Neurosurgery practice最新文献

{"title":"Preliminary Clinical Experience With a Novel Foamy Collagen-Based Dural Substitute (Foamagen) for Dural Closure Following Translabyrinthine Craniotomy: An Exploratory Comparison With DuraSeal.","authors":"Hsuan-Yi Wu, Po-Huang Chen, Chen-Shu Wu, Chun-Fu Lin, Sanford P C Hsu","doi":"10.1227/neuprac.0000000000000280","DOIUrl":"10.1227/neuprac.0000000000000280","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cerebrospinal fluid (CSF) leakage remains a common and clinically significant complication following skull base surgery, particularly with the translabyrinthine approach for cerebellopontine (CP) angle tumor resection. We aimed to evaluate the safety and efficacy of Foamagen in CP angle tumor resection performed through the translabyrinthine approach.</p><p><strong>Methods: </strong>Patients undergoing CP angle tumor resection using the translabyrinthine approach were categorized into 2 groups based on the dural closure material: the intervention group received Foamagen, whereas the control group received the standard sealant DuraSeal (Integra LifeSciences). Outcomes included CSF leakage (wound leak or rhinorrhea), surgical site infection, need for lumbar drainage, and reoperation at discharge and at 3-month follow-up.</p><p><strong>Results: </strong>Among 40 patients, 18 were assigned to the Foamagen group and 22 to the DuraSeal group. Baseline characteristics were comparable between the groups. At discharge, the incidence of CSF leakage was low and similar in both groups [5.6% (95% CI: 0.1%-27.3%) vs 4.5% (95% CI: 0.1%-22.8%); risk difference +1.0% (95% CI: -12.7% to +14.7%), <i>P</i> = 1.000]. No significant differences were observed in postoperative infection (5.6% vs 4.5%, <i>P</i> = 1.000), lumbar drain placement (11.1% vs 4.5%, <i>P</i> = .579), or reoperation rates (0% vs 4.5%, <i>P</i> = .369). At the 3-month follow-up, no CSF leakage or abnormal dural thickening was identified in either group.</p><p><strong>Conclusion: </strong>In this small exploratory cohort, Foamagen demonstrated outcomes comparable with those of the standard sealant DuraSeal. Foamagen may therefore serve as a safe and effective alternative for preventing CSF leakage following CP angle tumor resection. However, the study was substantially underpowered to establish noninferiority, and larger prospective studies are warranted to confirm this observation.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000280"},"PeriodicalIF":0.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726932","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":"Protocol for Development of Guidelines for Rapid Restoration of Readiness.","authors":"Simon Oczkowski, Thomas Bayuk, Bradley A Dengler, Michael McCrea, Sameer Sharif, Katie Stout, Gregory W J Hawryluk, Halinder S Mangat, Jamshid Ghajar","doi":"10.1227/neuprac.0000000000000274","DOIUrl":"10.1227/neuprac.0000000000000274","url":null,"abstract":"<p><p>Combat and sport require individuals to be ready for successful completion of the task at hand. Cognitive readiness and attention may be impaired for many reasons, including concussion or subconcussive injury, insufficient sleep, fatigue, or any other disruption or deviation of baseline physiology. While rapid readiness screening may identify individuals who are not \"ready\" for a given task, it is also important to find interventions which can rapidly return an individual to a state of readiness. Although general health practices such as nutrition, physical conditioning, and adequate rest support overall performance, targeted interventions-focused on oculo-vestibular, verbal-cognitive function, and motor control-may accelerate return to readiness. Additional modalities such as structured sleep optimization protocols, controlled stimulant use, and specific supplements may also contribute to rapid restoration. This paper describes an evidence-based framework for developing guidelines that identify, evaluate, and implement rapid readiness restoration strategies across diverse preclinical settings, including military far-forward environments, sports sidelines, and garrison or training contexts.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000274"},"PeriodicalIF":0.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725152","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":"Posterior Cervicothoracic Fusion During Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion: Sagittal Alignment and Deformity Outcomes.","authors":"Stephen M Bergin, Joshua Woo, Mohamed Alwadai, Benjamin S Succop, Blake Parente, Peter G Passias, Allan H Friedman, Shivanand P Lad, Muhammad M Abd-El-Barr","doi":"10.1227/neuprac.0000000000000278","DOIUrl":"10.1227/neuprac.0000000000000278","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dorsal root entry zone (DREZ) lesioning is an established treatment of refractory deafferentation pain after brachial plexus avulsion. Exposure often requires multilevel cervical or cervicothoracic laminectomy, which may predispose to postoperative kyphosis. We evaluated whether concurrent posterior instrumented fusion preserves sagittal alignment and reduces delayed deformity after DREZ lesioning.</p><p><strong>Methods: </strong>We retrospectively reviewed patients undergoing cervical or cervicothoracic DREZ lesioning at a single institution from 2013 to 2025. Patients were grouped by concurrent posterior fusion vs nonfusion DREZ. Radiographic outcomes included C2-C7 Cobb angle, cervical sagittal vertical axis (CSVA), T1 slope, C2 slope, and T1 slope minus cervical lordosis. Nonfusion patients with paired standing radiographs underwent exploratory comparison. Clinical outcomes included pain relief, complications, and reoperation.</p><p><strong>Results: </strong>Twenty-three patients were included: 8 fusion and 15 nonfusion. In the fusion cohort, median follow-up was 16.0 (IQR: 10.9-21.4). Paired standing radiographs were available in 7 of 8 fusion patients and 3 of 15 nonfusion patients. In the fusion cohort, mean C2-C7 Cobb improved from 2.5° ± 23.1° to 18.3° ± 20.8°, whereas CSVA remained stable. All fusion patients maintained postoperative CSVA ≤40 mm, and 7 of 8 maintained T1 slope minus cervical lordosis ≤20°. No fusion patient developed new or progressive postoperative kyphosis. Durable pain relief occurred in 5 of 8 fusion patients and 10 of 15 nonfusion patients. In the nonfusion cohort, postoperative kyphosis was documented in 8 of 15 patients, new or progressive kyphosis/deformity in 5 of 12 evaluable patients, and reoperation for deformity, instability, or radiographic failure in 5 of 15.</p><p><strong>Conclusion: </strong>Concurrent posterior fusion during cervicothoracic DREZ lesioning was associated with preserved sagittal alignment and absence of new progressive postoperative kyphosis. Fusion should be considered when DREZ requires extensive multilevel exposure, particularly across the cervicothoracic junction.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000278"},"PeriodicalIF":0.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686855","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":"A Validation of the Tarlov Cyst Quality-of-Life Scale in Patients Surgically Treated for Intrasacral Meningoceles.","authors":"Frank Feigenbaum, Susan E Parks, Debbie A West, Tanishu M Deckard-Ross, Onesica P Coleman, Kristina M Kupanoff","doi":"10.1227/neuprac.0000000000000277","DOIUrl":"10.1227/neuprac.0000000000000277","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intrasacral meningoceles (IM) are a type of spinal meningeal cyst that can develop within the sacral spinal canal and cause sacral radiculopathy symptoms. The research on IM is sparse, comprised largely of case reviews lacking standardization with validated measures. However, a disease-specific health-related quality-of-life scale has been published for Tarlov cysts to measure symptoms before and after surgical treatment. The purpose of this study was to validate the Tarlov Cyst Quality-of-Life (TCQoL) survey as a disease-specific health-related quality-of-life measure for patients surgically treated for symptomatic IM.</p><p><strong>Methods: </strong>Patients surgically treated for IM between 2016 and 2024 were included. Patients completed preoperative surveys within 2 weeks of surgery and postoperative surveys 6 months after surgery. Surveys included the Short-Form 36, the Oswestry Disability Index, a visual analog scale for pain, and the TCQoL scale. Psychometric analyses including construct validity, internal consistency, sensitivity to clinical change, and discriminative validity were performed to validate the TCQoL.</p><p><strong>Results: </strong>Our cohort included 81 patients. Discriminative validity was demonstrated by significant improvement in each of the 11 items and the overall scale score from preoperative to postoperative (<i>P</i> < .001 for all comparisons). Cronbach alpha was 0.84 for the scale, suggesting good internal consistency. Concurrent validity was established by correlating scale scores of the TCQoL with the Oswestry Disability Index r(79) = 0.68 (0.54, 0.79), <i>P</i> < .001 and all 8 of the Short-Form 36 subscale scores with correlations ranging from -0.19 (-0.45, -0.03) for mental health to -0.59 (-0.70, -0.40) for physical function. The minimum clinically important difference was 0.6.</p><p><strong>Conclusion: </strong>We validated the TCQoL for patients surgically treated for IM. This scale can be used as a disease-specific health-related quality-of-life measure that is sensitive to measure clinical change in this population.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000277"},"PeriodicalIF":0.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686899","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":"Impact of Cervical Sagittal Alignment Changes on Postoperative C5 Palsy: A Systematic Review and Meta-Analysis.","authors":"Sadegh Bagherzadeh, Leila Bahari, Ramin Kordi, P Mitchell Johansen, Gersham Rainone, Gautam Rao, Khalil Komlakh, Ali Keipourfard, Kamkar Aeenfar, Puya Alikhani, Mohsen Rostami","doi":"10.1227/neuprac.0000000000000276","DOIUrl":"10.1227/neuprac.0000000000000276","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative C5 palsy (CP) is a recognized complication after cervical decompressive surgery for degenerative cervical myelopathy. Although cervical sagittal alignment has been implicated in its pathogenesis, the relative impact of static alignment parameters vs postoperative alignment changes remains unclear. This study aimed to evaluate the association between cervical sagittal alignment and postoperative CP, with emphasis on the magnitude of alignment correction.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Web of Science, Scopus, and Embase were searched from inception to January 2025. Retrospective cohort studies comparing degenerative cervical myelopathy patients with and without postoperative CP and reporting cervical sagittal parameters were included. Outcomes included preoperative values, postoperative values, and magnitude of change (Δ) in C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), C4-C5 segmental lordosis, T1 slope, T1 slope-cervical lordosis mismatch, and Ishihara index. Standardized mean differences (SMDs) with 95% CIs were pooled.</p><p><strong>Results: </strong>Thirty-seven studies comprising 4948 patients were included, with an overall CP incidence of 10.83%. Static preoperative parameters, including C2-C7 lordosis, C2-C7 SVA, T1 slope, and T1 slope-cervical lordosis mismatch, were not significantly associated with CP. By contrast, patients who developed CP demonstrated significantly greater postoperative increases in C2-C7 lordosis (SMD = 1.04), C2-C7 SVA (SMD = 1.38), C4-C5 segmental lordosis (SMD = 0.44), and Ishihara index (SMD = 1.79). Subgroup analyses showed significant associations in anterior procedures and laminectomy, but not in laminoplasty.</p><p><strong>Conclusion: </strong>Postoperative CP is primarily driven by the magnitude of sagittal alignment correction rather than baseline alignment. These findings support a stretch-mediated mechanism related to postoperative spinal cord and nerve root biomechanics and highlight the importance of balanced sagittal correction to reduce the risk of CP.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000276"},"PeriodicalIF":0.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686925","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":"Pediatric Neurosurgery Procedural Coding: Current Lay of the Land.","authors":"Meena Vessell, Ryan S Chung, Randaline Barnett, Kristin Zieles, David Bonda, Benjamin Best, Virendra R Desai","doi":"10.1227/neuprac.0000000000000254","DOIUrl":"10.1227/neuprac.0000000000000254","url":null,"abstract":"<p><strong>Background and objectives: </strong>Physician compensation models increasingly rely on productivity metrics, with current procedural terminology (CPT) codes and relative value unit (RVU) assignments standardizing procedure complexity and informing reimbursement. Pediatric neurosurgery receives lower RVU assignments than adult counterparts, with many procedures lacking assigned codes despite yearly evaluations. Understanding current coding knowledge, patterns, and interest in change among pediatric neurosurgeons is essential for accurate CPT and RVU alignment with procedure complexity.</p><p><strong>Methods: </strong>The Pediatric Coding and Reimbursement Committee developed a 24-question survey using Modified Delphi methodology to assess coding habits, knowledge, training, resources, and perceptions within pediatric neurosurgery. The American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Pediatric Section distributed the survey to members in Spring 2024, collecting 119 responses.</p><p><strong>Results: </strong>Response rate for the survey was 21.6%. Overall, 94.2% of the respondents were full-time attendings and the remainder were fellows (3.3%) and residents (2.5%). Although 55.6% code independently or with billing departments, others rely solely on billing assistance. Self-reported coding knowledge was poor, with only 15.7% feeling confident coding without billing support. Notably, 59.3% have never performed formal coding training postresidency, and 30.6% do not know how to find formal training. In addition, 41.6% were unfamiliar with American Association of Neurological Surgeons coding resources. However, 68.6% considered coding \"very\" important for training incorporation, and 90.2% believed a Pediatric Neurosurgery Coding Manual would be beneficial. Clinical scenarios with unclear coding guidance showed significant practice variability.</p><p><strong>Conclusion: </strong>The pediatric coding landscape features predominantly large academic practices with RVU-based compensation, yet individual surgeons report disparities between coding importance and abilities. Despite expressing poor coding knowledge and limited awareness of formal training resources, pediatric neurosurgeons demonstrate high interest in coding education while simultaneously expressing poor coding knowledge and lack of awareness of formal training or online resources. These findings highlight significant opportunities for coding education and standardization within existing CPT architecture, enabling better protection of the field's financial viability through improved reimbursement understanding.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000254"},"PeriodicalIF":0.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671514","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":"Surgical Reduction Techniques and Outcomes for Cervical Spondyloptosis: A Technical Report and Case Series.","authors":"Gordon Mao, Barnabas Obeng-Gyasi, Anoop S Chinthala, Kenneth L Virgin, Ethan D L Brown, Daniel Schneider, Matthew Perry, Ahmed Belal, James C Miller","doi":"10.1227/neuprac.0000000000000272","DOIUrl":"10.1227/neuprac.0000000000000272","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cervical spondyloptosis, defined as Grade V spondylolisthesis with complete vertebral body displacement, represents the most severe form of spinal trauma with fewer than 100 cases reported in literature. Despite increasing case reports, optimal surgical management remains controversial, with significant heterogeneity regarding reduction techniques and stabilization approaches.</p><p><strong>Methods: </strong>We present 2 distinct patients with traumatic C7-T1 cervical spondyloptosis treated at our institution between 2021 and 2023, with differences in neurological presentation and fracture morphology that influenced management decisions. Comprehensive literature review analyzed predictive factors for reduction success and surgical approach selection.</p><p><strong>Results: </strong>Both patients achieved successful anatomic reduction and stabilization. However, neurological outcomes were variable and correlated with initial injury severity. Patient 2 (American Spinal Injury Association C) progressed to near-complete recovery (4+/5 grip strength only) by the 6-month follow-up, while the Patient 1 (American Spinal Injury Association A) showed no motor recovery at the 4-week follow-up and was subsequently lost to long-term care. No hardware failure or loss of reduction occurred. Literature analysis revealed that facet joint morphology is the primary predictor of closed reduction success, with locked facets necessitating open reduction in 67% of cases.</p><p><strong>Conclusion: </strong>Cervical spondyloptosis requires individualized surgical planning based on 2 critical decision points: reduction success (predicted primarily by facet joint integrity) and stabilization strategy selection. Single-approach techniques are sufficient when complete closed reduction is achieved, while combined approaches provide optimal stability for complex cases, particularly at the cervicothoracic junction. While successful anatomic reduction can be achieved, neurological recovery remains highly variable and primarily dependent on initial injury severity.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000272"},"PeriodicalIF":0.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564060","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":"Automated Generation and Human Evaluation of Neurosurgical Board Examination Self-Assessment Questions.","authors":"Anton Alyakin, Jaden Stryker, Daniel Alexander Alber, Jin Vivian Lee, Shrutika Singh, Akshay Save, David Kurland, Cordelia Orillac, Aly A Valliani, Sean Neifert, Darryl Lau, Ilya Laufer, Peter A Rozman, Eveline Teresa Hidalgo, Howard Riina, Eric C Leuthardt, Douglas Kondziolka, Laura Snyder, Eric Karl Oermann","doi":"10.1227/neuprac.0000000000000275","DOIUrl":"10.1227/neuprac.0000000000000275","url":null,"abstract":"<p><strong>Background and objectives: </strong>Multiple-choice questions are the primary assessment format for neurosurgical board certification. Creating high-quality examination questions requires significant expert time and resources. The goal of this study was to develop an automated system to generate board-style neurosurgical multiple-choice questions using state-of-the-art vision-language models and compare their quality with authentic self-assessment questions.</p><p><strong>Methods: </strong>We developed an automated pipeline using OpenAI generative pre-trained transformer (GPT)-4o and Anthropic Claude Sonnet-3.5 to generate neurosurgical board-style questions from <i>Neurosurgery Publications</i> articles. We generated 89 587 synthetic questions: 45 689 with GPT-4o and 43 898 with Claude. Each question was associated with a single image extracted from the articles' figures. We evaluated the quality of synthetic questions through 5 surveys comparing 20 synthetic questions (10 from each model) with 10 authentic questions from the Self-Assessment for Neurological Surgeons (SANS) question bank. Each survey was completed by a neurosurgery resident and an attending who guessed the source [human vs artificial intelligence (AI)-generated] and rated suitability for board examination use. We also evaluated the question-answering performance of the generalist GPT-4o and the specialized CNS-Obsidian.</p><p><strong>Results: </strong>SANS questions were more often perceived as human-made than GPT-generated (residents, <i>P</i> = .0002; attendings, <i>P</i> = .1091) and Claude-generated (residents, <i>P</i> = .0002; attendings, <i>P</i> = .0272) questions. Notably, 54% of AI-generated questions misled at least one evaluator, and 23% misled both. In quality assessments, SANS questions outperformed GPT-generated (residents, <i>P</i> < 10^-5; attendings, <i>P</i> = .0001) and Claude-generated (residents and attendings, <i>P</i> < 10^-5) questions. Particularly, 25% of AI-generated questions were rated as suitable for board examinations vs 72% of human-generated questions when measured by evaluator consensus (<i>P</i> < 10^-7).</p><p><strong>Conclusion: </strong>Although quality gaps exist between AI-generated and human-created neurosurgical board examination questions, our approach demonstrates the potential of vision-language models to augment assessment development in specialized medical fields, reducing the burden on examination boards and credentialing organizations.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000275"},"PeriodicalIF":0.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564038","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":"Posterior Cervical Fixation: Accuracy and Safety of Free-Hand Inserted Screws.","authors":"Veera Kivistö, Eero Ylipulli, Heikki Mäntymäki, Antti Ronkainen, Juhana Frösen, Tuomo Thesleff","doi":"10.1227/neuprac.0000000000000273","DOIUrl":"10.1227/neuprac.0000000000000273","url":null,"abstract":"<p><strong>Background and objectives: </strong>Posterior fixation of the cervical spine (PFC) is commonly performed with rod-connected screws inserted in the vertebras. Because of the many sensitive structures located adjacent to the vertebras, computer-assisted navigation is often used with PFCs. We assessed safety and efficacy of free-hand placed PFCs.</p><p><strong>Methods: </strong>We retrospectively identified all the patients in our institution between Januray 2006 and December 2016 who underwent a primary PFC for any indication. The postoperative images and medical records were evaluated for possible clinical failures, which was considered as a reoperation to cervical spine within 1 year after primary surgery for any reason, or a new screw-related adverse event including nerve root injury, spinal cord injury, or vertebral artery injury.</p><p><strong>Results: </strong>In total, 332 patients and 1476 screws were included in the study. The evaluated screws were primarily pedicle and lateral mass screws. The rate of screw malposition was 12% (171/1476). The overall rate of clinical failure was 16% (52/332) and was significantly higher in patients with screw malposition than in those without malposition (24% vs 12%, <i>P</i> = .03). The rate of screw insertion-related clinical failure was 6.0% (20/332). The C7 pedicle seemed to be more prone to screw malposition than other locations (26/86, 30%).</p><p><strong>Conclusion: </strong>Clinical failure after posterior cervical spine fixation occurs significantly more frequently in patients with screw malposition compared with those without malposition. The overall rate of screw insertion-related clinical failure was 6.0%. These findings suggest that improving screw placement accuracy may reduce the risk of complications.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000273"},"PeriodicalIF":0.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564104","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":"Middle Fossa Craniotomy With Hydroxyapatite Cement as a Structural Repair for Noniatrogenic Cranial Cerebrospinal Fluid Leaks: A Case Series.","authors":"Kelly Shaftel, Abdullah Al Tekreeti, Kristen Angster, Laura Brainard, Karam Asmaro, Jack Rock","doi":"10.1227/neuprac.0000000000000265","DOIUrl":"10.1227/neuprac.0000000000000265","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cranial cerebrospinal fluid (CSF) leaks due to tegmen defects can be repaired through transmastoid or transcranial surgical approaches with different repair substrates, including autologous grafts or nonimmunogenic cements. Here, we describe a case series of patients who underwent middle fossa craniotomy for repair of noniatrogenic cranial CSF leak with the use of hydroxyapatite (HA) bone cement.</p><p><strong>Methods: </strong>A retrospective analysis of all patients who underwent craniotomy with HA cement for repair of noniatrogenic cranial CSF leak at Henry Ford Hospital in Detroit between January 1, 2013, and September 30, 2024. Patient demographic features, presenting symptoms, location of cranial defect, comorbid conditions, and the outcomes of hospital length-of-stay and leak recurrence within 3-6 month follow-up were collected.</p><p><strong>Results: </strong>HA cement middle fossa craniotomy repair of noniatrogenic cranial CSF leak was performed in 15 patients (11 women [73%] and 4 men [27%]). The median age was 56 years (range, 29-77), and the mean body mass index was 35.7 ± 8.8 kg/m². Most patients presented with hearing loss (n = 12; 80%) and/or encephalocele (n = 12; 80%), and more than half (n = 8; 53%) had otorrhea. There were 8 patients (53%) with obstructive sleep apnea, and only 3 (20%) had idiopathic intracerebral hypertension. Defects were located within various cranial regions, with most patients (n = 9; 60%) having a defect in the tegman tympani. The median hospital length of stay was 3 days (range, 1-28), and no patients had leak recurrence within the follow-up period.</p><p><strong>Conclusion: </strong>Using HA bone cement for middle fossa craniotomy to repair cranial CSF leaks due to tegmen defects led to durable repair with no leak recurrence, suggesting that this approach may be highly effective for temporal bone repair.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"7 4","pages":"e000265"},"PeriodicalIF":0.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427111","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}