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Garrido E, Ngoc HL, Guyotat J, Pelissou-Guyotat I, Jacquesson T, Delabar V, Manet R, Gallet C, Fenouil T, Streichenberger N, Vasiljevic A, Meyronet D, Jouanneau E, Ducray F, Dumot C, Picart T. Predictors of Progression in a Series of 81 Adult Patients Surgically Managed for an Intracranial Hemangioblastoma: Implications for the Postoperative Follow-Up. Cancers (Basel) 2024; 16:1261. [PMID: 38610939 PMCID: PMC11010926 DOI: 10.3390/cancers16071261] [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: 02/26/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
The aim was to identify predictors of progression in a series of patients managed for an intracranial hemangioblastoma, in order to guide the postoperative follow-up modalities. The characteristics of 81 patients managed for an intracranial hemangioblastoma between January 2000 and October 2022 were retrospectively analyzed. The mean age at diagnosis was of 48 ± 16 years. Eleven (14%) patients had von Hippel-Lindau disease. The most frequent tumor location was the cerebellar hemispheres (n = 51, 65%) and 11 (14%) patients had multicentric hemangioblastomas. A gross total resection was achieved in 75 (93%) patients. Eighteen (22%) patients had a local progression, with a median progression-free survival of 56 months 95% CI [1;240]. Eleven (14%) patients had a distant progression (new hemangioblastoma and/or growth of an already known hemangioblastoma). Local progression was more frequent in younger patients (39 ± 14 years vs. 51 ± 16 years; p = 0.005), and those with von Hippel-Lindau disease (n = 8, 44% vs. n = 3, 5%, p < 0.0001), multiple cerebral locations (n = 3, 17% vs. n = 2, 3%, p = 0.02), and partial tumoral resection (n = 4, 18% vs. n = 1, 2%, p = 0.0006). Therefore, it is advisable to propose a postoperative follow-up for at least 10 years, and longer if at least one predictor of progression is present.
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Affiliation(s)
- Elisabeth Garrido
- Department of Neurosurgery, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France;
| | - Huy Le Ngoc
- Department of Neurosurgery, Hospital Bach Mai, 78 Giai Phong, Phuong Mai, Dong Da, Ha Noi 116305, Vietnam;
| | - Jacques Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Isabelle Pelissou-Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Timothée Jacquesson
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
| | - Violaine Delabar
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Romain Manet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Clémentine Gallet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Tanguy Fenouil
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Nathalie Streichenberger
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- CNRS UMR 5310—INSERM U1217, Institut NeuroMyogène, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Alexandre Vasiljevic
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - David Meyronet
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
| | - François Ducray
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuro-Oncology, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Chloe Dumot
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- CarMeN Laboratoire, INSERM, INRAER, Université Claude Bernard Lyon 1, 59 Boulevard Pinel, 69500 Bron, France
| | - Thiebaud Picart
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
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Jacquesson T, Djarouf I, Simon É, Haegelen C, Mertens P, Picart T, Fernandez-Miranda J. Educational stereoscopic representation of a step-by-step brain white fiber dissection according to Klingler's method. Surg Radiol Anat 2024; 46:303-311. [PMID: 38376527 DOI: 10.1007/s00276-024-03305-0] [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: 10/09/2023] [Accepted: 01/14/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Understanding and teaching the three-dimensional architecture of the brain remains difficult because of the intricate arrangement of grey nuclei within white matter tracts. Although cortical area functions have been well studied, educational and three-dimensional descriptions of the organization of deep nuclei and white matter tracts are still missing. OBJECTIVE We propose herein a detailed step-by-step dissection of the lateral aspect of a left hemisphere using the Klingler method and provide high-quality stereoscopic views with the aim to help teach medical students or surgeons the three-dimensional anatomy of the brain. METHODS Three left hemispheres were extracted and prepared. Then, according to the Klingler method, dissections were carried out from the lateral aspect. Photographs were taken at each step and were modified to provide stereoscopic three-dimensional views. RESULTS Gray and white structures were described: cortex, claustrum, putamen, pallidum, caudate nucleus, amygdala; U-fibers, external and internal capsules, superior longitudinal fasciculus, frontal aslant fasciculus, uncinate fasciculus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, corticospinal fasciculus, corona radiata, anterior commissure, and optic radiations. CONCLUSION This educational stereoscopic presentation of an expert dissection of brain white fibers and basal ganglia would be of value for theoretical or hands-on teaching of brain anatomy; labeling and stereoscopy could, moreover, improve the teaching, understanding, and memorizing of brain anatomy. In addition, this could be also used for the creation of a mental map by neurosurgeons for the preoperative planning of brain tumor surgery.
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Affiliation(s)
- Timothée Jacquesson
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France.
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Idriss Djarouf
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Émile Simon
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Claire Haegelen
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patrick Mertens
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
- Laboratoire d'Anatomie Rockefeller, Université de Lyon 1, 8 Avenue Rockefeller, 69003, Lyon, France
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thiébaud Picart
- Département de Neurochirurgie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon Cedex, France
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Chabert M, Dauleac C, Beaudoin-Gobert M, De-Quelen M, Ciancia S, Jacquesson T, Bertrand S, Vivier E, De-Marignan D, Jung J, Andre-Obadia N, Gobert F, Cotton F, Luauté J. Locked-in syndrome after central pontine myelinolysis, an outstanding outcome of two patients. Ann Clin Transl Neurol 2024; 11:826-836. [PMID: 38263791 DOI: 10.1002/acn3.51994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/30/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Central pontine myelinolysis (CPM) is a rare demyelinating disease that affects the pons and which can cause extreme disabilities such as locked-in syndrome (LIS) in the initial phase. The aim of the study was to describe the evolution over a 12-month period of two patients with CPM causing an initial LIS. METHOD We retrospectively report the unexpected clinical outcome of these two patients in relation with the anatomical damages documented by brain MRI, associated with diffusion tensor imaging and reconstruction of corticospinal tracts in tractography. The following clinical parameters systematically assessed at 3, 6, 9, and 12 months: muscle testing on 12 key muscles (Medical Research Council), prehension metrics (box and block test and purdue pegboard), and independence for acts of daily living (functional independence measure). RESULTS Both patients showed a progressive recovery beginning between 2 and 3 months after the onset of symptoms, leading to almost complete autonomy at 12 months (FIM > 110), with motor strength greater than 4/5 in all joint segments (MRC > 50/60). On brain MRI with tractography, CST appeared partially preserved at pons level. INTERPRETATION The possibility of a near-complete functional recovery at 12 months is important to consider given the ethical issues at stake and the discussions about limiting care that may take place initially. It seems to be the consequence of reversible myelin damage combined with partially preserved neurons. Development of collateral pathways or resolution of conduction block may explain this recovery. MRI comprising DTI and tractography could play a key role in the prognosis of motor recovery.
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Affiliation(s)
- Maïlys Chabert
- Department of Physical Medicine and Rehabilitation, Hospices Civils de Lyon, Lyon, France
- University Lyon 1 Claude Bernard, Villeurbanne, France
| | - Corentin Dauleac
- University Lyon 1 Claude Bernard, Villeurbanne, France
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, Inserm U1044, INSA-Lyon, Lyon, France
| | - Maude Beaudoin-Gobert
- University Lyon 1 Claude Bernard, Villeurbanne, France
- Lyon Neurosciences Research Center, Trajectoires Team, CAP Team, Inserm UMR-S 1028, CNRS UMR 5292, Lyon, France
| | - Mélaine De-Quelen
- Department of Physical Medicine and Rehabilitation, Hospices Civils de Lyon, Lyon, France
| | - Sophie Ciancia
- Department of Physical Medicine and Rehabilitation, Hospices Civils de Lyon, Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, Inserm U1044, INSA-Lyon, Lyon, France
- Department of Anatomy, University of Lyon 1, Lyon, France
| | - Simon Bertrand
- Department of Physical Medicine and Rehabilitation, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Vivier
- Department of Intensive-Care, Hôpital Saint Luc Saint Joseph, Lyon, France
| | - Donatien De-Marignan
- Department of Anesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France
| | - Julien Jung
- Department of Neurophysiology & Epilepsy, Hospices Civils de Lyon, Lyon, France
| | | | - Florent Gobert
- Lyon Neurosciences Research Center, Trajectoires Team, CAP Team, Inserm UMR-S 1028, CNRS UMR 5292, Lyon, France
- Department of Anesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France
| | - François Cotton
- University Lyon 1 Claude Bernard, Villeurbanne, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, Inserm U1044, INSA-Lyon, Lyon, France
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
| | - Jacques Luauté
- Department of Physical Medicine and Rehabilitation, Hospices Civils de Lyon, Lyon, France
- University Lyon 1 Claude Bernard, Villeurbanne, France
- Lyon Neurosciences Research Center, Trajectoires Team, CAP Team, Inserm UMR-S 1028, CNRS UMR 5292, Lyon, France
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Linn W, Barrios‐Martinez J, Fernandes‐Cabral D, Jacquesson T, Nuñez M, Gomez R, Anania Y, Fernandez‐Miranda J, Yeh F. Probabilistic coverage of the frontal aslant tract in young adults: Insights into individual variability, lateralization, and language functions. Hum Brain Mapp 2024; 45:e26630. [PMID: 38376145 PMCID: PMC10878181 DOI: 10.1002/hbm.26630] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
The frontal aslant tract (FAT) is a crucial neural pathway of language and speech, but little is known about its connectivity and segmentation differences across populations. In this study, we investigate the probabilistic coverage of the FAT in a large sample of 1065 young adults. Our primary goal was to reveal individual variability and lateralization of FAT and its structure-function correlations in language processing. The study utilized diffusion MRI data from 1065 subjects obtained from the Human Connectome Project. Automated tractography using DSI Studio software was employed to map white matter bundles, and the results were examined to study the population variation of the FAT. Additionally, anatomical dissections were performed to validate the fiber tracking results. The tract-to-region connectome, based on Human Connectome Project-MMP parcellations, was utilized to provide population probability of the tract-to-region connections. Our results showed that the left anterior FAT exhibited the most substantial individual differences, particularly in the superior and middle frontal gyrus, with greater variability in the superior than the inferior region. Furthermore, we found left lateralization in FAT, with a greater difference in coverage in the inferior and posterior portions. Additionally, our analysis revealed a significant positive correlation between the left FAT inferior coverage area and the performance on the oral reading recognition (p = .016) and picture vocabulary (p = .0026) tests. In comparison, fractional anisotropy of the right FAT exhibited marginal significance in its correlation (p = .056) with Picture Vocabulary Test. Our findings, combined with the connectivity patterns of the FAT, allowed us to segment its structure into anterior and posterior segments. We found significant variability in FAT coverage among individuals, with left lateralization observed in both macroscopic shape measures and microscopic diffusion metrics. Our findings also suggested a potential link between the size of the left FAT's inferior coverage area and language function tests. These results enhance our understanding of the FAT's role in brain connectivity and its potential implications for language and executive functions.
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Affiliation(s)
- Wen‐Jieh Linn
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | | | - Timothée Jacquesson
- CHU de Lyon – Hôpital Neurologique et Neurochirurgical Pierre WertheimerLyonFrance
| | - Maximiliano Nuñez
- Department of Neurological SurgeryHospital El CruceBuenos AiresArgentina
| | - Ricardo Gomez
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Yury Anania
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Fang‐Cheng Yeh
- Department of Neurological SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of BioengineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
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Rault F, Jannelli G, Yazbeck M, Jacquesson T, Jouanneau E. Combined Endoscopic Transmaxillary Approach for Resection of an Extracranial V3 Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01049. [PMID: 38319149 DOI: 10.1227/ons.0000000000001088] [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: 08/03/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
Tumours of the pterygopalatine (PPF) and infratemporal fossa (ITF) are rare tumours and are difficult to access. The lateral cervical approach is hampered by the mandibular angle and the vascular nervous elements.1 The classic endonasal endoscopic medial maxillectomy approach has been developed over the past 2 decades but does not allow good control of the most lateral and inferior part of the ITF.2 The surgical video presents a 68-year-old woman with trigeminal neuralgia. The radiologic workup showed a trigeminal V3 schwannoma (TS) into the PPF and ITF. This tumor grew during the follow-up despite fractionated radiosurgery. A 2-dimensional intraoperative video illustrates the gross total removal of the TS through a combined endoscopic endonasal and transgingival transmaxillary approach. The combination of these 2 approaches allows on the one hand, a better view of the lateral and inferior part of the maxillary sinus and ITF and on the other hand, a gain of handling in the operating field and security for our surgical procedure.3 The mini-Caldwell-Luc approach gives good aesthetic results without stomatological complication. Neuralgia disappeared after the surgery, and a gross total resection was achieved, and no recurrence was observed during the follow-up. This combined approach is a good alternative of medial extended maxillectomy, which presents a risk for the lacrimal duct risk and postoperative aesthetic deformity because of the removal of the medial and anterior wall of the maxillary sinus. The patient consented to the procedure and publication of her image.
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Affiliation(s)
- Frédérick Rault
- Department of Neurosurgery, Caen University Hospital, Caen, France
- Department of Neurosurgery, Neurocenter of Southern Svizzera, EOC, Lugano, Switzerland
- Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Multidisciplinary Skull Base Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices civils de Lyon, Lyon, France
| | - Gianpaolo Jannelli
- Department of Neurosurgery, Neurocenter of Southern Svizzera, EOC, Lugano, Switzerland
- Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Multidisciplinary Skull Base Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices civils de Lyon, Lyon, France
| | - Mohamad Yazbeck
- Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Timothée Jacquesson
- Multidisciplinary Skull Base Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices civils de Lyon, Lyon, France
- Department of Anatomy, University of Lyon 1, Lyon, France
| | - Emmanuel Jouanneau
- Multidisciplinary Skull Base Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices civils de Lyon, Lyon, France
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Mechtouff L, Balanca B, Jung J, Bourgeois-Vionnet J, Dumot C, Guery D, Picart T, Bapteste L, Demarquay G, Bani-Sadr A, Rascle L, Berthezène Y, Jacquesson T, Amaz C, Macabrey J, Ramos I, Viprey M, Rode G, Cortet M. Interrater reliability in neurology objective structured clinical examination across specialties. Med Teach 2024; 46:239-244. [PMID: 37605843 DOI: 10.1080/0142159x.2023.2244146] [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] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE To assess interrater reliability and examiners' characteristics, especially specialty, associated with scoring of neurology objective structured clinical examination (OSCE). MATERIAL AND METHODS During a neurology mock OSCE, five randomly chosen students volunteers were filmed while performing 1 of the 5 stations. Video recordings were scored by physicians from the Lyon and Clermont-Ferrand university teaching hospitals to assess students performance using both a checklist scoring and a global rating scale. Interrater reliability between examiners were assessed using intraclass coefficient correlation. Multivariable linear regression models including video recording as random effect dependent variable were performed to detect factors associated with scoring. RESULTS Thirty examiners including 15 (50%) neurologists participated. The intraclass correlation coefficient of checklist scores and global ratings between examiners were 0.71 (CI95% [0.45-0.95]) and 0.54 (CI95% [0.28-0.91]), respectively. In multivariable analyses, no factor was associated with checklist scores, while male gender of examiner was associated with lower global rating (β coefficient = -0.37; CI 95% [-0.62-0.11]). CONCLUSIONS Our study demonstrated through a video-based scoring method that agreement among examiners was good using checklist scoring while moderate using global rating scale in neurology OSCE. Examiner's specialty did not affect scoring whereas gender was associated with global rating scale.
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Affiliation(s)
| | - Baptiste Balanca
- Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Lyon, France
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | | | - Chloé Dumot
- Department of Vascular and Tumoral Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Déborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - Thiébaud Picart
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bapteste
- Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Lyon, France
| | - Geneviève Demarquay
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | | | - Lucie Rascle
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | | | - Camille Amaz
- Clinical Investigation Center, Hospices Civils de Lyon, Lyon, France
| | - Juliette Macabrey
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Inès Ramos
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Marie Viprey
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Gilles Rode
- Physical Medicine and Rehabilitation Department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Marion Cortet
- Gynecology and Obstetrics Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
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7
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Dechaene V, Gallet C, Soueges S, Liu L, Delabar V, Adélaïde L, Jarraud S, Dauwalder O, Jouanneau E, Wan M, Jacquesson T, Guyotat J, Conrad A, Triffault-Fillit C, Ferry T, Valour F. Diagnostic, clinical management, and outcome of bone flap-related osteomyelitis after cranioplasty. Int J Infect Dis 2023; 137:48-54. [PMID: 37839505 DOI: 10.1016/j.ijid.2023.10.008] [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: 08/02/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES We aimed to describe diagnostic, management, and outcome of bone flap-related osteomyelitis after cranioplasty. METHODS Patients followed up in our tertiary care hospital for bone flap-related osteomyelitis after cranioplasty were included in a retrospective cohort (2008-2021). Determinants of treatment failure were assessed using logistic regression and Kaplan-Meier curves analysis. RESULTS The 144 included patients (81 [56.3%] males; median age 53.4 [interquartile range [IQR], 42.6-62.5] years) mostly presented wound abnormalities (n = 115, 79.9%). All infections were documented, the main pathogens being Staphylococcus aureus (n = 64, 44.4%), Cutibacterium acnes (n = 57, 39.6%), gram-negative bacilli (n = 40, 27.8%) and/or non-aureus staphylococci (n = 34, 23.6%). Surgery was performed in 140 (97.2%) cases, for bone flap removal (n = 102, 72.9%) or debridement with flap retention (n = 31, 22.1%), along with 12.7 (IQR, 8.0-14.0) weeks of antimicrobial therapy. After a follow-up of 117.1 (IQR, 62.5-235.5) weeks, 37 (26.1%) failures were observed: 16 (43.2%) infection persistence, three (8.1%) relapses, 22 (59.5%) superinfections and/or two (1.7%) infection-related deaths. Excluding superinfections, determinants of the 19 (13.4%) specific failures were an index craniectomy for brain tumor (odds ratio = 4.038, P = 0.033) and curettage of bone edges (odds ratio = 0.342, P = 0.048). CONCLUSION Post-craniectomy bone flap osteomyelitis are difficult-to-treat infection, necessitating prolonged antimicrobial therapy with appropriate surgical debridement, and advocating for multidisciplinary management in dedicated reference centers.
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Affiliation(s)
- Victor Dechaene
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Clémentine Gallet
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Sarah Soueges
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Lannie Liu
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Violaine Delabar
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Léopold Adélaïde
- Department of Infectious Diseases, Lucien Husset Hospital, Vienne, France
| | - Sophie Jarraud
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Olivier Dauwalder
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Marie Wan
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France; Department of Anatomy, University of Lyon 1, Lyon, France; CREATIS Laboratory, CNRS UMR5220, Inserm U1044, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Jacques Guyotat
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Anne Conrad
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Claire Triffault-Fillit
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Florent Valour
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.
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8
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Jannelli G, Calvanese F, Jouanneau E, Jacquesson T. Frontal trans-sinusal approach: how I do it. Acta Neurochir (Wien) 2023; 165:2963-2968. [PMID: 37672096 DOI: 10.1007/s00701-023-05785-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Anterior skull base lesions could be reached by different approaches (subfrontal, pterional, interhemispheric, etc.). In selected cases, the frontal trans-sinusal approach is an effective alternative to conventional techniques. METHODS We present our technique to perform a frontal trans-sinusal approach in a patient affected by a large olfactory groove meningioma. DISCUSSION-CONCLUSION The frontal trans-sinusal approach allows to approach safely lesions of the median anterior cranial fossa. This approach provides lower brain retraction, easier access to olfactory grooves, and earlier tumor devascularization. However, it remains limited to patients with large-sized frontal sinuses and entails some postoperative risks such as mucocele or CSF leak.
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Affiliation(s)
- Gianpaolo Jannelli
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale Di Lugano, Lugano, Switzerland
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France
| | - Francesco Calvanese
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France.
- Department of Neurosurgery, Helsinki University Central Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Emmanuel Jouanneau
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France
- Lyon 1 University, Lyon, France
| | - Timothée Jacquesson
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Claude Bernard University, Lyon, France
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9
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Dauleac C, Frindel C, Pélissou-Guyotat I, Nicolas C, Yeh FC, Fernandez-Miranda J, Cotton F, Jacquesson T. Full cervical cord tractography: A new method for clinical use. Front Neuroanat 2022; 16:993464. [PMID: 36237419 PMCID: PMC9550930 DOI: 10.3389/fnana.2022.993464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
Despite recent improvements in diffusion-weighted imaging, spinal cord tractography is not used in routine clinical practice because of difficulties in reconstructing tractograms, with a pertinent tri-dimensional-rendering, in a long post-processing time. We propose a new full tractography approach to the cervical spinal cord without extensive manual filtering or multiple regions of interest seeding that could help neurosurgeons manage various spinal cord disorders. Four healthy volunteers and two patients with either cervical intramedullary tumors or spinal cord injuries were included. Diffusion-weighted images of the cervical spinal cord were acquired using a Philips 3 Tesla machine, 32 diffusion directions, 1,000 s/mm2b-value, 2 × 2 × 2 mm voxel size, reduced field-of-view (ZOOM), with two opposing phase-encoding directions. Distortion corrections were then achieved using the FSL software package, and tracking of the full cervical spinal cord was performed using the DSI Studio software (quantitative anisotropy-based deterministic algorithm). A unique region of avoidance was used to exclude everything that is not of the nervous system. Fiber tracking parameters used adaptative fractional anisotropy from 0.015 to 0.045, fiber length from 10 to 1,000 mm, and angular threshold of 90°. In all participants, a full cervical cord tractography was performed from the medulla to the C7 spine level. On a ventral view, the junction between the medulla and spinal cord was identified with its pyramidal bulging, and by an invagination corresponding to the median ventral sulcus. On a dorsal view, the fourth ventricle—superior, middle, and inferior cerebellar peduncles—was seen, as well as its floor and the obex; and gracile and cuneate tracts were recognized on each side of the dorsal median sulcus. In the case of the intramedullary tumor or spinal cord injury, the spinal tracts were seen to be displaced, and this helped to adjust the neurosurgical strategy. This new full tractography approach simplifies the tractography pipeline and provides a reliable 3D-rendering of the spinal cord that could help to adjust the neurosurgical strategy.
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Affiliation(s)
- Corentin Dauleac
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
- *Correspondence: Corentin Dauleac
| | - Carole Frindel
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
| | - Isabelle Pélissou-Guyotat
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Célia Nicolas
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Radiologie, Lyon, France
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - François Cotton
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Radiologie, Lyon, France
| | - Timothée Jacquesson
- Service de Neurochirurgie, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Laboratoire CREATIS, CNRS UMR5220, Inserm U1206, INSA-Lyon, Villeurbanne, France
- Université de Lyon I, Lyon, France
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10
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Ng S, Lima Maldonado I, Destrieux C, Yeh FC, Fernandez-Miranda J, Duffau H, Jacquesson T. Magnetic Resonance Diffusion Tractography of Brain White Matter tracts-An Educational 3-Dimensional Stereoscopic Overview for Operative Planning and Mapping in Brain Tumor Surgery: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e177. [PMID: 35972103 DOI: 10.1227/ons.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | | | | | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Timothée Jacquesson
- Department of Anatomy, University of Lyon 1, Lyon, France.,Multidisciplinary Skull Base Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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11
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Picart T, Dumot C, Guyotat J, Pavlov V, Streichenberger N, Vasiljevic A, Fenouil T, Durand A, Jouanneau E, Ducray F, Jacquesson T, Berhouma M, Meyronet D. Clinical and pathological impact of an optimal assessment of brain invasion for grade 2 meningioma diagnosis: lessons from a series of 291 cases. Neurosurg Rev 2022; 45:2797-2809. [PMID: 35488071 DOI: 10.1007/s10143-022-01792-6] [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: 01/10/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
Brain invasion has not been recognized as a standalone criterion for atypical meningioma by the WHO classification until 2016. Since the 2007 edition suggested that meningiomas harboring brain invasion could be classified as grade 2, brain invasion study was progressively strengthened in our center, based on a strong collaboration between neurosurgeons and neuropathologists regarding sample orientation and examination. Practice changes were considered homogeneous enough in 2011. The aim of the present study was to evaluate the impact of gross practice change on the clinical and pathological characteristics of intracranial meningiomas classified as grade 2.The characteristics of consecutive patients with a grade 2 meningioma surgically managed before (1998-2005, n = 125, group A) and after (2011-2014, n = 166, group B) practices changed were retrospectively reviewed.Sociodemographical and clinical parameters were comparable in groups A and B, and the median age was 62 years in both groups (p = 0.18). The 5-year recurrence rates (23.2% vs 29.5%, p = 0.23) were similar. In group A, brain invasion was present in 48/125 (38.4%) cases and was more frequent than in group B (14/166, 8.4%, p < 0.001). In group A, 33 (26.4%) meningiomas were classified as grade 2 solely based on brain invasion (group ASBI), and 92 harbored other grade 2 criteria (group AOCA). Group ASBI meningiomas had a similar median progression-free survival compared to groups AOCA (68 vs 80 months, p = 0.24) and to AOCA and B pooled together (n = 258, 68 vs 90 months, p = 0.42).An accurate assessment of brain invasion is mandatory as brain invasion is a strong predictor of meningioma progression.
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Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France. .,Claude Bernard University, Lyon 1, Lyon, France. .,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.
| | - Chloé Dumot
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - Jacques Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France
| | - Vladislav Pavlov
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France
| | - Nathalie Streichenberger
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France.,CNRS UMR 5310 - INSERM U1217, Institut NeuroMyogène, Lyon, France
| | - Alexandre Vasiljevic
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Tanguy Fenouil
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Anne Durand
- Department of Neurosurgery, Medipole Lyon Villeurbanne MHP, Villeurbanne, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CNRS UMR5286, Inserm U1052, Cancer Research Center of Lyon, Lyon, France
| | - François Ducray
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Neurooncology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Timothée Jacquesson
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,Laboratory of Anatomy, Faculty of Medicine Lyon Est, University Claude Bernard Lyon 1, Lyon, France
| | - Moncef Berhouma
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CREATIS Laboratory, Inserm U1206, UMR 5220, Université de Lyon, Villeurbanne, France
| | - David Meyronet
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
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12
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Decroocq M, Des Ligneris M, Poquillon T, Vincent M, Aubert M, Jacquesson T, Frindel C. Automation of Cranial Nerve Tractography by Filtering Tractograms for Skull Base Surgery. Front Neuroimaging 2022; 1:838483. [PMID: 37555173 PMCID: PMC10406276 DOI: 10.3389/fnimg.2022.838483] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/04/2022] [Indexed: 08/10/2023]
Abstract
Fiber tractography enables the in vivo reconstruction of white matter fibers in 3 dimensions using data collected by diffusion tensor imaging, thereby helping to understand functional neuroanatomy. In a pre-operative context, it provides essential information on the trajectory of fiber bundles of medical interest, such as cranial nerves. However, the optimization of tractography parameters is a time-consuming process and requires expert neuroanatomical knowledge, making the use of tractography difficult in clinical routine. Tractogram filtering is a method used to isolate the most relevant fibers. In this work, we propose to use filtering as a post-processing of tractography to avoid the manual optimization of tracking parameters and therefore making a step forward automation of tractography. To question the feasibility of automated tractography of cranial nerves, we perform an analysis of main cranial nerves on a series of patients with skull base tumors. A quantitative evaluation of the filtering performance of two state-of-the-art and a new entropy-based methods is carried out on the basis of reference tractograms produced by experts. Our approach proves to be more stable in the selection of the optimal filtering threshold and turns out to be interesting in terms of computational time complexity.
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Affiliation(s)
- Méghane Decroocq
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Morgane Des Ligneris
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Titouan Poquillon
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Maxime Vincent
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Manon Aubert
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Timothée Jacquesson
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
- Skull Base Multi-Disciplinary Unit, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Carole Frindel
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
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13
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Dauleac C, Manet R, Meyronet D, Jacquesson T, Berhouma M, Robinson P, Berthiller J, Jouanneau E, Barrey CY, Mertens P. Prognostic factors for progression-free survival of the filum terminale ependymomas in adults. Neurochirurgie 2022; 68:273-279. [PMID: 34998798 DOI: 10.1016/j.neuchi.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To define the prognostic factors for progression and to determine the impact of the histological grading (according to the World Health Organization) on the progression-free survival (PFS) of filum terminale ependymomas. METHODS A retrospective chart review of 38 patients with ependymoma of the filum terminale was performed, focusing on demographic data, preoperative symptoms, tumor size, quality of resection, presence of a tumor capsule, and histological grade. RESULTS Gross total resection (GTR) was achieved in 30 patients (78.9%). Histopathological analysis found 21 (55.3%) myxopapillary grade I ependymoma (MPE), 16 (42.1%) ependymoma grade II (EGII), and 1 (2.6%) ependymoma grade III. There was no significant difference between the mean ± SD volume of MPE (5840.5 ± 5244.2 mm3) and the one of EGII (7220.3 ± 6305.9 mm3, p=0.5). The mean ± SD follow-up was 54.1 ± 38.4 months. At last follow-up, 30 (78.9%) patients were free of progression. In multivariate analysis, subtotal resection (p=0.015) and infiltrative tumor (p=0.03) were significantly associated with progression. The PFS was significantly higher in patients with encapsulated tumor than in patients with infiltrative tumor (log-rank p=0.01) and in patients who had a GTR in comparison with those who had an incomplete resection (log-rank p=0.05). There was no difference in PFS between patient with MPE and EGII (p=0.1). CONCLUSION The progression of ependymoma of the filum terminale highly depends on the quality of resection, and whether the tumor is encapsulated. Except for anaplastic grade, histopathological type does not influence progression.
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Affiliation(s)
- Corentin Dauleac
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France.
| | - Romain Manet
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France
| | - David Meyronet
- Université de Lyon I, Université de Lyon, Lyon, France; Service d'Anatomo-pathologie, Hospices Civils de Lyon, Lyon, France
| | - Timothée Jacquesson
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Moncef Berhouma
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Philip Robinson
- Unité d'Appui Méthodologique, Département de la Recherche Clinique et Innovation, Hospices Civils de Lyon, Lyon, France
| | - Julien Berthiller
- Unité d'Appui Méthodologique, EPICIME, Cellule Innovation DRCI, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Cédric Y Barrey
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
| | - Patrick Mertens
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon, France; Université de Lyon I, Université de Lyon, Lyon, France
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14
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Simon E, Beuriat PA, Delabar V, Jouanneau E, Fernandez-Miranda J, Jacquesson T. Cranial and Cerebral Anatomic Key Points for Neurosurgery: A New Educational Insight. Oper Neurosurg (Hagerstown) 2022; 22:e18-e27. [PMID: 34982906 DOI: 10.1227/ons.0000000000000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The anatomy of both the skull and the brain offers many landmarks that could lead surgery. Cranial "craniometric" key points were described many years ago, and then, cerebral key points-along sulci and gyri-were detailed more recently for microneurosurgical approaches that can reach deep structures while sparing the brain. Nonetheless, this anatomic knowledge is progressively competed by new digital devices, such as imaging guidance systems, although they can be misleading. OBJECTIVE To summarize cranial and sulcal key points and their related anatomic structures to renew their interest in modern neurosurgery and help surgical anatomy teaching. METHODS After a literature review collecting anatomic key points of skull and brain, specimens were prepared and images were taken to expose skull and brain from lateral, superior, posterior, and oblique views. A high-definition camera was used, and images obtained were modified, superimposing both key points and underlying anatomic structures. RESULTS From 4 views, 16 cranial key points were depicted: anterior and superior squamous point, precoronal and retrocoronal point, superior sagittal point, intraparietal point, temporoparietal point, preauricular point, nasion, bregma, stephanion, euryon, lambda, asterion, opisthocranion, and inion. These corresponded to underlying cerebral key points and relative brain parts: anterior and posterior sylvian point, superior and inferior rolandic point, supramarginal and angular gyri, parieto-occipital sulcus, and various meeting points between identifiable sulci. Stereoscopic views were also provided to help learning these key points. CONCLUSION This comprehensive overview of the cranial and sulcal key points could be a useful tool for any neurosurgeon who wants to check her/his surgical route and make the surgery more "gentle, safe, and accurate."
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Affiliation(s)
- Emile Simon
- Department of Anatomy, University of Lyon 1, Lyon, France
| | | | - Violaine Delabar
- Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Timothée Jacquesson
- Department of Anatomy, University of Lyon 1, Lyon, France.,Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,CREATIS Laboratory, CNRS UMR5220, Inserm U1044, INSA-Lyon, University of Lyon 1, Lyon, France
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15
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Calvanese F, Jacquesson T, Manet R, Vasiljevic A, Lasolle H, Ducray F, Raverot G, Jouanneau E. Neoadjuvant B-RAF and MEK Inhibitor Targeted Therapy for Adult Papillary Craniopharyngiomas: A New Treatment Paradigm. Front Endocrinol (Lausanne) 2022; 13:882381. [PMID: 35757402 PMCID: PMC9228029 DOI: 10.3389/fendo.2022.882381] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Surgical and clinical management of craniopharyngiomas is associated with high long-term morbidity especially in the case of hypothalamic involvement. Improvements in knowledge of craniopharyngioma molecular biology may offer the possibility of safe and effective medical neoadjuvant treatments in a subset of patients harboring papillary subtype tumors with a BRAFV600E mutation. METHOD We report herein two cases of tubero-infundibular and ventricular Papillary Craniopharyngiomas in which BRAF/MEK inhibitor combined therapy was used as adjuvant (Case 1) or neoadjuvant (Case 2) treatment, with a 90% reduction in tumor volume observed after only 5 months. In Case 2 the only surgical procedure used was a minimal invasive biopsy by the trans-ventricular neuroendoscopic approach. As a consequence, targeted therapy was administered in purely neoadjuvant fashion. After shrinkage of the tumor, both patients underwent fractionated radiotherapy on the small tumor remnant to achieve long-term tumor control. A review of a previously reported case has also been performed. RESULT This approach led to tumor control with minimal long-term morbidity in both cases. No side effects or complications were reported after medical treatment and adjuvant radiotherapy. CONCLUSION Our experience and a review of the literature argue for a change in the current treatment paradigm for Craniopharyngiomas (CPs). In giant and invasive tumors, confirmation of BRAFV600E mutated PCPs by biopsy and BRAF/MEK inhibitor therapy before proposing other treatments may be useful to improve long term outcomes for patients.
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Affiliation(s)
- Francesco Calvanese
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
- Department of Neurosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- *Correspondence: Francesco Calvanese, ; orcid.org/0000-0002-0966-2487
| | - Timothée Jacquesson
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Romain Manet
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
| | - Alexandre Vasiljevic
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- Department of Pathology, Groupement Hospitalier, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-Oncology & Neuro–Inflammation Team, Lyon, France
| | - Hélène Lasolle
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
- Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Louis Pradel, Lyon, France
| | - Francois Ducray
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- Cancerology Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity Department, Transcriptome Diversity in Stem Cells Laboratory, Lyon, France
- Service of Neuro-Oncology, Hospices Civils de Lyon, Groupement Hospitalier Est, Neurology Hospital, Lyon, France
| | - Gerald Raverot
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
- Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Louis Pradel, Lyon, France
| | - Emmanuel Jouanneau
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
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16
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Ng S, Messerer M, Engelhardt J, Bruneau M, Cornelius JF, Cavallo LM, Cossu G, Froelich S, Meling TR, Paraskevopoulos D, Schroeder HWS, Tatagiba M, Zazpe I, Berhouma M, Daniel RT, Laws ER, Knosp E, Buchfelder M, Dufour H, Gaillard S, Jacquesson T, Jouanneau E. Aggressive pituitary neuroendocrine tumors: current practices, controversies, and perspectives, on behalf of the EANS skull base section. Acta Neurochir (Wien) 2021; 163:3131-3142. [PMID: 34365544 DOI: 10.1007/s00701-021-04953-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022]
Abstract
Aggressive pituitary neuroendocrine tumors (APT) account for 10% of pituitary tumors. Their management is a rapidly evolving field of clinical research and has led pituitary teams to shift toward a neuro-oncological-like approach. The new terminology "Pituitary neuroendocrine tumors" (PitNet) that was recently proposed to replace "pituitary adenomas" reflects this change of paradigm. In this narrative review, we aim to provide a state of the art of actual knowledge, controversies, and recommendations in the management of APT. We propose an overview of current prognostic markers, including the recent five-tiered clinicopathological classification. We further establish and discuss the following recommendations from a neurosurgical perspective: (i) surgery and multi-staged surgeries (without or with parasellar resection in symptomatic patients) should be discussed at each stage of the disease, because it may potentialize adjuvant medical therapies; (ii) temozolomide is effective in most patients, although 30% of patients are non-responders and the optimal timeline to initiate and interrupt this treatment remains questionable; (iii) some patients with selected clinicopathological profiles may benefit from an earlier local radiotherapy and/or chemotherapy; (iv) novel therapies such as VEGF-targeted therapies and anti-CTLA-4/anti-PD1 immunotherapies are promising and should be discussed as 2nd or 3rd line of treatment. Finally, whether neurosurgeons have to operate on "pituitary adenomas" or "PitNets," their role and expertise remain crucial at each stage of the disease, prompting our community to deal with evolving concepts and therapeutic resources.
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Dridi M, Krebs-Drouot L, Meyronet D, Dumollard JM, Vassal F, Jouanneau E, Jacquesson T, Barrey C, Grange S, Boutonnat J, Péoc’h M, Karpathiou G. The Immune Microenvironment of Chordomas: An Immunohistochemical Analysis. Cancers (Basel) 2021; 13:cancers13133335. [PMID: 34283048 PMCID: PMC8268246 DOI: 10.3390/cancers13133335] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Chordoma patients may be amenable to immunotherapy; however, the immune microenvironment of chordomas needs further investigation. We performed the immunohistochemical analysis of a chordoma series, showing that these tumors have a unique microenvironment characterized by the absence of PD-L1 tumor cell expression, but feature PD-L1+ immune cells playing a negative prognostic role. Abstract Chordomas are rare sarcomas that are usually treated by surgery and/or radiotherapy since these are chemo-resistant tumors, but immunotherapy could be a possible option for chordoma patients. However, few reports investigating the composition of the chordoma immune microenvironment exist. We immunohistochemically studied 81 chordomas regarding their immune microenvironment factors and compared them with clinicopathological data. Macrophages and CD4 cells were the most prominent inflammatory cell populations, followed by CD8 T cells, while CD20 B cells and high endothelial venules (MECA-79+) were less frequently found. PD-L1 (22C3) expression by inflammatory cells was found in 21 (26%) tumors and was associated with a larger tumor size. None of the cases showed the expression of PD-L1 by tumor cells. Survival analysis showed that younger patients had a better overall survival. Considering the immunohistochemical factors studied, higher CD8, the presence of PD-L1+ immune cells, and higher vascular density were adverse prognostic factors, but in multivariate analysis, only PD-L1+ immune cells retained prognostic significance. To conclude, chordoma tumor cells do not express PD-L1, but PD-L1+ immune cells seem to play a negative prognostic role, supporting the need for further studies in this field and the possible beneficial role of immunotherapy in these patients.
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Affiliation(s)
- Maroa Dridi
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - Lila Krebs-Drouot
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - David Meyronet
- East Pathology Institute, Hospices Civils de Lyon, 69677 Lyon, France;
- Cancer Cell Plasticity Department, Cancer Research Center of Lyon, 69373 Lyon, France
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (E.J.); (C.B.)
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - François Vassal
- Neurosurgery Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Emmanuel Jouanneau
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (E.J.); (C.B.)
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France;
- Inserm U1052, CNRS UMR5286, «Signaling, Metabolism and Tumor Progression» The Cancer Research Center of Lyon, 69373 Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France;
- Department of Anatomy, Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, 69100 Lyon, France
| | - Cédric Barrey
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (E.J.); (C.B.)
- Department of Spine and Spinal Cord Surgery, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France
| | - Sylvain Grange
- Radiology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Jean Boutonnat
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
- Correspondence:
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Karpathiou G, Dridi M, Krebs-Drouot L, Vassal F, Jouanneau E, Jacquesson T, Barrey C, Prades JM, Dumollard JM, Meyronet D, Boutonnat J, Péoc’h M. Autophagic Markers in Chordomas: Immunohistochemical Analysis and Comparison with the Immune Microenvironment of Chordoma Tissues. Cancers (Basel) 2021; 13:cancers13092169. [PMID: 33946484 PMCID: PMC8124629 DOI: 10.3390/cancers13092169] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In contrast to normal notochords, autophagic factors are often present in chordomas. Furthermore, PD-L1+ immune cells also express LC3B, suggesting the need for further investigations between autophagy and the immune microenvironment. Abstract Chordomas are notably resistant to chemotherapy. One of the cytoprotective mechanisms implicated in chemoresistance is autophagy. There are indirect data that autophagy could be implicated in chordomas, but its presence has not been studied in chordoma tissues. Sixty-one (61) chordomas were immunohistochemically studied for autophagic markers and their expression was compared with the expression in notochords, clinicopathological data, as well as the tumor immune microenvironment. All chordomas strongly and diffusely expressed cytoplasmic p62 (sequestosome 1, SQSTM1/p62), whereas 16 (26.2%) tumors also showed nuclear p62 expression. LC3B (Microtubule-associated protein 1A/1B-light chain 3B) tumor cell expression was found in 44 (72.1%) tumors. Autophagy-related 16‑like 1 (ATG16L1) was also expressed by most tumors. All tumors expressed mannose-6-phosphate/insulin-like growth factor 2 receptor (M6PR/IGF2R). LC3B tumor cell expression was negatively associated with tumor size, while no other parameters, such as age, sex, localization, or survival, were associated with the immunohistochemical factors studied. LC3B immune cell expression showed a significant positive association with programmed death-ligand 1 (PD-L1)+ immune cells and with a higher vascular density. ATG16L1 expression was also positively associated with higher vascular density. Notochords (n = 5) showed different immunostaining with a very weak LC3B and M6PR expression, and no p62 expression. In contrast to normal notochords, autophagic factors such as LC3B and ATG16L1 are often present in chordomas, associated with a strong and diffuse expression of p62, suggesting a blocked autophagic flow. Furthermore, PD-L1+ immune cells also express LC3B, suggesting the need for further investigations between autophagy and the immune microenvironment.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
- Correspondence:
| | - Maroa Dridi
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - Lila Krebs-Drouot
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - François Vassal
- Neurosurgery Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Emmanuel Jouanneau
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France; (E.J.); (T.J.)
- Inserm U1052, CNRS UMR5286, «Signaling, Metabolism and Tumor Progression» The Cancer Research Center of Lyon, 69373 Lyon, France
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (C.B.); (D.M.)
| | - Timothée Jacquesson
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France; (E.J.); (T.J.)
- Department of Anatomy, Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, 69100 Lyon, France
| | - Cédric Barrey
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (C.B.); (D.M.)
- Department of Spine and Spinal Cord Surgery, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France
| | - Jean Michel Prades
- Head and Neck Surgery Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - David Meyronet
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (C.B.); (D.M.)
- East Pathology Institute, Hospices Civils de Lyon, 69677 Lyon, France
- Cancer Research Center of Lyon, Cancer Cell Plasticity Department, 69373 Lyon, France
| | - Jean Boutonnat
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
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Lechanoine F, Jacquesson T, Beaujoin J, Serres B, Mohammadi M, Planty-Bonjour A, Andersson F, Poupon F, Poupon C, Destrieux C. WIKIBrainStem: An online atlas to manually segment the human brainstem at the mesoscopic scale from ultrahigh field MRI. Neuroimage 2021; 236:118080. [PMID: 33882348 DOI: 10.1016/j.neuroimage.2021.118080] [Citation(s) in RCA: 4] [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: 09/15/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 01/03/2023] Open
Abstract
The brainstem is one of the most densely packed areas of the central nervous system in terms of gray, but also white, matter structures and, therefore, is a highly functional hub. It has mainly been studied by the means of histological techniques, which requires several hundreds of slices with a loss of the 3D coherence of the whole specimen. Access to the inner structure of the brainstem is possible using Magnetic Resonance Imaging (MRI), but this method has a limited spatial resolution and contrast in vivo. Here, we scanned an ex vivo specimen using an ultra-high field (11.7T) preclinical MRI scanner providing data at a mesoscopic scale for anatomical T2-weighted (100 µm and 185 µm isotropic) and diffusion-weighted imaging (300 µm isotropic). We then proposed a hierarchical segmentation of the inner gray matter of the brainstem and defined a set of rules for each segmented anatomical class. These rules were gathered in a freely accessible web-based application, WIKIBrainStem (https://fibratlas.univ-tours.fr/brainstems/index.html), for 99 structures, from which 13 were subdivided into 29 substructures. This segmentation is, to date, the most detailed one developed from ex vivo MRI of the brainstem. This should be regarded as a tool that will be complemented by future results of alternative methods, such as Optical Coherence Tomography, Polarized Light Imaging or histology… This is a mandatory step prior to segmenting multiple specimens, which will be used to create a probabilistic automated segmentation method of ex vivo, but also in vivo, brainstem and may be used for targeting anatomical structures of interest in managing some degenerative or psychiatric disorders.
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Affiliation(s)
- François Lechanoine
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France
| | - Timothée Jacquesson
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | | | - Barthélemy Serres
- ILIAD3, Université de Tours, Tours, France; LIFAT, EA6300, Université de Tours, Tours, France
| | | | - Alexia Planty-Bonjour
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France
| | | | | | - Cyril Poupon
- BAOBAB, Paris-Saclay University, CNRS, CEA, France
| | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France.
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Dauleac C, Frindel C, Mertens P, Jacquesson T, Cotton F. Overcoming challenges of the human spinal cord tractography for routine clinical use: a review. Neuroradiology 2020; 62:1079-1094. [DOI: 10.1007/s00234-020-02442-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023]
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21
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Jacquesson T, Simon E, Dauleac C, Margueron L, Robinson P, Mertens P. Stereoscopic three-dimensional visualization: interest for neuroanatomy teaching in medical school. Surg Radiol Anat 2020; 42:719-727. [PMID: 32114650 DOI: 10.1007/s00276-020-02442-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The anatomy of both the brain and the skull is particularly difficult to learn and to teach. Since their anatomical structures are numerous and gathered in a complex tridimensional (3D) architecture, classic schematical drawing or photography in two dimensions (2D) has difficulties in providing a clear, simple, and accurate message. Advances in photography and computer sciences have led to develop stereoscopic 3D visualization, firstly for entertainment then for education. In the present study, we report our experience of stereoscopic 3D lecture for neuroanatomy teaching to early medical school students. METHODS High-resolution specific pictures were taken on various specimen dissections in the Anatomy Laboratory of the University of Lyon, France. Selected stereoscopic 3D views were displayed on a large dedicated screen using a doubled video projector. A 2-h stereoscopic neuroanatomy lecture was given by two neuroanatomists to third-year medicine students who wore passive 3D glasses. Setting up lasted 30 min and involved four people. The feedback from students was collected and analyzed. RESULTS Among the 483 students who have attended the stereoscopic 3D lecture, 195 gave feedback, and all (100%) were satisfied. Among these, 190 (97.5%) reported a better knowledge transfer of brain anatomy and its 3D architecture. Furthermore, 167 (86.1%) students felt it could change their further clinical practice, 179 (91.8%) thought it could enhance their results in forthcoming anatomy examinations, and 150 (76.9%) believed such a 3D lecture might allow them to become better physicians. This 3D anatomy lecture was graded 8.9/10 a mean against 5.9/10 for previous classical 2D lectures. DISCUSSION-CONCLUSION The stereoscopic 3D teaching of neuroanatomy made medical students enthusiastic involving digital technologies. It could improve their anatomical knowledge and test scores, as well as their clinical competences. Depending on university means and the commitment of teachers, this new tool should be extended to other anatomical fields. However, its setting up requires resources from faculties and its impact on clinical competencies needs to be objectively assessed.
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Affiliation(s)
- Timothée Jacquesson
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France. .,Skull Base Multi-Disciplinary Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon, France.
| | - Emile Simon
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France.,Department of Functional Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon, France
| | - Corentin Dauleac
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France
| | - Loïc Margueron
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France
| | - Philip Robinson
- Department of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon, France
| | - Patrick Mertens
- Department of Anatomy, Faculté de médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon I, 8 Avenue Rockefeller, 69003, Lyon, France.,Department of Functional Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, 59 Bd Pinel, 69677, Lyon, France
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Chiaramonte C, Jacquesson T, Jouanneau E. Extra-intradural extracavernous subtemporal approach for chondrosarcomas: technical note and case report. Acta Neurochir (Wien) 2019; 161:2349-2352. [PMID: 31273444 DOI: 10.1007/s00701-019-03989-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/30/2019] [Accepted: 06/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skull base chondrosarcomas are rare tumors often invading the petrous apex and cavernous sinus, and many surgical approaches have been described. For most of them, these tumors grow slowly and their partial removal can be a first option before complementary radiotherapy. We described herein a minimally invasive approach that could be useful for soft non-calcified chondrosarcomas. METHOD AND RESULTS We report a case of right parasellar chondrosarcoma, for which an extra-intradural extracavernous subtemporal approach allowed a safe effective partial removal. CONCLUSION This surgical approach is indicated in selected cases to obtain good decompression or partial removal of lesions involving the parasellar space and the petrous apex.
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Affiliation(s)
- Carmela Chiaramonte
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University of Naples Federico II, Via Vincenzo Lombardi, 44 Gragnano, Naples, Italy.
| | - Timothée Jacquesson
- Skull Base Surgery Unit, Department of Neurosurgery B, Hospices Civils de Lyon, University Hospital of Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Skull Base Surgery Unit, Department of Neurosurgery B, Hospices Civils de Lyon, University Hospital of Lyon, Lyon, France
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Dauleac C, Jacquesson T, Mertens P. Anatomy of the human spinal cord arachnoid cisterns: applications for spinal cord surgery. J Neurosurg Spine 2019; 31:756-763. [PMID: 31299646 DOI: 10.3171/2019.4.spine19404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/29/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The goal in this study was to describe the overall organization of the spinal arachnoid mater and spinal subarachnoid space (SSAS) as well as its relationship with surrounding structures, in order to highlight spinal cord arachnoid cisterns. METHODS Fifteen spinal cords were extracted from embalmed adult cadavers. The organization of the spinal cord arachnoid and SSAS was described via macroscopic observations, optical microscopic views, and scanning electron microscope (SEM) studies. Gelatin injections were also performed to study separated dorsal subarachnoid compartments. RESULTS Compartmentalization of SSAS was studied on 3 levels of axial sections. On an axial section passing through the tips of the denticulate ligament anchored to the dura, 3 subarachnoid cisterns were observed: 2 dorsolateral and 1 ventral. On an axial section passing through dural exit/entrance of rootlets, 5 subarachnoid cisterns were observed: 2 dorsolateral, 2 lateral formed by dorsal and ventral rootlets, and 1 ventral. On an axial section passing between the two previous ones, only 1 subarachnoid cistern was observed around the spinal cord. This compartmentalization resulted in the anatomical description of 3 elements: the median dorsal septum, the arachnoid anchorage to the tip of the denticulate ligament, and the arachnoid anchorage to the dural exit/entrance of rootlets. The median dorsal septum already separated dorsal left and right subarachnoid spaces and was described from C1 level to 3 cm above the conus medullaris. This septum was anchored to the dorsal septal vein. No discontinuation was observed in the median dorsal arachnoid septum. At the entrance point of dorsal rootlets in the spinal cord, arachnoid trabeculations were described. Using the SEM, numerous arachnoid adhesions between the ventral surface of the dorsal rootlets and the pia mater over the spinal cord were observed. At the ventral part of the SSAS, no septum was found, but some arachnoid trabeculations between the arachnoid and the pia mater were present and more frequent than in the dorsal part. Laterally, arachnoid was firmly anchored to the denticulate ligaments' fixation at dural points, and dural exit/entrance of rootlets made a fibrous ring of arachnoidodural adhesions. At the level of the cauda equina, the arachnoid mater surrounded all rootlets together-as a sac and not individually. CONCLUSIONS Arachnoid cisterns are organized on each side of a median dorsal septum and compartmentalized in relation with the attachments of denticulate ligament and exit/entrance of rootlets.
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Affiliation(s)
- Corentin Dauleac
- 1Department of Neurosurgery, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon
- 2University of Lyon, Université Claude Bernard Lyon I; and
| | - Timothée Jacquesson
- 1Department of Neurosurgery, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon
- 2University of Lyon, Université Claude Bernard Lyon I; and
- 3Laboratory of Anatomy, Université Claude Bernard Lyon I, Lyon, France
| | - Patrick Mertens
- 1Department of Neurosurgery, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon
- 2University of Lyon, Université Claude Bernard Lyon I; and
- 3Laboratory of Anatomy, Université Claude Bernard Lyon I, Lyon, France
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Tawfik-Helika M, Mertens P, Ribas G, Cusimano MD, Catala M, Kirollos R, Jacquesson T. Understanding Anatomy of the Petrous Pyramid-A New Compartmental Approach. World Neurosurg 2019; 124:e65-e80. [PMID: 30620892 DOI: 10.1016/j.wneu.2018.11.234] [Citation(s) in RCA: 2] [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] [Received: 07/04/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Learning surgical anatomy of the petrous pyramid can be a challenge, especially in the beginning of the training process. Providing an easier, holistic approach can be of help to everyone with interest in learning and teaching skull base anatomy. We present the complex organization of petrous pyramid anatomy using a new compartmental approach that is simple to understand and remember. METHODS The surfaces of the petrous pyramid of two temporal bones were examined; and the contents of the petrous pyramid of 8 temporal bones were exposed through progressive drilling of the superior surface. RESULTS The petrous pyramid is made up of a bony container, and its contents were grouped into 4 compartments (mucosal, cutaneous, neural, and vascular). Two reference lines were identified (mucosal and external-internal auditory canal lines) intersecting at the level of the middle ear. The localization of contents relative to these reference lines was then described, and 2 methods of segmentation (the X method and the V method) were then proposed. This description was then used to describe middle ear relationships, facial nerve anatomy, and air cell distribution. CONCLUSIONS This new compartmental approach allows a comprehensive understanding of the distribution of petrous pyramid contents. Dividing it into anatomic compartments, and then navigating this mental map along specific reference points, lines, spaces, and segments, could create a useful tool to teach or learn its complex tridimensional anatomy.
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Affiliation(s)
- Mamdouh Tawfik-Helika
- Department of Neurosurgery, Beaujon University Hospital, Assistance publique hopitaux de Paris, Clichy, France.
| | | | - Guilherme Ribas
- Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Martin Catala
- Sorbonne Université, CNRS UMR 7622, INSERM ERL 1156, IBPS, Paris, France
| | - Ramez Kirollos
- Senior Consultant, National Neuroscience Institute, Singapore
| | - Timothée Jacquesson
- Department of Anatomy, University of Lyon 1, Lyon, France; Skull Base Multi-disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon Cedex, France
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Panesar SS, Abhinav K, Yeh FC, Jacquesson T, Collins M, Fernandez-Miranda J. Tractography for Surgical Neuro-Oncology Planning: Towards a Gold Standard. Neurotherapeutics 2019; 16:36-51. [PMID: 30542904 PMCID: PMC6361069 DOI: 10.1007/s13311-018-00697-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging tractography permits in vivo visualization of white matter structures. Aside from its academic value, tractography has been proven particularly useful to neurosurgeons for preoperative planning. Preoperative tractography permits both qualitative and quantitative analyses of tumor effects upon surrounding white matter, allowing the surgeon to specifically tailor their operative approach. Despite its benefits, there is controversy pertaining to methodology, implementation, and interpretation of results in this context. High-definition fiber tractography (HDFT) is one of several non-tensor tractography approaches permitting visualization of crossing white matter trajectories at high resolutions, dispensing with the well-known shortcomings of diffusion tensor imaging (DTI) tractography. In this article, we provide an overview of the advantages of HDFT in a neurosurgical context, derived from our considerable experience implementing the technique for academic and clinical purposes. We highlight nuances of qualitative and quantitative approaches to using HDFT for brain tumor surgery planning, and integration of tractography with complementary operative adjuncts, and consider areas requiring further research.
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Affiliation(s)
- Sandip S Panesar
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Kumar Abhinav
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothée Jacquesson
- CHU de Lyon - Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | - Malie Collins
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA
| | - Juan Fernandez-Miranda
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA, 94304, USA.
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Jacquesson T, Cotton F, Attyé A, Zaouche S, Tringali S, Bosc J, Robinson P, Jouanneau E, Frindel C. Probabilistic Tractography to Predict the Position of Cranial Nerves Displaced by Skull Base Tumors: Value for Surgical Strategy Through a Case Series of 62 Patients. Neurosurgery 2018; 85:E125-E136. [DOI: 10.1093/neuros/nyy538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/14/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Timothée Jacquesson
- Skull Base Multi-disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Department of Anatomy, University of Lyon 1, Lyon, France
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Francois Cotton
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
- Department of Radiology, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Attyé
- Department of Radiology, Grenoble University Hospital, Grenoble, France
| | - Sandra Zaouche
- Department of ENT Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Tringali
- Department of ENT Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Justine Bosc
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Philip Robinson
- Department of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Skull Base Multi-disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Carole Frindel
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
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Ferry T, Boucher F, Fevre C, Perpoint T, Chateau J, Petitjean C, Josse J, Chidiac C, L’hostis G, Leboucher G, Laurent F, Ferry T, Valour F, Perpoint T, Boibieux A, Biron F, Miailhes P, Ader F, Becker A, Roux S, Triffault-Fillit C, Conrad A, Bosch A, Daoud F, Lippman J, Braun E, Chidiac C, Lustig S, Servien E, Gaillard R, Schneider A, Gunst S, Batailler C, Fessy MH, Herry Y, Viste A, Chaudier P, Courtin C, Louboutin L, Martres S, Trouillet F, Barrey C, Jouanneau E, Jacquesson T, Mojallal A, Braye F, Boucher F, Shipkov H, Chateau J, Gleizal A, Aubrun F, Dziadzko M, Macabéo C, Laurent F, Rasigade JP, Dupieux C, Craighero F, Boussel L, Pialat JB, Morelec I, Janier M, Giammarile F, Tod M, Gagnieu MC, Goutelle S, Mabrut E. Innovations for the treatment of a complex bone and joint infection due to XDR Pseudomonas aeruginosa including local application of a selected cocktail of bacteriophages. J Antimicrob Chemother 2018; 73:2901-2903. [DOI: 10.1093/jac/dky263] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tristan Ferry
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Fabien Boucher
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Chirurgie Plastique et reconstructrice, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Perpoint
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Joseph Chateau
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Chirurgie Plastique et reconstructrice, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Jérôme Josse
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Christian Chidiac
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | | | - Gilles Leboucher
- Pharmacie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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Jacquesson T, Frindel C, Kocevar G, Berhouma M, Jouanneau E, Attyé A, Cotton F. Overcoming Challenges of Cranial Nerve Tractography: A Targeted Review. Neurosurgery 2018; 84:313-325. [PMID: 30010992 DOI: 10.1093/neuros/nyy229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/01/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Timothée Jacquesson
- Skull Base Multi-disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Department of Anatomy, University of Lyon 1, Lyon, France
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Carole Frindel
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Gabriel Kocevar
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Moncef Berhouma
- Skull Base Multi-disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Emmanuel Jouanneau
- Skull Base Multi-disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Attyé
- Department of Radiology, Grenoble University Hospital, Grenoble, France
| | - Francois Cotton
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
- Department of Radiology, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
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Panesar SS, Yeh FC, Jacquesson T, Hula W, Fernandez-Miranda JC. A Quantitative Tractography Study Into the Connectivity, Segmentation and Laterality of the Human Inferior Longitudinal Fasciculus. Front Neuroanat 2018; 12:47. [PMID: 29922132 PMCID: PMC5996125 DOI: 10.3389/fnana.2018.00047] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Abstract
The human inferior longitudinal fasciculus (ILF) is a ventral, temporo-occipital association tract. Though described in early neuroanatomical works, its existence was later questioned. Application of in vivo tractography to the neuroanatomical study of the ILF has generally confirmed its existence, however, consensus is lacking regarding its subdivision, laterality and connectivity. Further, there is a paucity of detailed neuroanatomic data pertaining to the exact anatomy of the ILF. Generalized Q-Sampling imaging (GQI) is a non-tensor tractographic modality permitting high resolution imaging of white-matter structures. As it is a non-tensor modality, it permits visualization of crossing fibers and accurate delineation of close-proximity fiber-systems. We applied deterministic GQI tractography to data from 30 healthy subjects and a large-volume, averaged diffusion atlas, to delineate ILF anatomy. Post-mortem white matter dissection was also carried out in three cadaveric specimens for further validation. The ILF was found in all 60 hemispheres. At its occipital extremity, ILF fascicles demonstrated a bifurcated, ventral-dorsal morphological termination pattern, which we used to further subdivide the bundle for detailed analysis. These divisions were consistent across the subject set and within the atlas. We applied quantitative techniques to study connectivity strength of the ILF at its anterior and posterior extremities. Overall, both morphological divisions, and the un-separated ILF, demonstrated strong leftward-lateralized connectivity patterns. Leftward-lateralization was also found for ILF volumes across the subject set. Due to connective and volumetric leftward-dominance and ventral location, we postulate the ILFs role in the semantic system. Further, our results are in agreement with functional and lesion-based postulations pertaining to the ILFs role in facial recognition.
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Affiliation(s)
- Sandip S Panesar
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Timothée Jacquesson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - William Hula
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States
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Picart T, Jacquesson T, Jouanneau E, Berhouma M. Delayed Posttraumatic Subacute Lumbar Subarachnoid Hematoma: Case Report and Review of the Literature. World Neurosurg 2018; 113:135-139. [PMID: 29454129 DOI: 10.1016/j.wneu.2018.02.035] [Citation(s) in RCA: 1] [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] [Received: 10/11/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Traumatic spinal subarachnoid hematoma, associated or not with a concurrent subdural hematoma, has rarely been described. The evolution of such hematomas is heterogeneous. This study aims at defining the most accurate management, which is currently not standardized. CASE DESCRIPTION A 20-year-old man, victim of a high-kinetic road accident 5 days before and with several nonneurologic nonsurgical vertebral fractures, experienced a sudden dorsolumbar pain radiating to his lower limbs. A rapidly progressive asymmetric paraparesis with loss of reflexes was noticed, associated with bilateral global hypoesthesia of the lower limbs and with acute urinary retention, whereas the anal tonicity was preserved (American Spinal Injury Association C). Magnetic resonance imaging scan revealed a conus medullaris compression at the level of the L1-L2 vertebrae by an intradural expansive mass. Immediate surgical decompression revealed a strictly subarachnoid hematoma. Venous bleeding was seen at the level of the conus medullaris and controlled. Pathologic examination of the clot excluded an underlying tumor or vascular abnormality. The complete coagulation profile was normal. CONCLUSION Six weeks after surgery, the neurologic examination revealed only a slight tactile hypoesthesia of the left thigh. With only 4 reported cases, purely subarachnoid spinal hematomas remain widely rarer than epidural hematomas. The reported case possesses a certain number of peculiarities: young age, pure subarachnoid location, lumbar location, occurrence after a car accident, subacute onset, and excellent neurologic recovery. In our opinion, a symptomatic subarachnoid spinal hematoma should be surgically evacuated at the early phase so neurologic recovery can be expected.
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Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Lyon University Hospital, Hospices Civils de Lyon, Bron, France
| | - Timothée Jacquesson
- Department of Neurosurgery, Lyon University Hospital, Hospices Civils de Lyon, Bron, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Lyon University Hospital, Hospices Civils de Lyon, Bron, France; University Claude Bernard Lyon, Lyon, France; Signaling, Metabolism and Tumor Progression, Cancer Research Centre of Lyon, Lyon, France
| | - Moncef Berhouma
- Department of Neurosurgery, Lyon University Hospital, Hospices Civils de Lyon, Bron, France; CREATIS Laboratory, Lyon University, Lyon, France.
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Jacquesson T, Frindel C, Cotton F. Diffusion Tensor Imaging Tractography Detecting Isolated Oculomotor Nerve Damage After Traumatic Brain Injury. World Neurosurg 2017; 100:707.e5-707.e7. [PMID: 28153623 DOI: 10.1016/j.wneu.2017.01.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 11/24/2022]
Abstract
A 24-year-old woman was hit by a bus and suffered an isolated complete oculomotor nerve palsy. Computed tomography scan did not show a skull base fracture. T2*-weighted magnetic resonance imaging revealed petechial cerebral hemorrhages sparing the brainstem. T2 constructive interference in steady state suggested a partial sectioning of the left oculomotor nerve just before entering the superior orbital fissure. Diffusion tensor imaging fiber tractography confirmed a sharp arrest of the left oculomotor nerve. This recent imaging technique could be of interest to assess white fiber damage and help make a diagnosis or prognosis.
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Affiliation(s)
- Timothée Jacquesson
- Department of Neurosurgery B, Skull Base Multi-disciplinary Unit, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; Department of Anatomy, University of Lyon 1, Lyon, France; CREATIS Laboratory, CNRS UMR 5220 - INSERM U1044, Villeurbanne, France.
| | - Carole Frindel
- CREATIS Laboratory, CNRS UMR 5220 - INSERM U1044, Villeurbanne, France
| | - Francois Cotton
- CREATIS Laboratory, CNRS UMR 5220 - INSERM U1044, Villeurbanne, France; Department of Radiology, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
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Beuriat PA, Jacquesson T, Jouanneau E, Berhouma M. Headholders' - complications in neurosurgery: A review of the literature and recommendations for its use. Neurochirurgie 2016; 62:289-294. [PMID: 27865516 DOI: 10.1016/j.neuchi.2016.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 10/19/2015] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
Abstract
Several types of headholders are routinely used in neurosurgical practice to secure the head in a precise position, providing better security during surgical dissection as well as an absence of eye compression during prone positions. Nevertheless, potentially lethal complications might occur. We performed a review of the literature via PubMed and Google Scholar using the terms "Mayfield skull clamp", "Sugita headholders", "headholder complications" and "skull clamp complications". Twenty-six complications directly related to the use of headholders were identified through 19 papers published from 1981 to 2014: mainly skull fractures with or without a dural laceration (50%), epidural hematomas (23.8%), skull fractures with or without a dural laceration (50%), and air embolism (9.5%). The authors propose recommendations for the safe use of headholders.
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Affiliation(s)
- P-A Beuriat
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - T Jacquesson
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - E Jouanneau
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - M Berhouma
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
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Salem-Memou S, Vallee B, Jacquesson T, Jouanneau E, Berhouma M. Pathogenesis of Delayed Tension Intraventricular Pneumocephalus in Shunted Patient: Possible Role of Nocturnal Positive Pressure Ventilation. World Neurosurg 2015; 85:365.e17-20. [PMID: 26363220 DOI: 10.1016/j.wneu.2015.09.001] [Citation(s) in RCA: 7] [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: 05/25/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Delayed intraventricular pneumocephalus is a very rare and potentially serious complication of ventriculoperitoneal shunt. It can occur several months or years after shunting. Its pathogenesis is unclear. We herein discuss the underlying mechanisms and particularly the possible role of positive pressure ventilation. CASE DESCRIPTION A 60 year-old man presented with a lateral ventricle neurocytoma microsurgically resected complicated by a late-onset (15 months) postoperative hydrocephalus requiring an adjustable ventriculoperitoneal (VP) shunt. One month later, the patient was diagnosed with a sleep apnea and required a continuous positive airway pressure (CPAP) device. A few weeks afterward the patient presented with headaches and alteration of consciousness. CT-Scan revealed a massive intraventricular pneumocephalus associated with a millimetric left petrous bone defect. A transient breakout of the positive ventilation and a subtemporal surgical repair of the defect led to the rapid resolution of the pneumocephalus. DISCUSSION Delayed intraventricular pneumocephalus requires two conditions: a VP shunt and an osteodural defect. The CPAP may play an important trigger role in the pathogenesis of this complication through a ball valve mechanism. The management relies on transient suspension of the positive ventilation and the surgical repair of the identified defect with or without pressure adjustments of the valve. CONCLUSION Intraventricular pneumocephalus is a potentially serious complication of patients with a VP shunt and receiving positive pressure ventilation. The introduction of a CPAP device must be discussed with the neurosurgeon beforehand in shunted patients.
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Affiliation(s)
- Sidi Salem-Memou
- Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, France
| | - Bernard Vallee
- Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, France; Research and Education Unit of Medicine, Claude Bernard University Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, France; Research and Education Unit of Medicine, Claude Bernard University Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, France; Research and Education Unit of Medicine, Claude Bernard University Lyon, France
| | - Moncef Berhouma
- Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, France.
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Jacquesson T, Berhouma M, Picart T, Jouanneau E. Total removal of a trigeminal schwannoma via the expanded endoscopic endonasal approach. Technical note. Acta Neurochir (Wien) 2015; 157:935-8; discussion 938. [PMID: 25845553 DOI: 10.1007/s00701-015-2409-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Because of their deep location surrounded by closed numerous neurovascular structures, skull base tumors of the cavernous sinus are still difficult to manage. Recently, the endoscopic endonasal approach commonly used for pituitary tumor resection has been "expanded" to the parasellar, infratemporal and orbital compartments with some advantages compared to the intracranial route. METHODS The authors reported the case of a 49-year-old male presenting a large extradural tumor of the left cavernous sinus with extensions toward the orbit, sphenoid sinus and infratemporal fossa. His ophthalmological examination was normal, and the body CT scan revealed no primary neoplasm. RESULTS In this operative video, the approach is described step by step with surgical nuances. The endoscopy provided a close-up panoramic view and various angles of vision. Also, it avoided an invasive craniotomy, cerebral retraction and cranial nerves damages. Thus, it allowed the total removal of this tumor originating from the maxillary branch of the trigeminal nerve. The pathologic examination confirmed a schwannoma. CONCLUSION The expanded endoscopic endonasal approach provides an interesting corridor to cavernous sinus tumors with satisfactory control of extensions inferiorly toward the infratemporal fossa, anteriorly via the superior orbital fissure and medially within the sphenoid. Finally, the skull base surgeon has to master this anterior endoscopic route as well as all the other "open" transcranial skull base approaches to propose the best surgical route fitting the tumor characteristics.
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Jacquesson T, Berhouma M, Jouanneau E. Response to: "considerations about endoscopic endonasal optic nerve and orbital apex decompression". Acta Neurochir (Wien) 2015; 157:631-2. [PMID: 25652722 DOI: 10.1007/s00701-015-2357-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Timothée Jacquesson
- Multidisciplinary Skull Base Surgery Unit, Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France,
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Jacquesson T, Berhouma M, Tringali S, Simon E, Jouanneau E. Which Routes for Petroclival Tumors? A Comparison Between the Anterior Expanded Endoscopic Endonasal Approach and Lateral or Posterior Routes. World Neurosurg 2015; 83:929-36. [PMID: 25700970 DOI: 10.1016/j.wneu.2015.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 09/03/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Petroclival tumors remain a surgical challenge. Classically, the retrosigmoid approach (RSA) has long been used to reach such tumors, whereas the anterior petrosectomy (AP) has been proposed to avoid crossing cranial nerves. More recently, the endoscopic endonasal approach has been "expanded" (i.e., EEEA) to the petroclival region. We aimed to compare these 3 approaches to help in the surgical management of petroclival tumors. METHODS Petroclival approaches were performed on 5 specimens after they were prepared with formaldehyde colored via latex injection. RESULTS The EEEA provides a simple straightforward route to the clivus, but reaching the petrous apex requires the surgeon to circumvent the internal carotid artery either via a medial transclival, an inferior transpterygoid, or a lateral variant through the Meckel's cave. In contrast, the AP offers a narrow direct superolateral access to the petroclival region crossed by the trigeminal nerve. Finally, the RSA provides a wide simple and quick exposure of the cerebellopontine angle, but access to the petroclival region needs the surgeon to deal with the V(th) to XI(th) cranial nerves. DISCUSSION/CONCLUSION The EEEA should be preferred for extradural midline tumors (chordomas, chondrosarcomas) or for cystic lesions when drainage is essential. The AP could be optimal for the radical removal of intradural vascularized tumors (meningiomas) with intrapetrous or supratentorial extensions. The RSA retains an advantage for small or cystic tumors near the internal acoustic meatus. The skull base surgeon has to master all of these routes to choose the more appropriate one according to the surgical objective, the tumor characteristics, and the patient's medical status.
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Affiliation(s)
- Timothée Jacquesson
- Skull Base Multidisciplinary Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Lyon Cedex, France; Department of Anatomy, University of Lyon, Lyon, France.
| | - Moncef Berhouma
- Skull Base Multidisciplinary Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Lyon Cedex, France
| | - Stéphane Tringali
- Skull Base Multidisciplinary Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Lyon Cedex, France; Department of Otorhinolaryngology, Pierre Benite, France
| | - Emile Simon
- Department of Anatomy, University of Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Skull Base Multidisciplinary Unit, Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Lyon Cedex, France
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Berhouma M, Jacquesson T, Jouanneau E. The minimally invasive endoscopic management of septated chronic subdural hematomas: surgical technique. Acta Neurochir (Wien) 2014; 156:2359-62. [PMID: 25223748 DOI: 10.1007/s00701-014-2219-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fibrin membranes and compartmentalization within the subdural space are a frequent cause of failure in the treatment of chronic subdural hematomas (CSH). This specific subtype of CSH classically requires craniotomy, which carries significant morbidity and mortality rates, particularly in elderly patients. In this work, we describe a minimally invasive endoscopic alternative. METHODS Under local scalp anesthesia, a rigid endoscope is inserted through a parietal burr hole in the subdural space to collapse fibrin septa and cut the internal membrane. It also allows cauterization of active bleedings and the placement of a drain under direct visualization. CONCLUSIONS The endoscopic treatment of septated CSH represents a minimally invasive alternative to craniotomy especially for the internal membranectomy.
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Affiliation(s)
- M Berhouma
- Minimally Invasive and Endoscopic Neurosurgery Program, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, Bron, 69500, France,
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Jouanneau E, Simon E, Jacquesson T, Sindou M, Tringali S, Messerer M, Berhouma M. The endoscopic endonasal approach to the Meckel's cave tumors: surgical technique and indications. World Neurosurg 2014; 82:S155-61. [PMID: 25107326 DOI: 10.1016/j.wneu.2014.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 07/15/2014] [Accepted: 08/01/2014] [Indexed: 11/24/2022]
Abstract
Many benign and malignant tumors as well as other inflammatory or vascular diseases may be located in the areas of Meckel's cave or the cavernous sinus. Except for typical features such as for meningiomas, imaging may not by itself be sufficient to choose the best therapeutic option. Thus, even though modern therapy (chemotherapy, radiotherapy, or radiosurgery) dramatically reduces the field of surgery in this challenging location, there is still some place for surgical biopsy or tumor removal in selected cases. Until recently, the microscopic subtemporal extradural approach with or without orbitozygomatic removal was classically used to approach Meckel's cave but with a non-negligible morbidity. Percutaneous biopsy using the Hartel technique has been developed for biopsy of such tumors but may fail in the case of firm tumors, and additionally it is not appropriate for anterior parasellar tumors. With the development of endoscopy, the endonasal route now represents an interesting alternative approach to Meckel's cave as well as the cavernous sinus. Through our experience, we describe the modus operandi and discuss what should be the appropriate indication of the use of the endonasal endoscopic approach for Meckel's cave disease in the armamentarium of the skull base surgeon.
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Affiliation(s)
- Emmanuel Jouanneau
- Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; INSERM, U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-Oncology an Neuro-Inflammation Team, Lyon, France.
| | - Emile Simon
- Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Department of Anatomy, Lyon 1 University, Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Department of Anatomy, Lyon 1 University, Lyon, France
| | - Marc Sindou
- Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Stéphane Tringali
- ENT Department, Lyon SUD Hospital Center, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Mahmoud Messerer
- Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Moncef Berhouma
- Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
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Moncef B, Jacquesson T, Picart T, Abouaf L, Vighetto J, Garnieri C, Jouanneau E. The Endoscopic Endonasal Transethmoido-Sphenoidal Optic Nerve Decompression: Surgical Technique, Case Series, and Potential Indications. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384029] [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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Moncef B, Picard T, Garnieri C, Jacquesson T, Jouanneau E. Temporal Fossa Ewing Sarcoma: Case Illustration. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384181] [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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Moncef B, Jacquesson T, Garnieri C, Delabar V, Jouanneau E. The Endoscopic Endonasal Transtubercular Route to the Suprasellar Cistern: Surgical Nuances and Rationale for Periinfundibular Tumors. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384061] [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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Moncef B, Jacquesson T, Gleizal A, Tringali S, Abouaf L, Vighetto J, Raverot G, D'hombres A, Jouanneau E. The Multidisciplinary Minimally Invasive Skull Base Surgery Unit: An Example of a Transversal Collaboration to Improve the Patient's Care Path. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384127] [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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Jacquesson T, Berhouma M, Jouanneau E. Comparison between the Anterior Petrosectomy and the Expanded Endoscopic Endonasal Approach. Interest in Skull Base Tumors Surgical Management. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1383984] [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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Jacquesson T, Streichenberger N, Sindou M, Mertens P, Simon E. What is the dorsal median sulcus of the spinal cord? Interest for surgical approach of intramedullary tumors. Surg Radiol Anat 2013; 36:345-51. [PMID: 23995517 DOI: 10.1007/s00276-013-1194-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/19/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE For intramedullary tumor (IMT) surgery, a balance has to be found between aggressively resecting the tumor and respecting all the sensory and motor pathways. The most common surgical approach is through the dorsal median sulcus (DMS) of the spinal cord. However, the precise organization of the meningeal sheats in the DMS remains obscure in the otherwise well-described anatomy of the spinal cord. A better understanding of this architecture may be of benefit to IMT surgeon to spare the spinal cord. METHODS Three spinal cords were studied. The organization of the spinal cord meninges in the DMS was described via macroscopic, microsurgical and optical microscopic views. A micro dissection of the DMS was also performed. RESULTS No macroscopic morphological abnormalities were observed. With the operative magnifying lens, the dura was opened, the arachnoid was removed and the pia mater was cut to access the DMS. The histological study showed that the DMS was composed of a thin rim of capillary-carrying connective tissue extending from the pia mater and covering the entire DMS. There was no true space between the dorsal columns, no arachnoid or crossing axons either. CONCLUSION Our work indicates that the DMS is not a sulcus but a thin blade of collagen extending from the pia mater. Its location is given by tiny vessels coming from the surface towards the deep. Thus, the surgical corridor has to follow the DMS as closely as possible to prevent damage to the spinal cord during midline IMT removal.
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Affiliation(s)
- Timothée Jacquesson
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Bd Pinel, 69677, Bron, Cedex, France,
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Jouanneau E, Ene B, Barral-Clavel F, Jacquesson T, Gleizal A, Berhouma M, Messerer M. Fully Endoscopic Surgery for Intracranial Anterior and Central Skull Base Tumors: Respective Indications and Limits of Endonasal and Supraorbital Keyhole Routes. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1313987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Berhouma M, Jacquesson T, Jouanneau E. The fully endoscopic supraorbital trans-eyebrow keyhole approach to the anterior and middle skull base. Acta Neurochir (Wien) 2011; 153:1949-54. [PMID: 21818644 DOI: 10.1007/s00701-011-1089-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 07/12/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purely endoscopic eyebrow supraorbital approach is an alternative to both the endoscopic endonasal and eyebrow microsurgical routes to the anterior and middle cranial base. It combines an enhanced visualization provided by the endoscope and the absence of cerebrospinal fluid (CSF) leaks and nasal complications. METHODS A trans-eyebrow 2-cm craniotomy is designed to allow the placement of a straight endoscope and visualize the skull base from the cribriform plate to the mesiotemporal lobe. RESULT Visualization is considerably improved, while the keyhole mini-invasive concept is respected. CONCLUSION The purely endoscopic eyebrow supraorbital keyhole approach is a valuable and alternative minimally invasive route to anterior and middle skull base lesions.
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Affiliation(s)
- Moncef Berhouma
- Skull Base Surgery Unit, Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
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Jacquesson T, Berhouma M, Jouanneau E. Chirurgie « mini-invasive » endoscopique trans-sourcilière des tumeurs des étages antérieur et moyen : technique chirurgicale et résultats à propos de 10 cas. Neurochirurgie 2011. [DOI: 10.1016/j.neuchi.2011.09.031] [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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Jacquesson T, Messrer M, Ayari S, Jouanneau E. Approche endoscopique endonasale des tumeurs parasellaires : technique opératoire ; à propos de 5 cas. (Vidéo). Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.129] [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: 10/18/2022]
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Jouanneau E, Messerer M, Jacquesson T, Sindou M. Algorithme de prise en charge des tumeurs de la région du cavum de Meckel (CM) : discussion à propos d’un cas clinique. Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.078] [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: 10/18/2022]
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Durand A, Pélissou-Guyotat I, Guerra-Sierra D, Jacquesson T, Guyotat J. Anastomoses extra-intracrâniennes : indications chirurgicales actuelles à partir d’une série de sept cas. Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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