Cost-Effectiveness of Cranioplasty with Polymethylmethacrylate Using a Customized 3D Mold: A Pediatric First Experience in Peru

使用定制的3D模具进行聚甲基丙烯酸甲酯颅骨成形术的成本效益: 秘鲁的儿科首次经验

Biocompatible computer-assisted design (CAD) implants for cranioplasty are associated with high costs and considerable waiting time. We present the results of the first cranioplasty experience in our country using polymethylmethacrylate (PMMA) with customized 3D molds of the cranial defect. Cranioplasty with PMMA and 3D custom mold is a safe and low-cost technique that would benefit patients in middle- and low-income countries. Compared to CAD implants, the cost was reduced by 95%-97%. This technique can be implemented on a large scale with remarkable benefits in low- and middle-income countries.

用于颅骨成形术的生物相容性计算机辅助设计 (CAD) 植入物与高成本和相当长的等待时间相关。我们介绍了我国首次使用聚甲基丙烯酸甲酯 (PMMA) 和颅骨缺损的定制3D模具进行颅骨成形术的结果。使用PMMA和3D定制模具的颅骨成形术是一种安全且低成本的技术，将使中低收入国家的患者受益。与CAD植入物相比，成本降低了95%-97%。这种技术可以在低收入和中等收入国家大规模实施，带来显著的好处。

REF: Flores-Sanchez JD, Perez Chadid DA, Azmi A, Sánchez JP, Ramirez A. Cost-Effectiveness of Cranioplasty with Polymethylmethacrylate Using a Customized 3D Mold: A Pediatric First Experience in Peru. World Neurosurg. Published online November 25, 2024. doi:10.1016/j.wneu.2024.10.139 PMID: 39522818

History of Cervical Spine Localization: Surface Landmarks

颈部脊柱定位的历史: 表面地标

Interest in the relational anatomy of the anterior neck among spine surgeons increased after the popularization of anterior cervical discectomy and fusion in the 1950s. Five surface landmarks and their relationship to specific spinal levels have been routinely described, comprising the angle of the mandible for the C2-C3 interspace, the hyoid bone for the C3 body, the thyroid cartilage for the C4-C5 disc, and the cricoid cartilage and carotid tubercle for the C6 body. We aimed to investigate the origins of these anatomic relationships and their application in modern practice.

在19 50年代前颈部椎间盘切除术和融合术的普及之后，脊柱外科医生对前颈关系解剖学的兴趣增加了。常规描述了五个表面标志及其与特定脊柱水平的关系，包括C2-C3间隙的下颌骨角度，C3体的舌骨，C4-C5的甲状软骨以及环状软骨和颈动脉结节C6体。我们旨在研究这些解剖关系的起源及其在现代实践中的应用。

REF: Johnson MD, Schwieterman W, Bugada M, Garner RM, Na J, Prestigiacomo CJ. History of Cervical Spine Localization: Surface Landmarks. World Neurosurg. Published online November 22, 2024. doi:10.1016/j.wneu.2024.10.119 PMID: 39491617

From Vesalius to Modern Neuroanatomical Training: The “Surgical Grammar” for the Next Generation of Neurosurgeons in Italy

从维萨里到现代神经解剖学训练: 意大利下一代神经外科医生的 “外科语法”

Anatomical knowledge plays a crucial role in the field of neurosurgery, originating from the rigorous requirements of surgical training. The study examines the training programs for young and future generations of neurosurgeons, highlighting the significance of rigorous dissection program in the laboratory of anatomy along with the challenges they face. It also details the training paths of aspiring surgeons, focusing on the high demands and challenges encountered in the anatomy laboratory and in a real surgical scenario. A historical overview of anatomic training in Italy is provided, emphasizing the contributions of the Schola Medica Salernitana, one of the earliest medical schools in Europe. The article also traces the development of the Neuroanatomy section within the Italian Society of Neurosurgery, the first dedicated neuroanatomy section within European societies, illustrating its importance in advancing neurosurgical education and practice. In conclusion, neuroanatomy remains as the surgical grammar essential to the field of neurosurgery, offering a foundation for those on the path to expertise.

解剖学知识在神经外科领域起着至关重要的作用，源于对外科培训的严格要求。该研究考察了年轻和后代神经外科医生的培训计划，强调了严格解剖计划在解剖学实验室中的重要性以及他们面临的挑战。它还详细介绍了有抱负的外科医生的培训路径，重点关注解剖实验室和真实手术场景中遇到的高要求和挑战。提供了意大利解剖学培训的历史概述，强调了欧洲最早的医学院之一Schola Medica Salernitana的贡献。本文还追溯了意大利神经外科学会的神经解剖学部分的发展，这是欧洲社会中第一个专门的神经解剖学部分，说明了其在推进神经外科教育和实践中的重要性。总之，神经解剖学仍然是神经外科领域必不可少的外科语法，为那些走上专业道路的人提供了基础。

REF: de Notaris M, Galzio R, Iaconetta G, Cappabianca P. From Vesalius to Modern Neuroanatomical Training: The "Surgical Grammar" for the Next Generation of Neurosurgeons in Italy. World Neurosurg. Published online December 31, 2024. doi:10.1016/j.wneu.2024.11.117 PMID: 39638239

Risk Factors of Proximal Junctional Failure After Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

成人脊柱畸形术后近端关节功能衰竭危险因素系统综述及Meta分析

This study aimed to identify surgical, patient-specific, and radiographic risk factors for proximal junctional failure (PJF), a complex complication following adult spinal deformity (ASD) surgery. In ASD patients, the presence of concurrent osteoporosis or paravertebral muscle wasting significantly increases the risk of developing PJF. The use of bicortical screws, UIV screw angle exceeding 1°, and positioning the UIV in the lower thoracic or lumbar region also further elevate this risk. Lower preoperative SS, higher preoperative PI-LL, higher preoperative pelvic tilt, higher preoperative SVA, higher postoperative LL, and a greater change in LL characterize patients with PJF.

这项研究旨在确定近端连接衰竭 (PJF) 的手术，患者特异性和影像学危险因素，PJF是成人脊柱畸形 (ASD) 手术后的复杂并发症。在ASD患者中，并发骨质疏松症或椎旁肌肉萎缩的存在显着增加了发生PJF的风险。使用双皮质螺钉，UIV螺钉角度超过1 °，并将UIV定位在下胸部或腰部区域也进一步增加了这种风险。较低的术前SS，较高的术前pi-ll，较高的术前骨盆倾斜度，较高的术前SVA，较高的术后LL和LL的更大变化是PJF患者的特征。

REF: Lu Z, Wang T, Wei W, Liu J, Ji X, Zhao Y. Risk Factors of Proximal Junctional Failure After Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis. World Neurosurg. Published online October 16, 2024. doi:10.1016/j.wneu.2024.09.101 PMID: 39349169

Quantum Computing in the Realm of Neurosurgery

神经外科领域的量子计算

Quantum computing leverages the principles of quantum mechanics to provide unprecedented computational power by processing data in a fundamentally different way from classical binary computers. Quantum computers use "qubits" which superimpose 0 and 1. Because qubits can exist in multiple states at the same time, quantum computers can perform "quantum parallelism" wherein data are processed simultaneously rather than sequentially. The quantum parallelism is what enables the computer to have exponentially larger processing capabilities and consider all potential outcomes simultaneously to derive solutions. Our study aims to explore aspects of neurosurgery through which quantum computing could improve patient outcomes and enhance quality of care. Quantum computing has the potential for future applications in neuroprosthetics, neurostimulation, surgical precision, diagnosis, and patient privacy and security. It promises improved patient outcomes, enhanced surgical precision, and personalized healthcare delivery. With its inherent sensitivity and precision, quantum computing could advance the understanding of disease processes and development, providing neurosurgeons with deeper insight into patient pathologies. Challenges such as biocompatibility, cost, and ethical considerations remain significant barriers to integrating the technology into neurosurgical practice. Addressing these challenges will be crucial for realizing the transformative potential of quantum computing in advancing neurosurgical care and improving clinical outcomes.

量子计算利用量子力学原理，通过以与经典二进制计算机根本不同的方式处理数据，提供前所未有的计算能力。量子计算机使用叠加0和1的 “量子位”。由于量子位可以同时存在于多个状态中，因此量子计算机可以执行 “量子并行性”，其中数据被同时处理而不是顺序处理。量子并行性使计算机具有指数级更大的处理能力，并同时考虑所有潜在结果以得出解决方案。我们的研究旨在探索神经外科的各个方面，通过这些方面，量子计算可以改善患者的治疗效果并提高护理质量。量子计算在神经修复，神经刺激，手术精度，诊断以及患者隐私和安全方面具有未来应用的潜力。它承诺改善患者的治疗效果，提高手术精度和个性化的医疗保健服务。凭借其固有的敏感性和精确性，量子计算可以促进对疾病过程和发展的理解，为神经外科医生提供对患者病理的更深入了解。生物相容性，成本和伦理考虑等挑战仍然是将该技术整合到神经外科实践中的重大障碍。应对这些挑战对于实现量子计算在推进神经外科护理和改善临床结果方面的变革潜力至关重要。

REF: Mohamed AA, Sargent E, Moriconi C, Williams C, Shah SM, Lucke-Wold B. Quantum Computing in the Realm of Neurosurgery. World Neurosurg. Published online October 21, 2024. doi:10.1016/j.wneu.2024.09.131 PMID: 39369789

Titanium Cages versus Polyetheretherketone Cages in Interbody Fusions: A Meta-Analysis of Clinical and Radiographic Outcomes

钛笼与聚醚醚酮笼在椎间融合中的比较: 临床和影像学结果的荟萃分析

The most widely adopted materials for interbody fusion implants are titanium and polyetheretherketone (PEEK), both of which have potential advantages and disadvantages. Despite the differences between PEEK and titanium, there is no consensus on which material provides better clinical and radiological outcomes. Therefore, the purpose of this meta-analysis was to analyze the clinical and radiographic outcomes between the 2 cages. In the lumbar spine, titanium cages were shown to have a lower rate of subsidence and revision compared with PEEK cages. In the cervical spine, the difference between cages did not reach statistical significance in any of the analyzed outcomes.

用于椎间融合植入物的最广泛采用的材料是钛和聚醚醚酮 (PEEK)，两者都具有潜在的优点和缺点。尽管PEEK和钛之间存在差异，但对于哪种材料提供更好的临床和放射学结果尚无共识。因此，这项荟萃分析的目的是分析2个笼之间的临床和影像学结果。在腰椎中，与PEEK笼相比，钛笼显示出较低的下沉率和翻修率。在颈部脊柱中，在任何分析结果中，笼之间的差异均未达到统计学显着性。

REF: Daher M, Aoun M, Farhat C, et al. Titanium Cages versus Polyetheretherketone Cages in Interbody Fusions: A Meta-Analysis of Clinical and Radiographic Outcomes. World Neurosurg. Published online October 22, 2024. doi:10.1016/j.wneu.2024.09.122 PMID: 39362592

An Updated Review on Treatment of Cervical Synovial Cyst

颈部滑膜囊肿治疗的最新进展

Cervical synovial cyst (CSC) is a rare condition that often leads patients to seek medical attention due to cervical stenosis symptoms. There's ongoing debate about the best management strategy. To address this, a review of literature from the past 20 years (2003-2023) was conducted using keywords like "cervical synovial cyst," "cervical ganglion cyst," and "cervical juxtafacet cyst." Data on patient demographics, imaging characteristics, treatment methods, and clinical outcomes were collected. A total of 79 patients were diagnosed with CSCs, averaging 62.3 years old, with a slight male predominance (45 males, 34 females). Most cysts were located at the C1-2 and C7-T1 joints, with myelopathy being the most common symptom. Subaxial CSCs had a higher incidence of radiculopathy compared to axial CSCs. Most cases were treated surgically, with decompression performed with or without fusion. Patients generally reported symptom improvement regardless of the surgical method. Overall, surgical intervention effectively improved neurological symptoms associated with CSCs.

颈部滑膜囊肿 (CSC) 是一种罕见的疾病，经常导致患者因颈部狭窄症状而就医。关于最佳管理策略的争论一直在进行。为了解决这个问题，使用 “颈部滑膜囊肿”，“颈部神经节囊肿” 和 “颈部近关节囊肿” 等关键字对过去20年 (2003-2023) 的文献进行了回顾。收集有关患者人口统计学，影像学特征，治疗方法和临床结果的数据。共有79例患者被诊断为CSCs，平均年龄62.3岁，男性占主导地位 (男性45例，女性34例)。大多数囊肿位于C1-2和C7-T1关节，脊髓病是最常见的症状。与轴型CSCs相比，轴型CSCs的神经根病发病率更高。大多数病例通过手术治疗，减压或不融合。无论手术方法如何，患者通常都报告症状改善。总体而言，手术干预有效改善了与csc相关的神经症状。

REF: Peng TC, Liu PC, Chang CC, et al. An Updated Review on Treatment of Cervical Synovial Cyst. World Neurosurg. Published online October 28, 2024. doi:10.1016/j.wneu.2024.09.135 PMID: 39395740

Role of Early Postoperative Measurement of Copeptin in Prediction of Diabetes Insipidus Following Pituitary Surgery in Adults: A Systematic Review Plus Meta-analysis

术后早期检测和肽素对成人垂体手术后尿崩症的预测作用: 一项系统综述和Meta分析

Early diagnosis of diabetes insipidus (DI), a complication following pituitary surgery, can avoid catastrophic results such as lethargy or even death. Measurement of arginine vasopressin (AVP) may help the early diagnosis, but its direct assaying is challenging. Copeptin, which is co-secreted in equimolar quantities to AVP, is suggested to be a reliable marker in prediction of postoperative DI. Therefore, this systematic review plus meta-analysis aims to discover this possible role. Copeptin level was significantly lower in DI patients than in non-DI patients who underwent pituitary surgery. Early measurement, as soon as possible (from the first hour to 48 hours after the operation) of copeptin after pituitary surgeries has good, but not excellent, accuracy to exclude postoperative DI.

早期诊断尿崩症 (DI) 是垂体手术后的并发症，可以避免诸如嗜睡甚至死亡等灾难性结果。精氨酸加压素 (AVP) 的测量可能有助于早期诊断，但其直接测定具有挑战性。与AVP等摩尔量共同分泌的Copeptin被认为是预测术后DI的可靠标志物。因此，本系统综述加荟萃分析旨在发现这一可能的作用。DI患者的Copeptin水平显着低于接受垂体手术的非DI患者。早期测量，尽快 (从术后第1小时到术后48小时) 和肽素在垂体手术后有良好的效果，但不优秀，排除术后DI的准确性。

REF: Sharifi A, Hwang PH, Kouhi A, Zojaji M, Ghaffari ME, Ghaedsharaf S. Role of Early Postoperative Measurement of Copeptin in Prediction of Diabetes Insipidus Following Pituitary Surgery in Adults: A Systematic Review Plus Meta-analysis. World Neurosurg. Published online October 28, 2024. doi:10.1016/j.wneu.2024.10.006 PMID: 39393633

Neuroendoscopic Surgery for Intraventricular Cavernous Malformations: A Review on Indications and Surgical Considerations

脑室内海绵状畸形的神经内镜手术: 适应症和手术注意事项的回顾

Intraventricular cavernous malformations (IVCs) are rare vascular lesions of the central nervous system. Surgical resection remains a challenging endeavor, with conventional microsurgical techniques associated with morbidity due to direct brain tissue manipulation. Neuroendoscopic approaches offer a minimally invasive alternative, though their efficacy and safety in treating IVCs remain underexplored. Neuroendoscopic surgery offers several advantages in treating IVCs, including minimally invasive access, precise visualization, and reduced brain tissue manipulation. Our findings support the efficacy and safety of endoscopic transventricular approaches, underscoring its potential as a valuable therapeutic strategy for selected IVCs.

脑室内海绵状畸形 (IVCs) 是中枢神经系统罕见的血管病变。手术切除仍然是一项具有挑战性的工作，由于直接的脑组织操作，常规的显微手术技术与发病率相关。神经内镜方法提供了一种微创替代方法，尽管它们在治疗IVCs中的功效和安全性仍有待探索。神经内窥镜手术在治疗ivc方面具有许多优势，包括微创进入，精确的可视化和减少的脑组织操作。我们的研究结果支持内窥镜经脑室入路的有效性和安全性，强调了其作为选择性ivc的有价值的治疗策略的潜力。

REF: Bossi B, Ferlendis L, Dallago D, et al. Neuroendoscopic Surgery for Intraventricular Cavernous Malformations: A Review on Indications and Surgical Considerations. World Neurosurg. Published online October 28, 2024. doi:10.1016/j.wneu.2024.10.002 PMID: 39374804