Plasma Neurofilament Light Chain as a Biomarker for Poor Outcome After Aneurysmal Subarachnoid Hemorrhage

血浆神经丝轻链作为动脉瘤性蛛网膜下腔出血后不良预后的生物标志物

Neurofilament light chain (NfL), a biomarker reflecting neuro-axonal damage, may be useful in improving clinical outcome prediction after aSAH. We explore the robust and additional value of NfL to neurological and radiological grading scales in predicting poor outcome after aSAH. In the entire aSAH cohort, plasma NfL has an acceptable predictive performance but does not improve clinical outcome prediction. However, NfL may have potential value in subgroups based on hemorrhage severity.

神经丝轻链 (NfL) 是反映神经轴突损伤的生物标志物，可用于改善aSAH后的临床结果预测。我们探讨了NfL对神经和放射学分级量表在预测aSAH后不良预后方面的强大和附加价值。在整个aSAH队列中，血浆NfL具有可接受的预测性能，但不能改善临床结果预测。然而，NfL在基于出血严重程度的亚组中可能具有潜在价值。

REF: Labib H, Tjerkstra MA, Teunissen CE, et al. Plasma neurofilament light chain as a biomarker for poor outcome after aneurysmal subarachnoid hemorrhage. World Neurosurg. Published online June 10, 2024. doi:10.1016/j.wneu.2024.06.024 PMID: 38866237

The Impact of Outpatient Physical Therapy on Patient-Reported Outcomes After Lumbar Fusion: Perspective from A Bundled Care Dataset

门诊物理治疗对腰椎融合术后患者报告结果的影响: 从捆绑护理数据集的视角

As value-based care grows in popularity across the United States, more payers have turned toward bundled payment models for surgical procedures. Though episode costs in spine are highly variable, physical therapy (PT) has been identified as a driver of 90-day cost. The goal of this study is to assess the impact of postoperative PT on patient-reported outcomes and cost after lumbar fusion surgery using bundled insurance data. Our study finds that PT after lumbar fusion is not associated with significant improvement in Oswestry Disability Index, PCS, mental component score, or visual analog scale pain scores. Additionally, the number of PT sessions a patient attends has no correlation with improvement in these outcomes.

随着基于价值的护理在美国越来越受欢迎，越来越多的付款人转向外科手术的捆绑支付模式。尽管脊柱的发作费用变化很大，但物理治疗 (PT) 已被确定为90天费用的驱动因素。这项研究的目的是使用捆绑保险数据评估术后PT对腰椎融合手术后患者报告的结果和成本的影响。我们的研究发现，腰椎融合术后的PT与Oswestry残疾指数，PCS，精神成分评分或视觉模拟量表疼痛评分的显着改善无关。此外，患者参加的PT疗程的数量与这些结果的改善没有相关性。

REF: McCurdy MA, Narayanan R, Trenchfield D, et al. The Impact of Outpatient Physical Therapy on Patient-Reported Outcomes After Lumbar Fusion: Perspective from A Bundled Care Dataset. World Neurosurg. Published online June 10, 2024. doi:10.1016/j.wneu.2024.06.020 PMID: 38866235

“Mail-slot” Technique for Minimally Invasive Placement of Subdural Grid Electrodes: A Single-institution Experience

用于微创放置硬膜下网格电极的 “邮件槽” 技术: 单机构经验

In the management of multi-drug-resistant focal epilepsies, intracranial electrode implantation is used for precise localization of the ictal onset zone. In select patients, subdural grid electrode implantation is utilized. Subdural grid placement traditionally requires large craniotomies to visualize the cortex prior to mapping. However, smaller craniotomies may enable shorter operations and reduced risks. We aimed to compare surgical outcomes between patients undergoing traditional large craniotomies with those undergoing tailored "mini" craniotomies (the "mail-slot" technique) for subdural grid placement. Our findings suggest that mini-craniotomies for subdural grid placement in epilepsy monitoring offer significant advantages, including smaller craniotomy sizes and shorter operation durations, without compromising safety or efficacy. These results support the trend towards minimally invasive, patient-tailored surgical approaches in epilepsy treatment.

在治疗耐多药的局灶性癫痫时，颅内电极植入用于精确定位发作区。在选定的患者中，使用硬膜下网格电极植入。传统上，硬膜下网格的放置需要较大的开颅手术才能在映射之前可视化皮质。然而，较小的开颅手术可以缩短手术时间并降低风险。我们旨在比较接受传统大颅骨切开术的患者与接受量身定制的 “迷你” 颅骨切开术 (“邮件槽” 技术) 进行硬膜下网格放置的患者的手术结果。我们的研究结果表明，在癫痫监测中进行硬膜下网格放置的微型开颅手术具有显着的优势，包括较小的开颅手术尺寸和较短的手术时间，而不会影响安全性或有效性。这些结果支持了癫痫治疗中微创、患者定制手术方法的趋势。

REF: Himstead AS, Picton B, Luzzi S, et al. "Mail-slot" Technique for Minimally Invasive Placement of Subdural Grid Electrodes: A Single-institution Experience. World Neurosurg. Published online June 10, 2024. doi:10.1016/j.wneu.2024.06.018 PMID: 38866238

Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile

在严重的矢状畸形中恢复L4-S1的脊柱前凸形状: 矫正技术对对准和并发症轮廓的影响

Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data are limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients. ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intraoperative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.

严重的矢状面畸形伴L4-S1脊柱前凸丧失是致残的，可以通过各种手术技术加以改善。然而，对于严重错位患者，前路腰椎椎间融合术 (ALIF)，椎弓根减影截骨术 (PSO) 和经椎间孔腰椎椎间融合术 (TLIF) 的不同能力的数据有限。ALIF可以像PSO一样有效地恢复L4-S1矢状位，术中和院内并发症更少。在可行的情况下，ALIF是PSO的合适替代方法，并且在纠正严重矢状位错位患者的L4-S1脊柱前凸方面可能优于TLIF。

REF: Singh M, Balmaceno-Criss M, Daher M, et al. Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile. World Neurosurg. Published online June 10, 2024. doi:10.1016/j.wneu.2024.06.021 PMID: 38866236

Hyperlipidemia, Obesity, and Diabetes, and Risk of Ossification of the Posterior Longitudinal Ligament

高脂血症，肥胖和糖尿病以及后纵韧带骨化的风险

Several risk factors of ossification of the posterior longitudinal ligament (OPLL) have been established, including diabetes and obesity. However, the relationship between hyperlipidemia (HLD) and OPLL is incompletely understood. Cervical OPLL rates were higher in patients with HLD even after accounting for demographics and comorbidities. HLD may be an independent risk factor for OPLL development.

已经确定了几种后纵韧带骨化 (OPLL) 的危险因素，包括糖尿病和肥胖。然而，高脂血症 (HLD) 和OPLL之间的关系尚不完全清楚。即使考虑到人口统计学和合并症，HLD患者的颈部OPLL率也较高。HLD可能是OPLL发展的独立危险因素。

REF: Singh M, Kuharski M, Balmaceno-Criss M, Diebo BG, Daniels A. Hyperlipidemia, Obesity, and Diabetes, and Risk of Ossification of the Posterior Longitudinal Ligament. World Neurosurg. Published online June 9, 2024. doi:10.1016/j.wneu.2024.06.022 PMID: 38857872

Under Pressure: Emotional Reactions to Stress of Neurosurgeons and Neurosurgical Trainees

压力下: 神经外科医生和神经外科学员对压力的情绪反应

Neurosurgeons demonstrate some of the highest levels of burnout among surgeons, yet little research has been done to understand the underlying stressors that neurosurgeons and trainees experience and the emotional responses to them. Our goal was to conduct a feasibility study identifying job stressors and emotional responses among neurosurgeons rather than generalize findings across the profession. The results of our study provide an understanding of neurosurgical professionals' unique emotional landscape, emphasizing the need for reforms in administrative practices, enhanced, healthy coping strategies, and career stage-specific mental health support.

神经外科医生在外科医生中表现出一些最高水平的倦怠，但很少有研究来了解神经外科医生和受训者所经历的潜在压力源以及对它们的情绪反应。我们的目标是进行一项可行性研究，以确定神经外科医生的工作压力和情绪反应，而不是将整个行业的发现一般化。我们的研究结果提供了对神经外科专业人员独特的情感状况的理解，强调了对行政实践进行改革，增强，健康的应对策略以及针对特定职业阶段的精神卫生支持的必要性。

REF: Lin-Siegler X, Lovett BJ, Wang K, et al. Under Pressure: Emotional Reactions to Stress of Neurosurgeons and Neurosurgical Trainees. World Neurosurg. Published online June 8, 2024. doi:10.1016/j.wneu.2024.06.016 PMID: 38857865

Ki67 Index Correlates with Tumoral Volumetry and 5-ALA Residual Fluorescence in Glioblastoma

Ki67指数与胶质母细胞瘤的肿瘤体积和5-ALA残留荧光相关

Malignant gliomas are the most prevalent primary malignant cerebral tumors. Preoperative imaging plays an important role, and the prognosis is closely related to surgical resection and histomolecular aspects. Our goal was to correlate Ki67 indexes with tumoral volumetry in semiautomatic segmentation on preoperative magnetic resonance images and residual fluorescence in a 5-ALA-assisted resection cohort. There is a correlation between Ki67, the metabolically active tumoral volumes (WT and ET), and 5-ALA residual fluorescence. Methodological inconsistencies are probably responsible for contradictory literature findings, and further prospective studies are needed to validate and reproduce these findings.

恶性神经胶质瘤是最常见的原发性恶性脑肿瘤。术前影像学检查具有重要作用，预后与手术切除和组织分子方面密切相关。我们的目标是将Ki67指数与术前磁共振图像半自动分割中的肿瘤体积和5-ALA辅助切除队列中的残余荧光相关联。Ki67、代谢活性肿瘤体积 (WT和ET) 和5-ALA残留荧光之间存在相关性。方法学上的不一致可能是造成矛盾的文献发现的原因，需要进一步的前瞻性研究来验证和重现这些发现。

REF: Sprenger F, da Silva Junior EB, Ramina R, et al. Ki67 Index Correlates with Tumoral Volumetry and 5-ALA Residual Fluorescence in Glioblastoma. World Neurosurg. Published online June 8, 2024. doi:10.1016/j.wneu.2024.06.023 PMID: 38857868

Association of Body Mass Index and Central Obesity with Spinopelvic Alignment Parameters in a Chinese Population: A Prospective Study

中国人群中体重指数和中心性肥胖与脊柱骨盆排列参数的关联: 一项前瞻性研究

The purpose of this study was to explore the impact of central obesity on spinal sagittal balance in adults aged 18 and older by examining correlations between waist circumference (WC) and abdominal circumference (AC) and spinopelvic alignment parameters. The findings highlight the impact of central obesity on spinal alignment and emphasize the importance of considering central obesity in clinical assessments of spinal pathologies. Further research is essential to better understand the relationship between obesity, spinal sagittal balance, and related health conditions.

这项研究的目的是通过检查腰围 (WC) 和腹围 (AC) 与脊柱骨盆对准参数之间的相关性，探讨中心性肥胖对18岁及以上成年人脊柱矢状面平衡的影响。研究结果强调了中心性肥胖对脊柱排列的影响，并强调了在脊柱病变的临床评估中考虑中心性肥胖的重要性。进一步的研究对于更好地了解肥胖，脊柱矢状面平衡和相关健康状况之间的关系至关重要。

REF: Qi H, Zhao Z, Zu F, et al. Association of Body Mass Index and Central Obesity with Spinopelvic Alignment Parameters in a Chinese Population: A Prospective Study. World Neurosurg. Published online June 8, 2024. doi:10.1016/j.wneu.2024.06.005 PMID: 38857870

Genetic Biomarkers in Astrocytoma: Diagnostic, Prognostic, and Therapeutic Potential

星形细胞瘤的遗传生物标志物: 诊断，预后和治疗潜力

Astrocytoma is the most common adult brain tumor, with glioblastoma being the deadliest neuro-related malignancy. Despite advances in oncology, the prognosis for astrocytoma, especially glioblastoma, remains poor, and tracking disease progression is challenging due to a lack of robust biomarkers. Genetic biomarkers, including microRNAs, cell-free DNA, circulating tumor DNA, circular RNA, and long noncoding RNA, can serve as potential diagnostic and therapeutic targets. In this review, we examine the existing literature, analyzing the various less established liquid and tumor genetic biomarkers and their potential to act as diagnostic, prognostic, and therapeutic targets. We highlight the clinical challenges and limitations in implementing liquid biopsy strategies in clinical practice. The article discusses the potential of liquid biopsies as valuable tools for personalized astrocytoma management while emphasizing the need for standardized protocols and further advancements to establish their clinical utility and therapeutic application.

星形细胞瘤是最常见的成人脑肿瘤，胶质母细胞瘤是最致命的神经相关恶性肿瘤。尽管肿瘤学取得了进步，但星形细胞瘤，尤其是胶质母细胞瘤的预后仍然很差，并且由于缺乏强大的生物标志物，追踪疾病进展具有挑战性。遗传生物标志物，包括microrna，无细胞DNA，循环肿瘤DNA，环状RNA和长链非编码RNA，可以作为潜在的诊断和治疗靶标。在这篇综述中，我们检查了现有的文献，分析了各种不太确定的液体和肿瘤遗传生物标志物及其作为诊断，预后和治疗靶标的潜力。我们强调了在临床实践中实施液体活检策略的临床挑战和局限性。本文讨论了液体活检作为个性化星形细胞瘤管理的宝贵工具的潜力，同时强调了对标准化方案的需求以及进一步发展以建立其临床实用性和治疗应用的需求。

REF: Shehaj A, Khristov V, Mareboina M, et al. Genetic Biomarkers in Astrocytoma: Diagnostic, Prognostic, and Therapeutic Potential. World Neurosurg. Published online June 8, 2024. doi:10.1016/j.wneu.2024.06.009 PMID: 38857866