World Neurosurg
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Hydrocephalus ranks among the most prevalent neurosurgical conditions worldwide, with a growing body of literature suggesting a potential association with inflammation. Employing bibliometric methods, this research visually analyzes the scholarly output on inflammation in hydrocephalus over the past 2 decades and provides a scientific framework for delineating research pathways and addressing key issues in this field. ⋯ This study will help researchers determine the mainstream research directions and latest hotspots of inflammation in hydrocephalus and provide a reference for revealing the molecular mechanism of hydrocephalus.
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The prevalence of osteoporotic vertebral fractures has increased with aging populations, necessitating effective treatments such as percutaneous kyphoplasty combined with posterior screw fixation. However, biomechanical research on the effects of using short screws on fixation stability and bone stress or on the impact of bone cement bonding to screws on structural strength is lacking. This study aimed to optimize short-segment fixation strategies for osteoporotic thoracolumbar burst fractures by analyzing the biomechanical effects of pedicle screw length and bone-cement augmentation. ⋯ Short screws in injured vertebrae without contact with the bone cement can achieve satisfactory stability and stress distribution. It is feasible to implant short screws in the injured vertebrae, reduce the number of bilaterally injured vertebrae, and inject bone cement through the non-pedicle approach during the surgical procedure, which simplifies the surgical process.
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ChatGPT is a natural language processing chatbot with a significant prevalence in modern media with a clear application in the medical triage workflow. ChatGPT has shown significant capacity for understanding clinical vignettes, radiology reports, and even passing the American Board of Neurological Surgery board examination. There has never been an evaluation of the chatbot in triage and diagnosing spinal vignettes common to primary and urgent care practice. ⋯ ChatGPT is a powerful tool for primary triage of spinal issues. It can rapidly and accurately evaluate clinical scenarios and provide clear diagnostic reasoning. GPT-4 is not designed for medical use and will provide a disclaimer as such. It did tend toward over-referring patients to the ER. With specific training, it is likely that artificial intelligence and natural language processing chatbots will become widely used in primary triage of spinal issues.
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Case Reports
Surgical Video: Percutaneous fusion and endoscopic resection of a thoracic metastatic tumor.
While endoscopic approaches to the spine have become increasingly utilized for spinal degenerative disease, there is a paucity of literature regarding the role of endoscopic approaches in spinal oncology.1 The endoscopic approach offers patients lower risk of wound infection, wound dehiscence, and postoperative hematoma when compared with an open approach.1 In many spinal oncology patients, an endoscopic approach allows for prompt postoperative radiation when compared with an open approach.2 Both the lower complication profile and decreased time to postoperative radiation highlight the importance of considering an endoscopic approach to metastatic spinal tumors. We present a case of a patient with a metastatic carcinoma to the thoracic spine resected via an endoscopic approach. The patient's tumor was first treated with endovascular embolization, followed by endoscopic hemilaminectomy, foraminotomy, and tumor resection. ⋯ Per institutional guidelines, the current case Video 1 did not classify as human subject research or require institutional review board review. In the Video 1, particular focus is placed on the surgical techniques involved in the endoscopic approach for resection a spinal metastatic tumor. With the increasing utilization of endoscopic approaches to the spine, the described technique for resection of spinal metastatic lesions will become increasingly relevant to spinal oncology surgeons.
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Lumbar pedicle screw placement surgery involves various assistive technologies, including fluoroscopic, stereotactic, or robotic navigation and intraoperative neuromonitoring (IONM). We aimed to discern neurosurgeons' preferences for screw placement techniques and IONM utility, while also considering the influence of experience. ⋯ This national survey shows that stereotactic navigation is the predominant technique for pedicle screw placement among less experienced neurosurgeons, with seasoned neurosurgeons leaning toward fluoroscopic guidance. Robotic guidance was the least used technique with no observed difference based on experience. Neurosurgeons employing multiple techniques use IONM the most, compared with surgeons who only use stereotactic navigation and/or robotic guidance.