Neurosurgery Clinics of North America

No abstract text is available yet for this article.

Applications and workflows around spinal robotics have evolved since these systems were first introduced in 2004. Initially approved for lumbar pedicle screw placement, the scope of robotics has expanded to instrumentation across different regions. Additionally, precise navigation can aid in tumor resection or spinal lesion ablation. Robot-assisted surgery can improve accuracy while decreasing radiation exposure, length of hospital stay, complication, and revision rates. Disadvantages include increased operative time, dependence on preoperative imaging among others...

The amount and quality of data being used in our everyday lives continue to advance in an unprecedented pace. This digital revolution has permeated healthcare, specifically spine surgery, allowing for very advanced and complex computational analytics, such as artificial intelligence (AI) and machine learning (ML). The integration of these methods into clinical practice has just begun, and the following review article will describe AI/ML, demonstrate how it has been applied in adult spinal deformity surgery, and show its potential to improve patient care touching on future directions...

The mainstay of treatment for spinal cord injury includes decompressive laminectomy and elevation of mean arterial pressure. However, outcomes often remain poor. Extensive research and ongoing clinical trials seek to design new treatment options for spinal cord injury, including stem cell therapy, scaffolds, brain-spine interfaces, exoskeletons, epidural electrical stimulation, ultrasound, and cerebrospinal fluid drainage. Some of these treatments are targeted at the initial acute window of injury, during which secondary damage occurs; others are designed to help patients living with chronic injuries...

There is a significant need for robust and objective outcome assessments in spine surgery. Constant monitoring via smartphones and wearable devices has the potential to fill this role by providing an in-depth picture of human well-being, creating an unprecedented amount of objective data to augment clinical decision-making. The metrics obtained from continuous patient monitoring increase the amount and ecological validity of data relevant to spine surgery. This can provide physicians with patient and disease-specific medical information, facilitating personalized patient care...

Smart spine implants promise to stimulate healing and provide objective information about healing progression. The ability of implants to accelerate healing and provide objective data could help guide postoperative care, foster better outcomes, and reduce complications. Real-time monitoring, remote control and programming, and data analytics are actively being developed and translated into clinical practice. This article discusses advances in smart spinal implant technology and how they may aid patients and surgeons...

Spine implants are becoming increasingly diversified. Taking inspiration from other industries, three-dimensional modeling of the spinal column has helped meet the custom needs of individual patients as both en bloc replacements and pedicle screw designs. Intraoperative tailoring of devices, a common need in the operating room, has led to expandable versions of cages and interbody spacers.

Augmented reality (AR) and virtual reality (VR) are powerful technologies with proven utility and tremendous potential. Spine surgery, in particular, may benefit from these developing technologies for resident training, preoperative education for patients, surgical planning and execution, and patient rehabilitation. In this review, the history, current applications, challenges, and future of AR/VR in spine surgery are examined.

A historical overview of the evolution of anterolateral approaches to the lumber spine and associated patient outcomes is presented. In addition, the modern incorporation of new technologies is discussed, including interbody cages, intraoperative image guidance, robotics, augmented reality, and machine learning, which have significantly improved the spine surgery safety and efficacy profile. Current challenges and future directions are also covered, emphasizing the need for further research and development, particularly in robotic assistance and machine learning algorithms...

Back pain is one of the most common aversive sensations in human experience. Pain is not limited to the sensory transduction of tissue damage; rather, it encompasses a range of nervous system activities including lateral modulation, long-distance transmission, encoding, and decoding. Although spine surgery may address peripheral pain generators directly, aberrant signals along canonical aversive pathways and maladaptive influence of affective and cognitive states can result in persistent subjective pain refractory to classical surgical intervention...

The realm of spine surgery is undergoing a transformative shift, thanks to the integration of image-guided navigation technology. This innovative system seamlessly blends real-time imaging data with precise location tracking. While the indispensable expertise of experienced spine surgeons remains irreplaceable, navigation systems bring a host of valuable advantages to the operating room. By offering a comprehensive view of the surgical anatomy, these systems empower surgeons to conduct procedures with accuracy, while minimizing radiation exposure for both patients and medical professionals...

Spine surgery has seen a rapid advance in the refinement and development of 3-dimensional and nuclear imaging modalities in recent years. Cone-beam CT has proven to be a valuable tool for improving the accuracy of pedicle screw placement. The use of synthetic CT and low-dose CT have also emerged as modalities which allow for little to no radiation while streamlining imaging workflows. Bone scans also serve to provide functional information about bone metabolism in both the preoperative and postoperative monitoring phases...

No abstract text is available yet for this article.

Temporal lobe epilepsy (TLE) is one of the most common drug-refractory epilepsies. However, the diagnosis and treatment of TLE may be improved by better understanding its complex network. In this article, the authors summarize their experience with TLE and discuss their process for using stereo-electroencephalography (SEEG) as part of presurgical evaluation in the past 10 years. The authors demonstrate the value of SEEG in different types of TLE and discuss how their findings have impacted treatment options...

The practice of invasive monitoring for presurgical epilepsy workup has evolved at Massachusetts General Hospital (MGH) in parallel to the evolution in the field's understanding of epilepsy as a network disorder. Implantations have shifted from an emphasis on singularly finding single foci for the purpose of resection to a network-hypothesis-driven approach aiming to delineate patients' seizure networks with the goal of developing surgical interventions that disrupt critical nodes of these networks. Here, the authors review all invasive monitoring cases at MGH from April 2016 through June 2023 to describe how this paradigm shift has taken form...

Overall stereoelectroencephalography (SEEG) has a favorable risk profile, patient tolerability, and superior investigative capability of individualized 3-dimensional seizure onset activity over subdural electrodes. Further, our recent surgical approach to safely enable multinuclear thalamic propagation mapping can only be performed with SEEG. For these reasons, SEEG has become the gold standard of phase II monitoring at our institution, and believe the ability to develop precision network-centric approaches to therapy will be critical to enhance our ability to care for medically refractory, and importantly, even complex multifocal, generalized, or surgically refractory epilepsy patients...

Understanding and discriminating the normal and abnormal elements of the intracranial electroencephalogram (iEEG) is essential in decision-making for epilepsy surgery. The hippocampus is widely acknowledged as a key structure in decision-making processes for surgical treatment in temporal lobe epilepsy and epilepsies that involve the mesial temporal structures. This review will provide a summary of the current state of our knowledge and understanding regarding normal and abnormal features of the iEEG of the human hippocampus...

Epilepsy surgery is a potentially curative treatment of drug-resistant epilepsy that has remained underutilized both due to inadequate referrals and incomplete localization hypotheses. The complexity of patients evaluated for epilepsy surgery has increased, thus new approaches are necessary to treat these patients. The paradigm of epilepsy surgery has evolved to match this challenge, now considering the entire seizure network with the goal of disrupting it through resection, ablation, neuromodulation, or a combination...

Epileptic encephalopathies are defined by the presence of frequent epileptiform activity that causes neurodevelopmental slowing or regression. Here, we review evidence that epilepsy surgery improves neurodevelopment in children with epileptic encephalopathies. We describe an example patient with epileptic encephalopathy without drug refractory seizures, who underwent successful diagnostic and therapeutic surgeries. In patients with epileptic encephalopathy, cognitive improvement alone is a sufficient indication to recommend surgical intervention in experienced centers...

Current applications of neurostimulation for generalized epilepsy use a one-target-fits-all approach that is agnostic to the specific epilepsy syndrome and seizure type being treated. The authors describe similarities and differences between the 2 "archetypes" of generalized epilepsy-Lennox-Gastaut syndrome and Idiopathic Generalized Epilepsy-and review recent neuroimaging evidence for syndrome-specific brain networks underlying seizures. Implications for stimulation targeting and programming are discussed using 5 clinical questions: What epilepsy syndrome does the patient have? What brain networks are involved? What is the optimal stimulation target? What is the optimal stimulation paradigm? What is the plan for adjusting stimulation over time?...