[Neurosurgical Residency in Portugal: What is the National Panorama?] / O Internato de Formação Especializada em Neurocirurgia: Qual o Atual Panorama Nacional?

INTRODUCTION: In Portugal, the number of neurosurgery residents has been rising steadily. However, there are no robust studies assessing the level of satisfaction and quality of the current training programs. The aim of this study was to describe and quantify the level of satisfaction about Neurosurgery residency in 2019, in Portugal. MATERIAL AND METHODS: Quantitative observational cross-sectional study based on an original questionnaire about the level of satisfaction of neurosurgical training in Portugal in 2019, sent electronically to residents and young consultants between October and December 2019. RESULTS: A total of 37 responses were obtained from physicians aged around 29.0 (± 4.0) years old, of which 78.4% were men and 54.1% from centers in the center/south of the country/islands. Overall, 51.4% of the answers came from first three years' residents. As for the theoretical training, there was dissatisfaction with the morbidity and mortality meetings (59.5%), existence of sessions/anatomical lab (89.2%), participation in medical education (64.9%) and in research (64.9%). As for practical training, there was dissatisfaction only towards outpatient clinics (56.8%). There is a tendency for the first surgery to occur in the first month of residency and, in ascending order, firstly a cranial trauma surgery (5.09 ± 4.59 months), then for cerebrospinal fluid diseases (5.95 ± 4.3 months), peripheral nerves (6.0 ± 7.0 months), craniotomy (6.59 ± 3.88 months) and lumbar spine diseases (11.41 ± 1.5 months). Pediatric surgery was the last type of surgery to begin (19.36 ± 20.0 months). There seems to be a generalized satisfaction with the annual (59.5%) but not with the final examination (37.8%). CONCLUSION: This study has succeed at being a better description of the Portuguese neurosurgical centers and of the level of satisfaction about neurosurgical training in Portugal.

Introdução: Em Portugal, o número de médicos internos em Neurocirurgia tem vindo a aumentar progressivamente ao longo dos anos, contudo esta evolução não tem sido acompanhada de estudos que permitam compreender o estado atual da formação. Foi objetivo deste estudo caracterizar e quantificar a satisfação na formação especializada em Neurocirurgia, em Portugal, no ano de 2019.Material e Métodos: Estudo quantitativo, observacional e transversal baseado num questionário original enviado eletronicamente aos internos e recém-especialistas de Neurocirurgia entre outubro e dezembro de 2019. Incluiu-se perguntas sobre características e satisfação em termos de formação teórica, prática, entre outras.Resultados: Obtiveram-se 37 respostas em médicos com cerca de 29,0 (± 4,0) anos, 78,4% homens e 54,1% provenientes de centros do Centro/Sul/Ilhas. Do total de respostas obtidas, 51,4% vieram de internos dos três primeiros anos. Quanto à formação teórica, evidenciou-se insatisfação em relação às reuniões de morbimortalidade (59,5%), existência de sessões/laboratório anatómico (89,2%), participação no ensino graduado (64,9%) e em investigação (64,9%). Quanto à formação prática, a insatisfação evidencia-se apenas em relação à consulta externa (56,8%). A primeira intervenção cirúrgica tende a ser realizada no primeiro mês de internato, no primeiro ano. Por ordem crescente, a primeira cirurgia é de trauma craniano (5,09 ± 4,59 meses), patologia de liquor (5,95 ± 4,3 meses), nervos periféricos (6,0 ± 7,0 meses), craniotomia (6,59 ± 3,88 meses) e patologia lombar (11,41 ± 1,5 meses). A cirurgia pediátrica é a última a ser iniciada (19,36 ± 20,0 meses). Parece existir satisfação geral com a avaliação anual (59,5%) mas não com a final (37,8%).Conclusão: Este estudo cumpriu o objetivo principal de ser um ponto de partida na caracterização dos centros neurocirúrgicos portugueses e da satisfação no internato de formação especializada em Neurocirurgia.

Multinodular and vacuolating neuronal tumor associated with focal cortical dysplasia in a child with refractory epilepsy: a case report and brief review of literature.

Multinodular and vacuolating neuronal tumor (MVNT) is a rare newly identified benign lesion, firstly included in the World Health Organization classification of tumors of the central nervous system in 2016, whose neoplastic or dysplastic nature remains unclear but with a distinctive cytoarchitectural pattern and radiological features. It is usually discovered as late-onset refractory epilepsy, headache related, or an incidental lesion of adulthood. As it is typically a stable disease, many opt for follow-up, as long as it keeps remaining asymptomatic, leaving surgery for refractory epilepsy, neurological deficits, or intracranial hypertension symptoms. A subtotal or complete resection seems to control seizures and neurological manifestations. We herein present the case of a child with refractory epilepsy related to MVNT and focal cortical dysplasia, a dual pathology case in a less frequent age group and without the typical radiological imaging. We report its radiologic features, histologic description, and management, and we present a brief literature review on MVNT focusing on the pediatric cases reported. MVNT should now be another probable low-grade epilepsy-associated lesion (LEAT) in patients of all ages, with a benign and stable course as it constitutes a curable cause of focal epilepsy. As all the refractory cases, surgery should be indicated after a comprehensive evaluation of a multidisciplinary epilepsy surgery team.

Supratentorial neuroenteric cyst in children: a case report and brief literature review.

Neurenteric cysts are rare developmental lesions typically found outside the central nervous system but when they do, we most likely find them in a spinal (cervical or dorsal) intradural extramedular location, often associated with dysraphism. The more unusual intracranial cases have been published because of its rarity, occurring mostly as a posterior fossa extra-axial cyst, in adults. Supratentorial cases are distinctly infrequent, especially in children, resulting in few case reports and even fewer case reviews. We describe a case of a child with a supratentorial neurenteric cyst and present a brief review of the literature about these cysts in children, a noticeable gap in the literature.

Non-adenomatous sellar lesions: single-centre 10-year experience.

OBJECTIVE: A minority of lesions found in the sellar region are non-adenomatous neoplastic, inflammatory, or cystic masses. Our study aims to describe the prevalence and characteristics of these lesions in a multidisciplinary pituitary outpatient clinic. DESIGN: We conducted an observational study which included 36 patients (15.9% of those followed up in this outpatient clinic between 2006 and 2016 who had pituitary surgery) submitted to pituitary surgery with histological results showing a non-adenomatous sellar lesion. We evaluated clinical, radiological, and biochemical (pituitary function) characteristics during the pre-operative and post-operative period. RESULTS: Thirty-six patients (50% female) with a mean age of 41.3 ± 21.9 years and a mean follow-up duration of 8.0 ± 9.0 years were included. Histologic diagnoses were divided into benign neoplasms (80.6%), malignant neoplasms (11.1%), inflammatory lesions (5.6%), and cystic masses (2.8%). The most common clinical presentation was headache (66.7%) and visual defects (61.1%). Forty-seven percent of patients had at least one pituitary axis insufficiency at the time of diagnosis. In the majority of cases (58.3%), a transsphenoidal approach was used for the initial pituitary surgery. Thirteen patients had more than one pituitary surgery and eight also had radiotherapy. At the time of data retrieval, five patients had no pituitary hormonal insufficiency and 13 patients had some visual defect improvement. CONCLUSIONS: Although rare, non-adenomatous sellar lesions may be associated with significant causes of morbidity, such as hypopituitarism and visual defects, per se or due to the various treatment modalities employed. Moreover, since the lesions are difficult to distinguish from adenomas, these patients require a careful multidisciplinary approach.