Neurochirurgie最新文献

英文中文

Diffuse axonal injury unveiling white matter tracts anatomy 弥漫性轴索损伤揭示白质束解剖

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-06-04 DOI: 10.1016/j.neuchi.2025.101690

Antoine Do tran , Charlotte Kelway , Aurore Sellier , Arnaud Dagain , Nathan Beucler

引用次数: 0

Surgical outcomes of ventriculoperitoneal shunts in the Gaza Strip: Insights from a conflict zone and low-resource setting 加沙地带脑室-腹膜分流术的手术结果：来自冲突地区和低资源环境的见解

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-06-04 DOI: 10.1016/j.neuchi.2025.101692

Baker Abojarad , Belal Aldabbour

Background

The Gaza Strip is a low-income, chronically unstable region. This study evaluates the outcomes of first VP shunt placements at the area’s largest tertiary hospital.

Methods

A retrospective study conducted at Shifa Medical Complex in the Gaza Strip examined VP shunts inserted between January 2020 and July 2022. The primary outcome was the shunt failure rates in the first year, while secondary outcomes included the causes of failure and surgical complications. The Chi-square test was used to assess the relationship between risk factors and failure rates. Univariate logistic regression analyzed the link between the duration of post-operative antibiotics and shunt failure rates.

Results

A total of 103 patients were included, with a median age of 11 months. Congenital hydrocephalus accounted for 60.2% of the etiologies. Failure rates were 7.8%, 19.4%, and 26.2% at one, six, and twelve months, respectively. Obstruction and infection were the commonest causes of initial (62.9% and 25.9%) and overall (46.2% and 36.5%) shunt failures. Failure risk increased with elective surgeries, surgeries performed by residents, congenital hydrocephalus, and in the 12-month or younger age group (p < 0.001, p = 0.035, p = 0.02, p < 0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most commonly isolated bacteria. No significant association was found between the duration of postoperative IV antibiotics and the one-year shunt failure rate.

Conclusion

The outcomes of VP shunt surgery at Gaza’s largest tertiary center from 2020 to 2022 aligned with global trends. Prolonged IV antibiotics did not lower revision or complication rates.

加沙地带是一个低收入、长期不稳定的地区。本研究评估了该地区最大的三级医院首次VP分流安置的结果。方法在加沙地带Shifa医疗中心进行的一项回顾性研究检查了2020年1月至2022年7月期间插入的副静脉分流器。主要结果是第一年的分流失败率，而次要结果包括失败的原因和手术并发症。采用卡方检验评估危险因素与失败率之间的关系。单变量logistic回归分析了术后抗生素使用时间与分流管失败率之间的关系。结果共纳入103例患者，中位年龄11个月。先天性脑积水占病因的60.2%。1个月、6个月和12个月的失败率分别为7.8%、19.4%和26.2%。梗阻和感染是最初（62.9%和25.9%）和总体（46.2%和36.5%）分流失败最常见的原因。选择性手术、住院医师手术、先天性脑积水以及12个月及以下年龄组的手术失败风险增加(p <；0.001, p = 0.035, p = 0.02, p <；0.001)。金黄色葡萄球菌和表皮葡萄球菌是最常见的分离细菌。术后静脉抗生素使用时间与1年分流失败率无显著相关性。结论2020年至2022年在加沙最大的三级中心进行副静脉分流手术的结果与全球趋势一致。延长静脉注射抗生素并没有降低翻修率或并发症发生率。

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引用次数: 0

Lumbar or ventricular external drainage for cerebrospinal fluid drainage in traumatic brain injury? Timing first, technique second 外伤性脑损伤脑脊液引流采用腰椎或脑室外引流？时机第一，技术第二

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-06-03 DOI: 10.1016/j.neuchi.2025.101689

Jean-Denis Moyer , Thomas Gaberel , Jonathan Charbit

引用次数: 0

Vestibular Schwannoma in Pregnancy: When Case Reports Become Clinical Compass 妊娠期前庭神经鞘瘤：当病例报告成为临床指南

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-05-27 DOI: 10.1016/j.neuchi.2025.101687

Vangipuram Shankar , Siddhartha Ghosh , Vangipuram Harshil Sai

引用次数: 0

Changes in patient-perceived balance and vestibular function after Gamma-knife stereotactic radiosurgery for vestibular schwannoma: 12-month outcomes in a single-centre pilot study 伽玛刀立体定向放射治疗前庭神经鞘瘤后患者感知平衡和前庭功能的变化：一项单中心先导研究的12个月结果

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-05-23 DOI: 10.1016/j.neuchi.2025.101688

Nadia El Fassi , Yohan Gallois , Olivier Deguine , Jacqueline Butterworth , Jean-François Sabatier , Oumar Sacko , Yassine Beltaïfa , Igor Latorzeff , Jean-Albert Lotterie , Sergio Boetto , Jean-Christophe Sol , Mathieu Marx

Background

Hearing outcomes are well-documented for patients with vestibular schwannoma (VS) treated with Gamma Knife stereotactic radiosurgery (GK-SRS). However, how GK-SRS affects patient-perceived balance and vestibular function remains unclear. This study therefore evaluated changes in these parameters one-year post-treatment.

Methods

A prospective, observational, before-and-after, pilot study was conducted on patients with unilateral VS treated with GK-SRS between June 2021 and July 2022. Balance-related handicap was assessed using the Dizziness Handicap Inventory (DHI). Objective vestibular function was evaluated through caloric tests and video head impulse tests (VHIT). Data were compared before treatment (0 M) and 12 months after treatment (12 M).

Results

Thirty-eight patients were included (median age 69 years, 52.6% male). Median total DHI scores significantly deteriorated (14 [5; 24] at 0 M vs. 18 [8;40] at 12 M, p = 0.027), with an increase in cases classed with moderate handicap (12%–29%, p = 0.025). We found a significant deterioration in median caloric deficit at low frequency (49 [29; 78]% vs. 72 [40; 87]%; p = 0.012) and a significant deterioration in median vestibulo-ocular reflex (VOR) gain of the anterior semicircular canal (SSC) at high frequency (0.94 [0.86;1.04] vs. 0.9 [0.72;0.98]; p = 0.012). Change in DHI score was only found weakly inversely correlated with change in VOR gain for the affected-side posterior SSC (r = −0.38; p = 0.04).

Conclusion

GK-SRS for VS can result in modest deterioration in subjective balance after one year. Changes in DHI were not strongly correlated with objective vestibular function deficits thus suggesting other factors can contribute to dizziness and balance outcomes.

背景：前庭神经鞘瘤（VS）患者接受伽玛刀立体定向放射手术（GK-SRS）治疗的听力结果有充分的文献记载。然而，GK-SRS如何影响患者感知的平衡和前庭功能仍不清楚。因此，本研究评估了治疗一年后这些参数的变化。方法：对2021年6月至2022年7月期间接受GK-SRS治疗的单侧VS患者进行前瞻性、观察性、前后对照的试点研究。使用眩晕障碍量表（DHI）评估与平衡相关的障碍。目的通过热量测试和视频头脉冲测试（VHIT）评估前庭功能。比较治疗前（0 M）和治疗后12个月（12 M）的数据。结果：纳入38例患者（中位年龄69岁，男性52.6%）。DHI总分中位数显著恶化(14 [5；[8；40]在12 M时，p = 0.027)，中度残疾的病例增加（12%至29%，p = 0.025）。我们发现，在低频率时，中位热量赤字显著恶化(49 [29；78 % vs 72 [40；87] %;p = 0.012)，高频前半规管（SSC）的前庭-眼正中反射（VOR）增益显著下降(0.94[0.86;1.04]vs 0.9[0.72;0.98]；p = 0.012)。DHI评分的变化仅与后侧SSC受累侧VOR增益的变化呈弱负相关(r=-0.38；p = 0.04)。结论：GK-SRS治疗VS可导致一年后主观平衡轻度恶化。DHI的变化与客观前庭功能缺陷没有很强的相关性，因此表明其他因素可能导致头晕和平衡结果。

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引用次数: 0

Neurosurgical management of the acute phase of adult and pediatric traumatic brain injury 成人和儿童创伤性脑损伤急性期的神经外科治疗。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-05-23 DOI: 10.1016/j.neuchi.2025.101686

Romain Manet , Hugues de Courson , Cyrille Capel , Christophe Joubert , Nathalie Chivoret , Matthieu Faillot , Baptiste Balanca , Alexandre Bani-Sadr , Mickael Cardinale , Andres Coca , François Cotton , Pierre Esnault , Clémentine Gallet , Sébastien Gazzola , Stéphane Goutagny , Vincent Jecko , Marion le Marechal , Jacques Luauté , Guillaume Mortamet , Jean-Denis Moyer , Arnaud Dagain

Objective

To develop a multidisciplinary French framework addressing neurosurgical management in the initial phase of traumatic brain injury (TBI) in adults and children.

Design

A panel of 29 experts was formed at the request of the French Society of Neurosurgery (SFNC), with the participation of the French Society of Pediatric Neurosurgery (SFNCP), French Society of Private-Practice Neurosurgeons (SFNCL), French-Speaking Neurocritical Care and Neuro-Anesthesiology Society (ANARLF), French Society of Anesthesia, Critical Care and Perioperative Medicine (SFAR), French-Speaking Pediatric Emergency and Intensive Care Group (GFRUP), French Society of Neuroradiology (SFNR), French-Speaking Infectious Diseases Society (SPILF), and the French Society of Physical Medicine and Rehabilitation (SOFMER).

Methods

Questions were formulated using the PICO (Patients, Intervention, Comparison, Outcome) format, grouped into 7 categories: 1. Factors of poor prognosis, 2. Extradural hematoma, 3. Acute subdural hematoma, 4. Skull-base fracture and dural tear, 5. Penetrating traumatic brain injury, 6. Post-traumatic cerebrospinal fluid disorder, and 7. Pediatric specificities.

Results

Synthesis by the experts and application of the GRADE® method resulted in the formulation of 45 recommendations. Strong consensus was reached for all recommendations at the first round of rating,

Conclusion

There was a strong consensus among the experts on important interdisciplinary recommendations to improve the neurosurgical management of patients with TBI.

目的：建立一个多学科的法国框架，解决成人和儿童创伤性脑损伤（TBI）初始阶段的神经外科治疗问题。设计:应法国神经外科学会（SFNC）的要求，组成了一个由29名专家组成的小组，其中包括法国儿科神经外科学会（SFNCP）、法国私人执业神经外科医生学会（SFNCL）、法语神经危重症护理和神经麻醉学学会（ANARLF）、法国麻醉、危重症护理和围手术期医学学会（SFAR）、法语儿科急诊和重症监护组（GFRUP）、法国神经放射学会（SFNR）、法语传染病学会（SPILF）和法国物理医学和康复学会（SOFMER）。方法：采用PICO（患者、干预、比较、结果）格式进行问卷调查，问卷分为7类：1。2.预后不良因素；3.硬膜外血肿；急性硬膜下血肿，4。颅底骨折和硬脑膜撕裂，5例。6.穿透性创伤性脑损伤；创伤后脑脊液紊乱，7。小儿特异性。结果：通过专家的综合和GRADE®方法的应用，形成了45条建议。结论：专家们对改善TBI患者神经外科治疗的重要跨学科建议达成了强烈的共识。

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引用次数: 0

Understanding what ‘what we do’ does 理解“我们在做什么”是有帮助的

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-05-20 DOI: 10.1016/j.neuchi.2025.101685

Jean Raymond , George Nilton Nunes Mendes , Tim E. Darsaut

引用次数: 0

Understanding the meaning of care trials and why they are essential to good practice: An example from ISAT-2 on ruptured aneurysms 了解护理试验的意义及其对良好实践至关重要的原因：ISAT-2对动脉瘤破裂的一个例子

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-05-19 DOI: 10.1016/j.neuchi.2025.101684

Jean Raymond , George Nilton Nunes Mendes , Tim E. Darsaut

Background

The research-care separation encourages clinicians to experiment without methods within the care context and trialists to design studies that may not properly inform practice. Care trials integrated into practice may solve these problems.

Methods

We first discuss clinical decision-making for SAH patients prior to the ISAT trial which compared surgery with coiling, and how the ISAT results changed practices. We then review the ISAT-2 care trial and its impact on practice in the presence of clinical uncertainty.

Results

Historically, ruptured aneurysms were treated with surgical clipping, with endovascular treatment limited to patients judged difficult to clip. ISAT was a turning point when it showed that many patients routinely treated with surgery would have better outcomes with coiling. With the proliferation of new endovascular devices, practices evolved and more patients could be treated endovascularly, but uncertainty regarding best management remained for numerous ruptured aneurysm patients that were not part of ISAT. Practicing under uncertainty, outside of a trial, is like performing research without methods within care. Without a scientific method of assessment, the notion of good surgical care is impossible to define, so ISAT-2 was designed. After 10 years, ISAT-2 remained inconclusive, but because the trial balanced risks for each patient, practicing within ISAT-2 provided the opportunity to realize that trial methods optimized care in real-time, long before conclusive results could be shown.

Conclusion

Care trials are integral to a good clinical practice, whether they provide final results or not. The research-care separation should be revised to encourage care research.

研究-护理分离鼓励临床医生在护理背景下进行没有方法的实验，并鼓励试验学家设计可能无法正确告知实践的研究。与实践相结合的护理试验可以解决这些问题。方法我们首先讨论ISAT试验前SAH患者的临床决策，比较手术与盘绕术，以及ISAT结果如何改变实践。然后我们回顾了ISAT-2护理试验及其在临床不确定性存在下对实践的影响。结果以往动脉瘤破裂均采用手术夹闭治疗，而血管内治疗仅限于难以夹闭的患者。ISAT是一个转折点，它表明许多常规手术治疗的患者采用盘绕术会有更好的结果。随着新型血管内装置的普及，实践也在不断发展，更多的患者可以接受血管内治疗，但对于许多不属于ISAT的破裂动脉瘤患者，最佳治疗方法仍然存在不确定性。在不确定的情况下，在试验之外进行实践，就像在没有方法的情况下进行研究一样。如果没有科学的评估方法，就无法定义良好手术护理的概念，因此设计了ISAT-2。10年后，ISAT-2仍然没有定论，但由于试验平衡了每个患者的风险，在ISAT-2中实践提供了机会，使人们认识到试验方法实时优化护理，早在结论性结果显示之前。结论无论是否提供最终结果，护理试验都是良好临床实践的组成部分。应修改研究-护理分离，以鼓励护理研究。

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引用次数: 0

Understanding heterogeneity of pragmatic trial results and subgroup analyses: The FIAT example 了解实用试验结果和亚组分析的异质性：FIAT的例子

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-05-19 DOI: 10.1016/j.neuchi.2025.101683

Jean Raymond , Tim E. Darsaut

Background and purpose

Pragmatic trial results are intrinsically heterogeneous and the ‘average treatment effect’, on which the paradigmatic verdict of explanatory trials is based may not suffice to translate trial results into clinically meaningful conclusions applicable in practice. Examining various subgroups is problematic because they are at risk of both false negative and false positive results.

Methods

We summarize FIAT, a pragmatic care trial on flow diversion where multiple subgroups were examined. The notions of average treatment effect and interaction tests are reviewed to better understand their application in pragmatic trials.

Results

The trial showed flow diversion to be superior to standard treatments, but the results do not apply to all intracranial aneurysms. The notion of a ‘true average treatment effect’ can hardly apply when there are multiple comparator interventions and clinical heterogeneity. Various subgroups were examined in spite of negative interaction tests, to help interpret the trial results. Subgroup findings can be credible so long as they are not data-dependent ‘fishing expeditions’. Meaningful clinical subgroups that have been pre-specified and integrated into the randomization scheme and power calculation provide the most credible conclusions.

Conclusion

Non-prespecified data-dependent subgroup analyses are at high risk of being incorrect and should not be used to make clinical decisions in practice. A critical assessment of pre-specified subgroup analyses can nonetheless help interpret heterogeneous pragmatic trial results.

背景和目的实用主义试验结果本质上是异质的，解释性试验的范式判断所基于的“平均治疗效果”可能不足以将试验结果转化为适用于实践的有临床意义的结论。检查不同的亚组是有问题的，因为他们有假阴性和假阳性结果的风险。方法我们总结了FIAT，一项实用护理试验，对多个亚组进行了检查。本文回顾了平均治疗效果和相互作用试验的概念，以便更好地理解它们在实用试验中的应用。结果该试验显示血流转移优于标准治疗，但结果并不适用于所有颅内动脉瘤。当存在多个比较干预和临床异质性时，“真正的平均治疗效果”的概念很难适用。尽管进行了负相互作用试验，但仍对不同的亚组进行了检查，以帮助解释试验结果。只要子群体的发现不是依赖于数据的“钓鱼考察”，它们就是可信的。预先指定有意义的临床亚组，并将其纳入随机化方案和功率计算，可提供最可信的结论。结论非预先设定的数据依赖亚组分析存在较高的错误风险，不应用于临床决策。然而，对预先指定的亚组分析的批判性评估可以帮助解释异质的实用试验结果。

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引用次数: 0

Impact of dural closure on postoperative complications in cerebellar metastasis surgery: A retrospective cohort study 硬脑膜闭合对小脑转移手术术后并发症的影响：一项回顾性队列研究

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-05-19 DOI: 10.1016/j.neuchi.2025.101682

Frédérick Rault , Mathilde Ducloie , Mathieu Lozouet , Elise Lopvet , Anaïs R. Briant , Evelyne Emery , Thomas Gaberel

Introduction

Cerebellar metastases represent the second most common location for brain metastases. Surgery is a key therapeutic option, but the rate of postoperative complications remains high. The impact of dural closure techniques on these complications has not yet been specifically evaluated.

Methods

We conducted a retrospective single-center study including all patients who underwent surgical resection of cerebellar metastasis between 2012 and 2021 at Caen University Hospital. The primary outcome was the occurrence of a postoperative complication withing 30 days (death, reoperation, or meningitis). We analyzed surgical data, particularly focusing on the type of dural closure: watertight (with sutured closure ± suturable duraplasty) versus non-watertight (non-sealing suture ± non-suturable patch).

Results

A total of 125 surgeries were analyzed. Postoperative complications occurred in 25% of cases, including hydrocephalus (10%), meningitis (9%), and cerebrospinal fluid leaks (8%). Watertight dural closure was significantly associated with a higher rate of complications (p = 0.039). Median overall survival was 10 months and complications were associated with shorter survival (p = 0.011).

Conclusion

Watertight dural closure appears to increase the risk of postoperative complications in cerebellar metastasis surgery. These findings question the relevance of systematic watertight dural suturing in the posterior fossa.

小脑转移是第二常见的脑转移部位。手术是一个关键的治疗选择，但术后并发症的发生率仍然很高。硬脑膜闭合技术对这些并发症的影响尚未得到具体评估。方法：我们进行了一项回顾性单中心研究，纳入了2012年至2021年在卡昂大学医院接受小脑转移手术切除的所有患者。主要终点是30天内发生的术后并发症（死亡、再手术或脑膜炎）。我们分析了手术数据，特别关注硬脑膜闭合的类型：水密（缝合闭合±可缝合的硬脑膜成形术）与非水密（非密封缝合±不可缝合的贴片）。结果共分析125例手术。25%的病例出现术后并发症，包括脑积水（10%）、脑膜炎（9%）和脑脊液漏（8%）。水密硬脑膜闭合与并发症发生率显著相关（p = 0.039）。中位总生存期为10个月，并发症与较短生存期相关（p = 0.011）。结论水密硬脑膜闭合增加了小脑转移手术术后并发症的发生风险。这些发现对后窝系统水密硬脑膜缝合的相关性提出了质疑。

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