Neurochirurgie最新文献

{"title":"Neurosurgical applications of the exoscope: from in vitro studies to real-life surgical use in selective dorsal rhizotomy","authors":"Arianna Barbotti ,&nbsp;Pierre-Aurélien Beuriat ,&nbsp;Anthony Toutikian ,&nbsp;Carmine Mottolese ,&nbsp;Matthieu Vinchon ,&nbsp;Alexandru Szathmari ,&nbsp;Federico Di Rocco","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":"70 6","pages":"Article 101586"},"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":"Jean Raymond ,&nbsp;William Boisseau ,&nbsp;Thanh N. Nguyen ,&nbsp;Tim E. Darsaut","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":"70 6","pages":"Article 101587"},"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":"Facundo Villamil ,&nbsp;Lucila Domecq Laplace ,&nbsp;Santiago E. Cicutti ,&nbsp;Yamila Slame ,&nbsp;Miguel Grijalba ,&nbsp;Guido Gromazdyn ,&nbsp;Marcelo Bartuluchi","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":"70 6","pages":"Article 101594"},"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":"Benjamin Buhot ,&nbsp;Yann Seznec ,&nbsp;Marie-Charlotte Tetard ,&nbsp;David Charier ,&nbsp;Jérome Morel ,&nbsp;Marina Sachet ,&nbsp;François Vassal","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":"70 6","pages":"Article 101591"},"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":"Jean Raymond,&nbsp;William Boisseau,&nbsp;Thanh N. Nguyen,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2024.101588","DOIUrl":"10.1016/j.neuchi.2024.101588","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101588"},"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}

{"title":"Understanding why restrictive trial eligibility criteria are inappropriate","authors":"Jean Raymond ,&nbsp;William Boisseau ,&nbsp;Thanh N. Nguyen ,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2024.101589","DOIUrl":"10.1016/j.neuchi.2024.101589","url":null,"abstract":"<div><h3>Background</h3><p>An important difference between explanatory and pragmatic clinical trials concerns eligibility criteria. Eligibility criteria are restrictive in explanatory trials, while pragmatic trials are more inclusive or even all-inclusive.</p></div><div><h3>Methods</h3><p>To better understand the diverging views regarding eligibility criteria, we examine the contrast between theoretical and clinical medicine, and 3 different research contexts: laboratory research, population studies and clinical trials. In each context we review the purpose for selecting study subjects or research material, as well as the type of inductive inference or generalization that is sought by such selection.</p></div><div><h3>Results</h3><p>In each context, selection concerns different things and serves different purposes: In the laboratory, selection concerns the homogenous research material that will help isolate a causal signal. In the epidemiological context selection concerns the (random) sampling method, designed to produce a representative sample of the population. In the clinical trial setting, selection concerns patients in need of care. Restrictive eligibility criteria become inappropriate in the care setting because the aim of the trial is not to represent a population nor to isolate a causal signal, but to find out which patients benefit from treatment.</p></div><div><h3>Conclusion</h3><p>The idea of selecting patients comes from methods that belong to theoretical medicine. In the care setting, most clinical trials should be pragmatic and as inclusive as possible.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101589"},"PeriodicalIF":1.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0028377024000602/pdfft?md5=e2015211be1486ca30f09bc6b272d734&pid=1-s2.0-S0028377024000602-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151925","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":"Prediction of intraoperative blood loss in pediatric posterior fossa tumors by neuroradiological evaluation: preliminary study","authors":"Takanari Okamoto ,&nbsp;Takumi Yamanaka ,&nbsp;Hayato Takeuchi ,&nbsp;Yoshinobu Takahashi ,&nbsp;Seisuke Tanigawa ,&nbsp;Takayuki Nakasho ,&nbsp;Satoshi Teramukai ,&nbsp;Naoya Hashimoto","doi":"10.1016/j.neuchi.2024.101592","DOIUrl":"10.1016/j.neuchi.2024.101592","url":null,"abstract":"<div><h3>Background</h3><p>Hemorrhage management is crucial for surgical resection of pediatric posterior-fossa tumors (PPFTs). Tumor volume and vascularity on preoperative magnetic resonance imaging (MRI) can help predict and control intraoperative blood loss (IBL). The present study aimed to assess the correlation between MRI features and IBL in PPFTs.</p></div><div><h3>Methods</h3><p>Eleven patients treated for PPFTs at our hospital using the transcerebellomedullary fissure approach were enrolled, including five (45.5%) males and six (54.5%) females, with a median age of 10 (range, 4–16) years. Nine patients with medulloblastoma, one with ependymoma, and one with atypical teratoid/rhabdoid tumor were included. Using susceptibility-weighted imaging-based intratumoral susceptibility signal (ITSS) grade as an index of tumor vascularity, we performed univariate analysis of the association of degree of vascularity (ITSS grade 0–2 vs. 3) and multivariate analysis of IBL.</p></div><div><h3>Results</h3><p>Univariate analysis showed that the high vascularity group (ITSS grade 3) had significantly larger tumor volume (<em>p</em> = 0.009) and higher IBL (<em>p</em> = 0.004). In multivariate analysis of age, tumor volume, ITSS grade, cerebral blood volume, and extent of resection, tumor volume was the only significant factor (<em>p</em> = 0.001); however, ITSS grade was also positively associated with IBL (<em>p</em> = 0.074).</p></div><div><h3>Conclusion</h3><p>In this study, tumor volume and vascularity of PPFTs were strongly correlated, and tumor volume was the sole factor significantly associated with IBL. This study suggests that ITSS grade and tumor volume collaboratively influence IBL in surgical resection of PPFTs. IBL should be assessed based on MRI features, and suitable treatment strategies should be established.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101592"},"PeriodicalIF":1.5,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146803","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 management of herniated intervertebral disc in children","authors":"Loubeyre Elise ,&nbsp;Terrier Louis-Marie ,&nbsp;Cognacq Gabrielle ,&nbsp;Aggad Mourad ,&nbsp;Francois Patrick ,&nbsp;Odent Thierry ,&nbsp;Amelot Aymeric","doi":"10.1016/j.neuchi.2024.101593","DOIUrl":"10.1016/j.neuchi.2024.101593","url":null,"abstract":"<div><h3>Study design</h3><p>Retrospective literature review analysis</p></div><div><h3>Objective</h3><p>Analyze the risk factors, characteristics, outcome, and follow up of surgical management of disc herniation in children ≤15 years old (y.o) through a review of the literature.</p></div><div><h3>Background</h3><p>Disc herniation is a rare disease in the pediatric population. While conservative treatment if very often tried, some cases require surgical treatment.</p></div><div><h3>Methods</h3><p>A literature search was conducted using PubMed data base using the terms ‘pediatric/children/adolescent disc herniation’ and ‘surgical management’ as key words. Significant manuscripts i.e: case reports, case series, reviews were identified and analyzed. The exclusion criteria were: series and cases with patients &gt;15 y.o, results non-individualizable and medical management.</p></div><div><h3>Results</h3><p>49 studies were identified, 28 were retained. 69 children &lt;15 y.o were identified with a median age of 13 y.o (SD 1–15). The mean FU was 3.3 years. Trauma and repeated micro traumatism were identified as the main causes of disc herniation in this population. It is mostly a lumbar disease, with very anecdotic cases of thoracic or cervical herniation described.</p><p>In the absence of neurological deficit, conservative treatment should be tried. Different types of surgery exist (open, endoscopic, tubular), with no difference in outcome or complications. The post-operative outcome was very satisfactory, with no neurological sequalae described with excellent recovery.</p></div><div><h3>Conclusions</h3><p>Pediatric disc herniation is often caused by precipitating factors such as trauma. In the absence of resolution with conservative treatment, surgical options yield favorable short term clinical outcomes with minimal complications and no neurological sequalae.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101593"},"PeriodicalIF":1.5,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S002837702400064X/pdfft?md5=e62b986f6ccf7c143734080315b402c7&pid=1-s2.0-S002837702400064X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146804","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":"Increasing burden of hydrocephalus in babies born to mothers in low- and middle-income countries","authors":"Tunde Olobatoke ,&nbsp;Vishal Chavda ,&nbsp;Bipin Chaurasia","doi":"10.1016/j.neuchi.2024.101590","DOIUrl":"10.1016/j.neuchi.2024.101590","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101590"},"PeriodicalIF":1.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146802","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":"Chiari malformation type III and its viability. Case report and literature review","authors":"Silvia Vázquez Sufuentes ,&nbsp;Jesús Esteban García ,&nbsp;Juan Casado Pellejero ,&nbsp;Beatriz Curto Simón ,&nbsp;David Fustero de Miguel","doi":"10.1016/j.neuchi.2024.101585","DOIUrl":"10.1016/j.neuchi.2024.101585","url":null,"abstract":"<div><p>Chiari malformation type III is a rare congenital anomaly. It consists of the posterior fossa contents herniation through an occipital or high cervical encephalocele sac. Although it has traditionally been associated with a high mortality rate, the absence of certain poor prognostic factors and appropriate medical and surgical treatment allow these children to survive and have a remarkable initial functional improvement. Surgical goals are defect repair, preservation of viable brain tissue, adequate skin coverage and hydrocephalus management. Despite all of this, the tendency of these newborns is to maintain a significant disability and if they present poor prognostic criteria, they usually demise within a short period of time.</p><p>We report the case of a newborn with Chiari malformation type III diagnosed during pregnancy. After characterizing the anomaly with a postnatal MRI, the encephalocele was excised and multi-layer closure was performed. The patient progressively developed hydrocephalus during the postoperative period and required ventriculoperitoneal shunt placement. After an initial uneventful course, our patient suffered several episodes of respiratory disturbances. The child became ventilator dependent and palliative care was established in agreement with the parents after ruling out shunt malfunction.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101585"},"PeriodicalIF":1.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914512","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}