Evaluating the role of 7-Tesla magnetic resonance imaging in neurosurgery: Trends in literature since clinical approval

BACKGROUND After approval for clinical use in 2017,early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated its feasibility as well as diagnostic capabilities in neuroimaging.However,there are no to few systematic reviews covering the entirety of its neurosurgical applications as well as the trends in the literature with regard to the aforementioned application.AIM To assess the impact of 7-Tesla MRI(7T MRI)on neurosurgery,focusing on its applications in diagnosis,treatment planning,and postoperative assessment,and to systematically analyze and identify patterns and trends in the existing literature related to the utilization of 7T MRI in neurosurgical contexts.METHODS A systematic search of PubMed was conducted for studies published between January 1,2017,and December 31,2023,using MeSH terms related to 7T MRI and neurosurgery.The inclusion criteria were:Studies involving patients of all ages,meta-analyses,systematic reviews,and original research.The exclusion criteria were:Pre-prints,studies with insufficient data(e.g.,case reports and letters),non-English publications,and studies involving animal subjects.Data synthesis involved standardized extraction forms,and a narrative synthesis was performed.RESULTS We identified 219 records from PubMed within our defined period,with no duplicates or exclusions before screening.After screening,125 articles were excluded for not meeting inclusion criteria,leaving 94 reports.Of these,2 were irrelevant to neurosurgery and 7 were animal studies,resulting in 85 studies included in our systematic review.Data were categorized by neurosurgical procedures and diseases treated using 7T MRI.We also analyzed publications by country and the number of 7T MRI facilities per country was also presented.Experi-mental studies were classified into comparison and non-comparison studies based on whether 7T MRI was compared to lower field strengths.CONCLUSION 7T MRI holds great potential in improving the characterization and understanding of various neurological and psychiatric conditions that may be neurosurgically treated.These include epilepsy,pituitary adenoma,Parkinson's disease,cerebrovascular diseases,trigeminal neuralgia,traumatic head injury,multiple sclerosis,glioma,and psychiatric disorders.Superiority of 7T MRI over lower field strengths was demonstrated in terms of image quality,lesion detection,and tissue characterization.Findings suggest the need for accelerated global distribution of 7T magnetic resonance systems and increased training for radiologists to ensure safe and effective integration into routine clinical practice.

Practice of Pediatric Neurosurgery at the “Hôpital SpécialiséMère-Enfant Blanche Gomes” in the Republic of the Congo

Introduction: Pediatric Neurosurgery is a growing specialty in its own right worldwide. Its practice in sub-Saharan Africa remains confronted with many challenges, notably the absence of a pediatric neurosurgeon, the lack of a dedicated service and the absence of multidisciplinary pediatric collaboration (neuroanesthesist, neurologist, oncologist and psychotherapist). The objective of this preliminary study is to describe the practice of pediatric neurosurgery at the HSMEBG and to present perspectives for its improvement. Methods: This is a retrospective, monocentric, descriptive study covering the period from March 2021 to March 2022 at the Pediatric Surgery Department of the HSMEBG. Résults: During the study period, 50 children were hospitalized for a neurosurgical condition. The sex ratio was 1.77. The average age was 6 years with extremes of 2 weeks and 16 years. Most children were from the emergency department (46%). Computed tomography (CT) was performed in 35 patients (70%), magnetic resonance imaging (MRI) in 4% and plain radiography in two patients (8%). Malformative, traumatic (cranial and spinal) and tumor pathology were the most frequent with 42%, 36% and 12% respectively. Twenty-six patients were operated (52%). We recorded one postoperative infection (2.5%). The overall mortality was 8% (N = 4). Conclusion: This preliminary study allowed us to identify the epidemiological and clinical profile of the patients treated in our context as well as the therapeutic approach. Malformative pathology remains the most frequent, followed by traumatic and tumor pathology. The development of the practice of this discipline remains a challenge in our working conditions and requires the training of pediatric neurosurgeons and dedicated paramedical staff.

Patient Safety Risks and Measures for Pediatric Neurosurgery Nursing

The aim of this study was to determine the patient safety risks and measures for pediatric neurosurgery nursing.A total of 564 pediatric patients admitted to the hospital from June 2020 to June 2023 under the neurosurgery department were included in this study.We analyzed the safety incidents in pediatric neurosurgery nursing and their causes and proposed corresponding measures for pediatric neurosurgery nursing in hope to reduce the occurrence of patient safety incidents in pediatric neurosurgery nursing and establish harmonious nurse-patient relationships.

Neurosurgery:颈动脉内膜剥脱术后同侧瞳孔散大是怎么回事?

急性瞳孔散大往往提示脑疝,是神经外科最严重的临床征象。颈动脉内膜剥脱术（carotid endarterectomy,CEA）后,急性瞳孔散大意味着再灌注出血引起占位效应压迫动眼神经。CEA手术后出血非常罕见,不足0.5%。

Mycoplasma hominis meningitis after operative neurosurgery:A case report and review of literature

BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.

Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area of 2019 Coronavirus Infection

Since December 2019,an outbreak of coronavirus disease 2019(COVID-19)has.posed significant threats to the public health and life in China.Unlike the other 6 identified coronaviruscs,the SARS-Cov-2 has a high infectious rate,a long incubation period and a variety of manifestations.In the absence of effective treatments for the virus,it becomes extremely urgent to develop scientific and standardized proposals for prevention and control of virus transmission.Hereby we focused on the surgical practice in Neurosurgery Department,Tongji Hospital,Wuhan,and drafted several recommendations based on the latest relevant guidelines and our experience.These recommendations have helped us until now to achieve'zero infection'of doctors and nurses in our department,we would like to share them with other medical staff of neurosurgery to fight 2019-nCoV infection.

Postoperative Outcome in Children Aged between 6 and 10 Years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

Background: Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study that there were multiple predictors of postoperative outcome, including American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. Objective: To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. Methods: The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old was retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. Results: There were 88 patients with a mean age of 98.7 ± 13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphylaxis. Nine patients (10.2%) had postoperative neurologic failure, and 2 (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42 (47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5 - 16]. Conclusion: Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade 3 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.

Prolonged coexistent central diabetes insipidus and cerebral salt wasting syndrome following neurosurgery

The coexistence of different water homeostasis abnormalities following neurosurgery represents a diagnostic and therapeutic challenge for intensive care units. This paper reports the case of a 13 year-old boy who underwent surgery for a suprasellar tumour and, immediately after surgery, developed a cerebral abscess, persistent diabetes insipidus (DI) as well as cerebral salt wasting syndrome (CSWS). The early onset of CSWS following DI has been associated with a poor prognosis and increased mortality. In cases in which these abnormalities coexist, the increased polyuria secondary to the rise in natriuresis associated with CSWS might be erroneously interpreted as a sign of poor control of the DI, thereby leading to therapeutic mistakes. Treatment basically consists of restoring electrolytes and the joint administration of desmopressin and fludrocortisone.

Comparison of Nasal and Frontal BIS Monitoring in Neurosurgery: Does the Site of Sensor Placement Affect the BIS Values?

Background and Goal of Study: Intraoperative awareness is a serious but preventable complication of general anaesthesia. Bispectral index (BIS) is the most widely used method monitoring anaesthesia depth. BIS monitoring requires attachment of forehead sensors, which poses a challenge when the surgical field involves the forehead. We aimed to compare the gold standard forehead position of BIS sensors with an alternative position across the nasal dorsum for neurosurgical procedures. Materials and Methods: After ethical committee approval and informed consent were obtained, 62 patients were enrolled in this prospective observational study. Frontal and nasal BIS values were compared in all patients. Results and Discussion: The mean BIS value from frontal versus nasal sensors was 49 ± 22 and 49 ± 21 respectively (n: 62). These values were statistically correlated (ICC 0.78, p < 0.001) indicating that nasal BIS measurement does not present a disadvantage for routine use when needed. Conclusion: Our data reveal that for measuring anesthesia depth, BIS sensor placement on the nasal dorsum shows comparable efficiency in comparison to standard frontal

Pain management using Han’s acupoint nerve stimulator combined with patient-controlled analgesia following neurosurgery A randomized case control study

BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE： To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING： A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （Ganzhou, Jiangxi Province, China） from January 2005 to February 2006. PARTICIPANTS： Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （China）, were included in this study. METHODS： Forty patients underwent neurosurgery and were randomly divided into two groups： patient-controlled analgesia plus HANS （＋HANS, n = 20） and patient-controlled analgesia （-HANS, n = 20）. Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. （China）. Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing （China）, with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE： The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS： Compared with the HANS group, the visual analogue scale scores were remarkably lower in the ＋HANS group six hours after surgery （P 〈 0.01）, and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased （P 〈 0.05）.CONCLUSION： The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.

Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

27th Congress of the European Society for Pediatric Neurosurgery

Time:May 3-6,2020,Venue:Athens,Greece,Website:https://www.erasmus.gr/microsites/1179The 27th Congress of the European Society for Pediatric Neurosurgery(ESPN)will take place in Athens,Greece on May 3-6,2020.ESPN aims to organize an outstanding scientific and educational congress to facilitate the spread and exchange of knowledge,skills and attitudes,between experts,researchers,clinicians and trainees,and to continue the development of pediatric neurosurgery in Europe.

Importance of the telemedicine network for neurosurgery in Slovenia

The number of invasive procedures in medicine is increasing,as is the employment of new technological achievements.In the era of informationcommunication technology,one such achievement is also the telemedicine network.In Slovenia,it is known as the Telekap(TeleStroke) network,which was primarily designed for fast and efficient management of stroke patients.In the neurosurgical community,the system is frequently used also for conveying vital information regarding subarachnoid haemorrhage and trauma.Especially in neurosurgical emergencies,this communication system offers thorough information about the extent and location of bleeding and facilitates the preoperative planning of neurosurgical interventions.From our experience so far,the system should be expanded to other neuro-centres as well to all neurosurgery departments in order to facilitate patient management,their acute hospital care,and inter-speciality collaboration.

The contribution of functional neurosurgery to the understanding of the physiopathology of Parkinson’s disease

Functional neurosurgery is nowadays a recognized treatment for advanced Parkinson’s disease with pharmacologically uncontrolled symptoms. This procedure brings us the unique opportunity to deepen in the knowledge of PD’s physiopathology by recording patients’ neural activity, and possibly in the future it will let us select the appropriate target and the optimal chronic stimulation pattern.

Anesthetic Practice in Neurosurgery at University Hospital of Brazzaville (Congo)

Aim: To evaluate the anesthetic management of neurosurgical patients in University Hospital of Brazzaville. Materials and methods: We performed a transversal and descriptive study during the period from January to June 2015 into operating room of the University Hospital of Brazzaville. 60 cases of anesthesia have been analyzed. Results: The neurosurgery represented 2.88% of the activity of the operating room in University Hospital of Brazzaville. The average age was 44.7 ± 18.36 years old. The sex ratio was 1.07. The scheduled interventions have concerned 83.4% of cases. Surgical indications were concerned the spine degenerative disease and spinal trauma in 40% and 18.3% of cases respectively. The patients classified ASA I and II were most represented in 40% and 46.7% of cases respectively. General anesthesia was used in 98.4% of cases. The peroperative complications were represented by arterial hypotension (31.7%), hemorrhage (11.7%), bradycardia (5%), difficult intubation (3.3%) and one case of peroperative cardiac arrest. The blood transfusion rate was 18.7%. The stay in ICU concerned 8.3% of the cases. We recorded three cases (5%) of death in our series. Conclusion: The neuroanesthesia knows an evolution in our country because of increasing number of neurosurgeons;it’s necessary to train medical staff in her practice.

Establishment and management of neurosurgery emergency observation ward during the COVID‑19 epidemic period

During the COVID‑19 epidemic period,the front‑line antiepidemic departments have attracted much attention.However,to meet people’s daily needs for the diagnosis and treatment,emergency department and intensive care unit are also the focus of work to control the source of infection,cut off the transmission route,and reduce the risk of novel coronavirus transmission while treating patients.In order to further strengthen the management,our department of neurosurgery took active measures in the emergency treatment for patients and summarized the coping strategies and relevant experience from the aspects of establishment of emergency observation wards,medical staff management,patients and family management,daily environment and object surface disinfection management,material management,and nursing quality management,hoping to provide reference for the nursing management of emergency wards after the outbreak of public health emergencies.

Neurocritical Care Training for the Neurosurgery Resident

Introduction: Recent data has associated favorable outcomes in patients who were treated in a “semi-closed” intensive care unit and attended to by a devoted team of neurointensivists as opposed to the neurosurgeons. This has led many to question the need for dedicated critical care education in the neurosurgical residency training program. Our aim was to determine what current neurosurgery residents and program directors/chairman thoughts were on NCC education in neurosurgical resident training, and to discuss possible methods to allow for collaboration between the NCC team and the neurosurgeons. Methods: Surveys were sent out electronically to all residency programs. Thirty-nine responses from junior residents, 36 responses from senior/chief residents, and eight responses from program directors/chairman were obtained. Results: No statistical difference between the majority responses of the different level residents, and between program directors/chairman and combined resident responses. Conclusions: Clearly, neurosurgery residents of all levels and program directors/chairman value NCC education and see a valuable role for this knowledge in their future. Most residents however do not want to spend an additional year of fellowship training to become certified neurointensivists. We discuss the role of NCC education in residency training and possible solutions to allow collaboration between the NCC team and the neurosurgical team.

Remodeling neuroscience education in medical student training:how early exposure and mentorship are promoting student interest in neurology and neurosurgery

Exposure to clinical neurology is an essential aspect of a young clinician＇s training. Neuroscience forms the cornerstone of a wide variety of clinical pathologies and many believe it is currently under represented in medical education. This phenomenon persists as the rapidly aging population places an increasing burden on neuromedical specialists. This demographic change, compounded by the expected 19% shortage in clinical neurologists by 2025, makes it imperative to reexamine specific aspects of neuro- medical education （Dall et al., 2013）. These aspects include the timing of pre-clinical neuroscience education, the presence of faculty supported interest groups, the existence of formal mentorship programs, and the availability of neurology and neurosurgical clerkships to 3rd year medical students. Given the increasing importance of neuromedi- cal training, several recent studies have examined the state of neurology training in modern medical education and its impact on medical graduates.

Intraoperative magnetic resonance imaging in neurosurgery and anesthetic considerations

Currently, magnetic resonance imaging(MRI) is the only imaging modality available which is capable of acquiring intra-operative images frequently with acceptable spatial and contrast resolution. However, the incorporation of MRI technology into the operating room requires special anesthetic considerations. It may include various aspects such as transport, remote location anesthesia, strong electromagnetic field, use of approved items, equipment counts, possible emergencies, and surgery in awake patients. The patient safety may be compromised by health-related, equipment-related, and procedure-related risks. Direct patient observation may be compromised by acoustic noise, darkened environment, obstructed line of sight, and distractions along with difficult access to the patient for airway management. Most often, the patient's head will be 180° away from the anesthesiologist during the procedure. Several monitors exist that are designed for conditional use in a MR environment. The general design criterion in these monitors is to eliminate conductors that carry electrical signals for monitoring physiologic parameters of the patient. General anesthesia requires an extended anesthetic circuit for ventilation maintenance and drug administration because the patient is located farther from the anesthesia machine than in traditional operating room settings. Dead space creates a time delay before the volatile anesthetic and drugs are administered and when expected effects can be observed. Therefore, the attending anaesthesiologists must understand the above aspects for safe conduct of neurosurgical procedures by minimizing MRI associated accidents while assuring optimal patient vigilance.