Acute Macrocystic Thoracic Schwannoma: Systematic Review and Illustrative Case Example.

BACKGROUND: Schwannomas are benign peripheral nerve sheath tumors arising from myelinating Schwann cells. Although macrocystic changes are regularly encountered in schwannoma variants such as vestibular nerve tumors, they are exceedingly rare among spinal neoplasms. METHODS: Case report and systematic review of 4 databases (Ovid Medline, PubMed, Science Direct, and SCOPUS) from inception to present. All peer-reviewed publications reporting intradural cystic thoracic schwannoma were included. RESULTS: We identified 8 publications documenting 9 cases of cystic thoracic schwannoma. Four were female, 5 male; median age was 41 years (range, 27-80). Presentations ranged from incidental to pain, sensory changes, lower extremity paresis, or bowel/bladder dysfunction. Characteristic radiographic findings included T1 hypointensity, T2 hyperintensity, and cord effacement or compression. The present case followed a similar pattern: a 52-year-old male presented with worsening bilateral lower extremity weakness, low back pain, and gait dysfunction, worsening over 3 days. Examination also revealed decreased left lower extremity sensation. Imaging identified a well-delineated intradural, extramedullary macrocystic extending over T7-T10. The patient underwent a laminectomy resulting in complete tumor resection and restoration of intact neurologic function. Final pathology confirmed benign cystic schwannoma. CONCLUSIONS: Macrocystic thoracic schwannomas are exceedingly rare and lack a comprehensive scheme for clinical classification of their natural history and pathogenesis. We report the 10th case of such a schwannoma, and the first associated systematic review. Although macrocystic thoracic schwannomas are not frequently encountered, accurate diagnosis and appropriate neurosurgical treatment is critical in these vulnerable patients, given the opportunity for excellent functional outcomes following neurosurgical treatment.

Gender diversity in neurosurgical training: an analysis of trends and resident program characteristics.

OBJECTIVE: Recent trends have shown more women entering neurosurgery, but large gender gaps in the number of female trainees continue to persist. A previous study on the gender diversity of residents and faculty in neurosurgery training programs found that only 18.2% of residents and 8.7% of faculty at neurosurgical training programs were female. The goal of this study was to better understand program characteristics that may affect the recruitment of female residents and the gender composition of neurosurgery residency programs. METHODS: The authors assessed publicly available information on websites and social media from 116 Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgery residency programs from the 2022-2023 academic year. Data collected on residents included gender and postgraduate year (PGY), geographic region, accreditation year, and complement size for programs. The authors analyzed the distribution of female residents at each program and compared accreditation year, program size, program geographics, PGY, and acceptance rates. RESULTS: There were 1602 residents across the 116 programs included in this study: 1223 (76.3%) male and 379 (23.7%) female residents. The gender distribution of female residents showed 29 programs had 30% or more female residents, 50 programs had between 16% and 30%, and 37 had fewer than 16%, including 8 with none. There were significantly more PGY-1 than PGY-7 female residents (28.9% vs 16.4%, p < 0.01). Programs with ACGME accreditation before 1970 had significantly higher percentages of female residents (26.0%) compared with those accredited after 1970 (18.2%, p < 0.01). Program size was associated with a higher percentage of female residents (large = 25.2%, medium = 24.9%, and small = 19.6%), although the results were not significant. The distribution of female trainees across five geographic regions of the United States was fairly even: Northeast (24.5%), West (25.2%), South Atlantic (23.1%), South Central (21.8%), and North Central (21.2%). Residency acceptance rates were similar between genders. CONCLUSIONS: The underrepresentation of women in neurosurgery residency programs remains a significant issue. While some programs have achieved higher female representation than the overall average proportion of female neurosurgery residents, many still fall short. There are twice as many female PGY-1 compared with PGY-7 residents, suggesting increased recruitment over the past few years. Programs with longer accreditation histories have significantly higher proportions of female residents. Larger program size can also play a role in attracting more female residents, but geographic location did not impact gender composition of resident cohorts in this study.

Correction of adult scoliosis via a posterior-only approach.

OBJECT: Adult scoliosis is a pathologically different entity from adolescent idiopathic scoliosis. The curves are more rigid, and rotational deformity and multilevel sagittal vertebral slippages compound the coronal malalignment. To correct these deformities, a surgical anterior release procedure is usually required, as well as posterior instrumentation-assisted fusion. This exposes the patient to the risks of a second procedure and of a thoracotomy or laparotomy. To decrease these risks, the authors have performed an anterior release, posterior release, and reduction via a posterior-only approach. The purpose of this study was to analyze quantitatively the degree of pre- and postoperative coronal deformity, the extent of correction, and related complications. METHODS: Data obtained in 20 patients with adult scoliosis were retrospectively studied. Patients presented with persistent back or lower-extremity pain, progressive deformity, or progressive neurological deficit. Sixteen patients underwent Gill-type laminectomy, radical discectomy (including fracture of any anterior and lateral osteophytes), and posterior lumbar interbody fusion (PLIF) of all apical and adjacent segments. One to four anterior release procedures were performed in each patient. Posterior instrumentation was placed over three to 15 levels. Autograft was obtained from the laminectomy sites and posterior iliac crest for fusion. There were no deaths; all patients were followed for a minimum of 1 year. The mean coronal Cobb angle improved from 36 degrees to 14.7 degrees. All spondylolisthetic lesions were reduced to at least Grade I. At the most recent follow-up examination, evidence of fusion was demonstrated in all patients. Reoperation for adjacent-segment failure, cephalad to the highest level of fusion, was required in two cases. CONCLUSIONS: In many cases of adult scoliosis, a satisfactory multiplanar correction may be obtained via a single posterior approach and by using extended PLIF techniques. Cephalad adjacent-segment failure remains a significant problem in patients with osteoporosis, and routine extension of posterior instrumentation to the upper thoracic spine should be considered in these cases.