Neurochirurgie最新文献

{"title":"The challenging task of establishing consensual and practical guidelines for the surgical management of traumatic brain injury","authors":"Romain Manet , Jean François Payen , Arnaud Dagain","doi":"10.1016/j.neuchi.2025.101693","DOIUrl":"10.1016/j.neuchi.2025.101693","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101693"},"PeriodicalIF":1.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250736","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 , Charlotte Kelway , Aurore Sellier , Arnaud Dagain , 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":"2025-06-04","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":"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":"2025-06-04","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":"Lumbar or ventricular external drainage for cerebrospinal fluid drainage in traumatic brain injury? Timing first, technique second","authors":"Jean-Denis Moyer ,&nbsp;Thomas Gaberel ,&nbsp;Jonathan Charbit","doi":"10.1016/j.neuchi.2025.101689","DOIUrl":"10.1016/j.neuchi.2025.101689","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101689"},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203946","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":"Vestibular Schwannoma in Pregnancy: When Case Reports Become Clinical Compass","authors":"Vangipuram Shankar ,&nbsp;Siddhartha Ghosh ,&nbsp;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 ,&nbsp;Yohan Gallois ,&nbsp;Olivier Deguine ,&nbsp;Jacqueline Butterworth ,&nbsp;Jean-François Sabatier ,&nbsp;Oumar Sacko ,&nbsp;Yassine Beltaïfa ,&nbsp;Igor Latorzeff ,&nbsp;Jean-Albert Lotterie ,&nbsp;Sergio Boetto ,&nbsp;Jean-Christophe Sol ,&nbsp;Mathieu Marx","doi":"10.1016/j.neuchi.2025.101688","DOIUrl":"10.1016/j.neuchi.2025.101688","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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%–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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 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 ,&nbsp;Hugues de Courson ,&nbsp;Cyrille Capel ,&nbsp;Christophe Joubert ,&nbsp;Nathalie Chivoret ,&nbsp;Matthieu Faillot ,&nbsp;Baptiste Balanca ,&nbsp;Alexandre Bani-Sadr ,&nbsp;Mickael Cardinale ,&nbsp;Andres Coca ,&nbsp;François Cotton ,&nbsp;Pierre Esnault ,&nbsp;Clémentine Gallet ,&nbsp;Sébastien Gazzola ,&nbsp;Stéphane Goutagny ,&nbsp;Vincent Jecko ,&nbsp;Marion le Marechal ,&nbsp;Jacques Luauté ,&nbsp;Guillaume Mortamet ,&nbsp;Jean-Denis Moyer ,&nbsp;Arnaud Dagain","doi":"10.1016/j.neuchi.2025.101686","DOIUrl":"10.1016/j.neuchi.2025.101686","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a multidisciplinary French framework addressing neurosurgical management in the initial phase of traumatic brain injury (TBI) in adults and children.</div></div><div><h3>Design</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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,</div></div><div><h3>Conclusion</h3><div>There was a strong consensus among the experts on important interdisciplinary recommendations to improve the neurosurgical management of patients with TBI.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 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}