Journal of neurosurgery
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Journal of neurosurgery · Nov 2024
The value of a neurosurgeon: is neurosurgical compensation proportional to value added? A systematic review of the literature and an update on a changing healthcare economy.
Determining the value of a neurosurgeon is complex. Services provided by neurosurgeons have a range of interested parties-from a patient's singular health interest to a community catchment area rendering on-call emergency services. Such complexity makes it difficult to determine and define value. As healthcare reimbursement changes continue to transition further toward value-based/bundled payments, such determinations remain difficult and confusing. Given these factors, now more than ever before, neurosurgeons need to be active participants in the evolving discussions surrounding healthcare advocacy, value, and compensation in an ever-evolving and convoluted system. The objective of this study was to review and present current trends within the evolving landscape of healthcare economics and their impacts on the perceived value of neurosurgical services. ⋯ Medical compensation continues to evolve toward more value-driven methods. Value created as a neurosurgeon is complex, but it should not be underestimated as a key driver of hospital revenue, with up to $2.6 million created annually from neurosurgical hospital admissions. Further discussion is needed to elucidate alternative innovative payment strategies to ensure physicians remain active in the evolving structure of our healthcare system.
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Journal of neurosurgery · Nov 2024
Surgical anatomy of the inferior hypophyseal artery and its relevance for endoscopic endonasal skull base surgery.
The inferior hypophyseal arteries (IHAs) are intimately related to pituitary and cavernous sinus (CS) lesions. There is still no anatomical study specifically analyzing the IHAs. The aim of this study was to investigate the surgical anatomy and variations of the IHA, and to translate this knowledge into surgical practice. ⋯ The IHA can be divided into proximal and distal segments. Its proximal segment is most often found crossing the CS at the level of the lower third of the PCP and entering the posterior third of the medial wall of the CS. A detailed understanding of the surgical anatomy of the IHA and its variability will help surgeons dealing with challenging lesions within the CS and when performing transcavernous approaches, interdural posterior clinoidectomies, and pituitary gland transpositions.
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Journal of neurosurgery · Nov 2024
Distinct brain network structure of mesial temporal lobe epilepsy compared to that of neocortical epilepsy: functional MRI study with surgically treated patients.
Mesial temporal lobe epilepsy (mTLE) and neocortical epilepsy (NE) have different anatomo-clinical characteristics. The authors hypothesized that this may be reflected in the different functional connectivity of the epileptogenic zone between mTLE and NE. The authors, therefore, examined preoperative resting-state functional connectivity MRI with regional global connectivity (rGC) analysis for surgically treated patients. The goal of this study was to detect the different functional networks associated with the epileptogenic zone between mTLE and NE. ⋯ The authors revealed a distinct brain network structure between mTLE and NE based on rGC analysis with resting-state functional MRI. The authors' unique functional connectivity analysis may be helpful for providing landmarks for lateralization or epileptogenic zones in mTLE and NE.
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Journal of neurosurgery · Nov 2024
Laser interstitial thermal therapy for cavernous malformations: a meta-analysis of individual patient-level data.
Several case series have investigated the use of laser interstitial thermal therapy (LITT) to treat cavernous malformations (CMs), for either seizure control or reduction of neurological symptoms and future hemorrhage risk. However, pooled outcomes are largely unknown. The authors aimed to quantify posttreatment seizure freedom, symptomatic progression or hemorrhage, perioperative complications, and imaging outcomes from the available literature. ⋯ LITT is a promising therapy for CMs with the goal of seizure control or prevention of symptomatic progression or hemorrhage. While there is a notable risk of immediate postablation neurological deficit, most were transient and nondisabling, and this risk must be weighed against that of continued observation or open resection. Considering the limited number of studies, small number of patients, and limited follow-up time available, additional experience and research with larger patient cohorts and longer-term follow-up will be necessary to validate these findings.
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Journal of neurosurgery · Nov 2024
Gamma Knife radiosurgery for relapsing trigeminal neuralgia following microvascular decompression.
Gamma Knife radiosurgery (GKRS) is a treatment option for refractory trigeminal neuralgia (TN). However, there is a paucity of data regarding the effectiveness of GKRS for relapsing TN following microvascular decompression (MVD). The aim of this study was to characterize the response rate, complications, pain relief durability, and predictors of pain relapse for salvage GKRS following MVD for TN. ⋯ Salvage GKRS presents an effective, noninvasive option for recurring TN after MVD, with a comparable response rate to primary GKRS or MVD, and a favorable complications profile relative to salvage MVD. Patients with postoperative facial numbness and a better initial pain response may experience more durable pain relief following salvage GKRS.