Outpatient telemedicine in neurosurgery: 15,677 consecutive encounters in a comparative analysis of its effectiveness and impact on the surgical conversion rate.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of telehealth visits (THVs). The effects on neurosurgical practice have not been well characterized, especially concerning new-patient THVs. Therefore, the authors of this study reviewed their institution's experience with outpatient clinic visits and THVs from before the COVID-19 pandemic to the present to focus on clinical metrics, rates of surgery, and the effects of implementing THVs in order to better understand their implications for clinical practice as more data emerge over time.

Applying to residency: survey of neurosurgical residency applicants on virtual recruitment during COVID-19.

Objective: The COVID-19 pandemic caused a significant disruption to residency recruitment, including a sudden, comprehensive transition to virtual interviews. The authors sought to characterize applicant experiences and perceptions concerning the change in the application, interview, and match process for neurological surgery residency during the 2020-2021 recruitment cycle.

Methods: A national survey of neurosurgical residency applicants from the 2020-2021 application cycle was performed.

Slow progress in the visibility of women in neurosurgery in the United States: opportunity for improvement.

Objective: The goal of this study was to analyze the visibility of women within organized neurosurgery, including leadership positions, lectureships, and honored guest/award recipients at neurosurgical conferences.

Methods: A cross-sectional study was used to analyze the gender demographics within the five major national neurosurgical societies (Congress of Neurological Surgeons [CNS], American Association of Neurological Surgeons [AANS], Society of Neurological Surgeons [SNS], American Board of Neurological Surgery [ABNS], and Council of State Neurosurgical Societies [CSNS]) from 2000 to 2020. Data for top leadership positions, keynote speakers, honored guests, and invited lectureships at these neurosurgical societies were reviewed.

Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases.

Purpose: Spinal ependymomas represent the most common primary intramedullary tumors for which optimal management remains undefined. When possible, gross total resection (GTR) is often the mainstay of treatment, with consideration of radiotherapy (RT) in cases of residual or recurrent tumor. The impact of extent of resection and radiotherapy remain understudied.

Radiographic assessment of surgical treatment of post-traumatic syringomyelia.

Symptomatic post-traumatic syringomyelia can affect the quality of life in patients whose neurologic function has already been impacted by a spinal cord injury. To investigate the radiographic and clinical outcomes following surgery for syringomyelia, we present a literature review along with a case series from a single surgeon's experience. A retrospective review was conducted on patients with post-traumatic syringomyelia who were treated by a single surgeon.

Magnetic Resonance Imaging Atlas-Based Volumetric Mapping of the Cervical Cord Gray Matter in Cervical Canal Stenosis.

Background: White matter volume loss may be an anatomic driver in the development of clinical symptoms in cervical spondylotic myelopathy (CSM). Considerably less attention has been devoted to gray matter (GM) injury. Newly developed atlas-based mapping techniques may allow evaluation of GM cord volume alterations in CSM.

The effect of positive sagittal spine balance and reconstruction surgery on standing balance.

Background: Positive sagittal spine balance (PSSB) may adversely influence standing balance in individuals with degenerative spine diseases. PSSB is often corrected with the help of spinal reconstructive surgeries involving multiple vertebral units.

Research Question: This study investigated the effect of PSSB and reconstructive surgery on postural sway as a measure of standing balance.

Emerging Safety of Intramedullary Transplantation of Human Neural Stem Cells in Chronic Cervical and Thoracic Spinal Cord Injury.

Background: Human central nervous system stem cells (HuCNS-SC) are multipotent adult stem cells with successful engraftment, migration, and region-appropriate differentiation after spinal cord injury (SCI).

Objective: To present data on the surgical safety profile and feasibility of multiple intramedullary perilesional injections of HuCNS-SC after SCI.

Methods: Intramedullary free-hand (manual) transplantation of HuCNS-SC cells was performed in subjects with thoracic (n = 12) and cervical (n = 17) complete and sensory incomplete chronic traumatic SCI.

Results of the Scoliosis Research Society Morbidity and Mortality Database 2009-2012: A Report From the Morbidity and Mortality Committee.

Introduction: Members of the Scoliosis Research Society are required to annually submit complication data regarding deaths, visual acuity loss, neurological deficit and infection (2012-1st year for this measure) for all deformity operations performed. The purpose of this study is to report the 2012 results and the differences in these complications from the years 2009-2012.

Methods: The SRS M&M database is a self-reported complications registry of deformity operations performed by the members.

Positive trends in neurosurgery enrollment and attrition: analysis of the 2000-2009 female neurosurgery resident cohort.

Objective: Women compose a minority of neurosurgery residents, averaging just over 10% of matched applicants per year during this decade. A recent review by Lynch et al. raises the concern that women may be at a higher risk than men for attrition, based on analysis of a cohort matched between 1990 and 1999.

Attrition rates in neurosurgery residency: analysis of 1361 consecutive residents matched from 1990 to 1999.

Object: The objective of this study is to determine neurosurgery residency attrition rates by sex of matched applicant and by type and rank of medical school attended.

Methods: The study follows a cohort of 1361 individuals who matched into a neurosurgery residency program through the SF Match Fellowship and Residency Matching Service from 1990 to 1999. The main outcome measure was achievement of board certification as documented in the American Board of Neurological Surgery Directory of Diplomats.

Minimally invasive thoracic decompression for multi-level thoracic pathologies.

We describe our experience using a minimal access approach for multi-level dorsal decompression of the thoracic spine that may limit approach-related soft-tissue injury and spinal destabilization. Additionally, three patients, each with unique compressive thoracic pathology, are discussed. A single minimal access technique, using multi-level hemilaminotomies, was used to address these unique pathologies via a similar approach.

History of simulation in medicine: from Resusci Annie to the Ann Myers Medical Center.

Medical and surgical graduate medical education has historically used a halstedian approach of "see one, do one, teach one." Increased public demand for safety, quality, and accountability in the setting of regulated resident work hours and limited resources is driving the development of innovative educational tools. The use of simulation in nonmedical, medical, and neurosurgical disciplines is reviewed in this article.

Developing an anterior cervical diskectomy and fusion simulator for neurosurgical resident training.

Background: Surgical simulators are useful in many surgical disciplines to augment residency training. Duty hour restrictions and increasing emphasis on patient safety and attending oversight have changed neurosurgical education from the traditional apprenticeship model. The Congress of Neurological Surgeons Simulation Committee has been developing neurosurgical simulators for the purpose of enhancing resident education and assessing proficiency.

Crouch gait in persons with positive sagittal spine alignment resolves with surgery.

Objective: Degenerative spinal conditions often result in positive sagittal alignment which may be corrected using multi-segment spinal reconstructive surgeries. The purpose of this study was to investigate gait kinematics before and after spinal reconstructive surgery in persons with positive sagittal alignment.

Methods: Subjects presenting with positive sagittal alignment of greater than or equal to 7 cm who were treated with spinal reconstructive surgery were included in this study.

The role of simulation in neurosurgical education: a survey of 99 United States neurosurgery program directors.

Objective: With the reduction of resident work hours and the increasing focus on patient safety, it has become evident that simulation has a growing role to play in surgical education. We surveyed the program directors of 99 U.S.

Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist.

Spine surgery carries an inherent risk of damage to critical neural structures. Intraoperative neurophysiological monitoring (IONM) is frequently used to improve the safety of spine surgery by providing real-time assessment of neural structures at risk. Evidence-based guidelines for safe and efficacious use of IONM are lacking and its use is largely driven by surgeon preference and medicolegal issues.

The effect of call on neurosurgery residents' skills: implications for policy regarding resident call periods.

Object: Although fatigue and its effects on surgical proficiency have been an actively researched area, previous studies have not examined the effect of fatigue on neurosurgery residents specifically. This study aims to quantify the effect of fatigue on the psychomotor and cognitive skills of neurosurgery residents.

Methods: Seven neurosurgery residents performed a minimum of 3 and a maximum of 4 sessions of 6 surgical exercises precall and postcall.

Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management.

Object: A syrinx is a fluid-filled cavity within the spinal cord that can be an incidental finding or it can be accompanied by symptoms of pain and temperature insensitivity. Although it is most commonly associated with Chiari malformation Type I, the advancement of imaging techniques has resulted in more incidental idiopathic syringes that are not associated with Chiari, tumor, trauma, or postinfectious causes. The authors present a comprehensive review and management strategies for the idiopathic variant of syringomyelia.

Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group.

Purpose: Standardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS).

Methods: Clinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group.

Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization.

Object: Ossification of the posterior longitudinal ligament (OPLL) is a complex multifactorial disease process combining both metabolic and biomechanical factors. The role for surgical intervention and choice of anterior or posterior approach is controversial. The object of this study was to review the literature and present a single-institution experience with surgical intervention for OPLL.