Robot-assisted trigeminal nerve rhizotomy with radiofrequency ablation using Globus ExcelsiusGPS: illustrative case.

Background: Trigeminal neuralgia (TN) is a disorder of chronic facial pain and can be treated by radiofrequency ablation (RFA) rhizotomy of the trigeminal nerve. The use of robotic systems like the Globus ExcelsiusGPS may enhance precision and safety in intracranial procedures.

Observations: A 58-year-old male with a history of TN unresponsive to multiple treatments, including microvascular decompression (MVD) and Gamma Knife radiosurgery, underwent robot-assisted RFA rhizotomy.

Patient Perspectives on Awake Transforaminal Endoscopic Decompression Surgery Outcomes.

Background: This study aims to evaluate patient perceptions of the outcomes following awake transforaminal endoscopic lumbar decompression surgery for treating degenerative spine diseases.

Methods: Over a 1-year period from 2022 to 2023, awake transforaminal endoscopic spine surgeries were performed on 183 patients using local anesthesia and sedation, allowing patients to communicate with the surgical team throughout the procedure. A follow-up app-based survey was sent to these patients to assess their perceptions and outcomes related to the surgery.

Ibn Sina's contributions to epilepsy management: Innovations from the Islamic Golden Age.

The historical understanding of epilepsy has evolved from supernatural beliefs in ancient Mesopotamia to scientific interpretations in the Islamic Golden Age. While early civilizations viewed epilepsy as a divine affliction, Greek and Roman physicians, notably Hippocrates, proposed a cerebral origin. However, significant advancements emerged during the Islamic Golden Age (7th-15th centuries), particularly through the works of Al-Razi and Ibn Sina (980-1037 CE).

AtlasGPT: a language model grounded in neurosurgery with domain-specific data and document retrieval.

Objective: Large language models (LLMs) have shown promising performance on medical licensing examinations, but their ability to excel in subspecialty domains and their robustness under adversarial conditions remain unclear. Herein, the authors present AtlasGPT, a subspecialty-focused LLM for neurosurgery, and evaluate its performance on a benchmark multiple-choice question bank and under adversarial testing, as well as its ability to generate high-quality explanations.

Methods: AtlasGPT was built by fine-tuning GPT-4 architecture and retrieval-augmented generation from neurosurgical knowledge sources.

IGV-001 cellular immunotherapy for newly diagnosed glioblastoma: overcoming the logistic challenge.

Background: IGV-001 is a type of cellular immunotherapy currently being investigated for treating glioblastoma (NCT04485949). It uses the patient's tumor to elicit an autologous immune response.

Methods: The process involves (i) craniotomy for maximum safe resection of the glioblastoma, (ii) treatment of the tumor with an anti-sense oligodeoxynucleotide against insulin-like growth factor 1 receptor followed by irradiation, (iii) placement of the treated tumor in multiple bio-diffusion chambers, which are implanted into the patient's abdominal sheath to elicit an immune response, and (iv) explantation of the chambers 48 hours later.

GLP-1 Receptor Agonists: Beyond Diabetes-What the Neurosurgeon Needs to Know.

Background And Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained increasing popularity since the approval of semaglutide by the United States Food and Drug Administration for chronic weight management. Significant benefits have been noted in glycemic control and cardiovascular health. However, as increasing numbers of patients are started on these medications, it is important for neurosurgeons to have knowledge of any perioperative considerations and side effects related to this class of drugs.

Vasopressor Use in Acute Spinal Cord Injury: Current Evidence and Clinical Implications.

Acute spinal cord injury (SCI) often results in severe neurologic deficits, with hemodynamic instability contributing to secondary ischemic damage. Beyond surgical decompression, maintaining adequate mean arterial pressure (MAP) is key to enhancing spinal cord perfusion and oxygenation. Vasopressor therapy is frequently used to achieve hemodynamic stability, but optimal MAP targets and vasopressor selection remain controversial.

Prevention and Management of Posterior Wound Complications Following Oncologic Spine Surgery: Narrative Review of Available Evidence and Proposed Clinical Decision-Making Algorithm.

Study Design: Narrative Review.

Objective: Contextualized by a narrative review of recent literature, we propose a wound complication prevention and management algorithm for spinal oncology patients. We highlight available strategies and motivate future research to identify optimal and individualized wound management for this population.

The literacy barrier in clinical trial consents: a retrospective analysis.

Background: Historically, the readability of consent forms in medicine have been above the average reading level of patients. This can create challenges in obtaining truly informed consent, but the implications on clinical trial participant retention are not fully explored. To address this gap, we seek to analyze clinical trial consent forms by determining their readability and relationship with the associated trial's participant dropout rate.

Neuro-oncology application of next-generation, optically tracked robotic stereotaxis with intraoperative computed tomography: a pilot experience.

Objective: Innovations in robotics continue to reshape the landscape of neurosurgery. Here, the authors evaluated the safety and efficacy of the ExcelsiusGPS robot in the treatment of neuro-oncological, intracranial lesions.

Methods: The authors conducted a retrospective analysis of 19 consecutive adult patients with a neuro-oncological diagnosis who underwent intracranial biopsy and/or laser interstitial thermal therapy (LITT) with the assistance of the ExcelsiusGPS robot and intraoperative CT.

Natural language processing augments comorbidity documentation in neurosurgical inpatient admissions.

Objective: To establish whether or not a natural language processing technique could identify two common inpatient neurosurgical comorbidities using only text reports of inpatient head imaging.

Materials And Methods: A training and testing dataset of reports of 979 CT or MRI scans of the brain for patients admitted to the neurosurgery service of a single hospital in June 2021 or to the Emergency Department between July 1-8, 2021, was identified. A variety of machine learning and deep learning algorithms utilizing natural language processing were trained on the training set (84% of the total cohort) and tested on the remaining images.

Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach.

Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impede patients' comprehension. This study investigates the use of GPT-4 to simplify surgical consent forms and introduces an AI-human expert collaborative approach to validate content appropriateness. Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests.

Al-Zahrawi (936-1013 AD): On the Surgical Treatment of Neurological Disorders by the Father of Operative Surgery.

Background: Medical knowledge during the medieval ages flourished under the influence of great scholars of the Islamic Golden age such as Ibn Sina (Latinized as Avicenna), Abu Bakr al-Razi (Rhazes), and Abu al-Qasim Khalaf ibn al-Abbas al-Zahrawi, known as Albucasis. Much has been written on al-Zahrawi's innovation in various disciplines of medicine and surgery. In this article, we focus for on the contributions of al-Zahrawi toward the treatment of neurological disorders in the surgical chapters of his medical encyclopedia, Kitab al-Tasrif (The Method of Medicine).

Demographic Representation in 3 Leading Artificial Intelligence Text-to-Image Generators.

Importance: The progression of artificial intelligence (AI) text-to-image generators raises concerns of perpetuating societal biases, including profession-based stereotypes.

Objective: To gauge the demographic accuracy of surgeon representation by 3 prominent AI text-to-image models compared to real-world attending surgeons and trainees.

Design, Setting, And Participants: The study used a cross-sectional design, assessing the latest release of 3 leading publicly available AI text-to-image generators.

Performance of ChatGPT and GPT-4 on Neurosurgery Written Board Examinations.

Background And Objectives: Interest surrounding generative large language models (LLMs) has rapidly grown. Although ChatGPT (GPT-3.5), a general LLM, has shown near-passing performance on medical student board examinations, the performance of ChatGPT or its successor GPT-4 on specialized examinations and the factors affecting accuracy remain unclear.

Performance of ChatGPT, GPT-4, and Google Bard on a Neurosurgery Oral Boards Preparation Question Bank.

Background And Objectives: General large language models (LLMs), such as ChatGPT (GPT-3.5), have demonstrated the capability to pass multiple-choice medical board examinations. However, comparative accuracy of different LLMs and LLM performance on assessments of predominantly higher-order management questions is poorly understood.

Endoscopic Techniques for Spinal Oncology: A Systematic Literature Review.

Background: Due to its ultraminimally invasive nature, endoscopic spinal surgery is an attractive tool in spinal oncologic care. To date, there has been no comprehensive review of this topic. The authors therefore present a thorough search of the medical literature on endoscopic techniques for spinal oncology.

Short- and long-term outcomes of moyamoya patients post-revascularization.

Objective: The post-bypass stroke risk factors and long-term outcomes of moyamoya patients are not well documented. Therefore, the authors studied 30-day stroke risks and patients' long-term physical, functional, and social well-being.

Methods: This was a single-institution combined moyamoya disease (MMD) database interrogation and questionnaire study.

Navigation Techniques in Endoscopic Spine Surgery.

Endoscopic spine surgery (ESS) advances the principles of minimally invasive surgery, including minor collateral tissue damage, reduced blood loss, and faster recovery times. ESS allows for direct access to the spine through small incisions and direct visualization of spinal pathology via an endoscope. While this technique has many applications, there is a steep learning curve when adopting ESS into a surgeon's practice.

Awake transforaminal endoscopic lumbar facet cyst resection: technical note and case series.

Objective: The aim of this study was to describe a minimally invasive transforaminal surgical technique for treating awake patients presenting with lumbar radiculopathy and compressive facet cysts.

Methods: Awake transforaminal endoscopic decompression surgery was performed in 645 patients over a 6-year period from 2014 to 2020. Transforaminal endoscopic decompression surgery utilizing a high-speed endoscopic drill was performed in 25 patients who had lumbar facet cysts.