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Albrahim M, Almutairi OT, Alhussinan MA, Alotaibi FE, Bafaquh M. Bibliometric overview of the Top 100 most cited articles on hydrocephalus. Surg Neurol Int 2022; 13:176. [PMID: 35509567 PMCID: PMC9062952 DOI: 10.25259/sni_115_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/31/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Hydrocephalus is one of the most common brain disorders and numerous articles were published to address the clinical aspect and its management. This study aims to highlight the most influential work on hydrocephalus on bibliometric basis. Methods: A thorough search of Scopus database was performed using the word “hydrocephalus.” The 100 most cited articles were retrieved, and variables of importance were collected including the article’s title, 1st author affiliation, country of origin, year and journal of publication, article’s category, and citation count according to Scopus and Google scholar databases. Results: The 100 most cited articles were thoroughly analyzed. Publication dates ranged from 1946 to 2014, with most articles (45) published between 1998 and 2007. The mean number of citations per publication was 201 with total of 20,177 citations. The United States of America contributed half of the articles. The leading institution was the Canadian hospital for Sick Children University of Toronto having published 5 articles. Hydrocephalus in general and normal pressure hydrocephalus was the two major categories addressed with most studies fall under the topic of surgical management. Neurosurgery was the specialty with the greatest contribution (47%). The articles were published in 46 different journals led by the Journal of Neurosurgery with total of 17 articles. Conclusion: This bibliometric analysis delineates the landmark publications in hydrocephalus. The listed articles depict the myriad of studied aspects historically which helps in understanding hydrocephalus overall in evidence-based module for neurosurgeons and non-neurosurgeons.
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Affiliation(s)
- Mohammed Albrahim
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Altawwan District, Riyadh, Saudi Arabia,
| | - Othman T. Almutairi
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Altawwan District, Riyadh, Saudi Arabia,
| | - Modhi A. Alhussinan
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Altawwan District, Riyadh, Saudi Arabia,
| | - Fahad E. Alotaibi
- Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Altawwan District, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Altawwan District, Riyadh, Saudi Arabia,
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Alshaqaq A, Al Abadi A, Altheaby A, Bukhari MA, Nasrallah B, Alamoudi A, Arabi Z, Alhejaili F, Saad KB, Busbaih A, Idris MA, Askandarani S, AlBugami MM, Alotaibi FE, Hamawi K, Akkari KB. Coronavirus Disease 2019 and Kidney Transplantation in Saudi Arabia: Outcomes and Future Opportunities. Ann Transplant 2021; 26:e931832. [PMID: 34083502 PMCID: PMC8186269 DOI: 10.12659/aot.931832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Kidney transplant services all over the world were severely impacted by the coronavirus disease 2019 pandemic. The optimum management of kidney transplant recipients with coronavirus disease 2019 remains uncertain. MATERIAL AND METHODS We conducted a multicenter cohort study of kidney transplant recipients with coronavirus disease 2019 infection in Saudi Arabia. Multivariable Cox regression analysis was used to study predictors of graft and patient outcomes at 28 days after coronavirus disease 2019 diagnosis. RESULTS We included 130 kidney transplant recipients, with a mean age of 48.7(±14.4) years. Fifty-nine patients were managed at home with daily follow-up utilizing a dedicated clinic, while 71 (54.6%) required hospital admission. Acute kidney injury occurred in 35 (26.9%) patients. Secondary infections occurred in 38 (29.2%) patients. SARS-CoV-2 antibodies testing was carried out in 84 patients, of whom 70 tested positive for IgG and/or IgM. Fourteen patients died (10.8%). A multivariable Cox regression analysis showed that age, creatinine at presentation, acute kidney injury, and use of azithromycin were significantly associated with worse patient survival. Graft loss was associated with requiring renal replacement therapy and development of secondary infections. CONCLUSIONS Despite kidney transplant recipients with coronavirus disease 2019 infection having higher rate of hospital admission and mortality compared to the general population, a significant number of them can be managed using a telemedicine clinic. Most kidney transplant patients seem to mount an antibody response following coronavirus disease 2019 infection, and it remains to be seen if they will have a similar response to the incoming vaccines.
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Affiliation(s)
- Ali Alshaqaq
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Abdulnaser Al Abadi
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Abdulrahman Altheaby
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | | | - Basil Nasrallah
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Alaa Alamoudi
- Kidney and Pancreas Transplant Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ziad Arabi
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Fayez Alhejaili
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Khalid Bin Saad
- Hepatobiliary Sciences and Organ Transplant Center, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia
| | - Ahmed Busbaih
- Critical Care Department, King Fahad Hospital, Hofuf, Saudi Arabia
| | - Mohammed Abdelrahim Idris
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Sumayah Askandarani
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Meteb M. AlBugami
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Fahad E. Alotaibi
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Khaled Hamawi
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Khalid Bel’eed Akkari
- Multi-Organ Transplant Center, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
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Elarjani T, Almutairi OT, Alhussinan M, Alzhrani G, Alotaibi FE, Bafaquh M. Bibliometric analysis of the top 100 most-cited articles on astrocytoma. Surg Neurol Int 2021; 12:62. [PMID: 33654565 PMCID: PMC7911206 DOI: 10.25259/sni_521_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background Citation analysis reflects the scientific recognition and influential performance of a published article within its field. We aim to identify the top 100 most-cited articles on astrocytoma using this bibliometric analysis method. Methods In May 2020, we performed a thorough search in the Scopus database using the word "Astrocytoma." The top 100 most-cited articles were arranged based on citation count in descending order. The resultant articles were then analyzed with an assessment of pertinent factors. Results The most-cited articles on astrocytoma had been cited 23,720 times. The top-cited article received a total of 682 citations, with an average of 34.1 citations annually. The list comprised eight clinical trials, in which the highest cited article received 625 citations. Articles were published from 1975 to 2015 with the 1995-2005 era as the most prolific period. Neuropathology studies were the most studied category, followed by clinical studies. The United States of America was the most significant contributor, with 49 published articles. The University of California San Francisco was the most contributing institution by producing 11 articles. Articles were published in 32 different journals led by the Cancer Research Journal, with a total of 12 publications. Approximately 160 authors contributed to the list in which Scheithauer, B.W. contributed the most with a total of eight articles. Conclusion This report clustered the most impactful articles on astrocytoma. It serves as an adequate tool to identify publication trends and helps in achieving evidence-based clinical practice.
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Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, Florida, United States
| | - Othman T Almutairi
- Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Gmaan Alzhrani
- Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad E Alotaibi
- Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
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Elarjani T, Almutairi OT, Alhussinan M, Alturkistani A, Alotaibi FS, Bafaquh M, Alotaibi FE. Bibliometric analysis of the top 100 most cited articles on craniosynostosis. Childs Nerv Syst 2021; 37:587-597. [PMID: 32780272 DOI: 10.1007/s00381-020-04858-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Craniosynostosis is the premature closure of cranial sutures and it continues to be a therapeutic challenge due to the diversity and complexity of the syndrome. Bibliometric analysis is a study of ranking citations and exploring the most impactful articles in a respective discipline. It also demonstrates the chronological trends of publications. METHODS In May 2020, we performed a title-specific search of the Scopus database using "craniosynostosis" as our query term without publication date restrictions. The top 100 articles in craniosynostosis were retrieved and analyzed. RESULTS The top 100 most-cited articles in craniosynostosis received a total 13,826 citations, and an average of 138 citations per paper. The publication dates ranged from 1920 to 2015, with a peak period of top publications between 1996 and 2005. The most common category is clinical, followed by neurogenetics. The top cited article received 540 citation counts and 19.29 citations per year. The USA was the most contributing country to the list. The Journal of Plastic and Reconstructive Surgery published the largest number of top cited articles. Neurosurgery as a specialty contributed to most articles in the list (27 articles). The institute who contributed the most was the Assistance Publique Hopitaux Paris. CONCLUSION Bibliometric analysis in craniosynostosis revealed major trend changes of research over the years, with a focus on neurogenetics and the different types of surgical corrections. The current collection of highly cited publications may assist physicians in gaining a better understanding of the evidence-based approach in craniosynostosis.
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Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, FL, USA.
| | - Othman T Almutairi
- Division of Neurological Surgery, Neurosciences Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Abdulelah Alturkistani
- Division of Neurological Surgery, Neurosciences Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad S Alotaibi
- Division of Neurological Surgery, Neurosciences Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Division of Neurological Surgery, Neurosciences Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad E Alotaibi
- Division of Neurological Surgery, Neurosciences Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Alammar F, Alharpi M, Ahmad M, Al-Banyan A, Alotaibi FE, Shakweer WA, Abedalthagafi M, Mobark NA. LGG-15. PEDIATRIC LOW-GRADE GLIOMAS IN SAUDI ARABIA: RETROSPECTIVE ANALYSIS OF CHILDREN WITH LOW-GRADE GLIOMAS TREATED IN KING FAHAD MEDICAL CITY KFMC- SINGLE INSTITUTIONAL EXPERIENCE. Neuro Oncol 2020. [PMCID: PMC7715258 DOI: 10.1093/neuonc/noaa222.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pediatric Low-grade gliomas (PLGGs) are extremely heterogeneous tumors and account for approximately 35% of childhood brain tumors. This retrospective study on 55 newly diagnosed children (<14 ys) with pathologically confirmed LGG from 2006 to 2016 aimed to review demographic data, clinical and therapeutic aspects and treatment outcome of PLGGs in children in Saudi Arabia. RESULTS: 33 (60.0%) males,22 (40.0%) females, median age at diagnosis 68 months. Pilocytic astrocytoma was the most common pathological diagnosis 42 (76.4%) location of tumor was Infratentorial in 30 patients (54.0%) and Supratentorial in 24 patients (43.2%), 19 patients (34.6%) had total surgical excision, 10 (18.2%) subtotal resection, 20 (36.4%) partial excision and 6 (10.9%) had biopsy only; After initial Surgery 30 patients (54.5%) required adjuvant chemotherapy of whom 14 patients (46.7%) experienced a treatment failure event, 25 patients (45.5%) who were initially observed post surgery 6 patients (24%) of them had relapse /progression and required further therapy. Only 2 patients (3.6%) received radiotherapy due to uncontrolled progression first line chemotherapy carboplatin and vincristine (CV) regimen was tolerated, Carboplatin allergic reactions developed in 21.1% of patients. Median follow-up of 6.49 years, the median time of relapse/ progression was 2.85 years The 5-year overall survival (OS) rates and progression free survival for all patients were 92.2 %, and 63.3% respectively. This study was to document the outcome of pediatric LGG in Saudi Arabia and to serve as a guideline for the future management with incorporation of molecular studies on pediatric LGGs which may help improve the outcome for Saudi children with LGG.
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Affiliation(s)
- Fahad Alammar
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Musa Alharpi
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Maqsood Ahmad
- Pediatric Neurosurgical Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman Al-Banyan
- Pediatric Neurosurgical Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad E Alotaibi
- Pediatric Neurosurgical Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wafa Al Shakweer
- Pathology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Nahla Ali Mobark
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
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Alturkistani A, Altuhayni K, Alluhaybi AA, Alotaibi FE. Pneumocephalus induced isolated oculomotor palsy :Case report and literature review. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Elarjani T, Almutairi OT, Alhussinan M, Alzhrani G, Alotaibi FE, Bafaquh M, Orz Y, AlYamany M, Alturki AY. Bibliometric Analysis of the Top 100 Most Cited Articles on Cerebral Vasospasm. World Neurosurg 2020; 145:e68-e82. [PMID: 32980568 DOI: 10.1016/j.wneu.2020.09.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Bibliometric analysis reflects the scientific recognition and influential performance of a published article within its field. Our aim is to identify and analyze the top 100 most-cited articles on cerebral vasospasm. METHODS A title-specific search was carried out using the Scopus database. The top 100 cited articles including the keywords "Cerebral Vasospasm" AND "Vasospasm" were retrieved and stratified in a descending order: title, authors, institution, publishing journal, country of origin, year of publication, and topic of each article were studied. RESULTS The top 100 articles have an accumulative citation count of 20,972, with 209 average citations per article. Publication dates ranged from 1968 to 2012, with the most productive years between 1998 and 2005. Clinical studies are the most frequent category, followed by pathophysiology. The list includes 7 clinical trials, which received accumulative citations of 1525. The top cited article had received 2109 citations, with 52.7 citations per year. The top 100 articles were published across 14 countries, with most originating from the United States. The lead research institution was the University of Alberta. The most used journal was Journal of Neurosurgery. CONCLUSIONS Bibliometric analysis has garnered major interest in recent years. It shows the publication trends, knowledge evolution, and evidence-based practice throughout the years. The collection of highly cited articles may assist physicians in gaining a better understanding of the nature of cerebral vasospasm and optimize their clinical practice.
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Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, Florida USA
| | - Othman T Almutairi
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Gmaan Alzhrani
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad E Alotaibi
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yasser Orz
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mahmoud AlYamany
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Y Alturki
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Neurocritical Care Divison, Adult Intensive Care Department, Critical Care Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia.
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Bajunaid K, Alqurashi A, Alatar A, Alkutbi M, Alzahrani AH, Sabbagh AJ, Alobaid A, Barnawi A, Alferayan AA, Alkhani AM, Salamah AB, Sheikh BY, Alotaibi FE, Alabbas F, Farrash F, Al-Jehani HM, Alhabib H, Alnaami I, Altweijri I, Khoja I, Taha M, Alzahrani M, Bafaquh MS, Binmahfoodh M, Algahtany MA, Al-Rashed S, Raza SM, Elwatidy S, Alomar SA, Al-Issawi W, Khormi YH, Ammar A, Al-Habib A, Baeesa SS, Ajlan A. Neurosurgical Procedures and Safety During the COVID-19 Pandemic: A Case-Control Multicenter Study. World Neurosurg 2020; 143:e179-e187. [PMID: 32702490 PMCID: PMC7370909 DOI: 10.1016/j.wneu.2020.07.093] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
Objective Quantitative documentation of the effects of outbreaks, including the coronavirus disease 2019 (COVID-19) pandemic, is limited in neurosurgery. Our study aimed to evaluate the effects of the COVID-19 pandemic on neurosurgical practice and to determine whether surgical procedures are associated with increased morbidity and mortality. Methods A multicenter case-control study was conducted, involving patients who underwent neurosurgical intervention in the Kingdom of Saudi Arabia during 2 periods: pre-COVID-19 and during the COVID-19 pandemic. The surgical intervention data evaluated included diagnostic category, case priority, complications, length of hospital stay, and 30-day mortality. Results A total of 850 procedures were included, 36% during COVID-19. The median number of procedures per day was significantly lower during the COVID-19 period (5.5 cases) than during the pre-COVID-19 period (12 cases; P < 0.0001). Complications, length of hospital stay, and 30-day mortality did not differ during the pandemic. In a multivariate analysis comparing both periods, case priority levels 1 (immediate) (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.24–2.67), 1 (1–24 h) (OR, 1.63; 95% CI, 1.10–2.41), and 4 (OR, 0.28; 95% CI, 0.19–0.42) showed significant differences. Conclusions During the early phase of the COVID-19 pandemic, the overall number of neurosurgical procedures declined, but the load of emergency procedures remained the same, thus highlighting the need to allocate sufficient resources for emergencies. More importantly, performing neurosurgical procedures during the pandemic in regions with limited effects of the outbreak on the health care system was safe. Our findings may aid in developing guidelines for acute and long-term care during pandemics in surgical subspecialties.
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Affiliation(s)
- Khalid Bajunaid
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada
| | - Ashwag Alqurashi
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alatar
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alkutbi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Anas H Alzahrani
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Alobaid
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulwahed Barnawi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed M Alkhani
- Division of Neurosurgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali Bin Salamah
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bassem Yousef Sheikh
- Vascular Endovascular and Skull Base Neurosurgery, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Fahad E Alotaibi
- Department of Pediatric Neurosurgery, National Neuroscience institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal Alabbas
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Farrash
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hosam M Al-Jehani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Husam Alhabib
- Department of Spine Surgery, Dr Sulaiman Alhabib Hospital, Khobar, Saudi Arabia
| | - Ibrahim Alnaami
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ikhlass Altweijri
- Division of Neurosurgery, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Isam Khoja
- Department of Neurosurgery, International Medical Center, Jeddah, Saudi Arabia
| | - Mahmoud Taha
- Department of Neurosurgery, King Fahad specialist Hospital, Dammam, Saudi Arabia
| | - Moajeb Alzahrani
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed S Bafaquh
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Binmahfoodh
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mubarak Ali Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Sabah Al-Rashed
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Syed Muhammad Raza
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Soha A Alomar
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wisam Al-Issawi
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Yahya H Khormi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Ammar
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Amro Al-Habib
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh S Baeesa
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrazag Ajlan
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Winkler-Schwartz A, Marwa I, Bajunaid K, Mullah M, Alotaibi FE, Bugdadi A, Sawaya R, Sabbagh AJ, Del Maestro R. A Comparison of Visual Rating Scales and Simulated Virtual Reality Metrics in Neurosurgical Training: A Generalizability Theory Study. World Neurosurg 2019; 127:e230-e235. [PMID: 30880209 DOI: 10.1016/j.wneu.2019.03.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adequate assessment and feedback remains a cornerstone of psychomotor skills acquisition, particularly within neurosurgery where the consequence of adverse operative events is significant. However, a critical appraisal of the reliability of visual rating scales in neurosurgery is lacking. Therefore, we sought to design a study to compare visual rating scales with simulated metrics in a neurosurgical virtual reality task. METHODS Neurosurgical faculty rated anonymized participant video recordings of the removal of simulated brain tumors using a visual rating scale made up of seven composite elements. Scale reliability was evaluated using generalizability theory, and scale subcomponents were compared with simulated metrics using Pearson correlation analysis. RESULTS Four staff neurosurgeons evaluated 16 medical student neurosurgery applicants. Overall scale reliability and internal consistency were 0.73 and 0.90, respectively. Reliability of 0.71 was achieved with two raters. Individual participants, raters, and scale items accounted for 27%, 11%, and 0.6% of the data variability. The hemostasis scale component related to the greatest number of simulated metrics, whereas respect for no-go zones and tissue was correlated with none. Metrics relating to instrument force and patient safety (brain volume removed and blood loss) were captured by the fewest number of rating scale components. CONCLUSIONS To our knowledge, this is the first study comparing participant's ratings with simulated performance. Given rating scales capture less well instrument force, quantity of brain volume removed, and blood loss, we suggest adopting a hybrid educational approach using visual rating scales in an operative environment, supplemented by simulated sessions to uncover potentially problematic surgical technique.
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Affiliation(s)
- Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Ibrahim Marwa
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Khalid Bajunaid
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Muhammad Mullah
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Fahad E Alotaibi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Neurosurgical Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulgadir Bugdadi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Robin Sawaya
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Abdulrahman J Sabbagh
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rolando Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
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Bugdadi A, Sawaya R, Bajunaid K, Olwi D, Winkler-Schwartz A, Ledwos N, Marwa I, Alsideiri G, Sabbagh AJ, Alotaibi FE, Al-Zhrani G, Maestro RD. Is Virtual Reality Surgical Performance Influenced by Force Feedback Device Utilized? J Surg Educ 2019; 76:262-273. [PMID: 30072262 DOI: 10.1016/j.jsurg.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/19/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The study objectives were to assess if surgical performance and subjective assessment of a virtual reality simulator platform was influenced by changing force feedback devices. DESIGN Participants used the NeuroVR (formerly NeuroTouch) simulator to perform 5 practice scenarios and a realistic scenario involving subpial resection of a virtual reality brain tumor with simulated bleeding. The influence of force feedback was assessed by utilizing the Omni and Entact haptic systems. Tier 1, tier 2, and tier 2 advanced metrics were used to compare results. Operator subjective assessment of the haptic systems tested utilized seven Likert criteria (score 1 to 5). SETTING The study is carried out at the McGill Neurosurgical Simulation Research and Training Centre, Montreal Neurological Institute and Hospital, Montreal, Canada. PARTICIPANTS Six expert operators in the utilization of the NeuroVR simulator platform. RESULTS No significant differences in surgical performance were found between the two haptic devices. Participants significantly preferred the Entact system on all 7 Likert criteria of subjective assessment. CONCLUSIONS Our results show no statistical differences in virtual reality surgical performance utilizing the two bimanual haptic devices tested. Subjective assessments demonstrated that participants preferred the Entact system. Our results suggest that to maximize realism of the training experience educators employing virtual reality simulators may find it useful to assess expert opinion before choosing a force feedback device.
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Affiliation(s)
- Abdulgadir Bugdadi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah Almukarramah, Saudi Arabia.
| | - Robin Sawaya
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Khalid Bajunaid
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Duaa Olwi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Ibrahim Marwa
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Ghusn Alsideiri
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdulrahman Jafar Sabbagh
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad E Alotaibi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gmaan Al-Zhrani
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rolando Del Maestro
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
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Bugdadi A, Sawaya R, Olwi D, Al-Zhrani G, Azarnoush H, Sabbagh AJ, Alsideiri G, Bajunaid K, Alotaibi FE, Winkler-Schwartz A, Del Maestro R. Automaticity of Force Application During Simulated Brain Tumor Resection: Testing the Fitts and Posner Model. J Surg Educ 2018; 75:104-115. [PMID: 28684100 DOI: 10.1016/j.jsurg.2017.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/12/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Fitts and Posner model of motor learning hypothesized that with deliberate practice, learners progress through stages to an autonomous phase of motor ability. To test this model, we assessed the automaticity of neurosurgeons, senior residents, and junior residents when operating on 2 identical tumors using the NeuroVR virtual reality simulation platform. DESIGN Participants resected 9 identical simulated tumors on 2 occasions (total = 18 resections). These resections were separated by the removal of a variable number of tumors with different visual and haptic complexities to mirror neurosurgical practice. Consistency of force application was used as a metric to assess automaticity and was defined as applying forces 1 standard deviation above or below a specific mean force application. Amount and specific location of force application during second identical tumor resection was compared to that used for the initial tumor. SETTING This study was conducted at the McGill Neurosurgical Simulation Research and Training Center, Montreal Neurologic Institute and Hospital, Montreal, Canada. PARTICIPANTS Nine neurosurgeons, 10 senior residents, and 8 junior residents. RESULTS Neurosurgeons display statistically significant increased consistency of force application when compared to resident groups when results from all tumor resections were assessed. Assessing individual tumor types demonstrates significant differences between the neurosurgeon and resident groups when resecting hard stiffness similar-to-background (white) tumors and medium-stiffness tumors. No statistical difference in consistency of force application was found when junior and senior residents were compared. CONCLUSION "Experts" display significantly more automaticity when operating on identical simulated tumors separated by a series of different tumors using the NeuroVR platform. These results support the Fitts and Posner model of motor learning and are consistent with the concept that automaticity improves after completing residency training. The potential educational application of our findings is outlined related to neurosurgical resident training.
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Affiliation(s)
- Abdulgadir Bugdadi
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine,Umm Al-Qura University, Makkah Almukarramah, Saudi Arabia.
| | - Robin Sawaya
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Duaa Olwi
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Gmaan Al-Zhrani
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hamed Azarnoush
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Biomedical Engineering, Amirkabir University of Technology, Tehran Polytechnic, Tehran, Iran
| | - Abdulrahman Jafar Sabbagh
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghusn Alsideiri
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Khalid Bajunaid
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, University of Jeddah, Jeddah, Saudi Arabia
| | - Fahad E Alotaibi
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alexander Winkler-Schwartz
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Rolando Del Maestro
- Department of Neurosurgery and Neurology, Neurosurgical Simulation Research and Training Centre, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Sawaya R, Bugdadi A, Azarnoush H, Winkler-Schwartz A, Alotaibi FE, Bajunaid K, AlZhrani GA, Alsideiri G, Sabbagh AJ, Del Maestro RF. Virtual Reality Tumor Resection: The Force Pyramid Approach. Oper Neurosurg (Hagerstown) 2017; 14:686-696. [DOI: 10.1093/ons/opx189] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The force pyramid is a novel visual representation allowing spatial delineation of instrument force application during surgical procedures. In this study, the force pyramid concept is employed to create and quantify dominant hand, nondominant hand, and bimanual force pyramids during resection of virtual reality brain tumors.
OBJECTIVE
To address 4 questions: Do ergonomics and handedness influence force pyramid structure? What are the differences between dominant and nondominant force pyramids? What is the spatial distribution of forces applied in specific tumor quadrants? What differentiates “expert” and “novice” groups regarding their force pyramids?
METHODS
Using a simulated aspirator in the dominant hand and a simulated sucker in the nondominant hand, 6 neurosurgeons and 14 residents resected 8 different tumors using the CAE NeuroVR virtual reality neurosurgical simulation platform (CAE Healthcare, Montréal, Québec and the National Research Council Canada, Boucherville, Québec). Position and force data were used to create force pyramids and quantify tumor quadrant force distribution.
RESULTS
Force distribution quantification demonstrates the critical role that handedness and ergonomics play on psychomotor performance during simulated brain tumor resections. Neurosurgeons concentrate their dominant hand forces in a defined crescent in the lower right tumor quadrant. Nondominant force pyramids showed a central peak force application in all groups. Bimanual force pyramids outlined the combined impact of each hand. Distinct force pyramid patterns were seen when tumor stiffness, border complexity, and color were altered.
CONCLUSION
Force pyramids allow delineation of specific tumor regions requiring greater psychomotor ability to resect. This information can focus and improve resident technical skills training.
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Affiliation(s)
- Robin Sawaya
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
| | - Abdulgadir Bugdadi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah Almukarramah, Saudi Arabia
| | - Hamed Azarnoush
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
| | - Fahad E Alotaibi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Bajunaid
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Saudi Arabia
| | - Gmaan A AlZhrani
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ghusn Alsideiri
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdulrahman J Sabbagh
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine and Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rolando F Del Maestro
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
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Bajunaid K, Mullah MAS, Winkler-Schwartz A, Alotaibi FE, Fares J, Baggiani M, Azarnoush H, Christie S, Al-Zhrani G, Marwa I, Sabbagh AJ, Werthner P, Del Maestro RF. Impact of acute stress on psychomotor bimanual performance during a simulated tumor resection task. J Neurosurg 2017; 126:71-80. [DOI: 10.3171/2015.5.jns15558] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Severe bleeding during neurosurgical operations can result in acute stress affecting the bimanual psychomotor performance of the operator, leading to surgical error and an adverse patient outcome. Objective methods to assess the influence of acute stress on neurosurgical bimanual psychomotor performance have not been developed. Virtual reality simulators, such as NeuroTouch, allow the testing of acute stress on psychomotor performance in risk-free environments. Thus, the purpose of this study was to explore the impact of a simulated stressful virtual reality tumor resection scenario by utilizing NeuroTouch to answer 2 questions: 1) What is the impact of acute stress on bimanual psychomotor performance during the resection of simulated tumors? 2) Does acute stress influence bimanual psychomotor performance immediately following the stressful episode?
METHODS
Study participants included 6 neurosurgeons, 6 senior and 6 junior neurosurgical residents, and 6 medical students. Participants resected a total of 6 simulated tumors, 1 of which (Tumor 4) involved uncontrollable “intraoperative” bleeding resulting in simulated cardiac arrest and thus providing the acute stress scenario. Tier 1 metrics included extent of blood loss, percentage of tumor resected, and “normal” brain tissue volume removed. Tier 2 metrics included simulated suction device (sucker) and ultrasonic aspirator total tip path length, as well as the sum and maximum forces applied in using these instruments. Advanced Tier 2 metrics included efficiency index, coordination index, ultrasonic aspirator path length index, and ultrasonic aspirator bimanual forces ratio. All metrics were assessed before, during, and after the stressful scenario.
RESULTS
The stress scenario caused expected significant increases in blood loss in all participant groups. Extent of tumor resected and brain volume removed decreased in the junior resident and medical student groups. Sucker total tip path length increased in the neurosurgeon group, whereas sucker forces increased in the senior resident group. Psychomotor performance on advanced Tier 2 metrics was altered during the stress scenario in all participant groups. Performance on all advanced Tier 2 metrics returned to pre-stress levels in the post–stress scenario tumor resections.
CONCLUSIONS
Results demonstrated that acute stress initiated by simulated severe intraoperative bleeding significantly decreases bimanual psychomotor performance during the acute stressful episode. The simulated intraoperative bleeding event had no significant influence on the advanced Tier 2 metrics monitored during the immediate post-stress operative performance.
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Affiliation(s)
- Khalid Bajunaid
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 2Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah
| | | | - Alexander Winkler-Schwartz
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Fahad E. Alotaibi
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 5National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City
| | - Jawad Fares
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Marta Baggiani
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Hamed Azarnoush
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 7Department of Biomedical Engineering, Tehran Polytechnic, Tehran, Iran
| | - Sommer Christie
- 4University of Calgary, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Gmaan Al-Zhrani
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 5National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City
| | - Ibrahim Marwa
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
| | - Abdulrahman Jafar Sabbagh
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
- 5National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City
- 6Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; and
| | - Penny Werthner
- 4University of Calgary, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Rolando F. Del Maestro
- 1Neurosurgical Simulation Research and Training Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital
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14
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Winkler-Schwartz A, Bajunaid K, Mullah MAS, Marwa I, Alotaibi FE, Fares J, Baggiani M, Azarnoush H, Zharni GA, Christie S, Sabbagh AJ, Werthner P, Del Maestro RF. Bimanual Psychomotor Performance in Neurosurgical Resident Applicants Assessed Using NeuroTouch, a Virtual Reality Simulator. J Surg Educ 2016; 73:942-953. [PMID: 27395397 DOI: 10.1016/j.jsurg.2016.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/01/2016] [Accepted: 04/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Current selection methods for neurosurgical residents fail to include objective measurements of bimanual psychomotor performance. Advancements in computer-based simulation provide opportunities to assess cognitive and psychomotor skills in surgically naive populations during complex simulated neurosurgical tasks in risk-free environments. This pilot study was designed to answer 3 questions: (1) What are the differences in bimanual psychomotor performance among neurosurgical residency applicants using NeuroTouch? (2) Are there exceptionally skilled medical students in the applicant cohort? and (3) Is there an influence of previous surgical exposure on surgical performance? DESIGN Participants were instructed to remove 3 simulated brain tumors with identical visual appearance, stiffness, and random bleeding points. Validated tier 1, tier 2, and advanced tier 2 metrics were used to assess bimanual psychomotor performance. Demographic data included weeks of neurosurgical elective and prior operative exposure. SETTING This pilot study was carried out at the McGill Neurosurgical Simulation Research and Training Center immediately following neurosurgical residency interviews at McGill University, Montreal, Canada. PARTICIPANTS All 17 medical students interviewed were asked to participate, of which 16 agreed. RESULTS Performances were clustered in definable top, middle, and bottom groups with significant differences for all metrics. Increased time spent playing music, increased applicant self-evaluated technical skills, high self-ratings of confidence, and increased skin closures statistically influenced performance on univariate analysis. A trend for both self-rated increased operating room confidence and increased weeks of neurosurgical exposure to increased blood loss was seen in multivariate analysis. CONCLUSIONS Simulation technology identifies neurosurgical residency applicants with differing levels of technical ability. These results provide information for studies being developed for longitudinal studies on the acquisition, development, and maintenance of psychomotor skills. Technical abilities customized training programs that maximize individual resident bimanual psychomotor training dependant on continuously updated and validated metrics from virtual reality simulation studies should be explored.
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Affiliation(s)
- Alexander Winkler-Schwartz
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - Khalid Bajunaid
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Muhammad A S Mullah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Ibrahim Marwa
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Fahad E Alotaibi
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute (NNI), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Jawad Fares
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Marta Baggiani
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Hamed Azarnoush
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Gmaan Al Zharni
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute (NNI), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Sommer Christie
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Abdulrahman J Sabbagh
- Section of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (Gen. Org) - Jeddah Branch, Jeddah, Saudi Arabia
| | - Penny Werthner
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Rolando F Del Maestro
- Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Alotaibi FE, AlZhrani GA, Mullah MAS, Sabbagh AJ, Azarnoush H, Winkler-Schwartz A, Del Maestro RF. Assessing bimanual performance in brain tumor resection with NeuroTouch, a virtual reality simulator. Neurosurgery 2015; 11 Suppl 2:89-98; discussion 98. [PMID: 25599201 DOI: 10.1227/neu.0000000000000631] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Validated procedures to objectively measure neurosurgical bimanual psychomotor skills are unavailable. The NeuroTouch simulator provides metrics to determine bimanual performance, but validation is essential before implementation of this platform into neurosurgical training, assessment, and curriculum development. OBJECTIVE To develop, evaluate, and validate neurosurgical bimanual performance metrics for resection of simulated brain tumors with NeuroTouch. METHODS Bimanual resection of 8 simulated brain tumors with differing color, stiffness, and border complexity was evaluated. Metrics assessed included blood loss, tumor percentage resected, total simulated normal brain volume removed, total tip path lengths, maximum and sum of forces used by instruments, efficiency index, ultrasonic aspirator path length index, coordination index, and ultrasonic aspirator bimanual forces ratio. Six neurosurgeons and 12 residents (6 senior and 6 junior) were evaluated. RESULTS Increasing tumor complexity impaired resident bimanual performance significantly more than neurosurgeons. Operating on black vs glioma-colored tumors resulted in significantly higher blood loss and lower tumor percentage, whereas altering tactile cues from hard to soft decreased resident tumor resection. Regardless of tumor complexity, significant differences were found between neurosurgeons, senior residents, and junior residents in efficiency index and ultrasonic aspirator path length index. Ultrasonic aspirator bimanual force ratio outlined significant differences between senior and junior residents, whereas coordination index demonstrated significant differences between junior residents and neurosurgeons. CONCLUSION The NeuroTouch platform incorporating the simulated scenarios and metrics used differentiates novice from expert neurosurgical performance, demonstrating NeuroTouch face, content, and construct validity and the possibility of developing brain tumor resection proficiency performance benchmarks.
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Affiliation(s)
- Fahad E Alotaibi
- *Neurosurgical Simulation Research Center, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; ‡Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; §Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; ¶Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia; ‖Department of Biomedical Engineering, Tehran Polytechnic, Tehran, Iran
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Abstract
Chordomas are rare, locally aggressive skull base neoplasms known for local recurrence and not-infrequent treatment failure. Current evidence supports the role of maximal safe surgical resection. In addition to open skull-base approaches, the endoscopic endonasal approach to clival chordomas has been reported with favorable albeit early results. Adjuvant radiation is prescribed following complete resection, alternatively for gross residual disease or at the time of recurrence. The modalities of adjuvant radiation therapy reported vary widely and include proton-beam, carbon-ion, fractionated photon radiotherapy, and photon and gamma-knife radiosurgery. As of now, no direct comparison is available, and high-level evidence demonstrating superiority of one modality over another is lacking. While systemic therapies have yet to form part of any first-line therapy for chordomas, a number of targeted agents have been evaluated to date that inhibit specific molecules and their respective pathways known to be implicated in chordomas. These include EGFR (erlotinib, gefitinib, lapatinib), PDGFR (imatinib), mTOR (rapamycin), and VEGF (bevacizumab). This article provides an update of the current multimodality treatment of cranial base chordomas, with an emphasis on how current understanding of molecular pathogenesis provides a framework for the development of novel targeted approaches.
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Affiliation(s)
- Salvatore Di Maio
- Division of Neurosurgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gmaan A Al Zhrani
- National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia ; Department of Neurology and Neurosurgery, The Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Fahad E Alotaibi
- National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia ; Department of Neurology and Neurosurgery, The Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Abdulrahman Al Turki
- National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia ; Department of Neurology and Neurosurgery, The Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Esther Kong
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robert C Rostomily
- Department of Neurological Surgery, University of Washington, University of Washington Medical Center, Seattle, WA, USA
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Alotaibi FE, AlZhrani GA, Sabbagh AJ, Azarnoush H, Winkler-Schwartz A, Del Maestro RF. Neurosurgical Assessment of Metrics Including Judgment and Dexterity Using the Virtual Reality Simulator NeuroTouch (NAJD Metrics). Surg Innov 2015; 22:636-42. [DOI: 10.1177/1553350615579729] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Advances in computer-based technology has created a significant opportunity for implementing new training paradigms in neurosurgery focused on improving skill acquisition, enhancing procedural outcome, and surgical skills assessment. NeuroTouch is a computer-based virtual reality system that can generate output data known as metrics from operator performance during simulated brain tumor resection. These measures of quantitative assessment are used to track and compare psychomotor performance during simulated operative procedures. Data output from the NeuroTouch system is recorded in a comma-separated values file. Data mining from this file and subsequent metrics development requires the use of sophisticated software and engineering expertise. In this article, we introduce a system to extract a series of new metrics using the same data file using Excel software. Based on the data contained in the NeuroTouch comma-separated values file, 13 novel NeuroTouch metrics were developed and classified. Tier 1 metrics include blood loss, tumor percentage resected, and total simulated normal brain volume removed. Tier 2 metrics include total instrument tip path length, maximum force applied, sum of forces utilized, and average forces utilized by the simulated ultrasonic aspirator and suction instrument along with pedal activation frequency of the ultrasonic aspirator. Advanced tier 2 metrics include instrument tips average separation distance, efficiency index, ultrasonic aspirator path length index, coordination index, and ultrasonic aspirator bimanual forces ratio. This system of data extraction provides researchers expedited access for analyzing the data files available for NeuroTouch platform to assess the multiple psychomotor and cognitive neurosurgical skills involved in complex surgical procedures.
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Affiliation(s)
- Fahad E. Alotaibi
- Montreal Neurological Institute and Hospital, McGill University, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gmaan A. AlZhrani
- Montreal Neurological Institute and Hospital, McGill University, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abulrahman J. Sabbagh
- Montreal Neurological Institute and Hospital, McGill University, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hamed Azarnoush
- Montreal Neurological Institute and Hospital, McGill University, Canada
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