Expertise in surgical neuro-oncology. Results of a survey by the EANS neuro-oncology section

Introduction: Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology. Research question: The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful. Material and methods: The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members. Results: Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents’ opinions. Discussion and conclusion: Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible

Rentabilidade da cultura da macieira cultivar Gala em duas densidades de plantio Investment return for Gala apple cultivar using two planting densities

O presente trabalho discute, com base em um estudo de caso, a viabilidade econômica de ampliar a densidade de plantio de macieiras cultivar Gala de 1.000 plantas por hectare para 3.378 plantas por hectare. Os resultados mostraram que a taxa interna de retorno não variou (próxima de 1,61% ao mês), independentemente da densidade utilizada, o que sugere o uso da menor densidade de plantio, uma vez que esta requer um menor volume de recursos financeiros. O custo unitário de produção também se mantém praticamente o mesmo ao se variar a densidade de plantio.<br>The present study was carried out to analyse economic performances of Gala apple orchards at different planting densities. Two orchard densities (1,000 and 3,378 plants/ha) were evaluated in an orchard near Fraiburgo, SC, Brazil. The use of both planting densities resulted in the same internal rate of return (approximately 1.6% a month). It is suggested to use a lower planting system, once it requires less capital. Unit cost also remained the same for both planting densities used in this study

Management of cranial deformity following ventricular shunting

Purpose: Ventricular shunt-induced craniosynostosis is a widely recognised cause of secondary craniosynostosis. We reviewed the management and long-term outcome of the cases of cranial deformity post cerebrospinal fluid shunting in our unit and compared these with previously published series. Methods: The Australian Craniofacial Unit and Department of Neurosurgery database was searched to identify cases of ventricular shunt-induced cranial deformity and a case note review was undertaken. Results: Eight cases were identified, and all were shunted within 6 months of birth. Our patients required shunting with a low pressure valve for hydrocephalus secondary to either aqueduct stenosis or intraventricular haemorrhage. The diagnosis was made following computed tomography (CT) three-dimensional surface reconstruction of the skull. Two cases of confirmed suture fusion were treated with cranial vault remodelling and programmable shunt insertion. In six cases, the sutures were not completely fused on the CT images despite a scaphocephalic head shape. These patients were managed conservatively with close monitoring. Conclusion: Cranial vault remodelling together with insertion of programmable shunt valve is indicated in CT confirmed cases of secondary craniosynostosis.X. Doorenbosch, C. J. Molloy, D. J. David, S. Santoreneos and P. J. Anderso