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:

code

"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:

code

"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:

code

"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:

code

"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:

code

"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:

code

"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

code

# 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

code

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

code

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

code

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

code

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

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