Background The integration of data-driven technologies into neurosurgery, particularly through the advent of synthetic data, marks a significant evolution in the field. This qualitative systematic review explores the impact of synthetic data on neurosurgical practices, including preoperative planning, intraoperative navigation, postoperative care, training, and research. The goal is to provide a comprehensive assessment of the current applications, benefits, challenges, and future directions of synthetic data in neurosurgery. Methods A thorough literature review was conducted, focusing on peer-reviewed articles and conference proceedings that detail the use of synthetic data in neurosurgery. The review prioritized studies offering qualitative evaluations, case studies, technological developments, and expert perspectives on synthetic data’s integration into neurosurgical practices. Inclusion criteria were established to select studies that explicitly discuss the generation, utilization, and impact of synthetic data in the discipline. Results The analysis reveals that synthetic data contributes significantly to neurosurgery, enhancing surgical planning precision, training simulation accuracy, and enabling personalized care. Identified benefits include addressing the scarcity of clinical data, maintaining patient privacy, and facilitating machine learning model development. Challenges such as ensuring data realism and variability, along with the integration of synthetic data into clinical workflows, were also identified. The review further highlights synthetic data’s role in supporting collaborative research, navigating data sharing obstacles, and fostering innovation in neurosurgical methods and patient outcomes. Conclusions Synthetic data presents a transformative opportunity for neurosurgery, addressing historical challenges and fostering advancements. Despite existing hurdles, its application across neurosurgical domains indicates a shift towards more personalized, precise, and effective patient care. Overcoming these challenges requires ongoing interdisciplinary cooperation and technological progress. The review emphasizes the necessity for standardized methodologies, ethical considerations, and a proactive stance to leverage synthetic data’s potential fully in neurosurgical advancements.

Immune checkpoint inhibitors (ICIs) and vascular endothelial growth factor (VEGF) pathway inhibitors are increasingly used in bone and soft tissue sarcomas. Risks associated with combination therapy, such as venous thromboembolism (VTE), carry significant consequences but remain poorly characterized. This study evaluated whether adding a VEGF pathway inhibitor to ICI therapy increases VTE risk in sarcoma patients. Using the TriNetX U.S. Collaborative Network, we identified patients with bone or soft tissue sarcoma [International Classification of Diseases (ICD)-10 C40, C41, C47, C49] who received either combination therapy (ICI plus VEGF pathway inhibitor within ±30 days of ICI initiation) or ICI monotherapy. Propensity score matching (1:1) balanced cohorts for age, sex, race, hypertension, diabetes, obesity, and smoking history. The primary outcome was 1-year VTE incidence (pulmonary embolism or venous thrombosis). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. After matching, 834 patients remained in each cohort (mean age 63 years; hypertension prevalence 60%). At 1 year, VTE occurred in 14.0% of the combination cohort and 12.4% of the monotherapy cohort (HR 1.23; 95% CI: 0.91-1.66; P=0.07), corresponding to an absolute risk difference of 1.6 percentage points (95% CI: -2.1 to 5.2). Musculoskeletal toxicity did not differ between groups (5.5% vs. 6.4%; HR 0.93; 95% CI: 0.61-1.41; P=0.82). Sarcoma patients receiving ICI-based therapy experienced a high 1-year VTE burden. Although we did not detect a statistically significant increase in VTE with the addition of a VEGF pathway inhibitor, the point estimates were compatible with a modestly higher risk; however, the CIs were wide and included no difference between groups. These findings support clinical vigilance and risk assessment and motivate prospective studies of risk-adapted thromboprophylaxis in this population.

Background: Care fragmentation has been linked to overuse and higher costs. Evidence on how fragmentation relates to outpatient imaging in the general U.S. population remains limited. Objective: To quantify the association between care fragmentation and outpatient imaging utilization and radiology expenditures among U.S. adults, and to test whether associations differ by multimorbidity and insurance. Design: Cross-sectional, survey-weighted analysis using the Medical Expenditure Panel Survey (MEPS) 2020. Participants: Adults aged ≥ 18 years in MEPS 2020 with non-missing survey design variables. Exposures: Care fragmentation category (None/Low/Medium/High), defined using person-level utilization breadth and intensity from the Full-Year Consolidated file. Main outcomes and measures: Primary outcomes included any advanced imaging (receipt of at least one MRI, CT, or ultrasound during office-based visits) and total radiology expenditures (sum of payments for imaging-flagged office-based visits). Secondary outcomes included any imaging, imaging visit count, and radiology spending as a proportion of total expenditures. Results: In survey-weighted models (reference = Low; “None” excluded from regressions), Medium fragmentation was associated with higher odds of any advanced imaging (OR 1.42, 95% CI 1.23–1.64), whereas High did not further increase the probability (OR 0.92, 0.71–1.19). Fragmentation substantially increased intensity: imaging visit counts (RR 2.51 Medium; 3.96 High vs Low) and radiology spending among spenders (2.36× Medium; 3.96× High vs Low). Older age (50–64, 65+), female sex, and Medicare coverage independently raised both imaging probability and spend. Conclusions: Care fragmentation is associated with both increased probability and intensity of advanced imaging utilization, with particularly strong effects on radiology expenditures among adults with positive spending. Findings support targeted interventions to improve care coordination and reduce potentially unnecessary imaging in fragmented care environments.

Outpatient advanced imaging is central to the evaluation of spine-related conditions, yet concerns persist about coordination and potential overuse. We assessed whether higher care fragmentation is associated with increased MRI/CT use and radiology expenditures among U.S. adults with spine-related conditions using 2020 Medical Expenditure Panel Survey (MEPS) data. A spine cohort was identified from ICD-10-CM and CCSR codes; care fragmentation was categorized using fixed cutpoints on full-year utilization. Outcomes included MRI/CT-only imaging in office-based care and radiology expenditures analyzed with survey-weighted regression models. Compared with Low fragmentation, Medium and High fragmentation were associated with higher odds of advanced imaging and higher odds of any radiology spending; conditional spending was directionally higher for High vs Low but imprecise. Effects appeared strongest among privately insured. Findings suggest opportunities to improve coordination and value in ambulatory spine care.