Second surgery for progressive glioblastoma: a multi-centre questionnaire and cohort-based review of clinical decision-making and patient outcomes in current practice.

PURPOSE: Glioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. METHODS: Current practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. RESULTS: 234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p = 0.874). CONCLUSIONS: This is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

Academic Productivity of Neurosurgeons Working in the United Kingdom: Insights from the H-Index and Its Variants.

OBJECTIVES: Academic metrics can be used to compare the productivity of researchers. We aimed to use a variety of bibliometric parameters to assess the productivity of neurosurgeons working in the United Kingdom. METHODS: Neurosurgical consultants working in the United Kingdom were identified using the Society of British Neurosurgeons' Audit Programme website. Baseline data collected included year of entry to specialist register, academic position and award of higher degree. Google Scholar was used to compute a range of academic metrics for each consultant including the h-index, hi-norm, e-index and g-index. Non-parametric tests were used to compare median results. RESULTS: Median metrics for the whole cohort were: h-index (5), hi-norm (3), g-index (10.4) and e-index (9). The top 3 units based on h-index were Addenbrookes (13), Great Ormond Street (12.5) and Queen's Square (11.5). The h-index correlated with academic position [Prof (17.5), Senior Lecturer (10.5) and non-academic (5); P < 0.0001], higher degree [PhD (10), MD (6) and none (4.5); P < 0.0001] and consultant experience [> 10 year (7), < 10 years (4); P < 0.0001]. No difference was found based on gender [male (5), female (4); P = 0.12]. The same trends were seen across the following other metrics: hi-norm, e-index and g-index. DISCUSSION: This study details the academic impact of United Kingdom-based neurosurgeons through the analysis of a number of citation metrics. It provides a benchmark bibliometric profile and we advocate future comparative assessments as a means to assess impact of and guide academic policy.