Neurochirurgie最新文献

{"title":"Impact of chronotherapy and time-of-day on surgical and adjuvant outcomes in glioblastoma and mixed high-grade glioma patients: a systematic review","authors":"Siddharth Shah ,&nbsp;Anuraag Punukollu ,&nbsp;Brandon Lucke-Wold","doi":"10.1016/j.neuchi.2026.101782","DOIUrl":"10.1016/j.neuchi.2026.101782","url":null,"abstract":"<div><h3>Background</h3><div>Circadian rhythms regulate DNA repair, cell-cycle progression, metabolism, and immune function processes central to glioblastoma (GBM) treatment response. Aligning therapy with intrinsic biological timing (“chronotherapy”) may improve efficacy without increasing toxicity. This systematic review evaluated the impact of treatment time-of-day on outcomes in GBM, focusing on temozolomide (TMZ) administration, radiotherapy (RT) scheduling, and surgical timing.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines, PubMed, Embase, and Google Scholar were searched through October 2025 for original human studies of adults with GBM or high-grade glioma comparing outcomes by time-of-day exposure (PROSPERO-CRD420251185806). Eligible endpoints included overall survival (OS), progression-free survival (PFS), postoperative complications, and length of stay (LOS). Randomized and observational studies were assessed using RoB 2 and ROBINS-I tools, respectively, and synthesized narratively due to heterogeneity.</div></div><div><h3>Results</h3><div>Six studies met inclusion criteria: three on TMZ timing, two on RT timing, and one on surgical timing. Morning TMZ was associated with longer OS in a retrospective cohort (median 1.43 vs 1.13 years; HR 0.67, 95% CI 0.46–0.98) and a similar trend in a feasibility trial (20.3 vs 16.4 months), though a large pooled analysis from two EORTC trials showed no OS/PFS difference but higher myelosuppression with morning dosing. Afternoon RT improved OS (25.6 vs 18.5 months, <em>p</em> = 0.014) and PFS (20.6 vs 13.3 months, <em>p</em> = 0.022) in a circadian-synchronized cohort, while other RT and surgical studies reported no time-dependent effects.</div></div><div><h3>Conclusion</h3><div>Available evidence suggests that treatment time-of-day may be associated with modest and context-dependent differences in adjuvant therapy outcomes in glioblastoma. Signals favoring morning temozolomide administration and afternoon radiotherapy are biologically plausible but inconsistent, while current data do not support a clinically meaningful effect of surgical timing. These findings should be considered hypothesis-generating, underscoring the need for prospective, biomarker-guided chronotherapy trials before clinical implementation.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101782"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133536","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}

{"title":"Risk factors and predictive model development for intracranial infection following surgical clipping of unruptured intracranial anterior circulation aneurysms","authors":"Kun Dai ,&nbsp;Chengyuan Ji ,&nbsp;Pengfei Xia,&nbsp;Youjia Qiu","doi":"10.1016/j.neuchi.2026.101775","DOIUrl":"10.1016/j.neuchi.2026.101775","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative intracranial infection (ICI) is a serious complication that occurs after craniotomy, typically caused by the invasion of microorganisms such as bacteria into the sterile cranial cavity. Aneurysm clipping is one of the primary treatment methods for intracranial aneurysms, and ICI can significantly impact patient prognosis. Our investigation aims to systematically identify the determinants of postoperative ICI after aneurysm clipping and develop a robust predictive model for clinical risk assessment. To eliminate potential confounding factors introduced by aneurysm rupture and subarachnoid hemorrhage, our study focuses exclusively on patients with unruptured intracranial anterior circulation aneurysms.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of clinical data from 428 patients with anterior circulation aneurysms. Based on the occurrence of postoperative ICI, patients were stratified into non-infected group and infected group. Univariate and multivariate statistical analyses were performed to evaluate the following variables: gender, age, body mass index (BMI), hypertension, diabetes mellitus, aneurysm location, number of aneurysm clips applied, operative duration, intraoperative blood loss, cerebrospinal fluid (CSF) leakage, and postoperative intracranial hemorrhage or cerebral infarction in the surgical region. Subsequently, a predictive nomogram was constructed based on the multivariate regression results to generate a robust predictive model.</div></div><div><h3>Results</h3><div>Among 428 patients with anterior circulation aneurysms, 38 developed postoperative ICI. Univariate analysis revealed that BMI, diabetes mellitus, operative duration, intraoperative blood loss, CSF leakage, and postoperative cerebral hemorrhage or infarction were significant factors influencing ICI. In contrast, variables such as gender, age, hypertension, and the number of aneurysm clips applied demonstrated no statistically significant association. Subsequent logistic regression analysis identified elevated BMI, diabetes mellitus, prolonged operative duration, substantial intraoperative blood loss, and postoperative CSF leakage as independent risk factors for ICI in UIA patients. A receiver operating characteristic (ROC) curve was constructed based on the predicted probabilities of ICI, yielding an area under the curve (AUC) of 0.8756, indicating strong predictive accuracy.</div></div><div><h3>Conclusion</h3><div>Postoperative ICI in patients with anterior circulation aneurysms is influenced by multiple factors, including BMI, diabetes mellitus, operative duration, intraoperative blood loss, and CSF leakage. A predictive model constructed based on the relative impact of these factors may assist clinicians in anticipating potential infection events during the perioperative period.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101775"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013360","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}

{"title":"Intraoperative contrast-enhanced ultrasound-assisted resection of brain tumors: a systematic review and meta-analysis","authors":"Márcio Yuri Ferreira ,&nbsp;Leonardo Januário Campos Cardoso ,&nbsp;Shayan Huda ,&nbsp;Netanel Ben-Shalom","doi":"10.1016/j.neuchi.2026.101774","DOIUrl":"10.1016/j.neuchi.2026.101774","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101774"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981248","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}

{"title":"Repeated salvage high precision radiotherapy for repeated recurrence of high-grade glioma","authors":"Mami Ishikawa ,&nbsp;Yukihiro Hama ,&nbsp;Etsuko Tate ,&nbsp;Masahiro Uematsu ,&nbsp;Masaki Takahashi ,&nbsp;Heiji Naritaka ,&nbsp;Gen Kusaka","doi":"10.1016/j.neuchi.2026.101784","DOIUrl":"10.1016/j.neuchi.2026.101784","url":null,"abstract":"<div><h3>Background</h3><div>Repeated high precision radiotherapy may be an additional salvage treatment for patients with recurrent high-grade glioma, delivering a low minimum radiation dose to brain and a high effective dose to tumor.</div></div><div><h3>Materials</h3><div>24 patients with high-grade gliomas (grade 3: 8 patients, grade 4: 16 patients) were treated by surgery, chemotherapy, and tomotherapy (CT-guided intensity-modulated radiotherapy (IMRT)). A total dose of 60 Gy was prescribed to PTVh (planning tumor volume h) and 40 Gy to PTV1 in 15 fractions each. PTVh and PTV1 were defined as the MRI contrast-enhanced area plus a margin and as high intensity area on the double inversion recovery images plus a margin, respectively. The planning for distant recurrence was performed as well as the first tomotherapy, and for invasive recurrence, 40 Gy or lower was prescribed to PTVh.</div></div><div><h3>Results</h3><div>The tomotherapy was performed for 14 of the 24 patients for the first recurrence, and for 7 of those 14 patients for the second or subsequent. Stepwise multiple regression analysis showed that patients with repeated tomotherapy had long survival time (<em>p</em> &lt; 0.0001). Median survival time from the first tomotherapy (based on Kaplan-Meier estimates) was 18 months in the 14 patients with repeated tomotherapy versus 5.5 months in the 10 patients without repeated tomotherapy (<em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Repeated tomotherapy may be one of the additional salvage treatments without symptomatic adverse events for patients with repeated recurrences of glioma. Accurate and precise tomotherapy planning and neurosurgery for eloquent areas are essential for the comprehensive treatment of glioma patients.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101784"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133576","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}

{"title":"Modern concepts of CSF disorders in monosutural craniosynostosis","authors":"Paolo Frassanito ,&nbsp;Marco Galeazzi ,&nbsp;Gianpiero Tamburrini","doi":"10.1016/j.neuchi.2026.101773","DOIUrl":"10.1016/j.neuchi.2026.101773","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>A thorough review of the literature has been performed. Accordingly, pathogenic theories, eventual impact of surgical strategy, and prognostic significance are discussed.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101773"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981249","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}

{"title":"Review of treatment modalities and clinical outcome of giant saccular superior cerebellar artery aneurysms","authors":"Andreas Theofanopoulos ,&nbsp;Ben Waldau ,&nbsp;Marc Ronald Schneider ,&nbsp;Katharina Faust ,&nbsp;Sajjad Muhammad","doi":"10.1016/j.neuchi.2026.101781","DOIUrl":"10.1016/j.neuchi.2026.101781","url":null,"abstract":"<div><h3>Introduction</h3><div>Giant superior cerebellar artery (SCA) aneurysms are rare lesions with significant morbidity due to mass effect and present therapeutic challenges due to proximity to critical neurovascular structures.</div></div><div><h3>Materials and methods</h3><div>A systematic literature review through the PubMed and Scopus databases was performed according to the PRISMA guidelines to identify cases of giant saccular SCA aneurysms treated either microsurgically or by endovascular techniques. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, clinical outcomes as well as follow-up information were retrieved.</div></div><div><h3>Results</h3><div>Data from 5 studies including 6 patients were obtained. Mean patient age was 53.83 years, with a male-to-female ratio of 2:1. Mean maximum aneurysm diameter was 31.3 mm. All patients presented at mRS 3 or more. A favorable outcome (mRS 0–2) was reported on 50% of cases. Two patients underwent microsurgery (one resulting in a favorable outcome), while two underwent endovascular treatment with both achieving a favorable outcome. Two more underwent a combination of microsurgical STA-SCA bypass followed by endovascular aneurysm treatment, both with unfavorable outcomes. All aneurysms were at least partially thrombosed; the ones treated microsurgically were debulked due to mass effect.</div></div><div><h3>Conclusions</h3><div>Giant SCA aneurysms may cause severe, often persistent neurologic morbidity due to brainstem compression and may be approached by either microsurgery or endovascular treatment. Advanced endovascular techniques may be required to prevent recurrence. Thrombosed aneurysms which cannot be safely embolized or ones with significant mass effect may benefit from microsurgical clip occlusion and may require debulking, while hybrid techniques should be used judiciously.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101781"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133557","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}

{"title":"The neurosurgeon as athlete, gentleman, and physician: Thierry de Martel (1875–1940) as a model for contemporary practice","authors":"Johan Pallud","doi":"10.1016/j.neuchi.2026.101772","DOIUrl":"10.1016/j.neuchi.2026.101772","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101772"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981247","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}

{"title":"Polyethylene glycol-coated patch versus standard dural sealing practices for preventing cerebrospinal fluid leaks in posterior fossa surgery: a randomized multicenter study","authors":"Alberto Acitores Cancela ,&nbsp;María Pérez Pérez ,&nbsp;Luis González Martínez ,&nbsp;Jorge Díaz Molina ,&nbsp;Laura Beatriz López López ,&nbsp;Sofía Sotos Picazo ,&nbsp;Carmen Tudela Ataz ,&nbsp;Cristina Barcelo López ,&nbsp;Juan Carlos Rial Básalo ,&nbsp;Cristina Ferreras ,&nbsp;Belén Álvarez ,&nbsp;Adán Fernández Canal ,&nbsp;Jose Manuel Ortega ,&nbsp;Jorge Bernal Piñeiro ,&nbsp;Yaiza López Ramírez ,&nbsp;Carlos Alberto Rodríguez Arias ,&nbsp;Rubén Martín Laez ,&nbsp;Patricia López Gómez ,&nbsp;Luís Ley-Urzaiz","doi":"10.1016/j.neuchi.2026.101777","DOIUrl":"10.1016/j.neuchi.2026.101777","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated the efficacy and safety of the polyethylene glycol (PEG)-coated patch as a dural sealant in elective non-traumatic posterior fossa surgeries (nTPFS) requiring dural closure.</div></div><div><h3>Methods</h3><div>This multicenter, randomized, controlled phase-IV study was conducted, between January and December 2022, on adult patients who underwent nTPFS requiring dural opening and closure. Patients were randomized to receive either PEG-coated patch reinforcement or standard sealing. The primary endpoint was the incidence of clinically evident cerebrospinal fluid (CSF)-leakage within four weeks post-intervention.</div></div><div><h3>Results</h3><div>A total of 121 patients were included, 57(47.1%) in the PEG-coated patch group and 64(52.9%) in the standard sealing group. No statistically significant differences were observed in the primary endpoint of clinically evident CSF leak (12.3% vs. 9.4%; incidence rate difference: 2.9%; 95%CI: –8.7% to 14.6%; p = 0.606). Secondary outcomes were also comparable between groups, including pseudomeningocele (24.6% vs. 20.3%; p = 0.575), hospital readmissions (12.3% vs. 9.4%; p = 0.606), surgical site infections (5.3% vs. 4.7%; p = 0.884), and adverse events (22.8% vs. 20.3%; p = 0.739). Two patients, one in each group, experienced serious adverse events classified as “hospitalization or prolonged stay.” Most adverse events were mild to moderate and resolved with standard medical management.</div></div><div><h3>Conclusions</h3><div>The PEG-coated patch, alone or with fibrin sealant, demonstrated comparable efficacy in preventing CSF leak compared to multiple product combinations. The study does not demonstrate superiority, but shows a reassuring safety profile and similar rates of secondary outcomes, including pseudomeningocele, hospital readmissions, surgical site infections and adverse events, in both groups. These findings support the PEG-coated patch as a safe dural sealing option in elective non-traumatic posterior fossa surgery, while potential workflow or economic advantages remain to be formally evaluated in future studies.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101777"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087900","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}

{"title":"The longest documented survival after cranial trepanation in the Renaissance: The thirteen years’ exceptional survival in Vespasiano Gonzaga Colonna","authors":"Annalisa Pace ,&nbsp;Cecilia Carubbi ,&nbsp;Luigi Cofone ,&nbsp;Marco Vitale ,&nbsp;Mauro Palmieri ,&nbsp;Ivano Pindinello ,&nbsp;Yaroslava Longhitano ,&nbsp;Marco Artico","doi":"10.1016/j.neuchi.2026.101790","DOIUrl":"10.1016/j.neuchi.2026.101790","url":null,"abstract":"<div><div>This essay focuses on the Vespasiano Gonzaga Colonna (1531–1591), a remarkable example of long-term life following cranial trepanation during the Renaissance. Gonzaga suffered from syphilis and frequent migraines; therefore, in 1578, his court surgeon used a scraping procedure to perform cranial trepanation. The right parietal bone had obvious indications of healing, and osteological data from his tomb validated the surgery. One of the longest reported survivors following cranial trepanation in the Italian archaeological record, Gonzaga, lived for 13 years after the treatment. This instance adds to the historical understanding of trepanation as one of the earliest neurosurgical procedures, and demonstrates the high degree of surgical expertise attained in early modern noble courts.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101790"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421641","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}

{"title":"Fatal pneumocephalus caused by Clostridium perfringens bacteremia originating from emphysematous cystitis after stroke-related blood–brain barrier disruption","authors":"Cyril Pernod ,&nbsp;Baptiste Quilly ,&nbsp;Philippe Lavrard ,&nbsp;Hilaire de Malleray ,&nbsp;Johan Schmitt ,&nbsp;Nathan Beucler","doi":"10.1016/j.neuchi.2026.101788","DOIUrl":"10.1016/j.neuchi.2026.101788","url":null,"abstract":"<div><div>Infectious pneumocephalus is rare and usually associated with meningitis or neurosurgical procedures. We report a fatal case of diffuse pneumocephalus caused by <em>Clostridium perfringens</em> bacteremia originating from emphysematous cystitis in a patient recently admitted for a large right middle cerebral artery infarction. Imaging demonstrated subarachnoid gas strictly confined to the infarcted hemisphere, followed by subdural air accumulation and fatal mass effect. We hypothesize that stroke-related blood–brain barrier disruption permitted hematogenous bacterial and gas diffusion into the subarachnoid space. This case highlights the distinction between negative-pressure postoperative pneumocephalus and positive-pressure infectious pneumocephalus in a closed skull.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 2","pages":"Article 101788"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147312365","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}