World Neurosurg
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Historically, women have been underrepresented in medicine but nowadays the underrepresentation is more applicable to surgical disciplines. Many efforts have been made to decrease the attrition rate of women in neurosurgery and to even career opportunities to be comparable to those of male colleagues. However, it is unclear if gender disparities occur between female and male neurosurgeons. Therefore, the aim of the current study is to identify gender differences in the professional and private life of neurosurgeons. ⋯ Despite efforts to increase the amount of women enrolling into neurosurgery and despite efforts to strive for equality, the results of the current study show gender disparities in professional and private careers among neurosurgeons. Practice patterns did not differ between male and female neurosurgeons, but perceptions of career and characteristics of private life did. Program directors and chairs should focus on measures to decrease gender differences and to strive for equal career satisfaction among female and male neurosurgeons.
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Case Reports
IS THIS TRULY A "LEAVE ME ALONE" LESION? AN UNUSUAL CASE OF MULTIPLE RING-SHAPED LATERAL VENTRICULAR NODULES.
Ring-shaped lateral ventricular nodules (RSLVNs) are commonly considered as benign asymptomatic lesions, which are sporadically detected as incidental findings on routine brain magnetic resonance imaging scans. Despite their not irrelevant frequency, the exact biological nature of these lesions remains largely unknown due to the lack of histopathologic studies. Here we present the clinical, neuroradiologic, and histopathologic findings of an unusual case of symptomatic multiple RSLVNs. ⋯ This report provides novel evidence characterizing RSLVNs as possible variants of subependymoma with a peculiar imaging appearance, also suggesting that, like subependymomas, they may occasionally grow large enough to cause mass effect-related symptoms, thus requiring neurosurgical intervention.
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Cervicomedullary compression in young children has been described in the context of Chiari type 1 malformation, with symptoms associated with the extent of tonsillar herniation below McRae line. Historically, Chiari type 1 malformation has been defined by tonsillar herniation of at least 5 mm. However, in certain populations, including very young children, Chiari symptoms may be present without this finding. A new Chiari classification is thus necessary. ⋯ We define a novel Chiari entity, Chiari type 0.5 malformation, characterized by ventral tonsillar wrapping around the medulla in young children in the absence of classic Chiari type 1 malformation imaging findings. These patients are more likely to present with medullary symptoms than patients without VH. They are also more likely to require surgical decompression and respond favorably to intervention.
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Klippel-Feil syndrome was first described in 1912; a short neck, low posterior hairline, and decreased cervical joint range of motion are the classical triad of this disease. In this syndrome, which is rarely observed, the characteristics that have been reported include the following: scoliosis; Sprengel deformity; cervical rib; ear, nose, oral, and laryngeal abnormalities; structural abnormalities of the urinary system; and congenital heart diseases. However, bilateral omovertebra and bilateral multilevel cervical ribs have not been reported. ⋯ Cases of Klippel-Feil syndrome may be accompanied by multiple abnormalities. We want to highlight the need for detailed examination of patients and lifestyle modification at an early age, before symptom appearance, as well as adaptation to habitual exercise.
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The recently described C1-C2 fixation without foramen magnum decompression (FMD) for the management of Chiari malformations (CMs) has sparked a controversy. C1-C2 fixation has been reported to be more effective than traditional FMD. However, the results after such a procedure have not been as well validated. We assessed the efficacy of C1-C2 distraction and fusion without FMD in patients with CM and without demonstrable atlantoaxial instability. ⋯ The overall results after C1-C2 distraction and fusion for CM without instability were not exceptionally better and appeared to be similar to the outcomes reported with FMD. The neurological improvement seen in some patients had possibly resulted from indirect ventral decompression (due to distraction of C1-C2) rather than the stabilization itself. The presence of bony anomalies such as an assimilated C1 arch, platybasia, basilar invagination, and ventral brainstem compression did not significantly influence the outcomes.