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Journal of Neurotrauma Jun 2020Globally, intracranial pressure (ICP) monitoring use in severe traumatic brain injury (sTBI) is inconsistent and susceptible to resource limitations and clinical...
Consensus-Based Management Protocol (CREVICE Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed.
Globally, intracranial pressure (ICP) monitoring use in severe traumatic brain injury (sTBI) is inconsistent and susceptible to resource limitations and clinical philosophies. For situations without monitoring, there is no published comprehensive management algorithm specific to identifying and treating suspected intracranial hypertension (SICH) outside of the one ad hoc Imaging and Clinical Examination (ICE) protocol in the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST:TRIP) trial. As part of an ongoing National Institutes of Health (NIH)-supported project, a consensus conference involving 43 experienced Latin American Intensivists and Neurosurgeons who routinely care for sTBI patients without ICP monitoring, refined, revised, and augmented the original BEST:TRIP algorithm. Based on BEST:TRIP trial data and pre-meeting polling, 11 issues were targeted for development. We used Delphi-based methodology to codify individual statements and the final algorithm, using a group agreement threshold of 80%. The resulting CREVICE (Consensus REVised ICE) algorithm defines SICH and addresses both general management and specific treatment. SICH treatment modalities are organized into tiers to guide treatment escalation and tapering. Treatment schedules were developed to facilitate targeted management of disease severity. A decision-support model, based on the group's combined practices, is provided to guide this process. This algorithm provides the first comprehensive management algorithm for treating sTBI patients when ICP monitoring is not available. It is intended to provide a framework to guide clinical care and direct future research toward sTBI management. Because of the dearth of relevant literature, it is explicitly consensus based, and is provided solely as a resource (a "consensus-based curbside consult") to assist in treating sTBI in general intensive care units in resource-limited environments.
Topics: Brain Injuries, Traumatic; Clinical Protocols; Consensus; Delphi Technique; Humans; Intracranial Hypertension; Intracranial Pressure; Monitoring, Physiologic; Neurosurgeons; Severity of Illness Index; Treatment Outcome
PubMed: 32013721
DOI: 10.1089/neu.2017.5599 -
Acta Neurochirurgica Sep 2022The World Health Organization (WHO) Classification of Tumours, also known as WHO Blue Books, represents an international standardised tool in the diagnostic work-up of... (Review)
Review
BACKGROUND
The World Health Organization (WHO) Classification of Tumours, also known as WHO Blue Books, represents an international standardised tool in the diagnostic work-up of tumours. This classification system is under continuous revision, and progress in the molecular classification of tumours in the central nervous system (CNS) enforced an update of the WHO 2016 classification, and the fifth edition, WHO CNS5, was published in 2021. The aim of this minireview is to highlight important changes in this new edition relevant for the practicing neurosurgeon.
METHODS
The sixth volume of the fifth edition of the WHO Blue Books of CNS tumours and related papers formed the basis for this minireview.
RESULTS
Major changes encompass standardisation of tumour grading and nomenclature as well as increased incorporation of molecular markers in the classification of CNS tumours.
CONCLUSION
Advances in molecular genetics have resulted in more accurate diagnosis and prognosis of CNS tumours, and this minireview summarises important changes implemented in the last edition of WHO classification of CNS tumours important for the practicing neurosurgeon.
Topics: Central Nervous System Neoplasms; Humans; Neurosurgeons; World Health Organization
PubMed: 35879477
DOI: 10.1007/s00701-022-05301-y -
Neurology India 2022
Topics: Career Choice; Female; Humans; Neurosurgeons; Neurosurgery; Neurosurgical Procedures
PubMed: 36076623
DOI: 10.4103/0028-3886.355167 -
World Neurosurgery Jan 2021Over the past century, the field of neurosurgery has evolved and expanded in various directions. Neurosurgeons have continuously pushed the boundaries of the specialty... (Review)
Review
Over the past century, the field of neurosurgery has evolved and expanded in various directions. Neurosurgeons have continuously pushed the boundaries of the specialty with scientific discovery and innovation. A diverse array of neurosurgical techniques, treatments, and new areas of study have emerged within the field. Meanwhile, the neurosurgical workforce has stayed demographically homogeneous throughout time. Certain groups remain underrepresented owing to systemic barriers based on social identities and categorizations, including gender, race, ability status, and others. In this article, we highlight some of the underrepresented groups in neurosurgery and chronicle the important contributions and achievements that individuals from these groups have made in the field despite structural barriers and discrimination. We present evidence from the basic sciences, economics, business, and other disciplines that illustrate that diversity is not only just but also the most rational pursuit for positive growth and advancement. Diversity is needed to enrich the specialty and augment its capacity to serve the heterogeneous population of patients that reflect our society. To promote equity and diversity in the field, ongoing deliberate, organized, and systematic efforts to change the status quo and make the field more inclusive are needed.
Topics: Cultural Diversity; Ethnicity; Female; History, 20th Century; History, 21st Century; Humans; Male; Neurosurgeons; Neurosurgery; Physicians, Women; Workforce
PubMed: 32891852
DOI: 10.1016/j.wneu.2020.08.219 -
International Journal of Radiation... Jan 2017To develop consensus contouring guidelines for postoperative stereotactic body radiation therapy (SBRT) for spinal metastases.
PURPOSE
To develop consensus contouring guidelines for postoperative stereotactic body radiation therapy (SBRT) for spinal metastases.
METHODS AND MATERIALS
Ten spine SBRT specialists representing 10 international centers independently contoured the clinical target volume (CTV), planning target volume (PTV), spinal cord, and spinal cord planning organ at risk volume (PRV) for 10 representative clinical scenarios in postoperative spine SBRT for metastatic solid tumor malignancies. Contours were imported into the Computational Environment for Radiotherapy Research. Agreement between physicians was calculated with an expectation minimization algorithm using simultaneous truth and performance level estimation with κ statistics. Target volume definition guidelines were established by finding optimized confidence level consensus contours using histogram agreement analyses.
RESULTS
Nine expert radiation oncologists and 1 neurosurgeon completed contours for all 10 cases. The mean sensitivity and specificity were 0.79 (range, 0.71-0.89) and 0.94 (range, 0.90-0.99) for the CTV and 0.79 (range, 0.70-0.95) and 0.92 (range, 0.87-0.99) for the PTV), respectively. Mean κ agreement, which demonstrates the probability that contours agree by chance alone, was 0.58 (range, 0.43-0.70) for CTV and 0.58 (range, 0.37-0.76) for PTV (P<.001 for all cases). Optimized consensus contours were established for all patients with 80% confidence interval. Recommendations for CTV include treatment of the entire preoperative extent of bony and epidural disease, plus immediately adjacent bony anatomic compartments at risk of microscopic disease extension. In particular, a "donut-shaped" CTV was consistently applied in cases of preoperative circumferential epidural extension, regardless of extent of residual epidural extension. Otherwise more conformal anatomic-based CTVs were determined and described. Spinal instrumentation was consistently excluded from the CTV.
CONCLUSIONS
We provide consensus contouring guidelines for common scenarios in postoperative SBRT for spinal metastases. These consensus guidelines are subject to clinical validation.
Topics: Algorithms; Confidence Intervals; Consensus; Humans; Magnetic Resonance Imaging; Neurosurgeons; Organs at Risk; Postoperative Period; Practice Guidelines as Topic; Radiation Oncologists; Radiosurgery; Sensitivity and Specificity; Spinal Cord; Spinal Neoplasms; Spine; Tomography, X-Ray Computed; Tumor Burden
PubMed: 27843035
DOI: 10.1016/j.ijrobp.2016.09.014 -
World Neurosurgery Oct 2020Harvey Cushing's 14-month Wanderjahr had a profound effect on his subsequent personal career, which in turn ushered in the modern age of American neurosurgery. From July... (Review)
Review
Harvey Cushing's 14-month Wanderjahr had a profound effect on his subsequent personal career, which in turn ushered in the modern age of American neurosurgery. From July 1900 to August 1901, he traveled to European neurosurgical centers in England, France, Switzerland, Italy, and Germany. His excursion happened at a crucial moment in his trajectory; it was built on his existing foundation of Halstedian surgical training and occurred at a time when interest in the special field of neurological surgery was emerging. The research and clinical experiences on his journey-good and bad-undoubtedly informed his fledgling neurosurgical practice. We present a concise account of Harvey Cushing's time in Europe that consolidates accounts from Cushing's travel journals, biographers, and other neurosurgeons. This article highlights tensions in prior works and reveals new insights into the transformative nature of his Wanderjahr. Furthermore, we contextualize his travels and achievements within the broader transformation of American medical education at the turn of the 20th century to elucidate how Europe influenced American medicine. We briefly consider parallel benefits of Harvey Cushing's Wanderjahr and modern domestic or international training opportunities and present potential areas of implementation.
Topics: Europe; History, 20th Century; Humans; Neurosurgeons; Neurosurgery; United States
PubMed: 32698081
DOI: 10.1016/j.wneu.2020.07.034 -
Neurology India 2019Being a neurosurgeon is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion...
Being a neurosurgeon is a protracted, time-consuming, and labor-intensive occupation. It presupposes excellent, continuing physical and mental competence, and a passion to always do better than the best. During the last two decades, the exponential deployment of operative technology has resulted in a radical transformation, making a neurosurgeon trained four decades ago, run the risk of being outdated. Expectations from patients have reached an all time high level. Socioeconomic and medicolegal aspects cannot be brushed aside. It is universally accepted that in spite of increasing longevity in the educated upper middle class, the process of ageing per se continues relentlessly. When is enough enough? Is there a risk that a "senior, experienced" neurosurgeon may even become a liability to his patients some day? Should there be a mandatory time point at which a neurosurgeon should necessarily stop operating. The author reviews the published literature and opines that after the age of 65 years, all seniors should agree to their operating privileges being formally reviewed regularly every 2 years.
Topics: Age Factors; Humans; Neurosurgeons; Neurosurgery; Retirement; Teaching
PubMed: 31085838
DOI: 10.4103/0028-3886.258036 -
Surgical Neurology International 2021A neurochip comprises a small device based on the brain-machine interfaces that emulate the functioning synapses. Its implant in the human body allows the interaction of...
A neurochip comprises a small device based on the brain-machine interfaces that emulate the functioning synapses. Its implant in the human body allows the interaction of the brain with a computer. Although the data-processing speed is still slower than that of the human brain, they are being developed. There is no ethical conflict as long as it is used for neural rehabilitation or to supply impaired or missing neurological functions. However, other applications emerge as controversial. To the best of our knowledge, there have no been publications about the neurosurgical role in the application of this neurotechnological advance. Deliberation on neurochips is primarily limited to a small circle of scholars such as neurotechnological engineers, artists, philosophers, and bioethicists. Why do we address neurosurgeons? They will be directly involved as they could be required to perform invasive procedures. Future neurosurgeons will have to be a different type of neurosurgeon. They will be part of interdisciplinary teams interacting with computer engineers, neurobiologist, and ethicists. Although a neurosurgeon is not expected to be an expert in all areas, they have to be familiar with them; they have to be prepared to determine indications, contraindications and risks of the procedures, participating in the decision-making processes, and even collaborating in the design of devices to preserve anatomic structures. Social, economic, and legal aspects are also inherent to the neurosurgical activity; therefore, these aspects should also be considered.
PubMed: 34084601
DOI: 10.25259/SNI_591_2020 -
Acta Neurochirurgica Oct 2023Since the late 1930s, electric brain stimulation (EBS) in awake patients has been known to occasionally elicit patient descriptions of a form of memory flashbacks, known... (Review)
Review
BACKGROUND
Since the late 1930s, electric brain stimulation (EBS) in awake patients has been known to occasionally elicit patient descriptions of a form of memory flashbacks, known as experiential phenomena. One understanding of these sensations are as caused by an augmentation of the capacity for memory retrieval. However, an alternative hypothesis holds that memory flashbacks during EBS are "synthetic constructions" in the form of mental events, falsely interpreted as memories.
METHODS
A critical narrative review is used to discuss the false memory hypothesis in relation to the current empirical literature and source attribution theory.
RESULTS
EBS as well as situational demands in the form of interaction between patient and neurosurgeon may both lead to the creation of mental events and influence their interpretation in a way that may create false memories. The false memory hypothesis provides a potential explanation for several apparent inconsistencies in the current literature such as (a) the fragmented nature of experiential reports, (b) the ability of EBS to induce memory retrieval errors in controlled studies, (c) that Penfield's elicitations of experiential phenomena are so rarely replicated in the modern era, and (d) the limited utility of techniques that elicit experiential phenomena in the treatment of memory disorders.
CONCLUSIONS
The hypothesis that experiential phenomena may largely be "synthetic constructions" deserves serious consideration by neurosurgeons.
Topics: Humans; Memory; Brain; Stereotaxic Techniques; Wakefulness; Electric Stimulation
PubMed: 35804269
DOI: 10.1007/s00701-022-05307-6 -
Neurology India 2021To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ' 'neurosurgeon's time,... (Review)
Review
BACKGROUND AND OBJECTIVE
To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ' 'neurosurgeon's time, and these are notoriously prone to complications. In this article, the author analysis his series of ventriculoperitoneal shunts and discusses his technique, nuances and avoidance of shunt complications.
METHODS AND MATERIALS
The author will review common issues related to hydrocephalus shunt management with a review of 549 procedures and associated complications.
RESULTS
Key features and basic principles of complication avoidance in shunt surgery is provided. The analysis looks into the complications and ways to avoid them based on the author's experience.
CONCLUSIONS
Specific measures may be adopted to minimize or avoid these complications. These will be discussed based on the author's series and experiences.
Topics: Child; Humans; Hydrocephalus; Prostheses and Implants; Ventriculoperitoneal Shunt
PubMed: 35103008
DOI: 10.4103/0028-3886.332256