Neurosurgical Advocacy in the Prevention of Neural Tube Defects: Impacting Global Fortification Policies Through Leadership, Collaboration, and Stakeholder Engagement.

The G4 Alliance and its member organizations formed a delegation that participated in the 76th World Health Assembly (WHA) in 2023, which unanimously adopted the resolution to address micronutrient deficiencies through safe, effective food fortification to prevent congenital disorders such as spina bifida and anencephaly, the first neurosurgery-led resolution since the founding of the World Health Organization. The WHA included other resolutions and side events by the G4 Alliance and other organizations relevant to neurosurgery. An opportunity exists for neurosurgeons to harness the momentum from this resolution to promote initiatives to prevent neurosurgical disease or expand access to neurosurgical care.

Education and Training in Global Neurosurgery: Current State and Path Toward a Uniform Curriculum.

Education is a sustainable long-term measure to address the global burden of neurosurgical disease. Neurosurgery residencies in high-income countries are accredited by a regional governing body and incorporate various educational activities. Few opportunities for training may be present in low-income and middle-income countries due to a lack of neurosurgery residency programs, tuition, and health care workforce reductions. Core components of a neurosurgical training curriculum include operative room experience, clinical rounds, managing inpatients, and educational conferences. A gold standard for neurosurgical education is essential for creating comprehensive training experience, though training must be contextually appropriate.

Venous thromboembolism in neurologic disease.

Patients with neurologic disease are at high risk of venous thromboembolism (VTE) because of relative immobility. They are also at increased risk due to the presence of a hypercoagulable state. Patients with spinal cord injuries, brain tumors, and strokes are at particularly high risk and extra vigilance is needed in these patients. Because VTE is very common in hospitalized neurologic and neurosurgical patients, mechanical thromboprophylaxis is indicated in virtually all patients. Pharmacologic prophylaxis with either subcutaneous heparin or low molecular heparinoids should be given to all high-risk neurologic and neurosurgical patients provided there are no major contraindications. The major concern would be a risk of bleeding but in some patients alternate drugs must be considered given the risk of thrombosis (i.e., in the context of heparin-induced thrombocytopenia). The immediate or long-term treatment of full dose anticoagulation for VTE may not be appropriate in all patients as VTE therapy represents a balance between the risks of bleeding related to anticoagulant therapy versus the risk of recurrent events. An inferior vena cava (IVC) filter is another option in these patients but may not necessarily be the best choice for most neurologic patients. Given the high risk of VTE in patients with neurologic diseases, early recognition by clinicians of the signs and symptoms of VTE is essential.

Application of a population pharmacokinetic model for vancomycin in patients with severe neurosurgical disease / 中国感染与化疗杂志

Objective This study was designed to validate the utility of a population pharmacokinetic model established for vancomycin in patients with severe neurosurgical disease . Methods The clinical data including patient gender , age , body weight ,serum creatinine and albumin were collected retrospectively from patients in Nanjing Drum Tower Hospital to calculate the steady trough concentration of vancomycin using the previously established pharmacokinetic model .The predicted value was compared with the actual value .Results During the period from March 2013 to March 2014 ,53 blood samples with serum trough concentration of vancomycin were collected from 42 patients .The average trough concentration of vancomycin was 10 .9 mg/L (range from 1 .6 to 49 .1 mg/L) .The predicted trough level of vancomycin based on the population pharmacokinetic model was significantly correlated to the actual value(r=0 .857 ,P<0 .001) .The mean absolute percentage error was 0 .407 9 . The confidence interval was 9 .36‐14 .07 for the predicted values ,and 8 .92‐14 .32 for the actual values .Conclusions The pharmacokinetic model is valid and useful for planning intravenous dose of vancomycin in patients with severe neurosurgical disease .Large error (about 30% ) was observed in estimation of body weight due to coma .Reduced renal function following contrast agent and/or diuretic drug has an impact on the predicted results . The accuracy of prediction can be increased to nearly 70% after adjusting the covariates .

The Emotional Distress Prior to the Surgery and the Parenting Stress in Elementary School Children with Neurosurgical Diseases: The Preliminary Study

OBJECTIVES: This study was conducted to compare emotional problems in children with neurosurgical diseases prior to surgery as well as levels of parenting stress experienced by mothers of children treated with surgery and those without surgery. The goals was to provide a basis on which comprehensive treatment interventions could be established. METHODS: Subjects included 78 elementary school children who visited the Department of Pediatric Neurosurgery as well as their mothers. The Children's Depression Inventory (CDI) and the Revised Children Manifest Anxiety Scale (RCMAS) were administered to children. The Parenting Stress Indexs (PSI) and Beck Depression Inventory (BDI) were administered to their mothers. RESULTS: The children with neurosurgical diseases showed higher levels of depression prior to surgery. In their mothers, parenting stress was relatively higher and parenting competence was lower. In particular, for those children who underwent surgery, depression was significantly higher. Specifically, they exhibited more negative expectations, and negative self-image. In mothers of children who underwent surgery, depression was significantly higher. CONCLUSION: Our results suggest higher levels of emotional distress and parental stress in children who undergo neurosurgical operations and their mothers, respectively. Based on this, the necessity for surgical and comprehensive psychological intervention is suggested.

Clinical Analysis of Pediatric Neurosurgical Diseases

The authors analyzed pediatric(under 15-year of age) neurosurgical disease patients admitted to the Department of Neurosurgery, Yeungnam University Hospital during the 6-year period from May 1983 to April 1989. The results were as follows : 1) Among the total 5,007 neurosurgical admission cases during this period, pediatric cases were 573(11.4%). 2) The total pediatric cases consist of traumatic(80.1%), tumor(5.9%), congenital anomaly(3.1%), infection(3.1%), vascular anomaly(2.1%) and miscellaneous(5.6%) lesions. 3) The male to female ratio was 1.67 : 1 in trauma. 4) The most common age of trauma are 3 to 8 years. 5) The incidence of trauma was relatively common in spring and autumn. 6) The traffic accident is most common cause of pediatric trauma. 7) The contusion case with GCS 9 to 15 revealed good result. 8) 23.1% of 108 intracranial hematoma had no skull fracture. 9) Mortality in trauma was relatively low(1.8%) compared to adult.