Florian Bernard

Centre Hospitalier Universitaire d'Angers | CHU Angers · 49100

OBJECTIVE Bilateral spheno-orbital meningiomas (bSOMs) are a rare entity among meningiomas. These tumors are benign and predominantly affect women. They represent 4% of spheno-orbital meningiomas (SOMs) and are poorly described in the literature. This study aimed to describe the characteristics, risk factors, evolution, and management of bSOMs. ME...

OBJECTIVE Neuroanatomy comprehension is a keystone of understanding intracranial surgeries. Traditionally taught to students during ex cathedra courses, neuroanatomy is described as complex. Mixed reality (MxR) opens new perspectives in the learning process. This study aims to compare MxR-based courses with traditional ex cathedra lectures for neur...

Background: Awake craniotomy (AC) with brain mapping for language and motor functions is often performed for tumors within or adjacent to eloquent brain regions. However, other important functions, such as vision and visuospatial and social cognition, are less frequently mapped, at least partly due to the difficulty of defining tasks suitable for...

Knowledge of both the spatial organization and functions of white-matter fiber tracts is steadily increasing. We report here the anatomy and functions of the frontal aslant tract (FAT) in the non-dominant hemisphere (usually the right hemisphere). Despite the structural symmetry between the right and left FAT, these two tracts seem to display funct...

Functional Magnetic Resonance Imaging (fMRI) is an essential tool for the pre-surgical planning of brain tumor removal, which allows the identification of functional brain networks to preserve the patient’s neurological functions. One fMRI technique used to identify the functional brain network is the resting-state-fMRI (rs-fMRI). This technique is...

We assessed the role of the general condition of the patient in addition to usual anatomical reasoning to improve the prediction of personalized surgical risk for patients harboring a large and giant petroclival meningiomas. Single-center, retrospective observational study including adult patients surgically treated for a large and giant petrocliva...

Background Professional horse racing is an activity known for its high risk of injuries, especially in the cranio-facial area. Nevertheless, despite the long history of horse races and the severity of the injuries sustained by professional jockeys, only very few epidemiological studies have been published to date. Cranio-maxillo-facial injuries in...

BACKGROUND The functional MRI (fMRI) is an essential tool for the presurgical planning of brain tumor removal, allowing the identification of functional brain networks in order to preserve the patient’s neurological functions. One fMRI technique used to identify the functional brain network is the resting-state-fMRI (rsfMRI). However, this techniqu...

Le principal but de ce travail était d’approfondir nos connaissances sur l’anatomie du réseau ventral de l’attention (VAN). Il s’agit du principal réseau fonctionnel cortical -identifié par l’IRM de repos- impliqué dans la cognition visuo-spatiale. L’identification anatomique des fibres blanches de ce réseau reste un défi. En traitant les données d...

La microtomographie computérisée aux rayons X (microCT), développée depuis la fin des années 1990, est une version miniaturisée des scanners utilisés quotidiennement en imagerie médicale. Elle permet de réaliser des images vasculaires différentes de celles obtenues par microradiographie, notamment en facilitant la vision dans l’espace et donc la co...

Visualizing major periventricular anatomical landmarks intraoperatively during brain tumor removal is a decisive measure toward preserving such structures and thus the patient's postoperative quality of life. The aim of this study was to describe potential standardized preoperative planning using standard landmarks and procedures and to demonstrate...

BACKGROUND Preserving major cognitive functions, such as visuo-spatial and social cognition in the surgical management of brain tumors could be decisive for the postoperative quality of life. Using virtual reality during awake brain surgery appears to be interesting for preserving complex cognitive functions. Developing neuropsychological tasks app...

Objective We assessed the role of the general condition of the patient in addition to usual anatomical reasoning to improve the prediction of personalized surgical risk for patients harbouring a large and giant petroclival meningiomas.Methods Single-center, retrospective observational study including adult patients surgically treated for a large an...

Supratentorial sensory perception, including pain, is subserved by the trigeminal nerve, in particular, by the branches of its ophthalmic division, which provide an extensive innervation of the dura mater and of the major brain blood vessels. In addition, contrary to previous assumptions, studies on awake patients during surgery have demonstrated t...

Purpose: The teaching of anatomy in medical education has historically been based on lectures, cadaveric dissections, and illustrated books for students. Stereoscopic 3D videos are now easily accessible via smartphone and affordable for students. This study aimed to investigate whether a 3D stereoscopic instruction video could improve learning ove...

Resting‐state functional MRI (RfMRI) analyses have identified two anatomically separable fronto‐parietal attention networks in the human brain: a bilateral dorsal attention network and a right‐lateralised ventral attention network (VAN). The VAN has been implicated in visuospatial cognition and, thus, potentially in the unilateral spatial neglect a...

Objective The objective of this study was to compare the tumor control and facial nerve outcome according to the therapeutic strategy i.e . extent of resection and post‐operative radiotherapy. Design Retrospective study of patients with a giant vestibular schwannoma surgically treated from 4 academic skull base centers. Setting Extent of resectio...

Background Interfascial dissection for pterional craniotomy is one of the main techniques to expose the pterional region. Method A step-by-step optimized method of interfascial dissection to avoid three main esthetic complications of the pterional approach—upper facial nerve palsy, temporal muscle atrophy, and retro-orbital depression. A video of...

Objective: Brain mapping by direct electrical stimulation (DES) during awake craniotomy is now a standard procedure which reduces the risk of permanent neurologic deficits. Virtual reality technology (VR) immerses the patient in a virtually controlled, interactive world, offering a unique opportunity to develop innovative tasks for peroperative ma...

Introduction La racine sensitive du nerf trijumeau dans le cavum trigéminal de Meckel est classiquement segmentée en deux parties : le ganglion trigéminal et le plexus triangulaire. Le plexus triangulaire a été défini comme la portion du nerf trijumeau située entre la partie postérieure du ganglion trigéminal et le bord supérieur de l’arête pétreus...

Introduction Le faisceau arqué est un réseau de fibres longues associatives intra-hémisphérique qui relie le cortex temporofrontal. Le faisceau arqué peut-être divisé en trois segments : deux faisceaux superficiels indirects courts (antérieurs et postérieurs) et un faisceau direct long. Les études IRM en tenseur de diffusion et les dissections de f...

Introduction: Preoperative language mapping using functional magnetic resonance imaging (fMRI) aims to identify eloquent areas in the vicinity of surgically resectable brain lesions. fMRI methodology relies on the blood-oxygen-level-dependent (BOLD) analysis to identify brain language areas. Task-based fMRI studies the BOLD signal increase in brai...

Background: Brain metastases occur in 15-30% of cancer patients and their frequency has increased over time. They can cause intracranial hypertension, even in the absence of hydrocephalus. Emergency surgical management of brain metastasis-related intracranial hypertension is not guided by specific recommendations. Objective: We aimed to make a F...

Purpose The arcuate fasciculus (AF) is a white matter fibers tract that links the lateral temporal with the frontal cortex. The AF can be divided into three components: two superficial indirect short tracts (anterior and posterior) and one deep direct long tract. Both DTI and white matter dissections studies find differences regarding the anatomy o...

Background: Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. Methods: A multicenter study of patients with PCMs larger than 2.5cm between 1984 and 2017 was conducted. The authors retrospect...

Background: The present study developed 3D video tutorials with commentaries, using virtual reality headsets (VRH). VRHs allow 3D visualization of complex anatomy from the surgeon's point of view. Students can view the surgery repeatedly without missing the essential steps, simultaneously receiving advice from a group of experts in the field. Met...

This review of the historical medical literature aimed at understanding the evolution of surgical management of degenerative spondylolisthesis over time. The Medic@, IndexCat and Gallica historical databases and PubMed and Embase medical databases were used, with several search-terms, exploring the years 1700-2018. Data from anatomical, biomechanic...

Introduction Le nerf trijumeau dans le cavum trigéminal est classiquement segmenté en deux parties : – le ganglion trigéminal ; – le plexus triangulaire. Il comporte une racine sensitive et une racine motrice. L’anatomie du plexus triangulaire est plutôt relativement méconnue dans les dissections anatomiques récentes. Cette revue de la littérature...

Background: Traumatic acute subdural hematomas (ASDHs) showed the highest mortality of intracranial hematomas. The aim of the current study was to identify predictive factors of poor prognosis among patients who were operated on. Methods: This is a single-center retrospective cohort study of 82 patients who underwent surgical evacuation of a tra...

Background The traditional retrosigmoid (RS) approach provides limited exposure of the inferior compartment of the CPA, while radical skull base approaches are demanding and associated with significant morbidity. Methods This study outlines the relevant surgical anatomy and the different surgical steps of a modified retrosigmoid (MRS) approach. R...

BACKGROUND The functional MRI (fMRI) is an essential tool for the presurgical planning of brain tumor removal, allowing the identification of functional brain networks in order to preserve the patient’s neurological functions. One fMRI technique used to identify the functional brain network is the resting-state-fMRI (rsfMRI). However, this techniqu...

The use of 3-dimensional (3D) videos allows students to visualize surgical procedures from the perspective of the surgeon without missing the essential parts.¹ This 3D commented video demonstrates the operative technique and surgical nuances of the combined petrosectomy, visualize using virtual reality headsets. Historically, traditional intradural...

Introduction/Objectifs La conservation au formaldéhyde permet la réalisation d’études neuro-anatomiques [1] de qualité. Cependant dans l’étude de la dure-mère basicranienne, un fraisage extensif est souvent nécessaire, pouvant entrainer une destruction durale ou arachnoïdienne. Dans notre expérience, une solution de formaldéhyde et d’eau oxygénée p...

Introduction: Anatomic pieces that are preserved using formaldehyde allow us to undertake high-quality skull base studies. However, extensive drilling is often necessary, which can lead to damages to the dura mater and thus arachnoid. Formaldehyde and hydrogen peroxide can soften the bone, which, in turn, can be easily cut with a scalpel or remove...

The non-dominant hemisphere (usually right) is determinant for main cognitive functions such as visuo-spatial and social cognitions. Awake surgery using direct electrical stimulation for right cerebral tumor removal remains challenging due to the complexity of the functional anatomy and the difficulties in adapting the classical bedside tasks for a...

Introduction: La Névralgie Vago-GlossoPharyngienne (NVGP) est une pathologie rare comparativement aux névralgies trigéminales. Si la douleur est résistante aux traitements médicaux et qu'un conflit neurovasculaire est suspecté une décompression microvasculaire peut être proposée. L'arachnoïde pourrait jouer un rôle physiopathologique parfois. Matér...

Introduction Le management optimal des fistules durales intracrâniennes demeure controversé. Certains auteurs préconisent un traitement endovasculaire, efficace mais pouvant être limité par (1) un accès impossible au pied de veine, (2) une embolisation incomplète, (3) une recanalisation. Nous rapportons ici notre expérience concernant le traitement...

Introduction: Le granulome réparateur à cellules géantes est une lésion ostéolytique bénigne rare. Classiquement, elle atteint la mandibule, rarement la base du crâne. Patient et méthodes: Un patient de 25 ans fut admis dans notre institution en août 2002 pour une tuméfaction indolore préauriculaire gauche, progressivement croissante depuis quelque...

The non-dominant hemisphere (usually the right) is responsible for primary cognitive functions such as visuo-spatial and social cognition. Awake surgery using direct electrical stimulation for right cerebral tumor removal remains challenging due to the complexity of the functional anatomy and difficulties in adapting standard bedside tasks to awake...

Background: In awake craniotomy, it is possible to temporarily inactivate regions of the brain using direct electrical stimulation, while the patient performs neuropsychological tasks. If the patient shows decreased performance in a given task, the neurosurgeon will not remove these regions, so as to maintain all brain functions. Objective: The...

Background: The radiological signs of intracranial dural arteriovenous fistulas (ICDAVFs) are heterogenous. While it is commonly accepted that hyper intense T2 Wedge MRI of the brainstem and cervical cord mainly concern gliomas, it is so far uncommon and probably unknown that ICDAVFs can imitate similar radiological pattern, especially with gadoli...

Background: Spheno-orbital meningiomas (SOMs) are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus with bone hyperostosis and sheet-like dural involvement. Optimal removal, proptosis cure and visual preservation remain a challenge. Objective: To study the management of surgically treated SOMs METHODS: The...

Vago-glossopharyngeal neuralgia (VGPN) is a rarely seen disease when compared to trigeminal neuralgia. When the pain is resistant to medical therapy, microvascular decompression can be performed if a vascular conflict is suspected on magnetic resonance imaging (MRI). In addition, arachnoid pathology may play a role in VGPN. We report two cases of V...

Background: A variety of lesions can affect the orbit. Surgical approaches must be available to provide 360 degrees of access. For tumors occupying the superomedial intraconal quadrant, there is a rationale to selecting the medial orbito-frontal approach. Methods: This article outlines the relevant surgical anatomy and the different surgical ste...

OBJECTIVE The dura mater is made of 2 layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which directly covers the brain and spinal cord. These 2 dural layers join together in most parts of the skull base and cranial convexity, and separate into the orbital and perisellar compartm...

Background: The anterior clinoid process shares a close relationship with the optic canal, the internal carotid artery, the superior orbital fissure and the cavernous sinus. These structures may be involved in diseases whose surgical exposure requires prior clinoid process resection. Method: Based on operative cases we describe the different ste...

OBJECTIVE In recent decades, progress in the medical management of cancer has been significant, resulting in considerable extension of survival for patients with metastatic disease. This has, in turn, led to increased attention to the optimal surgical management of bone lesions, including metastases to the spine. In addition, there has been a shift...

Background: The optimal management of skull base DAVFs remains controversial. Some groups advocate endovascular therapy, which is an efficient therapeutic option, but can be limited by inadequate access to the fistula point, non-target embolization, and recanalization risk. We report our experience in microsurgical obliteration after embolization f...

Background and importance: Giant cell reparative granuloma is a very rare benign osteolytic lesion. It typically arises in the mandible and rarely involves the skull. Clinical presentation: A 25-year-old male was admitted in August 2002 for a painless left preauricular mass of several months duration. CT scan revealed an osteolytic extradural le...

Introduction La division du foramen jugulaire en compartiments est sujet à controverse. Le but de ce travail était d’analyser la compartimentation du foramen jugulaire à la lumière du concept d’espace interpériostéodural. L’organisation durale du foramen jugulaire laisse apparaître pour certains, deux compartiments séparés par un tissu fibreux ou f...