Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"Reduction of Cerebrospinal Fluid Leaks in Idiopathic Intracranial Hypertension with Glucagon-like Peptide-1 Receptor Agonist Use.","authors":"Adam S Vesole, Steven A Gordon, Ahmad R Sedaghat, Katie M Phillips, Jonathan Forbes, Norberto Andaluz, Daniel Q Sun","doi":"10.1055/a-2678-8331","DOIUrl":"10.1055/a-2678-8331","url":null,"abstract":"<p><strong>Objectives: </strong>Elevated intracranial pressure (ICP) secondary to idiopathic intracranial hypertension (IIH) is a recognized risk factor for anterior and lateral skull base cerebrospinal fluid (CSF) leaks. A recent randomized controlled trial (Mitchell et al) demonstrated a significant reduction of ICP in IIH with the use glucagon-like peptide-1 (GLP-1) receptor agonists. This retrospective population study aims to evaluate the role of GLP-1 agonists in reducing CSF leaks.</p><p><strong>Design: </strong>Retrospective cohort database study.</p><p><strong>Setting: </strong>A collaborative global database (TriNetX) sourced from electronic medical records from 99 large healthcare organizations across the world.</p><p><strong>Participants: </strong>Adults (≥18 years old) with a diagnosis of IIH, stratified into groups based on the presence or absence of concurrent GLP-1 agonist use.</p><p><strong>Main outcome measures: </strong>The rate of spontaneous cranial CSF leak and the rate of anterior/lateral skull base CSF leak repair between GLP-1 users versus non-users over 3 years.</p><p><strong>Results: </strong>Compared with IIH patients not taking GLP-1 agonists ( <i>n</i>  = 11,825), IIH patients on GLP-1 agonists ( <i>n</i>  = 11,825) were 24% less likely to develop a spontaneous cranial CSF leak (OR 0.76, 95% CI, 0.61-0.94) and 72% less likely to undergo skull base CSF leak repair (OR 0.28, 95% CI, 0.15-0.51).</p><p><strong>Conclusions: </strong>GLP-1 agonist use in IIH patients is associated with a lower incidence of spontaneous cranial CSF leaks and a decreased rate of undergoing anterior and/or lateral skull base CSF leak repairs. These promising findings suggest that GLP-1 agonists may be an effective adjuvant therapeutic agent in preventing recurrence following CSF leak repair in IIH patients.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"490-494"},"PeriodicalIF":0.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391063","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":"Feasibility of Early Activation of a Cochlear Implant: Study of Electrophysiology, Audiometry, and Patient Satisfaction Data.","authors":"Florian Bonnafous, Abdulaziz Alghamdi, Solenn Virazels, Karine Aubry","doi":"10.1055/a-2655-3468","DOIUrl":"10.1055/a-2655-3468","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to determine the feasibility of early activation of a cochlear implant in terms of both effectiveness and safety.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study on a series of patients who had cochlear implant surgery between April 2018 and June 2023. In the early activation group (EA) 25 patients were included, with activation performed on days 0 to 1 post-implantation, and 14 patients were included in the control group (C), who underwent traditional activation between days 15 and 35 post-implantation. Impedance values, speech intelligibility thresholds at 60 dB, and processor usage time in each group were recorded at activation and on days 30, 60, and 90 post-implantations. The EA group also underwent a prospective satisfaction assessment.</p><p><strong>Results: </strong>We did not observe any statistically significant differences between the two groups regarding medium-term impedance evolution, speech intelligibility, or processor usage time. A significant improvement in satisfaction results was noted in the EA group. No complications related to early activation were observed.</p><p><strong>Conclusion: </strong>Based on our study results, early activation of a cochlear implant is a reliable technique that improves patient satisfaction without affecting electrophysiological and audiological outcomes or increasing the risk of complications.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"435-438"},"PeriodicalIF":0.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391243","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":"Postoperative CSF Characteristics After Extended Endoscopic Skull Base Surgery: Case Series and Review of the Literature.","authors":"Lachlan R Evans, Georgia M Dawson, Yi Chen Zhao, James A King","doi":"10.1055/a-2655-3525","DOIUrl":"10.1055/a-2655-3525","url":null,"abstract":"<p><strong>Background: </strong>Extended endoscopic endonasal approaches (EEA) to the skull base are associated with a greater risk of CSF leak and infection than standard trans-sellar cases. Postoperative CSF characteristics such as intracranial pressure, cytology, and microbiology are closely associated with this risk but have not previously been described.</p><p><strong>Study design: </strong>Consecutive patients undergoing extended EEA at our tertiary center underwent lumbar puncture 3 to 5 days after surgery in accordance with local protocol. Opening pressure (OP) and CSF characteristics were obtained from the medical record and reported descriptively. The incidence of CSF leak, meningitis, and any predictive factors of these complications were then evaluated.</p><p><strong>Results: </strong>A total of 43 patients met inclusion criteria, of which 36 were female (83.7%) and 24 (55.8%) underwent EEA for anterior fossa meningioma. Out of 43 patients, 28 (65.1%) had a recorded OP (median 16 cmH ₂ O [11-20]) and, notably, one-third (32.1%) had an elevated pressure greater than 20 cmH ₂ O. Two cases (4.7%) of CSF leak were observed and the need for perioperative CSF diversion was a statistically significant predictor of leak ( <i>p</i>  = 0.004). The cohort had a single case of microbiologically proven meningitis as well as two additional cases of asymptomatic CSF pleocytosis that prompted additional empirical antibiotic therapy.</p><p><strong>Conclusion: </strong>The risk of CSF leak and meningitis in a modern cohort of patients undergoing extended EEA is low. However, 32.1% of patients in this cohort had an elevated opening pressure and 4.7% had unexpected CSF pleocytosis. Careful consideration of these factors and their possible impact on postoperative morbidity is essential.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"485-489"},"PeriodicalIF":0.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391034","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":"Early Findings from the Multicenter RAPID Consortium on Papillary Craniopharyngiomas.","authors":"Michael P Catalino, Duy Pham, Robert C Rennert, William T Couldwell, James J Evans, Calen Callopy, Won Kim, Donato Pacione, Carter M Suryadevara, Albert Kim, Julie Silverstein, Michael Chicoine, Paul A Gardner, Garni Barkhoudarian, Juan C Fernandez Miranda, Carolina Benjamin, Varun R Kshettry, Gabriel Zada, Jamie J Van Gompel, Sandhya R Palit, Nathan Zwagerman, Stephanie Cheok, Daniel Prevedello, Kyle C Wu, Adam Mamelak, Mark Pacult, Andrew Little, Michael Karsy","doi":"10.1055/a-2646-2339","DOIUrl":"10.1055/a-2646-2339","url":null,"abstract":"<p><strong>Background: </strong>Craniopharyngiomas are rare parasellar tumors, and papillary craniopharyngiomas (PCPs) represent 8 to 20% of cases.</p><p><strong>Design: </strong>Interim analysis of retrospective data collected from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID).</p><p><strong>Setting: </strong>Fourteen U.S.-based academic skull base centers between 2011 and 2023.</p><p><strong>Participants: </strong>Patients with PCPs.</p><p><strong>Main outcome measures: </strong>Demographic, imaging, surgical, and outcome variables.</p><p><strong>Results: </strong>Ninety-nine patients with PCPs were included. The mean age was 51.8 ± 14.7, and 57.6% were male. Most tumors showed mixed cystic/solid components (67.5%), were transinfundibular (50.0%), and were treated with an endoscopic endonasal approach (74.5%), with 51.1% demonstrating gross total resection (GTR). Pituitary stalk was preserved in 51.9%. Permanent arginine vasopressin deficiency was seen in 67.1% and was associated with pituitary stalk sacrifice ( <i>p</i>  = 0.003). Cerebrospinal fluid leak was the most common nonendocrine postsurgical, 30-day complication (9.1%), reason for return to the operating room (3.1%), and reason for 90-day readmission (8.1%). Most patients (63.9%) received no adjuvant therapy; GTR was associated with decreased radiotherapy use ( <i>p</i>  = 0.0001). <i>BRAF ^V600E</i> mutation was detected in 64/69 tumors tested, although only one patient was treated with a BRAF inhibitor. A mean follow-up of 12.3 ± 14.6 months was seen for the group.</p><p><strong>Conclusions: </strong>RAPID consortium enabled the largest real-world clinical information dataset for PCPs. Early findings support that GTR and stalk preservation are important to outcomes. Iterative analysis and discussion of data led to the generation of a framework for future studies to fully leverage the capabilities of multicenter registries.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"406-413"},"PeriodicalIF":0.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391274","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":"Patency of the Cavernous Sinus After Medial Wall Resection: An Observational Study.","authors":"Axel E Renteria, Maxime Fieux, Bruna Castro, Lirit Levi, Li-Ting Hung, Alyssa Azevedo, Christine K Lee, Michael T Chang, Peter H Hwang, Jayakar V Nayak, Nancy Fischbein, Juan-Carlos Fernandez-Miranda, Zara M Patel","doi":"10.1055/a-2649-2098","DOIUrl":"10.1055/a-2649-2098","url":null,"abstract":"<p><strong>Introduction: </strong>The cavernous sinus medial wall (CSMW) is a critical structure that can be resected in cavernous sinus (CS)-invading tumors. Intraoperative venous bleeding is inevitable upon entering the CS and necessitates hemostatic agents use to cease its flow. There is no literature on the fate of CS patency after such hemostasis. This study aims to address that gap.</p><p><strong>Methods: </strong>An observational study was conducted between 2018 and 2025, including patients undergoing endoscopic endonasal approach (EEA) with CSMW or transcavernous resection for CS-invading tumors. Pre- and postoperative magnetic resonance imaging (MRI) images were collected and analyzed for CS patency. Postoperative imaging was grouped into three intervals: 0 to 3, 3 to 12, and >12 months. Demographic data were analyzed to identify predictors of CS non-patency.</p><p><strong>Results: </strong>Of the 186 patients included, postoperative CS patency was achieved in 87.1% after 3.72 months. Univariate analysis demonstrated that preoperative CS non-patency ( <i>p</i>  < 0.001), incomplete gross tumor resection ( <i>p</i>  = 0.015), meningioma diagnosis ( <i>p</i>  < 0.001), and previous head and neck radiation increased the postoperative CS non-patency risk. Multivariate analysis identified preoperative CS non-patency as the only independent factor for postoperative CS non-patency (odds ratio = 9.8, <i>p</i>  < 0.001). Persistent non-patency at 3 and 12 months increased long-term postoperative CS non-patency risk by 5.86 and 14.7 times, respectively.</p><p><strong>Conclusion: </strong>This is the first study to report that postoperative CS patency is preserved in most cases after EEA requiring CSMW. A strong predictor of postoperative CS non-patency was identified as preoperative CS non-patency. Further studies are warranted to assess if CS non-patency has significant clinical correlations.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"462-468"},"PeriodicalIF":0.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390936","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":"Pediatric Endoscopic Skull Base Surgery: Safety, Efficacy, and Lessons Learned.","authors":"Daniel P Lander, Peter Yang, Kate Dunsky, Michael R Chicoine, David D Limbrick, John S Schneider","doi":"10.1055/a-2646-2274","DOIUrl":"10.1055/a-2646-2274","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe our institution's experience with endoscopic approaches to pediatric skull base surgery.</p><p><strong>Design/setting/participants: </strong>A retrospective study of consecutive cases of patients under the age of 18 years who underwent endoscopic skull base surgery performed at our institution between 2016 and 2023.</p><p><strong>Main outcome measures: </strong>Postoperative outcomes, including hospital length of stay, 30-day readmission, postop cerebrospinal fluid (CSF) leak, tumor recurrence, intracranial infection, endocrinopathy, visual deficit, or cranial neuropathy.</p><p><strong>Results: </strong>In total, 37 surgeries were performed in 32 patients: 32 primary surgeries and 5 revision surgeries. Median patient age was 13.5 years (interquartile range [IQR] 5.3 years) with a slight female predominance ( <i>N</i>  = 18, 56%). Surgeries were performed for skull base tumor resection ( <i>N</i>  = 27, 73%), skull base defect repair ( <i>N</i>  = 5, 14%), optic nerve decompression ( <i>N</i>  = 3, 8%), and skull base tumor biopsy ( <i>N</i>  = 2, 5%). Median length of hospital stay was 5 days (IQR 5 days); a single postoperative CSF leak required revision surgery (3%), and three patients developed postoperative intracranial infections (8%). The most common endocrinopathy developed after surgery was transient diabetes insipidus (DI) ( <i>N</i>  = 6, 16%). There were no cases of internal carotid artery injury, new cranial neuropathies, or vision loss after surgery. Nine of the 25 endoscopic surgeries for a skull base tumor that achieved gross total resection had tumor recurrence (36%).</p><p><strong>Conclusion: </strong>Endoscopic surgery is a safe and efficacious intervention for skull base pathology in pediatric patient populations.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"477-484"},"PeriodicalIF":0.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390958","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":"Trends in Medicare Reimbursement for the Resection of Vestibular Schwannomas: 2000 to 2021.","authors":"Shravan Atluri, Dylan Dupont, Spencer Singh, Ethan Cline, Anthony Guidotti, Rani Nasser","doi":"10.1055/a-2642-0854","DOIUrl":"10.1055/a-2642-0854","url":null,"abstract":"<p><strong>Objectives: </strong>Current procedural terminology (CPT) for the surgical removal of vestibular schwannoma (VS) has been inconsistently applied due to the redundant plurality of coding possibilities. This report analyzes reimbursement rates between different CPT strategies to determine if financial incentives may be a potential driver of this divergent behavior.</p><p><strong>Methods: </strong>Medicare Part B National Summary files were queried for reimbursement data concerning VS resections from 2000 to 2021. Data were categorized by CPT codes for approach, excision, or combination codes encompassing both elements for three surgical approaches: middle fossa, translabyrinthine, and retrosigmoid (RS). Separated approach and excision codes were bundled in a pairwise fashion to imitate real-world billing practices. Inflation-adjusted data was curated according to the consumer price index and further analyzed by compound annual growth rate. Utilization trends were measured using gross allowed services.</p><p><strong>Results: </strong>Inflation-adjusted fees declined for all services. However, some services, namely piecemeal RS codes, experienced nominal payment increases that dampened inflationary value erosion. Intragroup assessment proved RS to be the most popular and best compensated approach within both the pairwise and combination groups. Intergroup assessment proved the RS combination code was most frequently employed overall, with the pairwise RS approach and excision bundle collecting the greatest average reimbursement.</p><p><strong>Conclusion: </strong>This study suggests the divergence in CPT assignment for surgically managed VS is likely driven, in part or in whole, by financial incentive and indicates the need for fiscal reform, or an erasure of redundant CPT, to unify CPT application.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"428-434"},"PeriodicalIF":0.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391099","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":"Comparing the Effects of Absorbable versus Nonabsorbable Nasal Packing on Postoperative Outcomes Following Endoscopic Ventral Skull Base Surgery.","authors":"Maya Hatley, Mackenzie O'Connor, Joseph Lebowitz, Joseph Connors, Wenqing Yang, Michele Santacatterina, Donato Pacione, Seth Lieberman","doi":"10.1055/a-2646-2482","DOIUrl":"10.1055/a-2646-2482","url":null,"abstract":"<p><strong>Background: </strong>Advances in endoscopic endonasal approaches in ventral skull base surgery have led to increasingly complex resections and reconstructions. This study investigates differences in postoperative outcomes, including postoperative cerebrospinal fluid (CSF) leak and infection, following anterior skull base surgery and reconstruction, as a function of the type of nasal packing (absorbable vs. nonabsorbable) used to bolster the skull base reconstruction.</p><p><strong>Methods: </strong>A retrospective chart review was performed at a single tertiary care institution. Patients who underwent ventral skull base surgery with placement of nasal packing between January 1, 2020, and December 1, 2023, were included. We included only patients of a single rhinologist (S.L.) involved. Outcome measures included postoperative CSF leaks and postoperative infection.</p><p><strong>Results: </strong>Of the 179 patients meeting inclusion criteria, 105 patients (58.7%) received absorbable nasal packing (Nasopore), and 72 patients (40.2%) received nonabsorbable nasal packing (Merocel). Fifteen postoperative leaks occurred overall, with six CSF leaks reported in patients with absorbable nasal packing (5.7%) and nine CSF leaks reported in patients with Merocel packing (12.5%). Fifteen cases of postoperative infection were recorded, with nine cases in patients with absorbable nasal packing (8.6%) and six cases in patients with nonabsorbable nasal packing (8.3%). Overall, no statistically significant difference was found for the rate of postoperative CSF leak ( <i>p</i>  = 0.168) or infection ( <i>p</i>  = 0.309) between these two cohorts of patients.</p><p><strong>Conclusion: </strong>While no significant differences were found in the rate of postoperative CSF leak or infection, additional patient factors should be taken into consideration when choosing between absorbable and nonabsorbable nasal packing for ventral skull base reconstruction.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"e110-e114"},"PeriodicalIF":0.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391210","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":"Techniques to Reduce Iatrogenic Nasal Seeding in Endoscopic Endonasal Surgery for Skull Base Chordoma.","authors":"Zachary C Gersey, Tritan Plute, Prakash Gupta, David T Fernandes Cabral, Hussam Abou-Al-Shaar, Hussein Abdallah, Nallammai Muthiah, Eric W Wang, Carl H Snyderman, Georgios A Zenonos, Paul A Gardner","doi":"10.1055/a-2646-2209","DOIUrl":"10.1055/a-2646-2209","url":null,"abstract":"<p><strong>Background and objectives: </strong>Iatrogenic tumor seeding after open and endoscopic endonasal approaches (EEAs) for skull base chordoma are well-described; however, strategies that specifically help to minimize or eliminate seeding in EEAs have not been described.</p><p><strong>Methods: </strong>The authors conducted a retrospective review of their experience with EEAs for clival chordomas in the past 20 years, with emphasis on recurrence attributable to iatrogenic seeding. Patterns and factors of seeding are reported and analyzed, and the impact of intraoperative techniques is evaluated for their impact on prevention.</p><p><strong>Results: </strong>About 271 EEAs were performed for 194 patients presenting with clival chordoma at the authors' institution between 2001 and 2020. A total of three cases of iatrogenic seeding (incidence 1.1%) were identified, two from primary tumors and one recurrent. The average time to seeding diagnosis was 32.7 months. Beginning in August 2014, an Endonasal Access Guide (nasal sleeve) was used (34.1% of all endonasal cases), and in June 2019, a side-cutting aspirator (used in 4.1% of total cases) was used. There were no incidences of seeding in patients operated on with either side-cutting aspirator or the nasal sleeve (mean follow-up 51.9 months), which was a significant decrease ( <i>p</i>  < 0.001).</p><p><strong>Conclusion: </strong>Nasal seeding is a rare but potentially preventable complication in endoscopic endonasal surgery for skull base chordoma. Recognition of this entity, deployment of novel surgical tools, and use of meticulous surgical technique should be utilized to minimize surgical seeding in EEA.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"e115-e119"},"PeriodicalIF":0.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391112","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":"Incorporating AI-Driven Vision Systems to Quantify Learning Curve in EVD Placement.","authors":"Rupert D Smit, Aria Mahtabfar, Nikolaos Mouchtouris, Kevin Hines, Emil Swanepoel, David P Bray, James J Evans","doi":"10.1055/a-2642-1221","DOIUrl":"10.1055/a-2642-1221","url":null,"abstract":"<p><strong>Objectives: </strong>There is an application for artificial intelligence (AI) to augment medical education. The aim of this study was to incorporate AI-powered cameras to quantify the learning curve and performance metrics associated with external ventricular drain (EVD) placement.</p><p><strong>Methods: </strong>Fourteen participants, comprising medical students and neurosurgical residents, were recorded performing an EVD on a trainer head. Five panoramic cameras were installed within the simulation suite. The model employed convolutional neural networks to track anatomical landmarks and assess task completion. Quantification of the learning curve was achieved by aggregating scores across three phases: preparation, insertion, and closing. Additional metrics included fluidity, a proxy for surgical finesse.</p><p><strong>Results: </strong>The model successfully itemized parameters that characterize EVD placement. The study demonstrated a clear learning curve in EVD placement. The overall scores were 64.4/126 (51.1%), 99.6/126 (79%), and 113/126 (89.7%) for the students, junior residents, and senior residents ( <i>p</i>  < 0.0001). Significant improvements were observed in the preparation, insertion, and closing phases. The mean scores for preparation were 16.4/37 (44.3%), 25.6/37 (69.2), and 30.5/37 (82.4) for the students, junior residents, and senior residents ( <i>p</i>  < 0.0001). The mean scores for insertion were 26.2/44 (59.5%), 37.8/44 (85.9%), and 38.5/44 (87.5%) for the students, junior residents, and senior residents ( <i>p</i>  = 0.026). The mean scores during closing were 13/25 (52%), 22.2/25 (88.8%), and 25/25 (100%) for the students, junior residents, and senior residents ( <i>p</i>  = 0.0034). Fluidity improved significantly with training level ( <i>p</i>  = 0.0006).</p><p><strong>Conclusion: </strong>Our platform effectively quantified the learning curve associated with EVD placement, underscoring the importance of objective feedback and AI's potential to facilitate skill acquisition.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"87 4","pages":"373-382"},"PeriodicalIF":0.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391266","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}