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}
Pub Date : 2024-09-14DOI: 10.1016/j.neuchi.2024.101586
Arianna Barbotti , Pierre-Aurélien Beuriat , Anthony Toutikian , Carmine Mottolese , Matthieu Vinchon , Alexandru Szathmari , Federico Di Rocco
Background
The microscope has been the gold standard in neurosurgical practice due to its ability to magnify anatomical structures. However, it has limitations, including restricted visual fields and ergonomic challenges that can lead to surgeon fatigue and musculoskeletal issues. The exoscope is an emerging technology that may address these limitations by offering comparable magnification with improved ergonomics.
Methods
This study compares the traditional microscope (KINEVO 900) with a 3D digital exoscope (Aeos Digital Microscope) in visual field width, image sharpness, and ergonomic impact. Visual field assessments were conducted using millimeter paper at a fixed distance, while image sharpness was evaluated using graph paper with pins at different depths. Ergonomic evaluation involved simulating surgical positions using a spine anatomical model. The practical applicability was tested during Selective Dorsal Rhizotomy (SDR) procedures, comparing the surgeon's experience with both devices over 20 consecutive cases.
Results
The exoscope provided a larger visual field (81.18 cm2) compared to the microscope's (54.10 cm2). Image sharpness was similar for both devices across various depths and zoom levels. Ergonomically, the exoscope allowed the surgeon to maintain a neutral posture while visualizing extreme angles, unlike the microscope, which required significant upper body movement. In SDR procedures, the exoscope improved surgeon comfort and interaction with the operating team, despite an initial learning curve.
Conclusions
The exoscope presents notable advantages in terms of visual field and ergonomics. The exoscope’s ability to facilitate better posture and team communication without compromising image quality makes it an addition to neurosurgical practice, as in SDR.
{"title":"Neurosurgical applications of the exoscope: from in vitro studies to real-life surgical use in selective dorsal rhizotomy","authors":"Arianna Barbotti , Pierre-Aurélien Beuriat , Anthony Toutikian , Carmine Mottolese , Matthieu Vinchon , Alexandru Szathmari , Federico Di Rocco","doi":"10.1016/j.neuchi.2024.101586","DOIUrl":"10.1016/j.neuchi.2024.101586","url":null,"abstract":"<div><h3>Background</h3><p>The microscope has been the gold standard in neurosurgical practice due to its ability to magnify anatomical structures. However, it has limitations, including restricted visual fields and ergonomic challenges that can lead to surgeon fatigue and musculoskeletal issues. The exoscope is an emerging technology that may address these limitations by offering comparable magnification with improved ergonomics.</p></div><div><h3>Methods</h3><p>This study compares the traditional microscope (KINEVO 900) with a 3D digital exoscope (Aeos Digital Microscope) in visual field width, image sharpness, and ergonomic impact. Visual field assessments were conducted using millimeter paper at a fixed distance, while image sharpness was evaluated using graph paper with pins at different depths. Ergonomic evaluation involved simulating surgical positions using a spine anatomical model. The practical applicability was tested during Selective Dorsal Rhizotomy (SDR) procedures, comparing the surgeon's experience with both devices over 20 consecutive cases.</p></div><div><h3>Results</h3><p>The exoscope provided a larger visual field (81.18 cm<sup>2</sup>) compared to the microscope's (54.10 cm<sup>2</sup>). Image sharpness was similar for both devices across various depths and zoom levels. Ergonomically, the exoscope allowed the surgeon to maintain a neutral posture while visualizing extreme angles, unlike the microscope, which required significant upper body movement. In SDR procedures, the exoscope improved surgeon comfort and interaction with the operating team, despite an initial learning curve.</p></div><div><h3>Conclusions</h3><p>The exoscope presents notable advantages in terms of visual field and ergonomics. The exoscope’s ability to facilitate better posture and team communication without compromising image quality makes it an addition to neurosurgical practice, as in SDR.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101586"},"PeriodicalIF":1.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233012","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 : 2024-09-13DOI: 10.1016/j.neuchi.2024.101587
Jean Raymond , William Boisseau , Thanh N. Nguyen , Tim E. Darsaut
Background
Despite multiple calls for more inclusive studies, most clinical trial eligibility criteria remain too restrictive. Thrombectomy trials have been no exception.
Methods
We review the landmark trials that have shown the benefits of thrombectomy, their eligibility criteria, and consequences on clinical practice. We discuss the rationale behind various reasons for exclusions. We also examine the logical problem involved in using eligibility criteria as indications for treatment.
Results
Most thrombectomy trials have been too restrictive. This has been shown by a plethora of follow-up studies that have refuted most of the previously recommended trial eligibility restrictions. Meanwhile, the effect of clinical recommendations based on restrictive eligibility criteria is that treatment has been denied to the majority of patients who could have benefitted. Trial eligibility criteria cannot be used to make clinical decisions or recommendations unless, like any other medical diagnosis, they have been shown capable of reliably differentiating patients into those that will, and those that will not benefit from treatment. This goal can only be achieved with all-inclusive pragmatic trials.
Conclusion
Restrictive eligibility criteria render clinical trials incapable of guiding medical decisions or recommendations.
{"title":"Trial selection criteria should not be used for clinical decisions and recommendations: the thrombectomy trials example","authors":"Jean Raymond , William Boisseau , Thanh N. Nguyen , Tim E. Darsaut","doi":"10.1016/j.neuchi.2024.101587","DOIUrl":"10.1016/j.neuchi.2024.101587","url":null,"abstract":"<div><h3>Background</h3><p>Despite multiple calls for more inclusive studies, most clinical trial eligibility criteria remain too restrictive. Thrombectomy trials have been no exception.</p></div><div><h3>Methods</h3><p>We review the landmark trials that have shown the benefits of thrombectomy, their eligibility criteria, and consequences on clinical practice. We discuss the rationale behind various reasons for exclusions. We also examine the logical problem involved in using eligibility criteria as indications for treatment.</p></div><div><h3>Results</h3><p>Most thrombectomy trials have been too restrictive. This has been shown by a plethora of follow-up studies that have refuted most of the previously recommended trial eligibility restrictions. Meanwhile, the effect of clinical recommendations based on restrictive eligibility criteria is that treatment has been denied to the majority of patients who could have benefitted. Trial eligibility criteria cannot be used to make clinical decisions or recommendations unless, like any other medical diagnosis, they have been shown capable of reliably differentiating patients into those that will, and those that will not benefit from treatment. This goal can only be achieved with all-inclusive pragmatic trials.</p></div><div><h3>Conclusion</h3><p>Restrictive eligibility criteria render clinical trials incapable of guiding medical decisions or recommendations.</p></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101587"},"PeriodicalIF":1.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0028377024000584/pdfft?md5=9e94a06c29b0faf5a03afb57292824e3&pid=1-s2.0-S0028377024000584-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142228760","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 : 2024-09-12DOI: 10.1016/j.neuchi.2024.101594
Facundo Villamil , Lucila Domecq Laplace , Santiago E. Cicutti , Yamila Slame , Miguel Grijalba , Guido Gromazdyn , Marcelo Bartuluchi
Purpose
Since it was first described in the 1970s, functional hemispherotomy has been an essential tool in treating disabling, medically refractory epilepsy resulting from diffuse unilateral hemispheric disease. We report our experience with 23 patients who underwent hemispherotomy, both using the functional hemispherotomy (FH) as well as a modified peri-insular hemispherotomy (PIH) technique. We present the surgical technique for the latter, review outcomes following disconnection surgery and discuss the differences between the techniques when it comes to complications and postoperative results.
Methods
A retrospective study of 23 patients with refractory seizures who underwent cerebral hemispherectomy. A thorough analysis of the clinical, imaging, surgical features and postoperative results was performed. We also present the surgical technique for a modified PIH technique.
Results
Between 2000 and 2020, 23 pediatric patients with refractory seizures underwent hemispherotomy (12 FHs, 11 modified PIHs). 91.3% of patients were seizure free at 6 months, 87% at 1 year, and 78.3% at last follow-up. None of the 23 patients presented Engel IV outcome. FH was found to have statistically longer surgical duration (5 ± 1.5 vs. 3.83 ± 0.5 h; p = <0.001). Neurocognition was improved in two thirds of the patients (66.9%). Our study also shows improvement of motor activity in the majority of the patients, regardless of the pathology and surgical technique. In the present report we modified the Cook et al. technique by implementing an amygdalohippocampectomy with resection of the tail of the hippocampus posteriorly and medially, to achieve temporo-occipital disconnection, instead of a complete temporal lobectomy.
Conclusion
When patients are wisely selected, the hemispherectomy procedure should be considered as a most attractive and curative treatment for children with refractory seizures, not only giving the patient a high chance of seizure freedom but also providing an improvement in motor and cognitive skills. In our particular case and based on the present study, the modified PIH proves to be a highly effective technique. It not only has a shorter surgical time but also a very low complication rate.
{"title":"Pediatric peri-insular hemispherotomy and functional hemispherectomy for severe medically refractory epilepsy: comparison of two techniques","authors":"Facundo Villamil , Lucila Domecq Laplace , Santiago E. Cicutti , Yamila Slame , Miguel Grijalba , Guido Gromazdyn , Marcelo Bartuluchi","doi":"10.1016/j.neuchi.2024.101594","DOIUrl":"10.1016/j.neuchi.2024.101594","url":null,"abstract":"<div><h3>Purpose</h3><div>Since it was first described in the 1970s, functional hemispherotomy has been an essential tool in treating disabling, medically refractory epilepsy resulting from diffuse unilateral hemispheric disease. We report our experience with 23 patients who underwent hemispherotomy, both using the functional hemispherotomy (FH) as well as a modified peri-insular hemispherotomy (PIH) technique. We present the surgical technique for the latter, review outcomes following disconnection surgery and discuss the differences between the techniques when it comes to complications and postoperative results.</div></div><div><h3>Methods</h3><div>A retrospective study of 23 patients with refractory seizures who underwent cerebral hemispherectomy. A thorough analysis of the clinical, imaging, surgical features and postoperative results was performed. We also present the surgical technique for a modified PIH technique.</div></div><div><h3>Results</h3><div>Between 2000 and 2020, 23 pediatric patients with refractory seizures underwent hemispherotomy (12 FHs, 11 modified PIHs). 91.3% of patients were seizure free at 6 months, 87% at 1 year, and 78.3% at last follow-up. None of the 23 patients presented Engel IV outcome. FH was found to have statistically longer surgical duration (5 ± 1.5 vs. 3.83 ± 0.5 h; p = <0.001). Neurocognition was improved in two thirds of the patients (66.9%). Our study also shows improvement of motor activity in the majority of the patients, regardless of the pathology and surgical technique. In the present report we modified the Cook et al. technique by implementing an amygdalohippocampectomy with resection of the tail of the hippocampus posteriorly and medially, to achieve temporo-occipital disconnection, instead of a complete temporal lobectomy.</div></div><div><h3>Conclusion</h3><div>When patients are wisely selected, the hemispherectomy procedure should be considered as a most attractive and curative treatment for children with refractory seizures, not only giving the patient a high chance of seizure freedom but also providing an improvement in motor and cognitive skills. In our particular case and based on the present study, the modified PIH proves to be a highly effective technique. It not only has a shorter surgical time but also a very low complication rate.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"70 6","pages":"Article 101594"},"PeriodicalIF":1.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300340","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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