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Is Knosp enough? A novel classification for Acromegaly: a retrospective analysis of cure rates and outcome predictors in a large tertiary centre

Acta Neurochirurgica (2025) 167:61

The study introduces the MI Ratio, a novel radiological metric, to predict surgical remission in acromegaly patients, demonstrating its utility alongside demographics and hormone profiles. Conducted at King’s College Hospital, the study highlights improved prediction accuracy over Knosp classification, emphasizing a personalized approach to treatment planning.

Study Overview

• Purpose: Evaluate surgical outcomes for acromegaly at King’s College Hospital.

• Methods: Retrospective analysis of 150 patients with somatotroph tumours.

• Novel Metric: Introduced MI Ratio for predicting clinical remission post-surgery.

Key Findings

• Cure Rates: 72% for microadenomas, 48% for macroadenomas, 53% overall.

• Significant Predictors: MI Ratio, microadenomas, Knosp score < 2, post-op GH level, gender.

• ROC Analysis: MI + Gender had the highest AUC of 0.76.

Methodology Details

• MI Ratio Calculation: Distance from the midline to a lateral maximum of tumour divided by intercarotid distance.

• Statistical Tools: Univariate and multivariate analysis, logistic regression.

Conclusions

• MI Ratio Utility: Effective in predicting surgical remission and improving treatment planning.

• Future Research: Larger prospective studies are needed to validate the MI Ratio for general use.

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Mental fatigue and cognitive functioning in patients presenting with non-enhancing gliomas

Acta Neurochirurgica (2025) 167:63

The study investigates the relationship between mental fatigue and cognitive functioning in patients with lower-grade gliomas (LGG) before surgery. It found a consistent correlation between self-reported mental fatigue and cognitive functioning but no correlation between self-reports and neuropsychological test results, highlighting the complexity of evaluating these symptoms.

• Study Purpose: Investigate mental fatigue and cognitive functioning in LGG patients pre-surgery.

• Patient Cohort: 101 patients with presumed LGG; 71 with confirmed IDH-mutated LGG.

• Methods: Self-reports, neuropsychological tests, and clinical/demographic data collected.

• Key Findings: No strong correlation between self-reports and neuropsychological tests.

• Correlation: A strong link was found between self-reported mental fatigue and cognitive functioning.

• Tumor Localization: Frontal tumors had more oligodendrogliomas; non-frontal had more glioblastomas.

• Neuropsychological Impairment: Higher RAVLT, FAS, and CWT test impairment rates.

• Statistical Analysis: Spearman’s partial correlations assess variable relationships.

• Clinical Implications: Need for a multi-perspective approach in evaluating LGG patient symptoms.

• Research Recommendations: Larger cohort studies and quantitative tumor localization metrics are suggested.

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Clinical Outcomes and Radiographic Results of Prone Transpsoas Lateral Lumbar Interbody Fusion

Neurosurgery 96:763–768, 2025

The study evaluates the prone transpsoas (PTP) approach for lateral lumbar interbody fusion, showing improved lumbar lordosis, reduced complications, and enhanced patient-reported outcomes. Conducted on 106 patients, the approach minimized operative time and demonstrated safety and efficacy in lumbar fusion.

Clinical Research Summary

• Study Focus: Prone transpsoas lateral lumbar interbody fusion (PTP) for lumbar fusion.

• Study Design: Retrospective observational study of 106 patients, single-surgeon series.

• Patient Demographics: Mean age 66 years, mean BMI 29.3, follow-up 13 months.

• Surgical Technique: Prone positioning, single-position access to anterior/posterior lumbar spine.

• Common Levels: The most common level treated was L4-5.

• Outcomes: Improved lumbar lordosis, reduced pelvic tilt, and decreased PI-LL mismatch.

• Complications: Minimal, with transient hip flexor weakness in 0.9% of patients.

• Pain Scores: VAS pain scores improved from 6 to 5 postoperatively.

• Surgical Indications: Degenerative scoliosis, spondylolisthesis, disk disease, adjacent segment disease, pseudoarthrosis.

• Adverse Events: No bowel or major vessel injuries were reported.

• Radiographic Results: Significant improvement in lumbar lordosis and pelvic parameters.

• Limitations: Single-surgeon study, short follow-up, retrospective data collection.

• Conclusion: PTP approach is safe and effective for lumbar fusion with minimal complications.

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The risk of intraoperative venous air embolism from neurosurgical procedures performed in the lounging position

J Neurosurg 142:797–807, 2025

The study investigated the risk of venous air embolism (VAE) during neurosurgery in the lounging position, finding no permanent sequelae or fatal events. Despite a 51.4% VAE detection rate, no hemodynamic instability occurred, suggesting experienced teams can safely use this position.

Study Overview

• Objective: Assess venous air embolism (VAE) risk and outcomes in lounging position neurosurgery.

• Study Design: Retrospective analysis of 1000 patients from 2010 to 2020.

• Primary Focus: VAE incidence, severity, and associated complications.

Key Findings

• VAE Detection: 51.4% of patients experienced VAE, with no grade 5 events.

• Complications: 0.3% developed acute respiratory distress syndrome (ARDS) linked to VAE grade.

• No Permanent Sequelae: No patients suffered permanent neurological deficits from VAE.

Patient Demographics

• Mean Age: 47.7 years; 56.5% female.

• Common Pathologies: 94.9% had posterior fossa tumors, mainly vestibular schwannomas.

Surgical Approach and Positioning

• Lounging Position: Feet elevated above head to improve venous return.

• Surgical Benefits: Reduced intracranial pressure and improved surgical field visibility.

Risk Factors and Outcomes

• High-Grade VAE: Associated with older age and lower BMI.

• No PFO Contraindication: PFO is not linked to paradoxical embolism in this cohort.

• Outcome Predictors: Preoperative KPS score is most relevant for clinical outcomes.

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Working Status in Patients With Untreated Unruptured Intracranial Aneurysms: A Descriptive Longitudinal Study

Neurosurgery 96:660–666, 2025

The study assessed the working status of Norwegian patients with untreated unruptured intracranial aneurysms (UIAs) from 2008 to 2018. It found that these patients had significantly lower work participation pre- and post-diagnosis compared to the general population, highlighting potential psychological and health burdens.

Study Overview

• Objective: Assess working status in patients with untreated unruptured intracranial aneurysms (UIAs).

• Design: Retrospective nationwide registry-based descriptive longitudinal study.

Key Findings

• Working Status Decline: From 62.1% prediagnosis to 51.3% postdiagnosis in patients.

• Comparison with Controls: Controls decreased from 77.9% to 73.4% in the same period.

• Odds of Working: 86.7% lower in patients than controls postdiagnosis.

• Death Rate: 2.4% of patients died during the 1-year follow-up.

Statistical Analysis

• Predictive Factors: Older age and sickness absence prediagnosis reduce postdiagnosis working status.

• Regression Model: Controlled for age, sex, and baseline working status.

Discussion Points

• Psychological Impact: UIA diagnosis causes stress, anxiety, and reduced work-life participation.

• Comorbidities: Patients may have additional health issues affecting working status.

Limitations

• Data Limitations: Lack of comorbidity and aneurysm characteristic data.

• Country-Specific Factors: Results may not apply to countries outside Norway.

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Cognitive improvement after endoscopic third ventriculostomy surgery in long-standing overt ventriculomegaly in adults

J Neurosurg 142:875–883, 2025

Endoscopic third ventriculostomy (ETV) significantly improves long-term memory and visuospatial skills in patients with long-standing overt ventriculomegaly in adults (LOVA), especially those with higher premorbid IQ. The study highlights the role of cognitive reserve in facilitating cognitive recovery post-surgery.

• Endoscopic third ventriculostomy (ETV) surgery leads to cognitive improvement in patients with long-standing overt ventriculomegaly in adults (LOVA), particularly in long-term memory and visuospatial skills.

• Cognitive reserve (CR) plays a crucial role in predicting cognitive recovery post-surgery, with higher premorbid IQ linked to better outcomes.

• LOVA is a chronic form of hydrocephalus that becomes symptomatic in adulthood, often characterized by cognitive deficits and gait disturbances.

• ETV is favored over ventriculoperitoneal shunt (VPS) due to lower complication rates, making it the preferred treatment option.

• Preoperative cognitive profiles of LOVA patients show deficits primarily in long-term memory and visuospatial skills, while other cognitive domains remain unaffected.

• Postoperative improvements are significant and sustained over time, with the majority of patients reporting enhanced cognitive function and quality of life.

• Symptom duration does not hinder the efficacy of ETV, and longer symptom history may lead to better outcomes in visuospatial skills.

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The oculomotor cistern and pituitary adenomas: anatomical and clinical study

J Neurosurg 142:766–776, 2025

• Study Focus: The research investigates the oculomotor cistern (OMC) and its involvement with pituitary adenomas (PitNETs), aiming to provide a histomorphological description and analyze its clinical impact.

• Methods: Ten hemisellae from formalin-fixed specimens were studied, and clinical data from patients undergoing endoscopic transsphenoidal surgery for PitNETs between 2014 and 2021 were analyzed.

• Results: OMC involvement was graded as not compressed, compressed, and invaded. Significant associations were found between OMC involvement and PitNET dimensions, Knosp grade, and preoperative oculomotor palsy.

• OMC Shape and Measurements: The OMC is elliptical with an average area of 3.1 mm² and a length of 5.5 mm. No points of weakness were identified in the histomorphological study.

• Clinical Findings: OMC compression and invasion were recorded in 43.1% and 9.3% of patients, respectively. Preoperative CN III palsy was documented in compressed (11.3%) and invasive (26.1%) OMCs.

• Surgical Implications: Endoscopic transsphenoidal surgery is effective in treating PitNETs with OMC involvement, though the choice between transcranial and endoscopic approaches remains debated.

• Histological Observations: The study confirmed the OMC’s extension ends before the anterior clinoid process (ACP), with potential points of weakness at the CS roof and MWCS.

• Conclusion: OMC involvement is significant in PitNETs, affecting patient outcomes. Detailed preoperative evaluation and postoperative follow-up are crucial for managing these cases.

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Effect of pituitary stalk preservation during craniopharyngioma removal on pituitary function, extent of resection, and recurrence: systematic review and meta-analysis

J Neurosurg 142:741–755, 2025

The meta-analysis evaluates the impact of pituitary stalk preservation during craniopharyngioma surgery on pituitary function, resection extent, and recurrence. Preservation reduces diabetes insipidus risk but may increase incomplete resection risk in pediatric patients. Results are cautious due to small study sizes and reporting biases.

• Pituitary stalk preservation reduces risk of postoperative diabetes insipidus (DI) and anterior pituitary dysfunction.

• Preservation shows no significant impact on tumor recurrence or extent of resection.

• Pediatric patients face higher risk of incomplete resection with stalk preservation.

• Meta-analysis included 33 studies with 2366 patients.

• Significant heterogeneity observed in DI and recurrence risk across studies.

• Stalk preservation benefits posterior pituitary function long-term, not anterior.

• High risk of bias in individual studies; findings should be interpreted cautiously.

• Subgroup analysis highlights higher recurrence risk in pediatric stalk preservation.

• Egger’s test indicates publication bias in DI analysis.

• Previous meta-analysis by Li et al. lacked age stratification and EEA cases.

• Authors recommend careful consideration of stalk preservation in pediatric cases.

• Lack of age-stratified data limits analysis and may increase bias.

• Study methods followed PRISMA guidelines, with data extracted from eligible studies

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Natural history and management outcomes of patients with ruptured Spetzler-Martin grade IV and V brain arteriovenous malformations

J Neurosurg 142:667–675, 2025

Study Objective: To explore the natural history and management outcomes of patients with ruptured Spetzler-Martin grade IV and V brain arteriovenous malformations (bAVMs).

• Patient Selection: The study involved 84 patients with ruptured high-grade bAVMs, identified from a database spanning 1990 to 2020.

• Hemorrhagic Risk: Annual hemorrhagic risk was 2.68% for cortical bAVMs and 8.37% for deep-seated bAVMs during natural history.

• Treatment Outcomes: Surgery reduced hemorrhagic risk significantly in cortical bAVMs, while radiosurgery was effective for deep-seated bAVMs. Embolization alone increased hemorrhagic risk.

• Predictors of Success: Surgery and radiosurgery were significant predictors of bAVM obliteration for cortical and deep-seated bAVMs, respectively.

• Management Strategies: Conservative management was compared to surgical interventions, showing similar functional outcomes but differing in obliteration rates.

• Conclusion: Surgery and radiosurgery may be viable options for certain patients, while embolization alone should be avoided

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How to Reduce the Risk of Mechanical Failures in Adult Deformity Surgery: Comparing GAP Score and Roussouly Type Restoration

Global Spine Journal 2025, Vol. 0(0) 1–15

DOI: 10.1177/21925682251328285

This study investigates the predictors of mechanical failure in adult spinal deformity surgery, highlighting the significance of the GAP score and Roussouly type restoration in minimizing complications. A proper post-operative GAP Score and spinal alignment restoration are crucial for reducing mechanical failure rates.

Study Design and Methods

• Retrospective cohort study with a 5-year follow-up on adult spinal deformity cases.

• Inclusion criteria: Patients over 18, with at least 4 vertebrae fused.

• Data collected: Demographic, surgical, spinopelvic parameters, and complications.

Key Findings

• Mechanical Complications: Revision surgery rate was 40.6%.

• Higher post-operative GAP scores linked to increased junctional failure risk.

• Roussouly Type Restoration: Failure to restore original type increases mechanical failure risk.

Predictive Analysis

• GAP Score and Roussouly Type are top predictors for mechanical failure.

• Gradient Boosting model showed high predictive accuracy (ASE 0.073).

• Kaplan-Meier Analysis: Higher GAP scores linked to earlier junctional failures.

Recommendations

• Surgical Planning: Restore original Roussouly type and achieve proper lumbar lordosis.

• Avoid Pelvic Retroversion: Ensure proper global balance.

Statistical Analysis

• Logistic regression confirmed GAP score and Roussouly type as significant predictors.

• ROC Curves: Moderate association between GAP score and revision surgery need.

Limitations

• Retrospective design with potential selection bias.

• Asymmetrical sample size of GAP score groups.

Level of Evidence

3 retrospective cohort study

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The gap between surgeon goal and achieved sagittal alignment in adult cervical spine deformity surgery

J Neurosurg Spine 42:309–319, 2025

This study assessed surgeons’ ability to achieve preoperative sagittal alignment goals in adult cervical spine deformity surgeries. Results showed significant deviations from targets, especially in severe deformities, highlighting the need for improved surgical planning and personalized implants.

Study Overview

• Objective: Assess surgeons’ ability to achieve preoperative sagittal alignment goals in CSD surgery.

• Methods: Prospective study with adult CSD patients across 13 North American centers.

• Patient Demographics: Mean age 63.6 years; 51.1% women; 38.6% had previous cervical fusion.

Key Findings

• Alignment Goals: Surgeons failed to meet goals by 17.2 mm for C2–7 SVA, 10.3° for Cobb angle.

• Factors Affecting Outcomes: Greater baseline TK linked to better Cobb angle achievement.

• Surgical Planning: 60% used PACS, 33.3% used spine-specific software.

• Tools and Criteria: Ames/ISSG criteria used by 33.3% of surgeons; others individualized goals.

Challenges and Recommendations

• Severe Deformities: More challenging to achieve alignment goals in severe cases.

• Need for Advancements: Personalized implants could improve intraoperative goal achievement.

• Alignment Correlations: Strong correlation for C7–S1 SVA, weak for C2–7 SVA.

Statistical Analysis

• Offset Groups: Patients categorized by offset magnitude from goal alignment.

• Significant Associations: Lower baseline TS-CL associated with better TS-CL goal achievement.

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Idiopathic cerebellar hemorrhage in a patient with isolated developmental venous anomaly: A case report

Surg Neurol Int. 2025;16:82.

A 33-year-old female with severe headaches and vertigo was diagnosed with cerebellar hemorrhage due to an isolated developmental venous anomaly (DVA). Conservative treatment led to full recovery, highlighting the importance of considering DVA in cerebellar hemorrhage etiology and recommending non-surgical management to avoid complications.

• Case Report: Idiopathic cerebellar hemorrhage with isolated developmental venous anomaly in a 33-year-old female.

• Symptoms: Severe headaches, vertigo, left oculomotor nerve palsy, left-sided hemidysmetria.

• Initial Misdiagnosis: Meniere’s disease.

• Imaging Findings: Acute hemorrhage in cerebellar vermis, isolated DVA with “caput medusae” sign.

• Management: Conservative treatment with steroids and analgesics, full recovery.

• DVA Characteristics: Benign anatomical variation, low-flow malformation, rarely causes hemorrhage.

• Hemorrhage Risk Factors: Coexisting cavernous malformation or arteriovenous malformation increase risk.

• Study Findings: Hemorrhage risk 0.22–0.68%/year, higher in infratentorial DVAs.

• Surgical Intervention: Reserved for life-threatening mass effects or raised intracranial pressure.

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Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing

 

Operative Neurosurgery 28:379–385, 2025

This study compares microsurgical suturing and patch-sealing techniques for repairing ventral cerebrospinal fluid leaks in spontaneous intracranial hypotension. Both methods are equally effective, but sealing is faster and involves less spinal cord manipulation, potentially reducing surgical complications.

Study Overview and Methods

• Compared microsurgical suture vs. patch-sealing for ventral dural leaks in SIH patients.

• Retrospective analysis conducted between 2013 and 2023 at a single center.

• 85 patients with Type 1 SIH leaks were included in the study.

Results

• No significant difference in headache resolution between techniques (89% vs 94%).

• Sealing technique was significantly faster than suturing (139 vs 169 minutes).

• Complication rates: 23% in suture group, 9% in sealing group (not statistically significant).

Clinical Outcomes

• No significant difference in postoperative Bern-Score between techniques.

• SLEC-positive postoperative rate: 13% in suture group, 22% in sealing group.

• 90% of patients reported headache improvement post-surgery.

Discussion

• Both techniques are effective, but sealing minimizes spinal cord manipulation.

• Sealing preferred due to faster surgery time and fewer complications.

• Limitations include retrospective design and potential selection bias.

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Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study

Operative Neurosurgery 28:357–367, 2025

The CANDID study compares duroplasty techniques in decompressive craniectomy for TBI, showing better outcomes with vascularized pericranial grafts over synthetic dural substitutes. The study highlights improved Glasgow Outcome Scale scores at 6 months and 1 year, with fewer complications in the autologous graft group.

• Study Objective: Compare two duroplasty techniques in primary decompressive craniectomy for traumatic brain injury.

• Methods: Retrospective analysis of 97 patients, using VP and SR techniques.

• Primary Outcome: GOS-E scores at 6 months and 1 year post-injury.

• Results: VP group showed better GOS-E scores at 6 months (P = .011) and 1 year (P = .026).

• Complications: Brain abscesses found only in SR group, though not statistically significant.

• Conclusions: VP technique associated with better long-term outcomes compared to SR.

• Study Limitations: Retrospective nature, small sample size, and potential selection bias.

• Recommendation: Further research through prospective randomized controlled trials is needed.

• Authors: Mahesh Ramola et al. conducted the study at S.G.R.R. Institute of Medical & Health Sciences.

• Study Period: April 2015 to February 2022.

• Data Collection: From medical files and telephone questionnaires.

• Statistical Analysis: Propensity score matching used to minimize baseline differences.

• Funding: No financial support or conflicts of interest reported.

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Conservative management of brain arteriovenous malformations: results of the prospective observation registry of a pragmatic trial

J Neurosurg 142:637–646, 2025

• Study Overview: TOBAS study on conservative management of brain AVMs.

• Objective: Monitor outcomes of patients with brain AVMs managed conservatively.

• Primary Outcome: Death or dependency (mRS score > 2) at 10 years.

• Patient Recruitment: 1010 patients recruited, 498 in observation registry.

• Follow-up Results: Low incidence of death or disability, 1.7% per year.

• Risk Factors: History of rupture, infratentorial location, age ≥ 55 years increase poor outcomes.

• SAEs Incidence: 3.6 per 100 patient-years, higher in ruptured AVMs.

• Methodology: Kaplan-Meier curves, Cox log-rank tests used for analysis.

• Study Design: Multicenter, includes randomized trials and prospective registries.

• Data Collection: Simple electronic forms, Good Clinical Practice compliance.

• Patient Characteristics: Majority with unruptured, low-grade AVMs.

• Statistical Analysis: Cox models and hazard ratios used.

• Conclusions: Observed patients had low rates of adverse neurological events

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From conservative to interventional management in unruptured intracranial aneurysms

J Neurosurg 142:619–625, 2025

• Study Focus: Management of unruptured intracranial aneurysms (UIAs) from conservative to interventional.

• Objective: Identify patterns and predictors for revising UIA management strategy.

• Methodology: Retrospective review of cases diagnosed between 2006-2022 with conservative management.

• Results: 10 of 144 cases shifted to interventional treatment due to aneurysm growth.

• UIA Growth: Most frequent reason for changing treatment strategy.

• Size Threshold: UIAs > 3 mm at diagnosis more likely to require intervention.

• Conservative Management: Regular radiographic follow-ups recommended, especially for UIAs > 3 mm.

• Guidelines: ESO and American Heart Association guidelines emphasize monitoring UIA growth.

• Statistical Analysis: Cox regression and Kaplan-Meier curves used for data analysis.

• Risk Factors: No significant effect of potential risk factors on treatment change.

• Imaging: DSA as confirmative modality for revising conservative management.

• Study Limitations: Low statistical power due to limited cases of treatment change.

• Conclusion: Regular monitoring crucial for conservatively managed UIAs, especially > 3 mm.

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Morphological analysis of the trigeminal nerve in trigeminal neuralgia using the nerve’s centerline and multiple cross-sections of a 3D model

J Neurosurg 142:884–891, 2025

• Study Objective: Quantify morphological changes in trigeminal nerve causing trigeminal neuralgia (TN).

• Methods: Retrospective analysis of patients with TN undergoing microvascular decompression (MVD).

• Parameters Analyzed: Centerline length, curvature, torsion, cross-sectional area, flattening ratio, long-axis angle.

• Results: Affected side showed longer centerline, greater curvature, smaller area pre-surgery.

• Postoperative Changes: Affected side showed shorter centerline, larger cross-sectional area post-surgery.

• Concordance Rate: 91.4% between intraoperative findings and 3D model flexion locations.

• Accuracy of Segmentation: Manual segmentation showed 80%-90% concordance with surgical findings.

• Limitations: Retrospective, single institution, manual segmentation, not fully matching surgical findings.

• Further Analyses: Needed for patients without neurovascular compression (NVC) and with venous compression.

• Study Implications: Method helps analyze TN pathophysiology, aid diagnosis, predict treatment efficacy.

• Statistical Analysis: Mann-Whitney U-test, significance set at p < 0.05

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Outcomes After Definitive Surgery for Spinal and Sacral Chordoma in 101 Patients Over 20 Years

Neurosurgery 96:494–504, 2025

• Study Objective: Investigate postoperative outcomes of spinal chordoma surgery over 20 years.

• Patient Cohort: 101 patients, average follow-up of 6.0 ± 4.2 years.

• Recurrence and Mortality: 24.8% recurrence, 9.9% mortality.

• Risk Factors: Tumors ≥100 cm³ and mobile spine chordomas linked to worse outcomes.

• Neoadjuvant Radiotherapy: Associated with improved local recurrence-free survival (LRFS).

• Age Impact: Patients ≥65 years at surgery have a higher mortality risk.

• Surgical Outcomes: Pain decreased post-surgery, sensory deficits and weakness remained static.

• Functional Outcomes: 39% of patients pain-free long-term, no significant change in sensory deficits.

• Surgical Complications: 65.3% experienced complications; 32.7% required reoperation.

• Radiotherapy Advances: Newer modalities like stereotactic photon therapy show promising LRFS rates.

• Study Design: Retrospective review from 2003-2023 at a quaternary spinal oncology center.

• Data Analysis: Multivariable Cox regression used to identify predictors of LRFS and OS.

• Surgical Approach: Enneking Appropriate surgery preferred for better outcomes.

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Fully Navigated Single-Position Prone Lateral Lumbar Interbody Fusion: A Detailed Technical Report and Description of 15 Cases

Int J Spine Surg 2025, 19 (1) 70-80

Surgical Technique and Study Overview

• Single-position prone lateral lumbar interbody fusion improves surgery efficiency and safety.

• Navigation enhances precision in pedicle screw placement and reduces radiation exposure.

• Study involved 15 patients with simultaneous cage and screw placement using intraoperative navigation.

• Mean surgery duration was 263 ± 94 minutes with blood loss of 315 ± 143 mL.

• No major complications reported, except for two cases of cerebrospinal fluid leakage.

Clinical Outcomes and Findings

• Significant improvements in Oswestry Disability Index (ODI) scores post-surgery (51.38 to 32.81).

• Segmental lordosis improved significantly from 3.26° to 13.09° (P < 0.001).

• No significant changes in total lumbar lordosis or sagittal vertical axis.

Technical Insights and Considerations

• Intraoperative navigation used for cage and screw placement without additional fluoroscopy.

• Radiation exposure reduced for surgical teams due to minimized fluoroscopy use.

• Simultaneous screw and cage placement guided by navigation and neuromonitoring.

• Challenges include navigation system inaccuracies due to segmental distraction.

• Learning curve observed with new workflow implementation affecting time savings.

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Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices

Operative Neurosurgery 28:295–302, 2025

• Robotic systems enhance accuracy in pedicle screw placement, reducing complications and hospital stays.

• Common errors in robotic spine surgery include registration, skiving, and interference errors.

• Registration errors occur due to imaging discrepancies or unexpected intraoperative movements.

• Skiving errors result from sliding of drilling instruments, often due to poor entry points.

• Interference errors arise from unintended interactions with soft tissue or robotic system malfunctions.

• Best practices include meticulous preoperative planning and careful patient positioning to minimize errors.

• High BMI and female sex are risk factors for screw deviation due to bone quality issues.

• Modern systems use sharp burrs to reduce skiving by ensuring smooth entry points.

• Soft tissue management is crucial to prevent interference errors during surgery.

• Intraoperative imaging helps confirm accurate screw placement, reducing registration errors.

• Screw failure rates: Registration errors (60%), skiving errors (26.8%), interference errors (19.5%).

• Newer robotic systems show improved accuracy but still face challenges with registration errors.

• Study limitations include varied resources, surgeon experience, and subjective error reporting.

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