Shelly D. Timmons

Grief is an under-recognized yet pervasive experience in neurosurgery, arising not only from the death of patients and loved ones but also from losses related to professional identity, health, and personal relationships. Despite its relevance, grief is often conflated with burnout or overlooked entirely within surgical culture. When personal adversity strikes, such as loss, illness, or major life upheaval, the intensity of neurosurgical practice can amplify these challenges, influencing professional identity, performance, and overall resilience. As the field continues to evolve and diversify, it is increasingly important to foster open dialogue about vulnerability, personal hardship, and life beyond the operating room. This perspective examines how neurosurgeons experience and process loss, distinguishing grief from burnout and resilience, and highlighting the need for institutional and cultural change.

To support the development of the National Trauma Research Repository (NTRR), a multidisciplinary workgroup used a consensus-driven approach to review established acute hospital-based trauma care data elements and recommend common data elements (CDEs) for inclusion in the NTRR data dictionary. A 14-member workgroup of military and civilian trauma researchers and data scientists located and reviewed databases, codebooks, data collection forms and published articles for trauma data elements relevant to the acute hospital-based trauma care environment. Identified data elements were reviewed in a three-round Delphi survey and monthly meetings with the workgroup were conducted. Consensus during the Delphi survey was defined by an 80% agreement threshold. 31 sources were reviewed for acute hospital-based trauma care data elements. After the three rounds and workgroup discussions, 62 elements (90%) reached consensus for inclusion, 2 elements (3%) were excluded, and 5 elements (7%) did not reach consensus. After final workgroup discussions, 61 elements were recommended for adoption in the NTRR The Delphi process proved effective in achieving expert consensus on data elements for acute hospital-based trauma care research. The resulting standardized CDEs will improve data harmonization and support consistent data collection in trauma research. These CDEs represent an initial framework and serve as a foundational starting point for acute hospital-based trauma care data collection within the NTRR. As researchers use the NTRR, the list of CDEs will grow and evolve to meet the needs of the trauma research community. VII.

"Editorial. Female authorship in neurosurgical journals: what remains to be done" published on Mar 2021 by American Association of Neurological Surgeons.

"Introduction. International women leaders in neurosurgery: past, present, and future" published on Mar 2021 by American Association of Neurological Surgeons.

Persistent post‐concussion symptoms (PCS) after a mild traumatic brain injury (mTBI) or concussion do not occur in the majority of patients sustaining such injuries, but when they do occur, they have significant functional consequences for patients. Delays in return to school, work, recreational, and social activities can deeply impact quality of life and have major long‐term negative life consequences that are anything but mild, despite the classification of the initial injury. Predictive abilities to determine which patients will suffer PCS are currently poor, although certain presentation characteristics may be associated, such as age at injury, the occurrence and timing of prior concussions, the mechanism of injury, and others. Research into utilization of various biomarkers as predictive tools is underway but clear answers are still forthcoming.

Background Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place. Methods Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting. Results We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms. Conclusions These protocols are intended to assist clinicians in the management of patients with both ICP and brain oxygen monitors but they do not reflect either a standard-of-care or a substitute for thoughtful individualized management. These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference.

The 2019 scientific meeting of the American Association of Neurological Surgeons (AANS) focused on the theme “The Science of Practice.” In her presidential address, 2018 AANS President Shelly Timmons discusses evolutions in medical and surgical practice, and explores how current technologies can be used to advance knowledge through thoughtful analyses of clinical observations and experiences.

Background Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation’s sTBI Management Guidelines, as they were not evidence-based. Methods We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists’ decision tendencies were the focus of recommendations. Results We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination. Conclusions Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.