European Medical Students' Views on Neurosurgery, with Emphasis on South-East Europe (Albania, Greece, Serbia, and Turkey).

BACKGROUND: Neurosurgery, an intricate and dynamic surgical specialty, faces challenges in attracting medical graduates. Despite its potential appeal, a decreasing trend in medical students opting for surgical specialties, including neurosurgery, is noted. This study aims to assess European medical students' perceptions of neurosurgery, focusing on South-East Europe, and address concerns about the declining interest in this field. METHODS: A comprehensive digital survey, comprising 33 questions, was distributed to 1115 medical students across 17 European countries. The survey, conducted over 9 months, gathered responses through European neurosurgical societies, the European Association of Neurosurgical Societies (EANS), and university channels. Statistical analysis utilized IBM Statistical Package for the Social Sciences, presenting data through counts, proportions, and χ2 tests. RESULTS: The study reveals that, over the survey period, 834 medical students completed the questionnaire, with a predominant representation from South-East Europe. While 43.2% of participants were considering a surgical career, neurosurgery emerged as the most preferred specialty (26.37%). Despite this interest, 80.2% reported insufficient knowledge about pursuing a neurosurgical career, with limited exposure during medical education. Concerns about work-life balance, heavy workload, and hierarchical structures were prominent among respondents. CONCLUSIONS: The findings underscore the need for targeted interventions to address concerns influencing medical students' decisions regarding neurosurgery. Improving neurosurgical education, dispelling misconceptions, and creating a supportive work environment are crucial steps to attract and retain diverse talented individuals in neurosurgery. These efforts will be vital in narrowing the gap between the demand for neurosurgeons and the number of medical graduates entering the field, ensuring a sustainable future for this essential surgical specialty.

Microsurgical anatomy of the auditory radiations: revealing the enigmatic acoustic pathway from a surgical viewpoint.

OBJECTIVE: The thalamocortical projections of the auditory system have not been detailed via microanatomical fiber dissections from a surgical viewpoint. The aim of this study was to delineate the course of the auditory radiations (ARs) from the medial geniculate body to their final destination in the auditory cortex. The authors' additional purpose was to display the relevant neural structures in relation to their course en route to Heschl's gyrus. METHODS: White matter fibers were dissected layer by layer in a lateral-to-medial, inferolateral-to-superomedial, and inferior-to-superior fashion. RESULTS: The origin of ARs just distal to the medial geniculate body was revealed following the removal of the parahippocampal gyrus, cingulum bundle, and mesial temporal structures, in addition to the lateral geniculate body. Removing the fimbria, stria terminalis, and the tail of the caudate nucleus along the roof of the temporal horn in an inferior-to-superior direction exposed the lateral compartment of the sublenticular segment of the internal capsule as the predominant obstacle that prevents access to the ARs. The ARs were initially obscured by the inferolaterally located temporopulvinar tract of Arnold, and their initial course passed posterolateral to the temporopontine fascicle of Türck. The ARs subsequently traversed above the temporopulvinar fibers in a perpendicular manner and coursed in between the optic radiations at the sensory intersection region deep to the inferior limiting sulcus of insula. The distal part of the ARs intermingled with the fibers of the anterior commissure and inferior fronto-occipital fasciculus during its ascent toward Heschl's gyrus. The ARs finally projected to a large area over the superior temporal gyrus, extending well beyond the anteroposterior boundaries of the transverse temporal gyri. CONCLUSIONS: The ARs can be appreciated as a distinct fiber bundle ascending between the fibers of the sublenticular segment of the internal capsule and traversing superiorly along the roof of the temporal horn by spanning between the optic radiations. Our novel findings suggest potential disruption of the ARs' integrity during transsylvian and transtemporal approaches along the roof of the temporal horn toward the mesial temporal lobe. The detailed 3D understanding of the ARs' relations and awareness of their course may prove helpful to secure surgical interventions to the region.

Cervical Oblique Corpectomy: Revitalizing the Underused Surgical Approach With Step-By-Step Simulation in Cadavers.

ABSTRACT: Recently, the World Federation of Neurosurgical Societies Spine committee recommended that additional research on cost-benefit analysis of various surgical approaches for cervical spondylotic myelopathy be carried out and their efficacy with long-term outcomes be compared. Unfortunately, it is highly probable that the oblique corpectomy (OC) will not be included in cost-benefit investigations due to its infrequent application by neurosurgeons dealing with the spine. In this cadaveric study, head and necks of 5 adult human cadavers stained with colored latex and preserved in 70% alcohol solution were dissected under a table-mounted surgical microscope using 3× to 40× magnifications. The OC approach was performed to simulate real surgery, and the neurovascular structures encountered during the procedure and their relations with each other were examined. Oblique corpectomy was performed unilaterally, although neck dissections were performed bilaterally on 10 sides in all 5 cadavers. At each stage of the dissection, multiple three-dimensional photographs were obtained from different angles and distances. For an optimal OC, both the anterior spinal cord must be sufficiently decompressed and sufficient bone must be left in place to prevent instability in the cervical spine. Oblique corpectomy is a valid and potentially low cost alternative to other anterior and posterior approaches in the surgical treatment of cervical spondylotic myelopathy. However, meticulous cadaver studies are essential before starting real surgical practice on patients in order to perform it effectively and to avoid the risks of the technique.

Retrospective Analysis and Comparison of 48 Intracranial Meningioma Cases As Two Groups According to Their Size.

Objective This study aims to examine the possible demographic, clinical, and surgical differences between giant and smaller meningiomas. Materials and Methods Forty-eight meningioma patients who were operated on in our clinic between 2016-2020 were included in our study. Fourteen meningiomas larger than 5 cm in diameter were defined as giant meningiomas and placed in group 1. Thirty-four remaining meningiomas, with sizes less than 5 cm, were placed in group 2. These patients were evaluated regarding age, sex, localization, symptoms and neurological findings, surgical results, histopathology, and postoperative results. Results The most common localization in group 1 was falcine-parasagittal, whereas in group 2 it was convexity. Simpson's grade I resection rate in group 1 was 35.71%, while in group 2 this rate was 67.65%. In histopathological examination, transitional type meningiomas (35.71%) were the most common in group 1, whereas fibrous type meningiomas (32.35%) were seen the most in group 2. Group 1 Karnofsky Performance Scale score average was 75.71 preoperatively and 85.71 postoperatively. In group 2, the preoperative and postoperative average was 97.35 and 96.76, respectively. The comparative statistical analysis reflects that: A) Resection rates were significantly lower in the giant meningioma group. B) Similarly, Karnofsky Performance Scale scores were also lower than group 2. C) When statistical comparisons were made according to sex, age, localization, histopathological results, postoperative complications, and recurrence rates, no significant differences were observed. Conclusion The term "Giant Meningioma" is a type of distinction that is frequently made in the literature. However, the single major difference we see in our study was the surgical results. The general condition of patients before and after surgery may be more critical than others in giant meningiomas. Although surgical resection is the main form of treatment in giant meningiomas, the risks arising from the size of the tumor should be taken into account, and necessary plans should be made for a successful surgical intervention.

The Role and Contribution of Lumbar Myelography in the Diagnosis and Treatment of Patients With Lumbar Degenerative Disorders: Clinical and Statistical Evaluation of Post-Myelography Treatment of 63 Patients.

Introduction Myelography is a radiological examination method that has been used for the diagnosis of spinal canal pathologies for a long time. More than 90 years of experience has been improved by the development of increasingly less toxic contrast agents. Nowadays, although there are many advanced diagnostic tools, lumbar myelography is a direct imaging technique and so it is a powerful diagnostic method for patients whose treatment has not been decided. The aim of our study is to evaluate the effect of lumbar myelography as a diagnostic method and its contribution to treatment. Materials and methods Between January 2016 and April 2018, 63 patients who were admitted to our neurosurgery clinic due to lumbar degenerative disorders and underwent myelography were included in our study. Patients over 30 years of age with lumbar disc disease, narrow spinal canal, and spinal instability, but for whom a surgical decision could not be made, were included in this study. Results After lumbar myelography, 55 of 63 patients underwent a surgical procedure and 8 were directed to non-surgical treatment options. The results of the patients were evaluated by Roland-Morris Low Back Pain and Disability Questionnaire (RMQ). Results showed that the contribution of selected treatment protocols to the recovery after myelography was statistically significant. Conclusion Nowadays, myelography is not the first choice for the diagnosis of lumbar degenerative disorders. However, according to the results of our study, lumbar myelography is an effective diagnostic tool for specific purposes.

Secondary Parkinsonism in a Patient With a Cerebral Cavernous Hemangioma Treated With Stereotactic Radiosurgery.

Secondary parkinsonism is defined with some symptoms similar to idiopathic Parkinson's disease, but with different etiologies. And cerebral cavernous hemangioma is one of the rare cases. A 51-year-old, male patient was consulted with tremor, rigidity and bradykinesia on the right upper extremity. The Hoehn and Yahr Parkinson's scale was Stage І. Radiological evaluations showed a deep-seated cerebral cavernous hemangioma at the left posterior insular region. The patient received stereotactic radiosurgery (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA). Clinical and radiological improvements revealed within follow-up, respectively. Stereotactic radiosurgery may be an alternative treatment for secondary parkinsonism by reducing the risk of re-bleeding and reducing its size.

Fiber dissection and 3-tesla diffusion tensor tractography of the superior cerebellar peduncle in the human brain: emphasize on the cerebello-hypthalamic fibers.

Experimental studies in various species using tract-tracing techniques showed clear evidence of the presence of cerebello-hypothalamic projections. However, these connections were not clearly described in humans. In the present study we aimed to describe the direct cerebello-hypothalamic connections within the superior cerebellar peduncle (SCP) using fiber dissection techniques on cadaveric brains and diffusion tensor tractography (DTI) in healthy adults. Fiber dissection was performed in a stepwise manner from lateral to medial on 6 cerebral hemispheres. The gray matter was decorticate and fiber tracts were revealed. The SCP was exposed and the fibers were traced distally using wooden spatulas. The MRI examinations were performed in seven cases using 3-tesla 3T unit. The direct cerebello-hyothalamic pathways were exposed using high-spatial-resolution DTI. The present study using both fiber dissection and DTI in adult human showed direct cerebello-hypothalamic fibers within the SCP. The SCP fibers course anterolateral to the cerebral aqueduct reaching the level of the red nucleus of the midbrain. The majority of the fibers crosses over and reached the contralateral diencephalic structures and some of these fibers terminated at the contralateral anterior hypothalamic area. Some of the uncrossed SCP fibers reached the ipsilateral diencephalic structures and terminated at the ipsilateral posterior hypothalamic area. We further reported the close relationship of the SCP with the MCP, lateral lemniscus, red nucleus and substantia nigra. In the DTI evaluations of the SCP we exposed unilateral left cerebello-hypothalamic fibers in five cases and bilateral cerebello-hypothalamic fibers in two cases. The present study demonstrates the direct cerebello-hypothalamic connections within the SCP for the first time using fiber dissection and DTI technique in the human brain. The detailed knowledge of the cerebello-hypothalamic fibers can outline the unexplained deficit that may occur during regional surgery.

Surgical technique for the protection of the cervical sympathetic trunk in anterolateral oblique corpectomy: A new cadaveric demonstration.

The cervical oblique corpectomy (OC) approach has the advantages of no grafting or instrumentation necessities and theoretically maintains natural neck motions. However, the risk of cervical sympathetic trunk (CST) injury and Horner's syndrome is one of the main difficulties of this demanding surgical approach. The upper necks of 3 adult human cadavers (6 sides) were dissected under a Zeiss surgical microscope. OC was performed in a stepwise manner to simulate the surgical procedure. We specifically studied the technique of the protection of the CST during the cervical OC approach. The superior ganglion of the cervical sympathetic chain is located under the prevertebral fascia over the longus capitis muscle at the level of C3 transverse process, while the CST is situated under the prevertebral fascia over the longus colli muscle. The CST courses obliquely from superolateral to inferomedial. The ganglia and CST are carefully dissected; the fascia of the longus colli muscle is cut medially, preferably in the midline over the vertebrae, and the fascia lifted up. Then, the aponeurotic flap is gently retracted laterally to cover the sympathetic chain safely and secured with a 3/0 suture laterally. Preservation of the CST while performing cervical OC is essential to avoid postoperative Horner's syndrome. The placement of self-retaining retractors, particularly inferiorly, where the sympathetic chain is located more medially, is probably the main cause of its injury. Further studies are needed documenting the incidence of Horner's syndrome in the application of this technique to live patients.