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The rising bibliometric profile of global neurosurgery
No full textOBJECTIVE: The rising interest in global neurosurgery (GNS) is reflected in the apparent rise in related research output. This study aims to examine bibliometric trends related to the research subdiscipline of GNS within three leading neurosurgery journals, Journal of Neurosurgery (JNS), Neurosurgery, and World Neurosurgery. METHODS: We performed a bibliometric analysis on all GNS-related articles from the three journals published in the Web of Science database from 2005 to April 2024. Publication type, authorship demographics, citation counts, and research themes were extracted, with quantitative analyses performed using STATA. RESULTS: Our analysis included 569 articles, demonstrating a marked increase in publications over time, from 0.8 % in 2010-2014 to 1.1 % in 2015-2019 (p \u3c 0.01), and 2.1 % in 2020-2024 (p \u3c 0.001). The majority were published in World Neurosurgery (85.7 %), followed by Neurosurgery (7.6 %), and JNS (6.7 %). Peak publication years were 2024, 2022, and 2021. Authorship trends revealed that 52.4 % of first authors and 53.6 % of senior authors were from high-income countries (HICs), while 47.6 % of the articles resulted from mixed low-to-middle-income country (LMIC)-HIC collaborations. Notably, mixed collaborations with equitable authorship roles increased, highlighting a trend towards shared research leadership. Research themes were diverse, with a significant focus on healthcare systems and capacity building (36.3 %), health advocacy (16.1 %), and clinical outcomes and guideline (15.7 %). CONCLUSIONS: Bibliometric trends indicate the growing recognition and development of GNS, evidenced by increasing publication rates, diverse research themes, and significant collaborative efforts. However, challenges in equitable representation and specialty coverage remain. Continued support for LMIC researchers and global collaboration is essential to address systemic and clinical issues, ultimately advancing GNS and health equity
Ventral Midline Hysterectomy, Ovariectomy, and Ovariohysterectomy in Mus Musculus: A Surgical Protocol.
No full textMice (Mus musculus) are one of the most commonly used animal species in basic science and translational research worldwide. Ovariectomy and hysterectomy are frequently employed to explore the systemic effects of the sex-hormone axis and other pathological conditions. While several surgical protocols exist for dorsal ovariectomy in rodents, very few address a ventral midline technique, and none are specific to the mouse model. Historically, ventral midline approaches have been considered technically challenging due to unique anatomical features, including long, thin uterine horns, fragile salpinges, short ovarian suspensory ligaments, and small animal size. This protocol provides a detailed guide for performing ovariectomy, hysterectomy, or ovariohysterectomy in mice, including the microsurgical steps required. All procedures were performed using an operative stereomicroscope under 3-5x magnification. The mean weight of the mice was 24 g (SD = 2 g), with ages ranging from 19 to 21 weeks. Of the 255 surgeries performed, 3 post-operative deaths occurred, resulting in an attrition rate of 1.18%. Post-operatively, all mice were housed in groups with fresh, paddy husk bedding, and no infections or wound breakdown were observed. Despite their small size and the manipulation of several vital anatomical structures, this procedure is easily reproducible and well-tolerated in mice
The cholinotrophic system in Down syndrome
No full textCholinergic basal forebrain (CBF) projection neurons within the nucleus basalis and striatal cholinergic interneurons degenerate in individuals with Down syndrome (DS). However, the neuropathobiology of these diverse cholinergic phenotypes remains underinvestigated. This review summarizes the alterations of cholinergic, neurotrophic survival and cell death factors as well as tau pathology and amyloidopathy, and their effects upon these cell types in DS. In trisomy, the developing cholinergic system remains stable, whereas the neurotrophic receptors are compromised between control and DS cases. Both cholinergic neuronal phenotypes display severe cellular degeneration in both adult and the aged people with DS. Although developing cholinergic striatal neurons display a similar morphology between phenotypes, cholinergic striatal neurons appear dystrophic in adults with DS. Both cholinergic cell types display tau tangle pathology in elders with DS. Novel findings suggest that alterations in plasma and cerebral spinal fluid levels of proNGF, NGF metabolites, and select classes of neuronal genes are potential biomarkers to distinguish nondemented from demented people with DS. Compounds that target cholinergic pathways, TrkA agonists, p75/proNGF small molecular antagonists, NGF metabolites, and select gene ontology classes are potential targets to slow degeneration of the CBF memory connectome in DS with translation to AD
Extended Retrosigmoid Craniotomy for Resection of a Cochlear Schwannoma
No full textCochlear schwannomas are a rare subset of schwannomas arising from the cochlear nerve within the cochlea or internal auditory canal. These tumors can present with posterior displacement of the facial nerve, making facial nerve preservation a more technically demanding goal during surgery. This video describes a woman in her early 50s who presented with right-sided complete hearing loss and was thought to have a vestibular schwannoma extending into the internal auditory canal. Institutional review board approval was not required for this case report. Patient consent was obtained. The patient underwent a right extended retrosigmoid craniotomy. Intraoperatively, after cerebrospinal fluid release and cerebellopontine angle exposure, the tumor capsule was stimulated to identify the facial nerve. This early stimulation revealed the facial nerve was posteriorly displaced and splayed over the tumor\u27s back wall. Dissection planes were developed superiorly and inferiorly along the nerve, allowing for careful central debulking of the tumor through these working windows. The facial nerve was identified in continuity from the brainstem, crossing under the cochlear nerve and adhering to the tumor\u27s back wall. Because of the nerve\u27s close adherence to the tumor, a thin layer of the tumor was left to protect the nerve. Postoperatively, the patient exhibited House-Brackmann grade 2 facial nerve function without new neurologic deficits. This case highlights key surgical techniques for schwannoma resection with posterior facial nerve displacement, emphasizing the importance of early facial nerve stimulation, meticulous debulking around the facial nerve using multiple dissection corridors, and careful balancing of complete resection with facial nerve preservation
Midline supracerebellar infratentorial approach with clip occlusion of a straight sinus dural arteriovenous fistula
No full textStraight sinus dural arteriovenous fistulas (dAVFs), classified as tentorial type 2, can be approached with a torcular craniotomy and supracerebellar infratentorial approach, with gravity retraction from a sitting position optimizing the view. This video presents the case of a man in his early 60s with a thunderclap headache. Imaging showed a subarachnoid hemorrhage, and angiography confirmed a straight sinus dAVF. Endovascular embolization reduced flow, but further obliteration with surgical ligation was required. Intraoperative identification of the arterialized veins led to the fistula, and 2 efferent veins were clipped and divided. The patient tolerated the procedure well without new deficits, and angiography confirmed dAVF occlusion. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2586
Natural history of dolichoectatic vertebrobasilar aneurysms: a multinational study
No full textOBJECTIVE: Dolichoectatic vertebrobasilar aneurysms (DVBAs) are expansions of arterial tissue leading to aneurysmal formations without an obvious neck. Their natural history is poorly understood; usually patients are admitted with thromboembolic complications and/or neurological symptoms from the mass effect. There have not been international collective data, and correct timing for highly risky treatments has been under discussion. The goal of this study was to define the natural history of DVBA by long-term follow-up in an international population of patients with DVBA. METHODS: The authors collected data in 382 patients with DVBAs from 11 centers in Europe, the US, and Japan. The patients were followed until new ischemic or hemorrhagic stroke, symptomatic compression of the brainstem or cranial nerves, decline in modified Rankin Scale score, or death. Treatment excluded patients from further analysis. Demographic and radiological characteristics of patients were collected and a new classification was created based on the radiological characteristics of the DVBA. In total 223 patients were treated conservatively in the first phase of treatment. The data required for natural history calculations were available for 221 patients, with a cumulative follow-up of 622.3 patient-years. Kaplan-Meier and Cox regression analyses were used to assess risk factors with an influence on patient outcomes. RESULTS: In total, 21.5% of patients were admitted due to the mass effect, and there were 67 (30%) patient deaths during follow-up, 45 (20.2%) of which were related to aneurysms. The annual mortality and morbidity were 10.8% and 1.6%, respectively. Most of the patients with DVBAs were male, although sex did not affect prognosis when compared to the radiological characteristics of the lesion. The natural history of DVBAs was also impacted by a new classification, in which an age 50 years and older predicted mortality. Furthermore, a DVBA\u27s maximum diameter was directly proportional to adverse events. CONCLUSIONS: This study verifies the malignancy of DVBAs and encourages invasive treatment in the early phase of disease progression based on radiological characteristics and patient age when a treatment option is considered suitable. This also stresses the need for continued investigations to develop new therapeutics with acceptable safety profiles
Posterior Inferior Cerebellar Artery Double Reimplantation Bypass for Treatment of a Dolichoectatic Posterior Inferior Cerebellar Artery Aneurysm: A Technical Report
No full textBACKGROUND AND IMPORTANCE: The surgical management of posterior inferior cerebellar artery (PICA) aneurysms often poses a challenge because of tight surgical corridors, proximity to the lower cranial nerves, and the presence of perforators supplying the medulla. This report describes an excision and double reimplantation bypass for treatment of a dolichoectatic PICA aneurysm found on familial screening in a young man with a family history of aneurysmal subarachnoid hemorrhage. CLINICAL PRESENTATION: The patient underwent a right far-lateral craniotomy with excision of the dolichoectatic right PICA aneurysm with an additional outflow branch. An end-to-end reanastomosis was performed from the proximal PICA to the larger distal outflow PICA vessel, followed by an end-to-side anastomosis of the second outflow branch to the distal PICA; a salvage bypass with side-to-side V4-p2 reimplantation was later conducted because of thrombus formation at the initial end-to-end reanastomosis. CONCLUSION: PICA aneurysms are uncommon and difficult to treat because of their location and complex anatomy, often requiring unique bypass techniques. This case was further complicated by a thrombus formation, which was likely caused by pathological aneurysmal tissue being incorporated in the bypass. This case required an unconventional bypass construct that proved to be effective
Temporopolar epilepsy stereoEEG: implant technique and outcomes
No full textThe temporal pole (TP) is an under-investigated region in temporal lobe epilepsy, often overlooked during stereoEEG (sEEG) due to the lack of characteristic Phase 1 findings and technical limitations in implanting using traditional orthogonal trajectories. We retrospectively reviewed consecutive patients with TP-onset seizures confirmed on sEEG. Two non-orthogonal trajectories were utilized targeting the inferior (iTP) and superior (sTP) aspects of TP. TP was implanted in 43 hemispheres of 30 patients, in whom seizure onset in TP was identified in 32 hemispheres. Seizure foci were spatially limited to TP in 50 % of cases, whereas the remainder involved broader regions, most commonly mesial temporal structures (88 %). In a subset of cases (22 %), TP seizures emerged from either the sTP or iTP, in contrast to those emerging more diffusely across both sub-regions. Encephaloceles were found in 43 % of patients and were associated with ipsilateral TP-onset seizures in 93 % of those cases. In a heterogeneous cohort who underwent surgical intervention, 50 % achieved Engel class I outcomes at 2 years. Our series illustrates the considerable variability in the seizure onset zone across patients with TP epilepsy, both within TP as well as in its involvement of neighboring regions. Inclusion of TP during invasive monitoring can inform subsequent surgical interventions
The History and Current State of Neurosurgery in the Republic of Moldova: Celebrating the 25th Anniversary of the Founding of the Department of Neurosurgery
No full textBACKGROUND: Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. This deficit is greatest in low- and middle-income countries, especially for specialty surgical services including neurosurgery, due to insufficient personnel, resources, and infrastructure. The southeastern European nation of the Republic of Moldova is one such middle-income country. METHODS: Discussions with key individuals involved in neurosurgical care in Moldova were conducted to characterize the history and current state of neurosurgery in Moldova. Via a process of chain referral sampling, all practicing neurosurgeons in Moldova were invited to participate in the execution and authorship of this project. RESULTS: Developing from origins in the Soviet Union, neurosurgery became part of the national health system in the 1940s, with the creation of the first neurosurgery department in 1999. Eleven hospitals, including eight public and 3 private, offer neurosurgical services, with 239 beds and 5330 cases performed in 2023. Most attending neurosurgeons and residents are male, but this is changing as women comprise over one-third of residents in training. There is one neurosurgery residency program and a 2-year fellowship in endovascular neurosurgery in Moldova, with further fellowship training received outside of the country. Computed tomography and magnetic resonance imaging are available at most centers. CONCLUSIONS: This article provides the first-ever description of the history and current state of neurosurgery in Moldova and presents key recommendations to guide the international neurosurgery community in developing neurosurgical care in countries with an unmet need
Transhorizontal Fissure Approaches to the Middle Cerebellar Peduncle: Quantitative Anatomical Analyses of the Retrosigmoid, Extended Retrosigmoid, and Presigmoid-Retrolabyrinthine Approaches
No full textBACKGROUND AND OBJECTIVE: Pontine cavernous malformation (CM) resection requires thorough surgical planning to minimize morbidity and recurrence. This study compared posterolateral middle cerebellar peduncle (MCP) access after opening the interlobular triangle via the retrosigmoid (RS), extended retrosigmoid (xRS), and presigmoid-retrolabyrinthine (PSRL) approaches. METHODS: The 3 approaches were performed in 6 cadaveric heads (12 sides). The interlobular triangle was configured over the MCP after dissecting the transhorizontal fissure. Quantitative comparisons of the MCP exposure area, volume of surgical freedom (VSF), and anteroposterior and rostrocaudal angles of attack (AOA) at the posterolateral MCP were completed. RESULTS: No significant difference was found for MCP exposure. The PSRL approach produced a VSF similar to the xRS approach (120 [44.8] mm vs. 114.7 [47.3] mm, P = 0.80), and the PSRL and xRS had significantly greater VSF than the RS approach (63 [23.4] mm, P \u3c 0.001 for both). The xRS (41.6° [7.4°]) and PSRL (47° [7.8°]) approaches had significantly larger anteroposterior AOAs than the RS (38.5° [7.4°]) approach (P \u3c 0.001, P = 0.007). The PSRL approach had a mean (SD) 15.3° (5.4°) and 29° (5.2°) anterior angle advantage in the anteroposterior AOA over the xRS and RS approaches, respectively. CONCLUSIONS: The PSRL- and xRS-transhorizontal fissure approaches were superior to the RS-transhorizontal fissure approach for all instrument maneuverability parameters in the posterolateral MCP. The former 2 approaches were preferable for access to lateral pontine CMs, especially those with dorsal extensions. The xRS approach compensates for disadvantages of the RS and PSRL approaches to achieve surgical corridors for extensive central pontine CM resection