World Neurosurg
-
Radiation therapy for central nervous system disease commonly involves collaboration between Radiation Oncology and Neurosurgery. We describe our early experience with a multidisciplinary clinic model. ⋯ The RADIANS clinic model has proved viable and well-liked by patients in a community setting, with the majority of radiation therapy administered being stereotactic radiosurgery/stereotactic body radiation therapy rather than conventional fractionation.
-
Since 2011, more women than men have graduated from medical school, yet there remains a paucity of female physicians in surgical specialties. After the 2018 Neurosurgery Match, only 17.5% of neurosurgery residents are women. Previous literature documented gender inequality, poor medical school exposure, and lack of female mentorship as reasons for this disparity. We sought to further explore factors that deter female medical students from pursuing neurosurgery. ⋯ Female medical students remain resilient, ambitious, interested in competitive specialties, and eager to explore surgical subspecialties during preclinical years. A multifaceted approach is imperative to recruit and retain qualified women interested in neurosurgery.
-
Next-day postoperative computed tomography (CT) has been routinely used to obtain radiographic "clearance" for transferring patients after elective craniotomy out of the intensive care unit. The value of this traditional policy, however, has repeatedly been questioned. However, the limited patient numbers might have underestimated the very rare, but catastrophic, events. Therefore, we analyzed the value of routine postoperative CT in a larger cohort of elective tumor, epilepsy, and vascular cases. ⋯ Routine postoperative CT did not reveal 1 patient with a serious hematoma that would not have been identified by clinical examination. Patients could be transferred safely from the intensive care unit, if the weaning process and clinical observation findings were uneventful, without deterioration of neurological symptoms or consciousness.
-
Observational Study
Predictive Factors for Delayed Hyponatremia After Endoscopic Transsphenoidal Surgery in Patients with Nonfunctioning Pituitary Tumors: A Retrospective Observational Study.
Delayed hyponatremia can occur after transsphenoidal pituitary tumor surgery, resulting in unexpected readmission. Predictive factors for delayed hyponatremia after this type of surgery are not well established. In this retrospective study, predictive factors for delayed hyponatremia were investigated in patients undergoing transsphenoidal pituitary tumor surgery. ⋯ The incidence of delayed hyponatremia in patients with nonfunctioning pituitary tumor who underwent endoscopic transsphenoidal surgery was 22.6%. Old age, low sodium concentration on POD 1-2, and long operation time were associated with the development of delayed hyponatremia in such patients.
-
In the setting of spinal metastases with epidural cord compression, radiosurgery is often only considered when there is sufficient separation between the epidural disease and the spinal cord. However, in patients who are nonsurgical candidates or those who prefer nonoperative management, there may be a benefit from stereotactic body radiation therapy, even when the epidural target is closer than the traditionally referenced 3 mm distance from the spinal cord. The purpose of this retrospective study is to evaluate our institution's experience in treating 20 such patients. ⋯ Although local control was less than expected when compared with spine radiosurgery with adequate separation between the target and spinal cord, this treatment appears to be a viable option in the nonsurgical candidate.