Search Results

Object

The Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF) was established in 1992 to oversee fellowship training in pediatric neurological surgery. The present study is a review of all graduates from 1992 through 2006 to identify predictors of American Board of Pediatric Neurological Surgery (ABPNS) certification.

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Basic demographic information including sex, year of graduation from residency, residency training program, year of fellowship training, and fellowship program was collected on each graduate from each of the 22 ACPNF programs. Individuals who did not meet ACPNF requirements (39 trainees) and those currently practicing in Canada (11 individuals) were excluded. Univariate and multivariate analysis were used to identify predictors of ABPNS certification.

Results

Of the 193 ACPNF graduates, 143 individuals met the criteria for analysis. Currently, 70 (49%) are ABPNS certified. There is a mean period of 5.1 ± 2.4 years (range 2–13 years) between finishing fellowship and ABPNS certification. If those who are not expected to be sitting for the boards yet (2002–2006 graduates, 57 individuals) are removed, the rate of ABPNS certification is 66.3%. On average, 9.5 ±3.0 (range 4–16) fellows are trained per year. There is no statistically significant relationship between fellowship or residency training program and ABPNS certification.

Conclusions

Although the present training infrastructure has the theoretical capacity to train > 20 pediatric neurosurgeons each year, this analysis suggests that current levels will provide ~ 6 ABPNS-certified pediatric neurosurgeons annually. This raises the question of the sufficiency of the future pediatric neurosurgical workforce.

Object

Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children.

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The authors searched Medline–Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000–2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years.

Results

Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08–0.69) and a higher rate of cerebrospinal fluid–related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53–23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95–1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91–2.25) were noted between PFDD and PFD.

Conclusions

Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid–related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.

Object

The purpose of this study was to evaluate the risk of progression of traumatic intracranial lesions in children by comparing initial and subsequent computed tomography (CT) scans. Reserving repeated CT imaging for patients who harbor higher-risk lesions may reduce overall radiation exposure, the need for sedative agents, and cost.

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作者进行了回顾性队列研究in 268 patients younger than 18 years of age who underwent repeated CT scanning within 24 hours of their initial CT scanning procedure. The risk of progression between the initial and repeated CT scanning sessions and the need for delayed neurosurgical intervention were determined for each lesion type.

In 54 patients (20.1%) the normal findings on the initial CT study did not change on subsequent imaging. In 61 (28.5%) of the 214 patients in whom abnormal findings were present on the initial scan, progression was demonstrated. Patients with epidural hematoma (EDH; odds ratio [OR] 12.29), subdural hematoma (SDH; OR 3.18), cerebral edema (OR 9.34), and intraparenchymal hemorrhage (IPH; OR 18.3) were found to be at a significantly increased risk for progression and to require delayed neurosurgical intervention (OR 11.91). No significantly increased risk was found for patients with subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), or skull fracture.

Conclusions

Repeated CT imaging in children with high-risk lesions such as EDH, SDH, cerebral edema, and IPH is recommended. However, in children with low-risk lesions, such as SAH, IVH, DAI, and isolated skull fractures but no sign of clinical deterioration, repeated imaging may be less likely to alter the clinical management scheme. The limited benefits of undertaking repeated imaging in these patients should be weighed against the risks of radiation exposure, sedation, intrahospital transportation, and patient monitoring.

Object

The purpose of this study was to determine a reliable estimate of the size, demographic, and practice characteristics of the current pediatric neurosurgical workforce. The authors also sought to differentiate pediatric from nonpediatric neurosurgical practitioners and compare the demographic and practice characteristics of these 2 groups. The term “pediatric practitioner” will be used in this study to describe a practitioner whose practice is > 75% pediatric patients in accordance with the American Board of Pediatric Neurological Surgery (ABPNS) requirements for board certification in pediatric neurosurgery. Those practitioners with < 75% pediatric patients in their practice will be designated as “nonpediatric practitioners.”

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The authors aggregated multiple databases of professional neurosurgical societies in an effort to identify pediatric neurosurgical practitioners. A 30-question survey was then administered to all identified practitioners, and responses were collected for 6 months. Primary analysis of pediatric versus nonpediatric practitioners was performed. Subgroup analyses of the characteristics of the pediatric practitioners were also performed to identify the effects of practitioner age, sex, and practice setting on survey responses.

Results

A total of 342 practitioners received the survey, and 267 responded (78.1% response rate); 158 pediatric practitioners and 92 nonpediatric practitioners were identified. Seventeen respondents were excluded from analysis. Pediatric practitioners were more likely to be women, ABPNS certified, have completed a pediatric fellowship, do fewer operative cases per year, have a more frequent call schedule, practice in a freestanding children's hospital, be in academic practice, and in need of recruiting additional faculty. Pediatric practitioners spent fewer hours per week in patient care, and were less likely to have a productivity-based salary or salary incentive based on relative value unit–production. Among pediatric practitioners, American Board of Neurological Surgery and ABPNS certification rates differed significantly among age groups, with older age groups being more likely to be certified by the American Board of Neurological Surgery and ABPNS. The rate of pediatric fellowship completion was significantly higher in the younger age groups. Anticipating retirement by age 65 was significantly more likely in the younger age groups, and hours spent per week spent in teaching and administrative duties were lower in the younger age groups. There were 27 female and 131 male pediatric practitioners. The women were more likely to have completed a pediatric fellowship and performed fewer operative cases per year than the men. Nonacademic pediatric practitioners were more likely to have a relative value unit–based salary incentive, be reimbursed for call coverage, and spend more hours per week in patient care than academic pediatric practitioners. Academic pediatric practitioners spent more hours per week in clinical research.

Conclusions

The authors estimate that there are fewer than 200 pediatric neurosurgeons currently practicing in the United States. Current practice patterns unique to pediatrics may have important implications in recruiting and retaining the next generation of pediatric neurosurgeons.