Pub Date : 2025-09-30DOI: 10.1016/j.neuchi.2025.101728
Sean O’Leary , Takara Newsome-Cuby , Sami Al-Horani , Usama AlDallal , Mazin E. Khalil , Umaru Barrie
{"title":"Letter to the editor regarding: “Awake surgery for isolated parenchymal degenerating neurocysticercosis - Case report and focused review of misdiagnosis of neurocysticercosis”","authors":"Sean O’Leary , Takara Newsome-Cuby , Sami Al-Horani , Usama AlDallal , Mazin E. Khalil , Umaru Barrie","doi":"10.1016/j.neuchi.2025.101728","DOIUrl":"10.1016/j.neuchi.2025.101728","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101728"},"PeriodicalIF":1.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208294","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 : 2025-09-20DOI: 10.1016/j.neuchi.2025.101726
Nathan Beucler , Anis Choucha , Julien Tinois , Antoine Do Tran , Michel Mouramba , Benjamin Guyot , Cédric Bernard , Arnaud Dagain
Symptomatic chronic subdural hematoma is a prevalent conditions among the elderly, making burr hole surgical evacuation a very frequent cranial neurosurgical procedure. Recurrence of chronic subdural hematoma requiring revision surgery is associated with higher morbidity and mortality. Decreasing postoperative pneumocephalus is a simple but helpful mean allowing to reduce chronic subdural hematoma recurrence. A few years ago, our team has already described the use of the subdural drain to fill the subdural drain with saline, thus helping pneumocephalus out. Zhou and colleagues present an ingenious system using fluid mechanics principles, with an opened syringe connected to the subdural drain and held above the level of the burr hole in order to make saline flow into the subdural space; then held below the level of the burr hole to make pneumocephalus out, the remaining saline acting as a one-way-valve like the drainage bag of a pneumothorax. Nevertheless, in order to optimize this system, the burr hole should be placed in the horizontal plane at the highest point of the skull to be able to fill the subdural space with saline completely.
{"title":"Using fluid mechanics to reduce postoperative pneumocephalus during chronic subdural hematoma burr hole surgery: Technical note","authors":"Nathan Beucler , Anis Choucha , Julien Tinois , Antoine Do Tran , Michel Mouramba , Benjamin Guyot , Cédric Bernard , Arnaud Dagain","doi":"10.1016/j.neuchi.2025.101726","DOIUrl":"10.1016/j.neuchi.2025.101726","url":null,"abstract":"<div><div>Symptomatic chronic subdural hematoma is a prevalent conditions among the elderly, making burr hole surgical evacuation a very frequent cranial neurosurgical procedure. Recurrence of chronic subdural hematoma requiring revision surgery is associated with higher morbidity and mortality. Decreasing postoperative pneumocephalus is a simple but helpful mean allowing to reduce chronic subdural hematoma recurrence. A few years ago, our team has already described the use of the subdural drain to fill the subdural drain with saline, thus helping pneumocephalus out. Zhou and colleagues present an ingenious system using fluid mechanics principles, with an opened syringe connected to the subdural drain and held above the level of the burr hole in order to make saline flow into the subdural space; then held below the level of the burr hole to make pneumocephalus out, the remaining saline acting as a one-way-valve like the drainage bag of a pneumothorax. Nevertheless, in order to optimize this system, the burr hole should be placed in the horizontal plane at the highest point of the skull to be able to fill the subdural space with saline completely.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101726"},"PeriodicalIF":1.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105836","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 : 2025-09-19DOI: 10.1016/j.neuchi.2025.101723
Mauricio Guerrero-Ocampo, Marcos Peña, Ana Riquelme, Fabrizio Frutos
Introduction
True middle meningeal artery aneurysms (MMAAs) are extremely rare, with fewer than 20 documented cases and only one previously described as a giant aneurysm in a patient with fibrous dysplasia. Typically measuring under 10 mm, these lesions can be mistaken for other vascular abnormalities such as intracranial aneurysms, arteriovenous malformations (AVMs), or dural arteriovenous fistulas (DAVFs). This report describes a unique vascular lesion combining four rare features: (1) true MMAA, (2) giant in size, (3) completely thrombosed, and (4) mimicking a tumor (pseudotumoral behavior).
Material and methods
A 70-year-old male with no history of cranial trauma presented with right hemiparesis following a seizure. Imaging revealed a 266cc extra-axial mass in the left fronto-parieto-temporal region, causing significant midline shift (18 mm) and ventricular compression. CT and MRI findings showed a well-circumscribed lesion with post-contrast enhancement and a dural tail sign, raising suspicion for a meningioma. Surgical resection was performed using standard meningioma techniques. During microsurgical dissection and debulking, intraoperative pathology revealed non-neoplastic tissue.
Conclusion
This case highlights the potential for true MMAAs to mimic other intracranial pathologies. Due to their location and dural involvement, a high index of suspicion is essential. We recommend specific preoperative and intraoperative considerations for surgeons encountering similar presentations to avoid misdiagnosis and guide appropriate management. These include invasive imaging techniques, acceptable subtotal resection of the lesion given the lack of regrowth possibilities and optimal dural reconstruction to avoid complications such as cerebrospinal fluid fistulae.
{"title":"Giant Thrombosed Middle Meningeal Artery Aneurysm Mimicking a Meningioma","authors":"Mauricio Guerrero-Ocampo, Marcos Peña, Ana Riquelme, Fabrizio Frutos","doi":"10.1016/j.neuchi.2025.101723","DOIUrl":"10.1016/j.neuchi.2025.101723","url":null,"abstract":"<div><h3>Introduction</h3><div>True middle meningeal artery aneurysms (MMAAs) are extremely rare, with fewer than 20 documented cases and only one previously described as a giant aneurysm in a patient with fibrous dysplasia. Typically measuring under 10 mm, these lesions can be mistaken for other vascular abnormalities such as intracranial aneurysms, arteriovenous malformations (AVMs), or dural arteriovenous fistulas (DAVFs). This report describes a unique vascular lesion combining four rare features: (1) true MMAA, (2) giant in size, (3) completely thrombosed, and (4) mimicking a tumor (pseudotumoral behavior).</div></div><div><h3>Material and methods</h3><div>A 70-year-old male with no history of cranial trauma presented with right hemiparesis following a seizure. Imaging revealed a 266cc extra-axial mass in the left fronto-parieto-temporal region, causing significant midline shift (18 mm) and ventricular compression. CT and MRI findings showed a well-circumscribed lesion with post-contrast enhancement and a dural tail sign, raising suspicion for a meningioma. Surgical resection was performed using standard meningioma techniques. During microsurgical dissection and debulking, intraoperative pathology revealed non-neoplastic tissue.</div></div><div><h3>Conclusion</h3><div>This case highlights the potential for true MMAAs to mimic other intracranial pathologies. Due to their location and dural involvement, a high index of suspicion is essential. We recommend specific preoperative and intraoperative considerations for surgeons encountering similar presentations to avoid misdiagnosis and guide appropriate management. These include invasive imaging techniques, acceptable subtotal resection of the lesion given the lack of regrowth possibilities and optimal dural reconstruction to avoid complications such as cerebrospinal fluid fistulae.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101723"},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103046","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 : 2025-09-19DOI: 10.1016/j.neuchi.2025.101724
Paul Maneuvrier-Hervieu , Xavier Humbert
{"title":"Sudden unexpected death in post-traumatic convulsions: An historical case report from the late 18th century","authors":"Paul Maneuvrier-Hervieu , Xavier Humbert","doi":"10.1016/j.neuchi.2025.101724","DOIUrl":"10.1016/j.neuchi.2025.101724","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101724"},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103015","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 : 2025-09-17DOI: 10.1016/j.neuchi.2025.101725
Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Dorsa Najari , Azin Ebrahimi , Ehsan Bahrami Hezaveh , Fatemeh Ghorbanpouryami , Mohammad Amin Habibi
Background
Jugular foramen schwannomas (JFS) are infrequent cranial nerve (CN) lesions accounting for up to 4% of intracranial schwannomas. The management of the JFS is challenging due to its proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) has emerged as a minimally invasive alternative to resection; however, the available data regarding the outcomes of SRS in JFS is limited. This study aims to evaluate the role of SRS in JFS.
Methods
A systematic search of PubMed, Embase, Scopus, and Web of Science was performed following PRISMA guidelines. Pooled estimates for local control (LC), cranial nerve (CN) deterioration, progression-free survival (PFS), and adverse radiation effects (ARE) were calculated using the R program.
Results
Seventeen studies with 529 patients were included. The pooled LC rate was 94% (95% CI: 91%–96%), with a CN deterioration rate of 9% (95% CI: 3%–16%). The pooled 1-year PFS rate was 98% (95% CI: 96%–100%), 3-year PFS rate was 95% (95% CI: 92–97%, 5-year PFS rate was 92% (95% CI: 88–95%), and 10-year PFS rate was 84% (95% CI: 76–90%). The pooled ARE rate was 6% (95% CI: 2–11%).
Conclusion
SRS results in promising LC and PFS rates along with low CN deterioration and ARE rates in JFS patients. Surgery remains the primary choice for those with larger lesions or mass-related symptoms, while SRS can be the first-line option for small to medium-sized lesions.
{"title":"Outcomes of Stereotactic Radiosurgery for Jugular Foramen Schwannomas: A Systematic Review and Meta-Analysis","authors":"Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Dorsa Najari , Azin Ebrahimi , Ehsan Bahrami Hezaveh , Fatemeh Ghorbanpouryami , Mohammad Amin Habibi","doi":"10.1016/j.neuchi.2025.101725","DOIUrl":"10.1016/j.neuchi.2025.101725","url":null,"abstract":"<div><h3>Background</h3><div>Jugular foramen schwannomas (JFS) are infrequent cranial nerve (CN) lesions accounting for up to 4% of intracranial schwannomas. The management of the JFS is challenging due to its proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) has emerged as a minimally invasive alternative to resection; however, the available data regarding the outcomes of SRS in JFS is limited. This study aims to evaluate the role of SRS in JFS.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, Scopus, and Web of Science was performed following PRISMA guidelines. Pooled estimates for local control (LC), cranial nerve (CN) deterioration, progression-free survival (PFS), and adverse radiation effects (ARE) were calculated using the R program.</div></div><div><h3>Results</h3><div>Seventeen studies with 529 patients were included. The pooled LC rate was 94% (95% CI: 91%–96%), with a CN deterioration rate of 9% (95% CI: 3%–16%). The pooled 1-year PFS rate was 98% (95% CI: 96%–100%), 3-year PFS rate was 95% (95% CI: 92–97%, 5-year PFS rate was 92% (95% CI: 88–95%), and 10-year PFS rate was 84% (95% CI: 76–90%). The pooled ARE rate was 6% (95% CI: 2–11%).</div></div><div><h3>Conclusion</h3><div>SRS results in promising LC and PFS rates along with low CN deterioration and ARE rates in JFS patients. Surgery remains the primary choice for those with larger lesions or mass-related symptoms, while SRS can be the first-line option for small to medium-sized lesions.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101725"},"PeriodicalIF":1.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093040","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 : 2025-09-17DOI: 10.1016/j.neuchi.2025.101727
Shuo Gao , Pule Liu , Kai Liu, Qiang Yang
Aim
Giant pituitary adenomas often present as dumbbell-shaped or multilobulated, presenting significant challenges for surgical treatment. Currently, there is no universally recognized optimal surgical strategy for choosing a dual-scope approach for primary or staged resection. This study aims to present surgical cases and clinical experience with endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches for the primary resection of giant pituitary adenomas.
Material and methods
Ten patients with giant pituitary adenomas underwent one-stage surgical resection using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches. Imaging findings and treatment outcomes were subsequently reviewed.
Results
All patients underwent single-stage tumor resection using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches. Nine patients underwent total resection, while one patient underwent near-total resection. Postoperatively, visual acuity improved in six patients, while four patients experienced no significant change in visual acuity. One patient experienced cerebrospinal fluid leakage postoperatively and underwent a second repair. One patient developed a postoperative infection, and one developed hypopituitarism. No deaths or serious complications occurred.
Conclusion
Single-stage resection of giant pituitary adenomas using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches facilitates complete tumor resection, minimizes the need for residual tumor and staged surgeries, and reduces postoperative bleeding due to tumor remnants. This method improves the total resection rate and reduces postoperative complications and mortality, demonstrating significant effects and clinical application value, making it worthy of promotion.
{"title":"Combined endoscopic endonasal transsphenoidal and microscopic transcranial approaches for the primary resection of giant pituitary adenomas","authors":"Shuo Gao , Pule Liu , Kai Liu, Qiang Yang","doi":"10.1016/j.neuchi.2025.101727","DOIUrl":"10.1016/j.neuchi.2025.101727","url":null,"abstract":"<div><h3>Aim</h3><div>Giant pituitary adenomas often present as dumbbell-shaped or multilobulated, presenting significant challenges for surgical treatment. Currently, there is no universally recognized optimal surgical strategy for choosing a dual-scope approach for primary or staged resection. This study aims to present surgical cases and clinical experience with endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches for the primary resection of giant pituitary adenomas.</div></div><div><h3>Material and methods</h3><div>Ten patients with giant pituitary adenomas underwent one-stage surgical resection using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches. Imaging findings and treatment outcomes were subsequently reviewed.</div></div><div><h3>Results</h3><div>All patients underwent single-stage tumor resection using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches. Nine patients underwent total resection, while one patient underwent near-total resection. Postoperatively, visual acuity improved in six patients, while four patients experienced no significant change in visual acuity. One patient experienced cerebrospinal fluid leakage postoperatively and underwent a second repair. One patient developed a postoperative infection, and one developed hypopituitarism. No deaths or serious complications occurred.</div></div><div><h3>Conclusion</h3><div>Single-stage resection of giant pituitary adenomas using endoscopic endonasal transsphenoidal combined with microscopic transcranial approaches facilitates complete tumor resection, minimizes the need for residual tumor and staged surgeries, and reduces postoperative bleeding due to tumor remnants. This method improves the total resection rate and reduces postoperative complications and mortality, demonstrating significant effects and clinical application value, making it worthy of promotion.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101727"},"PeriodicalIF":1.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092950","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}
Orbital cavernous hemangiomas (OCH) are the most common benign orbital tumors, often presenting with proptosis. The endoscopic transorbital approach (ETOA) is increasingly being utilized for the treatment of OCH, offering minimal invasiveness and superior cosmetic outcomes. This study aims to evaluate the safety, efficacy, and clinical outcomes of ETOA for OCH.
Methods
A retrospective cohort of eight patients who underwent ETOA for OCH between 2020 and 2024 at the Neurosurgical Departments of Fondazione IRCCS Policlinico San Matteo were recorded. Preoperative evaluations included clinical symptoms, radiological assessments, and histology. Data on demographics, clinical presentation, operative time, extent of resection (EOR), complications, and follow-up outcomes were analyzed.
Results
The study included eight patients (mean age 55.9 years), with a male-to-female ratio of 1:1.7. All patients presented with proptosis, and 87.5% of lesions were intraconal. Gross Total Resection (GTR) was achieved in 87.5% cases (7/8), with an average operative time of 143.6 min. 37.5% of patients experienced transient postoperative complications, including diplopia (25%) and supraorbital neuralgia (12.5%), but no permanent deficits. The follow-up period ranged from 6 to 32 months, with no cases of recurrence observed.
Conclusions
ETOA appears safe and effective technique for the treatment of orbital cavernous hemangiomas, achieving high rates of GTR and low complication rates in the present series. The approach may also offer favorable cosmetic outcomes and short hospitalization times. Nonetheless, further studies with larger cohorts and longer follow-up are needed before drawing definitive conclusions.
背景：眶海绵状血管瘤（OCH）是最常见的眼眶良性肿瘤，常表现为突出。内窥镜下经眶入路（ETOA）越来越多地被用于治疗OCH，提供最小的侵入性和良好的美容效果。本研究旨在评估ETOA治疗OCH的安全性、有效性和临床结果。方法回顾性分析2020年至2024年在圣马特奥医院（Fondazione IRCCS Policlinico San Matteo）神经外科接受ETOA的8例OCH患者。术前评估包括临床症状、放射学评估和组织学。分析了人口统计学、临床表现、手术时间、切除程度（EOR）、并发症和随访结果的数据。结果纳入8例患者，平均年龄55.9岁，男女比例为1:7 .7。所有患者均表现为突出，87.5%的病变为囊内病变。87.5%（7/8）的病例实现了总切除（GTR），平均手术时间为143.6 min。37.5%的患者出现短暂的术后并发症，包括复视（25%）和眶上神经痛（12.5%），但没有永久性缺陷。随访6 ~ 32个月，无复发病例。结论setoa是一种安全有效的眼眶海绵状血管瘤治疗技术，GTR率高，并发症发生率低。该方法还可以提供良好的美容效果和较短的住院时间。尽管如此，在得出明确的结论之前，还需要更多的研究和更长的随访时间。
{"title":"Endoscopic transorbital approach for orbital cavernous hemangioma: A case series","authors":"Cesare Zoia , Matteo De Simone , Daniele Bongetta , Francesco Salomi , Fabio Pagella , Giannantonio Spena , Vittorio Ricciuti","doi":"10.1016/j.neuchi.2025.101716","DOIUrl":"10.1016/j.neuchi.2025.101716","url":null,"abstract":"<div><h3>Background</h3><div>Orbital cavernous hemangiomas (OCH) are the most common benign orbital tumors, often presenting with proptosis. The endoscopic transorbital approach (ETOA) is increasingly being utilized for the treatment of OCH, offering minimal invasiveness and superior cosmetic outcomes. This study aims to evaluate the safety, efficacy, and clinical outcomes of ETOA for OCH.</div></div><div><h3>Methods</h3><div>A retrospective cohort of eight patients who underwent ETOA for OCH between 2020 and 2024 at the Neurosurgical Departments of Fondazione IRCCS Policlinico San Matteo were recorded. Preoperative evaluations included clinical symptoms, radiological assessments, and histology. Data on demographics, clinical presentation, operative time, extent of resection (EOR), complications, and follow-up outcomes were analyzed.</div></div><div><h3>Results</h3><div>The study included eight patients (mean age 55.9 years), with a male-to-female ratio of 1:1.7. All patients presented with proptosis, and 87.5% of lesions were intraconal. Gross Total Resection (GTR) was achieved in 87.5% cases (7/8), with an average operative time of 143.6 min. 37.5% of patients experienced transient postoperative complications, including diplopia (25%) and supraorbital neuralgia (12.5%), but no permanent deficits. The follow-up period ranged from 6 to 32 months, with no cases of recurrence observed.</div></div><div><h3>Conclusions</h3><div>ETOA appears safe and effective technique for the treatment of orbital cavernous hemangiomas, achieving high rates of GTR and low complication rates in the present series. The approach may also offer favorable cosmetic outcomes and short hospitalization times. Nonetheless, further studies with larger cohorts and longer follow-up are needed before drawing definitive conclusions.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101716"},"PeriodicalIF":1.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018450","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 : 2025-09-05DOI: 10.1016/j.neuchi.2025.101720
Benoit Simonet , Lydiane Mondot , Fabien Almairac
Background
Treating symptomatic deep-seated cerebral cavernous malformations (CCMs) is challenging due to surgical risks.
Case description
A 37-year-old man underwent awake craniotomy with direct electrical stimulation (DES) for excision of a left posterior thalamic CCM. A transcortical transventricular approach through the superior parietal lobe enabled safe navigation around critical associative and projection white matter tracts.
Results
Postoperative MRI confirmed complete resection with preservation of major tracts, and the patient showed significant recovery at three months.
Conclusion
This case highlights the potential of awake surgery with DES as a safe and effective method for deep-seated CCMs traditionally deemed inoperable.
{"title":"Awake surgery with direct electrical stimulation for safe resection of a deep posterior thalamic cavernous malformation","authors":"Benoit Simonet , Lydiane Mondot , Fabien Almairac","doi":"10.1016/j.neuchi.2025.101720","DOIUrl":"10.1016/j.neuchi.2025.101720","url":null,"abstract":"<div><h3>Background</h3><div>Treating symptomatic deep-seated cerebral cavernous malformations (CCMs) is challenging due to surgical risks.</div></div><div><h3>Case description</h3><div>A 37-year-old man underwent awake craniotomy with direct electrical stimulation (DES) for excision of a left posterior thalamic CCM. A transcortical transventricular approach through the superior parietal lobe enabled safe navigation around critical associative and projection white matter tracts.</div></div><div><h3>Results</h3><div>Postoperative MRI confirmed complete resection with preservation of major tracts, and the patient showed significant recovery at three months.</div></div><div><h3>Conclusion</h3><div>This case highlights the potential of awake surgery with DES as a safe and effective method for deep-seated CCMs traditionally deemed inoperable.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101720"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016660","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 : 2025-09-05DOI: 10.1016/j.neuchi.2025.101714
Jean Guyot, Amandine Gavotto, Stéphane Litrico, Antoine Gennari
Background
Posterior lumbar fusion (PLF) has become one of the most common spinal surgery procedures. Early symptomatic loosening of the pedicle screw could be a critical complication, leading to pseudarthrosis. However, revision strategies for pedicle screw loosening are still under debate.
Objective & methods
Based on a clinical case, we conducted a literature review of pedicle screw loosening, its risk factors, aetiologies, surgical revision options and outcomes.
Results
We describe a clinical case of early mechanical failure of a posterior L4-L5 arthrodesis due to septic cause. Revision surgery consisted of circumferential surgery using ALIF, posterior larger screws and extension of the arthrodesis.
The review of the literature highlights numerous risk factors for screw loosening and underlines the importance of fitting an interbody device during index surgery in patients at risk.
In the event of a screw loosening, bacteriological samples should be systematic.
Symptomatic screw loosening should benefit from revision surgery. There are various options for revision surgery, including anterior revision and the revision of posterior screws.
Conclusion
This review highlights the key elements of initial PLF surgery, the importance of septic aetiology in pedicle screw loosening, and suggested surgical strategies in the face of early mechanical failure.
{"title":"Early mechanical failure of posterior lumbar fusion: Literature review based on an illustrative case","authors":"Jean Guyot, Amandine Gavotto, Stéphane Litrico, Antoine Gennari","doi":"10.1016/j.neuchi.2025.101714","DOIUrl":"10.1016/j.neuchi.2025.101714","url":null,"abstract":"<div><h3>Background</h3><div>Posterior lumbar fusion (PLF) has become one of the most common spinal surgery procedures. Early symptomatic loosening of the pedicle screw could be a critical complication, leading to pseudarthrosis. However, revision strategies for pedicle screw loosening are still under debate.</div></div><div><h3>Objective & methods</h3><div>Based on a clinical case, we conducted a literature review of pedicle screw loosening, its risk factors, aetiologies, surgical revision options and outcomes.</div></div><div><h3>Results</h3><div>We describe a clinical case of early mechanical failure of a posterior L4-L5 arthrodesis due to septic cause. Revision surgery consisted of circumferential surgery using ALIF, posterior larger screws and extension of the arthrodesis.</div><div>The review of the literature highlights numerous risk factors for screw loosening and underlines the importance of fitting an interbody device during index surgery in patients at risk.</div><div>In the event of a screw loosening, bacteriological samples should be systematic.</div><div>Symptomatic screw loosening should benefit from revision surgery. There are various options for revision surgery, including anterior revision and the revision of posterior screws.</div></div><div><h3>Conclusion</h3><div>This review highlights the key elements of initial PLF surgery, the importance of septic aetiology in pedicle screw loosening, and suggested surgical strategies in the face of early mechanical failure.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101714"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016612","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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