Neurochirurgie最新文献

英文中文

Outcomes for Patients Undergoing Burr Holes for Subdural Hematoma Evacuation versus Craniotomies in the Middle Meningeal Artery Embolization Era 在中脑膜动脉栓塞时代，硬膜下血肿钻孔引流术与开颅术的疗效比较。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-12-17 DOI: 10.1016/j.neuchi.2025.101762

Richard Cook, Laura Zima, Ryan Kitagawa

Introduction

Middle meningeal artery embolization (MMAE) has become increasingly utilized for the management of non-acute subdural hematomas (SDH). However, there is minimal literature comparing outcomes between patients undergoing burr holes versus craniotomy in conjunction with MMAE.

Methods

All patients undergoing craniotomy or burr hole operation for SDH with subsequent MMAE during the same admission within a 3-year period were included (n = 135). Binary logistic regression was used to assess association of craniotomy with SDH reoperation. Continuous and ordinal data were analyzed via Wilcoxon rank-sum test, and categorical data were analyzed via chi-squared test.

Results

Chi-squared analysis demonstrated no significant difference in SDH reoperation within 90 days based on surgical management. Further, 90-day readmission, length of stay, GCS, and modified Rankin Scale (mRS) at discharge were comparable between groups. Mean estimated blood loss was higher among those undergoing craniotomy compared to those undergoing burr holes (P = 0.042). Craniotomies also had longer surgery duration compared to burr holes (P < 0.001). Binary logistic regression showed no association between craniotomy and reoperation.

Conclusion

Among patients with SDH undergoing MMAE, there were no significant observed differences in outcomes between burr hole and craniotomy. These findings suggest that when the patient needs surgical evacuation in conjunction with MMAE, and SDH consistency is amenable to burr holes, this less invasive procedure may be considered.

脑膜中动脉栓塞术（MMAE）已越来越多地用于治疗非急性硬膜下血肿（SDH）。然而，很少有文献比较接受钻孔术与开颅术联合MMAE患者的结果。方法：选取3年内同一次住院期间接受SDH开颅或钻孔手术并随后MMAE的所有患者（n = 135）。采用二元logistic回归评估开颅手术与SDH再手术的关系。连续和有序资料采用Wilcoxon秩和检验，分类资料采用卡方检验。结果：卡方分析显示，根据手术处理，90天内SDH再手术无显著差异。此外，90天再入院、住院时间、出院时GCS和修正Rankin量表（mRS）在两组之间具有可比性。开颅术患者的平均估计失血量高于钻孔术患者（P = 0.042）。开颅术的手术时间也比钻孔术长（P < 0.001）。二元logistic回归分析显示开颅手术与再手术无相关性。结论：行MMAE的SDH患者，钻孔与开颅在预后上无显著差异。这些研究结果表明，当患者需要联合MMAE进行手术抽吸，并且SDH一致性适合钻孔时，可以考虑采用这种侵入性较小的手术。

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引用次数: 0

Comment on “Surgical versus endovascular treatment for idiopathic intracranial hypertension” 对“特发性颅内高压手术与血管内治疗”的评论。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-12-01 DOI: 10.1016/j.neuchi.2025.101754

Georgios Tsermoulas , Nicholas Gikas , Alexandra J. Sinclair , Susan P. Mollan , Gabriele Berman

引用次数: 0

Idiopathic normal pressure hydrocephalus and caregiver burden 特发性常压脑积水和照顾者负担。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-12-16 DOI: 10.1016/j.neuchi.2025.101761

James Kelbert , Ashley Kern , Robert W Bina , Ganesh Murthy

引用次数: 0

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

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-11-04 DOI: 10.1016/j.neuchi.2025.101740

Nathan Beucler

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

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

引用次数: 0

Preoperative assessment of meningioma grade using ADC ratios: A multi-observer analytical approach 术前使用ADC比率评估脑膜瘤分级：多观察者分析方法。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-11-03 DOI: 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.

背景：脑膜瘤是一种常见的原发性颅内肿瘤，具有不同的生物学行为。准确的术前分级对手术计划和患者管理至关重要。目的：评价1.5T MRI表观弥散系数（ADC）值和ADC比值在鉴别低级别和高级别脑膜瘤中的诊断价值和观察者间的一致性。材料和方法：本回顾性单中心研究纳入155例组织学证实的脑膜瘤患者。三位独立观察员测量ADC值，并使用ROI分析计算ADC比率。使用ROC曲线评估诊断效果，使用类内相关系数（ICC）评估观察者间的一致性。结果：平均ADC值诊断效果较差（auc: 0.39 ~ 0.44）。ADC比值在观察者间的一致性稍好（ICC = 0.78），但诊断价值同样较弱（auc: 0.38-0.42）。观察组间差异无统计学意义（p = 0.0668）。结论：平均ADC值和ADC比值对脑膜瘤分级的鉴别效果较差。尽管观察者之间有一定程度的一致，但这两个参数在临床上都没有用处。可能需要替代成像生物标志物或多模式方法来进行可靠的非侵入性分级。

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引用次数: 0

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

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-11-04 DOI: 10.1016/j.neuchi.2025.101739

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

引用次数: 0

Telesurgery in neurosurgery: An emerging tool to close – or widen – the global equity gap? 神经外科中的远程手术：一种新兴的工具来缩小或扩大全球公平差距？

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2026-01-06 DOI: 10.1016/j.neuchi.2025.101765

Fritz Fidel Váscones-Román , Gonzalo Jair Callahuanca-Flores , Johnny Alejandro Mendoza-Riega

引用次数: 0

Understanding the choice of the experimental and control groups: Thrombectomy under general anesthesia or conscious sedation 了解实验组和对照组的选择：全麻或清醒镇静下取栓

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-12-12 DOI: 10.1016/j.neuchi.2025.101758

William Boisseau , Tim E. Darsaut , Jean Raymond

Background

The choice of control group in randomized clinical trials (RCTs) is crucial, from both an ethical and a scientific perspective. Thrombectomy can be performed under general anesthesia (GA) or conscious sedation (CS). Non-randomized studies and the first thrombectomy trials showed worse outcomes with GA, but studies were obviously confounded: more severe strokes required intubation for airway protection. Thrombectomy centers advocating the use of GA had to compare GA and CS in a randomized fashion. But which arm should be ‘experimental’, and which ‘standard care’?

Methods

We review the design of RCTs comparing GA to CS during thrombectomy for acute stroke, paying particular attention to the trial hypothesis.

Results

In early trial centers GA was the standard approach, with CS considered ‘experimental’. Thus, most trials tested the potential superiority of CS over GA, but most trials were too small, yielding inconclusive results that were erroneously interpreted as equivalent. In principle, GA had the burden of proof and should have been considered the experimental intervention, as GA is more invasive and associated with worse outcomes. Interventions that introduce greater risk must be justified by evidence of benefit and should be tested as experimental treatments. However, in practice, centers routinely working under GA had a learning curve to use CS, and for them the experimental intervention was CS.

Conclusion

We need to integrate clinical trials into practice to optimize care but the best way to compare two active treatments remains a work in progress.

从伦理和科学的角度来看，随机临床试验（RCTs）中对照组的选择至关重要。取栓可以在全麻（GA）或清醒镇静（CS）下进行。非随机研究和第一次取栓试验显示GA的预后较差，但研究明显混淆：更严重的中风需要插管来保护气道。提倡使用GA的取栓中心必须以随机方式比较GA和CS。但是哪一组应该是“实验性”的，哪一组应该是“标准治疗”的呢？方法回顾急性脑卒中取栓过程中比较GA与CS的随机对照试验设计，特别注意试验假设。结果在早期的试验中心，GA是标准的方法，CS被认为是“实验性的”。因此，大多数试验测试了CS相对于GA的潜在优势，但大多数试验规模太小，结果不确定，被错误地解释为等效。原则上，GA有举证责任，应被视为实验性干预，因为GA更具侵入性，且与较差的结果相关。引入更大风险的干预措施必须以有益的证据来证明其合理性，并应作为实验性治疗进行测试。然而，在实践中，通常在GA下工作的中心有一个学习曲线来使用CS，对他们来说，实验干预就是CS。结论我们需要将临床试验与实践相结合，以优化护理，但比较两种积极治疗方法的最佳方法仍有待研究。

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引用次数: 0

Learning to design clinical trials that optimize care is a work in progress 学习设计临床试验以优化护理是一项正在进行的工作

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-12-06 DOI: 10.1016/j.neuchi.2025.101760

William Boisseau , Tim E. Darsaut , Jean Raymond

引用次数: 0

Efficacy and Safety of Stereotactic Radiosurgery for Cerebellopontine Angle Meningiomas: A Systematic Review and Meta-Analysis 立体定向放射治疗桥小脑角脑膜瘤的疗效和安全性：一项系统评价和荟萃分析：运行标题：SRS治疗CPA脑膜瘤。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2026-01-01 Epub Date: 2025-12-13 DOI: 10.1016/j.neuchi.2025.101763

Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Dorsa Najari , Azin Ebrahimi , Mohammadamin Sabbagh Alvani , Alireza Kooshki , Fatemeh Ghorbanpouryami , Ehsan Bahrami Hezaveh , Mohammad Amin Habibi

Background

Management of cerebellopontine angle (CPA) meningiomas is challenging due to their proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) has been increasingly utilized for the management of individuals with CPA meningiomas; however, the comprehensive data on its effectiveness and safety profile are limited.

Methods

A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. The local control (LC), progression-free survival (PFS), serviceable hearing preservation (SHP), facial nerve (FN) deterioration, trigeminal nerve (TN) deterioration, and adverse radiation effects (ARE) pooled estimates following SRS were calculated using R software.

Results

Thirteen studies, including 604 individuals with CPA meningioma, were included. The meta-analysis revealed a pooled LC rate of 98% (95% CI: 96–99%), 1-year PFS of 100% (95% CI: 100–100%), and 5-year PFS of 94% (95% CI: 81–100%) following SRS. The meta-analysis demonstrated a pooled SHP rate of 96% (95% CI: 86–100%). FN deterioration of 0% (95% CI: 0–2%), and TN deterioration of 1% (95% CI: 0–2%) with a pooled ARE rate of 1% (95% CI: 0–3%). The Meta-regression showed that greater prescribed doses and cochlear doses were correlated with lower SHP and higher ARE rates.

Conclusion

SRS provides a promising LC with functional outcomes concurrent with a favorable safety profile for CPA meningiomas. SRS should be considered as a primary option or as an adjunct to subtotal resection in CPA meningiomas.

背景：桥小脑角（CPA）脑膜瘤的治疗具有挑战性，因为它们靠近关键的神经血管结构。立体定向放射外科（SRS）已越来越多地用于治疗CPA脑膜瘤；然而，关于其有效性和安全性的综合数据有限。方法：根据PRISMA指南进行系统评价和荟萃分析。使用R软件计算SRS后的局部控制（LC）、无进展生存（PFS）、可用听力保存（SHP）、面神经（FN）恶化、三叉神经（TN）恶化和不良辐射效应（ARE）汇总估计。结果：纳入13项研究，包括604例CPA脑膜瘤患者。荟萃分析显示，SRS后合并LC率为98% (95% CI: 96-99%)， 1年PFS为100% (95% CI: 100-100%)， 5年PFS为94% （95% CI: 81-100%）。荟萃分析显示合并SHP率为96% （95% CI: 86-100%）。FN恶化为0% (95% CI: 0-2%)， TN恶化为1% (95% CI: 0-2%)，合并ARE率为1% （95% CI: 0-3%）。meta回归显示，较大的处方剂量和耳蜗剂量与较低的SHP和较高的ARE率相关。结论：SRS为CPA脑膜瘤提供了一种有前景的LC，具有功能结果和良好的安全性。SRS应作为CPA脑膜瘤次全切除术的主要选择或辅助选择。

{"title":"Efficacy and Safety of Stereotactic Radiosurgery for Cerebellopontine Angle Meningiomas: A Systematic Review and Meta-Analysis","authors":"Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Dorsa Najari , Azin Ebrahimi , Mohammadamin Sabbagh Alvani , Alireza Kooshki , Fatemeh Ghorbanpouryami , Ehsan Bahrami Hezaveh , Mohammad Amin Habibi","doi":"10.1016/j.neuchi.2025.101763","DOIUrl":"10.1016/j.neuchi.2025.101763","url":null,"abstract":"<div><h3>Background</h3><div>Management of cerebellopontine angle (CPA) meningiomas is challenging due to their proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) has been increasingly utilized for the management of individuals with CPA meningiomas; however, the comprehensive data on its effectiveness and safety profile are limited.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. The local control (LC), progression-free survival (PFS), serviceable hearing preservation (SHP), facial nerve (FN) deterioration, trigeminal nerve (TN) deterioration, and adverse radiation effects (ARE) pooled estimates following SRS were calculated using R software.</div></div><div><h3>Results</h3><div>Thirteen studies, including 604 individuals with CPA meningioma, were included. The meta-analysis revealed a pooled LC rate of 98% (95% CI: 96–99%), 1-year PFS of 100% (95% CI: 100–100%), and 5-year PFS of 94% (95% CI: 81–100%) following SRS. The meta-analysis demonstrated a pooled SHP rate of 96% (95% CI: 86–100%). FN deterioration of 0% (95% CI: 0–2%), and TN deterioration of 1% (95% CI: 0–2%) with a pooled ARE rate of 1% (95% CI: 0–3%). The Meta-regression showed that greater prescribed doses and cochlear doses were correlated with lower SHP and higher ARE rates.</div></div><div><h3>Conclusion</h3><div>SRS provides a promising LC with functional outcomes concurrent with a favorable safety profile for CPA meningiomas. SRS should be considered as a primary option or as an adjunct to subtotal resection in CPA meningiomas.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"72 1","pages":"Article 101763"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764571","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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