Background Recent studies suggest that large language models (LLMs) such as ChatGPT are useful tools for medical students or residents when preparing for examinations. These studies, especially those conducted with multiple-choice questions, emphasize that the level of knowledge and response consistency of the LLMs are generally acceptable; however, further optimization is needed in areas such as case discussion, interpretation, and language proficiency. Therefore, this study aimed to evaluate the performance of six distinct LLMs for Turkish and English neurosurgery multiple-choice questions and assess their accuracy and consistency in a specialized medical context. Methods A total of 599 multiple-choice questions drawn from Turkish Board examinations and an English neurosurgery question bank were presented to six LLMs (ChatGPT-o1pro, ChatGPT-4, AtlasGPT, Gemini, Copilot, and ChatGPT-3.5). Correctness rates were compared using the proportion z-test, and inter-model consistency was examined using Cohen’s kappa. Results ChatGPT-o1pro, ChatGPT-4, and AtlasGPT demonstrated relatively high accuracy for Single Best Answer–Recall of Knowledge (SBA-R), Single Best Answer–Interpretative Application of Knowledge (SBA-I), and True/False question types; however, performance notably decreased for questions with images, with some models leaving many unanswered items. Conclusion Our findings suggest that GPT-4-based models and AtlasGPT can handle specialized neurosurgery questions at a near-expert level for SBA-R, SBA-I, and True/False formats. Nevertheless, all models exhibit notable limitations in questions with images, indicating that these tools remain supplementary rather than definitive solutions for neurosurgical training and decision-making.

Background/Objectives: This study aimed to investigate the surgical treatment and management of hydrocephalus in infants with meningomyelocele and compare the single-center experience with the previous studies. Methods: This retrospective study included 81 infants (47 females and 34 males) who underwent meningomyelocele closure surgery and subsequent ventriculoperitoneal (VP) shunt surgery for hydrocephalus. Clinical and demographic data were retrospectively collected from hospital records, focusing on variables such as the timing of VP shunt placement relative to MMC closure, postoperative complications, and the need for shunt revisions. Patients were followed for a mean duration of 58.11 months to monitor long-term outcomes and identify factors associated with shunt failures and infections. Results: The mean follow-up period since birth was 58.11 (33.72) months. Shunt problems affected 30% (25/81) of patients with mechanical causes (8/25) and infections (6/25). A proximal mechanical malfunction/dysfunction was seen in 32% (8/25) of the shunts. Shunt infections occurred in 23% (19/81) of infants, and the mean time for shunt infection onset following the VP shunt procedure was 0 (0–39) median (min–max) months. Overall, 8 (9.9%) infants had short-term shunt infections, whereas 11 (13.6%) had long-term shunt infections. The mean length of the intensive care unit stay was 35.75 (25.28) days. Significant difference was seen in the number of shunt reoperations for short- and long-term infections (p < 0.001). All infants had at least one operation before the infection of their shunt system. Male gender was significantly associated with long-term shunt infections (p = 0.021). The study revealed methicillin-resistant coagulase-negative staphylococcus to be the most common isolated organism from infected shunts at 72.7% (6/11). Conclusions: This study demonstrates that hydrocephalic infants with meningomyelocele undergoing VP shunt surgery face notable risks of infection and mechanical complications, with methicillin-resistant coagulase-negative staphylococcus identified as the most common pathogen. The findings emphasize the importance of comprehensive postoperative care and targeted infection management to improve outcomes in this vulnerable population.

BACKGROUND AND OBJECTIVES: The intricate anatomy of the posterior fossa comprises layered muscles, fasciae, and both extracranial and intracranial neurovascular structures. Surgical intervention in this region requires a precise and comprehensive understanding of these structures, which can be difficult to achieve with only 2-dimensional materials. Traditional cadaver dissections provide basic 3-dimensional anatomic insight but are increasingly constrained by cost, ethical concerns, and difficulties in cadaver sourcing. Advances in 3-dimensional (3D) modeling, particularly through photogrammetry, offer an innovative approach for improving visuospatial understanding for neurosurgical education. This study aimed to create realistic 3D models of the suboccipital musculature and neurovascular anatomy of the posterior fossa with photogrammetry. In addition, a middle fossa dissection was included to define cranial nerve pathways, providing a supplementary educational tool for neurosurgical training. METHODS: Five silicone-injected cadaveric head specimens were used for posterior and middle fossa dissection under a surgical microscope. Photographs were taken from multiple angles to generate 3D models through photogrammetry, which were then processed with the Scaniverse application and uploaded to the Sketchfab platform. Each model's anatomic structures were labeled and made accessible for augmented reality and virtual reality viewing on multiple devices, enhancing interactive learning experiences. Patient-specific step-by-step 3D models were generated using radiological segmentation to support preoperative planning for the posterior fossa approach. RESULTS: Sixteen 3D models were created, illustrating detailed anatomy of suboccipital and deep neck muscles, neurovascular structures, and cranial nerve pathways within the posterior and middle fossae. These models improve visualization and spatial understanding of complex anatomic relationships, making them a valuable resource for neurosurgical education. CONCLUSION: The 3D models developed in this study provide an effective tool to enhance the spatial understanding of the complex neurovascular anatomy of posterior fossa and cranial nerve routes, supporting and complementing traditional cadaver dissection in neurosurgical training.

Background/Objectives: We aimed to review pediatric patients who underwent surgical treatment for posterior fossa tumors and to share our experience with the various types of dural grafts used in these patients. Methods: We carried out a retrospective study on pediatric patients who received surgical treatment for posterior fossa tumors and underwent duraplasty using either an autograft or a xenograft from January 2018 to December 2022. Data were gathered from patients’ medical records, encompassing demographic details. Additional information included tumor locations and the extent of resection. Factors such as postoperative complications like meningitis, pseudo-meningocele, and hydrocephalus were also noted. Results: Our cohort included 50 patients, 13 of whom underwent surgeries with autografts and 37 had xenografts. The patients’ tumors were in various areas, including intraventricular or those extending into the ventricle (31) and intracerebellar (17) and extra-axial (2) cases. Subtotal resection occurred in 8 cases, near-total resection in 9, and gross-total resection in 33. Postoperatively, meningitis occurred in 12 patients, pseudo-meningocele in 13, and hydrocephalus in 10, with 9 requiring V/P placement. Conclusions: In conclusion, techniques for dural closure hold great significance in neurosurgery, particularly during pediatric posterior fossa surgeries. Although the modest size of the autograft cohort limited statistical power, our epidural onlay fascia lata autograft produced fewer postoperative complications than the bovine xenograft and achieved outcomes comparable to those reported for watertight closure.