SUMMARY; See Part 1 summary

SUMMARY: Parts 1 & 2. “Let’s Talk” Discussion on the topic of “Women in Neurosurgery”. In a wide-ranging discussion with a panel of women and men neurosurgeons, the challenges faced by women (and men) choosing neurosurgery as a career are discussed. Drs. Nancy Epstein, Kathrin Whitehouse, Saqiba Jadoon, Eric and Leslie Nussbaum and James Ausman, provide their perspectives on a number of questions submitted by an audience of young neurosurgeons, residents, and medical students. Are women better neurosurgeons than men? Do women have more empathy? Are they technically better? What is the Imposter Syndrome? (Should I be here?)

Who is your competition? How do you balance family life and medical obligations? Should you have children before you compete your residency? Should the state pay for childcare for your children? Should you FAKE IT TILL YOU MAKE IT? What comes first ? your job, your spouse, your children, your pet, studying, the patient? How do you balance all of these obligations. Can you be the best neurosurgeon? What does it take? Are you happy? Is money your goal? John F. Kennedy (President of USA in the 1960s) said  “Ask not what your country can do for you, what can you do for your country?” Do you believe this? What if you do not? What if everyone does not? Does Socialistic thinking affect your career, choices, motivation, commitment?

Should you get training outside your country? What does the patient want from you as a doctor? Is the patient important as a person or just a number? What is your unwritten contract with the patient? What would you expect from the doctor if you were the patient? Would you expect the best doctor? One who tells you the Truth and is Competent? In today’s society? 

Comments from the audience: “Amazing discussion, diverse panel, open, candid, honestly refreshing, have we been deceived by socialism? enlightening, breadth I don’t really get in other webinars, rare to hear neurosurgeons speak so openly about culture, bias, and things that do not get acknowledged in training, inspiring, liked roundtable discussion, greatly overdue, not afraid to agree or disagree with each other, fantastic……Very popular. And much more for 90 minutes. Part 1 is 48 minutes and Part 2 is 60 minutes. Excellent for Podcast and Video on snidigital.org (JIA) 

SUMMARY: Management of Clival Chordoma and giant Anterior and Middle Fossa Meningiomas: How we do it. From UC Irvine Skull Base Surgery Team; Frank Hsu, Edward Kuan, Dennis Malkasian; Alexander Himstead. CHORDOMA: history and examination; outstanding imaging, preoperative planning; Anatomical Diagrams, Choosing best approach to eliminate complications, endoscopy, microsurgery techniques, when to stop surgery, how to deal with tumor remnant; meticulous closure, post operative management. Excellent outcome. Discussion of molecular and genetic basis of chordomas and future treatments. (40 minutes with discussion). 

GIANT ANTERIOR AND MIDDLE FOSSA MENINGIOMA: Subtile clinical presentation; imaging and interpretation, preoperative planning, angiography, embolization options, surgical strategy attacking blood supply, dissection and removal of tumor; closure, post operative management. What neural deficits did the patient actually have in retrospect. How do we measure impaired cerebral function? Our limited ability, as neurosurgeons, to understand neurological impairments. Imaging does not describe function; why the classic neurological examination can reveal what we miss as surgeons. Are these subtile deficits crucial to the patient? What would you be like if you had subtile neurological deficits? Could you function as a neurosurgeon? Could AI help in providing that information? Does fiber tract imaging tell us the answer? No. Is detailed neuropsychological testing important? What we do not know and what can we do better? Is Excellence your goal? (20 minutes with discussion). (JIA)

SUMMARY: Drs Frank Hsu, Head of Neurosurgery at UC Irvine; Edward Kuan Professor of Otolaryngology and Co-director of the Comprehensive Skull Base program; Dennis Malkasian, Neurosurgeon, Molecular Biologist, and Anatomist, and Alexander Himstead, PGY 4 in Neurosurgery, moderated by Dr. Ausman, have an intergenerational discussion on the Present and Future of Skull Base surgery. The panel’s ages range from 30 to 80’s with a wide surgical experience. The field has grown from the gross removal of these tumors in complex locations to using minimal retraction, different corridors to reach the lesion, using advancing technology, and better understanding of the biology of the lesions to quality of life considerations and multimodality treatment. 

With about 17,000 new primary brain tumors a year of which ~25% are acoustic and pituitary lesions, and 110 academic programs in the USA with skull base programs, are there enough cases to train competent skull base surgeons for the future? How is over-treatment controlled? Are Multi-Disciplinary teams of specialists the future of Skull base surgery? What are the limits of surgery? Is Proton Beam therapy with focused radiation only on the lesion, the future? What about the biology of the neoplasm? Will molecular treatments limit the use of surgery? NF2 acoustics have a genetic abnormality as do chordomas. Will DNA, RNA, or protein manipulation be the future? Should this interdisciplinary approach to managing complex medical problems be suited for academia rather than competing with the practicing physicians over routine cases? Should geneticists be part of a multidisciplinary team to mange these lesions? Will expansion into orbital lesions add a new dimension to the field? Is total removal the goal or quality of life and limited morbidity? When does a surgeon stop and why? In acoustic neuromas, is subtotal removal followed by radiation, sparing a 7th nerve deficit, lead to better outcomes? How aggressive should we be with benign disease? 

Do multidisciplinary teams have better outcomes? How are diverse people in these teams to be compensated? Are Skull Base fellowships filled, and what is the future for the young surgeon? How will advancing technology with 3D imaging, MR 7-Tesla angiography and detailed imaging change skull base surgery? Is the future more sub-specialization where we know more and more about less and less be satisfying? Will surgery be eliminated as a treatment by 2100? 85% of diseases in the world occur in 85% of the population that lives in developing countries. How can these advances be brought to billions of people who have no access to them? Is the high cost of treating these lesions justified? Because skull based lesions are fixed, image guided surgery can avoid brain shift and allow better imaging at surgery. Does technology make a better surgeon or is good surgical judgment an essential component of success? How do you teach Judgment? What is the importance of the anatomy laboratory in refining the surgeons knowledge to utilize all modalities at his/her disposal? Can AI solve all these questions? Is an excellent patient outcome the goal over surgical or other treatments? 

What are your answers to these questions which are fundamental to all of Medicine? Who is thinking about all of these factors and planning for the future? An outstanding discussion with many pearls of wisdom. See the upcoming video on the UCI team’s approach to chordomas and large meningiomas. How are all the above considerations used in the treatment of the patient? (60 minutes) Excellent for Video and Podcast. (JIA) 

SUMMARY: WHAT IS YOUR FUTURE?

AN INTERVIEW WITH DR. DAVID HUGHES ON WW III, OR OMNIWAR, -

A FIGHT OF CENTRAL CONTROL VS INDIVIDUAL LIBERTY.  WHAT IT MEANS TO YOU. PART 1 

SUMMARY Part 1: At the time of the 1930s there was the Great Economic Depression and the rise of Naziism in Germany and Communism in the Soviet Union. In the 1930s, the “elitest” segment of the population, decided to create a “perfect society” to avoid what they considered the social and economic problems of that time. Concurrently, the wealthy “elite” controlled giant businesses and subsequently had developed significant influence over US government and the world governments, as well. They not only wanted to grow and preserve their own wealth and influence into the future, but they also desired to create a “New World Order”. In fact, this “New World Order” was introduced over 100 years earlier and carefully described in philosophical/political writings at that time. They had no faith that the people, in any way, were smart enough or technologically savvy enough to meet the coming challenges these elite envisioned globally. The elitists believed that the timing was conducive to launch the New World Order.”

In 1930’s technology began to emerge which would provide a means to influence the future. Over the succeeding decades, technological developments allowed everyone and everything to be interconnected, digitized, and controlled ‘from the molecular level of the cell to the stratosphere’. Research advances in technology allowed unprecedented control of the brain, an ability to produce vision in the blind, movement in paralyzed people, and eventually mind control. Technology became a tool to achieve a utopian society and was pursued largely outside of government by Non-Government Organizations (NGOs). Military technological research was conducted under the guise of ‘protecting the Nation’. It appears that this research and these organizations were supported by funds (the missing $21 trillion dollars) taken from the US Government resources (from taxpayer monies) and by money from the rich “elite” behind this utopian idea. 

These para-governmental organizations and influential people outside of government needed to destroy the existing governing systems to establish their totalitarian, technocratic system that would eventually control everything and erase personal privacy by extensive surveillance of the population. In a World Economic Forum chart, control of everything is listed except the local governments and religion. A Transnational Deep State using a Global Digital Network would be in total control of people and their privacy. Technical advances would be used to gather private personal information so that individual’s data including, medical, personal and economic, would be exposed and as a result, individual privacy would be lost. 

Dr. David Hughes, an expert in psychological warfare and technocracy, describes this as World War III, or an Omniwar for power and money, fought at multiple levels in society.  In the 1970s supported by David Rockefeller of the Rockefeller Foundation, who advocated a one world government, Communist China has become an example of a total Technocratic State, with subjugation of its population. The Ukraine-Russia war provided an opportunity to digitize all the state records of everything, as a first step in the West, leading to actual digitized states and a world of central government control. The democratic governments of the USA and Israel were opposed by the Transnational Deep State as Free Democracies in opposition its New World Order concept. The unprovoked October 7 attack on Isreal by Hamas and the neighboring Arab countries elicited a devastating counterattack by Isreal using advanced technology to defend itself against extermination by its enemies. This was a message of resistance to the New World Order in the use of technology for defense. 

In 2020 the Covid-19 false pandemic, first simulated in a computer trial in 2019, under the guidance of Bill Gates as a plan to thwart predicted future pandemics. The benign Covid Virus was unleashed on the public in China. However, the inadequately tested Covid Vaccine which followed, resulted in 20 million deaths in a world of 8 billion people, with many additional injured for life. This series of events demonstrated that the people would willingly surrender their freedoms in the face of a carefully crafted, programmed fear. The Covid-19 false pandemic was the largest major psychological operation against people in history and was initiated by coordinated international government activity and compliance. This series of events was unlikely to have been accidental. Who was behind this deeply organized transnational effort has never been revealed for obvious reasons of gross treason and murder.  

Presently, with the growing threat of AI, there is a concern that decisions could be made by machines, and not people, eliminating laws and regulations based on Constitutional mandates. This would be the end of politics as we know it.  In this Technocracy, people are irrelevant and dispensable. Dr. Hughes provides many examples to support this scenario, many of which are taking place in China today. These concerns were raised in this discussion between David Hughes and Dr. Blaylock as moderator, with Dr. Ausman, and Dr. Kaplan. Hughes’ book, “Covid-19”, Psychological Operations, and the War for Technocracy, Vol I, discusses the present “Omniwar” and is filled with excellent information. He also has three videos discussing this Omniwar with other experts in the field. (80 minutes of Discussion in each) (80 MINUTES -DISCUSSION) 

James I. Ausman and Russell L. Blaylock 

SUMMARY: Professor Chika Ndubuisi, Acting Head of Neurosurgery at Memfys Hospital in Enugu, Nigeria explains his groups experience with the management of Giant pituitary tumors (Ademonas) at his hospital. There are difficulties in some of the transmission but his message comes across on how to handle these cases. An active discussion follows that is informative. 41 minutes. Ok for video but some audio troubled for Podcasts. (JIA)

SUMMARY: At the 17th Monthly SubSaharan International Neurosurgery Grand Rounds meeting, the subject of the Management of Giant Brain tumors was discussed. These tumors are seen all over the world, usually related to people seeking medical care late in the disease. Dr. Eric Nussbaum, who has treated a number of these patents from outside the USA describes his experience with a patient who had a Giant Osteogenic Sarcoma and a second with an ossifying fibroma and Fibrous Dysplasia. Fibrous Dysphasia is a rare bone condition that happens when abnormal fibrous (scar-like) tissue replaces healthy bone tissue. It is not hereditary but is related to a GNAS1 gene changes after conception. This genetic change affects the osteoblasts.  Major deformities occur as a result of this disease. See how Eric managed these diseases. What would you do? The widely known and respected African Professor Nim Juniahs Mwang'ombe of Kenya, makes some excellent comments on his experience with these tumors. Excellent for video and OK for Podcast, but the images must be seen to be appreciated. With the rise in Medical Tourism, patients with these types of lesions are treated locally and in countries in the developing world for less cost than in the USA. (A message for the developed countries as a trend for the future) (70 minutes presentation and discussion) First rate. (JIA) 

SUMMARY. Another interview with a successful Neurosurgeon-scientist you would never see or hear elsewhere. Dr Richard Ellenbogen is interviewed by Dr. James Ausman about how he got into Medicine, Neurosurgery, his time as Chair at Walter Reed Hospital, in the armed services. He now is Head of a large successful Department of Neurosurgery at the University of Washington, Seattle, that is highly ranked with outstanding people on faculty. Listen to what he considers important for success in Medicine and Life; How to work with people successfully; What he thinks about the future of Neurosurgery; and how important Soul is to a physician. The interview will grab your attention. Good tips for everyone. Well worth 60 minutes. Excellent for Podcasts and Video (JIA)

SUMMARY: Dr. Ramsis Ghaly, with Board certification as a Neurosurgeon, Anesthesiologist; Critical Care Specialist and Pain Medicine Specialist presents a complicated case of a woman who had multiple spine operations and cervical and lumbar fusions for back pain without relief. She became addicted to drugs for the pain. When she was seen by Dr. Ghaly he stopped her drugs, used spinal cord stimulation for her pain and she returned to work. The case is an example of how pain medicine treatments can be abused, patients harmed, and diagnosed a failed back syndrome. Dr. Ghaly reviews the entire spectrum of Drugs used to treat Chronic Pain and their complications; drugs of choice and the invasive treatments now being performed by pain specialists. globally. Dr. Banson, who is from Ghana, also specializes in Pain Management and describes the multiple treatment centers established in Ghana for patients with chronic pain problems. This is an outstanding review of the subject of Chronic Pain and its Management. As other specialists assume the invasive treatments, the potential for patient harm rises. Dr. Ghaly suggests a solution for this growing problem. Total presentation by two specialists 2 hours. Dr. Ghaly's talk could have been divided into 3 of 4 parts but I chose to present them together for continuity. Excellent for Video for Podcast (JIA)

SUMMARY: Drs Asif and Qasim Bashir with the mentoring of Dr Ghaus Malik, describe how they built a First Rate Stroke Center and Neuroscience Center in Punjab, Pakistan for 160 million people. Combining the needs of of the private sector with those of the large public population and using government and private funds, they have developed a leading practice, research and educational program that is a model for those in the LMIC. 85% of the world's population and 85% of global disease occurs in the LMIC. This program is an example of why the centers of disease management will shift from the HIC to the LMIC where billions of the world's population reside. It also describes how to attract and use public and private funds to address the health needs of the country. Both centers are being used as training grounds for those in the HIC, who do not have access to large volumes of clinical experience or for less costly but quality care medicine. (2 hours of Presentations and Discussions). Videos and Podcasts are also available in separate sections for independent viewing and listening. A must see and hear for those worldwide as an example of the future in Healthcare. Excellent for video or Podcast (JIA)