Search

Introduction: The recent emphasis on simulation-based training in neurosurgery has led to the development of many simulation models and training courses. We aimed to identify the currently available simulators and training courses for neurovascular surgery and endovascular interventions to assess their validity and determine their effectiveness to suggest widespread applicability in educational curricula., Evidence Acquisition: Literature research was performed on academic databases for English language articles that validate simulation or virtual reality intracranial aneurysm models. Studies for neurosurgery and interventional neuroradiology published between January 2011 and January 2021 were included. Each study was assessed according to the Medical Education Research Quality Instrument., Evidence Synthesis: Between January 2011 and January 2021, 44 articles were screened and 12 were identified to be included in our research. The study involved 177 trainers. Participant trainers' characteristics reveal sensible homogeneity between studies. All studies reported a significant improvement in technical outcomes after simulator or virtual reality training. The Medical Education Research Quality Instrument average rate from 12 studies was M=11.7 (range: 8.5-14.5)., Conclusions: Nowadays, the training of a medical doctor in the neurovascular field benefits from modern methods like simulators and virtual reality. With the advent of increasing neurosurgery simulators and training instruments, there is a need for more validity studies. More training tools incorporating full-immersion simulation are recommended to develop a standardized learning curve in neurovascular procedures.

Background: Burnout syndrome (BS) is a common condition among medical professionals. It is composed of 3 different subdimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). In the last years, interest in BS in the neurosurgical community has increased. Here we investigated burnout among neurosurgeons and residents in neurosurgery., Methods: A systematic review with meta-analysis was performed following PRISMA guidelines. A search of bibliographic databases was conducted from study inception to February 2020. A total of 16,377 studies were found. Six articles were included in our final analysis. Their references were checked for additional studies, but none were found., Results: From the initial 16,377 studies identified, only 6 met our inclusion criteria. These studies included a total of 3310 physicians. The general prevalence of BS was 48%. The prevalence in neurosurgeons was 51.1%, higher than that recorded in neurosurgical residents (45.4%). Regarding subdimensions, personal accomplishment seemed to be the most influential factor for burnout development among neurosurgeons (42.57%) and residents (51.56%) alike., Conclusions: Neurosurgery is a rewarding career choice, but numerous challenges and stressors can lead to lower levels of satisfaction and dangerously increased levels of burnout. We hope that our results will generate discussion, raise awareness, stimulate further studies, and lead to programs designed to mitigate excessive stress and burnout in neurosurgeons., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.

Simple Summary: Glioblastoma is a highly aggressive type of brain tumor that is very difficult to treat, and surgery is crucial for improving patient survival. However, there are significant differences in access to brain tumor surgery based on factors like income, location, and available healthcare resources. People in low- and middle-income countries often struggle to receive the surgery they need due to a lack of specialized doctors, inadequate healthcare facilities, and financial challenges. As a result, patients in these regions are often diagnosed later, receive less effective treatment, and have lower survival rates compared to those in wealthier countries. This not only affects the patients but also adds economic and social burdens to their communities. The study calls for urgent actions to address these inequalities through international cooperation, better healthcare policies, and fair distribution of resources, with the goal of improving access to brain tumor surgeries for everyone, no matter where they live. Glioblastoma: a highly aggressive brain tumor, presents substantial challenges in treatment and management, with surgical intervention playing a pivotal role in improving patient outcomes. Disparities in access to brain tumor surgery arise from a multitude of factors, including socioeconomic status, geographical location, and healthcare resource allocation. Low- and middle-income countries (LMICs) often face significant barriers to accessing surgical services, such as shortages of specialized neurosurgical expertise, limited healthcare infrastructure, and financial constraints. Consequently, glioblastoma patients in LMICs experience delays in diagnosis, suboptimal treatment, and poorer clinical outcomes compared to patients in high-income countries (HICs). The clinical impact of these disparities is profound. Patients in LMICs are more likely to be diagnosed at advanced disease stages, receive less effective treatment, and have lower survival rates than their counterparts in HICs. Additionally, disparities in access to surgical care exacerbate economic and societal burdens, emphasizing the urgent need for targeted interventions and health policy reforms to address healthcare inequities. This review highlights the importance of addressing global disparities in access to brain tumor surgery for glioblastoma through collaborative efforts, policy advocacy, and resource allocation, aiming to improve outcomes and promote equity in surgical care delivery for all glioblastoma patients worldwide. [ABSTRACT FROM AUTHOR]

Background and Objectives: The global outbreak caused by the SARS-CoV-2 pandemic disrupted healthcare worldwide, impacting the organization of intensive care units and surgical care units. This study aimed to document the daily neurosurgical activity in Alsace, France, one of the European epicenters of the pandemic, and provide evidence of the adaptive strategies deployed during such a critical time for healthcare services. Materials and Methods: The multicentric longitudinal study was based on a prospective cohort of patients requiring neurosurgical care in the Neurosurgical Departments of Alsace, France, between March 2020 and March 2022. Surgical activity was compared with pre-pandemic performances through data obtained from electronic patient records. Results: A total of 3842 patients benefited from care in a neurosurgical unit during the period of interest; 2352 of them underwent surgeries with a wide range of pathologies treated. Surgeries were initially limited to neurosurgical emergencies only, then urgent cases were slowly reinstated; however, a significant drop in surgical volume and case mix was noticed during lockdown (March–May 2020). The crisis continued to impact surgical activity until March 2022; functional procedures were postponed, though some spine surgeries could progressively be performed starting in October 2021. Various social factors, such as increased alcohol consumption during the pandemic, influenced the severity of traumatic pathologies. The progressive return to the usual profile of surgical activity was characterized by a rebound of oncological interventions. Deferrable procedures for elective spinal and functional pathologies were the most affected, with unexpected medical and social impacts. Conclusions: The task shifting and task sharing approaches implemented during the first wave of the pandemic supported the reorganization of neurosurgical care in its aftermath and enabled the safe and timely execution of a broad spectrum of surgeries. Despite the substantial disruption to routine practices, marked by a significant reduction in elective surgical volumes, comprehensive records demonstrate the successful management of the full range of neurosurgical pathologies. This underscores the efficacy of adaptive strategies in navigating the challenges imposed by the largest healthcare crisis in recent history. Those lessons will continue to provide valuable insights and guidance for health and care managers to prepare for future unpredictable scenarios. [ABSTRACT FROM AUTHOR]

Objective To analytically discuss some protocols in Deep vein thrombosis (DVT)/pulmonary Embolism (PE) prophylaxis currently use in Neurosurgical Departments around the world. Data sources Analysis of the prophylaxis protocols in the English literature: An analytical and narrative review of literature concerning DVT prophylaxis protocols in Neurosurgery have been conducted by a PubMed search (back to 1978). Data extraction 80 abstracts were reviewed, and 74 articles were extracted. Data analysis The majority of DVT seems to develop within the first week after a neurosurgical procedure, and a linear correlation between the duration of surgery and DVT occurrence has been highlighted. The incidence of DVT seems greater for cranial (7.7%) than spinal procedures (1.5%). Although intermittent pneumatic compression (IPC) devices provided adequate reduction of DVT/PE in some cranial and combined cranial/spinal series, low-dose subcutaneous unfractionated heparin (UFH) or low molecular-weight heparin (LMWH) further reduced the incidence, not always of DVT, but of PE. Nevertheless, low-dose heparin-based prophylaxis in cranial and spinal series risks minor and major postoperative haemorrhages: 2–4% in cranial series, 3.4% minor and 3.4% major haemorrhages in combined cranial/spinal series, and a 0.7% incidence of major/minor haemorrhages in spinal series. Conclusion This analysis showed that currently most of the articles are represented by case series and case reports. As long as clear guidelines will not be defined and universally applied to this diverse group of patients, any prophylaxis for DVT and PE should be tailored to the individual patient with cautious assessment of benefits versus risks. [ABSTRACT FROM AUTHOR]

Objective: In emergency care of patients with severe blunt head injury, uncontrollable high intracranial pressure is one of major causes of morbidity and mortality. The purpose of this study was to evaluate the efficacy of aggressive surgical treatment in managing uncontrollable elevated intracranial pressure coupled with early skull reconstruction. Methods: This was a prospective study on a series of 147 consecutive patients, managed according to the same protocol by five different neurosurgical units, for severe head injuries (Glasgow coma scale score ≤8/15 and high intracranial pressure >25 mm Hg) during a five-year period. All patients received a wide decompressive craniectomy and duroplasty in the acute phase, and a cranioplasty was also performed within 12 weeks (median 6 weeks, range 4–12 weeks). Results: The emergency decompressive surgery was performed within 28 hours (median 16 hours, range 6–28 hours) after sustaining the head injury. The median preoperative Glasgow coma scale score was 6/15 (range 3–8/15). At a mean follow-up of 26 months (range 14–74 months) 14 patients were lost to long-term follow-up, leaving only 133 patients available for the study. The outcome was favorable in 89 (67%, Glasgow outcome score 4 or 5), it was not favorable in 25 (19%, Glasgow outcome score 2 and 3), and 19 patients (14%) died. A younger age (<50 years) and earlier operation (within 9 hours from trauma) had a significant effect on positive outcomes (P < 0.0001 and P < 0.03, respectively). Conclusions: A prompt aggressive surgery, including a wide decompressive craniectomy coupled with early cranioplasty, could be an effective treatment method to improve the outcome after a severe closed head injury reducing, perhaps, many of the complications related to decompressive craniectomy. [ABSTRACT FROM AUTHOR]

ABSTRACT: Traditional skin sutures (TSS) and metal skin clips (SC) are the most common devices utilized for closure of surgical incisions. They are safe and effective, although they require instruments to apply them, are time consuming and, above all, create an extra staff and cost burden for removal of sutures/staples. The ideal incision closure should be simple, effective, safe, rapid, inexpensive, painless, cosmetic and bactericidal. The present study was designed to determine the safety and efficacy of N-butyl octyl cyanoacrylate (NCA) tissue adhesive, a liquid bandage surgical product, for wound closure in brain surgery. Our prospective randomized controlled study compared NCA with traditional methods for wound closure in brain surgery. Over a 6-month period, 40 patients who underwent a supratentorial elective craniotomy were enrolled and randomly allocated into two groups. The 20 participants in group A were treated using a new NCA tissue adhesive while the 20 participants in group B were treated using either nylon monofilament, TSS or SC. In the post-operative period and during follow-up, two different nurses (the second nurse was blinded to the closure method used) recorded details regarding wound aspects, complications and patient satisfaction using a modified version of the Hollander Wound Score Scale. We found no difference in the cosmetic outcome of the two groups, or in wound complications rate, but the patient satisfaction score was higher in group A (9.4 vs. 7.1; p <0.005). The mean application time of the tissue adhesive was significantly faster than that of the standard suture (115s vs. 300s; p <0.001); in the skin clips subgroup it was 105s. Our study suggests that the new NCA tissue adhesive is a safe, effective and reliable skin closure for neurosurgical procedures in the supratentorial region; it also achieves optimal cosmetic results, is less time consuming to use and has greater patient satisfaction. However, further studies with a larger number of patients are necessary to corroborate these results. [Copyright &y& Elsevier]

In recent years, introduction of the exoscope system has been responsible for a new era of optics in surgery. Such a system has started to be widely used in neurosurgery. More recently, the exoscope has also been increasingly used for spinal procedures. Thus, we aimed to explore the potential for exoscope-assisted spinal procedures and define the advantages and drawbacks of implementing the system into our daily routine. To achieve the aim of the study, we retrospectively reviewed the case series of patients treated by a senior surgeon and analyzed the results, complications, and operative time. The operating times were compared between the exoscope-assisted procedures and microscope-assisted procedures. A total of 24 spinal procedure were performed with the exoscope in a 2-month period. In this first patient series performed by a single surgeon without experience with the exoscope, the learning curve seemed to be relatively low, with mastery of the instrument achieved after the performance of only a few cases. Comparing the cases after the plateau of the learning curve had been reached with those performed during the still active phase of the learning curve, a significant difference was found in the operative times. No statistically significant difference was detected in terms of blood loss or intraoperative complications. Based on our first experience, use of the exoscope shows promising potential for opening up new frontiers in spinal microsurgery. In addition, it has a low learning curve for experienced surgeons. [ABSTRACT FROM AUTHOR]

Background The incidence of venous thromboembolism (VT) in neurosurgical practice is astonishingly high, representing a major cause of morbidity and mortality. Prophylaxis strategies include elastic stockings, low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) devices. Objective To assess the safety and efficacy of 2 different VT prophylaxis protocols implemented in a European neurosurgical center. Methods All patients admitted for neurosurgical intervention between 2012 and 2016 were stratified as low, moderate, and high risk of VT and received a combination of elastic stockings and LMWH. The protocol was modified in 2014 with the inclusion of perioperative IPC devices for all patients and only in the high-risk group also postoperatively. Results At time of post-hoc analysis, data obtained from patients included in this study before 2014 (Protocol A, 3169 patients) were compared with those obtained after the introduction of IPC (Protocol B, 3818 patients). Among patients assigned to protocol A, 73 (2.3%) developed deep-vein thrombosis (DVT) and 28 (0.9%) developed pulmonary embolism (PE), 9 of which were fatal (0.3%). Among patients assigned to protocol B, 32 developed DVT (0.8%) and 7 (0.18%) developed PE, with 2 eventually resulting in the death of the patient. A post-hoc analysis confirmed that the use of preoperative LMWH was not associated with a statistically significant greater risk of postoperative bleeding. Conclusions This study, despite its limitations of the nonrandomized design, seems to suggest that perioperative IPC devices are a non-negligible support in the prophylaxis of clinically symptomatic DVT and PE. [ABSTRACT FROM AUTHOR]