Neurochirurgie最新文献

{"title":"Ossification of the posterior longitudinal ligament (OPLL) in the Wallis and Futuna population: A hidden and underestimated enemy","authors":"L. Mongardi , M.C. Hesler , J.R. Vignes , S. Fuentes , P. Roblot","doi":"10.1016/j.neuchi.2025.101712","DOIUrl":"10.1016/j.neuchi.2025.101712","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101712"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812657","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":"Trends and development of enhanced recovery after surgery programs in cranial and spinal neurosurgery","authors":"Shichao Liu ,&nbsp;Jingyu Zhou","doi":"10.1016/j.neuchi.2025.101704","DOIUrl":"10.1016/j.neuchi.2025.101704","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) has garnered considerable attention and demonstrated substantial clinical benefits across multiple surgical specialties. However, its integration into cranial and spinal neurosurgery remains nascent and fraught with challenges. This study aims to systematically assess the current research landscape, identify emerging hotspots, and forecast future directions for ERAS in neurosurgery through comprehensive bibliometric analysis. These findings seek to inform clinical practice and guide future investigations.</div></div><div><h3>Methods</h3><div>Relevant publications indexed in the Web of Science Core Collection from January 1, 1999, to December 1, 2024, were analyzed. Bibliometric tools, primarily CiteSpace, were utilized to evaluate annual publication trends, author and institutional contributions, journal dissemination, keyword co-occurrence, and citation network structures.</div></div><div><h3>Results</h3><div>A total of 273 articles were included. The analysis reveals that ERAS implementation in spinal neurosurgery has reached a relatively advanced stage, while its application in cranial procedures remains underdeveloped, yet promising. The United States and China are leading in publication output, although China’s global influence is comparatively limited. Key research themes include hospital length of stay, cost-effectiveness, postoperative complication management, and multimodal analgesia. Anticipated trends suggest a growing focus on personalized ERAS protocols tailored to specific neurosurgical conditions and enhanced patient engagement in recovery processes.</div></div><div><h3>Conclusion</h3><div>Through bibliometric and visualization techniques, this study offers a comprehensive overview of ERAS-related neurosurgical research, delineating its evolution and thematic shifts. The insights derived herein may facilitate strategic planning, foster interdisciplinary collaboration, and promote evidence-based advancements in perioperative neurosurgical care.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101704"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721479","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":"Identifying early postoperative acute symptomatic seizure risk after burr hole drainage for chronic subdural hematoma","authors":"Dang-Khoi Tran ,&nbsp;Minh-Anh Nguyen ,&nbsp;Thanh-Tinh Truong ,&nbsp;Hong-Hai Do ,&nbsp;Quoc-Tuan Tran ,&nbsp;Viet-Thang Le ,&nbsp;Yuang-Seng Tsuei","doi":"10.1016/j.neuchi.2025.101705","DOIUrl":"10.1016/j.neuchi.2025.101705","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute symptomatic seizures (ASz) are a recognized postoperative complication following burr hole drainage for chronic subdural hematoma (CSDH); however, the risk factors remain poorly understood. This study aimed to identify clinical and radiological predictors of early postoperative seizures in CSDH patients, with the goal of enhancing risk stratification and informing individualized management approaches.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 266 patients who underwent burr hole drainage for CSDH between 2022 and 2024. Data on demographics, comorbidities, hematoma characteristics, and postoperative complications, including seizures, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of early postoperative ASz.</div></div><div><h3>Results</h3><div>ASz occurred in 10 patients (3.8%), with 4 experiencing isolated seizures and 6 having status epilepticus. Univariable analysis identified prior stroke (OR = 9.5, 95% CI [2.2–42.0], p = 0.011), diabetes mellitus (OR = 4.2, 95% CI [1.2–15.2], p = 0.032), and separated hematoma type (OR = 5.4, 95% CI [1.5–19.5], p = 0.015) as significant predictors of ASz. However, in multivariate analysis, prior stroke remained a significant independent predictor (OR = 6.4, 95% CI [1.3–30.9], p = 0.021), while diabetes mellitus and separated hematoma type were no longer statistically significant.</div></div><div><h3>Conclusion</h3><div>Prior stroke is the most consistent predictor of early postoperative seizures following burr hole drainage for CSDH. While diabetes mellitus and separated hematoma type showed initial associations, these did not persist in adjusted analysis.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101705"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704124","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":"Robot-assisted MIS surgery in a pregnant woman with lumbar traumatic fracture: A technical note","authors":"J. Bride ,&nbsp;R. Assaker ,&nbsp;B. Ghannam ,&nbsp;P. Haettel ,&nbsp;B. Bouyer ,&nbsp;H.A. Leroy","doi":"10.1016/j.neuchi.2025.101702","DOIUrl":"10.1016/j.neuchi.2025.101702","url":null,"abstract":"<div><div>The occurrence of a vertebral fracture in a pregnant woman presents unique challenges in terms of diagnosis and therapeutic. Managing such cases requires multidisciplinary collaboration to minimize x-rays and preserve fetus development while ensuring efficient treatment of the fracture in the mother.</div><div>We report the case of an 18 y/o primiparous woman at 20 weeks of gestation who suffered a polytrauma without neurological deficit. Full body CT-scan reported an A2 M1 <em>(AO Spine Classification)</em> fracture of L3 and an A1 fracture of L2.</div><div>In this situation, both patient positioning and irradiation were challenging. The surgeons, anesthesiologists and physicists discussed the pros and cons between conservative treatment and various types of surgery (open technique, percutaneous). A left lateral decubitus robot-assisted percutaneous L2-L4 osteosynthesis was performed. We depict the procedure as well as the patient outcome and follow-up.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101702"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656873","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":"Diffuse axonal injury unveiling white matter tracts anatomy","authors":"Antoine Do tran ,&nbsp;Charlotte Kelway ,&nbsp;Aurore Sellier ,&nbsp;Arnaud Dagain ,&nbsp;Nathan Beucler","doi":"10.1016/j.neuchi.2025.101690","DOIUrl":"10.1016/j.neuchi.2025.101690","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101690"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203945","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 prognostic models: The example of the PHASES score for unruptured intracranial aneurysms","authors":"François Zhu ,&nbsp;Tim E. Darsaut ,&nbsp;Jean Raymond","doi":"10.1016/j.neuchi.2025.101666","DOIUrl":"10.1016/j.neuchi.2025.101666","url":null,"abstract":"<div><h3>Background</h3><div>Prognostic studies may inform individuals about the future course of their disease and help clinical decision making, but problems abound.</div></div><div><h3>Methods</h3><div>We summarize a study on the natural history of unruptured intracranial aneurysms (UIAs) and review the various steps in the construction of prognostic models. We emphasize the fundamental inductive problems of prognostic studies that attempt to use the backward road from the extension of patients suffering an event to create a new intensional definition of classes of patients at risk.</div></div><div><h3>Results</h3><div>The first step in a prognostic model is to identify candidate baseline variables to be entered into the model, according to background knowledge, previous studies, and statistical associations with the event of interest. This is a multivariate task. The modeler already knows the outcomes the model is supposed to ‘predict’, so that multiple models are tested against the data until a satisfactory fit is obtained. The variables used to construct the model should not be added in an <em>ad hoc</em> fashion to fit heterogeneous studies. They should be selected in such a fashion as to be exportable outside the study to new patients. An infinite number of models can fit the same data. Thus, the most important step is to validate the prognostic value of the model in patients that were not used to construct the model. In the case of UIAs, this has never been done.</div></div><div><h3>Conclusion</h3><div>Prognostic studies present multiple problems. Unvalidated models should not be used in clinical practice.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101666"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776447","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":"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":"2025-07-01","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":"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":"2025-07-01","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":"Surgical outcomes of ventriculoperitoneal shunts in the Gaza Strip: Insights from a conflict zone and low-resource setting","authors":"Baker Abojarad ,&nbsp;Belal Aldabbour","doi":"10.1016/j.neuchi.2025.101692","DOIUrl":"10.1016/j.neuchi.2025.101692","url":null,"abstract":"<div><h3>Background</h3><div>The Gaza Strip is a low-income, chronically unstable region. This study evaluates the outcomes of first VP shunt placements at the area’s largest tertiary hospital.</div></div><div><h3>Methods</h3><div>A retrospective study conducted at Shifa Medical Complex in the Gaza Strip examined VP shunts inserted between January 2020 and July 2022. The primary outcome was the shunt failure rates in the first year, while secondary outcomes included the causes of failure and surgical complications. The Chi-square test was used to assess the relationship between risk factors and failure rates. Univariate logistic regression analyzed the link between the duration of post-operative antibiotics and shunt failure rates.</div></div><div><h3>Results</h3><div>A total of 103 patients were included, with a median age of 11 months. Congenital hydrocephalus accounted for 60.2% of the etiologies. Failure rates were 7.8%, 19.4%, and 26.2% at one, six, and twelve months, respectively. Obstruction and infection were the commonest causes of initial (62.9% and 25.9%) and overall (46.2% and 36.5%) shunt failures. Failure risk increased with elective surgeries, surgeries performed by residents, congenital hydrocephalus, and in the 12-month or younger age group (p &lt; 0.001, p = 0.035, p = 0.02, p &lt; 0.001). <em>Staphylococcus aureus</em> and <em>Staphylococcus epidermidis</em> were the most commonly isolated bacteria. No significant association was found between the duration of postoperative IV antibiotics and the one-year shunt failure rate.</div></div><div><h3>Conclusion</h3><div>The outcomes of VP shunt surgery at Gaza’s largest tertiary center from 2020 to 2022 aligned with global trends. Prolonged IV antibiotics did not lower revision or complication rates.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101692"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230305","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":"2025-07-01","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}