Neurosurgery

Application and Effectiveness Evaluation of Ultra-Micro Flexible Electrode Arrays in Treating Neuronal Abnormal Discharge Zhibo Wang, PhD, Ziyang Peng, PhD, Lei Wang, PhD, Zhenguo Zhang, PhD, Le Huan, Can Xia, PhD, Haoqian Peng, PhD, Juanjuan Wang, PhD, Rongqian Wu, PhD, Yi Lyu, PhD Xi’an Jiaotong University, Xi’an, China Introduction: We developed ultra-micro flexible electrode arrays using magnetron sputtering technology for targeting areas of neuronal abnormal discharges. These arrays were precisely implanted in patients’ brains with a robotic arm to counteract abnormal neuronal discharge by delivering opposing currents, restoring normal activity. Methods: Ultra-micro electrode arrays were fabricated and robotically implanted into patient brains at sites of abnormal discharge. A controlled trial divided patients into 2 groups: 1 received the electrode implantation, the other standard care. We tracked neural activity, seizure frequency, and intensity, assessed neural function recovery via NIH Stroke Scale/Score (NIHSS), and monitored safety indicators, including operative complication and electrode stability. Statistical analysis was performed using t-tests, Wilcoxon tests, and Fisher’s exact test to ensure research reliability. Results: The implantation group exhibited a 35.6% reduction in abnormal neural discharge and a 20.5% decrease in seizure frequency. NIHSS scores improved from 33-40 to 28-36, indicating significant neural function enhancement compared with controls (p < 0.05). No significant complication or adverse effects were noted during follow-up, with treated patients showing a return to normal neural activity over time, unlike the control group. Conclusion: The study confirms the ultra-micro electrode arrays’ effectiveness in reducing abnormal neuronal discharge and facilitating neural activity normalization, offering new avenues in neural regulation therapy and addressing neural functional disorder. Assessing the Fragility Index of Randomized Controlled Trials on Carotid Artery Stenosis: Systematic Review Eva Liu, MD, Natalie Tilbury, BSc, Amy Zhou, BSc, Jack Su, MD, Amit Persad, MD, FRCSC, Braeden Newton, MD, Syed Uzair U Ahmed, MD, FRCSC, Lissa Peeling, MD, FRCSC, Michael E Kelly, MD, PhD, FRCSC, FACS University of Saskatchewan, Saskatoon, SK, Canada; Stanford University, Palo Alto, CA Introduction: The fragility index (FI) is the minimum number of patients whose status would have to change from a nonevent to an event to turn a statistically significant result to a non-significant result. We used this to measure the robustness of trials comparing carotid endarterectomy (CEA) to carotid artery stenting (CAS). Methods: A search was conducted in MEDLINE, Embase, and PubMed on randomized controlled trials (RCTs) comparing CEA to CAS. The trials need to have statistically significant results and dichotomous primary endpoints to be included. Results: Our literature search identified 10 RCTs which included 9382 patients (4734 CEA, 4648 CAS). The primary endpoints of all included trials favored CEA over CAS. The median FI was 9.5 (interquartile range 2.25-21.25). All the studies that reported lost-to-follow-up (LTFU) had LTFU greater than its fragility index, which raises concern that the missing data could change the results of the trial from statistically significant to statistically insignificant. Conclusion: A small number of events (FI, median 9.5) were required to render the results of carotid artery stenosis RCTs comparing CEA with CAS statistically insignificant. All the studies that reported LTFU had LTFU greater than its fragility index. Combined Quetiapine and Propranolol after Severe Traumatic Brain Injury Additively Reduce Penumbral Leukocyte Mobilization and Cerebral Edema Priyanka Bele, MD, Patricia Santos Carlin, MD, Matthew Culkin, BS, Patricia Martinez Quinones, MD, Anastasia Georges, MS, Christina Jacovides, MD, Lewis J Kaplan, MD, FACS, Victoria Johnson, MBChB, PhD, Douglas H Smith, MD, Jose L Pascual-Lopez, MD, PhD, FACS, FRCS(C), FCCM Jefferson University Hospital, Philadelphia, PA; University of Pennsylvania, Philadelphia, PA; Temple University Hospital, Philadelphia, PA Introduction: After traumatic brain injury (TBI), quetiapine (Q) reduces intracranial pressure, and propranolol (B) may improve survival by blunting neurovascular inflammation and preserving blood-brain barrier (BBB) integrity. We hypothesized that combining Q & B after TBI optimally reduces penumbral leukocyte (LEU) mobilization and enhances neuroclinical recovery. Methods: A total of 35 CD1 male mice underwent severe TBI (controlled cortical impact: injury, I) or sham craniotomy (S) followed by intraperitoneal saline (placebo, P), Q (10 mg/kg), B (2 mg/kg), or a combination of both (Q + B) BID for 2 days. At 48 hours, in vivo pial intravital microscopy assessed BBB endothelial-LEU interaction and microvascular permeability. Cerebral tissue was procured for wet-to-dry (edema) analysis. Animal weight loss recovery and the Garcia Neurological Test (GNT) gauged neuroclinical recovery. Results: In vivo LEU rolling was greatest in I + P and lowest with combined treatments I + Q + B (Figure 1A). In vivo BBB permeability was greatest in I + P (0.7 ± 0.03%) and similarly reduced by Q (0.4 ± 0.03%), B (0.4 ± 0.03%), and I + Q + B (0.4 ± 0.02%) (all p < 0.0001 vs I + P). However, whole hemisphere cerebral edema was lowest in I + Q + B (Figure 1B). Post-injury dual treatment (I + Q + B) optimized weight loss recovery (Figure 1C) and GNT scores (17.7 ± 0.2) normalizing them to sham as compared with I + P (15.3 ± 0.2, p < 0.0001).Figure 1Conclusion: Combining post-TBI quetiapine and propranolol demonstrates potent additive effects, reducing BBB leukocyte mobilization and brain edema while also enhancing neuroclinical recovery. Dual therapy should be investigated in humans after severe TBI. Microscopic Assisted Uninstrumented Surgical Tumor Decompression as a Viable Alternative to Instrumented Open Operation for Symptomatic Metastatic Epidural Spinal Cord Compression? Arthur L Jenkins III, MD, FACS, Camryn Harvie, BS, Richard J Chung, BS, Jack O’Donnell, BS Jenkins NeuroSpine, New York, NY Introduction: A retrospective review assessed the microsurgically assisted uninstrumented spinal tumor decompression (MUST-D) approach for tumor decompression’s role in treating symptomatic metastatic epidural spinal cord compression (MESCC). Methods: This study retrospectively reviewed 2 groups: “standard” open decompression of MESCC and fusion (Control, n = 38) and a group operated via minimally invasive surgery (MIS) with cement vertebral body augmentation without fusion (MUST-D, n = 21). Inclusion criteria were symptoms of spinal instability/neural compression from spinal metastasis, radiographic evidence of MESCC, and operative treatment-confirmed metastatic disease. Recorded outcomes were operation length, anesthesia duration, complications, Cobb Angle, estimated blood loss (EBL), survival, and ambulation. Results: MUST-D showed a significant decrease in the length of operation (p = 0.0001), anesthesia duration (p = 0.0041), and complication compared with the control. MUST-D exhibited a significant decrease in deformity postoperatively (p < 0.001). No significant difference was observed in EBL (p = 0.063) and survival (p = 0.35) between groups. Patients with good ambulation (Hauser Ambulation Index [HAI] < 5) in the MUST-D group saw improvement postoperatively (n = 15, means 1.53, 2.53, 1.00), whereas the control group did not return to baseline (n = 22, means 2.23, 3.55, 3.27). For poor ambulation patients (HAI >5), MUST-D improved by 1-month postoperatively (n = 6, means 6.67, 5.17, 1), whereas the control showed less improvement (n = 14, 8.00, 8.08, 7.22). While preoperative HAI scores did not differ significantly between groups (p = 0.09), MUST-D demonstrated significantly better ambulation postoperatively (p = 0.02), (Figure 1).Figure 1Conclusion: MUST-D provides a viable alternative to open operation for MESCC, exhibiting significant reduction in postoperative deformity, complication, and operative duration compared with standard procedures. For patients with severe neurological deficits, MUST-D is superior to the standard of care. Larger studies are warranted given these improved outcomes. Surgical Site Infection in Patients Undergoing Craniotomy for Meningioma Resection: Incidence, Risk Factors, and Outcomes Usama Waqar, MBBS, Abiha Abdullah, MD, Syed Ali Gardezi, MBBS, Muhammad Hamza, MBBS, M. Shahzad Shamim, MBBS Aga Khan University, Karachi, Pakistan; University of Pittsburgh, Pittsburgh, PA Introduction: Surgical site infection (SSI) significantly affects outcomes in patients undergoing craniotomy for meningioma resection. This study aims to delineate the incidence, risk factors, and outcomes associated with SSI in this patient cohort. Methods: A retrospective analysis of NSQIP from 2005 to 2020 was conducted. Patients who underwent elective craniotomy for meningioma resection, except those with disseminated disease, were included. Binary logistic multivariable regression was used to assess perioperative factors and 30-day outcomes associated with SSI. Results: We included 6,850 patients, and of whom 132 (1.9%) developed SSI. Univariate analysis identified 15 factors (age, gender, comorbidity, smoking status, surgical indication, etc). Multivariate logistic regression narrowed these to 4 significant factors associated with increased odds (adjusted odds ratio) of SSI development. These included male gender (1.8 [1.3-2.6]), American Society of Anesthesiologists classification of 3-5 (1.6 [1.1-2.5]), wound classified as contaminated (4.8 [1.1-21.8]), and operative time >300 minutes (2.2 [1.4-3.4]), all p < 0.05. Conversely, anemia was inversely associated with SSI (0.6 [0.3-0.9], p = 0.047) and BMI, steroid use, and patient age showed no significant association with SSI incidence. Consequently, the occurrence of SSI was significantly associated with increased odds of overall morbidity and specific 30-day postoperative complications such as sepsis, septic shock, pneumonia, wound disruption, and others stratified in Figure 1.Figure 1Conclusion: Our study elucidates key risk factors and postoperative outcomes of SSI in meningioma resection patients and emphasizes the need for tailoring perioperative care to patient-specific risk factors, ultimately improving operative outcomes in this patient population. Teach the Unteachable with a Virtual Reality Brain Death Scenario: 800 Students and 2 Years of Experience Anna Junga, MD, Pascal Kockwelp, PhD, Bernhard Marschall, MD, PhD, Benjamin Risse, PhD, Markus Holling, MD, PhD University of Münster, Münster, Germany Introduction: Medical education is potentially the most crucial teaching infrastructure of modern society and has profound social and political reach. Addressing these challenges requires innovative teaching concepts and skill training while enabling effective scalability and adaptability. To meet these national and international demands we here introduce an AI-empowered virtual reality (VR) training for medical students. Methods: Since the summer term of 2021, over 800 students at the Münster campus independently performed a brain death examination on a virtual unconscious patient requiring intensive care. The goal was to develop an immersive and sustainable way to teach this highly relevant topic, reduce student anxiety, and provide information about the process of brain death diagnosis. In our presentation, we want to outline the design process and adjustments based on the experience gained. Results: Students were asked to rate the course format, and the VR course was preferred with a score of 74.4 (±22.2) points, while the former manikin-based course received a score of 47.4 (±28.9) points (p < 0.001). The mean score for subjective competence before simulation was 2.21 (±0.85) [scale 1-5]. After the brain death simulation had been carried out, the value was significantly higher at 2.98 (±0.97; n = 91). Conclusion: Based on our experience and findings, cognitive skills, competencies, and decision-making abilities can be effectively trained on a large scale using VR. VR- and AI-supported teaching is a cost-effective and targeted alternative to traditional methods, which can be used as a modern and excellent supplement to conventional teaching techniques. The Impact of Artificial Intelligence on Large Vessel Occlusion Stroke Detection and Management: A Systematic Review Meta-Analysis Sonali Dadoo, BS, Elan J Zebrowitz, BS, Paige Brabant, MS, Anaz Uddin, BS, Esewi Aifuwa, BS, Danielle N Maraia, BS, Mill Etienne, CDR, MD, MPH, Neriy Yakubov, MD, Myoungmee Babu, BS, Benson Babu, MD, MBA, FACP New York Medical College, Valhalla, NY; Wyckoff Heights Medical Center, New York, NY Introduction: Stroke remains the second leading cause of death worldwide, with many survivors facing significant disability. The adage, ‘time is brain,’ underscores the need for quick action. Artificial intelligence (AI) potentially offers swift detection and management of acute ischemic strokes. Methods: The study is registered with Prospero under CRD42024496716 and adheres to the Problem, Intervention, Comparison, and Outcomes framework (PICO). The analysis used PRISMA guidelines. Embase, PubMed, DBLP, Google Scholar, IEEE Xplore, Cochrane database, IEEE, Web of Science, ArXiv, MedRxiv Web of Science, and Semantic Scholar were searched. Out of 1,528 articles identified, 38 articles, published from 2019 to 2023, were included in this study. Results: Triage time, door-to-intervention notification time, and door-to -arterial puncture time were significantly faster with AI-augmented large vessel occlusion detection vs non-AI (odds ratio [OR]: 0.39; 95% CI: 0.29-0.54; OR: 0.3; 95% CI: 0.21-0.42; OR: 0.50; 95% CI: 0.30-0.82, respectively). CT-to-puncture-time was faster, but not significantly, with AI-augmentation vs non-AI (OR: 0.57 95% CI: 0.31-1.04). Sensitivity of AI-detection was higher than non-AI (OR: 0.91 95% CI: 0.88-0.95). Patient transfer times between primary and comprehensive stroke centers, and door-in-door-out time did not significantly differ between groups. Conclusion: Our findings highlight AI’s ability to augment healthcare providers’ detection and management of acute ischemic stroke. Future longitudinal studies are critical in evaluating AI’s impact on workflow efficiency, cost-effectiveness, and clinical outcomes. The Impact of the Hexapeptide Novokinin on a Neuropathic Pain Model in Wistar Rats Filippos S Chelmis, Paraskevas Pakataridis, MD, Iliana N Sorotou, Daniela Pechlivanova Sofia University St. Introduction: Neuropathic is a with impact on of from neurological or postoperative of patients with is as the including and are not and cause effects, the need for of new Novokinin is an that has been to have significant and The of the study is to the effects of Novokinin in a after in Methods: Our study male divided into groups. 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