We recommend neurosurgical consultation for all patients with an incidental meningioma.

Conclusion Nous conseillons que tout patient chez lequel a été découvert fortuitement un méningiome puisse bénéficier de l’avis d’un neurochirurgien.

Background and purpose. - Long-term efficiency (>5 years) of spinal cord stimulation for failed back surgery syndrome is poorly described in literature. The aims of our study were to evaluate the long-term efficiency and the quality of life of our series of patients with spinal cord stimulation for failed back surgery syndrome.Methods. - The data of 55 patients implanted successively in our institution between 1995 and 2005 for failed back surgery syndrome were collected retrospectively. We contacted them for a telephone survey focused on efficiency, quality of life and treatment satisfaction.Results. - An internal pulse generator was placed in 42 patients. Thirty-two of them were contacted to answer our survey with a mean follow-up of 8.3 years. Seventy-five percent of our population reported a pain decrease of greater or equal to 50%. The efficiency of percutaneous leads was reported as 50% for the quadripolars and 83% for the octopolars. The surgical leads evaluations were positive in 70% for 4 x 1 as well as for 4 x 2 leads. We observed a default of low back pain relief in 84% of patients with an incomplete pain relief (59%). The ability to sit, get out of the bed, and climb stairs increased in 75%. The walk was better in 82%. Decrease in drug consumption of greater or equal to 50% was observed in 66%.Conclusions. - Our retrospective study demonstrates a satisfaction of 75% of the patients after 8.3-years follow-up. Spinal cord stimulation is an effective treatment for refractory failed back surgery syndrome. (C) 2011 Elsevier Masson SAS. All rights reserved.

Les kystes dermoïdes du système nerveux central sont très rares. La symptomatologie clinique habituelle est dominée par un tableau d’hypertension intracrânienne, épilepsie et atteintes des nerfs crâniens. Le mode de révélation peut être des méningites aseptiques récidivantes.Le but de ce rapport est de considérer le kyste dermoïde dans le diagnostic différentiel des enfants traités pour des méningites aseptiques récidivantes afin d’éviter les erreurs diagnostiques et le traitement inadéquat.Il s’agit de deux enfants hospitalisés au niveau du service de pédiatrie pour des méningites aseptiques récidivantes, dont l’imagerie a été évocatrice de kyste dermoïde.Disparition des méningites après exérèse microchirurgicale.Le diagnostic de kyste dermoïde est à reconsidérer précocement dans les méningites aseptiques afin d’instaurer une thérapeutique adéquate qui est la chirurgie.Dermoid cysts of central nervous system are very rare. The usual clinical presentation is dominated by intracranial hypertension, epilepsy and cranial palsy. The revelation mode could be recurrent aseptic meningitis.The aim of this case report is to consider the dermoid cyst as regards the differential diagnosis in children treated for recurrent aseptic meningitis to avoid misdiagnosis and ice qui a orienté le diagnostic à une méningitnadequate treatment.Two children were admitted in the pediatric department for recurrent aseptic meningitis. The MRI confirmed the presence of a posterior fossa dermoid cyst.Loss of meningitis after microsurgical resection.The diagnosis of dermoid cyst is performed and reconsidered at an early stage in aseptic meningitis in order to establish an adequate therapy, which is surgery.

The present work intends to provide a numerical tool for the efficient design of the multidirectional carbon fiber reinforced plastic (CFRP) material using finite element simulation software ABAQUS®. A 3D model has been established for simulation of the tensile test composite specimen which enables to understand the mechanical strength and strain at failure of the composite materials. 15 ply CFRP specimens with various stacking sequences were analyzed for their strength and displacement. Exhaustive parametric studies reveal the dependency of reinforcing material and ply orientation on the strength and stiffness of composite materials. Carbon fibers with cross ply lamination were found to be stiffer than angle ply glass fiber lamination. A fairly good comparison was obtained between the predicted results with available experimental and theoretical data in open literature

Vestibular schwannomas are slow-growing tumors of the myelin-forming cells that cover cranial nerve VIII. The treatment options for patients with vestibular schwannoma include active observation, surgical management, and radiotherapy. However, the optimal treatment choice remains controversial.We have reviewed the available data and summarized the radiotherapeutic options, including single-session stereotactic radiosurgery, fractionated conventional radiotherapy, fractionated stereotactic radiotherapy, and proton beam therapy.The comparisons of the various radiotherapy modalities have been based on single-institution experiences, which have shown excellent tumor control rates of 91–100%. Both stereotactic radiosurgery and fractionated stereotactic radiotherapy have successfully improved cranial nerve V and VII preservation to >95%. The mixed data regarding the ideal hearing preservation therapy, inherent biases in patient selection, and differences in outcome analysis have made the comparison across radiotherapeutic modalities difficult. Early experience using proton therapy for vestibular schwannoma treatment demonstrated local control rates of 84–100% but disappointing hearing preservation rates of 33–42%. Efforts to improve radiotherapy delivery will focus on refined dosimetry with the goal of reducing the dose to the critical structures.As future randomized trials are unlikely, we suggest regimented pre- and post-treatment assessments, including validated evaluations of cranial nerves V, VII, and VIII, and quality of life assessments with long-term prospective follow-up. The results from such trials will enhance the understanding of therapy outcomes and improve our ability to inform patients.

Neurofibromatosis type 2 (NF2) is a complex disease characterized by the development of multiple schwannomas, especially vestibular schwannomas, as well as other types of benign tumours including meningioma and spinal ependymoma. Due to its multisystem nature, the management of NF2 requires a multidisciplinary approach. In England, the delivery of care for NF2 patients has been centralized to four-“hub” centres in Manchester, Cambridge, Oxford and London each having associated “spoke” centres. Each centre has a core multidisciplinary team consisting of genetics, otolaryngology, neurosurgery, paediatrics, neurology, audiology, radiology, psychology, physiotherapy, specialist nurses and administrative staff. In addition, the core team has access to plastic surgery, ophthalmology, peripheral nerve surgery and adult and paediatric oncology. There are weekly multidisciplinary clinics each with six to eight patients. Each patient is discussed during a team meeting and the management decisions that are made are then discussed with the patients. All patients are reviewed at least annually and have annual head magnetic resonance imaging (MRI) and three yearly spinal MRI. Annual audiological assessment is performed. Cochlear implantation and auditory brainstem implantation are offered if indicated. Surgery, stereotactic radiosurgery and bevacizumab therapy are available for the management of intracranial and spinal tumours. The integration of the service in England has provided significant benefits to patient care and, in the long term, will provide robust patient outcome data that will provide an evidence base to assist in optimizing management of patients with NF2.La neurofibromatose de type 2 (NF2) est une maladie complexe caractérisée par le développement de multiples schwannomes, en particulier vestibulaires et d’autres types tumoraux bénins incluant les méningiomes et les épendymomes médullaires. À cause de l’atteinte diffuse, la prise en charge des patients NF2 nécessite une approche multidisciplinaire. En Angleterre, les soins pour les patients NF2 sont regroupés sur 4 centres (Manchester, Cambridge, Oxford et Londres), chacun ayant des centres relais. Chaque centre a une équipe multidisciplinaire compétente en génétique, oto-rhinologie, neurochirurgie, pédiatrie, neurologie, audiologie, radiologie, psychologie, rééducation avec des infirmières spécialisées et un staff administratif. De plus, ces équipes peuvent faire appel à la chirurgie plastique, l’ophtalmologie, la chirurgie des nerfs périphériques et de l’oncologie pédiatrique. Il y a des réunions multidisciplinaires hebdomadaires pour 5 à 6 patients. Le cas de chaque patient est ensuite discuté en équipe et les décisions prises conjointement et expliquées au patient. Tous les patients sont vus au moins une fois par an et ont, en plus du bilan audiologique, une imagerie par résonance magnétique (IRM) cérébrale annuelle et une IRM du rachis tous les 3 ans. L’implant cochléaire et l’implant auditif du tronc cérébral sont disponibles. La chirurgie, la radiochirurgie et le traitement par bévacizumab sont utilisés pour le traitement des lésions intracrâniennes et intrarachidiennes. Ce type d’organisation en Angleterre a montré une amélioration de la prise en charge et à long terme permettra d’avoir suffisamment de données pour optimiser les soins.

Background and purpose. - Optimal treatment for low-grade glioma remains controversial. Moreover, though surgery is recommended for disease management, evidence is lacking concerning the appropriate extent of surgery and the use of adjunctive therapy. Available data is basically retrospective, coming from series with substantial limitations. We reviewed our institution's series in order to evaluate the efficiency of surgical management and the influence of the extent of surgical removal for patients with low-grade glioma.Methods. - Data were collected from a series of 201 patients who underwent first-intention therapy for low-grade glioma, the standard practice in our institution between 1994 and 2005. After applying certain exclusion criteria, we retained for analysis 123 patients with grade 11 glioma (WHO classification). We compared progression-free survival curves for the three surgical treatment groups defined as biopsy, partial removal, or total removal.Results. - Statistical evaluation of the progression free survival shows a benefit in total surgery as a first intention treatment. No statistical significance was demonstrated between partial surgery and stereotactic biopsy.Conclusion. - For patients with low-grade glioma we recommend total surgical removal as first intention management. (C) 2007 Elsevier Masson SAS.

Les avancées rapides en matière de biologie moléculaire ont permis l’identification d’anomalies génétiques clés impliquées dans la genèse et la progression des tumeurs du système nerveux central (SNC). L’identification de telles anomalies a permis d’élaborer une classification histomoléculaire des tumeurs du SNC publiée par l’OMS en 2016. La croissance exponentielle des données générées et l’avènement de nouvelles technologies, telles que le méthylome, ont imposé ces dernières années des mises à jour régulières (cIMPACT-NOW) de la classification des tumeurs du SNC jusqu’à la publication en 2021 de la cinquième édition de la classification OMS. Dans cette dernière édition, de nouveaux types et sous-types sont introduits et les critères de diagnostic histomoléculaire et de grading sont affinés, notamment pour les gliomes diffus. La reconnaissance des gliomes diffus « de sous-type pédiatrique » (de bas ou haut grade) représente une amélioration majeure de la classification. Par ailleurs, la nomenclature est simplifiée et harmonisée avec celle des autres pathologies d’organe. La place des anomalies génétiques et épigénétiques dans le diagnostic intégré des tumeurs est sans surprise plus importante par rapport à l’édition 2016. Le méthylome, même s’il n’est pas encore accessible à tous, deviendra certainement incontournable dans les années à venir. Cette cinquième édition, tant attendue, devrait permettre une meilleure prise en charge des patients.Rapid technical advances in molecular biology allowed for the identification of key genetic alterations in central nervous system (CNS) tumors. Our ever-expanding knowledge of brain tumor genetics and the development of new technologies, such as DNA-methylation profiling, required an update of the 2016 fourth edition of the WHO classification of CNS tumors. Updates were regularly published by the Consortium to Inform Molecular Practical Approaches to CNS Tumor Taxonomy-Not Official WHO (c-IMPACT-NOW) until the publication of the fifth edition of the WHO classification of CNS tumors in 2021. In that edition, new types and subtypes are introduced and criteria for histo-molecular diagnostic and grading are refined, especially for diffuse gliomas. The definition of a broad category “diffuse glioma, pediatric subtype” (low or high grade) is a major improvement of the classification. Moreover, the nomenclature was simplified and aligned with that of other blue books. The 2021 edition truly advances the role of molecular diagnostics in CNS tumor classification. Methyloma profiling may become a cornerstone of CNS tumor diagnostic. The new WHO classification will lead to better management of brain tumor patients.

An autoregulated tetracycline-inducible recombinant adeno-associated viral vector (rAAV-pTet(bidi)ON) utilizing the rtTAM2 reverse tetracycline transactivator (rAAV-rtTAM2) was used to conditionally express the human GDNF cDNA. Doxycycline, a tetracycline analog, induced a time- and dose-dependent release of GDNF in vitro in human glioma cells infected with rAAV-rtTAM2 serotype 2 virus. Introducing the Woodchuck hepatitis virus posttranscriptional regulatory element (WPRE) downstream to the rtTAM2 coding sequence, resulted in a more rapid induction and a higher basal expression level. In vivo, 8 weeks after a single injection of the rAAV-rtTAM2-GDNF vector encapsidated into AAV serotype 1 capsids in the rat striatum, the GDNF protein level was 60 pg/mg tissue in doxycycline-treated animals whereas in untreated animals, it was undistinguishable from the endogenous level (similar to 4 pg/mg tissue). However, a residual GDNF expression in the uninduced animals was evidenced by a sensitive immunohistochemical staining. As compared to rAAV1-rtTAM2-GDNF, the rAAV1-rtTAM2-WPRE-GDNF vector expressed a similar concentration of GDNF in the induced state (with doxycycline) but a basal level (without doxycycline) similar to 2.5-fold higher than the endogenous striatal level.As a proof for biological activity, for both vectors, downregulation of tyrosine hydroxylase was evidenced in dopaminergic terminals of doxycycline-treated but not untreated animals.In conclusion, the rAAV1-rtTAM2 vector which expressed biologically relevant doses of GDNF in the striatum in response to doxycycline with a basal level undistinguishable from the endogenous striatal level, as measured by quantitative ELISA assay, constitutes an interesting tool for local conditional transgenesis. (c) 2006 Elsevier Inc. All rights reserved.