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Beuriat PA, Flaus A, Portefaix A, Szathmari A, Janier M, Hermier M, Lorthois-Ninou S, Scheiber C, Isal S, Costes N, Merida I, Lancelot S, Vasiljevic A, Leblond P, Faure Conter C, Saunier C, Kassai B, Vinchon M, Di Rocco F, Mottolese C. Preoperative 11 C-Methionine PET-MRI in Pediatric Infratentorial Tumors. Clin Nucl Med 2024; 49:381-386. [PMID: 38498623 DOI: 10.1097/rlu.0000000000005174] [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] [Indexed: 03/20/2024]
Abstract
PURPOSE MRI is the main imaging modality for pediatric brain tumors, but amino acid PET can provide additional information. Simultaneous PET-MRI acquisition allows to fully assess the tumor and lower the radiation exposure. Although symptomatic posterior fossa tumors are typically resected, the patient management is evolving and will benefit from an improved preoperative tumor characterization. We aimed to explore, in children with newly diagnosed posterior fossa tumor, the complementarity of the information provided by amino acid PET and MRI parameters and the correlation to histopathological results. PATIENTS AND METHODS Children with a newly diagnosed posterior fossa tumor prospectively underwent a preoperative 11 C-methionine (MET) PET-MRI. Images were assessed visually and semiquantitatively. Using correlation, minimum apparent diffusion coefficient (ADC min ) and contrast enhancement were compared with MET SUV max . The diameter of the enhancing lesions was compared with metabolic tumoral volume. Lesions were classified according to the 2021 World Health Organization (WHO) classification. RESULTS Ten children were included 4 pilocytic astrocytomas, 2 medulloblastomas, 1 ganglioglioma, 1 central nervous system embryonal tumor, and 1 schwannoma. All lesions showed visually increased MET uptake. A negative moderate correlation was found between ADC min and SUV max values ( r = -0.39). Mean SUV max was 3.8 (range, 3.3-4.2) in WHO grade 4 versus 2.5 (range, 1.7-3.0) in WHO grade 1 lesions. A positive moderate correlation was found between metabolic tumoral volume and diameter values ( r = 0.34). There was no correlation between SUV max and contrast enhancement intensity ( r = -0.15). CONCLUSIONS Preoperative 11 C-MET PET and MRI could provide complementary information to characterize pediatric infratentorial tumors.
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Affiliation(s)
| | | | | | - Alexandru Szathmari
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Marc Hermier
- Department of Neuroradiology, Hôpital Neurologique et Neurochirurgical P. Wertheimer, Hospices Civils de Lyon
| | - Sylvie Lorthois-Ninou
- Department of Pediatric Radiology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Sibel Isal
- Department of Nuclear Medicine, Hospices Civils de Lyon
| | | | | | | | | | - Pierre Leblond
- Institut d'Hématologie et d'Oncologie Pédiatrique (IHOPe), Centre Léon Bérard, Lyon, France
| | - Cécile Faure Conter
- Institut d'Hématologie et d'Oncologie Pédiatrique (IHOPe), Centre Léon Bérard, Lyon, France
| | - Clarisse Saunier
- EPICIME-CIC 1407 de Lyon, Inserm, Département d'Épidémiologie Clinique, Hospices Civils de Lyon
| | | | - Matthieu Vinchon
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
| | | | - Carmine Mottolese
- From the Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon
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de Laurentis C, Pasquali C, Beuriat PA, Mottolese C, Szathmari A, Vinchon M, Di Rocco F. Role of sodium fluorescein in pediatric low-grade glioma surgery: an update. Childs Nerv Syst 2024:10.1007/s00381-024-06402-y. [PMID: 38662222 DOI: 10.1007/s00381-024-06402-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Complete surgical resection is still the mainstay in the treatment of central nervous system low-grade tumors, eventually resulting curative. The complete surgical removal of these lesions, however, may be difficult in some cases because of their infiltrative nature. Intraoperative adjuncts may be a game changer. Sodium fluorescein (SF) is among the ideal candidates as intraoperative tools to favor the actual recognition of the tumor extension, since it accumulates in areas of altered blood-brain barrier, a typical characteristic of pediatric gliomas, and has a low rate of adverse events. This work proposes an update of previous works about the evaluation of the feasibility and usefulness of a systematic use of SF in a low-grade lesion group of pediatric patients. METHODS Pediatric patients operated on for a resection or a biopsy of a low-grade glial or glioneuronal lesion (WHO grade I and II) at our Institution between September 2021 and December 2023, with the intraoperative use of sodium fluorescein (SF), were enrolled in the study. We collected pre-operative and postoperative clinical and radiological data, intraoperative findings, and post-operative pathological diagnoses. RESULTS No adverse events were registered related to the intraoperative use of SF. SF appeared useful for the localization of boundaries of tumors, especially when characterized by a high degree of infiltration or by a deep-seated location, and for the checking of possible tumor remnants at the end of surgery. A good tumor-to-healthy tissue contrast was registered when tumor visualization was in a range between 1 to 2 h and 30 min after SF injection. Possible "false positives" due to intraoperative vascular wall injury and clearance of SF from both tumor and healthy tissue were observed in some cases and still remain open issues. CONCLUSIONS SF is a feasible and safe intraoperative adjunct tool in the surgical removal of pediatric low-grade tumors. SF may show its usefulness especially in selected cases, such as deep-seated lesions and infiltrating tumors. Its safety profile, user-friendly management, and potential utility in both tumor resections and neuronavigated biopsies favor its wider use in the surgical treatment of pediatric low-grade tumors.
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Affiliation(s)
- Camilla de Laurentis
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
- Functional Neurosurgery Unit, Hôpital Pierre Wertheimer, Lyon, France
| | - Claudia Pasquali
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - Pierre-Aurélien Beuriat
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
- Functional Neurosurgery Unit, Hôpital Pierre Wertheimer, Lyon, France
- Department of Medicine and Surgery, Université Claude Bernard, Lyon 1, Lyon, France
| | - Carmine Mottolese
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - Alexandru Szathmari
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
- Functional Neurosurgery Unit, Hôpital Pierre Wertheimer, Lyon, France
| | - Matthieu Vinchon
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - Federico Di Rocco
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France.
- Department of Medicine and Surgery, Université Claude Bernard, Lyon 1, Lyon, France.
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Szathmari A, Vasiljevic A, Di Rocco F, Beuriat PA, Mottolese C. Pineal cysts in children: a paediatric series treated over the last twenty years in Lyon. Childs Nerv Syst 2023; 39:3467-3474. [PMID: 37898987 DOI: 10.1007/s00381-023-06181-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Pineal cysts are a rare lesion of the pineal gland. Pineal cysts are benign lesions, generally asymptomatic, and are usually an incidental discovery on MRI performed for other problems. The management of pineal cysts in children remains a matter for debate. Here, we report our own retrospective paediatric cases that have been surgically treated and review the paediatric literature on this topic. METHODS This is a retrospective monocentric study. All patients operated by the senior author (CM) for a benign pineal cyst from 2000 to 2021 were included. All other pineal region cystic lesions were excluded. Medical and surgical data were extracted from the hospital medical database. RESULTS Twelve patients were included. The clinical symptomatology was characterized by headaches in seven patients, visual troubles in two patients, precocious puberty in one patient, signs of intracranial hypertension in two patients, seizures associated with headache in one patient, and headaches associated with behavioural troubles in another patient. No major post-operative complications were observed in this series. It is to noted that surgery was performed because a suspicion of a true pineal parenchymal tumour has been made. Histopathological study came back with the diagnosis of pineal cyst. CONCLUSIONS Pineal cyst is rare. If the radiological diagnosis is clear, no surgery is advocated except in cases associated with hydrocephalus and rapid growth. In case of a suspicion of a true pineal parenchymal tumour, a surgery may be needed to confirm the diagnosis. Lastly, we stress that only cystic lesions of the pineal gland itself should be considered as pineal cyst.
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Affiliation(s)
- Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, GHE, Hospices Civils de Lyon, 69500, Bron, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France.
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Beuriat PA, Szathmari A, Di Rocco F, Mottolese C. The sub-occipital transtentorial approach for pineal region tumors: how I do it. Acta Neurochir (Wien) 2023; 165:3461-3465. [PMID: 37743435 DOI: 10.1007/s00701-023-05813-1] [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: 04/15/2023] [Accepted: 07/31/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Two major approaches exist for the surgical removal of pineal region tumors: the supracebellar infratentorial and the sub-occipital transtentorial. METHODS We present the Lyon's technique of the sub-occipital transtentorial approach for pineal region tumors and our tricks to avoid complications. The principle is to expose the pineal region under the occipital lobe and not through the interhemispheric fissure. CONCLUSIONS The sub-occipital transtentorial approach is a direct, extra cerebral, safe, and effective way to access tumors of the pineal region.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France.
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France.
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France
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Boukaka RG, Beuriat PA, Di Rocco F, Vasiljevic A, Szathmari A, Mottolese C. Brainstem tumors in children: a monocentric series in the light of genetic and bio-molecular progress in pediatric neuro-oncology. Front Pediatr 2023; 11:1193474. [PMID: 37936887 PMCID: PMC10626527 DOI: 10.3389/fped.2023.1193474] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Brainstem tumors represent a challenge. Their management and prognosis vary according to anatomopathological findings and genetic and bio-molecular fingerprints. We present our experience with pediatric brainstem tumors. Material and methods All patients admitted for a brainstem tumor at the Pediatric Neurosurgical Unit at Hôpital Femme Mère Enfant hospital between January 1997 and December 2019 were considered. Patients data were obtained through a retrospective review of the medical records; follow-up was from the last outpatient consultation. Results One hundred and twelve patients were included. Eighty-five patients (75.9%) had open surgery or stereotactic biopsy. Thirty-five patients were treated for hydrocephalus. Sixty-six received an adjuvant treatment. Several protocols were adopted according to the SFOP and SIOP during this time period. The overall survival rate was 45% with a median follow-up of five years (range 1-18 year). However, the survival rate was very different between the diffuse intrinsic pontine gliomas (DIPG) and the others tumor types. If we exclude the DIPG (59 patients), of which only 1 was alive at 3 years, the survival rate was 90.6% (only 5 deaths over 53 patients) with a median follow up of 5 years. Conclusions Our series confirms that benign tumors of the brainstem have a good survival when treated with surgical removal ± adjuvant therapy. Diffuse pontine gliomas continue to have a dismal prognosis. Individualized treatment based on molecular fingerprints may help to select the best adjuvant therapy and hence potentially improve survival.
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Affiliation(s)
- Rel Gerald Boukaka
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de, Lyon, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de, Lyon, France
- Université Claude Bernard, Lyon 1, Lyon, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de, Lyon, France
- Université Claude Bernard, Lyon 1, Lyon, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de, Lyon, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de, Lyon, France
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Szathmari A, Beuriat PA, Vasiljevic A, Leblond P, Faure-Conter C, Claude L, Di Rocco F, Mottolese C. Results of the treatment of pineal tumors in children: the Lyon experience. Childs Nerv Syst 2023; 39:2317-2327. [PMID: 36242638 DOI: 10.1007/s00381-022-05649-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Pineal tumors are rare and their incidence is of 1% among all pediatric tumors of the central nervous system. Patient survival depends on the histology, the extension of the surgical removal, and the efficacy of the complementary treatment (chemotherapy and cranio-spinal irradiation), as well as the age of the patient. MATERIALS AND METHODS In this study, we analyzed 151 pediatric patients treated for pineal tumors from 1997 to 2020 in Lyon, France. All patients were recorded in the French Register of Pineal tumors, which has been centralized and maintained in Lyon since 2010. RESULTS Our analysis shows that benign tumors have an overall positive prognosis with total surgical removal. Concerning pineal parenchymal tumors, pinealoblastomas have a poor prognosis , especially in children less than three years old. A new pathological classification system allows for a better stratification of patient risk within different groups of patients with pineal tumors. It is also important to note that the identification of DICER 1 syndrome in families with pinealoblastomas warrant further medical investigation. Patients with Germ Cell Tumors have more favorable outcomes, with a global survival rate of 87 % and a pure germinoma survival rate of almost 97%. When analyzing the prognosis of pineal gland gliomas, otherwise known as tectal plate gliomas, pilocytic astrocytomas had a promising prognosis. Otherwise, prognosis of other tectal plate gliomas are related to the grade of malignancy and the efficacy of complementary treatment. Lastly, papillary tumors need a complete removal for the best chance of survival, and Atypical teratoid/ rabdoid tumors (AT/TR) still have a bad prognosis, regardless of surgical resection. CONCLUSIONS Our results show that, with regards to pediatric pineal region tumors, there are still areas in prognostic indicators that need to be improved. Similarly, these pathologies need to be treated via a multidisciplinary approach to improve a patient's survival rate and their quality of life.
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Affiliation(s)
- Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69500, Hospices Civils de LyonBron, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69500, Hospices Civils de LyonBron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, GHE, Hospices Civils de Lyon, 69500, Bron, France
| | - Pierre Leblond
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008, Lyon, France
| | - Cécile Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008, Lyon, France
| | - Line Claude
- Department of Radiotherapy, Centre Léon Bérard, 69008, Lyon, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69500, Hospices Civils de LyonBron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69500, Hospices Civils de LyonBron, France.
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Boukaka RG, Szathmari A, Di Rocco F, Leblond P, Faure-Conter C, Claude L, Vasiljevic A, Beuriat PA, Mottolese C. Posterior fossa ependymoma in children: A long-term single-center experience. Neurochirurgie 2023; 69:101459. [PMID: 37295279 DOI: 10.1016/j.neuchi.2023.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Ependymomas in the posterior fossa have poor prognosis. This study reports a single-center pediatric series, focusing on the value of surgical resection. MATERIAL AND METHODS A single-center retrospective study included all patients operated on by the senior author (CM) for posterior fossa ependymoma from 2002 to 2018. Medical and surgical data were extracted from the hospital's medical database. RESULTS Thirty-four patients were included. Age ranged from 6 months to 18 years, with a median of 4.7 years. Fourteen patients underwent initial endoscopic third ventriculocisternostomy before the direct surgical resection. Surgical removal was complete in 27 patients. There were 32 surgeries for second-look, local recurrence or metastasis despite complementary chemotherapy and/or radiotherapy. Twenty patients were WHO grade 2 and 14 grade 3. Sixteen patients showed recurrence (47%). Overall survival was 61.8% at a mean 10.1 years' follow-up. Morbidities comprised facial nerve palsy, swallowing disorder, and transient cerebellar syndrome. Fifteen patients had normal schooling, 6 had special assistance; 4 patients reached university, 3 of whom experienced difficulties. Three patients had a job. CONCLUSION Posterior fossa ependymomas are aggressive tumors. Complete surgical removal is the most important prognostic factor, despite risk of sequelae. Complementary treatment is mandatory, but no targeted therapy has so far proved effective. It is important to continue the search for molecular markers in order to improve outcomes.
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Affiliation(s)
- R G Boukaka
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - P Leblond
- Department of Pediatric Hematology and Oncology, institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - C Faure-Conter
- Department of Pediatric Hematology and Oncology, institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - L Claude
- Department of Radiotherapy, centre Léon-Bérard, 69008 Lyon, France
| | - A Vasiljevic
- Department of Pathology and Neuropathology, GHE, hospices civils de Lyon, 69500 Bron, France
| | - P-A Beuriat
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France.
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Di Rocco F, Rossi M, Verlut I, Szathmari A, Beuriat PA, Chatron N, Chauvel-Picard J, Mottolese C, Monin P, Vinchon M, Guernouche S, Collet C. Clinical interest of molecular study in cases of isolated midline craniosynostosis. Eur J Hum Genet 2023; 31:621-628. [PMID: 36732661 PMCID: PMC10250395 DOI: 10.1038/s41431-023-01295-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/16/2022] [Revised: 01/02/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
In some cases of infants with apparently isolated single-suture synostosis, an underlying variant can be found. We aimed to determine the molecular substratum in isolated sagittal and metopic craniosynostosis. To this end, we included all infants who presented isolated midline synostosis (sagittal or metopic) and had undergone surgery at the craniosynostosis national reference center of Lyon University Hospital. All infants were examined by a multidisciplinary team including neurosurgeons, clinical geneticists and neuropsychologist. Among 101 infants tested, 13 carried a total of 13 variants; that is, 12.9% of the infants carried a variant in genes known to be involved in craniosynostosis. Seven infants carried SMAD6 variants, 2 in FGFR2, 1 in TWIST1, one in FREM1, one in ALX4 and one in TCF12. All variants were detected at the heterozygous level in genes associated with autosomal dominant craniosynostosis. Also, neurodevelopmental testing showed especially delayed acquisition of language in children with than without variants in SMAD6. In conclusion, a high percentage of young children with isolated midline craniosynostosis, especially in isolated trigonocephaly, carried SMAD6 variants. The interpretation of the pathogenicity of the genes must take into account incomplete penetrance, usually observed in craniosynostosis. Our results highlight the interest of molecular analysis in the context of isolated sagittal and/or metopic craniosynostosis to enhance an understanding of the pathophysiology of midline craniosynostosis.
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Affiliation(s)
- Federico Di Rocco
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant Hospices Civils de Lyon, University of Lyon, INSERM 1033, Lyon, France
| | - Massimiliano Rossi
- Department of Genetics, Lyon University Hospitals, INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | - Isabelle Verlut
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant Hospices Civils de Lyon, University of Lyon, INSERM 1033, Lyon, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant Hospices Civils de Lyon, University of Lyon, INSERM 1033, Lyon, France
| | - Pierre Aurélien Beuriat
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant Hospices Civils de Lyon, University of Lyon, INSERM 1033, Lyon, France
| | - Nicolas Chatron
- Department of Genetics, Lyon University Hospitals, INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | - Julie Chauvel-Picard
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant Hospices Civils de Lyon, University of Lyon, INSERM 1033, Lyon, France
| | - Pauline Monin
- Department of Genetics, Lyon University Hospitals, INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | - Matthieu Vinchon
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant Hospices Civils de Lyon, University of Lyon, INSERM 1033, Lyon, France
| | - Sofia Guernouche
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant Hospices Civils de Lyon, University of Lyon, INSERM 1033, Lyon, France
| | - Corinne Collet
- Department of Genetics, Robert Debré Hospital, Inserm 1132, Université de Paris Cité, Paris, France.
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de Laurentis C, Bteich F, Beuriat PA, Mottolese C, Giussani C, Szathmari A, Vinchon M, Di Rocco F. Sodium fluorescein in pediatric neurosurgery: a systematic review with technical considerations and future perspectives. Childs Nerv Syst 2022; 39:1451-1462. [PMID: 36459209 DOI: 10.1007/s00381-022-05772-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Sodium fluorescein (SF) is routinely used in several centers as a valid intraoperative adjunct in adult oncological neurosurgery. Its use in pediatric neurosurgery is increasing, although its role is not yet well-defined in children. We reviewed the current literature in order to evaluate the use of SF in children with CNS and PNS lesions. METHODS For this systematic review, we searched PubMed, Scopus, and Embase databases, and forward and backward citations for studies published between database inception and July 31st, 2022. We included any article type or congress abstract adding at least a new case, without restrictions of language or publication status, concerning the use of SF in neurosurgical procedures in patients under 18 years of age. We excluded studies concerning purely vascular cases and cerebrospinal fluid leaks. RESULTS Of 4094 records identified, 19 articles were eligible and included for further analysis. As per July 31st, 2022, at least 119 patients aged from 11 months to 17.9 years underwent surgery with SF. No serious adverse events were reported. A large variety of tumor types was operated, in most cases resected under the specific YELLOW 560 nm filter after a low-dose SF injection (2-5 mg/kg) at the end of anesthesia induction. SF was reported particularly useful in gangliogliomas and pilocytic astrocytomas. DISCUSSION/CONCLUSION Given its easy-to-use profile, low cost, and safety, SF seems to be a feasible and valid adjunct in the pediatric population when aiming at individuating a biopsy target or maximizing extent of resection, particularly in some tumor types. Further studies are required to strengthen the evidence on its impact on outcomes.
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Affiliation(s)
- Camilla de Laurentis
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France. .,Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
| | - Fred Bteich
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Carmine Mottolese
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - Carlo Giussani
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.,Neurosurgery Unit, San Gerardo Hospital, Monza, Italy
| | | | - Matthieu Vinchon
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - Federico Di Rocco
- Pediatric Neurosurgery Unit, Hôpital Femme Mère Enfant, Lyon, France.,Department of Medicine and Surgery, Université Claude Bernard Lyon I, Lyon, France
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10
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Faure Conter C, Calaminus G, Nicholson J, Idbaih A, Hoang Xuan K, Vasiljevic A, Morana G, Szathmari A, Ajithkumar T, Frappaz D. Central nervous system germ cell tumor, an archetypal AYA tumor and a model for pediatric and neuro-oncology collaboration, review from the EURACAN domain 10 group. Front Oncol 2022; 12:971697. [PMID: 36248981 PMCID: PMC9557181 DOI: 10.3389/fonc.2022.971697] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary: Adolescents and young adults (AYA) with cancer often fall through gaps between children's and adults' cancer services. They are consequently under-represented in clinical trials, and their survival is often inferior to that of children or adults with the same tumor type; in this paper, we use the example of central nervous system germ cell tumors (CNS-GCT), as a model of AYA tumor to illustrate this challenge. We describe how we have built bridges between pediatric and adult oncology, how this can apply to other types of brain tumors, and discuss ways to promote cancer care in the AYA population. Adolescents and young adults (AYA) with cancer are under-represented in clinical trials and have thus not benefited from the same improvement in outcomes as either younger or older patients. Central nervous system germ cell tumors (CNS-GCT) represent an ideal model of AYA tumor as their incidence peaks during adolescence and young adulthood. Since the early 90's, SIOP (International Society of Pediatric Oncology) has launched two successive European trials: SIOP CNS-GCT96 (January 1996 to December 2005) and SIOP CNS-GCTII protocols (October 2011 to July 2018), for CNS-GCTs. With the removal of the upper age limit in the SIOP CNS-GCTII trial, and closer collaboration between pediatric and adult oncologists within AYA multidisciplinary tumor boards, the proportion of adults enrolled in France has dramatically increased over time. The current article will use the example of CNS-GCT to illustrate how to build a bridge between pediatric and adult oncology, how this can apply to other types of brain tumors, and how to promote cancer care in the AYA population.
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Affiliation(s)
- Cecile Faure Conter
- Institute of Pediatric Hematology and Oncology, Lyon, France,*Correspondence: Cecile Faure Conter,
| | | | - James Nicholson
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ahmed Idbaih
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | - Khê Hoang Xuan
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin, Italy
| | - Alexandru Szathmari
- Department of Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Thankamma Ajithkumar
- Department of Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Didier Frappaz
- Institute of Pediatric Hematology and Oncology, Lyon, France
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11
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Idriceanu T, Beuriat PA, Di Rocco F, Szathmari A, Mottolese C. Recurrent tethering in conus lipomas: a late complication not to be ignored. World Neurosurg 2022; 168:e12-e18. [PMID: 35863646 DOI: 10.1016/j.wneu.2022.07.048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUNDS Recurrent symptomatic tethered cord (RTC) is a long-term complication of spinal cord lipomas, responsible for progressive motor deficits, urologic dysfunction and aggravation of spinal deformities.We retrospectively analysed all cases of recurrent tethering after spinal cord lipoma surgery, the clinical and radiological features that led to the diagnosis, the surgical management and the neuro-orthopedic outcome at the last follow-up. METHODS The study was carried out over a period of 20 years on a total of 209 pediatric patients from a single institution, initially treated for a conus lipoma. RESULTS 9 patients (4,8 %) were surgically treated for a RTC. The age at retethering ranged from 2 to 12 years -median of 7, 4 years. The time before the first and the second surgical procedure, ranged from 19 to 140 months - median of 7 years and a half. The follow-up period after the second surgery ranged from 3 months to 13 years with a median of 50 months. Among symptoms, pain responded very well to surgery. Gait disturbances improved in 50 % after the surgery. One patient with bladder dysfunctions also improved. The rest of the patients maintained the pre-surgical status. CONCLUSIONS When RTC is confirmed, child should be referred to surgery as soon as possible, as we showed that the post- operative clinical outcome improved and surgery did not worsen patients. We stressed the fact that the follow-up should be as long as possible for these patients.
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Affiliation(s)
- T Idriceanu
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - P A Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677 Lyon Cedex, France.
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12
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Cabet S, Szathmari A, Mottolese C, Franco P, Guibaud L, Rossi M, Di Rocco F. New insights in craniovertebral junction MR changes leading to stenosis in children with achondroplasia. Childs Nerv Syst 2022; 38:1137-1145. [PMID: 35505148 DOI: 10.1007/s00381-022-05514-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To characterize natural history and early changes of craniovertebral junction stenosis in achondroplasia correlating with clinical and radiological outcome. METHODS Retrospective measures on craniovertebral junction were performed blindly, on sagittal T2-weighted images, in 21 patients with achondroplasia referred from 2008 to 2020. Clinical and polysomnography data were retrospectively collected. Each patient was paired for age and gender with four controls. Wilcoxon means comparison or Student's t-tests were applied. RESULTS Twenty-one patients (11 females, from 0.1 to 39 years of age) were analyzed and paired with 84 controls. A craniovertebral junction stenosis was found in 11/21 patients (52.4%), all before the age of 2 years. Despite a significant reduction of the foramen magnum diameter (mean ± SD: patients 13.6 ± 6.2 mm, controls 28.5 ± 4.7 mm, p < .001), craniovertebral junction stenosis resulted from the narrowing of C2 dens-opisthion antero-posterior diameter (8.7 ± 3.9 mm vs 24.6 ± 5.1 mm, p < .001). Other significant changes were opisthion anterior placement (-0.4 ± 2.8 mm vs 9.4 ± 2.3 mm, p < .001), posterior tilt of C2 (46.2 ± 13.7° vs 31.6 ± 7.9°, p < .001) and of C1 (15.1 ± 4.3° vs 11.9 ± 5.0°, p = 0.01), and dens thickening (9.4 ± 2.2 mm vs 8.5 ± 2.1 mm, p = 0.03), allowing to define three distinguishable early craniovertebral junction patterns in achondroplasia. All children with C2-opisthion antero-posterior diameter of more than 6 mm had a better clinical and radiological outcome. CONCLUSION Craniovertebral junction in achondroplasia results from narrowing between C2 dens and opisthion related to anterior placement of opisthion, thickening of C2 dens, and posterior tilt of C1-C2. A threshold of 6 mm for dens-opisthion sagittal diameter seems to correlate with clinical and radiological outcome.
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Affiliation(s)
- Sara Cabet
- Department of Pediatric Radiology, Groupement Hospitalier Est, Hospices Civils de LyonBron, France.,Department of Genetics, National Referral Center for Developmental Abnormalities and Competence Center for Skeletal Dysplasia, UMR5292, Lyon Neuroscience Research Center, INSERM U1028, CNRS, GENDEV Team, Claude Bernard Lyon 1 University, Hospices Civils de LyonBron, France.,Claude Bernard Lyon 1 University, Lyon, France
| | - Alexandru Szathmari
- Department of Neurosurgery, National Referral Center for Craniosynostosis and Craniofacial Malformations, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Carmine Mottolese
- Department of Neurosurgery, National Referral Center for Craniosynostosis and Craniofacial Malformations, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Patricia Franco
- Pediatric Sleep Unit, Hospices Civils de Lyon, Groupement Hospitalier Est, INSERM U1028, CNRL, Waking Team, Claude Bernard Lyon 1 University, Bron, France
| | - Laurent Guibaud
- Department of Pediatric Radiology, Groupement Hospitalier Est, Hospices Civils de LyonBron, France.,Claude Bernard Lyon 1 University, Lyon, France
| | - Massimiliano Rossi
- Department of Genetics, National Referral Center for Developmental Abnormalities and Competence Center for Skeletal Dysplasia, UMR5292, Lyon Neuroscience Research Center, INSERM U1028, CNRS, GENDEV Team, Claude Bernard Lyon 1 University, Hospices Civils de LyonBron, France
| | - Federico Di Rocco
- Claude Bernard Lyon 1 University, Lyon, France. .,Department of Neurosurgery, National Referral Center for Craniosynostosis and Craniofacial Malformations, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France.
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13
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Licci M, Zaed I, Beuriat PA, Szathmari A, Guibaud L, Mottolese C, Di Rocco F. CSF shunting in myelomeningocele-related hydrocephalus and the role of prenatal imaging. Childs Nerv Syst 2021; 37:3417-3428. [PMID: 34076708 DOI: 10.1007/s00381-021-05217-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hydrocephalus is commonly associated with myelomeningocele (MMC). Indication and timing of cerebrospinal fluid (CSF) shunting are still a topic of discussion. The aim of this study was to investigate whether the analysis of prenatal cerebral imaging studies could provide information that is predictive of the necessity of CSF shunting in the postnatal period. MATERIAL AND METHODS Among 73 infants operated on because of MMC between January 2003 and June 2020, 50 had undergone prenatal and postnatal MRI studies and were considered for analysis. For each patient, frontal horn width, atrial ventricle diameter, third ventricle diameter, and subarachnoid spaces (sinocortical width, craniocortical width, and the interhemispheric width) have been measured on prenatal, postnatal, and a follow-up MRI study. The need of CSF shunting device placement in relation to prenatal and early postnatal MRI data was investigated. RESULTS Of the 50 infants, 31 (62%) developed a progressive hydrocephalus. Of these, 30 needed a CSF shunt and the majority of them (n=29) was operated on within 28 days after birth. One patient needed CSF shunt implantation at 45 days after birth and one child developed a late progressive hydrocephalus, successfully treated by ETV alone, at 14.2 months of age. All patients with an atrial ventricle diameter greater than 1.9 cm and a 3rd ventricle diameter larger than 0.3 cm on antenatal third trimester imaging have undergone CSF shunting within 1 month after birth. Conversely, all the children that did not undergo a CSF shunt placement showed an atrial cerebral ventricle diameter inferior to 1.2 cm and a 3rd ventricle width < 0.3 cm on antenatal imaging. Frontal horn width and subarachnoid CSF spaces' evolution did not seem to play a role. CONCLUSION The prenatal MRI assessment of the associated prenatal ventriculomegaly in MMC provides parameters that have a predictive value heralding the probability of a CSF diversion procedure after birth. In the same way, the analysis of intrauterine MRI studies may identify those subjects that are less at risk of developing a progressive hydrocephalus after birth, therefore encouraging a more cautious attitude towards the early implantation of CSF shunting devices in the current clinical practice.
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Affiliation(s)
- Maria Licci
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France
| | - Ismail Zaed
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France
| | - Pierre-Aurélien Beuriat
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France
| | - Alexandru Szathmari
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France.,Department of Pediatric Radiology, Hôpital Femme Mère-Enfant, Hospices civils de Lyon, 69003, Lyon, France
| | - Laurent Guibaud
- Department of Pediatric Radiology, Hôpital Femme Mère-Enfant, Hospices civils de Lyon, 69003, Lyon, France
| | - Carmine Mottolese
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France.,Department of Pediatric Radiology, Hôpital Femme Mère-Enfant, Hospices civils de Lyon, 69003, Lyon, France
| | - Federico Di Rocco
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France.
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14
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DI Rocco F, Licci M, Paasche A, Szathmari A, Beuriat PA, Mottolese C. Fixed posterior cranial vault expansion technique. Childs Nerv Syst 2021; 37:3137-3141. [PMID: 34170377 DOI: 10.1007/s00381-021-05270-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Different techniques to reshape the posterior skull vault have been developed in the last decades, all sharing the same goals of increasing the skull volume, decreasing the intracranial pressure (ICP), correcting the cranial dysmorphy, and contributing to a better growth of the skull. Though over the last years most refinements in these techniques have focused on the use of hardware as distractors or springs, the fixed posterior vault expansion remains a valuable procedure for cranial remodeling. METHODS We describe in details the technique used for fixed posterior vault expansion in children that is applied at the French Referral center for Craniosynostosis of Lyon, France. DISCUSSION The fixed posterior vault expansion increases the risk of perioperative complications due to the elevation of the posterior bone flap from the dura but allows an immediate decompression and correction of the shape, simplifying the postoperative course.
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Affiliation(s)
- Federico DI Rocco
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis Hôpital Femme Mère-Enfant Hospices Civils de Lyon University of Lyon, INSERM 1033, Lyon, France.
| | - Maria Licci
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis Hôpital Femme Mère-Enfant Hospices Civils de Lyon University of Lyon, INSERM 1033, Lyon, France
| | - Agnes Paasche
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis Hôpital Femme Mère-Enfant Hospices Civils de Lyon University of Lyon, INSERM 1033, Lyon, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis Hôpital Femme Mère-Enfant Hospices Civils de Lyon University of Lyon, INSERM 1033, Lyon, France
| | - Pierre Aurélien Beuriat
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis Hôpital Femme Mère-Enfant Hospices Civils de Lyon University of Lyon, INSERM 1033, Lyon, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis Hôpital Femme Mère-Enfant Hospices Civils de Lyon University of Lyon, INSERM 1033, Lyon, France
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15
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Licci M, Beuriat PA, Szathmari A, Paulus C, Gleizal A, Mottolese C, Di Rocco F. Metopic triangle osteotomy in trigonocephaly Piezosurgery: a technical variant to control metopic emissary veins. Neurosurgical Focus: Video 2021; 4:V4. [PMID: 36284856 PMCID: PMC9542591 DOI: 10.3171/2021.1.focvid20132] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
Premature fusion of the metopic suture results in trigonocephaly with variable degrees of anterior cranial fossa dysmorphia and craniofacial deformity. Different surgical corrective techniques that aim to reshape the forehead and enlarge the cranial volume have been described. Typical variations of the standard fronto-orbitary advancement carry the risk of relevant blood loss during frontal osteotomy, where paired emissary metopic veins are disrupted. The authors present a technical variant that preserves a bony triangle over the glabella to optimize control of these veins, which represent the major source of bleeding, and applies Piezosurgery to perform the osteotomies to minimize bone substance loss.
The video can be found here: https://vimeo.com/511536423.
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Affiliation(s)
- Maria Licci
- Pediatric Neurosurgery,
- Centre de Référence Craniosténoses, and
| | | | | | - Christian Paulus
- Centre de Référence Craniosténoses, and
- Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, Université de Lyon, France
| | - Arnaud Gleizal
- Centre de Référence Craniosténoses, and
- Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, Université de Lyon, France
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16
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Beuriat PA, Szathmari A, Chauvel-Picard J, Gleizal A, Paulus C, Mottolese C, Di Rocco F. Coronal and lambdoid suture evolution following total vault remodeling for scaphocephaly. Neurosurg Focus 2021; 50:E4. [PMID: 33794500 DOI: 10.3171/2021.1.focus201004] [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: 11/24/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Different types of surgical procedures are utilized to treat craniosynostosis. In most procedures, the fused suture is removed. There are only a few reports on the evolution of sutures after surgical correction of craniosynostosis. To date, no published study describes neosuture formation after total cranial vault remodeling. The objective of this study was to understand the evolution of the cranial bones in the area of coronal and lambdoid sutures that were removed for complete vault remodeling in patients with sagittal craniosynostosis. In particular, the investigation aimed to confirm the possibility of neosuture formation. METHODS CT images of the skulls of children who underwent operations for scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital, Lyon, France, from 2004 to 2014 were retrospectively reviewed. Inclusion criteria were diagnosis of isolated sagittal synostosis, age between 4 and 18 months at surgery, and availability of reliable postoperative CT images obtained at a minimum of 1 year after surgical correction. Twenty-six boys and 11 girls were included, with a mean age at surgery of 231.6 days (range 126-449 days). The mean interval between total vault reconstruction and CT scanning was 5.3 years (range 1.1-12.2 years). RESULTS Despite the removal of both the coronal and lambdoid sutures, neosutures were detected on the 3D reconstructions. All combinations of neosuture formation were seen: visible lambdoid and coronal neosutures (n = 20); visible lambdoid neosutures with frontoparietal bony fusion (n = 12); frontoparietal and parietooccipital bony fusion (n = 3); and visible coronal neosutures with parietooccipital bony fusion (n = 2). CONCLUSIONS This is the first study to report the postoperative skull response after the removal of normal patent sutures following total vault remodeling in patients with isolated sagittal synostosis. The reappearance of a neosuture is rather common, but its incidence depends on the type of suture. The outcome of the suture differs with the incidence of neosuture formation between these transverse sutures. This might imply genetic and functional differences among cranial sutures, which still have to be elucidated.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and.,4Université de Lyon, France
| | - Alexandru Szathmari
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and
| | - Julie Chauvel-Picard
- 1French Referral Center for Craniosynostosis.,3Pediatric Maxillo-Facial Surgery, Hôpital Femme Mère Enfant; and.,4Université de Lyon, France
| | - Arnaud Gleizal
- 1French Referral Center for Craniosynostosis.,3Pediatric Maxillo-Facial Surgery, Hôpital Femme Mère Enfant; and.,4Université de Lyon, France
| | - Christian Paulus
- 1French Referral Center for Craniosynostosis.,3Pediatric Maxillo-Facial Surgery, Hôpital Femme Mère Enfant; and
| | - Carmine Mottolese
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and
| | - Federico Di Rocco
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and.,4Université de Lyon, France
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17
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Richard N, Desmurget M, Teillac A, Beuriat PA, Bardi L, Coudé G, Szathmari A, Mottolese C, Sirigu A, Hiba B. Anatomical bases of fast parietal grasp control in humans: A diffusion-MRI tractography study. Neuroimage 2021; 235:118002. [PMID: 33789136 DOI: 10.1016/j.neuroimage.2021.118002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/30/2020] [Revised: 01/26/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
The dorso-posterior parietal cortex (DPPC) is a major node of the grasp/manipulation control network. It is assumed to act as an optimal forward estimator that continuously integrates efferent outflows and afferent inflows to modulate the ongoing motor command. In agreement with this view, a recent per-operative study, in humans, identified functional sites within DPPC that: (i) instantly disrupt hand movements when electrically stimulated; (ii) receive short-latency somatosensory afferences from intrinsic hand muscles. Based on these results, it was speculated that DPPC is part of a rapid grasp control loop that receives direct inputs from the hand-territory of the primary somatosensory cortex (S1) and sends direct projections to the hand-territory of the primary motor cortex (M1). However, evidence supporting this hypothesis is weak and partial. To date, projections from DPPC to M1 grasp zone have been identified in monkeys and have been postulated to exist in humans based on clinical and transcranial magnetic studies. This work uses diffusion-MRI tractography in two samples of right- (n = 50) and left-handed (n = 25) subjects randomly selected from the Human Connectome Project. It aims to determine whether direct connections exist between DPPC and the hand control sectors of the primary sensorimotor regions. The parietal region of interest, related to hand control (hereafter designated DPPChand), was defined permissively as the 95% confidence area of the parietal sites that were found to disrupt hand movements in the previously evoked per-operative study. In both hemispheres, irrespective of handedness, we found dense ipsilateral connections between a restricted part of DPPChand and focal sectors within the pre and postcentral gyrus. These sectors, corresponding to the hand territories of M1 and S1, targeted the same parietal zone (spatial overlap > 92%). As a sensitivity control, we searched for potential connections between the angular gyrus (AG) and the pre and postcentral regions. No robust pathways were found. Streamline densities identified using AG as the starting seed represented less than 5 % of the streamline densities identified from DPPChand. Together, these results support the existence of a direct sensory-parietal-motor loop suited for fast manual control and more generally, for any task requiring rapid integration of distal sensorimotor signals.
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Affiliation(s)
- Nathalie Richard
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France
| | - Michel Desmurget
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France
| | - Achille Teillac
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France; Institut de neurosciences cognitives et intégratives d'Aquitaine, CNRS / UMR 5287, 33076 Bordeaux, France
| | - Pierre-Aurélien Beuriat
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France; Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500, Bron, France
| | - Lara Bardi
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France
| | - Gino Coudé
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France
| | - Alexandru Szathmari
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France; Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500, Bron, France
| | - Carmine Mottolese
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France; Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500, Bron, France
| | - Angela Sirigu
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France
| | - Bassem Hiba
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS / UMR 5229, 69500 Bron, France; Université Claude Bernard, Lyon 1, 69100 Villeurbanne, France.
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18
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Dauleac C, Mottolese C, Beuriat PA, Szathmari A, Di Rocco F. Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population. Eur Spine J 2021; 30:3036-3042. [PMID: 33475841 DOI: 10.1007/s00586-020-06681-4] [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] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/06/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Thoracolumbar fractures are the most common kind of spine injury in children. Several types of spine injury can occur, and for this reason, treatment algorithms have been put in place for the management of these patients. At present, the thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AOSpine injury score (AOSpine score) aimed at providing treatment recommendations. We aimed to assess the reliability, in children, of the TLICS scoring and AOSpine scoring systems, and to define the superiority of one of the methods of scoring, to spread its use in routine clinical management in the pediatric spine trauma. METHODS A retrospective chart review of consecutive children admitted to a Level 1 trauma center for traumatic thoracolumbar fractures, between 2006 and 2019, was performed. We compared the management we performed in clinical practice in children with spine trauma, to the decisional algorithms based on the TLICS and AOSpine scores. According to these scores, surgical treatment should be performed when the TLICS score ≥ 5 and the AOSpine score > 5; and surgical or conservative treatment was considered reasonable when the TLICS score = 4 and the AOSpine score = 4 or 5. Surgical indications were based on the clinical status, the anatomy of the fracture, and the risk of sagittal imbalance of the growing spine. RESULTS Fifty-four patients met the inclusion criteria. We demonstrated that both the AOSpine score and the TLICS scores had a significant correlation for surgical management decision of spine trauma (p < 0.0001). We found a high concordance between surgical decision making in the pediatric clinical practice and the TLICS score. In our pediatric cohort, there were significantly more patients with TLICS ≥ 5 (n = 47, 87%) than with AOSpine score > 5 (n = 26, 46%, p < 0.0001). There were significantly more patients with TLICS ≥ 4 (n = 53, 98%), than with AOSpine score ≥ 4 (n = 42, 77%, p = 0.001). ConclusionsThe TLICS score was significantly more appropriate than the AOSpine score, for the surgical treatment decision in children, especially when considering the future risk of sagittal imbalance.
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Affiliation(s)
- Corentin Dauleac
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital Neurologique Et Neurochirurgical Pierre Wertheimer, 69003, Lyon, France.,Université de Lyon, Université Claude Bernard, 69008, Lyon, France
| | - Carmine Mottolese
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital Neurologique Et Neurochirurgical Pierre Wertheimer, 69003, Lyon, France.,Service de Neurochirurgie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bd Pinel, 69003, Lyon, France
| | - Pierre-Aurélien Beuriat
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital Neurologique Et Neurochirurgical Pierre Wertheimer, 69003, Lyon, France.,Université de Lyon, Université Claude Bernard, 69008, Lyon, France.,Service de Neurochirurgie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bd Pinel, 69003, Lyon, France
| | - Alexandru Szathmari
- Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital Neurologique Et Neurochirurgical Pierre Wertheimer, 69003, Lyon, France.,Service de Neurochirurgie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bd Pinel, 69003, Lyon, France
| | - Federico Di Rocco
- Université de Lyon, Université Claude Bernard, 69008, Lyon, France. .,Service de Neurochirurgie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bd Pinel, 69003, Lyon, France.
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19
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Grassiot B, Beuriat PA, Di Rocco F, Leblond P, Faure-Conter C, Szathmari A, Mottolese C. Surgical management of posterior fossa medulloblastoma in children: The Lyon experience. Neurochirurgie 2021; 67:52-60. [PMID: 33482236 DOI: 10.1016/j.neuchi.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/31/2020] [Revised: 11/22/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Modern approach for the treatment of posterior fossa medulloblastomas remains a challenge for pediatric neurosurgeons and pediatric oncologists and requires a multidisciplinary approach to optimize survival and clinical results. MATERIAL AND METHODS We report the surgical principles of the treatment of posterior fossa medulloblastomas in children and how to avoid technical mistakes especially in very young patients. We also report our experience in a series of 64 patients operated from a medulloblastoma between 2000 and 2018 in Lyon. RESULTS All patients had a craniospinal MRI. Eighty-one percent of the patients (n=50) had strictly midline tumor while 19% (n=14) had lateralized one. Eleven percent (n=7) had metastasis at diagnosis on the initial MRI. Forty-one percent (n=29) had an emergency ETV to treat hydrocephaly and the intracranial hypertension. All patient underwent a direct approach and a complete removal was achieved in 78% (n=58) of the cases on the postoperative MRI realized within 48h postsurgery. Histological findings revealed classical medulloblastoma in 73% (n=46), desmoplastic medulloblastoma in 17% (n=11) and anaplastic/large cell medulloblastoma in 10% (n=7). Patients were classified as low risk in 7 cases, standard risk in 30 cases and high risk in 27 cases. Ninety-six percent (n=61) of the patient received radiotherapy. Seventy-six percent (n=48) received pre-irradiation or adjuvant chemotherapy. At last follow-up in December 2018, 65% (n=41) of the patient were in complete remission, 12% (n=8) were in relapse and 27% (n=15) had died from their disease. The overall survival at five , ten and fifteen years for all the series was of 76%, 73% and 65.7% respectively. CONCLUSIONS Medulloblastomas remain a chimiosensible and radiosensible disease and the complete surgical removal represents a favorable prognostic factor. The extension of surgery has also to be weighted in consideration of the new biomolecular and genetic knowledge that have to be integrated by surgeons to improve quality of life of patients.
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Affiliation(s)
- B Grassiot
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - P A Beuriat
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - P Leblond
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - C Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, hôpital Femme-Mère-Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Lyon Cedex, France.
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20
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Di Rocco F, Scavarda D, Vinchon M, Szathmari A, Riffaud L, Bohra A, Blauwblomme T, Boetto S, Gimbert E, Ferrand S, Coca A, Chivoret N, Coll G, Delion M, Roujeau T, Mottolese C, Zerah M. Impact de la pandémie COVID-19 sur la neurochirurgie pédiatrique en France. Neurochirurgie 2020; 66:192-194. [PMID: 32504645 PMCID: PMC7833797 DOI: 10.1016/j.neuchi.2020.05.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022]
Affiliation(s)
- F Di Rocco
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France.
| | - D Scavarda
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Vinchon
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Szathmari
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - L Riffaud
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Bohra
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - T Blauwblomme
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - S Boetto
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - E Gimbert
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - S Ferrand
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - A Coca
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - N Chivoret
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - G Coll
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Delion
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - T Roujeau
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - C Mottolese
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
| | - M Zerah
- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
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- Neurochirurgie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69003 Lyon, France
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21
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Szathmari A, Morgado A, Beuriat P, Petrescu P, Di Rocco F, Mottolese C. Cranioplasty for bone defects after craniosynostosis surgery. Case series with literature review. Neurochirurgie 2020; 66:97-101. [DOI: 10.1016/j.neuchi.2019.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 10/24/2022]
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22
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Beuriat PA, Cristofori I, Richard N, Bardi L, Loriette C, Szathmari A, Di Rocco F, Leblond P, Frappaz D, Faure-Conter C, Claude L, Mottolese C, Desmurget M. Cerebellar lesions at a young age predict poorer long-term functional recovery. Brain Commun 2020; 2:fcaa027. [PMID: 32954287 PMCID: PMC7425375 DOI: 10.1093/braincomms/fcaa027] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022] Open
Abstract
Early studies on long-term functional recovery after motor and premotor lesions showed better outcomes in younger monkeys than in older monkeys. This finding led to the widespread belief that brain injuries cause less impairment in children than adults. However, this view has limitations and a large body of evidence now indicates that cerebral damages can be more harmful when inflicted at young age, during critical periods of neural development. To date, this issue has been mainly investigated in the context of focal and diffuse cortical lesions. Much less is known about the potential influence of early cerebellar damages. Several studies exist in survivor of posterior fossa tumours. However, in these studies, critical confounders were not always considered and contradictory conclusions were provided. We studied the impact or early cerebellar damage on long-term functional recovery in three groups of 15 posterior fossa survivors, comparable with respect to their tumour characteristics (type, size and location) but operated at different ages: young (≤7 years), middle (>7 and ≤13 years) and older (>13 years). Daily (health-related quality of life scale, performance status scale), motor (International Cooperative Ataxia Rating Scale, Pegboard Purdue Test) and cognitive (full-scale intelligence quotient) functioning were assessed. A general linear model controlling for age at surgery, radiotherapy, preservation of deep cerebellar nuclei, tumour volume and delay between surgery and assessment was used to investigate significant variations in outcome measures. Early age at surgery, lesion of deep cerebellar nuclei and postoperative radiotherapy had a significant, independent negative influence on long-term recovery. Tumour volume and delay between surgery and assessment had no statistically detectable impact. The negative influence of early age at surgery was significant in all domains: daily functioning (health-related quality of life scale, performance status scale), motor functioning (International Cooperative Ataxia Rating Scale, Pegboard Purdue Test) and cognitive functioning (full-scale intelligence quotient). These results support the existence of an early critical period of development during which the cerebellar ‘learning machine’ is of critical importance. Although the extent to which the early deficits here observed can be reversed needs now to be established, our data plead for the implementation of prompt and intense rehabilitation interventions in children operated before 7 years of age.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Irene Cristofori
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Nathalie Richard
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Lara Bardi
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Celia Loriette
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Alexandru Szathmari
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Federico Di Rocco
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Pierre Leblond
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Didier Frappaz
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Cécile Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d'hématologie et d'oncologie Pédiatrique, 69008 Lyon, France
| | - Line Claude
- Department of Radiotherapy, Centre Léon Bérard, 69008 Lyon, France
| | - Carmine Mottolese
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.,Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Michel Desmurget
- Institute of Cognitive Science Marc Jeannerod, CNRS/UMR 5229, 69500 Bron, France.,Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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23
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Li BK, Vasiljevic A, Dufour C, Yao F, Ho BLB, Lu M, Hwang EI, Gururangan S, Hansford JR, Fouladi M, Nobusawa S, Laquerriere A, Delisle MB, Fangusaro J, Forest F, Toledano H, Solano-Paez P, Leary S, Birks D, Hoffman LM, Szathmari A, Faure-Conter C, Fan X, Catchpoole D, Zhou L, Schultz KAP, Ichimura K, Gauchotte G, Jabado N, Jones C, Loussouarn D, Mokhtari K, Rousseau A, Ziegler DS, Tanaka S, Pomeroy SL, Gajjar A, Ramaswamy V, Hawkins C, Grundy RG, Hill DA, Bouffet E, Huang A, Jouvet A. Pineoblastoma segregates into molecular sub-groups with distinct clinico-pathologic features: a Rare Brain Tumor Consortium registry study. Acta Neuropathol 2020; 139:223-241. [PMID: 31820118 DOI: 10.1007/s00401-019-02111-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022]
Abstract
Pineoblastomas (PBs) are rare, aggressive pediatric brain tumors of the pineal gland with modest overall survival despite intensive therapy. We sought to define the clinical and molecular spectra of PB to inform new treatment approaches for this orphan cancer. Tumor, blood, and clinical data from 91 patients with PB or supratentorial primitive neuroectodermal tumor (sPNETs/CNS-PNETs), and 2 pineal parenchymal tumors of intermediate differentiation (PPTIDs) were collected from 29 centres in the Rare Brain Tumor Consortium. We used global DNA methylation profiling to define a core group of PB from 72/93 cases, which were delineated into five molecular sub-groups. Copy number, whole exome and targeted sequencing, and miRNA expression analyses were used to evaluate the clinico-pathologic significance of each sub-group. Tumors designated as group 1 and 2 almost exclusively exhibited deleterious homozygous loss-of-function alterations in miRNA biogenesis genes (DICER1, DROSHA, and DGCR8) in 62 and 100% of group 1 and 2 tumors, respectively. Recurrent alterations of the oncogenic MYC-miR-17/92-RB1 pathway were observed in the RB and MYC sub-group, respectively, characterized by RB1 loss with gain of miR-17/92, and recurrent gain or amplification of MYC. PB sub-groups exhibited distinct clinical features: group 1-3 arose in older children (median ages 5.2-14.0 years) and had intermediate to excellent survival (5-year OS of 68.0-100%), while Group RB and MYC PB patients were much younger (median age 1.3-1.4 years) with dismal survival (5-year OS 37.5% and 28.6%, respectively). We identified age < 3 years at diagnosis, metastatic disease, omission of upfront radiation, and chr 16q loss as significant negative prognostic factors across all PBs. Our findings demonstrate that PB exhibits substantial molecular heterogeneity with sub-group-associated clinical phenotypes and survival. In addition to revealing novel biology and therapeutics, molecular sub-grouping of PB can be exploited to reduce treatment intensity for patients with favorable biology tumors.
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Affiliation(s)
- Bryan K Li
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandre Vasiljevic
- Faculté de Médecine, Université de Lyon, Lyon, France
- Service d'Anatomie et Cytologie Pathologiques, CHU de Lyon, Lyon, France
| | - Christelle Dufour
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, Villejuif, Paris, France
| | - Fupan Yao
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ben L B Ho
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Mei Lu
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Eugene I Hwang
- Department of Oncology, Children's National Medical Center, Washington, DC, USA
| | - Sridharan Gururangan
- Department of Pediatrics, Preston A. Wells Jr. Center for Brain Tumor Therapy, UF Health Shands Hospital, University of Florida, Gainesville, FL, USA
| | - Jordan R Hansford
- Children's Cancer Centre, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Maryam Fouladi
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Annie Laquerriere
- Department of Pathology, Normandy Center for Genomic and Personalized Medicine, Rouen University Hospital, Normandie University, UNIROUEN, Inserm U1245, F 76000, Rouen, France
| | | | - Jason Fangusaro
- Department of Pediatric Hematology and Oncology, Children's Healthcare of Atlanta and the Emory University School of Medicine, Atlanta, GA, USA
| | - Fabien Forest
- Department of Pathology, CHU St. Etienne, Saint-Étienne, France
| | - Helen Toledano
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Palma Solano-Paez
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Hospital Infantil Virgen del Rocio, Seville, Spain
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children's, Seattle, WA, USA
| | - Diane Birks
- Department of Pediatrics, University of Colorado Denver, Denver, CO, USA
| | - Lindsey M Hoffman
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Alexandru Szathmari
- Département de Neurochirurgie Adulte et Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Xing Fan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Catchpoole
- Children's Cancer Research Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Li Zhou
- Children's Cancer Research Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Kris Ann P Schultz
- Cancer and Blood Disorder, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | | | - Nada Jabado
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Chris Jones
- The Institute of Cancer Research, London, UK
| | - Delphine Loussouarn
- Service d'Anatomie et de Cytologie pathologiques, CHU Nantes, Nantes, France
| | - Karima Mokhtari
- Département de Neuropathologie, Hôpital Universitaire Pitie-Salpetriere, Paris, France
| | - Audrey Rousseau
- Département de Pathologie Cellulaire et Tissulaire, CHU d'Angers, Angers, France
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Children's Cancer Institute, Lowy Cancer Centre, University of New South Wales, Sydney, NSW, Australia
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Scott L Pomeroy
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Amar Gajjar
- Department of Oncology, Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cynthia Hawkins
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Richard G Grundy
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - D Ashley Hill
- Division of Pathology, Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC, USA
| | - Eric Bouffet
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada
| | - Annie Huang
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., 10421B, Black, Toronto, ON, M5G 1X8, Canada.
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.
- Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Anne Jouvet
- Service d'Anatomie et Cytologie Pathologiques, CHU de Lyon, Lyon, France
- Pathology and Molecular Biology, SFCE, Bordeaux, France
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Picart T, Beuriat PA, Szathmari A, Di Rocco F, Mottolese C. Positional cranial deformation in children: A plea for the efficacy of the cranial helmet in children. Neurochirurgie 2020; 66:102-109. [PMID: 31958410 DOI: 10.1016/j.neuchi.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/23/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cranial deformations have historically aroused the interest of people worldwide. One of the more debated points about positional plagiocephaly is the choice of the treatment. In this article, the senior author (CM) shares his experience on almost 30 years of use of the helmet molding therapy in children with deformation plagiocephaly. METHODS AND POPULATION We retrospectively and systematically reviewed the cases of 2188 patients (75% males and 25% females) presenting positional head deformity and treated between 1991 and 2013 with a cranial helmet. To assess the effectiveness of the helmet, we compared the cranial index in bilateral plagiocephaly and the Cranial Diagonals Difference (CDD) in unilateral plagiocephaly at the beginning and at the end of the treatment. RESULTS The cranial indexes ranged between 94.4% and 124.2% before the treatment and decreased significantly between 86.8% and 121.4% after the treatment (P<0.01). The CDD ranged between 0.3 cm and 4.5 cm with an average of 1.50±0.54 cm before the treatment and decreased significantly between 0.1 cm and 2.5 cm with an average of 0.72±0.37 cm after the treatment (P<0.01). For unilateral plagiocephaly, at the beginning of the treatment, 2.5% children presented a mild plagiocephaly, 19.6% a moderate plagiocephaly and 77.9% a severe plagiocephaly. At the end of the treatment, the deformation was classified as mild in 40.2% children, moderate in 44.3% children and severe in 15.5% children with significantly less children in the most severe subgroups (P<0.01) Facial symmetry pre-existed before the treatment in 13.7% of children. This rate was significantly increased at the end of the treatment to 66.7% (P<0.01). In only 8 cases (0.2%), the helmet therapy did not allow to obtain correct clinical results and a surgical posterior cranial remodeling was performed. CONCLUSIONS The results observed in this series confirms that cranial helmet is a simple and well tolerated alternative which bring satisfying results. Its success implies a good collaboration with parents and a management both by orthoptist, physiotherapist and doctor. Nevertheless, it remains many controversies in the literature concerning in particular long-term cosmetic and functional outcomes. A long-term multicentric prospective study could enable to remove doubts.
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Affiliation(s)
- T Picart
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - P A Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France; Claude-Bernard University Lyon 1, 8, avenue Rockefeller, 69003 Lyon; Reference center for Craniosynostosis, Hôpital Femme Mère Enfant, 32, avenue du Doyen Jean-Lépine, 69677 Bron cedex, France.
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Zaharia MC, Rocco FD, Beuriat P, Szathmari A, Javouhay E, Gillet Y, Mottolese C. MULTIPLE POSTERIOR FOSA ASPERGILOMAS IN A PATIENT WITH CHRONIC GRANULOMATOSIS. JSS 2019. [DOI: 10.33695/jss.v6i4.289] [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: 11/23/2022] Open
Abstract
The invasive infection with Aspergillus fumigatus usually occurs in immunocompromised patients. CNS involvement is extremely rare in children. Usually, the diagnosis is hard, often made after the death of the patient. We describe the first report of a pediatric case of multiple CNS aspergillomas confirmed by a biopsy. We present the case of 3 years old boy who was hospitalized for evolving intracranial hypertension with a cerebellar syndrome. A brain CT showed a left cerebellar mass and early tonsillar commitment and a supra-tentorial lesion in the right occipital lobe. Therefore, a metastatic tumor was suspected and an emergency surgical intervention with cerebral biopsy and ventriculocisternostomy was performed. The cerebral biopsy revealed an Aspergillus fumigatus granuloma and further investigations showed that the patient has chronic granulomatosis due to a homozygous mutation of CYBA gene encoding p22phox. After a favorable evolution in reanimation, he continued the treatment with Voriconazole. At last follow-up, the neurological examination finds no sign of motor focus, no cerebellar syndrome or nystagmus. Walking is difficult with the enlargement of the support base. CNS invasive infection with Aspergillus fumigatus in a child is extremely rare and the presentation might mimic that of a tumor especially with a location of aspergilloma as in our case both supratentorially and infratentorially.
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Lohkamp LN, Mottolese C, Szathmari A, Huguet L, Beuriat PA, Christofori I, Desmurget M, Di Rocco F. Awake brain surgery in children-review of the literature and state-of-the-art. Childs Nerv Syst 2019; 35:2071-2077. [PMID: 31377911 DOI: 10.1007/s00381-019-04279-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 06/10/2019] [Accepted: 06/25/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Awake brain surgery (ABS) is poorly reported in children as it is considered having limited indications due to age and neuropsychological aspects interfering with its feasibility and psychological outcome. The aim of this article is to review the current state-of-the-art of ABS in children and to offer an objective summary of the published literature on diversified outcome aspects of pediatric awake procedures. METHODS A literature review was performed using the MEDLINE (PubMed) electronic database applying the following MeSH terms to the keyword search within titles and abstracts: "awake brain surgery children," "awake brain surgery pediatric," "awake craniotomy children," "awake craniotomy pediatric," and "awake surgery children." Of the initial 753 results obtained from these keyword searches, a full text screening of 51 publications was performed, ultimately resulting in 18 eligible articles for this review. RESULTS A total of 18 full text articles reporting the results of 50 patients were included in the analysis. Sixteen of the 18 studies were retrospective studies, comprising 7 case series, 9 case reports, and 2 reviews. Eleven studies were conducted from anesthesiological (25 patients) and 7 from neurosurgical (25 patients) departments. Most of the patients underwent ABS for supratentorial lesions (26 patients), followed by epilepsy surgery (16 patients) and deep brain stimulation (DBS) (8 patients). The median age was 15 years (range 8-17 years). Persistent deficits occurred in 6 patients, (12%), corresponding to minor motor palsies (4%) and neuropsychological concerns (8%). An awake procedure was aborted in 2 patients (4%) due to cooperation failure and anxiety, respectively. CONCLUSIONS Despite well-documented beneficial aspects, ABS remains mainly limited to adults. This review confirms a reliable tolerability of ABS in selected children; however, recommendations and guidelines for its standardized implementation in this patient group are pending. Recommendations and guidelines may address diagnostic workup and intra-operative handling besides criteria of eligibility, psychological preparation, and coordinated neuropsychological testing in order to routinely offer ABS to children.
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Affiliation(s)
- Laura-Nanna Lohkamp
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France.
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France
| | - Ludivine Huguet
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre-Aurelien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France.,Center for Cognitive Neuroscience, Lyon, France
| | | | | | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon, France.
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Di Rocco F, Gleizal A, Szathmari A, Beuriat P, Paulus C, Mottolese C. Sagittal suture craniosynostosis or craniosynostoses? The heterogeneity of the most common premature fusion of the cranial sutures. Neurochirurgie 2019; 65:232-238. [DOI: 10.1016/j.neuchi.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
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Verlut I, Mottolese C, Szathmari A, Banvillet E, Poncet A, Blache A, Rousselle C, Gleizal A, Paulus C, Di Rocco F. [Neuropsychological consequences of craniosynostosis: Non-syndromic scaphocephaly]. Neurochirurgie 2019; 65:330-336. [PMID: 31585152 DOI: 10.1016/j.neuchi.2019.09.018] [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: 08/26/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scaphocephaly increases the rate of some modifications of cognitive and mood profile in a manner that remains to be elucidated. OBJECTIVE We aimed to describe the impact of scaphocephaly on neuropsychological profile and more particularly on the executive functions. PATIENTS AND METHODS An experimental group of 19 children older than 5 years, operated on for scaphocephaly, was compared with a control group of 10 children operated on for trigonocephaly, using IQ tasks, attention tasks and mood scales. A group of 6 children from 2 to 4 years old, operated on for scaphocephaly, and a group of 6 children with non-operated scaphocephaly are also described. RESULTS Both the experimental group and the control group showed unchanged IQ, whereas attention deficit and anxiety disorder were more frequent in the experimental group. Cognitive profiles differed between groups, with a higher rate of impaired inhibitory control of visual processing in the scaphocephaly group, contrasting with a higher rate of impaired auditory verbal working memory in the trigonocephaly group. Comparable profiles were also found in groups of younger or non-operated children with scaphocephaly. CONCLUSIONS Many children with scaphocephaly must cope with a specific neuropsychological profile throughout development. This study suggests the interest for these children and their families of specific follow-up in reference centers.
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Affiliation(s)
- I Verlut
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France.
| | - C Mottolese
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Szathmari
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - E Banvillet
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Poncet
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Blache
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - C Rousselle
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Gleizal
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - C Paulus
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - F Di Rocco
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
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Huguet L, Mottolese C, Paulus C, Beuriat PA, Szathmari A, Gleizal A, Di Rocco F. [Psychological support for children operated on for craniosynostosis and their family. Some thoughts for the craniofacial surgeon]. Neurochirurgie 2019; 65:337-340. [PMID: 31557490 DOI: 10.1016/j.neuchi.2019.09.004] [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: 07/04/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
Abstract
What is the impact on child and family when they receive a diagnosis of craniostenosis? And what is the impact of surgery? What is the role of the clinical psychologist in accompanying the child and family, especially during hospital stay and surgery time? We present a few thoughts that help understand the psychological processes at work in case of craniostenosis, giving a little hint of the impact on the life of the child and family - which surgeons, preoccupied by more technical questions, sometimes tend to overlook.
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Affiliation(s)
- L Huguet
- , Hôpital Femme Mère Enfant, hospices civiles de Lyon, centre de référence Craniosténoses, université de Lyon, inserm 1033, boulevard Pinel, 69000 Lyon, France
| | - C Mottolese
- , Hôpital Femme Mère Enfant, hospices civiles de Lyon, centre de référence Craniosténoses, université de Lyon, inserm 1033, boulevard Pinel, 69000 Lyon, France
| | - C Paulus
- , Hôpital Femme Mère Enfant, hospices civiles de Lyon, centre de référence Craniosténoses, université de Lyon, inserm 1033, boulevard Pinel, 69000 Lyon, France
| | - P-A Beuriat
- , Hôpital Femme Mère Enfant, hospices civiles de Lyon, centre de référence Craniosténoses, université de Lyon, inserm 1033, boulevard Pinel, 69000 Lyon, France
| | - A Szathmari
- , Hôpital Femme Mère Enfant, hospices civiles de Lyon, centre de référence Craniosténoses, université de Lyon, inserm 1033, boulevard Pinel, 69000 Lyon, France
| | - A Gleizal
- , Hôpital Femme Mère Enfant, hospices civiles de Lyon, centre de référence Craniosténoses, université de Lyon, inserm 1033, boulevard Pinel, 69000 Lyon, France
| | - F Di Rocco
- , Hôpital Femme Mère Enfant, hospices civiles de Lyon, centre de référence Craniosténoses, université de Lyon, inserm 1033, boulevard Pinel, 69000 Lyon, France.
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Manfiotto M, Beccaria K, Rolland A, Paternoster G, Plas B, Boetto S, Vinchon M, Mottolese C, Beuriat PA, Szathmari A, Di Rocco F, Scavarda D, Seigneuret E, Wrobleski I, Klein O, Joud A, Gimbert E, Jecko V, Vignes JR, Roujeau T, Dupont A, Zerah M, Lonjon M. Decompressive Craniectomy in Children with Severe Traumatic Brain Injury: A Multicenter Retrospective Study and Literature Review. World Neurosurg 2019; 129:e56-e62. [PMID: 31054345 DOI: 10.1016/j.wneu.2019.04.215] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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Beuriat PA, Lohkamp LN, Szathmari A, Rousselle C, Sabatier I, Di Rocco F, Mottolese C. Repair of Cranial Bone Defects in Children Using Synthetic Hydroxyapatite Cranioplasty (CustomBone). World Neurosurg 2019; 129:e104-e113. [DOI: 10.1016/j.wneu.2019.05.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022]
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Fouret M, Jamilloux Y, Szathmari A, Vasiljevic A, Meyronet D, Ducray F, Seve P. Simultaneous occurrence of giant cell arteritis and cerebral amyloid angiopathy. Rheumatology (Oxford) 2019; 58:1503-1505. [PMID: 30927437 DOI: 10.1093/rheumatology/kez099] [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] [Accepted: 02/19/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marine Fouret
- Department of Neurology, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron.,University Claude Bernard Lyon 1
| | - Yvan Jamilloux
- University Claude Bernard Lyon 1.,Department of Internal Medicine, University Hospital Croix-Rousse, Hospices Civils de Lyon, Lyon
| | | | - Alexandre Vasiljevic
- University Claude Bernard Lyon 1.,Department of Neuropathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - David Meyronet
- University Claude Bernard Lyon 1.,Department of Neuropathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France.,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon
| | - François Ducray
- University Claude Bernard Lyon 1.,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon.,Department of Neuro-Oncology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Pascal Seve
- University Claude Bernard Lyon 1.,Department of Internal Medicine, University Hospital Croix-Rousse, Hospices Civils de Lyon, Lyon
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Beuriat PA, Poirot I, Hameury F, Demede D, Sweeney KJ, Szathmari A, Di Rocco F, Mottolese C. Low level myelomeningoceles: do they need prenatal surgery? Childs Nerv Syst 2019; 35:957-963. [PMID: 30915531 DOI: 10.1007/s00381-019-04123-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postnatal closure of a myelomeningocele remains the standard of care in many countries. The prenatal closure has given hope for decreasing the damage to the neural placode and has challenged classic management. However, this technique presents potential sources of complications. Patients with MMC with an anatomical level of L4 and below have a better functional prognosis than higher level malformations. Are they still candidates for prenatal surgery? OBJECTIVE To evaluate outcome of MMC with an anatomical level of L4 and below and discuss, with support of the literature, the indications to perform prenatal closure in this particular group of patients. MATERIALS AND METHODS Twenty-nine children were included in this observational study. The level of the vertebral malformation was sacral in 12 cases (41.4%) or lumbar (level ≤ L4) in 17 cases (58.6%). All the patients was operated postnatally for closure of the MMC with microsurgical technique as soon as possible after clinical evaluation (range 0-97 days). RESULTS Only 11 out of 29 patients (37.9%) needed of a CSF diversion. A Chiari II malformation was present before MMC closure in 17 patients (58.6%) and only in 5 (17%) after. Twenty-six patients (89.7%) were able to walk. Seven (23%) and 16 (55%) of our patients have a normal bladder and bowel control, respectively. All school-aged children attend school. CONCLUSIONS The functional outcome for low-level MMC is good when managed with modern microneurosurgical techniques with a low risk for the patient and the mother. Therefore, we do not suggest prenatal surgery for subgroup of infant with MM.
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Affiliation(s)
- Pierre-Aurelien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France
| | - Isabelle Poirot
- Department of Pediatric Rehabilitation l'ESCALE, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France
| | - Frederic Hameury
- Department of Urologic Surgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France
| | - Delphine Demede
- Department of Urologic Surgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France
| | - Kieron J Sweeney
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France.
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Sweeney KJ, Mottolese C, Belot A, Szathmari A, Frappaz D, Lesca G, Putoux A, Di Rocco F. The first case report of medulloblastoma associated with Tatton-Brown-Rahman syndrome. Am J Med Genet A 2019; 179:1357-1361. [PMID: 31066180 DOI: 10.1002/ajmg.a.61180] [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: 11/21/2018] [Revised: 03/13/2019] [Accepted: 04/17/2019] [Indexed: 02/06/2023]
Abstract
DNMT3A codes for a DNA methyl transferase enzyme that plays a central role embryogenesis. Somatic mutations in this gene have been associated with tumorigenesis and are associated with a number of cancers. The recently described Tatton-Brown-Rahman syndrome (TBRS) is due to heterozygous germline mutations in the DNMT3A gene. So far, only one case of hematological malignancy associated with TBRS have been reported. Here, we describe the first case presenting with TBRS and medulloblastoma. We also discuss the associations between mutations in DNMT3A found in TBRS, AML, and medulloblastoma.
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Affiliation(s)
- Kieron J Sweeney
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Le service de neurochirurgie pédiatrique, Hopital Mere Femme, Hospices Civils de Lyon, Lyon, France
| | - Carmine Mottolese
- Le service de neurochirurgie pédiatrique, Hopital Mere Femme, Hospices Civils de Lyon, Lyon, France
| | - Alexandre Belot
- Service de néphrologie-rhumatologie-dermatologie pédiatriques, Hopital Mere Femme, Hospices Civils de Lyon, Lyon, France
| | - Alexandru Szathmari
- Le service de neurochirurgie pédiatrique, Hopital Mere Femme, Hospices Civils de Lyon, Lyon, France
| | | | - Gaetan Lesca
- Service de cytogenetique constitutionnelle, Hospices Civils de Lyon, Lyon, France
| | - Audrey Putoux
- Service de génétique, CHU de Lyon, Lyon, France.,Centre de Recherche en Neurosciences de Lyon, équipe GENDEV, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Federico Di Rocco
- Le service de neurochirurgie pédiatrique, Hopital Mere Femme, Hospices Civils de Lyon, Lyon, France
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Di Rocco F, Szathmari A, Paulus C, Broussole T, Sweeney K, Beuriat P, Gleizal A, Mottolese C. Contrôle des veines émissaires métopiques dans la chirurgie de trigonocéphalie. Note technique. Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.111] [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: 10/26/2022]
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Dauleac C, Beuriat PA, Di Rocco F, Szathmari A, Mottolese C. Surgical Management of Pediatric Spine Trauma: 12 Years of Experience. World Neurosurg 2019; 126:e1494-e1502. [PMID: 30910750 DOI: 10.1016/j.wneu.2019.03.134] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Spine trauma management in children varies from one team to another, and to date, no clear consensus has been reached. The goal of this study was to describe the epidemiology of spine trauma in children and evaluate the timing and techniques of surgery when it was required. METHODS A retrospective review of all patients admitted to our pediatric trauma center for spine traumas that required surgical management, between 2005 and 2016, was performed. All patients were followed with clinical and radiologic examination to evaluate the quality of fusion and realignment. RESULTS Seventy-three children, with a mean age of 14.1 years, were admitted. Spinal injuries were more common in the teenage group (14-18 years). The predominant etiology of spine injuries was motor vehicle collision (36%). The spinal level of injury varied according to the age group: young children presented more cervical traumas (P < 0.01), while teenagers presented more lumbar traumas. There were more fractures alone in the teenage group (P < 0.005), while there were more luxations alone in the school-age group (P < 0.05). Median timing for surgical intervention in patients with neurologic deficits was 1 day. Patients with posterior wall recession >5 mm underwent surgical management quicker than patients with no posterior wall recession (P < 0.03). At follow-up, out of the 37 patients with initial neurologic deficits, 14 had improved (38%). CONCLUSIONS Diskoligament maturation is an essential concept in spine traumas in children, as well as in surgical management. Surgical procedures should be carried out as soon as possible when patients present with neurologic deficits. At the thoracolumbar junction, a 2-level up-and-down fixation is recommended.
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Affiliation(s)
- Corentin Dauleac
- Department of Neurosurgery, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France; Université de Lyon, Université Claude Bernard, Lyon, France.
| | - Pierre-Aurélien Beuriat
- Department of Neurosurgery, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France; Université de Lyon, Université Claude Bernard, Lyon, France; Department of Pediatric Neurosurgery, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - Federico Di Rocco
- Université de Lyon, Université Claude Bernard, Lyon, France; Department of Pediatric Neurosurgery, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - Alexandru Szathmari
- Department of Neurosurgery, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France; Department of Pediatric Neurosurgery, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - Carmine Mottolese
- Department of Neurosurgery, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France; Department of Pediatric Neurosurgery, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
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Beuriat PA, Cattiaux L, Guibaud L, Szathmari A, Sabatier I, Rousselle C, Mottolese C, Di Rocco F. Isolated antenatal hydrocephalus after foetal exposure to misoprostol : a teratogenic effect of the cytotec® ? World Neurosurg 2019; 124:98-100. [PMID: 30639481 DOI: 10.1016/j.wneu.2018.12.177] [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: 11/09/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
Misoprostol is often used for termination of pregnancy in France and others countries. However, some pregnancies are continued after taking the drug and congenital malformations are known to be the consequence of fetal exposure to misoprostol, among then hydrocephalus. The type of hydrocephalus in case of misoprostol exposure is not known. We report the first case in the literature of an obstructive hydrocephalus due to an aqueduct of Sylvius stenosis diagnosed during the pregnancy after misoprostol intake. The possible physiopathological implications of the drug are discussed regarding the genesis of this malformation.
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Affiliation(s)
- Pierre-Aurelien Beuriat
- Pediatric Neurosurgical Unit, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France
| | - Lucile Cattiaux
- Pediatric Neurosurgical Unit, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France
| | - Laurent Guibaud
- Service d'Imagerie Pédiatrique et Foetale, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France
| | - Alexandru Szathmari
- Pediatric Neurosurgical Unit, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France
| | - Isabelle Sabatier
- Pediatric Neurosurgical Unit, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France; Pediatric Neurological Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - Christophe Rousselle
- Pediatric Neurosurgical Unit, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France; Pediatric Neurological Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - Carmine Mottolese
- Pediatric Neurosurgical Unit, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France.
| | - Federico Di Rocco
- Pediatric Neurosurgical Unit, Hôpital Femme Mère Enfant, Claude Bernard University, Lyon, France
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di Rocco F, Gleizal A, Lohkamp L, Szathmari A, Paulus C, Mottolese C. Control of metopic emissary veins in trigonocephaly surgery. Technical note. Childs Nerv Syst 2018; 34:2481-2484. [PMID: 30054806 DOI: 10.1007/s00381-018-3928-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/16/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Trigonocephaly with its premature fusion of the metopic synostosis is associated with a risk of cerebral compression and several craniofacial morphological deformations. Numerous surgical techniques have been proposed to enlarge and reshape the forehead. They all carry a risk of bleeding during osteotomies, especially in the region of the superior sagittal sinus (SSS) encased in the early fused suture and of the paired metopic transosseous emissary veins superior to the glabella, which is typical of this type of synostosis. In fact, these paired metopic transosseous veins are often, if not always, the source of major bleeding when torn during the elevation of the frontal flap. TECHNICAL NOTE A simple technical variant may prevent or at least easily control bleeding in this region during the early phases of the surgical repair. The technical variant to the standard surgical techniques utilized to correct trigonocephaly consists in preserving a triangle of bone above the glabella (about 4 cm at the base and 4 cm in height). The triangle of bone contains the initial segment of the SSS and the emissary metopic veins draining the frontal poles. After removing the frontal flap in a conventional manner, this technical variant allows to detach the veins as well as the SSS from the surrounding bone structures under direct visualization, also in case of vessels running partially encased in the bone. Once the venous structure is detached and hemostasis controlled, this last piece of frontal bone may be removed without unnecessary "iatrogenic" bleeding. CONCLUSION The propounded procedure does not prolong the surgical time significantly and does not require additional surgical skills or equipment.
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Affiliation(s)
- Federico di Rocco
- Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Centre de Référence Craniosténoses, Université de Lyon, Lyon, France. .,Centre de Référence Craniosténoses, Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Université de Lyon, 59 bd Pinel, 69677, Bron Cedex, France.
| | - Arnaud Gleizal
- Centre de Référence Craniosténoses, Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Université de Lyon, 59 bd Pinel, 69677, Bron Cedex, France.,Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, Centre de Référence Craniosténoses, Université de Lyon, Lyon, France
| | - Laura Lohkamp
- Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Centre de Référence Craniosténoses, Université de Lyon, Lyon, France
| | - Alexandru Szathmari
- Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Centre de Référence Craniosténoses, Université de Lyon, Lyon, France.,Centre de Référence Craniosténoses, Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Université de Lyon, 59 bd Pinel, 69677, Bron Cedex, France
| | - Christian Paulus
- Centre de Référence Craniosténoses, Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Université de Lyon, 59 bd Pinel, 69677, Bron Cedex, France.,Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, Centre de Référence Craniosténoses, Université de Lyon, Lyon, France
| | - Carmine Mottolese
- Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Centre de Référence Craniosténoses, Université de Lyon, Lyon, France.,Centre de Référence Craniosténoses, Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Université de Lyon, 59 bd Pinel, 69677, Bron Cedex, France
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Abstract
The original version of this article unfortunately contained an error. The authors have been published with inverted given and family names. Given in this article are the corrected author names.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France.
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Beuriat P, Szathmari A, Rousselle C, Sabatier I, Di Rocco F, Mottolese C. Réversibilité de la malformation de chiari de type II après fermeture postnatale de la myéloméningocèle. Neurochirurgie 2018. [DOI: 10.1016/j.neuchi.2018.05.176] [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: 11/28/2022]
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Peron C, Di Rocco F, Plaisant F, Claris O, Nguyen K, Beuriat P, Szathmari A, Mottolese C. Devenir des hydrocéphalies posthémorragie intraventriculaire sévère du prématuré. Qui a besoin d’une valve ? Neurochirurgie 2018. [DOI: 10.1016/j.neuchi.2018.05.144] [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: 11/16/2022]
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Piaton N, Beuriat P, Szathmari A, Di Rocco F, Frappaz D, Mottolese C. Gliomes chiasmato-hypothalamiques : existe-t-il encore une place pour une chirurgie agressive ? Neurochirurgie 2018. [DOI: 10.1016/j.neuchi.2018.05.037] [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: 11/25/2022]
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Beuriat PA, Di Rocco F, Szathmari A, Mottolese C. Management of split cord malformation in children: the Lyon experience. Childs Nerv Syst 2018; 34:883-891. [PMID: 29582170 DOI: 10.1007/s00381-018-3772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/09/2017] [Accepted: 03/01/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Split cord malformation (SCM) is a rare congenital spinal abnormality. Clinical presentation varies. Other congenital defects can be associated. Management is surgical. MATERIAL AND METHODS We retrospectively reviewed all our SCM cases and reported our experience for its management. From 1990 to 2014, 37 patients were operated. Five situations lead to the diagnosis (orthopedic disorders (n = 8), orthopedic and neurological disorders (n = 16), pure neurological disorders (n = 5), no symptoms except cutaneous signs (n = 7), antenatal diagnosis (n = 1)). Scoliosis was the most common associated condition. The level of the spur was always under T7 except in one case. There were more type I (n = 22) than type II (n = 15) SCM. RESULTS Patients with preoperative neurological symptoms (n = 21) were improved in 71.4%. Five out of nine patients that had preoperative bladder dysfunction were improved. Eleven patients needed surgical correction of the scoliosis. CONCLUSIONS For us, the surgical procedure is mandatory even in case of asymptomatic discovery in order to avoid late clinical deterioration. In any case, the filum terminale need to be cut in order to untether completely the spinal cord. In case a surgical correction of a spinal deformity is needed, we recommend a two-stage surgery, for both SCM type. The SCM surgery can stop the evolution of the scoliosis and it may just need an orthopedic treatment with a brace.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France.
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Beuriat PA, Poirot I, Hameury F, Szathmari A, Rousselle C, Sabatier I, di Rocco F, Mottolese C. Postnatal Management of Myelomeningocele: Outcome with a Multidisciplinary Team Experience. World Neurosurg 2018; 110:e24-e31. [DOI: 10.1016/j.wneu.2017.09.169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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Beuriat PA, Szathmari A, Rousselle C, Sabatier I, Di Rocco F, Mottolese C. Complete Reversibility of the Chiari Type II Malformation After Postnatal Repair of Myelomeningocele. World Neurosurg 2017; 108:62-68. [DOI: 10.1016/j.wneu.2017.08.152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/15/2022]
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Manfiotto M, Mottolese C, Szathmari A, Beuriat PA, Klein O, Vinchon M, Gimbert E, Roujeau T, Scavarda D, Zerah M, Di Rocco F. Decompressive craniectomy and CSF disorders in children. Childs Nerv Syst 2017; 33:1751-1757. [PMID: 29149390 DOI: 10.1007/s00381-017-3542-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Decompressive craniectomy (DC) is a lifesaving procedure but is associated to several post-operative complications, namely cerebrospinal fluid (CSF) dynamics impairment. The aim of this multicentric study was to evaluate the incidence of such CSF alterations after DC and review their impact on the overall outcome. MATERIAL AND METHODS We performed a retrospective multicentric study to analyze the CSF disorders occurring in children aged from 0 to 17 years who had undergone a DC for traumatic brain injury (TBI) in the major Departments of Pediatric Neurosurgery of France between January 2006 and August 2016. RESULTS Out of 150 children, ranging in age between 7 months and 17 years, mean 10.75 years, who underwent a DC for TBI in 10 French pediatric neurosurgical centers. Sixteen (6 males, 10 females) (10.67%) developed CSF disorders following the surgical procedure and required an extrathecal CSF shunting. External ventricular drainage increased the risk of further complications, especially cranioplasty infection (p = 0.008). CONCLUSION CSF disorders affect a minority of children after DC for TBI. They may develop early after the DC but they may develop several months after the cranioplasty (8 months), consequently indicating the necessity of clinical and radiological close follow-up after discharge from the neurosurgical unit. External ventricular drainage and permanent CSF shunt placement increase significantly the risk of cranioplasty infection.
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Affiliation(s)
| | - Carmine Mottolese
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France
| | - Alexandru Szathmari
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France
| | - Pierre-Aurelien Beuriat
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France
| | - Olivier Klein
- Centre Hospitalier Universitaire de Nancy, Nancy, France
| | | | - Edouard Gimbert
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Thomas Roujeau
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Didier Scavarda
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | | | - Federico Di Rocco
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, 59 Bd Pinel, 69677, Bron Cedex, France.
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Frappaz D, Pedone C, Thiesse P, Szathmari A, Conter CF, Mottolese C, Carrie C. Visual complaints in intracranial germinomas. Pediatr Blood Cancer 2017; 64. [PMID: 28436607 DOI: 10.1002/pbc.26543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/02/2016] [Revised: 02/10/2017] [Accepted: 02/23/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Patients with brain tumors often report having visual complaints. This may be due to increased intracranial pressure, compression/invasion of the optic pathway or diplopia. We assessed the incidence and the etiology of visual symptoms in patients with intracranial germinoma tumors (ICGTs). METHODS AND MATERIALS We performed a blinded retrospective review of the clinical charts and the initial magnetic resonance imaging (MRI) of 28 patients with ICGT. Thirteen tumors were pineal, five suprasellar, seven bifocal, and further three involved either the optic nerve, the corpus callosum, or the brainstem. RESULTS Twelve patients reported visual disturbances, seven of whom mainly experienced a decrease in vision. Two of those were initially managed as "retrobulbar neuritis" when endocrinologic symptoms prompted assessment by MRI. Involvement of the optic pathway was underestimated, and both relapsed. Field deficits were definitive sequelae, whereas visual acuity was sometimes regressive in the absence of optic atrophy. CONCLUSIONS Compression or invasion of the optic pathway by germinomas is not a rare occurrence, and this possibility should not be overlooked when thickening or contrast enhancement is detected. Radiotherapy fields should be extended accordingly.
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Affiliation(s)
- Didier Frappaz
- Department of Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Claire Pedone
- Department of Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Philippe Thiesse
- Department of Radiology, Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | | | - Cécile Faure Conter
- Department of Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | | | - Christian Carrie
- Department of Radiotherapy, Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
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Frappaz D, Pedone C, Thiesse P, Faure-Conter C, Carrie C, Szathmari A, Mottolese C. P11.05 Visual impairment in intracranial germinomas. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.349] [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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Grassiot B, Szathmari A, Beuriat PA, Frappaz D, Jouvet A, Mottolese C. Évolution des stratégies thérapeutiques du médulloblastome chez l’enfant. Étude de la série lyonnaise de 2000 à 2015. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.016] [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: 10/19/2022]
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Di Rocco F, Beuriat P, Szathmari A, Mottolese C. Scaphocéphalie : analyse du parcours de soins chez les enfants de plus d’un an. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.029] [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: 10/19/2022]
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