World Neurosurg
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We previously performed a nationwide survey of American neurosurgical residents before the initiation of the 2011 Accreditation Council for Graduate Medical Education regulations, in which more than 70% indicated the proposed changes would negatively impact residency training. We sought to resurvey the resident population as to the actual changes that occurred to their programs after the 2011 standards went into effect. ⋯ Respondents indicated that the 2011 Accreditation Council for Graduate Medical Education regulations have had a smaller perceived effect on neurosurgical training programs than previously predicted. However, the majority of residents admitted to underreporting duty hours, with a quarter doing so on a regular basis. The 16-hour rule for interns remains unpopular.
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Meningiomas with growth onto or into the major venous sinuses, that is, venous meningiomas, provide management problems regarding their radical removal and preservation of venous drainage. The relationship to venous structures often precludes radical surgery; the risk of recurrence and aggressive histology is greater for parasagittal meningiomas than in other locations. Older series reflect the conflict between radical surgery and subtotal removal followed by the "wait-and-scan" approach for the residual. This review summarizes our experience of a more contemporary series of venous meningiomas, after to the introduction of gamma-knife radiosurgery, for residual tumors and a long follow-up of 10 years. ⋯ Surgical microscopic radicality was unexpectedly difficult to achieve. Gamma-knife radiosurgery was a useful adjunct but only in patients with tumors of low proliferative index. It should probably be used as part of the initial surgical management. As expected, treatment results for these patients seem to have improved during the last decades but recurrence and malignancy remained a problem, which is not always solved by repeated radiosurgery.