Field Of Neurosurgery Research Articles

What has been the most important advancement in neurosurgical practice over the last 10 years?

Neurosurgery is considered one of the oldest specialties, with evidence of surgical intervention being observed in skull specimens dating back to pre-history. Yet, the modern idea of neurosurgery is a very recent concept. Increasingly sophisticated technology has revolutionised the field, but arguably the greatest impact on patient outcomes has come from an only seemingly less exciting reform, which has transformed the structure of the service.
 
 Over the last decade, efforts have been made to redefine the relationship between patients and healthcare practitioners, in favour of a more holistic and collaborative approach with the patient being placed at the centre of their own care. This shift has particularly impacted specialities like neurosurgery, where meticulous care planning frequently involves input from several other experts and healthcare professionals. Furthermore, advancements in the field of neurosurgery tend to stem from the process of optimisation of techniques, or tool kits, that were actually devised decades ago.
 
 True paradigm shifts simply do not occur as frequently, and they are the result of new ways of understanding disease, or new ways of working. The work towards multidisciplinary approaches, patient centred care and social care constitutes the most significant advancement for patient outcomes and satisfaction in the field of neurosurgery over the last decade.

Smart haptic gloves for virtual reality surgery simulation: a pilot study on external ventricular drain training.

Smart haptic gloves are a new technology emerging in Virtual Reality (VR) with a promise to enhance sensory feedback in VR. This paper presents one of the first attempts to explore its application to surgical training for neurosurgery trainees using VR-based surgery simulators. We develop and evaluate a surgical simulator for External Ventricular Drain Placement (EVD), a common procedure in the field of neurosurgery. Haptic gloves are used in combination with a VR environment to augment the experience of burr hole placement, and flexible catheter manipulation. The simulator was integrated into the training curriculum at the 2022 Canadian Neurosurgery Rookie Bootcamp. Thirty neurosurgery residents used the simulator where objective performance metrics and subjective experience scores were acquired. We provide the details of the simulator development, as well as the user study results and draw conclusions on the benefits added by the haptic gloves and future directions.

Endoscopic hemispherotomy: an illustrative video

Endoscopic surgery has brought about a paradigm shift in the field of neurosurgery. It provides a panoramic view, heightened illumination, magnification, and the unique ability to navigate corners, all of which significantly enhance surgical precision. Endoscopic hemispherotomy is a procedure that allows functional disconnection of the abnormal hemisphere from the ipsilateral basal ganglia, thalamus, and contralateral brain. This video article gives an overview of endoscopic hemispherotomy for a case of drug-refractory epilepsy due to an old middle cerebral artery infarct. It also showcases the value of functional magnetic resonance imaging in deciding the surgery.

Large Language Models in Neurosurgery.

A large language model (LLM), in the context of natural language processing and artificial intelligence, refers to a sophisticated neural network that has been trained on a massive amount of text data to understand and generate human-like language. These models are typically built on architectures like transformers. The term "large" indicates that the neural network has a significant number of parameters, making it more powerful and capable of capturing complex patterns in language. One notable example of a large language model is ChatGPT. ChatGPT is a large language model developed by OpenAI that uses deep learning techniques to generate human-like text. It can be trained on a variety of tasks, such as language translation, question answering, and text completion. One of the key features of ChatGPT is its ability to understand and respond to natural language inputs. This makes it a powerful tool for generating a wide range of text, including medical reports, surgical notes, and even poetry. Additionally, the model has been trained on a large corpus of text, which allows it to generate text that is both grammatically correct and semantically meaningful. In terms of applications in neurosurgery, ChatGPT can be used to generate detailed and accurate surgical reports, which can be very useful for sharing information about a patient's case with other members of the medical team. Additionally, the model can be used to generate detailed surgical notes, which can be very useful for training and educating residents and medical students. Overall, LLMs have the potential to be a valuable tool in the field of neurosurgery. Indeed, this abstract has been generated by ChatGPT within few seconds. Potential applications and pitfalls of the applications of LLMs are discussed in this paper.

Students' perspectives regarding needs for and opportunities with mixed-reality education in neurosurgery at German medical schools.

Despite mixed reality being an emerging tool for tailored neurosurgical treatment and safety enhancement, the use of mixed reality in the education of German medical students is not established in the field of neurosurgery. The present study aimed to investigate medical students' perspectives on the use of mixed reality in neurosurgical medical education. Between July 3, 2023, and August 31, 2023, an online survey was completed by German medical students through their affiliated student associations and educational institutions. The survey included 16 items related to mixed reality in neurosurgery, with participants providing ratings on a 4-point Likert scale to indicate their level of agreement with these statements. A total of 150 students from 27 medical schools in Germany took part in the survey. A significant majority comprising 131 (87.3%) students expressed strong to intense interest in mixed-reality courses in neurosurgery, and 108 (72%) reported an interest in incorporating mixed reality into their curriculum. Furthermore, 94.7% agreed that mixed reality may enhance their understanding of operative neuroanatomy and 72.7% agreed with the idea that teaching via mixed-reality methods may increase the probability of the use of mixed reality in their future career. The majority (116/150 [77.3%]) reported that the preferred optimum timepoint for teaching with mixed reality might be within the first 3 years of medical school. In particular, more students in the first 2 years preferred to start mixed-reality courses in the first 2 years of medical school compared to students in their 3rd to 6th years of medical school (71.9% vs 41.5%, p = 0.003). Residents and attending specialists were believed to be appropriate teachers by 118 students (78.7%). German medical students exhibited significant interest and willingness to engage in mixed reality in neurosurgery. Evidently, there is a high demand for medical schools to provide mixed-reality courses. Students seem to prefer the courses as early as possible in their medical school education in order to transfer preclinical neuroanatomical knowledge into operative neurosurgical anatomy by using this promising technique.

Machine learning predictive model for lumbar disc reherniation following microsurgical discectomy

IntroductionThe integration of machine learning (ML) algorithms into the field of neurosurgery has the potential to facilitate the decision-making process for the surgeons, improve the surgical outcomes and the overall patient satisfaction rates. Reoperations for same level lumbar disc reherniation are associated with poorer outcomes and greater rate of complications. Research questionProper preoperative patient evaluation could reveal the individuals at higher risk of reherniation. A novel machine learning algorithm was used for the creation of a predictive scoring system for lumbar disc reherniation for patients requiring microdiscectomy without fusion. Material and methodsRetrospective chart review was completed of all adult patients that underwent microdiscectomy without fusion for symptomatic single level LDH, in a single center, over the last 3 years. 230 patients met the inclusion criteria. 19 of them required a second surgical intervention due to same level reherniation. ResultsUtilizing the Risk-SLIM model, the Lumbar Reherniation Score (LRS) was created. The score's accuracy was tested against other model architectures, and a standard five-fold cross-validation was performed. The LRS has AUC of 0.87, confusion matrix accuracy of 0.74, Matthews correlation coefficient of 0.36 and informedness of 0.62. The LRS individual reherniation risk probability ranges from 0% to 88.1%. Discussion and conclusionThe LRS is a novel, easy-to-use, patient-specific tool for preoperative prediction of the individual patient-specific risk of same level symptomatic reherniation following microdiscectomy. Further validation and testing of the model is needed before it can be used in real-life patient treatment.

My Short-Term Neurointerventional Training in Thailand Supported by a Women's Observership Program of the World Federation of Interventional and Therapeutic Neuroradiology.

This short report describes my personal experience of 1-month neurointerventional training at Ramathibodi Hospital in Thailand, supported by a women's observership grant from the World Federation of Interventional and Therapeutic Neuroradiology, in which many interventional neuroradiology (INR) fellows from various regions of Thailand also participated. The training program allowed me to experience numerous neurointerventional cases and to acquire skills on how to function as a member of the INR team. This experience prompts me to contemplate the significance of team-based medicine and the role of women in the field of neurosurgery and INR.

Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework

IntroductionThe field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery. Research questionTo assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges. Materials and methodsAnalysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee. ResultsWe explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers. Discussion and conclusionThe potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.

Craniofacial 3D Morphometric Analysis with Smartphone-Based Photogrammetry.

Obtaining 3D craniofacial morphometric data is essential in a variety of medical and educational disciplines. In this study, we explore smartphone-based photogrammetry with photos and video recordings as an effective tool to create accurate and accessible metrics from head 3D models. The research involves the acquisition of craniofacial 3D models on both volunteers and head mannequins using a Samsung Galaxy S22 smartphone. For the photogrammetric processing, Agisoft Metashape v 1.7 and PhotoMeDAS software v 1.7 were used. The Academia 50 white-light scanner was used as reference data (ground truth). A comparison of the obtained 3D meshes was conducted, yielding the following results: 0.22 ± 1.29 mm for photogrammetry with camera photos, 0.47 ± 1.43 mm for videogrammetry with video frames, and 0.39 ± 1.02 mm for PhotoMeDAS. Similarly, anatomical points were measured and linear measurements extracted, yielding the following results: 0.75 mm for photogrammetry, 1 mm for videogrammetry, and 1.25 mm for PhotoMeDAS, despite large differences found in data acquisition and processing time among the four approaches. This study suggests the possibility of integrating photogrammetry either with photos or with video frames and the use of PhotoMeDAS to obtain overall craniofacial 3D models with significant applications in the medical fields of neurosurgery and maxillofacial surgery.

Advancements in Glioma Care: Focus on Emerging Neurosurgical Techniques.

Despite significant advances in understanding the molecular pathways of glioma, translating this knowledge into effective long-term solutions remains a challenge. Indeed, gliomas pose a significant challenge to neurosurgical oncology because of their diverse histopathological features, genetic heterogeneity, and clinical manifestations. Relevant sections: This study focuses on glioma complexity by reviewing recent advances in their management, also considering new classification systems and emerging neurosurgical techniques. To bridge the gap between new neurosurgical approaches and standards of care, the importance of molecular diagnosis and the use of techniques such as laser interstitial thermal therapy (LITT) and focused ultrasound (FUS) are emphasized, exploring how the integration of molecular knowledge with emerging neurosurgical approaches can personalize and improve the treatment of gliomas. The choice between LITT and FUS should be tailored to each case, considering factors such as tumor characteristics and patient health. LITT is favored for larger, complex tumors, while FUS is standard for smaller, deep-seated ones. Both techniques are equally effective for small and superficial tumors. Our study provides clear guidance for treating pediatric low-grade gliomas and highlights the crucial roles of LITT and FUS in managing high-grade gliomas in adults. This research sets the stage for improved patient care and future developments in the field of neurosurgery.

Maxine Deborrah Hyde: First Female Graduate of Case Western Reserve University's Neurologic Surgery Residency Program and Second Black Female Neurosurgeon in the United States

The historical diversity gap in the neurosurgical workforce persists to this day. Women, despite constituting over half of the yearly total of medical school graduates, comprise only 6% of certified practicing neurosurgeons in the United States. Furthermore, Black Americans make up under 4% of U.S. neurosurgeons, despite making up around 14% of the national population. The purpose of this account is to highlight the life and career of Dr. Maxine Deborrah Hyde and illustrate the importance and necessity of diversity and inclusivity in advancing the field of neurosurgery. Through this paper, we aspire to encourage the development of new diversity initiatives. Original scientific and bibliographic materials of Hyde were examined, and an extensive analysis of her life was compiled. Despite growing up during the era of Jim Crow, Dr. Hyde persevered and became the valedictorian of Oak Park High School. As a first-generation college student at Tougaloo College, she later earned her MS from Cleveland State University. Dr. Hyde graduated with honors from Case Western Reserve University School of Medicine in 1977. Thereafter, she became the first female and first Black graduate of Case Western's neurosurgery residency and the second Black woman to receive certification from the American Board of Neurological Surgery. Later in life, Dr. Hyde established the Beacon of Hope Scholarship Foundation to assist disadvantaged students in overcoming educational barriers. Dr. Hyde was a trailblazer who overcame systematic barriers and paved the way for future generations of aspiring neurosurgeons.

Peculiarities of training neurosurgeons in modern conditions using the example of a number of foreign countries

The possibility of unifying the training of neurosurgeons using the experience of different countries seems to be the most promising. At the same time, the uniqueness of the countries, the historical facts of the development of the neurosurgical specialty, scientific and technical achievements in them determined the diversity and specificity of individual neurosurgical schools. As a result, there is no unified model for a neurosurgical training program. In order to study the peculiarities of training neurosurgeons in foreign countries for the subsequent development of optimal models for training and advanced training of neurosurgery specialists in the Russian Federation, a search for foreign information was conducted in the databases Scopus, Web of Science, MedLine, Cochrane Library, EMBASE, Global Health, CyberLeninka, eLibrary.ru, RSCI for 2015–2022 to study the peculiarities of training neurosurgeons in the USA, England, Germany, Italy, Turkey. The analysis undertaken showed that the scope and training programs for neurosurgeons have their own characteristics in a number of countries. Thus, the duration of residency training in neurosurgery varies from 2 years in Russia to 6 years in Italy, Germany and 8 years in the UK. In the USA, postgraduate education for training a neurosurgeon includes 7 years of residency. Training programs also differ: in Italy they focus on primarily mastering practical skills; in Germany, during a 6-year training program, the student must master a wide range of theoretical and practical surgical skills. In the UK, training takes place in several stages: at the initial stage, mastering basic surgical skills common to all surgical specialties, skills and competencies in the field of basic neurosurgical care and emergency medicine. Competencies are further developed in relation to traumatic brain injury, degenerative spinal diseases, neuro-oncology and many other conditions. The final stage of training in the UK is in-depth neurosurgical training with the student spending a large amount of time in the operating room. In the USA, the “red thread” is the interdisciplinary integration of competencies and technologies. International cooperation within the framework of global neurosurgery is considered as the main vector for the development of the neurosurgical industry. The possibility of unifying the training of neurosurgeons using the experience of different countries and creating a global platform for the exchange of knowledge in the field of neurosurgery seem to be the most promising and useful in revising the training programs for neurosurgeons in our country.

Developing interdisciplinary research teams in neurosurgery: key elements to success in brachial plexus and peripheral nerve surgery.

The highest-impact medical literature is increasingly produced by interdisciplinary teams. The field of neurosurgery, which involves complex pathologies and recoveries, is particularly amenable to interdisciplinary research approaches. However, research in the medical context regarding the characteristics of effective teams, as well as how to develop and maintain interdisciplinary teams, remains lacking. Here, the authors used the business literature to identify the characteristics of effective teams. They then used the University of Michigan Brachial Plexus and Peripheral Nerve Program, founded under the leadership of the late Dr. Lynda Yang, as a case study for how these principles can be applied to build and operationalize a successful interdisciplinary team. They suggest that these same techniques can be used to create interdisciplinary research groups in other areas of neurosurgery.

Women in neurosurgery: a cross-sectional demographic study of female neurosurgery residents in the United States.

Over the past several decades, the number of women applying to medical school has increased significantly. However, parallel recruitment and retention of women in the field of neurosurgery continues to lag. The aim of this study was to identify the ratio and trend of female neurosurgery residents to the total number of residents during the past 7 years across all US neurosurgery residency programs. The authors conducted a cross-sectional demographic study investigating the ratio of female neurosurgery residents to the total number of neurosurgery residents across US neurosurgical programs from 2016 to 2022. Using the Fellowship and Residency Electronic Interactive Database, all neurosurgical residency programs in the US were collected. Data were further divided into postgraduate years 1-7 to dissect the data collection per residency year. One hundred fourteen programs were included in the study. The number of female neurosurgery residents was 71 (29.8%) in 2022, 58 (25.2%) in 2021, 65 (27.9%) in 2020, 62 (27.3%) in 2019, 46 (21.4%) in 2018, 33 (15.2%) in 2017, and 34 (15.9%) in 2016. The trend line showed a significant increase using the Mann-Kendall test (p = 0.035). The total number of international medical graduate (IMG) female neurosurgery residents was 3 (4.2%) in 2022, 4 (6.9%) in 2021, 3 (4.6%) in 2020, 1 (1.6%) in 2019, 1 (2.2%) in 2018, 1 (3%) in 2017, and 2 (5.9%) in 2016. The number of women matching into neurosurgery residency programs is modestly increasing, especially for IMG women. Future steps toward fewer gender disparities should focus on career advancement and leadership diversification in organized and academic neurosurgery.

Medical student specialty decision-making and perceptions of neurosurgery. Part 1: Role of gender.

Although women account for 50% of medical school graduates, less than 30% of neurosurgery residency applicants and less than 10% of neurosurgeons are female. In order to diversify the field of neurosurgery and recruit more women, it is necessary to understand why there is a disproportionately low entry rate into neurosurgery by female medical students. Factors contributing to specialty decision-making and perceptions of neurosurgery among medical students and residents, specifically differences by gender, have not been studied. The authors aimed to investigate these differences using quantitative and qualitative methods. A Qualtrics survey was administered at the authors' institution to all medical students and resident physicians to assess factors influencing medical specialty decision-making and perceptions of neurosurgery. Likert scale responses converted to numerical values on a 5-point scale were analyzed with the Mann-Whitney U-test. The chi-square test was performed on binary responses. Semistructured interviews were conducted in a subset of survey respondents and were analyzed by using the grounded theory method. Of the 272 survey respondents, 48.2% were medical students and 61.0% were female. When making specialty decisions, female medical students considered maternity/paternity leave more (p = 0.028) than their male counterparts. Female medical students were more hesitant toward neurosurgery due to maternity/paternity needs (p = 0.031) and the technical skill required (p = 0.020) than male medical students. Across both genders, the majority of medical students were hesitant toward neurosurgery due to opportunities for work/life integration (93%), length of training (88%), malignancy of the field (76%), and perceived happiness of the people in the field (76%). Female residents indicated they were more likely than male residents to consider the perceived happiness of the people in the field (p = 0.003), shadowing experiences (p = 0.019), and elective rotations (p = 0.004) when making specialty decisions. Two major themes emerged from the semistructured interviews: 1) maternity needs were more of a concern for women and 2) length of training was a concern for many individuals. Compared with their male counterparts, female students and residents consider different factors and experiences when choosing a medical specialty and have different perceptions of neurosurgery. Exposure to and education within neurosurgery, specifically maternity needs, may help address hesitancy in pursuing a neurosurgical career among female medical students. However, cultural and structural factors may need to be addressed within neurosurgery in order to ultimately increase representation of women.

Analysis of Surgical Smoke Generated by Electrocautery in a Simulated Neurosurgical Operating Room Using a Postmortem Porcine Model for Laminectomy and Craniotomy Exposures: A Preliminary Study

BACKGROUND AND OBJECTIVES: Electrocautery is a widely used tool to coagulate and separate tissue during neurosurgical procedures. Surgical smoke generated by electrocautery has harmful properties if inhaled over long-term. To our knowledge, no efforts have been made within the neurosurgery field to investigate the air quality of operating rooms (ORs) where neurosurgical procedures are being performed. We analyzed the presence and quantitation of volatile organic compounds and respirable dust in surgical smoke generated by electrocautery use during a neurosurgical OR simulation for laminectomies and craniotomies and evaluated whether surgical masks can adequately prevent inhalation of such substances. METHODS: Two laminectomy exposures and two bicoronal exposures were performed in two freshly euthanized pigs using electrocautery in a simulated neurosurgical OR. In each of the four neurosurgical procedure models, air sampling media and pumps were connected to a 3D-printed human face model. In two of these models, the face was covered with a standard surgical mask; in the other two models, no masks were placed. The models were positioned at a distance of 40 cm from the surgical field. Air samples were analyzed by an independent laboratory. Analyses of total amounts of respirable dust and 31 organic volatile compounds were conducted. The mean total amounts of the samples obtained from the masked and nonmasked models were compared. RESULTS: In the two masked and two nonmasked models, all 31 organic volatile compounds were below the levels of quantitation. The total amounts of respirable dust were higher in the two nonmasked models than in the two masked models. CONCLUSION: The total amount of organic volatile compounds seems to be low at the distance measured regardless of mask use; however, further studies are needed to determine whether even small amounts can be harmful over time. Standard surgical masks reduced the amounts of inhalable respirable dust.

A bibliometric analysis study on coccydynia treatment

AimThe objective of this study was to shed light on the topic of coccidynia, a condition of significant importance within the field of neurosurgery, by examining the scientific publications dedicated to its understanding and treatment. By conducting a comprehensive bibliometric analysis, we aimed to explore the extent of research conducted on coccidynia, identify key contributing countries, prolific authors, and prevalent research themes. Our study sought to provide an in-depth understanding of the temporal evolution of coccidynia literature and contribute to the accumulation of knowledge in this specialized area. Material and methodTo achieve our objective, we conducted an extensive literature search utilizing the esteemed Web of Science database. Through the advanced search engine within the WOS system, we meticulously curated a comprehensive dataset by focusing on the keyword “coccydynia treatment.” This specific keyword allowed us to identify relevant scientific articles and publications related to the treatment of coccidynia. The dataset was then analyzed to extract crucial information, including the number of articles published over time, the geographic distribution of research, the co-authorship patterns among researchers, and the prevalent keywords associated with coccidynia literature. ResultsOur investigation revealed intriguing insights into the landscape of coccidynia research. We discovered that the earliest scientific article on this subject was published in 1991, signifying the relatively recent emergence of scholarly interest in this domain. Notably, the volume of publications experienced a substantial surge after 2010, suggesting a growing recognition of coccidynia's clinical significance. In total, we identified and examined 143 articles published between 1970 and 2023, encompassing several decades of scientific inquiry into the condition. By meticulously analyzing the geographical distribution of research, we found that the United States of America emerged as the leading country in terms of producing publications on “coccydynia treatment.” Within this literature, we also identified key authors who made significant contributions to the field, with notable names including Maigne JY, Finsen V, and Knobloch RG. Moreover, our analysis of citation patterns revealed that articles originating from the United States received a commendable number of citations, with an average of 3.48 citations per article, while publications from Turkey garnered an average of 2.33 citations per article. Furthermore, we identified the most frequently utilized keywords in coccidynia literature, highlighting the emphasis placed on terms such as “idiopathic coccygodynia,” “sitting position,” “coccydynia,” “coccyx,” and “coccygectomy.” By conducting this bibliometric analysis of original scientific studies published since 1970, our study contributes to the existing knowledge base regarding coccidynia and its treatment. ConclusionThrough our meticulous bibliometric analysis, we have contributed to the existing body of knowledge surrounding coccidynia and its treatment. The comprehensive examination of scientific publications since 1970 has provided valuable insights into the temporal evolution of research on this condition. Our findings highlight the growing interest and recognition of coccidynia as a clinically significant neurosurgical topic. The identification of leading countries, prolific authors, and prevalent research themes serves as a foundation for future investigations and allows researchers to better understand the landscape of coccidynia research. We emphasize the importance of periodic updates and revisions to these studies, ensuring that the scientific community has access to the most current and comprehensive information for rational analysis and decision-making in the field of coccidynia research and treatment.

Surgical Characteristics of Intracranial Biopsy Using a Frameless Stereotactic Robotic Platform: A Single-Center Experience

BACKGROUND AND OBJECTIVES: Cranial robotics are a burgeoning field of neurosurgery. To date, all cranial robotic systems described have been computerized, arm-based instruments that take up significant space in the operating room. The Medtronic Stealth Autoguide robot has a smaller operating room footprint and offers multiaxial, frame-based surgical targeting. The authors set out to define the surgical characteristics of a novel robotic platform for brain biopsy in a large patient cohort. METHODS: Patients who underwent stereotactic biopsy using the Stealth Autoguide cranial robotic platform from July 2020 to March 2023 were included in this study. Clinical, surgical, and histological data were collected and analyzed. RESULTS: Ninety-six consecutive patients (50 female, 46 male) were included. The mean age at biopsy was 53.7 ± 18.0 years. The mean target depth was 68.2 ± 15.3 mm. The biopsy diagnostic tissue acquisition rate was 100%. The mean time from incision to biopsy tissue acquisition was 15.4 ± 9.9 minutes. Target lesions were located throughout the brain: in the frontal lobe (n = 32, 33.3%), parietal lobe (n = 21, 21.9%), temporal lobe (n = 22, 22.9%), deep brain nuclei/thalamus (n = 13, 13.5%), cerebellum (n = 7, 7.3%), and brainstem (n = 1, 1.0%). Most cases were gliomas (n = 75, 78.2%). Patients were discharged home on postoperative day 0 or 1 in 62.5% of cases. A total of 7 patients developed postoperative complications (7.2%). CONCLUSION: This cranial robotic platform can be used for efficient, safe, and accurate cranial biopsies that allow for reliable diagnosis of intracranial pathology in a minimally invasive setting.

How to objectively evaluate the impact of image-guided surgery technologies.

This manuscript aims to provide a better understanding of methods and techniques with which one can better quantify the impact of image-guided surgical technologies. A literature review was conducted with regard to economic and technical methods of medical device evaluation in various countries. Attention was focused on applications related to image-guided interventions that have enabled procedures to be performed in a minimally invasive manner, produced superior clinical outcomes, or have become standard of care. The review provides examples of successful implementations and adoption of image-guided surgical techniques, mostly in the field of neurosurgery. Failures as well as newly developed technologies still undergoing cost-efficacy analysis are discussed. The field of image-guided surgery has evolved from solely using preoperative images to utilizing highly specific tools and software to provide more information to the interventionalist in real time. While deformations in soft tissue often preclude the use of such instruments outside of neurosurgery, recent developments in optical and radioactive guidance have enabled surgeons to better account for organ motion and provide feedback to the surgeon as tissue is cut. These technologies are currently undergoing value assessments in many countries and hold promise to improve outcomes for patients, surgeons, care teams, payors, and society in general.

Alfred Washington Adson: Perspectives on Intracranial Neurosurgery and the Responsibilities of the Neurosurgeon.

In a period when the budding field of neurosurgery was believed to have little promise, Dr Alfred Washington Adson founded and led the first neurosurgical department at Mayo Clinic. He was not without reservations-surgical intervention for neurological conditions was rarely pursued because of poor outcomes and high complication rates, and Dr Adson acknowledged his early concerns about the future of neurosurgery in his memoirs. However, his education, mentorship, his training, and his first neurosurgical cases helped to shape the impact he ultimately had on the field and his legacy as a neurosurgeon. Dr Adson trained with several renowned Mayo general surgeons, notably his mentor Dr Emil Beckman, whose desire for operative precision shaped Dr Adson's drive to develop his own skills as a surgeon. Two years into his residency, he became the youngest staff surgeon and was tasked with managing the neurosurgical cases at Mayo. The five neurosurgical cases overseen by Dr Adson in the next year illuminated the opportunity for neurosurgery to drastically improve the lives of patients. Dr Adson, given the option of continuing as either a general surgeon or a neurosurgeon, ultimately chose to pursue neurosurgery. This article seeks to provide a historical perspective on the neurosurgeon Dr Alfred Washington Adson using primary and secondary accounts from the Mayo archives, highlighting his contributions to the early understanding of intracranial pathology and how his early experiences as a trainee developed into a personal passion for self-improvement, education, and advocacy for health care in America.