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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has exerted a significant impact on health care workers. Recent studies have reported the detrimental effects of the pandemic on neurosurgery residents in North America, Asia, and Italy. However, the impact of the pandemic on neurosurgical training in Latin America and Spain has not yet been reported. In the present report, we describe effects of COVID-19 on training and working conditions of neurosurgery residents in these countries. METHODS: An electronic survey with 33 questions was sent to neurosurgery residents between September 7, 2020 and October 7, 2020. Statistical analysis was made in SPSS version 25. RESULTS: A total of 293 neurosurgery residents responded. The median age was 29.47 ± 2.6 years, and 79% (n = 231) were male. Of respondents, 36.5% (n = 107) were residents training from Mexico; 42% surveyed reported COVID symptoms and 2 (0.7%) received intensive care unit care; 61.4% of residents had been tested for COVID and 21.5% had a positive result; 84% of the respondents mentioned persisted with the same workload (≥70 hours per week) during the pandemic. Most residents from Mexico were assigned to management of patients with COVID compared with the rest of the countries (88% vs. 68.3%; P < 0.001), mainly in medical care (65.4% vs. 40.9%; P < 0.001), mechanical ventilators (16.8% vs. 5.9%; P = 0.003), and neurologic surgeries (94% vs. 83%; P = 0.006). CONCLUSIONS: Our results offer a first glimpse of the changes imposed by the COVID-19 pandemic on neurosurgical work and training in Latin America and Spain, where health systems rely strongly on a resident workforce.

Background PSMA (prostate-specific membrane antigen) protein is heavily expressed in the proliferating microvasculature of high-grade gliomas (HGG) and brain metastases (BM). This research aimed to assess [99mTc]Tc-iPSMA SPECT brain imaging as a potential specific diagnosis of HGG and BM by PSMA-targeting in their proliferating vasculature. Methods Forty-one patients, with suspected brain tumors, as detected by enhanced MRI scanning, were enrolled to undergo preoperative [99mTc]Tc-iPSMA SPECT brain imaging. Semiquantitative image analyses, to evaluate the maximum target-to-background ratio (TBRmax), were performed. All diagnoses were histopathologically confirmed. PSMA expression was evaluated by immunohistochemistry (IHC) in 11 brain tumor tissues. TBRmax values were correlated with IHC results and tumor WHO grade (HGG vs LGG). Results [99mTc]Tc-iPSMA images showed increased uptake in BM, HGG, and recurrent gliomas (TBRmax of 25.1 ± 7.1, 18.5 ± 9.0, 15.0 ± 9.9, respectively), and was negative in treatment-naive patients with LGG and reactive gliosis. PSMA was highly expressed in the vascular endothelium of grade IV gliomas and BM, while its expression was extremely low in LGG and completely absent in gliosis. By using 2.8 as a threshold value for TBRmax, the specificity, sensitivity, PPV, NPV and accuracy were 100%, 94%, 100%, 77% and 95%, respectively. Conclusions The results of this pilot study show that [99mTc]Tc-iPSMA SPECT brain imaging is a specific and potentially useful neuroimaging tool for assessing tumoral neovasculature formation in gliomas and brain metastases.

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.

Background: Recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an important negative impact on global training of neurosurgery residents. Even before the pandemic, discrimination is a challenge that neurosurgical residents have consistently faced. In the present study, we evaluated discriminatory conditions experienced by residents during their neurosurgical training in Mexico before the SARS-CoV-2 pandemic. Methods: An electronic survey of 18 questions was sent among residents registered in the Mexican Society of Neurological Surgery (MSNS), between October 2019 and July 2020. Statistical analysis was made in IBM SPSS Statistics 25. The survey focused on demographic characteristics, discrimination, personal satisfaction, and expectations of residents. Results: A response rate of 50% (132 of 264 residents’ members of MSNS) was obtained and considered for analysis. Median age was 30.06 ± 2.48 years, 5.3% (n = 7) were female and 16.7% (n = 22) were foreigners undergoing neurosurgical training in Mexico. Approximately 27% of respondents suffered any form of discrimination, mainly by place of origin (9.1%), by gender (8.3%) or by physical appearance (6.1%). About 42.9% (n = 3) of female residents were discriminated by gender versus 6.4% (n = 8) of male residents (P = 0.001); while foreign residents mentioned having suffered 10 times more an event of discrimination by place of origin compared to native Mexican residents (36.4% vs. 3.6%, P < 0.001). Conclusion: This manuscript represents the first approximation to determine the impact of discrimination suffered by residents undergoing neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Background History has taught us that Mexican culture has been largely supported by women, despite gender prejudice from the society. Neurosurgery has not been the exception. Therefore, we investigated the challenges and influence of female neurosurgeons in Mexico. Methods We conducted a review of the literature and an analysis of the internal database of the Mexican Society of Neurological Surgery focusing on 3 topics: 1) the historical presence of women and gender inequality in Mexico; 2) the life and legacy of the woman who became the first neurosurgeon in Mexico and in Latin America; and 3) the participation of women in neurosurgery in the past 3 decades. Results In Latin America, the first woman in neurosurgery was Maria Cristina Garcia-Sancho, who completed her neurosurgical training in 1951. Currently, women represent 6.2% of the total members of the Mexican Society of Neurological Surgery (MSNS). This percentage is still low, although data collected in this study suggest that it might increase in the next few years because 16.7% of Board Directors of the MSNS are women, the next elected president is a female neurosurgeon, and 14.5% of neurosurgery residents are women. Conclusions Although a steady increase has occurred of women in neurosurgery in Mexico, there is still work to do, especially to overcome the barriers related to the old assumptions of the cultural and social roles of women.

High-grade gliomas (HGG) are locally situated tumors that unfortunately have no cure at this time. The mean survival is between 15 and 18 months after standardized treatment is given, including surgical resection (particularly gross total resection (GTR)) plus concomitant radiotherapy and adjuvant chemotherapy. There is a clear relationship between a greater extent of resection (EOR) and patient survival and several retrospective studies have shown that the more aggressive the resection, the better prognosis for the patient. In order to decide the best treatment option, the neurosurgeon must take into consideration not only the possible diagnosis of glioblastoma but also the location of the tumor and its relationship with eloquent areas of the brain; the first resection surgery is the most important and the best opportunity for the patient to get the best prognosis. In the last two decades, technology inside the operating room has expanded in a very important way, and glioma surgery is considered technology dependent in order to obtain the best functional outcome for the patient by reducing the odds of a new neurological deficit. In the present chapter, the authors discuss the value of surgical resection, analyzing the different thresholds that have been proposed, as well as the usefulness of intraoperative technology to obtain the best surgical results, both to increase the survival expectancy of the patient and to reduce the risk that this entails.

ObjectiveThis paper seeks to quantify the normalized expression of transcripts FOXM1*3, VEGF, CD133, and MGMT and their relation with the histopathological and molecular diagnosis and with the probability of estimating tumor progression-free survival of gliomas.MethodsA cohort of patients was made up of patients aged over 18 years with a histological and molecular diagnosis of gliomas from the year 2011 to 2018. The patients had a complete tumor resection. Patients with high-grade glioma received adjuvant management (temozolamide and radiotherapy). Clinical and imaging follow-up was carried out periodically to identify the time of progression free survival (PFS).ResultsNinety-one patients (age range, 18–85 years) comprised the study cohort with a predominance of males. The expression of FOXM1*3, VEGF, and CD133 allowed the differentiation of astrocytomas grade II from GBM. ROC curves proved statistically significant in the GBM model (p < 0.05), demonstrating greatest sensitivity with FOXM1*3 (91%), and greatest specificity with VEGF (93%). The age-adjusted Cox multivariate model established that a PFS50% of 25 months corresponds to a median value of 5.3 for VEGF and 0.42 for CD133.ConclusionsThe normalized expression of transcripts FOXM1*3, VEGF, and CD133 allow us to estimate the probability of PFS, especially in gliomas grades II and IV; likewise, their overexpression defines the diagnosis of GBM.AuthorshipSubstantial contributions to conception and design (IAFR, BNR, MARF, GG, IG), acquisition of data (IAFR, BNR, MARF, IFE, LCP, JCM, SOS, JAC, CRA), analysis and interpretation of data (IAFR, BNR, MARF, JCM, SOS, CEN, HMG, IG).Drafting the article (IAFR, BNR, MARF, IFE, LCP, SOS, JAC, IG), revising it critically for important intellectual content (IAFR, JCM, CEN, GG, HMG, CRA, IG)Final approval of the version to be published (IAFR, BNR, MARF, IFE, LCP, JCM, SOS, JAC, CEN, GG, HMG, CRA, IG).

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.