Academically Inclined: Predictors of Early Career Trajectory and Avenues for Early Intervention Among Neurosurgery Trainees

BACKGROUND: The relationship of academic activities before and during neurosurgery residency with fellowship or career outcomes has not been studied completely. OBJECTIVE: To assess possible predictors of fellowship and career outcomes among neurosurgery residents. METHODS: US neurosurgery graduates (2018-2020) were assessed retrospectively for peer-reviewed citations of preresidency vs intraresidency publications, author order, and article type. Additional parameters included medical school, residency program, degree (MD vs DO; PhD), postgraduate fellowship, and academic employment. RESULTS: Of 547 neurosurgeons, 334 (61.1%) entered fellowships. Fellowship training was significantly associated with medical school rank and first-author publications. Individuals from medical schools ranked 1 to 50 were 1.6 times more likely to become postgraduate fellows than individuals from medical schools ranked 51 to 92 (odds ratio [OR], 1.63 [95% CI 1.04-2.56]; P = .03). Residents with ≥2 first-author publications were almost twice as likely to complete a fellowship as individuals with \u3c2 first-author publications (OR, 1.91 [95% CI 1.21-3.03]; P = .006). Among 522 graduates with employment data available, academic employment obtained by 257 (49.2%) was significantly associated with fellowship training and all publication-specific variables. Fellowship-trained graduates were twice as likely to pursue academic careers (OR, 1.99 [95% CI 1.34-2.96]; P \u3c .001) as were individuals with ≥3 first-author publications ( P \u3c .001), ≥2 laboratory publications ( P = .04), or ≥9 clinical publications ( P \u3c .001). CONCLUSION: Research productivity, medical school rank, and fellowships are independently associated with academic career outcomes of neurosurgeons. Academically inclined residents may benefit from early access to mentorship, sponsorship, and publishing opportunities

Volumetric 3-Dimensional Analysis of the Supraorbital vs Pterional Approach to Paramedian Vascular Structures: Comprehensive Assessment of Surgical Maneuverability

BACKGROUND: Both the pterional and supraorbital approaches have been proposed as optimal access corridors to deep and paramedian anatomy. OBJECTIVE: To assess key intracranial structures accessed through the surgical approaches using the angle of attack (AOA) and the volume of surgical freedom (VSF) methodologies. METHODS: Ten pterional and 10 supraorbital craniotomies were completed. Data points were measured using a neuronavigation system. A comparative analysis of the craniocaudal AOA, mediolateral AOA, and VSF of the ipsilateral paraclinoid internal carotid artery (ICA), terminal ICA, and anterior communicating artery (ACoA) complex was completed. RESULTS: For the paraclinoid ICA, the pterional approach produced larger craniocaudal AOA, mediolateral AOA, and VSF than the supraorbital approach (28.06° vs 10.52°, 33.76° vs 23.95°, and 68.73 vs 22.59 mm3 normalized unit [NU], respectively; P \u3c .001). The terminal ICA showed similar superiority of the pterional approach in all quantitative parameters (27.43° vs 11.65°, 30.62° vs 25.31°, and 57.41 vs 17.36 mm3 NU; P \u3c .05). For the ACoA, there were statistically significant differences between the results obtained using the pterional and supraorbital approaches (18.45° vs 10.11°, 29.68° vs 21.01°, and 26.81 vs 16.53 mm3 NU; P \u3c .005). CONCLUSION: The pterional craniotomy was significantly superior in all instrument maneuverability parameters for approaching the ipsilateral paraclinoid ICA, terminal ICA, and ACoA. This global evaluation of 2-dimensional and 3-dimensional surgical freedom and instrument maneuverability by amalgamating the craniocaudal AOA, mediolateral AOA, and VSF produces a comprehensive assessment while generating spatially and anatomically accurate corridor models that provide improved visual depiction for preoperative planning and surgical decision-making