Evolution of the meta-neurosurgeon: A systematic review of the current technical capabilities, limitations, and applications of augmented reality in neurosurgery.

Background: Augmented reality (AR) applications in neurosurgery have expanded over the past decade with the introduction of headset-based platforms. Many studies have focused on either preoperative planning to tailor the approach to the patient's anatomy and pathology or intraoperative surgical navigation, primarily realized as AR navigation through microscope oculars. Additional efforts have been made to validate AR in trainee and patient education and to investigate novel surgical approaches. Our objective was to provide a systematic overview of AR in neurosurgery, provide current limitations of this technology, as well as highlight several applications of AR in neurosurgery. Methods: We performed a literature search in PubMed/Medline to identify papers that addressed the use of AR in neurosurgery. The authors screened three hundred and seventy-five papers, and 57 papers were selected, analyzed, and included in this systematic review. Results: AR has made significant inroads in neurosurgery, particularly in neuronavigation. In spinal neurosurgery, this primarily has been used for pedicle screw placement. AR-based neuronavigation also has significant applications in cranial neurosurgery, including neurovascular, neurosurgical oncology, and skull base neurosurgery. Other potential applications include operating room streamlining, trainee and patient education, and telecommunications. Conclusion: AR has already made a significant impact in neurosurgery in the above domains and has the potential to be a paradigm-altering technology. Future development in AR should focus on both validating these applications and extending the role of AR.

Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy.

Background: The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus is one of the most common life-saving procedures that neurosurgeons perform worldwide. There are many well-known complications associated with EVD placement, including tract hemorrhages, intra-parenchymal and subdural hemorrhages, infection, and catheter misplacement. Given the variety of complications associated with EVD placement and the inconsistent findings on the relationship of accuracy to complications, the present study reviewed short- and long-term complications related to EVD placement at our institution. Methods: A retrospective review was conducted for all consecutive patients who underwent bedside EVD placement for any indication between December 2020 and December 2021. Collected variables included demographic information, etiology of disease state, pre-and post-operative head computed tomography measurements, and post-procedural metrics (immediate and delayed complications). Results: A total of 124 patients qualified for inclusion in our study. EVDs that were non-functioning/exchanged were not significantly related to age, accuracy, ventriculomegaly, sex, disposition, laterality, type of EVD used, intraventricular hemorrhage (IVH), etiology, or Kakarla Grade (KG) (all P > 0.17). The need for a second EVD was similarly not related to age, accuracy, ventriculomegaly, sex, disposition, location, laterality, type of EVD used, IVH, etiology, or KG (all P > 0.130). Patients who died, however, were significantly more likely to have a second contralateral EVD placed (18.2% vs. 4.9% P = 0.029). We also found that left-sided EVDs were significantly more likely to fail within seven days of placement (29.4% vs 13.3%, P = 0.037; relative risk (RR) 1.93, 95% confidence interval: 1.09-3.43), unrelated to age, sex, etiology, type of EVD, IVH, location of the procedure, or accuracy (all P > 0.07). This remained significant when using a binary logistic regression to control for ventriculomegaly, accuracy, mortality, age, sex, and etiology (P = 0.021, B = 3.43). Conclusion: In our cohort, although a clear relationship between inaccuracy and complication rates was not found, our data did demonstrate that left-sided EVDs were more likely to fail within the immediate postoperative time point, and patients who died were more likely to have a second, contralateral EVD placed.

A Coach-Delivered Dating Violence Prevention Program: Coach Perspectives on Implementation.

Coaching Boys into Men (CBIM), an evidence-based violence prevention program, utilizes the coach-athlete relationship to deliver information about healthy, respectful relationships to adolescent boys involved in athletics. Although CBIM has demonstrated effectiveness in clinical research trials, its implementation outside of an effectiveness study has not been explored. The purpose of this current study was to explore facilitators and barriers of effective implementation in community settings using experiences from one regional implementation in Southwestern Pennsylvania. Head coaches who implemented CBIM from 2017-2018 seasons (n = 35) were contacted and 22 (63%) agreed to participate. Coaches were asked how they delivered CBIM to their team, what aided the process, barriers to facilitation, and their overall thoughts on CBIM implementation. Interviews were structured to uncover specific information regarding implementation while also providing time and space for coaches to voice their suggestions and opinions. Interviews were coded using descriptive content analysis. Key facilitators to implementation were involvement of violence prevention advocates, athletic directors, assistant coaches, and players and having flexibility to integrate current events to emphasize topics covered in CBIM. Observed improvements in bystander intervention behaviors and better attitudes towards women and girls among athletes were key motivators for coaches to continue the program. Main barriers were inconsistencies in time available to discuss topics with players and need to refresh curriculum content over multiple seasons. Coaches identified components necessary for broader and sustained implementation of this evidence-based violence prevention intervention in community settings. Coaches' confidence in delivering program content can be bolstered with appropriate strategies in place to address barriers. As coaches witness positive impacts among their athletes, these successes contribute to coaches recognizing their role in transforming sports into a platform for community-wide violence prevention.