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2. Follow-Up MRI for Small Brain AVMs Treated by Radiosurgery: Is Gadolinium Really Necessary?

Author

Leclerc, X, Guillaud, O, Reyns, N, Hodel, J, Outteryck, O, Bala, F, Bricout, N, Bretzner, M, Ramdane, N, Pruvo, J-P, Kuchcinski, G, and Hacein-Bey, Lotfi

Subjects
Adolescent, Adult, Aged, Angiography, Digital Subtraction, Female, Follow-Up Studies, Gadolinium, Humans, Intracranial Arteriovenous Malformations, Magnetic Resonance Imaging, Male, Middle Aged, Neuroimaging, Radiosurgery, Retrospective Studies, Spin Labels
Abstract

BACKGROUND AND PURPOSE: Follow-up MR imaging of brain AVMs currently relies on contrast-enhanced sequences. Noncontrast techniques, including arterial spin-labeling and TOF, may have value in detecting a residual nidus after radiosurgery. The aim of this study was to compare noncontrast with contrast-enhanced MR imaging for the differentiation of residual-versus-obliterated brain AVMs in radiosurgically treated patients. MATERIALS AND METHODS: Twenty-eight consecutive patients with small brain AVMs (

Published
2020

31. Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers

Author

Zanello, M, Meyer, B, Still, M, Goodden, J, Colle, H, Schichor, C, Bello, L, Wager, M, Smits, A, Rydenhag, B, Tate, M, Metellus, P, Hamer, P, Spena, G, Capelle, L, Mandonnet, E, Robles, S, Sarubbo, S, Martino Gonzalez, J, Fontaine, D, Reyns, N, Krieg, S, Huberfeld, G, Wostrack, M, Colle, D, Robert, E, Noens, B, Muller, P, Yusupov, N, Rossi, M, Conti Nibali, M, Papagno, C, Visser, V, Baaijen, H, Galbarritu, L, Chioffi, F, Bucheli, C, Roux, A, Dezamis, E, Duffau, H, Pallud, J, Zanello M., Meyer B., Still M., Goodden J. R., Colle H., Schichor C., Bello L., Wager M., Smits A., Rydenhag B., Tate M., Metellus P., Hamer P. D. W., Spena G., Capelle L., Mandonnet E., Robles S. G., Sarubbo S., Martino Gonzalez J., Fontaine D., Reyns N., Krieg S. M., Huberfeld G., Wostrack M., Colle D., Robert E., Noens B., Muller P., Yusupov N., Rossi M., Conti Nibali M., Papagno C., Visser V., Baaijen H., Galbarritu L., Chioffi F., Bucheli C., Roux A., Dezamis E., Duffau H., Pallud J., Zanello, M, Meyer, B, Still, M, Goodden, J, Colle, H, Schichor, C, Bello, L, Wager, M, Smits, A, Rydenhag, B, Tate, M, Metellus, P, Hamer, P, Spena, G, Capelle, L, Mandonnet, E, Robles, S, Sarubbo, S, Martino Gonzalez, J, Fontaine, D, Reyns, N, Krieg, S, Huberfeld, G, Wostrack, M, Colle, D, Robert, E, Noens, B, Muller, P, Yusupov, N, Rossi, M, Conti Nibali, M, Papagno, C, Visser, V, Baaijen, H, Galbarritu, L, Chioffi, F, Bucheli, C, Roux, A, Dezamis, E, Duffau, H, Pallud, J, Zanello M., Meyer B., Still M., Goodden J. R., Colle H., Schichor C., Bello L., Wager M., Smits A., Rydenhag B., Tate M., Metellus P., Hamer P. D. W., Spena G., Capelle L., Mandonnet E., Robles S. G., Sarubbo S., Martino Gonzalez J., Fontaine D., Reyns N., Krieg S. M., Huberfeld G., Wostrack M., Colle D., Robert E., Noens B., Muller P., Yusupov N., Rossi M., Conti Nibali M., Papagno C., Visser V., Baaijen H., Galbarritu L., Chioffi F., Bucheli C., Roux A., Dezamis E., Duffau H., and Pallud J.

Abstract

Purpose: The practical management of cavernous angioma located within eloquent brain area before, during and after surgical resection is poorly documented. We assessed the practical pre-operative, intra-operative, and post-operative management of cavernous angioma located within eloquent brain area. Method: An online survey composed of 61 items was sent to 26 centers to establish a multicenter international retrospective cohort of adult patients who underwent a surgical resection as the first-line treatment of a supratentorial cavernous angioma located within or close to eloquent brain area. Results: 272 patients from 19 centers (mean 13.6 ± 16.7 per center) from eight countries were included. The pre-operative management varied significantly between centers and countries regarding the pre-operative functional assessment, the pre-operative epileptological assessment, the first given antiepileptic drug, and the time to surgery. The intra-operative environment varied significantly between centers and countries regarding the use of imaging systems, the use of functional mapping with direct electrostimulations, the extent of resection of the hemosiderin rim, the realization of a post-operative functional assessment, and the time to post-operative functional assessment. The present survey found a post-operative improvement, as compared to pre-operative evaluations, of the functional status, the ability to work, and the seizure control. Conclusions: We observed a variety of practice between centers and countries regarding the management of cavernous angioma located within eloquent regions. Multicentric prospective studies are required to solve relevant questions regarding the management of cavernous angioma-related seizures, the timing of surgery, and the optimal extent of hemosiderin rim resection.

Published
2019

32. Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas

Author

Zanello, M, Goodden, J, Colle, H, Wager, M, Hamer, P, Smits, A, Bello, L, Tate, M, Spena, G, Bresson, D, Capelle, L, Robles, S, Sarubbo, S, Rydenhag, B, Martino, J, Meyer, B, Fontaine, D, Reyns, N, Schichor, C, Metellus, P, Colle, D, Robert, E, Noens, B, Muller, P, Rossi, M, Nibali, M, Papagno, C, Galbarritu, L, De Gopegui, E, Chioffi, F, Bucheli, C, Krieg, S, Wostrack, M, Yusupov, N, Visser, V, Baaijen, J, Roux, A, Dezamis, E, Mandonnet, E, Corns, R, Duffau, H, Pallud, J, Zanello M., Goodden J. R., Colle H., Wager M., Hamer P. C. D. W., Smits A., Bello L., Tate M., Spena G., Bresson D., Capelle L., Robles S. G., Sarubbo S., Rydenhag B., Martino J., Meyer B., Fontaine D., Reyns N., Schichor C., Metellus P., Colle D., Robert E., Noens B., Muller P., Rossi M., Nibali M. C., Papagno C., Galbarritu L., De Gopegui E. R., Chioffi F., Bucheli C., Krieg S. M., Wostrack M., Yusupov N., Visser V., Baaijen J. C., Roux A., Dezamis E., Mandonnet E., Corns R., Duffau H., Pallud J., Zanello, M, Goodden, J, Colle, H, Wager, M, Hamer, P, Smits, A, Bello, L, Tate, M, Spena, G, Bresson, D, Capelle, L, Robles, S, Sarubbo, S, Rydenhag, B, Martino, J, Meyer, B, Fontaine, D, Reyns, N, Schichor, C, Metellus, P, Colle, D, Robert, E, Noens, B, Muller, P, Rossi, M, Nibali, M, Papagno, C, Galbarritu, L, De Gopegui, E, Chioffi, F, Bucheli, C, Krieg, S, Wostrack, M, Yusupov, N, Visser, V, Baaijen, J, Roux, A, Dezamis, E, Mandonnet, E, Corns, R, Duffau, H, Pallud, J, Zanello M., Goodden J. R., Colle H., Wager M., Hamer P. C. D. W., Smits A., Bello L., Tate M., Spena G., Bresson D., Capelle L., Robles S. G., Sarubbo S., Rydenhag B., Martino J., Meyer B., Fontaine D., Reyns N., Schichor C., Metellus P., Colle D., Robert E., Noens B., Muller P., Rossi M., Nibali M. C., Papagno C., Galbarritu L., De Gopegui E. R., Chioffi F., Bucheli C., Krieg S. M., Wostrack M., Yusupov N., Visser V., Baaijen J. C., Roux A., Dezamis E., Mandonnet E., Corns R., Duffau H., and Pallud J.

Abstract

BACKGROUND: The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. OBJECTIVE: To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery. METHODS: Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas. RESULTS: A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P =. 013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P =. 042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P <. 001) is an independent predictor of inability to work at the time of surgery. History of epileptic seizures at the time of surgery (OR, 7.61; 95% CI, 1.67-85.42; P =. 003) and partial resection of the CA and/or of the hemosiderin rim (OR, 12.02; 95% CI, 3.01-48.13; P <. 001) are independent predictors of uncontrolled seizures postoperatively. Inability to work at the time of surgery (OR, 19.54; 95% CI, 1.90-425.48; P =. 050), Karnofsky Performance Status ≤ 70 (OR, 51.20; 95% CI, 1.20-2175.37; P =. 039), uncontrolled seizures postoperatively (OR, 105.33; 95% CI, 4.32-2566.27; P =. 004), and worsening of cognitive functions postoperatively (OR, 13.71; 95% CI, 1.06-176.66; P =. 045) are independent predictors of inability to work postoperatively. CONCLUSION: The functional-based resection using intraoperative functional brain mapping allows safe resection of CA and the peripheral hemosiderin rim located within or close to eloquent brain areas.

Published
2019

33. Trigeminal Neuralgia Secondary to Meningiomas and Vestibular Schwannoma Is Improved after Stereotactic Radiosurgery: A Systematic Review and Meta-Analysis

Author

Peciu-Florianu, I., Régis, J., Levivier, M., Dedeciusova, M., Reyns, N., and Tuleasca, C.

Subjects
Gamma knife surgery, Meningioma, Stereotactic radiosurgery, Trigeminal neuralgia, Vestibular schwannoma
Abstract

Trigeminal neuralgia (TN) secondary to tumors is encountered in up to 6% of patients with facial pain syndromes and is considered to be associated with tumors affecting the trigeminal nerve pathways. The most frequent are meningiomas and vestibular schwannomas (VS). Stereotactic radiosurgery (SRS) has emerged as a valuable treatment, with heterogeneity of clinical results. We sought to review the medical literature on TN treated with SRS for meningiomas and VS and investigate the rates of improvement of TN symptoms. We reviewed articles published between January 1990 and December 2019 in PubMed. Pain relief after SRS, the maintenance of pain relief, and TN recurrence and complications were evaluated with separate meta-analyses, taking into account the data on individual patients. Pain relief after SRS was reported as Barrow Neurological Institute (BNI) pain intensity scores of BNI I in 50.5% (range 36-65.1%) of patients and BNI I-IIIb in 83.8% (range 77.8-89.8%). There was no significant difference in series discussing outcomes for tumor targeting versus tumor and nerve targeting. Recurrences were described in 34.7% (range 21.7-47.6; tumor targeting). Maintenance of BNI I was reported in 36.4% (range 20.1-52.7) and BNI I-IIIb in 41.2% (range 29.8-52.7; tumor targeting series). When both the nerve and the tumor were targeted, only 1 series reported 86.7% with BNI I-IIIb at last follow-up. Complications were encountered in 12.6% (range 6.3-18.8; tumor targeting series) of patients; however, they were much higher, as high as 26.7%, in the only study reporting them after targeting both the nerve and the tumor. The most common complication was facial numbness. SRS for TNB secondary to benign tumors, such as meningiomas and VS, is associated with favorable clinical course, but less favorable than in idiopathic TN. There was, however, heterogeneity among reports and targeting approaches. Although targeting both the nerve and the tumor seemed to achieve better long-term results, the rate of complications was much higher and the number of patients treated was limited. Future clinical studies should focus on the standard reporting of clinical outcomes and randomization of targeting methods.

Published
2021

39. Traitement des patients atteints d’un mélanome métastatique cérébral par ipilimumab à haute dose et radiochirurgie : résultats à 5 ans

Author

Macaire, C., primary, Jamme, P., additional, Henri, M., additional, Robert, C., additional, Lesimple, T., additional, Thomas, L., additional, Machet, L., additional, Philippe, S., additional, Lebbe, C., additional, Dutriaux, C., additional, Grob, J.-J., additional, Duhamel, A., additional, Labreuche, J., additional, Desmedt, E., additional, Templier, C., additional, Mirabel, X., additional, Reyns, N., additional, Le Rhun, E., additional, and Mortier, L., additional

Published
2020
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49. Ipilimumab combiné à une radiochirurgie-stéréotaxique chez des patients porteurs d’un mélanome avec métastases cérébrales. Une étude de phase 2, multicentrique, ouverte

Author

Mortier, L., primary, Jamme, P., additional, Lacour, J.-P., additional, Robert, C., additional, Lesimple, T., additional, Thomas, L., additional, Machet, L., additional, Saiag, P., additional, Lebbe, C., additional, Dutriaux, C., additional, Grob, J.J., additional, Duhamel, A., additional, Desmedt, E., additional, Templier, C., additional, Mirabel, X., additional, Reyns, N., additional, and Le Rhun, E., additional

Published
2018
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