1
|
Coll G, Arrighi M, Berton Q, Coste A, de Schlichting E, Chazal J, Sakka L, Abed Rabbo F. Mechanical Complications of Sophysa SM8 Shunt in Adult Hydrocephalus: A Monocentric Experience. Oper Neurosurg (Hagerstown) 2022; 23:318-325. [PMID: 36001762 DOI: 10.1227/ons.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sophysa SM8 is widely used by neurosurgeons in France. Published studies report shunt malfunction rates in adults between 18% and 29%. However, these studies included multiple valve types and thus entailed a serious confounding factor. OBJECTIVE To ascertain the incidence the Sophysa SM8 cerebrospinal fluid (CSF) shunt malfunctions in adults. METHODS We present a retrospective series of adult patients who underwent CSF shunt placement between 2000 and 2013 with Sophysa SM8. RESULTS In total, 599 patients (329 males and 270 females) were included. The mean age at surgery was 64.15 years (19-90) (SD 16.17; median 68.0). The causes of hydrocephalus were normal pressure hydrocephalus (49%), traumatic hemorrhages (26.5%), tumors (15.7%), cerebral aqueduct stenoses (3%), and arachnoid cysts (2%). The mean follow-up was 3.9 years (0-16) (SD 4.10; median 3 years). The rate of complications was 22.04% (132 of 599). Most frequent causes of complications were disconnection (25%), migration (12.9%), overdrainage (9.1%), and proximal obstruction (6.8%). In 17 cases (12.9%), no failure was diagnosed during revision. Seven infections (5.3%) were reported. The mean delay for the first revision was 1.70 years (0-13.93) (SD 2.67, median 0.35). The risk of shunt failure was 36% at 10 years. Seventeen percent of revisions occurred during the first year after shunt placement. CONCLUSION Disconnections are a very frequent complication of Sophysa SM8 valve. They are related to the 2-connector system of this valve. Based on these results, we recommend using 1-piece valves.
Collapse
Affiliation(s)
- Guillaume Coll
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marta Arrighi
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Quentin Berton
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Coste
- Service de Neurochirurgie, CHU Grenoble-Alpes, Grenoble, France
| | | | - Jean Chazal
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Sakka
- Département d'Anatomie et d'Organogenèse, NeuroDol UMR INSERM 1107 CNRS, UFR de Médecine et des Professions Paramédicales, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Francis Abed Rabbo
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
2
|
Zaldivar-Jolissaint JF, Lechanoine F, Krummenacher B, Arruda RF, Bobinski L, Schlichting ED, Duff JM. Using Smartphones for Clinical Assessment in Cervical Spondylotic Myelopathy a Feasibility Study. J Med Device 2021; 15:044503. [DOI: 10.1115/1.4052609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/20/2021] [Indexed: 11/08/2022] Open
Abstract
Abstract
Degenerative cervical myelopathy (DCM) is characterized by a progressive deterioration in spinal cord function. Its evaluation requires subjective clinical examination with wide interobserver variability. Objective quantification of spinal cord function remains imprecise, even though validated myelopathy-grading scales have emerged and are now widely used. We created a Smartphone Application, the N-Outcome App, with the aim of quantifying accurately and reliably spinal cord dysfunction using a 5-minute Test. A patient suffering from DCM was clinically evaluated before surgery, at 3 and 6 months follow-up after surgical decompression of the cervical spinal cord. Standard scores (Nurick grade, modified Japanese Orthopedic Association (mJOA) score) were documented at these time points. A 5-minute motor and proprioceptive performance test aided by a smartphone with the N-outcome App was also performed. Motor performance in rapid alternating movements and finger tapping improved in correlation with improvements in standard grading scale scores. Clinical improvements were seen in maximum reflex acceleration and in Romberg testing which showed less closed/open eyes variation, suggesting pyramidal and proprioceptive function recovery. We demonstrate that using the N-Outcome App as an adjunct to clinical evaluation of compressive myelopathy is feasible and potentially useful. The results correlate with the results of clinical assessment obtained by standard validated myelopathy scores.
Collapse
Affiliation(s)
| | - François Lechanoine
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble 38000, France
| | | | - Rivus Ferreira Arruda
- Department of Neurosurgery, Hospital Universitário Onofre Lopes, Natal 59012-300, Brazil
| | - Lukas Bobinski
- Department of Orthopedic Surgery, Spine Unit, University Hospital of Umea, Umea 907 37, Sweden
| | - Emmanuel de Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble 38000, France
| | | |
Collapse
|
3
|
Coll G, Abed Rabbo F, de Schlichting E, Coste A, Chazal J, Garcier JM, Peyre H, Sakka L. Mechanical complications of cerebrospinal fluid shunt. Differences between adult and pediatric populations: myths or reality? Childs Nerv Syst 2021; 37:2215-2221. [PMID: 33768313 DOI: 10.1007/s00381-021-05125-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Shunt malfunctions seem more frequent in children (44 to 81%) than in adults (18 to 29%). Because of discrepancies between studies, it is not possible to affirm this disparity. The objective was to verify whether the incidence of cerebrospinal fluid (CSF) shunt malfunctions is higher in children than adults. METHODS We present a retrospective series of child and adult patients who underwent CSF shunt placement between 2000 and 2013 with a Sophysa SM8® valve. RESULTS 599 adults and 98 children (sex ratio 1.28) underwent CSF shunt placement. Age at first surgery ranged between 1 day of life and 90 years (mean of 55.8 years, SD 25.8, median 64.8 years). The mean follow-up was 4 years (SD 4.264, 0-16; median 3 years). The cumulative complication rate was 25.5% (178/697). Mechanical complications were disconnection (25.1%), migration (11.8%), intracranial catheter obstruction (8.9%) and malposition (8.4%). The mean delay for the first revision was 1.90 years (0-13.9), (SD 2.73, median 0.5). The probability of shunt failure was 65% at 10 years in the child group and 36% at 10 years in the adult group. Moreover, in the child group, 33% of revisions occurred during the first year after shunt placement versus 17% in the adult group. Thus, the probability of shunt failure was higher in children than in adults (log-rank test, p < 0.001). CONCLUSIONS This is the first retrospective study, comparing children and adults undergoing CSF shunt using the same valve, able to confirm the higher rate of complications in children.
Collapse
Affiliation(s)
- Guillaume Coll
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France
| | - Francis Abed Rabbo
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France. .,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France.
| | | | - Aurélien Coste
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France
| | - Jean Chazal
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France.,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Jean-Marc Garcier
- Service de Radiologie Pédiatrique, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Hugo Peyre
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75005, Paris, France
| | - Laurent Sakka
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France.,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| |
Collapse
|
4
|
Metayer T, Terrier L, de Schlichting E, Lechanoine F, Bougaci N, Derrey S, Barbier C, Papagiannaki C, Ashraf A, Tahon F, Leplus A, Naveau M, Gay E, Emery E, Lonjon M, Vivien D, Gaberel T. Rate of Rebleed and Retreatment of Previously Treated Intracranial Aneurysms. World Neurosurg 2021; 148:e650-e657. [PMID: 33497825 DOI: 10.1016/j.wneu.2021.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) can be treated through endovascular treatment (EVT) or microsurgery (MS). Treated IAs can recanalize, which can lead to rupture or retreatment. OBJECTIVE The aim of our study was to evaluate the natural history of previously treated IA, by evaluating the risk of rupture and the risk of retreatment. METHODS All patients treated for an IA between 2007 and 2017 in 4 hospitals were included. The rate of (recurrent) hemorrhage and the rate of prophylactic retreatment were retrospectively evaluated. Kaplan-Meier survival analysis with log-rank tests was used to compare the rates of rupture or retreatment. Patients with ruptured and unruptured aneurysms were separated, and we compared the risk of retreatment between EVT and the surgical treatment. RESULTS A total of 4997 IAs were included in the study, corresponding to 20,489 patient-years. Overall, 28 (0.6%) aneurysms that had been previously treated demonstrated hemorrhage. Moreover, 237 (4.7%) aneurysms were retreated for recanalization without hemorrhage. The rate of retreatment was higher in the EVT-treated IAs as compared with the MS-treated IAs (LogRank: P < 0.0001) and higher in the previously ruptured IAs versus unruptured IAs (LogRank: P < 0.0001). However, the rate of posttreatment hemorrhage/IA rupture was similar for both groups. CONCLUSIONS The rate of IA retreatment is low; however, the rate of hemorrhage/rupture from treated IAs is even lower. A higher rate of retreatment was noted in EVT-treated IAs versus MS-treated IAs and in ruptured IAs versus unruptured IAs; however, the rate of hemorrhage or rerupture was comparable between the groups.
Collapse
Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, Cyceron, France.
| | - Laura Terrier
- Department of Neurosurgery, University Hospital, Rouen, France
| | | | | | - Nassim Bougaci
- Department of Neurosurgery, University Hospital, Nice, France
| | - Stephane Derrey
- Department of Neurosurgery, University Hospital, Rouen, France
| | - Charlotte Barbier
- Department of Neuroradiology, University Hospital of Caen, Caen, France
| | | | - Ahmad Ashraf
- Department of Neurosurgery, University Hospital, Grenoble, France
| | - Florence Tahon
- Department of Neuroradiology, University Hospital, Grenoble, France
| | - Aurelie Leplus
- Department of Neurosurgery, University Hospital, Nice, France
| | - Mikaël Naveau
- Normandie University, Cyceron, France; UMS 3408 Cyceron, CNRS, University of Caen Normandy, GIP CYCERON, Caen, France
| | - Emmanuel Gay
- Department of Neurosurgery, University Hospital, Grenoble, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Medical School, University of Caen Normandy, Caen, France
| | - Michel Lonjon
- Department of Neurosurgery, University Hospital, Nice, France
| | - Denis Vivien
- Normandie University, Cyceron, France; UMS 3408 Cyceron, CNRS, University of Caen Normandy, GIP CYCERON, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, Cyceron, France
| |
Collapse
|
5
|
Zaldivar-Jolissaint JF, de Schlichting E, Haller C, Morard M. Foot Drop After Iliocaval Vein Stenting: Radicular Syndrome from Stent Misplacement in Spinal Canal. World Neurosurg 2020; 137:43-45. [DOI: 10.1016/j.wneu.2020.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
|
6
|
de Schlichting E, Coll G, Zaldivar-Jolissaint JF, Coste J, Marques AR, Mulliez A, Durif F, Lemaire JJ. Pulse generator battery life in deep brain stimulation: out with the old… in with the less durable? Acta Neurochir (Wien) 2019; 161:2043-2046. [PMID: 31444678 DOI: 10.1007/s00701-019-04043-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Battery life of the most commonly used implantable pulse generators in deep brain stimulation is limited. Device replacement is costly and may expose patients to additional risks. Driven by the observation that in our experience newer generation devices seemed to need earlier replacement than the older generation, we aimed to retrospectively analyze the battery life of two generations of non-rechargeable devices, manufactured by a single company (Medtronic, USA). METHODS Battery life of 281 devices in 165 patients was taken into account for data analysis. This represented 243 older generation devices (Kinetra and Soletra) and 38 newer generation devices (Activa). RESULTS The battery life of older generation stimulators was 2-fold longer than the newer generation. CONCLUSIONS Newer devices are more versatile than the older generation. Their battery life is however significantly shorter. Development of next-generation devices needs to address this issue in order to limit health risks and reduce financial costs.
Collapse
|
7
|
Planche V, Munsch F, Pereira B, de Schlichting E, Vidal T, Coste J, Morand D, de Chazeron I, Derost P, Debilly B, Llorca PM, Lemaire JJ, Marques A, Durif F. Anatomical predictors of cognitive decline after subthalamic stimulation in Parkinson's disease. Brain Struct Funct 2018; 223:3063-3072. [PMID: 29736590 DOI: 10.1007/s00429-018-1677-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
Abstract
We investigated whether pre-operative MRI measures of focal brain atrophy could predict cognitive decline occurring after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson's disease (PD). For that purpose, we prospectively collected data of 42 consecutive patients with PD who underwent bilateral STN-DBS. Normalized brain structure volumes and cortical thicknesses were measured on pre-operative T1-weighted MRI. Patients were tested for their cognitive performances before surgery and 1 year after. After controlling for age, gender, pre-operative disease severity, change in dopaminomimetic dose after surgery and contact location, we found correlations: (1) between the variation of the total Mattis dementia rating scale (MDRS) score and left lateral ventricle volume (p = 0.032), (2) between the variation of the initiation/perseveration subscore of the MDRS and the left nucleus accumbens volume (p = 0.042) and the left lateral ventricle volume (p = 0.017) and (3) between the variation of the backward digit-span task and the right and left superior frontal gyrus thickness (p = 0.004 and p = 0.007, respectively). Left nucleus accumbens atrophy was associated with decline in the initiation/perseveration subscore with the largest effect size (d = - 1.64). Pre-operative left nucleus accumbens volume strongly predicted postoperative decline in the initiation/attention subscore (AUC = 0.92, p < 0.001, 96.3% sensitivity, 80.0% specificity, 92.9% PPV and 92.9% NPV). We conclude that the morphometric measures of brain atrophy usually associated with cognitive impairment in PD can also explain or predict a part of cognitive decline after bilateral STN-DBS. In particular, the left accumbens nucleus volume could be considered as a promising marker for guiding surgical decisions.
Collapse
Affiliation(s)
- Vincent Planche
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
| | - Fanny Munsch
- Service de Neuroradiologie diagnostique et thérapeutique, CHU Bordeaux, Université Bordeaux, 33000, Bordeaux, France
| | - Bruno Pereira
- Unité de Biostatistiques, Direction à la Recherche Clinique et à l'Innovation (DRCI), CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Emmanuel de Schlichting
- Service de Neurochirurgie, CHU Clermont-Ferrand, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Tiphaine Vidal
- Centre Mémoire de Ressources et de Recherche (CMRR), CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Jerome Coste
- Service de Neurochirurgie, CHU Clermont-Ferrand, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Dominique Morand
- Unité de Biostatistiques, Direction à la Recherche Clinique et à l'Innovation (DRCI), CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Ingrid de Chazeron
- Centre Médico-Psychologique B (CMP-B), CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Bérangère Debilly
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Centre Médico-Psychologique B (CMP-B), CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Service de Neurochirurgie, CHU Clermont-Ferrand, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Ana Marques
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Franck Durif
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| |
Collapse
|