AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8868/321
1Dr. Md. Rezaul Amin. Associate Professor, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka.
2DR. K. M. Tarikul Islam. Associate Professor, Pediatric Neurosurgery, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka.
3Dr. ABM Manwar Hossain, Neurosurgeon, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka.
4Professor Moududul Haque, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka.
*Corresponding Author: Md. Rezaul Amin, Associate Professor, Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical Dhaka, Bangladesh.
Citation: Amin MR, Islam KMT, Hossain ABM, Haque M, (2024), Outcome of Midline Posterior Cranial Fossa Tumor Surgery with Preoperative Ventriculo - Peritoneal (V-P) Shunt in Children, J. Neuroscience and Neurological Surgery, 14(4); DOI:10.31579/2578-8868/321
Copyright: © 2024, Md. Rezaul Amin. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 13 May 2024 | Accepted: 28 May 2024 | Published: 12 June 2024
Keywords: midline posterior fossa tumor; ventriculo-peritoneal shunt; children; obstructive hydrocephalus
Introduction: Pediatric patients with midline posterior cranial fossa tumors present with features of raised intracranial pressure due to development of hydrocephalus. Due to the big size tumour and lack of facility we did Ventriculoperitoneal shunt before definitive surgery for all patients.
Material and Methods: This cross-sectional experimental study was carried out on 55 consecutive patients with midline posterior cranial fossa brain tumors with obstructive hydrocephalus with age ranged from 3 to 15 years got admitted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University from March 2021 to April 2023. We did preoperative ventriculoperitoneal shunt before definitive surgery but didn’t do the Endoscopic third ventriculostomy.
Results: In this study, the age of the patients was 3-15 years, the mean age was 9.47+_3.18 and the peak incidence was 11-15 years which was 20(36.36%). Majority of the patients was male (56%), male female ratio was 1.27:1. Most of the children were presented with headache 51(92.73%) followed by papilloedema 47(85.45%), vomiting 46(83.64%), gait disturbance 37(67.27%), diminution of vision 31(56.36%), swallowing difficulty 12(21.82%), cranial nerve palsy 12(21.82%). 19 patients developed postoperative complications among them 15(27.27%) was meningitis followed by wound infection 7(12.73%), pseudomeningocele 8(14.55%), csf leakage 4(7.27%), hydrocephalous 3(5.45%). Logistic regression analysis was non-significant statistically in my study.
Discussion and Conclusion: In conclusion we found satisfactory outcome of doing pr-operative VP Shunt in posterior fossa midline tumor causing obstructive Hydrocephalus in children, however major postoperative complications were development of hydrocephalus, CSF leak, pseudo meningocele, wound infection and meningitis. Future prospective studies with sufficient sample size are warranted to reach a definitive conclusion.
VP Shunt; Ventriculoperitoneal Shunt
CSF: Cerebrospinal Fluid
ETV: Endoscopic Third Ventriculostomy
ICP: Intracranial Pressure
CT: Computer tomography
MRI: Magnetic resonance imaging
Posterior fossa tumors are the most frequent primary neoplasms in children. Tumors in the posterior fossa are considered critical brain lesions, due to the risks involved like brainstem compression, herniation, and death.1
Hydrocephalus and subsequent need for cerebrovascular fluid (CSF) diversion following posterior fossa tumor excision in the pediatric age group is the most common clinical comorbidity. Despite advances in surgical techniques, up to 30% (18%–40%) of patients need CSF diversion as ventriculoperitoneal shunt (VP shunt) or endoscopic third ventriculostomy (ETV) after tumor excision.2
The evolution of surgical technique reflects the maturation of modern neurosurgery. The majority of patients with posterior fossa tumors have hydrocephalus at the time of presentation. The management of hydrocephalus with posterior fossa tumors remains controversial.3
Moreover, postoperative elevations of intracranial pressure (ICP) are reduced with a lower incidence of pseudomeningocele formation and CSF leakage, and hence shortened hospitals stay.4
Ventriculo-peritoneal shunting may decrease operative mortality by affording time to perform diagnostic tests, prepare the patient and schedule a major neurosurgical procedure electively. Reduction in intracranial pressure also permits safer resection.5.
Several complications have been associated with CSF diversion including: supratentorial intracranial hematomas (e.g., extradural, subdural, intracerebral, and intraventricular hemorrhage). Many shunts associated complications such as malfunction, infection, multiple abdominal complications, long-term shunt dependence and infratentorial complications e.g., intratumoral hemorrhage and upward transtentorial herniation.6
Several case reports have been published describing the serious infratentorial complications that may occur because of pre-resectional CSF diversion, either by ventricular shunting or ETV in patients with posterior cranial fossa tumors. Therefore, the actual incidence of such complications is unknown.7
This cross-sectional experimental study was carried out on 55 consecutive patients with midline posterior cranial fossa brain tumors with obstructive hydrocephalus with age 3 to 15 years got admitted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University from March 2021 to April 2023 who underwent preoperative ventriculoperitoneal shunt before definitive surgery. On admission, a detailed history of the illness was taken from the patient and/or his/her attendant, after that thorough neurological examination was carried out. Preoperative and postoperative clinical features for raised intracranial pressure (ICP) and findings of Computer Tomography (CT) scan and Magnetic Resonance Imaging (MRI) of brain were recorded. A data collection sheet was used to collect the necessary information. Informed written consent was taken from each participant and or guardian. Ventriculoperitoneal shunt was done by using medium pressure Chhabra shunt. Later, definitive surgery was performed. Follow-up of these patients was done up to7 th postoperative day. We assessed the patient in respect to the development of postoperative hydrocephalus, cerebrospinal fluid leakage, pseudomeningocele, wound infection and meningitis within 7th postoperative day after definitive surgery. Datas were processed and analyzed. Demographic data were expressed in number and percentage. Development of postoperative hydrocephalus, cerebrospinal fluid leakage, pseudomeningocele, wound infection and meningitis were expressed in number and percentage. Logistic regression analysis was done to predict the relationship between dependent variable (development of hydrocephalous) and independent variables (age, sex and the extent of tumor removal). Odds ratio (OR) was calculated by using Chi-square test. Chi-square test gave a wald statistic by observing at the 95% CI of the odds ratio. Statistical significance was set to p-value < 0>
The age of the patients was 3-15 years, the mean age was 9.47±3.18, and the peak incidence was 11-15 years which was 20 (36.36%).
Majority of the patient was male (56%), male female ratio was 1.27:1.
Characteristic | n=55 (%) | |
|---|---|---|
| Age (years) | 3-15 (Mean 9.47±3.18) | |
| Sex | Male | 56 (Ratio was 1.27:1) |
| Female | 44 | |
| Symptoms before surgery | Vomiting | 46 (83.64) |
| Hydrocephalus | 55 (100) | |
| Headache | 51 (92.73) | |
| Papilloedema | 47 (85.45) | |
| Gait disturbance | 37 (67.27) | |
| Diminution of vision | 31 (56.36) | |
| Cranial nerve disorders (except papilledema) | 12 (21.82) | |
| Decreased level of consciousness | 4 (7.27) | |
Extend of removal (according to CT scan of brain after definitive surgery) | Gross Total | 41 (74.55) |
| Sub Total | 6 (10.91) | |
| Near Total | 8 (14.55) | |
| Post-operative complication | Development of hydrocephalus | 3 (5.45%) |
| Wound infection | 7 (12.73%) | |
| CSF leakage | 4 (7.27%) | |
| Pseudomeningocele | 8 (14.55%) | |
| Meningitis | 15 (27.27) | |
Tumour Histopathology |
Astrocytoma |
20 (36.36) |
| Meduloblastoma | 16 (29.09) | |
| Ependymoma | 13 (23.64) | |
| Choroid plexus papilloma | 2 (3.64) | |
| Dermoid | 2 (3.64) | |
| Meningioma | 2 (3.64) | |
Table 1 shows preoperative clinical features of the study subject. Headache 51(92.73%), papilledema 47(85.45%), vomiting 46(83.64%), gait disturbance 37(67.27%), visual 31(56.36%), swallowing 12(21.82%), cranial nerve palsy 12(21.82%).
Table 1: Characteristics of the patient of posterior fossa tumour with hydrocephalus (n=55)
Out of 55 patients 31 patients developed complications, among them hydrocephalus was 3(5.45%), CSF leakage 4(7.27%), pseudomeningocele 11(20%), wound infection 12(21.82%) and meningitis 19(34.55%) (Table 1).
In CT scan of brain after definitive surgery, gross total removal of tumor was done in 41(74.55%) patients, near total removal in 6 (10.91%) patients and subtotal removal in 8(14.55%) patients (Table 1).
In histopathological findings, 20(36.36%) patients were found to have astrocytoma, 16(29.09%) medulloblastoma, 13(23.64%) ependymoma, 2(3.64%) choroid plexus papilloma, 2(3.64%) dermoid and 2(3.64%) meningioma (Table 1).
| Outcome | Gross total removal | Near total removal | Subtotal removal | |||
| n | % | n | % | n | % | |
| Development of hydrocephalus | 3 | 5.45 | 0 | 0.00 | 0 | 0.00 |
| CSF leakage | 4 | 7.27 | 0 | 0.00 | 0 | 0.00 |
| Pseudomeningocele | 8 | 14.55 | 3 | 5.45 | 0 | 0.00 |
| Wound infection | 7 | 12.73 | 3 | 5.45 | 2 | 3.64 |
| Meningitis | 15 | 27.27 | 2 | 3.64 | 2 | 3.64 |
Table 2: Outcome of the study subject according to the extent of tumor removal during postoperative follow up (n=55)
Development of hydrocephalus was 3 (5.45%) and CSF leakage was 4(7.27%) in gross total removal. Pseudomeningocele was found 8(14.55%) in gross total removal and 3(5.45%) in near total removal. Wound infection was found 7(12.73%) in gross total removal, 3(5.45%) in near total removal and 2(3.64%) in subtotal removal. Meningitis was found 15(27.27%) in gross total removal, 2(3.64%) in near total removal and 2(3.64%) in subtotal removal.
| B | P value | OR | 95% CI for OR | ||
| Lower | Upper | ||||
| Age (11-15 years) | -0.123 | 0.934 | 0.886 | 0.063 | 10.018 |
| Male | 1.831 | 0.161 | 6.023 | 0.489 | 76.653 |
| Near total removal | -19.088 | 0.998 | 0.001 | 0.000 | - |
| Subtotal removal | -1.254 | 0.999 | 0.002 | 0.000 | - |
OR=Odds ratio, CI= Confidence interval
Multivariable logistic regression analysis was performed.
Table 3: Logistic regression of development of hydrocephalus
Age (11-15 years) had 0.886 (95% CI 0.063 to 10.018) times increase in odds having development of hydrocephalus. Male had 6.023 (95% CI 0.489 to 76.653) times increase in odds having development of hydrocephalus. Age, male, near total removal and subtotal removal were not significantly associated with development of hydrocephalus.
In this study the age of the patients was 3-15 years, the mean age was 9.47±3.18, and the peak incidence was 11-15 years which was 20 (36.36%). Emara et al.8 reported the mean age was 17.5±14.2 years with an age range from 2 to 30 years. Moussalem et al.9 observed mean age of 6.19±4.42 years. Ghani et al.3 reported mean age was 61.45±30.37 months. Gopalakrishnan et al.10 found the ages ranged from 1.5 to 18 years and mean age 8 years at the time of diagnosis. Helmbold et al.11 found that significant number of patients was between ages 0.4-20.8 years (mean, 8.5; median, 8.2). 15 out of 70 patients (21.4%) required shunt placement over the post-operative course. Patients in the shunt group (n = 15; mean, 5.4 median, 3.0) were younger than in the non – shunt group (n=55; mean, 9.3; median, 9.0). An age < 3>
Current study observed majority of the patient were male (56%), male female ratio was 1.27:1. Emara et al.8 reported out of 44 patients, 28 (63.6%) patients were males and 16 (36.4%) were females. Moussalem et al.9 observed 59.37% patients were males. Habib13 found in his study that 29 (69%) were males and 13 (31%) were females, with a male to female ratio of 2.2:1. Our study has similarity with the study of de Oliveira et al.12; Habib.13
In this study observed preoperative clinical features of the study subject were headache 51(92.73%), papilloedema 47(85.45%), vomiting 46(83.64%), gait disturbance 37(67.27%), diminution of vision 31(56.36%), swallowing difficulty 12(21.82%) and cranial nerve palsy 12(21.82%). Emara et al.8 reported most common presentation in (90.9%) of cases followed by vomiting (77.3%), then ataxia (22.7%) and cranial nerve palsy (18.2%). Patients with severe hydrocephalus caused by posterior fossa lesions were characterized by headache, nausea, vomiting, diplopia, ventricular collapse, intracranial hypertension, papilloedema and somnolence which has also mentioned by Arriada and Sotelo.14 According to de Oliveira et al.12 preoperative clinical features were headaches 89%, cerebellar ataxia 61%, papilloedema 41%, vomiting 77% and also found some typical signs and symptoms in patients namely headaches (89%), ataxia (61%), papilloedema (41%). vomiting (77%), cranial nerve palsy (28%), motor deficits (11%), full anterior fontanelle in infants, and torticollis (27%). Habib13 found in the pediatric group, headache was the most common presentation in 75.7% of patients, followed by vomiting 51.5% and 45.5% with papilledema, diminution of vision and diplopia was noted in 15.1% and 12.1% respectively.
Uddin et al.1 it indicates that preoperative V-P shunt was less required in 11-15 years age groups. Our findings are similar to the findings of other authors and in close agreement with de Oliveira et al.12 It can be interpreted that elderly children with preoperative hydrocephalus due to posterior fossa midline tumor have less chance of requirement of VP shunt. Though ETV (endoscpic 3rd ventriculostomy) is an alternative procedure of Ventriculoperitoneal shunt procedure but due to unavailability of the instrument in our centre this procedure can’t be done.
Present study observed post-operative complication of the study population CSF leakage 4(7.27%), pseudomeningocele 11(20%), wound infection 12(21.82%) and meningitis 19(34.55%). Emara et al.8 reported the most common complications are as follows: shunt obstruction 8 cases (18.2%), haemorrhage 6 cases (13.6%), cerebrospinal fluid leakage ± pseudomeningocele 6 cases (13.6%), wound infection 4 cases (9.1%), mutism 2 cases (4.55%), cranial nerve palsy 4 cases (9.1%) and seizures 2 cases (4.55%).
EI Molla and Hamza (2016) found their study that failure of V-P shunt was 5 (50%), infection 3 (30 5), CSF leak 2 (20%), upward herniation 1 (10%), subdural collection 2 (20%) and mortality 1 (10%) among 10 patients with pre insertion V-P shunt and 12 patients of direct tumor surgery, 5 (41.6%) showed recurrence of hydrocephalus within two weeks and all were treated with V-P shunt, pseudomeningocele was 3 (25%) and mortality was 2(16.7%) patients15.
A study of Islam et al.16 of 32 patients concluded that cerebrospinal fluid leakage was the most common complication which occurred in 26.7% of cases followed by pseudomeningocele in 23.5% of cases. Charles and Morgan17, complication rate 19% with a single case mortality. An uneventful postoperative period in 31% of cases and only 19% had neurological complications at long-term.18 Moussalem et al.9 reported 12.28 % of the patients developed hydrocephalus postoperatively. In our study postoperative hydrocephalous was in 3(5.45%) patients which was statistically significant with comparison of the study of Helmbold et al. 201911. CSF leak was found in 4 (7.27%) patients of this study which was statistically significant with comparison of the published literature of Sainte-Rose et al.19. Pseudomeningocele was found in 11 (20.0%) patients which was statistically significant in comparison to the study of Gopalakrishnan et al.10; Aljubour et al.20; Marx et al.21. Meningitis was found in 19 (34.55%) patient which was statistically significant with comparison of the published literature of Fritsch et al.22; Abou-Madawi23; Due-Tonnessen and Helseth24; de Oliveria et al.12; Aljubour et al.20; Marx et al.21; Helmbold et al.11.
Current study showed in CT scan of brain after definitive surgery, gross total removal of tumor was done 41(74.55%), near total removal 6(10.91%) and subtotal removal 8(14.55%). Helmbold et al.11 found in their study that within the shunt group, gross total resection was achieved in 9 (60%) and a subtotal resection in 6 patients (40%). There was no significance found between postoperative shunt placement and gross total tumor resection according to the postoperative neuroradiological report.
In histopathological findings, 20(36.36%) patients were astrocytoma, 16 (29.09%) medulloblastoma, 13(23.64%) ependymoma, 2(3.64%) choroid plexus papilloma, 2(3.64%) dermoid and 2(3.64%) meningioma. Emara et al.8 observed the most common is astrocytoma in 16 cases (36.3%) which its variants are pilocytic and anaplastic in 14 and 2 cases of them respectively, then medulloblastoma 12 cases (27.3%), ependymoma 10 cases (22.7%), metastatic tumour 4 cases (9.1%), ganglioglioma one case (2.3%) and dermoid tumour one case (2.3%). A case study was represented a rare intracranial dermoid tumour with its uncommon location in the posterior fossa.26 Moussalem et al.9 reported the most common tumor pathology was pilocytic astrocytoma (40.62 %) followed by medulloblastoma (35.93 %) and ependymoma.
Present study observed 31 patients developed post-operative complications. Development of hydrocephalus was 3 (5.45%) and CSF leakage was 4(7.27%) in gross total removal. Pseudomeningocle was found 8(14.55%) in gross total removal and 3(5.45%) in near total removal. Wound infection was found 7(12.73%) in gross total removal, 3(5.45%) in near total removal and 2(3.64%) in subtotal removal. Meningitis was found 15(27.27%) in gross total removal, 2(3.64%) in near total removal and 2(3.64%) in subtotal removal. Ghani et al.3 reported 81.58% patients were found in gross total and 18.42% in subtotal. Aljubour et al.20 reported patients who had a gross total excision of their tumor have significantly lower risk to need a VP- shunt insertion.
In this study showed age (11-15 years) had 0.886 (95% CI 0.063 to 10.018) times increase in odds having development of hydrocephalus. Male had 6.023 (95% CI 0.489 to 76.653) times increase in odds having development of hydrocephalus. Near total removal and subtotal removal were not significantly associated with development of hydrocephalus. Moussalem et al.9 reported midline tumors were more associated with the development of mutism (OR = 4.632, p = 0.306) and hydrocephalus (OR = 5.056, p = 0.135) postoperatively, a bit not statistically significant. The presence of a preoperative shunt was shown to be protective against the development of CSF leak (OR = 0.636, p = 0.767), as none of the patients that came in with CSF diversion developed a CSF leak after their surgery. Morelli et al.25 found in their study that tumor removal can restore CSF circulation, obstructive hydrocephalus persists or progresses postoperatively in approximately 15 to 30% of cases in which patients need postoperative treatment. Authors of many studies have suggested that a young age and an incomplete tumor resection could be related to a higher incidence of persistent hydrocephalus. de Oliveira et al.12 described that chronic arachnoiditis after posterior fossa surgery, leading to adhesions, may have been responsible for the higher rate of shunt requirements.
In conclusion we found satisfactory outcome of doing pr-operative VP Shunt in posterior fossa midline tumor causing obstructive Hydrocephalus in children, however major postoperative complications were development of hydrocephalus, CSF leak, pseudo meningocele, wound infection and meningitis. Future prospective studies with sufficient sample size are warranted to reach a definitive conclusion.
1. Sample size was very small.
2. The study was conducted within a short period of time
3. Outcome of the study varies with benign and malignant tumor as well as with different age groups.
4. Postoperative outcome depends on the extent of tumor removal.
1. Further study should be carried out incorporating large numbers of patients for a better conclusion.
2. Study should be done for a longer period for a better result.
3. A lifesaving operation should be performed in case of acute hydrocephalus.
Authors Contributions:
Conception, Diagnosis and Design, Radiological Diagnosis and Final approval of manuscript:
Dr Md Rezaul Amin, Dr KM Tarikul Islam, Dr ABM Manwar Hossain, Prof. Moududul Haque
Manuscript Preparation, Technical Revision, and Manuscript editing and revision:
Dr Md Rezaul Amin, Dr KM Tarikul Islam, Dr ABM Manwar Hossain
Literature Review: Dr Md Rezaul Amin, Dr KM Tarikul Islam
Ethical Approval:
Not applicable, in our country no ethical committee has been established.
Competing Interest: There is no interest in financial and personal nature.
Acknowledgements: None
Funding Support and Sponsorship: This research didn’t receive any specific grant from funding agencies in the public, commercial or not for profit sector.
Conflict of Interest: There is no conflict of interest.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
