An Artificial Intelligence Tool for the Diagnosis of Facial Pain

一种用于诊断面部疼痛的人工智能工具

Differentiation between temporomandibular disorders (TMDs) and trigeminal neuralgia (TN) as causes of orofacial pain is very important because the nature of these disorders and their treatments are vastly different. TMDs are usually treated with a rehabilitative approach, although dental correction or even surgery may be necessary in rare cases where the origin of the pain appears to be related to oral or temporomandibular joint pathology. By contrast, TN is largely treated with anticonvulsant medications, trigeminal nerve surgery, or trigeminal ablative procedures. TMDs are several orders of magnitude more common than TN, which may result in misdiagnosis and mistreatment if the proper diagnosis is not made initially. The analysis of this network indicated that TMDs and TN can be reliably differentiated using a standardized questionnaire and physical examination with approximately 90% accuracy.

区分作为口面部疼痛病因的颞下颌关节紊乱病（TMDs）和三叉神经痛（TN）非常重要，因为这两种疾病的性质和治疗方法截然不同。TMDs通常采用康复治疗方法，不过在极少数情况下，如果疼痛根源似乎与口腔或颞下颌关节病变有关，可能需要进行牙科矫正甚至手术。相比之下，TN主要采用抗惊厥药物治疗、三叉神经手术或三叉神经毁损术。TMDs的发病率比TN高几个数量级，如果最初没有做出正确诊断，可能会导致误诊和误治。对该网络的分析表明，使用标准化问卷和体格检查能够可靠地区分TMDs和TN，准确率约为90%。

REF: Burchiel KJ, Bergman S, McGehee M, Obayashi J. An Artificial Intelligence Tool for the Diagnosis of Facial Pain. Neurosurgery. Published online June 30, 2025. doi:10.1227/neu.0000000000003610 PMID: 40586544

External Ventricular Drain Versus Intraparenchymal Pressure Monitor in Severe Traumatic Brain Injury: A TRACK-TBI Study

重型创伤性脑损伤中脑室外引流与脑实质内压力监测器的比较：TRACK - TBI研究

The 2 most common intracranial pressure (ICP)-monitoring devices in traumatic brain injury (TBI) are external ventricular drains (EVDs) and intraparenchymal monitors (IPMs). EVDs and IPMs differ in functionality and debate remains as to whether device selection affects patient outcomes. We aimed to determine whether the use of EVDs or IPMs for ICP monitoring was associated with better outcomes using data from severe TBI patients prospectively enrolled in the 18-center US Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Our study of a multicenter severe TBI cohort did not find a significant difference in 6-month GOSE-TBI between patients monitored with an EVD and those monitored with an IPM. When correcting for other patient characteristics, the selection of ICP monitor type may not affect acute hospital or 6-month functional outcomes.

创伤性脑损伤（TBI）中最常见的两种颅内压（ICP）监测设备是脑室外引流管（EVD）和脑实质内监测仪（IPM）。EVD和IPM在功能上有所不同，关于设备选择是否会影响患者预后仍存在争议。我们旨在利用美国18个中心前瞻性纳入的严重TBI患者数据，通过“创伤性脑损伤转化研究与临床知识”（TRACK - TBI）研究，确定使用EVD或IPM进行ICP监测是否与更好的预后相关。我们对多中心严重TBI队列的研究发现，使用EVD监测的患者和使用IPM监测的患者在伤后6个月的创伤性脑损伤格拉斯哥预后量表扩展版（GOSE - TBI）评分上没有显著差异。在对其他患者特征进行校正后，选择何种类型的ICP监测仪可能不会影响急性住院期间或6个月的功能预后。

REF: Greil ME, Barber JK, Temkin NR, et al. External Ventricular Drain Versus Intraparenchymal Pressure Monitor in Severe Traumatic Brain Injury: A TRACK-TBI Study. Neurosurgery. Published online June 30, 2025. doi:10.1227/neu.0000000000003594 PMID: 40586594

Return-to-Sport Recommendations for Athletes With Cervical Spine Trauma: A Modified Delphi Consensus Survey of Expert Opinion

颈椎创伤运动员的重返运动建议：一项改良德尔菲专家意见共识调查

Recommendations regarding return to sport (RTS) for athletes who have experienced cervical spine trauma are lacking, and management of these athletes remains challenging. The objective of this article was to perform a modified Delphi consensus survey of expert opinion on RTS in athletes who have suffered a traumatic injury to the cervical spine. Following a modified Delphi survey on RTS in athletes with spine pathology, the following scenarios reached consensus to RTS to high impact/high frequency forces sports: healed fractures of C1, C2; fractures of the subaxial facet/lamina/body; fibrous union of a prior laminar fracture; and cervical disk abutting the cord without compression. However, many scenarios of unhealed cervical spine fractures with fibrous union did not reach consensus.

对于经历过颈椎损伤的运动员重返运动（RTS）的相关建议十分匮乏，对这些运动员的管理仍然颇具挑战。本文的目的是针对遭受颈椎创伤性损伤的运动员重返运动问题开展一项改良德尔菲专家意见共识调查。在针对有脊柱病变的运动员重返运动进行改良德尔菲调查后，以下情况达成了重返高冲击/高频受力运动的共识：C1、C2 骨折愈合；下颈椎小关节/椎板/椎体骨折；既往椎板骨折纤维愈合；颈椎间盘与脊髓相邻但无压迫。然而，许多未愈合且呈纤维愈合状态的颈椎骨折情况未达成共识。

REF: Zuckerman SL, Jo J, Rigney GH, et al. Return-to-Sport Recommendations for Athletes With Cervical Spine Trauma: A Modified Delphi Consensus Survey of Expert Opinion. Neurosurgery. Published online June 27, 2025. doi:10.1227/neu.0000000000003564 PMID: 40576346

Evaluation of Nidus Occlusion After Radiosurgery in Brain Arteriovenous Malformations—A Prospective Study Using Arterial Spin Labeling

脑动静脉畸形放射外科治疗后病灶闭塞情况评估——一项采用动脉自旋标记技术的前瞻性研究

The gold standard for the evaluation of brain arteriovenous malformation (AVM) nidus occlusion after stereotactic radiosurgery is digital subtraction angiography (DSA), which is an invasive technique. We evaluated the role of MRI, especially arterial spin labeling (ASL) in the assessment of nidus occlusion after radiosurgery. DSA was used as the gold standard for comparison. MRI evaluation of nidus occlusion including ASL is highly sensitive for residual nidus detection and has a high potential to replace invasive DSA examinations for patients who underwent radiosurgery of brain AVMs.

立体定向放射外科手术后评估脑动静脉畸形（AVM）病灶闭塞情况的金标准是数字减影血管造影（DSA），这是一种有创技术。我们评估了磁共振成像（MRI），尤其是动脉自旋标记（ASL）在放射外科手术后评估病灶闭塞情况中的作用。以DSA作为对照的金标准。包括ASL在内的MRI对病灶闭塞情况的评估在检测残留病灶方面具有很高的敏感性，并且极有可能取代对接受脑AVM放射外科手术患者进行的有创DSA检查。

REF: Hirschmann D, Marik W, Cho A, et al. Evaluation of Nidus Occlusion After Radiosurgery in Brain Arteriovenous Malformations-A Prospective Study Using Arterial Spin Labeling. Neurosurgery. Published online June 27, 2025. doi:10.1227/neu.0000000000003590 PMID: 40576348

Return-to-Sport Recommendations for Athletes With Congenital Cervical Spine Pathology: A Modified Delphi Consensus Survey of Expert Opinion

先天性颈椎病变运动员的重返运动建议：一项专家意见的德尔菲改良共识调查

Recommendations guiding participation in sports for athletes with congenital cervical spine pathology are lacking, and management of these athletes remains challenging. Thus, the objective was to perform a modified Delphi consensus survey of expert opinion on return-to-sport (RTS) decisions in athletes with congenital cervical spine pathologies. The following scenarios reached ≥70% consensus recommending athletes to return to high impact/high frequency sports: C1 ring anomaly without a prior neurapraxic event, occipitalized C1, Klippel-Feil syndrome involving 1 motion segment, and asymptomatic Chiari malformation without a syrinx. In addition, consensus was reached advising athletes with congenital stenosis with 2 or more neurapraxic events not to RTS. Although consensus was not obtained in other areas, notable findings are discussed.

目前缺乏针对先天性颈椎病变运动员参与体育活动的指导建议，对这些运动员的管理仍然具有挑战性。因此，本研究的目的是对先天性颈椎病变运动员的重返运动（RTS）决策进行专家意见的改良德尔菲共识调查。以下情况达成了≥70%的共识，建议运动员重返高冲击/高频运动：无既往神经失用事件的C1环异常、枕化的C1、累及1个运动节段的Klippel - Feil综合征以及无脊髓空洞症的无症状Chiari畸形。此外，对于有2次或更多次神经失用事件的先天性椎管狭窄运动员，达成了不建议重返运动的共识。尽管在其他方面未达成共识，但对一些值得注意的发现进行了讨论。

REF: Zuckerman SL, Jo J, Rigney GH, et al. Return-to-Sport Recommendations for Athletes With Congenital Cervical Spine Pathology: A Modified Delphi Consensus Survey of Expert Opinion. Neurosurgery. Published online June 27, 2025. doi:10.1227/neu.0000000000003576 PMID: 40576340

Risk Factors, Indications, and Effectiveness of Cerebrospinal Fluid Diversion in Patients With High-Grade Glioma–Associated Hydrocephalus: A Systematic Review and Meta-Analysis

高级别胶质瘤相关脑积水患者脑脊液分流的危险因素、适应证及有效性：系统评价与荟萃分析

The role of cerebrospinal fluid (CSF) diversion in patients with high-grade glioma (HGG)-associated hydrocephalus is debated. This systematic review and meta-analysis summarizes the risk factors, indications, and effectiveness of CSF diversion in patients with HGG-associated hydrocephalus, with the goal of evaluating patient survival, functional improvement, and symptomatic improvement after CSF diversion. CSF diversion in adults with HGG-associated hydrocephalus led to a significant improvement in both KPS score and symptoms. If functionality and symptom improvement are patients' priorities, CSF diversion may be recommended.

脑脊液（CSF）分流在高级别胶质瘤（HGG）相关性脑积水患者中的作用存在争议。本系统评价和荟萃分析总结了HGG相关性脑积水患者脑脊液分流的危险因素、适应证和有效性，旨在评估脑脊液分流后患者的生存率、功能改善情况和症状改善情况。成人HGG相关性脑积水患者进行脑脊液分流后，卡氏功能状态（KPS）评分和症状均显著改善。如果患者优先考虑功能和症状改善，则可建议进行脑脊液分流。

REF: Tracz JA, Saint-Germain MA, Kuo CC, et al. Risk Factors, Indications, and Effectiveness of Cerebrospinal Fluid Diversion in Patients With High-Grade Glioma-Associated Hydrocephalus: A Systematic Review and Meta-Analysis. Neurosurgery. Published online June 25, 2025. doi:10.1227/neu.0000000000003592 PMID: 40558064

Early Retinal Microcirculation Loss in Nonfunctioning Pituitary Adenomas Before Visual Field Defect by Wide-Field Swept Source Optical Coherence Tomography

采用宽视野扫频源光学相干断层扫描技术发现无功能垂体腺瘤患者在出现视野缺损前早期视网膜微循环丢失情况

So far, little is known about early macular microcirculation changes in nonfunctioning pituitary adenomas (NFPAs), particularly in patients before visual field defects (VFD) occur. The aim of our study was to evaluate the early retinal microcirculation alteration in NFPA before VFD by wide-field swept source optical coherence tomography (WF SS-OCTA). NFPA patients before VFD produce a characteristic pattern of early retinal microcirculation loss that WF SS-OCTA can recognize. WF SS-OCTA is a useful tool for early predicting visual impairment in NFPA.

到目前为止，关于无功能性垂体腺瘤（NFPA）患者早期黄斑微循环变化的了解甚少，尤其是在视野缺损（VFD）出现之前的患者。本研究的目的是通过宽场扫频源光学相干断层扫描血管造影（WF SS - OCTA）评估VFD出现前NFPA患者的早期视网膜微循环改变。VFD出现前的NFPA患者会出现一种早期视网膜微循环缺失的特征性模式，而WF SS - OCTA能够识别这种模式。WF SS - OCTA是早期预测NFPA患者视力损害的有用工具。

REF: Tang C, Huang F, Yang Y, et al. Early Retinal Microcirculation Loss in Nonfunctioning Pituitary Adenomas Before Visual Field Defect by Wide-Field Swept Source Optical Coherence Tomography. Neurosurgery. Published online June 25, 2025. doi:10.1227/neu.0000000000003586 PMID: 40558060

Impact of Extent of Resection on Survival in Brain Metastasis: An Analysis of 867 Patients

切除范围对脑转移瘤患者生存的影响：一项针对867例患者的分析

The association between extent of resection (EOR) and outcomes after brain metastasis (BM) surgery remains unclear. The aim of this study was to examine the relation between EOR and overall survival (OS)/intracranial progression-free survival (IC-PFS) in this patient group. Residual tumor on postoperative MRI after BM resection correlated with worse IC-PFS and OS after adjusting for confounding variables. An increased prevalence of LMD may be a possible mechanism through which these patients experience worse outcomes.

脑转移瘤（BM）手术后切除范围（EOR）与预后之间的关联仍不明确。本研究的目的是探讨该患者群体中EOR与总生存期（OS）/颅内无进展生存期（IC - PFS）之间的关系。在调整混杂变量后，BM切除术后磁共振成像（MRI）显示的残留肿瘤与较差的IC - PFS和OS相关。软脑膜转移（LMD）患病率增加可能是这些患者预后较差的一种可能机制。

REF: Hulsbergen AFC, Siddi F, Cerecedo C, et al. Impact of Extent of Resection on Survival in Brain Metastasis: An Analysis of 867 Patients. Neurosurgery. Published online June 23, 2025. doi:10.1227/neu.0000000000003544 PMID: 40548745

Active Cerebrospinal Fluid Exchange vs External Ventricular Drainage in the Neurocritical Care Unit: An International, Retrospective Cohort Study

神经重症监护室中主动脑脊液交换与脑室外引流的比较：一项国际回顾性队列研究

Active cerebrospinal fluid exchange (ACE) through the dual-lumen IRRAflow catheter is a technique that has been used in the treatment of intraventricular hemorrhage and subarachnoid hemorrhage, ventriculitis, and others. Previous reports have consisted of small numbers of patients and focused on particular conditions. Our objective was to complete a multi-institutional retrospective cohort study to evaluate the safety and clinical outcomes of ACE therapy through the IRRAflow catheter. ACE therapy with the IRRAflow catheter is associated with fewer complications and improvement in some clinical outcomes. These results need to be confirmed with prospective and randomized trials.

通过双腔IRRAflow导管进行的主动脑脊液交换（ACE）是一种已用于治疗脑室内出血、蛛网膜下腔出血、脑室炎等疾病的技术。此前的报告涉及的患者数量较少，且侧重于特定病症。我们的目标是完成一项多机构回顾性队列研究，以评估通过IRRAflow导管进行ACE治疗的安全性和临床疗效。使用IRRAflow导管进行ACE治疗与较少的并发症相关，且能改善一些临床结局。这些结果需要通过前瞻性随机试验来进一步证实。

REF: Jahromi BR, Monachello G, Khan MB, et al. Active Cerebrospinal Fluid Exchange vs External Ventricular Drainage in the Neurocritical Care Unit: An International, Retrospective Cohort Study. Neurosurgery. Published online June 23, 2025. doi:10.1227/neu.0000000000003587 PMID: 40548731