Neurosurgical Review最新文献

{"title":"Inpatient neurosurgical mortality in germany: a comprehensive analysis of 2023 in-hospital data.","authors":"Marcel A Kamp, Christine Jungk, Matthias Schneider, Georgia Fehler, Antonio Santacroce, N Dinc, Florian H Ebner, Christiane von Sass","doi":"10.1007/s10143-025-03664-1","DOIUrl":"https://doi.org/10.1007/s10143-025-03664-1","url":null,"abstract":"<p><strong>Background: </strong>Neurosurgical conditions and procedures are associated with varying in-hospital mortality rates, which represent one of several quality indicators. This study aims to determine and report in-hospital mortality rates across German neurosurgical departments in 2023.</p><p><strong>Methods: </strong>A cross-sectional analysis of all neurosurgical cases treated in Germany in 2023 was conducted using nationwide hospital billing data reported under § 21 of the Hospital Remuneration Act. In-hospital mortality was defined as death during hospitalization (discharge status: deceased).</p><p><strong>Results: </strong>Neurosurgical departments treated 222,158 inpatient cases, with 49% female and 48% aged ≥ 65 years. The overall mortality rate was 3.8% (8,338 cases), with significantly lower rates in females (3.3% vs. 4.2%, p < 0.0001). The most common fatal diagnoses included traumatic subdural hematomas (1,278 cases), subcortical intracerebral hemorrhages (611 cases) and traumatic subarachnoid hemorrhages (504 cases). Mortality rates varied by diagnosis: malignant brain tumors (4%), cerebral metastases (6%), benign meningeal tumors (1.3%), non-traumatic subarachnoid hemorrhages (7%), intracerebral hemorrhages (29%), and traumatic subdural hematomas (12%). Mortality for selected procedures was 3% for primary brain tumor resections, 9% for vascular reconstructions, 1% for spinal fusions, 2% for dynamic stabilizations, and 4% for vertebral body replacements.</p><p><strong>Conclusions: </strong>This study analyzes and reports neurosurgical in-hospital mortality rates in Germany, providing a national benchmark that may inform clinicians, policymakers, and patients. While the use of administrative billing data imposes inherent limitations - particularly regarding clinical detail and causality - the findings may offer a foundation for future research. Subsequent studies should aim to explore disease- and procedure-specific mortality more granularly and may identify underlying risk factors.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"525"},"PeriodicalIF":2.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted versus navigated spinal fusion surgery: a comparative multicenter study on transpedicular screw placement accuracy and patient outcomes.","authors":"Giada Garufi, Gianluca Scalia, Francesca Graziano, Roberta Costanzo, Massimiliano Porzio, Giancarlo Ponzo, Massimiliano Giuffrida, Giuseppe Ricciardo, Giuseppe Emmanuele Umana, Giovanni Federico Nicoletti, Salvatore Massimiliano Cardali","doi":"10.1007/s10143-025-03674-z","DOIUrl":"https://doi.org/10.1007/s10143-025-03674-z","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The transpedicular screw placement has been the gold standard for over a decade in treating degenerative diseases of the lumbo-sacral spine related to vertebral instability. The evolution of neuronavigation and robotic surgery has mitigated many perioperative complications such as mispositioning, vascular damage, and nerve structure injuries, leading to enhanced postoperative outcomes, reduced blood loss, and decreased intraoperative radiation exposure. Our study proposes a multicenter comparison between robotic surgery and neuronavigation for treating degenerative diseases of the lumbo-sacral spine. We conducted a retrospective analysis at Papardo Hospital in Messina and Garibaldi Hospital in Catania, examining a consecutive series of 76 patients treated for degenerative diseases of the lumbo-sacral spine between March 2024 and December 2024 using the Excelsius GPS Robot and neuronavigation with the O-arm. We evaluated each procedure based on age, sex, body mass index, number of involved metameres, number of screws placed, operative times, estimated blood loss (EBL), radiation exposure, type of anesthesia, accuracy (using the Gertzbein and Robbins scale), and then compared various pre- and postoperative parameters through univariate statistical analysis. Patients were randomly assigned in a 1:1 ratio using a computer-generated sequence with permuted blocks of variable size (4-6). This ensured balanced allocation and minimized selection bias. A detailed statistical plan has been included: continuous variables were assessed using Student's t-test or Mann-Whitney U test depending on distribution (Shapiro-Wilk test), while categorical variables were evaluated with Chi-square or Fisher's exact test as appropriate. 48 out of 76 patients (average age 60.47 years) underwent pedicle screw placement via robotic surgery, and 28 patients (average age 65.92 years) via neuronavigation surgery. Robotic surgery showed comparable results to neuronavigation surgery in terms of blood loss. Additionally, functional outcomes, especially those evaluated with the ODI scale and VAS scale, were similar between the two patient groups. Despite a reported mispositioning rate of 2.2% in neuronavigation surgery, no clinical impact was observed in these specific cases. The surgical procedures included both decompression (laminectomy with partial facetectomy) and fusion in all patients. Operative time was recorded as skin-to-skin time, excluding anesthesia induction and positioning. Patients with prior surgeries at the index level, complex spinal deformities (Cobb angle &gt; 30°), or revision surgeries were excluded from this study. The included diagnoses were degenerative disc disease (RS: 56%, NS: 52%), spinal stenosis (RS: 28%, NS: 31%), spondylolisthesis (RS: 12%, NS: 14%), and traumatic pathology (RS: 4%, NS: 3%). While there was a trend towards greater precision in screw placement with robotic technology, no significant difference was observed compared to neuronavigat","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"524"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for the development of hydrocephalus in traumatic brain injury: a systematic review and meta-analysis.","authors":"Zhen Kun Xiao, YongHong Duan, Ge Gao, Yang Wang, MingJia Huang, JianHua Liu, Bing Wang, AiHua Liu","doi":"10.1007/s10143-025-03611-0","DOIUrl":"https://doi.org/10.1007/s10143-025-03611-0","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a significant public health issue, with 30% to 50% of patients developing post-traumatic hydrocephalus (PTH). This condition can elevate intracranial pressure, leading to headaches, vomiting, altered consciousness, and potentially coma or death, severely impacting quality of life. This study aims to systematically evaluate risk factors associated with PTH following TBI. The authors searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for studies published from 2000 to 2024. Data extraction was standardized, and statistical analysis was performed using State 14.0 software. We assessed the risk of bias and compared patient characteristics, using fixed or random effects models to summarize PTH risk factors, calculating pooled odds ratios (OR) and 95% confidence intervals (CI). A total of 25 studies involving 1,383,328 TBI patients met the inclusion criteria. Significant factors associated with an increased risk of PTH included decompressive craniectomy (DC) (p < 0.001), intraventricular hemorrhage (IVH) (p = 0.016), lower Glasgow Coma Scale (GCS) scores (p < 0.001), subdural hematoma (p < 0.001), postoperative meningitis (p = 0.027), external ventricular drainage (EVD) (p < 0.001), traumatic subarachnoid hemorrhage (SAH) (p < 0.001), and epidural hematoma (p < 0.001). Age was not significantly correlated with PTH. Identifying these risk factors (DC, IVH, GCS, subdural hematoma, postoperative meningitis, external ventricular drainage, traumatic SAH, and epidural hematoma) highlights the importance of close monitoring in TBI patients. This approach aims to enable early identification of PTH and reduce its incidence, ultimately improving survival outcomes and long-term prognosis for TBI patients.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"522"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between triglyceride-glucose index and intracranial aneurysm rupture: findings from a retrospective study.","authors":"Jiancheng Lin, Xin Feng, Zhuohua Wen, Chi Huang, Mengshi Huang, Jiwan Huang, Runze Ge, Anqi Xu, Gengwu Ma, Hongyu Shi, Yuqi Hu, Hao Yuan, Can Li, Ruizhe Yi, Yuheng Jin, Shuyin Liang, Xin Zhang, Xifeng Li, Chuanzhi Duan","doi":"10.1007/s10143-025-03680-1","DOIUrl":"10.1007/s10143-025-03680-1","url":null,"abstract":"<p><strong>Background: </strong>Limited studies investigated the relationship between triglyceride-glucose (TyG) index and the rupture of intracranial aneurysm (IA). We aimed to examine the association between TyG index and IA rupture in patients diagnosed with IAs.</p><p><strong>Materials and methods: </strong>Participants with IAs from January 2012 to April 2022 were retrospectively included. The association between TyG index and IA rupture was assessed by multivariable-adjusted logistic regression models, restricted cubic spline (RCS) models and subgroup analysis.</p><p><strong>Results: </strong>Among 1535 patients with 1901 IAs, 596 (31.4%) IA rupture cases occurred. The incidence of IA rupture rose along with elevated TyG index. The positive correlation persisted after adjusting for age, sex, and other covariates, with adjusted odds ratios of 1.64 (95% CI 1.26-2.14) and 1.85 (95% CI 1.41-2.42) for TyG index tertiles 2 and 3. RCS curves showed a linear trend of TyG index with the risk of IA rupture. In the subgroup analysis, similar relationships were observed across subgroups defined by age, sex, hypertension, TC and aneurysm size.</p><p><strong>Conclusions: </strong>There is a significant association between TyG index and the occurrence of IA rupture, indicating TyG index has the potential for risk assessment of IA rupture. Further prospective studies are warranted to validate its clinical utility.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT06456814). Registered on June 7, 2024.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"521"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-traumatic hydrocephalus after decompressive craniectomy: a multidimensional analysis of clinical, radiological, and surgical risk factors.","authors":"Sérgio Miguel Fernandes Romualdo, Tareq Adnan Juratli, Ilker Eyüpoglu, Gabriele Schackert, Markus Dengl, Markus Prem, Mido Max Hijazi, Kerim-Hakan Sitoci-Ficici","doi":"10.1007/s10143-025-03673-0","DOIUrl":"10.1007/s10143-025-03673-0","url":null,"abstract":"<p><p>Decompressive craniectomy is a key treatment for refractory intracranial pressure after severe traumatic brain injury (TBI). Post-traumatic hydrocephalus (PTH) occurs in 7.6-36% of cases, and early diagnosis significantly improves rehabilitation outcomes. This retrospective study analyzed risk factors for shunt-dependent PTH in 126 TBI patients (93 men, 33 women, median age 53 years). Patients were divided into those requiring shunts and those who did not. Clinical and radiological characteristics, including volumetric measurements and surgical techniques, were assessed using SPSS^® Statistics 25. The incidence of shunt-dependent PTH was 27%. Multivariate analysis identified significant risk factors: advanced age at craniectomy (p = 0.008; OR 1.048), traumatic subarachnoid hemorrhage in the basal cisterns (p = 0.015; OR 7.545), post-traumatic ischemic infarcts (p = 0.003; OR 5.319), transcalvarial brain herniation (p = 0.012; OR 5.543), subdural hygroma (p = 0.004; OR 8.131), and progression of contusion hemorrhages (p = 0.013; OR 4.386). Operative parameters did not show statistical significance. Neurological outcomes in shunt patients, assessed via the modified Rankin Scale and Extended Glasgow Outcome Scale, were significantly worse than in non-shunt patients (mRS > 3, GOS-E < 5, p = 0.001-0.011). Our findings suggest that subarachnoid hemorrhage in the cisterns, advanced age, hygromas, ischemic infarcts, transcalvarial herniation, and contusion hemorrhage progression are independent risk factors for shunt-dependent PTH. Additionally, shunt placement was linked to poorer neurological outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"523"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dural tail in intracranial meningioma: Heads up or tail down? A systematic review of the literature.","authors":"Q C F Cordia, B M Dijkstra, R J M Groen","doi":"10.1007/s10143-025-03658-z","DOIUrl":"10.1007/s10143-025-03658-z","url":null,"abstract":"<p><p>Meningiomas are the most common primary intracranial tumours. Recurrence occurs in up to 20%, with even higher percentages in atypical or malignant meningiomas. The non-removal of the dural tail may be a risk factor for recurrence. In this review, we aimed to determine the prevalence of tumour tissue in the radiological dural tail sign. Our secondary outcome was to determine the clinical relevance of the dural tail, if possible. PubMed, Embase, ISI Web of Science and the Cochrane Library were systematically searched for studies. Articles evaluating dural tails with both radiological and histopathological findings were included. Two reviewers independently screened studies. Data was extracted manually. 18 articles met the inclusion criteria out of 843 identified reports. In total, 406 patients with a radiological and histopathological evaluated dural tail were found. 286 patients (70.9%) had tumour infiltrate; 110 non-neoplastic dural tails showed vascular changes, loose connective tissue proliferation or inflammation. 65 patients with seemingly normal dura mater were reported, of which 26 (40.0%) showed tumour infiltration. It appears that tumour tissue in the radiological dural tail is common. Concerningly, approximately 40% of non-enhancing dura also revealed tumour tissue in the pathological examination. This highlights the need for further systematic research into the dural tail and its clinical impact on recurrence. Clinical trial number Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"520"},"PeriodicalIF":2.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flow diverter with or without adjunctive coils in the treatment of large and giant intracranial aneurysms: a meta-analysis.","authors":"Matias E Sein, Alejandro Ceciliano, Fernando Navarro, Silvina Molina, Francisco Villasante, Eduardo E Tejado, Manuel Requena, David Hernandez, Marta de Dios Lascuevas, Alejandro Tomasello, Francesco Diana","doi":"10.1007/s10143-025-03675-y","DOIUrl":"https://doi.org/10.1007/s10143-025-03675-y","url":null,"abstract":"<p><p>To evaluate the available evidence on the efficacy and safety of flow diverters (FD) with or without adjunctive coils (C) for the treatment of large and giant aneurysms. A systematic review and meta-analysis of relevant studies in PubMed and selected articles up to December 2022 were conducted. The primary objective was to evaluate the rate of favorable occlusion O'Kelly Marotta (OKM) C-D at the last follow-up, while the secondary objective was to assess complication rates. A fixed-effects model was used, and relative risks (RR) and 95% confidence intervals (CI) were calculated. A total of 146 articles were identified, but only 10 were included in the meta-analysis. This included 541 controlled aneurysms out of a total of 680 large and giant aneurysms from 1,667 patients. We found no statistical differences in favorable OKM C-D outcomes with or without the adjunctive use of coils (RR 1.06 [0.96, 1.17]; p = 0.280). However, FD + C presented fewer complications (RR 0.56 [0.33, 0.95]; I²=0%; p = 0.03). No statistical differences were found for mortality (RR 0.86 [0.34, 2.18]; I²=0%; p = 0.75). The use of adjunctive coils during treatment of large and giant aneurysms with FD seems to reduce the risk of procedural and delayed complications, while it does not increase the aneurysm occlusion rate.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"519"},"PeriodicalIF":2.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of neuroendoscopy in treatment of pediatric brain abscesses: case series and systematic review of the literature.","authors":"Piero Spennato, Francesco Tengattini, Stefania Picariello, Linda Gritti, Massimiliano Porzio, Claudio Ruggiero, Giulia Meccariello, Giuseppe Cinalli","doi":"10.1007/s10143-025-03669-w","DOIUrl":"https://doi.org/10.1007/s10143-025-03669-w","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"518"},"PeriodicalIF":2.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid peroxidation metabolites as biomarkers in patients with aneurysmal subarachnoid hemorrhage and cerebral vasospasm or delayed cerebral ischemia: a systematic review.","authors":"Natalia Anna Koc, Maurycy Rakowski, Samuel D Pettersson, Adriana Mika, Piotr Zieliński, Tomasz Szmuda","doi":"10.1007/s10143-025-03662-3","DOIUrl":"10.1007/s10143-025-03662-3","url":null,"abstract":"<p><p>Intracranial aneurysms often remain asymptomatic until rupture, causing aneurysmal subarachnoid hemorrhage (aSAH). aSAH frequently leads to cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI), significantly increasing the risk of severe neurological deficits and mortality. Identifying reliable biomarkers, such as lipid peroxidation metabolites (LPMs), is crucial for early prediction and timely intervention. This study summarizes current knowledge on LPMs as potential biomarkers for CVS and DCI after aSAH. A systematic review was conducted following PRISMA guidelines. Two independent authors searched PubMed, Web of Science, and Scopus for articles studying the association between non-enzymatic and enzymatic lipid metabolites and CVS or DCI after aSAH. Quality and risk of bias were evaluated using the Newcastle-Ottawa Scale. Extracted data included metabolite concentrations, biological sample types, timing of collection, patient demographics, clinical severity of aSAH, Fisher's grade, DCI definition, and relationship to DCI. Of 519 records screened, 17 studies were included. Lipid metabolites were measured in blood (5 studies), cerebrospinal fluid (11 studies), and urine (2 studies). F2-isoprostanes (F2-IsoPs), studied in 7 articles, were linked to increased DCI risk, with elevated levels observed within three days post-aSAH. Isofurans (IsoFs) predicted DCI risk between days 5 and 8 post-aSAH, while elevated cholesteryl ester hydroperoxide (CEOOH) levels on day 2 linked to symptomatic vasospasm. Enzymatic arachidonic acid (AA) metabolites, including 6-keto-prostaglandin F1-α, prostaglandin D2, and leukotriene C4, were also associated with early DCI risk. To the best of our knowledge, this review is the first to comprehensively assess all LPMs in relation to CVS and DCI. Elevated concentrations of F2-IsoPs and enzymatic AA derivatives may serve as biomarkers for DCI prediction in aSAH. These findings highlight the need to explore the potential of LPMs, paving the way for risk stratification and timely interventions to improve patient outcomes and aid researchers in developing predictive scoring systems for DCI. Clinical trial number Not applicable.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"516"},"PeriodicalIF":2.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reshaping neurosurgical training: a novel simulation-based concept for structured skill acquisition and curriculum integration.","authors":"Belal Neyazi, Amir Amini, Vanessa M Swiatek, Klaus-Peter Stein, Ali Rashidi, I Erol Sandalcioglu","doi":"10.1007/s10143-025-03666-z","DOIUrl":"10.1007/s10143-025-03666-z","url":null,"abstract":"<p><p>As neurosurgical caseloads decline, alternative training methods are essential for practical, hands-on training and technical skill acquisition. Physical simulators have the potential to enhance surgical training, but current models lack realism and fail to replicate the full surgical workflow. This study aims to develop and evaluate a novel, affordable microneurosurgical simulator designed for structured, effective and transferable skill acquisition. Based on previously established methodologies, we developed a novel high-fidelity yet cost-effective simulator that replicates the key steps of the neurosurgical workflow, including patient positioning, craniotomy, microsurgical dissection, clipping of aneurysms, tumor resection, and closure techniques. The simulator's fidelity was validated through intense rheological testing and tactile evaluations by experienced neurosurgeons. It was subsequently implemented in a two-day microneurosurgical simulation course involving 12 neurosurgical residents from leading German institutions. Participants completed pre- and post-course evaluations. Objective evaluations of technical proficiency and surgical learning curves were conducted using a newly developed tool-the Objective Structured Assessment of Neurosurgical Skills (OSANS). Participants rated the simulator highly for anatomical accuracy and tactile realism, with 95% considering it \"highly realistic.\" Objective assessments revealed significant improvements in technical skills, including craniotomy precision and dural closure. Confidence in performing complex neuro-oncological and vascular procedures increased by 40%. Incorporating simulation-based training into neurosurgical curricula can enhance resident education, improve skill acquisition, and promote patient safety. This presented cost-effective, reusable simulator bridges gaps in neurosurgical training by enabling realistic and repetitive practice.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"517"},"PeriodicalIF":2.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}