bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of micro and nanoemulsions on wound healing: a review
Authors: Hendawy Amira , A. M. Elgharbawy Amal
Published: February 2025

Emulsions, categorised by their particle size into microemulsions (<100 nm) and nanoemulsions (<200 to <100 nm), hold a position of burgeoning significance in the field of wound healing. Beyond their established role in diverse medical domains, emulsions have emerged as promising agents for drug delivery with wound-healing properties. This review explores a comprehensive analysis of the available literature to shed light on the impact of micro and nanoemulsions on wound healing. Covering research articles published from 2011 to 2022, this study meticulously follows the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines while employing bibliometric analysis tools, PRISMA, and VOSviewer. Through an extensive exploration of databases such as PubMed, Scopus, and ScienceDirect, this study identifies and includes 26 articles that align with the rigorous criteria for investigating emulsions in wound healing. Our bibliometric analysis underscores 'wound healing' as the most prominent keyword in this corpus. In conclusion, this study contributes substantially to the research by combining insights into the effects of nano and microemulsions on wound healing, offering a foundation for future investigations and applications within emerging nanotechnology.
Circadian Variation of Zinc, Copper, Selenium, and Bromine in Human Milk
Authors: Mohd Taufek Nor Hidayah , Hafiz Majdi Hana’ Nahlaa , Azhar Aina Zafirah , Fata Nahas Abdul Rahman , Mohmad Sabere Awis Sukarni , Bidai Joseph
Published: February 2025

Introduction: Human milk undergoes dynamic modifications throughout lactation to optimally meet the dietary and immunological requirements of the growing infant, with variations of its composition also occurring throughout the day. Circadian variation in some bioactive components helps the development of the biological clock by passing on chronobiological information from mother to infant. This study aimed to identify the circadian variation of zinc, copper, selenium, and bromine in human milk during the postpartum period. Methods: Human milk samples were collected from a postpartum mother who was taking zinc and copper supplements. Milk samples were analysed using inductively coupled plasma mass spectrometry. Data on zinc, copper, selenium, and bromine concentrations were analysed using Microsoft Excel 2021 and reported descriptively to determine circadian variation. Results: The concentration of all four trace elements declined throughout the six months postpartum period with consistent fluctuations for bromine. Zinc, copper, and bromine possess the most similar circadian variation throughout the day with a ‘V’ shaped pattern, but selenium showed inconsistent circadian pattern over the first six months postpartum. The ‘V’ shaped pattern generally disappeared in the fourth, fifth, and sixth months. Conclusion: Circadian rhythms for zinc, copper, selenium, and bromine varied during the first six months postpartum. This may indicate a functional circadian clock regulating infants’ biological development. Future studies should explore the factors influencing the development of fully functional circadian rhythmicity in infants.
The challenges of using Escherichia coli as a host in recombinant insulin production
Authors: Taher Muhammad
Published: February 2025

Diabetes mellitus is a metabolic disease characterised by elevation of blood glucose level which leads to serious damage to the blood vessels, eyes, heart, kidney, and nerves affecting about 830 million people worldwide. The most common diabetes is type 2 which usually happened in adults when the body becomes resistant to insulin, or the body does not produce enough insulin. Type 1 diabetes mellitus is dependent on insulin which required accessible and affordable insulin (Diabetes, 2025).
In Malaysia, the prevalence of diabetes mellitus (DM), depends on factors such as gender, age, and ethnicity, with women, the elderly, and the Indian community having the highest prevalence of DM. In the 103,063 participants that made up the study's sample, the combined prevalence of diabetes by gender in the population-based studies was 13.80% for men and 14.54% for women, while the combined prevalence of prediabetes was 11.40% for women and 10.98% for men (Akhtar et al., 2022). For age, from this study, it can be observed that the prevalence of diabetes showed a notable upward trend as people aged, rising from 3.16% in the 20–29 age group to 13.71% in the 30-45 age group, 25.66% in the 46–59 age group, and 33.45% in the 60 and older age group (Akhtar et al., 2022). Ethnicity and races can also affect the prevalence of DM. The subpopulation of Indian had the greatest prevalence of diabetes which is 25.10%, among all ethnic groups, followed by Malay with 15.25%, Chinese with 12.87%, Bumiputera with 8.62%, and others with 6.91%. The prevalence demands oral hypoglycaemic agents (OHAs) market size in Malaysia at USD282.22 million in 2025 with a CAGR of greater than 3% during forecast period (2025-2030). The drugs are mainly fall under the following segment: biguanides, alpha-glucosidase inhibitors, dopamine-d2 receptor agonists, sodium-glucose cotransport-2 (SGLT-2) inhibitor, dipeptidyl peptidase-4 (DPP-4) inhibitors, sulfonylureas, and meglitinides (Malaysia Oral Anti-Diabetic Drug Market Size | Mordor Intelligence, 2025).
TECNOLOGIA E INOVAÇÃO: INSTRUMENTOS PARA A PERSONALIZAÇÃO DO ENSINO NO AMBIENTE EDUCACIONAL
Authors: Lino Johnnata Luiz Silva , Kusunoki Márcio , Norato Mônica Moghrabi Marinho , Campos Eduardo de Castro , Araujo Tiago do Amor Divino , Antunes Márcia Regina Vieira
Published: February 2025

A tecnologia tem impactado de forma concisa na sociedade, incluso na área educacional, proporcionando vantagens e desvantagens para professores e alunos. Desde modo, o objetivo deste trabalho é dissertar, através de uma revisão bibliográfica, sobre os impactos da utilização da tecnologia no ambiente escolar, destacando metodologias ativas deste aspecto, como também os benefícios e dificuldades enfrentadas por professores e estudantes, visando assim contribuir para que pesquisadores e a sociedade entendam a temática e como podem fazer uso da tecnologia de forma mais consciente e eficaz do dia a dia escolar. A partir da metodologia de revisão bibliográfica, realizada nas plataformas Google Acadêmico e Periódicos Capes, fica evidente que a utilização da tecnologia em sala de aula prevê um auxílio relevante para os docentes no quesito do aprendizado individualizado, melhoria do engajamento dos alunos e na visualização das dificuldades de cada discente, possibilitando que as atividades sejam mais direcionadas e atinjam as habilidades defasadas de cada indivíduo. Todavia, dificuldades nas formações continuadas dos professores, falta de recursos das escolas e redução nas interações sociais, são fatores que elencam desvantagens no uso da tecnologia. Sendo assim, os recursos tecnológicos, sejam eles chatbots, jogos educacionais, smartphones e tablets necessitam de uma análise, perante o currículo escolar proposto e acerca do domínio da equipe escolar sobre essas metodologias, permitindo que este aspecto tenha seus objetivos alcançados e o ensino-aprendizagem seja de fato melhorado com estes recursos.
The Pronounced Loneliness Pandemic: A Systematic Review and Thematic Synthesis of Qualitative Studies
Authors: Omambia Matagi Salim
Published: February 2025

Human beings are not meant to be lonely, but being lonely is human. From a prevalence estimated to be 11% to 17% in the 1970s, loneliness has increased to over 40% in middle-aged and older adults. There is consensus in the existing body of literature on risk factors for loneliness, which shows that demographics, socioeconomic status, mental health, disabilities, societal participation, and social contact are all correlates of loneliness. Since its designation as a pandemic in the 1990s, loneliness has been characterized in many ways: it has been referred to as 'the leprosy' of the 21st century; called a silent pandemic and a public health concern; and as a behavioral epidemic in the year 2020. Loneliness has been framed as the 'antithesis of happiness', increasingly regarded as a key global public health challenge; as well as being officially recognized by the World Health Organization as a priority policy matter, in particular, for older persons. Whereas most instances of loneliness are transient and may be dealt with through individual commitment and effort, persisting loneliness may require treatment from specialists. A comprehensive review of the literature on the effects of loneliness during pandemics was conducted through an extensive search using a variety of search engines. This used a combination of keywords and Medical Subject Headings (MeSH) terminology to capture the relevant literature. In a time of great social upheaval and unexpected pandemics, it becomes all the more important to understand how chronic loneliness shapes our physical and emotional health behaviors.
Differences between Posterior Malleolus and Posterior Pilon Fractures-A Review
Authors: Lu Jike
Published: February 2025

Based on our last 7 years (2015-2022) 98 consecutive trimalleolar ankle fracture data base, we did a review of literature review trying to elucidate the differences between posterior malleolus fractures and posterior Pilon fractures. Posterior malleolus fractures are commonly caused by rotational forces on the ankle joint with foot in different positions, leading to different injuries from tearing of the posterior inferior tibiofibular ligament (PITFL) to an avulsion fracture of the posterior malleolus (PM). This is generally a low-energy injury and actually does not involve the joint articular surface. Posterior Pilon fractures result from a combination of rotational and vertical compression forces on the ankle joint, causing an intra-articular fracture of the distal posterior tibia. This type of fracture is commonly missed on plain gradiographs and often misdiagnosed. This review aims to provide an overview of the differences between posterior malleolus fractures and posterior Pilon fractures and some issues of clinical concerns such as how to make correct diagnosis for planning managements.
PEMODELAN FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP KEMISKINAN DENGAN EFEK SPASIAL DI PROVINSI PAPUA
Authors: Paranoan Nicea Roona
Published: February 2025

Salah satu masalah sosial yang disebabkan faktor ekonomi adalah kemiskinan. Kemiskinan merupakan masalah sosial yang serius dan hingga saat ini masih dihadapi oleh pemerintah Indonesia. Provinsi Papua merupakan wilayah yang memiliki persentase penduduk miskin tertinggi di Indonesia dari tahun 2020 hingga 2023. Provinsi Papua memiliki sumber daya alam yang melimpah dan potensi yang besar untuk dimanfaatkan bagi kesejahteraan masyarakat. Akan tetapi, pemanfaatan sumber daya alam tersebut belum mampu meningkatkan kesejahteraan masyarakat Papua, sehingga perlu dilakukan penelitian mengenai faktor-faktor apa saja yang mempengaruhi kemiskinan di Provinsi Papua menggunakan analisis spasial. Melalui pendekatan spasial, dapat diketahui distribusi spasial dari kemiskinan beserta faktor-faktor yang mempengaruhinya dan dapat mengidentifikasi pola-pola yang mungkin terjadi pada Kabupaten/Kota di Provinsi Papua. Tahapan awal yang dilakukan pada penelitian ini yaitu mengumpulkan data persentase penduduk miskin dan faktor-faktor yang diduga mempengaruhi kemiskinan di Provinsi Papua, kemudian mendeskripsikan data penelitian, mendapatkan model regresi klasik (Ordinary Least Square). Langkah selanjutnya adalah membuat matriks pembobot spasial yang akan digunakan untuk menguji efek spasial pada sebaran data, kemudian melakukan uji dependensi spasial dengan Moran’s I dan penggandaan Lagrange Multiplier (LM). Setelah itu, dipilih model regresi yang sesuai dengan uji LM lalu dilakukan estimasi dan pemodelan SAR. Langkah akhir adalah menginterpretasikan model terbaik dan menarik kesimpulan. Luaran yang ditargetkan dalam penelitian ini adalah jurnal nasional terakreditasi.
Pengaruh Media PhET Terhadap Peningkatan Hasil Belajar Siswa Tingkat Sekolah Menengah Pertama
Authors: Nengsi Surya
Published: February 2025

Penelitian ini bertujuan untuk mengevaluasi pengaruh media pembelajaran PhET terhadap peningkatan hasil belajar kognitif siswa di tingkat Sekolah Menengah Pertama (SMP). Penelitian menggunakan metode kuasi-eksperimen dengan pendekatan kuantitatif dan melibatkan dua kelompok, yaitu kelas eksperimen dan kelas kontrol. Sampel terdiri dari siswa kelas VIII SMP Negeri 1 Watubangga yang dipilih secara acak. Data dikumpulkan melalui pretest dan posttest, kemudian dianalisis menggunakan uji-t, dan regresi linier sederhana.  Hasil penelitian menunjukkan bahwa tidak ada perbedaan signifikan pada pretest antara kelas kontrol dan eksperimen. Namun, hasil posttest siswa di kelas eksperimen lebih tinggi dibandingkan dengan kelas kontrol. Media PhET terbukti meningkatkan hasil belajar secara signifikan, dengan kontribusi sebesar 21,9%. Simulasi ini efektif dalam memfasilitasi pemahaman konsep abstrak dan meningkatkan keterlibatan siswa dalam proses pembelajaran.
Aplicación del ABP en el diseño de redes de monitoreo de calidad de agua. Caso ríos Malacatos y Zamora, Ecuador
Authors: Gonzaga Vallejo Sonia
Published: February 2025

Introducción: La ONU revela cifras alarmantes sobre la escasez proyectada de agua para el año 2050; se prevé que será fuente de conflictos ambientales y sociales, agravados por el crecimiento urbano desordenado, que causa deforestación, contaminación del agua y pérdida de hábitats. Así, el objetivo de este trabajo es aplicar el Aprendizaje Basado en Problemas (ABP) como estrategia educativa para desarrollar el pensamiento crítico y las habilidades blandas en los estudiantes universitarios. Metodología: Se formaron grupos de tres estudiantes, para levantar información de campo con equipo básico, identificando descargas de alcantarillado activas y demás características en los tramos urbanos de los ríos Malacatos y Zamora en el sur de Ecuador. La información se procesó en mapas utilizando SIG, para finalmente diseñar redes de monitoreo de calidad de agua, la frecuencia y los parámetros a vigilar. Resultados: El promedio de nota alcanzado por los estudiantes fue de 8.6/10 y el grado de satisfacción de los estudiantes con la actividad fue del 93% Discusión: Estos resultados indican que se logró alcanzar el objetivo planteado. Conclusiones: La metodología ABP resultó efectiva, permitiendo a los estudiantes aplicar sus conocimientos en calidad de agua y otras asignaturas; desarrollando sus competencias profesionales de manera integral y práctica.
Clival dural reconstruction via transnasal approaches: fat graft fixation technique
Authors: Luzzi Sabino , Doğruel Yücel , Güngör Abuzer , Gurses Muhammet Enes , Rahmanov Serdar , Türe Hatice , Türe Uğur
Published: February 2025

OBJECTIVE

CSF fistulas are the weak spots of transnasal endoscopic and microsurgical skull base approaches. An autologous fat graft is considered the best substrate for clival dural reconstruction via transnasal approaches. However, potential gravitational displacement of the graft may result in CSF leakage. The authors have developed and described herein the fat graft fixation (FGF) technique to secure the fat graft against dislocation after transclival resection of chordomas invading the dura.

METHODS

Seventy-five patients with cranial chordomas underwent surgical treatment at the authors’ institution from September 2006 through June 2023. Of these, the authors collected demographic, clinical, radiological, surgical, and outcome data from 34 patients who underwent an endoscope-assisted microsurgical transclival approach via a transnasal, sublabial, or sublabial transmaxillary extended corridor. The FGF reconstruction technique was progressively implemented to improve clival reconstruction, with a focus on the results. With a custom-made 8-mm 3/8 round atraumatic surgical suture needle, a 4/0 Vicryl stitch was placed through the adjacent dural borders. An abdominal autologous fat graft was then placed over the dural defect. One triple knot was tied to secure the graft and prevent its delayed gravitational displacement. The primary outcome was to determine if the FGF group had a higher rate of early or late oronasal CSF fistula compared to the unlocked free graft group. Secondary outcomes included tension pneumocephalus, surgical site infection, and meningitis.

RESULTS

The fat graft was not used in 8 (23.5%) of the 34 patients because the dura was intraoperatively intact. The unlocked free graft and FGF techniques were used in 20 (58.8%) and 6 (17.6%) patients, respectively. Of the 34 patients, no fistulas were observed in the group treated with the FGF technique, while 4 fistulas were found in the unlocked free graft group (p < 0.05), with 2 of these cases involving meningitis. Patients with a CSF fistula underwent a total of 7 surgical procedures: 3 revision surgical procedures, 2 lumboperitoneal shunts, and 2 ventriculoperitoneal shunts.

CONCLUSIONS

In the authors’ preliminary experience, the FGF technique has shown promise in eliminating the risk of CSF fistula and other related complications after the transclival approach for clival chordomas involving the dura.
Results of a German national survey to assess early mobilization versus bed rest in the postoperative management of incidental durotomy during lumbar surgery and the need for a randomized clinical trial
Authors: Abboud Tammam , Asendorf Thomas , Evangelou Petros , Younes Bilal , Mielke Dorothee , Rohde Veit
Published: February 2025

OBJECTIVE

Incidental durotomy during degenerative lumbar spine surgeries poses a complex medical challenge. Despite its relatively common occurrence, consensus on its management remains elusive due to the absence of robust, high-level evidence, resulting in significant variations in practice across medical institutions. The aim of this survey was to assess the current practices in Germany regarding early mobilization versus bed rest in the postoperative management of incidental durotomy during lumbar surgery to estimate the need for a randomized clinical trial.

METHODS

A digital survey titled "Postoperative management of incidental durotomy in lumbar spine surgery" was conducted among 119 neurosurgical departments in Germany. Key questions included the use of bed rest postsurgery, timing of mobilization, and whether the practice depended on the complexity of the surgery or the quality of the dural tear repair. The survey also explored the role of lumbar drains in management and respondents’ potential participation in a multicenter study on the benefits of bed rest.

RESULTS

Invitations were sent in November 2023, and responses were collected during November and December 2023. A total of 89 (75%) departments completed the survey. Among them, 75% reported using bed rest in the postoperative management of incidental durotomy. For 57%, this practice depends on the complexity of the surgical procedure or the quality of the surgical repair of the dural tear, while 18% apply it independently. Twenty-nine of the 89 departments (33%) answered that mobilization is allowed 24 hours after surgery, 13 departments (15%) allow mobilization after 48 hours, and 19 departments (21%) allow it after 72 hours. Additionally, 34% reported using a lumbar drain in cases of persistent postoperative CSF leakage, 36% use it for secondary surgical revision, and 30% do not use it in either case. Furthermore, 55 departments (62%) expressed potential interest in participating in a multicenter randomized trial addressing the postoperative management of incidental durotomy.

CONCLUSIONS

The postoperative management of incidental durotomy during lumbar surgery exhibits significant variation across neurosurgical departments in Germany. Postoperative bed rest remains a common practice. To evaluate the true benefits of bed rest, a randomized multicenter study is recommended. A summary proposal for such a study is presented to address this need.
Management of incisional cerebrospinal fluid leak in open cranial surgeries and the "folding technique" in duraplasty
Authors: Bayatli Eyup , Ozgural Onur , Erdin Engin , Karadagoglu Ümit , Kahilogullari Gokmen , Ugur Hasan Caglar , Tuna Hakan , Attar Ayhan , Unlu Agahan , Caglar Y. Sukru , Dogan Ihsan
Published: February 2025

OBJECTIVE

The aim of this study was to review a series of patients who underwent open cranial surgeries to evaluate the incidence of iatrogenic incisional CSF leaks and discuss its prevention and management. The authors also discuss the utility of the "folding technique" used in duraplasty as an alternative to conventional dural reconstruction techniques.

METHODS

All patients undergoing open cranial surgery were reviewed, and those with incisional CSF leak were included in this study. CSF leakage was managed using either conservative nonsurgical methods or surgical interventions. When the conservative nonsurgical methods failed to curb the leak, surgical procedures such as lumbar external drainage (LED) using lumbar subarachnoid drainage, external ventricular drainage (EVD), a lumboperitoneal or ventriculoperitoneal shunt (VPS), and reexploration of the surgical site were considered.

RESULTS

Between 2019 and 2024, 2149 patients underwent open cranial surgeries at our hospital for any cranial pathology; 39 (1.8%) of these patients experienced postoperative incisional CSF leakage. The majority of the pathologies requiring surgeries were located in the supratentorial region (76.9%). Patients were classified according to the type of dural closure technique used. Primary stitching, the patient’s fascia, or synthetic dura (resorbable, nonresorbable, or both) were used for dural reconstruction. The median interval between the surgery and the start of the leakage was 19 (IQR 1–79) days in patients with no history of radiotherapy; however, this duration was longer in patients who received radiotherapy (median 45 [IQR 10–540] days). The surgical interventions for CSF leakage were classified as wound resuturing (combined with other conservative approaches such as tightened dressing and elevating the head end of the bed), LED or EVD, or surgical reexploration. The folding technique in duraplasty is a simple way to achieve watertight duraplasty even with autograft or synthetic material.

CONCLUSIONS

Incisional CSF leakage is a potentially preventable complication with high morbidity. Such cases could be managed via conservative approaches including wound resuturing, LED or EVD, and surgical reexploration. However, the management strategy is beyond any strict algorithm. This folding technique for duraplasty is a worthy replacement for conventional primary suturing for dural repair or reconstruction in cranial and even spinal defects. This study highlights the importance of regaining the watertight nature of the dura in the primary surgery to prevent any further intervention and lower the overall morbidity.
Dural and cranial reconstruction techniques in retrosigmoid craniotomy: key factors associated with CSF leaks in 225 patients
Authors: Auricchio Anna Maria , Martinelli Renata , Offi Martina , Nichelatti Michele , Valeri Federico , Rapisarda Alessandro , Di Domenico Michele , Montano Nicola , Olivi Alessandro , Della Pepa Giuseppe Maria
Published: February 2025

OBJECTIVE

This study evaluated the effectiveness of various dural closure and bone reconstruction techniques in preventing CSF leakage following retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors. The goal was to identify whether newer combinations of reconstructive materials offer any advantage in reducing CSF leaks and improving surgical outcomes.

METHODS

The authors conducted a retrospective review of 225 patients who underwent a retrosigmoid craniotomy for CPA neoplasms between January 2018 and August 2024. Patient demographics, intraoperative reports, and postoperative complications were analyzed. Various reconstructive methods, including the use of TachoSil, HydroSet, autologous or heterologous dural patches, and bone flap repositioning, were compared. CSF-related complications such as CSF leakage, infections, and postoperative hydrocephalus were systematically evaluated.

RESULTS

CSF leakage occurred in 31% of cases (n = 69), while CSF infections and postoperative hydrocephalus were noted in 6% and 7% of patients, respectively. HydroSet combined with bone flap repositioning significantly reduced CSF leakage (p = 0.008), as did the combination of HydroSet and heterologous dural patches (p = 0.007). TachoSil did not show a significant reduction in CSF leakage. Craniectomy with titanium mesh or heterologous cranioplasty was not associated with any CSF leaks. No other single or combined techniques showed significant associations with CSF leakage.

CONCLUSIONS

HydroSet in combination with bone reconstruction and heterologous patches demonstrated superior outcomes in reducing CSF leaks. TachoSil did not significantly affect leakage rates, with less definite results. Refining surgical techniques and selecting appropriate materials for dural and bone reconstruction may help reduce complications and improve patient outcomes in CPA tumor surgeries using the retrosigmoid approach.
Recent experience with calcium phosphate cement cranioplasty after lateral supraorbital keyhole approach to the anterior cranial fossa
Authors: Joncas Colby T. , Lee Veronica , Tugend Margaret , Chance Rachel , McKhann Guy M. , Sekula Raymond F.
Published: February 2025

OBJECTIVE

Through an eyebrow incision, the lateral supraorbital (LSO) keyhole approach provides access to various lesions in the anterior cranial fossa and affords many of the advantages of minimal access and minimally invasive surgery. The LSO approach and other minimal access approaches including various endonasal approaches to the anterior cranial fossa, however, have been associated with nonnegligible rates of CSF leaks postoperatively. The authors report their recent experience using calcium phosphate cement cranioplasty as a method of preventing CSF leakage after LSO keyhole craniectomy.

METHODS

A retrospective medical records review was performed for 9 consecutive patients undergoing operations by the senior authors using the LSO keyhole approach with skull defect repair using calcium phosphate cement cranioplasty alone between 2022 and 2024. Review of the medical records included clinic notes, imaging studies, and operative notes as well as details regarding the length of hospital stay, complications, and rate of tumor recurrence.

RESULTS

Eight of 9 patients underwent resection of meningiomas, while 1 underwent resection of a cavernous malformation. The cohort consisted of 7 females (78%) and 2 males (22%) with a mean age of 55.2 years. The mean tumor volume among the 8 meningiomas was 18.09 cm3, and peritumoral edema was present in 8 of the 9 cases (89%). Gross-total resection was achieved in 7 of 8 meningioma cases (87.5%). Among the 9 patients, the mean length of hospital stay was 2.4 days. Two patients (22%) experienced complications. No patients experienced a CSF leak postoperatively. At a mean follow-up of 13.8 months, 1 patient (12.5%) experienced tumor recurrence.

CONCLUSIONS

Based on this and prior experience, the use of calcium phosphate cement cranioplasty alone following an LSO keyhole approach to the anterior cranial fossa is a safe alternative to traditional closure techniques, which rely on replacement of bone flap with plates and screws, and it might reduce the rate of postoperative CSF leakage. Larger studies are required to confirm these findings.
Trends in Medicare procedural and reimbursement rates for spinal CSF leak repair (2000–2021)
Authors: Jalal Muhammad I. , Singh Rohin , Santangelo Gabrielle , Schick Alex , Singh Aman , Furst Taylor , Stone Jonathan J. , Vates G. Edward , Paul David A.
Published: February 2025

OBJECTIVE

CSF leaks are a common complication of spinal surgery, occurring in 3%–16% of elective cases and up to 12% of operatively managed traumatic spinal injuries. They can also occur following lumbar puncture. However, there are limited data on utilization and reimbursement trends within Medicare for CSF leak repairs. Characterizing the economic burden and market of spinal CSF leak repair has implications for optimizing effective management strategies. This study evaluates reimbursement and utilization trends for both surgical repair and epidural blood patch (EBP) management of spinal CSF leaks between the years 2000 and 2021.

METHODS

The 2000–2021 provider utilization and payment files from the Centers for Medicare & Medicaid Services was queried to identify all spinal CSF leak repair procedures billed to Medicare part B. For each management strategy, the number of procedures, total charges submitted by providers, and total Medicare reimbursements were extracted. Monetary data were adjusted to 2021 US dollars using changes to the Consumer Price Index. Spearman rank correlation coefficients were used to analyze trends in reimbursement and utilization.

RESULTS

From 2000 to 2021, 62,826 open surgical repairs were reported with $37,082,407 paid in reimbursement (45.9% repaired without additional laminectomy, 28.8% with laminectomy, and 25.3% requiring a spinal dural graft). An additional 63,227 EBPs were reported for CSF leak repair with $7,567,776 in reimbursement. Reimbursement for CSF leak repair without laminectomy totaled $15,707,094; repairs with laminectomy, $12,429,690; and use of spinal dural grafts, $8,945,444. Both a significant 162% increase in the utilization of spinal dural grafts (333 to 872, p < 0.001) and a decrease in reimbursement ($671 to $496, p = 0.02) was observed from 2000 to 2021. There was a significant 31% decrease in reimbursement for EBP ($148 to $102, p < 0.001).

CONCLUSIONS

Significant variability exists in the management strategy and rates of utilization and reimbursement for treating spinal durotomy. Despite increasing utilization of spinal dural grafts, reimbursement has declined between the years 2000 and 2021. Further studies are required to optimize both the cost effectiveness and efficacy of spinal durotomy repair techniques.
Fibrin-coated collagen fleece "sandwich" closure technique for cranial and spinal dural reconstruction and closure
Authors: Kramer Dallas E. , Kaye Brandon , Sandoval-Consuegra Jose , Jeong Seung W. , Woodhouse Cody , Yu Alexander
Published: February 2025

OBJECTIVE

Persistent CSF leakage and symptomatic pseudomeningocele formation are a primary concern following intradural posterior fossa and spinal surgeries, with rates approaching 23.7% and 10%, respectively. These complications occur at a higher rate in cases in which a watertight primary closure cannot be attained. In such cases, various dural substitutes and sealants are at the surgeon’s disposal and often require suturing a dural substitute to the existing dura. Herein, the authors describe a novel sutureless inlay-onlay fibrin-coated collagen fleece (TachoSil) "sandwich" closure technique for dural reconstruction and closure.

METHODS

The authors retrospectively reviewed posterior fossa and intradural spinal cases performed by the senior author from January 1, 2021, to August 30, 2024, which used the described novel closure technique when primary closure without expansion could not be attained. Primary outcomes were rates of postoperative CSF leakage, symptomatic pseudomeningocele formation, CSF diversion, infection, and revision surgery.

RESULTS

A total of 13 patients (8 craniotomies, 2 craniectomies, and 3 spinal cases) were identified with a mean age of 61.3 ± 14.0 years. Surgical indications included intra-axial and extra-axial tumors, acute cerebellar infarcts, an unruptured aneurysm, and a ruptured arteriovenous malformation. One patient (7.7%) who underwent emergency craniectomy for acute cerebellar infarct developed a postoperative CSF leak and symptomatic pseudomeningocele with suspicion of pseudotumor cerebri, ultimately requiring CSF diversion. There were no complications among patients receiving craniotomy or intradural spinal surgery. No postoperative infections or revision surgeries occurred.

CONCLUSIONS

The TachoSil sandwich technique represents an effective means of cranial and spinal dural reconstruction and closure in cases in which watertight primary dural closure cannot be achieved.
Management of a large pseudomeningocele and cerebrospinal fluid fistula after microsurgical resection of recurrent lipomyelomeningocele in children
Authors: Etter Manina M. , Greuter Ladina , Guzman Raphael , Soleman Jehuda , Licci Maria
Published: February 2025

OBJECTIVE

Symptomatic retethering in pediatric patients following complex spinal dysraphism surgery for lipomyelomeningocele (LMMC) repair occurs in approximately 20% of cases. Common complications after repeat surgery for retethering include infection, pseudomeningocele (PMC), and cerebrospinal fluid (CSF) fistula. The authors of this report aim to describe the treatment options for large PMCs or CSF fistulas in a series of patients who underwent repeat surgery for recurrent LMMC at their institution. Additionally, they review management strategies from the literature.

METHODS

This retrospective, descriptive case series includes patients with LMMC who required revision surgery for postoperative PMC or CSF fistula after recurrent untethering procedures at the authors’ institution between 2013 and 2023. The surgical strategies for managing PMC and CSF fistula were examined. References for the narrative literature review were sourced from the PubMed and MEDLINE databases.

RESULTS

Eight patients underwent surgery for recurrent retethering due to worsening neurological deficits, including 2 (25.0%) patients who had undergone multiple previous untethering surgeries. The mean duration between symptom onset and repeat surgery was 11.30 ± 5.50 months. Of these 8 cases, 3 (37.5%) developed large postoperative PMCs and CSF fistulas. These patients required a mean of 4.7 ± 2.9 revision surgeries (range 3–8). Management often involved multiple techniques, including local wound revision, dural repair or sealing, mechanical coverage, tissue reconstruction, and external or internal fluid diversion. In all cases, PMCs and CSF fistulas were successfully treated, and at the final follow-up, all patients had stable neurological conditions compared to their preoperative status.

CONCLUSIONS

Managing symptomatic retethering after LMMC repair is challenging, often complicated by PMC and CSF fistulas due to missing normal anatomical tissue layers, large defects, and poor dorsal support. Successful treatment typically requires a combination of techniques to address CSF-related issues. In the authors’ experience, a multifaceted approach and familiarity with these methods are essential for achieving optimal outcomes.
Modified graded skull base reconstruction for intraoperative CSF leak repair in endoscopic endonasal surgeries: a single-surgeon experience in initial years of practice and nuances in the early learning curve
Authors: Khaleghi Mehdi , Shahid Adnan Hussain , Suggala Sudhir , Dyess Garrett , Hummel Ursula Noelle , Chason Danielle N. , Butler Danner , Thakur Jai Deep
Published: February 2025

OBJECTIVE

The purpose of this study was to evaluate the outcome of a modified graded reconstruction technique based on the size of intraoperative CSF leaks in patients undergoing endoscopic endonasal surgery performed by a single surgeon in the early years of his practice.

METHODS

The database of patients who underwent endoscopic endonasal approaches (EEAs) between September 2020 and August 2024 was included. Surgical complexity was categorized into levels II, III, and IV. Intraoperative CSF leak was categorized into 4 grades (0–3). Patients were divided into 2 timeline groups (those undergoing an EEA between 2020 and 2022 [group A] and between 2023 and 2024 [group B]) to assess the trends in surgical complexity and repair outcomes.

RESULTS

A total of 69 patients with a mean age of 56 ± 16.9 years (range 12–83 years) were identified; 34 (49.3%) were female. The median body mass index was 31 (> 25 in 82.6%). The most common pathology was nonsecretory macroadenoma (57.9%). The EEA at complexity levels II, III, and IV was performed in 36.2%, 46.4%, and 17.4% of the patients, respectively. Intraoperative CSF leaks grades 1, 2, and 3 were encountered in 39.1%, 7.2%, and 17.4% of the patients, whereas 36.2% did not develop leaks (grade 0). Fat grafts and collagen matrix were used for all patients with grades 1–3. Patients with complexity level II only developed grade 1 and 2 leaks, and none of level III developed grade 3. A nasoseptal flap was used in 4 patients (5.8%), with all having level IV surgery and grade 3 intraoperative leak. Only 1 patient (1.4%) developed a postoperative CSF leak, and a lumbar drain was only used for this patient (1.4%) at the revision surgery. The rate of grades 2 and 3 leaks in group B was significantly lower than in group A (8.3% vs 33.3%, p = 0.022). Temporary nasal packing usage was also significantly lower in group B (8.3%) than in group A (28.9%) (p = 0.049), whereas high-complexity EEA rates and pedicled flap usage were not correlated with the year of surgery.

CONCLUSIONS

A graded endoscopic endonasal repair protocol, combined with the judicious use of lumbar drains and nasoseptal flaps rather than a reflexive approach, helps in minimizing postoperative CSF leak rates. Cross-training of neurosurgery graduates focusing on skull base practice is highly recommended for maximizing good outcomes in their early years of practice. With growing experience, intraoperative leak rates tend to decrease, and the reconstruction relies on a tailored multilayer strategy rather than bulky synthetic materials.
Clinical and radiological presentation of cavernomas according to the Zabramski classification
Authors: Saari Emilia , Koivisto Timo , Rauramaa Tuomas , Frösen Juhana
Published: February 2025

OBJECTIVE

Cerebral cavernous malformations (CCMs) are a cluster of abnormal vessels of the brain. CCMs have a low risk for intracerebral hemorrhage and appear increasingly often as incidental findings on MRI. Zabramski classification has been used to describe the radiological features of CCMs. How the Zabramski classification associates with the clinical symptoms at presentation and clinical course of the disease is not well established.

METHODS

The authors reviewed the medical records of conservatively managed and surgically treated CCM patients over a 20-year period treated in Kuopio and Tampere University Hospitals. Both clinical and radiological data were analyzed. The modified Rankin Scale (mRS) was used to score the symptoms.

RESULTS

Altogether, 775 CCM patients were identified. In both cohorts, most patients were asymptomatic (53% in the Kuopio University Hospital [KUH] cohort and 64% in the Tampere University Hospital [TAUH] cohort). Most CCMs were located supratentorially (77%, 661/858), and most patients presented with epileptic seizures. Of the infratentorial CCMs, most were located in the cerebellum (61%, 121/198). The most common symptoms caused by these CCMs were double vision, sensory deficits, and impaired balance. The median mRS score for symptoms in all CCMs was 0, and if only symptomatic CCMs were accounted for, it was 2. Most CCMs were Zabramski type II, and these CCMs were relatively asymptomatic, similar to Zabramski type III CCMs. Zabramski type I CCMs were mostly symptomatic, whereas Zabramski type IV CCMs were completely asymptomatic. Of patients with type I CCMs, approximately 15% developed new symptoms within 1 year, and in the long-term follow-up 26% had new symptoms. In radiological follow-up, 81% of the type I CCMs regressed to type II or III. Of type II or III CCMs, 2.3% changed over time to type I. Age was associated with the Zabramski classification (p < 0.001 in the TAUH cohort and p = 0.034 in the KUH cohort).

CONCLUSIONS

Most CCMs are asymptomatic, incidental findings, in particular, nearly all Zabramski type IV CCMs. If symptoms are present, they are mainly associated with Zabramski type I CCMs and occasionally with Zabramski type II or III CCMs. Although most Zabramski type I CCMs will regress to type II or III and remain asymptomatic, over long-term follow-up, up to one-quarter develop new symptoms.
Celebrating advocacy: a pioneer and role model
Authors: Bederson Maria M. , Haid Regis W.
Published: February 2025

Continued advancement of the neurological surgery specialty depends on health policy engagement aimed at advocating for and protecting neurosurgeons and their patients. Dr. Ann R. Stroink, born in Seattle, Washington, and former president of the American Association of Neurological Surgeons (2022–2023), is an exemplar pioneer and role model in neurosurgery and advocacy. She has held numerous significant leadership positions in grassroots and national efforts to improve neurosurgical care and compensation, including serving as chair of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Washington Committee, the Neurosurgery Delegation to the American Medical Association, and the Council of State Neurosurgical Societies. This brief historical vignette highlights the qualities of a pioneer advocate in neurosurgery who rose to be a successful leader while overcoming the challenges of practicing in a rural setting and within a historically male-dominated profession. Dr. Stroink’s legacy serves as a beacon of inspiration, reminding us that through perseverance and advocacy we can pave the way for a brighter future in neurosurgery and beyond.
Prognostic factors for long-term outcomes of bilateral pallidal deep brain stimulation in the treatment of Meige syndrome
Authors: Zheng Wentao , Hao Qingpei , Chen Xi , Liu Yezu , Zhang Zihao , Li Zhangyu , Mao Jianyao , Zhou Liwei , Chen Sifang , Tan Guowei , Liu Ruen
Published: February 2025

OBJECTIVE

This study aimed to investigate the effects of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) on both motor and nonmotor symptoms in patients with Meige syndrome and to further explore prognostic factors for postoperative outcomes based on the long-term follow-up results.

METHODS

The authors retrospectively reviewed the medical records of a consecutive cohort of patients with refractory Meige syndrome who underwent GPi-DBS at their center from January 2016 to October 2023. Motor function, quality of life, neuropsychological status, and emotional state were assessed using standardized scales at baseline and every 3–6 months thereafter. Univariate and multivariate linear regression analyses were performed to identify independent risk factors affecting long-term motor function after GPi-DBS in patients with steady-state (stable) Meige syndrome.

RESULTS

Fifty steady-state patients were ultimately included and assessed, with a mean follow-up duration of 62.9 ± 24.8 months. At the final postoperative evaluation, Burke-Fahn-Marsden Dystonia Rating Scale movement and disability scores showed improvements of 69% (p < 0.001) and 61% (p < 0.001), respectively. A significant improvement from baseline was observed in postoperative scores on the 36-item Short-Form General Health Survey. Throughout continuous neurostimulation, global cognitive function, neuropsychological status, and mood remained stable. Multivariate linear regression analysis revealed that longer disease duration (standardized β-coefficient −0.375, 95% CI −0.033 to −0.011; p < 0.001) and reduced volume of activated tissue within the sensorimotor subregion of the GPi (standardized β-coefficient 0.597, 95% CI 0.002–0.003; p < 0.001) were independently associated with worse long-term motor performance.

CONCLUSIONS

Bilateral GPi-DBS is an effective, safe, and promising treatment option for intractable Meige syndrome and provides sustained benefits in motor function and quality of life without inducing cognitive or mood-related side effects. Early intervention and accurate electrode placement in the sensorimotor subregion of the GPi are essential for optimizing long-term therapeutic outcomes.
The effect of delayed-release antibiotics on the rate of postoperative wound infection for implanted neuromodulatory devices
Authors: Cleary Daniel R. , Palan Mihir J. , Useinovic Nemanja , Burchiel Kim J.
Published: February 2025

OBJECTIVE

Implanted neuromodulatory devices are important for the surgical management of pain, epilepsy, movement disorders, and spasticity. These devices are surgically implanted, but many must be periodically explanted and replaced as batteries deplete or devices fail. Replacement surgery risks further infections that require device explantation, incur large financial costs, and reduce patient quality of life. To reduce infection rates, a single surgeon began using vancomycin-impregnated absorbable calcium sulfate delayed-response beads with neuromodulatory device and intrathecal pump primary implantations and replacements. The infection rates when using vancomycin-impregnated beads were compared with previously published rates from the same surgeon.

METHODS

Patients were identified who underwent primary placement or replacement of an implanted neuromodulatory control device (pumps, generators, and stimulators) with vancomycin-impregnated absorbable calcium sulfate beads between 2019 and 2022. Control data were obtained from patients who underwent surgery prior to the start of using antibiotic beads (2016–2019). Postoperative infection status as well as de-identified demographic and clinical data were extracted from electronic health records. Patients were stratified by use of antibiotic beads, device type, and whether they had an infection within 1 year requiring explantation. Statistical comparisons were made using independent t-tests, Fisher’s exact test, and the chi-square test, with α set at 0.05. Effect size was calculated using Cohen’s h statistic.

RESULTS

A total of 665 surgeries were included for 611 patients who received antibiotic beads with device implantation, compared to 393 surgeries for 379 patients without antibiotic beads. The postoperative wound infection rate was 1.5% (n = 10 patients) versus 3.6% (n = 14 patients) for antibiotic beads versus controls (p = 0.03). When stratified by device type, a significant reduction in infection rate was found only with deep brain stimulation (DBS) generators (3.4% for controls vs 0.2% for beads, p = 0.002), which corresponds to a small to medium effect size (h = 0.27).

CONCLUSIONS

The use of vancomycin-impregnated absorbable calcium sulfate beads was associated with a reduced rate of postoperative infection rates with implantable devices, and specifically for DBS primary implantation and replacement surgeries.
Study of Histomorphological Patterns of Uterine Leiomyomas: An Observational Study
Authors: Tiwari Archana , Sapkota Pratima
Published: February 2025

Introduction: Uterine leiomyoma, also known as a fibroid, is a benign mesenchymal tumor derived from the smooth muscle of the uterus. It is the most common tumor in women with an estimated incidence of 20%-40% in women during their reproductive years. Leiomyoma can occur in any organ, but the most common forms appear in the uterus. This study is conducted to analyze histomorphological patterns of uterine leiomyomas.Methods: An observational cross-section was conducted between 1st June 2021 and 31st May 2023 in the Department of Pathology of a Medical College and Teaching Hospital. Patients with leiomyoma were included in the study. Clinical, sonographic, gross, and histopathology findings were analyzed. Ethical approval for the study was obtained from Institutional Review Committee (Reference Number: LMC10/B-021).Results: There were 100 patients with leiomyoma during the study period, among whom 55 (55%) were 40-49 years old. There were 65 (65%) patients in the group with a parity of two to three. Abnormal uterine bleeding was observed in 60 (60%) of the cases. Histologically 84 (84%) of the cases were simple conventional leiomyoma. The co-existing conditions found were cystic ovarian disease 37 (37%), adenomyosis 19 (19%), and cervical intraepithelial neoplasia 12 (12%).Conclusions: Conventional leiomyoma is the commonest histological subtype and and the most common clinical presentation is abnormal uterine bleeding.