Notes

Management of Upsetting Cervical Spondyloptosis having an Unsealable Dura Split: In a situation Statement.
Women have now surpassed men in the number of medical students currently enrolled in the United States. However, in surgical subspecialties including neurosurgery, women continue to be significantly underrepresented. The objective of this study was to investigate the academic accomplishments of women in academic neurosurgery as measured by academic title, publications, and grant funding.

A list of ACGME (Accreditation Council for Graduate Medical Education) accredited neurosurgery departments was utilized and department websites were reviewed to collect data regarding female and male faculty. Scopus and National Institutes of Health (NIH) RePORTER websites were used to collect other variables.

Women comprise 11.0% of all academic neurosurgeons. Of the 116 neurosurgery residency programs in the United States, 77% have at least 1 female faculty member. There are 172 academic female neurosurgeons in practice in the United States currently. Of academic female neurosurgeons, 61% are assistant professors, 21% are associate professors, and 18% are professors. Only 20 women hold leadership positions in their departments. Women have an average of 39.7 49.6 publications. The average h-index of academic female neurosurgeons is 12.0 11.1. GSK2606414 research buy Twenty-two women have or have had NIH funding with an average cumulative total grant value of $3,409,919. Having NIH funding and more publications is associated with higher academic rank and holding a leadership position. Women have significantly less funding and publications than men.

Women represent younger faculty with expected publication and grant funding productivity. As women continue to advance into more senior positions, the trends for number of publications and grant funding is expected to increase.
Women represent younger faculty with expected publication and grant funding productivity. As women continue to advance into more senior positions, the trends for number of publications and grant funding is expected to increase.
The loss of stereopsis and the need for markedly enhanced hand-eye coordination are obstacles to overcome when performing exoscopic procedures, but both should improve with training. Our objectives were to describe an exoscopy training station and to compare time and performance of a given microsurgical technique among neurosurgery residents and junior neurosurgeons.

We designed a low-cost exoscopy training station featuring a notebook computer, a webcam, and a light-emitting diode source. Surgeons and surgical trainees with no experience in exoscopy were enrolled and divided into 2 groups (trainees and controls). Performance and time in suture placement were evaluated by a skilled observer in both groups at baseline and 3 days later. Between evaluations, trainees completed an exoscopy training module.

There were 22 participants divided equally into 2 groups. At baseline, trainees had a greater percentage of proper sutures than controls (58% vs. 35%), but they were also slower (32 minutes vs. 25 minutes). On final evaluation, not only were trainees approximately 14 minutes faster than at baseline (P= 0,03), but also their successful suture rate had increased by 18% (final rate 76%, P= 0.02). Moreover, controls were faster compared with baseline by 6 minutes (P= 0.003), but their percentage of successful sutures did not increase (final rate 38%, P= 0.49). The change from baseline to final evaluation favored trainees for both outcomes (P= 0.03 and P=0.02).

Using the exoscopy training station, the trainees were able to improve their time and performance of exoscopy compared with the controls.
Using the exoscopy training station, the trainees were able to improve their time and performance of exoscopy compared with the controls.
Hematoma volume in chronic subdural hematoma (CSDH) may predict neurologic deterioration and need for surgical evacuation. Several computer software-assisted methods exist for accurate volume measurements of intracerebral hemorrhage, but no reliable method has been identified for measurement of CSDH volume.

A total of 30 consecutive patients with CSDH from 2018-2019 admitted to our institution were selected. The noncontrast computed tomography head studies were reviewed by 2 residents. link2 The region of interest method on a Horos Open Source Medical Image Viewer (version 3.3.6) was utilized for volume measurement by each resident (resident-1 and resident-2) independently. Resident-1 repeated the protocol on the same studies 1 month later. We calculated the intra- and interobserver reliability of hematoma volume measurements using the Bland-Altman method.

Mean age of the patients was 79 years (range, 50-92 years). For interobserver analysis, resident-1 mean hematoma volume was 85.46 cm
(range, 6.40-178.63 clinical and research implications for risk stratification.
Intracranial germ cell tumors (GCTs) predominantly occur in the adolescent and young adult population and are most frequently located at the pineal gland. Tumor masses in the pineal region may cause ophthalmic symptoms due to compression to the midbrain, frequently presenting with Parinaud syndrome and hydrocephalus due to aqueductal compression.

We conducted a single-institution cohort study of primary, pineal region GCTs to characterize the clinical presentation, as well as associated ophthalmic and hydrocephalus outcomes.

Fifty-six primary pineal GCTs were identified. link3 Among the 40 isolated pineal region GCTs, 15 were germinomas while 25 were nongerminomatous GCTs. Among 43 cases of hydrocephalus, endoscopic third ventriculostomy was the primary treatment in 27 cases, which was successful in 23 but failed and required additional treatment for the rest. Pineal tumor mass was significantly larger in cases with hydrocephalus compared with those without, and the 20-mm diameter of the tumor was the crucialnd in most cases both cerebrospinal fluid diversion and tissue diagnosis can be successfully achieved via endoscopic third ventriculostomy.
The current treatment options for chronic subdural hematoma (CSDH) include burr hole drainage, twist drill drainage, and craniotomy with or without postoperative catheter drainage. Although generally effective, these treatments have continued to be complicated by recurrence, especially in partially hemolyzed or septated hematomas. Recently, interest in the use of fibrinolytic agents as an adjunct to surgical treatment to address this limitation has been increasing. We conducted a systematic review, focusing on the efficacy and safety profile of fibrinolytic agents and compared the different fibrinolytic agents.

The PubMed, EMBASE, CINAHL Plus, and Cochrane Library databases were searched for trials relevant to fibrinolytic administration in the treatment of CSDH. The findings are reported in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The data from 1702 subjects from 6 retrospective observational studies were qualitatively analyzed. In additispective controlled studies are warranted to confirm the benefit and safety of this treatment strategy and to identify the optimal agent and dosing regimen.
To establish a new scoring system to assess spinal cord compression of ossification of posterior longitudinal ligament (OPLL) of the cervical spine.

Literature review and expert advice were used to determine variables of the novel CSFM scoring system. The CSFM score included 4 variables curvature of spinal cord (C), increased signal intensity of spinal cord (S), cerebrospinal fluid imaging (F), and cross-section morphology of spinal cord (M). From June 2015 to June 2018, clinical and imaging data of 387 patients with cervical OPLL were retrospectively analyzed. The 4 variables were measured and recorded. Different scores were assigned based on analysis of the relationship between the variables and the Japanese Orthopaedic Association score. Two spine surgeons scored the patients according to the CSFM score and analyzed the internal consistency and reliability of the CSFM score.

The CSFM scoring system consisted of 4 variables, each of which was divided into 4 grades. Each variable was assigned a score of 0-3 according to different grades. The total possible score was 12, and the minimum score was 0. A higher score indicated more severe spinal cord compression.

The CSFM scoring system can effectively reflect the degree of spinal cord compression for cervical OPLL.
The CSFM scoring system can effectively reflect the degree of spinal cord compression for cervical OPLL.
Microelectrode recording (MER)-guided deep brain stimulation (DBS) remains the standard electrophysiological procedure to place the DBS lead at the optimal target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are needed. Intraoperative computed tomography (iCT) can be useful to visualize the microelectrode and verify possible adjustments. The aim of this study was to evaluate the effect of iCT in MER during frameless stereotactic DBS for Parkinson's disease (PD).

We retrospectively collected 28 PD patients, of whom 19 received iCT and nine did not, and measured intracranial volume, cerebral volume, cerebrospinal fluid (CSF) volume, and pneumocephalus volume. Euclidean distance was assessed according to merged preoperative brain CT and magnetic resonance imaging and postoperative brain CT.

Fifty-six hemispheres in the 28 patients were analyzed for MER tracks. The patients who received iCT had a significantly lower mean number of MER tracks (1.6 vs. 2.6, p = 0.013) and lower mean Euclidean distance (2.2 mm vs. 2.7 mm, p = 0.033) compared to those who did not receive iCT. Although there was a trend of a decrease in pneumocephalus using intraoperative imaging, there was no significant difference in surgical time.

ICT can reduce the number of MER tracks and increase surgical accuracy. Further studies are warranted to investigate whether iCT can reduce surgical complications and improve surgical outcomes.
ICT can reduce the number of MER tracks and increase surgical accuracy. Further studies are warranted to investigate whether iCT can reduce surgical complications and improve surgical outcomes.
Existing data have demonstrated significant differences in morbidity and mortality measures between men and women undergoing various spinal surgeries. However, studies of lumbar fusion surgery have been limited. Thus, we investigated the effects of patient sex on 30-day perioperative outcomes after elective lumbar fusion spine surgery.

Patients who had undergone lumbar fusion from 2015 to 2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching was used to determine whether the patient's sex had influenced the 30-day perioperative complications.

A total of 44,526 cases had met the inclusion criteria and were reviewed. Of the 44,526 patients, 13,715 had undergone posterior lumbar fusion, 21,993 had undergone posterior/transforaminal lumbar interbody fusion, and 8818 had undergone anterior/lateral lumbar interbody fusion. The women were more likely to be older, functionally dependent, and taking steroids for chronic conditions and to have a higher body mass index and lower preoperative hematocrit level.
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