World Neurosurg
-
This report portrays our pitfall in the initial diagnosis of an intracranial arterial dissection that we misinterpreted as a saccular aneurysm. Intracranial arterial dissections presenting with convexity subarachnoid hemorrhage are rare, thus being easily mistaken with mild traumatic head injuries and therefore preventing transfer to a tertiary hospital. ⋯ Thrombus within the dissected segment can be mistaken by vasospasm and may even reveal fake images of saccular aneurysms, thus prompting inadequate endovascular or surgical treatment. The case reported here illustrates all these likely pitfalls in the diagnosis and management of intracranial arterial dissections.
-
Neurosurgery residency is becoming an increasingly competitive match. The process of screening and ranking applicants is a multifactorial process that lacks uniformity across residency programs. A significant factor is the applicant's performance on the United States Medical Licensing Examination (USMLE) Step 1. USMLE Step 1 scores are often used to project future success in residency and performance on specialty boards like the American Board of Neurological Surgery (ABNS) examination. The authors of this study investigate the strength of correlations between USMLE Step 1 and ABNS scores. ⋯ USMLE Step 1 and ABNS scores are directly correlated. USMLE Step 1 scores will continue to be a valuable measure of projected success on ABNS written examinations, but more sophisticated measures are needed.
-
To compare the clinical outcomes of patients with recurrent lumbar disk disease undergoing percutaneous endoscopic lumbar diskectomy or minimally invasive transforaminal lumbar interbody fusion at a single clinic. ⋯ Both PELD and MIS-TLIF showed favorable clinical outcomes for recurrent disk herniation. Compared with MIS-TLIF, PELD has the following several advantages: 1) performed under local anesthesia; 2) performed with very few approach-related complications, such as dural tear; and 3) rare possibility of fusion disease, such as adjacent segment. However, PELD is also faced with several problems, such as 1) the relative higher rate of postoperative long-term chronic low back pain, and (2) the possibility of recurrence, despite the opportunity being low.
-
China has a large and aging population. The need for physicians with training in clinical neurosciences will grow. There is little known regarding the factors that lead physicians in China to pursue careers in clinical neurosciences. The objective of this study was to garner a clearer understanding of factors that influence physicians to pursue careers in neurosurgery and neurology in China. ⋯ The intellectual challenges are important factors for physicians in China influencing the pursuit of careers in the clinical neurosciences. This finding echoes results found elsewhere in the world. However, differences with trainees elsewhere in the world emerge when evaluating additional factors influencing trainees pursuing careers in the clinical neurosciences. Trainees in China rate educational experiences and mentorship more highly, whereas U.S. trainees rate altruistic goals more highly. This study provides a clearer understanding of factors influencing career choice among clinical neuroscientists in China.
-
Extent of resection (EOR) remains controversial in therapy for glioblastoma (GBM). However, an increasing number of studies favor maximum EOR as being associated with longer patient survival. Residual tumor volume (RTV) has also recently emerged as a prognostic factor. Low-field intraoperative magnetic resonance imaging (iMRI) has contributed to improve the EOR of GBM. The purpose of this study was to analyze the relationships between EOR/RTV and overall survival (OS)/progression-free survival (PFS) in patients with newly diagnosed GBM using low-field iMRI. ⋯ This volumetric analysis for low-field iMRI showed that both EOR and RTV were significantly associated with survival and recurrence. We determined a threshold RTV of 3 cm3 as the maximum RTV associated with survival.