BACKGROUND: This historical account reviews the course and lasting impact of Dr. Harvey Cushing (1869-1939) in neurosurgery. METHODS: The writing of this project was sparked by the discovery of original scientific and bibliographical information about Cushing. It is a thorough review of archival documents about Harvey Cushing and the Cushing family. RESULTS: Harvey Cushing received his early schooling at the Cleveland Manual Training School, which provided him early access to science and developed his manual dexterity. Along with obtaining a degree at Yale University and training at both Harvard Medical School and The Johns Hopkins Hospital, Cushing collaborated with Louise Eisenhardt, Riva Rocci, Ivan Petrovich Pavlov, William Stewart Halstead, and Sir William Osler. Cushing wrote several monographs including Blood Vessel Tumours of the Brain, The Pituitary Body and its Disorders, and Tumors of the Nervus Acousticus. Cushing served in the U.S. Army Medical Corps, worked as the surgical unit head for a French military hospital, and treated Lieutenant Edward Revere Osler. Cushing's armamentarium included electromagnets for brain surgery. He was elected to the American Academy of Arts and Sciences and received various accolades. Cushing trained CONCLUSIONS: This historical reconstruction provides glimpses into the personality of Dr. Harvey Cushing and his marked impact on neurosurgery and adds to the growing literature on his person.

BACKGROUND AND OBJECTIVE:Birth defects occur more often in low-income and middle-income countries. This study delineates the epidemiology of myelomeningocele (MMC) patients presenting to the Bernard Mevs Hospital (HBM) in Haiti. METHODS:Pediatric patients with MMC at HBM between 2018 and 2022 were reviewed, and statistical analyses were performed. RESULTS:The study included 54 spina bifida patients with a mean age of 1.2 ± 2.4 months, predominantly male (64.8%, n = 35). The prevalence from 2018 to 2022 was approximately 0.4 cases per 10 000 live births. Half of the patients (50.0%, n = 27) had a birth weight of 2500 to 4000 g. Hydrocephalus was commonly associated, present in 55.6% (n = 30) of patients. Lumbar defects were most frequent, found in 63% (n = 34) of cases. The average hospital stay was 31.3 ± 43.5 days, with 94.4% (n = 51) showing clinical improvement; there were 3 deaths (5.6%). Regarding timing of intervention, 25.9% (14/54) underwent early repair and 74.1% (40/54) late repair. Hydrocephalus was present in 64.3% of the early group and 52.5% of the late group (P = .652). Favorable postoperative results were slightly lower in the early group (85.7% vs 97.5%, P = .328). Folate supplementation was reported in 44.4% (n = 24) of mothers, and unemployment was common among parents, with 42.6% of mothers and 31.5% of fathers being unemployed. CONCLUSION:The study highlights the epidemiology of MMC at HBM, with a high prevalence of hydrocephalus and lumbar defects. Shorter postoperative stays were linked to better outcomes. The findings highlight the need for improved prenatal care, folate supplementation, and addressing socioeconomic challenges to improve outcomes.

Tourette’s syndrome is a neuropsychiatric disorder characterized by formidable motor and vocal tics. Many individuals also present with comorbid neuropsychiatric conditions. Though patients often benefit from pharmacological and behavioral therapies, a subset of individuals develop severe, treatment-resistant symptoms that might necessitate more invasive interventions, such as Deep Brain Stimulation (DBS). DBS, particularly targeting regions like the globus pallidus internus (GPi) and the centromedian-parafascicular complex (CM-Pf) of the thalamus, has demonstrated effectiveness in reducing tic severity and improving quality of life. This review outlines the mechanism, clinical efficacy, and long-term outcome of DBS in TS. Results from clinical studies reveal significant reductions in tics. However, success with DBS is variable depending on a number of factors, including target selection and electrode placement. The use of DBS has ethical considerations, which include risks to the surgical procedure, the need for full and complete informed consent, and questions about the implications of such treatment on cognitive and emotional growth. Long-term follow-up will be required to ensure appropriate patient outcomes and complication management. Additional research and ethical debate will be needed with advancing DBS technology to ensure responsible and equitable treatment. This paper narratively summarizes the surgical options available for TS, with a focus on the current status of DBS in the management of the disease.

Background: This historical account reviews the life and times of Mildred Codding (1902-1991) in neurosurgery and medical illustration. Methods: The writing of this project was sparked by the discovery of original scientific and bibliographical information about Codding, testimony on personal relationships, and viewpoints after comprehensive compilation of information. Results: Mildred Codding learned the carbon dust technique from Max Br & ouml;del at the Johns Hopkins Hospital (Baltimore, Maryland USA), and worked at Peter Bent Brigham Hospital, now Brigham and Women's Hospital (Boston, Massachusetts, USA). Codding was Dr. Cushing's medical illustrator, colleague, and friend. She provided photographs, diagrams, and sketches for the majority of Cushing's collection of intracranial tumors from 1929 to 1932. A 1991 interview of Codding was hosted by Brigham and Women's Hospital and Boston Children's Hospital for the permanent collection of the Archives of the American Association of Neurologic Surgeons and provides additional photographs and insignia, drawings with pen and ink method, multistepped layering, and illustration implements. Importantly, the Brigham Surgical Alumni insignia showing a surgeon's hand with scalpel was modeled after Codding's left hand. Outside of the operating room, Codding's interests included Pediatrics, Zoology and Genetics, atlantes of surgical operations, teatime, and paint with watercolor, particularly seascapes, lighthouses and dunes. Conclusions: This article provides glimpses into the personality and marked influence of Mildred Codding on neurosurgery and medical education and adds to the growing literature on her person.

Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality, with approximately 69 million individuals affected globally each year, particularly in low- and middle-income countries (LMICs) where neurosurgical resources are limited. The neurocognitive consequences of TBI range from life-threatening conditions to more subtle impairments such as cognitive deficits, impulsivity, and behavioral changes, significantly impacting patients’ reintegration into society. LMICs bear about 70

The author wished to detail the life and contributions of Dr. Adelola Adeloye, MBBS, MS, FWCS, FRCS, FACS, FRCP, in hope to pay homage to this giant in Global Neurosurgery. Dr. Adelola Adeloye was born on July 18, 1935 in Illesa, Osun State, present-day South-West Nigeria. The Adeloye-Odeku disease is an eponym for a congenital dermoid or epidermoid inclusion cyst (CDIC/CEDIC) over the anterior fontanelle and below the galea aponeurotica. In 1971, Adeloye and Odeku first described these cysts in 18 Nigerian patients. While overall rare and predominantly noted in children, the Adeloye-Odeku disease has been found to impact adults too. In terms of rarity, CDICs make up 0.1–0.5

Deep brain stimulation (DBS) is a neurosurgical procedure that utilizes implanted electrodes and electrical stimulation for the treatment of neurological disorders. In cases where patients present with severe functional impairment while being refractory to less invasive treatment options, DBS is considered “gold standard.” Still, DBS-related work is still widely under investigation, with ethical issues arising that may impact a patient’s physical and psycho-social status. These include patient selection, informed consent, patient autonomy, pre-operation counseling and professional psycho-social preparation and follow-up support. Bioethicists and philosophers have increasingly worked together with in clinicians and researchers to identify, address and present ethical consideration in both clinical practice and research to balance the risk–benefit ratio in DBS treatment for obsessive-compulsive disorder.

Occipital lobe epilepsy (OLE) is an uncommon type of extratemporal epilepsy constituting roughly 2–13

In 2020, realizing that a President was not immune to a public health emergency, United States Speaker of the House Nancy Pelosi recommended the passing of a Bill (Raskin J (2021) A Bill To establish the Commission on Presidential Capacity to Discharge the Powers and Duties of the Office, and for other purposes. 116th Congress, 2nd Session. https://raskin.house.gov/sites/raskin.house.gov/files/Commission ) that would create a bipartisan group of experts to evaluate the Commander-in-Chief’s mental and physical health and advise Congress on whether a President could be demoted under the 25th Amendment. Neurosurgeons are equipped to advice Congress in the advent of such a need. The authors aimed to provide a brief history of the 25th amendment during US history and implications for neurosurgeons within the jurisdictions of US Congress.

In this review, the author highlights the role of IL4 in mitigating all the “hallmarks” of cancer growth and resistance to current immunotherapy, providing a framework for its role in GBM as well as guideline for future treatment regimens. This review is organized around six strategies by which IL4 contributes to the immune resistance seen in GBM: (i) apoptosis evasion, (ii) self-sufficiency in growth signals, (iii) insensitivity to anti-growth signals, (iv) invasion and metastasis, (v) limitless replicative potential, (vi) sustained angiogenesis.

The authors propose the generation of a multi-institutional TBI registry. Barriers to registry implementation include: (1) difficulties in acquiring ethical approval; (2) incomplete clinical data available; (3) lack of information and insufficient technology (IT) support; (4) limited available resources; (5) time constraints involving understaffing yet managing high patient volumes; (6) time constraints associated with entering patient data into the registry tool. The authors detail the current state of affairs on neurotrauma registries worldwide and propose the creation of a multi-institutional, global neurotrauma registries. This private-public partnership will enable appropriate balance among stakeholders while offering care to the largest number of citizens. This initiative will require coordinated efforts involving vetted members of organized neurosurgery. Support from these entities, such as fellowship program creation, provided funding through travel vouchers to LMICs, secured housing and transportation costs in LMI nations, facilitated meetings with global local stakeholders, and promotion of key developments via social media, will accelerate the creation of this global neurotrauma registry. We propose the creation of a global TBI registry, in partnership with large, academic medical centers. Several proposed limitations of registry implementation can be addressed with support from local stakeholders, including government officials and administrative members at key institutions. Several American institutions have well-established global health programs to support this initiative. Further, at Harvard Medical School, the program in Global Surgery and Social Change offers the Paul Farmer Global Surgery Fellowship that trains leaders in policy development and implementation. The fellowship consists of 2 separate tracks: a 2-year research fellow (PGY-5—PGY-6) and 1-year research associate (MD and MBBS, etc.). Funding could be allocated towards creating a year-long fellowship dedicated towards implementing a neurotrauma registry, with this selected scholar granted the resource and connections to network with government officials and healthcare groups in every nation within that jurisdiction. A scholar would be assigned a region of the world with the goal to generate a registry that would later be combined with those generated by peer scholars. In addition, we propose the creation of a fund, controlled by donors, as a funding model.

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

Tourette's syndrome is a neuropsychiatric disorder characterized by formidable motor and vocal tics. Many individuals also present with comorbid neuropsychiatric conditions. Though patients often benefit from pharmacological and behavioral therapies, a subset of individuals develop severe, treatment-resistant symptoms that might necessitate more invasive interventions, such as Deep Brain Stimulation (DBS). DBS, particularly targeting regions like the globus pallidus internus (GPi) and the centromedian-parafascicular complex (CM-Pf) of the thalamus, has demonstrated effectiveness in reducing tic severity and improving quality of life. This review outlines the mechanism, clinical efficacy, and long-term outcome of DBS in TS. Results from clinical studies reveal significant reductions in tics. However, success with DBS is variable depending on a number of factors, including target selection and electrode placement. The use of DBS has ethical considerations, which include risks to the surgical procedure, the need for full and complete informed consent, and questions about the implications of such treatment on cognitive and emotional growth. Long-term follow-up will be required to ensure appropriate patient outcomes and complication management. Additional research and ethical debate will be needed with advancing DBS technology to ensure responsible and equitable treatment. This paper narratively summarizes the surgical options available for TS, with a focus on the current status of DBS in the management of the disease.

Rathke’s cleft cysts (RCCs) are benign, non-neoplastic lesions located in the sellar and suprasellar regions of the brain, originating from remnants of Rathke’s pouch, an embryonic precursor to the anterior pituitary gland. Although RCCs are frequently asymptomatic and discovered incidentally during imaging studies, they can present with a variety of symptoms, including headaches, visual disturbances, and endocrine dysfunction due to the compression of adjacent neural structures. The management of RCCs is particularly challenging, as the decision to pursue conservative monitoring or surgical intervention depends heavily on the cyst’s size, growth potential, and the severity of symptoms. Transsphenoidal surgery is the primary treatment for symptomatic RCCs, offering effective relief from symptoms through decompression of the cyst. However, recurrence remains a significant issue, with rates reported up to 33

Vein of Galen malformations (VOGMs), also known as Vein of Galen Aneurysmal Malformations (VGAMs), are rare and complex cerebrovascular anomalies that pose significant diagnostic and therapeutic challenges. These malformations result from abnormal arteriovenous shunts during embryonic development, leading to a range of severe clinical manifestations, including high-output cardiac failure and hydrocephalus. Advances in prenatal imaging, particularly fetal MRI, have improved early detection, allowing for timely intervention. Endovascular techniques, especially transarterial embolization, have become the primary treatment modality, often preferred over surgical approaches due to their effectiveness and lower risk. However, challenges remain, particularly in managing these malformations in neonates and infants, where the risk of complications is high. Gamma Knife radiosurgery offers a non-invasive alternative for select cases, though its effects are gradual and may carry delayed risks. Despite advancements, the management of VOGMs continues to require a multidisciplinary approach, with ongoing research focused on improving outcomes through a better understanding of the genetic and molecular underpinnings of the disease. Future directions include the integration of genetic studies into clinical practice and the refinement of treatment strategies to optimize outcomes for this complex condition.

Deep Brain Stimulation (DBS) has emerged as a revolutionary neurosurgical technique with significant implications for the treatment of various neuropsychiatric disorders. Initially developed for movement disorders like Parkinson’s disease, DBS has expanded to psychiatric conditions such as obsessive-compulsive disorder, depression, anorexia nervosa, dystonia, essential tremor, and Tourette’s syndrome. This paper explores the clinical efficacy and ethical considerations of DBS in treating these disorders. While DBS has shown substantial promise in alleviating symptoms and improving quality of life, it raises ethical challenges, including issues of informed consent, patient selection, long-term management, and equitable access to treatment. The irreversible nature of DBS, potential adverse effects, and the high cost of the procedure necessitate a rigorous ethical framework to guide its application. The ongoing evolution of neuromodulation requires continuous ethical analysis and the development of guidelines to ensure that DBS is used responsibly and equitably across different patient populations. This paper underscores the need for a balanced approach that integrates clinical efficacy with ethical considerations to optimize patient outcomes and ensure sustainable practice.

Neural tube defects (NTDs), such as spina bifida and anencephaly, are severe congenital anomalies affecting the development of the brain and spine. These conditions are often linked to folic acid deficiency during early pregnancy, a modifiable risk factor. While high-income countries have implemented mandatory folic acid fortification in staple foods, resulting in significant reductions in NTD prevalence, low- and middle-income countries (LMICs) continue to experience disproportionately high rates of these birth defects. Folic acid supplementation and fortification are proven interventions for preventing NTDs, but many LMICs face political, financial, and logistical barriers to implementing these programs. This paper highlights the importance of mandatory folic acid fortification as a cost-effective public health intervention and advocates for its expansion in LMICs. It reviews the successes of fortification programs in high-income countries, explores alternative food vehicles like rice for regions with different dietary staples, and discusses the potential of multi-nutrient fortification strategies. Additionally, this paper emphasizes the need for global collaboration, enhanced monitoring and evaluation, and public health education campaigns to ensure that women of reproductive age, especially in LMICs, receive adequate folic acid. By addressing these challenges, the global health community can significantly reduce the incidence of NTDs, improve maternal and child health, and promote health equity worldwide. The time to act is now, as the benefits of folic acid fortification far outweigh the costs of inaction.

Despite unprecedented survival in patients with glioblastoma (GB), the aggressive primary brain cancer remains largely incurable and its mechanisms of treatment resistance have gained particular attention. The cytokine interleukin 6 (IL-6) and its receptor weave through the hallmarks of malignant gliomas and may represent a key vulnerability to GB. Known for activating the STAT3 pathway in autocrine fashion, IL-6 is amplified in GB and has been recognized as a negative biomarker for GB prognosis, rendering it a putative target of novel GB therapies. While it has been recognized as a biologically active component of GB for three decades only with concurrent advances in understanding of complementary immunotherapy has the concept of targeting IL-6 for a human clinical trial gained scientific footing.

Liquid biopsy, the process of identifying circulating biomarkers in patients with cancer, has emerged as clinically significant in population screening, tumor status subclassification, and individualized patient treatment from tumor genotyping. While advances in genome sequencing and mass spectrometry have yielded large datasets available for mining and identified promising biomarkers in breast, melanoma, and lung cancers, among others, challenges persist in identifying biomarkers in neuro-oncology. Despite growing efforts in biomarker research and promise in their emergent clinical potential, there presently exists no validated circulating biomarker test for patients presenting with gliomas, the most common primary brain cancer.