Gerstmann Syndrome: What is the Possible Role of Deep Brain Stimulation?

Gerstmann syndrome, characterized by a tetrad of symptoms, which are agraphia, acalculia, left-right disorientation, and finger agnosia, presents challenges in both understanding its pathophysiology and establishing effective treatment modalities. Neuroanatomical studies have highlighted the involvement of the dominant parietal lobe, particularly the inferior parietal lobule, in the development of Gerstmann syndrome. Although current treatment options are largely supportive, recent research suggests a potential role for deep brain stimulation (DBS) in managing this condition. DBS, known for its efficacy in various neurological disorders, has been hypothesized to modulate neuronal pathways associated with Gerstmann syndrome. However, clinical evidence supporting DBS in Gerstmann syndrome remains scarce, posing challenges in patient selection and ethical considerations. Future research should prioritize investigating the efficacy and safety of DBS in Gerstmann syndrome to improve patient outcomes and quality of life.

The Prognostic Utility of Frailty on the Outcomes of Primary Brain Tumor Surgery Patients: A Meta-Analysis.

BACKGROUND: Frailty refers to a state of weakness that can arise due to age or illnesses, and frailty predisposes individuals to several adverse health outcomes. This has been postulated to prognosticate the outcome of various surgeries, including surgeries for primary brain tumors; however, no meta-analysis has validated this finding. METHODS: We conducted a systematic review and meta-analysis to investigate the prognostic utility of frailty for the outcome of primary brain tumor surgery. We performed a systematic search of the PubMed, EMBASE, and SCOPUS databases for studies investigating the ability of frailty to predict the outcome of primary brain tumor surgery. RESULTS: Meta-analysis of the information provided in the thirteen studies that made up our sample. Hospital length of stay (effect size 0.94; 95% confidence interval [CI]: 0.37, 1.51; p: 0.00), postoperative complications (effect size 10.31; 95% CI: -5.88, 26.86; p: 0.21), readmission (effect size 0.82; 95% CI: 0.23, 1.41; p: 0.01), nonroutine discharge (effect size 1.07; 95% CI: 0.48, 1.65; 0.00), postoperative mortality (effect size 1.48; 95% CI: 0.81, 2.02; p: 0.00), and overall survival (effect size 1.53; 95% CI: 0.29, 2.76; p: 0.02). CONCLUSIONS: This study showed little correlation with postoperative mortality, readmission, nonroutine discharge, length of hospital stay, or overall survival, and fragility had less significance in these areas but showed no statistical significance in predicting postoperative complications following surgery for primary brain tumors.

The outcomes of peripheral nerve surgeries in Africa: Narrative synthesis from existing literature.

BACKGROUND: In Africa, peripheral nerve pathologies are a major source of disability, and the results of surgical therapies differ greatly among countries. The goal of this narrative review is to compile the most recent data on peripheral nerve surgery results in Africa, pinpoint critical variables that affect surgical outcomes, and offer suggestions for enhancing patient care. METHODS: A comprehensive literature review was conducted, focusing on studies published over the past four decades. The sources included peer-reviewed journals, hospital records, and reports from healthcare organizations. The review examined outcomes related to functional recovery, quality of life, and postoperative complications. RESULTS: The outcomes of peripheral nerve surgeries in Africa are influenced by the availability of medical infrastructure, the level of surgeon expertise, and the timeliness of the intervention. Urban centers with better resources tend to report more favorable outcomes, whereas rural areas face significant challenges. Common barriers include limited access to advanced surgical tools, a shortage of specialized surgeons, and inadequate postoperative care and rehabilitation services. Despite these challenges, successful interventions have been reported, particularly in settings where targeted training programs and international collaborations are in place. CONCLUSION: Enhancing surgeon training programs, building comprehensive postoperative care and rehabilitation facilities, and investing in healthcare infrastructure are critical to improving peripheral nerve surgery results in Africa. International and regional collaborations can be extremely helpful in advancing these initiatives by enabling the sharing of knowledge and granting access to cutting-edge methods. Patients with peripheral nerve injuries across the continent may experience improved functional recovery and overall quality of life if these criteria are met.

The prognostic utility of neutrophil-lymphocyte ratio in spinal surgery: A systematic review and meta-analysis.

PURPOSE: Neutrophil-lymphocyte ratio (NLR) is reportedly an effective prognostic tool across various medical and surgical fields, but its value in spinal surgery is unestablished. We aim to investigate the relationship between elevated baseline/postoperative NLR and patient outcomes in spinal surgery. MATERIALS AND METHODS: We performed a systematic search in PubMed, EMBASE, and SCOPUS databases for studies investigating the prognostic value of NLR in spine patients.Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were analysed on the RevMan 5.4 software. Where meta-analysis was not possible, we vote-counted the direction of the effect of elevated NLR. The GRADE framework for prognostic factor research was utilised to assess the certainty of the evidence for each outcome measure. RESULTS: Five outcome measures (overall survival, mortality, disease-free survival, functional recovery and complications) were assessed across 16 studies involving 5471 patients. Elevated baseline NLR was associated with reduced overall survival (HR: 1.63, 95 % CI: 1.05 - 2.54) (GRADE: low) and worsened functional recovery (OR: 0.93, 95 % CI: 0.87 - 0.98) (GRADE: low). There was no association between baseline NLR and disease-free survival (HR: 2.42, 95 % CI: 0.49 - 11.83) (GRADE: very low) or mortality (OR: 1.39, 95 % CI: 0.41 - 4.75) (GRADE: very low). Elevated NLR levels measured on days 3-4 and days 6-7 postoperatively, but not NLR measured at baseline or on days 1-2 postoperatively, were associated with greater risks of complications (GRADE: low). CONCLUSIONS: NLR is an objective tool with the potential to identify the patients that would benefit from surgery and facilitate shared decision-making.

Navigating Challenges and Embracing Opportunities: The Outlook of Functional Neurosurgery in Africa.

This narrative review explores the current landscape of functional neurosurgery in Africa, focusing on the challenges and opportunities facing the field. Drawing upon existing literature and expert insights, the review highlights the scarcity of resources, including trained personnel, infrastructure, and specialized equipment, as major hurdles impeding the widespread adoption of advanced neurosurgical techniques. Despite these challenges, the review identifies a growing recognition of the importance of functional neurosurgery in addressing neurological disorders prevalent across the continent. Efforts to enhance training programs, establish collaborations with international partners, and leverage technology are discussed as promising strategies to overcome logistical barriers. Moreover, the review underscores the significance of addressing cultural beliefs and stigmas surrounding neurological conditions to ensure equitable access to care and promote acceptance of neurosurgical interventions. By navigating these challenges and embracing emerging opportunities, functional neurosurgery in Africa holds the potential to significantly impact neurological health outcomes and enhance overall well-being.

Surgical outcomes of glioblastoma multiforme in low and middle-income countries: current state and future directions.

Glioblastoma (GBM) is a highly aggressive and deadly brain tumor. The challenges in managing GBM in low- and middle-income countries (LMICs) have been underexplored. This review provides a review of surgical management techniques, challenges, outcomes, and future directions for GBM treatment in LMICs. A search of academic databases yielded studies from various LMICs, focusing on surgical management techniques and their outcomes. The data were analyzed in the context of socio-economic, cultural, and infrastructural factors. Comparative analyses were performed to highlight disparities between LMICs and high-income countries. GBM management in LMICs faces multi-faceted challenges, including healthcare infrastructure deficiencies, delayed diagnosis, high treatment costs, cultural beliefs, and limited research funding. This adversely affects patient outcomes and survival rates. Surgical excision followed by radiation and chemotherapy remains the standard of care, but LMICs have not significantly benefited from recent advancements in GBM management. Intraoperative neurosurgery ultrasound is identified as an affordable and practical alternative for LMICs. Patient outcomes following GBM surgery in LMICs vary widely, making early detection challenging. Cultural sensitivity and ethical considerations are crucial factors in improving healthcare practices. Surgical management of GBM in LMICs is hindered by complex challenges that require multi-faceted interventions. By addressing socio-economic, cultural, and infrastructural factors, LMICs can improve GBM care and outcomes. Raising awareness and advocating for change are crucial steps in this process.

A comprehensive analysis of the triad of frailty, aging, and obesity in spine surgery: the risk analysis index predicted 30-day mortality with superior discrimination.

BACKGROUND CONTEXT: The United States has experienced substantial shifts in its population dynamics due to an aging population and increasing obesity rates. Nonetheless, there is limited data about the interplay between the triad of frailty, aging, and obesity. PURPOSE: To investigate discriminative thresholds and independent associations of the Risk Analysis Index (RAI), Modified Frailty Index-5 (mFI-5), and greater patient age. STUDY DESIGN: An observational retrospective cohort study. PATIENT SAMPLE: We analyzed 49,754 spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. OUTCOME MEASURE: A total of 30-day postoperative mortality. METHODS: Using receiver operating characteristic (ROC) and multivariable (odds ratios [OR] and 95% confidence intervals [CI]) analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age in elderly obese patients who underwent spine surgery. RESULTS: There were 49,754 spine surgery patients, with a median age of 71 years (IQR: 68-75), largely white (82.6%) and male (51.9%). The ROC analysis for 30-day postoperative mortality demonstrated superior discrimination for RAI (C-statistic 0.779, 95%CI 0.54-0.805) compared to mFI-5 (C-statistic 0.623, 95% CI 0.594-0.651) and greater patient age (C-statistic 0.627, 95% CI 0.598-0.656). Multivariable analyses revealed a dose-dependent association and a larger effect magnitude for RAI: frail patients OR: 19.52 (95% CI 18.29-20.82) and very frail patients OR: 65.81 (95% CI 62.32-69.50). A similar trend was observed in the interaction evaluating RAI-age-obesity (p<.001). CONCLUSION: Our study highlights a strong association between frailty and 30-day postoperative mortality in elderly obese spine patients, revealing a dose-dependent relationship. The RAI has superior discrimination than the mFI-5 and greater patient age in predicting 30-day postoperative mortality after spine surgery. Using the RAI in preoperative assessments may improve outcomes and help healthcare providers effectively communicate accurate surgical risks and potential benefits, set realistic recovery expectations, and enhances patient satisfaction.

The outlook of rheumatological care in Africa: Current state, challenges, and recommendation.

There is a gross lack of access to rheumatological access in Africa. For example, the most populous country in the continent, Nigeria, has just 30 rheumatologists serving a population of about 200 million. In Ghana, there are just 2 rheumatologists serving a population of about 28 million people. Unfortunately, the prevalence of rheumatologic and musculoskeletal diseases is on the rise in Africa. The main issues facing rheumatologic care in Africa are inadequate health professionals, inadequate research, and a weak health system. These factors have hindered the progress of rheumatologic care and treatment in the region. Prompt action must be taken in tackling these effects and to achieve better care for rheumatologic patients in Africa. This paper analyzes carefully the current state of rheumatologic care in Africa, identifying the needs for rheumatologic care, determinants of quality of rheumatologic care delivery, and the challenges currently facing rheumatology care in Africa. Also, this review gives some recommendations on ways by which the existing system of rheumatologic care in Africa can be improved.