Evaluating Neurosurgical Care Perception Across Mexico: Insights from a Nationwide Survey.

BACKGROUND: Most of the scientific and healthcare resources in Mexico are limited to the large major cities. However, many communities with complex socioeconomic and cultural backgrounds have limited access to neurosurgical care. A cross-sectional study aiming to evaluate the population's perception regarding neurosurgical care was conducted. METHODS: A nationwide online survey, conducted starting February 2023, assessed public perception of neurosurgical care. Data analysis was performed based on sociodemographic characteristics such as age, socioeconomic status, religion, and education. Pearson's chi-square and odds ratio were employed for statistical comparisons of categorical variables. RESULTS: A total of 508 participants consented to the survey. Younger participants and higher education levels correlated with greater perceived knowledge about neurosurgery (P = <0.001) and higher confidence in neurosurgical healthcare personnel (P = 0.021 and P = 0.022, respectively). Lower educational levels were prone to perceive neurosurgical care as less safe and effective (P = 0.002) and preferred to seek initial alternative/traditional treatments for neurosurgical issues (P = 0.012). A higher income level was associated with a preference for private healthcare over public services P = <0.001). Odds ratio analysis corroborated these findings. Healthcare personnel emerged as the most common source of information for neurosurgical diseases (71.4%). CONCLUSIONS: Our findings suggest that sociodemographic factors such as age, education, and income correlate with the population's self-perceived knowledge, trust and beliefs about safety and effectiveness regarding neurosurgical care in Mexico. These findings can be instrumental for developing healthcare policies that address the needs of Mexico's patient population.

Simultaneous Parkinsonism and Dementia as Initial Presentation of Intracranial Dural Arteriovenous Fistulas: A Systematic Review.

BACKGROUND: Intracranial dural arteriovenous fistulas (IDAVFs) are abnormal vascular connections between dural arteries and various venous structures within the brain. IDAVFs, rarely present with parkinsonism and dementia concurrently, making this a unique and underexplored clinical scenario. To the best of our knowledge, this is the first systematic review to comprehensively analyze cases of IDAVFs manifesting as both parkinsonism and dementia. METHODS: We assessed databases from inception to September 18, 2023. We identified studies describing patients with IDAVFs initially presenting with dementia or parkinsonism. Inclusion criteria encompassed case reports and case series, while excluding review articles, guidelines, technical notes, comments, conference abstracts, and editorials. RESULTS: The systematic search resulted in the initial screening of 383 studies, with 33 articles meeting the inclusion criteria. Among these, 29 were case reports, often describing 3 or fewer patients. From the remaining 4 case series, data pertinent to patients presenting both parkinsonism and dementia were selectively extracted, yielding a total study population of 43 patients. The anatomical distribution of IDAVFs within this cohort was diverse, with the transverse and sigmoid sinuses being the most common locations. Although most of these patients received endovascular therapy, a few underwent microsurgical occlusion or combined surgical and endovascular treatment. CONCLUSIONS: IDAVFs presenting with both parkinsonism and dementia represent a rare clinical entity. This systematic review provides valuable insights into the clinical characteristics, treatment options, and outcomes for such cases. However, additional research involving larger cohorts is essential to better comprehend the underlying mechanisms and establish standardized therapeutic guidelines.