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In 2019, we highlighted the disparities in scientific production between high-income countries (HICs) and low- to middle-income countries (LMICs) by emphasizing how scientific research was underrepresented in the latter. The present study aimed to investigate research productivity in neurosurgery of low-income countries (LICs) and LMICs for the years 2018-2020 and to compare it with the results of our previous study for 2015-2017.We performed a retrospective bibliometric analysis using PubMed and Scopus databases to record all the reports published in 2018-2020 by investigators affiliated with neurosurgical departments in LICs and LMICs. The attribution of the study to LMICs was based on the presence of either the first author or the majority of authors.Our systematic search identified 486 studies reported by LICs and LMICs for full text examination in 12 journals. These articles represent 4.9% of all published neurosurgical articles, compared with 4.5% in the 2015-2017 study. India remained the country with the highest contribution, with a 17.1% increase in reports. Other countries, such as Nigeria and Philippines, also show an increased percentage of reports (from 0.9% to 3.7% and from 0.6% to 2.1%, respectively).There is growing consensus in the neurosurgical scientific community that the dissemination and analysis of epidemiologic and clinical data from developing countries can provide guidelines and practical suggestions worldwide. However, our study shows that the number of neurosurgical articles published by low-income countries in 2018-2020 remained at approximately 5% of the total, resulting in a negative impact on the process of globalization.

Spine vascular lesions like brain vascular lesions include spinal cord stroke, vascular malformation such as venous malformation or venous angioma, cavernous malformation, arteriovenous malformation or arteriovenous fistula. Embryogenesis of spinal vascular is the basic principle to understand the vascular malformation of the spine. This study aims to report serial cases with review of spinal vascular lesions. MR angiography techniques with contrast injection may reflect the direction of flow epidural veins to describe the site of arterial feeders. Serpiginous veins are commonly visible through the dorsal cord surface in MR myelography. The gold standard for diagnosing vascular malformation is Digital Subtraction Angiography (DSA). MRA helps to guide the location for DSA. Several cases are reported using MRA modalities and show the special location site of the spinal disorder.

This study aims to determine the relationship between disc height as objective data and the degree of disc degenerative Pfirrmann score assessed on MRI imaging, the imaging modality with the best current degenerative lumbal disease’s diagnosis. The measurements of disc height and Pfirrmann degenerative degree of the intervertebral disc were performed on a T2WI MRI sequence, sagittal sections of the 1-2 lumbar intervertebral discs to 5-sacral 1 (5 disc levels) using dicom MRI data using the Horos dicom viewer software. Analysis of the correlation between disc height and the degree of degeneration on MRI was performed using the Pearson correlation test. Statistical tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). The results were evaluated with a significance value of p

This study aims to provide the latest information regarding the accuracy of contrast and non-contrast 1.5 Tesla MRI in the diagnosis of lumbar Herniated Nucleus Pulposus (HNP) compared with surgical findings. We included studies with subjects diagnosed with lumbar HNP due to degenerative processes, preoperative 1.5 Tesla contrast, and non-contrast MRI and described the number of findings of MRI diagnostic tests (index test) on the actual conditions found during surgery (reference standard). We searched literature from 5 databases: ProQuest, Pubmed, Cochrane Library, Biomed Central, and ScienceDirect. The sensitivity and specificity of contrast and non-contrast 1.5 Tesla MRI ranged between 64-95% and 55-100% (95% CI) with the area under the curve above the threshold on the ROC curve. Two studies compared the accuracy of MRI and Computed Tomography (CT) myelography with a wider ROC curve on CT myelography than on MRI. The ROC curve which has a wide area under the curve above the threshold depicts the relationship between sensitivity and specificity, shows that contrast non-contrast 1.5 Tesla MRI has a good accuracy in HNP diagnostic.

Purpose: We evaluate the relationship between the severity of hydrocephalus and AQP­1 levels. Methods: This research was conducted in an experimental research design. The research subjects were Rattus Norvegicus rats of the Sprague-Dawley strain which were injected with kaolin to create a hydrocephalus model. The study included 24 rats in total, which were divided into four groups of six each: the control group, and the hydrocephalus induction group on day 7, day 14, and day 21. AQP1 expression was then observed histopathologically by immunohistochemical staining and counted semi-quantitatively. The collected data were then compared and analyzed using SPSS software version 24. Results: The average AQP1 expression increased with observation time in the hydrocephalus rat model on the 7th, 14th, and 21st days. The ANOVA test showed a significant difference between the four study groups (p=0.001). The correlation between the expression of AQP1 levels and the severity of hydrocephalus showed a statistically significant difference (p=0.000). The results showed an increase in the expression of AQP1 levels in the sub-ventricle zone with the higher severity of hydrocephalus. Conclusion: The severity of hydrocephalus and AQP1 levels are correlated, with the latter being higher the more severe the degree of hydrocephalus.

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49). Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. Funding: National Institute for Health Research Global Health Research Group.

Background: Differentiation of typical from atypical meningiomas would greatly improve surgical planning and further treatment options. Appparent diffusion coefficient (ADC) has the potential to characterize meningioma subtypes. This study aimed to assess the value of ADC in differentiating typical and atypical meningiomas. Method: A retrospective study was conducted using medical records at RSUD Dr. Soetomo Surabaya in January 2019 – September 2021. ADC values were obtained by placing three ROIs on tumors. We used receiver operating curve (ROC) analysis to determine the optimal cut-off ADC value to differentiate meningioma grading and Mann-Whitney U test to evaluate the difference in ADC values between the two groups. In addition, Chi-square was used to assess the correlation between ADC values and the type of meningioma. Results: The ADC values in typical meningiomas ranged from 1.12 - 2.47 × 10-3 mm2/s with an average of 1.45 ± 0.38 × 10-3 mm2/s, while in atypical meningiomas ranged from 0.64 – 1.12 × 10-3 mm2/s with an average of 0.81 ± 0.20 × 10-3 mm2/s. Based on ROC analysis to distinguish typical and atypical meningiomas, the cut-off mean ADC value is 1.12 × 10-3 mm2/s with a sensitivity of 100%, specificity of 96.87%, and area under the curve (AUC) of 0.996. The cut-off difference in the ADC value and the relationship between the ADC value and meningioma type based on histopathology were significant. Conclusion: Typical meningiomas have higher ADC values than atypical cases. ADC value can help differentiate typical from atypical meningiomas.

The incidence of a metastatic tumor of the calvaria is uncommon, but it has a considerable impact in the field of neurosurgery. The hematogenous metastatic spread was common in leiomyosarcoma. Calvaria is one of the most uncommon metastatic locations for this type of cancer. A 70-year-old man with a history of rhabdomyosarcoma and thyroid cancer came with a parietal mass that rapidly enlarged, followed by sudden hemiparesis and severe cognitive impairment. Head CT scan revealed a destructive soft tissue mass, indicating a metastatic development and mass effect of tumor pushing the brain parenchymal with slight compression of the right lateral ventricle and midline deviation of 8 mm to the left side. Perioperative embolization was done, and the tumor was effectively excised through extensive excision. Histopathology indicated a malignant spindle cell mesenchymal tumor, indicating leiomyosarcoma. After the operation, the patient's neurological status was stable, and there was no sign of tumor recurrence. Recommendation for managing metastatic calvaria tumor based on histopathological findings is insufficient. The information in this case report is essential for scholarly purposes and the participant gave written informed consent for publication. For the treatment of metastases in the skull, complete excision of osteolytic calvaria lesions is indicated.

Stroke is one of the most important causes of morbidity and mortality worldwide, with survivors subjected to long-term disability. Stroke is classified as ischemic and hemorrhagic. 87 % of strokes are classified as ischemic. Except for thrombolytic therapy, there is no established treatment to reduce the neurological deficits caused by an ischemic stroke. Therefore, it is necessary to develop new therapeutic strategies designed to improve neurological functions after ischemic stroke. Stem cell-based therapies aim to promote neurogenesis and replacement of lost neurons or protect surviving neurons to improve neurological recovery. Further understanding of the mechanisms by which the stem cells exert their beneficial effect could potentially revolutionize the field. The next decade of stem cell research in stroke needs to focus on. Although still in need of exploration, stem cell treatments for stroke may offer ways to protect and replace neurons to improve outcomes for stroke patients.

Meningioma is not uncommon case; however, the differentiation of high-grade from low-grade meningioma is important. The rate of recurrence of grade I meningioma is 7-20%, but in grade II meningioma is 30-40% and in grade III 50-80%. Non-invasive MRI techniques that can differentiate high-grade from low-grade meningiomas before surgery are useful for surgical planning and subsequent treatment. We present a review article and some case studies of low-grade (WHO grade I) and high-grade (WHO grade II and grade III) meningioma with conventional MRI and continue with advanced MRI; we performed diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value, dynamic susceptibility contrast (DSC), dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion and 3D ASL. From these three cases show that advanced magnetic resonance imaging with ADC value, DSC, DCE, and 3D arterial spin-labelling (ASL) is an essential sequence to differentiate high-grade from low-grade meningioma.

Deep Vein Trombosis (DVT) is one of the extracranial complications after TBI. Prophylaxis DVT using on TBI reduce incidence and mortality. Climate variants of an area affect the risk of DVT. UV ray increasing synthesis of vitamin D and lowering risk of thrombus fomation. A systematic review and meta-analysis we performed according PRISMA guidelines. A through literature search was conducted on PubMed, Scopus, and Cochrane database. Total 3 publications match study criteria with 178 samples, without 144 samples and 34 samples with prophylaxis. The overall incidence is 5% (0-6.8%), without 6.25% (5.3-6.8%) and with prophylaxis 0%. No reported complications and 100% survival rate. The incidence of DVT in TBI in tropical climate is low on average 5% (0-6.8%). There was no difference in the outcome of DVT in TBI in tropical climate which given and without DVT prophylaxis. Asian races ethnic protective factor and UV ray exposure may contributed to the low of incidence rate. Prevention of DVT is still recommended for the use of prophylaxis, mechanical compression and early mobilization in cases of TBI to prevent the occurrence of DVT.

Background: The maternal deaths due to obstetrical cases declined, but the maternal deaths that caused by nonobstetrical cases still increase. The study reported that traumatic cases in pregnancy are the highest causes of mortality in pregnancy (nonobstetrical cases) in the United States. Another study reported that 1 in 12 pregnant women that experienced traumatic accident and as many as 9.1% of the trauma cases were caused by traumatic brain injury (TBI). The female sex hormone has an important role that regulates the hemodynamic condition. Anatomical and physiological changes during pregnancy make the examination, diagnosis, and treatment of TBI different from non-pregnant cases. Therefore, it is very important to lead the algorithm for each institution based on their own resources. Case Series: A 37-year-old woman with a history of loss of consciousness after traffic accident. She rode a motorbike then hit the car. She was referred at 18 weeks' gestation. Glasgow Coma Scale (GCS) E1V1M4, isochoric of the pupil, reactive to the light reflex, and right-sided hemiparesis. The non-contrast head computed tomography (CT) scan revealed subdural hematoma (SDH) in the left frontal-temporal-parietal region, SDH of the tentorial region, burst lobe intracerebral hemorrhage, and cerebral edema. There was not a fetal distress condition. The next case, a 31 years old woman, in 26 weeks gestation, had a history of unconscious after motorcycle accident then she fell from the height down to the field about 3 m. GCS E1V1M3, isochoric of the pupil, but the pupil reflex decreased. Noncontrast CT scan revealed multiple contusion, subarachnoid hemorrhage, and cerebral edema. She had a good fetal condition. Discussion: We proposed the algorithm of TBI in pregnancy that we already used in our hospital. The main principle of the initial management must be resuscitating the mother and that also the maternal resuscitation. The primary and secondary survey is always prominent of the initial treatment. Conclusion: The clinical decision depends on the condition of the fetal, the surgical lesion of the intracranial, and also the resources of the neonatal intensive care unit in our hospital.

Background Spinal cord injury (SCI) is a significant cause of morbidity since it results in the inflammation process which leads to necrosis or apoptosis. Inflammatory response to the tissue damage increases IL-6 and IL-8 levels. ACTH4–10Pro8-Gly9-Pro10 is a peptide community that has been shown to have a beneficial effect on minimizing the morbidity and increasing the recovery time. Methods This study is a true experimental laboratory research with a totally randomized method. The subjects were animal models with light and extreme compression of spinal cord, respectively. Results The administration of ACTH 4–10 in mild SCI in the 3-hour observation group did not show a significant difference in IL-6 expression compared with the 6-hour observation group. The administration of ACTH 4–10 in severe SCI showed a significantly lower expression level of IL-6 in the 3-hour observation group compared with the 6-hour one. The administration of ACTH 4–10 in severe SCI led to a significantly lower IL-8 expression in the 3-hour observation group compared with the 6-hour one. However, there was no significant difference in IL-8 expression in the group receiving ACTH 4–10 in 3 hours observation compared with that in 6 hours observation. Conclusion The administration of ACTH4–10Pro8-Gly9-Pro10 can reduce the expression of IL-6 and IL-8 at 3-hour and 6-hour observation after mild and severe SCI in animal models. Future research works are recommended.

Schwannomas are the most common peripheral nerve sheath tumors. Benign schwannomas with malignant transformation are rarely reported. Most common schwannomas occur in the head and neck region. Sciatic schwannomas are rare, as are completely cystic schwannomas. Sciatic nerve schwannomas represent less than 1% of all schwannomas. Benign tumors in the sciatic nerve consist of 60% neurofibromas and 38% schwannomas. In general, a schwannoma induces chronic symptoms. It can be misleading, sometimes mimicking degenerative spinal pathology due to disc herniation. Schwannoma involving the sciatic nerve can be asymptomatic or may present with sciatica or neurological deficits. Most schwannomas are solid or heterogeneous tumors, and completely cystic schwannomas are rare. The differential diagnoses of nondiscogenic sciatica include lumbar disc herniation, tumor, abscess, hematoma, facet syndrome, lumbar instability, sacroiliitis, piriformis syndrome, and sciatic neuritis. We report a rare case of a long completely cystic sciatic schwannoma in the left foraminal L5–S1 zone extending to the left ischial groove with chronic sciatica that was diagnosed radiologically with a combination of conventional MRI and MR neurography and confirmed histopathologically by surgical resection. The patient previously had conservative therapy, but the complaints were not reduced. Nonsurgical therapy is considered the first choice, and surgical therapy is indicated in cases that do not respond to conservative therapy, with recurrent cysts, severe pain, or neurological deficits.

The cervicothoracic junction is prone to infection by tuberculosis bacteria, which leads to spinal instability. Meanwhile, cervicothoracic junction spinal tuberculosis is a disease that affects the C7 to T3 vertebral, and it accounts for 5% of all spinal tuberculosis cases. Surgical procedures of treating this disease vary, and the most commonly used method is the combined anterior and posterior approach. This case report presents the disease with uncommon location in pediatric, which is rarely reported, and performed with the single-stage posterior approach to treat the patient, which showed a good clinical and radiological result.A 15-years old girl with one-month history of progressive inferior paraplegia (within a month, her muscle strength went from score 5 to 0) initially complained of neck pain, gradual weakness of the lower extremities, and hypoesthesia below T4. The spine's MRI also showed a tuberculous spondylitis in the T1 to T3 vertebral and a huge paravertebral abscess at the C5 to T3 level. Subsequently, an adequate decompression, debridement, maintenance and reinforcement of stability as well as deformity correction were carried out using the single-stage posterior approach.The cervicothoracic junction spinal tuberculosis with huge paravertebral abscess makes surgical procedures difficult, specifically in pediatric patients. However, the single stage posterior approach produced a better clinical and radiological result with a short operation time. The selection of appropriate surgical approach management with good perioperative planning as well as effective medical management improved the patient's condition.

Ossification of ligamentum flavum (OLF) is calcification of the ligamentum flavum, which might narrow the spinal canal and causes myeloradiculopathy. This condition mainly affects the lower thoracal segment. Published reports on OLF are mostly from East Asia. There was only one Indonesian OLF case that had been published. The majority of OLF involves a single level only. This is the first Indonesian case-report on multilevel OLF. Through this case report, we aim to describe the natural history of the patient and our treatment strategy in managing the multilevel OLF case. Delayed time to surgery is the key contributory factor in unfavorable surgical outcome in thoracic OLF. Choosing an appropriate surgical procedure is important. The neurological symptoms of the patient may not improve or worsen when an inadequate surgical procedure is used.

Main management for the frontal sinus fracture is using the pericranial flap. Pericranial flaps based on the supraorbital and supratrochlear vasculature have previously been used with significant success for the separation of intracranial and extracranial spaces after major trauma. Defect closure was modified due to lack of the frontal periosteum; the graft was made from the temporal side of periosteum to make primary periosteal flap longer. Defect closure could be optimum. Evaluation for 6 months showed a significant improvement without major complications. In this article, we propose a new modification technique as one of promising alternatives.

Oral anticoagulant and antiplatelet are often prescribed in clinical practice. These drugs are mainly consumed by geriatric patients to prevent or treat cerebrovascular, systemic embolism, or heart condition. Managing anticoagulated TBI patients is a challenging task for surgeons. This study aims to review available literatures regarding anticoagulated TBI patients and to suggest a treatment algorithm for such cases. Based on several retrospective and prospective studies, it might be wasteful to do a routine follow-up CT scan on anticoagulated TBI patients. The risk of new lesion development or presenting lesion progression seems to be especially low among patients with negative initial CT scan. We suggest to reserve repeat CT scan for patients with evident neurological deterioration. Tighter observation for anticoagulated patients with positive initial CT scan might be useful. Anticoagulation reversal is recommended by the American College of Cardiology, but some studies reported that reversal should be directed by INR. Acute antiplatelet cessation is still controversial for aspirin, but it is advised for clopidogrel. Preoperative management of both anticoagulant and antiplatelet should take into account the bleeding risk of the surgical procedure. Blind cessation and reversal of anticoagulant and/or antiplatelet might delay the timing of surgery and thus would better be avoided

Background Hydrocephalus induces mechanical and biochemical changes in neural cells of the brain. Astrogliosis, as the hallmark of cellular changes in white matter, is involved in demyelination process, re-myelination inhibitory effect, and inhibition of axonal elongation and regeneration. The pathophysiology of this process is not well understood. The purpose of the present study is to elucidate the effect of lipid peroxidation product on astrogliosis through WNT/ β-catenin in kaolin-induced hydrocephalic rats. Methods The study used kaolin-induced hydrocephalic rats. Obstructive hydrocephalus was expected to develop within seven days after induction. The hydrocephalus animals were killed at day 7, 14 and 21 after induction. One group of the saline-injected animals was used for sham-treatment. Results We demonstrated that the hydrocephalic rats exhibited a high expression of 4-hydroxynonenal (4-HNE) in the periventricular area. The expression of β-catenin also increased, following the pattern of 4-HNE. Reactive astrocyte, expressed by positive glial fibrillary acidic protein (GFAP), was upregulated in an incremental fashion as well as the microglia. Conclusion This work suggests that lipid peroxidation product, 4-HNE, activated the WNT/β-catenin pathway, leading to the development of reactive astrocyte and microglia activation in hydrocephalus.

Highlights • Stereotactic hematoma evacuation can be performed without anticoagulant agent. • Stereotactic evacuation of intracerebral hematoma can be adopted in any center. • Stereotactic evacuation of intracerebral hematoma is a safe procedure. • Stereotactic surgery can minimize brain injury., Introduction Minimally invasive techniques such as stereotactic aspiration of spontaneous intracerebral hematoma (SICH) evacuation can minimize brain tissue damage due to surgery. We share our experience of adopting stereotactic aspiration of SICH in our center without compromising safety. Presentation of cases Three stereotactic aspiration procedures for SICH immediately after 24 h of onset are reported. All cases showed good results. Level of consciousness of all the patient returned to normal. Two patients could carry out routine activities independently. One patient has left hemiparesis. Discussion Stereotactic aspiration of SICH has been newly implemented at our center with acceptable results achieved. Patient selection has an important role in determining the choice of technique. The procedures were done without anticoagulant agent. Stereotactic aspiration of SICH is associated with limited brain tissue damage, shorter duration of surgery, reduced length of stay, faster postoperative healing, and better functional improvement. Conclusion Stereotactic aspiration of SICH is a minimally invasive defined strategy for hematoma evacuation without compromising safety.

BACKGROUND: Severe TBI is leading in death and disability worldwide. The initial stage resulted from direct tissue damage and impaired autoregulation of cerebral blood flow. The level of S-100β, IL-6 and AQ4 in CSF increased in neuronal injury and BBB damage. PROG effect is assessed on biomarkers of S-100β, IL-6, and AQP4. AIM: The study examined the 1st to 4th day of progesterone administration. METHODS: The sample consisted of 23 participants in the control group and 16 participants in the treated group. Patients with GCS 4–8, not surgical, aged 15-50 years, coming in the first 24 h and patient’s family agreed to this research are included. The sample was taken from the serum, and the biomarker processed using ELISA. GOS 3 months used as prognostic. RESULTS: The result showed the mean value serum level of S100β, AQP4, and IL-6 increased on 24 h and 96 h after given PROG. Change of mean value of S100β day to day was 44.75 (96 h)–40.57 (24 h) – 4.18. In control group, change of S100β decrease to 42.51 (96 h)–46.11 (24 h) = −3.60, showing effect still unclearly proven in repairing neuronal injury, BBB disruption or another consideration on concentration of S100β, AQP4, and IL-6 in serum. CONCLUSION: S-100β serum levels is significant to predict outcome of severe TBI. Progesterone still unclearly proven in repairing neuronal injury and/or BBB disruption. Another consideration is temporal trajectory of S100β, AQP4, and IL-6. In future study, natural endogenous PROG should be sought. S-100β in future pharmaceutical trials may be possible as pharmacological target.

Globally, the discipline of neurosurgery has evolved remarkably fast. Despite being one of the latest medical specialties, which appeared only around hundred years ago, it has witnessed innovations in the aspects of diagnostics methods, macro and micro surgical techniques, and treatment modalities. Unfortunately, this development is not evenly distributed between developed and developing countries. The same is the case with neurosurgical education and training, which developed from only traditional apprentice programs in the past to more structured, competence-based programs with various teaching methods being utilized, in recent times. A similar gap can be observed between developed and developing counties when it comes to neurosurgical education. Fortunately, most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice. In context to this understanding, a symposium was organized during the World Federation of Neurological Surgeons (WFNS) Special World Congress Beijing 2019. This symposium was the brain child of Prof. Yoko Kato—one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons. Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries. This paper summarizes the outcome of these presentations, with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.

The purpose of this study was to analyze the response of inflammatory cytokines interleukin-8 (IL-8) and NF-κB to the closure of skull defect with periosteum as a scaffolding material in bone healing used after surgery.ThirtyHistological examination showed a more well-developed formation of woven bone in the periosteum group. Immunohistochemical examinations showed that the use of periosteum in the closure of skull defects reduced the NF-κB and IL-8 response which affected the ossification process.The experiment showed that the use of periosteum was linked with IL-8 and NF-κB downregulation toward ossification effects at any point throughout the trial. Periosteum usage might be beneficial as a scaffolding material in bone healing for autograft cranioplasty in animal model and could be applied to clinical practice.

Background: Mortality predictions following traumatic brain injury (TBI) may be improved by including genetic risk in addition to traditional prognostic variables. One promising target is the gene coding for brain-derived neurotrophic factor (BDNF), a ubiquitous neurotrophin important for neuronal survival and neurogenesis. Methods: A total of seven publications pertaining to BDNF in the study of traumatic head injury were included and reviewed. The majority of patients were male, that is, 483 (83.85%) patients, compared to 93 (16.15%) female patients. The median length of follow-up was 6 months (3 days–12 months). Measurement of the patient’s initial condition was carried out by measuring the initial GCS of the patient at the time of admission across the five studies being 6.5. The median CSF BDNF levels in the unfavorable group being 0.2365 (0.19–0.3119) ng/ml, from favorable group which was 0.20585 (0.17–0.5526) ng/ml. The median serum BDNF level in the unfavorable group being 3.9058 (0.6142–13.0) ng/ml, from favorable group which was 4.3 (0.6174–23.3) ng/ml. Results: Six studies reported on the sex distribution of patients, the majority of patients were male, that is, 483 (83.85%) patients, compared to 93 (16.15%) female patients. Six studies reported the number of patients per outcome group. The comparison of the number of patients in the two groups was quite balanced with the number of patients in the good group as many as 269 patients (55.5%) and the number of patients in the unfavorable group as many as 216 patients (44.5%). Measurement of the patient’s initial condition was carried out by measuring the patient’s initial GCS at the time of admission. It was reported in five studies, with the overall mean baseline GCS across five studies being 6.5 (3.2–8.8). Measurement of patient outcome was carried out by several methods, two studies used Glasgow Outcome Scale, Glasgow Outcome Scale Extended was used in two studies, and five studies used survival as a patient outcome measure. The patient’s BDNF level was measured in CSF and/or serum. A total of four studies measuring BDNF CSF levels and serum BDNF levels. Measurement of BDNF levels in TBI patients conducted on patients in seven literatures showed that there were differences in the trend of BDNF levels from CSF sources and serum sources. Measurement of CSF BDNF levels CSF BDNF levels was reported in two of the seven literatures, with the median CSF BDNF level in the unfavorable group being 0.2365 (0.19–0.3119) ng/ml. CSF BDNF levels were higher than the median in the preferred group, which was 0.20585 (0.17–0.5526) ng/ml. The results of the analysis from three other literatures stated that there was a tendency for lower CSF BDNF levels in the preferred group. Serum BDNF levels were reported in two of the seven literatures, with the median serum BDNF level in the unfavorable group being 3.9058 (0.6142–13.0) ng/ml. This serum BDNF level was lower than the median in the preferred group, which was 4.3 (0.6174–23.3) ng/ml. The results of the analysis of four literatures reporting serum BDNF stated that there was a tendency for lower serum BDNF levels in the poor group. A risk assessment of bias for each study was performed using ROBINS-I because all included studies were non-RCT studies. Overall the results of the risk of bias analysis were good, with the greatest risk of confounding bias and outcome bias. Conclusion: Serum BDNF levels were found to be lower in the unfavorable group than in the favorable group. This is associated with an increase in autonomic function as well as a breakdown of the blood–brain barrier which causes a decrease in serum BDNF levels. Conversely, CSF BDNF levels were found to be higher in the unfavorable group than in the favorable group. This is associated with an increase in the breakdown of the blood–brain barrier which facilitates the transfer of serum BDNF to the brain, leading to an increase in CSF BDNF levels.

The intramedullary spinal cord cavernoma is a rare vascular disease that occur within spinal cord or intramedullary and account for about 5%-12% of all pathology in the spinal vascular disease. We report a clinical progression of disease and evolution of the haemorrhage every years until patient underwent surgical procedure. A 63-years old male with progressive weakness of the lower extremity since 1 month before admission, worse in the left side He also complained loss of sensation at the level of the T4 and below it. Patient suffer three times rebleeding before underwent surgery. MR imaging showing intramedullary spinal cord cavernoma and a histology examination exhibited the characteristics of a cavernoma. Intramedullary spinal cord cavernoma is a rare disease that should be treated before rebleeding occur and enlargement of the lesion. Postoperative neurological function in intramedullary spinal cord cavernoma patient is determined by the preoperative neurological status.