Functional and Neuropsychological Outcome After Surgical Treatment of Moyamoya Disease.

BACKGROUND: Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive stenosis of the supraclinoid internal carotid artery. As a result of chronically decreased brain perfusion, eloquent areas of the brain become hypoperfused, leading to cognitive changes in patients. Repeated infarcts and bleeds produce clinically apparent neurologic deficits. OBJECTIVES: 1) To study the functional and neuropsychological outcome in MMD after revascularization surgery. 2) To find postrevascularization correlation between functional and neuropsychological improvement and radiologic improvement. METHODS: A single-center prospective and analytic study was carried out including 21 patients with MMD during the study period from March 2021 to December 2022. Patients were evaluated and compared before and after revascularization for functional, neuropsychological, and radiologic status. RESULTS: Postoperative functional outcome in terms of modified Rankin Scale score showed improvement in 33.33% of cases (P = 0.0769). An overall improving trend was observed in different neuropsychological domains in both adult and pediatric age groups. However, the trend of neuropsychological improvement was better in adults compared with pediatric patients. Radiologic outcome in the form of the Angiographic Outcome Score (AOS) significantly improved after revascularization (P = 0.0001). There was a trend toward improvement in magnetic resonance imaging (MRI) perfusion in the middle cerebral artery and anterior cerebral artery territories, 4.7% (P = 0.075) and 9.33% (P = 0.058) respectively, compared with preoperative MRI perfusion. CONCLUSIONS: After revascularization, significant improvement occurred in functional and neuropsychological status. This result was also shown radiologically as evidenced by improvement in MRI perfusion and cerebral angiography.

A review of virtual reality simulators for neuroendoscopy.

Neurosurgery is a challenging surgical specialty that demands many technical and cognitive skills. The traditional surgical training approach of having a trainee coached in the operating room by the faculty is time-consuming, costly, and involves patient risk factors. Simulation-based training methods are suitable to impart the surgical skills outside the operating room. Virtual simulators allow high-fidelity repeatable environment for surgical training. Neuroendoscopy, a minimally invasive neurosurgical technique, demands additional skills for limited maneuverability and eye-hand coordination. This study provides a review of the existing virtual reality simulators for training neuroendoscopic skills. Based on the screening, the virtual training methods developed for neuroendoscopy surgical skills were classified into endoscopic third ventriculostomy and endonasal transsphenoidal surgery trainers. The study revealed that a variety of virtual reality simulators have been developed by various institutions. Although virtual reality simulators are effective for procedure-based skills training, the simulators need to include anatomical variations and variety of cases for improved fidelity. The review reveals that there should be multi-centric prospective and retrospective cohort studies to establish concurrent and predictive validation for their incorporation in the surgical educational curriculum.