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Background: Subarachnoid hemorrhage is one of high morbidity in vascular neurology and neurosurgery and one of the clipart for this is symptomatic vasospasm that can leads to delayed cerebral ischemia. Other common complication is electrolytes and fluid homeostasis disturbance and among these, is Sodium disequilibrium, either hypo- or hypernatremia. In our institution we observed that hyponatremia is common, and it is more evident in patient with symptomatic vasospasm. For that we retrospectively looked at the association of hyponatremia and the occurrence of symptomatic vasospasm or delayed cerebral ischemia in aSAH. Methods: Retrospective chart review with daily monitoring of sodium level from day 1to day 21 from the ictus, aSAH. We include all adult patients (Age > 18 years) who were admitted to intensive care with diagnosis of aSAH and undergone aneurysm securing procedures within 48 h. Results: Among 45 patients 24 (43%) developed symptomatic vasospasm and delayed cerebral ischemia and it was most common in males (13/22: 59%). Sodium level especially hyponatremia in period between days (1–4) with median of 134 in vasospasm group (50%). Conclusions: Delayed cerebral ischemia/symptomatic vasospasm occurs more commonly in males and associated with hyponatremia (Na+

Background: Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training. Methods: An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April–November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed. Results: In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively (P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues (P < 0.001), neurosurgical journals (P < 0.0001), and textbooks (P = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests (n = 953; 1673 requests) were research (n = 384), education (n = 296), and subspecialty/fellowship training (n = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested. Conclusions: Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training.

Background: Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development. Methods: This was a cross-sectional study in which a widely disseminated online survey (April 2018–November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ2 tests because of its categorical nature. Results: There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education. Conclusions: These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them.