Implanted cortical neuroprosthetics for speech and movement restoration.

Implanted cortical neuroprosthetics (ICNs) are medical devices developed to replace dysfunctional neural pathways by creating information exchange between the brain and a digital system which can facilitate interaction with the external world. Over the last decade, researchers have explored the application of ICNs for diverse conditions including blindness, aphasia, and paralysis. Both transcranial and endovascular approaches have been used to record neural activity in humans, and in a laboratory setting, high-performance decoding of the signals associated with speech intention has been demonstrated. Particular progress towards a device which can move into clinical practice has been made with ICNs focussed on the restoration of speech and movement. This article provides an overview of contemporary ICNs for speech and movement restoration, their mechanisms of action and the unique ethical challenges raised by the field.

Mapping the Clinical Pathway for Patients Undergoing Vestibular Schwannoma Resection.

BACKGROUND: The introduction of the electronic health record (EHR) has improved the collection and storage of patient information, enhancing clinical communication and academic research. However, EHRs are limited by data quality and the time-consuming task of manual data extraction. This study aimed to use process mapping to help identify critical data entry points within the clinical pathway for patients with vestibular schwannoma (VS) ideal for structured data entry and automated data collection to improve patient care and research. METHODS: A 2-stage methodology was used at a neurosurgical unit. Process maps were developed using semi-structured interviews with stakeholders in the management of VS resection. Process maps were then retrospectively validated against EHRs for patients admitted between August 2019 and December 2021, establishing critical data entry points. RESULTS: In the process map development, 20 stakeholders were interviewed. Process maps were validated against EHRs of 36 patients admitted for VS resection. Operative notes, surgical inpatient reviews (including ward rounds), and discharge summaries were available for all patients, representing critical data entry points. Areas for documentation improvement were in the preoperative clinics (30/36; 83.3%), preoperative skull base multidisciplinary team (32/36; 88.9%), postoperative follow-up clinics (32/36; 88.9%), and postoperative skull base multidisciplinary team meeting (29/36; 80.6%). CONCLUSIONS: This is a first use to our knowledge of a 2-stage methodology for process mapping the clinical pathway for patients undergoing VS resection. We identified critical data entry points that can be targeted for structured data entry and for automated data collection tools, positively impacting patient care and research.

Can ChatGPT outperform a neurosurgical trainee? A prospective comparative study.

PURPOSE: This study aimed to compare the performance of ChatGPT, a large language model (LLM), with human neurosurgical applicants in a neurosurgical national selection interview, to assess the potential of artificial intelligence (AI) and LLMs in healthcare and provide insights into their integration into the field. METHODS: In a prospective comparative study, a set of neurosurgical national selection-style interview questions were asked to eight human participants and ChatGPT in an online interview. All participants were doctors currently practicing in the UK who had applied for a neurosurgical National Training Number. Interviews were recorded, anonymised, and scored by three neurosurgical consultants with experience as interviewers for national selection. Answers provided by ChatGPT were used as a template for a virtual interview. Interview transcripts were subsequently scored by neurosurgical consultants using criteria utilised in real national selection interviews. Overall interview score and subdomain scores were compared between human participants and ChatGPT. RESULTS: For overall score, ChatGPT fell behind six human competitors and did not achieve a mean score higher than any individuals who achieved training positions. Several factors, including factual inaccuracies and deviations from expected structure and style may have contributed to ChatGPT's underperformance. CONCLUSIONS: LLMs such as ChatGPT have huge potential for integration in healthcare. However, this study emphasises the need for further development to address limitations and challenges. While LLMs have not surpassed human performance yet, collaboration between humans and AI systems holds promise for the future of healthcare.

Adverse intraoperative events during surgical repair of ruptured cerebral aneurysms: a systematic review.

Compared with endovascular techniques, clipping of ruptured cerebral aneurysms has been shown to associate with increased morbidity in several studies. Despite this, clipping remains the preferred option for many aneurysms. The objective of this study is to describe the reported adverse events of open repair of ruptured cerebral aneurysms and their impact on patient outcome. The PubMed, Embase and Cochrane databases were searched between June 1999 and June 2019 to identify original studies of at least 100 patients undergoing surgical repair of ruptured cerebral aneurysms and in which adverse event rates were reported. Thirty-six studies reporting adverse events in a total of 12,410 operations for repair of ruptured cerebral aneurysms were included. Surgical adverse events were common with 36 event types reported including intraoperative rupture (median rate of 16.6%), arterial injury (median rate of 3.8%) and brain swelling (median rate 5.6%). Only 6 surgical events were statistically shown to associate with poor outcomes by any author and for intraoperative rupture (the most frequently analysed), there was an even split between authors finding a statistical association with poor outcome and those finding no association. Even with modern surgical techniques, the technical demands of surgical aneurysm repair continue to lead to a high rate of intraoperative adverse events. Despite this, it is not known which of these intraoperative events are the most important contributors to the poor outcomes often seen in these patients. More research directed towards identifying the events that most drive operative morbidity has the potential to improve outcomes for these patients.

An Exit Strategy for Resuming Nonemergency Neurosurgery after Severe Acute Respiratory Syndrome Coronavirus 2: A United Kingdom Perspective.

INTRODUCTION: Substantial healthcare resources have been diverted to manage the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and nonemergency neurosurgery has been effectively closed. As we begin to emerge from the crisis, we will need to manage the backlog of nonemergency neurosurgical patients whose treatment has been delayed and remain responsive to further possible surges of SARS-CoV-2 infections. METHODS: In the present study, we aimed to identify the core themes and challenges that will limit resumption of a normal neurosurgical service after the SARS-CoV-2 pandemic and to provide pragmatic advice and solutions that could be of utility to clinicians seeking to resume nonemergency neurosurgical care. We reviewed the relevant international policies, a wide range of journalistic and media sources, and expert opinion documents to address the stated aims. RESULTS: We have presented and discussed a range of factors that could become potential barriers to resuming full elective neurosurgical provision and important steps that must be completed to achieve pre-SARS-CoV-2 surgical capacity. We also explored how these challenges can be overcome and outlined the key requirements for a successful neurosurgical exit strategy from the pandemic. CONCLUSION: The performance of nonemergency neurosurgery can start once minimum criteria have been fulfilled: 1) a structured prioritization of surgical cases; 2) virus infection incidence decreased sufficiently to release previously diverted healthcare resources; 3) adequate safety criteria met for patients and staff, including sufficient personal protective equipment and robust testing availability; and 4) maintenance of systems for rapid communication at organizational and individual levels.

Trajectories for frontal external ventricular drain placement: virtual cannulation of adults with acute hydrocephalus.

OBJECTIVES: External ventricular drains (EVDs) are commonly placed freehand using targeting landmarks unchanged since the pre-CT era; it is known to be an inaccurate procedure. To our knowledge, this is the first study to assess the geometric reliability of specific trajectories in a three-dimensional model. DESIGN: Three-dimensional volume reconstruction of EVD trajectories in a Stealth Station S7. SUBJECTS: Adults with a primary EVD sited for acute hydrocephalus secondary to spontaneous subarachnoid haemorrhage with CT angiography less than 24 hours previously. METHODS: CT angiograms from 10 consecutive patients meeting the inclusion criteria were reconstructed. The surgical planning tool was used to construct three trajectories from Kocher's point: i) perpendicular to the skull (PTS) ii) towards the ipsilateral medial canthus coronally and the external auditory meatus sagitally (IMC) iii) towards the contralateral medial canthus coronally and the external auditory meatus sagitally (CMC). Their engagement with the frontal horn of the ipsilateral lateral ventricle (FILV) and distance from the ventricular wall and foramen of Monro were measured. RESULTS: Mean supratentorial ventricular volume was 55.8 cc (range 35.2-83.4 cc). The IMC met the FILV in only one patient, on average missing the ventricular wall by 5.5±2.3 degrees (95% confidence interval). CMC and PTS met the FILV in 9 and 10 cases, respectively. Mean engagement was 16.3±5.1 mm (95% confidence interval) for PTS and 20.0±7.1 mm (95% confidence interval) for CMC. CMC and PTS gave significantly better engagement and aiming error margins than the IMC trajectory. CONCLUSIONS: Despite its widespread use, the IMC trajectory performed poorly; PTS and CMC trajectories are more reliable ways of targeting the FILV when placing an EVD.

Porcine small intestine submucosa for repair of goat meniscal defects.

This study evaluated the effectiveness of small intestine submucosa used as a graft to fill surgically created meniscal defects in a large animal model. Four goats underwent unilateral interior subtotal meniscectomies (approximately 70%) within the avascular portion of the medial meniscus. The contralateral meniscus acted as a control. Grafts of porcine small intestine submucosa were trimmed to fill the resected defects and sutured into place. After surgery the operated knees were casted in partial flexion to limit weight bearing on the affected limb. All of the animals were sacrificed at 12 weeks at which point meniscal regeneration and articular cartilage degradation were evaluated by gross and histologic examination. Grossly, the defects in the small intestine submucosa-grafted goats were partially filled with meniscal-appearing connective tissue. Histologically, the replacement tissue was typified by the presence of dense, cellular, irregularly organized connective tissue. Evaluation of the articular cartilage displayed increased degeneration in the grafted compartment of the operative knees. Each of the operative menisci partially regenerated. The grafts were conducive to repopulation with host meniscal elements. Despite partial meniscal regeneration, comparatively more articular cartilage degeneration in the treated knees was observed than in the untreated contralateral controls.