Breaking barriers: Addressing gender disparity in neurosurgery.

Neurosurgery is still dominated by men, with only 16.7% of neurosurgeons being women and even fewer in leadership roles. This disparity affects research, patient care, and health policy. To enhance care and equity, addressing barriers for women through targeted mentorship, inclusive practices, and policy changes is essential. CORRESPONDENCE: Despite significant progress in medical education and practice, neurosurgery remains a male-dominated specialty. This gender disparity is not merely a reflection of societal biases but a systemic issue that affects both the professional advancement of women and the quality of care delivered to patients. As the global health community strives for equity, the underrepresentation of women in neurosurgery demands urgent attention.

Survey of European neurosurgeons' management of unruptured intracranial aneurysms: inconsistent practice and organization.

BACKGROUND: The discovery of an unruptured intracranial aneurysm creates a dilemma between observation and treatment. Neurosurgeons' routines for risk assessment and treatment decision-making are unknown. The position of evidence-based medicine in European neurosurgery is considered to be weak, high-grade guidelines do not exist and variations between institutions are probable. We aimed to explore European neurosurgeons' management routines for newly discovered unruptured intracranial aneurysms. METHODS: In cooperation with the European Association of Neurosurgical Societies (EANS), we conducted an online, cross-sectional survey of 420 European neurosurgeons during Spring/Summer 2016 (1533 non-Norwegians invited through the EANS, and 16 Norwegians invited through heads of departments because of the need for additional information for a separate study). We asked about demographic variables, routines for management and risk assessment of newly discovered unruptured intracranial aneurysms and presented a case. We collected information about gross domestic product (GDP) per capita from the International Monetary Fund. RESULTS: The response rate to the invite from the EANS was 26%, with respondents from 47 countries. More than half of the respondents (n = 226 [54%]) reported that their department treated less than 25 unruptured aneurysms yearly. Forty percent said their department used aneurysm size cut-off to guide treatment decisions, with a mean size of 6 mm. Presented with a case, respondents from countries with a lower GDP per capita recommended intervention more often than respondents from higher-income countries. Vascular neurosurgeons more commonly recommended observation. CONCLUSION: The answers to this self-reported survey indicate that many centers have a treatment volume lower than recommended by international guidelines, and that there are socioeconomic differences in care. Better documentation of treatment and outcome, for example with clinical quality registries, is needed to drive improvements of care.

Neurosurgeons on the front line: experience from the center of the storm in Italy.

In this tumultuous time, the entire world has been shaken up by the COVID-19 outbreak. Italy has had one of the highest infection-related mortality rates. Bergamo, a city in eastern Lombardy, was among the most affected. Here, the authors describe the main healthcare actions taken at their institution to stem the crisis, with particular concern regarding the fate of their neurosurgery department. Among the different topics, the authors particularly focus on the retraining of neurosurgeons, organization of activities, and what should be the role of neurosurgeons during a pandemic.

Workforce planning in neurosurgery.

Purpose: Since the introduction of run-through training in UK Neurosurgery in 2007, there has been no limit on the number of posts deaneries may apply for. The rationale for run-through training was based on the premise that the number of trainees recruited would match the number of consultant posts eight years later. There has been no formal survey of the number of consultant neurosurgeons in the UK for several years. A survey was undertaken to measure the current Neurosurgical workforce.Methods: The Specialist Advisory Committee undertook a survey to establish the current workforce and estimate how best to ensure that the correct number of trainees are being recruited. Data was also obtained from public bodies including the GMC, NHS Jobs and JCST.Results: Since 1993 the number of Neurosurgeons in UK and Ireland has increased from 132.5 to 389 whole time equivalents (4.4% curvilinear annual increase). The number of registered neurosurgical trainees fell 9% from 278 in 2012 to 248 in 2017. The number of UK graduates in Neurosurgical training has remained constant. The number of trainees failing to complete training has increased from 1.25 per annum in 2009-2012 to 5-6 in 2014-2017. The number of ST1 level trainees recruited has risen, which a fall in the number of trainees entering at the ST3 level has partially offset. The number of doctors with a CCT in Neurosurgery but no substantive consultant post has risen from 26 to 43 between 2015 and 2018.Conclusions: Neurosurgical workforce data should be collected regularly and a workforce planning process should be implemented. Consultant expansion is required to reduce the number of CCT holders without consultant jobs. The specialty should prevent any further increase in the number of trainees recruited and we should consider a marginal reduction in recruitment.

[Significance of Existence and Future Prospects of Nurse Practitioners in Neurosurgical Teams].

Recently, hospitals and medical facilities have been experiencing a shortage of doctors along with heavy workload. The role of a mid-level provider may be important as a potential solution to these problems. A nurse practitioner(NP)is the most famous mid-level provider, and in our institution, the neurosurgery department has 3 NPs. Contrary to America, in Japan, the job of an NP is not an occupation independent from doctors or nurses. NPs perform 38 specific procedures according to doctors' instructions. Their activities include assisting with operations, writing prescriptions, participation in neurosurgical rounds and conferences, transportation of patients by helicopter, etc. The safe transportation of patients to isolated islands by a helicopter is especially a representative activity in our institution. Inclusion of NPs in clinical settings may bring forth medical improvements and superior work efficiency. According to regional characteristics, the job profile of a NP presents a potential scope for added capabilities.

Academic neurosurgery in the UK: present and future directions.

Academic neurosurgery encompasses basic science and clinical research efforts to better understand and treat diseases of relevance to neurosurgical practice, with the overall aim of improving treatment and outcome for patients. In this article, we provide an overview of the current and future directions of British academic neurosurgery. Training pathways are considered together with personal accounts of experiences of structured integrated clinical academic training and unstructured academic training. Life as an academic consultant is also described. Funding is explored, for the specialty as a whole and at the individual level. UK academic neurosurgical organisations are highlighted. Finally, the UK's international standing is considered.

Neurosurgical referral service using smartphone client WhatsApp: preliminary study at a tertiary referral neurosurgical unit.

BACKGROUND: Smartphone-based clients are being increasingly used in a medical world for individual as well as group communications. The authors report the use of WhatsApp, a common social media smartphone client for neurosurgical referral service in their Institution. They extend the use of WhatsApp application from a purely intra-departmental informal communication to a formal tertiary referral service for Neurosurgical referrals. The pros and cons of deploying such system are discussed and important concerns are highlighted. METHODS: Over a period of one year, the authors record 1412 referrals to the Neurosurgical service at a tertiary referral centre using WhatsApp application. All the data gathered through WhatsApp referrals was subsequently validated and analysed for any errors. They identify eight incidences where the system did not accurately convey the intended information. They highlight the potential issues related to data accuracy and confidentiality encountered in using such a system. OBSERVATIONS: In this preliminary study, the authors consider WhatsApp application as an important tool for Neurosurgical referrals. It is safe, cheap, reliable and user-friendly application allowing seamless transfer of data including clinical videos and scan images to the on call neurosurgical team. Loss of data quality, concerns surrounding patient confidentiality, errors caused by inter-operator variability in capturing data and default prohibition of use of such social media applications in many institutions are important disadvantages in regularly using such service. CONCLUSIONS: Smartphone-based social media clients such as WhatsApp provide a promising future for faster, reliable communication of clinical and radiological data, which can be used for on-call neurosurgical referrals. Integration with PACs applications and facial recognition may facilitate increasing use of such applications in future addressing many of the concerns that currently prohibit their universal use.

Development of pediatric neurosurgical service at Dr. Soetomo Hospital, Surabaya, Indonesia.

PURPOSE: This review traces the history of pediatric neurosurgery at Dr. Soetomo General Hospital (DSGH) and its role in advancing the field of pediatric neurosurgery. METHODS: The history, the founding fathers, and the next generations of the pediatric neurosurgery in DSGH were traced back from original sources and authors' life stories. RESULT: Pediatric neurosurgical service at DSGH has its own unique perspective being a pediatric service in general hospital setting. It serves second largest city of Indonesia - the fifth most populated country in the world. Historical vignette and future perspectives are narratively presented. CONCLUSION: As a pediatric neurosurgical service at general hospital in developing country, its development deserves a special mention.

The first lady president of the ISPN: Prof. Dr. Graciela Zuccaro and her journey through pediatric neurosurgery.

The International Society for Pediatric Neurosurgery (ISPN) was founded in 1972 in Chicago, IL, USA. It has been 45 years since the creation of the ISPN, but it is not until now that the pediatric neurosurgery community has been led by a female neurosurgeon.

Neurosurgery at Kasturba Medical College: Past, present and future.

Kasturba Medical College (KMC), Manipal, is the oldest and one of the most reputed medical institutes in coastal Karnataka, catering to a population of over 4 million, spanning a stretch of over 350 kms along the southwest coast of India from Mangalore to Goa. The Department of Neurosurgery at KMC, established in 1968, continues to be the leading and most preferred referral center providing high quality neurosurgical services in this region. The article provides an insight into the origin of the department, its infancy and teething troubles, its continuous growth and landmark achievements over the years. This brief review also highlights the current area of focus and describes the plans for its future development.

Dose fractionated gamma knife radiosurgery for large arteriovenous malformations on daily or alternate day schedule outside the linear quadratic model: Proof of concept and early results. A substitute to volume fractionation.

BACKGROUND: To evaluate the feasibility, safety and efficacy of dose fractionated gamma knife radiosurgery (DFGKRS) on a daily schedule beyond the linear quadratic (LQ) model, for large volume arteriovenous malformations (AVMs). MATERIAL AND METHODS: Between 2012-16, 14 patients of large AVMs (median volume 26.5 cc) unsuitable for surgery or embolization were treated in 2-3 of DFGKRS sessions. The Leksell G frame was kept in situ during the whole procedure. 86% (n = 12) patients had radiologic evidence of bleed, and 43% (n = 6) had presented with a history of seizures. 57% (n = 8) patients received a daily treatment for 3 days and 43% (n = 6) were on an alternate day (2 fractions) regimen. The marginal dose was split into 2 or 3 fractions of the ideal prescription dose of a single fraction of 23-25 Gy. RESULTS: The median follow up period was 35.6 months (8-57 months). In the three-fraction scheme, the marginal dose ranged from 8.9-11.5 Gy, while in the two-fraction scheme, the marginal dose ranged from 11.3-15 Gy at 50% per fraction. Headache (43%, n = 6) was the most common early postoperative complication, which was controlled with short course steroids. Follow up evaluation of at least three years was achieved in seven patients, who have shown complete nidus obliteration in 43% patients while the obliteration has been in the range of 50-99% in rest of the patients. Overall, there was a 67.8% reduction in the AVM volume at 3 years. Nidus obliteration at 3 years showed a significant rank order correlation with the cumulative prescription dose (p 0.95, P value 0.01), with attainment of near-total (more than 95%) obliteration rates beyond 29 Gy of the cumulative prescription dose. No patient receiving a cumulative prescription dose of less than 31 Gy had any severe adverse reaction. In co-variate adjusted ordinal regression, only the cumulative prescription dose had a significant correlation with common terminology criteria for adverse events (CTCAE) severity (P value 0.04), independent of age, AVM volume, number of fractions and volume of brain receiving atleast 8 Gy of radiation. CONCLUSION: DFGKRS is feasible for large AVMs with a fair nidus obliteration rate and acceptable toxicity. Cumulative prescription dose seems to be the most significant independent predictor for outcome following DFGKRS with 29-30 Gy resulting in a fair nidus obliteration with least adverse events.

[Organisation of care and initial management of severe head injury in Spain: Results of a national survey]. / Organización de la asistencia y manejo inicial del traumatismo craneoencefálico grave en España: resultados de una encuesta nacional.

OBJECTIVE: The main objective of the study is to obtain knowledge about the organisation of care for severe head trauma as well as the initial management of these patients in Neurosurgical Departments in Spain. MATERIAL AND METHOD: A 22-item questionnaire was designed and sent to 59 Neurosurgical Departments. The aim of the questionnaire was to collect data regarding the general profile of the patients with a severe head injury, the general characteristics of the hospitals, the initial care of these patients, the monitoring techniques used, and the measures used to control Intracranial pressure (ICP). RESULTS: Of the 59 Neurosurgical Departments identified, 29 (49.2%) completed the questionnaire. There was a wide variability in the number of patients treated per year between the different departments. The leadership of care often fell (58.6%) on the intensive care specialist. Many (69%) of the departments did not have a neurosurgeon specially dedicated to the management and monitoring of these patients. The initial care in the Emergency department usually fell (51.7%) on the general medicine practitioner. The availability of computed tomography (CT) was universal. The use of telemedicine was highly variable. ICP monitoring was performed on more than 75% of patients in most (89.7%) of departments, but there was limited use of other monitoring techniques. Most Departments followed the recommendations of the Brain Trauma Foundation (BTF) guidelines for the control of ICP. CONCLUSIONS: The organisation of care and the initial management of severe head trauma in Spain is very similar to its neighbouring countries. However, there are shortcomings, such as low participation by a neurosurgeon in the initial management of these patients, insufficient use of telemedicine, and the low implementation of certain brain monitoring techniques (SjO2, PtiO2, and Doppler).

Scheduled consultation in neurosurgery: Profile of patients admitted in the university hospital of Brazzaville.

INTRODUCTION: The determination of the types of neurosurgical pathologies in Sub-Saharan Africa is essential to prepare the practitioner aiming to pursue that specialty in that area. The aim of our study was to determine the patient's epidemiological profile admitted in a scheduled neurosurgical consultation in the University Hospital of Brazzaville. METHODS: We performed a prospective and descriptive study in a population of patients admitted to the neurosurgical consultation by appointment, for a period of 27 months. The parameters evaluated were socio-anthropometric, diagnostic and evolutionary. RESULTS: We recorded in total 354 patients. The average age was 45.38 years with a sex ratio of 1.02. The majority of patients (72.31%) did not have health assurance. 83.05% of the cases were from the city of Brazzaville and its surroundings. The most common symptom in the consultation was lomboradiculalgia with 99 cases (27.96%). 80 patients (22.59%) had a lumbar spinal stenosis. Surgical indication was raised in 32 patients (9.03%). CONCLUSION: Lomboradiculalgia in lumbar spinal stenosis is the most frequent situation in the scheduled neurosurgical consultation. The low ratio of neurosurgeons and the socioeconomic level of the patients are the main barriers to optimal care of patients.

[A new concept of organization and scope of neurosurgical care in the US army during armed conflicts in the early 2000s]. / Novaya kontseptsiya organizatsii i soderzhaniya pomoshchi po profilyu 'Neirokhirurgiya' v armii SShA v khode vooruzhennykh konfliktov nachala KhKhI veka.

Military operations in various parts of the world in the early 2000s are becoming more regionalized; new warfare tactics emerge, which makes it necessary to review and modify the neurosurgical care system. The article reviews the results of original studies on this issue and summarizes the experience of the US Army medical service in Afghanistan and Iraq. The article discusses the structure of sanitary losses, organization and scope of medical and evacuation neurosurgical measures, types and techniques of surgical interventions, and the rate of complications. We describe five levels of neurosurgical care echelons and an implemented "injury control - neurosurgery" concept; particular attention is paid to the peculiarities of research and specialist training. We demonstrate that implementation of the new concept for organization and scope of neurosurgical care has improved treatment outcomes and reduced the mortality rate in the mentioned military conflicts of recent years compared to those in the Vietnam War. We may conclude that the described experience of the US Army can be used to improve the efficacy of neurosurgical care to the wounded and victims of armed conflicts.

[Glioblastoma and nursing care in neurosurgery]. / Glioblastome et soins infirmiers en neurochirurgie.

Nurses in neurosurgical departments play a critical role as they are involved in the first stages of the care pathway of patients with glioblastoma. Indeed, surgery enables a definitive histopathological diagnosis to be established and the size of the tumour to be significantly reduced, thereby improving the prognosis.

Intensive care practices in brain death diagnosis and organ donation.

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).

[Establishment of diagnosis and treatment patterns of holistic integrated medicine for neuro-ophthalmology].

Neuro-ophthalmology, as an interdisciplinary, covers at least three disciplines- ophthalmology, neurology and neurosurgery. With limited knowledge in each discipline, doctors often make misdiagnoses for neuro-ophthalmology diseases. Therefore, it is imperative to abandon the distinction between disciplines and combine all the knowledge to diagnose and treat patients in patterns of holistic integrated medicine in order to effectively improve the diagnosis and treatment of neuro-ophthalmology.