Journal of neurosurgery
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Journal of neurosurgery · Aug 2021
ReviewSurgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression.
Intracranial facial nerve schwannomas (FNS) requiring treatment are frequently recommended for surgery or stereotactic radiosurgery (SRS). The objective of this study was to compare facial nerve function outcomes between these two interventions for FNS via a systematic review and meta-analysis. ⋯ Unfavorable facial nerve function outcomes are associated with surgical treatment of intracranial FNS, whereas stable facial nerve function outcomes are associated with SRS. Therefore, SRS should be recommended to patients with FNS who require treatment, and surgery should be reserved for patients with another indication, such as decompression of the brainstem. Further study is required to definitively optimize and validate management strategies for these rare skull base tumors.
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Journal of neurosurgery · Aug 2021
ReviewAssessment of burnout prevention and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature.
Neurosurgeon burnout is a serious and prevalent issue that has been shown to impact professionalism, physician health, and patient outcomes. Interventions targeting physician burnout primarily focus on improving physician wellness. Many academic neurosurgery programs have established wellness curricula to combat burnout and improve wellness. No official recommendations exist for establishing a wellness program that effectively targets sources of burnout. The aim of this review was to examine measures of burnout and report objective results of wellness interventions for neurosurgical faculty and residents. ⋯ Burnout among neurosurgical faculty and residents is prevalent and permeates the daily lives of neurosurgeons, negatively affecting patient outcomes, career satisfaction, and quality of life. Many neurosurgery programs have instituted wellness programs to combat burnout, but few have published evidence of improvement after implementation. While studies have shown that residents and faculty recognize the importance of wellness and look favorably on such initiatives, very few studies have reported objective outcomes.
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Journal of neurosurgery · Aug 2021
ReviewThe Simpson grade: abandon the scale but preserve the message.
The Simpson grading scale, developed in 1957 by Donald Simpson, has been considered the gold standard for defining the surgical extent of resection for WHO grade I meningiomas. Since its introduction, the scale and its modifications have generated enormous controversy. The Simpson grade is based on an intraoperative visual assessment of resection, which is subjective and notoriously inaccurate. ⋯ Nevertheless, his eponymous scale is no longer relevant in modern meningioma surgery. While his message of maximizing extent of resection and minimizing morbidity is still germane, a single measure using subjective criteria cannot be applied universally to all meningiomas, regardless of location. Meningioma surgery should be performed with the goal of achieving maximal safe resection, ideally guided by molecularly tagged fluorescent labeling and assessed using objective criteria, including postoperative MRI as well as molecularly tagged scans such as [68Ga]-DOTATATE-PET.