Search

To assess the efficacy and surgical outcomes of the simultaneous single-trajectory endoscopic biopsy and third ventriculostomy (ETV) in pineal region tumors. A systematic review and meta-analysis adhering to Cochrane Standards and PRISMA framework were conducted. PubMed, Embase, and Web Of Science databases were searched until December 2023. Outcomes included rate of histopathologic diagnosis success, ETV success, complications, required VPS, and mortality. Seventeen studies (N = 388) met inclusion criteria. Histopathologic diagnosis success rate was 90% for general population (95% CI: 86%–95%; I2 = 42%) and 94% for pediatric patients (95% CI: 89%–98%; I2 = 19%). ETV Success rate was 93% (95% CI: 88%–97%; I2 = 60%). An estimated risk of postoperative ETV complications was found to be 16% for the general population (95% CI: 5%–28%; I2 = 90%) and 5% for pediatric patients (95% CI: 0%–13%; I2 = 51%). The risk of requiring VPS was estimated as 2% (95% CI: 0%–4%; I2 = 39%) and for the pediatric population it was 7% (95% CI: 0%–16%; I2 = 69%). Mortality risk was found to be 1% (95% CI: 0%–3%; I2 = 0%). Simultaneous endoscopic biopsy and ETV demonstrated high diagnostic and therapeutic success rates. The procedure's safety profile, with low mortality and complications, supports its role in treating hydrocephalus associated to pineal region tumors. Subgroup analyses revealed higher diagnostic success rates and required VPS in the pediatric population, whilst it had lower complication rates. [ABSTRACT FROM AUTHOR]

Though currently considered a 'black box,' machine learning (ML) has a promising future to ameliorate the health-care burden of stroke which is the second leading cause of mortality worldwide. Through this study, we sought to review the most influential articles on the applications of ML in stroke. Web of Sciences database was searched, and a list of the top 50 most cited articles, assessing the application of ML in stroke, was prepared by 2 authors, independently. Subsequently, a detailed analysis was performed to characterize the most impactful studies. The total number of citations to the top 50 articles were 2959 (range 35–243 citations) with a median of 47 citations. Highest number of articles were published in the journal Stroke and the United States was the major contributing country. The majority of the studies focused on the utilization of ML to improve stroke risk prediction, diagnosis, and outcome prediction. Statistical analysis revealed an insignificant association between the total and mean number of citations and the impact factor of the journal (P = 0.516 and 0.987, respectively). Recent years have witnessed a surge in the application of ML in stroke, with an enhancement in interest and funding over the years. ML has revolutionized the management of stroke and continues to aid in the neurosurgical decision-making and care in stroke patients. [ABSTRACT FROM AUTHOR]

Medically refractory cases of trigeminal neuralgia often require treatment escalation. Surgical options include microvascular decompression and percutaneous ablation. This paper provides a bibliometric analysis of the most influential articles on the surgical management of trigeminal neuralgia. The Web of Science database was queried to identify the top 100 cited articles concerning surgical treatment of trigeminal neuralgia. The search terms used included ALL=(("trigeminal neuralgia" OR "tic douloureux" OR "Fothergill's disease" OR "Trifacial neuralgia") AND ("surgical treatment" OR "surgical management" OR "surgery" OR "neurosurgery") NOT ("radiosurgery" OR "gamma knife")). The extracted variables included the first and senior author names, journal, publication year, institution, and surgical modality. Our bibliometric search yielded 2104 studies, with 41,502 citations overall. Within the top 100 articles, Zakrzewska had the most first author papers (n = 5), and Burchiel had the most senior author papers (n = 6). The Massachusetts General Hospital was the most represented institution (n = 5). The United States was the most represented country (51%). Microvascular decompression was the most studied surgical strategy (51%), followed by percutaneous radiofrequency coagulation (9%), balloon/nerve compression (7%), and glycerol rhizolysis (7%). Some studies assessed multiple treatment modalities (22%). The types of studies included retrospective articles (58%), prospective articles (26%), reviews (10%), anatomic studies (2%), and basic science (1%). Neurosurgery (35%) and the Journal of Neurosurgery (33%) were the most represented journals. The current literature consists of retrospective reviews and mostly describes microvascular decompression for trigeminal neuralgia. Future studies should include further characterization of other surgical modalities such as percutaneous radiofrequency thermocoagulation, glycerol injection, and balloon compression. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to evaluate the risk factors for cage subsidence (CS) after oblique lumbar interbody fusion (OLIF). The cohort and case-control studies which reporting potential risk factors for CS following OLIF were searched in PubMed, Embase, and Web of Science from database inception to June 17, 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the literature according to the Newcastle Ottawa Scale. RevMan5.3 software was used for Meta analysis. χ2 statistics and I 2 statistics were used to evaluate heterogeneity, and the analysis results were represented by forest plots. A total of 8 studies with 280 cases of CS from 832 patients who underwent OLIF met the inclusion criteria. Elderly patients over 60 years old (odds ratio [OR] 2.44, 95% CI 1.38–4.31, P = 0.002), osteoporosis (OR 4.18, 95% CI 2.30–7.61, P = 0.002), end plate injury (OR 5.72, 95% CI 2.32–14.11, P = 0.0002), and overdistraction of intervertebral space (OR 1.67, 95% CI 1.3 2–2.11, P < 0.0001) were potential risk factors, while Hounsfield units value of the vertebral body (OR 0.97, 95% CI 0.95–1.00, P = 0.02) is a protective factor. The number of operative segments did not increase the risk of CS. Older age, osteoporosis, endplate injury, and overdistraction of the intervertebral space may increase the risk of CS after OLIF. Although the incidence rate of CS is low, implementing effective preventions is a priority for clinicians based on these risk factors. [ABSTRACT FROM AUTHOR]

To compare the safety and radiological effectiveness of lumbar interbody fusion with a 3D-printed porous titanium (3D-PPT) cage versus a polyetheretherketone (PEEK) cage for the treatment of lumbar degenerative disease. This study was registered at PROSPERO (CRD42023461511). We systematically searched the PubMed, Embase, and Web of Science databases for related studies from inception to September 3, 2023. Review Manager 5.3 was used to conduct this meta-analysis. The reoperation rate, complication rate, fusion rate, and subsidence rate were assessed using relative risk and 95% confidence intervals. Ten articles reporting 9 studies comparing lumbar interbody fusion with 3D-PPT cages versus PEEK cages for the treatment of lumbar degenerative disease were included. The subsidence rate at the 1-year follow-up in the 3D-PPT cage was significantly lower than that in the PEEK cage. The fusion rate in the 3D-PPT cage was significantly higher than that in the PEEK cage at the 6-month follow-up. No significant difference was identified between the 2 groups at the 12-month follow-up. No significant difference was identified between the 2 groups in terms of the complication rate and reoperation rate. There was a trend toward a lower complication rate and reoperation rate with the 3D-PPT cage. Compared with the PEEK cage, the 3D-PPT cage may be a safer implant. The 3D-PPT cage was associated with a higher fusion rate and lower subsidence rate. The 3D-PPT cage may accelerate the intervertebral fusion process, improve the quality of fusion and prevent the occurrence of subsidence. [ABSTRACT FROM AUTHOR]

The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory recommendations in the literature, which is limited to mostly case reports. We aimed to provide a comprehensive summary and analysis of symptoms, operative techniques, outcomes, and recurrence of all available surgical cases of AC of the CPA to date. A systematic literature search was performed in May 2022 querying several scientific databases. Inclusion criteria specified all studies and case reports of patients with AC located at the CPA for which any relevant surgical procedures were performed. A total of 55 patients from the literature and 5 treated at our institution were included. Mean patient age was 29 years (range, 0.08–79 years), with nearly twice (1.7×) as many female as male patients (37 female, 22 male). Headaches (35%), hearing loss (30%), vertigo (22%), and ataxia (22%) were the most common presentations. Following surgery, 95% experienced symptom improvement, with complete resolution in 64%. Of patients with hearing loss, 44% reported a return to normal. The rate of mortality was 1.69%, and 10% of tumors recurred (mean follow-up 2.3 years [range, 0–15 years]. Symptomatic AC of the CPA is rare. It exhibits a proclivity for females and commonly manifests with headache, hearing loss, vertigo, and ataxia. While careful selection for surgical candidacy is needed and intervention should be reserved for patients with severe symptoms, surgical decompression is an effective tool for symptom alleviation and recovery. [ABSTRACT FROM AUTHOR]

To systematically evaluate the efficacy of valproic acid (VPA) in rats with spinal cord injury (SCI) to reduce the risk of clinical conversion and provide a valuable reference for future animal and clinical studies. We searched scientific databases, including PubMed, Ovid-Embase, Web of Science, and Scopus databases. The relevant literature was searched from the establishment date of the database to June 28, 2023. The search results were screened, data were extracted, and the quality of the literature was evaluated independently by 2 reviewers. Among 656 nonduplicated references, 14 articles were included for meta-analysis. The summary results showed that the overall Basso, Beattie and Bresnahan scores of the VPA intervention group were significantly higher than those in the control group at 1–6 weeks after VPA intervention. Subgroup analysis showed that the injury model, administration dose, rat strain, country of study, or follow-up duration had no significant effect on the efficacy of VPA on rats with SCI. In addition, mesh analysis showed that high doses of the VPA group had a better effect on SCI rats, compared with the low dose group and the medium dose group. To date, this is the first systematic evaluation of the potential effects of VPA on motor recovery in rats with SCI. We concluded that VPA can promote motor recovery in rats with SCI, and higher doses of VPA seem to be more effective in rats with SCI. However, the limited quality and sample of included studies reduced the application of this meta-analysis. In the future, more high-quality, direct comparative studies are needed to explore this issue in depth. [ABSTRACT FROM AUTHOR]

To conduct a quantitative analysis of published studies on hematoma enlargement after intracerebral hemorrhage. Studies on hematoma enlargement after cerebral hemorrhage were retrieved from the Web of Science database on June 30, 2023. Microsoft Excel, VOSviewer, and CiteSpace software were used for bibliometric analysis and visualization, focusing on the quantitative characteristics of the literature. A total of 444 articles were published in 161 journals, with 2161 authors from 41 countries and 717 institutions. The most published authors, countries, and institutions were Goldstein, the USA, and Massachusetts General Hospital. Stroke published the most studies, but the average citation number per year of Lancet Neurology far exceeded that of other journals. The research field of hematoma enlargement is mainly divided into 3 focuses, including mechanisms, identification (computed tomography signs, predictive models), and treatment (hemostasis, antihypertensive therapy). Most bursts in publication number have been since 2010, where the highest burst was from research on spot signs, and the latest burst focused on tranexamic acid. Treatment using tranexamic acid based on different computed tomography signs is a focus of current research, but the effectiveness still requires further exploration. This bibliometric analysis analyzed the research framework and hotspots on hematoma enlargement after cerebral hemorrhage, which can help researchers better understand this field and provide potential suggestions for collaborations and research. [ABSTRACT FROM AUTHOR]

To compare the effect of different Modic changes (MC) grades on the cage subsidence rate after spinal interbody fusion surgery. We comprehensively searched the PubMed, Embase, and Web of Science databases from inception to August 13, 2023, for relevant randomized controlled trials and prospective and retrospective cohort studies. Review Manager 5.3 and STATA13.0 were used to conduct this meta-analysis. The subsidence rate was assessed using relative risk and 95% confidence intervals. Six studies with a total of 716 segments were allocated to four groups according to the type of MC. The subsidence rate in the non-Modic changes (NMC) was significantly lower than that in the MC. The subsidence rate in the NMC was significantly lower than that in the MC in the subgroup of cages with extra instrumentation. No significant difference was identified between the 2 groups in the oblique lumbar interbody fusion subgroup. The subsidence rate in the NMC was significantly lower than that in the MC in the transforaminal lumbar interbody fusion subgroup. The subsidence rate in the NMC was significantly lower than that in the MC1 and MC2. We found no significant difference between NMC and MC3, MC1 and MC2, MC1 and MC3, or MC2 and MC3. MC may be associated with a higher cage subsidence rate. With the increase in MC grades, the incidence of subsidence decreased gradually, but it was always higher than that in the NMC. Oblique lumbar interbody fusion may be a better choice for the treatment of lumbar degenerative disease with MC. [ABSTRACT FROM AUTHOR]

The field of neurosurgery has consistently represented an area of innovation and integration of technology since its inception. As such, machine learning (ML) has found its way into applications within neurosurgery relatively rapidly. Through this bibliometric review and cluster analysis, we seek to identify trends and emerging applications of ML within neurosurgery. A bibliometric analysis was carried out in the Web of Science database on publications from January 2000 to March 2023. The full data set of the 200 most cited publications including title, author information, journal, citation count, keywords, and abstracts for each publication was evaluated in CiteSpace. CiteSpace was used to elucidate publication characteristics, trends, and topic clusters via collaborate network analysis using the Kamada-Kawai algorithm. The 25 most cited titles were included in our analysis. Harvard University and its affiliates represented the top institution, contributing nearly 25% of publications in the literature. WORLD NEUROSURGERY was the journal with the highest net citation count of 747 (29%). Collaborative network analysis generated 12 unique clusters, the largest of which was machine learning, followed by feature importance and deep brain stimulation. This review highlights the most impactful articles pertaining to ML in the field of neurosurgery. ML has been applied into several sub-specialties within neurosurgery to optimize patient care, with special attention to outcome predictors, patient selection, and surgical decision making. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effectiveness and safety of various adjuvant regimens in patients with low-grade gliomas and to further explore the optimal adjuvant treatment for patients with low-grade gliomas and the differences in the efficacy of each treatment regimens in different tumor types. A comprehensive search of the PubMed, Cochrane Library, Ovid, Embase, and Web of Science databases was conducted to screen randomized and nonrandomized controlled trials related to adjuvant therapy in patients with low-grade gliomas. The Cochrane quality assessment method and the Newcastle-Ottawa Scale were used to assess the quality of the included randomized and nonrandomized controlled trials, respectively. The data from previous studies were extracted using Excel and GetData Graph Digitizer 2.26 software, and network meta-analysis was performed using RevMan 5.3 and Stata 16.0 statistical software. The specific ranking of 5-year progression-free survival (5-year PFS) for each treatment regimen from the best to the worst in patients with low-grade gliomas was surgery (S) combined with procarbazine, lomustine, and vincristine (S + PCV); surgery combined with standard radiotherapy and PCV multidrug chemotherapy (S + RT + PCV); surgery combined with standard radiotherapy and temozolomide monotherapy (S + RT + TMZ); surgery combined with enhanced radiotherapy (S + H-RT); surgery combined with standard radiotherapy (S + RT); surgery combined with TMZ (S + TMZ); and S. The 5-year overall survival (OS) ranking was S + RT + TMZ, S + RT + PCV, surgery combined with enhanced radiotherapy and TMZ monotherapy (S + H-RT + TMZ), S + H-RT, S + RT, and S. The 2-year progression-free survival ranking was S + RT + TMZ, S + PCV, S + RT, S + RT + PCV, S + TMZ, S + H-RT, and S. The 2-year overall survival ranking was S + RT + TMZ, S + H-RT + TMZ, S + RT, S + RT + PCV, S + H-RT, and S. The incidence of adverse events (≥3) was ranked from highest to lowest as follows: S + RT + PCV, S + RT + TMZ, S + PCV, S + H-RT, S + TMZ, and S + RT. In the isocitrate dehydrogenase 1/2 mutation nonchromosome 1p and 19q chromosome whole arm codeletion (IDHmt/noncoder) group, the S + RT + PCV and S + H-RT regimens had better 5-year PFS and 5-year OS. In the isocitrate dehydrogenase 1/2 mutation and chromosome 1p and 19q chromosome whole arm codeletion (IDHmt/coder) group, the 5-year PFS of each treatment regimen ranked from the best to the worst was S + RT + TMZ, S + RT + PCV, S + H-RT, S + RT, S + TMZ, and S. The order of 5-year OS from the best to the worst was S + H-RT, S + RT + TMZ, S + RT + PCV, S + RT, and S. In the isocitrate dehydrogenase 1/2 wild-type (IDHwt) group, the S + H-RT and S + TMZ regimens had better 5-year PFS. This study revealed that both the S + RT + TMZ and S + RT + PCV regimens might be effective therapies for treating patients with low-grade gliomas. Among these, the S + RT + TMZ regimen seemed to be safer but might lead to tumor deterioration. In the IDHmt/coder type, the S + RT + TMZ scheme might have a significant advantage. In the IDHmt/noncoder type, the S + RT + PCV scheme might be more dominant, while in the IDHwt type, the S + H-RT and S + TMZ schemes also might be good treatment options. [ABSTRACT FROM AUTHOR]

This study aimed to determine the bibliometric characteristics of scientific articles on systematic reviews of neurosurgery worldwide. Bibliographic searches were performed in journals indexed by the Web of Science database until 2022, with no language restrictions. A total of 771 articles were ultimately included on the basis of predefined inclusion criteria, which were manually reviewed. The bibliometric analysis involved the use of quantitative bibliometric indicators and network analysis, which were performed using the bibliometrix package in R and VOSviewer, respectively. The first publication was in 2002, and the number of publications increased over time, with the largest number of publications in 2021 (156 articles). The average number of citations per document was 17.36, and the annual growth rate was 6.82%. Nathan A. Shlobin was the author with the most published articles (19 articles). The most cited study was published by Jobst BC (2015). WORLD NEUROSURGERY was the journal with the most publications (51 articles). The country of corresponding authors with the most publications and the greatest number of total citations was the United States. The affiliations with the most articles were University of Toronto (67 articles) and Harvard Medical School (54 articles). The increasing trend during the past 20 years, and especially in the past 2 years, highlights the advancements in various subspecialities in the field. Our analysis revealed that North American and Western European countries are at the forefront of the field. There is a poor output of publications, authors, and affiliations in Latin-American and African countries. [ABSTRACT FROM AUTHOR]

Despite the use of intraoperative opioid analgesia, postoperative pain is often reported by patients undergoing craniotomies. Opioids also cause undesirable side effects in neurosurgical patients. Hence, the role of nonopioid analgesia has been explored for craniotomies in recent years. This systematic review evaluated evidence from randomized controlled trials (RCTs) comparing opioid and nonopioid analgesia during craniotomies regarding postoperative pain, recovery, and adverse events. Of the 10,459 records obtained by searching MEDLINE, Embase, and Web of Science databases, 6 RCTs were included. No difference was observed in pain scores between opioid and nonopioid analgesia at 1 and 24 hours after surgery: mean difference (MD), 1.11 units; 95% confidence interval [CI], −0.16 to 2.38, P = 0.09 and MD, −0.06 units; 95% CI, −1.14 to 1.01, P = 0.91, respectively. The time for first postoperative analgesic requirement was shorter with opioids but was not statistically significant (MD, −84.77 minutes; 95% CI, −254.65 to 85.11; P = 0.33). Postoperative nausea and vomiting (relative risk = 1.60; 95% CI, 0.96–2.66; P = 0.07) was similar but shivering (relative risk = 2.01; 95% CI, 1.09–3.71; P = 0.03) was greater in the opioid group than nonopioid group. There were no important differences in clinical outcomes between the groups in our review. The GRADE certainty of evidence was rated low for most outcomes. Available evidence does not suggest superiority of intraoperative nonopioid over opioid analgesia for postoperative pain in patients undergoing craniotomy. More studies are needed to firmly establish the role of nonopioid intraoperative analgesics as an alternative to opioids in this population. [ABSTRACT FROM AUTHOR]

Research serves to bolster clinical neurosurgery by critically assessing various disease pathologies, while identifying important challenges and opportunities. However, there is limited information on the landscape of the Ghanaian neurosurgical literature. A scoping review and bibliometric analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched from inception until December 21, 2021 for English language articles about neurosurgery in Ghana. 927 articles were identified and 66 were ultimately included in the analysis. A majority of them, 42.4%, were retrospective cohort studies, with 62.1% published after 2010. There were no randomized controlled or basic science studies. Most articles were published in the West African Journal of Medicine (24.2%) and non-infectious/non-traumatic spinal pathology was the most commonly discussed topic (22.7%); 66.7% of articles included only authors affiliated with Ghanaian institutions, and international collaborators frequently originated from the United States (15.9%). Only 22.7% of the manuscripts reported a funding source. Commonly reported challenges included limited sample sizes, delays in diagnosis and treatment, and lack of proper diagnostic tools and specialized care. This review revealed that while the Ghanaian academic neurosurgery output has been increasing over time, these have been limited to cohort studies largely assessing spine pathology. The Ghanaian neurosurgical research environment may be bolstered by an increase in research funding, the establishment of longitudinal clinical databases, training in research methodology, increased incentives for researchers, strengthening of research collaborative networks, and increased engagement of neurosurgical trainees in research. [ABSTRACT FROM AUTHOR]

Stroke represents the second highest disease burden worldwide. It is well documented that rapid stroke identification and treatment are associated with improved outcomes. In particular, prehospital stroke detection (PSD) devices have emerged as possible tools to facilitate more rapid and accurate stroke triage. Bibliometric analyses offer a powerful tool to characterize the entire field from an interdisciplinary perspective. This bibliometric analysis aims to analyze current themes and identify future trends within the PSD space. The Web of Science collection database was surveyed for PSD literature. Search terms focused on stroke diagnostic techniques, clinical indicators for ischemia/hemorrhage, and prehospital timing. Subsequently, VOSviewer was used for visual mapping analyses. A total of 237 documents were identified between 1995 and 2021 from 1190 different authors. Publication volume has increased greatly in recent years. Publications were spread across 156 journals with the largest journal, Stroke , contributing just 7 studies over 26 years. Keywords analysis showed that stroke, near-infrared spectroscopy, and electroencephalography were the most common keywords. Novel PSD devices are promising tools for the early detection and characterization of stroke. This study identifies recent increased attention to PSD technology, a trend that will likely continue in the coming years. Devices using near-infrared spectroscopy, ultrasonography, microwave, and electroencephalography represent the central areas of future PSD research. The multidisciplinary, and therefore fractured, nature of the PSD space requires those interested in the field to maintain active search habits across multiple journals to remain up to date on PSD innovations. [ABSTRACT FROM AUTHOR]

The goal of this study was to systematically review the management and outcomes of patients who developed pseudoaneurysm (PA) after carotid endarterectomy (postendarterectomy PA [PEPA]). Following the PRISMA guidelines, a systematic literature review was performed using PubMed, Scopus, and Web of Science databases from date of inception to June 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective review was conducted of patients who underwent neurosurgical evaluation of suspected PEPA at our institution. Of the 321 articles in the original literature search, 62 were selected. A total of 143 patients (93 men, 27 women; mean age, 70.7 years) diagnosed with PEPA were included. Mean time from carotid endarterectomy to PA diagnosis was 41.8 months. Primary repair data were available for 135 patients, including 19 with primary closures, 112 with patch or graft repairs, and 4 with eversion procedures. Fifty-five patients with PA (39%) presented with infection. Staphylococcal species were the most common causative organism. Of infected PAs, 89.1% were treated with open procedures. Overall complication rates of PAs treated via open, endovascular, and hybrid methods were 31%, 15.4%, and 0%, respectively. Open ligation (42.9%) and aneurysmectomy with grafting (36.4%) resulted in the highest rates of complications. Despite higher complication rates after open repair strategies, use of these techniques remains a viable option in situations requiring removal of infected patches or evacuation of large extravascular collections. Endovascular treatment options are associated with low numbers of complications and can be considered for primary PEPA treatment when infection is not present. [ABSTRACT FROM AUTHOR]

To systematically review existing literature on the neurosurgical management and outcomes of brain metastasis from pancreatic cancer in comparison with our institutional experience of this patient cohort. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was performed using PubMed, Ovid Embase, Scopus, and Web of Science databases from date of database inception to March 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective analysis was conducted of patients who underwent neurosurgical evaluation and treatment for intracranial metastatic lesions from pancreatic origin at a single institution. The original literature search yielded 292 articles, of which 17 studies comprising 23 patients with brain metastases of pancreatic origin were ultimately selected. Median overall survival from primary diagnosis of pancreatic cancer was 22 months (interquartile range: 3–84) and 3 months (interquartile range: 1–36) after diagnosis of brain metastasis. In our institutional cohort, 4 patients were identified with a median overall survival of 30.5 months (interquartile range: 2–108). Our institutional cohort experienced a prolonged median overall survival (3 months vs. 30.5 months, P = 0.03) compared with the literature. Brain metastasis from pancreatic cancer is rare and associated with a fatal outcome. However, based on the data presented in this review, patient-specific and treatment-related factors could signal better prognosis. Further studies are needed to elucidate multimodal therapy and survival to suggest a more personalized decision-making process. [ABSTRACT FROM AUTHOR]

This bibliometric analysis aims to identify the most impactful articles on hemangioblastoma (HB) and evaluate the trajectory of academic literature in the field. The authors performed a title search using the Web of Science database, with ("hemangioblastoma" OR "haemangioblastoma") as a search query. The top 100 cited articles from the years 1900–2020 were sorted by the descending order of the total citation count. The following variables were assessed for each article: title, first author name and institution, publication year, country of origin, citation count, citations per year, and journal impact factor. The query yielded 1918 articles related to the topic of HB that were published between the years 1900 and 2020 in 42 unique journals. The most prolific decade of publication was the 2000s (35%), followed by the 1990s (33%) and the 1980s (11%). The average citation count was 88.3 (range, 47–426), and the mean number of citations per year was 3.74 (range, 0.660–17.8). This is the first bibliometric analysis to evaluate the most influential HB publications. Though a majority of HBs are sporadic, these results suggest a research focus on von Hippel-Lindau–associated tumors. Despite established evidence for the potential to control HB growth with vascular endothelial growth factor inhibition, there are no known clinical trials underway for this investigation. There is a need for consistent treatment guidelines for asymptomatic HBs, as resection can prevent the development of neurological deficits. An improved understanding of the etiology of these neoplasms could promote the development of novel diagnostic and treatment methods. [ABSTRACT FROM AUTHOR]

Determine the bibliometric characteristics of scientific articles that address the subject of neurosurgery in Latin America and the Caribbean. A bibliographic search of original articles published in the Web of Science database up to 2021 was performed, without language restrictions. The terms included in the search strategy were Neurosurgery, neurosurgical procedures, and neurological surgical procedure. Articles according to the inclusion criteria in the Rayyan application were included. Subsequently, a quantitative bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer. We identified 882 articles published in 271 journals. The first publication was in 2006, the highest number of publications was in 2021, the annual percentage growth rate was 25.9, and the average number of citations per document was 11.2. The author with the highest number of publications was Teixeira MJ (41 articles), and the University of Sao Paulo had the highest number of articles on this topic. WORLD NEUROSURGERY was the journal with the most publications (120 articles), and the study by Carney et al (2017) was the most cited (1175 citations). The country of corresponding authors with the most publications and the greatest number of total citations was Brazil. Surgery, and Management were the most used keywords plus; however, in the most recent articles Simulation and Guidelines were used. In the past decade, there has been an increase in articles on neurosurgery in Latin America and the Caribbean. Scientific production in neurosurgery must continue to increase in order to promote evidence-based medicine. [ABSTRACT FROM AUTHOR]

With no cure for Alzheimer disease (AD), current efforts involve therapeutics that prevent further cognitive impairment. Deep brain stimulation (DBS) has been studied for its potential to mitigate AD symptoms. This systematic review investigates the efficacy of current and previous targets for their ability to slow cognitive decline in treating AD. A systematic review of the literature was performed through a search of the PubMed, Scopus, and Web of Science databases. Human studies between 1994 and 2023 were included. Sample size, cognitive outcomes, and complications were recorded for each study. Fourteen human studies were included: 7 studies with 6 distinct cohorts (n = 56) targeted the fornix, 6 studies with 3 distinct cohorts (n = 17) targeted the nucleus basalis of Meynert (NBM), and 1 study (n = 3) investigated DBS of the ventral striatum (VS). The Alzheimer's Disease Assessment Scale–Cognitive Subscale, Mini-Mental State Examination, and Clinical Dementia Rating Scale Sum of Boxes were used as the primary outcomes. In 5 of 6 cohorts where DBS targeted the fornix, cognitive decline was slowed based on the Alzheimer's Disease Assessment Scale–Cognitive Subscale or Mini-Mental State Examination scores. In 2 of 3 NBM cohorts, a similar reduction was reported. When DBS targeted the VS, the patients' Clinical Dementia Rating Scale Sum of Boxes scores indicated a slowed decline. This review summarizes current evidence and addresses variability in study designs regarding the therapeutic benefit of DBS of the fornix, NBM, and VS. Because of varying study parameters, varying outcome measures, varying study durations, and limited cohort sizes, definitive conclusions regarding the utility of DBS for AD cannot be made. Further investigation is needed to determine the safety and efficacy of DBS for AD. [ABSTRACT FROM AUTHOR]

Exoscopes were recently developed as an alternative to the operative microscope (OM) and endoscope for intraoperative visualization during neurosurgery. Prior reviews studying mixed cranial and spinal surgical cohorts reported advantages with exoscope use, including improved ergonomics and teaching. In recent years, there has been an increase in exoscope research, with no updated systematic review focused exclusively on the benefits and limitations of exoscope use in spine surgery. Thus, we sought to systematically synthesize the literature related to exoscope-assisted spine surgery. A literature search was conducted using the PubMed, Embase, Scopus, Cochrane, and Web of Science databases to identify relevant studies reported between 2010 and September 2023. Data, such as the exoscope model used, procedure types performed, and user observations, were then collected. A total of 31 studies met our inclusion criteria, including 481 patients with spine pathologies who underwent a surgical procedure using 1 of 9 exoscope models. The lumbar region was the most frequently operated area (n = 234; 48.6%), and discectomies comprised the most overall procedures (n = 273; 56.8%). All patients benefited clinically. The reported advantages of exoscopes compared with OMs or endoscopes were improved focal distance, surgeon posture, trainee education, compactness, and assistant participation. Other aspects such as stereopsis, illumination, and cost had various observations. Exoscopes have advantages compared with OMs or endoscopes during spine surgery. The user learning curve is minimal, and no negative patient outcomes have been reported. However, some aspects of exoscope use necessitate longer term prospective research before exoscopes can be considered a standard tool in the armamentarium of intraoperative visualization strategies. [ABSTRACT FROM AUTHOR]

The National Inpatient Sample (NIS) (the largest all-payer inpatient database in the United States) is an important instrument for big data analysis of neurosurgical inquiries. However, earlier research has determined that many NIS studies are limited by common methodological pitfalls. In this study, we provide the first primer of NIS methodological procedures in the setting of neurosurgical research and review all reported neurosurgical studies using the NIS. We designed a protocol for neurosurgical big data research using the NIS, based on our subject matter expertise, NIS documentation, and input and verification from the Healthcare Cost and Utilization Project. We subsequently used a comprehensive search strategy to identify all neurosurgical studies using the NIS in the PubMed and MEDLINE, Embase, and Web of Science databases from inception to August 2021. Studies underwent qualitative categorization (years of NIS studied, neurosurgical subspecialty, age group, and thematic focus of study objective) and analysis of longitudinal trends. We identified a canonical, 4-step protocol for NIS analysis: study population selection; defining additional clinical variables; identification and coding of outcomes; and statistical analysis. Methodological nuances discussed include identifying neurosurgery-specific admissions, addressing missing data, calculating additional severity and hospital-specific metrics, coding perioperative complications, and applying survey weights to make nationwide estimates. Inherent database limitations and common pitfalls of NIS studies discussed include lack of disease process–specific variables and data after the index admission, inability to calculate certain hospital-specific variables after 2011, performing state-level analyses, conflating hospitalization charges and costs, and not following proper statistical methodology for performing survey-weighted regression. In a systematic review, we identified 647 neurosurgical studies using the NIS. Although almost 60% of studies were reported after 2015, <10% of studies analyzed NIS data after 2015. The average sample size of studies was 507,352 patients (standard deviation = 2,739,900). Most studies analyzed cranial procedures (58.1%) and adults (68.1%). The most prevalent topic areas analyzed were surgical outcome trends (35.7%) and health policy and economics (17.8%), whereas patient disparities (9.4%) and surgeon or hospital volume (6.6%) were the least studied. We present a standardized methodology to analyze the NIS, systematically review the state of the NIS neurosurgical literature, suggest potential future directions for neurosurgical big data inquiries, and outline recommendations to improve the design of future neurosurgical data instruments. [ABSTRACT FROM AUTHOR]

The purpose of our bibliometric analysis was to explore the disciplinary hotspots and collaborative networks in research on neuropathic pain (NPP) during in the past 20 years. The studies related to NPP were obtained from Web of Science database. Global publications on NPP were analyzed for different factors, including the number of reports, citation rates, authors, institutions, countries and regions, journals, funding, and relevant partnerships and topic hotspots. From 2001 to 2020, 6905 studies related to NPP research were reported worldwide. The number of publications had increased continually during the past 20 years. Pain was the most productive and most frequently co-cited journal. Ralf Baron was the most productive and influential author. The most productive country and institution were the United States and Harvard University, respectively. Investigators and institutions from the United States, Japan, and China were the core research forces. We found broad and close cooperation in the field worldwide. The top authors and top institutions had collaborated relatively closely with others. The research of NPP is a well-developed and prospective field of medical study. The journals Pain, European Journal of Pain, and Molecular Pain showed more interested in this field. The United States, Harvard University, and Ralf Baron were the top country, institution, and author, respectively. Global research collaboration was extensive, with the top institutions and authors cooperating with others. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF)-venous fistula presents a pathologic connection between spinal subarachnoid space and adjacent epidural vein or veins. It is one of the 3 main causes of spontaneous intracranial hypotension along with dural defects and meningeal diverticulum. We performed a systematic review of the literature and analyzed individual participants' data focusing on clinical outcomes after different treatment modalities of CSF-venous fistula. Systematic review was conducted according to PRISMA recommendations. Literature search was performed in PubMed and Web of Science databases with following key phrases: "CSF-venous fistula", "Spontaneous intracranial hypotension". Overall, 97 articles were found during the initial search; 15 were included for the final analysis, with a total number of 137 patients. Epidural blood patch (EBP) was performed as a first-line treatment in 37.1% of patients in individual data group, often not combined with fibrin glue (61.5%). Either partial (69.2%) or no resolution (30.8%) of symptoms was achieved after EBP injection. Nerve root ligation was the most common method of exclusion of CSF-venous fistula. Complete resolution of symptoms was achieved in 69.0% of patients, in 21.4% it was partial and in 9.5% no regress was found. Endovascular treatment was described only in 1 study. Surgical ligation of fistula is a treatment of choice. In approximately 70% of patients complete long-term resolution of symptoms is achieved after surgery. Endovascular treatment and fibrin glue injections are prospective and evolving options, which require further investigation. [ABSTRACT FROM AUTHOR]

Gliomas are the most common primary malignant tumor of the central nervous system. At the present time, radiotherapy (RT) is the cornerstone of therapeutic approaches, but the worldwide research trends in RT for gliomas in the world are unclear. This bibliometric analysis aimed to investigate trends in glioma RT research since 2011. The Web of Science database was searched, and SigmaPlot 14.0 and VOSviewer software were used to analyze and visualize the trends. Bibliometric analysis of 5106 articles was conducted. While the number of publications per year was relatively steady, the number of citations grew exponentially from 356 in 2011 to 21,051 in 2020. Articles originated from 89 countries, with the majority from the United States. Journal of Neuro-Oncology and Texas A&M University were the journal and institution, respectively, with the highest number of publications. The articles mainly involved oncology, neurology, radiology, and surgery. This bibliometric analysis found an increased focus on glioblastoma, survival, and chemotherapy in glioma RT research. [ABSTRACT FROM AUTHOR]

Acta Neurochirurgica (ANCH) and World Neurosurgery (WN), are 2 journals of significant importance in the neurosurgical community and have been associated with international federations. These journals carry a similar impact factor. The difference is the years they have been active (ANCH starting publication in 1973 and WN in 2010). This factor allows for a unique opportunity to delve deep into comparative, scientometric parameters, to understand the evolution of neurosurgical research. A title-specific search of the Web of Science database using the keywords "Acta Neurochirurgica," "Acta," "Neurochirurgica," "World Neurosurgery," "World," and "Neurosurgery" was performed and arranged according to number of citations. The title of the articles, authors, corresponding authors, country of origin, journal of publication, year of publication, citation count. and journal impact factor were assessed. The average citation for ANCH was 170.1 citations, most being original articles (83/100). The articles of WN garnered nearly 70.48 citations, averaging 8.3 citations per publication. Most corresponding authors in ANCH originated from Germany with neuro-oncology, followed by neurotrauma and vascular as subjects. In contrast, the United States followed by China were the most common countries of origin for WN , with endoscopy and skull base being the topics achieving high impact. Neurotrauma and consensus guidelines have been shown to have maximal citations for ANCH whereas endoscopy and skull base lesions garnered the most for WN. Author subspecialization and increased collaboration across specialties with more articles on refinement of technique and outcome have emerged as recent trends. [ABSTRACT FROM AUTHOR]

To conduct a systematic review and meta-analysis comparing the fusion rate after spinal fusion surgery between smokers and nonsmokers. We searched PubMed, Embase, Cochrane Library, and Web of Science electronic databases through March 10, 2021 for cohort and case–control studies assessing the effect of smoking on the fusion rate of spinal fusion surgery. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. Statistical analysis was performed using RevMan, version 5.4. A total of 26 studies, including 4 case–control studies and 22 cohort studies, with 4409 patients, were included in the present meta-analysis. Follow-up was at least 6 months. Overall, the pooled results demonstrated that the fusion rate of smokers after spinal fusion was significantly lower than that of nonsmokers. The odds ratio (OR) was 0.55 (95% confidence interval [CI] 0.45–0.67, P < 0.0001). Subgroup analyses by fusion level showed the adverse effect of smoking on the fusion rate at single level (OR 0.61, 95% CI 0.41–0.91, P = 0.02) was more significant than that of multiple levels (OR 0.55, 95% CI 0.38–0.80, P = 0.0010). Subgroup analysis according to the type of bone graft revealed an apparent association between smoking and fusion rate in the autograft subgroup (OR 0.47, 95% CI 0.33–0.66, P < 0.0001) but not in the allograft subgroup (OR 0.69, 95% CI 0.47–1.01, P = 0.06). The fusion rate of smokers is significantly lower than that of nonsmokers in spinal fusion surgery. Smokers should be encouraged to quit smoking to improve the outcome of spinal fusion surgery. [ABSTRACT FROM AUTHOR]

Primary intraparenchymal meningiomas are exceedingly rare and often challenging to diagnose, given their misleading radiologic features. It is hypothesized that they arise from the cap cells of the pia mater that enter the brain via penetrating blood vessels during brain development. We systematically reviewed and analyzed previously reported features of primary intraparenchymal meningiomas in terms of radiography, presenting symptoms, and histopathology. A literature search of the Web of Science and PubMed databases and crossed references was performed in March 2021, per PRISMA guidelines, with no restrictions regarding publication date. Data regarding demographic features, clinical, radiographic, and histopathologic characteristics were extracted. A total of 52 patients (including the reported case) were included in this review. The mean age was 21.1 years (range, 0.3–66 years) with a male/female ratio of 1.9:1. The most common localizations of intraparenchymal meningiomas were in the frontal (30.8%) and temporal (21.2%) lobes. Cyst formation was more readily observed and was noted in 51.4% of patients. Histopathology showed a higher incidence of World Health Organization grade II (14/52, 26.9%) and World Health Organization grade III (7/52, 13.5%) of primary intraparenchymal meningiomas. We present a comprehensive analysis of every reported primary intraparenchymal meningioma. Because of their rarity and capacity to mimic other more common intra-axial tumors, they represent a diagnostic challenge. This systematic review highlights the importance of paying attention to atypical intra-axial lesions, with a particular reflection on the discrepancy between clinical characteristics and imaging features. [ABSTRACT FROM AUTHOR]

Our aim was to re-evaluate the h-index of neurosurgical units in the United Kingdom and Ireland because it was 5 years since it was last reported. Using the Web of Science database, we collated cumulative (1950–2020), 10-year (2011–2020), 5-year (2016–2020), and 3-year (2018–2020) data for neurosurgical units in the United Kingdom and Ireland. Data included h-index, number of publications, and average number of citations. In total, 37 neurosurgical units were found in the United Kingdom and Ireland, which we ranked according to h-index. Since last reviewed 5 years previously, some units had changed their position, whereas others had remained reasonably static. The top 5 units were the same for the 10-year h-index between 2015 and 2020. The 5-year h-index showed some variation in the top 5 compared with the 10-year h-index. We were also able to compare 2 other studies with similar methods but differing from ours. The h-index for neurosurgical units is the most reliable bibliometric, which shows the academic standing and correlates well with amount of research grant obtained and size of department. It is particularly useful when calculated for the most recent 10-year and 5-year periods. Neurosurgical units change their rankings over time and, therefore, it is important to update the tables periodically. We propose an online database with open access showing all h-index and bibliometric data for neurosurgical units in the United Kingdom and Ireland. This database could provide a live and dynamic report of the academic standings of those units and could be used for grant applications and reviews. [ABSTRACT FROM AUTHOR]

The management of spine tumors is multimodal and personalized to each individual patient. Patients often require radiation therapy after surgical fixation. Although titanium implants are used most commonly, they produce significant artifact, leading to decreased confidence in target-volume coverage and normal tissue sparing. Carbon-based materials have been found to have minimal effects on dose perturbation in postoperative radiation therapy and have shown biostability and biocompatibility that are comparable to titanium implants. Using the PubMed and Web of Sciences databases, we conducted a systematic review of carbon-based screw and rod fixation systems in the treatment of spinal tumors. We reviewed clinical studies regarding safety of spine fixation with carbon fiber–reinforced (CFR) implants and biomechanical studies, as well as radiation and dosimetric studies. The radiolucency of CFR–polyether ether ketone implants has the potential to benefit patients with spine tumor. Clinical studies have shown no increase in complications with implementation of CFR–polyether ether ketone implants, and these devices seem to have sufficient stiffness and pullout strength. However, further trials are necessary to determine if there is a clinically significant impact on local tumor control. [ABSTRACT FROM AUTHOR]

The purpose of this bibliometric analysis was to identify trends and hot topics in research on lumbar spinal stenosis (LSS) over the past decade, for helping researchers explore new directions for future research in that area. All research articles on LSS, written in English and indexed in the Web of Science database (WoS) between 2010 and 2020, were used. The visualization of network and in-depth bibliometric analysis including the number of publications, countries, institutions, journals, authors, cited references, and key words was carried out with the help of CiteSpace. A total of 4033 papers (3577 original articles and 476 reviews) were identified and included in the study. The most productive year was in 2019. The Spine was the journal that published the highest number of articles and received the most citations. The most productive country and institutions in this field were the United States and Seoul National University, respectively. Kim HJ was the most prolific author, and Deyo RA ranked the first in the cited authors. The most cited article was published in 2010 by Deyo et al. and described the complications and charges index for LSS. From the coword cluster analysis, there were 3 frontiers in lumbar spinal stenosis: intervention, outcomes, and pathogenesis. We have summarized the literature on LSS in the past decade including publication information, country, institution, authors, and journal. Research on minimally invasive surgery, outcomes, and gene therapies in LSS will be hot topics in the future. [ABSTRACT FROM AUTHOR]

Surgery is the definitive treatment option for symptomatic Chiari malformation I (CMI), but there is no clear consensus as to the preferred surgical method. This study aimed to quantitatively assess and compare the effect and safety of dura splitting decompression (DSD) and posterior fossa decompression with duraplasty (PFDD) in treating patients with CMI. A literature search of EMBASE, MEDLINE, PubMed, Cochrane Library, and Web of Science databases was conducted. References from January 1990 to September 2020 were retrieved. We only included papers containing original data, comparing the use of DSD and PFDD in CMI patients. Overall, 11 relevant studies were identified, wherein 443 patients treated for CMI by DSD were compared with 261 patients treated by PFDD. No difference was observed between PFDD and PFD in terms of clinical improvement (P = 0.69), syringomyelia improvement (P = 0.90), or reoperation (P = 0.22). DSD was associated with shorter operation durations (P = 0.0007), shorter length of stay (P = 0.0007), and shorter overall postoperative complications (P < 0.0001) (especially cerebrospinal fluid [CSF] leak P = 0.005], meningitis P = 0.002], and pseudomeningocele P = 0.002]), as compared with PFDD. This study confirmed that dura splitting decompression has clinical and syringomyelia improvement outcomes comparable to posterior fossa decompression with duraplasty. Compared with PFDD, DSD not only significantly shortened the operation time and length of stay, but also significantly reduced the overall complication rate, especially those related to incidence of CSF-related complications. More evidence from advanced multicenter studies are needed to require to validate the findings. [ABSTRACT FROM AUTHOR]

This article is the first to identify the most influential articles on medulloblastoma using the citation analysis methodology. To perform a bibliometric analysis of the 100 most-cited articles on medulloblastoma. Using the Web of Science database, search criteria included the title-specific keyword "medulloblastoma" OR "cerebellar primitive neuroectodermal tumor (PNET)" OR "cerebellar PNET." Publications from 1900 to 2020 labeled "article," "review," "data set," or "clinical trial" were chosen and ranked based on total number of citations in descending order. Each article was evaluated based on the following variables: total citations, average citations per year, first author, institution of first author, title, publication year, country of origin, SCImago Journal Rank, and Scopus SNIP (Source Normalized Impact per Paper). Our search yielded 4928 articles on medulloblastoma. The 100 most-cited articles ranged from 192 to 2017 across 42 unique journals; Journal of Clinical Oncology accounted for the most publications (16%). Paul A. Northcott was first author of the most articles on the list (n = 7.7%), and the most widely cited article was "Altered neural cell fates and medulloblastoma in mouse patched mutants" by Goodrich et al., published in Science (1997). Because medulloblastoma represents the most common form of pediatric cancerous brain tumor, it is important to identify works that have significantly contributed to the body of knowledge regarding this disease. The 100 most-cited medulloblastoma articles comprise a significant collection of data regarding the histopathologic and molecular classification of medulloblastoma as well as clinical outcomes of therapeutics used to treat this disease. [ABSTRACT FROM AUTHOR]

There has been a significant expansion in endonasal endoscopic skull base surgery (EES) that has been used to address a wide range of intracranial and sinonasal pathologies. Although there exists a large amount of literature on approaches and patient outcomes, there is a paucity of data describing ergonomics in this field. Our goal was to evaluate and summarize the literature on ergonomics in EES. We systematically reviewed all published, peer-reviewed, English language literature in the PubMed and Web of Science databases as screened by multiple reviewers describing ergonomics as related to EES. A total of 50 articles were found that described significant conclusions and descriptions on ergonomics in EES. We found and summarized the different technical aspects of ergonomics as pertaining to EES and provided evidence-based suggestions on operating room and surgeon setup. There are several improvements in EES ergonomics that can decrease fatigue, improve efficiency, and overall surgeon well-being. [ABSTRACT FROM AUTHOR]

Radiation was first demonstrated to be associated with cavernomagenesis in 1992. Since then, a growing body of literature has shown the unique course and presentation of radiation-induced cavernous malformations (RICMs). This study summarizes the literature on RICMs and presents a single-center experience. A prospectively maintained single institution vascular malformation database was searched for all cases of intracranial cavernous malformation (January 1, 1997–December 31, 2021). For patients with a diagnosis of RICM, information on demographic characteristics, surgical treatments, radiation, and surgical outcomes was obtained and analyzed. A comprehensive literature search was conducted using PubMed, Embase, Cochrane, and Web of Science databases for all reported cases of RICM. A retrospective review of 1662 patients treated at a single institution yielded 10 patients with prior radiation treatment in the neck or head region and a subsequent diagnosis of intracranial RICM. The median (interquartile range) latency between radiation and presentation was 144 (108–192) months. Nine of 10 patients underwent surgery; symptoms improved for 5 patients, worsened for 3, and were stable for 1. The systematic literature review yielded 64 publications describing 248 patients with RICMs. Of the 248 literature review cases, 71 (28.6%) involved surgical resection. Of 39 patients with reported surgical outcomes, 32 (82%) experienced improvement. RICMs have a unique course and epidemiology. RICMs should be considered when patients with a history of radiation present with neurologic impairment. When RICMs are identified, symptomatic patients can be treated effectively with surgical excision and close follow-up. [ABSTRACT FROM AUTHOR]

Global neurosurgery is the practice of neurosurgery with the primary purpose of delivering timely, safe, and affordable neurosurgical care to all who need it. The aim of this study is to identify the most frequently cited articles in global neurosurgery through a bibliographic review to characterize articles and trends around this growing topic. The top most-cited articles in global neurosurgery were determined by searching the Web of Science database using a priori search terms. Articles with at least 5 citations were selected, and there were no time period or language restrictions. The data were extracted from each included article and all characteristics were summarized. A total of 932 articles were identified using the search terms; 69 articles fulfilled inclusion criteria and 17 articles were selected that had more than 5 citations. The articles' number of citations ranged from 6 to 98 for the most-cited article. Authors from, or affiliated with, 14 countries contributed to the 17 articles, and the country that had the greatest representation was the United States. The main topic discussed was surgical capacity, the second topic was the treatment of different neurosurgical conditions, and volunteerism was the third topic. There is currently a deficit in both the amount of literature surrounding the topic of global neurosurgery and how much that literature is cited. Developing innovative ways to increase academic productivity within, or in collaboration with, low-middle income countries is essential to contribute to global neurosurgery. [ABSTRACT FROM AUTHOR]

Bibliometric indexes are often used to evaluate and compare neurosurgeons and departments, and they have been shown to correlate with academic rank and department reputation. We evaluated academic productivity of neurosurgeons practicing in departments accredited by the Joint Residency Advisory and Accreditation Committee and European Association of Neurological Surgeons. In a cross-sectional study, we calculated number of publications, citations, h-index, and m-quotient from PubMed and Web of Science databases for 285 neurosurgeons affiliated with 19 departments that are accredited or in progress of accreditation by the Joint residency Advisory and Accreditation Committee. Academic productivity was compared as a function of academic rank and research degree. Median number of publications in PubMed and Web of Science indexed journals were 13 (range, 0–352) and 15 (range, 0–323), respectively. Median h-index was 4 (range, 0–41), and median m-quotient was 0.56 (range, 0–2.86). There was a significant variability between the studied departments in median number of publications and h-index (P = 0.001). Professors and associate professors had significantly higher bibliometric indexes than neurosurgeons without academic rank (all P values < 0.001). Department chairmen had higher bibliometric indexes than other faculty members (all P values < 0.001). Neurosurgeons holding a research degree authored more publications and had higher bibliometric indexes than faculty members not holding a research degree (P < 0.001). This is the first study to evaluate academic productivity of neurosurgeons practicing in Europe and Turkey. Higher academic rank and advanced research degree were associated with greater academic productivity. Further studies exploring regional differences in academic productivity of European neurosurgeons are encouraged. [ABSTRACT FROM AUTHOR]

A vast amount of articles centered on brain metastases have been published. To present the 100 most-cited articles dedicated to brain metastasis and to accomplish a broad literature review. In December 2019, we performed a title-focused search using the Thomson Reuters Web of Science database to identify the most cited articles centered on brain metastatic disease. Our search query term was based on using the following algorithm: "brain metastases" OR "brain metastasis" OR "brain metastatic disease" OR "cerebral metastases" OR "cerebral metastasis" OR "cerebral metastatic disease." Afterward, we reviewed the results to certify that they were relevant to the purposes of our research protocol. The 100 most cited papers were chosen and further analyzed. Our search resulted in 11,579 articles, published from 1975 until the completion of our survey. The most cited article, by Patchell et al., was published in 1990, with 1862 citations, and an average of 62.07 citations per year, whereas the last in our list, by Gaspar et al., was published in 2010, with 195 total citations, and an average of 19.50 citations per year. Countries with the highest-cited articles included the United States (75 records), followed by Canada (16 records). We discovered the top 100 most-cited articles centered on brain metastasis, all of which show a potentially increased level of interest, because they are meaningful scientific reports. In addition, we reviewed the historical development and advances in brain metastasis research and relevant points of interest, alongside the relevant contributions of different authors, fields of special interest, and countries. Many of the most cited articles were written by authors whose specialty was not neurosurgery or by neurosurgeons who were supported by colleagues from other medical fields. As a consequence, many of these articles were not published in neurosurgery-dedicated journals. [ABSTRACT FROM AUTHOR]

Most patients with glioma experience recurrence and have a poor prognosis. Scientometric analysis is effective and widely used to summarize the most influential studies within a certain field. We present the first scientometric analysis of recurrent glioma. We conducted a generalized search for articles on recurrent glioma in the Web of Science database and evaluated the top 100 most cited articles among 4651 articles. The number of citations from the top 100 cited articles on recurrent glioma ranged from 149 to 1471; most of these articles were published in oncology-specific journals (66) and were submitted by institutions in the United States (n = 67). The top-cited articles consisted of 98 articles and 2 literature reviews. Articles were classified into 4 major categories based on subject matter: 82 pertained to treatment, 6 pertained to genetic mechanisms, 7 pertained to diagnosis, and 5 pertained to prognosis. Treatment-related articles were subdivided into the following 7 categories: targeted therapy (n = 21), chemotherapy (n = 20), immunotherapy (n = 12), combination therapy (n = 12), radiotherapy (n = 9), surgical resection (n = 6), a new therapy (physiotherapy) (n = 1), and treatment summary (n = 1). The results of the analysis indicated that the core problem is the treatment of recurrent glioma. Although the number of citations on targeted therapy and combination therapy has increased in recent years, the proportion of randomized controlled trials, basic medical research, literature reviews, and meta-analyses is relatively low; thus, there is an urgent need to conduct these types of studies on recurrent glioma. [ABSTRACT FROM AUTHOR]

Up to 20% of patients fail to achieve reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) scores of 0–1 after mechanical thrombectomy (MT). Furthermore, underlying intracranial atherosclerotic disease, particularly when associated with >70% residual or flow limiting stenosis, is associated with higher rates of failed MT and high failure risk MT. The aim of this study was to systematically review the procedural and clinical outcomes in patients with failed MT and high failure risk MT. We also explored differences between patients receiving acute rescue stenting compared with medical management alone. A systematic literature search was conducted in Ovid MEDLINE, PubMed, Embase, and Cochrane online scientific publication databases for English language publications from their date of inception until October 2018. Studies including adult patients with acute ischemic stroke because of emergent large vessel occlusion with failed (mTICI score 0–1) or high failure risk MT within the anterior circulation who underwent rescue stenting were included. A systematic review and meta-analysis of proportions was performed. Rescue intracranial stenting after failed MT or high failure risk MT results in improved clinical outcomes compared with patients without stenting (48.5% vs. 19.7%, respectively; P < 0.001), without an increase in the rate of symptomatic intracranial hemorrhage, despite additional use of antiplatelet agents (9.7% vs. 14.1%, respectively; P = 0.04). In patients who fail initial attempts at MT or are high risk for acute reocclusion, rescue intracranial stenting could be considered with the aim to improve functional outcomes. Antiplatelet agents do not increase the risk of hemorrhage in these patients. [ABSTRACT FROM AUTHOR]

Spinal cord stimulation (SCS), a common invasive neuromodulation technique, induces pain relief via electrical stimulation of the dorsal column of the spinal cord. To present an overview of research publications on SCS, a bibliometric analysis of scientific publications from 1998 to 2017 was performed. The relevant data were obtained from the Web of Science and PubMed database. These articles were classified into several categories, such as total number, countries, institutions, authors, and citations reports. The analysis of co-occurrence key words was handled by VOSviewer software. We found that there existed an increasing trend in the number of publications on SCS between 1998 and 2017. Among these countries, the United States published the largest number of papers in the past 20 years. Case Western Reserve University in the United States contributed the most publications. Among all research categories, neuroscience neurology was the most common area. In addition, regarding article types, basic research comprised a great proportion of the total papers on SCS in the PubMed database. The author V. Reggie Edgerton from the United States was the most-frequent contributor among the authors. The results showed that "spinal cord," "stimulation," and "pain" were the most common key words in the past 20 years. This bibliometric analysis first provides a basic overview of research publications on SCS published during the last 2 decades. Considering the expanded indications of SCS, there are a lot of things to do, and various countries should increase support to complete high-quality SCS studies. [ABSTRACT FROM AUTHOR]

The use and timing of flow diversion for aneurysmal subarachnoid hemorrhage is controversial. The objective of this study is to perform a meta-analysis and systematic review to compare overall complication rate between early versus delayed flow diversion for ruptured aneurysms. A literature search for all eligible articles was performed using PubMed, Cochrane, and Web of Science databases. The primary outcome was the overall complication rate (any complication in the perioperative period), and secondary outcomes were 1) hemorrhage and 2) stroke/death (all hemorrhagic/ischemic strokes and/or death). Thirteen articles including 142 patients met inclusion criteria. Eighty-nine (62.7%) patients underwent early deployment of flow diverters (i.e., 2 days or less). The odds ratio for overall complication rate with early versus delayed flow diversion was 0.95 (95% confidence interval [CI] 0.36–2.49, P = 0.42). The odds ratio for the secondary outcome of hemorrhagic complication for early versus delayed flow diversion was 1.44 (95% CI 0.45–4.52, P = 0.87) and of stroke/death was 1.67 (95% CI 0.5–4.9, P = 0.69). The odds ratio of early versus delayed flow diversion for blister/dissecting/fusiform aneurysms was 0.82 (95% CI 0.29–2.30) and for saccular/giant aneurysms was 2.23 (95% CI 0.17–29.4). At last follow-up, 71.6% of patients had good performance status (modified Rankin Scale score 0–2), and the rate of angiographic aneurysm occlusion was 90.2%. This meta-analysis did not show a difference in overall complication rate between early versus delayed flow diversion for ruptured aneurysms. Early flow diversion for ruptured blister/fusiform/dissecting aneurysms carries a lower risk of aneurysm rerupture and overall complications as compared with that for ruptured saccular/giant aneurysms. [ABSTRACT FROM AUTHOR]

Anterior cervical spine operations are commonly performed on cervical spine pathologies and to a large extent are safe and successful. However, these surgical procedures expose the vertebral artery, posing a risk of harm to it. A systematic review was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to critically assess primary articles discussing treatment strategies "vertebral artery injury" AND "anterior cervical spine" and develop a management strategy based on our experience and meta-analysis of the literature. In addition, we present an illustrative case of iatrogenic vertebral artery injury presenting with 6 to 7 months' history of progressive dysphagia was transferred to our care from an outside institution. Included and analyzed were 43 articles that detailed 75 cases involving vertebral artery injury (VAI) in anterior cervical spine operations. Preoperatively, frequent clinical findings reported were sensory deficit (26 patients [63.41%]), motor deficit (20 patients [48.78%]), and pain (17 patients [41.46%]). In total, 32 patients (50.00%) endured injury of their left VA, and 30 patients had a right VAI. The 2 common causes of VAI were drilling (24 patients [40.00%]) and instrumentation (8 patients [13.33%]). Altogether, our review recommends repair or tamponade packing with a hemostatic agent for primary management. Should tamponade packing with a hemostatic agent be used for primary management, secondary management should entail either repair, stenting occlusion, embolization, anticoagulants, or ligation. Further examination of this treatment strategy based on a larger cohort is necessary. [ABSTRACT FROM AUTHOR]

Neurosurgeons, especially spine surgeons, have the highest risk of facing a malpractice claim. Average verdicts in spine surgery litigation has been shown to be over USD $1 million/case. This systematic review aimed to clarify the impact of tort reforms on neurosurgical health care environments across the United States, including patient outcomes, practice of defensive medicine, and physician supply aims. A systematic literature search was performed using PubMed, Embase, Cochrane, and Web of Science databases until May 13, 2022. Study quality was assessed using the quality assessment tool for studies reporting prevalence data. Five studies (all rated as good quality) were included. Two studies found that in higher-risk state malpractice environments, risk of postoperative complications was higher and odds of nonhome discharge were larger (odds ratio 1.1169, 95% confidence interval 1.139–1.200). One study found that neurosurgeons reported practice of defensive medicine by ordering more imaging in a higher-risk environment, while this was not shown in a study examining imaging rates in different medicolegal environments. One study observed that noneconomic damage caps were associated with a 3.9% increase of physician supply in high-risk specialties. There was a suggestive association between tort reforms and less practice of defensive medicine among neurosurgeons, improvement in postoperative outcomes in spinal fusion patients, and increase in physician supply. More elaborate studies on the medicolegal environment in neurosurgical practice are needed to give more insight on the current size of the problem that litigation presents in the United States and the effects tort reforms have on neurosurgical health care environments. [ABSTRACT FROM AUTHOR]

Inflammatory pathologies of the sella and orbit are rare but require prompt diagnosis to initiate effective treatment. Because uniform recommendations for treatment are currently lacking, we performed an evidence-based review to identify recommendations. We performed a literature search of the PubMed, Embase, and Web of Science databases to identify papers evaluating treatment of inflammatory pathologies of the sella and orbit. We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to define recommendations, specifically examining aggregated sample sizes, disease-specific patient follow-up, and clinical trials focused on inflammatory diseases of the sella and orbit. A total of 169 studies were included and organized by disease pathology. Treatments for various pathologies were recorded. Treatment options included surgery, radiation, steroids, targeted treatments, immunomodulators, intravenous immune globulin, and plasmapheresis. Steroids were the most often employed treatment, second-line management options and timing varied. Pathological diagnosis was highly associated with treatment used. Most evidence were level 3 without available control groups, except for 13 trials in neuromyelitis optica with level 1 or 2 evidence. This is the first evidence-based review to provide recommendations on specific treatments for pathologies of the orbit and sella. The reported data may be useful to help guide randomized clinical trials and provide resource for clinical management decisions based on the available evidence. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has the potential to augment clinicians' diagnostic and decision-making capabilities. It is well suited to identify patterns and correlations within data sets and may be applied to identify elements of importance in complex and data-laden areas such as patient selection, diagnostics, treatment, and outcome prediction. The development of modern neurosurgery has been dependent on major technological advances. In line with this, a growing interest is seen in the use of AI to assist in neurosurgical research and enhance neurosurgical practices. A bibliometric analysis of the 50 most-cited articles alluding to the use of AI in neurosurgery, from inception until July of 2022, was undertaken using the Web of Science database. Statistical analyses were performed on R. The citation count ranged from 29 to 159 (mean: 51.9, standard deviation: 24.8), and the top-cited article was a 2018 systematic review published in World Neurosurgery. Most articles were published after 2015 (85%). The United States was the largest contributing country on the list with 22 articles. Four first and last authors, each, had 2 or more publications. Female first and last authorship was attributed to 18% and 0% of the articles, respectively. This review highlights the most-impactful articles pertaining to AI in the field of neurosurgery. Although female authors were significantly underrepresented on the list, their work was at least as impactful as their male peers. Finally, the striking dominance of articles originating from the developed world raises concerns as to the future of AI in attending to the global health crisis. [ABSTRACT FROM AUTHOR]

The use of directional deep brain stimulation (dDBS) electrodes for the treatment of movement disorders such as Parkinson disease (PD) has become relatively widespread. However, the efficacy of dDBS relative to its omnidirectional deep brain stimulation (oDBS) counterpart is not well characterized. This systematic review aims to synthesize the literature comparing clinical and therapeutic outcomes of dDBS relative to oDBS in patients with PD. A systematic literature search for studies with comparative clinical outcome data between dDBS and oDBS was performed across the PubMed, Ovid MEDLINE, and Web of Science databases. Data including therapeutic window (TW) and surrogate measures and the Unified Parkinson's Disease Rating Scale score were collected and summarized across multiple time periods. Ten studies met the eligibility criteria. Three of these studies evaluated motor performance in the form of Unified Parkinson's Disease Rating Scale III, with none finding differences between dDBS and oDBS. Two studies assessed quality-of-life measures with neither finding differences between dDBS and oDBS. TW or a surrogate measure was assessed in 6 studies; 5 studies found an increase or strong trend toward increase in dDBS relative to oDBS. The current evidence, although limited by bias, does suggest that dDBS in the treatment of PD yields improvements in motor symptoms and quality of life that are comparable to oDBS; TW and surrogate measures are consistently improved in patients with PD under a directional configuration relative to omnidirectional. [ABSTRACT FROM AUTHOR]

In recent years, biportal endoscopic surgery has gained popularity, and the number of publications on it has also increased. We herein aimed to investigate the complications of biportal endoscopic surgery. In this study, the available literature was reviewed systematically and the published complications of discectomy in biportal endoscopic spinal surgery were summarized. A systematic search of the literature published until December 31, 2021, was performed using the PubMed, Cochrane Library, Embase, and Web of Science databases. Studies on spinal discectomy using the biportal method were included. Twenty-two articles were finally included for review. The reported complication rate of this procedure was 0%–23.6% (radiological hematoma). In most studies, the complication rate was less than 11%. The mean complication rate was 5.37% when 596 patients (from 16 studies) underwent unilateral biportal endoscopic discectomy for the treatment of lumbar disk herniation. The reported complications of this procedure included dural tear, hematoma, incomplete decompression, recurrence, instability, neurological complications (post-op paresthesia, dysthesia or numbness, or root injury), pseudomeningocele, ascites, infection, retinal hemorrhage, and burn injury. The complication rate was higher in the early learning curve. Unilateral biportal endoscopic discectomy has an acceptable complication rate. Knowing the possible complications and risks of this procedure could help surgeons in taking measures to avoid common complications. [ABSTRACT FROM AUTHOR]

Cell-derived exosomes bearing microRNAs (miRNAs) have emerged as a potential therapeutic option for cerebral ischemia-reperfusion injury (CIRI). However, their mechanism of action and clinical translation value remain unclear. The present meta-analysis investigated the therapeutic effects of miRNA-modified exosomes used in preclinical animal models of CIRI. The PubMed, Embase, and Web of Science databases were searched on April 20, 2022, to retrieve studies involving middle cerebral artery occlusion model animals treated with exosomes bearing miRNAs. The primary outcome was infarct volume, and the secondary outcome was neurobehavioral performance. FunRich software was used for bioinformatic analysis of exosomal miRNAs, and statistical analysis was performed using R version 4.1.1 (R Foundation for Statistical Computing). Eleven relevant studies were included in the meta-analysis. miRNA-modified exosomes significantly reduced infarct volume (standardized mean difference [SMD], 4.50 [95% confidence interval, 3.02–5.99]; P < 0.01) and improved neurological score (SMD, 2.80 [95% confidence interval, 1.37–4.23]; P < 0.01). Subgroup analysis revealed that a higher injection frequency of exosomes could better reduce infarct volume. The top 6 biological pathways, expression sites, and transcription factors of related exosomal miRNAs were identified through bioinformatics analysis. An asymmetrical funnel plot and Egger's test (P = 0.10) revealed publication bias. Trim-and-fill analysis identified 5 unpublished studies addressing the primary outcome. miRNA-modified exosomal therapy demonstrated the potential to improve infarct volume and neurobehavioral performance in preclinical animal models of CIRI. Despite the heterogeneity among studies, the results may provide some direction for future clinical research. [ABSTRACT FROM AUTHOR]

Extracranial-intracranial (EC-IC) bypass is a procedure in which a blood vessel outside the skull is connected to one inside the skull to improve cerebral blood flow. Certain aneurysms cannot be treated through standard clipping, and EC-IC bypass may be recommended in such cases. A vast body of literature exists on the use of EC-IC bypass as a treatment for cerebrovascular disorders. While beneficial to surgeons, these publications may not reach all the intended audience, which encourages the use of bibliometric analyses. Although a fraction of historically meaningful publications may not have been sufficiently valued through citation count, bibliometric analysis is the gold standard for assessing the impact of a publication. Using bibliometric analysis, we queried the Web of Science database to identify the 50 most impactful publications on EC-IC bypass based on citation count. The literature search retrieved 125 publications that met inclusion criteria, from which the top 50 most-cited ones were selected. The mean number of citations for each article was 117.06 (range 35–1437). Case reports and series constituted 15 (30%) of the top 50 publications on EC-IC bypass, followed by 8 (16%) editorials and 7 (14%) randomized controlled trials. A total of 265 authors in 10 countries contributed to the 50 manuscripts, which were published in 15 different journals. We retrieved the top 50 most-cited articles on EC-IC bypass surgery and identified the landmark publications to provide a foundational understanding of the procedure as a treatment for complex disorders. [ABSTRACT FROM AUTHOR]