Increasing Use of Rapid Magnetic Resonance Imaging for Children with Blunt Head Injury.

Objective: To increase the percentage of patients who undergo rapid magnetic resonance imaging (rMRI) rather than computed tomography (CT) for evaluation of mild traumatic brain injury (TBI) from 45% in 2020 to 80% by December 2021.

Study Design: This was a quality improvement initiative targeted to patients presenting to the pediatric emergency department presenting with mild TBI, with baseline data collected from January 2020 to December 2020. From January 2021 to August 2021, we implemented a series of improvement interventions and tracked the percentage of patients undergoing neuroimaging who received rMRI as their initial study.

Innovative growth and development of a neurological surgery residency cadaveric spine-simulation training program: a single-institution experience.

Objective: Cadaveric and dry 3D model-based simulation training is a valuable educational tool for neurosurgical residents. Such simulation training is an opportunity for residents to hone technical skills and decision-making and enhance their neuroanatomy knowledge. The authors describe the growth and development of the Oregon Health & Science University Department of Neurological Surgery resident-focused, hands-on, spine-simulation surgery courses and provide details of course evaluations, layout, and setup.

Active Teaching Techniques Using Virtual Didactics: Novel Experience From a National Neurosurgery Resident Course.

Objective: To investigate the attitudes of neurosurgery residents regarding active teaching techniques and virtual didactics based on a national neurosurgery resident sample. We also evaluated the relative cost and time commitment required for faculty participation in virtual versus in-person resident courses.

Design: The Society of Neurological Surgeons (SNS) national junior resident courses (JRCs) were reformatted for active teaching in a virtual setting in 2020 due to the COVID-19 pandemic.

Surgical Resection of Focal Cortical Dysplasia in a Neonate with Novel TSC1 Mutation Leading to Resolution of Refractory Seizures: Case Report.

We describe a neonate presenting on first day of life with refractory seizures secondary to a single, large area of focal cortical dysplasia (FCD) who underwent surgical resection at age 3 weeks leading to resolution of seizure activity and dramatic improvement in developmental trajectory. Surgical intervention for epilepsy is infrequently offered for neonates, often reserved only for those with catastrophic presentations. This case demonstrates that surgical intervention can be safe and efficacious in neonates for pharmaco-resistant seizures associated with a focal lesion.

On-Call Workload Differences in Neurosurgery: Resident Call "Weather" and a Departure from Colored Cloud Labels.

Background And Objectives: Labeling residents as "black" or "white" clouds based on perceived or presumed workloads is a timeworn custom across medical training and practice. Previous studies examining whether such perceptions align with objective workload patterns have offered conflicting results. We assessed whether such peer-assigned labels were associated with between-resident differences in objective, on-call workload metrics in three classes of neurosurgery junior residents.

Evaluating the Effect of Nursing-Performed Point-of-Care Ultrasound on Septic Emergency Department Patients.

Introduction Nursing-performed point-of-care ultrasound (NP-POCUS) studies have been performed on applications such as ultrasound-guided peripheral intravenous line placement and assessing bladder volume. However, research on the use of NP-POCUS in the management of septic patients remains limited. The purpose of this quality improvement study was to investigate how NP-POCUS could impact fluid treatment decisions affecting septic patients in the emergency department (ED) using a focused IVC and lung ultrasound protocol.

An assessment of the long-term impacts of the coronavirus disease 2019 pandemic on academic neurosurgery.

Objective: The goal of this study was to survey residents, fellows, and residency program leadership to assess the long-term impacts of the coronavirus disease 2019 (COVID-19) on residency training by using a structured survey methodology.

Methods: A survey was distributed to US neurosurgical residents and fellows (n = 2085) as well as program directors (PDs) and chairs (n = 216) in early 2022. Bivariate analysis was performed to identify factors associated with a decreased likelihood of pursuing a career in academic neurosurgery because of the pandemic, a perception that surgical skills preparation was negatively impacted, personal financial concerns, and a preference for remote education.

Milestones for neurosurgery sub-interns: a novel evaluation tool to quantitatively differentiate residency applicants.

Objective: The study objective was to create a novel milestones evaluation form for neurosurgery sub-interns and assess its potential as a quantitative and standardized performance assessment to compare potential residency applicants. In this pilot study, the authors aimed to determine the form's interrater reliability, relationship to percentile assignments in the neurosurgery standardized letter of recommendation (SLOR), ability to quantitatively differentiate tiers of students, and ease of use.

Methods: Medical student milestones were either adapted from the resident Neurological Surgery Milestones or created de novo to evaluate a student's medical knowledge, procedural aptitude, professionalism, interpersonal and communication skills, and evidence-based practice and improvement.

Toward rational use of repeat imaging in children with mild traumatic brain injuries and intracranial injuries.

Objective: Limited evidence exists on the utility of repeat neuroimaging in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs). Here, the authors identified factors associated with repeat neuroimaging and predictors of hemorrhage progression and/or neurosurgical intervention.

Methods: The authors performed a multicenter, retrospective cohort study of children at four centers of the Pediatric TBI Research Consortium.

Anti-inflammatory effects of vagus nerve stimulation in pediatric patients with epilepsy.

Introduction: The neural control of the immune system by the nervous system is critical to maintaining immune homeostasis, whose disruption may be an underlying cause of several diseases, including cancer, multiple sclerosis, rheumatoid arthritis, and Alzheimer's disease.

Methods: Here we studied the role of vagus nerve stimulation (VNS) on gene expression in peripheral blood mononuclear cells (PBMCs). Vagus nerve stimulation is widely used as an alternative treatment for drug-resistant epilepsy.

Innovative growth and development of a neurological surgery residency cadaveric skull base simulation training program: A single institution experience.

Objective: Neurosurgical cadaveric and simulation training is a valuable opportunity for residents and fellows to develop as neurosurgeons, further neuroanatomy knowledge, and develop decision-making and technical expertise. The authors describe the growth and development of Oregon Health & Science University (OHSU) Department of Neurological Surgery (NSG) resident hands-on simulation skull base course and provide details of course layout and setup.

Methods: A three-part surgical simulation series was created to provide training in cadaveric skull base procedures.

Physiological Responses and Training Satisfaction During National Rollout of a Neurosurgical Intraoperative Catastrophe Simulator for Resident Training.

Background: Systematic use of neurosurgical training simulators across institutions is significantly hindered by logistical and financial constraints.

Objective: To evaluate feasibility of large-scale implementation of an intraoperative catastrophe simulation, we introduced a highly portable and low-cost immersive neurosurgical simulator into a nationwide curriculum for neurosurgery residents, during years 2016 to 2019.

Methods: The simulator was deployed at 9 Society of Neurological Surgeons junior resident courses and a Congress of Neurological Surgeons education course for a cohort of 526 residents.

Effects of 24-hour versus night-float call schedules on the clinical and operative experiences of postgraduate year 2 and 3 neurosurgical residents.

Objective: To comply with the removal of the 88-hour week exemption and to support additional operative experience during junior residency, Oregon Health & Science University (OHSU) switched from a night-float call schedule to a modified 24-hour call schedule on July 1, 2019. This study compared the volumes of clinical, procedural, and operative cases experienced by postgraduate year 2 (PGY-2) and PGY-3 residents under these systems.

Methods: The authors retrospectively studied billing and related clinical records, call schedules, and Accreditation Council for Graduate Medical Education case logs for PGY-2 and PGY-3 residents at OHSU, a tertiary academic health center, for the first 4 months of the academic years from 2017 to 2020.

Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium.

Objective: The aim of this study was to determine differences in complications and outcomes between posterior fossa decompression with duraplasty (PFDD) and without duraplasty (PFD) for the treatment of pediatric Chiari malformation type I (CM1) and syringomyelia (SM).

Methods: The authors used retrospective and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM1-SM who received PFD or PFDD and had at least 1 year of follow-up data. Preoperative, treatment, and postoperative characteristics were recorded and compared between groups.

Technical challenges to anterior temporal lobectomy after laser interstitial thermal therapy for mesial temporal lobe epilepsy: technical note.

Mesial temporal sclerosis (MTS) is a frequent cause of medically refractory epilepsy, for which laser interstitial thermal therapy (LITT) is an effective treatment. However, experience with the technical considerations posed by additional surgery after an initial LITT procedure is lacking. The authors present the case of a 12-year-old female with medically refractory temporal lobe epilepsy and left MTS who underwent LITT at a separate institution prior to referral.

Measures of Intracranial Injury Size Do Not Improve Clinical Decision Making for Children With Mild Traumatic Brain Injuries and Intracranial Injuries.

Background: When evaluating children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs), neurosurgeons intuitively consider injury size. However, the extent to which such measures (eg, hematoma size) improve risk prediction compared with the kids intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model, which only includes the presence/absence of imaging findings, remains unknown.

Objective: To determine the extent to which measures of injury size improve risk prediction for children with mild traumatic brain injuries and ICIs.

Optimizing the residency application process: insights from neurological surgery during the pandemic virtual application cycle.

Objective: In this article, the authors describe the impact of the COVID-19 virtual match cycle and discuss approaches to optimize future cycles through applicant and neurosurgical education leadership insights.

Methods: Anonymous surveys of neurosurgery program leaders (program directors and program chairs), program administrators (PAs), and 2020-2021 neurosurgery residency match applicants were distributed by the SNS, in conjunction with the Association of Resident Administrators in Neurological Surgery and AANS Young Neurosurgeons Committee.

Results: Responses were received from 77 (67.

Speech-related auditory salience detection in the posterior superior temporal region.

Processing auditory human speech requires both detection (early and transient) and analysis (sustained). We analyzed high gamma (70-110 Hz) activity of intracranial electroencephalography waveforms acquired during an auditory task that paired forward speech, reverse speech, and signal correlated noise. We identified widespread superior temporal sites with sustained activity responding only to forward and reverse speech regardless of paired order.

The 2021 Neurosurgery Match: An Analysis of the Impact of Virtual Interviewing and Other COVID-19-Related Changes.

Background: Given the safety concerns during the COVID-19 (coronavirus disease 2019) pandemic, residency programs suspended away rotations in 2021, and the interview process was transitioned to a virtual video format. In the present study, we assessed the extent to which these changes had affected match outcomes and whether medical school ranking, international graduate status, or affiliation with a home neurosurgery program had affected these outcomes.

Methods: A cross-sectional analysis of neurosurgery match data from 2016 to 2021 was performed, and the match outcomes were assessed by matched program geography and program research ranking.

Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia.

Objective: The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM).

Methods: The authors used retro- and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM-I and SM who received surgical treatment and had at least 1 year of follow-up data. Race, ethnicity, and insurance status were used as comparators for preoperative, treatment, and postoperative characteristics and outcomes.