查看更多>>摘要：? 2021 Elsevier Inc.Objective: Addressing equitable opportunities for medical student (MS) education is important for minimizing disparities in neurosurgical care. However, international MSs, particularly from low- and middle-middle income countries (LMICs) may lack access to educational opportunities compared with their contemporaries in high-income countries. We compare the usefulness of virtual neurosurgery training camps (VNTC) between U.S. and international MSs. Methods: A survey assessing demographics, baseline interests, and ratings of usefulness was sent to attendees after the VNTC. Ratings were compared between international and U.S. MSs. Results: Thirty-three (27.7%) of 119 attendees were international MSs, of whom 24 (72.7%) were from LMICs. International MSs were more likely to hold an advanced degree (P = 0.0009), more likely to be MS3/MS4s (P = 0.0111) or postdoctoral (P < 0.0001), and less likely to be MS1/MS2s (P = 0.0059). After the VNTC, international MSs reported greater increase in interest in neurosurgery in general (P = 0.0009) and subspecialties of spine (P = 0.0002), peripheral nerve (P = 0.002), vascular (P = 0.0468), functional/epilepsy (P = 0.001), pediatric (P = 0.0285), and trauma/neurocritical care (P = 0.0067). International MSs reported greater post-VNTC willingness to pursue a career in neurosurgery (P = 0.0001), likelihood of taking a year off during medical school (P = 0.0363), and preparedness for subinternships (P = 0.0003). International MSs reported greater increases in awareness of burnout (P = 0.0157) and work–life balance in neurosurgery (P = 0.0249). Conclusions: International MSs experience prolonged periods of education before applying to residency and have unmet informational needs. Distance learning is useful for international MSs. MS neurosurgery education, through online platforms, represents a long-term strategy for addressing disparities in neurosurgical care worldwide.
查看更多>>摘要：? 2021 Elsevier Inc.Objective: Interest groups for medical students (MSs) facilitate interest and engagement in neurosurgery. Students without interest groups are at a disadvantage as a result of greater barriers to exposure. We aimed to compare the usefulness of a virtual neurosurgery training camp for MSs with and without interest groups. Methods: A survey assessing demographics, interests, and ratings of informativeness and usefulness was sent to attendees of virtual neurosurgery training camps. Ratings were quantified on modified 7-point Likert scales. Data were compared between respondents with and without neurosurgery interest groups. Results: Students without an interest group were less likely to be MS1/MS2 (P = 0.0007) and more likely to be postdoctoral students (P = 0.0017). Students without an interest group were less likely to list breakout sessions as their primary reason for attendance (P = 0.0007), more likely to rate the resident panel as most useful (P = 0.0429), and less likely to rate the breakout session as most useful (P = 0.0231). Students without interest groups reported greater increases in interest in neurosurgery in general (P = 0.0284) and subspecialties of spine (P = 0.0003), peripheral nerve (P = 0.0054), and pediatric (P = 0.0137). There was no difference in willingness to pursue a neurosurgical career (P = 0.06), likelihood of taking a year off during medical school (P = 0.45), or preparedness for subinternships (P = 0.18) or residency application process (P = 0.43). Conclusions: Distance learning increases both general and subspecialty-specific interest in neurosurgery among MSs without neurosurgery interest groups to a greater degree than among those with interest groups. Future initiatives seeking to benefit students without home programs should address the specific concerns of these students.
查看更多>>摘要：? 2021 Elsevier Inc.Objective: Neurosurgery has a high barrier of educational access for medical students. The Medical Student Neurosurgery Training Center (MSNTC) is a novel online learning platform that provides on-site and virtual training opportunities and resources that aim to increase student access to neurosurgical education. The objective of this article was to describe student-reported utility of Medical Student Neurosurgery Training Center educational resources. Methods: A Qualtrics survey was sent to attendees after the 2020 Virtual Neurosurgery Training Camp. Ratings were quantified on modified 5-point Likert scales and compared using Wilcoxon rank sum tests, with a P value of 0.05. Results: Response was obtained from 119 (25.2%) of 473 Virtual Neurosurgery Training Camp registrants. Of respondents, 65 (54.6%) reported prior use of Brain & Spine Report (BSR), 68 (57.14%) reported use of the Video Library (VL), and 78 (65.5%) reported use of the Global Events Calendar (GEC). Among respondents who previously used the BSR, VL, or GEC, mean ratings of usefulness were 3.94 ± 1.01, 4.06 ± 0.91, and 4.10 ± 0.99, respectively. Medical students with a neurosurgery interest group at their home institution reported greater utility of the BSR (P = 0.0008), VL (P = 0.0018), and GEC (P = 0.0250). Medical students with a home program reported greater utility of the BSR (P = 0.0079), and international students reported greater utility of the VL (P = 0.0447). Conclusions: Medical Student Neurosurgery Training Center resources appear to have promising preliminary benefits for students. Increasing medical student awareness, continued development of these resources, and objectively assessing outcomes in neurosurgery education are warranted.
查看更多>>摘要：? 2022 Elsevier Inc.Spinal surgery is undergoing a major transformation toward a minimally invasive paradigm. This shift is being driven by multiple factors, including the need to address spinal problems in an older and sicker population, as well as changes in patient preferences and reimbursement patterns. Increasingly, minimally invasive surgical techniques are being used in place of traditional open approaches due to significant advancements and implementation of intraoperative imaging and navigation technologies. However, in some patients, due to specific anatomic or pathologic factors, minimally invasive techniques are not always possible. Numerous algorithms have been described, and additional efforts are underway to better optimize patient selection for minimally invasive spinal surgery (MISS) procedures in order to achieve optimal outcomes. Numerous unique MISS approaches and techniques have been described, and several have become fundamental. Investigators are evaluating combinations of MISS techniques to further enhance the surgical workflow, patient safety, and efficiency.
查看更多>>摘要：? 2022 Elsevier Inc.Minimally invasive spinal surgery (MISS) techniques offer several beneficial prospects and are being increasingly requested by patients. However, these techniques have not been uniformly adopted by spinal surgeons, and they remain controversial among some. Several barriers have prevented widespread adoption of MISS. These include concerns regarding high start-up costs, limited evidence base, and lack of surgeon training. In addition, the unique approaches involved in MISS expose spinal surgeons to unfamiliar anatomy. Further, while MISS can address a growing spectrum of spinal pathology, some conditions, as well as complications encountered during MISS procedures, require open surgery. This requires surgeons to not only acquire the new and specialized MISS skillset but also maintain their ability to perform open surgery. These factors present challenges common to developing and innovative surgical techniques. Here, we review the barriers preventing wider adoption of MISS and present a framework to promote the safe and effective growth of MISS.
查看更多>>摘要：? 2022 Elsevier Inc.Strong forces are pushing minimally invasive spinal surgery (MISS) to the forefront of spine care. Less-invasive surgical techniques have been enabled by a variety of technical advances. Despite the promise of MISS, however, several factors, including few training opportunities, perception of a steep learning curve, and high upfront costs, have limited the adoption of these techniques. The “6 T's” is a framework highlighting key factors that must be accounted for to ensure safe and effective MISS as techniques continually evolve. Further, technological advancement in endoscopy, robotics, and augmented/virtual reality is enhancing minimally invasive surgeries to make them even less invasive and safer for patients. The evolution of these new techniques and technologies is driving the future of MISS.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Previous studies have reported the return to play (RTP) rates for athletes after lumbar discectomy but not specifically for younger athletes. The purpose of the present study was to evaluate the RTP rate for young athletes after lumbar microdiscectomy. Methods: The medical records from a single spine surgeon were reviewed to identify patients who had undergone lumbar microdiscectomy. The patients were included if they were aged ≤21 years at surgery and were athletes. A total of 38 patients (25 males and 13 females) were identified, with a mean age at surgery of 19 years. The level of the herniated nucleus pulposus, variant anatomy, degenerative changes, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. The patients were interviewed to determine when and if they had returned to play. Results: Most patients had had degenerative changes at surgery, with a mean Pfirrmann score of 2.2. The average time from symptom onset to surgery was 11 months. All patients were reached for follow-up at an average of 51 months postoperatively. Of the 38 patients, 71% had returned to play at an average of 4.5 months postoperatively. No statistically significant differences were found in the Pfirrmann grade and RTP rates between the high school and collegiate athletes, between the genders, nor between patients with 2-level and 1-level discectomy. The Pfirrmann grade was not significantly different between the patients who had and had not returned to play. Conclusions: The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. The RTP rate and Pfirrmann grade were not related to gender, sport level, or discectomy level.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Moyamoya disease (MMD) is characterized by stenosis, occlusion, and formation of aberrant collaterals of brain vessels. This derangement in the brain vessels in conditions associated with changes in intracranial pressure can lead to arterial ischemic stroke (AIS). A major challenge for stroke physicians is to recommend the safest method of delivery for pregnant patients with MMD. Using a large national database, our objective in this study was to analyze the risk of AIS in patients with MMD who underwent vaginal delivery (VD) and cesarean section (C-section). Methods: We used the National Inpatient Sample database for the years 2013–2018 to identify patients with a diagnosis of MMD who underwent VD or C-section. Multiple logistic regression was performed to assess the risk of AIS in VD versus C-section. Results: Of 2166 female patients with MMD, 97 underwent VD or C-section: 49 (50.51%) underwent VD, and 48 (49.48%) underwent C-section. The analysis of outcomes between VD and C-section showed a higher prevalence of AIS after VD compared with C-section (8.2% vs 6.3%, P = 0.716). The multivariate analysis for AIS showed that VD is not an independent risk factor compared with C-section (odds ratio = 2.1, 95% CI = 0.3–13.3, P = 0.417). Conclusions: Our data did not find evidence that VD and C-section are risk factors for AIS in pregnant patients with MMD.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Shaken baby syndrome occurs following inertial loading of the pediatric head, resulting in retinal hemorrhaging, subdural hematoma, and encephalopathy. However, the anatomically vulnerable cervical spine receives little attention. Automotive safety literature is replete with biomechanical data involving forward-facing pediatric surrogates in frontal collisions, an environment analogous to shaking. Publicly available data involving child occupants were utilized to study pediatric neck and head injury potential. We hypothesized that inertial loading provides a greater risk of injury to the cervical spine than to the head. Methods: Full-scale automotive crash tests (n = 131) and deceleration sled tests (n = 32) utilizing forward-facing 3-year-old surrogates with head accelerometers and cervical force sensors were analyzed. One hundred sixty-seven full-scale vehicle and 33 sled test runs were assessed in the context of published injury assessment reference values (IARVs) for closed head injury (head injury criterion 15 [HIC15]) and cervical tensile strength in the 3-year-old model. Results: One hundred sixty-one (96%) child surrogates in full-scale crash tests exceeded the cervical peak tension IARV, while only 37 (22%) surpassed the HIC15 IARV. Similarly, in sled testing runs, 27 (82%) pediatric surrogates exceeded cervical tension IARVs, while 1 (3%) surpassed the HIC15 IARV. In both full-scale and sled tests, all surrogates surpassing the HIC15 IARV also exceeded the cervical tension IARV. Positive linear correlations were observed between HIC15 and cervical tensile forces in both full-scale vehicle (R2 = 0.15) and sled testing runs (R2 = 0.54). Conclusions: These data support the hypothesis that inertial loading of the head provides a greater injury risk to the cervical spine than to closed-head injury.
查看更多>>摘要：? 2022 Elsevier Inc.Background: The role of chemotherapy (CT) in the treatment of adult patients with medulloblastoma (MB) is unclear. The aim of this study is to compare the survival difference between adult patients with MB treated with and without chemotherapy. Methods: Data were derived from the SEER (Surveillance Epidemiology and End Results) database from 2010 to 2018. The Kaplan-Meier method with log-rank tests, univariate and multivariate Cox proportional hazard analyses, and propensity score matching (PSM) were used to investigate the association between chemotherapy and survival. We further conducted an exploratory subgroup analysis. The outcomes of interest were cancer-specific survival (CSS) and overall survival (OS). Results: We included 333 patients in this study, with 227 patients in the CT cohort and 106 in the nonchemotherapy cohort. The median follow-up time and the median age of the study population were 61 months and 30 years, respectively. The 5-year CSS of the CT cohort was superior to the nonchemotherapy cohort, whereas the 5-year OS was not. Kaplan-Meier curves after PSM supported the survival benefit of CT on CSS but not on OS. In the multivariate analysis after PSM, CT was the only prognostic factor for CSS, whereas there were no independent prognostic factors for OS. The survival of patients receiving CT who were diagnosed between 2010 and 2018 was better than that of previous patients. The subgroup analysis showed that there were interaction effects between CT and sex. Conclusions: CT improved CSS for adult patients with MB. With therapeutic advances, adult patients with MB might benefit from the use of CT.
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