Neurosurgical Literature Research Articles

Implications of molecular classifications in glioma surgery.

The incorporation of molecular markers into neuro-oncology has transformed our understanding of adult diffuse gliomas. While surgical resection is the mainstay of treatment for many patients with gliomas, surgical management strategies warrant re-exploration in the context of characteristic molecular profiles. We reviewed the neurosurgical and neuro-oncological literature for studies investigating surgery in molecularly defined cohorts of adult diffuse gliomas. We discuss key molecular markers associated with the three subtypes of adult diffuse glioma: glioblastoma IDH-wildtype, astrocytoma IDH-mutant, and oligodendroglioma IDH-mutant and 1p/19q codeleted. We additionally discuss surgical strategies and extent of resection in these tumors, framing them in the context of key molecular alterations. Finally, we briefly discuss the practical utility of molecular markers in guiding surgical decision making. Molecular markers in gliomas are of growing relevance to surgical intervention. Advancements in preoperative and intraoperative molecular diagnostics will increase the utility of molecular biomarkers in informing surgical decision-making for patients with gliomas.

Neuroanatomy of the vertebrobasilar perforators: implications for aneurysm treatment.

The anatomy of vertebrobasilar perforators has been widely studied in human cadavers, with most reports found in the neurosurgical literature. These arterial perforators are extremely hard to visualize consistently with traditional two-dimensional digital subtraction angiography, but are reliably visible with cross sectional cone beam CT techniques. A clear understanding of this specific neurovascular anatomy and pathology is essential for informed treatment decisions. This review analyzes the anatomy of vertebrobasilar perforators with a focus on practical implications for aneurysm treatment, particularly flow diversion.

Artificial intelligence as a modality to enhance the readability of neurosurgical literature for patients.

In this study the authors assessed the ability of Chat Generative Pretrained Transformer (ChatGPT) 3.5 and ChatGPT4 to generate readable and accurate summaries of published neurosurgical literature. Abstracts published in journal issues released between June 2023 and August 2023 (n = 150) were randomly selected from the top 5 ranked neurosurgical journals according to Google Scholar. ChatGPT models were instructed to generate a readable layperson summary of the original abstract from a statistically validated prompt. Readability results and grade-level indicators (RR-GLIs) scores were calculated for GPT3.5- and GPT4-generated summaries and original abstracts. Two physicians independently rated the accuracy of ChatGPT-generated layperson summaries to assess scientific validity. One-way ANOVA followed by pairwise t-test with Bonferroni correction were performed to compare readability scores. Cohen's kappa was used to assess interrater agreement between the two rater physicians. Analysis of 150 original abstracts showed a statistically significant difference for all RR-GLIs between the ChatGPT-generated summaries and original abstracts. The readability scores are formatted as follows (original abstract mean, GPT3.5 summary mean, GPT4 summary mean, p value): Flesch-Kincaid reading grade (12.55, 7.80, 7.70, p < 0.0001); Gunning fog score (15.46, 10.00, 9.00, p < 0.0001); Simple Measure of Gobbledygook (SMOG) index (11.30, 7.13, 6.60, p < 0.0001); Coleman-Liau index (14.67, 11.32, 10.26, p < 0.0001); automated readability index (10.87, 8.50, 7.75, p < 0.0001); and Flesch-Kincaid reading ease (33.29, 68.45, 69.55, p < 0.0001). GPT4-generated summaries demonstrated higher RR-GLIs than GPT3.5-generated summaries in the following categories: Gunning fog score (0.0003); SMOG index (0.027); Coleman-Liau index (< 0.0001); sentences (< 0.0001); complex words (< 0.0001); and % complex words (0.0035). A total of 68.4% and 84.2% of GPT3.5- and GPT4-generated summaries, respectively, maintained moderate scientific accuracy according to the two physician-reviewers. The findings demonstrate promising potential for application of the ChatGPT in patient education. GPT4 is an accessible tool that can be an immediate solution to enhancing the readability of current neurosurgical literature. Layperson summaries generated by GPT4 would be a valuable addition to a neurosurgical journal and would be likely to improve comprehension for patients using internet resources like PubMed.

Use of extracorporeal membrane oxygenation during a decompressive hemicraniectomy for severe traumatic brain injury: illustrative case.

Decompressive hemicraniectomy (DHC) can be a life-saving treatment for patients with severe traumatic brain injury (TBI) with a focal mass lesion who develop refractory elevated intracranial pressure (ICP). Nonetheless, successful completion of this procedure requires maintaining hemodynamic and respiratory stability. Extracorporeal membrane oxygenation (ECMO) use in patients with respiratory or cardiac failure is well described in the literature and has become routinely used in patients with refractory hypoxia unresponsive to traditional mechanical ventilation strategies, but few cases of its use have been reported in the neurosurgical literature. Herein, the authors describe a unique case in which a man presented after an unwitnessed fall that caused severe TBI without a focal mass lesion. The patient subsequently developed medically refractory elevated ICP secondary to traumatic cerebral edema. He required DHC, but the procedure could only be completed safely with the utilization of intraoperative ECMO. As more is learned about the techniques and pitfalls of ECMO, its indications are rapidly expanding. The case presented describes the safe use of ECMO during a major neurosurgical procedure, showing that the technique can be completed safely and offering a therapeutic option for effectively addressing refractory hypoxia and hypercarbia in patients with severe TBI who require urgent or emergency neurosurgical procedures. https://thejns.org/doi/10.3171/CASE24264.

Exploring the Evolution of Research Connectivity and Funding in Global Neurosurgical Publications

There are critical disparities in the neurosurgical care provided around the globe due to challenges in resource allocation, training, and infrastructure. Global neurosurgical collaborations have replaced classical mission trips to address these disparities. However, the development of these collaborations and the impact of research funding on their growth has not yet been systematically studied. In this article, we use a graph theoretical approach to investigate trends in funding and co-authorship between and among authors from high-income countries (HICs) and authors from low- and middle-income countries (LMICs). A bibliometric search of the global neurosurgical literature returned 307 articles between 1985 and 2020. A connectivity analysis was conducted to compute the number of co-authorships between HIC-HIC, LMIC-HIC, and LMIC-LMIC authors. The number of connections, summarized as either a global sum of connections or an average number of connections per manuscript, were analyzed in the context of time and funding through parametric statistical tests. An exponential increase in co-authorship collaboration was observed over time, especially after 2015. Notably, LMIC-LMIC collaborations appear to be rising at over twice the rate of other collaboration types. The presence of funding, in general, was associated with increased co-authorship of manuscripts by LMIC and HIC authors together (p = 0.033). A significant majority of the funding associated with LMIC-HIC co-authorships was supplied through charitable organizations and government grants (p = 0.034, p = 0.009, respectively). Most LMIC-LMIC co-authorships had no funding. This work shows significant and rapid growth in international neurosurgical partnerships, especially in HIC-LMIC and LMIC-LMIC collaborations. Also, a significant positive relationship exists between research funding and LMIC-HIC co-authorship trends. This work encourages us as a community to continue to expand our translational collaborations with LMIC neurosurgeons and establish funding mechanisms independent of HIC authors.

Novel Delivery of Cryoablation Through Transoral Surgical Approach for Atypical Presentation of Osteoid Osteoma of the C1 Lateral Mass: Technical Case Illustration

BACKGROUND AND IMPORTANCE: Neurosurgical literature rarely explores cases of osteoid osteomas of the atlas. Traditionally, neurosurgeons performed en bloc surgical resection for refractory osteoid osteomas in the subaxial and lumbar spine, but minimally invasive ablation therapies have gained favor. Complete lesioning of the nidus, either by surgical or minimally invasive therapies, produces curative results with recurrence only developing after partial lesioning. CLINICAL PRESENTATION: We discuss the case of a 16-year-old adolescent boy who presented with neck and occipital pain refractory to multimodal pain management. Prolonged workup demonstrated a subtle radiographic lesion of the left C1 lateral mass. Interventional radiologists attempted a posterior approach percutaneous computed tomography-guided radiofrequency ablation but aborted due to proximity of the vertebral artery. Surgeons then pursued an open transoral approach to provide a corridor for cyclical cryoablation therapy, which proceeded without complication. The patient was discharged on postoperative day one with remission of occipital pain at the 10-month follow-up. No clinical or radiographic evidence of instability appeared on postoperative cervical films. CONCLUSION: No reports exist in the literature of an osteoid osteoma of C1 treated by an open anterior approach and with cryoablation. The transoral approach is a safe, effective method to access ventral pathologies of C1. The transoral approach may minimize blood loss and reduce the risk of craniocervical instability, allowing for preserved cervical mobility and improved patient outcomes. Surgeons may especially consider cryoablation when the nidus is within proximity to critical neural structures.

Survey Research Among Neurosurgeons: A Bibliometric Review of the Characteristics, Quality, and Citation Predictors of the Top 50 Most-Influential Publications in the Neurosurgical Literature.

Survey research enables the gathering of information on individual perspectives in a large cohort. It can be epidemiological, attitude or knowledge focussed. Assessmentof survey studies sampling neurosurgeons is currently lacking in the literature. This study aimed to highlight the characteristics, quality, and citation predictors of the most influential survey research studies published in the neurosurgical literature. Using PubMed and Google Scholar, the 50 most cited survey research publications were identified and reviewed. Data relating to the characteristics of the articles, participants and questionnaires were retrieved. The studies' quality and citation patterns were assessed. The median articles' age and publishing journal impact factor (IF) were 15.5 years and 2.82, respectively. Thirty-two (64%) articleswere first authored by researchers from the USA while 28(56%) studies were focussed on specific disease management. The median number of participants and response rates were 222 and 51%, respectively. A full version of the questionnaire was provided in 18 (36%) articles. Only four (8%) articles reported validation of the questionnaire. The overall quality of reporting of the surveys was considered fair (based on good grading in five parameters, fair grading in one parameter, and poor grading in four parameters). The median citation number was 111. The citation analysis showed that the participantnumber, articleage (≥15.5 years), and questionnairecategory (surgical complications) were significant predictors of citation numbers. The citation rates were not influenced by the response rates or the journal's IF. In conclusion, high-impact survey publications in the neurosurgical literature were moderately cited and of fair quality. Their citation numbers were not affected by response rates but were positively influenced by the publicationage, number of participants, and by novel data or the questions raised in the survey category. Surveys are valuable forms of research that require extensive planning, time, and effort in order to produce meaningful results. Increasing awareness of the factors that could affect citations may be useful to those who wish to undertake survey research.

False claims of equivalence in the neurosurgical trauma literature: prevalence and associated factors—a systematic review protocol

IntroductionResearch quality within the neurosurgical field remains suboptimal. Therefore, many studies published in the neurosurgical literature lack enough statistical power to establish the presence or absence of clinically important differences...

An Appraisal of the Quality of Development and Reporting of Predictive Models in Neurosurgery: A Systematic Review

BACKGROUND AND OBJECTIVES: Significant evidence has indicated that the reporting quality of novel predictive models is poor because of confounding by small data sets, inappropriate statistical analyses, and a lack of validation and reproducibility. The Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement was developed to increase the generalizability of predictive models. This study evaluated the quality of predictive models reported in neurosurgical literature through their compliance with the TRIPOD guidelines. METHODS: Articles reporting prediction models published in the top 5 neurosurgery journals by SCImago Journal Rank-2 (Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of NeuroInterventional Surgery, and Journal of Neurology, Neurosurgery, and Psychiatry) between January 1st, 2018, and January 1st, 2023, were identified through a PubMed search strategy that combined terms related to machine learning and prediction modeling. These original research articles were analyzed against the TRIPOD criteria. RESULTS: A total of 110 articles were assessed with the TRIPOD checklist. The median compliance was 57.4% (IQR: 50.0%-66.7%). Models using machine learning-based models exhibited lower compliance on average compared with conventional learning-based models (57.1%, 50.0%-66.7% vs 68.1%, 50.2%-68.1%, P = .472). Among the TRIPOD criteria, the lowest compliance was observed in blinding the assessment of predictors and outcomes (n = 7, 12.7% and n = 10, 16.9%, respectively), including an informative title (n = 17, 15.6%) and reporting model performance measures such as confidence intervals (n = 27, 24.8%). Few studies provided sufficient information to allow for the external validation of results (n = 26, 25.7%). CONCLUSION: Published predictive models in neurosurgery commonly fall short of meeting the established guidelines laid out by TRIPOD for optimal development, validation, and reporting. This lack of compliance may represent the minor extent to which these models have been subjected to external validation or adopted into routine clinical practice in neurosurgery.

The Epidemiological Burden of Neurovascular Pathology in Nigeria: A Systematic Review and Pooled Patient-Level Analysis

Vascular neurosurgery has developed significantly in Nigeria, but its burden and challenges remain unclear. This study systematically reviewed vascular neurosurgical literature from Nigeria. Four research databases and gray literature sources were searched from 1962-2021. ROBINS-I tool was used to assess risk of bias. Descriptive, narrative, and statistical analyses were conducted on all variables. Where appropriate, paired t-tests and Chi-squared independence tests were used (α= 0.05). 56 articles were included and 3203 patients pooled for analysis. Risk of bias was moderate-high. Most articles were published over the last 20 years with retrospective cohort studies and case reports being the most common study designs. The cohort had a relatively even gender split and an average age of 49 years (±22). Cerebrovascular accidents accounted for over 85% of diagnoses, with most etiologies being traumatic. Headache and motor deficit were the most prevalent clinical features. X-ray and carotid angiography were the most commonly reported imaging modalities, closely followed by computed tomography (CT) and CT angiography. The top two radiological diagnoses were ischemic cerebrovascular disease and intracerebral hematoma. Aneurysmal clipping and hematoma evacuation were the most commonly reported treatment modalities. Outcome at last follow-up was favorable in 48%. The mortality rate was 6%. Post-treatment complications included chest infection and rebleeding. This study illustrates the epidemiological burden of neurovascular pathology (based on the available data in published literature) in Nigeria, and raises awareness amongst service providers and researchers of the attendant challenges and epochal trends seen within vascular neurosurgery in Nigeria.

Neurosurgical Practice, Training, and Research Capacity Assessment in Nigeria: A Methodological Approach

There has been a progressive growth of neurosurgery in Nigeria over the past 6 nulldecades. This study aims to comprehensively evaluate the state of neurosurgical practice, training, and research in the country. We used a mixed-methods approach that combined a survey of neurosurgery providers and a systematic review of the neurosurgical literature in Nigeria. The 83-question online survey had 3 core sections for assessing capacity, training, and gender issues. The systematic review involved a search of 4 global databases and gray literature over a 60-year period. One hundred and forty-nine respondents (95% male) completed the survey (65.4%). Their age ranged from 20 to 68years, with a mean of 41.8 (±6.9) years. Majority were from institutions in the nation's South-West region; 82 (55.0%) had completed neurosurgery residency training, with 76 (51%) employed as consultants; 64 (43%) identified as residents in training, 56 (37.6%) being senior residents, and 15 (10.1%) each held academic appointments as lecturers or senior lecturers. The literature review involved 1,023 peer-reviewed journal publications: 254 articles yielding data on 45,763 neurotrauma patients, 196 on 12,295 pediatric neurosurgery patients, and 127 on 8,425 spinal neurosurgery patients. Additionally, 147 papers provided data on 5,760 neuro-oncology patients, and 56 on 3,203 patients with neuro-vascular lesions. Our mixed-methods approach provided significant insights into the historical, contemporary, and future trends of neurosurgery in Nigeria. The results could form the foundation for policy improvement; health-system strengthening; better resource-planning, prioritization, and allocation; and more purposive collaborative engagement in Nigeria and other low- and middle-income countries.

Unveiling the vulnerability of the human abducens nerve: insights from comparative cranial base anatomy in mammals and primates.

The topographic anatomy of the abducens nerve has been the subject of research for more than 150 years. Although its vulnerability was initially attributed to its length, this hypothesis has largely lost prominence. Instead, attention has shifted toward its intricate anatomical relations along the cranial base. Contrary to the extensive anatomical and neurosurgical literature on abducens nerve anatomy in humans, its complex anatomy in other species has received less emphasis. The main question addressed here is why the human abducens nerve is predisposed to injury. Specifically, we aim to perform a comparative analysis of the basicranial pathway of the abducens nerve in mammals and primates. Our hypothesis links its vulnerability to cranial base flexion, particularly around the sphenooccipital synchondrosis. We examined the abducens nerve pathway in various mammals, including primates, humans (N = 40; 60% males; 40% females), and human fetuses (N = 5; 60% males; 40% females). The findings are presented at both the macroscopic and histological levels. To associate our findings with basicranial flexion, we measured the cranial base angles in the species included in this study and compared them to data in the available literature. Our findings show that the primitive state of the abducens nerve pathway follows a nearly flat (unflexed) cranial base from the pontomedullary sulcus to the superior orbital fissure. Only the gulfar segment, where the nerve passes through Dorello's canal, demonstrates some degree of variation. We present evidence indicating that the derived state of the abducens pathway, which is most pronounced in humans from an early stage of development, is characterized by following the significantly more flexed basicranium. Overall, the present study elucidates the evolutionary basis for the vulnerability of the abducens nerve, especially within its gulfar and cavernous segments, which are situated at the main synchondroses between the anterior, middle, and posterior cranial fossae-a unique anatomical relation exclusive to the abducens nerve. The principal differences between the pathways of this nerve and those of other cranial nerves are discussed. The findings suggest that the highly flexed human cranial base plays a pivotal role in the intricate anatomical relations and resulting vulnerability of the abducens nerve.

SELECTED PATHOLOGICAL CONDITIONS WITHIN THE CAVERNOUS SINUS

The neurosurgical literature shows that the effectiveness of the main sinus outflow in its main function depends on access to the anatomy and pathology in the presellar area and the development of neuroimaging methods. The pathology of the cavernous sinus is often revealed in imaging tests, which are often accompanied by other tests unrelated to the cause. Tumors located within the cavernous sinus pose a significant challenge for surgeons. Although it is often possible to decide to opt out, it is possible. Not only tumors can be located in the cavernous sinus and affect placement in any structure. The aim of this work is to raise awareness of pathological conditions within the cavernous sinus. Methods: Selected articles from Pubmed and specialist textbooks were analyzed in detail. We focused on selected pathological conditions occurring within the cavernous sinus, which a doctor may often encounter in his clinical work. Conclusion: The cavernous sinus is a place where tumors and other pathologies arise. The development of imaging diagnostics allows neurosurgeons to more precisely determine the place within the sinus that has changed, and access to it is quite a challenge. Numerous observations of clinical conditions are increasingly a source of knowledge that can provide a therapeutic trial, but also speed up the detection of potential changes.

Clival Metastases: Single-Center Retrospective Case Series and Literature Review.

Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience and review the concerning literature. Methods: Our institutional registry was retrospectively reviewed, and patients who underwent surgical treatment for clival metastasis from 1998 to 2023 were included. A PRISMA systematic review of the literature was performed. Results: Four patients were enrolled, and all of them underwent an endoscopic endonasal approach (EEA). Three presented with cranial nerve (CN) VI palsy. The aim of surgery was biopsy in all cases. No complications were reported. Mean overall survival (OS) was 6 ± 1 months. The systematic review retrieved 27 papers reporting 39 patients who underwent the surgical treatment of clivus metastases. Most of them (79.5%) presented with CN palsies, and EEA was the preferred approach in 92.3% of the cases, to perform a biopsy in most patients (59%). Two hemorrhagic complications (5.1%) were reported, and the mean OS was 9.4 ± 5.6 months. Conclusions: Clival metastases are uncommonly observed, in most cases, during advanced stages of oncological disease. The aim of surgery should be the confirmation of diagnosis and symptomatic relief, balancing the risk-benefit ratio in a multidisciplinary context. EEA is the approach of choice, and it should be carried out in experienced tertiary skull base centers.

Is foramen magnum decompression for acquired Chiari I malformation like putting a finger in the dyke? - A simplistic overview of artificial intelligence in assessing critical upstream and downstream etiologies.

Missed diagnosis of evolving or coexisting idiopathic (IIH) and spontaneous intracranial hypotension (SIH) is often the reason for persistent or worsening symptoms after foramen magnum decompression for Chiari malformation (CM) I. We explore the role of artificial intelligence (AI)/convolutional neural networks (CNN) in Chiari I malformation in a combinatorial role for the first time in literature, exploring both upstream and downstream magnetic resonance findings as initial screening profilers in CM-1. We have also put together a review of all existing subtypes of CM and discuss the role of upright (gravity-aided) magnetic resonance imaging (MRI) in evaluating equivocal tonsillar descent on a lying-down MRI. We have formulated a workflow algorithm MaChiP 1.0 (Manjila Chiari Protocol 1.0) using upstream and downstream profilers, that cause de novo or worsening Chiari I malformation, which we plan to implement using AI. The PRISMA guidelines were used for "CM and machine learning and CNN" on PubMed database articles, and four articles specific to the topic were encountered. The radiologic criteria for IIH and SIH were applied from neurosurgical literature, and they were applied between primary and secondary (acquired) Chiari I malformations. An upstream etiology such as IIH or SIH and an isolated downstream etiology in the spine were characterized using the existing body of literature. We propose the utility of using four selected criteria for IIH and SIH each, over MRI T2 images of the brain and spine, predominantly sagittal sequences in upstream etiology in the brain and multiplanar MRI in spinal lesions. Using MaChiP 1.0 (patent/ copyright pending) concepts, we have proposed the upstream and downstream profilers implicated in progressive Chiari I malformation. The upstream profilers included findings of brain sagging, slope of the third ventricular floor, pontomesencephalic angle, mamillopontine distance, lateral ventricular angle, internal cerebral vein-vein of Galen angle, and displacement of iter, clivus length, tonsillar descent, etc., suggestive of SIH. The IIH features noted in upstream pathologies were posterior flattening of globe of the eye, partial empty sella, optic nerve sheath distortion, and optic nerve tortuosity in MRI. The downstream etiologies involved spinal cerebrospinal fluid (CSF) leak from dural tear, meningeal diverticula, CSF-venous fistulae, etc. AI would help offer predictive analysis along the spectrum of upstream and downstream etiologies, ensuring safety and efficacy in treating secondary (acquired) Chiari I malformation, especially with coexisting IIH and SIH. The MaChiP 1.0 algorithm can help document worsening of a previously diagnosed CM-1 and find the exact etiology of a secondary CM-I. However, the role of posterior fossa morphometry and cine-flow MRI data for intracranial CSF flow dynamics, along with advanced spinal CSF studies using dynamic myelo-CT scanning in the formation of secondary CM-I is still being evaluated.

344 The World Neurosurgery Global Champions Program: First-year Experience of a Model Initiative for Reducing Disparities in Global Neurosurgical Literature

INTRODUCTION: Most surgical journals are published in English, representing a challenge for individuals from non-Anglophone countries and contributing to disparities in research globally. METHODS: The GCP was advertised via the journal website and social media. Applicants were selected to be a reviewer for the GCP if they demonstrated English proficiency. Authors received information about the program if their article was rejected on the basis of poor English language. The workflow is shown.The demographics of GCP members and characteristics and outcomes of articles edited by the GCP during its first year were reviewed. Surveys of GCP members and authors who used the service were conducted. RESULTS: Twenty-one individuals became part of the GCP, representing 8 countries and 16 languages apart from English. A total of 380 manuscripts were peer-reviewed and a final decision given by the editor-in-chief to have potentially worthwhile content but rejected due to poor language. The authors of these manuscripts were informed of the existence of this language assistance program. Forty-nine articles (12.9%) were edited by the GCP in 41.6 ± 22.8 days. Of 40 articles resubmitted to World Neurosurgery, 24 (60.0%) were accepted. GCP members and authors understood the purpose and workflow of the program and recognized improvements in article quality and the probability of acceptance through their participation. CONCLUSIONS: The World Neurosurgery Global Champions Program mitigated a critical barrier to publication in an English language journal for authors from non-Anglophone countries and promoted research equity by providing a free, largely medical student and trainee operated, English language editing service. This model or a similar service can be replicated by other journals.

Incidence and Risk Factors of Surgical Site Infection After Cranial Surgery for Patients with Brain Tumors: A Systematic Review and Meta-analysis

Surgical site infections after craniotomy (SSI-CRANs) are a serious adverse event given the proximity of the wound to the central nervous system. SSI-CRANs are associated with substantial patient morbidity and mortality. Despite the importance and recognition of this event in other surgical fields, there is a paucity of evidence in the neurosurgical literature devoted to SSI-CRAN specifically in patients after brain tumor surgery. Systematic searches of Medline, Embase, and Cochrane Central were undertaken. The primary outcome was the incidence of SSI-CRAN at 30 and 90 days. Secondary outcomes were risk factors for SSI-CRAN. Thirty-seven studies reporting 91,907 patients with brain tumors who underwent cranial surgery were included in the meta-analysis. Pooled incidence of SSI-CRAN at 30 and 90 days was 4.03% (95% CI: 2.94%-5.28%, I2= 97.3) and 6.17% (95% CI: 3.16%-10.07%, I2= 97.3), respectively. Specifically, incidence of SSI-CRAN following surgery for posterior fossa tumors was the highest at 9.67% (95% CI: 5.98%-14.09%, I2= 75.5). Overall pooled incidence of readmission within 30 days and reoperation due to SSI-CRAN were 13.9% (95% CI: 12.5%-15.5%, I2= 0.0) and 16.3% (95% CI: 5.4%-31.3%, I2= 72.9), respectively. Risk factors for SSI-CRAN included reintervention (risk ratio [RR] 1.58, 95% CI: 1.22-2.04, I2= 0.0), previous radiotherapy (RR 1.69, 95% CI: 1.20-2.38, I2= 0.0), longer duration of operation (mean difference 64.18, 95% CI: 3.96-124.40 minutes, I2= 90.3) and cerebrospinal fluid (CSF) leaks (RR 14.26, 95% CI: 2.14-94.90, I2= 73.2). SSI-CRAN affects up to 1 in 14 patients with brain tumors. High-risk groups include those with reintervention, previous radiotherapy, longer duration of operation, and CSF leaks. Further prospective studies should focus on bundles of care that will reduce SSI-CRAN.

Neurosurgical literature classification – Evaluation of three automated methods and time trend analysis of the literature

BackgroundAutomated supervised text classification methods require preclassified training data. Their application in scenarios that a large amount of preclassified data is not accessible is challenging. Neurosurgical literature classification into subspecialties is an example of this situation. We have introduced an automated similarity-based text classification method, evaluated it along with two other automated methods and applied the introduced method in neurosurgical literature classification. MethodsPerformance of an introduced similarity-based text classification method along with two other automated methods (Lbl2Vec and keyword counting-based methods) was compared with performance of two senior neurosurgery registrars in classification of neurosurgical literature to 5 subspecialties. The Kappa-statistic measure of interrater agreement, overall marginal homogeneity using the Stuart-Maxwell test, marginal homogeneity relative to individual categories using McNemar tests and the sensitivity and specificity of each of the three methods were calculated.The introduced method was used to classify 211617 neurosurgical publications indexed in Pubmed to different subspecialties based on keywords extracted from subspecialty sections of a neurosurgery textbook. ResultsThe introduced similarity-based method showed the highest agreement with the registrars (raw agreement and Kappa value) followed by the Lbl2Vec and the counting-based method. Classifications of the English neurosurgical publications indexed in Pubmed into categories of Oncology, Vascular, Spine and functional using the introduced similarity-based method were more reliable (closer to the registrars’ classifications) than Cranial trauma. The classifications and future forecast showed highest publications in Oncology, followed by Cranial trauma, Vascular, spine and functional neurosurgery. ConclusionThe classification of the English neurosurgical publications indexed in Pubmed to different subspecialties, using the introduced method, shows that Oncology and tumour has been the main battleground for the neurosurgeons over years and probably in the near future. The performance of the introduced classification method in comparison with the human performance shows its potential application in the situations that enough preclassified data are not accessible for automated text classification.

Metal allergy and neurovascular stenting: A systematic review.

Intracranial stents and flow diverters contain significant amounts of metals, notably nickel, which can cause allergic reactions in a considerable portion of the population. These allergic responses may lead to complications like in-stent stenosis (ISS) and TIA/Stroke in patients receiving stents or flow diverters for intracranial aneurysms. We conducted a systematic review of studies from inception until July 2023, which reported outcomes of patients with metal allergy undergoing neurovascular stenting. The skin patch test was used to group patients into those with positive, negative, or absent patch test results but with a known history of metal allergy. Our review included seven studies with a total of 39 patients. Among them, 87% had a history of metal allergy before treatment. Most aneurysms (89%) were in the anterior circulation and the rest (11%) were in the posterior circulation. Skin patch tests were performed in 59% of patients, with 24% showing positive results and 33% negative. Incidental ISS was observed in 18% of patients, and the rate of TIA/Stroke was reported in 21%. The pooled rates of ISS and TIA/Stroke were higher in the first group (43% and 38%) compared to the second (18% and 9%) and third groups (15% and 15%), but these differences were not statistically significant. The current neurosurgical literature does not provide a conclusive association between metal allergy and increased complications among patients undergoing neurovascular stenting. Further studies are necessary to gain a more comprehensive understanding of this topic.

Cerebral Salt Wasting Syndrome in an Elderly Patient with Cerebral Small Vessel Disease

Background: Cerebral salt wasting syndrome is reported in neurosurgical literature from traumatic and non-traumatic brain injuries. No cases have been reported in the medical literature secondary to cerebral small vessel disease. Introduction: Hyponatremia is a common electrolyte disturbance seen among the acute geriatric admissions with two common diagnostic entities; the secretion of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSWS) that have different clinical and biochemical presentations, different pathogenesis and therapeutic approaches. Hyponatremia caused by CSWS in patients with cerebral small vessel disease (cSVD)- a prevalent condition among the elderly, can be masked in geriatric patients with concomitant fluctuating neurological deficits. Correct diagnosis is crucial to appropriate management. In this case report we describe an association between hyponatremia caused by CSWS in a patient with cSVD.