Neurosurgery
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The pathway to military neurosurgical practice can include a number of accession options. This article is an objective comparison of fiscal, tangible, and intangible benefits provided through different military neurosurgery career paths. Neurosurgeons may train through active duty, reserve, or civilian pathways. These modalities were evaluated on the basis of economic data during residency and the initial 3 years afterwards. When available, military base pay, basic allowance for housing and subsistence, variable special pay, board certified pay, incentive pay, multiyear special pay, reserve drill pay, civilian salary, income tax, and other tax incentives were analyzed using publically available data. Civilians had lower residency pay, higher starting salaries, increased taxes, malpractice insurance cost, and increased overhead. Active duty service saw higher residency pay, lower starting salary, tax incentives, increased benefits, and almost no associated overhead including malpractice coverage. Reserve service saw a combination of civilian benefits with supplementation of reserve drill pay in return for weekend drill and the possibility of deployment and activation. Being a neurosurgeon in the military is extremely rewarding. From a financial perspective, ignoring intangibles, this article shows most entry pathways with initially modest differences between the cumulative salaries of active duty and civilian career paths and with higher overall compensation available from the reserve service option. These pathways become increasingly discrepant over time as civilian pay greatly exceeds that of military neurosurgeons. We hope that those curious about or considering serving in the United States military benefit from our accounting and review of these comparative paths. ⋯ FAP, Financial Assistance ProgramNADDS, Navy Active Duty Delay for SpecialistsTMS, Training in Medical Specialties.
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Removal of a pin during Gamma Knife stereotactic radiosurgery (GK-SRS) may be necessary to prevent collision and allow treatment. ⋯ Treating posteriorly located brain metastases with GK-SRS using only 3 pins provided excellent local control and no difference in treatment toxicity, which may make it a safe and reasonable option for lesions that may otherwise be difficult to treat.
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Intramedullary spinal cord tumors are rare but clinically significant entities. Resection is critical to prevent permanent neurological deficits. However, no studies have investigated the quality of life (QOL) benefit of resection in adults. ⋯ EQ-5D, EuroQol 5-DimensionsGTR, gross total resectionIMSCT, intramedullary spinal cord tumorsMCID, minimal clinically important differenceMMS, Modified McCormick ScalePDQ, Pain Disability QuestionnairePHQ-9, Patient Health Questionnaire-9POD, plane of dissectionQOL, quality of lifeSSI, surgical site infection.
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Thresholds for spinal pelvic parameters in adult spinal deformity (ASD) were previously defined in North American patients and are commonly used to guide surgical planning. However, it is unclear whether these same threshold parameters can be more widely applied in other geographic regions and in other ethnicities. ⋯ ASD, adult spinal deformityHRQOL, health-related quality of lifeLL, lumbar lordosisODI, Oswestry Disability IndexODIni, Oswestry Disability Index need for improvementPCS, physical component summaryPI, pelvic incidencePI-LL, pelvic incidence-lumbar lordosis mismatchPT, pelvic tiltSRS, Scoliosis Research SocietySVA, sagittal vertical axisTK, thoracic kyphosis.
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Depression has been associated with poor outcomes in neurosurgical patients, including increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding an association of psychiatric diagnoses with outcomes after brachial plexus reconstruction. As outcomes and patient satisfaction become increasingly important to payers and physician reimbursement, assessing modifiable preoperative risk factors for their association with poor outcome and patient satisfaction is imperative. ⋯ MRC, Medical Research CouncilTBI, traumatic brain injury.