Journal of neurosurgical sciences最新文献

{"title":"Prediction of diabetes insipidus occurrence after endoscopic endonasal removal of sellar lesions using MRI-based radiomics and machine learning.","authors":"Ciro Mastantuoni, Lorenzo Ugga, Domenico Solari, Serena D'Aniello, Gaia Spadarella, Renato Cuocolo, Filippo F Angileri, Luigi M Cavallo","doi":"10.23736/S0390-5616.23.06162-3","DOIUrl":"10.23736/S0390-5616.23.06162-3","url":null,"abstract":"<p><strong>Background: </strong>Pituitary adenomas and craniopharyngiomas are the most common lesions of the sellar region. These tumors are responsible for invasion or compression of crucial neurovascular structures. The involvement of the pituitary stalk warrants high rates of both pre- and post- operative diabetes insipidus. The aim of our study was to assess the accuracy of machine learning analysis from preoperative MRI of pituitary adenomas and craniopharyngiomas for the prediction of DI occurrence.</p><p><strong>Methods: </strong>All patients underwent MRI exams either on a 1.5- or 3-T MR scanner from two Institutions, including coronal T2-weighted (T2-w) and contrast-enhanced T1-weighted (CE T1-w) Turbo Spin Echo sequences. Feature selection was carried out as a multi-step process, with a threshold of 0.75 to identify robust features. Further feature selection steps included filtering based on feature variance (threshold >0.01) and pairwise correlation (threshold <0.80). A Bayesian Network model was trained with 10-fold cross validation employing SMOTE to balance classes exclusively within the training folds.</p><p><strong>Results: </strong>Thirty patients were included in this study. In total 2394 features were extracted and 1791 (75%) resulted stable after ICC analysis. The number of variant features was 1351 and of non-colinear features was 125. Finally, 10 features were selected by oneR ranking. The Bayesian Network model showed an accuracy of 63% with a precision of 77% for DI prediction (0.68 area under the precision-recall curve).</p><p><strong>Conclusions: </strong>We assessed the accuracy of machine learning analysis of texture-derived parameters from preoperative MRI of pituitary adenomas and craniopharyngiomas for the prediction of DI occurrence.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"378-383"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575532","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":"Comparison of intra-operative skull fixation techniques on cervical sagittal parameters.","authors":"Connor C Jacob, Ryan G Eaton, Andrew J Grossbach, Asad Akhter, Nathaniel Toop, Joshua Wang, Joravar Dhaliwal, Stephanus V Viljoen","doi":"10.23736/S0390-5616.24.06255-6","DOIUrl":"10.23736/S0390-5616.24.06255-6","url":null,"abstract":"<p><strong>Background: </strong>There is limited literature concerning the use of bi-vector traction to a Mayfield following posterior cervical fusion with respect to cervical alignment parameters. The objective of this study was to determine how variability of intra-operative fixation methods for posterior cervical fusion affects post-operative cervical sagittal alignment parameters.</p><p><strong>Methods: </strong>After institutional review board (IRB) approval, retrospective chart review of a total of 54 patients who underwent posterior cervical fusion from July 2017 to December 2019 was conducted. The patients were divided into two cohorts based on their intra-operative positioning, those who were affixed to a three-point fixation system, and those who were placed in bi-vector traction. Pre- and post-operative cervical alignment parameters were measured.</p><p><strong>Results: </strong>There was no difference in post-operative sagittal parameters between the two groups. Each group showed a statistically significant difference in T1-slope when comparing pre- and post-operative measurements.</p><p><strong>Conclusions: </strong>In our study we did not find that any of our techniques including bi-vector traction, static Mayfield positioning, or dynamic Mayfield positioning were very effective in adding lordosis during posterior cervical fusion surgeries. Interestingly, we also found a statistically significant increase in T1 slope and resulting trend towards increased cervical SVA.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"373-377"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668283","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":"Comparing short term clinical outcomes of elective robot-assisted vs. non-robot assisted posterior lumbar interbody fusions: a NSQIP analysis.","authors":"Taylor Furst, Aman Singh, Prasanth Romiyo, Jonathan Stone, Tyler Schmidt","doi":"10.23736/S0390-5616.25.06535-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06535-X","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic lumbar degenerative changes impact millions of patients per year. Recent technological advances have increased the usability of robot-assisted spinal fusions to treat this pathology. Although the safety profile of robotic systems appears favorable, the impact of robotics on surgical outcomes and efficiency remains unclear.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was queried for cases of elective posterior lumbar interbody fusions in adult patients with data available regarding the use of robotics. Univariate and multivariate analyses were performed. The purpose of this study is to compare rates of 30-day unplanned readmissions, unplanned reoperation (return to operating room [RTOR]), postoperative complications, non-home discharges, operative time, blood transfusions and length of stay (LOS) in adult elective robot-assisted (robot-assisted posterior lumbar interbody fusion [rPLIF] / transforaminal lumbar interbody fusion [TLIF]) vs. non-robotic PLIF/TLIF (nPLIF/TLIF).</p><p><strong>Results: </strong>There was no statistically significant difference in rates of 30-day readmissions (6.0% vs. 4.4%, P=0.48), RTOR (4.0% vs. 3.0%, P=0.66), postoperative complications (10.0% vs. 11.2%, P=0.51) nor need for blood transfusion (6.0% vs. 6.5%, P=0.59) between rPLIF/TLIF and nPLIF/TLIF cohorts, respectively. There were no differences in LOS or operative time between groups (LOS: rPLIF/TLIF = 3.5±3.3 days, nPLIF/TLIF = 3.6±2.8 days, P=0.29; operative time: rPLIF/TLIF = 208.7±101.1 minutes, nPLIF/TLIF = 225.1±100.4 minutes, P=0.087).</p><p><strong>Conclusions: </strong>rPLIF/TLIF and nPLIF/TLIF 30-day readmissions, RTOR, non-home discharges, need for blood transfusion, LOS and operative times are similar within these data, though results should be interpreted with caution given study limitations. Ongoing data on surgical outcomes of robot-assisted lumbar fusions are needed.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015667","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":"Suspected and surgically managed cauda equina syndrome nationwide: epidemiological trends and socioeconomic factors influencing access to care.","authors":"Thomas M Johnstone, Vaibhavi Shah, Ghani Haider, Kelly H Yoo, Martin N Stienen, Anand Veeravagu","doi":"10.23736/S0390-5616.24.06300-8","DOIUrl":"10.23736/S0390-5616.24.06300-8","url":null,"abstract":"<p><strong>Background: </strong>Cauda equina syndrome (CES) is a critical condition requiring timely intervention to prevent severe morbidity. This study investigates the epidemiology and socioeconomic factors influencing access to CES care in USA Emergency Departments.</p><p><strong>Methods: </strong>Data was used from the Nationwide Emergency Department Sample (NEDS) from 2016-2020. Encounters for patients presenting with suspected CES were queried using ICD 10 codes. Incidence estimates for suspected and surgically managed CES were constructed. Encounter characteristics were tabulated to describe aspects of a typical CES presentation to a USA ED. Multivariable regression analysis ascertained the impact of hospital and socioeconomic features on in-hospital mortality, surgical management, length of stay, visit costs, and patient transfer.</p><p><strong>Results: </strong>The incidences of suspected and surgically managed CES rose year-by-year (P=0.006; P=0.005). Uninsured patients (P<0.001) and African American (P=0.002) were less likely to be admitted for care. Patients residing in the wealthiest quartile of zip codes were more likely to be admitted for care (P<0.001). In addition, uninsured (P=0.017) and African American patients (P=0.009) were less likely to receive surgical management of suspected CES. Lastly, uninsured (P<0.001), Hispanic (P=0.038), and rurally located patients (P=0.007) were more likely to be transferred, while patients residing in the wealthiest zip codes (P=0.007) were less likely to be transferred.</p><p><strong>Conclusions: </strong>Socioeconomic factors like race, income, insurance, and residence potentially alter CES management, which may inform health policy and future patient care.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"297-304"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837072","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":"Monocentric experience of transforaminal endoscopic lumbar discectomy and foraminotomy outcomes: pushing the indications and avoiding failure. Report of 200 cases.","authors":"Alessandro Grieco, Letizia Dell'aglio, Jacopo Del Verme, Domenico Billeci, Roberto Zanata, Giuseppe Canova, Enrico Giordan","doi":"10.23736/S0390-5616.23.06105-2","DOIUrl":"10.23736/S0390-5616.23.06105-2","url":null,"abstract":"<p><strong>Background: </strong>This paper reports the results of the treatment of our first 200 cases of lumbar disc herniation and foraminal stenosis using full-endoscopic transforaminal lumbar discectomy (FETLD). We analyzed outcomes and radiological parameters to overcome failure and inappropriate indications and also highlighted the red flags for surgeons coming to this field as well as the pathways to success.</p><p><strong>Methods: </strong>Data on endoscopic procedures were retrospectively analyzed between October 2018 and March 2023. We abstracted sex, age, leg pain by NPRS, postoperative satisfaction according to the MacNaab score, postoperative surgical complications/adverse events (≤30 days), and history of any previous surgery. Furthermore, we measured different radiological parameters to determine the grade of stenosis or discopathy.</p><p><strong>Results: </strong>Once the learning curve was completed, patients' satisfaction increased to 94%, with only a small percentage (6%) of patients unsatisfied 30 days after the operation. Perioperatively, 33.5% of the patients experienced mild to moderate transitory paresthesia. Univariate analysis showed a tendency toward a higher risk of failure in those patients with degenerative listhesis (odds ratio [OR] 4.8, 95% CI 0.97-23.9, P=0.055) as well as those with severely degenerated discs (OR 8.7, 95% CI 0.96-79.4, P=0.054). Conversely, the chances of failure seemed to be lower in patients with severe foraminal stenosis.</p><p><strong>Conclusions: </strong>FETLD proved its efficacy in treating several degenerative spine conditions or was useful for avoiding previous scarring in patients already operated on to the same extent. Therefore, FETLD can be safely used in patients with comorbidities, the elderly, and when the invasiveness of an open technique is not suitable.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"324-330"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521128","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":"Intraoperative seizures during neuro-oncological supratentorial surgery: the role of prophylaxis with levetiracetam and intraoperative monitoring in a consecutive series of 353 patients.","authors":"Francesca Battista, Giovanni Muscas, Alberto Parenti, Maddalena Spalletti, Cristiana Martinelli, Riccardo Carrai, Andrea Amadori, Alessandro Della Puppa","doi":"10.23736/S0390-5616.24.06154-X","DOIUrl":"10.23736/S0390-5616.24.06154-X","url":null,"abstract":"<p><strong>Background: </strong>The aim of this paper was to understand the role of prophylaxis with levetiracetam at skin incision in preventing convulsive intraoperative seizures (IOS) during neurosurgical procedures with and without intraoperative neuromonitoring (IONM).</p><p><strong>Methods: </strong>Authors retrospectively reviewed the Institutional database for cases of supratentorial brain tumors undergoing surgical resection performed from January 2021 to October 2022. Patients were operated on both under general anesthesia and awake, using motor-evoked potentials (MEP) and direct cortical stimulation for cortical mapping. 1000 mg ev of Levetiracetam before skin incision in case of a history of seizures was administrated. We excluded all infratentorial cases.</p><p><strong>Results: </strong>Three hundred fisty three consecutive cases were retrieved. IOS occurred in 22 patients (6.2%). Prophylaxis with Levetiracetam was administered in 149 patients, and IOS occurred in 16 cases (10.7%) in this group of patients. The IOS rate in the case of no Levetiracetam prophylaxis administration (3.5%) was significantly lower (P<0.001, OR=3.38 [1.35-8.45], RR=3.12 [1.32-7.41]). The Penfield technique stimulation evoked seven of all 22 IOS reported (31.8%) (P=0.006, RR 5.4 [1.44 -20.58], OR 21 [2.3-183.9]), and the train-of-five technique stimulation caused two of all registered IOS (8.7%) (P=0.2, RR 2.3 [0.99-5.67], OR 6.5 [0.55-76.17]). Transcranial MEPs evoked no IOS.</p><p><strong>Conclusions: </strong>Under levetiracetam prophylaxis, the IOS rate was not significantly lower than in the group of patients without Levetiracetam prophylaxis, regardless of the histology of the tumor and IONM. Neither the transcranial stimulation (MEP) nor train-of-five technique stimulation increases the risk of convulsive IOS, as Penfield technique stimulation does.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"315-323"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335968","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":"What have we learned in fluorescein-guided resection of brain metastases? An update after 79 consecutive cases.","authors":"Jacopo Falco, Morgan Broggi, Emanuele Rubiu, Francesco Restelli, Bianca Pollo, Marco Schiariti, Paola Lanteri, Mario Stanziano, Emanuele LA Corte, Elio Mazzapicchi, Ignazio G Vetrano, Paolo Ferroli, Francesco Acerbi","doi":"10.23736/S0390-5616.23.06134-9","DOIUrl":"10.23736/S0390-5616.23.06134-9","url":null,"abstract":"<p><strong>Background: </strong>Cerebral metastasis (CM) is the most common malignancy affecting the brain. Individualized treatment of CM still represents a challenge for neuro-oncological teams: in patient eligible for surgery, complete tumor removal is the most relevant predictor of overall survival (OS) and neurological outcome. The development of surgical microscopes harboring specific filter able to elicit the fluorescent response from sodium fluorescein (SF) has facilitated fluorescein-guided microsurgery and the identification of pathological tumor tissue, especially at the tumor margins. In this study, we analyzed the effect of SF on the visualization and resection of a large monoinstitutional cohort of CM.</p><p><strong>Methods: </strong>Surgical database of FLUOCERTUM study (Besta Institute, Milan, Italy) was retrospectively reviewed to find CM surgically removed with a fluorescein-guided technique from March 2016 to December 2022. SF was intravenously injected (5 mg/kg) immediately after induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW560 filter (Carl Zeiss Meditec, Oberkochen, Germany). In the most recent cases, biopsies at the tumor margins were performed to evaluate the ability of fluorescein to discriminate between fluorescent and nonfluorescent tissue at the lesion borders.</p><p><strong>Results: </strong>Seventy-nine patients were included; most of them showed a bright, diffuse fluorescent staining that markedly enhanced tumor visibility; 11 melanomas presented a specific faint enhancement of the black pigmented central nodule with high fluorescence at tumor boundaries. Only in a minimal percentage of cases (N.=4-5.1%), fluorescein enhancement was tenuous, thus not providing a significant help during tumor resection. Altogether, in more than 90% of cases, SF was considered useful in the identification of tumoral tissue and in achieving a high rate of CM resection; thus, gross total resection was achieved in 96.2% (N.=76) of patients and in no case the detection of tumor remnants was an unexpected event. The resulted sensitivity and specificity of fluorescein in identifying tumor tissue at the tumor margin was 88.9% with a predictive positive value of 88.9%. No adverse event was registered during the postoperative course.</p><p><strong>Conclusions: </strong>The use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of CM, suggesting a role in improving the extent of resection of these lesions.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"305-314"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397767","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":"Real-life implementation of molecular criteria for diagnosing gliomas according to 2021 WHO Classification: a national survey from the Italian Association of Neuro-Oncology and Society of Neurosurgery.","authors":"Alessia Pellerino, Teresa Somma, Francesco Bruno, Quintino G D'Alessandris, Valeria Internò, Valentina Polo, Denis Aiudi, Giannantonio Spena, Tamara Ius, Vincenzo Esposito, Antonio Silvani, Roberta Rudà","doi":"10.23736/S0390-5616.25.06457-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06457-4","url":null,"abstract":"<p><strong>Background: </strong>The Italian Association of Neuro-Oncology (AINO) and the Italian Society of Neurosurgery (SINch) promoted a national survey to explore how the 2021 WHO molecular diagnostic criteria for gliomas have been implemented into clinical practice.</p><p><strong>Methods: </strong>A survey containing 38-item multiple-choice questions was sent to members of the AINO and SINch from January 2022 to March 2022.</p><p><strong>Results: </strong>We collected 152 answers. Participants from non-academic vs academic hospitals were 78 (51.3%) and 74 (48.7%). Assessment of IDH mutations and 1p/19q codeletion was reported by 140 (92.1%) and 88 (57.9%) responders, respectively. MGMTp methylation, either at diagnosis or at second surgery, was reported by 110 (72.4%) and 82 (53.9%) responders, respectively. CDKN2A/B homozygous deletion in IDH-mutant astrocytomas was investigated according to 53 (34.9%) responders. Assessment of either EGFR amplification or pTERT mutation or +7-10 chromosome changes in IDH-wild type astrocytomas was reported by 76 (50.0%), 43 (28.3%), and 16 (10.5%) responders, respectively. Academic vs non-academic hospitals had a higher availability of molecular markers, including CDKN2A/B deletion (34/70, 48.6% vs 19/82, 23.2%, P=0.001), MGMTp at second surgery (48/69, 69.6% vs 34/72, 47.2%, P=0.008), EGFR/pTERT/+7-10 (46/70, 65.7% vs 32/77, 41.6%, P=0.003), BRAF mutation (14/70, 20.0% vs 4/82, 4.9%, P=0.002), NTRK fusion (14/70, 20.0% vs 2/81, 2.5%, P<0.001).</p><p><strong>Conclusions: </strong>The availability of molecular markers for gliomas is widespread among Italian centers. The implementation of the molecular criteria for diagnostic and prognostic purposes in gliomas according to WHO 2021 Classification needs to be improved. Moreover, a critical issue for the future will be the search for rare actionable mutations, which is continuously evolving, in light of the use of targeted therapy.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475670","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":"A history of anterior cervical discectomy and fusion predicts proximal junctional kyphosis after spinal deformity surgery.","authors":"Ryan B Juncker, Nathan Ritchey, Joshua H Weinberg, Ryan G Eaton, Joshua L Wang, Stephanus Viljoen, David S Xu, Andrew J Grossbach","doi":"10.23736/S0390-5616.25.06425-2","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06425-2","url":null,"abstract":"<p><strong>Background: </strong>Proximal junctional kyphosis (PJK) is a common complication following adult spinal deformity (ASD) surgery and puts patients at an increased risk for neurological injury. As reoperation continues to be the mainstay treatment, there is utility in identifying independent preoperative risk factors for PJK development. The aim of this study was to determine whether a history of anterior cervical discectomy and fusion (ACDF) predicts increased incidence of PJK after ASD correction.</p><p><strong>Methods: </strong>Data was retrospectively collected from the medical record of patients who underwent ASD long-segment spinal fusion between 10/2015 and 9/2020. Patients were divided into cohorts based on whether they had previously undergone ACDF. Demographic, radiographic, perioperative, complication, and patient-reported outcomes measures (PROMs) were analyzed. The primary outcome measure was the development of PJK by the 2-year postoperative timepoint.</p><p><strong>Results: </strong>Eighty-six patients met inclusion criteria, 14 of which had previously undergone ACDF. Patients with prior ACDF demonstrated a significantly higher risk of developing PJK by 2 years after ASD surgery. The prior ACDF cohort also showed significantly greater proximal junctional sagittal cobb angles (PJCA) from the upper instrumented vertebra (UIV) to UIV+2 at 2-years postoperatively, greater pre- to postoperative changes in PJCA at 1-year postoperatively, and less absolute global sagittal flexibility than the no prior ACDF cohort. No differences were seen in demographic, comorbidity, complication, or PROM data between groups.</p><p><strong>Conclusions: </strong>These retrospective data demonstrate that a history of ACDF may independently predict the development of PJK after ASD correction and should be considered in the operative decision-making for these patients.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275064","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":"Transforming neurosurgical practice with large language models: comparative performance of ChatGPT-omni and Gemini in complex case management.","authors":"Barış Çöllüoğlu, Şamil Dikici","doi":"10.23736/S0390-5616.25.06447-1","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06447-1","url":null,"abstract":"<p><strong>Background: </strong>Recent advancements in artificial intelligence, particularly in large language models (LLMs), have catalyzed new opportunities within medical domains, including neurosurgery. This study aims to evaluate and compare the performance of two advanced LLMs - ChatGPT-Omni and Gemini -in addressing clinical case inquiries on various neurosurgical conditions.</p><p><strong>Methods: </strong>A prospective observational study was conducted utilizing 500 case-based questions relevant to neurosurgery, covering 10 prevalent conditions. The questions were designed to simulate real-world clinical scenarios encompassing diagnosis, interpretation, and management and were asked again two months (phase 2) later. Responses were evaluated using a 6-point Likert scale by two independent neurosurgeons.</p><p><strong>Results: </strong>ChatGPT-Omni exhibited consistent superiority across all evaluation metrics. In Phase 1, its overall average score across all conditions was 5.38±0.12, which increased to 5.46±0.08 in Phase 2 (P<0.001). While exhibiting moderate improvements, Gemini trailed behind ChatGPT-Omni with an overall average score of 4.93±0.15 in Phase 1, which improved to 5.1±0.14 in Phase 2 (P<0.001). Subgroup analyses indicated that ChatGPT-Omni provided superior contextual accuracy across all conditions (P<0.001).</p><p><strong>Conclusions: </strong>The study underscores the transformative potential of LLMs in neurosurgery, with ChatGPT-Omni demonstrating superior accuracy, relevance, and clarity compared to Gemini. While both models improved over time, ChatGPT-Omni consistently excelled across all clinical scenarios, highlighting its potential utility in neurosurgical decision support and education.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225739","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}