ICAR: endoscopic skull‐base surgery

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Giant intracranial aneurysms in the paediatric population: Suggested management and a review of the literature

International audienceObjectivesIntracranial aneurysms are rare in children although giant aneurysms more commonly occur in adolescence. The aims of our study were to perform an extensive review of the literature over the past two decades and assess intracranial aneurysm management.MethodsBased on a Pubmed search, we carried out a review of the literature from 1990 to 2012 regarding giant intracranial aneurysms diagnosed in the paediatric population. This descriptive study concerned clinical presentation, cerebral aneurysm characteristics, therapeutic management procedures and outcome.ResultsForty-six cases were reported in 31 papers. The male/female sex ratio was 1.15, the clinical presentation was a tumour mass syndrome in 56.6%, followed by rupture in 30.4%. The aneurysm location was the posterior circulation in 41.3%, and microsurgical treatment (52.2%) predominated over endovascular coiling (28.3%).ConclusionTo date, no evidence-based medicine recommendation has been accepted for the management of rare intracranial aneurysms. Each reported patient was the object of a multidisciplinary clinical decision. Management of this challenging pathology should be performed on a case-to-case basis.Les anévrismes géants de l’enfant, exceptionnels, sont rapportés uniquement sous forme d’observations. L’objectif de ce travail était de réaliser une revue exhaustive des publications sur le sujet afin de mieux définir cette situation clinique qui constitue un challenge thérapeutique

Une cause rare d’épanchement pleural

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Untreated unruptured aneurysm: Natural history at long-term

International audienceBACKGROUND AND OBJECTIVES:Although the diagnosis of unruptured intracranial aneurysm (IA) has become more frequent, its natural history and management still remain controversial. A better comprehension of its evolution could optimize our therapeutic strategies. The aim of our study was to evaluate, in a cohort of patients with untreated unruptured IA based on the proposition of multidisciplinary staff meetings, the proportion of bleeding, death and cardiovascular events during a long-term prospective follow-up.PATIENTS AND METHODS:This longitudinal study concerned a series of patients with unruptured IA collected over a period of 8 years (2006-2014) identified from a prospectively collected database including all patients with unruptured IA discussed during multidisciplinary staff meetings in the neurosurgery department at Rouen University Hospital. Clinical endpoints were the rupture rate, incidence of death or occurrence of noticeable pathological event defined by any event leading to death, admission to the intensive care unit or challenging the vital prognosis.RESULTS:After a mean follow-up delay of 46.9±18.7 months, the IA remained stable in 73 patients (98.6%) out of 74. The rate of rupture per aneurysm year of follow-up was 0.3%, the rate of cardiovascular events was 2.1% and the death rate was 2.8% per year of follow-up.DISCUSSION:In this study, we emphasize the important incidence of adverse events in these patients, which has to be taken into account before proposing a prophylactic IA exclusion. The low incidence of IA rupture confirmed the decision of conservative treatment made during a multidisciplinary staff meeting

Sudden paraplegia due to spontaneous bleeding in a thoracic epidural angiolipoma and literature review

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Pituitary metastasis: is there still a place for neurosurgical treatment ?

International audiencePituitary metastases are uncommon, ranging from 1 to 5 % of all metastases. Between 10 and 30 % of pituitary lesions are symptomatic responsible for diabetes insipidus, visual field defect or cranial nerve palsy. Primary sites are lung or breast in two-thirds of cases. There is no current reference concerning treatment of such lesions. Overall survival is poor and depends on primary site. Although the role of surgery is currently limited, discussion is warranted in several indications for diagnostic or symptomatic purposes. We report two cases of symptomatic pituitary metastases in a context of breast cancer and review the litterature concerning the role of surgery and other treatment modalities

Effects of melatonin in the treatment of asthenia in aneurysmal subarachnoid hemorrhage

International audienceBACKGROUND AND OBJECTIVES:Survivors of aneurysmal subarachnoid hemorrhage (aSAH) commonly experience sleep disorders resulting in asthenia. The objective of this prospective study was to determine, in a cohort of patients with treated ruptured intracranial aneurysm (IA), the proportion of asthenia at 2months, in a cohort of patients treated with melatonin and in a control cohort.PATIENTS AND METHODS:Twenty consecutive patients admitted for the treatment of ruptured IA and able to answer a standardized questionnaire were included in the study. After evaluation for fatigue at discharge, we divided our population into 2 cohorts of 10 patients: the first cohort was treated with melatonin for a period of 2months; the second cohort had no specific treatment for fatigue. The primary endpoint was the proportion of asthenia at 2months in both groups. Confounding factors, such as depression, autonomy and apathy were evaluated at the same time.RESULTS:At discharge, there was no significant difference observed between both groups in terms of mean age and initial clinical status (WFNS, Rankin Scale and Fatigue Severity Scale). At 2months, the mean FSS score in the control group was of 4.7±1.0 versus 3.8±0.9 in the melatonin group (P=0.03). The mean MADRS score in the control group was of 1.1±1.45 versus 2.7±2.5 in the melatonin group (P=0.10). The mean LARS score in the control group was of -32.5±1.7 versus -31.7±1.9 in the melatonin group (P=0.24).DISCUSSION:In a prospective evaluation of post-aSAH fatigue, we suggest that melatonin could decrease fatigue. There is no significant impact on depression and apathy. Further studies would be necessary to improve our comprehension of fatigue physiopathology in a context of aSAH

Patient with perinatal brain injury dystonia treated by deep brain stimulation: Management during pregnancy

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