Journal of neurosurgery
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Journal of neurosurgery · Jul 2024
Review Historical ArticleThe AANS/CNS Section on Tumors: a summary of 40 years of advocacy to advance the care of patients with brain and spine tumors.
The AANS/CNS Section on Tumors was founded 40 years ago in 1984 to assist in the education of neurosurgeons interested in neuro-oncology, and serves as a resource for other national organizations regarding the clinical treatment of nervous system tumors. The Section on Tumors was the first national physicians' professional organization dedicated to the study and treatment of patients with brain and spine tumors. Over the past 40 years, the Section on Tumors has built solid foundations, including establishing the tumor section satellite meetings, founding the Journal of Neuro-Oncology (the first medical journal dedicated to brain and spine surgical oncology), advancing surgical neuro-oncology education and research, promoting neurosurgical involvement in neuro-oncology clinical trials, and advocating for patients with brain and spine tumors. This review provides a synopsis of the Section on Tumors' history, its challenges, and its opportunities, drawing on the section's archives and input from the 17 section chairs who led it during its first 40 years.
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Journal of neurosurgery · Jul 2024
Randomized Controlled TrialEffect of patient-controlled analgesia on development of postoperative nausea and vomiting in patients undergoing microvascular decompression: a prospective randomized controlled trial.
Postoperative nausea and vomiting (PONV) occurs frequently after microvascular decompression (MVD). Fentanyl, an opioid, is strongly related to the development of PONV, and ketorolac, a nonsteroidal anti-inflammatory drug, has been approved for postoperative pain management. However, how ketorolac-based patient-controlled analgesia (PCA) causes PONV or how its efficacy differs from that of fentanyl-based PCA after MVD is unclear. In this study, the authors compared ketorolac-based with fentanyl-based PCA in terms of the incidence and severity of PONV and analgesia after MVD. ⋯ In patients with MVD, ketorolac-based PCA resulted in a decrease in PONV incidence and severity compared with fentanyl-based PCA, with analgesic effects similar to those of fentanyl-based PCA. This study provides clinical evidence that ketorolac-based PCA may be a valid alternative to fentanyl-based PCA in postoperative care.
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Journal of neurosurgery · Jul 2024
Mapping the global neurosurgery workforce. Part 1: Consultant neurosurgeon density.
It is unknown whether efforts to expand access to neurosurgery worldwide have translated to an increase in the global neurosurgery workforce, particularly in low- and middle-income countries. The main objective of this study was to quantify the number and distribution of consultant neurosurgeons worldwide, while also identifying temporal and geographic trends in the neurosurgery workforce in different income levels and WHO regions, and analyzing what factors might contribute to the growth of a national workforce. ⋯ The authors estimate a global consultant neurosurgeon workforce of nearly 73,000 neurosurgeons, with stark disparities in the density and growth of the workforce in different WB income-level groups and WHO regions. The presence of a neurosurgery society was correlated with the growth of the workforce, and this study identified several regional targets for further intervention to expand access to neurosurgery.
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Journal of neurosurgery · Jul 2024
A taxonomy for superficial cerebral cavernous malformations: subtypes of cortical and subcortical lesions.
A taxonomy for superficial cerebral cavernous malformations (CMs), those based cortically in gyral gray matter or subcortically in underlying white matter, is proposed to build on the comprehensive, systematic characterization of CMs in the entire brain. ⋯ Superficial cerebral CMs were resected through a gyrus or sulcus to open the subarachnoid dissection corridors, traversing the full extent of sulci to deepen the approach and minimize tissue transgression. Transgyral dissection avoids associated arteries but is inherently transgressive, whereas transsulcal dissection preserves cortical tissue and may reduce morbidity. Superficial cerebral CMs occupy the largest territory of the 7 types, and the size and surface complexity of the cerebrum make taxonomic subtyping valuable for clear anatomical description.
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Journal of neurosurgery · Jul 2024
Multicenter StudyDevelopment and internal-external validation of the ATHE Scale: predicting acute large vessel occlusion due to underlying intracranial atherosclerosis prior to endovascular treatment.
The diagnosis of intracranial atherosclerosis (ICAS) associated with large vessel occlusion (LVO) before endovascular treatment (EVT) remains a clinical challenge. This study was aimed at developing a predictive model for ICAS-LVO in the anterior circulation preceding EVT. ⋯ The ATHE Scale, incorporating atrial fibrillation, truncal-type occlusion, hyperdense artery sign, and baseline examination NIHSS score, is an accurate, objective tool for predicting ICAS-LVO prior to EVT.