No abstract

No abstract

No abstract

We thank Dr. Herrera-Martinez and colleagues for their thoughtful Letter to the Editor following the publication of our article. Their letter further highlights critical aspects of the problem of sexual harassment in neurosurgery as well as the negative impact on individuals and the healthcare system. We are in full agreement with this statement: "Because harassment is a problem that is rarely discussed, we should encourage the medical community to foster education among students, trainees, and surgeons about each phase of harassment to be able to identify it and to have clear protocols when harassment occurs." The published data will certainly help to make all aware of the extent of this issue. Already, new policies have been written to address the issue, and organized neurosurgery has clearly shown they will face the problem and find effective solutions.

No abstract

Highlights This manuscript will provide new evidence regarding the results of the highest quality evidence (systematic reviews and meta-analysis), on a topic of public interest in neuroscience (mental health), based on a publication made in your prestigious journal.

No abstract

To the Editor:We read with great interest the article published by Broocks et al 1 titled "Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake," which was recently published in Neurosurgery. The authors conducted a study in which they found that quantitative measurements of net water uptake (NWU) based on computed tomography (CT) are an important marker for the early prediction of malignant cerebral edema (MCE) in patients who suffered a posterior circulation infarction (POCI). During their analysis, they obtained a high predictive value with an area under the curve of 0.94, a sensitivity of 94.3%, and a specificity of 82.6%, concluding that this parameter could help to identify patients at risk of presenting with MCE earlier and thus to have strict control with more timely and precise therapeutic measures. We appreciate the attempt of Broocks et al 1 to find new diagnostic and predictive methods for the management of MCE in patients with POCI.Although POCI is rare (about 3% of all ischemic accidents), 2 MCE is a relatively frequent complication within this subgroup, with an incidence ranging from 10% to 54%. 3,4 For the management of this condition, decompressive craniectomy is the intervention of choice in those institutions that do not count on modern equipment, 5 and, therefore, the only available solution is a highly invasive intervention. For this reason, it is imperative to seek diagnostic tools for the timely prediction of this complication, which will facilitate its management and allow an increase in the survival of those affected. This is especially true in regions in which the health system lacks resources for the care, diagnosis, timely, and effective treatment of these pathologies, such as developing countries, where specialized stroke care units are scarce or nonexistent. Besides, this type of study supports the need to invest in infrastructure in the health area too, because of the benefits granted by having specialized units in the management of conditions that carry a high burden of morbidity and mortality, and that helps to carry out quality research.Since the arrival of the patient at the health institution, data such as the time elapsed since the beginning of the injury and high scores on the scale of strokes, and even a high hypodensity that occupies more than two-thirds of the territory of the involved artery in a CT, 4,6 are variables used for the prediction of MCE in patients with infarction of other brain zones, which could be applied and studied in patients with POCI, to evaluate whether these variables impact on the final results of a stroke, regardless of the established therapy.Another very interesting tool for the early prediction of MCE is the whole-brain CT perfusion (WB-CTP). Fabritius et al 2 in the