Increased Traumatic Brain Injury Severity and Mortality in Undocumented Immigrants

无证移民的创伤性脑损伤严重程度和死亡率增加

Health disparities related to traumatic brain injury (TBI) have focused on socioeconomic status, race, and ethnicity. We sought to characterize TBI patterns and outcomes based on undocumented status. Undocumented immigrants presented from farther distances with increased TBI severity, likely from both more severe trauma and delayed presentation, requiring more neurosurgical intervention. They also had greater length of stay, charges, and nearly double the mortality rate. Importantly, undocumented status was a strong predictor for mortality. Despite worse outcomes, they were discharged to a health care facility at a lower rate. Advocacy efforts should be directed at increasing health care coverage and migrant community engagement and education.

与创伤性脑损伤 (TBI) 相关的健康差异主要集中在社会经济地位，种族和种族上。我们试图根据未记录的状态来描述TBI模式和结果。无证移民从更远的距离出现，TBI严重程度增加，可能是由于更严重的创伤和延迟出现，需要更多的神经外科手术干预。他们的逗留时间更长，收费也更长，死亡率几乎翻了一番。重要的是，无证件状态是死亡率的有力预测指标。尽管结果更糟，他们还是以较低的比率出院到医疗机构。宣传工作应针对增加医疗保健覆盖面以及移民社区的参与和教育。

REF: Tenorio A, Brandel MG, McCann CP, et al. Increased Traumatic Brain Injury Severity and Mortality in Undocumented Immigrants. Neurosurgery. Published online August 30, 2024. doi:10.1227/neu.0000000000003158 PMID: 39212417

A Meta-Analysis of Medication Reduction and Motor Outcomes After Awake Versus Asleep Deep Brain Stimulation for Parkinson Disease

帕金森病清醒与睡眠脑深部电刺激后药物减量与运动结局的荟萃分析

There remains significant debate regarding the performance of deep brain stimulation (DBS) procedures for Parkinson disease (PD) under local or general anesthesia. The aim of this meta-analysis was to compare the clinical outcomes between "asleep" DBS (general anesthesia) and "awake" DBS (local anesthesia) for PD. There was no significant difference in the primary motor outcomes and LEDD improvement between asleep vs awake DBS. The variables of target selection and MER use had no statistically significant impact on outcome. We find that asleep techniques are both safe and effective compared with the awake technique.

关于局部或全身麻醉下帕金森病 (PD) 的脑深部电刺激 (DBS) 程序的性能仍存在重大争议。这项荟萃分析的目的是比较PD的 “睡眠” DBS (全身麻醉) 和 “清醒” DBS (局部麻醉) 之间的临床结果。睡眠和清醒DBS之间的主要运动结果和LEDD改善没有显着差异。目标选择和MER使用的变量对结果没有统计学上的显著影响。我们发现，与清醒技术相比，睡眠技术既安全又有效。

REF: Li L, Rae AI, Burchiel KJ. A Meta-Analysis of Medication Reduction and Motor Outcomes After Awake Versus Asleep Deep Brain Stimulation for Parkinson Disease. Neurosurgery. Published online August 28, 2024. doi:10.1227/neu.0000000000003138 PMID: 39194217

Neurological Surgery Resident ABNS Written Exam Scores Before and After Introduction of a Weekly Didactic Educational Intervention: A 12-Year Single-Institution Retrospective Study

神经外科住院医师ABNS笔试成绩在引入每周教学教育干预之前和之后: 一项为期12年的单机构回顾性研究

United States neurological surgery residency education has undergone substantive changes over the past 2 decades. Neurosurgical professional bodies have developed numerous initiatives providing standardized assessments and training opportunities for residency programs. However, there have been few studies using standardized measures to assess core components of educational programming in individual programs. We conducted a 12-year retrospective review of resident American Board of Neurological Surgery (ABNS) board scores using our institutional data from 2010 to 2021 to determine the effect of introducing a weekly didactic resident education hour (REH) on resident scores in the ABNS written in-training examination. ABNS scaled scores were analyzed before (2010-2016) and after (2017-2021) REH introduction. To account for a practice effect, we used a 2-factor linear regression model with an interaction term. We obtained ABNS scores from 43 residents representing 132 test attempts. The average ABNS scaled score significantly improved after the introduction of REH (319 vs 410, t = -3.44, P = .0008). Accounting for the practice effect revealed a significant interaction effect between the number of attempts taking the ABNS examination and whether formal didactics were taught, accounting for 46.2 points on the examination (t = 2.309, P = .023); however, REH alone did not have a significant effect on the scaled scores (t = -1.649, P = .102). ABNS written board scores represent a standardized metric by which educational initiatives within training programs may be assessed for efficacy. Further research is needed to identify educational approaches that are effective to meet the goal of demonstrated mastery of fundamental knowledge in neurosurgery across a diversity of neurological surgery residency programs.

在过去的20年中，美国神经外科住院医师教育发生了实质性变化。神经外科专业机构已经制定了许多举措，为住院医师计划提供标准化评估和培训机会。但是，很少有研究使用标准化措施来评估各个计划中教育计划的核心组成部分。我们使用2010年至2021年的机构数据对美国神经外科委员会 (ABNS) 的住院医师评分进行了为期12年的回顾性审查，以确定引入每周的教学住院医师教育时间 (REH) 对ABNS的住院医师评分的影响书面培训考试。在引入REH之前 (2010-2016) 和之后 (2017-2021) 分析ABNS评分。为了说明实践效果，我们使用了具有相互作用项的2因素线性回归模型。我们从代表132次测试尝试的43名居民那里获得了ABNS分数。引入REH后，平均ABNS评分显着提高 (319 vs 410，t = -3.44，P = .0008)。对练习效果的说明显示，参加ABNS考试的尝试次数与是否教授正式教学法之间存在显着的交互作用，占考试的46.2分 (t = 2.309，P = .023); 但是，仅REH对比例分数没有显着影响(t = -1.649，P = .102)。Abn书面董事会分数代表了一种标准化的度量标准，可以通过该度量标准评估培训计划中的教育计划的有效性。需要进一步的研究来确定有效的教育方法，以满足在各种神经外科住院医师计划中证明掌握神经外科基础知识的目标。

REF: Boop S, Durfy S, Bass D, et al. Neurological Surgery Resident ABNS Written Exam Scores Before and After Introduction of a Weekly Didactic Educational Intervention: A 12-Year Single-Institution Retrospective Study. Neurosurgery. Published online August 28, 2024. doi:10.1227/neu.0000000000003150 PMID: 39194226

Integral Dose or Mean Dose for Predicting Radiosurgery Response in Patients With Trigeminal Neuralgia: A Proposal to Target the Narrowest Part of the Nerve

预测三叉神经痛患者放射外科反应的积分剂量或平均剂量: 针对神经最窄部分的建议

Stereotactic radiosurgery (SRS) is effective for patients with medically refractory trigeminal neuralgia with a 75%-90% response rate. Consideration of the integral dose (ID) to the target nerve within the 50% isodose line was reported to help select prescription doses to maximize effectiveness and minimize bothersome numbness. The objective of this study was to externally validate the ID as a predictor of outcomes after SRS. The ID did not predict recurrence-free survival or sensory dysfunction. Our observations suggest improved nerve coverage by the most powerful area of the isocenter, for instance, by targeting a narrower segment if feasible, could result in more durable pain relief. Further studies to validate these findings are needed.

立体定向放射外科 (SRS) 对药物难治性三叉神经痛患者有效，缓解率75% 90%。据报道，考虑50% 等剂量线内的目标神经的积分剂量 (ID) 有助于选择处方剂量，以最大程度地提高有效性并最大程度地减少麻木。这项研究的目的是从外部验证ID作为SRS后结果的预测指标。ID不能预测无复发生存率或感觉功能障碍。我们的观察结果表明，通过等中心最强大的区域改善神经覆盖，例如，如果可行，通过瞄准较窄的部分，可以更持久地缓解疼痛。需要进一步的研究来验证这些发现。

REF: Meng Y, Santhumayor B, Mashiach E, et al. Integral Dose or Mean Dose for Predicting Radiosurgery Response in Patients With Trigeminal Neuralgia: A Proposal to Target the Narrowest Part of the Nerve. Neurosurgery. Published online August 28, 2024. doi:10.1227/neu.0000000000003145 PMID: 39194227

Spatial Distribution of Meningiomas: A Magnetic Resonance Image Atlas

脑膜瘤的空间分布: 磁共振图像图谱

The size and anatomic location of meningiomas have been shown to correlate with distinct clinical manifestations, histopathological subtypes, and surgical risk. However, meningioma anatomic origin sites can be obscured in large tumors and those crossing compartments. We therefore sought to apply unbiased lesion mapping to localize intracranial meningioma distributions and their association with biology and grade. We demonstrate the utility of voxel-based lesion mapping for intracranial tumors, characterizing distinct meningioma distribution patterns across histopathological and molecularly defined grades. Molecular grading associated with sharper tumor spatial clusters, supporting a phenotype-genotype association in meningiomas.

脑膜瘤的大小和解剖位置与不同的临床表现，组织病理学亚型和手术风险相关。然而，脑膜瘤的解剖起源部位可能在大肿瘤和那些交叉隔室中被掩盖。因此，我们试图应用无偏见的病变映射来定位颅内脑膜瘤的分布及其与生物学和等级的关联。我们证明了基于体素的病变映射对颅内肿瘤的实用性，可在组织病理学和分子定义的等级上表征不同的脑膜瘤分布模式。与更尖锐的肿瘤空间簇相关的分子分级，支持脑膜瘤的表型-基因型关联。

REF: Patel RV, Yao S, Aguilar Murillo E, Huang RY, Bi WL. Spatial Distribution of Meningiomas: A Magnetic Resonance Image Atlas. Neurosurgery. Published online August 28, 2024. doi:10.1227/neu.0000000000003149 PMID: 39194267

The Power of Advocacy in Global Neurosurgery

全球神经外科的倡导力量

Advocacy, one of the five domains of global neurosurgery, represents a powerful avenue to influence public policy to expand access to safe, timely, and affordable neurosurgical care. In this manuscript, we characterize advocacy in global neurosurgery, describe specific neurosurgeon-led initiatives, and delineate how neurosurgeons can become involved in global neurosurgery advocacy efforts. Advocacy in global neurosurgery involves working together in organized neurosurgery with organizations focused on clinical provisions, training, and policy initiatives. Effective advocacy uses a data-driven approach with myriad facilitators, including collaboration and approach strategies for sharing information and a variety of contextual, ideological, and practical barriers. The main action fronts for global neurosurgery include identifying needs, broadening access, and assuring quality. Neurosurgery-led initiatives transforming public policy have occurred on regional and global scales and accelerated since 2019. Folate fortification of staple foods to prevent neural tube defects represents a recent and notably successful area of advocacy and remains in progress. Neurosurgeons who aspire to become involved in advocacy efforts must obtain competencies and skills distinct from, yet complementary to, the traditional neurosurgical training curriculum.

倡导是全球神经外科的五个领域之一，是影响公共政策以扩大获得安全，及时和负担得起的神经外科护理的有力途径。在这份手稿中，我们描述了全球神经外科的倡导，描述了神经外科医生主导的具体举措，并描述了神经外科医生如何参与全球神经外科的倡导工作。全球神经外科的倡导涉及在有组织的神经外科中与专注于临床规定，培训和政策举措的组织合作。有效的倡导使用数据驱动的方法与无数的促进者，包括协作和方法策略共享信息和各种背景，意识形态和实际障碍。全球神经外科的主要行动包括确定需求，扩大访问范围和确保质量。神经外科主导的改变公共政策的举措已经在区域和全球范围内发生，并自2019年以来加速。主食叶酸强化预防神经管缺陷代表了最近的一个非常成功的倡导领域，并且仍在进行中。渴望参与倡导工作的神经外科医生必须获得与传统神经外科培训课程不同但又相辅相成的能力和技能。

REF: Ghotme KA, Rosseau G, Blount J, et al. The Power of Advocacy in Global Neurosurgery. Neurosurgery. Published online August 26, 2024. doi:10.1227/neu.0000000000003108 PMID: 39185896

Global Neurosurgery: A Path Forward Through Health System Strengthening

全球神经外科: 通过加强卫生系统前进的道路

The future of global neurosurgery should focus on addressing the unmet neurosurgical need from a health system approach should we hope to achieve sustainable and ethical change. In this article, we review the global building blocks, as defined by the World Health Organization, and use this framework to propose strategies to strengthen neurosurgical care on the global frontier. The targets for Universal Healthcare Coverage by 2030, as outlined by the United Nations Sustainable Development Goals, are reviewed, and the role of neurosurgeons in addressing the global targets is discussed. Surgical indicators according to the Lancet Commission on Global Surgery are also reviewed, and neurosurgical indicators are proposed according to the 6 surgical indicators of the commission. The execution of these global targets and indicators within the context of health system strengthening will be a persistent challenge, given the complexity of health system and its components. The neurosurgical community must continue to support, promote, and diversify collaborations, especially among deserts of neurosurgical care across the world. Innovative technology and education are essential to this global dilemma.

如果我们希望实现可持续和道德变革，全球神经外科的未来应该集中于从卫生系统方法中解决未满足的神经外科需求。在本文中，我们回顾了世界卫生组织定义的全球构建模块，并使用此框架提出了在全球前沿加强神经外科护理的策略。回顾了联合国可持续发展目标所概述的到2030年实现全民医疗覆盖的目标，并讨论了神经外科医生在实现全球目标中的作用。还审查了柳叶刀全球外科委员会的手术指标，并根据该委员会的6项手术指标提出了神经外科指标。鉴于卫生系统及其组成部分的复杂性，在加强卫生系统的背景下执行这些全球目标和指标将是一项持续的挑战。神经外科学界必须继续支持，促进和多样化合作，特别是在世界各地的神经外科护理沙漠中。创新技术和教育对于这一全球困境至关重要。

REF: Rosseau G, Shlobin NA, Baticulon RE, Ghotme KA, Garcia RM. Global Neurosurgery: A Path Forward Through Health System Strengthening. Neurosurgery. Published online August 26, 2024. doi:10.1227/neu.0000000000003106 PMID: 39185893

Achieving Equity Through Global Neurosurgery Research

通过全球神经外科研究实现公平

Since the release of the Lancet Commission on Global Surgery report in 2015, there has been an increase in the number of published papers on global neurosurgery, gaining widespread support from major neurosurgery journals. However, there remains no consensus on what may be considered part of global neurosurgery literature. Here, we propose that global neurosurgery research encompasses all scholarly work that measure, explore, or address inequity in the care of neurosurgical disease. We describe the growth of global neurosurgery research, cite landmark papers, and discuss barriers to participation, particularly among neurosurgeons in low- and middle-income countries. We introduce the 3Rs framework, advocating for global neurosurgery research that is rigorous, responsive, and responsible. This narrative review aims to guide young neurosurgeons and other researchers interested in the field, and to provide a framework through which global neurosurgery practitioners and advocates can evaluate previously accomplished work, paving the way toward neurosurgery that is timely, safe, and affordable to all.

自2015年《柳叶刀》全球外科委员会报告发布以来，全球神经外科论文的发表数量有所增加，得到了主要神经外科期刊的广泛支持。然而，对于什么可以被认为是全球神经外科文献的一部分，仍然没有达成共识。在这里，我们建议全球神经外科研究涵盖所有测量，探索或解决神经外科疾病护理不平等的学术工作。我们描述了全球神经外科研究的增长，引用了具有里程碑意义的论文，并讨论了参与的障碍，特别是在低收入和中等收入国家的神经外科医生中。我们引入了3Rs框架，倡导严谨，反应灵敏和负责任的全球神经外科研究。这篇叙述性评论旨在指导年轻的神经外科医生和其他对该领域感兴趣的研究人员，并提供一个框架，通过这个框架，全球神经外科从业者和倡导者可以评估以前完成的工作，为及时，安全和负担得起的神经外科铺平道路。

REF: Baticulon RE, Dewan MC, Karekezi C, et al. Achieving Equity Through Global Neurosurgery Research. Neurosurgery. Published online August 26, 2024. doi:10.1227/neu.0000000000003107 PMID: 39185879

Education and Training in Global Neurosurgery: The Quest for Diversity and Equitable Collaborations

全球神经外科的教育和培训: 寻求多样性和公平的合作

Education and training are essential components of global neurosurgery because they provide a sustainable solution to address the workforce deficits in the neurosurgical burden of disease. Neurosurgery training programs and opportunities exist in most areas of the world, but some countries still lack formal mechanisms to train future generations. In this special article, we review the neurosurgical workforce deficit, characterize factors influencing the absence or inadequacy of neurosurgical training, and identify strategies that could facilitate global efforts in building a stronger workforce. We summarize the key neurosurgical training models worldwide and the factors influencing the standardization of neurosurgical education by region. In addition, we evaluate the "brain drain" issue in the larger context of the healthcare workforce and propose solutions to mitigate this phenomenon in neurosurgical practice. Future generations of neurosurgical trainees depend on our efforts to intensify and expand education and training in this new virtual era. As we look to the future, we must prioritize education to strengthen the future neurosurgeons who will lead and shape the frontiers of our field.

教育和培训是全球神经外科的重要组成部分，因为它们为解决神经外科疾病负担中的劳动力不足提供了可持续的解决方案。神经外科培训计划和机会在世界大多数地区都存在，但一些国家仍然缺乏培训后代的正式机制。在这篇特别文章中，我们回顾了神经外科劳动力的不足，描述了影响神经外科培训缺乏或不足的因素，并确定了可以促进全球努力建设更强大劳动力的策略。我们总结了全球主要的神经外科培训模式以及影响地区神经外科教育标准化的因素。此外，我们在医疗保健人员的更大背景下评估 “人才流失” 问题，并提出解决方案以减轻神经外科实践中的这种现象。未来几代神经外科受训者依赖于我们在这个新的虚拟时代加强和扩大教育和培训的努力。当我们展望未来时，我们必须优先考虑教育，以加强未来的神经外科医生，他们将领导和塑造我们领域的前沿。

REF: Thango NS, Ceccato G, Baticulon RE, et al. Education and Training in Global Neurosurgery: The Quest for Diversity and Equitable Collaborations. Neurosurgery. Published online August 26, 2024. doi:10.1227/neu.0000000000003123 PMID: 39185887