Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis

腹腔镜辅助腹膜入路在脑室-腹腔分流术中的系统综述和Meta分析

The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting. Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.

脑积水最常见的治疗方法是脑室腹膜 (VP) 分流术。腹膜进入通常通过开腹手术进行，但是腹腔镜腹膜进入越来越受欢迎。许多研究报道了微创腹腔镜腹膜入路的好处，但对其使用尚无共识。我们进行了系统综述和荟萃分析，以比较开腹手术与腹腔镜腹膜入路在VP分流中的作用。与开腹手术相比，腹腔镜腹膜入路进行VP分流术可改善预后，包括减少远端分流失败，减少手术时间和减少医院LOS，应考虑进行分流术。有必要进行其他研究以进一步确定腹腔镜入路的益处，尤其是在儿科人群中。

REF: Abdelmageed S, Sarkar P, Shlobin NA, Davila DG, Potts MB. Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis. Neurosurgery. Published online October 28, 2024. doi:10.1227/neu.0000000000003213 PMID: 39465943

Academic Neurosurgery Gender and Authorship Trends in the United States

美国学术神经外科性别和作者趋势

Women represent ∼20% of the national neurosurgical resident cohort but only ∼10% of academic neurosurgeons in the United States. Recognizing that the publication of scientific literature contributes to academic advancement, we measured authorship trends of academic neurosurgeons to query publication differences as an explanation for the discrepancy of female representation in academic positions. These data suggest that women publish earlier but have fewer first-author publications at -1 year, the timepoint of peak publication for both genders. There was no significant gender difference in rates of the first author and all publications over the years 0 to 10. The ratio of publications to the h-index did not differ significantly but showed a trend suggesting that women produce higher-impact articles and may need fewer publications to achieve the same change in the h-index.

女性代表国家神经外科住院医师队列的20%，但仅代表美国学术神经外科医师的10%。认识到科学文献的出版有助于学术进步，我们测量了学术神经外科医生的作者趋势，以查询出版差异，以解释女性在学术职位上的代表性差异。这些数据表明，女性出版较早，但在-1年，即男女出版高峰的时间点，第一作者的出版物较少。在0到10年间，第一作者和所有出版物的比率没有显着的性别差异。出版物与h指数的比率没有显著差异，但显示出一种趋势，表明妇女产生的文章影响较大，可能需要更少的出版物才能实现h指数的相同变化。

REF: Kearns KN, Kurker KP, Marino AC, et al. Academic Neurosurgery Gender and Authorship Trends in the United States. Neurosurgery. Published online October 28, 2024. doi:10.1227/neu.0000000000003252IF: 3.9 Q1 PMID: 39465950

Comparative Outcomes of Unilateral vs Bilateral Revascularization in Moyamoya Disease: A Multicenter Retrospective Study

烟雾病单侧与双侧血运重建的比较结果: 一项多中心回顾性研究

Moyamoya disease (MMD) is characterized by progressive steno-occlusion of the internal carotid arteries, leading to compensatory collateral vessel formation. The optimal surgical approach for MMD remains debated, with bilateral revascularization potentially offering more comprehensive protection but involving more extensive surgery compared to unilateral revascularization. This study aims to compare bilateral revascularization and unilateral revascularization short-term safety profile in the treatment of MMD. This study found no significant differences between bilateral and unilateral revascularization in MMD. Patients who had bilateral revascularization had higher tendency of perioperative stroke, though not statistically significant. Further prospective studies are needed to validate these results.

烟雾病 (MMD) 的特征是颈内动脉进行性狭窄闭塞，导致代偿性侧支血管形成。MMD的最佳手术方法仍存在争议，与单侧血运重建相比，双侧血运重建可能提供更全面的保护，但涉及更广泛的手术。本研究旨在比较双侧血运重建和单侧血运重建治疗MMD的短期安全性。这项研究发现MMD的双侧和单侧血运重建之间没有显着差异。进行双侧血运重建的患者围手术期卒中的趋势更高，尽管没有统计学意义。需要进一步的前瞻性研究来验证这些结果。

REF: Musmar B, Roy JM, Abdalrazeq H, et al. Comparative Outcomes of Unilateral vs Bilateral Revascularization in Moyamoya Disease: A Multicenter Retrospective Study. Neurosurgery. Published online October 28, 2024. doi:10.1227/neu.0000000000003243 PMID: 39465938

Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Target Therapy: A Single-Center Experience

免疫治疗或靶向治疗的黑色素瘤脑转移患者的立体定向放射外科剂量降低: 一项单中心经验

Better local control but higher rates of adverse radiation events (ARE) have been reported when combining American Society for Radiation Oncology (ASTRO)-guideline-suggested dose (SD) stereotactic radiosurgery (SRS) with immunotherapy or targeted therapy for melanoma brain metastases. The objective of this study is to explore the efficacy and safety of lower prescription doses compared with ASTRO guidelines for single-fraction SRS for patients with melanoma metastases who are concurrently receiving immunotherapy or targeted therapy. This study provides evidence that RD SRS could offer reduced toxicity rates, while maintaining high local control as compared with the current guideline-SDs for the treatment of melanoma brain metastases.

据报道，将美国放射肿瘤学会 (ASTRO)-指南-建议剂量 (SD) 立体定向放射外科 (SRS) 与黑色素瘤脑转移的免疫疗法或靶向疗法相结合时，局部控制更好，但不良辐射事件 (ARE) 的发生率更高。这项研究的目的是探索与ASTRO指南相比，较低处方剂量对同时接受免疫治疗或靶向治疗的黑色素瘤转移患者的单部分SRS的疗效和安全性。这项研究提供的证据表明，与目前用于治疗黑色素瘤脑转移的指南-SDs相比，RD SRS可以降低毒性率，同时保持较高的局部控制。

REF: Tos SM, Mantziaris G, Shaaban A, Pikis S, Dumot C, Sheehan JP. Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Target Therapy: A Single-Center Experience. Neurosurgery. Published online October 28, 2024. doi:10.1227/neu.0000000000003239 PMID: 39465916

Time-Dependent Association of Preinjury Anticoagulation on Traumatic Brain Injury-Induced Coagulopathy: A Retrospective, Multicenter Cohort Study

创伤前抗凝治疗与创伤性脑损伤所致凝血功能障碍的时间依赖性关联: 一项回顾性、多中心队列研究

The impact of preinjury anticoagulation on coagulation parameters over time after traumatic brain injury (TBI) has remained unclear. Based on the hypothesis that preinjury anticoagulation significantly influences the progression and persistence of TBI-induced coagulopathy, we retrospectively examined the association of preinjury anticoagulation with various coagulation parameters during the first 24 hours postinjury in 5 periods. Despite more severe TBI signs and poorer outcomes, the preinjury anticoagulation group had significantly lower D-dimer levels, especially within 2 to 24 hours postinjury. Thus, D-dimer levels during this period may not reliably represent TBI severity in patients receiving anticoagulation therapy before injury. Preinjury anticoagulation was also associated with an elevated PT-INR and prolonged APTT from early to 24 hours postinjury, highlighting the importance of aggressive anticoagulant reversal early after injury.

创伤性脑损伤 (TBI) 后，损伤前抗凝对凝血参数随时间的影响仍不清楚。基于损伤前抗凝显著影响TBI诱导的凝血病的进展和持续的假设，我们回顾性研究了损伤后5个时期的前24小时内，损伤前抗凝与各种凝血参数的关系。尽管有更严重的TBI体征和较差的预后，但损伤前抗凝组的D-二聚体水平明显较低，尤其是在损伤后2至24小时内。因此，在此期间的D-二聚体水平可能无法可靠地代表受伤前接受抗凝治疗的患者的TBI严重程度。损伤前抗凝治疗也与pt-inr升高和损伤后早期至24小时的APTT延长有关，突出了损伤后早期积极抗凝逆转的重要性。

REF: Matsuo K, Aihara H, Suehiro E, et al. Time-Dependent Association of Preinjury Anticoagulation on Traumatic Brain Injury-Induced Coagulopathy: A Retrospective, Multicenter Cohort Study. Neurosurgery. Published online October 24, 2024. doi:10.1227/neu.0000000000003238 PMID: 39446739

Smartphone Magnetometers for Assessing Programmable Shunt Valve Settings: A Proof-of-Concept Study

用于评估可编程分流器阀设置的智能手机磁力计: 概念验证研究

Programmable shunt valves (PSVs) used to treat hydrocephalus require specialized valve-specific devices that determine their setting. However, these devices are typically only accessible in major medical centers. This study explores the feasibility of using smartphone magnetometers to assess PSV settings. This proof-of-concept study suggests that smartphones can be used for PSV assessment. However, further development and validation are needed to refine this method for clinical use. This technology could enhance PSV management accessibility, allowing for remote or at-home evaluations by trained individuals or caregivers, thus improving patient care in underserved areas.

用于治疗脑积水的可编程分流阀 (psv) 需要专门的特定于阀的设备来确定其设置。然而，这些装置通常仅在主要医疗中心中是可访问的。本研究探讨了使用智能手机磁力计评估PSV设置的可行性。这项概念验证研究表明，智能手机可用于PSV评估。然而，需要进一步的开发和验证来完善该方法以供临床使用。这项技术可以增强PSV管理的可访问性，允许受过培训的个人或护理人员进行远程或在家评估，从而改善服务不足地区的患者护理。

REF: McCoy C, Patel SK, Skoch J. Smartphone Magnetometers for Assessing Programmable Shunt Valve Settings: A Proof-of-Concept Study. Neurosurgery. Published online October 23, 2024. doi:10.1227/neu.0000000000003221 PMID: 39440942

Lack of Association of Chronological Age and Antithrombotic Agents With Acute Intracranial Hemorrhage in the Group of Older Adults With Traumatic Brain Injury

年龄和抗血栓药与急性颅内出血的关联缺乏老年人创伤性脑损伤

Some reports suggest that older patients with traumatic brain injury (TBI) are more likely to experience acute intracranial hemorrhage, resulting in poor outcomes. However, the association between precise chronological age and use of antithrombotic agents with acute intracranial hemorrhage in these patients remains unknown. The aim of this study was to determine factors associated with acute intracranial hemorrhage and poor outcomes in patients with TBI, including chronological age and use of antithrombotic agents. Our findings confirmed the lack of an association of chronological age and antithrombotic agents with acute intracranial hemorrhage in the group of older adults with TBI. Our findings suggest that antithrombotic agents may be safely used, even in older adults.

一些报告表明，老年创伤性脑损伤 (TBI) 患者更容易发生急性颅内出血，导致预后不良。然而，这些患者的确切年龄和使用抗血栓药与急性颅内出血之间的关系尚不清楚。这项研究的目的是确定与急性颅内出血和TBI患者不良预后相关的因素，包括年龄和抗血栓药的使用。我们的研究结果证实，在患有TBI的老年人组中，年龄和抗血栓药物与急性颅内出血之间缺乏关联。我们的研究结果表明，即使在老年人中，抗血栓药也可以安全使用。

REF: Kambara M, Ikawa F, Hidaka T, et al. Lack of Association of Chronological Age and Antithrombotic Agents With Acute Intracranial Hemorrhage in the Group of Older Adults With Traumatic Brain Injury. Neurosurgery. Published online October 23, 2024. doi:10.1227/neu.0000000000003240 PMID: 39440941

Subthalamic Nucleus Deep Brain Stimulation for Meige Syndrome: Long-Term Outcomes and Analysis of Prognostic Factors

丘脑底核脑深部电刺激治疗Meige综合征的远期疗效及预后因素分析

The aim of this study was to explore the impacts of subthalamic nucleus deep brain stimulation (STN-DBS) on both motor and nonmotor symptoms in individuals with Meige syndrome, as well as further investigates prognostic factors for long-term postoperative outcomes. Bilateral STN-DBS is an effective, safe, and promising treatment option for Meige syndrome, which can improve motor function and quality of life without cognitive and mood side effects. Early diagnosis, prompt intervention, and accurate lead placement in the dorsolateral STN are crucial to optimize long-term therapeutic outcomes.

这项研究的目的是探讨丘脑底核脑深部电刺激 (stn-dbs) 对Meige综合征患者运动和非运动症状的影响，并进一步研究长期术后预后的预后因素。双侧stn-dbs是Meige综合征的有效，安全且有前途的治疗选择，可改善运动功能和生活质量，而无认知和情绪副作用。早期诊断，及时干预和在背外侧STN中准确放置导线对于优化长期治疗效果至关重要。

REF: Zheng W, Hao Q, Chen X, et al. Subthalamic Nucleus Deep Brain Stimulation for Meige Syndrome: Long-Term Outcomes and Analysis of Prognostic Factors. Neurosurgery. Published online October 21, 2024. doi:10.1227/neu.0000000000003228 PMID: 39431779

Assessing Neurosurgery Training: Accreditation Council for Graduate Medical Education Case Minimums Versus Surgical Autonomy

评估神经外科培训: 研究生医学教育认证委员会的最低案例与手术自主性

The Accreditation Council for Graduate Medical Education (ACGME) requires neurosurgery residents to reach a set number of cases in specified procedure types (case minimums) before graduation and mandates completion of Milestones. We used the Surgical Autonomy Program, a validated method of autonomy-based resident evaluation, to determine the number of cases it took for residents to become competent and compared these with the ACGME case minimums. We found variation in the case numbers to reach competency and that for some procedures (tumor, ACDF, PCF, discectomy/laminectomy, and PSF), most residents required more cases than the ACGME case minimums to achieve competency. The ACGME case minimums may not accurately reflect the number of cases required for neurosurgical residents to reach competency. To promote trainee-centered education, individualized, competency-based evaluation systems may be better determining readiness for graduation, including a system that builds off the established ACGME Milestones.

研究生医学教育认证委员会 (ACGME) 要求神经外科住院医师在毕业前达到指定程序类型 (最低病例数) 的病例数，并要求完成里程碑。我们使用了手术自主性计划，这是一种经过验证的基于自主性的居民评估方法，以确定居民胜任所需的病例数，并将其与ACGME病例最小值进行比较。我们发现达到能力的病例数有所不同，对于某些程序 (肿瘤，ACDF，PCF，椎间盘切除术/椎板切除术和PSF)，大多数居民需要比ACGME最低病例数更多的病例才能达到能力。ACGME最低病例数可能无法准确反映神经外科住院医师达到能力所需的病例数。为了促进以受训者为中心的教育，个性化的，基于能力的评估系统可能会更好地确定毕业准备情况，包括建立在已建立的ACGME里程碑基础上的系统。

REF: Venkatraman V, Kelly-Hedrick M, Suarez AD, Dharmapurikar R, Lad SP, Haglund MM. Assessing Neurosurgery Training: Accreditation Council for Graduate Medical Education Case Minimums Versus Surgical Autonomy. Neurosurgery. Published online October 21, 2024. doi:10.1227/neu.0000000000003241 PMID: 39471099