Neurochirurgie最新文献_第8页

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 : 2025-08-05 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

4D-DSA for the assessment of the rupture point of delayed rupture of a large cavernous carotid aneurysm following pipeline placement 4D-DSA用于评估管道置入后延迟破裂的大海绵状颈动脉瘤破裂点

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-31 DOI: 10.1016/j.neuchi.2025.101708

Atsushi Fujita, Hiroki Goto, Masaaki Kohta, Takashi Sasayama

引用次数: 0

Attachment ≠ Origin: A Critical Appraisal of the Olfactory Schwannoma Literature 依附≠起源：嗅觉神经鞘瘤文献的批判性评价

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-31 DOI: 10.1016/j.neuchi.2025.101706

Shankar Vangipuram, Harshil Sai Vangipuram, Shamshudheen Cholayil

引用次数: 0

Response to Critique of “On the Origin of Olfactory Schwannomas: A Systematic Review and Analysis of Attachment Site Variability and Clinical Implications” 对《嗅觉神经鞘瘤的起源：附着部位变异性及其临床意义的系统回顾与分析》评论的回应

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-31 DOI: 10.1016/j.neuchi.2025.101707

Brandon Edelbach , Miguel Angel Lopez-Gonzalez

引用次数: 0

Trends and development of enhanced recovery after surgery programs in cranial and spinal neurosurgery 颅脊神经外科手术后增强恢复的趋势和发展

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-29 DOI: 10.1016/j.neuchi.2025.101704

Shichao Liu , Jingyu Zhou

Background

Enhanced Recovery After Surgery (ERAS) has garnered considerable attention and demonstrated substantial clinical benefits across multiple surgical specialties. However, its integration into cranial and spinal neurosurgery remains nascent and fraught with challenges. This study aims to systematically assess the current research landscape, identify emerging hotspots, and forecast future directions for ERAS in neurosurgery through comprehensive bibliometric analysis. These findings seek to inform clinical practice and guide future investigations.

Methods

Relevant publications indexed in the Web of Science Core Collection from January 1, 1999, to December 1, 2024, were analyzed. Bibliometric tools, primarily CiteSpace, were utilized to evaluate annual publication trends, author and institutional contributions, journal dissemination, keyword co-occurrence, and citation network structures.

Results

A total of 273 articles were included. The analysis reveals that ERAS implementation in spinal neurosurgery has reached a relatively advanced stage, while its application in cranial procedures remains underdeveloped, yet promising. The United States and China are leading in publication output, although China’s global influence is comparatively limited. Key research themes include hospital length of stay, cost-effectiveness, postoperative complication management, and multimodal analgesia. Anticipated trends suggest a growing focus on personalized ERAS protocols tailored to specific neurosurgical conditions and enhanced patient engagement in recovery processes.

Conclusion

Through bibliometric and visualization techniques, this study offers a comprehensive overview of ERAS-related neurosurgical research, delineating its evolution and thematic shifts. The insights derived herein may facilitate strategic planning, foster interdisciplinary collaboration, and promote evidence-based advancements in perioperative neurosurgical care.

手术后增强恢复（ERAS）已经引起了相当大的关注，并在多个外科专业中显示出实质性的临床效益。然而，它与颅脑和脊柱神经外科的结合仍处于初期阶段，充满了挑战。本研究旨在通过综合文献计量分析，系统评估神经外科ERAS的研究现状，识别新兴热点，并预测未来发展方向。这些发现旨在为临床实践提供信息并指导未来的研究。方法对Web of Science Core Collection 1999年1月1日至2024年12月1日收录的相关出版物进行分析。文献计量工具（主要是CiteSpace）用于评估年度出版趋势、作者和机构贡献、期刊传播、关键词共现和引文网络结构。结果共纳入文献273篇。分析表明，ERAS在脊柱神经外科的应用已达到较先进的阶段，而在颅脑外科的应用仍不发达，但前景广阔。尽管中国的全球影响力相对有限，但美国和中国在出版物产量方面处于领先地位。主要研究主题包括住院时间、成本效益、术后并发症管理和多模式镇痛。预期的趋势表明，针对特定神经外科条件量身定制的个性化ERAS方案日益受到关注，并增强了患者在康复过程中的参与度。通过文献计量学和可视化技术，本研究提供了erass相关神经外科研究的全面概述，描绘了其演变和主题转变。本文得出的见解可以促进战略规划，促进跨学科合作，并促进围手术期神经外科护理的循证进步。

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引用次数: 0

Identifying early postoperative acute symptomatic seizure risk after burr hole drainage for chronic subdural hematoma 慢性硬膜下血肿钻孔引流术后早期急性症状性发作风险的探讨

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-23 DOI: 10.1016/j.neuchi.2025.101705

Dang-Khoi Tran , Minh-Anh Nguyen , Thanh-Tinh Truong , Hong-Hai Do , Quoc-Tuan Tran , Viet-Thang Le , Yuang-Seng Tsuei

Introduction

Acute symptomatic seizures (ASz) are a recognized postoperative complication following burr hole drainage for chronic subdural hematoma (CSDH); however, the risk factors remain poorly understood. This study aimed to identify clinical and radiological predictors of early postoperative seizures in CSDH patients, with the goal of enhancing risk stratification and informing individualized management approaches.

Methods

A retrospective analysis was conducted on 266 patients who underwent burr hole drainage for CSDH between 2022 and 2024. Data on demographics, comorbidities, hematoma characteristics, and postoperative complications, including seizures, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of early postoperative ASz.

Results

ASz occurred in 10 patients (3.8%), with 4 experiencing isolated seizures and 6 having status epilepticus. Univariable analysis identified prior stroke (OR = 9.5, 95% CI [2.2–42.0], p = 0.011), diabetes mellitus (OR = 4.2, 95% CI [1.2–15.2], p = 0.032), and separated hematoma type (OR = 5.4, 95% CI [1.5–19.5], p = 0.015) as significant predictors of ASz. However, in multivariate analysis, prior stroke remained a significant independent predictor (OR = 6.4, 95% CI [1.3–30.9], p = 0.021), while diabetes mellitus and separated hematoma type were no longer statistically significant.

Conclusion

Prior stroke is the most consistent predictor of early postoperative seizures following burr hole drainage for CSDH. While diabetes mellitus and separated hematoma type showed initial associations, these did not persist in adjusted analysis.

急性症状性癫痫（ASz）是慢性硬膜下血肿（CSDH）钻孔引流术后公认的并发症；然而，人们对风险因素的了解仍然很少。本研究旨在确定CSDH患者术后早期癫痫发作的临床和影像学预测因素，目的是加强风险分层，并为个性化的管理方法提供信息。方法回顾性分析2022 ~ 2024年266例CSDH钻孔引流患者的临床资料。收集了人口统计学、合并症、血肿特征和术后并发症（包括癫痫发作）的数据。进行单因素和多因素logistic回归分析，以确定术后早期ASz的独立预测因素。结果10例患者发生asz(3.8%)，其中孤立性癫痫发作4例，癫痫持续状态6例。单变量分析发现既往卒中（OR = 9.5, 95% CI [2.2 ~ 42.0], p = 0.011）、糖尿病（OR = 4.2, 95% CI [1.2 ~ 15.2], p = 0.032）和分离血肿类型（OR = 5.4, 95% CI [1.5 ~ 19.5], p = 0.015）是ASz的显著预测因素。然而，在多因素分析中，既往卒中仍然是一个重要的独立预测因子（OR = 6.4, 95% CI [1.3-30.9], p = 0.021），而糖尿病和分离性血肿型不再具有统计学意义。结论既往卒中是CSDH钻孔引流术后早期癫痫发作最一致的预测因素。虽然糖尿病和分离血肿类型显示了最初的关联，但这些在调整分析中并未持续存在。

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引用次数: 0

A Novel Technique for Eliminating Pneumocephalus in Chronic Subdural Hematoma Burr-hole Surgery 一种消除慢性硬膜下血肿颅内气肿的新技术

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-18 DOI: 10.1016/j.neuchi.2025.101703

Jiankuai Zhou, Huimin Shen, Jianchen Jin, Guotao Peng, Dan Xu, Yili Chen, Jun Mo

Background

Chronic subdural hematoma (cSDH) is a common neurosurgical condition with increasing prevalence in the aged population. Burr-hole surgery is the most common and effective treatment. However, subsequent pneumocephalus is a complication and has been a cause leading to recurrence and reoperation. This study aims to describe a novel technique to eliminate pneumocephalus via subdural catheter following subdural hematoma evacuation, as a method to reduce subdural potential space and decrease recurrence.

Methods

In this retrospective study, 52 patients who underwent burr-hole craniotomy evacuation of cSDH between January 2023 and September 2024 were assessed. Ten patients underwent modified intraoperative pneumocephalus elimination. Quantitative volumetric analysis was performed on preoperative, postoperative, and one-month follow-up computed tomography scans to assess the volume of pneumocephalus.

Results

There were no differences in baseline characteristics between the present technique and control groups. The present technique resulted in decreased pneumocephalus volume (5.6 mL vs 16.6 mL; P = .035) and subdural air ratio (0.05 vs 0.19; P = .010) on post-operative day 1. At three-month follow-up, the recurrence rate was lower in the present technique group, though this difference did not reach statistical significance (0.0% vs 4.7%; P = 1.000).

Conclusion

In conclusion, we present an innovative surgical technique that demonstrates remarkable efficacy in eliminating subdural air during cSDH burr-hole surgery. This technique offers a safe, streamlined approach that not only simplifies the surgical procedure but also shows promise in reducing cSDH recurrence rates.

背景：慢性硬膜下血肿（cSDH）是一种常见的神经外科疾病，在老年人群中发病率越来越高。钻孔手术是最常见、最有效的治疗方法。然而，继发的脑气是一种并发症，是导致复发和再次手术的原因。本研究旨在描述一种在硬膜下血肿引流后通过硬膜下导管消除脑气的新技术，以减少硬膜下电位空间和减少复发。方法回顾性分析2023年1月至2024年9月间，52例经钻孔开颅引流的cSDH患者。10例患者行改良术中气头消除术。对术前、术后和随访1个月的计算机断层扫描进行定量体积分析，以评估脑积水的体积。结果本技术与对照组在基线特征上无差异。目前的技术导致气头体积减少(5.6 mL vs 16.6 mL；P = 0.035)和硬膜下空气比(0.05 vs 0.19；P = 0.010)。随访3个月时，该技术组复发率较低，但差异无统计学意义(0.0% vs 4.7%；P = 1.000)。总之，我们提出了一种创新的手术技术，在cSDH钻孔手术中消除硬膜下空气效果显著。这项技术提供了一种安全、简化的方法，不仅简化了手术过程，而且在降低cSDH复发率方面也显示出希望。

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引用次数: 0

Robot-assisted MIS surgery in a pregnant woman with lumbar traumatic fracture: A technical note 机器人辅助MIS手术治疗1例腰椎外伤性骨折孕妇：技术说明

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-16 DOI: 10.1016/j.neuchi.2025.101702

J. Bride , R. Assaker , B. Ghannam , P. Haettel , B. Bouyer , H.A. Leroy

The occurrence of a vertebral fracture in a pregnant woman presents unique challenges in terms of diagnosis and therapeutic. Managing such cases requires multidisciplinary collaboration to minimize x-rays and preserve fetus development while ensuring efficient treatment of the fracture in the mother.

We report the case of an 18 y/o primiparous woman at 20 weeks of gestation who suffered a polytrauma without neurological deficit. Full body CT-scan reported an A2 M1 (AO Spine Classification) fracture of L3 and an A1 fracture of L2.

In this situation, both patient positioning and irradiation were challenging. The surgeons, anesthesiologists and physicists discussed the pros and cons between conservative treatment and various types of surgery (open technique, percutaneous). A left lateral decubitus robot-assisted percutaneous L2-L4 osteosynthesis was performed. We depict the procedure as well as the patient outcome and follow-up.

孕妇椎体骨折的发生在诊断和治疗方面提出了独特的挑战。处理此类病例需要多学科合作，以尽量减少x射线，保护胎儿发育，同时确保对母亲骨折的有效治疗。我们报告的情况下，18岁的初产妇在妊娠20周谁遭受了多创伤没有神经功能缺损。全身ct扫描报告L3为A2 M1 （AO脊柱分类）骨折，L2为A1骨折。在这种情况下，患者的体位和照射都具有挑战性。外科医生，麻醉师和物理学家讨论了保守治疗和各种手术（开放技术，经皮）的利弊。左侧卧机器人辅助下经皮L2-L4骨融合术。我们描述的过程，以及病人的结果和随访。

引用次数: 0

Short-segment percutaneous osteosynthesis with long pedicle screw fixation of the injured vertebra for thoracolumbar and lumbar non neurological fractures: The Trident Fixation 短节段经皮骨融合术联合长椎弓根螺钉固定伤椎体治疗胸腰椎非神经性骨折：三叉戟固定。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-03 DOI: 10.1016/j.neuchi.2025.101700

Félix Barbier , David Giber , Michel Dagher , Charles Henri Flouzat Lachaniette , Marc Khalifé , Arnaud Dubory

Study design

Prospective cohort study

Objective

This study aimed to assess the interest of a short percutaneous monaxial pedicle screw (PS) osteosynthesis, named the Trident Fixation (TF): fixation of one vertebra above and below the vertebral fracture and including two long monoaxial PS into the injured vertebra to treat thoracolumbar (TL) and lumbar (L) fractures.

Methods

Patients operated by this surgical method were prospectively included. Preoperative data and immediate, one-year follow-up, and two-year follow-up postoperative data were collected. The surgical correction was studied, evaluating the radiologic parameters as follows: vertebral body angle, regional traumatic kyphosis, regional traumatic angulation, Anterior/Middle Column Vertebral Body Compression Ratio (VBCR) and Anterior Vertebral Body Compression Percentage and the mid sagittal diameter of the spinal canal. PS placement, bone fusion and the occurrence of instrumentation failure were sought.

Results

Sixty-six patients were included (mean follow-up of 1.9 years (95% CI [1.9–2.6]). Regarding the accurate position of the PS, 11 of them (16.7%) presented a cortical bone violation. At the last follow-up, 3 patients (4.5%) presented a screw loosening, but no one progressed to a screw pull-out. One patient (1.5%) suffered from a rod breakage. All the radiologic parameters improved postoperatively, except the VBCR, which remained unchanged, despite the surgery. Vertebral fracture was healed for 54 patients (82%). Twenty (30.3%) patients presented an intervertebral fusion, either posterior facet fusion (12 patients [18.2%]) or interbody fusion (11 patients [16.6%]).

Conclusion

TF gives relevant postoperative radiological outcomes and is an alternative to the kyphoplasty, which remains an expensive method.

研究设计：前瞻性队列研究目的：本研究旨在评估短经皮单轴椎弓根螺钉（PS）骨融合术的应用价值，该技术被命名为三叉戟固定术（Trident Fixation， TF）：在椎体骨折上方和下方固定一根椎体，并将两根长单轴椎弓根螺钉置入受伤椎体，用于治疗胸腰椎（TL）和腰椎(L)骨折。方法：前瞻性纳入采用该手术方式的患者。收集术前资料及术后即时、1年随访和2年随访资料。对手术矫正进行研究，评估以下影像学参数：椎体角度、区域性外伤性后凸、区域性外伤性成角、前/中柱椎体压缩比（VBCR）和前椎体压缩百分比以及椎管中矢状径。研究了PS放置、骨融合和内固定失败的发生情况。结果：纳入66例患者(平均随访1.9年（95% CI[1.9-2.6]）。在PS的准确位置方面，11例（16.7%）出现皮质骨侵犯。在最后一次随访中，3例患者（4.5%）出现螺钉松动，但没有一例进展到螺钉拔出。1例患者（1.5%）出现棒断裂。术后所有放射学参数均得到改善，除了VBCR，尽管手术仍保持不变。54例（82%）患者椎体骨折愈合。20例（30.3%）患者行椎间融合术，其中12例（18.2%）为后路小关节融合术，11例（16.6%）为椎间融合术。结论：TF可提供相关的术后放射学结果，是后凸成形术的替代方法，后凸成形术仍然是一种昂贵的方法。

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引用次数: 0

Performance of the Marshall and Rotterdam scales as predictors of mortality in children with severe traumatic brain injury 马歇尔和鹿特丹量表作为严重创伤性脑损伤儿童死亡率预测指标的表现。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-07-03 DOI: 10.1016/j.neuchi.2025.101699

Júlia Calviello Giordano , José Roberto Tude Melo , Chiara Maria Brito Tischer , Larah Domingos de Oliveira , Max Yunio Orsi Salazar , Antônio José da Rocha , Jean Gonçalves de Oliveira , José Carlos Esteves Veiga

Objective

Traumatic brain injury (TBI) is a public health problem and the Glasgow Coma Scale (GCS) is recognized as the gold standard tool for grading TBI severity, but it may underestimate severity when applied in the pediatric population. The combined use of the GCS with criteria established in brain CT scan images enhances the ability to predict prognosis in this group of patients. The Marshall and Rotterdam scales are the most commonly used for this purpose. This study aims to evaluate and compare the performances of these scales as predictors of in-hospital mortality in children with severe TBI.

Methods

This was a retrospective study using data from consecutive medical records of children and adolescents (<17 years old) with severe TBI (GCS score ≤8) hospitalized between January 2016 and December 2023 at a Brazilian trauma reference center. Brain CT scan images were retrospectively analyzed for calculation of scores in the Marshall and Rotterdam scales. The cutoff score of 4 established as a predictor of prognosis was used to dichotomize the group. We calculated the performance and accuracy of both scales as predictors of prognosis.

Results

The area under the receiver operating characteristic curve (AUC) of the 37 children with severe TBI included in the study was 0.65 in the Marshall scale and 0.73 in the Rotterdam scale, considering in-hospital mortality as the outcome. In both scales the mortality rate was higher in children with scores ≥4, being 42% (42% vs. 12%; p = 0.05; OR 5.23; 95% CI 0.9910–27.6872) in the Marshall scale, and 50% (50% vs. 11%; p = 0.01; OR 8; 95% CI 1.4247–44.9212) in the Rotterdam scale.

Conclusion

The Rotterdam scale performed better as a predictor of in-hospital mortality (AUC 0.73) when compared to the Marshall scale (AUC 0.65) in the group of children with severe TBI analyzed. The cutoff point of 4 in the Marshall and Rotterdam scales can be used in clinical practice as a predictor of mortality with accuracy of 73% and 78% respectively.

目的：创伤性脑损伤（TBI）是一个公共卫生问题，格拉斯哥昏迷量表（GCS）被认为是评估TBI严重程度的金标准工具，但在儿科人群中应用时可能低估了严重程度。GCS与脑CT扫描图像中建立的标准联合使用增强了预测该组患者预后的能力。马歇尔磅秤和鹿特丹磅秤是最常用的磅秤。本研究旨在评估和比较这些量表作为严重创伤性脑损伤儿童住院死亡率预测指标的表现。方法：采用儿童和青少年连续病历资料进行回顾性研究。结果：纳入研究的37例重度脑外伤儿童的受试者工作特征曲线下面积（AUC），马歇尔量表为0.65，鹿特丹量表为0.73，以住院死亡率为评价指标。在两种量表中，得分≥4分的儿童死亡率均较高，为42%(42%对12%；p = 0.05；或5.23;95% CI 0.9910 - 27.6872), 50%(50%对11%；p = 0.01；或8;95% CI 1.4247 - 44.9212)。结论：与马歇尔量表（AUC 0.65）相比，鹿特丹量表对重度脑外伤患儿住院死亡率的预测效果更好（AUC 0.73）。马歇尔量表和鹿特丹量表的截止点4在临床实践中可作为死亡率的预测指标，准确率分别为73%和78%。

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引用次数: 0