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BackgroundAir pollution is a known risk factor for cardiovascular diseases, including stroke. This study examines the impact of county-level air pollution on ischemic and hemorrhagic stroke mortality among U.S. individuals aged 65 and older, emphasizing racial and socioeconomic disparities.MethodsUsing data from the Center for Disease Control (CDC) Interactive Atlas of Heart Disease and Stroke, we analyzed county-level ischemic stroke mortality rates for older residents between 2016 and 2020. The data on air pollution at the county level, specifically particulate matter (PM2.5) levels, were obtained from the CDC. We applied multivariable linear and logistic regression models to examine the association between PM2.5 levels and stroke mortality, as well as the probability of meeting the Environmental Protection Agency (EPA) air quality standards.ResultsCounty-level analysis revealed a significant correlation (R = 0.68, R2 = 0.48, p

Background and objectivesThis study investigates geographic disparities in aneurysmal subarachnoid hemorrhage (aSAH) care for Black patients and aims to explore the association with segregation in treatment facilities. Understanding these dynamics can guide efforts to improve healthcare outcomes for marginalized populations.MethodsThis cohort study evaluated regional differences in segregation for Black patients with aSAH and the association with geographic variations in disparities from 2016 to 2020. The National Inpatient Sample (NIS) database was queried for admission data on aSAH. Black patients were compared to White patients. Segregation in treatment facilities was calculated using the dissimilarity (D) index. Using multivariable logistic regression models, the regional disparities in aSAH treatment, functional outcomes, mortality, and end-of-life care between Black and White patients and the association of geographical segregation in treatment facilities was assessed.Results142,285 Black and White patients were diagnosed with aSAH from 2016 to 2020. The Pacific division (D index = 0.55) had the greatest degree of segregation in treatment facilities, while the South Atlantic (D index = 0.39) had the lowest. Compared to lower segregation, regions with higher levels of segregation (global F test p

BackgroundThis study examines the lasting impact of historical redlining on contemporary neurosurgical care access, highlighting the need for equitable healthcare in historically marginalized communities.ObjectiveTo investigate how redlining affects neurosurgeon distribution and reimbursement in U.S. neighborhoods, analyzing implications for healthcare access.MethodsAn observational study was conducted using data from the Center for Medicare and Medicaid Services (CMS) National File, Home Owner’s Loan Corporation (HOLC) neighborhood grades, and demographic data to evaluate neurosurgical representation across 91 U.S. cities, categorized by HOLC Grades (A, B, C, D) and gentrification status.ResultsOf the 257 neighborhoods, Grade A, B, C, and D neighborhoods comprised 5.40%, 18.80%, 45.8%, and 30.0% of the sample, respectively. Grade A, B, and C neighborhoods had more White and Asian residents and less Black residents compared to Grade D neighborhoods (p

Objective Intraoperative ultrasound (IOUS) is an imaging method that can be used in various neurosurgical procedures. It assists in the removal of brain tumors, hematomas, in the insertion of ventricular catheters, and in spinal and peripheral nerve surgeries. The original studies using IOUS were performed with devices that produced lower-quality images, generating little interest in their use. The introduction of ultrasound devices that yielded higher-quality images associated with a relative low cost and ease of use rendered IOUS attractive. Thus, we started using it in multiple neurosurgical procedures, studying its practicality, efficacy and limitations.

Ewing sarcoma (ES) is a malignant neoplasm that affects bones and soft tissues, usually in young patients. Currently, ES is grouped with other tumors that share the same histological and genotypic characteristics, forming the Ewing Sarcoma Family of Tumors (ESFT), which includes ES of bone, extraosseous ES (peripheral neuroepithelioma), Askin tumor, and peripheral primitive neuroectodermal tumor (PNET). Its origin in peripheral nerves is extremely rare, making its diagnosis and treatment very challenging. We describe a case of a 27-year-old male with extraosseous ES originating in the sciatic nerve, which was surgically removed, and discuss the difficulties encountered in the management of this patient.