We present the case of a 2-year-old boy with progressive left-sided weakness and a cranial magnetic resonance imaging (MRI) scan showing a lesion with a cystic component in the right thalamus and basal ganglia. The lesion was subtotally resected and diagnosed as a pilocytic astrocytoma by histopathology. Tumor seeding along the surgical tract was seen on MRI 16 days and 10 weeks after surgery. The patient received vincristine and carboplatin, and MRI performed 4 months after chemotherapy revealed no additional or residual lesions. This case illustrated that a World Health Organization grade I astrocytoma could disseminate along the surgical tract.

Background: With the emergence of competency-based residency education (CBME) in Europe and North America, supervised operative experience is essential for residents to demonstrate competency in requisite neurosurgical procedures prior to board certification. This study explores the implications of such operative exposure to patient safety. Methods: Using a pro- and retrospectively maintained databank at two Swiss teaching hospitals, we compared complications, revision surgery rates, and outcome of consecutive patients undergoing lumbar microdiscectomy (n=102), lumbar decompression (n=471), anterior cervical discectomy and fusion (n=281), cranioplasty (n=240), shunt implantation (n=200), and epidural steroid injections (n=354) by a supervised resident versus a board-certified faculty neurosurgeon as primary surgeon using logistic regression. Results: Intra- (OR 0.68, 95%CI 0.33–1.41, p=0.305) and postoperative complications (OR 1.14, 95%CI 0.78–1.65, p=0.49), revision surgeries (OR 1.23, 95%CI 0.78–1.93, p=0.36), operating time (p=0.87), blood loss (p=0.57) and the likelihood to be considered treatment responder (OR 0.91, 95%CI 0.65–1.28, p=0.62) was similar for both groups. Specifics of European and Canadian neurosurgery training are compared and discussed. Conclusions: Hands-on surgical education within the framework of a structured residency-training program is safe in cervical and lumbar spine surgery and for standard cranial procedures. The summarized results in conjunction with the literature suggest that CBME in Europe and Northern America would not compromise patient safety.

Background: Despite increasing awareness of scientific fraud, no attempt has been made to assess its prevalence in neurosurgery. The aim of our review was to assess the chronological trend and reasons for the retraction of neurosurgical publications. Methods: We searched the EMBASE and MEDLINE databases using a comprehensive search strategy for retracted articles from January 1995 to December 2016. Archives of retracted articles on www.retractionwatch.com and the independent websites of neurosurgical journals were also searched. Data including the journal name and its impact factor, reason for retraction, country of origin, and citations were extracted. Results: A total of 72 studies were included for data extraction. Journal impact factor ranged from 0.24 to 14.4. Most studies(76%) were retracted within the last 5 years. The most common reason for retraction was because of a duplicated publication found elsewhere(25%), followed closely by plagiarism(21%), or falsifying data(17%). Other reasons included scientific errors/mistakes, author misattribution, and fraudulent peer review. Articles originated from several different countries and some were widely cited. Conclusions: Retractions of neurosurgical publications are increasing globally, mostly due to issues of academic integrity. Implementation of more transparent data sharing and screening as well as additional education for new researchers may help mitigate these issues moving forward.

Background: Trigeminal Neuralgia (TN) is rarely caused by a dolichoectatic vertebrobasilar artery (eVB) compression of the trigeminal nerve. These patients present a surgical challenge and are often not considered for microvascular decompression (MVD) due to assumed risk. We present our experience demonstrating the technique and outcomes of MVD in these patients. Methods: A retrospective chart review of patients who were surgically treated by the senior author between 1997 and 2016 with an admitting diagnosis of TN was performed. Patients with pre-operative neuroimaging demonstrating eVB compression of their trigeminal nerve root were included. Results: During the 20-year review, 552 patients underwent microvascular decompression for TN and 13 (2.4%) had dolichoectactic vertebrobasilar compressions (10 male, 3 female). The average hospital length of stay was 2.8 days (Range 2-7) with no major complications. At final follow-up (>2 years): 7 had no pain with no medications (78%), 2 had persistent pain (22%) – one of which underwent a successful glycerol rhizotomy at 8 months, 2 were lost to follow-up, and 2 had surgery within 2 years. Conclusions: Microvascular Decompression for Trigeminal Neuralgia caused by a dolichoectatic vertebrobasilar artery can be performed with a high rate of safety and success in the setting of a high case volume centre.

Background: Neurapraxia is considered to be a temporary disorder of peripheral nerve conduction due to trauma that does not cause axonopathy. However, patients with radiculopathy, confirmed by MRI, who may not have active axonal damage with evidence of spontaneous activity may still report transient give-way weaknesss. In the absence of active changes on intramuscular recording a neurophysiologic consultation may fail to substantiate any significant neurologic concern. This report documents and objectifies prone positioning-induced radicular neurapraxic weakness in an elderly man. Methods: An 83-year-old gentleman was referred for neuromuscular evaluation with regards to peripheral neuropathy. He had a history of low back pain and MRI evidence of multilevel DDD and discogenic neuroforaminal narrowing. Strength testing was performed by Biodex evaluation. Routine electrophysiologic assessments were performed. Results: On neurologic examination proximal strength iwas normal with grade 4 dorsiflexion strength. Stocking-glove loss to pinprick was absent. Preliminary objective testing of the right quadriceps revealed a peak torque of 87.1 Nm. Immediately after lying prone for 3 minutes (for paraspinal EMG), his power dropped to 33.7 Nm. Strength fully recovered by 36 hrs. Conclusions: This case documents evidence of a 61% reversible reduction in torque in the right quadriceps after prone lying. Electromyographers need to be cautious with radiculopathy patients during paraspinal testing.

Background: A well-constructed search strategy is an important feature of any systematic review. We aimed to design and validate electronic database (e.g. Pubmed) search strategies (i.e. a hedge or series of words used to identify articles of interest) for six neurological conditions. Methods: We enumerated 10311 consecutive articles in the 21 highest impact factor English-language general neurology journals. We constructed a simple hedge, limited to one keyword, for each condition. We also constructed a complex hedge using a series of MeSH terms and keywords. Two reviewers independently reviewed (confirmed by a third reviewer) all articles and established which condition(s) were the article’s subject. We calculated sensitivity/specificity estimates for the simple and complex hedges, and compared these using McNemar’s test. Results: The results are summarized in the Table. Conclusions: Our complex hedges for most conditions dramatically improve sensitivity without compromising specificity. This study will help improve the accuracy of search strategies in future systematic reviews.