ImportanceHigh-grade gliomas (HGG) are the most aggressive and common malignant brain tumors in adults. They have a dismally fatal prognosis. Even if gross total resection of the enhancing tumor is achieved, inevitably, invading tumor cells that are indistinguishable to the un-aided eye are left behind, which eventually leads to tumor recurrence. 5-aminolevulinic acid (5-ALA) is an increasingly utilized intraoperative uorescent imaging agent for patients with HGG. It enhances visualization of HGG tissue. Despite early promising randomized clinical trial data suggesting a survival bene t for 5-ALA-guided surgery, the growing body of literature must be analyzed to con rm e cacy on patient outcomes. ObjectiveTo perform a systematic review of the literature to evaluate whether there is a bene cial effect upon survival and extent of resection due to the utilization of 5-ALA in HGG surgery. Evidence ReviewLiterature regarding 5-ALA usage in HGG surgery was reviewed according to the PRISMA guidelines. One database, PubMed, was searched for assorted combinations of the keywords "5-ALA," "high-grade glioma," "5-aminolevulinic acid," and "resection" in July 2020 for case reports and retrospective, prospective, and randomized clinical trials assessing and analyzing 5-ALA intraoperative use in patients with HGG. Entailed studies on PubMed and SCOPUS were found for screening using a snowball search technique upon the initially searched PubMed papers. Systematic reviews and meta-analyses were excluded from our PRISMA table . Findings 1,951 previously published studies were screened, 536 of which were further evaluated, and ultimately 45 were included in our systematic review. There were no date restrictions on the screened publications. Our literature search was nalized on July 16, 2020. We found an observed increase in the overall survival (OS) and progression-free survival (PFS) of the 5-ALA group compared to the white light group, as well as an observed increase in the OS and PFS of complete resections compared to incomplete resections. Of the studies that directly compared the use of 5-ALA to white light (13 of the total analyzed 45, or 28.9%), 5-ALA lead to a better PFS and OS in 88.4% and 67.5% of patients, respectively.When the studies that reported postoperative neurologic outcomes of surgeries using 5-ALA vs. white light were analyzed, 42.2% of subjects demonstrated 5-ALA use was associated with less post-op neurological de cits, whereas 34.5% demonstrated no statistically signi cant difference between 5-ALA and without. 23.3% of studies showed that intraoperative 5-ALA guided surgeries lead to more post-op neurological de cits.

Introduction: Neurosurgeons represent 0.5% of all physicians and currently face a high burden of disease. Physician-scientists are essential to advance the mission of National Academies of Science (NAS) and National Institutes of Health (NIH) through discovery and bench to bedside translation. We investigated trends in NIH neurosurgeon-scientist funding over time as an indicator of physician-scientist workforce training. Methods: We used NIH Research Portfolio Online Reporting Tools (RePORTER) to extract grants to neurosurgery departments and neurosurgeons from 1993 to 2017. Manual extraction of each individual grant awardee was conducted. Results: After adjusting for U.S. inflation (base year: 1993), NIH funding to neurosurgery departments increased yearly ( P <0.00001 ). However, neurosurgeon-scientists received significantly less NIH funding compared to scientists (including basic scientists and research only neurosurgeons) (P = 0.09). The ratio of neurosurgeon-scientists to scientists receiving grants was significantly reduced ( P = 0.002 ). Interestingly, the percentage of oncology-related neurosurgery grants significantly increased throughout the study period ( P = 0.002). The average number of grants per neurosurgeon-scientists showed an upward trend ( P <0.001 ); however, the average number of grants for early-career neurosurgeon-scientists, showed a significant downward trend ( P = 0.05 ). Conclusion: Over the past 23 years, despite the overall increasing trends in the number of NIH grants awarded to neurosurgery departments overall, the proportion of neurosurgeon-scientists that were awarded NIH grants compared to scientists demonstrates a declining trend. This observed shift is disproportionate in the number of NIH grants awarded to senior level compared to early-career neurosurgeon-scientists, with more funding allocated towards neurosurgical-oncology-related grants.

Vogt-Koyanagi-Harada (VKH) disease is a T-cellmediated multisystemic autoimmune inflammatory disorder characterized by skin, ocular, auditory, and neurologic involvement. The T-cell-mediated granulomatous intraocular inflammation is responsible for vitritis, disk edema, serous retinal detachments, and eventual sunset glow fundus. 1 T cells target melanocytes, with an ensuing cascade leading to four distinct disease phases as follows: prodromal, uveitis, convalescent, and recurrent. 2 VKH symptoms include headache, meningismus, hearing loss, poliosis, alopecia, and vitiligo. 3 It is most prevalent in Asians, Native Americans, Hispanics, and Middle Easterners. If promptly and adequately treated, patients can experience good outcomes and avoid complications including sunset glow fundus, cataracts, glaucoma, subretinal fibrosis, and choroidal neovascularization. Some studies have reported the link between some viral infections such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) and the development of VKH. It has been postulated that similarity between peptides on melanocytes and some exogenous viral peptides lead to adverse T cells attacks on melanocytes-containing tissues and lead to the symptoms seen in VKH. 4 We report a case of a VKH syndrome in a patient diagnosed with COVID-19. | CASE REPORTA 27-year-old male patient with no significant past medical history presented with a two-week history of intermittent unilateral headache, bilateral eye pain with photophobia, and phonophobia, followed by tinnitus and blurry vision, which ultimately progressed to total bilateral vision loss. His initial physical examination was unremarkable including vitals, except for total bilateral visual loss with preserved light perception. An ophthalmologic examination revealed normal intraocular pressure and panuveitis with serous retinal detachments bilaterally.The patient was admitted for further evaluation. Infectious work-up revealed positive COVID-19 PCR. Other infectious and metabolic panels were unremarkable. Cerebrospinal fluid studies (CSF), venereal disease research laboratory test (VDRL), fluorescent treponemal antibody absorption test (FTA), QuantiFERON gold, flow cytometry, cytology, and cultures were all negative, except for moderate pleocytosis with lymphocytic predominance

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