Notes

COVID-19 along with cardiothoracic surgery: Consequences about training and labourforce consumption in a international crisis.
2%) were repaired using a vascularized mucosal flap. There were 3 patients who required a second revision surgery. All CSF leaks were repaired without completely deconstructing the initial repair. Failure sites most frequently occurred outside of the sella (80%), likely reflecting their direct relationship to the intracranial cisterns. Initial operative repair provided definitive treatment in most cases (70%). Correct placement of a vascularized local pedicle-based flap is essential for successful repair. Knowledge of alternative flaps is particularly important when the nasoseptal flap is no longer available.The advent of the COVID-19 pandemic has disrupted all aspects of neurosurgery education, and it is now challenging to conduct routine sessions. Maintenance of essential standard education among novice neurosurgeons during the pandemic is of paramount importance. The aim of this study was the development of virtual modules and validation of its role to supplement the neurosurgery education program. We developed the virtual modules relevant to neuro-anatomy, neurosurgical procedures, instrumentation, and neurosurgical planning. These modules were virtually demonstrated to twenty-seven resident neurosurgeons through CiscoWebexonline platform. They provided their rating on the aptness of virtual modules for different neurosurgery applications on various parameters using 10 points Likert scale. The parameters included quality, learning, confidence building capacity, usefulness, and overall satisfaction. The results obtained for each module were analysed and the average score was used for the comparison. The highest rating on quality was obtained by the neurosurgical instrumentation module. The highest rating for learning and confidence building capacity was given to neurosurgical procedure animation. The usefulness and overall satisfaction were highly rated for neurosurgical planning module. The results show that developed virtual modules provide an effective method to supplement the neurosurgery education program in the current scenario involving physical distancing and shift rearrangements. These virtual modules help in limiting the visits to operation room, anatomy and surgical training labs, and allow residents to learn online at their pace.
Papillary meningioma is rare and displays an aggressive clinical behavior with poor prognosis. Therefore, we performed an extensive literature review to evaluate the adverse factors and treatment strategy of survival.

We performed Ovid, Medline, Embase, Pubmed, Web of Science and Cochrane database queries for articles published between 1938 and 2019 with the search term "WHO grade III meningioma" or "papillary meningioma" and "central nervous system", "cerebral", or "intracranial".

After a careful evaluation, a total of 19 studies were included. The entire cohort included the 67 patients, 34 (50.7%) were male and 33 (49.3%) were female with a mean age of 32.6±2.1years ranging from 4.5months to 74years. Gross total resection was achieved in 48(71.6%) cases, and 29 (51.8%) patients received postoperative radiation. The mean follow-up period was 42.3±4.4months (range, 2-197months). Thirty-six (53.7%) patients happened to recurrences, 11 (16.4%) patients happened to extracranial metastasis and 25 (37.3%) patients died. Univariate analysis revealed that the MIB>5% trended toward a shorter time to recurrence (p=0.084). Gross total resection was associated with favorable progression-free survival (p=0.007) and overall survival (p=0.001). Postoperative radiation was associated with favorable progression-free survival (p=0.001).

Gross total resection and adjuvant radiation were recommended as the initial treatment option for patients with papillary meningioma.
Gross total resection and adjuvant radiation were recommended as the initial treatment option for patients with papillary meningioma.Surgical resection of meningioma leaves residual solid tumour in over 25% of patients. Selection for further treatment and follow-up strategy may benefit from knowledge of volumetric growth and factors associated with re-growth. The aim of this review was to evaluate volumetric growth and variables associated with growth in patients that underwent incomplete resection of a meningioma without the use of adjuvant radiotherapy. A systematic review was conducted in accordance with the PRISMA statement and registered a priori with PROSPERO (registration number CRD42020177052). Six databases were searched up to May 2020. Full text articles analysing volumetric growth rates in at least 10 patients who had residual meningioma after surgery were assessed. Four single-centre, retrospective studies totalling 238 patients were included, of which 99% of meningioma were WHO grade 1. The absolute tumour growth rate ranged from 0.09 to 4.94 cm3 per year. The relative growth rate ranged from 5.11 to 14.18% per year. Varying methods of volumetric assessment and definitions of growth impeded pooled analysis. Pre-operative and residual tumour volume, and hyperintensity on T2 weighted MRI were identified as variables associated with residual meningioma growth, however this was inconsistent across studies. Risk of bias was high in all studies. Radiological regrowth occurred in 42-67% of cases. Our review identified that volumetric growth of residual meningioma is scarcely reported. Sufficiently powered studies are required to delineate volumetric growth and prognostic factors to stratify management.Emerging evidence suggest WHO grade III meningiomas that arise de novo as opposed to dedifferentiating from a lower grade may harbor differing prognoses. To investigate this, a single institution retrospective analysis of prospectively acquired patients between 1999 and 2018 was performed. Clinical data and radiographic parameters were reviewed to calculate progression free survival and overall survival in patients undergoing microsurgical resection. Next generation targeted sequencing of meningioma associated genes was performed on 11 tumors. Eighteen patients were identified as undergoing surgical resection of WHO grade III meningioma. Nine patients (50%) had de novo arising tumors and nine patients had secondary progressive tumors. To compare outcomes, only those patients undergoing gross total resection (Simpson grade I) were included for survival analysis. There was an improvement in median progression free survival for de novo resected tumors as compared to secondary progressive tumors (p = 0.02). Median overall survival for patients with de novo tumors was not statistically improved compared to that of secondary progressive tumors (p = 0.22). Next generation sequencing of targeted genes (NF2, BAP1, TRAF7, KLF4, SMO and AKT) revealed 5/11 tumors containing mutations in the NF2 gene, 2/11 containing BAP1 mutations, and a single tumor containing mutations in both NF2 and TRAF7. More mutations in NF2 and BAP1 were seen in the secondary progressive tumors. In conclusion, patients undergoing gross total resection for de novo arising grade III meningiomas showed improved progression free survival, though similar overall survival, as compared to those patients with secondary progressive tumors. Further studies focused on tumor associated genes and other associated risk factors are needed to improve risk-stratification.This systematic review investigated the added value of intraoperative magnetic resonance imaging (iMRI)-guidance in epilepsy surgery, compared to conventional non-iMRI surgery, with respect to the rate of gross total resection (GTR), postoperative seizure freedom, neurological deficits, non-neurological complications and reoperations. A comprehensive literature search was conducted using Medline, Embase, PubMed, and Cochrane Reviews databases. Randomized control trials, case control or cohort studies, and surgical case series published from January 1993 to February 2021 that reported on iMRI-guided epilepsy surgery outcomes for either adults or children were eligible for inclusion. Studies comparing iMRI-guided epilepsy surgery to non-iMRI surgery controls were selected for meta-analysis using random-effects models. Forty-two studies matched the selection criteria and were used for qualitative synthesis and ten of these were suitable for meta-analysis. Overall, studies included various 0.2-3.0 Tesla iMRI systems, contained small numbers with heterogenous clinical characteristics, utilized subjective GTR reporting, and had variable follow-up durations. Meta-analysis demonstrated that the use of iMRI-guidance led to statistically significant higher rates of GTR (RR = 1.31 [95% CI = 1.10-1.57]) and seizure freedom (RR = 1.44 [95% CI = 1.12-1.84]), but this was undermined by moderate to significant statistical heterogeneity between studies (I2 = 55% and I2 = 71% respectively). Currently, there is only level III-2 evidence supporting the use of iMRI-guidance over conventional non-iMRI epilepsy surgery, with respect to the studied outcomes.
Despite its toxic and carcinogenic nature, formaldehyde is a widely used reactant for specimen preservation. With the need of specimens for both anatomical and surgical training, alternative preservation solutions (PS) have been proposed, however, their use is limited due to high costs and complexity. Hence, a new formaldehyde-free solution (FFS) is evaluated as a potential alternative for anatomical and surgical training.

Qualitative and Quantitative data were acquired. Selleck Poly-D-lysine Specimens preserved using three different methods were selected. Flexibility was measured by joints goniometry and pneumoperitoneum pressures were evaluated followed by an exploratory laparoscopy. Undergraduate student's perceptions on cadavers preserved with different PS were obtained using surveys and focus groups.

The main reason why cadaveric specimens were considered as useful tools was the perceived interaction with real tissues and the 'practical' concept of getting in touch with what students would be facing in the future as phytraditional PS.
Assess milk type provision (commercially prepared infant and toddler formula, cow's milk, and plant milk) to infants and toddlers, accounting for sociodemographic characteristics and marketing claims.

Caregivers (N = 1,645) of children (aged 6-36 months) recruited through online panels in 2017.

Cross-sectional survey analysis (system of probit equations) estimated associations between sociodemographics and agreement with marketing claims (independent variables) with milk type provision in the past month (binary dependent variable).

Most caregivers (63%) of infants (aged 6-11 months) provided only breastmilk and/or commercially prepared infant formula. Sixty-five percent of caregivers of 12-month-old infants provided commercially prepared infant formula, and 47% provided cow's milk. Most caregivers (64%) of toddlers (aged 13-36 months) provided cow's milk; some also provided other non-recommended milk types (51%).Associations between milk types suggested milk-based drink provision should be evaluated aransition from breastmilk (or commercially prepared infant formula) to cow's milk, and conduct outreach to communities at risk for health disparities about the dangers of serving milk that is not recommended for their child's age. Research is needed to understand how diverse populations interpret product claims and how marketing may perpetuate health disparities.
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