Publications by authors named "Gilles Zah-Bi"

10 Publications

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Is function-based resection using intraoperative awake brain mapping feasible and safe for solitary brain metastases within eloquent areas?

Neurosurg Rev 2021 Mar 4. Epub 2021 Mar 4.

Service de Neurochirurgie, GHU Paris, Hôpital Sainte-Anne, 1, rue Cabanis, F-75014, Paris, France.

To assess feasibility and safety of function-based resection under awake conditions for solitary brain metastasis patients. Retrospective, observational, single-institution case-control study (2014-2019). Inclusion criteria are adult patients, solitary brain metastasis, supratentorial location within eloquent areas, and function-based awake resection. Case matching (1:1) criteria between metastasis group and control group (high-grade gliomas) are sex, tumor location, tumor volume, preoperative Karnofsky Performance Status score, age, and educational level. Twenty patients were included. Intraoperatively, all patients were cooperative; no obstacles precluded the procedure from being performed. A positive functional mapping was achieved at both cortical and subcortical levels, allowing for a function-based resection in all patients. The case-matched analysis showed that intraoperative and postoperative events were similar, except for a shorter duration of the surgery (p<0.001) and of the awake phase (p<0.001) in the metastasis group. A total resection was performed in 18 cases (90%, including 10 supramarginal resections), and a partial resection was performed in two cases (10%). At three months postoperative months, none of the patients had worsening of their neurological condition or uncontrolled seizures, three patients had an improvement in their seizure control, and seven patients had a Karnofsky Performance Status score increase ≥10 points. Function-based resection under awake conditions preserving the brain connectivity is feasible and safe in the specific population of solitary brain metastasis patients and allows for high resection rates within eloquent brain areas while preserving the overall and neurological condition of the patients. Awake craniotomy should be considered to optimize outcomes in brain metastases in eloquent areas.
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http://dx.doi.org/10.1007/s10143-021-01504-6DOI Listing
March 2021

Evolution of the neurosurgical management of progestin-associated meningiomas: a 23-year single-center experience.

J Neurooncol 2021 Apr 15;152(2):279-288. Epub 2021 Jan 15.

Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France.

Purpose: The improving knowledge of interactions between meningiomas and progestin refines the management of this specific condition. We assessed the changes over time of the management of progestin-associated meningiomas.

Methods: We retrospectively studied consecutive adult patients who had at least one meningioma in the context of progestin intake (October 1995-October 2018) in a tertiary adult Neurosurgical Center.

Results: 71 adult women with 125 progestin-associated meningiomas were included. The number of progestin-associated meningioma patients increased over time (0.5/year before 2008, 22.0/year after 2017). Progestin treatment was an approved indication in 27.0%. A mean of 1.7 ± 1.2 meningiomas were discovered per patient (median 1, range 1-6). Surgery was performed on 36 (28.8%) meningiomas and the histopathologic grading was WHO grade 1 in 61.1% and grade 2 in 38.9%. The conservative management of meningiomas increased over time (33.3% before 2008, 64.3% after 2017) and progestin treatment withdrawal increased over time (16.7% before 2008, 95.2% after 2017). Treatment withdrawal varied depending on the progestin derivative used (88.9% with cyproterone acetate, 84.6% with chlormadinone acetate, 28.6% with nomegestrol acetate, 66.7% with progestin derivative combination). The main reason for therapeutic management of meningiomas was the presence of clinical signs. Among the 54 meningiomas managed conservatively for which the progestin had been discontinued, MRI follow-up demonstrated a regression in 29.6%, a stability in 68.5%, and an ongoing growth in 1.9% of cases.

Conclusions: Conservative management, including progestin treatment discontinuation, has grown over time with promising results in terms of efficacy and safety.
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http://dx.doi.org/10.1007/s11060-021-03696-9DOI Listing
April 2021

Robot-Assisted Stereotactic Biopsies in 377 Consecutive Adult Patients with Supratentorial Diffuse Gliomas: Diagnostic Yield, Safety, and Postoperative Outcomes.

World Neurosurg 2021 Apr 4;148:e301-e313. Epub 2021 Jan 4.

Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, IMA-BRAIN, Paris, France. Electronic address:

Background: Multiple biopsy samples are warranted for the histomolecular diagnosis of diffuse gliomas in the current molecular era, which possibly increases morbidity.

Objective: We assessed diagnostic yield, safety, and risk factors of postoperative morbidity after robot-assisted serial stereotactic biopsy sampling along 1 biopsy trajectory for diffuse gliomas.

Methods: Observational retrospective analysis of consecutive magnetic resonance imaging-based robot-assisted stereotactic biopsies performed at a single institution to assess the diagnosis of nonresectable newly diagnosed supratentorial diffuse gliomas in adults (2006-2016).

Results: In 377 patients, 4.2 ± 1.9 biopsy samples were obtained at 2.6 ± 1.2 biopsy sites. The histopathologic diagnosis was obtained in 98.7% of cases. Preoperative neurologic deficit (P = 0.030), biopsy site hemorrhage ≥20 mm (P = 0.004), and increased mass effect on postoperative imaging (P = 0.014) were predictors of a new postoperative neurologic deficit (7.7%). Postoperative neurologic deficit (P < 0.001) and increased mass effect on postoperative imaging (P = 0.014) were predictors of a Karnofsky Performance Status decrease ≥20 points postoperatively (4.0%). Increased intracranial pressure preoperatively (P = 0.048) and volume of the contrast-enhanced area ≥13 cm (P = 0.048) were predictors of an increased mass effect on postoperative imaging (4.4%). Preoperative Karnofsky Performance Status <70 (P = 0.045) and increased mass effect on postoperative imaging (P < 0.001) were predictors of mortality 1 month postoperatively (2.9%). Preoperative neurologic deficit (P = 0.005), preoperative Karnofsky Performance Status <70 (P < 0.001), subventricular zone contact (P = 0.004), contrast enhancement (P = 0.018), and steroid use (P = 0.003), were predictors of the inability to discharge to home postoperatively (37.0%).

Conclusions: Robot-assisted stereotactic biopsy sampling results in high diagnostic accuracy with low complication rates. Multiple biopsy sites and samples do not increase postoperative complications.
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http://dx.doi.org/10.1016/j.wneu.2020.12.127DOI Listing
April 2021

Meningioangiomatosis: Multimodal Analysis and Insights From a Systematic Review.

Neurology 2021 02 22;96(6):274-286. Epub 2020 Dec 22.

From the Department of Neurosurgery (A.R., M.Z., M.E.H.S., G.Z.-B., E.D., E.P, J.P.), GHU Paris-Psychiatrie et Neurosciences Sainte-Anne Hospital; Paris Descartes University (A.R., M.Z., A.T.-E., G.Z.-B., E.D., J.-F.M., E.P., F.C., P.V., C.O., E.L.-Z., J.P.), Sorbonne Paris Cité; Inserm (A.R., M.Z., G.Z.-B., E.D., J.-F.M., E.P., P.V., C.O., J.P.), U894, IMA-Brain, Centre de Psychiatrie et Neurosciences; Délégation à la Recherche Clinique et à l'Innovation (R.L.M.), GHU Paris-Psychiatrie et Neurosciences Sainte-Anne Hospital, Paris, France; University of Texas Southwestern Medical Center (M.E.H.S.), Dallas, TX; Department of Neurology (F.A.N.), Baylor College of Medicine, Houston, TX; Department of Neurology (F.A.N.), Massachusetts General Hospital, Boston, MA; Department of Neuropathology (A.T.-E., F.C., P.V., E.L.-Z.), GHU Paris-Psychiatrie et Neurosciences Sainte-Anne Hospital; Department of Neurophysiology (G.H.), Pitié-Salpêtrière Hospital, APHP, Sorbonne Université; Infantile Epilepsy and Brain Plasticity (G.H.), INSERM U1129 Paris Descartes University, PRES Sorbonne; Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Labex Memolife, PSL Research University; Department of Neuroradiology (F.M., C.O.), GHU Paris-Psychiatrie et Neurosciences Sainte-Anne Hospital; and Department of Neurosurgery (M.B.), Necker Enfants-Malades Hospital, Paris, France.

Background: Meningioangiomatosis is a poorly studied, rare, benign, and epileptogenic brain lesion.

Objective: To demonstrate that surgical resection and a short-time interval to surgery improves epileptic seizure control, we performed a systematic review and meta-analysis of meningioangiomatosis cases.

Methods: Using PRISMA-IPD guidelines, the authors performed a systematic review and meta-analysis of histopathologically-proven meningioangiomatosis cases. Literature search in French and English languages (PubMed, Embase, the Cochrane Library, and the Science Citation Index) including all studies (January 1981 to June 2020) dealing with histopathologically-proven meningioangiomatosis, without age restriction. We assessed clinical, imaging, histomolecular, management, and outcome findings of patients with meningioangiomatosis.

Results: Two-hundred and seven cases of meningioangiomatosis from 78 studies were included. Most meningioangiomatosis was sporadic, preferentially concerned male patients, younger than 20 years old, and allowed a functionally independent status. Epileptic seizure was the main symptom, with 81.4% of patients having uncontrolled seizures at the time of surgery. Meningioangiomatosis mainly had frontal (32.3%) or temporal (30.7%) locations. Imaging presentation was heterogeneous, and the diagnosis was often missed preoperatively. The histopathologic pattern was similar whatever the clinical presentation, and immunohistochemistry had limited diagnostic value. On molecular analysis, allelic loss at 22q12 was more frequent in samples of meningioangiomatosis-associated meningioma (37.5%) than in isolated meningioangiomatosis (23.1%). Time interval from diagnosis to surgery ( = 0.011) and lack of surgical resection of the meningioangiomatosis ( = 0.009) were independent predictors of postoperative seizure control.

Conclusions: Owing to low scientific evidence, a multicentric prospective study should help refining the management of meningioangiomatosis.
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http://dx.doi.org/10.1212/WNL.0000000000011372DOI Listing
February 2021

Predictors of early postoperative epileptic seizures after awake surgery in supratentorial diffuse gliomas.

J Neurosurg 2020 Mar 13:1-10. Epub 2020 Mar 13.

1Department of Neurosurgery, Sainte-Anne Hospital, Paris.

Objective: Functional-based resection under awake conditions had been associated with a nonnegligible rate of intraoperative and postoperative epileptic seizures. The authors assessed the incidence of intraoperative and early postoperative epileptic seizures after functional-based resection under awake conditions.

Methods: The authors prospectively assessed intraoperative and postoperative seizures (within 1 month) together with clinical, imaging, surgical, histopathological, and follow-up data for 202 consecutive diffuse glioma adult patients who underwent a functional-based resection under awake conditions.

Results: Intraoperative seizures occurred in 3.5% of patients during cortical stimulation; all resolved without any procedure being discontinued. No predictor of intraoperative seizures was identified. Early postoperative seizures occurred in 7.9% of patients at a mean of 5.1 ± 2.9 days. They increased the duration of hospital stay (p = 0.018), did not impact the 6-month (median 95 vs 100, p = 0.740) or the 2-year (median 100 vs 100, p = 0.243) postoperative Karnofsky Performance Status score and did not impact the 6-month (100% vs 91.4%, p = 0.252) or the 2-year (91.7 vs 89.4%, p = 0.857) postoperative seizure control. The time to treatment of at least 3 months (adjusted OR [aOR] 4.76 [95% CI 1.38-16.36], p = 0.013), frontal lobe involvement (aOR 4.88 [95% CI 1.25-19.03], p = 0.023), current intensity for intraoperative mapping of at least 3 mA (aOR 4.11 [95% CI 1.17-14.49], p = 0.028), and supratotal resection (aOR 6.24 [95% CI 1.43-27.29], p = 0.015) were independently associated with early postoperative seizures.

Conclusions: Functional-based resection under awake conditions can be safely performed with a very low rate of intraoperative and early postoperative seizures and good 6-month and 2-year postoperative seizure outcomes. Intraoperatively, the use of the lowest current threshold producing reproducible responses is mandatory to reduce seizure occurrence intraoperatively and in the early postoperative period.
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http://dx.doi.org/10.3171/2020.1.JNS192774DOI Listing
March 2020

Imaging growth as a predictor of grade of malignancy and aggressiveness of IDH-mutant and 1p/19q-codeleted oligodendrogliomas in adults.

Neuro Oncol 2020 07;22(7):993-1005

Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France.

Background: We quantified the spontaneous imaging growth rate of oligodendrogliomas. We assessed whether (i) it discriminates between World Health Organization (WHO) grade II and grade III oligodendrogliomas, and (ii) grade III oligodendrogliomas with neo-angiogenesis are associated with more fast growth rates (≥8 mm/y).

Methods: This work employed a retrospective bicentric cohort study (2010-2016) of adult patients harboring a newly diagnosed supratentorial oligodendroglioma, isocitrate dehydrogenase (IDH) mutant and 1p/19q codeleted (WHO 2016 classification), with a minimum of 2 available MRIs before any treatment (minimum 6-week interval) to measure the spontaneous tumor growth rate.

Results: We included 108 patients (age 44.7 ± 14.1 y, 60 males). The tumor growth rate was higher in grade III oligodendrogliomas with neo-angiogenesis (n = 37, median 10.4 mm/y, mean 10.0 ± 6.9) than in grade III oligodendrogliomas with increased mitosis count only (cutoff ≥6 mitoses, n = 18, median 3.9 mm/y, mean 4.5 ± 3.2; P = 0.004), and higher than in grade II oligodendrogliomas (n = 53, median 2.3 mm/y, mean 2.8 ± 2.2; P < 0.001). There was increased prevalence of fast tumor growth rates in grade III oligodendrogliomas with neo-angiogenesis (54.1%) compared with grade III oligodendrogliomas with increased mitosis count only (11.1%; P < 0.001), and in grade II oligodendrogliomas (0.0%; P < 0.001). The tumor growth rate trends did not differ between centers (P = 0.121). Neo-angiogenesis (P < 0.001) and mitosis count at ≥9 (P = 0.013) were independently associated with tumor growth rates ≥8 mm/year. A tumor growth rate ≥8 mm/year was the only predictor independently associated with shorter progression-free survival (P = 0.041).

Conclusions: The spontaneous tumor growth rate recapitulates oligodendroglioma aggressiveness, permits identification of grade III oligodendrogliomas preoperatively when ≥8 mm/year, and questions the grading by mitosis count.
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http://dx.doi.org/10.1093/neuonc/noaa022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339891PMC
July 2020

Minimal-Access Endoscopic Endonasal Management of Dysthyroid Optic Neuropathy: The Dysthone Study.

Neurosurgery 2019 12;85(6):E1059-E1067

Department of Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France.

Background: Dysthyroid optic neuropathy (DON) is a devastating complication of thyroid eye disease. Corticosteroids are the primary medical treatment for DON, but some refractory patients may require surgical management.

Objective: To evaluate the efficacy of endoscopic endonasal decompression of the orbital apex in refractory DON.

Methods: This study included patients with refractory DON who underwent endoscopic endonasal decompression of the orbital apex from February 2015 to October 2016. A total of 23 orbital apices were decompressed across 17 patients. Visual acuity, ophthalmometry, tonometry, and visual field were evaluated at the preoperative, early and delayed postoperative stages. Statistical analyses were performed using RStudio software. A Wilcoxon test for matched data was performed to determine if there was a statistically significant difference between pre- and postsurgical treatment for the following items: visual acuity, proptosis, visual field, and intraocular pressure.

Results: Visual acuity improved in 69.5% of the cases with a mean gain of 2.5 points ± 1.6 (P < .05). Additionally, there was an 18.3% reduction in mean proptosis across all cases (P < .05) and a 13.7% decrease in intraocular pressure (P < .05) for all patients. Finally, visual field improved in 82.6% (P < .05) of the cases. The mean time for follow-up was of 6.28 ± 3.7 mo. There were 3 cases of transient postoperative rhinitis and 2 cases of transient diplopia. Two patients experienced recurrence at 4 and 8 mo, respectively.

Conclusion: Endoscopic endonasal decompression of the orbital apex significantly improves visual parameters. As a result, multidisciplinary screening for patients is crucial to ensure prompt surgical decompression.
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http://dx.doi.org/10.1093/neuros/nyz268DOI Listing
December 2019

High Prevalence of Developmental Venous Anomaly in Diffuse Intrinsic Pontine Gliomas: A Pediatric Control Study.

Neurosurgery 2020 04;86(4):517-523

Université Paris Descartes, Sorbonne Paris Cité, Paris, France.

Background: No link has been demonstrated between diffuse intrinsic pontine glioma and developmental venous anomaly in pediatric patients.

Objective: To determine the prevalence of developmental venous anomaly in a pediatric cohort of diffuse intrinsic pontine glioma.

Methods: We performed a retrospective cohort study (1998-2017) of consecutive pediatric patients harboring a diffuse intrinsic pontine glioma (experimental set, n = 162) or a craniopharyngioma (control set, n = 142) in a tertiary pediatric neurosurgical center. The inclusion criteria were the following: age <18 yr at diagnosis; histopathological diagnosis of diffuse intrinsic pontine glioma or craniopharyngioma according to the 2016 World Health Organization classification of tumors of the central nervous system; no previous oncological treatment; and available preoperative magnetic resonance imaging performed with similar acquisition protocol.

Results: We found a significantly higher prevalence of developmental venous anomaly in the experimental set of 162 diffuse intrinsic pontine gliomas (24.1%) than in the control set of 142 craniopharyngiomas (10.6%; P = .001). The prevalence of developmental venous anomalies was not significantly impacted by demographic data (sex, age at diagnosis, and underlying pathological condition), biomolecular analysis (H3-K27M-mutant subgroup, H3.1-K27M-mutant subgroup, and H3.3-K27M-mutant subgroup), or imaging findings (anatomic location, anatomic extension, side, and obstructive hydrocephalus) of the studied diffuse intrinsic pontine gliomas.

Conclusion: We report a higher prevalence of developmental venous anomaly in pediatric diffuse intrinsic pontine glioma patients than in control patients, which suggests a potential underlying common predisposition or a causal relationship that will require deeper investigations.
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http://dx.doi.org/10.1093/neuros/nyz298DOI Listing
April 2020

Carmustine Wafer Implantation at the Era of Standardized Chemoradiation Protocol.

Asian J Neurosurg 2019 Apr-Jun;14(2):616-617

Department of Neurosurgery, Sainte-Anne Hospital Center, Paris, France.

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http://dx.doi.org/10.4103/ajns.AJNS_297_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516040PMC
May 2019

Developmental venous anomaly in adult patients with diffuse glioma: A clinically relevant coexistence?

Neurology 2019 01 30;92(1):e55-e62. Epub 2018 Nov 30.

From the Departments of Neurosurgery (A.R., M.Z., E.D., G.Z.-B., J.P.), Neuroradiology (M.E., S. Porelli, C.O), and Neuropathology (A.T.-E., P.V.), Sainte-Anne Hospital; Paris Descartes University (A.R., M.E., S. Porelli, A.T.-E., M.Z., E.D., G.Z.-B., S. Puget, P.V., C.O., J.P.), Sorbonne Paris Cité; Inserm (A.R., M.E., M.Z., E.D., P.V., C.O., J.P.), U894, IMA-Brain, Centre Psychiatrie et Neurosciences; Departments of Neuro-oncology (M.S.) and Neurosurgery (L.C.), Pitié-Salpêtrière Hospital; and Department of Pediatric Neurosurgery (S. Puget), Necker Hospital, Paris, France.

Objective: To determine the prevalence of developmental venous anomaly in adult patients with diffuse glioma.

Methods: We performed a retrospective cohort study (2010-2016) of consecutive adult patients harboring a supratentorial diffuse glioma in 2 centers: Sainte-Anne Hospital (experimental and control sets) and Pitié-Salpêtrière Hospital (external validation set). We included 219 patients with diffuse glioma (experimental set), 252 patients with brain metastasis (control set), and 200 patients with diffuse glioma (validation set). The inclusion criteria were age ≥18 years at diagnosis, histopathologic diagnosis of diffuse glioma according to the 2016 World Health Organization classification of tumors of the CNS, surgery as first-line treatment without previous oncologic treatment, available presurgical MRI performed with similar acquisition protocol, and absence of a nodular-like or a ring-like pattern of contrast enhancement on MRI that may preclude the identification of a possible developmental venous anomaly within the glioma.

Results: We found more developmental venous anomaly in the experimental set (21.5%) than in the control set (5.2%, < 0.001). Similarly, we found more developmental venous anomaly in the validation set (23.5%) than in the control set (5.2%, < 0.001). There was no difference in the developmental venous anomaly prevalence between the experimental and validation sets. The developmental venous anomaly distribution was not significantly associated with histopathologic, molecular, or imaging findings of the diffuse gliomas.

Conclusions: We report and replicate in an external cohort a high prevalence of developmental venous anomaly in adult patients with diffuse glioma, which suggests a potential underlying common predisposition or a causal relationship that requires deeper investigations.
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http://dx.doi.org/10.1212/WNL.0000000000006690DOI Listing
January 2019