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Background: The dura mater, a fibrous membrane protecting the brain and spinal cord, is prone to lacerations during spinal surgery, often leading to complications such as cerebrospinal fluid (CSF) leakage. Anatomical differences in the spinal dura mater, particularly in regions under high biomechanical stress, suggest that chronic inflammatory processes may compromise its structural integrity. This pilot study investigates the molecular and anatomical characteristics of the spinal dura mater, focusing on its response to inflammation and the challenges of surgical repair., Methods: The study involves the collection of 40-60 cadaveric spinal dura mater samples and 100 preoperative blood samples from patients undergoing major spinal surgery. Histological and biomolecular analyses will assess tissue integrity, elastin, collagen content, and the expression of inflammatory biomarkers (heat shock proteins and cytokines). Multiplex assays, mass spectrometry, and Western blot techniques will analyze biomarker profiles in both dura mater and blood samples. Comparative and correlation analyses will be performed to identify common molecular patterns between cadaveric tissue and patient blood samples, with statistical tests applied to detect significant differences., Results: Preliminary power analysis justifies the sample sizes, aiming to detect moderate effect sizes (Cohen's d = 0.5) with 80% power. Histological and biomolecular results will focus on the impact of chronic inflammation on spinal dura integrity, specifically its thinning and vulnerability to laceration. Key findings will include biomarker profiles correlating with tissue damage and postsurgical complications like CSF leakage., Conclusions: This pilot study aims to enhance our understanding of the inflammatory processes affecting the dura mater and their role in frequent lacerations during spinal surgery. Findings are expected to guide future clinical practices in dura repair strategies, potentially improving surgical outcomes and reducing complications related to CSF leakage., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Sofia Ionescu (1920-2008) was the first female neurosurgeon in the world, pioneering her field with skill, dedication, and humility. Born in Romania, she began her career amid the tumult of World War II, performing her first neurosurgical procedure in 1944. Despite initial skepticism, her talent and commitment earned her recognition, culminating in her acknowledgment as the first female neurosurgeon by the World Federation of Neurosurgical Societies in 2005. Throughout her illustrious career, she mentored colleagues, contributed to scientific literature, and innovated surgical techniques, all while maintaining a compassionate and composed demeanor. Her legacy serves as a beacon of inspiration for neurosurgeons worldwide, reminding them of the importance of diligence, empathy, and unwavering dedication to patient care. Even in retirement, her influence endures, as she continues to be revered for her remarkable contributions to the field of neurosurgery., Methods: We searched Google, PubMed, and others about Sofia Ionescu and compiled the data about her., Results: We got very important information about her and compiled together for this article., Conclusions: Sofia Ionescu is regarded as the first female neurosurgeon of the world and she paved the way and encouraged many young female neurosurgeons in the field., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The ischemia/reperfusion mechanism is believed to be responsible for parenchymal damage caused by temporary hypoperfusion and worsened by the subsequent attempt of reperfusion. This represents a true challenge for physicians of several fields, including neurosurgeons. A limited number of papers have shed the light on a rare pathologic condition that affects patients experiencing an unexplained neurologic deficit after spine surgery, the so-called "white cord syndrome." This entity is believed to be caused by an "ischemia/reperfusion" injury on the spinal cord, documented by a postoperative intramedullary hyperintensity on T2-weighted magnetic resonance imaging sequences. To date, the cases of white cord syndrome reported in literature mostly refer to cervical spine surgery. However, the analysis of several reviews focusing on spine surgery outcome suggests postoperative neurologic deficits of new onset could be charged to a mechanism of ischemia/reperfusion, even if the physiopathology of this event is seldom explored or at least discussed. The same neuroradiologic finding can suggest mechanical damage due to inappropriate surgical manipulation. On this purpose, we performed a systematic review of the literature with the aim to identify and analyze all the factors potentially contributing to ischemic/reperfusion damage of the spinal cord that may potentially complicate any spinal surgery, without distinction between cervical or thoracic segments. Finally, we believe that postoperative neurologic deficit after spinal surgery constituting the "white cord syndrome" could be under-reported; both neurosurgeons and patients should be fully aware of this rare but potentially devasting complication burdening cervical and thoracic spine surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Medicine has made progress toward gender equality and has achieved almost equal distribution between men and women among graduates. However, more still needs to be done because most surgical subspecialties are still lacking adequate female representation and this persisting gender gap is particularly evident in both practical neurosurgery and the academic world. Gradual advancements have enabled a few women to pursue a successful career in neurologic surgery, pairing clinical practice with mentoring and involvement in academic research. These efforts show that more needs to be done to bridge the historic and current gap, which has recently aroused increasing interest among the neurosurgical community through internationally relevant studies. In neurosurgical societies worldwide, the existence of gender-related issues and women-reserved sections has started to attract attention and recognition on how to properly address this issue among present and future neurosurgeons., Methods: In this study, we discuss the timeline of women's road to gaining their place in neurosurgery, inspired by Hippocrates' motto "Declare the past, diagnose the present, foretell the future." Although neurosurgery had been traditionally considered too difficult a subject in which to engage, the first female neurosurgeons challenged themselves in this field, previously reserved only for men, at a time when society was not yet ready to embrace women's presence. Their successes paved the way for future generations of women, progressively shedding light on complex themes such as peer considerations, difficulty in reaching academic positions, and work-life balance., Results: Our aim is to analyze the historic reasons for inequality among men and women, which might be found in the themes of personal choice and willingness, aside from cultural bias or stereotypically based thinking., Conclusions: Accordingly, if the difference in numbers were considered a reality related to personal inclination, perhaps, nobody would pay attention to this topic and the presence of even a few women in neurosurgery would be considered less strange. By thinking along those lines on a daily basis, we could all simply write about the history of valuable neurosurgeons in the past, present, and future without any distinction between men and women., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Recurrent and chronic low back pain, caused by degenerative lumbar spondylosis, commonly affects elderly patients, even those with no previous low back surgery. These patients, like those affected by failed back surgery syndrome (FBSS), may become unresponsive to medical conservative treatment and their quality of life could be easily compromised. Moreover, general comorbidities, obesity, and other typical conditions of the elderly may make surgery under general anesthesia riskier than the natural history of the disease. These patients could be considered affected by surgical back risk syndrome (SBRS)., Methods: In this article, we report our preliminary observational prospective study on the role of spinal cord stimulation (SCS) in 3 groups of patients: the FBSS group, the SBRS group, and the "other" group. Selection criteria, treatment modality, and outcomes for each patient group are described and discussed. Moreover, a potentially useful diagnostic and therapeutic flowchart on the management options for lumbar back diseases is discussed., Results: The FBSS group included 25 patients, the SBRS group included 10 patients, and the other group included 3 patients. In 22/25 patients with FBSS (88% of the total), the implantation of a definitive neurostimulator was successful. In almost all patients in both the SBRS and the other groups, the implantation of a definitive neurostimulator was successful., Conclusions: In our opinion, SCS could be considered as a valid alternative treatment not only in selected patients affected by FBSS but also in selected patients affected by SBRS, in whom back surgery under general anesthesia may be challenging and overcome the potential benefit of the surgery itself. SBRS could be considered a new disease entity to be managed through SCS., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Drawbacks of the far-lateral approach to the lower clivus and pontomedullary region include the morbidity of a large incision extending into the cervical musculature and tedious exposure of the vertebral artery (VA), particularly when performing the transcondylar and transtubercular extensions. The authors describe a minimally invasive alternative to the far-lateral approach that has the potential to minimize operative morbidity and decrease the need for VA manipulation., Methods: The minimally invasive supracondylar transtubercular (MIST) and far-lateral supracondylar transtubercular (FLST) approaches were performed in 10 adult cadaveric specimens (20 sides). The microsurgical anatomy of each step and the surgical views were analyzed and compared. In addition, the endoscopic view through the MIST was examined in five fresh cadaveric specimens (10 sides)., Results: The MIST approach provided exposure of the inferior-middle clivus, the anterolateral brainstem, and the premedullary cisterns, including the PICA-VA and vertebrobasilar junctions. The endoscope provided a clear view of cranial nerves III through XII, as well as the vertebrobasilar system. The FLST approach increased visualization of the anterolateral margin of the foramen magnum; otherwise, the surgical view is similar between the MIST and FLST approaches., Conclusions: The MIST approach could be considered as a potential alternative to the FLST approach in the treatment of lesions involving the inferior and middle clivus, and anterolateral lower brainstem; it does not require a C1 laminectomy, significant disruption of the atlanto-occipital joint, nor extensive exposure of the extracranial VA. Moreover, the MIST approach is an ideal companion to endoscope-assisted neurosurgery., (Copyright © 2012 Elsevier Inc. All rights reserved.)