Access to neurosurgical care is essential for addressing elective and non-elective neurosurgical conditions. Disparities in healthcare access in Canada persist, disproportionately affecting rural, Indigenous and socioeconomically disadvantaged populations. This scoping review sought to identify barriers and facilitators influencing neurosurgical access to care while highlighting gaps in the literature on equity-deserving groups.

A systematic literature search of articles published from January 2000 to August 2024 was conducted using MEDLINE, EMBASE, Cochrane Library, PsycINFO and Scopus. Gray literature from governmental and non-governmental organizations was also reviewed. Of 1400 identified records, eight studies met the inclusion criteria. These studies were analyzed using inductive coding and thematic analysis to explore socioeconomic, geographic, racial, gender-based and cultural barriers.

Four major themes emerged: delays in access, alternative healthcare options, policy barriers and communication and coordination. Barriers including transportation gaps, socioeconomic inequities and systemic discrimination were prominent, especially for rural and Indigenous populations. Facilitators like telehealth and improved inter-hospital coordination showed promise but were hindered by infrastructure limitations and cultural misalignments. Few studies addressed the intersectionality of these barriers, highlighting gaps in understanding their cumulative impact.

The findings in this review underscore the need for systemic reforms, including equitable resource allocation, digital infrastructure expansion and culturally congruent care. Addressing these barriers is critical to ensuring timely and equitable neurosurgical care across Canada. Future research should prioritize intersectional approaches to better understand overlapping access challenges and evaluate the efficacy of tailored interventions.

Neurosurgery is a demanding specialty, and a trainee’s exposure to its tenets is usually achieved through residency. Medical students only access neurosurgical knowledge via brief stints in clerkships/electives and often lack mentorship and early exposure. This study sought to investigate the varying expectations about neurosurgical training held by Canadian medical students, with the goal of determining the impact of early exposure through educational opportunities and mentorship in developing interest and familiarity in the field.

A cross-sectional study across Canada was conducted where students were provided with a 35-point questionnaire pertaining to mentorship, educational opportunities and interests regarding neurosurgery through REDcap. Questions were open-ended, closed-ended (single choice) or five-point Likert scale (matrix format). Interest in pursuing neurosurgery was selected as the primary outcome of this study and was dichotomized into high or low interest. Predictors of interest were determined using multivariable logistic regressions.

A total of 136 students from 14 accredited Canadian medical schools responded to the study. Most (55.9%) had prior exposure, and the most commonly reported deterring factors were work–life balance (94.5%) and family (84.6%). Predictors of interest included participation in relevant case-based discussion (OR = 2.644, 95% CI [1.221–5.847], p = 0.015) and involvement in neurosurgical research encouraged by home institution (OR = 1.619, 95% CI [1.124–2.396], p = 0.012).

Future efforts to improve student interest should focus on early exposure to the field such as developing pre-clerkship neurosurgical electives or medical student groups focused on neurosurgery.

Chronic subdural hematoma (cSDH) is a common condition, especially in the older population, and causes considerable morbidity. Recently, middle meningeal artery embolization (MMAE) has shown promise as a minimally invasive intervention for cSDH by disrupting the flow to the hematoma neomembranes and thus reducing recurrence.

We performed a systematic review of the literature using PubMed/Medline and Google Scholar to identify studies reporting on MMAE for cSDH over the past 30 years. After screening 4103 articles and reviewing 600 full-text studies, 176 studies were selected, including case reports, case series, retrospective and prospective studies and randomized controlled trials. Patient demographics, embolic agents used, frequency, type and severity of complications, hematoma recurrence and need for repeat surgery were extracted from the included studies.

Our analysis included 9780 patients (75.9% male), with mean/median ages ranging from 62.1 to 82.5 years. MMAE-related complications were reported in approximately 3%. Procedure-related neurological complications were the most frequent, followed by systemic complications, access site, non-procedure-related neurological complications, procedure-linked vascular complications specific to MMA and miscellaneous complications. Hematoma recurrence was reported in 6%, and repeat or rescue surgery was necessary in 6.1%. These results are consistent with major clinical trials evaluating MMAE safety and efficacy in cSDH.

Based on current published literature, MMAE appears to be an effective and overall safe treatment option for cSDH. Complications, although infrequent, can occur, and some of these are disabling. Meticulous pre-procedural planning and imaging are essential to reduce the risk of complications.

Meningiomas are benign spinal arachnoid tumours, typically presenting as intradural extramedullary (IDEM) lesions that can compress the spinal cord and require surgical intervention. Minimally invasive surgery (MIS) techniques like mini-open, tubular and endoscopic approaches minimize tissue manipulation, reduce pain and accelerate recovery. This systematic review provides insights into current practices regarding MIS for cervical meningioma and presents a case series of eight patients with cervical meningioma effectively managed by MIS.

A comprehensive literature search was conducted across Embase, PubMed and Medline Ovid, focusing on MESH terms related to cervical vertebrae, nervous system neoplasms and minimally invasive surgical procedures. Risk of bias in retained studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for case series and case reports. A narrative synthesis of our results is presented.

Nine studies with 15 patients undergoing MIS for cervical meningioma were included. Most tumours were at the craniospinal junction. Gross total resection (Simpson grade 2) was achieved in 14 cases, with no reported post-operative complications. The length of stay (LOS) ranged from 2 to 6 days, and no tumour recurrence was observed. Our case series of eight patients confirmed MIS benefits, including shorter operative times, comparable surgical outcomes, and the avoidance of spinal deformities requiring instrumentation.

In well-selected patients, MIS for cervical meningioma is a safe and effective procedure offering direct lateral access, minimal bony resection, limited soft tissue manipulation, and avoidance of cervical fusion, thereby minimizing post-operative complications and LOS.

Poorly managed inpatient flow can lead to adverse health outcomes, including increased mortality and readmission rates. In neurosurgery, optimizing inpatient flow is crucial to improving patient experience and outcomes, but the factors influencing it are unclear. A preliminary analysis revealed suboptimal average length of stay (ALOS) and expected length of stay (ELOS) rates – key metrics used to assess inpatient flow – across Alberta, Canada. The purpose of this study was to evaluate the current state of inpatient flow in Alberta’s neurosurgical care and explore strategies for enhancement.

This study used mixed methods: a rapid scoping review and a retrospective cohort study. The rapid scoping review synthesized peer-reviewed and gray literature (after a three-stage screening process) to identify factors impacting neurosurgery inpatient flow across jurisdictions. The cohort study analyzed Alberta’s adult neurosurgical patient data from 2009 to 2019 to explore how patient- and system-level factors relate to ALOS/ELOS rates.

Nine of the 391 screened articles were included in the review. Three main themes emerged influencing neurosurgery inpatient flow: interdisciplinary care pathways, introducing new roles and identification of risk factors. Building on these themes, patient- and system-level factors impacting ALOS/ELOS were explored. ALOS/ELOS rates varied among the five Alberta Health Services zones, with Rural Zone 1 having the highest and significantly different rate. Age, sex, zone and comorbidities significantly accounted for differences in ALOS/ELOS rates (p < 0.001).

Neurosurgery patients in Alberta are experiencing longer hospital stays than expected. Several areas requiring further research have been identified, along with potential strategies to enhance patient care and outcomes.

Functional MRI (fMRI) has proven valuable in presurgical planning for people with brain tumors. However, it is underutilized for patients with epilepsy, likely due to less data on its added clinical value in this population. We reviewed clinical fMRI referrals at the QEII Health Sciences Center (Halifax, Nova Scotia) to determine the impact of fMRI on surgical planning for patients with epilepsy. We focused on reasons for fMRI referrals, findings and clinical decisions based on fMRI findings, as well as postoperative cognitive outcomes.

We conducted a retrospective chart review of patients who underwent fMRI between June 2015 and March 2021.

Language lateralization represented the primary indication for fMRI (100%), with 7.7% of patients also referred for motor and sensory mapping. Language dominance on the side of resection was observed in 12.8% of patients; in 20.5%, activation was adjacent to the proposed resection site. In 18% of patients, fMRI provided an indication for further invasive testing due to the risk of significant cognitive morbidity (e.g., anterograde amnesia). Further invasive testing was avoided based on fMRI findings in 69.2% of patients. Cognitive outcomes based on combined neuropsychological findings and fMRI-determined language dominance were variable.

fMRI in epilepsy was most often required to identify hemispheric language dominance. Although fMRI-determined language dominance was not directly predictive of cognitive outcomes, it helped identify patients at low risk of catastrophic cognitive morbidity and those at high risk who required additional invasive testing.

Many Royal College of Physicians and Surgeons of Canada (RCPSC) graduates in neurosurgery face significant challenges in finding full-time employment. The current study describes the career outcomes of neurosurgery residents from Canadian programs.

All RCPSC neurosurgery graduates (n = 106) who completed their residency between 2015 and 2020 were included in this study. Baseline characteristics were determined for the entire cohort and then stratified by employment status. Several logistic regression models were used to identify predictors of full-time employment after residency.

Overall, 26.4% of neurosurgery graduates from 2015 to 2020 have been underemployed, defined as locum and clinical associate positions (6.6%), the pursuit of multiple fellowships (16%) and career change/nonsurgical career (3.8%). Only 52.0% of graduates were fully employed in Canada, with 30.2% appointed at academic institutions. Skull-base/open vascular (OR: 0.055, 95%CI [<0.01, 0.74]) and general neurosurgery (OR: 0.027, 95% CI [<0.01, 0.61]) fellowships were associated with underemployment. Advanced research degrees (master’s or Ph.D.) and sex were not associated with full-time employment.

Over one-quarter of recent Canadian neurosurgery graduates were underemployed, and nearly half do not find employment in Canada. These results reflect a concerning reality for current and prospective neurosurgery graduates in Canada and will hopefully serve as a call to action for the Canadian neurosurgery community.

Meningiomas are common brain neoplasms that can significantly influence health-related quality of life (HRQOL), yet the factors influencing HRQOL in adult patients remain unclear. We aimed to bridge this knowledge gap by determining these key factors.

We conducted a systematic review, searching EMBASE, MEDLINE, CINAHL, Scopus and PsycINFO up to February 2024. We included original, peer-reviewed studies focusing on adult patients (>18 years) with current or past meningioma at any stage of treatment that measured HRQOL or its proxies in relation to patient-, tumour- and treatment-related factors. Two independent reviewers screened abstracts and full-texts, selecting studies with an acceptable risk of bias for data extraction and narrative synthesis. The protocol of this review was registered on PROSPERO (# CRD42023431097).

Of N = 3002 studies identified, N = 31 studies were included. Key factors found to influence HRQOL in adult meningioma patients include surgery, radiotherapy, neurological function, functional status, comorbidities, sleep quality, psychological impairment, age and employment. Factors related to tumour characteristics yielded inconsistent findings. Heterogeneity and inconsistencies in HRQOL measurement across studies hindered definitive conclusions about the impact of factors on HRQOL.

Our review elucidates the multifaceted influences on HRQOL in meningioma patients, with significant variability due to patient-, tumour- and treatment-related factors. We emphasize the need for standardized, disease-specific HRQOL assessments in meningioma patients. Collaborative efforts towards consistent, large-scale, prospective research are essential to comprehensively understand and improve HRQOL, thereby enhancing tailored care for this population.

Operative cancellations adversely affect patient health and impose resource strain on the healthcare system. Here, our objective was to describe neurosurgical cancellations at five Canadian academic institutions.

The Canadian Neurosurgery Research Collaborative performed a retrospective cohort study capturing neurosurgical procedure cancellation data at five Canadian academic centres, during the period between January 1, 2014 and December 31, 2018. Demographics, procedure type, reason for cancellation, admission status and case acuity were collected. Cancellation rates were compared on the basis of demographic data, procedural data and between centres.

Overall, 7,734 cancellations were captured across five sites. Mean age of the aggregate cohort was 57.1 ± 17.2 years. The overall procedure cancellation rate was 18.2%. The five-year neurosurgical operative cancellation rate differed between Centre 1 and 2 (Centre 1: 25.9%; Centre 2: 13.0%, p = 0.008). Female patients less frequently experienced procedural cancellation. Elective, outpatient and spine procedures were more often cancelled. Reasons for cancellation included surgeon-related factors (28.2%), cancellation for a higher acuity case (23.9%), patient condition (17.2%), other factors (17.0%), resource availability (7.0%), operating room running late (6.4%) and anaesthesia-related (0.3%). When clustered, the reason for cancellation was patient-related in 17.2%, staffing-related in 28.5% and operational or resource-related in 54.3% of cases.

Neurosurgical operative cancellations were common and most often related to operational or resource-related factors. Elective, outpatient and spine procedures were more often cancelled. These findings highlight areas for optimizing efficiency and targeted quality improvement initiatives.