Comparing Outcomes in Pediatric Neurosurgery

OBJECTIVEThe objective of this study was to examine the socioeconomic benefits to the patients and families attending a regional pediatric neurosurgery telemedicine clinic (PNTMC).METHODSA PNTMC was organized by the Division of Pediatric Neurosurgery of the University of Florida College of Medicine–Jacksonville based at Wolfson Children’s Hospital and by the Children’s Medical Services (CMS) to service the Southeast Georgia Health District. Monthly clinics are held with the CMS nursing personnel at the remote location. A retrospective review of the clinic population was performed, socioeconomic data were extracted, and cost savings were calculated.RESULTSClinic visits from August 2011 through January 2017 were reviewed. Fifty-five patients were seen in a total of 268 initial and follow-up PNTMC appointments. The average round-trip distance for a family from home to the University of Florida Pediatric Neurosurgery (Jacksonville) clinic location versus the PNTMC remote location was 190 versus 56 miles, respectively. The families saved an average of 2.5 hours of travel time and 134 miles of travel distance per visit. The average transportation cost savings for all visits per family and for all families was $180 and $9711, respectively. The average lost work cost savings for all visits per family and for all families was $43 and $2337, respectively. The combined transportation and work cost savings for all visits totaled $223 per family and $12,048 for all families. Average savings of $0.68/mile and $48.50/visit in utilizing the PNTMC were calculated.CONCLUSIONSManaging pediatric neurosurgery patients and their families via telemedicine is feasible and saves families substantial travel time, travel cost, and time away from work.

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Advocacy in pediatric neurosurgery: results from a 2017 survey of the American Society of Pediatric Neurosurgeons

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.4.peds1911 ◽

2019 ◽

Vol 24 (3) ◽

pp. 338-342 ◽

Cited By ~ 1

Author(s):

Melissa LoPresti ◽

Sandi Lam ◽

Katie Orrico ◽

Samuel R. Browd ◽

Richard G. Ellenbogen ◽

...

Keyword(s):

Public Health ◽

Pediatric Neurosurgery ◽

Clinical Issues ◽

Economic Issues ◽

Advocacy Effort ◽

Health Related ◽

Key Issues ◽

American Society ◽

Advocacy Program

OBJECTIVEPediatric neurosurgeons are unswerving advocates for public health–related issues in children, with most providers participating in local, regional, national, or international efforts. Collective advocacy efforts by organized pediatric neurosurgeons have not been undertaken to date.METHODSA 10-item survey was administered to members of the American Society of Pediatric Neurosurgeons (ASPN) in order to evaluate attitudes and opinions regarding the development of a formal advocacy effort by the organization.RESULTSSeventy-nine of 178 registered members of the ASPN (44.38%) participated in the survey. Participants were 82.61% male, with age, stage of career, and practice type varied. Although there was unequivocal support for participation in organized advocacy, respondents were divided on methods and topics for advocacy. In this survey, the ASPN membership prioritized public health and clinical issues over economic issues that affected children.CONCLUSIONSMost respondents favored the drafting of position statements on key issues and partnerships with larger organizations to pursue an advocacy agenda. The survey provides data regarding pediatric neurosurgeons’ attitudes that may assist with the design of a successful advocacy program.

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Pediatric neurosurgery in Asia and Australasia: training and clinical practice

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds20399 ◽

2021 ◽

Vol 27 (1) ◽

pp. 93-101

Author(s):

Ronnie E. Baticulon ◽

Michael C. Dewan ◽

Nunthasiri Wittayanakorn ◽

Philipp R. Aldana ◽

Wirginia J. Maixner

Keyword(s):

Clinical Practice ◽

Online Survey ◽

Vascular Malformations ◽

Economic Status ◽

Pediatric Neurosurgery ◽

Income Group ◽

Fellowship Training ◽

Pediatric Epilepsy ◽

Skill Sets ◽

Survey Responses

OBJECTIVEThere are limited data on the pediatric neurosurgical workforce in Asia and Australasia. The training and clinical practice of pediatric neurosurgeons need to be characterized in order to identify gaps in knowledge and skills, thereby establishing a framework from which to elevate pediatric neurosurgical care in the region.METHODSAn online survey for pediatric neurosurgeons was created in REDCap (Research Electronic Database Capture), collecting demographic information and data on pediatric neurosurgical training and clinical practice. The link to answer the survey was sent to the mailing lists of the Asian Australasian Society for Pediatric Neurosurgery and the Japanese Society for Pediatric Neurosurgery, disseminated during the 2019 Asian Australasian Pediatric Neurosurgery Congress, and spread through social media. The survey was open to neurosurgeons who operated on patients ≤ 18 years old in Asian Australasian countries, whether or not they had completed fellowship training in pediatric neurosurgery. Descriptive statistics were computed and tabulated. Data were stratified and compared based on surgeon training and World Bank income group.RESULTSA total of 155 valid survey responses were analyzed, representing neurosurgeons from 21 countries. A total of 107 (69%) considered themselves pediatric neurosurgeons, of whom 66 (43%) had completed pediatric neurosurgery training. Neurosurgeons in East Asia commonly undergo a fellowship in their home countries, whereas the rest train mostly in North America, Europe, and Australia. A majority (89%) had operating privileges, and subspecialty pediatric training usually lasted from 6 months to 2 years. On average, trained pediatric neurosurgeons perform a higher number of pediatric neurosurgical operations per year compared with nonpediatric-trained respondents (131 ± 129 vs 56 ± 64 [mean ± SD], p = 0.0001). The mean number of total neurosurgical operations per year is similar for both groups (184 ± 129 vs 178 ± 142 [mean ± SD], p = 0.80). Respondents expressed the desire to train further in pediatric epilepsy, spasticity, vascular malformations, craniofacial disorders, and brain tumors.CONCLUSIONSBoth pediatric and general neurosurgeons provide neurosurgical care to children in Asia and Australasia. There is a need to increase pediatric neurosurgery fellowship programs in the region. Skill sets and training needs in pediatric neurosurgery vary depending on the country’s economic status and between pediatric-trained and nonpediatric-trained surgeons.

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Ultrasonic Welding in a Bioresorbable Implant System: Uses in Pediatric Neurosurgery

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/4/paper7 ◽

2008 ◽

Vol 1 (4) ◽

pp. A352-A352

Author(s):

Philipp R. Aldana ◽

R. A. Postlethwait ◽

P. Munson ◽

S. Roy ◽

H. E. James

Keyword(s):

Pediatric Neurosurgery ◽

Ultrasonic Welding ◽

Implant System

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The effect of GMFCS level, age, sex, and dystonia on multi-dimensional outcomes after selective dorsal rhizotomy: prospective observational study

Child s Nervous System ◽

10.1007/s00381-021-05076-0 ◽

2021 ◽

Vol 37 (5) ◽

pp. 1729-1740

Author(s):

Conor Scott Gillespie ◽

◽

Alan Matthew George ◽

Benjamin Hall ◽

Steven Toh ◽

...

Keyword(s):

Motor Function ◽

Self Care ◽

Pediatric Neurosurgery ◽

Care Quality ◽

Fine Motor ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Significant Difference ◽

Age Category ◽

Gmfcs Level

Abstract Purpose Investigate the effect of age category (1–9 years vs 10–18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR). Methods Prospective, single-center study of all children aged 3–18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes. Results From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05–7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively). Conclusion SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.

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