Perioperative Glucagon-Like Peptide-1 Agonist Use and Rates of Pseudarthrosis After Single-Level Lumbar Fusion: A Large Retrospective Cohort Study

单节段腰椎融合术后围手术期胰高血糖素样肽-1激动剂的使用和假关节发生率: 一项大型回顾性队列研究

Pseudarthrosis is a common surgical complication after arthrodesis and is associated with poor clinical outcomes. The association between glucagon-like peptide-1 (GLP-1) agonist use and pseudarthrosis is yet to be explored. This study aims to examine the association of GLP-1 agonists with rates of pseudarthrosis in patients undergoing single-level lumbar fusion. In this cohort study, patients who were prescribed GLP-1 agonists in the perioperative period had reduced rates of pseudarthrosis compared with patients without GLP-1 agonist prescriptions. These findings suggest a potential therapeutic benefit of GLP-1 agonists in enhancing spinal fusion outcomes and warrant further prospective studies to confirm these results and explore the underlying mechanisms.

假关节是关节融合术后常见的手术并发症，并且与不良的临床结果相关。胰高血糖素样肽-1 (GLP-1) 激动剂的使用与假关节之间的关联尚待探索。这项研究旨在研究GLP-1激动剂与接受单级腰椎融合术的患者假关节发生率的关系。在这项队列研究中，与没有使用GLP-1激动剂处方的患者相比，在围手术期使用GLP-1激动剂处方的患者的假关节发生率降低。这些发现表明GLP-1激动剂在增强脊柱融合结果方面具有潜在的治疗益处，并需要进一步的前瞻性研究来证实这些结果并探索潜在的机制。

REF: Agrawal V, Amasa S, Karabacak M, Margetis K. Perioperative Glucagon-Like Peptide-1 Agonist Use and Rates of Pseudarthrosis After Single-Level Lumbar Fusion: A Large Retrospective Cohort Study. Neurosurgery. Published online November 26, 2024. doi:10.1227/neu.0000000000003291 PMID: 39589142

Prediction of Shunt Malfunction Using Automated Ventricular Volume Analysis and Radiomics

使用自动心室容积分析和影像组学预测分流功能障碍

The assessment of ventricle size is crucial in diagnosing hydrocephalus and in detecting shunt malfunctions. Current methods primarily involve 2-dimensional measurements or ratios. We evaluated the accuracy of volumetric analysis and radiomics in diagnosing hydrocephalus and shunt malfunction. Automated ventricle segmentation using convolutional neural networks combined with radiomics analysis can be used with age and sex to assist in the diagnosis of hydrocephalus and shunt malfunctions when combined with a reference normative data set. It offers a time-efficient alternative to manual segmentation, reduces interobserver variability, and holds promise in improving patient outcomes by facilitating early and accurate diagnosis of hydrocephalus/shunt malfunction.

脑室大小的评估对于诊断脑积水和检测分流功能障碍至关重要。当前的方法主要涉及二维测量或比率。我们评估了体积分析和影像组学在诊断脑积水和分流故障中的准确性。使用卷积神经网络结合影像组学分析的自动心室分割可以与年龄和性别一起使用，以在与参考规范数据集结合时辅助诊断脑积水和分流故障。它为手动分割提供了一种省时的替代方法，减少了观察者之间的可变性，并通过促进早期和准确诊断脑积水/分流故障来改善患者预后。

REF: Kellogg RT, Vargas J, Nguyen M, et al. Prediction of Shunt Malfunction Using Automated Ventricular Volume Analysis and Radiomics. Neurosurgery. Published online November 26, 2024. doi:10.1227/neu.0000000000003296 PMID: 39589123

Vertebral Bone Quality Score as a Predictor of Subsequent Fractures After Cement Augmentation for Osteoporotic Vertebral Compression Fracture

椎体骨质量评分预测骨质疏松性椎体压缩骨折骨水泥强化后的后续骨折

Dual-energy X-ray absorptiometry (DXA) T-scores have been shown to predict fragility fractures in population-based studies. Recently, a novel MRI-based vertebral bone quality (VBQ) score has been proposed, showing better predictability for fragility fractures compared with DXA T-scores. The aim of this study was to explore the correlation between VBQ scores and DXA T-scores and to determine the impact of VBQ scores on the risk of subsequent fragility fractures after cement augmentation for osteoporotic vertebral compression fracture (OVCF). In patients who received cement augmentation for OVCF, the VBQ score is significantly correlated with the DXA T-score and may be a more reliable predictor of subsequent fragility fractures.

在基于人群的研究中，双能x射线吸收法 (DXA) T评分已被证明可以预测脆性骨折。最近，提出了一种基于MRI的新型椎骨质量 (VBQ) 评分，与DXA T评分相比，对脆性骨折的可预测性更好。这项研究的目的是探讨VBQ评分与DXA T评分之间的相关性，并确定VBQ评分对骨质疏松性椎体压缩骨折 (OVCF) 骨水泥强化后随后脆性骨折风险的影响。在因OVCF接受骨水泥强化的患者中，VBQ评分与DXA T评分显着相关，可能是随后脆性骨折的更可靠预测指标。

REF: Yeh YC, Chen MZ, Hu YH, et al. Vertebral Bone Quality Score as a Predictor of Subsequent Fractures After Cement Augmentation for Osteoporotic Vertebral Compression Fracture. Neurosurgery. Published online November 26, 2024. doi:10.1227/neu.0000000000003282 PMID: 39589124

Postoperative Blood Pressure Goals After Craniotomy for Tumor Resection: A National Survey

开颅手术切除肿瘤后的术后血压目标: 一项全国性调查

Acute hypertension can occur in 90% of postcraniotomy patients for tumor resection, and 60% to 90% of patients require treatment with antihypertensive agents. Postoperative intracranial hemorrhage is a major driver of morbidity and mortality after craniotomy for tumor resection, and perioperative hypertension is believed to be a risk factor. Many neurosurgeons impose postoperative blood pressure (BP) goals to mitigate this risk, but there is little evidence to guide the selection of a specific target BP, leading to a wide variation in patient care. In this article, we have conducted a national survey to report the current practices regarding postoperative BP management. Most of the academic neurosurgical programs use a postoperative SBP goal after craniotomy for tumor resection. Programs are evenly divided between goals of SBP <140 mm Hg and SBP <160 mm Hg. The variability among programs indicates clinical equipoise between these 2 approaches in the context of a future clinical trial.

90% 开颅手术后进行肿瘤切除术的患者会发生急性高血压，并且60% 至90% 的患者需要使用降压药治疗。术后颅内出血是开颅肿瘤切除术后发病率和死亡率的主要驱动因素，围手术期高血压被认为是危险因素。许多神经外科医生强加了术后血压 (BP) 目标来减轻这种风险，但是几乎没有证据可以指导选择特定的目标BP，从而导致患者护理的广泛差异。在本文中，我们进行了一项全国性调查，以报告有关术后BP管理的现行做法。大多数学术神经外科计划在开颅手术切除肿瘤后使用术后SBP目标。计划在SBP <140毫米Hg和SBP <160毫米Hg的目标之间平均分配。程序之间的可变性表明在未来临床试验的背景下这两种方法之间的临床平衡。

REF: Kelly PD, Gauhar F, Kang K, Kayne A, Bray DP, Evans JJ. Postoperative Blood Pressure Goals After Craniotomy for Tumor Resection: A National Survey. Neurosurgery. Published online November 26, 2024. doi:10.1227/neu.0000000000003293 PMID: 39589136

Outcome of Fourth Ventricular Hemorrhage in Ruptured Brain Aneurysms: Impact of Active Blood Clearance and Delayed Cerebral Ischemia Prevention

破裂脑动脉瘤的第四脑室出血的结果: 主动血液清除和延迟脑缺血预防的影响

Blood in the fourth ventricle is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). We investigated (1) the prognostic significance of the amount of blood in the fourth ventricle and (2) the influence of active blood clearance and delayed cerebral ischemia prevention (ABCD). Ballooning fourth ventricular hemorrhage (grade 4 FVH) is a powerful predictor of poor outcomes after aSAH. With the introduction of ABCD, the prognosis of these patients improved considerably and 25% reached functional independence 6 months after aSAH.

第四脑室的血液与动脉瘤性蛛网膜下腔出血 (aSAH) 患者的不良预后有关。我们研究了 (1) 第四脑室血液量的预后意义，以及 (2) 主动血液清除和延迟脑缺血预防 (ABCD) 的影响。气球状第四脑室出血 (4级FVH) 是aSAH后不良预后的有力预测指标。随着ABCD的引入，这些患者的预后得到了显着改善，并且在aSAH后6个月25% 达到功能独立性。

REF: Overstijns M, Csók I, Watzlawick R, et al. Outcome of Fourth Ventricular Hemorrhage in Ruptured Brain Aneurysms: Impact of Active Blood Clearance and Delayed Cerebral Ischemia Prevention. Neurosurgery. Published online November 26, 2024. doi:10.1227/neu.0000000000003284 PMID: 39589117

Evaluation of 2 Surgical Techniques—Transposition Versus Interposition Microvascular Decompression for Hemifacial Spasm: A Systematic Review of 19 437 Patients

2种手术技术的评估-移位与间置微血管减压术治疗面肌痉挛: 19   437例患者的系统综述

Hemifacial spasm (HFS) is a rare movement disorder characterized by brisk, irregular, involuntary, and unilateral contraction of the facial musculature. This systematic review aims to synthesize the existing literature and compare the use of 2 microvascular decompression (MVD) techniques-transposition and interposition-used in the treatment of HFS. Both transposition and interposition are safe and effective techniques for MVD in patients with HFS. Available literature to date does not provide conclusive evidence that 1 method is superior to the other in safety or efficacy although there are specific instances that favor the use of interposition. A prospective trial would be required to delineate the true differences between these techniques.

面肌痉挛 (HFS) 是一种罕见的运动障碍，其特征是面部肌肉组织轻动，不规则，不自主和单侧收缩。本系统综述旨在综合现有文献，比较2种微血管减压 (MVD) 技术-移位和间置术-用于治疗HFS。移位和插入都是HFS患者MVD的安全有效技术。迄今为止，现有的文献没有提供确凿的证据表明一种方法在安全性或有效性方面优于另一种方法，尽管有一些特定的情况有利于使用介入治疗。需要进行前瞻性试验来描述这些技术之间的真正差异。

REF: Tugend M, Joncas CT, Lee V, Simmons GB, Sekula RF Jr. Evaluation of 2 Surgical Techniques-Transposition Versus Interposition Microvascular Decompression for Hemifacial Spasm: A Systematic Review of 19 437 Patients. Neurosurgery. Published online November 26, 2024. doi:10.1227/neu.0000000000003290 PMID: 39589121

So the Bone Flap Hit the Floor, Now What? An In Vitro Comparison of Cadaveric Bone Flap Decontamination Procedures

骨瓣撞到地板上了，现在怎么办？尸体骨瓣去污程序的体外比较

Over the course of their career, 66% of neurosurgeons will witness someone accidentally dropping a bone flap on the floor during a craniotomy procedure. Although this event is rare, it can have significant consequences for the patient, and little literature is available to guide management of this complication. Our objective was to compare 5 bone flap decontamination protocols for efficacy in reducing bacterial load, with the goal of safely reimplanting the dropped flap. In the event of the accidental fall of a bone flap, decontamination by rinsing in an alcohol-chlorhexidine solution followed by 3 successive washes in saline seemed to provide the best balance between effectiveness, safety, and complexity of the method.

在他们的职业生涯中，66% 的神经外科医生都会目睹有人在开颅手术过程中不小心将骨瓣掉落在地板上。尽管此事件很少见，但可能对患者造成重大后果，并且几乎没有文献可指导该并发症的治疗。我们的目标是比较5种骨瓣净化方案在减少细菌负荷方面的功效，目的是安全地重新植入掉落的皮瓣。在骨瓣意外掉落的情况下，通过在酒精-氯己定溶液中冲洗然后在盐水中连续洗涤3次进行去污似乎可以在方法的有效性，安全性和复杂性之间提供最佳平衡。

REF: Marion A, Lévesque S, Touchette C, et al. So the Bone Flap Hit the Floor, Now What? An In Vitro Comparison of Cadaveric Bone Flap Decontamination Procedures. Neurosurgery. Published online November 21, 2024. doi:10.1227/neu.0000000000003289 PMID: 39570728

Decoding Glioblastoma Heterogeneity: Neuroimaging Meets Machine Learning

解码胶质母细胞瘤异质性: 神经影像学与机器学习的结合

Recent advancements in neuroimaging and machine learning have significantly improved our ability to diagnose and categorize isocitrate dehydrogenase (IDH)-wildtype glioblastoma, a disease characterized by notable tumoral heterogeneity, which is crucial for effective treatment. Neuroimaging techniques, such as diffusion tensor imaging and magnetic resonance radiomics, provide noninvasive insights into tumor infiltration patterns and metabolic profiles, aiding in accurate diagnosis and prognostication. Machine learning algorithms further enhance glioblastoma characterization by identifying distinct imaging patterns and features, facilitating precise diagnoses and treatment planning. Integration of these technologies allows for the development of image-based biomarkers, potentially reducing the need for invasive biopsy procedures and enabling personalized therapy targeting specific pro-tumoral signaling pathways and resistance mechanisms. Although significant progress has been made, ongoing innovation is essential to address remaining challenges and further improve these methodologies. Future directions should focus on refining machine learning models, integrating emerging imaging techniques, and elucidating the complex interplay between imaging features and underlying molecular processes. This review highlights the pivotal role of neuroimaging and machine learning in glioblastoma research, offering invaluable noninvasive tools for diagnosis, prognosis prediction, and treatment planning, ultimately improving patient outcomes. These advances in the field promise to usher in a new era in the understanding and classification of IDH-wildtype glioblastoma.

神经影像学和机器学习方面的最新进展显着提高了我们诊断和分类异柠檬酸脱氢酶 (IDH)-野生型胶质母细胞瘤的能力，这种疾病的特征是显着的肿瘤异质性，这对于有效治疗至关重要。神经成像技术，如扩散张量成像和磁共振放射组学，提供了对肿瘤浸润模式和代谢概况的非侵入性见解，有助于准确诊断和预后。机器学习算法通过识别不同的成像模式和特征进一步增强胶质母细胞瘤的表征，促进精确的诊断和治疗计划。这些技术的整合允许开发基于图像的生物标志物，潜在地减少对侵入性活检程序的需求，并实现针对特定的促肿瘤信号通路和抗性机制的个性化治疗。尽管已经取得了重大进展，但持续的创新对于应对剩余挑战和进一步改进这些方法至关重要。未来的方向应该集中在完善机器学习模型，整合新兴的成像技术，并阐明成像特征和潜在分子过程之间的复杂相互作用。这篇综述强调了神经影像学和机器学习在胶质母细胞瘤研究中的关键作用，为诊断，预后预测和治疗计划提供了宝贵的非侵入性工具，最终改善了患者的预后。该领域的这些进展有望开启对IDH野生型胶质母细胞瘤的理解和分类的新时代。

REF: Fares J, Wan Y, Mayrand R, Li Y, Mair R, Price SJ. Decoding Glioblastoma Heterogeneity: Neuroimaging Meets Machine Learning. Neurosurgery. Published online November 21, 2024. doi:10.1227/neu.0000000000003260 PMID: 39570018

Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry

微小 (≤ 3毫米) 未破裂大脑中动脉动脉瘤治疗的安全性和有效性: 对神经血管质量倡议-质量结果数据库脑动脉瘤注册表的分析

Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.

改进的成像方式导致颅内动脉瘤的检测增加，其中许多是小的。微小动脉瘤的适当管理存在不确定性。这项研究的目的是使用大型，多机构神经血管质量倡议质量结果数据库 (NVQI-QOD) 来评估治疗未破裂的微小大脑中动脉 (MCA) 动脉瘤的频率，安全性和有效性。微小的，未破裂的MCA动脉瘤的治疗是有效的，但可能有很高的并发症发生率。医生在决定治疗微小的，未破裂的MCA动脉瘤时应谨慎。

REF: Padmanaban V, Harbaugh T, Zhu J, et al. Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry. Neurosurgery. Published online November 21, 2024. doi:10.1227/neu.0000000000003283 PMID: 39570023