Neurosurgical Management of Cerebrospinal Tumors in the Era of Artificial Intelligence : A Scoping Review

Central nervous system tumors are identified as tumors of the brain and spinal cord. The associated morbidity and mortality of cerebrospinal tumors are disproportionately high compared to other malignancies. While minimally invasive techniques have initiated a revolution in neurosurgery, artificial intelligence (AI) is expediting it. Our study aims to analyze AI’s role in the neurosurgical management of cerebrospinal tumors. We conducted a scoping review using the Arksey and O’Malley framework. Upon screening, data extraction and analysis were focused on exploring all potential implications of AI, classification of these implications in the management of cerebrospinal tumors. AI has enhanced the precision of diagnosis of these tumors, enables surgeons to excise the tumor margins completely, thereby reducing the risk of recurrence, and helps to make a more accurate prediction of the patient’s prognosis than the conventional methods. AI also offers real-time training to neurosurgeons using virtual and 3D simulation, thereby increasing their confidence and skills during procedures. In addition, robotics is integrated into neurosurgery and identified to increase patient outcomes by making surgery less invasive. AI, including machine learning, is rigorously considered for its applications in the neurosurgical management of cerebrospinal tumors. This field requires further research focused on areas clinically essential in improving the outcome that is also economically feasible for clinical use. The authors suggest that data analysts and neurosurgeons collaborate to explore the full potential of AI.

Acupuncture treatment of facial palsy

Bell's palsy is an idiopathic, acute peripheral-nerve palsy involving the facial nerve which supplies all the muscles of facial expression. This study was conducted to evaluate the effects of Electro-Acupuncture on patients with Facial Palsy. This study was conducted on patients with facial palsy at a private clinic at Peshawar during 1999-2009, and 49 cases were included in the study. All those cases that were within first two weeks of illness or who had related history of stroke or they had upper motor neuron lesion were not included in the study. Electroacupuncture was used as the main therapeutic technique to treat these cases. Patients were subjected to acupuncture treatment at four major points on the face for 20-25 minutes everyday for 10 days. Specific points were used for nasolabial fold and watering of the eye. After rest for a week patients were again evaluated and another course of treatment comprising of 5-10 days was sufficient in most cases. Frequency of electro-acupuncture is kept at 60-80 cycles per minute. Total number of patients studied was 49 with duration of illness as early as 3 weeks to a year and above. Cases with duration of illness from 3 weeks onward showed rapid recovery of palsy symptoms with electro-acupuncture. All cases showed recovery. Palsy of the angle of the mouth did not recover completely. Electro-acupuncture is effective in treating facial palsy cases

Glucose-6-phosphate dehydrogenase [G6PD] deficency in neonates presenting with Jaundice

To determine the frequency of Glucose-6-phosphate dehydrogenase [G6PD] deficiency in infants presenting with jaundice. This retrospective study was conducted in Fazal Rahim Clinical Laboratory Timergara District Dir North West Frontier Province of Pakistan, from 1st January 2004 to 31st December 2004 on 120 neonates. Data regarding sex and age, serum bilirubin total, serum bilirubin direct and G6PD status was extracted using database software designed by the principal author. The inclusion criterion was neonates with high serum bilirubin and G6PD test performed simultaneously. The exclusion criterion was premature babies and incomplete request forms. Microsoft Excel 2000 was used for data analysis Out of 120 patients, 97 [80.8%] were male and 23 [19.2%] were female ranging in age from 3 - 10 days with mean 6.5 days and median 5 days. Thirty two [26.6%] neonates were found G6PD deficient. Among patients with normal G6PD level male to female ratio was 3.63:1. In G6PD deficient patients male to female ratio was 7:1. The serum bilirubin of the G6PD normal patients was 12.8 + 5.0 mg/dl and that of G6PD deficient patients was 13.5 + 6.8 mg/dl. G6PD deficiency is quite high in neonates presenting with jaundice. The diagnosis is simple and if left undetected may cause serious consequences in situations of oxidant stress

Pain management in lumbago: role of acupuncture in addition to local steroid infiltration at trigger points

To know the effect of Acupuncture in addition to local steroid infiltration at trigger points in patients of lumbago. All patients who reported to Pain and Plegia Centre with lumbago were included in the study. Majority among them gave the history of treatment by various surgeons, orthopedic surgeons and neurosurgeons. Patients with caries spine, ankylosing spondylitis and those who had under gone spinal surgery were excluded. Acupuncture and ancillary techniques were used as primary modality to relieve chronic diffuse pain. Trigger spots were identified by deep palpation and were injected with steroid for complete cure. Total number of patients studied was 400. Among them 371 [92.75%] cases of low back pain of muscular origin responded well with complete relief of symptoms. In the remaining 29 [7.25%] cases of low back pain with radiological findings of marginal disc prolapse 20 [5%] recovered completely, four [1%] could live with residual symptoms while 5 cases [1.25%] were uncomfortable and were referred for surgery. Nonspecific chronic low back pain is due to spasm of paraveretebral muscles in the lumbosacral region and its primary cause is trigger spots in the muscles. This spasm is effectively relieved by acupuncture form of treatment unmasking trigger spots, which heal to local pinpointed injections of steroids

role of acupuncture in arthritis of the knee joint in addition to local steroid injection

This study was conducted to know the effects of acupuncture on patients with osteoarthriiis [OA] of the knee joint and to identify the trigger points in these patients. This study was conducted on OA of knee joint at Pain and Plegia center Peshawar from 1999 to 2004. Patients with multiple small joints pain, rheumatoid arthritis, gout or in whom knee joint was distended with fluid were excluded. All patients were treated with acupuncture for pain relief. Trigger spots were identified by palpating the knee. These trigger spots were treated by local instillation of triamcinolone acetonide 40 mg. These patients were then treated with Transcutaneous Electro-Neuro Stimulator [TENS] to treat muscle weakness. Out of 250, 225 cases [90%] were symptoms free. Only 25 cases [10%] relapsed with in a month after completion of treatment. Pain knee was mainly due to tendonitis, in close proximity to the knee joint. Main trigger points were outside the knee joint at adductor tubercle possibly at the insertion of adductor magnus and on the lateral side at the origin of gastrocnemius lateral head. The third trigger spot was on the medial aspect probably in tibial collateral ligament. Pain knee joint attributed to OA Knee is in fact due to tendonitis and not due to osteoarthritic changes in the joint and it is very much amenable to complete recovery by using both acupuncture therapy and local steroid injections