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Background: Online education has provided an important tool to continue medical education during the COVID-19 pandemic. Our study aimed to evaluate trainee and attending perceptions of online webinars as an educational tool in neurosurgery., Methods: We conducted a cross-sectional survey study. A web-based 19-question survey was distributed to the people who attended the webinar series that was carried out by the Saudi Association of Neurological Surgery from March 29, 2020 to May 31, 2020. Candidates were identified through their registration e-mails. The survey was distributed June 5-8, 2020., Results: A total of 156 responses were received (survey response rate: 60%). The overall satisfaction rate among residents and attendings (board-certified neurosurgeons) was similar (>80%). However, only 56.4% of attendings reported they were comfortable with online webinars compared with 81.2% of residents (P value <0.0001). Seventy-five percent of residents found online lectures more useful than traditional in-person lectures compared with 52% of attendings (P value = 0.01)., Conclusions: Online educational webinars provide an educational value that can be considered as an adjunct to traditional (in-person) education methods. Among trainees, the satisfaction of neurosurgery webinars was encouraging to consider as an education method. More objective research and progress are required to adopt and refine existing online didactic and neurosurgical teaching tools while creating more engaging future distant learning models., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Quantitative documentation of the effects of outbreaks, including the coronavirus disease 2019 (COVID-19) pandemic, is limited in neurosurgery. Our study aimed to evaluate the effects of the COVID-19 pandemic on neurosurgical practice and to determine whether surgical procedures are associated with increased morbidity and mortality., Methods: A multicenter case-control study was conducted, involving patients who underwent neurosurgical intervention in the Kingdom of Saudi Arabia during 2 periods: pre-COVID-19 and during the COVID-19 pandemic. The surgical intervention data evaluated included diagnostic category, case priority, complications, length of hospital stay, and 30-day mortality., Results: A total of 850 procedures were included, 36% during COVID-19. The median number of procedures per day was significantly lower during the COVID-19 period (5.5 cases) than during the pre-COVID-19 period (12 cases; P < 0.0001). Complications, length of hospital stay, and 30-day mortality did not differ during the pandemic. In a multivariate analysis comparing both periods, case priority levels 1 (immediate) (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.24-2.67), 1 (1-24 h) (OR, 1.63; 95% CI, 1.10-2.41), and 4 (OR, 0.28; 95% CI, 0.19-0.42) showed significant differences., Conclusions: During the early phase of the COVID-19 pandemic, the overall number of neurosurgical procedures declined, but the load of emergency procedures remained the same, thus highlighting the need to allocate sufficient resources for emergencies. More importantly, performing neurosurgical procedures during the pandemic in regions with limited effects of the outbreak on the health care system was safe. Our findings may aid in developing guidelines for acute and long-term care during pandemics in surgical subspecialties., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: This observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice., Methods: We included 29 participating neurosurgeons in centers from all geographical regions in the Kingdom of Saudi Arabia. The study period, which was between March 5, 2020 and May 20, 2020, was divided into three equal periods to determine the longitudinal effect of COVID-19 measures on neurosurgical practice over time., Results: During the 11-week study period, 474 neurosurgical interventions were performed. The median number of neurosurgical procedures per day was 5.5 (interquartile range [IQR]: 3.5-8). The number of cases declined from 72 in the first week and plateaued at the 30's range in subsequent weeks. The most and least number of performed procedures were oncology (129 [27.2 %]) and functional procedures (6 [1.3 %]), respectively. Emergency (Priority 1) cases were more frequent than non-urgent (Priority 4) cases (178 [37.6 %] vs. 74 [15.6 %], respectively). In our series, there were three positive COVID-19 cases. There was a significant among-period difference in the length of hospital stay, which dropped from a median stay of 7 days (IQR: 4-18) to 6 (IQR: 3-13) to 5 days (IQR: 2-8). There was no significant among-period difference with respect to institution type, complications, or mortality., Conclusion: Our study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post pandemic health-care system intolerable overload., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Medical evidence is obtainable from approaches, which might be descriptive, analytic and integrative and ranked into levels of evidence, graded according to quality and summarized into strengths of recommendation. Sources of evidence range from expert opinions through well-randomized control trials to meta-analyses. The conscientious, explicit, and judicious use of current best evidence in making decisions related to the care of individual patients defines the concept of evidence-based neurosurgery (EBN). We reviewed reference books of clinical epidemiology, evidence-based practice and other previously related articles addressing principles of evidence-based practice in neurosurgery. Based on existing theories and models and our cumulative years of experience and expertise conducting research and promoting EBN, we have synthesized and presented a holistic overview of the concept of EBN. We have also underscored the importance of clinical research and its relationship to EBN. Useful electronic resources are provided. The concept of critical appraisal is introduced.

Every neurosurgeon ought to be acquainted with the basics of research methods to enhance the comprehension of the research process and critical appraisal procedures of a scientific write-up. This in turn will ensure the appropriate application of scientific knowledge to patient care. Recent publications reveal that a significant proportion of articles published in neurosurgery are mislabeled with dire consequences on the sorting and indexing of evidence. Furthermore, many clinicians report that they feel unqualified to read the medical literature critically hence, it is for this reason that we conducted this review. Herein, we present a simple algorithm to facilitate the comprehension of research methods, as well as elucidate on the anatomy of common study designs in neurosurgery. Illustrative examples are provided when necessary. Understanding research methods and the critical analysis of published reports of clinical investigation is a fundamental skill of the physician to enable the incorporation of new clinical knowledge to practice.

Objectives: Neurosurgery program trainers are continuously searching for new methods to evaluate trainees' competency besides number of cases and training duration. Recently, efforts are made on the development of reliable methods to teach competency and valid methods to measure teaching efficacy. Herein, we propose the "Resident's Operative Case Tracking and Evaluation System" (ROCTES) for the assessment and monitoring of the resident's performance quality during each procedure., Methods: We developed a data-based website and smartphone application for neurosurgical attending physicians, residents, and resident review committees in our accredited neurosurgical institutions. ROCTES runs through five steps: Login (Resident), Case Entry, Login (Attending Physician), Case Approval and Evaluation, and Report. The Resident enters each case record under "Case Entry" field and can "save," "edit," or "submit" the case data to the Attending Physician. The latter from the attending physician login profile will be able to "approve and evaluate" the resident's "knowledge," "skills," and "attitude" ranking from 1 to 15 for that particular case; add his comments and then "save," "edit," or "submit" the data, which can be viewed by users as a "report." Program Directors can also "login" to monitor the resident's progress., Results: The implementation of this communication tool should enable the filtering and retrieval of information needed for the better assessment and monitoring of residents' exposure to variety of cases in each training center., Conclusions: This proposed evaluation system will provide a transparent assessment for residency training programs and should convert trainees into competent neurosurgeons., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Remote cerebellar hemorrhage (RCH) is a rare complication in neurosurgery that remains enigmatic both in underlying mechanism and clinical behavior. The range of procedures associated with RCH is diverse and includes both supratentorial and spinal procedures that entail significant CSF loss or lesion resection. The risk factors identified in the literature are not sufficient in predicting the patients at risk of developing RCH. It thereby remains an unpredictable hazard that requires better understanding of its pathophysiology. This study is a comprehensive review of the available literature to provide an understanding of where it stands so far, and to explain an observation in the literature that may have implications for better understanding the disease. Areas of future research are also identified.

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Neurosciences is the property of Neurosciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)