Acta Neurochirurgica最新文献

{"title":"MGMT methylation and its prognostic significance in inoperable IDH-wildtype glioblastoma: the MGMT-GBM study","authors":"Prajwal Ghimire,&nbsp;Ahmad Kamaludin,&nbsp;Berta F. Palau,&nbsp;Jose P. Lavrador,&nbsp;Richard Gullan,&nbsp;Francesco Vergani,&nbsp;Ranjeev Bhangoo,&nbsp;Keyoumars Ashkan","doi":"10.1007/s00701-024-06300-x","DOIUrl":"10.1007/s00701-024-06300-x","url":null,"abstract":"<div><h3>Introduction</h3><p>The methylation of the O6-Methylguanine-DNA Methyltransferase (MGMT) promoter is a valid biomarker for predicting response to therapy with alkylating agents and, independently, prognosis in IDH-wildtype(IDH-w) glioblastoma. We aim to study the impact of its methylation in overall survival of the unresectable IDH-w glioblastoma undergoing biopsy and systemic treatment.</p><h3>Methods</h3><p>We collected six-year retrospective (2017–2023) data at a quaternary neurosurgery center for patients undergoing biopsy as the only surgical procedure for an unresectable IDH wildtype glioblastoma. Data was collected from patient records including neuro-oncology multidisciplinary team meeting (MDT) documentation. Patients were grouped into categories according to different types of treatment received after biopsy (no treatment, chemotherapy (CT), radiotherapy (RT), chemoradiotherapy (CRT), chemoradiotherapy with adjuvant temozolomide (CRT with adjuvant TMZ), EORTC-NCIC protocol followed by second line treatment) and according to methylation status (unmethylated (&lt; 5%), borderline methylated (5–15%) and strongly methylated (&gt; 15%)). Survival analysis was performed.</p><h3>Results</h3><p>166 glioblastoma IDH wildtype patients were included in the study with mean age of 62.5 years (M: F = 1.5: 1). 70 (49.3%) patients had unmethylated MGMT status (&lt; 5%), 29 (20.4%) patients had borderline methylated MGMT status (5–15%) and 43 (30.2%) patients had methylated MGMT status (&gt; 15%). 36 (25.3%) patients did not receive any treatment post biopsy, 13 (9.1%) received CT only, 27 (19%) RT only, 12 (8.4%) CRT, 33 (23.2%) CRT with adjuvant TMZ, whereas 21 (14.7%) received EORTC-NCIC protocol along with second line treatment.</p><p>In biopsy only group, there was no notable difference in survival outcomes among the different methylation statuses. For biopsy and any-other-form-of-treatment methylated groups showed a distinct trend of better survival compared to the borderline or unmethylated groups. Overall, methylated patients had better survival as compared to unmethylated or borderline groups.</p><h3>Conclusion</h3><p>Methylated MGMT status are predictors for better overall survival in unresectable IDH wildtype glioblastoma patients undergoing biopsy and treatment regardless of the treatment modality.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142374967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined intra-extradural approach for posterolateral thoracic disk herniations: how I do it","authors":"Ciro Mastantuoni,&nbsp;Maria Rosaria Scala,&nbsp;Raffaele de Falco,&nbsp;Antonio Bocchetti","doi":"10.1007/s00701-024-06278-6","DOIUrl":"10.1007/s00701-024-06278-6","url":null,"abstract":"<div><h3>Background</h3><p>Thoracic disc herniation is a rare degenerative spine disease that can cause severe neurological deficits. Nowadays, controversies still stand on the most effective surgical route.</p><h3>Method</h3><p>Herein, we describe the combined intra-extradural approach for a posterolateral thoracic disk herniation. We divided the technique into four steps: bony, extradural, intradural and intra-extradural. We disclose perioperative shrewdness aimed at improving outcomes and reducing complications.</p><h3>Conclusion</h3><p>The combined intra-extradural approach represents an effective technique for posterolateral thoracic disk herniations, reducing both the risk of spinal cord damages and post-operative CSF leaks.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fenestrated clipping of previously coiled posterior-superiorly projecting anterior communicating artery aneurysms: How I do it","authors":"R. Chase Ransom,&nbsp;Stephen Graepel,&nbsp;Giuseppe Lanzino,&nbsp;Lorenzo Rinaldo","doi":"10.1007/s00701-024-06279-5","DOIUrl":"10.1007/s00701-024-06279-5","url":null,"abstract":"<div><h3>Background</h3><p>Anterior communicating artery (ACOM) aneurysms are among the most common aneurysms associated with aneurysmal subarachnoid hemorrhage (International Study of Unruptured Intracranial Aneurysms I (N Engl J Med 339:1725-1733, 1998), Wiebers (Lancet 362:103-110, 2003)). Surgical clipping of posterior-superiorly projecting ACOM aneurysms can be challenging, as the ipsilateral A2 can interfere with clip trajectory and ACOM perforating vessels obstructed from view. Intraluminal coils can further increase the difficulty of the procedure.</p><h3>Method</h3><p>The relevant surgical anatomy with illustration is presented. A video detailing our technique on an illustrative case is provided.</p><h3>Conclusion</h3><p>Surgical clipping of posterior-superiorly projecting ACOM aneurysms can require complex clip configurations. We describe the key steps of posterior-superiorly projecting ACOM aneurysm clipping through a lateral supraorbital craniotomy and fenestrated tandem clipping.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored surgical approaches for spinal chordomas: A multidisciplinary perspective","authors":"Lukas Klein,&nbsp;Pavlina Lenga,&nbsp;Philip Dao Trong,&nbsp;Helena Kleineidam,&nbsp;Sandro M. Krieg,&nbsp;Basem Ishak","doi":"10.1007/s00701-024-06290-w","DOIUrl":"10.1007/s00701-024-06290-w","url":null,"abstract":"<div><h3>Introduction</h3><p>The treatment of spinal chordomas presents a significant challenge due to their resistance to both radiotherapy and chemotherapy as well as the complexity of the surgical procedures required. This study presents a series of cases of primary spinal chordomas, focusing on the development of a personalized therapeutic strategy that is tailored to each patient's unique clinical status. This approach aims to ensure that treatments are optimally aligned with the patient’s overall prognosis and surgical eligibility.</p><h3>Methods</h3><p>This retrospective study analyzed 14 patients with primary spinal chordomas treated at our institution. We evaluated surgical strategies, clinical outcomes, and survival rates, The therapeutic strategy was formulated after interdisciplinary conferences with sarcoma management specialists. Data were collected on patient demographics, surgical details, postoperative outcomes, and follow-up status.</p><h3>Results</h3><p>All patients presented with neurological deficits preoperatively, which generally improved post-surgery. The study included a detailed analysis of two distinct surgical approaches: five patients underwent en bloc resection with dorsal stabilization and nine received decompression only. Patients undergoing en bloc resection showed a reduced need for additional surgery due to the comprehensive removal of the tumor. As anticipated, 40% of the patients who underwent decompression experienced tumor progression within the first three months. However, given the poor overall prognosis, the objective of maintaining neurological function was achieved.</p><h3>Conclusions</h3><p>Surgical en bloc resection offers a viable and effective intervention for spinal chordomas, enhancing neurological function. It is imperative to tailor treatment strategies to individual prognoses, integrating insights from multidisciplinary discussions that meticulously evaluate surgical risks. This collaborative approach aids in selecting the most appropriate surgical technique tailored to each patient’s specific condition.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term analysis of ABI auditory performance in patients with neurofibromatosis type 2-related schwannomatosis","authors":"Hannah Daoudi,&nbsp;Renato Torres,&nbsp;Isabelle Mosnier,&nbsp;Emmanuelle Ambert-Dahan,&nbsp;Amélie Liagre-Cailles,&nbsp;Mustapha Smail,&nbsp;Yann Nguyen,&nbsp;Evelyne Ferrary,&nbsp;Olivier Sterkers,&nbsp;Ghizlène Lahlou,&nbsp;Michel Kalamarides","doi":"10.1007/s00701-024-06243-3","DOIUrl":"10.1007/s00701-024-06243-3","url":null,"abstract":"<div><h3>Purpose</h3><p>This retrospective monocentric study aimed to evaluate long-term auditory brainstem implant (ABI) function in patients with neurofibromatosis type 2, and to investigate the prognostic factors for ABI use.</p><h3>Methods</h3><p>Between 1997 and 2022, 27 patients with at least five years of follow-up underwent implantation with 32 ABIs. At 1- and 5-years post-implantation and at last follow-up, ABIs were classified as used or non-used and the size of the ipsilateral tumor was recorded. For patients who used their ABIs, we assessed speech perception (disyllabic words, MBAA sentences) in quiet conditions with the ABI only, by lip-reading (LR), and with a combination of the two (ABI + LR). Hearing improvement was calculated as <span>(Delta)</span> ABI = (ABI + LR)–LR scores. Predictive factors for ABI use were analyzed.</p><h3>Results</h3><p>One year post-implantation, 74% patients were ABI-users and 66% of the ABIs were used. Two of these patients were non-users at five years, and another two at last follow-up (14 ± 5.2 years); 54% of the patients were ABI-users at last follow-up. <span>(Delta)</span> ABI revealed a hearing improvement of 32–41% (disyllabic words) and 28–37% (MBAA sentences). Among 16 ABIs with at least LR improvement at 1-year post-implantation, 4 decreased their performance, coinciding with a large growing ipsilateral tumor in 3/4 ABIs. We identified no significant prognostic factors for ABI use.</p><h3>Conclusions</h3><p>ABIs are indicated in case of bilateral deafness with a non-functional cochlear nerve. Half the patients with ABIs used their implants and auditory performance remained stable over time, except in cases of ipsilateral tumor growth.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic radiosurgery for recurrent/residual nonfunctioning pituitary adenoma: a single-arm systematic review and meta-analysis","authors":"Fernando De Nigris Vasconcellos,&nbsp;Marcos Antônio Dias Vilela,&nbsp;Fabricio Garcia Torrico,&nbsp;Marcos Agustín Scalise,&nbsp;Vanessa Pamela Salolin Vargas,&nbsp;Cristian D. Mendieta,&nbsp;Pavel Pichardo-Rojas,&nbsp;Maria Eduarda Almagro Rosi,&nbsp;Laura Tajara Fleury,&nbsp;Nádia Dantas de Brito Rebelo,&nbsp;Carolina Benjamin,&nbsp;Jason P. Sheehan","doi":"10.1007/s00701-024-06296-4","DOIUrl":"10.1007/s00701-024-06296-4","url":null,"abstract":"<div><h3>Background</h3><p>Nonfunctioning pituitary adenomas (NFPAs) are a significant subtype of pituitary tumors, accounting for 30% of all pituitary tumors and 10–20% of intracranial tumors. The primary treatment for NFPAs is resection, but complete resection is often challenging due to the tumor's proximity to critical structures, leading to frequent recurrences. Stereotactic radiosurgery (SRS) has emerged as a viable treatment option for recurrent or residual NFPAs, but its long-term efficacy and safety profile require further investigation.</p><h3>Methods</h3><p>This systematic review followed PRISMA guidelines and included studies published up to February 2024. We searched MEDLINE, Embase, and Cochrane databases for studies evaluating SRS for recurrent/residual NFPAs. Inclusion criteria focused on studies reporting outcomes and complications of SRS, while exclusion criteria omitted case reports, case series, and non-English studies. Data extracted included demographic details, dosimetry parameters, and follow-up durations. The risk of bias was assessed using the ROBINS-I tool, and statistical analyses were performed using single-arm meta-analyses.</p><h3>Results</h3><p>A total of 24 studies involving 3,781 patients were included. The mean follow-up duration was 60 months. Tumor control was achieved in approximately 92.3% of patients. The risk of developing hypopituitarism post-SRS was 13.62%, while the risk for panhypopituitarism was 2.55%. New visual field deficits occurred in 3.94% of patients. Cranial nerve deficits were rare, with event rates below 1% for CN III, CN V, and CN VI.</p><h3>Conclusion</h3><p>SRS is effective in managing recurrent or residual NFPAs, achieving high tumor control rates. However, the risk of hypopituitarism remains a significant concern, necessitating regular endocrinological monitoring. While generally safe, the potential for new visual field deficits and other cranial nerve deficits must be considered. SRS remains a valuable treatment option, but clinicians should be aware of its potential complications.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of self-measured objective functional impairment using the timed up and go test in patients with diseases of the spine","authors":"Melvyn R. Lüssi,&nbsp;Gregor Fischer,&nbsp;Lorenzo Bertulli,&nbsp;Martin N. Stienen,&nbsp;Felix C. Stengel","doi":"10.1007/s00701-024-06293-7","DOIUrl":"10.1007/s00701-024-06293-7","url":null,"abstract":"<div><h3>Background</h3><p>Accurate assessment of a patient's functional status is crucial for determining the need for treatment and evaluating outcomes. Objective functional impairment (OFI) measures, alongside patient-reported outcome measures (PROMs), have been proposed for spine diseases. The Timed-Up and Go (TUG) test, typically administered by healthcare professionals, is a well-studied OFI measure. This study investigates whether patient self-measurement of TUG is similarly reliable.</p><h3>Methods</h3><p>In a prospective, observational study, patients with spinal diseases underwent two TUG assessments: one measured by a healthcare professional and one self-measured by the patient. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects model, considered excellent between 0.75 – 1.00. Paired t-tests directly compared both measurements. The impact of variables such as age, sex, disease type, symptom severity (via PROMs), comorbidities, and frailty on reliability was also analysed.</p><h3>Results</h3><p>Seventy-four patients were included, with a mean age of 62.9 years (SD 17.8); 29 (39.2%) were female. The majority (64.9%) were treated for degenerative disc disease. The lumbo-sacral region was most affected (71.6%), and 47.3% had previous surgeries. Patient self-measurement reliability was excellent (ICC 0.8740, <i>p</i> &lt; 0.001), and the difference between healthcare professional (19.3 ± 9.4 s) and patient measurements (18.4 ± 9.7 s) was insignificant (<i>p</i> = 0.116). Interrater reliability remained high in patients &gt; 65 years (ICC 0.8584, <i>p</i> &lt; 0.001), patients with ASA grades 3&amp;4 (ICC 0.7066, <i>p</i> &lt; 0.001), patients considered frail (ICC 0.8799, <i>p</i> &lt; 0.001), and in patients not using any walking aid (ICC 0.8012, <i>p</i> &lt; 0.001). High symptom severity still showed strong reliability (ICC 0.8279, <i>p</i> &lt; 0.001 for Oswestry Disability Index &gt; 40; ICC 0.8607, <i>p</i> = 0.011 for Neck Disability Index &gt; 40).</p><h3>Conclusions</h3><p>Patients with spine diseases can reliably self-measure OFI using the TUG test. The interrater reliability between self-measurements and those by healthcare professionals was excellent across all conditions. These findings could optimize patient assessments, especially in resource-limited settings.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How i do it: Robot-assisted transcerebellar stereotactic approach for brainstem lesion","authors":"Mathieu Lozouet,&nbsp;Gautier Djrolo,&nbsp;Cheima Mortier,&nbsp;Stéphane Derrey","doi":"10.1007/s00701-024-06280-y","DOIUrl":"10.1007/s00701-024-06280-y","url":null,"abstract":"<div><h3>Background</h3><p>Stereotactic approaches to diffuse intrinsic pontine gliomas (DIPGs) remain essential due to advances in molecular biology and management, necessitating tissue sampling. Here we present an effective technique with a biopsy by robot-assisted transcerebellar approach.</p><h3>Method</h3><p>Our procedure was performed using the ROSA robotic system and the OARM CT scan, which provided stereotactic conditions for this transcerebellar approach to brainstem lesions.</p><h3>Conclusion</h3><p>The robot-assisted transcerebellar stereotactic approach remains essential to provide complications for biopsy of brainstem lesions.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Watkins’ & ‘Watkins2.0’: Smart phone applications (Apps) for gait-assessment in normal pressure hydrocephalus and decompensated long-standing overt ventriculomegaly","authors":"Kanza Tariq,&nbsp;Lewis Thorne,&nbsp;Ahmed Toma,&nbsp;Laurence Watkins","doi":"10.1007/s00701-024-06275-9","DOIUrl":"10.1007/s00701-024-06275-9","url":null,"abstract":"<div><h3>Objective</h3><p>Gait disturbance is one of the features of normal pressure hydrocephalus (NPH) and decompensated long-standing overt ventriculomegaly (LOVA). The timed-up-and-go (TUG) test and the timed-10-m-walking test (10MWT) are frequently used assessments tools for gait and balance disturbances in NPH and LOVA, as well as several other disorders. We aimed to make smart-phone apps which perform both the 10MWT and the TUG-test and record the results for individual patients, thus making it possible for patients to have an objective assessment of their progress. Patients with a suitable smart phone can perform repeat assessments in their home environment, providing a measure of progress for them and for their clinical team.</p><h3>Methods</h3><p>10MWT and TUG-test were performed by 50 healthy adults, 67 NPH and 10 LOVA patients, as well as 5 elderly patients as part of falls risk assessment using the Watkins2.0 app. The 10MWT was assessed with timed slow-pace and fast-pace. Statistical analysis used SPSS (version 25.0, IBM) by paired t-test, comparing the healthy and the NPH cohorts. Level of precision of the app as compared to a clinical observer using a stopwatch was evaluated using receiver operating characteristics curve.</p><h3>Results</h3><p>As compared to a clinical observer using a stopwatch, in 10MWT the app showed 100% accuracy in the measure of time taken to cover distance in whole seconds, 95% accuracy in the number of steps taken with an error ± 1–3 steps, and 97% accuracy in the measure of total distance covered with error of ± 0.25–0.50 m. The TUG test has 100% accuracy in time taken to complete the test in whole seconds, 97% accuracy in the number of steps with an error of ± 1–2 steps and 87.5% accuracy in the distance covered with error of ± 0.50 m. In the measure of time, the app was found to have equal sensitivity as an observer. In measure of number of steps and distance, the app demonstrated high sensitivity and precision (AUC &gt; 0.9). The app also showed significant level of discrimination between healthy and gait-impaired individuals.</p><h3>Conclusion</h3><p>‘Watkins’ and ‘Watkins2.0’ are efficient apps for objective performance of 10MWT and the TUG-test in NPH and LOVA patients and has application in several other pathologies characterised by gait and balance disturbance.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications and scientific support for supratentorial unilateral decompressive craniectomy for different subgroups of patients: A scoping review","authors":"Nathan Beucler","doi":"10.1007/s00701-024-06277-7","DOIUrl":"10.1007/s00701-024-06277-7","url":null,"abstract":"<div><h3>Context</h3><p>Even though supratentorial unilateral decompressive craniectomy (DC) has become the gold standard neurosurgical procedure aiming to provide long term relief of intractable intracranial hypertension, its indication has only been validated by high-quality evidence for traumatic brain injury and malignant middle cerebral artery infarction. This scoping review aims to summarize the available evidence regarding DC for these two recognized indications, but also for less validated indications that we may encounter in our daily clinical practice.</p><h3>Materials and methods</h3><p>A scoping review was conducted on Medline / Pubmed database from inception to present time looking for articles focused on 7 possible indications for DC indications. Studies’ level of evidence was assessed using Oxford University level of evidence scale. Studies’ quality was assessed using Newcastle–Ottawa scale for systematic reviews of cohort studies and Cochrane Risk of Bias Tool for randomized controlled trials.</p><h3>Results</h3><p>Two randomized trials (level 1b) reported the possible efficacy of unilateral DC and the mitigated efficiency of bifrontal DC in the trauma setting. Five systematic reviews meta-analyses (level 2a) supported DC for severely injured young patients with acute subdural hematoma probably responsible for intraoperative brain swelling, while one randomized controlled trial (level 1b) showed comparable efficacy of DC and craniotomy for ASH with intraoperative neutral brain swelling. Three randomized controlled trials (level 1b) and two meta-analyses (level 1a and 3a) supported DC efficacy for malignant ischemic stroke. One systematic review (level 3a) supported DC efficacy for malignant meningoencephalitis. One systematic review meta-analysis (level 3a) supported DC efficacy for malignant cerebral venous thrombosis. The mitigated results of one randomized trial (level 1b) did not allow to conclude for DC efficacy for intracerebral hemorrhage. One systematic review (level 3a) reported the possible efficacy of primary DC and the mitigated efficacy of secondary DC for aneurysmal subarachnoid hemorrhage. Too weak evidence (level 4) precluded from drawing any conclusion for DC efficacy for intracranial tumors.</p><h3>Conclusion</h3><p>To date, there is some scientific background to support clinicians in the decision making for DC for selected cases of severe traumatic brain injury, acute subdural hematoma, malignant ischemic stroke, malignant meningoencephalitis, malignant cerebral venous thrombosis, and highly selected cases of aneurysmal subarachnoid hemorrhage.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}