Adequate control of seizures in a case of lead migration and neuromodulation of the posterior Sylvian junction: A case report.

Background: This report aims to describe the neuromodulation effect on seizure control in a patient with a left hippocampal migrated electrode to the Posterior Sylvian Junction (PSJ) during a follow-up of 17 years. Case Description: We report a case of a female patient with drug-resistant epilepsy who initiated at seven years old and underwent a stereotactic frame-based insertion of a left hippocampal electrode for deep brain stimulation (DBS). Posterior migration of the electrode was identified at PSJ by postoperative magnetic resonance imaging one month after surgery. A consistent seizure reduction (Engel IC) was obtained with 2v-120 uS-145 Hz, contacts 0-3 negative, casing positive DBS parameters and maintained to this day. Patient data were collected from electronic medical records preceded by obtaining an informed consent for research and publication purposes. Stimulation parameter adjustments were confirmed with the digital records of the local device provider (Medtronic). Results: PSJ is a connectivity confluence point of white matter pathways in the posterior quadrant of the hemispheres. White mater DBS could be considered for research as a potential complementary target for neuromodulation of refractory epilepsy.

Microsurgical and illustrative anatomy of the cavernous sinus, middle fossa, and paraclival triangles: a straightforward, comprehensive review.

The middle fossa, cavernous sinus, and paraclival triangles consist of ten triangles. Their use in a surgical approach is vast; most are used as landmarks to access and identify other structures of surgical interest. Multiple labels, borders, and contents mentioned by different authors make understanding and reproduction challenging and confusing. This study aims to organize and clarify recent or most relevant publications and disclose our portrayal of the ten triangles using cadaveric dissection and simple and practical figures. Four middle fossa triangles, four cavernous sinus triangles, and two paraclival triangles were dissected and delineated in a cadaveric specimen. Drawings were simplified to eliminate confusion and evaluate the triangles effortlessly. Similarities and differences in triangle names, border limits, and contents are described in a precise form. The recognition of triangle landmarks allows for treating pathologies in a frequently distorted anatomy or challenging to access structure. That is why an accurate knowledge of the surgical anatomy should be mastered, and a safe approach should be accomplished.

Prevalence and factors associated with the depressive symptoms in rural and urban Mexican older adults: evidence from the Mexican Health and Aging Study 2018.

OBJECTIVE: To determine the prevalence and factors related to depressive symptoms in older Mexican adults in urban and rural areas. MATERIALS AND METHODS: Cross-sectional study. We examined older adults from a sample taken from the Mexican Health and Aging Study (MHAS-2018). 14 230 older Mexicans were screened for self-reported depressive symptoms. RESULTS: The prevalence of depressive symptoms was 29.8% (33.4% rural vs. 28.9% urban). In the rural and urban population, the probability of a high prevalence of depressive symptoms was higher in older adults with multimorbidity ≥3, severe pain, and fair/poor SRH. Only in the urban population the prevalence of depressive symptoms increased with lower schooling. CONCLUSION: Identification of the factors related to depressive symptoms may help healthcare professionals provide better treatment for specific groups in the population.

Burnout, Discrimination, Abuse, and Mistreatment in Latin America Neurosurgical Training During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Discrimination, abuse, and mistreatment are prevailing problems reported in neurosurgical training programs globally. Moreover, the current coronavirus disease 2019 (COVID-19) pandemic may also show a negative impact on burnout levels in neurosurgery residents. This study aims to evaluate burnout, discrimination, and mistreatment in neurosurgical residents training in Latin America during the severe acute respiratory syndrome coronavirus 2 era. METHODS: A 33-item electronic survey was sent to neurosurgery residents from Latin America from May 10 to 25, 2021. Statistical analysis was performed using SPSS version 25. RESULTS: A total of 111 neurosurgery residents responded to the survey. Mean age was 29.39 ± 2.37 years; 22.5% were female and 36% were training in Mexico. Residents who reported experiencing discrimination for testing positive to COVID-19 had the highest levels of depersonalization (66.7%; P = 0.043) and emotional exhaustion (75%; P = 0.023). Female respondents reported higher rates of gender discrimination (80% vs. 1.2%; P = 0.001), abuse (84% vs. 58.1%; P < 0.005), and sexual harassment (24% vs. 0%; P < 0.001) than did male respondents. Residents training in Mexico reported lower rates of emotional or verbal abuse (59.2% vs. 32.5%; P = 0.007) and bullying (P < 0.005) than did those in other countries in Latin America. Older age was a protective factor for high depersonalization scores (odds ratio [OR], 0.133; 95% confidence interval [CI], 0.035-0.500). Experiencing discrimination represented a risk factor for presenting high emotional exhaustion scores (OR, 3.019; 95% CI, 1.057-8.629). High levels of depersonalization were associated with a 7-fold increased risk of suicidal ideation (OR, 7.869; 95% CI, 1.266-48.88). CONCLUSIONS: The COVID-19 pandemic has been a significant burden on several aspects of health care workers' lives. Our results provide a broad overview of its impact on burnout, discrimination, and mistreatment as experienced by neurosurgery residents training in Latin America, laying the groundwork for future studies and potential interventions.

Neurosarcoidosis Presentation as Adipsic Diabetes Insipidus Secondary to a Pituitary Stalk Lesion and Association with Anti-NMDA Receptor Antibodies.

Sarcoidosis is a multisystemic inflammatory disease of unknown cause. It is characterized by the presence of noncaseating granuloma on a biopsy specimen. Clinical presentation varies across case report series with myriad of symptoms ranging from fever, respiratory symptoms, and skin lesions, or atypical symptoms like heart block or neurological symptoms. Hence, we report the case of a 22-year-old woman with encephalitis, a pituitary mass, and adipsic diabetes insipidus. The diagnostic approach did not end on the biopsy of the lesion, which reported noncaseating granulomas; on the contrary, it was the beginning of a path to exclude other causes of the central nervous system granulomas that ended with the diagnosis of the isolated central nervous system sarcoidosis. Also, we report the first proven association between anti-NMDA receptor antibodies and sarcoidosis.