Generation Of Neurosurgeons Research Articles

Exploring the impact of early exposure and mentorship on the neurosurgery career aspirations of medical students in low- and middle-income countries.

Early exposure to neurosurgery has been shown to have a positive influence on students' perceptions and attitudes towards the field of neurosurgery. This review delves into the problems faced by the neurosurgery workforce in LMICs, highlighting the necessity for local and international collaborative strategies and plans to enhance the medical education curriculum, training, and retention of neurosurgeons in their home countries. Mentorship also emerges as a crucial factor in neurosurgical career progress, narrowing the gap between theoretical knowledge and real-world practical skills, and providing guidelines in career pathways. Despite numerous benefits of early exposure and mentorship, limitations such as limited resources, inadequate elective opportunities, and negative cultural influences, hinder students' interest in neurosurgery. However, initiatives such as global outreach programs and collaborations between HICs and LMICs aim to address these challenges and improve access to mentorship and training opportunities and programs. This review recommends the integration of mentorship into career development strategies, establishing well-structured mentorship programs, and strengthening neurosurgery exposure in medical education. By implementing these recommendations, the next generation of neurosurgeons can be better equipped to address the complex challenges in LMICs, ultimately, enhancing easy access to neurosurgical care and strengthening healthcare systems.

A Disputed Hegemony: Negotiating Neurosurgical Patient Care in the Netherlands, 1930-1952.

The emergence of the neurosurgical patient as a novel clinical entity in the Netherlands was marked by a lingering conflict between neurologists and neurosurgeons, in which both types of specialists sought to assume the clinical and institutional leadership of neurosurgical patient care. In the 1920s and 1930s, neurologists had facilitated the establishment of the first generation of neurosurgeons in the country, and in the process, had managed to clinically and institutionally subordinate neurosurgery to neurology. As the demand for neurosurgical patient care grew, the neurosurgeons began to challenge this hegemonic relationship. The neurologists, however, were unwilling to give up their control, fearing that they would be bypassed in the diagnosis of patients eligible to neurosurgery. These conflicting aims and interests resulted in an intricate demarcation battle, in which the boundary work between neurologists and neurosurgeons was directly played out at the local workplace and at the meetings of the Study Club for Neuro-Surgery, and indirectly at various other sites of contestation, such as medical journals and academic lecture halls, as both parties sought to rally external stakeholders to their cause. During these negotiations, local, national, and international forces increasingly intertwined to shape the particular organization of Dutch neurosurgery in the middle of the twentieth century. By analyzing this multilayered demarcation process, this article draws attention to the complexity of medical boundary work, and to the way in which, despite pervasive international influences, specialist practice was ultimately negotiated at the local and national levels.

OTHER-15 ENDOSCOPIC SURGERY FOR PATHOLOGIES OF SKULL BASE: ABOUT A SERIES OF CASES

Abstract INTRODUCTION Transsphenoidal endoscopic surgery (TS) is currently the reference method for the treatment of pathologies affecting the sellar region. It is a relatively safe technique, with low per and postoperative morbidity. We report through this retrospective study the experience of the neurosurgery department of the HSR in this field. PATIENTS AND METHODS We have collected the records of 176 patients operated endoscopically (TS), since the advent of the technique in the service in January 2016 until March 2022. Epidemiological, radiological and endocrine clinical data were analyzed by jamovi software version 1.6. RESULTS Over 6 years, 176 interventions were performed endoscopically transsphenoidal, these were 66 men and 110 women sex ratio = 1.66. The average age at surgery was estimated at 42 years. Several pathologies were treated by TS route, namely: pituitary adenoma (80%), and the other pathologies were divided between meningiomas; craniopharyngiomas; chordomas; pituitary abscess and OMB. Symptoms were dominated by: intracranial hypertension syndrome, optochiasmatic syndrome, endocrine syndrome. The diagnosis was based on imaging all our patients benefited from an injected brain MRI, as well as the anatomo-pathological examination the endocrine balance was disrupted in 9 patients (5.3%) Postoperative follow-up was favorable in 128 patients (75%),15 patients required revision surgery, 8 patients developed transient or prolonged diabetes Insipidus (4%), 5 cases of rhinorrhea (2%), 11 patients had meningitis (6%), new pituitary deficiency constituted 3.20%, hemorrhages and Epistaxis found in 6% of patients, no cases of ophthalmic complication were reported, deploring the death of 2 patients postoperatively. CONCLUSION The usage of Endoscopic Surgery (TS) in our department is the result of several efforts developed by different generations of neurosurgeons. Currently we operate about thirty patients per year by adopting this technique, with a significant reduction in hospitalization days as well as complications.

History of Cranial Surgery in World War I: Experience on the Italian Front.

Since ancient history, men have been attempting to intervene when skull trauma occurs. The majority of traumas were always linked to war injuries, and in the modern era, the culprit was reached during World War I. Cranial traumas in wartime were very common, and consequently, physicians in wartime became particularly interested in the subject of cranial traumatology. In the following text, we want to bring to light the experience of some of the pioneers of cranial surgery in Italy during the First Great War. In fact before the war, very few medical officers had received training in central nervous system surgery. In addition, the surgical instruments for that clinical activity were inadequate and obsolete, but to deal with the medical emergency that had arisen on the front lines, the Italian government established Battlefield Medical Schools. And it is also from the reports and lectures of surgeons working on the front lines that the next generations of neurosurgeons were able to develop this surgical field into the complex and well-established surgical specialty that it is today.

Quantifying the Opportunity Cost of Neurosurgical Resident Education

Education is at the core of neurosurgical residency, but little research in to the cost of neurosurgical education exists. This study aimed to quantify costs of resident education in an academic neurosurgery program using traditional teaching methods and the Surgical Autonomy Program (SAP), a structured training program. SAP assesses autonomy by categorizing cases into zones of proximal development (opening, exposure, key section, and closing). All first-time, 1-level to 4-level anterior cervical discectomy and fusion (ACDF) cases between March 2014 and March 2022 from 1 attending surgeon were divided into 3 groups: independent cases, cases with traditional resident teaching, and cases with SAP teaching. Surgical times for all cases were collected and compared within levels of surgery between groups. The study found 2140 ACDF cases, with 1758 independent, 223 with traditional teaching, and 159 with SAP. For 1-level to 4-level ACDFs, teaching took longer than it did with independent cases, with SAP teaching adding additional time. A 1-level ACDF performed with a resident (100.1 ± 24.3 minutes) took about as long as a 3-level ACDF performed independently (97.1 ± 8.9 minutes). The average time for 2-level cases was 72.0 ± 18.2 minutes independently, 121.7 ± 33.7 minutes traditional, and 143.4 ± 34.9 minutes SAP, with significant differences among all groups. Teaching takes significant time compared with operating independently. There is also a financial cost to educating residents, because operating room time is expensive. Because attending neurosurgeons lose time to perform more surgeries when teaching residents, there is a need to acknowledge surgeons who devote time to training the next generation of neurosurgeons.

A new generation of neurosurgeons and a new training era in open vascular neurosurgery

A new generation of neurosurgeons and a new training era in open vascular neurosurgery

Characterizing the Next Generation of Neurosurgeons: A Descriptive Analysis and Publicly Available Web Application of Neurosurgery Residency Programs’ Website Data

Neurosurgery program websites serve as a valuable resource for applicants. However, each website exists in isolation, and it can be difficult to understand the general trends in U.S. neurosurgery resident demographics. In the present study, we collected data from program websites and analyzed the trends in the demographics of the current U.S. neurosurgery residents. We used a program list obtained from the American Association of Medical Colleges Electronic Residency Application System to extract data from the current resident complement listed in each program's website, including program, year in program, medical school, sex (male vs. female), graduate and/or PhD degrees, and assessed the trends during 7 years of resident data using linear regression. We identified 116 neurosurgery residency programs in the United States, with 111 providing information on their current resident complement, yielding a dataset of 1599 residents. Of these 1599 residents, 348 (22%) were female, 301 (19%) had a graduate degree in addition to an MD or DO degree, 151 (9.4%) had a PhD degree, 300 (19%) had matched at the program affiliated with their medical school, and 121 (7.6%) had graduated from a foreign medical school. The proportion of matriculating female residents had increased an average of 2.1% annually (95% confidence interval, 0.6%-3.7%) from 2015 to 2021. The other demographic data had not changed significantly during the same period. In addition to summarizing the current resident demographics, our analysis identified a significant increase in the proportion of female residents between 2015 (15.1%) and 2021 (25.6%). This publicly available dataset should enable additional analyses of the evolution of neurosurgery resident demographics.

Dr. Thanjavur Santhanakrishna Kanaka—A Pioneer and Neurosurgical Innovator

Thanjavur Santhanakrishna Kanaka, M.B.B.S., M.S. (General Surgery), M.S. (Neurosurgery), Ph.D., and former Captain, Indian Army Medical Corps, was born on March 31, 1932. She became the first woman neurosurgeon in India and all of Asia. This manuscript was compiled through a combination of interviews and references to other articles and some of the published manuscripts of Dr. Kanaka and her colleagues. Dr. Kanaka was a trailblazer for women in neurosurgery and a pioneer in functional and stereotactic neurosurgery. During her long and productive career, she authored dozens of articles reported in prestigious neurosurgical journals worldwide and helped inspire and train the next generations of neurosurgeons in India and abroad. Even after retirement, Dr. Kanaka continued to focus on serving the medical community through her Sri Santhanakrishna Padmavathi Health Care and Research Foundation in Chennai with the mission of serving underprivileged and senior citizens in the local community. In addition to her accomplishments as a practicing neurosurgeon, Dr. Kanaka's career was notable for her successful collaborations with biomedical engineers on medical device development using locally sourced materials and talent in India. Through her innovative thinking, compassion for her patients, and unwavering resilience, Dr. Kanaka has continued to serve as an inspiration to all pursuing a career in academic medicine and neurosurgery.

Andrei Petrovich Romodanov (for the 100th anniversary of birth)

The article traces the life of famous Soviet neurosurgeon Andrei Petrovich Romodanov from his school years and participation in the Great Patriotic War to headship of the Kiev Neurosurgery Research Institute. Dr. Romodanov was the full member of the Academy of Medical Sciences, deputy of the Supreme Soviet of the USSR, mentor of several generations of neurosurgeons. His contributions to organization of the neurosurgical service, pedagogical work, participation in All-Soviet Union research programs are described.

Neurosurgical management of brain and spine tumors in the COVID-19 era: an institutional experience from the epicenter of the pandemic.

The challenges of neurosurgical patient management and surgical decision-making during the 2019–2020 COVID-19 worldwide pandemic are immense and never-before-seen in our generation of neurosurgeons. In this case-based formatted report, we present the Mount Sinai Hospital (New York, NY) Department of Neurosurgery institutional experience in the epicenter of the pandemic and the guiding principles for our current management of intracranial, skull base, and spine tumors. The detailed explanations of our surgical reasoning for each tumor case is tailored to assist neurosurgeons across the United States as they face these complex operative decisions put forth by the realities of the pandemic.

Recruiting Medical Students to Neurosurgery Through a Focused Neuroanatomy Lab Initiative

Many medical students find neurosurgery interesting, but few pursue it as a career. Reasons for this mismatch include lack of exposure and poor perceptions of its career demands, work-life balance, personalities, and patient outcomes. It is imperative to recruit promising students early in medical school to build a pipeline of future neurosurgeons. We aimed to recruit medical students to neurosurgery and improve perceptions of the field by hosting an optional cadaver laboratory event (Neuroanatomy Lab Initiative [NLI]) during first-year students' gross anatomy course. Five neurosurgery residents and a rotating faculty member led students through the hands-on performance of a retrosigmoid craniotomy on 4 anatomic specimens in the students' cadaveric laboratory. Questionnaires with 6-point Likert scores were distributed to students before and after the NLI. Thirty-nine students with broad specialty interests and previous experiences attended. They perceived neurosurgery to be demanding, competitive, and incongruent with work-life balance and family. At baseline, their interest in neurosurgery was high despite perceived lack of knowledge about the field. Students were eager to participate in neurosurgical procedures and interactions with neurosurgeons. After the NLI, students felt more knowledgeable about neurosurgery and perceived neurosurgery faculty and residents as more pleasant/friendly, approachable, and satisfied with their careers. An NLI during first-year medical students' anatomy course was an effective, relatively low-resource means of engaging students and improving their perceptions of neurosurgery. We provide a framework for scaling this initiative to other institutions to help recruit the next generation of neurosurgeons.

Neurointerventional Training for Neurosurgeons: Past, Present, and Future

AbstractEndovascular therapy as any other specialty has continuously been developed since 1904, but acceptability among neurosurgeons remains low despite being other subspecialties and techniques, like endoscope and for that matter microscope also, being adopted very rapidly. From injecting particles for vascular lesions to balloons for fistulas and arteriovenous malformations and embolizing agents to detachable coils for aneurysm coiling, it has come a long way. Old generations of neurosurgeons used to perform carotid puncture for diagnosing mass lesions, but once CT/MRI came in to the picture, this procedure was stopped and handed over to radiologists. A debate continues among neurosurgeons about the feasibility of aneurysm coiling since international subarachnoid aneurysm trial (ISAT) and doubts about the long-term efficacy of this novel treatment cost a subspecialty. With the recent addition of endovascular treatment of stroke and long-term efficacy of endovascular treatment of aneurysm, there is a lot of debate among clinicians and nonclinicians about who will be the true heir of this sub specialty.

Nurturing the Next Generation of Neurosurgeons: How Important Are Nontechnical Skills?

A recent trend has occurred of increased awareness and an emphasis for teaching nontechnical skills (NTSs) in the world of surgery. Although neurosurgery has incorporated simulation-based training as a part of the training curriculum in the United Kingdom, it has yet to formally introduce NTS training. The present study, therefore, queried both neurosurgical trainees and tutors regarding how much they valued NTSs and their development. We performed a questionnaire-based, mixed-methods study to determine the knowledge, attitudes, and practices of both neurosurgical trainees and tutors regarding NTSs across neurosurgical centers in the United Kingdom in2015. The trainees valued NTSs and their development more than did their tutor counterparts (P < 0.05, z-testing). This was evident from both the quantitative results and the qualitative data gained from the questionnaire. Various areas for potential improvement of the curriculum were also identified. The results of the present study highlight the importance of NTS development in neurosurgery. These results could act as a good starting point for further larger scale similar studies and discussion on curriculum committees.

Training the Next Generation of Neurosurgeons in Developing Countries – Mission Possible

Training the Next Generation of Neurosurgeons in Developing Countries – Mission Possible

International differences in the management of intracranial aneurysms: implications for the education of the next generation of neurosurgeons.

The publication of the International Subarachnoid Aneurysm Trial rapidly changed the management of patients with subarachnoid hemorrhage. The present and perceived future trends of aneurysm management have significant implications for patients and how we educate future cerebrovascular specialists. To determine present perceived competencies of final-year neurosurgical residents who have just finished their residencies and to relate those to what practitioners from a variety of continents expect of these persons. The goal is to provide a basis for further discussion regarding the design of further educational programs in neurosurgery. A 55-item questionnaire with 33 questions related to competencies and expectations of competency from final-year residents who have just finished residency was completed by 229 neurosurgeons and neuro-radiologists (81 % response rate) of mixed seniority from 45 countries. We used bivariate and descriptive analyses to determine future trends and geographic differences in cerebral aneurysm management as well as the educational implications on the future. More North Americans than those from the rest of the world are of the opinion that graduating residents are presently competent to perform basic cerebrovascular procedures like evacuation of a hematoma and clipping a simple 7-mm middle cerebral artery aneurysm. Extremely few graduating neurosurgical residents anywhere are presently capable of performing endovascular techniques for even the most basic of aneurysms. Most of those surveyed also believe that endovascular and open surgical management of aneurysms should be a part of residency training for all residents (70.4 and 88.7 %, respectively). Our findings have implications for the design of neurosurgical curricula for residents as well as for certification examinations and procedures. Specialty and educational organizations and those responsible for the education of future clinicians who will care for patients with cerebrovascular problems should adjust educational objectives and implement curricula and learning experiences that will ensure that cerebrovascular specialists are capable of providing the best care possible to the patient with an aneurysm, whether that be open surgery or endovascular management. These findings mean that organizations around the world will need to make these adjustments to the education of future specialists.

The personal and professional legacy of John Edwin Scarff

Dear Sir, We read with appreciation the comprehensive article by Azab et al. about our father and grandfather, John Edwin Scarff.[1] We particularly respect their efforts in acknowledging the historical elements of his career and his contributions to neurosurgery. He was proud to have been associated with the early innovations of Walter Dandy, Harvey Cushing, and other pioneers, and frequently acknowledged their fundamental roles in his own accomplishments. He also enjoyed teaching and training the next generation of neurosurgeons throughout his academic career. He would be gratified to know how choroid plexus coagulation and endoscopic ventriculostomy have achieved recognition as contemporary neurosurgical procedures, due in great part to technological advances. He often spoke with pleasure and gratitude of his professional experiences traveling abroad. He enjoyed and benefited from his interaction with Neurological Surgeons in the Middle East, Central and South America, and Europe, and he related to us the Neurosurgical personalities, history, contributions, and techniques he encountered there. This thoughtful article honors him by highlighting his legacy as investigator, scientist, and physician that he embodied and passed on to future generations.

OMICS and 21st century brain surgery from education to practice: James Rutka of the University of Toronto interviewed by Joseph B. Martin (Boston) and Türker Kılıç (İstanbul).

The Science-in-Backstage interviews aim to share experiences by global medical and life sciences thought leaders on emergent technologies and novel scientific, medical, and educational practices, situating them in both a historical and contemporary science context so as to "look into the biotechnology and innovation futures" reflexively and intelligently. OMICS systems diagnostics and personalized medicine are greatly impacting brain surgery, not to forget the training of the next generation of neurosurgeons. What do the futures hold for the practice of, and education in 21(st) century brain surgery in the age of OMICS systems science, personalized medicine, and the use of simulation in surgeon training? James Rutka is a clinician scientist and a world leader in diagnosis and treatment of brain tumors. He is Professor and Chair of the Department of Surgery at the Faculty of Medicine, University of Toronto, a President Emeritus of the American Association of Neurological Surgeons, and Editor-in-Chief of the Journal of Neurosurgery. Professor Rutka was interviewed for the global medical, biotechnology, and life sciences readership of the OMICS: A Journal of Integrative Biology to speak on these pressing questions in his personal capacity as an independent senior scholar. The issues debated in the present interview are of broad relevance for 21(st) century surgery and postgenomics medicine. The interviewers were Professor Joseph B. Martin, Harvard Medical School Dean Emeritus in Boston and Joint Dean of Medicine at Bahçeşehir University in İstanbul, and the author of "Alfalfa to Ivy: Memoir of a Harvard Medical School Dean," and Professor Türker Kılıç, Dean of Medicine at Bahçeşehir University in İstanbul, and an elected member of the Turkish Academy of Sciences.

Mixed reality ventriculostomy simulation: experience in neurosurgical residency.

Medicine and surgery are turning toward simulation to improve on limited patient interaction during residency training. Many simulators today use virtual reality with augmented haptic feedback with little to no physical elements. In a collaborative effort, the University of Florida Department of Neurosurgery and the Center for Safety, Simulation & Advanced Learning Technologies created a novel "mixed" physical and virtual simulator to mimic the ventriculostomy procedure. The simulator contains all the physical components encountered for the procedure with superimposed 3-D virtual elements for the neuroanatomical structures. To introduce the ventriculostomy simulator and its validation as a necessary training tool in neurosurgical residency. We tested the simulator in more than 260 residents. An algorithm combining time and accuracy was used to grade performance. Voluntary postperformance surveys were used to evaluate the experience. Results demonstrate that more experienced residents have statistically significant better scores and completed the procedure in less time than inexperienced residents. Survey results revealed that most residents agreed that practice on the simulator would help with future ventriculostomies. This mixed reality simulator provides a real-life experience, and will be an instrumental tool in training the next generation of neurosurgeons. We have now implemented a standard where incoming residents must prove efficiency and skill on the simulator before their first interaction with a patient.

Endoscopic Pituitary Tumor Surgery: The Learning Curve

Introduction: Endoscopic endonasal pituitary surgery is increasing utilized and is being passed on to the next generation of neurosurgeons. This approach can be technically challenging due to lack of 3 dimensional visualization, increased operative working distance and novel/different instrumentation. We present our experience with the exclusive endoscopic endonasal approach over the past 10 years.

Optimal invasive key-hole neurosurgery with a miniaturized 3D chip on the tip: Microendoscopic device

Objective:The goal of the performed study was to evaluate the possibility of a three-dimensional endoscope to become a combined microscope-endoscope device in one. We analyzed the ergonomy of the device, the implementation into the surgical workflow, the image quality, and the future perspectives such devices could have for the next generation of neurosurgeons.Materials and Methods:Within 6 months, 22 patients (10 male, 12 female, 20-65 age) underwent surgery in neuroaxis using the new 3D-microendoscope (ME). The new 3D-ME has (a) the ability to visualize the surgical field from out- to inside with all advantages offered by a microscope, and in the same moment, (b) its design is like a small diameter endoscope that allows stereoscopic views extracorporal, intracorporal, and panoramic “para-side” of the lesion.Results:In general, transcranial 3D-“microendoscopy” was performed in all patients with high-resolution 3D quality. No severe complications were observed intra- or postoperatively. With the addition of depth perception, the anatomic structures were well seen and observed.Conclusion:The 3D-microendoscopy is a very promising surgical concept associated with new technological developments. The surgeon is able to switch to a modern visualization instrument reaching the most optimal surgical approach without compromising safety, effectiveness, and visual information.