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OBJECTIVE Female neurosurgeon representation has increased, but women still represent only 8.4% of neurosurgeons in the US. Women are significantly underrepresented as authors in neurosurgical and spine journals, a key indicator of professional success in academic medicine. In this study, the authors aimed to assess the gender diversity of first and last authors of accepted abstracts at neurosurgical conferences in 2015 and 2019. METHODS Annual meeting abstracts for 2015 and 2019 of the American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS), and pediatrics, spine, stereotactic and functional surgery, and cerebrovascular AANS/CNS subspecialty sections were obtained and analyzed for gender. Partial data were obtained for tumor and pain sections. Composite gender data were obtained from the societies. Percentage differences were calculated using comparison of proportions testing. RESULTS Overall, female neurosurgeons accounted for only 8.3% of first and 5.8% of last authors, and 7.2% of authors overall. The pediatrics section had the highest proportion of female neurosurgeons as first (13.7%) and last (12.4%) abstract authors, while the spine section had the lowest proportions of female neurosurgeon first (4.6%) and last (2.0%) authors. Qualitatively, a higher proportion of women were first authors, while a higher proportion of men were last authors. Overall, there was no significant change in female neurosurgeon authorship between 2015 and 2019. With regard to society demographics, female neurosurgeons accounted for only 6.3% of AANS membership. The pediatrics section had the highest proportion of female neurosurgeons at 18.1% and the stereotactic and functional surgery section had the lowest of the subspecialty sections (7.6%). While female neurosurgeons represented 12.6% of spine section membership, they represented only 4.7% of first authors (−7.9% difference; p < 0.0001) and 2.4% of last authors (−10.2% difference; p < 0.0001). For the 2019 cerebrovascular section, female neurosurgeons were underrepresented as presenting authors (5.8%) compared with their membership representation (14.8%, −9.0% difference; p = 0.0018). CONCLUSIONS Despite an increase in the number of female neurosurgeons, there has not been a corresponding increase in the proportion of female neurosurgeons as abstract authors at annual neurosurgery conferences, and female neurosurgeons remain underrepresented as authors compared with their male colleagues.

OBJECTIVE Transependymal flow (TEF) of CSF, often delineated as T2-weighted hyperintensity adjacent to the lateral ventricles on MRI, is a known imaging finding, usually in the setting of CSF flow disturbances. Specific radiological features of TEF and their relationships with clinical markers of hydrocephalus and underlying disease pathology are not known. Here, the authors describe the radiological features and clinical associations of TEF with implications for CSF circulation in the setting of intracranial pathology. METHODS After obtaining IRB review and approval, the authors reviewed the radiological records of all patients who underwent intracranial imaging with CT or MRI at St. Louis Children’s Hospital, St. Louis, Missouri, between 2008 and 2019 to identify individuals with TEF. Then, under direct review of imaging, TEF pattern, degree, and location and underlying pathology and other radiological and clinical features pertaining to CSF circulation and CSF disturbances were noted. RESULTS TEF of CSF was identified in 219 patients and was most prevalent in the setting of neoplasms (72%). In 69% of the overall cohort, TEF was seen adjacent to the anterior aspect of the frontal horns and the posterior aspect of the occipital horns of the lateral ventricles, and nearly half of these patients also had TEF dorsal to the third ventricle near the splenium of the corpus callosum. This pattern was independently associated with posterior fossa medulloblastoma when compared with pilocytic astrocytoma (OR 4.75, 95% CI 1.43–18.53, p = 0.0157). Patients with congenital or neonatal-onset hydrocephalus accounted for 13% of patients and were more likely to have TEF circumferentially around the ventricles without the fronto-occipital distribution. Patients who ultimately required permanent CSF diversion surgery were more likely to have the circumferential TEF pattern, a smaller degree of TEF, and a lack of papilledema at the time of CSF diversion surgery. CONCLUSIONS CSF transmigration across the ependyma is usually restricted to specific periventricular regions and is etiology specific. Certain radiological TEF characteristics are associated with tumor pathology and may reflect impaired or preserved ependymal fluid handling and global CSF circulation. These findings have implications for TEF as a disease-specific marker and in understanding CSF handling within the brain.

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BACKGROUND: Women comprise more than half of medical school matriculants, but only 8.4% of US neurosurgeons. Awards given by neurosurgical societies are instrumental in shaping and advancing careers of women within academic neurosurgery, which can serve to increase the pipeline of women in the field. OBJECTIVE: To quantify the gender diversity of awards given by neurosurgical societies over 54 years. METHODS: Awards given by the American Association of Neurological Surgeons, Congress of Neurological Surgeons, and American Association of Neurological Surgeons/Congress of Neurological Surgeons joint sections were classified as research, humanitarian/achievement, or lectureships and analyzed for gender. Composite gender data were obtained from the societies. Percentage differences were calculated using comparison of proportions testing. RESULTS: Ninety six distinct awards granted to 1281 individuals from 1965 to 2019 were analyzed, and 9.4% were awarded to women. Seven percent of neurosurgeon awardees were women (excluding Women in Neurosurgery Section [WINS] awards). 36.1% of awards given at least 5 times were never awarded to women. Female awardees increased from 2000-2009 to 2010-2019 (5.2% difference, P = .018). The Cerebrovascular (2.0%) and Spine (2.3%) sections awarded the fewest awards to women, whereas the WINS (73.3%) and Pediatric section (20.6%) awarded the most. Spine, WINS, Pain, Cerebrovascular, and Tumor sections awarded significantly fewer awards to women than respective society demographic proportions. One-hundred percent (39 of 39) of named awards (excluding 2 from WINS) were named after men. CONCLUSION: Women remain underrepresented in the field of neurosurgery and as award winners. Many subspecialty sections continue to give significantly fewer awards to women than their society demographic proportions.