Samuel Moscovici

Introduction The World Federation of Neurosurgical Societies (WFNS) Young Neurosurgeons Committee conducted a global survey to identify key challenges affecting early-career neurosurgeons. These challenges ranging from restricted access to advanced training and limited research funding to insufficient mentorship, work-life imbalance, and experiences of gender and racial bias pose significant obstacles to professional growth and equitable neurosurgical development worldwide. Methods A cross-sectional, web-based survey comprising 49 structured and open-ended questions was disseminated through neurosurgical networks, mailing lists, and social media. The target group included neurosurgeons within 10 years of completing residency. Data were analyzed using descriptive statistics for quantitative responses and thematic analysis for qualitative insights. Results Of the 500 respondents, 56.1% reported limited access to advanced training, 50.6% highlighted insufficient funding opportunities, and 48.2% cited a lack of mentorship. Work-life balance was a major concern for 87.1% of participants. Reports of gender and racial/ethnic bias were noted by 40.5% and 22.4% of respondents, respectively. While most participants worked in public hospitals, institutional support for career development varied considerably. Key recommendations included structured mentorship, equitable resource distribution, improved training access, flexible work policies, and targeted strategies to promote diversity and inclusion. Conclusion The findings underscore persistent structural and institutional barriers confronting young neurosurgeons globally. Addressing these challenges through coordinated strategies including mentorship networks, funding reforms, international collaborations, and inclusive leadership policies is essential to cultivating the next generation of neurosurgical leaders and ensuring equitable progress in the field.

Intracranial epidermoid cysts are considered benign tumors with good general prognosis. However, their radical removal may be associated with certain morbidity, especially when the capsule is attached to neurovascular structures. Epidermoid cysts located in the cavernous sinus are very rare. We present an operative video of a 22-year-old female patient, who suffered a right-sided headache for 5 years. The video demonstrates main steps and surgical nuances of resection of a right interdural cavernous sinus epidermoid cyst, measuring 22 × 19 × 21 mm (4.3 cc) (Fig. 1A). On initial physical examination, the patient had a right partial third nerve palsy (mild ptosis with minimal diplopia), without any other cranial nerve deficit. A right no-keyhole pterional craniotomy was performed, followed by extradural anterior clinoidectomy and peeling of the outer dural layer of the lateral wall of the cavernous sinus. The dura matter was also detached from the distal carotid dural ring, which was exposed by the clinoidectomy (Fig. 2A). This maneuver provided excellent exposure of the interdural epidermoid cyst, which severely compressed the oculomotor nerve against the posterior petroclinoid dural fold (Fig. 2B). Gross total resection of the epidermoid cyst was achieved (Fig. 1B and C). The patient developed a transient worsening of the third nerve palsy, which recovered completely 3 months after the surgery. Postoperative magnetic resonance imaging revealed no signs of residual tumor.The link to the video can be found at: https://youtu.be/pobhYb5ZNig.

Background Hemangioblastomas (HGBs) are highly vascular benign tumors, commonly located in the posterior fossa, and 80% of them are sporadic. Patients usually present with features of raised intracranial pressure and cerebellar symptoms. HGB can be classified as either mostly cystic or solids. Although the solid component is highly vascularized, aneurysm or hemorrhagic presentation is rarely described, having catastrophic results. Methods We identified 32 consecutive patients with posterior fossa HBG who underwent surgery from 2008 through 2020 at our medical center. Tumors were classified as predominantly cystic or solid according to radiological features. Resection was defined as gross total (GTR) or subtotal (STR). Results During the study period, 32 posterior fossa HGBs were resected. There were 26 cerebellar lesions and 4 medullar lesions, and in 2 patients, both structures were affected. Predominant cystic tumors were seen in 15 patients and solids in 17. Preoperative digital subtraction angiography (DSA) was performed in 8 patients with solid tumors, and 4 showed tumor-related aneurysms. Embolization of the tumors was performed in 6 patients, including the four tumor-related aneurysms. GTR was achieved in 29 tumors (91%), and subtotal resection in 3 (9%). Three patients had postoperative lower cranial nerve palsy. Functional status was stable in 5 patients (16%), improved in 24 (75%), and 3 patients (9%) deteriorated. One patient died 2 months after the surgery. Two tumors recurred and underwent a second surgery achieving GTR. The mean follow-up was 42.7 months (SD ± 51.0 months). Conclusions Predominant cystic HGB is usually easily treated as the surgery is straightforward. Those with a solid predominance present a more complex challenge sharing features similar to arteriovenous malformations. Given the important vascular association of solid predominance HGB with these added risk factors, the preoperative assessment should include DSA, as in arteriovenous malformations, and endovascular intervention should be considered before surgery.