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Minimally invasive procedures for coronary revascularization have been performed for over 20 years; however, their technical complexity, steep learning curves and absence of training programs explain the weak acceptance of these techniques. The aim of this study is to describe the step-by-step learning process on how to establish a minimally invasive coronary artery revascularization program. The short-term outcomes of our first 30 patients were compared to our left internal mammary artery (LIMA) to left anterior descending (LAD) artery off pump coronary artery bypass (OPCAB) cohort as a quality control baseline.All patients who benefited from an endoscopic atraumatic coronary artery bypass (Endo-ACAB) in our hospital, from July 2018 to May 2020 (Twenty-eight patients were planned for a single LIMA-LAD Endo-ACAB. The remaining two had a T-graft double Endo-ACAB. Ten patients had a hybrid revascularization with the culprit lesion being treated first. Three patients were converted to sternotomy because of a LIMA lesion during thoracoscopic harvesting. We accounted three major adverse cardiovascular events (MACE). Demographic, peri and postoperative data showed no significant differences between the Endo-ACAB and the OPCAB group.Endo-ACAB is a technically demanding operation, however, it can safely be introduced in centers with no previous experience with no extra cost in terms of morbidity or mortality. Thoracoscopic LIMA harvesting is the most demanding surgical skill to acquire.

Background: Neurooncologic patients frequently require surgery, and neurosurgical devices are often implanted during neurosurgery. These devices could disturb oncologic follow-up by magnetic resonance imaging. Methods: The authors describe the use of neurosurgical devices, such as bone substitutes, ventriculoperitoneal shunts, and titanium skull fixations, in neurooncologic patients. Results: Acrylic cement cranioplasty, valve of ventriculoperitoneal shunt, and titanium skull fixations produced magnetic artifacts disturbing postoperative magnetic resonance imaging. Conclusions: The authors highlight the fact that all these neurosurgical devices implanted during surgery should be carefully evaluated to allow appropriate imaging follow-up for neurooncologic patients, which is a problem that remains underreported in the literature., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction: Despite the combined adjuvant treatment of radiotherapy plus chemotherapy with temozolomide (TMZ) followed by 6 cycles of temozolomide after surgery, the prognosis of patients with glioblastoma remains poor. We conducted a monocentric prospective study to explore the tolerance and potential efficacy of an early temozolomide cycle after surgery. Method: Patients with newly diagnosed glioblastoma (unmutated IDH1) and of poor prognosis (age > 50 years, biopsy or partial resection or unmethylated MGMT promoter) were prospectively included from June 2014 to 2017. They all received a cycle of 5 days of temozolomide between surgery and the combined adjuvant treatment. Results: Twelve patients of median age 64.5 years (45–73) were included in the study. The median doses of temozolomide administered were respectively 265 mg (225–300) for the early cycle; 130 mg (110–150) for the concomitant treatment and 310 mg (225–400) for the adjuvant one. Side effects during treatment were grade III lymphopenia, grade III neutropenia, fatigue and nausea/vomiting respectively in 4, 1, 7 and 5 patients. Progression-free survival and overall survival were respectively 90% and 91.7% at 6 months; 58.3 and 71.3% at 12 months; 31.1 and 71.3% at 18 months. Conclusion: Early postsurgical temozolomide treatment prior to standard adjuvant therapy for poor prognosis glioblastoma patients in our small prospective series presents toxicity and survival similar to those published in the literature for the general population of glioblastoma. These encouraging results should be confirmed by a multicentric study comparing this regiment with the standard treatment., SCOPUS: ar.j, info:eu-repo/semantics/published

Resume Introduction Les astrocytomes intramedullaires de grade II sont des tumeurs rares. Contrairement aux gliomes cerebraux, la place de la chimiotherapie adjuvante n’est pas clairement definie. Methode Nous avons retrospectivement analyse le dossier de 5 patients adultes traites par temozolomide entre 2008 et 2015 pour un astrocytome intramedullaire de grade II evolutif apres chirurgie. Resultats Cinq patients, âges de 19 a 70 ans (mediane 37), presentant un astrocytome intramedullaire de grade II evolutif apres une premiere chirurgie ont beneficie d’une seconde chirurgie (survie sans progression mediane de 26 mois [8–90]) confirmant l’absence de progression en grade de malignite de la tumeur intramedullaire. Une seconde progression clinique et/ou radiologique defavorable a conduit a une chimiotherapie par temozolomide apres une nouvelle periode de survie sans progression mediane de 37 mois (5–66). Tous les patients ont recu au moins 12 cycles (moyenne 14 ± 5 ; range 12–24) de temozolomide (150–200 mg/m2/jour pendant 5 jours/28 jours). Tous nos patients sont en vie apres un suivi median de 10 ans a partir du diagnostic (6–13). Tous nos patients marchent sauf un, en score IV d’autonomie de McCormick avant le traitement par temozolomide. Le score d’autonomie de McCormick apres traitement est stable chez 4 patients et s’est ameliore pour 1 patient. Un seul patient a presente une toxicite hematologique qui a retarde le traitement. Conclusion Le traitement par temozolomide a permis la stabilisation clinique des 5 patients sans toxicite majeure. Cette experience indique que le traitement par temozolomide a une place a confirmer dans l’arsenal therapeutique face aux astrocytomes intramedullaires de grade II en progression.

Purpose: The current study investigates the usefulness of metabolic positron emission tomography (PET) imaging (in particular with 11C-methionine (MET)), for target definition during gamma knife radiosurgery (GKRS) of locally multirecurrent malignant glioma at inoperable stage. Patients and Methods: We retrospectively evaluated the results of GKRS with MET-PET targeting for 24 adult focally recurrent inoperable malignant gliomas treated at the Erasme Gamma Knife Center between 2007 and 2018. We evaluated the type of tumour progression (local vs remote), progression-free survival (PFS), overall survival (OS) and toxicity after MET-PET targeting of GKRS for these 24 patients. Results: The median PFS after GKRS for the 24 patients with malignant gliomas was 5.5 (2-46) months and 4.5 (3-10), 4.5 (2-8) and 13.5 (2-46) months for glioblastoma, anaplastic glioma and grade II glioma patients, respectively. The median OS from the GKRS procedure for patients with recurrent glioblastomas (n=12) was 18 (6-45) months, 8 (6-184) months for anaplastic gliomas (n=6), and 22 (16-65) months for grade II gliomas (n=6). All patients with grade III and II multirecurrent gliomas (n=12) showed an early favourable local metabolic response, while this response was observed only in 6/12 of the glioblastomas. However, the majority (9/12=75%) of these grade II/III glioma patients further developed new lesions. GKRS treatment was associated with diverse chemotherapies in more than 50% (13/24) of cases. Post-GKRS radio-necrosis was observed in only one patient. Conclusion: Based on a limited series of 24 patients, our study shows, for the first time, the GKRS-induced metabolic response in focally recurrent inoperable malignant gliomas. GKRS could be part of the multidisciplinary approach for multirecurrent malignant gliomas that cannot be anymore treated by surgery.

Neuro-oncological patients frequently require surgery, and neurosurgical devices are often implanted during neurosurgery. These devices could disturb oncological follow-up by magnetic resonance imaging.The authors describe the use of neurosurgical devices such as bone substitutes, ventriculoperitoneal shunts and titanium skull fixations in neuro-oncological patients.Acrylic cement cranioplasty, valve of ventriculo-peritoneal shunt and titanium skull fixations produced magnetic artifacts disturbing postoperative magnetic resonance imaging.The authors highlight the fact that all these neurosurgical devices implanted during surgery should be carefully evaluated to allow appropriate imaging follow-up for neuro-oncological patients, which is a problem that remains underreported in the literature.

Despite the combined adjuvant treatment of radiotherapy plus chemotherapy with temozolomide (TMZ) followed by 6 cycles of temozolomide after surgery, the prognosis of patients with glioblastoma remains poor. We conducted a monocentric prospective study to explore the tolerance and potential efficacy of an early temozolomide cycle after surgery.Patients with newly diagnosed glioblastoma (unmutated IDH1) and of poor prognosis (age50 years, biopsy or partial resection or unmethylated MGMT promoter) were prospectively included from June 2014 to 2017. They all received a cycle of 5 days of temozolomide between surgery and the combined adjuvant treatment.Twelve patients of median age 64.5 years (45-73) were included in the study. The median doses of temozolomide administered were respectively 265mg (225-300) for the early cycle; 130mg (110-150) for the concomitant treatment and 310mg (225-400) for the adjuvant one. Side effects during treatment were grade III lymphopenia, grade III neutropenia, fatigue and nausea/vomiting respectively in 4, 1, 7 and 5 patients. Progression-free survival and overall survival were respectively 90% and 91.7% at 6 months; 58.3 and 71.3% at 12 months; 31.1 and 71.3% at 18 months.Early postsurgical temozolomide treatment prior to standard adjuvant therapy for poor prognosis glioblastoma patients in our small prospective series presents toxicity and survival similar to those published in the literature for the general population of glioblastoma. These encouraging results should be confirmed by a multicentric study comparing this regiment with the standard treatment.

BACKGROUND The survival of the patients with high-grade gliomas may be improved through a multidisciplinary approach including stereotactic re-irradiation such as Gamma-Knife at recurrence in a selected population. We report our experience in targeting the hypermetabolic areas of high-grade gliomas using 11C-Methionine PET/CT in selected patients. MATERIAL AND METHODS We retrospectively evaluated the local response in patients treated by Gamma-Knife for recurrent high-grade gliomas in our Institution between 2000 and 2018, targeting the hypermetabolic area with Methionine PET/CT. RESULTS We included 25 patients bearing high-grade gliomas (14 female, 11 male) with a median age of 45 years (5–64). There were 11 WHO grade III gliomas (6 astrocytomas, 5 oligodendrogliomas) and 14 glioblastomas. A total number of 33 Gamma-Knife procedures were performed. In all patients, the targeting was based on the hypermetabolic area as defined by Methionine PET/CT. Four patients were treated concomitantly on 2 or more targets. One patient was treated twice on different targets. We observed a positive response in 29 Gamma-Knife procedures, after a median interval of 2 months (1–33) and no response after 4 procedures (4 glioblastomas). In most cases, progression after Gamma-Knife was observed 4 months after irradiation. CONCLUSION Targeting the hypermetabolic areas with Methionine PET/CT was associated with favorable response in most patients treated by Gamma-Knife radiosurgery for local high-grade gliomas recurrence. Our results must be confirmed by a prospective study with regular and homogeneous morphological and metabolic monitoring.