Neurochirurgie最新文献

英文中文

The Neurosurgical Exodus — A Loss for Latin American Science and Public Health 神经外科的外流——拉丁美洲科学和公共卫生的损失

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-21 DOI: 10.1016/j.neuchi.2025.101749

Jack Váscones-Román , Fritz Fidel Váscones-Román

引用次数: 0

Relationship Among Preoperative and Intraoperative Contralateral Analysis along the Perivascular Space Indexes and Postoperative Mini-Mental State Examination Scores in Newly Diagnosed Glioblastoma 新诊断的胶质母细胞瘤术前、术中对侧分析血管周围间隙指数与术后精神状态检查评分的关系。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-19 DOI: 10.1016/j.neuchi.2025.101752

Ryohei Ono, Shunichiro Miki, Alexander Zaboronok, Eiichi Ishikawa

Objective

Analysis along the Perivascular Space (ALPS) index has been proposed as a quantitative magnetic resonance imaging (MRI) marker for evaluating the function of the brain’s glia-dependent waste clearance pathway, known as the glymphatic system. We hypothesized that the ALPS index on the contralateral side of the brain lesion may relate to postoperative memory disturbance. This study aimed to evaluate the relationship among the preoperative and intraoperative contralateral ALPS indexes and postoperative mini-mental state examination (MMSE) scores in patients with newly diagnosed glioblastoma (GBM).

Methods

Thirty-three patients with newly diagnosed, solitary GBMs who underwent intraoperative MRI and diffusion tensor imaging (DTI) were enrolled in this retrospective study. Patient data included tumor volume, peritumoral edema volume, preoperative and postoperative MMSE scores, and the preoperative and intraoperative contralateral ALPS index.

Results

A higher preoperative ALPS index was associated with older age, and a significant negative correlation was observed between the preoperative ALPS index and MMSE scores both before and after surgery, while the index was unrelated to the degree of improvement in the MMSE scores. Unexpectedly, the intraoperative ALPS index tended to show a negative correlation with the postoperative MMSE score and showed a strong correlation with the degree of improvement in the MMSE scores.

Conclusions

These findings suggest that the contralateral glymphatic pathway may associated with irreversible higher brain dysfunction in GBM patients. However, further studies are needed to confirm this speculation.

目的：沿血管周围间隙（ALPS）指数的分析已被提出作为定量磁共振成像（MRI）标记物，用于评估脑胶质细胞依赖的废物清除途径，即淋巴系统的功能。我们假设脑损伤对侧的ALPS指数可能与术后记忆障碍有关。本研究旨在探讨新诊断的胶质母细胞瘤（GBM）患者术前和术中对侧ALPS指数与术后最小精神状态检查（MMSE）评分的关系。方法：对33例新诊断的孤立性GBMs患者进行术中MRI和弥散张量成像（DTI）的回顾性研究。患者资料包括肿瘤体积、瘤周水肿体积、术前和术后MMSE评分、术前和术中对侧ALPS指数。结果：术前阿尔卑斯指数越高，年龄越大，术前阿尔卑斯指数与术前和术后MMSE评分呈显著负相关，而该指数与MMSE评分改善程度无关。出乎意料的是，术中ALPS指数与术后MMSE评分呈负相关，与MMSE评分的改善程度有很强的相关性。结论：这些发现提示对侧淋巴通路可能与GBM患者不可逆的高级脑功能障碍有关。然而，需要进一步的研究来证实这一推测。

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引用次数: 0

Awake surgery and music: Two illustrative cases of frontal resection in pianists 清醒手术与音乐：钢琴家额叶切除术两例。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-19 DOI: 10.1016/j.neuchi.2025.101753

Francesca Di Nardo , Florence Le Vourc’h , Justine Bleunven , Marine Pedreni , Romuald Seizeur , Vanessa Saliou

Functional anatomy underlyng music perception and production has been quite abundantly described in literature, together with some examples of musical tasks adopted during awake surgery. We have used a keyboard-playing test for per-operative monitoring of two patients affected by a glial lesion.

Our two cases differ in age, lateralization and hemispheric localization of the lesion. One of them, who presented a left middle frontal gyrus lesion, showed a decrease in his ability to play piano, together with other neurological abnormalities, from which he completely recovered within a year. The other patient, whose lesion was instead right and prefrontal, didn’t show any music-related anomalies.

Our patients’ outcomes are consistent with previous literature concerning lateralization and localization of music-related functions in musicians.

In our left-sided case, the emerging of a slowdown in piano playing, without other relevant language, sensitive or motor abnormalities, confirmed by mistakes in picture naming (DO80 N-1) performed simultaneously with a motor task, led us to interrupt our resection, allowing the patient to fully recover within a year, suggesting, with the limitations that we will further discuss, a certain sensibility of the action of playing for early detection of cognitive abnormalities, usually determined with a task-switching test strategy.

在文献中，已经对音乐感知和产生的功能解剖学进行了大量的描述，并提供了一些在清醒手术中采用的音乐任务的例子。我们使用键盘演奏测试术中监测两例神经胶质病变患者。我们的两例不同的年龄，侧边和半球定位病变。其中一人表现为左额叶中回损伤，钢琴演奏能力下降，并伴有其他神经系统异常，但他在一年内完全康复。另一名患者的病变位于右侧和前额叶，没有显示出任何与音乐相关的异常。我们患者的结果与先前关于音乐家音乐相关功能偏侧和定位的文献一致。在我们的左脑病例中，钢琴演奏出现了减速，没有其他相关的语言、敏感或运动异常，并被与运动任务同时进行的图片命名错误（DO80 N-1）所证实，导致我们中断了手术切除，让患者在一年内完全康复，这表明，尽管我们将进一步讨论的局限性，演奏动作的某种敏感性可以早期发现认知异常。通常通过任务切换测试策略来确定。

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引用次数: 0

Postoperative Management Following Degenerative Lumbar Spine Surgery: Results From a Survey Conducted by the French Society of Spine Surgery and Literature Review 腰椎退行性手术后的术后处理：来自（盲法回顾）和文献回顾的调查结果。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-19 DOI: 10.1016/j.neuchi.2025.101751

Mathieu Lozouet , Mourad Ould-Slimane , Marc Szadkowski , Henri-Arthur Leroy , Jérôme Delambre , Thais Dutra Vieira , François Lucas , Xavier Castel , Martin Dupuy , Henri d’Astorg , the French Spine Society (SFCR)

Background

Postoperative instructions influence lumbar surgery outcomes, but lack of consensus and differing expertise lead to varied practices.

Methods

An online, practice-based questionnaire was distributed in 2021 to all members of the (blinded for review). This survey investigated postoperative care following degenerative lumbar surgery, focusing on follow-up procedures, postoperative imaging practices, recommendations for immobilization and timelines for returning to work and sports activities.

Results

The survey involved 239 surgeons, with neurosurgeons (66%) and orthopaedic surgeons (34%), achieving a response rate of 68.2%. The diversity of opinions varies by item. Notably, routine postoperative imaging was not advocated in 62.7% of non-instrumented procedures. In contrast, it was recommended in 91.9% of cases after instrumented surgeries. Less than 16% of surgeons preconized a postoperative immobilization. Physiotherapy was generally recommended after the first follow-up visit by more than 80% of surgeons. Recommendations for return to work varied, with 62.7% suggesting a 6-week medical leave for non-instrumented surgery and 61.9% recommending over 2 months for instrumented procedures. Most surgeons (94.8%) advised avoiding sports for at least three months post-surgery. Differences between orthopaedic and neurosurgeons were noted, particularly regarding immobilization practices (p < 0.0001) and postoperative imaging for non-instrumented surgeries (p < 0.0001).

Conclusion

A variety of postoperative care practices for lumbar spine surgery exists in France. This mainly relates to recommendations for imaging and return to work following non-instrumented surgery. Finally, there were few differences between the practices of neurosurgeons and orthopaedic surgeons, aligning with contemporary literature on the subject.

背景：术后指导影响腰椎手术的结果，但缺乏共识和不同的专业知识导致不同的做法。方法：一份基于实践的在线问卷于2021年分发给所有成员（盲法审查）。本研究调查了退行性腰椎手术的术后护理，重点是随访程序、术后影像学实践、固定的建议以及重返工作和体育活动的时间表。结果：239名外科医生参与调查，其中神经外科医生占66%，骨科医生占34%，有效率为68.2%。意见的多样性因项目而异。值得注意的是，62.7%的非器械手术不提倡常规的术后影像学。相比之下，91.9%的病例在器械手术后被推荐使用。不到16%的外科医生在手术后预固定。超过80%的外科医生在第一次随访后普遍推荐物理治疗。对于重返工作岗位的建议各不相同，62.7%的人建议进行无器械手术的患者请6周病假，61.9%的人建议进行有器械手术的患者休2个多月病假。大多数外科医生（94.8%）建议术后至少三个月内避免运动。注意到骨科和神经外科医生之间的差异，特别是在固定做法方面(p结论：法国存在各种腰椎手术术后护理做法。这主要涉及无器械手术后影像学和重返工作岗位的建议。最后，神经外科医生和骨科医生的实践之间几乎没有什么不同，与当代关于该主题的文献一致。

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引用次数: 0

Letter to the Editor regarding “Laser Interstitial Thermal Therapy (LITT) in pediatric neurosurgery: Single center retrospective analysis of 41 consecutive procedures” 致编辑关于“激光间质热疗法（LITT）在儿科神经外科中的应用：41例连续手术的单中心回顾性分析”

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-08 DOI: 10.1016/j.neuchi.2025.101745

Parth Aphale , Himanshu Shekhar , Shashank Dokania

引用次数: 0

Introducing the « J » shaped dural tack-up suture technique when you’re missing the right handpiece for the drill bit during craniotomy: technical note 当你在开颅手术中缺少合适的钻头机头时，介绍“J”形硬脑膜缝合技术：技术说明。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-04 DOI: 10.1016/j.neuchi.2025.101740

Nathan Beucler

Placing dural tack-up sutures is part of the surgical treatment of cranial epidural hematoma, but it is also very useful to stop untimely epidural bleeding during any craniotomy procedure. Hence, dural tack-up sutures stand among the essential technical skills that should be taught to every neurosurgery resident. Traditional tack-up sutures involve passing a thread suture between the thickness of dura mater and a small hole drilled at the bone edge of the craniotomy flap. Alternative dural tack-up sutures can also be tied up between the dura mater and the galea or pericranium when the proper drill handpiece is missing, for example in surgical teams deployed overseas. With this in mind, we present a new technical tip for dural tack-up sutures, which involves making a « J » shaped cut at the edge of the craniotomy. Passing the thread suture down to the bottom of the « J » provides the bone anchor for the dural tack-up suture. This helpful technique only requires the same drill handpiece that is used to cut the craniotomy bone flap.

硬膜缝合是颅硬膜外血肿的外科治疗的一部分，但在任何开颅手术中，它也非常有用，以防止过早的硬膜外出血。因此，硬脑膜缝合是每个神经外科住院医师都应该学习的基本技术技能之一。传统的缝合方法是在硬脑膜厚度和开颅皮瓣骨边缘钻一个小孔之间通过线缝合线。当缺少合适的钻头时，也可以在硬脑膜和胼胝体或颅包皮之间进行替代硬脑膜缝合，例如在海外部署的外科团队中。考虑到这一点，我们提出了硬脑膜缝合的新技术技巧，包括在开颅边缘做一个“J”形切口。将线缝线向下至“J”形底部，为硬脑膜缝合提供骨锚。这种有用的技术只需要与切割开颅骨瓣相同的钻头。

引用次数: 0

Ethics and Simulation in Neurosurgery: The Twin Pillars of Modern Surgical Training 神经外科伦理与模拟：现代外科训练的两大支柱。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-04 DOI: 10.1016/j.neuchi.2025.101739

Fritz Fidel Váscones-Román , Luis Felipe Macha-Quillama , Frank Gleb Solis-Chucos

引用次数: 0

Assessment of dural involvement in calvarial and skull base fibrous dysplasia 颅及颅底纤维性发育不良患者硬脑膜受累的评估。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-03 DOI: 10.1016/j.neuchi.2025.101744

Elif Gozgec , Hayri Ogul , Ahmet Tugrul Akkus , Muhammed Furkan Barutcugil

Objectives

Neurogenic symptoms in craniofacial fibrous dysplasia (FD) are typically caused by direct compression due to the lesion's expansile nature. However, in rare cases, atypical symptoms unrelated to direct compression and associated dural contrast enhancement have been reported. The aim of this study was to investigate the relationship between FD and adjacent dural contrast enhancement.

Material and Methods

This observational study included patients with FD localized to the skull base or calvarium. The location of the lesion, its axial dimensions, and the presence of destruction of the inner table were determined on CT images. On contrast enhanced cranial MR imaging, the presence of dural enhancement was evaluated. The relationship between dural enhancement and other parameters was statistically analyzed.

Results

Of the 27 patients included in the study, 15 were female. Dural contrast enhancement was detected in 16 cases. It was higher in skull base localization than in calvarial localization. Fibrous dysplasia was most commonly localized in the frontal bones, with the highest rate of concomitant dural contrast enhancement in the temporal bone (100%). There was a significant correlation between dural contrast enhancement and inner table destruction. There was no correlation between the size of the lesions and dural contrast enhancement.

Conclusions

MRI findings suggest that FD is frequently associated with dural contrast enhancement, particularly in cases with inner table destruction. This may contribute to neurogenic symptoms and influence treatment strategies. Understanding this association may aid in determining optimal management and avoiding unnecessary surgical interventions.

目的：颅面纤维发育不良（FD）的神经源性症状通常是由病变的扩张性直接压迫引起的。然而，在少数病例中，非典型症状与直接压迫和相关的硬脑膜对比增强无关。本研究的目的是探讨FD与相邻硬膜对比增强之间的关系。材料和方法：本观察性研究纳入了局限于颅底或颅骨的FD患者。在CT图像上确定病变的位置，其轴向尺寸和内表破坏的存在。在增强颅磁振造影上，评估硬脑膜增强的存在。统计分析硬脑膜增强与其他参数的关系。结果：纳入研究的27例患者中，15例为女性。硬膜造影增强16例。颅底定位高于颅骨定位。纤维性发育不良最常见于额骨，颞骨伴硬脑膜增强的比例最高（100%）。硬脑膜造影增强与内表破坏有显著相关性。病灶大小与硬脑膜造影增强无相关性。结论：MRI显示FD常与硬脑膜造影增强有关，特别是在内表破坏的情况下。这可能导致神经源性症状并影响治疗策略。了解这种关联可能有助于确定最佳管理和避免不必要的手术干预。

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引用次数: 0

How I Do It: Mini-Open Decompression for Lumbar Spinal Stenosis Using the Quadrant Retractor System Without Fusion 我怎么做：使用无融合的象限牵开器系统进行腰椎管狭窄小开口减压。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-03 DOI: 10.1016/j.neuchi.2025.101742

Hamad Almarzouki Abuhussain , Kaissar Farah , Mikael Meyer , Stéphane Fuentes

Background

Minimally invasive techniques for lumbar spinal stenosis (LSS) aim to reduce soft-tissue injury while achieving adequate neural decompression. Traditional open decompression remains effective but is associated with extensive muscle dissection and prolonged recovery. Although the Quadrant retractor system is commonly used in transforaminal lumbar interbody fusion (TLIF), its application for non-fusion decompression has been seldom reported [1].

Objective

To describe a reproducible, muscle-sparing decompression technique using the Quadrant system for central and lateral recess stenosis without instrumentation or fusion. Technique Summary: Through a paramedian Wiltse approach and a 4–5 cm vertical incision, the Quadrant retractor is docked on the facet-laminar junction [1,2]. Microscopic decompression is performed including ipsilateral laminotomy, medial facetectomy, and undercutting of the contralateral side. The technique preserves midline structures and avoids unnecessary tissue trauma [2,3].

Conclusion

The Quadrant-assisted decompression technique offers a safe, efficient, and minimally invasive alternative to conventional laminectomy for LSS in appropriately selected patients [9].

背景：腰椎管狭窄症（LSS）的微创技术旨在减少软组织损伤，同时实现充分的神经减压。传统的开放式减压仍然有效，但伴有广泛的肌肉剥离和较长的恢复时间。尽管象限牵开器系统常用于经椎间孔腰椎椎体间融合术（TLIF），但其在非融合术减压中的应用鲜有报道。目的：描述一种可重复的、保留肌肉的减压技术，该技术使用象限系统治疗中央和外侧隐窝狭窄，无需内固定或融合。技术总结：通过旁位Wiltse入路和4-5 cm的垂直切口，将象限牵开器停靠在椎面-椎板交界处[1,2]。显微减压包括同侧椎板切开术、内侧面切开术和对侧切开术。该技术保留了中线结构，避免了不必要的组织损伤[2,3]。结论：在适当选择的LSS患者中，象限辅助减压技术为传统椎板切除术提供了一种安全、有效、微创的替代方法。

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引用次数: 0

Implementation of robot-assisted spine surgery in an academic center: workflow, learning curve and perspectives 在学术中心实施机器人辅助脊柱手术：工作流程、学习曲线和观点。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-03 DOI: 10.1016/j.neuchi.2025.101741

Malick Sagenly , Pierre Haettel , Boulos Ghannam , Richard Assaker , Henri-Arthur Leroy

Surgical robotics represent a significant advancement in healthcare, enhancing precision and safety in operative procedures. While widely used in neurosurgery, visceral surgery, and urology, its adoption in spinal surgery remains in development. This study reports the implementation of robotic-assisted spine surgery within a neurosurgical department, focusing on the learning curve, workflow integration, complications, and prospects.

Successful integration requires a dedicated technical infrastructure and thorough training—both theoretical and practical—for the entire surgical team. Collaboration among surgeons, paramedical staff, and biomedical engineers is essential to optimize outcomes. We used a table-mounted robotic system (Mazor X Stealth Edition, Medtronic), with surgical planning based on preoperative, sub-millimetric bone-density CT scans to ensure personalized care.

From November 2022 to May 2023, we included 32 patients with an average age of 58 y/o (SD 15 (19; 87)) for a total of 204 inserted screws. Degenerative spine represented the main indication followed by tumoral spine. Optimal accuracy for pedicle screw placement was 97 % corresponding to grade A (90.1%) and grade B (6.9%) from GRS. The operating time was of 186.7 min (SD 89.7 (45; 386)) and the average fluoroscopy time per screw was of 3.0 s (1.8–5.5). Installation is a time-consuming step. We observed a trend towards shorter operating times as more cases are operated on. No revision surgery was needed during the study period. Only 2 superficial skin infections were reported, with no other complication.

Robotic spine surgery improves standardization, enhances accuracy, and promotes personalized medicine, with potential for further workflow optimization.

外科机器人代表了医疗保健的重大进步，提高了手术过程的精度和安全性。虽然它广泛应用于神经外科、内脏外科和泌尿外科，但在脊柱外科的应用仍在发展中。本研究报告了机器人辅助脊柱手术在神经外科的实施，重点是学习曲线、工作流程集成、并发症和前景。成功的整合需要专门的技术基础设施和对整个外科团队的全面的理论和实践培训。外科医生、辅助医务人员和生物医学工程师之间的合作对于优化结果至关重要。我们使用台式机器人系统（Mazor X Stealth Edition, Medtronic），手术计划基于术前，亚毫米骨密度CT扫描，以确保个性化护理。从2022年11月至2023年5月，我们纳入了32例患者，平均年龄58岁（SD 15(19; 87)），共204枚螺钉。主要指征为退行性脊柱，其次为肿瘤性脊柱。置入椎弓根螺钉的最佳准确度为97%，对应于GRS的A级（90.1%）和B级（6.9%）。手术时间186.7 min (SD 89.7(45; 386))，平均每颗螺钉透视时间3.0 s（1.8 ~ 5.5）。安装是一个耗时的步骤。我们观察到，随着手术病例的增多，手术时间有缩短的趋势。研究期间未进行翻修手术。仅报告2例浅表皮肤感染，无其他并发症。机器人脊柱手术提高了标准化，提高了准确性，促进了个性化医疗，具有进一步优化工作流程的潜力。

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