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Review of treatment modalities and clinical outcome of giant saccular posterior inferior cerebellar artery aneurysms
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-26 DOI: 10.1016/j.neuchi.2025.101674
Andreas Theofanopoulos , Lucas Troude , Katharina Faust , Sajjad Muhammad

Introduction

Giant posterior inferior cerebellar artery (PICA) aneurysms are rare lesions carrying significant morbidity due to mass effect and present therapeutic challenges due to proximity to critical neurovascular structures.

Materials and methods

A systematic literature review through the PubMed and Scopus databases was performed according to the PRISMA guidelines to identify cases of giant PICA aneurysms treated either microsurgically or by endovascular means. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, clinical outcomes as well as follow-up information were retrieved.

Results

Data from 24 studies including 24 patients was obtained. Mean patient age was 53.42 years, with a male-to-female ratio of approximately 1:2. Mean maximum aneurysm diameter was 33.43 mm. A favorable outcome (mRS 0–2) was reported on 66.7% of endovascular and 84.2% of microsurgical cases. Death rate was 0% for endovascular and 5.3% for open cases. The PICA was sacrificed in 33% of the patients without lasting morbidity. 87.5% of the aneurysms were partially thrombosed, 41.7% were debulked due to mass effect and 20.8% required a revascularization procedure.

Conclusions

Giant PICA aneurysms are amenable to both microsurgery and endovascular treatment. The latter may require PICA sacrifice which may be safely attempted in distal aneurysms. Proximal aneurysms which cannot be safely embolized or ones with significant mass effect may benefit from microsurgical occlusion and may require debulking and/or PICA bypass.
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引用次数: 0
From experimental to essential: The evolving role of augmented reality in neurosurgery (2012–2024)
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-23 DOI: 10.1016/j.neuchi.2025.101672
Leonardo Di Cosmo , Jad El Choueiri , Francesca Pellicanò , Hamza Salman , Filippo Colella , Ismail Zaed , Delia Cannizzaro
Recent years have seen augmented reality (AR) transition from experimental to clinical practice. Advancements in hardware, software, and its integration with complementary technologies such as machine learning and robotics have improved its workflow and integration into the neurosurgical environment. This systematic review evaluates shifts in trends in AR adoption in neurosurgery from 2022 to 2024. A systematic review of PubMed was conducted following PRISMA guidelines. Studies published between January 2022 and December 2024 that had direct clinical or educational applications were included. Extracted data included the clinical context and geographical context from each study, and was analyzed with data from a previous systematic review from 2012 to 2021 to assess research evolution. A total of 275 new studies were identified, revealing a substantial increase in AR-related publications. Research trends have shifted towards more clinical embedded topics, particularly centered around neuronavigation (101), education (87), and spinal surgery (70), with the subspecialties exhibiting the most growth being spinal surgery, vascular surgery and neuro-oncology. Research output remained concentrated in high-income countries, led by the United states (53%), Switzerland (18.55%) and the UK (9.45%), reinforcing an expanding global disparity. Topic clustering analysis identified education as a central point of focus across subspecialties. As AR continues to become increasingly integrated within the neurosurgical workflow, future research should emphasize standardizing its clinical implementation and addressing global disparities in access and adoption.
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引用次数: 0
Microsurgical clipping of ruptured basilar artery perforator aneurysms in the endovascular era: A single-center experience
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-08 DOI: 10.1016/j.neuchi.2025.101669
Ahmed Abdelsalam , Soliman Oushy , Alex Lu , Ian A. Ramsay , Jacob Young , Sai Sanikommu , Lorenzo Rinaldo , Atakan Orscelik , Soumya Shrigiri , Luis E. Savastano , Robert M. Starke , Adib A. Abla

Background

Basilar artery perforator aneurysms (BAPAs) are a rare subset of intracranial aneurysms, accounting for <1% of cases. The natural history of BAPAs is unknown, and a standardized management approach is lacking. This report presents the largest cohort of surgically treated BAPAs to date, addressing gaps in the literature and guiding management strategies.

Methods

A single-center retrospective analysis was conducted utilizing a prospectively maintained, IRB-approved database, which included a series of seven consecutive patients treated for BAPAs. The dataset included patient characteristics, surgical details, postoperative outcomes, complication rates, and imaging and clinical follow-up data. It also featured case illustrations.

Results

A total of seven patients were included, all presenting with subarachnoid hemorrhage. The median age was 60 years (IQR: 56.5, 69), and 57% were female. The most common location of the perforators was mid-basilar (43%). Five cases (71.4%) had aneurysms that went undetected on the initial angiogram. All patients underwent microsurgical clipping as their treatment. Post-surgery, oculomotor nerve palsy was observed in four patients (57.1%), and three (42.8%) experienced hemiparesis, which improved during their hospital stay. Follow-up diagnostic angiograms revealed a complete aneurysm occlusion of all aneurysms with no residual filling.

Conclusion

Microsurgical clipping is an effective treatment option for BAPAs when observation and endovascular interventions are not feasible. Treatment decisions should be guided by presentation, aneurysm characteristics, and overall risk profile. A multicenter registry is needed to establish standardized management guidelines. A multidisciplinary, tailored approach is recommended to optimize individual patient outcomes.
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引用次数: 0
Understanding prognostic models: The example of the PHASES score for unruptured intracranial aneurysms
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-05 DOI: 10.1016/j.neuchi.2025.101666
François Zhu , Tim E. Darsaut , Jean Raymond

Background

Prognostic studies may inform individuals about the future course of their disease and help clinical decision making, but problems abound.

Methods

We summarize a study on the natural history of unruptured intracranial aneurysms (UIAs) and review the various steps in the construction of prognostic models. We emphasize the fundamental inductive problems of prognostic studies that attempt to use the backward road from the extension of patients suffering an event to create a new intensional definition of classes of patients at risk.

Results

The first step in a prognostic model is to identify candidate baseline variables to be entered into the model, according to background knowledge, previous studies, and statistical associations with the event of interest. This is a multivariate task. The modeler already knows the outcomes the model is supposed to ‘predict’, so that multiple models are tested against the data until a satisfactory fit is obtained. The variables used to construct the model should not be added in an ad hoc fashion to fit heterogeneous studies. They should be selected in such a fashion as to be exportable outside the study to new patients. An infinite number of models can fit the same data. Thus, the most important step is to validate the prognostic value of the model in patients that were not used to construct the model. In the case of UIAs, this has never been done.

Conclusion

Prognostic studies present multiple problems. Unvalidated models should not be used in clinical practice.
方法我们总结了一项关于未破裂颅内动脉瘤（UIAs）自然史的研究，并回顾了构建预后模型的各个步骤。我们强调了预后研究中的基本归纳问题，这些研究试图利用从罹患某种疾病的患者扩展开来的逆向途径，对高危患者的类别进行新的内涵定义。结果预后模型的第一步是根据背景知识、先前的研究以及与相关事件的统计学关联，确定要输入模型的候选基线变量。这是一项多变量任务。建模者已经知道模型要 "预测 "的结果，因此要根据数据对多个模型进行测试，直到得到满意的拟合结果。用于构建模型的变量不应临时添加，以适应不同的研究。在选择变量时，应使其能够在研究之外输出到新的患者身上。有无数个模型可以拟合相同的数据。因此，最重要的一步是在未用于构建模型的患者中验证模型的预后价值。结论预后研究存在多种问题。未经验证的模型不应在临床实践中使用。
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引用次数: 0
New 3D printed simulator for training of endoscopic transsphenoidal surgery used in a dedicated pituitary course: Comment
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-05 DOI: 10.1016/j.neuchi.2025.101670
Hinpetch Daungsupawong , Viroj Wiwanitkit
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引用次数: 0
Model-based ‘personalized’ care or pragmatic trials?
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-04 DOI: 10.1016/j.neuchi.2025.101668
Jean Raymond , François Zhu , Tim E. Darsaut
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引用次数: 0
Understanding decision making for preventive interventions: The unruptured intracranial aneurysm example
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-04 DOI: 10.1016/j.neuchi.2025.101667
Jean Raymond , François Zhu , Tim E. Darsaut

Background

Decision making for preventive interventions in asymptomatic patients, such as the treatment of incidental intracranial aneurysms, is eminently uncertain and at risk of over-treatment. One approach suggests that the weighing of the natural risk of the disease against the risk of intervention should be replaced by a comparison of outcomes measured as expected quality-adjusted life-years survival.

Methods

We review the problems of over-diagnosis and over-treatment and how prognostic studies can help address the clinical uncertainty. We examine and compare the assumptions that underlie the mathematical transformations that are involved in the so-called outcome-based approach with the risk-based approach when they are both derived from observational data. Finally, we propose a more pragmatic approach.

Results

Both risk-based and outcome-based models depend on two strong assumptions: exchangeability of patients selected to be observed and patients selected to be treated (in other words ignorability of treatment assignment), and ii) dominance of time-to-event data (the only thing pertinent for decision making is the time to the first event in the patient’s history). The outcome-based approach needs an additional assumption: fatality (once a patient suffers a poor outcome from an event, recovery is impossible). These three theoretical assumptions are rarely verified in practice.

Conclusion

Clinical decision-making based on observational data relies on unrealistic assumptions. Clinical practice should instead be guided by conducting pragmatic clinical trials.
{"title":"Understanding decision making for preventive interventions: The unruptured intracranial aneurysm example","authors":"Jean Raymond ,&nbsp;François Zhu ,&nbsp;Tim E. Darsaut","doi":"10.1016/j.neuchi.2025.101667","DOIUrl":"10.1016/j.neuchi.2025.101667","url":null,"abstract":"<div><h3>Background</h3><div>Decision making for preventive interventions in asymptomatic patients, such as the treatment of incidental intracranial aneurysms, is eminently uncertain and at risk of over-treatment. One approach suggests that the weighing of the natural risk of the disease against the risk of intervention should be replaced by a comparison of outcomes measured as expected quality-adjusted life-years survival.</div></div><div><h3>Methods</h3><div>We review the problems of over-diagnosis and over-treatment and how prognostic studies can help address the clinical uncertainty. We examine and compare the assumptions that underlie the mathematical transformations that are involved in the so-called outcome-based approach with the risk-based approach when they are both derived from observational data. Finally, we propose a more pragmatic approach.</div></div><div><h3>Results</h3><div>Both risk-based and outcome-based models depend on two strong assumptions: exchangeability of patients selected to be observed and patients selected to be treated (in other words ignorability of treatment assignment), and ii) dominance of time-to-event data (the only thing pertinent for decision making is the time to the first event in the patient’s history). The outcome-based approach needs an additional assumption: fatality (once a patient suffers a poor outcome from an event, recovery is impossible). These three theoretical assumptions are rarely verified in practice.</div></div><div><h3>Conclusion</h3><div>Clinical decision-making based on observational data relies on unrealistic assumptions. Clinical practice should instead be guided by conducting pragmatic clinical trials.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101667"},"PeriodicalIF":1.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of non-neurological complications on the functional outcome of patients with ruptured intracranial aneurysms
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-03 DOI: 10.1016/j.neuchi.2025.101663
Diego A. Ortega Moreno, Ibrahim Almulhim, Jerry C. Ku, Nicole Cancelliere, Danilo B. Diestro, Julian Spears, Vitor Mendes Pereira

Background

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening pathology associated with significant neurological and non-neurological complications. While the impact of neurological factors has been extensively studied, the impact of non-neurological complications remains underexplored. This study aimed to assess the effect of non-neurological complications on hospital stay and functional outcomes of patients with ruptured intracranial aneurysms (IAs).

Methods

A retrospective cohort study assessed patients with ruptured IAs treated within a neurovascular program of a tertiary hospital between October 2019 and September 2023. Inclusion criteria were: ≥18 years old, confirmed aSAH, and available follow-up information. The primary outcome corresponded to non-excellent functional outcomes at 6- and 12-month follow-ups. Secondary outcomes included length of in-hospital and intensive care unit (ICU) stay. Multivariate logistic regression models, adjusted for age, sex, and baseline World Federation of Neurosurgical Societies (WFNS) scores, were conducted.

Results

A total of 220 patients were included in this study, with a mean age of 56.66 ± 13.79 years; 74.5% were female. The most prevalent non-neurological complications were isolated fever (56.4%), arrhythmias (44.1%), and urinary tract infections (38.6%). Patients with poor neurological presentation had a higher prevalence of non-neurological complications. Pneumonia, pulmonary embolism, hyperglycemia, as well as fever were associated with higher odds of non-excellent functional outcomes (mRS 2–6) at 6- and 12-month follow-ups.

Conclusions

Non-neurological complications significantly impact hospital stay and functional recovery in aSAH patients. Early diagnosis and intervention, as well as the implementation of comprehensive clinical algorithms, are crucial for improving long-term outcomes in patients with ruptured IAs.
{"title":"Effect of non-neurological complications on the functional outcome of patients with ruptured intracranial aneurysms","authors":"Diego A. Ortega Moreno,&nbsp;Ibrahim Almulhim,&nbsp;Jerry C. Ku,&nbsp;Nicole Cancelliere,&nbsp;Danilo B. Diestro,&nbsp;Julian Spears,&nbsp;Vitor Mendes Pereira","doi":"10.1016/j.neuchi.2025.101663","DOIUrl":"10.1016/j.neuchi.2025.101663","url":null,"abstract":"<div><h3>Background</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening pathology associated with significant neurological and non-neurological complications. While the impact of neurological factors has been extensively studied, the impact of non-neurological complications remains underexplored. This study aimed to assess the effect of non-neurological complications on hospital stay and functional outcomes of patients with ruptured intracranial aneurysms (IAs).</div></div><div><h3>Methods</h3><div>A retrospective cohort study assessed patients with ruptured IAs treated within a neurovascular program of a tertiary hospital between October 2019 and September 2023. Inclusion criteria were: ≥18 years old, confirmed aSAH, and available follow-up information. The primary outcome corresponded to non-excellent functional outcomes at 6- and 12-month follow-ups. Secondary outcomes included length of in-hospital and intensive care unit (ICU) stay. Multivariate logistic regression models, adjusted for age, sex, and baseline World Federation of Neurosurgical Societies (WFNS) scores, were conducted.</div></div><div><h3>Results</h3><div>A total of 220 patients were included in this study, with a mean age of 56.66 ± 13.79 years; 74.5% were female. The most prevalent non-neurological complications were isolated fever (56.4%), arrhythmias (44.1%), and urinary tract infections (38.6%). Patients with poor neurological presentation had a higher prevalence of non-neurological complications. Pneumonia, pulmonary embolism, hyperglycemia, as well as fever were associated with higher odds of non-excellent functional outcomes (mRS 2–6) at 6- and 12-month follow-ups.</div></div><div><h3>Conclusions</h3><div>Non-neurological complications significantly impact hospital stay and functional recovery in aSAH patients. Early diagnosis and intervention, as well as the implementation of comprehensive clinical algorithms, are crucial for improving long-term outcomes in patients with ruptured IAs.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101663"},"PeriodicalIF":1.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767868","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
Sport-related concussion in French amateur rugby: A descriptive cross-sectional survey on adult player management, medical care and knowledge
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-04-02 DOI: 10.1016/j.neuchi.2025.101671
Timotey Lagisquet , Hélène Cassoudesalle

Background

The French Rugby Federation (FFR) has established regulations to protect amateur players from the risks of concussions. To assess compliance with the FFR protocol, our objectives were to evaluate players' knowledge in a sample of rugby clubs and to analyze the management of recent concussions, including the rate of concussion reporting to the FFR.

Methods

In this cross-sectional descriptive survey, amateur adult rugby players from FFR-licensed clubs in southwestern France were interviewed during the 2019/2020 and 2021/2022 seasons. Players were asked to complete a questionnaire.

Results

Among the 193 players surveyed, only 27% (n = 52) reported being aware of the return-to-play protocol. Of the 28 players (14.5%) who experienced a recent concussion, just 11 sought medical attention and only 3 of these concussions were officially reported to the FFR. Fewer than half of the players who received guidance on a gradual return to sports followed the recommendations in full.

Conclusion

These findings highlight the need for educational initiatives to raise awareness within clubs.
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引用次数: 0
Rethinking age barriers in Parkinson’s disease for deep brain stimulation
IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Neurochirurgie
Pub Date : 2025-03-27 DOI: 10.1016/j.neuchi.2025.101665
Roberto M. Franco , Carolina Soares , Ana Oliveira , Rui Vaz , Maria J. Rosas

Background

The age cutoff for subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) has been a contentious issue. Typically, it is offered to patients younger than 70 years. This study, however, aims to compare DBS efficacy outcomes between patients with age ≥70 years and those aged <70 years, potentially paving the way for a more inclusive approach to DBS in PD treatment.

Methods

This study is a retrospective, cross-sectional cohort study of PD patients who underwent STN-DBS between 2002 and 2019. The analysis included a comprehensive range of sociodemographic and clinical variables. The primary outcome was the reduction in Movement Disorder Society - Unified Parkinson's Disease Rating Scale part III (MDS-UDPRSIII). The secondary outcome was reduced levodopa equivalent daily dose (LEDD). The statistical analysis was performed in SPSS-25, with a stringent threshold of p < 0.05, to reject the null hypothesis, ensuring the robustness of our findings.

Results

From a cohort of 360 patients with PD who underwent STN-DBS, we included 15 patients 70 years or older with a mean age of 70.4 ± 0.9 years, a mean disease duration of 13.0 ± 2.8 years, and 61 patients younger than 70 years old with a mean age of 61.2 ± 6.6 years; median disease duration of 13.0 [IQR:10.0]. No significant statistical differences were found in the MDS-UPDRS-III score on both groups at the at baseline (p = 0.480), at one year (p = 0.341) and at three years of follow-up (p = 0.117). In both groups, postoperative reduction of LEDD was similar (35.7 [IQR: 33.91] vs 31.6 ± 18.3); (p = 0.960) in patients with age 70 years or older and those younger than 70 years respectively; nevertheless, patients with 70 years or older had higher LEDD at three years (p < 0.001).

Conclusion

Our study found no significant differences in the MDS-UPDRS-III in groups younger and older than 70 at baseline, at one year and at three years of follow-up. However, higher LEDD was necessary in the elderly group. This highlights the urgent need for more inclusive research to better understand the cost-effectiveness of DBS in this population. By conducting such research, we can ensure that all PD patients, regardless of age, have access to the most effective treatments.
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