Neurosurgery Fact of the day

@siemionowkris @MostlyMonkey This is for device innovation and not generalizable to the profession.

@MostlyMonkey Most people don’t understand how top surgeons make money, and it’s not surgery, it’s royalties. You can search public database. Here is one neurosurgeon making $16m year after year afer year

Top lawyers are a far more.elite group than neurosurgeons. The difference is that the selection is less legible and more gradual. The 170 lsat (call it top 3% of college grads) is just the start of a 20 year-long process that screens out the vast majority of the remainder.

A wonderful read for young neurosurgeons

The literature has consistently supported that a retro odontoid pannus will regress over time with atlantoaxial fixation and fusion. On rare occasion, compressive cysts can accompany the pannus, leading to progressive myelopathy. The literature is not as clear in this setting regarding the timing of cyst regression after fusion. There are times when it is necessary to think outside the box in order to rapidly get the patient’s cord out of trouble, providing a direct & immediate decompression. In this surgical video and manuscipt, we detail our posterior transdural approach for resecting a retro-odontoid cyst causing neurological decline. Many thanks to Mark Shornak for his complementary illustrations. thejns.org/caselessons/vi… @TheJNS @AANSNeuro @spinesection @uncneuro @unc_neurorads @UNCneurosurgery

My latest for AAOx2 An illustrative example of a major undiscussed problem

In 1980, DeBakey operated on the Shah of Iran. He declares success. Soon, the patient is dead. Reoperation is psychologically brutal: how bias delay truth & what might save us from the same trap. leezhaomd.org/post/the-secon… #MedTwitter #Surgery #MedEd

@drs462 @DrDiGiorgio youtube.com/watch?v=CzewIn…

@DrDiGiorgio I remember rotating on NSG as an ortho intern and the junior NSG resident carried 3 pagers, including the consult pager (AKA “the gimp”). Those things went off constantly and nobody envied that resident

One person's personal bias doesn't mean 24h shifts aren't useful. Just to counter this, I'm extremely grateful for my 24h shifts in medical school and residency. It absolutely helped me prepare, honed my ability to traige while exhausted, and made me a better doctor. Oh, and 1-2x pages per hour is extremely low. Many neurosurgery residents get paged every 90 seconds for 24 hours straight. After that experience, there is literally no middle of the night phone call that a neurosurgeon can't handle.

I had a chance to review the reasoning and math shared by Arianna Konstantopoulous, @cchildersmd and @drdevirgilio My thoughts below:

And the award for the most interesting case at the Mortality Morbidity Neuroendovascular Meeting goes to… Has anyone experienced something similar?

I compiled this flow chart based on the most recent clinical guidelines for spinal trauma. It includes when to operate immediately, when it’s OK to observe, and some important ICU-level management regarding perfusion pressure and arterial pressure. Clinical guidelines are very important for us to be able to have a uniform understanding of what’s considered a surgical emergency versus something that can be monitored. As of right now this is what the most recent data tells us.

Great example of mesial temporal sclerosis following a temporal lobectomy. Atrophic and rubbery, but great cross sectional anatomy! #epilepsy @CwruEpilepsy @UHCLENeurosurg @UHhospitals

@STateshimaMD @S_Pesch @CarlosC74716941

Recently tried the 7Fr radial balloon guide PATH catheter by Crossroads Neurovascular and encountered a radial loop. Radial loops are present in 1-2% of the population. They can be reduced, though often it is painful in the awake patient.

SAH case with no aneurysm. The key? Not a positive finding - a negative one. After proper angling & longer injection, proximal PICA showed up. Distal portion occluded from dissection. Treated with PAO. Patient did well with partial Wallenberg. Always look for what's not there.

@DutchRojas Maybe venous sinus stenting will join this trend soon

Bariatric surgery volume is down 33% in 24 months. What other procedures are being done less due to GLP-1’s?

Diagnosing/localizing CSF leak is harder than treating. But transdural repair for ventral bone spur is beautiful, technical surgery March 2025 @StrokeBern series showed no diff bw suture and patch, though I like both @NeurosurgeryCNS PMID 39132996 @WouterSchievink @tdobrocky

One of the hardest tumors I’ve tackled in a long time. 2 year-old male presents with vision loss and sleepiness. Biopsy shows adamantinomatous craniopharyngioma. Subfrontal approach. Encasing every major neurovascular structure of the skull base. Was able to take it back to the hypothalamus, the chiasm, and dissect off the nerves and vessels. Likely stage 2 transcallosal from the top needed. Thinking about toci/avastin. Thoughts? @PhxChildrens @BarrowNeuro

@chenjared @cvsection @AANSNeuro @CNS_Update @StrokeAHA_ASA @UTHealthStroke @UTHNeuro @chenjared It would be interesting to know what the respondents did before ENRICH. ENRICH does not support evacuation of basal ganglia hemorrhages.

@georgetolisjr I have been following @georgetolisjr posts for a while. Would very much enjoy listening to him on the nsgy podcSt @JPGK_MD

There are very reputable institutions that routinely book cases following that pattern to this date.Their outcomes are advertised as among best in the country setting a benchmark the rest of us try to emulate.Their surgeons are sitting this conversation out, for obvious reasons…

@independentMDs Neither. Continue the hiring search

Which surgeon would you choose as new partner:

01/02 I'm asking for a friend: what do you think these spots are that you see during embolization with Onyx of a chronic subdural hematoma? Respond to the survey below and leave a comment. #MMAe #subduralhematoma #neurosurgery #Onyx #endovascular #INR #endovascularneurosurgery