World Neurosurg
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The intricate nature of spinal surgery demands unprecedented precision to avoid severe complications such as nerve damage and paralysis. Recent advancements have steered spinal surgery toward robotic assistance, which enhances precision beyond human capabilities. These robotic systems allow for detailed preoperative planning and real-time guidance during surgery, significantly reducing the margin for error and promoting the adoption of minimally invasive techniques. This review aimed to evaluate the application of robotic systems in spinal surgeries, focusing on the accuracy and efficacy of these technologies in clinical settings. ⋯ Robotic systems significantly enhance the precision and safety of spinal surgeries. They reduce the risk of complications, minimize surgical invasiveness, and maintain or improve operative outcomes. However, challenges such as high costs and the need for specialized training persist. Continuous technological advancements and training are essential for the broader adoption of these systems in spinal surgeries.
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This review was performed to analyze the research on cervical spondylotic myelopathy published during the past 25 years, summarize the developments in existing research, and predict future hotspots in the field. The goal is to provide a comprehensive overview and exploration of developments in this research area. A bibliometric analysis was performed using CiteSpace and VOSviewer to quantitatively and visually analyze relevant literature from Web of Science between 1998 and 2023. ⋯ Japan and the United States contributed the highest number of publications. The predicted future research hotspots include risk factor analysis, outcome prediction, and machine learning. This study provides both an overview of the research trajectory in the field of cervical spondylotic myelopathy for scholars interested in this area, as well as offering insights and references for future research directions in the field.
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Comparative Study
ChatGPT as a Decision Support Tool in the Management of Chiari I Malformation: A Comparison to 2023 CNS Guidelines.
ChatGPT has been increasingly investigated for its ability to provide clinical decision support in the management of neurosurgical pathologies. However, concerns exist regarding the validity of its responses. To assess the reliability of ChatGPT, we compared its responses against the 2023 Congress of Neurological Surgeons (CNS) guidelines for patients with Chiari I Malformation (CIM). ⋯ Moderate incoherence was observed between ChatGPT responses and CNS guidelines on the diagnosis and management of CIM. The recency of the CNS guidelines and mixed support for contradictory ChatGPT responses highlights a need for further refinement of large language models prior to their application as clinical decision support tools.
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In the Brazilian public national healthcare system, botulinum toxin type A has traditionally been the sole treatment option for patients with dystonia. However, as of October 2022, deep brain stimulation (DBS) garnered positive recommendations for the condition. This study aims to assess the cost-effectiveness of DBS in treating adults with generalized and cervical dystonia within the Brazilian healthcare context, considering its recent inclusion. ⋯ From the perspective of the Brazilian public health system, the combination of DBS and BCP appears to be cost-effective for the treatment of both generalized and cervical dystonia when compared to BCP alone.
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The aim of this study was to assess the diagnostic yield of follow-up investigations in aneurysm-negative subarachnoid hemorrhage (SAH) patients. ⋯ The results of this study support the use of repeat DSA in patients with NPM-SAH; however, routine repeat DSA may not be indicated in PM-SAH patients. The routine use of MRI remains controversial.