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Marc Zanello and Johan Pallud

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Marc Zanello, Thomas Baugnon, Alexandre Roux and Federico Di Rocco

OBJECTIVE

Breaking bad news is a difficult task in medical practice. Several breaking-bad-news training programs have been proposed. However, long-term results of such training have rarely been investigated. The aim of this study was to compare the short- and long-term evaluations by young neurosurgeons of a training program for breaking bad news to patients and their parents.

METHODS

Between 2012 and 2015, pediatric neurosurgery residents participated in a training day on breaking bad news in pediatric neurosurgery with professional actors. A personal debriefing, followed by a theoretical session, completed the training. Immediate feedback was evaluated through a survey administered at the end of the day. Long-term results were explored via an online form sent at least 3 years after the training completion.

RESULTS

Seventeen participants from 9 different countries were interviewed. Their immediate feedback confirmed their interest. For 71% of them, the program was very interesting, and 77% were extremely satisfied or very satisfied. All trainees wanted more training sessions. At a mean of 4.5 years of follow-up (range 3–6 years), 71% of the trainees fully remembered the session. Most of them (86%) reported a positive impact of the training on their career. Only 21% had another training session on breaking bad news during their residency. At long-term analysis, fewer trainees considered the duration of the training to have been sufficient (p = 0.044).

CONCLUSIONS

Breaking-bad-news training has a positive long-term educational impact even several years later. Such a training program should be implemented into pediatric neurosurgery residency.

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Marc Zanello, Johan Pallud, Nicolas Baup, Sophie Peeters, Baris Turak, Marie Odile Krebs, Catherine Oppenheim, Raphael Gaillard and Bertrand Devaux

Sainte-Anne Hospital is the largest psychiatric hospital in Paris. Its long and fascinating history began in the 18th century. In 1952, it was at Sainte-Anne Hospital that Jean Delay and Pierre Deniker used the first neuroleptic, chlorpromazine, to cure psychiatric patients, putting an end to the expansion of psychosurgery. The Department of Neuro-psychosurgery was created in 1941. The works of successive heads of the Neurosurgery Department at Sainte-Anne Hospital summarized the history of psychosurgery in France.

Pierre Puech defined psychosurgery as the necessary cooperation between neurosurgeons and psychiatrists to treat the conditions causing psychiatric symptoms, from brain tumors to mental health disorders. He reported the results of his series of 369 cases and underlined the necessity for proper follow-up and postoperative re-education, illustrating the relative caution of French neurosurgeons concerning psychosurgery.

Marcel David and his assistants tried to follow their patients closely postoperatively; this resulted in numerous publications with significant follow-up and conclusions. As early as 1955, David reported intellectual degradation 2 years after prefrontal leucotomies.

Jean Talairach, a psychiatrist who eventually trained as a neurosurgeon, was the first to describe anterior capsulotomy in 1949. He operated in several hospitals outside of Paris, including the Sarthe Psychiatric Hospital and the Public Institution of Mental Health in the Lille region. He developed stereotactic surgery, notably stereo-electroencephalography, for epilepsy surgery but also to treat psychiatric patients using stereotactic lesioning with radiofrequency ablation or radioactive seeds of yttrium-90.

The evolution of functional neurosurgery has been marked by the development of deep brain stimulation, in particular for obsessive-compulsive disorder, replacing the former lesional stereotactic procedures.

The history of Sainte-Anne Hospital’s Neurosurgery Department sheds light on the initiation—yet fast reconsideration—of psychosurgery in France. This relatively more prudent attitude toward the practice of psychosurgery compared with other countries was probably due to the historically strong collaboration between psychiatrists and neurosurgeons in France.

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Marc Zanello, Alexandre Roux, Gilles Zah-Bi, Bénédicte Trancart, Eduardo Parraga, Myriam Edjlali, Arnault Tauziede-Espariat, Xavier Sauvageon, Tarek Sharshar, Catherine Oppenheim, Pascale Varlet, Edouard Dezamis and Johan Pallud

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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Sophie Peeters, Mélanie Pagès, Guillaume Gauchotte, Catherine Miquel, Stéphanie Cartalat-Carel, Jean-Sébastien Guillamo, Laurent Capelle, Jean-Yves Delattre, Patrick Beauchesne, Marc Debouverie, Denys Fontaine, Emmanuel Jouanneau, Jean Stecken, Philippe Menei, Olivier De Witte, Philippe Colin, Didier Frappaz, Thierry Lesimple, Luc Bauchet, Manuel Lopes, Laurence Bozec, Elisabeth Moyal, Christophe Deroulers, Pascale Varlet, Marc Zanello, Fabrice Chretien, Catherine Oppenheim, Hugues Duffau, Luc Taillandier and Johan Pallud

OBJECTIVE

The goal of this study was to provide insight into the influence of gliomas on gestational outcomes, the impact of pregnancy on gliomas, and the identification of patients at risk.

METHODS

In this multiinstitutional retrospective study, the authors identified 52 pregnancies in 50 women diagnosed with a glioma.

RESULTS

For gliomas known prior to pregnancy (n = 24), we found the following: 1) An increase in the quantified imaging growth rates occurred during pregnancy in 87% of cases. 2) Clinical deterioration occurred in 38% of cases, with seizures alone resolving after delivery in 57.2% of cases. 3) Oncological treatments were immediately performed after delivery in 25% of cases. For gliomas diagnosed during pregnancy (n = 28), we demonstrated the following: 1) The tumor was discovered during the second and third trimesters in 29% and 54% of cases, respectively, with seizures being the presenting symptom in 68% of cases. 2) The quantified imaging growth rates did not significantly decrease after delivery and before oncological treatment. 3) Clinical deterioration resolved after delivery in 21.4% of cases. 4) Oncological treatments were immediately performed after delivery in 70% of cases. Gliomas with a high grade of malignancy, negative immunoexpression of alpha-internexin, or positive immunoexpression for p53 were more likely to be associated with tumor progression during pregnancy. Deliveries were all uneventful (cesarean section in 54.5% of cases and vaginal delivery in 45.5%), and the infants were developmentally normal.

CONCLUSIONS

When a woman harboring a glioma envisions a pregnancy, or when a glioma is discovered in a pregnant patient, the authors suggest informing her and her partner that pregnancy may impact the evolution of the glioma clinically and radiologically. They strongly advise a multidisciplinary approach to management.

■ CLASSIFICATION OF EVIDENCE Type of question: association; study design: case series; evidence: Class IV.