Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

Introduction

The field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery.

Research question

To assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges.

Materials and methods

Analysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee.

Results

We explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers.

Discussion and conclusion

The potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.

The impact of mental health on health-related quality of life in patients with NF2-related Schwannomatosis

NF2-related schwannomatosis (NF2-SWN) is a rare genetic disorder and is associated with progressive morbidities. This study aimed to investigate the relationship between NF2-SWN disease severity, health-related Quality of Life (QoL), and mental health aspects of patients. Standardised questionnaires assessing mental health problems (symptoms of depression, anxiety, and somatic burden), psychological factors (resilience, loneliness, and personality functioning), and health-related QoL were administered to 97 patients with NF2-SWN. The results of these questionnaires were compared with physician-rated disease severity. Questionnaires were completed by 77 patients. Physician-rated disease severity scores were available for 55 patients. NF2-SWN patients showed a high prevalence of clinically relevant symptoms of depression (30%), anxiety (16%), and somatic burden (32%). Almost all variables showed moderate to high correlations with NF2-SWN-related QoL. NF2-SWN-related QoL was associated with physician-reported disease severity (r = 0.614). In the stepwise hierarchical linear regression analysis, a significant model with four predictors (disease severity type, depression symptoms, personality functioning, and gender) explained 64% of the variance in NF2-SWN-related QoL. Our results showed a strong association between NF2-SWN-related QoL and depression symptoms. Moreover, personality functioning is an important influencing factor, representing a modifiable construct that can be targeted by prevention programs or psychotherapy.

Large language models as decision aids in neuro-oncology: a review of shared decision-making applications

Shared decision-making (SDM) is crucial in neuro-oncology, fostering collaborations between patients and healthcare professionals to navigate treatment options. However, the complexity of neuro-oncological conditions and the cognitive and emotional burdens on patients present significant barriers to achieving effective SDM. This discussion explores the potential of large language models (LLMs) such as OpenAI's ChatGPT and Google's Bard to overcome these barriers, offering a means to enhance patient understanding and engagement in their care. LLMs, by providing accessible, personalized information, could support but not supplant the critical insights of healthcare professionals. The hypothesis suggests that patients, better informed through LLMs, may participate more actively in their treatment choices. Integrating LLMs into neuro-oncology requires navigating ethical considerations, including safeguarding patient data and ensuring informed consent, alongside the judicious use of AI technologies. Future efforts should focus on establishing ethical guidelines, adapting healthcare workflows, promoting patient-oriented research, and developing training programs for clinicians on the use of LLMs. Continuous evaluation of LLM applications will be vital to maintain their effectiveness and alignment with patient needs. Ultimately, this exploration contends that the thoughtful integration of LLMs into SDM processes could significantly enhance patient involvement and strengthen the patient-physician relationship in neuro-oncology care.

Integrating Shared Decision-Making into Undergraduate Oncology Education: A Pedagogical Framework

The integration of shared decision-making (SDM) into undergraduate oncology education represents a critical evolution in medical pedagogy, reflecting the growing complexity and patient-centric focus of contemporary healthcare. This paper introduces a comprehensive pedagogical framework designed to embed SDM within the undergraduate medical curriculum, particularly in oncology, where the multiplicity of treatment options and their profound impact on patient life underscore the necessity of this approach. Grounded in a systematic literature review and aligned with established educational theories, this framework proposes twelve strategic approaches to cultivate future physicians proficient in both clinical acumen and patient-collaborative decision-making. The framework emphasizes real-world clinical experience, role-playing, case studies, and decision aids to deepen students' understanding of SDM. It advocates for the development of communication skills, ethical deliberation, and cultural competence, recognizing the multifaceted nature of patient care. The inclusion of patient narratives and evidence-based decision-making further enriches the curriculum, offering a holistic view of patient care. Additionally, the integration of digital tools within the SDM process acknowledges the evolving technological landscape in healthcare. The paper also addresses challenges in implementing this framework, such as curricular constraints and the need for educator training. It underscores the importance of continual evaluation and adaptation of these strategies to the dynamic field of medical education and practice. Overall, this comprehensive approach aims not only to enhance the quality of oncological care but also to prepare medical students for the complexities of modern medicine, where patient involvement in decision-making is both a necessity and an expectation.

Frequency of social burden and underage children in neuro-oncological patients

OBJECTIVE

Brain tumours can cause significant burden for patients and their families, including physical, psychological, and social challenges. This burden can be particularly difficult for patients with malignant brain tumours and those with underage children. However, the frequency of social burden among neuro-oncological patients and the proportion of patients with underaged children is currently unknown. The aim of this retrospective study is to determine the frequency of social and family dysfunction among neuro-oncological patients, the percentage of such patients who have underage children, and to assess their associated burden.

METHODS

During a 22-month period, all brain tumour patients were asked to complete a short questionnaire that included epidemiological data, the EORTC-qlq-C30 and -BN20 questionnaire, and the distress thermometer. Data were collected and analysed using Prism 9 for macOS (version 9, GraphPad Prism).

RESULTS

Our analysis included 881 brain tumour patients, of which 540 were female. Median age was 61 years (ranging from 16 to 88 years). Of all patients, 228 suffered from malignant intracranial tumours. More than half of all patients and more than 65% of patients with malignant tumours reported that their illness or medical treatment interfered with their social activities and family life. Almost 30% of patients reported moderate or severe complaints. About 27% of all patients (and 31% of patients with malignancies) expressed moderate or major concerns that their family life could be disrupted. Among the patients with malignancies, 83.5% of patients had a total of 318 children at the time of tumour diagnosis, with a mean age of 33 ± 0.9. Of these patients with malignancies, 38 (17.9%) had a total of 56 underage children at the time of tumour diagnosis, and currently have 53 underage children. Patients with minor children had more financial worries but less interference of their disease with social activities, less psycho-oncological distress, and a more positive outlook into the future (each, p < 0.0001). They evaluated their general health status and quality of life in the week prior to their current appointment significantly better (each p < 0.0001).

CONCLUSION

Our study found that 17.9% of patients with malignant brain tumours have underage children. However, having underage children may actually be a positive resource for these patients, as they show lower distress values and better quality of life.

Development and implementation of a student tumor board as a teaching format for medical students

PURPOSE

Tumor boards serve as established platforms for interdisciplinary expert discussions and therapeutic recommendations tailored to individual patient characteristics. Despite their significance, medical students often lack exposure to such interdisciplinary discussions as tumor boards are currently not integrated into medical curricula. To address this, we aimed to enhance future physicians' interdisciplinary communication skills and subject-specific knowledge by introducing an interactive series of five linked tumor board seminars within the domain of neuro-oncology.

METHODS

We developed a neuro-oncological student tumor board using a flipped-classroom format. The primary objectives of this case-centered approach included fostering an understanding of the tumor board process, active participation in multidisciplinary case discussions, honing appropriate communication strategies, and creating personalized therapy plans that consider inputs from all relevant disciplines, individual patient factors, and ethical considerations. To gauge the effectiveness of the seminar series, we administered structured pre- and post-course questionnaires.

RESULTS

Fourteen medical students in third to fifth year participated in the pilot series. Despite its organizational complexity, the interdisciplinary seminars were feasible. Students demonstrated significant growth in competence, aligned with predefined learning objectives. Notably, they appreciated the supportive learning environment and interactive teaching format, which kindled their interest in interdisciplinary oncology.

CONCLUSION

Active participation in a student tumor board can empower students to tackle the diverse challenges of caring for cancer patients within an interdisciplinary team during the early stages of their careers. The student tumor board represents an innovative, learner-centered approach to teach interdisciplinary cancer treatment, communication strategies, and ethical aspects of medical practice.

Resilience and recovery in neurosurgical residency: Unpacking lessons from video game mechanics

Introduction

Neurosurgical residency is a challenging journey demanding cognitive acuity and resilience, mirrored strikingly in the dynamics of video gaming. Gaming concepts of Down-But-Not-Out (DBNO), Heal-over-Time (HoT), and Damage-over-Time (DoT) can serve as compelling analogues to elements of neurosurgical training.

Material and methods

An innovative, cross-disciplinary methodology was implemented, blending elements of autoethnography, personal reflective narrative, and comprehensive literary review. The cornerstone of this approach was an experiential reflective analysis, where two neurosurgical residents critically examined the parallels between their residency experiences and video game mechanics, thereby applying a lens of heuristic introspection to their professional journey. Complementing this, a comprehensive narrative synthesis of existing literature on resilience, wellness, and stress in neurosurgical residency training was conducted.

Results

The DBNO concept parallels the resilience demonstrated by neurosurgical residents, emphasizing the importance of a supportive network. The HoT concept, analogous to wellness practices, underscores the incremental restoration of energy necessary for maintaining stamina in neurosurgery training. The DoT concept symbolizes the need to manage the often insidious and deleterious effects of chronic stress on residents' wellbeing.

Discussion and conclusion

These gaming concepts provide an integrative framework for understanding the challenges faced and strategies employed in neurosurgical residency. The interplay between resilience, wellness practices, and effective stress management, represented by DBNO, HoT, and DoT respectively, is critical for maintaining health and fostering professional excellence. By embedding these metaphors within the training paradigm, the neurosurgical residency journey can be navigated more effectively, promoting not only professional success but also personal growth and wellbeing.

Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility

OBJECTIVE The use of high-field intraoperative MRI has been largely studied for the treatment of intracranial tumors in adult patients. In this study, the authors investigated the safety, advantages, and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric patients, with particular attention to craniopharyngiomas and gliomas. METHODS The authors performed 82 surgical procedures in patients under 16 years of age (range 0.8-15 years) over an 8-year period (2007-2014) using iMRI. The population was divided into 3 groups based on the condition treated: sellar region tumors (Group 1), gliomas (Group 2), and other pathological entities (Group 3). The patients' pre- and postoperative neurological status, the presence of residual tumor, the number of intraoperative scans, and complications were evaluated. RESULTS In Group 1, gross-total resection (GTR) was performed in 22 (88%) of the procedures and subtotal resection (STR) in 3 (12%). In Group 2, GTR, STR, and partial resection (PR) were performed, respectively, in 15 (56%), 7 (26%), and 5 (18%) of the procedures. In Group 3, GTR was performed in 28 (93%) and STR in 2 (7%) of the procedures. In cases of craniopharyngioma (Group 1) and glioma (Group 2) in which a complete removal was planned, iMRI allowed localization of residual lesions and attainment of the surgical goal through further resection, respectively, in 18% and 27% of the procedures. Moreover, in gliomas the resection could be extended from partial to subtotal in 50% of the cases. In 17% of the patients in Group 3, iMRI enabled the identification and further removal of tumor remnants. There was no intra- or postoperative complication related to the use of iMRI despite special technical difficulties in smaller children. CONCLUSIONS In this study, the use of iMRI in children proved to be safe. It was most effective in increasing the extent of tumor resection, especially in patients with low-grade gliomas and craniopharyngiomas. The most prominent disadvantage of high-field iMRI was the limitation with respect to operative positioning due to the configuration of the surgical table.

Growth dynamics of intramedullary spinal tumors in patients with neurofibromatosis type 2

OBJECTIVES

Volumetric data on the natural growth of intramedullary tumors in patients with neurofibromatosis type 2 (NF2) are rare, but crucial for long-term disease monitoring. Our aim was to evaluate the growth rates and growth patterns of these tumors.

PATIENTS AND METHODS

Patient records from the regional neurofibromatosis referral center were evaluated for inclusion in this analysis. Magnetic resonance images of the spine were collected and digitized as necessary. Tumor volumes were determined by volumetric extrapolation after segmentation in datasets (iPlan Net software, BrainLAB, Munich) if the tumors met the following inclusion criteria: sagittal T2-weighted MRI scans had to be available from at least two investigations and tumors had to be visible on at least two slices. All tumors that had undergone previous therapy, such as surgery, radiation or bevacizumab treatment were excluded from this study.

RESULTS

Suitable MR images of the spine were available from 51 patients (20 males, 31 females) with NF2. The median follow-up time per patient was 54 months (range 0-190 months). 23 patients (15 females, 11 males) of the 51 patients with spinal imaging harbored intramedullary tumors. Across this cohort, there was an aggregate of 68 tumors at baseline. Over the course of follow-up, the patients developed 19 additional tumors, resulting in a total of 87 tumors. A final set of 42 tumors from 19 patients met the inclusion criteria and was included in the growth analysis. The median follow-up time per tumor was 44 months (range 9-122 months). 23 of the tumors were located in the cervical spine; 19 of them were located in the thoracic spine. The median tumor size±standard deviation (SD) after 5 years was 136±71.0% compared to baseline. The median time to ≥20% tumor growth was 24 months. Overall, 30 tumors (71.4%) grew, 8 (19.1%) remained stable and 4 (9.52%) decreased in size. The most common growth pattern was saltatory growth.

CONCLUSION

Intramedullary spinal cord tumors are present in about half of patients with NF2. The majority of these tumors grow over time, albeit slowly. Given the confines of the spinal medulla and the limited scope for functional recovery after symptomatic tumor expansion, NF2 patients should be under continual surveillance in order to rapidly identify intramedullary spinal tumors that may require microsurgical resection.

Google Search Queries About Neurosurgical Topics: Are They a Suitable Guide for Neurosurgeons?

OBJECTIVE

Google is the most popular search engine, with about 100 billion searches per month. Google Trends is an integrated tool that allows users to obtain Google's search popularity statistics from the last decade. Our aim was to evaluate whether Google Trends is a useful tool to assess the public's interest in specific neurosurgical topics.

METHODS

We evaluated Google Trends statistics for the neurosurgical search topic areas "hydrocephalus," "spinal stenosis," "concussion," "vestibular schwannoma," and "cerebral arteriovenous malformation." We compared these with bibliometric data from PubMed and epidemiologic data from the German Federal Monitoring Agency. In addition, we assessed Google users' search behavior for the search terms "glioblastoma" and "meningioma."

RESULTS

Over the last 10 years, there has been an increasing interest in the topic "concussion" from Internet users in general and scientists. "Spinal stenosis," "concussion," and "vestibular schwannoma" are topics that are of special interest in high-income countries (eg, Germany), whereas "hydrocephalus" is a popular topic in low- and middle-income countries. The Google-defined top searches within these topic areas revealed more detail about people's interests (eg, "normal pressure hydrocephalus" or "football concussion" ranked among the most popular search queries within the corresponding topics). There was a similar volume of queries for "glioblastoma" and "meningioma."

CONCLUSIONS

Google Trends is a useful source to elicit information about general trends in peoples' health interests and the role of different diseases across the world. The Internet presence of neurosurgical units and surgeons can be guided by online users' interests to achieve high-quality, professional-endorsed patient education.