Journal of Korean Neurosurgical Society最新文献

{"title":"Cost-Effectiveness Analysis of Cervical Laminoplasty According to the Severity of Cervical Myelopathy.","authors":"Hangeul Park, Ho Sung Myeong, Seunghoon Lee, Jun-Hoe Kim, Woojin Kim, Jungbo Sim, John M Rhee, Yunhee Choi, Chang-Hyun Lee, Chi Heon Kim","doi":"10.3340/jkns.2026.0150","DOIUrl":"https://doi.org/10.3340/jkns.2026.0150","url":null,"abstract":"<p><strong>Objective: </strong>Cervical laminoplasty is widely used for multilevel degenerative cervical myelopathy. However, despite its broad clinical application, evidence evaluating its cost-effectiveness in terms of quality-adjusted life years (QALYs) remains limited. In addition, little is known about whether the economic value of laminoplasty differs according to the severity of preoperative myelopathy. This study aimed to evaluate the cost-effectiveness of cervical laminoplasty and to determine whether cost-effectiveness varies across severity groups.</p><p><strong>Methods: </strong>We retrospectively reviewed 116 consecutive patients who underwent cervical laminoplasty for degenerative multilevel cervical stenosis between 2017 and 2022 with a minimum follow-up of 24 months. Patient-reported outcomes (PROs), including the Numeric Rating Scale for neck pain (NRS-neck), Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scores, and Euro Quality of Life-5 Dimension (EQ-5D) index value, were collected at baseline and at 3, 6, 12, and 24 months postoperatively. Two-year QALYs were calculated using the EQ-5D index values. Direct and indirect medical costs were obtained from billing records and converted to 2025 US dollars ($). Missing preoperative mJOA scores were addressed using multiple imputation. Patients were stratified into mild, moderate, and severe myelopathy groups based on imputed mJOA scores.</p><p><strong>Results: </strong>The mean total costs per patient were $5,612.9, and a Cost/QALY gain of $29,604.6. All PROs demonstrated significant improvement at 24 months compared with baseline (P < .05). Total costs did not differ among mild, moderate, and severe myelopathy groups (P = .950). However, QALY gains differed significantly (P < .001), with median values of 0.022, 0.052, and 0.397 for mild, moderate, and severe myelopathy, respectively. Patients with severe disease demonstrated significantly higher utility gains than those with mild or moderate disease (adjusted P < .001), whereas no significant difference was observed between the mild and moderate groups (adjusted P = .521).</p><p><strong>Conclusion: </strong>Cervical laminoplasty was associated with clinical improvement in degenerative cervical myelopathy. Patients with more severe preoperative myelopathy achieved greater QALY gains despite similar costs.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy and Outcomes of KYMERO Robot-Guided Deep Brain Stimulation for Dystonia : Retrospective Cohort Analysis.","authors":"Ryoong Huh, Il Jang","doi":"10.3340/jkns.2025.0212","DOIUrl":"10.3340/jkns.2025.0212","url":null,"abstract":"<p><strong>Objective: </strong>Deep brain stimulation (DBS) of the internal globus pallidus (GPi) represents the standard treatment for medically refractory dystonia, with clinical efficacy critically dependent on precise electrode placement. While robotic stereotactic systems promise enhanced targeting accuracy, comparative data for dystonia populations remain limited. To compare stereotactic accuracy and clinical outcomes of KYMERO robot-assisted versus conventional frame-based GPi-DBS in dystonia patients.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study compared 35 patients (68 leads) who underwent KYMERO robot-assisted bilateral GPi-DBS (July 2023 to June 2025) with 42 historical controls receiving frame-based procedures (March 2019 to December 2020). All patients had medically refractory primary dystonia. Primary outcomes included stereotactic accuracy (radial and Euclidean error) and 6-month Burke-Fahn-Marsden dystonia rating scale (BFMDRS) motor improvement. Secondary outcomes encompassed response rates, complications, and procedural consistency.</p><p><strong>Results: </strong>KYMERO robot-assisted DBS achieved significantly superior targeting accuracy compared to frame-based procedures (mean radial error, 0.89±0.30 vs. 1.92±1.20 mm; p<0.001; euclidean error, 1.15±0.38 vs. 2.80±1.56 mm; p<0.001). The proportion of electrodes within 1.5 mm of target was higher in the KYMERO group (94.1% vs. 66.7%, p<0.001), with fewer targeting outliers exceeding 2 mm (2.9% vs. 23.8%). Clinical outcomes were equivalent between groups, with 6-month BFMDRS motor improvement of 66.9%±13.8% for KYMERO versus 64.7%±23.5% for frame-based procedures (p=0.614). Response rates (≥50% improvement) were 85.7% and 78.6%, respectively. Complication rates were low and comparable (5.7% vs. 9.5%). The KYMERO cohort demonstrated reduced outcome variability, suggesting enhanced procedural reproducibility.</p><p><strong>Conclusion: </strong>KYMERO robot-assisted GPi-DBS achieves significantly superior stereotactic accuracy compared to conventional frame-based approaches while maintaining equivalent clinical efficacy and safety. The enhanced precision and reduced outcome variability support robotic assistance as a valuable advancement for dystonia DBS procedures.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"616-629"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Language Model and Pediatric Neurosurgery - A Neurosurgeon's Perspective on the Artificial Nervous System.","authors":"Woon Tak Yuh, Seung-Jun Ryu, Tae-Shin Kim, Il Choi","doi":"10.3340/jkns.2026.0029","DOIUrl":"10.3340/jkns.2026.0029","url":null,"abstract":"<p><p>Large language models (LLMs) are rapidly transforming healthcare, yet their implications for pediatric neurosurgery remain underexplored. This narrative review interprets LLM evolution through a neuroscientific lens familiar to pediatric neurosurgeons. We trace the parallel development of LLMs and the human brain : architecture evolving from sequential processing to attention mechanisms mirrors prefrontal cortex maturation; training stages parallel synaptic exuberance, adolescent pruning, and socialization; reasoning capabilities emerge through chain-of-thought prompting and reinforcement learning, analogous to deliberate cognitive processing. We then examine capabilities current LLMs lack but would require for artificial general intelligence (AGI)-continual learning, multimodal perception, selfawareness, world models, and physical embodiment-mapping each to corresponding neural functions. Using a representative case of pediatric medulloblastoma, we illustrate how these technologies will reshape clinical practice, surgery, research, and education. Current frontier models deliver excellent medical performance with multimodal reasoning at low cost, yet pediatric neurosurgery presents a \"long-tail\" challenge where rare conditions and reliance on expert consensus demand domain-specific augmentation. The emergence of agentic artificial intelligence (AI), physical AI, and autonomous research systems signals a shift from AI as advisory tool to executing partner. LLMs externalize intellectual labor at unprecedented scale, redefining physicians as \"responsible interpreters\" who orchestrate AI while retaining judgment, accountability, and ethical authority. In pediatric neurosurgery, this role uniquely integrates metacognitive and emotional dimensions beyond AI's reach within the child-caregiver-physician relationship, enabling human-centered care and empowering neurosurgeons to actively shape AI integration rather than merely adapt to it.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"496-514"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Deep-Seated Satellite Lesions in DNET : Is It a Tumor?","authors":"Sung Hyun Kang, Sokhoeun Heng, Se Hoon Kim, Seung-Ki Kim, Ji Hoon Phi","doi":"10.3340/jkns.2025.0164","DOIUrl":"10.3340/jkns.2025.0164","url":null,"abstract":"<p><p>Dysembryoplastic neuroepithelial tumor (DNET) is a benign, pediatric brain tumor characterized by focal seizures, often progressing to drug-resistant epilepsy. Satellite lesions (SLs), small lesions adjacent to the main tumor mass typically embedded within normal parenchyma, are identified in approximately 50% of DNET cases and may contribute to recurrent seizures if not totally removed. However, detailed histopathological descriptions of SL remain limited to date. We report on an 8-year-old boy with medically intractable seizures and a T2 hyperintense mass in the left frontal lobe with smaller deep-seated SLs. The lesions were near totally removed, with deep-seated SLs successfully removed by performing a wider resection including the adjacent normal white matter with the aid of intraoperative ultrasonography, rather than through direct visual inspection. Histological analysis of deep-seated SLs showed homogeneous, typical DNET features identical to the main mass, including glioneuronal columns with oligodendrocyte-like cells and floating neurons within a mucoid matrix, confirming that deep-seated SLs are true tumors. In order to reduce the risk of recurrence, maximal safe resection of deep-seated SLs with the aid of ultrasonography might be helpful.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":"69 4","pages":"652-656"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Clinical Outcomes of Repeat Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformations.","authors":"Ju In Park, Jiwook Ryu, Chang Kyu Park, Seok Keun Choi","doi":"10.3340/jkns.2025.0208","DOIUrl":"10.3340/jkns.2025.0208","url":null,"abstract":"<p><strong>Objective: </strong>Gamma knife radiosurgery (GKRS) is an established treatment for cerebral arteriovenous malformations (AVMs). However, incomplete obliteration after initial GKRS continues to pose a risk of hemorrhage. Although repeat GKRS is used as a salvage treatment, specific guidelines and safety profiles remain to be fully defined. By analyzing the clinical outcomes of repeat GKRS in 60 patients with incompletely obliterated AVMs, this study aims to test the hypothesis that optimizing treatment-related variables, particularly the timing of retreatment, may improve the safety and efficacy of repeat GKRS for residual AVMs.</p><p><strong>Methods: </strong>This retrospective study included 60 patients with AVMs who underwent repeat GKRS between 1992 and 2024. Clinical charts, radiologic imaging, and treatment parameters were analyzed to assess complete obliteration, hemorrhage after repeat GKRS, and adverse radiation effects (AREs). Kaplan-Meier survival analysis was performed to estimate obliteration and hemorrhage rates. Univariate and multivariate analyses were conducted to identify factors associated with complete obliteration, hemorrhage, and AREs.</p><p><strong>Results: </strong>Complete obliteration was achieved in 40 patients (66.7%). The actuarial obliteration rates were 1.7%, 22.5%, 53.5%, and 73.9% at 1, 3, 5, and 10 years, respectively. A target volume reduction rate >50% (p=0.004; hazard ratio [HR], 3.002; 95% confidence interval [CI], 1.414-6.374) and lower initial Spetzler-Martin (SM) grade (p=0.008; HR, 0.608; 95% CI, 0.420-0.879) were independently associated with complete obliteration. Six patients (10%) experienced hemorrhage after repeat GKRS, corresponding to an annual hemorrhage rate of 2.3%. AVMs located in the posterior fossa (p=0.005; HR, 80.958; 95% CI, 3.891-1684.629) and hemorrhage prior to repeat GKRS (p=0.020; HR, 19.075; 95% CI, 1.576-230.805) were independently associated with hemorrhage. Seven patients (11.7%) experienced AREs after repeat GKRS. Larger repeat target volume (p=0.042; odds ratio [OR], 3.170; 95% CI, 1.044-9.626) and a shorter interval of months between initial and repeat treatment (p=0.040; OR, 0.823; 95% CI, 0.683-0.991) were independently associated with AREs.</p><p><strong>Conclusion: </strong>Repeat GKRS for incompletely obliterated AVMs may provide favorable obliteration rates. Adequate volume response after initial GKRS and lower SM grades may predict successful complete obliteration. Patients with prior hemorrhage and AVMs located in the posterior fossa may be at greater risk of hemorrhage after repeat GKRS. Larger treatment volume and shorter intervals between initial and repeat GKRS were associated with AREs. Extending the interval between initial and repeat GKRS may reduce the risk of AREs and provide a safer approach for treating incompletely obliterated AVMs.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"575-585"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146045956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirty-Five Years of the Korean Brain Tumor Society (1991-2026) : A Historical Review.","authors":"Youngbeom Seo, Eui Hyun Kim, Shin-Hyuk Kang","doi":"10.3340/jkns.2026.0117","DOIUrl":"10.3340/jkns.2026.0117","url":null,"abstract":"<p><p>The Korean Brain Tumor Society (KBTS) was established in 1991 as the Korean Brain Tumor Study Group and has since evolved into a leading multidisciplinary academic organization in neuro-oncology. In its early phase, the society focused on building essential academic infrastructure, including the initiation of a nationwide brain tumor registry in 1992 and the implementation of structured educational programs. In 1999, this organization was renamed the Korean Brain Tumor Society, reflecting its expanding academic scope. In 2002, the KBTS launched the Journal of Korean Brain Tumor Society, establishing an official platform for scholarly communication. During the 2000s, the society expanded its academic and international engagement through scientific meetings-including the 2nd Meeting of the Asian Society for Neuro-Oncology (ASNO) in 2003 and the 7th ASNO Meeting in 2010-regional collaborations, and its admission to the Korean Academy of Medical Sciences in 2007. A major transition occurred in 2011 when its official journal, which was subsequently relaunched in 2013 as Brain Tumor Research and Treatment (BTRT), was integrated with the Journal of Korean Society for Neuro-Oncology, marking a strategic step toward internationalization. In 2018, the publication of the comprehensive textbook \"Brain Tumors\" further strengthened the society's academic foundation. In 2020, despite the challenges posed by the coronavirus disease 2019 pandemic, the KBTS maintained continuity through adaptive academic activities and the development of clinical recommendations. In 2022, the society successfully hosted the World Federation of Neuro-Oncology Societies in Seoul, underscoring its growing global leadership. This trajectory culminated in 2025, with the indexing of BTRT in Scopus, representing a significant milestone in international academic recognition. Over the past 35 years, the KBTS has made substantial contributions to research, education, and international collaboration while advancing clinical practice and surgical management through multicenter studies and the dissemination of operative strategies.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"657-663"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering Biomechanical-Psychosocial-Metabolic Interactions in Low Back Pain among Medical Students.","authors":"Tirayut Veerasathian, Schawanya K Rattanapitoon, Nathkapach K Rattanapitoon","doi":"10.3340/jkns.2025.0201","DOIUrl":"10.3340/jkns.2025.0201","url":null,"abstract":"","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"664-665"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Gut Microbiota-Derived Extracellular Vesicles in Post-Anesthesia Neuroinflammation and Cognitive Impairment.","authors":"Haiou Sun, Jingtian Wang","doi":"10.3340/jkns.2025.0218","DOIUrl":"10.3340/jkns.2025.0218","url":null,"abstract":"<p><p>Neuroinflammation and cognitive impairment during the perioperative period significantly affect patient recovery, making them critical targets for therapeutic intervention. Recently, there has been growing interest in gut-derived exosomes (bacterial extracellular vesicles, BEVs) and their potential to modulate the central nervous system. The gut-brain axis, a vital pathway linking the gut to the central nervous system, offers a unique lens through which to explore the role of BEVs in nerve regeneration. This study investigates the biological properties and functions of BEVs during the perioperative period, focusing on their mechanisms in promoting post-anesthesia nerve recovery, including anti-inflammatory effects, neurotrophic support, and metabolic reprogramming. Additionally, the study explores potential BEV-based therapeutic approaches, current challenges in research, and future directions, aiming to provide novel insights and rationales for clinical application.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"515-531"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between Short-Segment versus Long-Segment Screw Fixation in Osteoporotic Vertebral Compression Fractures in Thoracolumbar Junction with Myelopathy.","authors":"Chan Yang Noh, Jin Hoon Park, Jae Hwan Cho, Sung Bum Kim, Chongman Kim, Sun Woo Jang, Danbi Park, Sang Hoon Hwang, Min Han Kim, So Jin Song, Il Young Lee","doi":"10.3340/jkns.2025.0162","DOIUrl":"10.3340/jkns.2025.0162","url":null,"abstract":"<p><strong>Objective: </strong>Osteopenic and osteoporotic vertebral compression fracture (OVCF) is a prevalent clinical problem, particularly in the elderly. Although the majority of compression fractures do not result in myelopathy and are managed nonoperatively, surgical intervention, including screw fixation, may be necessary in select cases of OVCF associated with myelopathy. This retrospective study compared the clinical outcomes, radiographic results, and complication rates between short-segment and long-segment screw fixation in patients with OVCF at the thoracolumbar junction (TLJ) and myelopathic symptoms due to a spinal cord-compressing lesion.</p><p><strong>Methods: </strong>A total of 48 patients with OVCFs at the TLJ and myelopathic symptoms, who underwent either short-segment (two-level, n=17) or long-segment (>2 levels, n=31) screw fixation were studied. Postoperative outcomes including clinical parameters, radiographic parameters, and incidence of complications were evaluated.</p><p><strong>Results: </strong>Postoperative improvement in Frankel scale was significantly greater in the short-segment versus long-segment fixation group (p=0.01). Long-segment fixation resulted in superior preservation of the postoperative correction angle (p<0.01). No difference in incidence of mechanical failure was demonstrated between the two groups (p=0.99).</p><p><strong>Conclusion: </strong>Short-segment fixation demonstrated greater postoperative neurological improvement and less invasiveness, whereas long-segment fixation was associated with superior preservation of the correction angle. It is also noteworthy that short-segment screw fixation is not predisposed to instrument failure compared to long-segment screw fixation. These findings suggest that short-segment screw fixation may be a viable option for many patients with OVCFs, depending on clinical condition.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"586-595"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of the Perfusion Index as an Indicator of Anesthetic Depth during Total Intravenous Anesthesia in Neurosurgery with Intraoperative Neuromonitoring : A Prospective Observational Study.","authors":"Ji Young Min, Joon Pyo Jeon, Dong Hyun Kim, Mee Young Chung","doi":"10.3340/jkns.2025.0197","DOIUrl":"10.3340/jkns.2025.0197","url":null,"abstract":"<p><strong>Objective: </strong>Anesthetics influence sympathetic tone, a key determinant of anesthetic depth. This study aimed to evaluate whether the perfusion index (Pi), reflecting propofol-mediated sympathetic modulation, can serve as a continuous real-time indicator of anesthetic depth during propofol-based total intravenous anesthesia (TIVA) requiring intraoperative neuromonitoring (IOM) in neurosurgery.</p><p><strong>Methods: </strong>This single center, prospective observational study included patients scheduled for anterior cervical decompression and fusion under propofol-based TIVA with IOM. Patients were eligible for inclusion (anterior cervical decompression and fusion) if they were aged 40-75 years and classified as American Society of Anesthesiologists physical status 1 or 2. At designated time intervals, from preinduction to extubation, the Bispectral index (BIS), a marker of anesthetic depth, alongside finger and ear perfusion indices (FPi and EPi) was assessed to examine correlations between these variables. The primary outcome was to find correlation between FPi and BIS.</p><p><strong>Results: </strong>Thirty participants were enrolled in this study. FPi and BIS showed significant correlation (correlation coefficient, -0.629; 95% confidence interval, -0.696 to -0.551; p<0.001), while EPi showed no significant correlation with BIS (correlation coefficient, 0.078; 95% confidence interval, -0.042 to 0.196; p=0.202).</p><p><strong>Conclusion: </strong>FPi monitoring may serve as a complementary technique for evaluating anesthetic depth during propofol-based TIVA requiring IOM in neurosurgery, as indicated by its correlation with BIS.</p>","PeriodicalId":16283,"journal":{"name":"Journal of Korean Neurosurgical Society","volume":" ","pages":"640-651"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}