Dorian Chauvet

Fondation Rothschild · Neurosurgery

Background: During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, it was necessary to prepare for the possibility of triaging patients who could benefit from access to an intensive care unit (ICU). In our neuroscience institution, the challenge was to continue to manage usual neurological emergencies as well as the influx of C...

Objective: Percutaneous balloon compression (PBC) is a popular treatment option for trigeminal neuralgia. However, the efficacy of PBC is widely considered to be associated with the occurrence of sensitive complications, although neither this correlation nor the underlying mechanisms have been established. The objectives of the present study were...

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Preserving cortical frontal bridging veins draining into the superior sagittal sinus is a factor of good neurological outcome in anterior interhemispheric transcallosal approaches, classically performed to reach intraventricular tumors. Challenging the idea that veins are utterly variable, we propose a statistical analysis of 100 selective cerebral...

The transsphenoidal approach represents the gold standard for surgical excision of pituitary tumors. Over the last few decades the endoscopic endonasal transsphenoidal approach has become widely accepted, with angled-endoscopes providing excellent visualization of the operative field and possibly allowing for a greater likelihood of complete resect...

Purpose When dealing with paraclinoid carotid aneurysms, the distinction between intradural and extradural location is a major component for decision-making as only intradural aneurysms carry a risk of subarachnoid hemorrhage (SAH). The aim of this study was to test the accuracy and reliability of computed tomography (CT) bony landmarks for the dis...

Objective The great heterogeneity of meningiomas is challenging and we need to distinguish relevant subgroups. Spheno-orbital osteomeningiomas (SOOM) constitute a clinically specific entity, with slow-growing benign osteo-meningiomatous tumors, which recur after surgery in one fourth of cases. Neurosurgical daily practice, supported by the literatu...

BACKGROUND Predictors of visual outcomes after optic nerve decompression are controversial. OBJECTIVE To identify the predictors of poor visual outcomes after surgery of meningiomas responsible of a compressive optic neuropathy. METHODS We focused on paraoptic meningiomas (POMs), which gathered tuberculum sellae meningiomas (TSMs) and anterior cl...

Background: Occipital arteriovenous malformations (AVMs) carry a high risk of postoperative morbidity because of their anatomic relation to the visual cortex and optic radiations. Data regarding endovascular management of these lesions are scant. Objective: To report our single-center experience with occipital AVMs, most of which were treated en...

Background Multinodular and Vacuolating Neuronal Tumor of the cerebrum (MVNT) is a rare brain lesion with suggestive imaging features. The aim of our study was to report the largest series of MVNTs so far and to evaluate the utility of advanced multiparametric Magnetic Resonance (MR) techniques. Methods This multicenter retrospective study was app...

Background and purpose: Surgical resection is usually considered as the first-line curative strategy for low-grade (Spetzler-Martin grade I-II) brain arteriovenous malformations because it has a high cure rate and low complications. The role of endovascular treatment remains to be clarified in this indication, especially after A Randomized Trial o...

This study was made to assess the possibilities and limits of minimally invasive transoral approach to the nasopharynx using the Da Vinci surgical robot. It was conducted on eleven corpses, without need for palatine split; using surgical robots Da Vinci models S HD and Si HD. We have defined “anatomical key landmarks” on all sides of the nasopharyn...

The functional mapping of brain activity is essential to perform optimal glioma surgery and to minimize the risk of postoperative deficits. We introduce a new, portable neuroimaging modality of the human brain based on functional ultrasound (fUS) for deep functional cortical mapping. Using plane-wave transmissions at an ultrafast frame rate (1 kHz)...

Introduction La chirurgie hypophysaire s’est enrichie des techniques endoscopiques transnasales. Neanmoins, certains ecueils peuvent etre soulignes : complications rhinologiques, vision en 2D. Parallelement, la chirurgie assistee par le robot da Vinci, qui offre une vision en 3D et une demultiplication du geste, s’est developpee par voie transorale...

Transcranial brain therapy has recently emerged as a non-invasive strategy for the treatment of various neurological diseases, such as essential tremor or neurogenic pain. However, treatments require millimeter-scale accuracy. The use of high frequencies (typically > = 1 MHz) decreases the ultrasonic wavelength to the millimeter scale, thereby incr...

OBJECTIVE The aim of this study was to confirm the feasibility of an innovative transoral robotic surgery (TORS), using the da Vinci Surgical System, for patients with sellar tumors. This technique was designed to offer a new minimally invasive approach, without soft-palate splitting, that avoids the rhinological side effects of classic endonasal a...

A wide spectrum of methods is used to image brain activation in vivo, such as functional MRI (fMRI) or positron emission tomography. Both techniques have excellent depth penetration but do not provide good spatial nor temporal resolution. By contrast, ultrasound imaging achieves good spatiotemporal resolution in depth, but until now its poor sensit...

Background: Malignant optic glioma of adulthood is a rare, invasive neoplasm of the anterior visual pathway. In this article, the clinical features of a case series of 3 malignant optic nerve glioblastomas (WHO grade IV) are presented, and the modalities of treatment and their associated survivals are discussed through a review of the existing lit...

Background: The prognosis of the unruptured giant Basilar Artery (BA) aneurysm remains appalling. Yet, no treatment has shown efficacy in survival. This pilot case-control study examines the overall benefit on the survival prognosis on surgical management of giant BA aneurysms associated with endovascular therapy. Methods: A combined treatment i...

Objectif Proposer un nouvel abord des adénomes hypophysaires, mini-invasif, par voie transorale assistée par le robot da Vinci (Intuitive Surgical), ce afin d’éviter les désagréments rhinologiques des voies endonasales. Matériel et méthodes En s’appuyant sur des travaux cadavériques [1], une étude prospective a permis d’inclure des patients porteu...

The posterior inferior cerebellar artery (PICA) is a vessel located between the intra- and extracranial circulation. The artery is characterized by a complex embryological development and numerous anatomical variants. The authors present a case of the PICA supplied by both a hypertrophic anterior spinal artery and a hypoplastic bulbar artery. This...

One of the procedural risks in arteriovenous malformation (AVM) embolization is possible migration of the embolic agent into the venous drainage with an incomplete nidus occlusion, which may lead to severe hemorrhagic complications. This report presents the case of a 29-year-old man who presented with a deep intraparenchymal hematoma on the left si...

In most cases, glioblastomas are associated with seizures, headaches, neurological deficits, aphasia, or bleeding. But these tumors are rarely associated with cerebral infarction and never so deadly. A 40-year-old man presented with sudden morning isolated aphasia. One hour later, he developed a motor deficit at right upper member, quickly complete...

Please find the full text at: http://www.jultrasoundmed.org/content/34/8/1.6.short

The role of transoral robotic surgery (TORS) in the skull base emerges and represents the natural progression toward miniinvasive resections in confined spaces. The accessibility of the sella via TORS has been recently described on fresh human cadavers. An anatomic study is mandatory to know if this approach would be feasible in the majority of pat...

Purpose: Objective Shear wave elastography (SWE) enabled living tissue assessment of stiffness. This is routinely used for breast, thyroid and liver diseases, but there is currently no data for the brain. We aim to characterize elasticity of normal brain parenchyma and brain tumors using SWE. Materials and Methods: Patients with scheduled brain tum...

Purpose We describe our protocol of three-dimensional (3D) Roadmap intracranial navigation and image fusion for analysis of the angioarchitecture and endovascular treatment of brain arteriovenous malformations (AVMs). Methods We performed superselective catheterization of brain AVMs feeders under 3D-Roadmap navigation. Angiograms of each catheteriz...

Ultrasonography is proving to be an invaluable tool in brain surgery. Recently, new ultrasonic modalities called shear wave elastography (SWE) enabled living tissue assessment of stiffness. SWE is routinely used for breast or liver diseases, but brain data are missing. We aim to characterize elasticity of normal brain and brain tumors by using SWE...

Erdheim-Chester disease (ECD) is a rare non–Langerhans cell histiocytosis characterized by the accumulation of foamy CD68+CD1a− histiocytes. Tissue infiltration preferentially affects long bones and retroperitoneal and peri-aortic spaces, but almost any organ or system can be affected.¹ Cardiac and neurologic involvements are associated with signif...

Transoral robotic surgery (TORS) offers new possibilities that have not been experimented in the field of minimally invasive skull base neurosurgery. We propose to evaluate the feasibility of transoral approach to the sella turcica with the da Vinci system on cadavers. We performed four robot-assisted dissections on human fresh cadavers in order to...

Oculomotor nerve palsy (ONP) is a common clinical manifestation of ruptured or unruptured posterior communicating artery (PcomA) aneurysms. Although microsurgical clip ligation has been proven a safe and durable treatment, endovascular management is emerging as an increasingly popular alternative. The aim of our study is to compare the recovery rat...

Object: This work aimed at evaluating the accuracy of MR-guided high-intensity focused ultrasound (MRgHIFU) brain therapy in human cadaver heads. Methods: Eighteen heads of fresh human cadavers were removed with a dedicated protocol preventing intracerebral air penetration. The MR images allowed determination of the ultrasonic target: a part of...

A 26-year-old male presented with a mild confusion and hemianopsia after traumatic brain injury. Cerebral CT-scan revealed a 62.5 cm(3) left occipital extradural haematoma (EDH). Although conventional neurosurgical management would have been to evacuate the haematoma, a conservative strategy was preferred, and the patient made a total recovery.

Apart from the iatrogenic effects of treatment, neurologic complications of Hodgkin lymphoma (HL) can be divided into direct (meningeal or intracranial/spinal localization) and indirect (paraneoplastic/immune complications).(1) Here, we present a patient with granulomatous angiitis of the CNS (GANS) associated with HL that dramatically improved aft...

Background: Multiple spinal hemangioblastomas constitute a rare pathology; most patients have von Hippel-Lindau disease. In the literature, spinal surgery has been complicated with remote intracranial hemorrhage in a very few cases. Methods: A 51-year-old woman, with no pertinent familial past medical history, presented with low back pain. Medul...

Laser-induced thermal therapy (LITT), coupled with magnetic resonance thermal imaging (MRTI) guidance, provides a minimally invasive and safe approach to treat brain tumors, especially metastases. We report here our experience using this treatment for recurrent glioblastomas. Four patients, from 40 to 58 years old, were diagnosed with glioblastoma....

The aim of this study in patients with traumatic brain injury (TBI) was to assess the effectiveness of continuous cerebrospinal fluid (CSF) drainage in controlling intracranial pressure (ICP) and minimizing the use of other ICP-lowering interventions potentially associated with serious adverse events. We studied 20 TBI patients. In each patient, we...

This study aims to demonstrate, using human cadavers the feasibility of energy-based adaptive focusing of ultrasonic waves using magnetic resonance acoustic radiation force imaging (MR-ARFI) in the framework of non-invasive transcranial high intensity focused ultrasound (HIFU) therapy. Energy-based adaptive focusing techniques were recently propose...

L’idrocefalo è caratterizzato da un disturbo dell’idrodinamica intracranica del liquor cerebrospinale (LCS), che provoca una dilatazione dei ventricoli e/o degli spazi subaracnoidei. Si tratta, in effetti, di un’entità polimorfa, sia sul piano della presentazione clinica che su quello dell’eziologia. Tipicamente, è abituale distinguere gli idrocefa...

La hidrocefalia se caracteriza por una alteración de la hidrodinámica intracraneal del líquido cefalorraquídeo (LCR) que provoca la dilatación de los ventrículos y/o de los espacios subaracnoideos. Se trata de hecho de una entidad polimórfica, tanto respecto a su presentación clínica como a su etiología. Clásicamente, se acostumbra a distinguir ent...

CSF leakages constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture watertightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure. We have designed an experimental system capable of testing CSF leak pressure levels in ord...

Gas nuclei exist naturally in living bodies. Their activation initiates cavitation activity, and is possible using short ultrasonic excitations of high amplitude. However, little is known about the nuclei population in vivo, and therefore about the rarefaction pressure required to form bubbles in tissue. A novel method dedicated to in vivo investig...

To evaluate the in vivo accuracy of the new Pressio(®) device for intraparenchymal monitoring of intracranial pressure (ICP) versus the Codman(®) device and intraventricular measurement external ventricular drainage (EVD). Data were collected retrospectively for 30 consecutive patients admitted into a 25-bed neurosurgical intensive care unit of a u...

Trepanation is known to be the first surgical procedure ever performed. Its origins date from the Neolithic Age in Europe and the operation was particularly performed in South America at the Pre-Colombian era, a few thousand years later. Based on many archeological studies on trepanned skulls, we compare the differences and similarities of these tw...

Trepanation is known to be the first surgical procedure ever performed. Its origins date from the Neolithic Age in Europe and the operation was particularly performed in South America at the Pre-Colombian era, a few thousand years later. Based on many archeological studies on trepanned skulls, we compare the differences and similarities of these tw...

Many techniques are described to treat Chiari type I malformation. One of them is a splitting of the dura, removing its outer layer only to reduce the risks of cerebrospinal fluid (CSF) leak. We try to show the effectiveness of this technique from histological and biomechanical observations of dura mater. Study was performed on 25 posterior fossa d...

Passive cavitation detection techniques are usually of relatively low sensitivity to single cavitation events. Moreover, a single‐element transducer is generally used, so that the spatial localization of these cavitation events is not possible, or is limited to the probing volume. To both detect and localize single cavitation events over an extend...

A novel MR-guided brain therapy device operating at 1MHz has been designed and constructed. The system has been installed and tested in a clinical 1.5 T Philips Achieva MRI. Skull bone distortions induced on the ultrasonic beam are corrected using the concept of time reversal focusing. Prior to the treatment, a 3D CT scan of the patient head is per...

A novel MR-guided brain therapy device operating at 1 MHz has been designed and constructed. The system has been installed and tested in a clinical 1.5 T Philips Achieva MRI. Skull bone distortions induced on the ultrasonic beam are corrected using the concept of time reversal focusing. Prior to the treatment, a 3D CT scan of the patient head is pe...

To restore the cerebrospinal fluid (CSF) flow at the craniocervical junction in Chiari I malformation (CM-I), most surgeons practice a suboccipital craniectomy with duraplasty. To reduce the risk of CSF leak, a dura splitting decompression is created removing only the dural outer layer. We report on a series of 11 patients with CM-I (five with syri...

We present the first case of early epidural hematoma after CSF shunt probably caused by defective material. A 26-year-old man was treated for obstructive hydrocephalus associated with a tonsillar herniation, revealed by headaches and papillary edema. Ventriculoperitoneal shunt was preferred to endoscopic ventriculostomy. Three hours after the opera...

We present the first case of early epidural hematoma after CSF shunt probably caused by defective material. A 26-year-old man was treated for obstructive hydrocephalus associated with a tonsillar herniation, revealed by headaches and papillary edema. Ventriculoperitoneal shunt was preferred to endoscopic ventriculostomy. Three hours after the opera...

Metastases to the heart are rare. We report a case of squamous cell carcinoma of the base of tongue secondarily complicated with cardiac metastasis 6 months after surgical treatment resulted in successful local control. The lesion was found using computerized axial tomography in a patient with minimal cardiologic symptoms. The patient died shortly...

After completing a craniotomy, whenever possible, it is crucial to replace and fix the removed bone flap to the cranium; this in order to keep the brain's protection as well as for cosmetic purposes. Visible skull defects might cause patients psychosocial problems and, most importantly, expose the brain to accidental damage. A fixation device shoul...