Facteurs de risque de récidive des méningiomes de grade II‎ : analyse rétrospective chez 68 patients opérés au CHU de Rouen

Les méningiomes sont des tumeurs habituellement bénignes développées au dépend des cellules arachnoïdiennes. Selon la classification de l'OMS, les méningiomes sont classés en trois grades selon leur degré d'agressivité. Les méningiomes de grade II, d'agressivité intermédiaire, représentent entre 3 et 10% de l'ensemble des méningiomes. Le traitement de ces tumeurs repose en premier lieu sur l'exérèse chirurgicale. Il n'existe pas de consensus sur les traitements complémentaires à proposer en post opératoire. La survie sans récidive et globale des patients porteurs de méningiomes de grade II est respectivement de 50% et 80 % à 5 ans. L'enjeu chez ces patients est d'éviter la récidive de la tumeur. Objectifs : L'objectif principal de ce travail rétrospectif était d'analyser la survie sans récidive et globale de notre cohorte de 68 patients opérés d'un méningiome de grade II. L'objectif secondaire était de mettre en évidence les facteurs de risque de récidive de ces méningiomes de grade II. Matériel et méthodes : 68 patients consécutifs ont été inclus dans notre cohorte. Les patients ont été opérés au CHU de Rouen entre 2000 et 2014. Un suivi minimum de 36 mois était nécessaire pour être inclus. Les données cliniques, radiologiques et anatomopathologiques ont été recueillies. Résultats : La survie globale à 5 ans de nos patients était de 90,6%. La survie sans récidive était quant à elle de 53,3% à 5 ans. La médiane de survie sans récidive était évaluée à 110 mois. Les facteurs de risque d'évolution défavorable étaient un âge de moins de 66 ans et le sexe masculin. Un état général altéré et une exérèse chirurgicale incomplète semblaient prédire une récidive sans être significatifs. L'impact de la radiothérapie quelle qu'en soit la modalité n'avait pu être évalué dans notre étude faute d'un effectif suffisant. Conclusion : Nous avons retrouvé un taux de survie sans récidive comparable à ceux des grandes séries. L'étude de la littérature concernant la radiothérapie, nous montre qu'en cas d'exérèse incomplète, il semble souhaitable d'effectuer sur le résidu tumoral une radiochirurgie stéréotaxique ou Gamma Knife. En cas de récidive, aucun article ne permet à ce jour de savoir quel traitement appliquer, la chirurgie semble à proposer, à chaque fois que celle-ci est possible

Improving surgical outcome for gliomas with intraoperative mapping

Radical glioma resection improves overall survival, both in low-grade and high-grade glial tumors. However, preservation of the quality of life is also crucial. Areas covered: Due to the diffuse feature of gliomas, which invade the central nervous system, and due to considerable variations of brain organization among patients, an individual cerebral mapping is mandatory to solve the classical dilemma between the oncological and functional issues. Because functional neuroimaging is not reliable enough, intraoperative electrical stimulation, especially in awake patients benefiting from a real-time cognitive monitoring, is the best way to increase the extent of resection while sparing eloquent neural networks. Expert commentary: Here, we propose a paradigmatic shift from image-guided resection to functional mapping-guided resection, based on the study of the dynamic distribution of delocalized cortico-subcortical circuits at the individual level, i.e., the investigation of brain connectomics and neuroplastic potential. This surgical philosophy results in an improvement of both oncological outcomes and quality of life. This highlights the need to reinforce the link between glioma surgery and cognitive neurosciences

The landscape of postsurgical recurrence patterns in diffuse low-grade gliomas

International audienceEarly and maximal safe surgical resection optionally followed by adjuvant treatment is currently recommended in diffuse low-grade glioma (DLGG). Although this management delays malignant transformation (MT), recurrence will most often occur. Because this relapse usually arises locally, reoperation can be considered, with possible further chemotherapy/radiotherapy. However, due to a prolonged overall survival, a large spectrum of unusual recurrence patterns begins to emerge during long-term follow-up, beyond the classical slow and local tumor re-growth. We review various atypical patterns of DLGG relapse, we discuss their pathophysiological mechanisms and how to adapt the treatment(s). Those patterns include very diffuse, ipsi- or bilateral gliomatosis-like progression, multicentric recurrence with emergence of remote low-grade or high-grade glioma, leptomeningeal dissemination, acute (early or delayed) local MT or bulky relapse into the operating cavity. This landscape of recurrence patterns may allow physicians to elaborate new tailored therapeutic strategies and scientists to develop original hypotheses for basic research

Facteurs de risque de shunt dépendance chez les patients présentant une hémorragie intraventriculaire neonatale

National audienc

Post hemorrhagic hydrocephalus and neurodevelopmental outcomes in a context of neonatal intraventricular hemorrhage: an institutional experience in 122 preterm children

Abstract Background Intraventricular hemorrhage (IVH) is a frequent complication in extreme and very preterm births. Despite a high risk of death and impaired neurodevelopment, the precise prognosis of infants with IVH remains unclear. The objective of this study was to evaluate the rate and predictive factors of evolution to post hemorrhagic hydrocephalus (PHH) requiring a shunt, in newborns with IVH and to report their neurodevelopmental outcomes at 2 years of age. Methods Among all preterm newborns admitted to the department of neonatalogy at Rouen University Hospital, France between January 2000 and December 2013, 122 had an IVH and were included in the study. Newborns with grade 1 IVH according to the Papile classification were excluded. Results At 2-year, 18% (n = 22) of our IVH cohort required permanent cerebro spinal fluid (CSF) derivation. High IVH grade, low gestational age at birth and increased head circumference were risk factors for PHH. The rate of death of IVH was 36.9% (n = 45). The rate of cerebral palsy was 55.9% (n = 43) in the 77 surviving patients (49.4%). Risk factors for impaired neurodevelopment were high grade IVH and increased head circumference. Conclusion High IVH grade was strongly correlated with death and neurodevelopmental outcome. The impact of an increased head circumference highlights the need for early management. CSF biomarkers and new medical treatments such as antenatal magnesium sulfate have emerged and could predict and improve the prognosis of these newborns with PHH

Spinal meningioma and factors predictive of post-operative deterioration

International audiencePURPOSE:Spinal meningiomas are slow-growing intradural-extramedullary tumors. They are usually associated with good outcomes. However, there are few descriptions of factors predictive of impaired evolution. Our objective was to identify predictive factors of post-operative deterioration as well as outcomes at follow-up.METHODS:Between 2009 and 2016, 87 patients had surgery for spinal meningioma in our referral center. Clinical presentation, management and outcomes were reported during the post-operative period and at 3-month follow-up. Evaluation was based on post-operative neurological deterioration defined as an increase of at least one point in the McCormick score compared to the status at admission.RESULTS:During the study period, post-operative deterioration occurred in 17 patients (19.5%). Risk factors associated with this deterioration were the absence of pre-operative neurological signs (Relative Risk; RR = 2.38, p = 0.04), an anterior location of the meningioma and a grade 2 meningioma on WHO classification score (RR = 6, p ≤ 0.01). At 3-month follow-up, in patients who initially presented with a motor deficit, partial recovery was found in 75%, stability in 20% and a deterioration of their clinical status in 5%. After a mean follow-up of 92.4 ± 51.9 months, the recurrence rate was 8%.CONCLUSIONS:Spinal meningiomas are usually benign tumors whose treatment is based on complete surgical resection. Progress in surgical techniques has resulted in lower morbidity rates and improvement in post-operative recovery. In this study, we observed several factors associated with clinical deterioration. Before surgery, patients should be fully informed of these predictive factors of post-operative deterioration and their association with surgical morbidity

Modèle in vivo de résection de gliome chez la souris et mise au point de pièges à tumeurs

National audienc

Modèle in vivo de résection de gliome chez la souris et mise au point de pièges à tumeurs

National audienc

Chemoattraction of glioma cells and immune activation

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Beneficial effect of a brain local hydrogel containing the chemokine urotensine II in a mouse model of glioblastoma resection

National audienc