Preface. The leadership of Women in Neurosurgery (WINS) has been asked by the Board of Directors of the American Association of Neurological Surgeons (AANS) to compose a white paper on the recruitment and retention of female neurosurgical residents and practitioners.Introduction. Neurosurgery must attract the best and the brightest. Women now constitute a larger percentage of medical school classes than men, representing approximately 60% of each graduating medical school class. Neurosurgery is facing a potential crisis in the US workforce pipeline, with the number of neurosurgeons in the US (per capita) decreasing.Women in the Neurosurgery Workforce. The number of women entering neurosurgery training programs and the number of board-certified female neurosurgeons is not increasing. Personal anecdotes demonstrating gender inequity abound among female neurosurgeons at every level of training and career development. Gender inequity exists in neurosurgery training programs, in the neurosurgery workplace, and within organized neurosurgery.Obstacles. The consistently low numbers of women in neurosurgery training programs and in the workplace results in a dearth of female role models for the mentoring of residents and junior faculty/practitioners. This lack of guidance contributes to perpetuation of barriers to women considering careers in neurosurgery, and to the lack of professional advancement experienced by women already in the field. There is ample evidence that mentors and role models play a critical role in the training and retention of women faculty within academic medicine. The absence of a critical mass of female neurosurgeons in academic medicine may serve as a deterrent to female medical students deciding whether or not to pursue careers in neurosurgery. There is limited exposure to neurosurgery during medical school. Medical students have concerns regarding gender inequities (acceptance into residency, salaries, promotion, and achieving leadership positions). Gender inequity in academic medicine is not unique to neurosurgery; nonetheless, promotion to full professor, to neurosurgery department chair, or to a national leadership position is exceedingly rare within neurosurgery. Bright, competent, committed female neurosurgeons exist in the workforce, yet they are not being promoted in numbers comparable to their male counterparts. No female neurosurgeon has ever been president of the AANS, Congress of Neurological Surgeons, or Society of Neurological Surgeons (SNS), or chair of the American Board of Neurological Surgery (ABNS). No female neurosurgeon has even been on the ABNS or the Neurological Surgery Residency Review Committee and, until this year, no more than 2 women have simultaneously been members of the SNS. Gender inequity serves as a barrier to the advancement of women within both academic and community-based neurosurgery.Strategic Approach to Address Issues Identified. To overcome the issues identified above, the authors recommend that the AANS join WINS in implementing a strategic plan, as foll...
Intracranial cavernous malformations are vascular anomalies consisting of endothelium-lined caverns filled with blood at various stages of thrombosis and organization and separated by a collagenous stroma devoid of mature vessel wall elements. They occur in an estimated 0.45 to 0.9% of the population, with male and female patients equally affected and all ages represented. They commonly manifest as seizures, gross intracranial hemorrhage, and focal neurological deficits. Lesions are frequently multiple in the same patient, and 10 to 30% are associated with familial clustering. Several reports have documented a dynamic clinical-radiological lesion behavior with de novo lesion genesis, intralesional and perilesional hemorrhage, and corresponding fluctuations in lesion size. Hemorrhagic risk and neurological disability seem to be related to multiple factors, including lesion location, age, gender, state of reproductive cycle, and previous hemorrhage. Lesions may behave aggressively with repetitive hemorrhages and cumulative disability or may remain quiescent for many years. Management strategies include expectant follow-up in patients with asymptomatic or inaccessible lesions, excision of symptomatic and accessible lesions, and radiosurgery of progressively symptomatic lesions in inoperable locations. Relevant disease-specific outcome parameters are proposed to guide clinical decisions and future research. Prospective, stratified, hypothesis-driven studies using rigorous epidemiological methods must be undertaken to delineate patient and lesion factors influencing clinical aggressiveness. Biological studies are essential to uncover strategies to predict and modify lesion behavior.
Background and Purpose-Hemorrhagic stroke has a high initial mortality rate. While survivors often recover motor function, many experience significant changes in their quality of life (QOL). Available outcome measures assess neurological impairment, disability, or handicap, yet often inadequately characterize the full impact of a stroke on patients' lives. In this study, we develop and validate a QOL instrument specific for young patients with hemorrhagic strokes. Methods-Methodological guidelines for instrument development were initially established. Based on the content of 40open-ended patient interviews, a 54-item instrument (HSQuale) was developed. The reliability (test-retest and internal consistency) and validity (content and construct) of HSQuale were assessed in another 71 patients (18 to 49 years of age, 63% women, 77% white), at 1 year after their hemorrhagic stroke. Comparisons were made between HSQuale and other commonly used outcome measures. Results-HSQuale demonstrated reproducibility (test-retest , 0.40 to 0.96) and internal consistency (Cronbach ␣ Ն0. 80 for 5 of 7 domains). HSQuale scores had broad frequency distributions (Յ33% of subjects scored in any single score decile), avoided ceiling effects found for other outcome measures (Barthel Index and Short Form-36), and discriminated among clinically distinct subject groups (eg, intracerebral versus subarachnoid hemorrhage patients). Conclusions-HSQuale is a reliable and valid QOL instrument. Compared with other outcome measures, it assesses abroader range of deficits and is better able to discriminate among subgroups of hemorrhagic stroke survivors. Key Words cerebral hemorrhage Ⅲ cerebrovascular disorders Ⅲ outcome assessment Ⅲ prognosis Ⅲ quality of life A mong patients with hemorrhagic stroke, the communitybased, 30-day case-fatality rate is 30% to 60%. 1-4 Approximately 70% of survivors, however, are independent in their activities of daily living at 1 year. 2,3 For this reason, some authors have concluded that hemorrhagic stroke patients who survive the first few weeks have a "good" prognosis. 1,3,5 A favorable outcome for hemorrhagic stroke patients, however, has been questioned, as many patients with good motor recovery exhibit marked cognitive disturbances and difficulties with emotional adjustment. 6 -9 Furthermore, while stroke scales, the Barthel Index, 10 and the modified Rankin Scale 11 continue to be the most commonly used stroke outcome measures, these traditional measures do not capture the full range of deficits experienced by stroke survivors. The evaluation of a broader range of patient outcomes (eg, cognitive, occupational) has been advocated. [12][13][14][15] Although the consensus classification system recently developed by the Classification of Stroke Outcome Task Force of the American Heart Association 16 is useful for assessing neurological impairments, disabilities, and handicaps of patients, a consensus instrument for assessing quality-of-life (QOL) outcomes for stroke patients is still lacking.The need for stroke-s...
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