surgeon within 60 minutes from the point of injury paired with a neurocritical care-trained intensivist. This also set the stage for intraoperative telemedicine infrastructure for neurosurgery and optimized the ability to evaluate, triage, and stabilize patients prior to medical evacuation. This novel military partnership ultimately allowed the neurosurgeon to focus on the tenets of the craft and thereby the dynamic needs of the patient first and foremost. Since the success of these missions, the NeuroTeam has evolved into a detachable unit, the "Head and Neck Team," comprising neurosurgeons, otolaryngologists, and ophthalmologists, supported by a postinjury hospital unit, which includes an embedded neurocritical care physician. The creation and evolution of the NeuroTeam, necessitated by a shortage of military neurosurgeons and the dangerous shift in military wartime tactics, best exemplifies multidisciplinary collaboration and military medicine agility. As neurocritical care continues to evolve into a highly complex, distinct specialty, the lessons learned by the NeuroTeam ultimately serve as a reminder for civilian and military physicians alike. Despite the conditions and despite one's professional ego, patients with highly complex morbid neurological disease deserve expert, multidisciplinary management for survival.


Asunto(s)
Traumatismos por Explosión , Medicina Militar , Personal Militar , Neurocirugia , Traumatismos por Explosión/cirugía , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos
15.
Neurosurg Focus ; 53(3): E8, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-36052634

RESUMEN

Dr. Harvey Cushing is considered the father of modern neurological surgery, and his role and efforts in World War I continue to have a lasting effect on today's practice of neurosurgery. During World War I, he embodied the tenets of a neurosurgeon-scientist: he created and implemented novel antiseptic techniques to decrease infection rates after craniotomies, leading him often to be referred to as "originator of brain wound care." His contributions did not come without struggles, however. He faced criticism for numerous military censorship violations, and he developed a severe peripheral neuropathy during the war. However, he continued to stress the importance of patient care and his surgical prowess was evident. In this paper, the authors summarize Cushing's notes published in From a Surgeon's Journal, 1915-1918 and discuss the impact of his experiences on his own practice and the field of neurosurgery.


Asunto(s)
Personal Militar , Neurocirugia , Craneotomía , Historia del Siglo XX , Humanos , Masculino , Neurocirujanos , Neurocirugia/métodos , Procedimientos Neuroquirúrgicos/historia
16.
Neurol India ; 70(4): 1338-1339, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36076624
17.
18.
J Clin Neurosci ; 105: 109-114, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36148727

RESUMEN

When neurosurgical care is needed, the distance to a facility staffed with a neurosurgeon is critical. This work utilizes geospatial analysis to analyze access to neurosurgery in the Medicare population and relevant socioeconomic factors. Medicare billing and demographic data from 2015 to 2019 were combined with national National Provider Identifier (NPI) registry data to identify the average travel distance to reach a neurosurgeon as well as the number of neurosurgeons in each county. This was merged with U.S. Census data to capture 23 socioeconomic attributes. Moran's I statistic was calculated across counties. Socioeconomic variables were compared using ANOVA. Hotspots with the highest neurosurgeon access were predominantly located in the Mid-Atlantic region, central Texas, and southern Montana. Coldspots were found in the Great Plains, Midwest, and Southern Texas. There were statistically significant differences (p < 0.05) between high- and low-access counties, including: stroke prevalence, poverty, median household income, and total population density. There were no statistically significant differences in most races or ethnicities. Overall, there exist statistically significant clusters of decreased neurosurgery access within the United States, with varying sociodemographic characteristics between access hotspots and coldspots.


Asunto(s)
Medicare , Neurocirugia , Anciano , Humanos , Neurocirujanos , Factores Socioeconómicos , Texas , Estados Unidos/epidemiología
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