OBJECTIVEThe COVID-19 pandemic has forced medical professionals throughout the world to adapt to the changing medical scenario. The objective of this survey was to assess the change in neurosurgical training in India following the COVID-19 pandemic.METHODSBetween May 7, 2020, and May 16, 2020, a validated questionnaire was circulated among neurosurgical residents across India by social media, regarding changes in the department’s functioning, patient interaction, surgical exposure, changes in academics, and fears and apprehensions associated with the pandemic. The responses were kept anonymous and were analyzed for changes during the COVID-19 pandemic compared to before the pandemic.RESULTSA total of 118 residents from 29 neurosurgical training programs across 17 states/union territories of the country gave their responses to the survey questionnaire. The survey revealed that the surgical exposure of neurosurgical residents has drastically reduced since the onset of the COVID-19 pandemic, from an average of 39.86 surgeries performed/assisted per month (median 30) to 12.31 per month (median 10), representing a decrease of 67.50%. The number of academic sessions has fallen from a median of 5 per week to 2 per week. The survey uncovered the lack of universal guidelines and homogeneity regarding preoperative COVID-19 testing. The survey also reveals reluctance toward detailed patient examinations since the COVID-19 outbreak. The majority of respondents felt that the COVID-19 pandemic will hamper their operative and clinical skills. Fear of rescheduling or deferring of licensing examinations was significantly higher among those closest to the examination (p = 0.002).CONCLUSIONSThe adverse impact of the pandemic on neurosurgical training needs to be addressed. While ensuring the safety of the residents, institutes and neurosurgical societies/bodies must take it upon themselves to ensure that their residents continue to learn and develop neurosurgical skills during these difficult times.

No abstract

Objective?The aim of the study was to analyze the relationship of cerebral perfusion pressure (CPP) and its relationship to microdialysis (MD) analysates and their role as predictors of outcome in severe traumatic brain injury (TBI). Methods?A total of 41 patients with severe TBI who underwent decompressive craniectomy were prospectively monitored with intracerebral MD catheters. The relation between cerebral perfusion pressure and MD-measured interstitial brain glycerol and lactate-pyruvate ratio (LPR) concentrations was studied. Results?Twenty-six (63.4%) patients had a good outcome in terms of GOS at 6 months whereas the rest (15 patients) had poor GOS at 6 months. There was significant difference in mean CPP values between the two groups (p?=?0.000). In the poor outcome group, the mean LPR was 80.16 as compared with a mean of 45.77 in the good outcome group (p?=?0.00). Taking a cutoff of both LPR??70?mm Hg, a significant difference in outcome was seen (p?=?0.03). Conclusion?CPP seems essential to maintaining normal metabolism. Low CPP values and high ICP values are associated with a poor outcome. MD variables glycerol and LPR are dependent on CPP and are prognostic factors for the outcome.

After decompressive craniectomy in severe TBI, there was a poor correlation between the plasma and CMD glucose concentration. A higher degree of variation was seen in the correlations for individual patients. Neither the mean blood glucose values nor the mean cerebral glucose values predicted the outcome at 3 months. The good outcome group had fewer episodes of both hyperglycemia and hypoglycemia.

No abstract