Neurochirurgie最新文献_第8页

Sudden unexpected death in post-traumatic convulsions: An historical case report from the late 18th century 创伤后惊厥的突然意外死亡：18世纪晚期的历史病例报告。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-09-19 DOI: 10.1016/j.neuchi.2025.101724

Paul Maneuvrier-Hervieu , Xavier Humbert

引用次数: 0

Post-hemorrhagic external hydrocephalus in adults 成人出血性外脑积水

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-08-28 DOI: 10.1016/j.neuchi.2025.101711

Anaïs Mayras , Romain Manet , Baptiste Balança

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 : 2025-11-01 Epub 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

Microsurgical approach versus endovascular treatment of craniocervical junction arteriovenous fistulas: A Systematic Review and Meta-analysis 显微外科入路与血管内治疗颅颈交界处动静脉瘘：系统回顾和荟萃分析。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-10-07 DOI: 10.1016/j.neuchi.2025.101729

Filipe Virgilio Ribeiro , Rudolfh Batista Arend , Bruno Zilli Peroni , Helvécio Neves Feitosa Filho , Maria Fernanda P. Santana , Leonardo Januario Campos Cardoso , Leandro Vieira Lessa , André Nishizima , Marcelo Porto Sousa , Alex Roman

Introduction

Craniocervical junction arteriovenous fistulas (CCJ AVFs) are rare and complex vascular lesions that pose significant diagnostic and therapeutic challenges. Despite advances in neuroimaging, optimal treatment strategies remain controversial. This systematic review and meta-analysis aimed to compare the safety and efficacy of microsurgical versus endovascular approaches for treating CCJ AVFs.

Methods

A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted up to March 2024. Studies were included if they reported outcomes of microsurgical or endovascular treatment for CCJ AVFs, including neurological improvement, complete obliteration, recurrence, and complications. Data were synthesized using a random-effects meta-analysis, and heterogeneity was assessed using the I² statistic.

Results

Seven studies with 451 patients were included (microsurgery: n = 348; endovascular: n = 103). Microsurgery showed no statistically significant advantage in neurological improvement compared to endovascular treatment (OR = 2.10, 95% CI: 0.83–5.31, p = 0.5651, I² = 0%). Complete obliteration rates were significantly higher in the microsurgical group (OR = 11.93, 95% CI = 2.12–66.97, p = 0.0049; I² = 70.6%). Recurrence rates did not differ significantly (OR = 0.22, 95% CI: 0.02–2.81, p = 0.2416). Overall complications were similar (OR = 0.63, 95% CI: 0.09–4.62, p = 0.0007, I² = 79.1%), although microsurgery had significantly fewer ischemic complications (OR = 0.23, 95% CI: 0.07–0.70, p = 0.0104). Mortality rates were also comparable (RR = 1.87, 95% CI: 0.28–12.66, p = 0.5213, I² = 25.9%).

Conclusion

Microsurgery offers higher obliteration rates and fewer ischemic complications, while overall outcomes support individualized treatment planning.

颅颈交界处动静脉瘘（ccjavfs）是一种罕见且复杂的血管病变，对诊断和治疗提出了重大挑战。尽管神经影像学有所进步，但最佳治疗策略仍存在争议。本系统综述和荟萃分析旨在比较显微手术与血管内入路治疗CCJ房颤的安全性和有效性。方法：系统检索PubMed、Embase、Web of Science、Cochrane Library，检索截止至2024年3月。如果研究报告了显微手术或血管内治疗CCJ AVFs的结果，包括神经系统改善、完全闭塞、复发和并发症，则纳入研究。采用随机效应荟萃分析综合数据，采用I²统计量评估异质性。结果：纳入7项研究，共451例患者（显微外科：n = 348；血管内：n = 103）。与血管内治疗相比，显微手术在神经系统改善方面没有统计学上的显著优势（OR = 2.10, 95% CI: 0.83-5.31, p = 0.5651, I²= 0%）。显微手术组的完全闭塞率明显高于对照组（OR = 11.93, 95% CI = 2.12 ~ 66.97, p = 0.0049; I²= 70.6%）。复发率差异无统计学意义（OR = 0.22, 95% CI: 0.02 ~ 2.81, p = 0.2416）。总体并发症相似（OR = 0.63, 95% CI: 0.09-4.62, p = 0.0007, I²= 79.1%），尽管显微手术的缺血性并发症明显较少（OR = 0.23, 95% CI: 0.07-0.70, p = 0.0104）。死亡率也具有可比性（RR = 1.87, 95% CI: 0.28-12.66, p = 0.5213, I²= 25.9%）。结论：显微手术具有较高的闭塞率和较少的缺血性并发症，总体结果支持个体化治疗方案。

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引用次数: 0

Surgical versus endovascular treatment for idiopathic intracranial hypertension 特发性颅内高压的手术与血管内治疗。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-10-21 DOI: 10.1016/j.neuchi.2025.101735

William Boisseau , Manon Philibert , Catherine Vignal-Clermont , Koorosh Jeshrani , Amira Al Raaisi , Raphael Blanc , Jean-Philippe Desilles , Simon Escalard , Mikael Mazighi , Michel Piotin , Hocine Redjem , Erwan Robichon , Stanislas Samjda , Rabih Hage , Alexia Tran , Dorian Chauvet , Sorin Aldea , Samiya Abi-Jaoude , Pierre Bourdillon

Introduction

Idiopathic intracranial hypertension (IIH) is severe condition affecting patients’ vision and quality of life. When medical treatment is insufficient, an invasive approach may be proposed, consisting of either performing a ventricular shunt or stenting a stenosed venous sinus. The aim of this study is to compare these two techniques.

Methods

All patients who received one of these treatments for IIH associated with papilledema over a 5-year period were analysed. The primary outcome was the resolution of papilledema at 3 months coupled with the absence of complications.

Results

Over a 5-year period, 101 patients were analysed, of whom 61 underwent endovascular treatment and 40 underwent surgical treatment. Resolution of papilledema at three months without complications was achieved in 72% of cases in the surgical group and in 89% of cases in the endovascular group (p = 0.04). There was a higher proportion of IIH in the surgical group (60% vs 1.6%, p < 0.001) associated with higher intracranial pressure (38.8 vs 33.1 cmH₂O) and more severe visual impairment (55% vs 15%). Resolution of papilledema at three months, headache, tinnitus, and visual improvement did not differ significantly between the groups. The average time to improvement was significantly (p < 0.0001) shorter in the surgery-treated group (3.62 vs 8.74 weeks).

Conclusion

Endovascular treatment appears to have a better benefit-risk balance compared to surgery, with the caveat that the surgery group had a more severe presentation in this study. This encourages the conduction of a randomized study to have two homogeneous groups.

特发性颅内高压（Idiopathic intracranial hypertension， IIH）是一种严重影响患者视力和生活质量的疾病。当药物治疗不足时，可以建议采用侵入性方法，包括进行心室分流术或狭窄静脉窦支架置入。本研究的目的是比较这两种技术。方法：对5年内所有接受IIH合并乳头水肿治疗的患者进行分析。主要结果是3个月时乳头水肿的消退和无并发症。结果：5年内共分析101例患者，其中61例行血管内治疗，40例行手术治疗。手术组和血管内组分别有72%和89%的病例在3个月内无并发症地解决了乳头水肿（p = 0.04）。手术组的IIH比例更高（60% vs 1.6%, p 2O），视力障碍更严重（55% vs 15%）。三个月后乳头水肿、头痛、耳鸣和视力改善的缓解在两组之间没有显著差异。结论：与手术相比，血管内治疗似乎具有更好的收益-风险平衡，但需要注意的是，在本研究中，手术组的表现更为严重。这鼓励进行随机研究，有两个同质组。

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引用次数: 0

Utility of sodium fluorescein in peripheral nerve tumor resection: A single institution experience 荧光素钠在周围神经肿瘤切除术中的应用：单一机构经验。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-11-01 Epub Date: 2025-10-08 DOI: 10.1016/j.neuchi.2025.101732

Joseph N. Frazzetta , Seunghyuk Daniel Yang , Oleksandr Strelko , William Y. Shin , John T. Tsiang , Miri Kim , Vikram C. Prabhu

Introduction

The optimal management for symptomatic or enlarging peripheral nerve schwannomas is maximal, safe resection. Sodium Fluorescein (SF) has been utilized to facilitate tumor identification and removal.

Methods

This single-institution study evaluated 17 patients with 19 tumors who underwent a microscope assisted peripheral nerve schwannoma resection with intravenous SF administration. White-light and the yellow-560 lens filter were used for microscope visualization. A grading scale was created to assess the utility of SF in differentiating tumor from normal nerve fascicles. In all patients, intraoperative neurophysiological monitoring and nerve stimulation to identify and preserve functional fascicles was utilized.

Results

Improved visualization of the tumor and normal fascicles were noted using the operating microscope with white-light. It was possible to distinguish tumor tissue from normal nerve fascicles under both white-light and the yellow-560 lens.Administration of SF imparted a distinct bright-green fluorescence to tumor tissue under the yellow-560 lens. No side effects from SF use were observed. The cost of SF was $32.64 per vial. 1 patient experienced a new motor deficit, and 1 patient developed a new sensory deficit post-operatively that did not resolve at last follow up.

Discussion

Microsurgical resection of peripheral nerve schwannomas with the use of SF and the microscope yellow-560 les may be helpful in differentiating tumor from normal healthy nerve fascicles. However, white-light illumination also allowed good visualization of the tumor and normal nerve fascicles. Intraoperative neurophysiological monitoring and nerve stimulation are indispensable to facilitate tumor resection with preservation of normal nerve fascicles

对有症状或扩大的周围神经鞘瘤的最佳治疗是最大限度的安全切除。荧光素钠（SF）已被用于促进肿瘤的识别和切除。方法：这项单机构研究评估了17例19例肿瘤患者，这些患者接受了显微镜辅助下静脉注射SF的周围神经鞘瘤切除术。显微镜显像采用白光和黄-560滤光片。建立了一个分级量表来评估SF在区分肿瘤与正常神经束方面的效用。所有患者均采用术中神经生理监测和神经刺激来识别和保存功能肌束。结果：白光下手术显微镜下肿瘤和正常肌束的显像明显改善。在白光和黄-560晶状体下均能区分肿瘤组织和正常神经束。在黄-560晶状体下，SF给药使肿瘤组织呈现明显的亮绿色荧光。未观察到SF使用的副作用。顺丰的成本是每瓶32.64美元。1例患者术后出现新的运动障碍，1例患者术后出现新的感觉障碍，最后随访未解决。讨论：显微外科手术切除周围神经鞘瘤，使用SF和显微镜黄色-560纤维可能有助于肿瘤与正常健康神经束的鉴别。然而，白光照明也可以很好地显示肿瘤和正常神经束。术中神经生理监测和神经刺激是促进肿瘤切除并保留正常神经束的必要条件。

{"title":"Utility of sodium fluorescein in peripheral nerve tumor resection: A single institution experience","authors":"Joseph N. Frazzetta , Seunghyuk Daniel Yang , Oleksandr Strelko , William Y. Shin , John T. Tsiang , Miri Kim , Vikram C. Prabhu","doi":"10.1016/j.neuchi.2025.101732","DOIUrl":"10.1016/j.neuchi.2025.101732","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal management for symptomatic or enlarging peripheral nerve schwannomas is maximal, safe resection. Sodium Fluorescein (SF) has been utilized to facilitate tumor identification and removal.</div></div><div><h3>Methods</h3><div>This single-institution study evaluated 17 patients with 19 tumors who underwent a microscope assisted peripheral nerve schwannoma resection with intravenous SF administration. White-light and the yellow-560 lens filter were used for microscope visualization. A grading scale was created to assess the utility of SF in differentiating tumor from normal nerve fascicles. In all patients, intraoperative neurophysiological monitoring and nerve stimulation to identify and preserve functional fascicles was utilized.</div></div><div><h3>Results</h3><div>Improved visualization of the tumor and normal fascicles were noted using the operating microscope with white-light. It was possible to distinguish tumor tissue from normal nerve fascicles under both white-light and the yellow-560 lens.Administration of SF imparted a distinct bright-green fluorescence to tumor tissue under the yellow-560 lens. No side effects from SF use were observed. The cost of SF was $32.64 per vial. 1 patient experienced a new motor deficit, and 1 patient developed a new sensory deficit post-operatively that did not resolve at last follow up.</div></div><div><h3>Discussion</h3><div>Microsurgical resection of peripheral nerve schwannomas with the use of SF and the microscope yellow-560 les may be helpful in differentiating tumor from normal healthy nerve fascicles. However, white-light illumination also allowed good visualization of the tumor and normal nerve fascicles. Intraoperative neurophysiological monitoring and nerve stimulation are indispensable to facilitate tumor resection with preservation of normal nerve fascicles</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101732"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prioritizing clinical indicators over radiological findings in the management of chronic subdural hematoma associated with spontaneous intracranial hypotension 在处理自发性颅内低血压相关的慢性硬膜下血肿时，优先考虑临床指标而不是影像学表现

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-01 Epub Date: 2025-08-05 DOI: 10.1016/j.neuchi.2025.101709

Kuniyuki Onuma , Kiyoyuki Yanaka , Kazuhiro Nakamura , Hitoshi Aiyama , Nobuyuki Takahashi , Keiichi Tajima , Alexander Zaboronok , Eiichi Ishikawa

Objective

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.

目的慢性硬膜下血肿（CSDH）是自发性颅内低血压（SIH）的影像学表现，通常采用保守治疗。虽然影像学上发现的大血肿通常会提示早期手术干预，但这种方法仍然不清楚。本研究旨在通过回顾我们的临床经验来阐明最佳的治疗策略。方法回顾性分析我院2010年至2024年间连续收治的14例CSDH合并SIH患者。从医疗记录中提取患者人口统计学、临床症状和影像学结果并进行统计分析。结果7例持续性头痛患者行血肿引流治疗，7例体位性头痛患者单用SIH治疗成功。持续性头痛组中位血肿体积大于体位性头痛组（88.9 cm3比38.9 cm³）。然而，持续性头痛组的格拉斯哥昏迷评分中位数明显低于体位性头痛组（13比15，p = 0.011）。持续性头痛组7例患者中有5例出现乳头水肿，体位性头痛组无乳头水肿（p = 0.079）。结论我们的研究表明，临床指标——尤其是乳头水肿、意识改变和头痛特征——对于指导伴有SIH的CSDH是否需要进行血肿引流至关重要。血肿体积等放射学特征不能充分预测手术需求。

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引用次数: 0

Endonasal endoscopic surgical approach for treating trigeminal schwannomas: A systematic review and meta-analysis 鼻内窥镜手术入路治疗三叉神经鞘瘤：系统回顾和荟萃分析

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-01 Epub Date: 2025-05-10 DOI: 10.1016/j.neuchi.2025.101676

Filipe Virgilio Ribeiro , Marcelo Porto Sousa , Lucca B. Palavani , Filipi Fim Andreão , Ary Rodrigues Neto , Maria Antônia Oliveira Machado Pereira , Christian Ken Fukunaga , Luis F. Fabrini Paleare , Laura Mora Montecino , Stefeson Gomes Cabral Júnior , Leonardo O. Brenner , Marcio Yuri Ferreira , Herika Negri Brito

Introduction

Trigeminal schwannomas (TSs) are the second most common type of intracranial schwannoma. Surgical approaches are chosen depending on the type of tumor extension. The middle fossa extradural approach, infratemporal extradural approach, transmaxillary approach, transmandibular approach, and transcervical approach have been used. However, these approaches are associated with a variety of complications including other cranial nerve dysfunction. Recently, with the wide application of endoscopic technology, the endoscopic endonasal approach (EEA) seems to be an alternative skull base surgical approach for skull base pathology.

Objective

The objective of the present study is to evaluate the safety and efficacy EEA approach for TSs.

Methods

We searched Medline, Embase, and Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95% confidence intervals (CI) under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥4 patients treated with the endoscopic endonasal approach for trigeminal schwannomas.

Results

Of the 2550 initially identified studies, 9 were selected, involving 195 patients, with a median follow-up of 36 months. The combined analysis showed a 29% (CI: 11%–49%) partial resection rate, while a pooled analysis for complete resection demonstrated an 84% rate (CI: 68%–99%). Preservation of cranial nerves reached a 99% rate (CI: 96%–100%) with a 100% preservation of facial function rate (CI: 97%–100%) and a 5% complications rate (CI: 0%–13%).

Conclusion

Based on these findings, our meta-analysis identified that the endonasal endoscopic approach for the treatment of trigeminal schwannomas presents a low rate of complications, favorable results regarding the preservation of facial function and cranial nerves, and, a high rate of effectiveness, demonstrated by the results of complete resection.

三叉神经鞘瘤（TSs）是第二常见的颅内神经鞘瘤。手术入路的选择取决于肿瘤扩散的类型。中窝硬膜外入路、颞下硬膜外入路、经上颌入路、经下颌入路和经颈椎入路已被采用。然而，这些入路有多种并发症，包括其他脑神经功能障碍。近年来，随着内窥镜技术的广泛应用，内窥镜鼻内入路（EEA）似乎成为治疗颅底病理的另一种颅底手术入路。目的评价EEA方法治疗TSs的安全性和有效性。方法按照PRISMA指南检索Medline、Embase和Web of Science数据库。我们采用随机效应模型下95%置信区间（CI）的单比例分析（I2）来评估异质性，采用Baujat和敏感性分析来解决高异质性。符合条件的研究包括≥4例经鼻内窥镜入路治疗三叉神经鞘瘤的患者。在最初确定的2550项研究中，选择了9项，涉及195名患者，中位随访时间为36个月。综合分析显示部分切除率为29% (CI: 11%-49%)，而综合分析显示完全切除率为84% （CI: 68%-99%）。颅神经保存率达99% (CI: 96%-100%)，面部功能保存率为100% (CI: 97%-100%)，并发症发生率为5% （CI: 0%-13%）。基于这些发现，我们的meta分析发现鼻内窥镜入路治疗三叉神经鞘瘤的并发症发生率低，在保留面部功能和脑神经方面效果良好，并且完全切除的结果表明其有效率高。

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引用次数: 0

A rare cause of intracranial hypertension: Intradiploic epidermoid cyst with superior sagittal sinus compression 颅内高压的罕见病因：上矢状窦压迫的椎体内表皮样囊肿

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-01 Epub Date: 2025-06-24 DOI: 10.1016/j.neuchi.2025.101694

Frédérick Rault , Jean Bouchart , Mohammad Ismail , Marie-Alice Laville , Thomas Gaberel

引用次数: 0

Foix-Alajouanine syndrome: A systematic review and meta-analysis of presentation, management, and outcomes fox - alajouanine综合征：一项关于表现、管理和结果的系统回顾和荟萃分析。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-09-01 Epub Date: 2025-08-08 DOI: 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。

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引用次数: 0