Neurochirurgie最新文献

英文中文

Meaningful work, organizational commitment and administrative burden among attending neurosurgeons

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-02-13 DOI: 10.1016/j.neuchi.2025.101645

Charles E. Mackel , Brian F. Saway , Ron L. Alterman , Alejandro M. Spiotta , Jennifer A. Sweet , Roger B. Davis , Theresa Williamson , Martina Stippler

Objective

Neurosurgery is regarded as a meaningful career. However, there is no assessment of how many neurosurgeons hold this belief, factors that affect it, or the consequences that follow when neurosurgeons cannot practice in ways they find meaningful. We sought to quantify the neurosurgical experience of meaningful work, evaluate the impact of administrative burden, and relate meaningful work to physician attrition.

Methods

An online survey investigating meaningful work, administrative burden, organizational commitment, and practice patterns was emailed to attending neurosurgeon members of the Congress of Neurological Surgeons.

Results

308 neurosurgeons completed the survey. 85.1% of neurosurgeons reported that they found their career to be meaningful; however, most also reported their administrative burden as excessive (59.4%). Over the past 10 years, 17.2% of neurosurgeons left a position due to excessive administrative burden. On multivariable analysis, increased burnout score correlated with increases in administrative hours outside of work (p = 0.0042), perception of excessive administrative burden (p = 0.0267), and willingness to leave a current position of employment (p = 0.0006). Rising administrative burden trended towards reduced experience of meaningful work (p = 0.062). A positive working relationship with their neurosurgical department enhanced meaningful work (p < 0.0017) and willingness to remain at place of employment (p = 0.0027).

Conclusion

The majority of neurosurgeons find neurosurgery to be a meaningful career. Critical to meaningful work is maintaining a good departmental working relationship and reducing administrative tasks. When neurosurgeons cannot practice their work meaningfully, they risk burnout. Organizations that do not invest in reducing their neurosurgical administrative burdens are at high risk for neurosurgeon attrition.

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引用次数: 0

Highly cited scores, scoring systems, grading systems, and classifications of daily use in cranial neurosurgery: A must-have during residency training! A mini-review

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-02-12 DOI: 10.1016/j.neuchi.2025.101646

Nathan Beucler

Context

Neurosurgery has much evolved since the time of Kocher and Cushing. Thanks to operative microscope, radiation therapy, progress of neuroresuscitation care, and data from evidence-based neurosurgical research, neurosurgery patients’ prognostic has improved. Now more than ever, we need simple, reliable, and reproducible scores, grades, and classifications to assist us in the surgical decision making, to assess patients’ clinical evolution, and to conduct proper neurosurgical research.

Materials and methods

We conducted a three stage scoping review: (1) identification of sections of interest: brain trauma, tumor, vascular, infection, stroke, functional outcome (2) identification of the most common diseases within each section, (3) we retained every score, scale, classification that is internationally recognized and/or highly cited and/or used daily in clinical practice or research setting and/or that is currently used by the author.

Results

23 scores were retained. Brain trauma section: Glasgow coma scale (1974), Glasgow Liège scale (1982), SHE score (2019), RASH score (2022). Tumor section: Karnofsky Performance status (1948), Graded Prognostic Assessment (2008), Simpson grade (1957), Sindou grade (2006), House and Brackmann (1983), Koos grade (1993), Knosp scale (1993). Vascular section: PHASES score (2014), UIATS score (2015), Hunt and Hess scale (1968), Fisher scale (1980), WFNS scale (1988), Spetzler Martin scale (1986), Borden scale (1995), Cognard scale (1995), Zabramski scale (1995). Stroke section: ICH score (2001), NIHSS (1989). Functional outcome section: Rankin scale (1957).

Conclusion

We provide a non-exhaustive list of 23 reference scales, scores, and classifications that can be safely used for cranial neurosurgery clinical practice and research.

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引用次数: 0

Management of vestibular schwannoma during pregnancy: A systematic review

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-02-01 DOI: 10.1016/j.neuchi.2025.101643

Younis Al-Mufargi , Asma AlHosni , Salim Al-kalbani , Tariq Al-Saadi

Objective

This systematic review evaluates the management strategies for vestibular schwannoma (acoustic neuroma) during pregnancy, a rare but significant clinical condition, by synthesizing findings from case reports.

Methods

A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases. Relevant case reports were included based on predefined inclusion and exclusion criteria. Data were extracted on patient demographics, tumor characteristics, clinical symptoms, management strategies, and outcomes.

Results

Thirty-seven cases were included, with a mean patient age of 28.72 years and a mean gestational age at diagnosis of 26.63 weeks. Hearing loss was the most common symptom (92.3%), followed by facial numbness (53.8%) and headache (41%). Tumor sizes ranged from 2.0 to 6.5 cm, with larger tumors associated with increased neurological symptoms. Surgical intervention was performed post-delivery in 78.9% of cases, while 21.1% underwent surgery during pregnancy. Seizures showed a statistically significant difference with the timing of surgery, with one case occurring during pregnancy and none post-delivery (p = 0.05). Most cases were managed conservatively, with surgery deferred until postpartum unless neurological decline or tumor growth warranted earlier intervention.

Conclusions

The management of vestibular schwannoma during pregnancy requires a multidisciplinary approach, balancing maternal and fetal health. Conservative management is generally preferred, with surgical intervention reserved for cases with significant symptoms. Hormonal changes during pregnancy may exacerbate tumor growth, underscoring the need for early diagnosis and careful monitoring. Further research is needed to optimize management guidelines and improve outcomes.

{"title":"Management of vestibular schwannoma during pregnancy: A systematic review","authors":"Younis Al-Mufargi , Asma AlHosni , Salim Al-kalbani , Tariq Al-Saadi","doi":"10.1016/j.neuchi.2025.101643","DOIUrl":"10.1016/j.neuchi.2025.101643","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review evaluates the management strategies for vestibular schwannoma (acoustic neuroma) during pregnancy, a rare but significant clinical condition, by synthesizing findings from case reports.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases. Relevant case reports were included based on predefined inclusion and exclusion criteria. Data were extracted on patient demographics, tumor characteristics, clinical symptoms, management strategies, and outcomes.</div></div><div><h3>Results</h3><div>Thirty-seven cases were included, with a mean patient age of 28.72 years and a mean gestational age at diagnosis of 26.63 weeks. Hearing loss was the most common symptom (92.3%), followed by facial numbness (53.8%) and headache (41%). Tumor sizes ranged from 2.0 to 6.5 cm, with larger tumors associated with increased neurological symptoms. Surgical intervention was performed post-delivery in 78.9% of cases, while 21.1% underwent surgery during pregnancy. Seizures showed a statistically significant difference with the timing of surgery, with one case occurring during pregnancy and none post-delivery (p = 0.05). Most cases were managed conservatively, with surgery deferred until postpartum unless neurological decline or tumor growth warranted earlier intervention.</div></div><div><h3>Conclusions</h3><div>The management of vestibular schwannoma during pregnancy requires a multidisciplinary approach, balancing maternal and fetal health. Conservative management is generally preferred, with surgical intervention reserved for cases with significant symptoms. Hormonal changes during pregnancy may exacerbate tumor growth, underscoring the need for early diagnosis and careful monitoring. Further research is needed to optimize management guidelines and improve outcomes.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101643"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081960","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

Preoperative cervical alignment parameters can predict postoperative disability scores and myelopathy outcomes

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-02-01 DOI: 10.1016/j.neuchi.2025.101642

Murat Baloglu , Hakan Millet , Erdal Yayla , Serdar Ercan

Purpose

This study aims to investigate the relationship between preoperative cervical spine alignment and changes in postoperative myelopathy after surgery in patients with cervical myelopathy who underwent anterior cervical corpectomy and fusion (ACCF) surgery as treatment.

Methods

Patients who underwent anterior cervical corpectomy and fusion surgery for the treatment of cervical myelopathy were included in the study. We evaluated various cervical alignment parameters such as T1 sagittal angle, T1 slope, and C2–7 sagittal vertical axis (SVA) before surgery. Postoperative myelopathy outcomes were assessed using the Modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS). Statistical analysis was performed using Pearson correlation coefficient and multiple linear regression to determine the relationship between preoperative radiological parameters and postoperative clinical outcomes.

Results

There were no significant differences in age, gender, or BMI between the single-level and multilevel corpectomy groups. Significant differences were observed in postoperative C2–7 Cobb angle, operative time, and blood loss. Patients with higher C2–7 SVA had worse operative outcomes.

Conclusion

Preoperative cervical alignment measurements such as T1 slope and C2–7 SVA may be helpful in predicting myelopathy outcomes after ACCF surgery. Predicting the clinical outcomes of the patient after surgery is important for preparing postoperative care and adjusting treatment.

{"title":"Preoperative cervical alignment parameters can predict postoperative disability scores and myelopathy outcomes","authors":"Murat Baloglu , Hakan Millet , Erdal Yayla , Serdar Ercan","doi":"10.1016/j.neuchi.2025.101642","DOIUrl":"10.1016/j.neuchi.2025.101642","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to investigate the relationship between preoperative cervical spine alignment and changes in postoperative myelopathy after surgery in patients with cervical myelopathy who underwent anterior cervical corpectomy and fusion (ACCF) surgery as treatment.</div></div><div><h3>Methods</h3><div>Patients who underwent anterior cervical corpectomy and fusion surgery for the treatment of cervical myelopathy were included in the study. We evaluated various cervical alignment parameters such as T1 sagittal angle, T1 slope, and C2–7 sagittal vertical axis (SVA) before surgery. Postoperative myelopathy outcomes were assessed using the Modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS). Statistical analysis was performed using Pearson correlation coefficient and multiple linear regression to determine the relationship between preoperative radiological parameters and postoperative clinical outcomes.</div></div><div><h3>Results</h3><div>There were no significant differences in age, gender, or BMI between the single-level and multilevel corpectomy groups. Significant differences were observed in postoperative C2–7 Cobb angle, operative time, and blood loss. Patients with higher C2–7 SVA had worse operative outcomes.</div></div><div><h3>Conclusion</h3><div>Preoperative cervical alignment measurements such as T1 slope and C2–7 SVA may be helpful in predicting myelopathy outcomes after ACCF surgery. Predicting the clinical outcomes of the patient after surgery is important for preparing postoperative care and adjusting treatment.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 2","pages":"Article 101642"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081963","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

Empyemas secondary to ENT infections in children before, during and after the COVID-19 pandemic

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-01-29 DOI: 10.1016/j.neuchi.2025.101644

Anthony Joud, Fred Bteich, Irène Stella, Olivier Klein

Objectives

This study aims to analyze a series of cases admitted with intracranial empyema, either subdural or epidural, secondary to otorhinolaryngological (ENT) infections over a period of 10 years, including the COVID-19 pandemic. The incidence, characteristics, severity, and management of these conditions, as well as the influence of COVID-19, are described below.

Methods

The authors conducted a retrospective review of all of the children admitted to the Pediatric Neurosurgery Department of Nancy with intracranial empyemas secondary to a confirmed sinus (sinogenic) or mastoid (otogenic) infection between 2014 and 2024. They recorded their age, clinical presentation, initial Glasgow Coma Scale (GCS) score, bacteriological results, as well as the number and type of neurosurgical procedures they were subjected to, and their clinical outcome. These results were compared across two periods: before, and after the start of the COVID-19 pandemic.

Results

Nineteen children in total were surgically treated, with twelve having a subdural location for their empyema, and seven located exclusively in the epidural compartment. The clinical presentation and evolution were positive in all except for one epidural empyema (6/7), and in the majority of the subdural locations (10/12). Twelve patients (63,16%) were treated after the start of the COVID pandemic, including 11 between 2022 and 2023. No differences were observed in patient characteristics, bacterial population and prognosis between these two periods. No patient was proven positive for COVID-19 at the time of their treatment.

Conclusions

Empyemas secondary to ENT infections are potentially serious pathologies, whose prognosis has clearly improved over the years. The incidence has significantly increased during the COVID-19 pandemic, without changing the characteristics or prognosis of the pathology. This increase mainly took place in the last 2 years of the pandemic in our department. The incidence remains even higher than before 2020.

{"title":"Empyemas secondary to ENT infections in children before, during and after the COVID-19 pandemic","authors":"Anthony Joud, Fred Bteich, Irène Stella, Olivier Klein","doi":"10.1016/j.neuchi.2025.101644","DOIUrl":"10.1016/j.neuchi.2025.101644","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to analyze a series of cases admitted with intracranial empyema, either subdural or epidural, secondary to otorhinolaryngological (ENT) infections over a period of 10 years, including the COVID-19 pandemic. The incidence, characteristics, severity, and management of these conditions, as well as the influence of COVID-19, are described below.</div></div><div><h3>Methods</h3><div>The authors conducted a retrospective review of all of the children admitted to the Pediatric Neurosurgery Department of Nancy with intracranial empyemas secondary to a confirmed sinus (sinogenic) or mastoid (otogenic) infection between 2014 and 2024. They recorded their age, clinical presentation, initial Glasgow Coma Scale (GCS) score, bacteriological results, as well as the number and type of neurosurgical procedures they were subjected to, and their clinical outcome. These results were compared across two periods: before, and after the start of the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>Nineteen children in total were surgically treated, with twelve having a subdural location for their empyema, and seven located exclusively in the epidural compartment. The clinical presentation and evolution were positive in all except for one epidural empyema (6/7), and in the majority of the subdural locations (10/12). Twelve patients (63,16%) were treated after the start of the COVID pandemic, including 11 between 2022 and 2023. No differences were observed in patient characteristics, bacterial population and prognosis between these two periods. No patient was proven positive for COVID-19 at the time of their treatment.</div></div><div><h3>Conclusions</h3><div>Empyemas secondary to ENT infections are potentially serious pathologies, whose prognosis has clearly improved over the years. The incidence has significantly increased during the COVID-19 pandemic, without changing the characteristics or prognosis of the pathology. This increase mainly took place in the last 2 years of the pandemic in our department. The incidence remains even higher than before 2020.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101644"},"PeriodicalIF":1.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076397","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

Current trends and challenges in intracranial aneurysm treatment

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-01-21 DOI: 10.1016/j.neuchi.2025.101640

Harisinh Parmar , Vishal Chavda , Creed M. Stary , Nicola Montemurro

引用次数: 0

Infected psammomatous intracranial meningioma 感染性沙粒性颅内脑膜瘤。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-01-16 DOI: 10.1016/j.neuchi.2025.101639

Monique Boukobza , Augustin Gaudemer , Gueorgui Iacovlev , Dominique Cazals-Hatem , Nathan Peiffer-Smadja , Jean-Pierre Laissy

引用次数: 0

Multimodal use of endoscopy in pain surgery: Overview, applications, and future directions 内窥镜在疼痛手术中的多模式应用：综述、应用和未来方向。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-01-15 DOI: 10.1016/j.neuchi.2025.101634

Rayan Fawaz , Claire Haegelen , Muriel Curtet , Anne-Marie Giner , Audrey Thomas , Patrick Mertens , Manon Duraffourg , Emile Simon

引用次数: 0

Transoral C2 osteotomy for treatment of severe irreducible atlantoaxial dislocation after odontoid fracture: about 3 cases 经口C2截骨治疗齿状突骨折后严重寰枢脱位约3例。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-01-10 DOI: 10.1016/j.neuchi.2025.101637

Daniel Startun , Kaissar Farah , Mikael Meyer , Thomas Graillon , Henry Dufour , Stéphane Fuentes

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.

目的：报道经口C2截骨术（或部分齿状突切除术）和后路固定治疗齿状突骨折后严重不可复位寰枢脱位（IAAD）患者的疗效和安全性。方法：对3例（2012年、2016年、2023年）齿状突骨折合并脊髓压迫后发生严重IAAD的患者行经口C2截骨、软组织切除、小关节松解或不松解后后路固定。然后评估放射学和临床结果。结果：3例患者均获得满意的脊髓压迫解除和良好的IAAD复位。无神经或血管并发症报道。没有发生内固定失败、螺钉周围形成透光区、感染或脱位复发。所有患者均成功实现骨融合。结论：经口C2截骨术（或部分齿状突切除术）、软组织切除术，伴或不伴小关节松解，后路固定是治疗齿状突骨折后重度IAAD的有效、可靠的方法。

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引用次数: 0

Influence of meteorological changes on the occurrence of cerebral aneurysm rupture in the Montpellier region: A retrospective study 气象变化对蒙彼利埃地区脑动脉瘤破裂发生的影响：回顾性研究。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-01-10 DOI: 10.1016/j.neuchi.2025.101630

Camille Desbordes , Vivien Szabo , Frédéric Greco , Kévin Chalard , Cyril Dargazanli , Nicolas Molinari , Eric Matzner , Valérie Macioce , Joana Pissarra , Gérald Chanques , Pierre Francois Perrigault

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.

背景/背景：动脉瘤性蛛网膜下腔出血（aSAH）是一种突发性和潜在的严重事件。公认的aSAH危险因素包括吸烟、高血压和饮酒。一些研究报告了aSAH风险与气候条件之间的联系，但没有达成共识。本研究旨在探讨aSAH与气象条件的关系。方法：回顾性纳入2018-2022年在蒙彼利埃大学医院收治的aSAH患者。我们分析了aSAH的发生与发病前24 h和7 d内降水、温度、气压、风速、湿度、日照时数、风暴等气象因子的相关性。我们收集了没有aSAH病例作为对照的天数的气象数据。采用10块交叉验证和惩罚套索法进行多元逻辑回归。结果：在5年的时间里，分析了492例患者。2月和8月的月发病例数较高，冬季最高。诊断主要在中午到午夜之间进行。基于9个天气变量的多变量预测模型预报精度为0.55。曲线下面积为0.58 （95% CI 0.55 ~ 0.62）。aSAH日的气压与前5天的平均值相似。结论：由于统计模型的准确性较低，我们的研究不能提供天气变量与aSAH发生之间联系的证据。这个问题需要进一步的调查和可靠的流行病学数据，以充分了解天气对aSAH的病理生理和实际影响。

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