Objectif De la même manière que le sommeil, l’éveil fait l’objet d’un contrôle local et ne survient pas simultanément dans toutes les régions du cerveau. L’objectif de cette étude est d’explorer la dynamique d’activation corticale pendant les éveils en sommeil lent profond. Méthodes Cette étude observationnelle rétrospective a été conduite chez 4 patients atteints d’épilepsie pharmacorésistante pour qui une indication d’exploration SEEG a été retenue. À partir des enregistrements intracrâniens, nous avons identifié 92 éveils en sommeil lent profond. Nous avons extrait les données issues de régions saines et réalisé une analyse temps-fréquence du signal électrique pour chaque éveil en fonction des patients et des aires cérébrales d’intérêt. Nous avons ensuite comparé les changements de l’activité électrique corticale pendant l’éveil par rapport à une période de référence définie dans le sommeil lent profond. Résultats Nous avons observé trois changements séquentiels et significatifs dans l’activité électrique corticale durant l’éveil : 1) une activité delta pré éveil (<1,5 Hertz) survenant quelques secondes avant l’éveil, 2) une bouffée alpha (7–13 Hertz) puis 3) une diminution de l’activité delta-thêta dans les secondes suivant l’éveil. Ces modifications apparaissent précocement dans l’insula, l’hippocampe et les régions frontales (Gyrus frontal inférieur et gyrus rectus). Conclusion Ces résultats suggèrent l’existence d’une dynamique reproductible d’activité corticale durant l’éveil en sommeil lent profond. L’insula, l’hippocampe et les régions frontales semblent tout particulièrement impliquées dans l’initiation de l’activité delta pré éveil suivie de la bouffée alpha, signaux électriques précoces sous-tendant l’éveil.

BACKGROUND:Cerebral cavernomas are vascular malformations that can cause neurological problems such as hemorrhage and seizures. MRI is the preferred imaging modality, but hemosiderin deposits in cavernomas often lead to signal loss artifacts, complicating treatment planning. MRI-guided laser interstitial thermal therapy (MRIg-LITT) is an innovative, minimally invasive technique that offers a new approach to treating these lesions, but confirming ablation on MRI may be challenging due to these artifacts. METHODS:We evaluated six patients (4 females, 2 males; median age 29 years old) with symptomatic cerebral cavernomas treated with MRIg-LITT. The procedure involved immediate post-treatment imaging to assess lesion reduction and edema. A volumetric T1-weighted subtraction technique was employed after ablation to enhance visualization of contrast enhancement. RESULTS:Thermal ablation was assessed by diffusion hyperintensity and gadolinium-enhanced peripheral rings, despite susceptibility artifacts. T1-weighted volumetric subtraction sequences effectively minimized artifacts and improved visualization of the lesions. No hemorrhagic complications occurred, and expected post-LITT edema was managed with corticosteroid therapy. CONCLUSION:T1-weighted volumetric subtraction sequences reduce magnetic susceptibility artifacts and improve visualization of the post-ablation enhancing rim in MRIg-LITT for cerebral cavernomas. Their clinical impact on treatment assessment remains to be determined.

Introduction La mésencéphalotomie stéréotaxique cible les voies spinothalamiques pour traiter les douleurs réfractaires. Nous rapportons le premier cas de mésencéphalotomie par MRgLITT assistée par robot pour douleur maligne intraitable. Observation Un homme de 47 ans atteint de mélanome métastatique présentait des douleurs sévères réfractaires (EVA>7) liées à des lésions sous-cutanées inflammatoires de l’hémicorps droit, malgré corticoïdes, opioïdes, kétamine et anesthésiques topiques. Une mésencéphalotomie par MRgLITT assistée par robot ROSA a été proposée dans ce contexte palliatif.La planification utilisait une IRM haute résolution (3D-T1, SWAN, tenseur de diffusion) et un scanner en coupes fines. Les coordonnées cibles localisaient le faisceau spinothalamique avant son entrée thalamique (1mm en avant de la tangente à l’aqueduc, 5mm postérieur à CP, 5mm sous CA-CP, 8mm latéral).Sous anesthésie locale, un cadre stéréotaxique a été fixé. Le robot a guidé une microélectrode pour macrostimulation de contrôle (50Hz, 2,5V). Ensuite, une sonde laser a été positionnée. L’ablation thermique sous controle IRM en temps réel a permit de créé une lésion sphérique de 5mm de diamètre (Fig. 1).En postopératoire, l’EVA a diminué à moins de 3, sans déficit neurologique. Les opioïdes ont été réduits. Le patient est malheureusement décédé un mois plus tard des suites de la maladie cancéreuse. Discussion La MRgLITT offre un guidage IRM temps réel et une précision lésionnelle supérieure aux techniques neurochirurgicales historiques. Les alternatives (cordotomie, myélotomie, stimulation cérébrale profonde) étaient inadaptées à la topographie douloureuse ou présentaient des risques spécifiques. Cette technique mini-invasive représente une option prometteuse pour les douleurs réfractaires en contexte palliatif. Conclusion La mésencéphalotomie par MRgLITT constitue une option mini-invasive prometteuse pour les douleurs cancéreuses réfractaires, permettant une amélioration significative de la qualité de vie en soins palliatifs.

OBJECTIVE Pharmacoresistant tremors, often seen in Parkinson disease and essential tremor, significantly impair patient quality of life. Although deep brain stimulation has been effective, its invasive nature limits its applicability. MR-guided focused ultrasound (MRgFUS) thalamotomy offers a noninvasive alternative, but its cognitive impacts are not fully understood. This meta-analysis aimed to evaluate the cognitive and emotional effects of unilateral MRgFUS thalamotomy in patients with pharmacoresistant tremors. METHODS Adhering to PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, and the Cochrane Library. Studies were included if they involved unilateral MRgFUS thalamotomy and assessed cognitive functions pre- and postprocedure. The primary outcomes were changes in cognitive functions and emotional states postthalamotomy. RESULTS Of 90 identified articles, 5 met the inclusion criteria, encompassing 112 patients (74 essential tremor, 38 Parkinson disease). The analysis revealed no significant deterioration in cognitive domains or emotional states postprocedure. Statistical heterogeneity among studies was small for cognitive outcomes but moderate for emotional states. CONCLUSIONS Unilateral MRgFUS thalamotomy appears to be a safe procedure with respect to cognitive and emotional outcomes in patients with pharmacoresistant tremors. However, the small number of studies and the short-term nature of assessments necessitate caution. Further research, especially on long-term cognitive effects and in the context of bilateral procedures, is essential for a comprehensive understanding of MRgFUS thalamotomy’s neuropsychological impact. Systematic review registration no.: CRD42023491757 (www.crd.york.ac.uk/prospero)

Stereotactic mesencephalotomy is a neurosurgical technique designed to sever spinothalamic pain transmission pathways for medically intractable pain. This report presents the first case of Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) mesencephalotomy for severe malignant pain due to metastatic melanoma. The procedure significantly reduced the patient’s pain, with a postoperative visual analog scale (VAS) score decreasing from > 7 to < 3. No adverse effects were observed. The case underscores the potential of MRgLITT mesencephalotomy as a precise, minimally invasive option for pain management in palliative care settings.

Objectifs Suivi longitudinal des caractéristiques morphologiques, spectroscopiques et métaboliques de la région thalamique du noyau intermédiaire ventral (VIM) traitée par LITT (Figure 1 A et B) chez des patients atteints de tremblements résistants aux médicaments. Matériels et Méthodes 29 patients traités par LITT au CHU d'Amiens, suivis par IRM (séquences T1, T2 FLAIR, T2*, Diffusion, Perfusion et 3DT1) et SRM (séquence PRESS avec 3 TEs de 35 ms, 144 ms et 288 ms). Les données ont été collectées en préopératoire et en post-opératoire : immédiat, à J2-J7, à M6, à M12 et au-delà. Analyses: calcul des volumes IRM d'hypersignaux T2-FLAIR et de diffusion de la région VIM ainsi que de ratios de métabolites en SRM. Résultats En IRM (Figure 1. C): présence de petits volumes d'hypersignal en postop immédiat en T2-FLAIR et en diffusion. Ces hypersignaux ont augmenté chez 100 % des patients à J2 et J7 en T2-FLAIR et en diffusion. Ensuite ces hypersignaux diminuent de 98% en moyenne à M6-M12 en T2 FLAIR et en diffusion. En SRM (Figure 1. D): principalement le rapport mI/Cr augmente chez 100 % des patients en post-op immédiat puis diminue à M12. Le rapport Lac/Cr augmente chez 85% des patients en post-op immédiat et/ou à J2-J7, puis diminue bien qu'une quantité résiduelle persiste. Conclusion Ce travail fournit une vue globale de la dynamique des profils morphologique et métabolique de la région thalamique VIM traitée par LITT, pour mieux évaluer la thalamotomie. L'approche combinant IRM et SRM semble être plus prometteuse que l'IRM seule, pour améliorer davantage la mise en ‘uvre, l'analyse, l'interprétation et le suivi de cette nouvelle neurochirurgie mini-invasive innovante par LITT.

Introduction La stimulation cérébrale profonde (SCP) du noyau sous-thalamique (NST) est une thérapie efficace pour la maladie de Parkinson (MP). Avec les nouvelles électrodes de plus en plus complexes, la programmation de la SCP devient un vrai challenge. Objectifs Déterminer si l’utilisation exclusive de la programmation basée sur l’imagerie (IG-VTA) peut atteindre une amélioration motrice comparable à la méthode conventionnelle (CP-RM) chez les patients atteints de MP traités par SCP-NST. Méthodes Nous avons inclus 26 patients avec SCP-NST, 12 en IG-VTA et 14 en CP-RM. Les évaluations incluaient l’UPDRS partie III, la dose équivalente de lévodopa, les hospitalisations et la durée de séjour postopératoire. Résultats Les deux groupes ont montré une amélioration significative de l’UPDRS III à un an postopératoire (IG-VTA : 43,62, CP-RM : 41,29), sans différence significative entre les groupes. L’IG-VTA a montré une réduction significative de la durée de séjour. Discussion Dans notre étude, l’IG-VTA a permis des résultats cliniques comparables à la CP-RM avec une réduction significative de la durée de séjour. Cependant, des études prospectives, de plus grande ampleur sont nécessaires pour vérifier ces résultats. Conclusion L’IG-VTA offre une alternative à la CP-RM dans la programmation des SCP-NST, nécessitant une évaluation continue dans ce domaine en constante évolution.

Human activity recognition (HAR) consists of identifying and then analyzing a person’s behavior, using a motion capture device. It has been of interest to many authors since the 1980s. This study has proved useful in various fields such as video game animation, sports training or, for this work, health management. The project aims, more precisely, to recognize and evaluate the postures and movements to correct, improve or assist in care. We work particularly on tremor, dyskinesia or any other movement induced by Parkinson’s disease (PD). This type of HAR application is now possible thanks to the embedded sensors. These can be found in all our connected devices such as our phones, watches, sports, and health sensors. These tools provide 3-D time signals that can be interpreted by different algorithms. Deep learning has, moreover, proven its performance in HAR with data extracted from these sensors. This article presents a new technique for motion recognition, using a neural network model, named the CNN-BiLSTM-FCN (CBF) model. It is composed of two branches with different input data. As the name suggests, it is structured with three networks, namely a convolutional neural network (CNN), a recurrent neural network (RNN), and a fully connected network (FCN). This technique was tested using a benchmark considering the UCI-HAR dataset. It has already been used to compare this type of HAR method. The experimental results highlight the effectiveness of our approach, which differs significantly from those presented in the literature. Finally, this technique is applied to movement data, including Parkinson-type movements, collected in our laboratory.

Background Despite the growing sophistication of robot-assisted surgery, it is necessary to demonstrate that robots can reliably perform complex procedures on site and then remotely. Although a flow diverter stent is one of the most effective and widely used devices, its placement is sometimes challenging. Objective To evaluate the feasibility and safety of the CorPath GRX robotic platform for the embolization of cerebral and cervical aneurysms using flow diverter stents. Methods We performed a single-center technical study of the first 10 flow diverter stent deployments with the CorPath GRX Robotic System (Corindus Inc, Waltham, Massachusetts, USA) for the treatment of cerebral aneurysms between April and October 2022. Results Ten patients underwent robot-assisted embolization with flow diverter stents: there were nine intracranial aneurysms (paraclinoid n=6; posterior communicating artery aneurysm n=1; anterior communicating artery n=2) and one cervical aneurysm. Four procedures were performed with coils plus a flow diverter stent, one was performed with woven endobridge plus a flow diverter stent and four were performed with flow diverter stents alone. Of these procedures, two were performed with telescoping flow diverters. All flow diverter stents were deployed with robotic assistance, with only one partial conversion to a manual technique (caused by guidewire torquability limitations). No perioperative complications were observed. Conclusion Robot-assisted flow diverter stent deployment using the CorPath GRX platform is feasible and appears to be safe. Larger, in-depth studies of the technique’s safety and benefits are now warranted.

Background and ObjectivesDeep brain stimulation (DBS) is a well-established treatment for Parkinson disease (PD), with programming methods continually evolving. This study aimed to compare the efficacy and patient burden between conventional ring-mode programming (CP-RM) and image-guided volume of tissue activated (IG-VTA) programming for subthalamic nucleus (STN) DBS in PD.MethodsIn this retrospective study, patients with PD who underwent STN-DBS between 2011 and 2014 (CP-RM group) and 2019 and 2021 (IG-VTA group) were evaluated. The primary outcome was the improvement in the UPDRS III score from preoperative OFF to postoperative ON state without medication at one-year follow-up. Secondary outcomes included hospital stay duration and programming sessions.ResultsA total of 26 patients were analyzed (IG-VTA: n = 12, CP-RM: n = 14). Both groups showed similar improvements in UPDRS III scores (IG-VTA: 43.62, CP-RM: 41.29). However, the IG-VTA group experienced shorter immediate postoperative hospital stays and fewer hospitalizations after discharge.DiscussionIG-VTA programming preserved the clinical efficacy of STN-DBS over 1 year and reduced the patient and clinician burden of hospital stay and programming sessions. However, conclusions drawn must consider the limitations of retrospective design, differing time epochs, and evolving clinical practices. Further multicentric and prospective studies are warranted to validate these findings in the evolving field of neurostimulation.Trial Registration InformationThe trial is registered on clinicaltrials.gov (NCT05103072).

Introduction Cette étude explore la thalamotomie unilatérale par MRgLITT dans le tremblement essentiel (TE) réfractaire aux traitements médicamenteux, une alternative prometteuse aux méthodes chirurgicales conventionnelles. Objectifs Évaluer la sécurité et l’efficacité de thalamotomies unilatérales par MRgLITT dans le traitement du TE pharmaco-résistant, en termes de réduction des symptômes et de qualité de vie. Méthodes Une étude pilote rétrospective a impliqué neuf patients avec TE pharmaco-résistant. Ces derniers ont subi une thalamotomie par MRgLITT unilatérale. L’évaluation a inclus la sévérité du tremblement, la qualité de vie, les fonctions cognitives et les événements indésirables sur 12 mois, utilisant des mesures standardisées pour quantifier les changements avant et après l’intervention. Résultats Les patients ont montré une réduction significative de la sévérité du tremblement (83,37 %) et une amélioration de la qualité de vie (74,60 %) à 12 mois. Les effets indésirables étaient principalement transitoires, incluant dysarthrie, troubles proprioceptifs et problèmes d’équilibre. Aucune altération cognitive significative n’a été observée. Discussion La thalamotomie par MRgLITT semble être une option sécuritaire et efficace pour le TE pharmaco-résistant, avec des bénéfices substantiels sur les symptômes et la qualité de vie. Les effets indésirables semblent gérables et temporaires, démontrant un avantage sur les traitements lésionnels invasifs existants. Conclusion La thalamotomie par MRgLITT offre une alternative prometteuse pour traiter le TE pharmaco-résistant, avec des améliorations significatives et durables des symptômes.

Meningiomas stand as the predominant intracranial tumors, with surgical excision being the gold standard treatment.For inoperable or recurrent cases, radiosurgery emerges as a viable option.The amalgamation of surgical and radiosurgical approaches is gaining traction in treatment paradigms.While extracranial metastasis in benign meningiomas is exceedingly rare, we present the case of a 62-year-old woman manifesting multiple lung masses five years post-complete resection of a benign parasagittal meningioma.Subsequent wedge lung excision unveiled a surprising diagnosis of meningioma.Six months thereafter, magnetic resonance imaging of the brain unveiled two small recurrent parasagittal meningiomas, promptly addressed via Cyberknife radiosurgery with a single fraction of 14 Gy.Astonishingly, complete tumor disappearance was observed at the 12-month follow-up.This report underscores a dual rarity-benign meningioma metastasis and complete tumor regression post-radiosurgery at the 12-month mark.

OBJECTIVE:Holmes tremor (HT) is a complex syndrome characterized by resting, postural, and kinetic tremors. HT significantly impacts patients' quality of life (QOL) and daily activities. Conventional pharmacological treatments for HT often yield inconsistent results. Emerging surgical treatments such as deep brain stimulation and various thalamotomy techniques show promise but come with challenges, including adverse events (AEs) and potential tremor recurrence. This study aimed to evaluate the clinical outcomes of unilateral MRI-guided laser interstitial thermal therapy (MRIgLITT) thalamotomy in patients with medically intractable HT, focusing on tremor reduction, QOL, and AE incidence, and provide a comprehensive review of the literature on thalamotomy techniques for HT. METHODS:Five patients with medically intractable HT underwent unilateral MRIgLITT thalamotomy between June 2020 and January 2023. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) at baseline and at 3 and 12 months postoperatively. QOL was measured using the Quality of Life in Essential Tremor (QUEST) questionnaire and 39-item Parkinson's Disease Questionnaire (PDQ-39). Subjective patient-rated improvement was evaluated using the Patient Global Impression of Clinical Status (PGI-C) scale at 12 months. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) before the procedure and at 12 months postoperatively. AEs were monitored throughout the follow-up period. RESULTS:The mean patient age was 50.2 ± 22.37 years, with a mean tremor duration of 5.8 ± 4.55 years. Significant tremor reduction was observed in the treated hand, with mean TRS scores decreasing from 19.00 ± 4.36 at baseline to 11.20 ± 4.44 (p = 0.043) at 3 months and 13.40 ± 5.94 (p = 0.042) at 12 months, indicating a relative reduction of 41.05% and 29.47%, respectively. A significant effect was observed on the QUEST scale at 3 months (p = 0.043), but this effect was no longer present at 12 months. No significant effect was found on the PDQ-39 QOL scale. The PGI-C scale showed a high mean subjective improvement of 88.60% ± 8.36% at 12 months. One patient experienced severe AEs, including dysarthria, hemiparesis, and swallowing difficulties, which required prolonged hospitalization and multidisciplinary rehabilitation, but regressed within 3 months. Cognitive performance, as measured by the MMSE, remained stable (p = 0.785). CONCLUSIONS:Unilateral MRIgLITT thalamotomy showed promise as a treatment for medically intractable HT, providing significant tremor reduction with a favorable safety profile. However, the potential for tremor recurrence and minimal functional improvement in fine motor skills highlight the need for long-term follow-up and further research. Larger, multicenter studies are necessary to validate these findings.

BackgroundEssential tremor (ET) affects numerous adults, impacting quality of life (QOL) and often defying pharmacological treatment. Surgical interventions like deep brain stimulation (DBS) and lesional approaches, including radiofrequency, gamma-knife radiosurgery, and magnetic resonance imaging (MRI)-guided focused ultrasound, offer solutions but are not devoid of limitations.ObjectivesThis retrospective, single-center, single-blinded pilot study aimed to assess the safety and efficacy of unilateral MRI-guided laser interstitial thermal therapy (MRIg-LITT) thalamotomy for medically intractable ET.MethodsNine patients with ET, unresponsive to medications and unsuitable for DBS, underwent unilateral MRIg-LITT thalamotomy. We assessed tremor severity, QOL, cognitive function, and adverse events (AE) over a 12-month period.ResultsTremor severity significantly improved, with a reduction of 83.37% at 12 months post-procedure. QOL scores improved by 74.60% at 12 months. Reported AEs predominantly included transient dysarthria, proprioceptive disturbances, and gait balance issues, which largely resolved within a month. At 3 months, 2 patients (22%) exhibited contralateral hemiparesis requiring physiotherapy, with 1 patient (11%) exhibiting persistent hemiparesis at 12 months. No significant cognitive impairment was detected post-procedure.ConclusionsUnilateral MRIg-LITT thalamotomy yielded substantial and enduring tremor alleviation and enhanced QOL in patients with ET that is resistant to medication. The AE profile was acceptable. Our findings support the need for additional research with expanded patient cohorts and extended follow-up to corroborate these outcomes and to refine the role of MRIg-LITT as a targeted and minimally invasive approach for ET management. (c) 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

BackgroundMedically intractable Parkinson's disease (PD) tremor is a common difficult clinical situation with major impact on patient's quality of life (QOL). Deep brain stimulation (DBS) is an effective therapy but is not an option for many patients. Less invasive lesional brain surgery procedures, such as thalamotomy, have proven to be effective in these indications. Here, we describe the technical nuances and advantages of stereotactic robot-assisted MRI-guided laser interstitial thermal therapy (MRIg-LITT) thalamotomy for medically intractable PD tremor.MethodWe describe 2 patients with medically intractable PD tremor treated with stereotactic robot-assisted MRIg-LITT thalamotomy performed under general anesthesia with intraoperative electrophysiological testing. Pre and postoperative tremor scores were assessed using the Fahn-Tolosa-Marin tremor rating scale (TRS).ResultsAt 3-month follow-up, both patients demonstrated significant improvement in tremor symptoms subjectively and according to the TRS (75% for both). Patients also had substantial improvements in their QOL (32.54% and 38%) according to the 39-item PD questionnaire. Both patients underwent uncomplicated MRIg-LITT thalamotomy.ConclusionsIn patients with medically intractable PD tremor who are unsuitable candidates for DBS, thalamotomy utilizing a stereotactic robot, intraoperative electrophysiological testing, and laser ablation with real-time MRI guidance may be a viable treatment option. However, further studies with larger sample sizes and longer follow-up periods are necessary to confirm these preliminary results.

BACKGROUND:Intracranial solitary fibrous tumour (iSFT) is an exceptional mesenchymal tumour with high recurrence rates. We aimed to analyse the clinical outcomes of newly diagnosed and recurrent iSFTs.METHODS:We carried out a French retrospective multicentre (n = 16) study of histologically proven iSFT cases. Univariate and multivariate Cox models were used to estimate the prognosis value of the age, location, size, WHO grade, and surgical extent on overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS).RESULTS:Eighty-eight patients were included with a median age of 54.5 years. New iSFT cases were treated with gross tumour resection (GTR) (n = 75) or subtotal resection (STR) (n = 9) and postoperative radiotherapy (PORT) (n = 32, 57%). The median follow-up time was 7 years. The median OS, PFS, and LRFS were 13 years, 7 years, and 7 years, respectively. Forty-two patients experienced recurrence. Extracranial metastasis occurred in 16 patients. Median OS and PFS after the first recurrence were 6 years and 15.4 months, respectively. A higher histological grade was a prognosis factor for PFS (p = 0.04) and LRFS (p = 0.03). GTR influenced LRFS (p = 0.03).CONCLUSION:GTR provided benefits as a first treatment for iSFTs. However, approximately 40% of patients experienced relapse, which remains a challenging state.