Neurosurgery最新文献

Background and objectives: Patients with severe brain injury requiring decompressive craniectomy are at increased risk of developing chronic hydrocephalus, often necessitating both cranioplasty and shunt surgery. The optimal sequence of these procedures remains unclear, with limited and conflicting evidence on associated complication rates and outcomes. The aim of this study was to investigate clinical practices and outcomes associated with 3 procedural sequences: (1) cranioplasty before shunt, (2) simultaneous cranioplasty and shunt, and (3) shunt before cranioplasty.

Methods: In this multicenter retrospective cohort study, 99 patients from 4 Swedish neurosurgical centers who underwent both cranioplasty and shunt surgery over 15 years (2008-2022; only the first 10 years at 1 center) were included. Clinical data, surgical details, complications, and functional outcomes (modified Rankin Scale) were analyzed by each sequence group.

Results: Of 99 patients, 37 (37%) underwent cranioplasty before shunt, 37 (37%) had simultaneous procedures, and 25 (25%) received a shunt before cranioplasty. There was no significant difference in complications rates after cranioplasty or shunt surgery between these groups (P > .05). However, shunt before cranioplasty was associated with slightly higher rates of shunt complications (36% revision) but lower rates of cranioplasty removal (8%), whereas the inverse pattern was observed in the cranioplasty before shunt group (24% shunt revision; 30% cranioplasty removal). There was no difference in functional outcomes before or after cranioplasty or shunt surgery between the groups (P > .05).

Conclusion: The sequence of cranioplasty and shunt surgery did not significantly influence overall risks of implant revision or functional outcome, although complication patterns and their clinical severity differed between approaches. Cranioplasty implant removal remains a particularly serious event, while shunt infections can be equally detrimental. Future studies should refine sequencing strategies considering hydrocephalus type, timing, and procedural factors to minimize risk and improve patient outcomes.

Background and objectives: High-resolution ultrasonography (US) has become increasingly popular in cubital tunnel syndrome (CubTS). In this article, we confirmed the diagnostic role of US in a large and homogeneous cohort of patients. Our primary aim was to analyze the predictive role of US findings. By systematically re-evaluating neurosonographic abnormalities over time, we also sought to assess the role of US during follow-up.

Methods: Patients diagnosed with CubTS based on clinical, electrophysiological, and sonography findings and operated on for in situ decompression of the ulnar nerve (UN) at the elbow using the standard surgical technique between 2015 and 2024 were enrolled in this study. Clinical, US, and electrodiagnostic examination data at diagnosis and follow-up were retrospectively analyzed.

Results: One hundred patients were enrolled. Preoperatively, we found a negative correlation between UN motor conduction velocity (MCV) and cross-sectional area (CSA) at the precubital (P < .001) and cubital (P < .001) levels. The mean follow-up was 8.5 months. Clinical outcome defined by the Bishop scale was favorable in 68 patients and poor in 32. At multivariate logistic analysis, preoperative MCV (P < .0001), cubital UN CSA (P = .006), and postcubital CSA (P < .0001) resulted as independent predictors for surgical outcomes. At follow-up, multivariate logistic analysis confirmed the inverse relationship between postoperative cubital CSA and Bishop score (P = .0062) and the direct relationship between postoperative MCV and the clinical outcome (P = .0026).

Conclusion: US allows the depiction of morphological modifications because of chronic nerve compression in CubTS, both in the preoperative and postoperative period: precubital and cubital CSAs provide accurate diagnostic information; postcubital CSA could be considered a good predictor of clinical outcome; postoperative cubital CSA seems to provide important information regarding the UN recovery during follow-up.

Background and objectives: Dual antiplatelet therapy is the gold standard regimen after carotid artery stenting (CAS). However, optimal regimens in patients undergoing this procedure with preexisting conditions requiring anticoagulation remain largely unknown. Here, we compare the safety and efficacy of combining a direct oral anticoagulant (DOAC) with clopidogrel vs aspirin with clopidogrel in patients undergoing CAS.

Methods: We conducted a retrospective cohort comparison study of 469 consecutive patients with carotid artery stenosis who underwent CAS and were prescribed either a DOAC plus clopidogrel or aspirin plus clopidogrel. Propensity scores were generated based on baseline characteristics with an absolute standardized difference of ≥0.20 between cohorts. Patients were matched in a 1:1 ratio using propensity score matching based on the calculated propensity scores. Safety and efficacy outcomes were compared.

Results: The study cohort consisted of 419 patients treated with aspirin and clopidogrel and 50 patients treated with a DOAC and clopidogrel. There was no significant difference in the primary safety outcome, total periprocedural complication rate, between cohorts before and after matching. Overall bleeding complications through femoral access were significantly lower in the DOAC plus clopidogrel group after matching (0.0% vs 11.4%, P = .043). Additional secondary safety outcomes and all efficacy outcomes (symptomatic in-stent stenosis, total in-stent stenosis, and retreatment) were not significantly different between groups.

Conclusion: In this study, we found that a DOAC plus clopidogrel exhibits similar safety and efficacy profiles as compared with aspirin plus clopidogrel for patients undergoing CAS. Although bleeding complications through femoral access were significantly lower in the DOAC plus clopidogrel group, further studies are needed to clarify this finding.

Antony Chipault (1866-1920) was the first French surgeon to devote his entire professional career to the nervous system. A brilliant scholar, polyglot, and accomplished illustrator, he authored monumental textbooks, including the two-volume Chirurgie opératoire du système nerveux (Operative Surgery of the Nervous System, 1894-1895) and the three-volume collaborative treatise L'État actuel de la chirurgie nerveuse (Current State of Neurological Surgery, 1902), which united contributors from 34 countries. His writings-richly illustrated with his own drawings-emphasized cadaveric validation, meticulous anatomic correlation, statistical analysis, and an international perspective uncommon for his time. Between 1896 and 1902, Chipault published an annual review initially entitled Travaux de neurologie chirurgicale (Surgical Neurology Works), which is recognized as the first recurring periodical dedicated to neurosurgery. Clinically, Chipault was among the first in France to perform craniotomies and spinal procedures and among the earliest worldwide to use radiography to localize intracranial foreign bodies. Yet, despite his vision, he failed to convince many contemporaries of the promise of neurological surgery. Forced into early retirement by illness at the age of 39, he died in obscurity in 1920. This historical vignette revisits his life and work, highlighting Chipault's legacy as a visionary who anticipated neurosurgery as a distinct specialty in France decades before its formal recognition.