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The power of discernment


Shelly D. Timmons

The 2019 scientific meeting of the American Association of Neurological Surgeons (AANS) focused on the theme “The Science of Practice.” In her presidential address, 2018 AANS President Shelly Timmons discusses evolutions in medical and surgical practice, and explores how current technologies can be used to advance knowledge through thoughtful analyses of clinical observations and experiences.

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Shelly D. Timmons and Steven A. Toms

Comparative effectiveness research (CER) is emerging as a commonly applied technique to determine the usefulness of medical interventions. Such research aims to compare various treatments for specific disease entities for overall effectiveness and potential for harm. According to the Centers for Disease Control, an estimated 1.7 million patients sustain a traumatic brain injury (TBI) annually in the US. In this review the authors examine the existence of CER reports in the area of neurotrauma to date and consider the context in which clinical research and evidence-based guidelines have and will continue to inform such analyses, with special attention to TBI.

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Concussion: pathophysiology and sequelae

Paul S. Echlin, M. Sean Grady, and Shelly D. Timmons

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Shelly D. Timmons, Ann-Christine Duhaime, and Stefan M. Lee

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Shelly D. Timmons, Dana Waltzman, Ann-Christine Duhaime, Theodore J. Spinks, and Kelly Sarmiento

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Gail L. Rosseau, Shelly D. Timmons, Karin M. Muraszko, Katharine J. Drummond, Mary Murphy, Nelci Zanon, and Farideh Nejat

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Steven N. Kalkanis, Christopher I. Shaffrey, Ganesh Rao, Shelly D. Timmons, Brian L. Hoh, and John A. Wilson

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Mihir Gupta, Allison Reichl, Luis Daniel Diaz-Aguilar, Pate J. Duddleston, Jamie S. Ullman, Karin M. Muraszko, Shelly D. Timmons, Isabelle M. Germano, Aviva Abosch, Jennifer A. Sweet, Susan C. Pannullo, Deborah L. Benzil, and Sharona Ben-Haim


Despite recently heightened advocacy efforts relating to pregnancy and family leave policies in multiple surgical specialties, no studies to date have described female neurosurgeons’ experiences with childbearing. The AANS/CNS Section of Women in Neurosurgery created the Women and Pregnancy Task Force to ascertain female neurosurgeons’ experiences with and attitudes toward pregnancy and the role of family leave policies.


A voluntary online 28-question survey examined the pregnancy experiences of female neurosurgeons and perceived barriers to childbearing. The survey was developed and electronically distributed to all members of the American Association of Neurological Surgeons and Congress of Neurological Surgeons who self-identified as female in February 2016. Responses from female resident physicians, fellows, and current or retired practicing neurosurgeons were analyzed.


A total of 126 women (20.3%) responded to the survey; 57 participants (49%) already had children, and 39 (33%) planned to do so. Participants overwhelmingly had or planned to have children during the early practice and senior residency years. The most frequent obstacles experienced or anticipated included insufficient time to care for newborns (47% of women with children, 92% of women planning to have children), discrimination by coworkers (31% and 77%, respectively), and inadequate time for completion of board requirements (18% and 51%, respectively). There was substantial variability in family leave policies, and a minority of participants (35%) endorsed the presence of any formal policy at their institution. Respondents described myriad unique challenges associated with pregnancy and family leave.


Pregnancy and family leave pose significant challenges to the recruitment, retention, and advancement of women in neurosurgery. It is thus imperative to promote clear family leave policies for trainees and practitioners, address discrimination surrounding these topics, and encourage forethought and flexibility to tackle obstacles inherent in pregnancy and the early stages of child rearing.