Neurosurgical training in Europe. 2nd report of the training committee of the European Association of Neurosurgical Societies (E.A.N.S.).
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OBJECTIVE: To systematically review the role of virtual reality (VR), augmented reality (AR), and mixed reality (MR) in neurosurgical education and training. DESIGN: Systematic review conducted in accordance with the PRISMA guidelines. SETTING: A comprehensive search was performed across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for English-language studies published between 1 January 2020 and 30 April 2026. PARTICIPANTS: Studies involving neurosurgeons, fellows, residents, and medical students (maximum sample size: n = 48) were included. RESULTS: Of 7,204 initially identified studies, 25 met the inclusion criteria. VR was primarily used for surgical simulation (100% of VR studies) and anatomical education (62.5%). AR demonstrated broader applications, including preoperative planning (40%) and intraoperative support (30%). MR was evenly distributed across simulation, planning, and intraoperative support (40% each). The most frequently improved outcomes were training effectiveness (52%) and technical proficiency (44%). Methodological quality scores, assessed using the Modified Medical Education Research Study Quality Instrument (MMERSQI), ranged from 39.5 to 84.5, indicating varied rigor. CONCLUSION: VR, AR, and MR technologies show potential to enhance surgical precision, technical skills, and educational outcomes in neurosurgical training. However, standardization of methodologies and cost-effective solutions remain essential. Future research should focus on long-term clinical impact and integration of AI-driven training models.
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The recently completed report of the Study on Surgical Services for the United States (SOSSUS) reveals several features of interest to neurosurgeons. There are approximately 2000 individuals practicing neurosurgery in the United States at the present time. Three-fourths of them are board-certified, and about 100 residents complete their training each year. Neurosurgical training rates have been increasing at six to 10 times the growth rate for the nation's population. Despite moderate variation in regional geographic distribution of practicing neurosurgeons, there is no real evidence of underserved areas. Distribution is even in communities with a population of 75,000 and greater. A critical feature of practice is that of work loads. Diagnostic studies make up a large protion of neurosurgical work, and the SOSSUS Area Studies reveal that complex operations are relatively relatively infrequent. This has serious implications regarding the maintenance of clinical competence, and in concentration sufficient clinical experience to train future generations of neurosurgeons. It is important to realize that the number of neurosurgeons now in practice is sufficient to meet the nation's needs. Selective cutbacks in training programs by approximately 20% seem to be in order, in coordination with similar cuts in other surgical specialties as well. This should be accompanied by a readjustment to a modest growth rate, approximately 1% per 5 years, in the ratio of neurosurgeons per 100,000 population. An accurate system of data collection is needed to provide the basis for future change in response to alterations in national needs.
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Injuries of the nervous system are common, and cause many deaths and much permanent disability. They inflict an enormous financial burden on the national economy; in Australia, adequate data are at present lacking, but a simple extrapolation from Canadian statistic suggests an estimate of more than $500,000,000 annually for the injuries resulting from road traffic accidents alone; if other causes of injury are included, the figure may reach one billion dollars. The neurosurgeon is specifically trained to undertake the management of all forms of neurological trauma; however, in Australia, and in many other countries, only a small minority of such injuries receive neurosurgical care. This is chiefly because the number of neurosurgeons at present available is small in relation to the tasks. Many cases must therefore be in the care of general or orthopaedic surgeons, especially in country centres, and it is important that these surgeons should have some basic neurosurgical training. The Neurosurgical Society of Australasia wishes to formulate a programme to ensure that opportunities for such training are available throughout Australia. This programme should also embody a national plan for research into the treatment and prevention of neurological trauma.
The ever-widening horizons in the neurosciences are noted by the author. Maintenance of the bridges between research and clinical practice will result in improved therapy. Research interest is expanding, and involvement by neurosurgeons and neurosurgical training programs is vital for future progress. Techniques are required to evaluate and assess new surgical procedures that evolve from research endeavors.
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The 1977 Cushing Orator looks at the question of neurosurgical manpower and its relation to national health policies, proposed or abandoned. The impact on residency training as well as patient care and research effort require constant monitoring by the profession, so that the specialty will continue to contribute significantly to human betterment.
Recent technical developments and improvements in angiographic equipment, variable stiffness microcatheters, embolic materials, and better training increased efficacy, safety, and growing acceptance of endovascular procedures by various specialties. Additional treatment options, frequently supplementary to neurosurgical procedures can be offered to patients with intracranial vascular lesions, using existing vascular pathways and avoiding the need for surgical exposure. For endovascular embolization of unclippable aneurysms coils which are soft, retrievable, and thrombogenic appear a better alternative than detachable balloons. New understanding and capabilities in brain arteriovenous malformations (AVMs) as an adjunct to microsurgical resection, or as the sole form of treatment may improve results and long-term outcome. Experience with intravascular thrombolysis and balloon angioplasty of extracranial and intracranial vessels will potentially improve neurological deficits in cerebrovascular or vasospastic occlusive disease. Safety, efficacy, and long-term follow up are needed to maintain and improve standards of practice and offer new therapeutic alternatives.
To obtain continuous information about the cerebral electrical activity in the early course of coma, an apparatus was designed which included a small fast computer capable of calculating the Fourier transform. The practical application of this system of CSA to 123 comatose patients in a neurosurgical intensive care unit overcame the technical difficulties connected both with the patient's and environmental conditions. The advantages of such a technique are mainly due to its capacity of synthetising EEG signals and to its clarity of presentation, which is easily grasped even by people not specifically trained in electroencephalography. Hours of EEG activity are compressed into a pictorial and synoptic representation that shows in real time the distribution and temporal behaviour of frequencies as well as the intensity of total electrical activity. The immediate detection of these parameters permits evaluation of any worsening or improvement of cerebral electrogenesis, as well as of the inter-hemispheric asymmetries at their onset. EEG monitoring thus provides useful elements for assessing the comatose state in individual cases and for adjusting treatment. Finally, the spectrographic aspect of the first 48 h, as a whole, carries a great prognostic significance. The most striking finding from this study was the confirmation that the comatose states that, in their early course, show only a fixed slow-wave EEG activity are far more rare than those that display an electrical activity changing in time.
PURPOSE: More than 70% of patients with cancer develop significant pain at some time during the course of their illness. Despite the general consensus that most cancer pain can be treated effectively, many patients receive inadequate treatment of their pain. One significant contributing factor is the failure of health care professionals to receive formal training in this important aspect of oncology. The Cancer Pain Assessment and Treatment Curriculum Guidelines reflect the American Society of Clinical Oncology's commitment to providing optimal pain relief to patients with cancer. These guidelines represent an effort to promote formal instruction on the assessment and treatment of cancer pain in training programs and continuing education courses. DESIGN AND RESULTS: The curriculum is broad in scope and applicable to patients of all ages. The guidelines emphasize the need for (1) routine pain assessment, (2) proficiency in prescribing opioids, nonopioid analgesics, and adjuvant medications, and (3) an understanding of the potential benefits of antineoplastic, anesthetic, neurosurgical, and behavioral approaches, which often require a coordinated multidisciplinary approach. CONCLUSION: This curriculum should prove a valuable guide to those who wish further education on the optimal treatment of cancer pain.
A retrospective survey of 1100 patients with head, spine, and cord injuries who were treated in The Prince Henry Hospital, and The Prince of Wales Hospital, Sydney, from January, 1960, to December, 1965, was published in The Medical Journal of Australia during 1967 and 1968. The present series of admissions from January, 1975, to December, 1976 comprises 179 head injury patients. The epidemiological data related to head injuries and specified in the two series are compared in the available details. The pattern of change in the structure of neurosurgical services is evaluated in relation to the ever-increasing neurological trauma on the roads of New South Wales. Growing numbers of patients with serious head injuries are treated in district and country hospitals in areas where neurosurgical consultative services cannot be obtained. The standards of treatment of these patients are unknown, and cannot be evaluated. The need for planning for better standards of care in district and country hospitals is stressed. A permanent system of statistical monitoring of all neurotrauma across the State is advocated. Organization of permanent postgraduate training courses in the management of acute neurotraumatic admissions, readily available to all those treating head injuries in the country hospitals is considered as a basic and imperative requirement.