Dr. Harvey Cushing is considered the father of modern neurological surgery, and his role and efforts in World War I continue to have a lasting effect on today’s practice of neurosurgery. During World War I, he embodied the tenets of a neurosurgeon-scientist: he created and implemented novel antiseptic techniques to decrease infection rates after craniotomies, leading him often to be referred to as “originator of brain wound care.” His contributions did not come without struggles, however. He faced criticism for numerous military censorship violations, and he developed a severe peripheral neuropathy during the war. However, he continued to stress the importance of patient care and his surgical prowess was evident. In this paper, the authors summarize Cushing’s notes published in From a Surgeon’s Journal, 1915-1918 and discuss the impact of his experiences on his own practice and the field of neurosurgery.
The birth of modern military neurosurgery through the eyes of Harvey Cushing’s war memoir From a Surgeon’s Journal, 1915-1918
Harjus Birk, Caleb Stewart, and Jennifer A. Kosty
Jacques Jean Lhermitte and the syndrome of peduncular hallucinosis
Jennifer A. Kosty, Juan Mejia-Munne, Rimal Dossani, Amey Savardekar, and Bharat Guthikonda
Jacques Jean Lhermitte (1877–1959) was among the most accomplished neurologists of the 20th century. In addition to working as a clinician and instructor, he authored more than 800 papers and 16 books on neurology, neuropathology, psychiatry, and mystical phenomena. In addition to the well-known “Lhermitte’s sign,” an electrical shock–like sensation caused by spinal cord irritation in demyelinating disease, Lhermitte was a pioneer in the study of the relationship between the physical substance of the brain and the experience of the mind. A fascinating example of this is the syndrome of peduncular hallucinosis, characterized by vivid visual hallucinations occurring in fully lucid patients. This syndrome, which was initially described as the result of a midbrain insult, also may occur with injury to the thalamus or pons. It has been reported as a presenting symptom of various tumors and as a complication of neurosurgical procedures. Here, the authors review the life of Lhermitte and provide a historical review of the syndrome of peduncular hallucinosis.
Improving patient care in neurosurgery through postoperative telephone calls: a systematic review and lessons from all surgical specialties
Dylan Goehner, Sandeep Kandregula, Harjus Birk, Christopher P. Carroll, Bharat Guthikonda, and Jennifer A. Kosty
Postoperative telephone calls are a simple intervention that can be used to improve communication with patients, potentially affecting patient safety and satisfaction. Few studies in the neurosurgical literature have examined the effect of a postoperative telephone call on patient outcomes, although several exist across all surgical specialties. The authors performed a systematic review and analyzed studies published since 2000 to assess the effect of a postoperative telephone call or text message on patient safety and satisfaction across all surgical specialties.
A search of PubMed-indexed articles was performed on June 12, 2021, and was narrowed by the inclusion criteria of studies from surgical specialties with > 50 adult patients published after 1999, in which a postoperative telephone call was made and its effects on safety and satisfaction were assessed. Exclusion criteria included dental, medical, and pediatric specialties; systematic reviews; meta-analyses; and non–English-language articles. Dual review was utilized.
Overall, 24 articles met inclusion criteria. The majority reported an increase in patient satisfaction scores after a postoperative telephone call was implemented, and half of the studies demonstrated an improvement in safety or outcomes.
Taken together, these studies demonstrate that implementation of a postoperative telephone call in a neurosurgical practice is a feasible way to enhance patient care. The major limitations of this study were the heterogeneous group of studies and the limited neurosurgery-specific studies.
Insights into potential targeted nonsurgical therapies for the treatment of moyamoya disease
Dylan Goehner, Sandeep Kandregula, Christopher P. Carroll, Mario Zuccarello, Bharat Guthikonda, and Jennifer A. Kosty
Since its initial description in 1957 as an idiopathic disease, moyamoya disease has proved challenging to treat. Although the basic pathophysiology of this disease involves narrowing of the terminal carotid artery with compensatory angiogenesis, the molecular and cellular mechanisms underlying these changes are far more complex. In this article, the authors review the literature on the molecular and cellular pathophysiology of moyamoya disease with an emphasis on potential therapeutic targets.
Factors impacting neurosurgery residents’ operative case volume: a nationwide survey
Edward Burkhardt, Nimer Adeeb, Danielle Terrell, Carlie Proctor, Basel Musmar, Christoph J. Griessenauer, Jennifer A. Kosty, and Bharat Guthikonda
Neurological surgery residency remains one of the most competitive and longest specialties in terms of training in medicine. The Accreditation Council for Graduate Medical Education uses residents’ case volume throughout residency as one of its measures for the quality of surgical training. The objective was to study the variability of residency case volume among US training programs and to analyze the factors that potentially influence that case volume.
In line with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines, an online survey regarding department size, case volume, number of residents per year, number of dedicated research years, presence of fellows, and resident case volume by the time of graduation was created using Google Forms and distributed to all neurosurgery residency program directors and coordinators in the US.
A total of 97 of the 115 programs (84.3%) responded to the survey. Fifteen programs were excluded due to missing data or incomplete resident cohort at the time of the survey, and a total of 82 programs were included in the analysis. The average number of cases performed by residents as lead or senior surgeons by the time of graduation ranged from 900 to 2250 (median 1600 cases). The resident case volume did not have a significant correlation with the program case volume, number of operating attending neurosurgeons, number of residents, number of research years, or presence of fellows. The only factor that impacted the resident case volume was the number of cases performed per faculty.
The number of cases performed by residents throughout residency varied significantly between programs. Although other factors play important roles in the quality of training, including autonomy, variation, and complexity of cases, the resident case volume is one of the only measurable factors. This study sheds some light on the factors that potentially influence neurosurgical resident case volume.
Gender disparities in academic rank achievement in neurosurgery: a critical assessment
Rimal H. Dossani, Danielle Terrell, Jennifer A. Kosty, Robert C. Ross, Audrey Demand, Elizabeth Wild, Racheal Peterson, Laura B. Ngwenya, Deborah L. Benzil, and Christina Notarianni
The objective of this study was to evaluate whether there are disparities in academic rank and promotion between men and women neurosurgeons.
The profiles of faculty members from 50 academic neurosurgery programs were reviewed to identify years in practice, number of PubMed-indexed publications, Doctor of Philosophy (PhD) attainment, and academic rank. The number of publications at each academic rank was compared between men and women after controlling for years in practice by using a negative binomial regression model. The relationship between gender and each academic rank was also determined after controlling for clustering at the institutional level, years in practice, and number of publications.
Of 841 faculty members identified, 761 (90%) were men (p = 0.0001). Women represented 12% of the assistant and associate professors but only 4% of the full professors. Men and women did not differ in terms of the percentage holding a PhD, years in practice, or number of publications at any academic rank. After controlling for years in practice and clustering at the facility level, the authors found that men were twice as likely as women to be named full professor (OR 2.2, 95% CI 1.09–4.44, p = 0.03). However, when institution, years in practice, PhD attainment, h-index, and number of publications were considered, men and women were equally likely to attain full professorship (OR 0.9, 95% CI 0.42–1.93).
Data analysis of the top neurosurgery programs suggests that although there are fewer women than men holding positions in academic neurosurgery, faculty rank attainment does not seem to be influenced by gender.
Aneurysm growth and de novo aneurysms during aneurysm surveillance
Joseph C. Serrone, Ryan D. Tackla, Yair M. Gozal, Dennis J. Hanseman, Steven L. Gogela, Shawn M. Vuong, Jennifer A. Kosty, Calen A. Steiner, Bryan M. Krueger, Aaron W. Grossman, and Andrew J. Ringer
Many low-risk unruptured intracranial aneurysms (UIAs) are followed for growth with surveillance imaging. Growth of UIAs likely increases the risk of rupture. The incidence and risk factors of UIA growth or de novo aneurysm formation require further research. The authors retrospectively identify risk factors and annual risk for UIA growth or de novo aneurysm formation in an aneurysm surveillance protocol.
Over an 11.5-year period, the authors recommended surveillance imaging to 192 patients with 234 UIAs. The incidence of UIA growth and de novo aneurysm formation was assessed. With logistic regression, risk factors for UIA growth or de novo aneurysm formation and patient compliance with the surveillance protocol was assessed.
During 621 patient-years of follow-up, the incidence of aneurysm growth or de novo aneurysm formation was 5.0%/patient-year. At the 6-month examination, 5.2% of patients had aneurysm growth and 4.3% of aneurysms had grown. Four de novo aneurysms formed (0.64%/patient-year). Over 793 aneurysm-years of follow-up, the annual risk of aneurysm growth was 3.7%. Only initial aneurysm size predicted aneurysm growth (UIA < 5 mm = 1.6% vs UIA ≥ 5 mm = 8.7%, p = 0.002). Patients with growing UIAs were more likely to also have de novo aneurysms (p = 0.01). Patient compliance with this protocol was 65%, with younger age predictive of better compliance (p = 0.01).
Observation of low-risk UIAs with surveillance imaging can be implemented safely with good adherence. Aneurysm size is the only predictor of future growth. More frequent (semiannual) surveillance imaging for newly diagnosed UIAs and UIAs ≥ 5 mm is warranted.