Smaller thoracic canal diameters are associated with thoracic radiculopathy and abdominal pain after spinal cord stimulator paddle lead placement.

Introduction: It is not uncommon for patients to experience postoperative neurologic deficit, thoracic radiculopathy, abdominal pain, or lower extremity paresthesia after the implantation of thoracic spinal cord stimulator (SCS) paddle leads. Smaller thoracic canal diameters have previously been associated with postoperative neurologic deficits.

Objective: This imaging study examined whether postoperative SCS neurologic complaints other than neurologic deficit may be correlated with thoracic spinal canal diameter.

Analysis of spinal canal diameter in the placement of thoracic spinal cord stimulator paddle leads.

Background: Neurologic deficit is known as a rare complication of thoracic spinal cord stimulator (SCS) paddle lead implantation, but many believe its incidence after SCS paddle lead placement is under-reported. It is possible that imaging characteristics may be used to help predict safe paddle lead placement.

Objective: This imaging study was undertaken to determine the minimum canal diameter required for safe paddle lead placement.

Life Expectancy and Metastatic Spine Scoring Systems: An Academic Institutional Experience.

Study Design: A retrospective data collection study with application of metastatic spine scoring systems.

Objectives: To apply the Tomita and revised Tokuhashi scoring systems to a surgical cohort at a single academic institution and analyze spine-related surgical morbidity and mortality rates.

Summary Of Background Data: Surgical management of metastatic spine patients requires tools that can accurately predict patient survival, as well as knowledge of morbidity and mortality rates.

Assessment of the Interrater Reliability of the Congress of Neurological Surgeons Microanastomosis Assessment Scale.

Background: The potential for simulation-based learning in neurosurgical training has led the Congress of Neurosurgical Surgeons to develop a series of simulation modules. The Northwestern Objective Microanastomosis Assessment Tool (NOMAT) was created as the corresponding assessment tool for the Congress of Neurosurgical Surgeons Microanastomosis Module. The face and construct validity of the NOMAT have been previously established.

Imaging characteristic analysis of metastatic spine lesions from breast, prostate, lung, and renal cell carcinomas for surgical planning: Osteolytic versus osteoblastic.

Background: Surgeons treating metastatic spine disease can use computed tomography (CT) imaging to determine whether lesions are osteolytic, osteoblastic, or mixed. This enables treatment that considers the structural integrity of the vertebral body (VB), which is impaired with lytic lesions but not blastic lesions. The authors analyzed CT imaging characteristics of spine metastasis from breast, lung, prostate, and renal cell carcinomas (RCCs) to determine the metastasis patterns of each of these common tumors.

The role of biopsy in the management of patients with presumed diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline.

Question: What is the optimal role of biopsy in the initial management of presumptive low-grade glioma in adults?

Target Population: Adult patients with imaging suggestive of a low-grade glioma.

Level Iii: Stereotactic biopsy is recommended when definitive surgical resection is limited by lesions that are deep-seated, not resectable, and/or located within eloquent cortex, or in patients unable to undergo craniotomy due to medical co-morbidities to obtain the critical tissue diagnosis needed for targeted treatment planning for patients with low-grade gliomas.

Question: What is the best technique for brain biopsy?

Target Population: Adult patients with imaging suggestive of a low-grade glioma.

Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts.

Background: Much has been written about injuries sustained by US and coalition soldiers during the Global War on Terrorism campaigns. However, injuries to civilians, including children, have been less well documented.

Objective: To describe the epidemiologic features and outcomes associated with isolated severe head injury in children during Operations Enduring Freedom and Iraqi Freedom (OEF and OIF).

Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey.

Unlabelled: OBJECT :The object of this study was to identify and quantify predictors of burnout and career satisfaction among US neurosurgeons.

Methods: All US members (3247) of the American Association of Neurological Surgeons (AANS) were invited to participate in a survey between September and December 2012. Responses were evaluated through univariate analysis.

Posterior fixation without debridement for vertebral body osteomyelitis and discitis.

Object: The authors evaluated the efficacy of posterior instrumentation for the management of spontaneous spinal infections. Standard surgical management of spontaneous spinal infection is based on debridement of the infected tissue. However, this can be very challenging as most of these patients are medically debilitated and the surgical debridement requires a more aggressive approach to the spine either anteriorly or via an expanded posterior approach.

An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs.

Background: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted the 24+6-hour work schedule and 80-hour workweek, and in 2011, it enhanced work hour and supervision standards.

Innovation: In response, Oregon Health & Science University's (OHSU) neurological surgery residency instituted a 3-person night float system.

Methods: We analyzed work hour records and operative experience for 1 year before and after night float implementation in a model that shortened a combined introductory research and basic clinical neurosciences rotation from 12 to 6 months.

Timing of cranioplasty after decompressive craniectomy for trauma.

Background: The optimal timing of cranioplasty after decompressive craniectomy for trauma is unknown. The aim of this study was to determine if early cranioplasty after decompressive craniectomy for trauma reduces complications.

Methods: Consecutive cases of patients who underwent autologous cranioplasty after decompressive craniectomy for trauma at a single Level I Trauma Center were studied in a retrospective 10 year data review.

Methodology and reporting of meta-analyses in the neurosurgical literature.

Object: Neurosurgeons are inundated with vast amounts of new clinical research on a daily basis, making it difficult and time-consuming to keep up with the latest literature. Meta-analysis is an extension of a systematic review that employs statistical techniques to pool the data from the literature in order to calculate a cumulative effect size. This is done to answer a clearly defined a priori question.

Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke.

Object: The optimal timing of cranioplasty after decompressive craniectomy for stroke is not known. Case series suggest that early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be associated with higher rates of bone resorption. The authors examined whether the timing of cranioplasty after decompressive craniectomy for stroke affects postoperative complication rates.

Career satisfaction and burnout among U.S. neurosurgeons: a feasibility and pilot study.

Objective: Neurosurgery is a challenging and stressful field. Excessive stress and professional dissatisfaction can lead to medical errors, negatively impact patient care, and cause physician burnout. Our objective is to develop and critically evaluate a survey measuring professional stress and satisfaction and to obtain preliminary data on sources and degree of stress and the prevalence of burnout among American neurosurgeons.

Optimal timing of autologous cranioplasty after decompressive craniectomy in children.

Object: The object of this study was to determine if early cranioplasty after decompressive craniectomy for elevated intracranial pressure in children reduces complications.

Methods: Sixty-one consecutive cases involving pediatric patients who underwent autologous cranioplasty after decompressive craniectomy for raised intracranial pressure at a single academic children's hospital over 15 years were studied retrospectively.

Results: Sixty-one patients were divided into early (< 6 weeks; 28 patients) and late (≥ 6 weeks; 33 patients) cranioplasty cohorts.

The pediatric cervical spine instability study. A pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries.

Purpose: Cervical spine clearance in severely injured children after trauma is often difficult because of unique injury patterns, concerns about radiation exposure to growing tissue, and unfamiliarity with unstable cervical injuries. We prospectively assessed the utility of four radiographic modalities to clear the cervical spine in children after severe trauma.

Methods: Twenty-four comatose, intubated children with severe traumatic injuries underwent radiographic evaluation to clear the cervical spine.

Decompressive craniectomy in a neurologically devastated pregnant woman to maintain fetal viability.

Severe traumatic brain injury (TBI) in pregnant women can result in devastating outcomes for both the mother and the fetus. Historically, there has been concern regarding the issues involved when the fetus is not yet viable outside the womb. Currently, the ability to treat severe TBI with aggressive management of intracranial pressure (ICP) has led to the possibility of sustaining maternal life until the fetus is of a viable age and can be delivered.

Antibiotic-impregnated shunt systems versus standard shunt systems: a meta- and cost-savings analysis.

Object: Infection is a serious and costly complication of CSF shunt implantation. Antibiotic-impregnated shunts (AISs) were introduced almost 10 years ago, but reports on their ability to decrease the infection rate have been mixed. The authors conducted a meta-analysis assessing the extent to which AISs reduce the rate of shunt infection compared with standard shunts (SSs).

Median nerve repair with autologous sciatic nerve graft: a case report.

Background. Peripheral nerve injury treatment options are limited to primary nerve repair, nerve grafting, and tendon transfers. In this case, a large suitable donor site was easily accessible and delayed grafting was indicative of poor prognosis.

Late occurrence of drop metastasis to the spine in a case of esthesioneuroblastoma.

Esthesioneuroblastoma is an aggressive neuroectodermal tumor that originates from the olfactory mucosa and often recurs locally. Distant metastasis of esthesioneuroblastoma has been described, but there are few reports of drop metastasis to the spinal cord. Here, we report a case of multiple drop metastases to the cervical, thoracic, and lumbar regions of the spinal cord that occurred 18 years after resection and radiotherapy of the original anterior cranial fossa lesion.

Economic analysis of the military health professions scholarship program for neurosurgeons.

Background: The 4-year military Health Professions Scholarship Program (HPSP) provides funds for medical school tuition, books, and a monthly stipend in exchange for a 4-year military commitment (to receive all physician bonuses, an additional 3 months must be served).

Objective: To analyze the economics of the HPSP for students with an interest in neurosurgery by comparing medical school debt and salaries of military, academic, and private practice neurosurgeons.

Methods: Salary and medical school debt values from the American Association of Medical Colleges, salary data from the Medical Group Management Association, and 2009 military pay tables were obtained.