[Glioblastoma incident studies from May 2006 to May 2007 in Angers and Nice, France]. / Études des glioblastomes incidents de mai 2006 à mai 2007, Angers-Nice.

The present work is a retrospective study on glioblastomas treated in the Angers and Nice Hospital Departments of Neurosurgery between 2006 and 2007. This study was conducted 2 years after the audit on incident glioblastoma in France in 2004. New events that may modify the care or survival of glioblastoma have occurred since 2004, justifying the present study. The results show that the Karnowsky Index is more often included in the clinical files and that the rate of complete resection has increased, indicating that neurosurgeons are becoming aware of neuro-oncology. Patients with total resection still have the longest survival (14 months). Surprisingly, less than half the patients having surgery received concomitant radiochemotherapy according to the Stupp protocol. Median overall survival remains at 9 months with intention to treat. For patients treated with concomitant chemoradiotherapy with temozolomide, the median survival is 12 months. For patients having a total resection, the median survival is 14 months, whatever adjuvant treatment is used. Median survival for patients having total resection and chemoradiotherapy with temozolomide is 18 months, with a 23.3% 2-year survival rate, less than the ORTC trial rate.

[Subthalamic nucleus stimulation using a Fisher ZD stereotactic frame, MR-CT fusion guidance and peroperative orthogonal radiographs, in Parkinson disease]. / Evaluation de la stimulation du noyau sous-thalamique utilisant un cadre de Fischer adapté, un guidage par fusion IRM-scanner et un contrôle radiographique stéréotaxique peropératoire, dans la maladie de Parkinson.

BACKGROUND: We present the method and results of an original technique to implant electrodes in the subthalamic nucleus (STN) to treat Parkinson's disease, based on adaptations of the Fisher ZD stereotactic frame. METHODS: Targets coordinates were calculated after fusion of stereotactic CT-scan and MRI images. STN was localized by its theoretical coordinates according to AC-PC and by its direct visualization on T2 images. Electrodes were implanted after local anesthesia, using peroperative multicanal microrecordings and test stimulation. Electrodes location was checked by peroperative perpendicular radiographs. To avoid projection of the frame arm on the area of interest on anteroposterior and lateral radiographs, the arm was fixed at 45 degrees from the usual 90 degrees position. This original fixation needed a trigonometric transformation of the X and Y stereotactic coordinates. Radiopaque markers, fixed on the frame, were identified on the radiographs, allowing the calculation of the stereotactic coordinates of the electrode tip, which were then entered in the stereotactic MRI, to check its location from the defined target. RESULTS: No problem due to adaptations of the frame occurred in the 60 patients. In all cases, peroperative radiographs allowed to confirm the correct location of electrodes. Six months after surgery, UPDRS III score without medication was decreased by 52% with stimulation "on". UPDRS IV items 32, 33 and 39 scores were decreased by 75,7, 79,5 and 72%. Daily dopa-equivalent dose was decreased by 71%. One asymptomatic thalamic hematoma and two wound infections occurred. CONCLUSION: This method was efficient and safe to implant deep electrodes.

Thrombotic carotid megabulb: fibromuscular dysplasia, septae, and ischemic stroke.

The proximal internal carotid artery is most commonly spared in cerebral fibromuscular dysplasia. The authors report the cases of three young black patients with stroke and carotid megabulbs with fibrous components, two of whom had superimposed thrombi.

An improved silver staining technique as an alternative nuclear or combined nuclear nerve-fiber impregnation for comparative light-, secondary and backscattered electron scanning microscopy.

Slices of rat brain were stained by a new silver impregnation technique. This method takes into consideration the pH-dependent differences of silver stain affinity of nerve tissues and can be used alternatively as a stain for nuclei or as a method for combined demonstration of nuclei nerves fibers. The slices were studied at the light microscopical (LM) level and subsequently with a scanning electron microscope, using secondary (SSEM = classical SEM), and backscattered electron detectors (BSEM). This new silver staining technique offers the opportunity of comparative studies with regard to different information acquired with LM, SSEM and BSEM. The described method allows to distinguish between nervous and glial tissue without necessarily damaging the glial tissue surrounding the nerve fibers. Specifically, scanning electron microscopy with backscattered electron detector of in situ preparations provides a higher contrast of stained and unstained tissue and increased depth of focus as compared to secondary electron detectors.