Neurosurgery
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The Accreditation Council for Graduate Medical Education Milestones assessment system provides a structured framework for evaluating the developmental progression of neurosurgery residents. Understanding the variability in learning trajectories and identifying critical intervention points are essential for refining educational strategies and enhancing training outcomes. In this article, we aim to identify learning trajectories of neurosurgery residents and pinpoint pivotal junctures for potential interventions to aid residents struggling to meet expected competency levels. ⋯ Our findings highlight the need for educational strategies tailored to residents' unique development paths to support the achievement of competency thresholds. While the data suggest potential benefits of adaptive learning, further exploration is required to confirm its impact on educational outcomes.
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Intracranial epidermoid cysts are rare, slow-growing but highly recurrent tumors with incompletely understood symptoms, progression, complications, and outcomes. The aim of the study was to characterize the symptomatology, surgical management, and long-term outcomes of these tumors. ⋯ The clinical progression of intracranial epidermoid cysts is marked by a spectrum of troublesome presenting symptoms and a notable tendency for recurrence, particularly following subtotal resection. Nevertheless, symptomatic improvement is the rule even if reoperations are needed, and mortality is exceedingly rare.
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Nearly one-third of individuals with epilepsy have drug-resistant epilepsy, treated most effectively with surgery. This study aims to discuss the demographic profile, surgical access, and strategies used in drug-resistant epilepsy in Africa. ⋯ These findings demonstrate the efficacy and long-term benefits of epilepsy surgery in Africa, where epilepsy is a significant public health challenge. The high rates of seizure freedom and reduced seizure frequency from surgery highlight its potential to improve the quality of life for individuals with drug-resistant epilepsy in Africa.
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Patients undergoing thalamic ventral intermediate nucleus stimulation to treat essential tremor (ET) develop tolerance over time, requiring higher stimulation amplitudes that lead to more frequent battery changes and suboptimal tremor control. The study objective is to determine whether amplitude tolerance differs between patients with omnidirectional vs directional leads. ⋯ Both omnidirectional and directional deep brain stimulation reduces tremor severity in ET patients. However, directional leads offer more stable voltage requirements and less year-to-year voltage change, particularly in the first year. The increased likelihood of significant pulse width changes in omnidirectional leads suggests that directional leads may provide more sustainable therapeutic effects through other programming parameters. Ongoing research is needed to optimize deep brain stimulation technology and programming strategies to maximize patient benefit and device longevity.
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Monitoring of electrocorticography for the purpose of detecting spreading depolarization (SD) events is becoming increasingly used both for research and clinical applications. Although such monitoring bears many similarities to standard long-term epilepsy monitoring, there are a number of differences that neurosurgeons need to be aware of when initiating such a program. In addition, most of the focus in SD monitoring has been on traumatic and vascular conditions, where invasive monitoring is used commonly, but electrocorticography is not commonly used. ⋯ It is also recognized that this is a rapidly evolving field and that new advances may disrupt these approaches and that there is a diversity of opinion on these topics, even among SD experts. Nonetheless, the general approach to SD monitoring has now been in use for >15 years and is the basis for several active and proposed clinical trials (NCT05337618, NCT04966546), so an understanding from a neurosurgical perspective of the rationale and approach to monitoring is warranted. In this review, we will consider the potential indications for SD monitoring in clinical trials or clinical care, the methodology for recording and interpreting, and finally some potential therapeutic approaches that are being considered in patients with clinically detected SD.