Background Supraorbital eyebrow craniotomy is a minimally invasive alternative to a frontotemporal craniotomy and is often used for tumor and vascular pathologies. The purpose of this study was to investigate how patient cosmetic outcomes are affected by technique variations of this approach. Methods PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to PRISMA guidelines. For the meta-analysis portion, the DerSimonian–Laird random effects model was used, and the primary end points were patient satisfaction and percentage of permanent cosmetic complications. Results A total of 2,629 manuscripts were identified. Of those, 124 studies (8,241 surgical cases) met the inclusion criteria. Overall, 93.04 ± 11.93% of patients reported favorable cosmetic outcome following supraorbital craniotomy, and mean number of cases with permanent cosmetic complications was 6.62 ± 12.53%. We found that vascular cases are associated with more favorable cosmetic outcomes than tumor cases ( p = 0.0001). Addition of orbital osteotomy or use of a drain is associated with adverse cosmetic outcomes ( p = 0.001 and p = 0.0001, respectively). The location of incision, size of craniotomy, utilization of an endoscope, method of cranial reconstruction, skin closure, use of antibiotics, and addition of pressure dressing did not significantly impact cosmetic outcomes ( p > 0.05 for all). Conclusions Supraorbital craniotomy is a minimally invasive technique associated with generally high favorable cosmetic outcomes. While certain techniques used in supraorbital keyhole approach do not pose significant cosmetic risks, utilization of an orbital osteotomy and the addition of a drain correlate with unfavorable cosmetic outcomes.
Aim: H3G34 diffuse hemispheric glioma is a CNS tumor that is difficult to diagnose and treat and accompanied with poor prognosis. It is becoming clear that extra CNS metastasis may present in a subset of patients with H3G34 gliomas, further complicating diagnosis and treatment. Materials & methods: We present a case of a 19-year-old female with a H3G34 mutant diffuse hemispheric glioma with osseous metastases. We then provide a literature review of the most recent understanding of H3G34 mutant malignancies. Conclusion: Given the stress that patients with H3G34 can experience and the poor prognosis, it is imperative to expand our knowledge and ascertain accurate diagnostic methodologies and targeted therapeutic approaches.
Background: Vertebral artery (VA) aneurysm is a rare etiology of cervical radiculopathy and there is a paucity of case reports described in the literature. Case Description: We describe a case of a patient with no history of trauma presenting with a large right VA aneurysm at the C5–C6 level compressing the C6 nerve root and causing a painful radiculopathy. The patient underwent successful external carotid artery-radial artery-VA bypass followed by trapping of the aneurysm and decompression of the C6 nerve root. Conclusion: VA bypass is an effective tool for treatment of symptomatic large extracranial VA aneurysms and a rare cause of radiculopathy.
OBJECTIVE The United States Medical Licensing Examination (USMLE) Step 1 recently transitioned to a pass/fail outcome, renewing interest in how programs select neurosurgical residents. This study investigates the association between match status and key academic metrics over time. METHODS Data are from the National Resident Matching Program from 2009 to 2022 for matched and unmatched US allopathic (MD) seniors. Investigated metrics included the mean number of contiguous ranks; mean number of distinct specialties ranked; mean USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores; mean number of abstracts, presentations, and publications; mean number of research, work, and volunteer experiences; Alpha Omega Alpha status; attendance at a top 40 NIH-funded institution; PhD degree; and other degree. Multiple linear regression without an interaction term was used to evaluate how these have varied between the two groups during the study period and whether there is a difference between unmatched and matched MD seniors applying for a neurosurgical residency. Multiple linear regression with an interaction term was then used to test whether the difference in variables between the two groups changed over time. RESULTS Regardless of match status, MD senior neurosurgical residency applicants exhibited an increase in USMLE Step 1 and 2 scores; average research experiences; abstracts, presentations, and publications; and work and volunteer experiences (p < 0.001). The percentage of applicants from a top 40 NIH-funded school decreased (p = 0.018), and the percentage who held an additional degree increased (p = 0.007). Between groups, there were significant differences in all categories except work experiences and other degree obtained. Over time, the difference between USMLE Step 2 scores between matched and unmatched seniors diminished (p = 0.027); in contrast, the difference in abstracts, presentations, and publications between the two groups increased over time (p < 0.001). CONCLUSIONS From 2009 to 2022, neurosurgical residency applicants grew in their achievements across many metrics. In the advent of Step 1 becoming pass/fail, this study suggests that Step 2 is not viewed by programs as an adequate replacement. However, the Step 1 grading transition may serve as an opportunity for other factors to be considered that may better predict success in neurosurgical residency.
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