Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Flail bone flap in decompressive craniotomy for infants: A case series of five patients

Background: Subdural hematoma in infants is a challenging condition. Acute subdural hematomas can cause intracranial hypertension and a midline shift, but decompressive craniotomies in young patients have shown promising results with specific complications in this age group. Hinge craniotomy is an old technique used in many neurosurgical procedures associated with elevated intracranial pressure. The objective of this study is to report the usage of flail bone flap in the management of acute subdural hematoma in infants, its outcome, advantages, disadvantages and related complications. Methods: This is a review of the medical records of 5 infants younger than one-year-old who underwent decompressive craniotomy as management of acute subdural hematoma at Mansoura university hospital. Results: In this series, five babies were included. Operative time for decompressive craniotomy (DC) ranged from 1 h and 40 min to 3 h. Four infants survived. Three infants recovered with good outcomes and one infant developed hemiparesis. Conclusion: The use of flail bone flap technique in decompressive craniotomy is associated with a high success rate and low incidence of complications. Large-based studies are still required for a better assessment of the results

Endoscopic Management of Pediatric Complex Hydrocephalus

Objective: To define the role of neuroendoscopy as an adjuvant technique for the management of pediatric complex hydrocephalus. Methods: We performed a retrospective analysis of a series of pediatric patients who had undergone surgery for complex hydrocephalus from January 2002 to March 2017 at 2 pediatric neurosurgery units in Rome, Italy and Mansoura, Egypt. The endoscopic procedures performed included cyst or membrane fenestration, septum pellucidotomy, foraminoplasty, and aqueductoplasty with or without a stent. In selected cases, endoscopic third ventriculostomy was performed as a combined procedure. The mean follow-up period was 5 years. Results: A total of 68 patients (26 females, 42 males), with a mean age of 2 years (range, 0\u201318), underwent 109 endoscopic procedures. Of the 68 patients, 39 (57%) were affected by multiloculated hydrocephalus, 17 by isolated lateral ventricle (24.6%), 3 by an excluded lateral ventricle horn (4.3%), 7 by an isolated fourth ventricle (10.1%), and 1 each by an isolated third ventricle and a cavum septi pellucidi cyst. The overall postoperative complications rate was 28% (shunt infection, 16.1%; shunt malfunction, 8.8%; subdural collection, 2.9%). At the latest clinical follow-up visit, 65% of the children had only 1 shunt, 25% (n = 17) had a double ventricular catheter, and 10% (n = 7) were shunt free. Conclusions: We have confirmed that neuroendoscopy has a main role in the long-term management of complex hydrocephalus, significantly contributing to the reduction of the number of shunts and the shunt revision rate. Neuronavigation should be performed in all cases in which the ideal trajectory should be established