Pub Date : 2025-11-01Epub 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":"2025-11-01","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}
Pub Date : 2025-11-01Epub 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":"2025-11-01","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 : 2025-11-01Epub 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":"2025-11-01","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 : 2025-11-01Epub 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":"2025-11-01","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 : 2025-11-01Epub 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":"2025-11-01","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 : 2025-11-01Epub 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":"2025-11-01","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 : 2025-11-01Epub 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":"2025-11-01","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 : 2025-11-01Epub 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":"2025-11-01","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}
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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号