Nerve-targeted surgical treatments for spasticity: a narrative review

针对痉挛的神经靶向手术治疗: 叙述性回顾

Spasticity is a potentially debilitating symptom of various acquired and congenital neurologic pathologies that, without adequate treatment, may lead to long-term disability, compromise functional independence, and negatively impact mental health. Several conservative as well as non-nerve targeted surgical strategies have been developed for the treatment of spasticity, but these may be associated with significant drawbacks, such as adverse side effects to medication, device dependence on intrathecal baclofen pumps, and inadequate relief with tendon-based procedures. In these circumstances, patients may benefit from nerve-targeted surgical interventions such as (i) selective dorsal rhizotomy, (ii) hyperselective neurectomy, and (iii) nerve transfer. When selecting the appropriate surgical approach, preoperative patient characteristics, as well as the risks and benefits of nerve-targeted surgical intervention, must be carefully evaluated. Here, we review the current evidence on the efficacy of these nerve-targeted surgical approaches for treating spasticity across various congenital and acquired neurologic pathologies.

痉挛是各种获得性和先天性神经系统疾病的潜在衰弱症状，如果没有适当的治疗，可能会导致长期残疾，损害功能独立性并对精神卫生产生负面影响。已经开发了几种保守和非神经靶向的手术策略来治疗痉挛，但是这些策略可能与显着的缺点有关，例如药物的不良副作用，对鞘内巴氯芬泵的设备依赖性以及对肌腱的缓解不足为基础的程序。在这些情况下，患者可能会受益于神经靶向手术干预，例如 (i) 选择性背根切断术，(ii) 超选择性神经切除术和 (iii) 神经转移。在选择合适的手术方法时，必须仔细评估术前患者特征以及神经靶向手术干预的风险和益处。在这里，我们回顾了这些神经靶向手术方法治疗各种先天性和获得性神经系统疾病痉挛的疗效的最新证据。

REF: Ran KR, Das O, Johnston DT, et al. Nerve-targeted surgical treatments for spasticity: a narrative review. World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.084 PMID: 38649021

Green Hospital as A New Standard in Japan: How far can Neurosurgery go in Japan?

绿色医院成为日本的新标准: 日本的神经外科能走多远？

Climate change is a significant challenge that the medical community must address. Hospitals are large facilities with high water and energy consumption, as well as high levels of waste generation, which makes it important to pursue green hospital initiatives. Neurosurgery requires substantial energy for surgeries and tests. The advent of 'green hospitals' in Japan is imminent. The active participation of neurosurgeons can play a crucial role in diminishing the environmental footprint of health care while simultaneously enhancing medical standards. Given the pressing challenges posed by climate change, there is a critical need for an overhaul of medical practices. It is imperative for neurosurgeons to pioneer the adoption of new, sustainable medical methodologies.

气候变化是医学界必须应对的重大挑战。医院是大型设施，水和能源消耗高，废物产生量高，因此推行绿色医院计划非常重要。神经外科手术需要大量的能量进行手术和测试。“绿色医院” 在日本的出现迫在眉睫。神经外科医生的积极参与可以在减少医疗保健的环境足迹方面发挥关键作用，同时提高医疗标准。鉴于气候变化带来的紧迫挑战，迫切需要对医疗实践进行彻底改革。神经外科医生必须率先采用新的，可持续的医疗方法。

REF: Asamoto S, Sawada H, Muto J, Arai T, Kawamata T. Green Hospital as A New Standard in Japan: How far can Neurosurgery go in Japan?. World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.086 PMID: 38649025

Prognostic factors and outcomes in WHO Grade 1 and Grade 2 intracranial meningiomas - 5 year institutional experience

WHO 1级和2级颅内脑膜瘤的预后因素和结果-5年机构经验

Meningiomas are the most frequent primary intracranial tumour. While histological grade and grade of excision are established predictors of recurrence, nuances such as the role of radical excision of dural attachment and postoperative radiotherapy in intermediate-risk groups remain unanswered. WHO Grade and Simpson grade are independent predictors of recurrence among meningiomas. Irrespective of Grade, gross total resection must be effected when possible, and postoperative radiotherapy may be recommended in Grade 2 meningioma.

脑膜瘤是最常见的原发性颅内肿瘤。虽然组织学等级和切除等级是复发的既定预测因素，但诸如硬脑膜附件的根治性切除和术后放疗在中危组中的作用等细微差别仍未得到解答。WHO分级和Simpson分级是脑膜瘤复发的独立预测因子。无论级别如何，都必须在可能的情况下进行总切除，并且建议对2级脑膜瘤进行术后放疗。

REF: Nadeem M, Goyal-Honavar A, Sravya P, Beniwal M, Santosh V, Srinivas D. Prognostic factors and outcomes in WHO Grade 1 and Grade 2 intracranial meningiomas - 5 year institutional experience. World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.082 PMID: 38649022

Artificial intelligence assistance for the measurement of full alignment parameters in whole-spine lateral radiographs

人工智能辅助测量全脊柱侧位片的全对准参数

Measuring spinal alignment with radiological parameters is essential in patients with spinal conditions likely to be treated surgically. These evaluations are not usually included in the radiological report. As a result, spinal surgeons commonly perform the measurement, which is time-consuming and subject to errors. We aim to develop a fully automated artificial intelligence tool to assist in measuring alignment parameters in whole-spine lateral radiograph (WSL X-rays). Vertebrai's measurements can accurately detect alignment parameters, making it a promising tool for measuring GSP automatically.

在可能需要手术治疗的脊柱疾病患者中，使用放射学参数测量脊柱对准是必不可少的。这些评估通常不包括在放射学报告中。因此，脊柱外科医生通常执行测量，这是耗时的并且容易出错。我们的目标是开发一种全自动人工智能工具，以帮助测量全脊柱侧位x光片 (WSL x射线) 中的对准参数。Vertebrai的测量可以准确地检测对准参数，使其成为自动测量GSP的有前途的工具。

REF: Landriel F, Franchi BC, Mosquera C, et al. Artificial intelligence assistance for the measurement of full alignment parameters in whole-spine lateral radiographs. World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.091 PMID: 38649028

Imaging feature of Leukoencephalopathy with calcifications and cysts (Labrune syndrome)

伴有钙化和囊肿的白质脑病 (Labrune综合征) 的影像学特征

Labrune syndrome is an uncommon CNS disorder characterized by leukoencephalopathy, cerebral calcifications, and cysts on brain imaging. The basic pathology is microangiopathy resulting from a mutation in the SNORD118 gene. Radiological imaging is the hallmark of the disease.

Labrune综合征是一种罕见的中枢神经系统疾病，其特征是脑白质病，脑钙化和脑成像囊肿。基本病理是由SNORD118基因突变引起的微血管病。放射成像是该疾病的标志。

REF: Gaikwad SB, Charan BD, Jain S. Imaging feature of Leukoencephalopathy with calcifications and cysts (Labrune syndrome). World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.083 PMID: 38649023

Prevalence, Characteristics, and Trends in Retracted Spine Literature: 2000 – 2023

脊柱回缩文献的患病率、特征和趋势: 2000 - 2023

Retraction of scientific publications is an important check on scientific misconduct and serves to maintain the integrity of the scientific literature. The present study aims to examine the prevalence, trends, and characteristics of retracted spine literature across basic science and clinical spine literature. The rate of retractions has been increasing over the past 23 years, and clinical studies have been the most frequently retracted publication type. Clinicians treating disorders of the spine should be aware of these trends when relying on the clinical literature to inform their practice.

撤回科学出版物是对科学不端行为的重要检查，有助于维护科学文献的完整性。本研究旨在检查基础科学和临床脊柱文献中脊柱回缩文献的患病率，趋势和特征。在过去的23年中，撤回率一直在增加，临床研究已成为最常见的撤回出版物类型。当依靠临床文献为他们的实践提供信息时，治疗脊柱疾病的临床医生应该意识到这些趋势。

REF: Singh A, Botros M, Guirguis P, Punreddy A, Mesfin A, Puvanesarajah V. Prevalence, Characteristics, and Trends in Retracted Spine Literature: 2000 - 2023. World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.080 PMID: 38649024

Predicting the need for occipitocervical fusion for patients with lower clival chordoma: a single-center retrospective study

预测下斜坡脊索瘤患者需要枕颈融合术: 一项单中心回顾性研究

This is to assess the impact of tumor extension into the occipital condyle (OC) in lower clival chordoma management and the need for occipito-cervical fusion (OCF). In the absence of mobility-related neck pain, patients with lower clival chordoma and intact OC≥60%, intact apical ligament, and intact tectorial membrane, may not require OCF.

这是为了评估肿瘤扩展到枕con (OC) 在下斜坡脊索瘤治疗中的影响以及枕颈融合 (OCF) 的必要性。在没有与活动相关的颈部疼痛的情况下，下斜坡脊索瘤和完整的och ≥ 60%，完整的顶端韧带和完整的盖膜的患者可能不需要OCF。

REF: Hong S, Shinya Y, Lakomkin N, et al. Predicting the need for occipitocervical fusion for patients with lower clival chordoma: a single-center retrospective study. World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.081 PMID: 38649026

Evaluation of utility of Invasive Electroencephalography for definitive surgery in patients with Drug-Resistant epilepsy: A Systematic Review and Meta-analysis

有创脑电图在耐药性癫痫患者根治性手术中应用的系统评价和Meta分析

When non-invasive tests are unable to define the epileptogenic zone in patients, intracranial electroencephalography (iEEG) is a method of localising the epileptogenic zone. Compared to non-invasive evaluations, it offers more precise information about patterns of epileptiform activity, which results in useful diagnostic information that supports surgical decision-making. The primary aim of the present study was to assess the utility of iEEG for definitive surgery for patients suffering from drug-resistant epilepsy (DRE). Online databases like PubMed, Medline, Embase, Scopus, Cochrane Library, Web of Science and IEEE explorer were searched for MeSH terms and free-text keywords. ROBINS I critical appraisal tool was used for quality assessment. Prevalence from different studies was pooled together using the inverse variance heterogeneity method. Eggers regression analysis and funnel plot were used to evaluate publication bias. The systematic review included eighteen studies, while the meta-analysis included ten studies to estimate the prevalence of seizure freedom (class I Engel) in patients undergoing surgery after iEEG. There were 526 patients in all that were included in the meta-analysis. The period of follow-up ranged from one to ten years. The overall pooled estimate of the prevalence of seizure freedom (class I Engel) in patients undergoing surgery after iEEG was 53% (95% CI: 44, 62). The results additionally demonstrated that twelve studies had a moderate risk of bias, whereas six studies had a low risk. Future studies are crucial to enhance our understanding of iEEG, guiding patient choices and unraveling their implications.

当非侵入性测试无法确定患者的致痫区时，颅内脑电图 (iEEG) 是一种定位致痫区的方法。与非侵入性评估相比，它提供了关于癫痫样活动模式的更精确的信息，从而产生了支持手术决策的有用诊断信息。本研究的主要目的是评估iEEG在耐药性癫痫 (DRE) 患者确定性手术中的实用性。在PubMed，Medline，Embase，Scopus，Cochrane图书馆，Web of Science和IEEE explorer等在线数据库中搜索了网格术语和自由文本关键字。ROBINS I关键评估工具用于质量评估。使用逆方差异质性方法将来自不同研究的患病率汇总在一起。Eggers回归分析和漏斗图用于评估发表偏倚。系统评价包括18项研究，而荟萃分析包括10项研究，以估计iEEG术后接受手术的患者癫痫发作自由 (I类Engel) 的患病率。共有526名患者被纳入荟萃分析。随访时间从1年到10年不等。iEEG术后接受手术的患者中无癫痫发作 (I类Engel) 患病率的总体汇总估计值为53% (95% CI: 44，62)。结果还表明，12项研究具有中等偏倚风险，而6项研究具有低风险。未来的研究对于增强我们对iEEG的理解，指导患者选择并阐明其含义至关重要。

REF: Patel M, Mittal AK, Joshi V, et al. Evaluation of utility of Invasive Electroencephalography for definitive surgery in patients with Drug-Resistant epilepsy: A Systematic Review and Meta-analysis. World Neurosurg. Published online April 20, 2024. doi:10.1016/j.wneu.2024.04.079 PMID: 38649027

Single-center experience in resection of 120 cases of intradural spinal tumors

120例硬膜内脊柱肿瘤切除的单中心经验

Our study presents a single center experience in resection of intradural spinal tumors either with or without using intraoperative CT (iCT)-based registration and microscope-based augmented reality (AR). Microscope-based AR was recently described for improved orientation in the operative field in spine surgery, using superimposed images of segmented structures of interest in a two- (2D) or three-dimensional (3D) mode. High rates of GTR with favorable neurological outcome in a vast majority of patients as well as low recurrence rate with comparable complication rates was noted in our single center experience. AR improved intraoperative orientation and increased surgeons comfort by enabling early identification of important anatomical structures , however clinical and radiological outcomes did not differ, when AR was not used.

我们的研究提供了使用或不使用基于术中CT (iCT) 的配准和基于显微镜的增强现实 (AR) 切除硬膜内脊柱肿瘤的单中心经验。最近描述了基于显微镜的AR，用于改善脊柱手术中手术区域的方向，使用二维 (2D) 或三维 (3D) 模式下感兴趣的分割结构的叠加图像。在我们的单中心经验中，绝大多数患者的GTR发生率高，神经系统预后良好，复发率低，并发症发生率相当。通过早期识别重要的解剖结构，AR改善了术中定位并增加了外科医生的舒适度，但是当不使用AR时，临床和放射学结果没有差异。

REF: Pojskić M, Bopp M, Saß B, Nimsky C. Single-center experience in resection of 120 cases of intradural spinal tumors. World Neurosurg. Published online April 18, 2024. doi:10.1016/j.wneu.2024.04.071 PMID: 38642835