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Simulation plays a pivotal role in neurosurgical training by allowing trainees to develop the requisite expertise to enhance patient safety. Several models have been used for simulation purposes. Non-living animal models offer a range of benefits, including affordability, availability, biological texture, and a comparable similarity to human anatomy. In this paper, we review the available literature on the use of non-living animals in neurosurgical simulation training. We aim to answer the following questions: (1) what animals have been used so far, (2) what neurosurgical approaches have been simulated, (3) what were the trainee tasks, and (4) what was the experience of the authors with these models. A search of the PubMed Medline database was performed to identify studies that examined the use of non-living animals in cranial neurosurgical simulation between 1990 and 2020. Our initial search yielded a total of 70 results. After careful screening, we included 22 articles for qualitative analysis. We compared the reports in terms of the (1) animal used, (2) type of surgery, and (3) trainee tasks. All articles were published between 2003 and 2019. These simulations were performed on three types of animals, namely sheep, cow, and swine. All authors designed specific, task-oriented approaches and concluded that the models used were adequate for replicating the surgical approaches. Simulation on non-living animal heads has recently gained popularity in the field of neurosurgical training. Non-living animal models are an increasingly attractive option for cranial neurosurgical simulation training. These models enable the acquisition and refinement of surgical skills, with the added benefits of accessibility and cost-effectiveness. To date, 16 different microneurosurgical cranial approaches have been replicated on three non-living animal models, including sheep, cows, and swine. This review summarizes the experience reported with the use of non-living animal models as alternative laboratory tools for cranial neurosurgical training, with particular attention to the set of tasks that could be performed on them.

Intradural spinal cord compression impairs perfusion pressure and is putatively rate-limiting for recovery after traumatic spinal cord injury (tSCI). After cervical tSCI, even minimally improved tissue preservation may help promote neurological recovery. To assess the nature and extent of spinal cord swelling and compression post-acute cervical tSCI, we evaluated several baseline MRI parameters including BASIC score, intramedullary lesion (IML) length, maximal canal compromise (MCC), maximal spinal cord compression (MSCC), extent of cord compression (ECC), maximal swollen anteroposterior diameter adjacent to injury site (Dmax), and maximal cord swelling (MCS) in 169 consecutive patients across 2 centers. In patients with either primarily intradural or combined (MSCC ≤5% or >5%, respectively) cord compression, we examined the predictive value of clinical and imaging admission parameters on American Spinal Injury Association Impairment Scale (AIS) severity and conversion up to 1-year follow-up. 37 (21.9%) patients presented with primarily intradural while 132 (78.1%) had combined cord compression. MSCC, MCS, and Dmax values differed significantly between the two groups (p < 0.0001, < 0.01 and < 0.001, respectively). MSCC was associated with age, MCC and MCS at baseline, while MCS was associated with age, MSCC and Dmax, on multivariable analysis. Logistic regression analysis of areas under receiver operating characteristic curve (AUROC) confirmed ECC (AUC 0.678) and MCS (AUC 0.922) as good and excellent predictors, respectively of AIS-conversion at 1-year for intradural compression participants. Additionally, MCS was significantly more accurate in predicting AIS-conversion in intradural group and the probability of AIS-conversion significantly decreased with each 1% increase in MCS (p = 0.003; OR 0.949), for both compression subtypes. In conclusion, baseline measures of cord swelling predict AIS-conversion likelihood up to 1-year. The deleterious effects of intradural cord compression, either isolated or presenting with extradural compression, may benefit from supplemental decompression strategies in addition to current standard-of-care.

BackgroundPrevious studies have demonstrated that successful reperfusion does not always correlate with long-term functional benefit in patients with acute ischemic stroke (AIS) treated via endovascular therapy (EVT). We evaluated patient characteristics and clinical outcomes in patients with AIS who underwent EVT with successful reperfusion resulting in either beneficial recanalization (BR) or futile recanalization (FR).MethodsThe authors conducted a single-institution retrospective, observational study of patients with AIS who underwent EVT between January 2019 and January 2024. Baseline characteristics, procedural details, and clinical metrics were reviewed, and FR predictors were identified.ResultsOf 441 subjects, 151 (34.24%) experienced FR, with this cohort displaying a higher mean blood glucose level on admission compared with the BR cohort (168±87.77 mg/dL vs 143±70.48 mg/dL; P=0.0029). Multivariable logistic regression analysis found blood glucose on admission to be a significant independent predictor of FR (P=0.0081). Hyperglycemia (glucose≥126 mg/dL) carried a twofold higher risk of FR (OR 2.088, 95% CI 1.399 to 3.137, P=0.0003), whereas glucose exceeding 300 mg/dL carried a threefold increased risk (OR 3.321, 95% CI 1.367 to 8.565, P=0.0093).ConclusionsRates of futile recanalization increased in a stepwise fashion as glucose levels on admission worsened in this study cohort. These findings suggest that early and rapid glucose management in patients with AIS undergoing EVT may improve outcomes and reduce the incidence of futile recanalization.

Aneurysms of the distal anterior inferior cerebellar artery (AICA) are uncommon. They can present with subarachnoid hemorrhage (SAH), cerebellopontine angle syndrome, or a combination of the two. We describe the technique and nuances of microsurgical clipping of a ruptured distal AICA aneurysm using a retrosigmoid approach.After performing the craniotomy, the AICA was exposed in a distal to proximal fashion and the aneurysm and the proximal parent vessel were identified. After establishing proximal control, a clip was placed across the neck of the aneurysm to obliterate it while maintaining flow within the parent vessel. Finally, the flow within the parent vessel was confirmed and the final clip position was checked to ensure that it was not compressing any of the cranial nerves in the vicinity. The aneurysm was completely obliterated, and the parent vessel remained patent.Distal AICA aneurysms are rare and challenging to treat. The retrosigmoid approach is commonly used to treat these aneurysms. Careful planning, which includes studying the vascular anatomy and the aneurysm characteristics, and proficient execution of the procedure can increase the safety and improve outcomes of surgical clipping of these aneurysms.

INTRODUCTION Since their advent in the 1920s, tear gas canisters have been frequently used in crowd-control. Previous studies have focused on their chemical toxicities on the eyes, skin, and respiratory system. Few case reports have documented non-penetrating injuries attributed directly to the tear gas canisters (TGC). METHODS We conducted a retrospective medical chart review of all the patients who were admitted to the Neurosurgery Teaching Hospital (NTH) since the start of the anti-government protests (October/2019). All patients who suffered a penetrating head trauma caused by the TGC were included in our study. We collected variables such as patients' demographics, wound location, neurological exam, head CT scan findings, surgical management and clinical outcomes. RESULTS We documented 10 cases of penetrating head trauma caused by the TGC. All victims were males, with a mean age of 16 years (rang = 14- 19 years). The TGCs penetrated the skull in all patients. The mean GCS was 7 (range of 3–10). The neurological examination revealed unilateral hemiplegia/hemiparesis and pupillary defect in 40% (N = 4) and 50% (N = 5) of the patients, respectively. Head CT scans revealed an extensive pattern of brain damage. The TGCs crossed the midline in 40% of the cases (N = 4) and assumed a complete intracranial location in 20% (N = 2). Surgical intervention which included removal of the TGCs, debridement of both brain and skin, and hemostasis was achieved in 70% of the patients (N = 7). The in-hospital mortality rate was 100% (N = 10), with all fatalities occurring within (1-3) days of admission. CONCLUSION Our findings demonstrate that, when fired directly at the head, tear gas weapons have significant potential to inflict serious injuries and death. For penetrating head injuries related to TGC, the mortality rate can be extremely high. Consequently, strict international guidelines are required before the use of these weapons can be condoned again.