Publications by authors named "Marc Levivier"

Background: Cavernous sinus hemangiomas (CSHs) are rare benign vascular tumors and surgical resection carries substantial risks of morbidity and mortality. Stereotactic radiosurgery (SRS) and fractionated SRS (FSRS) have emerged as an effective non-invasive surgical alternative; however, appropriate patient selection, dosing, and outcomes remain unclear and underreported.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines to evaluate the efficacy and safety of SRS/FSRS for CSHs.

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Introduction: Stereotactic radiosurgery (SRS) has become a standard of care for small- to medium- size vestibular schwannomas (VS), while the majority of patients with large VS still require microsurgical resection due to potential consequences of long tract and cranial nerve compression, intracranial hypertension or hydrocephalus.

Methods: We performed a systematic review and meta-analysis of the literature specific to planned subtotal resection for large VSs followed by SRS to the residual tumor to inform clinical practice guideline development. The Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach to search for manuscripts reporting outcomes for large VSs treated with this paradigm, with a search end date of June 1st 2023.

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Introduction: The incidence of intracranial meningiomas rises with advancing age, raising the question of whether similar surgical outcomes in morbidity and mortality can be expected compared to younger population. We conducted a systematic review and meta-analysis of research examining microsurgical outcomes in those aged 80 years or older.

Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we reviewed articles published between January 1995 and January 2024, referenced in PubMed or Embase.

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Introduction: Cystic brain metastases (BMs) are often more challenging to treat than solid BMs. Stereotactic cyst aspiration for volume reduction followed by stereotactic radiosurgery (SRS) is an alternative treatment modality that may benefit patients with large cystic BMs not favorable for SRS alone nor microsurgical resection.

Research Question: Here, we perform a systematic review and meta-analysis of stereotactic aspiration alone or reservoir (Ommaya) placement plus aspiration followed by SRS for cystic BMs.

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Introduction: Stereotactic radiosurgery (SRS) is one of the treatment options for the management of residual or recurrent secreting pituitary adenomas (PA). While the role of radiosurgery (RS) by Gamma Knife (GK) has been clearly established, Cyberknife (CK) RS has been evaluated in fewer series.

Material And Methods: To perform a systematic review of the literature and meta-analysis, with the aim of focusing on the effect of CK RS on secreting PA.

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Article Synopsis
  • A systematic review was conducted to evaluate the use of stereotactic radiosurgery (SRS) specifically in pediatric patients, aiming to inform guidelines by the International Stereotactic Radiosurgery Society (ISRS).
  • The study analyzed 68 articles focusing on outcomes for around 400 children with brain tumors and over 5000 with arteriovenous malformations (AVMs) from 1989 to 2021, reporting varying local control rates for different tumor types.
  • The findings indicated that SRS demonstrated suitable local control rates for pediatric brain tumors and AVMs, but data availability is limited, leading to the development of ISRS consensus guidelines for its use in this population.
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Objective: The International Stereotactic Radiosurgery Society aims to establish evidence-based guidelines for single-fraction stereotactic radiosurgery (SRS) in treating intracranial cavernous malformations.

Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, searching electronic databases up to January 2024 to assess SRS's impact on post-treatment hemorrhage rates. Pooled risk ratios (RRs) and confidence intervals were used to quantify this effect, along with assessments of lesion volume changes, seizure outcomes, and SRS-related adverse effects.

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Article Synopsis
  • - Recent studies indicate a strong link between Biologically Effective Doses (BED) and treatment outcomes in stereotactic radiosurgery, but previous BED calculations used a simplified model that ignored the complexities of dose delivery.
  • - This study aims to compare these simplified BED calculations with a more complex model that takes into account the timing and spatial distribution of dose delivery and accounts for how sub-lethal damage repairs over time.
  • - Results show that the simplified model tends to overestimate BED values, particularly in larger and more complex tumors, highlighting that more refined BED distributions could lead to better predictions of clinical outcomes.
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Background: Stereotactic radiosurgery (SRS) represents a minimally invasive and valuable alternative for jugular foramen schwannomas (JFS), both as upfront and/or adjuvant treatment (in hybrid approaches).

Methods: We conducted a retrospective review of our cases treated at the Lausanne University Hospital (CHUV) from June 2010 to October 2023. Eleven patients underwent SRS, among whom three had prior surgery, two in our center in the frame of a planned combined approach and one in another center.

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Background And Objectives: Consensus guidelines do not exist to guide the role of stereotactic radiosurgery (SRS) in the management of patients with Spetzler-Martin Grade III-V arteriovenous malformations (AVMs). We sought to establish SRS practice guidelines for Grade III-V AVMs based on a critical systematic review of the published literature.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of Medline, Embase, and Scopus, 1986 to 2023, for publications reporting post-SRS outcomes in ≥10 Grade III-V AVMs with the median follow-up ≥24 months was performed.

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Background And Objectives: Repeat stereotactic radiosurgery (SRS) for residual arteriovenous malformations (AVMs) can be considered as a salvage approach after failure of initial SRS. There are no published guidelines regarding patient selection, timing, or SRS parameters to guide clinical practice. This systematic review aimed to review outcomes and complications from the published literature to inform practice recommendations provided on behalf of the International Stereotactic Radiosurgery Society.

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Patients with drug-resistant essential tremor (ET) may undergo Gamma Knife stereotactic radiosurgical thalamotomy (SRS-T), where the ventro-intermediate nucleus of the thalamus (Vim) is lesioned by focused beams of gamma radiations to induce clinical improvement. Here, we studied SRS-T impacts on left Vim dynamic functional connectivity (dFC, n = 23 ET patients scanned before and 1 year after intervention), and on surface-based morphometric brain features (n = 34 patients, including those from dFC analysis). In matched healthy controls (HCs), three dFC states were extracted from resting-state functional MRI data.

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Background: The choice of an appropriate strategy for intracanalicular vestibular schwannoma (ICVS) is still debated. We conducted a systematic review and meta-analysis with the aim to compare treatment outcomes amongst management strategies (conservative surveillance (CS), microsurgical resection (MR), or stereotactic radiosurgery (SRS)) aiming to inform guideline recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS).

Methods: Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2021 referenced in PubMed or Embase.

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We report the case of a 67-year-old left-handed female patient with disabling medically refractory essential tremor who underwent successful right-sided magnetic resonance-guided focused ultrasound (MRgFUS) of the ventral intermediate nucleus after ipsilateral gamma knife radiosurgery (GKRS) thalamotomy performed 3 years earlier. The GKRS had a partial effect on her postural tremor without side effects, but there was no reduction of her kinetic tremor or improvement in her quality of life (QoL). The patient subsequently underwent a MRgFUS thalamotomy, which induced an immediate and marked reduction in both the postural and kinetic tremor components, with minor complications (left upper lip hypesthesia, dysmetria in her left hand, and slight gait ataxia).

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Perioptic meningiomas, defined as those that are less than 3 mm from the optic apparatus, are challenging to treat with stereotactic radiosurgery (SRS). Tumor control must be weighed against the risk of radiation-induced optic neuropathy (RION), as both tumor progression and RION can lead to visual decline. We performed a systematic review and meta-analysis of single fraction SRS and hypofractionated radiosurgery (hfRS) for perioptic meningiomas, evaluating tumor control and visual preservation rates.

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Purpose: To perform a systematic review of literature specific to single-fraction stereotactic radiosurgery (SRS) for large vestibular schwannomas (VS), maximum diameter ≥ 2.5 cm and/or classified as Koos Grade IV, and to present consensus recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS).

Methods: The Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach.

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Article Synopsis
  • Enhanced Recovery After Surgery (ERAS®) guidelines aim to streamline postoperative care and boost recovery for various surgical procedures, and the authors focused on implementing these for cranial neurosurgery, specifically for pituitary neuroendocrine tumors and craniosynostosis repair.
  • A multidisciplinary team was established, which included hiring an ERAS® nurse coordinator and undergoing a certification process that involved seminars and active phases with an ERAS® coach to ensure proper implementation.
  • The ERAS® program successfully achieved certification in 18 months by identifying areas for improvement, creating local protocols, and developing patient-centered strategies, highlighting the importance of teamwork and dedicated personnel in the process.
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Background And Objectives: Brain metastases (BM) develop in nearly half of the patients with advanced melanoma. The aim of this retrospective historical cohort study was to analyze radiological response of melanoma BM to single-fraction Gamma Knife radiosurgery (GKRS), in relation to biologically effective dose (BED) for various alpha/beta ratios.

Methods: Included in the study were 274 lesions.

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Cingulate gyrus gliomas are rare among adult, hemispheric diffuse gliomas. Surgical reports are scarce. We performed a systematic review of the literature and meta-analysis, with the aim of focusing on the extent of resection (EOR), WHO grade, and morbidity and mortality, after microsurgical resection of gliomas of the cingulate gyrus.

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Independently, both 5-aminolevulinic acid (5-ALA) and intraoperative neuromonitoring (IONM) have been shown to improve outcomes with high-grade gliomas (HGG). The interplay and overlap of both techniques are scarcely reported in the literature. We performed a systematic review and meta-analysis focusing on the concomitant use of 5-ALA and intraoperative mapping for HGG located within eloquent cortex.

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Article Synopsis
  • - A review of literature assessed various treatments for radiation necrosis (RN) resistant to corticosteroids, focusing on the effectiveness and safety of treatments like bevacizumab, laser interstitial thermal therapy (LITT), surgical resection, and hyperbaric oxygen therapy.
  • - Bevacizumab showed promising results with an 86% improvement/stability rate for symptoms and very high rates for T2 (93%) and T1 postcontrast (94%) imaging outcomes; lower doses were particularly effective for symptom relief.
  • - Other treatments such as LITT and surgical resection had similar efficacy, reporting 88% and 89% improvement/stability rates respectively, with toxicity generally reported as low across all treatment options. *
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Background And Objectives: Stereotactic radiosurgery (SRS) is a useful alternative for small- to medium-sized vestibular schwannoma. To evaluate whether biologically effective dose (BED Gy2.47 ), calculated for mean (BED Gy2.

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Objective: Proton beam therapy is considered, by some authors, as having the advantage of delivering dose distributions more conformal to target compared with stereotactic radiosurgery (SRS). Here, we performed a systematic review and meta-analysis of proton beam for VSs, evaluating tumor control and cranial nerve preservation rates, particularly with regard to facial and hearing preservation.

Methods: We reviewed, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) articles published between 1968 and September 30, 2022.

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Article Synopsis
  • Stereotactic radiosurgery (SRS) involves delivering precise radiation to targeted tissue, effectively used in both short- and long-term treatments.
  • The technology has advanced, but there are still unresolved issues regarding dosing patterns and intervals, highlighting the complexity of this treatment.
  • Research is ongoing to better understand the radiobiology of SRS, which differs from traditional radiation therapy and requires deeper investigation into dose calculations and tissue sensitivity.
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