Neurochirurgie最新文献

Background: Skull-base surgery, including skull-base meningiomas (SBMs), is among the most challenging medical fields which has witnessed leaps in advancement, owing to ever evolving technological and scientific progress. We performed a comprehensive bibliometric analysis and analysis of clinical reports on SBMs to describe the evolution and identify trends and relationships between basic and applied research in the field.

Methods: The study was a qualitative and quantitative bibliometric analysis of SBM research and review of SBM clinical series via a systematic search of the Web of Science for SBM topics and SBM case series. Quantitative analysis included the most cited publications, most productive authors, most cited journals, and number of publications per country. Keyword co-occurrence and co-authorship maps were produced to visualize research hotspots. Data output from the visualization analysis was analyzed qualitatively to identify themes within separate clusters and delineate evolution of clusters across time. Publications were screened to extract clinical reports of at least ten SBM cases to analyze year, type of treatment, country, and sample size in order to use the data to investigate the lag period between research and clinical adaptation of individual treatment modalities.

Results: We identified 3258 publications and 451 series reporting on 33559 cases of SBMs. The United States of America is the leading country in publications and reported number of SBM cases. The most productive authors are active neurosurgeons in their 40s, or older. Among the top cited publications, most are related to endoscopic surgery, followed by research on genomics. Open surgery is the most common treatment modality being reported for SBM cases, however it's prevalence has been on the decrease as more recently there has been a substantial increase in other types of treatment.

Conclusions: Complexity of the field is reflected in the delayed age of peak scientific productivity. Over the past fifty years the SBM research has undergone a rapid expansion and can currently be seen as developing in four separate areas and the efforts are being led by three broadly collaborating research groups. The research-to-clinical routine lag of less than ten years speaks of the dynamic nature of SBM research and treatment.

Background: The recent advent of anti-IDH therapies and changes in the WHO classification of gliomas implies estimating the number of patients who could benefit (or not) from anti-IDH treatment. As published data on the current incidence of different subtypes of IDH-mutant gliomas (based on the latest histomolecular WHO classification) are lacking in many countries. The present analysis aims to review the main factors impacting the incidence of gliomas and lower-grade gliomas and to estimate the incidence and prevalence of IDH-mutant gliomas in France.

Methods: Our analysis was based on data from the French Brain Tumor DataBase and literature.

Results: Case definition, recording methods, histological classifications, age, sex, ethnicity, ancestry, environment, genetics, etc., impact the incidence of gliomas overall and lower-grade gliomas. In France, for the year 2024, the incidence estimates of all gliomas and all adult-type diffuse IDH-mutant gliomas are 6.6/100,000 and 1/100,000 person-years, respectively. The incidence estimates of grades 2, 3, and 4 diffuse IDH-mutant gliomas are 0.5, 0.3, 0.2 per 100,000 person-years, respectively. Of note, the incidence estimate of grade 3 diffuse IDH-mutant glioma versus grade 2 or 4 is slightly more difficult to assess due to the possible variability in histological criteria to define tumor grade. The prevalence of diffuse IDH-mutant grade 2 glioma would be more than 6.57/100,000 persons.

Discussion/conclusion: Our epidemiological analysis provides estimates of potential number of patients, but large prospective real-world studies are required to determine the positioning of anti-IDH treatments among all therapeutic strategies [surgery(ies), chemotherapy(ies), radiotherapy(ies), clinical/radiological follow-up, etc.].

Context: Pituitary Neuroendocrine Tumors are rare in children, but challenging, implying the two purposes to cure the child, and preserve pituitary function. In this paper, we describe our population of children who underwent endoscopic endonasal resection of a pituitary adenoma, in Lille University Hospital.

Patients and methods: Between 2007 and 2021, all children undergoing EEN surgery for pituitary adenoma were included. Age at surgery, surgical course, type of adenoma, knosp grade and extent of resection were collected.

Results: 26 patients were included. 88% were female. All adenomas were functioning. 15 patients had prolactine-secreting adenomas (58%), 9 patients had ACTH-secreting adenomas (35%) and 2 patients had GH-secreting adenomas (8%). Visual disturbance was present at diagnosis in 5 patients. Among them, visual function was improved after surgery in 4 patients and stable in one. Surgical course was always easy. 66% of prolactinomas, all Cushing disease were in remission after surgery. The two patients with acromegaly had to undergo complementary treatment. Follow up was maintained at least 5 years.

Discussion: Surgical treatment remain mainstay in pituitary adenomas. In the pediatric population, surgery can be performed safely and efficiently via en EEN approach.

Background: The Da Vinci robot ® (DVR), released in the early 2000s, provided a set of innovation aiming at pushing minimally invasive surgery forward. Its stereoscopic magnified visualization camera, motions that exceed the natural range of the human hand, or tremor reduction enhanced the surgeon's skills and added value in many surgical fields.

Objective: To map the current use of the DVR in spine surgery, identify gaps, address its limits and future perspectives.

Methods: We conducted a scoping review upon PRISMA guidelines through Pubmed from inception to July 2024, including english-written articles describing clinical use of the DVR on procedures related to spinal conditions. We collected a broad range of data, from journals publishing those articles, to the study design, the purpose of the study, the sample size or conclusions. We then provided a narrative review on the scope of indications and results of those studies.

Results: Seventeen studies including a total of forty-nine patients were included. Those included procedures in the craniocervical junction for 4 patients, thoracic spine for 5 cases, 29 patients involved the lumbar and lumbosacral segment, and 11 on the sacral region. Pathologies included degenerative diseases with 25 cases (14 ALIF and 11 OLIF), tumors as paraspinal schwannomas and odontoid lesions, but also basilar invagination of the odontoid process, Tarlov cyst, and sacral fracture.

Conclusion: The DVR presents as a valuable tool for minimally invasive surgery in selected cases. Further studies including cost effectiveness, leaning curve, and control trial are needed.

Introduction: Meningomyelocele is the most common congenital anomaly. It is associated with significant complications and can result in morbidity and mortality. The present study aims to identify short-term prognostic markers by investigating the characteristics of patients with meningomyelocele during hospitalization.

Methods: This is a retrospective study for patients with meningomyelocele who underwent surgery between 2019 and 2022. Preoperative and postoperative characteristics of the patients were statistically analyzed.

Results: Of the total of 161 patients included in the study, 137 (85.1%) were female and 24 (14.9%) were male. Examination of the relationship between the preoperative characteristics of the patients and mortality showed a significant correlation with Apgar scores at the first and fifth minutes (p < 0.01). Comparison of the preoperative and postoperative characteristics of the patients showed that those with necrosis at the wound site had significantly lower 1-min and 5-min Apgar scores (p < 0.001), experienced motor deficits (p < 0.001), and underwent a delayed surgery (p = 0.048). Analysis of patients requiring postoperative ventriculoperitoneal (VP) shunt placement showed significant associations with low 1-min and 5-min Apgar scores (p < 0.001) and motor deficits (p < 0.001).

Conclusions: The present study demonstrated that low Apgar scores, surgical timing, defect size, and neurological deficits were associated with the length of hospital stay and prognosis. Postoperative complications significantly prolonged the follow-up period of patients. We found that the Apgar score has a significant effect on both complications and mortality.

Background: Malignant peripheral nerve-sheath tumor (MPNST) is rare, occurring in approximately 0.001% of the general population. Cases involving cranial nerves, and particularly the trigeminal nerve (V), are exceptionally rare, with only 36 cases reported in a literature review in 2013. Standardized treatment and follow-up protocols are lacking. Here, we present a case of MPNST of the trigeminal nerve, provide a review of all cases described in the literature, and discuss treatment, surgical approach, recurrence rate, follow-up time and prognosis.

Methods: Based on PRISMA guidelines, we reviewed all cases of trigeminal MPNST published between 1950 and September 2023. We analyzed risk factors for recurrence. And we report the case of a patient with trigeminal MPNST admitted to our hospital.

Results: The literature review retrieved 39 relevant studies, reporting 48 cases. Patient age ranged from 4 to 71 years, for a mean 44.4 ± 17 years. The male:female ratio was 3.8:1. Most cases developed sporadically; 1 patient had neurofibromatosis type 1 and 1 had type 2. Surgery was the first-line treatment (85%), and radiotherapy was often included as adjuvant (65%). During a mean follow-up of 23.1 ± 24.4 months, fatal outcomes occurred in approximately 30% of patients. Only 1 case of systemic metastasis was reported. The only prognostic factor significantly associated with a lower rate of recurrence was complete surgical resection (p = 0.0035).

Conclusion: Cranial nerve MPNST is extremely rare, and trigeminal MPNST is even rarer. Treatment corresponds to current recommendations for intracranial MPNST, in which radical resection with adjuvant radiotherapy under stereotactic conditions results in the best outcome. Because of the high risk of recurrence, especially in case of incomplete resection, close follow-up is mandatory. Proton-beam therapy could be an interesting alternative adjuvant therapy after surgery.

This case reports the outcome of endoscopic optic nerve decompression in a rare case of idiopathic pachymeningitis in a patient solely reliant on the affected eye. A 70 year old man with complete blindness in his left eye presented with deterioration of vision in his right eye. An MRI head and orbits was suggestive of idiopathic pachymeningitis extending into the right orbital apex, causing a compressive optic neuropathy. He subsequently underwent endoscopic optic nerve compression. Visual acuity and colour vision were measured pre-operatively, and at 6 weeks and one year post operatively. Pre-operative visual acuity was measured at 6/9, compared to 6/9 at 6 weeks post operatively and 6/60 at one year. Colour vision was measured at 0/17 pre-operatively and did not improve post-. We report a rare case of optic neuropathy secondary to pachymeningitis, in which endoscopic nerve decompression did not offer the expected benefit of halting visual deterioration.

Introduction: This study aimed to evaluate the clinical outcomes of transforaminal full-endoscopic lumbar discectomy (FELD) for treating lateral lumbar disc herniation.

Methods: A retrospective single-center study was conducted at Centre Orthopédique Santy, Lyon, France, including 58 adult patients with foraminal or extraforaminal lumbar disc herniations who underwent surgery between October 2020 and January 2023. Inclusion criteria were patients with significant functional impairment due to unilateral radicular pain unresponsive to conservative treatment for over six weeks. Data on demographics, clinical characteristics, and outcomes were collected, evaluated preoperatively and at 12 months postoperatively using Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and Macnab criteria.

Results: The cohort had a mean age of 56.5 years and consisted predominantly of males, with 35 men (60%). Most herniations were at the L4-L5 level (29 patients, 50%). Significant improvements were observed in lumbar VAS (mean reduction of 1.9 points, p < 0.001), radicular VAS (mean reduction of 4.9 points, p < 0.001), and ODI (mean reduction of 41.9 points, p < 0.001) scores. Patient satisfaction was high, with 91% (53 patients) reporting excellent or good outcomes. The reoperation rate was 6.9% (4 patients). Linear regression analysis indicated that longer symptom duration and higher preoperative radicular VAS scores predicted greater satisfaction.

Conclusions: Transforaminal FELD is a safe and effective technique for treating lateral lumbar disc herniation, offering high patient satisfaction. Symptom duration and preoperative radicular VAS scores are key predictors of positive outcomes. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.

Objective: To analyze postoperative seizure outcomes and factors associated with unfavorable seizure control (Engel III-IV) in adults with drug-resistant unilateral mesial temporal epilepsy who underwent temporal lobectomy.

Methods: This was an observational, longitudinal, and retrospective study. A descriptive analysis of sociodemographic, clinical, and paraclinical characteristics was performed. The incidence rate of inadequate seizure control was calculated, and a Kaplan-Meier curve was reported. Cox regression analysis was conducted to identify factors associated with unfavorable outcomes.

Results: A total of 285 patients were included, 56.4% were women, and 49.12% underwent standard temporal lobectomy. Engel I were achieved in 70.87% of patients, while 6.31% experienced postsurgical complications. The estimated incidence rate of unfavorable outcomes was 3.87 cases per 100 person-years (95% CI: 3.51-4.27). Cox regression analysis indicated that patients with a temporal functional deficit zone, as identified by neuropsychological testing, had a 55.34% lower risk of an unfavorable outcome (adjusted HR: 0.4466, 95% CI: 0.236-0.854) compared to those with non-conclusive or extratemporal deficits. Concordance between video-electroencephalogram and brain magnetic resonance imaging findings in patients with right-sided lesions was also a protective factor (adjusted HR: 0.1868, 95% CI: 0.06-0.578). Discontinuation of anti-seizure treatment significantly increased the risk of an unfavorable outcome (adjusted HR: 6.718, 95% CI: 3.309-13.64).

Conclusion: Temporal lobe epilepsy surgery can achieve long-term seizure control in a significant proportion of patients. Neuropsychological assessment and concordance between MRI and video-EEG are essential presurgical factors for favorable outcomes. Additionally, patients should continue with antiepileptic treatment post-surgery to prevent seizure recurrence.