Pub Date : 2025-06-23DOI: 10.1016/j.neuchi.2025.101696
Mejdeddine Al Barajraji , Sami Barrit , Thibault Remacle
{"title":"In memoriam: Professor M. Gazi Yaşargil (1925–2025)","authors":"Mejdeddine Al Barajraji , Sami Barrit , Thibault Remacle","doi":"10.1016/j.neuchi.2025.101696","DOIUrl":"10.1016/j.neuchi.2025.101696","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101696"},"PeriodicalIF":1.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364781","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 : 2025-06-20DOI: 10.1016/j.neuchi.2025.101697
Etienne Dugast , Cédric Aumont , Ilyess Zemmoura
Background and objectives
Primary central nervous system lymphoma (PCNSL) is a rare hematological malignancy, affecting the central nervous system (CNS), meninges, or eyes. Advancements in treatment, particularly with IV high-dose methotrexate, have improved patient survival. Diagnosis is primarily based on contrast-enhanced brain MRI, followed by confirmation through brain biopsy. However, biological markers such as cerebrospinal fluid (CSF) or vitreous humor lymphocyte immunophenotyping and interleukin levels (IL-6 and IL-10) can aid diagnosis, especially in cases where biopsy is difficult.
Methods
This retrospective observational study examines the diagnostic features of PCNSL patients at CHRU de Tours from 2017 to 2023. It focuses on MRI feature, ophthalmological examination, brain biopsy results and biomarker findings in CSF and vitreous humor.
Results
65 adult patients with a confirmed PCNSL were included. Brain biopsy, performed in 34 cases (52%), remained the gold standard. Cytological confirmation, including immunophenotyping, was decisive in 17% of cases with vitreous samples and 14% with cerebrospinal fluid (CSF) samples. Elevated interleukin levels alone guided treatment in 6% of patients with vitreous samples and 5% with CSF samples. Lastly, 6% of patients, without definitive biological markers, were treated based on clinical presentation and characteristic MRI features after ruling out major differential diagnoses.
Conclusions
PCNSL diagnosis can be achieved through various methods. Indirect biological markers like interleukin 6 and 10, while helpful, remain supplementary diagnostic tools. A standardized diagnostic protocol could enhance rapid diagnosis and timely treatment, which is crucial for improving therapeutic outcomes.
{"title":"Primary central nervous system lymphoma: A 7 years single-center experience","authors":"Etienne Dugast , Cédric Aumont , Ilyess Zemmoura","doi":"10.1016/j.neuchi.2025.101697","DOIUrl":"10.1016/j.neuchi.2025.101697","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Primary central nervous system lymphoma (PCNSL) is a rare hematological malignancy, affecting the central nervous system (CNS), meninges, or eyes. Advancements in treatment, particularly with IV high-dose methotrexate, have improved patient survival. Diagnosis is primarily based on contrast-enhanced brain MRI, followed by confirmation through brain biopsy. However, biological markers such as cerebrospinal fluid (CSF) or vitreous humor lymphocyte immunophenotyping and interleukin levels (IL-6 and IL-10) can aid diagnosis, especially in cases where biopsy is difficult.</div></div><div><h3>Methods</h3><div>This retrospective observational study examines the diagnostic features of PCNSL patients at CHRU de Tours from 2017 to 2023. It focuses on MRI feature, ophthalmological examination, brain biopsy results and biomarker findings in CSF and vitreous humor.</div></div><div><h3>Results</h3><div>65 adult patients with a confirmed PCNSL were included. Brain biopsy, performed in 34 cases (52%), remained the gold standard. Cytological confirmation, including immunophenotyping, was decisive in 17% of cases with vitreous samples and 14% with cerebrospinal fluid (CSF) samples. Elevated interleukin levels alone guided treatment in 6% of patients with vitreous samples and 5% with CSF samples. Lastly, 6% of patients, without definitive biological markers, were treated based on clinical presentation and characteristic MRI features after ruling out major differential diagnoses.</div></div><div><h3>Conclusions</h3><div>PCNSL diagnosis can be achieved through various methods. Indirect biological markers like interleukin 6 and 10, while helpful, remain supplementary diagnostic tools. A standardized diagnostic protocol could enhance rapid diagnosis and timely treatment, which is crucial for improving therapeutic outcomes.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101697"},"PeriodicalIF":1.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369522","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}
The aim of the study is to ascertain which neurosurgical procedures can be safely and effectively performed in an isolated rural neurosurgical unit, despite the lack of advanced technological infrastructure available in tertiary neurosurgical departments in high-income countries.
Methods
The authors draw upon their experience of establishing a first-line neurosurgical unit in a remote Pacific archipelago, which was accomplished without significant technological investments. All the patients operated in the neurosurgical unit of the Territorial Hospital of Nouméa, New Caledonia, from December 1, 2023, to February 1, 2025, were included. The primary outcome measure was a composite endpoint, including the mortality within three months post-surgery, reoperation within three months post-surgery, secondary transfer due to postoperative complications.
Results
134 patients underwent 155 procedures. Among them, 129 patients underwent cranial surgery while 5 patients underwent spinal cord surgery. Among the 155 procedures, 107 (69.0%) were emergency surgeries, 48 (31.0%), were planned surgeries. The most frequent indications for emergency surgery were traumatic brain injuries (TBI) (47/107–43.9%), CSF disorders (24/107–22.4%), and spontaneous cranial infections (13/107–12.1%). Among the planned surgeries, 31 were tumor resection (31/48–64.5 %) while 12 were heterologous cranioplasties (12/48−25.0%). The postoperative course was favorable for 93.8% of planned surgeries. Among the 107 emergency surgeries, 14 (14/107−13.1%) required reoperation (4 postoperative infections, 2 postoperative hematomas, 1 postoperative intracranial hypertension, 2 recurrences of chronic subdural hematomas and 5 wound infections).
Conclusion
Our experience confirmed that the majority of neurosurgical cases can be safely manage on site without all the technological tools even if the possibility to transfer high complexity cases in a center equipped with advanced surgical devices still plays a fundamental role.
In isolated regions where transfer to a tertiary center within four hours is impossible, the presence of such a unit is not only safe but essential to improve the quality of healthcare services.
Having a resident neurosurgeon in a rural unit can also be beneficial in reducing the need for secondary transfers due to the possibility to manage on-site post operative complication.
{"title":"Rural Health: What can and cannot be done in an isolated rural neurosurgical unit","authors":"Lorenzo Mongardi , Etienne Lefevre , Stéphane Litrico , Marie-Charlotte Hesler , Ugo Torrente , Guillaume Coll , Léo Nanty , Jean-Rodolphe Vignes , Stephane Fuentes , Paul Roblot","doi":"10.1016/j.neuchi.2025.101695","DOIUrl":"10.1016/j.neuchi.2025.101695","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of the study is to ascertain which neurosurgical procedures can be safely and effectively performed in an isolated rural neurosurgical unit, despite the lack of advanced technological infrastructure available in tertiary neurosurgical departments in high-income countries.</div></div><div><h3>Methods</h3><div>The authors draw upon their experience of establishing a first-line neurosurgical unit in a remote Pacific archipelago, which was accomplished without significant technological investments. All the patients operated in the neurosurgical unit of the Territorial Hospital of Nouméa, New Caledonia, from December 1, 2023, to February 1, 2025, were included. The primary outcome measure was a composite endpoint, including the mortality within three months post-surgery, reoperation within three months post-surgery, secondary transfer due to postoperative complications.</div></div><div><h3>Results</h3><div>134 patients underwent 155 procedures. Among them, 129 patients underwent cranial surgery while 5 patients underwent spinal cord surgery. Among the 155 procedures, 107 (69.0%) were emergency surgeries, 48 (31.0%), were planned surgeries. The most frequent indications for emergency surgery were traumatic brain injuries (TBI) (47/107–43.9%), CSF disorders (24/107–22.4%), and spontaneous cranial infections (13/107–12.1%). Among the planned surgeries, 31 were tumor resection (31/48–64.5 %) while 12 were heterologous cranioplasties (12/48−25.0%). The postoperative course was favorable for 93.8% of planned surgeries. Among the 107 emergency surgeries, 14 (14/107−13.1%) required reoperation (4 postoperative infections, 2 postoperative hematomas, 1 postoperative intracranial hypertension, 2 recurrences of chronic subdural hematomas and 5 wound infections).</div></div><div><h3>Conclusion</h3><div>Our experience confirmed that the majority of neurosurgical cases can be safely manage on site without all the technological tools even if the possibility to transfer high complexity cases in a center equipped with advanced surgical devices still plays a fundamental role.</div><div>In isolated regions where transfer to a tertiary center within four hours is impossible, the presence of such a unit is not only safe but essential to improve the quality of healthcare services.</div><div>Having a resident neurosurgeon in a rural unit can also be beneficial in reducing the need for secondary transfers due to the possibility to manage on-site post operative complication.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101695"},"PeriodicalIF":1.5,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314582","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 : 2025-06-07DOI: 10.1016/j.neuchi.2025.101691
Nathan Beucler , Antoine Do Tran , Benjamin Guyot , Arnaud Dagain
Reconstruction of the meninges and secondary hydrocephalus are salient issues following decompressive craniectomy. We propose a simple technique using a silicone sheet leaning on the opened dura mater and the brain during decompressive craniectomy. During cranioplasty, the removal of the silicone layer reveals that a new translucent and highly vascularized membrane has been naturally generated underneath, covering the dura mater flaps and the brain. We believe that this new cranial membrane arising from Masquelet’s technique could allow covering large meningeal defects notably after wartime craniocerebral injury, and could also help reducing the occurrence of secondary hydrocephalus thanks to better cerebrospinal fluid circulation underneath.
{"title":"Masquelet induced cranial membrane under silicone layer during cranioplasty: Toward a natural technique for regeneration of meninges after decompressive craniectomy","authors":"Nathan Beucler , Antoine Do Tran , Benjamin Guyot , Arnaud Dagain","doi":"10.1016/j.neuchi.2025.101691","DOIUrl":"10.1016/j.neuchi.2025.101691","url":null,"abstract":"<div><div>Reconstruction of the meninges and secondary hydrocephalus are salient issues following decompressive craniectomy. We propose a simple technique using a silicone sheet leaning on the opened dura mater and the brain during decompressive craniectomy. During cranioplasty, the removal of the silicone layer reveals that a new translucent and highly vascularized membrane has been naturally generated underneath, covering the dura mater flaps and the brain. We believe that this new cranial membrane arising from Masquelet’s technique could allow covering large meningeal defects notably after wartime craniocerebral injury, and could also help reducing the occurrence of secondary hydrocephalus thanks to better cerebrospinal fluid circulation underneath.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101691"},"PeriodicalIF":1.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230306","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 : 2025-06-05DOI: 10.1016/j.neuchi.2025.101693
Romain Manet , Jean François Payen , Arnaud Dagain
{"title":"The challenging task of establishing consensual and practical guidelines for the surgical management of traumatic brain injury","authors":"Romain Manet , Jean François Payen , Arnaud Dagain","doi":"10.1016/j.neuchi.2025.101693","DOIUrl":"10.1016/j.neuchi.2025.101693","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101693"},"PeriodicalIF":1.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250736","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 : 2025-06-04DOI: 10.1016/j.neuchi.2025.101692
Baker Abojarad , Belal Aldabbour
Background
The Gaza Strip is a low-income, chronically unstable region. This study evaluates the outcomes of first VP shunt placements at the area’s largest tertiary hospital.
Methods
A retrospective study conducted at Shifa Medical Complex in the Gaza Strip examined VP shunts inserted between January 2020 and July 2022. The primary outcome was the shunt failure rates in the first year, while secondary outcomes included the causes of failure and surgical complications. The Chi-square test was used to assess the relationship between risk factors and failure rates. Univariate logistic regression analyzed the link between the duration of post-operative antibiotics and shunt failure rates.
Results
A total of 103 patients were included, with a median age of 11 months. Congenital hydrocephalus accounted for 60.2% of the etiologies. Failure rates were 7.8%, 19.4%, and 26.2% at one, six, and twelve months, respectively. Obstruction and infection were the commonest causes of initial (62.9% and 25.9%) and overall (46.2% and 36.5%) shunt failures. Failure risk increased with elective surgeries, surgeries performed by residents, congenital hydrocephalus, and in the 12-month or younger age group (p < 0.001, p = 0.035, p = 0.02, p < 0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most commonly isolated bacteria. No significant association was found between the duration of postoperative IV antibiotics and the one-year shunt failure rate.
Conclusion
The outcomes of VP shunt surgery at Gaza’s largest tertiary center from 2020 to 2022 aligned with global trends. Prolonged IV antibiotics did not lower revision or complication rates.
加沙地带是一个低收入、长期不稳定的地区。本研究评估了该地区最大的三级医院首次VP分流安置的结果。方法在加沙地带Shifa医疗中心进行的一项回顾性研究检查了2020年1月至2022年7月期间插入的副静脉分流器。主要结果是第一年的分流失败率，而次要结果包括失败的原因和手术并发症。采用卡方检验评估危险因素与失败率之间的关系。单变量logistic回归分析了术后抗生素使用时间与分流管失败率之间的关系。结果共纳入103例患者，中位年龄11个月。先天性脑积水占病因的60.2%。1个月、6个月和12个月的失败率分别为7.8%、19.4%和26.2%。梗阻和感染是最初（62.9%和25.9%）和总体（46.2%和36.5%）分流失败最常见的原因。选择性手术、住院医师手术、先天性脑积水以及12个月及以下年龄组的手术失败风险增加(p <；0.001, p = 0.035, p = 0.02, p <；0.001)。金黄色葡萄球菌和表皮葡萄球菌是最常见的分离细菌。术后静脉抗生素使用时间与1年分流失败率无显著相关性。结论2020年至2022年在加沙最大的三级中心进行副静脉分流手术的结果与全球趋势一致。延长静脉注射抗生素并没有降低翻修率或并发症发生率。
{"title":"Surgical outcomes of ventriculoperitoneal shunts in the Gaza Strip: Insights from a conflict zone and low-resource setting","authors":"Baker Abojarad , Belal Aldabbour","doi":"10.1016/j.neuchi.2025.101692","DOIUrl":"10.1016/j.neuchi.2025.101692","url":null,"abstract":"<div><h3>Background</h3><div>The Gaza Strip is a low-income, chronically unstable region. This study evaluates the outcomes of first VP shunt placements at the area’s largest tertiary hospital.</div></div><div><h3>Methods</h3><div>A retrospective study conducted at Shifa Medical Complex in the Gaza Strip examined VP shunts inserted between January 2020 and July 2022. The primary outcome was the shunt failure rates in the first year, while secondary outcomes included the causes of failure and surgical complications. The Chi-square test was used to assess the relationship between risk factors and failure rates. Univariate logistic regression analyzed the link between the duration of post-operative antibiotics and shunt failure rates.</div></div><div><h3>Results</h3><div>A total of 103 patients were included, with a median age of 11 months. Congenital hydrocephalus accounted for 60.2% of the etiologies. Failure rates were 7.8%, 19.4%, and 26.2% at one, six, and twelve months, respectively. Obstruction and infection were the commonest causes of initial (62.9% and 25.9%) and overall (46.2% and 36.5%) shunt failures. Failure risk increased with elective surgeries, surgeries performed by residents, congenital hydrocephalus, and in the 12-month or younger age group (p < 0.001, p = 0.035, p = 0.02, p < 0.001). <em>Staphylococcus aureus</em> and <em>Staphylococcus epidermidis</em> were the most commonly isolated bacteria. No significant association was found between the duration of postoperative IV antibiotics and the one-year shunt failure rate.</div></div><div><h3>Conclusion</h3><div>The outcomes of VP shunt surgery at Gaza’s largest tertiary center from 2020 to 2022 aligned with global trends. Prolonged IV antibiotics did not lower revision or complication rates.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101692"},"PeriodicalIF":1.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230305","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 : 2025-05-27DOI: 10.1016/j.neuchi.2025.101687
Vangipuram Shankar , Siddhartha Ghosh , Vangipuram Harshil Sai
{"title":"Vestibular Schwannoma in Pregnancy: When Case Reports Become Clinical Compass","authors":"Vangipuram Shankar , Siddhartha Ghosh , Vangipuram Harshil Sai","doi":"10.1016/j.neuchi.2025.101687","DOIUrl":"10.1016/j.neuchi.2025.101687","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 4","pages":"Article 101687"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139353","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}
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