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Discrimination, abuse, and mistreatment are prevailing problems reported in neurosurgical training programs globally. Moreover, the current coronavirus disease 2019 (COVID-19) pandemic may also show a negative impact on burnout levels in neurosurgery residents. This study aims to evaluate burnout, discrimination, and mistreatment in neurosurgical residents training in Latin America during the severe acute respiratory syndrome coronavirus 2 era.A 33-item electronic survey was sent to neurosurgery residents from Latin America from May 10 to 25, 2021. Statistical analysis was performed using SPSS version 25.A total of 111 neurosurgery residents responded to the survey. Mean age was 29.39 ± 2.37 years; 22.5% were female and 36% were training in Mexico. Residents who reported experiencing discrimination for testing positive to COVID-19 had the highest levels of depersonalization (66.7%; P = 0.043) and emotional exhaustion (75%; P = 0.023). Female respondents reported higher rates of gender discrimination (80% vs. 1.2%; P = 0.001), abuse (84% vs. 58.1%; P0.005), and sexual harassment (24% vs. 0%; P0.001) than did male respondents. Residents training in Mexico reported lower rates of emotional or verbal abuse (59.2% vs. 32.5%; P = 0.007) and bullying (P0.005) than did those in other countries in Latin America. Older age was a protective factor for high depersonalization scores (odds ratio [OR], 0.133; 95% confidence interval [CI], 0.035-0.500). Experiencing discrimination represented a risk factor for presenting high emotional exhaustion scores (OR, 3.019; 95% CI, 1.057-8.629). High levels of depersonalization were associated with a 7-fold increased risk of suicidal ideation (OR, 7.869; 95% CI, 1.266-48.88).The COVID-19 pandemic has been a significant burden on several aspects of health care workers' lives. Our results provide a broad overview of its impact on burnout, discrimination, and mistreatment as experienced by neurosurgery residents training in Latin America, laying the groundwork for future studies and potential interventions.

Introduction Gliomas are neoplasms with high recurrence and mortality. Due to the difficulty to apply the World Health Organization (2016) classification, developing countries continue to use histological evaluation to diagnose and classify these neoplasms. Objective To develop a semi-quantitative scale to numerically grade gliomas by its morphological characteristics. Method A cohort of patients with gliomas was assessed and followed for 36 months. Tumor tissue sections were analyzed and graded, including aspects such as cell line, cellularity, nuclear pleomorphism, mitosis, endothelial hyperplasia, hypoxic changes, apoptotic bodies, necrosis, hemorrhage and proliferation index. Results 58 cases were analyzed. Low-grade gliomas median score was 12 points (9 and 13.5 for percentiles 25 and 75, respectively), whereas for high-grade gliomas it was 17 points (16 and 20.5 for percentiles 25 and 75, respectively) (p < 0.0001). Thirty-six-month survival of patients with low (13/17) and high grade gliomas (6/41) was also significantly different (p < 0.0001). Conclusions The semi-quantitative morphological scale allows an objective evaluation of gliomas, with an adequate correlation between the score, tumor grade and survival time.

Gliomas are neoplasms with high recurrence and mortality. Due to the difficulty to apply the World Health Organization (2016) classification, developing countries continue to use histological evaluation to diagnose and classify these neoplasms.To develop a semi-quantitative scale to numerically grade gliomas morphological characteristics.A cohort of patients with gliomas was assessed and followed for 36 months. Tumor tissue sections were analyzed and graded, including aspects such as cell line, cellularity, nuclear pleomorphism, mitosis, endothelial hyperplasia, hypoxic changes, apoptotic bodies, necrosis, hemorrhage and proliferation index.58 cases were analyzed. Low-grade gliomas median score was 12 points (9 and 13.5 for percentiles 25 and 75, respectively), whereas for high-grade gliomas it was 17 points (16 and 20.5 for percentiles 25 and 75, respectively) (p0.0001). Thirty-six-month survival of patients with low (13/17) and high grade gliomas (6/41) was also significantly different (p0.0001).The semi-quantitative morphological scale allows an objective evaluation of gliomas, with an adequate correlation between the score, tumor grade and survival time.Los gliomas son neoplasias con alta recurrencia y mortalidad. Por la dificultad para aplicar la clasificación de la Organización Mundial de la Salud (2016), los países en desarrollo siguen utilizando la evaluación histológica para diagnosticarlos y clasificarlos.Desarrollar una escala semicuantitativa para calificar numéricamente las características morfológicas de los gliomas.Cohorte de pacientes con gliomas evaluada y seguida durante 36 meses. Se analizaron y calificaron cortes del tejido tumoral, incluyendo aspectos como estirpe celular, celularidad, pleomorfismo nuclear, mitosis, hiperplasia endotelial, cambios hipóxicos, cuerpos apoptóticos, necrosis, hemorragia e índice de proliferación.Se analizaron 58 casos. La mediana de la calificación de los gliomas de bajo grado fue de 12 puntos (percentiles 25 y 75 de 9 y 13.5, respectivamente) y la de los gliomas de alto grado fue de 17 puntos (percentiles 25 y 75 de 16 y 20.5, ­respectivamente) (p0.0001). La supervivencia a 36 meses de los pacientes con gliomas de bajo (13/17) y alto grado (6/41) también fue significativamente diferente (p0.0001).La escala morfológica semicuantitativa permite una evaluación objetiva de los gliomas, con una adecuada correlación entre la calificación, el grado del tumor y el tiempo de supervivencia.

The empty sella is an entity that only rarely presents signs and symptoms. When noted, visual field deficits are an indication for surgical management.We studied twenty patients with primary empty sella and visual field deficits surgically treated with a technique termed by us as "sellar remodeling." We treated 19 females and 1 male. Aside from visual deficits, all participants reported headache. We reported an increase in prolactin serum level in three cases. Patients with an increase in cerebrospinal fluid pressure were excluded. The surgical procedure involved placing through a transsphenoidal route an autologus graft formed by fat, aponeurosis and two bone lamina, with precise dimensions according to each patient's sella turcica.After surgery, visual deficits improved in 18 patients and headache in 17. Two patients displayed normal prolactin levels. No serious complications were reported during surgery.Sellar remodeling is a precise, simple, safe and inexpensive technique that significantly improves symptoms such as visual deficits and headache observed in primary empty sella syndrome.

Management of pituitary adenoma is a real challenge because of neurovascular structures that surround the sellar region. In this paper we included 336 patients with pituitary tumors greater than 10 mm in diameter to make an analysis of surgical results. In this group, a discrete female predominance was found, with an average of 43.2 years of age and 21.5 mm in diameter of lesions. The clinical course was dominated by headache and visual deficit and only one quarter of patients had functioning tumors. The majority of the tumors were operated on by a transsphenoidal approach; in 72% of cases, the lesion was completely removed. Visual recovery was observed in 68% of patients, better in those who had a shorter clinical course; on the other hand, only 34 of 84 patients with functioning tumors could be cured. Complications were specially related to growing pattern of adenoma and its consistency. Even though higher morbidity and mortality was found in patients operated on by craniotomy, they also had the most complex lesions. Based on our experience, we are proposing here some recommendations to chose correctly the best surgical option and to avoid complications. Finally, we designed a diagram showing the critical route for optimal treatment of these lesions.