Neurosurgery最新文献

{"title":"A Meta-Analysis of Medication Reduction and Motor Outcomes After Awake Versus Asleep Deep Brain Stimulation for Parkinson Disease.","authors":"Luyuan Li, Ali I Rae, Kim J Burchiel","doi":"10.1227/neu.0000000000003138","DOIUrl":"10.1227/neu.0000000000003138","url":null,"abstract":"<p><strong>Background and objectives: </strong>There remains significant debate regarding the performance of deep brain stimulation (DBS) procedures for Parkinson disease (PD) under local or general anesthesia. The aim of this meta-analysis was to compare the clinical outcomes between \"asleep\" DBS (general anesthesia) and \"awake\" DBS (local anesthesia) for PD.</p><p><strong>Methods: </strong>We conducted a comprehensive literature review of all published studies on DBS for PD following PRISMA guideline on PubMed and Cochrane library from January 2004 to April 2023. Inclusion criteria included cohort ≥15 patients, clinical outcomes data which included Unified Parkinson's Disease Rating Scale (UPDRS) score and levodopa equivalent daily dosage (LEDD), and ≥3 months of follow-up. Analysis was conducted using Stata software.</p><p><strong>Results: </strong>There were 18 articles that met inclusion criteria. On meta-analysis, there were no significant differences between awake or asleep DBS with regard to percent change in UPDRS III \"off\" med/\"on\" DBS condition ( P = .6) and LEDD score ( P = .99). On subgroup analysis, we found that the choice of target had no significant effect on improvement of UPDRS III ( P = 1.0) or LEDD ( P = .99) change for the asleep vs awake operative approach. There were also no statistically significant differences between microelectrode recording (MER) use and no MER use in postoperative UPDRS III ( P = 1.0) or LEDD improvement ( P = .90) between awake and asleep surgery.</p><p><strong>Conclusion: </strong>There was no significant difference in the primary motor outcomes and LEDD improvement between asleep vs awake DBS. The variables of target selection and MER use had no statistically significant impact on outcome. We find that asleep techniques are both safe and effective compared with the awake technique.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"481-493"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081108","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":"Minimally Invasive Posterior Cervical Fusion Strategies.","authors":"Vincent Rossi, Domagoj Coric","doi":"10.1227/neu.0000000000003341","DOIUrl":"https://doi.org/10.1227/neu.0000000000003341","url":null,"abstract":"<p><p>Thoracolumbar minimally invasive spine surgery (MIS) has become widely adopted over the past two decades. MIS cervical fixation has lagged behind, largely because of complex and variable cervical spinal anatomy. Traditional open spine fixation techniques are associated with high fusion rates but are plagued by significant approach-related morbidity. This morbidity is due to paraspinal muscle denervation and atrophy secondary to disruption of the posterior musculoligamentous complex leading to wound healing difficulties, including relatively high rates of wound infection and dehiscence as well as aesthetic issues. Therefore, novel MIS fixation techniques have focused on percutaneous tissue-sparing approaches in an effort to decrease wound morbidity and hospital readmission. In addition, more biomechanically robust minimally invasive constructs may provide smaller alternative surgical solutions. Previously described fluoroscopic MIS cervical pedicle screw placement has been revitalized with the recent description of a navigated percutaneous minimally invasive technique. With the incorporation of new enabling navigation technologies, this technique is feasible, reproducible, and safe. In addition, these procedures have provided unique solutions for approaching cervical pathology in line with currently accepted MIS principles of the thoracolumbar spine. This review article discusses current minimally invasive posterior fusion strategies with a description of the technique and case demonstrations.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S42-S50"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414319","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":"How Do Robotics and Navigation Facilitate Minimally Invasive Spine Surgery? A Case Series and Narrative Review.","authors":"Esteban Quiceno, Mohamed A R Soliman, Asham Khan, Jeffrey P Mullin, John Pollina","doi":"10.1227/neu.0000000000003352","DOIUrl":"https://doi.org/10.1227/neu.0000000000003352","url":null,"abstract":"<p><strong>Background and objectives: </strong>Image guidance has transformed minimally invasive spine surgery (MISS), allowing for safer procedures without excessive bony exposure and reducing radiation exposure for the surgical team. Robotic platforms have enhanced the benefits of navigation by providing high precision and accuracy. Here we describe a case series to demonstrate the accuracy and low complication rates of real-time image-guided robotic-assisted (RA) MISS at a tertiary referral center. In addition, we performed a narrative review on how robotics and navigation facilitate MISS.</p><p><strong>Methods: </strong>A retrospective chart review was conducted to obtain data for patients who underwent RA lumbar fusions with real-time navigation for degenerative lumbar pathology between September 1, 2021, and January 1, 2024. The Mazor X Stealth Edition (Medtronic) robotic platform was used. The accuracy of screw placement was determined according to Gertzbein-Robbins classification. Intraoperative and postoperative complication rates up to 90 days were recorded. Intraoperative variables and length of stay were compared between open and percutaneous groups.</p><p><strong>Results: </strong>A total of 247 patients underwent insertion of 1156 pedicle screws. The mean patient age was 61.1 ± 11.5 years. The mean total operative time was 195.1 ± 80.8 minutes. The mean operative time per screw was 4.2 ± 1.4 minutes, with a mean of 4.6 ± 1.4 screws per case. The mean fluoroscopy time per screw was 6.4 ± 6.2 seconds. Eighty-five patients (34.4%) underwent open RA pedicle screw placement, and 162 (65.6%) underwent percutaneous RA pedicle screw placement. No differences in operative time, length of stay, fluoroscopy time, and surgical complications were found between groups. Intraoperatively, 2 patients (0.8%) experienced complications and 4 patients (1.6%) developed complications within 90 days. Screw placement accuracy was perfect in 1126 screws (97.4%) and clinically acceptable in 30 screws (2.6%). These results were consistent with those reported in the literature.</p><p><strong>Conclusion: </strong>Robotic platforms have further enhanced navigation benefits by providing high precision and accuracy, with low complication rates.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S84-S93"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414223","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":"Single Position Lateral Anterior Lumbar Interbody Fusion at L5/S1.","authors":"Martin N Stienen, Kelly Yoo, Ethan Schonfeld, Vaihabi Shah, Matthew Abikenari, Dhiraj Pangal, Venita Chandra, Anand Veeravagu","doi":"10.1227/neu.0000000000003332","DOIUrl":"https://doi.org/10.1227/neu.0000000000003332","url":null,"abstract":"<p><p>Anterior lumbar interbody fusion (ALIF) is an established surgical approach for spinal fusion, offering distinct advantages in restoring lumbar lordosis, indirectly decompressing neural elements, and facilitating high fusion rates because of the increase in the fusion surface area. Traditionally, ALIF is performed with the patient in a supine position, necessitating repositioning for additional posterior interventions, which increases operative time, anesthetic time, and complexity. The recent development of single position lateral ALIF (SPL-ALIF) enables anterior and posterior access without repositioning, enables gravity facilitated retroperitoneal access, and optimizes surgical efficiency, particularly in cases necessitating multilevel anterior column fusion. The current review comprehensively examines SPL-ALIF at the L5-S1 level, presenting technical considerations and comparative benefits over traditional techniques. The approach has demonstrated significant reductions in operative time, blood loss, and postoperative ileus, with equivalent radiographic outcomes compared with supine ALIF. Furthermore, SPL-ALIF has been evidenced to have a similar safety profile to supine ALIF with equivalent vascular, abdominal, and neurological complications, as well as comparable revision rates between the two procedures. However, SPL-ALIF is not without limitations. The technique may be less effective in cases requiring direct decompression or in patients with complex vascular anatomy or extensive retroperitoneal scarring. These challenges necessitate careful patient selection to optimize outcomes and minimize intraoperative risks. Future studies are warranted to validate the clinical benefits of SPL-ALIF, particularly concerning fusion rates, patient-reported outcomes, and complication profiles, thereby solidifying its role in the evolving landscape of minimally invasive spine surgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S17-S25"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414653","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":"The Role of Minimally Invasive Surgery in Spinal Trauma: A Review of Techniques, Outcomes, and Limitations.","authors":"Mounica R Paturu, Joshua Woo, Brett Rocos, Peter Passias, Michael Haglund, Douglas Orndorff, C Rory Goodwin, Kristen Jones, Khoi D Than","doi":"10.1227/neu.0000000000003342","DOIUrl":"https://doi.org/10.1227/neu.0000000000003342","url":null,"abstract":"<p><p>Minimally invasive surgery (MIS) has significantly revolutionized spine surgery by reducing morbidity, minimizing tissue damage, and improving postoperative outcomes compared with traditional open surgeries. Although MIS is well-documented for degenerative spine diseases, its full scope and limitations in spine trauma remains underexplored. Thus, this review aims to address this gap by examining relevant literature on the evolution, current practices, and future directions of MIS applications in spinal trauma care. We conducted a PubMed search with keywords including \"MIS,\" \"percutaneous pedicle screw,\" \"lateral corpectomy,\" \"anterior thoracoscopic surgery,\" and \"transpsoas/direct lateral approach,\" both individually and in combination with \"thoracolumbar trauma,\" \"cervical trauma,\" and \"spine trauma.\" After screening abstracts and full-text manuscript review, articles meeting inclusion/exclusion criteria were reviewed including prospective and retrospective case-control studies, case reports, and reviews. Exclusionary criteria included studies not involving traumatic injuries of the thoracolumbar or cervical spine, lack of clinical follow-up, and studies in foreign languages. Based on a literature review of 85 studies, the following manuscript focuses on the indications, complications, current literature, clinical outcomes, future directions, and limitations of MIS in managing thoracolumbar and cervical spine injuries with particular emphasis on percutaneous pedicle screw fixation, lateral thoracic and lumbar corpectomies, anterior thoracoscopic/endoscopic approaches, and treatment algorithms. Although MIS for spinal trauma offers numerous advantages, continuous research and data collection are crucial to developing clear treatment algorithms and improving clinical outcomes. However, the future of MIS in spine trauma care remains promising, with advancements in technology and surgical techniques anticipated to enhance safety, efficacy, and patient satisfaction.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S129-S138"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414756","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":"Evaluating Linear Heuristics for Ventricular Volume in Healthy Adults Using a Fully Automated Algorithm: Implications for Defining the Normal.","authors":"Birra R Taha","doi":"10.1227/neu.0000000000003132","DOIUrl":"10.1227/neu.0000000000003132","url":null,"abstract":"<p><strong>Background and objectives: </strong>Linear metrics for ventricular volume play a large role in the rapid, approximate evaluation of ventricular volume. In this article, we automatically extract linear measures of ventricular volume to explore their correlation with lateral ventricular volume (LVV) in the healthy adult population and comprehensively define normal values.</p><p><strong>Methods: </strong>We automatically extract Evans' ratio (ER), Frontal-Occipital Horn Ratio (FOHR), and anteroposterior lateral ventricle index (ALVI) from an open MRI data set of healthy adults ( https://brain-development.org/ixi-dataset/ ). Indices have been correlated with corresponding LVVs and lateral ventricular volumes divided by supratentorial brain volumes. Spearman rank correlation was used to compare strength of correlation.</p><p><strong>Results: </strong>ER shows correlation with lateral ventricle volume based on sex (r = 0.58; men, r = 0.65; women P < .001), including when controlling for supratentorial volume (r = 0.57; men, r = 0.63). ER did not profoundly correlate with age (r = 0.29, men; r = 0.35, women; P < .001) and seemed normally distributed around 0.25. ALVI showed strong correlation with LVV with only slight gender differences (r = 0.83, men; r = 0.84, women) and LVV to supratentorial cortical volume ratio (r = 0.9, men; r = 0.86, women). FOHR was also normally distributed around a value of 0.37 and showed moderate correlation with LVV (r = 0.68, men; r = 0.73, women) and LVV to supratentorial cortical volume ratio (r = 0.69, men; r = 0.74, women).</p><p><strong>Conclusion: </strong>ALVI is a newer index with strong correlation with LVV and has strong potential for clinical use. Both FOHR and ER show moderate correlation with LVV. Reference values for linear estimates of ventricular volume may help clinicians better identify patients with pathological ventriculomegaly.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"693-699"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902435","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: Predictors of Durable Remission After Successful Surgery for Cushing Disease: Results From the Multicenter RAPID Registry.","authors":"Matthew C Findlay, Michael Karsy","doi":"10.1227/neu.0000000000003318","DOIUrl":"10.1227/neu.0000000000003318","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e78"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952131","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":"Role of Minimally Invasive Spine Surgery in Spine Oncology.","authors":"W Christopher Newman, Mark H Bilsky, Ori Barzilai","doi":"10.1227/neu.0000000000003340","DOIUrl":"https://doi.org/10.1227/neu.0000000000003340","url":null,"abstract":"<p><p>The application of minimally invasive spine surgery (MISS) in degenerative spine disease and deformity has seen rapid growth in the past 20 years. Building on this experience, such methods have been adopted into spine oncology in the past decade, particularly for metastatic disease. The impetus for this growth stems from the benefits of surgical decompression combined with radiation treatment in patients with metastatic disease in conjunction with the need for less morbid interventions in a patient population with limited life expectancy. The result of these two realizations was the application of minimally invasive techniques for the treatment of spine tumors including re-establishment of spinal stability, decompression of the spinal cord or nerve roots, and restoration of spinal alignment. Technological advancement and improvement in biomaterials have allowed for durable stabilization with short constructs even for patients with poor bone quality. The implementation of navigation and robotic capabilities has transformed MISS by streamlining surgery and further reducing the surgical footprint while laser ablation, endoscopy, and robotic surgery hold the potential to minimize the surgical footprint even further. MISS for intradural tumors is commonly performed, while the role for other primary tumors has yet to be defined. In this article, we describe the evolution of and indications for MISS in spine oncology through a retrospective literature review.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S119-S128"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414516","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":"Single-Position Prone Transpsoas Lateral Interbody Fusion at L4-L5: Technical Pearls.","authors":"Winward Choy, Ximena Serur, Juan P Giraldo, Juan S Uribe","doi":"10.1227/neu.0000000000003338","DOIUrl":"https://doi.org/10.1227/neu.0000000000003338","url":null,"abstract":"<p><p>Single-position prone transpsoas (PTP) lateral interbody fusion has been proposed as an alternative to lateral lumbar interbody fusion performed in the lateral decubitus position. The advantages to this single-position technique include facilitating segmental lordosis, obviating the need for repositioning for posterior instrumentation, and providing access for posterior decompression. Although PTP lateral interbody fusion can be a powerful and efficient technique, adopting and navigating this approach is challenging. A learning curve should be expected, even for surgeons who are experienced with traditional lateral lumbar interbody fusion. This review provides a detailed technical description of the PTP technique at L4-L5. In addition, we provide technical pearls aimed at improving surgical ergonomics, workflow, and safety.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"96 3S","pages":"S3-S8"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414723","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":"First Reported Series of Cerebral Angiography Performed at an Outpatient Center: Safety and Satisfaction Results.","authors":"Tyler A Scullen, Ming X Lian, Vinay Jaikumar, Jennifer L Gay, Pui Man Rosalind Lai, Matthew J McPheeters, Steven B Housley, Kunal P Raygor, Mehdi Bouslama, Hamid S Khan, Adnan H Siddiqui, Jason M Davies, Douglas B Moreland, Elad I Levy","doi":"10.1227/neu.0000000000003119","DOIUrl":"10.1227/neu.0000000000003119","url":null,"abstract":"<p><strong>Background and objective: </strong>Ambulatory surgery centers (ASCs) are increasingly common venues for same-day neurosurgical procedures, allowing for cost-effective, high-quality patient care. We present the first and largest series of patients undergoing diagnostic cerebral angiography at an ASC to demonstrate the effectiveness, safety, and efficiency of outpatient endovascular care.</p><p><strong>Methods: </strong>We retrospectively reviewed data for consecutive patients who underwent diagnostic cerebral angiography at our ASC between January 1, 2024, and May 29, 2024. Data collected included vascular access approach, procedural duration, turnover time, and periprocedural complications. Using a standardized 2-week postprocedural survey, patients were asked to provide comments and rate their subjective satisfaction from a 1 to 5 scale, with \"5\" being completely satisfied. All cases were performed with a physician team comprising 1 attending neuroendovascular neurosurgery and 1 neuroendovascular fellow present. Fentanyl and midazolam were administered for conscious sedation in all cases.</p><p><strong>Results: </strong>Among the 67 patients included in this series, the mean procedural duration was 29.4 ± 8.6 minutes. The mean turnover time was 13.7 ± 3.6 minutes. Between transradial (46 of 67 [68.7%]) and transfemoral (21 of 67 [31.3%]) access site approaches, there were no statistically significant differences in mean procedural duration (29.4 ± 8.0 vs 29.2 ± 9.9 minutes, respectively; P = .72) or turnover time (14.0 ± 3.9 vs 12.9 ± 2.8 minutes, respectively; P = .4). No complications occurred periprocedurally or within the 2-week follow-up period. A total of 48 (71.6%) of 67 patients responded to the postprocedural survey, all of whom unanimously reported a score of \"5.\"</p><p><strong>Conclusion: </strong>We found that diagnostic cerebral angiography performed at our ASC was safe and effective for patient care. In addition, all survey respondents (71.6% of those provided the survey) reported highest levels of satisfaction. The integration of neuroendovascular procedures into ASCs potentially offers a cost-effective and highly efficient option in an evolving economic landscape.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"539-544"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748705","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}