Neurosurgery最新文献

{"title":"Commentary: Application and Safety of Externally Controlled Metronomic Drug Delivery to the Brain by an Implantable Smart Pump in a Sheep Model.","authors":"Nasser M F El-Ghandour","doi":"10.1227/neu.0000000000003164","DOIUrl":"https://doi.org/10.1227/neu.0000000000003164","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140665","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: Clinical Outcomes and Radiographic Results of Prone Transpsoas Lateral Lumbar Interbody Fusion: A Single-Institution Case Series.","authors":"Julie L Chan, Robert G Whitmore","doi":"10.1227/neu.0000000000003165","DOIUrl":"https://doi.org/10.1227/neu.0000000000003165","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140666","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: \"Neurological Surgery Residency Programs in the United States: A National Cross-Sectional Survey\".","authors":"Alexander G Yearley, Patrick R Ng, Brian V Nahed","doi":"10.1227/neu.0000000000003168","DOIUrl":"https://doi.org/10.1227/neu.0000000000003168","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140667","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: Performance of ChatGPT and GPT-4 on Neurosurgery Written Board Examinations.","authors":"Shuo Wang, Shotaro Kinoshita, Hiromi M Yokoyama","doi":"10.1227/neu.0000000000003172","DOIUrl":"https://doi.org/10.1227/neu.0000000000003172","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140669","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":"Application and Safety of Externally Controlled Metronomic Drug Delivery to the Brain by an Implantable Smart Pump in a Sheep Model.","authors":"Thomas C Chen, Winston H Wu, Ki-Eun Chang, Axel H Schönthal, Eli S Gang, Vic Indravudh, Thomas Lobl, Frank Adell, Yehoshua Shachar","doi":"10.1227/neu.0000000000003155","DOIUrl":"https://doi.org/10.1227/neu.0000000000003155","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intraventricular drug delivery enables the delivery of therapeutics to the central nervous system, while minimizing peripheral drug exposure and toxicity. However, currently used delivery devices cannot be controlled externally to adjust their output during delivery. Here, the authors investigated the performance of a conceptually novel device designed to metronomically deliver a drug to the cerebrospinal fluid in a manner that can be adjusted wirelessly from an external controller.</p><p><strong>Methods: </strong>Six sheep were subcutaneously implanted in the shoulder region with a drug delivery pump and a catheter connecting to the brain ventricles. Three groups of 2 sheep received low, medium, and high dosages of metronomic methotrexate (MTX) over several weeks, while kept mobile outdoors in a pen. MTX dosages were adjusted from a wireless external controller, and intraventricular MTX concentrations were measured in regular intervals with an Ommaya reservoir.</p><p><strong>Results: </strong>Over the course of this 12-week study, sheep showed no signs of toxicity. MTX measurements in the cerebrospinal fluid confirmed that the pump remained responsive to external control and able to deliver drug in an adjustable, metronomic fashion.</p><p><strong>Conclusion: </strong>This implantable pump system enables external control of drug output, so that the resulting intraventricular drug concentrations can continuously be maintained within the therapeutic range.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140663","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: Neurological Surgery Residency Programs in the United States: A National Cross-Sectional Survey.","authors":"Abigail Jenkins, Donald Detchou","doi":"10.1227/neu.0000000000003167","DOIUrl":"https://doi.org/10.1227/neu.0000000000003167","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140668","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":"Clinical Outcomes and Radiographic Results of Prone Transpsoas Lateral Lumbar Interbody Fusion: A Single-Institution Case Series.","authors":"Jeff Ehresman, S Harrison Farber, Madison Battista, Katriel E Lee, Bryan S Lee","doi":"10.1227/neu.0000000000003151","DOIUrl":"https://doi.org/10.1227/neu.0000000000003151","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study assessed feasibility, radiologic parameters, and clinical outcomes in patients who underwent the prone transpsoas (PTP) approach for lateral lumbar interbody fusion.</p><p><strong>Methods: </strong>This retrospective observational study included consecutive patients who underwent PTP performed by a single surgeon. Data were collected including age, sex, body mass index, operative levels, retraction time, complications, radiographic measurements, and visual analog scale pain scores. Statistical analyses were performed using nonparametric Wilcoxon 2-sample tests.</p><p><strong>Results: </strong>A total of 106 consecutive patients (mean [SD] age, 66 [15] years; mean [SD] body mass index, 29.3 [5.0]) underwent PTP on 173 spinal levels, with a mean (SD) follow-up of 13 (8) months. Sixty of 106 (57%) patients underwent a 1-level PTP procedure (range, 1-4 levels), most commonly on L4-5. The mean (SD) retraction time was 10.4 (3.1) minutes for L1-2, 9.7 (2.8) minutes for L2-3, 9.3 (2.3) minutes for L3-4, and 9.5 (3.2) minutes for L4-5. Adverse events included incidental anterior longitudinal ligament release (3 of 173 [2%] levels) and transient ipsilateral hip flexor weakness (1 of 106 [0.9%] patients). The mean pelvic incidence was 57°. Lumbar lordosis increased from a mean of 44° to 51° (P < .001). Pelvic tilt decreased from a mean of 20° to 12° (P < .001). Pelvic incidence-lumbar lordosis mismatch decreased from a mean of 13 to 5 (P < .001). Visual analog scale pain scores improved from a mean of 6 preoperatively to 5 postoperatively (P < .001).</p><p><strong>Conclusion: </strong>In this single-institution patient series, the PTP approach was effective and safe for lateral lumbar fusion, with minimal complications and improved lumbar lordosis and patient-reported pain outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140664","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":"Global Neurosurgery: An Overview.","authors":"Roxanna M Garcia, Nathan A Shlobin, Ronnie E Baticulon, Kemel A Ghotme, Laura Lippa, Luis A Borba, Mahmood Qureshi, Nqobile Thango, Tariq Khan, Peter Hutchinson, Gail Rosseau","doi":"10.1227/neu.0000000000003109","DOIUrl":"https://doi.org/10.1227/neu.0000000000003109","url":null,"abstract":"<p><p>In the following article, we define the practice of global neurosurgery and review the major historical events defining this movement within the larger context of global surgery. The current state of the neurosurgical workforce, disease burden, and ongoing collaborative efforts are highlighted. Ethical practice leading the sustainability is discussed, as well as future targets for the global community as we look beyond the next decade of opportunities to affect the neurosurgical burden of disease.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982852","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":"Optimizing Recurrent Glioblastoma Salvage Treatment: A Multicenter Study Integrating Genetic Biomarkers From the Korean Radiation Oncology Group (21-02).","authors":"Dowook Kim, Joo Ho Lee, Nalee Kim, Do Hoon Lim, Jin Ho Song, Chang-Ok Suh, Chan Woo Wee, In Ah Kim","doi":"10.1227/neu.0000000000002903","DOIUrl":"10.1227/neu.0000000000002903","url":null,"abstract":"<p><strong>Background and objectives: </strong>Few studies have used real-world patient data to compare overall treatment patterns and survival outcomes for recurrent glioblastoma (rGBM). This study aimed to evaluate postprogression survival (PPS) according to the treatment strategy for rGBM by incorporating biomarker analysis.</p><p><strong>Methods: </strong>We assessed 468 adult patients with rGBM who underwent standard temozolomide-based chemoradiation. The impact of predictors on PPS was evaluated in patients with isocitrate dehydrogenase wild-type rGBM (n = 439) using survival probability analysis. We identified patients who would benefit from reirradiation (re-RT) during the first progression.</p><p><strong>Results: </strong>Median PPS was 3.4, 13.8, 6.6, and 10.0 months in the best supportive care (n = 82), surgery (with/without adjuvant therapy, n = 112), chemotherapy alone (n = 170), and re-RT (with/without chemotherapy, n = 75) groups, respectively. After propensity score matching analysis of the cohort, both the surgery and re-RT groups had a significantly better PPS than the chemotherapy-only group; however, no significant difference was observed in PPS between the surgery and re-RT groups. In the surgery subgroup, surgery with chemotherapy ( P = .024) and surgery with radio(chemo)therapy ( P = .039) showed significantly improved PPS compared with surgery alone. In the no-surgery subgroup, radio(chemo)therapy showed significantly improved PPS compared with chemotherapy alone ( P = .047). Homozygous deletion of cyclin-dependent kinase inhibitor 2A/B, along with other clinical factors (performance score and progression-free interval), was significantly associated with the re-RT survival benefit.</p><p><strong>Conclusion: </strong>Surgery combined with radio(chemo)therapy resulted in the best survival outcomes for rGBM. re-RT should also be considered for patients with rGBM at first recurrence. Furthermore, this study identified a specific genetic biomarker and clinical factors that may enhance the survival benefit of re-RT.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175805","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":"Impact of Molecular Subgroups on Prognosis and Survival Outcomes in Posterior Fossa Ependymomas: A Retrospective Study of 412 Cases.","authors":"Bo Wang, Minjun Yan, Bo Han, Xing Liu, Pinan Liu","doi":"10.1227/neu.0000000000002923","DOIUrl":"10.1227/neu.0000000000002923","url":null,"abstract":"<p><strong>Background and objectives: </strong>Posterior fossa ependymomas (PFEs) are rare brain tumors classified as PF-EPN-A (PFA) and PF-EPN-B (PFB) subgroups. The study aimed to evaluate the prognosis and survival outcomes in PFEs, with a focus on the impact of molecular subgroups.</p><p><strong>Methods: </strong>A retrospective study was conducted on 412 patients with PFEs. Kaplan-Meier survival analyses were conducted to evaluate the overall survival (OS) and progression-free survival. Cox regression analyses were conducted to assess the prognostic factors. A nomogram was developed to predict the OS rates of PFEs.</p><p><strong>Results: </strong>The study revealed significant differences between PFA and PFB in patient and tumor characteristics. PFAs were associated with poorer OS (hazard ratios [HR] 3.252, 95% CI 1.777-5.950, P < .001) and progression-free survival (HR 4.144, 95% CI 2.869-5.985, P < .001). World Health Organization grade 3 was associated with poorer OS (HR 2.389, 95% CI 1.236-4.617, P = .010). As for treatment patterns, gross total resection followed by radiotherapy or the combination of radiotherapy and chemotherapy yielded the most favorable OS for PFA ( P = .025 for both), whereas gross total resection followed by radiotherapy rather than observation showed improved OS for PFB ( P = .046). The nomogram demonstrated a high degree of accuracy and discrimination capacity for the prediction of OS rates for up to 10 years. In addition, 6 cases of PFA (3.51%) with H3K27M mutations were identified.</p><p><strong>Conclusion: </strong>PFAs demonstrate worse prognosis and survival outcomes compared with PFBs. Both PFAs and PFBs necessitate maximal resection followed by intensive adjuvant therapies in long-term effects.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288673","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}