World Neurosurg
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Early exposure to neurosurgery during medical school is critical to improving recruitment into the specialty. About 30% of medical schools in the U. S. lack a home program in neurosurgery, thereby, limiting their exposure to the field of neurosurgery. ⋯ We identified 16 resources through a database search and through popular social media platforms. Nine out of 16 resources were video based, and 2 utilized the concept of spaced repetition through flashcards. Our review describes these educational resources and aims to serve as a guide for medical students interested in neurosurgery.
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Meta Analysis
Safety and Accuracy of Robot-Assisted Cervical Screw Placement: A Systematic Review and Meta-Analysis.
The purpose of this study was to compare the accuracy and safety of robot-assisted (RA) cervical screw placement with conventional freehand (FH) technique. ⋯ RA surgery significantly improves the accuracy of cervical screw insertion and offers potential advantages in terms of reduced complications and blood loss, shorter hospital stays, and decreased radiation exposure. However, the impact on operative time remains uncertain. Further high-quality studies, including large-scale randomized controlled trials, are needed to strengthen the evidence base.
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Meta Analysis
Management of Atypical Teratoid/Rhabdoid Tumors in the Pediatric Population: A Systematic Review and Meta-Analysis.
Atypical teratoid/rhabdoid tumors are rare and aggressive tumors that mainly affect children <3 years of age. Despite aggressive treatment, the overall survival rate for pediatric atypical teratoid/rhabdoid tumors remains poor. Due to their rarity, little is known regarding prognostic factors, and there is no official standard of treatment. ⋯ The results of this study indicate that while surgery is a crucial treatment modality for pediatric atypical teratoid/rhabdoid tumors, the effect of extent of resection is unclear. Multimodal therapy including surgery, radiotherapy, and chemotherapy is effective in improving overall survival. Future studies should focus on using larger datasets to efficiently account for confounding factors and biases.
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Idiopatic normal pressure hydrocephalus (iNPH) is a progressive neurologic syndrome featured by the triad of gait disturbance, mental deterioration and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. The clinical presentation may be atypical or incomplete, or mimicked by other diseases, so conventional neuroradiologic imaging plays an important role in defining this pathology. iNPH pathophysiologic mechanisms have not yet been fully elucidated, although several studies have demonstrated the involvement of the glymphatic system, a highly organized fluid transport system, the malfunction of which is involved in the pathogenesis of several disorders including normotensive hydrocephalus. ⋯ iNPH can represent a real diagnostic challenge; a proper correlation among clinical features, traditional MRI, and CSF dynamics analysis can lead to a correct diagnosis.
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Case Reports
Bypass Surgery for Vertebral Artery and PICA Fusiform Aneurysms: Surgical Technique and Key Lessons.
Fusiform vertebral artery (VA) aneurysms are challenging to treat due to their pathophysiology, morphology, and anatomic location.1,2 Endovascular treatments are considered to be a widely adopted safe option for this pathology.1 Open microsurgical treatment is considered for complex anatomy, important branch involvement, poor collateral flow, or failed endovascular therapy.3-7 This report aims to show the flow-replacement strategy and bypass technique for a VA aneurysm with complex anatomy and branch involvement. A 24-year-old man presented to our clinic with a bilateral fusiform VA aneurysm discovered during workup of progressive headaches. Further investigation revealed that the left-side aneurysm was mostly thrombosed and the posterior inferior cerebellar artery arose from the aneurysm dome with a fusiform enlargement within a few millimeters from the branching point. ⋯ Antegrade flow to the distal VA was reestablished using a radial artery interposition graft, thus preventing any flow alterations that may cause growth or rupture of the contralateral aneurysm caused by increased hemodynamic stress if the ipsilateral VA flow is not preserved.8 After in-hospital physical rehabilitation, the patient was discharged with a modified Rankin Scale score of 1. The contralateral aneurysm is managed with serial imaging and treatment will ensue if there is clinical-radiologic evolution. The patient consented to the procedure and publication of his image.