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    Caffeine, Alcohol, and Drug Use as Work Adjuncts Among Neurosurgeons. Prevalence, Contributing Factors, and Proposed Strategies
    (Elsevier Inc., 2024) Karampouga, Maria; Karagianni, Maria; Mihaylova, Stiliana; Aydın, Ayşegül Esen; Salokorpi, Niina; Lambrianou, Xanthoula; Tsianaka, Eleni; Janssen, Insa K.; Duran, Silvia Hernandez; Ivan, Daniela Luminita; Rodríguez-Hernandez, Ana; Broekman, Marike LD.; Gazioğlu, Nurperi; Tasiou, Anastasia; Murphy, Mary
    Background: Neurosurgeons may resort to caffeine, alcohol, and various drugs to maintain peak performance as they grapple with work demands and escalated stress. The prevalence of this controversial strategy remains largely unexplored. Methods: An anonymous survey of 23 questions formulated by our research group was distributed through personal contacts and neurosurgical societies. Inquiries revolved around the use of medications and other substances for job-related reasons. Data were analyzed via regression and descriptive statistics in python. Results: In total, 215 neurosurgeons (43 residents) were included, with 213 disclosing their gender (94 females). Out of all, 9.3% were <30, 38.1% were 30–39, 44.6% were 40–59, and 7.9% were >60 years old. Most (70.7%) practiced in Europe, 18.6% in Asia, 6.5% in North and South America, and the rest in Africa or Australia. While 132 participants stated they consume caffeine to manage challenging schedules, drugs for cognitive and mood enhancement were utilized by 18 and 35 respectively. Alcohol was employed for stress relief by 28 with 4 reporting as heavy drinkers. Drugs posed a solution to sleep disorders for 82, and helped 8 others in strengthening their hand dexterity. Notably, 12 of those claiming drug use initiated it in medical school. Exercise, self-care activities, and relational support were the main alternatives sought. Ultimately, most responders recommended extending mental health assistance and raising awareness about drug use. Conclusions: Reflecting on our results on job-associated drug use by neurosurgeons, we propose the judicious use of pharmacological or nonpharmacological adjuncts, alongside the prioritization of neurosurgeons' well-being. © 2024 Elsevier Inc.
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    The Complexities of Aeronautical Transfer of Acutely Unwell Neurosurgical Patients
    (Elsevier Inc., 2025) Tasiou, Anastasia; Tzerefos, Christos; Karagianni, Maria; Tsianaka, Eleni; Jarratt, Mark; Gazioğlu, Nurperi; Peramatzis, Konstantinos; Broekman, Marike LD.; Rodríguez-Hernández, Ana; Ivan, Daniela L.; Janssen, Insa K.; Karampouga, Maria
    Objective: Neurosurgical care is difficult to access in many scenarios. Aeromedical evacuation of acutely unwell neurosurgical patients from remote, isolated, or poorly equipped locations can be considered. This article aims to provide a framework of logistical factors that deserve special consideration in the preparation of these patients for transfer. Methods: We searched all relevant medical literature, military reports, and travel industry documents on transfer of neurosurgical patients. This review was combined with a senior author's (M.J.) extensive relevant experience, to present important factors for neurosurgeons to consider during planning of aeromedical evacuation, highlighting potential preventable causes of deterioration en route. Results: Several criteria must be met for a transfer to be considered. The safe transfer of patients with craniospinal pathology requires efficient collaboration between the referring teams, the receiving units/departments, and the medical transfer service. Clear communication, qualified personnel, and appropriate transportation equipment must be available for the transfer. One must consider unique stressors during the air transfer, including the risk of hypoxia on certain types of flights. Vibration, loud noise, acceleration, and changes in barometric pressure en route may negatively affect the patient during transfer. Patient stabilization before transfer is a priority. Medical conditions that can potentially worsen in-flight should be corrected before transfer. The use of a checklist before departure is highly recommended and is included herein. The timing of transfer concerning the postoperative patient deserves special consideration. Conclusions: Although there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients. © 2025 The Authors
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    What to expect, when you expect the neurosurgical perspective
    (Churchill livingstone, 2024) Karagianni, Maria; Mihaylova, Stiliana; Tzerefos, Christos; Janssen, Insa K.; Tsianaka, Eleni; Murphy, Mary; Gazioğlu, Nurperi; Broekman, Marike L.D.; Salokorpi, Niina; Karampouga, Maria; Rodríguez-Hernández, Ana; Lambrianou, Xanthoula
    Background: Women in neurosurgery often have to delay pregnancy and child-rearing because the optimum time for having children overlap with an intense period of training and/or career advancement. The purpose of the study is to investigate the personal experiences of women neurosurgeons and understand the complex interaction between pursuing a career and embracing motherhood. Methods: We employed anonymized, semi-structured interviews with women actively involved in the field of neurosurgery. Person-to-person interviews were performed online via video call. Responses were grouped and analyzed with thematic analysis. We identified recurring patterns and insights in the interview responses. Results: We included twenty-one women neurosurgeons, at various career levels. Thematic analysis revealed diverse perspectives. More than half favored a delayed pregnancy announcement. The majority perceived a workplace, social stigma attached to pregnancy. Although most of them reported adequate support from their colleagues, several explained that the support was theoretical rather than practical. Many interviewees expressed their fears about losing their surgical skills, while 57.2% had concerns regarding their physical abilities during or after pregnancy. All but one felt that female neurosurgeons should not postpone or sacrifice motherhood for their career. However, alternative paths within neurosurgery could be an option. Conclusions: Finding a way to combine a career in neurosurgery with pregnancy can be very challenging and may be vital to keep attracting quality professionals to the field. Efforts should be made to maintain the balance between career and home and to facilitate greater flexibility at the workplace for women who are pregnant and/ or child-rearing.