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J Régis

Publications and source records attributed to J Régis.

At least 19 recordsLinked to original sources
PubMed2005

The role of Gamma Knife radiosurgery in the treatment of pineal parenchymal tumours.

OBJECT: The aim of this study was to document the possible role of Gamma Knife radiosurgery, suitable for the treatment of deep and well limited tumors, in the management of pineal parenchymal tumors (PPT). POPULATION AND METHODS: We reviewed retrospectively a series of 13 patients with PPT treated by Gamma Knife radiosurgery during 16 procedures. Mean age was 31 (range 10 to 74). Eight patients had pineocytomas (61.5%), and 5 had pineoblastomas (38.5%). Radiosurgery was performed alone in 6 cases, after partial microsurgical resection in 3 cases, in association with chemotherapy in 3 cases and following conventional fractionated radiotherapy in 1 case. The marginal dose to these tumors ranged from 11 to 20 Gy (mean 15 Gy). RESULTS: With a mean follow-up of 34 months (range 6 to 88), all tumors responded to treatment and disappeared or ceased growing. Two patients with pineoblastoma had tumor size progression out of the initial target requiring several radiosurgery procedures. At the end of the follow-up period, 10 out of 12 patients were alive. Two patients with pineoblastoma died because of carcinomatous meningitis or tumor size progression. We observed no mortality or major morbidity related to radiosurgery. CONCLUSION: This study confirms that radiosurgery can be an effective and safe primary treatment modality for patients with pineocytomas. It should have a role in multimodality therapy which includes microsurgical resection, fractionated radiotherapy and chemotherapy for the management of malignant pineal tumors.

Adolescent↗
PubMed2005

Anatomically constrained surface parameterization for cortical localization.

We present here a method that aims at defining a surface-based coordinate system on the cortical surface. Such a system is needed for both cortical localization and intersubject matching in the framework of neuroimaging. We propose an automatic parameterization based on the spherical topology of the grey/white matter interface of each hemisphere and on the use of naturally organized and reproducible anatomical features. From those markers used as initial constraints, the coordinate system is propagated via a PDE solved on the cortical surface.

Algorithms↗
PubMed2005

Gamma knife treatment for refractory cluster headache: prospective open trial.

BACKGROUND: Since the initial report of Ford et al in 1998 no further study has evaluated radiosurgery of the trigeminal nerve in chronic cluster headache (CCH). METHODS: We carried out a prospective open trial of neurosurgery and enrolled 10 patients (nine men, one woman; mean age 49.8 years, range 32-77) presenting with severe and drug resistant CCH (mean duration 9 years, range 2-33). The cisternal segment of the nerve was targeted with a single 4 mm collimator (80-85 Gy max). RESULTS: The mean follow up was 13.2 months. No improvement was observed in two patients and three patients had no further attacks. Three patients showed dramatic improvement with a few attacks per month or very few attacks over the last six months. Two patients were pain free for only one and two weeks and their headaches recurred with the same severity as before. Three patients developed paraesthesia with no hypoaesthesia, one developed hypoaesthesia, and one developed deafferentation pain. CONCLUSIONS: The rate and severity of trigeminal nerve injury appeared to be significantly higher than in trigeminal neuralgia, and this study does not support the positive results of the study of Ford et al. We consider the morbidity to be significant for the low rate of pain cessation, making this procedure less attractive even for the more severely affected subgroup of patients.

Adult↗
PubMed2004

Cortical stimulation study of the role of rhinal cortex in déjà vu and reminiscence of memories.

OBJECTIVE: To study the role of perirhinal (PC) and entorhinal cortices (EC) in dreamy state symptoms (déjà vu and reminiscence of scenes). These phenomena have been attributed to functional alteration of memory networks supported by the medial temporal lobes, principally involving the amygdala and hippocampus. The role of sub-hippocampal structures (EC and PC) in inducing these phenomena has not previously been addressed. METHODS: The authors studied the symptoms evoked by direct electrical stimulations of PC and EC in comparison with those obtained after stimulation of the amygdala and hippocampus. Stimulations were performed in a group of 24 patients with epilepsy, during stereoelectroencephalographic (SEEG) recordings in the setting of presurgical evaluation. All patients had electrodes that sampled the rhinal cortices, amygdala, and hippocampus. RESULTS: A total of 280 stimulations were analyzed. Entorhinal and perirhinal stimulations induced classic mesial temporal lobe responses (emotional, dysautonomic) but also more specific responses, particularly the déjà vu phenomenon and reminiscence of scenes. Such déjà vu or déjà vécu type responses were produced proportionately more often by stimulation of the EC than by stimulation of the amygdala and hippocampus. In particular, déjà vu was associated with stimulation of the EC and reminiscence of memories with PC stimulation. CONCLUSION: This study strongly suggests that experiential symptoms are largely dependent upon functional modification of the physiology of the rhinal cortices.

Adult↗
PubMed2004

Gamma knife surgery for epilepsy related to hypothalamic hamartomas.

OBJECTIVE: Drug resistant epilepsy associated with hypothalamic hamartoma (HH) can be cured by microsurgical resection of the lesion. Morbidity and mortality risks of microsurgery in this area are significant. Gamma Knife Surgery's (GKS) reduced invasivity seems to be well adapted. In view of the severity of the disease and risks of surgical resection it is crucial to evaluate GKS for this indication. A first retrospective study has shown a very good safety and efficacy level but for a more reliable evaluation a prospective study would be required. METHODS: Between Oct 1999 and July 2002, 30 patients with HH and associated severe epilepsy were included. Seizure semiology (video EEG) and frequency, behavioural disturbances, neuropsychological performance, endocrinological status, sleep electroclinical abnormalities, MR imaging, and visual function were systematically evaluated before and after GKS (6, 12, 18, 24, 36 months). Twenty patients had experienced precocious puberty at a median age of 3,7 (0-9). Range of maximum diameter was from 7,5 to 23 mm with only 3 larger than 18 mm. The median marginal dose was 17 gy (14-20). RESULTS: Sufficient follow up for final evaluation is not yet available. Only 6 patients have a follow-up of more than 12 months and 19 more than 6 months. However a lot of very dramatic changes did occur during that period in this group. Among the 19 patients with more than 6 months of follow-up, a lot had already experienced an increase of gelastic seizures around 3 months (3), an improvement in their seizure rate (18), behaviour (9), sleep (3), and EEG background activity (3), a cessation of partial complex seizures (7). No complications have occurred till now except one patient experiencing at 5 months a hyperthermia without infection and concomitant increase of gelastic seizures both ceasing suddenly and spontaneously after 15 days. CONCLUSION: Our first results indicate that GKS is as effective as microsurgical resection and very much safer. GKS also allows to avoid the vascular risk related to radiofrequency lesioning or stimulation. The disadvantage of radiosurgery is its delayed action. Longer follow-up is mandatory for a serious evaluation of the role of GKS. Results are faster and more complete in patients with smaller lesions inside the 3rd ventricle (grade II). The early effect on subclinical discharges turns out to play a major role in the dramatic improvement of sleep quality, behaviour, developmental acceleration at school.

Adolescent↗
PubMed2004

Short-latency components of evoked potentials to median nerve stimulation recorded by intracerebral electrodes in the human pre- and postcentral areas.

OBJECTIVE: To study whether sensory afferents of the hand projected directly to the primary motor cortex (M1) as they have been well electrophysiologically described in monkeys but not in humans. METHODS: We recorded intracerebrally in the central areas (pre- and/or postcentral gyrus) somatosensory evoked potentials (SEPs) to median nerve stimulation in 5 (4 women, 1 man; age 14-37 years) epileptic patients during presurgical evaluation. RESULTS: The primary somatosensory cortex (S1) showed negative-positive components peaking at about 20 and 30 ms, respectively. By contrast, M1 disclosed SEPs of two types of waveforms depending on the portion of the precentral gyrus explored by the different contacts of the electrode. Here, we demonstrated, for the first time, in the medial portion of M1, shaped like an omega in the axial plane, corresponding to the motor hand area, the occurrence of a primary negative component as in S1, but of higher amplitude and peaking at about 4 ms later. In other respects, the lateral portion of M1 disclosed positive-negative components peaking at about 21 and 31 ms, respectively. CONCLUSIONS: These electrophysiological findings, based on accurate spatial and temporal resolution of intracerebral recordings, suggested that somatosensory inputs from the hand projected directly to M1 in its medial portion.

Adolescent↗
PubMed2004

Brain morphometry using 3D moment invariants.

This paper advocates the use of shape descriptors based on moments of 3D coordinates for morphometry of the cortical sulci. These descriptors, which have been introduced more than a decade ago, are invariant relatively to rotations, translations and scale and can be computed for any topology. A rapid insight into the derivation of these invariants is proposed first. Then, their potential to characterize shapes is shown from a principal component analysis of the 12 first invariants computed for 12 different deep brain structures manually drawn for 7 different brains. Finally, these invariants are used to find some correlates of handedness and sex among the shapes of 116 different cortical sulci automatically identified in each of 142 brains of the ICBM database.

Algorithms↗
PubMed2004

A framework to study the cortical folding patterns.

This paper describes a decade-long research program focused on the variability of the cortical folding patterns. The program has developed a framework of using artificial neuroanatomists that are trained to identify sulci from a database. The framework relies on a renormalization of the brain warping problem, which consists in matching the cortices at the scale of the folds. Another component of the program is the search for the alphabet of the folding patterns, namely, a list of indivisible elementary sulci. The search relies on the study of the cortical folding process using antenatal imaging and on backward simulations of morphogenesis aimed at revealing traces of the embryologic dimples in the mature cortical surface. The importance of sulcal-based morphometry is illustrated by a simple study of the correlates of handedness on asymmetry indices. The study shows for instance that the central sulcus is larger in the dominant hemisphere.

Brain Mapping↗
PubMed2004

Coordinate-based versus structural approaches to brain image analysis.

A basic issue in neurosciences is to look for possible relationships between brain architecture and cognitive models. The lack of architectural information in magnetic resonance images, however, has led the neuroimaging community to develop brain mapping strategies based on various coordinate systems without accurate architectural content. Therefore, the relationships between architectural and functional brain organizations are difficult to study when analyzing neuroimaging experiments. This paper advocates that the design of new brain image analysis methods inspired by the structural strategies often used in computer vision may provide better ways to address these relationships. The key point underlying this new framework is the conversion of the raw images into structural representations before analysis. These representations are made up of data-driven elementary features like activated clusters, cortical folds or fiber bundles. Two classes of methods are introduced. Inference of structural models via matching across a set of individuals is described first. This inference problem is illustrated by the group analysis of functional statistical parametric maps (SPMs). Then, the matching of new individual data with a priori known structural models is described, using the recognition of the cortical sulci as a prototypical example.

Brain↗
PubMed2004

Object-based morphometry of the cerebral cortex.

Most of the approaches dedicated to automatic morphometry rely on a point-by-point strategy based on warping each brain toward a reference coordinate system. In this paper, we describe an alternative object-based strategy dedicated to the cortex. This strategy relies on an artificial neuroanatomist performing automatic recognition of the main cortical sulci and parcellation of the cortical surface into gyral patches. A set of shape descriptors, which can be compared across subjects, is then attached to the sulcus and gyrus related objects segmented by this process. The framework is used to perform a study of 142 brains of the International Consortium for Brain Mapping (ICBM) database. This study reveals some correlates of handedness on the size of the sulci located in motor areas, which was not detected previously using standard voxel based morphometry.

Algorithms↗
PubMed2004

[Radiology of radiosurgery].

Proper understanding of the fundamentals of radiosurgery and the main principles of radiobiology is a key point for the development and adaptation of therapeutic strategies and for the definition of indications. The prediction of local effects of radiosurgery requires taking into account both the target Volume and the marginal dose (energy,...) and not only the marginal dose which alone is poorly predictive of the outcome. Other additional factors such as topography, age, previous irradiations,... are likely to influence this risk relationship. The comparison of different dose regimens leads to proposing theoretical models for calculating radiobiological equivalences: the Biological Equivalent Dose (BED) Using these models one can think in terms of the practical consequences of dose fractionation. This allows, depending on the medical context, identifying the potential advantages of the radiosurgery or of a fractionated regimen. For small mid-sized vestibular schwannomas this approach indicates a clear advantage for a single-dose regimen. Retrospectively it has been possible to identify the dose-Volume relationship to the risk of neuropathy for facial motor function, facial sensitivity, and hearing.

Dose Fractionation, Radiation↗
PubMed2004

[Radiosurgery: basic principles].

Radiosurgery is a way of treating in-brain lesions which uses convergence of very thin multiple ionisation beams in a unique focus point coinciding with the target. This enables obtaining a therapeutic effect without opening the skull, and thus avoiding eventual complications or contraindications of classical neurosurgery. In certain cases irradiation can be delivered with submillimetric precision. This particularly new approach is historically essentially based on the work of the Swedish neurosurgeon Lars Leksell in the 50s. Since that time new imaging techniques (e.g. digital imaging) have considerably widened indications. Three ionisation beam sources are generally used in this context: gamma rays emitted by radioactive cobalt 60 sources for the Gamma Knife, high energy LINAC X-rays modified in comparison to their classical use in external radiation therapy, and, more rarely, protons produced in cyclotrons. Several teams world-wide are still perfecting and refining this developing technique.

Ear Neoplasms↗
PubMed2004

[Stereotactic mapping for radiosurgical treatment of vestibular schwannomas].

RATIONALE: As an exclusively image-guided surgery method, radiosurgery requires special attention in the choice of imaging modalities and acquisition parameters must be set with extreme care. METHODS: Quality control for resolution and accuracy of computed tomography (CT) scanners must be performed. Magnetic resonance imaging (MRI) distortions should be limited through magnetic field homogeneity adjustment (shimming) and acquisition parameters optimization. These inaccuracies should then be quantified through systematic combination of MRI and CT in the radiosurgery planning system. MRI pulse sequences selection criteria are defined by their ability to delineate tumor contrast enhancement and to image cranial nerves and vessels relative arrangement in the cistern and canal. Topography of the petrous structures, such as cochlea, vestibulum and facial nerve canal should be visible. Exact definition of real extension of the lesion at the end of the canal may require specific technical solutions. These technical requirements must be balanced depending on the lesion Volume staging (Koos), the treatment history (microsurgery), the clinical condition (hearing quality), the pathological context (NF2) or the age of the patient. RESULTS: T1-weighted Volumetric MRI pulse sequences (3D-T1) show a contrast enhanced signal that is useful for both the pons interface delineation in Koos III cases, and the canal ending in Ohata A and B. On the other hand, 3D-T1 introduce inaccuracies from magnetic susceptibility distortions and partial Volume effects. High resolution CISS T2-weighted Volumetric pulse sequences (3D-T2) give superior stereotaxic definition attributable to their better resolution (half a millimeter) minimizing partial Volume effects and to their lower magnetic susceptibility minimizing distortions. 3D-T2 allows direct nerve visualization. Moreover, this pulse sequence with contrast injection, show improved distinction between the pons and the nerves due to signal differences within the schwannomas. Fat saturation pulse sequences are of interest in post-microsurgery conditions. CONCLUSIONS: Radiology phase quality is critical and its complexity requires a high commitment to obtain satisfactory clinical results. Solelt the 3D-T1 MRI modality seems to us not to comply to minimum security criteria.

Diffusion Magnetic Resonance Imaging↗
PubMed2004

[Dosimetric planning for radiosurgical treatment of vestibular schwannomas].

Dosimetry planning is certainly the most typical neurosurgical instant in the radiosurgical procedure for the treatment of vestibular schwannomas (VS). Indeed, it is a key-moment in which the therapeutical choices will have a major influence on the clinical results, in terms of efficacy and safety. The therapist has to inform the patient about the rationale of the treatment, its limitations, the expected results, and the specific risks. Deep knowledge of the radiosurgical technique, of the principles of dosimetry, and of the therapist's personal experience, allows an a posteriori analytical study of the influence of the dosimetry therapeutic choices on the patient's outcome. Correlation between the preoperative therapeutic choices and the postoperative clinico-radiological information is mandatory to optimize therapeutic strategies. These therapeutic choices should be the result of a reflection integrating the clinical status of the patient, an understanding of the specific pathology of VS, awareness of the other therapeutic choices, and knowledge of radiological and surgical anatomy. The way a certain number of parameters will be defined during the dosimetry planning will have a major influence on the clinical results. This explains wide variability of clinical results from one operator to another, for the same radiological and radiosurgical tools. This emphasizes the need for specific and long-term training, associated with continuous education and a good knowledge of the very active literature.

Ear Neoplasms↗
PubMed2004

[Functional outcomes of radiosurgical treatment of vestibular schwannomas: 1000 successive cases and review of the literature].

RATIONALE: To evaluate the functional results of Gamma Knife surgery of vestibular schwannomas relying on a large and prospective series of consecutive cases. MATERIAL AND METHOD: The first 1000 patients with cerebello-pontine angle schwannomas were consecutively treated by Gamma Knife in Marseille Timone University Hospital between July 1992 and March 2001. Patients without NF2 and or clinico-radiological arguments in favor of a facial origin accounted for a population of 927 patients (414 males, for 513 females) including 843 treated in first intention. In this series the Koos classification was: stage I 77 patients, stage II 520 patients, stage III 287 patients and stage IV 42 patients. The average Volume was 12.7mm3. Haring was usefull (Gardner and Robertson) before radiosurgery in 47% of the patients (subnormal in 20.3%). RESULTS: Tumor control at last follow-up was 97%. Globally, a clinical trigeminal injury was observed in 0.6% of the patients and a facial palsy in 1.3%. There was clearly a decrease of the incidence of neuropathies with time; no facial palsy being reported among the last 258 patients. The rate of functional hearing preservation (Gardner) for patients initially in class I was 77.8% (47.6% for class II) at 3 Years. This rate of functional preservation reached 95% among patients with tinnitus as a first symptom. CONCLUSION: Today, strong evidence surports the superiority of Gamma Knife surgery in term of functional perservation and equal efficacy compared with microsurgical removal. Consequently, radiosurgery must be preferred as a first intention choice for young patients with few symptoms presenting with a small to middle size vestibular schwannomas (Koos I-III).

Aged↗
PubMed2004

[Changing radiological results, pitfalls and criteria of failure].

RATIONALE: To evaluate the morphological changes occurring during the Years following radiosurgery in order to better define the cure-failure parameters. MATERIAL AND METHODS: Between July 1992 and January 2002 the otoneurosurgical group of the Timone Hospital in Marseille have operated 1000 vestibular schwannomas. The MR imaging performed before (at diagnosis) during and after radiosurgery (6 months, 1 year, 2 years, 3 years, 5 years, 7 years and 10 years) was carefully studied. Systematically six lenghts measurements were obtained for each lesion. RESULTS: Preoperatively 129 patients were had progressive tumors. At time of radiosurgery, median tumor Volume was 732mm3 (mean: 1346, range: 20-14405). According to the Koos topographical classification, lesions were stage I in 80 patients, stage II in 538 patients, stage III in 322 patients and stage IV in 56 patients. A clear loss of the central enhancement was visible on the postoperative MR control at 6 months and/or 1 Year in 45.5% of patients. In 64% of these patients, this loss of the central contrast enhancement have disappeared. A significant increase of the tumor size was recorded in 15% of the patients. The median increase was 62% (mean: 78%, range: 30-350%). Progression led to salvage surgery (either resection or radiosurgery), in only 3% of the patients. CONCLUSION: The specificity of the morphological changes after radiosurgery, when ignored, can lead to misinterpretation and eventually to inappropriate decisions, dangerous for the patient. The analysis of our results had led us to consider continuous progression after 3 Years as mandatory to retain the diagnosis of failure.

Diffusion Magnetic Resonance Imaging↗
PubMed2004

Histopathological observations on vestibular schwannomas after Gamma Knife radiosurgery: the Marseille experience.

BACKGROUND AND PURPOSE: Radiosurgery has become a successful treatment modality in the management of vestibular schwannomas (VS) during the past four decades. Although the number of treated cases has been increasing continuously we know relatively little about the pathological effect of high dose irradiation on VS following radiosurgery. The purpose of this study was to analyze histopathological changes in VS after Leksell Gamma Knife (LGK) radiosurgery. METHODS: Out of a series of 1350 VS cases treated with LGK surgery 22 patients underwent craniotomy for tumor removal in 6-92 Months interval after radiosurgery. Surgical pathology material was available in 17 cases. Routine histological and immunohistochemical investigations were performed on the tIssue samples. Histopathological findings were compared with clinical and radiological follow-up data. RESULTS: Coagulation necrosis in the central part of the schwannomas surrounded with a transitional zone containing loosened tIssue structure of shrunken tumor cells covered with an outer capsule of vigorous neoplastic cells was the basic histopathological lesion. Granulation tIssue proliferation with inflammatory cell infiltration, different extent of hemorrhages and scar tIssue development was usually present. Endothelial destruction or wall damage of vascular channels was a common finding. Analyzing the follow-up data it turned out that 7 patients out of the 22 were operated on because of radiological progression only without clinical deterioration and 4 of them was removed during the latency period after radiosurgery. CONCLUSION: Results of the present histopathological study suggest that radiosurgery works with double effect on VS: it seems to destroy directly tumor cells (with necrosis or inducing apoptosis), and causes vascular damages as well. The loss of central contrast enhancement on CT and MR images following radiosurgery might be consequence of necrosis and vascular impairment. From clinical-pathological point of view we think that patients should not undergo craniotomy just because of radiological progression of the tumor without clinical deterioration, mainly in the latency period. This requires consultation and common decision-making between the radiosurgical and the microsurgical team.

Adult↗