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Article ; Online: Neurological outcome following delayed traction and fixation in severe tetraparesis consecutive to posterior decompression for Chiari malformation: a case report.

Vigneul, Eric / Del Gaudio, Nicole / de Nijs, Loïc / Raftopoulos, Christian

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2024

Abstract: Background: Chiari malformation type 1 (CM1) is a congenital hindbrain malformation characterized by herniation of the cerebellar tonsils below the foramen magnum. The term Chiari type 1.5 is used when herniation of the brainstem under the McRae line ... ...

Abstract	Background: Chiari malformation type 1 (CM1) is a congenital hindbrain malformation characterized by herniation of the cerebellar tonsils below the foramen magnum. The term Chiari type 1.5 is used when herniation of the brainstem under the McRae line and anomalies of the craniovertebral junction are also present. These conditions are associated with several symptoms and signs, including headache, neck pain, and spinal cord syndrome. For symptomatic patients, surgical decompression is recommended. When radiographic indicators of craniovertebral junction (CVJ) instability or symptoms related to ventral brainstem compression are present, CVJ fixation should also be considered. Case description: We report the case of a 13-year-old girl who presented with severe tetraparesis after posterior decompression for Chiari malformation type 1.5, followed 5 days later by partial C2 laminectomy. Several months after the initial surgery, she underwent two fixations, first without and then with intraoperative cervical traction, leading to significant neurological improvement. Discussion and conclusion: This case report underscores the importance of meticulous radiological analysis before CM surgery. For CM 1.5 patients with basilar invagination, CVJ fixation is recommended, and C2 laminectomy should be avoided. In the event of significant clinical deterioration due to nonadherence to these guidelines, our findings highlight the importance of traction with increased extension before fixation, even years after initial destabilizing surgery.
Language	English
Publishing date	2024-02-19
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-024-06327-6
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Article: Modified Vertical Parasagittal Sub-Insular Hemispherotomy-Case Series and Technical Note.

Del Gaudio, Nicole / Ferrao Santos, Susana / Raftopoulos, Christian

Brain sciences

2023 Volume 13, Issue 10

Abstract: 1) Background: Hemispherotomy is the generally accepted treatment for hemispheric drug-resistant epilepsy (DRE). Lateral or vertical approaches are performed according to the surgeon's preference. Multiple technical variations have been proposed since ... ...

Abstract	(1) Background: Hemispherotomy is the generally accepted treatment for hemispheric drug-resistant epilepsy (DRE). Lateral or vertical approaches are performed according to the surgeon's preference. Multiple technical variations have been proposed since Delalande first described his vertical technique. We propose a sub-insular variation of the vertical parasagittal hemispherotomy (VPH) and describe our case series of patients operated on using this procedure. (2) Methods: Data from a continuous series of patients with hemispheric DRE who were operated on by the senior author (CR) using the modified sub-insular VPH technique were analyzed retrospectively. Pre-operative demographic and epilepsy characteristics, functional outcome, and surgical complications were extracted from medical charts. (3) Results: Twenty-five patients were operated on between August 2008 and August 2023; 23 have at least 3 months of follow-up. Of this group, 20 (86.9%) patients are seizure-free. Only two patients developed postoperative hydrocephalus (8.7%). All patients who were able to walk autonomously preoperatively and 20 (86.9%) of those with follow-up were able to walk without assistance. A total of 17 (74%) patients were able to perform adapted social activities at the latest follow-up. (4) Conclusions: Modified sub-insular VPH is a successful surgical technique for hemispheric DRE with seizure freedom rates similar to the largest series reported in the literature. Compared to other series, patients who were operated on with our modified technique had a lower rate of postoperative hydrocephalus and excellent long-term motor and cognitive outcomes.
Language	English
Publishing date	2023-09-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci13101395
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Article ; Online: Tubular Microdiscectomy for Recurrent Lumbar Disc Herniation: A Valuable Alternative to Endoscopic Techniques.

de Nijs, Loïc / Fomekong, Edward / Raftopoulos, Christian

World neurosurgery

2023 Volume 173, Page(s) e401–e407

Abstract: Objective: The efficacy of tubular microdiscectomy (TMD) in the treatment of recurrent lumbar disc herniation (rLDH) is still unclear, especially compared with the endoscopic technique. We performed a retrospective study to analyze this question.: ... ...

Abstract	Objective: The efficacy of tubular microdiscectomy (TMD) in the treatment of recurrent lumbar disc herniation (rLDH) is still unclear, especially compared with the endoscopic technique. We performed a retrospective study to analyze this question. Methods: We retrospectively included all patients with an rLDH confirmed by magnetic resonance imaging who underwent TMD between January 2012 and February 2019. The general data included sex, age, body mass index, level of rLDH, first surgical approach, reoperation interval, occurrence of dural leak, re-recurrence, and re-reoperation. The clinical outcome was evaluated using a visual analog scale for leg pain, and the modified MacNab criteria were used to evaluate patient satisfaction. Results: The visual analog scale score for leg pain was statistically significantly reduced from 7.46 preoperatively to 0.80 postoperatively (P < 0.00001), and the patient satisfaction was good or excellent in 85.7% of cases, according to the modified MacNab criteria. Complications occurred in 3 of the 15 included patients: 2 dural tears (13.3%) and 2 re-recurrence (13.3%), but none of the patients underwent a third surgical procedure. Conclusions: TMD seems to be an efficient technique for the surgical treatment of leg pain caused by rLDH. In the literature, this technique seems to be at least as good as the endoscopic technique and is easier to master.
MeSH term(s)	Humans ; Intervertebral Disc Displacement/diagnostic imaging ; Intervertebral Disc Displacement/surgery ; Retrospective Studies ; Diskectomy, Percutaneous/methods ; Treatment Outcome ; Endoscopy/methods ; Pain/surgery ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery
Language	English
Publishing date	2023-02-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2023.02.063
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Article ; Online: Intermediate grade meningeal melanocytoma of the posterior fossa, GNAQ mutation-positive.

Daoud, Lina / Gunes Tatar, Idil / Raftopoulos, Christian / Lammens, Martin

Acta neurologica Belgica

2023 Volume 124, Issue 1, Page(s) 311–314

MeSH term(s)	Adult ; Humans ; Meningeal Neoplasms/diagnostic imaging ; Meningeal Neoplasms/genetics ; Melanoma ; Head ; Mutation/genetics ; GTP-Binding Protein alpha Subunits, Gq-G11/genetics
Chemical Substances	GNAQ protein, human ; GTP-Binding Protein alpha Subunits, Gq-G11 (EC 3.6.5.1)
Language	English
Publishing date	2023-06-14
Publishing country	Italy
Document type	Letter
ZDB-ID	127315-2
ISSN	2240-2993 ; 0300-9009
ISSN (online)	2240-2993
ISSN	0300-9009
DOI	10.1007/s13760-023-02298-8
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Article ; Online: Tonic, Burst, High-Density, and 10-kHz High-Frequency Spinal Cord Stimulation: Efficiency and Patients' Preferences in a Failed Back Surgery Syndrome Predominant Population. Review of Literature.

Peeters, Jean-Baptiste / Raftopoulos, Christian

World neurosurgery

2020 Volume 144, Page(s) e331–e340

Abstract: Background: Spinal cord stimulation (SCS) is a neuromodulation process to treat neuropathic pain, initially developed on tonic paresthesia-based stimulation. In the last decade, 3 major paresthesia-free SCSs have emerged. Several studies show their ... ...

Abstract	Background: Spinal cord stimulation (SCS) is a neuromodulation process to treat neuropathic pain, initially developed on tonic paresthesia-based stimulation. In the last decade, 3 major paresthesia-free SCSs have emerged. Several studies show their superiority over tonic stimulation. Objective: We summarize the data on SCS efficacy and patients' preferences. Methods: We selected studies from the last decade to clarify whether the different paresthesia-free SCSs are superior to tonic or not and for which SCS the patient has a preference. Study selection was focused on a failed back surgery syndrome predominant population. Results: SCS is an effective way to treat intractable neuropathic pain of the limbs and back, compared with conventional medical management and reoperation. Paresthesia-free SCSs as burst, high-density, and 10-kHz frequency are equal to tonic SCS in some studies and superior in most. Analysis of patients' preferences shows a clear trend toward paresthesia-free SCS. Conclusions: Recent studies show superiority of paresthesia-free SCS compared with tonic SCS and those results are corroborated by analysis of patients' preferences. Taking these data into account should motivate physicians to opt for multimodal capable devices before implanting SCS.
MeSH term(s)	Failed Back Surgery Syndrome/therapy ; Female ; Humans ; Male ; Neuralgia/therapy ; Pain Management/methods ; Patient Preference ; Spinal Cord Stimulation/methods
Language	English
Publishing date	2020-09-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2020.08.128
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Article: Natural history and surgical outcome of incidentally discovered clinically nonfunctioning pituitary macroadenomas.

Constantinescu, Stefan M / Duprez, Thierry / Fomekong, Edward / Raftopoulos, Christian / Alexopoulou, Orsalia / Maiter, Dominique

Endocrine connections

2023 Volume 12, Issue 12

Abstract: Objectives: The incidental diagnosis of nonfunctioning pituitary macroadenomas (NFPMAs) is becoming more prevalent with the spread of modern brain imaging techniques. We sought to uncover new data about their natural history and surgical outcome.: ... ...

Abstract	Objectives: The incidental diagnosis of nonfunctioning pituitary macroadenomas (NFPMAs) is becoming more prevalent with the spread of modern brain imaging techniques. We sought to uncover new data about their natural history and surgical outcome. Design: This is a retrospective single-center observational study. Methods: Among 210 patients seen for a NFPMA between 2010 and 2019, 70 (33%) were discovered incidentally (i-NFPMA). We analyzed outcomes in a total of 65 patients with available follow-up data. Results: Mean age at diagnosis (± s.d.) was 60 ± 14 years and mean maximal diameter was 20.0 ± 7.3 mm. At diagnosis, 29 patients (45%) had pituitary hormone deficits (LH/FSH 41%, TSH 29%, ACTH 15%) and 12% had visual field deficits. 26 patients underwent initial surgery, while 12 had delayed surgery after initial surveillance. In the surveillance group, the risk of tumor growth was estimated at 10%/year. Patients with hormonal deficits at diagnosis experienced earlier growth at 24 months (P < 0.02). Overall, surgical resection of the i-NFPMA led to stable or improved endocrine function in 91% of patients, with only 6% postoperative permanent diabetes insipidus. Moreover, surgery was more effective in preserving intact endocrine function (10/12) than restoring altered endocrine function to normal (6/22, P = 0.03). Conclusion: About one-third of NFPMAs are now discovered incidentally and a significant subset may be responsible for unrecognized endocrine and visual deficits. Under surveillance the risk of further tumor growth is significant (10%/year) and seems to occur faster in patients already harboring an endocrine deficit. Early surgical removal before onset of endocrine deficits appears to lead to better endocrine outcome.
Language	English
Publishing date	2023-10-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2668428-7
ISSN	2049-3614
ISSN	2049-3614
DOI	10.1530/EC-23-0224
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Article ; Online: Intravascular ultrasound: a plus in the management of cerebral venous intravascular problems?

Raftopoulos, Christian

World neurosurgery

2013 Volume 80, Issue 5, Page(s) 519–520

MeSH term(s)	Cerebral Veins/diagnostic imaging ; Cerebrovascular Disorders/diagnostic imaging ; Female ; Humans ; Intracranial Hypertension/diagnostic imaging ; Male ; Ultrasonography, Interventional ; Venous Thrombosis/diagnostic imaging
Language	English
Publishing date	2013-11
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2012.06.003
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Article ; Online: Extradural malignant rhabdoid tumor of the spine in children: A case-based review.

Vigneul, Eric / Rooijakkers, Herbert / Joris, Vincent / Daoud, Lina / Van Damme, An / Raftopoulos, Christian

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2023 Volume 40, Issue 4, Page(s) 979–986

Abstract: Background: Extradural malignant rhabdoid tumors of the spine are highly malignant and invasive tumors (WHO grade IV) with poor prognosis, most frequently occurring in young children before 2 years of age. Pain and motor deficit are the most common ... ...

Abstract	Background: Extradural malignant rhabdoid tumors of the spine are highly malignant and invasive tumors (WHO grade IV) with poor prognosis, most frequently occurring in young children before 2 years of age. Pain and motor deficit are the most common presenting signs. Case description: We report a case of a 2-year-old girl presenting with axial ataxia and paraparesis related to an extradural malignant rhabdoid tumor causing posterior thoracic spinal cord compression (D3-D6). She underwent two near-total removal of the tumor, adjuvant chemotherapy according to the Eu-Rhab protocol and proton beam therapy. She then developed multiple cranial nerve paresis (meningeal carcinomatosis) after 4 cycles of chemotherapy and died at 4.32 months of follow-up. Discussion and conclusion: The role of the PET scan was essential to guide us to remove a residue, while two concomitant spinal MRIs were considered negative. We reviewed the 16 cases reported in the literature. Multiple surgeries and radiotherapy seem to be correlated with longer survival. No child younger than 2 years old had a documented survival higher than 4.32 months.
MeSH term(s)	Female ; Humans ; Child, Preschool ; Rhabdoid Tumor/diagnosis ; Thoracic Vertebrae ; Magnetic Resonance Imaging/adverse effects ; Spinal Cord Compression/etiology
Language	English
Publishing date	2023-11-23
Publishing country	Germany
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-023-06224-4
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Article ; Online: Second surgery after vertical paramedian hemispherotomy for epilepsy recurrence

Baltus, Cedric / El M'Kaddem, Bouchra / Ferrao Santos, Susana / Ribeiro Vaz, José Géraldo / Raftopoulos, Christian

Heliyon. 2023 Mar., v. 9, no. 3 p.e14326-

2023

Abstract: Vertical Paramedian Hemispherotomy (VPH) is considered an effective surgical treatment for drug-resistant epilepsy with 80% of patients experiencing seizure freedom or worthwhile improvement. Identifying persistent connective tracts is challenging in ... ...

Abstract	Vertical Paramedian Hemispherotomy (VPH) is considered an effective surgical treatment for drug-resistant epilepsy with 80% of patients experiencing seizure freedom or worthwhile improvement. Identifying persistent connective tracts is challenging in failed VPH. We reviewed our series of consecutive patients undergoing VPH for hemispheric drug-resistant epilepsy and included cases with recurrent epileptic seizures undergoing second surgery with at least 6 months of postoperative follow-up. The cases were extensively assessed to propose a targeted complementary resection. Two children suffering from seizure recurrence following hemispherotomy leading to second surgery were included. After complete assessment, persisting amygdala residue was suspected responsible for the epilepsy recurrence in both patients. Complementary resection of the amygdala residue led to seizure freedom for both patients (Engel IA/ILAE Class 1) without complication. Different diagnostic tools are used to assess patients after failed hemispherotomy including routine EEG, prolonged video EEG, MRI (particularly DTI sequences), SPECT or PET scans and clinical evaluation. These tools allow to rule out epileptic foci in the contralateral hemisphere and to localize a potentially persisting epileptogenic zone. Assessment of these patients should be as systematic and integrated as the initial workup. Although our two patients suffered from Rasmussen's encephalitis, seizure recurrence after VPH has been described in other pathologies. Lying deep and medially in the surgical corridor of VPH, the amygdala can be incompletely resected and cause recurrent epilepsy. Complementary selective resection of the amygdala residue may safely lead to success in epilepsy control.
Keywords	amygdala ; clinical examination ; drug resistance ; encephalitis ; epilepsy ; resection ; Drug-resistant epilepsy ; Hemispherotomy ; Paramedian ; Rasmussen ; Repeat ; Vertical ; Fail vertical paramedian hemispherotomy
Language	English
Dates of publication	2023-03
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e14326
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: MRI-guided DBS of STN under general anesthesia for Parkinson's disease: results and microlesion effect analysis.

Soler-Rico, Morgane / Peeters, Jean-Baptiste / Joris, Vincent / Delavallée, Maxime / Duprez, Thierry / Raftopoulos, Christian

Acta neurochirurgica

2022 Volume 164, Issue 9, Page(s) 2279–2286

Abstract: Background: The efficacy of the subthalamic nucleus (STN) stimulation for Parkinson's disease has been widely established. The microlesion effect (MLE) due to deep brain stimulation (DBS) electrode implantation has been reputed to be a good predictor ... ...

Abstract	Background: The efficacy of the subthalamic nucleus (STN) stimulation for Parkinson's disease has been widely established. The microlesion effect (MLE) due to deep brain stimulation (DBS) electrode implantation has been reputed to be a good predictor for long-term efficacy of the procedure but its analysis in asleep implantation is still unclear. We thus analyzed MLE rate in our strategy of targeting the STN on MRI under general anesthesia and its correlation with our long-term results. Method: We retrospectively analyzed 32 consecutive parkinsonian patients implanted with a DBS targeting the STN bilaterally under general anesthesia between October 2013 and December 2020. Targeting was performed after head frame and localizer placement using a stereotactic peroperative robotic 3D fluoroscopy (Artis Zeego, Siemens) fused with preoperative CT and MRI data. We collected intraoperative data, postoperative occurrence of MLE, modification of Unified Parkinson Disease Rating Scale item III (UPDRS III) postoperatively and at subsequent visit, as well as reduction of medication. Results: The mean operative time was 223 min. No permanent complication occurred. MLE was observed in 90.7%. The mean follow-up time was 17 months. The UPDRS III for the off medication/on stimulation condition improved by 64.8% from baseline. The mean dose reduction of Prolopa after the surgical procedure was 31.3%. Conclusions: Direct targeting of STN under general anesthesia based on preoperative CT and MRI data fused with a preoperative 3D fluoroscopy is safe. It allows for a high rate of postoperative MLE (90.7%) and results in prolonged clinical improvement.
MeSH term(s)	Anesthesia, General ; Deep Brain Stimulation/methods ; Humans ; Magnetic Resonance Imaging ; Parkinson Disease/drug therapy ; Parkinson Disease/therapy ; Retrospective Studies ; Subthalamic Nucleus/diagnostic imaging ; Subthalamic Nucleus/surgery ; Treatment Outcome
Language	English
Publishing date	2022-07-16
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-022-05302-x
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