Digital Posters

Management of Spinal Intramedullary Tumors: Microsurgical Techniques, Pitfalls and Results, Based on 350 Cases

Presenting Author – Shatabdi Chakraborty
Co-Author – Prof. Dr. Keki Turel

Abstract

Introduction: The management of spinal intramedullary tumors has evolved significantly with the advent of microsurgical techniques. Traditional approaches such as laminectomy, dural decompression, and radiotherapy are no longer the primary modalities. Current evidence supports the feasibility of gross total resection with favorable outcomes.

Objective: This paper reviews over 350 cases, focusing on the past decade, to highlight the efficacy of microsurgical techniques in treating both benign and malignant intramedullary tumors.

Methods: This retrospective study includes 350 cases of spinal intramedullary tumors operated on over the past ten years. Pre-operative and post-operative-MRI were utilized for diagnosis and evaluation. The surgical approach typically involves a laminotomy followed by laminoplasty to preserve spinal architecture. A midline myelotomy was performed under high magnification for tumor resection. Factors affecting surgical outcomes, such as tumor location, number of segments involved, and chronicity of symptoms, were analyzed.

Results: Gross total resection was achieved in a significant number of cases. The cervical and cervicomedullary regions demonstrated higher resectability whereas the dorsal and conus regions tend to be less favorable. The number of segments involved did not significantly impact the degree of resection or clinical outcomes. Chronic symptoms were associated with poorer outcomes. None of the patients experienced posterior column dysfunction following midline myelotomy. Post-operative MRI often revealed a thinned spinal cord, which, if managed meticulously, maintained functional integrity.

Conclusion: Microsurgical techniques have markedly improved the management of spinal intramedullary tumors, allowing for gross total resection with minimal complications. The study confirms that even a thinned spinal cord can maintain function with meticulous surgical handling. Tumor location and symptom chronicity are critical factors influencing surgical outcomes. Continued advancements in microsurgical approaches are expected to further enhance patient recovery and long-term prognosis.

The importance of continued education for young neurosurgeons: The ATCHYN experience

Glaucia Jong-A-Liem, MD – Neurosurgeon
Beneficência Portuguesa de São Paulo, São Paulo, SP – Brazil
Cleiton Onofre de Menezes, MD – Neurosurgery resident
Hospital Santa Rosa, Cuiabá, MT – Brazil
Daniel Araujo Starling, MD – Neurosurgery resident
Santa casa de Ribeirão Preto, Ribeirão Preto, SP – Brazil
Fabrício Frazão de Mattos, MD – Neurosurgeon
Hospital Municipal Miguel Couto, Rio de Janeiro, RJ – Brazil
Felipe Areias Mourão, MD – Neurosurgeon
Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ – Brazil
Ingrid Campos, MD – Neurosurgery resident
INC, Curitiba, PR – Brazil
Ericka Ramirez Arquez, MD – Neurosurgery resident
Fundación Santa Fe de Bogota, Universidad el Bosque, Bogota – Colombia
Pierre-Yves Fonseca Mazeau, MD – Neurosurgery resident
Fundación Santa Fe de Bogota, Universidad el Bosque, Bogota – Colombia
Marcos Soares Tatagiba, MD, PhD – Chief of Department of Neurosurgery
Universitatsklinikum Tübingen – CRONA Klinik, Tübingen – Germany

Introduction: To become a neurosurgeon, attending medical school (6-7 years) and doing a medical residency in neurosurgery (5-7 years) are necessary. Is this enough? A young neurosurgeon (YNS) is a trained and board-certified neurosurgeon in his/her first five years of professional practice. As with any other medical specialty, a neurosurgeon needs continuous education and surgical practice to upscale the long and shallow learning curve of this complex and challenging specialty.

Methods: A Brazilian neurosurgical organization (ABNc) promotes, in partnership with the neurosurgery department in the university hospital in Tubingen, Germany, a summer course for last-year-neurosurgery-residents (LYNR) and YNS. This summer course includes daily case discussions and lectures, surgical observerships, and hands-on cadaver training for one month in a high-volume neurosurgical department in Germany. For this study, we have invited participants from different course editions to enter an online survey to measure, longitudinally and retrospectively, the impact this course has had on their professional careers and personal lives.

Results: This course had 16 editions from 2006 until 2024 and had 127 participants from different Latin American countries. The participants were mainly from Brazil (86.6%) and Colombia (9.4%), male (88.2%) and aged 25-34. During one month, the participants attended approximately 200 neurosurgical procedures, 15 lectures, two workshops, cadaver-lab training, and 16 round meetings. Most surgeries were oncological (42%) and spine (25%). One-sixth of the oncological surgeries (n=14) were in the semi-sitting position. The most common skull base surgery during the 1-month experience was the resection of pituitary adenoma (N=15), vestibular schwannoma (n=12), and meningiomas (n=12). Based on the online survey, 81.2% of participants changed how they manage and operate vestibular schwannoma cases and posterior fossa tumors, and 64% have grown interest in the semi-sitting position for posterior fossa cases. 64% of the interviewed participants have considered this summer course an inflection point in their career, and 100% recommend it to LYNR and YNS.

Conclusion: Medicine is an evolving science, and continuous education is mandatory. To be a successful neurosurgeon, exposure through observership and hands-on training is essential, even after formal medical residency training. A longitudinal retrospective analysis of the participants reinforces the importance of such programs.

Risk Factors and In-Hospital Mortality in Spondylodiscitis: Insights from a National Inpatient Sample Analysis

L. Jouppi, Julius Gerstmeyer (1,2), Clifford Pierre (1), Neel Patel (1), Bryan Anderson (1), Donald Davis (1), Periklis Godolias (3), Thomas Schildhauer (2), Amir Abdul-Jabbar (1), Rod Oskouian (1), Jens Chapman (1)
1 Swedish Neuroscience Institute, Swedish Neurosurgery- Cherry Hill, Seattle, United States of America;2 Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Bochum, Germany;3 Department of Orthopedics and Trauma Surgery, St. Josef Krankenhaus Essen-Werden GmbH, Essen, Germany

Introduction: Spondylodiscitis (SD) displays insidious onset, diverse clinical manifestations, and high overall mortality despite recent advances. Epidemiological studies showed growing incidences due to an aging population, increased prevalence of immunocompromised states, and enhanced diagnostic testing. This study assessed in-hospital mortality in SD patients in different age-groups and identified risk factors.

Methods: Data was obtained from the 2020 NIS, Healthcare Utilization Project (HCUP). Admitted adults (>18 years) were screened using the primary diagnosis of SD by ICD-10 Code (M46.2x, M46.3x and M46.4x). Demographic information, clinical data, and surgical treatment were extracted. The primary outcome was in-hospital mortality, with independent risk factors identified through binary logistic regression analysis. Subgroup analysis by age (elderly ≥65y or young ≤ 65y) was also performed.

Results: In total 3975 cases met our inclusion criteria with a mean age of 59 years (18-90). The overall in-hospital mortality rate was 0.9%, with a difference between age groups. Most admissions were non-elective (91.4%). Alcohol/drug abuse (7.3%, 38.5%) was more frequent in younger patients. Chronic diseases were more prevalent in elderly patients. Overall, 1613 patients were treated surgically. Frequent procedures included spine fusion and discectomy (33%; 19.65%). Age, malnutrition, septicemia, endocarditis, heart, and respiratory failure were identified as independent risk factors.

Conclusion: Management of SD is complex. Although we observed a low in-hospital mortality, the present study highlights various comorbidities and complications between different age-groups. This emphasizes the importance of early identification and management of risk factors to improve patient outcomes, especially in elderly patients.

The hidden risk: Cranial hemorrhages following spine surgery

L. Jouppi, Julius Gerstmeyer (1,2), Clifford Pierre (1), Neel Patel (1), Donald Davis (1), Bryan Anderson (1), Periklis Godolias (3), Thomas Schildhauer (2), Amir Abdul-Jabbar (1), Rod Oskouian (1), Jens Chapman
1 Swedish Neuroscience Institute, Swedish Neurosurgery- Cherry Hill, Seattle, United States of America;2 Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Bochum, Germany;3 Department of Orthopedics and Trauma Surgery, St. Josef Krankenhaus Essen-Werden GmbH, Essen, Germany

Introduction: Cranial hemorrhages (CH) after spine surgery pose a significant risk to patient outcomes. Decompression, discectomy, and fusion risk dural tears leading to cerebrospinal fluid leakage (CSFL), which can precipitate decreases in intracranial pressure and potential CH. Although limited data is available, hemorrhages were mostly localized to the cerebellum in case reports and series. This study aimed to assess the incidence of cranial hemorrhages in patients undergoing spine surgery and to identify risk factors using the National Inpatient Sample (NIS).

Methods: Data was obtained from the 2020 NIS, Healthcare Utilization Project (HCUP). Adults (>18 years) were selected by primary procedure category codes for spine fusion, discectomy, spinal cord decompression, and cervicothoracic/lumbosacral nerve decompression. Exclusion criteria were trauma and malignancy. Demographic information, admission details, and clinical data were extracted. The primary outcome was the occurrence of cranial hemorrhage, with independent risk factors identified via binary logistic regression analysis.

Results: In total 41,217 cases met our inclusion criteria with a mean age of 60 years (18-90). Most admissions were elective (80.7%). The overall in-hospital mortality rate was 0.2% with the incidence of cranial hemorrhages at 0.08%. Fusion was the most common surgery (67.98%) followed by discectomy (12.46%), spinal cord decompression (8.28%), and cervicothoracic/lumbosacral nerve decompression (10.17%;1.1%). Dural tears (3.1%) were dominant, followed by CSFL at 0.3%. Regression analysis revealed a significant correlation of CH to dural tear and death.

Conclusion: Cranial hemorrhages after spine surgery are rare but potentially life threatening. Our analysis revealed an incidence of 0.08%, with dural tears as an independent risk factor.

Lateral Lumbar Interbody Fusion (LLIF) Surgery, Psoas Muscle Size Changes, and Clinical Findings: Do they Correlate?

L. Jouppi, Clifford Pierre, MD (1,2), Neel Patel, MD (1,2), Julius Gerstmeyer, MD (1,2,3), Bryan G. Anderson, DO (1,2), Donald David Davis, MD (1,2), Zeyad Daher, BS (1), Tara Heffernan, BS (1), Daniel C. Norvell, PhD (4), Amir Abdul-Jabbar, MD (1,2), Rod Oskouian, MD (1,2), Jens R. Chapman, MD (1)
1 Seattle Science Foundation, Seattle, WA 2 Swedish Neuroscience Institute, Seattle, WA 3 Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany 4 Spectrum Researching Consulting, Tacoma, WA

Introduction: Lateral Lumbar Interbody Fusion (LLIF) may be less disruptive to soft tissues as compared to other approaches. Major concerns have been raised over nerve injury after LLIF, with reported postoperative sensory deficits and iliopsoas weakness. This study sought to determine associations of LLIF with psoas muscle size changes, postsurgical hip flexor (HF) weakness, and lower extremity numbness after surgical intervention.

Methods: We retrospectively reviewed LLIF-consecutive patients at our institution from 2016 to present. Psoas area and axial dimensions were measured bilaterally at mid-body of L3. Change from preoperative to postoperative ipsilateral and contralateral measurements of psoas area, HF strength, and numbness were compared. Postoperative imaging was required to be at least one
month after the surgery.

Results: Ninety-three LLIF patients met our initial criteria, and 37 (40%) had suitable imaging available for comparison. Twenty-seven and 10 patients had CT and MRI imaging, respectively. On CT imaging, only ipsilateral psoas area significantly decreased (p=0.05) after LLIF. Contralateral HF strength increased postoperatively at least one grade (p=0.04), with significant changes in
ipsilateral HF strength, numbness, or contralateral numbness. Of the 32 patients with documented symptoms, 9 patients reported preoperative numbness and a different 9 reported postoperative numbness. Resolution of postoperative symptoms occurred between 1 to 7 months (2.47 ± 1.97), except for three patients who required further surgery.

Conclusion: LLIF may be associated with decreases in ipsilateral psoas size, though postoperative weakness and numbness associated with LLIF appear to be transient. Future studies with greater sample size may be helpful to support these findings.

Real Estate for Fusion: An Anatomical Comparison of Surface Area Between Cervical Facet Joints versus the Intervertebral Disc Space

L. Jouppi, Christopher Seidel, MPH, DO (1); Clifford Pierre, MD (2,3); Luke Jouppi, BS (2,3); Luke DiPasquale, DO (5); Chelsea Bush, MS (6); Anna Anderson, BS (3); Amit R Patel, MD (7)
1 WellSpan Health, 1001 S. George St. PO Box 15198, York, PA, 17405-7198 2 Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, 98122 3 Seattle Science Foundation, Seattle, WA, 98122 4 Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany 5 Kettering Health, 405 W. Grand Ave. Dayton, OH, 45405 6 WellSpan Health, 1001 S. George St. PO Box 15198, York, PA, 17405-7198 7 OSS Health, 1855 Powder Mill Rd #111, York, PA 17402

Introduction: Cervical stenosis is commonly treated with anterior cervical discectomy and fusion (ACDF) performed through a Smith-Robinson approach. Recently, facet fusion achieved with
implantable devices from a posterior approach has been described as an alternative. To our knowledge, no anatomic studies have been performed comparing the combined surface area of the facet joints to the surface area of the intervertebral space. This study aimed to evaluate the cervical facet joints versus the interbody spaces and provide a better understanding of the potential surface area for fusion surgery.

Methods: We performed a cross-sectional retrospective review using cervical spine CT scans conducted from 2014-2017. Using our institution’s imaging software, we measured the area within the intervertebral space and the facet joints bilaterally. Surface areas for each intervertebral space were compared using a paired t-test to the cumulative surface area of the facet joints calculated
at each level.

Results: Two-hundred twelve patients (120 male, 92 female) were eligible for the analysis based on our inclusion and exclusion criteria. The mean age was 33 years (range 18-55). The mean BMI was 29 (range 19-58). In each of the comparisons, the combined intra-facet joint surface area (IFSA) was significantly greater than the intervertebral surface area (IVSA) of the corresponding
interbody space.

Conclusion: Our study found that the surface area between the IFSA is two to three times greater than the IVSA. This study may help establish an anatomic basis for comparable fusion results between the traditional intervertebral space method and an intra-facet joint fusion.

The Association of Bone Mineral Density with Distal Junctional Kyphosis and Distal Junctional Failure after Multilevel Spine Fusions: A Systematic Review and Meta-Analysis

L. Jouppi, Zeyad A. Daher BS, Bryan G. Anderson DO, Clifford Pierre MD, Donald D. Davis MD, Neel Patel MD, Julius Gerstmeyer MD, Gautam Rao MD, Daniel Norvell PhD, Giorgio Cracchiolo, Amir Abdul-Jabbar MD, Rod Oskouian MD, Jens Chapman MD

Introduction: Distal junctional kyphosis (DJK) and distal junctional failure (DJF) are known complications of adult multilevel spinal fusion surgery. Previous literature has extensively investigated proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), but DJK and DJF are relatively under-studied. This study investigates the association between bone mineral density (BMD) and DJK/DJF via a Systematic Review (SR) and Meta-Analysis (MA).

Methods: A literature search was conducted across PubMed, Cochrane, Web of Science, Embase, and Scopus to find studies reporting DJK, DJF, and BMD. A 12-month minimum follow-up and radiographic biomarker for BMD (Hounsfield units {HU} or a T-score) individually reported for each patient type were required for inclusion. Studies that did not report individualized biomarkers but provided averaged estimates of the effect of BMD on DJK/DJF development were used for SR.

Results: Our search yielded 12 unique studies with 1,094 patients, of which five studies with a total of 519 patients were suitable for comparison by MA. Patients who developed DJK/DJF had significantly lower HUs (113.17 ± 33.86) than patients who did not develop DJK/DJF (142.51 ± 41.39). No significant difference was found with regards to DEXA measurements, age, or BMI between patients who did and did not develop DJK/DJF.

Conclusions: Patients who developed DJK/DJF had significantly lower CT-measured HU as compared to those without DJK/DJF. Our findings highlight the potential importance of BMD evaluation with CT prior to multilevel spine fusion surgery, though further research would be helpful to evaluate the significance of DEXA-based BMD measurements on DJK/DJF development.

Management And Outcomes Of Recurrent Trigeminal Neuralgia After Microvascular Decompression: A Comprehensive Review

Shatabdi Chakraborty1, Prof Dr. Keki Turel1
1Bombay Hospital Institute of Medical Sciences and Research Centre

Introduction: Trigeminal neuralgia (TN) is an excruciating facial pain condition that can be primary (vascular compression) or secondary (tumor, AVM, aneurysm, MS). Microvascular decompression (MVD) is an effective surgical treatment that removes the cause of pain, providing instant relief with rare complications and almost no mortality. However, some patients experience persistent or recurrent pain after MVD, which is the focus of this review.

Objective: To comprehensively analyze the causes, management and outcomes of recurrent trigeminal neuralgia after MVD.

Methods: A cohort of 200 patients who underwent MVD was examined. Out of these, 8 patients (4%) developed recurrent pain 1 to 8 years post-surgery. The study analyzed potential causes of recurrence in detail, including insufficient decompression (particularly of veins), issues related to Teflon (such as granuloma formation, dislocation, and size mismatch), and other unknown factors. The review also compared the outcomes of various surgical treatments for recurrence, including repeat MVD, partial sensory rhizotomy (PSR), and Teflon granuloma resection.

Results: The primary causes of recurrence were identified as insufficient decompression (78% of cases), especially of veins; Teflon-related issues (23% of cases); and unknown factors. Repeat MVD, with careful and thorough decompression, yielded the highest success rate at 75%. PSR was effective in cases where no neurovascular conflict was detected. Teflon granulomas, though rare, were treatable through resurgery, occurring in 1.5% of cases. Following repeat MVD, 27% of patients experienced facial numbness. Long-term success rates for MVD decrease over time, with only 70% of patients maintaining good results at 10 to 15 years. In contrast, neurodestructive procedures such as radiofrequency thermocoagulation (RFTC) and radiosurgery exhibited poorer long-term outcomes (40-50%) but were associated with a lower incidence of facial numbness.

Conclusion: Repeat MVD with the same meticulousness as the initial surgery, sometimes combined with PSR, provides the best management for recurrent trigeminal neuralgia. Teflon granulomas are a rare complication that can be treated surgically. Despite meticulous diagnosis and surgery, a small percentage of patients may have persistent or recurrent pain. Careful patient selection and counseling is important, as repeat surgery has a higher risk of facial numbness. Neurodestructive procedures may be considered in some cases, but have inferior long-term outcomes compared to repeat MVD.

Complication Avoidance in Spinal Trauma

Shatabdi Chakraborty1, Prof Dr. Keki Turel1
1Bombay Hospital Institute of Medical Sciences and Research Centre

Introduction: Spinal cord injuries (SCI) present severe challenges, significantly impacting individuals and their families through disabilities, reduced quality of life, and elevated healthcare costs. The complexities in managing spine trauma necessitate effective strategies to minimize complications and enhance patient outcomes.

Objective: This study aims to identify effective strategies for preventing complications in spine trauma management, providing healthcare professionals with best practices for timely and appropriate interventions.

Methodology: This study reviews historical and current practices in spine trauma management, emphasizing immediate spinal immobilization and a systematic approach to assess life-threatening conditions while maintaining spinal precautions. It outlines protocols for neurological assessments and airway management, referencing NEXUS and Canadian Cspine rules for clinical clearance, and guidelines from the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

Results: India reports about 10,000 new cases of traumatic spinal cord injury (SCI) annually, primarily affecting the cervical spine. There is a bimodal age distribution, with injuries predominantly occurring in young males and the elderly. Early and late complications include spinal shock, pressure sores, and DVT. Prompt rehabilitation is essential to prevent these issues. The study highlights the severe long-term impacts of SCI, such as increased mortality and substantial healthcare costs, with affected individuals being 3-5 times more likely to die prematurely. The average lifetime cost for a young adult with tetraplegia exceeds $4 million, with a reduced life expectancy, especially in low and middle-income countries.

Conclusion: Preventing complications in spine trauma management is crucial. Adherence to established protocols during initial evaluations and interventions is essential. Ongoing education and training for first responders and medical professionals are vital. A multidisciplinary approach is advocated to enhance collaboration and promote evidencebased practices, reducing the impact of spinal cord injuries on individuals and society.

Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction: Efficacy, Timing and Outcomes

Shatabdi Chakraborty1, Prof Dr. Keki Turel1
1Bombay Hospital Institute of Medical Sciences and Research Centre

Introduction: Malignant middle cerebral artery infarction (MMCAI) represents a grave complication of acute ischemic stroke, marked by progressive neurological deterioration, space-occupying edema, and increased intracranial pressure leading to brain stem herniation. The condition is associated with a high mortality rate, often up to 80%, despite maximal medical treatment.

Objective: This study aims to provide a thorough overview of the efficacy of decompressive craniectomy (DC), evaluation of patient selection criteria, optimal timing for surgery, and outcomes in the management of MMCAI.

Methodology: A comprehensive review of the literature was conducted, focusing on Randomised Controlled Trials (RCTs), as well as comparative studies and systematic reviews. The review assessed outcomes related to the timing of surgery (early vs. late) and compared the results of DC to conservative medical treatment. Additionally, a case report of a 47-year-old male who underwent suboccipital decompressive craniectomy for a massive cerebellar infarction with space-occupying edema was included to demonstrate clinical management.

Result: The literature review revealed that early decompressive craniectomy (performed within 24 hours of symptom onset) is associated with a significantly lower mortality rate (16%) compared to late surgery (>24 hours) with a mortality rate of 34.4%, and medical treatment with a mortality rate of up to 80%. Three key RCTs (DESTINY, HAMLET, DECIMAL) supported the efficacy of DC when performed within 48 hours of symptom onset in patients aged 60 years or younger, showing a reduction in mortality from 70-80% with conservative treatment to 20-30% with surgery, and improved functional outcomes. Comparative studies indicated that early DC had a lower mortality rate (4.8% – 21%) compared to medical treatment (42-83%). Minor complications from DC included seizures (15.6%), subgaleal fluid collections (3.1%), superficial wound infections (3.1%), hydrocephalus (3.1%), transient neurological deficits (3.1%), and osteomyelitis (2.1%), with an overall complication rate of up to 35%. The case report highlighted the successful management of a patient with clinical deterioration due to space-occupying edema, underscoring the benefits of DC.

Conclusion: Decompressive craniectomy is an effective treatment for MMCAI, significantly reducing mortality and improving functional outcomes when performed early (within 48 hours) in patients aged 60 years or younger. While older patients also benefit from surgery, many remain highly disabled. Careful patient selection, timing of intervention, and adequate size of the craniectomy (at least 12 cm) are crucial factors for successful outcomes. Despite the high rates of physical disability and depression, most patients are satisfied with their quality of life after treatment.

Early Multimodal Neurointerventional and Neurosurgical Management of Penetrating Cerebrovascular Injuries: Wartime Experience from Ukraine

Ehsan Dowlati, MD; Andrii Sirko, MD, PhD; Yurii Cherednychenko, MD; Rocco A. Armonda, MD

Abstract

Introduction: The war in Ukraine has resulted in a large number of penetrating head wounds with concomitant neurovascular injuries. In this study, we analyze management of these injuries and propose a multimodal treatment approach used for these complex patients.

Methods: This is a prospective study from a single center near the combat frontlines in Dnipro, Ukraine (Mechnikov Dnipropetrovsk Regional Clinical Hospital). Data was collected for a 28-month period (February 2022-June 2024). Patients with intracranial neurovascular injuries were evaluated and their management and outcomes were analyzed.

Results: 1,310 patients with head and neck injuries underwent angiography; 253 (19.3%) of them had traumatic head and neck vascular injuries. 20 patients (1.5%) sustained traumatic intracranial arterial injuries. In 15 patients (75%), arterial injury led to traumatic intracranial aneurysms (TICAs). 11 underwent endovascular treatment, one patient underwent open surgical treatment of the TICA and 3 were treated with observation. Two patients had traumatic direct carotid cavernous fistulas, and three patients had traumatic dural arteriovenous fistulas. In 8 patients (40%), there was concurrent damage to the paranasal sinuses. Surgical intervention immediately followed endovascular intervention in 14 cases (70%) (Table). There was one mortality (5.0%) due to sequela of severe vasospasm. The Glasgow outcome score at one month after the injury in the other 19 patients ranged from 2 to 5 (median 4).

Conclusion: This is the largest wartime cohort of penetrating head trauma with neurovascular injuries. Early angiographic diagnosis allows for effective management and treatment. Thus, we
propose early combination of endovascular and open surgical intervention for penetrating craniocerebral injuries.

Social Media as a Tool for Patient Education in Neurosurgery: A Literature Review of Current Practices and Future Directions

Aaron D De La Cruz1 and Andres Pope1
Methodist Healthcare System of  San Antonio1

Introduction: Social media has evolved from primarily a communication media to a platform for enhancing education and engagement for patients and physicians. YouTube, Facebook, Twitter(X), and Snapchat are channels for accessible, interactive, and patient-specific educational content that is global. Utilizing these technologies has welcomed the possibility of virtual and augmented reality to help further educate and understand patients of their neurosurgical procedures. This study aims to explore the most current published literature on the transformative role of social media in disseminating neurosurgical information and improving patient outcomes and satisfaction.

Methods: A search was conducted across PubMed, OVID, and Cochrane Library for peer-reviewed articles published between January 2010 and May 2024. Search terms included “social media,” “neurosurgery,” “patient education,” “neurosurgeon,” and “medical professionalism.”

Results: 13 peer-reviewed articles were included in this article, comprising  5 reviews,  7 observational studies, and 1 pilot study.

Conclusion: The current use of social media for neurosurgical education includes sharing educational videos, infographics, and patient testimonials. This media type has enhanced patient engagement, and the integration of VR and AR improves patient understanding and engagement. Limitations include privacy concerns, misinformation, and disparities in health literacy and accessibility. Continued research should focus on targeting limitations and ensuring a safe and effective integration in neurosurgical practice with the goal of improving patient outcomes.