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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.

International audience; Glioblastoma Multiform (GBM) is a high-grade brain tumour with local recurrence and poor outcome. Photodynamic therapy to treat glioblastoma has been recently reported to improve overall survival. However, controlled study to evidence treatment efficacy is still expected and treatment delivery has to be optimized. Several parameters might be optimized such as fluence rate, dose escalation or fractionation of light delivery. Specially, fractionation of light delivery is expected to enhance treatment efficiency by restoring tissue oxygenation. Thus, we have evaluated light fractionation on a preclinical rodent model harbouring grafted GBM. Thirty-nine " Nude " rats were grafted with human U87 cells. Cells were stereotactically grafted in rat brain. After the presence and the size of the tumour were assessed by microMRI, PDT was delivered interstitially. Light was delivered through an optical fibre introduced into the tumour after PS precursor intake (5-ALA). The rats were randomized in three groups: (1) without illumination, (2) with 2-steps light fractionation and (3) with 5-steps light fraction-ation. Brain immunohistology and microMRI images were achieved to evaluate the treatment effects. On diffusion MRI, elevated diffusion values in tumour centre among treated animals were observed, especially for the 5-steps fractionation group. Perfusion decreased around the treatment site, especially in the 5-steps fractionation group. Histology confirmed our MRI findings, with a more extensive necrosis and apopto-sis associated with a rarefiedangiogenic network in the treatment area, after 5-steps fractionation PDT. However, more surrounding oedema and neovascularization in the peripheral ring after 5-steps fractionation PDT were also noticed. Finally we observed that interstitial PDT induced more tumour necrosis and apoptosis when applying 5-steps fractionation. However , this scheme also led to significant peripheral oedema and neovascularization. Diffusion and perfusion were able to predict the histological lesions. Nevertheless, apoptosis cells death remains the preferred effect in order to decrease potential side effects. We hypothesize a lower fluence rate with the same light fractionation scheme might increase apoptosis while decreasing necrosis and oedema. Preclinical study is still on going to verify this hypothesis. http://dx.

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