Aboukais R., Zairi F., Marinho P., Lejeune J. P.   Management of cardiac migration of a distal shunt catheter: The radiological pitfalls.  Neurochirurgie.  2015 ;61 :43-45

Cardiac migration is a rare complication of the ventriculoperitoneal shunt. We report a case of a late migration of the distal shunt into the pulmonary arteries. The authors underline the radiological features that suggested the presence of a knot. Preoperative planning and the assistance of a vascular surgeon were required due to the presence of a knot.

Aboukais R., Zairi F., Lejeune J. P., Le Rhun E., Vermandel M., Blond S., Devos P., Reyns N.   Grade 2 meningioma and radiosurgery.  J. Neurosurg..  2015 ;122 :1157-1162

OBJECT: World Health Organization Grade 2 meningiomas are aggressive tumors associated with a high recurrence rate leading to repeated surgical procedures, which can seriously worsen a patient's neurological status. Although radiosurgery is an increasingly popular technique, its role in the management of Grade 2 meningiomas has yet to be defined. In this study the authors aimed to evaluate radiosurgery in achieving control of proven tumor progression occurring after resection of Grade 2 meningioma. METHODS: This retrospective study included consecutive patients who, between 2000 and 2012, had undergone radiosurgery for radiologically proven progression of a previously surgically treated Grade 2 meningioma. RESULTS: Twenty-seven patients were eligible for analysis. There were 9 men and 18 women with a mean age of 59 years. The mean radiation dose was 15.2 Gy (range 12-21 Gy), and the mean target volume was 5.4 cm(3) (range 0.194-14.2 cm(3)). Thirty-four radiosurgical procedures were performed in the 27 patients. The mean progression-free survival after radiosurgery was 32.4 months among those with progression in a target irradiated volume and 26.4 months among those with progression in any intracranial meninges. With a mean follow-up of 56.4 months (range 12-108 months), the 12-, 24-, and 36-month actuarial local control rates for all patients were 75%, 52%, and 40%, respectively, and the regional control rates were 75%, 48%, and 33%. A single case of transient hemiparesis completely resolved without sequelae. CONCLUSIONS: Radiosurgery appears to be a safe and effective treatment for the local control of delayed progression after resection of a Grade 2 meningioma. Higher radiation doses similar to those applied for malignant tumors should be recommended when possible.

Aboukais R., Zairi F., Le Rhun E., Lejeune J. P., Devos P., Reyns N.   Radiation-associated grade 2 meningiomas: A nine patient-series and review of the literature.  Clin. Neurol. Neurosurg..  2015 ;136 :10-14

INTRODUCTION: Radiation-associated meningiomas (RAM) remain rare but recognized to harbor a high potential of aggressiveness. Only few studies focused on grade 2 histological variants. OBJECTIVE: Our study aims to report the natural history of patients with radiation-associated grade 2 meningiomas followed in a single institution. MATERIALS AND METHODS: This retrospective study included all patients with grade 2 RAM operated in our institution between 1994 and 2011. We used the WHO 2007 classification for histological grading. The degree of resection was evaluated using Simpson Classification. The tumor was considered radiation-associated, if the patient had a medical history of cranial irradiation for another medical condition (1 year before at least). Patients benefited from a post-operative close clinical and radiological (cranial MRI) follow-up every 4 months during 2 years and annually thereafter, to detect any tumor progression. Adjuvant therapy and/or monitoring were systematically decided during a multidisciplinary team meeting. RESULTS: Nine patients (6 men and 3 women) were included in the study. The mean age at diagnosis was 34 years old (range 20-55 years). The mean follow-up was 77 months (range 31-180 months). The mean delay between initial cranial radiation therapy and the diagnosis of grade 2 RAM was 23 years (range 16-33 years). Among all patients, 4 harbored a meningiomatosis, while 5 patients harbored a single tumor. Post-operative local tumor progression was noted in 4 patients. Progression free survival (PFS) after the first surgery in these 4 patients was 15, 23, 35, and 47 months. In these 4 progressive patients, 7 surgical resections, 3 GKS and 1 fractionated radiation therapy have been performed. Post-operative tumor progression was noted at distance from the operated meningioma in 1 patient with meningiomatosis. At final control, 2 patients had severe oculomotor palsy and 1 patient needed palliative cares related to progressive meningiomatosis with anorexia and swallowing disturbance. CONCLUSION: Grade 2 RAM is a severe radiation-associated disease occurring preferentially in younger male patients. Although, surgery remains the mainstay treatment, the high potential of tumor progression often requires adjuvant therapeutic tools. Thus, new radiation therapy should be discussed in some cases and the role of radio surgery is still to be better defined.

Aboukais R., Zairi F., Bourgeois P., Thines L., Lejeune J. P.   Radiological Pitfalls of a Large Intracranial Dissecting Aneurysm.  Turk. Neurosurg..  2015 ;25 :158-161

We report the case of a large dissecting aneurysm of the anterior cerebral artery revealed by cerebral infarction in 38-year-old man. The volume and aspect of the aneurysm initially led us to the diagnosis of saccular aneurysm. Given the complete thrombosis, the risk of bleeding was low and antithrombotic therapy was started. Surgery could be discussed later. However radiological monitoring by MRI (magnetic resonance imaging) showed a rapid decrease in volume of the aneurysm. The final angiography found an aspect of stenosis followed by a little arterial dilatation. The diagnosis of dissecting anterior cerebral aneurysm was a posteriori established.

Aboukaïs R., Zairi F., Bourgeois P., Boustia F., Leclerc X., Lejeune J. P.   Pericallosal aneurysm: A difficult challenge for microsurgery and endovascular treatment.  Neurochirurgie.  2015 ;61 :244-249

INTRODUCTION: Pericallosal artery aneurysms (PAA) represent 2 to 9% of intracranial aneurysms and their management remains difficult. OBJECTIVE: We aimed to report our experience to evaluate the outcome of patients with ruptured and unruptured PAA, when the treatment modality is decided in a multidisciplinary fashion. MATERIALS AND METHODS: In this retrospective study, we included 28 patients (8 men and 20 women) treated for a PAA in our institution between 2002 and 2012, among the 2430 patients who underwent the treatment of an intracranial aneurysm in the same period. Fifteen patients harbored a ruptured aneurysm while 13 benefited from a prophylactic treatment. The mean age at diagnosis was 52 years (range 37 to 75 SD: +/- 5) in patients with ruptured aneurysm and 54.2 years (range 35 to 66 SD: +/- 5) in patients with unruptured aneurysm. Endovascular treatment has been performed in 9 patients while 19 patients underwent a microsurgical treatment. Clinical outcome has been assessed using the modified Rankin scale (mRS) at 3 months. Long-term imaging follow-up included a CT angiography at 36 months for clipped aneurysms and MR angiography at 6, 18 and 36 months for coiled aneurysms. RESULTS: The median follow-up was 3.4 years (range 2.8 to 4.2). The mRS was

Aboukais R., Zairi F., Bonne N. X., Baroncini M., Schapira S., Vincent C., Lejeune J. P.   Causes of mortality in neurofibromatosis type 2.  Br. J. Neurosurg..  2015 ;29 :37-40

Object. The causes of mortality in neurofibromatosis type 2 (NF2) patients are poorly studied in the literature. Our study aimed to fit this gap by analyzing the main causes of death in this population. Methods. This study is the retrospective review of prospectively collected data of 80 patients with NF2 disease followed in Lille University Hospital between 1987 and 2011. Demographical data, diagnosis criteria, and cause of death were recorded. Results. There were 45 men and 35 women, with a mean age at diagnosis of 27.2 years (range: 6-73 years; SD: +/- 15.4). Sixty-eight patients met Manchester criteria and the others had an identified mutation in the NF2 gene which confirmed the diagnosis. Of all patients, we noted 7 deaths. The mean age at diagnosis of dead patients was 26 years. The mean age of death was 38.9 years. The causes of death were suicide in 1 patient, hematoma after surgical removal of grade IV vestibular schwannoma in 1 patient, aspiration pneumonia after swallowing disturbances in 3 patients, intracranial hypertension related to growth of multiple meningiomas in 1 patient, and brachial plexus sarcoma grade 3 in the last patient. Conclusion. NF2 is a serious disease that can quickly be life-threatening. The presence of lower cranial nerves schwannomas is a poor prognostic factor, and radiosurgery should be considered for their treatment, as surgical removal often worsens the swallowing disturbances. A psychological support should also be provided.

Aboukais R., Bonne N. X., Baroncini M., Zairi F., Schapira S., Vincent C., Lejeune J. P.   Management of multiple tumors in neurofibromatosis type 2 patients.  Neurochirurgie.  2015

INTRODUCTION: Neurofibromatosis type 2 is characterized by the presence of bilateral vestibular schwannomas. However, other nervous system tumors may also occur. Therefore, the management of NF2 patients is complex and requires a multidisciplinary discussion in a specialized center. MATERIALS AND METHODS: All recent articles concerning tumors other than vestibular schwannoma in NF2 disease were reviewed, using PubMed databases. RESULTS: Intracranial meningiomas occur in 50% of NF2 patients, and are often multiple. Surgery remains the main treatment and should be performed in cases of growing tumors. The role of antiangiogenic therapy is currently under evaluation and the role of radiosurgery still remains to be defined in NF2 disease. Spinal tumors occur in about half of NF2 patients. Surgery should be discussed when radiological tumor progression is demonstrated, even if spinal tumors are asymptomatic, in order to preserve neurological function and good quality of life. As regards lower cranial nerve schwannomas, radiosurgery appears to be a more appropriate treatment for growing tumor with a small volume in order to avoid post-operative complications, especially swallowing disorders. Facial nerve schwannomas may appear, on MRI, like vestibular schwannomas. The diagnosis should be suspected when the facial palsy is an early symptom during cerebello-pontine tumor progression. Trigeminal schwannomas are frequent in NF2 disease and fortunately they are often asymptomatic. Among major neurofibromatosis types, peripheral nerve sheath schwannomas are only present in patients with NF2 disease and schwannomatosis. Surgical resection is required when the cutaneous schwannomas is painful or when tumor progression is observed and causes symptoms. CONCLUSION: Tumors other than vestibular schwannoma are also associated with a poor prognosis in NF2 patients. Surgery remains the main treatment in most cases. Each treatment decision in NF2 disease requires a complete evaluation of all cranial and spinal locations of the disease in order to establish surgical priorities and strategies.