Search Results (75)

Background/Objectives: Spinal ependymoma is the most common intramedullary spinal cord tumor in adults, and maximal safe resection is the cornerstone of treatment. Patients aged 75 years and older are underrepresented in surgical neuro-oncology cohorts. We sought to characterize treatment patterns and identify predictors of overall survival in very elderly patients with spinal ependymoma. Methods: We performed a retrospective cohort study of patients aged 65 years or older with spinal ependymoma using the National Cancer Database. The primary cohort was patients aged 75 years or older (very elderly); patients aged 65–74 years served as a comparison cohort. Multivariable Cox proportional-hazards models were fit within each cohort, and a surgery-by-age-cohort interaction was tested. Results: Of 1497 eligible patients aged 65 years or older with spinal ependymoma, 422 patients (28.2%) met criteria for the final analytic cohort. Intramedullary versus extramedullary tumor status was not available in the NCDB PUF and therefore could not be characterized. Very elderly patients were less likely to undergo surgery than the comparison cohort (70% vs. 85%; p < 0.001) despite similar tumor characteristics. Among very elderly patients, median overall survival was 59.7 months without surgery and 106.0 months with surgery, an approximately 46-month difference favoring surgery. Surgery was independently associated with lower mortality (HR 0.46; 95% CI, 0.24–0.89; p = 0.021). Increasing age (HR 1.15 per year; 95% CI, 1.07–1.22; p < 0.001), Charlson–Deyo score ≥ 2 (HR 4.41; 95% CI, 1.65–11.79; p = 0.003), and increasing tumor size (HR 1.02 per mm; 95% CI, 1.01–1.04; p < 0.001) were also independently associated with worse survival. In the 65–74 cohort, no significant association between surgery and overall survival was detected (HR 1.23; 95% CI, 0.54–2.81; p = 0.623), though statistical power was limited by only 7 deaths in the no-surgery arm. The surgery-by-age-cohort interaction was significant (HR 0.37; p = 0.043). Conclusions: Surgical resection was independently associated with improved overall survival in very elderly patients with spinal ependymoma despite lower utilization. Chronological age alone may be an imperfect basis for excluding older adults from surgical consideration. Full article

Introduction: Neurosurgery has evolved from an anatomy-driven analog discipline into a digitally augmented field supported by multimodal imaging, neuronavigation, intraoperative imaging, neurophysiological monitoring, robotics, augmented reality, and artificial intelligence. Objective: To examine how this transition has altered professional responsibility, informed consent, training, and medico-legal accountability in neurosurgical practice. Methods: We performed a structured narrative review of the literature on digital neurosurgery and its ethical and professional implications, focusing on publications from 1990 onward and supplemented by landmark historical papers. Sources were selected for relevance to cranial, spinal, skull base, stereotactic, and neuro-oncological neurosurgery, and then synthesized into thematic domains including brain shift, eloquent cortex preservation, stereotactic accuracy, intraoperative neurophysiology, workflow integration, equity, and liability. Results: Digital systems improve lesion localization, function-preserving surgery, stereotactic precision, documentation, and training, but they also introduce new vulnerabilities related to registration error, brain shift, platform dependence, data overload, cost, cybersecurity, deskilling, and diffuse accountability. Conclusions: Digital augmentation expands rather than diminishes the neurosurgeon’s responsibility. The neurosurgeon remains accountable for surgical indication, interpretation of technology-generated information, intraoperative override, and communication of technology-specific risks. The central ethical challenge is to integrate digital tools without weakening patient-centered judgment. Full article

Background: Preoperative anxiety and postoperative pain are prevalent and are frequently associated with poor postoperative functional outcomes. Comprehensive postoperative management, including both pharmacological and psychological components, is essential for proper postoperative care and better recovery. While the analgesic effect of traditional non-pharmacological intervention, such as cognitive behavior therapy, has been investigated by other trial studies, the newer innovative methods for delivering psychological interventions for reducing anxiety and pain are extensively being investigated. Virtual reality (VR) has emerged as a novel and promising technology that offers opportunities to mitigate patient perception and cognitive responses, and has been shown to be associated with lower levels of anxiety and pain. The aim of this randomized clinical trial (RCT) is to determine whether delivering the psychological content through virtual reality (VR) along with the standard preoperative and postoperative care results in better anxiety and pain relief outcomes than standard care in patients undergoing spinal surgery. Methods: This study protocol outlines a parallel-group RCT to be conducted in the Department of Neurosurgery at the University Clinical Hospital of Medical University of Lodz. The objective is to assess the efficacy of immersive VR environments in reducing preoperative anxiety and postoperative pain intensity in the following day after surgery. Adult patients (18–70) will be randomly assigned to either (1) standard care before surgery (control group), (2) VR exposure simulating the hospital environment alongside standard care, or (3) VR-based exposure to calming natural landscapes accompanied by soothing background sound along with standard care. In each group, a minimum of 50 patients will be recruited. The primary outcome is the change in preoperative anxiety measured using the State-Trait Anxiety Inventory-State (STAI-S) scale from baseline to immediately after intervention. Secondary outcomes include postoperative pain measured using the Visual Analogue Scale (VAS), postoperative analgesic consumption, patient satisfaction, and VR-related adverse effects. To facilitate a comprehensive understanding of the VR intervention’s impact, the primary outcome will be complemented with measures of the adverse effects, level of immersion, and level of presence in the VR environment. Secondary outcomes of self-reported satisfaction scores and postoperative analgesics from patients’ medical charts will be assessed. Conclusions: This trial will evaluate whether VR-based interventions may reduce preoperative anxiety and postoperative pain in patients undergoing spine surgery. This study may provide evidence supporting the future implementation of VR as a non-pharmacological adjunct in perioperative care. This intervention may hold significant clinical relevance clinically, particularly in patients with high level of preoperative anxiety, by offering an alternative method to pharmacological anxiolytics in the future. Full article

Background: Three-dimensional (3D)-printed vertebral body replacement (VBR) and artificial vertebral body (AVB) implants are increasingly used for anterior column reconstruction after spinal tumor resection. However, the available evidence on complications remains limited, heterogeneous, and methodologically inconsistent. This systematic review aimed to synthesize reported complications, revision patterns, and mechanical outcomes of 3D-printed VBR/AVB implants in spinal oncology and to critically appraise the quality of the available clinical literature. Methods: This systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from 1 January 1980 to 26 February 2026. Eligible studies included clinical series and cohort studies reporting extractable complication and/or revision data in patients who underwent spinal tumor resection followed by reconstruction with a 3D-printed VBR/AVB implant. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Due to substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed. Results: Eleven studies comprising 217 analyzable 3D-printed reconstructions were included. Most were retrospective single-center series and showed marked heterogeneity in tumor histology, spinal level, implant strategy, follow-up duration, and complication definitions. Because adverse-event reporting was inconsistent across studies, no pooled overall complication rate was calculated. Reported perioperative non-mechanical complications included neurological deterioration, cerebrospinal fluid- or dural-related events, wound infection, pleural effusion, pneumonia, and vascular injury. Mechanical implant failure appeared relatively uncommon, although radiographic subsidence was variably defined and inconsistently reported. Implant mismatch and hardware-related problems were infrequent but clinically relevant, particularly with prefabricated or off-the-shelf devices. Revision procedures were most commonly associated with wound complications, clinically significant subsidence, hardware failure, or tumor recurrence. Overall study quality was limited by retrospective designs, small sample sizes, and non-standardized outcome reporting. Conclusions: Current evidence suggests that 3D-printed VBR/AVB implants are a feasible option with encouraging mechanical performance for spinal reconstruction after tumor resection. Most reported adverse events appear to reflect the complexity of oncologic spine surgery rather than device-specific failure alone. However, the available evidence remains low level and heterogeneous. Larger multicenter comparative studies with standardized outcome definitions and longer follow-up are needed to better define the clinical value and durability of 3D-printed vertebral reconstruction in spinal oncology. Full article

Background and Objectives: Functional neurosurgery encompasses surgical interventions aimed at modulating the function of the central and peripheral nervous systems. Spinal cord stimulation (SCS), as a form of neuromodulation, is an established treatment for chronic pain and is increasingly utilized by both anesthesiologists and neurosurgeons. The aim of this study was to evaluate the effectiveness of SCS in patients with chronic neuropathic spinal pain. Materials and Methods: This prospective study included 42 patients who demonstrated a positive response to trial stimulation. Only patients achieving a clinically meaningful response (≥50% pain reduction) during the trial phase were included in the final analysis. Pain intensity and functional disability were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). All patients underwent a two-stage percutaneous implantation procedure using burst stimulation. A follow-up assessment was performed 3–6 months after implantation. Results: A statistically significant reduction in pain intensity was observed (p < 0.0001), with median VAS scores decreasing from 8 to 3, corresponding to a 62.5% reduction in pain intensity and exceeding the minimal clinically important difference (MCID) for VAS. Functional status improved significantly, with ODI scores decreasing from 74% to 38%, markedly surpassing the established MCID threshold. A clinically meaningful reduction in pain (≥50%) was achieved in the majority of patients. All patients requiring opioid analgesics at baseline discontinued their use following SCS implantation, and a reduction in overall analgesic consumption was observed across the cohort. Conclusions: These findings suggest that burst SCS may be an effective treatment option for carefully selected patients with chronic neuropathic spinal pain who are not candidates for conventional spine surgery. However, the results should be interpreted with caution due to the enriched study design and limited follow-up period. Full article

Surgical navigation and augmented reality (AR) are widely used in neurosurgery, spinal surgery, and orthopedics. However, their use in minimally invasive abdominal and thoracic soft-tissue surgery is limited, as tracking deformable, mobile organs is challenging. Recent advances in AR may address these challenges to improve intraoperative navigation. This systematic review, registered in PROSPERO (2024) and based on PRISMA guidelines, analyzes literature from 2014 to 2024 about AR in minimally invasive abdominal and thoracic soft-tissue surgery. It identifies target organs, describes AR hardware and software, and evaluates accuracy levels, usability outcomes, clinical benefits, technical limitations, and research needs. Searches of PubMed, Web of Science, and Embase for English-language studies found 1297 records, of which only 28 (2%) met the inclusion criteria. Nearly half (n =12; 42%) focused on liver surgery; none on gynecologic surgery. The AR devices varied in tracking methods, image processing, visualization, and display. Overall, AR improved anatomical guidance and procedural planning, especially in complex surgeries. Integration with robotic systems may further boost visualization, precision, and workflow, though challenges remain in standardization, large-cohort validation, and workflow integration. Full article

Background and Objectives: Complicated osteoporotic thoracolumbar fractures represent a major surgical challenge because compromised bone quality predisposes to progressive deformity, neurological deterioration, and fixation failure. This study aimed to evaluate the clinical and radiological outcomes of hybrid stabilization in patients with severe osteoporotic fractures classified as AO Spine-DGOU OF4–OF5. Materials and Methods: This single-center retrospective observational cohort study included 87 consecutively treated patients with complicated osteoporotic thoracolumbar fractures who underwent surgical treatment between 2012 and 2022. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes included the regional kyphotic angle (RKA) and interbody fusion graded according to the Bridwell classification. Imaging was reviewed preoperatively, immediately postoperatively, and at follow-up, with 12-month outcomes used for the principal analysis. Additionally, a retrospective comparative analysis was undertaken between the two largest fixation subgroups within the cohort to explore outcome differences across the most representative construct patterns. Results: At 12 months, complete interbody fusion (Bridwell grade I) was achieved in 75.9% of patients. Mean RKA improved from 29.4° ± 14.1° preoperatively to 7.9° ± 8.0° immediately after surgery, with only minimal loss of correction during follow-up. Mean VAS improved from 7.0 ± 1.8 to 2.1 ± 1.2, while mean ODI decreased from 61.3% ± 6.8% to 9.8% ± 1.2% (both p < 0.001). Reoperation for implant-related mechanical failure was required in three patients (3.4%). Conclusions: Hybrid stabilization with cement augmentation was associated with marked improvement in pain, functional disability, and sagittal alignment, as well as a high rate of interbody fusion at 12 months, in patients with complicated osteoporotic thoracolumbar fractures. Given the retrospective observational design, these findings should be interpreted as associations within the treated cohort. Prospective comparative studies are warranted to further validate these results. Full article

Synthetic biomaterials used as bone graft extenders (BGE) in spinal fusion surgery can supplement but do not replace autologous bone. This pilot study evaluated a calcium sulfate/hydroxyapatite (CaS/HA) material as an antibiotic-eluting BGE and a carrier for bone morphogenetic protein-2 (BMP-2) in a rabbit posterolateral lumbar (L4–L5) spinal fusion model (PLF). Pre-set CaS/HA beads were loaded with tobramycin (TOB) and tested for in vitro antibiotic release and antibacterial activity against Staphylococcus aureus. For the in vivo PLF study, CaS/HA beads were used in two treatment strategies: (1) CaS/HA + TOB + autograft (left side) and (2) CaS/HA + BMP-2 (right side). Serum levels of TOB were quantified and spinal fusion was evaluated after 12 weeks. TOB exhibited a rapid initial release, followed by a decline below detectable levels after 6 h in vitro and 48 h in vivo. TOB-loaded CaS/HA beads demonstrated in vitro antibacterial activity for 19 days. In the PLF study, 5/6 and 6/6 specimens were fused radiologically in the TOB and BMP groups, respectively, and 100% using mechanical testing. Micro-CT analysis showed no significant difference in bone volume between the TOB and BMP-2 groups (364 ± 84 vs. 479 ± 95 mm³). Histology verified continuous bone bridging in both groups. Our in vitro findings indicate that locally added TOB could protect the CaS/HA material from bacterial colonization and did not adversely impact the CaS/HA material negatively to act as BGE. The addition of low-dose BMP-2 to the CaS/HA material proved effective in building bone without the need to harvest autologous bone. In summary, this pilot PLF study demonstrates that the tested CaS/HA material combined with BMP-2 could replace autologous bone harvesting in spinal fusion surgery. Addition of TOB could potentially protect the material from bacterial colonization during the early post-operative period but further studies in infection models are warranted. Full article

Biportal endoscopic (BE) spine surgery has gained increasing attention as a minimally invasive alternative to conventional spinal procedures, yet the distribution of procedural applications and anatomic targets within influential BE-specific publications has not been clearly synthesized. This study aimed to synthesize influential publications on BE spine surgery to describe the evolution of procedural applications, anatomic focus, and clinically relevant themes reflected in the literature. A comprehensive search of the Web of Science database was performed using terms related to biportal and multiportal endoscopic spine techniques. Influential articles were identified using citation frequency as a screening criterion, and relevant study characteristics, including publication year, authorship, institutional affiliation, geographic region, journal, and spinal region addressed, were extracted. Full-text screening confirmed inclusion of true biportal endoscopic spinal procedures and categorized the anatomical region and surgical technique addressed. Publications spanned 1997 to 2023, with a marked increase after 2018 and peak productivity in 2022. Influential publications were most frequently published in World Neurosurgery, with substantial contributions originating from South Korea, including work by Dae-Jung Choi. Most studies focused on lumbar procedures, primarily decompression techniques and transforaminal lumbar interbody fusion. Overall, this review highlights the rapid clinical growth of BE spine surgery, with influential literature emphasizing lumbar applications and underscoring the need for further research on outcomes, learning curves, and broader international adoption. Full article

Background/Objectives: Pediatric neurosurgical procedures often involve significant blood loss and rapid hemodynamic shifts, necessitating accurate hemoglobin (Hb) monitoring. While continuous non-invasive Hb (SpHb) monitoring offers real-time trending, its accuracy in high-risk pediatric populations remains debated. We aimed to evaluate the diagnostic accuracy and clinical utility of SpHb compared to invasive arterial blood gas (ABG) analysis in pediatric patients undergoing cranial and spinal surgeries. Methods: This prospective, observational study enrolled 60 pediatric patients (aged 0–16 years) scheduled for high-risk neurosurgery. SpHb was measured continuously and compared with intermittent ABG-Hb values. Statistical analysis included Bland–Altman agreement, Pearson’s correlation, and Error Grid Analysis. Subgroup analyses assessed the impact of the Perfusion Index (PI), hypotension, and metabolic acidosis on device performance. Results: Data from 57 patients (median age: 12 months, interquartile range: 6–42 months; 70.2% aged <24 months) were analyzed. SpHb demonstrated a moderate correlation with ABG-Hb (r = 0.567, p < 0.001) but exhibited systematic overestimation with a mean bias of +1.60 ± 1.54 g/dL. Crucially, SpHb showed 0% sensitivity for detecting critical anemia (Hb < 8.0 g/dL). Device performance was significantly compromised by physiological extremes: severe metabolic acidosis significantly increased bias to +2.27 g/dL (p = 0.038), and intraoperative hypotension significantly widened the limits of agreement (SD of bias: 1.79 g/dL vs. 1.45 g/dL in normotension). Furthermore, hemodynamic analysis revealed a loss of autoregulation during hypotension, where the pressure-perfusion coupling strengthened (r = 0.44) compared to the normotensive state (r = 0.15). Conclusions: SpHb monitoring provides fair Hb trending but is limited by systematic overestimation and poor sensitivity for critical anemia. Accuracy worsens during severe acidosis and hemodynamic instability. Therefore, SpHb should function as a complementary “early warning” trend monitor rather than a sole transfusion trigger, with invasive validation remaining essential for intraoperative decision-making. Full article

Background: Osteoporosis and low bone mineral density are highly prevalent among patients undergoing spinal fusion, contributing to higher rates of hardware failure, revision surgery, and poor postoperative outcomes. Despite clear risks, perioperative screening and treatment for osteoporosis remain inconsistent. Bone Health Clinics (BHCs) and Fracture Liaison Services (FLSs) have emerged as multidisciplinary models to address this care gap. We describe the implementation of a dedicated BHC at a single academic center and evaluate perioperative pharmacotherapy patterns, treatment barriers, and surgical outcomes among spine patients. Methods: We retrospectively reviewed 174 consecutive perioperative spine patients referred to our institutional BHC between October 2019 and April 2024. Demographics, surgical characteristics, bone health status, laboratory and DXA results, pharmacologic management, contraindications, insurance-related barriers, and medication sequencing were collected. Surgical outcomes included hardware failure and revision surgery. Bone health response was assessed by follow-up DXA scans. Results: The cohort was predominantly female (78.2%) with a mean age of 71.9 years. Most patients were referred by neurosurgery (53.4%) or orthopedics (41.4%). Based on DXA and fragility fracture history, 27.0% had osteopenia, 56.3% osteoporosis, and 13.8% severe osteoporosis. Pharmacotherapy was prescribed in 146 patients (83.9%), most commonly romosozumab (32.9%), denosumab (22.6%), and abaloparatide (21.2%). Twenty-eight patients (16.1%) did not receive medication, primarily due to contraindications. Insurance-related barriers disproportionately affected anabolic agents, whereas denosumab had the lowest denial rate (15.2%, p = 0.0124). Sequential therapy was common (32.1%), most frequently romosozumab followed by denosumab. Hardware failure occurred in 11.5% of patients, with 5.7% requiring revision surgery. Among the 80 patients (46.0%) with follow-up DXA, 60% demonstrated improved bone mineral density, with an average T-score gain of 0.6 ± 0.5. Conclusions: Integration of a multidisciplinary BHC into perioperative spine care was feasible, associated with high rates of pharmacotherapy initiation, and demonstrated favorable early surgical outcomes compared to published complication rates in this population. Insurance and contraindications remain key barriers to anabolic therapy access, driving prescribing toward denosumab. Prospective studies are needed to confirm the impact of perioperative bone optimization on surgical durability, cost-effectiveness, and patient-centered outcomes. Full article

The objective of this study was to assess the accuracy of autoclavable, three-dimensionally (3D) printed drill guides (3DPG) created with a rapid printing protocol and utilized by both an experienced and inexperienced surgeon in constraining the trajectory of drill tracts to intended corridors within canine cervical vertebrae. The 3DPG were designed using computed tomographic (CT) images of six complete cadaveric canine cervical vertebral columns and used to create drill tracts in all vertebrae by both an experienced and a novice surgeon. Repeat CT imaging was used to assess the entry point (EPD) and angular deviation (AD) of the actual versus planned drill tracts. Unintended cortical bone violations were also assessed. A total of 80 3DPG were used to create 144 drill tracts in 42 vertebrae. The overall mean EPD was 1.1 mm (median 0.9 mm, range 0.1–5.1 mm) and the overall mean AD was 7.3° (median 5.2°, range 0.5–33.8°). There were no differences in overall EPD (p = 0.85) or AD (p = 0.20) between the inexperienced and novice surgeons. There were no unintended cortical bone breaches. These 3DPG allowed the creation of safe and accurate drill tracts within the canine cervical spine by both an experienced and an inexperienced surgeon. Full article

Recent advances in neuromodulation are opening new pathways for treating chronic pain, with spinal cord stimulation (SCS) poised for substantial transformation in the coming years. Evolving technologies and a deeper understanding of pain mechanisms are driving a move away from traditional, standardized stimulation models toward more precise and personalized interventions. This shift reflects not only technical progress but also a growing emphasis on tailoring treatment to individual patient profiles. Advances in neuromodulation have introduced new stimulation patterns such as high-frequency, burst and dorsal root ganglion stimulation, which developed to address the limitations of conventional tonic SCS, especially declining long-term efficacy and the need for paresthesia. Early studies show promising results for these newer modalities, but findings are inconsistent and long-term data remain limited. In this article, we explore the current landscape of SCS innovation, highlight emerging clinical approaches and discuss the conceptual and technological trends that are likely to redefine the role of neuromodulation in chronic pain management. Full article

Intraoperative ultrasound (IOUS) has developed from a rudimentary adjunct into a versatile modality that now plays a crucial role in neurosurgery. Offering real-time, radiation-free and repeatable imaging at the surgical site, it provides distinct advantages over intraoperative magnetic resonance (MRI) and computed tomography (CT) in terms of accessibility, workflow integration and cost. The clinical spectrum of IOUS is broad: in cranial surgery it enhances the extent of resection of gliomas and metastases, supports dissection in meningiomas and enables localization of MRI-negative pituitary adenomas; in spinal surgery, it guides resection of intradural and intramedullary tumors, assists in myelotomy planning and confirms decompression in degenerative conditions such as cervical myelopathy and ossification of the posterior longitudinal ligament. IOUS also offers unique insights into cerebrospinal fluid disorders, including arachnoid webs, cysts, syringomyelia and Chiari malformation, where it visualizes cord compression and CSF flow restoration. In trauma and oncological emergencies, it provides immediate confirmation of decompression, directly influencing surgical decisions. Recent innovations, including contrast-enhanced ultrasound, elastography, three-dimensional navigated systems and experimental integration with artificial intelligence and robotics, are extending its functional scope. Despite heterogeneity of evidence and operator dependence, IOUS is steadily transitioning from an adjunctive tool to a cornerstone of multimodal intraoperative imaging, bridging precision, accessibility and innovation in contemporary neurosurgical practice. Full article

Neurosurgery is undergoing a significant transformation driven by advances in biomaterials and tissue engineering. These interdisciplinary innovations address challenges in repairing and regenerating neural tissues, integrating cranial and spinal implants, and improving patient outcomes. The incidence of neurological injuries such as traumatic brain injury and spinal cord injury remains high, underscoring the need for improved therapeutic strategies. This review provides a comprehensive overview of current biomaterial and tissue engineering approaches in neurosurgery, highlighting developments in neural tissue repair, cranial and spinal implants, spinal cord injury treatment, and peripheral nerve regeneration. Key challenges—such as ensuring biocompatibility, modulating the immune response, and bridging the gap between laboratory research and clinical application—are discussed. Emerging technologies including 3D bioprinting, nanotechnology (removing microfluidics), and microfluidics are examined for their potential to revolutionize neurosurgical treatments. The need for interdisciplinary collaboration among neurosurgeons, material scientists, and biologists is emphasized as critical for overcoming translational barriers and accelerating the clinical translation of these promising technologies. Full article