[Dosimetric stereotactic radiosurgical accident: Study of 33 patients treated for brain metastases]. / Traitement des métastases cérébrales par radiochirurgie stéréotaxique : étude de 33 cas liés à un accident de "surexposition".

The consequences of a dosimetric radiosurgery accident are not the same as a conventional radiotherapy accident. The objective of this study was to estimate the clinical and radiological outcome of patients treated by radiosurgery for metastasis during the period of the overexposure accident that occurred in the Toulouse Radiosurgery Unit. Between April 2006 and March 2007, 33 patients with 57 metastases were treated in the Toulouse Radiosurgery Unit (Novalis(®), BrainLab). An initial error in the estimation of the scatter factors led to an overexposure to radiation. The median age was 55 years [range, 35-85]. Twenty-one patients (64%) harbored a single metastasis. The primary tumor location was lung (16 cases), kidney (nine cases), breast (four cases), and others (four cases). The mean tumoral volume was 3.2cm(3) [0.04-14.07]. The mean prescribed dose at the isocenter was 20 Gy [range, 10-23], the mean delivered dose was 31.5 Gy [range, 13-52], and the mean overdose was 61.2% [range, 5.6-226.8]. In order to evaluate the consequences of the overdose, three parameters were analyzed: a risk index using dose and volume, the volume of parenchyma that received more than 12 Gy, and the mean dose in a sphere of 20cm(3) surrounding the target volume. Median actuarial survival was 14.1 months, the survival rate was 79.4 % at six months, 59.1% at 12 months, and 27.2% at 24 months. The rate of tumor control was 80.7%. No morbidity was observed. There was no correlation between death and the parameters studied. The survival rates and times observed in our study of the patients treated for brain metastases by radiosurgery and overexposed were among the good results of the international literature. Deaths were not related to the overdose and no side effect was noted. This dosimetric accident has not had worse consequences in this population.

[Intramedullary tumors. Results of a national investigation in private neurosurgery]. / Les tumeurs intramédullaires. Résultat d'une enquête nationale en neurochirurgie libérale.

UNLABELLED: The frequency of intramedullary tumors is 0.5 cases per year for 100,000 inhabitants. The study reported herein was a retrospective study conducted from January 1985 to September 2007. MATERIAL: Seventy-nine cases were distributed in the following manner: ependymomas, 38; astrocytomas, 22; oligodendrogliomas, four; gangliogliomas, two; hemangioblastomas, 10 (nine sporadic cases and one case of Von Hippel-Lindau disease); primitive melanoma, one; and intramedullary neurinomas, two. Three patients were lost to follow-up and 10 patients died. METHOD: All patients were explored using MRI and were operated using a microsurgical technique. Tumor removal was complete in the cases of ependymoma and hemangioblastoma and subtotal in the cases of astrocytoma. RESULTS: Ependymoma: 38 cases with three cases of ependymoblastoma. Mean age: 47 years (range, 17-74 years); 17 males and 21 females. Diagnostic delay: less than one year, 11; one year, 15 cases; two years, nine cases; three years, three cases. Seven recurrences with one 35 years after a prior removal. Localizations: cervical and cervicodorsal, 19; dorsal, ten; dorsolumbar, seven; holomedullary, one. Number of levels concerned: 5-12 (with the cysts associated). Mean follow-up was 10 years (range, two months to 35 years). Patients stabilized, 19; worse, six; improved, nine. Patients deceased: four, one by suicide, three cases of ependymoblastoma (survival, seven months). Astrocytomas: 22 cases, with 14 cases of astrocytoma, two pilocytic astrocytoma, four malignant astrocytoma, and two glioblastoma. Mean age: 44 years (range, 22-73 years); 14 males and eight females. Diagnostic delay: malignant tumors, one to nine months; low grades; three to six years (range, eight months to 25 years). Number of levels concerned: two to eight. Mean follow-up: seven years (range, six months to 10 years). Stabilized patients: 13; worse, five; deaths, four. Oligodendroglioma: four cases. Mean age: 58 years; two males and two females. Diagnostic delay: 10months. Localization: cervical, three; dorsal, one. Oligodendroglioma A, two; B, two. Results: two cases stabilized, one case with recurrence, and one patient deceased. Ganglioglioma: two. Both cases were associated with scoliosis. Recurrence in the eighth month and two years for the second case. One patient died. Hemangioblastoma: 10 cases, nine sporadic and one case of Von Hippel-Lindau disease. Nine cervical localizations, one on the medulla cone. Mean age: 45 years (range, 11-54 years); eight males and two females. Total removal in nine cases. One case of recurrence seven years after a prior surgery and operated a second time with no recurrence after 10 years of follow-up. Intramedullary neurinomas: two cases with a total removal and 15 years of follow-up. Primitive melanoma: one case with mediothoracic location. Treatment with surgery plus radiotherapy. Follow-up, seven years without recurrence. CONCLUSION: Total removal of the intramedullary tumors is a challenge. In cases of removal, the risk of worsening status is 18-19.5%. Subtotal or incomplete removal 27-40% risk of recurrence.

[Is it necessary to operate on asymptomatic aneurysms? Apropos of 114 surgically treated asymptomatic aneurysms]. / Faut-il opérer les anévrysmes asymptomatiques? A propos de 114 anévrysmes asymptomatiques opérés.

A six years retrospective analysis of asymptomatic aneurysms (A.A.) was done in 4 neurosurgical departments: 114 AA were clipped in 99 patients. In 44 patients (48 asymptomatic aneurysms) the surgical procedure was achieved in one step for both symptomatic and asymptomatic aneurysms. In 59 patients (66 asymptomatic aneurysms) the surgical procedure was delayed as it necessitated a second and elective craniotomy. As regard the treatment of asymptomatic aneurysms, there was no morbidity, and one death due to a massive pulmonary embolism. These surgical results are undoubtebly better than the risk of hemorrhage from unruptured aneurysm as emphasized in the literature.

[Early surgery of ruptured aneurysms. A factor in preventing ischemia]. / L'opération précoce des anévrysmes rompus. Un facteur de prévention de l'ischémie.

110 patients with ruptured aneurysms were operated on within 4 to 96 hours after subarachnoid hemorrhage. Clinical grades (Hunt) were: 1-2-3 in 93 cases and 4-5 in 17 cases. Among the patients grades 1-2-3, 81% had a good out come without any neurological abnormality, among the patients graded 4-5, only 27% had a fair out come. Cerebral ischemia has been noted (CTS can + neurological deficits) in 7 cases only among patients graded 1-2-3 (93 cases). The results, concerning ischemia, are better than the natural course of ruptured aneurysms and better than the course in series with delayed operation. Probably vasospasm is not alone to create ischemia.

[Surgical and pathological study of the approach to the superior choroid plexus of the 3 rd ventricle. One case of posterior choroid arteriovenous aneurysm (author's transl)]. / Etude anatomo-chirurgicale de la voie d'abord de la toile choroïdienne supérieure du 3e ventricule. A propos d'un anévrysme artério-veineux choroïdien postérieur.

The authors describe a case of an arterio venous malformation of the tela choroidea of the third ventricle which was feeding by the postero medial choroidal artery and draining by the internal cerebral vein. This A-V malformation was microsurgically excluded in sitting position by an occipital interhemispheric, transtentorial and transversal transcallosal approach without any postsurgical clinical signs. An anatomical study of this region shows an easy recognition of the choroidal postero medial artery by the regular presence of an arterial loop which concavity is crossed by the terminal segment of the basilar vein of Rosenthal. The knowledge of the occipital internal veins drained in the callosal posterior vein to form a common trunk, the cuneo limbic vein drained itself into the vein of Galen is important to know. This venous system is to preserve at the time of retraction of the occipital lobe to not give rise to infarction and therefore hemianopsia. At least the transverse section of the posterior part of corpus callosum permits a good approach of the roof of the third ventricle and is clinically very harmless if the protection of the cuneo limbic vein is assumed.