Societies

Neurosurgical Training in Germany

Neurosurgical Training in Germany

There has been a fivefold increase in neurosurgeons over the last three decades in Germany, despite a lesser increase in operations. Currently, there are approximately 1000 neurosurgical residents employed at training hospitals.

Neurosurgery remains an attractive specialty in Germany, but there are two concerns that may impede its appeal in the near future. The administrative burden for a neurosurgeon is onerous: Perhaps 50 percent of a neurosurgeon’s time is spent on administrative responsibilities such as coding and other tasks not involving patient care. Of perhaps greater concern is the limited pay. An international ranking of physicians’ pay published in Der Spiegel magazine in 2006 showed German doctors at the bottom, below their colleagues in other European countries as well as those in the U.S. and Australia. Physician pay in Germany increased by 10 percent after physician strikes in 2006, but the dissatisfaction with pay remains, as was evidenced in September by protests for higher physician pay and increased hospital funding. Neurosurgery is a hospital-based specialty, and most neurosurgeons are salaried employees of hospitals. Neurosurgeons, like most physicians, see private patients to supplement their income.

These concerns are likely to negatively influence the recruitment to neurosurgical training programs in the future. This problem is compounded by the fact that approximately 70 percent of medical students are women, to whom other specialties have appealed more than neurosurgery. Roughly one-third of all neurosurgeons in Germany, including those already certified and those in training, are women.

The neurosurgical training program lasts six years, and trainees work 40 to 48 hours or 50 to 66 hours per week, depending on the state and local hospital arrangements. Providing adequate training within the prescribed time frame remains a challenge 1)

Little is known about the overall training experience and career opportunities for these trainees.

Stienen et al. evaluated the current status of neurosurgical training of residents in Germany.

An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time). Results Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18-0.49; p < 0.0001). The satisfaction rate with hands-on operating room exposure was 73.9% and equal to the rate in Europe (OR: 0.94; 95% CI, 0.56-1.59; p = 0.834). German trainees were 2.3 times as likely to perform a lumbar spine intervention as the primary surgeon within the first year of training (OR: 2.27; 95% CI, 1.42-3.64; p = 0.001). However, they were less likely to perform a cervical spine procedure within 24 months of training (OR: 0.38; 95% CI, 0.17-0.82; p = 0.014) and less likely to perform a craniotomy within 36 months of training (OR: 0.49; 95% CI, 0.31-0.79; p = 0.003). Only 25.6% of German trainees currently adhere to the weekly limit of 48 hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25-3.61; p = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11-0.59; p = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13-2.96; p = 0.015).

Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. This analyses provide the opportunity for a critical review of the local conditions in German training facilities 2).

Survey on training satisfaction

As a resident representative, Lawson McLean et al. implemented a mailing list for interested German neurosurgical trainees. Thereafter, they created a survey including 25 items to assess the trainees’ satisfaction with their training and their perceived career prospects, which they then distributed through the mailing list. The survey was open from 1st April until 31st May 2021.

90 trainees were enrolled in the mailing list and they received 81 completed responses to the survey. Overall, 47% of trainees were very dissatisfied or dissatisfied with their training. 62% of trainees reported a lack of neurosurgical training. 58% of trainees found it difficult to attend courses or classes and only 16% had consistent mentoring. There was an expressed desire for a more structured Neurosurgical Resident Training Program and mentoring projects. In addition, 88% of trainees were willing to relocate for fellowships outside their current hospitals.

Half of the responders were dissatisfied with their neurosurgical training. There are various aspects that require improvement, such as the training curriculum, the lack of structured mentoring, and the amount of administrative work. They propose the implementation of a modernized structured curriculum, which addresses the mentioned aspects, in order to improve neurosurgical training and, consecutively, patient care 3).

1)

https://aansneurosurgeon.org/practicing-neurosurgery-in-germany/
2)

Stienen MN, Gempt J, Gautschi OP, Demetriades AK, Netuka D, Kuhlen DE, Schaller K, Ringel F. Neurosurgical Resident Training in Germany. J Neurol Surg A Cent Eur Neurosurg. 2017 Jul;78(4):337-343. doi: 10.1055/s-0036-1594012. Epub 2016 Nov 30. PubMed PMID: 27903015.
3)

Lawson McLean A, Maurer S, Nistor-Gallo D, Moritz I, Tourbier M. Survey on training satisfaction among German neurosurgical trainees. J Neurol Surg A Cent Eur Neurosurg. 2023 Mar 13. doi: 10.1055/a-2053-3108. Epub ahead of print. PMID: 36914157.

Korle-Bu Neuroscience Foundation

Korle-Bu Neuroscience Foundation

https://kbnf.org/

Korle-Bu Neuroscience Foundation (KBNF) is a Canada based charity enhancing the delivery of quality brain and spinal medical care in West Africa and beyond. The vision is to alleviate the suffering of West Africans with a special focus on those affected by diseases of the brain and spine, and to address related health care issues.

KBNF has been working with the Liberian Government since 2014 to develop its neurosurgery capacity, but the program is still in its infancy suffering setbacks from Ebola, lack of trained medical professionals across all disciplines, and extremely limited resources. KBNF works to address these deficits with shipments of equipment and supplies and annual medical missions.

Liberia recently employed the first neurosurgeon in the country‘s history. In a country with a population of 4.7 million people and staggering rates of cranial and spine trauma, as well as hydrocephalus and neural tube defects, neurosurgery is considered a luxury. A study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and Biomedical engineering who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, Bowen et al. aimed to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty practice in Liberia.

The institutions, in collaboration with the Korle-Bu Neuroscience Foundation, spent 10 days in Liberia, based in Tappita, and performed 18 surgeries in addition to seeing several hundred clinic patients. This is a retrospective review of the cases performed along with outcomes to investigate obstacles in providing neurosurgical services in the country.

Before arriving in Liberia, they evaluated, planned, and supplied staff and materials for treating complex neurosurgical patients. Sixteen patients underwent 18 surgeries at a hospital in Tappita, Liberia, in November 2018. Their ages ranged from 1 month to 72 years (average 20 years). Five patients (28%) were female. Ten patients (56%) were under the age of 18. Surgeries included ventriculoperitoneal shunting (VP-shunt), lumbar myelomeningocele repair, encephalocele repair, laminectomy, and a craniotomy for tumor resection. Ten patients (55%) underwent VP-shunting. Two patients (11%) had a craniotomy for tumor resection. Three patients (17%) had laminectomy for lumbar stenosis. Two patients (11%) had repair of lumbar myelomeningocele.

After an aggressive and in-depth approach to planning, conducting, and supplying complex neurosurgical procedures in Liberia, the greatest limiting factor to successful outcomes lie in real-time is access to health care, which is largely limited by overall infrastructure. The study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, they aimed to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty procedural practice in the country of Liberia. Most notably, they focused on infrastructure factors, including power, roads, water, education, and overall health care 1).

1)

Bowen I, Toor H, Zampella B, Doe A, King C, Miulli DE. Infrastructural Limitations in Establishing Neurosurgical Specialty Services in Liberia. Cureus. 2022 Sep 20;14(9):e29373. doi: 10.7759/cureus.29373. PMID: 36284802; PMCID: PMC9584543.

Glioma Guidelines

Glioma Guidelines

The Korean Society for Neuro-Oncology (KSNO) published guidelines for managing adult glioma in 2019, and the National Comprehensive Cancer Network and European Association of Neuro-Oncology published guidelines in September 2021 and March 2021, respectively. However, these guidelines have several different recommendations in practice, including tissue management, adjuvant treatment after surgical resection, and salvage treatment for recurrent/progressive gliomas. Currently, the KSNO guideline working group is preparing an updated version of the guideline for managing adult gliomas 1).

EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. 2)

The National Comprehensive Cancer Network (NCCN) Guidelines for Patients Brain Cancer: Gliomas https://www.nccn.org/patients/guidelines/content/PDF/brain-gliomas-patient.pdf

Zhao et al. systematically searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang databases to retrieve guidelines on glioma in China published from the establishment of the database to 24 January 2022. We performed a narrative review of current clinical studies related to the management of glioblastoma, especially in the surgical, targeted, and immunotherapy therapy and tumor-treating fields.

Key content and findings: In this review, 19 guidelines were included, including 8 subclassified as the guideline, 8 subclassified as the consensus, and 3 subclassified as the standard. Two guidelines reported the contents of the system search, 4 guidelines are updated, and 9 guidelines reported the source of funding. At present, most clinical trials on the immune and targeted therapy of glioblastoma are ongoing in China.

China’s guidelines still need to be improved in terms of preciseness, applicability, and editorial independence. In addition, the cooperation in clinical research of glioblastoma in multiple centers needs to be strengthened in China 3).

To follow the revision of the fourth edition of WHO classification and the recent progress on the management of diffuse gliomas, the joint guideline committee of Chinese Glioma Cooperative Group (CGCG), Society for Neuro-Oncology of China (SNO-China) and Chinese Brain Cancer Association (CBCA) updated the clinical practice guideline. It provides recommendations for diagnostic and management decisions, and for limiting unnecessary treatments and cost. The recommendations focus on molecular and pathological diagnostics, and the main treatment modalities of surgery, radiotherapy, and chemotherapy. In this guideline, we also integrated the results of some clinical trials of immune therapies and target therapies, which we think are ongoing future directions. The guideline should serve as an application for all professionals involved in the management of patients with adult diffuse glioma and also a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in China and other countries 4).

1)

Kim YZ, Kim CY, Lim DH. The Overview of Practical Guidelines for Gliomas by KSNO, NCCN, and EANO. Brain Tumor Res Treat. 2022 Apr;10(2):83-93. doi: 10.14791/btrt.2022.0001. PMID: 35545827; PMCID: PMC9098981.
2)

Weller M, van den Bent M, Preusser M, Le Rhun E, Tonn JC, Minniti G, Bendszus M, Balana C, Chinot O, Dirven L, French P, Hegi ME, Jakola AS, Platten M, Roth P, Rudà R, Short S, Smits M, Taphoorn MJB, von Deimling A, Westphal M, Soffietti R, Reifenberger G, Wick W. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2021 Mar;18(3):170-186. doi: 10.1038/s41571-020-00447-z. Epub 2020 Dec 8. Erratum in: Nat Rev Clin Oncol. 2022 May;19(5):357-358. PMID: 33293629; PMCID: PMC7904519.
3)

Zhao MJ, Lu T, Ma C, Wang ZF, Li ZQ. A narrative review on the management of glioblastoma in China. Chin Clin Oncol. 2022 Aug;11(4):29. doi: 10.21037/cco-22-18. PMID: 36098100.
4)

Jiang T, Nam DH, Ram Z, Poon WS, Wang J, Boldbaatar D, Mao Y, Ma W, Mao Q, You Y, Jiang C, Yang X, Kang C, Qiu X, Li W, Li S, Chen L, Li X, Liu Z, Wang W, Bai H, Yao Y, Li S, Wu A, Sai K, Li G, Yao K, Wei X, Liu X, Zhang Z, Dai Y, Lv S, Wang L, Lin Z, Dong J, Xu G, Ma X, Zhang W, Zhang C, Chen B, You G, Wang Y, Wang Y, Bao Z, Yang P, Fan X, Liu X, Zhao Z, Wang Z, Li Y, Wang Z, Li G, Fang S, Li L, Liu Y, Liu S, Shan X, Liu Y, Chai R, Hu H, Chen J, Yan W, Cai J, Wang H, Chen L, Yang Y, Wang Y, Han L, Wang Q; Chinese Glioma Cooperative Group (CGCG); Society for Neuro‐Oncology of China (SNO-China); Chinese Brain Cancer Association (CBCA); Chinese Glioma Genome Atlas (CGGA); Asian Glioma Genome Atlas (AGGA) network. Clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett. 2021 Feb 28;499:60-72. doi: 10.1016/j.canlet.2020.10.050. Epub 2020 Nov 6. PMID: 33166616.

German Pituitary Tumor Registry

German Pituitary Tumor Registry

In 1996, the German Registry of Pituitary Tumors was founded by the Pituitary Section of the German Society of Endocrinology as a reference center for collection and consultant pathohistological studies of pituitary tumors.

The collection comprises a total of 16,283 cases up until the end of 2018. Of these cases, 12,673 originated from surgical and 3,610 from autopsy material. All specimens were fixed in formalin and embedded in paraffin. The sections were stained with H&E stain and PAS. Monoclonal (prolactin, TSH, FSH, LH, and alpha subunit) or polyclonal (GH and ACTH) antibodies were used to detect pituitary hormones in the lesions. Since 2017, antibodies against the transcription factors Pit-1, T-Pit, and SF-1 has been used in difficult cases. The criteria of the The 2017 World Health Organization classification of tumors of the pituitary gland have been basic principles for classification since 2018 (Osamura et al. 2017). For differentiation of other sellar tumors, such as meningiomas, chordomas, or metastases, the use of additional antibodies was necessary. For these cases, it was possible to use a broad antibody spectrum. Autopsy pituitaries were generally studied by H&E and PAS sections. If any lesions were demonstrated in these specimens, additional immunostaining was performed.

Multiple tumorous lesions with more than one pituitary neuroendocrine tumor (PitNET) respectively adenoma make up 1.4% (232 cases) in our collection. Within the selected cases, synchronous multiple pituitary neuroendocrine tumors (PitNETs) account for 17.3%, PANCH cases (pituitary adenoma with neuronal choristoma) for 14.7%, PitNETs and posterior lobe tumors for 2.2%, PitNETs and metastases for 5.2%, PitNETs and mesenchymal tumors for 2.6%, PitNETs and cysts for 52.2%, and PitNETs and primary inflammation for 6.0%. The mean patient age was 53.8 years, with a standard deviation of 18.5 years. A total of 55.3% of the patients were female and 44.7% were male. From 1990 to 2018, there was a continuous increase in the number of multiple tumorous lesions.

From the studies, Schöning et al. concluded that considering possible tumorous double lesions during surgeries and in preoperative X-ray analyses is recommended 1).

Inflammatory pituitary lesions account for 1.8% of all specimens from the German Pituitary Tumor Registry. They occur in 0.5% of the autoptical specimens and in 2.2% of the surgical cases. Women are significantly more often affected than men and are often younger when first diagnosed. In general, primary and secondary inflammation can be distinguished, with secondary types occurring more frequently (75.1%) than idiopathic inflammatory lesions (15.4%). In primary inflammation, the lymphocytic type is more common (88.5%) than the granulomatous type of hypophysitis (11.5%). The most common causes of secondary inflammation are Rathke’s cleft cysts (48.6%), followed by tumors (17.4%) such as craniopharyngioma (9.1%), and adenoma (5.5%) or germinoma (2.0%). More causes are tumor-like lesions (7.1%) such as xanthogranuloma (3.5%) or Langerhans histiocytosis (3.5%), abscesses (5.5%), generalized infections (5.1%), spread inflammations (4.7%) and previous surgeries (4.0%). In 1.6% of all specimens, the reason for the inflammation remains unclear. The described classification of hypophysitis is important for specific treatment planning after surgery 2).

Searching the data bank of the German Pituitary Tumor Registry 12 double pituitary adenomas with diverse lineage were identified among 3654 adenomas and 6 hypophyseal carcinomas diagnosed between 2012 and 2020. The double adenomas were investigated immunohistochemically for the expression of hormones and lineage markers. In addition, chromosomal gains and losses as well as global DNA methylation profiles were assessed, whenever sufficient material was available (n = 8 PA).

In accordance with the literature, combinations of GH/prolactin/TSH-FSH/LH adenoma (4/12), GH/prolactin/TSH-ACTH adenoma (3/12), and ACTH-FSH/LH adenoma (3/12) were observed. Further, two out of 12 cases showed a combination of a GH/prolactin/TSH adenoma with a null-cell adenoma. Different expression patterns of hormones were confirmed by different expression of transcription factors in 11/12 patients. Finally, multiple lesions that were molecularly analyzed in 4 patients displayed distinct copy number changes and global methylation patterns.

The data confirm and extend the knowledge on multiple PAs and suggest that such lesions may originate from distinct cell types 3).

Between 1996 and 2020, 12,565 cases were enrolled in the German Registry of Pituitary Tumors including 10,084 PitNETs (10,067 adenomas and 19 carcinomas obtained surgically and 193 adenomas diagnosed at autopsy) as well as 69 spindle cell tumors of the neurohypophysis (64 surgical specimens and 5 autopsies). In six patients (1 post-mortem and 5 surgical specimens), PitNETs, as well as posterior lobe tumors, were found in the specimens. Two of the PitNETs were sparsely granulated prolactin-producing tumors, combined in one case with a granular cell tumor and in one case with a pituicytoma. One of the PitNETs revealed that the autopsy was a sparsely granulated GH tumor combined with a neurohypophyseal granular cell tumor. Two PitNETs were null cell adenomas combined with a pituicytoma and a spindle cell oncocytoma, respectively. Further, one Crooke cell tumor was combined with a spindle cell oncocytoma. In five cases, the PitNETs were larger than the posterior lobe tumors and accounted for the clinical symptoms. Previously, four cases of co-existing pituitary anterior and posterior lobe tumors were described in the literature, comprising two ACTH PitNETs, one gonadotrophic PitNET and one null cell PitNET, each in combination with a pituicytoma. PitNETs and concomitant granular cell tumor or spindle cell oncocytoma, as observed in our cohort, have not been reported before 4).

The first 10 years of this registry based on 4122 cases were reported by Saeger et al. The data supplement former collections of the years 1970-1995 with 3480 surgically removed tumors or lesions of the pituitary region. The cases were studied using histology, immunostainings, and in some cases also molecular pathology or electron microscopy. The adenomas were classified according to the current World Health Organization classification in the version of 2004. From 1996 on 3489 adenomas (84.6%), 5 pituitary carcinomas (0.12%), 133 craniopharyngiomas (3.2%), 39 meningiomas (0.94%), 25 metastases (0.6%), 22 chordomas (0.5%), 115 cystic non-neoplastic lesions (2.8%), and 46 inflammatory lesions (1.1%, 248 other lesions or normal tissue (6.0%)) were collected by us. The adenomas (100%) were classified into densely granulated GH cell adenomas (9.2%), sparsely granulated GH cell adenomas (6.3%), sparsely granulated prolactin (PRL) cell adenomas (8.9%), densely granulated PRL cell adenomas (0.3%), mixed GH/PRL cell adenomas (5.2%), mammosomatotropic adenomas (1.1%), acidophilic stem cell adenomas (0.2%), densely granulated ACTH cell adenomas (7.2%), sparsely granulated ACTH cell adenomas (7.9%), Crooke cell adenomas (0.03%), TSH cell adenomas (1.5%), FSH/LH cell adenomas (24.8%), null cell adenomas (19.3%), null cell adenoma, oncocytic variant (5.8%), and plurihormonal adenomas (1.3%). Following the WHO classification of 2004, the new entity ‘atypical adenoma’ was found in 12 cases in 2005. Various prognostic parameters and clinical implications are discussed 5)

1)

Schöning JV, Flitsch J, Lüdecke DK, Fahlbusch R, Buchfelder M, Buslei R, Knappe UJ, Bergmann M, Schulz-Schaeffer WJ, Herms J, Glatzel M, Saeger W. Multiple tumorous lesions of the pituitary gland. Hormones (Athens). 2022 Aug 10. doi: 10.1007/s42000-022-00392-9. Epub ahead of print. PMID: 35947342.
2)

Warmbier J, Lüdecke DK, Flitsch J, Buchfelder M, Fahlbusch R, Knappe UJ, Kreutzer J, Buslei R, Bergmann M, Heppner F, Glatzel M, Saeger W. Typing of inflammatory lesions of the pituitary. Pituitary. 2022 Feb;25(1):131-142. doi: 10.1007/s11102-021-01180-1. Epub 2021 Aug 31. PMID: 34463941; PMCID: PMC8821060.
3)

Hagel C, Schüller U, Flitsch J, Knappe UJ, Kellner U, Bergmann M, Buslei R, Buchfelder M, Rüdiger T, Herms J, Saeger W. Double adenomas of the pituitary reveal distinct lineage markers, copy number alterations, and epigenetic profiles. Pituitary. 2021 Dec;24(6):904-913. doi: 10.1007/s11102-021-01164-1. Epub 2021 Sep 3. PMID: 34478014; PMCID: PMC8550269.
4)

Saeger W, von Schöning J, Flitsch J, Jautzke G, Bergmann M, Hagel C, Knappe UJ. Co-occurrence of Pituitary Neuroendocrine Tumors (PitNETs) and Tumors of the Neurohypophysis. Endocr Pathol. 2021 Dec;32(4):473-479. doi: 10.1007/s12022-021-09677-y. Epub 2021 Jun 15. PMID: 34129177.
5)

Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol. 2007 Feb;156(2):203-16. doi: 10.1530/eje.1.02326. PMID: 17287410.

American Society for Stereotactic and Functional Neurosurgery

American Society for Stereotactic and Functional Neurosurgery

https://www.assfn.org/

Position Statement on Magnetic resonance image-guided laser interstitial thermal therapy for epilepsy

Magnetic resonance image-guided laser interstitial thermal therapy (MRgLITT) is a tool in the neurosurgical armamentarium for the management of drug-resistant epilepsy. Given the introduction of this technology, the American Society for Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, consisting of failure to respond to, or intolerance of, at least 2 appropriately chosen medications at appropriate doses for disabling, localization-related epilepsy in the setting of well-defined epileptogenic foci, or critical pathways of seizure propagation accessible by MRgLITT. Applications of MRgLITT in mesial temporal lobe epilepsy and hypothalamic hamartoma, along with its contraindications in the treatment of epilepsy, are discussed based on current evidence. To put this position statement in perspective, they detailed the evidence and authority on which this ASSFN position statement is based 1)

Position Statement on Deep Brain Stimulation for Medication-Refractory Epilepsy

A persistent underuse of epilepsy surgery exists. Neuromodulation treatments including deep brain stimulation (DBS) expand the surgical options for patients with epilepsy and provide options for patients who are not candidates for resective surgery. DBS of the bilateral anterior nucleus of the thalamus is an Food and Drug Administration-approved, safe, and efficacious treatment option for patients with refractory focal epilepsy. The purpose of this consensus position statement is to summarize evidence, provide recommendations, and identify indications and populations for future investigation in Deep Brain Stimulation for epilepsy. The recommendations of the American Society for Stereotactic and Functional Neurosurgery are based on several randomized and blinded clinical trials with high-quality data to support the use of DBS to the anterior nucleus of the thalamus for the treatment of refractory focal-onset seizures.

Online surveys

Cabrera et al. designed a 51-question online survey comprising Likert-type, multiple-choice, and rank-order questions and distributed it to members of the American Society for Stereotactic and Functional Neurosurgery (ASSFN). Descriptive and inferential statistical analyses were performed on the data.

They received 38 completed surveys. Half (n = 19) of responders reported devoting at least a portion of their clinical practice to psychiatric neurosurgery, utilizing DBS and treating obsessive compulsive disorder (OCD) most frequently overall. Respondents indicated that psychiatric neurosurgery is more medically effective (OR 0, p = 0.03242, two-sided Fisher’s exact test) and has clearer clinical indications for the treatment of OCD than for the treatment of depression (OR 0.09775, p = 0.005137, two-sided Fisher’s exact test). Seventy-one percent of all respondents (n = 27) supported the clinical utility of ablative surgery in modern neuropsychiatric practice, 87% (n = 33) agreed that ablative procedures constitute a valid treatment alternative to DBS for some patients, and 61% (n = 23) agreed that ablative surgery may be an acceptable treatment option for patients who are unlikely to comply with postoperative care.

This up-to-date account of practices, perceptions, and predictions about psychiatric neurosurgery contributes to the knowledge about evolving attitudes over time and informs priorities for education and further surgical innovation on the psychiatric neurosurgery landscape 2).

Biennial Meetings

2022 AMERICAN SOCIETY FOR STEREOTACTIC AND FUNCTIONAL NEUROSURGERY BIENNIAL MEETING

2016 Biennial Meeting of the American Society for Stereotactic and Functional Neurosurgery, Chicago, IL, USA, June 18-21, 2016: Abstracts 3)

1)

Wu C, Schwalb JM, Rosenow JM, McKhann GM 2nd, Neimat JS; American Society for Stereotactic and Functional Neurosurgeons. The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Neurosurgery. 2022 Feb 1;90(2):155-160. doi: 10.1227/NEU.0000000000001799. PMID: 34995216.
2)

Cabrera LY, Courchesne C, Kiss ZHT, Illes J. Clinical Perspectives on Psychiatric Neurosurgery. Stereotact Funct Neurosurg. 2019;97(5-6):391-398. doi: 10.1159/000505080. Epub 2020 Jan 17. PMID: 31955163.
3)

2016 Biennial Meeting of the American Society for Stereotactic and Functional Neurosurgery, Chicago, IL, USA, June 18-21, 2016: Abstracts. Stereotact Funct Neurosurg. 2017 Jan 16;94 Suppl 2:1-77. doi: 10.1159/000455386. [Epub ahead of print] PubMed PMID: 28092908.

Scientific meeting

Scientific meeting

It is ironic that doctors, for whom protecting health are a primary responsibility, contribute to global warming through unnecessary attendances at international conferences.

High quality medical education is essential for patient care, and the educational benefits of conference attendance must also be considered. But “let’s be honest, when did you last learn anything really important at a large meeting?”

Evidence that attending conference lectures improves practice is scant.

Annual scientific meetings serve as a forum for the dissemination of new research findings. The presentations of these meetings should be of high scientific quality because they have the potential to impact future research projects and current clinical practice. Moreover, the publication of these findings as full articles is extremely important to increase its dissemination. Unfortunately, while evaluating the publication rate of 307,028 abstracts presented in biomedical meetings, a systematic review reported that only 37.3% were further published, leaving a great number of studies restricted to the events.

Medical conferences: value for money? 1).

Student/trainee conferences are typically cheaper than professional conferences, but as they are not acknowledged in national scoring systems for medical and surgical training applications, they may have worse attendance than otherwise possible.

In a cross-sectional database review, 162 conferences were identified through a systematic search of two conference databases by three independent researchers. χ2 tests were used to compare scientific quality between student/trainee and professional conferences and the likelihood of offering different types of discounts. Independent t-tests were employed to determine cost differences between the two categories of conferences.

The data revealed that there was no significant difference between student/trainee and professional conference’s likelihood of declaring information on their abstract review processes (p=0.105). There was no difference in speaker seniority, determined by the tool the authors developed (p=0.172). Student/trainee conferences were significantly more likely to offer workshops (p<0.0005) and were cheaper than professional conferences (p<0.0005).

These results show that student/trainee conferences offer a similar level of scientific quality to professional medical conferences in the UK at a fraction of the cost, which should be reflected within the national scoring systems 2).

The advantages of Web conferencing are multiple. It removes the need for long and expensive travels that take up a lot of time, and remove you from your family and practice. By avoiding cost for travel and stay, conferences (and therefore, knowledge) can be made accessible for a larger audience, especially in developing countries. By avoiding travel itself, assuming you do not travel by bike or sailboat, CO2 emission can be reduced too. Online conferencing also allows for a more flexible schedule: you may not be able to attend a conference abroad for that one surgery or appointment that cannot be postponed. In that case you may still be able to attend other lectures or sessions if you can follow them from your office or your home. It is perfectly possible to include checks whether you actually watched a video, which would allow for CME points as you would get during an on-site conference 3).

Quality

The quality of a scientific meeting can be quantified by the rate of full publications arising from the presented abstracts and the impact factor of the journals in which the studies were published.

The aim of a study of Sarica et al. was to investigate the publication rates of presentations from the 2013 World Society for Stereotactic and Functional Neurosurgery (WSSFN) quadrennial meeting.

Scopus and PubMed databases were searched for the authors of the presentations to identify full publications arising from the relevant abstracts. Author and content matching were used to match an abstract with a full publication. Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis.

In total, 77% (57/74), 56% (44/79), and 50% (79/157) of the paper, flash, and poster presentations, respectively, have been published, with an overall publication rate of 58% (180/310). Articles received a total of 5,227 citations, with an average of 29 ± 64.1 citations per article. The first authors who published their studies had a significantly higher h-index than those who did not publish (p = 0.003). The most preferred journals for publication were Journal of Neurosurgery, Acta Neurochirurgica, and Stereotactic and Functional Neurosurgery. The majority of the articles (117/180 [65%]) were published in a quartile 1 or 2 journal. The average journal impact factor (JIF) was 4.5 for all presentations, and 7.8 for paper session presentations. Studies presented in paper sessions were published in significantly higher-impact factor journals than those presented in poster sessions (p < 0.001).

The WSSFN Congress had a relatively high overall publication rate (58%) compared to both other neurosurgical congresses and congresses in other scientific fields. The average JIF of 7.8 is a reflection of the high quality and high impact of the paper session presentations 4).

Tips

Six Tips for Getting the Most from Your Next Conference

  1. Sit at the front during talks: Even if this is not your style (or especially if this is not your preference), this will help you feel more involved in the talk.

  2. Take copious notes: Whether you need them or not, taking notes during presentations helps focus the mind.

  3. Rate all speakers for content and presentation: This is a way to keep yourself alert as well as help yourself think critically about talks’ content. For the best presentations, it will also give you notes about style or techniques to integrate into your next talk.

  4. Break away: People tend to attend conferences with colleagues, co-workers, and friends – people they already know. But during talks and at meal times, try and sit with people you don’t know. You are bound to learn something new, whether it is about work in your field, how other institutions function, or how different people approach questions relevant to your work.

  5. Be excited about your science: If you’re excited about your science, others will feed off of that excitement. Whether it is during a formal talk, a panel discussion, a poster session or just talking to people in the hallways, keep in mind that you are selling your science. Also remember that everyone is being bombarded with talks and research: the enthusiasm you muster will go a long way to getting peoples’ attention.

  6. Size matters: Small meetings often have a singlemindedness about a particular subject that can benefit all participants. There are likely to be fewer competing sessions at small meetings, and you can probably actually meet the speakers, instead of stand in line.

References

1)

Swash M, Lees AJ. Medical conferences: value for money? J Neurol Neurosurg Psychiatry. 2019 Apr;90(4):483-484. doi: 10.1136/jnnp-2018-319248. Epub 2018 Oct 18. PubMed PMID: 30337441.
2)

Sharp EW, Curlewis K, Clarke THS. Stop paying through the nose: student and trainee medical conferences offer better value for money than professional alternatives. Postgrad Med J. 2019 Nov;95(1129):577-582. doi: 10.1136/postgradmedj-2019-136734. Epub 2019 Jul 24. PubMed PMID: 31341039.
3)

Kubben PL. Online conferencing: Less CO(2), more effective? Surg Neurol Int. 2012;3:115. doi: 10.4103/2152-7806.102322. Epub 2012 Oct 13. PubMed PMID: 23226602; PubMed Central PMCID: PMC3512339.
4)

Sarica C, Kucuk F, Ozen A, Aksu Sayman O. Publication Patterns of Presentations at the 16th Quadrennial Meeting of the World Society for Stereotactic and Functional Neurosurgery. Stereotact Funct Neurosurg. 2020 Feb 19:1-7. doi: 10.1159/000505703. [Epub ahead of print] PubMed PMID: 32074619.

WFNS Neurosurgical Anatomy Webinar (12th – 13th May 2020)

WFNS Neurosurgical Anatomy Webinar (12th – 13th May 2020)

Dear Colleagues,

On behalf of the World Federation of Neurological Surgeons “Neuroanatomy Committee” we are pleased to launch its “1st online, dynamic educational course” to promote sound clinical judgement, enhance the neurosurgical skills of young neurosurgeons and trainees around the globe, encourage them to rise to their challenges and respond to their enquiries.

The course will encompass special presentations by distinguished faculty, case discussions and short video sessions reflecting the importance and relevance of anatomical knowledge to neurosurgical interventions.

Sincerely,

Imad N. Kanaan & Vladimír Beneš

Chairmen of WFNS Neuroanatomy

The World of Neurosurgery: New Articles Out Now

The World of Neurosurgery: New Articles Out Now

Neurosurgeons around the world are united by their desire to help patients, especially in these unpredictable times. In the latest articles from AANS Neurosurgeon, authors share experiences of global neurosurgery and how the field has developed over time. New today:

Roger Stupp, MD; Mark Youngblood, MD, PhD

Martina Stippler, MD, FAANS; Jaini Shah

H. Hunt Batjer, MD, FAANS

Clarence B. Watridge, MD, FAANS(L)

Gail Rosseau, MD, FAANS; Walter D. Johnson, MD, FAANS(L)

Scott C. Mitchell

Gary D. VanderArk, MD, FAANS

The Search for a Biological Link between Reactivated HSV and Neurological Disease

Without even knowing it, most of us carry around latent Herpes Simplex Virus (HSV) in our nervous system—a simple result of being born and living together with others carrying the virus.

Aerobic Exercise May Treat Persistent Post-concussive Symptoms in Adults

A new study will evaluate whether persistent symptoms following concussion, also known as post-concussion syndrome, can be treated using a personalized, progressive aerobic exercise program.

Novel use of Robotics for Neuroendovascular Procedures

Surgeons at the Sidney Kimmel Medical College at Thomas Jefferson University are pioneering the use of robotics in neuroendovascular procedures, which are performed via the blood vessels of the neck and brain.

Acta Editor’s Choice! Free access as of 7 May until 18 June 2020

Acta Editor’s Choice! Free access as of 7 May until 18 June 2020

  • Neurosurgery during the COVID-19 pandemic: update from Lombardy, Northern Italy. Read more
  • The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study. Read more
  • Letter to the editor by Dobran Mauro, Paracino Riccardo, and Iacoangeli Maurizio regarding “Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy.” Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fontanella MM. Acta Neurochir (Wien). 2020 Mar 28. doi: 10.1007/s00701-020-04305-w. Read more
  • The response during a pandemic is a blurred vision of the future. Reflections on the Lombardy reorganization of the neurosurgical emergencies during the COVID-19. Read more
  • Our darkest hours (being neurosurgeons during the COVID-19 war). Read more
  • Long-term excess mortality after chronic subdural hematoma. Read more. Read more
  • Intermediate-term clinical and radiographic outcomes with less invasive adult spinal deformity surgery: patients with a minimum follow-up of 4 years. Read more