Women in Neurosurgery (WIN): Barriers to Progress, World WIN Directory and the Way Forward.

Women in Neurosurgery (WIN) have come a long way and are making inroads in every neurosurgical subspecialty. There has been a worldwide increase in the number of female neurosurgeons both in the training and practice. Although this is a welcome trend, gender equality at work in terms of opportunities, promotions, and pay scales are yet to be attained. This is more apparent in the developing and underdeveloped nations. Barriers for a female neurosurgeon exist in every phase before entering residency, during training, and at workplace. In the neurosurgical specialty, only a few women are in chief academic and leadership positions, and this situation needs to improve. WIN should be motivated to pursue fellowships, sub-specialty training, research, and academic activities. Furthermore, men should come forward to mentor women, only then the gender debates will disappear and true excellence in neurosurgery can be attained. This article reviews the issues that are relevant in the present era focusing on the barriers faced by female neurosurgeons in the developing and underdeveloped countries and the possible solutions to achieve gender equality in neurosurgery. The authors also present the data from the World WIN Directory collected as a part of Asian Congress of Neurological Surgeons-WINS project 2019. These numbers are expected to grow as the WIN progress and add value to the neurosurgical community at large.

What it is to be a Woman Neurosurgeon in India: A Survey.

BACKGROUND: Around the world, measures are being undertaken to increase the number of women in the field of neurosurgery, by improving their working conditions and developing a supportive system. This survey was conducted to assess the status of women neurosurgeons in India. AIMS AND OBJECTIVES: To assess the barriers, supportive system and professional/personal satisfaction of Indian women neurosurgeons. MATERIALS AND METHODS: A survey questionnaire containing 19 questions was designed. The number of women neurosurgeons in India was found to be 73 as of September 2017. An anonymous Google survey was undertaken by sending the survey questionnaire through email to 69 female neurosurgeons in the month of September 2017, and the email ids of 4 neurosurgeons were not available. 55 out of 69 replied to the survey questionnaire (79.7%) in a time period of 4 weeks. Results were collected and analyzed. RESULTS: Our survey showed that 34.54% of Indian women neurosurgeons were being residents and 65.45% being younger than 40 years of age. Majority of them (92.72%) joined neurosurgery with passion and only 30.9% had a medical professional who kindled the interest in neurosurgery. 72.68% were discouraged before joining into neurosurgical residency. 74.4% reported to receive good to excellent support from the parent department. Only 40% had another female colleague in the department and they received good to excellent support from the female colleagues. Though 74.5% received good support from male colleagues the excellent support remained low. 40% reported to face discrimination by gender. 74.5% are married and 96.4% reported to receive good to excellent support from the family members. 80% face difficulty in balancing career and personal life. 70.9% have satisfaction in professional life and 69% lead a satisfactory personal life. 67.3% of female neurosurgeons felt that formation of an exclusive women neurosurgeons' forum would benefit them. CONCLUSION: In India there is a positive trend in female physicians taking up neurosurgery. The present residency program in our country is supportive to women in majority. However active measures should be taken to encourage female physicians to take up neurosurgery, reduce the existing gender discrimination and improve the supportive system especially during pregnancy and child rearing.

Management of Recurrent Glossopharyngeal Neuralgia Following Microvascular Decompression Surgery.

BACKGROUND: Glossopharyngeal neuralgia (GPN) is a rare condition, commonly misdiagnosed as trigeminal neuralgia. Microvascular decompression (MVD) is considered the first line of treatment in medically refractive idiopathic GPN, and the recurrence rate is reported to be 7.1%. We present our first case report on the surgical management of a patient with recurrent GPN and analyze the possible causes for recurrence after MVD. CASE DESCRIPTION: A 73-year-old gentleman was referred to us with a diagnosis of recurrent left GPN. He was diagnosed 6 years ago with left mandibular branch trigeminal neuralgia for the complaint of left-side tongue pain. He received left mandibular nerve block twice earlier and Gamma Knife radiotherapy 2 years ago without relief. A year ago he was diagnosed with GPN by a neurosurgeon, and MVD was performed. The posterior inferior cerebellar artery and vertebral artery were the offending vessels and were interposed with Teflon. After a temporary pain relief, the patient had a recurrence. Redo-MVD with transposition of the vertebral artery and further interposition of posterior inferior cerebellar artery did not help. After referral to us, we operated on the patient again and found 2 small arteries at the root entry zone (REZ). Interposition with Teflon and splitting of the rootlets relieved the pain. CONCLUSIONS: MVD is considered the first line of treatment in drug-resistant idiopathic GPN. Thorough exploration of REZ for small arteries and veins is mandatory to prevent recurrence. Vascular compression can occur at the cisternal portion or at the REZ. In recurrent cases, splitting of the glossopharyngeal nerve rootlets adds to the good outcome.

Transcondylar Fossa Approach to Unruptured Vertebral Artery and Vertebral Artery-Posterior Inferior Cerebellar Artery Aneurysms: Surgical Outcome.

OBJECTIVE: Surgical treatment of vertebral artery (VA) and VA-proximal posterior inferior cerebellar artery (PICA) aneurysms poses a special challenge to the operating surgeon because of the complex anatomy of the neck and the location of the aneurysm. We report our surgical results of unruptured VA and VA-PICA aneurysms operated on through the transcondylar fossa approach. METHODS: We retrospectively analyzed the data of 20 patients with unruptured VA and VA-PICA aneurysms who were treated by the transcondylar fossa approach in a single institution from November 2014 to March 2018. Data including clinical profile, radiology, complications, and outcome were analyzed. RESULTS: Five patients had VA aneurysms and 15 had VA-PICA aneurysms. All were unruptured aneurysms, and 4 patients were symptomatic. All underwent surgical treatment through the transcondylar fossa approach. Proximal VA occlusion alone for 4 patients along with revascularization for 3 patients was performed. Twelve patients underwent clipping and 1 underwent wrapping of the aneurysm. The transcondylar fossa approach was adequate to expose the aneurysms successfully. There were no intraoperative complications encountered. Only 3 patients had transient postoperative complications. Follow-up imaging showed complete occlusion of all clipped aneurysms and complete thrombosis of the sac in all patients with proximal VA occlusion with or without revascularization. CONCLUSIONS: Although the incidence of rupture of asymptomatic unruptured VA and VA-PICA aneurysms is low, they should be considered for surgical treatment because they carry higher early mortality and morbidity after rupture. The transcondylar fossa approach provides adequate exposure of the aneurysm without permanent lower cranial nerve morbidity.