Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has an impact also on neurosurgical training and education, especially in most affected countries. We surveyed Italian neurosurgical residents, asking them to provide a brief description and analyze the situation they are experiencing and how the educational system reacted to the pandemic in one of the most affected countries all over the world. Methods An 18-question, web-based survey was administered to Italian neurosurgical residents from May 3 to May 11, 2020, by web-link or e-mail invitation. Closed-ended, multiple choice questions were focused on the experience of neurosurgical residents in the last 2 months (from March to May 2020) concerning both clinical and educational aspects. Results Among 331 Italian neurosurgical residents invited to participate, 192 responded to the survey (58%). According to the participants' responses, in the whole country, only 29.7% of residents were directly involved in the clinical management of COVID-19 patients. Time spent in the clinic and surgical activity was significantly reduced in most of the cases. Educational activities as well as scientific activity and time spent for studying, on the other hand, were reported to be significantly increased by the majority of respondents. Conclusions Most Italian neurosurgical residents reported significant changes on both training and education, highlighting a prompt reaction of the educational system in the whole country, regardless the local and regional diffusion of the pandemic.

The effects of spinal cord stimulation (SCS) on cerebral blood flow (CBF) are well known based on experimental investigations, and its vasodilator effect on peripheral arteries is widely used in clinical settings in the treatment of peripheral vascular disease. Since Hosobuchi’s [Appl Neurophysiol 1985;48:372–376] first observations on the effects of SCS on CBF were published 22 years ago, many advances have been made in understanding SCS-mediated effects on CBF. This paper reviews the main laboratory observations and analyzes the most significant neurophysiological theories on the SCS-mediated effect on CBF. Most significant experimental data have been discussed, with specific reference to possible mechanisms such as ‘functional reversible sympathectomy’, cerebral infarction and related ischemic edema, hemodynamic deterioration in experimental combined ischemic-traumatic brain injury and cerebral vasospasm. The authors revised the published experiences in humans with hypoperfusion syndromes and ‘adjuvant’ locoregional CBF increase in chemotherapy of brain tumors. SCS represents a new perspective in challenging neurosurgical clinical fields such as cerebral ischemia and vasospasm, and seems promising as a new trend of functional neurosurgery in cerebrovascular diseases.

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Chiari I malformation (CI) continues to raise great interest among physicians due to the larger and larger number of newly diagnosed cases. The clinical and radiological picture and the management options of such a chronic disease are well acknowledged as well as those of the associated syringomyelia. Little is known, on the other hand, about abrupt clinical onset following decompensation of CI/syringomyelia complex. This review on the sudden onset of these two conditions shows that this is a very rare phenomenon; only 41 cases are being reported in the last three decades. In all these cases, acute onset was referable to CI/syringomyelia and the clinical course quickly precipitated. Motor deficits (36.5 %), respiratory failure (29 %), cranial nerve palsy (17 %), and cardiac arrest (14.5 %) were the most common findings, thus confirming that abrupt onset may have severe and life-threatening consequences. Indeed, sudden or early mortality accounted for 19.5 % of cases. In spite of that, most of the surviving subjects had an excellent outcome following either surgical or medical/rehabilitation treatment. Physiopathology of abrupt onset is attributed to the acute compression of the brainstem/upper cervical spinal cord by ectopic tonsils and syringobulbia/syringomyelia, frequently precipitated by a minor injury, followed by impairment of medullary baroreceptors and midbrain reticular substance (cardiac arrest, syncope), medullary chemoreceptors and phrenic nerve nuclei (respiratory failure), lower cranial nerve nuclei (cardiac arrest, cranial nerve palsy), and pyramidal tracts (motor deficits). About 87 % of patients of this review were asymptomatic prior to their acute onset. The problem of the management of asymptomatic subjects is still open.