This month’s edition spans continents and complexity—from a vascular rescue in Taiwan to a 3D-guided tumor resection in Germany. We spotlight global disparities in glioma care and trauma outcomes in Ethiopia, reminding us that neurosurgery isn’t just about technique—it’s about context, access, and timing. The tools may differ, but the mission is shared: safer, smarter, and more equitable care.
— Editor, The Short Report on Neurosurgery
In This Issue
- Mapping the Divide: Global Disagreement in Oligodendroglioma Care A multinational survey reveals how geography shapes glioma treatment far more than guidelines.
- Trauma in Transit: Gunshot Wounds to the Head in Ethiopia One of the first studies of civilian GSWH in a low-income setting—spotlighting survival predictors and system gaps.
- Cut Once, Cure Twice: 3D-Printed Precision for Cranial Osteosarcoma A single-sitting, digitally planned surgery redefines function and form in skull tumor management.
- Threading the Needle: Saving a Transected Vertebral Artery A rebar injury leads to a landmark vascular salvage using covered stents—no sacrifice required.
Mapping the Divide: Global Disagreement in Oligodendroglioma Care
What happens when the same tumor meets different zip codes? A multinational survey study in World Neurosurgery asked 63 neurosurgeons and neuro-oncologists across 12 countries how they manage oligodendrogliomas—and found a striking lack of consensus.
While diagnostic testing for IDH mutation and 1p/19q codeletion was largely consistent, treatment plans varied widely. For grade 2 tumors with subtotal resection, options ranged from observation to surgery to immediate chemoradiation—heavily influenced by region.
European providers leaned toward repeat surgery, while U.S. and Canadian physicians favored radiation and chemotherapy. Similarly, for grade 3 disease, Europeans preferred the time-tested PCV regimen, while North Americans opted for temozolomide (TMZ), despite its lack of phase III trial validation in this setting.
Why it matters: This study reveals not just clinical ambiguity, but how local guidelines, access to drugs, and provider background shape global neurosurgical care. With new therapies like IDH inhibitors entering the picture, it’s time to unify and update how we treat this slow-growing but stubborn tumor.
Trauma in Transit: Gunshot Wounds to the Head in Ethiopia
Civilian gunshot wounds to the head (GSWH) are catastrophic—but in resource-limited settings, survival is shaped as much by timing as by technique. A four-year retrospective study from WFNS Journal analyzed 42 surgically treated GSWH cases at Ethiopia’s major trauma center and identified critical predictors of mortality.
Most patients were young men (mean age: 26.7), and 83% arrived more than 24 hours after injury—a delay that proved deadly. Overall mortality was 24%, with a favorable outcome in 62%.
Prognostic red flags included:
- Age over 30
- GCS < 9 at presentation
- Pupillary abnormalities
- Rotterdam CT score ≥ 4
- Surgery duration > 4 hours
Surgical site infections (26%) and chest infections (19%) further worsened prognosis, while longer surgeries doubled the mortality rate. Despite limited resources, the study emphasizes how timely surgery and targeted interventions can yield good outcomes—even in the toughest trauma cases.
Why it matters: This study provides one of the first comprehensive looks at GSWH outcomes in a low-income setting, offering insights to improve trauma protocols and drive systemic reforms.
Cut Once, Cure Twice: 3D-Printed Precision for Cranial Osteosarcoma
Primary cranial osteosarcomas are a surgical and aesthetic challenge—but what if one operation could solve both? A case from Journal of Neurological Surgery Reports showcases a 20-year-old male with a large right frontal osteosarcoma treated in a single-session surgery using 3D-printed craniotomy templates and custom cranioplasty molds.
After imaging showed rapid tumor growth and a 10mm midline shift, surgeons at the German Armed Forces Hospital resected the tumor en bloc with 10mm margins, excised the involved dura, and reconstructed the defect with a tailored PMMA implant shaped using patient-specific 3D-printed molds. The design and printing took a week and cost less than €160 in materials.
Post-op, the patient received EURAMOS protocol chemotherapy and remains recurrence-free at 18 months. The approach avoided a second surgery, minimized cosmetic defects, and enabled early oncologic treatment—setting a new bar for complex cranial reconstructions.
Why it matters: This case highlights how interdisciplinary design and digital fabrication can turn a rare tumor into a one-time fix—restoring form, function, and timing in cranial oncology.
Threading the Needle: Saving a Transected Vertebral Artery
When a 64-year-old construction worker took a rebar to the neck, it set off one of the rarest—and riskiest—vascular emergencies in neurosurgery: a grade V vertebral artery transection. In this case from JNS Case Lessons, the trauma triggered hemorrhagic shock, a large pseudoaneurysm, and an arteriovenous fistula (AVF) between the vertebral artery and internal jugular vein.
Initial coil embolization failed. Surgeons at China Medical University Hospital, Taiwan, switched to a high-stakes strategy: endovascular reconstruction with overlapping covered stents.
Multiple stents and balloon dilations restored vessel patency, followed by posterior cervical fixation and epidural hematoma decompression the next day. The patient was discharged without neurological deficits, and a year later, a minor in-stent stenosis was resolved with balloon dilation.
Why it matters: This may be the first reported case of a grade V vertebral artery transection successfully treated with stenting, showing that preservation—not sacrifice—of the artery can be both possible and life-saving, even in the face of massive trauma.
That’s a wrap on this edition of The Short Report on Neurosurgery!
Which of these advancements intrigued you the most? Let’s discuss in the comments! 💬
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