World neurosurgery最新文献

Objective: Deep learning enables precise hand tracking without the need for physical sensors, allowing for unsupervised quantitative evaluation of surgical motion and tasks. We quantitatively assessed the hand motions of experienced cerebrovascular neurosurgeons during simulated microvascular anastomosis using deep learning. We explored the extent to which surgical motion data differed among experts.

Methods: A deep learning detection system tracked 21 landmarks corresponding to digit joints and the wrist on each hand of 5 expert cerebrovascular neurosurgeons. Tracking data for each surgeon was analyzed over long and short time intervals to examine gross movements and micromovements, respectively. Quantitative algorithms assessed the economy and flow of motion by calculating mean movement distances from the baseline median landmark coordinates and median times between sutures, respectively.

Results: Tracking data correlated with specific surgical actions observed in microanastomosis video analysis. Economy of motion during suturing was calculated as 19, 26, 29, 27, and 28 pixels for surgeons 1, 2, 3, 4, and 5, respectively. Flow of motion during microanastomosis was 31.96, 29.40, 28.90, 7.37, and 47.21 secs for surgeons 1, 2, 3, 4, and 5, respectively.

Conclusions: Hand tracking data showed similarities among experts, with low movements from baseline, minimal excess motion, and rhythmic suturing patterns. The data revealed unique patterns related to each expert's habits and techniques. The results showed that surgical motion can be correlated with hand motion and assessed using mathematical algorithms. We also demonstrated the feasibility and potential of deep learning-based motion detection to enhance surgical training.

Objective: The aim of this study is to evaluate the efficacy of cerebral revascularization for Moyamoya disease (MMD) with extra-cranial internal carotid artery occlusion (ICAO).

Methods: This study retrospectively analyzed 37 patients diagnosed with MMD with extra-cranial ICAO who underwent cerebral revascularization surgery. We conducted propensity score matching for MMD patients without extra-cranial ICAO from database of 932 MMD patients. Outcome data, recurrent strokes and modified Rankin Scale (mRS) were collected during follow-up.

Results: A total of 37 MMD patients with extra-cranial ICAO were included in the study. The average follow-up time of MMD patients with extra-cranial ICAO included in the study was 74 months. During the follow-up period, there were 15 hemispheres recurred stroke events. All hemispheres underwent surgery, and the follow-up mRS score was significantly reduced (P <0.001). Kaplan-Meier analysis showed no significant statistical difference in stroke events between the indirect bypass (IB), direct bypass (DB), and combined bypass (CB) groups (P = 0.131). After propensity matching, 48 hemispheres of MMD patients without extra-cranial ICAO were identified from a review of 932 MMD patients. There was no significant statistical difference in stroke events between the MMD patients with extra-cranial ICAO group and the MMD group (P = 0.271).

Conclusions: Cerebral revascularization can prevent recurrent ischemic and hemorrhagic stroke events for MMD patients with extra-cranial ICAO. There was no difference on long-term clinical outcomes after CB, DB, and IB surgery. The cerebral revascularization has similar effect on the MMD patients with extra-cranial ICAO and MMD patients without.

Objectives: To verify the feasibility and to discuss advantages and disadvantages of a piezoelectric orbitotomy (PO) during Superior Eyelid Endoscopic Transorbital Approach (SETOA).

Methods: Five adult specimens underwent exoscopic/endoscopic SETOA to middle cranial fossa. The surgical corridor was created via piezoelectric orbitotomy by performing three selective and safe micrometric bone cuts providing a one-piece trapezoid bone flap which was repositioned and secured at the end of procedure. A 3D scan of the bone flap allowed us to reconstruct a 3D model and calculate its volume. An illustrative case demonstrating the application of this novel technique was also presented.

Results: Anatomical-morphometric quantitative analysis showed a mean bony-volume gain of 1,574.26 mm³ by using PO. PO yielded concrete surgical advantages and theoretical benefits in terms of functional and esthetic outcomes. All osteotomies were micrometric clear-cut and precise, resulting in a very thin bony gap; a complete sparing of soft tissues and neurovascular structures in- and around the orbit was observed. Lateral orbital wall reconstruction by replacing the bone flap aims to mitigate the risk of enophthalmos, proptosis, CSF leakage, pseudomeningocele and pulsatile headache, which represent significant challenges in the relevant literature.

Conclusion: PO may offer a viable, selective, effective, safe alternative to high-speed drilling during SETOA, especially for patients affected by intra-axial pathologies in which a watertight closure is mandatory. This procedure could prevent/decrease the risk of some of the main postoperative complications associated to the standard SETOA, resulting potentially in better functional and esthetic outcome.

Spinal injuries occur in 3% of all trauma patients, most commonly in males, and often due to high-velocity impact followed by abrupt deceleration. The most affected region following spinal trauma is the thoracolumbar junction due to the anterior center of gravity at T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus non-operative management of traumatic injuries at this site. However, the current classifications do not consider the segmental alignment of the spine - an aspect which has been shown to improve quality of life in non-traumatic post-operative spinal patients. Ignoring this aspect of thoracolumbar management often contributes to the development of post-traumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the injured vertebra's level, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to demonstrate the importance of segmental sagittal alignment and the vertebral level on patient outcomes.

Objective: To analyze the complications and long-term follow-up results of endovascular treatment for ruptured intracranial posterior circulation aneurysms and identify outcome predictors.

Methods: A total of 194 patients with ruptured intracranial posterior circulation aneurysms treated at our center between January 2014 and June 2023 were included in this retrospective analysis. Factors influencing complications during hospitalization and clinical and angiographic outcomes were analyzed.

Results: Complications occurred in 57 patients (29.4%) during hospitalization. The median clinical follow-up time was 46.5 (IQR 26.0-65.3) months, with favorable outcomes observed in 81.4% (158/194) and unfavorable outcomes in 18.5% (36/194) of cases, resulting in an overall mortality rate of 11.9% (23/194). The overall 1-year and 5-year complication-free survival rates were 76.4% and 70.7%, respectively. The overall 1-year and 5-year overall survival rates were 89.5% and 85.4%, respectively. Multifactorial analysis revealed that involvement of the basilar artery (p=0.032) and perioperative external ventricular drainage (p<0.001) were independent risk factors for complications during hospitalization, while advanced age (p=0.030), poor WFNS grade (p=0.003), and use of closed cell design laser cut stents (p=0.041) were independent risk factors for unfavorable outcomes during follow-up. Among the survivors, angiography follow-up was available for 139 patients, with a follow-up rate of 81.2% (139/171) and a median follow-up time of 8 months (IQR 6-12). During this period, 9 patients experienced aneurysm recanalization, and the complete occlusion rate was 85.6%.

Conclusion: Endovascular treatment is feasible and effective for treating ruptured intracranial aneurysms; however, there are still risks of complications and unfavorable clinical outcomes. The involvement of the BA trunk increases the risk of complications, and the use of closed cell design laser cut stents is associated with unfavorable outcomes. Clinicians should be cautious to avoid the risk factors when treating ruptured posterior circulation aneurysms and strive to minimize the occurrence of complications and unfavorable clinical outcomes.

Objective: 3D printing technology presents a promising avenue for the development of affordable neurosurgical simulation models, addressing many challenges related to the use of cadavers, animal models, and direct patient engagement. The aim of this study is to introduce and evaluate a new high-fidelity neurosurgical simulation model targeted for both burr hole and craniotomy procedures.

Methods: Twelve different 3D printed skull models were manufactured using five different materials (PEEK, White Resin, Rigid10K, Bone^STN, Skull^STN) from three different 3D print processes (Fused Filament Fabrication, Stereolithography, Material Jetting). Six consultant neurosurgeons conducted burr holes and craniotomies on each sample while blinded to these manufacturing details. Participants completed a survey based on the qualities of the models, including; mechanical performance, visual appearance, interior feeling, exterior feeling, sound, overall quality, and recommendations for training purposes based on their prior experience completing these procedures on human skulls.

Results: This study found that the multi-material stereolithography printed models consisting of White Resin for the outer table and Rigid 10K for the diploe and inner table were successful in replicating a human skull for burr hole and craniotomy simulation. This was followed by the porous General Bone^STN preset material on a Stratasys J750 Digital Anatomy Printer.

Conclusions: The findings indicate that widely accessible and economical desktop stereolithography 3D printers can provide an effective solution in neurosurgical training, thus promoting their integration in hospitals.

Importance: Disparities in access and delivery of care have been shown to disproportionately affect certain racial groups. Studies have been conducted to assess these disparities within the spinal metastasis population, but the extent of their effects in the setting of other socioeconomic measures remains unclear.

Objective: The purpose of this study was to perform a systematic review to understand the effect of racial disparities on outcomes in patients with metastatic spine disease.

Evidence review: The PRISMA guidelines were followed, where a comprehensive online search was performed using Pubmed, Medline, Web of Science, Cochrane, Embase, and Science Direct using MeSH terms related to metastatic spine tumor surgery and racial disparities up to February 2023. Two independent reviewers screened and analyzed articles to include studies assessing the following primary outcomes: clinical presentation, treatment type, postoperative complications, readmission, reoperation, survival and/or mortality, length of hospital stay, discharge disposition, and advance care planning.

Findings: A total of 13 studies were included in final analysis; 12 were retrospective cohort studies (Level of evidence III) and 1 was a prospective study (Level of evidence II). Postoperative complications were the most studied outcome in 46% of studies (6 of 13), followed by survival in 31% (4 of 13), and treatment type also in 31% (4 of 13). Overall, race was found to be significantly associated with at least one evaluated outcome in 69% of studies (9 of 13). Racial disparities were found in the incidence of cord compression, non-routine discharge, and treatment type in patients with metastatic spine disease. No differences were found on rates of post-operative ambulation, advance care planning, readmission, or survival; inconsistent results were seen for postoperative complications and length of stay. Nine studies (69%) included at least one other measure of socioeconomic status in multivariate analysis, with the two most common being insurance type and income.

Conclusions and relevance: Although some studies suggest race to be associated with presenting characteristics, treatment type and outcome of patients with spinal metastases, there was significant variability in the inclusion of measures of socioeconomic status in study analyses. As such, the association between race and outcomes in oncologic spine surgery remains unclear.