Journal of neurosurgery
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Journal of neurosurgery · Jul 2019
Development of a performance model for virtual reality tumor resections.
Previous work from the authors has shown that hand ergonomics plays an important role in surgical psychomotor performance during virtual reality brain tumor resections. In the current study they propose a hypothetical model that integrates the human and task factors at play during simulated brain tumor resections to better understand the hand ergonomics needed for optimal safety and efficiency. They hypothesize that 1) experts (neurosurgeons), compared to novices (residents and medical students), spend a greater proportion of their time in direct contact with critical tumor areas; 2) hand ergonomic conditions (most favorable to unfavorable) prompt participants to adapt in order to optimize tumor resection; and 3) hand ergonomic adaptation is acquired with increasing expertise. ⋯ The study results confirm the experts' (neurosurgeons) greater capacity to adapt their hand ergonomics during simulated neurosurgical tasks. The proposed hypothetical model integrates the study findings with various human and task factors that highlight the importance of learning in the acquisition of hand ergonomic adaptation.
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Journal of neurosurgery · Jul 2019
Long-term patency in cerebral revascularization surgery: an analysis of a consecutive series of 430 bypasses.
Large cohort analysis concerning intracerebral bypass patency in patients with long-term follow-up (FU) results is rarely reported in the literature. The authors analyzed the long-term patency of extracranial-to-intracranial (EC-IC) and intracranial-to-intracranial (IC-IC) bypass procedures. ⋯ The overall bypass patency of 97% indicates a high likelihood of success with microsurgical revascularization. Surgical indication (ischemia), low-flow bypass, and number of anastomosis (one site) were associated with higher patency rates. EC-IC and IC-IC bypasses have comparable patency rates, supporting the use of intracranial reconstructive techniques. Bypasses that remain patent 1 week postoperatively and have the opportunity to mature have a high likelihood of remaining patent in the long term. In experienced hands, cerebral revascularization is a durable treatment option with high patency rates.
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Journal of neurosurgery · Jul 2019
Clinical and biological significance of adamantinomatous craniopharyngioma with CTNNB1 mutation.
The Wnt/β-catenin signaling pathway is strongly implicated in the pathogenesis of adamantinomatous craniopharyngioma (adaCP). However, there is no evidence that the CTNNB1 mutation activates the target gene of Wnt/β-catenin signaling, and it is unknown whether it affects the tumorigenesis of adaCP. To assess the effect of the CTNNB1 mutation of adaCP, the authors analyzed the correlation between the mutation and clinical, radiological, pathological, and biological findings. ⋯ These results raise the possibility that the CTNNB1 mutation in adaCP may be associated with disease recurrence, and genes related to the Wnt/β-catenin signaling pathway might represent a therapeutic target.
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Journal of neurosurgery · Jul 2019
Professionalism and performance issues during neurosurgical training and job satisfaction after training: a single training center 50-year experience.
Neurosurgery is often self-selecting. Concern has been raised that residents in the millennial era (born between 1982 and 2004) may have more serious professionalism and performance issues (PPIs) during training compared to prior trainees. Serious PPIs were defined as concerns that led to specific resident disciplinary actions ranging from initial warnings to termination. In order to evaluate this concern, the authors retrospectively reviewed a 50-year experience at a single training center. They then prospectively surveyed living graduates of the program to assess variations in practice patterns and job satisfaction over 5 decades. ⋯ There was no statistically significant difference in the incidence of serious PPIs over 5 decades of training neurosurgery residents at the authors' institution. During the millennial era, serious PPIs have not been increasing. However, reporting of all levels of PPIs is increasing coincident with the ease of electronic reporting. There was remarkably little variance in satisfaction metrics or type of practice over the 5 decades studied.