Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

SUMMARY: Intracranial aneurysm is a common cerebrovascular disease with high mortality. Neurosurgical clipping for the treatment of intracranial aneurysms can easily lead to serious postoperative complications. Studies have shown that intraoperative monitoring of the degree of cerebral ischemia is extremely important to ensure the safety of operation and improve the prognosis of patients. Aim of this study was to probe the application value of combined monitoring of intraoperative neurophysiological monitoring (IONM)-intracranial pressure (ICP)-cerebral perfusion pressure (CPP) in craniotomy clipping of intracranial aneurysms. From January 2020 to December 2022, 126 patients in our hospital with intracranial aneurysms who underwent neurosurgical clipping were randomly divided into two groups. One group received IONM monitoring during neurosurgical clipping (control group, n=63), and the other group received IONM-ICP-CPP monitoring during neurosurgical clipping (monitoring group, n=63). The aneurysm clipping and new neurological deficits at 1 day after operation were compared between the two groups. Glasgow coma scale (GCS) score and national institutes of health stroke scale (NIHSS) score were compared before operation, at 1 day and 3 months after operation. Glasgow outcome scale (GOS) and modified Rankin scale (mRS) were compared at 3 months after operation. All aneurysms were clipped completely. Rate of new neurological deficit at 1 day after operation in monitoring group was 3.17 % (2/63), which was markedly lower than that in control group of 11.11 % (7/30) (P0.05). Combined monitoring of IONM-ICP-CPP can monitor the cerebral blood flow of patients in real time during neurosurgical clipping, according to the monitoring results, timely intervention measures can improve the consciousness state of patients in early postoperative period and reduce the occurrence of early postoperative neurological deficits.

El aneurisma intracraneal es una enfermedad cerebrovascular común con alta mortalidad. El clipaje neuroquirúrgico para el tratamiento de aneurismas intracraneales puede provocar complicaciones posoperatorias graves. Los estudios han demostrado que la monitorización intraoperatoria del grado de isquemia cerebral es extremadamente importante para garantizar la seguridad de la operación y mejorar el pronóstico de los pacientes. El objetivo de este estudio fue probar el valor de la aplicación de la monitorización combinada de la monitorización neurofisiológica intraoperatoria (IONM), la presión intracraneal (PIC) y la presión de perfusión cerebral (CPP) en el clipaje de craneotomía de aneurismas intracraneales. Desde enero de 2020 hasta diciembre de 2022, 126 pacientes de nuestro hospital con aneurismas intracraneales que se sometieron a clipaje neuroquirúrgico se dividieron aleatoriamente en dos grupos. Un grupo recibió monitorización IONM durante el clipaje neuroquirúrgico (grupo de control, n=63) y el otro grupo recibió monitorización IONM-ICP-CPP durante el clipaje neuroquirúrgico (grupo de monitorización, n=63). Se compararon entre los dos grupos el recorte del aneurisma y los nuevos déficits neurológicos un día después de la operación. La puntuación de la escala de coma de Glasgow (GCS) y la puntuación de la escala de accidentes cerebrovasculares de los institutos nacionales de salud (NIHSS) se compararon antes de la operación, 1 día y 3 meses después de la operación. La escala de resultados de Glasgow (GOS) y la escala de Rankin modificada (mRS) se compararon 3 meses después de la operación. Todos los aneurismas fueron cortados por completo. La tasa de nuevo déficit neurológico 1 día después de la operación en el grupo de seguimiento fue del 3,17 % (2/63), que fue notablemente inferior a la del grupo de control del 11,11 % (7/30) (P 0,05). La monitorización combinada de IONM-ICP-CPP puede controlar el flujo sanguíneo cerebral de los pacientes en tiempo real durante el corte neuroquirúrgico; de acuerdo con los resultados de la monitorización, las medidas de intervención oportunas pueden mejorar el estado de conciencia de los pacientes en el período postoperatorio temprano y reducir la aparición de problemas postoperatorios tempranos y déficits neurológicos.

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.

Targeted muscle reinnervation: a surgical technique of human-machine interface for intelligent prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees.@*METHODS@#Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR.@*RESULTS@#TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations.@*CONCLUSION@#TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.

Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture / 中国修复重建外科杂志

OBJECTIVE@#To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture.@*METHODS@#A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.@*RESULTS@#The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05).@*CONCLUSION@#In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.

Progress and prospect of biological treatment for rotator cuff injury repair / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress in biotherapy of rotator cuff injury in recent years, in order to provide help for clinical decision-making of rotator cuff injury treatment.@*METHODS@#The literature related to biotherapy of rotator cuff injury at home and abroad in recent years was widely reviewed, and the mechanism and efficacy of biotherapy for rotator cuff injury were summarized from the aspects of platelet-rich plasma (PRP), growth factors, stem cells, and exosomes.@*RESULTS@#In order to relieve patients' pain, improve upper limb function, and improve quality of life, the treatment of rotator cuff injury experienced an important change from conservative treatment to open surgery to arthroscopic rotator cuff repair. Arthroscopic rotator cuff repair plus a variety of biotherapy methods have become the mainstream of clinical treatment. All kinds of biotherapy methods have ideal mid- and long-term effectiveness in the repair of rotator cuff injury. The biotherapy method to promote the healing of rotator cuff injury is controversial and needs to be further studied.@*CONCLUSION@#All kinds of biotherapy methods show a good effect on the repair of rotator cuff injury. It will be an important research direction to further develop new biotherapy technology and verify its effectiveness.

The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation: a prospective single-center study / 亚洲男科学杂志(英文版)

Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.

Application of ulnar nerve diameter changes examined by HRUS in patients with cubital tunnel syndrome / 中国骨伤

OBJECTIVE@#To evaluate the value of high-resolution ultrasound the diagnosis and prognosis of cubital tunnel syndrome.@*METHODS@#From January 2018 to June 2019, 47 patients with cubital tunnel syndrome were treated with ulnar nerve release and anterior subcutaneous transposition. There were 41 males and 6 females, aged from 27 to 73 years old. There were 31 cases on the right, 15 cases on the left, and 1 case on both sides. The diameter of ulnar nerve was measured by high-resolution ultrasound pre-and post-operatively, and measured directly during the operation. The recovery status of the patients was evaluated by the trial standard of ulnar nerve function assessment, and the satisfaction of the patients was assessed.@*RESULTS@#All the 47 cases were followed up for an average of 12 months and the incisions healed well. The diameter of ulnar nerve at the compression level was (0.16±0.04) cm pre-operatively, and the diameter of ulnar nerve was (0.23±0.04) cm post-operatively. The evaluation of ulnar nerve function:excellent in 16 cases, good in 18 cases and fair in 13 cases. Twelve months post-operatively, 28 patients were satisfied, 10 patients were general and 9 patients were dissatisfied.@*CONCLUSION@#The preoperative examination of ulnar nerve by high-resolution ultrasound is consistent with the intuitive measurement during operation, and the result of postoperative examination of ulnar nerve by high-resolution ultrasound is consistent with follow-up results. High-resolution ultrasound is an effective auxiliary method for the diagnosis and treatment of cubital tunnel syndrome.

An expandable chamber for safe brain retraction: new technologies in the field of transcranial endoscopic surgery / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Neurosurgery is a highly specialized field: it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions. There are still no reliable methods preventing possible retraction complications. The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue. The chamber is designed to be inserted close to the intracranial point of interest; once it is best placed it can be opened. This should guarantee an appreciable workspace similar to that of current neurosurgical procedures. The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase. Following pterional craniotomy, pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations. Note that, although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same, the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly. A new method of cerebral retraction using a chamber retractor (CR) has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma.

Aspects épidémiologiques et thérapeutiques des pathologies neurochirurgicales chez l'enfant de moins de 5 ans à Libreville (Gabon) de 2019 à 2021 / Epidemiology and management of neurosurgical diseases of children aged 5 years or less in Libreville (Gabon) from 2019 to 2021

Introduction. Les pathologies neurochirurgicales sont un ensemble d'affections qui touche le cerveau, la moelle épinière, et les paires crâniennes nécessitant une prise en charge médico-chirurgicale. Leur incidence en Afrique sub-saharienne et plus particulièrement au Gabon est mal connue. Objectif. Décrire les aspects épidémiologiques et évolutifs des pathologies neurochirurgicales chez l'enfant de moins 5 ans à Libreville. Patients et méthodes. Il s'agit d'une étude rétrospective descriptive et analytique, multicentrique portant sur des patients de moins de 5ans pris en charge pour une affection neurochirurgicale de Janvier 2019 à Décembre 2021 à Libreville. Résultats. Sur 4811 enfants hospitalisés, 130 répondaient aux critères d'inclusion (prévalence : 2,7%). L'âge moyen était de 13,1 mois. Le sex-ratio était de 1,3. Les grossesses étaient mal suivies dans 72,2% des cas. Les pathologies neurochirurgicales malformatives représentaient 63,5%. L'hydrocéphalie était la plus observée dans 71,2%. Sur les 115 enfants, 71 ont bénéficié d'un traitement chirurgical, soit un taux de 61,7% et le taux de mortalité globale était de 6,1%. Dans le groupe des enfants présentant une malformation congénitale, 8,2% n'avaient pas été traités, le taux de mortalité était de 8,2%. Les complications à court termes étaient dominées par les infections. Conclusion. Les pathologies neurochirurgicales sont en fréquentes dans notre contexte. Une prise en charge immédiate reste de mise, nécessitant donc un plateau technique de pointe pour améliorer l'évolution à court terme voire à moyen et long terme de ces affections.

Introduction. Neurosurgical pathologies are a set of conditions that affect the brain, spinal cord, and cranial pairs requiring medical and surgical management. Their incidence in subSaharan Africa and more particularly in Gabon is poorly known. Objective. To describe the epidemiological and evolutionary aspects of neurosurgical pathologies in children under 5 years old in Libreville. Patients and methods. This is a retrospective descriptive and analytical, multicenter study of patients under 5 years of age treated for a neurosurgical condition from January 2019 to December 2021 in Libreville. Results. Of the 4811 hospitalized children, 130 met the inclusion criteria (prevalence of 2.7%) and 15 were excluded for incomplete records. The average age was 13.1 months. The age group of 28 days-1 year was the most observed. The sex ratio was 1.3. Pregnancies were poorly followed in 72.2% of cases. Malformative neurosurgical pathologies accounted for 63.5% of cases. Hydrocephalus was the most observed in 71.2%. Of the 115 children, 71 received surgical treatment, a rate of 61.7% and the overall mortality rate was 6.1%. In the group of children with congenital malformation, 8.2% had not been treated, the mortality rate was 8.2%. Short-term complications were dominated by infections. Conclusion. Neurosurgical pathologies are frequent in our context. Immediate care remains essential, therefore requiring a cutting-edge technical platform to improve the short-term or even medium- and long-term evolution of these conditions.

Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

Neurosurgical patients are the most critical ICU admissions. While advancements in neurosurgical ICUs (NICU) have improved outcomes of care globally, ICU mortality remains a major clinical issue in developing nations. This study evaluates ICU mortalities of neurosurgical patients in a general ICU setting at the UNIOSUN Teaching Hospital, Osogbo, Nigeria. Method: Case records of neurosurgery patients who died in the ICU of UNIOSUN Teaching Hospital, Osogbo, South-Western, Nigeria from June 2012 to May 2022 were reviewed. Simple descriptive statistics of data on demographics, clinical diagnoses, management and outcome were done. Results: Mortality rate was 38.9% (84 of 216 admissions). Males were 67(79.8%) and the mean age was 41.5years (Range: 2-85years). The average duration of ICU stay was 3.5days (Range: 30minutes-20days). Most patients had severe traumatic brain injury (TBI) (62, 73.8%). This was followed by cerebrovascular diseases (12, 14.3%) and brain tumours (6, 7.1%). Two had brain abscess. One patient each had mixed subacute/chronic subdural haematoma and severe cervical spondylotic myelopathy. Of the 69 whose case files were found, 7(10.1%) had a diagnosis of brainstem death before eventual 'final' death after an average of 13.5 additional hours on mechanical life support. The identified secondary causes of death included raised ICP, sepsis, primary surgical haemorrhage, seizures, acute kidney injury, malignant hypertension, poor glycaemic control and aggressive blood pressure lowering. Only 1 patient had autopsy. Conclusion: Most ICU mortalities among neurosurgical patients were from severe TBI. The establishment of NICU is necessary to improve outcome of care of neurosurgical patients

Traitement chirurgical du Mal de Pott et de ses séquelles au Centre Hospitalier de l'Ordre de Malte Dakar / Surgical treatm ent of Pott's diseaseand its sequelae at the Hospital of the Order of Malta/Daka

Introduction. Evaluer les résultats du traitement chirurgical du Mal de Pott et de ses séquelles au Centre hospitalier de l'ordre de Malte de Dakar. Patients et méthodes. Nous présentons les résultats préliminaires d'une série consécutive de 23 patients (13 hommes et 10 femmes) d'âge moyen de 32,35 ans [6 ­70 ans] présentant des Maux de Pott ou de leurs séquelles nécessitant un traitement chirurgical. L'échelle d'incapacité d'Oswestry, l'échelle visuelle analogique et le score ASIA ont été utilisés pour l'évaluation clinique. Les radiographies pré opératoires, post opératoires et au recul ont été utilisés pour les résultats anatomiques. Tous ces patients ont été opérés selon trois stratégies opératoires sur une période de 67 mois (Avril 2014- Novembre 2019). Nous avons réalisé une laminectomie arthrodèse postérieure dans 52,2% ; une laminectomie plus OTP et arthrodèse postérieure dans 43,5% ; une discectomie et hémicorporectomie avec arthrodèse antérieure par plaque vissée de Roy Camille à l'étage cervical dans 4,3%. Résultats. La symptomatologie était dominée par la douleur rachidienne, la cyphose et les troubles neurologiques. La cyphose post opératoire était significativement améliorée (la moyenne passe de 48,52° en pré opératoire à 17,09° en post opératoire). On a obtenu 100% de fusion vertébrale. On note une nette amélioration de la douleur rachidienne (avec une baisse au recul de 55,44 points pour l'OID et de 5,66 pour l'EVA) ; 78,3% des patients étaient très satisfaits, 17,4% satisfaits et 4,3% mécontents. Conclusion. Le traitement chirurgical du Mal de Pott et de ses séquelles a fortement amélioré les rachis au Centre hospitalier de l'Ordre de Malte.

Introduction. To evaluate the results of the surgical treatment of Pott's disease and its sequelae at the Hospital Center of the Order of Malta in Dakar. Patients and methods. We present the preliminary results of a consecutive series of 23 patients (13 men and 10 women) with an average age of 32.35 years [6-70 years] presenting with Pott's disease or its sequelae requiring treatment. surgical treatment. Oswestry Disability Scale, Visual Analogue Scale and ASIA score were used for clinical assessment. Preoperative, postoperative and followup radiographs were used for anatomical results. All these patients were operated according to three operating strategies over a period of 67 months (April 2014- November 2019). We performed posterior laminectomy-arthrodesis in 52.2%; laminectomy plus OTP and posterior arthrodesis in 43.5%; discectomy and hemicorpectomy with anterior arthrodesis by Roy Camille screwed plate at the cervical level in 4.3%. Results. The symptomatology was dominated by spinal pain, kyphosis and neurological disorders. Postoperative kyphosis was significantly improved (the average goes from 48.52° preoperatively to 17.09° postoperatively). We got 100% spinal fusion. There is a clear improvement in spinal pain (with a drop at follow-up of 55.44 points for the OID and 5.66 for the EVA); 78.3% of patients were very satisfied, 17.4% satisfied and 4.3% dissatisfied. Conclusion. The surgical treatment of Pott's disease and its sequelae greatly improved the spines at the Hospital Center of the Order of Malta.

Uso de asistolía inducida por adenosina de aneurismas cerebrales / Asystole induce by adenosine for management of cerebral aneurysms

The treatment of cerebral aneurysms can currently be performed through endovascular technique and/or surgical treatment by clipping the aneurysm. The decision to use a particular technique will depend on the location, morphology and other characteristics. The techniques described are aimed to facilitate the surgical procedure, allowing to improve the approach, visualization and definitive clipping. Some of these techniques include temporary clipping of the proximal blood vessel, proximal control of the carotid artery at the cervical level, extracranial to intracranial bypass, and cardiac pause or arres

El tratamiento de los aneurismas cerebrales actualmente puede ser realizado a través de técnicas endovasculares y/o tratamiento quirúrgico con clipaje del aneurisma, la decisión de utilizar una técnica en particular dependerá de la localización, morfología y otras características. Las técnicas descritas están orientadas a facilitar el procedimiento quirúrgico, permitiendo mejorar el abordaje, la visualización y el clipaje definitivo. Algunas de estas técnicas incluyen clipaje transitorio de vaso sanguíneo proximal, control proximal de arteria carótida a nivel cervical, bypass extracraneal a intracraneal y la pausa o paro cardíaco

Neurosurgery in the Treatment of Alcohol Use Disorder: A Systematic Literature Review

Alcohol abuse has impacts on public health worldwide. Conservative treatment to achieve abstinence consists of detoxification combined with psychotherapy and the use of drugs, but it is estimated that only half of the individuals achieve long-term abstinence with the available treatments. In this sense, neurosurgery appears as a therapeutic proposal. The present study aimed to gather information about the circuitry related to alcohol use disorder (AUD), to describe possible surgical targets, and to establish whether a surgical approach could be a safe and effective treatment option. A systematic review of the literature was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The 14 selected articles analyze ablative operations, deep brain stimulation (DBS), and a new procedure in which the patient is first submitted to repetitive transcranial magnetic stimulation to evaluate their response, and later an implant is surgically positioned on the evaluated target to obtain more lasting results. The most relevant outcomes were found when the anterior cingulate cortex (ACC) and the nucleus accumbens (NAcc) were used as targets, demonstrating a large reduction in alcohol intake and even its cessation. However, important side effects were observed, such as psychotic symptoms, right frontal venous infarction, seizures after implantation in the ACC and a hypomanic period after DBS in the NAcc, which could be reversed. Due to the lack of studies involving the surgical treatment of AUD, more clinical trials are needed to compare targets, to assess surgical techniques, and to estimate the safety of these techniques.

Conciencia transoperatoria en personas operadas mediante craneotomía despierto / Intraoperative awareness in awake craniotomy patients

La craneotomía con paciente despierto (CPD) demanda un manejo multidisciplinario particular debido al componente de conciencia transoperatoria que aporta beneficios en la resección tumoral y preservación neurológica, pero también implica el manejo de los riesgos asociados a la necesidad de cooperación del paciente durante el procedimiento. En este trabajo se describen los beneficios y las complicaciones en pacientes operados bajo la modalidad de CPD. Además, se abordan los retos documentados tanto para el equipo profesional a cargo, como para los pacientes, los cuales tienen un rol activo durante la cirugía. En ese sentido, se exponen los criterios para la selección, preparación psicológica y neuropsicológica tanto previo como durante la cirugía. A su vez, se proponen las consideraciones para lograr un procedimiento exitoso y evitar las posibles secuelas psicológicas a largo plazo, como insumos para la protocolización de este tipo de procedimientos con base en nuestra experiencia.

Awake craniotomy (AC) requires a multidisciplinary management due to trans operative awareness, which benefits the tumor resection and neurologic preservation, but it also implies risks for the patient cooperation during the procedure. This article describes the benefits and complications in patients operated under AC. Besides, it approaches the documented challenges for both the professional team and patients, who have an active role during surgery. In this regard, the criteria for selection and psychological and neuropsychological preparation before and during surgery are set out. It suggests considerations to achieve a successful procedure and to avoid possible long- term psychological sequelae, as a resource for the protocol of this type of procedures based on our experience.

Gestion de la qualité des soins au service d'acceuil des urgences (SAU) de l'hôpital du Mali: enjeux et perspectives / Management of the quality of care at the emergency reception service (SAU) of the hospital of Mali : challenges et perspectives

Introduction : La Neurochirurgie au Mali reste une discipline relativement jeune par rapport aux autres spécialités chirurgicales. Le but de ce travail est de décrire le parcours des urgences neurochirurgicales admises au SAU de l'hôpital du Mali.Patient et méthodes : C'est une étude prospective transversale analytique qui s'est déroulée au SAU de l'hôpital du Mali sur une durée de 02 mois. Sont inclus dans cette étude, tous les patients admis au SAU et dont on a eu recours à un avis neurochirurgical. Nous avons recensé et analysé les données épidémiologiques, cliniques, paracliniques et thérapeutiques chez 82 patients. Résultats : Sur un total de 152 patients admis au SAU, il y'avait 82 cas pour lesquels un avis neurochirurgical a été demandé soit 53, 95 % des admissions. Parmi ces 82 patients, il y avait 50 cas de traumatismes crâniens, 20 cas de traumatismes du rachis, 08 cas d'accident vasculaire cérébral hémorragique (AVCH), 03 cas de suppurations intracrâniennes et 01 cas de tumeur cérébrale. Nous avons opéré 41 patients (50%) et mis en observation 32 patients (39,02%). Malgré nos efforts, 09 patients sont sortis contre avis médical ou par faute de moyens. Nous avons noté 03 cas de décès. Conclusion : La qualité des soins et l'accès aux soins sont très souvent considérés par les patients comme les éléments essentiels de la performance d'un système de santé. En tant que Etablissement Public Hospitalier (EPH) de niveau 3, il doit bénéficier d'un plateau technique adéquat et d'un personnel médical et paramédical suffisant afin d'assurer une prise en charge correcte des patients

Introduction : Neurosurgery in Mali remains a relatively young discipline compared to other surgical specialties.The aim of this study is to describe the course of neurosurgical emergencies in "Hôpital du Mali". Patients and methods: This is a prospective cross-sectional analytical study that took place at the emergency department of "hôpital du Mali" over a period of 02 months. Are included in this study, all the patients admitted in emergency for whom neurosurgical advice was sought. We identified and analyzed epidemiological, clinical, paraclinical and therapeutic data in 82 patients.Results: Out of a total of 152 patients admitted to our emergency unit, there were 82 cases for which a neurosurgical opinion was requested, ie 53.95% of admissions. Among these 82 patients, there were 50 cases of head trauma, 20 cases of spinal trauma, 08 cases of brain stroke, 03 cases of intracranial suppurations and 01 case of brain tumor. We operated on 41 patients (50%) and observed 32 patients (39.02%). Despite our efforts, 09 patients were released against medical advice or for lack of funds. We noted 03 cases of death. Conclusion: The quality of care and access to care are very often seen by patients as essential elements of the performance of a health system. As a level 3 public hospital, it must have an adequate technical platform and sufficient medical and paramedical staff to ensure correct patient care

A tropical tertiary neurosurgical center response to COVID-19 pandemic and its effect on neurosurgical practices

Background: COVID-19 pandemic may decrease the quantum of care for patients with neurosurgical conditions. Objectives: To determine outpatient clinic (OPC) patient load, neurosurgical procedures volume and disease spectrum following the institution of a new care protocol during the ongoing COVID-19 pandemic and compare with previous practice data in our institution. Methods: A monocentric retrospective analysis of all patients requiring neurosurgical care over a 2-year period. Results: There was a 42.4% reduction in OPC attendance and 41.8% reduction in surgical procedures in 2020 compared to 2019. There was >60 percent reduction in the volume of surgery that was done at the onset and peak of the pandemic, but this has normalized in November 2020 despite the resurgence of COVID-19, after the institution of a new care protocol. Neurotrauma procedures (29.6%) were the most common neurosurgical operation in 2020 while congenital malformation surgery (37.3%) was the most common procedure performed in 2019. Conclusions: The ongoing COVID-19 pandemic initially led to significant decrease in quantum and spectra of patients who presented at the OPC and for neurosurgical procedures. Instituted local protocol and Teleclinics, if added to clinical care armamentarium, may help to improve on the low patient attendance during pandemics

La neuroendoscopia: una técnica revolucionaria en el campo de la neurocirugía / Neuroendoscopy: a revoluciotionary technique in neurosurgery

La neuroendoscopia es un procedimiento mínimamente invasivo que se desarrolló a principios del siglo pasado y tiene importancia en el campo de la neurocirugía, representa un método innovador ya que aporta una amplia visualización de las estructuras anatómicas con mínimo traumatismo del tejido nervioso, contribuyendo al diagnóstico y tratamiento de diversas afecciones intra y extracerebral. Se realizó una búsqueda bibliográfica con el propósito de identificar, analizar y describir algunas patologías neuroquirúrgicas que se han tratado bajo neuroendoscopia, así como los aportes más relevantes en cirugía pediátrica y de columna, con el fin de exponer el impacto que ha tenido esta técnica en el desarrollo de la cirugía moderna.

Neuroendoscopy is a minimally-invasive procedure that was developed at the beginning of the last century and plays an important role in neurosurgery. It is an innovative method since it enables a broad visualization of the anatomical structures with minimal damage to the nervous tissue, contributing to the diagnosis and treatment of a variety of intra and extracerebral conditions. A bibliographic search was carried out to identify, analyze and describe some neurological pathologies that have been treated using neuroendoscopic surgery. The most relevant contributions to pediatric and spine surgery are also outlined to show the impact that this technique has had in the progress of modern surgery.

Monitorización neurofisiológica intraoperatoria en cirugía de columna / Neurophisiologic monitoring in spinal surgery

The most feared complication in spinal surgeries is damage to the spinal cord due to inadvertent compression or interference in the blood supply with the consequent motor and/or sensory déficit. Intraoperative physiological surveillance reduces the risk of generating direct damage or due to hypoxia, helping in the early detection of complications. Publications in the Pubmed database are reviewed.

La complicación más temida en las cirugías de columna es el daño de la médula espinal por una compresión inadvertida o interferencia en el aporte sanguíneo con el consiguiente déficit motor y/o sensitivo. La vigilancia fisiológica intra operatoria disminuye el riesgo de generar daño directo o por hipoxia, ayudando en la detección temprana de las complicaciones. Se revisan publicaciones en base de datos Pubmed.

Clinical Applications of Additive Manufacturing Models in Neurosurgery: a Systematic Review

Introduction Three-dimensional (3D) printing technologies provide a practical and anatomical way to reproduce precise tailored-made models of the patients and of the diseases. Those models can allow surgical planning, besides training and surgical simulation in the treatment of neurosurgical diseases. Objective The aim of the present article is to review the scenario of the development of different types of available 3D printing technologies, the processes involved in the creation of biomodels, and the application of those advances in the neurosurgical field. Methods We searched for papers that addressed the clinical application of 3D printing in neurosurgery on the PubMed, Ebsco, Web of Science, Scopus, and Science Direct databases. All papers related to the use of any additivemanufacturing technique were included in the present study. Results Studies involving 3D printing in neurosurgery are concentrated on threemain areas: (1) creation of anatomical tailored-made models for planning and training; (2) development of devices and materials for the treatment of neurosurgical diseases, and (3) biological implants for tissues engineering. Biomodels are extremely useful in several branches of neurosurgery, and their use in spinal, cerebrovascular, endovascular, neuro-oncological, neuropediatric, and functional surgeries can be highlighted. Conclusions Three-dimensional printing technologies are an exclusive way for direct replication of specific pathologies of the patient. It can identify the anatomical variation and provide a way for rapid construction of training models, allowing the medical resident and the experienced neurosurgeon to practice the surgical steps before the operation.

Microsurgical Resection of Glioblastoma in a Patient Infected with Covid-19: A Case Report

The COVID-19 pandemic has affected a large number of patients in all countries, overwhelming healthcare systems worldwide. In this scenario, surgical procedures became restricted, causing unacceptable delays in the treatment of certain pathologies, such as glioblastoma. Regarding this tumor with high morbidity and mortality, early surgical treatment is essential to increase the survival and quality of life of these patients. Association between COVID-19 and neurosurgical procedures is quite scarce in the literature, with a few reported cases. In the present study, we present a rare case of a patient undergoing surgical resection of glioblastoma with COVID-19.