Pub Date : 2025-11-04DOI: 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.
{"title":"Introducing the « J » shaped dural tack-up suture technique when you’re missing the right handpiece for the drill bit during craniotomy: technical note","authors":"Nathan Beucler","doi":"10.1016/j.neuchi.2025.101740","DOIUrl":"10.1016/j.neuchi.2025.101740","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101740"},"PeriodicalIF":1.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453256","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 : 2025-11-04DOI: 10.1016/j.neuchi.2025.101739
Fritz Fidel Váscones-Román , Luis Felipe Macha-Quillama , Frank Gleb Solis-Chucos
{"title":"Ethics and Simulation in Neurosurgery: The Twin Pillars of Modern Surgical Training","authors":"Fritz Fidel Váscones-Román , Luis Felipe Macha-Quillama , Frank Gleb Solis-Chucos","doi":"10.1016/j.neuchi.2025.101739","DOIUrl":"10.1016/j.neuchi.2025.101739","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101739"},"PeriodicalIF":1.4,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453302","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 : 2025-11-03DOI: 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.
{"title":"Assessment of dural involvement in calvarial and skull base fibrous dysplasia","authors":"Elif Gozgec , Hayri Ogul , Ahmet Tugrul Akkus , Muhammed Furkan Barutcugil","doi":"10.1016/j.neuchi.2025.101744","DOIUrl":"10.1016/j.neuchi.2025.101744","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Material and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101744"},"PeriodicalIF":1.4,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454090","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}
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].
{"title":"How I Do It: Mini-Open Decompression for Lumbar Spinal Stenosis Using the Quadrant Retractor System Without Fusion","authors":"Hamad Almarzouki Abuhussain , Kaissar Farah , Mikael Meyer , Stéphane Fuentes","doi":"10.1016/j.neuchi.2025.101742","DOIUrl":"10.1016/j.neuchi.2025.101742","url":null,"abstract":"<div><h3>Background</h3><div>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 [<span><span>1</span></span>].</div></div><div><h3>Objective</h3><div>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 [<span><span>1</span></span>,<span><span>2</span></span>]. 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 [<span><span>2</span></span>,<span><span>3</span></span>].</div></div><div><h3>Conclusion</h3><div>The Quadrant-assisted decompression technique offers a safe, efficient, and minimally invasive alternative to conventional laminectomy for LSS in appropriately selected patients [<span><span>9</span></span>].</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101742"},"PeriodicalIF":1.4,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454062","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 : 2025-11-03DOI: 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。
{"title":"Implementation of robot-assisted spine surgery in an academic center: workflow, learning curve and perspectives","authors":"Malick Sagenly , Pierre Haettel , Boulos Ghannam , Richard Assaker , Henri-Arthur Leroy","doi":"10.1016/j.neuchi.2025.101741","DOIUrl":"10.1016/j.neuchi.2025.101741","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div><div>Robotic spine surgery improves standardization, enhances accuracy, and promotes personalized medicine, with potential for further workflow optimization.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101741"},"PeriodicalIF":1.4,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454046","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 : 2025-11-03DOI: 10.1016/j.neuchi.2025.101743
Antonio Navarro-Ballester, Rosa Álvaro-Ballester, Miguel A. Lara-Martínez, María S. Arnau-Ferragut, María P. Fernández-García, Santiago F. Marco-Doménech
Background
Meningiomas are common primary intracranial tumors with varying biological behavior. Accurate preoperative grading is essential for surgical planning and patient management.
Purpose
To evaluate the diagnostic performance and interobserver agreement of apparent diffusion coefficient (ADC) values and ADC ratios in differentiating low-grade and high-grade meningiomas using 1.5T MRI.
Materials and Methods
This retrospective single-center study included 155 patients with histologically confirmed meningiomas. Three independent observers measured ADC values and calculated ADC ratios using ROI analysis. Diagnostic performance was assessed using ROC curves, and interobserver agreement was evaluated using intraclass correlation coefficients (ICC).
Results
Mean ADC values showed poor diagnostic performance (AUCs: 0.39–0.44). ADC ratios showed slightly better interobserver agreement (ICC = 0.78) but similarly weak diagnostic value (AUCs: 0.38–0.42). Differences among observers were not statistically significant (p = 0.0668).
Conclusion
Both mean ADC values and ADC ratios demonstrated poor performance in differentiating meningioma grades. Despite moderate interobserver agreement, neither parameter was clinically useful. Alternative imaging biomarkers or multimodal approaches may be needed for reliable non-invasive grading.
{"title":"Preoperative assessment of meningioma grade using ADC ratios: A multi-observer analytical approach","authors":"Antonio Navarro-Ballester, Rosa Álvaro-Ballester, Miguel A. Lara-Martínez, María S. Arnau-Ferragut, María P. Fernández-García, Santiago F. Marco-Doménech","doi":"10.1016/j.neuchi.2025.101743","DOIUrl":"10.1016/j.neuchi.2025.101743","url":null,"abstract":"<div><h3>Background</h3><div>Meningiomas are common primary intracranial tumors with varying biological behavior. Accurate preoperative grading is essential for surgical planning and patient management.</div></div><div><h3>Purpose</h3><div>To evaluate the diagnostic performance and interobserver agreement of apparent diffusion coefficient (ADC) values and ADC ratios in differentiating low-grade and high-grade meningiomas using 1.5T MRI.</div></div><div><h3>Materials and Methods</h3><div>This retrospective single-center study included 155 patients with histologically confirmed meningiomas. Three independent observers measured ADC values and calculated ADC ratios using ROI analysis. Diagnostic performance was assessed using ROC curves, and interobserver agreement was evaluated using intraclass correlation coefficients (ICC).</div></div><div><h3>Results</h3><div>Mean ADC values showed poor diagnostic performance (AUCs: 0.39–0.44). ADC ratios showed slightly better interobserver agreement (ICC = 0.78) but similarly weak diagnostic value (AUCs: 0.38–0.42). Differences among observers were not statistically significant (p = 0.0668).</div></div><div><h3>Conclusion</h3><div>Both mean ADC values and ADC ratios demonstrated poor performance in differentiating meningioma grades. Despite moderate interobserver agreement, neither parameter was clinically useful. Alternative imaging biomarkers or multimodal approaches may be needed for reliable non-invasive grading.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101743"},"PeriodicalIF":1.4,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453080","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}
Epidermoid cysts of the cerebellopontine angle (CPA) are rare benign congenital lesions derived from ectodermal inclusions during early embryogenesis. Despite their slow growth, they may become giant and cause progressive cranial nerve dysfunction due to their close relationship with critical neurovascular structures.
Case presentation
We report the case of a 60-year-old woman who presented with cochleovestibular symptoms, including vertigo, tinnitus, and hearing loss, in association with cerebellar static ataxia. Preoperative examination revealed intact facial and lower cranial nerve function. Magnetic resonance imaging (MRI) revealed a giant CPA epidermoid cyst.
Surgical management
The lesion was resected via a retrosigmoid approach in a semi-sitting position under continuous intraoperative facial nerve monitoring. Microsurgical dissection enabled near-total removal of the tumor while preserving the surrounding neurovascular structures. Endoscopic inspection of the surgical cavity revealed residual tumor remnants in blind spots, which were subsequently removed, ensuring complete resection.
Conclusion
The combination of microsurgical and endoscopic techniques offers a safe and effective approach to the management of giant CPA epidermoid cysts. Complete resection, including capsule removal, remains the key to minimizing recurrence while preserving neurological function.
{"title":"Giant Epidermoid Cyst of the Cerebellopontine Angle: Value of Endoscopic Assistance in Microsurgical Resection","authors":"Lotfi Boublata, Mohamed Lamine Boukhanoufa, Nassim Mezlah","doi":"10.1016/j.neuchi.2025.101736","DOIUrl":"10.1016/j.neuchi.2025.101736","url":null,"abstract":"<div><h3>Background</h3><div>Epidermoid cysts of the cerebellopontine angle (CPA) are rare benign congenital lesions derived from ectodermal inclusions during early embryogenesis. Despite their slow growth, they may become giant and cause progressive cranial nerve dysfunction due to their close relationship with critical neurovascular structures.</div></div><div><h3>Case presentation</h3><div>We report the case of a 60-year-old woman who presented with cochleovestibular symptoms, including vertigo, tinnitus, and hearing loss, in association with cerebellar static ataxia. Preoperative examination revealed intact facial and lower cranial nerve function. Magnetic resonance imaging (MRI) revealed a giant CPA epidermoid cyst.</div></div><div><h3>Surgical management</h3><div>The lesion was resected via a retrosigmoid approach in a semi-sitting position under continuous intraoperative facial nerve monitoring. Microsurgical dissection enabled near-total removal of the tumor while preserving the surrounding neurovascular structures. Endoscopic inspection of the surgical cavity revealed residual tumor remnants in blind spots, which were subsequently removed, ensuring complete resection.</div></div><div><h3>Conclusion</h3><div>The combination of microsurgical and endoscopic techniques offers a safe and effective approach to the management of giant CPA epidermoid cysts. Complete resection, including capsule removal, remains the key to minimizing recurrence while preserving neurological function.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101736"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318831","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 : 2025-10-29DOI: 10.1016/j.neuchi.2025.101737
Seungbo Lee , Hyun-Jun Jang , Sung Jun Ahn , Mina Park , Bio Joo , Hong Seon Lee , Sung-Uk Kuh , Dong-Kyu Chin , Keun-Su Kim , Sungjun Kim
Study design
Retrospective cohort study.
Summary of background data
Preoperative identification of intradural extension in nerve sheath tumors (NSTs) is crucial for surgical planning. While MRI is the primary imaging modality, reliable markers distinguishing intra- and extradural (IED) from extradural-only (EDO) NSTs remain uncertain.
Objective
To assess the diagnostic utility of MRI features in differentiating IED from EDO NSTs.
Methods
Forty-five patients with confirmed IED or EDO NSTs were retrospectively reviewed. Two radiologists analyzed MRI features, including cerebrospinal fluid (CSF) claw sign and candy shape, with interobserver agreement assessed. Fisher’s exact test and receiver operating characteristic analysis were performed.
Results
Nine cases were IED, and 36 were EDO NSTs. Interobserver agreements of all imaging features between the two radiologists were excellent. IED tumors showed significantly more CSF claw sign and candy shape, and the prediction performance was assessed for these two imaging features. The CSF claw sign showed AUC values of 0.875 and 0.889, while the candy shape showed AUC values of 0.847 and 0.958.
Conclusion
CSF claw sign and candy shape are useful MRI findings to differentiate between IED and EDO NSTs.
{"title":"Performance of magnetic resonance imaging in discriminating between intra- and extradural versus extradural-only nerve sheath tumor","authors":"Seungbo Lee , Hyun-Jun Jang , Sung Jun Ahn , Mina Park , Bio Joo , Hong Seon Lee , Sung-Uk Kuh , Dong-Kyu Chin , Keun-Su Kim , Sungjun Kim","doi":"10.1016/j.neuchi.2025.101737","DOIUrl":"10.1016/j.neuchi.2025.101737","url":null,"abstract":"<div><h3>Study design</h3><div>Retrospective cohort study.</div></div><div><h3>Summary of background data</h3><div>Preoperative identification of intradural extension in nerve sheath tumors (NSTs) is crucial for surgical planning. While MRI is the primary imaging modality, reliable markers distinguishing intra- and extradural (IED) from extradural-only (EDO) NSTs remain uncertain.</div></div><div><h3>Objective</h3><div>To assess the diagnostic utility of MRI features in differentiating IED from EDO NSTs.</div></div><div><h3>Methods</h3><div>Forty-five patients with confirmed IED or EDO NSTs were retrospectively reviewed. Two radiologists analyzed MRI features, including cerebrospinal fluid (CSF) claw sign and candy shape, with interobserver agreement assessed. Fisher’s exact test and receiver operating characteristic analysis were performed.</div></div><div><h3>Results</h3><div>Nine cases were IED, and 36 were EDO NSTs. Interobserver agreements of all imaging features between the two radiologists were excellent. IED tumors showed significantly more CSF claw sign and candy shape, and the prediction performance was assessed for these two imaging features. The CSF claw sign showed AUC values of 0.875 and 0.889, while the candy shape showed AUC values of 0.847 and 0.958.</div></div><div><h3>Conclusion</h3><div>CSF claw sign and candy shape are useful MRI findings to differentiate between IED and EDO NSTs.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101737"},"PeriodicalIF":1.4,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423434","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 : 2025-10-21DOI: 10.1016/j.neuchi.2025.101735
William Boisseau , Manon Philibert , Catherine Vignal-Clermont , Koorosh Jeshrani , Amira Al Raaisi , Raphael Blanc , Jean-Philippe Desilles , Simon Escalard , Mikael Mazighi , Michel Piotin , Hocine Redjem , Erwan Robichon , Stanislas Samjda , Rabih Hage , Alexia Tran , Dorian Chauvet , Sorin Aldea , Samiya Abi-Jaoude , Pierre Bourdillon
Introduction
Idiopathic intracranial hypertension (IIH) is severe condition affecting patients’ vision and quality of life. When medical treatment is insufficient, an invasive approach may be proposed, consisting of either performing a ventricular shunt or stenting a stenosed venous sinus. The aim of this study is to compare these two techniques.
Methods
All patients who received one of these treatments for IIH associated with papilledema over a 5-year period were analysed. The primary outcome was the resolution of papilledema at 3 months coupled with the absence of complications.
Results
Over a 5-year period, 101 patients were analysed, of whom 61 underwent endovascular treatment and 40 underwent surgical treatment. Resolution of papilledema at three months without complications was achieved in 72% of cases in the surgical group and in 89% of cases in the endovascular group (p = 0.04). There was a higher proportion of IIH in the surgical group (60% vs 1.6%, p < 0.001) associated with higher intracranial pressure (38.8 vs 33.1 cmH2O) and more severe visual impairment (55% vs 15%). Resolution of papilledema at three months, headache, tinnitus, and visual improvement did not differ significantly between the groups. The average time to improvement was significantly (p < 0.0001) shorter in the surgery-treated group (3.62 vs 8.74 weeks).
Conclusion
Endovascular treatment appears to have a better benefit-risk balance compared to surgery, with the caveat that the surgery group had a more severe presentation in this study. This encourages the conduction of a randomized study to have two homogeneous groups.
特发性颅内高压（Idiopathic intracranial hypertension， IIH）是一种严重影响患者视力和生活质量的疾病。当药物治疗不足时，可以建议采用侵入性方法，包括进行心室分流术或狭窄静脉窦支架置入。本研究的目的是比较这两种技术。方法：对5年内所有接受IIH合并乳头水肿治疗的患者进行分析。主要结果是3个月时乳头水肿的消退和无并发症。结果：5年内共分析101例患者，其中61例行血管内治疗，40例行手术治疗。手术组和血管内组分别有72%和89%的病例在3个月内无并发症地解决了乳头水肿（p = 0.04）。手术组的IIH比例更高（60% vs 1.6%, p 2O），视力障碍更严重（55% vs 15%）。三个月后乳头水肿、头痛、耳鸣和视力改善的缓解在两组之间没有显著差异。结论：与手术相比，血管内治疗似乎具有更好的收益-风险平衡，但需要注意的是，在本研究中，手术组的表现更为严重。这鼓励进行随机研究，有两个同质组。
{"title":"Surgical versus endovascular treatment for idiopathic intracranial hypertension","authors":"William Boisseau , Manon Philibert , Catherine Vignal-Clermont , Koorosh Jeshrani , Amira Al Raaisi , Raphael Blanc , Jean-Philippe Desilles , Simon Escalard , Mikael Mazighi , Michel Piotin , Hocine Redjem , Erwan Robichon , Stanislas Samjda , Rabih Hage , Alexia Tran , Dorian Chauvet , Sorin Aldea , Samiya Abi-Jaoude , Pierre Bourdillon","doi":"10.1016/j.neuchi.2025.101735","DOIUrl":"10.1016/j.neuchi.2025.101735","url":null,"abstract":"<div><h3>Introduction</h3><div>Idiopathic intracranial hypertension (IIH) is severe condition affecting patients’ vision and quality of life. When medical treatment is insufficient, an invasive approach may be proposed, consisting of either performing a ventricular shunt or stenting a stenosed venous sinus. The aim of this study is to compare these two techniques.</div></div><div><h3>Methods</h3><div>All patients who received one of these treatments for IIH associated with papilledema over a 5-year period were analysed. The primary outcome was the resolution of papilledema at 3 months coupled with the absence of complications.</div></div><div><h3>Results</h3><div>Over a 5-year period, 101 patients were analysed, of whom 61 underwent endovascular treatment and 40 underwent surgical treatment. Resolution of papilledema at three months without complications was achieved in 72% of cases in the surgical group and in 89% of cases in the endovascular group (p = 0.04). There was a higher proportion of IIH in the surgical group (60% vs 1.6%, p < 0.001) associated with higher intracranial pressure (38.8 vs 33.1 cmH<sub>2</sub>O) and more severe visual impairment (55% vs 15%). Resolution of papilledema at three months, headache, tinnitus, and visual improvement did not differ significantly between the groups. The average time to improvement was significantly (p < 0.0001) shorter in the surgery-treated group (3.62 vs 8.74 weeks).</div></div><div><h3>Conclusion</h3><div>Endovascular treatment appears to have a better benefit-risk balance compared to surgery, with the caveat that the surgery group had a more severe presentation in this study. This encourages the conduction of a randomized study to have two homogeneous groups.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101735"},"PeriodicalIF":1.4,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349788","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 : 2025-10-16DOI: 10.1016/j.neuchi.2025.101738
Youngoh Bae , Sung Ho Park , Hohyun Jung , Min Soo Kim
Background
This study assessed the long-term risk of acquired hydrocephalus in individuals with head trauma to identify time-specific risk patterns and to evaluate high-risk subgroups using a nationwide cohort in South Korea.
Methods
Data from the Korean National Health Insurance Service cohort (2005–2013) were analyzed. The study included 53,567 patients with head trauma and 535,668 matched controls. This study analyzed the incidence of hydrocephalus in patients with head trauma, and time-stratified Cox proportional hazards models were employed to calculate the adjusted hazard ratios (aHRs) for hydrocephalus across 9 years, adjusting for demographic and clinical covariates.
Results
The incidence of hydrocephalus was significantly higher in the head trauma group than in the control group (incidence rate ratio, 3.92). Male patients and those aged ≥60 years exhibited the highest risk. The risk of hydrocephalus was highest within the first 3 years after trauma and decreased gradually thereafter. Furthermore, smokers and ex-smokers were at a higher risk than nonsmokers.
Conclusions
Patients with head trauma are at a significantly higher risk of posttraumatic hydrocephalus, particularly within the first 3 years. These findings highlight the need for early monitoring and intervention. Further research is required to improve our understanding of hydrocephalus risk.
{"title":"Risk of Hydrocephalus after Head Trauma: A nationwide cohort study in South Korea","authors":"Youngoh Bae , Sung Ho Park , Hohyun Jung , Min Soo Kim","doi":"10.1016/j.neuchi.2025.101738","DOIUrl":"10.1016/j.neuchi.2025.101738","url":null,"abstract":"<div><h3>Background</h3><div>This study assessed the long-term risk of acquired hydrocephalus in individuals with head trauma to identify time-specific risk patterns and to evaluate high-risk subgroups using a nationwide cohort in South Korea.</div></div><div><h3>Methods</h3><div>Data from the Korean National Health Insurance Service cohort (2005–2013) were analyzed. The study included 53,567 patients with head trauma and 535,668 matched controls. This study analyzed the incidence of hydrocephalus in patients with head trauma, and time-stratified Cox proportional hazards models were employed to calculate the adjusted hazard ratios (aHRs) for hydrocephalus across 9 years, adjusting for demographic and clinical covariates.</div></div><div><h3>Results</h3><div>The incidence of hydrocephalus was significantly higher in the head trauma group than in the control group (incidence rate ratio, 3.92). Male patients and those aged ≥60 years exhibited the highest risk. The risk of hydrocephalus was highest within the first 3 years after trauma and decreased gradually thereafter. Furthermore, smokers and ex-smokers were at a higher risk than nonsmokers.</div></div><div><h3>Conclusions</h3><div>Patients with head trauma are at a significantly higher risk of posttraumatic hydrocephalus, particularly within the first 3 years. These findings highlight the need for early monitoring and intervention. Further research is required to improve our understanding of hydrocephalus risk.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101738"},"PeriodicalIF":1.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318842","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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