Métastases cérébrales

, par  Philippe Meneï, Philippe Metellus, Rogatien Faguer, Sébastien Boissonneau , popularité : 13%

CONCLUSION

La prise en charge des MC est devenue un véritable enjeu oncologique du fait de l’allongement de la survie des patients atteints de cancer et l’amélioration du monitoring de ces patients. Le neurochirurgien joue un rôle fondamental dans cette maladie du diagnostic jusqu’au traitement adjuvant. La connaissance des indications chirurgicales est primordiale. La chirurgie s’inscrit dans la stratégie diagnostique et thérapeutique des MC tant à la phase diagnostique qu’au moment du traitement local et lors du monitoring de ces patients. Bien que les indications respectives de la chirurgie et de la radiochirurgie soient relativement bien codifiées, leur intégration dans la stratégie de prise en charge des patients doit se faire au sein d’un comité d’experts. La décision de la stratégie thérapeutique doit donc faire l’objet d’une discussion collégiale au sein des réunions de concertation pluridisciplinaires en présence des radiothérapeutes et des oncologues médicaux impliqués dans la prise en charge thérapeutique des patients atteints de cancer.

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LEGENDE DES FIGURES

Figure 1 : Différentes séquences IRM d’une métastase pariétale gauche d’un adénocarcinome mammaire : lésion tumorale siège d’une importante néo-angiogenèse, entouré d’un important œdème réactionnel.

  • Séquence axiale (A) et coronale (B) T1 après injection de Gadolinium
  • Séquence axiale T2 FLAIR (C)
  • Séquence axiale T2 FSE (D)

Figure 2 : Illustration d’une métastase cérébrale de la fosse postérieure sur une séquence axiale T1 après injection de Gadolinium.

Métastase cérébelleuse droite d’un adénocarcinome bronchique, nécrotique, rehaussée de façon hétérogène par le produit de contraste et entourée d’un important œdème péri-lésionnel réalisant un effet de masse sur le IVème ventricule.

Figure 3 : Indication de radio-chirurgie sur une séquence axiale T1 après injection de Gadolinium.

Lésion de petite taille, profonde, asymptomatique et sans œdème.