Journal of neurosurgery
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Journal of neurosurgery · Feb 2022
Routine postoperative fluid restriction to prevent syndrome of inappropriate antidiuretic hormone secretion after transsphenoidal resection of pituitary adenoma.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common problem during the postoperative course after pituitary surgery. Although treatment of this condition is well characterized, prevention strategies are less studied and reported. The authors sought to characterize outcomes and predictive factors of SIADH after implementation of routine postoperative fluid restriction for patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma. ⋯ Routine fluid restriction reduced the rate of SIADH in patients who underwent surgery for pituitary adenoma but was not associated with reduction in 30-day readmission rate.
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Journal of neurosurgery · Feb 2022
Neurosurgery residency and fellowship education in the United States: 2 decades of system development by the One Neurosurgery Summit organizations.
The purpose of this report is to chronicle a 2-decade period of educational innovation and improvement, as well as governance reform, across the specialty of neurological surgery. Neurological surgery educational and professional governance systems have evolved substantially over the past 2 decades with the goal of improving training outcomes, patient safety, and the quality of US neurosurgical care. Innovations during this period have included the following: creating a consensus national curriculum; standardizing the length and structure of neurosurgical training; introducing educational outcomes milestones and required case minimums; establishing national skills, safety, and professionalism courses; systematically accrediting subspecialty fellowships; expanding professional development for educators; promoting training in research; and coordinating policy and strategy through the cooperation of national stakeholder organizations. ⋯ Since 2010, ongoing meetings of the One Neurosurgery Summit have provided strategic coordination for specialty definition, neurosurgical education, public policy, and governance. The Summit now includes leadership representatives from the Society of Neurological Surgeons, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the American Board of Neurological Surgery, the Review Committee for Neurological Surgery of the Accreditation Council for Graduate Medical Education, the American Academy of Neurological Surgery, and the AANS/CNS Joint Washington Committee. Together, these organizations have increased the effectiveness and efficiency of the specialty of neurosurgery in advancing educational best practices, aligning policymaking, and coordinating strategic planning in order to meet the highest standards of professionalism and promote public health.
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Journal of neurosurgery · Feb 2022
Increasing author counts in neurosurgical journals from 1980 to 2020.
Scientific productivity, as assessed by publication volume, is a common metric by which the academic neurosurgical field assesses its members. The number of authors per peer-reviewed article has been observed to increase over time across a broad range of medical specialties. This study provides an update to this trend in the neurosurgical literature. ⋯ Author counts for peer-reviewed articles in neurosurgical academic journals have increased significantly during the past 4 decades, with large increases in the numbers of articles with more than 10 authors in the past 5 years. A total of 28% of the variation in this increase can be explained by an increase in multiinstitutional or multidepartmental studies.
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Journal of neurosurgery · Feb 2022
Historical ArticleThe birth of experimental neurosurgery: Wilder Penfield at Montreal's Royal Victoria Hospital, 1928-1934.
Wilder Penfield is well known as the founder of the Montreal Neurological Institute (MNI), the site of his most important contributions to the investigation and treatment of epilepsy and to our understanding of the structure-function relationship of the brain. The seeds of the MNI were sown 6 years before its opening in 1934, when Penfield accepted the position of head of the Subdepartment of Neurosurgery at McGill University's Royal Victoria Hospital (RVH). ⋯ Penfield and his first neurosurgical research fellows Joseph Evans, Jerzy Choróbski, Nathan Norcross, Theodore Erickson, Isadore Tarlov, and Arne Torkildsen studied the substrate of focal epilepsy, the innervation of cortical arteries, the function of the diencephalon, the microscopic structure of spinal nerve roots, and the ventricular system in health and disease. In his 6 years at the RVH, Penfield and his fellows effected a paradigm shift that saw neurosurgery pass from empirical practice to scientific discipline.
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Journal of neurosurgery · Feb 2022
Synergy between glutamate modulation and anti-programmed cell death protein 1 immunotherapy for glioblastoma.
Immune checkpoint inhibitors such as anti-programmed cell death protein 1 (anti-PD-1) have shown promise for the treatment of cancers such as melanoma, but results for glioblastoma (GBM) have been disappointing thus far. It has been suggested that GBM has multiple mechanisms of immunosuppression, indicating a need for combinatorial treatment strategies. It is well understood that GBM increases glutamate in the tumor microenvironment (TME); however, the significance of this is not well understood. The authors posit that glutamate upregulation in the GBM TME is immunosuppressive. The authors utilized a novel glutamate modulator, BHV-4157, to determine synergy between glutamate modulation and the well-established anti-PD-1 immunotherapy for GBM. ⋯ In this study, the authors showed synergy between anti-PD-1 immunotherapy and glutamate modulation. The authors provide a possible mechanism for this synergistic benefit by showing that BHV-4157 relies on CD4+ and CD8+ T cells. This study sheds light on the role of excess glutamate in GBM and provides a basis for further exploring combinatorial approaches for the treatment of this disease.