Movement disorders (Parkinson’s disease, essential tremor, dystonia) are debilitating, progressive conditions that profoundly impact patients’ quality of life. Surgical therapies, such as deep brain stimulation (DBS) can provide tremendous relief to patients but remain costly and, therefore, limited in availability. It is critical to understand regional barriers to accessing this service to improve access for all patients who may benefit from it.

This is a mixed methods survey of stakeholders (patients/family members, advocacy groups, family physicians, neurologists, neurosurgeons) assessing perceived barriers to DBS for movement disorders. Closed and open-ended questions were used. Descriptive statistics were used to highlight regions of Canada where perceived access is poor and to identify barriers to access.

A total of 220 responses were recorded (12 neurosurgeons, 22 neurologists, 30 family physicians, 153 patients and caregivers and 3 advocacy group personnel). Themes included limited resources/centralization of resources, education, burdensome referral patterns and personal patient factors. Barriers included costs associated with travel, waitlists, lack of specific resources and poor understanding of movement disorders, DBS indications and referral pathways.

A number of barriers to access to DBS have been identified, related to geography and centralization of services, referrals and need for further education of indications and safety. The use of virtual care, centralized referral pathways and further research to determine the true prevalence of candidates for this therapy are required to improve access to DBS for movement disorders in Canada.

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.

Cranioplasty is a commonly performed neurosurgical procedure used to repair defects of the cranial vault. For large defects, 3D printing allows for the creation of patient-specific synthetic cranioplasties. Although these implants provide excellent cosmetic results for patients, costs are quite high. This makes their routine use challenging in the current Canadian healthcare environment. The purpose of this study is to report our experience with a novel, cost-effective method for cranioplasty using desktop 3D printers to manufacture patient-specific molds to aid in the shaping of polymethyl methacrylate (PMMA) cranioplasty intraoperatively.

A retrospective review of patients who underwent cranioplasty utilizing 3D printed custom molds was conducted at a single center between 2018 and 2020. Either a two-piece self-align or open-air mold was utilized. Material cost, as well as demographic, clinical, and radiologic data, was reviewed. A five-point ordinance scale was used to evaluate patient satisfaction with cosmesis.

Four patients had previous craniectomies with infected bone flaps, 2 patients had significant bony destruction from tumor invasion, and 1 patient had bone flap resorption. Three patients underwent an open-air mold technique with a Ti-mesh/PMMA-combined implant. The remaining 4 patients underwent two-piece mold with PMMA-only implant. All patients had ‘Good’ to ‘Excellent’ cosmetic outcome with one post-operative acute subdural hematoma and one post-operative infection. Two-piece mold resulted in improved cosmetic outcome and cost savings.

3D printing can be used in a cost-effective manner to deliver good cranioplasty cosmesis. Wider adoption of this technique can result in significant healthcare cost savings without compromising patient outcome.