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6. Expertise in surgical neuro-oncology. Results of a survey by the EANS neuro-oncology section

Author

Agrawal, Rachit, Albano, Luigi, Alexiou, George A., Ali, Amanj, Al-Mahfoudh, Rafid, Amoo, Michael, Anagnostopoulos, Christos, Bamps, Sven, Bandyopadhyay, Soham, Barone, Damiano G., Barone, Fabio, Barrit, Sami, Behling, Felix, Blaga, Alin, Boukas, Alexandros, Brennan, Paul, Butenschoen, Vicki M., Campello, Mauro, Cara, Areda, Chibbaro, Salvatore, Chrenko, Robert, Cifre Serra, Pere J., Clusmann, Hans, Corell, Alba, Cornelius, Jan F., D'Andrea, Marcello, Demetriades, Andreas K., De Vleeschouwer, Steven, Drexler, Richard, Duerinck, Johnny, Fanarjyan, Ruben V., Fernandez-Coello, Alejandro, Fountas, Kostas, Freiman, Thomas M., Gadzhiagaev, Vadim, Georgiopoulos, Miltiadis, Gilis, Nathalie, Golubovic, Jagos, Lippi Fernandes, Eric Goulin, Grasso, Giovanni, Guerrini, Francesco, Gulsuna, Beste, Hill, Ciaran S., Höhne, Julius, Holling, Markus, Iarmoliuk, Ievgenii, Ioan-Alexandru, Florian, Ius, Tamara, Jacikevicius, Kestutis, Jakola, Asgeir S., Jakubowski, Paweł, Kalantzis, Georgios, Karabatsou, Konstantina, Kirollos, Ramez, König, Ralph, Kozyrev, Danil A., Krex, Dietmar, Ladisich, Barbara, Lau, Ruth, Lizunou, Yauhen, Lombard, Arnaud, Low, Hu Liang, Alves, José Luís, Maghrabi, Yazid, Mammi, Marco, Marji, Ala, Massimi, Luca, Mavridis, Ioannis, McLean, Aaron Lawson, Lawson McLean, Anna C., Meyer, Bernhard, Mohme, Malte, Branco, Pedro Moura, Müther, Michael, Musleh, Issam, Nasiri, Danial, Navarro, Ramon, Omerhodzic, Ibrahim, Oppong, Marvin Darkwah, Paidakakos, Nikolaos A., Pantera, Zoi, Patel, Mohammed A., Pawlowski, Mateusz, Petridis, Athanasios, Praeger, Adrian J., Price, Stephen, Ricklefs, Franz, Rigante, Luigi, Ringel, Florian, Robe, Pierre A., Rössler, Karl, Sá-Marta, Eduarda, Sanmillan, Jose L., Scerrati, Alba, Schneider, Matthias, Schroeder, Henry W.S., Schwake, Michael, Shoaib, Mohamed, Sirbu, Octavian Mihai, Sistiaga, Iñigo L., Skajster, Tomasz J., Sliauzys, Albertas, Sokotukhin, Vitaly, Soleman, Jehuda, Stoecklein, Veit M., Suero Molina, Eric, Świątnicki, Wojciech, Syrmos, Νikolaos, Taddei, Graziano, Taher, Avin, Tamarit, Martin, Laan, Mark ter, Theocharous, Theocharis, Thijs, Dieter, Trakolis, Leonidas, Truffelli, Monica, Weiss, Miriam, Uhl, Eberhard, Valentini, Laura Grazia, Vanhauwaert, Dimitri, Zebian, Bassel, Zivkovic, Bojana, Zoli, Matteo, Gousias, K., Hoyer, A., Mazurczyk, L.A., Bartek, J., Jr., Bruneau, M., Celtikci, E., Foroglou, N., Freyschlag, C., Grossman, R., Jungk, C., Metellus, P., Netuka, D., Rola, R., Schucht, P., Senft, C., Signorelli, F., Vincent, A.J.P.E., and Simon, M.

Published
2024
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7. Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

Author

Iaccarino, Corrado, Chibbaro, Salvatore, Sauvigny, Thomas, Timofeev, Ivan, Zaed, Ismail, Franchetti, Silvio, Mee, Harry, Belli, Antonio, Buki, Andras, De Bonis, Pasquale, Demetriades, Andreas K., Depreitere, Bart, Fountas, Kostantinos, Ganau, Mario, Germanò, Antonino, Hutchinson, Peter, Kolias, Angelos, Lindner, Dirk, Lippa, Laura, Marklund, Niklas, McMahon, Catherine, Mielke, Dorothee, Nasi, Davide, Peul, Wilco, Poca, Maria Antonia, Pompucci, Angelo, Posti, Jussi P., Serban, Nicoleta-Larisa, Splavski, Bruno, Florian, Ioan Stefan, Tasiou, Anastasia, Zona, Gianluigi, and Servadei, Franco

Published
2024
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16. Learning curve and influencing factors of performing microsurgical anastomosis: a laboratory prospective study

Author

Lefevre, Etienne, Ganau, Mario, Zaed, Ismail, de Macedo Machado-Filho, Guaracy, Scibilia, Antonino, Mallereau, Charles-Henry, Bresson, Damien, Todeschi, Julien, Cebula, Helene, Proust, Francois, Vignes, Jean-Luc, Masquelet, Alain-Charles, Facca, Sybille, Livernaux, Philippe, Alfieri, Alex, Ramos, Taise Cruz Mosso, Magaldi, Marcelo, Bruno, Carmen, and Chibbaro, Salvatore

Published
2022
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17. Efficacy of endoscopic management of primary central nervous system lymphoma: a multicentric study and literature review

Author

Ganau, Mario, Zaed, Ismail, Todeschi, Julien, Prisco, Laura, Cebula, Helene, Bruno, Carmen, Spatola, Giorgio, Ligarotti, Gianfranco K. I., Alessandrello, Raffaele, Fricia, Marco, Romano, Antonio, Pop, Raoul, Baloglu, Seyyid, Savarese, Luciano, Scibilia, Antonino, Nannavecchia, Beniamino, Proust, Francois, and Chibbaro, Salvatore

Published
2022
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19. Odontoid Type II fractures in elderly: what are the real management goals and how to best achieve them? A multicenter European study on functional outcome

Author

Chibbaro, Salvatore, Mallereau, Charles-Henry, Ganau, Mario, Zaed, Ismail, Teresa Bozzi, Maria, Scibilia, Antonino, Cebula, Helene, Ollivier, Irene, Loit, Marie-Pierre, Chaussemy, Dominique, Coca, Hugo-Andres, Dannhoff, Guillaume, Romano, Antonio, Nannavecchia, Beniamino, Gubian, Arthur, Spatola, Giorgio, Signorelli, Francesco, Iaccarino, Corrado, Pop, Raoul, Proust, François, Baloglu, Seyyid, and Todeschi, Julien

Published
2022
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21. Managing Incomplete and Complete Thoracolumbar Burst Fractures (AO Spine A3 and A4). Results from a Prospective Single-Center Study Comparing Posterior Percutaneous Instrumentation plus Mini-Open Anterolateral Fusion versus Single-Stage Posterior Instrumented Fusion

Author

Todeschi, Julien, Ganau, Mario, Zaed, Ismail, Bozzi, Maria Teresa, Mallereau, Charles-Henry, Gallinaro, Paolo, Cebula, Helene, Ollivier, Irene, Spatola, Giogio, Chaussemy, Dominique, Coca, Hugo-Andres, Proust, François, and Chibbaro, Salvatore

Published
2021
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22. Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: Exploring the Potentialities of a Modified Lateral Retrocanthal Approach

Author

Chibbaro, Salvatore, Ganau, Mario, Scibilia, Antonino, Todeschi, Julien, Zaed, Ismail, Bozzi, Maria Teresa, Ollivier, Irène, Cebula, Hélène, Santin, Marie des Neiges, Djennaoui, Idir, Debry, Christian, Mahoudau, Pierre, Di Emidio, Paolo, Kraemer, Stephane, Baloglu, Seyyid, Proust, Francois, and Nannavecchia, Beniamino Alessandro

Published
2021
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24. Challenges and Opportunities in Accessing Surgery for Glioblastoma in Low–Middle Income Countries: A Narrative Review.

Author

Tini, Paolo, Rubino, Giovanni, Pastina, Pierpaolo, Chibbaro, Salvatore, Cerase, Alfonso, Marampon, Francesco, Paolini, Sergio, Esposito, Vincenzo, and Minniti, Giuseppe

Subjects
HEALTH services accessibility, MIDDLE-income countries, GLIOMAS, NEUROSURGERY, SURVIVAL rate, SOCIOECONOMIC factors, HEALTH policy, MEDICAL care, TREATMENT effectiveness, CANCER patients, HEALTH equity, BRAIN tumors, LOW-income countries, HEALTH care rationing
Abstract

Simple Summary: Glioblastoma is a highly aggressive type of brain tumor that is very difficult to treat, and surgery is crucial for improving patient survival. However, there are significant differences in access to brain tumor surgery based on factors like income, location, and available healthcare resources. People in low- and middle-income countries often struggle to receive the surgery they need due to a lack of specialized doctors, inadequate healthcare facilities, and financial challenges. As a result, patients in these regions are often diagnosed later, receive less effective treatment, and have lower survival rates compared to those in wealthier countries. This not only affects the patients but also adds economic and social burdens to their communities. The study calls for urgent actions to address these inequalities through international cooperation, better healthcare policies, and fair distribution of resources, with the goal of improving access to brain tumor surgeries for everyone, no matter where they live. Glioblastoma: a highly aggressive brain tumor, presents substantial challenges in treatment and management, with surgical intervention playing a pivotal role in improving patient outcomes. Disparities in access to brain tumor surgery arise from a multitude of factors, including socioeconomic status, geographical location, and healthcare resource allocation. Low- and middle-income countries (LMICs) often face significant barriers to accessing surgical services, such as shortages of specialized neurosurgical expertise, limited healthcare infrastructure, and financial constraints. Consequently, glioblastoma patients in LMICs experience delays in diagnosis, suboptimal treatment, and poorer clinical outcomes compared to patients in high-income countries (HICs). The clinical impact of these disparities is profound. Patients in LMICs are more likely to be diagnosed at advanced disease stages, receive less effective treatment, and have lower survival rates than their counterparts in HICs. Additionally, disparities in access to surgical care exacerbate economic and societal burdens, emphasizing the urgent need for targeted interventions and health policy reforms to address healthcare inequities. This review highlights the importance of addressing global disparities in access to brain tumor surgery for glioblastoma through collaborative efforts, policy advocacy, and resource allocation, aiming to improve outcomes and promote equity in surgical care delivery for all glioblastoma patients worldwide. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Surgical preference regarding different materials for custom-made allograft cranioplasty in patients with calvarial defects: Results from an internal audit covering the last 20 years

Author

Ganau, Mario, Cebula, Helene, Fricia, Marco, Zaed, Ismail, Todeschi, Julien, Scibilia, Antonino, Gallinaro, Paolo, Coca, Andres, Chaussemy, Dominique, Ollivier, Irene, Ligarotti, Gianfranco K.I., des Neiges Santin, Marie, Proust, Francois, and Chibbaro, Salvatore

Published
2020
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33. Evolution of Prophylaxis Protocols for Venous Thromboembolism in Neurosurgery: Results from a Prospective Comparative Study on Low-Molecular-Weight Heparin, Elastic Stockings, and Intermittent Pneumatic Compression Devices

Author

Chibbaro, Salvatore, Cebula, Helene, Todeschi, Julien, Fricia, Marco, Vigouroux, Doris, Abid, Houssem, Kourbanhoussen, Houssen, Pop, Raoul, Nannavecchia, Beniamino, Gubian, Arthur, Prisco, Lara, Ligarotti, Gianfranco K.I., Proust, Francois, and Ganau, Mario

Published
2018
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35. Effects of the COVID-19 Pandemic on Everyday Neurosurgical Practice in Alsace, France: Lessons Learned, Current Perspectives, and Future Challenges—Preliminary Results of a Longitudinal Multicentric Study Registry.

Author

Dannhoff, Guillaume, Mallereau, Charles-Henry, Ganau, Mario, Carangelo, Biagio Roberto, Spatola, Giorgio, Todeschi, Julien, Prisco, Lara, Maduri, Rodolfo, Santin, Marie des Neiges, Woelffel, Sandrine, Mastrobuono, Isabella, Voirin, Jimmy, Moruzzi, Franco, Nannavecchia, Beniamino, Muzii, Vitaliano Francesco, Zalaffi, Alessandro, Bruno, Carmen, and Chibbaro, Salvatore

Subjects
COVID-19 pandemic, TASK shifting, SURGICAL intensive care, INTENSIVE care units, LONGITUDINAL method, SPINAL surgery
Abstract

Background and Objectives: The global outbreak caused by the SARS-CoV-2 pandemic disrupted healthcare worldwide, impacting the organization of intensive care units and surgical care units. This study aimed to document the daily neurosurgical activity in Alsace, France, one of the European epicenters of the pandemic, and provide evidence of the adaptive strategies deployed during such a critical time for healthcare services. Materials and Methods: The multicentric longitudinal study was based on a prospective cohort of patients requiring neurosurgical care in the Neurosurgical Departments of Alsace, France, between March 2020 and March 2022. Surgical activity was compared with pre-pandemic performances through data obtained from electronic patient records. Results: A total of 3842 patients benefited from care in a neurosurgical unit during the period of interest; 2352 of them underwent surgeries with a wide range of pathologies treated. Surgeries were initially limited to neurosurgical emergencies only, then urgent cases were slowly reinstated; however, a significant drop in surgical volume and case mix was noticed during lockdown (March–May 2020). The crisis continued to impact surgical activity until March 2022; functional procedures were postponed, though some spine surgeries could progressively be performed starting in October 2021. Various social factors, such as increased alcohol consumption during the pandemic, influenced the severity of traumatic pathologies. The progressive return to the usual profile of surgical activity was characterized by a rebound of oncological interventions. Deferrable procedures for elective spinal and functional pathologies were the most affected, with unexpected medical and social impacts. Conclusions: The task shifting and task sharing approaches implemented during the first wave of the pandemic supported the reorganization of neurosurgical care in its aftermath and enabled the safe and timely execution of a broad spectrum of surgeries. Despite the substantial disruption to routine practices, marked by a significant reduction in elective surgical volumes, comprehensive records demonstrate the successful management of the full range of neurosurgical pathologies. This underscores the efficacy of adaptive strategies in navigating the challenges imposed by the largest healthcare crisis in recent history. Those lessons will continue to provide valuable insights and guidance for health and care managers to prepare for future unpredictable scenarios. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Comparison of three antithrombotic strategies for emergent carotid stenting during stroke thrombectomy: a multicenter study.

Author

Pop, Raoul, Burel, Julien, Finitsis, Stephanos Nikolaos, Papagiannaki, Chrysanthi, Severac, Francois, Mangin, Pierre H., Mihoc, Dan, Leonard-Lorant, Ian, Gheoca, Roxana, Wolff, Valerie, Chibbaro, Salvatore, Sibon, Igor, Richard, Sébastien, Beaujeux, Remy, Marnat, Gaultier, and Gory, Benjamin

Subjects
FIBRINOLYTIC agents, RESEARCH, KRUSKAL-Wallis Test, STROKE, INTRAVENOUS therapy, ANALYSIS of variance, CONFIDENCE intervals, CAROTID artery stenosis, SURGICAL stents, RETROSPECTIVE studies, ACQUISITION of data, TREATMENT effectiveness, CLOPIDOGREL, THROMBECTOMY, MEDICAL records, ASPIRIN, CHI-squared test, DESCRIPTIVE statistics, ENDOVASCULAR surgery, HEPARIN, ODDS ratio, DATA analysis software, PATIENT safety, LONGITUDINAL method, TIROFIBAN
Abstract

Background Periprocedural antithrombotic treatment is a key determinant for the risk-benefit balance of emergent carotid artery stenting (eCAS) during stroke thrombectomy. We aimed to assess the safety and efficacy of three types of antithrombotic treatment. Methods Retrospective review of prospectively collected endovascular databases in four comprehensive stroke centers, including consecutive cases of eCAS for tandem lesion strokes between January 2019 and July 2021. During this period, each center prospectively applied one of three periprocedural protocols: (a) two centers administered aspirin (250 mg IV); (b) one center administered aspirin and heparin (bolus+24 hours infusion); and (c) one center applied an aggressive antiplatelet strategy consisting of aspirin and clopidogrel (loading doses), with added intravenous tirofiban if in-stent thrombosis was observed during thrombectomy. Dichotomized comparisons of outcomes were performed between aggressive versus non-aggressive strategy (aspirin±heparin) and aspirin+heparin versus aspirin-alone groups. Results Among 161 included patients, 62 received aspirin monotherapy, 38 aspirin+heparin, and 61 an aggressive treatment. Aggressive antiplatelet treatment was associated with an increased rate of excellent (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) recanalization and reduced carotid stent thrombosis at day 1 (3.5% vs 16.3%), compared with non-aggressive strategy. There were no significant differences in hemorrhagic transformation or 90-day mortality. There was a tendency towards better clinical outcome with aggressive treatment, without reaching statistical significance. Addition of heparin to aspirin was not associated with an increased rate of carotid stent patency. Conclusions Aggressive antiplatelet treatment was associated with improved intracranial recanalization and carotid stent patency, without safety concerns. These findings have implications for randomized trials and may be of utility for clinicians when making antithrombotic treatment choices. [ABSTRACT FROM AUTHOR]

Published
2023
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38. Delayed Intracerebral Hematoma after Ventriculoperitoneal Shunt in the Context of Ruptured Brain Arteriovenous Malformation: A Literature Review.

Author

Dannhoff, Guillaume, Chibbaro, Salvatore, Mallereau, Charles-Henry, Ganau, Mario, Agbo-Ponzo, Martial, Santin, Marie des Neiges, Ollivier, Irène, Pop, Raoul, Proust, François, and Todeschi, Julien

Subjects
*CEREBRAL arteriovenous malformations, *LITERATURE reviews, *CEREBROSPINAL fluid shunts, *INTRACEREBRAL hematoma, *INTRACRANIAL hemorrhage, *CLINICAL deterioration
Abstract

Hemorrhagic complications arising from ventricular drainage procedures are typically asymptomatic and of low volume. A particular subset of these complications, known as delayed intracranial hemorrhage (DICH), is however recognized for its particularly poor prognosis. We primarily aimed to identify epidemiological characteristics associated with DICH, to shed light on its occurrence and potential risk factors. To do so, we performed a retrospective analysis of a series of ten patients who presented with DICH in the context of a ruptured brain arteriovenous malformation (bAVM) and a systematic literature review of all DICH cases reported in the literature. Our ten patients showed delayed neurological deterioration after a ventriculoperitoneal shunt (VPS) procedure, with a computed tomography (CT) scan revealing a DICH surrounding the ventricular catheter, distinct and away from the nidus of their previously ruptured bAVM. Four patients (40%) rapidly declined and passed away, three (30%) required surgical management and the remaining three (30%) demonstrated gradual clinical improvement with conservative management. In the literature, most patients presenting with DICH had hydrocephalus associated with neurovascular disorders (47% of cases), such as bAVM rupture in our present series. These constatations point out the significance of the underlying pathologies potentially being predisposed to these unusual complications. [ABSTRACT FROM AUTHOR]

Published
2023
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40. Conservative versus aggressive antiplatelet strategy for emergent carotid stenting during stroke thrombectomy.

Author

Pop, Raoul, Severac, François, Hasiu, Anca, Mihoc, Dan, Mangin, Pierre H, Chibbaro, Salvatore, Simu, Mihaela, Tudor, Raluca, Gheoca, Roxana, Quenardelle, Véronique, Wolff, Valérie, and Beaujeux, Rémy

Subjects
THROMBECTOMY, PLATELET aggregation inhibitors, MUCOCUTANEOUS lymph node syndrome, CONSERVATIVE treatment
Abstract

Background: There is no consensus regarding optimal antiplatelet regimen for emergent carotid stenting during stroke thrombectomy. We aimed to assess the safety and efficacy of an aggressive periprocedural antiplatelet strategy focused on preserving stent patency, in comparison with conservative antiplatelet strategy consisting of aspirin monotherapy. Materials and Methods: Retrospective review of a prospectively collected database in a comprehensive stroke center, including all cases of emergent carotid stenting for tandem lesions stroke between 01.03.2012–01.06.2021. Aggressive antiplatelet strategy consisted of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel loading doses, with added intravenous (IV) tirofiban if in-stent thrombosis was observed during thrombectomy. Clinical and radiological outcomes were compared between conservative and aggressive antiplatelet treatment groups using inverse probability of treatment weighting (IPTW) analysis based on propensity scores. Results: We included 132 cases (76.5% atheroma, 22.7% dissection, 0.7% carotid web). Forty-five patients (34%) cases received conservative antiplatelet therapy. The remaining 87 (65.9%) received aggressive antiplatelet therapy: 66 (75.8%) treated with DAPT, 21 (24.1%) with DAPT and tirofiban. Periprocedural heparin was avoided in all cases. In adjusted analysis of the weighted samples, aggressive antiplatelet strategy was associated with improved carotid stent patency (aOR 0.23, 95% CI 0.07–0.80, p = 0.021), higher proportion of moderate clinical outcome (mRS ≤ 3, aOR 2.72, 95% CI 1.01–7.30, p = 0.04), with no significant differences in mortality and hemorrhagic transformation (HT) rates. Conclusions: In this retrospective study, aggressive periprocedural antiplatelet strategy led to improved stent patency and clinical outcomes, without increased HT. Further prospective randomized research is warranted to identify the optimal combination of antiplatelet agents for emergent carotid stenting in the setting of acute stroke. [ABSTRACT FROM AUTHOR]

Published
2023
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49. A Laboratory Investigation on a Tailored Skin and Muscle Flap Variant for the Retrosigmoid Approach.

Author

Chibbaro, Salvatore, Cebula, Helene, Zaed, Ismail, Gubian, Arthur, Todeschi, Julien, Scibilia, Antonino, Nannavecchia, Beniamino, Scheer, Louise, Bozzi, Maria Teresa, Mahoudeau, Pierre, Coca, Andres, Signorelli, Francesco, Djennaoui, Idir, Debry, Christian, and Ganau, Mario

Subjects
*SKIN innervation, *CEREBELLOPONTILE angle, *IATROGENIC diseases, *OPERATIVE surgery, *MUSCLE injuries, *LABORATORIES
Abstract

Introduction  An anatomical study was conducted to test a modified C-shaped flap designed for patients undergoing a keyhole approach and/or minicraniotomy for retrosigmoid approach (KRSA). Materials and Methods  Ten heads specimens were used. The surgical technique investigated was based on a 4-cm C-shaped skin incision with medial convexity (placed 8 cm laterally to the external occipital protuberance, with the lower edge terminating 1.5 to 2 cm above the mastoid tip), which followed by careful subperiosteal dissection and completed by reflecting and securing the skin flap layer anteriorly and the muscle flaps superiorly and inferiorly by stitches. Anatomical findings, including depth of surgical corridor till to the cerebellopontine cistern (CPC) as well as the sparing of neurovascular structures, were evaluated in every specimen. Results  Twenty surgical approaches to CPC were conducted, resulting in a short working distance to the target (32 mm) without any need for a self-retaining retractor. In every specimen, the integrity of occipital muscles and cutaneous nerves was maintained, and a solid multilayer closure was always achieved. These data suggest that landmarks-based design of this C-shaped incision could be helpful in avoiding damages to the soft tissues encountered during KRSA. Conclusion  This modified approach provides a wide surgical corridor to access the CPC while ensuring the minimal invasiveness of the standard S-shaped incision. Compared with the latter, it preserves better the integrity of the surrounding soft tissues and appears less likely to cause any iatrogenic injury to occipital muscles and cutaneous nerves. [ABSTRACT FROM AUTHOR]

Published
2022
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