Big Data in Neurosurgery: A Guideline on Data Structures, Machine Learning Models, and Ethical Considerations.

Artificial intelligence (AI) is reshaping neurosurgery, offering unprecedented opportunities to enhance diagnostics, personalize treatment, and predict outcomes. At the heart of this transformation is the ability to effectively harness big data (BD) within the electronic medical record. Understanding these data structures is essential for making sense of the vast volumes of information generated in modern neurosurgical practice.

U.S. Surgical Practice: 23-Year Trends in Medicare Procedures and Reimbursement.

Objective: This study has two goals: first, to characterize the procedural utilization among the Medicare population for the top 10 most commonly performed procedures by the 11 largest surgical specialties from 2000 to 2022. Second, to quantify the trends in reimbursement rates for these procedures over the study period.

Summary Background Data: Understanding current trends and financial forces that are impacting surgical practice is crucial for ensuring continued patient access to care.

ChatGPT-4 in Neurosurgery: Improving Patient Education Materials.

Background And Objectives: Adequate understanding of health information has been shown to be a stronger determinant of health than several demographic factors, including age, income, or employment status. However, existing neurosurgical patient education materials (PEMs) may be too complex for the average American and may contribute to poor health literacy. Large language model chatbots may provide a rapid and low-cost means of rewriting existing PEMs at a lower reading level to improve patient understanding and overall health literacy.

Minimally Invasive Techniques for Intercostal Nerve Transfer: A Technical Note on Thoracoscopic and Robotic Approaches.

Background And Objectives: Brachial plexus injuries are a devastating and often life-altering event. For patients with flail limb and no intraplexal donors, intercostal (IC) to musculocutaneous nerve transfer allows for restoration of elbow flexion although the surgery can be long with a painful recovery. In this article, we demonstrate a minimal incision video-assisted thoracoscopic surgery (VATS) method and a robotic approach to IC harvesting for nerve to biceps brachii reanimation.

Optimizing predictive model performance in adult spinal deformity surgery: a comparative head-to-head analysis of learning models for perioperative complications.

Objective: The aim of this study was to develop and compare 4 predictive algorithms, including logistic regression (LR), random forest (RF), gradient boosting machine (GBM), and neural network (NN), for perioperative outcomes in adult spinal deformity (ASD) surgery. By evaluating these models, the authors sought to explore how linear and nonlinear interactions unique to each outcome influence predictive accuracy, emphasizing the need for outcome-specific model selection.

Methods: A retrospective cohort of 7430 patients (mean age of 67 years) who underwent multilevel thoracolumbar deformity correction was identified using the Nationwide Readmissions Database (2016-2019).

Trends in Spinal Pain Procedure Volumes and Reimbursements: An Analysis of 20 Years of Medicare Data.

Introduction: Chronic back/neck pain costs the United States around 250 billion dollars annually. Treatment strategies include medication, physical therapy, and specialized procedures. This study aimed to investigate the trends in procedural frequency and Medicare reimbursement rates for common back pain procedures.

Intraoperative indocyanine green videoangiography versus postoperative catheter angiography to confirm microsurgical occlusion of cranial dural arteriovenous fistulas.

Objective: Intracranial dural arteriovenous fistulas (DAVFs) are diagnosed with catheter digital subtraction angiography (DSA) and confirmed intraoperatively with indocyanine green videoangiography (ICG-VA). Stand-alone ICG-VA has been demonstrated to successfully predict complete obliteration of spinal DAVFs with an associated cost reduction. The predictive value of standalone ICG-VA has not been assessed; this study sought to assess the diagnostic value of intraoperative ICG-VA versus postoperative DSA for obliteration of cranial DAVFs.

Carotid webs and stroke: a comprehensive overview of clinical characteristics, risk factors, and treatment modalities.

Introduction: Carotid web (CW) refers to an atypical manifestation of fibromuscular dysplasia that affects the intimal layer of the internal carotid artery (ICA) and carotid bulb. CWs involve a shelf-like intraluminal projection within the ICA, increasing the risk of thrombus formation in young patients without known cardiovascular risk factors. The relative lack of literature regarding CWs may cause this pathology to go largely underdiagnosed.

Clinical characteristics and management of gunshot wound injuries to the peripheral nerves.

Peripheral nerve injuries (PNI) secondary to gunshot wounds (GSW) are a unique category of neurologic injury that can cause morbidity in young, otherwise healthy individuals, occurring in 25-36% of GSWs. The management of these injuries is understudied and varies throughout the literature. To characterize the clinical characteristics, management, and outcomes of peripheral nerve injury secondary to GSWs through a retrospective review of a single urban Level 1 trauma center's experience.

Intracranial stimulation for pediatric refractory epilepsy: A single institutional experience using evolving therapies.

Objective: Neuromodulation for pediatric refractory epilepsy (PRE) is preferred when the seizure onset zone is not amenable to surgical resection, due to multifocal onset or involvement of eloquent cortex. Given its rapidly evolving landscape, we describe our institutional experience with neurostimulation therapies including deep brain stimulation (DBS) of the anterior nucleus (DBS-ANT), the centromedian nucleus (DBS-CM), responsive neurostimulation (RNS), and chronic subthreshold stimulation (CSS) to treat PRE.

Methods: A retrospective chart review was conducted to identify pediatric patients (≤18 years of age) who presented to our institution with PRE.

Accuracy and quality of ChatGPT-4o and Google Gemini performance on image-based neurosurgery board questions.

Large-language models (LLMs) have shown the capability to effectively answer medical board examination questions. However, their ability to answer imagebased questions has not been examined. This study sought to evaluate the performance of two LLMs (GPT-4o and Google Gemini) on an image-based question bank designed for neurosurgery board examination preparation.

Trigeminal nerve stimulation in drug-resistant epilepsy: A systematic review.

Introduction: Trigeminal Nerve Stimulation (TNS) is a technique that may be useful to reduce seizure burden in drug-resistant epilepsy (DRE), but its efficacy is not well characterized. This study sought to understand the application of TNS in DRE by providing a comprehensive overview of the current use and efficacy of TNS for neuromodulation in DRE.

Methods: A systematic review examining the use of TNS for DRE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Trends in Medicare procedural and reimbursement rates for spinal CSF leak repair (2000-2021).

Objective: CSF leaks are a common complication of spinal surgery, occurring in 3%-16% of elective cases and up to 12% of operatively managed traumatic spinal injuries. They can also occur following lumbar puncture. However, there are limited data on utilization and reimbursement trends within Medicare for CSF leak repairs.

Treatment of Terminal Syrinx With a Syringo-Subarachnoid Shunt and the Novel Use of a Titanium Knot Fastener: A Case Report.

A syrinx involves cystic dilation of the central canal of the spinal cord due to the accumulation of cerebrospinal fluid and often results in a neurological deficit. While treatment options vary, surgical management is often utilized and requires an open durotomy. A 70-year-old female presented with one year of progressive low back pain with associated leg numbness, urinary incontinence, bilateral foot drop, and imbalance resulting in multiple falls.

The Rochester Model for Spinal CSF Leak Repair Simulation and Scoring.

Background And Objective: Iatrogenic spinal durotomies occur at a rate of 1% to 17%. Surgical simulation for durotomy repair is needed to provide affordable, accessible, and validated practice. This study sought to design and validate a simple 3-dimensional printed model for spinal cerebrospinal fluid (CSF) leak repair and to introduce the Rochester original objective structured assessment of technical skills (OSATS) CSF leak (ROCL) repair criteria for assessment.

Temporal Trends in the Epidemiology of Lower Back Pain in the United States.

Study Design: This was an observational study.

Objective: This study aims to explore sociodemographic and regional geographic variations in lower back pain (LBP) incidence, prevalence, and burden in the United States (US from 2000 to 2019).

Summary Of Background Data: LBP is a major contributor to lost wages and disability in the United States.

Endovascular therapy versus medical management for ischemic stroke presenting beyond 24 hours: Systematic review and meta-analysis.

Objective: The ideal management for ischemic stroke presenting in the very late time window, or beyond 24 hours from onset, is poorly understood. It is unknown if endovascular therapy (EVT) or best medical management (MM) is associated with superior clinical outcomes.

Methods: A systematic literature and comparative meta-analysis was completed to evaluate the safety and efficacy of EVT vs.

External Validation of the Modified Southwestern Aneurysm Severity Index in the Barrow Ruptured Aneurysm Trial Surgical Cohort.

Background And Objectives: Predicting functional outcomes after surgical management of ruptured aneurysms is essential. This study sought to validate the modified Southwestern Aneurysm Severity Index (mSASI), which predicts functional outcomes 1 year after treatment.

Methods: The surgical arm of a randomized controlled trial, the Barrow Ruptured Aneurysm Trial, was used to validate the mSASI model.

Elucidating the pathogenesis behind arteriovenous malformations of the central nervous system: a bibliometric analysis.

Arteriovenous malformations (AVMs) are vascular malformations of the central nervous system (CNS) with potential for significant consequences. The exact pathophysiologic mechanism of AVM formation is not fully understood. This study aims to evaluate bibliometric parameters and citations of the literature of AVMs to provide an overview of how the field has evolved.

High-Value Epilepsy Care in the United States: Predictors of Increased Costs and Complications from the National Inpatient Sample Database 2016-2019.

Background: For patients with medically refractory epilepsy, newer minimally invasive techniques such as laser interstitial thermal therapy (LITT) have been developed in recent years. This study aims to characterize trends in the utilization of surgical resection versus LITT to treat medically refractory epilepsy, characterize complications, and understand the cost of this innovative technique to the public.

Methods: The National Inpatient Sample database was queried from 2016 to 2019 for all patients admitted with a diagnosis of medically refractory epilepsy.

Alfred Washington Adson: Perspectives on Intracranial Neurosurgery and the Responsibilities of the Neurosurgeon.

In a period when the budding field of neurosurgery was believed to have little promise, Dr Alfred Washington Adson founded and led the first neurosurgical department at Mayo Clinic. He was not without reservations-surgical intervention for neurological conditions was rarely pursued because of poor outcomes and high complication rates, and Dr Adson acknowledged his early concerns about the future of neurosurgery in his memoirs. However, his education, mentorship, his training, and his first neurosurgical cases helped to shape the impact he ultimately had on the field and his legacy as a neurosurgeon.

Assessing views and attitudes toward the use of extended reality and its implications in neurosurgical education: a survey of neurosurgical trainees.

Objective: Extended reality (XR) systems, including augmented reality (AR), virtual reality (VR), and mixed reality, have rapidly emerged as new technologies capable of changing the way neurosurgeons prepare for cases. Thus, the authors sought to evaluate the perspectives of neurosurgical trainees on the integration of these technologies into neurosurgical education.

Methods: A 20-question cross-sectional survey was administered to neurosurgical residents and fellows to evaluate perceptions of the use of XR in neurosurgical training.