Neurochirurgie最新文献

英文中文

The neurosurgeon as athlete, gentleman, and physician: Thierry de Martel (1875–1940) as a model for contemporary practice 作为运动员、绅士和内科医生的神经外科医生：蒂埃里·德·马特尔（1875-1940）是当代实践的典范

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-16 DOI: 10.1016/j.neuchi.2026.101772

Johan Pallud

引用次数: 0

Relational precision in neurosurgery: a patient-safety and liability imperative 神经外科的关系精确：病人安全和责任的当务之急

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-14 DOI: 10.1016/j.neuchi.2026.101769

Fritz Fidel Váscones-Román , Jack Váscones-Román , Gonzalo Jair Callahuanca-Flores , Johnny Alejandro Mendoza-Riega , Adrian Elioth Mendoza-Peréz

引用次数: 0

A contemporary reappraisal of a 1st c. AD. polytrauma on a 65-year-old male from Qumran (Near-East): from archaeology to clinical practice 当代对公元1世纪的重新评估。库姆兰（近东）65岁男性多发外伤：从考古到临床实践

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-13 DOI: 10.1016/j.neuchi.2026.101771

E.M. Conlon , P. Charlier , I. Huynh , V. Reina , J.B. Humbert

引用次数: 0

Intraoperative contrast-enhanced ultrasound-assisted resection of brain tumors: a systematic review and meta-analysis 术中造影增强超声辅助脑肿瘤切除术：一项系统综述和荟萃分析

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-12 DOI: 10.1016/j.neuchi.2026.101774

Márcio Yuri Ferreira , Leonardo Januário Campos Cardoso , Shayan Huda , Netanel Ben-Shalom

Background

Given the critical importance of optimizing the extent of resection (EoR) in brain tumor surgery, intraoperative imaging techniques continue to evolve, enhancing tumor localization and margin delineation to enable maximal safe resection. Among these, intraoperative contrast-enhanced ultrasound (iCEUS) has recently been introduced into neurosurgical practice, with emerging evidence supporting its role in improving EoR. This systematic review and meta-analysis aim to evaluate the impact of iCEUS on the EoR in intracranial tumor surgery.

Methods

The literature was searched for studies on iCEUS use in intracranial tumor resection. The primary endpoints were the gross total resection (GTR) rate among iCEUS patients and its comparison with non-iCEUS patients. The secondary endpoint was the ultrasound contrast agent (UCA)-related adverse events (AEs). Subgroup analyses were performed for all gliomas and specifically for high-grade gliomas (HGG).

Results

Five studies with 193 patients, including 106 (54.1%) undergoing iCEUS-assisted resection, were analyzed. The GTR rate in iCEUS-assisted cases was 81.13% (95% CI: 70.41%–91.84%; I² = 51%), significantly higher than in non-iCEUS cases (OR: 5.37; 95% CI: 2.41–11.97; I² = 0%). Among patients with gliomas (all grades), the GTR rate was 76.12% (95% CI: 58.82%–93.84%; I² = 61%), while in the HGG subgroup, it reached 79.26% (95% CI: 61.39%–97.13%; I² = 37%). No UCA-related AEs were reported.

Conclusion

iCEUS is a valuable intraoperative imaging tool with the potential to improve GTR rates in brain tumor surgery. Further research, particularly randomized controlled trials, is needed to clarify its impact on resection and survival outcomes across tumor types and to establish its comparative effectiveness against other intraoperative imaging modalities.

鉴于优化脑肿瘤手术切除范围（EoR）的重要性，术中成像技术不断发展，增强肿瘤定位和边界划定，以实现最大限度的安全切除。其中，术中对比增强超声（iCEUS）最近被引入神经外科实践，越来越多的证据支持其在提高EoR中的作用。本系统综述和荟萃分析旨在评估iCEUS对颅内肿瘤手术EoR的影响。方法查阅相关文献，了解超声在颅内肿瘤切除术中的应用。主要终点是iCEUS患者的总切除率（GTR）及其与非iCEUS患者的比较。次要终点是超声造影剂（UCA）相关不良事件（ae）。对所有胶质瘤进行亚组分析，特别是对高级别胶质瘤（HGG）。结果我们分析了5项研究193例患者，其中106例（54.1%）接受了iceus辅助切除。iceus辅助下的GTR率为81.13% (95% CI: 70.41% ~ 91.84%; I2 = 51%)，显著高于非iceus组（OR: 5.37; 95% CI: 2.41 ~ 11.97; I2 = 0%）。胶质瘤（所有级别）患者的GTR率为76.12% (95% CI: 58.82%-93.84%; I2 = 61%)，而HGG亚组的GTR率为79.26% （95% CI: 61.39%-97.13%; I2 = 37%）。无uca相关ae报告。结论超声造影是一种有价值的术中成像工具，可提高脑肿瘤手术的GTR率。需要进一步的研究，特别是随机对照试验，来阐明其对不同肿瘤类型的切除和生存结果的影响，并确定其与其他术中成像方式的比较有效性。

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引用次数: 0

Modern concepts of CSF disorders in monosutural craniosynostosis 单侧颅缝闭合症脑脊液紊乱的现代概念

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-12 DOI: 10.1016/j.neuchi.2026.101773

Paolo Frassanito , Marco Galeazzi , Gianpiero Tamburrini

Introduction

Although hydrocephalus is randomly encountered in monosutural craniosynostosis (CS), CSF disorders may present more subtly and accompany these pictures. Indeed, dilation of subarachnoid spaces is frequently reported. The pathogenesis of these disorders is still under debate, as well as their prognostic significance.

Methods

A thorough review of the literature has been performed. Accordingly, pathogenic theories, eventual impact of surgical strategy, and prognostic significance are discussed.

Results

Most data come from scaphocephaly and trigonocephaly. Focal dilation of subarachnoid spaces is the most encountered CSF disorder in monosutural CS, followed by general dilation of subarachnoid spaces. Arachnoid cysts are exclusively associated to trigonocephaly. On the other side, overt hydrocephalus is a fortuitous occurrence, its pathogenesis being unrelated to monosutural CS. Pathogenesis of these CSF disorders has been related to CSF malabsorption, secondary to venous hypertension, and compensatory phenomenon. However, it is likely that local mechanisms, namely local venous hypertension and passive expansion, may better explain these pictures. Dilation of subarachnoid spaces usually resolve or at least improve after cranial remodeling and expansion. On the other side, arachnoid cysts may enlarge after fronto-orbital advancement.

Conclusions

Future study should clarify the pathogenesis of CSF disorder in monosutural CS and possibly assess the risk of raised intracranial pressure if the CS is left untreated. Furtherly, the impact on timing and surgical strategy should be carefully explored.

虽然脑积水在单缝颅缝闭闭（CS）中是随机出现的，但脑脊液疾病可能更微妙地出现并伴随这些图像。事实上，蛛网膜下腔扩张经常被报道。这些疾病的发病机制及其预后意义仍在争论中。方法对相关文献进行全面复习。因此，致病理论，最终影响的手术策略，和预后意义进行了讨论。结果大部分数据来自舟头和三角头。蛛网膜下腔的局灶性扩张是单缝CS中最常见的脑脊液紊乱，其次是蛛网膜下腔的全局性扩张。蛛网膜囊肿只与三角头有关。另一方面，明显的脑积水是偶然发生的，其发病机制与单缝合线CS无关。这些脑脊液疾病的发病机制与脑脊液吸收不良、继发于静脉高压和代偿现象有关。然而，可能是局部机制，即局部静脉高压和被动扩张，可以更好地解释这些图片。蛛网膜下腔的扩张通常在颅骨重塑和扩张后消退或至少改善。另一方面，蛛网膜囊肿可在额眶推进后扩大。结论未来的研究应阐明单缝脑脊液紊乱的发病机制，并可能评估脑脊液未经治疗后颅内压升高的风险。此外，应仔细探讨对时机和手术策略的影响。

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引用次数: 0

Telesurgery in neurosurgery: An emerging tool to close – or widen – the global equity gap? 神经外科中的远程手术：一种新兴的工具来缩小或扩大全球公平差距？

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 DOI: 10.1016/j.neuchi.2025.101765

Fritz Fidel Váscones-Román , Gonzalo Jair Callahuanca-Flores , Johnny Alejandro Mendoza-Riega

引用次数: 0

Systematic intraoperative bacteriological testing in patients operated for primary chronic subdural hematoma – A prospective analysis 原发性慢性硬膜下血肿患者的系统性术中细菌学检查——一项前瞻性分析

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-12-19 DOI: 10.1016/j.neuchi.2025.101766

Kevin Comair , Adrien Galy , Karim Chirani , Tania Idriceanu , Hela Krimi , Amel Marniche , Anne-Sophie Montero , Lyes Rabia , Suhan Senova , Sanaa Tazi , Stéphane Palfi , Vincent Fihman , Paul-Louis Woerther , Florence Reibel , Caroline Apra

Introduction

Chronic subdural hematomas (CSDH), with an incidence of 20/100,000/year, often necessitates surgical intervention. Recurrence requiring redo surgery occurs in 12% of patients. This study aims to assess the presence of bacteria in CSDH by systematically collecting multiple tissue samples and analyzing the association between positive cultures, prognosis, and recurrence.

Methods

This prospective single-center study was conducted at Henri Mondor University Hospital, France, between January 2023 and June 2024. Adult patients operated for CSDH were included. Clinical, radiological, and microbiological data were analysed with a 6-months follow-up. Surgery involved burr-hole or mini-craniotomy with systematic postoperative drainage. Three independent subdural samples were collected intraoperatively.

Results

Eighty patients were included. Recurrence occurred in 20% of patients, with a median time to redo surgery of 15 days. Subdural germs were detected in 21% of patients, with a majority of positive samples in 53% and a majority of negative samples in 47%. The most common bacteria were Cutibacterium acnes and Staphylococcus species. No correlation was found between germ detection and hematoma recurrence or death. No patient developed postoperative empyema.

Discussion

This study is the first to report systematic bacteriological testing of subdural collection. Detection of skin microbiota bacteria was not uncommon, but there was no significant increase in recurrence if bacteria were detected. The findings suggest that bacterial contamination rather than infection is more likely.

Conclusion

Clinically inapparent infection of subdural hematoma is not common and should not be explored systematically. The decision to treat with antibiotics should be based on multiple positive bacterial samples and clinical data.

慢性硬膜下血肿（CSDH）的发病率为20/10万/年，通常需要手术治疗。复发需要重做手术的患者占12%。本研究旨在通过系统收集多个组织样本，分析阳性培养物、预后和复发之间的关系，评估CSDH中细菌的存在。方法本前瞻性单中心研究于2023年1月至2024年6月在法国亨利蒙多大学医院进行。包括因CSDH手术的成年患者。在6个月的随访中分析了临床、放射学和微生物学数据。手术包括钻孔或小开颅，术后系统引流。术中采集三个独立的硬膜下样本。结果共纳入80例患者。20%的患者出现复发，重做手术的中位时间为15天。在21%的患者中检测到硬膜下细菌，阳性样本占53%，阴性样本占47%。最常见的细菌是痤疮角质杆菌和葡萄球菌。细菌检测与血肿复发或死亡无相关性。术后无患者发生脓胸。本研究首次报道了硬膜下收集物的系统细菌学检测。皮肤微生物群细菌的检测并不罕见，但如果检测到细菌，复发率没有显著增加。研究结果表明，细菌污染而不是感染的可能性更大。结论临床上硬膜下血肿隐性感染并不常见，不应系统探讨。使用抗生素治疗的决定应基于多个阳性细菌样本和临床数据。

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引用次数: 0

Outcomes for Patients Undergoing Burr Holes for Subdural Hematoma Evacuation versus Craniotomies in the Middle Meningeal Artery Embolization Era 在中脑膜动脉栓塞时代，硬膜下血肿钻孔引流术与开颅术的疗效比较。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-12-17 DOI: 10.1016/j.neuchi.2025.101762

Richard Cook, Laura Zima, Ryan Kitagawa

Introduction

Middle meningeal artery embolization (MMAE) has become increasingly utilized for the management of non-acute subdural hematomas (SDH). However, there is minimal literature comparing outcomes between patients undergoing burr holes versus craniotomy in conjunction with MMAE.

Methods

All patients undergoing craniotomy or burr hole operation for SDH with subsequent MMAE during the same admission within a 3-year period were included (n = 135). Binary logistic regression was used to assess association of craniotomy with SDH reoperation. Continuous and ordinal data were analyzed via Wilcoxon rank-sum test, and categorical data were analyzed via chi-squared test.

Results

Chi-squared analysis demonstrated no significant difference in SDH reoperation within 90 days based on surgical management. Further, 90-day readmission, length of stay, GCS, and modified Rankin Scale (mRS) at discharge were comparable between groups. Mean estimated blood loss was higher among those undergoing craniotomy compared to those undergoing burr holes (P = 0.042). Craniotomies also had longer surgery duration compared to burr holes (P < 0.001). Binary logistic regression showed no association between craniotomy and reoperation.

Conclusion

Among patients with SDH undergoing MMAE, there were no significant observed differences in outcomes between burr hole and craniotomy. These findings suggest that when the patient needs surgical evacuation in conjunction with MMAE, and SDH consistency is amenable to burr holes, this less invasive procedure may be considered.

脑膜中动脉栓塞术（MMAE）已越来越多地用于治疗非急性硬膜下血肿（SDH）。然而，很少有文献比较接受钻孔术与开颅术联合MMAE患者的结果。方法：选取3年内同一次住院期间接受SDH开颅或钻孔手术并随后MMAE的所有患者（n = 135）。采用二元logistic回归评估开颅手术与SDH再手术的关系。连续和有序资料采用Wilcoxon秩和检验，分类资料采用卡方检验。结果：卡方分析显示，根据手术处理，90天内SDH再手术无显著差异。此外，90天再入院、住院时间、出院时GCS和修正Rankin量表（mRS）在两组之间具有可比性。开颅术患者的平均估计失血量高于钻孔术患者（P = 0.042）。开颅术的手术时间也比钻孔术长（P < 0.001）。二元logistic回归分析显示开颅手术与再手术无相关性。结论：行MMAE的SDH患者，钻孔与开颅在预后上无显著差异。这些研究结果表明，当患者需要联合MMAE进行手术抽吸，并且SDH一致性适合钻孔时，可以考虑采用这种侵入性较小的手术。

{"title":"Outcomes for Patients Undergoing Burr Holes for Subdural Hematoma Evacuation versus Craniotomies in the Middle Meningeal Artery Embolization Era","authors":"Richard Cook, Laura Zima, Ryan Kitagawa","doi":"10.1016/j.neuchi.2025.101762","DOIUrl":"10.1016/j.neuchi.2025.101762","url":null,"abstract":"<div><h3>Introduction</h3><div>Middle meningeal artery embolization (MMAE) has become increasingly utilized for the management of non-acute subdural hematomas (SDH). However, there is minimal literature comparing outcomes between patients undergoing burr holes versus craniotomy in conjunction with MMAE.</div></div><div><h3>Methods</h3><div>All patients undergoing craniotomy or burr hole operation for SDH with subsequent MMAE during the same admission within a 3-year period were included (n = 135). Binary logistic regression was used to assess association of craniotomy with SDH reoperation. Continuous and ordinal data were analyzed via Wilcoxon rank-sum test, and categorical data were analyzed via chi-squared test.</div></div><div><h3>Results</h3><div>Chi-squared analysis demonstrated no significant difference in SDH reoperation within 90 days based on surgical management. Further, 90-day readmission, length of stay, GCS, and modified Rankin Scale (mRS) at discharge were comparable between groups. Mean estimated blood loss was higher among those undergoing craniotomy compared to those undergoing burr holes (P = 0.042). Craniotomies also had longer surgery duration compared to burr holes (P < 0.001). Binary logistic regression showed no association between craniotomy and reoperation.</div></div><div><h3>Conclusion</h3><div>Among patients with SDH undergoing MMAE, there were no significant observed differences in outcomes between burr hole and craniotomy. These findings suggest that when the patient needs surgical evacuation in conjunction with MMAE, and SDH consistency is amenable to burr holes, this less invasive procedure may be considered.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101762"},"PeriodicalIF":1.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783666","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}

引用次数: 0

Idiopathic normal pressure hydrocephalus and caregiver burden 特发性常压脑积水和照顾者负担。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-12-16 DOI: 10.1016/j.neuchi.2025.101761

James Kelbert , Ashley Kern , Robert W Bina , Ganesh Murthy

引用次数: 0

Efficacy and Safety of Stereotactic Radiosurgery for Cerebellopontine Angle Meningiomas: A Systematic Review and Meta-Analysis 立体定向放射治疗桥小脑角脑膜瘤的疗效和安全性：一项系统评价和荟萃分析：运行标题：SRS治疗CPA脑膜瘤。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-12-13 DOI: 10.1016/j.neuchi.2025.101763

Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Dorsa Najari , Azin Ebrahimi , Mohammadamin Sabbagh Alvani , Alireza Kooshki , Fatemeh Ghorbanpouryami , Ehsan Bahrami Hezaveh , Mohammad Amin Habibi

Background

Management of cerebellopontine angle (CPA) meningiomas is challenging due to their proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) has been increasingly utilized for the management of individuals with CPA meningiomas; however, the comprehensive data on its effectiveness and safety profile are limited.

Methods

A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. The local control (LC), progression-free survival (PFS), serviceable hearing preservation (SHP), facial nerve (FN) deterioration, trigeminal nerve (TN) deterioration, and adverse radiation effects (ARE) pooled estimates following SRS were calculated using R software.

Results

Thirteen studies, including 604 individuals with CPA meningioma, were included. The meta-analysis revealed a pooled LC rate of 98% (95% CI: 96–99%), 1-year PFS of 100% (95% CI: 100–100%), and 5-year PFS of 94% (95% CI: 81–100%) following SRS. The meta-analysis demonstrated a pooled SHP rate of 96% (95% CI: 86–100%). FN deterioration of 0% (95% CI: 0–2%), and TN deterioration of 1% (95% CI: 0–2%) with a pooled ARE rate of 1% (95% CI: 0–3%). The Meta-regression showed that greater prescribed doses and cochlear doses were correlated with lower SHP and higher ARE rates.

Conclusion

SRS provides a promising LC with functional outcomes concurrent with a favorable safety profile for CPA meningiomas. SRS should be considered as a primary option or as an adjunct to subtotal resection in CPA meningiomas.

背景：桥小脑角（CPA）脑膜瘤的治疗具有挑战性，因为它们靠近关键的神经血管结构。立体定向放射外科（SRS）已越来越多地用于治疗CPA脑膜瘤；然而，关于其有效性和安全性的综合数据有限。方法：根据PRISMA指南进行系统评价和荟萃分析。使用R软件计算SRS后的局部控制（LC）、无进展生存（PFS）、可用听力保存（SHP）、面神经（FN）恶化、三叉神经（TN）恶化和不良辐射效应（ARE）汇总估计。结果：纳入13项研究，包括604例CPA脑膜瘤患者。荟萃分析显示，SRS后合并LC率为98% (95% CI: 96-99%)， 1年PFS为100% (95% CI: 100-100%)， 5年PFS为94% （95% CI: 81-100%）。荟萃分析显示合并SHP率为96% （95% CI: 86-100%）。FN恶化为0% (95% CI: 0-2%)， TN恶化为1% (95% CI: 0-2%)，合并ARE率为1% （95% CI: 0-3%）。meta回归显示，较大的处方剂量和耳蜗剂量与较低的SHP和较高的ARE率相关。结论：SRS为CPA脑膜瘤提供了一种有前景的LC，具有功能结果和良好的安全性。SRS应作为CPA脑膜瘤次全切除术的主要选择或辅助选择。

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