INA. Neurocirugia en Valencia

Acta Neurochirurgica (2024) 166:351 Microvascular decompression (MVD) is a well-established and effective treatment for primary trigeminal neuralgia (TN). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflict and minimizes the damages of brain retraction during MVD. Objectives To preliminarily evaluate the surgical safety and efficacy of fully endoscopic microvascular decompression (EMVD) for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope....

Standard operating procedure and surgical technique innovation in fully endoscopic microvascular decompression for trigeminal neuralgia Endoscopic ,Microvascular decompression,Trigeminal neuralgia,Standard operating procedure,Surgical technique

Neurosurgery 95:651–659, 2024 Posterior fossa ependymomas (PFEs) are rare brain tumors classified as PF-EPN-A (PFA) and PF-EPN-B (PFB) subgroups. The study aimed to evaluate the prognosis and survival outcomes in PFEs, with a focus on the impact of molecular subgroups. METHODS: A retrospective study was conducted on 412 patients with PFEs. Kaplan–Meier survival analyses were conducted to evaluate the overall survival (OS) and progression-free survival....

Impact of Molecular Subgroups on Prognosis and Survival Outcomes in Posterior Fossa Ependymomas: A Retrospective Study of 412 Cases Cranial fossa, Posterior, Ependymoma, Molecular subgroups, Prognosis, Survival analysis

J Neurosurg Spine 41:353–359, 2024 Microsurgical decompression for patients with symptomatic lumbar spinal stenosis (LSS) has demonstrated long-term improvement concerning pain and function. Nonetheless, a considerable proportion of these patients do not experience satisfactory alleviation of symptoms. Previous studies have not found a direct influence of single sagittal parameters on patient outcomes. However, recent research indicates that a composite of parameters, presented in specific sagittal profile types (SPTs) that were defined by Roussouly and colleagues, may affect these outcomes....

Influence of the sagittal spinal profile type on the long-term outcome of patients with symptomatic lumbar spinal stenosis after microsurgical decompression sagittal profile, lumbar spinal stenosis, microsurgical decompression, long-term follow-up, degenerative

Neurosurgery 95:627–633, 2024 Cervical disk arthroplasty (CDA) offers the advantage of motion preservation in the treatment of focal cervical pathology. At present, implant sizing is performed using subjective tactile feedback and imaging of trial cages. This study aims to construct interpretable machine learning (IML) models to accurately predict postoperative range of motion (ROM) and identify the optimal implant sizes that maximize ROM in patients undergoing CDA....

Optimal Implant Sizing Using Machine Learning Is Associated With Increased Range of Motion After Cervical Disk Arthroplasty Cervical disk arthroplasty, Cervical disk replacement, Implant sizing, Machine learning

J Neurosurg 141:695–701, 2024 Intraoperative MRI (iMRI) is the gold-standard technique for intraoperative evaluation of the extent of resection in brain tumor surgery. Unfortunately, it is currently available at only a few neurosurgical centers. A commercially available software, Virtual iMRI Cranial, provides an elastic fusion between preoperative MRI and intraoperative CT (iCT). The aim of this study was to evaluate the accuracy of this software in determining the presence of residual tumor....

Evaluation of the extent of resection of intracranial tumors with virtual intraoperative MRI extent of resection,brain tumor, glioma, image-guided surgery, maximal safe resection, virtual intraoperative MRI

Neurosurgery 95:669–675, 2024 Microsurgical resection is the only curative intervention for symptomatic brainstem cavernous malformations (BSCMs), but the management of these lesions in older adults (≥65 years) is not well described. This study sought to address this gap by examining the safety and efficacy of BSCM resection in a cohort of older adults. METHODS: Records of patients who underwent BSCM resection over a 30-year period were reviewed retrospectively....

Microsurgical Resection of Brainstem Cavernous Malformations in Older Adults: A Multicenter, 30-Year Experience 80 years, Aged, Brainstem, Cavernoma elderly, Cavernous malformation, Microsurgery

Operative Neurosurgery 27:158–173, 2024 Biportal endoscopic decompression is a minimally invasive surgical technique for lumbar spinal stenosis (LSS). This meta-analysis aimed to evaluate the efficacy and safety of biportal endoscopic decompression through both a single-arm analysis and a comparative analysis. METHODS: A comprehensive literature search was conducted to identify eligible studies reporting the outcomes of biportal endoscopic decompression for LSS. Single-arm analysis and comparisons with microscopic and uniportal endoscopic decompression were performed....

Efficacy of Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Meta-Analysis With Single-Arm Analysis and Comparative Analysis With Microscopic Decompression and Uniportal Endoscopic Decompression Biportal endoscopic decompression, Biportal endoscopic spinal surgery, Uniportal endoscopic surgery, Microscopic surgery, Lumbar spinal stenosis, Unilateral biportal endoscopic

Neurosurgery 95:469–479, 2024 Hydrocephalus is characterized by progressive enlargement of cerebral ventricles, resulting in impaired microvasculature and cerebral hypoperfusion. This study aimed to demonstrate the microvascular changes in hydrocephalic rats and the effects of cerebrospinal fluid (CSF) release on cerebral blood flow (CBF). METHODS: On postnatal day 21 (P21), male Wistar rats were intracisternally injected with either a kaolin suspension or saline....

Microcirculatory Impairment and Cerebral Injury in Hydrocephalus and the Effects of Cerebrospinal Fluid Diversion Hydrocephalus, Microvasculature, Cerebral blood flow, CSF diversion, Oxidative stress

Acta Neurochirurgica (2024) 166:351 Microvascular decompression (MVD) is a well-established and effective treatment for primary trigeminal neuralgia (TN). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflict and minimizes the damages of brain retraction during MVD. Objectives To preliminarily evaluate the surgical safety and efficacy of fully endoscopic microvascular decompression (EMVD) for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope....

Standard operating procedure and surgical technique innovation in fully endoscopic microvascular decompression for trigeminal neuralgia: technical note on 189 patients Endoscopic ,Microvascular decompression ,Trigeminal neuralgia,Standard operating procedure,Surgical technique

Neurosurgery 95:259–274, 2024 Persistent neuropathic pain after brachial plexus avulsion (BPA) is common and generally nonresponsive to medical management. Dorsal root entry zone (DREZ) lesioning is the last resort for pain management in patients with BPA. This study aims to investigate and compare the outcomes and complications of DREZ procedures. METHODS: A systematic literature search was conducted to identify all related studies....

The Safety and Efficacy of Dorsal Root Entry Zone Lesioning for Pain Management in Patients With Brachial Plexus Avulsion Dorsal root entry zone lesioning, DREZ, Brachial plexus avulsion, Microsurgical DREZotomy, Radiofrequency lesioning, Neuropathic pain, Pain

J Neurosurg 141:491–499, 2024 Medical illustration played a crucial, yet often overlooked, role in the evolution of pituitary surgery. From the late 1800s to the present, many preeminent surgeons, in partnership with their surgical illustrator collaborators, developed and then shifted the paradigm of pituitary surgery, from an open procedure with high mortality and morbidity, to an endonasal approach with high success rates that is widely utilized today....

The role of medical illustration in the evolution of transsphenoidal pituitary surgery medical illustration, transsphenoidal, pituitary surgery,history, Harvey Cushing, Max Brödel, otolaryngology

The Spine Journal 24 (2024) 1451−1458 Lateral approaches for lumbar interbody fusion (LIF) allow for access to the lumbar spine and disc space by passing through a retroperitoneal corridor either preor trans-psoas. A contraindication for this approach is the presence of retroperitoneal scarring that may occur from prior surgical intervention in the retroperitoneal space or from inflammatory conditions with fibrotic changes and pose challenges for the mobilization and visualization needed in this approach....

A retrospective analysis of perioperative complications of lateral approach lumbar interbody fusion in patients with prior abdominal surgery or a history of colonic inflammatory disease The Spine Journal 24 (2024) 1451−1458 Lateral approaches for lumbar interbody fusion (LIF) allow for access to the lumbar spine and disc space by passing through a retroperitoneal corridor either preor trans-psoas. A contraindication for this approach is the presence of retroperitoneal scarring th...

Acta Neurochirurgica (2024) 166:317 Addressing the challenges that come with identifying and delineating brain tumours in intraoperative ultrasound. Our goal is to both qualitatively and quantitatively assess the interobserver variation, amongst experienced neuro-oncological intraoperative ultrasound users (neurosurgeons and neuroradiologists), in detecting and segmenting brain tumours on ultrasound. We then propose that, due to the inherent challenges of this task, annotation by localisation of the entire tumour mass with a bounding box could serve as an ancillary solution to segmentation for clinical training, encompassing margin uncertainty and the curation of large datasets....

Challenges with segmenting intraoperative ultrasound for brain tumours Acta Neurochirurgica (2024) 166:317 Addressing the challenges that come with identifying and delineating brain tumours in intraoperative ultrasound. Our goal is to both qualitatively and quantitatively assess the interobserver variation, amongst experienced neuro-oncological intraoperative ultrasoun...

Acta Neurochirurgica (2024) 166:337 Intraoperative ultrasound (IOUS) is a profitable tool for neurosurgical procedures’ assistance, especially in neuro-oncology. It is a rapid, ergonomic and reproducible technique. However, its known handicap is a steep learning curve for neurosurgeons. Here, we describe an interesting postoperative analysis that provides extra feedback after surgery, accelerating the learning process. Method We conducted a descriptive retrospective unicenter study including patients operated from intra-axial brain tumors using neuronavigation (Curve, Brainlab) and IOUS (BK-5000, BK medical) guidance....

Intraoperative ultrasound and magnetic resonance comparative analysis in brain tumor surgery: a valuable tool to flatten ultrasound’s learning curve Intraoperative ultrasound ,3D navigated ultrasound,Intraoperative imaging,Brain tumor surgery

J Neurosurg 141:394–405, 2024 Anterior capsulotomy (AC) is a therapeutic option for patients with severe, treatment-resistant obsessive-compulsive disorder (OCD). The procedure can be performed via multiple techniques, with stereotactic radiosurgery (SRS) gaining popularity because of its minimally invasive nature. The risk-benefit profile of AC performed specifically with SRS has not been well characterized. Therefore, the primary objective of this study was to characterize outcomes following stereotactic radiosurgical AC in OCD patients....

Benefits of stereotactic radiosurgical anterior capsulotomy for obsessive-compulsive disorder: a meta-analysis stereotactic radiosurgery, anterior capsulotomy, obsessive,compulsive disorder, functional neurosurgery

Operative Neurosurgery 27:322–328, 2024 Adjacent segment disease is a relatively common late complication after lumbar fusion. If symptomatic, certain patients require fusion of the degenerated adjacent segment. Currently, there are no posterior completely minimally invasive techniques described for fusion of the adjacent segment above or below a previous fusion. We describe here a novel minimally invasive technique for both implant removal (MIS-IR) and adjacent level transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar stenosis....

Completely Minimally Invasive Implant Removal and Transforaminal Lumbar Interbody Fusion for Adjacent Segment Disease: Case Series and Operative Video MIS, TLIF, Implant removal, ASD, Hardware removal

J Neurosurg 141:529–539, 2024 The anatomy and function of the brainstem have fascinated scientists for centuries; however, the brainstem remains one of the least studied regions of the human brain. As the authors delved into studying this structure, they observed a growing tendency to forget or neglect previously identified structures. The aim of this study was to describe two such structures: the transverse peduncular tract, also known as the Gudden tract, and the taenia pontis....

Neglected tracts of the brainstem: transverse peduncular tract of Gudden and taenia pontis brainstem,Gudden tract,microscopic fiber dissection,microsurgical anatomy, taenia pontis, transverse peduncular tract

J Neurosurg Spine 41:188–198, 2024 The role of interbodies in lumbar arthrodesis has been insufficiently supported by evidence, impacting clinical decision-making and occasionally insurance coverage. This study aimed to compare clinical and radiological outcomes between lumbar arthrodesis with a synthetic interbody spacer (cage) versus structural bone graft alone (autograft or allograft) in patients with degenerative spine disease. METHODS A systematic review of the literature was performed to identify studies directly comparing outcomes of lumbar interbody arthrodesis with and without interbody cage use....

Interbody cages versus structural bone grafts in lumbar arthrodesis: a systematic review and meta-analysis lumbar arthrodesis, interbody cage,allograft, autograft; back pain,intervertebral disc height, fusion

J Neurosurg 141:540–554, 2024 The ventral amygdalofugal pathway (VAFP) provides afferent and efferent connections to the amygdala and spans along some of the frequently traversed intra-axial surgical corridors as a dominant fiber bundle. This study aimed to reveal the frequently overlooked VAFP fibers by examining their courses and connections to the basal forebrain, septal region, hypothalamus, thalamus, tegmentum, and brainstem....

Ventral amygdalofugal pathway as an integrated surgically important network J Neurosurg 141:540–554, 2024 The ventral amygdalofugal pathway (VAFP) provides afferent and efferent connections to the amygdala and spans along some of the frequently traversed intra-axial surgical corridors as a dominant fiber bundle. This study aimed to reveal the frequently overlooked VAFP fi...

J Neurosurg 141:570–580, 2024 The medial forebrain bundle (MFB) is a novel promising deep brain stimulation (DBS) target in severe affective disorders that courses through the subthalamic region according to tractography studies. Its potential therapeutic role arose in connection with the development of hypomania during stimulation of the subthalamic nucleus (STN) in Parkinson’s disease, offering an alternative explanation for the occurrence of this side effect....

Topographical anatomy of the subthalamic region with special interest in the human medial forebrain bundle anatomy Deep Brain Stimulation Fiber dissection functional neurosurgery Medial forebrain bundle subthalamus tractography

Acta Neurochirurgica (2024) 166:319 Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach....

Variations of the extrapsoas course of the lumbar plexus with implications for the lateral transpsoas approach to the lumbar spine: a cadaveric study Genitofemoral nerve ,Femoral nerve ,Iliohypogastric nerve ,Ilioinguinal nerve ,Lateral transpsoas approach,Lateral femoral cutaneous nerve ,Lumbar plexus ,Obturator nerve

J Neurosurg 140:1777–1784, 2024 Operative interposition of material between the trigeminal nerve and offending artery for surgical treatment of drug-resistant trigeminal neuralgia (TGN), following the Jannetta method, has been proven to be the most successful invasive treatment. Reexplorations of patients with recurrence of TGN have revealed nerve root irritations and scarring due to interposed material. To prevent these complications, modifications of microvascular decompression (MVD) aim at transposing the vessel away from the trigeminal nerve, without attachment of additional material to the nerve root....

Transposition versus interposition method in microvascular decompression for trigeminal neuralgia microvascular decompression, transposition, interposition, trigeminal neuralgia, sling technique, surgical technique

J Neurosurg 141:461–473, 2024 Recent studies have suggested that biologically effective dose (BED) is an important correlate of pain relief and sensory dysfunction after Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The goal of this study was to determine if BED is superior to prescription dose in predicting outcomes in TN patients undergoing GKRS as a first procedure. METHODS This was a retrospective study of 871 patients with type 1 TN from 13 GKRS centers....

The relevance of biologically effective dose for pain relief and sensory dysfunction after Gamma Knife radiosurgery for trigeminal neuralgia: an 871-patient multicenter study trigeminal neuralgia, Gamma Knife radiosurgery, biologically effective dose, facial pain,facial numbness, stereotactic radiosurgery

J Neurosurg 141:291–305, 2024 Cerebral cavernous malformations (CMs) are pathological lesions that cause discrete cortical disruption with hemorrhage, and their transcortical resections can cause additional iatrogenic disruption. The analysis of microsurgically treated CMs might identify areas of “eloquent noneloquence,” or cortex that is associated with unexpected deficits when injured or transgressed. METHODS Patients from a consecutive microsurgical series of superficial cerebral CMs who presented to the authors’ center over a 13-year period were retrospectively analyzed....

Eloquent noneloquence: redefinition of cortical eloquence based on outcomes of superficial cerebral cavernous malformation resection J Neurosurg 141:291–305, 2024 Cerebral cavernous malformations (CMs) are pathological lesions that cause discrete cortical disruption with hemorrhage, and their transcortical resections can cause additional iatrogenic disruption. The analysis of microsurgically treated CMs might identify areas of ...

Neurosurgery 95:487–495, 2024 ChatGPT is a natural language processing chatbot with increasing applicability to the medical workflow. Although ChatGPT has been shown to be capable of passing the American Board of Neurological Surgery board examination, there has never been an evaluation of the chatbot in triaging and diagnosing novel neurosurgical scenarios without defined answer choices. In this study, we assess ChatGPT’s capability to determine the emergent nature of neurosurgical scenarios and make diagnoses based on information one would find in a neurosurgical consult....

A Quantitative Assessment of ChatGPT as a Neurosurgical Triaging Tool Chat-GPT, Triage, Artificial intelligence, Neurosurgery

Neurosurgery 95:284–296, 2024 With lumbar spine fusion being one of the most commonly performed spinal surgeries, investigating common complications such as adjacent segment disease (ASD) is a high priority. To the authors’ knowledge, there are no previous studies investigating the utility of the preoperative magnetic resonance imaging based vertebral bone quality (VBQ) score in predicting radiographic and surgical ASD after lumbar spine fusion....

Vertebral Bone Quality Score as a Predictor of Adjacent Segment Disease After Lumbar Interbody Fusion Adjacent segment disease, Lumbar interbody fusion, Magnetic resonance imaging, Vertebral bone quality score

J Neurosurg Spine 41:105–114, 2024 Chiari malformations (CMs) are a group of congenital or acquired disorders characterized by hindbrain overcrowding into an underdeveloped posterior cranial fossa. CM is considered largely sporadic—however, there exists growing evidence of transmissible genetic underpinnings. The purpose of this systematic review of all familial studies of CM was to investigate the existence of an inherited component and provide recommendations to manage and monitor at-risk family members....

Familial Chiari malformation: a systematic review and illustrative cases Chiari malformation, familial,genetics,congenital, inheritance,syringomyelia, congenital abnormality,surgery, posterior fossa