Stimulation du noyau sous-thalamique dans la maladie de Parkinson (repérage et effets sur la motricité digestive)

La stimulation bilatérale du noyau sous-thalamique (NST) est un traitement efficace dans les formes avancées de la maladie de Parkinson. Le repérage de la cible et des électrodes de stimulation cérébrale profonde est une étape cruciale de la procédure chirurgicale qui doit réponde à une méthodologie stricte et rigoureuse. Après avoir évalué notre système de repérage radio-scopique per-opératoire, nous avons quantifié en post opératoire précoce l'effet de la micro-lésion du NST ou effet lésionnel, qui en plus d'être un indicateur indirect d'avoir atteint la cible fonctionnelle, est apparu comme un facteur prédictif du résultat moteur au 6"1e mois post opératoire. Sur la base de ce pré requis, nous développons ensuite l'effet de la stimulation du NST sur la motricité digestive chez le rat. Nous avons montré que la stimulation du NST augmentait l'activité motricité colique de type phasique avec une activation de plusieurs centres du tronc cérébral impliqués directement ou indirectement dans le contrôle de cette motricité. Ces résultats pourraient expliquer l'amélioration de la constipation retrouvée chez les patients parkinsoniens opérés. Ce travail ouvre la voie à des travaux cliniques et expérimentaux qui permettrons de mieux comprendre les effet viscéraux de la stimulation du NST et leurs mécanismes étio-pathogéniques.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Etude comparative des cibles anatomique, électrophysiologique et thérapeutique chez 20 patients opérés d'une maladie de Parkinson par implantation bilatérale des noyaux sous-thalamiques

Objectifs : Les cibles anatomique préopératoire, électrophysiologique peropératoire et le plot sélectionné au 6 ème mois pour la stimulation chronique du noyau sous-thalamique (NST) ont été comparés rétrospectivement chez 20 patients consécutifs opérés d'une maladie de Parkinson idiopathique (MPI). Patients et méthodes : La cible anatomique étaient repérée directement sur une IRM. Un enregistrement électrophysiologique et un repérage radioscopique numérisé contrôlaient la trajectoire en peropératoire. Une IRM postopératoire donnait les coordonnées des plots contacts. Dans le repère CA-CP, nous avons comparé axe par axe les coordonnées des différentes cibles et la distance tridimensionnelle (distance 3 D) les séparant du milieu de CA-CP. En, parallèle, nous avons analysé les résultats cliniques à 6 mois. Résultats : Par rapport au milieu de CA-CP, les coordonnées moyennes (x, y, z), étaient pour la cible directe +- 12,4; - 1,3; - 3,0 mm. En distance 3 D, la cible directe différait significativement du plot actif dans l'axe des x et z. Au 6ème mois postopératoire, la réduction de l'UPDRS III, IV et de la LDopa était significative. Conclusion : Dans notre expérience du traitement chirurgical de la MPI par stimulation du NST, il existe une différence significative entre les cibles anatomique, électrophysiologique et thérapeutique. La NST n'est peut-être pas l'unique structure de la région sous-thalamique impliquée dans l'effet thérapeutique de la stimulation cérébrale profonde.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Precision Neurosurgery: A Path Forward

Since the inception of their profession, neurosurgeons have defined themselves as physicians with a surgical practice. Throughout time, neurosurgery has always taken advantage of technological advances to provide better and safer care for patients. In the ongoing precision medicine surge that drives patient-centric healthcare, neurosurgery strives to effectively embrace the era of data-driven medicine. Neuro-oncology best illustrates this convergence between surgery and precision medicine with the advent of molecular profiling, imaging and data analytics. This convenient convergence paves the way for new preventive, diagnostic, prognostic and targeted therapeutic perspectives. The prominent advances in healthcare and big data forcefully challenge the medical community to deeply rethink current and future medical practice. This work provides a historical perspective on neurosurgery. It also discusses the impact of the conceptual shift of precision medicine on neurosurgery through the lens of neuro-oncology

Stereotactic brain biopsy: evaluation of robot-assisted procedure in 60 patients

International audienceBackground Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers.Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robotassisted technology is necessary in particular, when a team has chosen to switch from one to another method.Objective The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data.Methods We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assistedstereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure includedMagnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with atouch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Datacollected were success rate, bleeding, clinical worsening, infection, and mortality.Results All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion wasglial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinicalimpairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did notreport any infection and mortality.Conclusion Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. Theoperating time can be reduced, without increasing morbidity and mortality rates

Diagnosis and Management of Glioblastoma: A Comprehensive Perspective

Glioblastoma is the most common malignant brain tumor in adults. The current management relies on surgical resection and adjuvant radiotherapy and chemotherapy. Despite advances in our understanding of glioblastoma onset, we are still faced with an increased incidence, an altered quality of life and a poor prognosis, its relapse and a median overall survival of 15 months. For the past few years, the understanding of glioblastoma physiopathology has experienced an exponential acceleration and yielded significant insights and new treatments perspectives. In this review, through an original R-based literature analysis, we summarize the clinical presentation, current standards of care and outcomes in patients diagnosed with glioblastoma. We also present the recent advances and perspectives regarding pathophysiological bases as well as new therapeutic approaches such as cancer vaccination and personalized treatments

Accuracy of the robot‐assisted procedure in deep brain stimulation

International audienc

Factors associated with favorable visual outcome after surgery of clinoidal meningiomas

Background: The anatomical relationship between clinoidal meningiomas and the optic nerve accounts for their frequent finding on visual disturbances. The goal of the surgery is to perform complete resection and obtain visual recovery. The aim of this study is to determine the factors associated with favorable visual outcome. Methods: We recorded clinical (including ophthalmological), imaging and surgical data of all patients operated on for clinoidal meningiomas between 2010 and 2020 in 2 French neurosurgical departments and we analyzed their impact on visual outcome. Results: A total of 34 patients were included. At 3-4 months after surgery, 23 patients (68%) had favorable visual outcome. Factors associated with favorable visual outcome were duration of ophthalmologic symptoms 0.5, absence of optic atrophy, meningioma in high signal intensity on T2weighted or FLAIR MRI, absence of optic canal involvement and absence of bone hyperostosis on pre-operative CT scan. A soft tumor and a clear brain/tumor border were intra-operative factor associated with favorable ophthalmological outcome. Conclusions: In clinoidal meningiomas, an early surgery should be performed to optimize visual improvement. Hyperintense lesion on T2-weighted/FLAIR preoperative MRI is correlated with a soft consistency which allows an easier surgery associated with a favorable visual outcome. Invasion of the optic canal and bone hyperostosis should reserve the visual prognosis

Alleviation of off-period dystonia in Parkinson disease by a microlesion following subthlamic implantation

International audienc

Does early verbal fluency decline after STN implantation predict long-term cognitive outcome after STN-DBS in Parkinson's disease?

International audienceBackgrounds: An early and transient verbal fluency (VF) decline and impairment in frontal executive function, suggesting a cognitive microlesion effect may influence the cognitive repercussions related to subthalamic nucleus deep brain stimulation (STN-DBS.)Methods: Neuropsychological tests including semantic and phonemic verbal fluency were administered both before surgery (baseline), the third day after surgery (T3), at six months (T180), and at an endpoint multiple years after surgery (Tyears). Results: Twenty-four patients (mean age, 63.5 ± 9.5 years; mean disease duration, 12 ± 5.8 years) were included. Both semantic and phonemic VF decreased significantly in the acute post-operative period (44.4 ± 28.2 and 34.3 ± 33.4, respectively) and remained low at 6 months compared to pre-operative levels (decrease of 3.4 ± 47.8% and 10.8 ± 32.1%) (P < 0.05). Regression analysis showed phonemic VF to be an independent factor of decreased phonemic VF at six months. Age was the only independent predictive factor for incident Parkinson's disease dementia (PDD) (F (4,19) = 3.4, P <0.03).Conclusion: An acute post-operative decline in phonemic VF can be predictive of a long-term phonemic VF deficit. The severity of this cognitive lesion effect does not predict the development of dementia which appears to be disease-related

allevation of off-period dystonia in parkinson disease by a microlesion following subthalamic implantation

International audienc