Brain & spine最新文献

{"title":"Risk factors for failure in short segment pedicle instrumentation in thoracolumbar fractures","authors":"Ana Vilela ,&nbsp;Bibiana Couto ,&nbsp;David Ferreira ,&nbsp;António Cruz ,&nbsp;Joana Azevedo ,&nbsp;João Pereira ,&nbsp;André Santos-Moreira ,&nbsp;Nuno Oliveira ,&nbsp;Paulo Gil Ribeiro ,&nbsp;Pedro Varanda ,&nbsp;Direito-Santos Bruno","doi":"10.1016/j.bas.2025.104266","DOIUrl":"10.1016/j.bas.2025.104266","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of thoracolumbar fractures, particularly through short-segment posterior fixation (SSPF), remains a topic of ongoing debate in spine surgery.</div></div><div><h3>Research question</h3><div>This study aimed to identify the factors influencing SSPF failure in traumatic thoracolumbar fractures’ treatment, focusing on variables such as age, bone mineral density (BMD), fracture level, posterior ligamentous complex (PLC) injury, screw length, type of screw (monoaxial or polyaxial), instrumentation of the fractured vertebra and sagittal screw angle (SSA).</div></div><div><h3>Material and methods</h3><div>A total of 66 patients were included, with 43 in the non-failure group (Group N) and 23 in the failure group (Group F). Failure was defined by criteria including screw pull-out, material failure, loss of vertebral height ≥50%, or postoperative kyphosis ≥30°.</div></div><div><h3>Results</h3><div>The results indicated that age, the use of monoaxial screws and BMD were statistically significant predictors of failure, with older patients (&gt;60 years) showing an eighteen-fold higher risk of failure. Survival analysis revealed that older patients, those with PLC injuries, and those with monoaxial screw instrumentation experienced failure at significantly earlier times.</div></div><div><h3>Discussion and conclusion</h3><div>These findings suggest that rigorous patient selection, considering factors such as age, BMD, and screw type, is crucial for minimizing the risk of failure in SSPF treatment. Further multicenter prospective studies with larger sample sizes are necessary to validate these results and enhance risk prediction models.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104266"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life assessment in schwannomatosis – A systematic review","authors":"Anna C. Lawson McLean ,&nbsp;Steffen K. Rosahl ,&nbsp;Aaron Lawson McLean ,&nbsp;Pascal Fehringer ,&nbsp;Anna Freier ,&nbsp;Denise Löschner ,&nbsp;Marcel A. Kamp ,&nbsp;Christian Senft ,&nbsp;Andreas K. Demetriades","doi":"10.1016/j.bas.2025.104279","DOIUrl":"10.1016/j.bas.2025.104279","url":null,"abstract":"<div><h3>Introduction</h3><div>The term schwannomatosis refers to rare genetic disorders characterized by the development of multiple tumors within the central and/or peripheral nervous system. Recent advancements in our molecular understanding of these disorders have led to a redefined conceptual framework within the field, grouping NF2-related schwannomatosis with other forms of schwannomatosis.</div></div><div><h3>Research question</h3><div>This systematic review aims to compile and analyse existing literature on QoL in individuals with schwannomatosis.</div></div><div><h3>Methods</h3><div>A comprehensive search of electronic databases was conducted up until January 2025. Inclusion criteria included studies evaluating QoL in adults with schwannomatosis, using validated QoL assessment tools or patient-reported outcome measures. There were no geographical or time restrictions placed on the search. Case reports and reviews were excluded from the analysis to focus on original research contributions.</div></div><div><h3>Results</h3><div>The initial search identified 241 articles, after removal of duplicates. Three articles were added after screening references. 40 articles were selected for final analysis. These studies utilized various assessment tools, including PHQ-9 (n = 10), WHOQOL-BREF (n = 9) and the disease-specific questionnaire NFTI-QOL (n = 15). The collective findings consistently indicated compromised QoL among individuals with schwannomatosis, particularly in domains such as physical functionality, pain perception, emotional well-being, and social interactions.</div></div><div><h3>Discussion and conclusion</h3><div>This systematic review reveals substantial variability in QoL assessment for schwannomatosis, highlighting significant physical and psychological impacts in NF2-SWN and predominant bodily pain in non-NF2-SWN patients. We call for an international, interdisciplinary consensus on standardized QoL tools to enable clearer research comparisons, guide clinical practice, and improve patient-centered care.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104279"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, interest and perspectives on Artificial Intelligence in Neurosurgery. A global survey","authors":"A. Boaro ,&nbsp;E. Mezzalira ,&nbsp;F. Siddi ,&nbsp;C. Bagattini ,&nbsp;N. Gabrovsky ,&nbsp;N. Marchesini ,&nbsp;M. Broekman ,&nbsp;F. Sala","doi":"10.1016/j.bas.2024.104156","DOIUrl":"10.1016/j.bas.2024.104156","url":null,"abstract":"<div><h3>Introduction</h3><div>Artificial Intelligence (AI) applications in healthcare are growing exponentially. The field of neurosurgery is particularly suited to implement AI solutions given its technology-driven nature. It is of paramount importance to understand the basics of AI to make informed decision on how to shape current and future applications.</div></div><div><h3>Research question</h3><div>What is the level of confidence, knowledge and the attitude of the global neurosurgical community towards AI basic concepts and applications?</div></div><div><h3>Material and methods</h3><div>A 24-item survey was designed and distributed. The survey results reported on level of knowledge, confidence and interest in AI, perspectives and attitude towards the application of AI technologies in neurosurgery. The potential influence of demographics and work-related environment features on AI knowledge was investigated.</div></div><div><h3>Results</h3><div>We received a total of 250 responses from 61 countries. The correct definition of ‘Machine Learning’, ‘Deep Learning’ and main Big Data features were identified by respectively 42%, 23% and 23% of the respondents. The survey unveiled a strong interest and a positive attitude towards the introduction of AI in the neurosurgical practice. The main concerns included trustworthiness and liability, the main barriers to implementation were considered lack of funding, infrastructure, knowledge and multidisciplinary collaboration.</div></div><div><h3>Discussion and conclusion</h3><div>There is a low familiarity with basic AI concepts in the neurosurgical community. Nevertheless, there is a strong interest and a positive attitude towards AI implementation. The systematization of training and the production of educational resources will be key in guaranteeing a successful implementation of AI in the evolving history of neurosurgery.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104156"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current state and future perspectives of spinal navigation and robotics—an AO spine survey","authors":"Stefan Motov ,&nbsp;Vicki M. Butenschoen ,&nbsp;Philipp E. Krauss ,&nbsp;Anand Veeravagu ,&nbsp;Kelly H. Yoo ,&nbsp;Felix C. Stengel ,&nbsp;Nader Hejrati ,&nbsp;Martin N. Stienen","doi":"10.1016/j.bas.2024.104165","DOIUrl":"10.1016/j.bas.2024.104165","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of robotics in spine surgery has gained popularity. This study aims to assess the current state of robotics and raise awareness of its educational implications.</div></div><div><h3>Research question</h3><div>What are the current adoption trends and barriers to the implementation of robotic assistance in spine surgery?</div></div><div><h3>Material and methods</h3><div>An online questionnaire comprising 27 questions was distributed to AO spine members between October 25th and November 13th, 2023, using the SurveyMonkey platform (<span><span>https://www.surveymonkey.com</span><svg><path></path></svg></span>; SurveyMonkey Inc., San Mateo, CA, USA). Statistical analyses (descriptive statistics, Pearson Chi-Square tests) and generation of all graphs were performed using SPSS Version 29.0.1.0 (IBM SPSS Statistic).</div></div><div><h3>Results</h3><div>We received 424 responses from AO Spine members (response rate = 9.9 %). The participants were mostly board-certified orthopedic surgeons (46 %, n = 195) and neurosurgeons (32%, n = 136). While 49% (n = 208) of the participants reported occasional or frequent use of navigation assistance, only 18 % (n = 70) indicated the use of robotic assistance for spinal instrumentation. A significant difference based on the country's median income status (p &lt; 0.001) and the respondent's number of annual instrumentation procedures (p &lt; 0.001) has been observed. While 11 % (n = 47) of all surgeons use a spinal robot frequently, 36 % (n = 153) of the participants stated they don't need a robot from a current perspective. Most participants (77%, n = 301) concluded that high acquisition costs are the primary barrier for the implementation of robotics.</div></div><div><h3>Discussion and conclusion</h3><div>Although the hype for robotics in spine surgery increased recently, robotic systems remain non-standard equipment due to cost constraints and limited usability.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104165"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling neurocysticercosis: A call for heightened awareness and action","authors":"Inibehe Ime Okon ,&nbsp;Muhammad Danish Shafqat ,&nbsp;Muhammad Daniyal Shafqat ,&nbsp;Javeria Hussain ,&nbsp;Youssef Razouqi","doi":"10.1016/j.bas.2024.104174","DOIUrl":"10.1016/j.bas.2024.104174","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104174"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative assessment of tumor consistency and gross total resection in pituitary adenoma: Radiomic analysis of T2-weighted MRI and interpretation of contributing radiomic features","authors":"Martin Černý ,&nbsp;Vojtěch Sedlák ,&nbsp;Martin Májovský ,&nbsp;Petr Vacek ,&nbsp;Kateřina Sajfrídová ,&nbsp;Kíra R. Patai ,&nbsp;Alexia-Ştefana Mârza ,&nbsp;David Netuka","doi":"10.1016/j.bas.2025.104237","DOIUrl":"10.1016/j.bas.2025.104237","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative knowledge of tumor consistency and the likelihood of gross total resection (GTR) would greatly benefit planning of pituitary adenoma surgery, however, no reliable methods currently exist.</div></div><div><h3>Objectives</h3><div>To evaluate the utility of radiomic analysis of MRI for predicting tumor consistency and GTR. To explore the interpretability of contributing radiomic features.</div></div><div><h3>Methods</h3><div>Patients undergoing first endoscopic surgery for pituitary macroadenomas were included. Tumor consistency was assessed intraoperatively, GTR was assessed based on postoperative MRI. Radiomic features were extracted from axial T2-weighted MRI. Low-variability and highly intercorrelated features were removed. Random Forest Classifiers were optimized using 70 % of patient data and evaluated on the remaining 30 %. Relative feature importance was assessed using the Gini–Simpson index.</div></div><div><h3>Results</h3><div>542 patients were included. GTR was achieved in 325 (60.0 %) cases, firm tumors were encountered in 122 (22.5 %) cases. There was a significant correlation between GTR and tumor consistency (67.1 % vs. 35.2 %, p &lt; 0.001). 1688 radiomic variables were extracted, 442 were removed due to low variance and 699 due to high intercorrelation. The consistency prediction model achieved an accuracy of 81.6 % and utilized 32 features, GTR prediction model achieved 79.1 % accuracy using 73 features.</div></div><div><h3>Conclusions</h3><div>Radiomic analysis demonstrated significant potential for preoperative evaluation of pituitary adenomas. Texture and intensity-based features were the primary contributors to consistency prediction. However, the explanation of these features was insufficient. GTR prediction was predominantly driven by shape-related features. Our findings highlight the challenges of linking radiomic features to underlying tissue properties and emphasize the need for cautious interpretation.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104237"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"About the pressure to conform: A tribute to Dr Henry D. Messer","authors":"Fares Komboz ,&nbsp;Yu-Mi Ryang ,&nbsp;Silvia Hernandez-Duran","doi":"10.1016/j.bas.2025.104230","DOIUrl":"10.1016/j.bas.2025.104230","url":null,"abstract":"<div><h3>Introduction</h3><div>Dr. Henry D. Messer was a pioneering figure in neurosurgery and LGBT rights activism in the USA during the 1950s, a time of significant societal stigma. Despite facing discrimination due to his sexual orientation, Messer's resilience led him to become one of the first openly gay neurosurgeons in the United States.</div></div><div><h3>Research question</h3><div>The authors aimed to explore the life and contributions of Dr. Henry D. Messer to the medical and neurosurgical community.</div></div><div><h3>Materials and methods</h3><div>The authors performed a review of the literature as well as the works and the publications of Dr. Henry D. Messer.</div></div><div><h3>Results</h3><div>After overcoming professional setbacks linked to his identity, Messer became chief of neurosurgery at Wayne County General Hospital in 1976. His activism was instrumental in advocating for LGBT representation within the medical community. His 1974 chapter \"The Homosexual as Physician\" was critical for medical literature, challenging stereotypes and calling for greater acceptance of homosexual physicians. Messer's work coincided with broader LGBT rights movements, including the Stonewall riots, laying the groundwork for future advocacy efforts. The article also highlights Messer's scientific contributions, which includes 10 peer-reviewed publications in the field of neurosurgery.</div></div><div><h3>Discussion and conclusion</h3><div>Messer's legacy continues to influence contemporary discussions on diversity in medicine, emphasizing the importance of representation for underrepresented minorities in neurosurgery. By reflecting on his journey, this article focuses on the ongoing challenges faced by LGBTQ+ and female neurosurgeons today, advocating for a more inclusive and innovative field that enhances patient care through diversity.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104230"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural steroid injections in lumbar disc herniation- Evidence synthesis from 72 randomised controlled trials (RCTs) and a total of 7701 patients","authors":"Alexandros G. Brotis ,&nbsp;Theodosios Spiliotopoulos ,&nbsp;Adamantios Kalogeras ,&nbsp;Kostas N. Fountas ,&nbsp;Andreas K. Demetriades","doi":"10.1016/j.bas.2025.104216","DOIUrl":"10.1016/j.bas.2025.104216","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of epidural steroid injection in treating sciatica still remains debatable.</div></div><div><h3>Research question</h3><div>To compare epidural steroid injection with other manipulations in terms of pain control, quality of life and other parameters (Q1), compare the various available ESI alternatives regarding the approach (Q2), compare ESI to analgesia (Q3), identify the ideal ESI protocol (Q4), compare different guiding techniques (Q5) and determine the role of ESI as e predictive factor for the outcome.</div></div><div><h3>Material and methods</h3><div>This systematic review searched three databases from inception to February 2024. Independent reviewers assessed and gathered the data and also the quality of evidence was critically appreciated.</div></div><div><h3>Results</h3><div>The systematic review included 72 randomized controlled trials 7701 patients. There was a big variation among the aim of the studies. ESI proved to surpass other conservative methods for treating sciatica, however it does not provide long-term results. US- guided as well asFL-guided ESI was proved to have superior results. On the other hand, the role of ESIs in predicting the requirement for surgery is understudied. Comparing the different approaches in ESI the TFESI proved mostly to have better results.Surgery still remains the method with the most instant results providing also long-term treatment.</div></div><div><h3>Discussion and conclusions</h3><div>ESI has superior results to other conservative treatment modalities for sciatica; However surgery seems to have more immediate effect and better long term outcome. Apart from different approaches, additional agents such as amitriptyline proved to have effect when administered additionally to ESI. More studies need to be conducted for ESI as a predictive factor for the outcome or need of surgery.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104216"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the SITE score for de-novo spinal infection patients in clinical practice – A case-based approach","authors":"Manuel Kramer ,&nbsp;Martin N. Stienen ,&nbsp;Benjamin Martens ,&nbsp;Felix C. Stengel ,&nbsp;Stefan Motov","doi":"10.1016/j.bas.2025.104228","DOIUrl":"10.1016/j.bas.2025.104228","url":null,"abstract":"<div><h3>Study design</h3><div>Validation study.</div></div><div><h3>Introduction</h3><div>De-novo spinal infections (DNSI) are a concerning healthcare problem. The treatment is established case-based in the absence of clear guidelines. The recently proposed Spinal-Infection-Treatment-Evaluation (SITE) score combines clinical and radiological variables to support decision-making, but it has not been validated among non-spine surgeons.</div></div><div><h3>Research question</h3><div>We aimed to validate this novel score in a real-life setting among surgeons from different clinical specialties.</div></div><div><h3>Methods</h3><div>A single-center study was conducted from 1/10/2023 until 31/12/2023. We collected clinical and radiological data of DNSI patients, treated at our institution. We created fifteen representative specific case presentations, including all spinal locations. A survey was designed to distribute the specific case presentations among physicians from the departments that agreed to participate. Participants were asked to score each case by using the SITE score and calculated intra-class correlation coefficients (ICC3).</div></div><div><h3>Results</h3><div>Forty-eight survey forms were analyzed (seven spine-surgeons, 41 others) Spine surgeons demonstrated good interobserver reliability (ICC3 = 0.78). Non-spine surgeons showed poor interobserver reliability (ICC3 = 0.48). Subgroup analysis by specialty revealed overall low reliability scores (internal medicine ICC3 = 0.48, orthopaedics ICC3 = 0.43, other surgical specialties ICC3 = 0.56, infectiology ICC3 = 0.55). Participants with more frequent exposure to DNSI (&gt;10 per year; n = 9) showed higher reliability, achieving similar scores to spine surgeons (ICC3 = 0.7).</div></div><div><h3>Discussion and conclusions</h3><div>We found acceptably high interobserver values for the SITE score only for spine surgeons and non-spine surgeons with frequent exposure to DNSI. The reliability of the score was much lower when applied by physicians from other specialties with lesser experience of DNSI.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104228"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-specific titanium-reinforced calcium-phosphate (CaP: Ti) implants for revision cranioplasty","authors":"Paul Vincent Naser ,&nbsp;Friederike Zacharias ,&nbsp;Henrik Giese ,&nbsp;Sandro M. Krieg ,&nbsp;Andreas W. Unterberg ,&nbsp;Alexander Younsi","doi":"10.1016/j.bas.2025.104213","DOIUrl":"10.1016/j.bas.2025.104213","url":null,"abstract":"<div><h3>Introduction</h3><div>Cranioplasty is a common neurosurgical procedure, but infections can complicate it, necessitating revision surgery. Alloplastic patient-specific implants (PSI) are increasingly utilized, and different materials are available. This study evaluates the role of titanium-reinforced calcium-phosphate (CaP:Ti) implants in revision cranioplasty.</div></div><div><h3>Research question</h3><div>Assessing the efficacy and safety of CaP:Ti PSI in patients requiring revision cranioplasty following complications with previously failed cranioplasty attempts.</div></div><div><h3>Material and methods</h3><div>Retrospective analysis of 15 patients who underwent CaP:Ti PSI implantation for revision cranioplasty between 2016 and 2022 at a single neurosurgical department. Data on demographics, perioperative details, and outcomes were collected and assessed. Differences in distribution were assessed using Fisher's exact test, and groups were numerically compared using student's t-test. A p-value &lt;0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>In most patients, CP failure occurred early (38 days) following elective craniotomy for tumor and vascular procedures. The first revision cranioplasty was conducted in 12 cases using CaP:Ti PSI in 8 cases successfully requiring no further revision. Three cases implanted with other alloplastic materials required revision and received CaP:Ti PSI in the second (n = 2) or third (n = 1) CP attempt. The overall success rate for CaP:Ti PSI was 73.3% over more than two years of follow-up. success rate in revision cranioplasty. Surgical site complications, predominantly infections, were the main cause of CP failure. The average interval between implant removal and re-cranioplasty was 300 days. Prehabilitation using skin expanders and postoperative antibiotic use were strategies successfully utilized in this cohort.</div></div><div><h3>Discussion and conclusion</h3><div>Our findings suggest that CaP:Ti PSI implants hold promise in salvaging complicated cranioplasty in most cases despite challenges such as infection and implant failure. The use of techniques like skin expanders may contribute to better outcomes. However, further research is crucial to establish optimal timing and patient selection guidelines in revision cranioplasty using CaP:Ti implants, which could significantly impact future neurosurgical practices.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104213"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}