OBJECTIVENeuronavigation has become a crucial tool in the surgical management of CNS pathology in higher-income countries, but has yet to be implemented in most low- and middle-income countries (LMICs) due to cost constraints. In these resource-limited settings, neurosurgeons typically rely on their understanding of neuroanatomy and preoperative imaging to help guide them through a particular operation, making surgery more challenging for the surgeon and a higher risk for the patient. Alternatives to assist the surgeon improve the safety and efficacy of neurosurgery are important for the expansion of subspecialty neurosurgery in LMICs. A low-cost and efficacious alternative may be the use of intraoperative neurosurgical ultrasound. The authors analyze the preliminary results of the introduction of intraoperative ultrasound in an LMIC setting.METHODSAfter a training program in intraoperative ultrasound including courses conducted in Dar es Salaam, Tanzania, and Aurora, Colorado, neurosurgeons at the Muhimbili Orthopaedic and Neurosurgical Institute began its independent use. The initial experience is reported from the first 24 prospective cases in which intraoperative ultrasound was used. When possible, ultrasound findings were recorded and compared with postoperative imaging findings in order to establish accuracy of intraoperative interpretation.RESULTSOf 24 cases of intraoperative ultrasound that were reported, 29.2% were spine surgeries and 70.8% were cranial. The majority were tumor cases (95.8%). Lesions were identified through the dura mater in all 24 cases, with 20.8% requiring extension of craniotomy or laminectomy due to inadequate exposure. Postoperative imaging (typically CT) was only performed in 11 cases, but all 11 matched the findings on post–dural closure ultrasound.CONCLUSIONSThe use of intraoperative ultrasound, which is affordable and available locally, is changing neurosurgical care in Tanzania. Ultimately, expanding the use of intraoperative B-mode ultrasound in Tanzania and other LMICs may help improve neurosurgical care in these countries in an affordable manner.

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Generally, giant cell tumors are rare and their localization in the spine is even more so. They are locally aggressive leading to spine instability and neurologic deficits. Radical excision is highly advocated. A role of radiotherapy in these tumors is controversial. We report the case of a giant cell tumor localized in D1 and D2 on a 39-year-old patient, presented with interscapular back pain, paraparesis grade 3/5 and sphincter dysfunction. Thoracic spine computed tomogarphy and magnetic resonance imaging showed a vertebral body tumor in D1 and D2, compressing the spinal cord at the same level. The patient initially underwent decompressive laminectomy of affected levels and stabilized with laminar hooks and rods. Second surgery performed through an anterior approach whereby tumor excision together with corpectomy of D1 and D2 carried out, autograft was placed and plate applied. Three weeks postoperatively, the patient's neurologic deficit recovered fully and back pain subsided.

Background: Gliomas are the most common solid malignant tumors of the brain; diffuse gliomas pose a remarkable conundrum on treatment strategy. WHO Grade IV (Glioblastomas) delineate a refractory resistance to treatment even with standard combination regimen therapy of surgery, chemotherapy and radiation therapy causing increased recurrence rate with a median survival of less than one year. Management of gliomas is precluded by several factors including intra and inter tumoral heterogeneity, genomic landscape and microenvironment immunosuppression ability, which spell the inflicted pathways that counteract the therapeutic interventions. This is systematic review aiming to evaluate the effect of Tumor Mutation Burden (TMB) and Tumor Microenvironment (TME) as biomarkers of treatment outcome and prognosis of gliomas. Methods and Analysis: This systematic Review and Meta-analysis will consider the PRISMA 2020 guideline correspondence. For source of literature evidence several electronic databases including EMBASE, PubMed, Cochrane Library, SCOPUS, Web of Science, Semantic Scholar and Google scholar will be searched. All non-RCTs peer reviewed original research articles addressing the prognostic role of tumor mutation burden, tumor mutation pathways, microenvironment will be included, and data will be extracted using the Ms Excel Sheets. Studies with homogeneity and low risk of bias according to NOS 4-9 will constitute a Meta-analysis for evaluating the effect of TMB, Mutation pathways and Microenvironment for treatment outcome and prognosis of glioma. Ethical Consideration and Dissemination: Ethical approval does not apply for there is no human participant involvement in this review study .The findings of this study will be disseminated at scientific conferences and the manuscript for publication will be submitted for publication to a reputable peer reviewed journal of Neurosurgery. This review was registered at PROSPERO CRD42022377829.

Introduction Despite the broad spectrum of neurological symptomatic manifestation in COVID19 patients, the brain tissue susceptibility and permissiveness to SARS-Cov2 infection is yet uncertain. This critical appraisal aims at bridging the gap by consolidating the body of evidence for meticulous evaluation of molecular neuropathological pathways and CSF diagnostic signatures of SARS-Cov2 infection in the central nervous system (CNS) that will underpin further strategic approach for neuroprotection and treatment of neurological COVID19 Methods and Analysis We have developed the protocol of this review according to the provisions of Joanna Briggs Institute Reviewer Manual for Evidence Synthesis ,2015 and Arksey and O Malley Methodological Framewotk ,2005.The articles for this review will be sourced from several electronic databases including EMBASE, PubMed, Scopus, Web of Science (WOS), Cochrane, Crossref Metadata and Semantic scholar. Herein we generated the search strategy using the medical subject headings [ MeSH Terms] , term in all field bibliography at all permutations in conjunctions with boolean operators Ethical Clearance and Dissemination plan Herein the review will not involve the human participants henceforth the ethical clearance approval is not applicable .We will disseminate the final findings of this review to scientific conferences at local and international level. The manuscript for final findings will be published on reputable journal of neuroscience. Keywords: Molecular, Neuropathology, CSF biomarkers, SARS-Cov2