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The Cannabis sativa plant contains more than 120 cannabinoids. With the exceptions of ∆9-tetrahydrocannabinol (∆9-THC) and cannabidiol (CBD), comparatively little is known about the pharmacology of the less-abundant plant-derived (phyto) cannabinoids. The best-studied transducers of cannabinoid-dependent effects are type 1 and type 2 cannabinoid receptors (CB1R, CB2R). Partial agonism of CB1R by ∆9-THC is known to bring about the ‘high’ associated with Cannabis use, as well as the pain-, appetite-, and anxiety-modulating effects that are potentially therapeutic. CB2R activation by certain cannabinoids has been associated with anti-inflammatory activities. We assessed the activity of 8 phytocannabinoids at human CB1R, and CB2R in Chinese hamster ovary (CHO) cells stably expressing these receptors and in C57BL/6 mice in an attempt to better understand their pharmacodynamics. Specifically, ∆9-THC, ∆9-tetrahydrocannabinolic acid (∆9-THCa), ∆9-tetrahydrocannabivarin (THCV), CBD, cannabidiolic acid (CBDa), cannabidivarin (CBDV), cannabigerol (CBG), and cannabichromene (CBC) were evaluated. Compounds were assessed for their affinity to receptors, ability to inhibit cAMP accumulation, βarrestin2 recruitment, receptor selectivity, and ligand bias in cell culture; and cataleptic, hypothermic, anti-nociceptive, hypolocomotive, and anxiolytic effects in mice. Our data reveal partial agonist activity for many phytocannabinoids tested at CB1R and/or CB2R, as well as in vivo responses often associated with activation of CB1R. These data build on the growing body of literature showing cannabinoid receptor-dependent pharmacology for these less-abundant phytocannabinoids and are critical in understanding the complex and interactive pharmacology of Cannabis-derived molecules.

Background: Robotics is currently being adopted across the spectrum of neurosurgery from deep brain stimulation to spine surgery instrumentation. Mastoidectomy is a cognitively demanding procedure that involves careful removal of bone around the critical structures of the temporal bone. Herein, we report a pilot study that serves as a proof of concept for real-time, multiparameter recording during mastoidectomy. Methods: This pilot study involved the iterative development of a platform for the real time recording of video, 3D position, velocity, acceleration, and force data during the performance of mastoidectomy using cadaveric specimens. Results: Across all 8 replicates, the average distance traveled by the drill tip in the x, y, and z axes was 39.88 mm (±11.98 mm), 38.52 mm (±8.24 mm), 31.40 mm (±7.89 mm), respectively. The overall average ranges for velocity and acceleration of the drill tip in the x axis were 412.81 mm/s (±91.12 mm/s) and 6383.05 mm/s2 (±941.05 mm/s2). The range of forces recorded was 8.52 N (±2.90 N), 40.94 N (±9.81 N), and 35.42 N (±11.06 N) in the x-, y-, and z-axis, respectively. Conclusions: This study represents a proof-of-concept that the mechanical parameters associated with surgeon-performed mastoidectomy can be recorded in real-time. This represents a crucial step in understanding the human drilling process which incorporates visual and haptic sensory input with experiential and explicit knowledge using fuzzy logic feedback. Ultimately, data collected using this methodology may provide the groundwork for the development of an algorithm for robotic mastoidectomy.

The use of optic technology in skull base surgeries has the potential to revolutionize the field of medicine, particularly neurosurgery and neurology. Here, we briefly present the past, present, and future of skull-base surgery, with an emphasis on the applications of optical topography techniques. We discuss optical topography techniques such as functional near-infrared spectroscopy, optical diffusion tomography, and optical topographical imaging. Optical topography techniques are particularly advantageous when combined with other imaging methods. For instance, optical topography can be combined with techniques such as functional magnetic resonance imaging (fMRI) to combine the temporal resolution of optical topography with the spatial resolution of fMRI. Multimodal approaches will be critical to advance brain-related research as well as medicine. Structured light imaging techniques are also writing the future of 3-dimensional imaging. In short, optical topography can allow for non-invasive, high-resolution imaging that will provide real-time visualizations of the brain that are ideal for neurosurgery. From the limitations of traditional skull base surgeries to the newest developments in optical neuroimaging, here we will discuss the potential applications of optics in skull base procedures.

Background Tubular approach surgery now includes complex spinal and cranial procedures. Aided by modified instrumentation and frameless stereotaxy, minimal access surgery is being offered for a growing array of neurosurgical conditions. Methods This article explores the flexibility and adaptability of the tubular retractor system for multiple indications by highlighting the 12-year experience of the primary surgeon using a tubular retractor system reported for the entire neuroaxis including intracranial, foramen magnum, and the craniocaudal extent of the spine for intra- and extradural pathologies. For this article we have not analyzed our experience with degenerative spinal disease. Patient characteristics, pathology, resection results, length of hospital stay, and complications are discussed. Results From August 2005 through March 2017, 538 patients underwent neurosurgical procedures with mini-tubular access. Of these, the 127 patients who underwent mini-tubular access operations for nontraditional indications are discussed here. There were 65 women and 61 men with an average age of 53.5 years. The cases by anatomical location are as follows: 27 cranial cases, 11 foramen magnum decompressions, and 89 for spinal indications. The cranial pathologies included primary and metastatic tumors. The spinal pathologies included intra- and extradural spinal tumors, spina bifida occulta, syringomyelia, and other cystic lesions in the spine. In the vast majority of the patients where gross total resection was the goal, it was achieved. The mean length of stay was 2.94 days. Conclusions This report demonstrates that mini-tubular access surgery can be adapted to pathologies in the entire neuroaxis with outcomes that are comparable with open techniques. Limited tissue dissection, smaller incisions, and limited bone resection make the mini-tubular access approach a desirable option when feasible. Greater experience with all of these techniques is needed before the definitive status of these procedures in the neurosurgical armamentarium can be demonstrated.

Surgical brain injury caused by brain retraction is a well-known consequence of intracranial surgery. Modern retractor designs, particularly since the 1980s, have significantly improved ease of use, improved visibility for surgeons, and minimized retraction-induced injuries, though not yet been entirely eliminated. Today, brain retractors come in a broad range of styles, each with its own pros and cons regarding operational utility and patient safety. Which type is chosen for use depends on the surgical approach, lesion size and depth, cost, and surgeon preference. Traditionally, self-retaining brain retractors with moveable arms and 1 or more attachable blades made from malleable stainless steel or silicone rubber have been the tool of choice; however, recently tubular retraction systems that only require fixation to the head frame and cause less focal pressure damage than older retractors have gained in popularity for some cases. This review aims to address the history of brain retraction and discuss each of the commonly used brain retractor types, as well as some newer and less common varieties especially in terms of the extent of tissue damage typically caused as well as the types of injuries reported by the users.

Cannabinoids are compounds that are structurally and/or functionally related to the primary psychoactive constituent of Cannabis sativa, [INCREMENT]-tetrahydrocannabinol (THC). Cannabinoids can be divided into three broad categories: endogenous cannabinoids, plant-derived cannabinoids, and synthetic cannabinoids (SCs). Recently, there has been an unprecedented surge of interest into the pharmacological and medicinal properties of cannabinoids for the treatment of epilepsies. This surge has been stimulated by an ongoing shift in societal opinions about cannabinoid-based medicines and evidence that cannabidiol, a nonintoxicating plant cannabinoid, has demonstrable anticonvulsant activity in children with treatment-refractory epilepsy. The major receptors of the endogenous cannabinoid system (ECS)-the type 1 and 2 cannabinoid receptors (CB1R, CB2R)-have critical roles in the modulation of neurotransmitter release and inflammation, respectively; so, it is not surprising therefore that the ECS is being considered as a target for the treatment of epilepsy. SCs were developed as potential new drug candidates and tool compounds for studying the ECS. Beyond the plant cannabinoids, an extensive research effort is underway to determine whether SCs that directly target CB1R, CB2R, or the enzymes that breakdown endogenous cannabinoids have anticonvulsant effects in preclinical rodent models of epilepsy and seizure. This research demonstrates that many SCs do reduce seizure severity in rodent models and may have both positive and negative pharmacodynamic and pharmacokinetic interactions with clinically used antiepilepsy drugs. Here, we provide a comprehensive review of the preclinical evidence for and against SC modulation of seizure and discuss the important questions that need to be addressed in future studies.

Background Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in terminating SVT episodes. We aimed to compare the standard VM (SVM) to the modified valsalva maneuver (MVM). We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department. Methods In this systematic review and meta-analysis, we searched Medline/PubMed, Ovid, Web of Science, and Cochrane Central Register of Controlled trials. We included only randomized controlled trials (RCTs) that compared the modified valsalva to the standard valsalva maneuver in treating SVT. Our main outcome was the termination of SVT within 1 min. Results Four articles met the eligibility criteria of our review. Sinus rhythm was achieved 2.5 times more in the MVM group compared to the SVM group (risk ratio (RR) = 2.54, CI 1.98–3.24, P Conclusion Our review found MVM to be more effective than the SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.

Over the past 30 years, the application of robotics in the field of neurotology has grown. Robots are able to perform increasingly complex tasks with ever improving accuracy, allowing them to be used in a broad array of applications. A mastoidectomy, in which a drill is used to remove a portion of the mastoid part of the temporal bone at the base of the skull, is one such application. To determine the current state of neurotologic robotics in the specific context of mastoidectomy, a review of the literature was carried out. This qualitative review explores what has been done in this field to date, as well as what has yet to be done. Although the research suggests that robotics can be and has been successfully used to assist with mastoidectomy, it also suggests the incompleteness of robotic development in the field. At present, only 2 robotic systems have been approved by the U.S. Food and Drug Administration for neurosurgical use and the literature lacks evidence of meaningful clinical testing of new systems to change that. The cost of robotics also remains prohibitive. However, strides have been made, with at least 1 robot for mastoidectomy having reached the point of cadaveric trials. In addition, the research suggests some of the characteristics that should be considered when designing robots for mastoidectomy, such as burr size and the type of forces that should be applied. Overall, the outlook for robots in neurotology, particularly mastoidectomy, is bright but some hurdles still remain to be overcome.

Cannabinoid 1 receptor (CB1R) allosteric ligands hold a far-reaching therapeutic promise. We report the application of fluoro- and nitrogen-walk approaches to enhance the drug-like properties of GAT211, a prototype CB1R allosteric agonist-positive allosteric modulator (ago-PAM). Several analogs exhibited improved functional potency (cAMP, β-arrestin 2), metabolic stability, and aqueous solubility. Two key analogs, GAT591 (6r) and GAT593 (6s), exhibited augmented allosteric-agonist and PAM activities in neuronal cultures, improved metabolic stability, and enhanced orthosteric agonist binding (CP55,940). Both analogs also exhibited good analgesic potency in the CFA inflammatory-pain model with longer duration of action over GAT211 while being devoid of adverse cannabimimetic effects. Another analog, GAT592 (9j), exhibited moderate ago-PAM potency and improved aqueous solubility with therapeutic reduction of intraocular pressure in murine glaucoma models. The SAR findings and the enhanced allosteric activity in this class of allosteric modulators were accounted for in our recently developed computational model for CB1R allosteric activation and positive allosteric modulation.

PURPOSE: To assess the perceptions about ophthalmology as a career among undergraduate medical students and to investigate the determinants of career choice in ophthalmology. METHODS: A questionnaire was administered to all medical students (from 4th year to interns) in King Abdulaziz University, Jeddah, Saudi Arabia. A total of 519 students were included in the study. Students who aspire for ophthalmology as a career, i.e., those who mentioned it in their top three choices (Group A), were compared to those who did not (Group B) regarding demographic and academic factors, factors generally influencing career choice and perception about and experience in ophthalmology. RESULTS: Among 519 included students, ophthalmology was the first career choice of 5.6% and in the top three choices of 13.5% of students. Students from Group A had female preponderance and comparable academic skills, by reference to Group B. Group A reported to have a better experience in ophthalmology, including conference attendance, research activity, and community services related to ophthalmology, as well as greater advantage from ophthalmology rotation. Determinants of career choice in ophthalmology included giving importance for workload during their residency (odds ratio [OR] = 3.38; P = 0.021), having concern about challenging instrumental features (OR = 0.29, P = 0.012), believing that ophthalmology should be included in primary care (OR = 13.60, P = 0.002), and having participated in community service activity in ophthalmology (OR = 10.10, P = 0.005). CONCLUSION: Students who aspire for a career in ophthalmology showed to have an early involvement in related academic activities and less concern about instrumental and intellectual challenges, as compared to their counterparts. The formal ophthalmology rotation is the key step to recruit future ophthalmologists by correcting misconceptions and enhancing interest about the specialty.

Crown root cracking is uncommon, accounting for less than 7% of irreversible damage. All the hard tissues of the teeth (crust, dentin, and cementum), as well as the pulp and periodontal ligament, are commonly involved in these complicated fractures. The care of such instances offers major biological hurdles, and success is dependent on considering a variety of regenerative, endodontic, and temporal variables. Numerous clinical investigations demonstrate that adhesive coronal attachment might be an essential therapy for fractured teeth with crown roots. Because it maintains the original tooth, this technique may save the gums and decrease the time and expense of therapy. Before considering adhesive attachments for dental fractures, several factors should be considered-the site and size of the fracture, the fracture pattern, and the position of traumatized teeth. The aim of the article was to review the role of adhesive attachments in a traumatic dental injury.

Background and importance Myxoid liposarcoma is not an uncommon form of sarcoma. However, it usually affects the lower extremity long bones. Scapular involvement is extremely rare, as is a metastasis to the parasellar region. We present a case of liposarcoma of the skull base originating in the scapular region and metastasizing to the sellar and parasellar regions and provide a review of the pertinent literature. Clinical presentation A 43-year-old female patient diagnosed with left scapular myxoid liposarcoma was treated with surgical resection. She had clear resection margins and was treated pre- and postoperatively with radiotherapy to the region. She remained asymptomatic for 2 years following surgery, after which she abruptly developed diplopia with right lateral gaze. There were no symptoms of raised intracranial pressure or impaired vision. Her examination was normal apart from complete right sixth nerve palsy. Imaging studies of the brain showed a large mass in the clivus eroding into the floor of the sella, encircling the right internal carotid artery in the cavernous sinus. The mass also displaced the sellar contents superiorly. An endonasal, endoscopic skull base approach was undertaken, and a subtotal resection was performed in an effort to avoid multiple cranial nerve pareses. Conclusion Our literature search revealed that this case report is the first to document liposarcoma metastasis to the skull base originating from the scapular region. Subtotal surgical resection resulted in minimal improvement of the patient's sixth nerve palsy. Postoperative radiation was undertaken. A multidisciplinary approach on an individual patient basis is recommended.

Background Poor Quality of Life (QoL) among medical students is associated with an unhealthy lifestyle, psychological distress, and academic failure, which could affect their care for patients in the future. This study aimed to evaluate the reliability and validity of the Arabic WHOQOL-BREF tool among Saudi medical students and to assess the effect of gender, educational level, and academic performance on their QoL. Methods This was a cross-sectional study among medical students of King Abdulaziz University in February 2016, using the Arabic version of the WHOQOL-BREF instrument. Results Six-hundred-thirty medical students were included, where females constituted (51.1%). Cronbach’s α coefficient for the overall domains of WHOQOL-BREF was 0.86. Students’ self-reported QoL mean score was 3.99 ± 0.95, and their mean score for the overall satisfaction with health was 3.66 ± 1.06. The environmental domain had the highest mean score (67.81 ± 17.39). High achievers showed lower psychological health, while poor academic performance was associated with better psychological health and social relationship QoL scores (P P Conclusions The WHOQOL-BREF is valid and reliable for assessing QoL among Saudi medical students. Although gender and academic year had no impact on the students’ QoL, better-performing students reported lower psychological health and social relationships scores.

Aim: Obesity carries with itself an increased risk of psychological distress, depression and anxiety. Several studies have proven that the best modality of treatment for morbid obesity is bariatric surgery. However, the outcome of bariatric surgery on psychological health varies between individuals. Comprehensive perioperative mental health evaluation for patients seeking bariatric surgery is important, as psychiatric comorbidities could result in poor outcomes, and based on our knowledge, studies on psychiatric outcomes post bariatric surgery are limited in Saudi Arabia. This study is aimed at assessing the impact of bariatric surgery on developing depression and anxiety symptoms.Methods: Data for this cross-sectional study were collected from patients via an electronic self-administered questionnaire of both genders who underwent bariatric surgery during the period between July 2013 and July 2017 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia.Results: The total number of the participants was 214, wherein 66 (30.8%) were males and 150 (69.2%) were females. Participants who underwent bariatric surgery ranged between 17 and 64 years of age with a median age of 36.69 years. With regards to preoperative assessment, we found that 95.8% of our sample did not visit a psychiatry clinic. The postoperative percentage of depression and anxiety among patients was 67 (31.3%) and 40 (18.7%), respectively. Using multivariate regression analysis, patients’ income was found to be significantly associated with anxiety, those who had higher income had less odds of being anxious compared to the group with low income (

Amaç: Obezite, artmış psikolojik stres, depresyon ve anksiyete riski taşır. Bazı çalışmalar morbid obezite için en iyi tedavi yönteminin bariatrik cerrahi olduğunu kanıtlamıştır. Ancak, bariatrik cerrahinin psikolojik sağlık konusundaki sonucu bireyler arasında değişmektedir. Bariatrik cerrahi arayan hastalar için kapsamlı perioperatif zihinsel sağlık değerlendirmesi önemlidir, çünkü psikiyatrik komorbiditeler kötü sonuçlara neden olabilir ve bilgilerimize dayanarak, Suudi Arabistan'da bariyatrik cerrahi sonrası psikiyatrik sonuçlarla ilgili çalışmalar sınırlıdır. Bu çalışma, bariatrik cerrahinin depresyon ve anksiyete semptomları geliştirmedeki etkisini değerlendirmeyi amaçlamaktadır.Yöntemler: Bu kesitsel çalışmaya ilişkin veriler, Temmuz 2013 ile Temmuz 2017 arasında Kral Abdulaziz Üniversitesi Hastanesi (KAUH), Cidde, Suudi Arabistan'da bariatrik cerrahi uygulanan her iki cinsiyetten elektronik olarak uygulanan bir anket formu ile hastalardan toplandı.Bulgular: Katılımcıların toplam sayısı 214 olup, 66'sı (%30,8) erkek, 150'si (%69,2) kadındır. Bariatrik cerrahi geçiren katılımcılar 17-64 yaşları arasındaydı ve ortanca yaşları 36,69 idi. Preoperatif değerlendirme açısından, örneklemimizin% 95.8'inin bir psikiyatri kliniğini ziyaret etmediğini bulduk. Postoperatif depresyon ve anksiyete yüzdesi hastalar arasında sırasıyla 67 (%31,3) ve 40 (%18,7) idi. Çok değişkenli regresyon analizini kullanarak, hastaların gelirlerinin kaygı ile anlamlı bir şekilde ilişkili olduğu, daha yüksek geliri olanların düşük gelirli gruplara göre (, Aim: Obesity carries with itself an increased risk of psychological distress, depression and anxiety. Several studies have proven that the best modality of treatment for morbid obesity is bariatric surgery. However, the outcome of bariatric surgery on psychological health varies between individuals. Comprehensive perioperative mental health evaluation for patients seeking bariatric surgery is important, as psychiatric comorbidities could result in poor outcomes, and based on our knowledge, studies on psychiatric outcomes post bariatric surgery are limited in Saudi Arabia. This study is aimed at assessing the impact of bariatric surgery on developing depression and anxiety symptoms.Methods: Data for this cross-sectional study were collected from patients via an electronic self-administered questionnaire of both genders who underwent bariatric surgery during the period between July 2013 and July 2017 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia.Results: The total number of the participants was 214, wherein 66 (30.8%) were males and 150 (69.2%) were females. Participants who underwent bariatric surgery ranged between 17 and 64 years of age with a median age of 36.69 years. With regards to preoperative assessment, we found that 95.8% of our sample did not visit a psychiatry clinic. The postoperative percentage of depression and anxiety among patients was 67 (31.3%) and 40 (18.7%), respectively. Using multivariate regression analysis, patients’ income was found to be significantly associated with anxiety, those who had higher income had less odds of being anxious compared to the group with low income (

Background: Heart failure, mainly systolic dysfunction, has been studied as a determining factor in the prognosis of patients with acute pulmonary embolism (PE). However, left ventricular diastolic dysfunction (LVDD) has not been well studied in this regard. Methods: A total of 516 patients were diagnosed with acute PE from January 2013 to December 2016. Both hemodynamically stable and unstable patients (i.e. massive PE) who underwent echocardiography within two months of diagnosis were included. Of these, 161 patients were finally included in the study. A comparative cross-sectional study was conducted to investigate the prevalence of LVDD in patients with acute PE and its influences on in-hospital mortality or poor clinical outcomes. Results: Of 161 patients, 35 patients died during hospitalization (mortality rate 21.7%). Among 73 patients without left ventricular diastolic dysfunction, 14 died (mortality rate 19.2%). Among 88 patients with left ventricular diastolic dysfunction, 21 died (mortality rate 23.9%). The odds ratio of mortality in these patients was 1.321 (0.617 to 2.828), with 95% confidence intervals (P = 0.473). Conclusions: In patients with acute PE, LVDD identified by echocardiography was associated with higher in-hospital mortality rates (23.9 compared with 19.2 for those without LVDD), although this effect was not statistically significant. Additional studies with a larger sample size are required to fully clarify the prognostic effects of LVDD on patients with acute PE. Keywords: pulmonary embolism, heart failure, diastolic dysfunction, prevalence, mortality.

Background An intraoperative technique for foramen magnum decompression of Chiari malformation is presented. The technique uses minimal exposure tubular retractors attached to a flexible arm to keep the retractor in a fixed position, while allowing flexible angulation under fluoroscopic guidance. Methods Operations were performed between 2009 and 2018 on 22 patients with cerebellar tonsillar descent below the foramen magnum and a diagnosis of type I Chiari malformation. A linear durotomy was necessary, but only the outer layer of the dura was opened for some patients, which is less invasive than the traditional procedure where a durotomy is performed for both the inner and outer layers, and then a duraplasty is performed. Results The approach allowed access to a wide working area, minimized soft tissue exposure, and optimized extent of decompression. The postoperative imaging demonstrated satisfactory bony removal, and magnetic resonance imaging of the area with cerebrospinal (CSF) flow study showed good CSF flow across the foramen magnum. There was a low incidence of postoperative complications, and the average length of hospital stay was 1 day. For 19 of 22 cases, the symptoms completely resolved or markedly improved, and each of the patients who attended the last follow-up demonstrated syrinx resolution. Conclusions Based on our experience with this technique, when used to assist in foramen magnum decompression of Chiari malformation I, the minimally invasive tubular retractor is a useful tool, providing the surgeon with enhanced visualization of the operative field, while reducing potential damage to tissue and optimizing surgical outcomes.

Breast cancer (BC) accounts for 24 % of all women cancer cases diagnosed in Saudi Arabia each year. Awareness is extremely important in combating this disease. This study was undertaken to assess male high school students' response to BC. This cross-sectional survey was performed on male high school students across schools in Jeddah. A questionnaire gathered data on respondent demographics, beliefs about BC, BC risk factors, early screening methods, and role of men in BC. Statistical analysis was done using SPSS 20. A total of 824 students participated, with an average age of 17.0 years. There was more than 50 % agreement that early detection of BC enhances the chances of recovery, that BC is treatable, and that clinical breast examination and breastfeeding provide protection from BC. Around half the survey population thought that BC was fatal and contagious. Fewer than 50 % thought that BC was inherited and related to smoking, consumption of contraceptive pills, repeated exposure to radiation, obesity, and wearing a bra and that breast tumors were all malignant and spread to different parts of the body. Others knew that mammograms should be performed periodically. A high percentage persuaded their relatives to have mammograms and provided them with psychological support. Knowledge of BC among male high school students in Saudi Arabia is still limited, and, therefore, programs and activities need to be established to increase awareness among high school students.

OBJECT Although intracranial arachnoid cysts are a common incidental finding on pediatric brain imaging, only a subset of patients require surgery for them. For the minority who undergo surgery, the comparative effectiveness of various surgical approaches is debated. The authors explored predictors of surgery and compared operative techniques for pediatric patients with an intracranial arachnoid cyst seen at a tertiary care center. METHODS The authors reviewed records of pediatric patients with an intracranial arachnoid cyst. For each patient, data on baseline characteristics, the method of intervention, and surgical outcomes for the initial surgery were extracted, and cyst size at diagnosis was calculated (anteroposterior × craniocaudal × mediolateral). Baseline variables were analyzed as predictors of surgery by using logistic regression modeling, excluding patients whose surgery was not related to cyst size (i.e., those with obstructive hydrocephalus secondary to the cyst compressing a narrow CSF flow pathway or cyst rupture/hemorrhage). Data collected regarding surgical outcomes were analyzed descriptively. RESULTS Among 83 pediatric patients with an intracranial arachnoid cyst seen over a 25-year period (1989–2013), 27 (33%) underwent surgery; all had at least 1 cyst-attributed symptom/finding. In the multivariate model, age at presentation and cyst size at diagnosis were independent predictors of surgery. Cyst size had greater predictive value; specifically, the area under the curve for the receiver-operating-characteristic curve was 0.89 (95% CI 0.82–0.97), with an ideal cutoff point of ≥ 68 cm3. This cutoff point had 100% sensitivity (95% CI 79%–100%), 75% specificity (95% CI 61%–85%), a 53% positive predictive value (95% CI 36%–70%), and a 100% negative predictive value (95% CI 91%–100%); the positive likelihood ratio was 4.0 (95% CI 2.5–6.3), and the negative likelihood ratio was 0 (95% CI 0–0.3). Although the multivariate model excluded 7 patients who underwent surgery (based on prespecified criteria), excluding these 7 cases did not change the overall findings, as shown in a sensitivity analysis that included all the cases. Descriptive results regarding surgical outcomes did not indicate any salient differences among the surgical techniques (endoscopic fenestration, cystoperitoneal shunting, or craniotomy-based procedures) in terms of symptom resolution within 6 months, need for reoperation to date, cyst-size change from before the operation, morbidity, or mortality. CONCLUSIONS The results of these exploratory analyses suggest that pediatric patients with an intracranial arachnoid cyst are more likely to undergo surgery if the cyst is large, compresses a narrow CSF flow pathway to cause hydrocephalus, or has ruptured/hemorrhaged. There were no salient differences among the 3 surgical techniques for several clinically important outcomes. A prospective multicenter study is required to enable more robust analyses, which could ultimately provide a decision-making framework for surgical indications and clarify any differences in the comparative effectiveness of surgical approaches to treating pediatric intracranial arachnoid cysts.

OBJECTIVEAlthough endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus was introduced in 1923, the method was relegated to the sidelines in favor of extracranial techniques. Since the 1990s to the beginning of the current century, however, ETV has undergone a remarkable resurgence to become the first-line treatment for obstructive hydrocephalus, and for some groups, the procedure has been applied for communicating hydrocephalus as well. In the present study, the authors identified the top 50 cited ETV works. These articles represent works of significance that document current practices and provide guidance for future inquiry.METHODSThe top 50 cited articles pertaining to ETV were identified using bibliometric data obtained with the Harzing’s Publish or Perish software search engine. These high-impact works were evaluated for publication properties including year, country of authorship, category, and journal.RESULTSThe top 50 works were cited an average of 141.02 times with a mean of 9.45 citations per year. Articles published in 2005 were the most numerous in the top 50 group. These top articles were most frequently published in the Journal of Neurosurgery: Pediatrics. Most of the articles were clinical studies reporting on patients in the pediatric age group. The country of most authorship was the US, although many other countries were among the top 50 works.CONCLUSIONSThe present report discusses the bibliometric analysis of the top 50 ETV articles. This list may be useful to those interested in the progress and current status of this procedure.