Gender disparity in neurosurgery: A multinational survey on gender-related career satisfaction.

Introduction: Women continue to be underrepresented in the majority of surgical specialties, including neurosurgery. Research question: In this multinational survey, we aimed to assess current gender disparities in neurosurgery focusing on job satisfaction and inequity/discrimination at work. Material and methods: Female and male members of the European Association of Neurosurgical Societies were asked to complete an electronic survey (Google Forms, Mountain View) containing demographic baseline data and questions on attitudes regarding gender disparity, personal experience with gender inequity and career satisfaction/work-life balance. Quantitative analyses were performed to analyse the responses, including summary and comparative statistics. Results: We received 168 responses from 40 different countries. Survey responders had a mean age of 40.8 â€‹± â€‹11.5 years; 29.8% were female. There were significant more male than female residents and attending surgeons per department. Eighty-eight percent of female and 38.1% of male responders experienced gender inequity or discrimination at work (adjusted OR 10.8, 95%CI 4.2-27.8, p<0.001). Female neurosurgeons were more likely to be discriminated by colleagues (aOR 4.32, 95%CI 2.1-9.1, p<0.001) and by patients/relatives (aOR 3.65, 95%CI 1.77-7.54, p<0.001). There was a trend towards lower job satisfaction (p=0.012), less satisfaction with career goals (p=0.035) and worse work-life balance (p=0.0021) in female surgeons. Discussion and conclusion: This survey underlines that a significant proportion of neurosurgeons - in particular females - continue to experience gender inequity & discrimination at work, which may translate into lower work-related satisfaction. A better understanding of the gender-related aspects of job satisfaction is an important step to improving gender equity in our profession.

Regeneration of nerve crush injury using adipose-derived stem cells: A multimodal comparison.

INTRODUCTION: To restore full function following nerve crush injuries is critical but challenging. In an attempt to develop a viable therapy, we evaluated the effect of rat adipose-derived stem cells (rASC) in 2 different settings of a sciatic crush injury model. METHODS: In the first group, after 14 days of nerve crush injury, rASCs were injected distal to the lesion under ultrasound guidance. In the other group, alleviation of compression through clip removal (CR) was combined with epineural injection of rASCs. Gait analyses, MRI, gastrocnemius muscle weight ratio (MWR), and histomorphometry were performed for outcome analysis. RESULTS: CR combined with rASC injection resulted in less muscle atrophy, as evidenced by MWR. These findings are further supported by better functional and anatomical outcomes. DISCUSSION: Animals treated with CR and epineural stem cell injection showed enhanced anatomical and functional recovery. Muscle Nerve 58: 566-572, 2018.

Epineural adipose-derived stem cell injection in a sciatic rodent model.

BACKGROUND: The aim was to evaluate the regenerative effect of epineural injection of rat ASCs (rASCs) in three different settings of acute and chronic compression in a rat sciatic nerve model. METHODS: Acute compression (60 s) with a vessel clamp over a distance of 1 mm (group 1) or 10 mm (group 2), as well as chronic compression with a permanent remaining, nonabsorbable polymeric clip over a distance of 1 mm (group 3) was performed. Depending on the group, either 5 × 106 rASCs or the same volume (25 µl) of culture medium (CM) was injected with a 30G needle in the epineurium at the time of compression. Outcome measures were functional gait evaluations, imaging analysis, histomorphometric analyses, and muscle weight. RESULTS: The rats in group 2 had a better function than those with group 1 at one and especially at 2 weeks. After 4 weeks however, almost all rats were close to a normal function. There was a similar Muscle Weight Ratio (MWR) after 2 weeks in all groups, whereas after 4 weeks, the MWR in group 3 was lower compared with group 1 and 2. Histomorphometric analysis showed a better myelination in group 1 & 2 compared to group 3 after 4 weeks. ASCs have a beneficial effect on myelin thickness (G-Ratio). CONCLUSIONS: We successfully evaluated the regenerative effect of epineural injection of rASCs in three different settings of acute and chronic compression. However, there were no significant differences in outcomes between the ASC-treated groups and control groups.

Shunts: Is Surgical Education Safe?

BACKGROUND: More data regarding complications in neurosurgery residents' cases are needed to assess patients' safety during hands-on surgical education. METHODS: A retrospective 2-center study was performed comparing consecutive patients undergoing shunt implantation by a supervised neurosurgery resident (teaching cases) versus a board-certified faculty neurosurgeon (nonteaching cases). The primary end point was surgical revision after shunting. Univariate and multivariate Cox proportional hazard models (Breslow method for ties) with time censored at 2 years were used to examine time-to-event data. Operation time, length of hospitalization, intracranial hemorrhage, and misplacement of the shunt catheter were other outcome measures to be compared between the groups. RESULTS: A total of 320 shunts (180 [56.3%] teaching and 140 [43.7%] nonteaching cases) with a mean follow-up of 563 ± 771 days (standard deviation) were analyzed. Revision rates for the entire cohort were 9.3% at 90 days, 13.3% at 6 months, 18.4% at 1 year, and 26.5% at 2 years. In univariate analysis, teaching cases were 96% as likely as nonteaching cases to be surgically revised (hazard ratio, 0.96; 95% confidence interval, 0.54-1.70; P = 0.877). In multivariate analysis adjusted for indication and shunt type, teaching cases were 94% as likely as nonteaching cases to undergo surgical revision (hazard ratio, 0.94; 95% confidence interval, 0.53-1.69; P = 0.847). There were no group differences in operation time, length of hospitalization, intracranial hemorrhage, and rates of shunt misplacement. CONCLUSIONS: The results of the current study in addition to the literature on neurosurgery resident training support the safety of supervised early surgical education for shunt surgery.