1
|
Guadix SW, Pandey A, Gundlach C, Walsh M, Moss NS, Souweidane MM. Laser interstitial thermal therapy as a radiation-sparing approach for central nervous system tumors in children with cancer predisposition syndromes: report of a child with Li-Fraumeni syndrome. Illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23595. [PMID: 38315990 PMCID: PMC10849145 DOI: 10.3171/case23595] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Ionizing radiation and alkylating chemotherapies increase secondary malignancy risk in patients with cancer predisposition syndromes (CPSs), such as Li-Fraumeni syndrome. Laser interstitial thermal therapy (LITT) is a minimally invasive ablation technique that has not been associated with mutagenic risks. We describe the case of a child with LFS and a history of treated choroid plexus carcinoma (CPC) who developed a second primary glial tumor that was safely treated with magnetic resonance imaging (MRI)-guided LITT. OBSERVATIONS A 4-year-old male with left parietal World Health Organization grade III CPC associated with a TP53 germline mutation was evaluated. The patient underwent neoadjuvant platinum-based chemotherapy before near-total resection, followed by 131I-8H9 immunotherapy and 30 fractions of 54-Gy proton radiotherapy. He remained without evidence of disease for 2 years before developing a slow-growing mass adjacent to the left frontal ventricular horn. Stereotactic biopsy revealed a glial neoplasm. Given the nonsuperficial location and focality of the lesion, MRI-guided LITT was performed for ablative therapy. There were no complications, and 2 years of surveillance revealed continued retraction of the ablated tumor focus and no subsequent disease. LESSONS Alternatives to mutagenic therapies for brain tumors should be explored for patients with CPS. LITT paired with imaging surveillance is a logical strategy to ensure durable outcomes and mitigate treatment-related secondary neoplasms.
Collapse
Affiliation(s)
- Sergio W Guadix
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
| | - Abhinav Pandey
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
| | - Carson Gundlach
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
| | - Michael Walsh
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nelson S Moss
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark M Souweidane
- 1Department of Neurological Surgery, Weill Cornell Medicine, New York, New York; and
- 2Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
2
|
Tosi U, Guadix SW, Cohen AR, Souweidane MM. Neuroendoscopy: How We Got Here. World Neurosurg 2023; 178:298-304. [PMID: 37803685 DOI: 10.1016/j.wneu.2023.07.124] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/08/2023]
Abstract
From its inception in ancient Egyptian rituals, neuroendoscopy always promised a minimally invasive route to the cerebrum. Early visionaries, however, hit the proverbial wall of technical development until the 20th century, when new technologies allowed for light to be transmitted across a tube for visualization of intracranial structures. Despite a hiccupping start, with surgical microscopy hampering initial excitement, the development and transformation of neuroendoscopy continued, and today it is a widespread and reliable surgical option for the treatment of numerous varied and complex pathologies.
Collapse
Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Alan R Cohen
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
| |
Collapse
|
3
|
Tosi U, Guadix SW, Souweidane MM. Neuroendoscopy: The State of the Art. World Neurosurg 2023; 178:305-310. [PMID: 37803686 DOI: 10.1016/j.wneu.2023.07.125] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/08/2023]
Abstract
Over the past century, neuroendoscopy developed into a mainstay of neurosurgical practice, allowing for minimally invasive approaches to the ventricles, skull base, and spine. Its development, however, is far from over. Current challenges are inherent in the very feature that renders neuroendoscopy appealing-the small channels of the modern endoscope allow surgery to be performed with minimal tissue retraction, but they also make hemostasis and resection of large masses difficult. New optics allow for significantly improved image quality; yet open craniotomy often allows for 3-dimensional visualization and bimanual dissection and is part of everyday neurosurgical training. Finally, the utilization of neuroendoscopy remains limited, presenting ongoing challenges for neurosurgical teaching and achievement of technical mastery.
Collapse
Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
| |
Collapse
|
4
|
Medina MP, Imahiyerobo T, Odigie E, Guadix SW, De Silva N, Buontempo M, Souweidane MM, Hoffman CE. Comparative Analysis of 2D and 3D Metrics for Evaluation of Postoperative Outcomes Following Endoscopic Suturectomy for Sagittal Craniosynostosis. J Craniofac Surg 2023; 34:1699-1704. [PMID: 37477605 DOI: 10.1097/scs.0000000000009485] [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: 04/03/2023] [Accepted: 05/09/2023] [Indexed: 07/22/2023] Open
Abstract
To assess whether 3-dimensional (3D) volumetrics can be used to track and evaluate postoperative course of patients treated with endoscopic suturectomy for nonsyndromic sagittal synostosis, we compared changes in 2-dimensional (2D) measurements along with 3D volumetric correlates throughout the period of helmet therapy. Forty-six patients treated at our institution with endoscopic suturectomy for sagittal synostosis were retrospectively reviewed. Head circumference (HC), cephalic index (CI), and total cranial volumes (TCVs) were measured at 3 timepoints following surgery using optical surface scans obtained for helmet orthotics. All measurements showed significant differences between timepoints on the analysis of variance ( P <0.001). There was a significant correlation between CI and TCV (r=0.35, P =0.004) and between HC and TCV (r=0.81, P <0.001). The normalized rate of change over the course of treatment was significantly higher for TCV (36.7%) than for CI (8.8%) and HC (8.4%, P <0.001), with no difference between HC and CI. The authors conclude that 3D metrics were able to reliably follow the course of postoperative 2D metrics. There was a direct and linear correlation between HC and CI with TCV. Total cranial volumes showed the highest rate of sustained change at every timepoint. Although CI and HC plateau after the first measurement, TCV continues to adapt over the course of treatment. These results demonstrate the feasibility and value of volumetrics from 3D imaging to provide a more comprehensive evaluation of postoperative surgical outcomes than traditional 2D metrics without the ionizing radiation traditionally utilized for CT to obtain 3D metrics.
Collapse
Affiliation(s)
- Mauricio P Medina
- Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
| | - Thomas Imahiyerobo
- Department of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
- Department of Plastic & Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY
| | - Eseosa Odigie
- Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
| | - Sergio W Guadix
- Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
| | - Neranjan De Silva
- Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
| | - Michelle Buontempo
- Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
- Department of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
| | - Mark M Souweidane
- Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
| | - Caitlin E Hoffman
- Department of Neurological Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
- Department of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital-Weill Cornell Medicine
| |
Collapse
|
5
|
Guadix SW, Marianayagam NJ, Weidman EK, Yuan M, Liechty B, Greenfield JP, Souweidane MM. Defining Occult High-Risk Cysts of the Pineal Region: A Case Series. Oper Neurosurg (Hagerstown) 2023; 24:572-581. [PMID: 36716050 DOI: 10.1227/ons.0000000000000620] [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: 04/29/2022] [Accepted: 11/08/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Absence of hydrocephalus on neuroimaging may impart a false sense of security for patients with pineal cysts. In this case series, we characterize a subset of patients with pineal cysts having an occult presentation. Unifying features of worsening paroxysmal headaches suggesting intermittent obstructive hydrocephalus and radiographic evidence of third ventricular invagination characterize these patients as high risk. OBJECTIVE To define features of occult, high-risk pineal cysts and outcomes of endoscopic cyst fenestration. METHODS Charts were retrospectively reviewed for patients with pineal cysts evaluated at our institution between 2018 and 2021 who underwent endoscopic cyst fenestration. To capture cysts presenting as occult, patients were excluded if hydrocephalus was noted at presentation. Relevant clinical history, imaging, operative data, and clinical outcomes were reviewed. RESULTS Of 50 pineal cyst patients, 4 satisfied inclusion criteria. All patients presented with worsening paroxysmal headaches. In addition, 75% (3/4) also experienced intermittent syncope. Patients exhibited no hydrocephalus (n = 3) or fluctuating ventricular size on longitudinal imaging (n = 1). In all cases, high-resolution sagittal 3-dimensional T2 magnetic resonance imaging demonstrated invagination of the cyst anteriorly into the posterior third ventricle. All patients underwent endoscopic cyst fenestration with complete symptom resolution (mean follow-up of 20.6 months; range 3.5-37.4 months). CONCLUSION The clinical history for occult, high-risk pineal cysts is notable for worsening paroxysmal headaches and episodic alterations of consciousness suggesting intermittent obstructive hydrocephalus. Because ventricular size can appear normal on standard imaging protocols, clinical suspicion should trigger workup with high-resolution magnetic resonance imaging designed to detect these cysts. Endoscopic cyst fenestration is a safe and efficacious management strategy.
Collapse
Affiliation(s)
- Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Neelan J Marianayagam
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Elizabeth K Weidman
- Department of Radiology, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Melissa Yuan
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Benjamin Liechty
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
6
|
Guadix SW, Garman TS, Gundlach C, Pisapia DJ, Souweidane MM. Durability of an endoscopic management strategy for recurrent choroid plexus carcinoma with a comprehensive molecular characterization: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22508. [PMID: 36880511 PMCID: PMC10550668 DOI: 10.3171/case22508] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/14/2022] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Choroid plexus carcinoma (CPC) is a rare, primarily intraventricular neoplasm. Extent of resection correlates with improved outcomes but is limited due to tumor vascularity and size. Evidence on optimal surgical management and molecular drivers of recurrence remains limited. Here the authors characterize a case of multiply recurrent CPC treated with sequential endoscopic removals over 10 years and highlight its genomic properties. OBSERVATIONS Five years after standard treatment, a 16-year-old female presented with a distant intraventricular recurrence of CPC. Whole exome sequencing revealed NF1, PER1, and SLC12A2 mutations, FGFR3 gain, and no TP53 alterations. Repeat sequencing on recurrences 4 and 5 years later showed persistent NF1 and FGFR3 alterations. Methylation profiling was consistent with plexus tumor, subclass pediatric B. Short-term magnetic resonance imaging detected four total isolated recurrences, all treated with complete endoscopic resections at 5, 6.5, 9, and 10 years after initial diagnosis. Mean hospital stay for all recurrences was 1 day with no complications. LESSONS The authors describe a patient with four isolated recurrences of CPC over a decade, each treated with complete endoscopic removal, and identify unique molecular alterations that persisted without TP53 alterations. These outcomes support frequent neuroimaging to facilitate endoscopic surgical removal following early detection of CPC recurrence.
Collapse
Affiliation(s)
| | - Tyler S. Garman
- Brady Urological Institute & Department of Urology, Johns Hopkins University, Baltimore, Maryland; and
| | | | - David J. Pisapia
- Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Mark M. Souweidane
- Departments of Neurological Surgery, and
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
7
|
Rallo MS, Zappi KE, Koller GM, Guadix SW, Kortz MW, Hersh DS, Pannullo SC. Letter: Addressing Barriers to Student Participation in Neurosurgical Conferences: Experiences From the Inaugural Early Career Neuroscience Virtual Research Symposium. Neurosurgery 2023; 92:e66-e68. [PMID: 36700755 DOI: 10.1227/neu.0000000000002315] [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: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Michael S Rallo
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc, Pasadena, California, USA
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kyle E Zappi
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc, Pasadena, California, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Gretchen M Koller
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc, Pasadena, California, USA
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, USA
| | - Sergio W Guadix
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc, Pasadena, California, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Michael W Kortz
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc, Pasadena, California, USA
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David S Hersh
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc, Pasadena, California, USA
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Susan C Pannullo
- Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc, Pasadena, California, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
8
|
Koller GM, Reardon T, Kortz MW, Shlobin NA, Guadix SW, McCray E, Radwanski RE, Snyder HM, DiGiorgio AM, Hersh DS, Pannullo SC. Shared Objective Mentorship via Virtual Research and Education Initiatives for Medical Students and Residents in Neurosurgery: A Systematic Review and Methodological Discussion of the Neurosurgery Education and Research Virtual Group Experience. World Neurosurg 2023; 172:20-33. [PMID: 36646418 DOI: 10.1016/j.wneu.2023.01.035] [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: 09/24/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Virtual mentorship and research programs are becoming increasingly popular to facilitate education and career development for students and residents. We review virtual research initiatives for early trainees in neurosurgery and describe our effort to expand access to resources and shared objective mentorship (SOM) via the novel Neurosurgery Education and Research Virtual Group (NERVE). METHODS A systematic review of neurosurgical programming delivered via a virtual platform was conducted using PubMed, Embase, and Scopus databases. Identified articles were screened. Those meeting prespecified inclusion criteria were reviewed in full and examined for relevant data. Data analysis was performed using Microsoft Excel, and means and standard deviations were calculated. Descriptive analysis of NERVE characteristics was also performed. RESULTS Of the 2438 identified articles, 10 were included. The most common (70%) implementation style was a webinar-based lecture series. The least common (10%) was a longitudinal curricular interest group. Of the total NERVE cohort, 90% were first generation medical students and 82% attended institutions without home programs. Survey results indicated 73.8% had contributed to at least 2 research projects throughout the year. CONCLUSIONS There is a scarcity of virtual neurosurgical resources which facilitate SOM opportunities for trainees. In our systematic review, NERVE is the only multi-institutional virtual initiative aimed at increasing access to neurosurgical education and research opportunities for the purpose of SOM among early trainees from disadvantaged backgrounds. This highlights the group's niche and potential impact on increasing diversity in neurosurgery, improving trainees' career development, and facilitating future resident research productivity.
Collapse
Affiliation(s)
- Gretchen M Koller
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA.
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Michael W Kortz
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Nathan A Shlobin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Edwin McCray
- Department of Orthopedic Surgery, University of Arizona, Tucson, Arizona, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Ryan E Radwanski
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA; Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Harrison M Snyder
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Anthony M DiGiorgio
- Department of Neurosurgery, University of California, San Francisco, California, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| |
Collapse
|
9
|
Evins AI, Rothbaum M, Kim N, Guadix SW, Boyette D, Xia JJ, Stieg PE, Bernardo A. A novel 3D surgical neuroanatomy course for medical students: Outcomes from a pilot 6-week elective. J Clin Neurosci 2023; 107:91-97. [PMID: 36527811 DOI: 10.1016/j.jocn.2022.12.009] [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: 11/02/2022] [Revised: 11/17/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Developing and maintaining a three-dimensional working knowledge of neuroanatomy is an essential skill in neurosurgery. However, conventional 2D head, neck, and neuroanatomy education is typically characterized by the separate rote learning of constituent tissues and often fails to provide learners with a contextual understanding of the relationships between these highly complex and interconnected structures. This can pose a significant challenge to medical students entering neurosurgery who lack a topographic understanding of intracranial anatomy. METHODS We report on the design and efficacy of a novel 6-part 3D surgical neuroanatomy pilot elective for medical students that utilized a navigation-based pedagogical technique with the goal of providing students with a framework for developing a 3D mental map of the skull base, neurovasculature, ventricular system, and associated brain regions. Students took on the perspective of physically traveling along the paths of key structures with a 360-degree view of surrounding anatomy such that they could appreciate the integration and relative spatial relationships of the varying tissues within the cranium. Mental navigation exercises and pre- and post-course surveys were used to assess students' baseline and learned familiarity with the different anatomical regions covered. RESULTS At the conclusion of the course, all students were able to successfully complete all of the multifaceted mental navigation exercises. Post-course survey data indicated that respondents perceived significant increases in their knowledge of cranial nerves; anterior, middle, and posterior skull base anatomy; anterior and posterior cranial circulation; and the ventricular system. CONCLUSION 3D navigation-based fly-through instruction is a novel and effective technique for teaching complex anatomy and can provide learners with the foundational skills for developing and maintaining a 3D mental map of intracranial anatomy.
Collapse
Affiliation(s)
- Alexander I Evins
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Michael Rothbaum
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA; Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - NamHee Kim
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Deborah Boyette
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA; Department of Neurological Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jimmy J Xia
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA; Department of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Antonio Bernardo
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
10
|
Radwanski RE, Winston G, Younus I, Guadix SW, Shlobin NA, Rothbaum M, Kortz MW, Campbell JM, Evins A, Greenfield JP, Pannullo SC. Reevaluating Innovations in Medical Student Neurosurgery Education: Lessons Learned Today from Data Collected Before COVID-19. World Neurosurg 2022; 163:171-178. [PMID: 35729818 DOI: 10.1016/j.wneu.2021.11.022] [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: 09/25/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Virtual learning has made neurosurgery education more available to medical students (MSs) of all stages than ever before. We aimed to evaluate the impact of on-site learning in order to assess whether a return to this method of teaching, when safe, is warranted for MSs of all years. METHODS Registrants of the 2019 MS Neurosurgery Training Camps were sent precourse and postcourse surveys to assess changes in self-assessed confidence in concrete neurosurgical skills. Data were analyzed using a 2-tailed paired Student's t-test for continuous variables. A P value <0.05 was considered significant. RESULTS The 2019 Training Camp had 105 attendees, of whom 94 (89.5%) completed both surveys. Students reported statistically significant improvements in every surveyed skill area, except for understanding what is and is not sterile in an operating room. The cohort of MS 3/4 students indicated a postcourse decrease in confidence in their ability to understand what is and is not sterile in an operating room (93.69 ± 16.41 vs. 86.20 ± 21.18; P < 0.05). MS 3/4 students did not benefit in their ability to perform a neurologic examination or tie knots using a 1-handed technique. CONCLUSIONS Neurosurgical education initiatives for MSs should continue to be developed. Hands-on neurosurgical training experiences for MSs serve as a valuable educational experience. Improvement in training models will lead to capitalizing on MS education to better improve readiness for neurosurgical residency without concern for patient safety.
Collapse
Affiliation(s)
- Ryan E Radwanski
- Department of Neurological Surgery, Rutgers University, Newark, New Jersey, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA.
| | - Graham Winston
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Michael Rothbaum
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Michael W Kortz
- Department of Neurological Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Justin M Campbell
- Department of Neurological Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Alexander Evins
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Bridgewater, New Jersey, USA
| |
Collapse
|
11
|
Radwanski RE, Guadix SW, Rothbaum M, Shlobin NA, Kortz MW, Evins A, Pannullo SC. New Educational Paradigms in Neurosurgery and a Novel Learning Platform. World Neurosurg 2022; 163:151-154. [PMID: 35729815 DOI: 10.1016/j.wneu.2022.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ryan E Radwanski
- Department of Neurological Surgery, Rutgers University, Newark, New Jersey, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA.
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Michael Rothbaum
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Michael W Kortz
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Alexander Evins
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Medical Student Neurosurgery Training Center, Brain and Spine Group, Inc., Pasadena, California, USA
| |
Collapse
|
12
|
Tosi U, Maayan O, An A, Lavieri MET, Guadix SW, DeRosa AP, Christos PJ, Pannullo S, Stieg PE, Brandmaier A, Knisely JPS, Ramakrishna R. Stereotactic radiosurgery for vestibular schwannomas in neurofibromatosis type 2 patients: a systematic review and meta-analysis. J Neurooncol 2022; 156:431-441. [PMID: 35040021 DOI: 10.1007/s11060-021-03910-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Neurofibromatosis type 2 (NF2) is characterized by often bilateral vestibular schwannomas (VS) that result in progressive hearing loss and compression of nearby brainstem structures causing cranial nerve palsies. Treatment of these tumors remains challenging, as both surgical removal and expectant management can result in symptom progression. Stereotactic radiosurgery (SRS) has been investigated for the management of NF2-associated VS; however, the role, promises, and pitfalls of this treatment modality remain unclear. METHODS Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Reviews were searched for studies assessing SRS outcome in NF2-associated VS only. Primary endpoints included tumor control, serviceable hearing, presence of tinnitus, and cranial nerve V and VII symptoms. RESULTS A total of 16 studies (589 patients harboring 750 tumors) were analyzed. Clinical tumor control was achieved in 88% of cases (95% CI 80-95%); salvage surgery was needed in 8% (95% CI 4-13%) of cases. Treatment resulted in a worsening of pre-treatment serviceable hearing (OR = 0.26, p < 0.01), increased facial nerve (OR = 1.62, p < 0.01) and trigeminal nerve (OR = 1.42, p = 0.07) impairment. The incidence of vestibular symptoms and hydrocephalus were not consistently reported and thus could not be assessed. CONCLUSIONS The treatment of NF2-associated VS continues to pose a challenge, as current SRS regimens result in impaired hearing and worse cranial nerve comorbidities, despite achieving high tumor control. It remains unclear if these findings have to be regarded as treatment complications or, rather, continued disease progression.
Collapse
Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Omri Maayan
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Anjile An
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Miguel E Tusa Lavieri
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Antonio P DeRosa
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Susan Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | | | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, 525 E. 68th St.10065, Box 99, New York, NY, USA.
| |
Collapse
|
13
|
Guadix SW, Tao AJ, An A, Demetres M, Tosi U, Chidambaram S, Knisely JPS, Ramakrishna R, Pannullo SC. Assessing the long-term safety and efficacy of gamma knife and linear accelerator radiosurgery for vestibular schwannoma: A systematic review and meta-analysis. Neurooncol Pract 2021; 8:639-651. [PMID: 34777833 DOI: 10.1093/nop/npab052] [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] Open
Abstract
Background Differences in long-term outcomes of single-fraction stereotactic radiosurgery (SRS) between gamma knife (GK) and linear accelerator (LINAC) systems for vestibular schwannoma (VS) management remain unclear. To investigate differences in safety and efficacy between modalities, we conducted a meta-analysis of studies over the past decade. Methods MEDLINE, EMBASE, and Cochrane databases were queried for studies with the following inclusion criteria: English language, published between January 2010 and April 2020, cohort size ≥30, and mean/median follow-up ≥5 years. Odds ratios (OR) compared rates of tumor control, hearing preservation, and cranial nerve toxicities before and after SRS. Results Thirty-nine studies were included (29 GK, 10 LINAC) with 6516 total patients. Tumor control rates were 93% (95% CI 91-94%) and 94% (95% CI 91-97%) for GK and LINAC, respectively. Both GK (OR 0.06, 95% CI 0.02-0.13) and LINAC (OR 0.47, 95% CI 0.29-0.76) reduced odds of serviceable hearing. Neither GK (OR 0.71, 95% CI 0.41-1.22) nor LINAC (OR 1.13, 95% CI 0.64-2.00) impacted facial nerve function. GK decreased odds of trigeminal nerve (TN) impairment (OR 0.55, 95% CI 0.32-0.94) while LINAC did not impact TN function (OR 1.45, 95% CI 0.81-2.61). Lastly, LINAC offered decreased odds of tinnitus (OR 0.15, 95% CI 0.03-0.87) not observed with GK (OR 0.70, 95% CI 0.48-1.01). Conclusions VS tumor control and hearing preservation rates are comparable between GK and LINAC SRS. GK may better preserve TN function, while LINAC decreases tinnitus rates. Future studies are warranted to investigate the efficacy of GK and LINAC SRS more directly.
Collapse
Affiliation(s)
| | - Alice J Tao
- Weill Cornell Medical College, New York, New York, USA
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
| | - Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
14
|
Newman WC, Goldberg J, Guadix SW, Brown S, Reiner AS, Panageas K, Beal K, Brennan CW, Tabar V, Young RJ, Moss NS. The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes. J Neurooncol 2021; 153:507-518. [PMID: 34146223 DOI: 10.1007/s11060-021-03790-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/24/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Radiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes. METHODS A single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003 to 2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups. RESULTS Forty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (N = 42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p < 0.05). EOR correlated with edema reduction at last follow-up, with significantly greater T2-FLAIR reduction with GTR versus subtotal resection (p < 0.05). Among surviving patients, a significant proportion were able to decrease their steroid use: steroid-dependency decreased from 54% preoperatively to 15% at 12 months postoperatively (p = 0.001). CONCLUSIONS RN resection conferred both durable T2-FLAIR reduction, which correlated with EOR; and reduced steroid dependency.
Collapse
Affiliation(s)
- William C Newman
- Department of Neurosurgery, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Jacob Goldberg
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Sergio W Guadix
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn Beal
- Department of Radiation Oncology and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cameron W Brennan
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Viviane Tabar
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Robert J Young
- Department of Radiology and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nelson S Moss
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| |
Collapse
|
15
|
Pannullo SC, Guadix SW, Souweidane MM, Juthani RG, Baaj AA, Dupree T, Strybing K, Henry RF, Linen H, O'Neill J, Stieg PE. COVID-19: A Time Like No Other in (the Department of) Neurological Surgery. World Neurosurg 2021; 148:256-262. [PMID: 33770848 PMCID: PMC7982988 DOI: 10.1016/j.wneu.2020.11.166] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/10/2020] [Indexed: 01/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has disrupted lives and indelibly impacted the practice of medicine since emerging as a pandemic in March 2020. For neurosurgery departments throughout the United States, the pandemic has created unique challenges across subspecialties in devising methods of triage, workflow, and operating room safety. Located in New York City, at the early epicenter of the COVID-19 crisis, the Weill Cornell Medicine Department of Neurological Surgery was disrupted and challenged in many ways, requiring adaptations in clinical operations, workforce management, research, and education. Through our department's collective experience, we offer a glimpse at how our faculty and administrators overcame obstacles, and transformed in the process, at the height of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | | | - Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rupa G Juthani
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Ali A Baaj
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Tracey Dupree
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Kristin Strybing
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Roseann F Henry
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Harry Linen
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - John O'Neill
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
16
|
Chidambaram S, Guadix SW, Kwon J, Tang J, Rivera A, Berkowitz A, Kalnicki S, Pannullo SC. Evidence-based practice of stereotactic radiosurgery: Outcomes from an educational course for neurosurgery and radiation oncology residents. Surg Neurol Int 2021; 12:77. [PMID: 33767881 PMCID: PMC7982098 DOI: 10.25259/sni_539_2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background: As the field of brain and spine stereotactic radiosurgery (SRS) continues to grow, so will the need for a comprehensive evidence base. However, it is unclear to what degree trainees feel properly equipped to use SRS. We assess the perceptions and comfort level reported by neurosurgery and radiation oncology residents concerning the evidence-based practice of SRS. Methods: A continuing medical education (CME) course provided peer-reviewed updates regarding treatment with intracranial and spinal SRS. Presentations were given by neurosurgery and radiation oncology residents with mentorship by senior faculty. To gauge perceptions regarding SRS, attendees were surveyed. Responses before and after the course were analyzed using the Fisher’s exact test in R statistical software. Results: Participants reported the greatest knowledge improvements concerning data registries (P < 0.001) and clinical trials (P = 0.026). About 82% of all (n = 17) radiation oncology and neurosurgery residents either agreed or strongly agreed that a brain and spine SRS rotation would be beneficial in their training. However, only 47% agreed or strongly agreed that one was currently part of their training. In addition, knowledge gains in SRS indications (P = 0.084) and ability to seek collaboration with colleagues (P = 0.084) showed notable trends. Conclusion: There are clear knowledge gaps shared by potential future practitioners of SRS. Specifically, knowledge regarding SRS data registries, indications, and clinical trials offer potential areas for increased educational focus. Furthermore, the gap between enthusiasm for increased SRS training and the current availability of such training at medical institutions must be addressed.
Collapse
Affiliation(s)
- Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, Bronx, New York, United States
| | - Sergio W Guadix
- Weill Cornell Medical College, Bronx, New York, United States
| | - John Kwon
- Weill Cornell Medical College, Bronx, New York, United States
| | - Justin Tang
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Amanda Rivera
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Aviva Berkowitz
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, Bronx, New York, United States
| |
Collapse
|
17
|
Tosi U, Lavieri MET, An A, Maayan O, Guadix SW, DeRosa AP, Christos PJ, Pannullo S, Stieg PE, Brandmaier A, Knisely JPS, Ramakrishna R. Outcomes of stereotactic radiosurgery for large vestibular schwannomas: a systematic review and meta-analysis. Neurooncol Pract 2021; 8:405-416. [PMID: 34277019 DOI: 10.1093/nop/npab011] [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] [Indexed: 11/12/2022] Open
Abstract
Background Large vestibular schwannomas (VS) pose a treatment challenge for both microsurgery (MS) and stereotactic radiosurgery (SRS). Technical developments have allowed for safer irradiation of large tumors. It remains unclear if SRS can achieve appropriate tumor control and acceptable cranial nerve toxicities. In this study, we assess outcomes of irradiation for large VS. Methods PubMed MEDLINE, EMBASE, Web of Science, and Cochrane were searched for all the studies assessing SRS outcome in large VS. Primary endpoints included clinical and radiographic tumor control, need for salvage surgery, serviceable hearing, cranial nerve V and VII impairment, presence of hydrocephalus requiring shunting, and presence of vertigo/dizziness. Results Twenty-two studies were identified that met selection criteria for analysis from an initial pool of 1272 reports. They were evaluated according to treatment protocol: 1) single-dose SRS (13 studies, 483 patients), 2) combination of MS and SRS (7 studies, 182 patients), and 3) fractionated SRS (3 studies, 82 patients). Tumor control was achieved in 89%, 94%, and 91% of patients, respectively. Odds ratios (ORs) of post- over pretreatment serviceable hearing were 0.42 (P < .01), 0.47 (P = .05), and 0.60 (P = .22); for facial nerve impairment, these ORs were 1.08 (P = .69), 3.45 (P = .28), and 0.87 (P = .71), respectively. Conclusions The management of large VS remains challenging. All treatment modalities resulted in high tumor control rates and worsening of pretreatment hearing. None, however, caused significant facial nerve impairment, suggesting that management strategies incorporating focal irradiation can be successful.
Collapse
Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Anjile An
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Omri Maayan
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Antonio P DeRosa
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Susan Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
18
|
Harris A, Guadix SW, Riley LH, Jain A, Kebaish KM, Skolasky RL. Changes in racial and ethnic disparities in lumbar spinal surgery associated with the passage of the Affordable Care Act, 2006-2014. Spine J 2021; 21:64-70. [PMID: 32768655 DOI: 10.1016/j.spinee.2020.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/19/2020] [Accepted: 07/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Since implementation of the Patient Protection and Affordable Care Act (ACA) in 2010, more Americans have health insurance, and many racial/ethnic disparities in healthcare have improved. We previously reported that Black and Hispanic patients undergo surgery for spinal stenosis at lower rates than do white patients. PURPOSE To assess changes in racial/ethnic disparities in rates of lumbar spinal surgery after passage of the ACA. STUDY DESIGN Retrospective analysis. PATIENT SAMPLE Approximately 3.2 million adults who underwent lumbar spinal surgery in the US from 2006 through 2014. OUTCOME MEASURES Racial disparities in discharge rates before versus after ACA passage. METHODS Using the Nationwide Inpatient Sample, the U.S. Census Bureau Current Population Survey Supplement, and International Classification of Diseases, Ninth Revision, Clinical Modification, criteria for definite lumbar spinal surgery, we calculated rates of lumbar spinal surgery as the number of hospital discharges divided by population estimates and stratified patients by race/ethnicity after controlling for sociodemographic characteristics. Calendar years were stratified as before ACA passage (2006-2010) or after ACA passage (2011-2014). Poisson regression was used to model hospital discharge rates as a function of race/ethnicity before and after ACA passage after adjustment for potential confounders. RESULTS All rates are expressed per 1,000 persons. The overall median discharge rate decreased from 1.9 before ACA passage to 1.6 after ACA passage (p < .001). After adjustment for sociodemographic factors, the Black:White disparity in discharge rates decreased from 0.40:1 before ACA to 0.44:1 after ACA (p < .001). A similar decrease in the Hispanic:White disparity occurred, from 0.35:1 before ACA to 0.38:1 after ACA (p < .001). CONCLUSION Small but significant decreases occurred in racial/ethnic disparities in hospital discharge rates for lumbar spinal surgery after ACA passage.
Collapse
Affiliation(s)
- Andrew Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Sergio W Guadix
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Lee H Riley
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA; Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA.
| |
Collapse
|
19
|
Guadix SW, Winston GM, Chae JK, Haghdel A, Chen J, Younus I, Radwanski R, Greenfield JP, Pannullo SC. Medical Student Concerns Relating to Neurosurgery Education During COVID-19. World Neurosurg 2020; 139:e836-e847. [PMID: 32426066 PMCID: PMC7229732 DOI: 10.1016/j.wneu.2020.05.090] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [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: 05/02/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 11/20/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has created significant obstacles within medical education. For medical students interested in pursuing neurosurgery as a specialty, the educational policies surrounding COVID-19 have resulted in unique challenges. The present study used a nationwide survey to identify the concerns of medical students interested in pursuing neurosurgery during the COVID-19 pandemic. Methods Students who had previously registered for medical student neurosurgery training camps were sent an online Qualtrics survey requesting them to assess how the COVID-19 pandemic was affecting their neurosurgical education. The Pearson χ2 test and post hoc pairwise Fisher exact test were used for analysis of categorical variables, and the 2-tailed paired Student t test was used for continuous variables. Results The survey was distributed to 852 medical students, with 127 analyzed responses. Concerns regarding conferences and networking opportunities (63%), clinical experience (59%), and board examination scores (42%) were most frequently cited. Of the third-year medical students, 76% reported ≥1 cancelled or postponed neurosurgery rotation. On average, students were more likely to take 1 year off from medical school after than before the start of the COVID-19 pandemic, measured from 0 to 100 (25.3 ± 36.0 vs. 39.5 ± 37.5; P = 0.004). Virtual mentorship pairing was the highest rated educational intervention suggested by first- and second-year medical students. The third- and fourth-year medical students had cited virtual surgical skills workshops most frequently. Conclusions The results from the present nationwide survey have highlighted the concerns of medical students regarding their neurosurgery education during the COVID-19 pandemic. With these findings, neurosurgery organizations can consider targeted plans for students of each year to continue their education and development.
Collapse
Affiliation(s)
- Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Graham M Winston
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - John K Chae
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Arsalan Haghdel
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Justin Chen
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Iyan Younus
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Ryan Radwanski
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| |
Collapse
|
20
|
Chae JK, Haghdel A, Guadix SW, Winston GM, Younus I, Radwanski R, Schwartz TH, Greenfield JP, Apuzzo MLJ, Pannullo SC. Letter: COVID-19 Impact on the Medical Student Path to Neurosurgery. Neurosurgery 2020; 87:E232-E233. [PMID: 32355961 PMCID: PMC7197528 DOI: 10.1093/neuros/nyaa187] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- John K Chae
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | - Arsalan Haghdel
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | - Sergio W Guadix
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | - Graham M Winston
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | - Iyan Younus
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | - Ryan Radwanski
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | - Theodore H Schwartz
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | | | - Michael L J Apuzzo
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| | - Susan C Pannullo
- Department of Neurological Surgery Weill Cornell Medicine New York, New York
| |
Collapse
|
21
|
Guadix SW, Younus I, Winston G, ElJalby M, Xia J, Nario JJ, Rothbaum M, Radwanski RE, Greenfield JP, Pannullo SC. Medical Students' Perceived Interests and Concerns for a Career in Neurosurgery. World Neurosurg 2020; 139:e203-e211. [PMID: 32272266 DOI: 10.1016/j.wneu.2020.03.169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/15/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The factors that attract and concern medical students about a career in neurosurgery have never been clearly characterized or delineated in a large nationwide cohort of medical students intending to pursue a career in neurosurgery. The objective of the present study was to characterize the factors that influence medical student interest in neurosurgery and assess the effects of a formal neurosurgery training course on participants' perceptions of a career in neurosurgery. METHODS Before the Medical Student Neurosurgery Training Camp for subinternship preparation, registered students were surveyed about their interest level in neurosurgery, factors that attracted or concerned them about a career in neurosurgery, attendance at a national neurosurgery conference or course, formal clinical neurosurgery exposure in medical school, and whether they had a resident or attending mentor in neurosurgery. At the end of the course, all the participants completed the surveyed again. P < 0.05 was considered significant on Pearson's χ2 and Fisher's exact tests for categorical variables and 2-tailed paired Student's t tests for continuous variables. RESULTS Of the training camp attendees, >95% completed both pre- and postcourse surveys, including 41 first-year, 19 second-year, 30 third-year, and 5 fourth-year medical school students. The most common factors that concerned students about a career in neurosurgery were work-life balance (76%) and competitiveness (56%). All factors of concern were decreased in the postcourse survey, except for competitiveness. A small cohort (8.4%) of students had no concerns about a career in neurosurgery; this cohort had doubled to 17% after the course (P < 0.05). The students that indicated no concern had a greater postcourse interest level in neurosurgery (95.8 ± 8.7 vs. 86.7 ± 20.5; P < 0.05). Student reasons for an interest in neurosurgery included intellectually stimulating work (94%), interest in neurosciences (93%), effect on patients (84%), innovation and new technology (80%), research opportunities (77%), and prestige (24%). All reasons increased after the course, with the exception of prestige, which decreased to 22%. CONCLUSION A training camp for students pursuing a neurosurgery subinternship was effective in providing transparency and positively influencing the factors that attract and concern students about a career in neurosurgery. Characterization of medical student perceptions of neurosurgery from a large, nationwide cohort of students pursuing a subinternship has provided novel data and could help identify factors protecting against burnout later in life.
Collapse
Affiliation(s)
- Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Iyan Younus
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Graham Winston
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mahmoud ElJalby
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jimmy Xia
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Joel Jose Nario
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Michael Rothbaum
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Ryan E Radwanski
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|