Neurosurgery最新文献

{"title":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Role of Medical Perioperative Management for Patients With Functioning Pituitary Adenomas.","authors":"Christie G Turin, Janice M Kerr, Kalmon D Post, Gabriel Zada, Isabelle M Germano, D Ryan Ormond","doi":"10.1227/neu.0000000000003608","DOIUrl":"10.1227/neu.0000000000003608","url":null,"abstract":"<p><strong>Background and objectives: </strong>Standardized perioperative management of patients with functioning pituitary adenomas is important for optimal medical and surgical outcomes. Review of the literature to evaluate the impacts of (1) postoperative fluid restriction and sodium level checks to prevent delayed hyponatremia and hospital-related readmissions, (2) preoperative somatostatin analog (SSA) medical treatment in patients with growth hormone-secreting tumors and its effects on surgical and medical outcomes, and (3) immediate postoperative pituitary hormone testing in patients with adrenocorticotropic hormone (ACTH)-secreting tumors to predict adrenal insufficiency and disease remission.</p><p><strong>Methods: </strong>Systematic literature search using Embase and PubMed from 1946 to June 2021.</p><p><strong>Results: </strong>A total of 1953 abstracts were identified for review: 124 studies were selected for full-text review, and 44 studies were included in the analyses. Overall, based on predominantly level III evidence, the literature supported the following: (1) fluid restriction (1000-1500 mL/day for ∼7 postoperative days), with/without a routine serum sodium check, to lower the risk of delayed hyponatremia and hospital-related readmission, and (2) basal morning serum cortisol (±ACTH levels), within the immediate postoperative period (≤72 h) for patients with ACTH-secreting tumors to predict adrenal insufficiency and disease remission. Conversely, perioperative treatment of patients with growth hormone-secreting tumors with a SSA is not recommended to improve surgical or medical outcomes.</p><p><strong>Conclusion: </strong>Limited fluid restriction is recommended for all patients after trans-sphenoidal surgery (without diabetes insipidus), as is routine postoperative morning cortisol testing in patients with Cushing disease, but not somatostatin presurgical treatment in acromegalic patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 3S","pages":"S1-S14"},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855908","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":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Role of Imaging for Patients With Functioning Pituitary Adenomas.","authors":"Jacqueline C Junn, Kalmon D Post, Manish K Aghi, Gabriel Zada, Daniel Prevedello, Bradley Delman, Puneet Belani, D Ryan Ormond, Isabelle M Germano","doi":"10.1227/neu.0000000000003607","DOIUrl":"10.1227/neu.0000000000003607","url":null,"abstract":"<p><strong>Background: </strong>Patients with functioning pituitary adenomas (FPA) present a diagnostic challenge with identification of microadenomas and/or invasion of the cavernous sinus.</p><p><strong>Objective: </strong>The aim of this study was to provide evidence-based recommendations on the use of imaging to facilitate an accurate diagnosis.</p><p><strong>Methods: </strong>PubMed and Embase were searched from the inception of the database to June 8, 2021, using search terms and search strategies to identify pertinent abstracts. These were then screened using published exclusion/inclusion criteria to identify full-text review articles. Evidence tables were constructed using data from full-text reviews, and recommendations were made.</p><p><strong>Results: </strong>Of the total 8685 identified abstracts pertinent to this topic, 138 full articles met the eligibility criteria. Of these, 18 met the inclusion criteria and were included in the evidence tables. Class III evidence supported 4 Level III recommendations for adult patients with FPA.</p><p><strong>Conclusion: </strong>This systematic review provides evidence-based recommendations to guide providers caring for adult patients with FPA when making decisions pertinent to imaging. The Congress of Neurological Surgeons will continue to pursue timely updates and to further improve the care of patients with diagnosis.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 3S","pages":"S15-S23"},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855907","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: Optimal Tracheostomy Timing After Traumatic Complete Spinal Cord Injury: A Comparative Analysis of Ultraearly, Early, and Delayed Practice.","authors":"Xia Feng, Libing Jiang","doi":"10.1227/neu.0000000000003714","DOIUrl":"10.1227/neu.0000000000003714","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e136-e138"},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855902","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: The Use of a 405-nm Blue Light System in a Neurosurgical Department as an Adjunct for Lowering Environmental Contamination and Perioperative Infections: Results From a Prospective Observational Cohort Study.","authors":"Laiba Azhar, Md Moshiur Rahman","doi":"10.1227/neu.0000000000003698","DOIUrl":"10.1227/neu.0000000000003698","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e143-e144"},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855903","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":"Automating the Referral of Bone Metastases Patients With and Without the Use of Large Language Models.","authors":"Karl L Sangwon, Xu Han, Anton Becker, Yuchong Zhang, Richard Ni, Jeff Zhang, Daniel Alexander Alber, Anton Alyakin, Michelle Nakatsuka, Nicola Fabbri, Yindalon Aphinyanaphongs, Jonathan T Yang, Abraham Chachoua, Douglas Kondziolka, Ilya Laufer, Eric Karl Oermann","doi":"10.1227/neu.0000000000003683","DOIUrl":"https://doi.org/10.1227/neu.0000000000003683","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bone metastases, affecting more than 4.8% of patients with cancer annually, and particularly spinal metastases require urgent intervention to prevent neurological complications. However, the current process of manually reviewing radiological reports leads to potential delays in specialist referrals. We hypothesized that natural language processing (NLP) review of routine radiology reports could automate the referral process for timely multidisciplinary care of spinal metastases.</p><p><strong>Methods: </strong>We assessed 3 NLP models-a rule-based regular expression (RegEx) model, GPT-4, and a specialized Bidirectional Encoder Representations from Transformers (BERT) model (NYUTron)-for automated detection and referral of bone metastases. Study inclusion criteria targeted patients with active cancer diagnoses who underwent advanced imaging (computed tomography, MRI, or positron emission tomography) without previous specialist referral. We defined 2 separate tasks: task of identifying clinically significant bone metastatic terms (lexical detection), and identifying cases needing a specialist follow-up (clinical referral). Models were developed using 3754 hand-labeled advanced imaging studies in 2 phases: phase 1 focused on spine metastases, and phase 2 generalized to bone metastases. Standard McRae's line performance metrics were evaluated and compared across all stages and tasks.</p><p><strong>Results: </strong>In the lexical detection, a simple RegEx achieved the highest performance (sensitivity 98.4%, specificity 97.6%, F1 = 0.965), followed by NYUTron (sensitivity 96.8%, specificity 89.9%, and F1 = 0.787). For the clinical referral task, RegEx also demonstrated superior performance (sensitivity 92.3%, specificity 87.5%, and F1 = 0.936), followed by a fine-tuned NYUTron model (sensitivity 90.0%, specificity 66.7%, and F1 = 0.750).</p><p><strong>Conclusion: </strong>An NLP-based automated referral system can accurately identify patients with bone metastases requiring specialist evaluation. A simple RegEx model excels in syntax-based identification and expert-informed rule generation for efficient referral patient recommendation in comparison with advanced NLP models. This system could significantly reduce missed follow-ups and enhance timely intervention for patients with bone metastases.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874347","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":"Commentary: Automating the Referral of Bone Metastases Patients With and Without the Use of Large Language Models.","authors":"Harsh Jain, Tyler C Zeoli, Scott L Zuckerman","doi":"10.1227/neu.0000000000003635","DOIUrl":"https://doi.org/10.1227/neu.0000000000003635","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855896","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":"Gender Differences in Publications, Authorship, and Match Patterns Among Neurosurgical Residency Applicants.","authors":"Logan Muzyka, Ethan A Wetzel, Alexander F Wang, Timothy R West, Ali M Nasser, Uyanga Batsaikhan, Andreas Runde, Martina Stippler, Sharona Ben-Haim, Τheresa L Williamson, Brian V Nahed","doi":"10.1227/neu.0000000000003674","DOIUrl":"https://doi.org/10.1227/neu.0000000000003674","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent efforts have highlighted gender disparities in neurosurgery in leadership, conference involvement, and scientific productivity. Despite efforts to improve diversity, systemic barriers persist. Given the weight publications carry in the neurosurgical match, this study analyzes gender differences in publication metrics among matched neurosurgical residency applicants, identifying opportunities to increase female representation.</p><p><strong>Methods: </strong>Neurosurgical residents from the 2023 match were examined using PubMed, Scopus, and departmental websites for detailed publication information, program details, gender, and medical school.</p><p><strong>Results: </strong>Of the 242 successfully matched applicants, male applicants tended to work with male senior authors (84.62% vs 76.68%, P = .044), and more female applicants worked with female senior authors (23.21% vs 15.33%, P = .045). Having a female senior author increased odds of female first authorship (odds ratio = 1.64, 95%, P < .001). Compared with female-identifying applicants, male-identifying applicants had more publications (11.80 vs 6.78, P < .001), first-authorships (3.88 vs 2.00, P < .001), higher H-indices (4.74 vs 3.27, P < .001), and more unique senior authors (5.63 vs 4.37, P = .036). Male applicants published more often in spine (P < .001). Geographically, female applicants were more likely from the West, least likely from the South (P = .036), and more likely to match at home programs than male applicants (32.8% vs 19.8%, P = .037).</p><p><strong>Conclusion: </strong>For matched neurosurgical applicants, gender of the senior author influences likelihood of junior authorship. Specifically, having female senior authors correlates with increased likelihood of publication for female applicants and is associated with female first authorship. Gender disparities persist in publications: male applicants typically publish, collaborate with senior authors, and work with male senior authors at higher rates. These results highlight systemic barriers female applicants face in preparing competitive applications and ensuring equal residency acceptance. Research instruction and active mentorship of female applicants from both male and female neurosurgical mentors is critical to improving gender disparity in neurosurgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855897","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":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Role of Surgery for Patients With Functioning Pituitary Adenomas.","authors":"Kevin O Lillehei, Sarah Travers, Garni Barkhoudarian, Nelson M Oyesiku, Isabelle M Germano, D Ryan Ormond","doi":"10.1227/neu.0000000000003559","DOIUrl":"10.1227/neu.0000000000003559","url":null,"abstract":"<p><strong>Background and objectives: </strong>With the recent improvements in surgery, along with our ability to manage many pituitary tumors medically, the exact role of surgery for the treatment of functioning pituitary adenomas (PA) remains unclear. The purpose of this evidence-based clinical practice guideline was to determine the role of surgery in the treatment of functioning PA.</p><p><strong>Methods: </strong>A systematic review of the literature was performed using the National Library of Medicine/PubMed database and Embase for studies relevant to the role of surgery in the treatment of patients with functioning PA. Clinical studies evaluating the role of trans-sphenoidal surgery vs medical management, endoscopic techniques vs microsurgery, the benefit of the use of adjunct surgical techniques to patient outcome, and the role of second surgery were selected for review.</p><p><strong>Results: </strong>The literature search yielded 7073 abstracts. Of these, 60 studies met inclusion criteria, and evidence-based guidelines were formulated on the use of surgical resection compared with medical management, the use of endoscopic techniques and/or other surgical adjunct techniques, and the benefit of reoperation for recurrent tumors compared with medical treatment and/or radiation.</p><p><strong>Conclusion: </strong>Class III evidence suggests a benefit to surgery over medical management for growth hormone-secreting adenomas without evidence to support a benefit to pretreatment with a somatostatin analog before surgery. Class III evidence suggests a benefit to medical management over surgery in the treatment of patients with prolactinomas at primary diagnosis. There are insufficient data to support the benefit of endoscopic surgery compared with microscopic surgery, with or without additional adjuvant surgical techniques, for extent of surgical resection, hormone remission, length of stay, or complication rate, in the treatment of functional PA. There is a suggestion, however, that the endoscopic technique may be superior to the microscopic technique, for a shorter operative time and for extent of surgical resection and hormone remission rates for noninvasive pituitary macroadenomas. Similarly, there are insufficient data to support the use of reoperation for recurrent tumor compared with radiation and/or medical treatment.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 3S","pages":"S24-S35"},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855836","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":"Sponsor Acknowledgments.","authors":"","doi":"10.1227/neu.0000000000003685","DOIUrl":"https://doi.org/10.1227/neu.0000000000003685","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 3S","pages":"N1"},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855838","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":"Outcomes Following Different Treatment Modalities of Aggressive Vertebral Hemangiomas: A Systematic Review and Patient-Level Meta-Analysis.","authors":"Teleale F Gebeyehu, Stavros Matsoukas, Glenn A Gonzalez, Eric Mong, Zachary Sokol, Giovanna Failla, Joshua E Heller, Alexander R Vaccaro, Jack Jallo, Srinivas K Prasad, James S Harrop","doi":"10.1227/neu.0000000000003684","DOIUrl":"https://doi.org/10.1227/neu.0000000000003684","url":null,"abstract":"<p><strong>Background and objectives: </strong>Vertebral hemangiomas are the most common primary spine tumors with an estimated prevalence of 10% to 12%. Approximately 1% are \"aggressive\", expanding and eroding osseous confines. Treatment aims at limiting their growth and symptomatology. This study evaluated the effectiveness of various treatment modalities for symptoms and recurrence control.</p><p><strong>Methods: </strong>Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 compliant study. Medline and Scopus were searched in March 2024. Inclusion criteria were English language, published between 2000 and 2023, adults (older than 18 years), primary aggressive vertebral hemangioma (AVH) Enneking stage 3. Data included patient-level demographics, treatment, outcomes, and recurrence. Excluded were case reports, studies focusing on nonaggressive vertebral hemangioma, other primary or metastatic tumors, and studies on the treatment of recurrent AVHs. Results of descriptive studies, pooled proportions, correlation, and regression are presented in tables and forest plots.</p><p><strong>Results: </strong>Sixteen studies with 150 AVHs in 149 patients. Mean age (SD) was 50.4 (16.8) years, and 55/149 (36.9%) were men. Mean follow-up (SD) was 49.8 (57) months. Weighted pooled proportions: gross total resection 18.2%, recurrence 7.9%, symptom resolution 43.4%, and Frankel score improvement 68.4%. Initial sensory deficit (OR: 29.1, P = .02) and performing corpectomy/spondylectomy (OR: 0.034, P < .01) were independent predictors for symptom resolution. Embolization (49.5%, P = .0151), open surgery (48.8%, P = .0019), and complete resection (82.1%, P < .0001) showed strong correlation with symptom improvement. Higher symptom resolution was observed with kyphoplasty/vertebroplasty (82.5%, P < .0001), no open surgery (78.9%, P = .0019), and no surgical tumor resection (72%, P < .0001). No independent predictors were found for recurrence.</p><p><strong>Conclusion: </strong>Embolization, intralesional ablation, vertebroplasty, and kyphoplasty are options for AVH without cord compression and neurological deficits. For cord compression, open surgery with or without these interventions can be considered. Radiation is for persistent pain and locally advanced tumors. The extent of tumor progression is correlated with symptom control.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855905","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}