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Planty-Bonjour A, Terrier LM, Cognacq G, Aggad M, Bernard F, Lopez C, Tabourel G, Dannhoff G, Bako F, Kerdiles G, Francois P, Amelot A. Bilateral spheno-orbital meningiomas: surgical management, progression, and recurrence. J Neurosurg 2024:1-9. [PMID: 38626467 DOI: 10.3171/2024.1.jns232406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE Bilateral spheno-orbital meningiomas (bSOMs) are a rare entity among meningiomas. These tumors are benign and predominantly affect women. They represent 4% of spheno-orbital meningiomas (SOMs) and are poorly described in the literature. This study aimed to describe the characteristics, risk factors, evolution, and management of bSOMs. METHODS Twenty patients with bSOMs were enrolled in a multicentric descriptive study including 15 neurosurgical departments. RESULTS In this study, the authors found that bSOMs affected exclusively women, with a mean age of 50 years. Approximately 65% of patients were on progestin therapy. The mean follow-up in this series was 55 months. Clinically, visual symptoms were predominant: proptosis was present in 17 of 20 patients (85%; 7 unilateral, 10 bilateral), and a decrease in visual acuity was observed in 11 of 20 patients (55%; 6/10 to 9/10 in 6 patients, 3/10 to 5/10 in 1 patient, and < 3/10 in 4 patients). Contrary to unilateral SOMs, the authors identified that intracranial hypertension was a common presentation (25%) of bSOMs. Surgical management with gross-total resection was the gold standard treatment. Recurrences only occurred following subtotal resection in 36% to 60% of patients, with a median time of 50 to 54 months after surgery. Visual improvement or stability was observed in 75% of cases postoperatively. Progesterone receptor expression levels were 70% to 100% in 10 of 11 (91%) cases. CONCLUSIONS Bilateral SOMs are usually found in female patients and are strongly associated with hormone replacement therapy. Early surgical management with gross-total resection is the most effective treatment in terms of recurrence and improves visual acuity. Given the slow progressive nature of bSOMs and their time to recurrence, which can be up to 10 years, long-term follow-up of patients is essential.
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Affiliation(s)
| | - Louis-Marie Terrier
- 2Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | - Gabrielle Cognacq
- 3University of Oxford, John Radcliffe Hospital, Headington, Oxford, Oxfordshire, United Kingdom
| | - Mourad Aggad
- 1Department of Neurosurgery, CHRU de Tours, France
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Le Petit L, Roblot P, Durouchoux A, Kerdiles G, Liguoro D, Jecko V. How to understand an enlarged Meckel's cave? An anatomical study. Surg Radiol Anat 2023:10.1007/s00276-023-03177-w. [PMID: 37318563 DOI: 10.1007/s00276-023-03177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/27/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Dilatation of the trigeminal cavum, or Meckel's cave (MC), is usually considered a radiological sign of idiopathic intracranial hypertension. However, the normal size of the trigeminal cavum is poorly characterized. In this study, we describe the anatomy of this meningeal structure. METHODS We dissected 18 MCs and measured the length and width of the arachnoid web and its extension along the trigeminal nerve. RESULTS Arachnoid cysts were clearly attached to the ophthalmic (V1) and maxillary (V2) branches until they entered the cavernous sinus and foramen rotundum, respectively, without extension to the skull base. Arachnoid cysts were close to the mandibular branch toward the foramen ovale, with a median anteromedial extension of 2.5 [2.0-3.0] mm, lateral extension of 4.5 [3.0-6.0] mm, and posterior extension of 4.0 [3.2-6.0] mm. The trigeminal cavum arachnoid had a total width of 20.0 [17.5-25.0] mm and length of 24.5 [22.5-29.0] mm. CONCLUSION Our anatomical study revealed variable arachnoid extension, which may explain the variability in size of the trigeminal cavum in images and calls into question the value of this structure as a sign of idiopathic intracranial hypertension. The arachnoid web extends beyond the limits described previously, reaching almost double the radiological size of the cavum, particularly at the level of V3 afference of the trigeminal nerve. It is possible that strong adhesion of the arachnoid to the nerve elements prevents the formation of a true subarachnoid space that can be visualized by magnetic resonance imaging.
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Affiliation(s)
- Laetitia Le Petit
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux, France.
- Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France.
| | - Paul Roblot
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux, France
- Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France
| | - Arthur Durouchoux
- Department of Neurosurgery B, University Hospital of Bordeaux, Bordeaux, France
| | - Gaëlle Kerdiles
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux, France
- Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France
| | - Dominique Liguoro
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux, France
- Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France
| | - Vincent Jecko
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux, France
- Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France
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Roblot P, Belaroussi Y, Peiffer-Smadja N, Lafarge X, Cotto E, Colombat M, Blohorn L, Gardere M, Kerdiles G, Le Petit L, Wavasseur T, Liguoro D, Jecko V, Vignes JR. Effect of microorganisms isolated by preoperative osseous sampling on surgical site infection after autologous cranioplasty: A single-center experience. Neurochirurgie 2023; 69:101458. [PMID: 37301131 DOI: 10.1016/j.neuchi.2023.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The most frequent postoperative complication in autologous cranioplasty (AC) is infection. European recommendations include osseous sampling before cryogenic storage of a bone flap. We evaluated the clinical impact of this sampling. METHODS All patients who underwent decompressive craniectomy (DC) and AC in our center between November 2010 and September 2021 were reviewed. The main outcome was the rate of reoperation for infection of the cranioplasty. We evaluated risk factors for bone flap infection, rate of reoperation for any reason (hematoma, skin erosion, cosmetic request, or bone resorption), and radiological evidence of bone flap resorption. RESULTS A total of 195 patients with a median age of 50 (interquartile range: 38.0-57.0) years underwent DC and AC between 2010 and 2021. Of the 195 bone flaps, 54 (27.7%) had a positive culture, including 48 (88.9%) with Cutibacterium acnes. Of the 14 patients who underwent reoperation for bone flap re-removal for infection, 5 and 9 had positive and negative bacteriological cultures, respectively. Of patients who did not have bone flap infection, 49 and 132 had positive and negative bacteriological cultures, respectively. There were no significant differences between patients with and without positive bacteriological culture of bone flaps in the rates of late bone necrosis and reoperation for bone flap infection. CONCLUSIONS A positive culture of intraoperative osseous sampling during DC is not associated with a higher risk of re-intervention after AC.
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Affiliation(s)
- Paul Roblot
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France.
| | - Yaniss Belaroussi
- Thoracic Surgery Unit, Haut-Lévêque Hospital, CHU de Bordeaux, Pessac, France
| | - Nathan Peiffer-Smadja
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Xavier Lafarge
- Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Emmanuelle Cotto
- Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Marie Colombat
- Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Lucas Blohorn
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Maxime Gardere
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Gaëlle Kerdiles
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Laetitia Le Petit
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Thomas Wavasseur
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Dominique Liguoro
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Jean-Rodolphe Vignes
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France; University of Bordeaux, CNRS UMR 5287, INCIA, Zone nord, bâtiment 2, 2(e) étage, 146, rue Léo Saignat, 33076 Bordeaux cedex, France
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Mongardi L, Belaroussi Y, Kara M, Le Petit L, Gimbert E, Kerdiles G, De Courson H, Wavasseur T, Liguoro D, Vignes JR, Jecko V, Roblot P. When to discharge patients following a neuronavigation-assisted brain biopsy for supratentorial lesion? A single-center experience. Clin Neurol Neurosurg 2023; 229:107727. [PMID: 37119654 DOI: 10.1016/j.clineuro.2023.107727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE Most brain biopsies are performed using the frame-based stereotactic technique and several studies describe the time taken and rate of complications, often allowing an early discharge. In comparison, neuronavigation-assisted biopsies are performed under general anesthesia and their complications have been poorly described. We examined the complication rate and determined which patients will worsen clinically. METHODS All adults who underwent a neuronavigation-assisted brain biopsy for a supratentorial lesion from Jan, 2015, to Jan, 2021, in the Neurosurgical Department of the University Hospital Center of Bordeaux, France, were analyzed retrospectively in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. The primary outcome of interest was short-term (7 days) clinical deterioration. The secondary outcome of interest was the complication rate. RESULTS The study included 240 patients. The median postoperative Glasgow score was 15. Thirty patients (12.6 %) showed acute postoperative clinical worsening, including 14 (5.8 %) with permanent neurological worsening. The median delay was 22 h after the intervention. We examined several clinical combinations that allowed early postoperative discharge. A preoperative Glasgow prognostic score of 15, Charlson Comorbidity Index ≤ 3, preoperative World Health Organization Performance Status ≤ 1, and no preoperative anticoagulation or antiplatelet treatment predicted postoperative worsening (negative predictive value, 96.3 %). CONCLUSION Optical neuronavigation-assisted brain biopsies might require longer postoperative observation than frame-based biopsies. Based on strict preoperative clinical criteria, we consider to plan postoperative observation for 24 h a sufficient hospital stay for patients who undergo these brain biopsies.
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Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Yaniss Belaroussi
- ISPED, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Clinical and Epidemiological Research Unit, France; Institut Bergonié, Inserm CIC1401, Clinical and Epidemiological Research Unit, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Mohammed Kara
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Laetitia Le Petit
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Gaëlle Kerdiles
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Hugues De Courson
- ISPED, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Clinical and Epidemiological Research Unit, France; Institut Bergonié, Inserm CIC1401, Clinical and Epidemiological Research Unit, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Thomas Wavasseur
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Dominique Liguoro
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Jean-Rodolphe Vignes
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France; University of Bordeaux, CNRS UMR 5287, INCIA, Zone nord, Bat 2, 2e étage, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - Paul Roblot
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France.
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Baumgarten C, Aggad M, Kerdiles G, Amelot A. Massive cerebral venous air embolism promoting fatal subdural hematoma? Neurochirurgie 2021; 68:252-254. [PMID: 33915147 DOI: 10.1016/j.neuchi.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Affiliation(s)
- C Baumgarten
- Department of Neurosurgery, University Hospital of Grenoble, France.
| | - M Aggad
- Department of Neurosurgery, University Hospital of Tours, France
| | - G Kerdiles
- Department of Neurosurgery, University Hospital of Tours, France
| | - A Amelot
- Department of Neurosurgery, University Hospital of Tours, France
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