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1.
Chirurgia (Bucur) ; 116(eCollection): 1-9, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34749845

RESUMEN

Neurosurgery is a medical speciality that diagnoses and treats brain and spine pathologies of infants, children, and adults, having 2 components: clinical and surgical activities. The history of neurosurgery dates back to the Prehistoric Period when first trepanations took place. However, the extensive amount of information we use today was discovered and invented thanks to Joseph Lister (1827-1912), William T.G. Morton (1819-1868) and Pierre Paul Broca (1823-1880) who implemented systematic antisepsis rules, anaesthesia and, respectively, the localization of different areas of the brain. Nevertheless, professors such as Harvey Cushing (1869-1939) and Gazi Yasargil (n.1925) are responsible for the definition of neurosurgery as a stand-alone surgical specialty and the significant improvement of the surgical techniques. Moreover, Professor Dumitru Bagdasar (1893-1946) is the one responsible for the introduction of neurosurgery in Romania, training a "golden neurosurgeon team" who are remarked as the first neurosurgeons of Romania. Even though it is such a new medical field, a vast amount of theoretical and practical study is necessary. Therefore, a student needs dedication and lots of effort to achieve perfection in one of the most complex medical speciality, requiring more than 100 exams and over 14,900 hours of practice during the 6 years of medical school and 6 years of neurosurgical residency. Still, even if it seems a lot at first, the moral rewards stand out in the end due to the significant contrast between the preoperative and postoperative condition of the patient. Nevertheless, some of the students might be negatively influenced by family and friends through different myths that neurosurgery is a goal that is almost impossible to be achieved since the amount of practice and sacrifices it requires are a lot bigger than other medical specialities. In conclusion, neurosurgery accomplished to overcome the mystery of the human brain and developed at a fast pace. Today, neurosurgeons around the world treat more and more pathologies that seemed incurable and inoperable 100 years ago.


Asunto(s)
Neurocirugia , Niño , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos , Estudiantes , Resultado del Tratamiento
3.
J Neurosurg Sci ; 65(5): 465-473, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34814649

RESUMEN

BACKGROUND: Traumatic brain injury (TBI) is going to be the third-leading cause of death worldwide, according to the WHO. Two European surveys suggested that adherence to brain trauma guidelines is poor. No study has compared compliance between low- (LMICs) and high-income (UHICs) countries. Hence, this study aimed to investigate differences in the management of severe TBI patients, comparing low- and high-income, and adherence to the BTF guidelines. METHODS: A web-based survey was spread through the Global Neuro Foundation, different neurosurgical societies, and social media. RESULTS: A total of 803 neurosurgeons participated: 70.4 from UHICs and 29.6% from LMICs. Hypertonic was administered as an early measure by the 73% and 65% of the responders in LMICs and UHICs, respectively (P=0.016). An invasive intracranial pressure monitoring was recommended by the 66% and 58% of the neurosurgeons in LMICs and UHICs, respectively (P<0.001). Antiseizure drugs (P<0.001) were given most frequently in LMICs as, against recommendations, steroids (87% vs. 61% and 86% vs. 81%, respectively). In the LMICs both the evacuation of the contusion and decompressive craniectomy were performed earlier than in UHICs (30% vs. 17% with P<0.001 and 44% vs. 28% with P=0.006, respectively). In the LMICs, the head CT control was performed mostly between 12 and 24 hours from the first imaging (38% vs. 23%, P<0.001). CONCLUSIONS: The current Guidelines on TBI do not always fit to both the resources and circumstances in different countries. Future research and clinical practice guidelines should reflect the greater relevance of TBI in low resource settings.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Neurocirujanos , Lesiones Traumáticas del Encéfalo/cirugía , Humanos , Encuestas y Cuestionarios
4.
Neurol Med Chir (Tokyo) ; 61(11): 619-628, 2021 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-34629353

RESUMEN

This study investigated the number of epilepsy surgeries performed over time in Japan, and conducted a questionnaire survey of the Japan Neurosurgical Society (JNS) training program core hospitals to determine the current status and future objectives of surgical therapies and epilepsy training programs for physicians in Japan. This article presents part of a presentation delivered as a presidential address at the 44th Annual Meeting of the Epilepsy Surgery Society of Japan held in January 2021. The number of epilepsy surgeries performed per year has increased in Japan since 2011 to around 1,200 annually between 2015 and 2018. The questionnaire survey showed that 50% of the responding hospitals performed epilepsy surgery and 29% had an epilepsy center, and that these hospitals provided senior residents with education regarding epilepsy surgery. The presence of an epilepsy center in a hospital was positively correlated with the availability of long-term video electroencephalography monitoring beds as well as the number of epilepsy surgeries performed at the hospital. In regions with no medical facilities offering specialized surgical therapies for epilepsy, the JNS training program core hospitals may help improve epilepsy diagnosis and treatment. They may also increase the number of safe and effective surgeries by establishing epilepsy centers that can perform long-term video electroencephalography monitoring, providing junior neurosurgeons with training regarding epilepsy, and playing a core role in surgical therapies for epilepsy in tertiary medical areas in close cooperation with neighboring medical facilities.


Asunto(s)
Epilepsia , Electroencefalografía , Epilepsia/cirugía , Humanos , Japón , Neurocirujanos , Procedimientos Neuroquirúrgicos
6.
Neurol India ; 69(4): 829-832, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34507396

RESUMEN

Background and Introduction: Unlocking of the frontotemporal dural fold (FTDF) and extradural removal of the anterior clinoid process (EACP) are challenging but mandatory skills for micro-neurosurgeons. Despite the presence of an extensive body of literature on this subject, the translation of this cadaveric and 3D simulation to a real patient turns out to be a very demanding and difficult task. Objective: This video is aimed to address the surgical nuances and major adjustments necessary in the unlocking of the FTDF and extradural ACP removal in an actual case for an early-career neurosurgeon. Surgical Technique: A 40-year lady presented with features of acromegaly with radiological evidence of significant component of the tumor in the right cavernous sinus along with sellar suprasellar component. To achieve a good hormonal control, a complete tumor excision was required, which was achieved with FTDF and EACP removal. The cavernous sinus was approached through the Parkinson's triangle. Results: The patient had uneventful recovery and good hormonal control at the 3-month follow-up. Conclusion: FTDF unlocking and EACP are elegant procedures and need to be learned by all neurosurgeons. This article will provide excellent teaching material for young neurosurgeons.


Asunto(s)
Seno Cavernoso , Base del Cráneo , Cadáver , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos , Hueso Esfenoides
7.
World Neurosurg ; 155: e576-e587, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34481104

RESUMEN

OBJECTIVE: The severe acute respiratory coronavirus 2 (SARS-CoV2) crisis led to many restrictions in daily life and protective health care actions in all hospitals to ensure basic medical supply. This questionnaire-based study among spinal surgeons in central Europe was generated to investigate the impact of coronavirus disease 2019 (COVID-19) and consecutively the differences in restrictions in spinal surgery units. METHODS: An online survey consisting of 32 questions on the impact of the COVID-19 pandemic and the related restrictions on spinal surgery units was created. Surgical fellows and consultants from neurosurgical, orthopedic, and trauma departments were included in our questionnaire-based study with the help of Austrian, German, and Swiss scientific societies. RESULTS: In a total of 406 completed questionnaires, most participants reported increased preventive measurements at daily clinical work (split-team work schedule [44%], cancellation of elective and/or semielective surgeries [91%]), reduced occurrence of emergencies (91%), decreased outpatient work (45%) with increased telemedical care (73%) and a reduced availability of medical equipment (75%) as well as medical staff (30%). Although most physicians considered the political restrictive decisions to be not suitable, most considered the medical measures to be appropriate. CONCLUSIONS: The COVID-19 pandemic resulted in comparable restrictive measures for spinal surgical departments in central Europe. Elective surgical interventions were reduced, providing additional resources reserved for severe acute respiratory coronavirus 2-positive patients. Although similar restrictions were introduced in most participants' departments, the supply of personal protective equipment and the outpatient care remained insufficient and should be re-evaluated intensively for future global health care crises.


Asunto(s)
COVID-19/epidemiología , Neurocirujanos/tendencias , Procedimientos Neuroquirúrgicos/tendencias , Enfermedades de la Columna Vertebral/epidemiología , Enfermedades de la Columna Vertebral/cirugía , Encuestas y Cuestionarios , Adulto , Atención Ambulatoria/tendencias , COVID-19/prevención & control , Atención a la Salud/tendencias , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Equipo de Protección Personal/tendencias
8.
BMJ Open ; 11(9): e051806, 2021 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-34551952

RESUMEN

OBJECTIVES: Low-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by those in LMICs. The aim of this study was to understand neurosurgeons' experiences of, aspirations for, and ability to conduct and disseminate clinical research in LMICs. DESIGN: This was a two-stage inductive qualitative study situated within the naturalistic paradigm. This study committed to an interpretivist way of knowing (epistemology), and considered reality subjective and multiple (ontology). Data collection used online methods and included a web-based survey tool for demographic data, an asynchronous online focus group and follow-up semistructured interviews. Data were analysed using Braun and Clarke's Reflexive Thematic Analysis supported by NVivo V.12. SETTING: LMICs. PARTICIPANTS: In April-July 2020, 26 neurosurgeons from 11 LMICs participated in this study (n=24 in the focus groups, n=20 in follow-up interviews). RESULTS: The analysis gave rise to five themes: The local landscape; creating capacity; reach and impact; collaborative inquiry; growth and sustainability. Each theme contained an inhibitor and stimulus to neurosurgeons conducting and disseminating clinical research, interpreted as 'the neurosurgical research potential in LMICs'. Mentorship, education, infrastructure, impact and engagement were identified as specific accelerators. Whereas lack of generalisability, absence of dissemination and dissemination without peer review may desensitise the impact of research conducted by neurosurgeons. CONCLUSION: The geographical, political and population complexities make research endeavour challenging for neurosurgeons in LMICs. Yet in spite of, and because of, these complexities LMICs provide rich opportunities to advance global neurosurgery. More studies are required to evaluate the specific effects of accelerators of research conducted by neurosurgeons and to understand the effects of desensitisers on high-quality, high-impact clinical research.


Asunto(s)
Neurocirujanos , Neurocirugia , Países en Desarrollo , Humanos , Renta , Pobreza
9.
Curr Opin Anaesthesiol ; 34(5): 590-596, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34435602

RESUMEN

PURPOSE OF REVIEW: We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery. RECENT FINDINGS: In recent years, the use of IONM has increased significantly. It has developed into a mature discipline, enabling neurosurgical procedures of ever-increasing complexity. It is thus of growing importance for the anesthesiologist to appreciate the interplay between IONM and anesthesia and to build up experience working in a team with the neurosurgeon and the neurophysiologist. SUMMARY: Safety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM.


Asunto(s)
Anestesia , Monitorización Neurofisiológica Intraoperatoria , Anestesia/efectos adversos , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos , Médula Espinal
11.
J Clin Neurosci ; 91: 125-130, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34373016

RESUMEN

The advent of the COVID-19 pandemic has disrupted all aspects of neurosurgery education, and it is now challenging to conduct routine sessions. Maintenance of essential standard education among novice neurosurgeons during the pandemic is of paramount importance. The aim of this study was the development of virtual modules and validation of its role to supplement the neurosurgery education program. We developed the virtual modules relevant to neuro-anatomy, neurosurgical procedures, instrumentation, and neurosurgical planning. These modules were virtually demonstrated to twenty-seven resident neurosurgeons through CiscoWebexonline platform. They provided their rating on the aptness of virtual modules for different neurosurgery applications on various parameters using 10 points Likert scale. The parameters included quality, learning, confidence building capacity, usefulness, and overall satisfaction. The results obtained for each module were analysed and the average score was used for the comparison. The highest rating on quality was obtained by the neurosurgical instrumentation module. The highest rating for learning and confidence building capacity was given to neurosurgical procedure animation. The usefulness and overall satisfaction were highly rated for neurosurgical planning module. The results show that developed virtual modules provide an effective method to supplement the neurosurgery education program in the current scenario involving physical distancing and shift rearrangements. These virtual modules help in limiting the visits to operation room, anatomy and surgical training labs, and allow residents to learn online at their pace.


Asunto(s)
COVID-19 , Neurocirugia , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos , Pandemias , SARS-CoV-2
12.
J Clin Neurosci ; 91: 243-248, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34373035

RESUMEN

The study aimed to determine how much change in neurogenic claudication spinal surgeons expect in patients following lumbar decompression for lumbar spine stenosis (LSS), and radicular leg pain following microdiscectomy. Secondary aims were to identify surgeons' preferences regarding surgical techniques for lumbar decompression, and their rating of the quality of current evidence for lumbar decompression. All Australian spine surgeons were invited, of whom 71 completed the survey (31% response rate). Only registered spinal surgeons were included. The online survey, administered using REDCap, included 4 sections: demographics and background; expected change in symptoms on a +/- 100% scale (-100% worst, 0% no change and 100% best possible); surgical preference; and rating of current evidence for lumbar decompression compared with other treatments. There were 71 complete responses, 76% were neurosurgeons (N = 54), predominantly male (96%; N = 68). On average, surgeons expected an 86% (median: 87%, inter-quartile range (IQR): 80%, 91%) improvement in neurogenic claudication following lumbar decompression for LSS and 89% (median: 91%, IQR: 85%, 95%) improvement in radicular pain following microdiscectomy. A multiple linear regression found no surgeon characteristics were associated with expected change following surgery. The preferred surgical technique for LSS was full laminectomy (58%; N = 41). Thirty-five percent of surgeons accurately rated the evidence supporting the superiority of lumbar decompression compared with non-surgical care for LSS as low quality. Spine surgeons expect large symptom improvements following lumbar decompression and microdiscectomy. Understanding of the current evidence was higher for lumbar decompression with fusion, than for decompression alone for LSS.


Asunto(s)
Descompresión Quirúrgica , Estenosis Espinal , Australia , Dolor de Espalda , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Neurocirujanos , Procedimientos Neuroquirúrgicos , Estenosis Espinal/cirugía , Resultado del Tratamiento
13.
Neurosurg Focus ; 51(2): E18, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34333473

RESUMEN

OBJECTIVE: Performing aneurysmal clipping requires years of training to successfully understand the 3D neurovascular anatomy. This training has traditionally been obtained by learning through observation. Currently, with fewer operative aneurysm clippings, stricter work-hour regulations, and increased patient safety concerns, novel teaching methods are required for young neurosurgeons. Virtual-reality (VR) models offer the opportunity to either train a specific surgical skill or prepare for an individual surgery. With this study, the authors aimed to compare the spatial orientation between traditional 2D images and 3D VR models in neurosurgical residents or medical students. METHODS: Residents and students were each randomly assigned to describe 4 aneurysm cases, which could be either 2D images or 3D VR models. The time to aneurysm detection as well as a spatial anatomical description was assessed via an online questionnaire and compared between the groups. The aneurysm cases were 10 selected patient cases treated at the authors' institution. RESULTS: Overall, the time to aneurysm detection was shorter in the 3D VR model compared to 2D images, with a trend toward statistical significance (25.77 ± 37.26 vs 45.70 ± 51.94 seconds, p = 0.052). No significant difference was observed for residents (3D VR 24.47 ± 40.16 vs 2D 33.52 ± 56.06 seconds, p = 0.564), while in students a significantly shorter time to aneurysm detection was measured using 3D VR models (26.95 ± 35.39 vs 59.16 ± 44.60 seconds, p = 0.015). No significant differences between the modalities for anatomical and descriptive spatial mistakes were observed. Most participants (90%) preferred the 3D VR models for aneurysm detection and description, and only 1 participant (5%) described VR-related side effects such as dizziness or nausea. CONCLUSIONS: VR platforms facilitate aneurysm recognition and understanding of its spatial anatomy, which could make them the preferred method compared to 2D images in the years to come.


Asunto(s)
Realidad Virtual , Humanos , Neurocirujanos
14.
Artículo en Ruso | MEDLINE | ID: mdl-34463445

RESUMEN

Since 2013, neurosurgeons have been guided by the RUANS recommendation protocol for surgical management of patients with acute cervical spine fractures in Russia. However, there are no studies devoted to interobserver agreement between specialists with different experience. OBJECTIVE: To evaluate the role of the RUANS recommendation protocol for decision-making in patients with acute traumatic cervical spine injuries. MATERIAL AND METHODS: Twenty-one neurosurgeons from 5 hospitals estimated data of 64 patients with cervical spine fractures. The study implied choosing an option for patient treatment (conservative therapy; anterior, posterior and circular fusion surgery). Two evaluations of CT and MR scans with an interval of 1.5 months were conducted. In the main group (9/21), neurosurgeons strictly followed the RUANS recommendation protocol during re-evaluation. In the control group (12/21), neurosurgeons analysed data considering their own knowledge and experience. Interobserver agreement was evaluated using a Fleiss' or Cohen's Kappa (K). RESULTS: Among the junior neurosurgeons (up to 5 years of experience), change in consent level during re-evaluation was greater in the main group (∆K=0.25) compared to the control group (∆K= -0.17). Among neurosurgeons with medium level of experience (5-10 years), ∆K was 0.19 in the main group and -0.15 in the control group. Among experienced neurosurgeons (over 10 years of experience), the main group showed an increase in Kappa (∆K=0.24), while level of consent remained almost the same in the control group (∆K=0.05). CONCLUSION: The RUANS recommendation protocol can significantly improve interobserver agreement between specialists with various levels of experience regarding management of acute cervical spine injury.


Asunto(s)
Enfermedades de la Columna Vertebral , Fracturas de la Columna Vertebral , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Humanos , Neurocirujanos , Federación de Rusia
17.
World Neurosurg ; 154: e781-e789, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34389525

RESUMEN

OBJECTIVE: To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic. METHODS: Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected. RESULTS: A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits (P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation. CONCLUSIONS: This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.


Asunto(s)
COVID-19 , Estudios de Factibilidad , Neurocirujanos , Pandemias , Examen Físico/métodos , Enfermedades de la Columna Vertebral/diagnóstico , Telemedicina/métodos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Cuidados Posoperatorios , Cuidados Preoperatorios
19.
Childs Nerv Syst ; 37(10): 3083-3087, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34427745

RESUMEN

With respect to the tremendous deficit in surgical care plaguing developing nations, it is critical that medical outreach models be organized in such a fashion that sustainable advancements can be durably imparted beyond the duration of targeted missions. Using a didactic framework focused on empowering host neurosurgeons with an enhanced surgical skillset, a mission was launched in Managua, Nicaragua, after previous success in Kiev, Ukraine, and Lima, Peru. Unfortunately, the failure to critically assess the internal and external state of affairs of the region's medical center compromised the outreach mission. Herein lies the visiting team's lessons from failure and insights on facilitating effective communication with host institutions, circumventing geopolitical instability, and utilizing digital collaboration and video-conferencing tools in the post-COVID-19 era to advance the surgical care of developing regions in a fashion that can be generationally felt.


Asunto(s)
COVID-19 , Neurocirugia , Humanos , Neurocirujanos , Nicaragua , SARS-CoV-2
20.
J Clin Neurosci ; 90: 212-216, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34275552

RESUMEN

BACKGROUND: Performing a successful microsurgical vascular anastomosis (MVA) is challenging and requires lots of practice. However, the most efficient practice protocol is yet to be found. We aimed to compare and analyze two major practice patterns for fine motor tasks as applied to learning MVA: distributed and mass practice protocols. Ten neurosurgeons with comparable experience in microsurgery (but no experience in vascular anastomosis) were randomized to practice MVA either using a distributed (1 session/day) or a mass practice (6 sessions/day) protocol. A total of 24 sessions of practice and 2 recall test sessions were given. Anastomosis score, time to complete a single stitch and the total time to complete an anastomosis were recorded. Mass practice protocol caused a clear fatigue effect observed toward the end of each mass practice trial block. Statistical comparison using one-way analysis of variance showed significantly higher anastomosis scores and shorter times to place a single stitch as well as to complete the anastomosis in distributed practice group for the last 3 acquisition practice trials, and the 2 recall tests (p < 0.05). The relative advantage of the distributed practice protocol could be attributed to forgetting/spacing effect. Although mass practice protocol resulted in worse performance, it still showed a gradual improvement trend in performance from beginning to the end. Therefore, certain adjustments to a mass practice protocol (such as increasing the number of practice blocks) could potentially lead to an eventual performance level comparable to a distributed protocol. This point is a subject of further investigation.


Asunto(s)
Anastomosis Quirúrgica/educación , Microcirugia/educación , Neurocirujanos/educación , Entrenamiento Simulado/métodos , Anastomosis Quirúrgica/métodos , Competencia Clínica , Humanos , Aprendizaje , Microcirugia/métodos
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