Radiation exposure is a significant concern in spine surgeries due to the extensive use of fluoroscopic imaging. This review aims to evaluate the risks, consequences, and prevention strategies associated with radiation exposure in spine surgeries. The risks of radiation exposure include potential biological damage to patients and surgical staff, such as skin burns, cataracts, and an increased risk of developing cancer. The consequences of radiation exposure can have long-term health implications and may result in substantial healthcare costs. To mitigate the risks, various prevention strategies are recommended. These include optimizing the use of fluoroscopy by adopting low-dose imaging techniques, minimizing the duration of exposure, and ensuring proper shielding of personnel. Additionally, the use of alternative imaging modalities, such as intraoperative three-dimensional (3D) navigation systems, can reduce reliance on fluoroscopy and subsequently decrease radiation exposure. Furthermore, implementing a culture of radiation safety through education, training, and awareness programs is crucial. This involves educating surgeons, nurses, and other healthcare professionals about the potential risks, proper use of equipment, and radiation protection measures. Strict adherence to radiation safety guidelines and continuous monitoring of radiation doses are essential to ensure the well-being of both patients and healthcare providers. In short, radiation exposure in spine surgeries poses significant risks and potential consequences. However, with the adoption of appropriate prevention strategies, such as optimizing imaging techniques, implementing alternative modalities, and fostering a culture of radiation safety, the potential risks can be mitigated. By prioritizing radiation safety, healthcare facilities can provide better outcomes for patients and minimize the long-term health implications associated with radiation exposure in spine surgeries.

Intracranial lipomas are rare, frequently asymptomatic, congenital malformations. They are most commonly located in the pericallosal region and are often detected incidentally during neuroimaging studies or postmortem examinations. While other associated brain malformations, most notably callosal agenesis, are frequently reported, association with a subcutaneous scalp lipoma is extremely rare. We present a case of pericallosal lipoma associated with callosal agenesis and subcutaneous lipoma over the anterior fontanelle in a 6-month-old female infant who had excision of only the extracranial mass and has remained asymptomatic from the intracranial mass for the 3 years of follow up.

Object. Our aim is to demonstrate the various aspects of clinical-Radiological presentation and surgical Outcome with association to the tumour size concerning cerebellopontine angle (CPA) tumours.
 Materials and method. This is a prospective study of 40 patients at the Department of Neurosurgery, Jayarogya Group of Hospitals, GRMC Gwalior, M.P. India. All of the patients were pre-operatively evaluated with either non-enhanced and enhanced computerized tomography (CT) or Magnetic-resonance (MR) imaging or both.CPA tumours (predominantly acoustic neuroma) that underwent surgical removal using a suboccipital retro sigmoid approach over a 2-year period (June 2019 to May 2021).
 Results. There was a female preponderance. The most common presentation was Sensorineural hearing loss (90%) followed by Headache (67.5%). The majority of cases of Vestibular Schwannoma have heterogenous enhancement with cystic component.65% of patients have large (26-40mm) size tumours and facial nerve preservation is 86.4% in medium size tumours (10-25 mm).and Incidence of post-postoperative of facial nerve palsy is more in Giant size tumour (> 40mm) so Positive association between size of lesion and Incidence of Post-operative facial nerve palsy. CSF leak occurs in 6 patients and postoperative Hydrocephalus occur in 2 patients and Mortality occurs in 3 patients.
 Conclusion. CP angle Tumor was common in middle age group, with the incidence in females slightly more than in males. The majority of lesions were of large size (26-40mm). Most of the patients on admission had a non-serviceable hearing. Heterogeneous enhancement with cystic components was found in most of the lesions. Gross-total excision was one in the majority of cases and vestibular schwannoma was the most common histopathological lesion obtained. Facial nerve palsy was the most complication and as the size of the lesion increased, the possibility of facial nerve palsy also increased post-operatively. Overall mortality is 7.5%.

Background. Apoptosis is one of the indicators to check for following brain damage. Along with this trend, treatment in the form of herbal and phytopharmaca therapy is required more frequently to treat brain injury complications. Black cumin possesses a function that opposes the apoptotic mechanism.
 Objectives. This study sought to determine the effect of black seed on an animal model of brain damage using apoptotic measures.
 Methods. Four treatment groups were created from the experimental animals as follows: Group BC1: For 7 days following the brain contusion, they were given [0.3 gram] g/kg bw of black cumin extract daily. Group BC2: For 7 days following the brain contusion, they were given [0.4 gram] g/kg bw of black cumin extract daily. Following the brain contusion, Group K received 3 ml of Nacl 0.9% daily for 7 days. The TUNEL DNA fragmentation method was used to count the amount of apoptotic cells and analysis was conducted using ANOVA with F-test and Tukey HSD.
 Results. The control group had the greatest amount of apoptosis at 30.4. Apoptosis averages for BC1 (0.3 g), and BC2 (0.4 g) groups of rats were 25.0, and 18.8, respectively. Black cumin anova test with apoptosis was present while a higher dose of black cumin will minimize the amount of apoptosis.
 Conclusions. Injecting black cumin extracts into rats with head injuries reduced apoptosis, albeit not significantly. In rats with experimental head injuries, black cumin extract induces a connection through the apoptosis mechanism.

Objective. To obtain evidence that the use of endoscopy along with a microscope in the surgical management of pituitary tumours improves intraoperative visualization and significantly impacts operative outcomes in the trans-nasal approach. Material and methods. Each patient underwent endonasal transsphenoidal microscopic tumour resection. The procedure was modified by the use of intrasellar endoscopy as an adjunctive imaging modality. Following complete microscopic resection of tumour, rigid 0° and 30° 4.0-mm endoscopes were used to conduct a final survey of the sellar and parasellar spaces. Residual tumour fragments identified during this endoscopic examination were removed. Results. In 50 patients with pituitary macroadenomas, the rigid 30 ° angled rigid endoscope was found to be highly beneficial. Hidden areas could be visualized and tumour residues were detected. In the majority of the patients with detected tumour residues, adenomatous remnants were safely removed by meticulous endoscopic dissection under optimum visual control after the main part of the tumour had been removed with the operating microscope. Conclusions. Endoscopy provides distinct advantages over microscopy in imaging intrasellar and parasellar structures during pituitary tumour resection which are often missed by microscopy alone.

Between September 28 and October 1, 2022, took place the 47th National Congress of the Romanian Society of Neurosurgery. It was organized in Iasi, at the Palace of Culture. On this occasion, the 26th Francophone Course and the 4th National Congress of Modern Neuroscience were held. These three events represent the quintessence of all current modern neurosurgical problems. Extremely important topics were disputed which helped to grow the passion in the hearts of young enthusiasts and their mentors.

Introduction. Endoscopic third ventriculostomy (ETV) is the treatment of choice in obstructive hydrocephalus. It has become the main standard choice in management since 1962. However, there is scant data regarding the complications from clinical or multi-centre trials. This study highlights the specific complications and prevention methods related to ETV in Neurosurgical Teaching Hospital, Baghdad, Iraq. Methods. It is a prospective case series study conducted on cases in the Neurosurgical Teaching Hospital in Baghdad, Iraq, from January 2014- October 2019. We selected ninety patients. The sample selection was convenient as any patients admitted in the study period who met the selection criteria were included. All included patients underwent a Computerized Tomography scan or Magnetic Resonance Imaging in the periprocedural management. Results. Ninety cases have 59 (65.5%) females and 31 (34.5%) males. The most common cause of hydrocephalus is congenital causes (51 cases (56.6%), especially within the first decade of life. Aqueduct stenosis is the leading cause in 37 cases (72%). ETV complications were found in 32 cases (35.5%). The most common cause of complications is congenital cases of 14 (15%). Intraoperative complications include bleeding (mild, moderate, and severe) in 18 cases (20%). Mild bleeding constitutes 15 cases (16.6%) of all complicated cases. Conclusion. ETV is a standard procedure in the management of obstructive hydrocephalus. The complication rate is found in around one-third of the cases in our study. Surgeons’ selection of indicated patients and better surgical experience decrease the failure rate of ETV and complications.

Letter to Editor Contusion index - a diagnostic and treatment algorithm for neurointensive care

Background: In thoracal disc herniation (TDH) requiring surgery, the size, level, anatomic location, and calcification of the disc are extremely important in the selection of the technique to be applied. Since the thoracic region does not allow spinal cord manipulation, the surgery is difficult and requires experience. A consecutive series of patients who underwent thoracic discectomy through a posterior transfacet approach is presented in this study. Methods: Eleven patients (6 men, and 5 women) underwent surgery at 12 disc levels. The mean age was 53.54 years (range 28-72 years). Patients presented with myelopathy (n = 8, 73%), radiculopathy (n = 7, 64%), back pain (n =10, 91%), and urinary dysfunction (n = 6, 55%). Seven (58%) lateral, 3 (25%) calcified, and 4 (33%) large disc herniations were revealed by preoperative imaging. The mean follow-up period was 21.02 ± 8.04 months (range 6 – 43 months). Results: A posterior transfacet approach was used for all eleven patients with TDH. Thoracic discectomy was performed at T11- 12 (36%) level for 4 patients, and equally at T10- 11 (36%) level for the other 4 patients. A bilateral approach with laminotomy was performed in one patient, and a two-level discectomy was performed in another patient. Unilateral partial laminectomy was added for 3 patients. The average operating time was 146.85 minutes (range 125-220 minutes). The average hospital stay was 4.2 days (range, 2- 13 days) while no neurological functional deterioration was observed in any of the patients after surgery. Postoperative 1-month and 6-month ODI scores were found significantly different from preoperative ODI scores in all patients. Conclusions: Thoracal discectomy through the posterior transfacet approach route is a safe and effective technique to achieve adequate decompression without requiring instrumented fusion.

Objective: Spinal cord stimulation (SCS) is a widely employed technique in treating chronic pain, however, it still fails in significantly reducing pain in one-out-of-three cases. Poor consensus exists on the most predictive factors of SCS outcomes. Although psychological criteria such as emotional stability are recommended for this treatment, it is not well understood if the perception of patients’ own health may impact the SCS success. Therefore, we retrospectively examine factors associated with the patient's subjective conditions, to investigate their relationship with SCS success. Methods: Before the implantation of an SCS trial per routine clinical decision-making, and independently from the implanted devices, patients treated in our clinical practice underwent an extensive evaluation of pain, disability, depression and the overall quality of life. In those patients with successful SCS trials, the pain level was also evaluated at the end of the trial period. Regression analyses were performed to investigate factors predicting successful trial stimulation. Results: Successful trial stimulation was effective in 15 patients (75%). Perceived disability, pain and general health resulted as independent predictive factors on SCS trial outcome. Further investigation showed perceived disability (i.e. Oswestry Disability Index) as a crucial factor, and ROC curve analysis identifies a cut-off of 38 as a predictive score of success. Conclusions: Although preliminary, these findings suggest that standardized scales examining the overall patients’ perceived health status, particularly the disability index may help shed light on predicting SCS trial success. Thus, it is argued the potential application of self-administered scales in SCS patients’ selection in routine clinical practice.