Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The aim of our study was to explore the impact of this pandemic on neurosurgeons with the hope of improving preparedness for future crisis. We created a 20-question survey designed to explore demographics (nation, duration and scope of practice, and case-burden), knowledge (source of information), clinical impact (elective clinic/surgery cancellations), hospital preparedness (availability of personal protective equipment [PPE] and cost of the supplies), and personal factors (financial burden, workload, scientific and research activities). The survey was first piloted with 10 neurosurgeons and then revised. Surveys were distributed electronically in 7 languages (Chinese, English, French, German, Italian, Portuguese, and Spanish) between March 20 and April 3, 2020 using Google Forms, WeChat used to obtain responses, and Excel (Microsoft) and SPSS (IBM) used to analyze results. All responses were cross-verified by 2 members of our team. After obtaining results, we analyzed our data with histograms and standard statistical methods (Chi-square and Fisher's exact tests and logistic regression). Participants were first informed about the objectives of our survey and assured confidentiality after they agreed to participate (Helsinki declaration). We received 187 responses from 308 invitations (60.7%), and 474 additional responses were obtained from social media-based neurosurgery groups (total responses = 661). The respondents were from 96 countries representing 6 continents (Figure ​(Figure11A-​A-11C)

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment.

BACKGROUND: Lateral interbody cages have been proven useful in spinal fusions. Spanning both lateral cortical rims while sparing the Anterior Longitudinal Ligament, the lateral interbody cages restore and maintain disc height while adding stability prior to supplemental fixation. The standard approach for their insertion is by a 90-degree lateral transpsoas method. This is relatively bloodless compared to other techniques although has its limitations, requiring neuro-monitoring and being, at times, very difficult at L4/5 due to iliac crest obstruction or an anterior plexus position. An oblique approach, with the patient in lateral decubitus, passes anterior to the iliac crest, retroperitoneal, and being anterior to psoas, eliminates the need for neuro-monitoring. METHODS: Twenty-one consecutive patients underwent surgery for a total of 32 levels instrumented with the ATP technique. Mean age at the time of surgery was 62.4±7.4 years. There was a 6 months minimum clinical follow up, with imaging to assess fusion, at 6 and 12 months. Indications included symptomatic degenerative lumbar spondylosis +/− spondylolisthesis, leg and back pain. All patients were assessed with the Oswestry Disability Index (ODI), Visual Analog Scale 100 mm for back pain (VASb) and for leg pain (VASl) preoperatively, at 3, 6 and 12 months. Last follow-up was at 12 months for 9 patients and the rest had 6 months follow up. RESULTS: Statistical analysis showed significance for the results in ODI, VASb and VASl with improvement in all components except for one patient with worsening VASl. Eight patients had complications related to surgery which were still present at last follow-up including moderate weakness of hip flexion and EHL weakness. Lateral cutaneous nerve (LCN) palsy on the side of the approach was also seen as well as sympathectomy effect related to the mobilization of the sympathetic trunk. One patient, who also suffered from multiple sclerosis, experienced psoas abscess 3 months post op that required drainage. CONCLUSIONS: The left sided anterior to psoas approach offers the most natural corridor to the disc space. The novel instruments and method described here allows insertion of large lateral cages between L2 to L5, without the problems associated with the transpsoas approach, particularly at L4/5

Anterior to psoas fusion of the lumbar spine

Lateral interbody cages have proven useful in lumbar fusion surgery. Spanning both lateral cortical rims while sparing the anterior longitudinal ligament, they restore disc height, improve coronal balance and add stability. The standard approach to their insertion is 90 degrees lateral transpsoas which is bloodless compared to other techniques of interbody cage insertion but requires neuro-monitoring and at L4/5 can be difficult because of iliac crest obstruction or an anterior plexus position. The oblique muscle-splitting approach with the patient in a lateral position, remains retroperitoneal, and on the left side enters the disc space through a window between psoas and the common iliac vein. Reports of this approach are few and none previously have described how to use the large lateral-type cages so effective at restoring spinal alignment. In this video we demonstrate our technique of anterior to psoas fusion of the lumbar spine with a retroperitoneal approach and gentle retraction of the psoas muscle. The video can be found here: http://youtu.be/OS2vNcX9JMA. Neurosurgical focus, Vol. 35, Suppl. 2, Video 13. Video length: 12 minutes 33 seconds.1 pag

Convexity and parasagittal approaches

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Carotid termination aneurysms

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Supracerebellar infratentorial approach to the pineal region

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Petroclival meningiomas

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Sulcal and gyral anatomy of the basal occipital-temporal lobe

Purpose: The sulcal and gyral anatomy of the basal occipital-temporal lobe is highly variable and detailed descriptions of this region are limited and often inconsistent. The aim of this study was to describe the salient features of the sulcal and gyral anatomy of the basal occipital-temporal lobe. Methods: We studied the sulcal and gyral patterns of 30 formalin-fixed cerebral hemispheres. Results: The major landmarks are the collateral sulcus (separated into the rhinal, proper, and caudal segments) and occipitotemporal sulcus (often interrupted), which were always present in this study. The bifurcation of the caudal collateral sulcus is a useful landmark. In relation to these sulci, we have described the surface anatomy and nominated landmarks of the medial (parahippocampal and lingual) and lateral (fusiform) occipitotemporal gyri. Conclusions: Understanding of the sulcal and gyral patterns of the basal occipital-temporal lobe may provide valuable information in its radiological and intraoperative interpretation.7 page(s

Outcomes for a case series of unruptured anterior communicating artery aneurysm surgery

Surgical outcomes following repair of unruptured anterior communicating artery (AcomA) aneurysms have not been adequately addressed in the literature. We present our operative experiences in a consecutive series of 103 patients with 115 unruptured AcomA aneurysms. Clinical results, operative complications, angiographic outcomes and prognostic factors associated with surgery are presented. Of the 115 aneurysm repairs attempted, 114 were treated by clipping or excision and suture. One aneurysm, less than 2 mm, was wrapped. Six patients (5.8%; 95% confidence interval [CI], 2.5-12.4) experienced a new permanent neurological deficit. There was no postoperative mortality. Transient morbidity occurred in 11 patients (10.7%; 95% CI, 5.9-18.3), including transient anosmia (four patients), acute postoperative confusion and memory disturbances (four patients), extradural haematoma requiring surgery (two patients) and cerebrospinal fluid rhinorrhea (one patient). Of the 84 aneurysms (73.0%) that had documented postoperative angiography, 82 (97.6%) had complete obliteration of the aneurysm and two (2.4%) had neck remnants (mean angiographic follow-up 28.0 months; range, 1.6-146.4 months). Retreatment was performed in one patient (1.0%). Logistic regression analysis of risk factors revealed that aneurysm size (p < 0.01) was a significant predictor of outcome. There was no incidence of subarachnoid haemorrhage in the 272 person years of follow-up. In the current study, surgical treatment of unruptured AcomA aneurysms resulted in 5.8% morbidity and no mortality. The robustness of aneurysm repair achieved by open microsurgery is an important consideration when considering the option between endovascular and microsurgical treatment for unruptured AcomA aneurysms.5 page(s