Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery: Two-center retrospective cohort study.

Background: Over the past two decades, endoscopic endonasal skull base surgery (EESBS) has revolutionized the treatment of skull base tumors by enabling minimal access to resect significant pathologies such as meningiomas, pituitary adenomas, and chordomas. Despite its efficacy, complications such as cerebrospinal fluid (CSF) leak pose significant challenges, with an average incidence of 8.9% following EESBS. Therefore, our study aims to investigate the risk factors associated with postoperative CSF leak after employing an endoscopic endonasal approach for skull base surgery, focusing on patients treated at King Abdul-Aziz Medical City in Jeddah and King Abdullah Medical City in Makkah, Saudi Arabia. Methods: A retrospective review of patients who underwent an endoscopic endonasal approach for the resection of intradural skull base pathology between January 2016 and December 2022 was performed with a total of 51 patients. Basic demographic data were collected, along with patient comorbidities, presenting symptoms, tumor pathology, tumor site, the extent of resection, and outcomes. Results: 51 participants were analyzed, with a mean age of 43.41. Male participants comprised (58.8%), while headaches were the most common symptom (74.5%), followed by visual disturbances (51.0%). Nonsecretory tumors predominated, primarily located in the sellar and suprasellar regions (58.8%). Gross total resection was performed in the majority (56.9%), with a 9.8% incidence of postoperative CSF leak. Notably, all four patients with CSF leak experienced preoperative headaches. Hypertension was prevalent in Cases 1 and 4, with Case 4 having a history of neurological disease and radiation therapy. Anterior skull base tumors were most frequent in Cases 3 and 4. Conclusion: The incidence of CSF leakage after surgery in this study was similar to that previously reported. It is worth noting that repeated surgeries may increase the risk of postoperative CSF leakage. Therefore, it is important to carefully evaluate the surgical approach for tumor removal and skull base reconstruction, considering the tumor characteristics and the patient's overall condition.

Epidemiological Characteristics of Traumatic Spinal Cord Injury in Saudi Arabia: A Systematic Review.

Traumatic spinal cord injury (TSCI) is a severe condition with high mortality and disability rates. Understanding the regional TSCI epidemiology may facilitate the development of targeted preventive initiatives and the optimization of resource allocation. The primary goal of this systematic review was to gather and analyze the existing literature on the frequency and characteristics of TSCI in Saudi Arabia. A literature search of PubMed, Web of Science, and Google Scholar was conducted in January 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Observational studies reporting TSCI epidemiology in Saudi Arabia between 2010 and 2022 were included. Data on demographics, mechanisms, levels/severity, and outcomes were extracted. Methodological quality was assessed using the Newcastle-Ottawa Scale. Nine studies involving 2,356 TSCI cases were analyzed. Most patients were young males. Road traffic accidents were shown to be the predominant cause, accounting for 56.5-90.8% of cases. Thoracic (28.7-48.3%) and cervical (26.6-39%) levels were the most common. The extent of neurological deficits showed significant variation throughout the studies. This review provides a baseline understanding of TSCI epidemiology in Saudi Arabia but highlights critical gaps that future research should address. The review emphasizes the need for evidence-based interventions targeting road safety and falls, standardized cervical spine evaluation and management, and the use of validated metrics to optimize patient outcomes. Large-scale population-based studies with standardized methodologies are necessary to fully understand TSCI epidemiology, prognosis, and long-term disability burden in Saudi Arabia, leading to better prevention strategies and improved patient outcomes.

Idiopathic spontaneous bilateral subdural hematoma in a 28-year-old male: A comprehensive literature review and case report.

Background: Subdural hematoma (SDH) is considered spontaneous in the absence of trauma history. It is a common presentation in the geriatric age group due to the many influential factors. Most cases have a known underlying etiology that explains the incidence, otherwise, they are considered idiopathic. We present a rare case report of idiopathic nontraumatic bilateral SDH with a literature review of similar cases. Case Description: A 28-year-old fit individual presented to the Emergency Department with a chronic history of severe headache and neck pain, associated with behavioral changes in the last 2 days. He reported that his symptoms started after lifting a heavy object 2 months ago; however, they became worse after a neck chiropractor therapy session. He is not on any chronic medications, and there was a negative history of trauma, seizure, hematological diseases, family history of neurological conditions, smoking, alcohol, or drug abuse with an unremarkable systemic review. A brain computerized tomography (CT) showed bilateral SDHs, for which he underwent bilateral mini craniotomies and drainage. The symptoms improved after surgery and the follow-up brain CT showed no recurrence. Conclusion: Idiopathic spontaneous bilateral SDH in the adult age group is an extremely rare pathology and the literature review only revealed three similar cases. With the absence of any pathology that would explain the presentation after extensive investigations, we hypothesized that a sudden rise in vascular pressure was the underlying etiology, especially with the fact that the symptoms became unbearable after the neck chiropractor therapy session.

Factors affecting the choice of becoming a neurosurgeon in the western region of Saudi Arabia.

Background: The preference of medical specialty for students can start even before enrollment into medical school, or as late as following their graduation. During their senior years, students often get a prospective on the working environment and the difficulties faced in the field. This, along with other factors, can strongly alter their career choice. This study aims to explore the degree of interest in neurosurgical specialty among medical students and the factors influencing their choice of becoming a neurosurgeon in the western region of Saudi Arabia. Methods: This is a cross-sectional study which was done across three universities of the western region of Saudi Arabia including King Saud bin Abdulaziz University for Health Sciences, Umm Al Qura University, and King Abdulaziz University. Results: A sample of 1023 students from the second medical year up to the internship was conducted, and out of them, 585 (57.2%) were males and 438 (42.8%) were females. Three hundred and fifty-nine (35.1%) of the students were interested in neurosurgery, while 664 (64.9%) were not. The data show that females have more interest (40.8% of females) compared to males (35.1% of males). Furthermore, there was a general trend toward a decrease in the interest in neurosurgery with time. The impact on patients "rewarding feeling" was the most reported attraction to the specialty, followed by income. Stress was the most reported deterring factor among students. Neurosurgery is one of the most challenging specialties, yet it is still considered one of the most competitive ones. Conclusion: Many factors have been found to influence medical students' choices to apply for neurosurgical training as we described. Interestingly, we noted higher interest among female students, and among college freshmen compared to their counterparts. Further studies should be conducted on a larger scale to analyze these findings.

Cervical Spinal Cord Ischemic Reperfusion Injury: A Comprehensive Narrative Review of the Literature and Case Presentation.

Cervical spinal ischemic reperfusion injury (CSIRI) refers to a state of sudden neurological deterioration after surgical spinal decompression. The CSCIRI refers to a state of sudden neurological deterioration after surgical spinal decompression. The pathophysiology is hypothesized to be due to instant relief of a chronically compressed spinal cord, leading to an inflammatory cascade named ischemic reperfusion injury. Deterioration of neurological function after cervical spine decompression surgery often occurs secondary to direct cord injury, compressing hematoma, or hardware failure. Complete loss of neurological function with no organic explanation is an extremely rare complication, with only a few cases reported in the literature. We are reporting a 67-year-old male patient diagnosed with severe cervical spinal canal stenosis at level C5/6 who underwent anterior cervical discectomy and fusion (ACDF). The patient developed complete transient loss of neurological functions after the surgery and was labeled as a case of CSCIRI after excluding compressing pathology. A literature review of the CSCIRI was carried out, and ten articles were included. Due to the rarity of these cases, there is no class 1 or 2 evidence to establish management protocol nor identifiable risk factors to predict their occurrence. However, we recommend using an intra-operative neurophysiology monitor in cases with long-standing severe cervical canal stenosis with myelomalacia and managing these cases according to the acute spinal cord injury management protocol after excluding compressing pathologies.

Attrition and Success Rates in the Saudi Board of Neurosurgery: Analysis of 115 Consecutive Residents Who Started Training From 2001 to 2014.

Objectives At present, the literature lacks data on the outcome of neurosurgery training programs in the Middle East. In this study we aim to assess the attrition, completion of training and success rates in the Saudi Board of Neurosurgery (SBNS). Methods A cohort of 115 trainees who started SBNS training during 2001-2014 was reviewed. The outcome was the rate of attrition, completion of training, and success in the final examination of the SBNS. Results Attrition rate was 29% (14% to neurosurgery training elsewhere and 15% to non-neurosurgery). Completion of training rate was 71%. Success in the final examination rate was 74% (60% on the first attempt). Attrition rate was significantly influenced by being sponsored by University Hospitals. Success rate was impacted positively by being sponsored by King Fahad Medical City and negatively by Ministry of Health Hospitals. Trainees who started during 2011-2014 had a significantly better success rate in the final examination. Conclusions SBNS attrition rate was high due to access to training opportunities abroad, particularly for university-sponsored trainees. Success rate in the final examination was considered comparable to some other neurosurgical qualifications. The first attempt pass rate was significantly impacted by being sponsored by certain hospitals. Factors contributing to attrition and failure should be identified and addressed during the selection process and during training.

De novo Craniopharyngioma of the Fourth Ventricle: Case Report and Review of Literature.

Craniopharyngiomas usually involve the sella and suprasellar space. Their occurrence in the posterior fossa without extension to the suprasellar region is uncommon with only 16 cases reported in the literature. We report a case of a primary posterior fossa craniopharyngioma that was managed by complete excision with a good recovery. Our case was unique in that the craniopharyngioma occurred in the fourth ventricle and extended downward to the level of C1, a manifestation that was reported only twice in the past. The literature on the topic is reviewed.