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Société de Neurochirurgie de Langue Franc ¸ aise / Neurochirurgie 60 (2014) 321–358 347 Conclusion Les fistules artérioveineuses durales rachidiennes sont réputées avoir une morbidité neurologique importante due au retard diagnostique. En cas d’impossibilité d’obtenir une occlusion complète par voie endovasculaire, le traitement chirurgical serait indiqué afin d’éviter une détérioration neurologique. Déclaration d’intérêts Les auteurs n’ont pas transmis de déclara- tion de conflits d’intérêts. http://dx.doi.org/10.1016/j.neuchi.2014.10.069 P10 Are infundibular dilatations at risk of further transformation? Ten years progression of a prior documented infundibulum into a saccular aneurysm and rupture C. Karekezi , B. Djoubairou Rabat, Morocco Corresponding author. E-mail address: [email protected] (C. Karekezi) Introduction Infundibular dilatations (IFDs) are conical, triangu- lar, or funnel-shaped enlargements of the origin of cerebral arteries (7–25%). They most frequently affect the origin of the posterior communicating artery (PComA) at its junction with the inter- nal carotid artery (ICA). They are considered normal anatomical variants devoid of pathogenic significance, however some IFDs present with time changes similar to the characteristic of saccular aneurysms. Materials and methods We report the case of a 60 years old female who presented 10 years ago with subarachnoid hemorrhage caused by a left internal carotid artery aneurysm rupture. Results At the time of the first admission, carotid angiography had showed a left internal carotid artery aneurysm and a right posterior communicating artery infundibular dilatation. Neck clip- ping for the left internal carotid artery aneurysm was performed and she was discharged without any neurological deficit. Ten years later, she suffered from a second subarachnoid hemorrhage; carotid angiography demonstrated a right posterior communicating artery aneurysm developed from the previously documented infundibular dilatation with a de novo right anterior choroidal artery aneurysm. Conclusion This case is another proof of the small but growing number of examples of infundibula transformation over time, their risk of progression into saccular aneurysms and subsequent rup- ture. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.neuchi.2014.10.070 P11 Targetting of the ventro-intermediate nucleus using ultra-high field (7 T) MRI for gamma knife surgery purposes: A pilot in vivo study on healthy subjects C. Tuleasca , E. Najdenovska , J. Marques , F. Vingerhoets , J. Thiran , M. Bach Cuadra , M. Levivier Lausanne, Switzerland Corresponding author. E-mail address: [email protected] (C. Tuleasca) Introduction Gamma Knife surgery (GKS) is a non-invasive neurosurgical stereotactic procedure, increasingly used as an alter- native to open functional procedures. This includes targeting of the ventro-intermediate nucleus of the thalamus (e.g. Vim) for tremor. We currently perform an indirect targeting, as the Vim is not visible on current 3 Tesla MRI acquisitions. Our objective was to enhance anatomic imaging (aiming at refining the precision of anatomic tar- get selection by direct visualisation) in patients treated for tremor with Vim GKS, by using high field 7 T MRI. Materials and methodsh Five young healthy subjects were scanned on 3 (T1-w and diffusion tensor imaging) and 7 T (high- resolution susceptibility weighted images (SWI)) MRI in Lausanne. All images were further integrated for the first time into the Gamma Plan Software ® (Elekta Instruments, AB, Sweden) and co-registered (with T1 was a reference). A simulation of targeting of the Vim was done using various methods on the 3 T images. Furthermore, a cor- relation with the position of the found target with the 7 T SWI was performed. The atlas of Morel et al. (Zurich, CH) was used to confirm the findings on a detailed analysis inside/outside the Gamma Plan. Results The use of SWI provided us with a superior resolution and an improved image contrast within the basal ganglia. This allowed visualization and direct delineation of some subgroups of thalamic nuclei in vivo, including the Vim. The position of the target, as asses- sed on 3 T, perfectly matched with the supposed one of the Vim on the SWI. Furthermore, a 3-dimensional model of the Vim-target area was created on the basis of the obtained images. Conclusion This is the first report of the integration of SWI high field MRI into the LGP, aiming at the improvement of targeting vali- dation of the Vim in tremor. The anatomical correlation between the direct visualization on 7 T and the current targeting methods on 3 T (e.g. quadrilatere of Guyot, histological atlases) seems to show a very good anatomical matching. Further studies are needed to validate this technique, both by improving the accuracy of the tar- geting of the Vim (potentially also other thalamic nuclei) and to perform clinical assessment. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.neuchi.2014.10.071 P12 Stimulation du cortex moteur à visée antalgique dans la douleur neuropathique : corrélations anatomo-cliniques A. Afif , P. Mertens Lyon, France Auteur correspondant. Adresse e-mail : afif [email protected] (A. Afif) Introduction L’objectif de cette étude est de localiser les contacts des électrodes en regard du cortex cérébral moteur et chercher la relation entre la localisation anatomique et l’effet antalgique de stimulation électrique de chaque contact. Patients et méthode Vingt-deux patients (14 hommes et 8 femmes) sont victimes de douleurs neuropathiques centrales et/ou périphériques. Ils ont bénéficié d’une stimulation corticale à visé antalgique mise en place dans le département de Neurochi- rurgie du CHU de Lyon. Implantation d’électrodes intracérébrales (Resume, Medtronic, MA) : Le positionnement des électrodes (en extradural) ont été effectuées à l’aide de : (1) repérage anatomique peropératoire par la Neuronavigation en utilisant l’IRM cérébrale en 3D ; (2) enregistrement de l’activité physiologique peropéra- toire du cortex cérébral concernant les deux zones motrice et sensitive, En utilisant : A. Recueil des potentiels évoqués somes- thésiques par stimulation périphérique. B. Recueil des réponses motrices par stimulation corticale peropératoire afin d’identifier la zone motrice et sa somatotopie ; (3) Choix de la position des contacts : (En fonction des résultats anatomo-physiologique et cliniques). Analyse des données anatomiques et cliniques : Dans le but de localiser les électrodes, nous réalisons tridimensionnelle d’imagerie pré-(IRM) et post-(TDM) implantation. Recueil les effets cliniques antalgiques de stimulation électrique de fac ¸ on régulière.

Targetting of the ventro-intermediate nucleus using ultra-high field (7T) MRI for gamma knife surgery purposes: A pilot in vivo study on healthy subjects

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Page 1: Targetting of the ventro-intermediate nucleus using ultra-high field (7T) MRI for gamma knife surgery purposes: A pilot in vivo study on healthy subjects

Société de Neurochirurgie de Langue Francaise / Neurochirurgie 60 (2014) 321–358 347

Conclusion Les fistules artérioveineuses durales rachidiennessont réputées avoir une morbidité neurologique importante due auretard diagnostique. En cas d’impossibilité d’obtenir une occlusioncomplète par voie endovasculaire, le traitement chirurgical seraitindiqué afin d’éviter une détérioration neurologique.

Déclaration d’intérêts Les auteurs n’ont pas transmis de déclara-tion de conflits d’intérêts.

http://dx.doi.org/10.1016/j.neuchi.2014.10.069

P10

Are infundibular dilatations at risk offurther transformation? Ten yearsprogression of a prior documentedinfundibulum into a saccularaneurysm and ruptureC. Karekezi ∗, B. DjoubairouRabat, Morocco∗ Corresponding author.E-mail address: [email protected] (C. Karekezi)

Introduction Infundibular dilatations (IFDs) are conical, triangu-lar, or funnel-shaped enlargements of the origin of cerebral arteries(7–25%). They most frequently affect the origin of the posteriorcommunicating artery (PComA) at its junction with the inter-nal carotid artery (ICA). They are considered normal anatomicalvariants devoid of pathogenic significance, however some IFDspresent with time changes similar to the characteristic of saccularaneurysms.Materials and methods We report the case of a 60 years old femalewho presented 10 years ago with subarachnoid hemorrhage causedby a left internal carotid artery aneurysm rupture.Results At the time of the first admission, carotid angiographyhad showed a left internal carotid artery aneurysm and a rightposterior communicating artery infundibular dilatation. Neck clip-ping for the left internal carotid artery aneurysm was performedand she was discharged without any neurological deficit. Ten yearslater, she suffered from a second subarachnoid hemorrhage; carotidangiography demonstrated a right posterior communicating arteryaneurysm developed from the previously documented infundibulardilatation with a de novo right anterior choroidal artery aneurysm.Conclusion This case is another proof of the small but growingnumber of examples of infundibula transformation over time, theirrisk of progression into saccular aneurysms and subsequent rup-ture.

Disclosure of interest The authors declare that they have noconflicts of interest concerning this article.

http://dx.doi.org/10.1016/j.neuchi.2014.10.070

P11

Targetting of the ventro-intermediatenucleus using ultra-high field (7 T)MRI for gamma knife surgerypurposes: A pilot in vivo study onhealthy subjectsC. Tuleasca ∗, E. Najdenovska , J. Marques , F. Vingerhoets ,J. Thiran , M. Bach Cuadra , M. LevivierLausanne, Switzerland∗ Corresponding author.E-mail address: [email protected] (C. Tuleasca)

Introduction Gamma Knife surgery (GKS) is a non-invasiveneurosurgical stereotactic procedure, increasingly used as an alter-native to open functional procedures. This includes targeting of theventro-intermediate nucleus of the thalamus (e.g. Vim) for tremor.We currently perform an indirect targeting, as the Vim is not visible

on current 3 Tesla MRI acquisitions. Our objective was to enhanceanatomic imaging (aiming at refining the precision of anatomic tar-get selection by direct visualisation) in patients treated for tremorwith Vim GKS, by using high field 7 T MRI.Materials and methodsh Five young healthy subjects werescanned on 3 (T1-w and diffusion tensor imaging) and 7 T (high-resolution susceptibility weighted images (SWI)) MRI in Lausanne.All images were further integrated for the first time into the GammaPlan Software® (Elekta Instruments, AB, Sweden) and co-registered(with T1 was a reference). A simulation of targeting of the Vim wasdone using various methods on the 3 T images. Furthermore, a cor-relation with the position of the found target with the 7 T SWI wasperformed. The atlas of Morel et al. (Zurich, CH) was used to confirmthe findings on a detailed analysis inside/outside the Gamma Plan.Results The use of SWI provided us with a superior resolution andan improved image contrast within the basal ganglia. This allowedvisualization and direct delineation of some subgroups of thalamicnuclei in vivo, including the Vim. The position of the target, as asses-sed on 3 T, perfectly matched with the supposed one of the Vim onthe SWI. Furthermore, a 3-dimensional model of the Vim-targetarea was created on the basis of the obtained images.Conclusion This is the first report of the integration of SWI highfield MRI into the LGP, aiming at the improvement of targeting vali-dation of the Vim in tremor. The anatomical correlation betweenthe direct visualization on 7 T and the current targeting methods on3 T (e.g. quadrilatere of Guyot, histological atlases) seems to showa very good anatomical matching. Further studies are needed tovalidate this technique, both by improving the accuracy of the tar-geting of the Vim (potentially also other thalamic nuclei) and toperform clinical assessment.

Disclosure of interest The authors declare that they have noconflicts of interest concerning this article.

http://dx.doi.org/10.1016/j.neuchi.2014.10.071

P12

Stimulation du cortex moteur à viséeantalgique dans la douleurneuropathique : corrélationsanatomo-cliniquesA. Afif ∗, P. MertensLyon, France∗ Auteur correspondant.Adresse e-mail : afif [email protected] (A. Afif)

Introduction L’objectif de cette étude est de localiser les contactsdes électrodes en regard du cortex cérébral moteur et chercher larelation entre la localisation anatomique et l’effet antalgique destimulation électrique de chaque contact.Patients et méthode Vingt-deux patients (14 hommes et8 femmes) sont victimes de douleurs neuropathiques centraleset/ou périphériques. Ils ont bénéficié d’une stimulation corticale àvisé antalgique mise en place dans le département de Neurochi-rurgie du CHU de Lyon. Implantation d’électrodes intracérébrales(Resume, Medtronic, MA) : Le positionnement des électrodes (enextradural) ont été effectuées à l’aide de : (1) repérage anatomiqueperopératoire par la Neuronavigation en utilisant l’IRM cérébraleen 3D ; (2) enregistrement de l’activité physiologique peropéra-toire du cortex cérébral concernant les deux zones motrice etsensitive, En utilisant : A. Recueil des potentiels évoqués somes-thésiques par stimulation périphérique. B. Recueil des réponsesmotrices par stimulation corticale peropératoire afin d’identifierla zone motrice et sa somatotopie ; (3) Choix de la position descontacts : (En fonction des résultats anatomo-physiologique etcliniques). Analyse des données anatomiques et cliniques : Dansle but de localiser les électrodes, nous réalisons tridimensionnelled’imagerie pré-(IRM) et post-(TDM) implantation. Recueil les effetscliniques antalgiques de stimulation électrique de facon régulière.