Neurosurgical simulation models developed in Latin America and the Caribbean: a scoping review.

Simulation training is an educational tool that provides technical and cognitive proficiency in a risk-free environment. Several models have recently been presented in Latin America and the Caribbean (LAC). However, many of them were presented in non-indexed literature and not included in international reviews. This scoping review aims to describe the simulation models developed in LAC for neurosurgery training. Specifically, it focuses on assessing the models developed in LAC, the simulated neurosurgical procedures, the model's manufacturing costs, and the translational outcomes. Simulation models developed in LAC were considered, with no language or time restriction. Cadaveric, ex vivo, animal, synthetic, and virtual/augmented reality models were included for cranial and spinal procedures. We conducted a review according to the PRISMA-ScR, including international and regional reports from indexed and non-indexed literature. Two independent reviewers screened articles. Conflicts were resolved by a third reviewer using Covidence software. We collected data regarding the country of origin, recreated procedure, type of model, model validity, and manufacturing costs. Upon screening 917 studies, 69 models were developed in LAC. Most of them were developed in Brazil (49.28%). The most common procedures were related to general neurosurgery (20.29%), spine (17.39%), and ventricular neuroendoscopy and cerebrovascular (15.94% both). Synthetic models were the most frequent ones (38.98%). The manufacturing cost ranged from 4.00 to 2005.00 US Dollars. To our knowledge, this is the first scoping review about simulation models in LAC, setting the basis for future research studies. It depicts an increasing number of simulation models in the region, allowing a wide range of neurosurgical training in a resource-limited setting.

Closure of a large lumbosacral myelomeningocele defect with a human pericardial graft: a case report.

INTRODUCTION: Myelomeningocele (MMC) is a complex congenital defect resulting from incomplete closure of the neural tube. The aim of this study is to present an unusual technique for the closure of a large defect. CASE REPORT: Here we report a patient that was prenatally diagnosed with MMC. At birth, a skin defect of approximately 5 x 7 cm was observed. To repair the defect, a Z-plasty was performed; however, necrosis of the flap developed 3 days after the surgery. The devitalized tissue was removed, and a human pericardial graft was used to cover the defect. DISCUSSION: Different techniques have been described for the repair of MMC with a large skin defect, such as rotation skin flaps as well as synthetic and biological grafts. In our patient, a new technique without prior experience consisting of the application of human cadaveric pericardial graft was used with good results and no complications. CONCLUSION: Closure of MMC is often a surgical challenge. Here we describe a surgical technique for the closure of large skin defects.

Lung destruction secondary to intrapulmonary migration of a ventriculoperitoneal shunt catheter: report of an unusual case and literature review.

Ventriculoperitoneal shunt placement for the treatment of hydrocephalus is one of the most common pediatric neurosurgical procedures. Complications, including infections, catheter obstruction, shunt breakdown, and hemorrhage, have been described in the literature. Occasionally, however, uncommon and devastating complications occur. We report a case of a 10-year-old female patient who at birth underwent surgical closure of lumbar myelomeningocele and placement of a CSF shunt at another center. Her neurosurgical follow-up was poor. She presented at our institution with a history of recurrent pneumonia. Control chest X-rays showed a right pulmonary infiltrate with lung retraction and mediastinal shift. Chest and brain CT scans confirmed the intrapulmonary location of the distal catheter tip and ventricular dilation. Surgical shunt revision was performed with removal of the intrapulmonary catheter and placement of a new intraperitoneal catheter. Subsequently, right pneumonectomy was performed with good postoperative recovery of the patient. Intrathoracic migration of the distal catheter of the CSF shunt is an extremely rare complication that may produce severe morbidity. To our knowledge, there have been no previous reports on extensive lung destruction secondary to intrathoracic and intrapulmonary ventriculoperitoneal shunt migration. In patients with CSF shunts and pulmonary symptoms, intrapulmonary catheter migration should be considered.

Complicaciones inusuales de las derivaciones ventrículoperitoneales. A propósito de 2 casos pediátricos / Unusual complications of ventriculoperitoneal shunts. About 2 pediatric cases

Introducción: Durante el seguimiento de los pacientes con derivación ventrículoperitoneal (DVP) para el tratamiento de la hidrocefalia se pueden presentar complicaciones habituales relacionadas a la derivación, tales como infecciones u obstrucción/ruptura del sistema derivativo. Sin embargo, raramente se pueden observar complicaciones más raras y graves que pueden afectan a órganos como el corazón y el pulmón. Pacientes y métodos: Presentamos 2 pacientes con raras complicaciones relacionadas a la DVP. El primero, un paciente de 10 años, que después de 7 años de la implantación de una DVP presentó episodios de neumonía recurrente secundaria a la migración intrapulmonar del catéter distal. El segundo caso, un paciente de 3 años, que 5 meses posteriores a la colocación de una DVP presentó síntomas de hipertensión endocraneana secundarios a migración intracardíaca del catéter distal. Conclusión: La migración intrapulmonar e intracardíaca del catéter distal son complicaciones extremadamente raras, pero que pueden producir morbilidad importante. Los pacientes con derivación ventrículoperitoneal deben ser controlados de forma rutinaria de por vida, con la finalidad de evitar comorbilidades asociadas a sus complicaciones.

Introduction: during the follow-up of patients with ventriculoperitoneal (VP) shunts for the treatment of hydrocephalus, common complications may occur, such as infections or obstruction/rupture of the shunt system. However, more rare and serious complications that affect organs such as the heart and lungs can be observed Patients and methods: we present 2 patients with rare complications related to VP shunts. The first, a 10-year-old patient, who 7 years after implantation of a VP shunt, presented episodes of recurrent pneumonia secondary to intrapulmonary migration of the distal catheter. The second case, a 3-year-old patient, who 5 months after the placement of a VP shunt, presented with symptoms of intracranial hypertension secondary to intracardiac migration of the distal catheter. Conclusion: intrapulmonary and intracardiac migration of the distal catheter are extremely rare complications, but they can cause significant morbidity. Patients with ventriculoperitoneal shunts should be routinely monitored for life by neurosurgeons, in order to avoid comorbidities associated with potential complications.

The technique of superselective ophthalmic artery chemotherapy for retinoblastoma: The Garrahan Hospital experience.

Background Superselective ophthalmic artery chemotherapy (SOAC) is a proven therapy for the treatment of retinoblastomas. We describe the technique, results and complications of SOAC performed in our hospital. Objective The aim of this article is to demonstrate that a seemingly complex technique can be carried out with a low morbidity rate. Methods A retrospective analysis of patients receiving SOAC in our department from November 2014 to April 2017 was performed. Data collected were age, gender, number of procedures, arteries approached, bilaterality of treatment, and complications. The procedure was performed using a 3F sheath and a flow-dependent 1.5F microcatheter that was navigated from the femoral artery to the ostium of the ophthalmic artery (OA). When the OA was too small or a stable position could not be achieved, the microcatheter was navigated in the external carotid artery to reach an anastomotic ramus (AR) of the middle meningeal artery (MMA) to the OA. The drugs were then injected through the microcatheter in a pulsatile way. Results Forty-one patients underwent SOAC. A total of 248 procedures were performed in 45 eyes, and 248 arteries were approached (205 OAs and 43 MMAs). Four patients underwent tandem therapy (both eyes treated in the same procedure). Complications were: hypotension and bradycardia during the procedure (five cases), transient thrombosis of the femoral artery (two cases), retinal hemorrhage (one case), alopecia (one case), and anaphylactic shock to carboplatin (one case). No patient showed adverse effects of radiation or ischemic stroke. Conclusion SOAC is a safe technique with a very low complication rate.