Neurochirurgie最新文献

{"title":"Awake microsurgical management of brain aneurysms: a comprehensive systematic review and meta-analysis on rationale, safety and clinical outcomes.","authors":"Jhon E Bocanegra-Becerra, Gabriel Simoni, Cristian D Mendieta, José Luis Acha Sánchez, Lucca B Palavani, Kim Wouters, Anuraag Punukollu, Gabriel Mangas, Raphael Bertani, Miguel Angel Lopez-Gonzalez","doi":"10.1016/j.neuchi.2024.101600","DOIUrl":"10.1016/j.neuchi.2024.101600","url":null,"abstract":"<p><strong>Introduction: </strong>Awake microsurgery for brain aneurysm treatment has emerged as a tool for real-time intraoperative monitoring, opportune detection of ischemic complications, and reduction of surgical morbidity. Herein, we aimed to explore the current state of the procedure's rationale, safety and clinical outcomes.</p><p><strong>Methods: </strong>In accordance with PRISMA guidelines, five databases were queried for articles reporting awake microsurgical management of brain aneurysms. Aggregate study results were combined using random-effects meta-analyses. Publication bias was evaluated through funnel plot analysis and Egger's regression test.</p><p><strong>Results: </strong>Out of 847 articles, 11 records satisfied the inclusion criteria. Seventy-five patients (68% female) with 75 brain aneurysms (68% unruptured) were analyzed. Clipping was the predominant technique (58%), followed by bypass (17%). Monitored anesthesia care was the principal anesthesia protocol (60%). The incidence of anesthesia-related complications was 1% [95%CI, 0.00-0.05, I² = 19%], and the conversion rate from an awake-induced anesthesia protocol to general anesthesia was 1% [95%CI, 0.00-0.05, I² = 0%]. No permanent anesthesia-related morbidity and mortality was reported. Complete aneurysm repair, occlusion and bypass patency rate was 100% [95%CI, 0.96-1.00, I² = 0%]. The transient postoperative symptomatic event rate was 34% [95%CI, 0.06-0.81, I² = 77%]. The overall morbidity rate was 4% [95%CI, 0.00-0.09, I² = 0%], and the overall mortality rate was 0% [95%CI, 0.00-0.03, I² = 0%].</p><p><strong>Conclusion: </strong>Awake microsurgery of brain aneurysms is feasible, yet current evidence stems from observational studies. This procedure can reduce surgical morbidity by providing accurate and real-time neurological monitoring during aneurysm repair. While this technique appears to be tolerated, higher level evidence is needed to evaluate judiciously its safety and preference over existing practices for intraoperative neurological monitoring.</p>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and comparative analysis of endovascular and microsurgical management of giant ruptured fusiform mca aneurysms with illustrative cases.","authors":"Brandon Edelbach, Ha Yeon Lee, Miguel Angel Lopez-Gonzalez","doi":"10.1016/j.neuchi.2024.101601","DOIUrl":"https://doi.org/10.1016/j.neuchi.2024.101601","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in neurosurgical techniques and technology, the management of ruptured giant fusiform MCA aneurysms remains challenging. In the literature, microsurgical intervention is the most commonly described approach. However, recent advancements in endovascular techniques have expanded therapeutic options and as a result there is no consensus on the optimal management of these aneurysms.</p><p><strong>Methods: </strong>A literature search was performed through the PubMed, Google Scholar, and Embase databases, for surgical and endovascular management of ruptured giant fusiform MCA aneurysms. Inclusion criteria included: fusiform morphology, hemorrhage, major diameter greater than 2.5 cm and located along the MCA.</p><p><strong>Results: </strong>Literature review yielded 21 studies published from 1981 to 2023 and a total of 32 patients ages 33.40 ± 18.28. The male to female ratio was 1.9:1. The average Hunt and Hess score upon presentation in the total population was 2.78 ± 1.48, and the average pre-operative mRS of the total population was 2.75 ± 1.83. The average major diameter was 3.80 ± 1.85 cm. Average follow-up was 8.9 ± 9.74 months. There was no statistical difference in age (p = 0.5609), pre-operative mRS (p = 0.2355), Hunt and Hess scale (p = 0.183), aneurysm major diameter (p = 0.594) or follow-up (0.8922) between the two modalities. There was no significant difference in clinical outcome between microsurgical and endovascular intervention, nor was there a significant difference when stratified according to sex, major diameter, or location along the MCA. Two case examples are presented after management with cerebral revascularization.</p><p><strong>Conclusion: </strong>Our analysis underscores the absence of statistical differences in clinical outcomes between microsurgical and endovascular strategies for ruptured giant fusiform MCA aneurysms, which highlights the need for complex surgical revascularization as represented on the illustrative cases where no endovascular option was available.</p>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompressive craniectomy versus best medical treatment alone in patients with severe deep intracerebral hemorrhage: is severe disability always preferable to death?","authors":"Daniel P O Kaiser","doi":"10.1016/j.neuchi.2024.101598","DOIUrl":"https://doi.org/10.1016/j.neuchi.2024.101598","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous and Open Anterolateral Cordotomy for Intractable Cancer Pain: a Technical Note.","authors":"Yann Seznec, Mathilde Pachcinski, David Charier, Christelle Créac'h, Benjamin Buhot, Sylvain Grange, François Vassal","doi":"10.1016/j.neuchi.2024.101602","DOIUrl":"https://doi.org/10.1016/j.neuchi.2024.101602","url":null,"abstract":"<p><strong>Introduction: </strong>Anterolateral cordotomy (AL-C) is a long-established treatment for alleviating intractable cancer pain. However, AL-C has progressively fallen into desuetude, leading to the risk of a definitive loss of expertise within neurosurgical teams. Our objective was therefore to provide an update on percutaneous and open AL-C, with special emphasis on contemporary operative technique.</p><p><strong>Material and methods: </strong>Patient selection, indications, outcomes and up-to-date operative technique are reviewed through illustrative cases, including intraoperative photographs and video.</p><p><strong>Results: </strong>Main indications are represented by unilateral, nociceptive pain refractory to best pharmacological treatment in patients with limited life expectancy. Percutaneous AL-C is performed under cooperative sedation at C1-C2 level. CT myelography guidance and intraoperative electrophysiology allow accurate targeting of the spinothalamic tract (STT). Thermocoagulation is performed at 80 °C for 60 seconds during a Mingazzini maneuver, in order to promptly detect the potential onset of a motor weakness. Open AL-C is performed under general anesthesia at T2-T3 level. The dentate ligament is suspended to gently rotate the spinal cord and expose the anterolateral column. Section of the STT is made with a micro scalpel blade at a depth of 4-5 mm, from the dentate ligament to the emergence of ventral rootlets. Success rate after AL-C is high and allows a marked reduction in antalgic drugs intake. Main limitations include failure in achieving long-standing pain relief and the new occurrence of spontaneous, mirror pain.</p><p><strong>Conclusion: </strong>AL-C is a safe and effective option for the management of opioid-resistant cancer pain, which should be part of the neurosurgeon's armamentarium.</p>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working towards understanding the natural history and treatment response of noncanonical IDH mutant astrocytomas","authors":"","doi":"10.1016/j.neuchi.2024.101599","DOIUrl":"10.1016/j.neuchi.2024.101599","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosurgical applications of the exoscope: from in vitro studies to real-life surgical use in selective dorsal rhizotomy","authors":"","doi":"10.1016/j.neuchi.2024.101586","DOIUrl":"10.1016/j.neuchi.2024.101586","url":null,"abstract":"<div><h3>Background</h3><p>The microscope has been the gold standard in neurosurgical practice due to its ability to magnify anatomical structures. However, it has limitations, including restricted visual fields and ergonomic challenges that can lead to surgeon fatigue and musculoskeletal issues. The exoscope is an emerging technology that may address these limitations by offering comparable magnification with improved ergonomics.</p></div><div><h3>Methods</h3><p>This study compares the traditional microscope (KINEVO 900) with a 3D digital exoscope (Aeos Digital Microscope) in visual field width, image sharpness, and ergonomic impact. Visual field assessments were conducted using millimeter paper at a fixed distance, while image sharpness was evaluated using graph paper with pins at different depths. Ergonomic evaluation involved simulating surgical positions using a spine anatomical model. The practical applicability was tested during Selective Dorsal Rhizotomy (SDR) procedures, comparing the surgeon's experience with both devices over 20 consecutive cases.</p></div><div><h3>Results</h3><p>The exoscope provided a larger visual field (81.18 cm²) compared to the microscope's (54.10 cm²). Image sharpness was similar for both devices across various depths and zoom levels. Ergonomically, the exoscope allowed the surgeon to maintain a neutral posture while visualizing extreme angles, unlike the microscope, which required significant upper body movement. In SDR procedures, the exoscope improved surgeon comfort and interaction with the operating team, despite an initial learning curve.</p></div><div><h3>Conclusions</h3><p>The exoscope presents notable advantages in terms of visual field and ergonomics. The exoscope’s ability to facilitate better posture and team communication without compromising image quality makes it an addition to neurosurgical practice, as in SDR.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trial selection criteria should not be used for clinical decisions and recommendations: the thrombectomy trials example","authors":"","doi":"10.1016/j.neuchi.2024.101587","DOIUrl":"10.1016/j.neuchi.2024.101587","url":null,"abstract":"<div><h3>Background</h3><p>Despite multiple calls for more inclusive studies, most clinical trial eligibility criteria remain too restrictive. Thrombectomy trials have been no exception.</p></div><div><h3>Methods</h3><p>We review the landmark trials that have shown the benefits of thrombectomy, their eligibility criteria, and consequences on clinical practice. We discuss the rationale behind various reasons for exclusions. We also examine the logical problem involved in using eligibility criteria as indications for treatment.</p></div><div><h3>Results</h3><p>Most thrombectomy trials have been too restrictive. This has been shown by a plethora of follow-up studies that have refuted most of the previously recommended trial eligibility restrictions. Meanwhile, the effect of clinical recommendations based on restrictive eligibility criteria is that treatment has been denied to the majority of patients who could have benefitted. Trial eligibility criteria cannot be used to make clinical decisions or recommendations unless, like any other medical diagnosis, they have been shown capable of reliably differentiating patients into those that will, and those that will not benefit from treatment. This goal can only be achieved with all-inclusive pragmatic trials.</p></div><div><h3>Conclusion</h3><p>Restrictive eligibility criteria render clinical trials incapable of guiding medical decisions or recommendations.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0028377024000584/pdfft?md5=9e94a06c29b0faf5a03afb57292824e3&pid=1-s2.0-S0028377024000584-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142228760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric peri-insular hemispherotomy and functional hemispherectomy for severe medically refractory epilepsy: comparison of two techniques","authors":"","doi":"10.1016/j.neuchi.2024.101594","DOIUrl":"10.1016/j.neuchi.2024.101594","url":null,"abstract":"<div><h3>Purpose</h3><div>Since it was first described in the 1970s, functional hemispherotomy has been an essential tool in treating disabling, medically refractory epilepsy resulting from diffuse unilateral hemispheric disease. We report our experience with 23 patients who underwent hemispherotomy, both using the functional hemispherotomy (FH) as well as a modified peri-insular hemispherotomy (PIH) technique. We present the surgical technique for the latter, review outcomes following disconnection surgery and discuss the differences between the techniques when it comes to complications and postoperative results.</div></div><div><h3>Methods</h3><div>A retrospective study of 23 patients with refractory seizures who underwent cerebral hemispherectomy. A thorough analysis of the clinical, imaging, surgical features and postoperative results was performed. We also present the surgical technique for a modified PIH technique.</div></div><div><h3>Results</h3><div>Between 2000 and 2020, 23 pediatric patients with refractory seizures underwent hemispherotomy (12 FHs, 11 modified PIHs). 91.3% of patients were seizure free at 6 months, 87% at 1 year, and 78.3% at last follow-up. None of the 23 patients presented Engel IV outcome. FH was found to have statistically longer surgical duration (5 ± 1.5 vs. 3.83 ± 0.5 h; p = &lt;0.001). Neurocognition was improved in two thirds of the patients (66.9%). Our study also shows improvement of motor activity in the majority of the patients, regardless of the pathology and surgical technique. In the present report we modified the Cook et al. technique by implementing an amygdalohippocampectomy with resection of the tail of the hippocampus posteriorly and medially, to achieve temporo-occipital disconnection, instead of a complete temporal lobectomy.</div></div><div><h3>Conclusion</h3><div>When patients are wisely selected, the hemispherectomy procedure should be considered as a most attractive and curative treatment for children with refractory seizures, not only giving the patient a high chance of seizure freedom but also providing an improvement in motor and cognitive skills. In our particular case and based on the present study, the modified PIH proves to be a highly effective technique. It not only has a shorter surgical time but also a very low complication rate.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitivity of the Unruptured Intracranial Aneurysm Treatment Score (UIATS) to detect aneurysms at high-risk of rupture: Retrospective analysis in a cohort of 346 patients with a proven subarachnoid hemorrhage","authors":"","doi":"10.1016/j.neuchi.2024.101591","DOIUrl":"10.1016/j.neuchi.2024.101591","url":null,"abstract":"<div><h3>Introduction</h3><p>The aim of this study was to assess the capability of the Unruptured Intracranial Aneurysm Treatment Score (UIATS) to discriminate unruptured intracranial aneurysms (UIAs) at high risk for subarachnoid hemorrhage (aSAH).</p></div><div><h3>Material and method</h3><p>During the period from January 2012 to December 2022, we included all consecutive adult patients admitted to our institution for an aSAH caused by the rupture of a saccular IA. The patient-related, aneurysm-related and treatment-related risk factors considered by UIATS were retrieved from medical records. After UIATS calculation for all ruptured IAs in the cohort, patients were categorized as “true positives (TP)” if UIATS would have (appropriately) oriented the management toward treatment, whereas patients for whom the UIATS would have (inappropriately) recommended observation were categorized as “false negatives (FN)”. Patients for whom UIATS was inconclusive were categorized as “undetermined (UND)”. Sensitivity of the UIATS (Se _UIATS) was calculated by using the following formula: TP/(TP + FN).</p></div><div><h3>Results</h3><p>A total of 346 patients (253 women, 73%; mean age = 56 ± 1.45 years) were incorporated into the final analysis. There were 140 T P (40%), 79 F N (23%) and 127 UND (37%), leading to a Se _UIATS of 63.9% (CI 58.3–69.5). Cumulatively, the UIATS failed to provide an appropriate recommendation in 60% of the entire cohort.</p></div><div><h3>Conclusion</h3><p>By retrospectively applying the UIATS in a cohort of ruptured IAs, our study emphasizes how vulnerable the UIATS can be. Even if the UIATS suggests conservative management, clinicians should inform patients that there is still a small risk of rupture.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0028377024000626/pdfft?md5=83e625ebd215c4b7e7b6a4208d8a0098&pid=1-s2.0-S0028377024000626-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How science can harm: The true history of thrombectomy trials","authors":"","doi":"10.1016/j.neuchi.2024.101588","DOIUrl":"10.1016/j.neuchi.2024.101588","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142158151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}