Context: Surgical work-related musculoskeletal disorders (WRMSDs) has mostly been investigated using qualitative observational assessments and questionnaires, as well as quantitative marker-based motion analysis. The main limitations of these methods are the subjectivity of questionnaires and the impracticality of markers in operating room. This study investigates the feasibility of predicting ergonomic level and surgical expertise level using quantitative postural metrics. Material and method: Sixty orthopedic surgeons with three expertise levels were recorded without markers using two cameras, frontal and sagittal views. Human pose was extracted from the 120 videos using OpenPose combined with a custom post-processing pipeline. The ergonomic level was assessed by two expert surgeons using a 5-point Likert scale. A large set of quantitative postural metrics, designed with expert surgeons, was computed and used to predict both ergonomic level and surgical expertise level using Random Forest and XGBoost Tree. Results: The best performance for surgical expertise prediction was achieved using Random Forest model, with a balanced accuracy of 48%. For ergonomic level prediction, the lowest error was obtained with the Random Forest model, with a RMSE of 0.77. The most informative postural metrics for predictions were primarily related to upper-limb joints.

OBJECTIVE:Surgical ergonomics is a public health challenge that ensures the well-being of both surgeons and patients. Non-ergonomic postures lead to the development of work-related musculoskeletal disorders, causing pain and fatigue for surgeons. It is therefore essential to identify and recognise these postures and to establish the key elements that may help in assessing surgical ergonomics. The objective of this study is to provide additional key insights into the definition of surgical ergonomics. MATERIAL AND METHOD:Four expert orthopaedic surgeon trainers were interviewed in semi-structured sessions. The protocol consisted of four non-directed stages with open questions and one directed stage with a presentation. Interviews were manually transcribed and analysed by one operator. RESULTS:Eight categories were derived from the interviews, encompassing the key points that define the expected and observed surgical ergonomics according to experts. To clearly define each category, remarks, advice, metrics, and visualisations were collected and interlinked. Interviews provided a list of relevant postural variables (metrics) and advice for assessing and improving ergonomics. CONCLUSION:These semi-structured interviews yielded eight categories defining surgical ergonomics, each containing comments, advice, metrics, and interconnected visualisations. Moreover, a comprehensive list of metrics was established to quantify surgical ergonomics. These metrics were also linked to visualisations. All results represent a significant advancement in defining ergonomic posture in surgery.

PURPOSE:Pelvic gynecological surgeries, whether for malignant or benign conditions, frequently result in functional complications due to injuries to the autonomic nervous system. Recognizing the deep uterine vein (DUV) as an essential anatomical reference can aid in preserving these structures. Despite its significance, the DUV is infrequently studied and lacks comprehensive documentation in Terminologia Anatomica. This research endeavors to elucidate a detailed characterization of the DUV. METHODS:We undertook a systematic literature review aligning with the "PRISMA" guidelines, sourcing from PUBMED and EMBASE. Our comprehensive anatomical examination encompassed cadaveric dissections and radio-anatomical evaluations utilizing the Anatomage® Table. RESULTS:The literary exploration revealed a consensus on the DUV's description based on both anatomical and surgical observations. It arises from the merger of cervical, vesical, and vaginal veins, coursing through the paracervix in a descending and rearward direction before culminating in the internal iliac vein. The hands-on anatomical study further delineated the DUV's associations throughout its course, highlighting its role in bifurcating the uterus's lateral aspect into two distinct zones: a superior vascular zone housing the uterine artery and ureter and an inferior nervous segment below the DUV representing the autonomic nerve pathway. CONCLUSION:A profound understanding of the subperitoneal space anatomy is paramount for pelvic surgeons to mitigate postoperative complications. The DUV's intricate neurovascular interplays underscore its significance as an indispensable surgical guide for safeguarding nerves and the ureter.

(1) Background: Understanding uterine innervation, an essential aspect of female reproductive biology, has often been overlooked. Nevertheless, the complex architecture of uterine innervation plays a significant role in conditions such as endometriosis. Recently, advances in histological techniques have provided unprecedented details about uterine innervation, highlighting its intricate structure, distribution, and density. The intricate nature of uterine innervation and its influence on pathologies such as endometriosis has garnered increasing attention. (2) Objectives: This review aims to compile, analyze, and summarize the existing research on uterine innervation, and investigate its implications for the pathogenesis of endometriosis and associated pain. (3) Methods: A systematic review was conducted in line with PRISMA guidelines. Using the PubMed database, we searched relevant keywords such as “uterine innervation”, “endometriosis”, and “pain association”. (4) Results: The initial literature search yielded a total of 3300 potential studies. Of these, 45 studies met our inclusion criteria and were included in the final review. The analyzed studies consistently demonstrated that the majority of studies focused on macroscopic dissection of uterine innervation for surgical purposes. Fewer studies focused on micro-innervation for uterine innervation. For endometriosis, few studies focused on neural pain pathways whereas many studies underlined an increase in nerve fiber density within ectopic endometrial tissue. This heightened innervation is suggested as a key contributor to the chronic pain experienced by endometriosis patients. (5) Conclusions: The understanding of uterine innervation, and its alterations in endometriosis, offer promising avenues for research and potential treatment.

This study sought to evaluate the biomechanical properties of the interface between the rotator cuff and the semicircular humeral ligament or rotator cable (RCa) using histological and biomechanical techniques. Out of 13 eligible cadaver specimens, 5 cadaver shoulders with an intact rotator cuff were included, 8 were excluded due to an injured rotator cuff. The histological study enables us to describe the capsule-tendon interface between the infraspinatus tendon (IST) or supraspinatus tendon (SST) and RCa, and to detect loose connective tissue layers to determine their precise location and measure their length along the interface. The biomechanical study sought to characterize and compare the mechanical strength of the IST-RCa versus SST-RCa interfaces. The average thickness of the RCa was 1.44 ± 0.20 mm. The histological study revealed a loose connective tissue layer at the IST-RCa interface, a finding not observed at the SST-RCa interface. The biomechanical study showed that the rigidity of the SST-RCa interface (72.10–2 N/mm) was 4.5 times higher than for the IST-RCa interface (16.10–2 N/mm) and the average maximum forces reached were 19.0 N and 10.6 N for the SST-RCa and IST- RCa interfaces, respectively. The IST-RCa interface consists of a loose connective tissue layer contrary to the SST-RCa interface. In parallel, two different groups in terms of the mechanical response were identified: the IST-RCa interface group had less rigidity and ruptured more quickly than the SST-RCa interface, therefore emerging as the most vulnerable interface and explaining a potential extension of rotator cuff tears.

Notre objectif était de décrire l'origine de l'innervation utérine. Il s'agissait d'une étude expérimentale. Nous avons disséqué les pelvis de quatre fœtus humains feminins traités par HES, et réalisé des immunomarquages (immunohistochimie classique complétée par immunofluorescence pour les co-marquages). Détection des nerfs (anticorps anti-protéine S100) et caractérisation des différents types de nerfs. Les tranches obtenues ont été scannées par un scanner optique haute résolution et alignées pour construire un modèle tridimensionnel. Les nerfs hypogastriques descendaient le long de la paroi latérale du rectum. Les nerfs hypogastriques étaient fortement TH+ (sympathiques). Les nerfs splanchniques pelviens naissaient des branches ventrales des racines sacrées, puis cheminaient vers l'avant Ils étaient riches en fibres nerveuses VAChT+ (parasympathiques cholinergiques) et TH+ (sympathiques). Le plexus hypogastrique inférieur se présentait comme un maillage dense de fibres nerveuses, recevant les nerf hypogastrique et splanchniques pelviens. Il couvrait les faces latérales du rectum, de l'isthme utérin et du col utérin jusqu'au culs de sac vaginaux. Beaucoup de fibres nerveuses TH+ (sympathiques), des fibres nerveuses VACHT+, nNOS+ ou VIP+ (parasympathiques), NPY+ et CGRP1+ (sensitives). Le principal point d'entrée des fibres nerveuses de l'utérus se situait latéralement au niveau du col utérin. Les fibres nerveuses provenaient directement des plexus hypogastriques inférieurs, et gagnaient le col utérin par ses angles postéro-latéraux, suivant le trajet antéro-interne des ligaments utérosacrés. L'uretère était comme pris en « sandwich » entre ce faisceau de fibres nerveuses latéralement, et celui bordant le cul de sac vaginal médialement. Nous avons décrit l'origine des nerfs à visée utérine avec un modèle tridimensionnel d Ce modèle pourrait constituer une base solide pour l'étude de l'innervation utérine avec de forts impacts chirurgicaux.

Disinhibition is a core symptom in behavioural variant frontotemporal dementia (bvFTD) particularly affecting the daily lives of both patients and caregivers. Yet, characterisation of inhibition disorders is still unclear and management options of these disorders are limited. Questionnaires currently used to investigate behavioural disinhibition do not differentiate between several subtypes of disinhibition, encompass observation biases and lack of ecological validity. In the present work, we explored disinhibition in an original semi-ecological situation, by distinguishing three categories of disinhibition: compulsivity, impulsivity and social disinhibition. First, we measured prevalence and frequency of these disorders in 23 bvFTD patients and 24 healthy controls (HC) in order to identify the phenotypical heterogeneity of disinhibition. Then, we examined the relationships between these metrics, the neuropsychological scores and the behavioural states to propose a more comprehensive view of these neuropsychiatric manifestations. Finally, we studied the context of occurrence of these disorders by investigating environmental factors potentially promoting or reducing them. As expected, we found that patients were more compulsive, impulsive and socially disinhibited than HC. We found that 48% of patients presented compulsivity (e.g., repetitive actions), 48% impulsivity (e.g., oral production) and 100% of the patients group showed social disinhibition (e.g., disregards for rules or investigator). Compulsivity was negatively related with emotions recognition. BvFTD patients were less active if not encouraged in an activity, and their social disinhibition decreased as activity increased. Finally, impulsivity and social disinhibition decreased when patients were asked to focus on a task. Summarising, this study underlines the importance to differentiate subtypes of disinhibition as well as the setting in which they are exhibited, and points to stimulating area for non-pharmacological management.

BACKGROUND: The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is an all-inclusive pragmatic study comprising 2 randomized clinical trials (RCTs). Pa-tients excluded from the RCTs are followed in parallel treatment and observation registries, allowing a compari-son between RCT and registry patients.METHODS: The first randomized clinical trial (RCT-1) offers 1:1 randomized allocation of intervention versus conservative management for patients with arteriovenous malformation (AVM). The second randomized clinical trial (RCT-2) allocates 1:1 pre-embolization or no pre-embolization to surgery or radiosurgery patients judged treatable with or without embolization. Characteristics of RCT patients are reported and compared to registry patients.RESULTS: From June 2014 to May 2021, 1010 patients with AVM were recruited; 498 patients were observed and 373 were included in the treatment registries. Randomized allocation in RCT-1 was applied to 139 (26%) of the 512 patients (including 127 of 222 [57%] with unruptured AVMs) considered for curative treatment. RCT-1 AVM patients differed (in rupture status, Spetzler-Martin grade and baseline modified Rankin Score) from those in the obser-vation or treatment registries (P< 0.001). Most patients had small (<3 cm; 71%) low-grade (Spetzler-Martin I-II; 64%) unruptured (91%) AVMs. The allocated management was conservative (n = 71) or curative (n = 68), using surgery (n = 39), embolization (n = 16), or stereotactic radio -surgery (n = 13). Pre-embolization was considered for 179/ 309 (58%) patients allocated/assigned to surgery or ste-reotactic radiosurgery; 87/179 (49%) were included in RCT-2. RCT-2 patient AVMs differed in size, eloquence and grade from patients of the pre-embolization registry (P < 0.01). Most had small (<3 cm in 82%) low-grade (83%) AVMs in non-eloquent brain (64%).CONCLUSIONS: Patients included in the RCTs differ significantly from registry patients. Meaningful results can be obtained if multiple centers actively participate in the TOBAS RCTs.

OBJECTIVE:The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. METHODS:TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score > 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score > 2. RESULTS:From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I-II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%-93%) and 105/110 low-grade (95%, 95% CI 90%-98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%-18%) had reached the primary safety outcome of mRS score > 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%-28%). Permanent treatment-related complications leading to mRS score > 2 occurred in 6/139 patients (4%, 95% CI 2%-9%), 5 (83%) of whom had complications due to preoperative embolization. CONCLUSIONS:The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 (ClinicalTrials.gov).

Es indispensable conocer la anatomía pélvica femenina para tratar mejor a las pacientes. Sin embargo, esta anatomía presenta muchos aspectos difíciles. Se distinguen dos regiones principales: intraperitoneal y subperitoneal. Sólo los ovarios son intraperitoneales. El resto del aparato genital femenino está revestido por peritoneo pélvico visceral. El conocimiento de la región subperitoneal es un elemento importante para el cirujano. Este espacio puede compararse con un botellero donde los elementos nobles deben preservarse absolutamente durante la cirugía. Contiene un tejido conjuntivo abundante, vasos, ganglios linfáticos y nervios. El parametrio y el paracérvix son zonas clave de la región subperitoneal. El hilo conductor de la pelvis es el uréter pélvico. El objetivo de este artículo es ofrecer claves para comprender mejor la anatomía pélvica femenina, detallando sus regiones y sus principales elementos.

La chirurgie gynécologique radicale pelvienne pour cancer ou maladie bénigne peut être la source de complications fonctionnelles pelviennes fréquentes en rapport avec des lésions du système nerveux autonome [1], [2], [3]. Afin d'épargner ces structures, la veine utérine profonde (VUP) a été identifiée comme un repère anatomique clé [4]. Cependant, peu de travaux se sont spécifiquement intéressés à ce vaisseau et il manque une description claire dans la terminologie anatomique. Ce travail visait, à travers une revue de la littérature et une étude anatomique, à apporter une description précise de la VUP. Une revue systématique de la littérature a été réalisée à partir des PUBMED et EMBASE selon les recommandations « PRISMA » [5]. L'étude anatomique était constituée d'une étude de dissection sur sujets anatomiques cadavériques et une étude radio-anatomique de sujets issus de la table Anatomage avec reconstruction tridimensionnelle. La revue de littérature a permis de démontrer, à partir 13 articles répondants aux critères PRISMA, un consensus des observations anatomiques et chirurgicales de la description de la VUP. Issue de la convergence des veines cervicales, vésicales et vaginales, elle entretient un trajet dans le paracervix, vers le bas et l'arrière jusqu'à sa terminaison dans la veine iliaque interne. L'étude anatomique a précisé les rapports de la VUP sur son trajet. La VUP divise la région latérale à l'utérus en deux parties : une part vascularis avec l'artère utérine cranialement, et l'uretère (paramètre), et une part nervosa caudalement, le plexus hypogastrique inférieur (paracervix). Nous avons systématisé la description de la VUP. Une connaissance anatomique profonde de l'espace sous péritonéale est indispensable au chirurgien pelvien afin de limiter les complications postopératoires. Ses rapports vasculonerveux confirment son intérêt comme repère chirurgicale pertinent pour l'épargne nerveuse, mais aussi de l'uretère.

Objective: To better understand the physiology of pain in pelvic pain pathological conditions, such as endometriosis, in which alter-ations of uterine innervation have been highlighted, we performed an anatomic and functional mapping of the macro-and microin-nervation of the human uterus. Our aim was to provide a 3-dimensional reconstruction model of uterine innervation. Design: This was an experimental study. We dissected the pelvises of 4 human female fetuses into serial sections, and treated them with hematoxylin and eosin staining before immunostaining. Setting: Academic Research Unit. Patients: None. Interventions: None. Main outcome measures: Detection of nerves (S100 +) and characterization of the types of nerves. The slices obtained were aligned to construct a 3-dimensional model. Results: A 3-dimensional model of uterine innervation was constructed. The nerve fibers appeared to have a centripetal path from the uterine serosa to the endometrium. Within the myometrium, innervation was dense. Endometrial innervation was sparse but present in the functional layer of the endometrium. Overall innervation was richest in the supravaginal cervix and rarer in the body of the uterus. Innervation was rich particularly laterally to the cervix next to the parametrium and paracervix. Four types of nerve fibers were identified: autonomic sympathetic (TH+), parasympathetic (VIP+), and sensitive (NPY+, CGRP1+ and VIP+). They were found in the 3 portions and the 3 layers of the uterus. Conclusions: We constructed a 3-dimensional model of the human uterine innervation. This model could provide a solid base for studying uterine innervation in pathologic situations, in order to find new therapeutic approaches. (C) 2022 by American Society for Reproductive Medicine.

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BACKGROUND:The placement of posterior mesh during pelvic organ prolapse laparoscopic surgery has been incriminated as responsible for postoperative adverse outcomes such as digestive symptoms, chronic pelvic pain, and sexual dysfunction. These complications may be related to neural injuries that occur during the fixation of the posterior mesh on the levator ani muscle.OBJECTIVES:The aim of our study was to describe the course of the autonomic nerves of the pararectal space and their anatomical relationship with the posterior mesh fixation zone on the levator ani muscle.STUDY DESIGN:Twenty hemi-pelvis specimens from 10 fresh female cadavers were dissected. We measured the distance between the posterior mesh fixation zone on the levator ani, and the nearest point of adjacent structures: the hypogastric nerve, inferior hypogastric plexus, uterosacral ligament, uterine artery, and ureter. Measurements were repeated starting from the inferior hypogastric plexus.RESULTS:Nerve fibers of the inferior hypogastric plexus spread out systematically above the superior aspect of the levator ani muscle. Median distance from the posterior mesh fixation zone and the inferior hypogastric plexus was around 2.8 (range 2.1-3.5) cm.CONCLUSIONS:The inferior hypogastric plexus lies above the superior aspect of the levator ani muscle. A short distance between the posterior mesh fixation zone on the levator ani muscle and inferior hypogastric plexus could explain in part postoperative digestive symptoms. These observations support the development of nerve-sparing procedures for posterior mesh placement in the context of pelvic organ prolapse repair and suggest that postoperative complications could be improved by changing the fixation zone.

Schwannomas are benign nerve tumors arising mainly in the intracranial, cervical, or lumbar regions. We describe the case of a presacral schwannoma in a 42-year-old woman. This atypical localization is most often discovered by symptoms related to compression of nervous structures. Our patient presented only with deep dyspareunia. The schwannoma was diagnosed on MRI which revealed a presacral hyperintense mass with an antero-posterior diameter of 47 mm opposite the S3 sacral orifice. After 6 years of follow-up, the mass was resected because of worsening dyspareunia and sudden lesion growth. The resection was performed through an open abdominal anterior approach and resulted in alleviation of the symptoms without postoperative complications. To our knowledge, this is the first case of pelvic schwannoma expressing a gynecological symptom such as dyspareunia.

PURPOSE:Surgery simulators can be used to learn technical and non-technical skills and, to analyse posture. Ergonomic skill can be automatically detected with a Human Pose Estimation algorithm to help improve the surgeon's work quality. The objective of this study was to analyse the postural behaviour of surgeons and identify expertise-dependent movements. Our hypothesis was that hesitation and the occurrence of surgical instruments interfering with movement (defined as interfering movements) decrease with expertise.MATERIAL AND METHODS:Sixty surgeons with three expertise levels (novice, intermediate, and expert) were recruited. During a training session using an arthroscopic simulator, each participant's movements were video-recorded with an RGB camera. A modified OpenPose algorithm was used to detect the surgeon's joints. The detection frequency of each joint in a specific area was visualized with a heatmap-like approach and used to calculate a mobility score.RESULTS:This analysis allowed quantifying surgical movements. Overall, the mean mobility score was 0.823, 0.816, and 0.820 for novice, intermediate and expert surgeons, respectively. The mobility score alone was not enough to identify postural behaviour differences. A visual analysis of each participants' movements highlighted expertise-dependent interfering movements.CONCLUSION:Video-recording and analysis of surgeon's movements are a non-invasive approach to obtain quantitative and qualitative ergonomic information in order to provide feedback during training. Our findings suggest that the interfering movements do not decrease with expertise but differ in function of the surgeon's level.

Uterine transplantation is on the rise worldwide. In contrast to its arterial anatomy, venous drainage of the uterus is poorly defined in the literature. Our aim was to provide a standardized description of uterine veins through a multimodal approach to establish anatomical landmarks for the uterine transplantation surgeon. Data were obtained from: (1) an anatomical study of eight fresh female cadavers (16 hemipelves) studied separately by an extra fascial dissection from the iliac bifurcation to the uterine pedicle, with analysis of the urinary tract and nerve structures and (2) a virtual anatomical study from the Anatomage® Table comprising a high-fidelity virtual reconstruction of two deceased female subjects by imaging and anatomical methods. An inconstant duality of uterine veins was identified: a deep uterine vein of larger caliber and a superficial uterine vein observed in 25% of cases. A close relationship of the ureter passing posterior to the superficial uterine vein and anterior to the deep uterine vein was evident in the parametrium. The inferior hypogastric plexus was identified in all cases immediately behind the deep uterine vein. The data obtained from the fresh female cadavers were validated by the Anatomage® Table. We describe the close relationship of the uterine veins with the ureter and the inferior hypogastric plexus. This knowledge represents a surgical landmark to support the success of uterine transplantation by respecting both the graft and the safety of the living donor by limiting the risk of injuries during uterus procurement.

Neurosurgeons use three main surgical approaches for left-sided glioblastoma (GB) in eloquent areas: biopsy, tumor resection under general anesthesia (GA), and awake craniotomy (AC) with brain mapping for maximal safe resection. We performed a retrospective study of functional and survival outcomes for left-sided eloquent GB, comparing these surgical approaches. We included 87 patients with primary left-sided eloquent GB from two centers, one performing AC and the other biopsy or resection under GA. We assessed Karnofsky performance score (KPS), language and motor deficits one month after surgery, progression-free survival (PFS) and overall survival (OS). The 87 patients had a median PFS of 8.6 months [95% CI: 7.3–11.6] and a median OS of 20.2 months [17-3-24.4], with no significant differences between the three surgical approaches. One month after surgery, functional outcomes for language were similar for all approaches, but motor function was poorer in the biopsy group than in other patients. The proportion of patients with a KPS score > 80 was higher in the resection with AC group than in the other patients at this timepoint. We detected no real benefit of a resection with AC over resection under GA for left-sided eloquent GB in terms of survival or functional outcomes for language. However, given the poorer motor function of biopsy patients, resection with AC should be proposed, when possible, to patients ineligible for surgical resection under GA, to improve functional outcomes and patient autonomy.

Objective: To assess the long-term surgical results on cranial nerve (CN) function and tumor control in patients harboring cerebellopontine angle (CPA) and petroclival area (PCA) epidermoid cysts (EC).Methods: This is a retrospective cohort study about 56 consecutive patients operated on for a CPA or PCA EC between January 2001 and July 2019 in six participating French cranial base referral centers.Results: Sixteen patients (29%) presented a PCA EC, and 40 a CPA EC (71%). The median clinical and radiological follow-up was 46 months (range 0-409). Preoperative CN disorders were present in 84% of patients (n=47), 72% of them experienced CN deficits improvement at last follow-up consultation (n=34) : 60% of cochlear and vestibular deficits (n=9/15 in both groups), 67% of trigeminal neuralgia (n=10/15), 53% of trigeminal hypoesthesia (n=8/15), 44% of lower cranial nerve disorders (n=4/9), 38% of facial nerve deficits (n=5/8), and 43% of oculomotor deficits (n=3/7) improved or were cured after surgery. New postoperative CN deficits occurred in 48% of patients (n=27). Most of them resolved at last follow-up, except for cochlear deficits which improved in only 14% of cases (n = 1/7). Twenty-six patients (46 %) showed evidence of tumor progression after a median duration of 63 months (range 7-210). Extent of resection, tumor location and tumor size were not associated with the occurrence of new postoperative CN deficit nor tumor progression. Conclusion: A functional nerve-sparing resection of posterior fossa EC is an effective strategy to optimize the results on preexisting CN deficits and reduces the risk of permanent de novo deficits.