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BACKGROUND: Most of the scientific and healthcare resources in Mexico are limited to the large major cities. However, many communities with complex socioeconomic and cultural backgrounds have limited access to neurosurgical care. A cross-sectional study aiming to evaluate the population's perception regarding neurosurgical care was conducted. METHODS: A nationwide online survey, conducted starting February 2023, assessed public perception of neurosurgical care. Data analysis was performed based on sociodemographic characteristics such as age, socioeconomic status, religion, and education. Pearson's chi-square and odds ratio were employed for statistical comparisons of categorical variables. RESULTS: A total of 508 participants consented to the survey. Younger participants and higher education levels correlated with greater perceived knowledge about neurosurgery (P = <0.001) and higher confidence in neurosurgical healthcare personnel (P = 0.021 and P = 0.022, respectively). Lower educational levels were prone to perceive neurosurgical care as less safe and effective (P = 0.002) and preferred to seek initial alternative/traditional treatments for neurosurgical issues (P = 0.012). A higher income level was associated with a preference for private healthcare over public services P = <0.001). Odds ratio analysis corroborated these findings. Healthcare personnel emerged as the most common source of information for neurosurgical diseases (71.4%). CONCLUSIONS: Our findings suggest that sociodemographic factors such as age, education, and income correlate with the population's self-perceived knowledge, trust and beliefs about safety and effectiveness regarding neurosurgical care in Mexico. These findings can be instrumental for developing healthcare policies that address the needs of Mexico's patient population.

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BACKGROUND: This analysis provides an overview of neurosurgery residency programs in Latin America; it evaluates strengths, weaknesses, and limitations within the Latin American Federation for Societies in Neurosurgery countries. Considering the shared cultural background between these neighboring countries and globalization of neurosurgical education, similarities in training characteristics and equal opportunities are expected. However, program differences are inevitable and should be investigated to promote collaboration and homogenization of training. METHODS: A 39-item survey was distributed to 970 neurosurgeons and residents in Latin America to assess aspects including working conditions, teaching, research, training, educational opportunities, and socioeconomics. RESULTS: In total, 276 neurosurgeons (28%) from 16 countries completed the survey. The average participant's age was 37 ± 7 years, and the average duration of residency programs was 5 ± 1 years. Trainees participated in around 5-10 cases during the typical 80-100 work hour week. Only 5% of survey respondents had a day off after a night shift, and 60% worked at least 3 night shifts per week. Only 34% had a mentorship program, Morbidity and mortality conferences were reported by 57% and research activities were compulsory in 45%. Satisfaction with evaluation methods was reported in 29%, although 96% reported satisfaction with their training programs overall. CONCLUSIONS: This study is the first of its kind to review neurosurgical training in Latin America's. Suggested areas of improvement include regulation of working hours, implementation of mentorship programs and standardized examinations, protected research time, increased support for conferences, and more opportunities for exchange rotations that will potentially bolster collaboration between programs.

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OBJECTIVE: To determine the feasibility of a Gamma Knife boost after intensity-modulated radiation therapy in combination with multimodal therapy in patients with nasopharyngeal carcinoma and sinonasal malignancies with skull base or cavernous sinus involvement. METHODS: Nine patients were treated with intensity-modulated radiation therapy followed by a Gamma Knife boost. In one case Gamma Knife was given as salvage treatment after resection. Five patients had sinonasal malignancies and 4 had nasopharyngeal carcinoma. The mean radiation therapy dose was 64.3 Gy (range, 54-70 Gy) at 2 Gy per fraction. The median interval from completion of radiation therapy to Gamma Knife boost was 2.2 months (range, 1-4 months). The most common indication for Gamma Knife boost was involvement of the cavernous sinus, which was identified in 7 patients. The median margin Gamma Knife dose delivered was 13 Gy (range, 12-20 Gy), with median prescription isodose of 50%. RESULTS: All patients tolerated the procedure well, with minimal toxicity. Local control rates were achieved in all patients and no acute grade 3-5 toxicity was observed. One patient experienced late grade 4 toxicity, which was potentially attributable to treatment. Distant failure occurred in 3 patients (1 patient with nasopharyngeal carcinoma and 2 patients with sinonasal malignancies). CONCLUSIONS: Planned Gamma Knife boost followed intensity-modulated radiation therapy is feasible, safe, and provides excellent local control in patients with sinonasal malignancies and nasopharyngeal carcinoma, particularly in cases with cavernous sinus involvement. Further follow-up will be necessary to determine the long-term effectiveness and complication profile.

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The rapid development of highly accurate imaging techniques, has led to the discovery of asymptomatic lesions within the pituitary gland that constitute a significant challenge for clinicians and neurosurgeons. These lesions found incidentally are termed incidentalomas and can be observed in approximately 10% of MRI studies performed among healthy subjects. The natural course of these lesions has not been clearly defined. Although some of these masses do not change in size overtime and some may even shrink spontaneously, others have the potential risk to increase in volume and cause symptoms associated with mass effect or hormonal hypersecretion. This review describes the current therapeutic and diagnostic consensus in incidentaloma management, and places special emphasis on hormonal and imaging factors suggestive of high risk tumors.

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El rápido desarrollo y la gran precisión en las técnicas de imagen han fomentado el hallazgo incidental de lesiones asintomáticas de la hipófisis que imponen un reto de manejo tanto para el clínico como para el neurocirujano. Estas masas llamadas incidentalomas se encuentran en cerca de 10% de las resonancias magnéticas realizadas en individuos sanos. Hasta ahora no se conoce con exactitud la historia natural de estas lesiones. Algunas no se modifican con el tiempo, e incluso disminuyen espontáneamente de tamaño, mientras que otras tienen el riesgo de aumentar de volumen y producir síntomas por efectos de masa o hipersecreción hormonal. Esta revisión pretende dar a conocer el consenso actual en cuanto a las estrategias diagnósticas y terapéuticas en el paciente con incidentaloma hipofisario. Se hace énfasis en los factores, ya sea clínicos, bioquímico-hormonales o imagenológicos, que por sí mismos sugieren un alto riesgo de crecimiento tumoral.

The rapid development of highly accurate imaging techniques, has led to the discovery of asymptomatic lesions within the pituitary gland that constitute a significant challenge for clinicians and neurosurgeons. These lesions found incidentally are termed incidentalomas and can be observed in approximately 10% of MRI studies performed among healthy subjects. The natural course of these lesions has not been clearly defined. Although some of these masses do not change in size overtime and some may even shrink spontaneously, others have the potential risk to increase in volume and cause symptoms associated with mass effect or hormonal hypersecretion. This review describes the current therapeutic and diagnostic consensus in incidentaloma management, and places special emphasis on hormonal and imaging factors suggestive of high risk tumors.

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BACKGROUND: Macroprolactinemia is defined as hyperprolactinemia with predominance of the big-big prolactine isoform. Its frequency has not been clearly established due to technical difficulties to identify it. This method used to detect it is gel filtration chromatography, an expensive and complicated procedure that could not be used routinely. OBJECTIVE: To validate the PEG precipitation technique, to identify the presence of macroprolactinemia and to correlate it with the clinical characteristics in a group of pre-selected patients with elevated serum PRL levels from different causes. PATIENTS AND METHOD: There were studied 14 patients non pre-selected with high PRL serum levels. Prolactine levels were determined with commercial immunometric quimioluminescence essays. All the essays were duplicated, and healthy patients serum (without hyperprolactinemia) were used. Technique consists on mixing 250 microL of serum with the same volume of polyethylene glycol. Later it was centrifugated at 3000 rpm during 30 minutes at 4 degrees C. Prolactine level was measured in supernatant. RESULTS: Within patients 7 to 14 macroprolactinemia was ruled out and confirmed truth hyperprolactinemia, some times slight and nontumoral, some times mild, and some times due to prolactin-producer hypophysial macroadenomas. CONCLUSIONS: Polyethylene glycol precipitation technique is reliable to detect macroprolactinemia.

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