AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Anna Konney, Institutional address: Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi- Ghana
Citation: Konney A, Dzogbefia M, Philip O Peprah, Gyimah D and Barnor I. (2020) Thyroidectomy under Local Anaesthesia; Experience from a Tertiary Hospital in Kumasi, Ghana. Journal of Clinical Otorhinolaryngology, 2(2): Doi: 10.31579/2692-9562/007
Copyright: © 2020. : Anna Konney, 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: 23 June 2020 | Accepted: 02 July 2020 | Published: 06 July 2020
Keywords: thyroidectomyꓼ regional cervical plexus blockꓼ local anaesthesiaꓼ outcomes
Objectives: Improvement in anaesthesia has allowed thyroidectomies to be performed mainly under general anaesthesia. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia. The objective of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia in a tertiary referral hospital in Ghana.
Materials and Methods: A retrospective study was conducted on all patients who had thyroidectomy under local anaesthesia from 1st January 2017 to 31st May 2018 in KATH. Data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness of the procedure. Data was analysed using Stata version 16.0software.
Results: A total of 105 thyroidectomies were done in the study period out of which 16 were done under local anaesthesia. All 16 patients (16 females, 100%) and majority 11 (68.75%) were aged between 30 and 50 years. 11 (68.75) had grade IB goitres. The most frequently performed surgery was thyroid lobectomy 12 (75%) and in 75% of cases the surgery was completed between 60 and 90 minutes. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. The cost of treatment was averagely 30% less compared to same surgery under general anaesthesia. No complications were recorded in the post-operative period.
Conclusions: Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia result in good surgical outcomes. The procedure is safe and cost-effective and should be performed by experienced surgeons for the best outcomes.
Thyroidectomy is the most common surgery performed for goitre in Ear Nose and Throat (ENT) Department, Komfo Anokye Teaching Hospital (KATH), Ghana due to high referrals from peripheral hospitals in the region and the whole country at large.
Historically, Dunhill T.P. as far back as 1908 described that thyroid surgeries were performed under local anaesthesia for a variety of indications including solitary nodules and toxic goitres [1, 2]. Improvements in anaesthesia has allowed the surgery to be performed mainly under general anaesthesia [3] with local anaesthesia restricted to those patients with contraindications to general anaesthesia [4]. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia [3].
The scope of indications may be widened depending on the experience of the surgeon and anaesthetist. Local anaesthesia may be converted to general at any point in the surgery, and the surgeon and anaesthetist must be prepared to do the conversion [5]. There is no data available on thyroidectomy under local/regional anaesthesia in Ghana.
The aim of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia at the ENT Department-KATH.
this was a retrospective study conducted in KATH, a tertiary referral hospital in Ghana from 1st January 2017 to 31st May 2018. All patients who had thyroid surgeries under regional cervical block/ local anaesthesia in ENT Department, KATH were included in this study. These patients were euthyroid or were rendered euthyroid prior to surgery. They had no suspicion of malignancy on FNAC and no retrosternal, retro-pharyngeal or retro-tracheal extensions on radiological investigations. All the patients were informed about the possibility of converting to general anaesthesia in case of intolerability of local anaesthesia or other adverse reaction to the drugs. All patients had thorough preoperative counselling and consented for the surgery.
The data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness. Patients who had thyroidectomy under general anaesthesia, previous thyroid surgeries, intrathoracic extension, malignancies, huge goitres, and bilateral thyroid involvement were excluded.
All the surgeries were performed by the same surgeon who was comfortable during surgery and was able to identify the recurrent laryngeal nerve and also to communicate with the patient for voice feedback and assessment of the comfort of the patient.
Procedure: The surgeon performed the superficial cervical plexus block in all the patients.
Technique of Superficial Cervical Plexus Block:
The patient is put in supine position and the head is slightly elevated and extended with the patient’s face turned away from the side that required surgery. (Picture 1)
The anterior and posterior borders and clavicular head of the sternocleidomastoid (SCM) muscle, mastoid tip and clavicle are identified and marked. A vertical line is drawn from the mastoid tip to the clavicular head of the SCM. The crossing point of the external jugular vein (EJV) is identified at the posterior border of the SCM. Most often the Erb’s point is located just above this point (Picture 2).
The four branches of the superficial cervical plexus (greater auricular, lesser occipital, transverse cervical, and supraclavicular) emerge at the posterior border of the sternocleidomastoid muscle at Erb’s Point. For local anaesthetic, 1% Lidocaine in 1ꓽ 100 000 adrenaline dilution is used. About 15mls of local anaesthetic is injected at Erb’s point just 1 to 2 cm deep for needle to enter the subplatysmal space (Picture 3).
The needle is advanced along the posterior border of the SCM and posteriorly in a” fan shaped” technique for even distribution of the anaesthetic to block all branches of the superficial cervical plexus (Picture 4).
The anterior border of the SCM is also injected subplatysmal with 10mls of the local anaesthetic to block the terminal anterior branches of the transverse cervical nerve (Picture 5).
The planned collar incision line is infiltrated with 10mls of local anaesthetics before the incision.
Intraoperatively, the patients’ vital signs were monitored by the anaesthetist and they were maintained in a state of mild, conscious sedation with intravenous analgesics (Fentanyl) and mild sedative (Midazolam). No bilateral block was done to avoid transient recurrent laryngeal nerve paralysis and airway compromise. The surgeon was able to monitor the recurrent laryngeal nerve during the procedure.
Statistical Analysis
Data was analysed using Stata version 16.0 software.
Ethical Considerations
The study received ethical approval from the Institutional Review Board (KATH-IRB). Permission was given to collect relevant data from the patients’ folders in total confidentiality.
A total of 105 thyroidectomies were done in the study period out of which 16 were done under Superficial Cervical plexus block/ Local anaesthesia. All 16 patients (16 females, 100%) fulfilled the inclusion criteria and were recruited in the study. Majority of the patients 11 (68.75%) were aged between 30 and 50 years. (Table 1).
By the WHO Grade of goitres, majority 11 (68.75) of the thyroidectomies were done for patients who had grade IB goitres and the rest, 5 (31.25%) had grade II. The duration of surgery is represented in (Figure 1).
Most of the surgeries were completed between 60 and 90minutes. The most frequently performed surgery was thyroid lobectomy 12 (75%) (Table 2).
None of the patients stayed more than 72 hours on the ward. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. Three patients were discharged home 24 hours following surgery (Table 3).
The study revealed a significant association (p-value less than 0.05) between surgery duration and age, type of surgery performed and hospital stayed. Surgery duration was statistically significant with age (X2 =24.0, p =0.002). Also, the type of surgery performed and hospital stay showed a statistically significant association with the surgery duration (X2 =12.44, p =0.042) and (X2 =19.0, p<0>
The bills on discharge of the patients who had the surgery under local anaesthesia were found to be averagely 30% less than those who had the same surgery under general anaesthesia.
No complications were recorded and all the patients were satisfied during the surgery and in the post-operative period. The surgeons were comfortable using this method of anaesthesia.
Prior to the year 2017 all thyroid surgeries in KATH were done under general anaesthesia with intubation.
The selection of suitable patients for thyroidectomy under local anaesthesia is very important. Contraindications to the procedure include large goitres, previous neck surgery, sleep apnoea, coagulopathies, obesity, retro-oesophageal or retro-tracheal goitres, intrathoracic goitres that would require a sternotomy, preoperative recurrent laryngeal nerve paralysis, known or suspected locally invasive cancer and patient’s preference for general anaesthesia.
Coincidentally, our study population of 16 were all females. Aliyu et al [6] had majority (88%) of patients operated under local anaesthesia in Northeastern Nigeria. All our patients cooperated well with the procedure and none was converted to general anaesthesia. Some of the factors that may necessitate conversion from local/regional anaesthesia to general anaesthesia include an unexpected intraoperative pathology, a reaction to the local anaesthetic agent and patient discomfort [7].
Studies have shown that local/regional anaesthesia is safe and effective to be used in surgeries of the thyroid [5, 6, 8, 9, and 10]. A crucial prerequisite for this is the availability of an anesthesiologist or a surgeon who is skilled in the administration of superficial and/or deep cervical blocks and proper levels of sedation [11]. In this study the surgeon successfully performed the local blocks.
The advantages of performing thyroidectomies under local/regional anaesthesia are numerous including the reduction in the risks associated with general anaesthesia such as the risks associated with endotracheal intubation and the untoward effects of anaesthetic agents [10, 12]. This is of particular benefit to singers and public speakers as studies have shown that endotracheal intubation is associated with vocal cord changes in about 5% of patients [8]. Again, both patients and surgeons alike find the avoidance of minor side effects like nausea, vomiting, headaches, drowsiness, pharyngitis and visual problems attractive [5].
Recovery from anaesthesia is also faster, when compared to general anaesthesia. Only 3 out of 16 patients were discharged within 24 hours after surgery. This contrasts with the study describing experience with outpatient thyroidectomy [13], where 76 out of 134 patients were discharged the same day after a postoperative evaluation period of 4 to 8 hours.
Overall cost of treatment for patients undergoing thyroidectomy under local/regional anaesthesia is lower than patients who had thyroidectomy under general anaesthesia as demonstrated in our study and also in Brazil [9, 10, and 14]. Ultimately, local/regional anaesthesia has been found to be superior in patients with compromised cardiac status and those with symptoms of obstruction due to a large goitre to avoid the risks associated with a difficult intubation [11, 15].
Major complications associated with LA/regional anaesthesia may include accidental injection into the internal jugular vein or carotid artery, direct infusion into the thyroid veins resulting in local anaesthetic toxicity and infiltration of the vagus nerve resulting in transient vocal cord paralysis and potential airway loss, resulting in the need for conversion to general anaesthesia.
Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia/superficial cervical plexus block result in good surgical outcomes, and these can be replicated successfully with great care in low resource settings where there is lack of anaesthetic services for endotracheal intubations. Such thyroidectomies are tolerable and also cost-effective and should be performed by experienced surgeons for the best outcomes.
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
