Neurochirurgie最新文献

英文中文

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 : 2025-08-28 DOI: 10.1016/j.neuchi.2025.101711

Anaïs Mayras , Romain Manet , Baptiste Balança

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 : 2025-08-08 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。

{"title":"Foix-Alajouanine syndrome: A systematic review and meta-analysis of presentation, management, and outcomes","authors":"Sean O’Leary , Nathan Fredricks , Peace Odiase , Sonia Pulido , Usama AlDallal , Ariadna Robledo , Christopher Thang , Umaru Barrie , Salah Aoun","doi":"10.1016/j.neuchi.2025.101710","DOIUrl":"10.1016/j.neuchi.2025.101710","url":null,"abstract":"<div><h3>Objective</h3><div>Foix-Alajouanine syndrome (FAS) is a grouping of rare, progressive spinal arteriovenous malformations causing significant neurological morbidity.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101710"},"PeriodicalIF":1.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818124","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

Ossification of the posterior longitudinal ligament (OPLL) in the Wallis and Futuna population: A hidden and underestimated enemy 后纵韧带骨化（OPLL）在沃利斯和富图纳人口：一个隐藏和低估的敌人。

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie

Pub Date : 2025-08-07 DOI: 10.1016/j.neuchi.2025.101712

L. Mongardi , M.C. Hesler , J.R. Vignes , S. Fuentes , P. Roblot

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 : 2025-08-05 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。

{"title":"Prioritizing clinical indicators over radiological findings in the management of chronic subdural hematoma associated with spontaneous intracranial hypotension","authors":"Kuniyuki Onuma , Kiyoyuki Yanaka , Kazuhiro Nakamura , Hitoshi Aiyama , Nobuyuki Takahashi , Keiichi Tajima , Alexander Zaboronok , Eiichi Ishikawa","doi":"10.1016/j.neuchi.2025.101709","DOIUrl":"10.1016/j.neuchi.2025.101709","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 cm<sup>3</sup> 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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101709"},"PeriodicalIF":1.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772625","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

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。

{"title":"Trends and development of enhanced recovery after surgery programs in cranial and spinal neurosurgery","authors":"Shichao Liu , Jingyu Zhou","doi":"10.1016/j.neuchi.2025.101704","DOIUrl":"10.1016/j.neuchi.2025.101704","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101704"},"PeriodicalIF":1.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721479","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

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。

{"title":"Identifying early postoperative acute symptomatic seizure risk after burr hole drainage for chronic subdural hematoma","authors":"Dang-Khoi Tran , Minh-Anh Nguyen , Thanh-Tinh Truong , Hong-Hai Do , Quoc-Tuan Tran , Viet-Thang Le , Yuang-Seng Tsuei","doi":"10.1016/j.neuchi.2025.101705","DOIUrl":"10.1016/j.neuchi.2025.101705","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101705"},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704124","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

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。

{"title":"A Novel Technique for Eliminating Pneumocephalus in Chronic Subdural Hematoma Burr-hole Surgery","authors":"Jiankuai Zhou, Huimin Shen, Jianchen Jin, Guotao Peng, Dan Xu, Yili Chen, Jun Mo","doi":"10.1016/j.neuchi.2025.101703","DOIUrl":"10.1016/j.neuchi.2025.101703","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101703"},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656872","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

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Neurochirurgie

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀