Sub-specialty in neurosurgery: Time has come for Nepal

With over 90 practicing neurosurgeons in the country, should we be developing sub-specialty in neurosurgery? The number of trained manpower has risen steadily, since neurosurgery was first practiced in Nepal in 1961.1Though we are halfway to the milestone of achieving a ratio of 1 neurosurgeon for every 1 lac population, the situation here is much better than in other Sub-Saharan African and south east Asian countries.2 All the seven states have now neurosurgeons working in its hospitals, though most are still concentrated in the capitals and major towns. Recently for the last five years, despite of lack of training opportunities for sub-specialty in the country, we have seen young neurosurgeons getting trained in skull base, spine, minimally invasive or endoscopic neurosurgery, functional neurosurgery, pediatric neurosurgery and vascular neurosurgery from abroad. There is a variation in nature and period of training, ranging from observership of a few weeks to fellowship of over a year. The interest seems to be getting stronger as the facilities and complexities of cases are increasing. In such scenarios, rather than few individuals we need units or teams offering these sub-specialized services from key centers and start supervised systematic training for the interested.

PubMed-indexed neurosurgical research productivity of Iraq-based neurosurgeons

Background: Research is a central component of neurosurgical training and practice and is increasingly viewed as a quintessential indicator of academic productivity. In this study, we focus on identifying the current status and challenges of neurosurgical research in Iraq. Methods: An online PubMed Medline database search was conducted to identify all articles published by Iraq-based neurosurgeons between 2003 and 2020. Information was extracted in relation to the following parameters: authors, year of publication, author’s affiliation, author’s specialty, article type, article citation, journal name, journal impact factor, and topic. This data were then tabulated and analyzed. Results: Between 2003 and 2021, a total of 52 PubMed indexed papers were published from Iraq. All publications have been clustered in the period of 2012–2020. From 2012 to 2016, only four papers were published, one per year. The number of publications increased from 2017 to 2021, with an average of 12 publications per year. The most common article type was “case reports” (n = 14). Neurotrauma (n = 10) and vascular neurosurgery (n = 10) were the two most common topics. Most of the studies came from the city of Bagdad (n = 46), with just nine studies coming from peripheral governorates. The Neurosurgery Teaching Hospital in Bagdad was the neurosurgery center with the highest research output (n = 38). Conclusion: The number of publications per year has been showing a, relatively, promising trend since 2012. However, to promote sustained growth in academic productivity, a strategic plan that acknowledges the political, financial, and health-system-related challenges are urgently needed.

Implementation and Rationale for a Unified Clinical and Imaging Protocol for Evaluation and Treatment of Moyamoya Angiopathy: A Single Institutional Experience

Moyamoya disease (MMD) is a complex and incompletely-understood cerebrovascular pathological entity that requires thorough clinical and imaging evaluation. Moyamoya is rare, thereby making the establishment of an effective, thorough and interdisciplinary patient evaluation protocol challenging, even within specialized referral centers. Nevertheless, implementation of such a protocol is crucial in order to provide the best possible evaluation and treatment for MMD patients. Here, we describe our institution's implementation of, rationale for, and experience with a comprehensive multidisciplinary collaboration and evaluation strategy for adult patients with moyamoya. This evaluation course consists of, first of all, a thorough clinical and laboratory evaluation with a vascular neurologist. This is followed by a comprehensive imaging assessment which evaluates angiographic and parenchymal features, in addition to cerebrovascular functionality. Finally, appropriate referrals are made to consulting services as indicated, which includes vascular neurosurgery. These steps are described in detail herein.

The p64 flow-diverting stent in the treatment of difficult cerebral vascular aneurysms: technical features and results

Introduction. Since the appearance of the first flow-diverting stents (FDS) Pipeline (Covidien, USA) and Silk (Balt Extrusion, France) in 2008, numerous studies have been conducted that have shown their high efficiency in the treatment of difficult aneurysms, accompanied by a low frequency long-term recanalization with a moderate risk of developing intra- and postoperative complications, thus making them an alternative to the classic use of coils.The study objective is to evaluate the results of the p64 PPS using in the treatment of patients with cerebral aneurysms of various localization in a single neurosurgical hospital.Materials and methods. In the department of vascular neurosurgery of the Federal Neurosurgical Center, Novosibirsk for the period from June 2017 to December 2019, 90 patients (10 (11.1 %) male, 80 (88.9 %) female) with cerebral aneurysms were operated using p64 FDS.Results. All 90 patients received 93 p64 FDS. In 79 (87.8 %) patients, only a stent was implanted, in 9 (12.2 %) – in combination with coils. Follow-up after 6 months was observed in 39 (43.3 %) patients, while it should be noted that no patient showed an increase in neurological deficit. The complete occlusion rate after 6 months was 76.9 %. A favorable treatment outcome according to the modified Rankin Scale at the time of discharge was obtained in 82 (91.1 %) patients. Mortality was in 1 (1.1 %) case.Conclusion. The p64 FDS is an effective endovascular device in the treatment of patients with difficult cerebral aneurysms and has a rather low incidence of intra- and postoperative complications.