Best evidence summary of nutrition management in patients of acoustic neuroma during the perioperative period / 中国实用护理杂志

Objective:To summarize and evaluate the best evidence of perioperative nutrition management for patients with acoustic neuroma, and to provide evidence-based basis for clinical nurses.Methods:BMJ best clinical practice, UpToDate, Cochrane Library, Guidelines International Network, Scottish Intercollegiate Guidelines Network, the official website of Ontario Registered Nurses Association, JBI Australian evidence-based health care center, PubMed, Embase, CINAHL, Yimaitong, Chinese biomedical literature database, CNKI, Wanfang database and other domestic and foreign databases related to clinical practice guidelines, expert consensus, evidence summary, systematic evaluation, sysmtem analysis, clinical randomized scientific control were seached. The retrieval time was limited from June 1st, 2013 to June 1st, 2023. Evaluated the quality of the included literatures, and conduct evidence extraction, grade evaluation and summary analysis.Results:A total of 17 literatures were included, including 5 guidelines, 6 expert consensus, 2 best practices and evidence summary, 2 system evaluation and 2 randomized scientific control. A total 27 of best evidence was formed, covering five aspects: nutrition management team construction, screening and evaluation of nutrition and dysphagia, timing and implementation of nutrition support, specific measures of nutrition management, continuous nutrition management after discharge.Conclusions:This study summarized the best evidence of perioperative nutritional management of acoustic neuroma, and provides evidence-based basis for clinical nurses. However, its recommendations are not specialized, some of them are controversial, and come from many countries. In clinical practice, we should make a comprehensive analysis in combination with the actual clinical situation and other relevant factors, and make some choices, so as to promote the improvement of clinical nursing quality.

Evaluation of the retention effect of nasointestinal canal indwelling in severe neurosurgical patients guided by miniature visualization system / 中国实用护理杂志

Objective:To investigate the feasibility, safety and reasonable operation of nasointestinal canal indwelling guided by miniature system in severe neurosurgery patients, and compare its advantages and disadvantages with traditional blind insertion.Methods:A prospective randomized controlled trial design was used to select 128 critically ill patients in need of enteral nutrition support at the Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from March 2022 to October 2023 by convenient sampling method. They were divided into blind insertion group and visualization group by random number table method, with 64 cases in each group. Nasointestinal canal indwelling was performed in the blind insertion group by traditional blind insertion method, and in the visualization group, nasointestinal canal indwelling was performed by indentations guided by the miniature visualization system. The success rate of initial catheterization, the time of catheterization, complications, changes of vital signs during catheterization and changes of nutritional indexes after catheterization were evaluated in 2 groups.Results:In the blind insertion group, there were 35 males and 29 females, aged (59.44 ± 13.84) years old. In the visualization group, there were 41 males and 23 females, aged (58.28 ± 12.08) years old. The success rate of the first catheter placement in the visual group was 96.8% (62/64), higher than that in the blind group 82.8% (53/64), and the difference was statistically significant ( χ2=6.94, P<0.05). The catheter placement time of the visualization group was (20.08 ± 2.69) min, which was shorter than that of the blind insertion group (38.19 ± 3.79) min, and the difference between the two groups was statistically significant ( t=29.99, P<0.05). There was no significant difference in the incidence of complications, changes of vital signs during catheterization and the changes of nutritional indexes after catheterization between two groups (all P>0.05). Conclusions:Compared with traditional blind nasointestinal canal indwelling, nasointestinal canal indwelling guided by the miniature visualization system can improve the success rate of the first catheterization and shorten the catheterization time. Although there is no difference in the complication rate, changes in vital signs during catheterization and changes in nutritional indexes after catheterization, it is believed that with the continuous development and upgrading of this technology, it will further reflect the advantages of this technology, which is worthy of further clinical trials and application.

Construction and application of a mixed-reality distance teaching model in neurosurgery / 中华医学教育探索杂志

Objective:To explore the application effects of a neurosurgical mixed-reality distance teaching (NMDT) model in standardized residency training in neurosurgery.Methods:We built an NMDT system using mixed-reality technology and remote interaction technology, and designed the implementation procedure according to the teaching objectives. After the teaching activities were completed, a teaching satisfaction questionnaire survey was conducted among 20 neurosurgery resident trainees, in which they provided satisfaction scores for the same teaching content with different teaching models (i.e., the NMDT model and traditional teaching model). SPSS 22.0 software was used to perform the t test for data analysis. Results:There were significant differences between the NMDT model and the traditional teaching model in key indicators including the score for "completion of teaching objectives" (9.20±0.68 vs. 8.25±0.70, P<0.001) and the score for "satisfaction with learning gains" score (8.95±0.67 vs. 8.05±0.92, P=0.001). The NMDT model also outperformed the traditional teaching model in the other individual scores and the total score. Conclusions:The NMDT model can improve teaching quality, increase training efficiency, and enrich teaching content, which is worthy of promotion.

Fundamentals of deep brain stimulation for Parkinson's disease in clinical practice: part 1 / Princípios da estimulação cerebral profunda na doença de Parkinson na prática clínica: parte 1

Abstract Deep brain stimulation (DBS) is recognized as an established therapy for Parkinson's disease (PD) and other movement disorders in the light of the developments seen over the past three decades. Long-term efficacy is established for PD with documented improvement in the cardinal motor symptoms of PD and levodopa-induced complications, such as motor fluctuations and dyskinesias. Timing of patient selection is crucial to obtain optimal benefits from DBS therapy, before PD complications become irreversible. The objective of this first part review is to examine the fundamental concepts of DBS for PD in clinical practice, discussing the historical aspects, patient selection, potential effects of DBS on motor and non-motor symptoms, and the practical management of patients after surgery.

Resumo Nas últimas três décadas, a estimulação cerebral profunda (ECP) se tornou um tratamento bem estabelecido para doença de Parkinson (DP) e outros transtornos do movimento. A eficácia a longo prazo na DP foi bem documentada para a melhora dos sintomas motores cardinais da DP e das complicações induzidas pelo uso do levodopa, como as flutuações motoras e as discinesias. O momento da seleção do paciente é crucial para se obter os benefícios ideais da ECP, antes que as complicações da DP se tornem irreversíveis. O objetivo desta primeira parte da revisão é examinar os conceitos fundamentais da ECP na prática clínica, discutindo os aspectos históricos, a seleção de pacientes, os potenciais efeitos da ECP nos sintomas motores e não motores da doença e o manejo prático dos pacientes após a cirurgia.

The Role of Sodium and Glucose in the Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage: A Literature Review of New Evidence / O papel do sódio e da glicose no prognóstico de pacientes com hemorragia subaracnóidea aneurismática: Uma revisão de literatura das novas evidências

The present study aims to review the influence of glycemia and natremia on the propensity to develop complications, worse prognosis, and mortality risk in patients with aneurysmal subarachnoid hemorrhage (aSAH). This is an integrative literature review guided by the guiding question: "Do changes in blood glucose levels or plasma sodium concentration influence in-hospital morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage?". The search for articles was performed on the PubMed platform, limiting the selection to works published in English in the period from 2017 to 2022. The results found demonstrate that the role of sodium ions in changes in the prognosis of patients is complex, with hypernatremia being the main factor described to worse outcomes. In contrast, the part of hyponatremia is controversial and may not have prognostic value, and serum sodium concentration is increasingly an important item to be evaluated in patients with aSAH. As for glucose, the variability of this substrate, both hyperglycemia and hypoglycemia, may be correlated with in-hospital and long-term mortality in patients with aSAH. Thus, the present study concludes that changes in blood glucose values and plasma sodium concentration influence the in-hospital morbidity and mortality of patients with aSAH. However, it is emphasized that the analysis of the independent influence of each of the related predictors must be done with caution due to the heterogeneity of the results found.

O presente estudo tem como objetivo a revisão da influência da glicemia e da natremia na propensão ao desenvolvimento de complicações, no pior prognóstico e no risco de mortalidade em pacientes com hemorragia subaracnóidea aneurismática (HSAa). Trata-se de uma revisão integrativa de literatura guiada pela questão norteadora: "Alterações nos valores da glicemia ou concentração de sódio plasmática influenciam na morbimortalidade intrahospitalar de pacientes com hemorragia subaracnóidea aneurismática?". A busca de artigos foi realizada na plataforma PubMed, limitando a seleção para trabalhos publicados em língua inglesa no período de 2017 a 2022. Os resultados encontrados demonstram que o papel do íon sódio nas alterações no prognóstico dos pacientes é complexo, sendo a hipernatremia o principal fator descrito em relação a piores desfechos, enquanto o papel da hiponatremia é controverso e pode não ter valor prognóstico, e a concentração de sódio sérica apresenta-se cada vez mais como um item importante a ser avaliado no paciente com HSAa. Já quanto à glicose, a variabilidade desse substrato, tanto a hiperglicemia como também a hipoglicemia, pode estar correlacionada com a mortalidade hospitalar e a longo prazo em pacientes com HSAa. Assim, o presente estudo conclui que as alterações nos valores de glicemia e concentração de sódio plasmático têm influência na morbimortalidade intrahospitalar dos pacientes com HSAa. Entretanto, ressalta-se que a análise da influência independente de cada um dos preditores relacionados deve ser feita com cautela devido à heterogeneidade dos resultados encontrados.

A Rare Case of Clival Hemangioma Simulating Chordoma / Um caso raro de hemangioma clival simulando cordoma

Primary intraosseous hemangiomas are rare, benign, vascular malformations that account for 1% of all primary bone neoplasias. A 59-year-old female patient with unknown comorbidities had a history of headache, visual impairment and dizziness that led to the diagnosis of a clivus tumor. Two resections were attempted through transcranial and transnasal transsphenoidal approach in the last two years in another hospital. The initial MRI scan showed an expansive lesion with T2 hyperintense signal and diffuse, heterogenic contrast enhancement. Clival chordoma was the main diagnostic hypothesis done. A CT scan was performed to evaluate the extent of clival invasion, the sinus anatomy, and the clival destruction - all simulating clival chordoma. The interdisciplinary tumor board decided to proceed with endoscopic endonasal tumor resection. There were no postoperative complications and the histopathological analysis revealed a primary intraosseous haemangioma. Skull base intraosseous hemangiomas are rare entities, with a limited number of case reports found after literature reviews, especially in the clival region. The clinical pattern and imaging characteristics can vary widely according to the tumor extension and development, simulating some other common tumors found at this topography. We present a case report of a clival intraosseous hemangioma presenting as an isolated abducens paresis with a positive outcome after intranasal endoscopic resection after two years of follow-up.

Os hemangiomas intraósseos primários são malformações vasculares benignas raras que representam cerca de 1% de todas as neoplasias ósseas primárias. Uma paciente de 59 anos do sexo feminino com comorbidades desconhecidas história de cefaleia deficiência visual e tontura que levou ao diagnóstico de tumor de clivus. Duas ressecções foram tentadas por via transcraniana e transesfenoidal transnasal nos dois anos anteriores ao presente estudo em outro hospital. A ressonância magnética inicial mostrou lesão expansiva com sinal hiperintenso em T2 e realce difuso e heterogêneo pelo contraste. Cordoma clival foi a principal hipótese diagnóstica. Uma tomografia computadorizada foi realizada para avaliar a extensão da invasão clival a anatomia do seio e a destruição clival - todas simulando cordoma clival. A comissão interdisciplinar do tumor decidiu prosseguir coma ressecção endoscópica do tumor endonasal. Não houve complicações pós-operatórias e a análise histopatológica revelou hemangioma intraósseo primário. Os hemangiomas intraósseos da base do crânio são entidades raras com número limitado de relatos de casos encontrados após revisões da literatura principalmente na região clival. O padrão clínico e as características de imagem podem variar amplamente de acordo com a extensão e desenvolvimento do tumor simulando alguns outros tumores comuns encontrados nesta topografia. Apresentamos um relato de caso de hemangioma clival intraósseo apresentando-se como uma paresia isolada do abducente com evolução positive após ressecção endoscópica intranasal e dois anos de acompanhamento.

What a Neurosurgeon Should Know about the Endolymphatic Sac: Part 1­Anatomy and Physiology / O que um neurocirurgião deve saber sobre o saco endolinfático: Parte 1­Anatomia e Fisiologia

Objective To describe the microsurgical anatomy and the physiology of the endolymphatic sac (ES) that a neurosurgeon should know. Methods Review of previous studies from 1927 to 2021, from basic and translational research using human and animal ES tissue or cells, as well as previous reviews about the subject. The present article is divided into three parts. In this first part, we review the microsurgical anatomy and physiology of the ES. Results The ES is a structure situated in the inner ear, together with the cochlea, the vestibular system, and other structures. Differently from its adjacent structures, the ES does not have a specialized epithelium; instead, it has mitochondria-rich cells and ribosomal-rich cells, which are responsible for ionic transportation and secretory activity. Apart from these functions, the ES is also responsible for homeostasis regulation of the inner ear, endolymphatic fluid volume control, immune response, elimination of inner ear cellular debris and floating otoconia, regulation of membranous labyrinth pressure, acid/basic transport, and secretion of substances. Its anatomy is not very variable, since in most studies no more than 20mm separates the location of the ES in the samples, in any direction. Conclusion The human ES has vital functions in the inner ear, and its anatomy is rarely variable. Knowing that, and the importance of this area for neurosurgery, the present study elucidates the exact location of the ES and the lost functions that a lesion in this structure must cause.

Objetivo Descrever a anatomia microcirúrgica e a fisiologia do saco endolinfático (SE) que um neurocirurgião deve saber. Métodos Revisão de estudos prévios de 1927 até 2021, de pesquisa básica até translacional usando tecidos ou células do SE humanas e animais, além de revisões sobre o assunto. O presente artigo é dividido em três partes. Nesta primeira, nós revisamos a anatomia microcirúrgica e a fisiologia do SE. Resultados O SE é uma estrutura situada no ouvido interno, junto da cóclea, do sistema vestibular e outras estruturas. Diferentemente das estruturas adjacentes, o SE não tem um epitélio especializado; ao invés disso, possui células ricas em mitocôndrias e outras ricas em ribossomos, que são responsáveis por transporte iônico e atividade secretória. Além dessas funções, o SE é responsável por regulação homeostática do ouvido interno, controle do fluido endolinfático, resposta imune, eliminação de detritos e otólitos livres, regulação da pressão da membrana labiríntica, transporte ácido/básico e secreção de substâncias. Sua anatomia não é muito variável, já que na maior parte dos estudos a máxima diferença de localização entre as amostras do SE foi dada em 20 mm, em todas as direções. Conclusão O SE humano tem uma função vital no ouvido interno e sua anatomia não é muito variável. Sabendo disso, e da importância dessa região para a neurocirurgia, o presente estudo elucida a localização exata do SE e as funções perdidas em uma eventual lesão dessa estrutura.

Ventriculovesical Shunting in a Patient with Leptomeningeal Carcinomatosis: An Alternative to VP Shunts. A Technique Report / Derivação ventriculovesical em paciente com Carcinomatose Leptomeníngea: Uma alternativa às DVPs. Relato de técnica

Leptomeningeal carcinomatosis (LC) is a rare but serious complication when cancer cells infiltrate the meninges. It is most commonly associated with breast cancer, but only 5% of breast cancer patients develop it. Leptomeningeal carcinomatosis typically presents with headaches, mainly due to hydrocephalus, and the diagnosis involves a cytological analysis of cerebrospinal fluid (CSF) and/or magnetic resonance imaging (MRI) scans. The treatment of LC consists of a combination of intra-CSF chemotherapy, systemic therapy, radiation therapy, and/or supportive care, including CSF drainage. In the case herein reported, a technique known as ventriculovesical shunting was performed on a female patient with LC and breast cancer who had hydrocephalus due to this condition. This procedure is not as common as ventriculoperitoneal shunts, which can lead, in this case, to serious complications such as peritoneal carcinomatosis.

Carcinomatose leptomeníngea (CL) é uma complicação infrequente, porém séria, que ocorre quando células cancerígenas infiltram as meninges. É mais comumente associada ao câncer de mama, mas apenas 5% dos pacientes com câncer de mama a desenvolvem. A CL apresenta-se tipicamente com dores de cabeça decorrentes principalmente da hidrocefalia, e o diagnóstico envolve uma análise citológica do líquido cefalorraquidiano (LCR) e/ou ressonância magnética (RM). O tratamento da CL envolve uma combinação de quimioterapia intra-LCR, terapia sistêmica, radioterapia e/ou cuidados de suporte, incluindo a drenagem do LCR. No caso aqui relatado, realizou-se uma técnica conhecida como derivação ventriculovesical em uma paciente feminina com CL e câncer de mama que tinha hidrocefalia em decorrência desta situação. Este procedimento não é tão comum em comparação com as derivações ventriculoperitoneais, as quais, nesse caso, podem levar à carcinomatose peritoneal.

Recomendaciones clínicas para la solicitud de evaluación de neurocirugía en el trastorno obsesivo compulsivo / Clinical recommendations for requesting neurosurgical evaluation in obsessive-compulsive disorder

Estas recomendaciones clínicas delinean los criterios utilizados por el Equipo de Cirugía de los Trastornos Psiquiátricos del Hospital de Clínicas para la selección de candidatos a neurocirugía en pacientes con trastorno obsesivo compulsivo grave y refractario al tratamiento convencional. Los criterios de inclusión se enfocan en la cronicidad, la gravedad y la resistencia, considerando procedimientos ablativos o de neuromodulación. La gravedad se evalúa mediante la Escala Yale-Brown Obsessive Compulsive, junto con una evaluación integral del desempeño y la discapacidad. La refractariedad se define como la falta de respuesta, según criterios consensuados, a diversos tratamientos farmacológicos y no farmacológicos respaldados por evidencia científica significativa para el trastorno obsesivo compulsivo. Es esencial realizar una evaluación dimensional del desempeño global y estimar el pronóstico sin intervención quirúrgica. Los criterios de exclusión abarcan comorbilidades graves, trastornos de personalidad específicos y discapacidad intelectual. Además, se especifican pruebas paraclínicas necesarias, incluyendo evaluaciones sanguíneas, serológicas, cardíacas y neurológicas. Se detallan las tablas utilizadas para el registro de información necesaria para la evaluación. Todas las evaluaciones de neurocirugía culminan en un ateneo clínico conjunto entre el Equipo de Cirugía de los Trastornos Psiquiátricos del Hospital de Clínicas y la Unidad Académica de Psiquiatría de la Facultad de Medicina en donde se determinan las estrategias terapéuticas posibles.

These clinical recommendations outline the criteria used by the Psychiatric Disorders Surgery Team for selecting neurosurgery candidates among patients with severe Obsessive Compulsive Disorder refractory to conventional treatment. Inclusion criteria focus on chronicity, severity, and resistance. Ablative procedures or neuromodulation are taken into consideration. Severity is assessed by means of Yale-Brown Obsessive Compulsive Scale, and a comprehensive evaluation of performance and disability. Refractoriness is defined as lack of response, according to consensus criteria, to various pharmacological and non-pharmacological treatments for Obsessive Compulsive Disorder supported by significant scientific evidence. It is essential to conduct a dimensional assessment of overall performance and estimate prognosis without surgical intervention. Exclusion criteria encompass serious comorbidities, specific personality disorders, and intellectual disability. Furthermore, necessary paraclinical tests are specified, including blood, serological, cardiac, and neurological evaluations. Tables used for recording essential information for assessment are detailed. All neurosurgical assessments culminate in a joint clinical discussion of possible therapeutic strategies between the Psychiatric Disorders Surgery Team and the Psychiatry Academic Department (Facultad de Medicina) at the Hospital de Clínicas.

Long-term complications and outcomes of therapeutic embolization of cerebral arteriovenous malformations: a systematic review

ABSTRACT BACKGROUND: Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking. OBJECTIVE: To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization. DESIGN AND SETTING: This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths). RESULTS: Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler-Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients. CONCLUSION: Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867.

Historia biográfica de Manuel Balado: aportes al desarrollo de la neurocirugía mundial / Biographical History of Manuel Balado: Contributions to the Development of Worldwide Neurosurgery

Investigación histórica y biográfica de Manuel Juan María Balado, uno de los primeros médicos dedicados a la neurocirugía en forma exclusiva, quien sentó las bases de la especialidad en Argentina y Latinoamérica. Su trabajo, investigaciones y descubrimientos tuvieron impacto sobre las corrientes científicas mundiales de la época, otorgándole características particulares a la escuela Argentina. Entre sus múltiples aportes se destacan trabajos sobre la inervación del iris, la vía óptica, el cuerpo geniculado y la aracnoiditis optoquiasmática, siendo su principal aporte la sistematización de la iodoventriculografía que alcanzó relevancia mundial hasta la aparición de la tomografía computada. El presente trabajo recorre la biografía de un hombre que quedó opacado en la historia médica por la importancia de sus descubrimientos

Historical and biographical research of Manuel Juan María Balado, one of the first physician dedicated exclusively to neurosurgery, who laid the foundations of the specialty in Argentina and Latin America. His work, research and discoveries had an impact on the world scientific currents of the time, giving high profile to the Argentine school. Among his many contributions, works on the innervation of the iris, the optic pathway, the geniculate body and optochiasmatic arachnoiditis stand out, with his main contribution being the systematization of iodoventriculography that achieved global relevance until the appearance of computed tomography. This work covers the biography of a man who was overshadowed in medical history due to the importance of his discoveries

Neuropsychology of epilepsy surgery and theory-based practice: an opinion review / Neuropsicologia da cirurgia de epilepsia e prática teórica: uma revisão de opinião

Abstract The present review attempts to discuss how some of the central concepts from the Lurian corpus of theories are relevant to the modern neuropsychology of epilepsy and epilepsy surgery. Through the lenses of the main Lurian concepts (such as the qualitative syndrome analysis), we discuss the barriers to clinical reasoning imposed by quadrant-based views of the brain, or even atheoretical, statistically-based and data-driven approaches. We further advice towards a systemic view inspired by Luria's clinical work and theorizing, given their importance towards our clinical practice, by contrasting it to the modular views when appropriate. Luria provided theory-guided methods of assessment and rehabilitation of higher cortical functions. Although his work did not specifically address epilepsy, his theory and clinical approaches actually apply to the whole neuropathology spectrum and accounting for the whole panorama of neurocognition. This holistic and systemic approach to the brain is consistent with the network approach of the neuroimaging era. As to epilepsy, the logic of cognitive functions organized into complex functional systems, contrary to modular views of the brain, heralds current knowledge of epilepsy as a network disease, as well as the concept of the functional deficit zone.

Resumo A presente revisão tenta discutir como alguns dos conceitos centrais do corpus de teorias lurianas são relevantes para a moderna neuropsicologia da epilepsia e cirurgia da epilepsia. Através das lentes dos principais conceitos lurianos (como a análise qualitativa de síndromes), discutimos as barreiras ao raciocínio clínico impostas por visões do cérebro baseadas em quadrantes, ou mesmo abordagens ateóricas, baseadas em estatísticas e orientadas por dados. Aconselhamos ainda uma visão sistêmica inspirada na clínica e na teorização de Luria, dada sua importância para nossa prática clínica, contrastando-a com as visões modulares quando apropriado. Luria forneceu métodos teóricos de avaliação e reabilitação de funções corticais superiores. Embora seu trabalho não abordasse especificamente a epilepsia, sua teoria e abordagens clínicas na verdade se aplicam a todo o espectro da neuropatologia e respondem por todo o panorama da neurocognição. Essa abordagem holística e sistêmica do cérebro é consistente com a abordagem de rede da era da neuroimagem. Quanto à epilepsia, a lógica das funções cognitivas organizadas em sistemas funcionais complexos, ao contrário das visões modulares do cérebro, anuncia o conhecimento atual da epilepsia como uma doença em rede, bem como o conceito de zona de déficit funcional.

Caracterización de pacientes operados de craneosinostosis no sindrómica. Villa Clara, 2018-2022

Fundamento la craneosinostosis es una de las patologías neuroquirúrgicas más frecuentes en la edad pediátrica. Los conocimientos sobre su manejo son de vital importancia para intervenir con el tratamiento de manera oportuna. Objetivo caracterizar los pacientes operados de craneosinostosis no sindrómica. Métodos se realizó un estudio descriptivo y de corte transversal, en el período enero/2018- diciembre/2022, con la totalidad de pacientes intervenidos de craneosinostosis en el Hospital Pediátrico José Luis Miranda, de Villa Clara (N=28). Las variables analizadas fueron: sexo, color de la piel, clasificación de la malformación según sutura afectada, síntomas y signos asociados a la malformación, edad al realizar la intervención quirúrgica, técnica quirúrgica y complicaciones. Resultados se observó predominio del sexo masculino y de pacientes con color blanco de la piel. La forma de presentación más frecuente fue la escafocefalia, y se asoció a síntomas como el retardo en el desarrollo psicomotor y estrabismo. Las técnicas quirúrgicas realizadas fueron de remodelado total de la bóveda craneal, que en la mayoría de los niños se realizó antes de los 23 meses. La complicación más frecuente fue la infección de la herida quirúrgica. Conclusiones la craneosinostosis es una patología neuroquirúrgica frecuente en el sexo masculino. La forma de presentación más frecuente es la escafocefalia y se puede asociar a síntomas y signos neurológicos. Las técnicas quirúrgicas realizadas para remodelado de la bóveda craneal se deben realizar antes del primer año de vida, con vistas a disminuir el índice de complicaciones.

Background craniosynostosis is one of the most frequent neurosurgical pathologies in the pediatric age. Knowledge about its management is of vital importance to intervene with treatment in a timely manner. Objective to characterize the patients operated on for non-syndromic craniosynostosis. Methods a descriptive and cross-sectional study was carried out, from January/2018 to December/2022, with all the patients operated on for craniosynostosis at the José Luis Miranda Pediatric Hospital, in Villa Clara (N=28). The analyzed variables were: sex, skin color, classification of the malformation according to the affected suture, symptoms and signs associated with the malformation, age at surgery, surgical technique, and complications. Results a predominance of the male sex and patients with white skin color was observed. The most frequent form of presentation was scaphocephaly, and it was associated with symptoms such as delayed psychomotor development and strabismus. The surgical techniques performed were total remodeling of the cranial vault, which in most children was performed before 23 months old. The most frequent complication was infection of the surgical wound. Conclusions craniosynostosis is a frequent neurosurgical pathology in the male sex. The most frequent form of presentation is scaphocephaly and it can be associated with neurological symptoms and signs. Surgical techniques performed for remodeling of the cranial vault must be performed before the first year of life, in order to reduce the complications rate.

Estudio sobre la prevalencia del dolor en pacientes hospitalizados en el Servicio de Neurocirugía del Hospital Universitario de Getafe, en Madrid / Study on the prevalence of pain in patients hospitalized in the Neurosurgery Service of the University Hospital of Getafe, in Madrid

Objetivos: El objetivo ha sido la medida de prevalencia e intensidad del dolor agudo en pacientes hospitalizados en el Servicio de Neurocirugía de un Hospital Terciario, utilizando una escala verbal numérica, la Escala Visual Analógica (EVA) para su evaluación. Material y métodos: Estudio observacional, transversal y prospectivo para evaluar el dolor agudo. Se utiliza una EVA de 0 a 10, considerando 0 la ausencia de dolor, 1-2 (dolor leve), 3-5 (dolor moderado), 6-8 (dolor intenso) y 9-10 (dolor insoportable). Se incluyen todos los pacientes ingresados en planta durante noviembre de 2019 y se excluyen aquellos con limitaciones para entender o evaluar el dolor según EVA. Resultados: Del total de 120 pacientes ingresados en planta durante el periodo de estudio, son excluidos 40 por no cumplir los criterios de inclusión. Se analizan 80 pacientes que presentan elevada prevalencia de dolor (76,61%), con una puntuación media de 3,47 ± 0.78. De los que refieren dolor, en un 20% es leve, 40% moderado y 40% intenso. Por patologías los valores más elevados corresponden a post-intervención. Los protocolos analgésicos del Hospital se aplicaron en todos los casos y ningún paciente acudió a urgencias por dolor tras el alta hospitalaria. La principal limitación del estudio fue que no en todos los pacientes se recogió adecuadamente la puntuación EVA. Conclusiones: La prevalencia de dolor en una planta de neurocirugía es elevada (76,61%), con unas puntuaciones medias (3-4, dolor moderado) que requieren mejorar nuestras estrategias analgésicas y la medición del mismo. Las enfermedades malignas, de predominio intracraneal, se asociaron con mayor dolor(AU)

Objectives: The objective has been to measure the prevalence and intensity of acute pain in hospitalized patients in the Neurosurgery Service of a Tertiary Hospital, using a numerical verbal scale, the Visual Analogue Scale (VAS) for its evaluation. Material and methods: An observational, cross-sectional and prospective study to evaluate acute pain. A VAS of 0 to 10 is used, considering 0 the absence of pain, 1-2 (mild pain), 3-5 (moderate pain), 6-8 (intense pain) and 9-10 (unbearable pain). All patients admitted to the ward during November 2019 are included and those with limitations to understand or evaluate pain according to VAS are excluded. Results: Of the total of 120 patients admitted to the ward during the study period, 40 were excluded because they did not meet the inclusion criteria. Eighty patients with a high prevalence of pain (76.61%) were analyzed, with a mean score of 3.47 +/- 0.78. Of those who report pain, 20% is mild, 40% moderate and 40% intense. For pathologies, the highest values correspond to post-intervention. Hospital analgesic protocols were applied in all cases and no patient went to the emergency room due to pain after hospital discharge. The main limitation of the study was that the VAS score was not adequately collected in all patients. Conclusions: The prevalence of pain in a neurosurgery ward is high (76.61%), with mean scores (3-4, moderate pain) that require improving our analgesic strategies and its measurement. Malignant diseases, predominantly intracranial, were associated with greater pain(AU)

Research on the status quo and influencing factors of decision-making regret of surrogate decision makers in neurocritically ill patients / 中国实用护理杂志

Objective:To investigate the status quo and influencing factors of decision-making regret of surrogate decision makers (SDMs) in neurocritically ill patients.Methods:This study was a cross-sectional survey. A total of 110 critically ill patients admitted to Department of Neurosurgery, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from August 2021 to April 2022 were selected as the research objects by convenient sampling method. Different methods were adopted in the research including general information questionnaire, Chinese Version of Decision-Making Regret Assessment Scale, Disease-Related Knowledge Awareness Questionnaire, General Self-Efficacy Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale to conduct a questionnaire survey on SDMs in neurocritically ill patients. Multiple linear stepwise regression was used to analyze the influencing factors of decision-making regret in SDMs in neurocritically ill patients.Results:Among the 110 patients with severe neurological diseases, 50.0% (55/110) had no regret, 30.9% (34/110) had mild regret, and 19.1 (21/110) had moderate and severe regret. The results of univariate analysis showed that gender had a statistically significant effect on the score of SDMs decision regret in neurocritical patients ( t=6.57, P<0.05). The age, relationship with patients, education level, decision-making style, place of residence, and monthly income of the family had no effect on the score of regret in decision-making ( t=0.09-1.01, all P>0.05). The results of correlation analysis showed that the score of decision-making regret of SDMs in neurocritically ill patients was negatively correlated with the scores of disease-related knowledge and self-efficacy ( r=-0.342, -0.252, both P<0.05), and positively correlated with the scores of anxiety and depression ( r=0.403, 0.360, both P<0.05). The results of multiple linear regression showed that gender, disease-related knowledge, self-efficacy, anxiety and depression were important factors affecting the decision-making regret of SDMs in neurocritically ill patients ( t values were -3.37-4.31, all P<0.05). Conclusions:SDMs in neurocritically ill patients have a higher degree of decision-making regret, and gender, disease-related knowledge, self-efficacy, anxiety, depression are important influencing factors, suggesting that medical staff can alleviate the decision-making regret of SDMs through decision-making assistance interventions.

Application of neurosurgical microscopic technology training in medical undergraduate teaching / 中华医学教育探索杂志

There are still many existing problems in the training of medical undergraduates and microsurgery talents in China, such as lack of scientific research ability and scientific literacy of medical undergraduates, insufficient practical ability, short of scientific research opportunities for medical undergraduates, and inadequate talent reserve in microsurgery. In view of the above shortcomings, Wannan Medical College has established a training course on microneurosurgery technology for medical undergraduates, and made a preliminary exploration to solve the above problems. Through the training, undergraduates not only improve their practical ability, but also stimulate their interest in microsurgery, which will help them adapt to clinical and scientific research work at an early stage. Neurosurgical microscopic technology training with emphasis on extracurricular expansion as main content, plays an important role in the cultivation of undergraduate microscopic skills, the establishment of basic theories of neurosurgery, the improvement of scientific research accomplishment and the expansion of extracurricular vision.

Practice and reflection of glioma subspecialist training in Neurosurgery / 中华医学教育探索杂志

The standardized training system for physicians has been implemented for many years in China. Based on the current situation of neurosurgery specialist training and the sub-professional development, the study discusses the specific plan and direction of glioma sub-professional physicians training from the aspects of glioma sub-professional physicians training outline, training content, requirements of glioma sub-professional training base, training assessment methods and training management. It provided reference for the training of neurosurgical glioma professionals in China, so as to make glioma receive comprehensive and standardized treatment.

Application of mind mapping combined with interactive communication mode in clinical teaching of Neurosurgery / 中华医学教育探索杂志

Objective:To observe the application effect of mind mapping combined with interactive communication mode in clinical teaching of neurosurgery.Methods:A total of 40 students who practiced in the Department of Neurosurgery in the Affiliated Hospital of Guizhou Medical University from September 2019 to September 2020 were included in the control group, and traditional teaching was adopted; another 40 students who practiced from October 2020 to October 2021 were included in the observation group, and mind mapping combined with interactive communication mode was adopted for teaching. The two groups of students were taught for 2 weeks, and after the teaching, the teaching effect was compared between the two groups. SPSS 25.0 software was used to conduct t-test and Chi-square test. Results:After 2 weeks of teaching, the scores of theoretical knowledge (90.38±4.03) and practical operation skills (93.37±3.48) in the two groups were higher than those before teaching [(85.52±5.26) and (87.25±4.48)], with statistically significant differences ( t=4.63, 6.83, P<0.001). The case analysis score of the two groups was higher than that before teaching, and that of the observation group (86.03±6.07) was higher than that of the control group (79.13±5.57), with statistically significant differences ( t=5.30, P<0.001). The scores of interpersonal communication ability and cooperation ability of the two groups were higher than those before teaching. The scores of interpersonal communication ability (82.53±4.74), cooperation ability (169.73±7.55) of the observation group were higher than those of the control group [(77.93±4.45) and (158.42±8.01)], with statistically significant differences ( t=4.48, 6.49, P<0.001). Conclusion:Mind mapping combined with interactive communication mode can effectively improve the clinical basic knowledge and clinical practice ability of interns in the Department of Neurosurgery, and improve their communication and cooperation ability.

Exploration and thinking of standardized residency training education for the residents in the intensive care unit of neurosurgery department / 中华医学教育探索杂志

Critical neurosurgery is one of the difficulties and key points in the standardized residency training of neurosurgery. Through the systematic and standardized training of the residents of the Intensive Care Unit of Neurosurgery Department in The First Affiliated Hospital of Chongqing Medical University, consisting of first aid skills training, multi-modal case analysis with complementary theory and practice, expansion of neuroimaging and electrophysiological knowledge, specialized knowledge training in surgical operation and perioperative management, and regular case discussion, their clinical thinking becomes more mature, the time to master the management methods of neurosurgical intensive care patients is significantly shortened, the initiative to participate in clinical practice is also significantly increased, and the perioperative management methods of neurosurgical patients are more deeply understood. These trainings have effectively improved the teaching effect of neurosurgery intensive care unit.

Application of progressive case teaching method based on core competency in standardized nursing training / 中华医学教育探索杂志

Objective:To explore the application effect of progressive case teaching method based on core competency in standardized nursing training.Methods:A total of 63 nursing students rotated in department of neurosurgery from June 2020 to June 2022 were selected as the research objects and randomized into experimental group ( n=31) and control group ( n=32). The experimental group adopted the progressive case teaching method based on core competency, and the control group adopted the conventional teaching mode. The data was analyzed using SPSS 26.0 to conduct t-test or non-parametric test based on the data normality for comparing the theory results, objective structure clinical examination (OSCE) scores, core competency, self-directed learning ability scores, teaching satisfaction and nursing satisfaction of patients in two wards between the two groups. Results:The theoretical results ( t=4.74, P<0.001) and OSCE scores ( t=3.81, P<0.001) of the experimental group were better than those of the control group. The scores of core competency and autonomous learning ability ( t=4.32, P<0.001) of the experimental group were better than those of the control group. The teaching satisfaction score ( t=2.21, P=0.044) and patient satisfaction score ( t=2.92, P=0.011) of the observation group were better than those of the control group. Conclusion:The progressive case teaching method based on core competency can improve the post competency of nurses, and also improve the teaching satisfaction rate and patient satisfaction rate, which is worthy of being carried out in the subsequent teaching activities.