Neurosurgery is lagging behind other surgical subspecialties in the recruitment of a more diverse physician workforce. The objective of this study was to explore the positive and negative factors affecting women's choice to pursue a career in neurosurgery. A self-administered questionnaire comprising 13 Likert-type questions was used to conduct this cross-sectional survey of medical students. A total of 266 medical students (147 females, 119 males) completed the questionnaire. Fewer female students (38%) than male students (45%) indicated that "neurosurgery is a demanding specialty for women" (P < 0.05). Furthermore, while 46% of the female students indicated that "women face inequality in neurosurgery," only 20% of their male counterparts agreed with this statement (P < 0.001). In addition, 78% of the females disagreed with the assertion that women's physical endurance is insufficient for neurosurgery, but only 53% of the men expressed the same views (P < 0.001). Twenty-three percent of the male students and 29% of the female students perceived the prevalence of a boys' club mentality in neurosurgery (P < 0.05). Moreover, 35% of the female students agreed that female neurosurgeons experience the glass ceiling syndrome, while only 18% of the male students held this opinion (P < 0.001). This study shows that students-regardless of gender-strongly believe neurosurgery residency training affects women's family lives more negatively than men's. While most participants rejected the idea that women lack the physical endurance for neurosurgery, female students perceived a glass ceiling and gender inequality in the field.

Digestive system perforations after anterior cervical spine surgery (ACSS), if left untreated, are life-threatening. These injuries are often categorized as pharyngoesophageal. Although the pharynx and esophagus are continuations of each other, they are two distinct anatomical structures. There is limited experience in managing patients with pharyngeal injuries after ACSS. Using PRISMA guidelines, a PubMed search was conducted on the iatrogenic pharyngeal perforations after ACSS for the treatment of disc herniation and degenerative cervical myeloradiculopathy. A total of 12 patients met our inclusion criteria. Eleven were from published studies, and one was our patient (2 female and 10 male, mean age = 56.25 years, range: 31–82 years). Clinical symptoms of patients with iatrogenic pharyngeal perforation after ACSS varied depending on whether the cases present early or late after surgery. Although clinical symptoms suggested a pharynx or esophageal injury, definitive diagnosis was challenging. All cases diagnosed either early or late after ACSS underwent surgical repair treatment, except for one case managed conservatively with antibiotics and nasogastric feeding. The overall outcome was favorable for all patients. However, the postoperative follow-up duration was not specified in two cases. In the remaining 10 cases, postoperative follow-up durations were generally short and varied significantly (mean = 4.87 months, median = 1.75 months, range:1 week–24 months). Iatrogenic pharyngeal injuries resulting from ACSS are extremely rare. They are relatively straightforward to diagnose and can be managed with a multidisciplinary approach. However, their long-term prognosis remains unknown.

Extradural anterior clinoidectomy is increasingly used to improve exposure and proximal vascular control in aneurysm surgery, but its isolated effect on an otherwise uncompromised optic nerve remains unclear. To evaluate the functional, structural, and electrophysiological impact of EAC with optic canal unroofing in patients without preoperative optic nerve compression or optic canal pathology. We conducted this single-center study included 16 adults who underwent no-drill extradural anterior clinoidectomy (EAC) during microsurgical clipping of ruptured aneurysms (January 2023–December 2024). Patients with visual or optic pathway pathology were excluded. Postoperative assessment (6–12 months) included visual acuity, automated perimetry (visual field index, VFI), OCT–derived retinal nerve fiber layer (RNFL) thickness, and visual evoked potentials (P100 latency). Eyes were compared using paired tests, with repeated-measures ANOVA for quadrant-based ΔRNFL. Visual acuity was preserved in all patients. Global RNFL thickness was similar in ipsilateral and contralateral eyes (95.8 ± 12.7 vs. 99.2 ± 18.6 μm; p = 0.230). Quadrant ΔRNFL varied by quadrant, but no pairwise differences remained after correction, with a trend toward greater thinning in the superior quadrant. VFI was similar (p = 0.7); one patient had inferior nasal quadrantanopia and two had mild blind-spot enlargement. P100 latency was comparable (114.8 ± 9.7 ms vs. 113.8 ± 8.9 ms; p = 0.223). No major EAC-related neurovascular complications were observed. Extradural anterior clinoidectomy was not associated with statistically significant optic nerve impairment, although visual field changes occurred in 3/16 patients (18.75%) with a trend toward superior RNFL thinning.

In recent years, the frequency of surgery due to lumbar degenerative disorders has increased. Thoracic spinal tumors are susceptible to delayed diagnosis because their symptoms often overlap with those of lumbar degenerative disorders. Studies have shown that the time from symptom onset to diagnosis in intraspinal meningiomas averages 6-23 months, with delays of up to 14 years reported. Similarly, we observed delayed diagnosis in four female patients with thoracic intraspinal masses in the past year. Two patients were 75 years old, and the others were 71 and 57 years old. Their symptoms had been present for 1, 2, 3, and 6 years, respectively. Since spinal meningiomas occur more frequently in women, typically between the ages of 49-54, and predominantly in the thoracic region, careful history taking, physical examination, and appropriate radiological evaluation in elderly female patients with back pain and lower extremity symptoms may help avoid overtreatment.