Journal of neurosurgery
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Journal of neurosurgery · Oct 2023
Reappraisal of the anatomy of the frontotemporal branches of the facial nerve.
The anatomy of the temporal branches of the facial nerve (FN) has been widely described in the neurosurgical literature because of its relevance in anterolateral approaches to the skull base and implication in frontalis palsies from these approaches. In this study, the authors attempted to describe the anatomy of the temporal branches of the FN and identify whether there are any FN branches that cross the interfascial space of the superficial and deep leaflets of the temporalis fascia. ⋯ The temporal branch of the FN gives off a twig that anastomoses with the zygomaticotemporal nerve, which crosses the superficial and deep leaflets of the temporal fascia. Interfascial surgical techniques aimed at protecting the frontalis branch of the FN are safe in their efforts to protect against frontalis palsy with no clinical sequelae when executed properly.
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Journal of neurosurgery · Oct 2023
Applying objective metrics to neurosurgical skill development with simulation and spaced repetition learning.
Surgical skills laboratories augment educational training by deepening one's understanding of anatomy and allowing the safe practice of technical skills. Novel, high-fidelity, cadaver-free simulators provide an opportunity to increase access to skills laboratory training. The neurosurgical field has historically evaluated skill by subjective assessment or outcome measures, as opposed to process measures with objective, quantitative indicators of technical skill and progression. The authors conducted a pilot training module with spaced repetition learning concepts to evaluate its feasibility and impact on proficiency. ⋯ Participants who underwent a 6-week simulation course showed significant objective improvement in technical indicators, particularly individuals who were early in their training. Small, nonrandomized grouping limits generalizability regarding degree of impact; however, introducing objective performance metrics during spaced repetition simulation would undoubtedly improve training. A larger multiinstitutional randomized controlled study will help elucidate the value of this educational method.
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Journal of neurosurgery · Oct 2023
Artery of Uchimura: origin and evolution of identification of the vascular supply to the hippocampus.
In 1928, neuroscientist Yushi Uchimura (1897-1980) published a landmark study detailing the hippocampal vasculature. Working in Walther Spielmeyer's Munich laboratory (1925-1927), Uchimura sought evidence for a vascular theory of Ammon's horn sclerosis (AHS). He described an artery supplying the vulnerable sector of the hippocampus, where pathognomonic changes of AHS were noted, and characterized the artery as particularly susceptible to circulatory disturbances. ⋯ Uchimura's description of hippocampal vasculature, which is still subject to debate after nearly a century, brought international attention to AHS and epilepsy and showed the hippocampal vasculature to be variable and vulnerable; important considerations for later neurosurgeons in the development of selective mesial temporal surgery. Prominent figures in neurosurgery have since developed classification systems for the hippocampal vasculature in which the artery of Uchimura remains central. Perhaps no other brain artery has been the nexus for such intense investigation and debate about its association to structure, function, disease, and treatment methodology.
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Journal of neurosurgery · Oct 2023
Mapping the geographic migration of United States neurosurgeons across training and current practice regions: associations with academic productivity.
Characterizing changes in the geographic distribution of neurosurgeons in the United States (US) may inform efforts to provide a more equitable distribution of neurosurgical care. Herein, the authors performed a comprehensive analysis of the geographic movement and distribution of the neurosurgical workforce. ⋯ Female neurosurgeons were less likely to practice in the South, and neurosurgeons in the South and West had reduced odds of holding academic rather than private positions. The Northeast was the most likely region to contain neurosurgeons who had completed their training in the same locality, particularly among academic neurosurgeons who did their residency in the Northeast.
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Journal of neurosurgery · Oct 2023
Natural history of intracavernous aneurysms: a consecutive single-center study of 250 patients with 276 aneurysms.
The natural history of cavernous carotid aneurysms (CCAs) is not fully understood. For robust clinical decision-making, the behavior of CCAs needs to be fully understood. The objective of this paper was to calculate the mortality and morbidity rates of patients with diagnosed but untreated CCAs from a relatively large single-center cohort. ⋯ The majority of the CCAs were asymptomatic during follow-up, and none caused the death of the patient. The incidence of symptoms increased with aneurysm size. Because CCAs have a benign natural course, treatment should be considered mainly if the CCA is symptomatic or grows during follow-up.