Pub Date : 2026-01-01Epub Date: 2025-11-19DOI: 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.
{"title":"Awake surgery and music: Two illustrative cases of frontal resection in pianists","authors":"Francesca Di Nardo , Florence Le Vourc’h , Justine Bleunven , Marine Pedreni , Romuald Seizeur , Vanessa Saliou","doi":"10.1016/j.neuchi.2025.101753","DOIUrl":"10.1016/j.neuchi.2025.101753","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>Our patients’ outcomes are consistent with previous literature concerning lateralization and localization of music-related functions in musicians.</div><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101753"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574846","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 : 2026-01-01Epub Date: 2025-11-19DOI: 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.
{"title":"Postoperative Management Following Degenerative Lumbar Spine Surgery: Results From a Survey Conducted by the French Society of Spine Surgery and Literature Review","authors":"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)","doi":"10.1016/j.neuchi.2025.101751","DOIUrl":"10.1016/j.neuchi.2025.101751","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative instructions influence lumbar surgery outcomes, but lack of consensus and differing expertise lead to varied practices.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101751"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574875","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}
{"title":"Letter to the Editor regarding “Laser Interstitial Thermal Therapy (LITT) in pediatric neurosurgery: Single center retrospective analysis of 41 consecutive procedures”","authors":"Parth Aphale , Himanshu Shekhar , Shashank Dokania","doi":"10.1016/j.neuchi.2025.101745","DOIUrl":"10.1016/j.neuchi.2025.101745","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101745"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145475268","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 : 2026-01-01Epub Date: 2025-12-06DOI: 10.1016/j.neuchi.2025.101759
William Boisseau , Tim E. Darsaut , Jean Raymond
Background
Non-inferiority (NI) trials are essential to evaluate whether new treatments which may offer some collateral benefit (such as less invasiveness, fewer side effects, availability, ease of administration, or lower cost) do so without significant loss of efficacy, as compared to treatments that are already established to be beneficial. NI trials pose specific design challenges, such as selecting appropriate NI margins, as well as unique problems of interpretation.
Methods
We examine six NI trials that compared thrombectomy with or without intravenous thrombolysis (IVT). We review fundamental problems with NI trials.
Results
Two of six trials reported that thrombectomy alone was non-inferior compared to thrombectomy combined with IVT. These trials used large NI margins or stopped recruitment prematurely after an interim analysis. The remaining four trials failed to demonstrate non-inferiority. In general, the chosen NI margins were unjustified and clinically unacceptable. A meta-analysis showed NI at a 10% margin, but not at a clinically pertinent 5% level. We examine (i) assay sensitivity, (ii) the constancy assumption and (iii) NI margins, three concepts that are crucial to understand NI trials. We question whether NI trials are appropriate in acute stroke, where there is little room to accept inferiority. Assessing superiority regarding surrogate outcome measures that have shown a causal relationship with clinical outcomes may be an alternative approach.
Conclusion
Thrombectomy alone has not properly been shown non-inferior to thrombectomy with IVT. The NI trial design is poorly adapted for use in acute stroke.
{"title":"Understanding non-inferiority trials: Lessons from trials comparing thrombectomy with or without intravenous thrombolysis","authors":"William Boisseau , Tim E. Darsaut , Jean Raymond","doi":"10.1016/j.neuchi.2025.101759","DOIUrl":"10.1016/j.neuchi.2025.101759","url":null,"abstract":"<div><h3>Background</h3><div>Non-inferiority (NI) trials are essential to evaluate whether new treatments which may offer some collateral benefit (such as less invasiveness, fewer side effects, availability, ease of administration, or lower cost) do so without significant loss of efficacy, as compared to treatments that are already established to be beneficial. NI trials pose specific design challenges, such as selecting appropriate NI margins, as well as unique problems of interpretation.</div></div><div><h3>Methods</h3><div>We examine six NI trials that compared thrombectomy with or without intravenous thrombolysis (IVT). We review fundamental problems with NI trials.</div></div><div><h3>Results</h3><div>Two of six trials reported that thrombectomy alone was non-inferior compared to thrombectomy combined with IVT. These trials used large NI margins or stopped recruitment prematurely after an interim analysis. The remaining four trials failed to demonstrate non-inferiority. In general, the chosen NI margins were unjustified and clinically unacceptable. A meta-analysis showed NI at a 10% margin, but not at a clinically pertinent 5% level. We examine (i) assay sensitivity, (ii) the constancy assumption and (iii) NI margins, three concepts that are crucial to understand NI trials. We question whether NI trials are appropriate in acute stroke, where there is little room to accept inferiority. Assessing superiority regarding surrogate outcome measures that have shown a causal relationship with clinical outcomes may be an alternative approach.</div></div><div><h3>Conclusion</h3><div>Thrombectomy alone has not properly been shown non-inferior to thrombectomy with IVT. The NI trial design is poorly adapted for use in acute stroke.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101759"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693620","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":"2026-01-01","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 : 2026-01-01Epub 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":"2026-01-01","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}
Chronic subdural hematomas (CSDH), with an incidence of 20/100,000/year, often necessitates surgical intervention. Recurrence requiring redo surgery occurs in 12% of patients. This study aims to assess the presence of bacteria in CSDH by systematically collecting multiple tissue samples and analyzing the association between positive cultures, prognosis, and recurrence.
Methods
This prospective single-center study was conducted at Henri Mondor University Hospital, France, between January 2023 and June 2024. Adult patients operated for CSDH were included. Clinical, radiological, and microbiological data were analysed with a 6-months follow-up. Surgery involved burr-hole or mini-craniotomy with systematic postoperative drainage. Three independent subdural samples were collected intraoperatively.
Results
Eighty patients were included. Recurrence occurred in 20% of patients, with a median time to redo surgery of 15 days. Subdural germs were detected in 21% of patients, with a majority of positive samples in 53% and a majority of negative samples in 47%. The most common bacteria were Cutibacterium acnes and Staphylococcus species. No correlation was found between germ detection and hematoma recurrence or death. No patient developed postoperative empyema.
Discussion
This study is the first to report systematic bacteriological testing of subdural collection. Detection of skin microbiota bacteria was not uncommon, but there was no significant increase in recurrence if bacteria were detected. The findings suggest that bacterial contamination rather than infection is more likely.
Conclusion
Clinically inapparent infection of subdural hematoma is not common and should not be explored systematically. The decision to treat with antibiotics should be based on multiple positive bacterial samples and clinical data.
{"title":"Systematic intraoperative bacteriological testing in patients operated for primary chronic subdural hematoma – A prospective analysis","authors":"Kevin Comair , Adrien Galy , Karim Chirani , Tania Idriceanu , Hela Krimi , Amel Marniche , Anne-Sophie Montero , Lyes Rabia , Suhan Senova , Sanaa Tazi , Stéphane Palfi , Vincent Fihman , Paul-Louis Woerther , Florence Reibel , Caroline Apra","doi":"10.1016/j.neuchi.2025.101766","DOIUrl":"10.1016/j.neuchi.2025.101766","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic subdural hematomas (CSDH), with an incidence of 20/100,000/year, often necessitates surgical intervention. Recurrence requiring redo surgery occurs in 12% of patients. This study aims to assess the presence of bacteria in CSDH by systematically collecting multiple tissue samples and analyzing the association between positive cultures, prognosis, and recurrence.</div></div><div><h3>Methods</h3><div>This prospective single-center study was conducted at Henri Mondor University Hospital, France, between January 2023 and June 2024. Adult patients operated for CSDH were included. Clinical, radiological, and microbiological data were analysed with a 6-months follow-up. Surgery involved burr-hole or mini-craniotomy with systematic postoperative drainage. Three independent subdural samples were collected intraoperatively.</div></div><div><h3>Results</h3><div>Eighty patients were included. Recurrence occurred in 20% of patients, with a median time to redo surgery of 15 days. Subdural germs were detected in 21% of patients, with a majority of positive samples in 53% and a majority of negative samples in 47%. The most common bacteria were Cutibacterium acnes and Staphylococcus species. No correlation was found between germ detection and hematoma recurrence or death. No patient developed postoperative empyema.</div></div><div><h3>Discussion</h3><div>This study is the first to report systematic bacteriological testing of subdural collection. Detection of skin microbiota bacteria was not uncommon, but there was no significant increase in recurrence if bacteria were detected. The findings suggest that bacterial contamination rather than infection is more likely.</div></div><div><h3>Conclusion</h3><div>Clinically inapparent infection of subdural hematoma is not common and should not be explored systematically. The decision to treat with antibiotics should be based on multiple positive bacterial samples and clinical data.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101766"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796592","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 : 2026-01-01Epub 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":"2026-01-01","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 : 2026-01-01Epub Date: 2025-11-21DOI: 10.1016/j.neuchi.2025.101749
Jack Váscones-Román , Fritz Fidel Váscones-Román
{"title":"The Neurosurgical Exodus — A Loss for Latin American Science and Public Health","authors":"Jack Váscones-Román , Fritz Fidel Váscones-Román","doi":"10.1016/j.neuchi.2025.101749","DOIUrl":"10.1016/j.neuchi.2025.101749","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101749"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579354","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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