A Scoping Review of Focused Ultrasound Enhanced Drug Delivery for Across the Blood–Brain Barrier for Brain Tumors

聚焦超声增强跨血脑屏障给药治疗脑肿瘤的概况性综述

Previous mechanisms of opening the blood-brain barrier (BBB) created a hypertonic environment. Focused ultrasound (FUS) has recently been introduced as a means of controlled BBB opening. Here, we performed a scoping review to assess the advances in drug delivery across the BBB for treatment of brain tumors to identify advances and literature gaps. Here, we review the role of FUS in BBBO. Identified gaps in the literature include impact of tumor microenvironment and extracellular space, improved understanding and control of MB and drug delivery, further work on ideal pharmacologics for delivery, and clinical use.

先前打开血脑屏障 (BBB) 的机制产生了高渗环境。最近已引入聚焦超声 (FUS) 作为受控BBB打开的手段。在这里，我们进行了一项概况性综述，以评估跨BBB药物递送治疗脑肿瘤的进展，以确定进展和文献空白。在这里，我们回顾一下FUS在BBBO中的作用。文献中发现的空白包括肿瘤微环境和细胞外空间的影响，对MB和药物递送的理解和控制的改善，对理想的药物递送的进一步研究以及临床应用。

REF: Young CM, Viña-González A, de Toledo Aguiar RS, et al. A Scoping Review of Focused Ultrasound Enhanced Drug Delivery for Across the Blood-Brain Barrier for Brain Tumors. Oper Neurosurg (Hagerstown). 2024;27(5):523-532. doi:10.1227/ons.0000000000001175 PMID: 38717167

Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation

腰椎融合中的节段矢状位排列: 术前测量，手术计划，术中执行和术后评估的循证评估综述

Maintaining and restoring global and regional sagittal alignment is a well-established priority that improves patient outcomes in patients with adult spinal deformity. However, the benefit of restoring segmental (level-by-level) alignment in lumbar fusion for degenerative conditions is not widely agreed on. The purpose of this review was to summarize intraoperative techniques to achieve segmental fixation and the impact of segmental lordosis on patient-reported and surgical outcomes. This review explores segmental correction's impact on short-segment lumbar fusion outcomes, finding the extent of correction to depend on patient positioning and choice of interbody cage. Notably, inadequate restoration of lumbar lordosis is associated with adjacent segment degeneration. Nevertheless, conclusive evidence linking segmental alignment to patient-reported outcomes, cage subsidence, or pseudoarthrosis remains limited, underscoring the need for future research.

保持和恢复整体和区域矢状面对齐是一个公认的优先事项，可改善成人脊柱畸形患者的预后。然而，在退行性疾病的腰椎融合中恢复节段 (逐级) 对齐的益处尚未得到广泛认可。本综述的目的是总结实现节段性固定的术中技术以及节段性脊柱前凸对患者报告和手术结果的影响。这篇综述探讨了节段矫正对短节段腰椎融合术结果的影响，发现矫正的程度取决于患者的位置和椎间融合器的选择。值得注意的是，腰椎前凸的恢复不足与相邻节段的退变有关。然而，将节段一致性与患者报告的结果，笼下沉或假关节联系起来的确凿证据仍然有限，强调了未来研究的必要性。

REF: Daniels AH, Balmaceno-Criss M, McDonald CL, et al. Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation. Oper Neurosurg (Hagerstown). 2024;27(5):533-548. doi:10.1227/ons.0000000000001179 PMID: 38690883

Do Iliac Screws Placed Close to the Sciatic Notch Have Greater Pullout Strength?

靠近坐骨切迹的髂骨螺钉有更大的拔出强度吗？

Optimal iliac screw position in relation to the sciatic notch remains unknown. In 12 cadavers undergoing S2 alar-iliac (S2AI) screw placement, we tested the pullout strength of screws placed in proximity to the sciatic notch (≤5 mm) vs farther away from the sciatic notch (>5 mm). Although placing S2AI screws ≤5 mm of the sciatic notch provided stronger fixation in 3 of 4 biomechanical testing categories, these results were not statistically significant. Therefore, placing S2AI screws ≤5 mm of the sciatic notch did not provide stronger fixation.

关于坐骨切迹的最佳螺钉位置仍然未知。在12例接受S2 alar骨 (S2AI) 螺钉放置的尸体中，我们测试了靠近坐骨切迹 (≤ 5毫米) 与远离坐骨切迹 (> 5毫米) 的螺钉的拔出强度。尽管在4个生物力学测试类别中的3个类别中，将S2AI螺钉放置在坐骨切口的 ≤ 5毫米处可提供更强的固定，但这些结果在统计学上并不显着。因此，在坐骨切迹处放置S2AI螺钉 ≤ 5毫米并不能提供更强的固定。

REF: Chanbour H, Roth SG, Chen JW, et al. Do Iliac Screws Placed Close to the Sciatic Notch Have Greater Pullout Strength?. Oper Neurosurg (Hagerstown). 2024;27(5):549-556. doi:10.1227/ons.0000000000001159 PMID: 38651901

The Incremental Clinical Benefit of Adding Layers of Complexity to the Planning and Execution of Adult Spinal Deformity Corrective Surgery

为成人脊柱畸形矫正手术的计划和执行增加复杂性的增量临床益处

For patients with surgical adult spinal deformity (ASD), our understanding of alignment has evolved, especially in the last 20 years. Determination of optimal restoration of alignment and spinal shape has been increasingly studied, yet the assessment of how these alignment schematics have incrementally added benefit to outcomes remains to be evaluated. Our evaluation of the incremental benefit that alignment schemas have provided in ASD corrective surgery suggests that the addition of Roussouly provided the greatest reduction in mechanical complications, while the incorporation of GAP provided the most significant improvement in patient-reported outcomes.

对于患有外科成人脊柱畸形 (ASD) 的患者，我们对对齐的理解已经发展，尤其是在过去的20年中。已越来越多地研究确定最佳的对齐方式和脊柱形状的恢复，但是对这些对齐方式示意图如何逐渐增加对结果的益处的评估仍有待评估。我们对ASD矫正手术中对齐方案提供的增量益处的评估表明，增加Roussouly可最大程度地减少机械并发症，而加入GAP可最大程度地改善患者报告的结局。

REF: Pierce KE, Mir JM, Dave P, et al. The Incremental Clinical Benefit of Adding Layers of Complexity to the Planning and Execution of Adult Spinal Deformity Corrective Surgery. Oper Neurosurg (Hagerstown). 2024;27(5):573-580. doi:10.1227/ons.0000000000001192 PMID: 38771063

One-Point Technique in Brainstem Cavernous Malformation Surgery: Evaluation of Approaches and Outcomes From a Different Perspective

脑干海绵状畸形手术中的单点技术: 从不同角度评估方法和结果

Brainstem cavernous malformations (BCMs) are a distinct clinical entity that carry a high risk of patient morbidity because of location and risk of hemorrhage. Surgical management of these lesions requires intimate knowledge of surgical anatomy and skull base approaches. This article is intended to highlight a modern approach for the treatment of BCMs, with an emphasis on the use of the one-point technique to guide resection. Despite surgical advances in recent decades and more widespread understanding of surgical anatomy and safe entry zones, surgical resection of BCMs remains a formidable challenge. While not necessarily the shortest access, the one-point technique offers a safe approach considering all the different modalities in our armamentarium and can be used as part of a strategy to determine the optimal approach to resect BCMs.

脑干海绵状畸形 (BCMs) 是一种独特的临床实体，由于出血的位置和风险，其具有很高的患者发病风险。这些病变的手术治疗需要对手术解剖和颅底入路有深入的了解。本文旨在强调一种治疗BCMs的现代方法，重点是使用单点技术指导切除。尽管近几十年来外科手术取得了进步，并且对外科手术解剖结构和安全进入区的理解越来越广泛，但BCMs的手术切除仍然是一个艰巨的挑战。虽然不一定是最短的访问，但单点技术提供了一种安全的方法，考虑了我们军械库中的所有不同方式，并且可以用作确定切除BCMs的最佳方法的策略的一部分。

REF: Prashant GN, Dehdashti AR. One-Point Technique in Brainstem Cavernous Malformation Surgery: Evaluation of Approaches and Outcomes From a Different Perspective. Oper Neurosurg (Hagerstown). 2024;27(5):557-565. doi:10.1227/ons.0000000000001176 PMID: 38717166

Subtemporal Approach for the Treatment of Ruptured and Unruptured Distal Basilar Artery Aneurysms: Is There a Contemporary Use?

颞下入路治疗破裂和未破裂的基底动脉远端动脉瘤: 是否有当代应用？

Distal basilar artery aneurysms (DBAs) are high-risk lesions for which endovascular treatment is preferred because of their deep location, yet indications for open clipping nonetheless remain. The subtemporal approach allows for early proximal control and direct visualization of critical posterior perforating arteries, especially for posterior-projecting aneurysms. Our objective was to describe our clinical experience with the subtemporal approach for clipping DBAs in the evolving endovascular era. These results demonstrate that microsurgical clip ligation of DBAs using the subtemporal approach remains a viable option for complex lesions not amenable to endovascular management.

基底动脉远端动脉瘤 (dba) 是高危病变，由于其位置较深，因此首选血管内治疗，但仍有开放夹闭的迹象。颞下入路允许早期近端控制和关键后穿孔动脉的直接可视化，特别是对于后突出的动脉瘤。我们的目标是描述我们在不断发展的血管内时代使用亚时间方法剪裁dba的临床经验。这些结果表明，对于不适合血管内治疗的复杂病变，使用颞下方法对dba进行显微外科手术夹结扎仍然是可行的选择。

REF: Findlay MC, Bounajem MT, Kim RB, et al. Subtemporal Approach for the Treatment of Ruptured and Unruptured Distal Basilar Artery Aneurysms: Is There a Contemporary Use?. Oper Neurosurg (Hagerstown). 2024;27(5):581-596. doi:10.1227/ons.0000000000001185 PMID: 38690880

The 3-Dimensional Intelligent Structured Light Technique: A New Registration Method in Stereotactic Neurosurgery

三维智能结构光技术: 立体定向神经外科的新配准方法

Surface-based facial scanning registration emerged as an essential registration method in the robot-assisted neuronavigation surgery, providing a marker-free way to align a patient's facial surface with the imaging data. The 3-dimensional (3D) structured light was developed as an advanced registration method based on surface-based facial scanning registration. We aspire to introduce the 3D structured light as a new registration method in the procedure of the robot-assisted neurosurgery and assess the accuracy, efficiency, and safety of this method by analyzing the relative operative results. The 3D structured light technique reduces the patients' discomfort and offers the advantage of a simpler procedure, which can improve the clinical efficiency with the sufficient accuracy and safety to meet the clinical requirements of the puncture and navigation.

基于表面的面部扫描配准是机器人辅助神经导航手术中的一种基本配准方法，它提供了一种无标记的方式来将患者的面部表面与成像数据对齐。三维 (3D) 结构光被开发为基于基于表面的面部扫描配准的高级配准方法。我们渴望在机器人辅助神经外科手术中引入3D结构光作为一种新的配准方法，并通过分析相关的手术结果来评估该方法的准确性，效率和安全性。3D结构光技术减少了患者的不适感，并提供了一个简单的程序的优势，可以提高临床效率，具有足够的准确性和安全性，以满足临床需求的穿刺和导航。

REF: Cai D, Wang X, Hu W, et al. The 3-Dimensional Intelligent Structured Light Technique: A New Registration Method in Stereotactic Neurosurgery. Oper Neurosurg (Hagerstown). 2024;27(5):566-572. doi:10.1227/ons.0000000000001184 PMID: 38687040

Immersive Photorealistic Three-Dimensional Neurosurgical Anatomy of the Cerebral Arteries: A Photogrammetry-Based Anatomic Study

脑动脉的沉浸式逼真的三维神经外科解剖: 基于摄影测量的解剖学研究

Neurosurgeons need a profound knowledge of the surgical anatomy of the cerebral arteries to safely treat patients. This is a challenge because of numerous branches, segments, and tortuosity of the main blood vessels that supply the brain. The objective of this study was to create high-quality three-dimensional (3D) anatomic photorealistic models based on dissections of the brain arterial anatomy and to incorporate this data into a virtual reality (VR) environment. Cerebral vascular anatomy presented with photogrammetry surface scanning method allows sufficient detail to present individual vessel's course and even small perforating arteries in photorealistic 3D models. These features, including VR visualization, provide new teaching prospects. The whole study was done with simplified algorithms and free or open-source software platforms allowing creation of 3D databases especially useful in cases with limited body donor-based dissection training availability.

神经外科医生需要对脑动脉的外科解剖有深刻的了解，以安全地治疗患者。这是一个挑战，因为供应大脑的主要血管有许多分支，节段和曲折。这项研究的目的是根据脑动脉解剖结构的解剖结构创建高质量的三维 (3D) 解剖真实感模型，并将这些数据整合到虚拟现实 (VR) 环境中。通过摄影测量法表面扫描方法呈现的脑血管解剖结构可以提供足够的细节，以在逼真的3D模型中呈现单个血管的路线，甚至是小的穿孔动脉。包括VR可视化在内的这些功能提供了新的教学前景。整个研究是使用简化的算法和免费或开源软件平台完成的，该平台允许创建3D数据库，在基于供体的解剖培训可用性有限的情况下特别有用。

REF: Spiriev T, Körner KM, Steuwe A, et al. Immersive Photorealistic Three-Dimensional Neurosurgical Anatomy of the Cerebral Arteries: A Photogrammetry-Based Anatomic Study. Oper Neurosurg (Hagerstown). 2024;27(5):597-607. doi:10.1227/ons.0000000000001198 PMID: 39254300

Surgical Anatomy and Technique of Peri-Insular Hemispherotomy in Pediatric Epilepsy

小儿癫痫的岛周半球切开术的手术解剖和技术

Hemispherotomy is a highly complex procedure that demands a steep learning curve. An incomplete brain disconnection often results in failure of seizure control. The purpose of this article was to present a step-by-step guide to the surgical anatomy of this procedure. It is composed of a 7-stage approach, enhancing access to and improving visualization of deep structures. The peri-insular hemispherotomy technique offers excellent seizure control with a low complication rate. Our visual documentation of surgical anatomy, complemented by detailed descriptions of surgical nuances, significantly contributes to a comprehensive understanding of this technique.

半球切开术是一个高度复杂的过程，需要一个陡峭的学习曲线。不完全的大脑网络连接破坏通常导致癫痫发作控制失败。本文的目的是为该手术的外科解剖提供分步指南。它由7阶段方法组成，可增强对深层结构的访问并改善其可视化。岛叶周围半球切开术技术可提供出色的癫痫发作控制，并发症发生率低。我们对手术解剖的视觉记录，加上对手术细微差别的详细描述，极大地促进了对这项技术的全面理解。

REF: Cicutti SE, Cuello JF, Villamil F, Gromadzyn GP, Bartuluchi M. Surgical Anatomy and Technique of Peri-Insular Hemispherotomy in Pediatric Epilepsy. Oper Neurosurg (Hagerstown). 2024;27(5):608-617. doi:10.1227/ons.0000000000001161 PMID: 38651858