Frédérique Dubrulle

Correlation between Ki-67 index and some clinical aspects of acoustic neuromas (vestibular schwannomas)

ABSTRACT Evaluation of the proliferation activity of neuromas has a practical meaning when there are doubts about the complete resection of the tumor. Evaluation of the clinical aspects connected with increased proliferation activity may have a much broader application. The aim of this study was to correlate selected clinical and radiologic aspects of vestibular schwannomas with the results of the Ki-67 index. The studied group included 23 males and 20 females. Unilateral neuromas were stated in 38 cases (mean age, 52.2 years) and bilateral tumors in 5 cases (mean age, 44.2 years). The immunohisto-chemical tests (Ki-67) were performed on the specimens preserved in formalin and stored in paraffin. The Ki-67 index was estimated in a semiquantitative study. The mean value of Ki-67 index was 1.86%. In case of unilateral neuromas (n = 38), the average Ki-67 index was 1.74%. In 5 cases of bilateral tumors, the index amounted to 2.79% (P = 0.278). No significant correlation was found by comparing the value of the Ki-67 index with the age of patients (P = 0.410: r = 0.128). Significant differences in the value of the Ki-67 index were noted in the subgroups of tumors that were evaluated radiologically as growing and stable. The mean value of Ki-67 index was 3.17% in the first subgroup; in stable neuromas, it was significantly lower, amounting to 1.11% (P = 0.020). Such results may confirm that the growth rate of vestibular schwannomas varies and may explain the difficulties in estimating the growth of neuromas on the basis of clinical aspects only.

Middle fossa approach for resection of vestibular schwannoma: impact of cochlear fossa extension and auditory monitoring on hearing preservation.

Objective To analyze the impact of patient selection and auditory monitoring on hearing results after middle fossa craniotomy approach for resection of a vestibular schwannoma (VS). Study Design Retrospective case review. Setting Tertiary referral center. Patients Patients undergoing a middle fossa craniotomy for resection of VS at a single institution between 1995 and 2006 were included in the study population. Patients presenting with Neurofibromatosis Type 2 or who underwent a combined approach (middle fossa and retrosigmoid) were excluded. Main Outcome Measures Hearing preservation as measured by serial audiograms. Results Seventy-seven patients were identified. Before excluding patients with cochlear fossa enhancement and the use of auditory monitoring, 47% of the patients maintained serviceable hearing (American Academy of Otolaryngology–Head and Neck Surgery Class A or B). By selecting tumors that did not involve the cochlear fossa and using auditory monitoring, serviceable postoperative hearing was preserved in 76% of the patients. Conclusion Modification of our selection criteria for surgery and the use of auditory monitoring have improved our hearing results for patients undergoing a middle fossa approach for resection of VS from 47% to 76%.

Imagerie en cancérologie du larynx et de l’hypopharynx

Imaging of tumors of the larynx and hypopharynx Evaluation of patients with laryngeal and hypopharyngeal tumors is based on multidetector CT imaging. The cervicomediastinal CT protocol and general guidelines with regards to planning and acquisition will be detailed. The primary role of imaging is accurate tumor staging but also detection of possible tumor extension to the superior aerodigestive tract and nodal areas. Therefore, images are acquired from the skull base to the cervicomediastinal junction. A chest CT must also be performed to look for distant metastases or other primary tumor. Deep tumor extension, detected only by imaging, is very important to consider for therapeutic planning: surgery or chemoradiotherapy. In case of surgery, accurate evaluation of tumor extension is of great importance to determine whether to perform partial or total surgery. Cervical nodal metastases are very common with laryngeal and hypopharyngeal carcinomas, and accurate staging of nodal disease is important.

Local extension staging of sinonasal tumours: retrospective comparison between CT/MRI assessment and pathological findings

To assess the reliability of clinical staging with CT and MRI in sinonasal cancers.

Long‐term growth rate of vestibular schwannoma in neurofibromatosis 2: A volumetric consideration

To determine the long‐term growth rate of vestibular schwannoma (VS) in neurofibromatosis type 2 (NF2) patients based on volumetric measurements.

Dossiers commentés en imagerie de l’oreille : imagerie du cholestéatome opéré-Intérêt de l'IRM dans les cas difficiles

Objectifs pedagogiques Connaitre l’aspect IRM d’un cholesteatome, d’un tissu fibro-inflammatoire, d’un granulome a cholesterine. Apprendre a analyser les differents tissus rencontres dans ces oreilles operees (y compris les materiaux de comblement). Savoir analyser l’examen en integrant les donnees du scanner, des sequences IRM classiques et specifiques. Le but de cette seance est d’illustrer l’interet de l’IRM dans les cas difficiles de cholesteatomes operes pour lesquels le scanner montre un comblement complet de l’oreille moyenne ou des opacites en plage difficiles a analyser. Des sequences specifiques (gadolinium tardif et diffusion) sont alors tres interessantes pour rechercher une recidive de cholesteatome qui devra beneficier d’une reprise chirurgicale ou pour eliminer une recidive ce qui permettra le plus souvent d’eviter une chirurgie. Ces oreilles, souvent multi-operees, sont frequemment d’analyse difficile. Les experts montreront l’interet d’une analyse comparative complete TDM-IRM associant des sequences classiques, des sequences de diffusion specifiques et du gadolinium tardif.