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}
Pub Date : 2025-10-08DOI: 10.1016/j.neuchi.2025.101733
Shuai Tian , Ali Shang , Wenqian Zhou , Zhen Xu , Yunpeng Kou , Zhenyu Guo , Fan Chen , Peigang Ji , Yulong Zhai , Wenjian Zhao , Yang Jiao , Zhipeng Song , Shunnan Ge , Yuan Wang , Liang Wang , Shaochun Guo
Objectives
This study aimed to investigate risk factors associated with pulmonary infection (PI) in elderly patients with traumatic brain injury (TBI). Additionally, this study sought to develop and validate a predictive model for PI in elderly patients with TBI using clinical data obtained upon admission.
Methods
The study retrospectively analyzed elderly patients (≥65 years) with TBI at Tangdu Hospital between January 2011 and December 2021. These patients were randomly allocated to training and validation sets in a 7:3 ratio. A nomogram model was developed to predict the risk of PI in elderly patients with TBI. Internal validation was conducted using a verification set, while external validation was performed using patient data from a different hospital.
Results
A total of 592 elderly patients with TBI were included. The Glasgow coma scale score on admission, chest injury, hemoglobin, albumin, C-reactive protein, procalcitonin, B-type natriuretic peptide, troponin, and surgery was found to be independent predictors of PI in elderly patients with TBI. The nomogram demonstrated good discrimination ability, with a consistency index of 0.918 (95% confidence interval (CI): 0.891–0.944), which was verified to be 0.848 (95% CI: 0.786–0.910). The area under the curve for the external validation cohorts was 0.836 (95% CI: 0.770–0.903).
Conclusions
This study developed and validated a prediction model for PI in elderly patients with TBI. The nomogram model demonstrated a favorable discriminatory and predictive capacity for predicting PI in elderly patients with TBI.
{"title":"Development and validation of a prediction model for pulmonary infection in elderly patients with traumatic brain injury","authors":"Shuai Tian , Ali Shang , Wenqian Zhou , Zhen Xu , Yunpeng Kou , Zhenyu Guo , Fan Chen , Peigang Ji , Yulong Zhai , Wenjian Zhao , Yang Jiao , Zhipeng Song , Shunnan Ge , Yuan Wang , Liang Wang , Shaochun Guo","doi":"10.1016/j.neuchi.2025.101733","DOIUrl":"10.1016/j.neuchi.2025.101733","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate risk factors associated with pulmonary infection (PI) in elderly patients with traumatic brain injury (TBI). Additionally, this study sought to develop and validate a predictive model for PI in elderly patients with TBI using clinical data obtained upon admission.</div></div><div><h3>Methods</h3><div>The study retrospectively analyzed elderly patients (≥65 years) with TBI at Tangdu Hospital between January 2011 and December 2021. These patients were randomly allocated to training and validation sets in a 7:3 ratio. A nomogram model was developed to predict the risk of PI in elderly patients with TBI. Internal validation was conducted using a verification set, while external validation was performed using patient data from a different hospital.</div></div><div><h3>Results</h3><div>A total of 592 elderly patients with TBI were included. The Glasgow coma scale score on admission, chest injury, hemoglobin, albumin, C-reactive protein, procalcitonin, B-type natriuretic peptide, troponin, and surgery was found to be independent predictors of PI in elderly patients with TBI. The nomogram demonstrated good discrimination ability, with a consistency index of 0.918 (95% confidence interval (CI): 0.891–0.944), which was verified to be 0.848 (95% CI: 0.786–0.910). The area under the curve for the external validation cohorts was 0.836 (95% CI: 0.770–0.903).</div></div><div><h3>Conclusions</h3><div>This study developed and validated a prediction model for PI in elderly patients with TBI. The nomogram model demonstrated a favorable discriminatory and predictive capacity for predicting PI in elderly patients with TBI.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101733"},"PeriodicalIF":1.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276668","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 : 2025-10-08DOI: 10.1016/j.neuchi.2025.101734
Elise Caron , Charlotte Rozenberg , Johann Peltier , Serge Metanbou , Julien Moyet , Olivier Balédent , Cyrille Capel
Introduction
idiopathic chronic hydrocephalus (iCH) is underdiagnosed in older adults. The diagnosis of iCH is important because effective surgical treatment is available. Indeed, iCH is the only curable dementia. The disproportionately enlarged subarachnoid space hydrocephalus (DESH) score was recently developed on the basis of morphologic MRI data, as a guide to the diagnosis of iCH in adults.
Patients and method
In a population of 68 patients having undergone placement of a ventriculoperitoneal shunt, the preoperative DESH score was calculated retrospectively by a senior neurosurgeon and a neurosurgery resident. To analyze inter-observer variability, the results obtained for each patient were compared. We calculated sensitivity, specificity, positive and negative predictive values of the DESH score.
Results
DESH score of 7 or more present the best diagnostic performance (sensitivity: 83%, specificity: 40%, positive predictive value: 89%, negative predictive value: 29%). The interobserver reliability of the DESH score was excellent, with an intraclass correlation coefficient of 0.936. Similarly, the levels of interobserver agreement for each individual item were fair (for Sylvian fissure dilatation, local focal sulci dilatation, and tight high convexity) to excellent (for the callosal angle).
Conclusion
The DESH score is a reliable score obtained by studying brain MRI and radiographic datasets. The score’s excellent reliability means that it can be included in the routine diagnosis of iCH.
{"title":"Interobserver reliability of the DESH score in idiopathic chronic hydrocephalus","authors":"Elise Caron , Charlotte Rozenberg , Johann Peltier , Serge Metanbou , Julien Moyet , Olivier Balédent , Cyrille Capel","doi":"10.1016/j.neuchi.2025.101734","DOIUrl":"10.1016/j.neuchi.2025.101734","url":null,"abstract":"<div><h3>Introduction</h3><div>idiopathic chronic hydrocephalus (iCH) is underdiagnosed in older adults. The diagnosis of iCH is important because effective surgical treatment is available. Indeed, iCH is the only curable dementia. The disproportionately enlarged subarachnoid space hydrocephalus (DESH) score was recently developed on the basis of morphologic MRI data, as a guide to the diagnosis of iCH in adults.</div></div><div><h3>Patients and method</h3><div>In a population of 68 patients having undergone placement of a ventriculoperitoneal shunt, the preoperative DESH score was calculated retrospectively by a senior neurosurgeon and a neurosurgery resident. To analyze inter-observer variability, the results obtained for each patient were compared. We calculated sensitivity, specificity, positive and negative predictive values of the DESH score.</div></div><div><h3>Results</h3><div>DESH score of 7 or more present the best diagnostic performance (sensitivity: 83%, specificity: 40%, positive predictive value: 89%, negative predictive value: 29%). The interobserver reliability of the DESH score was excellent, with an intraclass correlation coefficient of 0.936. Similarly, the levels of interobserver agreement for each individual item were fair (for Sylvian fissure dilatation, local focal sulci dilatation, and tight high convexity) to excellent (for the callosal angle).</div></div><div><h3>Conclusion</h3><div>The DESH score is a reliable score obtained by studying brain MRI and radiographic datasets. The score’s excellent reliability means that it can be included in the routine diagnosis of iCH.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101734"},"PeriodicalIF":1.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276666","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 : 2025-10-08DOI: 10.1016/j.neuchi.2025.101732
Joseph N. Frazzetta , Seunghyuk Daniel Yang , Oleksandr Strelko , William Y. Shin , John T. Tsiang , Miri Kim , Vikram C. Prabhu
Introduction
The optimal management for symptomatic or enlarging peripheral nerve schwannomas is maximal, safe resection. Sodium Fluorescein (SF) has been utilized to facilitate tumor identification and removal.
Methods
This single-institution study evaluated 17 patients with 19 tumors who underwent a microscope assisted peripheral nerve schwannoma resection with intravenous SF administration. White-light and the yellow-560 lens filter were used for microscope visualization. A grading scale was created to assess the utility of SF in differentiating tumor from normal nerve fascicles. In all patients, intraoperative neurophysiological monitoring and nerve stimulation to identify and preserve functional fascicles was utilized.
Results
Improved visualization of the tumor and normal fascicles were noted using the operating microscope with white-light. It was possible to distinguish tumor tissue from normal nerve fascicles under both white-light and the yellow-560 lens.Administration of SF imparted a distinct bright-green fluorescence to tumor tissue under the yellow-560 lens. No side effects from SF use were observed. The cost of SF was $32.64 per vial. 1 patient experienced a new motor deficit, and 1 patient developed a new sensory deficit post-operatively that did not resolve at last follow up.
Discussion
Microsurgical resection of peripheral nerve schwannomas with the use of SF and the microscope yellow-560 les may be helpful in differentiating tumor from normal healthy nerve fascicles. However, white-light illumination also allowed good visualization of the tumor and normal nerve fascicles. Intraoperative neurophysiological monitoring and nerve stimulation are indispensable to facilitate tumor resection with preservation of normal nerve fascicles
{"title":"Utility of sodium fluorescein in peripheral nerve tumor resection: A single institution experience","authors":"Joseph N. Frazzetta , Seunghyuk Daniel Yang , Oleksandr Strelko , William Y. Shin , John T. Tsiang , Miri Kim , Vikram C. Prabhu","doi":"10.1016/j.neuchi.2025.101732","DOIUrl":"10.1016/j.neuchi.2025.101732","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal management for symptomatic or enlarging peripheral nerve schwannomas is maximal, safe resection. Sodium Fluorescein (SF) has been utilized to facilitate tumor identification and removal.</div></div><div><h3>Methods</h3><div>This single-institution study evaluated 17 patients with 19 tumors who underwent a microscope assisted peripheral nerve schwannoma resection with intravenous SF administration. White-light and the yellow-560 lens filter were used for microscope visualization. A grading scale was created to assess the utility of SF in differentiating tumor from normal nerve fascicles. In all patients, intraoperative neurophysiological monitoring and nerve stimulation to identify and preserve functional fascicles was utilized.</div></div><div><h3>Results</h3><div>Improved visualization of the tumor and normal fascicles were noted using the operating microscope with white-light. It was possible to distinguish tumor tissue from normal nerve fascicles under both white-light and the yellow-560 lens.Administration of SF imparted a distinct bright-green fluorescence to tumor tissue under the yellow-560 lens. No side effects from SF use were observed. The cost of SF was $32.64 per vial. 1 patient experienced a new motor deficit, and 1 patient developed a new sensory deficit post-operatively that did not resolve at last follow up.</div></div><div><h3>Discussion</h3><div>Microsurgical resection of peripheral nerve schwannomas with the use of SF and the microscope yellow-560 les may be helpful in differentiating tumor from normal healthy nerve fascicles. However, white-light illumination also allowed good visualization of the tumor and normal nerve fascicles. Intraoperative neurophysiological monitoring and nerve stimulation are indispensable to facilitate tumor resection with preservation of normal nerve fascicles</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101732"},"PeriodicalIF":1.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276723","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 : 2025-10-07DOI: 10.1016/j.neuchi.2025.101729
Filipe Virgilio Ribeiro , Rudolfh Batista Arend , Bruno Zilli Peroni , Helvécio Neves Feitosa Filho , Maria Fernanda P. Santana , Leonardo Januario Campos Cardoso , Leandro Vieira Lessa , André Nishizima , Marcelo Porto Sousa , Alex Roman
Introduction
Craniocervical junction arteriovenous fistulas (CCJ AVFs) are rare and complex vascular lesions that pose significant diagnostic and therapeutic challenges. Despite advances in neuroimaging, optimal treatment strategies remain controversial. This systematic review and meta-analysis aimed to compare the safety and efficacy of microsurgical versus endovascular approaches for treating CCJ AVFs.
Methods
A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted up to March 2024. Studies were included if they reported outcomes of microsurgical or endovascular treatment for CCJ AVFs, including neurological improvement, complete obliteration, recurrence, and complications. Data were synthesized using a random-effects meta-analysis, and heterogeneity was assessed using the I² statistic.
Results
Seven studies with 451 patients were included (microsurgery: n = 348; endovascular: n = 103). Microsurgery showed no statistically significant advantage in neurological improvement compared to endovascular treatment (OR = 2.10, 95% CI: 0.83–5.31, p = 0.5651, I² = 0%). Complete obliteration rates were significantly higher in the microsurgical group (OR = 11.93, 95% CI = 2.12–66.97, p = 0.0049; I² = 70.6%). Recurrence rates did not differ significantly (OR = 0.22, 95% CI: 0.02–2.81, p = 0.2416). Overall complications were similar (OR = 0.63, 95% CI: 0.09–4.62, p = 0.0007, I² = 79.1%), although microsurgery had significantly fewer ischemic complications (OR = 0.23, 95% CI: 0.07–0.70, p = 0.0104). Mortality rates were also comparable (RR = 1.87, 95% CI: 0.28–12.66, p = 0.5213, I² = 25.9%).
Conclusion
Microsurgery offers higher obliteration rates and fewer ischemic complications, while overall outcomes support individualized treatment planning.
颅颈交界处动静脉瘘（ccjavfs）是一种罕见且复杂的血管病变，对诊断和治疗提出了重大挑战。尽管神经影像学有所进步，但最佳治疗策略仍存在争议。本系统综述和荟萃分析旨在比较显微手术与血管内入路治疗CCJ房颤的安全性和有效性。方法：系统检索PubMed、Embase、Web of Science、Cochrane Library，检索截止至2024年3月。如果研究报告了显微手术或血管内治疗CCJ AVFs的结果，包括神经系统改善、完全闭塞、复发和并发症，则纳入研究。采用随机效应荟萃分析综合数据，采用I²统计量评估异质性。结果：纳入7项研究，共451例患者（显微外科：n = 348；血管内：n = 103）。与血管内治疗相比，显微手术在神经系统改善方面没有统计学上的显著优势（OR = 2.10, 95% CI: 0.83-5.31, p = 0.5651, I²= 0%）。显微手术组的完全闭塞率明显高于对照组（OR = 11.93, 95% CI = 2.12 ~ 66.97, p = 0.0049; I²= 70.6%）。复发率差异无统计学意义（OR = 0.22, 95% CI: 0.02 ~ 2.81, p = 0.2416）。总体并发症相似（OR = 0.63, 95% CI: 0.09-4.62, p = 0.0007, I²= 79.1%），尽管显微手术的缺血性并发症明显较少（OR = 0.23, 95% CI: 0.07-0.70, p = 0.0104）。死亡率也具有可比性（RR = 1.87, 95% CI: 0.28-12.66, p = 0.5213, I²= 25.9%）。结论：显微手术具有较高的闭塞率和较少的缺血性并发症，总体结果支持个体化治疗方案。
{"title":"Microsurgical approach versus endovascular treatment of craniocervical junction arteriovenous fistulas: A Systematic Review and Meta-analysis","authors":"Filipe Virgilio Ribeiro , Rudolfh Batista Arend , Bruno Zilli Peroni , Helvécio Neves Feitosa Filho , Maria Fernanda P. Santana , Leonardo Januario Campos Cardoso , Leandro Vieira Lessa , André Nishizima , Marcelo Porto Sousa , Alex Roman","doi":"10.1016/j.neuchi.2025.101729","DOIUrl":"10.1016/j.neuchi.2025.101729","url":null,"abstract":"<div><h3>Introduction</h3><div>Craniocervical junction arteriovenous fistulas (CCJ AVFs) are rare and complex vascular lesions that pose significant diagnostic and therapeutic challenges. Despite advances in neuroimaging, optimal treatment strategies remain controversial. This systematic review and meta-analysis aimed to compare the safety and efficacy of microsurgical versus endovascular approaches for treating CCJ AVFs.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted up to March 2024. Studies were included if they reported outcomes of microsurgical or endovascular treatment for CCJ AVFs, including neurological improvement, complete obliteration, recurrence, and complications. Data were synthesized using a random-effects meta-analysis, and heterogeneity was assessed using the I² statistic.</div></div><div><h3>Results</h3><div>Seven studies with 451 patients were included (microsurgery: n = 348; endovascular: n = 103). Microsurgery showed no statistically significant advantage in neurological improvement compared to endovascular treatment (OR = 2.10, 95% CI: 0.83–5.31, p = 0.5651, I² = 0%). Complete obliteration rates were significantly higher in the microsurgical group (OR = 11.93, 95% CI = 2.12–66.97, p = 0.0049; I² = 70.6%). Recurrence rates did not differ significantly (OR = 0.22, 95% CI: 0.02–2.81, p = 0.2416). Overall complications were similar (OR = 0.63, 95% CI: 0.09–4.62, p = 0.0007, I² = 79.1%), although microsurgery had significantly fewer ischemic complications (OR = 0.23, 95% CI: 0.07–0.70, p = 0.0104). Mortality rates were also comparable (RR = 1.87, 95% CI: 0.28–12.66, p = 0.5213, I² = 25.9%).</div></div><div><h3>Conclusion</h3><div>Microsurgery offers higher obliteration rates and fewer ischemic complications, while overall outcomes support individualized treatment planning.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101729"},"PeriodicalIF":1.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253545","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 : 2025-10-06DOI: 10.1016/j.neuchi.2025.101730
Serratrice Nicolas
Delivering therapeutic agents to the spinal cord is crucial for treating conditions such as Spinal Cord Injury (SCI), chronic pain and neurodegenerative diseases. Various administration routes, including systemic, epidural, intrathecal, subarachnoid, localized and intraparenchymal injections, offer distinct advantages and challenges when it comes to achieving effective therapeutic outcomes. The invasiveness, precision and ability to bypass biological barriers, such as the Blood-Spinal Cord Barrier (BSCB), differ between these methods. This literature review summarizes the latest research on these delivery approaches, examining their principles, techniques, applications and associated risks. By analyzing the efficacy and limitations of each route for administering steroids, recombinant growth factors, gene therapies, stem cells and biomaterial scaffolds, the review aims to provide a comprehensive understanding of the most effective strategies for targeting the spinal cord. It will highlight key findings and identify areas for further investigation.
{"title":"Injectable approaches to deliver innovative treatments for spinal cord: When regenerative medicine meets precision medicine","authors":"Serratrice Nicolas","doi":"10.1016/j.neuchi.2025.101730","DOIUrl":"10.1016/j.neuchi.2025.101730","url":null,"abstract":"<div><div>Delivering therapeutic agents to the spinal cord is crucial for treating conditions such as Spinal Cord Injury (SCI), chronic pain and neurodegenerative diseases. Various administration routes, including systemic, epidural, intrathecal, subarachnoid, localized and intraparenchymal injections, offer distinct advantages and challenges when it comes to achieving effective therapeutic outcomes. The invasiveness, precision and ability to bypass biological barriers, such as the Blood-Spinal Cord Barrier (BSCB), differ between these methods. This literature review summarizes the latest research on these delivery approaches, examining their principles, techniques, applications and associated risks. By analyzing the efficacy and limitations of each route for administering steroids, recombinant growth factors, gene therapies, stem cells and biomaterial scaffolds, the review aims to provide a comprehensive understanding of the most effective strategies for targeting the spinal cord. It will highlight key findings and identify areas for further investigation.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101730"},"PeriodicalIF":1.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245346","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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