The impact of historical redlining on neurosurgeon distribution and reimbursement in modern neighborhoods.

Background: This study examines the lasting impact of historical redlining on contemporary neurosurgical care access, highlighting the need for equitable healthcare in historically marginalized communities. Objective: To investigate how redlining affects neurosurgeon distribution and reimbursement in U.S. neighborhoods, analyzing implications for healthcare access. Methods: An observational study was conducted using data from the Center for Medicare and Medicaid Services (CMS) National File, Home Owner's Loan Corporation (HOLC) neighborhood grades, and demographic data to evaluate neurosurgical representation across 91 U.S. cities, categorized by HOLC Grades (A, B, C, D) and gentrification status. Results: Of the 257 neighborhoods, Grade A, B, C, and D neighborhoods comprised 5.40%, 18.80%, 45.8%, and 30.0% of the sample, respectively. Grade A, B, and C neighborhoods had more White and Asian residents and less Black residents compared to Grade D neighborhoods (p < 0.001). HOLC Grade A (OR = 4.37, 95%CI: 2.08, 9.16, p < 0.001), B (OR = 1.99, 95%CI: 1.18, 3.38, p = 0.011), and C (OR = 2.37, 95%CI: 1.57, 3.59, p < 0.001) neighborhoods were associated with a higher representation of neurosurgeons compared to Grade D neighborhoods. Reimbursement disparities were also apparent: neurosurgeons practicing in HOLC Grade D neighborhoods received significantly lower reimbursements than those in Grade A neighborhoods ($109,163.77 vs. $142,999.88, p < 0.001), Grade B neighborhoods ($109,163.77 vs. $131,459.02, p < 0.001), and Grade C neighborhoods ($109,163.77 vs. $129,070.733, p < 0.001). Conclusion: Historical redlining continues to shape access to highly specialized healthcare such as neurosurgery. Efforts to address these disparities must consider historical context and strive to achieve more equitable access to specialized care.

North American survey on impact of the COVID-19 pandemic shutdown on DBS care.

BACKGROUND: The initial COVID-19 pandemic shutdown led to the canceling of elective surgeries throughout most of the USA and Canada. OBJECTIVE: This survey was carried out on behalf of the Parkinson Study Group (PSG) to understand the impact of the shutdown on deep brain stimulation (DBS) practices in North America. METHODS: A survey was distributed through RedCap® to the members of the PSG Functional Neurosurgical Working Group. Only one member from each site was asked to respond to the survey. Responses were collected from May 15 to June 6, 2020. RESULTS: Twenty-three sites participated; 19 (83%) sites were from the USA and 4 (17%) from Canada. Twenty-one sites were academic medical centers. COVID-19 associated DBS restrictions were in place from 4 to 16 weeks. One-third of sites halted preoperative evaluations, while two-thirds of the sites offered limited preoperative evaluations. Institutional policy was the main contributor for the reported practice changes, with 87% of the sites additionally reporting patient-driven surgical delays secondary to pandemic concerns. Pre-post DBS associated management changes affected preoperative assessments 96%; electrode placement 87%; new implantable pulse generator (IPG) placement 83%; IPG replacement 65%; immediate postoperative DBS programming 74%; and routine DBS programming 91%. CONCLUSION: The COVID-19 pandemic related shutdown resulted in DBS practice changes in almost all North American sites who responded to this large survey. Information learned could inform development of future contingency plans to reduce patient delays in care under similar circumstances.

Academic Productivity of United States Neurosurgeons Trained Abroad.

BACKGROUND: Previous research in neurosurgery has examined academic productivity for U.S. medical graduates and residents. However, associations between scholarly output and international medical education, residency training, and fellowship training are scarcely documented. METHODS: We identified 1671 U.S. academic neurosurgeons in 2020 using publicly available data along with their countries of medical school, residency, and fellowship training. Using Scopus, h-index, number of publications, and number of times publications were cited were compiled. Demographic, subspeciality, and academic productivity variables were compared between training locations using univariate analysis and multivariable linear regression. RESULTS: Of the current neurosurgery faculty workforce, 16% completed at least 1 component of their training abroad. Canada was the most represented international country in the cohort. Academic productivity for neurosurgeons with international medical school and/or international residency did not significantly differ from that of neurosurgeons trained in the United States. Neurosurgeons with ≥1 U.S. fellowships or ≥1 international fellowships did not have higher academic productivity than neurosurgeons without a fellowship. However, dual fellowship training in both domestic and international programs was associated with higher mean h-index (ß = 6.00, 95% confidence interval 1.01 to 10.98, P = 0.02), higher citations (ß = 2092.0, 95% confidence interval 460.1 to 3724.0, P = 0.01), and a trend toward higher publications (ß = 36.82, 95% confidence interval -0.21 to 73.85, P = 0.051). CONCLUSIONS: Neurosurgeon scholarly output was not significantly affected by international training in medical school or residency. Dual fellowship training in both a domestic and an international program was associated with higher academic productivity.

Disparities in the Geographic Distribution of Neurosurgeons in the United States: A Geospatial Analysis.

OBJECTIVE: Large disparities in access to neurosurgical care are known, but there are limited data on whether geographic distribution of the neurosurgery workforce potentially plays a role in these disparities. The goal of this study was to identify the geographic distribution of neurosurgeons in the United States and to study the association of the per capita workforce distribution with socioeconomic characteristics of the population. METHODS: The number of practicing neurosurgeons in the United States in 2016 was obtained from the 2017-2018 American Medical Association Masterfile contained within the Area Health Resource File. The association of the number of neurosurgeons per 100,000 population with socioeconomic characteristics was assessed through linear regression analysis at Hospital Referral Region (HRR) level. RESULTS: The median number of neurosurgeons per capita across all HRRs was 1.47 neurosurgeons per 100,000 population (interquartile range, 1.02-2.27). Bivariable analysis showed that greater supply of neurosurgeons was positively associated with regional levels of college education, median income, and median age. The number of neurosurgeons per capita at the HRR level was negatively associated with unemployment, poverty, and percent uninsured. CONCLUSIONS: Regions characterized by low socioeconomic status have fewer neurosurgeons per capita in the United States. Low income, low number of college graduates, and high unemployment rate are associated with fewer numbers of neurosurgeons per capita. Further research is needed to determine if these geographic workforce disparities contribute to poor access to quality neurosurgical care.

Clinical application of patient-specific 3D printing brain tumor model production system for neurosurgery.

The usefulness of 3-dimensional (3D)-printed disease models has been recognized in various medical fields. This study aims to introduce a production platform for patient-specific 3D-printed brain tumor model in clinical practice and evaluate its effectiveness. A full-cycle platform was created for the clinical application of a 3D-printed brain tumor model (3D-printed model) production system. Essential elements included automated segmentation software, cloud-based interactive communication tools, customized brain models with exquisite expression of brain anatomy in transparent material, adjunctive devices for surgical simulation, and swift process cycles to meet practical needs. A simulated clinical usefulness validation was conducted in which neurosurgeons assessed the usefulness of the 3D-printed models in 10 cases. We successfully produced clinically applicable patient-specific models within 4 days using the established platform. The simulated clinical usefulness validation results revealed the significant superiority of the 3D-printed models in surgical planning regarding surgical posture (p = 0.0147) and craniotomy design (p = 0.0072) compared to conventional magnetic resonance images. The benefit was more noticeable for neurosurgeons with less experience. We established a 3D-printed brain tumor model production system that is ready to use in daily clinical practice for neurosurgery.

Women in Neurosurgery: First Neurosurgeon in Latin America and Current Mexican Leaders.

BACKGROUND: History has taught us that Mexican culture has been largely supported by women, despite gender prejudice from the society. Neurosurgery has not been the exception. Therefore, we investigated the challenges and influence of female neurosurgeons in Mexico. METHODS: We conducted a review of the literature and an analysis of the internal database of the Mexican Society of Neurological Surgery focusing on 3 topics: 1) the historical presence of women and gender inequality in Mexico; 2) the life and legacy of the woman who became the first neurosurgeon in Mexico and in Latin America; and 3) the participation of women in neurosurgery in the past 3 decades. RESULTS: In Latin America, the first woman in neurosurgery was María Cristina García-Sancho, who completed her neurosurgical training in 1951. Currently, women represent 6.2% of the total members of the Mexican Society of Neurological Surgery (MSNS). This percentage is still low, although data collected in this study suggest that it might increase in the next few years because 16.7% of Board Directors of the MSNS are women, the next elected president is a female neurosurgeon, and 14.5% of neurosurgery residents are women. CONCLUSIONS: Although a steady increase has occurred of women in neurosurgery in Mexico, there is still work to do, especially to overcome the barriers related to the old assumptions of the cultural and social roles of women.

Postural ergonomics and work-related musculoskeletal disorders in neurosurgery: lessons from an international survey.

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) affect a significant percentage of the neurosurgical workforce. The aim of the current questionnaire-based study was to examine the prevalence of WMSDs amongst neurosurgeons, identify risk factors, and study the views of neurosurgeons regarding ergonomics. METHODS: From June to August 2020, members of the "European Association of Neurosurgical Societies," the "Neurosurgery Research Listserv," and the "Latin American Federation of Neurosurgical Societies" were asked to complete an electronic questionnaire on the topics of WMSDs and ergonomics. RESULTS: A total of 409 neurosurgeons responded to the survey, with a 4.7 male to female ratio. Most of the surgeons worked in Europe (76.9%) in academic public hospitals. The vast majority of the participants (87.9%) had experienced WMSDs, mainly affecting the shoulder, neck, and back muscles. The most common operations performed by the participants were "Craniotomy for convexity/intrinsic tumors" (24.1%) and "Open lumbar basic spine" (24.1%). Neurosurgeons agreed that ergonomics is an underexposed area in the neurosurgical field (84.8%) and that more resources should be spend (87.3%) and training curricula changes should be made (78.3%) in order to alleviate the burden of WMSDs on neurosurgeons. Univariate analysis did not reveal any associations between the development of WMSDs and age, gender, tenure, average duration of operation, operating time per week, type of operation, and surgical approach. CONCLUSIONS: The problem of WMSDs ought to be more closely addressed and managed by the neurosurgical community. More studies ought to be designed to investigate specific ergonomic parameters in order to formulate practice recommendations.

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management.

BACKGROUND: In Europe, aneurysm treatment performed by dually trained neurosurgeons is extremely scarce. We provide outcome data for un-ruptured aneurysm patients treated at a European hybrid center to prove that hybrid neurosurgeons achieve clinical and angiographical results allowing to integrate hybrid neurosurgery into routine aneurysm treatment. This will not only help to maintain neurovascular microsurgical skills but will influence staff costs in related hospitals. METHODS: We retrospectively analyzed all consecutively treated un-ruptured aneurysm patients between 2000 and 2016. The decision-making took into account the pros and cons of both modalities and considered patient and aneurysm characteristics. Clinical outcome was assessed by the modified Rankin scale (mRS). Occlusion rates were stratified into grade I for 100%, grade II for 99-90%, and grade III for <90% occlusion. To account for the introduction of stents, two treatment periods (p1, 2000 to 2008; p2, 2009 to 2016) were defined. RESULTS: The study population consisted of 274 patients (median age 55 years) harboring 338 un-ruptured aneurysms. Microsurgery (MS) was performed in 51.8% and endovascular therapy (EVT) in 43.1%; 5.1% required combined treatment. Overall, 93% showed a favorable clinical outcome (mRS 0-2), 94.3% after MS and 91.5% after EVT. Grade I aneurysm occlusion was achieved in 82.6% patients, 91.9% after MS and 72.9% after EVT. Procedure-related complications occurred after MS in 5.6% and after EVT in 4.4% patients. Mortality was recorded for five (1.8%) patients, one patient after MS and four after EVT. For the EVT cohort, significant improvement from p1 to p2 was seen with clinical outcomes (P=0.030, RR = 0.905, CI: 0.8351-0.9802) and occlusion rates (P=0.039, RR = 0.6790, CI: 0.499-0.923). CONCLUSION: Hybrid neurosurgeons achieve qualified clinical and angiographic results. Dual training will allow to maintain neurovascular caseloads and preserve future aneurysm treatment within neurosurgery. Furthermore economic benefits could be observed in hospital management.

Access to Neurosurgery in the Era of Narrowing Insurance Networks: Statewide Analysis of Patient Protection and Affordable Care Act Marketplace Plans in Arizona.

OBJECTIVE: The Patient Protection and Affordable Care Act (ACA) sought to expand access to health care for 46 million uninsured Americans. Increasing consumer coverage and ensuring affordability of care have raised concerns about ACA Marketplace plans with limited in-network physician coverage (narrow network plans). We assessed the neurosurgery coverage of ACA Marketplace plans in Arizona. METHODS: The Health Insurance Marketplace website was used to identify ACA Marketplace plans in Arizona. Plan-specific details were examined to search for in-network neurosurgeons (2016-2019). Physician- and patient-level information was obtained using Intellimed health care databases, which provide specific neurosurgery diagnosis-related group information. RESULTS: Although 5 insurance providers offered plans on the ACA Marketplace in Arizona, only 1 plan was available in 13 of 15 counties (87%). Evaluation of in-network coverage found that all in-network outpatient neurosurgery providers are in 5 of 15 counties (33%). Most of the other counties (9 of 10) have neurosurgery facilities, but do not have in-network access to neurosurgical care within the county (∼1.1 million people or 15% of the state population). CONCLUSIONS: By narrowing the network of providers, insurance companies are attempting to maintain fiscal viability of their ACA Marketplace products. However, 10 of the 15 counties (67%) in Arizona do not have access to outpatient neurosurgical care through these plans despite the presence of neurosurgical facilities in most counties. Access to neurosurgical care requires consideration of network coverage in policies designed to expand coverage and coverage options for patients insured through the ACA Marketplace.

Factors Associated With Pregnancy and Perinatal Outcomes in Female Neurosurgeons: A Cross-Sectional Study.

Neurosurgery is male dominated with women representing only 12% of residents and 5% of practicing neurosurgeons. The conflicting demands of training versus pregnancy and motherhood are significant deterrents to women entering the field. We examined pregnancy incidence and timing, perinatal complications, and the perceived career impact of motherhood on female neurosurgeons using an anonymous survey of 643 training, practicing, and retired female neurosurgeons from the United States. Among 260 respondents, 50.8% (132/260) reported pregnancies, with an average age at first pregnancy that was significantly higher than the national average (32.1 vs 26.3 yr). In all, 40.1% (53/132) of respondents reported perinatal complications in at least one of their pregnancies. Only 25% (33/132) of respondents noted designated program maternity allowances. The most significant challenges associated with being a mother and neurosurgeon reported were issues relating to work/life balance, "mommy guilt," and sleep deprivation. A majority of respondents, 70.1% (82/116), reported fear of backlash from co-residents, partners, and staff, as well as hindered career advancement related to childbearing. Female neurosurgeons face challenges surrounding family planning different from those faced by male practitioners. Higher perinatal and fetal complications, backlash from colleagues, and demanding workload are significant issues. Progress requires institutional support and mentorship for women to create a more diverse field of practitioners.

Differences by Practice Year in Numbers of U.S. Female Neurosurgeons.

OBJECTIVE: We sought to determine the proportion and number of female neurosurgeons in the workforce at different stages of practice. METHODS: The Physician Compare National Downloadable File data set was obtained from the Centers for Medicare & Medicaid Services for physicians who indicated "neurosurgery" as their primary specialty. Physician duplicates, physicians with no listed medical school graduation year, and physicians expected to be in residency (graduation years 2013-2019) were removed, yielding 4956 neurosurgeons. Five-year intervals were used to measure the number of male and female neurosurgeons by different stages of their careers. For example, graduates from years 2008-2012 were expected to be in their first 1-5 years of practice. RESULTS: There were 405 female (8.2%) and 4551 male (91.8%) neurosurgeons. At 1-5 years of practice, 13.8% (105/760) were women; 6-10 years, 11.5% (94/820) women; 11-15 years, 8.9% (64/720) women; 16-20 years, 8.7% (59/682) women; 21-25 years, 7.4% (46/619) women; 26-30 years, 3.8% (20/520) women; 31-35 years, 3.6% (15/413) women; and 36 years or more, 0.5% women (2/422). The number of female neurosurgeons varied among states, ranging from 0 in Hawaii to 53 in California. The states with the lowest percentage of female neurosurgeons were Hawaii (0%), Oklahoma (3.1%), and Nevada (3.6%). The states with the highest percentage of female neurosurgeons were New Hampshire (20.0%), Vermont (16.7%), and Rhode Island (15.8%). CONCLUSIONS: The number of practicing female neurosurgeons within the United States is increasing, as shown by the growing percentage of women who are earlier in their surgical careers.

Geographical Variation in Traumatic Brain Injury Mortality by Proximity to the Nearest Neurosurgeon.

BACKGROUND: Trauma mortality disproportionately affects populations farther from potentially lifesaving trauma care, and traumatic brain injury (TBI) is no exception. Previous examinations have examined proximity to trauma centers as an explanation for trauma mortality, but little is known about the relationship between proximity to neurosurgeons specifically in TBI mortality. MATERIALS AND METHODS: In this cross-sectional study, county-level TBI mortality rates from 2008 to 2014 were examined in relation to the distance to the nearest neurosurgeon and trauma facility. The locations of practicing neurosurgeons and trauma facilities in the United States were determined by geocoding data from the 2017 Medicare Physician and Other Supplier and Provider of Services files (respectively). The association between TBI mortality and the distance from the population-weighted centroid of the county to a closest neurosurgeon and trauma facility was examined using multivariate negative binomial regression. RESULTS: A total of 761 of the 3108 counties (24.5%) in the continental United States were excluded from the analysis because they had 20 or fewer TBI deaths during this time, producing unstable estimates. Excluded counties accounted for 1.67% of the US population. Multivariate analysis revealed a county's mortality increased 10% for every 25 miles from the nearest neurosurgeon (adjusted incident rate ratio: 1.10 [95% confidence interval: 1.08-1.12]; P < 0.001). The distance to the nearest trauma facility was not found to be significantly associated with mortality (adjusted incident rate ratio: 1.01 [95% confidence interval: 0.99-1.03]; P = 0.36). CONCLUSIONS: These findings suggest that proximity to neurosurgeons may influence county-level TBI mortality. Further research into this topic with more granular data may help to allocate scarce public health resources.

Geospatial Distribution of Neurosurgeons Age 60 and Older Relative to the Spread of COVID-19.

OBJECTIVE: To perform an ecological study to analyze the geospatial distribution of neurosurgeons ≥60 years old and compare these data with the spread of 2019 novel coronavirus disease (COVID-19) across the United States. METHODS: Data regarding distribution of COVID-19 cases were collected from the Environmental Systems Research Institute, and demographic statistics were collected from the American Association of Medical Colleges 2019 State Workforce Reports. These figures were analyzed using geospatial mapping software. RESULTS: As of July 5, 2020, the 10 states with the highest number of COVID-19 cases showed older neurosurgical workforce proportions (the proportion of active surgeons ≥60 years old) of 20.6%-38.9%. Among states with the highest number of COVID-19 deaths, the older workforce proportions were 25.0%-43.4%. Connecticut demonstrated the highest with 43.4% of neurosurgeons ≥60 years old. CONCLUSIONS: Regional COVID-19 hotspots may coincide with areas where a substantial proportion of the neurosurgical workforce is ≥60 years old. Continuous evaluation and adjustment of local and national clinical practice guidelines are warranted throughout the pandemic era.

Perioperative Practice Patterns of Craniotomies-Results of a National Neurosurgical Survey in Poland.

BACKGROUND: Perioperative craniotomy practices depend mainly on neurosurgeon preferences. To investigate the variations in these preferences, we surveyed neurosurgeons in Poland regarding different aspects of their practices. METHODS: Anonymous questionnaires were circulated in 2019 at the neurosurgery conferences in Poland. We then analyzed the responses, categorized in subgroups by sex, affiliation, and stage of training. RESULTS: A total of 114 responses to the questionnaire were obtained. For surgical site exposure, regional hair shaving was the most common pattern (64.9%), followed by whole-scalp (19.3%) and strip line shaving (12.3%). Most respondents (65.8%) used clamp-based devices for bone flap fixation, and approximately one third (30.7%) reported using bone suturing. During cranioplasty, respondents most often used artificial bone implants (69.3%), followed by a preserved bone flap from the patient (24.5%). More than three quarters reported that they (77.2%) performed routine radiologic evaluation after uncomplicated brain tumor surgery. Most patients (64.0%) were discharged between the third and sixth postoperative days. Almost half of emergent surgeries (48.2%) and most elective surgeries (89.5%) were performed with the help of an assistant surgeon. No significant differences were found in practice between the sexes or by affiliation or training stage. We inferred an influence of regional economic status on some of the reported choices. CONCLUSIONS: Perioperative craniotomy practices among Polish neurosurgeons show a significant heterogeneity. Economic factors can explain some choices, but others trace to a conservative mindset. Further studies are needed to identify which factors are most relevant and to identify approaches to a standardized method of care.

Characteristics of Reported Industry Payments to Neurosurgeons: A 5-Year Open Payments Database Study.

OBJECTIVE: The aim of this study was to characterize the payments made by medical industry to neurosurgeons from 2014 to 2018. METHODS: A retrospective study was performed from January 1, 2014 to December 31, 2018 of the Open Payments Database. Collected data included the total number of industry payments, the aggregate value of industry payments, and the mean value of each industry payment made to neurosurgeons per year over the 5-year period. RESULTS: A total of 105,150 unique surgeons, with 13,668 (12.99%) unique neurosurgeons, were identified to have received an industry payment during 2014-2018. Neurosurgeons were the second highest industry-paid surgical specialty, with a total 421,151 industry payments made to neurosurgeons, totaling $477,451,070. The mean average paid amount per surgeon was $34,932 (±$936,942). The largest proportion of payments were related to food and beverage (75.5%), followed by travel and lodging (14.9%), consulting fees (3.5%), nonconsulting service fees (2.1%), and royalties or licensing (1.9%), totaling 90.4% of all industry payments to neurologic surgeons. Summed across the 5-year period, the largest paid source types were royalties and licensing (64.0%; $305,517,489), consulting fees (11.8%; $56,445,950), nonconsulting service fees (7.3%; $34,629,109), current or prospective investments (6.8%, $32,307,959), and travel and lodging (4.8%, $22,982,165). CONCLUSIONS: Our study shows that over the most recent 5-year period (2014-2018) of the Centers for Medicare and Medicaid Services Open Payments Database, there was a decreasing trend of the total number of payments, but an increasing trend of the total amount paid to neurosurgeons.

Stereotactic Radiosurgery Results for Patients with 5-10 versus 11-20 Brain Metastases: A Retrospective Cohort Study Combining 2 Databases Totaling 2319 Patients.

OBJECTIVE: The treatment of patients with ≥11 brain metastases (BMs) with stereotactic radiosurgery (SRS) alone has yet to be established. The aim of this study was to compare results of SRS alone in patients with 5-10 BMs versus 11-20 BMs. METHODS: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 1515 patients with 5-10 tumors and 804 patients with 11-20 tumors treated with Gamma Knife SRS by 2 experienced neurosurgeons between 1998 and 2018. The Kaplan-Meier method was applied to determine post-SRS survival times, and competing risk analyses were used to estimate cumulative incidences of the secondary end points. RESULTS: The post-SRS median survival time was slightly longer in the group with 5-10 tumors (7.7 months) than in the group with 11-20 tumors (6.5 months) (P < 0.0001). Median survival time differences were statistically significant for patients with lung cancers but not for patients with breast, gastrointestinal tract, kidney, and other cancers. Multivariable analysis revealed female sex, better Karnofsky performance scale score, controlled primary cancer, and absence of extracerebral metastases to be statistically significant predictors of longer survival in the 2 patient cohorts. Crude and cumulative incidences of local recurrences were significantly lower in the group with 11-20 tumors than in the group with 5-10 tumors, while those of other secondary end points were similar to or lower in the group with 11-20 tumors than in the group with 5-10 tumors. Post-SRS outcomes were relatively poor in patients with 11-20 tumors from kidney or other cancers. CONCLUSIONS: Carefully selected patients with 11-20 BMs are not unfavorable candidates for SRS alone.

Attitudes of Neurosurgeons Toward Social Media: A Multi-Institutional Study.

BACKGROUND: Social media has become an important communication tool in modern life, and its use is undoubtedly increasing worldwide. Given the rising importance of social media in the health care system, little is known about neurosurgeons' social media use and interactions in the context of professional purposes. This study aimed to analyze social media usage and opinions among neurosurgeons in terms of age, gender, and practice setting. METHODS: An online survey was administered to neurosurgeons worldwide. A total of 1119 neurosurgeons from 104 different countries responded to the questionnaire. RESULTS: All respondents were members of at least 1 social media platform. Older neurosurgeons and neurosurgeons in nonacademic settings spent less time on social media (P < 0.05). Communication with peers via social media decreased with age, while communication via e-mail increased (P < 0.05). Most respondents perceived the effect of social media to be beneficial to neurosurgery (very beneficial [28.73%], somewhat beneficial [35.55%]). More women than men considered that social media platforms provided a greater chance for networking opportunities, learning about a new study or conference, and providing rapid and widespread knowledge transfer (P < 0.05). False guidance (44.68%) and violation of privacy (41.64%) were thought to be the main disadvantages. CONCLUSIONS: Social media use, opinions, and attitudes among neurosurgeons vary depending on their age, gender, and practice setting. Most neurosurgeons stated that the use of social media could have beneficial and advantageous effects on neurosurgery practice, while the frequency of misleading information and lack of privacy were perceived as barriers.

Women Neurosurgeons in Academic and Other Leadership Positions in the United States.

OBJECTIVE: To provide the status of women neurosurgeons (WNS) in academic faculty and/or leadership positions in neurosurgery in the United States. METHODS: Neurosurgery academic programs were defined as having an Accreditation Council for Graduate Medical Education (ACGME) neurosurgery residency program (NSRP). Using a Google search, gender, academic rank, postgraduate degrees, academic and clinical titles, and subspecialty were recorded for each neurosurgery faculty. Officer gender was recorded for the top 7 neurosurgery U.S. organizations, 7 subspecialty sections, and 50 state neurosurgical societies. RESULTS: WNS were faculty at 77% (89/115) of ACGME NSRPs and constituted 10% of the workforce (186/1773). WNS residents were in 92% of ACGME NSRPs and constituted 19% of the workforce (293/1515). Two NSRPs (8%) had neither WNS faculty nor WNS residents. Of NSRPs without WNS faculty, 52% (13/25) had a faculty size >10. WNS accounted for 3% of NSRP chair positions. Academic rank of WNS faculty was lower than academic rank of men neurosurgeons faculty (P < 0.05). WNS faculty had a higher number of postgraduate degrees (P < 0.05). Pediatrics was the most common subspecialty (30%) among WNS. Over time, WNS held 1% of the leadership positions within the top 7 U.S. neurosurgery organizations and 7% within the 7 subspecialty sections. Over the past 20 years, 28% (14/50) of U.S. state neurosurgical societies had WNS serve as president. CONCLUSIONS: In 2020, the gender gap for U.S. WNS faculty and residents still exists. By providing informed benchmarks, our study might help neurosurgery organizations, medical school leadership, hiring committees, editors, and conference speakers to plan their next steps.

Current Management of Small Unruptured Intracranial Aneurysms in the United States: Results of a National Survey.

OBJECTIVE: To understand how physicians in the United States manage patients with small unruptured intracranial aneurysms and factors that influence the management. METHODS: An online survey questionnaire was designed through SurveyMonkey and distributed electronically to The Society of Interventional Surgery, American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section of Cerebrovascular Surgery, American Academy of Neurology, and Massachusetts Neurologic Association. All participations were voluntary and anonymous. RESULTS: Among all the participants, 53.8% of them were neurosurgeons, 33.0% were neurointerventional radiologists, and 13.2% were neurologists. For management of aneurysms 2-4 mm, 87.8% of respondents favored routine surveillance with imaging follow-up, 3.8% preferred routine treatment, and 8.5% recommended routine treatment or follow-up only for high risk patients. In total, 25.5% preferred annual follow-up, and 67.9% liked follow-up once in a year and then space out at various intervals. For aneurysms between 5 and 7 mm, 73.6% supported routine treatment, 20.8% favored surveillance with imaging follow-up, and 5.7% recommended treating or follow-up only high-risk groups. In total, 58.5% preferred annual follow-up, whereas 34.9% liked follow-up once in a year and then space out at various intervals. For routine follow-up, 64.1% of the physicians chose magnetic resonance angiography without contrast, and 40.6% preferred computed tomography angiography. CONCLUSIONS: For aneurysms 2-4 mm, majority of the physicians preferred regular follow-up, whereas for aneurysms 5-7 mm, the majority favor treatment. There remains heterogeneity in practice among physicians in the United States regarding follow-up strategies for small unruptured aneurysms. Further studies are needed to evaluate the optimal management strategy, follow-up frequency and duration of imaging for small unruptured intracranial aneurysms.

Trends in Academic Spine Neurosurgeon Productivity as Measured by the Relative Citation Ratio.

BACKGROUND: Publication metrics such as the author-level h-index are often used to evaluate and compare research productivity in academia. The h-index, however, is not a field-normalized statistic and has been criticized as inappropriate for comparison of authors from different fields. For example, fields such as internal medicine have a larger audience and thus afford publications a higher likelihood of increased citations compared with a perhaps equally impactful paper in a smaller field such as neurosurgery. The National Institutes of Health (NIH) has developed a new field-normalized article-level metric called the relative citation ratio (RCR) that can be used to more accurately compare author productivity between fields. Spine represents a distinct subset of neurosurgery with a designated fellowship and distinct differences in the RCR metrics. The authors look to analyze the unique results found in the academic spine neurosurgeon RCR values compared with all academic neurosurgeons. PURPOSE: The assessment of academic physicians should use field-independent publication metrics to measure the improvement of grant outcomes, promotion, and continued evaluation of research productivity. Here, we provide an analysis of RCR indices for 358 academic spine neurosurgeons in the United States, including the mean RCR of each author's total publications and the weighted RCR, which is the sum of all publication-level RCR values of an author. We further assess the impact of gender, career duration, academic rank, and Ph.D. acquisition on the RCR scores of U.S. academic spine neurosurgeons. METHODS: The mean RCR is the total citations per year of a publication divided by average citations per year received by NIH-funded papers in the same field. A value of 1 is the normal NIH-funded standard. iCite database searches were performed for all physician faculty members affiliated with accredited neurological surgery programs who have subspecialized in spine as of November 1, 2019. Gender, career duration, academic rank, additional degrees, total publications, mean RCR, and weighted RCR were collected for each individual. RCR and weighted RCR were compared between variables to assess patterns of analysis. RESULTS: A total of 358 fellowship-trained academic spine neurosurgeons from 125 institutions were included in the analysis. Exceptional research productivity was noted, with a median RCR of 1.38 (interquartile range = 0.94-1.95) and a weighted median RCR of 25.28 (interquartile range = 6.87-79.93). Overall, gender and academic rank were associated with increased mean RCR and weighted RCR values. Career duration and Ph.D. acquisition were not. All subgroups analyzed had an RCR value above 1.0, with professor-level faculty or department chair having the highest mean and weighted RCR values overall. CONCLUSIONS: Current academic spine neurosurgeons have high median RCR values relative to the NIH standard RCR value of 1.0. Relative to the field of neurological surgery overall, RCR values for the spine subspecialty are comparable. These data offer a more accurate means for self-evaluation of academic neurosurgeons as well as evaluation of faculty by institutional and departmental leaders.