Neurosurgery Literature Search Skill

Overview

This skill provides domain-aware literature searching for neurosurgical systematic reviews. It understands neurosurgery subspecialties, common procedures, outcome measures, and builds optimized search strategies.

Subspecialty Knowledge Base

Vascular Neurosurgery

Conditions:

• Intracranial aneurysms (ruptured/unruptured, saccular/fusiform)
• Arteriovenous malformations (AVMs), dAVFs
• Cavernous malformations
• Moyamoya disease
• Ischemic stroke, hemorrhagic stroke
• Cerebral vasospasm, delayed cerebral ischemia

Procedures:

• Microsurgical clipping
• Endovascular coiling, flow diversion, WEB device
• Bypass surgery (EC-IC, STA-MCA, ELANA)
• Decompressive craniectomy/hemicraniectomy
• EVD placement, ICP monitoring

MeSH Terms:

"Intracranial Aneurysm"[MeSH]
"Arteriovenous Malformations"[MeSH]  
"Stroke"[MeSH]
"Subarachnoid Hemorrhage"[MeSH]
"Decompressive Craniectomy"[MeSH]
"Cerebral Revascularization"[MeSH]

Outcomes:

• mRS (modified Rankin Scale) 0-6
• GOS/GOS-E
• Mortality
• Rebleeding rate
• Vasospasm/DCI incidence
• Aneurysm occlusion rate

Neuro-Oncology

Conditions:

• Gliomas (WHO Grade 1-4, IDH status, 1p19q)
• Glioblastoma multiforme (GBM)
• Meningiomas (WHO Grade 1-3)
• Pituitary adenomas (functioning/non-functioning)
• Vestibular schwannomas
• Brain metastases
• Skull base tumors

Procedures:

• Craniotomy for tumor resection
• Awake craniotomy with mapping
• Fluorescence-guided surgery (5-ALA)
• Laser interstitial thermal therapy (LITT)
• Stereotactic biopsy
• Transsphenoidal surgery
• Radiosurgery (Gamma Knife, CyberKnife)

MeSH Terms:

"Brain Neoplasms"[MeSH]
"Glioma"[MeSH]
"Glioblastoma"[MeSH]
"Meningioma"[MeSH]
"Pituitary Neoplasms"[MeSH]
"Neuroma, Acoustic"[MeSH]

Outcomes:

• Extent of resection (GTR, STR, biopsy)
• Progression-free survival (PFS)
• Overall survival (OS)
• KPS (Karnofsky Performance Status)
• Neurological function
• Seizure control (Engel class)
• Endocrine outcomes (for pituitary)

Spine Surgery

Conditions:

• Degenerative disc disease
• Cervical/lumbar stenosis
• Spondylolisthesis
• Spinal deformity (scoliosis, kyphosis)
• Spinal trauma/fractures
• Spinal tumors
• Spinal infections

Procedures:

• ACDF (anterior cervical discectomy and fusion)
• Cervical disc arthroplasty
• Laminectomy, laminoplasty
• PLIF, TLIF, ALIF, LLIF, OLIF
• Pedicle screw fixation
• Corpectomy
• Minimally invasive spine surgery

MeSH Terms:

"Spinal Fusion"[MeSH]
"Diskectomy"[MeSH]
"Laminectomy"[MeSH]
"Spinal Stenosis"[MeSH]
"Spondylolisthesis"[MeSH]
"Intervertebral Disc Degeneration"[MeSH]

Outcomes:

• ODI (Oswestry Disability Index)
• NDI (Neck Disability Index)
• VAS (Visual Analog Scale) for pain
• JOA score (Japanese Orthopaedic Association)
• Fusion rate
• Adjacent segment disease
• Return to work

Functional Neurosurgery

Conditions:

• Parkinson's disease
• Essential tremor
• Dystonia
• Epilepsy (drug-resistant)
• Chronic pain syndromes
• Trigeminal neuralgia
• Spasticity
• Psychiatric disorders (OCD, depression)

Procedures:

• Deep brain stimulation (DBS) - STN, GPi, VIM, ANT
• Radiofrequency lesioning
• Gamma Knife radiosurgery
• MR-guided focused ultrasound (MRgFUS)
• Epilepsy surgery (ATL, SAH, lesionectomy)
• Laser ablation (LITT)
• Spinal cord stimulation
• Intrathecal baclofen pump
• Vagus nerve stimulation

MeSH Terms:

"Deep Brain Stimulation"[MeSH]
"Epilepsy Surgery"[MeSH]
"Movement Disorders"[MeSH]
"Parkinson Disease"[MeSH]
"Trigeminal Neuralgia"[MeSH]

Outcomes:

• UPDRS (Unified Parkinson's Disease Rating Scale)
• Tremor rating scales
• Engel classification (epilepsy)
• Seizure freedom rate
• Pain NRS/VAS
• Quality of life (SF-36, PDQ-39)

Pediatric Neurosurgery

Conditions:

• Hydrocephalus (congenital, acquired)
• Chiari malformation (Type I, II)
• Craniosynostosis
• Tethered cord syndrome
• Myelomeningocele/spina bifida
• Pediatric brain tumors
• Arachnoid cysts

Procedures:

• VP shunt, VA shunt
• Endoscopic third ventriculostomy (ETV)
• ETV with choroid plexus cauterization
• Chiari decompression
• Cranial vault remodeling
• Myelomeningocele repair
• Detethering

MeSH Terms:

"Hydrocephalus"[MeSH]
"Arnold-Chiari Malformation"[MeSH]
"Craniosynostoses"[MeSH]
"Myelomeningocele"[MeSH]
"Spinal Dysraphism"[MeSH]

Outcomes:

• Shunt revision rate
• ETV success score
• Developmental outcomes
• Cosmetic outcomes
• Neurological function

Trauma

Conditions:

• Traumatic brain injury (mild/moderate/severe)
• Epidural hematoma (EDH)
• Subdural hematoma (acute/chronic SDH)
• Contusions, DAI
• Skull fractures
• Spinal trauma, SCI

Procedures:

• Craniotomy for hematoma evacuation
• Decompressive craniectomy
• ICP monitoring (EVD, bolt)
• Cranioplasty
• Spine fixation

MeSH Terms:

"Craniocerebral Trauma"[MeSH]
"Brain Injuries, Traumatic"[MeSH]
"Hematoma, Epidural, Cranial"[MeSH]
"Hematoma, Subdural"[MeSH]
"Spinal Cord Injuries"[MeSH]
"Intracranial Pressure"[MeSH]

Outcomes:

• GCS (Glasgow Coma Scale)
• GOS/GOS-E
• Mortality
• ICP control
• ASIA score (spinal)
• Functional independence

Search Strategy Templates

Basic PICO Search

# Population
("{{CONDITION}}"[MeSH] OR "{{CONDITION}}"[Title/Abstract])

# Intervention  
AND ("{{INTERVENTION}}"[MeSH] OR "{{INTERVENTION}}"[Title/Abstract])

# Comparator (optional)
AND ("{{COMPARATOR}}"[MeSH] OR "{{COMPARATOR}}"[Title/Abstract])

# Outcome (optional)
AND ("{{OUTCOME}}"[Title/Abstract])

# Filters
AND humans[MeSH] 
AND english[Language]
AND ("{{START_YEAR}}"[PDAT]:"{{END_YEAR}}"[PDAT])

High-Quality Evidence Filter

AND (
  randomized controlled trial[pt] OR
  controlled clinical trial[pt] OR
  meta-analysis[pt] OR
  systematic review[pt] OR
  "comparative study"[pt]
)

Neurosurgery Journal Filter

AND (
  "J Neurosurg"[Journal] OR
  "Neurosurgery"[Journal] OR
  "World Neurosurg"[Journal] OR
  "Acta Neurochir"[Journal] OR
  "J Neurotrauma"[Journal] OR
  "Spine"[Journal] OR
  "Eur Spine J"[Journal] OR
  "J Neurosurg Spine"[Journal] OR
  "J Neurosurg Pediatr"[Journal] OR
  "Stereotact Funct Neurosurg"[Journal] OR
  "Epilepsia"[Journal]
)

Outcome Scales Quick Reference

Scale	Full Name	Range	Better
GCS	Glasgow Coma Scale	3-15	Higher
GOS	Glasgow Outcome Scale	1-5	Higher
GOS-E	GOS Extended	1-8	Higher
mRS	modified Rankin Scale	0-6	Lower
KPS	Karnofsky Performance Status	0-100	Higher
NIHSS	NIH Stroke Scale	0-42	Lower
ODI	Oswestry Disability Index	0-100%	Lower
NDI	Neck Disability Index	0-100%	Lower
VAS	Visual Analog Scale	0-10	Lower
Engel	Engel Epilepsy Classification	I-IV	Class I
UPDRS	Unified Parkinson's Rating	0-199	Lower
JOA	Japanese Ortho Association	0-17	Higher
ASIA	American Spinal Injury Assoc	A-E	E

Usage Examples

Example 1: Vascular Search

User: Search for studies on clipping vs coiling for ruptured aneurysms

Search Strategy:
("Intracranial Aneurysm"[MeSH] OR "cerebral aneurysm"[tiab] OR 
 "intracranial aneurysm"[tiab]) 
AND ("Subarachnoid Hemorrhage"[MeSH] OR "rupture"[tiab] OR "ruptured"[tiab])
AND (
  ("Neurosurgical Procedures"[MeSH] OR "clipping"[tiab] OR 
   "microsurgical"[tiab] OR "craniotomy"[tiab])
  OR
  ("Endovascular Procedures"[MeSH] OR "coiling"[tiab] OR 
   "embolization"[tiab] OR "endovascular"[tiab])
)
AND (outcome*[tiab] OR mortality[tiab] OR "mRS"[tiab] OR 
     rebleed*[tiab] OR occlusion[tiab])
AND humans[MeSH] AND english[Language]

Example 2: Spine Search

User: Find RCTs on ACDF vs arthroplasty for cervical disc disease

Search Strategy:
("Intervertebral Disc Degeneration"[MeSH] OR "cervical disc"[tiab] OR 
 "disc herniation"[tiab])
AND (
  ("Spinal Fusion"[MeSH] OR "ACDF"[tiab] OR 
   "anterior cervical discectomy"[tiab] OR "fusion"[tiab])
  OR
  ("Arthroplasty"[MeSH] OR "disc replacement"[tiab] OR 
   "disc arthroplasty"[tiab] OR "artificial disc"[tiab])
)
AND randomized controlled trial[pt]
AND humans[MeSH] AND english[Language]

Best Practices

1. Start broad, then narrow - Begin with sensitive search, add specificity
2. Use both MeSH and free text - Capture indexed and recent articles
3. Check for synonyms - Different terms for same concept
4. Document everything - Save strategy with date for reproducibility
5. Validate with known articles - Ensure key studies are captured
6. Consider grey literature - ClinicalTrials.gov, conference abstracts