Learning Curves for Robot-Assisted Pedicle Screw Placement: Analysis of Operative Time for 234 Cases

机器人辅助椎弓根螺钉置入学习曲线：234例手术时间分析

Robot-assisted pedicle screw placement is associated with greater accuracy, reduced radiation, less blood loss, shorter hospital stays, and fewer complications than freehand screw placement. However, it can be associated with longer operative times and an extended training period. We report the initial experience of a surgeon using a robot system at an academic medical center. This study documents the long-term learning curve of a fellowship-trained spine neurosurgeon. Operative time significantly decreased with more experience. Although gaining comfort with robotic systems may be challenging or require additional training, it can benefit surgeons and patients alike with continued reductions in operative time.

机器人辅助椎弓根螺钉放置与徒手螺钉放置相比具有更高的准确性、更少的辐射、更少的出血量、更短的住院时间和更少的并发症。然而，它可能与较长的手术时间和较长的训练期有关。我们报告了一名外科医生在学术医学中心使用机器人系统的初步经验。这项研究记录了一位接受过团契培训的脊椎神经外科医生的长期学习曲线。随着经验的增加，手术时间明显缩短。尽管获得机器人系统的舒适感可能是具有挑战性的，或者需要额外的培训，但它可以使外科医生和患者受益，手术时间持续减少。

REF: Jiang K, Hersh AM, Bhimreddy M, et al. Learning Curves for Robot-Assisted Pedicle Screw Placement: Analysis of Operative Time for 234 Cases. Oper Neurosurg (Hagerstown). 2023;25(6):482-488. doi:10.1227/ons.0000000000000862 PMID: 37578266

Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

经Galenic（深静脉）系统经静脉栓塞硬脑膜动静脉瘘：多中心病例系列和荟萃分析

Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, which may spare patients the traversal of deep structures needed for microsurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

累及深静脉系统的动静脉瘘通常采用显微手术或经动脉栓塞术治疗。对经静脉导航的日益熟悉和改进的血管内通路系统可能有助于对这些罕见和具有挑战性的病变进行经静脉栓塞术(TVE)。随着现代血管内导管系统和液体栓塞剂的出现，经静脉途径栓塞深部动静脉瘘已成为可能。这些病变可以通过血管内入路安全有效地治疗，这可能使患者不必穿越这些区域的显微外科手术所需的深层结构。TVE的结果与已发表的显微外科手术中断的结果相当。

REF: Srinivasan VM, Karahalios K, Colasurdo M, et al. Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis. Oper Neurosurg (Hagerstown). 2023;25(6):489-498. doi:10.1227/ons.0000000000000873 PMID: 37747335

Quantitative Blood Flow Reduction in Selective Embolization of Intranidal Fistula of Cerebral Arteriovenous Malformations: Case Series

脑动静脉畸形内瘘选择性栓塞术中的定量血流减少：病例系列

Arteriovenous malformations (AVMs) are often associated with high-flow intranidal fistulas (INFs). Although INF embolization has been suggested to provide higher reduction of total AVM flow compared with regular pedicle embolization, this effect has not previously been quantified. The aim of this study was to characterize the effect of AVM INF embolization on total AVM flow. This study represents the first to examine the effect of INF embolization on total AVM flow. AVMs with INFs showed higher baseline flow, and targeted embolization toward INFs significantly lowered AVM flow in comparison with controls without INFs. The results of this study emphasize the importance of recognizing the presence of INFs within AVMs and their embolization to reduce AVM flow as part of a multistep management paradigm.

动静脉畸形(AVM)常与高流量的内瘘(INF)相关。尽管与常规的椎弓根栓塞术相比，INF栓塞术可以提供更高的总AVM血流量的减少，但这一效果以前还没有被量化。本研究的目的是研究AVMINF栓塞术对AVM总血流量的影响。这项研究首次检测了INF栓塞术对AVM总血流量的影响。有INF的动静脉动静脉畸形表现出更高的基线血流量，与没有INF的对照组相比，对INF的靶向栓塞显著降低了AVM的血流量。这项研究的结果强调了认识动静脉动静脉畸形内INF的存在及其栓塞以减少动静脉动静脉畸形血流的重要性，作为多步骤管理范例的一部分。

REF: Souter J, Stone McGuire L, Choi J, et al. Quantitative Blood Flow Reduction in Selective Embolization of Intranidal Fistula of Cerebral Arteriovenous Malformations: Case Series. Oper Neurosurg (Hagerstown). 2023;25(6):499-504. doi:10.1227/ons.0000000000000876 PMID: 37747350

Use of an Endoscope Reduces the Size of Craniotomy Without Increasing Operative Time Compared With Conventional Microscopic Corpus Callosotomy

在不增加手术时间的情况下，使用内窥镜缩小开颅手术的大小，而不增加传统显微手术的时间

Corpus callosotomy (CC) is an epilepsy surgery that disconnects the commissural fibers at the corpus callosum, a structure that often plays a key role in propagating seizure activity. CC is particularly beneficial in patients with drop attacks. Less invasive endoscopic surgeries have recently been introduced to some fields of neurosurgery but have not yet become common in epilepsy surgery. Endoscopic surgeries offer better visualization and require a smaller corridor than conventional microscopic surgeries. Here, we presented a case series comparing endoscopic CC with microscopic CC. Endoscopic CC is a promising technique requiring a smaller craniotomy than microscopic CC, without significantly increasing operative time or complication rate compared with microscopic CC.

胼胝体切开术(CC)是一种癫痫手术，它切断了穹隆体处的连合纤维，该结构通常在传播癫痫发作活动中发挥关键作用。CC对Drop发作的患者尤其有益。侵入性较小的内窥镜手术最近已被引入神经外科的一些领域，但尚未在癫痫外科中变得常见。内窥镜手术提供了更好的可视化，并且比传统的显微手术需要更小的走廊。在这里，我们提出了一个病例系列比较内窥镜下CC和显微镜下CC。与显微CC相比，内窥镜CC是一种有前景的开颅手术，且不会显著增加手术时间和并发症发生率。

REF: Yindeedej V, Uda T, Kawashima T, et al. Use of an Endoscope Reduces the Size of Craniotomy Without Increasing Operative Time Compared With Conventional Microscopic Corpus Callosotomy. Oper Neurosurg (Hagerstown). 2023;25(6):505-511. doi:10.1227/ons.0000000000000867 PMID: 37578245

Anatomic Variants in the Anterior Inferior Cerebellar Artery Encountered During Resection of Vestibular Schwannomas

前庭神经鞘瘤切除术中小脑下前动脉的解剖变异

Vestibular schwannomas (VS) are often phenotypically benign lesions that may be technically challenging to resect because of involvement of neurovascular structures. The anterior inferior cerebellar artery (AICA) is commonly identified near VS, with variable position in relation to the tumor; however, little published literature describes anatomic and pathologic variants of AICA observed during VS resection. Anatomic variants of AICA occur in approximately 7% of VS operations. Most aberrations do not affect surgical or clinical outcomes, and the rate of major vascular injury was low. However, certain types variably add operative time and in the case of AICA encasement in the tumor, likely indicate a more aggressive tumor phenotype with lower rates of gross total resection and high incidences of facial nerve weakness.

前庭神经鞘瘤(VS)通常是典型的良性病变，由于累及神经血管结构，在技术上可能很难切除。小脑前下动脉(AICA)通常位于VS附近，与肿瘤的位置不同；然而，很少有发表的文献描述在VS切除过程中观察到的AICA的解剖和病理变异。AICA的解剖变异出现在约7%的VS手术中。大多数畸形不会影响手术或临床结果，而且主要血管损伤的发生率很低。然而，某些类型不同地增加了手术时间，在AICA包绕肿瘤的情况下，可能表明更具侵袭性的肿瘤表型，大体全切除率较低，面神经无力的发生率较高。

REF: Carlstrom LP, Dornhoffer JR, Randall NR, et al. Anatomic Variants in the Anterior Inferior Cerebellar Artery Encountered During Resection of Vestibular Schwannomas. Oper Neurosurg (Hagerstown). 2023;25(6):512-520. doi:10.1227/ons.0000000000000881 PMID: 37729626

Endovascular Embolization of Basilar Artery Fenestration Aneurysms: A 21-Year Institutional Case Series

基底动脉开窗动脉瘤的血管内栓塞术：21年机构病例系列

Basilar artery fenestration is a rare phenomenon sometimes associated with basilar artery fenestration aneurysms (BAFAs). This review investigates the natural history and management outcomes of BAFAs and describes the outcomes of BAFAs treated with embolization. Endovascular management of these rare aneurysms is feasible and safe, with high rates of favorable radiographic and clinical outcomes. This series reflects a general preference toward coiling and stent-assisted coiling, although flow diversion may be considered in select cases.

基底动脉开窗是一种罕见的现象，有时与基底动脉开窗动脉瘤(BAFA)有关。本文回顾了BAFAs的自然病史和治疗结果，并描述了BAFAs的栓塞术治疗结果。血管内治疗这些罕见的动脉瘤是可行和安全的，具有良好的放射学和临床结果。这一系列反映了对卷绕和支架辅助卷绕的普遍偏好，尽管在某些情况下可能会考虑分流。

REF: Srinivasan VM, Singh R, Karahalios K, et al. Endovascular Embolization of Basilar Artery Fenestration Aneurysms: A 21-Year Institutional Case Series. Oper Neurosurg (Hagerstown). 2023;25(6):521-528. doi:10.1227/ons.0000000000000882 PMID: 37707424

Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases

颅底脑膜瘤直线加速器单剂量放射外科治疗的远期经验：241例单中心回顾性研究

Stereotactic radiosurgery (SRS) is increasingly applied to treat meningiomas, attributable to their increased incidence in older individuals at greater surgical risk. To evaluate the effectiveness of treatment with linear accelerator (LINAC)-based stereotactic radiosurgery in skull base meningiomas as either primary treatment or postresection adjuvant therapy. Treatment of skull base meningiomas with single-dose SRS using LINAC is effective over the long term. Superior tumor control is obtained in patients without previous surgery. Adverse effects are related to localization in the cerebellopontine angle, and maximum brainstem radiation dose was >12.5 Gy.

立体定向放射外科(SRS)越来越多地应用于脑膜瘤的治疗，这是由于脑膜瘤在手术风险较大的老年人中发病率增加。目的评价直线加速器(LINAC)立体定向放射外科治疗颅底脑膜瘤的疗效。使用直线加速器单剂SRS治疗颅底脑膜瘤是长期有效的。未做过手术的患者可获得更好的肿瘤控制。不良反应与桥小脑角部位有关，最大脑干照射剂量>12.5Gy.

REF: Ortiz García IM, Rodríguez Valero P, Jorques Infante AM, Cordero Tous N, Expósito Hernández J, Olivares Granados G. Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases. Oper Neurosurg (Hagerstown). 2023;25(6):529-537. doi:10.1227/ons.0000000000000887 PMID: 37655877

Peritrigeminal Safe Entry Zone Access to Anterolateral Pons Using the Presigmoid Retrolabyrinthine Suprameatal Approach: A Cadaveric Morphometric Study

乙状窦前后上耳道入路三叉神经周围安全进入区至前外侧桥脑的形态测量研究

Access to the anterolateral pontine lesions can be achieved through the peritrigeminal and supratrigeminal safe entry zones using Kawase, retrosigmoid, or translabyrinthine approaches. However, these approaches entail shallow extensive dissection, tangential access, and compromise vestibulocochlear function. We aimed to investigate infratentorial presigmoid retrolabyrinthine approach to access pontine lesions through the peritrigeminal zone. Anterolateral pontine lesions can be accessed through a minimally invasive infratentorial presigmoid retrolabyrinthine approach by targeting the infratrigeminal safe entry zone. Further clinical studies should be conducted to evaluate the viability of this technique for treating these complex pathologies in real clinical settings.

使用Kawase、乙状窦后或迷路入路，可通过三叉神经周围和三叉神经上的安全入口区进入桥前外侧病变。然而，这些入路需要浅层广泛的解剖、切向入路和损害前庭耳蜗术后的功能。我们的目的是研究幕下乙状窦前迷路后入路通过三叉神经周带进入脑桥病变。脑桥前外侧病变可通过瞄准三叉神经下安全进入区的微创乙状窦前迷路后入路进入。应该进行进一步的临床研究，以评估这种技术在实际临床环境中治疗这些复杂病理的可行性。

REF: Hoz SS, Sharma M, Palmisciano P, et al. Peritrigeminal Safe Entry Zone Access to Anterolateral Pons Using the Presigmoid Retrolabyrinthine Suprameatal Approach: A Cadaveric Morphometric Study. Oper Neurosurg (Hagerstown). 2023;25(6):e303-e307. doi:10.1227/ons.0000000000000866 PMID: 37578224

Arteries Around the Superior Limiting Sulcus: Motor Complication Avoidance in Insular and Insulo-Opercular Surgery

上限沟周围动脉：岛叶和胰岛素-穹隆手术中运动性并发症的避免

Insulo-opercular surgery can cause ischemic motor complications. A source of this is the arteries around the superior limiting sulcus (SLS), which reach the corona radiata, but the detailed anatomy remains unclear. To characterize arteries around the SLS including the long insular arteries (LIAs) and long medullary arteries, we classified them and examined their distribution in relation to the SLS, which helps reduce the risk of ischemia. Approximately 90% of the arteries that entered the parenchyma and reached the corona radiata were within a 5-mm radius of the SLS in both the insula and operculum side. This suggests that using the SLS as a landmark during insulo-opercular surgery can decrease the chance of ischemia.

开腹手术可能会导致缺血性运动并发症。其中一个来源是上限沟(SLS)周围的动脉，这些动脉到达放射冠，但详细的解剖结构尚不清楚。为了确定SLS周围动脉的特征，包括岛长动脉(LIA)和长髓动脉，我们对它们进行了分类，并检查了它们与SLS的关系，这有助于降低缺血的风险。大约90%进入实质并到达放射冠的动脉位于岛叶和盖侧SLS的5 mm半径内。这表明，在开腹手术中使用SLS作为标志物可以减少缺血的机会。

REF: Ikegaya N, Hayashi T, Higashijima T, et al. Arteries Around the Superior Limiting Sulcus: Motor Complication Avoidance in Insular and Insulo-Opercular Surgery. Oper Neurosurg (Hagerstown). 2023;25(6):e308-e314. doi:10.1227/ons.0000000000000879 PMID: 37966479