Predictors of Surgical Outcomes in Patients with Abducens Nerve Schwannoma: A Comprehensive Systematic Review and a Case Report.

BACKGROUND: Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined. OBJECTIVE: To characterize clinical features of AN schwannomas and predictors of surgical outcomes. METHODS: PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes. RESULTS: A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040). CONCLUSIONS: AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.

History of Neurosurgery in Jordan.

OBJECTIVE: To raise the level of awareness regarding the role of Jordan as one of the leading countries in the region in providing excellent general medical and neurosurgical care. METHODS: This article is mainly a descriptive article. Data presented were collected from different sources that were available in either Arabic or English. RESULTS: Jordan has a well structured health care system that consists of three major sectors: public, private, and donors. The physician density is 2.86 physicians/1000 population and the bed density of 17 beds/10,000 population. Jordan has 58 neurosurgeons (1 neurosurgeon per approximately 115,000 population) who cover all neurosurgical subspecialties and provide the best modern neurosurgical care. CONCLUSION: Jordan has placed great importance on advancing the health care sector in accordance with international benchmarks yielding performance indicators that are among the best in the region. Moreover, Jordanian women are empowered to take leading roles in nursing, medicine, and surgery.