This is Dr. James Liu from Rutgers University, RWJBarnabas Health, and I'll be talking about the benefits of utilizing video platforms and how to edit videos to broaden your social media impact. I have no disclosures. Videos can make a significant impact in your social media engagement, particularly in neurosurgery. Why is that? Because videos are more attractive to the eyes, and neurosurgery is a very visual specialty. They are the most interactive type of content available on the internet and play a critical role in your online branding. Videos often get more attention than still photos or blog posts, and more than 50% of people who visit Facebook every day watch at least one video, so it's a faster way of communicating information than through a long, detailed, written post. Videos also show that they have a higher response rate and can also increase your credibility and trustworthiness, and therefore videos can also establish you as an expert in the field once your content is credible and trustworthy. Why is video exploding on social media in 2020? While views of branded video content have increased by 99% on YouTube and 258% on Facebook between 2016 and 2017, when a video is tweeted, it is six times more likely to be retweeted than a simple photograph. Facebook has the largest audience of any social network, more than 2.07 billion monthly active viewers, and around 100 million hours of video watched each day. And of course, YouTube has over 1 billion hours of video watched daily in 88 countries in 76 languages, and has the second largest search engine after Google. Instagram has 800 million monthly actives, 500 million daily actives, and 250 million daily stories. Video communicates more insight, sound, and feeling than words or images alone. Audiences love videos, especially in neurosurgery, particularly practitioners, trainees, and patients. In summary, it has a higher visibility and engagement. Here is a recent article from the Toronto Group showing YouTube as a source of information in neurosurgery, particularly as an educational and promotional platform. The types of videos you can find are educational videos targeted for patients, marketing videos promoting your practice, videos of webinars and lectures that have been recorded and posted, and of course, operative surgical videos that demonstrate technical procedures and technical nuances. You can often find these as short video clips or formal video manuscript publications found in peer-reviewed journals. Here are some videos I found on YouTube. Some of these are patient education videos describing a particular disease. Sometimes you can find patient stories or experiences that are often promotional videos of a practice, webinar lecture videos that were recorded, and of course, operative surgical videos. It's important to know that all videos posted here promote your brand and practice, and these YouTube videos can also be linked to all other social media platforms, thereby driving traffic back to the YouTube site. You can find a myriad of operative videos posted by individual practitioners as well as surgical journals. This is an operative video that I published in Neurosurgical Focus on the telovelar approach for fourth ventricular tumor. This was initially tweeted by Journal of Neurosurgery that I was able to retweet on my site, ended up getting 112 likes and 42 retweets. You can also post a video directly to Twitter using short video clips, roughly about one minute. This video clip was bootlegged from my laptop using my iPhone, taking a short video clip of a surgical procedure of a glomus tumor that I removed, and this was used to promote my lecture just hours before the North American Skull Base Society meeting, and it resulted in a large audience that was standing room only. This also ended up getting 732 views on Twitter and 829 views on Instagram. I also added a little music for a little flavor. Here's another short video clip of a parasagittal meningioma. This video was shot with my iPhone, and the voiceover was from the live captured clips. You can hear the surgeons talking in the background, and this is very easy to do. You can edit this on your iPhone with the iMovie app. The sights and sounds of the suctions and instrumentation give this a live surgery effect, and of course, don't forget to capture the aha moment where the tumor comes out and goes into the bucket. This is a one-minute clip of a three-headed aneurysm that I treated. I made this graphic on Instagram, which allows you to label your still images and create GIFs where you see this dragon breathing fire for fun, but once I made this still, I was then able to add it to my photo and edit it on iMovie. Again, these clips were captured bootleg from my iPhone held to the microscope display. I added a little music to engage the audience. Here you can see the three aneurysms coming off the ACOM complex done through a right tereonal approach. The initial clip is a fenestrated clip to preserve the flow through the ipsilateral A2, and then a secondary clip to close off the remainder of the aneurysm. Here's the second aneurysm using a bayoneted clip to gather the wide-necked aneurysm. This was a dual ACOM, a fenestrated ACOM, so here's the third aneurysm coming off the fenestrated ACOM. The flow is confirmed with yellow 560 and icy green with a post-op CT angiogram showing patency of the ACOM complex and triplicate A2 vessels. Here's a nice comment from Dr. Pascal Jabbour with over 1,000 views on Instagram. Here's another video that I shot from the microscope using an iPhone to capture short clips that was edited on the iMovie app on the iPhone, and this time I used real voiceover narration which is very easy to do. This video was posted on Twitter and it got over 800 views, and it's also important to tag your hospital, medical school, and patient support groups because this could increase your visibility and opportunity for others to reshare or retweet your post. So why do we edit surgical videos? Well, they're educational. They also demonstrate surgical techniques, and they're very helpful for self-learning and self-criticism. I really believe it helps us become better surgeons when we're critical of our own technique and try to improve them, much like a Monday morning quarterback, the way top elite athletes go back Monday morning and study the tape. And of course, this can also be used to promote your social media brand and presence. So in this video, we're demonstrating a side-to-side pica-to-pica bypass. Here we're using a tenosuture to close off the back wall of the anastomosis and then suturing the front wall of the anastomosis using a running technique. And now we'll reopen the clips to reperfuse the anastomosis and check the patency using IC green followed by yellow 560 fluorescein angiography. This was performed for a dissecting proximal pica aneurysm that was not amenable to endovascular coiling. So once the bypass has been confirmed patent, we went ahead and trapped the aneurysm. So, for the next segment of my talk, I wanted to give some pearls and principles of how to edit your video. So, I think as the neurosurgeon, we have to get into the mindset of being a movie director or cinematographer. We want to get the best quality raw footage as much as possible because this is critical for producing a high quality video. If you don't have good images, you're going to get a very low production video. So, you want to make sure the microscope or your endoscope camera is calibrated. You want to make sure the lighting and the focus is sharp. The worst thing to have is a video footage that is out of focus and you're not able to demonstrate the anatomy or the surgical technique. It's also important to remember to center the picture. You don't want your surgical action to be off screen or in the corner of the field of view. There is a fine balance when you're recording. If you have a long five or six hour tumor surgery that's on continuous recording, you can end up having too much footage to have to go through. But if you intermittently record, you can forget to unpause and then miss key portions of the recording. I think it's important to take still images throughout the case. This helps you create a storyboard so that when you go through the video, you can go through the still images and get an idea of how the surgery progressed. And of course, remember to transfer the video to an external hard drive immediately after the surgery. If you say, I'm going to do it tomorrow, it's easy to forget or have some other form of transferring to a cloud of some sort so that you store the video for later use. It's important to have good sources of media capture. This can be done through a high definition 2D or 3D microscope or endoscope. Again, it's important to capture still images throughout that can be used later for inserting still images into your video. I also like to take still photographs of the positioning incision and the exposure and closure for, I think, social media, short video clips. You can use your iPhone camera. But for video publication, you want to make sure you use high definition video footage. For endovascular or spine procedures, you will need to capture images from your fluoroscopic images in movies. I like to classify the videos as abridged versus unabridged. So an unabridged version would be a more exhaustive, complete version of the video, typically a four to eight minute video that you would use for a video publication manuscript that captures the entire operation. You can then, from your large video, cut it down and edit it to a shorter video that you can use for a one hour grand round lecture. Now for these lectures, I recommend having your video clips shorter, typically maybe two to three minutes or maybe even less so that you can get through more material in a one hour lecture. Now if you're giving a 10 to 15 minute lecture in, say, a breakfast seminar, you want to make sure the video clips are short, typically one minute or shorter, so that you can get through the rest of your talk without being bogged down with a long video clip. So I'm going to show you an abbreviated surgical video clip that I put together for this large skull base chordoma involving the jugular foramen and peripheral space. This tumor was removed through an extended far lateral transcondylar transjugular approach. This is the operative exposure demonstrating the extended lateral transjugular approach. An infralabyrinthine mastoidectomy has been performed and the sigmoid sinus is skeletonized. We can see here that the tumor has eroded the occipital condyle, causing destabilization of the cranial cervical junction. We then skeletonize the V3 segment of the vertebral artery and perform a fallopian bridge technique where we skeletonize the fallopian canal so that we have access to the jugular bulb. We then ligate the internal jugular vein and open up the sigmoid sinus and occlude it proximally so we can then isolate the sigmoid sinus system. Inferior flow is injected in a retrograde fashion to prevent backfilling of the inferior petrosal sinus. We then excise the lateral wall of the sigmoid sinus and jugular bulb and access this tumor within the jugular bulb. We then proceed to expose the tumor in the peripheral space and debulk the tumor using an ultrasonic aspirator as well as a side-cutting aspirator. This tumor is then carefully debulked up to the skull base, and we then excise the remainder of the jugular vein as we connect it into the jugular foramen. There's now tumor within the clivus that we're able to access, and then we drill off the remainder of the eroded occipital condyle to get more access of the tumor at the cranial cervical junction. Now we're able to drill off the remainder of the clival defect superiorly, anteriorly, and now we have access to the tip of the odontoid process, and we'll drill off the tip of the odontoid process to remove all abnormal bone. This gives us more access to the tumor. We now go intradurally and dissect the tumor away from the V4 segment of the vertebral artery and brain stem. The tumor can now be removed with aspiration. Here we see the lower cranial nerves invaded by the tumor, and these are preoperatively dysfunctional, so we'll divide these to allow us to remove the remainder of the tumor to achieve a radical resection of this aggressive chordoma. The clival dura is now excised, and we can now see the vertebral basilar junction and brain stem. The large skull base defect is now reconstructed using a multilayered technique with alloderm and occlusion of the eustachian tube orifice to prevent CSF leakage, followed by fat graft and a MedPor Titan plate. We initially tried to clip the aneurysm but the clip kept occluding the parent vessel, so the decision was then made to trap the aneurysm with temporary clips under birth suppression and then open up the aneurysm dome to thrombectomize and excise the coil mass. It is important to have your ultrasonic aspirator ready so that you can perform thrombectomy. The goal here is to decompress the aneurysm and neck so that proper clip reconstruction can be safely performed. Sharp dissection with micro scissors are then used to clean the walls of the aneurysm. So now we can see the lumen of the vessels and then reconstruct the aneurysm using a tandem clip technique. This is done with a fenestrated clip followed by a gentle curved clip. Now on these large calcified aneurysms it's important to leave the clip more generous to leave a more bulbous neck so that you don't occlude the MCA vessels. Now we can go ahead and excise the remainder of the coil mass. And here's the second clip to reinforce the backside with another fenestrated clip on the top side to reinforce. Although the reconstruction looks imperfect extraluminally, intraluminally you want to assure that there's good flow seen on the icy green and also on the postoperative angiogram. is in dissecting tumor or pathology away from key critical structures like vessels or cranial nerves. You don't need to show multiple clip readjustments unless you're demonstrating a specific technical point. And always remember to capture the aha moment. And sometimes, let's say when you're taking the tumor out and the record happens to be off, sometimes I'll put the tumor back into the tumor bed and then reshoot the video, sort of a take two. And of course, it's important to freeze frame the video every now and then and label the critical anatomical landmarks to help orient your viewer. Now, when you're preparing a video for a video publication or manuscript, such as neurosurgical focus videos or skull-based operative videos, you typically want to include the following components based on the journal's author instructions. It's important to include patient positioning, the surgical opening technique, dissection of the existing pathology, and treatment of the underlying process and the closure techniques. This is how I typically structure the video publication. You should have a title page with the authors and affiliations, a brief history with pertinent physical findings, the preoperative imaging, the approach selected. Sometimes it can be helpful in describing why you chose the particular surgical approach as opposed to alternative approaches. For positioning and skin incision, I think using still images is adequate. The surgical exposure can be done with either still images or live video. And the treatment of the lesion should be video content, usually taken from the microscope or endoscope. And closure, if it's a standard wound closure, still images are probably satisfactory. But if the closure is more involved, like a complex skull-based closure with fat grafts and pericranial flaps or nasoceptal flaps, you might want to use video content here. And of course, post-op imaging and a brief description of the clinical post-op course. And lastly, the corresponding author slide. When narrating the video, it's important to narrate off of a written script instead of free speaking. So here I'm going to show you an example of a recently published video in Neurosurgical Focus on a complex craniopharyngioma. This is the title slide, history and examination, pre-operative imaging. And these are the list of the approaches. I explain why we chose the endonasal approach for this. You can use anatomical drawings and dissections from the roten collection. These are free off the internet, so it does not require any permissions to use. This is the patient positioning. So here we'll start with the endonasal phase, opening up the middle turbinates and harvesting the nasoceptal flap. And so we'll open up the sphenoid sinus and drill off the bone off of the skull base, removing the plenum and the tuberculum sella. It's important to label the anatomical landmarks to help orient the viewer. I'll start the audio narration here so you have a good understanding. During the dural opening, the cyst cavity is entered and the yellow greenish cystic fluid is encountered. Initial debulking of the tumor is performed with angled ring curettes to decompress the tumor. The tumor capsule is dissected away from the left internal carotid as it exits the distal dural ring. Care is taken to identify and preserve the superior hypothesial perforators coming off the medial aspect of the carotid, as these tend to supply the optic apparatus. We identify the pituitary stalk by gently lifting the tumor off of the normal gland. The stalk is preserved by using sharp dissection to lyse tumor adhesions with bimanual microsurgical technique. The right tumor capsule is now dissected away from the right posterior communicating artery. The right tumor capsule is now dissected away from the right posterior communicating artery laterally and off of the membrane alleloquist inferiorly. We can now visualize the basilar artery apex posteriorly. It is important to ensure that all adhesions have been released before delivering the tumor and to avoid the temptation of premature pulling of the tumor. Final inspection shows the cavity of the frontal lobe cyst and microscopic adhesions to the anterior communicating artery complex. We determine that the cyst wall is beyond safe reach and dissection endonasally, and that we have achieved the best maximal safe resection from below. The vascularized pedicle nasoceptal flap is then mobilized and rotated into position over the dural closure. Care is taken to ensure that the flap is opposed to the bony skull-based surface without any tension on the pedicle. We now include a slide of the postoperative course, followed by postoperative imaging slides, followed by references, and the corresponding author slide. What makes a good video for publication? And these are my perspectives as a reviewer. Pick a case that illustrates important surgical techniques, fits the topic from the particular issue. It must have good video quality that has clarity and resolution, and it must be well narrated and tell a story with a clear voice. You should have appropriate stills and freeze frames pointing out key anatomical structures and, of course, show all the five key components to the procedure. In conclusion, incorporation of videos can significantly improve the visibility of the patient, and it is important to ensure that the patient is In conclusion, incorporation of videos can significantly improve the visibility and engagement of your social media presence. Surgical videos play a significant role in our education as neurosurgeons. Video editing can be very time-consuming and has a learning curve, but with time and practice, you can become more efficient at it. You can develop that eye for editing. And again, capture high-quality raw footage is critical in order to produce a good-quality video. Be a good storyteller, and these videos will be great for your future lectures, publications, and your social media impact. Thank you again for your attention. If you have any questions, you can email me, or you can contact me through my social media handle, at SkullBaseMD, or YouTube, Facebook, Twitter, and Instagram. Thank you very much.

Dr. James Liu

Rutgers University

RWJBarnabas Health

video platforms

neurosurgery

social media impact