Neurosurgery最新文献

{"title":"Next-Generation Neuromonitoring in Minimally Invasive Spine Surgery: Indications, Techniques, and Clinical Outcomes.","authors":"Chibuikem A Ikwuegbuenyi, Noah Willett, Galal Elsayed, Osama Kashlan, Roger Härtl","doi":"10.1227/neu.0000000000003330","DOIUrl":"https://doi.org/10.1227/neu.0000000000003330","url":null,"abstract":"<p><p>Neuromonitoring in minimally invasive spine surgery (MISS) provides real-time feedback to surgeons and enhances surgical precision for improved patient safety. Since the 1970s, established techniques like somatosensory evoked potentials, motor evoked potentials, and electromyography have been integrated into spine surgeries, significantly reducing the risk of neurological complications. These neuromonitoring modalities have been crucial, particularly in complex procedures with limited direct visualization. Refinements in these techniques have led to greater confidence in nerve root safety, contributing to the success of MISS. Despite some debate regarding the routine use of neuromonitoring in noncomplex surgeries, its importance in complex cases is well-documented. Studies have demonstrated high sensitivity and specificity rates for these techniques, with multimodal approaches offering the best outcomes. Advancements in mechanomyography and its potential integration into neuromonitoring protocols highlight the continuous improvement in this field. This review explores the historical development, current techniques, clinical outcomes, and future directions of neuromonitoring in MISS. It emphasizes the critical role of these technologies in enhancing surgical outcomes and patient care. As MISS continues to evolve, adopting next-generation neuromonitoring systems, including artificial intelligence and machine learning, will play a pivotal role in advancing the efficacy and safety of spine surgeries.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S111-S118"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmented Reality in Spine Surgery.","authors":"Bayard R Wilson, Timothy Y Wang, John O'Toole","doi":"10.1227/neu.0000000000003343","DOIUrl":"https://doi.org/10.1227/neu.0000000000003343","url":null,"abstract":"<p><p>Augmented reality (AR) is a technology that allows digital information to be superimposed onto a user's view of the real world, thereby enhancing the user's experience of a given real-world scenario. As recent advances in AR technology have made it more available for a variety of applications, hospitals and doctors have begun to test its utility in the operating room. AR technology allows surgeons to supplement their view of the operative field with useful patient-specific information for which they might otherwise need to turn their attention away from the task at hand. For spine surgeons in particular, AR has begun to emerge as a promising option to assist with surgical performance. The field of spine surgery is uniquely positioned to benefit from AR, given the extent to which many spine surgeons already rely on intraoperative navigation techniques for certain surgical tasks, including pedicle screw and interbody device placement. In this review, we outline the origins and history of AR in spine surgery and cover the current state of the literature regarding the applications, benefits, and drawbacks of its use within the field. Lastly, we speculate as to the future of AR in spine surgery and propose which gaps in knowledge must be addressed before the technology enjoys a degree of adoption on par with currently available intraoperative navigation techniques.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S103-S110"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene Expression Changes Associated With Recurrence After Gross Total Resection of Newly Diagnosed World Health Organization Grade 1 Meningioma.","authors":"Ramin A Morshed, Minh P Nguyen, Mark W Youngblood, Haley K Perlow, Calixto-Hope G Lucas, Akash J Patel, Joshua D Palmer, James P Chandler, Philip V Theodosopoulos, Stephen T Magill, William C Chen, David R Raleigh","doi":"10.1227/neu.0000000000003133","DOIUrl":"10.1227/neu.0000000000003133","url":null,"abstract":"<p><strong>Background and objective: </strong>Patients who undergo gross total resection (GTR) of Central Nervous System World Health Organization (WHO) grade 1 meningioma constitute a \"low-risk\" group, but some low-risk meningiomas can recur despite reassuring clinical and histological features. In this study, gene expression values in newly diagnosed WHO grade 1 meningiomas that had undergone GTR were evaluated for their association with recurrence.</p><p><strong>Methods: </strong>This was a retrospective, international, multicenter cohort study that included WHO grade 1 meningiomas that underwent GTR, as first treatment, based on postoperative magnetic resonance imaging. Normalized gene expression values from a previously validated 34-gene panel were evaluated for their association with recurrence. Kaplan-Meier, multivariable Cox proportional hazard analyses, and K-means clustering were performed to assess the association of genes of interest with recurrence and identify molecular subgroups among clinically and histologically low-risk meningiomas.</p><p><strong>Results: </strong>In total, 442 patients with WHO grade 1 meningiomas that underwent GTR and had available gene expression profiling data were included in the study. The median follow-up was 5.0 years (interquartile range 2.6-7.7 years), local recurrence occurred in 36 patients (8.1%), 5-year local freedom from recurrence was 90.5%, and median time to recurrence was 2.9 years (range 0.5-10.7 years). Eleven genes were associated with local recurrence, including lower expression of ARID1B , ESR1 , LINC02593 , PGR , and TMEM30B and higher expression of CDK6 , CDKN2C , CKS2 , KIF20A , PGK1 , and TAGLN . Of these genes, PGK1 had the largest effect size. K-means clustering based on these 11 genes distinguished 2 molecular groups of clinically and histologically low-risk meningiomas with significant differences in local freedom from recurrence (hazard ratio 2.5, 95% CI 1.2-5.1, P = .016).</p><p><strong>Conclusion: </strong>Gene expression profiling may help to identify newly diagnosed WHO grade 1 meningiomas that have an elevated risk of recurrence despite GTR.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"521-528"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructive Endovascular Treatment of Compensative-Flow-Related Posterior Circulation Aneurysms With Anterior Circulation Artery Occlusion.","authors":"Tao Quan, Xin Zhang, Jinyi Li, Zhaofei Wang, Xiaojie Fu, Xin Feng, Haowen Xu, Chuanzhi Duan, Sheng Guan","doi":"10.1227/neu.0000000000003148","DOIUrl":"10.1227/neu.0000000000003148","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to delineate the reconstructive endovascular treatment and periprocedural management of compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion.</p><p><strong>Methods: </strong>A total of 87 patients were enrolled in this retrospective double-center cohort study from May 2011 to November 2023. The baseline demographics, aneurysm characteristics, etiology and status of anterior circulation artery occlusion, treatment modalities, anesthesia management, complications, and clinical and angiographic outcomes of the patients were retrospectively analyzed in this study.</p><p><strong>Results: </strong>Atherosclerosis and moyamoya disease were found to be the two main etiologies of anterior circulation artery occlusion. The mean American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scores were significantly higher in patients with posterior communicating artery trunk collaterals than those with posterior cerebral artery pial collaterals ( P < .05). Treatment strategies included stent-assisted coiling (55, 63.2%), standard coiling (22, 25.3%), and flow diversion or flow diversion-assisted coiling (8, 9.2%). The overall rate of procedure-related ischemic and hemorrhagic complications (10.3%) was considered acceptable. The ischemic complication was significantly associated with a >20% drop in mean arterial pressure ( P < .05) during the procedure. Finally, 86.2% of all patients showed a modified Rankin Scale score of 0 to 2 at the final clinical follow-up.</p><p><strong>Conclusion: </strong>Our study indicates that reconstructive endovascular treatments are feasible and effective strategies for compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion. However, these treatments are associated with a risk of periprocedural ischemic complications, which can be reduced by collateral arterial assessment, appropriate periprocedural anesthesia management, and antiplatelet treatment.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"630-639"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: Working Status in Patients With Untreated Unruptured Intracranial Aneurysms: A Descriptive Longitudinal Study.","authors":"Paulina Majewska, Ole Solheim","doi":"10.1227/neu.0000000000003316","DOIUrl":"10.1227/neu.0000000000003316","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e73-e74"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: What Are We Transfusing? Evaluating the Quality and Clinical Utility of Intraoperatively Salvaged Red Blood Cells in Spinal Deformity Surgery: A Nonrandomized Controlled Trial.","authors":"Serhat Aydin, Abigail Jenkins, Donald Detchou, Mert Karabacak, Umaru Barrie, Salah G Aoun","doi":"10.1227/neu.0000000000003322","DOIUrl":"10.1227/neu.0000000000003322","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e68-e69"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iodine-123-Iomazenil Single-Photon Emission Computed Tomography Revealed Recovery of Neuronal Viability in Association With Improvement of Cognitive Dysfunction After Revascularization in Moyamoya Disease.","authors":"Hideyuki Yoshioka, Takuma Wakai, Koji Hashimoto, Toru Tateoka, Norito Fukuda, Ryo Horiuchi, Takako Umeda, Hiroshi Onishi, Hiroyuki Kinouchi","doi":"10.1227/neu.0000000000003127","DOIUrl":"10.1227/neu.0000000000003127","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent studies indicate that 123 I-iomazenil ( 123 I-IMZ) single-photon emission computed tomography (SPECT) can demonstrate neuronal viability. Although cognitive dysfunction has been recognized as an important issue in adult patients with moyamoya disease (MMD), no standard neuroradiological methods to define such conditions have been established. We examined the relationship between cognitive function and 123 I-IMZ SPECT before and after revascularization in patients with MMD.</p><p><strong>Methods: </strong>The study participants were 16 adult patients with MMD whose cerebrovascular reactivities were decreased only on the surgical sides of combined revascularization. Cognitive function was examined using the Mini-Mental State Examination (MMSE; cutoff: 27) and the Frontal Assessment Battery (FAB; cutoff: 16) before and at 3 to 6 months after surgery. 123 I-iodoamphetamine ( 123 I-IMP) SPECT with acetazolamide challenge and 123 I-IMZ SPECT were performed concurrently while evaluating cognitive function. The radioreactivities of 123 I-IMZ SPECT in regions with decreased cerebrovascular reactivities on 123 I-IMP SPECT were investigated using affected-to-contralateral side asymmetry ratio (IMZ-ACR).</p><p><strong>Results: </strong>Twelve patients showed normal cognitive function (MMSE: 29.8 ± 0.4, FAB: 18 ± 0) before surgery. No evident laterality of 123 I-IMZ uptake was seen (IMZ-ACR: 0.98 ± 0.04). Neither cognitive function nor 123 I-IMZ SPECT worsened after surgery (MMSE: 29.8 ± 0.3, FAB: 18 ± 0, IMZ-ACR: 1.00 ± 0.04). By contrast, 4 patients presented cognitive dysfunction (MMSE: 24.3 ± 3.9, FAB: 14.8 ± 2.7) before revascularization. Preoperative imaging of these patients showed decreased 123 I-IMZ uptake, and their IMZ-ACRs (0.83 ± 0.08) were significantly lower than those of the normal group. After revascularization, cognitive functions and 123 I-IMZ uptake tended to ameliorate (MMSE: 27.5 ± 1.7, FAB: 16.3 ± 2.2, IMZ-ACR: 0.94 ± 0.09).</p><p><strong>Conclusion: </strong>Preoperative cognitive function was associated with 123 I-IMZ uptake in adult patients with MMD. After revascularization, cognitive function could be recovered in the viable areas of the brain, which is consistent with 123 I-IMZ SPECT findings.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"577-584"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: What Are We Transfusing? Evaluating the Quality and Clinical Utility of Intraoperatively Salvaged Red Blood Cells in Spinal Deformity Surgery: A Nonrandomized Controlled Trial.","authors":"David B Kurland, Darryl Lau","doi":"10.1227/neu.0000000000003323","DOIUrl":"10.1227/neu.0000000000003323","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e70-e71"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: AO Spine & Praxis Spinal Cord Institute Clinical Practice Guidelines for the Management of Acute Spinal Cord Injury.","authors":"Michael G Fehlings, Nathan Evaniew, Shekar N Kurpad, Andrea C Skelly, Lindsay A Tetreault, Brian K Kwon","doi":"10.1227/neu.0000000000003328","DOIUrl":"10.1227/neu.0000000000003328","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e61-e63"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: AO Spine & Praxis Spinal Cord Institute Clinical Practice Guidelines for the Management of Acute Spinal Cord Injury.","authors":"P B Raksin, J Adair Prall, Luis M Tumialán, Erica F Bisson, Mohamad Bydon, Juan S Uribe, Eric A Potts, J P Mullin","doi":"10.1227/neu.0000000000003327","DOIUrl":"10.1227/neu.0000000000003327","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e58-e60"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}