Henri-Arthur Leroy

• MD PhD Neurosurgeon
• Professor (Associate) at Centre Hospitalier Régional Universitaire de Lille

Study design: Nested case-control study. Objective: Radiological adjacent segment degeneration is reported in a significant proportion of patients operated on following ACDF. Only a part of them will experience clinical symptoms, ultimately requiring a second cervical spine surgery (SASD). Our retrospective observational study, with prospective da...

Symptomatic spinal epidural hematoma (SSEH) is one of the most feared complications and source of litigation in spine surgery. Its occurrence rises up to 2% in minimally invasive spine surgery. In parts of the world where the population is aging, more fragile patients are expected to undergo degenerative spine surgery. Management of the SSEH includ...

Background: Anterior lumbosacral interbody fusion (ALIF) surgery is a predominant approach used in various indications such as treating discogenic back pain, spondylolisthesis, degenerative lumbar scoliosis, intervertebral foraminal stenosis, or spondylolysis. In comparison with posterior conventional approach, ALIF surgery has several advantages:...

Introduction: The combined use of intraoperative MRI and awake surgery is a tailored microsurgical resection to respect functional neural networks (mainly the language and motor ones). Intraoperative MRI has been classically considered to increase the extent of resection for gliomas, thereby reducing neurological deficits. Herein, we evaluated the...

Background Minimally invasive surgical resection of extraforaminal disc herniation is challenging. The anatomical landmarks are varying from common interlaminar approach. The main risk is to damage the exiting nerve root as it is not yet protected by any bony structure. Method Here, we present the different steps of the minimally invasive approach...

Background: Some authors used minimally invasive surgery (MIS) in the treatment of spinal cord tumor, but these studies had a small sample sizes and mixed extra- and intra-medullary tumors, resulting in confounding biases. The objectives of the present study were to evaluate the effectiveness and safety of MIS for spinal meningioma resection in co...

Microsurgical resection of primary brain tumors located within or near eloquent areas is challenging. Primary aim is to preserve neurological function, while maximizing the extent of resection (EOR), to optimize long-term neurooncological outcomes and quality of life. Here, we review the combined integration of awake craniotomy and intraoperative M...

Glioblastomas (GBMs) are high-grade malignancies with a poor prognosis. The current standard of care for GBM is maximal surgical resection followed by radiotherapy and chemotherapy. Despite all these treatments, the overall survival is still limited, with a median of 15 months. For patients harboring inoperable GBM, due to the anatomical location o...

Virtual Annual Meeting of the Swiss Society of Neurosurgery

A 67-yr-old patient presented with severe paraparesis and lower limb spasticity. The spinal cord magnetic resonance imaging (MRI) revealed the “scalpel sign” 1,2 at the T7 level, suggesting a diagnosis of a dorsal arachnoid web. This video demonstrates a microsurgical technique for the excision of a dorsal arachnoid web with a minimally invasive ap...

Résumé Introduction La chirurgie rachidienne est l’une des spécialités à haut risque médicolégal avec un recours en justice tous les 17 mois par praticien. L’une des complications redoutées est l’hématome épidural compliqué d’un déficit postopératoire. La gestion de cette complication reste débattue. Aussi, nous avons mené une étude rétrospective...

Background : Interstitial photodynamic therapy (iPDT), inserting optical fibers inside brain tumors, has been proposed for more than 30 years. While a promising therapeutical option, it is still an experimental treatment, with different ways of application, depending on the team performing the technique. Objective : In this systematic review, we r...

Introduction: Spine surgery is one of the specialties with the highest medicolegal risk, with a legal action initiated every 17 months per practitioner. One of the most dreaded complications is an epidural hematoma with postoperative deficit. The treatment of this complication is still being debated. We therefore conducted a retrospective study of...

PurposeGlioblastoma (GBM) is the most aggressive malignant primary brain tumor. The unfavorable prognosis despite maximal therapy relates to high propensity for recurrence. Thus, overall survival (OS) is quite limited and local failure remains the fundamental problem. Here, we present a safety and feasibility trial after treating GBM intraoperative...

Fronto-temporo-insular (FTI) gliomas continue to represent a surgical challenge despite numerous technical advances. Some authors advocate for surgery in awake condition even for non-dominant hemisphere FTI, due to risk of sociocognitive impairment. Here, we report outcomes in a series of patients operated using intraoperative magnetic resonance im...

Introduction Postoperative pain in spine surgery is an issue. Erector Spinae Plane Block (ESPB) may reduce such postoperative pain, but its usefulness has never been evaluated in the specific context of trauma surgery. We thus studied the effect of bilateral ultrasound-guided ESPB on postoperative pain and opioid requirement after percutaneous lumb...

The management of non-hemorrhagic arteriovenous malformations (AVMs) remains a subject of debate, even more since the ARUBA trial. Here, we report the obliteration rate, the risk of hemorrhage and the functional outcomes after Gamma Knife radiosurgery (GKRS) as first-line treatment for non-hemorrhagic AVMs treated before the ARUBA publication, in a...

Background For glial tumor management, the extent of resection (EOR) is the key to enhance tumor control and improve patient outcomes. Intraoperative MRI (IoMRI) neuronavigated microsurgery emerged as a useful neuroimaging tool for performing optimal and safe tumor resection. Method Here, we present the different steps of the microsurgical resecti...

EANS

Combined use of intraoperative MRI and awake tailored microsurgical resection to respect functional neural networks: Lille preliminary experience as a referral center

Introduction The Gamma Knife® planning software (TMR 10, Elekta Instruments, AB, Sweden) affords two ways of defining the skull volume, the “historical” one using manual measurements (still perform in some centers) and the new one using image-based skull contours. Our objective was to assess the potential variation of the dose delivery calculation...

OBJECTIVE Arteriovenous malformations (AVMs) present no pathologic tissue, and radiation dose is confined in a clear targeted volume. The authors retrospectively evaluated the role of the biologically effective dose (BED) after Gamma Knife radiosurgery (GKRS) for brain AVMs. METHODS A total of 149 consecutive cases of unruptured AVMs treated by up...

Background and purposeThe challenge of the neurosurgical management of gliomas lies in achieving a maximal resection without persistent functional deficit. Diffusion tensor imaging (DTI) allows non-invasive identification of white matter tracts and their interactions with the tumor. Previous DTI validation studies were compared with intraoperative...

Introduction: The management of antithrombotic therapy (AT) after surgery for chronic subdural hematoma (cSDH) requires taking account of the balance of risk between hemorrhage recurrence (HR) and the prophylactic thromboembolic effect (TE). The goal of the present study was to evaluate the prevalence of vascular events (VE: TE and/or HR) in the fi...

IntroductionPituitary adenomas (PA) are common intracranial tumors. In the context of the aging of the population, the question is whether postsurgical outcomes are comparable to the younger ones. The primary objective of the present study was to review published resection and recurrence rates after transsphenoidal resection. The secondary aim was...

The management of patients with novel 2019 coronavirus (Covid-19) represents a new challenge for medical and surgical teams. Each operating room in the world should be prepared with thinking and the development of a protocol and patient route seems mandatory. Adequate degree of protection must be used. We propose recommendations to help different p...

Purpose To evaluate whether left hip positioning widened the access corridor using oblique lateral interbody fusion (OLIF) approach during right lateral decubitus (RLD). Methods Ten healthy adult volunteers underwent a T2 lumbosacral MRI (1.5 T) in the supine position, RLD position with left hip in extension and then in flexion. L2–L3 to L5–S1 dis...

Résumé L’intérêt du drainage de la plaie en chirurgie du rachis dégénératif est débattu. L’objectif de cette étude a été d’évaluer les facteurs influençant le chirurgien dans sa décision de drainer. Un sondage en ligne a été envoyé à tous les membres de la Société française de neurochirurgie (383 membres) et la Société française de chirurgie du rac...

Background In case of suspected normal pressure hydrocephalus, MRI is performed systematically and can sometimes highlight an obstruction of the flow pathways of the CSF (aqueductal stenosis or other downstream obstruction). It seems legitimate for these patients to ask the question of a treatment with endoscopic third ventriculostomy (ETV), even i...

Background High-field intraoperative MRI (IoMRI) is part of the neurosurgical armamentarium to improve the extent of glioma resection (EOR). Objective To report our oncological and functional outcomes using IoMRI for neuronavigated glioma surgery. Methods In this prospective monocentric study, we reported 100 consecutive adult patients operated o...

Résumé Objectifs L’objectif de cette étude était d’évaluer l’intérêt de la mesure de l’espace extra vasculaire extracellulaire (ve) par l’imagerie de perfusion T1 (DCE IRM) pour différencier une pseudo progression d’une progression des métastases cérébrales après traitement par radiochirurgie. Matériels et méthodes 14 patients porteurs de 20 méta...

Introduction Le défi de la prise en charge neurochirurgicale des tumeurs gliales consiste à réaliser une ablation tumorale aussi complète que possible sans déficit fonctionnel postopératoire. La technique de tenseur de diffusion (DTI) permet l’identification non-invasive des fibres de substance blanche et leurs rapports avec la tumeur. Cependant, i...

Introduction Radiosurgery (RS) and fractionated radiotherapy (FRT) are part of the therapeutic armamentarium for the management of cavernous sinus meningiomas. We propose a systematic review of the local tumor control and clinical outcomes after monofractionated radiosurgical treatment, including gamma knife radiosurgery (GKRS) and linear accelerat...

Background: There is currently no therapy that prevents high-grade glioma recurrence. Thus, these primary brain tumors have unfavorable outcomes. Recently, 5-ALA photodynamic therapy (PDT) has been proposed to delay relapse and is highly expected to have potential synergistic effects with the current standard of care. However, PDT treatment delive...

Background: Glioblastoma (GBM) is characterized by marked proliferation, major infiltration, and poor prognosis. Despite current treatments, including surgery, radiation oncology, and chemotherapy, the overall median survival is 15 mo and the progression-free survival is 7 to 8 mo. Because of systematic relapse of the tumor, the improvement of loc...

Background: High-field intraoperative MRI (IoMRI) is a useful tool to improve the extent of glioma resection (EOR). Objective: To compare the interest of 1.5T IoMRI in glioma surgery between enhancing and non-enhancing tumors, based on volumetric analysis. Methods: A prospective single-center study included consecutive adult patients undergoin...

Background: High-grade gliomas are primary brain tumors that have shown increasing incidence and unfavorable outcomes. Local control is crucial to the management of this pathology. Photodynamic therapy (PDT), based on the light-induced activation of a photosensitizer (PS), achieves local treatment by inducing selective lesions in tumor tissue. Ob...

Background: The aim of our study was to report the usefulness of intraoperative MRI guidance in the resection of brain lesions adjacent to eloquent areas. Patients and methods: A single center prospective series of gliomas amenable to optimized resection with intraoperative MRI between September 2014 and December 2015. Results: The study inclu...

BACKGROUND: High-field Intraoperative MRI (IoMRI) is a useful tool to improve the extent of resection (EOR) of gliomas. For which kind of glioma is IoMRI the most beneficial? Objective: To compare the interest of a 1.5T IoMRI in glioma surgery for enhancing and non-enhancing tumors based on volumetric analyses. METHODS: In this prospective monocent...

Introduction La radiochirurgie (RC) et la radiotherapie stereotaxique fractionnee (RSF) representent des alternatives therapeutiques, soient en 1re ligne, soient adjuvantes, dans la prise en charge des meningiomes du sinus caverneux. Nous proposons une revue de la litterature concernant les resultats cliniques et le controle tumoral apres traitemen...

Background: Glioblastoma is a high-grade cerebral tumor with local recurrence and poor outcome. Photodynamic therapy (PDT) is a localized treatment based on the light activation of a photosensitizer (PS) in the presence of oxygen, which results in the formation of cytotoxic species. The delivery of fractionated light may enhance treatment efficacy...

OBJECTIVE Vestibular schwannomas (VSs) represent a common indication of Gamma Knife surgery (GKS). While most studies focus on the long-term morbidity and adverse radiation effects (AREs), none describe the acute clinical AREs that might appear on a short-term basis. These types of events are investigated, and their incidence, type, and outcomes ar...

Background Internal variation among spheno-orbital meningiomas (SOM) is surgically challenging. Optic canal invasion management is discussed. Method This retrospective study includes 70 patients with SOM who underwent surgery between 1995 and 2012. Preoperative ophthalmological, neurological and aesthetic clinical signs were collected. All patients...

Delineation of organs at risk (OARs) is a crucial step in surgical and treatment planning in brain cancer, where precise OARs volume delineation is required. However, this task is still often manually performed, which is time-consuming and prone to observer variability. To tackle these issues a deep learning approach based on stacking denoising aut...

We aimed to evaluate the functional outcome and risk factors of recurrence in patients operated on for a chronic subdural hematoma (CSH), and discuss systematic early postoperative CT scans. CSH is a very common disease in neurosurgical practice, especially in elderly patients who are treated with anticoagulation. The challenge is to rapidly restor...

Purpose To constrain the risk of severe toxicity in radiotherapy and radiosurgery, precise volume delineation of organs at risk is required. This task is still manually performed, which is time-consuming and prone to observer variability. To address these issues, and as alternative to atlas-based segmentation methods, machine learning techniques, s...

Objective: Photodynamic therapy (PDT) has become a well-established modality for the treatment of many cancers. Photodynamic eradication of tumor cells depends on the presence of a photosensitizer, oxygen and light. However, oxygen depletion during PDT is a well known problem. Modulation of light delivery could address this issue by counteracting...

Purpose. To constrain the risk of severe toxicity in radiotherapy and radiosurgery, precise volume delineation of organs at risk (OARs) is required. This task is still manually performed, which is time-consuming and prone to observer variability. To address these issues, and to overcome limitations of classical segmentation methods, machine learnin...

High-grade gliomas represent a widely heterogeneous group of tumors, the most frequent of which is glioblastoma multiforme. Its annual incidence has risen over the last decades, particularly amongst elderly people. The actual standards of care allow for a 15-month median survival rate for WHO grade IV gliomas. As recurrence occurs in more than 85%...

Delineating critical structures of the brain is required for advanced radiotherapy technologies to determine whether the dose from the proposed treatment will impair the functionality of those structures. Employing an automatic segmentation computer module in the radiation oncology treatment planning process has the potential to significantly incre...

Delineating critical structures of the brain is required for advanced radiotherapy technologies to determine whether the dose from the proposed treatment will impair the functionality of those structures. Employing an automatic segmentation computer module in the radiation oncology treatment planning process has the potential to significantly incre...

Background: Glioblastoma is a high-grade cerebral tumor with local recurrence and poor outcome. Photodynamic therapy (PDT) is a local treatment based on the light activation of a photosensitizer (PS) in the presence of oxygen to form cytotoxic species. Fractionation of light delivery may enhance treatment efficiency by restoring tissue oxygenation....

Introduction Paediatric low-grade astrocytomas of the fourth ventricle are rare tumours, generally revealed by hydrocephalus. However, some patients present with a history of severe anorexia. It might be a harbinger, which if recognized, could lead to earlier diagnosis. We decided to examine our database in order to evaluate the incidence and sign...

Lateral ventricular neoplasms are rare, and account for 50% of all intraventricular tumors in adults and 25% in children. Although these neoplasms are easily detected with computed tomography (CT) and magnetic resonance imaging (MRI), both techniques are relatively unspecific in identifying the type of tumor. However, few imaging patterns are speci...

Lateral ventricular neoplasms are rare, and account for 50% of all intraventricular tumors in adults and 25% in children. Although these neoplasms are easily detected with computed tomography (CT) and magnetic resonance imaging (MRI), both techniques are relatively unspecific in identifying the type of tumor. However, few imaging patterns are speci...