Neurosurgical Device Implantation for Neurooncologic Patients: What To Avoid?

Background: Neurooncologic patients frequently require surgery, and neurosurgical devices are often implanted during neurosurgery. These devices could disturb oncologic follow-up by magnetic resonance imaging. Methods: The authors describe the use of neurosurgical devices, such as bone substitutes, ventriculoperitoneal shunts, and titanium skull fixations, in neurooncologic patients. Results: Acrylic cement cranioplasty, valve of ventriculoperitoneal shunt, and titanium skull fixations produced magnetic artifacts disturbing postoperative magnetic resonance imaging. Conclusions: The authors highlight the fact that all these neurosurgical devices implanted during surgery should be carefully evaluated to allow appropriate imaging follow-up for neurooncologic patients, which is a problem that remains underreported in the literature.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Unexpected presentation of diabetes insipidus following pineal tumor resection: A case report

Background: Neuroendocrine dysfunction is a common complication of several neurosurgical conditions. In particular, central diabetes insipidus (CDI) can occur subsequent to traumatic brain injury, subarachnoid hemorrhage, cerebral tumors or as a result of a complication following pituitary neurosurgery. In contrast, surgical resection of non-sellar tumors does not commonly result in CDI, with only a few cases reported in the literature. Case description: We report the case of a 40-year-old man who presented a transient CDI following surgical resection of a pineal papillary tumor via an occipital interhemispheric trans-tentorial approach. The underlying pathogenesis of CDI occurring post resection of tumors arising at a distance from the sella is not yet clearly understood, especially since there is no evidence of direct compression of the pituitary stalk. With regards to our case, we hypothesize that restauration of the initial obstructive hydrocephalus might induce a rapid intracranial pressure variation leading to hemodynamics changes of the portal hypophyseal vascular system. Postoperative air entrapment in the sellar region might also lead to irritation of the pituitary stalk. Conclusion: This case highlights that CDI may happen as a consequence of pineal tumor resection and advocates for a careful postoperative monitoring.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A propos d'un cas de tumeur intramédullaire

Case report: A 52-year-old woman without relevant medical history presented neck pain and weakness of the right hand Since 2 months. We noted bilateral pyramidal signs With sensory disorders of the four limbs. Magnetic resonance imaging (MRI) evidenced a right-sided intramedullary lesion at the level of C6 and C7, measuring 10x15mm. The evoked diagnoses were astrocytoma and hemangioblastoma. Surgical resection was partial because of: i) the absence of cleavage plan between the tumor and the spinal cord, ii) the peroperative anatomopathological diagnosis of metastasis associated With poor prognosis and iii) the temporary loss of evoked potentials on neuromonitoring. The final anatomopathological diagnosis confirmed a metastatic pulmonary adenocarcinoma. The disease was pluri-metastatic and uncontrolled 8 months after neurosurgery. Discussion: Most intramedullary spinal cord tumors are ependymomas and astrocytomas. Intramedullary metastases from visceral cancers are rare, associated With advanced neoplasia and poor prognosis. Conclusion Intramedullary metastases rarely present as the revealing presentation of a neoplastic disease. However, the diagnosis must be kept in mind. The strategy is to exclude a primary cancer and Other metastatic lesions in cases of rapid clinical evolution, smoking patient or atypical MRI images. The present case underlines the importance of peroperative anatomopathological examination and intraoperative neuromonitoring during spinal cord surgery.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Administration précoce de témozolomide après chirurgie chez des patients ayant un glioblastome de mauvais pronostic: étude de faisabilité

Introduction: Despite the combined adjuvant treatment of radiotherapy plus chemotherapy with temozolomide (TMZ) followed by 6 cycles of temozolomide after surgery, the prognosis of patients with glioblastoma remains poor. We conducted a monocentric prospective study to explore the tolerance and potential efficacy of an early temozolomide cycle after surgery. Method: Patients with newly diagnosed glioblastoma (unmutated IDH1) and of poor prognosis (age > 50 years, biopsy or partial resection or unmethylated MGMT promoter) were prospectively included from June 2014 to 2017. They all received a cycle of 5 days of temozolomide between surgery and the combined adjuvant treatment. Results: Twelve patients of median age 64.5 years (45–73) were included in the study. The median doses of temozolomide administered were respectively 265 mg (225–300) for the early cycle; 130 mg (110–150) for the concomitant treatment and 310 mg (225–400) for the adjuvant one. Side effects during treatment were grade III lymphopenia, grade III neutropenia, fatigue and nausea/vomiting respectively in 4, 1, 7 and 5 patients. Progression-free survival and overall survival were respectively 90% and 91.7% at 6 months; 58.3 and 71.3% at 12 months; 31.1 and 71.3% at 18 months. Conclusion: Early postsurgical temozolomide treatment prior to standard adjuvant therapy for poor prognosis glioblastoma patients in our small prospective series presents toxicity and survival similar to those published in the literature for the general population of glioblastoma. These encouraging results should be confirmed by a multicentric study comparing this regiment with the standard treatment.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Contribution of temozolomide chemotherapy for intramedullary grade II spinal cord astrocytomas in adults: Our experience

Introduction Grade II intramedullary astrocytomas are rare tumors. Despite a well-defined role of adjuvant temozolomide chemotherapy for brain gliomas, the contribution of this therapy for intramedullary gliomas is not yet clearly defined. Method We retrospectively analyzed the data of 5 adult patients treated with temozolomide between 2008 and 2015 for a grade II intramedullary astrocytoma with progression after surgery. Results Five patients from 19 to 70 years of age (median, 37 years) underwent a second surgery for the progression of a grade II intramedullary astrocytoma (median progression-free survival 26 months [8–90]). All tumors remained grade II. Due to a second clinical or/and radiological tumor progression, the patients were treated with temozolomide after a 37 months median progression-free survival (5–66). All patients received at minimum 12 cycles (mean 14 ± 5; range 12–24) of temozolomide (150–200 mg/m2/day, 5 days/28 days). All patients were alive after a 10-year median follow-up after diagnosis (6–13). All patients were able to walk except one, who was previously in McCormick autonomy grade IV before chemotherapy. The McCormick autonomy rating after temozolomide was stable for 4 patients and improved for 1 patient. The treatment was delayed once for hematological toxicity. Conclusion Temozolomide stabilized all 5 patients without any major toxicity. Based on this experience that needs to be confirmed, we consider that temozolomide should be envisaged within the therapeutic arsenal for progressive intramedullary grade II astrocytomas.SCOPUS: ar.jinfo:eu-repo/semantics/publishe