Craniopagus is one of the rarest congenital abnormalities. Separation of craniopagus twin is associated with high morbidity and mortality, especially in total type, where the twin had shared dural venous sinuses. One of the complications after separation surgery is hydrocephalus. While detailed cerebral vasculature imaging is needed pre-operatively to ensure most optimal surgical approach, post-operative vasculature imaging is no less important to assess changes in cerebral venous system after separation surgery.
Case presentation
Separation surgery was successfully accomplished in a total vertical craniopagus twin with shared dural venous sinuses. One twin experienced hydrocephalus after surgery, while the other twin had CSF leakage from the wound. LP shunt was placed in both twin and they had good recovery. We then compared the cerebral venous structure in both twins, before and after separation surgery using reconstruction of CT venography.
Conclusion
Successful separation of total vertical craniopagus twin where both twin developed well without any neurological deficit is a very rare occurrence. Based on follow up CTV, cerebral venous system underwent re-arrangement to accommodate changing hemodynamic needs after separation surgery. This might give us new insight about cerebral venous system that favors good prognosis for craniopagus twin.
{"title":"5-year follow up after successful craniopagus separation: Review on hydrocephalus and venous system re-arrangement","authors":"Samsul Ashari , Alvi Aulia , Affan Priyambodo , Setyo Widi Nugroho , Amanda Aldilla","doi":"10.1016/j.neuchi.2025.101717","DOIUrl":"10.1016/j.neuchi.2025.101717","url":null,"abstract":"<div><h3>Introduction</h3><div>Craniopagus is one of the rarest congenital abnormalities. Separation of craniopagus twin is associated with high morbidity and mortality, especially in total type, where the twin had shared dural venous sinuses. One of the complications after separation surgery is hydrocephalus. While detailed cerebral vasculature imaging is needed pre-operatively to ensure most optimal surgical approach, post-operative vasculature imaging is no less important to assess changes in cerebral venous system after separation surgery.</div></div><div><h3>Case presentation</h3><div>Separation surgery was successfully accomplished in a total vertical craniopagus twin with shared dural venous sinuses. One twin experienced hydrocephalus after surgery, while the other twin had CSF leakage from the wound. LP shunt was placed in both twin and they had good recovery. We then compared the cerebral venous structure in both twins, before and after separation surgery using reconstruction of CT venography.</div></div><div><h3>Conclusion</h3><div>Successful separation of total vertical craniopagus twin where both twin developed well without any neurological deficit is a very rare occurrence. Based on follow up CTV, cerebral venous system underwent re-arrangement to accommodate changing hemodynamic needs after separation surgery. This might give us new insight about cerebral venous system that favors good prognosis for craniopagus twin.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101717"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016691","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.2025.101715
A. Nguyen , P. Haettel , B. Ghannam , R. Assaker , H.-A. Leroy
Background
Sacroiliac joint dysfunction (SIJD) accounts for 15–25% of chronic low back pain and often follows lumbar fusion. When conservative therapies fail, minimally invasive (MIS) SIJ fusion (SIJF) is indicated. The robot-assisted technique is feasible and safe, enhancing accuracy and reducing radiation exposure.
Case description
A 26-year-old woman, eight years after L4-S1 fusion, presented with bilateral SIJD refractory to physiotherapy and intraarticular steroids injection. SIJF was indicated. Here we describe the robot-assisted technique and its advantages.
Conclusion
Robot-assisted SIJF is a safe and accurate technique to treat SIJD while reducing radiation exposure. Trajectories planification and consideration of anatomical variations give the robot-assisted technique an advantage over conventional techniques such as fluoroscopy or navigation.
{"title":"Robot-assisted MIS transiliac sacroiliac joint fusion: Technical note","authors":"A. Nguyen , P. Haettel , B. Ghannam , R. Assaker , H.-A. Leroy","doi":"10.1016/j.neuchi.2025.101715","DOIUrl":"10.1016/j.neuchi.2025.101715","url":null,"abstract":"<div><h3>Background</h3><div>Sacroiliac joint dysfunction (SIJD) accounts for 15–25% of chronic low back pain and often follows lumbar fusion. When conservative therapies fail, minimally invasive (MIS) SIJ fusion (SIJF) is indicated. The robot-assisted technique is feasible and safe, enhancing accuracy and reducing radiation exposure.</div></div><div><h3>Case description</h3><div>A 26-year-old woman, eight years after L4-S1 fusion, presented with bilateral SIJD refractory to physiotherapy and intraarticular steroids injection. SIJF was indicated. Here we describe the robot-assisted technique and its advantages.</div></div><div><h3>Conclusion</h3><div>Robot-assisted SIJF is a safe and accurate technique to treat SIJD while reducing radiation exposure. Trajectories planification and consideration of anatomical variations give the robot-assisted technique an advantage over conventional techniques such as fluoroscopy or navigation.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101715"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016677","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.2025.101718
Remi Raclot , Jean-Christophe Sol , Franck-Emmanuel Roux , Maxime Pommier , Nicolas Astafieff , Lubin Klotz , Amaury De Barros
Background
Intracranial meningiomas are the most common benign central nervous system tumors, often managed with elective surgical resection. While outcomes are generally favorable, postoperative management remains variable, particularly regarding routine Intensive-Care Units (ICU) admission. Given increasing pressure on critical care resources, identifying patients who truly require ICU-level monitoring is essential.
Objective
To evaluate early postoperative complications after meningioma surgery and develop a practical risk-based score to guide ICU admission.
Methods
We performed a retrospective single-center study of 203 intracranial meningioma resections (2020–2022). Patients were included if they had scheduled surgery and at least one night of postoperative ICU monitoring. A composite endpoint defined ICU-relevant complications within 24 h, including seizures, new deficits, delayed awakening, reintubation, transfusion, intra-veinous (IV) antihypertensives, and urgent imaging or reoperation. Twenty-two clinical, radiological, and surgical factors were analyzed.
Results
Postoperative complications requiring ICU-level care occurred in 19.2% of cases, mostly neurological (13.8%). Two-thirds of events occurred upon awakening or in the post-anesthesia care unit (PACU). Univariate analysis identified seven significant predictors: intracranial hypertension, falcine location, motor cortex involvement, operative time ≥3 h, blood loss >500 mL, osmotherapy use, and transfusion. A 10-item risk score demonstrated high sensitivity (92.3%) and negative predictive value (95.9%) using a cut-off of 1 or more points. Using this model, in our population, 36.5% of patients could have safely avoided ICU admission.
Conclusion
A risk-based approach to ICU admission after meningioma surgery appears both safe and feasible. Implementation of this score, combined with extended PACU monitoring, could optimize resource use without compromising patient safety. Prospective validation is warranted.
{"title":"Evaluation of the necessity of systematic ICU after intracranial meningioma surgery: Towards a risk-based approach. Toulouse University Hospital experience","authors":"Remi Raclot , Jean-Christophe Sol , Franck-Emmanuel Roux , Maxime Pommier , Nicolas Astafieff , Lubin Klotz , Amaury De Barros","doi":"10.1016/j.neuchi.2025.101718","DOIUrl":"10.1016/j.neuchi.2025.101718","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial meningiomas are the most common benign central nervous system tumors, often managed with elective surgical resection. While outcomes are generally favorable, postoperative management remains variable, particularly regarding routine Intensive-Care Units (ICU) admission. Given increasing pressure on critical care resources, identifying patients who truly require ICU-level monitoring is essential.</div></div><div><h3>Objective</h3><div>To evaluate early postoperative complications after meningioma surgery and develop a practical risk-based score to guide ICU admission.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-center study of 203 intracranial meningioma resections (2020–2022). Patients were included if they had scheduled surgery and at least one night of postoperative ICU monitoring. A composite endpoint defined ICU-relevant complications within 24 h, including seizures, new deficits, delayed awakening, reintubation, transfusion, intra-veinous (IV) antihypertensives, and urgent imaging or reoperation. Twenty-two clinical, radiological, and surgical factors were analyzed.</div></div><div><h3>Results</h3><div>Postoperative complications requiring ICU-level care occurred in 19.2% of cases, mostly neurological (13.8%). Two-thirds of events occurred upon awakening or in the post-anesthesia care unit (PACU). Univariate analysis identified seven significant predictors: intracranial hypertension, falcine location, motor cortex involvement, operative time ≥3 h, blood loss >500 mL, osmotherapy use, and transfusion. A 10-item risk score demonstrated high sensitivity (92.3%) and negative predictive value (95.9%) using a cut-off of 1 or more points. Using this model, in our population, 36.5% of patients could have safely avoided ICU admission.</div></div><div><h3>Conclusion</h3><div>A risk-based approach to ICU admission after meningioma surgery appears both safe and feasible. Implementation of this score, combined with extended PACU monitoring, could optimize resource use without compromising patient safety. Prospective validation is warranted.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101718"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016668","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.2025.101719
Oumaima Aboubakr , Lelio Guida , Volodia Dangouloff Ros , Emma Losito , Marie Bourgeois , François Doz , Jacques Grill , Gilles Orliaguet , Estelle Vergnaud , Stéphane Auvin , Rima Nabbout , Kevin Beccaria , Nathalie Boddaert , Thomas Blauwblomme
Introduction
Laser Interstitial Thermal Therapy under MRI control has emerged as a safe and efficient alternative to microsurgery in epilepsy and neurooncology procedures. Yet it has been used only recently in seldom European centers. Here, we report our 4 years’ experience with LITT in children (complications, epileptic and oncologic outcomes).
Methods
Single center retrospective study of consecutive LITT procedures during the 2021–2024 period. LITT was restricted to pediatrics in the following indications: (i) circumscribed lesion (ii) benign pathology (iii) problematic location for microsurgical resection. After a robotic stereotactic implantation, ablation was performed under MRI guidance with the VISUALASE system. Post operative outpatient clinic and MRI were systematic at 1, 3, 6 and 12 months. Epileptic outcome was defined after ILAE classification, oncological relapse was defined as a volumetric increase after 1 month of follow up.
Results
35 children (mean age 11.4yo, M/F ratio = 0.8) were operated in 41 successive procedures. Main indication was focal epilepsy (n = 28 patients; FCD n = 13, LEAT n = 11, HH n = 4) while 7 children were treated for oncological purposes. Lesions were cortical in the insula (n = 8), mediotemporobasal (n = 8) and paracentral (n = 6) regions or subcortical (hypothalamus and basal ganglia n = 6, mesencephalon n = 4). Perioperative transient adverse events occurred in 25.7% and persistent neurological deficit was noted in 2 children. After a mean follow up of 31.2 months, 67.9% of the patients are seizure free and tumoral recurrence was observed in 3/18 cases.
Conclusion
In this pediatric cohort of 35 children with challenging brain lesions, LITT ablation was safe and efficient.
{"title":"Laser Interstitial Thermal Therapy (LITT) in pediatric neurosurgery: Single center retrospective analysis of 41 consecutive procedures","authors":"Oumaima Aboubakr , Lelio Guida , Volodia Dangouloff Ros , Emma Losito , Marie Bourgeois , François Doz , Jacques Grill , Gilles Orliaguet , Estelle Vergnaud , Stéphane Auvin , Rima Nabbout , Kevin Beccaria , Nathalie Boddaert , Thomas Blauwblomme","doi":"10.1016/j.neuchi.2025.101719","DOIUrl":"10.1016/j.neuchi.2025.101719","url":null,"abstract":"<div><h3>Introduction</h3><div>Laser Interstitial Thermal Therapy under MRI control has emerged as a safe and efficient alternative to microsurgery in epilepsy and neurooncology procedures. Yet it has been used only recently in seldom European centers. Here, we report our 4 years’ experience with LITT in children (complications, epileptic and oncologic outcomes).</div></div><div><h3>Methods</h3><div>Single center retrospective study of consecutive LITT procedures during the 2021–2024 period. LITT was restricted to pediatrics in the following indications: (i) circumscribed lesion (ii) benign pathology (iii) problematic location for microsurgical resection. After a robotic stereotactic implantation, ablation was performed under MRI guidance with the VISUALASE system. Post operative outpatient clinic and MRI were systematic at 1, 3, 6 and 12 months. Epileptic outcome was defined after ILAE classification, oncological relapse was defined as a volumetric increase after 1 month of follow up.</div></div><div><h3>Results</h3><div>35 children (mean age 11.4yo, M/F ratio = 0.8) were operated in 41 successive procedures. Main indication was focal epilepsy (<em>n</em> = 28 patients; FCD <em>n</em> = 13, LEAT <em>n</em> = 11, HH <em>n</em> = 4) while 7 children were treated for oncological purposes. Lesions were cortical in the insula (<em>n</em> = 8), mediotemporobasal (<em>n</em> = 8) and paracentral (<em>n</em> = 6) regions or subcortical (hypothalamus and basal ganglia <em>n</em> = 6, mesencephalon <em>n</em> = 4). Perioperative transient adverse events occurred in 25.7% and persistent neurological deficit was noted in 2 children. After a mean follow up of 31.2 months, 67.9% of the patients are seizure free and tumoral recurrence was observed in 3/18 cases.</div></div><div><h3>Conclusion</h3><div>In this pediatric cohort of 35 children with challenging brain lesions, LITT ablation was safe and efficient.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101719"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016657","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.2025.101713
C. Hervet , C. Le Roux , C. Gaborit , J. Maheut-Lourmiere , C. Fremont , H. Lardy , L. Grammatico-Guillon , T. Odent
Objective
Epidemiological data on rare spinal cord malformations in children are lacking in France. Using the national hospital discharge database (PMSI), we studied the care trajectories and estimated the morbidity and mortality burden of these conditions.
Study design
We conducted a nationwide historical cohort study from 2010 to 2020, including children diagnosed with rare spinal cord diseases within the scope of the C-MAVEM network. Cases were identified through ICD-10 codes using a semi-automated, multicenter-validated extraction algorithm (positive predictive value >80%). Incidence and in-hospital mortality rates were estimated for the following conditions: Spina Bifida (SB), Arnold Chiari syndrome (ACS), Syringomyelia and Syringobulbia (SM), Diastematomyelia (DM), and Hydromyelia (HM).
Results
A total of 10,114 children were identified, corresponding to an estimated prevalence of 67 per 100,000. Incidence rates per 100,000 live births were: 2.6 for SB, 2.2 for ACS, 1.0 for SM, 0.2 for DM, and 0.04 for HM. The mortality was 2.5%, 1.7%, 1.1%, 0.95%, no available for HM, respectively. Most patients were treated in university hospitals with considerable heterogeneity in surgical management depending on etiology and associated malformations.
Conclusion
This study provides, for the first time in France, national epidemiological estimates for rare pediatric spinal cord malformations. The use of a validated medico-administrative data extraction approach enables largescale surveillance of these rare conditions, improves understanding of their healthcare burden, and supports planning for specialized care and public health strategies.
{"title":"Spinal cord malformations’s epidemiology in French children: National cross sectional study based on medico-administrative database","authors":"C. Hervet , C. Le Roux , C. Gaborit , J. Maheut-Lourmiere , C. Fremont , H. Lardy , L. Grammatico-Guillon , T. Odent","doi":"10.1016/j.neuchi.2025.101713","DOIUrl":"10.1016/j.neuchi.2025.101713","url":null,"abstract":"<div><h3>Objective</h3><div>Epidemiological data on rare spinal cord malformations in children are lacking in France. Using the national hospital discharge database (PMSI), we studied the care trajectories and estimated the morbidity and mortality burden of these conditions.</div></div><div><h3>Study design</h3><div>We conducted a nationwide historical cohort study from 2010 to 2020, including children diagnosed with rare spinal cord diseases within the scope of the C-MAVEM network. Cases were identified through ICD-10 codes using a semi-automated, multicenter-validated extraction algorithm (positive predictive value >80%). Incidence and in-hospital mortality rates were estimated for the following conditions: Spina Bifida (SB), Arnold Chiari syndrome (ACS), Syringomyelia and Syringobulbia (SM), Diastematomyelia (DM), and Hydromyelia (HM).</div></div><div><h3>Results</h3><div>A total of 10,114 children were identified, corresponding to an estimated prevalence of 67 per 100,000. Incidence rates per 100,000 live births were: 2.6 for SB, 2.2 for ACS, 1.0 for SM, 0.2 for DM, and 0.04 for HM. The mortality was 2.5%, 1.7%, 1.1%, 0.95%, no available for HM, respectively. Most patients were treated in university hospitals with considerable heterogeneity in surgical management depending on etiology and associated malformations.</div></div><div><h3>Conclusion</h3><div>This study provides, for the first time in France, national epidemiological estimates for rare pediatric spinal cord malformations. The use of a validated medico-administrative data extraction approach enables largescale surveillance of these rare conditions, improves understanding of their healthcare burden, and supports planning for specialized care and public health strategies.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101713"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016647","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 : 2025-08-08DOI: 10.1016/j.neuchi.2025.101710
Sean O’Leary , Nathan Fredricks , Peace Odiase , Sonia Pulido , Usama AlDallal , Ariadna Robledo , Christopher Thang , Umaru Barrie , Salah Aoun
Objective
Foix-Alajouanine syndrome (FAS) is a grouping of rare, progressive spinal arteriovenous malformations causing significant neurological morbidity.
Methods
A systematic review of PubMed, Google Scholar, Embase, Science Direct, and Web of Science following PRISMA guidelines identified 30 articles addressing FAS presentation, management, and outcomes.
Results
In 27 case reports covering 46 patients (mean age 55.1 years, 71.7% male), common symptoms included lower extremity weakness (84.8%), bladder dysfunction (69.6%), sensory deficits (65.2%), and gait disturbance (65.2%). Imaging (MRI in 82.5%, angiography in 70.0%) frequently revealed dural arteriovenous fistulas and spinal cord hyperintensities, primarily in the thoracolumbar region. Among these patients, 58.7% improved, 13.1% showed no change, 21.7% worsened, and 6.5% died. Surgical clipping (OR 10.67, 95% CI [2.12–68.04], p = 0.002) and resection (OR 5.74, 95% CI [1.18–36.47], p = 0.029) were associated with neurological improvement, whereas lesions in the mid-thoracic region (T6–T9) had reduced likelihood of improvement (OR 0.18, 95% CI [0.04–0.76], p = 0.017). Conservative management correlated with higher mortality (OR 33.89, 95% CI [1.39–826.08], p = 0.023). In three retrospective studies covering 66 patients (mean age 61.5 years, 80.3% male), primary interventions were surgical or endovascular; 63.6% improved, 35.0% worsened, and 1.5% died at follow-up.
Conclusions
Early detection by clinical and radiologic signs with quick intervention in the subtypes of FAS are crucial. Surgical clipping and resection demonstrated particularly favorable results, whereas conservative management was associated with increased mortality. Clinicians should maintain a high index of suspicion for subacute myelopathy to facilitate timely diagnosis and improve long-term prognosis.
目的：fox - alajouanine syndrome （FAS）是一组罕见的进行性脊柱动静脉畸形，引起严重的神经系统疾病。方法：根据PRISMA指南对PubMed、b谷歌Scholar、Embase、Science Direct和Web of Science进行系统综述，确定了30篇关于FAS呈现、管理和结果的文章。结果：27例报告46例患者（平均年龄55.1岁，男性71.7%），常见症状包括下肢无力（84.8%）、膀胱功能障碍（69.6%）、感觉缺陷（65.2%）和步态障碍（65.2%）。影像学（MRI占82.5%，血管造影占70.0%）经常显示硬脑膜动静脉瘘和脊髓高信号，主要发生在胸腰椎区。其中58.7%好转，13.1%无变化，21.7%恶化，6.5%死亡。手术夹持（OR 10.67, 95% CI [2.12-68.04], p = 0.002）和切除（OR 5.74, 95% CI [1.18-36.47], p = 0.029）与神经系统改善相关，而胸中区域（T6-T9）病变改善的可能性较低（OR 0.18, 95% CI [0.04-0.76], p = 0.017）。保守治疗与较高的死亡率相关（OR 33.89, 95% CI [1.39 ~ 826.08], p = 0.023）。在三项回顾性研究中，66例患者（平均年龄61.5岁，80.3%为男性）的主要干预措施是手术或血管内治疗；63.6%好转，35.0%恶化，1.5%死亡。结论：通过临床和放射学征象及早发现，快速干预，可有效预防FAS复发。手术夹持和切除显示出特别有利的结果，而保守治疗与死亡率增加有关。临床医生对亚急性脊髓病应保持高度的怀疑指数，以便及时诊断和改善长期预后。
{"title":"Foix-Alajouanine syndrome: A systematic review and meta-analysis of presentation, management, and outcomes","authors":"Sean O’Leary , Nathan Fredricks , Peace Odiase , Sonia Pulido , Usama AlDallal , Ariadna Robledo , Christopher Thang , Umaru Barrie , Salah Aoun","doi":"10.1016/j.neuchi.2025.101710","DOIUrl":"10.1016/j.neuchi.2025.101710","url":null,"abstract":"<div><h3>Objective</h3><div>Foix-Alajouanine syndrome (FAS) is a grouping of rare, progressive spinal arteriovenous malformations causing significant neurological morbidity.</div></div><div><h3>Methods</h3><div>A systematic review of PubMed, Google Scholar, Embase, Science Direct, and Web of Science following PRISMA guidelines identified 30 articles addressing FAS presentation, management, and outcomes.</div></div><div><h3>Results</h3><div>In 27 case reports covering 46 patients (mean age 55.1 years, 71.7% male), common symptoms included lower extremity weakness (84.8%), bladder dysfunction (69.6%), sensory deficits (65.2%), and gait disturbance (65.2%). Imaging (MRI in 82.5%, angiography in 70.0%) frequently revealed dural arteriovenous fistulas and spinal cord hyperintensities, primarily in the thoracolumbar region. Among these patients, 58.7% improved, 13.1% showed no change, 21.7% worsened, and 6.5% died. Surgical clipping (OR 10.67, 95% CI [2.12–68.04], p = 0.002) and resection (OR 5.74, 95% CI [1.18–36.47], p = 0.029) were associated with neurological improvement, whereas lesions in the mid-thoracic region (T6–T9) had reduced likelihood of improvement (OR 0.18, 95% CI [0.04–0.76], p = 0.017). Conservative management correlated with higher mortality (OR 33.89, 95% CI [1.39–826.08], p = 0.023). In three retrospective studies covering 66 patients (mean age 61.5 years, 80.3% male), primary interventions were surgical or endovascular; 63.6% improved, 35.0% worsened, and 1.5% died at follow-up.</div></div><div><h3>Conclusions</h3><div>Early detection by clinical and radiologic signs with quick intervention in the subtypes of FAS are crucial. Surgical clipping and resection demonstrated particularly favorable results, whereas conservative management was associated with increased mortality. Clinicians should maintain a high index of suspicion for subacute myelopathy to facilitate timely diagnosis and improve long-term prognosis.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101710"},"PeriodicalIF":1.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818124","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 : 2025-08-07DOI: 10.1016/j.neuchi.2025.101712
L. Mongardi , M.C. Hesler , J.R. Vignes , S. Fuentes , P. Roblot
{"title":"Ossification of the posterior longitudinal ligament (OPLL) in the Wallis and Futuna population: A hidden and underestimated enemy","authors":"L. Mongardi , M.C. Hesler , J.R. Vignes , S. Fuentes , P. Roblot","doi":"10.1016/j.neuchi.2025.101712","DOIUrl":"10.1016/j.neuchi.2025.101712","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101712"},"PeriodicalIF":1.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812657","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 hematoma (CSDH) is a well-documented imaging finding in spontaneous intracranial hypotension (SIH) and is often managed conservatively. While large hematomas identified on imaging traditionally prompt early surgical intervention, this approach still seems unclear. This study aims to clarify optimal management strategies by reviewing our clinical experience.
Methods
We retrospectively analyzed 14 consecutive cases of CSDH associated with SIH treated at our institution between 2010 and 2024. Patient demographics, clinical symptoms, and imaging findings were extracted from medical records and statistically analyzed.
Results
Seven patients with persistent headaches underwent hematoma drainage in addition to SIH treatment, whereas seven patients with positional headaches were successfully managed with SIH treatment alone. The persistent headache group had a larger median hematoma volume than the positional headache group (88.9 cm3 vs. 38.9 cm³). However, the persistent headache group had a significantly lower median Glasgow Coma Scale score than the positional headache group (13 vs. 15, p = 0.011). Papilledema was observed in five of the seven patients in the persistent headache group, but was absent in the positional headache group (p = 0.079).
Conclusions
Our study demonstrates that clinical indicators—particularly papilledema, altered consciousness, and headache characteristics—are essential for guiding the need for hematoma drainage in CSDH associated with SIH. Radiological features such as hematoma volume were not sufficient predictors of surgical need.
{"title":"Prioritizing clinical indicators over radiological findings in the management of chronic subdural hematoma associated with spontaneous intracranial hypotension","authors":"Kuniyuki Onuma , Kiyoyuki Yanaka , Kazuhiro Nakamura , Hitoshi Aiyama , Nobuyuki Takahashi , Keiichi Tajima , Alexander Zaboronok , Eiichi Ishikawa","doi":"10.1016/j.neuchi.2025.101709","DOIUrl":"10.1016/j.neuchi.2025.101709","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic subdural hematoma (CSDH) is a well-documented imaging finding in spontaneous intracranial hypotension (SIH) and is often managed conservatively. While large hematomas identified on imaging traditionally prompt early surgical intervention, this approach still seems unclear. This study aims to clarify optimal management strategies by reviewing our clinical experience.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 14 consecutive cases of CSDH associated with SIH treated at our institution between 2010 and 2024. Patient demographics, clinical symptoms, and imaging findings were extracted from medical records and statistically analyzed.</div></div><div><h3>Results</h3><div>Seven patients with persistent headaches underwent hematoma drainage in addition to SIH treatment, whereas seven patients with positional headaches were successfully managed with SIH treatment alone. The persistent headache group had a larger median hematoma volume than the positional headache group (88.9 cm<sup>3</sup> vs. 38.9 cm³). However, the persistent headache group had a significantly lower median Glasgow Coma Scale score than the positional headache group (13 vs. 15, p = 0.011). Papilledema was observed in five of the seven patients in the persistent headache group, but was absent in the positional headache group (p = 0.079).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates that clinical indicators—particularly papilledema, altered consciousness, and headache characteristics—are essential for guiding the need for hematoma drainage in CSDH associated with SIH. Radiological features such as hematoma volume were not sufficient predictors of surgical need.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101709"},"PeriodicalIF":1.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772625","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 : 2025-07-31DOI: 10.1016/j.neuchi.2025.101708
Atsushi Fujita, Hiroki Goto, Masaaki Kohta, Takashi Sasayama
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