Comparative Analysis of Efficacy and Safety of Frame-Based, Frameless, and Robot-Assisted Stereotactic Brain Biopsies: A Systematic Review and Meta-Analysis

基于框架、无框架及机器人辅助立体定向脑活检术有效性和安全性的比较分析：系统评价与Meta分析

For 50 years, frame-based stereotactic brain biopsy has been the "gold standard" for its high diagnostic yield and safety, especially for complex or deep-seated lesions. Over the past decade, frameless and robotic alternatives have emerged. This report evaluates and compares the outcomes, diagnostic yield, and safety of these methods. Robot-assisted biopsy is not inferior in diagnostic yield and safety to the gold standard frame-based and neuronavigation-assisted frameless biopsy methods.

50年来，基于框架的立体定向脑活检因其高诊断率和安全性，一直是“金标准”，尤其适用于复杂或深部病变。在过去十年中，无框架和机器人辅助的替代方法应运而生。本报告对这些方法的结果、诊断率和安全性进行了评估和比较。机器人辅助活检在诊断率和安全性方面并不逊色于金标准的基于框架活检法和神经导航辅助的无框架活检法。

REF: Gecici NN, Hameed NUF, Habib A, Deng H, Lunsford LD, Zinn PO. Comparative Analysis of Efficacy and Safety of Frame-Based, Frameless, and Robot-Assisted Stereotactic Brain Biopsies: A Systematic Review and Meta-Analysis. Oper Neurosurg (Hagerstown). 2025;28(6):749-761. doi:10.1227/ons.0000000000001408 PMID: 40062857

Vertebral Column Subluxation in Neurofibromatosis Type 1–Associated Dystrophic Scoliosis: A Report of Two Cases and Narrative Review

1型神经纤维瘤病相关营养不良性脊柱侧凸中的脊柱半脱位：两例报告及叙述性综述

Neurofibromatosis-1 (NF1) dystrophic scoliosis is a challenging disease to manage surgically, with multiplanar curves progressing rapidly and unpredictably. Conservative management with bracing is often unsuccessful, and many patients necessitate instrumented fusion to halt progression of their curves. In rare cases, patients can present with spontaneous vertebral subluxation, significantly complicating the surgical management of this already complex disease process. The objective here was to describe 2 cases of vertebral subluxation in NF1-associated dystrophic scoliosis along with their surgical corrections and clinical courses. Dystrophic scoliosis in NF1 remains a difficult disease to treat, and deformity correction in patients with subluxation is particularly complex. These cases here highlight the unpredictability and possible complications of halo-gravity traction, need for good fixation to facilitate subluxation reduction, high chance of hardware complications and proximal or distal failure, and importance of cooperative management of these patients in conjunction with other surgical services.

神经纤维瘤病 1 型（NF1）营养不良性脊柱侧凸是一种手术治疗颇具挑战性的疾病，其多平面弯曲进展迅速且难以预测。采用支具进行保守治疗往往效果不佳，许多患者需要进行器械融合手术以阻止脊柱弯曲进展。在极少数情况下，患者会出现自发性椎体半脱位，这使得本就复杂的疾病治疗过程在手术管理方面变得更加棘手。本文旨在报告 2 例 NF1 相关营养不良性脊柱侧凸合并椎体半脱位的病例，以及相应的手术矫正方法和临床病程。NF1 相关的营养不良性脊柱侧凸仍是一种难以治疗的疾病，而合并半脱位患者的畸形矫正尤为复杂。这些病例凸显了头环 - 重力牵引的不可预测性和可能出现的并发症、良好固定对促进半脱位复位的必要性、内固定物并发症及近端或远端失败的高可能性，以及与其他外科科室协同管理此类患者的重要性。

REF: Dastagirzada Y, Neifert S, Kurland DB, et al. Vertebral Column Subluxation in Neurofibromatosis Type 1-Associated Dystrophic Scoliosis: A Report of Two Cases and Narrative Review. Oper Neurosurg (Hagerstown). 2025;28(6):762-771. doi:10.1227/ons.0000000000001373 PMID: 39808571

Posterior Reduction and Temporary Fixation Through Intermuscular Approach for Odontoid Fracture

经肌间隙入路后路复位及临时固定治疗齿状突骨折

Posterior reduction and temporary fixation (PRTF) through open approach can effectively avoid the loss of C1-C2 motion caused by posterior atlantoaxial fusion in the treatment of odontoid fracture. PRTF through intermuscular approach can preserve the integrity of the paravertebral muscle. However, its contribution to the preservation of C1-C2 rotation remains unassessed in the context of fresh odontoid fractures. PRTF through intermuscular approach can be used as a salvage treatment of an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation. This minimally invasive technique can effectively preserve the rotational function of the atlantoaxial complex.

在齿状突骨折的治疗中，开放入路的后路复位与临时固定（PRTF）可有效避免后路寰枢椎融合导致的C1 - C2节段活动丧失。肌间隙入路的PRTF可保留椎旁肌的完整性。然而，在新鲜齿状突骨折的情况下，其对保留C1 - C2旋转功能的作用尚未得到评估。对于横韧带完整的齿状突骨折，若前路螺钉固定失败或存在禁忌证，肌间隙入路的PRTF可作为挽救性治疗方法。这种微创技术可有效保留寰枢椎复合体的旋转功能。

REF: Xu Z, Wu J, Wang H, et al. Posterior Reduction and Temporary Fixation Through Intermuscular Approach for Odontoid Fracture. Oper Neurosurg (Hagerstown). 2025;28(6):772-778. doi:10.1227/ons.0000000000001399 PMID: 39450985

Extended Endoscopic Endonasal Approach for Giant Pediatric Craniopharyngiomas: Technical Note and Case Series

小儿巨大颅咽管瘤的扩大内镜经鼻入路手术：技术要点及病例系列报告

Giant pediatric craniopharyngiomas are rare tumors whose clinical and surgical management is extremely challenging. A variety of open transcranial approaches has been used to resect these lesions. Although there has been an increasing acceptance of the endoscopic endonasal approach (EEA) for the resection of pediatric craniopharyngiomas in recent years, many surgeons continue to recommend against the use of the EEA for giant pediatric craniopharyngiomas. This study aimed to evaluate the feasibility of extended EEA for giant craniopharyngiomas in the pediatric population. The extended EEA allows adequate access to this challenging tumor and enables complete resection and visual improvement with a reasonable approach-related complication rate.

小儿巨大颅咽管瘤是一种罕见肿瘤，其临床和手术治疗极具挑战性。多种开放式经颅入路已被用于切除这些病变。尽管近年来经鼻内镜入路（EEA）在小儿颅咽管瘤切除术中的接受度越来越高，但许多外科医生仍不建议对小儿巨大颅咽管瘤采用经鼻内镜入路。本研究旨在评估扩大经鼻内镜入路在小儿巨大颅咽管瘤治疗中的可行性。扩大经鼻内镜入路可充分暴露这一具有挑战性的肿瘤，能实现完全切除并改善视力，且与入路相关的并发症发生率处于合理范围。

REF: Bao Y, Pan L, Fu J, et al. Extended Endoscopic Endonasal Approach for Giant Pediatric Craniopharyngiomas: Technical Note and Case Series. Oper Neurosurg (Hagerstown). 2025;28(6):779-787. doi:10.1227/ons.0000000000001191 PMID: 38771078

Endoscopic Endonasal Internal Carotid Artery Transposition Technique in Tumor With Parasellar Extension: A Single-Center Experience

经鼻内镜下颈内动脉转位技术治疗累及鞍旁的肿瘤：单中心经验

Lateralization or mobilization of the internal carotid artery (ICA) during a midline approach is required to expose lesions behind or lateral to the ICA. However, there have been no published data regarding the surgical outcomes of the endoscopic endonasal internal carotid transposition technique (EEITT). This study aimed to analyze the relevant surgical anatomy around the ICA and propose a grading scheme of EEITT. The EEITT is technically feasible and could be graded according to the extent of disconnection of limiting structures. For complex tumor with parasellar extensions, the distinction into Grades 1, 2, and 3 will be of benefit to clinicians in predicting risks, avoiding complications, and generating tailored individualized surgical strategies.

在中线入路手术中，为暴露颈内动脉（ICA）后方或外侧的病变，需要对颈内动脉进行侧方移位或游离。然而，目前尚无关于内镜经鼻颈内动脉转位技术（EEITT）手术效果的公开数据。本研究旨在分析颈内动脉周围的相关手术解剖结构，并提出内镜经鼻颈内动脉转位技术的分级方案。内镜经鼻颈内动脉转位技术在技术上是可行的，并且可以根据限制结构的离断程度进行分级。对于有鞍旁扩展的复杂肿瘤，分为1级、2级和3级将有助于临床医生预测风险、避免并发症，并制定个性化的手术策略。

REF: Xiao L, Wu B, Ding H, et al. Endoscopic Endonasal Internal Carotid Artery Transposition Technique in Tumor With Parasellar Extension: A Single-Center Experience. Oper Neurosurg (Hagerstown). 2025;28(6):796-807. doi:10.1227/ons.0000000000001193 PMID: 38781485

Accuracy of Boltless Frame-Based Stereo-Electroencephalography Electrode Implantation

无框架立体定向脑电图电极植入的准确性

Boltless implantation of stereo-electroencephalography electrode is a useful alternative especially when anchor bolt is not available such as in country with limited resources or is less appropriate such as placement in patients with thin skull or at the occiput area, despite some drawbacks including potential dislodgement. While the accuracy of implantation using anchor bolt is well-studied, data on boltless implantation remain scarce. This study aimed to reveal the accuracy, permissible error for actual placement of electrodes within the grey matter, and delayed electrode dislodgement in boltless implantation. Boltless implantation of stereo-electroencephalography electrode offers an accuracy comparable to those using anchor bolt. During the planning of boltless implantation, target points should be placed within 3.2 mm from the gray-white matter junction and a possible delayed dislodgement of 2.2 mm should be considered.

立体脑电图电极无螺栓植入是一种有用的替代方法，特别是在无法使用锚固螺栓的情况下，如在资源有限的国家；或者在不太适合使用锚固螺栓的情况下，如在颅骨较薄的患者或枕部区域进行植入，尽管存在包括电极可能移位等一些缺点。虽然使用锚固螺栓进行植入的准确性已得到充分研究，但关于无螺栓植入的相关数据仍然稀缺。本研究旨在揭示无螺栓植入的准确性、电极在灰质内实际放置的允许误差以及电极延迟移位情况。立体脑电图电极无螺栓植入的准确性与使用锚固螺栓植入相当。在规划无螺栓植入时，靶点应放置在距灰白质交界处3.2毫米以内，并且应考虑到可能出现的2.2毫米的延迟移位。

REF: Fujita Y, Khoo HM, Kimoto Y, et al. Accuracy of Boltless Frame-Based Stereo-Electroencephalography Electrode Implantation. Oper Neurosurg (Hagerstown). 2025;28(6):788-795. doi:10.1227/ons.0000000000001209 PMID: 38888309

A Multivariate Approach to Quantifying Risk Factors Impacting Stereotactic Robotic-Guided Stereoelectroencephalography

一种量化影响立体定向机器人引导立体脑电图风险因素的多变量方法

Stereoelectroencephalography (SEEG) is an important method for invasive monitoring to establish surgical candidacy in approximately half of refractory epilepsy patients. Identifying factors affecting lead placement can mitigate potential surgical risks. This study applies multivariate analyses to identify perioperative factors affecting stereotactic electrode placement. Our study identified 2 primary predictors of SEEG lead error, region of implantation and entry angle, with nonsignificant contributions from lead length or order of electrode placement. Future considerations for SEEG may consider varying regional approaches and angles for more optimal accuracy in lead placement.

立体定向脑电图（SEEG）是一种重要的侵入性监测方法，可用于确定约半数难治性癫痫患者是否适合手术。识别影响电极置入的因素可以降低潜在的手术风险。本研究采用多变量分析方法，以确定影响立体定向电极置入的围手术期因素。我们的研究确定了SEEG电极误差的两个主要预测因素，即植入区域和进针角度，而电极长度或置入顺序的影响不显著。未来在进行SEEG时，可考虑采用不同的区域入路和角度，以提高电极置入的准确性。

REF: Song RR, Sharma A, Sarmey N, et al. A Multivariate Approach to Quantifying Risk Factors Impacting Stereotactic Robotic-Guided Stereoelectroencephalography. Oper Neurosurg (Hagerstown). 2025;28(6):824-831. doi:10.1227/ons.0000000000001383 PMID: 39329517

Treatment of Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents

使用血流导向装置支架治疗急性医源性脑血管损伤

Iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding. No consensus for management exists. This study describes endovascular treatment of these acute injuries with flow diverter stents. With proper antiplatelet regimens, flow diverter stents can be used safely to successfully treat complex acute iatrogenic injuries. Early repeat angiogram is needed when immediate postinjury imaging does not discover the point of vessel injury.

医源性脑血管损伤可导致颅内出血和假性动脉瘤形成，使患者面临较高的术后出血风险。目前对于此类损伤的处理尚无共识。本研究介绍了使用血流导向支架对这些急性损伤进行血管内治疗的情况。采用适当的抗血小板治疗方案时，血流导向支架可安全用于成功治疗复杂的急性医源性损伤。若损伤后即刻影像检查未发现血管损伤部位，则需要早期复查血管造影。

REF: Grin EA, Kvint S, Raz E, et al. Treatment of Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents. Oper Neurosurg (Hagerstown). 2025;28(6):808-816. doi:10.1227/ons.0000000000001379 PMID: 39311570

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With a D5W Push Technique: A Multicentric North American Study of 269 Patients

采用5%葡萄糖溶液推注技术使用氰基丙烯酸正丁酯行脑膜中动脉栓塞治疗慢性硬膜下血肿：一项针对269例患者的北美多中心研究

As the aging population increases, the incidence of chronic subdural hematomas (cSDHs) is expected to rise. Surgical evacuation, though effective, sees up to 30% recurrence. Middle meningeal artery (MMA) embolization, particularly with n-butyl cyanoacrylate (n-BCA) glue diluted in D5W for distal penetration, has shown promise in reducing recurrences. Limited reports have investigated the safety and technical feasibility of n-BCA as a primary liquid embolic agent using the D5W push technique in cSDH. This series is the largest in the literature investigating the outcomes of this technique in cSDH. MMA embolization using n-BCA with the D5W push technique is safe and technically feasible. It can be used adjunctively or as an alternative to surgery in patients with cSDH, resulting in decreased recurrence, high technical success, improved distal penetration, and low complication rates.

随着老年人口的增加，慢性硬膜下血肿（cSDH）的发病率预计将会上升。手术清除虽有效果，但复发率高达30%。脑膜中动脉（MMA）栓塞术，尤其是使用以5%葡萄糖注射液（D5W）稀释的氰基丙烯酸正丁酯（n - BCA）胶水以实现远端渗透，在降低复发率方面显示出了前景。目前仅有少量报告探讨了在cSDH治疗中采用D5W推注技术将n - BCA作为主要液体栓塞剂的安全性和技术可行性。本系列研究是文献中针对该技术在cSDH治疗中效果进行研究的最大规模的研究。采用D5W推注技术使用n - BCA进行MMA栓塞术是安全的，并且在技术上是可行的。该技术可作为辅助手段，或替代手术用于cSDH患者，能够降低复发率、获得较高的技术成功率、改善远端渗透效果，且并发症发生率较低。

REF: Abdelsalam A, Ramsay IA, Luther EM, et al. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With a D5W Push Technique: A Multicentric North American Study of 269 Patients. Oper Neurosurg (Hagerstown). 2025;28(6):817-823. doi:10.1227/ons.0000000000001369 PMID: 39311581