Patients undergoing craniotomy experience a higher risk of seizures in the ensuing months. Consensus is lacking regarding the appropriate timeframe for safe return to driving following craniotomy in patients not otherwise limited by neurological deficits or a history of epilepsy.

The Canadian Neurosurgery Research Collaborative (CNRC) distributed an anonymous, voluntary, electronic cross-sectional survey via SurveyMonkey to Canadian neurosurgeons. The survey comprised 16 questions designed to assess practice variations regarding recommendations for return to driving following craniotomy, stratified according to pathological diagnosis.

Forty-eight Canadian neurosurgeons responded to the survey. Driving recommendations varied greatly, with most surgeons recommending return to driving within one month of the craniotomy. The rationale behind these restrictions varied widely, consistent with the lack of evidence-based data to guide decision-making.

This study emphasizes the lack of standardized practices regarding return to driving recommendations for patients undergoing craniotomy without prior seizures. Development of national return to driving guidelines would assist Canadian clinicians in making informed decisions regarding the optimal timeframe for the safe return to driving.

Patients undergoing craniotomy experience a higher risk of seizures in the ensuing months. Consensus is lacking regarding the appropriate timeframe for safe return to driving following craniotomy in patients not otherwise limited by neurological deficits or a history of epilepsy.

We performed a systematic literature review on driving recommendations post-craniotomy. We then performed a scoping review on the risk of seizure post-craniotomy and used risk calculations and accepted risk thresholds from the epilepsy literature to develop an evidence-based approach to driving recommendations post-craniotomy.

The systematic review of driving recommendations revealed national guidelines (the United Kingdom, New Zealand, Australia). We transposed risk calculations and accepted risk thresholds from the epilepsy literature (accident risk ratio [ARR] < 2; chance of occurrence of a seizure in the next year < 20%) to patients who undergo a craniotomy. Using data from a large meta-analysis of seizure risk post-craniotomy, we calculated ARRs for various underlying pathologies at different postoperative timepoints and compared them with accepted risk thresholds from the epilepsy literature. We determine that patients who undergo a craniotomy for a higher-risk condition (like high-grade glioma) may resume driving after at least 1 month without seizure, whereas those patients undergoing a craniotomy for lower-risk conditions (like infratentorial pathology) may resume driving without consideration for the risk of seizure.

This systematic review of the literature and evidence-based approach to risk threshold calculations derived from the epilepsy literature provides a preliminary framework to guide clinicians regarding recommendations for return to driving following craniotomy.

Cerebrospinal fluid diversion via ventriculoperitoneal (VP) shunting is the mainstay treatment for hydrocephalus. Traditionally, neurosurgeons place the abdominal catheter through abdominal incision, which has become an efficient and standardized technique. This approach carries a 10–30% complication rate, including infection, catheter obstruction, misplacement, hemorrhage and post-operative pain. Laparoscopic assistance (LA) is an emerging alternative to mini-laparotomy, with potential benefits including reduced distal catheter malplacement and shorter operative times. Most investigations on LA are limited to single centers, with no data from Canada. This study aims to identify practice patterns in VP shunting within a Canadian context.

Practicing Canadian neurosurgeons were surveyed using a modified Delphi methodology. The survey was distributed to practicing neurosurgeons via the Canadian Neurosurgical Society and the Canadian Neurosurgery Research Collaborative.

Across two rounds, 36 neurosurgeons participated, representing all provinces with academic neurosurgical centers. Consensus was reached on five out of eight topics. Findings revealed that 65.5% of respondents had experience with LA, and 93% believed it reduced distal catheter malposition. Infection (77.8%), distal catheter obstruction (82.9%) and proximal obstruction (69.4%) were identified as the most common complications, each occurring in up to 10% of cases. In total, 71% anticipated eventual reduced operative times with increased LA experience.

Canadian neurosurgeons did not identify major barriers to LA beyond personal preference. LA is expected to improve distal catheter placement, though its broader benefits remain uncertain. Patient comorbidities were considered a greater risk factor for complications than surgical technique alone.

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.