bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategi Kepala Madrasah Dalam Optimalisasi Sarana Prasarana di Madrasah Aliyah
Authors: Nasution Nurwinda Aulia , Marpaung Syafri Fadillah
Published: April 2023

Optimization strategies are very important to support learning activities in limited facilities. the purpose of this study was to determine how the strategy of the head of the madrasah in the optimization of infrastructure experienced obstacles and solutions by the head of the madrasah, as well as how the results of the implementation of the strategy of the head of the madrasah in the optimization of infrastructure. This study uses descriptive qualitative research methods. The results showed that the strategy for optimizing infrastructure in MAS Muhammadiyah 1 Medan involves management activities that include planning, organizing, implementing, and evaluating. The constraints experienced are generally in the form of limited funds and locations that are not wide enough so the solution that can be done is to procure the facilities and make optimal use of the available infrastructure. The success of the madrasah head's strategy in optimizing infrastructure can be seen from the procurement, utilization, and good inventory and increasing the creativity and innovation of teachers and students in utilizing available facilities.
Manajemen Pembelajaran Pendidikan Al-Islam di SMA Muhammadiyah
Authors: Imamiyah Itsnaini Novi , Istikomah Istikomah
Published: April 2023

This study aims to determine the learning management of Al-Islam education at SMA Muhammadiyah 2 Surabaya by focusing on 4 sub-topics of discussion which include planning, organizing, implementing, and evaluating. This study uses a qualitative research method with a case study approach. Data collection techniques in this study are observation, interviews, and documentation. The techniques of analysis and interpretation of data in this study are data reduction, data presentation, and data verification. Data sources in this study include primary data sources where the data is obtained from informants when making observations at the research location. While secondary data sources are obtained from articles, theses, and journals that support primary data sources. The results of this study indicate that the learning management of Al-Islam education at SMA Muhammadiyah 2 Surabaya has been carried out following the learning mechanism and is conducted properly based on the learning objectives that have been set. To achieve all aspects Of learning management al Islam education is very dependent on the commitment and capability of educators towards education management itself.
Implementasi Evaluasi Pembelajaran Pendidikan Al Islam di Sekolah Menengah Atas Muhammadiyah
Authors: Fauzi Ahmad , Inayati Nurul Latifatul
Published: April 2023

The purpose of this study is to identify the basic ideas of evaluation and their consequences for the assessment of Islamic religious education taught in schools. Qualitative techniques and literature review methods were used in this work. The findings of the discussion show that measurement and assessment shape evaluation. Because it is included in the learning phase, evaluation plays an important strategic role in the learning environment. The aim is to evaluate the efficacy and efficiency of the learning system. Assessment of learning programs, learning activities, and learning outcomes are included in the discussion area. Continuity, completeness, fairness, objectivity, collaboration, and practicality are some of the common evaluation concepts. Its principles consist of responsibility, pedagogy, integration, and coherence, to be precise. Planning, development, monitoring, efficiency, effectiveness, and a comprehensive program are all evaluated as part of the learning process. According to the object, input, transformation, and output are all included in the learning evaluation. Trainers, trained police, and self-evaluating students are among the topics covered. It consists of tests and non-tests, technically speaking. Examination of Islamic religious subjects in schools must be carried out regularly, comprehensively, and holistically. As a result, Islamic religion teachers must be able to evaluate the progress of their students in Aqliyah, Qolbiyah, and Amaliyah.
فاعلية استخدام مدخل الأحداث الجارية في تدريس التاريخ في تنمية بعض مهارات التفكير الناقد لدى طالبات الصف الثاني الثانوي في منطقة الجوف
Authors: العنزي ليلى سلطان
Published: April 2023

هدفت الدراسة الحالية إلى التحقق من فاعلية استخدام مدخل الأحداث الجارية في تدريس التاريخ في تنمية بعض مهارات التفكير الناقد لدى طالبات الصف الثاني ثانوي في منطقة الجوف، وتم استخدام المنهج شبه التجريبي، وتكونت عينة الدراسة من (52) طالبة، تم توزيعهن على مجموعتين إحداهما تجريبية والأخرى ضابطة، واشتملت المجموعة الضابطة على (27) طالبة واشتملت المجموعة التجريبية على (25) طالبة، وتم إعداد اختبار التفكير الناقد. وقد أظهرت النتائج وجود فروق ذات دلالة إحصائية بين متوسط درجات المجموعة التجريبية ومتوسط درجات المجموعة الضابطة في التطبيق البعدي لاختبار التفكير الناقد عند مهارة التمييز بين الحقائق والآراء لصالح المجموعة التجريبية، ووجود فروق ذات دلالة إحصائية بين متوسط درجات المجموعة التجريبية ومتوسط درجات المجموعة الضابطة في التطبيق البعدي لاختبار التفكير الناقد عند مهارة التحقق من مصداقية مصادر المعلومات لصالح المجموعة التجريبية، ووجود فروق ذات دلالة إحصائية بين متوسط درجات المجموعة التجريبية ومتوسط درجات المجموعة الضابطة في التطبيق البعدي لاختبار التفكير الناقد عند مهارة الدقة في فحص الوقائع لصالح المجموعة التجريبية، ووجود فروق ذات دلالة إحصائية بين متوسط درجات المجموعة التجريبية ومتوسط درجات المجموعة الضابطة في التطبيق البعدي لاختبار التفكير الناقد عند مهارة كشف التناقض في المعلومات لصالح المجموعة التجريبية، ووجود فروق ذات دلالة إحصائية بين متوسط درجات المجموعة التجريبية ومتوسط درجات المجموعة الضابطة في التطبيق البعدي لاختبار التفكير الناقد عند مهارة تحديد العلاقة بين الأسباب والنتائج لصالح المجموعة التجريبية، ووجود فروق ذات دلالة إحصائية بين متوسط درجات المجموعة التجريبية ومتوسط درجات المجموعة الضابطة في التطبيق البعدي للدرجة الكلية لاختبار التفكير الناقد لصالح المجموعة التجريبية. وفي ضوء ما تم التوصل إليه من نتائج تم صياغة بعض التوصيات والمقترحات.
أثر استراتيجية المحطات العلمية في تنمية عادات العقل في الفيزياء لدى طلاب الصف العاشر الأساسي في محافظة قلقيلية
Authors: عبد الغني عبد العزيز نزار , الشمالي محمود أحمد , أبو الكباش شادي
Published: April 2023

هدفت الدراسة إلى تقصي أثر استراتيجية المحطات العلمية في تنمية عادات العقل لدى طلاب الصف العاشر الأساسي في تعلم الفيزياء، وتكونت عينة الدراسة من (60) طالبًا من طلاب الصف العاشر الأساسي من مدرسة ذكور السلام الثانوية التابعة لوزارة التربية والتعليم في محافظة قلقيلية للعام الدراسي 2019/2020 موزعين على شعبتين، تمثل الشعبة الأولى المجموعة الضابطة والمكونة من (30) طالبًا والذين تم تدريسهم وفق طريقة التدريس الاعتيادية، والشعبة الثانية تمثل المجموعة التجريبية والمكونة من (30) طالبًا والذين تم تدريسهم وفق استراتيجية المحطات العلمية. تم استخدم المنهج التجريبي بالتصميم شبه التجريبي، وتم استخدام أداة الدراسة المتمثلة باستبيان لقياس عادات العقل المكون من 35 فقرة وفق مقياس ليكرت الخماسي، وتم التحقق من صدقه وثباته بالطرق المناسبة. وأظهرت نتائج الدراسة وجود فروق دالة إحصائيًا لاستراتيجية المحطات العلمية في تنمية عادات العقل في الفيزياء لدى الطلاب. ويوصي الباحث بتضمين استراتيجية المحطات العلمية في برامج وزارة التربية والتعليم الخاصة بإعداد المعلمين والمشرفين التربويين.
أنماط التنشئة الأسرية وعلاقتها بالذكاء العاطفي لدى عينة من طالبات المرحلة الثانوية في محافظة حفر الباطن
Authors: العنزي مليحة محمد , شطناوي هديل محمد
Published: April 2023

هدفت الدراسة الحالية إلى التعرّف على التنشئة الأسرية وعلاقتها بالذكاء العاطفي لدى عينة من طالبات المرحلة الثانوية في محافظة حفر الباطن، تكونت عينة الدراسة من (204) طالبة من طالبات المرحلة الثانوية في المنطقة الشرقيَّة بمحافظة حفر الباطن في المملكة العربيَّة السعوديَّة، ولتحقيق هدف الدراية استخدم مقياسي الذكاء العاطفي لـ(بار- أون) المترجمة إلى اللغة العربية ومقياس أنماط التنشئة الأسرية، أظهرت النتائج أن مستوى الذكاء العاطفي (ككل) لدى عينة لدى طالبات المرحلة الثانوية في محافظة حفر الباطن كان مرتفعًا كما أظهرت النتائج بوجود علاقة ذات دلالة إحصائية بين أنماط التنشئة الأسرية والذكاء العاطفي، وأوصى البحث إلى ضرورة الاتجاه لطابع التنشئة الأسرية الديمقراطي، وتفعيل دور المدرسة في توضيح أهمية التنشئة الأسرية على الفرد، بالإضافة للتوافق بين الآباء والأمهات على أسلوب التنشئة الأسرية.
ممارسـات القيـادة التعليمية الداعمة لتحسـين التحصيل الدراسي للطلبة في الـمدارس الحكومية بسلطنة عُمان- دراسة نوعية
Authors: الـوهيبيـة أسيــة بنت حمــود بن محـمـد , المهدي ياسر فتحي الهنداوي , الحارثية عائشة بنت سالم بن علي
Published: April 2023

هدفت الدراسة إلى الكشف عن أفضل ممارسات القيادة التعليمية الداعمة لتحسين التحصيل الدراسي في عينة من المدارس الحكومية بسلطنة عُمان، وتمثلت عينة الدراسة في اثنتين من المدارس الحكومية المتميزة بارتفاع المستوى التحصيلي للطلاب على مستوى محافظة الداخلية، ولتحقيق أهداف الدراسة اتبعت الباحثة المنهج الوصفي. وتوصلت الدراسة إلى عدة نتائج أهمها؛ أن من أفضل ممارسات القيادة التعليمية الداعمة للتحصيل الدراسي في (تحديد رسالة المدرسة)؛ هو مشاركة جميع أطراف العملية التعليمية في بناء الأهداف، وفي (إدارة البرنامج التعليمي)؛ هو الزيارات الإشرافية للمعلم، وتحليل النتائج، ومتابعة تقدم الطلبة باستمرار، وفي (تعزيز مناخ إيجابي للتعلم)؛ هو الحفاظ على الوقت التعليمي، وتحفيز المعلمين والطلاب، والاهتمام بالتطوير المهني للمعلمين. كذلك توصلت الدراسة إلى مجموعة من الفجوات في ممارسات القيادة التعليمية منها: ضعف علاقة القائد التعليمي بعملية تنسيق المنهج وتطويره، وفي عملية التحليل للبيئة الداخلية والخارجية للمدرسة، وفجوة في تبني أسلوب فرق العمل، وكذلك ندرة استخدام البحث العلمي، والإجرائي للمشكلات التي تواجه القيادة التعليمية فيما يخص تحصيل الطلاب.
درجة امتلاك طلاب التأهيل التربوي بجامعة نزوى مهارات وكفاءات التعلم الإلكتروني من وجهة نظرهم
Authors: الوائلي محمود بن زهران , العزري سيف بن ناصر بن سيف , العمري حسن محمد , الذهلي ربيع بن المر , الدرعية إيمان بنت سعيد , السعدية أحلام بنت محمد
Published: April 2023

هدفت الدراسة الوقوف على مدى امتلاك طلبة التأهيل التربوي بكليَّة العـُلوم والآداب بجامعة نزوى مهارات وكفاءات التعلم الإلكتروني من وجهة نظرهم، واستخدمت الدراسة المنهج الوصفي، وقد قام الباحثون بإعداد استبانة استنادًا على الأدبيات والدراسات التي تناولت الموضوع، حيث تكونت الاستبانة من (36 فقرة) شملت مختلف المهارات والكفاءات المتعلقة بالتعلم الإلكتروني، تكونت عينة الدراسة من 196 طالبًا وطالبة يدرسون في برنامج التأهيل التربوي بكلية العلوم والآداب بجامعة نزوى في فصل الخريف 2021/2022، وقد بينت نتائج الدراسة أن مستوى تمكن طلبة التأهيل التربوي في جامعة نزوى من مهارات التعلم الإلكتروني ومهارات استخدام مودل Moodle ومهارات استخدام جوجل ميت Google Meet عالٍ جدًا. كما أشارت النتائج إلى عدم وجود فروق في مستويات تمكن طلبة التأهيل التربوي في جامعة نزوى من مهارات التعلم الإلكتروني ومهاراته الفرعية ترجع لاختلاف التخصص أو المعدل التراكمي. وقد أوصى الباحثون بضرورة تفعيل التعليم الإلكتروني في مختلف المساقات الأخرى التي لم تفعل التعليم الإلكتروني في الجامعة.
PENGARUH PENGGUNAAN GADGET TERHADAP KEMAMPUAN BERPIKIR KRITIS PESERTA DIDIK SEKOLAH DASAR
Authors: Ningsih Sulistia , Shanie Arsan
Published: April 2023

The use of gadgets nowadays has penetrated into the word of education including in elementary schools. Many parents facilitate their children who are still in elementary school with gadgets for learning media, communication tools, play tools, and to please children. However, these reasons ore not always good. Children will think that gadgets are everything for them. So that these conditions certainly have an impact on children's critical thinking skills. The purpose of this study was to see the effect of using gadgets on the critical thinking skills of grade 6 students at Madarah Ibtidaiyah Nashrul Fajar Meteseh Tembalang. This type of research uses quantitative methods with an ex post facto design. A total of 32 class 6 students were used as research subjects. Observation, questionnaires, tests, and documentation were used as data collection methods. The data analysis method used is the prerequisite test analysis, which consists of a normality test and a linearity test, with a hypothesis test as the final analysis. From the results of statistical analysis tests using SPSS 26 software using the t statistical test, the results obtained are t_count = 3.115 and t_table = 2.042. So that t_count ˃ t_table is 3.115 ˃ 2.042. So H0 is rejected, meaning that variable X (use of gadget) has a significant effect on variable Y (critical thinking skills). So it can be stated that the usage of gadgets is one among the factors influencing the critical thinking abilities of class 6 students at Madrasah Ibtidaiyah Nashrul Fajar Meteseh Tembalang
PENINGKATAN KETERAMPILAN LITERAS BACA TULIS MELALUI MEMBACA EKSTENSIF UNTUK MENINGKATKAN KEMAMPUAN BERFIKIR TINGKAT TINGGI DI SEKOLAH DASAR
Authors: Yunita Nourma , Suryanti Sri , L.R Sindy Ayu , L Nadia Putri
Published: April 2023

Students have speed reading skills are very important if they want to progress and develop and not be left behind with the current situation. With this skill, students will not be left behind in responding to the rapid flow of information and ideas that daily flood print and electronic media. How to improve extensive reading skills in order to improve thinking skills by using several methods including preview, read, review with jump reading techniques, The purpose of conducting this study is to analyze extensive reading skills, and analyze changes in high-level thinking patterns using several methods including preview, read, review with jump reading techniques in order to improve the thinking skills of grade V students at SD Muhammadiyah 1 GKB Gresik. The study uses the action research method which includes two cycles. Each cycle consists of four of them that are planned, actioned, observed, and reflected. To conduct data analysis carried out quantitatively and qualitatively, Extensive reading can be used several methods of preview, read, review with jump reading techniques to improve the ability of thinking grade V students at SD Muhammadiyah 1 GKB Gresik has run optimally. The research data carried out by the analysis, about increasing extensive reading skills using 3 preview, read, review methods with jump reading techniques is 15%. The result of the average value of the first cycle is 68.68 and the average value of the second cycle is 81.10. Conclusion of the average value of extensive reading skills to improve thinking skills using 3 methods preview, read, review with jumping reading techniques increased well. There is a change in the level of thinking skills and behavior that students show, namely students are increasingly excited, active, serious, and interested in extensive reading learning using 3 methods of preview, read, review with jump reading techniques
GAMIFIKASI BAHASA: MEDIA LITERASI UNTUK SISWA TINGKAT MADRASAH IBTIDAIYAH DI MASA PANDEMI
Authors: Arochman Taufik , Rizal Muhammad Daniel Fahmi
Published: April 2023

One of the ways to achieve literacy skills at Madrasah Ibtidaiyah is with the help of the media. Media literacy in learning is applied to improve the quality of students' listening, reading, writing, and speaking as well as media capable of gaining knowledge. One of the media literacy that can be applied in learning is language gamification activities. The objective of this study was to determine the extent of the benefits of language gamification for students at Madrasah Ibtidaiyah. The method of the research is qualitative, with research data collection techniques using participatory observation, interviews, and documentation. This research was conducted at MI Al Islam Balesari Magelang, with the research subjects were students in grades 3A and 3B with a total of 38 students. The data collected were analyzed and presented descriptively. The activities were carried out online considering the pandemic is still ongoing. The results of this study were, first, the process of using language gamification as a media for student literacy varies with the aim of enriching student vocabulary and, second, language gamification has a positive impact as a media for literacy for students at MI Al Islam Balesari. The activities were carried out effectively and the intended results were very good
PENGEMBANGAN VIDEO PEMBELAJARAN PENDAMPING GAMES EDUKATIF WORDWALL UNTUK MATERI PAI SEKOLAH DASAR
Authors: Aeni Ani Nur , Djuanda Dadan , Maulana Maulana , Nursaadah Rini , Sopian Salsabila Baliani Putri
Published: April 2023

This research is focused on PAI material and the target of this research is elementary school students. The research approach used is a mix method with a development design using a 4-D model formulated from Thiagarajan, Semmel and Semmel. This development model contains 4 steps, namely define, design, develop, and disseminate. Research data was obtained through interviews, questionnaires, and document analysis techniques. This research produces: 1) learning video product design made based on the results of questionnaire analysis of teacher needs for PAI SD learning media and based on PAI SD curriculum analysis by analyzing Basic Competencies. From this basis, learning video products are designed that are in accordance with the characteristics of elementary school students, 2) Products in the form of wordwall companion learning videos that last 8 minutes 44 seconds. 3) Product test results that get an assessment from users with a very good predicate, meaning that the product is very suitabel for use in PAI teaching. From the results of this research, learning videos can be further developed for other materials
Emotional Intelligence and Academic Achievement of Intermediate Level Students: A Correlational Study
Authors: Kiran Aisha , Farooq Umar , Akbar Gulnaz
Published: April 2023

The study looked at the connection between intermediate-level students' academic performance and emotional intelligence. Three hundred and fifty (350) intermediate-level students from public institutions of District Attock participated in the study. Surveys were used to gather information to assess emotional intelligence. Academic success was measured in terms of the percentage of students who had finished their first year of college. In order to arrange and statistically evaluate the acquired data, the Mean, SD, and Pearson's correlation were computed. The research revealed a strong connection in academic success and the emotional intelligence (EI) of college students.
The Enhanced Recovery After Surgery pathway for posterior cervical surgery: a retrospective propensity-matched cohort study
Authors: Porche Ken , Yan Sandra C. , Mehkri Yusuf , Sriram Sai , MacNeil Andrew , Melnick Kaitlyn , Garvan Cynthia , Vaziri Sasha , Seubert Christoph , Murad Gregory , Decker Matthew , Polifka Adam , Hoh Daniel J. , Mohamed Basma
Published: April 2023

OBJECTIVE

The Enhanced Recovery After Surgery (ERAS) protocol is a comprehensive, multifaceted approach aimed at improving postoperative outcomes. It incorporates a range of strategies to promote early and more effective recovery, including reducing pain, complications, and length of stay, without increasing readmission rate. To date, ERAS for spine surgery patients has been primarily limited to lumbar surgery and anterior cervical decompression and fusion (ACDF). ERAS has not been previously studied for posterior cervical surgery, which may present a greater opportunity for improvement in patient outcomes with ERAS than ACDF. This single-institution, multi-surgeon study assessed the impact of an ERAS protocol in patients undergoing posterior cervical decompression surgery.

METHODS

This study included a retrospective consecutive patient cohort with controls that were propensity matched for age, body mass index, sex, home opioid use, surgical levels, Nurick grade, and smoking status. In addition, consecutive patients who underwent posterior cervical decompression surgery for degenerative disease from December 2014 to December 2021 were included. ERAS was implemented in December 2018. Demographic, perioperative, clinical, and radiographic information was gathered. Regression models were created to evaluate length of stay, physiological function, pain levels, and opioid use. The primary focus was length of stay, with secondary outcomes including timing of ambulation, bowel movement, and voiding; daily pain scores; opioid consumption; discharge status; 30-day readmission rates; and reoperation rates.

RESULTS

There were 366 patients included in the study, all of whom were included in multivariate models, and 254 (127 in each cohort) were included on the basis of matching. After propensity matching, patient characteristics, operative procedures, and operative duration were similar between groups. The ERAS cohort had a significantly improved length of stay (3.2 vs 4.7 days, p < 0.0001) and home discharge rate (80% vs 50%, p < 0.001) without an increase in readmission rate. The ERAS cohort had an earlier day of the first ambulation (p = 0.003), bowel movement (p = 0.014), and voiding (p = 0.001). ERAS demonstrated a significantly lower composite complication rate (1.1 vs 1.8, p < 0.0001). ERAS resulted in better maximum pain scores (p = 0.043) and trended toward improved mean pain scores (p = 0.072), although total opioid use was similar.

CONCLUSIONS

Implementing a novel ERAS protocol significantly improved length of stay, return of physiological function, home discharge, complications, and maximum pain score after posterior cervical surgery.
Microsurgical and fiber tract anatomy of the interthalamic adhesion
Authors: Şahin Mehmet Hakan , Güngör Abuzer , Demirtaş Oğuz Kağan , Postuk Çağrı , Fırat Zeynep , Ekinci Gazanfer , Kadıoğlu Hakan Hadi , Türe Uğur
Published: April 2023

OBJECTIVE

The authors of this study aimed to define the microanatomy of the interthalamic adhesion (ITA) using microfiber dissection, magnetic resonance (MR) tractography, and histological analysis.

METHODS

Sagittal, coronal, and axial MR images from 160 healthy individuals 2–82 years of age were examined. The relationships between age range and ITA morphology as well as between gender and ITA morphology were evaluated statistically. Among these 160 individuals, 100 who had undergone MR tractography were examined. In this group, the presence of fiber tracts in the ITA and the relationship with ITA morphological types were examined. Thirty formalin-fixed human cadaveric brains were also examined endoscopically, and 6 hemispheres were dissected from the medial to lateral and superior to inferior directions under the microscope. Sections taken from one of the brains with an ITA type 2 with both thalami were examined histologically. Anti-neurofilament antibody was used in the histological examination.

RESULTS

Four morphological types of ITA were observed. Type 1 had an adhesion/adherent appearance, type 2 had a bridge/commissure appearance, type 3 showed no adhesion, and type 4 had a double bridge. Tractographic examination revealed that 28% had no fiber tract transition in the ITA, 21% had a significant transition, and 51% had an indistinct transition. Statistically, the presence of the ITA was significantly higher in the pediatric (age) and female (gender) groups. In specimens with ITAs of a bridge/commissure appearance (type 2), fiber tracts showed clear transitions between thalami. In type 1 (adherent/adhesive appearance), fiber tracts were observed within the ITA, but a reciprocal transition was unclear. Dissection showed that these fiber tracts in the ITA reach the nucleus accumbens, caudate nucleus, and frontoorbital region anteriorly and the lateral habenula and posterior commissure posteriorly. Some fibers also joined the ansa peduncularis. In histological studies, axonal fibers moving in the ITA were observed with anti-neurofilament antibody staining.

CONCLUSIONS

This is the first study to demonstrate fiber tracts of the ITA through fiber dissection and transillumination techniques as well as radiological and histological study. Statistical data were obtained by comparing the morphological group with age and gender groups. The anatomy of this structure, which has been neglected for many years, was reexamined. This study showed that the ITA has fibers connecting different parts of the brain, in contrast to previous studies suggesting that it was a simple massa.
Flow diversion: a disruptive technology coming of age. Lessons learned and challenges for the future
Authors: Enriquez-Marulanda Alejandro , Young Michael M. , Taussky Philipp
Published: April 2023

Intracranial aneurysm treatment has been revolutionized over the last decade with the development of flow diversion technology. The use of this technology has evolved rapidly and has proven that cerebrovascular disease treatment remains one of the forefront innovation areas in neurosurgery. The good results on the treatment of internal carotid artery aneurysms up to the communicating segment have motivated the use of flow diversion beyond the circle of Willis and in the posterior circulation. Further advances and innovations of flow-diverting devices are underway and intended to improve the safety and efficacy of this therapy. This review article provides a detailed discussion about the origin, mechanism of action, initial experience, complications, types of devices, and future perspectives of flow diversion technology.
The influence of tumor topography on the surgical outcome of craniopharyngiomas
Authors: Sadhasivam Saravanan , Menon Girish , Abraham Mathew , Arora Rajnish Kumar , Nair Suresh Narayanan
Published: April 2023

OBJECTIVE

Various topographical classifications for craniopharyngioma have been proposed based on their relationship with optic chiasm and the third ventricular floor. There is a paucity of literature evaluating the surgical outcome based on tumor topography. This study aims to compare the surgical outcomes of retrochiasmatic craniopharyngiomas (RCPs) and nonretrochiasmatic craniopharyngiomas (non-RCPs).

METHODS

This retrospective study includes newly diagnosed patients with craniopharyngioma who underwent surgery between January 2000 and December 2015. Clinical features, the extent of resection (EOR), surgical outcomes, tumor recurrence, and progression-free survival (PFS) of craniopharyngiomas were compared with respect to their relationship to the optic chiasm and third ventricular floor.

RESULTS

The authors identified RCPs in 104 and non-RCPs in 33 patients. RCPs were significantly larger and more associated with hydrocephalus than were non-RCPs (p < 0.001) at the time of diagnosis. Puget grade 2 hypothalamic involvement was more frequent with RCPs. EOR and PFS following either subtotal resection (p = 0.07) or gross-total resection (p = 0.7) were comparable between RCPs and non-RCPs. There was no significant difference in the postoperative visual outcome. Resection of RCPs resulted in higher postoperative hypopituitarism (64% vs 42%, p = 0.01) and hypothalamic dysfunction (18% vs 3%, p = 0.02). Location of the tumor, either retrochiasmatic (HR 0.5; 95% CI 0.14–2.2; p = 0.4) or nonretrochiasmatic (HR 1.3; 95% CI 0.3–5.5; p = 0.6), did not show association with recurrence. RCPs with extra- and intraventricular components (type 3b) had a higher incidence of postoperative hypothalamic morbidities (p = 0.01) and tumor recurrence (36% vs 19%; p = 0.05) during follow-up than the extraventricular (type 3a) RCP. Between prechiasmatic and infrachiasmatic/intrasellar craniopharyngiomas, EOR (p = 0.7), postoperative diabetes insipidus (p = 0.4), endocrinological outcome (p = 0.7), and recurrence (p = 0.1) were comparable. The patients with complex multicompartmental tumors had a lower rate of gross-total resection (25%, p = 0.02) and a higher incidence of tumor recurrence (75%, p = 0.004) than the rest.

CONCLUSIONS

The tumor topography can influence the postoperative outcome. RCPs can be associated with a higher incidence of hypopituitarism and hypothalamic morbidities postoperatively. The influence of topography on EOR and tumor recurrence is controversial. However, this study did not find a significant difference in EOR and tumor recurrence between RCPs and non-RCPs. PFS and overall mortality are also comparable.
Early stellate ganglion block for improvement of postoperative cerebral blood flow velocity after aneurysmal subarachnoid hemorrhage: results of a pilot randomized controlled trial
Authors: Wu Youxuan , Lin Fa , Bai Yang , Liang Fa , Wang Xinyan , Wang Bo , Jian Minyu , Wang Yunzhen , Liu Haiyang , Wang Anxin , Chen Xiaolin , Han Ruquan
Published: April 2023

OBJECTIVE

Stellate ganglion block (SGB) is a commonly used sympathetic nerve block technique that may have benefits for patients with aneurysmal subarachnoid hemorrhage (aSAH) in the early stage. Cerebral vasospasm (CVS), one of the most common complications of aSAH, is accompanied by an abnormal increase in cerebral blood flow velocity (CBFV) and neurological dysfunction. In this pilot study the authors sought to determine the feasibility of early SGB for CVS in aSAH patients by observing the incidence of symptomatic CVS.

METHODS

Prior to receiving surgical treatment, patients with aSAH were randomly assigned to the SGB group or the non-SGB group. The primary outcome was the incidence of symptomatic CVS within 14 ± 2 days after the onset of aSAH. As a higher CBFV is often associated with CVS and a poor prognosis, the mean CBFV of the middle cerebral artery was observed immediately after surgery and on postoperative days 1, 2, 3, 5, and 7. Other secondary outcomes included transcranial Doppler (TCD)/CTA-type CVS, delayed cerebral ischemia during hospitalization, new cerebral infarction within 3 months, adverse events (AEs), and clinical prognosis.

RESULTS

Symptomatic CVS occurred in 40% of patients in the non-SGB group and in 20% in the SGB group (RR 0.50, 95% CI 0.22–1.16). Continuous TCD sonography revealed that the postoperative mean CBFV was lower in the SGB group than in the non-SGB group (F = 3.608, p = 0.02). In addition, the percentages of patients with CVS evaluated by TCD (TCD-CVS) and total new infarctions within 3 months were also significantly lower than those in patients with CVS (TCD-CVS 36.7% vs 70%, RR 0.52, 95% CI 0.31–0.89, and total new infarctions 26.7% vs 53.3%, RR 0.50, 95% CI 0.25–0.99). In terms of AEs and mortality, there were no significant differences between the two groups.

CONCLUSIONS

This pilot study demonstrated for the first time, to the authors’ knowledge, that early SGB is feasible and has the potential to reduce the risk of CVS and improve the prognosis of aSAH. This method may be a new treatment for patients with aSAH that may have more advantages than traditional therapeutic drugs and is worth further study.

Clinical trial registration no.: NCT04691271 (ClinicalTrials.gov)
Vasospasm risk following aneurysmal subarachnoid hemorrhage in older adults
Authors: Pavelka Meghan , Necarsulmer Julie , Ho James , Sasaki-Adams Deanna
Published: April 2023

OBJECTIVE

Cerebral arterial vasospasm is a dreaded sequela of aneurysm rupture and can result in significant narrowing of the surrounding vasculature and subsequent cerebral ischemia. Treatment interventions are associated with distinct side effect profiles, including the risk of thrombosis and worsened ischemia, which may be associated with increased mortality—especially in older adults. An improved understanding of the likelihood of vasospasm in elderly patients would enable clinicians and patients to better consider the risks and benefits of vasospasm prophylaxis in this vulnerable population. This retrospective chart review aimed to assess the relationship between age at onset and the incidence of cerebral vasospasm among patients treated at the University of North Carolina Medical Center with spontaneous aneurysmal subarachnoid hemorrhage (aSAH).

METHODS

Electronic health record data from the Epic Systems Corp. database, compiled by the Carolina Data Warehouse for Health, were analyzed for patients older than 18 years who were previously treated for an SAH secondary to aneurysm at the University of North Carolina Medical Center within the past 10 years, ranging from June 2011 through June 2021. Logistic regression was used to calculate odds ratios and to determine the association of age with the occurrence of vasospasm following aSAH.

RESULTS

Of the 386 cases analyzed, 149 patients (38.6%) were older than 65 years at the time of aSAH. A total of 192 of the 386 patients (49.7%) developed vasospasm within the first 3–21 days following aSAH. Among the patients who developed vasospasm, only 31 of 192 patients (16.1%) were older than 65 years at the time of aneurysm rupture. Odds ratio calculations revealed that older adults (> 65 years) were 8 times less likely to develop vasospasm compared to their younger counterparts (p < 0.0001; 95% CI 5.0–13.0).

CONCLUSIONS

This study found that older patients are less likely to develop cerebral vasospasm following aSAH than are younger individuals. Age-associated changes in arteriosclerosis, inflammatory responses, and CSF dynamics may mitigate vascular narrowing in response to aSAH. This finding suggests that the aSAH treatment and vasospasm prevention paradigms should be revised to minimize potentially unnecessary interventions and avoid adverse outcomes for older adults.
Anton de Haen (1704–1776) and his extraordinary "portentosum infundibulum" case: the futile skull cauterization of a blind patient with a craniopharyngioma
Authors: Pascual José María , Prieto Ruth , Rosdolsky Maria , Hofecker Verena
Published: April 2023

Anton de Haen (1704–1776) became one of the most influential physicians in the Habsburg Empire as a reformer of clinical instruction at Vienna Citizen’s Hospital (Bürgerspital), where he introduced the bedside teaching method he had learned from Herman Boerhaave in Leyden, Holland. He also promoted the meticulous recording of clinical observations and the use of postmortem studies to identify the cause of death in hospitalized patients. Among the numerous clinicopathological reports compiled in his monumental 18-volume work Rationis Medendi in Nosocomio Practico, published in 1761, was the first documented patient with amenorrhea caused by a pituitary tumor, appearing in the 6th volume. This 20-year-old amaurotic woman, who had suffered from chronic excruciating headache, died after the unsuccessful application of a cauterizing iron to her temporal bone. At the autopsy, a large solid-cystic and calcified tumor with gross characteristics typical of adamantinomatous craniopharyngioma was found encroaching on the infundibulum and third ventricle. This is the first known account of an infundibulo-tuberal lesion associated with the impairment of sexual functions, predating by 140 years the pathological evidence for a sexual brain center sited at the basal hypothalamus. In this paper, the authors analyze the historical importance and impact of de Haen’s foundational report on the fields of neuroendocrinology and neurosurgery.
How can we differentiate supratentorial tumor recurrence from postradiation imaging changes in children treated for primary malignant brain tumors?
Authors: Zittoun Jacob , Dangouloff-Ros Volodia , Cardoen Liesbeth , Rutten Caroline , Bolle Stéphanie , Alapetite Claire , Levy Raphaël , Grévent David , Grill Jacques , Brisse Hervé J. , Doz François , Blauwblomme Thomas , Beccaria Kévin , Charpy Sarah , Roux Charles-Joris , Varlet Pascale , Dufour Christelle , Puget Stéphanie , Boddaert Nathalie
Published: April 2023

OBJECTIVE

Distinguishing tumor recurrence from therapy-induced imaging changes (TIIC) on brain MRI in children treated for primary malignant brain tumors may be challenging. The authors aimed to assess the diagnostic ability of multimodal MRI in differentiating TIIC from tumor recurrence.

METHODS

The authors retrospectively included children with abnormal supratentorial brain MRI findings after treatment for primary malignant brain tumors (regardless of their localization) with complete resection and radiotherapy. A total of 18 patients with TIIC and 25 patients with tumor recurrence were compared, according to structural, apparent diffusion coefficient (ADC), and arterial spin labeling (ASL) imaging data accrued over time. TIIC were defined by a new MRI scan that was stable for at least 1 year or had regressed, or by histopathology findings in specimens obtained when the anomaly was surgically treated.

RESULTS

The time interval between completion of radiotherapy and the appearance of abnormal brain MRI findings was significantly shorter in the TIIC group compared with the tumor recurrence group (median 6 vs 35 months; p < 0.001). TIIC appeared as foci of increased T2-weighted signal intensity, without nodule, associated with variable contrast enhancement. Tumor recurrence appeared as a well-defined nodule with intermediate signal intensity on T2-weighted images with nodular contrast enhancement. Relative ADC values were significantly higher in the TIIC group (median 1.43 vs 0.88; p < 0.001). Relative ASL–cerebral blood flow (CBF) values were significantly lower in the TIIC group (median 0.27 vs 0.43; p = 0.04). On follow-up MRI, TIIC could progress, regress, or remain stable. In most instances (72%), they decreased in size or remained stable at 4 years of follow-up.

CONCLUSIONS

MRI features of TIIC include foci of increased signal intensity without a demonstrable nodule on T2-weighted images, high ADC values, and lower ASL-CBF values, whereas tumor recurrence appears as a well-defined nodule with low ADC values and higher ASL-CBF values.
Effect of allograft patch closure on incidence of spinal inclusion cyst formation following open fetal myelomeningocele repair
Authors: Patel Smruti K. , Hartnett Sara , Gaulden Amber , Bethi Mridula , Habli Mounira A. , McKinney David N. , Lim Foong Y. , Peiro Jose L. , Stevenson Charles B.
Published: April 2023

OBJECTIVE

The aim of this study was to evaluate the incidence of spinal inclusion cyst (sIC) formation after open fetal myelomeningocele (fMMC) repair and the effect of dural patch closure.

METHODS

The authors conducted a retrospective review of patients who underwent open fMMC repair at their institution between March 2011 and June 2020. All patients met the criteria for intervention defined by the Management of Myelomeningocele Study (MOMS). The primary outcomes investigated were development of sIC and need for surgical intervention. Secondary outcomes included need for CSF diversion, extent of reversal of hindbrain herniation, and ambulatory status.

RESULTS

Of 56 patients who underwent open fMMC repair, 52 had adequate spinal imaging for review. Twelve of these patients (23%) developed sIC (95% CI 0.11–0.35). Six patients experienced symptoms and required surgical detethering with sIC resection. Six additional patients had evidence of sIC on surveillance MRI but remained asymptomatic. The authors found a statistically significant relationship between the use of a dural allograft patch and sIC formation (p = 0.05). In terms of sIC development, there was no statistically significant difference between patients who underwent primary closure and those who received an allograft at the level of the fascia (p = 0.34) or skin (p = 0.26). The rate of hydrocephalus requiring CSF diversion was 52%. Interestingly, 98% of patients had improvement in extent of hindbrain herniation. Dural patch closure did not have any effect on the rate of progressive hydrocephalus (p = 0.33) or degree of reversal of hindbrain herniation (p > 0.99).

CONCLUSIONS

This study suggested that children with prenatally repaired MMC are at higher risk for development of sIC and associated symptoms than those who undergo postnatal repair. The presentation of symptoms was also earlier in these patients than previously reported after postnatal repair. The use of a dural allograft patch appears to have a positive correlation with sIC formation. Future investigations evaluating the incidence of sIC after fetoscopic MMC repair, in which primary dural closure typically cannot be achieved and a dural patch is most often utilized, will be helpful in facilitating prenatal counseling for patients considering fetal intervention.
Spinal dysraphism in exstrophy: a single-center study of a 39-year prospective database
Authors: Judy Brendan F. , Materi Joshua , Lee Ryan P. , Tracz Jovanna A. , Patel Jaimin , Weber-Levine Carly , Crigger Chad , Mistry Preeya , Gearhart John P. , Jackson Eric M.
Published: April 2023

OBJECTIVE

The two main objectives of this study were to explore the rate of spinal dysraphism within bladder and cloacal exstrophy and to analyze the relationship between spinal dysraphism surgery, including timing of spinal dysraphism surgery, with urological and neurological outcomes.

METHODS

A prospectively maintained IRB-approved database of pediatric exstrophy patients treated from 1982 to 2021 was retrospectively reviewed for patients with spinal dysraphism. Spinal dysraphism was categorized into the following 7 subtypes: lipoma-based closed defect, myelomeningocele, meningocele, diastematomyelia, myelocystocele, low-lying conus with tethered cord/fatty filum, and sacral bony defect. Other factors assessed included patient demographic characteristics, type of spinal dysraphism procedure, reoperation, complication, presence of other neurological problems (e.g., hydrocephalus, Chiari malformation), neurological status, and urological function.

RESULTS

Analysis revealed that 114/1401 patients had coexisting spinal dysraphism. Of these 114, sufficient records including type of dysraphism were available for 54. Spinal dysraphism was most common within cloacal exstrophy (83.3% [45/54 patients]), followed by cloacal exstrophy variants (9.3% [5/54]), classic bladder exstrophy (3.7% [2/54]), and classic bladder exstrophy variants (3.7% [2/54]). Within spinal dysraphism, lipoma-based closed defects (63.0% [34/54]) and low-lying conus with tethered cord/fatty filum (11.1% [6/54]) were most common. Hydrocephalus and Chiari malformation occurred in 24.1% (13/54) and 11.1% (6/54) of patients. All 13 patients with hydrocephalus underwent shunt placement. Among those who underwent neurosurgical intervention, the complication rate for spinal dysraphism was 14.6% (7/48). Motor function data were available for 41 patients and revealed that motor function declined for 2/41 (4.8%) patients and improved for 6/41 (14.6%) after neurosurgery. There was no statistical difference in lower-extremity motor outcome related to timing of neurosurgery and exstrophy closure.

CONCLUSIONS

The authors have reported the surgical management and outcomes of patients with exstrophy and coexisting spinal dysraphism (n = 54). In 54 patients, spinal dysraphism was most common in the subset of patients with cloacal exstrophy (83.3%). Lipoma-based closed defects (63.0%) and low-lying conus with tethered cord/fatty filum (11.1%) were the most common, and the rates of hydrocephalus and Chiari malformation were 24.1% and 11.1%, respectively. There was no difference in lower-extremity motor outcome related to timing of neurosurgery and exstrophy closure.
Results of training with a low-cost simulation model for endoscope-assisted scaphocephaly repair
Authors: Cuello Javier F. , Gromadzyn Guido , Cicutti Santiago , Roel Macarena , Mantese Beatriz , Ruvinsky Silvina D.
Published: April 2023

OBJECTIVE

Endoscope-assisted repair of sagittal craniosynostosis is an effective technique that requires a learning curve. Surgical simulation models can be applied to acquire the necessary skills for this procedure. Several models with a wide range of costs have been described for training in this technique. The aim of this work was to present the results of training with a low-cost simulation model for endoscope-assisted sagittal craniosynostosis repair.

METHODS

A simulation model for sagittal craniosynostosis was developed using low-cost materials. The model is easily assembled and allows successive uses. Three neurosurgery residents, 3 fellows, and 2 neurosurgeons performed a 4-session training program in sagittal craniosynostosis repair. The Global Rating Scale (GRS) score, number of errors, and the time required to perform the task were reported by 2 independent evaluators using a checklist. Measurements were compared between the first and last training using the Wilcoxon signed-rank test. All participants completed a questionnaire (5-point Likert scale) regarding the realism of the simulation model.

RESULTS

A model was developed to recreate the steps required to perform an endoscope-assisted scaphocephaly repair with the patient in a simulated sphinx position. All participants improved their GRS performance between the first and final training. The median time needed to perform the initial training was 47.5 minutes (interquartile range [IQR] 44.5–48 minutes, interrater difference [IRD] p = 0.77), and for the last training was 40.5 minutes (IQR 35.5–43 minutes, IRD p > 0.99). The median number of errors reported in the initial training was 5.5 (IQR 3–7.75 errors, IRD p = 0.8), and in the last training was 1 (IQR 0.75–2.25 errors, IRD p = 0.35). There was a statistically significant difference regarding the time and number of errors between the initial and final training (p < 0.001). More than 85% of the participants found that the surface anatomy, skull and anterior fontanel, fused sagittal suture, and epidural space of the model were realistic and had appropriate detail required to perform the surgery. All respondents agreed or strongly agreed that the endoscope handling was realistic, and that the steps and skills required to complete the task were representative of those required for the real procedure.

CONCLUSIONS

A low-cost sagittal craniosynostosis simulation model was developed, allowing successive uses. The acquisition of skills within the simulation was demonstrated for all participants regarding the GRS score and the number of errors and time needed to perform the task. In addition, the model was found to be realistic in terms of anatomical references and the procedural steps required for this minimally invasive technique.