World Neurosurg
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The h-index was introduced as a means of quantifying the contribution a researcher makes to the scientific literature. We evaluated the h-index for academic neurosurgeons to assess the various methods of calculation and to determine whether the h-index can be used to differentiate groups of individuals by various classifications. ⋯ Application of the h-index as a bibliometric in neurosurgery can distinguish academic productivity on the basis of academic rank, years posttraining, and neurosurgical subspecialties. The application of the h-index to compare departments is problematic and, at this time, not reliable.
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An increasing number of neurological surgeons have sought fellowship training in recent years, and previous analyses have suggested these practitioners are more likely to pursue an academic career. Scholarly productivity is a key component in academic advancement. ⋯ No significant difference existed between the mean h-index scores of neurological surgeons who completed fellowships and those who did not. However, when stratified by academic rank, a trend was observed showing greater mean h-index scores for those who completed fellowships. This trend persists across nearly all subspecialties. Overall, being a senior faculty member corresponds with a greater h-index score, regardless of whether a fellowship was completed.
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Recently, somatosensory cortex stimulation has been proposed as a possible treatment for neuropathic deafferentation pain, based on a simple 4-step concept: (1) pain is associated with increased activity in the somatosensory cortex, (2) allodynia-evoked blood-oxygen-level dependence functional magnetic resonance imaging (fMRI) activation depicts the area involved in the pain, (3) if fMRI-guided, neuronavigation-based transcranial magnetic stimulation can transiently suppress the pain, then (4) an extradural electrode can be implanted targeting the same area. ⋯ Combining fMRI and PET scanning can potentially demonstrate continuing map plasticity under progressive somatosensory deafferentation. The functional imaging data can be used as target for pathophysiology-based somatosensory cortex stimulation.
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Case Reports
Rapid and progressive venous thrombosis after occlusion of high-flow arteriovenous fistula.
Cerebral venous thrombosis developing after surgical or endovascular obliteration of arteriovenous fistula (AVF) is a rare but devastating complication that has not been adequately reported. ⋯ Rapid occlusion of a high-flow AVF resulting in significant venous stasis can precipitate thrombosis of the venous system distal to the fistulous point. In the presence of large venous pouches and significant venous stasis, strict therapeutic anticoagulation may be required to prevent cerebral venous thrombosis. Therapeutic anticoagulation, though feasible following endovascular treatment, may prove particularly challenging after open surgical interventions given the risk of hemorrhagic complications.