Journal of neurosurgery
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The goal of this study was the creation and administration of a survey to assess the depth and breadth of sexual harassment across neurosurgery. ⋯ This study demonstrates that neurosurgeons report significant sexual harassment across all ages and practice settings. Sexual harassment impacts both men and women, with more than half personally subjected to this behavior and two-thirds having witnessed it. Male dominance, a hierarchical environment, and a permissive environment remain prevalent within the neurosurgical community. This is not just a historical problem, but it continues today. A change of culture will be required for neurosurgery to shed this mantle, which must include zero tolerance of this behavior, new policies, awareness of unconscious bias, and commitment to best practices to enhance diversity. Above all, it will require that all neurosurgeons and neurosurgical leaders develop an awareness of sexual harassment in the workplace and establish consistent mechanisms to mitigate against its highly deleterious effects in the specialty.
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Journal of neurosurgery · Aug 2021
Incidence and characteristics of cerebral hypoxia after craniectomy in brain-injured patients: a cohort study.
After craniectomy, although intracranial pressure (ICP) is controlled, episodes of brain hypoxia might still occur. Cerebral hypoxia is an indicator of poor outcome independently of ICP and cerebral perfusion pressure. No study has systematically evaluated the incidence and characteristics of brain hypoxia after craniectomy. The authors' objective was to describe the incidence and characteristics of brain hypoxia after craniectomy. ⋯ Cerebral hypoxia is common after craniectomy, despite ICP being controlled. ET secretion and patient mobilization are common causes that are easily treatable and often not identified by standard monitoring. These results suggest that monitoring should be pursued even if ICP is controlled. The authors' findings might provide a hypothesis to explain the poor functional outcome in the recent randomized controlled trials on craniectomy after traumatic brain injury where in which brain tissue oxygen pressure was not measured.
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Journal of neurosurgery · Aug 2021
A tribute to the late Professor Donald Simpson, Australian neurosurgeon and namesake of the Simpson grading system for meningioma extent of resection.
Donald Simpson (1927-2018) was a neurosurgeon from Adelaide, Australia, who is often cited for the 1957 publication he wrote as a trainee on the relationship between extent of resection and outcomes for meningiomas. That paper summarized a series of over 300 patients operated on in England by well-known neurosurgeons Sir Hugh Cairns and Joseph Buford Pennybacker. Simpson was also known later in his career, when he was at the University of Adelaide in South Australia, for his contributions to the areas of hydrocephalus, spina bifida, craniofacial anomalies, head injury, brain abscesses, and neurosurgical history, and he published extensively on these topics. ⋯ Simpson was an active member and leader of many Australian surgical organizations and was an officer of the Order of Australia. Donald Simpson's legacy as an adult and pediatric neurosurgeon, an academician, a leader, and a humanitarian is extensive and will prove long lasting. Professor Simpson's life serves as an example from which all neurosurgeons may learn.
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Journal of neurosurgery · Aug 2021
Ballistic lobar trajectory outcomes in civilian firearm penetrating brain injury.
Penetrating brain injury (PBI) is the most lethal of all firearm injuries, with reported survival rates of less than 20%. The projectile trajectory (PT) has been shown to impact mortality, but the significant lobar tracks have not been defined. The aim of this retrospective case-control study was to test for associations between distinct ballistic trajectories, missile types, and patient outcomes. ⋯ Patients with penetrating or perforating types of PBI associated with bitemporal or frontal-to-contralateral parietal PTs should be considered as potential donor candidates. Trauma patients with penetrating missile trajectories involving a single frontal or parietal lobe should be considered for early neurosurgical intervention, especially in the circumstances of a low GCS score (< 8). Surgeons should not base their decision-making solely on advanced patient age to defer further treatment. Patients with PBIs caused by nondeformable types of projectiles can survive multiple simultaneous intracranial missile trajectories.