Reappraisal of the anatomy of the frontotemporal branches of the facial nerve.

Objective: The anatomy of the temporal branches of the facial nerve (FN) has been widely described in the neurosurgical literature because of its relevance in anterolateral approaches to the skull base and implication in frontalis palsies from these approaches. In this study, the authors attempted to describe the anatomy of the temporal branches of the FN and identify whether there are any FN branches that cross the interfascial space of the superficial and deep leaflets of the temporalis fascia.

Methods: The surgical anatomy of the temporal branches of the FN was studied bilaterally in 5 embalmed heads (n = 10 extracranial FNs).

Do social determinants of health impact access to neurosurgical care in the United States? A workforce perspective.

Objective: This study attempts to use neurosurgical workforce distribution to uncover the social determinants of health that are associated with disparate access to neurosurgical care.

Methods: Data were compiled from public sources and aggregated at the county level. Socioeconomic data were provided by the Brookings Institute.

Magnesium Levels and Diastolic Blood Pressure (DBP) as a Vasospasm Prediction Metric in Patients With Aneurysmal Subarachnoid Hemorrhage (SAH).

Introduction Vasospasm is a significant cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to evaluate a possible link between vasospasm in patients with aneurysmal SAH and magnesium and blood pressure levels. Methods Subjects were selected based on chart review of patients presenting to a comprehensive stroke center in Southern California with aneurysmal SAH.

Neuropsychological Functioning in Primary Dystonia: Updated and Expanded Multidomain Meta-Analysis.

Background: Primary dystonia is conventionally considered as a motor disorder, though an emerging literature reports associated cognitive dysfunction.

Objectives: Here, we conducted meta-analyses on studies comparing clinical measures of cognition in persons with primary dystonia and healthy controls (HCs).

Methods: We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO (January 2000-October 2020).

The Impact of the COVID-19 Pandemic on Resident Physicians Well-Being in the Surgical and Primary Care Specialties in the United States and Canada.

Purpose:  The COVID-19 pandemic disrupted the professional, social, and spiritual activities of resident physicians around the world, impacting wellness and personal relationships. Moreover, social distancing caused significant limitations or shutdown of places of worship, including churches, synagogues, mosques, etc. Our goal was to survey resident physicians in primary care and surgical subspecialties in the United States (U.

Correction: Predictive Value of Credit Score on Surgery Resident and Fellow Academic and Professional Performance.

[This corrects the article DOI: 10.7759/cureus.15946.

Malignant lymphomatous invasion of Meckel's cave: pathoanatomical considerations of the petrous apex.

Secondary central nervous system lymphoma is rare, occurring in up to 10% of non-Hodgkin's lymphoma patients and in 5% of diffuse large B-cell lymphoma patients. The prognosis is poor, even rarer is metastasis of large B-cell lymphomas into Meckel's cave and the trigeminal nerve roots. We describe a relapsing case of a large B-cell lymphoma that migrated into Meckel's cave, the mandibular branch of the trigeminal nerve and the adjacent cavernous sinus.

Reliability of self-report versus the capacity to consent to treatment instrument to make medical decisions in brain metastasis and other metastatic cancers.

Objective: To evaluate the ability of persons with metastatic cancer to self-assess their medical decision-making capacity (MDC). To investigate this, we compared an objective measure of MDC with self-ratings and evaluated predictors of agreement.

Methods: Data were obtained from a cross-sectional study of metastatic cancer patients at a large academic medical center.

Perioperative Positioning in Neurosurgery: A Technical Note on Park Bench Positioning for the Obese Patient Using the "Arrowhead" Technique.

Complex neurosurgical procedures, such as those traversing the posterior fossa, require optimization of the operative corridor with advanced patient positioning methods. Even seemingly small changes in the location of intracranial mass lesions can require a more dramatic operative trajectory. Modifications of traditional lateral, semi-sitting, and park-bench approaches have been described in the literature to access these lesions; however, technical considerations with respect to enlarged body habitus have yet to be fully explored.

Myeloneuropathy in the Setting of Hypocupremia: An Overview of Copper-Related Pathophysiology.

A posterior cord or dorsal column myelopathy due to neurosyphilis presenting as a tabetic gait is a classic neurological vignette and is taught to all medical students. Its clinical presentation is so graphic that its simulacrum with diseases other than neurosyphilis is labeled as pseudotabes. The latter can be seen with vitamin B12 deficiency as a subacute combined degeneration (SCD) of the spinal cord, another neurology classic.

Predictive Value of Credit Score on Surgery Resident and Fellow Academic and Professional Performance.

Introduction Surgical specialties consistently remain among the most competitive residency and fellowship programs with some of the highest rates of unmatched applicants. Attrition in surgical specialties is as high as 30% and particularly problematic given the extended duration of training and limited number of positions. Applicants are traditionally evaluated using a streamlined set of objective metrics, such as board scores, class rank, leadership, letters of recommendation, research productivity, and volunteerism.

Isolated Double-Positive Optic Neuritis: A Case of Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody Seropositivity.

Optic neuritis (ON) causes acute vision loss with typical and atypical profiles, serological markers, imaging findings, and clinical outcomes depending on the associated underlying pathophysiology. Neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are the usual causes of acute severe sequential or simultaneous bilateral optic neuritis. These conditions are usually accompanied by multi-level spinal cord demyelination, and notably, they are typically positive for either NMO or Myelin oligodendrocyte glycoprotein (MOG) autoantibodies, but rarely both.

Steroid-Resistant Double-Seronegative Optic Neuritis Responds Favorably to Plasma Exchange.

The clinical presentation of optic neuritis is quite characteristic, and the epidemiology, differential diagnosis, and treatment protocol are well established. However, when the presentation of optic neuritis is atypical, bilateral, and intravenous steroid-resistant, the treatment guidelines are quite nebulous. We present a case of bilateral severe double-seronegative optic neuritis with catastrophic vision loss and intravenous steroid resistance.

Nonmissile penetrating head injury with a wooden table leg: An illustrative case.

Penetrating head injuries are relatively uncommon and require a unique approach. This report highlights a previously unreported mechanism of injury with a table leg and the steps required to evaluate and promptly treat the patient.

Branchial Cleft Cyst Harbors Metastatic Papillary Thyroid Carcinoma.

Branchial cleft cysts are congenital anomalies which develop in utero, most commonly arising from the second branchial cleft. They are often asymptomatic lateral neck masses but can enlarge and become symptomatic in the setting of infection. The cystic cavity can form a potential space which can harbor infection and, in rare cases, malignant spread of primary tumors.

Thoracic Osteomyelitis and Eustachian Valve Endocarditis: A Case Report and Literature Review.

Infective endocarditis and vertebral osteomyelitis are rare infections, most commonly caused by methicillin-sensitive (MSSA). The eustachian valve is an embryological remnant of the inferior vena cava that has the potential to harbor a nidus leading to infective endocarditis. Eustachian valve endocarditis has been documented in the literature on less than 50 occasions and has yet to be documented in the presence of concomitant vertebral osteomyelitis.

Atypical Neuroleptic Malignant Syndrome in the Setting of Quetiapine Overdose: A Case Report and Review of the Literature.

Neuroleptic malignant syndrome (NMS) is a rare and life-threatening emergency. The condition is largely iatrogenic and is often precipitated by medications such as antipsychotics. First-generation antipsychotics are more likely to cause NMS than second-generation antipsychotics.

Medical Simulation-Based Learning Outcomes in Pre-Clinical Medical Education.

Introduction Medical simulation is widely used in the United States medical curriculum. However, learning outcomes based on simulation have yet to be reported. In this study, we aim to characterize the objective performance of first- and second-year medical students following eight weeks of medical simulation-based learning.

Transtentorial Approach to Parahippocampal Lesions: A Technically Challenging Approach for Preserving Temporal Lobe Structures.

In this installment of the Neurosurgical Atlas Series for WORLD NEUROSURGERY, the authors examine the paramedian supracerebellar transtentorial (SCTT) approach as a means of accessing the basal posteromedial temporal lobe for both intradural and extradural lesions. While other approaches, such as the subtemporal, transtemporal, and transsylvian routes, are often used to reach this otherwise impervious region, all of them do so at the expense of supratentorial structural integrity. Despite the long and narrow working distance provided by the SCTT approach, the access it provides to critical, deep-seated regions with little to no associated morbidity makes it our preferred approach in these patients.

Nitrous Oxide Induced Posterior Cord Myelopathy: Beware of the Methyl Folate Trap.

Posterior cord myelopathy and subacute combined degeneration of the spinal cord are well-known complications of nitrous oxide abuse. Supplementation with vitamin B12 is an effective treatment strategy to correct low serum B12 levels or normal serum levels of dysfunctional vitamin B12 associated with this pathology. In this case, we report a patient with a one-year history of heavy nitrous oxide consumption; anywhere from eight to 30 canisters of 8 grams of nitrous oxide daily.

Bilateral Orbital Metastases Masquerading as Ocular Myasthenia Gravis: A Case Report and Review of the Literature.

Ocular myasthenia gravis and orbital metastases have overlapping symptoms but divergent diagnostic and treatment strategies. Here, we present a 58-year-old female, with a 20-year history of advanced metastatic breast cancer, who presented to the neurology clinic with fatigue, muscle weakness, bilateral ptosis, and diplopia that worsened throughout the day. While the initial presentation was consistent with ocular myasthenia gravis, a subsequent evaluation revealed bilateral metastatic lesions of breast origin within the orbits.

Capacity to consent to research participation in adults with metastatic cancer: comparisons of brain metastasis, non-CNS metastasis, and healthy controls.

Background: To evaluate the ability of individuals with metastatic cancer to provide informed consent to research participation, we used a structured vignette-based interview to measure 4 consenting standards across 3 participant groups.

Methods: Participants included 61 individuals diagnosed with brain metastasis, 41 individuals diagnosed with non-CNS metastasis, and 17 cognitively intact healthy controls. All groups were evaluated using the Capacity to Consent to Research Instrument (CCRI), a performance-based measure of research consent capacity.

Trauma and Triage: Applying the Dick and Carey Instructional Design Model to a Primary Survey Clinical Workshop.

Instructional design in the setting of medical education can be challenging. Multiple instructional design methods exist and have been documented in the literature. However, detailed applications of these models in the context of medical education are underreported.

Autoantibody-Negative Immune-Mediated Necrotizing Myopathy Responds to Early and Aggressive Treatment: A Case Report.

Immune-mediated necrotizing myopathy (IMNM) is a rare idiopathic disease that is further classified by the presence of serum antibodies. A modicum of patients lack serum autoantibodies. Significantly elevated creatine kinase (CK) is highly characteristic of IMNM.