Stenting for Venous Sinus Stenosis in Patients With Idiopathic Intracranial Hypertension: An Updated Systematic Review and Meta-Analysis of the Literature

特发性颅内高压患者静脉窦狭窄的支架置入术: 最新的系统回顾和文献荟萃分析

Although venous sinus stenting (VSS) improves cerebrospinal fluid reabsorption and decreases intracranial pressure in patients with idiopathic intracranial hypertension (IIH), the underlying pathophysiology of IIH is not well understood. We present a review and meta-analysis of the literature on VSS for IIH treatment, focusing on the rates of restenosis and symptom recurrence. VSS is effective in alleviating IIH signs and symptoms, but the associated high rates of restenosis and persistent symptoms highlight the need for further investigation of this procedure and other adjunctive treatments for IIH.

尽管静脉窦支架置入术 (VSS) 可改善特发性颅内高压 (IIH) 患者的脑脊液重吸收并降低颅内压，但IIH的潜在病理生理学尚不清楚。我们对IIH治疗VSS的文献进行了回顾和荟萃分析，重点是再狭窄和症状复发率。VSS可有效缓解IIH体征和症状，但相关的高再狭窄率和持续症状突出表明需要进一步研究该程序和IIH的其他辅助治疗。

REF: Lim J, Monteiro A, Kuo CC, et al. Stenting for Venous Sinus Stenosis in Patients With Idiopathic Intracranial Hypertension: An Updated Systematic Review and Meta-Analysis of the Literature. Neurosurgery. 2024;94(4):648-656. doi:10.1227/neu.0000000000002718 PMID: 37830801

Comparative Scoping Review of Prenatal Care Resources for Families of Children With Spinal Dysraphism and Hydrocephalus in High-Income Countries and Low- and Middle-Income Countries

高收入国家和低收入和中等收入国家脊柱发育不良和脑积水儿童家庭产前保健资源的比较范围审查

Low- and middle-income countries (LMICs) face higher incidences and burdens of care for neural tube defects (NTDs) and hydrocephalus compared with high-income countries (HICs), in part due to limited access to neurosurgical intervention. In this scoping review, we aim to integrate studies on prenatal care, counseling, and surgical management for families of children with spinal dysraphism and hydrocephalus in LMICs and HICs. NTDs have become a widely acknowledged public health problem in many LMICs. Prenatal counseling and care and folate fortification are critical in the prevention of spinal dysraphism. However, high-quality, standardized studies reporting their epidemiology, prevention, and management remain scarce. Compared with NTDs, research on the prevention and screening of hydrocephalus is even further limited. Future studies are necessary to quantify the burden of disease and identify strategies for improving global outcomes in treating and reducing the prevalence of NTDs and hydrocephalus. Surgical management of NTDs in LMICs is currently limited, but pediatric neurosurgeons may be uniquely equipped to address disparities in the care and counseling of families of children with spinal dysraphism and hydrocephalus.

与高收入国家 (hic) 相比，低收入和中等收入国家 (lmic) 面临更高的神经管缺陷 (ntd) 和脑积水的发病率和护理负担，部分原因是获得神经外科干预的机会有限。在本次范围综述中，我们旨在整合LMICs和HICs中脊柱闭合障碍和脑积水患儿家庭的产前护理，咨询和手术管理研究。Ntd已成为许多lmic广泛认可的公共卫生问题。产前咨询和护理以及叶酸强化对于预防脊柱发育不良至关重要。然而，报告其流行病学、预防和管理的高质量、标准化研究仍然很少。与NTDs相比，对脑积水的预防和筛查的研究更加有限。未来的研究有必要量化疾病负担，并确定改善治疗和减少NTDs和脑积水患病率的全球结果的策略。目前，lmic中NTDs的手术管理有限，但是儿科神经外科医生可能具有独特的装备，可以解决脊柱闭合不良和脑积水患儿家庭的护理和咨询差异。

REF: Jiang K, Kalluri AL, Ran KR, et al. Comparative Scoping Review of Prenatal Care Resources for Families of Children With Spinal Dysraphism and Hydrocephalus in High-Income Countries and Low- and Middle-Income Countries. Neurosurgery. 2024;94(4):657-665. doi:10.1227/neu.0000000000002750 PMID: 37947403

Hemimegalencephaly: A Systematic Comparison of Functional and Anatomic Hemispherectomy for Drug-Resistant Epilepsy

半脑畸形: 功能性和解剖性半球切除术治疗耐药性癫痫的系统比较

Hemimegalencephaly (HME) is a rare diffuse malformation of cortical development characterized by unihemispheric hypertrophy, drug-resistant epilepsy (DRE), hemiparesis, and developmental delay. Definitive treatment for HME-related DRE is hemispheric surgery through either anatomic (AH) or functional hemispherectomy (FH). This individual patient data meta-analysis assessed seizure outcomes of AH and FH for HME with pharmacoresistant epilepsy, predictors of Engel I, and efficacy of different FH approaches. We show that hemispheric surgery is a highly effective treatment for HME-related DRE. Unilateral ictal electroencephalography changes and using the FH approach as initial surgical management may result in better outcomes due to significantly lower posthemispherectomy hydrocephalus probability. However, larger HME registries are needed to further delineate the predictors of seizure outcomes.

半脑畸形 (HME) 是一种罕见的皮质发育弥漫性畸形，其特征是单侧半球肥大，耐药性癫痫 (DRE)，偏瘫和发育迟缓。HME相关DRE的确定性治疗是通过解剖 (AH) 或功能性半球切除术 (FH) 进行的半球手术。该个体患者数据荟萃分析评估了AH和FH对具有耐药性癫痫的HME的癫痫发作结局，Engel I的预测因子以及不同FH方法的疗效。我们表明，半球手术是HME相关DRE的高效治疗方法。单侧发作脑电图改变和使用FH方法作为初始手术治疗可能会导致更好的结果，因为显着降低了术后脑积水的可能性。然而，需要更大的HME登记处来进一步描述癫痫发作结局的预测因素。

REF: Goel K, Ghadiyaram A, Krishnakumar A, et al. Hemimegalencephaly: A Systematic Comparison of Functional and Anatomic Hemispherectomy for Drug-Resistant Epilepsy. Neurosurgery. 2024;94(4):666-678. doi:10.1227/neu.0000000000002759 PMID: 37975663

From Text to Insight: A Natural Language Processing-Based Analysis of Topics and Trends in Neurosurgery

从文本到洞察力: 基于自然语言处理的神经外科主题和趋势分析

Neurosurgical research is a rapidly evolving field, with new research topics emerging continually. To provide a clearer understanding of the evolving research landscape, our study aimed to identify and analyze the prevalent research topics and trends in Neurosurgery. Our study underscores the dynamic nature of neurosurgical research and the evolving focus of the field. The insights derived from the analysis can guide future research directions, inform policy decisions, and identify emerging areas of interest. The use of natural language processing in synthesizing and analyzing large volumes of academic literature demonstrates the potential of advanced analytical techniques in understanding the research landscape, paving the way for similar analyses across other medical disciplines.

神经外科研究是一个快速发展的领域，新的研究课题不断出现。为了更清楚地了解不断发展的研究前景，我们的研究旨在识别和分析神经外科的流行研究主题和趋势。我们的研究强调了神经外科研究的动态性质和该领域不断发展的重点。从分析中得出的见解可以指导未来的研究方向，为政策决策提供信息，并确定感兴趣的新兴领域。在综合和分析大量学术文献中使用自然语言处理证明了先进分析技术在理解研究领域方面的潜力，为其他医学学科的类似分析铺平了道路。

REF: Karabacak M, Schupper AJ, Carr MT, Hickman ZL, Margetis K. From Text to Insight: A Natural Language Processing-Based Analysis of Topics and Trends in Neurosurgery. Neurosurgery. 2024;94(4):679-689. doi:10.1227/neu.0000000000002763 PMID: 37988054

Focused Ultrasound Central Lateral Thalamotomy for the Treatment of Refractory Neuropathic Pain: Phase I Trial

聚焦超声中央外侧丘脑切开术治疗难治性神经性疼痛: 一期试验

Magnetic resonance-guided focused ultrasound (MRgFUS) central lateral thalamotomy (CLT) has not yet been validated for treating refractory neuropathic pain (NP). Our aim was to assess the safety and potential efficacy of MRgFUS CLT for refractory NP. MRgFUS CLT is feasible and safe for refractory NP and has potential utility in reducing symptoms as measured by validated pain scales.

磁共振引导聚焦超声 (MRgFUS) 中央外侧丘脑切开术 (CLT) 尚未被验证用于治疗难治性神经性疼痛 (NP)。我们的目的是评估MRgFUS CLT治疗难治性NP的安全性和潜在疗效。MRgFUS CLT对于难治性NP是可行且安全的，并且在通过经验证的疼痛量表测量减轻症状方面具有潜在效用。

REF: Ahmed AK, Zhuo J, Gullapalli RP, et al. Focused Ultrasound Central Lateral Thalamotomy for the Treatment of Refractory Neuropathic Pain: Phase I Trial. Neurosurgery. 2024;94(4):690-699. doi:10.1227/neu.0000000000002752 PMID: 37947407

Treatment of Acute Traumatic Central Cord Syndrome: A Study of North American Trauma Centers

急性创伤性脊髓中央综合征的治疗: 北美创伤中心的研究

Central cord syndrome (CCS) is expected to become the most common traumatic spinal cord injury, yet its optimal management remains unclear. This study aimed to evaluate variability in nonoperative vs operative treatment for CCS between trauma centers in the American College of Surgeons Trauma Quality Improvement Program, identify patient- and hospital-level factors associated with treatment, and determine the association of treatment with outcomes. Operative decision-making for CCS is influenced by patient factors. There remains substantial variability between trauma centers not explained by case-mix differences. Nonoperative treatment was associated with shorter hospital LOS and lesser inpatient morbidity.

中央脊髓综合征 (CCS) 有望成为最常见的创伤性脊髓损伤，但其最佳治疗方法尚不清楚。这项研究旨在评估美国外科医生学院创伤质量改进计划中创伤中心之间CCS的非手术与手术治疗的差异，确定与治疗相关的患者和医院水平因素，并确定治疗与结果的关联。CCS的手术决策受患者因素的影响。创伤中心之间仍然存在很大的差异，无法通过病例组合差异来解释。非手术治疗与住院时间较短和住院发病率较低有关。

REF: Badhiwala JH, Witiw CD, Wilson JR, da Costa LB, Nathens AB, Fehlings MG. Treatment of Acute Traumatic Central Cord Syndrome: A Study of North American Trauma Centers. Neurosurgery. 2024;94(4):700-710. doi:10.1227/neu.0000000000002767 PMID: 38038474

Developing Mixed-Effects Models to Compare the Predictive Ability of Various Comorbidity Indices in a Contemporary Cohort of Patients Undergoing Lumbar Fusion

开发混合效应模型，以比较当代接受腰椎融合术的患者中各种合并症指数的预测能力

As incidence of operative spinal pathology continues to grow, so do the rates of lumbar spinal fusion procedures. Comorbidity indices can be used preoperatively to predict potential complications. However, there is a paucity of research defining the optimal comorbidity indices in patients undergoing spinal fusion surgery. We aimed to use modeling strategies to evaluate the predictive validity of various comorbidity indices and combinations thereof. This investigation is the first to use big data and modeling strategies to delineate the relative predictive utility of the ECI and Johns Hopkins Adjusted Clinical Groups comorbidity indices for the prognostication of patients undergoing lumbar fusion surgery. With the knowledge gained from our models, spine surgeons, payers, and hospitals may be able to identify vulnerable patients more effectively within their practice who may require a higher degree of resource utilization.

随着手术脊柱病变的发生率不断增加，腰椎融合手术的发生率也在增加。合并症指数可用于术前预测潜在的并发症。然而，很少有研究定义接受脊柱融合手术的患者的最佳合并症指数。我们旨在使用建模策略来评估各种合并症指数及其组合的预测有效性。这项研究是第一个使用大数据和建模策略来描述ECI和Johns Hopkins调整后的临床组合并症指数的相对预测效用，以预测接受腰椎融合手术的患者。通过从我们的模型中获得的知识，脊柱外科医生，付款人和医院可能能够在他们的实践中更有效地识别可能需要更高程度资源利用的弱势患者。

REF: Shahrestani S, Reardon T, Brown NJ, et al. Developing Mixed-Effects Models to Compare the Predictive Ability of Various Comorbidity Indices in a Contemporary Cohort of Patients Undergoing Lumbar Fusion. Neurosurgery. 2024;94(4):711-720. doi:10.1227/neu.0000000000002733 PMID: 37855622

Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders

标准化腰椎退行性病变患者的体力活动监测

Degenerative thoracolumbar disorders (DTDs) typically cause pain and functional impairment. However, little is known regarding the DTD impact on patient's real-life physical activity. The objective of this study is to validate a wearable measure of physical activity monitoring in patients with DTD and to create gender- and sex-specific performance thresholds that are standardized to the mean of a control population. We establish the first wearable objective measure of real-life physical activity for patients with DTD, with the first age- and sex-adjusted standard scores to enable clinicians and researchers to set treatment goals and directly compare activity levels between individual patients with DTD and normal controls.

退行性胸腰椎疾病 (dtd) 通常会引起疼痛和功能障碍。然而，关于DTD对患者现实生活身体活动的影响知之甚少。这项研究的目的是验证DTD患者身体活动监测的可穿戴措施，并创建性别和性别特定的性能阈值，并将其标准化为对照人群的平均值。我们为DTD患者建立了第一个可穿戴的现实生活中身体活动的客观测量方法，并使用了第一个年龄和性别调整的标准评分，以使临床医生和研究人员能够设定治疗目标并直接比较DTD患者和正常对照组之间的活动水平。

REF: Maldaner N, Tang M, Fatemi P, et al. Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders. Neurosurgery. 2024;94(4):788-796. doi:10.1227/neu.0000000000002755 PMID: 37955445

Vertebral Compression Fracture After Spine Stereotactic Body Radiotherapy: The Role of Vertebral Endplate Disruption

脊柱立体定向放疗后椎体压缩性骨折: 椎体终板破坏的作用

Vertebral compression fracture (VCF) is a common, but serious toxicity of spinal stereotactic body radiotherapy (SBRT). Several variables that place patients at high risk of VCF have previously been identified, including advanced Spinal Instability Neoplastic Score (SINS), a widely adopted clinical decision criterion to assess spinal instability. We examine the role of tumoral endplate (EP) disruption in the risk of VCF and attempt to incorporate it into a simple risk stratification system. EP disruption is a novel risk factor for VCF in patients who will undergo spinal SBRT. A simple nomogram incorporating EP disruption, adverse histology, and SINS score is effective for quickly assessing risk of VCF. These data require validation in prospective studies and could be helpful in counseling patients regarding VCF risk and referring for prophylactic interventions in high-risk populations.

椎体压缩性骨折 (VCF) 是脊柱立体定向放射治疗 (SBRT) 的常见但严重的毒性。先前已经确定了使患者处于VCF高风险的几个变量，包括高级脊柱不稳定性肿瘤评分 (SINS)，这是一种广泛采用的评估脊柱不稳定性的临床决策标准。我们研究了肿瘤终板 (EP) 破坏在VCF风险中的作用，并尝试将其纳入简单的风险分层系统。EP中断是接受脊柱SBRT患者VCF的新危险因素。结合EP破坏，不良组织学和SINS评分的简单列线图可有效快速评估VCF的风险。这些数据需要在前瞻性研究中进行验证，可能有助于咨询患者的VCF风险，并在高危人群中进行预防性干预。

REF: Dibs K, Facer B, Mageswaran P, et al. Vertebral Compression Fracture After Spine Stereotactic Body Radiotherapy: The Role of Vertebral Endplate Disruption. Neurosurgery. 2024;94(4):797-804. doi:10.1227/neu.0000000000002742 PMID: 37902322