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Racial, ethnic, and gender diversity of applicants and matriculants to neurological surgery residency programs

Edwin Nieblas-Bedolla, Fatima El-ghazali, Saman Qadri, John R. Williams, Nabiha Quadri, Amy Lee, and Manuel Ferreira Jr.

OBJECTIVE

The aim of this study was to identify trends in the demographic constitution of applicants and matriculants to neurological surgery based on race, ethnicity, and gender.

开云体育世界杯赔率

作者进行了横断面斯图dy using compiled demographic data obtained from the Association of American Medical Colleges. Trends analyzed included proportional changes in race, ethnicity, and gender of applicants and matriculants to neurosurgical residency programs from academic years 2010–2011 to 2018–2019.

RESULTS

A total of 5100 applicants and 2104 matriculants to neurosurgical residency programs were analyzed. No significant change in the percentage of overall women applicants (+0.3%, 95% CI −0.7% to 1.3%; p = 0.77) or in the percentage of women matriculants (+0.3%, 95% CI −2.2% to 2.9%; p = 0.71) was observed. For applicants, no change over time was observed in the percentages of American Indian or Alaska Native (AI/AN) men (0.0%, 95% CI −0.3% to 0.3%; p = 0.65); Asian men (−0.1%, 95% CI −1.2% to 1.1%; p = 0.97); Black or African American men (−0.2%, 95% CI −0.7% to 0.4%; p = 0.91); Hispanic, Latino, or of Spanish Origin men (+0.4%, 95% CI −0.8% to 1.7%; p = 0.26); White men (+0.5%, 95% CI −2.1% to 3.0%; p = 0.27); Asian women (+0.1,% 95% CI −0.9% to 1.1%; p = 0.73); Black or African American women (0.0%, 95% CI −0.6% to 0.5%; p = 0.30); Hispanic, Latino, or of Spanish Origin women (0.0%, 95% CI −0.4% to 0.4%; p = 0.71); and White women (+0.3%, 95% CI −1.1% to 1.7%; p = 0.34). For matriculants, no change over time was observed in the percentages of AI/AN men (0.0%, 95% CI −0.6% to 0.6%; p = 0.56); Asian men (0.0%, 95% CI −2.7% to 2.7%; p = 0.45); Black or African American men (−0.3%, 95% CI −1.4% to 0.8%; p = 0.52); Hispanic, Latino, or of Spanish Origin men (+0.6%, 95% CI −0.8 to 2.0%; p = 0.12); White men (−1.0%, 95% CI −5.3% to 3.3%; p = 0.92); Asian women (+0.1%, 95% CI −1.3% to 1.5%; p = 0.85); Black or African American women (0.0%, 95% CI −0.6% to 0.7%; p = 0.38); Hispanic, Latino, or of Spanish Origin women (−0.1%, 95% CI −0.7% to 0.5%; p = 0.46); and White women (+0.3%, 95% CI −2.4% to 3.0%; p = 0.70).

CONCLUSIONS

Despite efforts to diversify the demographic constitution of incoming neurosurgical trainees, few significant advances have been made in recent years. This study suggests that improved strategies for recruitment and cultivating early interest in neurological surgery are required to further increase the diversification of future cohorts of neurosurgical trainees.

InJournal of Neurosurgery Volume 137: Issue 1 (Jul 2022)

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Pseudotumor cerebri following tapered corticosteroid treatment in an 8-month-old infant

Case report

Wilson Z. Ray, Amy Lee, Spiros L. Blackburn, Gregg T. Lueder, and Jeffrey R. Leonard

✓The authors report on an 8-month-old infant with an orbital capillary hemangioma. The patient had been treated with high-dose corticosteroid therapy and had had a recent decrease in dose. The patient presented to the emergency department with increased irritability and bulging fontanelles. On lumbar puncture the opening pressure was > 55 cm H2O. Ophthalmological examination revealed interval development of papilledema. The child was treated with high-volume lumbar puncture, subsequent drainage of 10 ml of cerebrospinal fluid, resumption of the previous steroid dose, and acetazolomide therapy. The patient's symptoms resolved and follow-up ophthalmological examination revealed interval resolution of papilledema. The authors present the youngest reported case of pseudotumor development after corticosteroid tapering.

InJournal of Neurosurgery: Pediatrics Volume 1: Issue 1 (Jan 2008)

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Medicolegal issues in abusive head trauma for the pediatric neurosurgeon

David I. Bass, Amy Lee, Samuel R. Browd, Richard G. Ellenbogen, and Jason S. Hauptman

The purpose of this article is to serve as a rational guide for the pediatric neurosurgeon in navigating common medicolegal issues that arise in the management of abusive head trauma (AHT). Many of these issues may be unfamiliar or unpleasant to surgeons focused on addressing disease. The authors begin with a brief history on the origins of the diagnosis of AHT and the controversy surrounding it, highlighting some of the facets of the diagnosis that make it particularly unique in pediatric neurosurgery. They then review some special medical considerations in these patients through the perspective of the neurosurgeon and provide several examples as illustration. The authors discuss how to appropriately document these cases in the medical record for expected legal review, and last, they provide an overview of the legal process through which the neurosurgeon may be called to provide testimony.

InNeurosurgical Focus Volume 49 (2020): Issue 5 (Nov 2020): Medicolegal issues in neurosurgery

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Low-dose head computed tomography in children: a single institutional experience in pediatric radiation risk reduction

Clinical article

Ryan P. Morton, Renee M. Reynolds, Rohan Ramakrishna, Michael R. Levitt, Richard A. Hopper, Amy Lee, and Samuel R. Browd

Object

In this study, the authors describe their experience with a low-dose head CT protocol for a preselected neurosurgical population at a dedicated pediatric hospital (Seattle Children's Hospital), the largest number of patients with this protocol reported to date.

开云体育世界杯赔率

All low-dose head CT scans between October 2011 and November 2012 were reviewed. Two different low-dose radiation dosages were used, at one-half or one-quarter the dose of a standard head CT scan, based on patient characteristics agreed upon by the neurosurgery and radiology departments. Patient information was also recorded, including diagnosis and indication for CT scan.

Results

Six hundred twenty-four low-dose head CT procedures were performed within the 12-month study period. Although indications for the CT scans varied, the most common reason was to evaluate the ventricles and catheter placement in hydrocephalic patients with shunts (70%), followed by postoperative craniosynostosis imaging (12%). These scans provided adequate diagnostic imaging, and no patient required a follow-up full-dose CT scan as a result of poor image quality on a low-dose CT scan. Overall physician comfort and satisfaction with interpretation of the images was high. An additional 2150 full-dose head CT scans were performed during the same 12-month time period, making the total number of CT scans 2774. This value compares to 3730 full-dose head CT scans obtained during the year prior to the study when low-dose CT and rapid-sequence MRI was not a reliable option at Seattle Children's Hospital. Thus, over a 1-year period, 22% of the total CT scans were able to be converted to low-dose scans, and full-dose CT scans were able to be reduced by 42%.

Conclusions

The implementation of a low-dose head CT protocol substantially reduced the amount of ionizing radiation exposure in a preselected population of pediatric neurosurgical patients. Image quality and diagnostic utility were not significantly compromised.

InJournal of Neurosurgery: Pediatrics Volume 12 (2013): Issue 4 (Oct 2013)

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Comparison of perceptions and treatment practices between neurosurgeons and plastic surgeons for infants with deformational plagiocephaly

Clinical article

Amy Lee, Andrea E. Van Pelt, Alex A. Kane, Thomas K. Pilgram, Daniel P. Govier, Albert S. Woo, and Matthew D. Smyth

Object

Deformational plagiocephaly (DP) is the leading cause of head shape abnormalities in infants. Treatment options include conservative measures and cranial molding. Pediatric neurosurgeons and craniofacial plastic surgeons have yet to agree on an ideal therapy, and no definable standards exist for initiating treatment with helmets. Furthermore, there may be differences between specialties in their perceptions of DP severity and need for helmet therapy.

开云体育世界杯赔率

Requests to participate in a web-based questionnaire were sent to diplomates of the American Board of Pediatric Neurological Surgery and US and Canadian members of the Pediatric Joint Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and the American Cleft Palate–Craniofacial Association. Questions focused on educational background; practice setting; volume of DP patients; preferences for evaluation, treatment, follow-up; and incentives or deterrents to treat with helmet therapy. Six examples of varying degrees of DP were presented to delineate treatment preferences.

Results

Requests were sent to 302 neurosurgeons and 470 plastic surgeons, and responses were received from 71 neurosurgeons (24%) and 64 plastic surgeons (14%). The following responses represented the greatest variations between specialties: 1) 8% of neurosurgeons and 26% of plastic surgeons strongly agreed with the statement that helmet therapy is more beneficial than conservative therapy (p < 0.01); and 2) 25% of neurosurgeons and 58% of plastic surgeons would treat moderate to severe DP with helmets (p < 0.01).

Conclusions

Survey responses suggest that neurosurgeons are less likely to prescribe helmet therapy for DP than plastic surgeons. Parents of children with DP are faced with a costly treatment decision that may be influenced more strongly by referral and physician bias than medical evidence.

InJournal of Neurosurgery: Pediatrics Volume 5: Issue 4 (Apr 2010)

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Intraoperative electrophysiology during single-level selective dorsal rhizotomy: technique, stimulation threshold, and response data in a series of 145 patients

Philippe De Vloo, Terhi J. Huttunen, Dalila Forte, Ivana Jankovic, Amy Lee, Mark Hair, Stephanie Cawker, Deepti Chugh, Lucinda Carr, Belinda H. A. Crowe, Matthew Pitt, and Kristian Aquilina

OBJECTIVE

Selective dorsal rhizotomy (SDR) is effective at permanently reducing spasticity in children with spastic cerebral palsy. The value of intraoperative neurophysiological monitoring in this procedure remains controversial, and its robustness has been questioned. This study describes the authors’ institutional electrophysiological technique (based on the technique of Park et al.), intraoperative findings, robustness, value to the procedure, and occurrence of new motor or sphincter deficits.

开云体育世界杯赔率

作者分析了电生理数据的all children who underwent SDR at their center between September 2013 and February 2019. All patients underwent bilateral SDR through a single-level laminotomy at the conus and with transection of about 60% of the L2–S2 afferent rootlets (guided by intraoperative electrophysiology) and about 50% of L1 afferent roots (nonselectively).

RESULTS

One hundred forty-five patients underwent SDR (64% male, mean age 6 years and 7 months, range 2 years and 9 months to 14 years and 10 months). Dorsal roots were distinguished from ventral roots anatomically and electrophysiologically, by assessing responses on free-running electromyography (EMG) and determining stimulation thresholds (≥ 0.2 mA in all dorsal rootlets). Root level was determined anatomically and electrophysiologically by assessing electromyographic response to stimulation. Median stimulation threshold was lower in sacral compared to lumbar roots (p < 0.001), and 16% higher on the first operated (right) side (p = 0.023), but unrelated to age, sex, or functional status. Similarly, responses to tetanic stimulation were consistent: 87% were graded 3+ or 4+, with similar distributions between sides. This was also unrelated to age, sex, and functional status. The L2–S2 rootlets were divided (median 60%, range 50%–67%), guided by response to tetanic stimulation at threshold amplitude. No new motor or sphincter deficits were observed, suggesting sparing of ventral roots and sphincteric innervation, respectively.

CONCLUSIONS

This electrophysiological technique appears robust and reproducible, allowing reliable identification of afferent nerve roots, definition of root levels, and guidance for rootlet division. Only a direct comparative study will establish whether intraoperative electrophysiology during SDR minimizes risk of new motor or sphincter worsening and/or maximizes functional outcome.

InJournal of Neurosurgery: Pediatrics Volume 25: Issue 6 (Jun 2020)

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Letter to the Editor: Avoiding routine postoperative head CT in children

Alexander G. Weil, John Ragheb, Toba N. Niazi, and Sanjiv Bhatia

InJournal of Neurosurgery: Pediatrics Volume 13 (2014): Issue 5 (May 2014)

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First-time tethered cord release among adults with myelomeningocele: an analysis of people in the National Spina Bifida Patient Registry

马克·s·迪亚斯明王、梁Menglu Elias Rizk, Robin Bowman, Michael D. Partington, Jeffrey P. Blount, Brandon G. Rocque, Betsy Hopson, Amy Lee, and William O. Walker

OBJECTIVE

The authors analyzed the National Spina Bifida Patient Registry (NSBPR), a national registry that tracks the outcomes for people with various forms of spinal dysraphism, to determine the ongoing longitudinal risk for tethered cord release (TCR) among adults with myelomeningocele who had not previously undergone TCR during childhood. The authors also sought to identify the impact of lesion level, ambulation status, and prior treatments for hydrocephalus or Chiari malformations on TCR rates.

开云体育世界杯赔率

Adults in the registry who had not previously undergone TCR during childhood were studied. This group was compared with the remaining adults in the registry. The frequency of first-time TCR and time to TCR (using Kaplan-Meier analysis) were determined independently for males and females. Cox proportional hazards analysis identified correlations between sex, best lesion level and ambulation status prior to TCR, and previous treatments for hydrocephalus and Chiari decompression.

RESULTS

Among 967 adults in the NSBPR (422 [43.6%] males and 545 [56.4%] females) who had not undergone TCR during childhood, the authors identified 47 people (4.9%) who underwent their first TCR during adulthood. This study cohort had significantly better mean functional motor levels and ambulation compared with the remaining adult cohort (both p < 0.001). The study group included 35 females (74.5%) and 12 males (25.5%); this sex distribution was significantly different in comparison with the remaining adult cohort (p = 0.016). The Kaplan-Meier curves for first TCR for females and males were significantly different (p = 0.01, log-rank test). TCR rates were correlated with sex (males had decreased risk; OR 0.31, 95% CI 0.16–0.62, p < 0.001), prior treatment for hydrocephalus (those who underwent prior treatment had decreased risk; OR 0.21, 95% CI 0.20–0.42, p < 0.001), and prior treatment for Chiari malformation (those who underwent prior treatment had greater risk; OR 3.84, 95% CI 1.50–9.88, p = 0.005).

CONCLUSIONS

成人脊髓脊膜突出那些逃脱的童年without undergoing TCR have an ongoing, albeit decreased, risk for spinal cord tethering requiring TCR. This risk is obviously not due to spinal column growth and therefore must reflect other factors such as dynamic changes in spinal cord health over time. Among people with MMC who underwent their first TCR as adults, females seemed to be overrepresented. Similar to the authors’ prior childhood study, people who underwent previous Chiari decompression seemed to be overrepresented, whereas those who underwent previous treatment for hydrocephalus seem to be underrepresented. These novel findings deserve further study.

InJournal of Neurosurgery: Spine Publish Before Print

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Tethered spinal cord among individuals with myelomeningocele: an analysis of the National Spina Bifida Patient Registry

Mark S. Dias, Ming Wang, Elias B. Rizk, Robin Bowman, Michael D. Partington, Jeffrey P. Blount, Brandon G. Rocque, Betsy Hopson, Daria Ettinger, Amy Lee, William O. Walker, and

OBJECTIVE

The aims of this study were to review the National Spina Bifida Patient Registry (NSBPR) data set to study the rates of tethered spinal cord release (TCR) among patients with myelomeningocele and variability between centers, to compare TCR rates between males and females, and to study the relationships between TCR rates and other condition-specific characteristics.

开云体育世界杯赔率

The NSBPR registry was queried to identify all patients with myelomeningocele. TCR rates were calculated over time using survival analyses; rates between centers and between males and females were compared. Cox proportional hazards models were constructed to identify relationships between TCR rates and sex, functional lesion level, ambulation status, treated hydrocephalus, and prior Chiari decompression.

RESULTS

Of 6339 patients with information about their operations, 1366 (21.5%) underwent TCR, with significant variability between centers. The majority (75.8%) underwent a single TCR. The annual TCR rate was linear between birth and 13 years (1.8%/year) but declined sharply from 14 to 21 years (0.7%/year). There was no period of time at which the TCR rate accelerated. There were no significant differences in TCR rates between males and females. TCR rate was not related to functional lesion level but was lower among nonambulators compared with community ambulators (p = 0.005) and among those with treated hydrocephalus (HR 0.30, p < 0.001), and higher among those having prior Chiari decompression (HR 1.71, p < 0.001).

CONCLUSIONS

These results extend the results of prior single-institution studies, demonstrate significant treatment variability between institutions, and challenge the traditional concept that tethering is related to spinal cord stretching due to spinal growth.

InJournal of Neurosurgery: Pediatrics Volume 28: Issue 1 (Jul 2021)

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Perioperative complications and secondary retethering after pediatric tethered cord release surgery

James Pan, Scott H. Boop, Jason K. Barber, Srinivas M. Susarla, Sharon Durfy, Jeffrey G. Ojemann, Hannah E. Goldstein, Amy Lee, Samuel Browd, Richard G. Ellenbogen, and Jason S. Hauptman

OBJECTIVE

系留绳综合症是指一个星座of symptoms characterized by neurological, musculoskeletal, and urinary symptoms, caused by traction on the spinal cord, which can be secondary to various etiologies. Surgical management of simple tethered cord etiologies (e.g., fatty filum) typically consists of a single-level lumbar laminectomy, intradural exploration, and coagulation and sectioning of the filum. More complex etiologies such as lipomyelomeningoceles or scar formation after myelomeningocele repair involve complex dissection and dural reconstruction. The purpose of this study was to evaluate operative complications and long-term outcomes of secondary retethering related to pediatric tethered cord release (TCR) at a tertiary children’s hospital.

开云体育世界杯赔率

Medical records of children who underwent surgery for TCR from July 2014 to March 2023 were retrospectively reviewed. Data collected included demographics, perioperative characteristics, surgical technique, and follow-up duration. Primary outcomes were 60-day postoperative complications and secondary retethering requiring repeat TCR surgery. Univariate and multivariate analyses were performed to identify risk factors associated with complications and secondary retethering.

RESULTS

A total of 363 TCR surgeries (146 simple, 217 complex) in 340 patients were identified. The mean follow-up was 442.8 ± 662.2 days for simple TCRs and 733.9 ± 750.3 days for complex TCRs. The adjusted 60-day complication-free survival rate was 96.3% (95% CI 91.3%–98.4%) for simple TCRs and 88.7% (95% CI 82.3%–91.4%) for complex TCRs. Lower weight, shorter surgical times, and intensive care unit admission were associated with complications for simple TCRs. Soft-tissue drains increased complications for complex TCRs. The secondary retethering rates were 1.4% for simple TCRs and 11.9% for complex TCRs. The 1-, 3-, and 5-year progression-free survival rates in complex cases were 94.7% (95% CI 89.1%–97.4%), 77.7% (95% CI 67.3%–85.3%), and 62.6% (95% CI 46.5%–75.1%), respectively. Multivariate analysis revealed that prior detethering (OR 8.15, 95% CI 2.33–28.50; p = 0.001) and use of the operative laser (OR 10.43, 95% CI 1.36–80.26; p = 0.024) were independently associated with secondary retethering in complex cases.

CONCLUSIONS

This is the largest series to date examining postoperative complications and long-term secondary retethering in TCR surgery. Simple TCR surgeries demonstrated safety, rare complications, and low secondary retethering rates. Complex TCR surgeries presented higher risks of complications and secondary retethering. Modifiable risk factors such as operative laser use influenced secondary retethering in complex cases.

InJournal of Neurosurgery: Pediatrics Publish Before Print

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