Reasons for delayed spinal cord decompression in individuals with traumatic spinal cord injuries in Iran: A qualitative study from the perspective of neurosurgeons / 中华创伤杂志(英文版)

PURPOSE@#The median time from the event leading to the spinal cord injury (SCI) to the time of decompressive surgery is estimated to be 6.9 days in Iran, which is much longer than the proposed ideal time (less than 24 h) in published guidelines. The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.@*METHODS@#This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.@*RESULTS@#The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews. Overall, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons. Other notable factors include delay in transferring patients to the trauma center, delay in availability of necessary equipment, and scarce medical personnel.@*CONCLUSION@#In the perspective of neurosurgeons, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.

Morphometric and Topographic Assessment of Foramen Ovale in Skulls of Jharkhand Population

Foramen ovale, situated in the greater wing of sphenoid, posterolateral to the foramen rotundum, transmits the sensory and motor root of mandibular nerve, accessory meningeal artery, emissary vein and lesser petrosal nerve to the infratemporal fossa. The normal shape of the foramen is oval, but its shape and size is quite variable. It plays an important role in the diagnostic and surgical procedures related to the middle cranial fossa. So, knowledge of the variations, dimensions and the topographic location is of importance to the neurosurgeons while dealing with surgeries in this region. Our study aims at finding the morphological variations in shape, dimensions of foramen ovale and its location in relation to the zygomatic arch.METHODSA cross-sectional observational study was carried out over a period of one year from 1/6/2018 to 31/5/2019, on 46 adult human skulls, taken from the department of Anatomy, RIMS, Ranchi. Fully dried, intact, adult human skulls were included in the study. Foramen ovale was observed for variation in shape, size and location. The presence of any accessory bony structure like bony plate, spine or septa was looked for and prevalence noted. The maximum antero-posterior length and width of foramen ovale and its distance from articular tubercle and the anterior root of zygomatic arch were measured using Vernier callipers. Pathologically malformed and damaged skulls were excluded from the study.RESULTSFour types of shapes were observed – oval (76.08%) , almond (5.43%) , semilunar (8.69%) and triangular (9.78%). The mean anteroposterior dimension of foramen ovale was 6.96 ± 1.17 mm (6.89 ± 1.28 mm on the right side & 7.02 ± 1.05 mm on the left side) and the mean transverse dimension was 3.35 ± 0.66 mm (3.25 ± 0.57 mm on the right side, 3.45 ± 0.73 mm on the left side) . The mean distance of foramen ovale from articular tubercle on zygomatic arch was 32.58 ± 1.29 mm (32.41 ± 1.10 mm on the right side, 32.74 ± 1.45 mm on the left side) and from anterior root of zygomatic arch was 24.75 ± 1.70 (23.91 ± 0.85 mm on the right side, 25.59 ± 1.92 mm on the left side).CONCLUSIONSThere is no significant average difference between FO_AP_RT – FO_AP_LT. There is no significant average difference between FO Width_RT - FO_Width_LT. There is a significant average difference between FO to Art. Tubercle Right - FO to Art Tubercle left. There is a significant average difference FO to ant. root Right - FO to ant. root left.

Ponticuli In Atlas Vertebrae And Its Clinical Aspect

Background: Atlas, the first cervical vertebra, has an oblique ligament which bridges the groove for vertebralartery. This ligament may ossify sometimes converting groove into foramen. These foramina are called asponticulus posterior or arcuate foramen of the atlas. The ponticuli can distort vertebral artery. They havetendency to cause vertebra basic insufficiency. During any manipulation of cervical spine, these variations ofatlas should be kept in mind.Objectives: To study the presence of ponticuli, their other features like whether complete or incomplete, unilateralor bilateral, sidedness- right or left.Material and Methods: A total of 50 fully dried adult human atlas were collected from the Department ofAnatomy, Government Medical College, Jammu and from the students of the first year MBBS, Government MedicalCollege, Jammu. Bones were intact and free from osteophytes. The superior surface of posterior arch was observedcarefully in each atlas for presence of ponticulus.Results: In the present study, 50 human atlas vertebrae were observed out of which 4 atlas (8%) had ponticuli. Itwas incomplete in 2 vertebrae (4%) and was complete in 2 atlas vertebrae (4%). It was unilateral in 3 atlasvertebrae (6%) and bilateral in 1 atlas vertebra (2%). 2 ponticuli were on the right side, 1 on left side and 2 werefound on both sides. All were ponticuli posterior except one which was lateral ponticulus.Conclusion: The presence of ponticuli can cause cervical pain and pressurize vertebral artery leading tocerebrovascular accidents. Detailed knowledge about the variations in the cervical region is very helpful toneurosurgeons, orthopaedicians and otolaryngologists to avoid any mishap. Spinal surgeons must be fullyaware about these ponticulus to prevent any complications during surgeries

Geographic Analysis of Neurosurgery Workforce in Korea

OBJECTIVE: In respect of the health and safety of the public, universal access to health care is an issue of the greatest importance. The geographic distribution of doctors is one of the important factors contributing to access to health care. The aim of this study is to assess the imbalances in the geographic distribution of neurosurgeons across Korea.METHODS: Population data was obtained from the National Statistical Office. We classified geographic groups into 7 metropolitan cities, 78 non-metropolitan cities, and 77 rural areas. The number of doctors and neurosurgeons per 100000 populations in each county unit was calculated using the total number of doctors and neurosurgeons at the country level from 2009 to 2015. The density levels of neurosurgeon and doctor were calculated and depicted in maps.RESULTS: Between 2009 and 2015, the number of neurosurgeons increased from 2002 to 2557, and the ratio of neurosurgeons per 100000 populations increased from 4.02 to 4.96. The number of neurosurgeons per 100000 populations was highest in metropolitan cities and lowest in rural areas from 2009 to 2015. A comparison of the geographic distribution of neurosurgeons in 2009 and 2015 showed an increase in the regional gap. The neurosurgeon density was affected by country unit characteristics (p=0.000).CONCLUSION: Distribution of neurosurgeons throughout Korea is uneven. Neurosurgeons are being increasingly concentrated in a limited number of metropolitan cities. This phenomenon will need to be accounted when planning for a supply of neurosurgeons, allocation of resources and manpower, and the provision of regional neurosurgical services.

Geographic Analysis of Neurosurgery Workforce in Korea

OBJECTIVE: In respect of the health and safety of the public, universal access to health care is an issue of the greatest importance. The geographic distribution of doctors is one of the important factors contributing to access to health care. The aim of this study is to assess the imbalances in the geographic distribution of neurosurgeons across Korea. METHODS: Population data was obtained from the National Statistical Office. We classified geographic groups into 7 metropolitan cities, 78 non-metropolitan cities, and 77 rural areas. The number of doctors and neurosurgeons per 100000 populations in each county unit was calculated using the total number of doctors and neurosurgeons at the country level from 2009 to 2015. The density levels of neurosurgeon and doctor were calculated and depicted in maps. RESULTS: Between 2009 and 2015, the number of neurosurgeons increased from 2002 to 2557, and the ratio of neurosurgeons per 100000 populations increased from 4.02 to 4.96. The number of neurosurgeons per 100000 populations was highest in metropolitan cities and lowest in rural areas from 2009 to 2015. A comparison of the geographic distribution of neurosurgeons in 2009 and 2015 showed an increase in the regional gap. The neurosurgeon density was affected by country unit characteristics (p=0.000). CONCLUSION: Distribution of neurosurgeons throughout Korea is uneven. Neurosurgeons are being increasingly concentrated in a limited number of metropolitan cities. This phenomenon will need to be accounted when planning for a supply of neurosurgeons, allocation of resources and manpower, and the provision of regional neurosurgical services.

Indices of agreement between neurosurgeons and a radiologist in interpreting tomography scans in an emergency department / Índice de concordância entre neurocirurgiões e radiologistas na interpretação de tomografias de crânio na emergência

The power of interpretation in the analysis of cranial computed tomography (CCT) among neurosurgeons and radiologists has rarely been studied. This study aimed to assess the rate of agreement in the interpretation of CCTs between neurosurgeons and a radiologist in an emergency department. Method 227 CCT were independently analyzed by two neurosurgeons (NS1 and NS2) and a radiologist (RAD). The level of agreement in interpreting the examination was studied. Results The Kappa values obtained between NS1 and NS2 and RAD were considered nearly perfect and substantial agreement. The highest levels of agreement when evaluating abnormalities were observed in the identification of tumors, hydrocephalus and intracranial hematomas. The worst levels of agreement were observed for leukoaraiosis and reduced brain volume. Conclusions For diseases in which the emergency room procedure must be determined, agreement in the interpretation of CCTs between the radiologist and neurosurgeons was satisfactory. .

O poder de interpretação na análise de tomografias de crânio (TCC) entre neurocirurgiões e radiologistas tem sido pouco estudada. O objetivo deste estudo é avaliar as taxas de concordância na interpretação de TCCs entre neurocirugiões e radiologista em um departamento de emergência. Método 227 TCCs foram independentemente analizadas por 2 neurocirugiões (NC1 e NC2) e um radiologista(RAD). O índice de concordância nas análises foi estudada posteriormente. Resultados O valor de Kappa obtido entre os NC1 e NC 2 e entre estes e RAD foram quase perfeitos e substancial respectivamente. O maiores índices de concordância quando avaliadas anormalidades foram observados na identificação de tumores, hidrocefalia e hematomas intracranianos. O piores índices foram observados com relação a leucaraiose e redução volumétrica. Conclusão Para doenças apresentadas em um departamento emergência que demandam tratamento mais agressivo o índice de concordância na interpretação de TCCs entre RAD e NC foi satisfatório. .

Standards for Endovascular Neurosurgical Training and Certification of the Society of Korean Endovascular Neurosurgeons 2013

The need for standard endovascular neurosurgical (ENS) training programs and certification in Korea cannot be overlooked due to the increasing number of ENS specialists and the expanding ENS field. The Society of Korean Endovascular Neurosurgeons (SKEN) Certification Committee has prepared training programs and certification since 2010, and the first certificates were issued in 2013. A task force team (TFT) was organized in August 2010 to develop training programs and certification. TFT members researched programs and systems in other countries to develop a program that best suited Korea. After 2 years, a rough draft of the ENS training and certification regulations were prepared, and the standard training program title was decided. The SKEN Certification Committee made an official announcement about the certification program in March 2013. The final certification regulations comprised three major parts: certified endovascular neurosurgeons (EN), certified ENS institutions, and certified ENS training institutions. Applications have been evaluated and the results were announced in June 2013 as follows: 126 members received EN certification and 55 hospitals became ENS-certified institutions. The SKEN has established standard ENS training programs together with a certification system, and it is expected that they will advance the field of ENS to enhance public health and safety in Korea.

Percepção da qualidade de vida no trabalho dos neurocirurgiões em São Paulo / Perception on quality of life at work by neurosurgeons in São Paulo

Contexto: Estudos da percepção da qualidade de vida no trabalho (QVT) permitem estimar a percepção de uma classe profissional inteira, identificar desequilíbrios específicos e proporcionar políticas de desenvolvimento profissional. Objetivo: Avaliar a percepção da QVT dos neurocirurgiões que trabalham em Serviços de Emergência em São Paulo usando instrumentos de validação disponíveis na língua portuguesa. Método: A percepção da QVT dos neurocirurgiões da cidade de São Paulo (Capital) foi estudada com questionário validado para língua portuguesa. Resultados: Cinquenta e oito neurocirurgiões responderam ao questionário. A análise revelou fortes tendências negativas na maioria das áreas de QVT. As áreas com forte tendência negativa deveriam ser tratadas com políticas específicas. Conclusão: Há fortes tendências negativas em quase todos os domínios da QVT.

Context: Studies of the perception of quality of work life (QWL) allow estimating the perception of an entire professional class, identifying specific imbalances and provide professional development policies. Objective: To evaluate the perception of QWL of neurosurgeons working in Emergency Services in São Paulo, using available validated instrument in Portuguese language. Method: The city of São Paulo (Capital) was defined as the geographical area to be studied with a validated questionnaire. Results: Fifty-eight neurosurgeons answered the QWL questionnaire revealing strong negative trends in most areas of QWL. These responses can be compared across institutions and over different periods of time, potentially allowing the identification of locations with more suitable development areas related to QWL. To improve the perception of QWL means, areas with strong negative trend should be treated with specific policies. Conclusion: There is strong negative trends in almost all areas of QWL.

Momentos históricos y profesores insignes de la neurocirugía en Camagüey / Historical moments and significant professors of the neurosurgery in Camagüey

Se realizó una investigación cualitativa en el Hospital Universitario Manuel Ascunce Domenech, en Camagüey, durante el año 2011 con el objetivo de describir la historia de la Neurocirugía en la provincia y los momentos más importantes de su desarrollo. Se realizaron entrevistas a personalidades que laboran en el hospital desde su fundación el 14 de enero de 1962, los que aportaron información valiosa para la identificación cronológica de los hechos. Además, se revisaron artículos publicados que ilustraron los principales momentos en el desarrollo de la especialidad. Se pudo determinar que antes del triunfo revolucionario y previo a la inauguración del hospital, la atención neuroquirúrgica especializada en la provincia era muy limitada y los traumatismos craneales eran atendidos fundamentalmente por ortopédicos y cirujanos. En marzo de 1968 se constituyó el servicio provincial de Neurología y Neurocirugía, y a partir de este momento comienza el desarrollo vertiginoso de la especialidad en sus diferentes vertientes: docente, asistencial y científica. Se destacan los resultados alcanzados en la atención al trauma craneoencefálico y a los aneurismas intracraneales así como la introducción de la cirugía estereotáctica para el tratamiento de los tumores malignos del encéfalo. El servicio de Neurocirugía de Camagüey con el decurso de los años se ha consolidado como uno de los polos neuroquirúrgicos de Cuba y como una escuela de neurociencias que ha garantizado la formación de más de treinta especialistas de Neurocirugía para Cuba y el mundo.

Since the foundation of the Neurology Service of the University Hospital Manuel Ascunce Domenech at the end of the decade of the 60, it has kept a sustained development in the different branches of the general neurosurgery, becoming a territorial teaching-assistancial service. The achieved development has been due to the efforts and dedication of its professors staff. Some of them have physically departed but have left their legacy in the new generations of neurosurgeons that continue developing the specialty in the territory. The objective of the current work is highlighting the inestimable work of two eminent Camagüeyan neurosurgeons that marked the development of this specialty out, the professors Enrique Mendoza Rivera and Sergio Vega Basalto. In the same way we mentioned important moments in the advance of our service after its foundation. After 1982 the vascular surgery is potentiated at the expenses of the surgical treatment of the brain aneurisms, the introduction of the computerized axial tomography at the end of the 90s, the application of the stereotactic surgery in the brain tumor treatment and the development of the neurotraumatology, all of them transcendental moments of the Camagüeyan neurosurgery. The results of the medical assistance have been supported by the achievements obtained in the scientific research. The beginning of the endoscopic neurosurgery and the application of the ambulatory surgery for the treatment of the cervical and lumbar disk hernia since 2010 have been the ultimate progress of our service.

Variations in Practice Patterns among Neurosurgeons and Orthopaedic Surgeons in the Management of Spinal Disorders

STUDY DESIGN: This is a case series. PURPOSE: We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders. OVERVIEW OF LITERATURE: Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders. METHODS: A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. The surgeons were working either in private practice or in academic institutions. The details of the questionnaire included demographic details and the specialty (orthopedic/neurosurgeon). The surgeons were classified according to the level of experience as up to 5 years, 6-10 years and > 10 years. Questions were asked about the approach to lumbar discectomy (fragmentectomy or aggressive disc removal), using steroids for treating discitis, the fusion preference for spondylolisthesis, the role of an orthosis after fusion, the preferred surgical approach for spinal stenosis, the operative approach for spinal trauma (early within 72 hours or late > 72 hours) and the role of surgery in complete spinal cord injury. The data was analyzed using SPSS ver 16. p-values < 0.05 were considered to be significant. RESULTS: Of the 30 surgeons who completed the questionnaire, 20 were neurosurgeons and 10 were orthopedic surgeons. Statistically significant differences were observed for the management of spinal stenosis, spondylolisthesis, using an orthosis after fusion, the type of lumbar discectomy and the value of surgical intervention after complete spinal cord injury. CONCLUSIONS: Our results suggest that there continues to exist a statistically significant lack of consensus among neurosurgeons and orthopedic spine surgeons when considering using an orthosis after fusion, the type of discectomy and the value of intervention after complete spinal injury.

Historia de los neurocirujanos argentinos en el mundo: tercera parte / Argentine neurosurgeons in the world: historial prespective: third part

La neurocirugía moderna como disciplina de la medicina y especialidad de la cirugía nació y se desarrolló principalmente en el hemisferio norte durante el siglo XX. Por ello, muchos neurocirujanos sudamericanos, y especialmente argentinos, se entrenaron en centros médicos de gran prestigio en Norteamérica y Europa, y al regresar a sus países de origen fundaron escuelas y centros hospitalarios neuroquirúrgicos importantes. Muchos de sus discípulos, así como otros jóvenes médicos, siguieron los pasos de estospioneros y buscaron nuevos horizontes en otras partes del mundo donde algunos se establecieron ejerciendo con distinción la neurocirugía. En este marco, el presente estudio aborda un conjunto de biografías de destacados neurocirujanos argentinos que ejercieron y aún ejercen la profesión en el exterior. Sus historias, en cuatro entregas de esta revista, dos de ellas ya publicadas, se presentan contextualizadas en el marco histórico de la especialidad. Nuestro propósito es contribuir a la Historia de la Medicina Argentina y estrechar los vínculos de la comunidad neuroquirúrgica argentina en el mundo.

Modern neurosurgery as a discipline of medicine and as a specialty of surgery was born mainly in the northern hemisphere and in the 20th Century. South American pioneers, including Argentine neurosurgeons trained in foreign medical institutions and then came back to start local neurosurgicalcenters and training programs. The 20th Century witnessed the phenomenon of increased migration of peoples. SomeArgentine neurosurgeons established their residence outside Argentina where they practiced and some are still practicing the “Princess of Surgical Specialties”. A brief summary of the 11. Andersen R. Laser Space Experiments Find a Museum Home. OPN 2006; 12-3. http://bit.ly/d58CRW 12. Smithsonian National Air and Space Museum. Laser, JULIE Payload, STS 61-C. http://bit.ly/cQraeY 13. Smithsonian National Air and Space Museum. Container, JULIEGetaway Special, STS 61-C. http://bit.ly/95J0Lm 14. Malis LI. Electrosurgery and bipolar technology. Neurosurgery2006; 58(1 Suppl): 1-12. 15. Camins MB, Moore FM, Carmel PW. Leonard I. Malis, MD, 1919– 2005: “a legend in his own time”. An obituary. J Neurosurg 2006; 104: 332-3 16. Galafassi HD. Ernesto Patricio Dowling: Un Inciador de la Neurocirugía. Rev Argent Neuroc 2004; 18(S1): 24-6. 17. Plot HM. Apuntes para la Historia del Servicio de Neurocirugía del Hospital Pirovano. Rev Argent Neuroc 2007; 21: 201-7.development of neurosurgery in the World, South America, and Argentina was included in the first article. It preceded a number of biographical sketches describing the personal andprofessional lives of some Argentine neurosurgeons throughout the world. This is the third article of four. The last one will include a discussion and conclusions. This contribution addsto the excellent publications dealing with the history of neurosurgeryin Argentina.

Historia de los neurocirujanos argentinos en el mundo: primera parte / Argentine neurosurgeons in the World: historical perspective: first part

La Neurocirugía moderna como disciplina de la medicina y especialidad de la Cirugía nació y se desarrolló principalmente en el hemisferio norte durante el siglo XX. Por ello, muchos neurocirujanos sudamericanos, y especialmente argentinos, se entrenaron en centros médicos de gran prestigio en Norteamérica y Europa, y al regresar a sus países de origen fundaron escuelas y centros hospitalarios neuroquirúrgicas importantes. Muchos de sus discípulos, así como otros jóvenes médicos, siguieron los pasos de estos pioneros y buscaron nuevos horizontes en otras partes del mundo donde se establecieron ejerciendo con distinción la Neurocirugía. En este marco, el presente estudio aborda un conjunto de biografías de destacados neurocirujanos argentinos que ejercieron y aún ejercen la profesión en el exterior. Sus historias, a publicarse en cuatro entregas de esta revista, se presentan contextualizadas en el marco histórico de la especialidad. Nuestro propósito es contribuir a la Historia de la Medicina Argentina y estrechar los vínculos de la comunidad neuroquirúrgica argentina en el mundo.

Modern neurosurgery as a discipline of medicine and as a specialty of surgery was born mainly in the northern hemisphere and in the 20th Century. South American pioneers, including Argentine neurosurgeons got training in foreign medical centers and then founded local neurosurgical centers and training programs. The 20th Century witnessed the phenomenon of the migration of peoples. Some Argentine neurosurgeons established their residence outside Argentina where they practiced and some are still practicing the "Princess of Surgical Specialties". A brief summary of the development of neurosurgery in the World, South America and Argentina precedes the presentation of a list of biographical sketches describing the personal and professional lives of some Argentine neurosurgeons throughout the world. This will be published in four parts. This contribution adds to the excellent publications dealing with the history of neurosurgery in Argentina.

Experiences of Clinical Teaching of Advanced Neurosurgeons / 中华医学教育探索杂志

On the basis of my experiences in advanced neurosurgeons teaching,I realized that it was important to accomplish the following tasks:to make reasonable plan in advanced teaching,to constitute strict rules,to attach importance to clinical neuroanato- my teaching,to cultivate clinical ability,and to strengthen medical morality construction.Only by doing these can we improve the advanced education quality.