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Mangham W, Parikh KA, Motiwala M, Gienapp AJ, Roach J, Barats M, Lillard J, Khan N, Arthur A, Michael LM. A Scoping Review of Professionalism in Neurosurgery. Neurosurgery 2024; 94:435-443. [PMID: 37819083 DOI: 10.1227/neu.0000000000002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education's Milestones provides a foundation for professionalism in residency training. Specific professionalism concepts from neurosurgery could augment and expand milestones for the specialty. We reviewed the current literature and identified professionalism concepts within the context of neurosurgical practice and training. METHODS We used a scoping review methodology to search PubMed/MEDLINE and Scopus and identify English-language articles with the search terms "professionalism" and "neurosurgery." We excluded articles that were not in English, not relevant to professionalism within neurosurgery, or could not be accessed. Non-peer-reviewed and qualitative publications, such as commentaries, were included in the review. RESULTS A total of 193 articles were included in the review. We identified 6 professionalism themes among these results: professional identity (n = 53), burnout and wellness (n = 51), professional development (n = 34), ethics and conflicts of interest (n = 27), diversity and gender (n = 19), and misconduct (n = 9). CONCLUSION These 6 concepts illustrate concerns that neurosurgeons have concerning professionalism. Diversity and gender, professional identity, and misconduct are not specifically addressed in the Accreditation Council for Graduate Medical Education's Milestones. This review could be used to aid the development of organizational policy statements on professionalism.
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Affiliation(s)
- William Mangham
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Kara A Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Andrew J Gienapp
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis , Tennessee , USA
| | - Jordan Roach
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Michael Barats
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Jock Lillard
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Nickalus Khan
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - Adam Arthur
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - L Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
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Nguyen VN, Motiwala M, Hoit DA, Michael LM, Arthur AS, Khan NR. Combined Endovascular Embolization and Far Lateral Craniectomy for Microsurgical Trapping and Resection of Giant Thrombosed Vertebrobasilar Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:354-355. [PMID: 37856731 DOI: 10.1227/ons.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/08/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Department of Neurosurgery, University of Southern California, Los Angeles , California , USA
| | - Mustafa Motiwala
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Daniel A Hoit
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis , Tennessee , USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis , Tennessee , USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis , Tennessee , USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis , Tennessee , USA
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3
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Parikh KA, Rangarajan S, Michael LM. Commentary: Superior Ethmoidal Approach to an Olfactory Groove Meningioma: Maximizing Preservation of Nasal Anatomy. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01060. [PMID: 38363852 DOI: 10.1227/ons.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Kara A Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sanjeet Rangarajan
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - L Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey, Memphis, Tennessee, USA
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Sorenson JM, Khan NR, Michael LM, Nguyen V, Baughman B, Boop FA, Arthur AS. Case Curve: A Novel Web-Based Platform and Mobile Phone Application to Evaluate Surgical Competence in Graduate Medical Education. Neurosurgery 2024:00006123-990000000-01026. [PMID: 38251907 DOI: 10.1227/neu.0000000000002822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Competency-based medical education is well established, yet methods to evaluate and document acquisition of surgical skill remain underdeveloped. We describe a novel web-based application for competency-based surgical education at a single neurosurgical department over a 3-year period. METHODS We used a web-based application to track procedural and cognitive skills acquisition for neurosurgical residents. This process included self-assessment, resident peer evaluations, evaluations from supervising attending physicians, and blinded video reviews. Direct observation by faculty and video recordings were used to evaluate surgical skill. Cases were subdivided into component skills, which were evaluated using a 5-point scale. The learning curve for each skill was continuously updated and compared with expectations. Progress was reviewed at a monthly surgical skills conference that involved discussion and analysis of recorded surgical performances. RESULTS During an escalating 3-year pilot from 2019 to 2022, a total of 1078 cases in 39 categories were accrued by 17 resident physicians with 10 neurosurgical faculty who participated as evaluators. A total of 16 251 skill performances in 110 categories were evaluated. The most evaluated skills were those that were common to several types of procedures, such as positioning, hemostasis, and wound closure. The concordance between attending evaluations and resident self-evaluations was 76%, with residents underestimating their performance in 17% of evaluations and overestimating in 7%. CONCLUSION We developed a method for evaluating and tracking surgical resident skill performance with an application that provides timely and actionable feedback. The data collected from this system could allow more accurate assessments of surgical skills and deeper insights into factors influencing surgical skill acquisition.
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Affiliation(s)
- Jeffrey M Sorenson
- Department of Neurosurgery, The University of Tennessee Health Sciences, Memphis, Tennessee, USA
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, The University of Tennessee Health Sciences, Memphis, Tennessee, USA
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Sciences, Memphis, Tennessee, USA
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Vincent Nguyen
- Department of Neurosurgery, The University of Tennessee Health Sciences, Memphis, Tennessee, USA
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Brandon Baughman
- Department of Neurosurgery, The University of Tennessee Health Sciences, Memphis, Tennessee, USA
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Frederick A Boop
- Department of Neurosurgery, The University of Tennessee Health Sciences, Memphis, Tennessee, USA
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Adam S Arthur
- Department of Neurosurgery, The University of Tennessee Health Sciences, Memphis, Tennessee, USA
- Semmes-Murphey Clinic, Memphis, Tennessee, USA
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Parikh KA, Khan N, Sorenson JM, Gienapp AJ, Robertson JH, Michael LM. The Development of Skull Base Surgery as a Discipline: Remembrances of Dr Jon H. Robertson. Neurosurgery 2024:00006123-990000000-01017. [PMID: 38206045 DOI: 10.1227/neu.0000000000002830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
Skull base surgery is a young surgical subspecialty currently led by its second generation of surgeons. At present, there is no literature that narrates the connection of the present to the past. An extended interview was held with Dr Jon H. Robertson, who helped establish the subspecialty in Memphis, TN, to aid in identifying and connecting sentinel events and key figures in the development of the discipline. The field drastically evolved during his era of practice (1975-present), with the advent of advanced imaging and technology, as well as the emergence of multidisciplinary skull base surgical teams. The intersection of the careers of Jon H. Robertson, James T. Robertson, Gale Gardner, Edwin Cocke, John Shea, Jr., and Jerrall Crook in Memphis catalyzed the standardization of a multidisciplinary approach to cranial base pathology. We report the findings of Dr Jon H. Robertson's extended interview, told against the backdrop of the history of the subspecialty. The story of the development of skull base surgery is told from the unique perspective of one who lived and shaped a pivotal segment in this historical timeline.
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Affiliation(s)
- Kara A Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nickalus Khan
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey, Memphis, Tennessee, USA
| | - Jeffrey M Sorenson
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey, Memphis, Tennessee, USA
| | - Andrew J Gienapp
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Jon H Robertson
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey, Memphis, Tennessee, USA
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6
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Nguyen VN, Motiwala M, Parikh KA, Miller LE, Barats M, Arthur AS, Michael LM, Khan NR. Extradural Proximal Control of Internal Carotid Artery for Clipping of a Ruptured Posterior Communicating Artery Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e172-e173. [PMID: 37306971 DOI: 10.1227/ons.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/01/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mustafa Motiwala
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara A Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Erin Miller
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Michael Barats
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
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Nguyen VN, Parikh KA, Wu E, Arthur AS, Michael LM, Khan NR. Modified Orbitozygomatic Craniotomy, Anterior Clinoidectomy, and Retrograde Suction Decompression "Dallas Technique" for Large Unruptured Clinoidal-Ophthalmic Segment Aneurysm. World Neurosurg 2023; 174:128. [PMID: 36966910 DOI: 10.1016/j.wneu.2023.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 04/18/2023]
Abstract
Simple clip trapping may not adequately decompress giant paraclinoidal or ophthalmic artery aneurysms for safe permanent clipping.1-10 Full temporary interruption of the local circulation via clipping of the intracranial carotid artery with concomitant suction decompression via an angiocatheter placed in the cervical internal carotid artery as originally described by Batjer et al3 allows the primary surgeon to use both hands to clip the target aneurysm. Detailed understanding of skull base and distal dural ring anatomy is critical for microsurgical clipping of giant paraclinoid and ophthalmic artery aneurysms.2-4 Microsurgical approaches allow for direct decompression of the optic apparatus as opposed to endovascular coiling or flow diversion that may contribute to increased mass effect.11 We describe the case of a 60-year-old woman who presented with left-sided visual loss, a family history of aneurysmal subarachnoid hemorrhage, and a giant unruptured clinoidal-ophthalmic segment aneurysm with both extradural and intradural components.2 The patient underwent an orbitopterional craniotomy, Hakuba "peeling" of the temporal dura propria from the lateral wall of the cavernous sinus, and anterior clinoidectomy (Video 1). The proximal sylvian fissure was split, the distal dural ring was completely dissected, and the optic canal and falciform ligament were opened. The aneurysm was trapped, and retrograde suction decompression via the "Dallas Technique" was employed for safe clip reconstruction of the aneurysm.3,4 Postoperative imaging showed complete obliteration of the aneurysm, and the patient remained at her neurologic baseline. The technical considerations and literature regarding the suction decompression technique to treat giant paraclinoid aneurysms are reviewed.2-4 The patient and family provided informed consent for the procedure and consented to the publication of her images.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara A Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Eva Wu
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA.
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8
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Parikh KA, Yagmurlu K, Michael LM. Commentary: Transcavernous Surgical Approach for the Treatment of Carotid-Cavernous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e216-e217. [PMID: 36701553 DOI: 10.1227/ons.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kara A Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey Clinic, Memphis, Tennessee, USA
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9
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Parikh KP, Motiwala M, Beer-Furlan A, Michael LM, Rangarajan SV, Choby GW, Kshettry VR, Saleh S, Mukherjee D, Kirsch C, McKean E, Sorenson JM. Erratum: Skull Base Registries: A Roadmap. J Neurol Surg B Skull Base 2023; 83:e1. [PMID: 36644671 PMCID: PMC9839424 DOI: 10.1055/s-0043-1760842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/15/2023] Open
Abstract
[This corrects the article DOI: 10.1055/a-1934-9191.].
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Affiliation(s)
- Kara P. Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Moffitt Cancer Center, Tampa, Florida, United States
| | - L. Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, United States
| | - Garret W. Choby
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, United States
| | - Varun R. Kshettry
- Brain Tumor and Neuro-Oncology Center Cleveland Clinic, Cleveland, Ohio, United States
| | - Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, United States
| | - Claudia Kirsch
- Yale University School of Medicine Department of Radiology and Biomedical Imaging, New Haven, Connecticut, United States,Department of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, England,Mount Sinai Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Erin McKean
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States,Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Jeffrey M. Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States,Address for correspondence Jeffrey M. Sorenson, MD Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine6325 Humphreys Boulevard Memphis, TN 38120United States
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10
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Nguyen VN, Parikh K, Motiwala M, Moore KA, Miller LE, Barats M, Sorenson JM, Michael LM, Arthur AS, Khan NR. Far Lateral Craniotomy, Occipital Artery-Posterior Inferior Cerebellar Artery Bypass, and Trapping of a Ruptured Dissecting Fusiform Right Vertebral Artery Aneurysm Involving the Posterior Inferior Cerebellar Artery Origin: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e39-e40. [PMID: 36227210 DOI: 10.1227/ons.0000000000000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mustafa Motiwala
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kenneth A Moore
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Erin Miller
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Michael Barats
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeffrey M Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Neurosurgery, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA
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11
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Parikh KP, Motiwala M, Beer-Furlan A, Michael LM, Rangarajan SV, Choby GW, Kshettry VR, Saleh S, Mukherjee D, Kirsch C, McKean E, Sorenson JM. Skull Base Registries: A Roadmap. J Neurol Surg B Skull Base 2022; 83:561-578. [PMID: 36393883 PMCID: PMC9653294 DOI: 10.1055/a-1934-9191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/17/2023] Open
Abstract
Hospitals, payors, and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed. Skull base lesions interact with surrounding anatomy to produce a complex spectrum of presentations and surgical challenges, requiring a wide variety of surgical approaches. Moreover, many skull base lesions are relatively rare. These factors and others often preclude the use of prospective randomized clinical trials, thus necessitating alternate methods of scientific inquiry. In this paper, we propose a roadmap for implementing a skull base registry, along with expected benefits and challenges.
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Affiliation(s)
- Kara P. Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Moffitt Cancer Center, Tampa, Florida, United States
| | - L. Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, United States
| | - Garret W. Choby
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, United States
| | - Varun R. Kshettry
- Brain Tumor and Neuro-Oncology Center Cleveland Clinic, Cleveland, Ohio, United States
| | - Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, United States
| | - Claudia Kirsch
- Yale University School of Medicine Department of Radiology and Biomedical Imaging, New Haven, Connecticut, United States
- Department of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, England
- Mount Sinai Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Erin McKean
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Jeffrey M. Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
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12
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Saleh S, Sullivan SE, Bellile E, Roxbury C, Das P, Hachem RA, Ackall F, Jang D, Celtikci E, Sahin MM, D'souza G, Evans JJ, Nyquist G, Khalafallah A, Mukherjee D, Rowan NR, Camp S, Choby G, Gompel JJV, Ghiam MK, Levine CG, Field M, Adappa N, Locke TB, Rassekh C, Sweis AM, Goyal N, Zacharia B, Wilson MN, Patel S, Gardner PA, Snyderman CH, Wang EW, Glancz LJ, Bagchi A, Dow G, Robertson I, Rangarajan SV, Michael LM, McKean EL. Retrospective Review of Surgical Site Infections after Endoscopic Endonasal Sellar and Parasellar Surgery: Multicenter Quality Data from the North American Skull Base Society. J Neurol Surg B Skull Base 2022; 83:579-588. [PMID: 36393885 PMCID: PMC9653291 DOI: 10.1055/a-1865-3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. Methods We conducted a multicenter retrospective analysis of shared quality data points for the endoscopic endonasal approach (EEA) for pituitary adenomas, along with other sellar and parasellar region masses that were included by participating institutions. Patient and operative characteristics, perioperative and postoperative antibiotic regimens and their durations, intraoperative and postoperative cerebrospinal fluid leak, and onset of postoperative meningitis and sinusitis were compared. Results Fifteen institutions participated and provided 6 consecutive months' worth of case data. Five hundred ninety-three cases were included in the study, of which 564 were pituitary adenomectomies. The incidences of postoperative meningitis and sinusitis were low (0.67 and 2.87% for all pathologies, respectively; 0.35% meningitis for pituitary adenomas) and did not correlate with any specific antibiotic regimen. Immunocompromised status posed an increased odds of meningitis in pituitary adenomectomies (28.6, 95% confidence interval [1.72-474.4]). Conclusions The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed.
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Affiliation(s)
- Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Stephen E. Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Emily Bellile
- Cancer Data Science, Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
| | - Christopher Roxbury
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, United States
| | - Paramita Das
- Department of Neurosurgery, University of Chicago, Chicago, Illinois, United States
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
| | - Feras Ackall
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
| | - David Jang
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Muammer Melih Sahin
- Department of Otolaryngology–Head and Neck Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Glen D'souza
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - James J. Evans
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Gurston Nyquist
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Adham Khalafallah
- Department of Neurosurgery, University of Miami/Jackson Health System, Miami, Florida, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nicholas R. Rowan
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Samantha Camp
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Neurosurgery and Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael K. Ghiam
- Department of Otolaryngology, University of Miami, Miami, Florida, United States
| | - Corinna G. Levine
- Department of Otolaryngology, University of Miami, Miami, Florida, United States
| | - Melvin Field
- Orlando Neurosurgery, Orlando, Florida, United States
| | - Nithin Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Tran B. Locke
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Christopher Rassekh
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Auddie M. Sweis
- Division of Otolaryngology–Head and Neck Surgery, Northshore University Health System, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Neerav Goyal
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Brad Zacharia
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Meghan N. Wilson
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Shivam Patel
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Paul A. Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl H. Snyderman
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric W. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Laurence Johann Glancz
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
- Manchester Skullbase Unit, Salford Royal Hospital, Manchester, United Kingdom
| | - Ananyo Bagchi
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Graham Dow
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Iain Robertson
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology, Head-Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L. Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Erin L. McKean
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States
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13
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Parikh KA, Rangarajan SV, Michael LM. Commentary: Combined Orbitozygomatic Pretemporal Transcavernous and Endonasal Transmaxillary Approach for Resection of a Giant Trigeminal Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e297. [PMID: 36103338 DOI: 10.1227/ons.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kara A Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sanjeet V Rangarajan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Otolaryngology Head-Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes Murphey Clinic, Memphis, Tennessee, USA
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14
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Ballo MT, Qualls KW, Michael LM, Sorenson JM, Baughman B, Karri-Wellikoff S, Pandey M. Determinants of Tumor Treating Field Usage in Patients with Primary Glioblastoma: A Single Institutional Experience. Neurooncol Adv 2022; 4:vdac150. [PMID: 36249289 PMCID: PMC9555297 DOI: 10.1093/noajnl/vdac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Determinates of tumor treating fields (TTFields) usage in patients receiving combined modality therapy for primary IDH wild-type glioblastoma are currently unknown.
Methods
Ninety-one patients underwent maximal debulking surgical resection, completed external beam radiotherapy with concurrent Temozolomide (TMZ), and initiated adjuvant TMZ with or without TTFields. We performed a retrospective analysis of patient, tumor, and treatment related factors that affected TTFields usage.
Results
We identified three TTFields usage subgroups: 32 patients that declined TTFields, 40 patients that started, but had a monthly compliance less than 75% or used it for less than 2 months, and 19 patients who used TTFields for 2 or more months and maintained an average monthly compliance greater than 75%. With 26.5 months median follow up for surviving patients, the 1 and 3-year actuarial overall survival for all patients was 80% and 18%, respectively. On multivariate analysis TTFields use (p=0.03), extent of surgical resection (p=0.02), and MGMT methylation status (p=0.01) were significantly associated with overall survival. TTFields usage was explored as a continuous variable and higher average usage was associated with longer overall survival (p=0.03). There was no relationship between patient, tumor, or treatment related factors and a patient’s decision to use TTFields.
Conclusions
No subgroup of patients was more or less likely to initiate TTFields therapy and no subgroup was more or less likely to use TTFields as prescribed. The degree of TTFields compliance may be associated with improved survival independent of other factors.
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Affiliation(s)
- Matthew T Ballo
- Department of Radiation Oncology West Cancer Center & Research Institute , Memphis, TN
| | - Kaitlin W Qualls
- Department of Radiation Oncology West Cancer Center & Research Institute , Memphis, TN
| | | | | | | | | | - Manjari Pandey
- Department of Medical Oncology, West Cancer Center & Research Institute , Memphis, TN
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15
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Parikh K, Michael LM. Commentary: The Final Cut: Evolution of Cavernous Sinus Decompression Beyond the Dolenc Cut. Oper Neurosurg (Hagerstown) 2022; 22:e204-e205. [PMID: 35315813 DOI: 10.1227/ons.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kara Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes Murphey Clinic, Memphis, Tennessee, USA
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16
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Romano R, Mukherjee D, Michael LM, Huang J, Snyder MH, Reddy VP, Guzman K, Lane P, Johnson JN, Selden NR, Wolfe SQ. Optimizing the residency application process: insights from neurological surgery during the pandemic virtual application cycle. J Neurosurg 2022; 137:1-9. [PMID: 35061981 DOI: 10.3171/2021.11.jns211851] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this article, the authors describe the impact of the COVID-19 virtual match cycle and discuss approaches to optimize future cycles through applicant and neurosurgical education leadership insights. METHODS Anonymous surveys of neurosurgery program leaders (program directors and program chairs), program administrators (PAs), and 2020-2021 neurosurgery residency match applicants were distributed by the SNS, in conjunction with the Association of Resident Administrators in Neurological Surgery and AANS Young Neurosurgeons Committee. RESULTS Responses were received from 77 (67.0%) of 115 PAs, 119 (51.7%) of 230 program leaders, and 124 (44.3%) of 280 applicants representing geographically diverse regions. During the virtual application cycle relative to the previous year, programs received more Electronic Residency Application Service applications (mean 314.8 vs 285.3, p < 0.0001) and conducted more applicant interviews (mean 45.2 vs 39.9, p = 0.0003). More than 50% of applicants applied to > 80 programs; 60.3% received ≤ 20 interview invitations, and 9% received > 40 invitations. Overall, 65% of applicants completed ≤ 20 interviews, whereas 34.7% completed > 20 interviews. Program leaders described one 4-week home subinternship (93.3%) and two 4-week external subinternships (68.9%) as optimal neurosurgical exposure; 62.8% of program leaders found the standardized letter of recommendation template to be somewhat (47.5%) or significantly (15.3%) helpful. Applicants, PAs, and program leaders all strongly preferred a hybrid model of in-person and virtual interview options for future application cycles over all in-person or all virtual options. Ninety-three percent of applicants reported matching within their top 10-ranked programs, and 52.9% of programs matched residents within the same decile ranking as in previous years. CONCLUSIONS Optimizing a national strategy for the neurosurgery application process that prioritizes equity and reduces costs, while ensuring adequate exposure for applicants to gain educational opportunities and evaluate programs, is critical to maintain a successful training system.
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Affiliation(s)
- Robert Romano
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Debraj Mukherjee
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - L Madison Michael
- 2Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Judy Huang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Harrison Snyder
- 3Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Vamsi P Reddy
- 4Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
| | - Katherine Guzman
- 5Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Pamela Lane
- 6Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee
| | | | - Nathan R Selden
- 8Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Stacey Q Wolfe
- 9Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina
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17
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Morvant SW, Maroda AJ, Reed LF, Sheyn AM, Peterson J, Elijovich L, Michael LM, DiNitto JM, Rangarajan SV. Endoscopic Endonasal Treatment of a Sinonasal Vascular Neoplasm in the Postnatal Period: Case Report and Review of Literature. Ann Otol Rhinol Laryngol 2021; 131:1287-1292. [PMID: 34918575 DOI: 10.1177/00034894211061992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Congenital vascular lesions commonly present in the head and neck, and most are managed conservatively. Location and rapid growth, however, may necessitate surgical intervention. Endoscopic endonasal surgery (EES) in the pediatric population has emerged as a viable option in treating sinonasal and skull base lesions. Utilizing these techniques in newborns carries unique challenges. The objective of this report is to describe the successful use of direct intralesional embolization followed by endoscopic endonasal resection of a venous malformation in a postnatal patient. METHODS We reviewed the case reported and reviewed the pertinent literature. RESULTS A 6-week-old infant was found to have a large right-sided sinonasal lesion confirmed as a venous malformation. Rapid growth, impending orbital compromise, and potential long-term craniofacial abnormalities demanded the need for urgent surgical intervention. Risk of bleeding was mitigated with direct intralesional embolization. Immediately afterward, the patient underwent endoscopic endonasal resection of the lesion. EES in the very young presents multiple challenges both anatomically and behaviorally. A multidisciplinary approach lead to a successful outcome. CONCLUSION We report a case of a 6-week-old infant, the youngest reported patient to the authors' knowledge, who successfully underwent direct intralesional embolization followed by endoscopic endonasal resection of a sinonasal vascular malformation. This report highlights the challenges of this technique in the very young and demonstrates it as a viable treatment strategy for sinonasal vascular anomalies in this population.
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Affiliation(s)
- Stephen W Morvant
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew J Maroda
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leighton F Reed
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony M Sheyn
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremy Peterson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lucas Elijovich
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - L Madison Michael
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Julie M DiNitto
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Siemens Medical Solutions, Malvern, PA, USA
| | - Sanjeet V Rangarajan
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
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18
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Parikh KA, Michael LM. Commentary: Endoscopic Endonasal Versus Transoral Odontoidectomy for Non-Neoplastic Craniovertebral Junction Disease: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:E463-E464. [PMID: 34498691 DOI: 10.1093/ons/opab322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kara A Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey Clinic, Memphis, Tennessee, USA
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19
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Basma J, Michael LM. Commentary: Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave. Oper Neurosurg (Hagerstown) 2021; 21:E69-E70. [PMID: 33956982 DOI: 10.1093/ons/opab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
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20
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Schievink WI, Michael LM, Maya M, Klimo P, Elijovich L. Spontaneous Intracranial Hypotension Due to Skull-Base Cerebrospinal Fluid Leak. Ann Neurol 2021; 90:514-516. [PMID: 34291846 DOI: 10.1002/ana.26175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Wouter I Schievink
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee, Memphis, TN.,Le Bonheur Children's Hospital, Memphis, TN.,Semmes-Murphey Neurologic and Spine Institute, Memphis, TN
| | - Marcel Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee, Memphis, TN.,Le Bonheur Children's Hospital, Memphis, TN.,Semmes-Murphey Neurologic and Spine Institute, Memphis, TN
| | - Lucas Elijovich
- Department of Neurosurgery, University of Tennessee, Memphis, TN.,Le Bonheur Children's Hospital, Memphis, TN.,Semmes-Murphey Neurologic and Spine Institute, Memphis, TN.,Department of Neurology, University of Tennessee, Memphis, TN
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21
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Basma J, Rangarajan SV, Michael LM, Magnuson JS, Muhlbauer MS, Gleysteen JP. Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction. Oper Neurosurg (Hagerstown) 2021; 21:14-19. [PMID: 33647934 DOI: 10.1093/ons/opab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) has become a routine technique for treating benign and malignant lesions of the oropharynx with the advantage of reducing morbidity compared to open surgical techniques. However, TORS has not been used routinely for accessing lesions of the spine. OBJECTIVE To describe how TORS can be used to access spinal lesions. METHODS We describe our technique of accessing the parapharyngeal space using the robotic technique, and then dissecting the prevertebral muscles to expose the ventral craniovertebral junction. Tubular retraction with endoscopic visualization is then employed for surgical resection. We then report a case of a 14-yr-old competitive athlete who presented with an osseous lesion of C1, which underwent resection using this novel TORS approach. RESULTS Our patient underwent successful resection of a lateral C1 osteoid osteoma utilizing a combined TORS/endoscopic approach. She tolerated soft diet immediately and was discharged on postoperative day 2. Postoperative imaging revealed complete resection of the lesion, and she returned to competitive athletics within 6 wk. CONCLUSION Utilizing this novel, robotic-assisted approach can definitively treat osseous cervical spine lesions while reducing morbidity, allowing for early return to normal diet and minimizing overall length of hospital stay.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sanjeet V Rangarajan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - J Scott Magnuson
- Head and Neck Surgery Program, Advent Health Orlando, Orlando, Florida, USA.,Department of Otolaryngology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Michael S Muhlbauer
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - John P Gleysteen
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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22
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Basma J, Anagnostopoulos C, Tudose A, Harty M, Michael LM, Teo M, Porter DG. History, Variations, and Extensions of the Retrosigmoid Approach: Anatomical and Literature Review. J Neurol Surg B Skull Base 2021; 83:e324-e335. [DOI: 10.1055/s-0041-1729177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/27/2021] [Indexed: 10/20/2022] Open
Abstract
AbstractThe retrosigmoid approach is the workhorse for posterior fossa surgery. It gives a versatile corridor to tackle different types of lesions in and around the cerebellopontine angle. The term “extended” has been used interchangeably in the literature, sometimes creating confusion. Our aim was to present a thorough analysis of the approach, its history, and its potential extensions. Releasing cerebrospinal fluid from the subarachnoid spaces and meticulous microsurgical techniques allowed for the emergence of the retrosigmoid approach as a unilateral variation of the traditional suboccipital approach. Anatomical landmarks are helpful in localizing the venous sinuses and planning the craniotomy, and Rhoton's rule of three is the key to unlock difficult neurovascular relationships. Extensions of the approach include, among others, the transmastoid, supracerebellar, far-lateral, jugular foramen, and perimeatal approaches. The retrosigmoid approach applies to a broad range of pathologies and, with its extensions, can provide adequate exposure, obviating the need for extensive and complicated approaches.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - Christos Anagnostopoulos
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - Andrei Tudose
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - Mikhail Harty
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - L. Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
- Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Mario Teo
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - David G. Porter
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
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23
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Basma J, Mahoney DE, Anagnostopoulos C, Michael LM, Sorenson JM, Porter DG, Pichierri A. The Asterion-to-Transverse Process of the Atlas Line as a Surgical Landmark. J Neurol Surg B Skull Base 2021; 83:e467-e473. [DOI: 10.1055/s-0041-1731032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 05/06/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction Proposed landmarks to predict the anatomical location and trajectory of the sigmoid sinus have varying degrees of reliability. Even with neuronavigation technology, landmarks are crucial in planning and performing complex approaches to the posterolateral skull base. By combining two major dependable structures—the asterion (A) and transverse process of the atlas (TPC1)—we investigate the A-TPC1 line in relation to the sigmoid sinus and in partitioning surgical approaches to the region.
Methods We dissected six cadaveric heads (12 sides) to expose the posterolateral skull base, including the mastoid and suboccipital bone, TPC1 and suboccipital triangle, distal jugular vein and internal carotid artery, and lower cranial nerves in the distal cervical region. We inspected the A-TPC1 line before and after drilling the mastoid and occipital bones and studied the relationship of the sigmoid sinus trajectory and major muscular elements related to the line. We retrospectively reviewed 31 head and neck computed tomography (CT) angiograms (62 total sides), excluding posterior fossa or cervical pathologies. Bone and vessels were reconstructed using three-dimensional segmentation software. We measured the distance between the A-TPC1 line and sigmoid sinus at different levels: posterior digastric point (DP), and maximal distances above and below the digastric notch.
Results A-TPC1 length averaged 65 mm and was posterior to the sigmoid sinus in all cadaver specimens, coming closest at the level of the DP. Using the transverse-asterion line as a rostrocaudal division and skull base as a horizontal plane, we divided the major surgical approaches into four quadrants: distal cervical/extreme lateral and jugular foramen (anteroinferior), presigmoid/petrosal (anterosuperior), retrosigmoid/suboccipital (posterosuperior), and far lateral/foramen magnum regions (posteroinferior). Radiographically, the A-TPC1 line was also posterior to the sigmoid sinus in all sides and came closest to the sinus at the level of DP (mean, 7 mm posterior; range, 0–18.7 mm). The maximal distance above the DP had a mean of 10.1 mm (range, 3.6–19.5 mm) and below the DP 5.2 mm (range, 0–20.7 mm).
Conclusion The A-TPC1 line is a helpful landmark reliably found posterior to the sigmoid sinus in cadaveric specimens and radiographic CT scans. It can corroborate the accuracy of neuronavigation, assist in minimizing the risk of sigmoid sinus injury, and is a useful tool in planning surgical approaches to the posterolateral skull base, both preoperatively and intraoperatively.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Medical Education Research Institute, Memphis, Tennessee, United States
| | - Dom E. Mahoney
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - L. Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Medical Education Research Institute, Memphis, Tennessee, United States
- Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Jeffrey M. Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Medical Education Research Institute, Memphis, Tennessee, United States
- Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - David G. Porter
- Department of Neurosurgery, North Bristol Trust, Bristol, United Kingdom
| | - Angelo Pichierri
- Department of Neurosurgery, North Bristol Trust, Bristol, United Kingdom
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24
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Kumar R, Hersh DS, Smith LGF, Gordon WE, Khan NR, Gienapp AJ, Gungor B, Herr MJ, Vaughn BN, Michael LM, Klimo P. Resident operative experience in pediatric neurosurgery across the United States. J Neurosurg Pediatr 2021; 27:716-724. [PMID: 33836496 DOI: 10.3171/2020.9.peds20518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgical residents receive exposure to the subspecialty of pediatric neurosurgery during training. The authors sought to determine resident operative experience in pediatric neurosurgery across Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgical programs. METHODS During 2018-2019, pediatric neurosurgical case logs for recent graduates or current residents who completed their primary pediatric exposure were collected from US continental ACGME training programs. Using individual resident reports and procedure designations, operative volumes and case diversity were analyzed collectively, according to training site characteristics, and also correlated with the recently described Resident Experience Score (RES). RESULTS Of the 114 programs, a total of 316 resident case logs (range 1-19 residents per program) were received from 86 (75%) programs. The median cumulative pediatric case volume per resident was 109 (IQR 75-161). Residents at programs with a pediatric fellowship reported a higher median case volume (143, IQR 96-187) than residents at programs without (91, IQR 66-129; p < 0.0001). Residents at programs that outsource their pediatric rotation had a lower median case volume (84, IQR 52-114) compared with those at programs with an in-house experience (117, IQR 79-170; p < 0.0001). The case diversity index among all programs ranged from 0.61 to 0.80, with no statistically significant differences according to the Accreditation Council for Pediatric Neurosurgery Fellowships designation or pediatric experience site (p > 0.05). The RES correlated moderately (r = 0.44) with median operative volumes per program. A program's annual pediatric operative volume and duration of pediatric experience were identified as significant predictive factors for median resident operative volume. CONCLUSIONS Resident experience in pediatric neurosurgery is variable within and between programs. Case volumes are generally higher for residents at programs with in-house exposure and an accredited fellowship, but case diversity is relatively uniform across all programs. RES provides some insight on anticipated case volume, but other unexplained factors remain.
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Affiliation(s)
| | - David S Hersh
- 2Department of Surgery, University of Connecticut School of Medicine, Farmington.,3Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut; and
| | - Luke G F Smith
- 4Department of Neurosurgery, The Ohio State University, Columbus, Ohio
| | | | | | - Andrew J Gienapp
- Departments of5Neurosurgery and.,6Le Bonheur Children's Hospital, Memphis; and
| | | | - Michael J Herr
- 7Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis
| | | | - L Madison Michael
- Departments of5Neurosurgery and.,6Le Bonheur Children's Hospital, Memphis; and.,8Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Departments of5Neurosurgery and.,6Le Bonheur Children's Hospital, Memphis; and.,8Semmes Murphey, Memphis, Tennessee
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25
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Basma J, Moore KA, Krisht K, Abuelem T, Arnautovic K, Michael LM, Aboud E, Krisht AF. Morphometric Comparison of the Pterional Trans-Sylvian and the Pretemporal Trans-Clinoidal Approaches to the Posterior Communicating Artery. Oper Neurosurg (Hagerstown) 2020; 20:E22-E30. [PMID: 32860710 DOI: 10.1093/ons/opaa261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Posterior communicating (Pcom) aneurysms in the modern era have tended toward increased complexity and technical difficulties. The pretemporal approach is a valuable extension to the pterional approach for basilar apex aneurysms, but its advantages for Pcom aneurysms have not been previously elucidated. OBJECTIVE To quantify characteristics of the pretemporal approach to the Pcom. METHODS We dissected 6 cadaveric heads (12 sides) with a pretemporal transclinoidal approach and measured the following variables: (1) exposed length of internal carotid artery (ICA) proximal to the Pcom artery; (2) exposed circumference of ICA at the origin of Pcom; (3) deep working area between the optic nerve and tentorium/oculomotor nerve; (4) superficial working area; (5) exposure depth; and (6) the frontotemporal (superior posterolateral) and (7) orbito-sphenoidal (inferior anterolateral) angles of exposure. RESULTS Compared with pterional craniotomy, the pretemporal transclinoidal approach increased the exposed length of the proximal ICA from 3.3 to 11.7 mm (P = .0001) and its circumference from 5.1 to 7.8 mm (P = .0003), allowing a 210° view of the ICA (vs 137.9°). The deep and superficial working areas also significantly widened from 53.7 to 92.4 mm2 (P = .0048) and 252.8 to 418.2 mm2 (P = .0001), respectively; the depth of the exposure was equivalent. The frontotemporal and spheno-Sylvian angles increased by 17° (P = .0006) and 10° (P = .0037), respectively. CONCLUSION The pretemporal approach can be useful for complex Pcom aneurysms by providing easier proximal control, wider working space, improved aneurysm visualization, and more versatile clipping angles. Enhanced exposure results in a potentially higher rate of complete aneurysm obliteration and complication avoidance.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Medical Education Research Institute, Memphis, Tennessee.,Arkansas Neuroscience Institute, Saint Vincent Infirmary, Little Rock, Arkansas
| | - Kenneth A Moore
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Khaled Krisht
- Arkansas Neuroscience Institute, Saint Vincent Infirmary, Little Rock, Arkansas
| | - Tarek Abuelem
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Arkansas Neuroscience Institute, Saint Vincent Infirmary, Little Rock, Arkansas
| | - Kenan Arnautovic
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Semmes-Murphey Clinic, Memphis, Tennessee
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Medical Education Research Institute, Memphis, Tennessee.,Semmes-Murphey Clinic, Memphis, Tennessee
| | - Emad Aboud
- Arkansas Neuroscience Institute, Saint Vincent Infirmary, Little Rock, Arkansas
| | - Ali F Krisht
- Arkansas Neuroscience Institute, Saint Vincent Infirmary, Little Rock, Arkansas
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26
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Knopf JD, Kumar R, Barats M, Klimo P, Boop FA, Michael LM, Martin JE, Bookland M, Hersh DS. Neurosurgical Operative Videos: An Analysis of an Increasingly Popular Educational Resource. World Neurosurg 2020; 144:e428-e437. [PMID: 32889185 PMCID: PMC7462871 DOI: 10.1016/j.wneu.2020.08.187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Surgical education has increasingly relied on electronic learning. In particular, online operative videos have become a core resource within neurosurgery. We analyze the forums for neurosurgical operative videos. METHODS Operative videos from 5 sources were reviewed: 1) the NEUROSURGERY Journal YouTube channel; 2) the American Association of Neurological Surgeons Neurosurgery YouTube channel; 3) The Neurosurgical Atlas Operative Video Cases; 4) Operative Neurosurgery; and 5) Neurosurgical Focus: Video. Title, year of publication, senior author, institution, country, and subspecialty were documented for each video. RESULTS A total of 1233 videos showing 1247 surgeries were identified. Ten videos included >1 surgery; of those, there was a median of 2 surgeries (interquartile range, 2.0-2.5) per video. The most frequently represented subspecialties included vascular (48.3%), tumor (35.2%), and skull base surgery (27.5%), with almost 40% of videos showing >1 category. Videos were submitted by investigators from 28 countries, but 82.1% of the videos originated in the United States. CONCLUSIONS Neurosurgical operative videos have become increasingly common through a variety of online platforms. Future efforts may benefit from collecting videos from underrepresented regions and subspecialties, providing long-term follow-up data and showing techniques for managing complications.
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Affiliation(s)
- Joshua D Knopf
- Department of Neurosurgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Rahul Kumar
- College of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Michael Barats
- College of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA; Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Semmes Murphey, Memphis, Tennessee, USA
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA; Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Semmes Murphey, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA; Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Semmes Murphey, Memphis, Tennessee, USA
| | - Jonathan E Martin
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Markus Bookland
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.
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27
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Motiwala M, Herr MJ, Jampana Raju SS, Lillard J, Ajmera S, Saad H, Schultz A, Fraser B, Wallace D, Norrdahl S, Akinduro O, Oravec CS, Xu R, Jimenez B, Justo M, Hardee J, Vaughn BN, Michael LM, Klimo P. Dissecting the Financial Relationship Between Industry and Academic Neurosurgery. Neurosurgery 2020; 87:1111-1118. [PMID: 32779708 DOI: 10.1093/neuros/nyaa257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Established by the Centers for Medicare and Medicaid Services (CMS), the Open Payments Database (OPD) has reported industry payments to physicians since August 2013. OBJECTIVE To evaluate the frequency, type, and value of payments received by academic neurosurgeons in the United States over a 5-yr period (2014-2018). METHODS The OPD was queried for attending neurosurgeons from all neurosurgical training programs in the United States (n = 116). Information from the OPD was analyzed for the entire cohort as well as for comparative subgroup analyses, such as career stage, subspecialty, and geographic location. RESULTS Of all identified neurosurgeons, 1509 (95.0%) received some payment from industry between 2014 and 2018 for a total of 106 171 payments totaling $266 407 458.33. A bimodal distribution was observed for payment number and total value: 0 to 9 (n = 438) vs > 50 (n = 563) and 0-$1000 (n = 418) vs >$10 000 (n = 653), respectively. Royalty/License was the most common type of payment overall (59.6%; $158 723 550.57). The median number (40) and value ($8958.95) of payments were highest for mid-career surgeons. The South-Central region received the most money ($117 970 036.39) while New England received the greatest number of payments (29 423). Spine surgeons had the greatest median number (60) and dollar value ($20 551.27) of payments, while pediatric neurosurgeons received the least (8; $1108.29). Male neurosurgeons received a greater number (31) and value ($6395.80) of payments than their female counterparts (11, $1643.72). CONCLUSION From 2014 to 2018, payments to academic neurosurgeons have increased in number and value. Dollars received were dependent on geography, career stage, subspecialty and gender.
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Affiliation(s)
- Mustafa Motiwala
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Michael J Herr
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Jock Lillard
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hassan Saad
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Andrew Schultz
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brittany Fraser
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sebastian Norrdahl
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Olutomi Akinduro
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Chesney S Oravec
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Raymond Xu
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brian Jimenez
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Melissa Justo
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennings Hardee
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brandy N Vaughn
- Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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28
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Gordon WE, Mangham WM, Michael LM, Klimo P. The economic value of an on-call neurosurgical resident physician. J Neurosurg 2020:1-7. [DOI: 10.3171/2020.3.jns193454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The cost of training neurosurgical residents is especially high considering the duration of training and the technical nature of the specialty. Despite these costs, on-call residents are a source of significant economic value, through both indirectly and directly supervised activities. The authors sought to identify the economic value of on-call services provided by neurosurgical residents.
METHODS
A personal call log kept by a single junior neurosurgical resident over a 2-year period was used to obtain the total number of consultations, admissions, and procedures. Current Procedural Terminology (CPT) codes were used to estimate the resident’s on-call economic value.
RESULTS
A single on-call neurosurgical resident at the authors’ institution produced 8172 work relative value units (wRVUs) over the study period from indirectly and directly supervised activities. Indirectly supervised procedures produced 7052 wRVUs, and directly supervised activities using the CPT modifier 80 yielded an additional 1120 wRVUs. Using the assistant surgeon billing rate for directly supervised activities and the Medical Group Management Association nationwide median neurosurgery reimbursement rate, the on-call activities of a single resident generated a theoretical billing value of $689,514 over the 2-year period, or $344,757 annually. As a program, the on-call residents collectively produced 39,550 wRVUs over the study period, or 19,775 wRVUs annually, which equates to potential reimbursements of $1,668,386 annually.
CONCLUSIONS
Neurosurgery residents at the authors’ institution theoretically produce enough economic value exclusively from on-call activities to far exceed the cost of their education. This information could be used to more precisely estimate the true overall cost of neurosurgical training and determine future graduate medical education funding.
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Affiliation(s)
- William E. Gordon
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
| | - William M. Mangham
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
| | - L. Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
- Semmes Murphey, Memphis; and
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
- Semmes Murphey, Memphis; and
- Le Bonheur Children’s Hospital, Memphis, Tennessee
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29
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Khan NR, Saad H, Oravec CS, Norrdahl SP, Fraser B, Wallace D, Lillard JC, Motiwala M, Nguyen VN, Lee SL, Jones AV, Ajmera S, Kalakoti P, Dave P, Moore KA, Akinduro O, Nyenwe E, Vaughn B, Michael LM, Klimo P. An Analysis of Publication Productivity During Residency for 1506 Neurosurgical Residents and 117 Residency Departments in North America. Neurosurgery 2020; 84:857-867. [PMID: 29850872 DOI: 10.1093/neuros/nyy217] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery continues to evolve. OBJECTIVE To calculate a number of publication productivity measures for almost all neurosurgical residents and departments within North America. These measures were correlated with survey results on the educational environment within residency programs. METHODS During May to June 2017, data were collected from departmental websites and Scopus to compose a bibliometric database of neurosurgical residents and residency programs. Data related to authorship value and study content were collected on all articles published by residents. A survey of residency program research and educational environment was administered to program directors and coordinators; results were compared with resident academic productivity. RESULTS The median number of publications in residency was 3; median h-index and Resident index were 1 and 0.17 during residency, respectively. There was a statistically significant difference in academic productivity among male neurosurgical residents compared with females. The majority of articles published were tier 1 clinical articles. Residency program research support was significantly associated with increased resident productivity (P < .001). Scholarly activity requirements were not associated with increased resident academic productivity. CONCLUSION This study represents the most comprehensive bibliometric assessment of neurosurgical resident academic productivity during training to date. New benchmarks for individual and department academic productivity are provided. A supportive research environment for neurosurgical residents is associated with increased academic productivity, but a scholarly activity requirement was, surprisingly, not shown to have a positive effect.
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Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hassan Saad
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas
| | - Chesney S Oravec
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Brittany Fraser
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jock C Lillard
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Siang Liao Lee
- Department of Neurosurgery, Louisiana State University, Shreveport, Louisiana
| | - Anna V Jones
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sonia Ajmera
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | | | - Kenneth A Moore
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Olutomi Akinduro
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Brandy Vaughn
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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30
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Nguyen V, Mangham W, Basma J, Khan N, Sorenson J, Michael LM. Resection of a Recurrent Cervicomedullary Junction Fibromyxoid Sarcoma through a Far Lateral Approach. J Neurol Surg B Skull Base 2020; 82:S39-S40. [PMID: 33717814 PMCID: PMC7935841 DOI: 10.1055/s-0040-1701688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/29/2019] [Indexed: 11/06/2022] Open
Abstract
Objectives
This study describes a far lateral approach for the resection of a recurrent fibromyxoid sarcoma involving the ventrolateral brainstem, with emphasis on the microsurgical anatomy and technique.
Design
A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses. The recurrent tumor is immediately visible. The involved dura is resected and aggressive internal debulking is performed. Subarachnoid dissection gives access to the lower cranial nerves. The tumor is dissected off the affected portions of the brainstem. A dural graft is used to reconstitute the dura. Photographs of the region are borrowed from Dr. Rhoton's laboratory to illustrate the microsurgical anatomy.
Participants
The senior author performed the surgery. The video was edited by Dr. V.N. chart review, and literature review were performed by Drs. W.M. and J.B.
Outcome measures
Outcome was assessed with the extent of resection and postoperative neurological function.
Results
A near gross total resection of the lesion was achieved. The patient developed a left vocal cord paresis, but her voice was improving at 3-month follow-up.
Conclusion
Understanding the microsurgical anatomy of the craniocervical junction and ventrolateral brainstem and meticulous microneurosurgical technique are necessary to achieve adequate resection of lesions involving the ventrolateral brainstem. The far lateral approach provides an adequate corridor to this region.
The link to the video can be found at:
https://youtube/uYEhgPbgrTs
.
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Affiliation(s)
- Vincent Nguyen
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - William Mangham
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Jaafar Basma
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Nickalus Khan
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Jeffrey Sorenson
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
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31
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Maroda AJ, Beckmann NA, Sheyn AM, Elijovich L, Michael LM, DiNitto JM, Rangarajan SV. Trimodal embolization of juvenile nasopharyngeal angiofibroma with intracranial extension. Int J Pediatr Otorhinolaryngol 2020; 130:109805. [PMID: 31864085 DOI: 10.1016/j.ijporl.2019.109805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/25/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/PURPOSE 1. Understand three different techniques for embolization of juvenile nasal angiofibroma (JNA) and assess their combined efficacy. 2. Perform successful endoscopic intralesional embolization of highly vascular sinonasal neoplasms. METHODS In this study, we present the case of a 10-year-old male patient diagnosed with juvenile nasal angiofibroma (JNA) who successfully underwent trimodal embolization and resection at a tertiary academic medical center after failed coil embolization in his home country. We examine the clinical details of the case and a review of pertinent literature. RESULTS Preoperative embolization is common in the treatment of JNA, but there is little consensus as to the proper timeframe and techniques utilized. In our case, preoperative imaging revealed a vascular tumor with intracranial extension consistent with UPMC Stage V JNA. Diagnostic angiogram revealed significant arborization from the internal and external carotid systems. A trimodal embolization technique, utilizing transarterial, percutaneous, and direct endoscopic intralesional injection of n-Butyl Cyanoacrylate (n-BCA) was performed. A two-staged endoscopic and open resection was subsequently performed one week later with minimal blood loss. In our case, combining intralesional embolization with traditional transarterial techniques resulted in an improved operative field and a successful clinical result. CONCLUSION Embolization of highly vascular sinonasal tumors with n-BCA is not limited to endovascular techniques, but can be safely combined with percutaneous and endoscopic intralesional embolization up to one week prior to surgical resection.
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Affiliation(s)
- Andrew J Maroda
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Nicholas A Beckmann
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Anthony M Sheyn
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Lucas Elijovich
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - L Madison Michael
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Julie M DiNitto
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA; Siemens Healthcare AG, Memphis, TN, USA.
| | - Sanjeet V Rangarajan
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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32
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Effendi ST, Momin EN, Basma J, Michael LM, Duckworth EAM. The Ultimate Skull Base Maneuver Does Not Involve Removing Bone: Quantifying the Benefits of the Interfascial Dissection. J Neurol Surg B Skull Base 2020; 81:62-67. [PMID: 32021751 DOI: 10.1055/s-0039-1679886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction Several adjunctive osteal skull base maneuvers have been proposed to increase surgical exposure of the anterolateral approach. However, one of the easiest methods does not involve bone: the interfascial temporalis muscle dissection. Methods Sequential dissections were performed bilaterally on five fixed silicone-injected cadaver heads. The amount of sphenoid drilling, scalp retraction, and brain retraction was standardized in all specimens. For each approach, surgical angles were measured for four deep targets: the tip of the anterior clinoid process, the internal carotid artery terminus, the origin of the posterior communicating artery, and the anterior communicating artery. Five surgical angles were measured for each target. Results There were increases on the order of 20% in the anteroposterior (AP)-mid, AP-lateral, and mediolateral-anterior angles for all deep targets with interfascial approach versus a myocutaneous flap. An orbitozygomatic osteotomy additionally increased almost all the angles, but incrementally less so. Conclusion An interfascial dissection increases the surgical exposure to a larger degree than additional osteotomies for several surgically relevant working angles. The addition of an orbitozygomatic osteotomy affords a particular benefit for the suprachiasmatic region. Increased adoption of interfascial mobilization or the temporalis muscle-an easily performed and low-risk maneuver-during anterolateral craniotomies may obviate the need for more involved skull base drilling.
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Affiliation(s)
- Sabih T Effendi
- Department of Neurosurgery, Houston Methodist, Houston, Texas
| | - Eric N Momin
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, United States
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33
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Gordon WE, Gienapp AJ, Khan NR, Hersh DS, Parikh K, Vaughn BN, Madison Michael L, Klimo P. Commentary: The Clinical Experience of a Junior Resident in Pediatric Neurosurgery and Introduction of the Resident Experience Score. Neurosurgery 2020; 86:E447-E454. [DOI: 10.1093/neuros/nyz565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/20/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- William E Gordon
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Andrew J Gienapp
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - David S Hersh
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Kara Parikh
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | | | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Semmes Murphey, Memphis, Tennessee
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Basma J, Nguyen VN, Mangham WM, Khan NR, Sorenson J, Michael LM. Far Lateral Approach for Clipping of a Posterior Inferior Cerebellar Artery Aneurysm. J Neurol Surg B Skull Base 2019; 80:S343. [PMID: 31750054 PMCID: PMC6864109 DOI: 10.1055/s-0039-1700893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives
To describe a far lateral approach for microsurgical clipping of a ruptured posterior inferior cerebellar artery (PICA) aneurysm involving the hypoglossal nerve, with emphasis on the microsurgical anatomy, and technique.
Design
A far lateral craniotomy is performed in the lateral decubitus position and the transverse and sigmoid sinuses were exposed. After opening the dura, sutures are placed to allow gentle mobilization of the sinuses. The ipsilateral cerebellar tonsil is mobilized and the PICA is followed to its junction with the vertebral artery. Hypoglossal nerve rootlets are draped over the dome of the aneurysm. Mobilization of the PICA and the hypoglossal nerve away from the lateral medulla allows microsurgical clipping of the aneurysm neck. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy.
Participants
The senior authors performed the surgery. The video was edited by Drs. V.N. and J.B. Chart review and literature review were performed by Drs. W.M. and J.B.
Outcome Measures
Outcome was assessed with successful clip occlusion and postoperative neurological function.
Results
There was complete clip occlusion of the PICA aneurysm with no postoperative neurological deficits. The patient was discharged home after an uneventful hospital course.
Conclusion
The far lateral approach provides an adequate corridor to the ventrolateral brainstem for microsurgical treatment of PICA aneurysms. An adequate understanding of the relevant microsurgical anatomy is the key to safe and effective clipping in this region.
The link to the video can be found at:
https://youtu.be/yhjKRIG5H74
.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - William M Mangham
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Jeffrey Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
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Venable GT, Dave P, Gordon WE, Fraser BD, Wallace DA, Mangham W, Taylor DR, Khan NR, Michael LM, Vaughn BN, Klimo P. Application of the Preventable Shunt Revision Rate to an Adult Population. World Neurosurg 2019; 134:e815-e821. [PMID: 31715417 DOI: 10.1016/j.wneu.2019.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The preventable shunt revision rate (PSRR) was recently introduced in pediatric hydrocephalus as a quality metric for shunt surgery. We evaluated the PSRR in an adult hydrocephalus population. METHODS All ventricular shunt operations (January 1, 2013 to March 31, 2018) performed at a university-based teaching hospital were included. For any index surgery (de novo or revision) resulting in reoperation within 90 days, the index surgery details were collected, and a consensus decision was reached regarding whether the failure had been potentially avoidable. Preventable failure was defined as failure due to infection, malposition, disconnection, migration, or kinking. The 90-day shunt failure rate and PSRR were calculated. Bivariate analyses were performed to evaluate the individual effects of each independent variable on preventable shunt failure. RESULTS A total of 318 shunt operations had been performed in 245 patients. Most patients were women (62%), with a median age of 48.2 years (interquartile range, 31.2-63.2 years). Most had had ventriculoperitoneal shunts placed (86.5%), and just more than one half were new shunts (51.6%). A total of 53 cases (16.7%) in 42 patients experienced shunt failure within 90 days of the index operation. Of these, 27 failures (8.5% of the total cases; 51% of the failures) were considered potentially preventable. The most common reasons were infection (37%; n = 10) and malposition of the proximal and distal catheters (both 25.9%; n = 7). Age was the only statistically significant difference between the 2 groups, with the patients experiencing preventable shunt failure older than those without preventable shunt failure (51.4 vs. 37.1 years; P = 0.017). CONCLUSIONS The 90-day PSRR can be applied to an adult population and serve as a quality metric.
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Affiliation(s)
- Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - William E Gordon
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brittany D Fraser
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David A Wallace
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - William Mangham
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Douglas R Taylor
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Clinic, Memphis, Tennessee, USA
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Clinic, Memphis, Tennessee, USA; Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
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36
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Basma J, Michael LM, Sorenson JM, Robertson JH. Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study. J Neurol Surg B Skull Base 2019; 80:518-526. [PMID: 31534895 DOI: 10.1055/s-0038-1676512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Methods Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Results Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. Conclusion The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Jeffrey M Sorenson
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
| | - Jon H Robertson
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States.,Medical Education Research Institute, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States
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37
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Nguyen VN, Basma J, Sorenson J, Michael LM. Microvascular Decompression for Geniculate Neuralgia through a Retrosigmoid Approach. J Neurol Surg B Skull Base 2019; 80:S322. [PMID: 31143613 PMCID: PMC6534696 DOI: 10.1055/s-0038-1676837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/11/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives
To describe a retrosigmoid approach for the microvascular sectioning of the nervus intermedius and decompression of the 5th and 9th cranial nerves, with emphasis on microsurgical anatomy and technique.
Design
A retrosigmoid craniectomy is performed in the lateral decubitus position. The dura is opened and cerebrospinal fluid (CSF) is released from the cisterna magna and cerebellopontine cistern. Dynamic retraction without rigid retractors is performed. Subarachnoid dissection of the cerebellopontine angle exposes the 7th to 8th nerve complex. A neuromonitoring probe is used with careful inspection of the microsurgical anatomy to identify the facial nerve and the nervus intermedius as they enter the internal auditory meatus. The nervus intermedius is severed. A large vein coursing superiorly across cranial 9th nerve was coagulated and cut. A Teflon pledget is inserted between a small vessel and the 5th nerve. Photographs of the region are borrowed from Dr. Rhoton's laboratory to illustrate the microsurgical anatomy.
Participants
The senior author performed the surgery. The video was edited by Drs. V.N. and J.B.
Outcome Measures
Outcome was assessed by postoperative neurological function.
Results
The nervus intermedius was successfully cut and the 5th and 9th nerves were decompressed. The patient's pain resolved after surgery and at later follow-up.
Conclusions
Understanding the microsurgical anatomy of the cerebellopontine angle is necessary to identify the cranial nerves involved in facial pain syndromes. Subarachnoid dissection and meticulous microsurgical techniques are key elements for a successful microvascular decompression.
The link to the video can be found at:
https://youtu.be/pV5Wip7WusE
.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Jaafar Basma
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Jeffrey Sorenson
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
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38
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Motiwala M, Ajmera S, Akinduro O, Wallace D, Norrdahl SP, Schultz A, Fraser B, Saad H, Justo M, Dave P, Nguyen V, Vaughn B, Michael LM, Klimo P. How Does the Media Portray Neurosurgeons? World Neurosurg 2019; 122:e598-e605. [PMID: 31108076 DOI: 10.1016/j.wneu.2018.10.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is not unusual to find neurosurgeons in the news and entertainment. The present study examined the portrayal of neurosurgeons by major print and online media sources. METHODS Two search strategies identified articles from October 1, 2012 to October 1, 2017 containing the keyword "neurosurgeon." The top 25 newspapers in the United States, determined by their circulation, were searched using the LexisNexis Academic or NewsBank databases; a layman's Google News search was used to collect online stories. Each identified article was evaluated to confirm the relevance and then examined for content. Relevant characteristics for each article and neurosurgeon were determined and analyzed. RESULTS Our searches returned 1005 articles comprising 561 unique stories about 203 different neurosurgeons. One particular neurosurgeon had 459 reports (45.7%). More articles were reported in 2015 (405; 40.3%) than any other single year. Most articles featured male neurosurgeons (879; 87.1%) and neurosurgeons who had been practicing for >20 years (636; 63.0%), with just 10 institutions accounting for the training of most of them (733; 72.6%). The articles were classified as positive (270; 26.9%), negative (356; 35.4%), or neutral (379; 37.7%) in terms of their reflection on the field of neurosurgery. The odds of a negative story were greater for male neurosurgeons, within 10 years of residency completion, and in a nonacademic position. CONCLUSIONS Neurosurgeons are naturally subject to media coverage, and we must be cognizant that this predilection can serve as both an occupational advantage and an occupational hazard.
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Affiliation(s)
- Mustafa Motiwala
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sonia Ajmera
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Olutomi Akinduro
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Wallace
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Andrew Schultz
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brittany Fraser
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Hassan Saad
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas, USA
| | - Melissa Justo
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Vincent Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brandy Vaughn
- Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Semmes Murphey, Memphis, Tennessee, USA.
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Basma J, Nguyen V, Sorenson J, Michael LM. Extended Retrosigmoid Approach for the Resection of a Pontomedullary Junction Cavernous Malformation. J Neurol Surg B Skull Base 2018; 79:S418-S419. [PMID: 30456048 PMCID: PMC6240420 DOI: 10.1055/s-0038-1669979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/11/2018] [Indexed: 12/03/2022] Open
Abstract
Objectives
To describe an extended retrosigmoid approach for the resection of a cavernoma involving the ponto-medullary junction, with emphasis on the microsurgical anatomy and technique.
Design
A retrosigmoid craniotomy is performed in the lateral decubitus position and the sigmoid sinus exposed. After opening the dura, sutures are placed medial to the sinus to allow its gentle mobilization. Cerebrospinal fluid (CSF) is drained from the cisterna magna, and cerebellopontine cistern, and dynamic retraction is used over the cerebellum. Subarachnoid dissection of the cerebellopontine angle gives access to cranial nerves IX/X, VII/VIII, and VI. Inspection of the pontomedullary junction medial to the facial nerve reveals hemosiderin staining in that region. A small pial opening is made, exposing the hemorrhagic cavity. The cavernous malformation is then identified, dissected circumferentially, and resected. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy.
Participants
The senior author performed the surgery. The video was edited by Drs. J.B. and V.N.
Outcome Measures
Outcome was assessed with extent of resection and postoperative neurological function.
Results
A gross total resection of the lesion was achieved. The patient did not develop any postoperative deficits.
Conclusion
Understanding the microsurgical anatomy of the cerebellopontine angle and meticulous microneurosurgical technique are necessary to achieve a complete resection of a brainstem cavernoma. The extended retrosigmoid approach provides an adequate corridor to the pontomedullary junction.
The link to the video can be found at:
https://youtu.be/FIKixWJT75w
.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Vincent Nguyen
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Jeffrey Sorenson
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
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40
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Gordon WE, Gienapp AJ, Jones M, Michael LM, Klimo P. An Analysis of the On-Call Clinical Experience of a Junior Neurosurgical Resident. Neurosurgery 2018; 85:290-297. [DOI: 10.1093/neuros/nyy248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
The process of transforming a medical student to a competent neurosurgeon is becoming increasingly scrutinized and formalized. However, there are few data on resident workload.
We sought to quantify the workload and educational experience of a junior resident while “on-call.”
A single resident's on-call log was reviewed from the period of July 1, 2014 to June 30, 2016, corresponding to that resident's postgraduate years 2 and 3. For each patient encounter (ie, consult or admission), information pertaining to the patient's demographics, disease or reason for consult, date/time/location of consult, and need for any neurosurgical intervention within the first 24 hours was collected.
In total, 1929 patients were seen in consultation. The majority of patients were male (62%) with a median age of 50 years (range, day of life 0-102 years) and had traumatic diagnoses (52%). The number of consults received during the 16:00 to 17:00 and 17:00 to 18:00 hours was +1.6 and +2.5 standard deviations above the mean, respectively. The busiest and slowest months were May and January, respectively. Neurosurgical intervention performed within the first 24 hours of consultation occurred in 330 (17.1%) patients: 221 (11.4%) major operations, 69 (3.6%) external ventricular drains, and 40 (2.1%) intracranial pressure monitors.
This is the first study to quantify the workload and educational experience of a typical neurosurgical junior resident while “on-call” (ie, carrying the pager) for 2 consecutive years. It is our hope that these findings are considered by neurosurgical educators when refining resident education.
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Affiliation(s)
- William E Gordon
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Andrew J Gienapp
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Department of Medical Education, Methodist University Hospital, Memphis, Tennessee
| | - Morgan Jones
- Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
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41
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. In Reply: Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2018; 82:E188-E189. [PMID: 29618065 DOI: 10.1093/neuros/nyy102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine University of Tennessee Health Science Center Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine University of Tennessee Health Science Center Memphis, Tennessee
| | - Kevin Reed
- College of Medicine University of Tennessee Health Science Center Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery New York University Langone Medical Center New York, New York
| | - Fred G Barker
- Department of Neurosurgery Massachusetts General Hospital Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery University of Tennessee Health Science Center Memphis, Tennessee.,Semmes Murphey Clinic Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery University of Tennessee Health Science Center Memphis, Tennessee.,Semmes Murphey Clinic Memphis, Tennessee.,Le Bonheur Children's Hospital Memphis, Tennessee
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42
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Nguyen V, Basma J, Klimo P, Sorenson J, Michael LM. Orbitopterional Approach for the Resection of a Suprasellar Craniopharyngioma: Adapting the Strategy to the Microsurgical and Pathologic Anatomy. J Neurol Surg B Skull Base 2018; 79:S239-S240. [PMID: 29588881 PMCID: PMC5868920 DOI: 10.1055/s-0038-1623525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/07/2017] [Indexed: 10/26/2022] Open
Abstract
Objectives To describe the orbitopterional approach for the resection of a suprasellar craniopharyngioma with emphasis on the microsurgical and pathological anatomy of such lesions. Design After completing the orbitopterional craniotomy in one piece including a supraorbital ridge osteotomy, the Sylvian fissure was split in a distal to proximal direction. The ipsilateral optic nerve and internal carotid artery were identified. Establishing a corridor to the tumor through both the opticocarotid and optic cisterns allowed for a wide angle of attack. Using both corridors, a microsurgical gross total resection was achieved. A radical resection required transection of the stalk at the level of the hypothalamus. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Understanding the cisternal and topographic relationships of the optic nerve, optic chiasm, and internal carotid artery is critical to achieving gross total resection while preserving normal anatomy. Participants The surgery was performed by the senior author assisted by Dr. Jaafar Basma. The video was edited by Dr. Vincent Nguyen. Outcome Measures Outcome was assessed with extent of resection and postoperative visual function. Results A gross total resection of the tumor was achieved. The patient had resolution of her bitemporal hemianopsia. She had diabetes insipidus with normal anterior pituitary function. Conclusions Understanding the microsurgical anatomy of the suprasellar region and the pathological anatomy of craniopharyngiomas is necessary to achieve a good resection of these tumors. The orbitopterional approach provides the appropriate access for such endeavor. The link to the video can be found at: https://youtu.be/Be6dtYIGqfs .
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Affiliation(s)
- Vincent Nguyen
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.,Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
| | - Jaafar Basma
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.,Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
| | - Paul Klimo
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
| | - Jeffrey Sorenson
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.,Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States.,Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, United States
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43
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Basma J, Nguyen V, Sorenson J, Michael LM. Orbitopterional Approach with Extradural Clinoidectomy for the Resection of a Tuberculum Sellae Meningioma: Adapting the Strategy to the Microsurgical and Pathological Anatomy. J Neurol Surg B Skull Base 2018; 79:S261-S262. [PMID: 29588892 PMCID: PMC5868926 DOI: 10.1055/s-0038-1623523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/07/2017] [Indexed: 10/25/2022] Open
Abstract
Objectives To describe the orbitopterional approach with extradural clinoidectomy for the resection of a tuberculum sellae meningioma, with an emphasis on the microsurgical and pathological anatomy of such lesions. Design After completing the orbitopterional craniotomy in one piece, the optic nerve is identified extradurally, unroofed, and the clinoid process resected. The falciform ligament is divided and the optic nerve is decompressed extradurally. Opening the frontotemporal dura exposes the tumor in the subfrontal region. The tumor is followed along the ipsilateral and contralateral optic nerves, and its dural tail is cut and coagulated at the level of the tuberculum. Care is taken to preserve the optic nerve perforators during the dissection. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The surgery was performed by the senior author assisted by Dr. Jaafar Basma, neurosurgery fourth-year resident. The video was edited by Dr. Vincent Nguyen, neurosurgery third-year resident. Outcome Measures Outcome was assessed with the extent of resection and visual symptoms. Results A near-total resection of the tumor was achieved. A small part of tumor significantly adherent to the optic nerve was intentionally left behind. The patient had a stable vision examination postoperatively. Conclusions Understanding the microsurgical anatomy of the suprasellar region and the pathological anatomy of the tuberculum sellae meningioma is necessary to achieve a good resection of these tumors while preserving functionality of the optic apparatus. The orbitopterional approach with anterior clinoidectomy provides the appropriate access for such endeavor. The link to the video can be found at: https://youtu.be/WtAP8uqSW0M .
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Vincent Nguyen
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - Jeffrey Sorenson
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
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44
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Khan NR, Saad H, Oravec CS, Rossi N, Nguyen V, Venable GT, Lillard JC, Patel P, Taylor DR, Vaughn BN, Kondziolka D, Barker FG, Michael LM, Klimo P. A Review of Industry Funding in Randomized Controlled Trials Published in the Neurosurgical Literature—The Elephant in the Room. Neurosurgery 2018; 83:890-897. [DOI: 10.1093/neuros/nyx624] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hassan Saad
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas
| | - Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nicholas Rossi
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vincent Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jock C Lillard
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas
| | - Prayash Patel
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas R Taylor
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brandy N Vaughn
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Fred G Barker
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
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45
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Venable GT, Roberts ML, Lee RP, Michael LM. Primary Dural Closure for Retrosigmoid Approaches. J Neurol Surg B Skull Base 2017; 79:330-334. [PMID: 30009112 PMCID: PMC6043179 DOI: 10.1055/s-0037-1607455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 07/10/2017] [Indexed: 11/19/2022] Open
Abstract
Object
Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported.
Methods
A retrospective chart review was conducted on all cases of retrosigmoid craniotomies performed by the senior surgeon from February 2009 to February 2015. The primary outcome was development of postoperative CSF leak or pseudomeningocele. Length of stay, lesion type, and other surgical complications were also reported.
Results
Eighty-six patients underwent a retrosigmoid craniotomy during the study period. The most common indications for retrosigmoid craniotomy were microvascular decompression (58%) and tumor resection (36%). No allo- or autografts to repair the dural defect were needed, and no lumbar drains were used. No patients developed CSF otorrhea, rhinorrhea, or incisional leak postoperatively.
Conclusion
Primary dural closure is possible in retrosigmoid approaches without the use of allo- or autografts and may prevent postoperative CSF leaks when combined with other posterior fossa closure techniques. Careful attention to the handling of the dural flap is necessary to achieve this.
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Affiliation(s)
- Garrett T Venable
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mallory L Roberts
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Ryan P Lee
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee, United States
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46
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Khan NR, Nguyen V, Michael LM. The role of endoscopy in anterior skull base surgery. J Neurosurg Sci 2017; 62:1-3. [PMID: 28895661 DOI: 10.23736/s0390-5616.17.04202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vincent Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA - .,Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
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47
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Giurintano JP, Somerville J, Sebelik M, Hoit D, Michael LM, Shires CB. Endovascular Extraction of a Needle from the Internal Carotid Artery: A Novel Approach to a Controversial Dental Misadventure. J Neurol Surg Rep 2017; 78:e106-e108. [PMID: 28845380 PMCID: PMC5568860 DOI: 10.1055/s-0037-1604282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/08/2017] [Indexed: 11/10/2022] Open
Abstract
Objective
To review the literature concerning the management of dental needles broken off into the deep spaces of the neck, to report what we believe is the first case of a fractured dental needle migrating into the jugular foramen, and the unconventional use of endovascular intervention to retrieve the needle fragment.
Design
Case report with review of literature.
Setting
Academic tertiary care center.
Participants
Intervention was performed by the otolaryngology–head and neck surgery, vascular surgery, and neurovascular interventional radiology teams.
Results
Transoral exploration, including palatal split and exposure of the poststyloid parapharyngeal space with C-arm image guidance, was unable to retrieve the broken needle, which traversed the internal carotid lumen with the distal end entering the jugular foramen. Through endovascular intervention, the neurovascular interventional radiology team captured the proximal end of the needle and retrieved it through the femoral artery. The patient recovered uneventfully.
Conclusion
Fracture and loss of oral injection needles remain a persistent and preventable problem. This case demonstrates a novel, minimally invasive, well-tolerated, and successful method to extract a fractured needle that migrated into the lumen of the internal carotid artery at the level of the skull base.
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Affiliation(s)
- Jonathan P Giurintano
- Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Jessica Somerville
- Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Merry Sebelik
- Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, Georgia, United States
| | - Daniel Hoit
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Courtney B Shires
- Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
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48
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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49
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Wakefield DV, Venable GT, VanderWalde NA, Michael LM, Sorenson JM, Robertson JH, Cunninghan D, Ballo MT. Comparative Neurologic Outcomes of Salvage and Definitive Gamma Knife Radiosurgery for Glomus Jugulare: A 20-Year Experience. J Neurol Surg B Skull Base 2017; 78:251-255. [PMID: 28593112 DOI: 10.1055/s-0036-1597986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022] Open
Abstract
Objective This case series investigates management of glomus jugulare (GJ) tumors utilizing definitive and salvage Gamma Knife stereotactic radiosurgery (GKSRS). Methods A retrospective chart review was performed to collect data. Statistical analysis included patient, tumor, and treatment information. Results From 1996 to 2013, 17 patients with GJ received GKSRS. Median age was 64 years (range, 27-76). GKSRS was delivered for definitive treatment in eight (47%) and salvage in nine (53%) patients. Median tumor volume was 9.8 cm 3 (range, 2.8-42 cm 3 ). Median dose was 15 Gy (range, 13-18 Gy). Median follow-up was 123 months (range, 38-238 months). Tumor size decreased in 10 (59%), stabilized in 6 (35%), and increased in 1 patient (6%). Overall neurological deficit improved in 53%, stabilized in 41%, and worsened in 6% of patients. Overall cause-specific survival was 100%, and actuarial local control was 94%. Eighty-eight percent of patients without prior resection experienced neurologic deficit improvement, while 25% of patients with prior resection experienced neurologic improvement ( p = 0.02). Conclusion Gamma Knife radiosurgery provides effective long-term control of GJ and overall improvement or stabilization of neurological deficit in most patients. Patients with prior resection are less likely to experience improvement of neurologic deficit.
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Affiliation(s)
- Daniel V Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,West Cancer Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Jeffery M Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Jon H Robertson
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - David Cunninghan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Clinic, Memphis, Tennessee, United States.,Memphis Regional Gamma Knife Center, Memphis, Tennessee, United States
| | - Matthew T Ballo
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,West Cancer Center, Memphis, Tennessee, United States
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50
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Khan NR, Klimo P, Michael LM. Predicting Academic Career Placement: Neurosurgery's Quest for the Holy Grail. World Neurosurg 2017; 101:746-747. [DOI: 10.1016/j.wneu.2017.03.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
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