Objective: This study sought to identify the prevalence of operations for spinal epi- dural neoplastic metastases relative to other spine and neurosurgical operative pro- cedures. Methods: This study was descriptive and involved a retrospective review of data collected from patients who underwent neurosurgeries between February 1997 and January 2015 at a single quaternary hospital. The examined population was dis- tributed across five descriptive categories to perform numerical distributions among neurosurgical operative procedures. Results: A total of 12,802 neurosurgical proce- dures were identified. These procedures were classified as follows: Skull and brain, 11,192 (87.42%); spinal column and spinal nervous tissue, 1462 (11.42%); and pe- ripheral nerves, 148 (1.16%). Surgical procedures for the 1462 (100%) cases of spinal column and spinal nervous tissue diseases were distributed by nosology as follows: Degenerative intervertebral disk and spondylosis, 768 (52.54%); neoplastic, 279 (19.08%); traumatic, 221 (15.11%); congenital, 163 (11.14%); infectious and inflam- matory, 27 (1.85%); and vascular, 4 (0.28%). With respect to the distribution of the 279 (100%) surgical procedures for spinal column and spinal nervous tissue neoplastic diseases, 124 (44.44%) procedures were for intradural neoplasms, and 155 (55.56%) procedures were for epidural spinal column neoplasms. The 155 (100%) operations for epidural neoplastic diseases were distributed into two groups: Primary epidural neoplasms, 42 (27.10%); and secondary epidural neoplasms, 113 (72.90%). Spinal column epidural neoplastic metastases (secondary neoplasms) represented 0.88% of the 12,802 neurosurgical procedures. Conclusions: Surgical procedures for spi- nal metastasis are uncommon with respect to all neurosurgical operative proce- dures. Trend analysis reveals an unchanging trend of prevalence for these proce- dures.
In 1980s a number of case reports appeared suggesting that postoperative deficits might occur in spite of unchanged SSEPs. A collection of these studies was published by Lesser et al., 1986 (3). One group (4) reported a 9% incidence of “false negative” SSEPs during the performance of thoracic vertebrectomy, while a second group (5) more specifically reported a case of an anterior cord syndrome following a 3-level thoracic spondylectomy, during which SSEPs remained unchanged. A recent study (6) found SSEPs to give “false negative” indications in 4.1% of 658 neurosurgical procedures involving the spine and/or the brain. In the context of spinal surgery it might be argued that any procedure where the cord is approached from the anterior side might potentially endanger the anterior spinal artery, and that such a compromise may possibly go undetected if only SSEPs are monitored. Even in routine procedures such as anterior cervical discectomy, two cases of temporary postoperative quadriparesis have been reported, which were not detected by peroperative SSEP monitoring (7).
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Although the vast majority of infectious complications of neurosurgical procedures are of bacterial origin, post- operative HSVE is an established entity. Although HSV- 1 is usually the causative agent, HSV-2 can also cause an encephalitic pattern. Given the severity of the disease and the prognostic implication of treatment delay, prompt initiation of IV acyclovir is of prime importance. Thus, we recommend empirical acyclovir treatment in the appropriate clinical setting whenever CSF analysis is consistent with viral meningo-encephalitis. CSF viral- specific PCR together with MRI brain imaging are diag- nostic modalities of choice. In agreement with other experts [5, 11, 15, 16], we recommend prophylactic anti- viral treatment for patients with an HSVE previous history undergoing neurosurgery. Considering that post- operative HSVE is rare, potentially overlooked and always severe, randomized controlled studies are im- probable and clinicians should adapt their clinical prac- tice based on these data.
Background: The sitting position during neurosurgical operations predisposes to air penetration through veins and the movement of the air through the pulmonary circulation. Contact of an air bubble with the endothelium can lead to acute lung injury. The presence of specific pulmonary proteins in the plasma such as surfactant protein D (SP-D) and Clara cell protein (CC16) is a biomarker of damaging processes at the air-blood barrier. The aim of our study was to examine the hypothesis that the level of investigated pulmonary biomarkers in plasma is higher in patients operated on in the sitting position.
arterial pressure (MAP), stroke volume index (SVI), and cardiac index (CI) in patients undergoing neurosurgical procedures in sitting position. None of the studies have prospectively studied the effects of crystalloid preloading on hemodynamic changes during positioning from supine to sitting position. Hence, this pilot study was designed to study the effect of crystalloid preloading on hemodynamic parameters such as MAP, SV, cardiac output (CO), CI, and inferior vena cava diameter (IVCD) during positioning the patient from supine to sitting position.
Introduction: Cost-effectiveness of medical intervention is becoming increasingly important in healthcare delivery. Treatment in neurosurgery is extremely expensive and there have been very few publications on neurosurgical health economics and comparative effectiveness analysis of neurosurgical procedures. Previous studies which had compared the costs of clipping and coiling were held out in European centers with data specifically from the ISAT study conducted in Europe. No significant differences were seen in the total cost of coiling when compared to clipping in a time period of one year.
Since the introduction of functional MR imaging into clinical practice, an overwhelming emphasis has been placed on its potential to replace invasive mapping techniques. An implication of this empha- sis is that functional MR imaging must replace ex- isting invasive techniques in order to justify itself as a clinically viable technique. Our experience over a 4 ½ -year period, however, has been that this notion is misguided, because the clinical value of functional MR imaging extends beyond simply re- placing invasive neurosurgical procedures. It has been our experience that, regardless of whether a patient eventually goes on to invasive mapping, the information available from functional MR imaging is useful to clinicians at several key triage points in the preoperative clinical management of patients who are being considered for resective tumor or epilepsy surgery: these include assessing the fea- sibility of a particular surgical resection, surgical planning, and selecting patients for invasive neu- rosurgical sensorimotor mapping studies.
Shimadzu surgical mobile C‑arm WHA‑200 opescope pleno imaging system upgraded with DSA software was used for diagnostic cerebral DSA and subsequent endovascular neurosurgical procedures. The machine also had roadmapping software necessary for coiling. The machine has one live monitor and one reference monitor, manually rotatable X‑ray tube assembly. Diagnostic cerebral angiograms and endovascular neurosurgical procedures were planned at an interval of at least 2 h to allow cooling of X‑ray tube. Standard anteroposterior and lateral views along with additional multiple oblique views were obtained for aneurysms till proper working projection for aneurysm coiling obtained.
This paper is based on MR images from 24 patients that un- derwent cranial neurosurgical procedures in the interventional MR suite at the University of Minnesota. During surgery, mag- netization-prepared rapid gradient echo (MP-RAGE) volume images were acquired with a 1.5-T interventional MR scanner (Philips ACS-NT, Philips Medical Systems). In addition to the normally acquired images, which generally contain only a small number of slices, additional whole brain images volumes were obtained at the start and at the end of each intervention (see Fig. 1). The voxel dimensions are typically 0.9 0.9 1.5 mm, and the readout gradient is oriented in the cra- nial–caudal direction with a magnitude of 4.7 mT/m. Since the images were acquired using an open-style radio-frequency coil (a “synergy” phased array coil), some images have substantial nonuniform signal intensity. Table I summarizes details of the 24 cases studied in this investigation.
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India, 59 now have neurosurgery training programs for a total of 1800 neurosurgeons nationwide. However, with 190 new graduates each year serving a population of 1.2 billion, large areas of the country are devoid of neurosurgical practice. Despite this shortage, urban health centers such as the Apollo Hospitals (Chennai, India) and the India Institute of Medical Science (Delhi, India), deemed “centers of excellence,” offer proficient services across all neurosurgical procedures from endovascular neurosurgery to stereotactic radiosurgery. The immense wealth difference and geographical distance between rural and urban populations, however, has limited the accessibility of these centers to subpopulations living in specific locales. An estimated 800 million Indians living in suburban/rural areas have limited access to general neurosurgery as a vast majority of India’s 1800 neurosurgeons live in urban centers such as Delhi, Mumbai and Chennai. 
This number is rather alarming given the high prevalence of trauma and other neurosurgical emergencies experienced in Australasia and there could be a few potential reasons for this. First, in most medical schools, neurosurgeons are not directly involved in face-to-face student education. As a result, the vast majority of emerging medical practitioners are taught about common neurosurgical conditions either by other specialists or not at all (Resnick, 2000a). Second, the neurosurgery-related curriculum is too short and the teaching methods are not adequate to generate and maintain the knowledge of basic neurosurgical images within the minds of new medical graduates. And third, there is not enough motivation from the side of medical students to learn the interpretation of scans, probably relying too much and hoping on the opinion of qualified radiologists.
The most commonly used medical biological data- bases—PubMed, Web of Science, and Google Scho- lar—each have their own strengths and weaknesses . Among them, Web of Science (WoS) is a strong re- search database that was officially inaugurated in 2004 by the Thomson Scientific and Health Care Corporation. The WoS database not only contains the affiliations of all authors but also provides the numbers of citations of pub- lished articles. WoS provides access to Thomson Reuter’s multidisciplinary databases of bibliographic information. WoS is a powerful web interface providing access to the citation database . WoS offers a significant advantage for literature reviews in some particular fields [5, 6], especially for efforts to understand overall trends [7, 8]. Previous studies have evaluated Chinese neurosurgical publications, but they only focused on local Chinese journals  or carried out only superficial research on Chinese neurosurgical publications . The aim of this study was to comprehensively analyze neurosurgical publications in China using the WoS database.
It is not as if the development of trauma care in India has significantly lagged compared to global standards.  Over the years, the number of Trauma Centers has increased with adequately equipped units distributed in different corners of the country based in and around major cities. But there is uneven distribution of emergency and essential neurosurgical care with even basic trauma care missing from small towns and rural areas. Even in big cities, slum dwellers and poor population lack accessibility to quality neurosurgical care.
CT should be considered. For those with altered mental status, focal neurological signs or decreas- ing levels of consciousness – regarded as high risk factors – immediate CT and neurosurgical consul- tation should be undertaken . Kuppermann et al. recommend immediate CT scan for all children with a GCS of 14, with an altered mental state or signs of basal skull fracture. For patients with 15 GCS points and loss of consciousness, a his- tory of vomiting, severe headache and/or a severe mechanism of injury, the choice between observa- tion and early CT should be based on factors like the physician’s experience, the parents’ preferences, and whether or not there is any worsening of signs or symptoms or signs after the initial observation in the emergency department. For children with 15 GCS points who do not present any of the afore- mentioned findings, CT is not recommended . Beaudin et al. presented the clinical pathways used in Canada for the management of minor pediatric head trauma after a domestic fall. These included skull X-ray for children less than 3 years of age, or when the trauma had resulted from major fall or was associated with a penetrating wound. Chil- dren with minor injury with headache, recurrent vomiting (more than three times) or loss of con- sciousness should be subjected to brief observa- tion in the emergency department. If they show improvement they can be discharged home; or they should be admitted to the hospital if no im- provement occurs. Those without the aforemen- tioned symptoms can be discharged home. Head CT is strongly recommended for children initially presenting with seizures, for those with depressed or open fractures, or for those with lineal fractures with diathesis wider than 4 mm .
Majority of our patients, 24 (55.81%) were referred from other health facilities. The high percentage of referred patients in our neurosurgical centers was due to high population coverage by our centers. The first center covers one state with about 15 million people, while the second center covers two states and parts of three adjoining states totalling about 7 million people  Emejulu et al. . In Nnewi, South East, Nigeria, found that referred patients constituted 42.4% in their study. Adeleye and Okonkwo  in South West, Nigeria, found that 75% of their patients were referred from other health facilities. The high volume of referred patients to neurosurgical centers in our country depicts not only the dearth of neurosurgical centers but also lack of trauma system and universal insurance coverage unlike what is obtained in developed countries [18,19].
ment. The patients’ conditions were typical of those in neurosurgical intensive care, i.e. mixed diagnoses of traumatic brain injury, tumors and neurovascular disease. In total, 101 sets of readings were obtained (including HR, systolic and diastolic blood pressures [SBP and DBP], MAP, mean CVP, CI, MPWP and BSA). Table 1 compares values of cCI and cPWP calculated using HeartSmart ® with mCI and mPWP or (mPAOP) for four
There was a gradual yearly increment of the frequency of neurosurgical pathologies in the children population presenting in this study period: 31 (12.0%) in 2003, 63 (11.72%) in 2005, and then 83 (17.77%) in 2007. This suggests a progressive improvement in the awareness of the local populations to the neurosurgery services rendered by our department. In the particular aspect of pediatric neurosurgical pathologies, much efforts are still needed to enforce knowledge among local communities and increase their adhesion to modern medical care related to children neurosurgical pathologies.
There are now a variety of state-of-the-art systems that allow for the fusion of intraoperative ultrasound with pre-operative images, displaying on-screen visualization of procedures in progress 1–4 . In doing so, US images can be employed as a template to which pre-operative images can be registered, to correct for brain-shift, to provide live-image feedback, and consequently to improve confidence when making resection margin decisions near eloquent regions during tumour surgery 1,5,6 . These systems often make use of infra-red camera-based tracking systems that estimate the pose of hand-held tools and imaging probes to present helpful interpretive visualizations. As can be surmised from Table 1, optically-tracked freehand ultrasound implementations are limited by line-of-sight issues, bulkiness of optical tracking tools, cost, maintenance of the sterile field, and space constraints in the neurosurgical operating room 30,53,54 . Despite the many advances in commercial and research systems, ultrasound continues to be underutilized.
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included both patients in the statistical analysis, otherwise the total infection rate would be incorrectly too low. Comparing AIS with non-AIS, the presented data could not demonstrate a significant reduction of shunt infection by AIS. Remarkably we found three out of five infections in the AIS group which were caused by skin ulcerations or neurosurgerical procedures highly susceptible for contam- ination after initial shunt implantation. Furthermore, the infection rate in the non-AIS group was obviously smaller than reported in the literature. Sciubba et al.  retro- spectively investigated 211 pediatric patients with 353 shunt placement procedures over a 3-year period. In the first 18 months, 208 shunts were placed with non-impreg- nated catheters. 12 % of these patients had shunt infec- tions compared to only two patients (1.4 %) out of 141 in whom AIS had been inserted in the second 18 months. The authors could demonstrate a significant decrease in the infection rate in the AIS group by changing their man- agement. Aryan  investigated 32 Bactiseal shunt implantations in 31 children aged from 6 months to 17 years and compared them to patients treated with non- impregnated shunts. In the AIS group 12.5 % early and 18.8 % late complications occurred compared to 23.4 and 34.8 % in the non-AIS group.
Patients who were aged 18 years or older and underwent elective or emergency craniotomy and survived at least 7 days after surgery were included in the study. Patients with primary cerebrospinal fluid (CSF) shunt implantations, endoscopic surgery such as third ventriculostomy, patients highly suspicious of central nervous infection prior to the procedure including subdural empyema, cerebral abscess, or infected pathological disease such as Tuberculosis, Toxoplasmosis or Cryptococcal infection, patients with dirty wound and patients who underwent spinal surgery, patients who passed away within 48 hours after the operation, craniotomies performed for wound infection complication and patient underwent re-operation were excluded. The follow-up period was at least 30 postoperative days or until death for patients surviving less than 30 days if patient is still in the ward. For patient who was transferred to other hospitals, it was assumed that patients suffering a wound infection would be referred back to our unit. Patients who have been discharged will be reviewed again in neurosurgical clinic 30 days post-operatively for review whether there is post-operative surgical site infection or not.