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Background: Surgical intervention is a critical tool to address adult spinal deformity (ASD). Given the evolution of spinal surgical techniques, we sought to characterize developments in ASD correction and barriers impacting clinical outcomes. Methods: We conducted a literature review utilizing PubMed, Embase, Web of Science, and Google Scholar to examine advances in ASD surgical correction and ongoing challenges from patient and clinician perspectives. ASD procedures were examined across pre-, intra-, and post-operative phases. Results: Several factors influence the effectiveness of ASD correction. Standardized radiographic parameters and three-dimensional modeling have been used to guide operative planning. Complex minimally invasive procedures, targeted corrections, and staged procedures can tailor surgical approaches while minimizing operative time. Further, improvements in osteotomy technique, intraoperative navigation, and enhanced hardware have increased patient safety. However, challenges remain. Variability in patient selection and deformity undercorrection have resulted in heterogenous clinical responses. Surgical complications, including blood loss, infection, hardware failure, proximal junction kyphosis/failure, and pseudarthroses, pose barriers. Although minimally invasive approaches are being utilized more often, clinical validation is needed. Conclusions: The growing prevalence of ASD requires surgical solutions that can lead to sustained symptom resolution. Leveraging computational and imaging advances will be necessary as we seek to provide comprehensive treatment plans for patients. [ABSTRACT FROM AUTHOR]

To examine complication rates and radiographic outcomes in patients undergoing surgery for adult spinal deformity (ASD) by a junior surgeon. A study was conducted of a retrospective cohort of patients who underwent an open posterior interbody fusion of the thoracic and/or lumbar regions by a single surgeon for ASD between 2018 and 2022. Patient characteristics, complications, and common radiographic parameters of spinopelvic alignment were collated. A total of 112 patients with an average of 4.2 comorbidities underwent surgical correction of ASD. Thirty-seven patients (33.0%) experienced 52 major complications and 50 patients (44.6%) experienced 66 minor complications. Twenty-three patients (20.5%) required a revision operation. Both sagittal vertical axis (P < 10–14) and pelvic incidence–lumbar lordosis mismatch (P < 10–7) significantly improved postoperatively. Number of levels (P < 0.05), operative time >650 minutes (P < 0.01), estimated blood loss >1500 mL (P < 0.01), length of intensive care unit stay >1 day (P < 0.05), and hospitalization length >5 days (P < 0.05) all significantly increased the risk of a major complication. No patient factors significantly increased the risk of minor complications or revision surgery. Observed complication and revision rates in this cohort were consistent with rates reported in the literature. No preoperative patient risk factors significantly increased risk of complications or need for revision, suggesting that no patient population is at increased risk undergoing surgery by a junior surgeon. The relatively high rate of complications observed in this cohort may be a result of high baseline morbidity. [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosis of posterior fossa tumors is challenging yet proper classification is imperative given that treatment decisions diverge based on tumor type. The aim of this systematic review is to summarize the current state of machine learning methods developed as diagnostic tools for these pediatric brain tumors. We found that, while individual algorithms were quite efficacious, the field is limited by its heterogeneity in methods, outcome reporting, and study populations. We identify common limitations in the study and development of these algorithms and make recommendations as to how they can be overcome. If incorporated into algorithm design, the practical guidelines outlined in this review could help to bridge the gap between theoretical algorithm diagnostic testing and practical clinical application for a wide variety of pathologies. Background: Posterior fossa tumors (PFTs) are a morbid group of central nervous system tumors that most often present in childhood. While early diagnosis is critical to drive appropriate treatment, definitive diagnosis is currently only achievable through invasive tissue collection and histopathological analyses. Machine learning has been investigated as an alternative means of diagnosis. In this systematic review and meta-analysis, we evaluated the primary literature to identify all machine learning algorithms developed to classify and diagnose pediatric PFTs using imaging or molecular data. Methods: Of the 433 primary papers identified in PubMed, EMBASE, and Web of Science, 25 ultimately met the inclusion criteria. The included papers were extracted for algorithm architecture, study parameters, performance, strengths, and limitations. Results: The algorithms exhibited variable performance based on sample size, classifier(s) used, and individual tumor types being investigated. Ependymoma, medulloblastoma, and pilocytic astrocytoma were the most studied tumors with algorithm accuracies ranging from 37.5% to 94.5%. A minority of studies compared the developed algorithm to a trained neuroradiologist, with three imaging-based algorithms yielding superior performance. Common algorithm and study limitations included small sample sizes, uneven representation of individual tumor types, inconsistent performance reporting, and a lack of application in the clinical environment. Conclusions: Artificial intelligence has the potential to improve the speed and accuracy of diagnosis in this field if the right algorithm is applied to the right scenario. Work is needed to standardize outcome reporting and facilitate additional trials to allow for clinical uptake. [ABSTRACT FROM AUTHOR]

The neurosurgical sub-internship is a crucial step for prospective neurosurgeons. However, the expectations for sub-interns, particularly the technical skills required by residents and attendings, often are unclear. We present survey data on what medical students, residents, and attendings believe are important procedural proficiencies for neurosurgical sub-internships. We incorporated these tasks into a pilot skills-based craniotomy workshop, and here we report on the impact of the session on the neurosurgical training of medical students. A 1-day craniotomy lab using cadaveric cranial specimens was conducted for medical students. Surveys querying important competencies for sub-internships were answered by residents and attendings at affiliated hospitals. Pre- and postlab surveys querying interest in and perceptions of neurosurgery, self-assessment of skills, and important competencies for sub-internship preparation were answered by attendees. Medical students, residents, and attendings agreed that burr-hole placement, bone replating, and galea and skin closure were of high importance for sub-interns. There was significant disagreement on the importance of dural opening and closure, establishing a craniotomy, and neuronavigation. The workshop altered perceptions of neurosurgery, with significant changes in recognizing the value of peer mentorship. Students also expressed increased confidence in technical skills, with significant improvements shown in understanding of neurosurgical high-speed drill use (P < 0.001). Although the expectations for sub-interns may be heterogeneous, there is general agreement that proficiency in the initial and final steps of craniotomies, as well as minor procedures, is recommended. Cadaveric labs can improve student engagement in neurosurgery, facilitate interactions with neurosurgical departments, and enhance technical skills. [ABSTRACT FROM AUTHOR]

• Novel conversion of a failed indirect bypass into a double barrel direct bypass in moyamoya disease. • Recycling the vessel provides the subset of patients with no other viable STA branches the option of a direct bypass. • Double-barrel direct bypass has the added benefits of increased flow and supply to multiple recipient territories. Moyamoya disease is an idiopathic cerebrovascular disorder in which patients experience recurrent transient ischemic attacks, ischemic or hemorrhagic strokes, headaches, and seizures from progressive stenosis of the vessels of the anterior circulation. The mainstay of treatment in symptomatic patients is surgical revascularization. Here, we present the case of a moyamoya patient in which a failed encephaloduroarteriosynangiosis, after new strokes, is recycled and converted into a combined "double barrel" direct superficial temporal artery to middle cerebral artery bypass with included video. We describe a 37-year-old woman with a history of hypertension, obstructive sleep apnea, celiac disease, and moyamoya disease complicated by multiple ischemic strokes who presented with progressive dysarthria, dysphagia, and new left-sided ischemic infarcts. The patient had previously undergone right-sided direct bypass and left-sided encephaloduroarteriosynangiosis in the setting of multiple ischemic strokes. After more strokes, the patient underwent a left-sided frontotemporoparietal craniotomy for conversion of the failed indirect bypass into a "double barrel" direct bypass. The literature is divided over which revascularization procedure should be preferred. Irrespectively, most failed bypass grafts are repaired via direct bypasses, to good effect. We highlight a case in which a failed indirect bypass is directly incorporated into a combined direct bypass with resulting restoration of blood flow. In the case of a failed indirect bypass in an adult patient with moyamoya disease, this method provides the operator with an additional option for restoration of perfusion, especially in patients without other viable vessels available for anastomosis. [ABSTRACT FROM AUTHOR]