Neurochirurgie最新文献

{"title":"Vestibular Schwannoma in Pregnancy: When Case Reports Become Clinical Compass","authors":"Vangipuram Shankar , Siddhartha Ghosh , Vangipuram Harshil Sai","doi":"10.1016/j.neuchi.2025.101687","DOIUrl":"10.1016/j.neuchi.2025.101687","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101687"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139353","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":"Changes in patient-perceived balance and vestibular function after Gamma-knife stereotactic radiosurgery for vestibular schwannoma: 12-month outcomes in a single-centre pilot study.","authors":"Nadia El Fassi, Yohan Gallois, Olivier Deguine, Jacqueline Butterworth, Jean-François Sabatier, Oumar Sacko, Yassine Beltaïfa, Igor Latorzeff, Jean-Albert Lotterie, Sergio Boetto, Jean-Christophe Sol, Mathieu Marx","doi":"10.1016/j.neuchi.2025.101688","DOIUrl":"https://doi.org/10.1016/j.neuchi.2025.101688","url":null,"abstract":"<p><strong>Background: </strong>Hearing outcomes are well-documented for patients with vestibular schwannoma (VS) treated with Gamma Knife stereotactic radiosurgery (GK-SRS). However, how GK-SRS affects patient-perceived balance and vestibular function remains unclear. This study therefore evaluated changes in these parameters one-year post-treatment.</p><p><strong>Methods: </strong>A prospective, observational, before-and-after, pilot study was conducted on patients with unilateral VS treated with GK-SRS between June 2021 and July 2022. Balance-related handicap was assessed using the Dizziness Handicap Inventory (DHI). Objective vestibular function was evaluated through caloric tests and video head impulse tests (VHIT). Data were compared before treatment (0 M) and 12 months after treatment (12 M).</p><p><strong>Results: </strong>Thirty-eight patients were included (median age 69 years, 52.6% male). Median total DHI scores significantly deteriorated (14 [5; 24] at 0 M vs 18[8;40] at 12 M, p = 0.027), with an increase in cases classed with moderate handicap (12% to 29%, p = 0.025). We found a significant deterioration in median caloric deficit at low frequency (49 [29; 78]% vs 72 [40; 87]%; p = 0.012) and a significant deterioration in median vestibulo-ocular reflex (VOR) gain of the anterior semicircular canal (SSC) at high frequency (0.94[0.86;1.04] vs 0.9[0.72;0.98]; p = 0.012). Change in DHI score was only found weakly inversely correlated with change in VOR gain for the affected-side posterior SSC (r=-0.38; p = 0.04).</p><p><strong>Conclusion: </strong>GK-SRS for VS can result in modest deterioration in subjective balance after one year. Changes in DHI were not strongly correlated with objective vestibular function deficits thus suggesting other factors can contribute to dizziness and balance outcomes.</p>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":" ","pages":"101688"},"PeriodicalIF":1.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144254","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 management of the acute phase of adult and pediatric traumatic brain injury.","authors":"Romain Manet, Hugues de Courson, Cyrille Capel, Christophe Joubert, Nathalie Chivoret, Matthieu Faillot, Baptiste Balanca, Alexandre Bani-Sadr, Mickael Cardinale, Andres Coca, François Cotton, Pierre Esnault, Clémentine Gallet, Sébastien Gazzola, Stéphane Goutagny, Vincent Jecko, Marion le Marechal, Jacques Luauté, Guillaume Mortamet, Jean-Denis Moyer, Hervé Quintard, Alice Rolland, Édouard Samarut, Stéphanie Sigaut, Eric Verin, Mathieu Vinchon, Philippe Decq, Jean-François Payen, Arnaud Dagain","doi":"10.1016/j.neuchi.2025.101686","DOIUrl":"https://doi.org/10.1016/j.neuchi.2025.101686","url":null,"abstract":"<p><strong>Objective: </strong>To develop a multidisciplinary French framework addressing neurosurgical management in the initial phase of traumatic brain injury (TBI) in adults and children.</p><p><strong>Design: </strong>A panel of 29 experts was formed at the request of the French Society of Neurosurgery (SFNC), with the participation of the French Society of Pediatric Neurosurgery (SFNCP), French Society of Private-Practice Neurosurgeons (SFNCL), French-Speaking Neurocritical Care and Neuro-Anesthesiology Society (ANARLF), French Society of Anesthesia, Critical Care and Perioperative Medicine (SFAR), French-Speaking Pediatric Emergency and Intensive Care Group (GFRUP), French Society of Neuroradiology (SFNR), French-Speaking Infectious Diseases Society (SPILF), and the French Society of Physical Medicine and Rehabilitation (SOFMER).</p><p><strong>Methods: </strong>Questions were formulated using the PICO (Patients, Intervention, Comparison, Outcome) format, grouped into 7 categories: 1. Factors of poor prognosis, 2. Extradural hematoma, 3. Acute subdural hematoma, 4. Skull-base fracture and dural tear, 5. Penetrating traumatic brain injury, 6. Post-traumatic cerebrospinal fluid disorder, and 7. Pediatric specificities.</p><p><strong>Results: </strong>Synthesis by the experts and application of the GRADE® method resulted in the formulation of 45 recommendations. Strong consensus was reached for all recommendations at the first round of rating, CONCLUSION: There was a strong consensus among the experts on important interdisciplinary recommendations to improve the neurosurgical management of patients with TBI.</p>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":" ","pages":"101686"},"PeriodicalIF":1.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144287","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":"Understanding what ‘what we do’ does","authors":"Jean Raymond ,&nbsp;George Nilton Nunes Mendes ,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2025.101685","DOIUrl":"10.1016/j.neuchi.2025.101685","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101685"},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090436","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":"Understanding the meaning of care trials and why they are essential to good practice: An example from ISAT-2 on ruptured aneurysms","authors":"Jean Raymond ,&nbsp;George Nilton Nunes Mendes ,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2025.101684","DOIUrl":"10.1016/j.neuchi.2025.101684","url":null,"abstract":"<div><h3>Background</h3><div>The research-care separation encourages clinicians to experiment without methods within the care context and trialists to design studies that may not properly inform practice. Care trials integrated into practice may solve these problems.</div></div><div><h3>Methods</h3><div>We first discuss clinical decision-making for SAH patients prior to the ISAT trial which compared surgery with coiling, and how the ISAT results changed practices. We then review the ISAT-2 care trial and its impact on practice in the presence of clinical uncertainty.</div></div><div><h3>Results</h3><div>Historically, ruptured aneurysms were treated with surgical clipping, with endovascular treatment limited to patients judged difficult to clip. ISAT was a turning point when it showed that many patients routinely treated with surgery would have better outcomes with coiling. With the proliferation of new endovascular devices, practices evolved and more patients could be treated endovascularly, but uncertainty regarding best management remained for numerous ruptured aneurysm patients that were not part of ISAT. Practicing under uncertainty, outside of a trial, is like performing research without methods within care. Without a scientific method of assessment, the notion of good surgical care is impossible to define, so ISAT-2 was designed. After 10 years, ISAT-2 remained inconclusive, but because the trial balanced risks for each patient, practicing within ISAT-2 provided the opportunity to realize that trial methods optimized care in real-time, long before conclusive results could be shown.</div></div><div><h3>Conclusion</h3><div>Care trials are integral to a good clinical practice, whether they provide final results or not. The research-care separation should be revised to encourage care research.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101684"},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090367","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":"Understanding heterogeneity of pragmatic trial results and subgroup analyses: The FIAT example","authors":"Jean Raymond ,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2025.101683","DOIUrl":"10.1016/j.neuchi.2025.101683","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Pragmatic trial results are intrinsically heterogeneous and the ‘average treatment effect’, on which the paradigmatic verdict of explanatory trials is based may not suffice to translate trial results into clinically meaningful conclusions applicable in practice. Examining various subgroups is problematic because they are at risk of both false negative and false positive results.</div></div><div><h3>Methods</h3><div>We summarize FIAT, a pragmatic care trial on flow diversion where multiple subgroups were examined. The notions of average treatment effect and interaction tests are reviewed to better understand their application in pragmatic trials.</div></div><div><h3>Results</h3><div>The trial showed flow diversion to be superior to standard treatments, but the results do not apply to all intracranial aneurysms. The notion of a ‘true average treatment effect’ can hardly apply when there are multiple comparator interventions and clinical heterogeneity. Various subgroups were examined in spite of negative interaction tests, to help interpret the trial results. Subgroup findings can be credible so long as they are not data-dependent ‘fishing expeditions’. Meaningful clinical subgroups that have been pre-specified and integrated into the randomization scheme and power calculation provide the most credible conclusions.</div></div><div><h3>Conclusion</h3><div>Non-prespecified data-dependent subgroup analyses are at high risk of being incorrect and should not be used to make clinical decisions in practice. A critical assessment of pre-specified subgroup analyses can nonetheless help interpret heterogeneous pragmatic trial results.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101683"},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090453","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":"Impact of dural closure on postoperative complications in cerebellar metastasis surgery: A retrospective cohort study","authors":"Frédérick Rault ,&nbsp;Mathilde Ducloie ,&nbsp;Mathieu Lozouet ,&nbsp;Elise Lopvet ,&nbsp;Anaïs R. Briant ,&nbsp;Evelyne Emery ,&nbsp;Thomas Gaberel","doi":"10.1016/j.neuchi.2025.101682","DOIUrl":"10.1016/j.neuchi.2025.101682","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebellar metastases represent the second most common location for brain metastases. Surgery is a key therapeutic option, but the rate of postoperative complications remains high. The impact of dural closure techniques on these complications has not yet been specifically evaluated.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center study including all patients who underwent surgical resection of cerebellar metastasis between 2012 and 2021 at Caen University Hospital. The primary outcome was the occurrence of a postoperative complication withing 30 days (death, reoperation, or meningitis). We analyzed surgical data, particularly focusing on the type of dural closure: watertight (with sutured closure ± suturable duraplasty) versus non-watertight (non-sealing suture ± non-suturable patch).</div></div><div><h3>Results</h3><div>A total of 125 surgeries were analyzed. Postoperative complications occurred in 25% of cases, including hydrocephalus (10%), meningitis (9%), and cerebrospinal fluid leaks (8%). Watertight dural closure was significantly associated with a higher rate of complications (<em>p</em> = 0.039). Median overall survival was 10 months and complications were associated with shorter survival (<em>p</em> = 0.011).</div></div><div><h3>Conclusion</h3><div>Watertight dural closure appears to increase the risk of postoperative complications in cerebellar metastasis surgery. These findings question the relevance of systematic watertight dural suturing in the posterior fossa.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101682"},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090435","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":"Iatrogenic pseudoaneurysm after surgery: Stay away from the evil. Case report and review of the literature","authors":"Anis Mansourt,&nbsp;Adrien May,&nbsp;Francesco Travaglini,&nbsp;Henry Dufour,&nbsp;Thomas Graillon,&nbsp;Kaissar Farah","doi":"10.1016/j.neuchi.2025.101680","DOIUrl":"10.1016/j.neuchi.2025.101680","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial pseudoaneurysms are rare and account for less than 2% of all intracranial aneurysms. They most frequently occur after head injury, but they also can be caused by iatrogenic arterial injury during neurosurgical or ENT procedures. No clear guidelines are established concerning the treatment and surveillance of such aneurysms.</div></div><div><h3>Methods</h3><div>In this article, we present 2 cases of iatrogenic pseudoaneurysms treated conservatively and we propose a review of literature of the management and outcome of intracranial iatrogenic pseudoaneurysms.</div></div><div><h3>Case report and results</h3><div>The first case is one during a transcranial approach and the second one during a transsphenoidal approach, that were both conservatively treated with a close follow-up and a spontaneous healing of the aneurysm.</div></div><div><h3>Conclusion</h3><div>Endovascular treatment or surgical clipping are 2 valid therapeutic options in iatrogenic pseudoaneurysms, which should be preferred when feasible with a reasonable risk. In contrast, in case of a small pseudoaneurysm, important risk and complex procedures, conservative treatment with a close follow-up appears to be a valuable alternative.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101680"},"PeriodicalIF":1.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144067949","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":"Robotic hydrocephalus surgery: A systematic review of the effectiveness in neurosurgical interventions","authors":"Paweł Łajczak ,&nbsp;Anna Łajczak ,&nbsp;Stanisław Buczkowski,&nbsp;Kamil Jóźwik,&nbsp;Przemysław Nowakowski","doi":"10.1016/j.neuchi.2025.101677","DOIUrl":"10.1016/j.neuchi.2025.101677","url":null,"abstract":"<div><h3>Background</h3><div>Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) deep within the brain, resulting in clinical symptoms, including disorientation, vision disturbances, headaches, cognitive and developmental impairment. Traditional non-navigated surgical treatment, with ventriculoperitoneal (VP) shunt and endoscopic third ventriculostomy (ETV), may lead to complications such as shunt obstruction and inaccurate catheter placement. Robotics-assisted (RA) surgery has potential to improve precision of procedures. The objective of this systematic review is to assess the clinical effectiveness, complications, and benefits of RA surgical interventions in the case of hydrocephalus.</div></div><div><h3>Methods</h3><div>PRISMA-guided literature search was done in databases including PubMed, Web of Science, Cochrane Reviews, Scopus, and Embase. Inclusion criteria encompassed English language, original, peer-reviewed journal articles in robotic-assisted surgical interventions in hydrocephalus. Patient demographics, robotic systems used, and results were extracted.</div></div><div><h3>Results</h3><div>In total, 12 of the articles discussed robotic-assisted interventions for hydrocephalus. The robotic systems used included ROSA, NaoTrac, Remebot, and more. The findings established that the robotic systems are accurate. Almost all the studies showed successful outcomes with minimum robot-related complications like minor bleeding or conversion to manual surgery.</div></div><div><h3>Conclusions</h3><div>The evidence supporting the use of robot-assisted surgery for hydrocephalus management remains very limited in the literature. There is currently insufficient evidence to suggest that it offers any significant additional benefits in terms of patient outcomes, safety, or cost-effectiveness compared to conventional neurosurgical methods. Moreover, given the high maintenance costs of robotic workstations and prolonged surgery times, well-designed prospective controlled trials are needed to evaluate robotic effectiveness, compared to navigation-based techniques.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101677"},"PeriodicalIF":1.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941149","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":"Endonasal endoscopic surgical approach for treating trigeminal schwannomas: A systematic review and meta-analysis","authors":"Filipe Virgilio Ribeiro ,&nbsp;Marcelo Porto Sousa ,&nbsp;Lucca B. Palavani ,&nbsp;Filipi Fim Andreão ,&nbsp;Ary Rodrigues Neto ,&nbsp;Maria Antônia Oliveira Machado Pereira ,&nbsp;Christian Ken Fukunaga ,&nbsp;Luis F. Fabrini Paleare ,&nbsp;Laura Mora Montecino ,&nbsp;Stefeson Gomes Cabral Júnior ,&nbsp;Leonardo O. Brenner ,&nbsp;Marcio Yuri Ferreira ,&nbsp;Herika Negri Brito","doi":"10.1016/j.neuchi.2025.101676","DOIUrl":"10.1016/j.neuchi.2025.101676","url":null,"abstract":"<div><h3>Introduction</h3><div>Trigeminal schwannomas (TSs) are the second most common type of intracranial schwannoma. Surgical approaches are chosen depending on the type of tumor extension. The middle fossa extradural approach, infratemporal extradural approach, transmaxillary approach, transmandibular approach, and transcervical approach have been used. However, these approaches are associated with a variety of complications including other cranial nerve dysfunction. Recently, with the wide application of endoscopic technology, the endoscopic endonasal approach (EEA) seems to be an alternative skull base surgical approach for skull base pathology.</div></div><div><h3>Objective</h3><div>The objective of the present study is to evaluate the safety and efficacy EEA approach for TSs.</div></div><div><h3>Methods</h3><div>We searched Medline, Embase, and Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95% confidence intervals (CI) under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥4 patients treated with the endoscopic endonasal approach for trigeminal schwannomas.</div></div><div><h3>Results</h3><div>Of the 2550 initially identified studies, 9 were selected, involving 195 patients, with a median follow-up of 36 months. The combined analysis showed a 29% (CI: 11%–49%) partial resection rate, while a pooled analysis for complete resection demonstrated an 84% rate (CI: 68%–99%). Preservation of cranial nerves reached a 99% rate (CI: 96%–100%) with a 100% preservation of facial function rate (CI: 97%–100%) and a 5% complications rate (CI: 0%–13%).</div></div><div><h3>Conclusion</h3><div>Based on these findings, our meta-analysis identified that the endonasal endoscopic approach for the treatment of trigeminal schwannomas presents a low rate of complications, favorable results regarding the preservation of facial function and cranial nerves, and, a high rate of effectiveness, demonstrated by the results of complete resection.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101676"},"PeriodicalIF":1.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941595","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}