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Daniel M. Sciubba, Li-Mei Lin, Graeme F. Woodworth, Matthew J. McGirt, Benjamin Carson, and George I. Jallo


Antibiotic-impregnated shunt (AIS) systems may decrease the incidence of cerebrospinal fluid (CSF) shunt infections. However, there is a reluctance to use AIS components because of their increased cost. In the present study the authors evaluated factors contributing to the medical costs associated with the treatment of CSF shunt infections in a hydrocephalic pediatric population, those implanted with AIS systems compared with those implanted with standard shunt systems.


The authors retrospectively reviewed data obtained in all pediatric patients who had undergone CSF shunt insertion at their institution over a 3-year period. All patients were followed up for 12 months after surgery. The independent association between AIS catheter use and subsequent shunt infection was assessed by performing a multivariate proportional hazards regression analysis. Factors contributing to the medical costs associated with shunt infection were evaluated.


Two hundred eleven pediatric patients underwent 353 shunting procedures. Two hundred eight shunts (59%) were placed with nonimpregnated catheters and 145 shunts (41%) were placed with AIS catheters. Twenty-five patients (12%) with non-AIS catheters experienced shunt infection, whereas only two patients (1.4%) with AIS catheters had a shunt infection within the 6-month follow-up period (p < 0.01). Among infected patients, infected patients with standard shunt components had a longer average hospital stay, more inpatient complications related to infection treatment, and more multiple organism infections and multiple antibiotic regimens, compared with those with AIS components.


Although individual AIS components are more expensive than standard ones, factors contributing to medical costs are fewer in pediatric patients with infected shunts when the components are antibiotic-impregnated rather than standard.

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Joseph C. Noggle, Daniel M. Sciubba, Clarke Nelson, Giannina L. Garcés-Ambrossi, Edward Ahn, and George I. Jallo


Treatments for brain abscesses have typically involved invasive craniotomies followed by debridement. These methods often require large incisions with vast exposure and may be associated with high morbidity rates. For supraorbital lesions of the anterior and middle cranial fossa, minimally invasive craniotomies may limit exposure and decrease surgically related morbidity while allowing adequate debridement and decompression. The authors report their experience in treating frontal epidural abscesses in pediatric patients through minimally invasive supraciliary craniotomies over a 4-year period.


Three pediatric patients with frontal epidural abscesses underwent minimally invasive debridement procedures. Each procedure consisted of a supraciliary incision and a small craniotomy to expose the abscess. All patients underwent pre- and postoperative radiological evaluation including computed tomography and magnetic resonance imaging. Data were collected on preoperative characteristics, operative management, and postoperative outcomes.


Two patients were male and 1 patient was female. The ages of the patients ranged from 6 to 10 years (mean 8 years). A frontal abscess was diagnosed in all patients, and all were treated surgically without perioperative complications. Microbes cultured postoperatively included methicillin-resistant Staphylococcus aureus in 2 patients and Staphylococcus viridans in 1 patient. The mean follow-up duration was 12.3 months. No neurological or vascular complications were noted during follow-up. All patients were treated with antibiotics postoperatively and experienced resolution of symptoms and excellent outcomes.


Frontal epidural abscesses can be adequately and safely debrided via a minimally invasive supraciliary craniotomy. This approach has a cosmetic benefit and may decrease approach-related morbidity.

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Wuyang Yang, Jordina Rincon-Torroella, James Feghali, Adham M. Khalafallah, Wataru Ishida, Alexander Perdomo-Pantoja, Alfredo Quiñones-Hinojosa, Michael Lim, Gary L. Gallia, Gregory J. Riggins, William S. Anderson, Sheng-Fu Larry Lo, Daniele Rigamonti, Rafael J. Tamargo, Timothy F. Witham, Ali Bydon, Alan R. Cohen, George I. Jallo, Alban Latremoliere, Mark G. Luciano, Debraj Mukherjee, Alessandro Olivi, Lintao Qu, Ziya L. Gokaslan, Daniel M. Sciubba, Betty Tyler, Henry Brem, and Judy Huang


International research fellows have been historically involved in academic neurosurgery in the United States (US). To date, the contribution of international research fellows has been underreported. Herein, the authors aimed to quantify the academic output of international research fellows in the Department of Neurosurgery at The Johns Hopkins University School of Medicine.


Research fellows with Doctor of Medicine (MD), Doctor of Philosophy (PhD), or MD/PhD degrees from a non-US institution who worked in the Hopkins Department of Neurosurgery for at least 6 months over the past decade (2010–2020) were included in this study. Publications produced during fellowship, number of citations, and journal impact factors (IFs) were analyzed using ANOVA. A survey was sent to collect information on personal background, demographics, and academic activities.


Sixty-four international research fellows were included, with 42 (65.6%) having MD degrees, 17 (26.6%) having PhD degrees, and 5 (7.8%) having MD/PhD degrees. During an average 27.9 months of fellowship, 460 publications were produced in 136 unique journals, with 8628 citations and a cumulative journal IF of 1665.73. There was no significant difference in total number of publications, first-author publications, and total citations per person among the different degree holders. Persons holding MD/PhDs had a higher number of citations per publication per person (p = 0.027), whereas those with MDs had higher total IFs per person (p = 0.048). Among the 43 (67.2%) survey responders, 34 (79.1%) had nonimmigrant visas at the start of the fellowship, 16 (37.2%) were self-paid or funded by their country of origin, and 35 (81.4%) had mentored at least one US medical student, nonmedical graduate student, or undergraduate student.


International research fellows at the authors’ institution have contributed significantly to academic neurosurgery. Although they have faced major challenges like maintaining nonimmigrant visas, negotiating cultural/language differences, and managing self-sustainability, their scientific productivity has been substantial. Additionally, the majority of fellows have provided reciprocal mentorship to US students.