A recent Neurosurgery digest,
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Study Type: Systematic review and meta-analysis

Key Question: What are the outcomes of microvascular decompression for trigeminal neuralgia caused by vertebrobasilar dolichoectasia?

Key Findings:

• Complete pain relief achieved in 95.8% (95% CI 92.3-98.2%) initially, sustained in 92.6% (95% CI 88.4-96.1%) at final follow-up across 315 patients
• Low recurrence rate of 5.5% (95% CI 2.9-8.9%) with only 1.3% requiring salvage procedures
• Permanent morbidity occurred in 2.4% (95% CI 0.8-4.8%); prior ablative procedures increased complication risk while V2 involvement predicted better long-term control

Clinical Relevance: This provides evidence-based outcome data for counselling patients with this rare but challenging form of trigeminal neuralgia, supporting MVD as a viable first-line surgical option in appropriately selected cases within UK neurosurgical practice.

Limitations: All included studies were retrospective, limiting the strength of evidence and preventing establishment of MVD as definitive standard of care.

Study Type: Bibliometric analysis

Key Question: What are the publication trends, citation patterns, and research gaps in the most influential global neurosurgery literature over four decades?

Key Findings:

• 68% of the top 100 most-cited global neurosurgery papers were published after 2012, showing accelerating research interest
• 50% of publications originated from the US while only 9% came from low/middle-income countries, despite these regions bearing the highest neurosurgical disease burden
• Trauma (31%) and paediatric neurosurgery (21%) dominated subspecialty research, with surgical access and workforce training each representing 11% of general global neurosurgery themes

Clinical Relevance: This analysis reveals significant research disparities that may inform UK neurosurgeons engaging in global health partnerships and international capacity-building initiatives.

Limitations: Bibliometric analysis cannot assess research quality or clinical impact, only citation frequency.

Study Type: Prospective case series

Key Question: Does mixed reality (MxR) 3D visualization improve surgical planning and anatomical understanding for carotid endarterectomy compared to standard imaging?

Key Findings:

• In 49 consecutive CEAs, MxR visualization led to modification (shortening) of planned skin incision in 16 cases (33%)
• Mean preparation time for 3D reconstruction was 17±8 minutes with intraoperative use lasting 5±2 minutes
• Both novice and experienced neurosurgeons (>25 CEAs annually) reported improved anatomical understanding and high satisfaction scores

Clinical Relevance: MxR technology may enhance CEA planning efficiency and surgical precision across experience levels, potentially reducing incision length and operative time in UK neurovascular practice.

Limitations: No control group comparison with standard imaging alone to quantify actual clinical benefits or surgical outcome improvements.

Study Type: Retrospective cohort study

Key Question: Does early resumption of positive pressure ventilation after transsphenoidal surgery with autologous fat graft repair increase cerebrospinal fluid leak risk?

Key Findings:

• Among 609 patients, CSF leak rates were similar between PPV users (4.1%, n=73) and non-PPV patients (3.2%, n=536) with no significant difference (RR 1.16, 95% CI 0.32-4.20, p=0.81)
• PPV was reinitiated at mean 3.5 days postoperatively with only 1 delayed leak (1.4%) occurring after discharge
• No differences observed in other postoperative complications between groups

Clinical Relevance: This supports safe early CPAP/BiPAP resumption in sleep apnoea patients after transsphenoidal surgery when autologous fat grafting is used, addressing a common clinical dilemma in UK neurosurgical practice.

Limitations: Retrospective design limits ability to control for unmeasured confounding factors affecting leak risk.

Study Type: Animal experimental study (rabbit model)

Key Question: Does VEGF-coated stenting combined with intra-arterial mesenchymal stem cell injection accelerate neointima formation and reduce thrombosis after intracranial stent placement?

Key Findings:

• VEGF/PLGA-coated stents with MSC injection showed superior neointimal area, coverage ratio, and maximum thickness compared to uncoated stents at 3 days
• SEM scores were significantly improved with VEGF/PLGA + MSC treatment
• Thrombus formation variability showed large reduction (p=0.06, non-significant) compared to uncoated stents

Clinical Relevance: This addresses the critical early thromboembolism risk in the first days post-intracranial stenting before complete endothelialisation, potentially offering a strategy to reduce dual antiplatelet therapy duration and associated bleeding risks.

Limitations: Very short 3-day follow-up period provides no data on long-term safety, restenosis rates, or inflammatory responses to stem cell therapy.

Study Type: Systematic review and meta-analysis

Key Question: What are the respiratory consequences of phrenic nerve transfer surgery?

Key Findings:

• Among 617 patients, 4.9% developed respiratory symptoms and 67.4% showed unilateral diaphragm paralysis post-operatively
• Meta-analysis revealed significant reduction in FEV1 and non-significant reduction in FVC after surgery
• 2.4% of patients experienced mild but persistent respiratory symptoms

Clinical Relevance: This evidence should inform consent discussions and patient selection for phrenic nerve transfers, particularly relevant as these procedures become more common in UK brachial plexus services.

Limitations: The analysis likely includes heterogeneous surgical techniques and follow-up protocols across different centres and time periods.

Study Type: Historical commentary

Key Question: What are the historical origins and evolution of Kocher's point as a ventricular access site?

Key Findings:

• Theodor Kocher originally described the anatomical landmark using craniometry to create a safe trajectory avoiding eloquent brain regions
• Albert Kocher (Theodor's son) simplified the technique by introducing direct drilling through skin and bone with local anaesthesia, eliminating the need for formal craniotomy
• The evolution addressed key problems of ventricular collapse, blood loss, infection risk, and anaesthetic requirements

Clinical Relevance: This historical perspective provides context for the most commonly used ventricular access point in contemporary UK neurosurgical practice, highlighting how technical refinements over generations shaped current EVD techniques.

Limitations: This appears to be a historical review rather than original research, so clinical applicability is limited to educational context.

Study Type: Retrospective cohort study with prospective validation

Key Question: Can clinical and imaging data predict short-term lower cranial nerve dysfunction after medulla oblongata glioma surgery to guide optimal resection strategy?

Key Findings:

• Four independent predictors identified: extent of resection (OR 1.84), infiltrative growth (OR 10.46), preoperative LCN impairment (OR 6.79), and cervical cord involvement (OR 4.64)
• Model showed strong discrimination with AUC 0.89 in prospective validation of 45 patients
• Risk-stratified resection approach recommended: gross-total resection (88.4% EOR) for low-risk patients versus limited resection (40.8% EOR) for high-risk patients

Clinical Relevance: Provides the first validated tool for UK neurosurgeons to individualise surgical planning for medullary gliomas, potentially reducing morbidity from lower cranial nerve dysfunction whilst optimising tumour control.

Limitations: Single-centre study with relatively small validation cohort may limit generalisability across different surgical teams and patient populations.