Abstract Introduction: The pia mater has received less attention in the literature compared to the dura and arachnoid maters. However, its presence as a direct covering of the nervous system and direct relation to the blood vessels gives it a special importance in neurosurgery. Method: A comprehensive review of the literature was conducted to study all that we could find relating to the pia mater, including history, macro- and microanatomy, embryology, and a full description of the related structures. Conclusion: The pia mater has an important anatomic position, rich history, complicated histology and embryology, and a significant contribution to a number of other structures that may stabilize and protect the nervous system. To read the full article, refer to the link below: https://www.ncbi.nlm.nih.gov/pubmed/?term=23381008

Abstract Object: In 1998 the authors identified 5 patients with syringomyelia and no evidence of Chiari malformation Type I (CM-I). Magnetic resonance imaging of the entire neuraxis ruled out other causes of a syrinx. Ultimately, abnormal CSF flow at the foramen magnum was the suspected cause. The label 'Chiari 0' was used to categorize these unique cases with no tonsillar ectopia. All of the patients underwent posterior fossa decompression and duraplasty identical to the technique used to treat patients with CM-I. Significant syrinx and symptom resolution occurred in these patients. Herein, the authors report on a follow-up study of patients with CM-0 who were derived from over 400 operative cases of pediatric CM-I decompression. Methods: The authors present their 12-year experience with this group of patients. Results: Fifteen patients (3.7%) were identified. At surgery, many were found to have physical barriers to CSF flow near the foramen magnum. In most of them, the syringomyelia was greatly diminished postoperatively. Conclusions: The authors stress that this subgroup represents a very small cohort among patients with Chiari malformations. They emphasize that careful patient selection is critical when diagnosing CM-0. Without an obvious CM-I, other etiologies of a spinal syrinx must be conclusively ruled out. Only then can one reasonably expect to ameliorate the clinical course of these patients via posterior fossa decompression. To read the full article, refer to the link below: https://www.ncbi.nlm.nih.gov/pubmed/?term=21721881

Abstract Background: Numerous randomized controlled trials (RCTs) relevant to the cerebrovascular field have been performed. The fragility index was recently developed to complement the P value and measure the robustness and reproducibility of clinical findings of RCTs. Objective: In this study, we evaluate the fragility index for key surgical and endovascular cerebrovascular RCTs and propose a novel RCT classification system based on the fragility index. Methods: Cerebrovascular RCTs reported between 2000 and 2018 were reviewed. Six key areas were specifically targeted in relation to stroke, carotid stenosis, cerebral aneurysms, and subarachnoid hemorrhage. The correlation between fragility index, number of patients lost to follow-up, and fragility quotient were evaluated to propose a classification system for the robustness of the studies. Results: A total of 20 RCTs that reported significant differences between both study groups in terms of the primary outcome were included. The median fragility index for the trials was 5.5. An additional 30 randomly selected RCTs were added to propose a classification system with high reliability. The difference between the number of patients lost to follow-up and fragility index inversely correlated with the fragility quotient and was used to divide the robustness of the RCTs into 3 classes reflecting the reproducibility of the trial. Conclusions: Neurosurgeons and neurointerventionalists should exercise caution with interpreting the results of cerebrovascular RCTs, especially when the sample size and events numbers are small and there is a high number of patients who were lost to follow-up, as quantitatively identified using the proposed classification system. to see the full article, check the link below: https://pubmed.ncbi.nlm.nih.gov/32437984/

Abstract Spinal cord injury (SCI) is a life-shattering neurological condition that affects between 250,000 and 500,000 individuals each year with an estimated two to three million people worldwide living with an SCI-related disability. The incidence in the USA and Canada is more than that in other countries with motor vehicle accidents being the most common cause, while violence being most common in the developing nations. Its incidence is two- to fivefold higher in males, with a peak in younger adults. Apart from the economic burden associated with medical care costs, SCI predominantly affects a younger adult population. Therefore, the psychological impact of adaptation of an average healthy individual as a paraplegic or quadriplegic with bladder, bowel, or sexual dysfunction in their early life can be devastating. People with SCI are two to five times more likely to die prematurely, with worse survival rates in low- and middle-income countries. This devastating disorder has a complex and multifaceted mechanism. Recently, a lot of research has been published on the restoration of locomotor activity and the therapeutic strategies. Therefore, it is imperative for the treating physicians to understand the complex underlying pathophysiological mechanisms of SCI. to see the full article, check the link below: https://www.ncbi.nlm.nih.gov/pubmed/?term=29998371

Abstract Hua Tuo (c. 108-208 AD), the Chinese surgical pioneer and herbal expert, excelled as a physician, making significant strides in anesthesia, surgery, and acupuncture. He is accredited for spearheading the practice of laparotomies and organ transplants, using anesthetics, and he was the first Chinese surgeon to operate on the abdomen including performing splenectomy and colostomy. Neurologically, Hua Tuo is said to have performed procedures to treat headache, paralysis, and suspected a brain tumor in one patient. Tuo's impact on medicine was so profound that the phrases 'A Second Hua Tuo' or 'Hua Tuo reincarnated' were coined in honor of his diligence and compassion to recognize outstanding physicians who demonstrate an equal caliber of surgical competence. It is the pioneering contributions to medicine and surgery as made by such physicians as Hua Tuo on which we base our current understanding. To read the full article, refer to the link below: https://www.ncbi.nlm.nih.gov/pubmed/?term=21452005

Abstract Introduction: Cervical spine injuries can be life-altering issues in the pediatric population. The aim of the present paper was to review this literature. Conclusions: A comprehensive knowledge of the special anatomy and biomechanics of the spine of children is essential in diagnosis and treating issues related to spine injuries. To read the full article, refer to the link below: https://www.ncbi.nlm.nih.gov/pubmed/?term=21104185