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Hoz SS, Palmisciano P, Ismail M, Sharma M, Muthana A, Forbes J, Prestigiacomo C, Samy R, Abdulsada AM, Zuccarello M, Andaluz N. Anatomical Study of the Supratentorial Extension for the Retrolabyrinthine Presigmoid Approaches. World Neurosurg 2024:S1878-8750(24)00817-9. [PMID: 38762023 DOI: 10.1016/j.wneu.2024.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Supra-tentorial craniotomy represents the upper part of the combined trans-tentorial or the supra-infra-tentorial presigmoid approach. In this study, we provide qualitative and quantitative analyses for the supratentorial extension of the presigmoid retrolabyrinthine suprameatal approach (PRSA). METHODS The infratentorial PRSA followed by the supratentorial extension craniotomy with dividing and removal of the tentorial strip were performed on both sides of 5 injected human cadaver heads (n=10 sides). Quantitative analysis was performed for the surface area gained (surgical accessibility) by adding the supratentorial craniotomy. Qualitative analysis was performed for the parts of the brainstem, cranial nerves, and vascular structures that became accessible by adding the supratentorial craniotomy. The anatomical obstacles encountered in the added operative corridor were analyzed. RESULTS The supratentorial extension of PRSA provides an increase in surgical accessibility of 102.65% as compared to the PRSA standalone. The mean surface area of the exposed brainstem is 197.98 (SD: 76.222) and 401.209 (SD: 123.96) for the infratentorial and the combined supra-infratentorial presigmoid approach, respectively. Exposure for parts of III, IV, and V cranial nerves is added after the extension, and the surface area of the outer craniotomy defect has increased by 60.32%. Parts of the basilar, anterior inferior cerebellar, and superior cerebellar arteries are accessible after the supratentorial extension. CONCLUSION The supratentorial extension of PRSA allows access to the supra-trigeminal area of the pons and the lower part of the midbrain. Considering this surgical accessibility and exposure significantly assists in planning such complex approaches while targeting central skull base lesions.
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Affiliation(s)
- Samer S Hoz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mustafa Ismail
- University of Baghdad College of Medicine, Baghdad, Iraq
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, KY, USA
| | - Ahmed Muthana
- University of Baghdad College of Medicine, Baghdad, Iraq
| | - Jonathan Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles Prestigiacomo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ravi Samy
- Departments of Neurosurgery and Otolaryngology Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | | | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Al-Ageely TA, Ismail M, Al-Araji ZA, Abdulsada AM, Algburi HA, Akar NM, Hoz SS. Effectiveness of Mentorships and Early Exposure in Neurosurgery. World Neurosurg 2023; 178:e773-e776. [PMID: 37562681 DOI: 10.1016/j.wneu.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Mentorship programs are crucial for continuous medical education, improving personal confidence, knowledge, and skills, and have been associated with staff retention and overall career satisfaction. However, there are limited studies evaluating the effectiveness of mentorship programs in neurosurgery. The study aims to evaluate the effectiveness of mentorship programs in neurosurgery, focusing on knowledge and skill development, personal growth, and networking opportunities. METHODS A cross-sectional study was conducted during the 9th Hoz Neurosurgery Mentorship Program, involving 175 participants from 16 countries. Precourse and postcourse surveys assessed participants' neurosurgical knowledge, research experience, personal abilities, and acknowledgment of neurosurgical subspecialties. RESULTS Of the participants, 89% were from Iraq, with the remaining from various countries. Most participants were medical students in their early years. The average neurosurgical knowledge score increased from 35.29/60 precourse to 38.4/60 postcourse. The total passing percentage increased from 71% precourse to 86% postcourse. Prior to the program, 87% of participants had not participated in research projects, and 69% had not presented at scientific meetings. Feedback from the postcourse survey highlighted personal development, leadership, teamwork, public speaking skills, and ethical and moral aspects of being a neurosurgeon. CONCLUSIONS Mentorship programs are effective in advancing the skills and capabilities of medical students, junior residents, and physicians. Evaluation of their effectiveness should consider not only scientific knowledge but also practical capabilities, personal growth, and critical thinking development. Free-of-charge programs with diverse participants and overall effectiveness make such experiences unique compared to other mentorship opportunities.
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Affiliation(s)
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | | | | | - Noor M Akar
- College of Medicine, University of Al-Nahrain, Baghdad, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Ismail M, AbdulWahid J, Al-Zaidy MF, Al-Khafaji AO, Albairmani SS, Abdulsada AM, Salih HR, Hoz SS. Neurosurgery theater-based learning: Etiquette and preparation tips for medical students. Surg Neurol Int 2023; 14:153. [PMID: 37151439 PMCID: PMC10159286 DOI: 10.25259/sni_966_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Mahmood F. Al-Zaidy
- Department of Neurosurgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Aktham O. Al-Khafaji
- Department of Neurosurgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Sama S. Albairmani
- Department of Neurosurgery, College of Medicine, University of Al-Iraqia, Baghdad, Iraq
| | | | - Hayder R. Salih
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
- Corresponding author: Samer S. Hoz, Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States.
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Abdulsada AM, Ismail M, Elsayed AM, Emara MR, Al-Khazaali YM, Albairmani SS, Muthana A, Hoz SS. Stephanion to cranial base penetrating stab wound with outstanding recovery: A case report. Surg Neurol Int 2023; 14:72. [PMID: 36895221 PMCID: PMC9990633 DOI: 10.25259/sni_962_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/11/2023] [Indexed: 02/26/2023] Open
Abstract
Background Mortality due to head trauma is common in developed countries in all age groups. Nonmissile penetrating skull base injuries (PSBIs) due to foreign bodies are quite rare, accounting for about 0.4%. PSBI carries that a poor prognosis brainstem involvement usually is often fatal. We are reporting the first case of PSBI with a foreign body insertion site through the stephanion with a remarkable outcome. Case Description The 38-year-old male patient was referred with a penetrating stab wound to the head through the stephanion caused by a knife after a conflict in the street. He had no focal neurological deficit or cerebrospinal fluid leak, and Glasgow coma scale (GCS) was 15/15 on admission. A preoperative computed tomography scan showed the path of the stab beginning at the stephanion, which is the point where the coronal suture crosses the superior temporal line, heading toward the cranial base. Postoperatively, GCS was 15/15 without any deficit apart from the left wrist drop, possibly due to a left arm stab. Conclusion Careful investigations and diagnoses must be made to ensure convenient knowledge of the case due to the variety of injury mechanisms, foreign body characteristics, and individual patients' characteristics. Reported cases of PSBIs in adults have not reported a stephanion skull base injury. Although brain stem involvement is usually fatal, our patient had a remarkable outcome.
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Affiliation(s)
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Mohamed R Emara
- University of Sharjah, College of Medicine, Sharjah, United Arab Emirates
| | - Younus M Al-Khazaali
- Department of Neurosurgery, University of Al-Nahrain, College of Medicine, Baghdad, Iraq
| | - Sama S Albairmani
- Department of Neurosurgery, University of Al-Iraqia, College of Medicine, Baghdad, Iraq
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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AbdulWahid J, Ismail M, Al-Mosawy MS, Abdulsada AM, Al-Ageely TA, Hoz SS. Ins and outs in deciding a future career in neurosurgery: A medical student’s perspective. Surg Neurol Int 2022; 13:530. [DOI: 10.25259/sni_884_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jaafer AbdulWahid
- Department of Neurosurgery, University of Al-Nahrain, College of Medicine,
| | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Mohammad S. Al-Mosawy
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | | | - Teeba A. Al-Ageely
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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Hoz SS, Abdulsada AM, Ismail M, Alfawares Y, Forbes JA, Prestigiacomo CJ, Andaluz N. The functional anatomy of the foramina of Luschka revisited. Surg Neurol Int 2022; 13:512. [DOI: 10.25259/sni_931_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background:
The German Anatomist Hubert Von Luschka first described the foramina of Luschka (FOL) in 1855 as lateral holes in the fourth ventricle. By his discovery, he refuted previous beliefs about the lateral recess as blind ends of the fourth ventricle, proving the continuity of the ventricular system with the central canal of the spinal cord. In this paper, we question the outline variations of the patent parts of FOL and their consistency, drawing attention to the apparent query of the valvular mechanism of FOL.
Methods:
We conducted a literature review in PubMed and Google Scholar databases to review the existing literature describing the history, pertinent anatomy, and function of FOL. In addition, we reviewed the original German book written by Luschka.
Results:
While reading the available articles and original works regarding FOL, we noticed the developmental phases through which FOL was discovered, tracking the process from Aristotle till Luschka’s discovery. We also discussed controversies and opinions about FOL’s existence and function.
Conclusion:
FOL is halved into two compartments: choroidal and patent. The function of FOL resembles a oneway valve mechanism, and it depends on the patent slit-like part. Luschka had discovered over 20 anatomical structures, including several foramina, confusion in a debate may result from eponyms.
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Affiliation(s)
- Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
| | | | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Yara Alfawares
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
| | - Jonathan A. Forbes
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
| | | | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States,
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Ismail M, Al-Ageely TA, Alzerkani MAA, Al-Khazaali YM, Salih HA, Al-Khafaji AO, Kareem ZM, Abdulsada AM, Salih HR, Hoz SS. Extracranial carotid localized fibromuscular dysplasia: A case report and literature review. Surg Neurol Int 2022; 13:498. [DOI: 10.25259/sni_937_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Fibromuscular dysplasia (FMD) is a noninflammatory and nonatherosclerotic arteriopathy that is characterized by irregular cellular proliferation and deformed construction of the arterial wall that causes segmentation, constriction, or aneurysm in the intermediate-sized arteries. The incidence of FMD is 0.42–3.4%, and the unilateral occurrence is even rarer. Herein, we report a rare case of a localized extracranial carotid unilateral FMD associated with recurrent transient ischemic attacks (TIAs) treated by extracranial-intracranial bypass for indirect revascularization. The specific localization of the disease rendered our case unique.
Methods:
We conducted a review of the PubMed Medline database search using the following combined formula: ((FMD [Title/Abstract]) AND ((isolated [Title/Abstract]) OR (localized [Title/Abstract]))) AND Internal carotid artery (ICA) (Title/Abstract). Additional resources were included by screening the reference list of the selected papers.
Results:
A total of six cases were found, and all accounted for localized FMD affecting the ICA. The age range was between 19 and 52, the male-to-female ratio was (2:4), and all of the cases consisted of unilateral carotid FMD, mainly on the left side with a left-to-right ratio of 5:1. The management and outcome of these cases varied according to the case and associated complications.
Conclusion:
Extracranial localized FMD of the ICA is a rare subtype of FMD that has little documentation in the literature. In our case, it was a localized extracranial carotid unilateral FMD associated with recurrent TIAs. The appropriate treatment was using the intracranial-extracranial bypass.
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Affiliation(s)
- Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Teeba A. Al-Ageely
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | | | - Younus M. Al-Khazaali
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Haneen A. Salih
- Department of Biology, University of Al-Mustansiriyah, College of Sciences, Baghdad, Iraq,
| | - Aktham O. Al-Khafaji
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Zahraa M. Kareem
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | | | - Hayder R. Salih
- Department of Neurosurgery, Neurosurgical Teaching Hospital, Baghdad, Iraq,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
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Sadiqo R, Abdulsada AM, Ismail M, Hoz SS. Ectopic schwannoma of the sellar region in a 1-year-old child: A case report and review of literature. Surg Neurol Int 2022; 13:438. [DOI: 10.25259/sni_658_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/07/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Schwannomas are cranial and spinal nerves’ sheath tumors accounting for up to 8% of all intracranial neoplasms. Although typical intracranial schwannomas originate from Schwann cells surrounding cranial nerves, ectopic schwannomas are not associated with a known cranial nerve or have an unknown origin. The location of schwannomas may impose clinical challenges. Sellar region schwannomas are rare whether it is ectopic or not. Herein, we report a pediatric case of a 1-year-old female with ectopic, intra-supra sellar with a literature review. We report the first case of juvenile ectopic schwannoma in the sellar region.
Methods:
A PubMed Medline database search was performed by the following combined formula of medical subject headings (MESH) terms and keywords: ((sella turcica [MeSH Terms]) OR (sella*[Title/Abstract]) OR (ectopic [Title/Abstract]) AND ((neurilemmoma [MeSH Terms]) OR (schwannoma [Title/Abstract]) OR (neuroma [Title/Abstract]) OR (neurinoma [Title/Abstract])).
Results:
Total results of 206 articles were obtained. In exclusion of intraparenchymal and intraventricular schwannomas, only 34 articles remained. Thirty-nine cases were included in 34 articles. According to the reported cases, intrasellar schwannomas are more common in elderly individuals in an average of 49.5 years (range: 19– 79 years). They have a good prognosis and affect males to females equally (20:19).
Conclusion:
Ectopic schwannoma sited in the sellar region is rare. It is the first case to be reported in the pediatric age group with a literature review. This lesion should be highlighted and included in the differential diagnosis of sellar mass.
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Affiliation(s)
- Rauf Sadiqo
- Department of Neurosurgery, Educational-Surgical Clinic by the Medical University of Azerbaijan, Azerbaijan, Iraq,
| | | | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, United States
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Ismail M, Ahmed FO, Abdulsada AM, Al-Khafaji AO, Hoz SS, Lazareff JA, Khonsary SA, Ausman JI. “The most inspiring and mind-blowing meetings ever:” Highlights of the 15 th SNI Baghdad Neurosurgery Online Meeting, from Participants’ Perspectives. Surg Neurol Int 2022; 13:353. [PMID: 36128134 PMCID: PMC9479626 DOI: 10.25259/sni_662_2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Education by lectures has been standard for 100 years or more. Given the 21st century technology, people can connect with others around the world instantly, electronically. With the pandemic, teaching changed to one-way information transfer with the loss of interpersonal learning experience. SNI® and now SNI Digital™ have been experimenting with different forms of communication to transfer information. Methods: Using an interactive education model, a meeting for neurosurgeons in Baghdad was held for students, residents, and neurosurgeons, the first in Iraq for a number of years because of the disruption from the war there. A national and international faculty participated. Results: This 15th meeting of the series was described by 42 out of 60 participants as “The best conference I have ever attended.” That significant response highlights the importance of such meetings and how they can be at the highest level possible and be a recipe for success. Conclusion: The 15th meeting provides a focused analysis of the underlying characteristics leading to its success so that it can be duplicated.
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Affiliation(s)
- Mustafa Ismail
- Department of Neurosurgery, College of Medicine, University of Baghdad, Baghdad, Iraq,
| | - Fatima O. Ahmed
- Department of Neurosurgery, University of Al-Mustansiriyah, College of Medicine, Baghdad, Iraq,
| | | | - Aktham O. Al-Khafaji
- Department of Neurosurgery, College of Medicine, University of Baghdad, Baghdad, Iraq,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
| | - Jorge A. Lazareff
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Center for Health Sciences, Room, United States
| | - Seyed Ali Khonsary
- Department of Neurosurgery, UCLA Medical Center, Los Angeles, California, United States
| | - James I. Ausman
- Department of Neurosurgery, University of California, Los Angeles, California, United States
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