Surgical Treatment of Symptomatic Small Medial Petrous Meningiomas Causing Trigeminal Neuralgia.

BACKGROUND: Symptomatic trigeminal neuralgia caused by small (<3 cm) skull base meningiomas is treated by radiosurgery or surgical resection. Although radiosurgery is less invasive, surgical resection provides more rapid resolution of symptoms. We reviewed a short series of patients who underwent an anterior transpetrosal approach for surgical resection of meningiomas causing trigeminal neuralgia. METHODS: A retrospective review of 5 consecutive patients with meningiomas causing trigeminal neuralgia of the senior author was included. Preoperative parameters (size, proximity to critical neurovascular structures, presence of brainstem compression), intraoperative parameters (Simpson grade of resection, loss of brainstem evoked potentials, surgical approach), and outcomes (symptom resolution, extent of resection, follow-up) were recorded. RESULTS: Patient median age was 67 years (range, 60-73 years). All patients had symptoms concerning trigeminal neuralgia with 2 having associated areas of facial numbness. The anterior transpetrosal approach was used to achieve complete resection (Simpson grade I). Postresection, the trigeminal nerve and brainstem were clearly visible to evaluate neurovascular structures and ensure decompression. No postoperative complications were reported, and all patients experienced sustained symptomatic relief 1 month postsurgery. CONCLUSIONS: With the advent of radiosurgery for skull base meningiomas, surgical resection is not always considered; however, such meningiomas causing trigeminal neuralgia can be resected safely using the anterior transpetrosal approach allowing rapid resolution of symptoms. This review of operative nuances provides a guide for neurosurgeons to provide safe surgical resection.

Surgical Risk Assessment and Prevention in Elderly Spinal Deformity Patients.

INTRODUCTION: Prevalence of adult deformity surgery in the elderly individuals continues to increase. These patients have additional considerations for the spine surgeon during surgical planning. We perform an informative review of the spinal and geriatric literature to assess preoperative and intraoperative factors that impact surgical complication occurrences in this population. SIGNIFICANCE: There is a need to understand surgical risk assessment and prevention in geriatric patients who undergo thoracolumbar adult deformity surgery in order to prevent complications. METHODS: Searches of relevant biomedical databases were conducted by a medical librarian. Databases searched included MEDLINE, Web of Science, CINAHL, IPA, Cochrane, PQ Health and Medical, SocINDEX, and WHO's Global Health Library. Search strategies utilized Medical Subject Headings plus text words for extensive coverage of scoliosis and surgical technique concepts. RESULTS: Degenerative scoliosis affects 68% of the geriatric population, and the rate of surgical interventions for this pathology continues to increase. Complications following spinal deformity surgery in this patient population range from 37% to 62%. Factors that impact outcomes include age, comorbidities, blood loss, and bone quality. Using these data, we summarize multimodal risk prevention strategies that can be easily implemented by spine surgeons. CONCLUSIONS: After evaluation of the latest literature on the complications associated with adult deformity surgery in geriatric patients, comprehensive perioperative management is necessary for improved outcomes. Preoperative strategies include assessing physiological age via frailty score, nutritional status, bone quality, dementia/delirium risk, and social activity support. Intraoperative strategies include methods to reduce blood loss and procedural time. Postoperatively, development of a multidisciplinary team approach that encourages early ambulation, decreases opiate use, and ensures supportive discharge planning is imperative for better outcomes for this patient population.

Characteristics and career outcomes of Neurosurgery Research and Education Foundation research fellowship recipients.

OBJECTIVE: The American Association of Neurological Surgeons (AANS) Neurosurgery Research and Education Foundation (NREF) provides ongoing competitive research fellowships for residents and young investigators. The authors sought to determine the characteristics and career tracks of award recipients. METHODS: The authors analyzed characteristics and academic productivity parameters of NREF resident and young investigator awardees in the United States and Canada from 1983 to 2017. Data were extracted from the NREF database and online resources (Web of Science, NIH reporter). RESULTS: In total, 224 research grants were awarded to 31 women (14%) and 193 men (86%) from 1983 to 2017. Neuro-oncology (36%) was the most common research category. Sixty percent of awardees were in training and most resident award winners were in postgraduate year 5 (37%). Forty-nine percent of all awardees had an additional postgraduate degree (PhD 39%, Master's 10%) with a significantly higher number of PhD recipients being from Canada in comparison to any US region (p = 0.024). The Northeastern and Southeastern United States were the regions with the highest and lowest numbers of award recipients, respectively. More than one-third (40%) of awardees came from institutions that have a National Institute of Neurological Disorders and Stroke Research Education Grant (NINDS R25) for neurosurgical training. Awardees from NINDS R25-funded programs were significantly more likely to go on to receive funding from the National Institutes of Health (NIH) (40.4% vs 26.1%; p = 0.024). The majority of recipients (72%) who were no longer in training pursued fellowships, with a significant likelihood that fellowship subspecialty correlated with NREF research category (p < 0.001). Seventy-nine percent of winners entered academic neurosurgery practice, with 18% obtaining the position of chair. The median h-index among NREF winners was 11. NIH funding was obtained by 71 awardees (32%) with 36 (18%) being a principal investigator on an R01 grant from the NIH Research Project Grant Program. CONCLUSIONS: The majority of AANS/NREF research award recipients enter academics as fellowship-trained neurosurgeons, with approximately one-third obtaining NIH funding. Analysis of this unique cohort allows for identification of characteristics of academic success.