【期刊速览】Neurosurgery｜Online 2024年10月速览（三）

1. Vesalius and His Manikin: An Enduring Influence on Modern Anatomic Teaching

Vesalius和他的人体模型: 对现代解剖学教学的持久影响

Anatomic teaching has long informed surgical knowledge, experience, and skills. One tool for teaching that emerged during the Renaissance was the fugitive anatomic sheet, which used flap layers to reveal different levels of anatomy. In 1538, Vogtherr introduced the first fugitive sheets, which included illustrations of male and female figures with a torso paper flap that, when lifted, revealed the internal organs in a cartoonish style. The popularity of these anatomic fugitive sheets spurred an increase in small print-and-sale workshops. In 1543, Vesalius included fugitive anatomic sheets in his books Fabrica and Epitome, containing large paper flapped models that could be created by cutting out and gluing images of human internal anatomy onto a base layer. Students could tack these manikins up to a nearby wall during dissection. Significant collaboration between Vesalius and his publisher occurred to coordinate the integration of large foldable sheets featuring the cutout models into his works. Vesalius's groundbreaking discoveries, his use of the most advanced printing techniques, and his innovative teaching style are fundamental aspects of the legacy of medical education. This article shows these remarkable fugitive anatomic sheets from the original publications of Fabrica and Epitome together for the first time. It explores the innovative concepts and applications of Vesalius's unique printings.

We aimed to develop and validate a prediction score for futile recanalization (FR) for large vessel occlusion (LVO) presenting low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) for patients who underwent endovascular thrombectomy (EVT). The SNAP score may be useful in predicting FR after EVT in low-ASPECTS patients with LVO. It can provide patients, family members, and physicians with reliable outcome expectations among patients with acute ischemic stroke with large infarcts.

REF: Matsukawa H, Chen H, Elawady SS, et al. Predicting Futile Recanalization After Endovascular Thrombectomy for Patients With Stroke With Large Cores: The SNAP Score. Neurosurgery. Published online October 11, 2024. doi:10.1227/neu.0000000000003220 PMID: 39471074

Access to neurosurgical care is limited in low-income and middle-income countries (LMICs) and in marginalized communities in high-income countries (HICs). International partnerships represent one possible means of addressing this issue. Insights from surgeons in HICs have been explored, but data from LMICs' counterparts are scarce. We aimed to study the perspectives of neurosurgeons and trainees from LMICs regarding global neurosurgery (GN) collaborations and interests, motivators, and challenges in participating. Understanding the perspectives of neurosurgeons and trainees from LMICs is essential to expanding HICs-LMICs collaborations and improving access to neurosurgical care worldwide. Financial support and targeted interventions are needed to address barriers and promote equitable partnerships in GN.

REF: Marchesini N, Kamalo P, Foroglou N, et al. The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations. Neurosurgery. Published online October 11, 2024. doi:10.1227/neu.0000000000003230 PMID: 39392305

Symptomatic chronic subdural hematoma (CSDH) is caused by repetitive hemorrhage and inflammation, which is commonly treated with burr-hole surgery and has a relatively high postoperative recurrence rate. A decrease in the platelet count is indicative of a hemorrhagic tendency, while an increase in the eosinophil count is associated with inflammation. Assessing the balance between platelet-associated hemostasis and eosinophil-associated inflammation using the indeterminate biomarker, the eosinophil-platelet ratio (EPR), may be essential. Therefore, in this study, the accuracy of the EPR in predicting postoperative CSDH recurrence was evaluated and their correlation was determined. This study reveals that a high EPR is a useful predictive biomarker for postoperative CSDH recurrence. Cases of CSDH with a high EPR potentially require careful and close postoperative follow-up.

REF: Yagi K, Kanda E, Hijikata Y, Tao Y, Hishikawa T. Eosinophil-Platelet Ratio as a Predictive Marker of the Postoperative Recurrence of a Chronic Subdural Hematoma. Neurosurgery. Published online October 11, 2024. doi:10.1227/neu.0000000000003229 PMID: 39471081

Surveillance studies offer sparse knowledge of predictors of future growth in sporadic vestibular schwannomas (VS).Our aim was identification of these risk factors. We propose a scoring system to estimate the risk of growth in sporadic vestibular schwannoma. Our retrospective study revealed that younger age, cystic morphology, cisternal extent, larger volume, and growth during 1st year were strong predictors of future growth. Moreover, we propose a scoring system that accurately estimates the risks of future tumor growth.

REF: Stastna D, Macfarlane R, Axon P, et al. Scoring System Assessing Risks of Growth in Sporadic Vestibular Schwannoma. Neurosurgery. Published online October 11, 2024. doi:10.1227/neu.0000000000003170 PMID: 39471095

The role of radiosurgery in the treatment of benign intracranial tumors is well established. However, there are limited long-term follow-up studies on outcomes after stereotactic radiosurgery (SRS) for benign intradural spinal tumors. In this article, we report a large single-institution experience in using SRS to treat patients with benign intradural tumors of the spine. The role of radiosurgery in the treatment of benign intracranial tumors is well established. However, there are limited long-term follow-up studies on outcomes after stereotactic radiosurgery (SRS) for benign intradural spinal tumors. In this article, we report a large single-institution experience in using SRS to treat patients with benign intradural tumors of the spine.

Prediction of patient outcomes after severe traumatic brain injury (sTBI) is limited with current clinical tools. This study aimed to improve such prognostication by combining clinical data and serum inflammatory and neuronal proteins in patients with sTBI to develop predictive models for post-traumatic vasospasm (PTV) and mortality. Inflammatory cytokine levels after sTBI may have predictive value that exceeds conventional clinical variables for certain outcomes. IL-9, pulse rate, and eotaxin as well as Rotterdam score and age predict development of PTV. Eotaxin, IL-6, IL-12, and glucose were predictive of mortality. These results warrant validation in a prospective cohort.