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Introduction: The glucose/potassium index (GPI) has been reported as a predictor biomarker of in-hospital complications in patients with aneurysmal subarachnoid hemorrhage (aSAH)., Objectives: To determine the association between GPI and functional outcome at 3-6 months after discharge in patients diagnosed with aSAH in a Peruvian referral hospital during 2018-2021., Materials and Methods: We conducted a retrospective cohort observational study with a secondary database in patients with aSAH during 2018-2021 in a Peruvian referral hospital. We evaluated the relationship between GPI values and motor functionality from 3 m to 6 months post-discharge, using a Poisson family generalized linear model with Log link function and robust variance according to categorization of good and poor outcome. We considered a value of p<0.05 as statistically significant. We used restricted cubic splines with five nodes to evaluate the linear correlation between the 2 main variables., Results: 212 patients were included in the analysis. 21.1 % and 19.3 % had poor outcome at 3 and 6 months after discharge, respectively. Multivariate analysis showed that GPI was not associated with poor outcome at 3 (RR=0.999; 95 %CI=0.979-1.018) or 6 months after discharge (RR=0.979; 95 %CI=0.979-1.020). On the other hand, Splines plots showed no correlation between GPI and modified Rankin., Conclusions: Despite the usefulness of GPI to prognosticate in-hospital complications, its association with functional outcome is inconclusive., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Basilar apex aneurysms (BAAs) represent 5%-8% of cerebral aneurysms. 1-3 Treating BAAs is long established in neurosurgery. 4-6 The morbid and lethal characteristics of aneurysmal subarachnoid hemorrhage coupled with potential medical complications of neurointensive care contribute to poor prognosis of patients with ruptured BAAs. 7 , 8 A 58-year-old woman presented to the emergency department with a 1-day course of intense headaches that progressed to loss of consciousness. Noncontrast computed tomography of the head revealed extensive intraventricular hemorrhage (Fisher grade 4). Computed tomography angiography revealed an 8.7 × 6.3 mm wide-neck BAA. Preoperatively, she developed rebleeding and cerebral vasospasm and was transferred to the neurointensive care unit. After initial management and consideration of her clinical course and complex aneurysm features, she underwent a right frontotemporal craniotomy and anterior extradural clinoidectomy to perform aneurysm neck clipping (Video 1). Endovascular treatment was not considered, given that our facility belongs to a low-income public health system with limited availability of endovascular devices. Postoperatively, the patient developed cerebral vasospasm and pneumonia, which led to respiratory failure and death. BAAs are vascular entities that require arduous microsurgical treatment. Despite the increasing trend in managing these patients with endovascular treatment, the role of microsurgery is predominant in clinical settings with limited availability of alternative therapies. This clinical scenario requires neurosurgery trainees to achieve a high-level microsurgical skill set to provide optimal treatment. Nonetheless, the course of BAAs can still be poor even after adequate surgical management. This case exemplifies the burdensome nature of BAAs and the difficult clinical course of patients despite meticulous microsurgical management. Fisher grade 4, which is associated with a 31% risk of vasospasm, was a notable factor contributing to this outcome. 7 Further, the patient's recovery was complicated by hospital-acquired pneumonia, which has a mortality rate of 9.7%. 8 Accordingly, amid the emergent discipline of enhanced recovery after surgery, optimized protocols for postoperative management could benefit these patients. 9-11 ., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Augmented reality (AR) and virtual reality (VR) technologies have been introduced to neurosurgery with the goal of improving the experience of human visualization. In recent years, the application of remote AR and VR has opened new horizons for neurosurgical collaboration across diverse domains of education and patient treatment. Herein, we aimed to systematically review the literature about the feasibility of this technology and discuss the technical aspects, current limitations, and future perspectives., Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 4 databases (PubMed, Embase, Scopus, and Cochrane Library) were queried for articles discussing the use of remote AR and VR technologies in neurosurgery. Data were collected in various fields, including surgery type, application type, subspecialty, software and hardware descriptions, haptic device utilization, visualization technology, internet connection, remote site descriptions, technical outcomes, and limitations. Data were summarized as counts and proportions and analyzed using IBM SPSS software., Results: Our search strategy generated 466 records, out of which 9 studies satisfied the inclusion criteria. The majority of AR and VR applications were used in cranial procedures (77.8%), mainly in education (63.6%), followed by telesurgical assistance (18.2%), patient monitoring (9.1%), and surgical planning (9.1%). Local collaborations were established in 55.6% of the studies, while national and international partnerships were formed in 44.4% of the studies. AR was the main visualization technology, and 3G internet connection was predominantly used (27.5%). All studies subjectively reported the utility of remote AR and VR for real-time interaction. The major technical challenges and limitations included audiovisual latency, the requirement for higher-fidelity and resolution image reconstructions, and the level of proficiency of the patient with the software., Conclusions: The results from this systematic review suggest that AR and VR technologies are dynamically advancing to offer remote collaboration in neurosurgery. Although still incipient in development and with an imperative need for technical improvement, remote AR and VR hold a frontierless potential for patient monitoring, neurosurgical education, and long-distance surgical assistance., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Complex intracranial aneurysms (CIAs) comprise a subset of lesions with defiant vascular architecture, difficult access, and prior treatment. Surgical management of CIAs is often challenging and demands an assessment on a case-by-case basis. The generational evolution of bypass surgery has offered a long-standing potential for effective cerebral revascularization. Herein, we aim to illustrate a single-center experience treating CIAs., Methods: The authors conducted a retrospective analysis of clinical records of patients treated with cerebral revascularization techniques at Hospital Nacional Dos de Mayo, Lima, Peru, during 2018-2022. Relevant data were collected, including patient history, aneurysm features on imaging, preoperative complications, the intraoperative course, aneurysm occlusion rates, bypass patency, neurological function, and postoperative complications., Results: Seventeen patients (70.59% female; median age: 53 years) with 17 CIAs (64.7% saccular; 76.5% ruptured) were included. The most common clinical presentation included loss of consciousness (70.6%) and headaches (58.8%). Microsurgical treatment included first-, second-, and third-generation bypass. In 47.1% of cases, an anastomosis between the superficial temporal artery and the M3 segment was predominantly used, followed by an A3-A3 bypass (29.4%), a superficial temporal artery-M2 bypass (17.6%), and an external carotid artery to M2 bypass (5.9%). The intraoperative aneurysm rupture rate was 11.8%. Postoperative complications included ischemia (40%), cerebrospinal fluid fistulas (26.7%), and pneumonia (20%). At hospital discharge, the median Glasgow Coma Scale score was 14 (range: 10-15). At the 6-month follow-up, 82.4% of patients had a modified Rankin Scale score ≤2, bypass patency was present in all cases, and the morbidity rate was 17.6%., Conclusions: CIAs represent a spectrum of defiant vascular lesions with a poor natural history. Bypass surgery offers the potential for definitive treatment. Our case series illustrated the predominant role of cerebral revascularization of CIAs with a critical case-by-case approach to provide optimal outcomes in a limited-resource setting., (Copyright © 2024 Elsevier Inc. All rights reserved.)