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Patrick Paullus, Taylor A. Wilson, Paul Lee, Arunprasad Gunasekaran and Noojan Kazemi

In this video, the authors demonstrate a minimally invasive approach and resection of a paraspinal schwannoma. Using an expandable retractor, the authors were able to identify important adjacent bony landmarks and hence visualize and remove this peripheral nerve sheath tumor. While a tubular retractor is commonly used for interbody fusion procedures, the location of the tumor allowed this minimally invasive approach resulting in excellent access, minimal soft-tissue injury, and a short hospital stay. The authors present this approach as a less invasive and yet effective technique for resection of otherwise difficult-to-access nerve lesions.

The video can be found here: https://youtu.be/89OY5wdMB_k.

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Taylor A. Wilson, Rebekah G. Langston, Ka Hin Wong and Analiz Rodriguez

OBJECTIVE

The American Association of Neurological Surgeons (AANS) Neurosurgery Research and Education Foundation (NREF) provides ongoing competitive research fellowships for residents and young investigators. The authors sought to determine the characteristics and career tracks of award recipients.

METHODS

The authors analyzed characteristics and academic productivity parameters of NREF resident and young investigator awardees in the United States and Canada from 1983 to 2017. Data were extracted from the NREF database and online resources (Web of Science, NIH reporter).

RESULTS

In total, 224 research grants were awarded to 31 women (14%) and 193 men (86%) from 1983 to 2017. Neuro-oncology (36%) was the most common research category. Sixty percent of awardees were in training and most resident award winners were in postgraduate year 5 (37%). Forty-nine percent of all awardees had an additional postgraduate degree (PhD 39%, Master’s 10%) with a significantly higher number of PhD recipients being from Canada in comparison to any US region (p = 0.024). The Northeastern and Southeastern United States were the regions with the highest and lowest numbers of award recipients, respectively. More than one-third (40%) of awardees came from institutions that have a National Institute of Neurological Disorders and Stroke Research Education Grant (NINDS R25) for neurosurgical training. Awardees from NINDS R25–funded programs were significantly more likely to go on to receive funding from the National Institutes of Health (NIH) (40.4% vs 26.1%; p = 0.024). The majority of recipients (72%) who were no longer in training pursued fellowships, with a significant likelihood that fellowship subspecialty correlated with NREF research category (p < 0.001). Seventy-nine percent of winners entered academic neurosurgery practice, with 18% obtaining the position of chair. The median h-index among NREF winners was 11. NIH funding was obtained by 71 awardees (32%) with 36 (18%) being a principal investigator on an R01 grant from the NIH Research Project Grant Program.

CONCLUSIONS

The majority of AANS/NREF research award recipients enter academics as fellowship-trained neurosurgeons, with approximately one-third obtaining NIH funding. Analysis of this unique cohort allows for identification of characteristics of academic success.

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Krishna Kumar, Jefferson R. Wilson, Rod S. Taylor and Shivani Gupta

Object

The long-term success of spinal cord stimulation is impeded by the high incidence of adverse events. The cost of complications to the healthcare budget is influenced by the time course needed to reverse the effect, and by the type of corrective measures required. Understanding the mechanism of complications and reducing them can improve the overall success rate and the cost factor.

Methods

The authors performed a retrospective analysis of data obtained in 160 patients treated during a 10-year period. For each category of complication, the level of healthcare resource use was assessed for each case and a unit cost was applied. The total cost of each complication was determined by summing across healthcare resource headings. All cost calculations were performed in Canadian dollars at 2005 prices.

To understand the mechanics of various hardware-related complications and how to avoid them, the authors have utilized the results of bench tests conducted at Medtronic, Inc.

Fifty-one adverse events occurred in 42 of the 160 patients. The complications were classified as either hardware related (39 events) or biological (12 events). The mean cost of complications during the 10-year study period was $7092 (range $130–$22,406).

Conclusions

Complications not only disrupt the effect of pain control but also pose an added expense to the already high cost of therapy. It is possible to reduce the complication rate, and thus improve the long-term success rate, by following the suggestions made in this paper, which are supported by the biomechanics of the human body and the implanted material.

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Omar Tanweer, Taylor A. Wilson, Stephen P. Kalhorn, John G. Golfinos, Paul P. Huang and Douglas Kondziolka

OBJECT

Physicians are often solicited by patients or colleagues for clinical recommendations they would make for themselves if faced by a clinical situation. The act of making a recommendation can alter the clinical course being taken. The authors sought to understand this dynamic across different neurosurgical scenarios by examining how neurosurgeons value the procedures that they offer.

METHODS

The authors conducted an online survey using the Congress of Neurological Surgeons listserv in May 2013. Respondents were randomized to answer either as the surgeon or as the patient. Questions encompassed an array of distinct neurosurgical scenarios. Data on practice parameters and experience levels were also collected.

RESULTS

Of the 534 survey responses, 279 responded as the “neurosurgeon” and 255 as the “patient.” For both vestibular schwannoma and arteriovenous malformation management, more respondents chose resection for their patient but radiosurgery for themselves (p = 0.002 and p = 0.001, respectively). Aneurysm coiling was chosen more often than clipping, but those whose practice was ≥ 30% open cerebrovascular neurosurgery were less likely to choose coiling. Overall, neurosurgeons who focus predominantly on tumors were more aggressive in managing the glioma, vestibular schwannoma, arteriovenous malformation, and trauma. Neurosurgeons more than 10 years out of residency were less likely to recommend surgery for management of spinal pain, aneurysm, arteriovenous malformation, and trauma scenarios.

CONCLUSIONS

In the majority of cases, altering the role of the surgeon did not change the decision to pursue treatment. In certain clinical scenarios, however, neurosurgeons chose treatment options for themselves that were different from what they would have chosen for (or recommended to) their patients. For the management of vestibular schwannomas, arteriovenous malformations, intracranial aneurysms, and hypertensive hemorrhages, responses favored less invasive interventions when the surgeon was the patient. These findings are likely a result of cognitive biases, previous training, experience, areas of expertise, and personal values.

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Bryan A. Lieber, Taylor A. Wilson, Randy S. Bell, William W. Ashley Jr., Daniel L. Barrow and Stacey Quintero Wolfe

Indirect costs of the interview tour can be prohibitive. The authors sought to assess the desire of interviewees to mitigate these costs through ideas such as sharing hotel rooms and transportation, willingness to stay with local students, and the preferred modality to coordinate this collaboration. A survey link was posted on the Uncle Harvey website and the Facebook profile page of fourth-year medical students from 6 different medical schools shortly after the 2014 match day. There were a total of 156 respondents to the survey. The majority of the respondents were postinterview medical students (65.4%), but preinterview medical students (28.2%) and current residents (6.4%) also responded to the survey. Most respondents were pursuing a field other than neurosurgery (75.0%) and expressed a desire to share a hotel room and/or transportation (77.4%) as well as stay in the dorm room of a medical student at the program in which they are interviewing (70.0%). Students going into neurosurgery were significantly more likely to be interested in sharing hotel/transportation (89.2% neurosurgery vs 72.8% nonneurosurgery; p = 0.040) and in staying in the dorm room of a local student when on interviews (85.0% neurosurgery vs 57.1% nonneurosurgery; p = 0.040) than those going into other specialties. Among postinterview students, communication was preferred to be by private, email identification–only chat room. Given neurosurgery resident candidates' interest in collaborating to reduce interview costs, consideration should be given to creating a system that could allow students to coordinate cost sharing between interviewees. Moreover, interviewees should be connected to local students from neurosurgery interest groups as a resource.