Search

Objective: The aim of this work is to summarize the elements of the "Cancer Plan" applicable to neurosurgical practice, and to give the results of a national inquiry concerning the daily practice of Neuro-Oncology from the neurosurgical point of view., Method: The Neuro-Oncology Group of the French Society of Neurosurgery has submitted a questionnaire to every department of Neurosurgery in France., Results: The response rate of the public centers was 96.5%. Moreover, responses were available from 7 private centers. The results are detailed in the text., Conclusion: This national survey highlights the interest and implication of French neurosurgeons in the field of Neuro-Oncology. But also, to be in accordance with the guidelines for good clinical practice, the importance of developing official neuro-oncological networks in order to offer the best access to clinical and fundamental data and hence optimise patient's care. The publication of the "Cancer Plan", the creation of a National Neuro-Oncology Group, and the results of this survey (actual multidisciplinary approach, better information and transparency, individualized care of the patients), are in the line with updating our daily practice, even though discrepancies remain among centers. French neurosurgeons must continue along the same path, but at the same time there is a need for additional help to definitely reach a truly, and homogeneous, optimized care of neuro-oncological patients.

During the past years, studies dealing with the pathophysiology of brain injuries have focused on certain agents that seem to be particularly involved in secondary brain lesions. Of them, some amino acids, and particularly glutamate, appears to deserve special attention. We discuss the role of glutamate neurotransmitters, review glutamate metabolism and actions, and then review in the pertinent literature devoted to the role of glutamate in the onset of brain injuries secondary to head trauma.

We report a case of iterative surgery of a spinal chordoma of the 10(th) thoracic vertebra. This kind of neoplasm constitutes 3 to 7% of primary malignant bone tumors. Approximately 50% originate in the sacrum, 35% at the base of the skull and 15% in the true vertebrae. The slow growth delays diagnosis and compromises effective surgical therapy. On the basis of a review of the literature, we advocate an aggressive surgical resection from the beginning, similar to management of solitary vertebral metastasis.

Large series of cauda equina tumors in adults are seldom reported. This study was based on the 231 cases collected in the French neurosurgery units for the congress of the Société Française de Neurochirurgie in October 1996. Schwannomas were the most frequent benign tumor in this series, followed by ependymomas. Very few malignant tumors were recorded, usually malignant neurinomas nearly always arising in patients with neurofibromatosis. Some other rare tumors were also observed including paragangliomas. This series confirms the contribution of pre-therapeutic neurological status to functional prognosis. All schwannomas can be cured while ependymomas and paragangliomas may recur after a very long delay. Surgery must be as complete as possible since adjuvant therapies have proven to have little efficacy. This type of tumor requires a very long follow-up. Prognosis is good for hemangioblastoma. When present, abnormal sphincter function is an argument for poor prognosis. It may appear after primary surgery or more often after treatment of recurrence.

This 67 year-old man experienced the sudden onset of generalized headache followed by visual troubles. Examination showed a poor visual acuity of the right eye with a palsy of the right third nerve and signs of panhypopituitarism confirmed by endocrinologic testing. CT- scan and MRI showed a large sellar tumor with a necrotic portion in the middle, so that the pre-operative diagnosis was: pituitary adenoma. The tumor was removed through a trans-sphenoïdal approach. The pathologic diagnosis was benign schwannoma. A review of the literature showed that this was the second reported case of an intra sellar schwannoma mimicking a pituitary adenoma clinically as well as radiologically. Surgical removal of these lesions by a trans-sphenoïdal approach seems to be more difficult than for an adenoma. The histopathogenic origin of such tumors could be either ectopic schwann cells of peri-vascular schwann cells in the sellar region.

The authors report two cases of brain metastasis of a testicular cancer in two young men. In the first case the histology was an embryonal carcinoma, in the second the association of a seminoma and a teratocarcinoma. The first patient was submitted to chemotherapy, neurosurgery and radiotherapy. The second one to chemotherapy alone. The survival time was respectively of 16 and 58 months. It looked interesting to review the different treatments and their indications in this extremely severe pathology to define the interest of surgery and radiotherapy, and the different prognostic factors. In the literature, among the various treatment, the role of chemotherapy is widely emphasized. The prognosis remains desperately bad when several brain metastasis exist, or if a brain metastasis develops during chemotherapy.