Neurochirurgie最新文献

{"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":"2025-04-05","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":"New 3D printed simulator for training of endoscopic transsphenoidal surgery used in a dedicated pituitary course: Comment","authors":"Hinpetch Daungsupawong ,&nbsp;Viroj Wiwanitkit","doi":"10.1016/j.neuchi.2025.101670","DOIUrl":"10.1016/j.neuchi.2025.101670","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101670"},"PeriodicalIF":1.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783902","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":"Model-based ‘personalized’ care or pragmatic trials?","authors":"Jean Raymond ,&nbsp;François Zhu ,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2025.101668","DOIUrl":"10.1016/j.neuchi.2025.101668","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101668"},"PeriodicalIF":1.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767981","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 decision making for preventive interventions: The unruptured intracranial aneurysm example","authors":"Jean Raymond ,&nbsp;François Zhu ,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2025.101667","DOIUrl":"10.1016/j.neuchi.2025.101667","url":null,"abstract":"<div><h3>Background</h3><div>Decision making for preventive interventions in asymptomatic patients, such as the treatment of incidental intracranial aneurysms, is eminently uncertain and at risk of over-treatment. One approach suggests that the weighing of the natural risk of the disease against the risk of intervention should be replaced by a comparison of outcomes measured as expected quality-adjusted life-years survival.</div></div><div><h3>Methods</h3><div>We review the problems of over-diagnosis and over-treatment and how prognostic studies can help address the clinical uncertainty. We examine and compare the assumptions that underlie the mathematical transformations that are involved in the so-called outcome-based approach with the risk-based approach when they are both derived from observational data. Finally, we propose a more pragmatic approach.</div></div><div><h3>Results</h3><div>Both risk-based and outcome-based models depend on two strong assumptions: exchangeability of patients selected to be observed and patients selected to be treated (in other words ignorability of treatment assignment), and ii) dominance of time-to-event data (the only thing pertinent for decision making is the time to the first event in the patient’s history). The outcome-based approach needs an additional assumption: fatality (once a patient suffers a poor outcome from an event, recovery is impossible). These three theoretical assumptions are rarely verified in practice.</div></div><div><h3>Conclusion</h3><div>Clinical decision-making based on observational data relies on unrealistic assumptions. Clinical practice should instead be guided by conducting pragmatic clinical trials.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101667"},"PeriodicalIF":1.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768691","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":"Effect of non-neurological complications on the functional outcome of patients with ruptured intracranial aneurysms","authors":"Diego A. Ortega Moreno,&nbsp;Ibrahim Almulhim,&nbsp;Jerry C. Ku,&nbsp;Nicole Cancelliere,&nbsp;Danilo B. Diestro,&nbsp;Julian Spears,&nbsp;Vitor Mendes Pereira","doi":"10.1016/j.neuchi.2025.101663","DOIUrl":"10.1016/j.neuchi.2025.101663","url":null,"abstract":"<div><h3>Background</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening pathology associated with significant neurological and non-neurological complications. While the impact of neurological factors has been extensively studied, the impact of non-neurological complications remains underexplored. This study aimed to assess the effect of non-neurological complications on hospital stay and functional outcomes of patients with ruptured intracranial aneurysms (IAs).</div></div><div><h3>Methods</h3><div>A retrospective cohort study assessed patients with ruptured IAs treated within a neurovascular program of a tertiary hospital between October 2019 and September 2023. Inclusion criteria were: ≥18 years old, confirmed aSAH, and available follow-up information. The primary outcome corresponded to non-excellent functional outcomes at 6- and 12-month follow-ups. Secondary outcomes included length of in-hospital and intensive care unit (ICU) stay. Multivariate logistic regression models, adjusted for age, sex, and baseline World Federation of Neurosurgical Societies (WFNS) scores, were conducted.</div></div><div><h3>Results</h3><div>A total of 220 patients were included in this study, with a mean age of 56.66 ± 13.79 years; 74.5% were female. The most prevalent non-neurological complications were isolated fever (56.4%), arrhythmias (44.1%), and urinary tract infections (38.6%). Patients with poor neurological presentation had a higher prevalence of non-neurological complications. Pneumonia, pulmonary embolism, hyperglycemia, as well as fever were associated with higher odds of non-excellent functional outcomes (mRS 2–6) at 6- and 12-month follow-ups.</div></div><div><h3>Conclusions</h3><div>Non-neurological complications significantly impact hospital stay and functional recovery in aSAH patients. Early diagnosis and intervention, as well as the implementation of comprehensive clinical algorithms, are crucial for improving long-term outcomes in patients with ruptured IAs.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101663"},"PeriodicalIF":1.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767868","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":"Sport-related concussion in French amateur rugby: A descriptive cross-sectional survey on adult player management, medical care and knowledge","authors":"Timotey Lagisquet ,&nbsp;Hélène Cassoudesalle","doi":"10.1016/j.neuchi.2025.101671","DOIUrl":"10.1016/j.neuchi.2025.101671","url":null,"abstract":"<div><h3>Background</h3><div>The French Rugby Federation (FFR) has established regulations to protect amateur players from the risks of concussions. To assess compliance with the FFR protocol, our objectives were to evaluate players' knowledge in a sample of rugby clubs and to analyze the management of recent concussions, including the rate of concussion reporting to the FFR.</div></div><div><h3>Methods</h3><div>In this cross-sectional descriptive survey, amateur adult rugby players from FFR-licensed clubs in southwestern France were interviewed during the 2019/2020 and 2021/2022 seasons. Players were asked to complete a questionnaire.</div></div><div><h3>Results</h3><div>Among the 193 players surveyed, only 27% (n = 52) reported being aware of the return-to-play protocol. Of the 28 players (14.5%) who experienced a recent concussion, just 11 sought medical attention and only 3 of these concussions were officially reported to the FFR. Fewer than half of the players who received guidance on a gradual return to sports followed the recommendations in full.</div></div><div><h3>Conclusion</h3><div>These findings highlight the need for educational initiatives to raise awareness within clubs.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101671"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759891","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":"Rethinking age barriers in Parkinson’s disease for deep brain stimulation","authors":"Roberto M. Franco ,&nbsp;Carolina Soares ,&nbsp;Ana Oliveira ,&nbsp;Rui Vaz ,&nbsp;Maria J. Rosas","doi":"10.1016/j.neuchi.2025.101665","DOIUrl":"10.1016/j.neuchi.2025.101665","url":null,"abstract":"<div><h3>Background</h3><div>The age cutoff for subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) has been a contentious issue. Typically, it is offered to patients younger than 70 years. This study, however, aims to compare DBS efficacy outcomes between patients with age ≥70 years and those aged &lt;70 years, potentially paving the way for a more inclusive approach to DBS in PD treatment.</div></div><div><h3>Methods</h3><div>This study is a retrospective, cross-sectional cohort study of PD patients who underwent STN-DBS between 2002 and 2019. The analysis included a comprehensive range of sociodemographic and clinical variables. The primary outcome was the reduction in Movement Disorder Society - Unified Parkinson's Disease Rating Scale part III (MDS-UDPRSIII). The secondary outcome was reduced levodopa equivalent daily dose (LEDD). The statistical analysis was performed in SPSS-25, with a stringent threshold of <em>p</em> &lt; 0.05, to reject the null hypothesis, ensuring the robustness of our findings.</div></div><div><h3>Results</h3><div>From a cohort of 360 patients with PD who underwent STN-DBS, we included 15 patients 70 years or older with a mean age of 70.4 ± 0.9 years, a mean disease duration of 13.0 ± 2.8 years, and 61 patients younger than 70 years old with a mean age of 61.2 ± 6.6 years; median disease duration of 13.0 [IQR:10.0]. No significant statistical differences were found in the MDS-UPDRS-III score on both groups at the at baseline (<em>p</em> = 0.480), at one year (<em>p</em> = 0.341) and at three years of follow-up (<em>p</em> = 0.117). In both groups, postoperative reduction of LEDD was similar (35.7 [IQR: 33.91] vs 31.6 ± 18.3); (<em>p</em> = 0.960) in patients with age 70 years or older and those younger than 70 years respectively; nevertheless, patients with 70 years or older had higher LEDD at three years (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Our study found no significant differences in the MDS-UPDRS-III in groups younger and older than 70 at baseline, at one year and at three years of follow-up. However, higher LEDD was necessary in the elderly group. This highlights the urgent need for more inclusive research to better understand the cost-effectiveness of DBS in this population. By conducting such research, we can ensure that all PD patients, regardless of age, have access to the most effective treatments.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101665"},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725534","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":"Evaluation of parenchymal collaterals in patients with meningioma using contrast-enhanced T1 MPRAGE sequence","authors":"Elif Gozgec ,&nbsp;Hayri Ogul ,&nbsp;Ibrahim Feyyaz Naldemir ,&nbsp;Zakir Sakci ,&nbsp;Mecit Kantarci","doi":"10.1016/j.neuchi.2025.101664","DOIUrl":"10.1016/j.neuchi.2025.101664","url":null,"abstract":"<div><h3>Background</h3><div>Post-contrast T1-MPRAGE sequence has been used in routine tumor imaging at many centers for decades. Meningiomas may be accompanied by leptomeningeal as well as parenchymal collaterals. In this study, we aimed to demonstrate the collaterals that may accompany meningiomas on postcontrast T1-MPRAGE imaging and to investigate their relationship with location, size, histologic features, adjacent bone, and parenchymal changes.</div></div><div><h3>Methods</h3><div>In this study, postcontrast T1-MPRAGE images of 326 meningiomas from 259 patients were independently analyzed by two observers. The presence of parenchymal collaterals and unilateral, contralateral or bilateral localization were determined. Meningiomas' diameters, locations, presence of dural sinus invasion, associated parenchymal changes and bony changes were determined. Histologic grades were determined if applicable. The data obtained were analyzed statistically.</div></div><div><h3>Results</h3><div>Parenchymal collaterals were demonstrated in 25% of meningiomas (66/259). Of these, 65% were unilateral, 12% contralateral and 23% bilateral. There was a significant correlation between malignancy and the presence of collaterals in histologically diagnosed meningiomas (77%, <em>p</em> = 0.01). The presence of collaterals was also significantly higher in meningiomas with sinus invasion and bone destruction (<em>p</em> &lt; 0.001). As tumor size increased, unilateral and bilateral collateral development increased (<em>p</em> &lt; 0.001, <em>p</em> = 0.008, respectively), but it was not significant in contralateral cases. There was significant concordance between the observers in terms of the presence of collaterals (kappa: 0.773).</div></div><div><h3>Conclusions</h3><div>Meningiomas may be accompanied by parenchymal collaterals. WHO grade 3 histologic type, sinus invasion, bone destruction and size increase are predictors of collateral development.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101664"},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714665","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":"Repairment of an interrupted oculomotor nerve in the cavernous sinus","authors":"Zhongding Zhang ,&nbsp;Yinda Tang ,&nbsp;Hua Zhao,&nbsp;Shiting Li","doi":"10.1016/j.neuchi.2025.101660","DOIUrl":"10.1016/j.neuchi.2025.101660","url":null,"abstract":"<div><div>Oculomotor nerve palsy following head trauma can cause eye movement disorders and severe visual problems, but it was considered to have a poor prognosis with a wide range of interventions in the past. However, we performed neuroanastomosis in a patient with isolated oculomotor nerve injury and obtained a satisfactory long-term recovery, although the short-term effect was not obvious. The clinical presentation, surgical management, and functional rehabilitation of this patient are discussed.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101660"},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588080","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":"Prediction of MRI in intra-operative findings for spinal meningeal diseases","authors":"Gabriele Capo ,&nbsp;Francesco Calvanese ,&nbsp;Nadim Tahhan ,&nbsp;Donato Creatura ,&nbsp;Ismail Zaed ,&nbsp;Emilia Bellina ,&nbsp;Ali Baram ,&nbsp;Francois Cotton ,&nbsp;Cédric Y. Barrey","doi":"10.1016/j.neuchi.2025.101661","DOIUrl":"10.1016/j.neuchi.2025.101661","url":null,"abstract":"<div><h3>Background</h3><div>A large variety of spinal meningeal diseases have been described in the literature, and differential diagnosis is often complex, requiring a good knowledge of the different entities and accurate neuroimaging. The purpose of this article was to depict the most relevant diagnostic features on the commonly utilized MRI sequences for the main and most frequent pathologies of the spinal arachnoid and to correlate them with intraoperative findings.</div></div><div><h3>Material and methods</h3><div>Five cases harboring each different spinal meningeal diseases were analyzed, illustrated, extensively described, and discussed: arachnoid web, arachnoiditis, idiopathic spinal cord herniation, intradural arachnoid cyst, extradural arachnoid cyst. All the cases were surgically treated in the same institution (Neurological Hospital, Lyon, France). We underlined imaging clues for differential diagnosis to help physicians to elaborate the right diagnosis and guide the surgical management.</div></div><div><h3>Results</h3><div>MRI was efficient to determine the nature of the arachnoid or/and dural disease as well as to predict precisely the intra-operative findings. Six key-radiological features were selected, helping differential diagnosis: localization (intra/extradural/both), aspect of the spinal cord (compressive effect/displacement/scalpel sign), arachnoid bride, CSF turbulent flow, vertebral scalloping, absence of gadolinium-enhancement.</div></div><div><h3>Conclusion</h3><div>MRI demonstrated excellent correlation with intra-operative findings for all the five spinal meningeal diseases analyzed. Although rare, these pathologies must be recognized by clinicians considering that appropriate treatment most often permit to relieve the symptoms.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101661"},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580455","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}