Neurosurgical Review最新文献

{"title":"Proposal of a predictive score for the occurrence of postoperative cerebral vasospasm: analysis of a large single institution retrospective series and literature review.","authors":"Marco Paolo Schiariti, Elio Mazzapicchi, Marco Gemma, Erica Pasquale, Francesco Restelli, Elisa Francesca Maria Ciceri, Jacopo Falco, Morgan Broggi, Francesco DiMeco, Paolo Ferroli, Francesco Acerbi","doi":"10.1007/s10143-024-03142-0","DOIUrl":"10.1007/s10143-024-03142-0","url":null,"abstract":"<p><p>Despite being uncommon, postoperative vasospasm (PoVS) present notably high morbidity and mortality rates. Our aim was to identify prognostic factors associated with this condition and introduce a scoring system to improve subsequent clinical and radiological surveillance strategies. We conducted a retrospective analysis of our institutional database covering patients aged over 18 who underwent craniotomic or transsphenoidal surgery for elective tumor removal at the Neurosurgical Unit of our institution between January 2016 and August 2023. A comprehensive search was conducted using the Cochrane Database of Systematic Reviews and PubMed database to identify the most correlated risk factors. Literature review included a final group of 32 studies (52 patients) and identified SAH, vessel encasement or vessel manipulation, hypothalamic disfunction, meningitis, younger age, tumor size > 3 cm, and long operative time as predictive factors for PoVS. Our cohort included 2132 patients, with only 13 individuals (0.61%) presenting PoVS. To predict the occurrence of PoVS, we developed a logistic multivariate regression model that identified thick (defined as Fisher grade ≥ 3) subarachnoid hemorrhage (coeff. 6.7, p < 0.001), intraparenchymal hemorrhage (coeff. 3.44, p < 0.001), lesion located in the parasellar region (coeff. 2.1, p = 0.064), and lesion size ≥ 4 cm (coeff. 2.0, p = 0.069) as potential independent predictors of PoVS. Based on statistical model for these variables was assigned a score: thick SAH 7 points, intraparenchymal hemorrhage 3 points, parasellar lesion site 2 points, and lesion size ≥ 4 cm 2 points. The cumulative scores ranged from 0 to 14. PoVS is a rare complication but its association with significant morbidity and mortality underscores the importance of early identification and treatment. In our study we proposed a stratified risk score to identify high risk patients. However, due to rarity of this condition, our score proposal should be considered as a training set a to be validated in future studies with a multicenter setting.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"896"},"PeriodicalIF":2.5,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801786","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":"Distribution of branches of anterior choroidal artery in the uncus: an anatomical study.","authors":"İdil Kacur, Gkionoul Nteli Chatzioglou, Emine Nas, Orhun Şahan, Ayşin Kale, Halit Çakir, Osman Coşkun, Özcan Gayretli","doi":"10.1007/s10143-024-03140-2","DOIUrl":"10.1007/s10143-024-03140-2","url":null,"abstract":"<p><p>The aim of our study was to examine the relationship between uncus and uncal branches of anterior choroidal artery (AChA) and to observe the morphological and morphometric features of these branches. 124 hemispheres from 62 fresh cadavers were included in the study. Measurement of the length of AChA and the distances of the uncal branches to the origin of AChA were measured by ImageJ software. Morphological variations of uncal branches originating from AChA were observed. The length of AChA was found as mean 26.24 ± 4.34 mm. It was determined that the average distance of these uncal branches arising from the AChA was 13.48 ± 7.31 mm. In 4 out of 124 AChAs, no branches were observed. 594 branches originating from 120 were detected. 130/594 branches appeared to be terminal branches. AChAs of 80/120 hemispheres have been reported to have uncal branches. Thirty of 130 uncal branches were observed to originate as the first branch of AChA. It was found that uncal branches may originate from AChA with a variability between 1 and 4. When evaluated according to the origin of each branch from the AChA, it was observed that the uncal branches originated from the midpoint of the AChA on average. Also, in 64 hemispheres, morophological variations were detected regarding the origin of uncal branches. We believe that the morphological and morphometric data we obtained from the uncal branches of the AChA are of clinical importance in terms of understanding this complex region and minimizing errors in surgical procedures.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"894"},"PeriodicalIF":2.5,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792142","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 serum phosphate level and mortality of patients with aneurysmal subarachnoid hemorrhage.","authors":"Ruoran Wang, Jing Zhang, Jianguo Xu, Min He","doi":"10.1007/s10143-024-03129-x","DOIUrl":"https://doi.org/10.1007/s10143-024-03129-x","url":null,"abstract":"<p><p>Disorders of serum phosphate, including hyperphosphatemia and hypophosphatemia, have been confirmed to be related to the poor prognosis of specific critically ill patients. No study analyzes the relationship between continuous serum phosphate level and mortality from aneurysmal subarachnoid hemorrhage (aSAH). This study was performed to explore this relationship. aSAH patients were divided into four groups based on serum phosphate quartiles. Significant factors discovered in the univariate Cox regression were included in the multivariate Cox regression to explore the independent relationship between serum phosphate and mortality of aSAH. Kaplan-Meier survival analysis was performed to compare the difference in survival between the four groups. The 60-day mortality of overall aSAH patients was 20.7%. The mortality of the group with the 1st quartile (29.4%) and the 4th quartile (24.7%) had higher mortality than others (p = 0.028). Univariate Cox regression showed the 2nd quartile (p = 0.020) and 3rd quartile (p = 0.017) were associated with lower mortality risk than the 1st quartile. Compared with the 1st quartile, the 4th quartile was not associated with lower mortality risk (p = 0.458). After adjusting confounding effects, multivariate Cox regression showed only the 4th quartile was significantly associated with higher mortality risk (p = 0.009) than the 1st quartile. The unadjusted relationship between serum phosphate and mortality of aSAH is U-shaped. While high serum phosphate even within the normal range is independently related to the mortality of aSAH. Low serum phosphate may be just a marker for the severity of aSAH. Evaluating the initial serum phosphate is useful for risk stratification of aSAH.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"891"},"PeriodicalIF":2.5,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792141","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 performance of ChatGPT versus neurosurgery residents in neurosurgical board examination-like questions: a systematic review and meta-analysis.","authors":"Edgar Dominic A Bongco, Sean Kendrich N Cua, Mary Angeline Luz U Hernandez, Juan Silvestre G Pascual, Kathleen Joy O Khu","doi":"10.1007/s10143-024-03144-y","DOIUrl":"10.1007/s10143-024-03144-y","url":null,"abstract":"<p><strong>Objective: </strong>Large language models and ChatGPT have been used in different fields of medical education. This study aimed to review the literature on the performance of ChatGPT in neurosurgery board examination-like questions compared to neurosurgery residents.</p><p><strong>Methods: </strong>A literature search was performed following PRISMA guidelines, covering the time period of ChatGPT's inception (November 2022) until October 25, 2024. Two reviewers screened for eligible studies, selecting those that used ChatGPT to answer neurosurgery board examination-like questions and compared the results with neurosurgery residents' scores. Risk of bias was assessed using JBI critical appraisal tool. Overall effect sizes and 95% confidence intervals were determined using a fixed-effects model with alpha at 0.05.</p><p><strong>Results: </strong>After screening, six studies were selected for qualitative and quantitative analysis. Accuracy of ChatGPT ranged from 50.4 to 78.8%, compared to residents' accuracy of 58.3 to 73.7%. Risk of bias was low in 4 out of 6 studies reviewed; the rest had moderate risk. There was an overall trend favoring neurosurgery residents versus ChatGPT (p < 0.00001), with high heterogeneity (I² = 96). These findings were similar on sub-group analysis of studies that used the Self-assessment in Neurosurgery (SANS) examination questions. However, on sensitivity analysis, removal of the highest weighted study skewed the results toward better performance of ChatGPT.</p><p><strong>Conclusion: </strong>Our meta-analysis showed that neurosurgery residents performed better than ChatGPT in answering neurosurgery board examination-like questions, although reviewed studies had high heterogeneity. Further improvement is necessary before it can become a useful and reliable supplementary tool in the delivery of neurosurgical education.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"892"},"PeriodicalIF":2.5,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792143","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":"Proton beam and carbon ion radiotherapy in skull base chordoma: a systematic review, meta-analysis and meta-regression with trial sequential analysis.","authors":"Amanda Cyntia Lima Fonseca Rodrigues, Salem M Tos, Ahmed Shaaban, Georgios Mantziaris, Daniel M Trifiletti, Jason Sheehan","doi":"10.1007/s10143-024-03117-1","DOIUrl":"10.1007/s10143-024-03117-1","url":null,"abstract":"<p><p>Chordomas are rare, locally aggressive tumors that have a high rate of recurrence, especially at the skull base. This systematic review and meta-analysis aimed to analyze the efficacy and safety of proton beam therapy (PBT) and carbon ion radiotherapy (CIRT) for skull base chordoma. We conducted a systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science, and Ovid up to November 26, 2023, following the PRISMA statement. Studies involving more than 10 patients with skull base chordoma treated with PBT or CIRT were included. The outcomes analyzed were local control, overall survival, progression-free survival, and toxicities. Meta-analysis was performed using the Mantel-Haenszel method and the inverse variance method. Fourteen studies met the inclusion criteria, encompassing 1,145 patients (671 treated with PBT and 474 with CIRT). No significant difference was found between PBT and CIRT for 5-year local control (LC) and overall survival (OS). The only timepoint with a difference in local control was at 3 years, when PBT showed an advantage in local control (90% vs. 83% for CIRT; p = 0.05) and progression-free survival was similar (94% for PBT vs. 83% for CIRT; p = 0.09). Sensitivity analysis and meta-regression revealed no significant influence of predefined parameters on outcomes. Publication bias was suggested by asymmetrical funnel plots. Both PBT and CIRT are effective treatments for skull base chordoma, with comparable long-term efficacy. This meta-analysis underscores the need for individualized treatment approaches and further research to refine these therapies in clinical practice.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"893"},"PeriodicalIF":2.5,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792140","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":"Robotic versus manual diagnostic and stenting procedures: a systematic review and meta-analysis.","authors":"Joanna M Roy, Basel Musmar, Antony A Fuleihan, Elias Atallah, Shady Mina, Shray Patel, Athina Jaffer, Stavropoula I Tjoumakaris, Michael R Gooch, Robert H Rosenwasser, Pascal M Jabbour","doi":"10.1007/s10143-024-03141-1","DOIUrl":"https://doi.org/10.1007/s10143-024-03141-1","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular procedures are associated with improved outcomes and patient satisfaction compared to open surgery in selected cases. However, this is at the cost of increased radiation exposure. Robotic procedures are thought to minimize radiation exposure and may confer procedural efficacy due to the lack of operator fatigue. Our systematic review and meta-analysis compares procedural efficacy of robotic versus manual diagnostic and stenting procedures.</p><p><strong>Methods: </strong>PubMed, Embase and Scopus were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Articles reporting comparative outcomes between robotic and manual diagnostic and stenting procedures were included. Articles related to stereotactic radiosurgery and open surgical procedures were excluded. The Newcastle Ottawa Scale was used to assess risk of bias. Effect sizes (mean difference for robotic and manual procedures) and variances were calculated for procedure time. The random effects model was used to calculate pooled estimates for technical success using the \"metafor\" package in R (R software v4.2.1, Vienna, Austria).</p><p><strong>Results: </strong>6465 articles were identified through our search strategy. After 4683 articles were excluded through a title and abstract screen and 30 articles were excluded through a full text review, 3 articles reporting outcomes in 175 patients undergoing robotic procedures and 185 patients undergoing manual procedures were included. These studies reported comparative outcomes for carotid artery stenting, diagnostic cerebral angiograms and transverse sinus stenting. There was no significant difference in procedure time (mean difference: 0.14 min [95% confidence interval (CI): -0.58, 0.86, p = 0.64, I² = 68%]. Technical success was 0.05-fold lower for robotic procedures compared to manual procedures [95% CI: 0.00- 0.84), P = 0.04]. One study was considered high quality using the NOS.</p><p><strong>Conclusions: </strong>Robotic procedures confer significantly lower rates of technical success with no significant difference in procedure time. Further studies are necessary to draw conclusions about potential benefits of robotic procedures including lower radiation exposure.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"890"},"PeriodicalIF":2.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786277","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":"Lesion filling index predicts brain arteriovenous malformation obliteration after Gamma knife radiosurgery: a hemodynamic analysis.","authors":"Ruinan Li, Yu Chen, Pingting Chen, Li Ma, Heze Han, Zhipeng Li, Wanting Zhou, Yu Zhou, Minhan Wang, Shibin Sun, Yuanli Zhao, Xiaolin Chen","doi":"10.1007/s10143-024-03135-z","DOIUrl":"https://doi.org/10.1007/s10143-024-03135-z","url":null,"abstract":"<p><p>Hemodynamics significantly influences the clinical outcomes of brain arteriovenous malformations (AVM). This study aimed to determine if the lesion filling index (LFI), obtained via quantitative digital subtraction angiography (QDSA), can predict complete complete obliteration after Gamma knife radiosurgery (GKRS). We retrospectively reviewed AVM patients who underwent GKRS and DSA exams from 2011 to 2021. Clinical, angioarchitectural, and QDSA hemodynamic features were analyzed. The LFI, derived from QDSA, was evaluated as a predictor of complete complete obliteration post-SRS using Cox proportional hazards and Kaplan-Meier analyses. Among 118 AVMs with a mean follow-up of 5.76 ± 2.76 years, post-SRS complete obliteration was linked to reduced nidus volume (7.27 ± 12.3 vs. 19.2 ± 35.7 mm³, p = 0.049), smaller nidus diameter (26.0 ± 14.9 vs. 34.1 ± 19.8 mm, p = 0.015), and absence of feeding artery dilation (21.1% vs. 46.3%, p = 0.008). Higher Arterial Diagnostic Window (ADW) (972.27 ± 1615.53 vs. 515.29 ± 730.26, p = 0.036), higher LFI (905.31 ± 2288.37 vs. 249.65 ± 1092.46, p = 0.037), and lower Transnidal Relative Velocity (TRV), a parameter defined as the maximum diameter of AVM divided by the full width at half maximum (74.31 ± 95.67 vs. 137.80 ± 152.01, p = 0.021), were also associated with complete obliteration. After adjusting for confounders, only two variables-absence of feeding artery dilation (HR 0.35, 95%CI 0.16-0.78, p = 0.010) and higher LFI (HR 1.00, 95%CI 1.00-1.00, p = 0.006) remained significant predictors. The ROC curve identified 188.4 as the LFI cutoff, and Kaplan-Meier analysis confirmed LFI's predictive value (log-rank test, χ² = 12.776, p < 0.001). Elevated LFI and absence of feeding artery dilation predict AVM complete obliteration after GKRS, indicating that overfilling and low blood flow in the nidus may promote complete obliteration.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"889"},"PeriodicalIF":2.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786276","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":"Surgical identification of brain tumour margins through impedance monitoring and electrocorticography and the potential for their combined use: A systematic review.","authors":"Ariadni Georgiannakis, Christopher A R Chapman, Dimitrios Paraskevopoulos","doi":"10.1007/s10143-024-03134-0","DOIUrl":"10.1007/s10143-024-03134-0","url":null,"abstract":"<p><strong>Context: </strong>Primary central nervous system tumours have poor survival outcomes. Surgery, the first-line treatment, presents technical limitations, such as visualising the whole tumour border. Intracranial impedance monitoring and electrocorticography techniques provide insights into the local field potential characteristics, resistance and capacitance properties of brain tissue. We hypothesised that measurements obtained by either modality can distinguish between tumour and healthy brain tissue intraoperatively.</p><p><strong>Methods: </strong>A \"Preferred Reporting Items for Systematic Reviews and Meta-Analyses\" (PRISMA)-compliant systematic review was conducted, searching PubMed, Ovid, Scopus, Cochrane and Web of Science. Studies on electrocorticography and impedance monitoring in patients with brain tumours were included. Data on patient demographics, technical details, obtained results and safety were extracted and analysed in Excel.</p><p><strong>Results: </strong>Eighteen studies involving 286 patients in total were identified. Ten impedance studies showed that brain tumour tissue has significantly different values than healthy tissue, while its resistivity varies, being either higher or lower. Eight electrocorticography studies indicated increased high gamma power and altered connectivity in tumour tissue. No studies integrated impedance monitoring and electrocorticography in one device.</p><p><strong>Conclusion: </strong>Impedance and electrocorticography measurements have the potential of differentiating between tumour and unaffected issues intra-operatively. Larger studies with standardised protocols are needed to validate these findings. Additionally, the combination of these two modalities has the potential for improved specificity with a single device. Future research should explore the role of these modalities in enhancing tumour margin identification across different tumour subtypes and in improving survival outcomes.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"888"},"PeriodicalIF":2.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786278","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":"Exploration and comparison of stress hyperglycemia-related indicators to predict clinical outcomes in patients with spontaneous intracerebral hemorrhage.","authors":"Guo-Guo Zhang, Xiao-Dan Zhang, Hong-Zhi Gao, Yuan-Xiang Lin, Zong-Qing Zheng","doi":"10.1007/s10143-024-03130-4","DOIUrl":"https://doi.org/10.1007/s10143-024-03130-4","url":null,"abstract":"<p><p>Spontaneous intracerebral hemorrhage (ICH) is a prevalent hemorrhagic stroke characterized by a significant fatality rate and severe neurological impairments. Stress hyperglycemia has been confirmed to have a significant prognostic role in a range of diseases. However, studies on the association between stress hyperglycemia and the outcome of ICH have not currently been reported. Critically ill patients diagnosed with ICH in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included in our study. Logistic regression and Cox regression were used to analyze the correlation between stress hyperglycemia and the outcome of ICH. The predictive ability of different glucose metrics was demonstrated by the receiver-operating characteristic (ROC) curve and was further compared by the integrated discrimination improvement (IDI) index. A total of 880 ICH patients in the MIMIC-IV database were included in this study. In logistic regression and Cox regression, blood glucose level (BGL), glycemic gap (GG), and stress hyperglycemia ratio (SHR) were independent predictors of unfavorable outcomes in ICH after adjustment for other confounders. The IDI results indicated that the 5-day maximum stress hyperglycemia ratio had better predictive performance than glycemic gap and blood glucose level in-hospital mortality and 1-year mortality, and the predictive performance of the 5-day maximum stress hyperglycemia ratio was better than that of stress hyperglycemia ratio measured at admission. In the age-stratified subgroup analysis, the 5-day maximum stress hyperglycemia ratio was more sensitive in predicting long-term outcomes in the young subgroup than in the elderly subgroup. The 5-day maximum stress hyperglycemia ratio is strongly correlated with an elevated risk of mortality in ICH patients and displays a better predictive ability than glycemic gap and blood glucose level in the short/long-term prognosis of ICH.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"887"},"PeriodicalIF":2.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780581","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 stereotactic brain biopsy: A systematic review and meta-analysis.","authors":"Silvio Porto Junior, Davi Amorim Meira, Beatriz Lopes Bernardo da Cunha, Jefferson Heber Marques Fontes, Hugo Nunes Pustilnik, Gabriel Souza Medrado Nunes, Gabriel Araújo Cerqueira, Maria Eduarda Messias Vassoler, Philippe Quadros Monteiro, Matheus Gomes da Silva da Paz, Tancredo Alcântara, Jules Carlos Dourado, Leonardo Miranda de Avellar","doi":"10.1007/s10143-024-03122-4","DOIUrl":"10.1007/s10143-024-03122-4","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial lesions often require tissue diagnosis through stereotactic biopsies. Originating in the 1970s, this technique has progressed, but limitations and risks persist. Recently, robot-assisted techniques have made strides, providing the potential for safer and more precise procedures. This study assesses the effectiveness and safety of robot-assisted brain biopsies.</p><p><strong>Methods: </strong>Following Cochrane and PRISMA guidelines, PubMed, Embase, and Web of Science were searched for publications up to July 2024. Outcomes assessed included neurological deficits, hemorrhage, mortality, target point error, operative time, and length of stay. Data extraction and bias assessment were conducted using standardized methods, and statistical analysis was performed using R software.</p><p><strong>Results: </strong>In this meta-analysis, 27 papers were included, involving 2605 patients. The gender distribution was 1448 males to 1141 females. The mean error in millimeters for the entry point error was 1.04 (95%CI: 0.72-1.37), while the target point error was 1.08 (95%CI: 0.49-1.66). The mean operative time was 52.45 min (95%CI: 37.83-67.07). Diagnostic yield had an estimated rate of 98% (95%CI: 97-98%; I²=31%). The length of hospital stay was 4.64 days (95%CI: 3.13, 6.14), from admission to discharge. The postoperative hemorrhage had an estimated risk of 6% (95%CI: 4-9%; I²=71%), while for transient neurological deficits, it was 4% (95%CI: 2-6%; I²=60%). Finally, the death related to the procedure was found to have an estimated risk of 0% (95%CI: 0-0%; I²=0%).</p><p><strong>Conclusion: </strong>Our study found that the diagnostic yield of stereotactic brain biopsy, especially with robotic assistance, has proven to be highly effective. Robot-assisted biopsies also seems to reduce operative times and demonstrate high precision with low entry point error and target point error. Additionally, complication rates appear to be relatively low, and the average hospital stay is favorably short, underscoring the advantages of robotic assistance in stereotactic brain biopsy procedures.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"47 1","pages":"886"},"PeriodicalIF":2.5,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770721","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}