Journal of neurosurgery
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Journal of neurosurgery · Feb 2023
Equity in neurosurgery: a worldwide survey of women neurosurgeons.
The global neurosurgery workforce does not have a defined stance on gender equity. The authors sought to study and characterize the demographic features of the international women neurosurgery community and to better understand the perceptions and reflections of their neurosurgical careers. The objective was to define and characterize the workplace inequities faced by the global women neurosurgeon community. ⋯ This survey provides international feedback for characterizing and understanding the experiences of women neurosurgeons worldwide. Future research should aim to understand all neurosurgeons' experiences throughout the pipeline and career life cycle of neurosurgery in order to improve the field of neurosurgery.
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Journal of neurosurgery · Feb 2023
Words matter: using natural language processing to predict neurosurgical residency match outcomes.
Narrative letters of recommendation (NLORs) are considered by neurosurgical program directors to be among the most important parts of the residency application. However, the utility of these NLORs in predicting match outcomes compared to objective measures has not been determined. In this study, the authors compare the performance of machine learning models trained on applicant NLORs and demographic data to predict match outcomes and investigate whether narrative language is predictive of standardized letter of recommendation (SLOR) rankings. ⋯ NLORs and demographic data similarly discriminate whether applicants will or will not match into a neurosurgical residency program. However, NLORs potentially provide further insight regarding applicant fit. Because words used in NLORs are predictive of both match outcomes and SLOR rankings, continuing to include narrative evaluations may be invaluable to the match process.
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Journal of neurosurgery · Feb 2023
Salvage radiosurgery following subtotal resection of vestibular schwannomas: does timing influence tumor control?
The goal of microsurgical resection of vestibular schwannoma (VS) is gross-total resection (GTR) to provide oncological cure. However, a popular strategy is to halt the resection if the surgical team feels the risk of cranial nerve injury is imminent, achieving a maximally safe subtotal resection (STR) instead. The tumor remnant can then be treated with stereotactic radiosurgery (SRS) once the patient has recovered from the immediate postoperative period, or it can be followed with serial imaging and treated with SRS in a delayed fashion if residual tumor growth is seen. In this study, the authors evaluated the efficacy of this multimodality approach, particularly the influence of timing and dose of SRS on radiological tumor control, need for salvage treatment, and cranial nerve function. ⋯ Delayed SRS after close observation of residuals following STR is a safe alternative to upfront SRS regarding tumor control and cranial nerve preservation in selected patients.
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Journal of neurosurgery · Feb 2023
Median trans-atlanto-occipital membrane microsurgical approach to the posterior cranial fossa without craniotomy.
Minimally invasive approaches are becoming increasingly popular and contributing to improving the results of the surgical treatment of a wide variety of intracranial pathologies. Fifteen patients with posterior cranial fossa tumors underwent microsurgery through the atlanto-occipital membrane without resection of any bone structures. Tumors were localized in the brainstem in 8 patients and in the fourth ventricle in 7 patients. ⋯ Total tumor resection was performed in 10 patients, subtotal resection in 2 patients, partial resection in 1 patient, and open biopsy in 2 patients. Surgical complications occurred in only 1 patient (meningoencephalitis). This minimally invasive trans-atlanto-occipital membrane approach for posterior cranial fossa tumors provides adequate visualization of the caudal part of the fourth ventricle and brainstem when the anthropometric parameters of the patient are suitable.
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Journal of neurosurgery · Feb 2023
Development of an ultrafast brain MR neuronavigation protocol for ventricular shunt placement.
Advancements in MRI technology have provided improved ways to acquire imaging data and to more seamlessly incorporate MRI into modern pediatric surgical practice. One such situation is image-guided navigation for pediatric neurosurgical procedures, including intracranial catheter placement. Image-guided surgery (IGS) requires acquisition of CT or MR images, but the former carries the risk of ionizing radiation and the latter is associated with long scan times and often requires pediatric patients to be sedated. The objective of this project was to circumvent the use of CT and standard-sequence MRI in ventricular neuronavigation by investigating the use of fast MR sequences on the basis of 3 criteria: scan duration comparable to that of CT acquisition, visualization of ventricular morphology, and image registration with surface renderings comparable to standard of care. The aim of this work was to report image development, implementation, and results of registration accuracy testing in healthy subjects. ⋯ The developed and tested sequence of this work allowed accurate intraoperative image registration and provided sufficient parenchymal contrast for visualization of ventricular anatomy. Further investigations will evaluate use of the PICO protocol as a substitute for CT and conventional MRI protocols in ventricular neuronavigation.