Faculty Bibliography

OBJECTIVE:Mentorship and training relationships shape the careers and influence of neurosurgeons. Network analysis can reveal structural characteristics and key individuals who support network connectivity and drive the field's development. This endeavor analyzed the U.S.-based neurosurgical training network derived from NeurosurGen.com. METHODS:A network graph was constructed representing neurosurgical training relationships, including chairperson-trainee, program director-trainee, and coresident connections. Graph- and node-level metrics, with a focus on centrality measures, were calculated for a trainer-trainee subgraph. RESULTS:The network consisted of 8840 neurosurgeons represented as nodes, and 382,143 relationships represented as edges. It evolved from an early small-world structure to a hierarchical and decentralized structure dominated by local clusters. Demographic shifts over time reflected increasing diversity and inclusion, with greater representation of female, Hispanic, Asian, and Black trainees across 285 training programs. Nodes were preferentially connected via residency, and the connectivity among underrepresented populations improved in concert with increased representation. Harvey W. Cushing was the quintessential neurosurgeon-influencer in the United States, ranking highly across most centrality measures over time. CONCLUSIONS:The neurosurgical training network is sparse but interconnected, typical of large real-world professional networks. While many small groups of neurosurgeons are closely tied within their immediate training hierarchy and peer group, in modern neurosurgery, each surgeon is only connected to a small fraction of the total network. Highly central individuals have played critical roles in linking disparate groups and shaping network structure. Increasing diversity in recent decades indicates progress toward inclusivity, although overall representation remains low.

PURPOSE/UNASSIGNED:Primary muscle tension dysphonia (pMTD) is a form of vocal hyperfunction with no preexisting tissue trauma to the vocal folds. There are no known structural or neurological causes of pMTD, and there is rarely obvious, confirmatory evidence to reliably diagnose individuals accurately. Furthermore, acoustic and aerodynamic measurements taken during voice assessments vary widely within this population. The purpose of this study was to find subgroups within a sample of pMTD patients based on acoustic and aerodynamic measurements. We use a computational approach to elucidate what has largely been observational in the past. METHOD/UNASSIGNED:-means clustering analysis was conducted. RESULTS/UNASSIGNED:The exploratory factor analysis grouped together variables across patients, which resulted in three principal axes. These three principal axes separately consisted of aperiodicity, fundamental frequency, and aerodynamic measurements. These principal axes explained 44.7% of the total variance. Four clusters of patients were identified across the three principal axes. These were characterized by (a) a high amount of aperiodicity in the voice, (b) lower fundamental frequency values, (c) higher fundamental frequency values, and (d) high aerodynamic values. CONCLUSIONS/UNASSIGNED:The clusters identified in the current study are reliable and moderately separated. Furthermore, these clusters align with previously identified subgroups in related work. The analysis presented here lays the groundwork for additional clustering analyses with new pMTD samples, as well as future work establishing subtype classifications of pMTD.

INTRODUCTION/BACKGROUND:Differentiated thyroid cancer is the most common endocrine malignancy and has an excellent 5-year survival rate after appropriate management. Current management guidelines state that thyroid lobectomy is adequate resection for papillary thyroid cancer (PTC) without preoperative evidence of high-risk features. However, the extent of surgery for PTC in the thyroid isthmus remains controversial, given the unclear lymphatic drainage and retrospective studies suggesting higher rates of lymphatic metastasis. The aim of this study was to examine the surgical management and outcomes of patients with isthmus PTC. METHODS:A retrospective review was performed at two high-volume centers of 138 patients who underwent thyroidectomy between 2013 and 2021 with isthmus PTC on final pathology. Preoperative tumor characteristics, surgical pathology, and postoperative outcomes were compared. RESULTS:There were 138 patients treated for isthmus PTC. Total thyroidectomy (TT) was most frequently performed (70.0 ​%), followed by lobectomy (TL, 17.1 ​%) and isthmusectomy (TI, 12.9 ​%). Among the 106 patients with Bethesda V/VI nodules, most underwent TT (75.5 ​%), followed by TL (13.2 ​%), and TI (11.3 ​%). Patients with Bethesda III/IV nodules most frequently had TI (44.4 ​%) or TL (44.4 ​%), then followed by TT (11.1 ​%). Patients who underwent TT more frequently had suspicious lymph nodes on preoperative imaging (n ​= ​30, n ​= ​1, n ​= ​0, p ​< ​0.001) and/or multiple nodules than TL and TI respectively (73.5 ​%, 70.8 ​%, 16.7 ​%, p ​< ​0.001). Of TT patients, 48 had central neck dissections (29 prophylactic and 19 therapeutic) and 20 had both therapeutic CND and lateral neck dissections. TT patients had larger median tumor size (1.5 ​cm; TL 1.1 ​cm; TI 1.0 ​cm; p ​= ​0.008). PTC variants were identified in 26.1 ​% of patients. Completion thyroidectomy was performed in 4 patients (TL, n ​= ​2; TI, n ​= ​2, p ​= ​0.41). Of 99 patients with lymph nodes sampled, 62 patients had metastatic lymph nodes (TT 58.2 ​%; TL, 16.7 ​%; TI: 11.1 ​%; p ​= ​0.02). At the last follow-up, 10 patients had persistent/recurrent disease (TT: 8, TI: 2, TL: 0). At one year, among patients who did not undergo TT, 10 patients required thyroid hormone replacement (TL: 56 ​%; TI: 10 ​%; p ​= ​0.018). CONCLUSION/CONCLUSIONS:Isthmus PTC may present with high-risk pathologic variants and positive nodes in 2 out of 3 patients. TI may be an appropriate management strategy in small, low-risk tumors, with similar reoperation rates as TL and lower rates of needing thyroid hormone replacement.

Remote access approaches to the neck have gained attention due to cosmetic concerns with conventional cervical incisions. Their safety, reproducibility, and oncologic outcomes remain to be fully validated. We retrospectively analyzed our initial experience with retroauricular robotic neck surgery using the Da Vinci system. Thirty-two patients were included. Data collected comprised demographics, procedure type, surgical features, and oncological follow-up. Thirty-five surgeries were performed: 13 posterolateral neck dissections (levels II-V) with central (VI), 5 modified radical dissections (I-V), 5 posterolateral dissections (II-V), and 1 super-selective neck dissection (I). Twelve neck dissections were combined with thyroidectomy. Additional procedures included 4 partial thyroidectomies, 3 submandibular gland resections, 3 schwannoma resections, and 1 branchial cyst excision, totaling 60 procedures. Twenty patients had malignant disease (62.5%). Median hospital stay was 2 days (range 1 9), similar to conventional approaches. Complications included 5 temporary nerve palsies, 1 lymphatic fistula, 1 transient hypoparathyroidism, and 1 minor flap necrosis, all managed conservatively; 1 hematoma required reoperation. Conversion to a conventional approach occured in 4 cases (6.7%). No additional intraoperative or postoperative complications were observed. The mean lymph node yield was 54 in posterolateral/radical dissections and 13 in central dissections. Median follow-up of malignant cases was 41.3 months (range 18-56), with a 3-year regional control rate of 94.7%. Our experience with 60 retroauricular robotic procedures demonstrates this approach to be safe, feasible, and oncologically effective, with complication rates, hospital stay, and oncological outcomes comparable to conventional surgery.

OBJECTIVE:Previous investigations demonstrated voice changes corresponding to menstrual cycle phases, but few explored longitudinal cycle-to-cycle variations. The aim of this longitudinal case study was to describe changes in acoustics, laryngeal kinematics, vocal effort, and ability to produce high soft phonation in relation to menstrual cycle phases over the course of multiple cycles in a single normally cycling individual. METHODS:Data were obtained from a 34-year-old professional voice user who had self-collected daily videostroboscopy, acoustics, vocal effort rating, and high soft phonation tasks for 394 days. Data were analyzed by cycle phase and across time for all cycles. RESULTS:Cycle length ranged from 24-32 days. All metrics demonstrated high cycle-to-cycle variability (±2 standard deviation or more). Greatest variability was during menses and luteal phases. The fertile window was the least variable and showed decreased glottal area index (GAI), asymmetry quotient, perceived vocal effort, and increased smoothed cepstral peak prominence, consistent with previous literature suggesting "best" voice quality during the periovulatory period. Perceived vocal effort and fundamental frequency were highest during the luteal phase. GAI was lowest during the luteal phase, and higher during estimated day of ovulation, which contradicts previous findings. CONCLUSION/CONCLUSIONS:This case study represents a unique, longitudinal data set demonstrating changes in phonatory characteristics across repeated menstrual cycles. In general, there was increased variability during rapid hormonal changes (menses, luteal phases) and less variability during hormonal stability (fertile window), suggesting that voice changes are sensitive to the rapid hormonal shifts. Future prospective studies should include multiple participants and concurrent hormone-level tracking. LEVEL OF EVIDENCE/METHODS:Level 4.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Neurosurgical clinical research depends on medical data collection and evaluation that is often laborious, time consuming, and inefficient. The goal of this work was to implement and evaluate a novel departmental data infrastructure (Neuro Data Hub) designed to provide specialized data services for neurosurgical research. Data acquisition would become available purely by request. METHODS:through collaboration between Department Leadership and Medical Center Information Technology, integrating it with Institutional Review Board workflows and an existing Epic electronic health record Datalake infrastructure. The system implementation included monthly departmental meetings and an asynchronous Research Electronic Data Capture-based request system. Data requests submitted between August 2023 and November 2024 were analyzed and categorized as basic, complex, or Natural Language Processing (NLP)-augmented, with optional visualization and database creation services. Request volumes, types, and execution times were assessed. RESULTS:The Hub processed 39 research data requests (2.6/month), comprising 3 basic, 22 complex, and 14 NLP-augmented requests. Two complex requests included visualization services, and one NLP request included database creation. Average request execution time was 36.5 days, with NLP-augmented requests showing increasing adoption over time. CONCLUSION/CONCLUSIONS:The Neuro Data Hub represents a paradigm shift from centralized to department-level data services, providing specialized support for neurosurgical research and democratizing access to institutional data. While effective, implementation may be limited by institutional information technology infrastructure requirements. This model could serve as a template for any form of medical-clinical research program seeking to improve data accessibility and research capabilities.