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Mongardi L, Belaroussi Y, Kara M, Le Petit L, Gimbert E, Kerdiles G, De Courson H, Wavasseur T, Liguoro D, Vignes JR, Jecko V, Roblot P. When to discharge patients following a neuronavigation-assisted brain biopsy for supratentorial lesion? A single-center experience. Clin Neurol Neurosurg 2023; 229:107727. [PMID: 37119654 DOI: 10.1016/j.clineuro.2023.107727] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/04/2023] [Revised: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE Most brain biopsies are performed using the frame-based stereotactic technique and several studies describe the time taken and rate of complications, often allowing an early discharge. In comparison, neuronavigation-assisted biopsies are performed under general anesthesia and their complications have been poorly described. We examined the complication rate and determined which patients will worsen clinically. METHODS All adults who underwent a neuronavigation-assisted brain biopsy for a supratentorial lesion from Jan, 2015, to Jan, 2021, in the Neurosurgical Department of the University Hospital Center of Bordeaux, France, were analyzed retrospectively in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. The primary outcome of interest was short-term (7 days) clinical deterioration. The secondary outcome of interest was the complication rate. RESULTS The study included 240 patients. The median postoperative Glasgow score was 15. Thirty patients (12.6 %) showed acute postoperative clinical worsening, including 14 (5.8 %) with permanent neurological worsening. The median delay was 22 h after the intervention. We examined several clinical combinations that allowed early postoperative discharge. A preoperative Glasgow prognostic score of 15, Charlson Comorbidity Index ≤ 3, preoperative World Health Organization Performance Status ≤ 1, and no preoperative anticoagulation or antiplatelet treatment predicted postoperative worsening (negative predictive value, 96.3 %). CONCLUSION Optical neuronavigation-assisted brain biopsies might require longer postoperative observation than frame-based biopsies. Based on strict preoperative clinical criteria, we consider to plan postoperative observation for 24 h a sufficient hospital stay for patients who undergo these brain biopsies.
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Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Yaniss Belaroussi
- ISPED, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Clinical and Epidemiological Research Unit, France; Institut Bergonié, Inserm CIC1401, Clinical and Epidemiological Research Unit, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Mohammed Kara
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Laetitia Le Petit
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Gaëlle Kerdiles
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Hugues De Courson
- ISPED, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Clinical and Epidemiological Research Unit, France; Institut Bergonié, Inserm CIC1401, Clinical and Epidemiological Research Unit, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Thomas Wavasseur
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Dominique Liguoro
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Jean-Rodolphe Vignes
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France; University of Bordeaux, CNRS UMR 5287, INCIA, Zone nord, Bat 2, 2e étage, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - Paul Roblot
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France.
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Marnat G, Jecko V, Gariel F, Gimbert E, Liguoro D, Tourdias T. Embolization as adjunctive treatment to achieve complete cure of ruptured arachnoid cyst associated with chronic subdural hematoma. Br J Neurosurg 2023; 37:104-107. [PMID: 34565281 DOI: 10.1080/02688697.2021.1981243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Chronic Subdural Hematoma (CSDH) is a rare but classical evolutive complication of arachnoid cysts (AC). Its management has rarely been evaluated to date. Several approaches have been proposed including conservative and surgical treatments. Endovascular treatment in such CSDH subtype remains poorly reported. CASE PRESENTATION We present here an original case of a 16 years-old-boy suffering from ruptured AC responsible for CSDH successfully treated with embolization. CONCLUSION Endovascular approach may be considered in the treatment of CSDH related to arachnoid cyst rupture.
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Affiliation(s)
- Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Florent Gariel
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Edouard Gimbert
- Neurosurgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Dominique Liguoro
- Neurosurgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Thomas Tourdias
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.,INSERM-U1215, Neurocentre Magendie, Bordeaux, France
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De Schlichting E, Pech-Gourg G, Jecko V, Lechanoine F, Gimbert E, Zaldivar-Jolissaint JF, Coll G. Posterior Cranial Vault Distraction for Treating Syndromic Brachyturricephaly: A 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 24:e363. [PMID: 36701418 DOI: 10.1227/ons.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 10/09/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
| | - Grégoire Pech-Gourg
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - Vincent Jecko
- Service de Neurochirurgie A, Centre Universitaire de BordeauSx, Bordeaux, France.,Université de Bordeaux, Laboratoire INCIA, CNRS, UMR5287, Bordeaux, France
| | | | - Edouard Gimbert
- Service de Neurochirurgie A, Centre Universitaire de BordeauSx, Bordeaux, France
| | | | - Guillaume Coll
- Service de Neurochirurgie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont Ferrand, France
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4
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Raymond J, Gentric JC, Magro E, Nico L, Bacchus E, Klink R, Cognard C, Januel AC, Sabatier JF, Iancu D, Weill A, Roy D, Bojanowski MW, Chaalala C, Barreau X, Jecko V, Papagiannaki C, Derrey S, Shotar E, Cornu P, Eker OF, Pelissou-Guyotat I, Piotin M, Aldea S, Beaujeux R, Proust F, Anxionnat R, Costalat V, Corre ML, Gauvrit JY, Morandi X, Brunel H, Roche PH, Graillon T, Chabert E, Herbreteau D, Desal H, Trystram D, Barbier C, Gaberel T, Nguyen TN, Viard G, Gevry G, Darsaut TE, _ _, _ _, Raymond J, Roy D, Weill A, Iancu D, Bojanowski MW, Chaalala C, Darsaut TE, O’Kelly CJ, Chow MMC, Findlay JM, Rempel JL, Fahed R, Lesiuk H, Drake B, Santos MD, Gentric JC, Nonent M, Ognard J, El-Aouni MC, Magro E, Seizeur R, Timsit S, Pradier O, Desal H, Boursier R, Thillays F, Roualdes V, Piotin M, Blanc R, Aldea S, Cognard C, Januel AC, Sabatier JF, Calviere L, Gauvrit JY, Raoult H, Eugene F, Bras AL, Ferre JC, Paya C, Morandi X, Lecouillard I, Nouhaud E, Ronziere T, Trystram D, Naggara O, Rodriguez-Regent C, Kerleroux B, Barbier C, Gaberel T, Emery E, Touze E, Papagiannaki C, Derrey S, Eker OF, Riva R, Pellisou-Guyotat I, Guyotat J, Berhouma M, Dumot C, Biondi A, Thines L, Bougaci N, Charbonnier G, Bracard S, Anxionnat R, Gory B, Civit T, Bernier-Chastagner V, Barreau X, Marnat G, Jecko V, Penchet G, Gimbert E, Huchet A, Herbreteau D, Boulouis G, Bibi R, Ifergan H, Janot K, Velut S, Brunel H, Roche PH, Graillon T, Peyriere H, Kaya JM, Touta A, Troude L, Boissonneau S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Boch AL, Cornu P, Nouet A, Costalat V, Bonafe A, Dargazanli C, Gascou G, Lefevre PH, Riquelme C, Corre ML, Beaujeux R, Pop R, Proust F, Cebula H, Ollivier I, Spatola G, Spell L, Chalumeau V, Gallas S, Ikka L, Mihalea C, Ozanne A, Caroff J, Chabert E, Mounayer C, Rouchaud A, Caire F, Ricolfi F, Thouant P, Cao C, Mourier KL, Farah W, Nguyen TN, Abdalkader M, Huynh T, Tawk RG, Carlson AP, Silva LAO, Froio NDL, Silva GS, Mont’Alverne FJA, Martins JL, Mendes GN, Miranda RR. Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 2022; 138:1393-1402. [PMID: 37132535 DOI: 10.3171/2022.9.jns22987] [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: 05/05/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic radiosurgery (SRS) (pre-embolization). The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmatic study that comprises two randomized trials and multiple registries.
METHODS
Results from the TOBAS curative and pre-embolization registries are reported. The primary outcome for this report is death or dependency (modified Rankin Scale [mRS] score > 2) at last follow-up. Secondary outcomes include angiographic results, perioperative serious adverse events (SAEs), and permanent treatment-related complications leading to an mRS score > 2.
RESULTS
From June 2014 to May 2021, 1010 patients were recruited in TOBAS. Embolization was chosen as the primary curative treatment for 116 patients and pre-embolization prior to surgery or SRS for 92 patients. Clinical and angiographic outcomes were available in 106 (91%) of 116 and 77 (84%) of 92 patients, respectively. In the curative embolization registry, 70% of AVMs were ruptured, and 62% were low-grade AVMs (Spetzler-Martin grade I or II), while the pre-embolization registry had 70% ruptured AVMs and 58% low-grade AVMs. The primary outcome of death or disability (mRS score > 2) occurred in 15 (14%, 95% CI 8%–22%) of the 106 patients in the curative embolization registry (4 [12%, 95% CI 5%–28%] of 32 unruptured AVMs and 11 [15%, 95% CI 8%–25%] of 74 ruptured AVMs) and 9 (12%, 95% CI 6%–21%) of the 77 patients in the pre-embolization registry (4 [17%, 95% CI 7%–37%] of 23 unruptured AVMs and 5 [9%, 95% CI 4%–20%] of 54 ruptured AVMs) at 2 years. Embolization alone was confirmed to occlude the AVM in 32 (30%, 95% CI 21%–40%) of the 106 curative attempts and in 9 (12%, 95% CI 6%–21%) of 77 patients in the pre-embolization registry. SAEs occurred in 28 of the 106 attempted curative patients (26%, 95% CI 18%–35%, including 21 new symptomatic hemorrhages [20%, 95% CI 13%–29%]). Five of the new hemorrhages were in previously unruptured AVMs (n = 32; 16%, 95% CI 5%–33%). Of the 77 pre-embolization patients, 18 had SAEs (23%, 95% CI 15%–34%), including 12 new symptomatic hemorrhages [16%, 95% CI 9%–26%]). Three of the hemorrhages were in previously unruptured AVMs (3/23; 13%, 95% CI 3%–34%).
CONCLUSIONS
Embolization as a curative treatment for brain AVMs was often incomplete. Hemorrhagic complications were frequent, even when the specified intent was pre-embolization before surgery or SRS. Because the role of endovascular treatment remains uncertain, it should preferably, when possible, be offered in the context of a randomized trial.
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Affiliation(s)
- Jean Raymond
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | - Elsa Magro
- Department of Neurosurgery, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Brest, France
| | - Lorena Nico
- Department of Radiology, CHU Saint-Etienne, France
| | - Emma Bacchus
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Ruby Klink
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | | | - Jean-François Sabatier
- Neurosurgery, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Daniela Iancu
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Alain Weill
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Michel W. Bojanowski
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Chiraz Chaalala
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Xavier Barreau
- Neuroradiology Department, Pellegrin Hospital Group, CHU Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, Pellegrin Hospital Group, CHU Bordeaux, France
| | | | - Stéphane Derrey
- Neurosurgery, Charles Nicolle Hospital, Rouen Normandy University Hospital, Rouen, France
| | | | - Philippe Cornu
- Neurosurgery, Mercy Salpetriere Hospital AP-HP, Paris, France
| | | | | | | | - Sorin Aldea
- Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | | | - François Proust
- Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - René Anxionnat
- Interventional Neuroradiology Department, University of Lorraine, Laboratory IADI INSERM U1254, CHRU Nancy, France
| | | | | | | | | | - Hervé Brunel
- Departments of Interventional Neuroradiology and
| | | | | | - Emmanuel Chabert
- Interventional Neuroradiology Department, CHU Clermont-Ferrand, France
| | - Denis Herbreteau
- Interventional Neuroradiology Department, Bretonneau Hospital, Tours, France
| | - Hubert Desal
- Interventional Neuroradiology Department, CHU de Nantes, France
| | - Denis Trystram
- Interventional Neuroradiology Department, University of Paris, INSERM U1266, IPNP, GHU Paris, France
- Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | | | | | - Thanh N. Nguyen
- Departments of Radiology,
- Neurology, and
- Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; and
| | | | - Guylaine Gevry
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Tim E. Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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Mazerand E, Benichi S, Taverne M, Paternoster G, Rolland A, Antherieu P, Todeschi J, Kamdem Noumoye L, Gilard V, Bretonnier M, Fournier LL, Jecko V, Gimbert E, Proust F, Boetto S, Roujeau T, James S, Khonsari RH, Riffaud L, Delion M, Zerah M, Scavarda D. Chiari malformation type I surgery in children: French multicenter 10-year cohort. J Neurosurg Pediatr 2022; 30:210-216. [PMID: 35916100 DOI: 10.3171/2022.4.peds21410] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chiari malformation type I (CM-I) is frequent in children and remains a surgical challenge. Several techniques have been described for posterior fossa decompression. No decision algorithm has been validated, and strategies are highly variable between institutions. The goal of this study was to define therapeutic guidelines that take into consideration patient specificities. METHODS The authors retrospectively collected data from patients who were < 18 years of age, were diagnosed with CM-I, and were treated surgically between 2008 and 2018 in 8 French pediatric neurosurgical centers. Data on clinical features, morphological parameters, and surgical techniques were collected. Clinical outcomes at 3 and 12 months after surgery were assessed by the Chicago Chiari Outcome Scale. The authors used a hierarchical clustering method to define clusters of patients by considering their anatomical similarities, and then compared outcomes between surgical strategies in each of these clusters. RESULTS Data from 255 patients were collected. The mean age at surgery was 9.6 ± 5.0 years, syringomyelia was reported in 60.2% of patients, the dura mater was opened in 65.0% of patients, and 17.3% of patients underwent a redo surgery for additional treatment. The mean Chicago Chiari Outcome Scale score was 14.4 ± 1.5 at 3 months (n = 211) and 14.6 ± 1.9 at 12 months (n = 157). The hierarchical clustering method identified three subgroups with potentially distinct mechanisms underlying tonsillar herniation: bony compression, basilar invagination, and foramen magnum obstruction. Each cluster matched with specific outcomes. CONCLUSIONS This French multicenter retrospective cohort study enabled the identification of three subgroups among pediatric patients who underwent surgery for CM-I, each of which was associated with specific outcomes. This morphological classification of patients might help in understanding the underlying mechanisms and providing personalized treatment.
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Affiliation(s)
| | - Sandro Benichi
- 2Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris
| | - Maxime Taverne
- 3Craniofacial Growth and Form, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris
| | - Giovanna Paternoster
- 2Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris.,12Department of Pediatric Neurosurgery, CHU Timone Enfant, Marseille, France
| | - Alice Rolland
- 4Department of Pediatric Neurosurgery, Montpellier University Hospital, Montpellier
| | - Pierre Antherieu
- 5Department of Neurosurgery, Toulouse University Hospital, Toulouse
| | - Julien Todeschi
- 6Department of Neurosurgery, Strasbourg University Hospital, Strasbourg
| | | | - Vianney Gilard
- 8Department of Neurosurgery, Rouen University Hospital, Rouen
| | | | - Luc Le Fournier
- 1Department of Neurosurgery, Angers University Hospital, Angers
| | - Vincent Jecko
- 7Department of Pediatric Neurosurgery, Bordeaux University Hospital, Bordeaux
| | - Edouard Gimbert
- 7Department of Pediatric Neurosurgery, Bordeaux University Hospital, Bordeaux
| | - François Proust
- 6Department of Neurosurgery, Strasbourg University Hospital, Strasbourg
| | - Sergio Boetto
- 5Department of Neurosurgery, Toulouse University Hospital, Toulouse
| | - Thomas Roujeau
- 4Department of Pediatric Neurosurgery, Montpellier University Hospital, Montpellier
| | - Syril James
- 2Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris.,10Department of Neurosurgery, French Reference Center for Chiari and Rare Vertebral and Medullary Malformations (C-MAVEM), Montpellier University Hospital, Montpellier
| | - Roman H Khonsari
- 3Craniofacial Growth and Form, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris.,11Department of Pediatric Maxillofacial and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris; and
| | - Laurent Riffaud
- 9Department of Neurosurgery, Rennes University Hospital, Rennes
| | - Matthieu Delion
- 1Department of Neurosurgery, Angers University Hospital, Angers
| | - Michel Zerah
- 2Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris.,10Department of Neurosurgery, French Reference Center for Chiari and Rare Vertebral and Medullary Malformations (C-MAVEM), Montpellier University Hospital, Montpellier
| | - Didier Scavarda
- 12Department of Pediatric Neurosurgery, CHU Timone Enfant, Marseille, France
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Jecko V, Roblot P, Mongardi L, Ollivier M, Piccoli ND, Charleux T, Wavasseur T, Gimbert E, Liguoro D, Chotard G, Vignes JR. Intramedullary Spinal Cord Lesions: A Single-Center Experience. Neurospine 2022; 19:108-117. [PMID: 35378585 PMCID: PMC8987546 DOI: 10.14245/ns.2143190.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/17/2022] [Indexed: 12/20/2022] Open
Abstract
Objective: Spinal cord tumors constitute a small part of spinal surgery owing to their rarity. This retrospective study describes their current management.Methods: Forty-eight patients were treated for an intramedullary tumor between 2014 and 2020 at a single institution. Patients’ files were retrospectively studied. We detailed clinical status according to neurological deficit and ambulatory ability using the modified McCormick Scale, radiological features like number of levels, associated syringomyelia, surgical technique with or without intraoperative electrophysiological monitoring, pathological findings, and postoperative outcome.Results: The median age of this population was 43 years, including 5 patients under 18 years. The median delay before first neurosurgical contact was 3 months after the first clinical complaint. Treatment was gross total resection in 43.8%, subtotal resection in 50.0%, and biopsy in 6.2%. A laminectomy was performed for all the patients except 2 operated using the laminoplasty technique. Pathological findings were ependymoma in 43.8%, hemangioblastoma in 20.8%, and pilocytic astrocytoma in 10.4%. Six patients were reoperated for a tumor recurrence less than 2 years after the first surgical resection. One patient was reoperated for a postoperative cervical kyphosis.Conclusion: Intramedullary tumors are still a challenging disease and they are treated by various surgical techniques. They must be managed in a specialized center including a trained surgical, radiological, electrophysiological, and pathological team. Arthrodesis must be discussed before performing extensive laminectomy to avoid postoperative kyphosis.
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Affiliation(s)
- Vincent Jecko
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Paul Roblot
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Lorenzo Mongardi
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Morgan Ollivier
- Department of Diagnostic and Therapeutic Neuroimaging, Pellegrin Hospital, Bordeaux, France
| | - Natalia Delgado Piccoli
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
- Department of Clinical Neurophysiology, University Hospital of Bordeaux, Bordeaux, France
| | - Thomas Charleux
- Department of Radiotherapy, University Hospital of Bordeaux, Bordeaux, France
| | - Thomas Wavasseur
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | - Dominique Liguoro
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | - Guillaume Chotard
- Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
| | - Jean-Rodolphe Vignes
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
- Corresponding Author Jean-Rodolphe Vignes https://orcid.org/0000-0003-0647-8657 Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
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7
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Laine G, Baldi I, Jecko V, Betancourt Z, Bertaud E, Huchet A, Menegon P, Eimer S, Chotard G, Cuny E, Gimbert E, Liguoro D, Mollier O, Monteil P, Penchet G, Vignes JR, Wavasseur T, Loiseau H, Engelhardt J. Descriptive epidemiology of ependymal tumors in Gironde, France: results from the Gironde Registry for the 2000-2018 period. Neuroepidemiology 2022; 56:250-260. [PMID: 35320802 DOI: 10.1159/000523954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Gironde Central Nervous System (CNS) Tumor Registry, in collaboration with the French National Cancer Institute, is the largest population-based registry focused exclusively on primary CNS tumors in France and represents a population of 1.62 million. This report focuses on ependymal tumors to refine current knowledge and provide up-to-date data on the epidemiology of these rare tumors. MATERIAL AND METHODS All of the ependymal tumors were extracted from the Gironde CNS Tumor Registry for the years 2000 to 2018. Demographic and clinical characteristics, incidence rates and time trends as well as survival outcomes were analyzed. RESULTS One hundred and forty-four ependymal tumors were retrieved, which represented 2.3% of all the CNS tumors recorded in the same period. Histological subtype was significantly dependent on age and topography in the CNS. The median age at diagnosis was 46 years old. The annual incidence rates varied between 0.15/100,000 (2004) and 0.96/100,000 (2016), with a significant increase over the study period by 4.67% per year. Five-year and 10-year OS rates were 87% and 80%, respectively. CONCLUSION An increase in the incidence of ependymal tumors was observed over the past two decades. Further studies are needed to confirm this result and provide etiological clues.
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Affiliation(s)
- Gaëtan Laine
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Isabelle Baldi
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Vincent Jecko
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Zamira Betancourt
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Emilie Bertaud
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Aymeri Huchet
- Department of Radiation Oncology, CHU de Bordeaux, Bordeaux, France
| | - Patrice Menegon
- Department of Neuroradiology, CHU de Bordeaux, Bordeaux, France
| | - Sandrine Eimer
- Department of Pathology, CHU de Bordeaux, Bordeaux, France
| | | | - Emmanuel Cuny
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | | | - Olivier Mollier
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | - Pascal Monteil
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
| | | | | | | | - Hugues Loiseau
- Department of Neurosurgery, CHU de Bordeaux, Bordeaux, France
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8
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Rahal F, Capdevielle C, Rousseau B, Yzotte J, Dupuy JW, Cappellen D, Chotard G, Ménard M, Charpentier J, Jecko V, Caumont C, Gimbert E, Grosset CF, Hagedorn M. An EZH2 blocker sensitizes histone mutated diffuse midline glioma to cholesterol metabolism inhibitors through an off-target effect. Neurooncol Adv 2022; 4:vdac018. [PMID: 35300150 PMCID: PMC8923007 DOI: 10.1093/noajnl/vdac018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Diffuse Midline Glioma, H3K27M-mutant (DMG) is a rare, highly aggressive pediatric tumor affecting the brainstem, and is one of the deadliest cancers. Currently available treatment options such as chemotherapy and radiotherapy do only modestly prolong survival. In this pathology, H3K27 mutations deregulate Polycomb Repressive Complex 2 (PRC2), including enzymatic activity of EZH2, which is therefore under investigation as a therapeutic target. Methods We used a chemical EZH2 inhibitor, GSK126, small interfering RNAs, and a CRISPR/Cas9 knockout approaches in a series of DMG tumor cell lines to investigate metabolic treatment responses by proteomic analysis. A combination strategy was elaborated and studied in primary and established DMG cells, spheroid 3D cultures, and in vivo in a chick chorio-allantoic membrane DMG assay and an orthotopic intracranial DMG mouse model. Results GSK126 shows significant (P < .05–.001) inhibitory effects in in vitro cell proliferation assays and induces apoptosis. Chemical targeting of EZH2 induced expression of proteins implicated in cholesterol metabolism. Low-dose GSK126 treatment together with statins revealed strong growth inhibition in combinatorial treatments, but not in single treatments, both in DMG cells in vitro, in DMG spheroid cultures, and in chick and mouse in vivo models (P < .05). All statistical tests were two-sided. Conclusions Our results reveal an unexpected GSK126-inducible sensitivity to cholesterol biosynthesis inhibitors in highly aggressive pediatric glioma that warrants further evaluation as treatment strategy. This combinatorial therapy should have few side effects because of the low doses used to achieve significant anti-tumor activity.
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Affiliation(s)
- Farah Rahal
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Inserm U1035, Bâtiment TP Zone Sud, Bordeaux, France
| | - Caroline Capdevielle
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Inserm U1035, Bâtiment TP Zone Sud, Bordeaux, France
| | - Benoit Rousseau
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Animalerie A2, Univ. Bordeaux, Bordeaux Cedex
| | - Julien Yzotte
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Animalerie A2, Univ. Bordeaux, Bordeaux Cedex
| | | | - David Cappellen
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Inserm U1035, Bâtiment TP Zone Sud, Bordeaux, France
| | - Guillaume Chotard
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, place Amélie Raba Léon, Bordeaux CEDEX, France
| | - Mélissa Ménard
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Inserm U1035, Bâtiment TP Zone Sud, Bordeaux, France
| | - Justine Charpentier
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Inserm U1035, Bâtiment TP Zone Sud, Bordeaux, France
| | - Vincent Jecko
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, place Amélie Raba Léon, Bordeaux CEDEX, France
| | - Charline Caumont
- Department of Pathology, Hôpital Pellegrin, Bordeaux University Hospital, place Amélie Raba Léon, Bordeaux CEDEX, France
| | - Edouard Gimbert
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, place Amélie Raba Léon, Bordeaux CEDEX, France
| | - Christophe F Grosset
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Inserm U1035, Bâtiment TP Zone Sud, Bordeaux, France
| | - Martin Hagedorn
- Univ Bordeaux, Campus de Carreire/Victoire, Sciences de la santé/Sciences de l'Homme, Bordeaux CEDEX, France
- Inserm U1035, Bâtiment TP Zone Sud, Bordeaux, France
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9
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Lainé G, Jecko V, Wavasseur T, Gimbert E, Vignes JR, Liguoro D. Anatomy of the greater occipital nerve: implications in posterior fossa approaches. Surg Radiol Anat 2022; 44:573-583. [PMID: 35201375 DOI: 10.1007/s00276-022-02906-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Because of its superficial location in the dorsal regions of the scalp, the greater occipital nerve (GON) can be injured during neurosurgical procedures, resulting in post-operative pain and postural disturbances. The aim of this work is to specify the course of the GON and how its injuries can be avoided while performing posterior fossa approaches. METHODS This study was carried out at the department of anatomy at Bordeaux University. 4 specimens were dissected to study the GON course. Posterior fossa approaches (midline suboccipital, paramedian suboccipital, retrosigmoid and petrosal) were performed on 4 other specimens to assess potential risks of GON injuries. RESULTS The GON runs around the obliquus capitis inferior (100%), crosses the semispinalis capitis (100%) and the trapezius (75%) or its aponeurosis (25%). Direct GON injuries can be seen in paramedian suboccipital approaches. Stretching of the GON can occur in midline suboccipital and paramedian suboccipital approaches. We found no evidence of direct or indirect GON injury in retrosigmoid or petrosal approaches. CONCLUSION Our study provides interesting data regarding the risk GON injury in posterior fossa approaches. Direct GON injuries in paramedian suboccipital approaches can be avoided with careful dissection. Placing retractors in contact with the periosteum and performing a minimal retraction may help to avoid excessive GON stretching in midline suboccipital and paramedian suboccipital approaches. Furthermore, the incision for retrosigmoid approaches should be as lateral as possible and not too caudal. Finally, avoiding extreme patient positioning reduces the risk of GON stretching in all approaches.
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Affiliation(s)
- G Lainé
- Department of Neurosurgery A, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France.
| | - V Jecko
- Department of Neurosurgery A, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - T Wavasseur
- Department of Neurosurgery A, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - E Gimbert
- Department of Neurosurgery A, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - J R Vignes
- Department of Neurosurgery A, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - D Liguoro
- Department of Neurosurgery A, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
- Department of Anatomy, Bordeaux University, 146 rue Léo Saignat, Bordeaux, France
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10
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Tauziède-Espariat A, Chotard G, le Loarer F, Baud J, Azmani R, Dangouloff-Ros V, Boddaert N, Icher-de-Bouyn C, Gimbert E, Hasty L, Métais A, Chrétien F, Varlet P. A novel LARGE1-AFF2 fusion expanding the molecular alterations associated with the methylation class of neuroepithelial tumors with PATZ1 fusions. Acta Neuropathol Commun 2022; 10:15. [PMID: 35115049 PMCID: PMC8812055 DOI: 10.1186/s40478-022-01317-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022] Open
Abstract
A novel DNA methylation class of tumor within the central nervous system, the "neuroepithelial tumor (NET), PATZ1 fusion-positive" has recently been identified in the literature, characterized by EWSR1- and MN1-PATZ1 fusions. The cellular origin of this tumor type remains unknown, wavering between glioneuronal or mesenchymal (as round cell sarcomas with EWSR1-PATZ1 of the soft tissue). Because of the low number of reported cases, this tumor type will not be added to the 2021 World Health Organization Classification of Tumors of the Central Nervous System (CNS). Herein, we report one case of a CNS tumor classified by DNA methylation analysis as NET-PATZ1 but harboring a novel LARGE1-AFF2 fusion which has until now never been described in soft tissue or the CNS. We compare its clinical, histopathological, immunophenotypical, and genetic features with those previously described in NET-PATZ1. Interestingly, the current case presented histopathological (astroblastoma-like features, glioneuronal phenotype), clinical (with a favorable course), genetic (1p loss), and epigenetic (DNA-methylation profiling) similarities to previously reported cases of NET-PATZ1. Our results added data suggesting that different histomolecular tumor subtypes seem to be included within the methylation class "NET, PATZ1 fusion-positive", including non PATZ1 fusions, and that further cases are needed to better characterize them.
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11
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Roblot P, Mollier O, Ollivier M, Gallice T, Planchon C, Gimbert E, Danet M, Renault S, Auzou N, Laurens B, Jecko V. Communicating chronic hydrocephalus: A review. Rev Med Interne 2021; 42:781-788. [PMID: 34144842 DOI: 10.1016/j.revmed.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
Formerly called normal pressure hydrocephalus, communicating chronic hydrocephalus (CCH) is a condition affecting 0.1 to 0.5% of patients over 60years of age. The pathophysiology of this disease is poorly understood, but a defect in cerebrospinal fluid (CSF) resorption appears to be commonly defined as the cause of the neurological disorders. The last important discovery is the description of the glymphatic system and its implication in CCH and CSF resorption. Comorbidities (Alzheimer's disease, microangiopathy, parkinsonism) are very frequent, and involve a diagnostic challenge. The clinical presentation is based on the Hakim and Adams triad, comprising gait disorders, mainly impairing walking, cognitive disorders, affecting executive functions, episodic memory, visuospatial cognition, and sphincter disorders as urinary incontinence (detrusor hyperactivity). The diagnosis is suspected through a set of arguments, combining the clinical presentation, the radiological data of the magnetic resonance imaging (MRI) showing a ventriculomegaly associated with signs of transependymomous resorption of the CSF and disappearance of the cortical sulci, and the clinical response to the depletion of CSF. In the presence of all these elements, or a strong clinical suspicion, the standard treatment will be of a permanent CSF shunt, using a ventriculoatrial or ventriculoperitoneal shunt. The effectiveness of this treatment defines the diagnosis. The clinical improvement is better when treatment occurs early after the onset of the disorders, reaching 75 to 90% of motor improvement.
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Affiliation(s)
- P Roblot
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Laboratory of anatomy, university of Bordeaux, Bordeaux, France.
| | - O Mollier
- Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - M Ollivier
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - T Gallice
- Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Department of critical care, Bordeaux university hospital, 33076 Bordeaux, France
| | - C Planchon
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Neurosurgery department B, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - E Gimbert
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - M Danet
- Department of geriatric medicine, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - S Renault
- Department of neurology, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - N Auzou
- Institute for neurodegenerative diseases, CNRS UMR 5293, university Bordeaux, Bordeaux, France
| | - B Laurens
- Department of neurology, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Institute for neurodegenerative diseases, CNRS UMR 5293, university Bordeaux, Bordeaux, France
| | - V Jecko
- Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Université de Bordeaux, CNRS UMR 5287, INCIA, Zone nord, Bat 2, 2e étage, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France
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12
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Engelhardt J, Nunes ML, Pouchieu C, Ferrière A, San-Galli F, Gimbert E, Vignes JR, Laurent F, Berge J, Baldi I, Tabarin A, Loiseau H. Increased Incidence of Intracranial Meningiomas in Patients With Acromegaly. Neurosurgery 2021; 87:639-646. [PMID: 31625569 DOI: 10.1093/neuros/nyz438] [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] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND An increased incidence of various neoplasms has been described in patients with acromegaly, and there is evidence to suggest that growth factors are risk factors for the development of meningiomas. OBJECTIVE To study if patients with acromegaly are more at risk for developing intracranial meningiomas. METHODS We conducted an observational study on 221 consecutive acromegalic patients recruited between January 1, 2000 and December 31, 2015, and 357 consecutive patients with a nonsomatotropic pituitary adenoma recruited between March 1, 2015 and December 31, 2016, in our institution. Patients underwent a gadolinium-enhanced 3D T1 brain magnetic resonance imaging to look for meningiomas. The proportion of meningiomas was compared between the 2 groups, and the standardized incidence ratio (SIR) was computed from the incidence rates of meningiomas observed in the population of acromegalic patients and compared to that of the general population given by the local registry of central nervous system tumors. RESULTS Patients with acromegaly had a significant risk for developing intracranial meningiomas as compared to patients without acromegaly (7.7% vs 2.2%, P = .005, OR = 3.45 [1.46; 8.15]). There was a significant increased incidence of intracranial meningiomas in patients with acromegaly (SIR = 126 [25; 367]) as compared to the general population. CONCLUSION Our study suggests strongly that patients with acromegaly are more at risk for developing intracranial meningiomas.
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Affiliation(s)
- Julien Engelhardt
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Marie-Laure Nunes
- Department of Endocrinology, Hôpital du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Camille Pouchieu
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Amandine Ferrière
- Department of Endocrinology, Hôpital du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - François San-Galli
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Edouard Gimbert
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Rodolphe Vignes
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - François Laurent
- Department of Thoracic, Digestive and Endocrine Imaging, Hôpital du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Jérôme Berge
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Isabelle Baldi
- Bordeaux Population Health Research Center, Team Epicene, UMR 1219, University of Bordeaux, INSERM, Bordeaux, France
| | - Antoine Tabarin
- Department of Endocrinology, Hôpital du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Hugues Loiseau
- Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France.,EA 7435 - IMOTION, University of Bordeaux, Bordeaux, France
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13
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Le Petit L, Liguoro D, Gimbert E, Jecko V. Lésions craniocérébrales induites par Flashball : à propos de 4 cas et revue de la littérature. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.04.047] [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] [Indexed: 11/28/2022]
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14
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Di Rocco F, Scavarda D, Vinchon M, Szathmari A, Riffaud L, Bohra A, Blauwblomme T, Boetto S, Gimbert E, Ferrand S, Coca A, Chivoret N, Coll G, Delion M, Roujeau T, Mottolese C, Zerah M. Impact de la pandémie COVID-19 sur la neurochirurgie pédiatrique en France. Neurochirurgie 2020; 66:192-194. [PMID: 32504645 PMCID: PMC7833797 DOI: 10.1016/j.neuchi.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022]
Affiliation(s)
- F Di Rocco
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France.
| | - D Scavarda
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Vinchon
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Szathmari
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - L Riffaud
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Bohra
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - T Blauwblomme
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - S Boetto
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - E Gimbert
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - S Ferrand
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Coca
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - N Chivoret
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - G Coll
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Delion
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - T Roujeau
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - C Mottolese
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Zerah
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
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- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
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Engelhardt J, Nunes M, Pouchieu C, San-Galli F, Gimbert E, Vignes J, Laurent F, Berge J, Baldi I, Tabarin A, Loiseau H. P09.08 Increased incidence of intracranial meningiomas in patients with acromegaly. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.140] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
An increased incidence of various neoplasms has been described in patients with acromegaly and there is evidence to suggest that growth factors are risk factors for the development of meningiomas. We aimed to study if patients with acromegaly are more at risk for developing intracranial meningiomas
MATERIAL AND METHODS
We conducted an observational study on 221 consecutive acromegalic patients recruited between January 1, 2000 and December 31, 2015, and 357 consecutive patients with a non-somatotropic pituitary adenoma recruited between March 1, 2015 and December 31, 2016 in our institution. Patients underwent a gadolinium-enhanced 3D T1 brain MRI to look for meningiomas. The proportion of meningiomas was compared between the two groups and the standardized incidence ratio (SIR) was computed from the incidence rates of meningiomas observed in the population of acromegalic patients and compared to that of the general population given by the local registry of central nervous system tumors.
RESULTS
Patients with acromegaly had a significant risk for developing intracranial meningiomas as compared to patients without acromegaly (7.7% vs. 2.2%, p = .005, OR = 3.45 [1.46; 8.15]). There was a significant increased incidence of intracranial meningiomas in patients with acromegaly (SIR = 126 [25; 367]) as compared to the general population.
CONCLUSION
Our study provides the first evidence that patients with acromegaly are more at risk for developing intracranial meningiomas.
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Affiliation(s)
| | - M Nunes
- CHU de Bordeaux, Bordeaux, France
| | - C Pouchieu
- Université de Bordeaux, Bordeaux, France
| | | | | | - J Vignes
- CHU de Bordeaux, Bordeaux, France
| | | | - J Berge
- CHU de Bordeaux, Bordeaux, France
| | - I Baldi
- Université de Bordeaux, Bordeaux, France
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16
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Manfiotto M, Beccaria K, Rolland A, Paternoster G, Plas B, Boetto S, Vinchon M, Mottolese C, Beuriat PA, Szathmari A, Di Rocco F, Scavarda D, Seigneuret E, Wrobleski I, Klein O, Joud A, Gimbert E, Jecko V, Vignes JR, Roujeau T, Dupont A, Zerah M, Lonjon M. Decompressive Craniectomy in Children with Severe Traumatic Brain Injury: A Multicenter Retrospective Study and Literature Review. World Neurosurg 2019; 129:e56-e62. [PMID: 31054345 DOI: 10.1016/j.wneu.2019.04.215] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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17
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Manfiotto M, Di Rocco F, Zerah M, Scavarda D, Vinchon M, Klein O, Gimbert E, Roujeau T. Decompressive Craniectomy and CSF disorders in children. Neurochirurgie 2018. [DOI: 10.1016/j.neuchi.2018.05.035] [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] [Indexed: 10/28/2022]
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18
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Beccaria K, Tauziède-Espariat A, Monnien F, Adle-Biassette H, Masliah-Planchon J, Pierron G, Maillot L, Polivka M, Laquerrière A, Bouillot-Eimer S, Gimbert E, Gauchotte G, Coffinet L, Sevestre H, Alapetite C, Bolle S, Thompson D, Bouazza S, George B, Zérah M, Sainte-Rose C, Puget S, Varlet P. Pediatric Chordomas: Results of a Multicentric Study of 40 Children and Proposal for a Histopathological Prognostic Grading System and New Therapeutic Strategies. J Neuropathol Exp Neurol 2018; 77:207-215. [DOI: 10.1093/jnen/nlx118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kévin Beccaria
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Franck Monnien
- Department of Pathology, Jean Minjoz Hospital, Besançon, France
| | | | | | - Gaëlle Pierron
- Department of Oncogenetics, Curie Institute, Paris, France
| | | | - Marc Polivka
- Department of Pathology, Lariboisière Hospital, APHP, Paris, France
| | | | | | - Edouard Gimbert
- Department of Pediatric Neurosurgery, Pellegrin Hospital, Bordeaux, France
| | | | - Laurent Coffinet
- Department of Pediatric Otorhinolaryngology, Nancy Hospital, Nancy, France
| | - Henri Sevestre
- Department of Pathology, Amiens Hospital, Amiens, France
| | - Claire Alapetite
- Department of Radiation Oncology & Proton Centre, Institut Curie, Paris and Orsay, France
| | - Stéphanie Bolle
- Department of Radiotherapy, Gustave Roussy Institute, Villejuif, France
| | - Dominic Thompson
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Bernard George
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France
| | - Michel Zérah
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christian Sainte-Rose
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Stéphanie Puget
- Department of Pediatric Neurosurgery, Necker Hospital, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Radiotherapy, Gustave Roussy Institute, Villejuif, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France
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19
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Manfiotto M, Mottolese C, Szathmari A, Beuriat PA, Klein O, Vinchon M, Gimbert E, Roujeau T, Scavarda D, Zerah M, Di Rocco F. Decompressive craniectomy and CSF disorders in children. Childs Nerv Syst 2017; 33:1751-1757. [PMID: 29149390 DOI: 10.1007/s00381-017-3542-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Decompressive craniectomy (DC) is a lifesaving procedure but is associated to several post-operative complications, namely cerebrospinal fluid (CSF) dynamics impairment. The aim of this multicentric study was to evaluate the incidence of such CSF alterations after DC and review their impact on the overall outcome. MATERIAL AND METHODS We performed a retrospective multicentric study to analyze the CSF disorders occurring in children aged from 0 to 17 years who had undergone a DC for traumatic brain injury (TBI) in the major Departments of Pediatric Neurosurgery of France between January 2006 and August 2016. RESULTS Out of 150 children, ranging in age between 7 months and 17 years, mean 10.75 years, who underwent a DC for TBI in 10 French pediatric neurosurgical centers. Sixteen (6 males, 10 females) (10.67%) developed CSF disorders following the surgical procedure and required an extrathecal CSF shunting. External ventricular drainage increased the risk of further complications, especially cranioplasty infection (p = 0.008). CONCLUSION CSF disorders affect a minority of children after DC for TBI. They may develop early after the DC but they may develop several months after the cranioplasty (8 months), consequently indicating the necessity of clinical and radiological close follow-up after discharge from the neurosurgical unit. External ventricular drainage and permanent CSF shunt placement increase significantly the risk of cranioplasty infection.
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Affiliation(s)
| | - Carmine Mottolese
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France
| | - Alexandru Szathmari
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France
| | - Pierre-Aurelien Beuriat
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France
| | - Olivier Klein
- Centre Hospitalier Universitaire de Nancy, Nancy, France
| | | | - Edouard Gimbert
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Thomas Roujeau
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Didier Scavarda
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | | | - Federico Di Rocco
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France.
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Fonmarty D, Bastier PL, Lechot A, Gimbert E, de Gabory L. Assessment of Abdominal Fat Graft to Repair Anterior Skull Base after Malignant Sinonasal Tumor Extirpation. Otolaryngol Head Neck Surg 2015; 154:540-6. [DOI: 10.1177/0194599815620781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/13/2015] [Indexed: 11/15/2022]
Abstract
Objective Adult abdominal fat, which is known to contain pluripotent stem cells, is frequently used to treat cerebrospinal fluid leak. The aim of this study was to assess the efficacy and reliability of abdominal fat graft to close large skull base defects after extirpation of malignant sinonasal tumors. Study Design Case series with chart review performed between 2009 and 2014. Subjects and Methods Twenty-nine cases were included of consecutive patients who were suffering from malignant sinonasal tumors, operated by an endoscopic endonasal approach with anterior skull base extirpation and surgically induced cerebrospinal fluid leak. Skull base was repaired by 1 layer of “en bloc” autologous fat graft used as a plug in the onlay position. Epidemiologic data, medical history, defect size, length of hospitalization, and morbidity were analyzed. Results Radiotherapy was given pre- and postoperatively in 4 (13.8%) and 23 (79.3%) patients, respectively. Mean defect size was 4.47 ± 2.9 cm2 (range, 0.24-9.1 cm2). Mean operative time was 210 ± 86 minutes. Mean length of hospitalization was 8.6 ± 3.7 days and 4.9 ± 2 days in the intensive care unit. No lumbar drain was used in this study. There was 1 case of cerebrospinal fluid leak (3.5%) and 2 cases of meningitis (6.9%), which resolved after medical treatment. Mean follow-up was 17 ± 13 months (range, 3-53 months). Conclusion Abdominal fat graft is a safe and reliable material to close the anterior skull base after extirpation of malignant sinonasal tumors.
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Affiliation(s)
- David Fonmarty
- ENT Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Amandine Lechot
- ENT Department, University Hospital of Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
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21
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Marnat G, Gimbert E, Berge J, Rougier MB, Molinier S, Dousset V. Chiasmatic cavernoma haemorrhage: To treat or not to treat? Concerning a clinical case. Neurochirurgie 2015; 61:343-6. [DOI: 10.1016/j.neuchi.2015.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/15/2015] [Accepted: 05/23/2015] [Indexed: 11/27/2022]
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22
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Gimbert E, Jecko V, Dautheribes M, Pena D, Penna M, Maachi B, Chehab A, Sesay M, Stockle M, Morel-Lequette L, Joubert C, Kolanek B, Liguoro D, Vignes JR. Réduction du taux de tansfusion lors de la chirurgie des crâniosténoses. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.098] [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] [Indexed: 12/01/2022]
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23
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Carlucci L, De Pomerol M, Laguerre D, Gimbert E, Dautheribes M, San-Galli F, Liguoro D, Le-Gall M, Vignes JR. [Intracranial hemorrhage in adults: place of antithrombotic treatment]. Neurochirurgie 2013; 59:17-22. [PMID: 23414772 DOI: 10.1016/j.neuchi.2012.10.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 10/12/2012] [Accepted: 10/16/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Antithrombotic (anticoagulants and antiplatelets) are responsible for iatrogenic accidents, with a specific impact in neurosurgery. Bleeding complications are the most common and best-known. But the link to antiplatelet or to dual association of antithrombotic treatment with intracranial haemorrhage is not complete yet. We studied the proportion of patients under antithrombotic treatment, when an intracranial hemorrhage occurred, as well as the morbi-mortality of each group of patients (with or without antithrombotic treatment). Finally, we studied the proportion of off-label prescriptions. METHODS We conducted a monocentric and comprehensive prospective study on a group of patients. All patients that had been admitted for intracranial hemorrhage to our hospital, in a 5-month period were included in the study. RESULTS One hundred and sixty patients admitted for an intracranial hemorrhage were included during 70days of call. Seventy-four of these patients (46.25%) were under antithrombotic treatment: 40 under antiplatelet treatment (54%), 29 under anticoagulant treatment (39.2%), four under dual antithrombotic treatment (5.4%), and one under Arixtra(®). Half of the patients under antithrombotic treatment had poor prognosis as compared to 40% of patients without antithrombotic treatment. Off-label antithrombotic therapy was estimated at 27.3% of all prescriptions. CONCLUSIONS The prevalence of antithrombotic therapy in patients is high when intracranial hemorrhage occurs. Some complications could be avoided by decreasing the number of off-label prescriptions and by better controlling their use (using standardized INR). Antiplatelet treatments and new antithrombotic therapies require better drug monitoring which could be part of the establishment of a specific register.
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Affiliation(s)
- L Carlucci
- Service de neurochirurgie A, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
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24
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Vidal V, Darrouzet P, Gimbert E, Darrouzet V. Interest of Audiovestibular Workup in Chiari Malformation. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314416] [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] [Indexed: 10/28/2022]
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25
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Sindou M, Gimbert E. Decompression for Chiari type I-malformation (with or without syringomyelia) by extreme lateral foramen magnum opening and expansile duraplasty with arachnoid preservation: comparison with other technical modalities (Literature review). Adv Tech Stand Neurosurg 2009; 34:85-110. [PMID: 19368082 DOI: 10.1007/978-3-211-78741-0_4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Posterior craniocervical decompression is the procedure most currently used for treating Chiari I malformation (alone or in association with syringomyelia in the absence of hydrocephalus). We reviewed the various technical modalities reported in the literature. We present a personal series of 44 patients harboring Chiari type I malformation (CM-I) operated with a suboccipital craniectomy and a C1 (or C1/C2) laminectomy, plus an extreme lateral Foramen Magnum opening, a "Y" shaped dural incision with preservation of the arachnoid membrane, and an expansile duraplasty employing autogenous periosteum. Outcomes were analyzed with follow-up ranging from 1 to 10 years (4 years on average). The presented technique was compared with the other surgical modalities reported in the literature. This comparative study shows that this type of craniocervical decompression achieved the best results with minimal complications and side-effects. Syringomyelia associated with CM-I must be treated by craniocervical decompression alone. Shunting no longer appears to be an appropriate method of treatment for syringomyelia.
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Affiliation(s)
- M Sindou
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, University of Lyon, Lyon, France
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Vignes J, Sesay M, Rezajooi K, Gimbert E, Liguoro D. Peritumoral edema and prognosis in intracranial meningioma surgery. J Clin Neurosci 2008; 15:764-8. [DOI: 10.1016/j.jocn.2007.06.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/24/2007] [Accepted: 05/30/2007] [Indexed: 12/01/2022]
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27
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Gimbert E, Vignes JR, San Galli F, Liguoro D. Les voies d’abord transfaciales du clivus : limites d’exposition et application clinique. Neurochirurgie 2006. [DOI: 10.1016/s0028-3770(06)71252-8] [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] [Indexed: 10/22/2022]
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