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Evidence from studies that have examined resident influence on the outcome of surgical procedures, in general, is heterogenous. (1-6) This is expected because of the different natures and complexities of [...], Background: The evidence on the benefits and drawbacks of involving neurosurgical residents in the care of patients who undergo neurosurgical procedures is heterogeneous. We assessed the effect of neurosurgical residency programs on the outcomes of such patients in a large single-payer public health care system. Methods: Ten population-based cohorts of adult patients in Ontario who received neurosurgical care from 2013 to 2017 were identified on the basis of procedural codes, and the cohorts were followed in administrative health data sources. Patient outcomes by the status of the treating hospital (with or without a neurosurgical residency program) within each cohort were compared with models adjusted for a priori confounders and with adjusted multilevel models (MLMs) to also account for hospital-level factors. Results: A total of 46 608 neurosurgical procedures were included. Operative time was 8%-30% longer in hospitals with neurosurgical residency programs in 9 out of 10 cohorts. Thirty-day mortality was lower in hospitals with neurosurgical residency programs for aneurysm repair (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.20-0.44), cerebrospinal fluid shunting (OR 0.52, 95% CI 0.34-0.79), intra cerebral hemorrhage evacuation (OR 0.66, 95% CI 0.52-0.84), and posterior lumbar decompression (OR 0.32, 95% CI 0.15-0.65) in adjusted models. The mortality rates remained significantly different only for aneurysm repair (OR 0.19, 95% CI 0.05-0.69) and cerebrospinal shunting (OR 0.42, 95% CI 0.21-0.85) in MLMs. Length of stay was mostly shorter in hospitals with neurosurgical residents, but this finding did not persist in MLMs. Thirty-day reoperation rates did not differ between hospital types in MLMs. For 30-day readmission rates, only extracerebral hematoma decompression was significant in MLMs (OR 1.41, 95% CI 1.07-1.87). Conclusion: Hospitals with neurosurgical residents had longer operative times with similar to better outcomes. Most, but not all, of the differences between hospitals with and without residency programs were explained by hospital-level variables rather than direct effects of residents. Contexte : Les donn es relatives aux avantages et aux inconv nients de la participation des r sidentes et r sidents en neurochirurgie aux interventions de cette sp cialit sont h t rog nes. Nous avons valu l'effet des programmes de r sidence en neurochirurgie sur les r sultats chez les malades concern s au sein d'un volumineux syst me de sant universel payeur unique. M thodes : Dix cohortes populationnelles compos es de malades adultes ayant re u des soins en neurochirurgie en Ontario entre 2013 et 2017 ont t identif es partir des codes d'acte, et suivies au moyen des bases de donn es administratives sur la sant . Les r sultats chez les malades de chaque cohorte selon le statut de leur h pital (offrant ou non un programme de r sidence en neurochirurgie) ont t compar s des mod les ajust s pour tenir compte de variables de confusion a priori, et des mod les multiniveaux ajust s (MMN) pour tenir compte aussi de facteurs propres aux h pitaux. En tout, nous avons inclus 46 608 interventions neurochirurgicales. Le temps op ratoire a t 8%-30% plus long dans les h pitaux offrant un programme de r sidence en neurochirurgie dans 9 cohortes sur 10. La mortalit 30 jours a t moindre dans les h pitaux offrant un programme de r sidence en neuro chirurgie pour les r parations d'an vrisme (rapport des cotes [RC] 0,30, intervalle de confance [IC] de 95% 0,20-0,44), les d rivations du liquide c phalorachidien (RC 0,52, IC de 95% 0,34-0,79), le drainage des h morragies intrac r brales (RC 0,66, IC de 95% 0,52-0,84) et la d compression post rieure lombaire (RC 0,32, IC de 95% 0,15-0,65) dans les mod les ajust s. Les taux de mortalit sont demeur s significativement diff rents uniquement pour les r parations d'an vrisme (RC 0,19, IC de 95% 0,05-0,69) et les d rivations du liquide c phalorachidien (RC 0,42, IC de 95% 0,21-0,85) dans les MMN. La dur e des s jours a t majoritairement moindre dans les h pitaux offrant un programme de r sidence en neurochirurgie, mais cette observation ne se maintenait pas dans les MMN. Les taux de r intervention 30 jours n'ont pas diff r entre les types d'h pitaux dans les MMN. Les taux de r admission 30 jours n'ont t significatifs que pour les cas de d compression d'h matomes extrac r braux dans les MMN (RC 1,41, IC de 95% 1,07-1,87). Conclusion : Les temps op ratoires ont t plus longs dans les h pitaux offrant un programme de r sidence en neurochirurgie, et les r sultats ont t similaires ou meilleurs. La plupart des diff rences entre les h pitaux offrant ou non un programme de r sidence en neurochirurgie ont pu s'expliquer par des variables propres aux h pitaux plus que par un quelconque effet direct des programmes de r sidence en neurochirurgie.

Introduction: Intramedullary metastases to the conus medullaris spinalis (IMCM) pose a rare problem in neurosurgical oncology and are usually encountered as a complicated clinical scenario in the setting of advanced systemic malignancy with poor overall survival. Despite the progress in interdisciplinary oncological care, their management remains complicated. Research Question: We performed a PRISMA-guided literature search to achieve a pooled analysis of all previously reported IMCM cases that contained detailed clinical data on this problem to investigate the currently employed management options and respective outcomes. We obtained a clinical vignette and performed a comprehensive narrative review of IMCM management. Materials and Methods: The PubMed/MEDLINE/Google Scholar, Cochrane and Embase databases were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All relevant publications retrieved were subjected to full-text analysis in detail and pertinent information was extracted. Results: The most common systemic primary tumor site as the origin of IMCM was the lung, followed by the breast. Overall, the pooled median survival was 6 months (range 0.5–36 months). Patients who received both surgery and radiation therapy had the longest overall survival (OS) (mean 9.9 months) and those who received no oncological treatment (neither surgery nor adjuvant therapy) had the shortest OS (mean 3.6 months). In cases where surgical resection was performed as part of the treatment plan for metastases, those with partial tumor resection had a more favorable neurological outcome than patients who underwent aggressive gross total resection. Conclusions: Based on the results of our analysis, we find that diligent microsurgical resection (subtotal or total) followed by radiation therapy appears as an effective and suitable treatment in select patients with IMCM. When surgery is not feasible as part of the treatment algorithm, radiation therapy alone (conventional or radiosurgery) also appears to be a suitable treatment option that confers a benefit to the patient. [ABSTRACT FROM AUTHOR]