Renaud Dulou

Evaluation of quantitative criteria for glioma grading with static and dynamic 18F-FDopa PET/CT.

Purpose The aim of this study was to compare various acquisition and processing protocols for noninvasive glioma grading using either static or dynamic 18F-FDopa PET. Methods Dynamic studies were performed in 33 patients. Based on histopathological analysis, 18 patients had a high-grade (HG) tumor and 15 patients had a low-grade (LG) tumor. For static imaging, SUVmean and SUVmax were calculated for different acquisition time ranges after injection. For dynamic imaging, the transport rate constant k1 was calculated according to a compartmental kinetic analysis using an image-derived input function. Results With the use of a 5-minute static imaging protocol starting at 38 minutes after injection, newly diagnosed HG tumors could be distinguished from LG tumors with a sensitivity of 70% and a specificity of 90% with a threshold of SUVmean of 2.5. In recurrent tumors, a sensitivity of 100% and a specificity of 80% for identifying HG tumors were obtained with a threshold set to 1.8. Dynamic imaging only slightly, but nonsignificantly, improved differential diagnosis. Conclusions Static and dynamic imaging without blood sampling can discriminate between LG and HG for both newly diagnosed and recurrent gliomas. In dynamic imaging, excellent discrimination was obtained by considering the transport rate constant k1 of tumors. In static imaging, the best discrimination based on SUV was obtained for SUVmean calculated from a 5-minute acquisition started at 38 minutes after injection.

The French mobile neurosurgical unit

The authors present the French concept of a mobile neurosurgical unit (MNSU) as used to provide specific support to remote military medicosurgical units deployed in Africa, South America, Central Europe, and Afghanistan. From 2001 to 2009, 15 missions were performed, for 16 patients. All but 3 of these missions (those in Kosovo, French Guyana, and Afghanistan) concerned Africa. Eleven patients were French soldiers, 3 were civilians, and 2 were Djiboutian soldiers. The conditions that MNSUs were requested for included craniocerebral wounds (2 cases), closed head trauma (7 cases), spinal trauma (5 cases), and spontaneous intracranial hemorrhage (2 cases). In 5 of the 16 cases, neurosurgical treatment was provided on site. All French soldiers and 2 civilians were evacuated to France. The MNSU can be deployed for timely treatment when some delay in neurosurgical management is acceptable.

Prise en charge chirurgicale des kystes synoviaux lombaires : étude rétrospective concernant 52 patients

PURPOSE OF THE STUDY Lumbar synovial cysts are an uncommon cause of radiculopathy, low back pain and neurogenic claudication. We report a retrospective analysis of the clinical presentation, radiological studies, operative findings and outcome in 52 patients surgically treated for symptomatic lumbar synovial cysts. MATERIAL AND METHODS Retrospective data from 52 consecutive patients treated from January 1996 to February 2006 were analyzed. We studied the clinical symptoms, diagnostic methods and radiological findings in all patients, reviewed the types of conservative therapy applied, the surgical findings and techniques, as well as the immediate and long-term results. Surgical outcomes were evaluated according to the Friedberg scale. RESULTS There were 35 women and 17 men with an average age of 63.2 years (range 36-84 years). The most common symptoms were radiculopathy (65,4%) and neurogenic multiroot claudication (34,6%). Forty-seven patients had back pain and 22 paresthesia. Preoperative neurological examination demonstrated motor weakness (5.7%), sensory loss (7.6%). The radiological work-up consisted in CT-scan and/or MRI for all patients. The correct preoperative diagnosis was established in 44 patients. A total of 56 cysts were found. Five patients had bilateral cysts. The L4-L5 level was affected in 66%. Total resection of the synovial cyst was possible for 46 patients. No fusion was performed as a first line procedure. However, subsequent fusion was necessary in one patient who developed delayed symptomatic spondylolisthesis. Mean follow up period was 14 months ranging from six to 24 months. Three recurrences occurred during the follow-up period. Functional outcome was excellent in 61.6%, good in 34.6% and poor in 3.8%. CONCLUSION Surgery should be proposed when synovial cysts fail to respond to conservative therapy. Recurrence and surgical complication rates are low. The usefulness of systematic fusion procedure is questionable.

MémoirePrise en charge chirurgicale des kystes synoviaux lombaires : étude rétrospective concernant 52 patientsSurgical management of synovial cyst of the lumbar spine: Retrospective study of 52 patients

PURPOSE OF THE STUDY Lumbar synovial cysts are an uncommon cause of radiculopathy, low back pain and neurogenic claudication. We report a retrospective analysis of the clinical presentation, radiological studies, operative findings and outcome in 52 patients surgically treated for symptomatic lumbar synovial cysts. MATERIAL AND METHODS Retrospective data from 52 consecutive patients treated from January 1996 to February 2006 were analyzed. We studied the clinical symptoms, diagnostic methods and radiological findings in all patients, reviewed the types of conservative therapy applied, the surgical findings and techniques, as well as the immediate and long-term results. Surgical outcomes were evaluated according to the Friedberg scale. RESULTS There were 35 women and 17 men with an average age of 63.2 years (range 36-84 years). The most common symptoms were radiculopathy (65,4%) and neurogenic multiroot claudication (34,6%). Forty-seven patients had back pain and 22 paresthesia. Preoperative neurological examination demonstrated motor weakness (5.7%), sensory loss (7.6%). The radiological work-up consisted in CT-scan and/or MRI for all patients. The correct preoperative diagnosis was established in 44 patients. A total of 56 cysts were found. Five patients had bilateral cysts. The L4-L5 level was affected in 66%. Total resection of the synovial cyst was possible for 46 patients. No fusion was performed as a first line procedure. However, subsequent fusion was necessary in one patient who developed delayed symptomatic spondylolisthesis. Mean follow up period was 14 months ranging from six to 24 months. Three recurrences occurred during the follow-up period. Functional outcome was excellent in 61.6%, good in 34.6% and poor in 3.8%. CONCLUSION Surgery should be proposed when synovial cysts fail to respond to conservative therapy. Recurrence and surgical complication rates are low. The usefulness of systematic fusion procedure is questionable.

ISOLATED DISTANT DIPLOPIA REVEALING BILATERAL CHRONIC SUBDURAL HEMATOMA

ACKNOWLEDGMENTS Financial Disclosures: This work was partially supported by a Ministerial grant (MIUR 40%). Author Contributions: A. Floreani: study concept and design and preparation of manuscript. E. Minola: acquisition of subjects and their treatment. I. Carderi: enrollment of patients. F. Ferrara: data collection. E. Rosa Rizzotto: follow-up of patients. V. Baldo: analysis and interpretation of data. Sponsor’s Role: None.

Schwannomes vestibulaires kystiques géants : intérêt du drainage kystopéritonéal

INTRODUCTION Surgical removal of giant cystic vestibular schwannomas is difficult because of adherences between the cyst membrane, brainstem, and the VII-VIII nerve complex. The recurrence of the cyst is frequent and requires reoperation. The aim of this study was to analyze the role of the palliative cystoperitoneal shunt in giant cystic vestibular schwannomas. MATERIALS AND METHODS Eighty-eight patients with a diagnosis of stage III or IV vestibular schwannoma were managed surgically from January 2000 to December 2005 in our department. Six schwannomas were deemed to be cystic according to the following criteria: a voluminous cystic component with mass effect causing symptoms as well as radiological and intraoperative identification of cystic elements. RESULTS Complete tumor removal was achieved in two patients. After a follow-up of 5 and 7 years, these patients were asymptomatic. In four cases, we performed cyst drainage. For three patients, we implanted a permanent cystoperitoneal shunt. These patients were asymptomatic with a mean follow-up of 19.7 months. CONCLUSIONS The cystoperitoneal shunt with no valve is a valid palliative surgical solution to remove brain stem compression. Neuronavigation allows proper positioning of the drain and secures the procedure.

Vertebromedullary Wound with Ureteral Fistula

We report a case of associated vertebromedullary and ureteral lesions in a severely injured patient, a victim of a gunshot aggression in Africa. Urine extended from the ureteral fistula through the third lumbar vertebral body, blended with cerebrospinal fluid from the dural attrition, and flowed very slowly through the dorsal exit ballistic hole. This is to our knowledge the first such case described in the literature. Uro-computed tomography scan finally made the diagnosis of ureteral fistula after two neurosurgical procedures determined that initially presumed dural persistent fistula needed to be closed.

Compression médullaire par kystes arachnoïdiens

Resume Nous presentons les cas de deux patientes ayant une compression medullaire par kystes arachnoidiens. Pour l’une d’entre elles, plusieurs interventions ont ete necessaires, a differentes etapes de l’evolution de sa maladie. A la lumiere des difficultes rencontrees pour traiter cette derniere patiente, il nous a paru interessant d’etudier les particularites de cette entite peu frequente de compression medullaire, au travers d’une revue de la litterature.

Expérience monocentrique d’un traitement par bévacizumab dans la prise en charge des glioblastomes récidivant

PURPOSE Although there is no standard treatment for recurrent glioblastoma, prospective data in selected patients have suggested the usefulness of bevacizumab. We report our single center experience with bevacizumab in a cohort of patients treated for a relapsing glioblastoma. METHODS We performed a retrospective analysis of consecutive patients treated with bevacizumab for a relapsed glioblastoma, between 2008 and 2013. Tumor responses, toxicities, time to progression and overall survival rates were analyzed. RESULTS Thirty-five consecutive patients were identified. They were treated with bevacizumab 10mg/kg biweekly, associated with irinotecan (n=29; 84%), temozolomide (n=3; 9%) or as single agent (n=3; 9%) for a glioblastoma relapsing after chemoradiation (n=29) or after first line temozolomide only because of a poor general health status or because of multifocal tumor. Two (6%), 28 (80%) and five (14%) patients presented with Recursive Partitioning Analysis (RPA) III, IV and V-VI, respectively. After 2-3 months of treatment, median dose of prednisolone per patient was decreased three times. Clinical improvements or stability were reported in eight (23%) and 17 patients (49%). The best tumor response was partial response in 14 patients (40%), stable disease in nine patients (26%) and tumor progression in 11 patients (31%). Toxicities requiring treatment disruption were reported in five patients (14%). Median survival was 18.4 months (5-41 months). Median time interval between bevacizumab initiation and its disruption because of clinical/radiological progression and/or toxicity was 5.0 months (0.6-21.4 months). Median survival from bevacizumab initiation was 8.1 months (1.4-34 months). CONCLUSION This single center retrospective experience suggests that bevacizumab is active for recurrent glioblastoma, in a series of poorly selected patients. Median survival times were in the range of those reported in therapeutic trials. This study questions the validity of usual predictive factors in the era of bevacizumab.

Sarcome d'Ewing sacré: à propos de deux cas.

Le sarcome d’Ewing est une tumeur osseuse rare de l’adulte jeune, sa localisation sacree est peu frequente. Pourtant, savoir l’evoquer devant une masse tumorale sacree est essentiel car elle oriente vers une biopsie systematique et peut modifier la prise en charge therapeutique. A partir de deux cas, nous discuterons les differents diagnostics a evoquer devant une masse sacree et rappellerons les elements semeiologiques du sarcome d’Ewing, les modalites de sa prise en charge et son pronostic.