Neurochirurgie最新文献_第7页

Outcomes of Stereotactic Radiosurgery for Jugular Foramen Schwannomas: A Systematic Review and Meta-Analysis 立体定向放射治疗颈静脉孔神经鞘瘤的疗效：系统回顾和荟萃分析。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-17 DOI: 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.

背景：颈静脉孔神经鞘瘤（JFS）是一种少见的脑神经病变，占颅内神经鞘瘤的4%。由于靠近关键的神经血管结构，JFS的管理具有挑战性。立体定向放射外科（SRS）已成为切除的微创替代方案；然而，关于JFS中SRS结果的可用数据是有限的。本研究旨在评价SRS在JFS中的作用。方法：按照PRISMA指南系统检索PubMed、Embase、Scopus和Web of Science。使用R程序计算局部控制（LC）、颅神经（CN）恶化、无进展生存（PFS）和不良辐射效应（ARE）的汇总估计。结果：纳入17项研究，529例患者。合并LC率为94% (95% CI: 91%-96%)， CN恶化率为9% （95% CI: 3%-16%）。合并1年PFS率为98% (95% CI: 96%-100%)， 3年PFS率为95% (95% CI: 92-97%)， 5年PFS率为92% (95% CI: 88-95%)， 10年PFS率为84% （95% CI: 76-90%）。合并ARE率为6% （95% CI: 2-11%）。结论：SRS在JFS患者中具有良好的LC和PFS率以及较低的CN恶化和ARE率。对于较大的病变或肿块相关症状，手术仍然是首选，而对于中小型病变，SRS可能是一线选择。

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引用次数: 0

Combined endoscopic endonasal transsphenoidal and microscopic transcranial approaches for the primary resection of giant pituitary adenomas 经鼻内窥镜和经颅镜联合入路治疗垂体巨大腺瘤。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-17 DOI: 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.

目的：巨大垂体腺瘤常表现为哑铃状或多分叶状，对手术治疗提出了重大挑战。目前，对于选择双镜入路进行原发性或分期切除，尚无普遍认可的最佳手术策略。本研究旨在报告经鼻内镜蝶窦联合经颅镜入路原发性切除垂体巨大腺瘤的手术病例及临床经验。材料与方法：对10例巨大垂体腺瘤采用经鼻内镜蝶窦联合经颅镜入路一期手术切除。随后回顾影像学表现和治疗结果。结果：所有患者均采用鼻内经蝶联合显微经颅入路行单期肿瘤切除术。9例患者行全切除，1例患者行近全切除。术后6例患者视力改善，4例患者视力无明显变化。1例患者术后出现脑脊液漏，并进行了第二次修复。1例患者发生术后感染，1例发生垂体功能减退。无死亡或严重并发症发生。结论：经鼻内窥镜经蝶窦联合经颅镜入路单期切除垂体巨大腺瘤，有利于肿瘤完全切除，减少残留肿瘤和分期手术，减少术后肿瘤残留出血。该方法提高了全切除率，降低了术后并发症和死亡率，效果显著，具有临床应用价值，值得推广。

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引用次数: 0

Endoscopic transorbital approach for orbital cavernous hemangioma: A case series 经眶内窥镜入路治疗眶海绵状血管瘤：一个病例系列

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-08 DOI: 10.1016/j.neuchi.2025.101716

Cesare Zoia , Matteo De Simone , Daniele Bongetta , Francesco Salomi , Fabio Pagella , Giannantonio Spena , Vittorio Ricciuti

Background

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。

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引用次数: 0

Awake surgery with direct electrical stimulation for safe resection of a deep posterior thalamic cavernous malformation 清醒手术直接电刺激安全切除深后丘脑海绵体畸形。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-05 DOI: 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.

背景：由于手术风险，治疗症状性深部脑海绵体畸形（CCMs）具有挑战性。病例描述：一名37岁男性接受清醒开颅直接电刺激（DES）切除左侧后丘脑CCM。经皮质经脑室入路经顶叶上，可安全绕过关键联合和投射白质束。结果：术后MRI证实完全切除并保留了大束，患者在3个月时恢复明显。结论：本病例强调了DES清醒手术作为一种安全有效的方法治疗传统上被认为无法手术的深层ccm的潜力。

引用次数: 0

Early mechanical failure of posterior lumbar fusion: Literature review based on an illustrative case 腰椎后路融合术早期机械失效：基于一例说明性病例的文献回顾。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-05 DOI: 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.

背景：后路腰椎融合术（PLF）已成为最常见的脊柱手术之一。早期症状性椎弓根螺钉松动可能是一个严重的并发症，导致假关节。然而，椎弓根螺钉松动的翻修策略仍在争论中。目的与方法：结合1例临床病例，对椎弓根螺钉松动的危险因素、病因、手术修复方案及预后进行文献回顾。结果：我们描述了一例由于脓毒性原因导致后路L4-L5关节融合术早期机械失效的临床病例。翻修手术包括采用ALIF、后路大螺钉和关节融合术进行环周手术。文献综述强调了螺钉松动的许多危险因素，并强调了在有风险的患者进行指数手术时安装椎间装置的重要性。在螺丝松动的情况下，应进行系统的细菌学取样。有症状的螺钉松动应从翻修手术中获益。翻修手术有多种选择，包括前路翻修和后路螺钉翻修。结论：本综述强调了PLF初始手术的关键因素，感染性病因在椎弓根螺钉松动中的重要性，以及面对早期机械故障时的手术策略。

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引用次数: 0

5-year follow up after successful craniopagus separation: Review on hydrocephalus and venous system re-arrangement 颅裂成功后5年随访：脑积水与静脉系统重排的研究进展。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-05 DOI: 10.1016/j.neuchi.2025.101717

Samsul Ashari , Alvi Aulia , Affan Priyambodo , Setyo Widi Nugroho , Amanda Aldilla

Introduction

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.

颅裂是一种罕见的先天性畸形。双生颅板分离与高发病率和死亡率相关，特别是在全型中，双胞胎共用硬脑膜静脉窦。分离手术后的并发症之一是脑积水。虽然术前需要详细的脑血管成像以确保最佳的手术入路，但术后血管成像对于评估分离手术后脑静脉系统的变化同样重要。病例介绍：分离手术成功地完成了完全垂直双颅与共享硬脑膜静脉窦。一个双胞胎术后出现脑积水，而另一个双胞胎有脑脊液从伤口渗漏。两名双胞胎均接受了LP分流术，恢复良好。然后，我们比较了这对双胞胎的大脑静脉结构，在分离手术前后使用重建CT静脉造影。结论：双胎发育良好且无神经功能缺损的全垂直颅斜双胎成功分离是非常罕见的。根据随访CTV，脑静脉系统重新排列以适应分离手术后血流动力学需求的变化。这可能会给我们对脑静脉系统的新认识，有利于预后良好的双颅畸形。

{"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}

引用次数: 0

Robot-assisted MIS transiliac sacroiliac joint fusion: Technical note 机器人辅助MIS经髂骶髂关节融合术：技术说明。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-05 DOI: 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.

背景：骶髂关节功能障碍（SIJD）占慢性腰痛的15-25%，常伴随腰椎融合。当保守治疗失败时，需要微创SIJ融合（SIJF）。机器人辅助技术可行且安全，可提高精度并减少辐射暴露。病例描述：一名26岁女性，L4-S1融合8年后，出现双侧SIJD，物理治疗和关节内类固醇注射难以治愈。表示SIJF。本文介绍了机器人辅助技术及其优点。结论：机器人辅助SIJF是一种安全、准确的治疗SIJD的技术，同时减少了辐射暴露。轨迹平面化和解剖变化的考虑使机器人辅助技术优于常规技术，如透视或导航。

引用次数: 0

Evaluation of the necessity of systematic ICU after intracranial meningioma surgery: Towards a risk-based approach. Toulouse University Hospital experience 颅内脑膜瘤术后系统ICU必要性的评价：以风险为基础的方法。图卢兹大学医院工作经验。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-05 DOI: 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.

背景：颅内脑膜瘤是最常见的良性中枢神经系统肿瘤，通常采用选择性手术切除治疗。虽然结果总体上是有利的，但术后管理仍然存在变数，特别是在常规重症监护病房（ICU）入住方面。鉴于重症监护资源的压力越来越大，确定真正需要icu监护的患者是至关重要的。目的：评价脑膜瘤术后早期并发症，建立实用的风险评分方法，指导ICU住院。方法：我们对203例颅内脑膜瘤切除术（2020-2022）进行了回顾性单中心研究。如果患者已安排手术，且术后至少有一晚ICU监护，则纳入研究。综合终点定义了24小时内icu相关并发症，包括癫痫发作、新的缺陷、延迟觉醒、重新插管、输血、静脉内（IV）抗高血压药物、紧急成像或再手术。分析了22个临床、放射学和外科因素。结果：术后并发症发生率为19.2%，主要为神经系统并发症（13.8%）。三分之二的事件发生在醒来时或麻醉后护理病房（PACU）。单因素分析确定了7个显著的预测因素：颅内高压、肿瘤位置、运动皮质受损伤、手术时间≥3小时、失血量≥500ml、使用渗透疗法和输血。10项风险评分显示高灵敏度（92.3%）和阴性预测值（95.9%），使用1分或更多的分界点。使用该模型，在我们的人群中，36.5%的患者可以安全地避免ICU住院。结论：脑膜瘤术后采用基于风险的方法入院是安全可行的。该评分的实施与扩展PACU监测相结合，可以在不影响患者安全的情况下优化资源利用。前瞻性验证是必要的。

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引用次数: 0

Laser Interstitial Thermal Therapy (LITT) in pediatric neurosurgery: Single center retrospective analysis of 41 consecutive procedures 激光间质热疗法（LITT）在小儿神经外科中的应用：41例连续手术的单中心回顾性分析。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-05 DOI: 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.

简介：MRI控制下的激光间质热疗法已经成为癫痫和神经肿瘤手术中安全有效的替代方法。然而，它只是最近才在少数几个欧洲中心使用。在此，我们报告了我们在儿童LITT治疗中4年的经验（并发症、癫痫和肿瘤预后）。方法：对2021-2024年期间连续LITT手术的单中心回顾性研究。在以下适应症中，LITT仅限于儿科：(i)限定病变（ii）良性病理（iii）显微手术切除位置有问题。机器人立体定向植入后，在MRI引导下使用VISUALASE系统进行消融。术后1个月、3个月、6个月和12个月进行系统门诊和MRI检查。癫痫预后在ILAE分类后定义，肿瘤复发定义为随访1个月后体积增加。结果：35例患儿，平均年龄11.4岁，M/F比值= 0.8，共41次手术。主要指征为局灶性癫痫28例，FCD 13例，LEAT 11例，HH 4例，肿瘤治疗7例。脑岛皮质区（n = 8）、中颞基底区（n = 8）和中央旁区（n = 6）或皮质下区（下丘脑和基底节区n = 6，中脑n = 4）出现病变。围手术期短暂性不良事件发生率为25.7%，2例患儿出现持续性神经功能缺损。平均随访31.2个月，67.9%的患者无癫痫发作，3/18例出现肿瘤复发。结论：在35例具有挑战性脑病变的儿童队列中，LITT消融是安全有效的。

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引用次数: 0

Spinal cord malformations’s epidemiology in French children: National cross sectional study based on medico-administrative database 法国儿童脊髓畸形的流行病学：基于医学管理数据库的全国横断面研究。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-05 DOI: 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.

目的：法国缺乏儿童罕见脊髓畸形的流行病学资料。利用国家医院出院数据库（PMSI），我们研究了护理轨迹，并估计了这些疾病的发病率和死亡率负担。研究设计：我们进行了一项2010年至2020年的全国性历史队列研究，包括C-MAVEM网络范围内诊断为罕见脊髓疾病的儿童。病例通过ICD-10代码识别，采用半自动、多中心验证的提取算法（阳性预测值>80%）。估计了以下情况的发病率和住院死亡率：脊柱裂（SB）、Arnold Chiari综合征（ACS）、脊髓空洞和脊髓空洞（SM）、脊髓空洞（DM）和脊髓水肿（HM）。结果：共有10,114名儿童被确定，相当于每10万人中估计有67人患病。每10万活产婴儿的发病率为：SB 2.6, ACS 2.2, SM 1.0, DM 0.2, HM 0.04。HM的死亡率分别为2.5%、1.7%、1.1%、0.95%。大多数患者在大学医院接受治疗，根据病因和相关畸形，手术治疗存在相当大的异质性。结论：这项研究首次在法国提供了罕见小儿脊髓畸形的全国流行病学估计。使用经过验证的医疗管理数据提取方法可以对这些罕见疾病进行大规模监测，提高对其医疗负担的了解，并支持专门护理和公共卫生战略的规划。

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引用次数: 0