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Aymeric A, Trunet S, Degos V, Cornu P, Hans S, Chauvet D. Anatomical Features of Skull Base and Oral Cavity: A Pilot Study to Determine the Accessibility of the Sella by Transoral Robotic-Assisted Surgery. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cornu P, Steurbaut S, De Beukeleer M, Putman K, van de Velde R, Dupont AG. Physician's expectations regarding prescribing clinical decision support systems in a Belgian hospital. Acta Clin Belg 2014; 69:157-64. [PMID: 24820921 DOI: 10.1179/2295333714y.0000000015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Developing and implementing clinical decision support systems (CDSSs) is time-consuming and costly. Therefore, prioritization of the most relevant systems is warranted. The physician's perceived usefulness has been identified as a decisive reason for using CDSSs. The objective of this study was to investigate the physician's perceived usefulness of different types of CDSSs and to identify the user needs and expectations regarding future CDSSs. METHODS Cross-sectional single-centre survey among physicians with a clinical assignment in a university hospital. Physicians were questioned about their current experiences with drug prescribing and the perceived usefulness and desired features of future CDSSs. RESULTS One hundred and sixty-four physicians completed the survey (52·6%). The majority acknowledged that it is very difficult to take all relevant information into account when prescribing drugs. Drug-drug interaction checking, drug-allergy checking, and dosing guidance were considered as most useful. Automated clinical guidelines and adverse drug event monitoring were considered as least useful. The user-friendliness of the systems, clinical relevance of the alerts, and prevention of alert fatigue were perceived as important aspects for a successful implementation. CONCLUSIONS From the physicians' perspective drug-drug interaction checking, drug-allergy checking, and dosing guidance should receive the highest priority for development and implementation. Because the perceived usefulness has been identified as a decisive reason for using CDSSs, it seems feasible to take into account this prioritization when developing and implementing CDSSs. In order to overcome the physicians' perceived disadvantages, attention should go to the development of user-friendly systems that deliver clinical relevant alerts.
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Chauvet D, Missistrano A, Hivelin M, Carpentier A, Cornu P, Hans S. Transoral robotic-assisted skull base surgery to approach the sella turcica: cadaveric study. Neurosurg Rev 2014; 37:609-17. [PMID: 24848406 DOI: 10.1007/s10143-014-0553-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/27/2014] [Accepted: 03/23/2014] [Indexed: 11/29/2022]
Abstract
Transoral robotic surgery (TORS) offers new possibilities that have not been experimented in the field of minimally invasive skull base neurosurgery. We propose to evaluate the feasibility of transoral approach to the sella turcica with the da Vinci system on cadavers. We performed four robot-assisted dissections on human fresh cadavers in order to reach the pituitary fossa by the oral cavity. Cavum mucosa dissection was performed by the head and neck surgeon at the console and then the sphenoid was drilled by the neurosurgeon at the bedside, with intraoperative fluoroscopy and a "double surgeon" control. Mucosa closure was attempted with robotic arms. We succeeded in performing a sellar opening in all cadavers with a minimally invasive approach, as the hard palate was never drilled. The video endoscope offered a large view inside the sphenoidal sinus, as observed in transnasal endoscopy, but with 3D visualization. The camera arm could be inserted into the sphenoidal sinus, and instrument arms in the pituitary fossa. Operative time to reach the pituitary fossa was approximately 60 min in all procedures: 20 min of initial setup, 10 min of mucosal dissection, and 30 min of sphenoid surgery. New anatomical landmarks were defined. Advantages and pitfalls of such an unpublished technique were discussed. This is the first cadaveric study reported da Vinci robotic transoral approach to the sella turcica with a minimally invasive procedure. This innovative technique may modify the usual pituitary adenoma removal as the sella is approached infero-superiorly.
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Mathon B, Karachi C, Di Maria F, Dormont D, Cornu P, Leclercq D. Intracranial neurenteric cyst mimicking prepontine subarachnoid hemorrhage. Rev Neurol (Paris) 2014; 170:301-2. [PMID: 24679484 DOI: 10.1016/j.neurol.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 12/09/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
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Welter ML, Schüpbach M, Czernecki V, Karachi C, Fernandez-Vidal S, Golmard JL, Serra G, Navarro S, Welaratne A, Hartmann A, Mesnage V, Pineau F, Cornu P, Pidoux B, Worbe Y, Zikos P, Grabli D, Galanaud D, Bonnet AM, Belaid H, Dormont D, Vidailhet M, Mallet L, Houeto JL, Bardinet E, Yelnik J, Agid Y. Optimal target localization for subthalamic stimulation in patients with Parkinson disease. Neurology 2014; 82:1352-61. [PMID: 24647024 PMCID: PMC4001189 DOI: 10.1212/wnl.0000000000000315] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To further determine the causes of variable outcome from deep brain stimulation of the subthalamic nucleus (DBS-STN) in patients with Parkinson disease (PD). Methods: Data were obtained from our cohort of 309 patients with PD who underwent DBS-STN between 1996 and 2009. We examined the relationship between the 1-year motor, cognitive, and psychiatric outcomes and (1) preoperative PD clinical features, (2) MRI measures, (3) surgical procedure, and (4) locations of therapeutic contacts. Results: Pre- and postoperative results were obtained in 262 patients with PD. The best motor outcome was obtained when stimulating contacts were located within the STN as compared with the zona incerta (64% vs 49% improvement). Eighteen percent of the patients presented a postoperative cognitive decline, which was found to be principally related to the surgical procedure. Other factors predictive of poor cognitive outcome were perioperative confusion and psychosis. Nineteen patients showed a stimulation-induced hypomania, which was related to both the form of the disease (younger age, shorter disease duration, higher levodopa responsiveness) and the ventral contact location. Postoperative depression was more frequent in patients already showing preoperative depressive and/or residual axial motor symptoms. Conclusion: In this homogeneous cohort of patients with PD, we showed that (1) the STN is the best target to improve motor symptoms, (2) postoperative cognitive deficit is mainly related to the surgery itself, and (3) stimulation-induced hypomania is related to a combination of both the disease characteristics and a more ventral STN location.
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Mathon B, Nouet A, Villa C, Mokhtari K, Alshehhi H, Faillot M, Dormont D, Cornu P, Leclercq D. Teaching neuroimages: Burkitt dural lymphoma mimicking a subacute subdural hematoma. Neurology 2013; 81:e128-9. [PMID: 24145887 DOI: 10.1212/wnl.0b013e3182a956d0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baizabal-Carvallo JF, Roze E, Aya-Kombo M, Romito L, Navarro S, Flamand-Rouvière C, Welter ML, Pidoux B, Bardinet E, Galanaud D, Cornu P, Vidailhet M, Pollak P, Grabli D. Combined pallidal and subthalamic nucleus deep brain stimulation in secondary dystonia-parkinsonism. Parkinsonism Relat Disord 2013; 19:566-8. [DOI: 10.1016/j.parkreldis.2013.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/19/2013] [Accepted: 01/22/2013] [Indexed: 11/30/2022]
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Burbaud P, Clair AH, Langbour N, Fernandez-Vidal S, Goillandeau M, Michelet T, Bardinet E, Chéreau I, Durif F, Polosan M, Chabardès S, Fontaine D, Magnié-Mauro MN, Houeto JL, Bataille B, Millet B, Vérin M, Baup N, Krebs MO, Cornu P, Pelissolo A, Arbus C, Simonetta-Moreau M, Yelnik J, Welter ML, Mallet L. Neuronal activity correlated with checking behaviour in the subthalamic nucleus of patients with obsessive-compulsive disorder. ACTA ACUST UNITED AC 2013; 136:304-17. [PMID: 23365104 DOI: 10.1093/brain/aws306] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Doubt, and its behavioural correlate, checking, is a normal phenomenon of human cognition that is dramatically exacerbated in obsessive-compulsive disorder. We recently showed that deep brain stimulation in the associative-limbic area of the subthalamic nucleus, a central core of the basal ganglia, improved obsessive-compulsive disorder. To understand the physiological bases of symptoms in such patients, we recorded the activity of individual neurons in the therapeutic target during surgery while subjects performed a cognitive task that gave them the possibility of unrestricted repetitive checking after they had made a choice. We postulated that the activity of neurons in this region could be influenced by doubt and checking behaviour. Among the 63/87 task-related neurons recorded in 10 patients, 60% responded to various combinations of instructions, delay, movement or feedback, thus highlighting their role in the integration of different types of information. In addition, task-related activity directed towards decision-making increased during trials with checking in comparison with those without checking. These results suggest that the associative-limbic subthalamic nucleus plays a role in doubt-related repetitive thoughts. Overall, our results not only provide new insight into the role of the subthalamic nucleus in human cognition but also support the fact that subthalamic nucleus modulation by deep brain stimulation reduced compulsive behaviour in patients with obsessive-compulsive disorder.
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Chauvet D, Reina V, Clarencon F, Bitar A, Cornu P. Conservative management of a large occipital extradural haematoma. Br J Neurosurg 2013; 27:526-8. [PMID: 23428147 DOI: 10.3109/02688697.2013.769499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 26-year-old male presented with a mild confusion and hemianopsia after traumatic brain injury. Cerebral CT-scan revealed a 62.5 cm(3) left occipital extradural haematoma (EDH). Although conventional neurosurgical management would have been to evacuate the haematoma, a conservative strategy was preferred, and the patient made a total recovery.
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Mathon B, Boch AL, Clémenceau S, Bitar A, Mokhtari K, Adam C, Dainese L, Galanaud D, Kalfon F, Cornu P, Carpentier A. Paragangliomes de la queue de cheval : à propos de six cas et revue de la littérature. Neurochirurgie 2012. [DOI: 10.1016/j.neuchi.2012.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Deuschl G, Schüpbach M, Knudsen K, Pinsker MO, Cornu P, Rau J, Agid Y, Schade-Brittinger C. Stimulation of the subthalamic nucleus at an earlier disease stage of Parkinson's disease: concept and standards of the EARLYSTIM-study. Parkinsonism Relat Disord 2012; 19:56-61. [PMID: 22841616 DOI: 10.1016/j.parkreldis.2012.07.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 11/29/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for advanced Parkinson's disease (PD) with disabling motor complications. However, stimulation may be beneficial at an earlier stage of PD when motor fluctuations and dyskinesia are only mild and psychosocial competence is still maintained. The EARLYSTIM trial was conducted in patients with recent onset of levodopa-induced motor complications (≤ 3 years) whose social and occupational functioning remained preserved. This is called 'early' here. The study was a randomized, multicenter, bi-national pivotal trial with a 2 year observation period. Quality of life was the main outcome measure, and a video-based motor score was a blinded secondary outcome of the study. Motor, neuropsychological, psychiatric and psychosocial aspects were captured by established scales and questionnaires. The patient group randomized here is the earliest in the disease course and the youngest recruited in controlled DBS trials so far. The methodological innovation for DBS-studies of this study lies in novel procedures developed and used for monitoring best medical treatment, neurosurgical consistency, best management of stimulation programming, blinded video assessment of motor disability, and prevention of suicidal behaviors.
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Mazeron JJ, Valéry CA, Boisserie G, Cornu P. Historique de la radiochirurgie. Cancer Radiother 2012; 16 Suppl:S2-4. [DOI: 10.1016/j.canrad.2011.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 09/23/2011] [Accepted: 09/26/2011] [Indexed: 10/28/2022]
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Welter ML, Czernecki V, Schupbach M, Fernandez-Vidal S, Karachi C, Navarro S, Cornu P, Pidoux B, Mallet L, Dormont D, Vidailhet M, Grabli D, Bonnet AM, Belaid H, Houeto JL, Bardinet E, Yelnik J, Agid Y. Why Does Bilateral Subthalamic Stimulation Induced Cognitive Decline in Patients with Parkinson's Disease? (S52.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s52.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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64
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Welter ML, Czernecki V, Schupbach M, Fernandez-Vidal S, Karachi C, Navarro S, Cornu P, Pidoux B, Mallet L, Dormont D, Vidailhet M, Grabli D, Bonnet AM, Belaid H, Houeto JL, Bardinet E, Yelnik J, Agid Y. Why Does Bilateral Subthalamic Stimulation Induced Cognitive Decline in Patients with Parkinson's Disease? (IN6-2.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in6-2.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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65
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Carpentier A, Chauvet D, Reina V, Beccaria K, Leclerq D, McNichols RJ, Gowda A, Cornu P, Delattre JY. MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas. Lasers Surg Med 2012; 44:361-8. [DOI: 10.1002/lsm.22025] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2012] [Indexed: 11/10/2022]
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Perot G, Clarençon F, Di Maria F, Sourour N, Biondi A, Cornu P, Chiras J. Persistent trigeminal artery feeding a hemispheric branch of the posterior inferior cerebellar artery: A rare anatomic variant. J Neuroradiol 2011; 38:251-4. [DOI: 10.1016/j.neurad.2011.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 02/13/2011] [Accepted: 02/28/2011] [Indexed: 11/16/2022]
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Valery C, Boskos C, Lekehal M, Duyme M, Lamproglou I, Cornu P, Mazeron J. Prediction of Local Control after Radiosurgery of Cerebral Metastases from Breast Cancer. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Valery C, Lekehal M, Boskos C, Duyme M, Lamproglu I, Boisserie G, Mazeron JJ, Cornu P. Prédiction du contrôle local après radiochirurgie des métastases cérébrales de cancer du sein. Neurochirurgie 2011. [DOI: 10.1016/j.neuchi.2011.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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69
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Kaloshi G, Benouaich-Amiel A, Diakite F, Taillibert S, Lejeune J, Laigle-Donadey F, Renard MA, Iraqi W, Idbaih A, Paris S, Capelle L, Duffau H, Cornu P, Simon JM, Mokhtari K, Polivka M, Omuro A, Carpentier A, Sanson M, Delattre JY, Hoang-Xuan K. Temozolomide for low-grade gliomas: Predictive impact of 1p/19q loss on response and outcome. Neurology 2011. [DOI: 10.1212/01.wnl.0000400061.70034.aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Valery CA, Boskos C, Boisserie G, Lamproglou I, Cornu P, Mazeron JJ, Simon JM. Minimized doses for linear accelerator radiosurgery of brainstem metastasis. Int J Radiat Oncol Biol Phys 2011; 80:362-8. [PMID: 20598449 DOI: 10.1016/j.ijrobp.2010.02.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 01/26/2010] [Accepted: 02/02/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Treatment of cerebral metastases located inside the brainstem remains a challenge, as the brainstem is considered to be a neurological organ at risk, whatever the treatment strategy. We report a retrospective study of 30 consecutive patients treated in our institution between 2005 and 2007 with micromultileaf linear accelerator (LINAC)-radiosurgery for brainstem metastases, with reduced doses compared to those usually reported in the literature. METHODS AND MATERIALS Mean follow-up was 311 days (range, 41-1351). Median age was 57 years (range, 37-82), Mean Karnofsky Index (KI) was 80. Primary tumor site was lung (n = 13), breast (n = 4), kidney (n = 4), skin (melanoma; n = 3), and others (n = 6). Primary tumor was controlled in 17 cases; extracranial metastases were controlled in 12 cases. Mean number of metastases was 1.46 (one to three); median volume was 2.82 cc (0.06-18). Dose was delivered by a micromultileaf collimator 6-MV LINAC . RESULTS Dose administered at the 70% isodose was 13.4 Gy (range, 8.2-15). Median survival was 10 months. Local control rates at 3, 6, and 12 months were 100%, 100%, and 79% respectively. Median neurological control duration was 5 months. Neurological control rates at 3, 6, and 12 months were 73%, 42%, and 25%, respectively. No parameter was found to significantly correlate with survival, local, or cerebral control. No patients had severe side effects (Grade III-IV), according to the Radiation Therapy Oncology Group (RTOG) scale. CONCLUSION Lower doses than previously reported can achieve the same local control and survival rates in brain metastases, with minimal side effects.
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Chargari C, Feuvret L, Levy A, Lamproglou I, Assouline A, Hemery C, Ghorbal L, Lopez S, Tep B, G GB, Lang P, Laigle-Donadey F, Cornu P, Mazeron JJ, Simon JM. Reappraisal of clinical outcome in adult medulloblastomas with emphasis on patterns of relapse. Br J Neurosurg 2011; 24:460-7. [PMID: 20726753 DOI: 10.3109/02688691003739881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical outcome and prognostic factors were assessed in adult medulloblastoma patients, with emphasis on patterns of relapse. PATIENTS AND METHODS Records of 36 consecutive adult patients with medulloblastoma were reviewed. Patients were classified into 2 prognostic groups according to the extent of disease and quality of surgical excision based on the early postoperative magnetic resonance imaging (MRI) findings. Standard-risk (SR) patients (n = 11) received postoperative craniospinal radiation therapy (RT) only, 36 Gy, 1.8 Gy per daily fraction, with a 18 Gy boost to the posterior cerebral fossa (PCF). High-risk (HR) patients (n = 25) received additional adjuvant chemotherapy. RESULTS With a median follow-up of 46 months (range 5-155), 19 patients experienced tumour relapse. Sites of relapse(s) included tumour bed in 6 patients, resulting in a PCF control of 83.4%. Three-year overall survival (OS) and progression-free survival (PFS) were 67.3% and 57.4%, respectively. The comparison of the HR and SR populations demonstrated significant differences in OS (p = 0.005) and PFS (p = 0.001). Quality of surgical excision and extent of disease beyond the PCF were predictive factors for OS (p = 0.04, p = 0.001, respectively) and PFS (p = 0.004, and p = 0.02, respectively). CONCLUSION The quality of resection was a significant prognostic factor, suggesting that surgery should be as extensive as possible. Systematic postoperative MRI allowed accurate selection of SR patients for whom RT alone was enough to obtain high local control. Every effort should be made to avoid RT disruption. Increased delay led to worse outcome.
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Azoulay-Zyss J, Roze E, Welter ML, Navarro S, Yelnik J, Clot F, Bardinet E, Karachi C, Dormont D, Galanaud D, Pidoux B, Cornu P, Vidailhet M, Grabli D. Bilateral deep brain stimulation of the pallidum for myoclonus-dystonia due to ε-sarcoglycan mutations: a pilot study. ACTA ACUST UNITED AC 2011; 68:94-8. [PMID: 21220679 DOI: 10.1001/archneurol.2010.338] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the efficacy of bilateral deep brain stimulation of the internal pallidum in patients with myoclonus-dystonia due to genetically proved ε-sarcoglycan (SGCE-M-D) deficiency. DESIGN Patients with documented SGCE-M-D undergoing bilateral deep brain stimulation of the internal pallidum were recruited. Standardized assessments of M-D were videorecorded before surgery and 6 to 9 months and 15 to 18 months after surgery, using the movement and disability subscales of the Burke-Fahn-Marsden Dystonia Rating Scale and the Unified Myoclonus Rating Scale. The analysis was based on blinded evaluation of the recordings. SETTING Movement disorder unit in a university hospital in Paris. PATIENTS Five consecutive patients with documented SGCE-M-D. MAIN OUTCOME MEASURES Myoclonus and dystonia scores at follow-up. RESULTS The median myoclonus score decreased from 76 before surgery (range, 38-116) to 10 at 6 to 9 months after surgery (range, 6-31). The median dystonia score decreased from 30.0 before surgery (range, 18.5-53.0) to 4.5 after surgery (range, 3.5-16.0). Disability was also improved and symptoms remained stable between the postoperative evaluations. No adverse effects occurred. CONCLUSIONS Bilateral deep brain stimulation of the internal pallidum is safe and highly effective in this homogeneous population of patients with SGCE-M-D. This therapeutic option should therefore be considered for patients with severe, drug-resistant forms of the disorder.
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Bardinet E, Belaid H, Grabli D, Welter ML, Vidal SF, Galanaud D, Derrey S, Dormont D, Cornu P, Yelnik J, Karachi C. Thalamic stimulation for tremor: Can target determination be improved? Mov Disord 2010; 26:307-12. [DOI: 10.1002/mds.23448] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 07/21/2010] [Accepted: 08/25/2010] [Indexed: 11/08/2022] Open
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Moro E, Lozano AM, Pollak P, Agid Y, Rehncrona S, Volkmann J, Kulisevsky J, Obeso JA, Albanese A, Hariz MI, Quinn NP, Speelman JD, Benabid AL, Fraix V, Mendes A, Welter ML, Houeto JL, Cornu P, Dormont D, Tornqvist AL, Ekberg R, Schnitzler A, Timmermann L, Wojtecki L, Gironell A, Rodriguez-Oroz MC, Guridi J, Bentivoglio AR, Contarino MF, Romito L, Scerrati M, Janssens M, Lang AE. Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease. Mov Disord 2010; 25:578-86. [PMID: 20213817 DOI: 10.1002/mds.22735] [Citation(s) in RCA: 291] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We report the 5 to 6 year follow-up of a multicenter study of bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) in advanced Parkinson's disease (PD) patients. Thirty-five STN patients and 16 GPi patients were assessed at 5 to 6 years after DBS surgery. Primary outcome measure was the stimulation effect on the motor Unified Parkinson's Disease Rating Scale (UPDRS) assessed with a prospective cross-over double-blind assessment without medications (stimulation was randomly switched on or off). Secondary outcomes were motor UPDRS changes with unblinded assessments in off- and on-medication states with and without stimulation, activities of daily living (ADL), anti-PD medications, and dyskinesias. In double-blind assessment, both STN and GPi DBS were significantly effective in improving the motor UPDRS scores (STN, P < 0.0001, 45.4%; GPi, P = 0.008, 20.0%) compared with off-stimulation, regardless of the sequence of stimulation. In open assessment, both STN- and GPi-DBS significantly improved the off-medication motor UPDRS when compared with before surgery (STN, P < 0.001, 50.5%; GPi, P = 0.002, 35.6%). Dyskinesias and ADL were significantly improved in both groups. Anti-PD medications were significantly reduced only in the STN group. Adverse events were more frequent in the STN group. These results confirm the long-term efficacy of STN and GPi DBS in advanced PD. Although the surgical targets were not randomized, there was a trend to a better outcome of motor signs in the STN-DBS patients and fewer adverse events in the GPi-DBS group.
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Kerim AA, Bonneville F, Jean B, Cornu P, LeJean L, Chiras J. Balloon-assisted embolization of skull base meningioma with liquid embolic agent. J Neurosurg 2010; 112:70-2. [DOI: 10.3171/2008.11.jns08175] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a novel technique of balloon-assisted embolization of a skull base meningioma supplied by a branch of the cavernous segment of the internal carotid artery using liquid embolic agent. A temporarily inflated balloon distal to the meningioma's feeding vessel may improve the access to this small branch and may reduce the chances of unintended reflux during delivery of the liquid embolic agent.
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