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The relationship between meningioma and progestins has not been elucidated. Meningioma regression after acetate cyproterone (CA) withdrawal has been reported. Our purpose was to evaluate the meningioma evolution after withdrawal of progestins in patients who underwent long-term exposure to CA, nomegestrol acetate (NA), chlormadinone acetate (ChlA)., info:eu-repo/semantics/published

Object The aim of this study was to assess the long-term results of intracranial aneurysms treated with Guglielmi detachable coils (GDCs) with the aid of contrast-enhanced magnetic resonance (MR) angiography. Methods Between January 1998 and August 2001, 92 patients with 92 aneurysms treated by endovascular coiling with GDCs underwent contrast-enhanced MR angiography. These patients underwent long-term follow-up (range 32–78 months, mean 42.1 ± 11.9 months [standard deviation]) after endovascular treatment. All images were compared with digital subtraction angiograms and contrast-enhanced MR angiograms that had been obtained during the short-term follow-up (range 5–25 months, mean 13 ± 5.1 months after treatment). The MR angiograms were analyzed independently by 2 senior radiologists. Findings were assigned to 1 of 3 categories: complete obliteration (Class 1), residual neck (Class 2), or residual aneurysm (Class 3). Results Of 92 contrast-enhanced MR angiograms obtained at the long-term follow-up, complete obliteration of the aneurysm was noted in 57 patients (Class 1), a residual neck was seen in 22 (Class 2), and a residual aneurysm was observed in 13 (Class 3). One patient experienced aneurysm rehemorrhaging during the follow-up period. The comparison of short- and long-term follow-up angiograms demonstrated a change in aneurysm classification in 7 patients (7.6%), including 4 that progressed from Class 1 to Class 2 and 3 from Class 2 to Class 3. However, 4 (14.2%) of the 28 long-term recurrences were not detected on the short-term control images. Conclusions Long-term follow-up with contrast-enhanced MR angiography after selective embolization of intracranial aneurysms can identify late aneurysm recanalization that is undetected at short-term follow-up.

SURG-18. IMPACT OF INTRAOPERATIVE MRI ON SURGICAL OUTCOME IN PATIENTS WITH GLIOMAS Henri-Arthur Leroy1, Christine Delmaire2, Emilie Le Rhun1, Sabine Caron2, Richard Assaker1, Jean-Paul Lejeune1, and Nicolas Reyns1; Lille University Hospital, Department of Neurosurgery, Lille, Nord-Pas de Calais, France; Lille University Hospital, Department of Neuroradiology, Lille, Nord-Pas de Calais, France INTRODUCTION: The management of gliomas is based on a first-line surgical resection when significant tumor reduction can be achieved. Since our institution is equippedwitha1.5T IntraoperativeMRI (IoMRI),weevaluated its impact on the extent of resection of gliomas, clinical outcomes and survival. METHODS: All patients operated on for gliomas using the IoMRI since its installation were systematically included. Functional MRI determined the cerebral dominance. Intraoperative evaluation of resection used a 3D FLAIR /T2orT13D withgadolinium basedonpreoperative tumoraspect, enhancing or not, automatically updating the neuronavigation. We studied clinical data, the course of the surgical procedure (number of MRI control, sequences used, operative time). Postoperative residual tumor volume after early postoperative MRI control (,72 h) wascompared with the preoperativevolume. RESULTS: 55 glial tumors were operated on using IoMRI. 60% of gliomas were “de novo”, 40% were recurrences. Histological analyses reported a majority of grade II and III. Their main location was the frontal lobe (38%), with a consistent group of fronto-temporo-insular tumors. Most patients only had one peroperative MRI control, lasting 39 min in average. If needed the second IoMRI was shorter, 23 min. The average preoperative tumor volume was 32.66 cm, and postoperative volume of 1.11 cm. Complete resection was reached in 70%. Low-grade gliomas required more IoMRI controls than high grade. The use of IoMRI has not been associated with an increased rate of complications (infectious, hemorrhagic). We noticed a temporary increase of neurological deficits during the post-operative week, not found 3 months later. CONCLUSION: IoMRI optimized the removal rate without additional complication despite an extension of the operating time of 1:30 on average. During dissection of critical areas, such as fronto-insular region, IoMRI allowed to readjust neuronavigation, offsetting brainshift and ensuring greateraccuracy for surgical resection. Neuro-Oncology 17:v214–v220, 2015. doi:10.1093/neuonc/nov235.18 Published by Oxford University Press on behalf of the Society for Neuro-Oncology 2015.

OBJECTIVE. The aim of this article is to describe the imaging features of the most common benign or malignant skull vault lesions, which may be focal, multifocal, or diffuse. CONCLUSION. Imaging features, in association with the age, history, and clinical symptoms of the patient, make it possible to propose a course of action: simple survey, pathologic confirmation, or complete surgical resection.

Background and Purpose— To compare the utility of contrast-enhanced MR Angiography (CE-MRA) with digital subtraction angiography (DSA) after endovascular treatment of intracranial aneurysms with Guglielmi detachable coils. Methods— From April 1999 to August 2002, 106 patients with 107 aneurysms treated by endovascular coiling using Guglielmi detachable coils underwent simultaneous DSA and CE-MRA at follow-up (mean: 12.9 range: 5 to 27 months). DSA was performed as the standard reference. MR angiographic images were analyzed independently by 2 senior radiologists (J.-Y.G., S.C.) and DSA by a third radiologist (X.L.). Findings were assigned to 1 of 3 categories: complete obliteration (class 1), residual neck (class 2) and residual aneurysm (class 3). Results— DSA at follow-up demonstrated 65 (60.6%) complete obliterations (group 1), 21 (19.7%) residual necks (group 2) and 21 (19.7%) residual aneurysms (group 3). One patient (0.9%) experienced aneurysm rebleed during the follow-up period. Among 101 assessable imaging comparisons, interobserver agreement was determined to be very good for CE-MRA (κ=0.96) with only 4 discrepancies between both examiners. Comparison between CE-MRA and DSA showed an excellent agreement between techniques (κ=0.93). Of the 21 with residual necks described on DSA, 20 were seen on CE-MRA. CE-MRA detected all 19 residual aneurysms. Conclusion— CE-MRA after selective embolization of intracranial aneurysm is useful and comparable to DSA in the assessment of aneurysmal recanalization either as residual neck or aneurysmal sac.

Starting from the well known precursor N,N-dimethyl(ferrocenylmethyl)amine, the total synthesis of double deuterium labelled ferrochloroquine, a ferrocenic compound mimicking chloroquine, is reported. The labelled drug 1 has been fully characterised by 1H, 2H, 13C NMR and MS MALDI TOF experiments. Copyright © 1998 John Wiley & Sons, Ltd.

Radiation-induced tumors (RIT) are increasingly recognized as delayed complications of brain irradiation during childhood. However, the true incidence is not established, their biology is poorly understood, and few guidelines exist regarding the long-term follow-up of irradiated children. We studied retrospectively patients irradiated for brain tumor under 18 years and followed in our institution since 1970. RIT were defined as new masses, different from the original tumor, occurring after delay in irradiated areas, and not related to phacomatosis. Among 552 irradiated patients, 42 (7.6%) developed one or more RIT, 26 months to 29 years after irradiation (mean 12.8 years). The cumulated incidence was 2.0% at 5 years and 8.9% at 10 years. Of the patients, 73.8% were adult at the time of diagnosis of RIT, and 75% were diagnosed within 18.1 years after irradiation. We identified 60 cavernomas, 26 meningiomas, 2 malignant gliomas, 1 meningosarcoma, and 6 thyroid tumors. Compared with meningiomas, cavernomas appeared earlier, in children irradiated at an older age, and with a male predominance. Although RIT were correlated with higher irradiation doses, 80.9% of these occurred at some distance from the maximum irradiation field. Twenty-five lesions were operated in 20 patients; three patients died because of progression of the RIT. A significant number of patients undergoing irradiation for brain tumor during childhood develop a RIT, often during adulthood. Our data suggest that radiation-induced cavernomas result from angiogenetic processes rather than true tumorigenesis. Protracted follow-up with MRI is warranted in children irradiated for brain tumor.

Recent improvements in imaging-based diagnosis, the broader application of neuroendoscopic techniques and advances in open surgery techniques mean that the need for stereotactic biopsies in the management of pineal region tumours must be reevaluated. The primary aim of this retrospective study was to establish whether stereotactic biopsy is still of value in the modern management of pineal region tumours. From 1985 to 2009, 88 consecutive patients underwent a stereotactic biopsy in our institution (51 males and 37 females; median age at presentation 30; range 2–74). Accurate tissue diagnoses were obtained in all but one case (i.e. 99%). In one case (1%), three distinct stereotactic procedures were necessary to obtain a tissue diagnosis. There was no mortality or permanent morbidity associated with stereotactic biopsy. One patient (1%) presented an intra-parenchymal hematoma but no related clinical symptoms. Five patients (6%) presented transient morbidity, which lasted for between 2 days and 3 weeks after the biopsy. To guide subsequent treatment, we believe that histological diagnosis is paramount. Stereotactic biopsies are currently the safest and the most efficient way of obtaining this essential information. Recent improvements in stereotactic technology (particularly robotic techniques) appear to be very valuable, with almost no permanent morbidity or mortality risk and no decrease in the accuracy rate. In our opinion, other available neurosurgical techniques (such as endoscopic neurosurgery, stereotactic neurosurgery and open microsurgery) are complementary and not competitive.

Focal imaging abnormalities of the corpus callosum are rare but have been described in various clinical conditions. Because the MRI appearance may mimic acute stroke, clinicians have to be aware of differential diagnoses. We report a patient with a stroke-like episode and transient hypersignal in diffusion with decreased ADC values of the corpus callosum in a setting of sepsis due to a Klebsiella pneumoniae infection. This stroke mimic may be due to an inflammatory process and should be recognized because of therapeutic implications.