Neurochirurgie
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Optic nerve sheath meningioma (ONSM) accounts for one-third of primary optic nerve tumors, and 2% of all meningiomas. ONSM must be distinguished from other meningiomas, in particular from cavernous meningiomas because of the different prognosis and treatment. The most frequent clinical sign is a progressive or sudden unilateral visual loss. Treatment of ONSM is still subject to discussion. This report covers a series of eight ONSM patients treated with fractionated stereotactic radiotherapy. ⋯ This is still a preliminary study, but the results suggest that fractionated stereotactic radiotherapy may emerge as a primary treatment for ONSM, delaying surgery, which has proven functionally disappointing.
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Internet has become the first place where patients go to when seeking information about their disease. Little is known about the type and the quality of the medical information available on French-speaking websites, especially in the field of neuro-oncology. The purpose of this study was to evaluate the quality of these sites. ⋯ This study shows that the search for medical information on the Internet is time consuming and often disappointing: very few websites provide information that is both clear and exhaustive. However, we also found that very few websites contained information that was seriously inaccurate. Given the growing popularity of the Internet, patients could certainly benefit from a high quality French speaking website that would specialize in cerebral tumors, as well as from a neuro-oncological portal that would take them to selected websites as it would save time and would be a guarantee for quality.
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Microsurgical training in neurosurgery is essential, the aim being to practise surgery with the microscope and to learn vascular and nervous anastomosis techniques. The objective of this project was to create a model simulating the human anatomy and surgical conditions. ⋯ Various models and techniques for training to microsurgical arterial anastomosis are described in the literature. The determining factor is the skill of the operator, which is in turn dependent on the level of training. This model allows the surgeon to gain significant technical experience with the EC-IC bypass, which is applicable to human neurosurgical practice and is indispensable for the prospective neurovascular surgeon.
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Review
[Role of radiosurgery in the management of intracranial cavernomas. Review of the literature].
From a review of the literature dealing with radiosurgery of cavernous malformations, we have analyzed its impact on hemorrhagic risk, epilepsy, histological modifications, morbidity and potential indications of treatment. Radiosurgery could significantly reduce the hemorrhagic risk, in a selected population with a high risk of hemorrhage, after an interval of about 2 years, but cannot provide protection against rebleeding. As for epilepsy related to the lesion, a significant reduction of seizures has been observed in certain cases, with better control in case of recent evolution and simple seizures linked to the site of the vascular malformation. ⋯ Radiosurgery can be proposed for non-surgical lesions with a high risk of hemorrhage, nevertheless the superiority of the technique over conservative treatment has to be proven. Without long-term prospective studies, the efficiency of RS for cavernomas remains questionable and subject to debate. New imaging methods proving the obstruction of the cavernous malformation are needed.