Advances and technical standards in neurosurgery最新文献

{"title":"Endoscopic Third Ventriculostomy with Choroid Plexus Coagulation for Infant Hydrocephalus.","authors":"Samuel Molot-Toker, Abhaya V Kulkarni","doi":"10.1007/978-3-032-22008-0_4","DOIUrl":"https://doi.org/10.1007/978-3-032-22008-0_4","url":null,"abstract":"<p><p>Endoscopic third ventriculostomy with choroid plexus coagulation/cauterization (ETV-CPC) is a well-established technique for treating certain types of infant hydrocephalus-a significant global issue. Since its first use by Dr. Benjamin Warf in Uganda over 20 years ago, pediatric neurosurgeons around the world have incorporated it into their practices. The primary benefit of the technique is the avoidance of indwelling shunts, which carry upfront costs that can be prohibitive in many parts of the world, and unpredictable long-term failure rates that are undesirable in any setting. Questions remain, however, about the comparative efficacy of ETV-CPC versus shunt and the factors predicting success or failure. This chapter reviews the history of the technique's development to provide context for its inception; summarizes the literature on its use in different geographic and etiologic populations; and highlights gaps in our knowledge that warrant further investigation. In summary, ETV-CPC is a safe and effective technique in the management of some forms of infant hydrocephalus, but surgeons should consider individual patient characteristics and family preferences when deciding between endoscopic treatment versus a shunt.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"61-80"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Approaches to Pineal Region Tumors.","authors":"Zachary A Abecassis, Richard G Ellenbogen","doi":"10.1007/978-3-032-22008-0_9","DOIUrl":"https://doi.org/10.1007/978-3-032-22008-0_9","url":null,"abstract":"<p><p>Pineal region tumors represent a diverse group of neoplasms arising from the pineal gland and its surrounding structures, posing unique diagnostic and surgical challenges due to their deep midline location and proximity to critical venous and neural anatomy. Advances in neuroimaging, microsurgical technique, and endoscopic technology have transformed their management, substantially improving outcomes compared to historical experiences of high morbidity and mortality. This chapter reviews the anatomical, diagnostic, and surgical principles essential to the contemporary management of pineal region lesions. Detailed descriptions are provided for key operative corridors, including the endoscopic third ventriculostomy with biopsy, supracerebellar infratentorial, occipital transtentorial, posterior interhemispheric transsplenial, anterior transchoroidal, and combined supra-/infratentorial approaches. Institutional experience and outcome data are presented to guide approach selection. Ultimately, optimal management depends on an individualized, anatomy-driven strategy integrating tumor pathology, patient presentation, and the surgeon's familiarity with each corridor.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"183-202"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pineal Region Tumors: Clinical Symptoms and Syndromes.","authors":"Pierre-Aurélien Beuriat, Christophe Rousselle, Isabelle Sabatier","doi":"10.1007/978-3-032-18608-9_5","DOIUrl":"10.1007/978-3-032-18608-9_5","url":null,"abstract":"<p><p>This chapter investigates the clinical picture and the different clinical signs that reveal pineal region tumors or appear during the course of the follow-up. Biological malignancy and tumor extension determine the semiology and its setting up mode. Typical endocrine signs, dominated by abnormal puberty development, are frequently a part of the clinical scene. Bifocal or ectopic localization in the hypothalamic-pituitary region is accompanied by other endocrine signs such as ante- or post-pituitary insufficiencies which occur several months or even years after the first neurological signs appear. Due to a mass syndrome and obstructive hydrocephalus, intracranial hypertension signs are frequent but unspecific. A careful ophthalmologic examination is essential to search upward gaze paralysis and other signs of the Parinaud's tetrad or pentad. Midbrain dysfunction, including extrinsic aqueduct stenosis, is also prevalent. Except for abnormal pubertal signs, hyper-melatoninemia (secretory tumors) or a-hypo-melatoninemia (tumors destructing pineal) generally remains dormant. Some patients present sleep problems such as narcolepsy or sleepiness during the daytime as well as behavioral problems. This suggests a hypothalamic extension rather than a true consequence of melatonin secretion anomalies. Similarly, some patients may present signs of a \"pinealectomized\" syndrome, including (cluster) headaches and tiredness, eventually responsive to melatonin.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"79-87"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathology and Molecular Pathology of Pineal Region Tumors.","authors":"Alexandre Vasiljevic","doi":"10.1007/978-3-032-18608-9_7","DOIUrl":"10.1007/978-3-032-18608-9_7","url":null,"abstract":"<p><p>Tumors of the pineal region are rare neoplasms accounting for only about 1% of all central nervous system tumors. This chapter details the histopathological features and molecular alterations of these tumors. The two most common types are germ cell tumors (GCTs) and pineal parenchymal tumors (PPTs). PPTs are a group of neoplasms that exhibit varying degrees of pinealocytic differentiation and diverse prognoses. They comprise well-differentiated low-grade pineocytomas, pineal parenchymal tumors of intermediate differentiation (PPTIDs), and poorly differentiated high-grade pineoblastomas (PBs). The molecular pathogenesis of PBs notably involves alterations in the microRNA biogenesis and retinoblastoma pathway. PPTIDs are characterized by small in-frame insertions in the KBTBD4 gene. Pineal GCTs are thought to originate from primordial germ cells that have overmigrated along the midline. They exhibit the same histopathological spectrum as their gonadal counterparts. Germinomas are the most frequent GCTs in the pineal region and frequently present mutations in the MAPK pathway. Papillary tumor of the pineal region is a specific type of ependymal tumor that primarily affects the pineal region and exhibits a loss of chromosome 10 in most cases.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"123-149"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pinealoprive Syndrome: Myth or Reality?","authors":"Laure Peter-Derex, V Raverot","doi":"10.1007/978-3-032-18608-9_18","DOIUrl":"10.1007/978-3-032-18608-9_18","url":null,"abstract":"<p><p>Although the role of melatonin in many biological functions, foremost among them the regulation of circadian rhythms and sleep, has been widely demonstrated, the definition of a specific disorder linked to melatonin deficiency remains debated. As the main function of the pineal gland is to secrete melatonin, pineal lesions and pinealectomy provide insightful models for understanding the effect of acute and chronic suppression of melatonin secretion (\"pinealoprive syndrome\"). In pineal parenchymal cell tumor, melatonin levels are usually normal/high, whereas impaired secretion is thought to reflect parenchymal destruction and thus tumors with malignant profiles. Following pinealectomy, low or undetectable levels of melatonin are observed, suggesting that melatonin assay may be used to monitor complete tumoral and pineal gland resection. However, the link between melatonin depletion in this context and the objective/subjective quality of sleep remains unclear. Likewise, while melatonin is involved in a large number of physiological functions, damage to the pineal gland does not appear to have any clear extra-neurological effects. This paradox might be explained by the presence of extra-pineal melatonin secretion sites. In addition, it is possible that the effects of melatonin depletion are long term, in real-life situations, and fluctuate according to the season. Importantly, most evidence relies on very small samples due to the rarity of pineal gland lesions. Further prospective longitudinal studies on wider cohorts are needed, to definitively conclude on the impact of pineal gland-related melatonin on health in general and sleep in particular. There is therefore no recommendation for melatonin supplementation after pinealectomy. Pragmatically, in the presence of melatonin deficiency and sleep disorders in the context of pineal gland tumor/pinealectomy, and given the safety of melatonin as a medication, it seems reasonable to propose exogenous melatonin, with a chronobiotic or sedative purpose depending on the type of disorder.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"323-342"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery of Pineal and Pineal Region Tumours: The Sub-Occipital Transtentorial Approach for Pineal Tumours: How We Do It in Lyon.","authors":"Alexandru Szathmari, Pierre-Aurélien Beuriat, Federico Di Rocco, Carmine Mottolese","doi":"10.1007/978-3-032-18608-9_11","DOIUrl":"10.1007/978-3-032-18608-9_11","url":null,"abstract":"<p><p>The sub-occipital transtentorial approach for pineal and pineal region tumours is reported as realized in Lyon. The approach described by C. Lapras is still performed today with a large skin flap and a large bone flap, which is sawn flush with the superior longitudinal sinus and the transverse sinus.The large bone flap allows elevation and separation of the hemisphere, avoiding its compression against the internal edge of the parietal bone.Opening the tentorium allows broad visualization of the pineal region space and of the venous arch formed by the basilar veins and the Galen vein.Protecting the occipital lobe with a rubber blade and cottonoids prevents compression of the calcarine scissure and has helped to reduce the incidence of the homonymous lateral hemianopia, which was the main criticism of this approach. In recent years, endoscopy assistance at the end of surgery has helped increase the rate of complete tumour removal by detecting pieces of tumour that were left in place.In Lyon, it was realized in more than 300 procedures.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"197-211"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Intracranial Hypertension: Updates on Pathophysiology and Diagnosis.","authors":"Davide Palombi, Jacopo Ciccani, Luca Massimi","doi":"10.1007/978-3-032-22008-0_3","DOIUrl":"10.1007/978-3-032-22008-0_3","url":null,"abstract":"<p><p>Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure (ICP) without a discernible structural cause. Historically referred to as pseudotumor cerebri, IIH primarily affects young women with obesity, reflecting its close association with metabolic and hormonal imbalances. Clinical manifestations include headaches, visual disturbances, and papilledema, which, if untreated, can lead to irreversible vision loss.Pathophysiological insights reveal a complex interplay of venous hypertension, glymphatic dysfunction, cerebrospinal fluid (CSF) dynamics, and metabolic and hormonal contributions. Transverse sinus stenosis exemplifies this complexity, acting as both a cause and consequence of elevated ICP. Dysfunction in the glymphatic system, impaired CSF reabsorption, and obesity-related hormonal dysregulation further elucidate IIH's multifactorial nature. Innovations like venous sinus stenting and pharmacological interventions targeting pathways like glucagon-like peptide-1 (GLP-1) show promise in managing refractory cases.Advances in diagnostics have refined IIH identification, integrating neuro-ophthalmological assessments, lumbar puncture, and imaging modalities such as magnetic resonance imaging (MRI), magnetic resonance venography (MRV), and optical coherence tomography (OCT). These tools enhance the detection of key findings like transverse sinus stenosis, optic nerve sheath dilation, and papilledema severity. Emerging non-invasive methods offer safer, real-time monitoring potential, including ultrasound-based optic nerve sheath diameter (ONSD) measurement and machine learning-based ICP estimation.Despite the significant and recent advances, challenges in standardizing diagnostic criteria and therapeutic approaches persist. This review integrates recent research to highlight critical developments, underscoring unresolved questions on pathophysiology and advocating for a multidisciplinary approach for the diagnosis. Future directions include hybrid diagnostic strategies and leveraging artificial intelligence to refine non-invasive monitoring and therapeutic precision.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"56 ","pages":"27-59"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery of Pineal and Pineal Region Tumors: Alternative Approaches to Pineal Tumors: How to Do It.","authors":"Alexandru Szathmari, Pierre-Aurélien Beuriat, Federico Di Rocco, Carmine Mottolese","doi":"10.1007/978-3-032-18608-9_13","DOIUrl":"10.1007/978-3-032-18608-9_13","url":null,"abstract":"<p><p>Alternative approaches can be used when pineal tumors extend into the third ventricle or the lateral ventricles.For tumors that develop in the posterior cerebral fossa, a combined supra- and infratentorial approach can be proposed.An anterior avenue for lesion of the third ventricle and the pineal region using a frontal transcallosal approach was proposed by Apuzzo in 1992. A posterior parietal transventricular approach had already been proposed by Van Vagenen in 1931 and later by Jomin in 1980, through the ventricular crossroads, allowing lateral exposure of the venous structures, the tumor, and the pineal region. The choice between a frontal transcortical transventricular approach or an interhemispheric transcallosal transventricular approach continues to fuel discussion today, with consideration of their respective advantages and disadvantages.The presence of hydrocephalus and the potential risks of behavioral or memory disturbances due to the damage to the body or the pillars of the fornix are important factors in the decision-making process.All the approaches described have advantages and disadvantages that the surgeon must evaluate in order to ensure the best option for the patient, taking into account the size and extent of the lesion as well as the possibility of avoiding sequelae.Surgeons interested in pineal region surgery must be familiar with several approaches, although in practice, each surgeon usually chooses the approach with which they are most experienced.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"227-245"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conclusions.","authors":"Carmine Mottolese","doi":"10.1007/978-3-032-18608-9_19","DOIUrl":"10.1007/978-3-032-18608-9_19","url":null,"abstract":"<p><p>Pineal tumours represent a valuable model of multidisciplinary collaboration. Over recent years, such collaboration has led to the significant improvements in outcomes, increased cure rates and reduction in long-term sequelae. Advances in diagnostic workup, including detailed tumour investigation and the study of tumoural markers, now allow more accurate treatment strategies.When a biopsy is required, a clear increase in the use of the endoscopic techniques has been observed in recent years, especially in paediatric patients. This approach allows simultaneous treatment of intracranial hypertension and establishment of a histological diagnosis. In cases of benign tumours, complete surgical removal should be the goal to ensure definitive cure. Advances in surgical techniques, including microsurgery, endoscopy-assisted surgery and the use of exoscopes, as well as progress in neuro-anaesthesiology have reinforced the concept that aggressive surgical resection represents a cornerstone of pineal tumour treatment when surgery is indicated.Results are less favourable for pinealoblastomas in both children and adults, but biomolecular and genetic studies have enabled the identification of different prognostic groups, allowing treatment intensification or de-escalation, thereby improving results while reducing the risk of treatment-related complications.The choice of complementary treatment based on histological diagnosis, biomolecular and genetic tumour markers and the possibility of tailored therapies may further improve survival and clinical outcomes in the future.Gamma Knife radiosurgery may be considered as an adjuvant or alternative treatment when surgery is contraindicated. However, the relatively high incidence of complications related to radionecrosis suggests that Gamma Knife should be used with caution, particularly in paediatric patients.Finally, to better understand the natural history of these rare tumours and the outcomes of surgical and complementary treatments, including chemotherapy and/or radiotherapy, it would be valuable to establish international registries. Although costly, such registries would provide substantial benefits for patients and their families.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"343-348"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrocephalus Secondary to Pineal Region Lesions.","authors":"Mariana Dandes, Carmine Mottolese, Carmen Lutz, Pierre-Aurélien Beuriat, Matthieu Vinchon, Alexandru Szathmari, Federico Di Rocco","doi":"10.1007/978-3-032-18608-9_9","DOIUrl":"10.1007/978-3-032-18608-9_9","url":null,"abstract":"<p><strong>Background: </strong>Hydrocephalus is a common complication associated with pineal lesions, including tumors and cysts. This structured abstract aims to provide a comprehensive overview of the pathophysiology, diagnostic evaluation, and management strategies for hydrocephalus in the context of pineal lesions.</p><p><strong>Methods: </strong>A review of relevant literature was conducted to gather current insights into hydrocephalus secondary to pineal lesions. PubMed, Google Scholar, and academic databases were searched for articles published between 2014 and 2024. Keywords included \"hydrocephalus,\" \"pineal lesion,\" \"pineal tumor,\" \"cyst,\" \"diagnosis,\" \"treatment,\" and \"management.\"</p><p><strong>Results: </strong>Pineal lesions, by obstructing CSF pathways, often lead to hydrocephalus due to impaired CSF flow dynamics. Neuroimaging, particularly MRI and CT scans, plays a pivotal role in diagnosing both the pineal lesion and associated hydrocephalus. Treatment strategies for hydrocephalus in pineal lesions include surgical interventions such as endoscopic third ventriculostomy (ETV), ventriculoperitoneal shunt (VPS) placement, and tumor resection. Nonsurgical options, including medical therapy and observation, may also be considered depending on the patient's clinical status and lesion characteristics.</p><p><strong>Conclusion: </strong>Hydrocephalus in pineal lesions presents a complex clinical scenario requiring a multidisciplinary approach for optimal management. Early diagnosis, accurate characterization of the lesion and associated hydrocephalus, and timely intervention are crucial for improving patient outcomes. Further research is needed to refine treatment algorithms and enhance our understanding of the underlying mechanisms of hydrocephalus in pineal lesions.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"54 ","pages":"165-176"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}