Pub Date : 2024-10-23DOI: 10.1016/j.neuchi.2024.101605
Dandan Yang, Yao Wu, Long Zheng, Zhenzhi Wu, Xing Rong, Buguo Chen
Objectives
The hourglass like constriction (HGC) of peripheral nerves is a characteristic pathological manifestation of Neuralgic Amyotrophy. Once identified, early surgical intervention is essential. However, the method of surgery is controversial, particularly regarding whether HGC needs to be excised. This study aims to explore the efficacy of early aggressive resection of HGC in the upper limb nerves.
Materials and methods
This retrospective study focuses on 13 nerves of spontaneous upper limb paralysis treated at our hospital from June 2019 to July 2023, in which HGC was identified during surgery. During surgery, epineurectomy and interfascicular neurolysis were performed on the constricted areas. Post-neurolysis, constriction excision was carried out if any of the following conditions were met: (1) A single constriction with constriction ≥75%. (2) Constriction combined with torsion. (3) The presence of ≥2 constrictions. Regular face-to-face follow-ups were conducted postoperatively.
Results
Four cases with a single constriction of less than 75% underwent epineurotomy and interfascicular neurolysis; eight underwent constriction excision, of which four cases with a single constriction and associated torsion had direct end-to-end suturing after excision, and four had more than two constrictions treated with autologous sural nerve grafts. Postoperative follow-ups showed good recovery in all but one case, which had unique pathological features and had underwent only epineurectomy, showing moderate recovery.
Conclusions
For early surgical treatment of HGCs in peripheral nerves of the upper limbs, if severe constriction, constriction combined with torsion, or the presence of more than two constrictions are identified during surgery, aggressive constriction resection may be a better option.
{"title":"Early aggressive constriction resection for hourglass-like constriction of peripheral nerve in the upper extremity: a retrospective study","authors":"Dandan Yang, Yao Wu, Long Zheng, Zhenzhi Wu, Xing Rong, Buguo Chen","doi":"10.1016/j.neuchi.2024.101605","DOIUrl":"10.1016/j.neuchi.2024.101605","url":null,"abstract":"<div><h3>Objectives</h3><div>The hourglass like constriction (HGC) of peripheral nerves is a characteristic pathological manifestation of Neuralgic Amyotrophy. Once identified, early surgical intervention is essential. However, the method of surgery is controversial, particularly regarding whether HGC needs to be excised. This study aims to explore the efficacy of early aggressive resection of HGC in the upper limb nerves.</div></div><div><h3>Materials and methods</h3><div>This retrospective study focuses on 13 nerves of spontaneous upper limb paralysis treated at our hospital from June 2019 to July 2023, in which HGC was identified during surgery. During surgery, epineurectomy and interfascicular neurolysis were performed on the constricted areas. Post-neurolysis, constriction excision was carried out if any of the following conditions were met: (1) A single constriction with constriction ≥75%. (2) Constriction combined with torsion. (3) The presence of ≥2 constrictions. Regular face-to-face follow-ups were conducted postoperatively.</div></div><div><h3>Results</h3><div>Four cases with a single constriction of less than 75% underwent epineurotomy and interfascicular neurolysis; eight underwent constriction excision, of which four cases with a single constriction and associated torsion had direct end-to-end suturing after excision, and four had more than two constrictions treated with autologous sural nerve grafts. Postoperative follow-ups showed good recovery in all but one case, which had unique pathological features and had underwent only epineurectomy, showing moderate recovery.</div></div><div><h3>Conclusions</h3><div>For early surgical treatment of HGCs in peripheral nerves of the upper limbs, if severe constriction, constriction combined with torsion, or the presence of more than two constrictions are identified during surgery, aggressive constriction resection may be a better option.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101605"},"PeriodicalIF":1.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512485","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}
Laser interstitial thermal therapy (LITT) is being performed more frequently for various lesions within neurosurgery, including epileptic foci, vascular malformations, and tumors. Though this technique generally has an excellent safety profile, it is important to be aware of potential complications. Thermal ablation of tissue leads to disruption of the blood brain barrier as well as an inflammatory response both of which cause the majority of complications from LITT. The most common complications of LITT include cerebral edema, focal neurologic deficits, and intracranial hemorrhage. Few studies have identified factors predicting development of these complications, but many of these are transient and resolve without intervention. Modifications to LITT technique that allows better visualization of patient anatomy along the tract, such as fusing vascular imaging with intraoperative MRI, reduce the risk of complications.
激光间质热疗（LITT）越来越多地用于神经外科的各种病变，包括癫痫灶、血管畸形和肿瘤。虽然这种技术通常具有极佳的安全性，但必须注意潜在的并发症。组织热消融会导致血脑屏障破坏和炎症反应，这两种情况是 LITT 并发症的主要原因。LITT 最常见的并发症包括脑水肿、局灶性神经功能缺损和颅内出血。很少有研究能确定预测这些并发症发生的因素，但许多并发症都是一过性的，无需干预即可缓解。对 LITT 技术进行改良，可以更好地观察患者沿导管的解剖结构，例如将血管成像与术中核磁共振成像融合，从而降低并发症的风险。
{"title":"Complications following laser interstitial thermal therapy: a review","authors":"Kyle McGrath , Matthew Frain , Grace Hey , Maryam Rahman","doi":"10.1016/j.neuchi.2024.101604","DOIUrl":"10.1016/j.neuchi.2024.101604","url":null,"abstract":"<div><div>Laser interstitial thermal therapy (LITT) is being performed more frequently for various lesions within neurosurgery, including epileptic foci, vascular malformations, and tumors. Though this technique generally has an excellent safety profile, it is important to be aware of potential complications. Thermal ablation of tissue leads to disruption of the blood brain barrier as well as an inflammatory response both of which cause the majority of complications from LITT. The most common complications of LITT include cerebral edema, focal neurologic deficits, and intracranial hemorrhage. Few studies have identified factors predicting development of these complications, but many of these are transient and resolve without intervention. Modifications to LITT technique that allows better visualization of patient anatomy along the tract, such as fusing vascular imaging with intraoperative MRI, reduce the risk of complications.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101604"},"PeriodicalIF":1.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480116","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}
Pub Date : 2024-10-22DOI: 10.1016/j.neuchi.2024.101606
Maite Jiménez Siebert, Nadine Kaiser, Kai Ziebarth
Introduction
Peroneal nerve palsy due to compression by an intraneural ganglion is an uncommon entity in the pediatric setting with a need for surgical treatment. Uniquely in this case, the ganglion presented as an elongated instead of a typical round cyst, delaying diagnosis and treatment.
Case presentation
We present the case of a 13 ½ year old boy with increasing peroneal nerve palsy due to an atypically shaped intraneural ganglion. An MRI of the knee revealed an elongated peroneal ganglion compressing the nerve between the lateral insertion of the gastrocnemius muscle and fibular head over a length of 10 cm. After surgical decompression and physiotherapy the peroneal nerve recovered well, achieving M 4–5 one year after surgery.
Conclusion
The atypical shape of the present peroneal ganglion delayed diagnosis and correct treatment. Though rare in the pediatric setting, this entity must be specifically looked for during the diagnostic workup of peroneal palsy, for time to surgery determines neurological outcome.
导言：因硬膜内神经节压迫导致的腓肠神经麻痹在儿科并不常见，需要手术治疗。本病例的独特之处在于，神经节呈拉长状而非典型的圆形囊肿，从而延误了诊断和治疗：本病例中，一名13岁半的男孩因形状异常的硬膜内神经节而导致腓总神经麻痹。膝关节核磁共振成像显示，腓肠肌外侧插入部和腓骨头之间有一个拉长的腓肠神经节，压迫神经的长度达 10 厘米。经过手术减压和物理治疗后，腓总神经恢复良好，术后一年达到 M 4 - 5：目前腓总神经节的不典型形状延误了诊断和正确治疗。虽然这种情况在儿童中很少见，但在腓骨神经麻痹的诊断过程中必须特别注意，因为手术时间决定了神经功能的预后。
{"title":"Complete foot drop due to atypical peroneal ganglion in a 13 ½ year old boy","authors":"Maite Jiménez Siebert, Nadine Kaiser, Kai Ziebarth","doi":"10.1016/j.neuchi.2024.101606","DOIUrl":"10.1016/j.neuchi.2024.101606","url":null,"abstract":"<div><h3>Introduction</h3><div>Peroneal nerve palsy due to compression by an intraneural ganglion is an uncommon entity in the pediatric setting with a need for surgical treatment. Uniquely in this case, the ganglion presented as an elongated instead of a typical round cyst, delaying diagnosis and treatment.</div></div><div><h3>Case presentation</h3><div>We present the case of a 13 ½ year old boy with increasing peroneal nerve palsy due to an atypically shaped intraneural ganglion. An MRI of the knee revealed an elongated peroneal ganglion compressing the nerve between the lateral insertion of the gastrocnemius muscle and fibular head over a length of 10 cm. After surgical decompression and physiotherapy the peroneal nerve recovered well, achieving M 4–5 one year after surgery.</div></div><div><h3>Conclusion</h3><div>The atypical shape of the present peroneal ganglion delayed diagnosis and correct treatment. Though rare in the pediatric setting, this entity must be specifically looked for during the diagnostic workup of peroneal palsy, for time to surgery determines neurological outcome.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101606"},"PeriodicalIF":1.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512484","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}
Pub Date : 2024-10-10DOI: 10.1016/j.neuchi.2024.101603
Marta Arrighi , Quentin Berton , Emmanuel de Schlichting , Djene Ibrahima Kaba , Paul Roblot , Guillaume Coll
Background and objective
Cerebral venous thrombosis (CVT) is a rare but critical condition, particularly in young women, often linked to oral contraceptive use. It can lead to complications like subdural hematoma (SH), which are challenging to diagnose and manage. We report the case of a 39-year-old woman who presented with severe headaches and neurological symptoms, leading to a diagnosis of chronic SH and CVT, associated with long-term oral contraceptive use. This case is unique as it documents the first known instance of chronic SH associated with CVT induced by oral contraceptives. Our objective was to explore this association using the Bradford Hill criteria and to review the diagnostic and therapeutic challenges of CVT and SH in this population.
Methods
We conducted a systematic literature review adhering to PRISMA guidelines, focusing on SH cases linked to CVT in women using oral contraceptives.
Results
Including our case, four cases of SH associated with CVT secondary to oral contraceptive use were identified. Common symptoms included severe headache and neurological deficits. All patients received anticoagulation therapy, with surgical intervention required in severe cases. Prognosis was generally favorable with appropriate management.
Conclusion
This case emphasizes the importance of considering CVT in women presenting with spontaneous SH, particularly those on oral contraceptives. Early diagnosis, careful clinical and radiological monitoring, and timely surgical intervention are crucial for optimal outcomes.
背景和目的：脑静脉血栓（CVT）是一种罕见但严重的疾病，尤其是在年轻女性中，通常与口服避孕药有关。它可导致硬膜下血肿（SH）等并发症，诊断和处理都具有挑战性。我们报告了一例 39 岁女性的病例，她出现了严重的头痛和神经症状，最终被诊断为慢性 SH 和 CVT，这与长期口服避孕药有关。这个病例是独一无二的，因为它记录了首个由口服避孕药诱发慢性 SH 和 CVT 的已知病例。我们的目的是利用布拉德福德-希尔（Bradford Hill）标准探讨这种关联，并回顾该人群中 CVT 和 SH 的诊断和治疗难题：我们按照 PRISMA 指南进行了系统性文献综述，重点关注使用口服避孕药的女性中与 CVT 相关的 SH 病例：结果：包括我们的病例在内，共发现了四例因口服避孕药而继发 CVT 的 SH 相关病例。常见症状包括剧烈头痛和神经功能障碍。所有患者都接受了抗凝治疗，严重病例需要手术治疗。通过适当的治疗，预后普遍良好：本病例强调了对自发性 SH 女性，尤其是口服避孕药的女性考虑 CVT 的重要性。早期诊断、仔细的临床和放射学监测以及及时的手术干预是获得最佳预后的关键。
{"title":"Unmasking hidden risks: cerebral venous sinus thrombosis and spontaneous subdural hematoma in women on oral contraceptives – insights from a case report and systematic literature review","authors":"Marta Arrighi , Quentin Berton , Emmanuel de Schlichting , Djene Ibrahima Kaba , Paul Roblot , Guillaume Coll","doi":"10.1016/j.neuchi.2024.101603","DOIUrl":"10.1016/j.neuchi.2024.101603","url":null,"abstract":"<div><h3>Background and objective</h3><div>Cerebral venous thrombosis (CVT) is a rare but critical condition, particularly in young women, often linked to oral contraceptive use. It can lead to complications like subdural hematoma (SH), which are challenging to diagnose and manage. We report the case of a 39-year-old woman who presented with severe headaches and neurological symptoms, leading to a diagnosis of chronic SH and CVT, associated with long-term oral contraceptive use. This case is unique as it documents the first known instance of chronic SH associated with CVT induced by oral contraceptives. Our objective was to explore this association using the Bradford Hill criteria and to review the diagnostic and therapeutic challenges of CVT and SH in this population.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review adhering to PRISMA guidelines, focusing on SH cases linked to CVT in women using oral contraceptives.</div></div><div><h3>Results</h3><div>Including our case, four cases of SH associated with CVT secondary to oral contraceptive use were identified. Common symptoms included severe headache and neurological deficits. All patients received anticoagulation therapy, with surgical intervention required in severe cases. Prognosis was generally favorable with appropriate management.</div></div><div><h3>Conclusion</h3><div>This case emphasizes the importance of considering CVT in women presenting with spontaneous SH, particularly those on oral contraceptives. Early diagnosis, careful clinical and radiological monitoring, and timely surgical intervention are crucial for optimal outcomes.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101603"},"PeriodicalIF":1.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401897","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}
Pub Date : 2024-10-10DOI: 10.1016/j.neuchi.2024.101597
Jie Li , Ming Jin , Jing Yang
Objective
This study aims to enhance prognostic accuracy in severe traumatic brain injury (STBI) by developing a novel nomogram that integrates clinical and paraclinical data.
Methods
Data from 263 STBI patients were analyzed, focusing on critical variables such as age, Glasgow Coma Scale scores, pupil responsiveness, CT findings, and blood markers. A rigorous regression analysis was conducted to identify significant predictors. The nomogram underwent internal and external validation, and its predictive performance was compared with existing models through a meta-analysis.
Results
The novel nomogram demonstrated superior predictive accuracy for STBI outcomes compared to traditional models. Key predictors, including age, Glasgow Coma Scale scores, pupil responsiveness, CT findings, and specific blood markers, were harmonized to provide a more precise prognostic tool. Validation processes confirmed the robustness and reliability of the nomogram.
Conclusion
The developed nomogram represents a significant advancement in STBI prognosis, offering clinicians a powerful tool to improve patient care strategies. By integrating CT imaging and blood parameters, the nomogram enhances the precision of outcome predictions, facilitating better-informed clinical decisions.
{"title":"Enhanced prognostic accuracy in severe TBI: a comprehensive nomogram analysis","authors":"Jie Li , Ming Jin , Jing Yang","doi":"10.1016/j.neuchi.2024.101597","DOIUrl":"10.1016/j.neuchi.2024.101597","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to enhance prognostic accuracy in severe traumatic brain injury (STBI) by developing a novel nomogram that integrates clinical and paraclinical data.</div></div><div><h3>Methods</h3><div>Data from 263 STBI patients were analyzed, focusing on critical variables such as age, Glasgow Coma Scale scores, pupil responsiveness, CT findings, and blood markers. A rigorous regression analysis was conducted to identify significant predictors. The nomogram underwent internal and external validation, and its predictive performance was compared with existing models through a meta-analysis.</div></div><div><h3>Results</h3><div>The novel nomogram demonstrated superior predictive accuracy for STBI outcomes compared to traditional models. Key predictors, including age, Glasgow Coma Scale scores, pupil responsiveness, CT findings, and specific blood markers, were harmonized to provide a more precise prognostic tool. Validation processes confirmed the robustness and reliability of the nomogram.</div></div><div><h3>Conclusion</h3><div>The developed nomogram represents a significant advancement in STBI prognosis, offering clinicians a powerful tool to improve patient care strategies. By integrating CT imaging and blood parameters, the nomogram enhances the precision of outcome predictions, facilitating better-informed clinical decisions.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 1","pages":"Article 101597"},"PeriodicalIF":1.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407195","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}
Pub Date : 2024-10-03DOI: 10.1016/j.neuchi.2024.101600
Jhon E. Bocanegra-Becerra , Gabriel Simoni , Cristian D. Mendieta , José Luis Acha Sánchez , Lucca B. Palavani , Kim Wouters , Anuraag Punukollu , Gabriel Mangas , Raphael Bertani , Miguel Angel Lopez-Gonzalez
Introduction
Awake microsurgery for brain aneurysm treatment has emerged as a tool for real-time intraoperative monitoring, opportune detection of ischemic complications, and reduction of surgical morbidity. Herein, we aimed to explore the current state of the procedure’s rationale, safety and clinical outcomes.
Methods
In accordance with PRISMA guidelines, five databases were queried for articles reporting awake microsurgical management of brain aneurysms. Aggregate study results were combined using random-effects meta-analyses. Publication bias was evaluated through funnel plot analysis and Egger's regression test.
Results
Out of 847 articles, 11 records satisfied the inclusion criteria. Seventy-five patients (68% female) with 75 brain aneurysms (68% unruptured) were analyzed. Clipping was the predominant technique (58%), followed by bypass (17%). Monitored anesthesia care was the principal anesthesia protocol (60%). The incidence of anesthesia-related complications was 1% [95%CI, 0.00−0.05, I2 = 19%], and the conversion rate from an awake-induced anesthesia protocol to general anesthesia was 1% [95%CI, 0.00−0.05, I2 = 0%]. No permanent anesthesia-related morbidity and mortality was reported. Complete aneurysm repair, occlusion and bypass patency rate was 100% [95%CI, 0.96−1.00, I2 = 0%]. The transient postoperative symptomatic event rate was 34% [95%CI, 0.06−0.81, I2 = 77%]. The overall morbidity rate was 4% [95%CI, 0.00−0.09, I2 = 0%], and the overall mortality rate was 0% [95%CI, 0.00−0.03, I2 = 0%].
Conclusion
Awake microsurgery of brain aneurysms is feasible, yet current evidence stems from observational studies. This procedure can reduce surgical morbidity by providing accurate and real-time neurological monitoring during aneurysm repair. While this technique appears to be tolerated, higher level evidence is needed to evaluate judiciously its safety and preference over existing practices for intraoperative neurological monitoring.
{"title":"Awake microsurgical management of brain aneurysms: a comprehensive systematic review and meta-analysis on rationale, safety and clinical outcomes","authors":"Jhon E. Bocanegra-Becerra , Gabriel Simoni , Cristian D. Mendieta , José Luis Acha Sánchez , Lucca B. Palavani , Kim Wouters , Anuraag Punukollu , Gabriel Mangas , Raphael Bertani , Miguel Angel Lopez-Gonzalez","doi":"10.1016/j.neuchi.2024.101600","DOIUrl":"10.1016/j.neuchi.2024.101600","url":null,"abstract":"<div><h3>Introduction</h3><div>Awake microsurgery for brain aneurysm treatment has emerged as a tool for real-time intraoperative monitoring, opportune detection of ischemic complications, and reduction of surgical morbidity. Herein, we aimed to explore the current state of the procedure’s rationale, safety and clinical outcomes.</div></div><div><h3>Methods</h3><div>In accordance with PRISMA guidelines, five databases were queried for articles reporting awake microsurgical management of brain aneurysms. Aggregate study results were combined using random-effects meta-analyses. Publication bias was evaluated through funnel plot analysis and Egger's regression test.</div></div><div><h3>Results</h3><div>Out of 847 articles, 11 records satisfied the inclusion criteria. Seventy-five patients (68% female) with 75 brain aneurysms (68% unruptured) were analyzed. Clipping was the predominant technique (58%), followed by bypass (17%). Monitored anesthesia care was the principal anesthesia protocol (60%). The incidence of anesthesia-related complications was 1% [95%CI, 0.00−0.05, I<sup>2</sup> = 19%], and the conversion rate from an awake-induced anesthesia protocol to general anesthesia was 1% [95%CI, 0.00−0.05, I<sup>2</sup> = 0%]. No permanent anesthesia-related morbidity and mortality was reported. Complete aneurysm repair, occlusion and bypass patency rate was 100% [95%CI, 0.96−1.00, I<sup>2</sup> = 0%]. The transient postoperative symptomatic event rate was 34% [95%CI, 0.06−0.81, I<sup>2</sup> = 77%]. The overall morbidity rate was 4% [95%CI, 0.00−0.09, I<sup>2</sup> = 0%], and the overall mortality rate was 0% [95%CI, 0.00−0.03, I<sup>2</sup> = 0%].</div></div><div><h3>Conclusion</h3><div>Awake microsurgery of brain aneurysms is feasible, yet current evidence stems from observational studies. This procedure can reduce surgical morbidity by providing accurate and real-time neurological monitoring during aneurysm repair. While this technique appears to be tolerated, higher level evidence is needed to evaluate judiciously its safety and preference over existing practices for intraoperative neurological monitoring.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101600"},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376195","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}
Pub Date : 2024-10-01DOI: 10.1016/j.neuchi.2024.101601
Brandon Edelbach , Ha Yeon Lee , Miguel Angel Lopez-Gonzalez
Background
Despite advances in neurosurgical techniques and technology, the management of ruptured giant fusiform MCA aneurysms remains challenging. In the literature, microsurgical intervention is the most commonly described approach. However, recent advancements in endovascular techniques have expanded therapeutic options and as a result there is no consensus on the optimal management of these aneurysms.
Methods
A literature search was performed through the PubMed, Google Scholar, and Embase databases, for surgical and endovascular management of ruptured giant fusiform MCA aneurysms. Inclusion criteria included: fusiform morphology, hemorrhage, major diameter greater than 2.5 cm and located along the MCA.
Results
Literature review yielded 21 studies published from 1981 to 2023 and a total of 32 patients ages 33.40 ± 18.28. The male to female ratio was 1.9:1. The average Hunt and Hess score upon presentation in the total population was 2.78 ± 1.48, and the average pre-operative mRS of the total population was 2.75 ± 1.83. The average major diameter was 3.80 ± 1.85 cm. Average follow-up was 8.9 ± 9.74 months. There was no statistical difference in age (p = 0.5609), pre-operative mRS (p = 0.2355), Hunt and Hess scale (p = 0.183), aneurysm major diameter (p = 0.594) or follow-up (0.8922) between the two modalities. There was no significant difference in clinical outcome between microsurgical and endovascular intervention, nor was there a significant difference when stratified according to sex, major diameter, or location along the MCA. Two case examples are presented after management with cerebral revascularization.
Conclusion
Our analysis underscores the absence of statistical differences in clinical outcomes between microsurgical and endovascular strategies for ruptured giant fusiform MCA aneurysms, which highlights the need for complex surgical revascularization as represented on the illustrative cases where no endovascular option was available
{"title":"Systematic review and comparative analysis of endovascular and microsurgical management of giant ruptured fusiform mca aneurysms with illustrative cases","authors":"Brandon Edelbach , Ha Yeon Lee , Miguel Angel Lopez-Gonzalez","doi":"10.1016/j.neuchi.2024.101601","DOIUrl":"10.1016/j.neuchi.2024.101601","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in neurosurgical techniques and technology, the management of ruptured giant fusiform MCA aneurysms remains challenging. In the literature, microsurgical intervention is the most commonly described approach. However, recent advancements in endovascular techniques have expanded therapeutic options and as a result there is no consensus on the optimal management of these aneurysms.</div></div><div><h3>Methods</h3><div>A literature search was performed through the PubMed, Google Scholar, and Embase databases, for surgical and endovascular management of ruptured giant fusiform MCA aneurysms. Inclusion criteria included: fusiform morphology, hemorrhage, major diameter greater than 2.5 cm and located along the MCA.</div></div><div><h3>Results</h3><div>Literature review yielded 21 studies published from 1981 to 2023 and a total of 32 patients ages 33.40 ± 18.28. The male to female ratio was 1.9:1. The average Hunt and Hess score upon presentation in the total population was 2.78 ± 1.48, and the average pre-operative mRS of the total population was 2.75 ± 1.83. The average major diameter was 3.80 ± 1.85 cm. Average follow-up was 8.9 ± 9.74 months. There was no statistical difference in age (p = 0.5609), pre-operative mRS (p = 0.2355), Hunt and Hess scale (p = 0.183), aneurysm major diameter (p = 0.594) or follow-up (0.8922) between the two modalities. There was no significant difference in clinical outcome between microsurgical and endovascular intervention, nor was there a significant difference when stratified according to sex, major diameter, or location along the MCA. Two case examples are presented after management with cerebral revascularization.</div></div><div><h3>Conclusion</h3><div>Our analysis underscores the absence of statistical differences in clinical outcomes between microsurgical and endovascular strategies for ruptured giant fusiform MCA aneurysms, which highlights the need for complex surgical revascularization as represented on the illustrative cases where no endovascular option was available</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101601"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367348","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}
Pub Date : 2024-10-01DOI: 10.1016/j.neuchi.2024.101598
Daniel P.O. Kaiser
{"title":"Decompressive craniectomy versus best medical treatment alone in patients with severe deep intracerebral hemorrhage: is severe disability always preferable to death?","authors":"Daniel P.O. Kaiser","doi":"10.1016/j.neuchi.2024.101598","DOIUrl":"10.1016/j.neuchi.2024.101598","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101598"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367347","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}
Pub Date : 2024-09-26DOI: 10.1016/j.neuchi.2024.101602
Yann Seznec , Mathilde Pachcinski , David Charier , Christelle Créac’h , Benjamin Buhot , Sylvain Grange , François Vassal
Introduction
Anterolateral cordotomy (AL-C) is a long-established treatment for alleviating intractable cancer pain. However, AL-C has progressively fallen into desuetude, leading to the risk of a definitive loss of expertise within neurosurgical teams. Our objective was therefore to provide an update on percutaneous and open AL-C, with special emphasis on contemporary operative technique.
Material and methods
Patient selection, indications, outcomes and up-to-date operative technique are reviewed through illustrative cases, including intraoperative photographs and video.
Results
Main indications are represented by unilateral, nociceptive pain refractory to best pharmacological treatment in patients with limited life expectancy. Percutaneous AL-C is performed under cooperative sedation at C1-C2 level. CT myelography guidance and intraoperative electrophysiology allow accurate targeting of the spinothalamic tract (STT). Thermocoagulation is performed at 80 °C for 60 s during a Mingazzini maneuver, in order to promptly detect the potential onset of a motor weakness. Open AL-C is performed under general anesthesia at T2-T3 level. The dentate ligament is suspended to gently rotate the spinal cord and expose the anterolateral column. Section of the STT is made with a micro scalpel blade at a depth of 4−5 mm, from the dentate ligament to the emergence of ventral rootlets. Success rate after AL-C is high and allows a marked reduction in antalgic drugs intake. Main limitations include failure in achieving long-standing pain relief and the new occurrence of spontaneous, mirror pain.
Conclusion
AL-C is a safe and effective option for the management of opioid-resistant cancer pain, which should be part of the neurosurgeon’s armamentarium.
{"title":"Percutaneous and open anterolateral cordotomy for intractable cancer pain: a technical note","authors":"Yann Seznec , Mathilde Pachcinski , David Charier , Christelle Créac’h , Benjamin Buhot , Sylvain Grange , François Vassal","doi":"10.1016/j.neuchi.2024.101602","DOIUrl":"10.1016/j.neuchi.2024.101602","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterolateral cordotomy (AL-C) is a long-established treatment for alleviating intractable cancer pain. However, AL-C has progressively fallen into desuetude, leading to the risk of a definitive loss of expertise within neurosurgical teams. Our objective was therefore to provide an update on percutaneous and open AL-C, with special emphasis on contemporary operative technique.</div></div><div><h3>Material and methods</h3><div>Patient selection, indications, outcomes and up-to-date operative technique are reviewed through illustrative cases, including intraoperative photographs and video.</div></div><div><h3>Results</h3><div>Main indications are represented by unilateral, nociceptive pain refractory to best pharmacological treatment in patients with limited life expectancy. Percutaneous AL-C is performed under cooperative sedation at C1-C2 level. CT myelography guidance and intraoperative electrophysiology allow accurate targeting of the spinothalamic tract (STT). Thermocoagulation is performed at 80 °C for 60 s during a Mingazzini maneuver, in order to promptly detect the potential onset of a motor weakness. Open AL-C is performed under general anesthesia at T2-T3 level. The dentate ligament is suspended to gently rotate the spinal cord and expose the anterolateral column. Section of the STT is made with a micro scalpel blade at a depth of 4−5 mm, from the dentate ligament to the emergence of ventral rootlets. Success rate after AL-C is high and allows a marked reduction in antalgic drugs intake. Main limitations include failure in achieving long-standing pain relief and the new occurrence of spontaneous, mirror pain.</div></div><div><h3>Conclusion</h3><div>AL-C is a safe and effective option for the management of opioid-resistant cancer pain, which should be part of the neurosurgeon’s armamentarium.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101602"},"PeriodicalIF":1.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331932","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}
Pub Date : 2024-09-26DOI: 10.1016/j.neuchi.2024.101599
Alexandre Roux , Tariq Al Saadi , Michael Luo , Phuong Uyen Le , Roberto Diaz , Kevin Petrecca
{"title":"Working towards understanding the natural history and treatment response of noncanonical IDH mutant astrocytomas","authors":"Alexandre Roux , Tariq Al Saadi , Michael Luo , Phuong Uyen Le , Roberto Diaz , Kevin Petrecca","doi":"10.1016/j.neuchi.2024.101599","DOIUrl":"10.1016/j.neuchi.2024.101599","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101599"},"PeriodicalIF":1.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331933","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}
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