Search

• Helicopter emergency medical services (HEMS) improve outcome in acute ischemic stroke. • HEMS reduce disability after an ischemic stroke, thus reducing costs in rehabilitation. • A high-standard strategy for operative logistics of HEMS needs to be carried out. • HEMS reduce neurologic sequelae but still need more studies to prove mortality reduction. The "time is brain" concept denotes the importance of the expedited transfer of patients to stroke care centers. Helicopter emergency medical services (HEMS) can reduce the time to definitive care, which could improve neurologic prognosis and reduce mortality. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a search for randomized controlled trials, nonrandomized controlled trials, and prospective and retrospective cohort studies was performed through specific databases from inception to February 2020. Helicopter, acute stroke, and their synonyms (according to Medical Subject Headings) were included in this search. The Newcastle-Ottawa Scale was used to assess the quality of the included studies, and the Egger test was used to assess for publication bias. A total of 8 studies matched the inclusion criteria and were included for meta-analysis. The overall number recruited for helicopter transportation was 1,372, and for emergency standard transportation, it was 8,587. The association among HEMS and mortality was not statistically significant (odds ratio [OR] = 0.7; 95% confidence interval [CI], 0.60-1.06; P =.12). There was a significant association between good outcomes and HEMS (OR = 2; 95% CI, 1.79-2.34; P ≤.001), and the overall poor neurologic outcome was reduced (OR = 0.52; 95% CI, 0.46-0.60; P ≤.001). A good neurologic outcome was higher with HEMS compared with emergency standard transportation. The mortality rate was less in the emergency standard transportation group after pooled analysis but was not significant; the reduction in a poor outcome was statistically significant. [ABSTRACT FROM AUTHOR]

A large body of evidence has suggested that the natural biology for symptomatic cerebral cavernous malformations (CCMs) is dynamic. These lesions exhibit a temporal clustering epiphenomenon and usually manifest with multispectral clinical patterns, the most relevant being hemorrhagic and seizurogenic events. Most patients with cerebral cavernous malformations are asymptomatic, and the lesions are detected as incidentalomas. However, association with the CCM3 gene, Zabramski type I and II lesions, and brainstem location have the propensity to increase the bleeding events. The rebleeding risk is 20%/year per lesion, which supports the need for surgical strategies for brainstem cavernous malformations; paradoxically, almost 50% of these patients develop new deficits postoperatively. A navigation-aided approach through safe entry zones is therefore of paramount importance in mitigating the surgical risks. Radiosurgery is currently reserved for biologically aggressive lesions that are not amenable for excision. Similarly, antiepileptic drug treatment is advised following the index seizure event. Early resection of the astrogliotic tissue, barring tissues within the brainstem, following detailed seizure semiology may be beneficial to patients with mesiotemporal lesions and in patients with noncompliance and severe adverse reactions to antiepileptic drug treatment. The proper dichotomization of symptomatic and high-risk cohorts and implementation of stringent surgical strategies performed by experienced surgeons result in good surgical outcomes. The guidelines from the Angioma Alliance Scientific Advisory Board Clinical Experts Panel greatly facilitate in formulating the proper management algorithm. [ABSTRACT FROM AUTHOR]

Nepal has a critical shortage of health workers for achieving its projected sustainable development goals pertaining to its health sector. To counteract this crisis and reduce the morbidity and mortality associated with untreated brain injuries secondary to inadequate access, it is pivotal to generate solutions through the establishment of improved educational and training objectives. Objectives must align themselves with achieving equitable access to neurologic health. To that end, the cadre of health professionals able to treat neurologic disease should be sharply skilled and increased in number. We outline potential sustainable solutions at the training level to address this public health problem. Demanding and limitless working hours, burnout, social stressors, and minimal monthly stipend likely contribute to limited applications for neurosurgery residency programs. Measures should be taken to improve participation and access to extracurricular nonwork activities so as to improve resident well-being and avoid burnout. Moreover, gender inequality has also become a matter of concern as there were no females among 31 new specialist registrations in neurosurgery in 2017 and only 5 female neurosurgeons in practice to date in Nepal as per the NMC registration. Every effort should be directed toward honing the "value of neurosurgeon" among residents and promoting and nurturing their capabilities thereby maximizing sustainability in our health care system. [ABSTRACT FROM AUTHOR]