Spinal Neurosurgery Research Articles

Enhanced recovery after surgery (ERAS) in spine surgery: A systematic review

Introduction. In recent years, Enhanced recovery after surgery (ERAS), or Fast-track, has been actively developed and introduced into clinical practice in many industry of surgery in Europe and the USA. However, the ERAS® Society has not yet approved a unified protocol in spinal neurosurgery, and most of the publications on the topic have appeared only in the last few years.The purpose of the study is to present a systematic review of the literature to identify the key elements of the ERAS program and the effect of their use, as well as the impact on complications in the following areas of spinal neurosurgery: deformities, trauma, degenerative, infectious and oncology diseases.Materials and methods. The authors analyzed and systematically reviewed all published literature on ERAS in spine and spinal cord surgery up to October 10, 2020 using the main databases of medical literature and search resources PubMed and eLibrary according to the PICOS inclusion and exclusion criteria, as well as the recommendations of the protocol for writing systematic reviews. and PRISMA meta-analyses.Results. We analyzed 13 articles considering the use of ERAS technology in surgery for deformities (n = 3), degenerative (n = 8) and tumor (n = 2) lesions of the spine. The level of evidence of the study is 2a. The publications contain information on the treatment of 2,777 patients, whose average age was 50.5 years (from 14.0 to 72.4 years). The ERAS protocol has been implemented in clinics in the USA (46 %), China (30 %), France (8 %), Russia (8 %) and Great Britain (8 %). The average number of key elements of the ERAS program was 13.7 (range 5 to 24). The most popular are: preoperative patient counseling and education, minimally invasive surgery, multimodal analgesia, early mobilization and enteral loading, as well as active follow-up and care. The introduction of the ERAS protocol in spinal surgery made it possible, compared with the control group, to reduce the duration of hospitalization by 1.8 days (from 0.17 to 3.2 days), the cost of treatment by $ 1,443.75 (from 146 to $ 3,444), the severity of pain syndrome and the use of opioids in 38 % of cases, the consumption of antiemetics after surgery, as well as the time of surgery and blood loss at 29 minutes and 188 ml, respectively. For ERAS-groups, cardiovascular and respiratory complications are more typical, and for control groups – urinary, infectious, thromboembolic complications and liquorrhea. In general, there is a decrease in the total number of complications by 8.5 % (from 2.3 to 9.6 %).Conclusions. Enhanced recovery after surgery is a promising technology for improving the quality of care for patients in spine surgery.

The Relation of Surgical Procedures and Diagnosis Groups to Unplanned Readmission in Spinal Neurosurgery: A Retrospective Single Center Study.

Background: Unplanned readmission has gained increasing interest as a quality marker for inpatient care, as it is associated with patient mortality and higher economic costs. Spinal neurosurgery is characterized by a lack of epidemiologic readmission data. The aim of this study was to identify causes and predictors for unplanned readmissions related to index diagnoses and surgical procedures. Methods: In this study, from 2015 to 2017, spinal neurosurgical procedures were recorded for surgical and non-surgical treated patients. The main reasons for an unplanned readmission within 30 days following discharge were identified. Multivariate logarithmic regression revealed predictors of unplanned readmission. Results: A total of 1172 patient records were examined, of which 4.27% disclosed unplanned readmissions. Among the surgical patients, the readmission rate was 4.06%, mainly attributable to surgical site infections, while it was 5.06% for the non-surgical patients, attributable to uncontrolled pain. A night-time surgery presented as the independent predictive factor. Conclusion: In the heterogeneous group of spinal neurosurgical patients, stratification into diagnostic groups is necessary for statistical analysis. Degenerative lumbar spinal stenosis and spinal abscesses are mainly affected by unplanned readmission. The surgical procedure dorsal root ganglion stimulation is an independent predictor of unplanned re-hospitalizations, as is the timing of surgery.

Minimally Invasive Posterolateral Approach for Surgical Resection of Dumbbell Tumors of the Lumbar Spine.

Minimally invasive spine surgery (MISS) has many advantages over traditional open surgical procedures that can be conducted for the therapy of different diseases of the spine. MISS provide many prospective advantages such as, for example, small incisions, less damage to soft tissues, early activation of patients, and a shorter postoperative hospital stay. The aim of the study was to evaluate institutional experience with Dumbbell tumors and metastatic lesions of the lumbar spine and compare it with traditional open surgical resection of this type of tumors. Fourteen patients underwent the surgery with minimally invasive posterolateral approach in experimental group, and 10 patients of the control group were operated using the traditional open surgery procedure at the Department of spinal neurosurgery and pathology of peripheral nervous system of JSC “National Center for Neurosurgery.” The intraoperative neuro monitoring system (ISIS IOM System Compact, Inomed, Germany) was used in both groups. Sensory and motor evoked potentials were intraoperatively recorded. The present study was approved by the local Ethics Committee of the National Center for Neurosurgery. Patients signed informed consent before the surgical procedure. The experimental group included 14 patients, that underwent the surgery during the period from January 2020 till March 2021. And the control group included 10 patients that was operated from January 2018 to December 2019. The results of the treatment in both groups were assessed according to the generally accepted visual analog scale (VAS) and the Oswestry scales before, on the third day, and 3 months after the surgery. In experimental group, average reduction of the pain syndrome of 3.36 points (from 3 to 0 points) was observed in patients postoperatively according to the VAS 3 days, and of 4.0 points (from 2 to 0 points) 3 months after surgical procedures. Improvement by 23.86% (36–16%) was also observed using the Oswestry Disease Index (ODI) 3 days after the surgery, and then reduced to 21.00% (16–34%) in average in 3 months. All patients were revived 3 h after transfer to the specialist department. The average stay in the hospital was 6.5 (9–4) days in both groups. In control group, average reduction of the pain syndrome of 2.60 points (from 4 to 1 points) was observed postoperatively according to the VAS 3 days after the operation, and of 3.9 points (from 2 to 0 points) 3 months after the surgery. The ODI of patients was also improved by an average of 35.40% (50–20%) 3 days after the surgical procedure, and reduced to 24.20% (16–32%) in average 3 months after the surgery.

Cognitive and emotional disorders in neurosurgical patients and their impact on postoperative rehabilitation

To evaluate the severity of emotional and cognitive disorders, as well as the effectiveness of cognitive-motor training in patients who have undergone spinal cord surgery. Sixty patients (30 men and 30 women), who were scheduled and subsequently underwent spinal cord surgery, were studied. The patients underwent clinical, somatic and neurological status examinations and quantitative neuropsychological testing. The study was conducted before surgery, a week later, 3 months and 6 months after surgery. The patients were randomly assigned to the main and control groups of 30/30 people by the method of random numbers. The patients did not significantly differ in gender, age and level of education. Patients of the main group, in addition to drug therapy, received cognitive training, which was conducted using the methodological manual «Cognitive training for patients with moderate cognitive disorders» developed by the staff of the Department of Nervous Diseases and Neurosurgery of the A.Ya. Kozhevnikov Clinic of the I.M. Sechenov First Moscow State Medical University on the basis of the I.M. Sechenov First Moscow State Medical University (Sechenov University). Cognitive and emotional disorders have an impact on the quality of rehabilitation of patients after spinal neurosurgery. Cognitive-motor training included in the rehabilitation program of patients has a positive effect on the cognitive functions of patients and the level of anxiety. Evaluation of the results of postoperative rehabilitation show that the patients of the main group have significantly higher quality of life. Cognitive and emotional-affective disorders in patients after spinal neurosurgery have a negative impact on the quality of life. The inclusion of cognitive-motor training in the rehabilitation program makes it possible to reduce the severity of cognitive and emotional disorders in the postoperative period and improves the quality of life of patients. The results allow us to recommend the inclusion of cognitive-motor training in the rehabilitation program of patients after spinal neurosurgical operations.

POSB78 Economic Analysis of Adherus Autospray Dural Sealant As an Adjunct to Standard Methods of Dural Repair to Provide Watertight Closure during Cranial Procedures: Postoperative Complications and Costs

Postoperative cerebrospinal fluid (CSF) leaks, pseudomeningoceles, and device related infections are among the most common and challenging complications in cranial and spinal neurosurgery, requiring revision surgeries and prolonged hospitalization, therefore resulting in increased healthcare costs. This analysis aims to estimate the budget impact of using Adherus Dural Sealant as an adjunct to standard methods of dural repair, such as sutures, to provide watertight closure during cranial procedures. A health economic model was developed comparing three different treatment scenarios for performing cranial procedures: [I] standard dural closures (no dural sealant), dural closure with dural sealants: [II] DuraSeal, or [III] Adherus Dural Sealant. Data from published clinical trial results for the number of patients (117 for standard closures, 117 for DuraSeal, and 114 for Adherus), treatment costs (€875 for dural sealant), post-operative complications (5 revisions with standard dural closures, 5 with DuraSeal, 1 with Adherus) and costs associated with treatment of complications (€48.898 for each revision) were used to estimate (i) the total costs and (ii) costs per patient associated with using each of the treatment options. Results are presented in EUR at 2021 price level. Costs associated with using dural sealant were $0 for standard dural closures, €102.375 for DuraSeal, and €99.750 for Adherus. Costs associated with performing revisions were €244.491 for standard dural closures, €244.491 for DuraSeal, and €48.898 for Adherus. Total costs were estimated to be €244.491 for standard dural closures, €346.866 for DuraSeal, and €148.648 for Adherus. This resulted in costs per patient as: €2.090 for standard dural closures, €2.965 for DuraSeal, and €1.304 for Adherus. Results from this model analysis suggest that, compared to standard dural closures, the use of Adherus in performing cranial procedures potentially has a positive budget impact driven by reduced post-operative complications and increased healthcare cost-savings.

Postoperative prolonged epidural analgesia using disposable elastomeric pumps in elderly patients after spinal neurosurgery

BACKGROUND: Postoperative pain is a significant problem in patients that causes various complications.
 AIM: To evaluate the efficacy and safety of prolonged epidural analgesia using
 disposable elastomeric pumps in elderly patients undergoing spinal neurosurgery and its comparison with the traditional method of postoperative analgesia in 80 patients.
 MATERIALS AND METHODS: Hemodynamic parameters were recorded and the efficiency of pain relief and nature of postoperative complications were assessed in comparable groups. The concentration of interleukin-6 (IL-6) and IL-2 were determined.
 RESULTS: In the group with prolonged epidural analgesia with 0.2% ropivacaine solution, an adequate level of analgesia was achieved in 92% of the patients. The revealed changes in the blood serum levels of cytokines IL-6 and IL-2 may indicate a balanced response of the immune system in the group with prolonged epidural analgesia.
 CONCLUSIONS: Prolonged epidural analgesia using disposable elastomeric pumps provides complete pain relief for patients and correction of individual links of the surgical stress response.

Important controversies in lumbar spine surgery: which patients benefit from lumbar spinal fusion and who should be fused?

Considering the rising tendency in the application of lumbar spine devices, a rigorous selection of candidates for lumbar spinal fusion must follow the benefit of the patient in terms of a better outcome than classical techniques or conservatory treatment. We pulled essential information from scientific sources regarding the clinical results of patients who underwent fusion surgery to sift patients who do better from fusion.
 We found out that imagistic proof of instability such as spondylolisthesis associated with lumbar spinal stenosis and refractory pain takes the most from spinal fusion procedures. Oswestry disability index improvement along with restoring the function and reduction of pain remained the postoperative desires of a successful fusion. Clinical amelioration with bracing test prior to intervention was a predictor of better results after fusion. Exclusion criteria like psychiatric disorders and prior lumbar spine surgery were highlighted since studies demonstrated that they are bad predictors of outcome in spinal fusion surgery.
 Laminectomy was nowhere implemented in the literature as to be urgently fused since only about 20% of patients manifest instability after this classical procedure. Iatrogenic segmental instability after laminectomy, radiologically proven should be a candidate for spinal fusion. These procedures have high costs and high rates of complications putting the patient’s functional status and quality of life at uncertainty since there is still a lot of debate in this area of spinal neurosurgery.

Assessment of the incidence and nature of adverse events and their association with human error in neurosurgery. A prospective observation

IntroductionAdverse events in surgery are a relevant cause of costs, disability, or death, and their incidence is a key quality indicator that plays an important role in the future of health care. In neurosurgery, little is known about the frequency of adverse events and the contribution of human error. Research questionTo determine the incidence, nature and severity of adverse events in neurosurgery, and to investigate the contribution of human error. Material and methodsProspective observation of all adverse events occurring at an academic neurosurgery referral center focusing on neuro-oncology, cerebrovascular and spinal surgery. All 4176 inpatients treated between September 2019 and September 2020 were included. Adverse events were recorded daily and their nature, severity and a potential contribution of human error were evaluated weekly by all senior neurosurgeons of the department. Results25.0% of patients had at least one adverse event. In 25.9% of these cases, the major adverse event was associated with human error, mostly with execution (18.3%) or planning (5.6%) deficiencies. 48.8% of cases with adverse events were severe (≥SAVES-v2 grade 3). Patients with multiple adverse events (8.6%) had more severe adverse events (67.6%). Adverse events were more severe in cranial than in spinal neurosurgery (57.6 vs. 39.4%). Discussion and conclusionAdverse events occur frequently in neurosurgery. These data can serve as benchmarks when discussing quality-based accreditation and reimbursement in upcoming health care reforms.The high frequency of human performance deficiencies contributing to adverse events shows that there is potential to further eliminate avoidable patient harm.

Assessment of Clinical Decision Support System Efficiency in Spinal Neurosurgery for Personalized Minimally Invasive Technologies Used on Lumbar Spine.

The aim of the study was to assess clinical decision support system (CDSS) in spinal surgery for personalized minimally invasive technologies on lumbar spine.Materials and MethodsThe prospective study involved 59 patients operated on using CDSS based on a personalized surgical algorithm considering patient-specific parameters of lumbar segments. Among them, 11 patients underwent total disk replacement (TDR), 25 and 23 patients had minimally invasive (MI-TLIF) and open (O-TLIF) dorsal rigid stabilization, respectively, according to an original technology. The comparative analysis was carried out using retrospective findings of 196 patients operated on involving TDR (n=42), MI-TLIF (n=79), and O-TLIF (n=75). The efficiency of CDSS medical algorithms was assessed by pain syndrome in the lumbar spine and lower limbs, as well as by patients’ functional status on discharge according to ODI, 3 and 6 months after the operation.ResultsThe comparison by gender characteristics and anthropometric data revealed no significant intergroup differences among the groups under study (p>0.05). Intergroup analysis of functional status by ODI, pain intensity in lower limbs and lumbar spine showed better clinical outcomes in patients operated using CDSS compared to a retrospective group (p<0.05): 6 months after TDR and O-TLIF, and 3 months after MI-TLIF.ConclusionThe study findings demonstrated high efficiency of CDSS developed for personalized surgical treatment of patients with degenerative lumbar spine diseases taking into consideration individual biometric parameters of lumbar segments.

Отдельные аспекты дифференциальной диагностики болевых синдромов при дискогенной нейрокомпрессионной патологии

Актуальность. Причин формирования синдрома неудачно оперированного позвоночника после оперативного удаления грыжи межпозвоночного диска (МПД) немало, и одной из них является неадекватный предоперационный отбор с гипердиагностикой или преувеличением клинического значения дискогенной нейрокомпрессионной патологии (ДНП). Нейрохирургическое лечение будет малоэффективным или неэффективным в случае сочетанной патологии с доминированием невертеброгенного заболевания или когда грыжа МПД является «маской» другой патологии, сопутствующей «немой» МРТ-находкой. Цель исследования — повышение качества предоперационного отбора больных с грыжами МПД путем усовершенствования дифференциальной диагностики дискогенных нейрокомпрессионных и других заболеваний, сопровождающихся болевым синдромом в шейно-плечевом или пояснично-тазовом участках и конечностях. Материалы и методы. По материалам клиники малоинвазивной и лазерной спинальной нейрохирургии ГУ «Институт нейрохирургии имени А.П. Ромоданова НАМНУ» (2013–2015 гг.), только 35,3 % больных с грыжами МПД, консультируемых по поводу устойчивых болевых синдромов, имели ДНП и нуждались в хирургическом лечении. Остальным пациентам (64,7 %) оперативное удаление грыж МПД не проводилось, поскольку единственной или доминирующей причиной боли у них были другие заболевания. В этой группе больных (4430 чел.) с клинически неактуальными грыжами МПД оценена структура причин болевого синдрома. Результаты. Установлено, что более чем в половине случаев причиной боли были мышечно-тонические и миосклеротомные синдромы (вертеброгенные рефлекторные (вторичные) и первичные энтезопатии в шейно-плечевом или пояснично-тазовом участках и конечностях) и почти по 17 % случаев приходилось на патологию внепозвоночных суставов или воспалительные заболевания нервной системы (ВЗНС). Приведены критерии дифференциальной диагностики болевых синдромов при ДНП и ВЗНС. Оценены этиологические факторы ВЗНС по данным комплексного лабораторного обследования. Описаны клинический случай ВЗНС у больного с грыжей МПД и алгоритм предоперационного отбора. Выводы. Диагностика грыжи МПД как причины неврологического синдрома возможна при полном соответствии клинических и нейровизуализационных данных. При выявленной диссоциации между неврологической симптоматикой и данными МРТ необходимо тщательное обследование пациентов с целью отграничения больных с ДНП, подлежащих нейрохирургическому лечению, от пациентов с асимптомными грыжами МПД при наличии других заболеваний или с доминированием невертеброгенного заболевания при сочетанной патологии.

Evaluating the utility and quality of large administrative databases in pediatric spinal neurosurgery research.

The purpose of this study was to assess the quality of articles utilizing large administrative databases toanswer questions related to pediatric spinal neurosurgery by quantifying their adherence to standard reportingguidelines. A systematic literature search was conducted with search terms including "pediatric" and "neurosurgery," associated neurosurgical diagnoses, and the names of known databases. Study abstracts were reviewed to identify clinical studies involving pediatric populations, spine-related pathology or procedures, and large administrative databases. Included studies were graded using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. A total of 28 papers of the initial 1496 identified met inclusion criteria. These papers involved 10 databases and had a mean study period of 11.46 ± 12.27 years. The subjects of these research papers were undergoing treatment of scoliosis (n = 5), spinal cord injury (n = 5), spinal cord tumors (n = 9), and spine surgery in general (n = 9). The mean STROBE score was 19.41 ± 2.02 (out of 22). Large administrative databases are commonly used within pediatric spine-related neurosurgical research to cover a broad spectrum of research questions and study topics. The heterogeneity of research to this point encourages the continued use of large databases to better understand treatment and diagnostic trends, perioperative and long-term outcomes, and rare pathologies within pediatric spinal neurosurgery.

Influences and consequences resulting in addictions in general and to chronic alcoholism, especially for patients with spinal cord injury

Introduction: Spinal cord injury can be a cause of severe disability, with important consequences at the individual and social levels. Causes are often produced by falls or road accidents; and addictions (particularly chronic ethylism) also increase the risk of vertebral-medullary lesions. Materials and Methods: With with the approval of the TEHBA Ethics Commission (no.17464/14.06.2019), we used specific tests (DASS-21, MOS SF-36, SMAST, AUDIT, CAGE, AIS) and we questioned a group of patients admitted to the THEBA Neuro-Muscle Recovery Clinic after being treated in the Spinal Neurosurgery Service for acute and subacute vertebral medullary trauma. Results: We evaluated the link between addictions (especially ethanol), the risk of spinal cord injury, and the underlying subacute evolution of patients with this pathology. Conclusions: Substance abuse (especially ethanol) increases the risk of spinal cord injury and is a serious public health problem. Keywords: SCI, DASS-21, MOS SF-36, AUDIT, CAGE, SMAST, Neuromuscular Recovery

Safety of Nitrous Oxide Anesthesia in a Selected Group of Patients Undergoing Neurosurgery: An Exploratory Subgroup Analysis of the ENIGMA Trials.

The Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia (ENIGMA)-I and ENIGMA-II were randomized clinical trials that assessed the safety of nitrous oxide anesthesia in patients undergoing noncardiac surgery. In this study, we performed an exploratory pooled analysis of both ENIGMA trials to assess the safety of nitrous oxide in a selected group of patients undergoing neurosurgery. Data from each ENIGMA trial were collated into a single database. Information regarding patient demographics, comorbidities, medication use, anesthesia, surgical procedure, and postoperative complications was extracted. Multivariate logistic regression was conducted for postoperative complications to assess the risk associated with nitrous oxide. A total of 830 patients were included in our analysis: 417 received nitrous oxide anesthesia, and 413 received nitrous oxide-free anesthesia. Baseline patient and perioperative characteristics were comparable. Procedural data were available for 535 patients (64%); of these, 507 (95%) underwent spinal neurosurgery and 28 (5%) underwent cranial neurosurgery. Patients in the nitrous oxide group had lower inspired oxygen concentration (30% vs. 38%; P<0.001) and end-tidal volatile agent concentration (0.56 vs. 0.89 minimal alveolar concentration equivalents; P<0.001) compared with the nitrous oxide-free group. Use of nitrous oxide was not associated with increased risk of postoperative complications (myocardial infarction, cardiac arrest, stroke, infection, severe vomiting, fever, pneumonia, pneumothorax, blood transfusion, venous thromboembolism, or death) (odds ratio: 1.22; 95% confidence interval: 0.89-1.65; P=0.22) or prolonged length of hospital stay (median 5.0 vs. 4.2 d for nitrous oxide and nitrous oxide-free groups; P=0.28). Nitrous oxide did not increase the risk of postoperative complications or prolonged length of hospital stay in the neurosurgical cohort enrolled in the ENIGMA-I and ENIGMA-II trials.

Commentary on "History of Spinal Neurosurgery and Spine Societies".

Commentary on "History of Spinal Neurosurgery and Spine Societies".

Reply to Commentary on "History of Spinal Neurosurgery and Spine Societies".

Reply to Commentary on "History of Spinal Neurosurgery and Spine Societies".

Patenting in medical sphere

This article is dedicated to examination of patenting in one of the crucial spheres of life &amp;ndash; medicine. Currently, the majority of countries, including Russia, send multiple patent requests for inventions that are important for restoration and support of human health. In compliance with the Decree of the President of the Russian Federation until 2024, it is planned that with regards of the number of patent applications for inventions Russia should shift to the fifth place worldwide. The subject of this research is the analysis of patent activity of inventors in medical sphere on the example of spinal neurosurgery. The history of patenting of the developments in medical sector in Russia is explored. The statistical data on patent applications from such countries as China, United States, Japan and South Korea is examined. The main goal of this work is to emphasize the importance of the developments in this sphere. The conclusion is made that Russian inventors can hold leading positions in the international market, but this requires giving due attention to patent legal protection of the inventions, as well as developing a set of measures that in one way or another would contribute to the export of inventions, copyright protection, and stimulation of their activity.

History of Spinal Neurosurgery and Spine Societies.

History of Spinal Neurosurgery and Spine Societies.

SI «A. P. ROMODANOV NEUROSURGERY INSTITUTE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE» CELEBRATES THE 70 - TH ANNIVERSARY

In 2020, State Institution «A. P. Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine» (hereinafter referred to as Institute) occupies the glorious anniversary – 70 years since its foundation. By order of the Minister of Health of the USSR No. 439 of July 3, 1950, the structure and staffing of the Kyiv Research Institute of Neurosurgery were approved in the amount of 291 units. The regulations on the Institute were approved by the Ministry of Health of Ukraine on August 4, 1950. Departments of Neuro-oncology, Acute Trauma of the Central and Peripheral Nervous System, Neurovascular Pathology, Restorative Neurosurgery and Pediatric Neurosurgery were established in the structure of the Institute. The Neurosurgery Institute in different years was headed by: O.I. Arutiunov (1950–1964), A.P. Romodanov (1964–1993), Yu.P. Zozulia (1993–2013), E.G. Pedachenko (since February 2013). Today, the Institute's clinical base consists of 15 specialized departments with 361 beds, where up to 7,000 patients are treated annually. In the out-patient department, from 30,000 to 40,000 patients receive counseling every year. In 15 operating rooms, more than 5,000 operations of the highest complexity are performed per year. Comprehensive examination and treatment of patients are provided by the scientific and diagnostic departments and laboratories. Currently, the Neurosurgery Institute staff amounts for 1,008 employees, including 38 doctors of medicine, 14 professors, and 80 candidates of medical sciences. Currently, the State Institution "Romodanov Neurosurgery Institute of NAMS of Ukraine" occupies a leading position in the diagnosing and treatment of neurosurgical pathology in Ukraine. The Institute has established and operates scientific schools on neurotrauma, neuro-oncology, vascular pathology of the brain and spinal cord, minimally invasive spinal neurosurgery, neurotransplantation, and neuroimmunology, which are headed and developed by leading specialists of the Institute. Throughout the existence of the Institute, training of scientific personnel is constantly carried out. The prospects for further development of the Neurosurgery Institute are intended in wide implementation of neuromodulation method, the development of gene therapy, the use of invasive electrophysiological studies and modern neuroimaging, the improvement and widespread adoption of endoscopic techniques in the neurosurgical practice, the development and implementation of methods of reconstructive neurosurgery and the treatment of chronic pain syndromes. It is extremely important for Ukraine to create a scientific and practical center for neurotrauma and a modern rehabilitation center on the basis of the Institute. Keywords: Neurosurgery Institute; anniversary; history

Artificial Intelligence Technologies in Neurosurgery: a Systematic Literature Review Using Topic Modeling. Part II: Research Objectives and Perspectives.

The current increase in the number of publications on the use of artificial intelligence (AI) technologies in neurosurgery indicates a new trend in clinical neuroscience.The aim of the study was to conduct a systematic literature review to highlight the main directions and trends in the use of AI in neurosurgery.Methods.Using the PubMed search engine, 327 original journal articles published from 1996 to July 2019 and related to the use of AI technologies in neurosurgery, were selected. The typical issues addressed by using AI were identified for each area of neurosurgery.Results.The typical AI applications within each of the five main areas of neurosurgery (neuro-oncology, functional, vascular, spinal neurosurgery, and traumatic brain injury) were defined.Conclusion.The article highlights the main areas and trends in the up-to-date AI research in neurosurgery, which might be helpful in planning new scientific projects.

Extending the Indication of the Superior Thyroid Artery as a Recipient Vessel for Complex Upper Body Defects.

Reconstruction of complex chest and upper back defects can pose a challenge to microsurgeons, especially when prior surgery, scarring, tumor resection, or radiotherapy, have caused a shortage of recipient vessels. Although already being a standard approach for head and neck reconstructions, we investigated whether the indication of the superior thyroid artery (STA) as a safe and universal recipient vessel could be extended for reconstruction in aforementioned regions. Seventeen patients received free myocutaneous vastus lateralis (MVL) muscle flaps for reconstruction of upper body defects (chest n = 11; upper back n = 6). In all cases, the STA was used for microvascular anastomosis because of a lack of standard recipient vessels. A retrospective chart review was performed and the data was screened for patients' demographics, intraoperative and perioperative details, flap survival, surgical complications, and overall long-term outcomes. Patients had a minimum follow-up of 6 months. Defects resulted from infections after cardiac surgery (n = 10), infections after spinal neurosurgery (n = 2) or tumor resection (n = 5). Average defect size measured 144.6 (range, 40-286 cm2; ±67.9 cm2), with a mean size of the MVL free flaps of 266.8 (range, 160-384 cm2; ±69.5 cm2). The flap success rate was 100%, with minor complications in 4 patients. No major complications were observed in any of the patients. The STA is a viable and safe alternative as a recipient vessel for reconstruction of upper body defects, especially when other vessels in proximity to the defect are deprived.