Neurochirurgie最新文献

Objective: To report the outcomes of transoral C2 osteotomy (or partial odontoidectomy) and posterior fixation, regarding efficacy and safety, in patients with severe irreducible atlantoaxial dislocation (IAAD) following odontoid fracture.

Methods: Transoral C2 osteotomy, soft tissue resection, with or without facet joint release, followed by posterior fixation were performed on 3 patients (2012, 2016, 2023) who were suffering from severe IAAD after an odontoid fracture with spinal cord compression. The radiological and clinical outcomes were then assessed.

Results: All 3 patients had satisfactory release of their spinal cord compression and good reduction of their IAAD. No neurological or vascular complications were reported. No instrumentation failure, radiolucent zone formation around the screws, infection, or recurrence of dislocation were encountered neither. Bony fusion was successfully achieved in every patient.

Conclusion: Transoral C2 osteotomy (or partial odontoidectomy), soft tissue resection, with or without facet joint release, followed by posterior fixation is an effective and reliable method to treat severe IAAD after odontoid fractures.

Background/context: Aneurysmal subarachnoid hemorrhage (aSAH) is a sudden and potentially serious event. Recognized risk factors of aSAH include smoking, high blood pressure, and alcohol consumption. Some studies have reported associations between risk of aSAH and climatic conditions, but no consensus exists. This study aimed to investigate the association between aSAH and meteorological conditions.

Methods: We retrospectively included patients admitted for aSAH at Montpellier University Hospital between 2018-2022. We analyzed the correlation between the occurrence of aSAH and several meteorological factors, including precipitation, temperature, barometric pressure, wind speed, humidity, sunshine duration, and storms, within 24 h and 7 days before symptom onset. We collected meteorological data for days without aSAH cases as controls. A multivariate logistic regression with 10-block cross-validation and a penalty lasso method was performed.

Results: For the 5-year period, 492 patients were analyzed. Incident cases per month in this period was higher in February and August and the highest in winter. Diagnoses were made predominantly between noon and midnight. The multivariate model based on 9 weather variables on the days preceding the aSAH event had an accuracy of 0.55. The area under the curve was 0.58 (95% CI 0.55-0.62). The barometric pressure was similar between aSAH days and the mean of the 5 preceding days.

Conclusion: Due to the low accuracy of the statistical model, our study could not provide evidence of a link between weather variables and occurrence of aSAH. This issue requires further investigation and reliable epidemiological data to fully understand the pathophysiology and real impact of weather on aSAH.

Background: We aim to investigate the potential association between the administration of Lumbosacral epidural steroid injections (LESIs) and the subsequent onset or progression of Lumbosacral epidural lipomatosis (LEL) in patients devoid of established risk factors for LEL.

Methods: We carried out a single-center retrospective study on patients who underwent LESI. We collected demographics including age and gender as well as clinical and radiological characteristics including the type of corticosteroids utilized, the number of LESIs administered, the use of epidural guidance during LESI procedures, and LEL grading. Any patient aged ≥18 years who underwent LESI was included. Exclusion criteria encompassed the absence of magnetic resonance imaging (MRI) data both prior to and following the intervention, presence of endocrinopathies such as Cushing's syndrome or hypothyroidism, diabetes mellitus, and hyperlipidemia.

Results: A total of 3,000 patients were initially screened, 268 patients met the inclusion criteria and were included in the analysis. Mean age was 53.63 years (±12.27), and 50% were male. The predominant treatment administered was methylprednisolone (96.4%). 86% of the patients underwent a single LESI. Fluoroscopy was the guiding modality in 250 (94%) patients. An analysis of LEL grades both before and after LESI revealed variations, with a 7.5% incidence of grade change observed. Logistic regression analysis indicated a trend between male gender and the occurrence of LEL.

Conclusions: Our study emphasizes the relationship between LESIs and the development of LEL and the progression of existing LEL. Further research should investigate this link by conducting larger controlled imaging studies.

Background: Spinal tuberculosis is a common cause of spinal deformity and neurological dysfunction, with surgical treatment being crucial in severe cases. This study evaluates the efficacy and safety of combined anterior and posterior surgery with autologous tricortical iliac bone and rib grafting for treating spinal tuberculosis.

Methods: We included 61 patients with thoracic tuberculosis, who underwent a surgical procedure involving initial posterior correction, followed by anterior debridement and reconstruction with autologous tricortical iliac bone and rib grafts. The surgical outcomes were assessed using preoperative and final follow-up visual analogy scale(VAS) scores, kyphotic Cobb angle, ASIA scores, and radiographic evaluations. Perioperative complications were recorded.

Results: Preoperative VAS scores were 6.65 ± 1.06, significantly decreasing to 2.63 ± 0.94 at the final follow-up (P < 0.001). The kyphotic Cobb angle improved from 26.28°±4.45°preoperatively to 12.05°±2.02°at the final follow-up (P < 0.001). Neurological function improved, with ASIA grade E increasing from 56 patients preoperatively to 59 at follow-up, and all patients achieved bony fusion at the final follow-up. The incidence of perioperative complications was 13.11%, primarily including deep vein thrombosis, superficial wound infections, and urinary tract infections, all of which resolved with symptomatic treatment.

Conclusions: Combined anterior and posterior surgery with autologous tricortical iliac bone and rib grafting is an effective method for treating spinal tuberculosis, significantly alleviating pain, correcting deformity, improving neurological function, and promoting bony fusion.

Background: Vagus nerve stimulation (VNS) is an established surgical option for neuromodulation. Lead failure is a significant complication mainly reported in children.

Methods: We conducted a retrospective review of all VNS-related surgeries for refractory epilepsy in adults performed by a single experienced surgeon at a French national referral center from November 2011 to March 2023. We analyzed lead survival using Kaplan-Meier estimators and calculated failure rates.

Results: The study included 267 patients (144 females, mean age 36.56 years) with a mean follow-up of 4.32 years. Of 235 leads implanted, accumulating 1355 device years, four lead failures (1.74%) were identified. The cumulative 5-year and 10-year lead survival probabilities were 98.14% (95% CI: 96.06%-100%) and 97.33% (95% CI: 94.75%-100%), respectively. The lead failure rate was 0.00295 events per device-year. All lead failures were associated with abnormally high impedance (>10,000 ohms).

Conclusions: This study characterizes technical VNS lead durability, with a failure rate comparable to other neuromodulation devices. Lead longevity is influenced by technical specifications, surgical techniques, and patient-related factors. To optimize lead durability, surgeons should consider the latest technical developments, adhere to best practices, and provide proper patient counseling. Future research should focus on refining lead design and implantation techniques to further improve long-term outcomes.

Purpose: The confluence of laser interstitial thermal therapy (LITT) with immunotherapeutic approaches represents a promising option for managing recurrent brain lesions. However, the potential synergy between these modalities is still unclear. This meta-analysis examines the literature to elucidate the adverse effects and overall survival associated with this combination in treating recurrent brain metastases and glioblastoma.

Methods: Systematic searches were performed on PubMed, Embase, and Web of Science databases. Inclusion criteria comprised studies investigating the combined utilization of LITT with immunotherapy, among adult patients diagnosed with recurrent brain metastases and recurrent glioblastoma. Our analysis, using a random-effects model, pooled Overall Survival (OS) and Adverse events (AEs) from all the included studies.

Results: We analyzed 162 patients from one RCT and three non-randomized studies. The pooled analysis of all patients revealed a median OS of 12.8 months (95% CI = 8.31-17.31; p < 0.01) with the combined treatment of LITT and immunotherapy. Similarly, approximately 6% of patients experienced AEs (95% CI = -0.01-0.11; p = 0.03). Subgroup analysis further demonstrated that among patients with recurrent glioma, the combined treatment showed pooled OS of 11 months (95% CI = 7.13-16.62; p < 0.01), while AEs were observed in 4% of patients (95% CI = -0.02-0.10; p = 0.21).

Conclusion: This meta-analysis showed a potentially comparable safety profile and overall survival to conventional treatment modalities. Further research is warranted to test differences in the incidence of AEs and OS from LITT with immunotherapy versus a control.

Background: Skull-base surgery, including skull-base meningiomas (SBMs), is among the most challenging medical fields which has witnessed leaps in advancement, owing to ever evolving technological and scientific progress. We performed a comprehensive bibliometric analysis and analysis of clinical reports on SBMs to describe the evolution and identify trends and relationships between basic and applied research in the field.

Methods: The study was a qualitative and quantitative bibliometric analysis of SBM research and review of SBM clinical series via a systematic search of the Web of Science for SBM topics and SBM case series. Quantitative analysis included the most cited publications, most productive authors, most cited journals, and number of publications per country. Keyword co-occurrence and co-authorship maps were produced to visualize research hotspots. Data output from the visualization analysis was analyzed qualitatively to identify themes within separate clusters and delineate evolution of clusters across time. Publications were screened to extract clinical reports of at least ten SBM cases to analyze year, type of treatment, country, and sample size in order to use the data to investigate the lag period between research and clinical adaptation of individual treatment modalities.

Results: We identified 3258 publications and 451 series reporting on 33559 cases of SBMs. The United States of America is the leading country in publications and reported number of SBM cases. The most productive authors are active neurosurgeons in their 40s, or older. Among the top cited publications, most are related to endoscopic surgery, followed by research on genomics. Open surgery is the most common treatment modality being reported for SBM cases, however it's prevalence has been on the decrease as more recently there has been a substantial increase in other types of treatment.

Conclusions: Complexity of the field is reflected in the delayed age of peak scientific productivity. Over the past fifty years the SBM research has undergone a rapid expansion and can currently be seen as developing in four separate areas and the efforts are being led by three broadly collaborating research groups. The research-to-clinical routine lag of less than ten years speaks of the dynamic nature of SBM research and treatment.

Background: The recent advent of anti-IDH therapies and changes in the WHO classification of gliomas implies estimating the number of patients who could benefit (or not) from anti-IDH treatment. As published data on the current incidence of different subtypes of IDH-mutant gliomas (based on the latest histomolecular WHO classification) are lacking in many countries. The present analysis aims to review the main factors impacting the incidence of gliomas and lower-grade gliomas and to estimate the incidence and prevalence of IDH-mutant gliomas in France.

Methods: Our analysis was based on data from the French Brain Tumor DataBase and literature.

Results: Case definition, recording methods, histological classifications, age, sex, ethnicity, ancestry, environment, genetics, etc., impact the incidence of gliomas overall and lower-grade gliomas. In France, for the year 2024, the incidence estimates of all gliomas and all adult-type diffuse IDH-mutant gliomas are 6.6/100,000 and 1/100,000 person-years, respectively. The incidence estimates of grades 2, 3, and 4 diffuse IDH-mutant gliomas are 0.5, 0.3, 0.2 per 100,000 person-years, respectively. Of note, the incidence estimate of grade 3 diffuse IDH-mutant glioma versus grade 2 or 4 is slightly more difficult to assess due to the possible variability in histological criteria to define tumor grade. The prevalence of diffuse IDH-mutant grade 2 glioma would be more than 6.57/100,000 persons.

Discussion/conclusion: Our epidemiological analysis provides estimates of potential number of patients, but large prospective real-world studies are required to determine the positioning of anti-IDH treatments among all therapeutic strategies [surgery(ies), chemotherapy(ies), radiotherapy(ies), clinical/radiological follow-up, etc.].

Context: Pituitary Neuroendocrine Tumors are rare in children, but challenging, implying the two purposes to cure the child, and preserve pituitary function. In this paper, we describe our population of children who underwent endoscopic endonasal resection of a pituitary adenoma, in Lille University Hospital.

Patients and methods: Between 2007 and 2021, all children undergoing EEN surgery for pituitary adenoma were included. Age at surgery, surgical course, type of adenoma, knosp grade and extent of resection were collected.

Results: 26 patients were included. 88% were female. All adenomas were functioning. 15 patients had prolactine-secreting adenomas (58%), 9 patients had ACTH-secreting adenomas (35%) and 2 patients had GH-secreting adenomas (8%). Visual disturbance was present at diagnosis in 5 patients. Among them, visual function was improved after surgery in 4 patients and stable in one. Surgical course was always easy. 66% of prolactinomas, all Cushing disease were in remission after surgery. The two patients with acromegaly had to undergo complementary treatment. Follow up was maintained at least 5 years.

Discussion: Surgical treatment remain mainstay in pituitary adenomas. In the pediatric population, surgery can be performed safely and efficiently via en EEN approach.