Differences Among Generations of Women Neurosurgeons in a Department Surpassing the Gender Tipping Point

某科室超越性别临界点的各代女性神经外科医生之间的差异

An increase in the proportion of women in neurosurgery may influence their professional experiences and support needs. This study examined generational differences in a Japanese department where women accounted for approximately 30% of neurosurgeons, an unusually high proportion in the country. Increased representation of women did not decrease demands and gender-specific challenges; rather, the most recent generation placed greater emphasis on systematic support to sustain their specialty skills while managing work-life balance. Efforts to increase women's representation should be accompanied by support structures that address both persistent and evolving needs.

神经外科中女性比例的增加可能会影响她们的职业经历和支持需求。本研究考察了日本某科室中的代际差异，在该科室，女性神经外科医生约占 30%，这一比例在日本异乎寻常地高。女性比例的增加并未减少需求和特定性别的挑战；相反，最新一代更强调在平衡工作与生活的同时，需要系统性支持来维持她们的专业技能。在努力提高女性比例的同时，应建立相应的支持体系，以满足持续存在的需求和不断变化的需求。

REF: Fujii S, Hara S, Kiyokawa J, Kuroha M, Sumita K, Maehara T. Differences Among Generations of Women Neurosurgeons in a Department Surpassing the Gender Tipping Point. World Neurosurg. Published online November 3, 2025. doi:10.1016/j.wneu.2025.124623 PMID: 41192506

Augmented and Virtual Reality in Open Neurovascular Surgery: A Systematic Review of the Literature

开放式神经血管外科手术中的增强现实和虚拟现实技术：一项系统文献综述

Innovative technologies such as augmented reality (AR) and virtual reality (VR) are increasingly utilized for teaching, training, and surgical planning in neurosurgery. This systematic review provides an overview of the literature on the application of AR and VR specifically in open neurovascular surgery. AR and VR are promising adjuncts for teaching, training, and planning in open neurovascular surgery, with the most consistent signals in aneurysm planning. However, evidence remains heterogeneous and largely based on surrogate or subjective measures. Comparative studies using standardized clinical endpoints are necessary to define the routine clinical impact and support broader implementation in clinical practice.

增强现实（AR）和虚拟现实（VR）等创新技术越来越多地用于神经外科的教学、培训和手术规划。这篇系统综述概述了AR和VR在开放性神经血管手术中应用的相关文献。AR和VR是开放性神经血管手术教学、培训和规划的有前景的辅助手段，在动脉瘤规划方面的效果最为显著。然而，相关证据仍然参差不齐，且大多基于替代指标或主观评估。需要开展使用标准化临床终点的对照研究，以明确其常规临床影响，并支持其在临床实践中的更广泛应用。

REF: Saemann A, de Wilde D, Guzman R, Soleman J, Greuter L. Augmented and Virtual Reality in Open Neurovascular Surgery: A Systematic Review of the Literature. World Neurosurg. Published online November 6, 2025. doi:10.1016/j.wneu.2025.124632 PMID: 41205868

Callosotomy Outcomes: A Meta-Analysis

胼胝体切开术的疗效：一项荟萃分析

Corpus callosotomy is a palliative surgical intervention for pediatric intractable epilepsy, yet the comparative efficacy and complication profiles of anterior corpus callosotomy (ACC), posterior corpus callosotomy (PCC), and total corpus callosotomy (TCC) remain unclear. This meta-analysis evaluates seizure reduction and postoperative complications across these approaches. While all corpus callosotomy approaches reduce seizures similarly, PCC may offer superior drop attack control and lower DCS risk. TCC is associated with the highest DCS incidence. These findings underscore the need for standardized reporting to further elucidate potential variation in postoperative complications across corpus callosotomy approaches. Data on seizure reduction indicate surgeon preference in the interim.

胼胝体切开术是治疗儿童难治性癫痫的一种姑息性手术干预手段，然而，前胼胝体切开术（ACC）、后胼胝体切开术（PCC）和全胼胝体切开术（TCC）的相对疗效和并发症情况仍不明确。这项荟萃分析评估了这些手术方法在减少癫痫发作和术后并发症方面的情况。虽然所有胼胝体切开术方法在减少癫痫发作方面效果相似，但PCC可能在控制跌倒发作方面更具优势，且降低分离综合征（DCS）风险的效果更好。TCC与最高的DCS发生率相关。这些发现强调了需要进行标准化报告，以进一步阐明不同胼胝体切开术方法术后并发症的潜在差异。关于癫痫发作减少的数据表明，在此期间手术方式的选择可能取决于外科医生的偏好。

REF: Blihar D, Assi J, Breininger L, et al. Callosotomy Outcomes: A Meta-Analysis. World Neurosurg. Published online November 3, 2025. doi:10.1016/j.wneu.2025.124605 PMID: 41192505

Complex Spine Surgery in the Setting of Alpha-Gal Syndrome

α-半乳糖综合征背景下的复杂脊柱手术

Alpha-gal syndrome (AGS) is an immunoglobulin E -mediated allergy to the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal) that can trigger delayed anaphylaxis after exposure to nonprimate mammal products. Although its perioperative impact is well described in cardiac surgery, guidance for spine surgery is lacking. We investigated common hemostatic agents, dural substitutes, and grafts used in spine surgery at our institution located in Suffolk County, NY, which has the highest prevalence of AGS nationwide, and classified them as safe or unsafe based on the presence or absence of mammal products. Additionally, we discuss anesthetic considerations and the workup and pretreatment of AGS patients, as well as present an illustrative case of an AGS patient who experienced intraoperative anaphylaxis during a deformity correction surgery. A review of 25 commonly used agents showed that 64% were potentially unsafe for AGS patients. In contrast, plant-based polysaccharide powders, oxidized cellulose, human recombinant thrombin, and synthetic dural sealants are safe alternatives. AGS poses unique risks in spine surgery because the use of many hemostatic, graft, and dural-repair agents that contain mammal products is commonplace. A structured pathway that includes preoperative allergy consultation, α-gal immunoglobulin E testing, premedication, pharmacy-verified product lists, and real-time team communication can prevent life-threatening reactions. As AGS incidence rises, spine surgeons must recognize high-risk patients, substitute for safe biomaterials when able, and coordinate perioperative care to avoid anaphylaxis.

α-半乳糖综合征（AGS）是一种由免疫球蛋白E介导的对哺乳动物寡糖半乳糖-α-1,3-半乳糖（α-半乳糖）的过敏反应，接触非灵长类哺乳动物制品后可引发迟发性过敏反应。虽然其在心脏手术中的围手术期影响已有详细描述，但脊柱手术方面的指导尚缺。我们对位于纽约萨福克县（全国AGS患病率最高的地区）的本机构脊柱手术中常用的止血剂、硬脑膜替代品和移植物进行了调查，并根据是否含有哺乳动物制品将其分为安全和不安全两类。此外，我们还讨论了AGS患者的麻醉注意事项、检查和预处理，并介绍了一例在畸形矫正手术中发生术中过敏反应的AGS患者案例。对25种常用制剂的审查显示，64%对AGS患者有潜在危险。相比之下，植物多糖粉末、氧化纤维素、人重组凝血酶和合成硬脑膜密封剂是安全的替代品。由于脊柱手术中常用许多含哺乳动物制品的止血剂、移植物和硬脑膜修复剂，AGS在脊柱手术中存在独特风险。一个结构化的流程，包括术前过敏咨询、α-半乳糖免疫球蛋白E检测、术前用药、药房核实的产品清单以及团队实时沟通，可预防危及生命的反应。随着AGS发病率上升，脊柱外科医生必须识别高危患者，尽可能使用安全生物材料替代，并协调围手术期护理以避免过敏反应。

REF: Razzaq BW, Passman JN, DiMaria S, et al. Complex Spine Surgery in the Setting of Alpha-Gal Syndrome. World Neurosurg. Published online November 6, 2025. doi:10.1016/j.wneu.2025.124634 PMID: 41205864

Artificial Intelligence Models as Predictors of Poor Outcomes in Transsphenoidal Pituitary Tumor Surgeries: A Diagnostic Test Accuracy Review

人工智能模型作为经蝶垂体肿瘤手术不良结局的预测因子：一项诊断测试准确性综述

Pituitary tumors are the second most common type of brain tumor in adults, accounting for 17% of adult tumors. Over the years, endoscopic transsphenoidal surgery has become widely used in the treatment of pituitary tumors. With the recent advancement of Artificial Intelligence (AI) and Machine Learning (ML) technologies to generate clinical predictions that aid in diagnostic medicine, they have stood out as preoperative planning tools with the aim of predicting clinical outcomes, including postoperative ones. This article aims to evaluate the applicability of ML models in predicting postoperative complications in the postoperative period of endoscopic transsphenoidal surgeries for pituitary lesions. Following the PRISMA protocol. Articles were included if they had an observational or randomized design, reported on patients with skull base tumors (pituitary adenomas) who underwent transsphenoidal surgery, used machine learning-based prediction for major outcomes after surgery, and reported at least one relevant outcome. Eight articles were included in this analysis. The 2 outcomes analyzed were diabetes insipidus and cerebrospinal fluid (CSF) leak. The models studied were Random Forest, Neural Network, Logistic Regression, and Decision Tree, and they presented sensitivity, specificity, and an average area under the curve greater than 0.7. The best model was Random Forest with an average area under the curve of 0.832, followed by the Neural Network model, which had an average area under the curve of 0.8. In the studies we identified, the best machine learning methodology for identifying patients at risk of Diabetes Insipidus and cerebrospinal fluid leak was Random Forest.

垂体瘤是成人中第二常见的脑肿瘤类型，占成人肿瘤的17%。多年来，内镜经蝶窦手术已广泛应用于垂体瘤的治疗。近年来，人工智能（AI）和机器学习（ML）技术不断发展，可用于生成辅助诊断医学的临床预测，这些技术作为术前规划工具崭露头角，旨在预测临床结局，包括术后结局。本文旨在评估机器学习模型在内镜经蝶窦手术治疗垂体病变术后预测术后并发症方面的适用性。遵循PRISMA方案。若文章采用观察性或随机设计，报道了接受经蝶窦手术的颅底肿瘤（垂体腺瘤）患者，使用基于机器学习的方法对术后主要结局进行预测，并至少报道了一项相关结局，则纳入研究。本分析共纳入8篇文章。分析的两项结局为尿崩症和脑脊液（CSF）漏。所研究的模型包括随机森林、神经网络、逻辑回归和决策树，这些模型的灵敏度、特异度以及平均曲线下面积均大于0.7。最佳模型为随机森林，平均曲线下面积为0.832，其次是神经网络模型，平均曲线下面积为0.8。在我们所确定的研究中，识别有尿崩症和脑脊液漏风险患者的最佳机器学习方法是随机森林。

REF: Bacelar Ferreira V, Batista da Hora DA, Vargas de Mendonça KL, et al. Artificial Intelligence Models as Predictors of Poor Outcomes in Transsphenoidal Pituitary Tumor Surgeries: A Diagnostic Test Accuracy Review. World Neurosurg. Published online November 13, 2025. doi:10.1016/j.wneu.2025.124640 PMID: 41241048

Altered Local Spontaneous Brain Activity in Cervical Spondylotic Myelopathy: A Meta-Analysis

脊髓型颈椎病患者局部自发脑活动改变的荟萃分析

This meta-analysis aimed to identify consistent alterations in local spontaneous brain activity in patients with cervical spondylotic myelopathy (CSM) by synthesizing findings from resting-state functional magnetic resonance imaging studies and to explore potential neural mechanisms underlying this condition. This meta-analysis confirms consistent patterns of altered local spontaneous brain function in specific regions among patients with CSM, which potentially correlate with their clinical symptoms. These findings provide valuable insights into the pathophysiology of CSM, thereby informing future clinical research and the development of novel therapeutic strategies.

本荟萃分析旨在综合静息态功能磁共振成像研究的结果，确定脊髓型颈椎病（CSM）患者局部自发性脑活动的一致性改变，并探索该疾病潜在的神经机制。本荟萃分析证实了CSM患者特定脑区局部自发性脑功能存在一致的改变模式，这些改变可能与他们的临床症状相关。这些发现为理解CSM的病理生理学提供了有价值的见解，从而为未来的临床研究和新治疗策略的开发提供参考。

REF: Zhang R, Yuan W, Yang Q, et al. Altered Local Spontaneous Brain Activity in Cervical Spondylotic Myelopathy: A Meta-Analysis. World Neurosurg. Published online November 7, 2025. doi:10.1016/j.wneu.2025.124599 PMID: 41205862

Surgical Approaches to the Hypothalamus: A Systematic Review of Anatomical Corridors and Postoperative Outcomes

下丘脑的手术入路：解剖通道及术后结局的系统评价

The hypothalamus is a vital neuroanatomical structure involved in endocrine, autonomic, and homeostatic regulation. Its deep location near critical neural and vascular structures makes surgical access complex. This review aims to evaluate and compare these surgical approaches, focusing on anatomical access and their clinical and functional outcomes. Endoscopic approaches showed the highest clinical improvement, while TC routes offered the safest profile. Skull base approaches, such as orbitozygomatic, were associated with higher morbidity and should be used selectively.

下丘脑是一个重要的神经解剖结构，参与内分泌、自主神经和体内稳态调节。它位置较深，靠近重要的神经和血管结构，这使得手术入路变得复杂。本综述旨在评估和比较这些手术入路，重点关注解剖学入路及其临床和功能结局。内镜入路显示出最高的临床改善效果，而经胼胝体入路的安全性最佳。颅底入路，如眶颧入路，与较高的发病率相关，应选择性使用。

REF: Al-Juboori AA, Badran SA, Shahadha AA, Alsamok AS, Al-Taie RH, Ismail M. Surgical Approaches to the Hypothalamus: A Systematic Review of Anatomical Corridors and Postoperative Outcomes. World Neurosurg. Published online November 21, 2025. doi:10.1016/j.wneu.2025.124648 PMID: 41276078

Dual Left-Sided Posterior Inferior Cerebellar Artery Aneurysms Presenting with Subarachnoid Hemorrhage, Intraventricular Hemorrhage and Hydrocephalus: A Rare Case Report and Systematic Review

以蛛网膜下腔出血、脑室内出血和脑积水为表现的左侧小脑后下动脉双发动脉瘤：1例罕见病例报告及系统评价

Aneurysms of the posterior inferior cerebellar artery (PICA) are among the least common intracranial aneurysms, accounting for approximately 0.5% to 3% of cases. Those arising distally are even rarer and are known to rupture at smaller sizes. Their rupture frequently results in subarachnoid hemorrhage, intraventricular hemorrhage (IVH), and hydrocephalus, posing considerable treatment challenges due to the surrounding vital brain structures. Although distal PICA aneurysms are uncommon, prompt diagnosis and individualized surgical intervention can lead to favorable outcomes, especially in cases involving multiple aneurysms and hemorrhagic complications. This paper provides a rare case and presents the first systematic review of distal PICA aneurysms.

小脑后下动脉（PICA）动脉瘤是最罕见的颅内动脉瘤之一，约占病例的0.5%至3%。起源于远端的PICA动脉瘤更为罕见，且已知其在尺寸较小时就会破裂。它们破裂常导致蛛网膜下腔出血、脑室内出血（IVH）和脑积水，由于周围有重要的脑结构，给治疗带来了相当大的挑战。尽管远端PICA动脉瘤并不常见，但及时诊断和个体化的手术干预可带来良好的预后，特别是在涉及多个动脉瘤和出血性并发症的病例中。本文报告了一例罕见病例，并首次对远端PICA动脉瘤进行了系统综述。

REF: Ibdah A, Hulliel AF, Abuhashem OH, Almomani AA. Dual Left-Sided Posterior Inferior Cerebellar Artery Aneurysms Presenting with Subarachnoid Hemorrhage, Intraventricular Hemorrhage and Hydrocephalus: A Rare Case Report and Systematic Review. World Neurosurg. Published online November 22, 2025. doi:10.1016/j.wneu.2025.124664 PMID: 41285349

Arcuate Foramen of the Atlas Vertebra and its Correlation with Clinical Implications in the Craniocervical Region: A Systematic Review and Meta-analysis

寰椎弓状孔及其与颅颈区临床意义的相关性：系统评价与荟萃分析

The arcuate foramen (FA) can present in various forms: it may be complete, incomplete, unilateral, or bilateral. This anatomical feature is relatively common, occurring in approximately 3-15% of the population, with a higher prevalence in females. This review emphasized the importance of considering the vertebral artery (VA) in the preoperative assessment of surgical procedures involving the placement of screws in the cervical spine, such as treatment for atlantoaxial instability. Lack of knowledge regarding the anatomy of this region can lead to complications, such as vertebral artery injury and, consequently, impaired blood flow to the brain, cerebellum, and brainstem. Therefore, the authors recommend further research on this topic, particularly in other patient populations and in collaboration with other disciplines, to advance our understanding of the vertebral artery and to provide valuable tools for healthcare professionals and researchers, thus contributing to improved patient care.

弓状孔（FA）可呈现多种形态：它可能是完整的、不完整的、单侧的或双侧的。这一解剖特征相对常见，约3% - 15%的人群存在该特征，女性的患病率更高。本综述强调了在涉及颈椎螺钉置入的手术（如寰枢椎不稳的治疗）的术前评估中考虑椎动脉（VA）的重要性。对该区域解剖结构缺乏了解可能会导致并发症，如椎动脉损伤，进而影响大脑、小脑和脑干的血液供应。因此，作者建议就这一主题开展更多研究，特别是针对其他患者群体并与其他学科合作进行研究，以增进我们对椎动脉的了解，并为医疗专业人员和研究人员提供有价值的工具，从而改善患者的治疗效果。

REF: Valenzuela-Fuenzalida JJ, Cornejo-Peña J, Martinez-Cid J, et al. Arcuate foramen of the atlas vertebra and its correlation with clinical implications in the craniocervical region: A systematic review and meta-analysis. World Neurosurg. Published online November 24, 2025. doi:10.1016/j.wneu.2025.124652 PMID: 41297626