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  1. Article ; Online: Transformation of practical exercise in neurosurgery depending on the level of training.

    Stengel, Felix C / Bozinov, Oliver / Stienen, Martin N

    Brain & spine

    2022  Volume 2, Page(s) 101700

    Language English
    Publishing date 2022-12-01
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2022.101700
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Can AI pass the written European Board Examination in Neurological Surgery? - Ethical and practical issues.

    Stengel, Felix C / Stienen, Martin N / Ivanov, Marcel / Gandía-González, María L / Raffa, Giovanni / Ganau, Mario / Whitfield, Peter / Motov, Stefan

    Brain & spine

    2024  Volume 4, Page(s) 102765

    Abstract: Introduction: Artificial intelligence (AI) based large language models (LLM) contain enormous potential in education and training. Recent publications demonstrated that they are able to outperform participants in written medical exams.: Research ... ...

    Abstract Introduction: Artificial intelligence (AI) based large language models (LLM) contain enormous potential in education and training. Recent publications demonstrated that they are able to outperform participants in written medical exams.
    Research question: We aimed to explore the accuracy of AI in the written part of the EANS board exam.
    Material and methods: Eighty-six representative single best answer (SBA) questions, included at least ten times in prior EANS board exams, were selected by the current EANS board exam committee. The questions' content was classified as 75 text-based (TB) and 11 image-based (IB) and their structure as 50 interpretation-weighted, 30 theory-based and 6 true-or-false. Questions were tested with Chat GPT 3.5, Bing and Bard. The AI and participant results were statistically analyzed through ANOVA tests with Stata SE 15 (StataCorp, College Station, TX). P-values of <0.05 were considered as statistically significant.
    Results: The Bard LLM achieved the highest accuracy with 62% correct questions overall and 69% excluding IB, outperforming human exam participants 59% (p = 0.67) and 59% (p = 0.42), respectively. All LLMs scored highest in theory-based questions, excluding IB questions (Chat-GPT: 79%; Bing: 83%; Bard: 86%) and significantly better than the human exam participants (60%; p = 0.03). AI could not answer any IB question correctly.
    Discussion and conclusion: AI passed the written EANS board exam based on representative SBA questions and achieved results close to or even better than the human exam participants. Our results raise several ethical and practical implications, which may impact the current concept for the written EANS board exam.
    Language English
    Publishing date 2024-02-13
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2024.102765
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Clinical and surgical results related to anterior-only multilevel cervical decompression and instrumented fusion for degenerative disease.

    Koller, Heiko / Stengel, Felix C / Hostettler, Isabel C / Koller, Juliane / Fekete, Tamas / Ferraris, Luis / Hitzl, Wolfgang / Hempfing, Axel

    Brain & spine

    2023  Volume 3, Page(s) 101716

    Abstract: Introduction: Anterior-only multilevel cervical decompression and fusion surgery (AMCS) on 3-5-levels is challenging due to potential complications. Also, outcome predictors after AMCS are poorly understood.: Research question: We hypothesize that in ...

    Abstract Introduction: Anterior-only multilevel cervical decompression and fusion surgery (AMCS) on 3-5-levels is challenging due to potential complications. Also, outcome predictors after AMCS are poorly understood.
    Research question: We hypothesize that in patients with at most mild/moderate cervical kyphosis (CK) of the cervical spine, restoration of cervical lordosis (CL) positively influences clinical outcomes.
    Methods: Analysis of consecutive patients presenting with symptomatic degenerative cervical disease or non-union undergoing AMCS. We measured CL from C2 to C7, Cobb angle of fused levels (fusion angle, FA), C7-Slope, and sagittal vertical axis C2-7 (cSVA, stratified into ≤4cm∖>4cm). Patients with excellent outcome were grouped in BEST-outcomes and with moderate/poor outcomes in WORST-outcomes.
    Results: We included 244 patients. Fifty-four percent had 3-, 39% 4-level and 7% had 5-level fusion. At mean follow-up of 26 months, 41% of patients achieved BEST-outcome and 23% WORST-outcome. Complications and reoperation rates did not significantly differ. Non-union significantly influenced outcomes. The number of patients with non-union was significantly higher in patients with a preoperative cSVA>4cm (OR 13.1 (95%CI:1.8-96.8). Our model, based on the multivariable analysis with WORST-outcome as outcome variable showed a high accuracy (NPV=73%, PPV=77%, specificity=79%, sensitivity=71%).
    Discussion and conclusion: In 3-5-level AMCS, improvement of FA and cSVA were independent predictors of clinical outcome. Improvement of CL positively influenced clinical outcomes and rates of non-union.
    Language English
    Publishing date 2023-01-26
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2023.101716
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Surgical Realignment After Anterior Multilevel Decompression Using Cages and Plate for 3-level to 5-level Degenerative Fusions: Lessons Learned From the Analysis of Geometric Changes, Reciprocal Coupling, and Prediction of Sagittal Cervical Balance.

    Koller, Heiko / Hostettler, Isabel C / Stengel, Felix C / Koller, Juliane / Ferraris, Luis / Hitzl, Wolfgang / Hempfing, Axel

    Clinical spine surgery

    2022  Volume 35, Issue 8, Page(s) E649–E659

    Abstract: Study design: Retrospective, single-center case study.: Objective: Postoperative cervical imbalance with cervical sagittal vertical axis (cSVA) >4 cm can be predicted in 3-level to 5-level anterior-only cervical multilevel fusion surgery (ACMS).: ... ...

    Abstract Study design: Retrospective, single-center case study.
    Objective: Postoperative cervical imbalance with cervical sagittal vertical axis (cSVA) >4 cm can be predicted in 3-level to 5-level anterior-only cervical multilevel fusion surgery (ACMS).
    Summary of background data: Previous studies established correlations between cervical kyphosis (CK) correction and postoperative balance (cSVA ≤4 cm) with improved clinical outcomes. Understanding of what influences restoration of cervical lordosis (CL) in patients with degenerative disease with mild to moderate CK subjected to ACMS is important. To achieve a better understanding of geometric changes after ACMS, this study examines factors predicting perioperative alignment changes and regional interdependencies.
    Materials and methods: Analysis of patients with ACMS. Analysis included patient baseline characteristics, demographics and complications, and focused on radiographic measures including CL C2-7, fusion angle (FA), C7-Slope (C7S), T1-slope (T1S), T1-CL mismatch, and cSVA (cSVA ≤4 cm/>4 cm). We aimed to predict postoperative imbalance (cSVA >4 cm) and conducted a multivariable logistic regression analysis.
    Results: Inclusion of 126 patients with 3-level to 5-level ACMS, mean age was 56 years and 4 fusion levels on average. Preoperative CK was present in 9%, mean FA-correction was 8 degrees, maximum 46 degrees. Postoperatively, 14 patients had cSVA >4 cm. A neural network model for prediction of cSVA >4 cm was established including preoperative cSVA, preoperative CL and correction of FA. The model achieved high performance (positive predictive value=100%, negative predictive value=94%, specificity=100%, sensitivity=20%). Also, variables such as nonunion, chronic lumbar pain or thoracolumbar multilevel fusion influenced the postoperative cSVA >4 cm rate. Alignment analysis highlighted strong correlations between C7S/T1S and cSVA/C2-tilt ( r =0.06/ r =0.7, P <0.0001). A formula was established to transfer cSVA data into C2-tilt data.
    Conclusion: This study identified independent variables predicting postoperative cSVA >4 cm including FA, which can be influenced by the surgeon. Our model supports the decision-making process targeting a postoperative cSVA ≤4 cm.
    MeSH term(s) Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/surgery ; Decompression ; Humans ; Kyphosis/diagnostic imaging ; Kyphosis/surgery ; Lordosis/diagnostic imaging ; Lordosis/surgery ; Middle Aged ; Retrospective Studies ; Thoracic Vertebrae/surgery
    Language English
    Publishing date 2022-06-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2849646-2
    ISSN 2380-0194 ; 2380-0186
    ISSN (online) 2380-0194
    ISSN 2380-0186
    DOI 10.1097/BSD.0000000000001337
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The prevalence of imposter syndrome among neurosurgeons in Europe: An EANS YNC survey.

    Zoia, Cesare / Stienen, Martin N / Zaed, Ismail / Menna, Grazia / Aldea, Cristina C / Bartek, Jiri / Bauer, Marlies / Belo, Diogo / Drosos, Evangelos / Freyschlag, Christian F / Kaprovoy, Stanislav / Lepic, Milan / Lippa, Laura / Mohme, Malte / Motov, Stefan / Schwake, Michael / Spiriev, Toma / Stengel, Felix C / Torregrossa, Fabio /
    Raffa, Giovanni / Gandía-Gonzalez, Maria L

    Brain & spine

    2024  Volume 4, Page(s) 102816

    Abstract: Introduction: Imposter syndrome (IS), characterized by persistent doubts about one's abilities and fear of exposure as a fraud, is a prevalent psychological condition, particularly impacting physicians. In neurosurgery, known for its competitiveness and ...

    Abstract Introduction: Imposter syndrome (IS), characterized by persistent doubts about one's abilities and fear of exposure as a fraud, is a prevalent psychological condition, particularly impacting physicians. In neurosurgery, known for its competitiveness and demands, the prevalence of IS remains high.
    Research question: Recognizing the limited literature on IS within the neurosurgical community, this European survey aimed to determine its prevalence among young neurosurgeons and identify associated factors.
    Material and methods: The survey, conducted by the Young Neurosurgeon Committee of the European Association of Neurosurgical Societies, gathered responses from 232 participants. The survey included demographics, the Clance Imposter Phenomenon Survey (CIPS), and an analysis of potential compensatory mechanisms.
    Results: Nearly 94% of respondents exhibited signs of IS, with the majority experiencing moderate (36.21%) or frequent (40.52%) symptoms. Analyses revealed associations between IS and factors such as level of experience, sex, and board-certification.
    Discussion and conclusion: The findings suggest a significant prevalence of IS among young neurosurgeons, with notable associations with sex and level of experience. Compensatory mechanisms, such as working hours, article reading, and participation in events, did not show significant correlations with IS. Notably, male sex emerged as an independent protective factor against frequent/intense IS, while reading more than five articles per week was identified as a risk factor. The identification of protective and risk factors, particularly the influence of gender and reading habits, contributes valuable insights for developing targeted interventions to mitigate IS and improve the well-being of neurosurgeons.
    Language English
    Publishing date 2024-04-16
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2024.102816
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: The use of advanced technology for preoperative planning in cranial surgery - A survey by the EANS Young Neurosurgeons Committee.

    Raffa, Giovanni / Spiriev, Toma / Zoia, Cesare / Aldea, Cristina C / Bartek, Jiri / Bauer, Marlies / Ben-Shalom, Netanel / Belo, Diogo / Drosos, Evangelos / Freyschlag, Christian F / Kaprovoy, Stanislav / Lepic, Milan / Lippa, Laura / Rabiei, Katrin / Schwake, Michael / Stengel, Felix C / Stienen, Martin N / Gandía-González, Maria L

    Brain & spine

    2023  Volume 3, Page(s) 102665

    Abstract: Introduction: Technological advancements provided several preoperative tools allowing for precise preoperative planning in cranial neurosurgery, aiming to increase the efficacy and safety of surgery. However, little data are available regarding if and ... ...

    Abstract Introduction: Technological advancements provided several preoperative tools allowing for precise preoperative planning in cranial neurosurgery, aiming to increase the efficacy and safety of surgery. However, little data are available regarding if and how young neurosurgeons are trained in using such technologies, how often they use them in clinical practice, and how valuable they consider these technologies.
    Research question: How frequently these technologies are used during training and clinical practice as well as to how their perceived value can be qualitatively assessed.
    Materials and methods: The Young Neurosurgeons' Committee (YNC) of the European Association of Neurosurgical Societies (EANS) distributed a 14-items survey among young neurosurgeons between June 1st and August 31st
    Results: A total of 441 responses were collected. Most responders (42.34%) received "formal" training during their residency. Planning techniques were used mainly in neuro-oncology (90.86%), and 3D visualization of patients' DICOM dataset using open-source software was the most frequently used (>20 times/month, 20.34% of responders). Software for 3D visualization of patients' DICOM dataset was the most valuable technology, especially for planning surgical approach (42.03%). Conversely, simulation based on augmented/mixed/virtual reality was considered the less valuable tool, being rated below sufficiency by 39.7% of responders.
    Discussion and conclusion: Training for using preoperative planning technologies in cranial neurosurgery is provided by neurosurgical residency programs. Software for 3D visualization of DICOM datasets is the most valuable and used tool, especially in neuro-oncology. Interestingly, simulation tools based on augmented/virtual/mixed reality are considered less valuable and, therefore, less used than other technologies.
    Language English
    Publishing date 2023-08-26
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2023.102665
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Transformation of neurosurgical training from "see one, do one, teach one" to AR/VR & simulation - A survey by the EANS Young Neurosurgeons.

    Stengel, Felix C / Gandia-Gonzalez, Maria L / Aldea, Cristina C / Bartek, Jiri / Belo, Diogo / Ben-Shalom, Netanel / De la Cerda-Vargas, María F / Drosos, Evangelos / Freyschlag, Christian F / Kaprovoy, Stanislav / Lepic, Milan / Lippa, Laura / Rabiei, Katrin / Raffa, Giovanni / Sandoval-Bonilla, Bayron A / Schwake, Michael / Spiriev, Toma / Zoia, Cesare / Stienen, Martin N

    Brain & spine

    2022  Volume 2, Page(s) 100929

    Abstract: Introduction: Modern technologies are increasingly applied in neurosurgical resident training. To date, no data are available regarding how frequently these are used in the training of neurosurgeons, and what the perceived value of this technology is.!## ...

    Abstract Introduction: Modern technologies are increasingly applied in neurosurgical resident training. To date, no data are available regarding how frequently these are used in the training of neurosurgeons, and what the perceived value of this technology is.
    Research question: The aim was to benchmark the objective as well as subjective experience with modern- and conventional training technologies.
    Material and methods: The EANS Young Neurosurgeons Committee designed a 12-item survey. It was distributed to neurosurgical residents and board-certified neurosurgeons between 6th of February and April 13, 2022.
    Results: We considered 543 survey responses for analysis. Most participants (67%) indicated not having gained any training experience with modern technology. Most (40.7%) indicated lack of any modern or conventional training technology. Cadaver training was available to 27.6% while all modern training technology to <10%. Participants from countries with high gross domestic product per capita had more access to modern training technologies (p ​< ​0.001). The perceived value of the different technologies was highest for hands-on OR training, followed by cadaver lab. The value of these was rated higher, compared to all modern technologies (p ​< ​0.001).
    Discussion and conclusion: Our survey reveals that cadaver labs are used more frequently than modern technologies for today's neurosurgical training. Hands-on training in the operating room (OR) was rated significantly more valuable than any conventional and modern training technology. Our data hence suggest that while modern technologies are well perceived and can surely add to the training of neurosurgeons, it remains critical to ensure sufficient OR exposure.
    Language English
    Publishing date 2022-08-15
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2022.100929
    Database MEDical Literature Analysis and Retrieval System OnLINE

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