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Objective: Burnout is experienced by up to two thirds of neurosurgery residents. Team sport participation as an adolescent protects against adverse mental health outcomes in adulthood. The objective of this study was to determine whether high school or collegiate team sport participation is associated with improved psychological well-being during neurosurgery residency., Methods: A cross-sectional survey study of U.S. neurosurgery residents was conducted between June 2020 and February 2021. Outcomes included self-ratings of sadness, anxiety, stress, burnout, optimism, and fulfillment, on 100-point scales, which were averaged into a "Burnout Composite Score" (BCS). Respondents were grouped and compared according to their prior self-reported participation in team sports (participants vs. nonparticipants). A 3-way analysis of variance tested the effects of resident level, exercise days, and team sport participation on BCS., Results: Of 229 submitted responses, 228 (99.5%) provided complete data and 185 (81.1%) residents participated in team sports. Days/week of exercise was similar across groups (2.5 ± 1.8 vs. 2.1 ± 1.8, P = 0.20). The team sport group reported lower mean BCS (37.1 vs. 43.6 P = 0.030, Cohen d = 0.369). There was a significant interaction between prior team sport participation and exercise regimen on BCS (F [3, 211] = 3.39, P = 0.019, n 2  = 0.046), such that more exercise days per week was associated with decreased BCS for prior team sport athletes (F [3, 211] = 11.10, P < 0.0005), but not for nonparticipants (F [3, 211] = 0.476, P = 0.699). The positive impact of prior team sport participation was more pronounced for senior residents (-11.5 points, P = 0.016) than junior residents (-4.3 points, P = 0.29)., Conclusions: Prior team sport participation was associated with lower BCS among neurosurgery residents, an effect more pronounced during senior residency. Lessons imparted during early team sport experience may have profound impacts on reducing burnout throughout a 7-year neurosurgery residency., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Neurosurgery residency programs are tasked with imparting large volumes of both clinical knowledge and technical skill to trainees in limited time. Many investigators have described local practices, which may offer evidence-based interventions in neurosurgical residency education, but this literature has not been systematically reviewed., Objective: To perform a scoping review of educational practices in neurosurgery, which are supported by quantitative, peer-reviewed research., Methods: A scoping review of the literature was performed. PubMed, Embase, and Web of Science databases were queried for articles describing educational interventions for neurosurgery residents, which included a quantitative assessment of the effect on resident performance., Results: From an initial set of 1785 unique articles, 29 studies were ultimately screened and included. Studies were into the following 6 topics: (1) didactics and curricula (n = 13), (2) nontechnical skills (n = 6), (3) wellness and burnout (n = 4), (4) assessment and feedback (n = 2), (5) mentorship and career development (n = 2), and (6) research (n = 2). Individual study results were described., Conclusion: Several educational interventions in neurosurgical training are supported by quantitative evidence. Methodological shortcomings are prevalent among studies of education, particularly in the selection of meaningful outcome measures. A summary of evidence-based considerations is provided for current and future program directors., (© Congress of Neurological Surgeons 2021.)

Background: Preclinical neurosurgery electives have been shown to increase student familiarity with neurosurgery, yet the impact on students without a home neurosurgery program is unknown. We conducted a preclinical neurosurgery elective in a mixed cohort of students with and without home neurosurgery programs to 1) evaluate changes in neurosurgery perceptions, 2) discern differences between cohorts, and 3) identify important factors in those considering neurosurgery., Methods: A yearly elective was offered to students at Vanderbilt University School of Medicine (VUSM; home program) or Meharry Medical College (MMC; no home program) from 2017 to 2018. Each class included a student-led presentation, faculty academic lecture, and faculty round-table discussion. Precourse and postcourse surveys were completed., Results: Thirty-two students completed the course. VUSM students (n = 15) showed no changes in initial perceptions, whereas MMC students (n = 17) had multiple improved perceptions, including collegiality (P = 0.001) and family achievability (P = 0.010), and believed residency to be less rigorous than their initial perceptions (P = 0.046). Fourteen students (44%) showed an increase in the likelihood of considering a neurosurgical career; eight (57%) were MMC students. These 14 students had improved perceptions of neurosurgery as less emotionally draining (P = 0.042), with favorable collegiality (P = 0.003) and work/life balance (P = 0.001) but did not believe residency to be less difficult (P = 0.102) or have added financial security (P = 0.380)., Conclusions: Early exposure to neurosurgery at medical schools without home programs through preclinical electives may improve students' perceptions of neurosurgery, provide valuable information about the benefits and rigors of neurosurgery, and allow students to make informed decisions about further pursuit of neurosurgery., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Once the accepted norm during Harvey Cushing's time, the mantra of work to the exclusion of family and lifestyle is now recognized as deleterious to overall well-being. A number of neurosurgical residency training programs have implemented wellness programs to enhance the physical, mental, and emotional well-being of trainees and faculty. This manuscript highlights existing organized wellness education within neurosurgery residency programs in order to describe the motivations behind development, structure, and potential implementation strategies, cost of implementation, and identify successes and barriers in the integration process. This manuscript is designed to serve as a "how-to" guide for other programs who may identify a need in their own trainees and begins the discussion of how to develop wellness, leadership, grit, and resiliency within our future generation of neurosurgeons., (Copyright © 2018 by the Congress of Neurological Surgeons.)

Background: Neurosurgical educators strive to identify the best applicants, yet formal study of resident selection has proved difficult. We conducted a systematic review to answer the following question: What objective and subjective preresidency factors predict resident success?, Methods: PubMed, ProQuest, Embase, and the CINAHL databases were queried from 1952 to 2015 for literature reporting the impact of preresidency factors (PRFs) on outcomes of residency success (RS), among neurosurgery and all surgical subspecialties. Due to heterogeneity of specialties and outcomes, a qualitative summary and heat map of significant findings were constructed., Results: From 1489 studies, 21 articles met inclusion criteria, which evaluated 1276 resident applicants across five surgical subspecialties. No neurosurgical studies met the inclusion criteria. Common objective PRFs included standardized testing (76%), medical school performance (48%), and Alpha Omega Alpha (43%). Common subjective PRFs included aggregate rank scores (57%), letters of recommendation (38%), research (33%), interviews (19%), and athletic or musical talent (19%). Outcomes of RS included faculty evaluations, in-training/board exams, chief resident status, and research productivity. Among objective factors, standardized test scores correlated well with in-training/board examinations but poorly correlated with faculty evaluations. Among subjective factors, aggregate rank scores, letters of recommendation, and athletic or musical talent demonstrated moderate correlation with faculty evaluations., Conclusion: Standardized testing most strongly correlated with future examination performance but correlated poorly with faculty evaluations. Moderate predictors of faculty evaluations were aggregate rank scores, letters of recommendation, and athletic or musical talent. The ability to predict success of neurosurgical residents using an evidence-based approach is limited, and few factors have correlated with future resident performance. Given the importance of recruitment to the greater field of neurosurgery, these data provide support for a national, prospective effort to improve the study of neurosurgery resident selection., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To quantify the proportion of academic neurosurgeons practicing in the United States who acquired residency training outside of the United States and compare their training backgrounds and academic success with those who received their residency training in the United States., Methods: We identified 1338 clinically active academic neurosurgeons from 104 programs that participated in the neurosurgery residency match in the United States in January-February 2015. Their training backgrounds, current academic positions, and history of National Institutes of Health (NIH) grant awards between 2005 and 2014 were retrieved from publicly accessible sources., Results: Eighty-four U.S. academic neurosurgeons (6.3%) received their residency training in 20 different countries outside of the United States/Puerto Rico, representing all major regions of the world. The majority trained in Canada (n = 48). We found no major differences between the foreign-trained and U.S.-trained neurosurgeons in male:female ratio, year of starting residency, proportion with positions in medical schools ranked in the top 15 by the U.S. News and World Report, general distribution of academic positions, and proportion with an NIH grant. Compared with U.S.-trained academic neurosurgeons, foreign-trained academic neurosurgeons had a significantly higher proportion of Ph.D. degrees (32.1% vs. 12.3%; P < 0.0001) and held more associate professorships (34.5% vs. 23.1%; P = 0.02). The academic practices of the foreign-trained neurosurgeons were widely distributed throughout the United States., Conclusions: A small group of U.S. academic neurosurgeons (6.3%) have acquired residency training outside of the United States, representing all major regions of the world. Their general demographic data and academic accomplishments are comparable to those of U.S.-trained neurosurgeons., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: Exposure to surgical subspecialties is limited during the preclinical years of medical school. To offset this limitation, the authors created a neurosurgery elective for first- and second-year medical students. The objective was to provide each student with early exposure to neurosurgery by combining clinical experience with faculty discussions about the academic and personal realities of a career in neurosurgery., Methods: From 2012 to 2013, the authors offered a neurosurgery elective course to first- and second-year medical students. Each class consisted of the following: 1) peer-reviewed article analysis; 2) student presentation; 3) faculty academic lecture; 4) faculty personal lecture with question and answer period., Results: Thirty-five students were enrolled over a 2-year period. After completing the elective, students were more likely to: consider neurosurgery as a future career (P < 0.0001), perceive the personalities of attending physicians to be more collegial and friendly (P = 0.0002), perceive attending quality of life to be higher (P < 0.0001), and believe it was achievable to be a neurosurgeon and have a family (P < 0.0001). The elective did not alter students' perceived difficulty of training (P = 0.7105)., Conclusions: The neurosurgery elective course significantly increased student knowledge across several areas and changed perceptions about collegiality, quality of life, and family-work balance, while not altering the students' views about the difficulty of training. Adopting a neurosurgery elective geared towards preclinical medical students can significantly change attitudes about the field of neurosurgery and has potential to increase interest in pursuing a career in neurosurgery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Object: A large volume of patients presented to a Level I pediatric trauma center during and after a recent tornado disaster. Injuries of the central and peripheral nervous systems and the medical responses of a pediatric neurosurgical team are reviewed., Methods: The clinical courses of patients who suffered cranial, spinal, and peripheral nerve injuries due to the tornado storm are reported. The clinical actions taken by the neurosurgical team during and after the event are reviewed and the lessons learned are discussed., Results: The tornado storm system moved through the Tuscaloosa and Birmingham metropolitan areas on the early evening hours of April 27, 2011. Twenty-four patients received care from the neurosurgical team. A total of 11 cranial (including placement of an external ventricular drain), 2 spine, and 2 peripheral procedures were performed for the victims. Nine procedures were performed within the first 12 hours of the event, and an additional 6 surgeries were performed in the following 24 hours. Injuries of the peripheral nervous system often presented in a delayed fashion. Several key components were identified that enabled adequate neurosurgical care for a large influx of acute patients., Conclusions: Massive casualties due to tornados are rare. A well-organized physician team working with the hospital administration may decrease the mortality and morbidity of such events.

Object: Cadavers are often used in the teaching of various neurosurgical procedures. One aspect of this resource that has not been previously explored is the postmortem dilation of the ventricular system, which is often collapsed, for the purpose of training neurosurgeons in the use of intraventricular endoscopy., Methods: Nine adult cadavers without a history of hydrocephalus or other known intracranial pathology were used for this study. Four specimens were obtained post embalming, and 5 specimens were fresh (time from death until the procedure < 5 hours). In all cadavers catheters were placed into the lateral ventricles; saline and then air were injected into the ventricles through the catheters. Ventriculostomy sites were filled with rubber stoppers, and in fresh specimens, formal embalming was performed with cadavers in the Trendelenburg position. Lastly, serial horizontal sectioning of the cranium was performed in all cadavers to verify ventricular dilation., Results: None of the 4 embalmed specimens were found to have ventriculomegaly following injection. However, this condition was found in 4 of the 5 fresh specimens. In the single fresh cadaver without ventriculomegaly, the cause of death had been massive intracranial subarachnoid hemorrhage, which distorted the ventricular system. This may have prevented cannulation of the ventricle and ventricular expansion in this specimen., Conclusions: The ventricular system of fresh human cadavers can be dilated postmortem. The method described herein may be useful to neurosurgical trainees or those trained neurosurgeons wishing to practice intraventricular endoscopy.

Historical observations and interpretations regarding the treatment of components of the nervous system can be found in the writings of the Bible and Talmud. A review of topics germane to modern neuroanatomy, neurology, and neurosurgery from these early, rich writings is presented herein. These historic writings provide a glimpse into the early understanding, description, and treatment of pathologies of the nervous system.

Objective: The purpose of this study was to collect and review available data on the incidence of sport-related complications in children with cerebrospinal fluid (CSF) shunts., Methods: After review of medical and legal literature revealed no reports on sports and shunts, an Internet-based survey was conducted of pediatric neurosurgeons. Observed complications, recommendations for sport participation, and shunt volume data were collected., Results: Ninety-two providers (55% sample) responded. Seventy-seven percent had never observed a sport-related shunt complication in their practice. The remaining 23% witnessed an estimated total of 25 to 30 complications. Broken shunt catheters and shunt dysfunction were the most common complications observed. Only one acute intracranial hematoma was reported in the entire series. The incidence of sport-related CSF complications in children seems to be significantly less than 1%. Ninety percent of pediatric neurosurgeons do not restrict their patients' participation in noncontact sports. For contact sports, approximately one-third of neurosurgeons preclude all participation, whereas another third restrict specific sports. The final third of neurosurgeons surveyed do not restrict participation in contact sports for children with CSF shunts., Conclusion: Sport-related complications in children with CSF shunts are very uncommon.