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Objective: We sought to assess the practice patterns of ventriculoperitoneal shunt (VPS) placement by neurosurgeons at academic, community, and government-based institutions., Methods: Using the American Association of Neurological Surgeons directory, a total of 3673 practicing neurosurgeons were contacted. The survey received 495 responses (57% academic, 41% community, 3% other/government based). The survey consisted of 9 questions to assess the frequency of general surgery assistance for distal VPS placement and the use of cranial neuronavigation for proximal placement and to assess subjective beliefs of personal practice pattern and the influence on shunt failure rates., Results: Almost half of the respondents reported using general surgery less than half of the time for distal VPS placement. Regardless of personal practice patterns, roughly one third of respondents reported that general surgery assistance is a common or somewhat common practice at their institution. The most common reasons for recruiting general surgery assistance were cases of higher complexity. Although commonly used, almost 40% of respondents believe that general surgery assistance does not decrease shunt failure rates. Cranial neuronavigation is used less than half of the time, and the most common reason was for improved accuracy. Almost half of the respondents believe navigation does decrease shunt failure rates., Conclusions: General surgery assistance for distal placement and neuronavigation for the proximal placement of VPS catheters are both commonly used by neurosurgeons in academic, community, and other practice locations. This survey provides the first assessment of practice patterns nationally. The results demonstrate that roughly half of the practicing neurosurgeons use general surgery assistance and neuronavigation, particularly for complex or high-risk cases., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Nontraumatic subarachnoid hemorrhage (SAH) refers to high pressure extravasation of blood into the subarachnoid space that typically occurs spontaneously from rupture of cerebral aneurysm. The purpose of this study was to identify postoperative complications requiring increased surveillance in obese, diabetic, and hypertensive patients., Methods: Patients who underwent surgical treatment for nontraumatic SAH were queried in the American College of Surgeons National Surgical Quality Improvement Program database from the years 2012-2018. Cases were identified using International Classification of Diseases codes and then classified independently by 3 dichotomous diagnoses: obesity, diabetes, and hypertension., Results: Among 1002 patients meeting inclusion criteria, 311 (31%) were obese (body mass index >30), 86 (9%) had diabetes treated with insulin or noninsulin agents, and 409 (41%) required medication for hypertension. There was a statistically significant association between diabetes and postoperative pneumonia (odds ratio [OR] = 1.694; 95% confidence interval [CI] = 0.995-2.883; P = 0.050), prolonged ventilator dependence (OR = 1.700; 95% CI = 1.087-2.661; P = 0.019), and death (OR = 1.846; 95% CI = 1.071-3.179; P = 0.025). Medication-dependent hypertension was statistically associated with incidence of stroke/cerebrovascular accident (OR = 1.763; 95% CI = 1.056-2.943; P = 0.023). Obesity was not associated with adverse outcomes in this population., Conclusions: In patients undergoing surgical management of SAH, hypertensive and diabetic patients had poorer outcomes, including prolonged ventilator dependence, pneumonia, stroke/cerebrovascular accident, and death. Surprisingly, preexisting obesity was not associated with poor outcomes. In fact, overweight body mass index, class I obesity, and class II obesity had decreased need for transfusion in the 30-day postoperative period., (Published by Elsevier Inc.)

Background: Women have been a minority in neurosurgery since the foundation of the specialty. Women who choose to pursue neurosurgery or advance in their career must overcome various obstacles. In this article, we discuss the proportion of women in neurosurgery globally and the obstacles they face, as well as the solutions being implemented., Methods: A systematic review of studies concerning international women in neurosurgery was conducted. Article inclusion was assessed based on relevance to women of neurosurgery, geographic region, date, and classification (rates/data, barriers, or solutions)., Results: From the specified search, 127 articles were retrieved, and 27 met the inclusion criteria. Of the total, 25 countries were represented and discussed in the articles. Primary classification of articles resulted in 50 for data/rates, 22 for barriers, and 17 for possible solutions., Discussion: Despite cultural differences among unique regions of the globe, women face similar challenges when pursuing neurosurgery, such as difficulty advancing their careers, balancing duties at work and at home, meeting social and cultural expectations, and finding support and mentorship. Encouragingly, measures are already being implemented worldwide to allow women to fulfill their multiple other roles through maternity leave policies, increasing their access to mentors, and enabling promotions throughout their careers., Conclusions: With the shortage of neurosurgeons in many regions of the world, the recruitment of female neurosurgeons plays a vital role in meeting those demands. Our cultures and professional societies should celebrate their inclusion and promotion and accommodate the complex role of women as neurosurgeons, mothers, partners, scientists, and leaders., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Patients with ideomotor apraxia (IMA) present with selective impairments in higher-order motor cognition and execution without damage to any motor or sensory pathways. Although extensive research has been conducted to determine the regions of interest (ROIs) underlying these unique impairments, previous models are heterogeneous and may be further clarified based on their structural connectivity, which has been far less described., Objective: The goal of this research is to propose an anatomically concise network model for the neurophysiologic basis of IMA, specific to the voluntary pantomime, imitation and tool execution, based on intrinsic white matter connectivity., Methods: We utilized meta-analytic software to identify relevant ROIs in ideomotor apraxia as reported in the literature based on functional neuroimaging data with healthy participants. After generating an activation likelihood estimation (ALE) of relevant ROIs, cortical parcellations overlapping the ALE were used to construct an anatomically precise model of anatomic substrates using the parcellation scheme outlined by the Human Connectome Project (HCP). Deterministic tractography was then performed on 25 randomly selected, healthy HCP subjects to determine the structural connectivity underlying the identified ROIs., Results: 10 task-based fMRI studies met our inclusion criteria and the ALE analysis demonstrated 6 ROIs to constitute the IMA network: SCEF, FOP4, MIP, AIP, 7AL, and 7PC. These parcellations represent a fronto-parietal network consisting mainly of intra-parietal, U-shaped association fibers (40%) and long-range inferior fronto-occipital fascicle (IFOF) fibers (50%). These findings support previous functional models based on dual-stream motor processing., Conclusion: We constructed a preliminary model demonstrating the underlying structural interconnectedness of anatomic substrates involved in higher-order motor functioning which is seen impaired in IMA. Our model provides support for previous dual-stream processing frameworks discussed in the literature, but further clarification is necessary with voxel-based lesion studies of IMA to further refine these findings., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: The supplementary motor area (SMA) plays an important role in the initiation and coordination of internally and externally cued movements. Such movements include reaching, grasping, speaking, and bilateral hand coordination. While many studies discuss the SMA and its relationship to other parts of the motor network, there is minimal literature examining the connectivity of the SMA outside of the motor network. Using region-based fMRI studies, we built a neuroanatomical model to account for these extra-motor connections., Methods: Thirty region-based fMRI studies were used to generate an activation likelihood estimation (ALE) using BrainMap software. Cortical parcellations overlapping the ALE were used to construct a preliminary model of the SMA connections outside the motor network. DSI-based fiber tractography was performed to determine the connectivity between cortical parcellations. The resulting connections were described using the cortical parcellation scheme developed by the Human Connectome Project (HCP)., Results: Four left hemisphere regions were found to comprise the SMA. These included areas SFL, SCEF, 6ma, and 6mp. Across mapped brains, these areas showed consistent interconnections between each other. Additionally, ipsilateral connections to the primary motor cortex, left inferior and middle frontal gyri, the anterior cingulate gyrus, and insula were demonstrated. Connections to the contralateral SMA, anterior cingulate, lateral premotor, and inferior frontal cortices were also identified., Conclusions: We describe a preliminary cortical model for the underlying structural connectivity of the supplementary motor area outside the motor network. Future studies should further characterize the neuroanatomic underpinnings of this network for the purposes of medical application., (Copyright © 2021. Published by Elsevier B.V.)

Introduction: The ventral attention network (VAN) is an important mediator of stimulus-driven attention. Multiple cortical areas, such as the middle and inferior frontal gyri, anterior insula, inferior parietal lobule, and temporo-parietal junction have been linked in this processing. However, knowledge of network connectivity has been devoid of structural specificity., Methods: Using relevant task-based fMRI studies, an activation likelihood estimation (ALE) of the VAN was generated Regions of interest corresponding to the HCP cortical parcellation scheme were co-registered onto this ALE in MNI coordinate space and visually assessed for inclusion in the network. DSI-based fiber tractography was performed to determine the structural connections between cortical areas comprising the VAN., Results: Fourteen regions within the right cerebral hemisphere were found to overlap the ALE of the VAN: 6a, 6r, 7AM, 7PM, 8C, AVI, FOP4, MIP, p9-46v, PCV, PFm, PGi, TPOJ1, and TPOJ2. Regions demonstrated consistent U-shaped interconnections between adjacent parcellations, and the SLF was found to connect frontal and parietal areas of the network., Conclusions: We present a tractographic model of the VAN. This model comprises parcellations within the frontal and parietal cortices that are linked via the SLF. Future studies may refine this model with the ultimate goal of clinical application., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: With the implementation of strict 80-hour work week in general surgery training, serious questions have been raised concerning the quality of surgical education and the ability of newly trained general surgeons to independently operate. Programs that were randomized to the interventional arm of the Flexibility In duty-hour Requirements for Surgical Trainees (FIRST) Trial were able to decrease transitions and allow for better continuity by virtue of less constraints on duty-hour rules. Using National Surgical Quality Improvement Program Quality In-Training Initiative data along with duty-hour violations compared with old rules, it was hypothesized that quality of care would be improved and outcomes would be equivalent or better than the traditional duty-hour rules. It was also hypothesized that resident perception of compliance with duty hour would not change with implementation of new regulations based on FIRST trial., Methods: Flexible work hours were implemented on July 1, 2014. National Surgical Quality Improvement Program Quality In-Training Initiative information was reviewed from July 2014 to January 2015. Patient risk factors and outcomes were compared between institutional resident cases and the national cohort for comparison. Residents' duty-hour logs and violations during this period were compared to the 6-month period before the implementation of the FIRST trial. The annual Accreditation Council for Graduate Medical Education resident survey was used to assess the residents' perception of compliance with duty hours., Results: With respect to the postoperative complications, the only statistically significant measures were higher prevalence of pneumonia (3.4% vs. 1.5%, p < 0.05) and lower prevalence of sepsis (0% vs. 1.5%, p < 0.05) among cases covered by residents with flexible duty hours. All other measures of postoperative surgical complications showed no difference. The total number of duty-hour violations decreased from 54 to 16. Had the institution not been part of the interventional arm of the FIRST trial, this number would have increased to 238. The residents' perception of compliance with 80-hour work week from the Accreditation Council for Graduate Medical Education survey improved from 68% to 91%., Conclusions: Residents with flexible work hours on the interventional arm of the FIRST trial at our institution took care of a significantly sicker cohort of patients as compared with the national dataset with equivalent outcomes. Flexible duty-hour policy under the FIRST trial has enabled the residents to have fewer work-hour violations while improving continuity of care to the patients. Additionally, the overall perception of resident compliance with the duty-hour requirements was improved., (Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)