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Laigle-Donadey F, Metellus P, Guyotat J, Menei P, Proust F, Dufour H, Chinot O, Honnorat J, Faillot T, Paquis P, Peruzzi P, Emery E, Guillamo JS, Carpentier A, Wager M, Lebbah S, Hajage D, Delattre JY, Cornu P, _ _. Surgery for glioblastomas in the elderly: an Association des Neuro-oncologues d’Expression Française (ANOCEF) trial. J Neurosurg 2022; 138:1199-1205. [PMID: 36242578 DOI: 10.3171/2022.8.jns221068] [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: 08/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The role of surgery in the treatment of malignant gliomas in the elderly is not settled. The authors conducted a randomized trial that compared tumor resection with biopsy only—both followed by standard therapy—in such patients.
METHODS
Patients ≥ 70 years of age with a Karnofsky Performance Scale (KPS) score ≥ 50 and presenting with a radiological suspicion of operable glioblastoma (GBM) were randomly assigned between tumor resection and biopsy groups. Subsequently, they underwent standard radiotherapy during the first years of the trial (2008–2017), with the addition of adjunct therapy with temozolomide when this regimen became standard (2017–2019). The primary endpoint was survival, and secondary endpoints were progression-free survival (PFS), cognitive status (Mini-Mental State Examination), autonomy (KPS), quality of life (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and QLQ-BN20), and perioperative morbidity and mortality.
RESULTS
Between 2008 and 2019, 107 patients from 9 centers were enrolled in the study; 101 were evaluable for analysis because a GBM was histologically confirmed (50 in the surgery arm and 51 in the biopsy arm). There was no statistically significant difference in median survival between the surgery (9.37 months) and the biopsy (8.96 months, p = 0.36) arms (adjusted HR 0.79, 95% CI 0.52–1.21, p = 0.28). However, the surgery group had an increased PFS (5.06 vs 4.02 months; p = 0.034) (adjusted HR 0.50, 95% CI 0.32–0.78, p = 0.002). Less deterioration of quality of life and KPS score evolution than in the biopsy group was observed. Surgery was not associated with increased mortality or morbidity.
CONCLUSIONS
This study suggests that debulking surgery is safe, and—compared to biopsy—is associated with a less severe deterioration of quality of life and autonomy, as well as a significant although modest improvement of PFS in elderly patients suffering from newly diagnosed malignant glioma. Although resection does not provide a significant survival benefit in the elderly, the authors believe that the risk/benefit analysis favors an attempt at optimal tumor resection in this population, provided there is careful preoperative geriatric evaluation.
Clinical trial registration no.: NCT02892708 (ClinicalTrials.gov)
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Affiliation(s)
- Florence Laigle-Donadey
- Department of Neurology 2, Pitié-Salpêtrière University Hospital, APHP, Sorbonne University, Paris
| | | | | | - Philippe Menei
- Department of Neurosurgery, University Hospital of Angers
| | | | | | | | - Jérôme Honnorat
- Neurooncology, University Hospital of Lyon HCL, Lyon
- NeuroMyogène Institute, Synaptopathies and Autoanticorps Team, University Claude Bernard of Lyon
| | | | | | | | | | | | - Alexandre Carpentier
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, APHP, Sorbonne University, Paris
| | - Michel Wager
- Department of Neurosurgery, University Hospital of Poitiers
| | - Said Lebbah
- Clinical Research Unit, Pitié-Salpêtrière University Hospital, APHP, Paris
| | - David Hajage
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, APHP Pitié-Salpêtrière University Hospital, Paris; and
- Department of Public Health, Pharmaco-epidemiological Center, Paris, France
| | - Jean-Yves Delattre
- Department of Neurology 2, Pitié-Salpêtrière University Hospital, APHP, Sorbonne University, Paris
| | - Philippe Cornu
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, APHP, Sorbonne University, Paris
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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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Darsaut TE, Magro E, Bojanowski MW, Chaalala C, Nico L, Bacchus E, Klink R, Iancu D, Weill A, Roy D, Sabatier JF, Cognard C, Januel AC, Pelissou-Guyotat I, Eker O, Roche PH, Graillon T, Brunel H, Proust F, Beaujeux R, Aldea S, Piotin M, Cornu P, Shotar E, Gaberel T, Barbier C, Corre ML, Costalat V, Jecko V, Barreau X, Morandi X, Gauvrit JY, Derrey S, Papagiannaki C, Nguyen TN, Abdalkader M, Tawk RG, Huynh T, Viard G, Gevry G, Gentric JC, Raymond J. Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 2022; 138:891-899. [PMID: 36087316 DOI: 10.3171/2022.7.jns22813] [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: 04/07/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. METHODS TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score > 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score > 2. RESULTS From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I-II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%-93%) and 105/110 low-grade (95%, 95% CI 90%-98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%-18%) had reached the primary safety outcome of mRS score > 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%-28%). Permanent treatment-related complications leading to mRS score > 2 occurred in 6/139 patients (4%, 95% CI 2%-9%), 5 (83%) of whom had complications due to preoperative embolization. CONCLUSIONS The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 (ClinicalTrials.gov).
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Affiliation(s)
- Tim E Darsaut
- 1Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Elsa Magro
- 2Department of Neurosurgery, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Brest, France
| | - Michel W Bojanowski
- 3Department of Surgery, Division of Neurosurgery, University of Montreal Health Centre (CHUM), Montreal, Quebec, Canada
| | - Chiraz Chaalala
- 3Department of Surgery, Division of Neurosurgery, University of Montreal Health Centre (CHUM), Montreal, Quebec, Canada
| | - Lorena Nico
- 4Division of Interventional Neuroradiology, Department of Radiology, CHU Saint-Etienne, North Hospital, Saint-Etienne, France
| | - Emma Bacchus
- 1Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Ruby Klink
- 5Research Centre of the University of Montreal Hospital Centre, Interventional Neuroradiology Research Laboratory (NRI), Montreal, Quebec, Canada
| | - Daniela Iancu
- 6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Alain Weill
- 6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Daniel Roy
- 6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Jean-Francois Sabatier
- 7Department of Neurosurgery, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Christophe Cognard
- 8Diagnostic and Therapeutic Neuroradiology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Anne-Christine Januel
- 8Diagnostic and Therapeutic Neuroradiology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | | | - Omer Eker
- 10Diagnostic and Interventional Neurological Imaging, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Graillon
- 12Department of Neurosurgery, Aix Marseille University, INSERM, AP-HM, MMG, UMR1251, Marmara Institute, La Timone Hospital, Marseille, France
| | - Hervé Brunel
- 13Department of Neuroradiology, La Timone Hospital, AP-HM, Marseille, France
| | - Francois Proust
- 14Department of Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - Rémy Beaujeux
- 15Department of Interventional Neuroradiology, University Hospital of Strasbourg, Strasbourg, France
| | | | - Michel Piotin
- 17Interventional Radiology, Adolphe de Rothschild Foundation Hospital, Paris, France
| | | | - Eimad Shotar
- 19Neuroradiology, Mercy Salpetriere Hospital AP-HP, Paris, France
| | | | - Charlotte Barbier
- 21Vascular and Interventional Imaging, CHU Caen Normandie, Caen, France
| | | | | | - Vincent Jecko
- 24Neurosurgery Department A, Pellegrin Hospital Group, CHU Bordeaux, Bordeaux, France
| | - Xavier Barreau
- 25Diagnostic and Therapeutic Neuroradiology Department, Pellegrin Hospital Group, CHU Bordeaux, Bordeaux, France
| | | | - Jean-Yves Gauvrit
- 27Neuroradiology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | | | | | - Thanh N Nguyen
- Departments of30Radiology.,31Neurology, and.,32Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Thien Huynh
- 34Radiology, Mayo Clinic, Jacksonville, Florida
| | - Geraldine Viard
- 35Clinical Investigation Center, CHU Brest, Brest, France; and
| | - Guylaine Gevry
- 5Research Centre of the University of Montreal Hospital Centre, Interventional Neuroradiology Research Laboratory (NRI), Montreal, Quebec, Canada
| | - Jean-Christophe Gentric
- 36Department of Interventional Neuroradiology, Cavale Blanche Hospital, Brest University Hospital, Brest, France
| | - Jean Raymond
- 5Research Centre of the University of Montreal Hospital Centre, Interventional Neuroradiology Research Laboratory (NRI), Montreal, Quebec, Canada.,6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
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Van Laere S, Tommelein E, Dreesen E, Buyl R, Cornu P. Discrepancies between ePrescriptions and dispensing in Belgium, 6 years after the launch of the electronic prescribing - a mixed-method study. Acta Clin Belg 2022; 77:377-386. [PMID: 33586629 DOI: 10.1080/17843286.2021.1885884] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The number of electronic prescriptions (ePrescriptions) grows steadily in Belgium as in other European countries. In the future, Belgium wants to dematerialize the ePrescription flow, removing all paper trails. A quality check of the digital content and implementation of national ePrescription guidelines in the field was conducted, comparing the content at both prescription and pharmacy side. METHODS An explanatory mixed-methods design was applied. In a first phase, potential problems (warning flags) were identified by consulting stakeholders. Secondly, the warning flags were validated to problems (errors) in a random set of ePrescriptions collected in April 2019. In a third phase, explanatory interviews were held with various stakeholders in order to find explanations and to identify the initiators of these errors. RESULTS In the first phase, 15 warning flags were identified to evaluate the quality of an ePrescription. In the second phase, a random selection of 11,798 ePrescriptions was validated. The most prevalent errors found, were the digital construction of the messages (18.88%), combined with lots of necessarily deemed substitutions by the pharmacist (3.39%) not following what was prescribed originally. In the third phase, stakeholders indicated that software of the prescriber and the use of inconsistent databases between prescriber and pharmacy can often be seen as the cause and initiator of these problems. CONCLUSIONS Use of authentic medication databases and well-designed software systems have the potential to solve ePrescription problems. Focus should go to prevention instead of detection.
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Affiliation(s)
- S. Van Laere
- Department of Public Health (GEWE), Vrije Universiteit Brussel, Brussels, Belgium
| | - E. Tommelein
- Department of Pharmaceutical Sciences (FARM), Drug Analysis and Drug Information (FASC), Vrije Universiteit Brussel, Brussels, Belgium
| | - E. Dreesen
- Tarification Service Koninklijk Limburgs Apothekers Verbond (KLAV), Hasselt, Belgium
| | - R. Buyl
- Department of Public Health (GEWE), Vrije Universiteit Brussel, Brussels, Belgium
| | - P. Cornu
- Centre for Pharmaceutical Research (Cephar), Vrije Universiteit Brussel, Brussels, Belgium
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Laigle-Donadey F, Metellus P, Guyotat J, Menei P, Proust F, Dufour H, Chinot O, Honnorat J, Faillot T, Paquis P, Peruzzi P, Emery E, Guillamo JS, Carpentier A, Wager M, Lebbah S, Hajage D, Delattre JY, Cornu P. PL03.1.A Surgery for glioblastomas in the elderly: an ANOCEF trial (CSA). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.003] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The role of surgery for the treatment of malignant gliomas in patients 70 years of age or older is unsettled. We conducted a randomized trial that compared surgical resection of the tumor and biopsy only, both followed by standard therapy, in such patients.
MATERIAL AND METHODS
Patients aged 70 years and older, with a KPS of at least 50, presenting with a radiological suspicion of an operable glioblastoma (GBM) were randomly assigned between tumor resection and biopsy. Subsequently, they underwent standard radiotherapy during the first years of the trial (2008–2017), with the adjunction of concomitant and adjuvant temozolomide when this regimen became standard (2017–2019). The primary end point was survival; secondary endpoints were progression free survival (PFS), cognitive status (MMS), autonomy (KPS), quality of life (EORTC QLQ C30 and BN20), and perioperative morbidity/ mortality.
RESULTS
From 2008 to 2019, 107 patients from 9 centers were enrolled in the study, of whom 101 were evaluable for analysis because the diagnosis of GBM was histologically confirmed (50 patients in the “surgery” arm and 51 patients in the “biopsy” arm). There was no statistically significant difference of median survival between the “surgery” arm (9.37 mo) and the “biopsy” arms (8.96 mo, p=0.36). However, the surgery group had increased PFS (5.06 mo vs 4.02 mo; p=0.034; p=0.002 on multivariate analysis) and better QOL (e.g. physical and cognitive functioning, motor dysfunction, fatigue) and KPS score evolution as compared to the “biopsy” group. Surgery was not associated with increased mortality or morbidity.
CONCLUSION
This study suggests that optimal debulking surgery does not provide a significant survival benefit in elderly patients suffering from newly diagnosed malignant glioma, but resection improves QOL and autonomy with a significant though modest improvement of PFS.
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Affiliation(s)
| | - P Metellus
- Hôpital Privé Clairval, Marseille, France
| | | | - P Menei
- CHU d’Angers, Angers, France
| | - F Proust
- Hôpital Charles Nicolle, Rouen, France
| | - H Dufour
- Hôpital de la Timone, Marseille, France
| | - O Chinot
- Hôpital de la Timone, Marseille, France
| | | | | | | | | | | | | | | | - M Wager
- CHU de Poitiers, Poitiers, France
| | - S Lebbah
- Hôpital Pitié-Salpêtrière, Paris, France
| | - D Hajage
- Hôpital Pitié-Salpêtrière, Paris, France
| | | | - P Cornu
- Hôpital Pitié-Salpêtrière, Paris, France
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Dechambenoit G, Moreau JJ, Roche PH, Cornu P. Sustainable neurosurgical training around the globe. A review and outline. Neurochirurgie 2021; 67:599-605. [PMID: 33753129 DOI: 10.1016/j.neuchi.2021.03.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/25/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Abstract
Sharing an equal and quality neurosurgical training across the globe without exclusion may seem utopian. However, such training is possible through educational opportunities and the ongoing digital revolution. The aim is to present the current state of neurosurgery training and education methods indicating strengths, weaknesses and opportunities. The thoughts, comments and suggestions of the authors are based on their academic experiences, training missions around the world and particularly in low- and middle-income countries by pointing out the French experience. The learning must be interactive and programmed over time, integrating varied courses and activities. Virtual reality and neurosurgical simulation need to be developed. The content of the teaching including e-learning must be evidence-based and peer-reviewed. Pedagogical training of trainers is fundamental. It is critical to evaluate the training under real working conditions. The optimization of human resources should create economies of scale that would attenuate the financial burden. The commitment of the teams, tutoring are success factors.
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Affiliation(s)
- G Dechambenoit
- Neurochirurgie, CMCO Côte d'Opale Route de Desvres, 62280 Saint Martin Boulogne, France.
| | - J-J Moreau
- Département Universitaire d'Enseignement Numérique en Santé, Faculté de Médecine, 2, rue Dr Marcland, 87025 Limoges cedex, France.
| | - P-H Roche
- Neurochirurgie Hôpital Nord, Pôle NEUROSCIENCES, Hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - P Cornu
- Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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7
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Amelot A, Nataloni A, François P, Cook AR, Lejeune JP, Baroncini M, Hénaux PL, Toussaint P, Peltier J, Buffenoir K, Hamel O, Hieu PD, Chibbaro S, Kehrli P, Lahlou MA, Menei P, Lonjon M, Mottolese C, Peruzzi P, Mahla K, Scarvada D, Le Guerinel C, Caillaud P, Nuti C, Pommier B, Faillot T, Iakovlev G, Goutagny S, Lonjon N, Cornu P, Bousquet P, Sabatier P, Debono B, Lescure JP, Vicaut E, Froelich S. Security and reliability of CUSTOMBONE cranioplasties: A prospective multicentric study. Neurochirurgie 2021; 67:301-309. [PMID: 33667533 DOI: 10.1016/j.neuchi.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/01/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.
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Affiliation(s)
- A Amelot
- Neurosurgery department, Hôpital de Bretonneau, Tours, France.
| | - A Nataloni
- Clinical research department, Finceramica Faenza S.p.A, Ravenna, Italy
| | - P François
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - A-R Cook
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - J-P Lejeune
- Neurosurgery department, CHRU Lille, Lille, France
| | - M Baroncini
- Neurosurgery department, CHRU Lille, Lille, France
| | - P-L Hénaux
- Neurosurgery department, CHU Rennes, Rennes, France
| | - P Toussaint
- Neurosurgery department, CHU Amiens, Amiens, France
| | - J Peltier
- Neurosurgery department, CHU Amiens, Amiens, France
| | - K Buffenoir
- Neurosurgery department, CHU Nantes, Nantes, France
| | - O Hamel
- Neurosurgery department, CHU Nantes, Nantes, France
| | - P Dam Hieu
- Neurosurgery department, CHU Brest, Brest, France
| | - S Chibbaro
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Kehrli
- Neurosurgery department, CHU Angers, Angers, France
| | - M A Lahlou
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Menei
- Neurosurgery department, CHU Angers, Angers, France
| | - M Lonjon
- Neurosurgery department, CHU Nice, Nice, France
| | - C Mottolese
- Neurosurgery department, CHU Neurologique Lyon, Lyon, France
| | - P Peruzzi
- Neurosurgery department, CHU Maison Blanche, Reims, France
| | - K Mahla
- Neurosurgery department, clinique du Tonkin, Villeurbanne, France
| | - D Scarvada
- Neurosurgery department, CHU La Timone, Marseille, France
| | - C Le Guerinel
- Neurosurgery department, CHU Henri Mondor, Creteil, France
| | - P Caillaud
- Neurosurgery department, CH de la Côte Basque, Bayonne, France
| | - C Nuti
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - B Pommier
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - T Faillot
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - G Iakovlev
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - S Goutagny
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - N Lonjon
- Neurosurgery department, CHU Gui de Chauliac, Montpellier, France
| | - P Cornu
- Neurosurgery department, CHU Pitié-Salpêtrière, Paris, France
| | - P Bousquet
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - P Sabatier
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - B Debono
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - J-P Lescure
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - E Vicaut
- Clinical research unit (URC), Hôpital de Lariboisière, APHP, Paris, France
| | - S Froelich
- Neurosurgery department, Hôpital de Lariboisière, APHP, Paris, France
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8
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Touat M, Li YY, Boynton AN, Spurr LF, Iorgulescu B, Bohrson CL, Cortes-Ciriano I, Geduldig JE, Pelton K, Lim-Fat MJ, Pal S, Ramkissoon SH, Dubois F, Bellamy C, Currimjee N, Qian K, Malinowski S, Shetty A, Chow KH, Verreault M, Guillerm E, Ammari S, Beuvon F, Mokhtari K, Alentorn A, Dehais C, Houillier C, Laigle-Donadey F, Psimaras D, Carpentier A, Cornu P, Capelle L, Mathon B, Barnholtz-Sloan JS, Chakravarti A, Bi WL, Frampton GM, Sanson M, Alexander BM, Cherniack A, Wen PY, Reardon DA, Marabelle A, Park PJ, Idbaih A, Beroukhim R, Bandopadhayay P, Bielle F, Ligon KL. Abstract 5705: Mechanisms and therapeutic implications of hypermutation in gliomas. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
High tumor mutational burden (hypermutation) is observed in some gliomas; however, its mechanisms of development and whether it predicts immunotherapy response are poorly understood. Here, we comprehensively analyze the molecular determinants of mutational burden and signatures in 10,294 gliomas including AACR Project GENIE and institutional datasets. We delineate two main pathways to hypermutation: a de novo pathway associated with constitutional defects in DNA polymerase and mismatch repair (MMR) genes, and a more common post-treatment pathway associated with acquired resistance driven by MMR defects in chemotherapy-sensitive gliomas that recur after temozolomide treatment. Experimentally, the mutational signature of post-treatment hypermutated gliomas was only recapitulated by temozolomide-induced damage in cells harboring MMR deficiency. MMR-deficient gliomas exhibited unique features including the lack of prominent T-cell infiltrates, extensive intratumoral heterogeneity, poor survival and low response rate to PD-1 blockade. Moreover, while microsatellite instability in MMR-deficient gliomas was not detected by bulk analyses, single-cell whole-genome sequencing of post-treatment hypermutated glioma cells demonstrated microsatellite mutations. This study shows that chemotherapy can drive acquisition of hypermutated populations without promoting response to PD-1 blockade and supports diagnostic use of mutational burden and signatures in cancer.
Citation Format: Mehdi Touat, Yvonne Y. Li, Adam N. Boynton, Liam F. Spurr, Bryan Iorgulescu, Craig L. Bohrson, Isidro Cortes-Ciriano, Jack E. Geduldig, Kristine Pelton, Mary J. Lim-Fat, Sangita Pal, Shakti H. Ramkissoon, Frank Dubois, Charlotte Bellamy, Naomi Currimjee, Kenin Qian, Seth Malinowski, Aniket Shetty, Kin-Hoe Chow, Maïté Verreault, Erell Guillerm, Samy Ammari, Frédéric Beuvon, Karima Mokhtari, Agusti Alentorn, Caroline Dehais, Caroline Houillier, Florence Laigle-Donadey, Dimitri Psimaras, Alexandre Carpentier, Philippe Cornu, Laurent Capelle, Bertrand Mathon, Jill S. Barnholtz-Sloan, Arnab Chakravarti, Wenya L. Bi, Garrett M. Frampton, Marc Sanson, Brian M. Alexander, Andrew Cherniack, Patrick Y. Wen, David A. Reardon, Aurelien Marabelle, Peter J. Park, Ahmed Idbaih, Rameen Beroukhim, Pratiti Bandopadhayay, Franck Bielle, Keith L. Ligon. Mechanisms and therapeutic implications of hypermutation in gliomas [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5705.
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Affiliation(s)
| | | | | | - Liam F. Spurr
- 2Broad Institute of MIT and Harvard, Cambridge, MA, MA
| | | | | | - Isidro Cortes-Ciriano
- 4European Molecular European Bioinformatics Institute, Wellcome Genome Campus, HInxton, United Kingdom
| | | | | | | | - Sangita Pal
- 5Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Frank Dubois
- 5Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | - Kenin Qian
- 1Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | - Erell Guillerm
- 8Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | | | | | | | | | | | | | | | - Alexandre Carpentier
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Philippe Cornu
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Laurent Capelle
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Bertrand Mathon
- 11Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | - Arnab Chakravarti
- 13Arthur G. James Hospital/Ohio State Comprehensive Cancer Center, Cleveland, OH
| | - Wenya L. Bi
- 14Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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Clarençon F, Shotar E, Pouvelle A, Mouyal S, Lenck S, Premat K, Cornu P, Sourour NA. Direct puncture of the superficial temporal artery for ethylene vinyl alcohol embolization of a type 3 arteriovenous fistula with a dual lumen balloon. J Neurointerv Surg 2020; 13:493. [PMID: 32737206 DOI: 10.1136/neurintsurg-2020-016351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/20/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 11/03/2022]
Abstract
Intracranial dural arteriovenous fistulas (dAVFs) may be difficult to treat by endovascular means, especially when the arterial feeders to the fistula are tortuous. 1 The usual main feeder to intracranial dAVFs is the middle meningeal artery, which may present very tight loops that are often difficult to cross with a microcatheter. 2 Direct puncture of a subcutaneous artery feeding the fistula indirectly via transosseous branches may be a valuable strategic option to overcome this limitation. 3 4 We report here the successful embolization of a Cognard type 3 parietal dAVF by direct puncture of the superficial temporal artery under roadmap guidance. The dAVF was subsequently embolized with ethylene vinyl alcohol via a dual lumen balloon, under balloon inflation. We highlight in this technical video 1 the potential difficulties and risks of direct puncture of the superficial temporal artery. We also stress the risk of delayed scalp necrosis using this technique. neurintsurg;13/5/493/V1F1V1Video 1.
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Affiliation(s)
- Frédéric Clarençon
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France .,Sorbonne University. Paris VI University, Paris, France
| | - Eimad Shotar
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Arnaud Pouvelle
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Samuel Mouyal
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Stéphanie Lenck
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Kevin Premat
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France.,Sorbonne University. Paris VI University, Paris, France
| | - Philippe Cornu
- Sorbonne University. Paris VI University, Paris, France.,Neurosurgery, University Hospital Pitié-Salpêtrière, Paris, France
| | - Nader-Antoine Sourour
- Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
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10
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Mangone G, Bekadar S, Cormier-Dequaire F, Tahiri K, Welaratne A, Czernecki V, Pineau F, Karachi C, Castrioto A, Durif F, Tranchant C, Devos D, Thobois S, Meissner WG, Navarro MS, Cornu P, Lesage S, Brice A, Welter ML, Corvol JC. Early cognitive decline after bilateral subthalamic deep brain stimulation in Parkinson's disease patients with GBA mutations. Parkinsonism Relat Disord 2020; 76:56-62. [PMID: 32866938 DOI: 10.1016/j.parkreldis.2020.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 12/05/2019] [Revised: 02/25/2020] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) has demonstrated its efficacy on motor complications in advanced Parkinson's disease (PD) but does not modify disease progression. Genetic forms of PD have been associated with different cognitive progression profiles. OBJECTIVE To assess the effect of PD-related genetic mutations on cognitive outcome after STN-DBS. METHODS Patients with STN-DBS were screened for LRRK2, GBA, and PRKN mutations at the Pitié-Salpêtrière Hospital between 1997 and 2009. Patients with known monogenetic forms of PD from six other centers were also included. The Mattis Dementia Rating Scale (MDRS) was used to evaluate cognition at baseline and one-year post-surgery. The standardized Unified PD Rating Scale (UPDRS) evaluation On and Off medication/DBS was also administered. A generalized linear model adjusted for sex, ethnicity, age at onset, and disease duration was used to evaluate the effect of genetic factors on MDRS changes. RESULTS We analyzed 208 patients (131 males, 77 females, 54.3 ± 8.8 years) including 25 GBA, 18 LRRK2, 22 PRKN, and 143 PD patients without mutations. PRKN patients were younger and had a longer disease duration at baseline. A GBA mutation was the only significant genetic factor associated with MDRS change (β = -2.51, p = 0.009). GBA mutation carriers had a more pronounced post-operative MDRS decline (3.2 ± 5.1) than patients with LRRK2 (0.9 ± 4.8), PRKN (0.5 ± 2.7) or controls (1.4 ± 4.4). The motor response to DBS was similar between groups. CONCLUSION GBA mutations are associated with early cognitive decline following STN-DBS. Neuropsychological assessment and discussions on the benefit/risk ratio of DBS are particularly important for this population.
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Affiliation(s)
- Graziella Mangone
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France
| | - Samir Bekadar
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Florence Cormier-Dequaire
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France
| | - Khadija Tahiri
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Arlette Welaratne
- Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France
| | - Virginie Czernecki
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Institut of Memory and Alzheimer's Disease (IM2A), Paris, France
| | - Fanny Pineau
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Institut of Memory and Alzheimer's Disease (IM2A), Paris, France
| | - Carine Karachi
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurochirurgie, Paris, France
| | - Anna Castrioto
- Unité des Troubles du Mouvement, Département de Neurologie, CHU de Grenoble, Université de Grenoble Alpes, INSERM U1216, F-38000, Grenoble, France
| | - Frank Durif
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Christine Tranchant
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - David Devos
- Département de Neurologie, Centre Expert maladie de Parkinson, Département de Pharmacologie Clinique et des Neurosciences, Université de Lille, Centre Hospitalier Universitaire de Lille, INSERM UMR_S 1171, LICEND, France
| | - Stéphane Thobois
- Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69500, Bron, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, Lyon, France; Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, CNRS, Bron, France
| | - Wassilios G Meissner
- Service de Neurologie, Centre Expert Parkinson, IMNc, CHU Bordeaux, 33000, Bordeaux, France; Univ. de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, UMR 5293, 33000, Bordeaux, France; Dept. Medicine, University of Otago, Christchurch, New Zealand; Brain Research Institute, Christchurch, New Zealand
| | - Maria Soledad Navarro
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurochirurgie, Paris, France
| | - Philippe Cornu
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurochirurgie, Paris, France
| | - Suzanne Lesage
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France
| | - Alexis Brice
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France
| | - Marie Laure Welter
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France; Département de Neurophysiologie, CHU Rouen, Université de Normandie, Rouen, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Inserm U1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Neurologie, Clinical Research Center Neurosciences, Paris, France.
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Brouwers D, Decramer A, Cornu P, Le Viet D. Does the DISI matter after distal scaphoidectomy with tendon interposition for STT osteoarthritis? Hand Surg Rehabil 2020; 39:284-290. [PMID: 32272185 DOI: 10.1016/j.hansur.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
Progression to dorsal extension of the lunate after distal scaphoidectomy was described more than a decade ago. Still, this technique remains a popular choice for surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis (STT OA). This study aimed to investigate short-term postoperative function, patient satisfaction and radiographic outcomes of distal scaphoidectomy with tendon interposition for isolated STT OA in the wrist. Scaphoid resection width, amount of DISI and postoperative complications were also assessed. We evaluated all distal scaphoidectomies done at our hospital from 2012 to 2018. Postoperative clinical analysis consisted of grip and key pinch strength, joint amplitude, pain on visual analog scale (VAS), hand usability (VAS) and functional scores (QuickDASH and PRWHE scores). On follow-up radiographs, we measured the amount of DISI, resection height and scaphoid working length and compared them to functional scores. Eighteen patients with 21 operated wrists were eligible. Average time to postoperative evaluation was 36 (5-78) months. We observed DISI in 95% of the cases (n=19). A mean increase of 13° (±6) in radiolunate angle was noted when comparing pre- and postoperative radiographs. Neither the amount of DISI nor the resection height was significantly correlated with the functional scores. No revision surgery for advanced wrist collapse was reported. Four concomitant surgeries were needed. Distal scaphoid excision with tendon interposition yields good short-term results in isolated STT OA. While 95% of cases developed a DISI deformity, there were no cases of functional impairment. Longitudinal studies with long-term follow-up are required to further evaluate lunate extension and possible clinical implications.
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Affiliation(s)
- D Brouwers
- AZ Delta, Rodekruisstraat 20, 8800 Roeselare, Belgium.
| | - A Decramer
- AZ Delta, Rodekruisstraat 20, 8800 Roeselare, Belgium
| | - P Cornu
- Research Group Clinical Pharmacology and Clinical Pharmacy, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - D Le Viet
- Institut de la main, clinique Bizet, 21, rue Georges-Bizet, 75016 Paris, France
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Touat M, Li YY, Boynton AN, Spurr LF, Iorgulescu JB, Bohrson CL, Cortes-Ciriano I, Birzu C, Geduldig JE, Pelton K, Lim-Fat MJ, Pal S, Ferrer-Luna R, Ramkissoon SH, Dubois F, Bellamy C, Currimjee N, Bonardi J, Qian K, Ho P, Malinowski S, Taquet L, Jones RE, Shetty A, Chow KH, Sharaf R, Pavlick D, Albacker LA, Younan N, Baldini C, Verreault M, Giry M, Guillerm E, Ammari S, Beuvon F, Mokhtari K, Alentorn A, Dehais C, Houillier C, Laigle-Donadey F, Psimaras D, Lee EQ, Nayak L, McFaline-Figueroa JR, Carpentier A, Cornu P, Capelle L, Mathon B, Barnholtz-Sloan JS, Chakravarti A, Bi WL, Chiocca EA, Fehnel KP, Alexandrescu S, Chi SN, Haas-Kogan D, Batchelor TT, Frampton GM, Alexander BM, Huang RY, Ligon AH, Coulet F, Delattre JY, Hoang-Xuan K, Meredith DM, Santagata S, Duval A, Sanson M, Cherniack AD, Wen PY, Reardon DA, Marabelle A, Park PJ, Idbaih A, Beroukhim R, Bandopadhayay P, Bielle F, Ligon KL. Mechanisms and therapeutic implications of hypermutation in gliomas. Nature 2020; 580:517-523. [PMID: 32322066 PMCID: PMC8235024 DOI: 10.1038/s41586-020-2209-9] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022]
Abstract
A high tumour mutational burden (hypermutation) is observed in some gliomas1-5; however, the mechanisms by which hypermutation develops and whether it predicts the response to immunotherapy are poorly understood. Here we comprehensively analyse the molecular determinants of mutational burden and signatures in 10,294 gliomas. We delineate two main pathways to hypermutation: a de novo pathway associated with constitutional defects in DNA polymerase and mismatch repair (MMR) genes, and a more common post-treatment pathway, associated with acquired resistance driven by MMR defects in chemotherapy-sensitive gliomas that recur after treatment with the chemotherapy drug temozolomide. Experimentally, the mutational signature of post-treatment hypermutated gliomas was recapitulated by temozolomide-induced damage in cells with MMR deficiency. MMR-deficient gliomas were characterized by a lack of prominent T cell infiltrates, extensive intratumoral heterogeneity, poor patient survival and a low rate of response to PD-1 blockade. Moreover, although bulk analyses did not detect microsatellite instability in MMR-deficient gliomas, single-cell whole-genome sequencing analysis of post-treatment hypermutated glioma cells identified microsatellite mutations. These results show that chemotherapy can drive the acquisition of hypermutated populations without promoting a response to PD-1 blockade and supports the diagnostic use of mutational burden and signatures in cancer.
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Affiliation(s)
- Mehdi Touat
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France.
| | - Yvonne Y Li
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Adam N Boynton
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Liam F Spurr
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - J Bryan Iorgulescu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham & Women's Hospital, Boston, Harvard Medical School, MA, USA
| | - Craig L Bohrson
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Bioinformatics and Integrative Genomics PhD Program, Harvard Medical School, Boston, MA, USA
| | - Isidro Cortes-Ciriano
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Cristina Birzu
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Jack E Geduldig
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kristine Pelton
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mary Jane Lim-Fat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sangita Pal
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Ruben Ferrer-Luna
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Foundation Medicine Inc., Cambridge, MA, USA
| | - Shakti H Ramkissoon
- Foundation Medicine Inc., Cambridge, MA, USA
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Frank Dubois
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Charlotte Bellamy
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Naomi Currimjee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Juliana Bonardi
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kenin Qian
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Patricia Ho
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Seth Malinowski
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Leon Taquet
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Robert E Jones
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Aniket Shetty
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kin-Hoe Chow
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Nadia Younan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Capucine Baldini
- Drug Development Department (DITEP), INSERM U1015, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - Maïté Verreault
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Marine Giry
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Erell Guillerm
- Unité fonctionnelle d'Oncogénétique et Angiogénétique Moléculaire, Département de génétique, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Samy Ammari
- Department of Diagnostic Radiology, Gustave Roussy, Villejuif, France
- IR4M (UMR8081), Université Paris-Sud, Centre National de la Recherche Scientifique, Orsay, France
| | - Frédéric Beuvon
- AP-HP, Université Paris Descartes, Hôpital Cochin, Service d'Anatomie et Cytologie Pathologiques, Paris, France
| | - Karima Mokhtari
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie Laboratoire Escourolle, Paris, France
| | - Agusti Alentorn
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Caroline Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Caroline Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Florence Laigle-Donadey
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Dimitri Psimaras
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Eudocia Q Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lakshmi Nayak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Ricardo McFaline-Figueroa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandre Carpentier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, Paris, France
| | - Philippe Cornu
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, Paris, France
| | - Laurent Capelle
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, Paris, France
| | - Bertrand Mathon
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, Paris, France
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, Arthur G. James Hospital/Ohio State Comprehensive Cancer Center, Columbus, OH, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katie Pricola Fehnel
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan N Chi
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tracy T Batchelor
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Brian M Alexander
- Foundation Medicine Inc., Cambridge, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Azra H Ligon
- Department of Pathology, Brigham & Women's Hospital, Boston, Harvard Medical School, MA, USA
| | - Florence Coulet
- Unité fonctionnelle d'Oncogénétique et Angiogénétique Moléculaire, Département de génétique, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Jean-Yves Delattre
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
- Onconeurotek Tumor Bank, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Khê Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - David M Meredith
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham & Women's Hospital, Boston, Harvard Medical School, MA, USA
| | - Sandro Santagata
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham & Women's Hospital, Boston, Harvard Medical School, MA, USA
- Ludwig Center at Harvard Medical School, Harvard Medical School, Boston, MA, USA
- Laboratory of Systems Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Alex Duval
- Sorbonne Université, Inserm, UMR 938, Centre de Recherche Saint Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
- Onconeurotek Tumor Bank, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Andrew D Cherniack
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Patrick Y Wen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Aurélien Marabelle
- Drug Development Department (DITEP), INSERM U1015, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - Peter J Park
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Rameen Beroukhim
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Pratiti Bandopadhayay
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Franck Bielle
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie Laboratoire Escourolle, Paris, France.
| | - Keith L Ligon
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Pathology, Brigham & Women's Hospital, Boston, Harvard Medical School, MA, USA.
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Touat M, Li Y, Boynton A, Spurr L, Iorgulescu B, Birzu C, Pal S, Ferrer-Luna R, Geduldig J, Bellamy C, Younan N, Baldini C, Verreault M, Guillerm E, Ammari S, Beuvon F, Mokhtari K, Alentorn A, Dehais C, Houiller C, Laigle-Donadey F, Lee E, Nayak L, Carpentier A, Cornu P, mathon B, Bi W, Chiocca E, Alexandrescu S, Chi S, Haas-Kogan D, Alexander B, Huang R, Ligon A, Coulet F, Delattre JY, Hoang-Xuan K, Meredith D, Santagata S, Duval A, Sanson M, Cherniack A, Wen P, Reardon D, Marabelle A, Idbaih A, Beroukhim R, Bandopadhayay P, Bielle F, Ligon K. DRES-08. CLINICAL SIGNIFICANCE OF HYPERMUTATION IN GLIOMAS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.296] [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
Hypermutation is an emerging biomarker for predicting response to immunotherapy in cancer patients, however its clinical value in gliomas is not established. We sought to assess the determinants of hypermutation in gliomas, and its value for predicting response to standard of care and immune checkpoint blockade (ICB).
METHODS
We performed comprehensive genomic characterization of 2,420 clinically annotated gliomas. We assessed the clinical and molecular characteristics associated with hypermutation and relationships between hypermutation and response to cancer treatments.
RESULTS
Hypermutation occurred predominantly as an adaptive resistance mechanism to temozolomide in gliomas and was most prevalent in recurrent gliomas with MGMTpromoter methylation (33.8%), IDH1/2mutation (41.0%) or 1p/19q co-deletion (59.5%). Hypermutation was almost always associated with molecular defects in DNA mismatch repair (MMR), and was associated with shorter survival after its appearance based on multivariate analysis (hazard ratio 1.91; 95% CI 1.24–2.94; P=0.004). The molecular mechanisms whereby gliomas undergo hypermutation during therapy with alkylating agents were dissected using patient-derived glioma models in vitro and in vivo. Outcomes of hypermutated gliomas treated with immune checkpoint blockade or with standard of care agents will be presented at the conference.
CONCLUSIONS
Using the largest set of hypermutated gliomas described to date, this study establishes that mutational burden and mutation signatures are clinically and biologically significant biomarkers that can be used to predict therapy response and guide treatment decisions in gliomas
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Affiliation(s)
- Mehdi Touat
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yvonne Li
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Liam Spurr
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Sangita Pal
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Nadia Younan
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | | | - Erell Guillerm
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | | | | | | | | | | | | | - Eudocia Lee
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Alexandre Carpentier
- Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires La Pitié-Salpêtrière, Service de Neurochirurgie, Paris, France
| | - Philippe Cornu
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | - Wenya Bi
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Ennio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital
- Harvard Medical School, Boston, MA, USA
| | | | - Susan Chi
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Azra Ligon
- Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Khe Hoang-Xuan
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | | | - Alex Duval
- Sorbonne Universités, Inserm, Paris, France
| | - Marc Sanson
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | - Patrick Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Ahmed Idbaih
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | | | | | - Franck Bielle
- Hôpitaux Universitaires La Pitié Salpêtrière, Paris, France
| | - Keith Ligon
- Dana-Farber Cancer Institute, Boston, MA, USA
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Borius PY, Garnier SR, Baumstarck K, Castinetti F, Donnet A, Guedj E, Cornu P, Blond S, Salas S, Régis J. An Open-Label, Analgesic Efficacy and Safety of Pituitary Radiosurgery for Patients With Opioid-Refractory Pain: Study Protocol for a Randomized Controlled Trial. Neurosurgery 2019; 83:146-153. [PMID: 28973682 DOI: 10.1093/neuros/nyx363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypophysectomy performed by craniotomy or percutaneous techniques leads to complete pain relief in more than 70% to 80% of cases for opioid refractory cancer pain. Radiosurgery could be an interesting alternative approach to reduce complications. OBJECTIVE To assess the analgesic efficacy compared with standard of care is the primary goal. The secondary objectives are to assess ophthalmic and endocrine tolerance, drug consumption, quality of life, and mechanisms of analgesic action. METHODS The trial is multicenter, randomized, prospective, and open-label with 2 parallel groups. This concerns patients in palliative care suffering from nociceptive or mixed cancer pain, refractory to standard opioid therapy. Participants will be randomly assigned to the control group receiving standards of care for pain according to recommendations, or to the experimental group receiving a pituitary GammaKnife (Elekta, Stockholm, Sweden) radiosurgery (160 Gy delivered in pituitary gland) associated with standards of care. Evaluation assessments will be taken at baseline, day0, day4, day7, day14, day28, day45, month3, and month6. EXPECTED OUTCOMES We could expect pain improvement in 70% to 90% of cases at day4. In addition we will assess the safety of pituitary radiosurgery in a vulnerable population. The secondary endpoints could show decay of opioid consumption, good patient satisfaction, and improvement of the quality of life. DISCUSSION The design of this study is potentially the most appropriate to demonstrate the efficacy and safety of radiosurgery for this new indication. New recommendations could be obtained in order to improve pain relief and quality of life.
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Affiliation(s)
- Pierre-Yves Borius
- Functional and Stereotaxic Neurosurgery Department, Hopital La Timone, Marseille University Hospital, Marseille, France.,Neurosurgery Department, Hopital Pitié Salpêtrière, Paris University Hospital, Paris, France
| | | | - Karine Baumstarck
- Methodological support Platform, Marseille University Hospital, Marseille, France
| | - Frédéric Castinetti
- Endocrinology Department, Hopital La Timone, Marseille University Hospital, Marseille, France
| | - Anne Donnet
- Pain center, Hopital La Timone, Marseille University Hospital, Marseille, France
| | - Eric Guedj
- Nuclear Medicine Department, Hopital La Timone, Marseille University Hospital, Marseille, France
| | - Philippe Cornu
- Neurosurgery Department, Hopital Pitié Salpêtrière, Paris University Hospital, Paris, France
| | - Serge Blond
- Functional Neurosurgery Department, Lille University Hospital, Lille, France
| | - Sébastien Salas
- Palliative Care Department, Hopital La Timone, Marseille University Hospital, Marseille, France
| | - Jean Régis
- Functional and Stereotaxic Neurosurgery Department, Hopital La Timone, Marseille University Hospital, Marseille, France
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15
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Lau B, Meier N, Serra G, Czernecki V, Schuepbach M, Navarro S, Cornu P, Grabli D, Agid Y, Vidailhet M, Karachi C, Welter ML. Axial symptoms predict mortality in patients with Parkinson disease and subthalamic stimulation. Neurology 2019; 92:e2559-e2570. [PMID: 31043471 PMCID: PMC6556086 DOI: 10.1212/wnl.0000000000007562] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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] [Received: 08/03/2018] [Accepted: 01/25/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To characterize how disease progression is associated with mortality in a large cohort of patients with Parkinson disease (PD) with long-term follow-up after subthalamic nucleus deep brain stimulation (STN-DBS). Methods Motor and cognitive disabilities were assessed before and 1, 2, 5, and 10 years after STN-DBS in 143 consecutive patients with PD. We measured motor symptoms “off” and “on” levodopa and STN-DBS and recorded causes of death. We used linear mixed models to characterize symptom progression, including interactions between treatment conditions and time to determine how treatments changed efficacy. We used joint models to link symptom progression to mortality. Results Median observation time was 12 years after surgery, during which akinesia, rigidity, and axial symptoms worsened, with mean increases of 8.8 (SD 6.5), 1.8 (3.1), and 5.4 (4.1) points from year 1–10 after surgery (“on” dopamine/“on” STN-DBS), respectively. Responses to dopaminergic medication and STN-DBS were attenuated with time, but remained effective for all except axial symptoms, for which both treatments and their combination were predicted to be ineffective 20 years after surgery. Cognitive status significantly declined. Forty-one patients died, with a median time to death of 9 years after surgery. The current level of axial disability was the only symptom that significantly predicted death (hazard ratio 4.30 [SE 1.50] per unit of square-root transformed axial score). Conclusions We quantified long-term symptom progression and attenuation of dopaminergic medication and STN-DBS treatment efficacy in patients with PD and linked symptom progression to mortality. Axial disability significantly predicts individual risk of death after surgery, which may be useful for planning therapeutic strategies in PD.
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Affiliation(s)
- Brian Lau
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France.
| | - Niklaus Meier
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Giulia Serra
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Virginie Czernecki
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Michael Schuepbach
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Soledad Navarro
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Philippe Cornu
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - David Grabli
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Yves Agid
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Marie Vidailhet
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Carine Karachi
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France
| | - Marie-Laure Welter
- From INSERM 1127 (B.L., N.M., Y.A., M.V., C.K., M.-L.W.), Sorbonne Universités, Université Pierre et Marie Curie-Paris Université Paris 06 6, Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; Department of Neurology (N.M., M.S.), Hôpital Universitaire de Bern, Switzerland; Clinical Investigation Centre (N.M., G.S.), Department of Neurology (V.C., D.G., M.V.), and Department of Neurosurgery (S.N., P.C., C.K.), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris; and Department of Neurophysiology (M.-L.W.), CHU Charles Nicolle, Rouen University, France.
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Le HM, Boch AL, Gerber S, Cornu P, Bodaghi B, Lehoang P, Touitou V. [Acute visual loss related to sphenoid meningioma]. J Fr Ophtalmol 2019; 42:485-491. [PMID: 30926270 DOI: 10.1016/j.jfo.2018.12.006] [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: 01/16/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
Meningiomas represent about 20% of intracranial tumors. Involvement of the medial sphenoid wing includes anterior clinoid, cavernous sinus and superior orbital fissure meningiomas. Due to the proximity of these tumors to the optic nerve, typically progressive unilateral vision loss, over several months to years, is the classic clinical presentation. We report three cases of acute monocular vision loss, two transient and one permanent, ipsilateral to a sphenoid meningioma. Ophthalmological involvement with sphenoid meningiomas is most often chronic, due to interruption of axoplasmic flow and demyelination of the optic nerve by local compression. However, vascular involvement with ischemia of the optic nerve or transient low blood flow secondary to compression of the carotid branches vascularizing these structures is another possible mechanism. In our series, two patients had amaurosis fugax, and one patient had sudden, persistent visual loss in relation to acute anterior ischemic optic neuropathy on the side of the meningioma. The mean age of patients with acute visual manifestations was 62 years. These ischemic and non-compressive visual symptoms, ipsilateral to sphenoid meningiomas, are difficult to interpret. Whether these temporary visual disturbances of vascular origin should be considered an early sign of future severe or permanent visual impairment when no optic nerve compression is observed is not certain. The place of these acute visual disturbances in the therapeutic decision, particularly surgical, remains to be defined. Larger multicentric prospective studies are needed to better understand the role of local circulatory factors attributable to meningioma in the occurrence of these acute visual signs.
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Affiliation(s)
- H M Le
- Département d'ophtalmologie, DHU vision et handicaps, hôpital Pitié-Salpêtrière, 47-92, boulevard de l'Hopital, 75013 Paris, France
| | - A-L Boch
- Département de neurochirurgie, hôpital Pitié-Salpêtrière, 47-92, boulevard de l'Hopital, 75013 Paris, France
| | - S Gerber
- Département de neuroradiologie, hôpital Pitié-Salpêtrière, 47-92, boulevard de l'Hopital, 75013 Paris, France
| | - P Cornu
- Département de neurochirurgie, hôpital Pitié-Salpêtrière, 47-92, boulevard de l'Hopital, 75013 Paris, France
| | - B Bodaghi
- Département d'ophtalmologie, DHU vision et handicaps, hôpital Pitié-Salpêtrière, 47-92, boulevard de l'Hopital, 75013 Paris, France
| | - P Lehoang
- Département d'ophtalmologie, DHU vision et handicaps, hôpital Pitié-Salpêtrière, 47-92, boulevard de l'Hopital, 75013 Paris, France
| | - V Touitou
- Département d'ophtalmologie, DHU vision et handicaps, hôpital Pitié-Salpêtrière, 47-92, boulevard de l'Hopital, 75013 Paris, France.
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17
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Klausner G, Troussier I, Biau J, Jacob J, Schernberg A, Canova CH, Simon JM, Borius PY, Malouf G, Spano JP, Roupret M, Cornu P, Mazeron JJ, Valéry C, Feuvret L, Maingon P. Stereotactic Radiation Therapy for Renal Cell Carcinoma Brain Metastases in the Tyrosine Kinase Inhibitors Era: Outcomes of 120 Patients. Clin Genitourin Cancer 2019; 17:191-200. [PMID: 30926219 DOI: 10.1016/j.clgc.2019.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/11/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the outcomes in terms of efficacy and safety of a large consecutive series of 362 patients with renal cell carcinoma (RCC) brain metastases treated using stereotactic radiosurgery (SRS) in the tyrosine kinase inhibitor (TKI) era. PATIENTS AND METHODS From 2005 to 2015, 362 consecutive patients with brain metastases from RCC were treated using SRS in 1 fraction: 226 metastases (61 patients) using Gamma-Knife at a median of 18 Gy (50% isodose line); 136 metastases (63 patients) using linear accelerator at a median of 16 Gy (70% isodose line). The median patient age was 58 years. At the first SRS, 37 patients (31%) received a systemic treatment. Among systemic therapies, TKIs were the most common (65%). RESULTS The local control rates were 94% and 92% at 12 and 36 months, respectively. In multivariate analysis, a minimal dose >17 Gy and concomitant TKI treatment were associated with higher rates of local control. The overall survival rates at 12 and 36 months were 52% and 29%, respectively. In multivariate analysis, factors associated with poor survival included age ≥65 years, lower score index for SRS, concomitant lung metastases, time between RCC diagnosis and first systemic metastasis ≤4 months, occurrence during treatment with a systemic therapy, no history of neurosurgery, and persistence or occurrence of neurological symptoms at 3 months after SRS. Seventeen patients had Grade III/IV adverse effects of whom 3 patients presented a symptomatic radionecrosis. CONCLUSION SRS is highly effective in patients with brain metastases from RCC. Its association with TKIs does not suggest higher risk of neurologic toxicity.
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Affiliation(s)
- Guillaume Klausner
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France.
| | - Idriss Troussier
- Radio-Oncology Department, Hopital Universitary of Geneva, Geneva, Switzerland
| | - Julian Biau
- Radio-Oncology Department, Lausanne Universitary Hospital (CHUV), Lausanne, Switzerland
| | - Julian Jacob
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Antoine Schernberg
- Radiation Oncology Department, Gustave Roussy Institut, Villejuif, France
| | - Charles-Henri Canova
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Jean-Marc Simon
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Pierre-Yves Borius
- Neurosurgery Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Gabriel Malouf
- Medical Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Jean-Philippe Spano
- Medical Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Morgan Roupret
- Urology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Philippe Cornu
- Neurosurgery Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Jean-Jacques Mazeron
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Charles Valéry
- Neurosurgery Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Loïc Feuvret
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
| | - Philippe Maingon
- Radiation Oncology Department, La Pitié-Salpêtrière Universitary Hospital, Paris, France
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Dautzenberg MD, Bara L, Cornu P, Samama M. Specific Anti-Xa Activity of LMWH (Kabi 2165, CY216 PK 10169) Against the First International Standard of LMWH: A Collaborative Study. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M D Dautzenberg
- Laboratoire Central d’Hématalogie Hôpital NECKER-Enfants Malades, Paris, France
| | - L Bara
- Laboratoire de Thrombose Expérimentale Faculté de Médecine, Paris, France
| | - P Cornu
- Laboratoire Central d’Hématalogie Hôpital NECKER-Enfants Malades, Paris, France
| | - M Samama
- Laboratoire de Thrombose Expérimentale Faculté de Médecine, Paris, France
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19
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Fischer AM, Cornu P, Sternberg C, Mériane F, Dautzenberg MD, Chafa O, Beguin S, Desnos M. Antithrombin III Alger: A New Homozygous AT III Variant. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661525] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA qualitative abnormality of antithrombin III (AT III) was found in the plasma of a 41-year old patient. The plasmatic AT III antigen concentration was 130% and the progressive anti-F IIa and anti-F Xa activities were normal (105% and 137%). The plasma heparin cofactor activity was less than 10%, when measured by F Ila or F Xa inhibition. Crossed immunoelectrophoresis of AT III in the presence of heparin revealed in the plasma an abnormal slow-moving peak. When tested by affinity chromatography on heparin Sepharose, this abnormal AT III did not bind to heparin. Among the investigated relatives, 5 subjects had normal AT III levels, whatever the test used, the nine others having reduced levels of antithrombin heparin cofactor activity (45-61%) but normal levels of immunoreactive AT III (97-122%). Consanguinity was found in the family history. We therefore considered our patient as homozygous for an AT III molecular abnormality affecting the binding site for heparin.
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Affiliation(s)
- A M Fischer
- The Département d’Hématologie, C. H. U. Necker-Enfants Malades, Paris, France
| | - P Cornu
- The Département d’Hématologie, C. H. U. Necker-Enfants Malades, Paris, France
| | - C Sternberg
- The Département d’Hématologie, C. H. U. Necker-Enfants Malades, Paris, France
| | - F Mériane
- The Laboratoire d’Hématologie, C. H. U. Mustapha, Alger, Algérie
| | - M D Dautzenberg
- The Département d’Hématologie, C. H. U. Necker-Enfants Malades, Paris, France
| | - O Chafa
- The Laboratoire d’Hématologie, C. H. U. Mustapha, Alger, Algérie
| | - S Beguin
- The Département d’Hématologie, C. H. U. Necker-Enfants Malades, Paris, France
| | - M Desnos
- The Service de Cardiologie, Hôpital Boucicaut, Paris, France
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20
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Apra C, Mokhtari K, Cornu P, Peyre M, Kalamarides M. Intracranial solitary fibrous tumors/hemangiopericytomas: first report of malignant progression. J Neurosurg 2018. [DOI: 10.3171/2017.1.jns162593] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEMeningeal solitary fibrous tumors/hemangiopericytomas (MSFTs/HPCs) are rare intracranial tumors resembling meningiomas. Their classification was redefined in 2016 by the World Health Organization (WHO) as benign Grade I fibrohyaline type, intermediate Grade II hypercellular type, and malignant highly mitotic Grade III. This grouping is based on common histological features and identification of a common NAB2-STAT6 fusion.METHODSThe authors retrospectively identified 49 cases of MSFT/HPC. Clinical data were obtained from the medical records, and all cases were analyzed according to this new 2016 WHO grading classification in order to identify malignant transformations.RESULTSRecurrent surgery was performed in 18 (37%) of 49 patients. Malignant progression was identified in 5 (28%) of these 18 cases, with 3 Grade I and 2 Grade II tumors progressing to Grade III, 3–13 years after the initial surgery. Of 31 Grade III tumors treated in this case series, 16% (5/31) were proved to be malignant progressions from lower-grade tumors.CONCLUSIONSLow-grade MSFTs/HPCs can transform into higher grades as shown in this first report of such progression. This is a decisive argument in favor of a common identity for MSFT and meningeal HPC. High-grade MSFTs/HPCs tend to recur more often and be associated with reduced overall survival. Malignant progression could be one mechanism explaining some recurrences or metastases, and justifying long-term follow-up, even for patients with Grade I tumors.
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Affiliation(s)
- Caroline Apra
- 1Sorbonne Universités, Université Pierre et Marie Curie; and
- Departments of 2Neurosurgery and
| | - Karima Mokhtari
- 1Sorbonne Universités, Université Pierre et Marie Curie; and
- 3Neuropathology, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Philippe Cornu
- 1Sorbonne Universités, Université Pierre et Marie Curie; and
- Departments of 2Neurosurgery and
| | - Matthieu Peyre
- 1Sorbonne Universités, Université Pierre et Marie Curie; and
- Departments of 2Neurosurgery and
| | - Michel Kalamarides
- 1Sorbonne Universités, Université Pierre et Marie Curie; and
- Departments of 2Neurosurgery and
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21
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Amelot A, van Effenterre R, Kalamarides M, Cornu P, Boch AL. Natural history of cavernous sinus meningiomas. J Neurosurg 2018; 130:435-442. [PMID: 29600913 DOI: 10.3171/2017.7.jns17662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 03/14/2017] [Accepted: 07/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas confined to the cavernous sinus (MCSs) are benign tumors. Due to the high risk of severe complications, the intracavernous surgical procedure was abandoned in favor of radiotherapy. However, the choice of treatment remains complicated due to the fact that the natural history of this lesion has not yet been described. METHODS The authors studied the natural history of this lesion using a prospective series of 53 consecutive patients suffering from MCSs. The median follow-up duration was 10.2 years (range 2-25 years), from 1990 to 2016. RESULTS Patients ranged in age from 30 to 72 years (mean 53 years). The meningiomas were diagnosed by major symptoms (mainly oculomotor palsy and neuralgia experienced in 28 patients), minor symptoms (headache, intermittent diplopia in 15 patients), or incidental findings (10 patients). Simple symptomatic treatment (short courses of corticosteroids and carbamazepine) allowed patients to become asymptomatic in 19 (67.9%) of 28 cases experiencing major symptoms, and for 12 (80%) of 15 patients with initial minor symptoms (p < 0.0001). All patients with incidental findings remained asymptomatic. Forty four (83%) of 53 MCSs did not show any significant growth and 42 (80%) of 53 patients were not symptomatic at the end of follow-up (p < 0.001). The radiographic progression-free survival rates (± SD) at 5, 10, and 20 years were 90% ± 4.2%, 82% ± 5.7%, and 70% ± 10.2%, respectively. Five patients (9.4%) with no evidence of any effect of the initial medical treatment desired additional conventional radiation therapy. CONCLUSIONS Because of the capricious, unpredictable, and slow growth of MCSs, together with high growth variability from one patient to the next, the symptomatic medical treatment of these tumors is a highly effective method. This series shows that these lesions are naturally, clinically, and radiologically indolent.
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Affiliation(s)
- Aymeric Amelot
- 1Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP; and
- 2Université Paris VI-Pierre et Marie Curie, Paris, France
| | - Remy van Effenterre
- 1Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP; and
- 2Université Paris VI-Pierre et Marie Curie, Paris, France
| | - Michel Kalamarides
- 1Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP; and
- 2Université Paris VI-Pierre et Marie Curie, Paris, France
| | - Philippe Cornu
- 1Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP; and
- 2Université Paris VI-Pierre et Marie Curie, Paris, France
| | - Anne-Laure Boch
- 1Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP; and
- 2Université Paris VI-Pierre et Marie Curie, Paris, France
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22
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Terrier LM, Bauchet L, Rigau V, Amelot A, Zouaoui S, Filipiak I, Caille A, Almairac F, Aubriot-Lorton MH, Bergemer-Fouquet AM, Bord E, Cornu P, Czorny A, Dam Hieu P, Debono B, Delisle MB, Emery E, Farah W, Gauchotte G, Godfraind C, Guyotat J, Irthum B, Janot K, Le Reste PJ, Liguoro D, Loiseau H, Lot G, Lubrano V, Mandonnet E, Menei P, Metellus P, Milin S, Muckenstrum B, Roche PH, Rousseau A, Uro-Coste E, Vital A, Voirin J, Wager M, Zanello M, François P, Velut S, Varlet P, Figarella-Branger D, Pallud J, Zemmoura I. Natural course and prognosis of anaplastic gangliogliomas: a multicenter retrospective study of 43 cases from the French Brain Tumor Database. Neuro Oncol 2018; 19:678-688. [PMID: 28453747 DOI: 10.1093/neuonc/now186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/08/2016] [Accepted: 07/21/2016] [Indexed: 12/11/2022] Open
Abstract
Background Anaplastic gangliogliomas (GGGs) are rare tumors whose natural history is poorly documented. We aimed to define their clinical and imaging features and to identify prognostic factors. Methods Consecutive cases of anaplastic GGGs in adults prospectively entered into the French Brain Tumor Database between March 2004 and April 2014 were screened. After diagnosis was confirmed by pathological review, clinical, imaging, therapeutic, and outcome data were collected retrospectively. Results Forty-three patients with anaplastic GGG (median age, 49.4 y) from 18 centers were included. Presenting symptoms were neurological deficit (37.2%), epileptic seizure (37.2%), or increased intracranial pressure (25.6%). Typical imaging findings were unifocal location (94.7%), contrast enhancement (88.1%), central necrosis (43.2%), and mass effect (47.6%). Therapeutic strategy included surgical resection (95.3%), adjuvant radiochemotherapy (48.8%), or radiotherapy alone (27.9%). Median progression-free survival (PFS) and overall survival (OS) were 8.0 and 24.7 months, respectively. Three- and 5-year tumor recurrence rates were 69% and 100%, respectively. The 5-year survival rate was 24.9%. Considering unadjusted significant prognostic factors, tumor midline crossing and frontal location were associated with shorter OS. Temporal and parietal locations were associated with longer and shorter PFS, respectively. None of these factors remained statistically significant in multivariate analysis. Conclusions We report a large series providing clinical, imaging, therapeutic, and prognostic features of adult patients treated for an intracerebral anaplastic GGG. Our results show that pathological diagnosis is difficult, that survivals are only slightly better than for glioblastomas, and that complete surgical resection followed with adjuvant chemoradiotherapy offers longer survival.
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Affiliation(s)
- Louis-Marie Terrier
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
| | - Luc Bauchet
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France.,French Brain Tumor DataBase, ICM, Montpellier, France
| | - Valérie Rigau
- French Brain Tumor DataBase, ICM, Montpellier, France.,Department of Neuropathology and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France
| | - Aymeric Amelot
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Sonia Zouaoui
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France.,French Brain Tumor DataBase, ICM, Montpellier, France
| | - Isabelle Filipiak
- Plateforme CIRE, UMR-PRC, 37380 Nouzilly, Centre INRA Val de Loire, France
| | - Agnès Caille
- Université François-Rabelais de Tours, Tours, France.,Inserm, CIC 1415, CHRU de Tours, Tours, France.,Service de Neurochirurgie, CHU Jean-Minjoz, 3 boulevard Alexander-Fleming, Besançon cedex, France
| | - Fabien Almairac
- Department of Neurosurgery, Hôpital Pasteur, University Hospital Center, 06000, Nice, France
| | - Marie-Hélène Aubriot-Lorton
- Department of Pathology, Hôpital François Mitterand, CHU de Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France
| | | | - Eric Bord
- Department of Neurosurgery and Neurotraumatology, Nantes University Hospital, Nantes, France
| | - Philippe Cornu
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Alain Czorny
- Service de Neurochirurgie, CHU Jean-Minjoz, 3 boulevard Alexander-Fleming, Besançon cedex, France
| | - Phong Dam Hieu
- Department of Neurosurgery, CHU de la Cavale Blanche, Brest, France
| | - Bertrand Debono
- Department of Neurosurgery, Cèdres Hospital, Toulouse, France
| | - Marie-Bernadette Delisle
- Laboratoire Universitaire d'Anatomie Patholgique, Neuropathologie humaine et expérimentale, CHU Rangueil, Toulouse, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France
| | - Walid Farah
- Service de Neurochirurgie, Hôpital François Mitterand, CHU de Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France
| | - Guillaume Gauchotte
- Department of Pathology, CHU Nancy and INSERM U954, Faculty of Medicine, Université de Lorraine, France
| | | | - Jacques Guyotat
- Department of Neurosurgery, Neurological Hospital, Lyon, France
| | - Bernard Irthum
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - Kevin Janot
- Service de Neuroradiologie, CHRU de Tours, Tours, France
| | - Pierre-Jean Le Reste
- Department of Neurosurgery, University Hospital Pontchaillou, 2, Rue Henri Le Guilloux, 35000, Rennes, France
| | - Dominique Liguoro
- Service de neurochirurgie A, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Hugues Loiseau
- Université de Bordeaux - Service de Neurochirurgie B, hôpital Pellegrin Tripode, Bordeaux, France
| | - Guillaume Lot
- Department of Neurosurgery, Fondation Ophtalmologique Rothschild, Paris, France
| | - Vincent Lubrano
- Service de neurochirurgie, hôpital de Rangueil, CHU de Toulouse, 1, avenue du Professeur-Jean-Poulhès, TSA, Toulouse, France
| | | | - Philippe Menei
- Département de neurochirurgie, CHU d'Angers, 4, rue Larrey, 49940 Angers cedex 9, France
| | - Philippe Metellus
- Département de neurochirurgie, Aix-Marseille université, CHU Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - Serge Milin
- Department of Pathology, CHU de Poitiers, Hôpital la Milétrie, Poitiers, France
| | | | - Pierre-Hugues Roche
- Service de Neurochirurgie, Hôpital Nord, APHM, University Hospital of Marseille Aix-Marseille Univ, Marseille, France
| | - Audrey Rousseau
- Département de Pathologie Cellulaire et Tissulaire, Centre Hospitalo-universitaire d'Angers, 4 rue Larrey, Angers Cedex, France
| | - Emmanuelle Uro-Coste
- CHU Toulouse, Hôpital de Rangueil, Service d'Anatomie et Cytologie Pathologique, Toulouse, France
| | - Anne Vital
- Bordeaux Institute of Neuroscience, CNRS UMR 5227, F-33076, Bordeaux, France
| | - Jimmy Voirin
- Department of Neurosurgery, Strasbourg-Colmar Hospital, France
| | - Michel Wager
- Department of Neurosurgery, Imaging Laboratory, University Hospital Poitiers, 2 Rue de La Miletrie, Poitiers Cedex, France
| | - Marc Zanello
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | | | - Stéphane Velut
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
| | - Pascale Varlet
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, Sainte-Anne Hospital, Paris, France
| | | | - Johan Pallud
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Ilyess Zemmoura
- CHRU de Tours, Service de Neurochirurgie, Tours, France.,Université François-Rabelais de Tours, Inserm, Imagerie et Cerveau UMR U930, Tours, France
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23
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Amelot A, Terrier LM, Mathon B, Cook AR, Mazeron JJ, Valery CA, Cornu P, Leveque M, Carpentier A. Can anticancer chemotherapy promote the progression of brain metastases? Med Oncol 2018; 35:35. [PMID: 29427159 DOI: 10.1007/s12032-018-1097-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/17/2017] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
Abstract
Brain metastases natural history from one primary tumor type might be accelerated or favored by using certain systemic chemotherapy. A great deal was described in mice and suggested in human with antiangiogenic drugs, but little is known about the metastatic progression generated by the perverse effect of anticancer drugs. A total of 413 patients who underwent treatment for brain metastasis (2013-2016) were included. The identification of all previous anticancer drugs received by patients from primary tumor diagnosis to brain metastases diagnosis was collated. The median value for the time of first appearance of brain metastasis in all patients was 13.1 months (SD 1.77). The values of brain metastasis-free survival (bMFS) for each primary cancer were: 50.9 months (SD 8.8) for breast, 28.5 months (SD 11.4) for digestive, 27.7 months (SD 18.3) for melanoma, 12.3 months (SD 8.3) for kidney, 1.5 months (SD 0.1) for lung and 26.9 months (SD 18.3) for others (p < 0.009). Through Cox multivariate proportional hazard model, we identified that the only independent factors associated with short bMFS were: lung primary tumor [odd ratio (OR) 0.234, CI 95% 0.16-0.42; p < 0.0001] and mitotic spindle inhibitor (taxanes) chemotherapy [OR 0.609, CI 95% 0.50-0.93; p < 0.001]. Contrariwise, breast primary tumor [odd ratio (OR) 2.372, CI 95% 1.29-4.3; p < 0.005] was an independent factor that proved a significantly longer bMFS. We suggest that anticancer drugs, especially taxane and its derivatives, could promote brain metastases, decreasing free survival. Mechanisms are discussed but still need to be determined.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP, 47-83 Boulevard de l'Hôpital, Batiment Babinski, 75013, Paris, France. .,Université Paris VI - Pierre et Marie Curie, Paris, France.
| | | | - Bertrand Mathon
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP, 47-83 Boulevard de l'Hôpital, Batiment Babinski, 75013, Paris, France.,Université Paris VI - Pierre et Marie Curie, Paris, France
| | - Ann-Rose Cook
- Department of Neurosurgery, Hopital Bretonneau, Tours, France
| | - Jean-Jacques Mazeron
- Université Paris VI - Pierre et Marie Curie, Paris, France.,Department of Radiotherapy, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France
| | - Charles-Ambroise Valery
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP, 47-83 Boulevard de l'Hôpital, Batiment Babinski, 75013, Paris, France.,Université Paris VI - Pierre et Marie Curie, Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP, 47-83 Boulevard de l'Hôpital, Batiment Babinski, 75013, Paris, France.,Université Paris VI - Pierre et Marie Curie, Paris, France
| | - Marc Leveque
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP, 47-83 Boulevard de l'Hôpital, Batiment Babinski, 75013, Paris, France.,Université Paris VI - Pierre et Marie Curie, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpétrière, APHP, 47-83 Boulevard de l'Hôpital, Batiment Babinski, 75013, Paris, France.,Université Paris VI - Pierre et Marie Curie, Paris, France
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24
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Amelot A, Terrier LM, Mazeron JJ, Valery CA, Cornu P, Carpentier A, Leveque M. Timeline metastatic progression: in the wake of the « seed and soil » theory. Med Oncol 2017; 34:185. [DOI: 10.1007/s12032-017-1045-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/04/2017] [Indexed: 12/16/2022]
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25
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Klausner G, Troussier I, Feuvret L, Jacob J, Simon JM, Malouf G, Canova CH, Lamproglou I, Borius PY, Valéry C, Rouprêt M, Cornu P, Mazeron JJ, Spano JP, Maingon P. Étude rétrospective monocentrique de la prise en charge des métastases cérébrales de cancer du rein. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.018] [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: 11/29/2022]
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26
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Klausner G, Troussier I, Malouf G, Feuvret L, Jacob J, Simon JM, Canova C, Lamproglou I, Borius PY, Valery C, Cornu P, Rouprêt M, Mazeron JJ, Spano JP, Maingon P. A retrospective study of the management of metastatic renal cell carcinoma brain tumors. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.048] [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: 11/14/2022] Open
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27
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Mathon B, Bielle F, Samson S, Plaisant O, Dupont S, Bertrand A, Miles R, Nguyen-Michel VH, Lambrecq V, Calderon-Garcidueñas AL, Duyckaerts C, Carpentier A, Baulac M, Cornu P, Adam C, Clemenceau S, Navarro V. Predictive factors of long-term outcomes of surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Epilepsia 2017; 58:1473-1485. [DOI: 10.1111/epi.13831] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Sorbonne University; UPMC University of Paris 06; Paris France
| | - Franck Bielle
- Sorbonne University; UPMC University of Paris 06; Paris France
- Department of Neuropathology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
| | - Séverine Samson
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- PSITEC Laboratory (EA 4072); University of Lille 3; Lille France
| | - Odile Plaisant
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- ANCRE; URDIA EA 4465; Paris Descartes University; Sorbonne Paris Cité University; Paris France
| | - Sophie Dupont
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Rehabilitation Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Anne Bertrand
- Sorbonne University; UPMC University of Paris 06; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
- Department of Neuroradiology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Inria Paris; Aramis Project Team; Paris France
| | - Richard Miles
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Vi-Huong Nguyen-Michel
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
| | - Virginie Lambrecq
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Ana Laura Calderon-Garcidueñas
- Department of Neuropathology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Institute of Forensic Medicine; Veracruzana University; Boca del Río Mexico
| | - Charles Duyckaerts
- Sorbonne University; UPMC University of Paris 06; Paris France
- Department of Neuropathology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
| | - Alexandre Carpentier
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Sorbonne University; UPMC University of Paris 06; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Michel Baulac
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Philippe Cornu
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Sorbonne University; UPMC University of Paris 06; Paris France
| | - Claude Adam
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Stéphane Clemenceau
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Vincent Navarro
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
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28
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Welter ML, Houeto JL, Thobois S, Bataille B, Guenot M, Worbe Y, Hartmann A, Czernecki V, Bardinet E, Yelnik J, du Montcel ST, Agid Y, Vidailhet M, Cornu P, Tanguy A, Ansquer S, Jaafari N, Poulet E, Serra G, Burbaud P, Cuny E, Aouizerate B, Pollak P, Chabardes S, Polosan M, Borg M, Fontaine D, Giordana B, Raoul S, Rouaud T, Sauvaget A, Jalenques I, Karachi C, Mallet L. Anterior pallidal deep brain stimulation for Tourette's syndrome: a randomised, double-blind, controlled trial. Lancet Neurol 2017. [PMID: 28645853 DOI: 10.1016/s1474-4422(17)30160-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) has been proposed to treat patients with severe Tourette's syndrome, and open-label trials and two small double-blind trials have tested DBS of the posterior and the anterior internal globus pallidus (aGPi). We aimed to specifically assess the efficacy of aGPi DBS for severe Tourette's syndrome. METHODS In this randomised, double-blind, controlled trial, we recruited patients aged 18-60 years with severe and medically refractory Tourette's syndrome from eight hospitals specialised in movement disorders in France. Enrolled patients received surgery to implant bilateral electrodes for aGPi DBS; 3 months later they were randomly assigned (1:1 ratio with a block size of eight; computer-generated pairwise randomisation according to order of enrolment) to receive either active or sham stimulation for the subsequent 3 months in a double-blind fashion. All patients then received open-label active stimulation for the subsequent 6 months. Patients and clinicians assessing outcomes were masked to treatment allocation; an unmasked clinician was responsible for stimulation parameter programming, with intensity set below the side-effect threshold. The primary endpoint was difference in Yale Global Tic Severity Scale (YGTSS) score between the beginning and end of the 3 month double-blind period, as assessed with a Mann-Whitney-Wilcoxon test in all randomly allocated patients who received active or sham stimulation during the double-blind period. We assessed safety in all patients who were enrolled and received surgery for aGPi DBS. This trial is registered with ClinicalTrials.gov, number NCT00478842. FINDINGS Between Dec 6, 2007, and Dec 13, 2012, we enrolled 19 patients. We randomly assigned 17 (89%) patients, with 16 completing blinded assessments (seven [44%] in the active stimulation group and nine [56%] in the sham stimulation group). We noted no significant difference in YGTSS score change between the beginning and the end of the 3 month double-blind period between groups (active group median YGTSS score 68·5 [IQR 34·0 to 83·5] at the beginning and 62·5 [51·5 to 72·0] at the end, median change 1·1% [IQR -23·9 to 38·1]; sham group 73·0 [69·0 to 79·0] and 79·0 [59·0 to 81·5], median change 0·0% [-10·6 to 4·8]; p=0·39). 15 serious adverse events (three in patients who withdrew before stimulation and six each in the active and sham stimulation groups) occurred in 13 patients (three who withdrew before randomisation, four in the active group, and six in the sham group), with infections in DBS hardware in four patients (two who withdrew before randomisation, one in the sham stimulation group, and one in the active stimulation group). Other serious adverse events included one electrode misplacement (active stimulation group), one episode of depressive signs (active stimulation group), and three episodes of increased tic severity and anxiety (two in the sham stimulation group and one in the active stimulation group). INTERPRETATION 3 months of aGPi DBS is insufficient to decrease tic severity for patients with Tourette's syndrome. Future research is needed to investigate the efficacy of aGPi DBS for patients over longer periods with optimal stimulation parameters and to identify potential predictors of the therapeutic response. FUNDING French Ministry of Health.
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Affiliation(s)
- Marie-Laure Welter
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France; Clinical Investigation Centre, INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Paris, France; Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France.
| | - Jean-Luc Houeto
- Department of Neurology, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Stéphane Thobois
- Department of Neurology C, Hôpital Neurologique, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; CNRS, Lyon Centre for Neuroscience Research, University Lyon 1, Bron, France
| | - Benoit Bataille
- Department of Neurosurgery, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Marc Guenot
- Department of Neurosurgery A, Hôpital Neurologique, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Yulia Worbe
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
| | - Andreas Hartmann
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
| | - Virginie Czernecki
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
| | - Eric Bardinet
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Jerome Yelnik
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Sophie Tezenas du Montcel
- AP-HP, Pitié-Salpêtrière Hospital, Biostatistics and Medical Informatics Unit and Clinical Research Unit, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Yves Agid
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Marie Vidailhet
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Philippe Cornu
- Neurosurgery, INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Paris, France
| | - Audrey Tanguy
- AP-HP, Pitié-Salpêtrière Hospital, Biostatistics and Medical Informatics Unit and Clinical Research Unit, Paris, France
| | - Solène Ansquer
- Department of Neurology, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Nematollah Jaafari
- Department of Psychiatry, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Emmanuel Poulet
- PsyR2 Team, U 1028, INSERM and UMR 5292, Centre Hospitalier Le Vinatier, Bron, France
| | - Giulia Serra
- Department of Neurology C, Hôpital Neurologique, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Burbaud
- Department of Neurophysiology, Charles Perrens Hospital, University Bordeaux 2, CNRS UMR 5543, Bordeaux, France
| | - Emmanuel Cuny
- Department of Neurosurgery, Charles Perrens Hospital, University Bordeaux 2, CNRS UMR 5543, Bordeaux, France
| | - Bruno Aouizerate
- Department of Psychiatry, Charles Perrens Hospital, University Bordeaux 2, CNRS UMR 5543, Bordeaux, France
| | - Pierre Pollak
- Department of Neurology, Grenoble Alpes University, CHU Grenoble, Grenoble, France
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble Alpes University, CHU Grenoble, Grenoble, France
| | - Mircea Polosan
- Department of Psychiatry, Grenoble Alpes University, CHU Grenoble, Grenoble, France
| | - Michel Borg
- Department of Neurology, University Hospital, Nice, France
| | - Denys Fontaine
- Department of Neurosurgery, University Hospital, Nice, France
| | - Bruno Giordana
- Department of Psychiatry, University Hospital, Nice, France
| | - Sylvie Raoul
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Tiphaine Rouaud
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Anne Sauvaget
- Department of Psychiatry, Nantes University Hospital, Nantes, France
| | - Isabelle Jalenques
- Department of Psychiatry, CHU Clermont-Ferrand and Clermont Auvergne University, Equipe d'Accueil 7280, Clermont-Ferrand, France
| | - Carine Karachi
- Neurosurgery, INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Paris, France; Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Luc Mallet
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; AP-HP, Personalised Neurology and Psychiatry University Department, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris Est Créteil, Créteil, France; Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Bernat AL, Clarençon F, André A, Nouet A, Clémenceau S, Sourour NA, Di Maria F, Degos V, Golmard JL, Cornu P, Boch AL. Risk factors for angiographic recurrence after treatment of unruptured intracranial aneurysms: Outcomes from a series of 178 unruptured aneurysms treated by regular coiling or surgery. J Neuroradiol 2017; 44:298-307. [PMID: 28602498 DOI: 10.1016/j.neurad.2017.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/13/2017] [Accepted: 05/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term stability after intracranial aneurysm exclusion by coiling is still a matter of debate; after surgical clipping little is known. OBJECTIVE To study outcome after endovascular and surgical treatments for unruptured intracranial aneurysms in terms of short- and long-term angiographic exclusion and risk factors for recanalization. METHODS From 2004 and 2009, patients treated for unruptured berry intracranial aneurysms by coiling or clipping were reviewed. Aneurysmal exclusion was evaluated using the Roy-Raymond grading scale; immediate clinical outcome was also assessed. Clinical outcome, recanalization, risk factors for recurrence and bleeding during the follow-up period were analyzed by groups; "surgery" and "embolization". RESULTS From 2004 to 2009, 178 consecutive unruptured aneurysms were treated. The post-procedure angiographic results for "surgery" were: total exclusion 75.6%; residual neck 13.5%; residual aneurysm 10.8%. For "embolization", the results were, respectively: 72%; 20.7%; and 7.2%. Morbidity was 3% for "surgery" and 1.6% for "embolization" (P=0.74); mortality was nil. Mean clinical and angiographic follow-up was 5years. Recurrence rate was of 11.5% for "surgery" vs. 44% for "embolization" with a mean follow-up of 4 and 5.75years, respectively (P=1.10-5). The retreatment rate was 8.4%. Two significant risk factors for recanalization were identified: maximum diameter of the aneurysm sac (P=0.0038) and pericallosal location (P=0.0388). No bleeding event occurred. CONCLUSION Both techniques are safe. The rate of aneurismal recurrence was significantly higher for embolization, especially for large diameter aneurysms and pericallosal locations. No bleeding event occurred after recanalization.
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Affiliation(s)
- Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière University Hospital, AP-HP, 75010 Paris, France; Paris VII University, Paris Diderot, Paris, France.
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France
| | - Arthur André
- Department of Neurosurgery, Lariboisière University Hospital, AP-HP, 75010 Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Stéphane Clémenceau
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Nader-Antoine Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Federico Di Maria
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Vincent Degos
- Paris VI University, Pierre-et-Marie-Curie, Paris, France; Department of Anesthesia and Perioperative Care, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Jean-Louis Golmard
- Paris VI University, Pierre-et-Marie-Curie, Paris, France; Department of Biomedical Statistics, Pitié-Salpêtrière University Hospital, AP-HP, 75013 Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
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André A, Boch AL, Di Maria F, Nouet A, Sourour N, Clémenceau S, Gabrieli J, Degos V, Zeghal C, Chiras J, Cornu P, Clarençon F. Complication Risk Factors in Anterior Choroidal Artery Aneurysm Treatment. Clin Neuroradiol 2017; 28:345-356. [PMID: 28321460 DOI: 10.1007/s00062-017-0575-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/18/2016] [Accepted: 02/21/2017] [Indexed: 01/12/2023]
Abstract
OBJECT The anterior choroidal artery (AChoA) is a rare location for intracranial aneurysms. The treatment of these aneurysms may be challenging due to the risk of occlusion of such a small and eloquent artery as the AChoA. We aimed to evaluate the risk factors for complications in AChoA aneurysm treatment. METHODS We retrospectively analyzed 47 consecutive AChoA aneurysms in 40 patients treated in our institution from 1999 and 2014 by endovascular means (87%) or surgical clipping (13%). Minor (transient or minor neurological deficits) and major complications (severe permanent neurological deficits or death) were systematically recorded. The influence of patient age, sex, aneurysm size, neck size, shape, dome-to-neck ratio and treatment technique on the occurrence of procedure-related complications was evaluated. RESULTS Of the patients 11 experienced procedure-related complications (5 major, 6 minor). Aneurysms with multilobed shape were significantly associated with a higher procedure-related complication rate. There was a tendency for higher major procedure-related complication rate in small volume aneurysms. We did not find any association between the other factors analyzed and occurrence of procedure-related complications. CONCLUSION Treatment of AChoA aneurysms has an acceptable complication risk. We did not find any significant differences between surgical and endovascular treatment in terms of procedure-related complication rates. Multilobed aneurysms were significantly associated with a higher procedure-related complication rate.
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Affiliation(s)
- Arthur André
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, 47 boulevard de l'hôpital, 75013, Paris, France. .,Pierre et Marie Curie University, Sorbonne Universités, Paris, France.
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, 47 boulevard de l'hôpital, 75013, Paris, France
| | - Federico Di Maria
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, 47 boulevard de l'hôpital, 75013, Paris, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Clémenceau
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, 47 boulevard de l'hôpital, 75013, Paris, France
| | - Joseph Gabrieli
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Degos
- Department of Anesthesiology, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Pierre et Marie Curie University, Sorbonne Universités, Paris, France
| | - Chiheb Zeghal
- Department of Anesthesiology, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Jacques Chiras
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Pierre et Marie Curie University, Sorbonne Universités, Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, 47 boulevard de l'hôpital, 75013, Paris, France.,Pierre et Marie Curie University, Sorbonne Universités, Paris, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Pierre et Marie Curie University, Sorbonne Universités, Paris, France
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Apra C, Mokhtari K, Cornu P, Kalamarides M. Tumeurs fibreuses solitaires/hémangiopéricytomes méningés : première description de transformations malignes. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.009] [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: 11/26/2022]
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Mathon B, Navarro V, Carpentier A, Bielle F, Cornu P, Clemenceau S. Résultats et facteurs pronostiques de la chirurgie de l’épilepsie mésiotemporale associée à une sclérose hippocampique. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.044] [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: 11/16/2022]
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Valery CA, Faillot M, Lamproglou I, Golmard JL, Jenny C, Peyre M, Mokhtari K, Mazeron JJ, Cornu P, Kalamarides M. Grade II meningiomas and Gamma Knife radiosurgery: analysis of success and failure to improve treatment paradigm. J Neurosurg 2016; 125:89-96. [DOI: 10.3171/2016.7.gks161521] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGrade II meningiomas, which currently account for 25% of all meningiomas, are subject to multiple recurrences throughout the course of the disease and represent a challenge for the neurosurgeon. Radiosurgery is increasingly performed for the treatment of Grade II meningiomas and is quite efficient in controlling relapses locally at the site of the lesion, but it cannot prevent margin relapses. The aim of this retrospective study was to analyze the technical parameters involved in producing marginal relapses and to optimize loco-marginal control to improve therapeutic strategy.METHODSEighteen patients presenting 58 lesions were treated by Gamma Knife radiosurgery (GKRS) between 2010 and 2015 in Hopital de la Pitié-Salpêtrière. The median patient age was 68 years (25%−75% interval: 61–72 years), and the sex ratio (M/F) was 13:5. The median delay between surgery and first GKRS was 3 years. Patients were classified as having Grade II meningioma using World Health Organization (WHO) 2007 criteria. The tumor growth rate was computed by comparing 2 volumetric measurements before treatment. After GKRS, iterative MRI, performed every 6 months, detected a relapse if tumor volume increased by more than 20%. Patterns of relapse were defined as being local, marginal, or distal. Survival curves were estimated using the Kaplan-Meier method, and the relationship between criterion and potential risk factors was tested by the log-rank test and univariable Cox model.RESULTSThe median follow-up was 36 months (range 8–57 months). During this period, 3 patients presented with a local relapse, 5 patients with a marginal relapse, and 7 patients with a distal relapse. Crude local control was 84.5%. The local control actuarial rate was 89% at 1 year and 71% at 3 years. The marginal control actuarial rate was 81% at 1 year and 74% at 2 years. The distal control actuarial rate was 100% at 1 year, 81% at 2 years, and 53% at 3 years. Median distal control was 38 months. Progression-free survival (PFS) was 71% at 1 year, 36% at 2 years, and 23% at 3 years. Median PFS was 18 months. Lesions treated with a minimum radiation dose of ≤ 12 Gy had significantly more local relapses than those treated with a dose > 12 Gy (p = 0.04) in univariate analysis.Marginal control was significantly influenced by tumor growth rate, with a lower growth rate being highly associated with improved marginal control (p = 0.002). There was a trend toward a relationship between dose and marginal control, but it was not significant (p = 0.09). PFS was significantly associated with delay between first surgery and GKRS (p = 0.03). The authors noticed few complications with no sequelae.CONCLUSIONSIn order to optimize loco-marginal control, radiosurgical treatment should require a minimum dose of > 12 Gy and an extended target volume along the dural insertion. Ideally, these parameters should correspond to the aggressiveness of the lesion, based on genetic features of the tumor.
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Affiliation(s)
| | | | | | | | | | - Matthieu Peyre
- Service de 2Neurochirurgie,
- 6Sorbonne Universités, UPMC Université Paris VI, Paris, France
| | - Karima Mokhtari
- 7Neuropathologie, Hopital de la Pitié-Salpêtrière, AP-HP, Paris; and
| | - Jean-Jacques Mazeron
- 5Radiothérapie, and
- 6Sorbonne Universités, UPMC Université Paris VI, Paris, France
| | - Philippe Cornu
- Unité de 1Radiochirurgie GK Region IDF,
- Service de 2Neurochirurgie,
- 6Sorbonne Universités, UPMC Université Paris VI, Paris, France
| | - Michel Kalamarides
- Unité de 1Radiochirurgie GK Region IDF,
- Service de 2Neurochirurgie,
- 6Sorbonne Universités, UPMC Université Paris VI, Paris, France
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Carpentier A, Canney M, Vignot A, Reina V, Beccaria K, Horodyckid C, Karachi C, Leclercq D, Lafon C, Chapelon JY, Capelle L, Cornu P, Sanson M, Hoang-Xuan K, Delattre JY, Idbaih A. Clinical trial of blood-brain barrier disruption by pulsed ultrasound. Sci Transl Med 2016; 8:343re2. [DOI: 10.1126/scitranslmed.aaf6086] [Citation(s) in RCA: 420] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/20/2016] [Indexed: 12/23/2022]
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Edjlali-Goujon M, Hassen WB, Aboukais R, Nouet A, Bielle F, Clarençon F, Nataf F, Mokhtari K, Oppenheim C, Meder JF, Cornu P, Galanaud D, Chrétien F, Lejeune JP, Leclerc X, Maurage CA, Naggara O. Inflammation et paroi anévrysmale. J Neuroradiol 2016. [DOI: 10.1016/j.neurad.2016.01.038] [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: 11/29/2022]
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Bourdillon P, Apra C, Cornu P, Chauvet D. An Unexpected Subdural Collection: Story of a Prostatic Metastasis. Clin Genitourin Cancer 2016; 14:e405-7. [PMID: 26873433 DOI: 10.1016/j.clgc.2016.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 01/17/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; University of Lyon, Université Claude Bernard Lyon 1, Lyon, France; Sorbonne University, Université Pierre et Marie Curie Paris 6, Paris, France.
| | - Caroline Apra
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; Sorbonne University, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; Sorbonne University, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Dorian Chauvet
- Department of Neurosurgery, Hôpital de la Pitié-Salpêtrière, Paris, France; Department of Neurosurgery, Fondation Rothschild, Paris, France
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Clarençon F, Di Maria F, Sourour NA, Gabrieli J, Nouet A, Shotar E, Cormier E, Fahed R, Cornu P, Chiras J. Evaluation of intra-aortic CT angiography performances for the visualisation of spinal vascular malformations' angioarchitecture. Eur Radiol 2016; 26:3336-44. [DOI: 10.1007/s00330-015-4204-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/12/2015] [Accepted: 12/30/2015] [Indexed: 11/29/2022]
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Senova S, Aggad M, Golmard JL, Hasboun D, Lamproglou I, Jenny C, Cornu P, Mazeron JJ, Valéry CA. Predictors of Trigeminal Neuropathy After Radiosurgery for Vestibular Schwannomas. Int J Radiat Oncol Biol Phys 2016; 95:721-8. [PMID: 26960748 DOI: 10.1016/j.ijrobp.2016.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 01/02/2016] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyze the relationship between dosimetric characteristics and symptoms related to trigeminal neuropathy (TN) observed after radiosurgery (RS) for vestibular schwannomas (VS); to propose guidelines to optimize planification in VS RS regarding TN preservation; and to detail the mechanism of TN impairment after VS RS. METHODS AND MATERIALS One hundred seventy-nine patients treated between 2011 and 2013 for VS RS and without trigeminal impairment before RS were included in a retrospective study. Univariate and multivariate analyses were performed to determine predictors of TN among characteristics of the patients, the dosimetry, and the VS. RESULTS There were 20 Koos grade 1, 99 grade 2, 57 grade 3, and 3 grade 4. Fourteen patients (7.8%) presented a transitory or permanent TN. Between the patients with and without TN after VS RS, there was no significant difference regarding dosimetry or VS volume itself. Significant differences (univariate analysis P<.05, Mann-Whitney test) were found for parameters related to the cisternal portion of the trigeminal nerve: total integrated dose, maximum dose, mean dose, volume of the Vth nerve (Volv), and volume of the Vth nerve receiving at least 11 Gy (VolVcist>11Gy), but also for maximal dose to the Vth nerve nucleus and intra-axial portion (Dose maxVax). After multivariate analysis, the best model predicting TN included VolVcist>11Gy (P=.0045), Dose maxVax (P=.0006), and Volv (P=.0058). The negative predictive value of this model was 97%. CONCLUSIONS The parameters VolVcist>11Gy, Dose maxVax, and Volv should be checked when designing dosimetry for VS RS.
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Affiliation(s)
- Suhan Senova
- Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris, France; Service de Neurochirurgie, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France; Inserm, U955, Equipe 14, Université Paris Est, Faculté de médecine, Créteil, France
| | - Mourad Aggad
- Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris, France; Service de Neurochirurgie, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Jean-Louis Golmard
- Service de Biostatistiques, CHU La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Dominique Hasboun
- Service de Neuroanatomie, CHU La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Ioannis Lamproglou
- Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris, France
| | - Catherine Jenny
- Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris, France; Service de Radiothérapie, Unité de physique médicale, CHU La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, France
| | - Philippe Cornu
- Service de Neurochirurgie, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Jean-Jacques Mazeron
- Service de Radiothérapie, Unité de physique médicale, CHU La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, France
| | - Charles A Valéry
- Unité de Radiochirurgie Gamma Knife, Region Ile De France, Paris, France; Service de Neurochirurgie, Centre Hospitalier Universitaire (CHU) La Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
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Mathon B, Clemenceau S, Hasboun D, Habert MO, Belaid H, Nguyen-Michel VH, Lambrecq V, Navarro V, Dupont S, Baulac M, Cornu P, Adam C. Safety profile of intracranial electrode implantation for video-EEG recordings in drug-resistant focal epilepsy. J Neurol 2015; 262:2699-712. [DOI: 10.1007/s00415-015-7901-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 11/25/2022]
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Amelot A, Baronnet-Chauvet F, Fioretti E, Mathon B, Cornu P, Nouet A, Chauvet D. Glioblastoma complicated by fatal malignant acute ischemic stroke: MRI finding to assist in tricky surgical decision. Neuroradiol J 2015; 28:483-7. [PMID: 26306931 DOI: 10.1177/1971400915598073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In most cases, glioblastomas are associated with seizures, headaches, neurological deficits, aphasia, or bleeding. But these tumors are rarely associated with cerebral infarction and never so deadly. CASE REPORT A 40-year-old man presented with sudden morning isolated aphasia. One hour later, he developed a motor deficit at right upper member, quickly completed with a total right hemiplegia. Imaging studies revealed a left frontotemporal enhancing glioblastoma with a perilesional edema which produced an important mass effect on the posterior arm of the external capsule, on the primary motor cortex posteriorly and the entire sylvian valley anteriorly. Due to major surgical risks associated with left middle cerebral artery (MCA) inclusion and large edema, we decided to postpone the tumor removal and introduce quickly high concentrations of steroids. Twenty-four hours after his admittance, the patient presented a sudden impaired consciousness, coma, and a left mydriasis. A brain magnetic resonance image (MRI) revealed a left malignant MCA infarction, deadly for the patient. CONCLUSION To our knowledge, glioblastomas complicated by fatal ischemic stroke have not been reported. We discuss the pathology of such an event and try to figure out if it was predictable based on MRI finding, and inevitable with precocious surgery.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | | | - Edith Fioretti
- Department of Radiology, Hôpital European Georges Pompidou, APHP, Paris, France
| | - Bertrand Mathon
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
| | - Dorian Chauvet
- Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France
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Sourour N, Hallout S, Di Maria F, Nouet A, Gabrieli J, Cornu P, Chiras J, Clarençon F. O-029 safety and effectiveness of middle cerebral artery aneurysms treatment (endovascular and surgical): retrospective analysis of a single center series with 362 consecutive patients. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.29] [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: 11/03/2022]
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Desmaele S, Dupont AG, Putman K, Cornu P, Steurbaut S. Comparison of two approaches of INR-follow-up and determinants of INR-stability. Acta Clin Belg 2015; 70:167-74. [PMID: 26103536 DOI: 10.1179/2295333714y.0000000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Patients with atrial fibrillation (AF) and treated with coumarins need a close follow-up of the international normalized ratio (INR)-values. This can be done by the general practitioner (GP) or by a haematologist in an outpatient hospital clinic. OBJECTIVE To compare both ways of follow-up and to investigate determinants of stable INR-patterns. METHODS Cross-sectional single-centre study in patients with AF treated at the UZ Brussel, a university hospital in Brussels. Of the 113 patients included in the study, 71 had their INR followed-up by their GP and 42 similar patients were followed-up by a haematologist. Data of these 113 patients were further analysed to identify possible determinants for stable INR-values. RESULTS The time in therapeutic range (TTR) did not significantly differ between both groups. However, patients in the GP-group had significantly more INR-values under 2.0 compared to patients from the haematologist-group (P = 0.044), whereas patients in the haematologist-group had significantly more INR-values above 3.0 compared to patients from the GP-group (P = 0.038). Reimbursement costs of both ways of follow-up were comparable, but the out-of-pocket costs for the patient were lower in the GP-group. The time since AF diagnosis was the only significant determinant predicting a higher TTR. CONCLUSION Both approaches of follow-up seem to lead to the same TTR, yielding no reason to advocate one approach above the other. However, the patient costs were lower when followed-up by the GP.
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Cao C, Sourour N, Reina V, Nouet A, Di Maria F, Chiras J, Cornu P, Clarençon F. Spontaneous thrombosis of the main draining vein revealing an unruptured brain arteriovenous malformation. Interv Neuroradiol 2015; 21:222-6. [PMID: 25964440 DOI: 10.1177/1591019915581989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/15/2022] Open
Abstract
Haemorrhage is the most frequent revealing condition of brain arteriovenous malformations (bAVMs). We report a rare case of unruptured parietal bAVM revealed by spontaneous thrombosis of the main draining vein, responsible for a focal neurological deficit. The bAVM was embolized in emergency conditions; complete regression of the neurological symptoms was observed within five days after the embolization. Potential mechanisms of such spontaneous thrombosis of the bAVM's main drainage pathway as well as an exhaustive review of the literature concerning this rare revealing condition are presented and discussed.
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Affiliation(s)
- Catherine Cao
- Department of Neurosurgery, Dijon University Hospital, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, France
| | - Vincent Reina
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris VI University, France
| | - Aurélien Nouet
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris VI University, France
| | - Federico Di Maria
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, France
| | - Jacques Chiras
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, France
| | - Philippe Cornu
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris VI University, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, France
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Welter ML, Grabli D, Karachi C, Jodoin N, Fernandez-Vidal S, Brun Y, Navarro S, Rogers A, Cornu P, Pidoux B, Yelnik J, Roze E, Bardinet E, Vidailhet M. Pallidal activity in myoclonus dystonia correlates with motor signs. Mov Disord 2015; 30:992-6. [PMID: 25880339 DOI: 10.1002/mds.26244] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 04/07/2014] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Myoclonus-dystonia related to epsilon-sarcoglycan gene mutations is characterized by myoclonic jerks and mild to moderate dystonia. The role of basal ganglia dysfunction in the pathogenesis is unknown. METHODS Pallidal neuronal activity was recorded in six myoclonus-dystonia and six primary generalized dystonia patients operated on for internal globus pallidus deep brain stimulation. RESULTS In myoclonus-dystonia patients compared with primary-dystonia patients, internal pallidum neurons showed higher burst frequency, lower mean burst, and pause durations. External pallidum neurons showed higher mean pause frequency. Oscillatory activity was present in 33% and 35% of internal pallidum neurons in myoclonus-dystonia and primary-dystonia patients, respectively, predominantly in the theta frequency band (3-8 Hz). In myoclonus-dystonia patients with more severe myoclonus, internal pallidum neurons exhibited a higher bursting activity with high intraburst frequency and lower oscillatory activity frequency. CONCLUSIONS Myoclonus-dystonia appears to be related to specific changes in internal pallidum activity, leading to disruption in striato-pallido-thalamo-cortical circuits. © 2015 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marie-Laure Welter
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Grabli
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carine Karachi
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Jodoin
- Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Neurologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sara Fernandez-Vidal
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Centre de Neuroimagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Yohann Brun
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France
| | - Soledad Navarro
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alister Rogers
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Cornu
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bernard Pidoux
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Yelnik
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Roze
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Bardinet
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Centre de Neuroimagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Vidailhet
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Amelot A, Lemaistre G, Cornu P, Kalamarides M, Peyre M. Multiple meningiomas in patients with Turner syndrome. Acta Neurochir (Wien) 2015; 157:621-3. [PMID: 25663140 DOI: 10.1007/s00701-015-2360-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/22/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, Batiment Babinski, Groupe Hospitalier Pitié-Salpétrière, APHP, 47-83 boulevard de l'Hôpital, 75013, Paris, France,
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Mathon B, Bédos-Ulvin L, Baulac M, Dupont S, Navarro V, Carpentier A, Cornu P, Clemenceau S. Évolution des idées et des techniques, et perspectives d’avenir en chirurgie de l’épilepsie. Rev Neurol (Paris) 2015; 171:141-56. [DOI: 10.1016/j.neurol.2014.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/10/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Zanello M, Peyre M, Mokhtari K, Boch A, Capelle L, Carpentier A, Clemenceau S, Karachi C, Navarro S, Nouet A, Reina V, Sanson M, Cornu P, Kalamarides M. Méningiomes multi-récidivants : établissement de critères de réponse thérapeutiques après analyse des cinétiques de croissance et des types de récidive. Neurochirurgie 2014. [DOI: 10.1016/j.neuchi.2014.10.031] [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: 11/17/2022]
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Millet B, Jaafari N, Polosan M, Baup N, Giordana B, Haegelen C, Chabardes S, Fontaine D, Devaux B, Yelnik J, Fossati P, Aouizerate B, Krebs MO, Robert G, Jay T, Cornu P, Vérin M, Drapier S, Drapier D, Sauleau P, Peron J, Le Jeune F, Naudet F, Reymann JM. Limbic versus cognitive target for deep brain stimulation in treatment-resistant depression: accumbens more promising than caudate. Eur Neuropsychopharmacol 2014; 24:1229-39. [PMID: 24950819 DOI: 10.1016/j.euroneuro.2014.05.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 10/29/2013] [Revised: 03/10/2014] [Accepted: 05/09/2014] [Indexed: 11/24/2022]
Abstract
High-frequency deep brain stimulation (DBS) represents a major stake for treatment for treatment-resistant depression (TRD). We describe a preliminary trial of DBS of two potential brain targets in chronic TRD: the nucleus accumbens (Acb) and, in the event of failure, the caudate nucleus. Patients were followed for 6 months before surgery (M0). From M1 to M5, they underwent stimulation of the Acb target. PET scans allowed us to track metabolic modifications resulting from this stimulation. The caudate target of nonresponders was stimulated between M5 and M9. Patients then entered an extension phase, in which it was possible to adapt stimulation parameters and treatments. Six patients were included and four were operated on. At M5, none of the patients were either responders or remitters, but we did observe a decrease in Hamilton Depression Rating Scale (HDRS) scores. Three patients were switched to caudate stimulation, but no improvement was observed. During the extension phase, the Acb target was stimulated for all patients, three of whom exhibited a significant response. A decrease in glucose metabolism was observed after Acb stimulation, in the posterior cingulate gyrus, left frontal lobe, superior and medial gyrus, and bilateral cerebellum. An increase in metabolism was observed in the bilateral frontal lobe (superior gyrus), left frontal lobe (medial gyrus), and right limbic lobe (anterior cingulate gyrus). The results of this trial suggest that Acb is a more promising target than the caudate. NCT01569711.
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Affiliation(s)
- Bruno Millet
- University Department of Adult Psychiatry, Guillaume Régnier Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France
| | - Nematollah Jaafari
- Intersector Clinical Psychiatric Research Unit (INSERM U 1084), Psychobiology of Compulsive Disorders Team, Experimental and Clinical Neurosciences Laboratory, Henri Laborit Hospital, University of Poitiers, France
| | - Mircea Polosan
- D Villars Ward (Adult Psychiatry), Department of Psychiatry and Neurology, North Hospital, University Hospital, Grenoble, France
| | - Nicolas Baup
- Adolescent and Young Adult Assessment Center, Sainte-Anne Hospital, Paris, France
| | - Bruno Giordana
- Psychiatry and Medical Psychology Clinic, University Department of Clinical Neuroscience, Pasteur University Hospital, Nice, France
| | - Claire Haegelen
- Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France
| | | | - Denys Fontaine
- Department of Neurosurgery, Pasteur University Hospital, Nice, France
| | - Bertrand Devaux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Jérome Yelnik
- CRICM UPMC/INSERM UMR S 975, CNRS UMR 7225, La Salpêtrière Hospital, Paris, France
| | - Philippe Fossati
- Department of Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Bruno Aouizerate
- University Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Marie Odile Krebs
- Adolescent and Young Adult Assessment Center, Sainte-Anne Hospital, Paris, France
| | - Gabriel Robert
- University Department of Adult Psychiatry, Guillaume Régnier Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France
| | - Thérèse Jay
- Inserm U894, Center for Psychiatry and Neuroscience, Paris Descartes University, Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Marc Vérin
- Department of Neurology, Pontchaillou University Hosptial, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France
| | - Sophie Drapier
- Department of Neurology, Pontchaillou University Hospital, Rennes, France
| | - Dominique Drapier
- University Department of Adult Psychiatry, Guillaume Régnier Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France
| | - Paul Sauleau
- Functional Neurological Exploration Unit, Pontchaillou University Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France
| | - Julie Peron
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Florence Le Jeune
- Department of Nuclear Medicine, Eugène Marquis Center, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France
| | - Florian Naudet
- Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Pontchaillou University Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
| | - Jean Michel Reymann
- Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Pontchaillou University Hospital, Rennes, France
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Chauvet D, Carpentier A, Cornu P, Hans S. Transoral Robot-Assisted Approach of the Sella: Preliminary Feasibility on Cadavers. J Neurol Surg B Skull Base 2014. [DOI: 10.1055/s-0034-1383951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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