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Gaberel T. Introduction: SNCLF and SFNC report on the vertebral artery. Neurochirurgie 2024; 70:101536. [PMID: 38316338 DOI: 10.1016/j.neuchi.2024.101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen F-14000, France; Normandie Univ., UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
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Vincent L, Hitier M, Gaberel T. Willis and his circle. Neurochirurgie 2024; 70:101548. [PMID: 38458059 DOI: 10.1016/j.neuchi.2024.101548] [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: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Louis Vincent
- Departement of ENT, University Hospital of Caen, F-14000 Caen, France.
| | - Martin Hitier
- Departement of ENT, University Hospital of Caen, F-14000 Caen, France; Department of Anatomy, Normandie University, UNICAEN, 14000 Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
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Leclerc A, Deboeuf L, Elia A, Aboubakr O, Planet M, Bedioui A, Rault F, Faisant M, Roux A, Simboli GA, Moiraghi A, Gaberel T, Pallud J, Emery E, Zanello M. Safety and efficacy of frameless stereotactic robot-assisted intraparenchymal brain lesion biopsies versus image-guided biopsies: a bicentric comparative study. Acta Neurochir (Wien) 2024; 166:67. [PMID: 38319393 DOI: 10.1007/s00701-024-05912-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE User-friendly robotic assistance and image-guided tools have been developed in the past decades for intraparenchymal brain lesion biopsy. These two methods are gradually becoming well accepted and are performed at the discretion of the neurosurgical teams. However, only a few data comparing their effectiveness and safety are available. METHODS Population-based parallel cohorts were followed from two French university hospitals with different surgical methods and defined geographical catchment regions (September 2019 to September 2022). In center A, frameless robot-assisted stereotactic intraparenchymal brain lesion biopsies were performed, while image-guided intraparenchymal brain lesion biopsies were performed in center B. Pre-and postoperative clinical, radiological, and histomolecular features were retrospectively collected and compared. RESULTS Two hundred fifty patients were included: 131 frameless robot-assisted stereotactic intraparenchymal brain lesion biopsies in center A and 119 image-guided biopsies in center B. The clinical, radiological, and histomolecular features were comparable between the two groups. The diagnostic yield (96.2% and 95.8% respectively; p = 1.000) and the overall postoperative complications rates (13% and 14%, respectively; p = 0.880) did not differ between the two groups. The mean duration of the surgical procedure was longer in the robot-assisted group (61.9 ± 25.3 min, range 23-150) than in the image-guided group (47.4 ± 11.8 min, range 25-81, p < 0.001). In the subgroup of patients with anticoagulant and/or antiplatelet therapy administered preoperatively, the intracerebral hemorrhage > 10 mm on postoperative CT scan was higher in the image-guided group (36.8%) than in the robot-assisted group (5%, p < 0.001). CONCLUSION In our bicentric comparative study, robot-assisted stereotactic and image-guided biopsies have two main differences (shorter time but more frequent postoperative hematoma for image-guided biopsies); however, both techniques are demonstrated to be safe and efficient.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, ISTCT/CERVOxy Group, UMR6030, GIP CYCERON, Normandy University, Caen, France
| | - Louise Deboeuf
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Angela Elia
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Oumaima Aboubakr
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Martin Planet
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Aziz Bedioui
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
| | - Fréderick Rault
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Maxime Faisant
- Department of Anatomopathology, Caen University Hospital, Caen, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Giorgia Antonia Simboli
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Alessandro Moiraghi
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Normandie University, Cyceron, Caen, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Caen, France
- UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Normandie University, Cyceron, Caen, France
| | - Marc Zanello
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, F-75014, Paris Cedex 14, France.
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-BRAIN, Université Paris Cité, 75014, Paris, France.
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Metayer T, Pasi M, Magro E, Lejeune JP, Thines L, Sibon I, Touze E, Cordonnier C, Gaberel T. Indications for surgical evacuation of cerebellar intracerebral hemorrhage: consensus guidelines from the French Society of Neurosurgery (SFNC) and the French Society of Vascular Neurology (SFNV). Neurochirurgie 2024; 70:101506. [PMID: 37925776 DOI: 10.1016/j.neuchi.2023.101506] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Cerebellar intracerebral hemorrhage (ICH) is associated with poor functional prognosis and high mortality. Surgical evacuation has been proposed to improve outcome. The purpose of this review was to determine the benefit of surgical evacuation of cerebellar ICH and to establish guidelines for when it should be performed. METHOD The writing committee comprised 9 members of the SFNV and the SFNC. Recommendations were established based on a literature review using the PICO questions. The American Heart Association (AHA) classification was used to define recommendation level. In case of insufficient evidence, expert opinions were provided. RESULTS Levels of evidence were low to moderate, precluding definitive recommendations. Based on available data, surgical hematoma evacuation is not recommended to improve functional outcome (Class III; Level B NR). However, based on subgroup analysis, surgical evacuation may be considered in strictly selected patients (Class IIb; Level C-EO): hematoma volume 15-25 cm3, GCS 6-10, and no oral anticoagulation or antiplatelet therapy. Moreover, surgical evacuation is recommended to decrease risk of death (Class IIa; Level B NR) in patients with a hematoma volume >15 cm3 and GCS score <10. CONCLUSION These guidelines were based on observational studies, limiting the level of evidence. However, except for strictly selected patients, surgical evacuation of cerebellar ICH was not associated with improved functional outcome, limiting indications. Data from RCTs are needed in this field.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - Marco Pasi
- Department of Neurology, University Hospital of Tours, Tours, F-37000, France
| | - Elsa Magro
- Department of Neurosurgery, University Hospital of Brest, Brest, F-29200, France
| | - Jean Paul Lejeune
- Department of Neurosurgery, University Hospital of Lille, Lille, F-59037, France
| | - Laurent Thines
- Université de Franche-Comté, CHU de Besançon, Department of neurosurgery, F-25000 Besançon, France
| | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, F-33000, France
| | - Emmanuel Touze
- Department of Neurology, University Hospital of Caen, Caen, F-14000, France; Medical University of Caen, Normandy, Caen, F-14000, France
| | | | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
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Moyer JD, Léger M, Trolonge B, Codorniu A, Lhermitte A, Gaberel T, Jeantrelle C, Gakuba C. Impact of early external ventricular drainage on functional outcome after traumatic brain injury: a bicentric retrospective cohort analysis. Neurochirurgie 2023; 69:101487. [PMID: 37696447 DOI: 10.1016/j.neuchi.2023.101487] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Several studies have confirmed that external ventricular drain decreases intracranial pressure (ICP) after traumatic brain injury (TBI). Considering its impact on ICP control and cerebral waste metabolites clearance, timing of external ventricular drain (EVD) insertion could improve CSF drainage efficiency. The aim of the study was to evaluate the impact of early EVD versus a later one on the 3-month outcome. METHODS For this retrospective cohort study conducted in two regional trauma-center (Caen CHU Côte de Nacre and Beaujon Hospital) between May 2011 and March 2019, all patients with intracranial hypertension following TBI and treated with EVD were included. We defined the early EVD by drainage within the 24 h of the hospital admission and the late EVD insertion by drainage beyond 24 h. A poor outcome was defined as a Glasgow Outcome Scale of one or two at 3 months. RESULTS Among the cohort of 671 patients, we analyzed 127 patients. Sixty-one (48.0%) patients had an early insertion of EVD. In the early EVD group, the mean time to insertion was 10 h versus 55 h in the late EVD group. Among the analyzed patients, 69 (54.3%) had a poor outcome including 39 (63.9%) in the early group and 30 (45.5%) in the later one. After adjustment on prognostic factors, early EVD insertion was not associated with a decrease in a poor outcome at 3-months (OR = 1.80 [0.73-4.53]). CONCLUSION Early insertion of EVD (<24 h) for intracranial hypertension after TBI was not associated with improved outcome at 3 months.
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Affiliation(s)
- Jean-Denis Moyer
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, Paris, France.
| | - Maxime Léger
- Department of Anesthesiology and Critical Care, CHU de Angers, Angers, France
| | - Baptiste Trolonge
- Department of Anesthesiology and Critical Care, CHU de Caen Normandie, 14000 Caen, France
| | - Anaïs Codorniu
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, Paris, France
| | - Amaury Lhermitte
- Department of Anesthesiology and Critical Care, CHU de Caen Normandie, 14000 Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, CHU de Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, 14000 Caen, France
| | - Caroline Jeantrelle
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, Paris, France
| | - Clément Gakuba
- Department of Anesthesiology and Critical Care, CHU de Caen Normandie, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, 14000 Caen, France
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Metayer T, Gilard V, Piotin M, Emery E, Borha A, Robichon E, Briant AR, Derrey S, Vivien D, Gaberel T. Microsurgery and Endovascular Therapy for Distal Anterior Cerebral Artery Aneurysm: A Multicenter Retrospective Cohort Study. World Neurosurg 2023; 178:e174-e181. [PMID: 37451360 DOI: 10.1016/j.wneu.2023.07.022] [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: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Distal anterior cerebral aneurysm (DACA) represents 4% of intracranial aneurysms. Two treatment modalities are available: microsurgery and endovascular therapy (EVT). OBJECTIVE To compare the results between microsurgery and EVT in a modern French cohort. METHODS A multicenter retrospective cohort study of 3 French neurosurgical units was carried out from January 1, 2015, to December 31, 2020. All participants were adult patients who required treatment for a ruptured or unruptured DACA aneurysm. RESULTS A total of 69 patients were included; 16 patients (23.2%) were treated by microsurgery and 53 (76.8%) were treated by EVT. Thirty-one patients (44.9%) had ruptured aneurysms. The complication rate was low, with 1 death and 1 symptomatic ischemia. There was no difference in complications between microsurgery and EVT (P = 0.22). The number of retreatments was higher in EVT (15% vs. 0%) but not significantly (P = 0.18). CONCLUSIONS In the specific subgroup of DACA, both treatment modalities are effective in ruptured and unruptured aneurysms, with a low rate of complications. Retreatment may be more frequent in EVT but it does not lead to more complications.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France.
| | - Vianney Gilard
- Department of Neurosurgery, University Hospital of Rouen, Rouen, France
| | - Michel Piotin
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France
| | - Alin Borha
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France
| | - Erwan Robichon
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Anais R Briant
- Department of Biostatistics, University Hospital of Caen, Caen, France
| | - Stephane Derrey
- Department of Neurosurgery, University Hospital of Rouen, Rouen, France
| | - Denis Vivien
- Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France; Medical School, University of Caen Normandy, Caen, France
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Metayer T, Dumot C, Bernard F, Le Reste PJ, Bernat AL, Cebula H, Mallereau CH, Peltier C, le Guerinel C, Vivien D, Piotin M, Emery E, Gillard V, Leclerc A, Magro E, Proust F, Pelissou-Guyotat I, Derrey S, Aldea S, Barbier C, Borha A, Nadin L, Briant AR, Gaberel T. Clipping Versus Coiling for Ruptured MCA Aneurysms Associated with Intracerebral Hematoma Requiring Surgical Evacuation. Neurocrit Care 2023; 39:162-171. [PMID: 36991178 DOI: 10.1007/s12028-023-01702-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ruptured middle cerebral artery aneurysm (MCAa) can lead to intracerebral hematoma, and surgical evacuation can be performed in these cases. MCAa can be treated by clipping or before by endovascular therapy (EVT). Our objective was to compare the impact on the functional outcome of MCAa in patients with intracerebral hematoma requiring evacuation. METHODS This is a multicenter, retrospective, cohort study with nine French neurosurgical units from January 1, 2013, to December 31, 2020. All participants were adult patients who required evacuation of an intracerebral hematoma. We looked for risk factors for poor outcomes by comparing the baseline characteristics and treatments performed by using the 6-month modified Rankin scale score. Poor outcomes were defined by an modified Rankin scale score of 3-6. RESULTS A total of 162 patients were included. A total of 129 (79.6%) patients were treated by microsurgery, and 33 (20.4%) patients were treated by EVT. In multivariate analysis, factors associated with poor outcomes included hematoma volume, realization of a decompressive craniectomy, occurrence of procedure-related symptomatic cerebral ischemia, occurrence of delayed cerebral ischemia, and EVT. In the propensity score matching analysis (n = 33 per group), poor outcomes were observed in 30% of the patients in the clipping group versus 76% in the EVT group (P < 0.001). These differences may have been related to a longer delay between hospital admission and hematoma evacuation in the EVT group. CONCLUSIONS In the specific subgroup of ruptured MCAa with intracerebral hematoma that requires surgical evacuation, clipping with concomitant hematoma evacuation could provide better functional outcomes than EVT followed by surgical evacuation.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, France.
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France.
- Service de Neurochirurgie, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Chloe Dumot
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Florian Bernard
- Department of Neurosurgery, University Hospital of Angers, Angers, France
| | | | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - Helene Cebula
- Department of Neurosurgery, University Hospital of Strasbourg, Strasbourg, France
| | | | - Charles Peltier
- Department of Neurosurgery, University Hospital of Brest, Brest, France
| | | | - Denis Vivien
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
| | - Michel Piotin
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
| | - Vianney Gillard
- Department of Neuroradiology, University Hospital of Rouen, Rouen, France
| | - Arthur Leclerc
- Department of Neurosurgery, University Hospital of Caen, Caen, France
| | - Elsa Magro
- Department of Neurosurgery, University Hospital of Brest, Brest, France
| | - Francois Proust
- Department of Neurosurgery, University Hospital of Strasbourg, Strasbourg, France
| | | | - Stephane Derrey
- Department of Neuroradiology, University Hospital of Rouen, Rouen, France
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Charlotte Barbier
- Department of Neuroradiology, University Hospital of Caen, Caen, France
| | - Alin Borha
- Department of Neurosurgery, University Hospital of Caen, Caen, France
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
| | - Lawrence Nadin
- Biostatistics and Clinical Research Unit, University Hospital of Caen Normandy, Caen, France
| | - Anais R Briant
- Biostatistics and Clinical Research Unit, University Hospital of Caen Normandy, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
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Gaberel T. Open vascular neurosurgery is not dead! Long live open vascular neurosurgery! Neurochirurgie 2023; 69:101454. [PMID: 37271054 DOI: 10.1016/j.neuchi.2023.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, 14000 Caen, France; Normandie University, UNICAEN, Inserm, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain at Caen-Normandie, Cyceron, 14000 Caen, France.
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Gaberel T. Highlights of vascular neurosurgery in Neurochirurgie in 2022. Neurochirurgie 2023; 69:101415. [PMID: 36774903 DOI: 10.1016/j.neuchi.2023.101415] [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] [Indexed: 01/22/2023]
Affiliation(s)
- T Gaberel
- Department of Neurosurgery, University Hospital of Caen, 14000 Caen, France; Normandie University, UNICAEN, Inserm, U1237, PhIND - Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain at Caen-Normandie, Cyceron, 14000 Caen, France.
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Leclerc A, Gohel H, Malczuk J, Anzalone L, Emery E, Gaberel T. Systematic Review of Meningiomas Revealed by Spontaneous Intracranial Hemorrhage: Clinicopathological Features, Outcomes, and Rebleeding Rate. World Neurosurg 2023; 172:e625-e639. [PMID: 36738963 DOI: 10.1016/j.wneu.2023.01.100] [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: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Meningiomas are rarely revealed by an intracranial hemorrhage (ICH). Rebleeding occurrence rate and time of onset are unknown. Here, we performed a systematic review of the literature of meningiomas revealed by ICH. METHODS We retrospectively collected all meningiomas revealed by spontaneous ICH published between January 1980 and December 2021. We reported clinicopathological features of meningiomas revealed by ICH. We also estimated rebleeding rate and time to onset. RESULTS Ninety-two studies met all inclusion criteria, led to a total of 120 cases. The mean age was 56.3 years, with 66 (55%) female. Seventy-nine (66%) cases were conscious before surgery, 20 (17%) were in coma, and 17 (14%) were unconscious after deterioration. The most frequent bleeding type was subdural hemorrhage (N = 49, 41%) followed by intraparenchymal hemorrhage (IPH) (N = 44, 37%), subarachnoid hemorrhage (SAH) (N = 22, 18%), and intraventricular hemorrhage (IVH) (N = 5, 4%). IPH and hindbrain/ventricular locations are associated with poor outcomes (P = 0.031 and < 0.001, respectively). Among the 19 patients who did not undergo surgical resection of the meningioma, 14 (74%) experienced rebleeding with a median occurrence of 120 days (interquartile, [90; -]). Rebleeding occurs earlier if the type of bleeding is SAH or IVH and for hindbrain location (both P < 0.01). CONCLUSIONS ICH is a rare presentation of meningiomas. Hindbrain and ventricular tumor location and IPH are associated with poor outcomes. Rebleeding rate is high and premature. It occurs earlier if the first bleeding was SAH or IVH and for hindbrain location.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France.
| | | | - Joséphine Malczuk
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France
| | - Louis Anzalone
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France; Normandie Université, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France; Normandie Université, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
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11
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Borha A, Lebrun F, Touzé E, Emery E, Vivien D, Gaberel T. Impact of Decompressive Craniectomy on Hemorrhagic Transformation in Malignant Ischemic Stroke in Mice. Stroke 2023; 54:e1-e6. [PMID: 36475467 DOI: 10.1161/strokeaha.122.041365] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endovascular thrombectomy has changed the management of ischemic stroke. The reperfusion can however lead to a hemorrhagic transformation (HT). Decompressive craniectomy (DC) is a surgical procedure used for malignant ischemic stroke. However, its efficacy was demonstrated before the era of endovascular thrombectomy trials. Here, we hypothesized that DC for ischemic stroke after thrombectomy could lead to a higher risk of HT. We thus evaluated this hypothesis in a mouse model of stroke induced by occlusion of the middle cerebral artery (MCAO) with or without mechanical reperfusion. METHODS Ninety mice subjected to MCAO were divided into 6 groups: permanent MCAO with or without DC; MCAO followed by a mechanical reperfusion with or without DC and MCAO with a mechanical reperfusion followed by r-tPA (recombinant tissue-type plasminogen activator)-induced reperfusion with or without DC. Mice were evaluated by magnetic resonance imaging 24 hours after the MCAO to assess ischemic lesion volumes, and the rate, type, and volume of HTs. RESULTS The ischemic volume was higher in the 2 groups without reperfusion than in the 4 groups with reperfusion independently of r-tPA treatment and DC. The distribution of HT types was different between the 6 groups. The HT volumes and HT scores was smaller in the 2 groups without reperfusion and in the reperfusion group without r-tPA and without DC. In mice having reperfusion, the mean HT score was higher in mice who had DC without r-tPA (HT score 5; P=0.048) or with r-tPA (HT score 8; P=0.02), than in mice without DC (HT score 1). CONCLUSIONS DC for a malignant stroke, after reperfusion, corresponding to an endovascular thrombectomy failure, increases the risk of severe hemorrhagic transformations in a model of ischemic stroke in mice. This result support the need of clinical studies to evaluate the added value of DC at the era of endovascular thrombectomy.
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Affiliation(s)
- Alin Borha
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Cyceron, France (A.B., F.L., E.T., E.E., D.V., T.G.).,Department of Neurosurgery, Caen University Hospital, France (A.B., E.E., T.G.)
| | - Florent Lebrun
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Cyceron, France (A.B., F.L., E.T., E.E., D.V., T.G.)
| | - Emmanuel Touzé
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Cyceron, France (A.B., F.L., E.T., E.E., D.V., T.G.).,Department of Neurology, Caen University Hospital, France (E.T.)
| | - Evelyne Emery
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Cyceron, France (A.B., F.L., E.T., E.E., D.V., T.G.).,Department of Neurosurgery, Caen University Hospital, France (A.B., E.E., T.G.)
| | - Denis Vivien
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Cyceron, France (A.B., F.L., E.T., E.E., D.V., T.G.).,Department of Clinical Research, Caen University Hospital, France (D.V.)
| | - Thomas Gaberel
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Cyceron, France (A.B., F.L., E.T., E.E., D.V., T.G.).,Department of Neurosurgery, Caen University Hospital, France (A.B., E.E., T.G.)
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12
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Leclerc A, Gaberel T, Laville MA, Derrey S, Quintyn JC, Emery E. Factors associated with favorable visual outcome after surgery of clinoidal meningiomas. Clin Neurol Neurosurg 2022; 223:107508. [DOI: 10.1016/j.clineuro.2022.107508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
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13
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Raymond J, Gentric JC, Magro E, Nico L, Bacchus E, Klink R, Cognard C, Januel AC, Sabatier JF, Iancu D, Weill A, Roy D, Bojanowski MW, Chaalala C, Barreau X, Jecko V, Papagiannaki C, Derrey S, Shotar E, Cornu P, Eker OF, Pelissou-Guyotat I, Piotin M, Aldea S, Beaujeux R, Proust F, Anxionnat R, Costalat V, Corre ML, Gauvrit JY, Morandi X, Brunel H, Roche PH, Graillon T, Chabert E, Herbreteau D, Desal H, Trystram D, Barbier C, Gaberel T, Nguyen TN, Viard G, Gevry G, Darsaut TE, _ _, _ _, Raymond J, Roy D, Weill A, Iancu D, Bojanowski MW, Chaalala C, Darsaut TE, O’Kelly CJ, Chow MMC, Findlay JM, Rempel JL, Fahed R, Lesiuk H, Drake B, Santos MD, Gentric JC, Nonent M, Ognard J, El-Aouni MC, Magro E, Seizeur R, Timsit S, Pradier O, Desal H, Boursier R, Thillays F, Roualdes V, Piotin M, Blanc R, Aldea S, Cognard C, Januel AC, Sabatier JF, Calviere L, Gauvrit JY, Raoult H, Eugene F, Bras AL, Ferre JC, Paya C, Morandi X, Lecouillard I, Nouhaud E, Ronziere T, Trystram D, Naggara O, Rodriguez-Regent C, Kerleroux B, Barbier C, Gaberel T, Emery E, Touze E, Papagiannaki C, Derrey S, Eker OF, Riva R, Pellisou-Guyotat I, Guyotat J, Berhouma M, Dumot C, Biondi A, Thines L, Bougaci N, Charbonnier G, Bracard S, Anxionnat R, Gory B, Civit T, Bernier-Chastagner V, Barreau X, Marnat G, Jecko V, Penchet G, Gimbert E, Huchet A, Herbreteau D, Boulouis G, Bibi R, Ifergan H, Janot K, Velut S, Brunel H, Roche PH, Graillon T, Peyriere H, Kaya JM, Touta A, Troude L, Boissonneau S, Clarençon F, Shotar E, Sourour N, Lenck S, Premat K, Boch AL, Cornu P, Nouet A, Costalat V, Bonafe A, Dargazanli C, Gascou G, Lefevre PH, Riquelme C, Corre ML, Beaujeux R, Pop R, Proust F, Cebula H, Ollivier I, Spatola G, Spell L, Chalumeau V, Gallas S, Ikka L, Mihalea C, Ozanne A, Caroff J, Chabert E, Mounayer C, Rouchaud A, Caire F, Ricolfi F, Thouant P, Cao C, Mourier KL, Farah W, Nguyen TN, Abdalkader M, Huynh T, Tawk RG, Carlson AP, Silva LAO, Froio NDL, Silva GS, Mont’Alverne FJA, Martins JL, Mendes GN, Miranda RR. Endovascular treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 2022; 138:1393-1402. [PMID: 37132535 DOI: 10.3171/2022.9.jns22987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The role of endovascular treatment in the management of patients with brain arteriovenous malformations (AVMs) remains uncertain. AVM embolization can be offered as stand-alone curative therapy or prior to surgery or stereotactic radiosurgery (SRS) (pre-embolization). The Treatment of Brain AVMs Study (TOBAS) is an all-inclusive pragmatic study that comprises two randomized trials and multiple registries.
METHODS
Results from the TOBAS curative and pre-embolization registries are reported. The primary outcome for this report is death or dependency (modified Rankin Scale [mRS] score > 2) at last follow-up. Secondary outcomes include angiographic results, perioperative serious adverse events (SAEs), and permanent treatment-related complications leading to an mRS score > 2.
RESULTS
From June 2014 to May 2021, 1010 patients were recruited in TOBAS. Embolization was chosen as the primary curative treatment for 116 patients and pre-embolization prior to surgery or SRS for 92 patients. Clinical and angiographic outcomes were available in 106 (91%) of 116 and 77 (84%) of 92 patients, respectively. In the curative embolization registry, 70% of AVMs were ruptured, and 62% were low-grade AVMs (Spetzler-Martin grade I or II), while the pre-embolization registry had 70% ruptured AVMs and 58% low-grade AVMs. The primary outcome of death or disability (mRS score > 2) occurred in 15 (14%, 95% CI 8%–22%) of the 106 patients in the curative embolization registry (4 [12%, 95% CI 5%–28%] of 32 unruptured AVMs and 11 [15%, 95% CI 8%–25%] of 74 ruptured AVMs) and 9 (12%, 95% CI 6%–21%) of the 77 patients in the pre-embolization registry (4 [17%, 95% CI 7%–37%] of 23 unruptured AVMs and 5 [9%, 95% CI 4%–20%] of 54 ruptured AVMs) at 2 years. Embolization alone was confirmed to occlude the AVM in 32 (30%, 95% CI 21%–40%) of the 106 curative attempts and in 9 (12%, 95% CI 6%–21%) of 77 patients in the pre-embolization registry. SAEs occurred in 28 of the 106 attempted curative patients (26%, 95% CI 18%–35%, including 21 new symptomatic hemorrhages [20%, 95% CI 13%–29%]). Five of the new hemorrhages were in previously unruptured AVMs (n = 32; 16%, 95% CI 5%–33%). Of the 77 pre-embolization patients, 18 had SAEs (23%, 95% CI 15%–34%), including 12 new symptomatic hemorrhages [16%, 95% CI 9%–26%]). Three of the hemorrhages were in previously unruptured AVMs (3/23; 13%, 95% CI 3%–34%).
CONCLUSIONS
Embolization as a curative treatment for brain AVMs was often incomplete. Hemorrhagic complications were frequent, even when the specified intent was pre-embolization before surgery or SRS. Because the role of endovascular treatment remains uncertain, it should preferably, when possible, be offered in the context of a randomized trial.
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Affiliation(s)
- Jean Raymond
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | - Elsa Magro
- Department of Neurosurgery, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Brest, France
| | - Lorena Nico
- Department of Radiology, CHU Saint-Etienne, France
| | - Emma Bacchus
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Ruby Klink
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | | | | | - Jean-François Sabatier
- Neurosurgery, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Daniela Iancu
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Alain Weill
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Michel W. Bojanowski
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Chiraz Chaalala
- Department of Surgery, Division of Neurosurgery, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Xavier Barreau
- Neuroradiology Department, Pellegrin Hospital Group, CHU Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, Pellegrin Hospital Group, CHU Bordeaux, France
| | | | - Stéphane Derrey
- Neurosurgery, Charles Nicolle Hospital, Rouen Normandy University Hospital, Rouen, France
| | | | - Philippe Cornu
- Neurosurgery, Mercy Salpetriere Hospital AP-HP, Paris, France
| | | | | | | | - Sorin Aldea
- Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | | | - François Proust
- Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - René Anxionnat
- Interventional Neuroradiology Department, University of Lorraine, Laboratory IADI INSERM U1254, CHRU Nancy, France
| | | | | | | | | | - Hervé Brunel
- Departments of Interventional Neuroradiology and
| | | | | | - Emmanuel Chabert
- Interventional Neuroradiology Department, CHU Clermont-Ferrand, France
| | - Denis Herbreteau
- Interventional Neuroradiology Department, Bretonneau Hospital, Tours, France
| | - Hubert Desal
- Interventional Neuroradiology Department, CHU de Nantes, France
| | - Denis Trystram
- Interventional Neuroradiology Department, University of Paris, INSERM U1266, IPNP, GHU Paris, France
- Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | | | | | - Thanh N. Nguyen
- Departments of Radiology,
- Neurology, and
- Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; and
| | | | - Guylaine Gevry
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l’Université de Montréal (CHUM), and CHUM Research Centre, Montréal, Québec, Canada
| | - Tim E. Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
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Boisseau W, Darsaut TE, Fahed R, Findlay JM, Bourcier R, Charbonnier G, Smajda S, Ognard J, Roy D, Gariel F, Carlson AP, Shotar E, Ciccio G, Marnat G, Sporns PB, Gaberel T, Jecko V, Weill A, Biondi A, Boulouis G, Bras AL, Aldea S, Passeri T, Boissonneau S, Bougaci N, Gentric JC, Diestro JDB, Omar AT, Al-Jehani HM, Hage GE, Volders D, Kaderali Z, Tsogkas I, Magro E, Holay Q, Zehr J, Iancu D, Raymond J. Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study. AJNR Am J Neuroradiol 2022; 43:1437-1444. [PMID: 36137654 PMCID: PMC9575541 DOI: 10.3174/ajnr.a7648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE MCA aneurysms are still commonly clipped surgically despite the recent development of a number of endovascular tools and techniques. We measured clinical uncertainty by studying the reliability of decisions made for patients with middle cerebral artery (MCA) aneurysms. MATERIALS AND METHODS A portfolio of 60 MCA aneurysms was presented to surgical and endovascular specialists who were asked whether they considered surgery or endovascular treatment to be an option, whether they would consider recruitment of the patient in a randomized trial, and whether they would provide their final management recommendation. Agreement was studied using κ statistics. Intrarater reliability was assessed with the same, permuted portfolio of cases of MCA aneurysm sent to the same specialists 1 month later. RESULTS Surgical management was the preferred option for neurosurgeons (n = 844/1320; [64%] responses/22 raters), while endovascular treatment was more commonly chosen by interventional neuroradiologists (1149/1500 [76.6%] responses/25 raters). Interrater agreement was only "slight" for all cases and all judges (κ = 0.094; 95% CI, 0.068-0.130). Agreement was no better within specialties or with more experience. On delayed requestioning, 11 of 35 raters (31%) disagreed with themselves on at least 20% of cases. Surgical management and endovascular treatment were always judged to be a treatment option, for all patients. Trial participation was offered to patients 65% of the time. CONCLUSIONS Individual clinicians did not agree regarding the best management of patients with MCA aneurysms. A randomized trial comparing endovascular with surgical management of patients with MCA aneurysms is in order.
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Affiliation(s)
- W Boisseau
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - T E Darsaut
- Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - R Fahed
- Department of Medicine (R.F.), Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - J M Findlay
- Department of Surgery (T.E.D., J.M.F.), Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - G Charbonnier
- Departments of Interventional Neuroradiology (G. Charbonnier, A.B.)
| | - S Smajda
- Departments of Interventional Neuroradiology (S.S.)
| | - J Ognard
- Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - D Roy
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - F Gariel
- Departments of Neuroradiology (F.G., G.M.)
| | - A P Carlson
- Department of Neurosurgery (A.P.C.), University of New Mexico Hospital, Albuquerque, New Mexico
| | - E Shotar
- Department of Neuroradiology (E.S.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France
| | - G Ciccio
- Department of Interventional Neuroradiology (G. Ciccio), Centre Hospitalier de Bastia, Bastia, Corse, France
| | - G Marnat
- Departments of Neuroradiology (F.G., G.M.)
| | - P B Sporns
- Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology (P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Gaberel
- Department of Neurosurgery (T.G.), University Hospital of Caen, Caen, France
| | - V Jecko
- Neurosurgery (V.J.), University Hospital of Bordeaux, Bordeaux, France
| | - A Weill
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - A Biondi
- Departments of Interventional Neuroradiology (G. Charbonnier, A.B.)
| | - G Boulouis
- Department of Neuroradiology (G.B.), University Hospital of Tours, Tours, Indre et Loire, France
| | - A L Bras
- Department of Radiology (A.L.B.), Groupement Hospitaliser Bretagne Atlantique-Hôpital Chubert, Vannes, Bretagne, France
| | - S Aldea
- Neurosurgery (S.A.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - T Passeri
- Department of Neurosurgery (T.P.), Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - S Boissonneau
- Department of Neurosurgery (S.B.), La Timone Hospital
- L'Institut National de la Santé et de la Recherche Médicale (S.B.), Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, France
| | - N Bougaci
- Neurosurgery (N.B.), Besançon University Hospital, Besançon, France
| | - J C Gentric
- Department of Interventional Neuroradiology (J.O., J.C.G.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - J D B Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A T Omar
- Division of Neurosurgery (A.T.O.), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - H M Al-Jehani
- Department of Neurosurgery, Radiology and Critical Care Medicine (H.M.A.-J.), King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Alkhobar, Saudi Arabia
| | - G El Hage
- Department of Neurosurgery (G.E.H.), Centre Hospitalier de l'Université de Montréal,Montreal, Québec, Canada
| | - D Volders
- Department of Radiology (D.V.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Z Kaderali
- Division of Neurosurgery (Z.K.), GB1-Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - I Tsogkas
- Department of Neuroradiology (P.B.S., I.T.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - E Magro
- Department of Neurosurgery (E.M.), Centre Hospitalier Universitaire Cavale Blanche, UBO L'Institut National de la Santé et de la Recherche Médicale, LaTIM UMR 1101, Brest, France
| | - Q Holay
- Department of Radiology (Q.H.), Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
| | - J Zehr
- Department of Mathematics and Statistics (J.Z.), Pavillon André-Aisenstadt,Montreal, Québec, Canada
| | - D Iancu
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
| | - J Raymond
- From the Department of Radiology (W.B., D.R., A.W., D.I., J.R.), Division of Neuroradiology
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Metayer T, Leclerc A, Borha A, Derrey S, Langlois O, Barbier C, Aldea S, le Guerinel C, Piotin M, Vivien D, Briant AR, Emery E, Gaberel T. Microsurgical clipping of middle cerebral artery aneurysms: complications and risk factors for complications. World Neurosurg 2022; 168:e87-e96. [PMID: 36115562 DOI: 10.1016/j.wneu.2022.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Middle cerebral artery aneurysms (MCAas) are considered good candidates for microsurgery. The objective was to evaluate the risk of complications and the risk factors for microsurgical treatment of MCAas to better define the indications for microsurgery. METHODS We conducted a retrospective cohort study from three tertiary neurosurgical units from January 2013 to May 2020. We evaluated the frequency of complications and searched for the risk factors for complications after microsurgery. Complications were defined as a composite criterion with the presence of one of the following: procedural-related death, symptomatic cerebral ischemia, impossible exclusion, incomplete exclusion, or (re)bleeding of the treated aneurysm and symptomatic surgical site hematoma. RESULTS 292 MCAas were treated. A total of 29 (9.9%) had a complication: symptomatic cerebral ischemia: 4.8%, aneurysm rebleeding: 0.3%, surgical site hematoma: 1.0%, impossible exclusion: 0.3%, and incomplete exclusion: 4.1%. Severe complications, defined as mRs score >4 at 3 months, were infrequent and occurred in 7/292 patients (2.4%). In multivariate analysis, risk factors were: ruptured aneurysm, larger maximum aneurysm size, larger neck size and arterial branches passing less than <1 mm from the aneurysm's neck or dome. CONCLUSIONS Microsurgical management of MCA aneurysms can be performed with very low morbidity rates. In some cases, at least for factors that do not present a significant difficulty for endovascular therapy, such as the presence of an "en passage" artery or ruptured aneurysm, endovascular therapy EVT may be considered at the same level as the clip.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - Arthur Leclerc
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France
| | - Alin Borha
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Stephane Derrey
- Department of Neuroradiology, University Hospital of Rouen, Rouen, F-76000, France
| | - Olivier Langlois
- Department of Neuroradiology, University Hospital of Rouen, Rouen, F-76000, France
| | - Charlotte Barbier
- Department of Neuroradiology, University Hospital of Caen, Caen, F-14000, France
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, F-75017, France
| | - Caroline le Guerinel
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, F-75017, France
| | - Michel Piotin
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris, F-75017, France
| | - Denis Vivien
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France; Medical School, University of Caen Normandy, Caen, F-14000, France
| | - Anaïs R Briant
- Department of Biostatistics, University Hospital of Caen, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Medical School, University of Caen Normandy, Caen, F-14000, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
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16
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Darsaut TE, Magro E, Bojanowski MW, Chaalala C, Nico L, Bacchus E, Klink R, Iancu D, Weill A, Roy D, Sabatier JF, Cognard C, Januel AC, Pelissou-Guyotat I, Eker O, Roche PH, Graillon T, Brunel H, Proust F, Beaujeux R, Aldea S, Piotin M, Cornu P, Shotar E, Gaberel T, Barbier C, Corre ML, Costalat V, Jecko V, Barreau X, Morandi X, Gauvrit JY, Derrey S, Papagiannaki C, Nguyen TN, Abdalkader M, Tawk RG, Huynh T, Viard G, Gevry G, Gentric JC, Raymond J. Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 2022; 138:891-899. [PMID: 36087316 DOI: 10.3171/2022.7.jns22813] [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: 04/07/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. METHODS TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score > 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score > 2. RESULTS From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I-II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%-93%) and 105/110 low-grade (95%, 95% CI 90%-98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%-18%) had reached the primary safety outcome of mRS score > 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%-28%). Permanent treatment-related complications leading to mRS score > 2 occurred in 6/139 patients (4%, 95% CI 2%-9%), 5 (83%) of whom had complications due to preoperative embolization. CONCLUSIONS The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 (ClinicalTrials.gov).
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Affiliation(s)
- Tim E Darsaut
- 1Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Elsa Magro
- 2Department of Neurosurgery, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Brest, France
| | - Michel W Bojanowski
- 3Department of Surgery, Division of Neurosurgery, University of Montreal Health Centre (CHUM), Montreal, Quebec, Canada
| | - Chiraz Chaalala
- 3Department of Surgery, Division of Neurosurgery, University of Montreal Health Centre (CHUM), Montreal, Quebec, Canada
| | - Lorena Nico
- 4Division of Interventional Neuroradiology, Department of Radiology, CHU Saint-Etienne, North Hospital, Saint-Etienne, France
| | - Emma Bacchus
- 1Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Ruby Klink
- 5Research Centre of the University of Montreal Hospital Centre, Interventional Neuroradiology Research Laboratory (NRI), Montreal, Quebec, Canada
| | - Daniela Iancu
- 6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Alain Weill
- 6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Daniel Roy
- 6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
| | - Jean-Francois Sabatier
- 7Department of Neurosurgery, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Christophe Cognard
- 8Diagnostic and Therapeutic Neuroradiology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | - Anne-Christine Januel
- 8Diagnostic and Therapeutic Neuroradiology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
| | | | - Omer Eker
- 10Diagnostic and Interventional Neurological Imaging, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Graillon
- 12Department of Neurosurgery, Aix Marseille University, INSERM, AP-HM, MMG, UMR1251, Marmara Institute, La Timone Hospital, Marseille, France
| | - Hervé Brunel
- 13Department of Neuroradiology, La Timone Hospital, AP-HM, Marseille, France
| | - Francois Proust
- 14Department of Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
| | - Rémy Beaujeux
- 15Department of Interventional Neuroradiology, University Hospital of Strasbourg, Strasbourg, France
| | | | - Michel Piotin
- 17Interventional Radiology, Adolphe de Rothschild Foundation Hospital, Paris, France
| | | | - Eimad Shotar
- 19Neuroradiology, Mercy Salpetriere Hospital AP-HP, Paris, France
| | | | - Charlotte Barbier
- 21Vascular and Interventional Imaging, CHU Caen Normandie, Caen, France
| | | | | | - Vincent Jecko
- 24Neurosurgery Department A, Pellegrin Hospital Group, CHU Bordeaux, Bordeaux, France
| | - Xavier Barreau
- 25Diagnostic and Therapeutic Neuroradiology Department, Pellegrin Hospital Group, CHU Bordeaux, Bordeaux, France
| | | | - Jean-Yves Gauvrit
- 27Neuroradiology, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | | | | | - Thanh N Nguyen
- Departments of30Radiology.,31Neurology, and.,32Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Thien Huynh
- 34Radiology, Mayo Clinic, Jacksonville, Florida
| | - Geraldine Viard
- 35Clinical Investigation Center, CHU Brest, Brest, France; and
| | - Guylaine Gevry
- 5Research Centre of the University of Montreal Hospital Centre, Interventional Neuroradiology Research Laboratory (NRI), Montreal, Quebec, Canada
| | - Jean-Christophe Gentric
- 36Department of Interventional Neuroradiology, Cavale Blanche Hospital, Brest University Hospital, Brest, France
| | - Jean Raymond
- 5Research Centre of the University of Montreal Hospital Centre, Interventional Neuroradiology Research Laboratory (NRI), Montreal, Quebec, Canada.,6Department of Radiology, Service of Neuroradiology, Hospital Centre of the University of Montreal (CHUM), Montreal, Quebec, Canada
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Moutel G, Goupille P, Suzat B, Rigaud JP, Charvin M, Grandazzi G, Gouriot M, Gakuba C, Gaberel T, Benoist G. Interrompre une grossesse en réanimation sans recueil du consentement de la patiente : enjeux éthiques et médico-légaux. Méd Intensive Réa 2022. [DOI: 10.37051/mir-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
En France, l'interruption volontaire d'une grossesse pour motif médical peut être demandée par la femme quel que soit le terme de la grossesse, s'il est attesté que la poursuite de celle-ci met gravement en péril sa santé. L’interruption de grossesse est alors soumise à l’avis collégial d’un Centre Pluridisciplinaire de Diagnostic Prénatal qui doit rendre une décision favorable après analyse de la situation. Suite à cet avis, c’est la femme qui prend la décision finale. Le respect de l’autonomie de la femme enceinte est donc un principe fondamental en matière de diagnostic prénatal et d’interruption de grossesse dans la loi française.
Nous analysons dans cet article une situation qui soulève des problématiques d’ordre éthique et décisionnel complexes dans le cas où l’interruption de grossesse se pose mais où la patiente n’est ni à même de formuler une demande ni à même de consentir, du fait de sa pathologie nécessitant une hospitalisation en réanimation.
Dès lors que le maintien de la grossesse met en péril grave la santé de la patiente, l’urgence peut apparaitre comme un argument recevable pour agir sans consentement de la patiente. Cette urgence s’entend ici par le fait que, sans une décision rapide, la situation clinique a peu de chance de s’améliorer, voire risque de se dégrader. Nous discutons dans ce contexte les arguments qui permettent de réaliser l’interruption et l’importance de consulter les parents et le conjoint, afin de ne pas exclure les proches du processus décisionnel. Notre analyse interroge enfin les limites du secret médical en réanimation quand un dialogue et un échange d’informations avec les proches apparait essentiel, en particulier dès lors que le patient ne peut participer à la décision et qu’il y a des décisions complexes à prendre.
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18
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Leclerc A, Gaberel T, Laville MA, Derrey S, Quintyn JC, Emery E. Predictive Factors of Favorable Visual Outcomes After Surgery of Tuberculum Sellae Meningiomas: A Multicenter Retrospective Cohort Study. World Neurosurg 2022; 164:e557-e567. [PMID: 35568126 DOI: 10.1016/j.wneu.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/20/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Because of their proximity to the visual structures, tuberculum sellae meningiomas are frequently revealed by ophthalmologic impairment. The goal of surgery is gross total resection and improvement of visual function. The purpose of the present study was to identify the predictors of favorable visual outcomes after surgery of tuberculum sellae meningioma. METHODS We retrospectively collected tuberculum sellae meningiomas treated at 2 neurosurgical centers from 2010 to 2020. We collected the clinical, imaging and surgical data and analyzed their effects on the visual outcome. A favorable visual outcome was defined as an increase in visual acuity of ≥0.2 point and/or an increase of >25% of the visual field or complete recovery. RESULTS A total of 50 patients were included. At 4 months after surgery, 30 patients (60%) had experienced visual improvement. The predictors of a favorable visual outcome were a symptom duration of <6 months, preoperative visual acuity >0.5, a smaller tumor size, and tumor with T2-weighted/fluid attenuated inversion recovery hypersignal on magnetic resonance imaging. During surgery, a soft tumor and a clear brain-tumor interface were associated with favorable visual outcomes. Preoperative optic coherence tomography measurements of the retinal nerve fiber layer thickness >80 μM and ganglion cell complex thickness >70 μM were also associated with a better ophthalmologic outcome. CONCLUSIONS In tuberculum sellae meningiomas, rapid surgical treatment must be performed to optimize vision improvement. A hyperintense lesion on T2-weighted/fluid attenuated inversion recovery magnetic resonance imaging and minor vision impairment at the initial ophthalmologic presentation might give hope for a favorable outcome. Performing optic coherence tomography measurements before surgery could clarify patients' expectations regarding their recovery.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen, France; Medical School, Université Caen Normandie, Caen, France.
| | - Thomas Gaberel
- Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen, France; Medical School, Université Caen Normandie, Caen, France; Physiopathology and Imaging of Neurological Disorders, Institut National de la Santé et de la Recherche Médicale, UMR-S U1237, GIP Cyceron, Caen, France
| | - Marie-Alice Laville
- Department of Ophthalmology, Centre Hospitalier Universitaire Caen, Caen, France
| | - Stephane Derrey
- Department of Neurosurgery, Centre Hospitalier Universitaire Rouen, Rouen, France; Medical School, Université Rouen Normandie, Rouen, France
| | - Jean-Claude Quintyn
- Department of Ophthalmology, Centre Hospitalier Universitaire Caen, Caen, France; Medical School, Université Caen Normandie, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen, France; Medical School, Université Caen Normandie, Caen, France; Physiopathology and Imaging of Neurological Disorders, Institut National de la Santé et de la Recherche Médicale, UMR-S U1237, GIP Cyceron, Caen, France
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19
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Hestin R, Kamga Totouom H, Gaberel T, Parienti JJ, Hanouz JL. Time to medical fitness for discharge following surgical evacuation of chronic subdural haematoma with general or regional anaesthesia: a prospective randomised trial. Anaesthesia 2022; 77:547-554. [PMID: 35238401 DOI: 10.1111/anae.15667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/22/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
General or regional anaesthesia can be used for chronic subdural haematoma evacuation, but no study has compared these types of anaesthesia in terms of peri-operative outcomes. This single-centre, prospective, randomised study included adult patients (age ≥ 18 years) undergoing surgical chronic subdural haematoma evacuation. Patients were randomly allocated to general (target-controlled total intravenous anaesthesia with propofol and remifentanil) or regional anaesthesia (bilateral scalp block with remifentanil sedation if required). The primary outcome measure was duration of hospital stay, based on the day patients were judged by an investigator blinded from the allocation group to be medically fit for discharge. Secondary outcomes included: rate of regional anaesthesia failure; rate of intra-operative and postoperative adverse events at 24 hours; and pain scores at 24 hours. Data from 60 patients were analysed (30 general anaesthesia and 30 regional anaesthesia). Median (IQR [range]) time until patients were judged medically fit for discharge was 3 (3-3 [2-10]) days and 3 (2-5 [2-15]) days for general and regional anaesthesia, respectively (p = 0.700). Regional anaesthesia failed in two patients. There were more intra-operative adverse events in patients who received general anaesthesia (25 vs. 11, respectively; p = 0.001). The occurrence of postoperative adverse events was similar for general and regional anaesthesia (16 vs. 13 patients, respectively; p = 0.605). In patients requiring chronic subdural haematoma evacuation, general and regional anaesthesia are comparable in terms of duration of time until medically fit for discharge and occurrence of postoperative complications. The rate of intra-operative adverse events (mainly arterial hypotension) is greater with general anaesthesia.
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Affiliation(s)
- R Hestin
- Department of Anaesthesiology and Intensive Care, Caen University Hospital and Caen Normandy University, Caen, France
| | - H Kamga Totouom
- Department of Anaesthesiology and Intensive Care, Caen University Hospital and Caen Normandy University, Caen, France
| | - T Gaberel
- Department of Neurosurgery, Caen University Hospital and Caen Normandy University, Caen, France
| | - J J Parienti
- Department of Clinical Research and Biostatistics, Caen University Hospital and Caen Normandy University, Caen, France
| | - J L Hanouz
- Department of Anaesthesiology and Intensive Care, Caen University Hospital and Caen Normandy University, Caen, France
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20
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Rault F, Briant AR, Kamga H, Gaberel T, Emery E. Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk? Neurosurg Rev 2022; 45:2385-2399. [PMID: 35243565 DOI: 10.1007/s10143-022-01756-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 01/10/2023]
Abstract
Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complication rate was higher for elderly patients and to find confounding factors. We conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded. Nine hundred ninety-six patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. Of the patients, 5.2% presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI and accidental durotomies were independent risk factors for SC. Surgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complication risk is increased although an optimal preparation is the way to avoid them.
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Affiliation(s)
- Frédérick Rault
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France.
| | - Anaïs R Briant
- Unité de Biostatistique Et Recherche Clinique (UBRC), Avenue de la Côte de Nacre, 14000, Caen, France
| | - Hervé Kamga
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
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21
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Leclerc A, Hello-Regnier EL, Faisant M, Bernard AL, Emery E, Ferracci FX, Gaberel T. Ganglioglioma revealed by spontaneous intracerebral hematoma: a cohort study. Neurochirurgie 2022; 68:e8-e15. [DOI: 10.1016/j.neuchi.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 10/18/2022]
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22
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Frechon P, Michon J, Baldolli A, Emery E, Lucas F, Verdon R, Fournier A, Gaberel T. Medicosurgical management of deep wound infections after thoracolumbar instrumentation: risk factors of poor outcomes. Acta Neurochir (Wien) 2022; 164:881-890. [PMID: 35128604 DOI: 10.1007/s00701-022-05128-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical site infection (SSI) after thoracolumbar osteosynthesis is a common complication. Its management relies on surgical revision and antibiotic therapy, but treatment failure is not uncommon. The aim of our study was to assess the frequency of SSI management failure and its risk factors. METHODS A retrospective study of patients hospitalized from 2011 to 2019 at the University Hospital of Caen was carried out. The infection rate and the time to onset of failure were assessed over a minimum follow-up of 1 year. Treatment failure was defined as the occurrence of a new intervention in the spine in the year following the end of antibiotic therapy, the establishment of long-term suppressive antibiotic therapy, or death from any cause within 1 year of the end of antibiotic therapy. We compared the treatment failure group with the treatment success group to determine risk factors for treatment failure. RESULTS A total of 2881 patients underwent surgery during the study period, and 92 developed an SSI, corresponding to an SSI rate of 3.19%. Thirty-six percent of the patients with an SSI presented treatment failure. The median time to failure was 31 days. On multivariate analysis, diabetes mellitus was identified as a risk factor for treatment failure, whereas prolonged postoperative drainage for 4 to 5 days was a protective factor. CONCLUSIONS The number of failures was significant, and failure occurred mainly during the early phase. To decrease the risk of treatment failure, prolonged duration of postoperative drainage seems to be helpful. Additionally, as diabetes is a risk factor for treatment failure, good control of glycemia in these patients might impact their outcomes.
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Affiliation(s)
- Paul Frechon
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France.
| | - Jocelyn Michon
- Department of Infectious Diseases, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France
| | - Aurelie Baldolli
- Department of Infectious Diseases, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France
- Physiopathology and Imaging of Neurological Disorders (PhIND), Normandie Université, UNICAEN, INSERM, UMR-S U1237, GIP Cyceron, 14000, Caen, France
| | - François Lucas
- Department of Neurosurgery, Saint Martin Private Hospital, 18 rue des Roquemonts, 14000, Caen, France
| | - Renaud Verdon
- Department of Infectious Diseases, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France
| | - Anna Fournier
- Department of Infectious Diseases, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France
- Physiopathology and Imaging of Neurological Disorders (PhIND), Normandie Université, UNICAEN, INSERM, UMR-S U1237, GIP Cyceron, 14000, Caen, France
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Metayer T, Orset C, Ali C, Furon J, Szabla N, Emery E, Vivien D, Gaberel T. Bumetanide lowers acute hydrocephalus in a rat model of subarachnoid hemorrhage. Acta Neurochir (Wien) 2022; 164:499-505. [PMID: 35094147 DOI: 10.1007/s00701-021-05088-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) can lead to acute hydrocephalus (AH). AH pathophysiology is classically attributed to an obstruction of the arachnoid granulations by blood. Recent findings in rodents suggest that after intraventricular hemorrhage, AH is related to cerebrospinal fluid (CSF) hypersecretion by the choroid plexus (CP), as it can be reduced by intracerebroventricular (ICV) injection of bumetanide. OBJECTIVE Here, we investigated if and how CSF hypersecretion and/or CSF outflow disorders contribute to post-SAH hydrocephalus. METHODS Ninety-four Wistar rats were used. SAH was induced by the endovascular perforation technique. The presence of AH was confirmed by magnetic resonance imaging (MRI), and rats with AH were randomly assigned to 4 groups: control group, superior sagittal sinus (SSS) thrombosis to block CSF reabsorption, ICV injection of saline, and ICV injection of bumetanide to decrease CSF secretion. Clinical outcome was evaluated with a neuroscore. A second MRI was performed 24 h later to evaluate the ventricular volume. RESULTS Fifty percent of rats that survived SAH induction had AH. Their ventricular volume correlated well to the functional outcome after 24 h (r = 0.803). In rats with AH, 24 h later, ventricular volume remained equally increased in the absence of any further procedure. Similarly, ICV injection of saline or SSS thrombosis had no impact on the ventricular volume. However, ICV injection of bumetanide reduced AH by 35.9% (p = 0.002). CONCLUSION In rodents, post-SAH hydrocephalus is may be due to hypersecretion of CSF by the CP, as it is limited by ICV injection of bumetanide. However, we cannot exclude other mechanisms involved in post-SAH acute hydrocephalus.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, 14000, Caen, France.
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France.
| | - Cyrille Orset
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France
| | - Carine Ali
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France
| | - Jonathane Furon
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France
| | - Nicolas Szabla
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, 14000, Caen, France
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France
- Medical School, University of Caen Normandy, 14000, Caen, France
| | - Denis Vivien
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France
- Medical School, University of Caen Normandy, 14000, Caen, France
- Department of Clinical Research, Caen-Normandie University Hospital, CHU, 14000, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, 14000, Caen, France
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, 14000, Caen, France
- Medical School, University of Caen Normandy, 14000, Caen, France
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Darsaut TE, Keough MB, Boisseau W, Findlay JM, Bojanowski MW, Chaalala C, Iancu D, Weill A, Roy D, Estrade L, Lejeune JP, Januel AC, Carlson AP, Sauvageau E, Al-Jehani H, Orlov K, Aldea S, Piotin M, Gaberel T, Gevry G, Raymond J. Middle Cerebral Artery Aneurysm Trial (MCAAT): A randomized care trial comparing surgical and endovascular management of MCA aneurysm patients. World Neurosurg 2021; 160:e49-e54. [PMID: 34971833 DOI: 10.1016/j.wneu.2021.12.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whether the best management of middle cerebral artery (MCA) aneurysm patients is surgical or endovascular remains uncertain, with little evidence to guide decision-making. A randomized care trial offering MCA aneurysm patients a 50% chance of surgical and a 50% chance of endovascular management may optimize outcomes in the presence of uncertainty. METHODS The Middle Cerebral Artery Aneurysm Trial (MCAAT) is an investigator-initiated, multi-center, parallel group, prospective, 1:1 randomized controlled clinical trial. All adult patients with MCA aneurysms, ruptured or unruptured, amenable to surgical and endovascular treatment can be included. The composite primary outcome is 'Treatment Success': i) occlusion or exclusion of the aneurysm using the allocated treatment modality; ii) no intracranial hemorrhage during follow-up; iii) no retreatment of the target aneurysm during follow-up, iv) no residual aneurysm on angiographic follow-up and v) independence (mRS <3) at 1 year. The trial tests two versions of the same hypothesis (one for ruptured and one for unruptured MCA aneurysm patients): Surgical management will lead to a 15% absolute increase in the proportion of patients reaching Treatment Success from 55% to 70% (ruptured) or from 75% to 90% (unruptured aneurysm patients) compared to endovascular treatment (any method). In this pragmatic trial, outcome evaluations are by treating physicians, except for 1 year angiographic results which will be core lab assessed. The trial will be monitored by an independent data safety monitoring committee to assure safety of participants. MCAAT is registered at clinicaltrials.gov: NCT05161377. CONCLUSION Patients with MCA aneurysms can be optimally managed within a care trial protocol.
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Affiliation(s)
- Tim E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada
| | - Michael B Keough
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada
| | - William Boisseau
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - J Max Findlay
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada
| | - Michel W Bojanowski
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Chiraz Chaalala
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Daniela Iancu
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Alain Weill
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Daniel Roy
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Laurent Estrade
- Department of Interventional Neuroradiology, CHU de Lille, Hôpital Salengro, Lille, France
| | - Jean-Paul Lejeune
- Department of Neurosurgery, CHU de Lille, Hôpital Salengro, Lille, France
| | - Anne-Christine Januel
- Department of Interventional Neuroradiology, CHU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Andrew P Carlson
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Health, Jacksonville, Florida, USA
| | - Hosam Al-Jehani
- Department of Neurosurgery and Radiology, King Fahad University Hospital, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Kirill Orlov
- Endovascular Neurosurgery Research Center, Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | | | - Guylaine Gevry
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
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Borha A, Chagnot A, Goulay R, Emery E, Vivien D, Gaberel T. Cranioplasty Reverses Dysfunction of the Solutes Distribution in the Brain Parenchyma After Decompressive Craniectomy. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa028_s041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Perrotte M, Lazardeux J, Sistiaga PP, Chazalviel L, Saulnier R, Metayer T, Isnard C, Emery E, Auvray P, Vivien D, Gaberel T. An updated model of hydrocephalus in sheep to evaluate the performance of a device for ambulatory wireless monitoring of cerebral pressure through shunts. Neurochirurgie 2021; 68:300-308. [PMID: 34774581 DOI: 10.1016/j.neuchi.2021.10.006] [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: 03/16/2021] [Revised: 07/16/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) diversion by shunts is the most common surgical treatment for hydrocephalus. Though effective, shunts are associated with risk of dysfunction leading to multiple surgical revisions, affecting patient quality-of-life and incurring high healthcare costs. There is a need for ambulatory monitoring systems for life-long assessment of shunt status. The present study aimed to develop a preclinical model assessing the feasibility of our wireless device for continuous monitoring of cerebral pressure in shunts. METHODS We first adapted a previous hydrocephalus model in sheep, which used an intracisternal kaolin injection. Seven animals were used to establish the model, and 1 sheep with naturally dilated ventricles was used as control. Hydrocephalus was confirmed by clinical examination and brain imaging before inserting the ventriculoperitoneal shunts and the monitoring device allowing continuous measurement of the pressure through the shunt for a few days in 3 sheep. An external ventricular drain was used as gold-standard. RESULTS Our results showed that a reduction in kaolin dose associated to postoperative management was crucial to reduce morbidity and mortality rates in the model. Ventriculomegaly was confirmed by imaging 4 days after injection of 75 mg kaolin into the cisterna magna. For the implanted sheep, recordings revealed high sensitivity of our sensor in detecting fluctuations in cerebral pressure compared to conventional measurements. CONCLUSIONS This proof-of-concept study highlights the potential of this preclinical model for testing new shunt devices.
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Affiliation(s)
- Morgane Perrotte
- Research and Development Department, Neurallys, Colombelles, Normandie, France.
| | - Johan Lazardeux
- Research and Development Department, Neurallys, Colombelles, Normandie, France
| | | | - Laurent Chazalviel
- UMR6301-ISTCT, CNRS, CERVOxy Group, GIP Cyceron, Caen, Normandie, France
| | | | - Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, Normandie, France; INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France
| | - Christophe Isnard
- Department of Microbiology, University Caen-Normandy, UNICAEN, University Hospital of Caen, Caen, Normandie, France; UNICAEN/UNIROUEN, EA2656 GRAM 2.0, University Caen-Normandy, Caen, Normandie, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, Normandie, France; INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France
| | - Philippe Auvray
- Research and Development Department, Neurallys, Colombelles, Normandie, France
| | - Denis Vivien
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France; Department of Clinical Research, University Hospital of Caen, Caen, Normandie, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, Normandie, France; INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, University Hospital of Caen, GIP Cyceron, Caen, Normandie, France
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27
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Metayer T, Lechanoine F, Bougaci N, de Schlichting E, Terrier L, Derrey S, Barbier C, Papagiannaki C, Ashraf A, Tahon F, Leplus A, Gay E, Emery E, Briant AR, Vivien D, Gaberel T. Retreatment of previously treated intracranial aneurysm: Procedural complications and risk factors for complications. Neurochirurgie 2021; 68:150-155. [PMID: 34487752 DOI: 10.1016/j.neuchi.2021.08.005] [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: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Intracranial aneurysm (IA) is a frequent vascular malformation that can be managed by endovascular treatment (EVT) or microsurgery. A previously treated IA can recanalize, which may require further treatment. The aim of our study was to evaluate procedural complications related to IA retreatment and their risk factors. METHODS All patients retreated for IA between 2007 and 2017 in 4 hospitals were included. We retrospectively reviewed the frequency of procedural complications of IA retreatment, defined as death or≥1-point increase in modified Rankin score 24h after the procedure. We then screened for risk factors of procedural complications by comparing the characteristics of patients with and without complications. RESULTS During the inclusion period, 4,997 IAs were treated in our 4 institutions. Of these, 237 (4.7%) were retreated. 29 (12.2%) had≥1 procedural complication. However, severe complications, defined as death or dependency at 1 month, occurred only in 3 patients (1.3%). The only risk factor for complications was microsurgical clipping as retreatment. CONCLUSIONS Procedural complications during IA retreatment were frequent but, in most cases, retreatment did not lead to death or severe disability. The only risk factor for complications of IA retreatment was clipping as retreatment. However, the design of the study did not allow any conclusion to be drawn as to the optimal means of aneurysm retreatment, and further studies are needed.
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Affiliation(s)
- T Metayer
- Department of Neurosurgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - F Lechanoine
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - N Bougaci
- Department of Neurosurgery, University Hospital of Nice, 06000 Nice, France
| | - E de Schlichting
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - L Terrier
- Department of Neurosurgery, University Hospital of Rouen, 76000 Rouen, France
| | - S Derrey
- Department of Neurosurgery, University Hospital of Nice, 06000 Nice, France
| | - C Barbier
- Department of Neurosurgery, University Hospital of Rouen, 76000 Rouen, France; Department of Biostatistics, University Hospital of Caen, Caen, France
| | - C Papagiannaki
- Department of Neuroradiology, University Hospital of Caen, 14000 Caen, France
| | - A Ashraf
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - F Tahon
- Department of Neuroradiology, University Hospital of Rouen, 76000 Rouen, France
| | - A Leplus
- Department of Neurosurgery, University Hospital of Nice, 06000 Nice, France
| | - E Gay
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - E Emery
- Department of Neurosurgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000 Caen, France; Department of Neuroradiology, University Hospital of Grenoble, 38000 Grenoble, France
| | - A R Briant
- Medical School, University of Caen Normandy, 14000 Caen, France; Department of Biostatistics, University Hospital of Caen, Caen, France
| | - D Vivien
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France; Department of Neuroradiology, University Hospital of Grenoble, 38000 Grenoble, France
| | - T Gaberel
- Department of Neurosurgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
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28
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Garrido E, Metayer T, Borha A, Langlois O, Curey S, Papagiannaki C, Di Palma C, Emery E, Derrey S, Gaberel T, Gilard V. Intracranial aneurysms in pediatric population: a two-center audit. Childs Nerv Syst 2021; 37:2567-2575. [PMID: 33876302 DOI: 10.1007/s00381-021-05151-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Intracranial aneurysms (IA) in children are rare, accounting for less than 5% of all IA. Due to their scarcity, the epidemiology is poorly understood and differs from adults in term of clinical presentation, size, location, and origin. Consequently, the treatment strategies are specific and cannot be only based on data from adult series. The aim of our study was to report the characteristics, management, and outcomes of children treated for IA in two university hospitals located in Normandy (France) over the last 17 years and to perform a literature review of this rare pathology. METHODS This retrospective study included 18 consecutive children (< 18 years old) admitted with cerebral aneurysm treated in two neurosurgery departments in Normandy, from 2001 to 2018. Computerized tomography and cerebral angiography established the diagnosis. Both endovascular and surgical procedures were discussed in all cases. Data focused on clinical condition at admission, characteristics of the IA, choice of the treatment modalities, and complications. The outcome at follow-up is based on Glasgow outcomes scale (GOS) at 1 year. RESULTS During the study period, 18 children (mean age: 12.6 years; sex ratio male/female: 2.3) were admitted with 21 IA. Aneurysms had a mean size of 13.6 mm with 4 giant aneurysms and were mostly located in the anterior circulation (16/21). Clinical presentations at onset were sudden symptoms related to a subarachnoid hemorrhage in 13 patients, headaches in 4 patients with giant aneurysm, and asymptomatic in one patient. Among the 13 patients with ruptured IA, 6 presented in poor preoperative condition (Hunt and Hess Grade ≥ 4). Treatment modalities consisted in embolization in 9 patients and surgery in 9 patients including 2 by-pass surgeries in fusiform aneurysms. Complications were similar in the two groups, but two cases of recanalization were observed in the endovascular group. At 1 year of follow-up, 14 children were in good condition (GOS Score > 4) and one died. Three children presented associated IA treated by the same technique as initial aneurysm. CONCLUSIONS Pediatric aneurysm is a different pathology compared with adults, occurring more frequently in male population with a higher proportion of giant aneurysms and aneurysms located in the internal carotid bifurcation. The use of endovascular techniques has progressed in the last years, but surgery was proposed for half of our population.
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Affiliation(s)
- Elisabeth Garrido
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
| | - Thomas Metayer
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Alin Borha
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Olivier Langlois
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Sophie Curey
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | | | - Camille Di Palma
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Vianney Gilard
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.,Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Normandie Univ, UNIROUEN, INSERM U1245, Rouen, France
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29
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Lopez C, Frechon P, Seizeur R, Emery E, Pelissou-Guyotat I, Proust F, Thines L, Gaberel T, Magro E. What is the role of neurosurgeons in the current management of intracranial aneurysm in France? An analysis of professional practices. Neurochirurgie 2021; 68:16-20. [PMID: 34246662 DOI: 10.1016/j.neuchi.2021.06.013] [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: 02/15/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN Retrospective observational survey-based study. INTRODUCTION In France, intracranial aneurysm (IA) patients are managed by neurosurgeons and by interventional neuroradiologists. The growth of endovascular treatment led us to reflect on the role of neurosurgeons in the management of patients with IA. The present study aimed to highlight the current organization of IA management in France. METHOD A 60-question survey was sent to the neurosurgeons in 34 hospitals managing IA patients. Thirty-three questions dealt with standards of care, follow-up procedures and the involvement of the specific specialist. RESULTS Twenty-seven centers (79.4%) responded to the survey. A Vascular Multidisciplinary Discussion Team was organized, including both surgeons and neuroradiologists, in 92% of responding centers. There were department protocols in 66% of centers, a local registry in 33% and clinical trials in IA in 60%. Patients with unruptured IA were first seen by a neurosurgeon or by an interventional neuroradiologist, with different practices. For ruptured IA, the neurosurgeons were contacted first in 93% of cases, and were systematically involved in initial intensive care unit management. The patients were hospitalized in the neurosurgery department in 89% of the centers. The neurosurgeons took care of initial follow-up in 85% of the centers, and of lifetime follow-up in 36%. In most centers, radiological monitoring of IA was based on MRI angiography for patients who were embolized or under surveillance, and on CT angiography after microsurgery. CONCLUSION Despite the growth of endovascular treatments, the present survey and the literature highlight a major role of neurosurgeons in treatment, follow-up and care coordination.
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Affiliation(s)
- C Lopez
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - P Frechon
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France
| | - R Seizeur
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France; Université de Bretagne Occidentale, INSERM, UMR 1101, LaTIM, Laboratoire de Traitement de l'Information Médicale, 29200 Brest, France
| | - E Emery
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
| | - I Pelissou-Guyotat
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Department of Neurosurgery, 59, Boulevard Pinel, 69667 Bron, France
| | - F Proust
- Department of Neurosurgery, Hautepierre Hospital Strasbourg, University Hospital, 67098 Strasbourg, France
| | - L Thines
- Neurosurgery Department, Besançon University Hospital, 3, Boulevard Alexandre Fleming, 25030 Besançon cedex, France
| | - T Gaberel
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
| | - E Magro
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France; Université de Bretagne Occidentale, INSERM, UMR 1101, LaTIM, Laboratoire de Traitement de l'Information Médicale, 29200 Brest, France
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Rault F, Terrier L, Leclerc A, Gilard V, Emery E, Derrey S, Briant AR, Gakuba C, Gaberel T. Decreased number of deaths related to severe traumatic brain injury in intensive care unit during the first lockdown in Normandy: at least one positive side effect of the COVID-19 pandemic. Acta Neurochir (Wien) 2021; 163:1829-1836. [PMID: 33813617 PMCID: PMC8019477 DOI: 10.1007/s00701-021-04831-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/23/2021] [Indexed: 12/11/2022]
Abstract
Background The COVID-19 pandemic has led to severe containment measures to protect the population in France. The first lockdown modified daily living and could have led to a decrease in the frequency of severe traumatic brain injury (TBI). In the present study, we compared the frequency and severity of severe TBI before and during the first containment in Normandy. Methods We included all patients admitted in the intensive care unit (ICU) for severe TBI in the two tertiary neurosurgical trauma centres of Normandy during the first lockdown. The year before the containment served as control. The primary outcome was the number of patients admitted per week in ICU. We compared the demographic characteristics, TBI mechanisms, CT scan, surgical procedure, and mortality rate. Results The incidence of admissions for severe TBI in Normandy decreased by 33% during the containment. The aetiology of TBI significantly changed during the containment: there were less traffic road accidents and more TBI related to alcohol consumption. Patients with severe TBI during the containment had a better prognosis according to the impact score (p=0.04). We observed a significant decrease in the rate of short-term mortality related to severe TBI during the period of lockdown (p=0.02). Conclusions Containment related to the COVID-19 pandemic has resulted in a modification of the mechanisms of severe TBI in Normandy, which was associated with a decline in the rate of short-term death in intensive unit care.
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Affiliation(s)
- Frederick Rault
- Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Laura Terrier
- Department of Neurosurgery, Rouen University Hospital, F-76000, Rouen, France
| | - Arthur Leclerc
- Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Vianney Gilard
- Department of Neurosurgery, Rouen University Hospital, F-76000, Rouen, France
- Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Normandie Univ, UNIROUEN, INSERM U1245, F-76000, Rouen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
- PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, 14000, Caen, France
- Medical School, Université Caen Normandie, F-14000, Caen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, F-76000, Rouen, France
| | - Anaïs R Briant
- Unité de Biostatistique et Recherche Clinique (UBRC), Caen, France
| | - Clément Gakuba
- PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, 14000, Caen, France
- Medical School, Université Caen Normandie, F-14000, Caen, France
- Department of Anesthesiology and Critical Care Medicine, CHU de Caen, F-14000, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14000, Caen, France
- PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, INSERM, U1237, Cyceron, 14000, Caen, France
- Medical School, Université Caen Normandie, F-14000, Caen, France
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31
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Borha A, Gaberel T. In Reply: Cranioplasty Reverses Dysfunction of the Solutes Distribution in the Brain Parenchyma After Decompressive Craniectomy. Neurosurgery 2021; 88:E464. [PMID: 33575780 DOI: 10.1093/neuros/nyab012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alin Borha
- Normandie University UNICAEN, INSERM, U1237 PhIND "Physiopathology and Imaging of Neurological Disorders" Institut Blood and Brain @ Caen-Normandie Caen, France.,Department of Neurosurgery Caen University Hospital Caen, France
| | - Thomas Gaberel
- Normandie University UNICAEN, INSERM, U1237 PhIND "Physiopathology and Imaging of Neurological Disorders" Institut Blood and Brain @ Caen-Normandie Caen, France.,Department of Neurosurgery Caen University Hospital Caen, France
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Gaberel T. Neurochirurgie 2021: Change in the Editorial Board and novelty in the journal. Neurochirurgie 2021; 67:299-300. [PMID: 34078540 DOI: 10.1016/j.neuchi.2021.04.016] [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] [Indexed: 10/21/2022]
Affiliation(s)
- T Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France.
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Metayer T, Terrier L, de Schlichting E, Lechanoine F, Bougaci N, Derrey S, Barbier C, Papagiannaki C, Ashraf A, Tahon F, Leplus A, Naveau M, Gay E, Emery E, Lonjon M, Vivien D, Gaberel T. Rate of Rebleed and Retreatment of Previously Treated Intracranial Aneurysms. World Neurosurg 2021; 148:e650-e657. [PMID: 33497825 DOI: 10.1016/j.wneu.2021.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/15/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) can be treated through endovascular treatment (EVT) or microsurgery (MS). Treated IAs can recanalize, which can lead to rupture or retreatment. OBJECTIVE The aim of our study was to evaluate the natural history of previously treated IA, by evaluating the risk of rupture and the risk of retreatment. METHODS All patients treated for an IA between 2007 and 2017 in 4 hospitals were included. The rate of (recurrent) hemorrhage and the rate of prophylactic retreatment were retrospectively evaluated. Kaplan-Meier survival analysis with log-rank tests was used to compare the rates of rupture or retreatment. Patients with ruptured and unruptured aneurysms were separated, and we compared the risk of retreatment between EVT and the surgical treatment. RESULTS A total of 4997 IAs were included in the study, corresponding to 20,489 patient-years. Overall, 28 (0.6%) aneurysms that had been previously treated demonstrated hemorrhage. Moreover, 237 (4.7%) aneurysms were retreated for recanalization without hemorrhage. The rate of retreatment was higher in the EVT-treated IAs as compared with the MS-treated IAs (LogRank: P < 0.0001) and higher in the previously ruptured IAs versus unruptured IAs (LogRank: P < 0.0001). However, the rate of posttreatment hemorrhage/IA rupture was similar for both groups. CONCLUSIONS The rate of IA retreatment is low; however, the rate of hemorrhage/rupture from treated IAs is even lower. A higher rate of retreatment was noted in EVT-treated IAs versus MS-treated IAs and in ruptured IAs versus unruptured IAs; however, the rate of hemorrhage or rerupture was comparable between the groups.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, Cyceron, France.
| | - Laura Terrier
- Department of Neurosurgery, University Hospital, Rouen, France
| | | | | | - Nassim Bougaci
- Department of Neurosurgery, University Hospital, Nice, France
| | - Stephane Derrey
- Department of Neurosurgery, University Hospital, Rouen, France
| | - Charlotte Barbier
- Department of Neuroradiology, University Hospital of Caen, Caen, France
| | | | - Ahmad Ashraf
- Department of Neurosurgery, University Hospital, Grenoble, France
| | - Florence Tahon
- Department of Neuroradiology, University Hospital, Grenoble, France
| | - Aurelie Leplus
- Department of Neurosurgery, University Hospital, Nice, France
| | - Mikaël Naveau
- Normandie University, Cyceron, France; UMS 3408 Cyceron, CNRS, University of Caen Normandy, GIP CYCERON, Caen, France
| | - Emmanuel Gay
- Department of Neurosurgery, University Hospital, Grenoble, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Medical School, University of Caen Normandy, Caen, France
| | - Michel Lonjon
- Department of Neurosurgery, University Hospital, Nice, France
| | - Denis Vivien
- Normandie University, Cyceron, France; UMS 3408 Cyceron, CNRS, University of Caen Normandy, GIP CYCERON, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, Cyceron, France
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Gakuba C, Hanouz JL, Abadie C, Gaberel T, Braud F, Courthéoux P, Touzé E, Labeyrie PE. Cervical arterial abnormalities and outcome after aneurysmal subarachnoid haemorrhage: A pilot cohort study. Anaesth Crit Care Pain Med 2020; 39:832-836. [DOI: 10.1016/j.accpm.2020.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/21/2019] [Accepted: 03/08/2020] [Indexed: 11/25/2022]
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35
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Bernat AL, Gaberel T, Giammattei L, Rault F, Gakuba C, Magro E, Peltier C, Graillon T, Baussart B, Premat K, Clarençon F, Nouet A, Civelli V, Froelich S. Intracranial hemorrhage related to brain vascular disease and COVID-19 containment: Where are the patients? Neurochirurgie 2020; 66:400-401. [PMID: 32781087 PMCID: PMC7837176 DOI: 10.1016/j.neuchi.2020.06.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A-L Bernat
- Neurosurgical Department, Lariboisière University Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Universités de Paris, Paris, France.
| | - T Gaberel
- Neurosurgical Department, University Hospital, Caen, France
| | - L Giammattei
- Neurosurgical Department, Lariboisière University Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Universités de Paris, Paris, France
| | - F Rault
- Neurosurgical Department, University Hospital, Caen, France
| | - C Gakuba
- Anesthesiology Department, University Hospital, Caen, France
| | - E Magro
- Neurosurgical Department, University Hospital, Brest, UMR 1101 LaTIM, UBO, France
| | - C Peltier
- Neurosurgical Department, University Hospital, Brest, UMR 1101 LaTIM, UBO, France
| | - T Graillon
- Neurosurgical Department, APHM La Timone Hospital, Marseille, France
| | - B Baussart
- Neurosurgical Department, Foch Hospital, Suresnes, France
| | - K Premat
- Interventional Neuroradiology Department, La Pitié-Salpêtrière Hospital, Paris, France; Universités de Paris, Paris, France
| | - F Clarençon
- Interventional Neuroradiology Department, La Pitié-Salpêtrière Hospital, Paris, France; Universités de Paris, Paris, France
| | - A Nouet
- Neurosurgical Department, La Pitié-Salpêtrière Hospital, Paris, France; Universités de Paris, Paris, France
| | - V Civelli
- Interventional Neuroradiology Department, Lariboisière Hospital, Paris, France; Universités de Paris, Paris, France
| | - S Froelich
- Neurosurgical Department, Lariboisière University Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Universités de Paris, Paris, France
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Affiliation(s)
- Suzanne Goursaud
- Université Caen Normandie, Institut National de la Santé et de la Recherche Médicale, Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France; Deparment of Medical Intensive Care, Caen University Hospital, Caen 14000, France.
| | - Thomas Gaberel
- Université Caen Normandie, Institut National de la Santé et de la Recherche Médicale, Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France; Deparment of Medical Intensive Care, Caen University Hospital, Caen 14000, France; Department of Neurosurgery, Centre Hospitalier Universitaire de Caen, Caen, France
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37
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Frechon P, Emery E, Gaberel T. Is there an interest in performing a systematic CT scan within the first two months after chronic subdural hematoma evacuation? A ten-year single-center retrospective study. Clin Neurol Neurosurg 2020; 191:105682. [DOI: 10.1016/j.clineuro.2020.105682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/05/2020] [Accepted: 01/13/2020] [Indexed: 11/28/2022]
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38
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Borha A, Chagnot A, Goulay R, Emery E, Vivien D, Gaberel T. Cranioplasty Reverses Dysfunction of the Solutes Distribution in the Brain Parenchyma After Decompressive Craniectomy. Neurosurgery 2020; 87:1064-1069. [DOI: 10.1093/neuros/nyaa028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/28/2019] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Solutes distribution by the intracranial cerebrospinal fluid (CSF) fluxes along perivascular spaces and through interstitial fluid (ISF) play a key role in the clearance of brain metabolites, with essential functions in maintaining brain homeostasis.
Objective
To investigate the impact of decompressive craniectomy (DC) and cranioplasty (CP) on the efficacy of solutes distribution by the intracranial CSF and ISF flux.
Methods
Mice were allocated in 3 groups: sham surgery, DC, and DC followed by CP. The solutes distribution in the brain parenchyma was assessed using T1 magnetic resonance imaging after injection of DOTA-Gadolinium in the cisterna magna. This evaluation was performed at an early time point following DC (after 2 d) and at a later time point (after 15 d). We evaluated the solutes distribution in the whole brain and in the region underneath the DC area.
Results
Our results demonstrate that the global solutes distribution in the brain parenchyma is impaired after DC in mice, both at early and late time-points. However, there was no impact of DC on the solutes distribution just under the craniectomy. We then provide evidence that this impairment was reversed by CP.
Conclusion
The solute distribution in the brain parenchyma by the CSF and ISF is impaired by DC, a phenomenon reversed by CP.
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Affiliation(s)
- Alin Borha
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, France
- Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
| | - Audrey Chagnot
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, France
| | - Romain Goulay
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, France
| | - Evelyne Emery
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, France
- Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
| | - Denis Vivien
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, France
- Department of Clinical Research, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
| | - Thomas Gaberel
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Cyceron, France
- Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
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39
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Proust F, Bracard S, Thines L, Pelissou-Guyotat I, Leclerc X, Penchet G, Bergé J, Morandi X, Gauvrit JY, Mourier K, Ricolfi F, Lonjon M, Sedat J, Bataille B, Drouineau J, Civit T, Magro E, Cebula H, Chassagne P, David P, Emery E, Gaberel T, Vignes JR, Aghakani N, Troude L, Gay E, Roche PH, Irthum B, Lejeune JP. Functional outcome 1 year after aneurysmal subarachnoid hemorrhage due to ruptured intracranial aneurysm in elderly patients. Neurochirurgie 2019; 66:1-8. [PMID: 31863744 DOI: 10.1016/j.neuchi.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/28/2019] [Revised: 10/13/2019] [Accepted: 11/03/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Population aging raises questions about extending treatment indications in elderly patients with aneurysmal subarachnoid hemorrhage (aSAH). We therefore assessed functional status 1 year after treatment. METHODS This study involved 310 patients, aged over 70 years, with ruptured brain aneurysm, enrolled between 2008 and 2014 in a prospective multicentre trial (FASHE study: NCT00692744) but considered unsuitable for randomisation and therefore analysed in the observational arms of the study: endovascular occlusion (EV), microsurgical exclusion (MS) and conservative treatment. The aims were to assess independence, cognition, autonomy and quality of life (QOL) at 1 year post-treatment, using questionnaires (MMSE, ADLI, IADL, EORTC-QLQ-C30) filled in by independent nurses after discharge. RESULTS The 310 patients received the following treatments: 208 underwent EV (67.1%), 54 MS (17.4%) and 48 were conservatively managed (15.5%). At 1 year, independence rates for patients admitted with good clinical status (WFNS I-III) were, according to the aneurysm exclusion procedure (EV, MS or conservative), 58.9%, 50% and 12.1% respectively. MMSE score was pathological in 26 of the 112 EV patients (23.2%), 10 of the 25 MS patients (40%) and 4 of the 9 patients treated conservatively (44%), without any statistically significant difference [Pearson's Chi2 test, F ratio=4.29; P=0.11]. Regarding QoL, overall score was similar between the EV and MS cohorts, but significantly lower with conservative treatment. CONCLUSION Elderly patients in good clinical condition with aSAH should be treated regardless of associated comorbidities. Curative treatment (EV or MS) reduced mortality without increasing dependence, in comparison with conservative treatment.
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Affiliation(s)
- F Proust
- Department of Neurosurgery, Hautepierre Hospital, Strasbourg University Hospital, 67098, Strasbourg, France; Department of Neurosurgery, Charles-Nicolle Hospital, Rouen University Hospital, 76000, Rouen, France.
| | - S Bracard
- University Hospital, neuroradiology department, 54000 Nancy, France
| | - L Thines
- University Hospital, neurosurgery department, 25000 Besancon, France
| | | | - X Leclerc
- University Hospital, neuroradiology department, 59000 Lille, France
| | - G Penchet
- University Hospital, neurosurgery department, 33000 Bordeaux, France
| | - J Bergé
- University Hospital, neurosurgery department, 33000 Bordeaux, France
| | - X Morandi
- University Hospital, neurosurgery department, 35000 Rennes, France
| | - J-Y Gauvrit
- University Hospital, neurosurgery department, 35000 Rennes, France
| | - K Mourier
- University Hospital, neurosurgery department, 21000 Dijon, France
| | - F Ricolfi
- University Hospital, neurosurgery department, 21000 Dijon, France
| | - M Lonjon
- University Hospital, neurosurgery department, 06000 Nice, France
| | - J Sedat
- University Hospital, neurosurgery department, 06000 Nice, France
| | - B Bataille
- University Hospital, neurosurgery department, 86000 Poitiers, France
| | - J Drouineau
- University Hospital, neurosurgery department, 86000 Poitiers, France
| | - T Civit
- University Hospital, neurosurgery department, 54000 Nancy, France
| | - E Magro
- University Hospital, neurosurgery department, 29000 Brest, France
| | - H Cebula
- University Hospital, neurosurgery department, 67000 Strasbourg, France
| | - P Chassagne
- University Hospital, Geriatry department, 76000 Rouen, France
| | - P David
- Bicêtre University Hospital, neurosurgery department, 94270 Le Kremlin-Bicêtre, France
| | - E Emery
- University Hospital, neurosurgery department, 14000 Caen, France
| | - T Gaberel
- University Hospital, neurosurgery department, 14000 Caen, France
| | - J R Vignes
- University Hospital, neurosurgery department, 33000 Bordeaux, France
| | - N Aghakani
- Bicêtre University Hospital, neurosurgery department, 94270 Le Kremlin-Bicêtre, France
| | - L Troude
- University Hospital, neurosurgery department, 13000 Marseille, France
| | - E Gay
- University Hospital, neurosurgery department, 38000 Grenoble, France
| | - P H Roche
- University Hospital, neurosurgery department, 13000 Marseille, France
| | - B Irthum
- University Hospital, neurosurgery department, 63000 Clermont Ferrand, France
| | - J-P Lejeune
- Lille University Hospital, neurosurgery department, 59000 Lille, France
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- Department of Neurosurgery, Hautepierre Hospital, Strasbourg University Hospital, 67098, Strasbourg, France; Department of Neurosurgery, Charles-Nicolle Hospital, Rouen University Hospital, 76000, Rouen, France
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Abstract
Background and Purpose- Subarachnoid hemorrhage (SAH) is a devastating form of stroke. Oxidative stress contributes to brain injury, but the mechanisms have been poorly studied. Here, we evaluated the role of 12/15-lipoxygenase (12/15-LOX), an enzyme known to cause cell death in ischemic stroke, on brain injury in a mouse model of SAH. Methods- C57Bl6 wild-type mice and Alox15 knockout mice were subjected to SAH using a direct blood injection technique. In SAH wild-type mice, half received the 12/15-LOX inhibitor ML351 and half received vehicle. Immunohistochemistry, brain edema, blood-brain barrier leakage and functional outcomes were assessed 1 and 3 days after SAH induction. Results- SAH led to increased 12/15-LOX in macrophages of the brain parenchyma, adjacent to the subarachnoid blood. Neuronal cell death after SAH was reduced by ML351 and in Alox15 knockout mice. Similarly, SAH induced brain edema, which was 12/15-LOX dependent. Finally, Alox15 gene knockout and inhibitor treatment in wild-type mice with SAH led to an improved behavioral outcome. Conclusions- 12/15-LOX is overexpressed in macrophages after SAH in mice, and inhibition of the 12/15-LOX pathway decreases brain injury and improves neurological outcome. This study suggests 12/15-LOX as a novel therapeutic target to limit brain injury after SAH.
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Affiliation(s)
- Thomas Gaberel
- From the Neuroprotection Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA (T.G., C.G., Y.Z., E.H.L., K.v.L.).,Department of Neurosurgery (T.G.), Caen University Hospital, Avenue de la côte de Nacre, France
| | - Clément Gakuba
- From the Neuroprotection Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA (T.G., C.G., Y.Z., E.H.L., K.v.L.).,Department of Anesthesiology and Critical Care Medicine (C.G.), Caen University Hospital, Avenue de la côte de Nacre, France
| | - Yi Zheng
- From the Neuroprotection Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA (T.G., C.G., Y.Z., E.H.L., K.v.L.)
| | - Matthieu Lépine
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, France (M.L.)
| | - Eng H Lo
- From the Neuroprotection Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA (T.G., C.G., Y.Z., E.H.L., K.v.L.)
| | - Klaus van Leyen
- From the Neuroprotection Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA (T.G., C.G., Y.Z., E.H.L., K.v.L.)
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Berro DH, L'Allinec V, Pasco-Papon A, Emery E, Berro M, Barbier C, Fournier HD, Gaberel T. Clip-first policy versus coil-first policy for the exclusion of middle cerebral artery aneurysms. J Neurosurg 2019; 133:1-8. [PMID: 31597117 DOI: 10.3171/2019.5.jns19373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/11/2019] [Accepted: 05/07/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Middle cerebral artery (MCA) aneurysms are a particular subset of intracranial aneurysms that can be excluded by clipping or coiling. A comparison of the results between these two methods is often limited by a selection bias in which wide-neck and large aneurysms are frequently treated with surgery. Here, the authors report the results of two centers using opposing policies in the management of MCA aneurysms: one center used a clip-first policy while the other used a coil-first policy, which limited the selection bias and ensured a good comparison of these two treatment modalities. METHODS All patients treated for either ruptured or unruptured MCA aneurysms at one of two institutions between January 2012 and December 2015 were eligible for inclusion in this study. At one center a clip-first policy was applied, whereas the other applied a coil-first policy. The authors retrospectively reviewed the medical records of these patients and compared their clinical and radiological outcomes. RESULTS A total of 187 aneurysms were treated during the inclusion period; 88 aneurysms were treated by coiling and 99 aneurysms by clipping. The baseline patient and radiological characteristics were similar between the two groups, but the clinical presentation of the ruptured aneurysm cohort differed slightly. In the ruptured cohort (n = 90), although patients in the coiling group had a higher rate of additional surgery, the complication rate, functional outcome, and risk of death were similar between the two treatment groups. In the unruptured cohort (n = 97), the complication rate, functional outcome, and risk of death were also similar between the two treatment groups, although the risk of discomfort related to the temporal muscle atrophy was higher in the surgical group. Overall, the rate of complete occlusion was higher in the clipping group (84.2%) than in the coiling group (31%), which led to a higher risk in the coiling group of aneurysm retreatment within the first 2 years (p = 0.04). CONCLUSIONS Clipping and coiling for MCA aneurysm treatment provide the same clinical outcome for ruptured and unruptured aneurysms. However, clipping provides higher short- and long-term rates of complete exclusion, which in turn decreases the risk of aneurysm retreatment. Whether this lower occlusion rate can have a clinical impact in the long-term must be further evaluated.
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Affiliation(s)
- David Hassanein Berro
- 1CHU de Caen, Department of Neurosurgery, Caen
- 2Université Caen Normandie, Medical School, Caen
- 3Normandie Université, UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP Cyceron, Caen
| | | | | | - Evelyne Emery
- 1CHU de Caen, Department of Neurosurgery, Caen
- 2Université Caen Normandie, Medical School, Caen
- 5INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen
| | - Mada Berro
- 2Université Caen Normandie, Medical School, Caen
- 6CHU de Caen, Department of Neurology, Caen
| | | | | | - Thomas Gaberel
- 1CHU de Caen, Department of Neurosurgery, Caen
- 2Université Caen Normandie, Medical School, Caen
- 5INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen
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Luong CQ, Nguyen AD, Nguyen CV, Mai TD, Nguyen TA, Do SN, Dao PV, Pham HTM, Pham DT, Ngo HM, Nguyen QH, Nguyen DT, Tran TH, Le KV, Do NT, Ngo ND, Nguyen VD, Ngo HD, Hoang HB, Vu HV, Vu LT, Ngo BT, Nguyen BX, Khuong DQ, Nguyen DT, Vuong TX, Be TH, Gaberel T, Nguyen LV. Effectiveness of Combined External Ventricular Drainage with Intraventricular Fibrinolysis for the Treatment of Intraventricular Haemorrhage with Acute Obstructive Hydrocephalus. Cerebrovasc Dis Extra 2019; 9:77-89. [PMID: 31408859 PMCID: PMC6751468 DOI: 10.1159/000501530] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intraventricular haemorrhage (IVH) patients with acute obstructive hydrocephalus (AOH) who require external ventricular drainage (EVD) are at high risk for poor outcomes. Intraventricular fibrinolysis (IVF) with low-dose recombinant tissue plasminogen activator (rtPA) can be used to improve patient outcomes. Here, we evaluated the impact of IVF on the risk of death and the functional outcomes in IVH patients with AOH. METHODS This prospective cohort study included IVH patients with hypertensive intracranial haemorrhage complicated by AOH who required EVD. We evaluated the risk of death and the functional outcomes at 1 and 3 months, with a specific focus on the impact of combined EVD with IVF by low-dose rtPA. RESULTS Between November 30, 2011 and December 30, 2014, 80 patients were included. Forty-five patients were treated with EVD alone (EVD group) and 35 received IVF (EVD+IVF group). The 30- and 90-day mortality rates were lower in the EVD+IVF group than in the EVD group (42.2 vs. 11.4%, p = 0.003, and 62.2 vs. 20%, p < 0.001, respectively). The Graeb scores were significantly lower in the EVD+IVF group than in the EVD group (p ≤ 0.001) during the first 3 days and on day 7 after assignment. The 30-day good functional outcome (modified Rankin Scale [mRS] score 0-3) was also higher in the EVD+IVF group than in the EVD group (6.7 vs. 28.6%, p = 0.008). However, the 90-day good functional outcome (mRS score 0-3) did not significantly increase in the EVD+IVF group (30.8% in the EVD group vs. 51.6% in the EVD+IVF group, p = 0.112). CONCLUSIONS In our prospective observational study, EVD+IVF was associated with a lower risk of death in IVH patients. EVD+IVF improved the chance of having a good functional outcome at 1 month; however, this result was no longer observed at 3 months.
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Affiliation(s)
- Chinh Quoc Luong
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam, .,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam,
| | - Anh Dat Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Chi Van Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Ton Duy Mai
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Son Ngoc Do
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | | | - Hanh Thi My Pham
- Epidemiology Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Dung Thi Pham
- Department of Science Management, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hung Manh Ngo
- Department of Neurosurgery II, Viet Duc Hospital, Hanoi, Vietnam
| | - Quan Huu Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | | | - Thong Huu Tran
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Ky Van Le
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Nam Trong Do
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Ngoc Duc Ngo
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | | | - Hung Duc Ngo
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Bui Hoang
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ha Viet Vu
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Lan Tuong Vu
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Binh Thanh Ngo
- Undergraduate Training and Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Bai Xuan Nguyen
- Department of Postgraduate Management, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | | | | | - Thu Hong Be
- Poison Control Centre, Bach Mai Hospital, Hanoi, Vietnam
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France.,Department of Neurosurgery, University of Caen Normandy, Caen, France
| | - Lieu Van Nguyen
- Department of Neurology, Bach Mai Hospital, Hanoi, Vietnam.,Department of Neurology, Hanoi Medical University, Hanoi, Vietnam
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Metayer T, Emery E, Ismail M, Gaberel T. Vertebral artery dissection associated with PICA aneurysm: PICA-PICA bypass technique. Neurochirurgie 2019; 65:427-429. [PMID: 31280900 DOI: 10.1016/j.neuchi.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/26/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- T Metayer
- Department of Neurosurgery, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen, France; UNICAEN, Inserm, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Normandie université, 14000 Caen, France.
| | - E Emery
- Department of Neurosurgery, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen, France; UNICAEN, Inserm, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Normandie université, 14000 Caen, France
| | - M Ismail
- Department of Radiology, University Hospital of Caen Normandy, 14000 Caen, France
| | - T Gaberel
- Department of Neurosurgery, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen, France; UNICAEN, Inserm, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Normandie université, 14000 Caen, France
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Metayer T, Emery E, Cogez J, Barbier C, Gaberel T. Entrapment of the basilar artery within a clivus fracture: Case report and literature review. Neurochirurgie 2019; 65:191-194. [PMID: 31095942 DOI: 10.1016/j.neuchi.2019.03.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/28/2018] [Revised: 01/06/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
A review of the literature revealed that basilar artery (BA) entrapment is a very rare (17 cases published) and severe pathological condition, which often leads to death. We report the case of a 72-year-old man who presented with a longitudinal clivus fracture associated with a basilar artery entrapment. This entrapment was responsible for a basilar artery dissection, which led to an ischemic stroke in the pons. The patient was managed with medical treatment, mainly to avoid a progression towards an ischemic stroke. It consisted of heparin therapy followed by antiplatelet therapy, which finally resulted in a successful outcome. In BA entrapment most of the patients who had a favorable outcome received antithrombotic therapy. This suggests that antithrombotic therapy might be useful in the first line treatment of post-traumatic BA entrapment.
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Affiliation(s)
- T Metayer
- Department of Neurosurgery, Caen University hospital Normandy, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - E Emery
- Department of Neurosurgery, Caen University hospital Normandy, avenue de la Côte-de-Nacre, 14000 Caen, France; UNICAEN, Inserm, UMR-S U1237, Normandie Université, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
| | - J Cogez
- Department of Neurology, Caen University hospital Normandy, 14000 Caen, France
| | - C Barbier
- Department of Radiology, Caen University hospital Normandy, 14000 Caen, France
| | - T Gaberel
- Department of Neurosurgery, Caen University hospital Normandy, avenue de la Côte-de-Nacre, 14000 Caen, France; UNICAEN, Inserm, UMR-S U1237, Normandie Université, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
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45
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Bretonnier M, Hénaux PL, Gaberel T, Roualdes V, Kerdiles G, Le Reste PJ, Morandi X. Spinal Dural Arteriovenous Fistulas: Clinical Outcome After Surgery Versus Embolization: A Retrospective Study. World Neurosurg 2019; 127:e943-e949. [PMID: 30974280 DOI: 10.1016/j.wneu.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/13/2019] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular spinal malformations. According to the reported data, surgery seems to result in better occlusion rates than endovascular treatment. However, the post-treatment evolution of neurological symptoms stratified by the treatment remains unknown. The main objective of the present study was to compare the clinical outcomes for patients according to the treatment method. METHODS The data from 63 patients with SDAVFs from 2000 to 2017 at 4 academic neurosurgical departments were retrospectively analyzed. Preoperative and postoperative examination neurological status was assessed using the Aminoff-Logue scale (ALS), which evaluates gait and micturition disturbances. Initial occlusion, late recurrence, and complications of the 2 techniques were also reviewed. RESULTS Patients who had undergone surgery and embolization improved clinically on the ALS (P = 0.0009), and no significant differences were found between the 2 techniques. Subgroup analysis using the ALS showed that patients who had undergone surgery and embolization without late recurrence improved (P < 0.0001 and P = 0.0334, respectively) and that patients who had undergone surgery or embolization with late recurrence did not improve. The initial occlusion rate was in favor of surgery, with 91.3% versus 70% for endovascular treatment (P = 0.050). The late recurrence rate was higher for embolization (21.4% vs. 9.1% for surgery; P = 0.28). CONCLUSIONS Surgery can be proposed as first-line treatment of SDAVFs after multidisciplinary discussion between neurosurgeons and neuroradiologists. The development of late recurrence negatively affects the neurological outcome of patients.
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Affiliation(s)
- Maxime Bretonnier
- Department of Neurosurgery, Rennes University Hospital, Rennes, France; University of Rennes, University Hospital of Rennes, French National Institute of Health and Medical Research, Rennes, France.
| | - Pierre-Louis Hénaux
- Department of Neurosurgery, Rennes University Hospital, Rennes, France; University of Rennes, University Hospital of Rennes, French National Institute of Health and Medical Research, Rennes, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Vincent Roualdes
- Department of Neurosurgery, Nord Laennec, Nantes University Hospital, Saint-Herblain, France
| | - Gaelle Kerdiles
- Department of Neurosurgery, Tours University Hospital, Tours, France
| | | | - Xavier Morandi
- Department of Neurosurgery, Rennes University Hospital, Rennes, France; University of Rennes, University Hospital of Rennes, French National Institute of Health and Medical Research, Rennes, France
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46
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Gaberel T, Gakuba C, Fournel F, Le Blanc E, Gaillard C, Peyro-Saint-Paul L, Chaillot F, Tanguy P, Parienti JJ, Emery E. FIVHeMA: Intraventricular fibrinolysis versus external ventricular drainage alone in aneurysmal subarachnoid hemorrhage: A randomized controlled trial. Neurochirurgie 2019; 65:14-19. [PMID: 30638547 DOI: 10.1016/j.neuchi.2018.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/18/2018] [Revised: 10/17/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (SAH) is a devastating form of stroke, which often causes acute hydrocephalus requiring the insertion of an external ventricular drain (EVD). A major complication of aneurysmal SAH is delayed cerebral ischemia (DCI). As DCI is linked to the presence of blood within the subarachnoid space, it has been hypothesized that removing this blood may decrease the risk of DCI. This could be achieved by injecting a fibrinolytic agent through the EVD, a strategy called intraventricular fibrinolysis (IVF). Here, we propose to conduct a phase III trial to directly evaluate the impact of IVF after aneurysmal SAH. MATERIALS AND METHODS We will perform an open-label randomized controlled trial comparing the standard of care, i.e. EVD alone, to the experimental treatment, i.e. IVF. We plan to include 440 patients to be able to show a 10% increase in the rate of good functional outcomes in the EVD+IVF group compared to the EVD alone group (α=0.05 and β=0.8). To obtain such sample, a multicenter trial is required, and to date 17 research sites in France have agreed to participate. PERSPECTIVE FIVHeMA would be the first phase III trial evaluating the relevance of IVF in aneurysmal SAH. If IVF is shown to be beneficial, then a new therapeutic tool will be available to improve the outcomes of aneurysmal SAH patients.
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Affiliation(s)
- T Gaberel
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Inserm U1237 'physiopathology & imaging of neurological disorders', university of Caen Normandy, 14000 Caen, 14000, France; Université Caen Normandie, Medical School, 14000 Caen, France.
| | - C Gakuba
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Inserm U1237 'physiopathology & imaging of neurological disorders', university of Caen Normandy, 14000 Caen, 14000, France; Department of intensive care medicine, CHU de Caen, 14000 Caen, France
| | - F Fournel
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - E Le Blanc
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - C Gaillard
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | | | - F Chaillot
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - P Tanguy
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Université Caen Normandie, Medical School, 14000 Caen, France
| | - J-J Parienti
- Department of clinical research, CHU de Caen, 14000 Caen, France
| | - E Emery
- Department of neurosurgery, CHU de Caen, 14000 Caen, France; Inserm U1237 'physiopathology & imaging of neurological disorders', university of Caen Normandy, 14000 Caen, 14000, France; Université Caen Normandie, Medical School, 14000 Caen, France
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47
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Goulay R, Aron Badin R, Flament J, Emery E, Hantraye P, Vivien D, Gaberel T. Cerebrospinal fluid leakage after posterior fossa surgery may impair brain metabolite clearance. Neurochirurgie 2018; 64:422-424. [PMID: 30477647 DOI: 10.1016/j.neuchi.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/19/2018] [Revised: 06/14/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
The discovery of the important role of cerebrospinal fluid (CSF) drainage of cerebral metabolite waste, known as the glymphatic system, has changed our view of brain waste clearance. We recently performed experiments to evaluate the glymphatic system in non-human primates (NHP). Here, we report the case of an NHP with iatrogenic CSF leakage. In this animal, solute transport through the brain, assessed by gadolinium injection in the CSF, was severely impaired by iatrogenic pseudomeningocele. This observation raises an important question: does brain surgery, and particularly posterior fossa surgery, lead to chronic impairment of parenchymal CSF circulation and solute transport?
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Affiliation(s)
- R Goulay
- Inserm U1237 'Physiopathology & Imaging of Neurological Disorders', university of Caen Normandy, 14000 Caen, France
| | - R Aron Badin
- Molecular imaging research center (MIRCen), institut de biologie François Jacob, direction de la recherche fondamentale (DRF), commissariat à l'énergie atomique (CEA), 92260 Fontenay-aux-Roses, France; Institut national de la santé et de la recherche médicale (Inserm), UMS 27, 92260 Fontenay-aux-Roses, France
| | - J Flament
- Molecular imaging research center (MIRCen), institut de biologie François Jacob, direction de la recherche fondamentale (DRF), commissariat à l'énergie atomique (CEA), 92260 Fontenay-aux-Roses, France; Institut national de la santé et de la recherche médicale (Inserm), UMS 27, 92260 Fontenay-aux-Roses, France
| | - E Emery
- Inserm U1237 'Physiopathology & Imaging of Neurological Disorders', university of Caen Normandy, 14000 Caen, France; Department of neurosurgery, Caen university hospital, avenue de la Côte de Nacre, 14000 Caen, France; Université Caen Normandie, medical school, Caen, France
| | - P Hantraye
- Molecular imaging research center (MIRCen), institut de biologie François Jacob, direction de la recherche fondamentale (DRF), commissariat à l'énergie atomique (CEA), 92260 Fontenay-aux-Roses, France; Institut national de la santé et de la recherche médicale (Inserm), UMS 27, 92260 Fontenay-aux-Roses, France
| | - D Vivien
- Inserm U1237 'Physiopathology & Imaging of Neurological Disorders', university of Caen Normandy, 14000 Caen, France; Department of clinical research, Caen university hospital, avenue de la Côte de Nacre, 14000 Caen, France; Université Caen Normandie, medical school, Caen, France
| | - T Gaberel
- Inserm U1237 'Physiopathology & Imaging of Neurological Disorders', university of Caen Normandy, 14000 Caen, France; Department of neurosurgery, Caen university hospital, avenue de la Côte de Nacre, 14000 Caen, France; Université Caen Normandie, medical school, Caen, France.
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Di Palma C, Goulay R, Chagnot S, Martinez De Lizarrondo S, Anfray A, Salaun JP, Maubert E, Lechapt-Zalcman E, Andreiuolo F, Gakuba C, Emery E, Vivien D, Gauberti M, Gaberel T. Cerebrospinal fluid flow increases from newborn to adult stages. Dev Neurobiol 2018; 78:851-858. [PMID: 30027587 DOI: 10.1002/dneu.22622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/14/2017] [Revised: 06/07/2018] [Accepted: 06/10/2018] [Indexed: 11/08/2022]
Abstract
Solute transport through the brain is of major importance for the clearance of toxic molecules and metabolites, and it plays key roles in the pathophysiology of the central nervous system. This solute transport notably depends on the cerebrospinal fluid (CSF) flow, which circulates in the subarachnoid spaces, the ventricles and the perivascular spaces. We hypothesized that the CSF flow may be different in the perinatal period compared to the adult period. Using in vivo magnetic resonance imaging (MRI) and near-infrared fluorescence imaging (NIRF), we assessed the dynamic of the CSF flow in rodents at different ages. By injecting a contrast agent into the CSF, we first used MRI to demonstrate that CSF flow gradually increases with age, with the adult pattern observed at P90. This observation was confirmed by NIRF, which revealed an increased CSF flow in P90 rats when compared with P4 rats not only at the surface of the brain but also deep in the brain structures. Lastly, we evaluated the exit routes of the CSF from the brain. We demonstrated that indocyanine green injected directly into the striatum spread throughout the parenchyma in adult rats, whereas it stayed at the injection point in P4 rats. Moreover, the ability of CSF to exit through the nasal mucosa was increased in the adult rodents. Our results provide evidence that the perinatal brain has nonoptimal CSF flow and exit and, thus, may have impaired clean-up capacity. © 2018 Wiley Periodicals, Inc. Develop Neurobiol, 2018.
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Affiliation(s)
- Camille Di Palma
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France.,CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France
| | - Romain Goulay
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France
| | - Sebastien Chagnot
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France
| | - Sara Martinez De Lizarrondo
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France
| | - Antoine Anfray
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France
| | - Jean-Philippe Salaun
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France.,CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France
| | - Eric Maubert
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France
| | - Emmanuèle Lechapt-Zalcman
- CHU Caen, Department of Pathology, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France.,Department of Neuropathology, Sainte-Anne Hospital, rue Cabanis, Paris, 75674, France
| | - Felipe Andreiuolo
- CHU Caen, Department of Clinical Research, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France
| | - Clément Gakuba
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France.,CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France
| | - Evelyne Emery
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France.,CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France
| | - Denis Vivien
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France.,CHU Caen, Department of Clinical Research, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France
| | - Maxime Gauberti
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France
| | - Thomas Gaberel
- Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, Caen, 14000, France.,CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, Caen, 14033, France
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Abstract
Intracerebral hemorrhage (ICH) is the most severe form of stroke. Catheter-delivered thrombolysis with recombinant tissue-type plasminogen activator (rtPA) for the drainage of ICH is currently under evaluation in a phase III clinical trial (MISTIE III). However, in a pig model of ICH, in situ fibrinolysis with rtPA was reported to increase peri-lesional edema by promoting N-methyl-D-aspartate (NMDA)-dependent excitotoxicity. In the present study, we engineered a non-neurotoxic tPA variant, OptPA, and investigated its safety and efficacy for in situ fibrinolysis in a rat model of ICH. Magnetic resonance imaging analyses of hematoma and edema volumes, behavioral tasks and histological analyses were performed to measure the effects of treatments. In vitro, OptPA was equally fibrinolytic as rtPA without promoting NMDA-dependent neurotoxicity. In vivo, in situ fibrinolysis using OptPA reduced hematoma volume, like rtPA, but it also reduced the evolution of peri-hematomal neuronal death and subsequent edema progression. Overall, this preclinical study demonstrates beneficial effects of OptPA compared to rtPA for the drainage of ICH.
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Affiliation(s)
- Romain Goulay
- UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Normandie University, Caen, France
| | - Mikaël Naveau
- UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Normandie University, Caen, France
| | - Thomas Gaberel
- UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Normandie University, Caen, France
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Denis Vivien
- UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Normandie University, Caen, France
- Department of Clinical Research, Caen University Hospital, Caen, France
- Denis Vivien, UMR-S INSERM UMR-S U1237 “Physiopathology and Imaging of Neurological Disorders” (PhIND), Caen Normandy University, GIP CYCERON, Bd Becquerel, BP 5229, Caen 14074, France.
| | - Jérôme Parcq
- UNICAEN, INSERM, Serine Proteases and Pathophysiology of the Neurovascular Unit, Normandie University, Caen, France
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50
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Metayer T, Emery E, Gaberel T, Proust F, Gilard V. Hémorragies intraventriculaires secondaires à la rupture d’un angiome cérébral : description, suivis et impact de la fibrinolyse. Neurochirurgie 2018. [DOI: 10.1016/j.neuchi.2018.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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