The progression of diversity: Black women in neurosurgery

While diversity in organized medicine has undoubtedly improved, a disparity remains in the racial and gender makeup of its constituents. This disparity is not distributed equally among all specialties of practice. The surgical subspecialties exemplify this phenomenon by having large gaps between the number of women and racial/ethnic minorities compared to their majority counterparts. Pertaining to neurosurgery in the US, this gap is substantial, with women reaching minority status only within the last 2 years. Among international women in neurosurgery, Black women are even further underrepresented despite efforts in recent years to close the gender gap. The reason for this disparity is likely multifactorial, as Black women demonstrate a unique intersectionality as a minority in regard to both race and gender. In this study, the authors provide historical context for the current state of diversity in neurosurgery and the global strides made by Black women within the field. The authors report recurrent themes in the experiences of Black female neurosurgery attendings and residents as revealed through personal interviews. Furthermore, they examine factors that contribute to the disproportionate representation of Black women in neurosurgery

The progression of diversity: Black women in neurosurgery

While diversity in organized medicine has undoubtedly improved, a disparity remains in the racial and gender makeup of its constituents. This disparity is not distributed equally among all specialties of practice. The surgical subspecialties exemplify this phenomenon by having large gaps between the number of women and racial/ethnic minorities compared to their majority counterparts. Pertaining to neurosurgery in the US, this gap is substantial, with women reaching minority status only within the last 2 years. Among international women in neurosurgery, Black women are even further underrepresented despite efforts in recent years to close the gender gap. The reason for this disparity is likely multifactorial, as Black women demonstrate a unique intersectionality as a minority in regard to both race and gender. In this study, the authors provide historical context for the current state of diversity in neurosurgery and the global strides made by Black women within the field. The authors report recurrent themes in the experiences of Black female neurosurgery attendings and residents as revealed through personal interviews. Furthermore, they examine factors that contribute to the disproportionate representation of Black women in neurosurgery

Fetal surgery: The Ochsner experience with in utero spina bifida repair

Background: Myelomeningocele is the most common form of congenital central nervous system defect that is compatible with life. Most patients with myelomeningocele have significant functional impairment of ambulation and bowel and bladder function, require permanent cerebrospinal fluid diversion with shunting, and have significant morbidity and mortality from hindbrain herniation (Chiari II malformation). The advent of intrauterine surgery has provided new opportunities to better address this lifelong debilitating disease. Case Report: The patient was a 19-year-old gravida 2 para 1 at 22-6/7 weeks whose fetus was diagnosed with an open neural tube defect and further demonstrated to have ventriculomegaly and hindbrain herniation. Amniocentesis confirmed normal karyotype and the presence of acetylcholinesterase. After an intrauterine procedure, the patient underwent cesarean section at 35-5/7 weeks and delivered a male infant. His spinal incision was well healed at birth without any evidence of cerebrospinal fluid leakage, and his extremities were normal in appearance, range of motion, and movement. The infant also has maintained relatively normal, age-appropriate bowel and bladder function and has no obvious neurologic deficit. Conclusion: As the benefit of fetal surgery becomes more widely accepted, quality of care and patient safety must be at the forefront of any institution's effort to offer fetal surgery. Given the current prevalence of spina bifida and the amount of resources required to treat this disease effectively either in utero or postnatally, it is our opinion that the treatment of spina bifida should be regionalized to tertiary referral centers with the interdisciplinary expertise to offer comprehensive treatment for all aspects of the disease and all phases of care for the patients

Aneurysms with persistent patency after treatment with the Pipeline Embolization Device

The Pipeline Embolization Device (PED) was approved for the treatment of intracranial aneurysms from the petrous to the superior hypophyseal segment of the internal carotid artery. However, since its approval, its use for treatment of intracranial aneurysms in other locations and non-sidewall aneurysms has grown tremendously. The authors report on a cohort of 15 patients with 16 cerebral aneurysms that incorporated an end vessel with no significant distal collaterals, which were treated with the PED. The cohort includes 7 posterior communicating artery aneurysms, 5 ophthalmic artery aneurysms, 1 superior cerebellar artery aneurysm, 1 anterior inferior cerebellar artery aneurysm, and 2 middle cerebral artery aneurysms. None of the aneurysms achieved significant occlusion at the last follow-up evaluation (mean 24 months). Based on these observations, the authors do not recommend the use of flow diverters for the treatment of this subset of cerebral aneurysms

Microsurgical Management of Intracranial Aneurysms After Failed Flow Diversion

Background: Flow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases. Methods: We present a multicenter series of 13 aneurysms for which FD failed and that were subsequently treated with open surgery. We also present a review of the reported data regarding operative management of aneurysms after unsuccessful FD. Results: Twelve patients with 13 aneurysms were included in the present study. All 12 patients had undergone surgery after FD because of persistent aneurysm filling, mass effect, or aneurysm rupture. The patients underwent aneurysm clipping and parent vessel reconstruction, decompression of the aneurysm mass, occlusion of proximal flow to the aneurysm, or aneurysm trapping with or without extracranial–intracranial artery bypass. Conclusions: Aneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise