Neurosurgical Societies Research Articles

A Study on Work Intensity, Work-Life Balance, and Burnout among Korean Neurosurgeons after the Enactment of the Special Act on Korean Medical Residents.

ObjectiveSince the enactment of the Special Act on Korean Medical Residents, neurosurgeons working at training hospitals have been performing the duties of residents, in addition to their existing patient care responsibilities, which include surgery, education, and research. This study explores the relationships between work intensity, work-life balance, and burnout experienced by Korean neurosurgeons. MethodsThe participants (n=451) were neurosurgeons working at training hospitals throughout Republic of Korea. Data on socio-demographic characteristics (including objective and subjective work environment), work intensity, work-life balance, and burnout were gathered using self-report questionnaires completed between March 1 and December 20, 2019. The data were analyzed using descriptive statistics, independent samples t-tests, one-way analysis of variance, Pearson’s correlations, and multiple regression analysis. IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, NY, USA) was used for the analyses. ResultsThe work intensity, work-life balance, and burnout levels of neurosurgeons were 3.95, 3.57 (on a scale from 1 to 5) and 4.60 (on a scale from 1 to 7); and 280 (62.1%) of 451 neurosurgeons were found to be experiencing burnout. By controlling for the socio-demographic characteristics, the effects of work intensity and work-life balance on burnout were analyzed. Work intensity (B=0.314), work-life balance-family and leisure (B=0.216), work-life balance-growth (B=0.147), job stress (B=0.133), and satisfaction with human relationships (B=-0.069) were shown to be significant (all p<0.05), and they were found to affect burnout in the abovementioned order. The overall explanatory power was 58.3% (p<0.05), and the explanatory power with the addition of independent variables such as work intensity and work-life balance was 14.5% (p<0.05). ConclusionThis study showed that Korean neurosurgeons working at training hospitals experienced a high level of work intensity and job stress, and low work-life balance. Additionally, nearly half of the neurosurgeons were found to experience burnout related to factors such as work intensity, work-life balance, job stress, and satisfaction with human relationships. In particular, these factors seem to have deteriorated further after the implementation of the Special Act on Korean Medical Residents. These very high levels of burnout among Korean neurosurgeons who care for patients with both brain and spinal diseases may have a very important impact on patients’ health. Therefore, it is recommended that the Korean Neurosurgical Society and the Korean government make efforts to improve the factors that affect burnout among Korean neurosurgeons.

Does intrathecal nicardipine for cerebral vasospasm following subarachnoid hemorrhage correlate with reduced delayed cerebral ischemia? A retrospective propensity score-based analysis.

Cerebral vasospasm and delayed cerebral ischemia (DCI) contribute to poor outcome following subarachnoid hemorrhage (SAH). With the paucity of effective treatments, the authors describe their experience with intrathecal (IT) nicardipine for this indication. Patients admitted to the Emory University Hospital neuroscience ICU between 2012 and 2017 with nontraumatic SAH, either aneurysmal or idiopathic, were included in the analysis. Using a propensity-score model, this patient cohort was compared to patients in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository who did not receive IT nicardipine. The primary outcome was DCI. Secondary outcomes were long-term functional outcome and adverse events. The analysis included 1351 patients, 422 of whom were diagnosed with cerebral vasospasm and treated with IT nicardipine. When compared with patients with no vasospasm (n = 859), the treated group was significantly younger (mean age 51.1 ± 12.4 years vs 56.7 ± 14.1 years, p < 0.001), had a higher World Federation of Neurosurgical Societies score and modified Fisher grade, and were more likely to undergo clipping of the ruptured aneurysm as compared to endovascular treatment (30.3% vs 11.3%, p < 0.001). Treatment with IT nicardipine decreased the daily mean transcranial Doppler velocities in 77.3% of the treated patients. When compared to patients not receiving IT nicardipine, treatment was not associated with an increased rate of bacterial ventriculitis (3.1% vs 2.7%, p > 0.1), yet higher rates of ventriculoperitoneal shunting were noted (19.9% vs 8.8%, p < 0.01). In a propensity score comparison to the SAHIT database, the odds ratio (OR) to develop DCI with IT nicardipine treatment was 0.61 (95% confidence interval [CI] 0.44-0.84), and the OR to have a favorable functional outcome (modified Rankin Scale score ≤ 2) was 2.17 (95% CI 1.61-2.91). IT nicardipine was associated with improved outcome and reduced DCI compared with propensity-matched controls. There was an increased need for permanent CSF diversion but no other safety issues. These data should be considered when selecting medications and treatments to study in future randomized controlled clinical trials for SAH.

MTT Heterogeneity in Perfusion CT Imaging as a Predictor of Outcome after Aneurysmal SAH.

Impairment of tissue oxygenation caused by inhomogeneous microscopic blood flow distribution, the so-called capillary transit time heterogeneity, is thought to contribute to delayed cerebral ischemia after aneurysmal SAH but has so far not been systematically evaluated in patients. We hypothesized that heterogeneity of the MTT, derived from CTP parameters, would give insight into the clinical course of patients with aneurysmal SAH and may identify patients at risk of poor outcome. We retrospectively analyzed the heterogeneity of the MTT using the coefficient of variation in CTP scans from 132 patients. A multivariable logistic regression model was used to model the dichotomized mRS outcome. Linear regression was used to eliminate variables with high linear dependence. T tests were used to compare the means of 2 groups. Furthermore, the time of the maximum coefficient of variation for MTT after bleeding was evaluated for correlation with the mRS after 6 months. On average, each patient underwent 5.3 CTP scans during his or her stay. Patients with high coefficient of variation for MTT presented more often with higher modified Fisher (P = .011) and World Federation of Neurosurgical Societies grades (P = .014). A high coefficient of variation for MTT at days 3-21 after aneurysmal SAH correlated significantly with a worse mRS score after 6 months (P = .016). We found no correlation between the time of the maximum coefficient of variation for MTT after bleeding and the patients' outcomes after 6 months (P = .203). Heterogeneity of MTT in CTP after aneurysmal SAH correlates with the patients' outcomes. Because the findings are in line with the pathophysiologic concept of the capillary transit time heterogeneity, future studies should seek to verify the coefficient of variation for MTT as a potential imaging biomarker for outcome.

Impact of aneurysm morphology on aneurysmal subarachnoid hemorrhage severity, cerebral infarction and functional outcome

ObjectiveAneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity. The objective was to evaluate, whether specific morphological aneurysm characteristics could serve as predictive values for aSAH severity, disease-related complications and clinical outcome. MethodsA total of 453 aSAH patients (mean age: 54.9 ± 13.8 years, mean aneurysm size: 7.5 ± 3.6 mm) treated at a single center were retrospectively included. A morphometric analysis was performed based on angiographic image sets, determining aneurysm location, aneurysm size, neck width, aneurysm size ratios, aneurysm morphology and vessel size. The following outcome measures were defined: World Federation of Neurosurgical Societies (WFNS) grade 4 and 5, Fisher grade 4, vasospasm, cerebral infarction and unfavorable functional outcome. ResultsRegarding morphology parameters, aneurysm neck width was an independent predictor for Fisher 4 hemorrhage (OR: 1.1, 95%CI: 1.0–1.3, p = 0.048), while dome width (OR: 0.92, 95%CI: 0.86–0.97, p = 0.005) and internal carotid artery location (OR: 2.1, 95%CI: 1.1–4.2, p = 0.028) predicted vasospasm. None of the analyzed morphological characteristics prognosticated functional outcome. Patient age (OR: 0.95, 95%CI: 0.93–0.96, p < 0.001), WFNS score (OR: 4.8, 95%CI: 2.9–8.0, p < 0.001), Fisher score (OR: 2.3, 95%CI: 1.4–3.7, p < 0.001) and cerebral infarction (OR: 4.5, 95%CI: 2.7–7.8, p < 0.001) were independently associated with unfavorable outcome. ConclusionsThe findings indicate a correlation between aneurysm morphology, Fisher grade and vasospasm. Further studies will be required to reveal an independent association of aneurysm morphology with cerebral infarction and functional outcome.

Clinical and Morphological Characteristics of Ruptured Small (

Context:Small intracranial aneurysms (IAs) are considered to have a low risk of rupture; however, in clinical practice, we often encounter patients with subarachnoid hemorrhage (SAH) due to rupture of small IAs.Aims:This study aims to clarify the clinical and morphological characteristics of ruptured small IA, focusing on posterior communicating artery (PCoA) aneurysms as a prone site.Settings and Design:We retrospectively reviewed 102 consecutive patients with SAH due to ruptured PCoA aneurysm who underwent microsurgical or endovascular aneurysm repair between April 2013 and March 2018.Subjects and Methods:All PCoA aneurysms were diagnosed using three-dimensional rotation angiography or three-dimensional computed tomography angiography. Information regarding the following clinical characteristics was collected: age, sex, past medical history, current smoking, antithrombotic therapy, multiplicity, hydrocephalus, intracerebral hemorrhage, intraventricular hemorrhage, and World Federation of Neurosurgical Societies (WFNS) Grade on admission.Statistical Analysis Used:We analyzed factors of ruptured small IA, focusing on PCoA aneurysms using univariate and multivariate regression analyses.Results:Univariate and multivariate analyses revealed that low aspect ratio (AR) (odds ratio [OR] = 0.33, P = 0.01) and nonfetal type of PCoA (OR = 0.31, P = 0.02) might be independent characteristics of ruptured small PCoA aneurysms. However, age, sex, past medical history, WFNS grade, and treatment outcome were not different between the small and nonsmall PCoA aneurysms. The aneurysm size was not associated to the selection of treatment, proportion of complications, and treatment outcome.Conclusions:In cases of ruptured PCoA aneurysms, low AR and nonfetal type of PCoA might be associated with rupture of small aneurysms.

Protocol Adherence in the Intensive Care Unit for the Management of Adult Patients Admitted with Acute Aneurysmal Subarachnoid Hemorrhage

AbstractBackground There are recognized protocols that exist for management with minimal data regarding protocol adherence. We conducted a retrospective analysis of aneurysmal subarachnoid hemorrhage (aSAH) to determine whether the level of protocol adherence varied based on patient demographics or specific aspects of management.Materials and Methods All cases of aSAH admitted to a tertiary-level intensive care unit (ICU) from 2014 to 2016 were identified from the Australia and New Zealand Intensive Care Society Core Database as well as the clinical records system. ICU demographic and descriptive data for protocol adherence, were collected from admission to discharge up to 22 days, or until death whichever was earlier.Results A total of 58 cases of aSAH were registered; mean age was 56.7 years, 70.7% of patients were female, and mean length of stay was 12.6 days. World Federation of Neurosurgical Societies (WFNS) scale was documented more than Fisher grading. Of the 58 cases, 63.7% (37) underwent surgical clipping, with 83.7% (30) patients having this surgery within 48 hours. SBP/MAP were the most consistently recorded observations within protocol ranges, with adherence of 82.4% and 82.1%, respectively. Thirty-two percent of temperature measurements were outside of the normothermic range of 36.5 to 37.5°C with a mean adherence of 47.5% (standard deviation = ±0.24, median = 40). There was no correlation between adherence and patient, disease, or admission factors.Conclusion This study demonstrated that there was no association between variation in protocol adherence based on age, admission dates, or disease factors including WFNS grade and Fisher scale. Best protocol adherence protocol for the management of aSAH within the ICU was blood pressure control. Areas for improvement were documentation of the WFNS and Fisher grading, and temperature measurement and management.

Modified Glasgow coma scale for predicting outcome after subarachnoid hemorrhage surgery

There are many grading scales that attempt to predict outcome following aneurysmal subarachnoid hemorrhage (aSAH). Most scales used to assess outcome are based on the neurological status of the patient. Here, we propose a new scale for aSAH patients that combines the Glasgow Coma Scale (GCS) and the modified Fisher scale (mFS).Five hundred ninety-seven patients with aSAH who were treated at our institution between January 2008 and December 2017 were retrospectively analyzed. Initial GCS score, Hunt and Hess scale, World Federation of Neurosurgical Societies scale, mFS, and modified Rankin Scale were obtained by reviewing data. Incidence of vasospasm was investigated. Factors found to be significant on a multivariable regression analysis were used to develop a scale that was compared with other grading systems using the area under the curve (AUC) calculated from receiver operating characteristic curve.The GCS score and mFS were related to outcomes in patients with aSAH. A simple score, which we call the GCS-F score, was calculated using these initial data. The GCS-F score had an AUC of 90.5% for unfavorable outcome prediction, and 88.4% for in-hospital mortality prediction. On the receiver operating characteristic curve analysis for vasospasm, the AUC for World Federation of Neurosurgical Societies, mFS and GCS-F scores were 0.912, 0.704, and 0.936, respectively.A simple arithmetic combination of the GCS score and mFS, the GCS-F score, includes the radiographic status as well as the clinical status of the patient, so that the state of the patient can be known in more detail than other single scales. The GCS-F score may be a useful scale for predicting outcome and the occurrence of vasospasm in patients with aSAH.

The Evolution of Journal of Korean Neurosurgical Society from 2017 to 2020 : The Beginning of a Great Development.

Every researcher wants their research to gain more recognition, and this desire is achieved by publishing their article in a journal with higher impact. It is very important to get researchers interested in the Journal of Korean Neurosurgical Society (JKNS). Therefore, the first goal was to promote the publication of papers in our journal. To do this, a table of contents was sent out, and the citation ranking was announced every 2 months. Several efforts have been made to publish good papers. Foreign speakers, who were invited to a conference hosted by the Korean Neurosurgical Society were contacted and politely requested to write a paper addressing their recent research. Domestic and international researchers highly renowned in their fields were also contacted to submit their novel works to our journal. The journal impact factor of our journal has continued to rise for the last 3 years and reached 1.376 in 2019. It can be said that the JKNS is now competitive with other international neurosurgery journals. These achievements were not due to the efforts of the editorial boards alone. This was because our society members have submitted very good papers, and because many of our members have cited the papers published in our journal. We believe that this will continue in the future. The next step of evolution of the JKNS has begun, and this is the beginning of another great development.

Global Neurosurgery: the role of WFNS Foundation

The World Federation of Neurosurgical Societies (WFNS) is the largest neurosurgical organization gathering more than 49.000neurosurgeons belonging to almost all existing neurosurgical societies worldwide, created in 1955 to promote neurosurgerycamaraderie among neurosurgeons. In 90's beginnings, the visionary leadership of professor "Pepe" Martin-Rodriguez and professorMadjidSamii made possible the creation of the WFNS Foundation; its mission can be defined as an improvement of neurosurgical carein developing countries (education, training and, intraoperative neurosurgical technology), with the vision to become the wor ldwideleader neurosurgical organization in the promotion of education and neurosurgical care in that c ountries. It is essential to mention thename of Professor Armando Basso, who exemplarily created the modern and current Foundation structure that nowadays is helpingthousands of patients and neurosurgeons.

The Concept and Current State of Neurosurgery in Southeast Europe

The term "Southeast Europe" was introduced by Austrian researcher Johann Georg von Hahn in the 19th century as a broader termthan the traditional "Balkans," designating the region settled by several different nations, mostly alike, but also richly diverse. The mostappropriate definition describes the inhabitants as the people geographically, demographically, and culture related to SoutheasternEurope (1).Contemporary neurosurgery in the Southeast Europe region has recently witnessed remarkable progress, guided by the "Think globally,act locally" concept as an essential driving force. This slogan has long been in use in environmental contexts and has been gainingincreased significance in various disciplines over the past decades. In international education, this slogan was first introduced in 1950and popularized by Stuart Grauer in 1989 (2). Neurosurgeons in Southeast Europe genuinely implement the concept of thinking globallyand acting locally, working together to expand the horizons to the benefit of our patients and our well-being and recognition in themodern world. This mini review aims to highlight the development and progress of the Southeast Europe neurosurgical society (SeENS)as a regional neurosurgical society dedicated to neurosurgical education, research, capacity building, and exchanging experienceswithin the Southeast region of Europe.

The Global Neurosurgery and the WFNS

In 2015, the Lancet Commission on Global Surgery highlighted surgical care disparities worldwide [1]. No one could ever imagi ne thatGlobal Neurosurgery would become a real movement, a source of inspiration for others surgical specialties [2]. Over the years, GlobalNeurosurgery allowed the realization of a collective awareness of surgery as a global health priority.The Neurosurgical community accepted the challenge of delivering timely, safe, and affordable neurosurgical care to all who need it.Multiple efforts have been made to address this need to promote national surgical policies, improve surgical education and tr aining,build quality research, and advocate for the surgical workforce. The critical factor has been the relationship between the World HealthOrganization (WHO) and the World Federation of Neurosurgical Societies (WFNS). Since 1955, the WFNS has promoted globalimprovement in neurosurgical care, building neurosurgical capacity through education, training, technology, and research.The goals are ambitious. By creating international partnerships, the WFNS has established multiple training programs in neurosurgical

The Journal of Global Neurosurgery (JGNS)

The Global Neurosurgery Committee of the World Federation of Neurosurgical Societies defines Global Neurosurgery as “the clinicaland public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to allwho need it” (1). The definition weaves the values of equity, social justice, and inclusivity through the fabric of the traditionalcharacteristics that define modern neurosurgery, such as excellence, technical mastery, integrity, and compassion. The recent additionof the global health dimension and the accompanying scientific and systems approach to address the unmet neurosurgical needs in theworld has galvanized our profession, stimulated academic inquiry, and inspired many who wish to enter it. One only needs to see theexplosive number of publications using the terms “global neurosurgery” over the last few years as a proxy of academic interest (2)(figure 1).

Global Neurosurgery: A call to Action

When it comes to surgical subspecialties such as neurological surgery, access to care goes from being a disparity to a complete absencein many cases as access to neurosurgical care is no longer a right but a luxury. To address this need multiple organizations have workedto improve access to neurosurgery, and as global neurosurgical efforts expand a concerted effort is necessary to ensure safe,sustainable and equitable care is provided and efforts by the multiple stakeholders are not duplicated. To that end, the GlobalNeurosurgery Committee (GNC) of the World Federation of Neurosurgical Societies (WFNS) created an action plan for directedcollaboration. We introduce the GNC Action Plan here and describe its guiding principles, divided into five objectives that encompassthe necessary steps to achieve universal access to neurosurgical care: 1) amplifying access to neurosurgical care, 2) aligning globalneurosurgery activities, 3) advancing global neurosurgery research efforts, 4) assimilating neurosurgical capacity building into s urgicalsystems, and 5) advocating for neurosurgical care within Universal Health Coverage.

Do We Really Need Another Journal?

A new Journal sees dawn – but didn't we already have too many journals and too many articles published to go to oblivion rapidly? Publishers take advantage of the move towards open access. The need to attract an audience and select papers for high-quality decreases with the move towards business models where journals charge article processing fees to cover expenses and create margins. The Journal of Global Neurosurgery (JGNS) is not a business project: it is far more altruistic and intends to fill a real need. The long-term prospects will not depend on revenue but on the sustainability of the publication model, which by necessity must be low cost and non-profit – other ways, the new journal will not be able to fill the need.&#x0D; "Global Neurosurgery" is becoming increasingly vogue. Individual neurosurgeons and the World Federation of Neurosurgical Societies have fostered projects to develop our specialty in low- and middle-income countries (LMIC), where single neurosurgeons have catered to many millions of patients. We see a worldwide quiet revolution of expanding surgical infrastructure and dissemination of knowledge in countries previously deprived. The stakeholders of this revolution have soon identified a veritable glass ceiling when it comes to publication. Submissions have frequently been seen as relevant or generalizable for the audiences of existing journals. Clinical neuroscience in LMICs is, much to the surprise of many practitioners and editors in previously established structures, different. Fundamental issues such as study population and external validity were rediscovered when population data, research findings, and practice guidelines from affluent, relatively elderly western people with access to smooth infrastructure and exquisitely equipped hospitals were applied with little meaning in LMICs with different demographics and epidemiology. Yet, many clinical studies from LMICs were adapted to previous literature's format and style, without detecting the unique qualities, "the cracks in the wall" of existing paradigms, that would bring the progress of knowledge and change. I believe that a research community with a thorough understanding of the specific qualities of infrastructure and epidemiology in LMICs is being established, and it needs dedicated platforms. A journal is one such platform that can serve to define and direct the subspecialty.

The Global Neurosurgery and the WFNS

In 2015, the Lancet Commission on Global Surgery highlighted surgical care disparities worldwide [1]. No one could ever imagine that Global Neurosurgery would become a real movement, a source of inspiration for others surgical specialties [2]. Over the years, Global Neurosurgery allowed the realization of a collective awareness of surgery as a global health priority.&#x0D; The Neurosurgical community accepted the challenge of delivering timely, safe, and affordable neurosurgical care to all who need it. Multiple efforts have been made to address this need to promote national surgical policies, improve surgical education and training, build quality research, and advocate for the surgical workforce. The critical factor has been the relationship between the World Health Organization (WHO) and the World Federation of Neurosurgical Societies (WFNS). Since 1955, the WFNS has promoted global improvement in neurosurgical care, building neurosurgical capacity through education, training, technology, and research.&#x0D; The goals are ambitious. By creating international partnerships, the WFNS has established multiple training programs in neurosurgical centers in Africa and other countries with limited facilities, allowing residents to work first in the host countries to learn and improve their skills and return to their country of origin [3,4,5]. Furthermore, the WFNS is working on sustainable surgical programs within Low-and Middle-income countries (LMICs) using digital technology [6]. Internet availability allows fast and easy access to digital resources, and digital education has become an emerging tool to bridge the gap between surgeons from High-Income Countries (HICs) and LMICs.

International Neurosurgery Activity after 2020- Silver Linings from the Covid-19 Pandemic &amp; Lessons from the European Association of Neurosurgical Societies (EANS)

“Every cloud has a silver lining,” and indeed, every crisis provides opportunities for learning lessons and changing tactics. Nobody couldhave foreseen what happened because of the Covid-19 disease, from the unfolding outbreak stages to the epidemic, and now a globalpandemic; second and possibly third waves into 2021, and 2 million deaths and 98 million confirmed infections globally as of 25thJanuary 2021. The European Association of Neurosurgical Societies (EANS) canceled all major on-site activities in 2020; This included allthree cycles of our flagship event, the residential Training Courses for Residents in Neurosurgery, as well as various hands-on courses(table 1). However, amidst the chaos, suffering, and lockdown, and the uncertainties of traveling, hotel availabilities, and quarantines,the opportunity arose to convert some events to an online version. Several organizations and societies acted along the same lines, andthere has been an explosion of webinars and videoconferencing on a variety of platforms (1).

The Journal of Global Neurosurgery

1 | WHAT IS GLOBAL NEUROSURGERY?&#x0D; The Global Neurosurgery Committee of the World Federation of Neurosurgical Societies defines Global Neurosurgery as “the clinical and public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it”(1). The definition weaves the values of equity, social justice, and inclusivity through the fabric of the traditional characteristics that define modern neurosurgery, such as excellence, technical mastery, integrity, and compassion. The recent addition of the global health dimension and the accompanying scientific and systems approach to address the unmet neurosurgical needs in the world has galvanized our profession, stimulated academic inquiry, and inspired many who wish to enter it. One only needs to see the explosive number of publications using the terms “global neurosurgery” over the last few years as a proxy of academic interest (2) (figure 1).

Temporal muscle thickness and area are an independent prognostic factors in patients aged 75 or younger with aneurysmal subarachnoid hemorrhage treated by clipping.

Background: Skeletal muscle mass is an important factor for various diseases’ outcomes. As for its indicators, temporal muscle thickness (TMT) and temporal muscle area (TMA) on the head computed tomography are useful, and TMT and TMA were reported as potential prognostic factors for aneurysmal subarachnoid hemorrhage (SAH). We examined the clinical characteristics, including TMT and TMA, of SAH patients aged 75 or younger.Methods: We retrospectively investigated 127 SAH patients with all World Federation of Neurosurgical Societies (WFNS) grades and treated by clipping between 2009 and 2019. Clinical outcome was measured with the modified Rankin Scale (mRS) at 6 months, with favorable outcome defined as mRS 0–2. The associations between the clinical variables and the outcomes were analyzed.Results: The mean age was 60.6 (32–74) years, and 65% were women. The mean ± standard deviation of WFNS grade was 2.8 ± 1.4. TMT and TMA were larger in the favorable outcome group than the poor one. Multivariate analysis revealed that age, smoking, WFNS grade, and TMT or TMA were associated with favorable outcome. Receiver operating characteristic analysis found that the threshold of TMT was 4.9 mm in female and 6.7 mm in male, and that of TMA was 193 mm2 in female and 333 mm2 in male.Conclusion: The odds ratios for TMT and TMA related to clinical outcome were lower than for smoking and WFNS grade; however, on multivariate analysis they remained independent prognostic factors in SAH patients aged 75 or younger treated by clipping. Further studies are needed to confirm these findings.

Characteristics of Global Neurosurgery Sessions: A Retrospective Analysis of Major International Neurosurgical Conferences

The global burden of neurosurgical disease is substantial, particularly in low- and middle-income countries (LMICs). Medical conferences are important in connecting those from LMICs to those from high-income countries for support and serve as an educational and networking tool. In this study, we sought to quantitatively assess the incorporation of global neurosurgery topics in international conferences related to the neurosurgical specialty. A database of major international neurosurgical conferences, from the conference of a group of 9 major neurosurgical societies, that had global neurosurgery featured from 2015 to 2020 was created. We then did a retrospective analysis to study the characteristics of these conferences ranging from geographic location to number to different components of the conferences. There was an increase in the number of conferences with global neurosurgery since 2015. This, in addition to the occurrence of 3 wholly global neurosurgery-related conferences in recent years, is promising and suggests growth in the field. However, 52.6% of conferences took place in North American or European countries, the majority of which were high-income countries. Furthermore, a majority of the presence of global neurosurgery was in the form of individual talks (54.5%) as opposed to plenaries or sessions. The preponderance of conferences in North America and Europe can pose barriers for those from LMICs including travel time, expenses, and visa problems. As global neurosurgery becomes an increasing part of the global health movement, we hope that these barriers are addressed. Conferences may become an even stronger tool to promote equity in neurosurgical education and practice.

日本脳神経外科学会第79回学術総会を岡山で開催して

日本脳神経外科学会第79回学術総会を岡山で開催して