Automatic mental simulation in native and non-native speakers.

Pictures of objects are verified faster when they match the implied orientation, shape, and color in a sentence-picture verification task, suggesting that people mentally simulate these features during language comprehension. Previous studies had an unintended correlation between match status and the required response, which may have influenced participants' responses by eliciting strategic use of this correlation. We removed this correlation by including color-matching filler trials and investigated if the color-match effect was still obtained. In both a native sample (Experiment 1) and a non-native sample (Experiment 2), we found strong evidence for a color-match advantage on median reaction time and error rates. Our results are consistent with the view that color is automatically simulated during language comprehension as predicted by the grounded cognition framework.

Traumatic tension pneumocephalus: a case report and perspective from Indonesia.

Traumatic tension pneumocephalus is a rare and life-threatening complication of traumatic brain injury necessitating prompt diagnosis and neurosurgical treatment. Nevertheless, various possibilities for impedance in timely management, including patient-related barriers are commonly experienced in low-and middle-income countries setting. Here we presented a delay of management in traumatic tension pneumocephalus case due to initial refusal for emergency surgery. A 59-year-old male presented to the emergency department following a motorcycle accident fully alert with no neurological deficit. He acknowledged clear nasal discharge within 1 h after the initial trauma, but no rhinorrhea or otorrhea was present during physical examination. Head CT revealed extensive pneumocephalus with "Mount Fuji sign," anterior skull base fracture, and frontal sinus fracture. The patient initially refused immediate surgical intervention due to excellent clinical condition and financial scare. Acute decrease of consciousness occurred 40 h post-trauma: GCS of 6 with slight dilatation of both pupils (4 mm) and sluggish pupillary reflex. Emergency bifrontal craniotomy, subdural air drainage, and dura mater tear repair were performed afterwards. Postoperative care was uneventful, with rapid improvement of consciousness and follow-up head CT showing minimal subdural fluid collection and absence of remaining pneumocephalus. The patient was discharged from the hospital after 7 days with GCS of 15 and GOS of 5, proving the importance of overcoming barriers for delay in delivering neurotrauma care in low-and middle-income countries.

Survey Assessment of Utility in Preoperative Magnetic Resonance (MR) Tractography Surgical Planning.

BACKGROUND: Although tractography-guided surgery is used by many surgeons, there is controversy in the published literature as it relates to its clinical utility. Here we adopted a survey-based approach with the goal of attaining a broader view of how tractography influence preoperative planning in a sampling of practicing neurosurgeons. METHODS: Three cases were prepared where the presence of a tumor distorted the optic radiation (case 1), arcuate fasciculus (case 2), and corticospinal tract (case 3). This survey was administered at the Medtronic Cranial Consortium attended by 20 practicing neurosurgeons. To avoid commercial bias, we used both the Brainlab and Medtronic platform to compute tractography. Each participant is asked to vote on a surgical trajectory before and after seeing the tractography images, as well as whether tractography added value in validating their surgical approach. RESULTS: In the 3 cases surveyed, 16%-44% of the surgeons changed the surgical corridor selected after seeing the tractography images. The most common finding associated with a change in surgical corridor involved intersection of the surgical corridor with visualized tracts. Consistently, >80% of the surgeons surveyed felt that tractography added value in their surgical planning. CONCLUSIONS: The clinical utility of tractography in preoperative planning varies as a function of surgeon and the tumor anatomy, with >80% of the participating surgeons believing that tractography added value in preoperative surgical planning.

Bone fusion in transcele reconstruction of frontoethmoidal meningoencephalocele.

OBJECTIVE: In surgical correction of frontoethmoidal encephalocele with transcranial approach, advanced facilities are required. While with extracranial approach, though deemed as a safe option in area with limited facilities, procedure was associated with cerebrospinal fluid (CSF) leakage. In this case series, we evaluate the results of transcele reconstruction of frontoethmoidal encephalocele, our approach to reduce the incidence of CSF leaks by focusing on the closure of layers by its embryological derivatives, by its bone fusion. METHODS: A case series of 14 patients with various types of frontoethmoidal encephalocele who underwent surgery for defect closure using transcele approach between June 2015 and December 2018 was carried out. Surgery was done by a single surgeon in the Department of Neurosurgery of Cipto Mangunkusumo Hospital in Jakarta, Indonesia. We collected the data of intraoperative blood loss and any signs of infection and CSF leak during the patients' one-year follow up. Bone fusion in the defect was evaluated from 3D rendering of head CT scan that was performed before and in 1 year after surgery. RESULTS: The median percentage of intraoperative blood loss was 5.9% (0.5-18.7%). All 3D rendering of head CT post-surgery during 1 year follow up showed bone fusion and no patient experienced CSF leaks or CNS infections. CONCLUSIONS: This study showed that using transcele approach in frontoethmoidal reconstruction could give good bone fusion with minimal blood loss and no CSF leaks. We assumed that closure of the layers by its embryological derivative played an important part in bone fusion and in reducing the incidence of CSF leaks, although this finding has to be validated with large-scale studies.

Purely extradural thoracal Schwanoma: Case report.

Introduction: and importance. Schwannomas are benign tumors that often occur in the medulla spinalis. It arises from the Schwann cells which form the sheath of peripheral nerves. Schwannomas comprise about 30% of primary intraspinal neoplasms and approximately 75% in intradural, 10% intra-extradural, and 15% extradural. Purely extradural schwannoma is rare. Case presentation: We present two adult males with extradural thoracal schwannoma. In this case, the main complaint is paraparesis and followed by suffered low back pain and spastic. The initial symptoms of this tumor depend on the level of the tumor location. Usually begins with localized pain, sharp and transient, followed by radicular pain and radiculopathy. We reported cases of schwannoma of the thoracal spine that have presented with neurological involvement. As a result of contrast, an MRI of the spine showed tumor extradural mass lesion extending from thoracal 1-2 vertebral and thoracal 4-6 vertebral level. Clinical discussion: The location of this tumor is rare because located in the extradural (15%), which are present between the bone structure and the dura. Surgery is the treatment of choice, in this case, usually results from excellent prognostic. This patient underwent hemilaminectomy and complete surgical resection. Conclusion: Early diagnostic and complete surgical resection before the occurrence of severe symptoms will show an excellent prognosis.

New adaptation of neurosurgical practice and residency programs during the Covid-19 pandemic and their effects on neurosurgery resident satisfaction and welfare at the National General Hospital, Jakarta, Indonesia.

INTRODUCTION: Many institutions in numerous countries have made changes in their health care services during the COVID-19 pandemic. One change has been to reduce elective neurosurgery cases, which has impacted neurosurgery education. Published literature is lacking about the healthcare services, education, and residents' well-being during adaptation to the pandemic, especially in national referral hospitals in developing countries. METHODS: We conducted a cross-sectional study on current neurosurgical services during 2020. We evaluated 34 neurosurgery residents in Cipto Mangunkusumo National General Hospital using a self-made questionnaire to determine the effects of the COVID-19 pandemic on their surroundings, education process, and satisfaction with the currently adapted education program. We used the modified Maslach Burnout Inventory to assess burnout in the residents before and during the pandemic. RESULTS: Neurosurgical residents spent more time studying neurosurgical theory (Mode 1-1.5h/day, p < 0.05) but spent less time learning neurosurgical skills (Mode 30 min-1 h/day, p < 0.05) compared to before the pandemic. The resident satisfaction mean score (scale 0-10) was 7.58 for live surgery and 8.53 for the microsurgical skills lab training program. On a scale of 1-10, the residents' stress level increased after the pandemic but the change was not statistically significant (6.61 ± 1.87, p > 0.05). The Modified Maslach Burnout inventory score was 3.02 ± 3.74 during the pandemic, and increased from before the pandemic (2.41 ± 3.18), but the difference was not statistically significant. CONCLUSION: The COVID-19 pandemics have reduced the working hours and the clinical exposure of neurosurgical residents. Fortunately, this pandemic has led to a new opportunity to find many suitable learning methods which may decrease the risk of burnout. The psychological burden of residents is still worrisome, and planned management is necessary to sustain resident performance.

Shark liver oil supplementation enriches endogenous plasmalogens and reduces markers of dyslipidemia and inflammation.

Plasmalogens are membrane glycerophospholipids with diverse biological functions. Reduced plasmalogen levels have been observed in metabolic diseases; hence, increasing their levels might be beneficial in ameliorating these conditions. Shark liver oil (SLO) is a rich source of alkylglycerols that can be metabolized into plasmalogens. This study was designed to evaluate the impact of SLO supplementation on endogenous plasmalogen levels in individuals with features of metabolic disease. In this randomized, double-blind, placebo-controlled cross-over study, the participants (10 overweight or obese males) received 4-g Alkyrol® (purified SLO) or placebo (methylcellulose) per day for 3 weeks followed by a 3-week washout phase and were then crossed over to 3 weeks of the alternate placebo/Alkyrol® treatment. SLO supplementation led to significant changes in plasma and circulatory white blood cell lipidomes, notably increased levels of plasmalogens and other ether lipids. In addition, SLO supplementation significantly decreased the plasma levels of total free cholesterol, triglycerides, and C-reactive protein. These findings suggest that SLO supplementation can enrich plasma and cellular plasmalogens and this enrichment may provide protection against obesity-related dyslipidemia and inflammation.

Predicting outcome of hemifacial spasm after microvascular decompression with intraoperative monitoring: A systematic review.

BACKGROUND: Microvascular decompression has been established as a primary treatment for hemifacial spasm. Intraoperative monitoring is used during the surgery to guide neurosurgeons to determine whether the decompression of facial nerve from the vessel is sufficient. We performed a systematic review to assess the role of lateral spread response (LSR) monitoring in predicting hemifacial spasm outcomes after microvascular decompression. METHOD: A systematic search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. We included studies that performed microvascular decompression surgery with intraoperative monitoring analyzing the correlation between lateral spread response and spasm relief. A critical appraisal was conducted for selected studies. RESULT: Twenty-two studies comprising 6404 cases of hemifacial spasm, which underwent microvascular decompression surgery with intraoperative monitoring, were included. Of 15 articles that assessed symptoms shortly after surgery, 12 studies showed a significant correlation between lateral spread response resolution and disappearance of spasm. Four of six studies that evaluated the outcome at 3-month follow-up showed significant relationship between LSR and outcome, so did five of six articles that assessed spasm relief at 6-month follow-up. As much as 62.5% of studies (10 of 16) showed the result at long-term follow-up (≥1-year) was not significant. CONCLUSION: Intraoperative monitoring during microvascular decompression surgery can be a useful tool to predict hemifacial spasm resolution. Though long-term outcomes of patients with LSR relief and persistence are similar, resolution of symptoms shortly after surgery will provide comfort to patients thereby improving their quality of life.

Algorithm of traumatic brain injury management at Indonesia in the COVID 19 pandemic ERA. Retrospective cohort study.

OBJECTIVES: COVID-19, a global pandemic, affects neurosurgical care in Indonesia. This study has objective to propose guideline and algorithm recommendation for the management of TBI patients during this pandemic, which can be used flexibly at neurosurgery centers, both in Indonesia and throughout the world. METHODS: We performed retrospective Cohort analysis from TBI database at tertiary public general hospitals. All neurotrauma cases from mid-February until mid-August 2020 was included in this study. The chronology of COVID-19 pandemics impact in Indonesia was defined by early period from mid-February until end of May 2020, and late period are latter. All subjects undergone the screening and perioperative measures that based on our proposes scoring system and algorithm as follows. RESULTS: There are many guidelines that explain screening methods in neurosurgery patients in general, as well as neurotrauma in particular. But here, we proposed our own scoring and screening algorithm that has been developed based on conditions in Indonesia. In total of 757 neurotrauma cases data were collected from the pandemic starts in Indonesia. DISCUSSION: Screening is a crucial initial step in this pandemic period, not only for COVID patients, but also all patients who enter the emergency room. The use of PPE is a necessity in several neurosurgery centers, especially with high COVID-19 case rates. CONCLUSION: The management of neurotrauma patients with suspected and confirmed COVID-19 requires special attention, starting from admission of the patient in ER. Rapid scoring and screening are important and the highest level of PPE is mandatory during patient care.

Localized asymptomatic cerebellar abscess after penetrating brain injury by wooden foreign object with adequate antibiotics administration: A case report.

INTRODUCTION: Brain abscess is a compilation of pus enclosed in capsule as a result of focal infection in brain parenchyma. It is one of several complications found in patients who suffered penetrating brain injury. CASE PRESENTATION: Thirty-four-year-old man suffered a penetrating brain injury after a 50 cm piece of wood penetrated through his facial skull and ended its tip in his cerebellum, the wood priorly ejected from a moulding machine. As a consequence, he had to undergo a craniotomy procedure to remove the foreign body object and its debris. Following the surgery, adequate antibiotics were administered. Postoperative enhanced head CT revealed a cystic mass formation in the left hemisphere of cerebellum, measured 20 × 28 mm with blood density lesions and a visible ring enhancement. These features suggested a cerebellar abscess. The follow-up enhanced head CT later demonstrated that the size, shape, and location of the abscess were relatively consistent with the previous head CT. DISCUSSION: Penetrating brain injury (PBI) is the most life-threatening head trauma. Although the prevalence number was low compared to other head traumas, its morbidity and mortality number were higher. Brain abscess formation is one of the many PBI complications. Due to direct inoculation of foreign body and its debris, PBI commonly leads an infection process. However, the infection process is supposed to be overcome by administering broad-spectrum antibiotics prophylactically. This case presented an inevitable brain abscess despite of the adequate antibiotics administration. CONCLUSION: Despite adequate antibiotics has been administered, cerebellar abscess after penetrating brain injury is still found challenging to manage. Therefore, holistic-multidisciplinary approaches are needed.