神经外科教学中虚拟现实技术、Seminar模式应用

目的探讨神经外科教学中虚拟现实技术、Seminar模式的应用效果。方法选取本院2014级临床专业实习学生24人,随机选取12人作为对照组,采用传统教学法;12人为观察组,采用虚拟现实技术、Seminar模式教学法。比较两组学生的病理分析能力,多学科协作能力,临床操作能力。结果观察组理论考试和操作考试评分分别为(84.5±3.9)分、(86.3±2.7)分,对照组分别为(80.2±2.8)分、(80.0±2.1)分,观察组理论考试和操作考试评分均高于对照组(P<0.05)。观察组病情分析、临床操作、手术胜任和多学科协作能力评分分别为(1.8±0.7)分、(1.7±0.5)分、(1.6±0.4)分、(1.5±0.5)分;对照组分别为(1.2±0.4)分、(1.1±0.2)分、(1.0±0.3)分、(1.1±0.2)分,观察组病情分析、临床操作、手术胜任和多学科协作能力评分均高于对照组(P<0.05)。结论虚拟现实技术、Seminar模式教学法联合应用提高学生的学习主动性、理论知识水平和实践技能操作水平,提高了神经外科教学效果。     

影像后处理技术在神经外科教学查房中的应用

目的  评价以问题为基础的教学法(problem-based learning,PBL)联合影像后处理技术在神经外科教学查房中的应用效果。方法  选择神经外科典型病例，以病例为基础，以问题为导向布置课前预习内容，联合影像后处理技术在教学查房中以导向问题为主线实施教学培训，与传统教学方法相比评价教学效果。结果  PBL联合影像后处理技术教学查房模式和传统讲授教学查房模式的学员理论考试成绩分别为92.53±2.17分、81.40±6.17分，临床诊疗考核成绩分别为91.10±1.97分、79.60±3.27分，P值分别为<0.001、<0.001，差异有统计学意义。接受PBL联合影像后处理技术教学模式的学员对教学方式的认可度、增加学习兴趣、利于神经科思维，P值分别为0.013、0.024、0.035。结论  PBL联合影像后处理技术可有效提高教学查房效果，帮助学员提高对基础知识的理解能力，抓住神经外科疾病的关键点加速神经外科诊疗思维能力的形成。     

Optic pathway tumor in children: Toward a new classification for neurosurgical use

ObjectOptic pathway tumors (OPT) represent a challenge for pediatric neurosurgeons. Role of surgery is debated due to the high risk of iatrogenic damage, and in lasts decades it lost its importance in favor of chemotherapy. However, in some cases surgery is necessary to make biomolecular and histological diagnosis, to manage intracranial hypertension (IH) and to cooperate with medical therapies in controlling tumor relapse. With the aim to standardize selection of surgical OPT cases, we propose a simple, practical and reproducible classification.MethodsWe retrospectively analyzed data of 38 patients with OPT treated at our institution (1990–2018). After careful analysis of MRI images, we describe a new classification system. Group 1: lesion limited to one or both optic nerve(s). Group 2: chiasmatic lesions extending minimally to hypothalamus. Group 3: hypothalamo-chiasmatic exophitic lesions invading the third ventricle; they can be further divided on the base of concomitant hydrocephalus. Group 4: hypothalamo-chiasmatic lesions extending widely in lateral direction, toward the temporal or the frontal lobes. Patients’ data and adopted treatment are reported and analyzed, also depending on this classification.ResultsTwenty children were operated on for treatment of OPT during the study period. Permanent clinical impairment was noted in 5 (25%) of operated patients, while visual improvement was noted in 1 patient. OS rate was 100% at 5 years, with a median follow up of 9 years (ranging from 2 to 23). Prevalence of intracranial hypertension and proportion of first-line surgical treatment decision were significantly higher in groups 3-4 compared to groups 1-2 (P < 0.001 for both tests).ConclusionSurgery can offer a valuable therapeutic complement for OPT without major risk of iatrogenic damage. Surgery is indispensable in cases presenting with IH, as in groups 3 and 4 lesions. Eligibility of patients to surgery can be based on this new classification system.     

神经外科住院患者人文关怀感知与护士关怀实践的对比研究

目的了解神经外科住院患者及护士对护士人文关怀的感知与评价差异,为更好地实施人文关怀护理服务提供参考。方法选取86例神经外科住院患者及92名神经外科护士作为研究对象,分别使用关怀行为量表进行问卷调查。结果患者与护士对护士人文关怀的总体评分分别为4.77±0.84、4.86±0.60,无统计学差异(P>0.05),双方均在“尊重患者”及“联系患者”2个维度评分较低。在“支持和保证”维度,患者对护士人文关怀的感知水平显著低于护士自评结果(P<0.01)。结论护患双方均对护士关怀行为的评价较好且双方在对护士关怀行为的整体认知上存在较高的一致度,但护士对患者心理层面的关怀相对不足,患者对护士在“支持和保证”相关关怀行为方面具有较高的期待。护士需要进一步改进与提升人文关怀质量。     

CTA三维重建结合外视镜在颅颈畸形教学中的应用

颅颈畸形手术涉及复杂的解剖变异,手术风险高,操作难度大,传统的教学方式受制于抽象的讲解,学习者很难对颅颈畸形解剖,手术方案及过程有直观的认识。本研究将CTA三维重建导航和术中外视镜操作技术引入颅颈畸形手术教学实践中,术前通过CTA三维重建在导航仪软件上了解颅颈畸形变异情况,规划手术方案。术中采用外视镜操作,所有学生戴上3D眼镜观看手术。将无法直观显示的、抽象的解剖结构以三维立体图像对学生进行展示。使传统被动抽象的教学方式变成直观形象生动的学习方式。增强了神经外科临床专业研究生对颅颈畸形手术解剖认识,提高了手术操作的积极性,缩短了培养时间。     

Anatomy and White Matter Connections of the Superior Frontal Gyrus

The superior frontal gyrus (SFG) is an important region implicated in a variety of tasks including motor movement, working memory, resting-state, and cognitive control. A detailed understanding of the subcortical white matter of the SFG could improve postoperative morbidity related to surgery around this gyrus. Through DSI-based fiber tractography validated by gross anatomical dissection, we characterized the fiber tracts of the SFG based on their relationships to other well-known neuroanatomic structures. Diffusion imaging from the Human Connectome Project from 10 healthy adult subjects was used for fiber tractography. We evaluated the SFG as a whole based on its connectivity with other regions. All tracts were mapped in both hemispheres, and a lateralization index was calculated based on resultant tract volumes. Ten cadaveric dissections were then performed using a modified Klingler technique to delineate the location of major tracts integrated within the SFG. We identified four major SFG connections: the frontal aslant tract connecting to the inferior frontal gyrus; the inferior fronto-occipital fasciculus connecting to the cuneus, lingual gyrus, and superior parietal lobule; the cingulum connecting to the precuneus and parahippocampal gyrus/uncus; and a callosal fiber bundle connecting the SFG bilaterally. The functional networks of the SFG involve a complex series of white matter tracts integrated within the gyrus, including the FAT, IFOF, cingulum, and callosal fibers. Postsurgical outcomes related to this region may be better understood in the context of the fiber-bundle anatomy highlighted in this study. Clin. Anat. 33:823–832, 2020. © 2019 Wiley Periodicals, Inc.     

Gender differences in NIH grant funding in neurological surgery

Research productivity is a vital component to an academic neurosurgeon’s career. We sought to evaluate gender differences in NIH funding among faculty in neurological surgery departments. NIH funding awarded to PIs of neurological surgery departments from 2014 to 2019 were obtained and analyzed for gender differences in funding trends, with attention to terminal degree and academic rank, as well as publication range in length of years and h-index. 79.4% of all NIH grants were awarded to male PIs, with the remaining 20.5% given to their female counterparts. Mean of the total NIH grants awarded to men was significantly higher at $1,796,684 (± Standard Error of Mean (SEM) $155,849, IQR: $1,759,250) compared to women at $1,151,968 (± SEM $137,914, IQR: $1,388,538) (P = 0.022). Mean NIH funding per grant for men was $365,760 (± SEM: $39,592, IQR: $189,692) and for women was $292,912 (± SEM: 28,239, IQR: $283,177). Differences in mean NIH funding per grant approached but did not reach statistical significance between men and women (P = 0.122). When stratified for academic rank, there was a significant difference in mean NIH funding per grant between men and women on the associate professor level (p < 0.005), with women exceeding men in funding at this academic level, with other academic ranks remaining non-significant. Overall, male neurosurgeons receive significantly more total NIH grant funding than their female counterparts, except at the level of associate professor where women were found to surpass men.