Neurochirurgie最新文献

英文中文

Artificial intelligence in spine surgery: a scoping review 人工智能在脊柱外科中的应用：综述。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-12-13 DOI: 10.1016/j.neuchi.2025.101764

Anis Choucha , Morgane Evin , Matteo de Simone , Guillaume Dannhoff , Henry Dufour , Valentin Avinens , Kaissar Farah , Florian Saby , Stephane Fuentes

Background

The integration of artificial intelligence (AI) into spinal surgery is gaining attention due to its potential to expand evidence-based medicine and provide personalized care. However, its application in day-to-day surgical practice is still in the developmental stage. This scoping review aims to map the landscape of AI applications in spinal surgery, draw current frontiers, and identify gaps in the literature.

Methods

Following PRISMA guidelines, a scoping review was conducted using PubMed and Cochrane databases up to January 2024. Included studies described AI models or validated AI applications in spinal surgery. A wide range of data was extracted, including objectives, outcomes, model architectures, validation techniques, the type of disease, the institutions involved, and journals.

Results

The United States led contributions (32%), followed by China (18%), Europe (15%), Japan (9%), and South Korea (9%). These publications reached journals with an average two-year impact factor of 3.4. Resource sharing was limited: 4 studies provided self-service applications, seven shared data, and 17 offered code access. The studies addressed diverse spinal pathologies, led by degenerative (24%) and oncological (19%) conditions. Deep learning methods dominated, alongside non-deep learning models. Validation was reported in 76% of studies, both internal (67%), or external (19%). An exhaustive table of all the articles' details is available in the supplementary material.

Conclusion

The lack of rigorous external validation and restricted access to AI models and datasets limits AI’s widespread adoption. To bridge this gap, stronger collaboration across disciplines, greater transparency in model development, and a concerted effort to ensure that validated models are made publicly accessible are needed.

背景：人工智能（AI）与脊柱外科的整合正受到关注，因为它有可能扩大循证医学和提供个性化护理。然而，其在日常外科实践中的应用仍处于发展阶段。这一范围审查旨在绘制人工智能在脊柱外科应用的景观，绘制当前的前沿，并确定文献中的空白。方法：遵循PRISMA指南，使用PubMed和Cochrane数据库进行范围综述，截止到2024年1月。纳入的研究描述了人工智能模型或验证了人工智能在脊柱外科中的应用。提取了广泛的数据，包括目标、结果、模型架构、验证技术、疾病类型、涉及的机构和期刊。结果：美国贡献最多（32%），其次是中国（18%）、欧洲（15%）、日本（9%）和韩国（9%）。这些出版物的平均两年影响因子为3.4。资源共享是有限的：4项研究提供自助服务应用程序，7项研究提供共享数据，17项研究提供代码访问。这些研究涉及多种脊柱病理，以退行性（24%）和肿瘤性（19%）疾病为主。深度学习方法和非深度学习模型占主导地位。76%的研究报告了验证，包括内部（67%）和外部（19%）。在补充材料中提供了所有条款细节的详尽表。结论：缺乏严格的外部验证以及对人工智能模型和数据集的限制访问限制了人工智能的广泛采用。为了弥合这一差距，需要更强的跨学科合作，模型开发中更大的透明度，以及确保公开访问经过验证的模型的一致努力。

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引用次数: 0

Awake surgery with direct electrical stimulation for safe resection of a deep posterior thalamic cavernous malformation 清醒手术直接电刺激安全切除深后丘脑海绵体畸形。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-09-05 DOI: 10.1016/j.neuchi.2025.101720

Benoit Simonet , Lydiane Mondot , Fabien Almairac

Background

Treating symptomatic deep-seated cerebral cavernous malformations (CCMs) is challenging due to surgical risks.

Case description

A 37-year-old man underwent awake craniotomy with direct electrical stimulation (DES) for excision of a left posterior thalamic CCM. A transcortical transventricular approach through the superior parietal lobe enabled safe navigation around critical associative and projection white matter tracts.

Results

Postoperative MRI confirmed complete resection with preservation of major tracts, and the patient showed significant recovery at three months.

Conclusion

This case highlights the potential of awake surgery with DES as a safe and effective method for deep-seated CCMs traditionally deemed inoperable.

背景：由于手术风险，治疗症状性深部脑海绵体畸形（CCMs）具有挑战性。病例描述：一名37岁男性接受清醒开颅直接电刺激（DES）切除左侧后丘脑CCM。经皮质经脑室入路经顶叶上，可安全绕过关键联合和投射白质束。结果：术后MRI证实完全切除并保留了大束，患者在3个月时恢复明显。结论：本病例强调了DES清醒手术作为一种安全有效的方法治疗传统上被认为无法手术的深层ccm的潜力。

引用次数: 0

Endoscopic transorbital approach for orbital cavernous hemangioma: A case series 经眶内窥镜入路治疗眶海绵状血管瘤：一个病例系列

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-09-08 DOI: 10.1016/j.neuchi.2025.101716

Cesare Zoia , Matteo De Simone , Daniele Bongetta , Francesco Salomi , Fabio Pagella , Giannantonio Spena , Vittorio Ricciuti

Background

Orbital cavernous hemangiomas (OCH) are the most common benign orbital tumors, often presenting with proptosis. The endoscopic transorbital approach (ETOA) is increasingly being utilized for the treatment of OCH, offering minimal invasiveness and superior cosmetic outcomes. This study aims to evaluate the safety, efficacy, and clinical outcomes of ETOA for OCH.

Methods

A retrospective cohort of eight patients who underwent ETOA for OCH between 2020 and 2024 at the Neurosurgical Departments of Fondazione IRCCS Policlinico San Matteo were recorded. Preoperative evaluations included clinical symptoms, radiological assessments, and histology. Data on demographics, clinical presentation, operative time, extent of resection (EOR), complications, and follow-up outcomes were analyzed.

Results

The study included eight patients (mean age 55.9 years), with a male-to-female ratio of 1:1.7. All patients presented with proptosis, and 87.5% of lesions were intraconal. Gross Total Resection (GTR) was achieved in 87.5% cases (7/8), with an average operative time of 143.6 min. 37.5% of patients experienced transient postoperative complications, including diplopia (25%) and supraorbital neuralgia (12.5%), but no permanent deficits. The follow-up period ranged from 6 to 32 months, with no cases of recurrence observed.

Conclusions

ETOA appears safe and effective technique for the treatment of orbital cavernous hemangiomas, achieving high rates of GTR and low complication rates in the present series. The approach may also offer favorable cosmetic outcomes and short hospitalization times. Nonetheless, further studies with larger cohorts and longer follow-up are needed before drawing definitive conclusions.

背景：眶海绵状血管瘤（OCH）是最常见的眼眶良性肿瘤，常表现为突出。内窥镜下经眶入路（ETOA）越来越多地被用于治疗OCH，提供最小的侵入性和良好的美容效果。本研究旨在评估ETOA治疗OCH的安全性、有效性和临床结果。方法回顾性分析2020年至2024年在圣马特奥医院（Fondazione IRCCS Policlinico San Matteo）神经外科接受ETOA的8例OCH患者。术前评估包括临床症状、放射学评估和组织学。分析了人口统计学、临床表现、手术时间、切除程度（EOR）、并发症和随访结果的数据。结果纳入8例患者，平均年龄55.9岁，男女比例为1:7 .7。所有患者均表现为突出，87.5%的病变为囊内病变。87.5%（7/8）的病例实现了总切除（GTR），平均手术时间为143.6 min。37.5%的患者出现短暂的术后并发症，包括复视（25%）和眶上神经痛（12.5%），但没有永久性缺陷。随访6 ~ 32个月，无复发病例。结论setoa是一种安全有效的眼眶海绵状血管瘤治疗技术，GTR率高，并发症发生率低。该方法还可以提供良好的美容效果和较短的住院时间。尽管如此，在得出明确的结论之前，还需要更多的研究和更长的随访时间。

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引用次数: 0

Reply to: Using fluid mechanics to reduce postoperative pneumocephalus during chronic subdural hematoma burr hole surgery: Technical note 答复：慢性硬膜下血肿钻孔手术中应用流体力学减少术后气脑：技术说明。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-09-19 DOI: 10.1016/j.neuchi.2025.101722

Jiankuai Zhou, Huimin Shen, Jianchen Jin, Guotao Peng, Dan Xu, Yili Chen, Jun Mo

引用次数: 0

Risk of Hydrocephalus after Head Trauma: A nationwide cohort study in South Korea 头部创伤后脑积水的风险：韩国一项全国性队列研究。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-10-16 DOI: 10.1016/j.neuchi.2025.101738

Youngoh Bae , Sung Ho Park , Hohyun Jung , Min Soo Kim

Background

This study assessed the long-term risk of acquired hydrocephalus in individuals with head trauma to identify time-specific risk patterns and to evaluate high-risk subgroups using a nationwide cohort in South Korea.

Methods

Data from the Korean National Health Insurance Service cohort (2005–2013) were analyzed. The study included 53,567 patients with head trauma and 535,668 matched controls. This study analyzed the incidence of hydrocephalus in patients with head trauma, and time-stratified Cox proportional hazards models were employed to calculate the adjusted hazard ratios (aHRs) for hydrocephalus across 9 years, adjusting for demographic and clinical covariates.

Results

The incidence of hydrocephalus was significantly higher in the head trauma group than in the control group (incidence rate ratio, 3.92). Male patients and those aged ≥60 years exhibited the highest risk. The risk of hydrocephalus was highest within the first 3 years after trauma and decreased gradually thereafter. Furthermore, smokers and ex-smokers were at a higher risk than nonsmokers.

Conclusions

Patients with head trauma are at a significantly higher risk of posttraumatic hydrocephalus, particularly within the first 3 years. These findings highlight the need for early monitoring and intervention. Further research is required to improve our understanding of hydrocephalus risk.

背景：本研究评估了头部创伤个体获得性脑积水的长期风险，以确定特定时间的风险模式，并利用韩国全国队列评估高风险亚群。方法：对2005-2013年韩国国民健康保险服务队列数据进行分析。该研究包括53567名头部创伤患者和535668名匹配的对照组。本研究分析了头部外伤患者脑积水的发病率，采用时间分层Cox比例风险模型计算9年间脑积水的调整风险比（aHRs），并对人口统计学和临床协变量进行了调整。结果：颅脑外伤组脑积水发生率明显高于对照组（发生率比为3.92）。男性患者和年龄≥60岁的患者风险最高。脑积水的风险在创伤后3年内最高，此后逐渐降低。此外，吸烟者和戒烟者比不吸烟者的风险更高。结论：头部外伤患者发生创伤后脑积水的风险明显较高，尤其是在头3年内。这些发现强调了早期监测和干预的必要性。需要进一步的研究来提高我们对脑积水风险的认识。

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引用次数: 0

Letter to the editor regarding: “Awake surgery for isolated parenchymal degenerating neurocysticercosis - Case report and focused review of misdiagnosis of neurocysticercosis” 致编辑关于：“孤立性脑实质退行性神经囊虫病的清醒手术——一例神经囊虫病误诊报告及重点回顾”。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-09-30 DOI: 10.1016/j.neuchi.2025.101728

Sean O’Leary , Takara Newsome-Cuby , Sami Al-Horani , Usama AlDallal , Mazin E. Khalil , Umaru Barrie

引用次数: 0

Injectable approaches to deliver innovative treatments for spinal cord: When regenerative medicine meets precision medicine 为脊髓提供创新治疗的注射方法：再生医学与精准医学的结合。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-10-06 DOI: 10.1016/j.neuchi.2025.101730

Serratrice Nicolas

Delivering therapeutic agents to the spinal cord is crucial for treating conditions such as Spinal Cord Injury (SCI), chronic pain and neurodegenerative diseases. Various administration routes, including systemic, epidural, intrathecal, subarachnoid, localized and intraparenchymal injections, offer distinct advantages and challenges when it comes to achieving effective therapeutic outcomes. The invasiveness, precision and ability to bypass biological barriers, such as the Blood-Spinal Cord Barrier (BSCB), differ between these methods. This literature review summarizes the latest research on these delivery approaches, examining their principles, techniques, applications and associated risks. By analyzing the efficacy and limitations of each route for administering steroids, recombinant growth factors, gene therapies, stem cells and biomaterial scaffolds, the review aims to provide a comprehensive understanding of the most effective strategies for targeting the spinal cord. It will highlight key findings and identify areas for further investigation.

向脊髓输送治疗药物对于治疗脊髓损伤（SCI）、慢性疼痛和神经退行性疾病等疾病至关重要。各种给药途径，包括全身、硬膜外、鞘内、蛛网膜下、局部和实质内注射，在实现有效治疗结果方面具有不同的优势和挑战。这些方法在侵入性、精确性和绕过生物屏障（如血脊髓屏障（BSCB））的能力上有所不同。这篇文献综述总结了这些交付方法的最新研究，检查了它们的原理、技术、应用和相关风险。通过分析类固醇、重组生长因子、基因治疗、干细胞和生物材料支架等治疗途径的疗效和局限性，本综述旨在全面了解针对脊髓的最有效策略。它将突出主要调查结果，并确定需要进一步调查的领域。

引用次数: 0

Development and validation of a prediction model for pulmonary infection in elderly patients with traumatic brain injury 老年外伤性脑损伤患者肺部感染预测模型的建立与验证。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-10-08 DOI: 10.1016/j.neuchi.2025.101733

Shuai Tian , Ali Shang , Wenqian Zhou , Zhen Xu , Yunpeng Kou , Zhenyu Guo , Fan Chen , Peigang Ji , Yulong Zhai , Wenjian Zhao , Yang Jiao , Zhipeng Song , Shunnan Ge , Yuan Wang , Liang Wang , Shaochun Guo

Objectives

This study aimed to investigate risk factors associated with pulmonary infection (PI) in elderly patients with traumatic brain injury (TBI). Additionally, this study sought to develop and validate a predictive model for PI in elderly patients with TBI using clinical data obtained upon admission.

Methods

The study retrospectively analyzed elderly patients (≥65 years) with TBI at Tangdu Hospital between January 2011 and December 2021. These patients were randomly allocated to training and validation sets in a 7:3 ratio. A nomogram model was developed to predict the risk of PI in elderly patients with TBI. Internal validation was conducted using a verification set, while external validation was performed using patient data from a different hospital.

Results

A total of 592 elderly patients with TBI were included. The Glasgow coma scale score on admission, chest injury, hemoglobin, albumin, C-reactive protein, procalcitonin, B-type natriuretic peptide, troponin, and surgery was found to be independent predictors of PI in elderly patients with TBI. The nomogram demonstrated good discrimination ability, with a consistency index of 0.918 (95% confidence interval (CI): 0.891–0.944), which was verified to be 0.848 (95% CI: 0.786–0.910). The area under the curve for the external validation cohorts was 0.836 (95% CI: 0.770–0.903).

Conclusions

This study developed and validated a prediction model for PI in elderly patients with TBI. The nomogram model demonstrated a favorable discriminatory and predictive capacity for predicting PI in elderly patients with TBI.

目的：本研究旨在探讨老年创伤性脑损伤（TBI）患者肺部感染（PI）的相关危险因素。此外，本研究试图利用入院时获得的临床数据，开发并验证老年TBI患者PI的预测模型。方法：回顾性分析2011年1月至2021年12月唐都医院老年TBI患者（≥65岁）。这些患者以7:3的比例随机分配到训练组和验证组。我们建立了一个nomogram模型来预测老年TBI患者发生PI的风险。内部验证使用验证集进行，而外部验证使用来自不同医院的患者数据进行。结果：共纳入592例老年TBI患者。入院时格拉斯哥昏迷评分、胸部损伤、血红蛋白、白蛋白、c反应蛋白、降钙素原、b型利钠肽、肌钙蛋白和手术是老年TBI患者PI的独立预测因子。nomogram具有较好的判别能力，一致性指数为0.918(95%置信区间（CI）： 0.891 ~ 0.944)，一致性指数为0.848（95%置信区间（CI）： 0.786 ~ 0.910）。外部验证队列的曲线下面积为0.836 （95% CI: 0.77 -0.903）。结论：本研究建立并验证了老年TBI患者PI的预测模型。nomogram模型对老年TBI患者PI的预测具有良好的判别和预测能力。

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引用次数: 0

Robot-assisted MIS transiliac sacroiliac joint fusion: Technical note 机器人辅助MIS经髂骶髂关节融合术：技术说明。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-09-05 DOI: 10.1016/j.neuchi.2025.101715

A. Nguyen , P. Haettel , B. Ghannam , R. Assaker , H.-A. Leroy

Background

Sacroiliac joint dysfunction (SIJD) accounts for 15–25% of chronic low back pain and often follows lumbar fusion. When conservative therapies fail, minimally invasive (MIS) SIJ fusion (SIJF) is indicated. The robot-assisted technique is feasible and safe, enhancing accuracy and reducing radiation exposure.

Case description

A 26-year-old woman, eight years after L4-S1 fusion, presented with bilateral SIJD refractory to physiotherapy and intraarticular steroids injection. SIJF was indicated. Here we describe the robot-assisted technique and its advantages.

Conclusion

Robot-assisted SIJF is a safe and accurate technique to treat SIJD while reducing radiation exposure. Trajectories planification and consideration of anatomical variations give the robot-assisted technique an advantage over conventional techniques such as fluoroscopy or navigation.

背景：骶髂关节功能障碍（SIJD）占慢性腰痛的15-25%，常伴随腰椎融合。当保守治疗失败时，需要微创SIJ融合（SIJF）。机器人辅助技术可行且安全，可提高精度并减少辐射暴露。病例描述：一名26岁女性，L4-S1融合8年后，出现双侧SIJD，物理治疗和关节内类固醇注射难以治愈。表示SIJF。本文介绍了机器人辅助技术及其优点。结论：机器人辅助SIJF是一种安全、准确的治疗SIJD的技术，同时减少了辐射暴露。轨迹平面化和解剖变化的考虑使机器人辅助技术优于常规技术，如透视或导航。

引用次数: 0

5-year follow up after successful craniopagus separation: Review on hydrocephalus and venous system re-arrangement 颅裂成功后5年随访：脑积水与静脉系统重排的研究进展。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-09-05 DOI: 10.1016/j.neuchi.2025.101717

Samsul Ashari , Alvi Aulia , Affan Priyambodo , Setyo Widi Nugroho , Amanda Aldilla

Introduction

Craniopagus is one of the rarest congenital abnormalities. Separation of craniopagus twin is associated with high morbidity and mortality, especially in total type, where the twin had shared dural venous sinuses. One of the complications after separation surgery is hydrocephalus. While detailed cerebral vasculature imaging is needed pre-operatively to ensure most optimal surgical approach, post-operative vasculature imaging is no less important to assess changes in cerebral venous system after separation surgery.

Case presentation

Separation surgery was successfully accomplished in a total vertical craniopagus twin with shared dural venous sinuses. One twin experienced hydrocephalus after surgery, while the other twin had CSF leakage from the wound. LP shunt was placed in both twin and they had good recovery. We then compared the cerebral venous structure in both twins, before and after separation surgery using reconstruction of CT venography.

Conclusion

Successful separation of total vertical craniopagus twin where both twin developed well without any neurological deficit is a very rare occurrence. Based on follow up CTV, cerebral venous system underwent re-arrangement to accommodate changing hemodynamic needs after separation surgery. This might give us new insight about cerebral venous system that favors good prognosis for craniopagus twin.

颅裂是一种罕见的先天性畸形。双生颅板分离与高发病率和死亡率相关，特别是在全型中，双胞胎共用硬脑膜静脉窦。分离手术后的并发症之一是脑积水。虽然术前需要详细的脑血管成像以确保最佳的手术入路，但术后血管成像对于评估分离手术后脑静脉系统的变化同样重要。病例介绍：分离手术成功地完成了完全垂直双颅与共享硬脑膜静脉窦。一个双胞胎术后出现脑积水，而另一个双胞胎有脑脊液从伤口渗漏。两名双胞胎均接受了LP分流术，恢复良好。然后，我们比较了这对双胞胎的大脑静脉结构，在分离手术前后使用重建CT静脉造影。结论：双胎发育良好且无神经功能缺损的全垂直颅斜双胎成功分离是非常罕见的。根据随访CTV，脑静脉系统重新排列以适应分离手术后血流动力学需求的变化。这可能会给我们对脑静脉系统的新认识，有利于预后良好的双颅畸形。

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