Neurosurgical Practice Research Articles

Quality indicators in cranial neurosurgery: current insights and critical evaluation - a systematic review.

In recent decades, there has been increasing interest in measuring the quality of care across all medical fields, including neurosurgery. This interest aims not only to optimize care but also to reduce healthcare costs. For this purpose, different quality indicators (QIs) have been developed. We performed a systematic review according to the PRISMA guidelines aiming at identifying studies that critically evaluate QIs applied in cranial neurosurgery. A total of 34 studies, suggesting 22 indicators, were identified. The most discussed indicator was the 30-day readmission rate, followed by the 30-day reoperation rate. The majority of QIs are influenced by baseline and underlying patient characteristics, reflecting the severity of the patient`s underlying disease, rather than adherence to best available evidence of treatment. Therefore, it is crucial to implement adequate risk adjustment strategies when applying QIs to compensate for differences in patient complexity and to ensure that departments that are treating high-risk patients do not have worse results. The review revealed several limitations of the currently used quality indicators. Most suggested indicators are attractive from a payer point of view, easy to measure and therefore convenient for reimbursement purposes. However, from a clinician's point of view, most indicators were considered poor performance markers as they do not correlate with meaningful outcome and do not reflect treatment quality. In addition, there is a lack of disease- and neurosurgery specific indicators. This highlights the need for clinicians to actively participate in developing more clinically relevant QIs tailored to neurosurgical practice.

Two-Stage surgical approach for type III odontoid fracture with C1-C2 fracture dislocation: A case report and management overview

Introduction and Importance: Odontoid fractures of the second cervical vertebra (C2) are categorized into three types, with type III extending into the body of the axis. These fractures, often resulting from high-energy trauma, can cause significant instability and neurological issues. This case report discusses a 43-year-old male with a type III odontoid fracture and C1-C2 fracture dislocation, demonstrating the effectiveness of traditional neurosurgical techniques in managing such complex injuries. Case Presentation: A 43-year-old male presented with upper cervical pain and right upper limb weakness following a road traffic accident. Imaging revealed a type III odontoid fracture with posterior displacement and atlanto-axial (C1-C2) joint dislocation. The patient underwent a two-stage surgical procedure. The first stage involved transoral decompression to address the retropulsed odontoid fragment and relieve spinal cord compression. The second stage involved posterior craniocervical fixation using an autologous iliac bone graft for stabilization. The patient showed postoperative improvement and was discharged on the third day, with a stable condition at a one-month follow-up. Clinical Discussion: Managing type III odontoid fractures with C1-C2 dislocation is challenging, requiring a strategic approach to ensure spinal stability and neurological recovery. Transoral decompression provides direct access for effective decompression, while posterior fixation ensures robust stabilization. The use of an autologous iliac bone graft enhances fusion and long-term stability. This case illustrates the successful integration of traditional neurosurgical techniques with modern surgical principles. Conclusion: This case underscores the importance of traditional neurosurgical techniques in managing complex odontoid fractures. The two-stage approach of transoral decompression followed by posterior craniocervical fixation proved effective, highlighting the relevance of these techniques in achieving positive outcomes in contemporary neurosurgical practice.

Disparities in neurosurgical care: Using length of stay to evaluate efficiency of care in New York City hospitals

Objective: We sought to analyze public and private hospital patient cohorts in New York City (NYC) to assess differences in hospital access and outcomes from 2009-2022.Methods: Inpatient neurosurgical discharges, as determined by APR-DRG codes, from 2009-2022 were aggregated for seven NYC hospitals, four private and three public, via the Statewide Planning and Research Cooperative System (SPARCS). Statistical analyses (Z-tests) were performed in Python.Results: 325,351 patients were identified, 223,361 private and 101,990 public. Private hospitals had lower high-severity to low-severity and higher high-mortality to low-mortality risk ratios relative to public hospitals (p < .001). Public hospitals treated a higher proportion of stroke and trauma (p < .001). Average length of stay (LOS) was shorter at private hospitals compared to public (5.3 vs. 7.1 days, p < .001). Statistical significance remained when stratifying for illness severity and elective versus non-elective surgery status. Interestingly, cranial trauma cases were associated with a longer LOS in private hospitals relative to public (7.9 vs. 5.7 days, p < .001).Conclusions: While many factors influence outcomes in private versus public hospitals, LOS can mark the efficiency of care. LOS was shorter at private hospitals in all instances except with cranial trauma. Care efficiency is important for hospital reimbursement, which can directly impact available resources for patient care. These findings emphasize the need to further analyze patient accessibility to neurosurgical care at private hospitals and the resources necessary to support neurosurgical practices within public hospitals.

MODERN PARAMETERS OF LABORATORY EXPRESS DIAGNOSTICS IN INTENSIVE NEUROLOGY AND NEUROSURGICAL PRACTICE IN PATIENTS WITH CRANIOCEREBRAL INJURIES

The parameters listed in the article show the huge path that laboratory express diagnosis of emergency conditions in neurology has taken over the past 50 years. And this is not the limit - new unique technologies appear. The range of measured and calculated parameters continues to expand, which makes it possible to more fully and adequately assess the condition of a critically ill patient. Thus, a timely and qualitative study of the gaseous composition of blood is important for carrying out differential diagnosis, prescribing adequate treatment and monitoring the therapy effectiveness. The aim of the study was to highlight the current parameters of laboratory rapid diagnostics in intensive neurology and neurosurgical practice in patients with traumatic brain injury. There are two situations that necessitate the development of rapid methods for monitoring hemostasis in the neurological intensive care unit and neurosurgical operating room: the need to immediately determine the concentration or biological effect of anticoagulants. Some areas of surgical intervention are associated with increased blood loss due to coagulopathy, which requires timely replacement therapy. A long process of determining hemostatic parameters by routine methods in a general laboratory leads to a delay in diagnosis and, as a result, untimely treatment. Quite a few express methods designed to obtain specific information about the hemostasis process are currently available in the operating room. If these monitoring methods are used correctly, the research results are reliable, so some researchers use them to develop algorithms for determining the need for transfusion of blood components. However, the development of new monitoring methods requires close collaboration with scientists specialized in hemostasis, plus quality control must be established. It is necessary to prove the positive effect of rapid diagnostic methods on the result to ensure the possibility of their wide application in various operations.

Defining pediatric neurosurgery in low-income countries: a cross-sectional study in Ethiopia.

Pediatric neurosurgical practice is prevalent in most low- and lower-middle-income countries but lacks comprehensive documentation of practice patterns, demographics, and case variety. This study aimed to present the current state of pediatric neurosurgery in Ethiopia, including workforce characterization, case variety, and relevant procedures. A survey was developed and distributed to all Ethiopian fully trained neurosurgeons (n = 50). Survey questions assessed sociodemographic variables, level of training, case variety, and neurosurgical practice. Statistical analysis was conducted to describe the current practice of pediatric neurosurgery. A total of 45 neurosurgeons responded (90%). Three respondents (7%) were women. There was only 1 fellowship-trained pediatric neurosurgeon, while most neurosurgeons were general neurosurgeons who served a pediatric patient population. Most neurosurgeons (56%) worked in the capital city, Addis Ababa, while another 13% worked in other urban settings. The top three indications for a pediatric neurosurgical procedure were neural tube defects (NTDs) (96%), hydrocephalus (93%), and trauma (60%). NTD-associated hydrocephalus was the most common hydrocephalus type seen (71%). The most common procedure for hydrocephalus was shunt insertion (96%). A prenatal diagnosis of NTD was made in < 10% of cases, as reported by 84% of respondents. The study highlights Ethiopia's need for more pediatric neurosurgeons. Suggested strategies to facilitate subspecialty training include the establishment of a fellowship program facilitated by the implementation of a nationwide pediatric neurosurgery registry. Promoting efforts for early diagnosis and treatment of pediatric conditions coupled with NTD prevention initiatives could improve pediatric neurosurgical care in Ethiopia.

AI-powered diagnostics and treatment strategies for Neurofibromatosis in neurosurgical practice

AI-powered diagnostics and treatment strategies for Neurofibromatosis in neurosurgical practice

The Legacy of Harrington's Rod and the Evolution of Long-Segment Constructs in Spine Surgery.

This paper delves into the historical evolution of spinal surgery, focusing on the pivotal role of the Harrington rod in treating spinal deformities. Introduced in 1955, the Harrington rod marked a significant breakthrough in neurosurgery, especially for scoliosis treatment, by offering a novel approach to spinal stabilization. Through a retrospective analysis, this study examines the development and impact of the Harrington rod, highlighting Dr. Paul Harrington's contributions to spinal surgery. His innovative technique revolutionized the management of spinal deformities, laying the groundwork for future advancements in spinal instrumentation. Despite initial skepticism, Harrington's methods gained acceptance, significantly influencing neurosurgical practices and patient outcomes. This study also explores subsequent advancements that built on Harrington's work, including the transition to long-segment spine constructs and the introduction of segmental pedicle screws, which allowed for more precise deformity correction. Reflecting on Harrington's legacy, this paper acknowledges the continuous evolution of spinal surgery, driven by the interplay between clinical challenges and technological innovations. Harrington's pioneering spirit exemplifies the ongoing pursuit of better surgical outcomes, underscoring the importance of innovation in the field of neurosurgery.

Role of intraoperative cranial ultrasonography in detection of residual brain lesions during surgery

BackgroundThe use of IOUS is increasingly common in recent neurosurgical practice. IOUS has become very valuable in neurosurgery. It plays a key role in the localization of space-occupying lesion location and decreasing operation time and hence improves both surgical efficiency and safety. Ultrasound is very useful in the determination of the lesion location, its most superficial portion, and in differentiation between solid tumors and cystic components.ResultsIntraoperative ultrasonography has a significant edge over the other intraoperative aids for image guidance in brain surgery, especially in terms of independence, cost, and adaptability to multiple different clinical scenarios. Ultrasound-based neuro-navigation is an easy-to-use, fast, and safe technique of real-time imaging for various neurosurgical procedures.ConclusionWe conclude that ultrasound-based neuro-navigation is an easy-to-use, fast, and safe technique of real-time imaging for various neurosurgical procedures.

Assessment of nurse practitioners’ capacity of using the ABC/2 formula for intracranial lesion volume measurement

BackgroundThis study investigates the precision of nurse practitioners (NPs) in measuring intracranial lesion volumes using the ABC/2 method, a simple yet widely used technique in neurosurgical practices. Amidst physician workforce shortages, the role of NPs in clinical practice, including specialized tasks like lesion volume estimation, is gaining importance.MethodsWe conducted a retrospective study involving patients treated for intracranial meningiomas. NPs estimated tumor volumes using the ABC/2 method, which was then compared with automated ABC/2 estimations considered as the gold standard. Statistical analyses, including paired sample t-tests, Bland-Altman analysis, and Intraclass Correlation Coefficient (ICC) analysis, were employed to assess measurement accuracy and consistency.ResultsAmong the 265 meningioma patients included, NPs measured the average tumor volume as 36.95 ml, generally underestimating it compared to the 39.57 ml average obtained by the automated ABC/2 method. This underestimation, however, was clinically modest, indicated by an average percentage difference of 6.59% and a Cohen’s d value of 0.08. Consistency in measurements, assessed using Bland-Altman and ICC analyses, demonstrated a high level of agreement between NPs measurements and the automated method. Additionally, no significant differences in measurement accuracy were observed either among different NPs or across NPs with varying levels of work experience.ConclusionsNurse practitioners can effectively employ the ABC/2 method for estimating intracranial lesion volumes with reasonable accuracy and consistency, irrespective of their work experience. This finding is pivotal in enhancing the role of NPs in neurosurgical practices and could be significant in alleviating the strain caused by the global shortage of physicians. Future research may explore extending NPs’ roles in other clinical diagnostic and therapeutic tasks.

Comment on "A mathematical model to predict "low-lying" posterior communicating artery aneurysms in neurosurgical practice".

Comment on "A mathematical model to predict "low-lying" posterior communicating artery aneurysms in neurosurgical practice".

Advancing endovascular neurosurgery training with extended reality: opportunities and obstacles for the next decade.

Extended reality (XR) includes augmented reality (AR), virtual reality (VR), and mixed reality (MR). Endovascular neurosurgery is uniquely positioned to benefit from XR due to the complexity of cerebrovascular imaging. Given the different XR modalities available, as well as unclear clinical utility and technical capabilities, we clarify opportunities and obstacles for XR in training vascular neurosurgeons. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Studies were critically appraised using ROBINS-I. 19 studies were identified. 13 studies used VR, while 3 studies used MR, and 3 studies used AR. Regarding specific educational applications, VR was used for simulation in 10 studies and anatomical modeling in 3 studies. AR was only used for live intra-operative guidance (n = 3 studies). MR was only used for modeling and intra-operative teaching. Considering disease-specific uses, XR enhanced trainee understanding of intracranial aneurysms (n = 12 studies) and stroke (n = 7). XR trained surgeons in diverse neurosurgical procedures, including aneurysm coiling (n = 5 studies), diagnostic angiography (n = 5), and thrombectomy (n = 5). Anatomical modeling with VR and MR enhances neurovascular anatomy education with patient-specific, 3-D models from imaging data. AR and MR enable live intra-operative guidance, allowing experienced surgeons to remotely instruct novices, potentially improving patient care and reducing geographic disparities. AR overlays enhance instruction by allowing the surgeon to highlight key procedural aspects during training. Inaccurate tracking of surgical tools is an XR technological barrier for modeling and intra-operative training. Importantly, the most reported application of XR is VR for simulation-using platforms like the Mentice VIST and Angio Mentor. 10 studies examine VR for simulation, showing enhanced procedural performance and reduced fluoroscopy use after short training, although long-term outcomes have not been reported. Early-stage trainees benefited the most. Simulation improved collaboration between neurosurgeons and the rest of the surgical team, a promising role in interprofessional teamwork. Given the strength of VR for simulation, MR for simulation is an important gap in the literature for future studies. In conclusion, XR holds promise for transforming neurosurgical education and practice for simulation, but technological research is needed in modeling and intra-procedural training.

Education and Training in Global Neurosurgery: The Quest for Diversity and Equitable Collaborations.

Education and training are essential components of global neurosurgery because they provide a sustainable solution to address the workforce deficits in the neurosurgical burden of disease. Neurosurgery training programs and opportunities exist in most areas of the world, but some countries still lack formal mechanisms to train future generations. In this special article, we review the neurosurgical workforce deficit, characterize factors influencing the absence or inadequacy of neurosurgical training, and identify strategies that could facilitate global efforts in building a stronger workforce. We summarize the key neurosurgical training models worldwide and the factors influencing the standardization of neurosurgical education by region. In addition, we evaluate the "brain drain" issue in the larger context of the healthcare workforce and propose solutions to mitigate this phenomenon in neurosurgical practice. Future generations of neurosurgical trainees depend on our efforts to intensify and expand education and training in this new virtual era. As we look to the future, we must prioritize education to strengthen the future neurosurgeons who will lead and shape the frontiers of our field.

Dorsal arachnoid web of the thoracic spine associated with an arachnoid cyst and a presyrinx state as an unexplained cause of thoracic myelopathy: illustrative case.

Dorsal thoracic arachnoid web is a rare diagnosis and is not commonly seen in neurosurgical practice. Patients can present with symptoms and signs of thoracic myelopathy in the setting of an arachnoid cyst and a presyrinx state. A 57-year-old male with a 10-year history of worsening bilateral leg weakness and chronic back pain re-presented to the neurosurgery clinic after being seen by neurology and orthopedic spine surgery. Initial imaging was concerning for myelomalacia and syringomyelia, and repeat delayed computed tomography myelography findings were consistent with an evolving thoracic arachnoid web, now demonstrating spinal cord compression secondary to arachnoid cyst formation and consistent with the signs of thoracic myelopathy. Intraoperative ultrasound displayed the arachnoid web as the cause of the evolving arachnoid cyst, edematous spinal cord, and a presyrinx-like state. The patient underwent surgical decompression, which restored cerebrospinal fluid (CSF) dynamics, resulting in clinical improvement. Dorsal thoracic arachnoid web is a dynamic condition that can occur in the setting of an arachnoid cyst. There appears to be a relationship between dorsal thoracic arachnoid web formation and the presence of an arachnoid cyst resulting from a ball-valve mechanism leading to the creation of a pressure gradient effect that alters CSF fluid dynamics. https://thejns.org/doi/10.3171/CASE24313.

Examining Introduction of E-consent in the Neurosurgical Caseload: Understanding the Barriers to Implementation

ObjectiveTo evaluate current usage and barriers of e-consent implementation in neurosurgical practice. Electronic consent (e-consent) forms provide an alternative method for conducting the informed consent (IC) procedure. IC requires an ability to understand, retain, weigh up and communicate decisions regarding the proposed procedure. Currently, e-consent has shown promise as a method of improving IC, yet barriers to implementation exist. MethodsA comparative analysis regarding procedural and consent data was collected over six months in two neurosurgical centres with elective and emergency caseloads. These were evaluated for changes over time following e-consent introduction. Clinicians were surveyed for their experience using of e-consenting to understand the barriers to implementation. ResultsOver half (55.6%) of neurosurgical procedures made use of e-consent for IC. Lower rates of e-consent were used in trauma related procedures (38.38%) as compared to elective procedures. This did not increase significantly over the study period. Positive clinician survey feedback indicated e-consenting reduces the time required to perform IC, with 50% of respondents strongly agreeing. Barriers to implementation were reported on free-text entry pertaining largely to difficulties in emergency situations due to form complexity. The inability to create and edit templates for personalised e-consent delivery was a further limitation. ConclusionDespite the advantages conferred by e-consent for the administration of IC in neurosurgical procedures, reflected in our survey data, there remains limited use of the technology. Limitations remain relating to ease of access and complexity of use in trauma scenarios.

Ventriculoatrial shunt remains a safe surgical alternative for hydrocephalus: a systematic review and meta-analysis

Hydrocephalus is a commonly encountered pathology in the neurosurgical practice. Since the first permanent ventriculo-subarachnoid-subgaleal shunt described by Mikulicz in 1893, there were multiple attempts to find solutions for draining the excess production/less reabsorption of the cerebrospinal fluid (CSF) from the brain. Nowadays, the most common technique is the ventriculoperitoneal shunt (VPS), whereas the ventriculoatrial shunt (VAS) is applied only in some rare conditions. To date there are still no specific guidelines or strong evidence in literature that guide the surgeon in the choice between the two methods, and the decision usually relies on the confidence and expertise of the surgeon. Considering the lack of established recommendations, this systematic review and meta-analysis aims to evaluate the effectiveness and safety of these two shunting techniques. This systematic review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). No chronological limits of study publications were included. Prospective and retrospective clinical studies, and reports of case series with at least five patients per group and reporting data on comparison between VAS and VPS techniques were eligible for inclusion. Nine studies reporting 3197 patients meeting the inclusion and exclusion criteria were identified and included in the quantitative synthesis. The risk of shunt dysfunction/obstruction was significantly lower in the VAS group [odds ratio (OR) 0.49, 95%-CI 0.34–0.70, I2 0%]. The risk of infection was not significantly different between the two groups (OR 1.02, 95%-CI 0.59–1.74, I2 0%). The risk of revision was not significantly different between the two groups; however, the heterogeneity between the studies was significant (OR 0.73, 95%-CI 0.36–1.49, I2 91%). Additionally, the risk of death was not significantly different between the two groups; however, the heterogeneity between the studies was high (OR 1.93, 95%-CI 0.81–4.62, I2 64%). VAS remains a safe surgical alternative for hydrocephalus. The results of this study highlight a lower risk of shunt dysfunction/obstruction variable in the VAS group, with no significant statistical differences regarding the occurrence of at least one infection-related complication. In consequence, the choice between these two techniques must be tailored to the specific characteristics of the patient.Protocol Registration: The review protocol was registered and published in Prospective Register of Systematic Reviews (PROSPERO) (www.crd.york.ac.uk/PROSPERO) website with registration number: CRD42023479365.

A mathematical model to predict “low-lying” posterior communicating artery aneurysms in neurosurgical practice

“Low-lying” posterior communicating artery (PCoA) aneurysms require great attention in surgical clipping due to their distinct anatomical characteristics. In this study, we propose an easy method to immediately recognize “low-lying” PCoA aneurysms in neurosurgical practice. A total of 89 cases with “low-lying” PCoA aneurysms were retrospectively analyzed. All patients underwent preoperative digital subtraction angiography (DSA) examinations and microsurgical clipping. Cases were classified into the “low-lying” and regular groups based on intraoperative findings. The distance- and angle-relevant parameters that reflected the relative location of the aneurysms and tortuosity of the internal carotid artery were measured using 3D-DSA images. The data were sequentially integrated into a mathematical analysis to obtain the prediction model. Finally, we proposed a novel mathematical formula to preoperatively predict the existence of “low-lying” PCoA aneurysms with great accuracy. Neurosurgeons might benefit from this model, which enables them to directly identify “low-lying” PCoA aneurysms and make appropriate surgical decisions accordingly.

Anatomical Features and Morphometric Characteristics of the Sphenoidal Sinus in MRI Studies.

Differential access to pathological sellar processes and adjacent regions is determined by the anatomic structures identified through diagnostic imaging. Both direct endonasal access (microscopic or endoscopic) and sublabial access utilize the sphenoid sinus (SS) as the primary surgical pathway. Critical factors include the pneumatization of the sinus, its intermediate septa, and the presence of a double wall, consisting of a connective tissue membrane along the dorsal wall of the SS. The present study aims to demonstrate the significance of the size and type of the SS based on MRI measurements. The type of SS, its pneumatization, and the proximity of adjacent brain structures are crucial for different surgical approaches to the SS and pituitary fossa. In neurosurgical practice, six main types of sinuses are recognized: sphenoid body type, lateral type, clival type, lesser wing type, anterior type, and combined type. Failure to consider these variations can lead to damage to the cavernous sinus, Meckel's cave, nerve structures in the middle cranial fossa, planum sphenoidale, suprasellar region, and vital brainstem structures located on the clivus. Randomly included MRI measurements were conducted on 112 patients from Pulmed University Hospital, Plovdiv, Bulgaria, categorized into two cohorts based on gender, with mean ages of 51 years for men and 47.8 years for women. The measurements, recorded in centimeters, were obtained using two imaging software programs, RadiAnt DICOM Viewer (Medixant, Poznan, Poland) and Weasis DICOM Viewer (Nicolas Roduit, https://github.com/nroduit/Weasis). No statistically significant differences were observed between the measurements produced by the two programs. Measurements of the SS were taken in two equal groups, using three different projections: axial, sagittal, and coronal. The results for height, width, and depth showed average sizes of 2.73-3.04 cm in axial projections, 1.70-2.64 cm in sagittal projections, and 2.86-3.03 cm in coronal projections. The minor differences between axial and coronal measurements of the same parameters (height and width) are statistically acceptable and attributed to the varying angles of the MRI scans. These measurements are crucial for planning surgical access to the sellar and parasellar regions, determining the necessary bony resection of the posterior wall of the SS, and preventing complications from excessive bony trepanation.

Online healthcare transition resources for pediatric neurosurgical care: supporting the journey of individuals living with spina bifida.

In the global environment in which neurosurgical providers practice, there is a pressing need to identify and highlight online resources to support families shifting from pediatric to adult-centered spina bifida (SB) care in general and neurosurgical care in particular. The purpose of this paper was to identify high-quality resources for clinicians and families of individuals affected by SB to be utilized during the transition years. With knowledge of, and access to, these online resources, neurosurgical providers can aim to make the transition process effective, to improve the quality of care for young adults with SB. All identified online resources were found on the GOT TRANSITION platform and by searching "spina bifida transition resources" between January and March 2024. Resources were coded for transition focus areas and stratified into predefined categories: 1) education for clinicians, 2) preparation for youth and families, 3) educational/school, and 4) employment and independent living. A total of 160 websites were cataloged; 11% of websites focused on medical provider education, 44% on preparation for youth, 29% on educational/school resources, and 16% on employment and independent living. In the global environment of today's medicine, online transition resources are available to assist clinicians and families in the transition process of individuals living with SB. With improved knowledge and utilization of online transition resources, neurosurgical providers can better serve individuals with SB and their families to improve quality of care with the aim of improving lifelong outcomes.

Health care transition models in spina bifida care: evidence-based lessons in support of neurosurgical practice.

The purpose of this study was to conduct a literature review on transition programs from pediatric to adult care and the role of neurosurgery as individuals with spina bifida (SB) transition, and to provide a framework for neurosurgical providers to assist in the transition to adult-centered care. A comprehensive literature review was conducted according to the PRISMA statement, with a search in Medline and Embase to identify US clinical programs reporting on their experiences establishing a transition program for adolescents and young adults with SB. Data were collected for authors, year, transition clinic location, model of care for transition clinic, ages served, and specialty clinical team. The literature search yielded 698 articles, 5 of which met the inclusion criteria. These 5 studies included 4 transition programs for which models of care and approach to transition, clinical services involved, establishment of goals, and age of initiation and transition were identified. All programs described setting transition goals, ranging from community services, to self-management, to health care navigation, to patient-driven goals, with 1 program reporting a quality-of-life measurement component to their model. Robust SB transition programs can be established by applying the expanded chronic care model, reviewing lessons learned by other programs, advocating at the institutional level, and seeking support via professional organizations. While the comprehensive role of neurosurgical providers in these programs is still being defined, a shared vision of enhancing the health and quality of life for individuals with SB and their families is needed by all subspecialists involved.

Insufficient evidence for an association between iatrogenic Alzheimer's disease and cadaveric pituitary-derived growth hormone.

A Nature Medicine paper published in January 2024 describes eight cases of iatrogenic Alzheimer's disease in individuals who received cadaveric pituitary-derived human growth hormone. The paper's conclusions argue for the transmissibility of Alzheimer's disease, which, if true, would create a significant public health crisis. For example, neurosurgical practices would require substantial revision, and many individuals who have undergone neurosurgical procedures would now be at considerable risk of Alzheimer's disease. A detailed review of the presented cases reveals that they do not have Alzheimer's disease, and there are alternative explanations for the cognitive decline described. In people with progressive cognitive decline, the diagnosis of Alzheimer's disease requires a demonstration of amyloid and tau pathology or amyloid and tau biomarkers. Extensive tau pathology is not demonstrated, and some also lack amyloid beta pathology. The cases described in this paper do not meet the criteria for dementia due to Alzheimer's disease by clinical and pathological standards. HIGHLIGHTS: Creutzfeldt-Jakob disease has been transmitted by cadaveric growth hormone. There is no evidence for the transmission of Alzheimer's disease by cadaveric growth hormone. There is no evidence that Alzheimer's disease is transmissible.