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  1. Article ; Online: The Application of Guideline-Based Care for Traumatic Brain and Spinal Cord Injury in Low- and Middle-Income Countries: A Provider-Based Survey.

    Lepard, Jacob R / Mediratta, Saniya / Rubiano, Andres M / Park, Kee B

    World neurosurgery: X

    2022  Volume 15, Page(s) 100121

    Abstract: Objective: Neurosurgical guidelines have resulted in improved clinical outcomes and more optimized care for many complex neurosurgical pathologies. As momentum in global neurosurgical efforts has grown, there is little understanding about the ... ...

    Abstract Objective: Neurosurgical guidelines have resulted in improved clinical outcomes and more optimized care for many complex neurosurgical pathologies. As momentum in global neurosurgical efforts has grown, there is little understanding about the application of these guidelines in low- and middle-income countries.
    Methods: A 29-question survey was developed to assess the application of specific recommendations from neurosurgical brain and spinal cord injury guidelines. Surveys were distributed to an international cohort of neurosurgeons and neurotrauma stakeholders.
    Results: A total of 82 of 222 (36.9%) neurotrauma providers responded to the survey. The majority of respondents practiced in low- and middle-income countries settings (49/82, 59.8%). There was a significantly greater mean traumatic brain injury volume in low-income countries (56% ± 13.5) and middle-income countries (46.5% ± 21.3) compared with high-income countries (27.9% ± 13.2),
    Conclusions: While some disparities in guideline implementation are inevitably related to the availability of clinical resources, other differences could be more quickly improved with accessibility of current evidence-based guidelines and development of local data.
    Language English
    Publishing date 2022-03-26
    Publishing country United States
    Document type Journal Article
    ISSN 2590-1397
    ISSN (online) 2590-1397
    DOI 10.1016/j.wnsx.2022.100121
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  2. Article ; Online: Barriers to neurotrauma care in low- to middle-income countries: an international survey of neurotrauma providers.

    Mediratta, Saniya / Lepard, Jacob R / Barthélemy, Ernest J / Corley, Jacquelyn / Park, Kee B

    Journal of neurosurgery

    2021  , Page(s) 1–10

    Abstract: Objective: Delays along the neurosurgical care continuum are associated with poor outcomes and are significantly greater in low- to middle-income countries (LMICs), with timely access to neurotrauma care remaining one of the most significant unmet ... ...

    Abstract Objective: Delays along the neurosurgical care continuum are associated with poor outcomes and are significantly greater in low- to middle-income countries (LMICs), with timely access to neurotrauma care remaining one of the most significant unmet neurosurgical needs worldwide. Using Lancet Global Surgery metrics and the Three Delays framework, the authors of this study aimed to identify and characterize the most significant barriers to the delivery of neurotrauma care in LMICs from the perspective of local neurotrauma providers.
    Methods: The authors conducted a cross-sectional study through the dissemination of a web-based survey to neurotrauma providers across all World Health Organization geographic regions. Responses were analyzed with descriptive statistics and Kruskal-Wallis testing, using World Bank data to provide estimates of populations at risk.
    Results: Eighty-two (36.9%) of 222 neurosurgeons representing 47 countries participated in the survey. It was estimated that 3.9 billion people lack access to neurotrauma care within 2 hours. Nearly 3.4 billion were estimated to be at risk for impoverishing expenditure and 2.9 billion were at risk of catastrophic expenditure as a result of paying for care for neurotrauma injuries. Delays in seeking care were rated as slightly common (p < 0.001), those in reaching care were very common (p < 0.001), and those in receiving care were slightly common (p < 0.05). The most significant causes for delays were associated with reaching care, including geographic distance from a facility, lack of ambulance service, and lack of finances for travel. All three delays were correlated to income classification and geographic region.
    Conclusions: While expanding the global neurosurgical workforce is of the utmost importance, the study data suggested that it may not be entirely sufficient in gaining access to care for the emergent neurosurgical patient. Significant income and region-specific variability exists with regard to barriers to accessing neurotrauma care. Highlighting these barriers and quantifying worldwide access to neurotrauma care using metrics from the Lancet Commission on Global Surgery provides essential insight for future initiatives aiming to strengthen global neurotrauma systems.
    Language English
    Publishing date 2021-12-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2021.9.JNS21916
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  3. Article ; Online: Far Lateral Approaches: C1 Meningioma With Vertebral Artery Involvement: 3-Dimensional Operative Video.

    Budohoski, Karol P / Barone, Damiano G / Mediratta, Saniya / Ross, Matthew I / Kirollos, Ramez W / Santarius, Thomas / Trivedi, Rikin A

    Operative neurosurgery (Hagerstown, Md.)

    2021  Volume 22, Issue 1, Page(s) e48

    Abstract: Tumors around the cervicomedullary junction are rare and constitute 5% of spinal tumors and 1% of cranial tumors. The approach to these lesions is difficult because of the close proximity of the medulla and cervical spinal cord, lower cranial nerves, and ...

    Abstract Tumors around the cervicomedullary junction are rare and constitute 5% of spinal tumors and 1% of cranial tumors. The approach to these lesions is difficult because of the close proximity of the medulla and cervical spinal cord, lower cranial nerves, and vertebral artery (VA) as well as the complex articulation between occipital condyle, C1 and C2. Cervicomedullary junction meningiomas are commonly classified based on their origin in relation to the dentate ligament, but the relationship to the VA typically plays an important role in deciding the surgical approach. For lesions located dorsal to the dentate ligament and not involving the VA, a midline approach is typically sufficient. However, when the VA is involved a far lateral approach is preferred as it offers better access to the V4 segment. We describe a case of a 55-yr-old man who presented with accessory nerve palsy and mild upper motor neuron signs and was found to have a C1 meningioma encasing and narrowing the VA at the V3/V4 segment. Informed consent was obtained. The patient was treated with a right far lateral approach with limited condylectomy to gain access to the V4 segment. We described the steps used for safe resection of the tumor around the VA from distal to proximal. We demonstrate the relationship of the tumor to the VA and the need to completely skeletonize the VA to achieve a gross total resection. We supplement the discussion with a 3D surgical video.
    Language English
    Publishing date 2021-12-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2767575-0
    ISSN 2332-4260 ; 2332-4252
    ISSN (online) 2332-4260
    ISSN 2332-4252
    DOI 10.1227/ONS.0000000000000031
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  4. Article ; Online: Far Lateral Approaches: Dural Arteriovenous Fistulae at the Hypoglossal Canal: 3-Dimensional Operative Video.

    Budohoski, Karol P / Barone, Damiano G / Mediratta, Saniya / Ross, Matthew / Kirollos, Ramez W / Santarius, Thomas / Trivedi, Rikin A

    Operative neurosurgery (Hagerstown, Md.)

    2021  Volume 22, Issue 1, Page(s) e50

    Abstract: Cognard type V dural arteriovenous fistulae (dAVF) are typically located at the foramen magnum. Their presentation often mimics that of cervical myelopathy, and they can be easily misdiagnosed even if spinal vascular imaging is undertaken. Treatment ... ...

    Abstract Cognard type V dural arteriovenous fistulae (dAVF) are typically located at the foramen magnum. Their presentation often mimics that of cervical myelopathy, and they can be easily misdiagnosed even if spinal vascular imaging is undertaken. Treatment typically involves endovascular embolization or surgery when embolization is not possible. We describe a case of a 67-yr-old man who presented with progressive symptoms of cervical myelopathy with a significant reduced ambulation and upper motor neuron signs. Imaging disclosed upper cervical cord edema, and angiography confirmed a Cognard type V dAVF with drainage into the perimedullary and spinal venous system. The dAVF was supplied by the hypoglossal division of the ascending pharyngeal artery. Endovascular treatment was believed to pose a risk of ischemic injury to the hypoglossal nerve, and therefore, surgery was offered. Informed consent was obtained. A far lateral approach was used to access the fistulous point. We describe the relevant vascular anatomy and the benefits of the far lateral approach for this lesion. We also demonstrate a tailored inferior condylectomy to gain access to the intracranial part of the hypoglossal canal, where the draining vein is expected to be found. We supplement the discussion with a 3D surgical video.
    Language English
    Publishing date 2021-12-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2767575-0
    ISSN 2332-4260 ; 2332-4252
    ISSN (online) 2332-4260
    ISSN 2332-4252
    DOI 10.1227/ONS.0000000000000033
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  5. Article ; Online: Post-haemorrhagic hydrocephalus is associated with poorer surgical and neurodevelopmental sequelae than other causes of infant hydrocephalus.

    Mohamed, Malak / Mediratta, Saniya / Chari, Aswin / da Costa, Cristine Sortica / James, Greg / Dawes, William / Aquilina, Kristian

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2021  Volume 37, Issue 11, Page(s) 3385–3396

    Abstract: Purpose: This retrospective cohort study aimed to investigate the surgical and neurodevelopmental outcomes (NDO) of infant hydrocephalus. We also sought to determine whether these outcomes are disproportionately poorer in post-haemorrhagic hydrocephalus ...

    Abstract Purpose: This retrospective cohort study aimed to investigate the surgical and neurodevelopmental outcomes (NDO) of infant hydrocephalus. We also sought to determine whether these outcomes are disproportionately poorer in post-haemorrhagic hydrocephalus (PHH) compared to other causes of infant hydrocephalus.
    Methods: A review of all infants with hydrocephalus who had ventriculoperitoneal (VP) shunts inserted at Great Ormond Street Hospital (GOSH) from 2008 to 2018 was performed. Demographic, surgical, neurodevelopmental, and other clinical data extracted from electronic patient notes were analysed by aetiology. Shunt survival, NDO, cerebral palsy (CP), epilepsy, speech delay, education, behavioural disorders, endocrine dysfunction, and mortality were evaluated.
    Results: A total of 323 infants with median gestational age of 37.0 (23.29-42.14) weeks and birthweight of 2640 g (525-4684 g) were evaluated. PHH was the most common aetiology (31.9%) and was associated with significantly higher 5-year shunt revision rates, revisions beyond a year, and median number of revisions than congenital or "other" hydrocephalus (all p < 0.02). Cox regression demonstrated poorest shunt survival in PHH, related to gestational age at birth and corrected age at shunt insertion. PHH also had the highest rate of severe disabilities, increasing with age to 65.0% at 10 years, as well as the highest CP rate; only genetic hydrocephalus had significantly higher endocrine dysfunction (p = 0.01) and mortality rates (p = 0.04).
    Conclusions: Infants with PHH have poorer surgical and NDO compared to all other aetiologies, except genetic hydrocephalus. Research into measures of reducing neurodisability following PHH is urgently required. Long-term follow-up is essential to optimise support and outcomes.
    MeSH term(s) Aged ; Cerebral Hemorrhage/surgery ; Humans ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Infant ; Infant, Newborn ; Infant, Premature, Diseases/surgery ; Retrospective Studies ; Ventriculoperitoneal Shunt
    Language English
    Publishing date 2021-06-19
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-021-05226-4
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  6. Article: Composite Grafts for Pediatric Fingertip Amputations: A Retrospective Case Series of 100 Patients.

    Borrelli, Mimi R / Dupré, Sophie / Mediratta, Saniya / Bisquera, Alessandra / Greig, Aina

    Plastic and reconstructive surgery. Global open

    2018  Volume 6, Issue 6, Page(s) e1843

    Abstract: Background: Fingertip amputations are common. This study reports on the outcomes of composite grafts used for fingertip amputations in children, measuring graft take, predictors of graft take, complications, and patient-reported outcomes.: Methods: A ...

    Abstract Background: Fingertip amputations are common. This study reports on the outcomes of composite grafts used for fingertip amputations in children, measuring graft take, predictors of graft take, complications, and patient-reported outcomes.
    Methods: A retrospective case series of consecutive patients (≤ 16 years) undergoing composite grafts for fingertip amputations in a tertiary pediatric hospital, January 06 to December 16, was performed. Information was collected on amputations, graft take, and complications. Logistic regression was used to analyze factors predicting graft take (partial/complete or failure) including age; amputation level; mechanism and time delay to surgery. Patients were contacted via post or telephone to ask about functional and cosmetic outcomes and their perception of graft take.
    Results: One hundred patients [57 (57%) males; mean age, 4.41 ± 3.98 years], presenting with 100 fingertip amputations, met the inclusion criteria. Amputation mechanism was crush in 75 (75%), avulsion in 13 (13%), and laceration in 12 (13%). Thirteen (13%) composite grafts survived completely, 46 (46%) partially, and 41 (41%) failed. Graft survival was higher in children under 4 years (
    Conclusions: Composite grafts for fingertip amputations mostly only partially survive, but morbidity is low, patient satisfaction is high, and acceptable cosmetic and functional outcomes are achieved.
    Language English
    Publishing date 2018-06-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2851682-5
    ISSN 2169-7574 ; 2169-7574
    ISSN (online) 2169-7574
    ISSN 2169-7574
    DOI 10.1097/GOX.0000000000001843
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  7. Article ; Online: Current state of global neurosurgery activity amongst European neurosurgeons.

    Mediratta, Saniya / Lippa, Laura / Venturini, Sara / Demetriades, Andreas K / El-Ouahabi, Abdessamad / Gandía-González, Maria L / Harkness, William / Hutchinson, Peter / Park, Kee B / Rabiei, Katrin / Rosseau, Gail / Schaller, Karl / Servadei, Franco / Lafuente, Jesus / Kolias, Angelos G

    Journal of neurosurgical sciences

    2022  

    Abstract: Background: The expanding field of global neurosurgery calls for a committed neurosurgical community to advocate for universal access to timely, safe, and affordable neurosurgical care for everyone, everywhere. This study aims to (i) assess the current ... ...

    Abstract Background: The expanding field of global neurosurgery calls for a committed neurosurgical community to advocate for universal access to timely, safe, and affordable neurosurgical care for everyone, everywhere. This study aims to (i) assess the current state of global neurosurgery activity amongst European neurosurgeons and (ii) identify barriers to involvement in global neurosurgery initiatives.
    Methods: Cross-sectional study through dissemination of a web-based survey, from September 2019 to January 2020, to collect data from European neurosurgeons at various career stages. Descriptive analysis was conducted on respondent data.
    Results: Three hundred and ten neurosurgeons from 40 European countries responded. 53.5% regularly follow global neurosurgery developments. 29.4% had travelled abroad with a global neurosurgery collaborative, with 23.2% planning a future trip. Respondents from high income European countries predominantly travelled to Africa (41.6%) or Asia (34.4%), whereas, respondents from middle income European countries frequently traversed Europe (63.2%) and North America (47.4). Cost implications (66.5%) were the most common barrier to global neurosurgery activity, followed by interference with current practice (45.8%), family duties (35.2%), difficulties obtaining humanitarian leave (27.7%) and lack of international partners (27.4%). 86.8% would incorporate a global neurosurgery period within training programmes.
    Conclusions: European neurosurgeons are interested in engaging in global neurosurgery partnerships, and several sustainable programmes focused on local capacity building, education and research have been established over the last decade. However, individual and system barriers to engagement persist. We provide insight into these to allow development of tailored mechanisms to overcome such barriers, enabling European neurosurgeons to advocate for the Global Surgery 2030 goals.
    Language English
    Publishing date 2022-02-11
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 193139-8
    ISSN 1827-1855 ; 0390-5616 ; 0026-4881
    ISSN (online) 1827-1855
    ISSN 0390-5616 ; 0026-4881
    DOI 10.23736/S0390-5616.21.05447-3
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  8. Article ; Online: Interhemispheric control of sensory cue integration and self-motion perception.

    Arshad, Qadeer / Ortega, Marta Casanovas / Goga, Usman / Lobo, Rhannon / Siddiqui, Shuaib / Mediratta, Saniya / Bednarczuk, Nadja F / Kaski, Diego / Bronstein, Adolfo M

    Neuroscience

    2019  Volume 408, Page(s) 378–387

    Abstract: Spatial orientation necessitates the integration of visual and vestibular sensory cues, in-turn facilitating self-motion perception. However, the neural mechanisms underpinning sensory integration remain unknown. Recently we have illustrated that spatial ...

    Abstract Spatial orientation necessitates the integration of visual and vestibular sensory cues, in-turn facilitating self-motion perception. However, the neural mechanisms underpinning sensory integration remain unknown. Recently we have illustrated that spatial orientation and vestibular thresholds are influenced by interhemispheric asymmetries associated with the posterior parietal cortices (PPC) that predominantly house the vestibulo-cortical network. Given that sensory integration is a prerequisite to both spatial orientation and motion perception, we hypothesized that sensory integration is similarly subject to interhemispheric influences. Accordingly, we explored the relationship between vestibulo-cortical dominance - assessed using a biomarker, the degree of vestibular-nystagmus suppression following transcranial direct current stimulation over the PPC - with visual dependence measures obtained during performance of a sensory integration task (the rod-and-disk task). We observed that the degree of visual dependence was correlated with vestibulo-cortical dominance. Specifically, individuals with greater right hemispheric vestibulo-cortical dominance had reduced visual dependence. We proceeded to assess the significance of such dominance on behavior by correlating measures of visual dependence with self-motion perception in healthy subjects. We observed that right-handed individuals experienced illusionary self-motion (vection) quicker than left-handers and that the degree of vestibular cortical dominance was correlated with the time taken to experience vection, only during conditions that induced interhemispheric conflict. To conclude, we demonstrate that interhemispheric asymmetries associated with vestibulo-cortical processing in the PPC functionally and mechanistically link sensory integration and self-motion perception, facilitating spatial orientation. Our findings highlight the importance of dynamic interhemispheric competition upon control of vestibular behavior in humans.
    MeSH term(s) Adult ; Cues ; Eye Movements/physiology ; Female ; Functional Laterality/physiology ; Humans ; Male ; Motion Perception/physiology ; Neural Pathways/physiology ; Parietal Lobe/physiology ; Transcranial Direct Current Stimulation ; Young Adult
    Language English
    Publishing date 2019-04-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 196739-3
    ISSN 1873-7544 ; 0306-4522
    ISSN (online) 1873-7544
    ISSN 0306-4522
    DOI 10.1016/j.neuroscience.2019.04.027
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  9. Parekh, Ravi / Jones, Melvyn Mark / Singh, Surinder / Yuan, Jack Shi Jie / Chan, See Chai Carol / Mediratta, Saniya / Smith, Rhys / Gunning, Elinor / Gajria, Camille / Kumar, Sonia / Park, Sophie

    BMJ open

    2021  Volume 11, Issue 7, Page(s) e049825

    Abstract: Objectives: Primary healthcare internationally is facing a workforce crisis with fewer junior doctors choosing general practice (GP) as a career. In the UK, a national report on GP careers highlighted adverse influences during medical school on students' ...

    Abstract Objectives: Primary healthcare internationally is facing a workforce crisis with fewer junior doctors choosing general practice (GP) as a career. In the UK, a national report on GP careers highlighted adverse influences during medical school on students' career choices. The authors explored these influences in two urban UK medical schools, both with relatively low numbers of students entering GP training.
    Design: Using a phenomenological approach, the authors thematically analysed the reflective diaries of four medical students who were recruited as 'participant researchers' over a period of 10 months. These students made regular reflexive notes about their experiences related to GP career perceptions in their academic and personal environments, aiming to capture both positive and negative perceptions of GP careers. The research team discussed emerging data and iteratively explored and developed themes.
    Setting: Two UK medical schools PARTICIPANTS: Undergraduate medical students RESULTS: Seven key themes were identified: the lack of visibility and physicality of GP work, the lack of aspirational GP role models, students' perceptions of a GP career as default, the performativity of student career choice with the perceptions of success linked to specialism, societal perceptions of GP careers, gender stereotyping of career choices and the student perception of life as a GP.
    Conclusions: Students overwhelmingly reflected on negative cues to GP careers, particularly through their experience of the hidden curriculum. Three recommendations are made: the need for increased representation of GP role models in clinical curricula content delivery and senior leadership; ensuring GP clerkships involve an active and authentic student role with patients, enabling students to experience GP's 'work' including managing complexity, uncertainty and risk. Finally, institutions need to consider students' experiences of the hidden curriculum and the effect this can have on students' perception of careers, alongside the challenges of rankings and perceived hierarchical positioning of disciplines.
    MeSH term(s) Attitude of Health Personnel ; Career Choice ; Curriculum ; Education, Medical, Undergraduate ; Humans ; Primary Health Care ; Students, Medical
    Language English
    Publishing date 2021-07-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-049825
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  10. Article ; Online: Longitudinal Changes in Size of Conservatively Managed Flow-Related Aneurysms Associated with Brain Arteriovenous Malformations.

    Budohoski, Karol P / Mohan, Midhun / Millar, Zack / Tajsic, Tamara / Barone, Damiano G / Cao, Jennifer J L / Mediratta, Saniya / Phelps, Ellie / Sukthankar, Tanmay / Kirollos, Ramez W / Helmy, Adel E / Guilfoyle, Mathew R / Trivedi, Rikin A

    World neurosurgery

    2021  Volume 154, Page(s) e754–e761

    Abstract: Background: Flow aneurysms (FAs) associated with brain arteriovenous malformations (AVMs) are thought to arise from increased hemodynamic stress due to high-flow shunting. This study aims to describe the changes in conservatively managed FAs after ... ...

    Abstract Background: Flow aneurysms (FAs) associated with brain arteriovenous malformations (AVMs) are thought to arise from increased hemodynamic stress due to high-flow shunting. This study aims to describe the changes in conservatively managed FAs after successful AVM treatment.
    Methods: Patients with symptomatic AVMs and associated FAs who underwent successful treatment of the AVM between 2008 and 2017 were included. FA dimensions were measured on surveillance angiography to assess longitudinal changes.
    Results: Thirty-two patients were identified with 48 FAs. Sixteen (33%) FAs were treated endovascularly; 18 (38%) FAs were treated surgically; and 14 (29%) FAs (11 patients) were monitored. FAs demonstrated a decrease in size from 5.0 mm to 3.8 mm (24%; P = 0.016) and 4.9 mm to 3.6 mm (27%; P = 0.013) in height and width, respectively, over a median 35 months. However, on subgroup analysis, only class IIb aneurysms demonstrated a significant decrease in size (51% reduction in largest diameter, P = 0.046) and only 3 FAs (21%) resolved. There were no hemorrhages observed during follow-up.
    Conclusions: While conservatively managed FAs demonstrated a reduction in size after the culprit AVM was treated, this was only significant in FAs located close to an AVM nidus (class IIb). There were no hemorrhages during the median 35 months' follow-up; however, long-term data are lacking. Our data support close observation of all conservatively managed aneurysms and a tailored approach based on the proximity to the nidus and observed changes in size.
    MeSH term(s) Adult ; Aged ; Conservative Treatment ; Endovascular Procedures ; Female ; Humans ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/pathology ; Intracranial Aneurysm/therapy ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/surgery ; Longitudinal Studies ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2021-08-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2021.07.125
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    ab Jg. 2022: Lesesaal (EG)

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