{"id":18404,"date":"2025-04-03T20:50:58","date_gmt":"2025-04-03T20:50:58","guid":{"rendered":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/management-protocol-indications-and-clinical-cases\/"},"modified":"2025-09-12T20:01:11","modified_gmt":"2025-09-12T20:01:11","slug":"management-protocol-indications-and-clinical-cases","status":"publish","type":"page","link":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/professionals\/management-protocol-indications-and-clinical-cases\/","title":{"rendered":"Management protocol, Indications and clinical cases"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"18404\" class=\"elementor elementor-18404 elementor-15525\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-14e0b3e1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"14e0b3e1\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-15b3be8d\" data-id=\"15b3be8d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-692565fe elementor-widget elementor-widget-pix-heading\" data-id=\"692565fe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div  class=\"pix-heading-el text-left \"><h3 class=\"text-gradient-primary font-weight-bold h3 heading-text el-title_custom_color mb-12\" style=\"\" data-anim-type=\"\" data-anim-delay=\"\">Procedure radiochirurgie metastases cerebrales de melanome<\/h3><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-19c1df91 elementor-widget elementor-widget-pix-text\" data-id=\"19c1df91\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"pix-el-text w-100 text-left \" ><p class=\"text-20 resp-option text-dark-opacity-5 text-left \" >Protocoles de prise en charge par pathologies<\/p><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-13ab5f10\" data-id=\"13ab5f10\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2b9786eb elementor-widget elementor-widget-pix-accordion\" data-id=\"2b9786eb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"accordion w-100 accordion-card\" id=\"accordion-2b9786eb\"><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-2b9786eb-972f147\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-2b9786eb-972f147\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-2b9786eb-972f147\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-statistics-board-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M19.5,3 L4.5,3 C3.67157288,3 3,3.67157288 3,4.5 L3,15.5 C3,16.3284271 3.67157288,17 4.5,17 L19.5,17 C20.3284271,17 21,16.3284271 21,15.5 L21,4.5 C21,3.67157288 20.3284271,3 19.5,3 Z M6,14 L6,9 M9,14 L9,12 M12,14 L12,6 M15,14 L15,9 M12,17 L8,21 M12,17 L17,21 M18,14 L18,11\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indications pour Metastase cerebrale unique de melanome<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-2b9786eb-972f147\" class=\"collapse \" aria-labelledby=\"headingpix-tab-2b9786eb-972f147\">\n                 <div class=\"card-body\"><p class=\"p1\">1\u00b0) URGENCE, d\u00e9gradation neurologique rapide, m\u00e9tastase volumineuse\u00a0: Chirurgie<\/p>\n<p class=\"p1\">2\u00b0) Urgence relative\u00a0: m\u00e9tastase mena\u00e7ante asymptomatique ou pauci symptomatique<\/p>\n<p class=\"p1\">BRAF mut\u00e9\u00a0: traitement cibl\u00e9 DABRA + TRAME (&gt; 60% r\u00e9ponse c\u00e9r\u00e9brale)<\/p>\n<p class=\"p1\">BRAF non mut\u00e9\u00a0: immunoth\u00e9rapie IPI (3) + NIVO(1), discuter anti PD1 adjuvant<\/p>\n<p class=\"p1\">3\u00b0) Hors urgence\u00a0: d\u00e9buter immunoth\u00e9rapie (55 % de r\u00e9ponse c\u00e9r\u00e9brale)<\/p>\n<p class=\"p2\">IPI(1) + NIVO(3), et discuter arbre d\u00e9cision<\/p>\n<p class=\"p2\">Dans tous les cas, suivi rapproch\u00e9 (1 mois) puis RCP\u00a0:<\/p>\n<ul class=\"ul1\">\n<li class=\"li1\">Traitement efficace\u00a0: ni neurochirurgie, ni radiochirurgie<\/li>\n<li class=\"li1\">Traitement inefficace\u00a0: discuter chirurgie, radiochirurgie et traitement cibl\u00e9 anti BRAF si BRAF mut\u00e9<\/li>\n<\/ul>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-full wp-image-17504\" src=\"http:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase.jpg\" alt=\"\" width=\"720\" height=\"540\" srcset=\"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase.jpg 720w, https:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase-300x225.jpg 300w, https:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase-600x450.jpg 600w\" sizes=\"(max-width: 720px) 100vw, 720px\" \/><\/p>\n<p class=\"p1\"><b>M\u00e9tastase c\u00e9r\u00e9brale unique<\/b><b><\/b><\/p>\n<ul>\n<li>\n<p class=\"p1\"><b>Arguments pour la chirurgie :<\/b><b><\/b><\/p>\n<ul>\n<li>\n<p class=\"p1\">Symptomatique : HTIC, d\u00e9ficit<\/p>\n<\/li>\n<li>\n<p class=\"p1\">\u0152d\u00e8me tr\u00e8s important<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Topographie fosse post\u00e9rieure, en particulier si dilatation ventriculaire<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Taille \u2265 2 cm<\/p>\n<\/li>\n<li>\n<p class=\"p1\">\u00c9volutivit\u00e9 des l\u00e9sions<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Caract\u00e8re kystique de la l\u00e9sion<\/p>\n<\/li>\n<li>\n<p class=\"p1\">M\u00e9tastase mena\u00e7ante pour la fonction et\/ou la vie<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Patient jeune<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Doute diagnostique<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<li>\n<p class=\"p1\"><b>Op\u00e9rabilit\u00e9 de la l\u00e9sion :<\/b><b><\/b><\/p>\n<ul>\n<li>\n<p class=\"p1\">Non op\u00e9rables : tronc c\u00e9r\u00e9bral, profondes, peu accessibles avec risque acceptable<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-2b9786eb-a4718a3\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-2b9786eb-a4718a3\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-2b9786eb-a4718a3\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-statistics-board-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M19.5,3 L4.5,3 C3.67157288,3 3,3.67157288 3,4.5 L3,15.5 C3,16.3284271 3.67157288,17 4.5,17 L19.5,17 C20.3284271,17 21,16.3284271 21,15.5 L21,4.5 C21,3.67157288 20.3284271,3 19.5,3 Z M6,14 L6,9 M9,14 L9,12 M12,14 L12,6 M15,14 L15,9 M12,17 L8,21 M12,17 L17,21 M18,14 L18,11\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indications pour Metastases cerebrales multiples de melanome<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-2b9786eb-a4718a3\" class=\"collapse \" aria-labelledby=\"headingpix-tab-2b9786eb-a4718a3\">\n                 <div class=\"card-body\"><p class=\"p1\">1\u00b0) <span class=\"s1\">URGENCE<\/span>, d\u00e9gradation neurologique rapide, une ou quelques m\u00e9tastases est\/sont volumineuse(s) et symptomatique(s)\u00a0: Chirurgie<\/p>\n<p class=\"p1\">2\u00b0)<span class=\"s1\"> Urgence relative<\/span>\u00a0: m\u00e9tastase(s) mena\u00e7ante(s) asymptomatique(s) ou pauci symptomatique(s), mena\u00e7ant la fonction avec perte d\u2019autonomie ou la vie (faisceau pyramidal et tronc c\u00e9r\u00e9bral)<\/p>\n<p class=\"p1\">BRAF mut\u00e9\u00a0: traitement cibl\u00e9 DABRA + TRAME (&gt; 60% r\u00e9ponse c\u00e9r\u00e9brale)<\/p>\n<p class=\"p1\">BRAF non mut\u00e9\u00a0: immunoth\u00e9rapie IPI (3)+ NIVO(1), discuter anti PD1 adjuvant<\/p>\n<p class=\"p1\">3\u00b0) Hors urgence\u00a0: d\u00e9buter immunoth\u00e9rapie (55 % de r\u00e9ponse c\u00e9r\u00e9brale)<\/p>\n<p class=\"p2\">IPI(3) + NIVO(1), et discuter arbre d\u00e9cision<\/p>\n<p class=\"p2\">Dans tous les cas, suivi rapproch\u00e9 (1 mois) puis RCP\u00a0:<\/p>\n<ul class=\"ul1\">\n<li class=\"li1\">Traitement efficace\u00a0: ni neurochirurgie, ni radiochirurgie<\/li>\n<li class=\"li1\">Traitement inefficace\u00a0: discuter chirurgie, radiochirurgie et traitement cibl\u00e9 anti BRAF si BRAF mut\u00e9<\/li>\n<\/ul>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-17505\" src=\"http:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase-multi.jpg\" alt=\"\" width=\"720\" height=\"540\" srcset=\"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase-multi.jpg 720w, https:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase-multi-300x225.jpg 300w, https:\/\/www.radiochirurgiezapx-lariboisiere.com\/wp-content\/uploads\/2025\/05\/shema-metastase-multi-600x450.jpg 600w\" sizes=\"(max-width: 720px) 100vw, 720px\" \/><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\">Si nbre de m\u00e9tas \u2265 5\n<ul class=\"ul1\">\n<li class=\"li1\">La RT st\u00e9r\u00e9otaxique se discute pour \u00e9viter une RT de l\u2019enc\u00e9phale in toto<\/li>\n<li class=\"li1\">Dans la mesure du possible, traiter toutes les m\u00e9tastases<\/li>\n<li class=\"li1\">Mais il est possible de n\u2019irradier que les m\u00e9tastases les plus mena\u00e7antes et laisser en place les autres si leur nombre est trop important<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p1\"><b>RT st\u00e9r\u00e9otaxique : modalit\u00e9s<\/b><b><\/b><\/p>\n<ul>\n<li>\n<p class=\"p1\"><b>Multifractionn\u00e9e :<\/b><b><\/b><\/p>\n<ul>\n<li>\n<p class=\"p1\">Syst\u00e9matique si m\u00e9tastase \u2265 2 cm<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Et si zone \u00e0 risque : p\u00e9doncules c\u00e9r\u00e9belleux, substance blanche<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Et si V12 &gt; 10 cc en mono-fractionn\u00e9e<\/p>\n<p class=\"p1\">ou contraintes non respect\u00e9es<\/p>\n<\/li>\n<li>\n<p class=\"p1\">\u2265 3 cm :<\/p>\n<\/li>\n<li>\n<p class=\"p1\">ou si proximit\u00e9 des OAR : voies optiques, cochl\u00e9e, trigone, tronc c\u00e9r\u00e9bral<\/p>\n<\/li>\n<li>\n<p class=\"p1\">on peut proposer : 5 x 5 ou 6 Gy<\/p>\n<\/li>\n<\/ul>\n<\/li>\n<li>\n<p class=\"p1\">Pas de CI pour l\u2019association RC ou RT hypofractionn\u00e9e avec l\u2019immunoth\u00e9rapie (voire effet synergique) ou les traitements cibl\u00e9s anti BRAF \/ anti MEK<\/p>\n<\/li>\n<\/ul>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-2b9786eb-18eea64\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-2b9786eb-18eea64\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-2b9786eb-18eea64\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-fast-thinking-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M3.43669391,17.5647941 C5.19699693,15.8549314 7.38476562,15 10,15 C12.6152344,15 14.8030031,15.8549314 16.5633061,17.5647941 C17.3559904,18.334031 17.3749542,19.6002189 16.6056898,20.3928765 C16.2295031,20.7805029 15.7125211,20.9994841 15.1723633,21 L4.82763672,21 C3.72306772,20.9989459 2.82849139,20.1026621 2.82954457,18.9980931 C2.83005959,18.4579353 3.04904073,17.9409532 3.43669391,17.5647941 Z M10,12 C12.209139,12 14,10.209139 14,8 C14,5.790861 12.209139,4 10,4 C7.790861,4 6,5.790861 6,8 C6,10.209139 7.790861,12 10,12 Z M18.5,7.5 L16,12 L18.5,12 L18.5,15.5 L21,11 L18.5,11 L18.5,7.5 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Traitement<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-2b9786eb-18eea64\" class=\"collapse \" aria-labelledby=\"headingpix-tab-2b9786eb-18eea64\">\n                 <div class=\"card-body\"><p class=\"p1\"><b>Modalit\u00e9s<\/b><\/p>\n<p class=\"p2\"><span class=\"s1\">\u2610<\/span> Cyberknife (rachis)<\/p>\n<p class=\"p2\"><span class=\"s1\">\u2610<\/span> ZAP-X (cranio-cervical)<\/p>\n<p class=\"p2\"><span class=\"s1\">\u2610<\/span> 1 fraction pr\u00e9f\u00e9rable si petit volume<\/p>\n<p class=\"p3\"><b>Imagerie\u00a0: FLAIR, T2 volumique, T1 gadolinium volumique<\/b><b><\/b><\/p>\n<p class=\"p1\"><b>Dosim\u00e9trie<\/b><\/p>\n<p class=\"p2\"><span class=\"s1\">\u2612<\/span> Doses<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p4\"><b>Nombre de fractions<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p4\"><b>Dose totale<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p4\"><b>Volume cible<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td3\" valign=\"top\">\n<p class=\"p4\"><b>Structures critiques<\/b><b><\/b><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p4\"><b>1 fraction<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p4\"><span class=\"s2\"><b>18<\/b><\/span><b>-20 Gy<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td5\" valign=\"top\">\n<p class=\"p5\"><b>GTV: Tumeur visible<\/b><\/p>\n<p class=\"p5\"><b>CTV: GTV + \u2264 10mm (extension microscopique)<\/b><\/p>\n<p class=\"p6\"><b>PTV: CTV + \u2264 2mm (marge)<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td6\" valign=\"top\">\n<p class=\"p7\"><b>Voies optiques V8 Gy&lt; 0.2cc, max 8 Gy<\/b><\/p>\n<p class=\"p7\"><b>Tronc v10 Gy &lt;0.5 cc, max 12 Gy<\/b><\/p>\n<p class=\"p8\"><b>Moelle V10 Gy &lt; 0.35cc, Max 12 Gy<\/b><b><\/b><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p4\"><b>3 fractions<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p4\"><span class=\"s2\"><b>24<\/b><\/span><b>-30 Gy<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p5\"><b>GTV: Tumeur visible<\/b><\/p>\n<p class=\"p5\"><b>CTV: GTV + \u2264 10mm (extension microscopique)<\/b><\/p>\n<p class=\"p6\"><b>PTV: CTV + \u2264 2mm (marge)<\/b><b><\/b><\/p>\n<\/td>\n<td class=\"td9\" valign=\"top\">\n<p class=\"p7\"><b>Voies optiques V23 Gy&lt; 0.2cc, max 12 Gy<\/b><\/p>\n<p class=\"p7\"><b>Tronc v23 Gy &lt;0.5 cc, max 18 Gy<\/b><\/p>\n<p class=\"p8\"><b>Moelle V23 Gy &lt; 0.35cc, Max 16 Gy<\/b><b><\/b><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-2b9786eb-099a016\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-2b9786eb-099a016\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-2b9786eb-099a016\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-clipboard-edit-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M15,5 L17,5 C18.1045695,5 19,5.8954305 19,7 L19,19 C19,20.1045695 18.1045695,21 17,21 L7,21 C5.8954305,21 5,20.1045695 5,19 L5,7 C5,5.8954305 5.8954305,5 7,5 L9,5 L9,5 M15.0417831,10.7273336 C15.3155532,11.0124282 15.3109771,11.4641391 15.0314873,11.7436288 L10.3437661,16.4313501 C10.233161,16.5419552 10.0977768,16.6245928 9.94884481,16.6724075 L8.70710678,17.0710678 L8.70710678,17.0710678 L9.11701829,15.7992422 C9.16488611,15.6507236 9.24739564,15.5157214 9.35773405,15.405383 L14.0458727,10.7172443 C14.3181556,10.4449615 14.7596133,10.4449615 15.0318962,10.7172443 C15.0352258,10.7205739 15.0385216,10.7239372 15.0417831,10.7273336 Z M13.2091945,11.5539226 L14.1948091,12.5803071 M11,3 L13,3 C14.1045695,3 15,3.8954305 15,5 C15,6.1045695 14.1045695,7 13,7 L11,7 C9.8954305,7 9,6.1045695 9,5 C9,3.8954305 9.8954305,3 11,3 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Suivi<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-2b9786eb-099a016\" class=\"collapse \" aria-labelledby=\"headingpix-tab-2b9786eb-099a016\">\n                 <div class=\"card-body\"><p class=\"p1\"><span class=\"s1\">Modalit\u00e9s<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li2\">IRM<\/li>\n<\/ul>\n<p class=\"p2\">S\u00e9quences T2, FLAIR 3D (tumeur, \u0153d\u00e8me, d\u00e9my\u00e9linisation)<\/p>\n<p class=\"p2\">S\u00e9quences T1 volumiques (r\u00e9f\u00e9rence, h\u00e9morragie)<\/p>\n<p class=\"p2\">S\u00e9quences 3D T1 gado volumiques (r\u00e9actions post radiques)<\/p>\n<ul class=\"ul1\">\n<li class=\"li2\">PET IRM DOPA<\/li>\n<\/ul>\n<p class=\"p2\">Si doute diagnostique entre progression tumorale et r\u00e9action post radique<\/p>\n<ul class=\"ul1\">\n<li class=\"li2\">S\u00e9quences IRM<span class=\"Apple-converted-space\">\u00a0 <\/span>diffusion \u2013perfusion<\/li>\n<\/ul>\n<p class=\"p2\">Autant que de besoin, si doute diagnostique<\/p>\n<p class=\"p1\"><span class=\"s1\">Rythme et dur\u00e9e<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li2\">Tous les 3 mois pendant 2 ans<\/li>\n<li class=\"li2\">Discuter en RCP \u00e0 2 ans l\u2019espacement \/ 6 mois en fonction de la r\u00e9ponse c\u00e9r\u00e9brale et extra-c\u00e9r\u00e9brale<\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Efficacit\u00e9<\/span><\/p>\n<p class=\"p2\">Taille identique ou diminution<\/p>\n<p class=\"p2\">Pas d\u2019augmentation de la prise de contraste (en dehors d\u2019une augmentation transitoire entre 3 et 6 mois post RC)<\/p>\n<p class=\"p1\"><span class=\"s1\">R\u00e9cidive<\/span><\/p>\n<p class=\"p2\">Augmentation continue de volume<\/p>\n<p class=\"p2\">Prise de contraste <span class=\"s1\">homog\u00e8ne<\/span> de la progression en IRM<\/p>\n<p class=\"p2\">PET-IRM DOPA en cas de doute (valeur si<span class=\"Apple-converted-space\">\u00a0 <\/span>hyperm\u00e9tabolisme tr\u00e8s franc)<\/p>\n<p class=\"p1\"><span class=\"s1\">Complications<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li2\">R\u00e9action parenchymateuse post radique (cf)<\/li>\n<li class=\"li2\">H\u00e9morragie<\/li>\n<li class=\"li2\">Clinique<\/li>\n<\/ul>\n<\/div>\n               <\/div>\n             <\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-13bb5af elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"13bb5af\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-027df65\" data-id=\"027df65\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4573cca elementor-widget elementor-widget-pix-heading\" data-id=\"4573cca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div  class=\"pix-heading-el text-left \"><h3 class=\"text-gradient-primary font-weight-bold h3 heading-text el-title_custom_color mb-12\" style=\"\" data-anim-type=\"\" data-anim-delay=\"\">Chordomes<\/h3><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8736298 elementor-widget elementor-widget-pix-text\" data-id=\"8736298\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"pix-el-text w-100 text-left \" ><p class=\"text-18 resp-option text-dark-opacity-5 text-left \" >Protocoles de prise en charge pour les chordomes<\/p><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ed5f762 elementor-widget elementor-widget-pix-button\" data-id=\"ed5f762\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<a href=\"https:\/\/www.neurochirurgie-lariboisiere.com\/chirurgie-de-la-base-du-crane\/chordome\/\" class=\"btn m-0      btn-outline-primary-light d-inline-flex align-items-center      btn-normal\" target=\"_blank\" rel=\"noopener\"><svg class=\"pixfort-icon font-weight-bold   mr-2\" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-earth-3\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C16.9705627,21 21,16.9705627 21,12 C21,7.02943725 16.9705627,3 12,3 C7.02943725,3 3,7.02943725 3,12 C3,16.9705627 7.02943725,21 12,21 Z M12,21 C7.47197168,16.2704727 5.91768618,9.00161626 12,3 M12,21 C16.0711325,17.5286447 18.4630656,8.77285509 12,3 M3.5,12 L20.5,12\"\/><\/svg><span class=\"font-weight-bold \" >En savoir plus - Site Neurochirurgie<\/span><\/a>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-0855939\" data-id=\"0855939\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3be6416 elementor-widget elementor-widget-pix-accordion\" data-id=\"3be6416\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"accordion w-100 accordion-card\" id=\"accordion-3be6416\"><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-3be6416-972f147\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-3be6416-972f147\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-3be6416-972f147\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-statistics-board-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M19.5,3 L4.5,3 C3.67157288,3 3,3.67157288 3,4.5 L3,15.5 C3,16.3284271 3.67157288,17 4.5,17 L19.5,17 C20.3284271,17 21,16.3284271 21,15.5 L21,4.5 C21,3.67157288 20.3284271,3 19.5,3 Z M6,14 L6,9 M9,14 L9,12 M12,14 L12,6 M15,14 L15,9 M12,17 L8,21 M12,17 L17,21 M18,14 L18,11\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indications<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-3be6416-972f147\" class=\"collapse \" aria-labelledby=\"headingpix-tab-3be6416-972f147\">\n                 <div class=\"card-body\"><p class=\"p1\">Par d\u00e9faut, le protocole de traitement d\u2019un chordome est une r\u00e9section neurochirurgicale maximale et une irradiation post-op\u00e9ratoire par protonth\u00e9rapie sur le foyer op\u00e9ratoire et la voie d\u2019abord.<\/p>\n<p class=\"p1\">Dans certains cas particuliers, la radiochirurgie (RC) ou plus souvent la radioth\u00e9rapie st\u00e9r\u00e9otaxique hypofractionn\u00e9e (RTHF) pourra \u00eatre indiqu\u00e9e, \u00e0 discuter syst\u00e9matiquement en RCP et dans les situations suivantes :<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> D\u2019EMBLEE Zone non trait\u00e9e Petit volume () Distance suffisante par rapport aux structures critiques <span class=\"s1\">\u2610<\/span> RECIDIVE APRES PROTONTHERAPIE Volume limit\u00e9 () D\u00e9lai par rapport \u00e0 la protonth\u00e9rapie (entre 10 et 20 ans apr\u00e8s protonth\u00e9rapie (selon les \u00e9quipes), il est possible de rediscuter une irradiation \u00e0 pleine dose, facteur d\u2019oubli entre 0.5%\/ et 1%\/ an.) Distance \/ OAR ()<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> POST OPERATOIRE D\u2019EMBLEE Sur un volume tr\u00e8s limit\u00e9 () Distance suffisante par rapport aux structures critiques ()<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> RECURRENCE POST OPERATOIRE (autre localisation) Petit volume, dont la valeur d\u00e9pendra de la localisation<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-3be6416-a4718a3\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-3be6416-a4718a3\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-3be6416-a4718a3\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-fast-thinking-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M3.43669391,17.5647941 C5.19699693,15.8549314 7.38476562,15 10,15 C12.6152344,15 14.8030031,15.8549314 16.5633061,17.5647941 C17.3559904,18.334031 17.3749542,19.6002189 16.6056898,20.3928765 C16.2295031,20.7805029 15.7125211,20.9994841 15.1723633,21 L4.82763672,21 C3.72306772,20.9989459 2.82849139,20.1026621 2.82954457,18.9980931 C2.83005959,18.4579353 3.04904073,17.9409532 3.43669391,17.5647941 Z M10,12 C12.209139,12 14,10.209139 14,8 C14,5.790861 12.209139,4 10,4 C7.790861,4 6,5.790861 6,8 C6,10.209139 7.790861,12 10,12 Z M18.5,7.5 L16,12 L18.5,12 L18.5,15.5 L21,11 L18.5,11 L18.5,7.5 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Traitement<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-3be6416-a4718a3\" class=\"collapse \" aria-labelledby=\"headingpix-tab-3be6416-a4718a3\">\n                 <div class=\"card-body\"><p class=\"p1\">Modalit\u00e9s<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Cyberknife ou autre LINAC (rachis)<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> ZAP-X (cranio-cervical) <span class=\"s1\">\u2610<\/span> 1 fraction si petit volume (tumeur hypoxique) Imagerie : T2 STIR, T2 volumique, T1 gadolinium Dosim\u00e9trie , 5 fractions la plupart du temps<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Doses<\/p>\n<p class=\"p1\">1 fraction\u00a0: 18-24 Gy<\/p>\n<p class=\"p1\">5 fractions\u00a0: 40 Gy (5x8 Gy)<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-3be6416-18eea64\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-3be6416-18eea64\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-3be6416-18eea64\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-clipboard-edit-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M15,5 L17,5 C18.1045695,5 19,5.8954305 19,7 L19,19 C19,20.1045695 18.1045695,21 17,21 L7,21 C5.8954305,21 5,20.1045695 5,19 L5,7 C5,5.8954305 5.8954305,5 7,5 L9,5 L9,5 M15.0417831,10.7273336 C15.3155532,11.0124282 15.3109771,11.4641391 15.0314873,11.7436288 L10.3437661,16.4313501 C10.233161,16.5419552 10.0977768,16.6245928 9.94884481,16.6724075 L8.70710678,17.0710678 L8.70710678,17.0710678 L9.11701829,15.7992422 C9.16488611,15.6507236 9.24739564,15.5157214 9.35773405,15.405383 L14.0458727,10.7172443 C14.3181556,10.4449615 14.7596133,10.4449615 15.0318962,10.7172443 C15.0352258,10.7205739 15.0385216,10.7239372 15.0417831,10.7273336 Z M13.2091945,11.5539226 L14.1948091,12.5803071 M11,3 L13,3 C14.1045695,3 15,3.8954305 15,5 C15,6.1045695 14.1045695,7 13,7 L11,7 C9.8954305,7 9,6.1045695 9,5 C9,3.8954305 9.8954305,3 11,3 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Suivi<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-3be6416-18eea64\" class=\"collapse \" aria-labelledby=\"headingpix-tab-3be6416-18eea64\">\n                 <div class=\"card-body\"><p class=\"p1\">Modalit\u00e9s<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> IRM S\u00e9quences T2\/ FLAIR axiales et volumiques (tumeur, \u0153d\u00e8me, d\u00e9my\u00e9linisation) S\u00e9quences T1 volumiques (r\u00e9f\u00e9rence, h\u00e9morragie) S\u00e9quences T1 gado volumiques (r\u00e9actions post radiques) S\u00e9quences T2 DIXON ou STIR (visualisation du chordome)<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> PET F18 FDG \u00e0 1 an de l\u2019irradiation PET IRM \u00e0 la Dopa si suspicion de radion\u00e9crose<\/p>\n<p class=\"p1\">Rythme et dur\u00e9e<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Tous les 4 mois pendant 2 ans<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Puis tous les 6 mois pendant 3 ans<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Puis tous les 12 mois \u00e0 vie (Rapprocher \u00e9ventuellement le suivi si tumeur agressive)<\/p>\n<p class=\"p1\">Efficacit\u00e9<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Taille identique ou diminution<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Parfois augmentation transitoire au d\u00e9but, avec n\u00e9crose centrale R\u00e9cidive<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Augmentation continue de volume<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Pas de RP<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> PET-IRM Dopa en cas de doute Complications<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> RP (CF) <span class=\"s1\">\u2610<\/span> H\u00e9morragie <span class=\"s1\">\u2610<\/span> Clinique<\/p>\n<p class=\"p1\">\n<\/div>\n               <\/div>\n             <\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b445494 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b445494\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-00a2638\" data-id=\"00a2638\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fdcdd29 elementor-widget elementor-widget-pix-heading\" data-id=\"fdcdd29\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div  class=\"pix-heading-el text-left \"><h3 class=\"text-gradient-primary font-weight-bold h3 heading-text el-title_custom_color mb-12\" style=\"\" data-anim-type=\"\" data-anim-delay=\"\">M\u00e9ningiomes<\/h3><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-11ba07d elementor-widget elementor-widget-pix-text\" data-id=\"11ba07d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"pix-el-text w-100 text-left \" ><p class=\"resp-option text-left \"><p class=\"p1\">Un m\u00e9ningiome est une tumeur qui se d\u00e9veloppe \u00e0 partir des m\u00e9ninges.<\/p><\/p><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d00e325 elementor-widget elementor-widget-pix-button\" data-id=\"d00e325\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<a href=\"https:\/\/www.neurochirurgie-lariboisiere.com\/chirurgie-de-la-base-du-crane\/meningiome\/\" class=\"btn m-0      btn-outline-primary-light d-inline-flex align-items-center      btn-normal\" target=\"_blank\" rel=\"noopener\"><svg class=\"pixfort-icon font-weight-bold   mr-2\" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-earth-3\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C16.9705627,21 21,16.9705627 21,12 C21,7.02943725 16.9705627,3 12,3 C7.02943725,3 3,7.02943725 3,12 C3,16.9705627 7.02943725,21 12,21 Z M12,21 C7.47197168,16.2704727 5.91768618,9.00161626 12,3 M12,21 C16.0711325,17.5286447 18.4630656,8.77285509 12,3 M3.5,12 L20.5,12\"\/><\/svg><span class=\"font-weight-bold \" >En savoir plus - Site Neurochirurgie<\/span><\/a>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-90b3d4f\" data-id=\"90b3d4f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f379b6e elementor-widget elementor-widget-pix-accordion\" data-id=\"f379b6e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"accordion w-100 accordion-card\" id=\"accordion-f379b6e\"><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-f379b6e-972f147\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-f379b6e-972f147\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-f379b6e-972f147\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-statistics-board-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M19.5,3 L4.5,3 C3.67157288,3 3,3.67157288 3,4.5 L3,15.5 C3,16.3284271 3.67157288,17 4.5,17 L19.5,17 C20.3284271,17 21,16.3284271 21,15.5 L21,4.5 C21,3.67157288 20.3284271,3 19.5,3 Z M6,14 L6,9 M9,14 L9,12 M12,14 L12,6 M15,14 L15,9 M12,17 L8,21 M12,17 L17,21 M18,14 L18,11\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indications<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-f379b6e-972f147\" class=\"collapse \" aria-labelledby=\"headingpix-tab-f379b6e-972f147\">\n                 <div class=\"card-body\"><p class=\"p1\">(pos\u00e9es en RCP et\/ou staff)<\/p>\n<p class=\"p1\">Petit volume (le volume acceptable d\u00e9pend de la localisation)<\/p>\n<p class=\"p1\">En alternative d\u2019un geste chirurgical quand il est \u00e9lev\u00e9<\/p>\n<p class=\"p1\">En compl\u00e9ment d\u2019un geste chirurgical lorsqu\u2019il reste un reliquat \u00e9volutif<\/p>\n<p class=\"p1\">En cas de r\u00e9cidive apr\u00e8s un geste chirurgical<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-f379b6e-a4718a3\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-f379b6e-a4718a3\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-f379b6e-a4718a3\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-fast-thinking-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M3.43669391,17.5647941 C5.19699693,15.8549314 7.38476562,15 10,15 C12.6152344,15 14.8030031,15.8549314 16.5633061,17.5647941 C17.3559904,18.334031 17.3749542,19.6002189 16.6056898,20.3928765 C16.2295031,20.7805029 15.7125211,20.9994841 15.1723633,21 L4.82763672,21 C3.72306772,20.9989459 2.82849139,20.1026621 2.82954457,18.9980931 C2.83005959,18.4579353 3.04904073,17.9409532 3.43669391,17.5647941 Z M10,12 C12.209139,12 14,10.209139 14,8 C14,5.790861 12.209139,4 10,4 C7.790861,4 6,5.790861 6,8 C6,10.209139 7.790861,12 10,12 Z M18.5,7.5 L16,12 L18.5,12 L18.5,15.5 L21,11 L18.5,11 L18.5,7.5 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Traitement<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-f379b6e-a4718a3\" class=\"collapse \" aria-labelledby=\"headingpix-tab-f379b6e-a4718a3\">\n                 <div class=\"card-body\"><p class=\"p1\">Modalit\u00e9s<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> 1 fraction si petit volume (le volume acceptable d\u00e9pend de la localisation)<\/p>\n<p class=\"p1\">Plusieurs fractions si volume important et\/ou proche de structures critiques<\/p>\n<p class=\"p1\">Imagerie : T2 FLAIR, T2 volumique, T1 gadolinium<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Doses<\/p>\n<p class=\"p1\">1 fraction\u00a0: 12-14 Gy (13 Gy le plus souvent)<\/p>\n<p class=\"p1\">3 fractions\u00a0: 19,5 Gy (3 x 6,5 Gy)<\/p>\n<p class=\"p1\">5 fractions\u00a0: 25 Gy (5 x 5 Gy)<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-f379b6e-18eea64\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-f379b6e-18eea64\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-f379b6e-18eea64\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-clipboard-edit-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M15,5 L17,5 C18.1045695,5 19,5.8954305 19,7 L19,19 C19,20.1045695 18.1045695,21 17,21 L7,21 C5.8954305,21 5,20.1045695 5,19 L5,7 C5,5.8954305 5.8954305,5 7,5 L9,5 L9,5 M15.0417831,10.7273336 C15.3155532,11.0124282 15.3109771,11.4641391 15.0314873,11.7436288 L10.3437661,16.4313501 C10.233161,16.5419552 10.0977768,16.6245928 9.94884481,16.6724075 L8.70710678,17.0710678 L8.70710678,17.0710678 L9.11701829,15.7992422 C9.16488611,15.6507236 9.24739564,15.5157214 9.35773405,15.405383 L14.0458727,10.7172443 C14.3181556,10.4449615 14.7596133,10.4449615 15.0318962,10.7172443 C15.0352258,10.7205739 15.0385216,10.7239372 15.0417831,10.7273336 Z M13.2091945,11.5539226 L14.1948091,12.5803071 M11,3 L13,3 C14.1045695,3 15,3.8954305 15,5 C15,6.1045695 14.1045695,7 13,7 L11,7 C9.8954305,7 9,6.1045695 9,5 C9,3.8954305 9.8954305,3 11,3 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Suivi<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-f379b6e-18eea64\" class=\"collapse \" aria-labelledby=\"headingpix-tab-f379b6e-18eea64\">\n                 <div class=\"card-body\"><p class=\"p1\">Modalit\u00e9s<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> IRM S\u00e9quences T2\/ FLAIR axiales et volumiques (tumeur, \u0153d\u00e8me, d\u00e9my\u00e9linisation) S\u00e9quences T1 volumiques (r\u00e9f\u00e9rence, h\u00e9morragie) S\u00e9quences T1 gado volumiques (r\u00e9actions post radiques)<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> PET IRM \u00e0 la Dopa si suspicion de radion\u00e9crose<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Bilan audiom\u00e9trique \/OPH autant que n\u00e9cessaire<\/p>\n<p class=\"p1\">Rythme et dur\u00e9e<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span>3,6 mois, puis annuel. L\u2019espacement se fait par la suite graduellement avec un suivi pendant au moins 15 ans<\/p>\n<\/div>\n               <\/div>\n             <\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-88e608d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"88e608d\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-8838023\" data-id=\"8838023\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e4dfa7c elementor-widget elementor-widget-pix-heading\" data-id=\"e4dfa7c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div  class=\"pix-heading-el text-left \"><h3 class=\"text-gradient-primary font-weight-bold h3 heading-text el-title_custom_color mb-12\" style=\"\" data-anim-type=\"\" data-anim-delay=\"\">Schwannomes<\/h3><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-23a2aa9 elementor-widget elementor-widget-pix-text\" data-id=\"23a2aa9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"pix-el-text w-100 text-left \" ><p class=\"text-20 resp-option text-dark-opacity-5 text-left \" >vestibulaires, foramen jugulaire, trijumeau<\/p><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3596855 elementor-widget elementor-widget-pix-button\" data-id=\"3596855\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<a href=\"https:\/\/www.neurochirurgie-lariboisiere.com\/chirurgie-de-la-base-du-crane\/neurinome-de-lacoustique\/\" class=\"btn m-0      btn-outline-primary-light d-inline-flex align-items-center      btn-normal\" target=\"_blank\" rel=\"noopener\"><svg class=\"pixfort-icon font-weight-bold   mr-2\" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-earth-3\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C16.9705627,21 21,16.9705627 21,12 C21,7.02943725 16.9705627,3 12,3 C7.02943725,3 3,7.02943725 3,12 C3,16.9705627 7.02943725,21 12,21 Z M12,21 C7.47197168,16.2704727 5.91768618,9.00161626 12,3 M12,21 C16.0711325,17.5286447 18.4630656,8.77285509 12,3 M3.5,12 L20.5,12\"\/><\/svg><span class=\"font-weight-bold \" >En savoir plus - Site Neurochirurgie<\/span><\/a>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-26f057c\" data-id=\"26f057c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2a120a5 elementor-widget elementor-widget-pix-accordion\" data-id=\"2a120a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"accordion w-100 accordion-card\" id=\"accordion-2a120a5\"><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-2a120a5-972f147\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-2a120a5-972f147\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-2a120a5-972f147\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-statistics-board-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M19.5,3 L4.5,3 C3.67157288,3 3,3.67157288 3,4.5 L3,15.5 C3,16.3284271 3.67157288,17 4.5,17 L19.5,17 C20.3284271,17 21,16.3284271 21,15.5 L21,4.5 C21,3.67157288 20.3284271,3 19.5,3 Z M6,14 L6,9 M9,14 L9,12 M12,14 L12,6 M15,14 L15,9 M12,17 L8,21 M12,17 L17,21 M18,14 L18,11\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indications<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-2a120a5-972f147\" class=\"collapse \" aria-labelledby=\"headingpix-tab-2a120a5-972f147\">\n                 <div class=\"card-body\"><p class=\"p1\">(pos\u00e9es en RCP et\/ou staff)<\/p>\n<p class=\"p1\">Petit volume (d\u00e9pend de la localisation et de la proximit\u00e9 des structures critiques)<\/p>\n<p class=\"p1\">En alternative d\u2019un geste chirurgical quand il est \u00e9lev\u00e9<\/p>\n<p class=\"p1\">En compl\u00e9ment d\u2019un geste chirurgical lorsqu\u2019il reste un reliquat \u00e9volutif<\/p>\n<p class=\"p1\">En cas de r\u00e9cidive apr\u00e8s un geste chirurgical<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-2a120a5-a4718a3\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-2a120a5-a4718a3\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-2a120a5-a4718a3\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-fast-thinking-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M3.43669391,17.5647941 C5.19699693,15.8549314 7.38476562,15 10,15 C12.6152344,15 14.8030031,15.8549314 16.5633061,17.5647941 C17.3559904,18.334031 17.3749542,19.6002189 16.6056898,20.3928765 C16.2295031,20.7805029 15.7125211,20.9994841 15.1723633,21 L4.82763672,21 C3.72306772,20.9989459 2.82849139,20.1026621 2.82954457,18.9980931 C2.83005959,18.4579353 3.04904073,17.9409532 3.43669391,17.5647941 Z M10,12 C12.209139,12 14,10.209139 14,8 C14,5.790861 12.209139,4 10,4 C7.790861,4 6,5.790861 6,8 C6,10.209139 7.790861,12 10,12 Z M18.5,7.5 L16,12 L18.5,12 L18.5,15.5 L21,11 L18.5,11 L18.5,7.5 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Traitement<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-2a120a5-a4718a3\" class=\"collapse \" aria-labelledby=\"headingpix-tab-2a120a5-a4718a3\">\n                 <div class=\"card-body\"><p class=\"p1\">Modalit\u00e9s<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> 1 fraction si petit volume (le volume acceptable d\u00e9pend de la localisation)<\/p>\n<p class=\"p1\">Plusieurs fractions si volume important et\/ou proche de structures critiques<\/p>\n<p class=\"p1\">Imagerie : T2 FLAIR, T2 volumique, T1 gadolinium<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Doses<\/p>\n<p class=\"p1\">1 fraction\u00a0: 12-14 Gy (13 Gy le plus souvent)<\/p>\n<p class=\"p1\">3 fractions\u00a0: 19,5 Gy (3 x 6,5 Gy)<\/p>\n<p class=\"p1\">5 fractions (rarement utilis\u00e9)\u00a0: 25 Gy (5 x 5 Gy)<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-2a120a5-18eea64\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-2a120a5-18eea64\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-2a120a5-18eea64\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-clipboard-edit-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M15,5 L17,5 C18.1045695,5 19,5.8954305 19,7 L19,19 C19,20.1045695 18.1045695,21 17,21 L7,21 C5.8954305,21 5,20.1045695 5,19 L5,7 C5,5.8954305 5.8954305,5 7,5 L9,5 L9,5 M15.0417831,10.7273336 C15.3155532,11.0124282 15.3109771,11.4641391 15.0314873,11.7436288 L10.3437661,16.4313501 C10.233161,16.5419552 10.0977768,16.6245928 9.94884481,16.6724075 L8.70710678,17.0710678 L8.70710678,17.0710678 L9.11701829,15.7992422 C9.16488611,15.6507236 9.24739564,15.5157214 9.35773405,15.405383 L14.0458727,10.7172443 C14.3181556,10.4449615 14.7596133,10.4449615 15.0318962,10.7172443 C15.0352258,10.7205739 15.0385216,10.7239372 15.0417831,10.7273336 Z M13.2091945,11.5539226 L14.1948091,12.5803071 M11,3 L13,3 C14.1045695,3 15,3.8954305 15,5 C15,6.1045695 14.1045695,7 13,7 L11,7 C9.8954305,7 9,6.1045695 9,5 C9,3.8954305 9.8954305,3 11,3 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Suivi<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-2a120a5-18eea64\" class=\"collapse \" aria-labelledby=\"headingpix-tab-2a120a5-18eea64\">\n                 <div class=\"card-body\"><p class=\"p1\">Modalit\u00e9s<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> IRM S\u00e9quences T2\/ FLAIR axiales et volumiques (tumeur, \u0153d\u00e8me, d\u00e9my\u00e9linisation) S\u00e9quences T1 volumiques (r\u00e9f\u00e9rence, h\u00e9morragie) S\u00e9quences T1 gado volumiques (r\u00e9actions post radiques)<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> PET IRM \u00e0 la Dopa si suspicion de radion\u00e9crose<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span> Bilan audiom\u00e9trique tonal et vocal \u00e0 chacune des consultations<\/p>\n<p class=\"p1\">Rythme et dur\u00e9e<\/p>\n<p class=\"p1\"><span class=\"s1\">\u2610<\/span>3,6 mois, puis annuel. L\u2019espacement se fait par la suite graduellement avec un suivi pendant au moins 15 ans<\/p>\n<\/div>\n               <\/div>\n             <\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-efd15fa elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"efd15fa\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7ed5cea\" data-id=\"7ed5cea\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-28c6717 elementor-widget elementor-widget-pix-heading\" data-id=\"28c6717\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div  class=\"pix-heading-el text-left \"><h3 class=\"text-gradient-primary font-weight-bold h3 heading-text el-title_custom_color mb-12\" style=\"\" data-anim-type=\"\" data-anim-delay=\"\">Malformations arterioveineuses cerebrales<\/h3><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6c17c87 elementor-widget elementor-widget-pix-text\" data-id=\"6c17c87\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"pix-el-text w-100 text-left \" ><p class=\"text-20 resp-option text-dark-opacity-5 text-left \" >Protocoles de prise en charge<\/p><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d9059e1 elementor-widget elementor-widget-pix-button\" data-id=\"d9059e1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<a href=\"https:\/\/www.neurochirurgie-lariboisiere.com\/chirurgie-de-la-base-du-crane\/neurinome-de-lacoustique\/\" class=\"btn m-0      btn-outline-primary-light d-inline-flex align-items-center      btn-normal\" target=\"_blank\" rel=\"noopener\"><svg class=\"pixfort-icon font-weight-bold   mr-2\" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-earth-3\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C16.9705627,21 21,16.9705627 21,12 C21,7.02943725 16.9705627,3 12,3 C7.02943725,3 3,7.02943725 3,12 C3,16.9705627 7.02943725,21 12,21 Z M12,21 C7.47197168,16.2704727 5.91768618,9.00161626 12,3 M12,21 C16.0711325,17.5286447 18.4630656,8.77285509 12,3 M3.5,12 L20.5,12\"\/><\/svg><span class=\"font-weight-bold \" >En savoir plus - Site Neurochirurgie<\/span><\/a>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-d1a28b2\" data-id=\"d1a28b2\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-acad2c2 elementor-widget elementor-widget-pix-accordion\" data-id=\"acad2c2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"accordion w-100 accordion-card\" id=\"accordion-acad2c2\"><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-acad2c2-972f147\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-acad2c2-972f147\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-acad2c2-972f147\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-bookmark-5\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C9,19.38 6,18.9875 3,20 L3,6 C3.99903488,5.46052116 4.99806976,5.16806482 5.99710464,5.05532623 M18.0014259,5.05516054 C19.0009506,5.16777811 20.0004753,5.46025667 21,6 L21,20 C18,18.9875 15,19.38 12,21 M12,6 C12.6125869,4.3601317 14.6125869,3.3601317 18,3 L18,17 C14.4375312,17.4017205 12.4375312,18.7350538 12,21 L12,6 Z M12,6 C11.3874131,4.3601317 9.38741307,3.3601317 6,3 L6,17 C9.56246879,17.4017205 11.5624688,18.7350538 12,21\" transform=\"matrix(-1 0 0 1 24 0)\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indications et Prise en charge<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-acad2c2-972f147\" class=\"collapse \" aria-labelledby=\"headingpix-tab-acad2c2-972f147\">\n                 <div class=\"card-body\"><p class=\"p1\">(pos\u00e9es en RCP et\/ou staff)<\/p>\n<p class=\"p1\">Petit volume (d\u00e9pend de la localisation et de la proximit\u00e9 des structures critiques)<\/p>\n<p class=\"p1\">En alternative d\u2019un geste chirurgical quand il est \u00e9lev\u00e9<\/p>\n<p class=\"p1\">En compl\u00e9ment d\u2019un geste chirurgical lorsqu\u2019il reste un reliquat \u00e9volutif<\/p>\n<p class=\"p1\">En cas de r\u00e9cidive apr\u00e8s un geste chirurgical<\/p>\n<p>Principes:\u00a0<\/p>\n<p class=\"p1\">Tous les sch\u00e9mas th\u00e9rapeutiques sont possibles (traitements combin\u00e9s)<\/p>\n<p class=\"p1\">La strat\u00e9gie de traitement doit \u00eatre si possible discut\u00e9e en RCP en amont<\/p>\n<p class=\"p2\"><span class=\"s1\"><b>Indications de radiochirurgie monofractionn\u00e9e (MAV non trait\u00e9e ou reliquat)<\/b><\/span>\u00a0:<\/p>\n<p class=\"p1\">Lors de la RCP, discussion de l\u2019indication de RC d\u2019embl\u00e9e ou combin\u00e9e \u00e0 d\u2019autres traitements (+\/-embolisation +\/- chirurgie)<\/p>\n<p class=\"p1\">Indications pr\u00e9f\u00e9rentielles\u00a0:<\/p>\n<p class=\"p1\">MAV rompue (valeur des s\u00e9quences IRM T2*, MAV non rompue \u00e0 discuter en RCP)<\/p>\n<p class=\"p1\">Taille \/ volume petit-moyen (le volume acceptable s\u2019appr\u00e9ciera en fonction de la topographie. Un petit volume en radiochirurgie des MAV est de l\u2019ordre de 1-2cc, moyen 2-3 cc, grand &gt; 3cc mais cela est tr\u00e8s indicatif et d\u00e9pendant de la localisation<\/p>\n<p class=\"p1\">Topographie (fonctionnelle ou pas\u00a0: avec une distance de s\u00e9curit\u00e9 suffisante par rapport aux zones fonctionnelles [voies optiques, tronc c\u00e9r\u00e9bral, faisceau pyramidal, cochl\u00e9e trigone], localisation en plein parenchyme)<\/p>\n<p class=\"p1\">Vitesse circulatoire relativement lente \/ taille des shunts de petit calibre (appr\u00e9ci\u00e9e sur l\u2019angiographie 3D)<\/p>\n<p class=\"p1\">Pas de facteur de risque h\u00e9morragique \u00e0 court terme (an\u00e9vrysme intra\/paranidal)<\/p>\n<p class=\"p3\">Risque acceptable<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-acad2c2-18eea64\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-acad2c2-18eea64\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-acad2c2-18eea64\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-fast-thinking-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M3.43669391,17.5647941 C5.19699693,15.8549314 7.38476562,15 10,15 C12.6152344,15 14.8030031,15.8549314 16.5633061,17.5647941 C17.3559904,18.334031 17.3749542,19.6002189 16.6056898,20.3928765 C16.2295031,20.7805029 15.7125211,20.9994841 15.1723633,21 L4.82763672,21 C3.72306772,20.9989459 2.82849139,20.1026621 2.82954457,18.9980931 C2.83005959,18.4579353 3.04904073,17.9409532 3.43669391,17.5647941 Z M10,12 C12.209139,12 14,10.209139 14,8 C14,5.790861 12.209139,4 10,4 C7.790861,4 6,5.790861 6,8 C6,10.209139 7.790861,12 10,12 Z M18.5,7.5 L16,12 L18.5,12 L18.5,15.5 L21,11 L18.5,11 L18.5,7.5 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Traitement<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-acad2c2-18eea64\" class=\"collapse \" aria-labelledby=\"headingpix-tab-acad2c2-18eea64\">\n                 <div class=\"card-body\"><p class=\"p1\">Cible (contourage)\u00a0: nidus + collecteurs veineux<\/p>\n<p class=\"p1\">En premier sur l\u2019angiographie 3D sans zoom, sans et avec soustraction<\/p>\n<p class=\"p2\">Ensuite sur l\u2019IRM qui sert \u00e0 minimiser le volume en excluant toute irradiation de parenchyme c\u00e9r\u00e9bral<\/p>\n<p class=\"p2\">Pas de marge\u00a0: CTV=PTV<\/p>\n<p class=\"p1\">Dose\u00a0: 20-22 Gy en fonction du volume et de la topographie<\/p>\n<p class=\"p1\">Isodose de prescription\u00a0: habituellement 70 \u00e0 95%, la plus conformationnelle sera choisie<\/p>\n<p class=\"p1\">L\u2019indice de conformit\u00e9 est prioritaire par rapport \u00e0 l\u2019indice d\u2019homog\u00e9n\u00e9it\u00e9<\/p>\n<p class=\"p1\">L\u2019indice de Paddick tient compte des diff\u00e9rents param\u00e8tres et doit tendre, autant que possible, vers 1<\/p>\n<p class=\"p1\">Fractionnement\u00a0: monofractionn\u00e9<\/p>\n<p class=\"p1\">Zones critiques\u00a0:<\/p>\n<table class=\"t1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td class=\"td1\" valign=\"top\">\n<p class=\"p3\">Nombre de fractions<\/p>\n<\/td>\n<td class=\"td2\" valign=\"top\">\n<p class=\"p4\">Dose totale<\/p>\n<\/td>\n<td class=\"td3\" valign=\"top\">\n<p class=\"p4\">Volume cible<\/p>\n<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p4\">Structures critiques<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td5\" valign=\"top\">\n<p class=\"p4\">1<\/p>\n<\/td>\n<td class=\"td6\" valign=\"top\">\n<p class=\"p4\">20-22 Gy<\/p>\n<\/td>\n<td class=\"td7\" valign=\"top\">\n<p class=\"p4\">CTV\u00a0= PTV (pas de marge)<\/p>\n<\/td>\n<td class=\"td8\" valign=\"top\">\n<p class=\"p4\">Voies optiques &lt; 8 Gy<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\u00a0<\/td>\n<td class=\"td2\" valign=\"top\">\u00a0<\/td>\n<td class=\"td3\" valign=\"top\">\u00a0<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p4\">Tronc &lt; 12 Gy<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td9\" valign=\"top\">\u00a0<\/td>\n<td class=\"td10\" valign=\"top\">\u00a0<\/td>\n<td class=\"td11\" valign=\"top\">\u00a0<\/td>\n<td class=\"td12\" valign=\"top\">\n<p class=\"p4\">Faisceau pyramidal &lt; 10=11 Gy<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\u00a0<\/td>\n<td class=\"td2\" valign=\"top\">\u00a0<\/td>\n<td class=\"td3\" valign=\"top\">\u00a0<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p4\">Cochl\u00e9e &lt; 4 Gy<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td class=\"td1\" valign=\"top\">\u00a0<\/td>\n<td class=\"td2\" valign=\"top\">\u00a0<\/td>\n<td class=\"td3\" valign=\"top\">\u00a0<\/td>\n<td class=\"td4\" valign=\"top\">\n<p class=\"p4\">Trigone &lt; 8 Gy<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"p1\">Traitement en \u00ab\u00a0staged\u00a0\u00bb<\/p>\n<p class=\"p1\">La MAV est divis\u00e9e en sous-volumes cibles sur la base des diff\u00e9rents compartiments individualis\u00e9s par cath\u00e9t\u00e9risme hypers\u00e9lectif.<\/p>\n<p class=\"p1\">Le planning pr\u00e9visionnel est \u00e9tabli d\u00e8s le d\u00e9but avec l\u2019ordre de traitement des diff\u00e9rents sous-volumes cibles<\/p>\n<p class=\"p7\">Chaque cible est irradi\u00e9e en monofractionn\u00e9 avec un d\u00e9lai de 6 mois entre chaque cible<\/p>\n<p class=\"p8\">A chaque nouvelle irradiation, une angiographie 3D est r\u00e9alis\u00e9e pour ajuster le volume r\u00e9el \u00e0 traiter par rapport au volume pr\u00e9visionnel<\/p>\n<p class=\"p8\">La dose est choisie de fa\u00e7on multidisciplinaire pour chacun des sous-volumes cibles, proche de la dose qui serait d\u00e9livr\u00e9e si le sous-volume \u00e9tait unique (18-22 Gy)<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-acad2c2-72eeed4\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-acad2c2-72eeed4\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-acad2c2-72eeed4\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-check-badge-3\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M11.0827833,19.8637958 L8.76718111,20.2959104 C7.07702893,20.6113098 5.45120814,19.4968525 5.13580875,17.8067003 C5.12537313,17.7507782 5.11647231,17.6945806 5.1091163,17.6381708 L4.80452132,15.3023714 C4.72477567,14.6908386 4.53258465,14.0993354 4.23765024,13.5577216 L3.11112435,11.4889838 C2.28887596,9.97901736 2.84638162,8.08838365 4.35634809,7.26613526 C4.40630836,7.23892952 4.45700496,7.21309832 4.50838077,7.18867074 L6.63573294,6.17718201 C7.1926925,5.91236533 7.6958551,5.54679631 8.11982069,5.09892914 L9.73919161,3.38826421 C10.9211663,2.13965422 12.8915446,2.08563566 14.1401546,3.26761039 C14.1814673,3.3067184 14.2217004,3.34695144 14.2608084,3.38826421 L15.8801793,5.09892914 C16.3041449,5.54679631 16.8073075,5.91236533 17.3642671,6.17718201 L19.4916192,7.18867074 C21.0443682,7.9269538 21.7046232,9.78420221 20.9663402,11.3369512 C20.9419126,11.388327 20.9160814,11.4390236 20.8888757,11.4889838 L19.7623498,13.5577216 C19.4674153,14.0993354 19.2752243,14.6908386 19.1954787,15.3023714 L18.8908837,17.6381708 C18.6685606,19.3430648 17.1062424,20.544926 15.4013484,20.3226029 C15.3449386,20.3152469 15.288741,20.3063461 15.2328189,20.2959104 L12.9172167,19.8637958 C12.3109716,19.7506644 11.6890284,19.7506644 11.0827833,19.8637958 Z M9,12 L11,14 L15,10\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Suivi<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-acad2c2-72eeed4\" class=\"collapse \" aria-labelledby=\"headingpix-tab-acad2c2-72eeed4\">\n                 <div class=\"card-body\"><p class=\"p1\"><b>Modalit\u00e9s\u00a0: <\/b><\/p>\n<p class=\"p2\">Clinique\u00a0: annuel<\/p>\n<p class=\"p2\">IRM\u00a0: annuelle, au minimum s\u00e9quences FLAIR,T2* 3D gado, ASL, +\/- TRICKS, +\/-3D TOF<\/p>\n<p class=\"p2\">Art\u00e9riographie c\u00e9r\u00e9brale\u00a0: en fonction et au choix de l\u2019\u00e9quipe qui adresse le patient\u00a0<\/p>\n<p class=\"p2\">Soit\u00a0: angiographie annuelle, tant que la MAV se modifie<\/p>\n<p class=\"p2\">Soit angiographie d\u00e8s que l\u2019ASL se normalise en IRM<\/p>\n<p class=\"p2\">Soit syst\u00e9matique \u00e0 5 ans<\/p>\n<p class=\"p3\"><b>Dur\u00e9e de suivi\u00a0:<\/b> suivi \u00e0 long terme souhaitable\u00a0(au minimum \u00e0 10 ans de la RC)<\/p>\n<p class=\"p2\">IRM syst\u00e9matique\u00a0: FLAIR, 3D gado, ASL<\/p>\n<p class=\"p2\">Angiographie souhaitable, \u00e0 discuter en fonction de l\u2019\u00e9quipe qui adresse le patient<\/p>\n<\/div>\n               <\/div>\n             <\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c731cea elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c731cea\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-96bfe9f\" data-id=\"96bfe9f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-81c505a elementor-widget elementor-widget-pix-heading\" data-id=\"81c505a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div  class=\"pix-heading-el text-left \"><h3 class=\"text-gradient-primary font-weight-bold h3 heading-text el-title_custom_color mb-12\" style=\"\" data-anim-type=\"\" data-anim-delay=\"\">Nevralgie du trijumeau<\/h3><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-792d1ad elementor-widget elementor-widget-pix-text\" data-id=\"792d1ad\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"pix-el-text w-100 text-left \" ><p class=\"text-20 resp-option text-dark-opacity-5 text-left \" >Protocoles de prise en charge<\/p><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8c82aa9 elementor-widget elementor-widget-pix-button\" data-id=\"8c82aa9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<a href=\"https:\/\/www.neurochirurgie-lariboisiere.com\/chirurgie-de-la-douleur\/nevralgie-du-trijumeau\/\" class=\"btn m-0      btn-outline-primary-light d-inline-flex align-items-center      btn-normal\" target=\"_blank\" rel=\"noopener\"><svg class=\"pixfort-icon font-weight-bold   mr-2\" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-earth-3\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C16.9705627,21 21,16.9705627 21,12 C21,7.02943725 16.9705627,3 12,3 C7.02943725,3 3,7.02943725 3,12 C3,16.9705627 7.02943725,21 12,21 Z M12,21 C7.47197168,16.2704727 5.91768618,9.00161626 12,3 M12,21 C16.0711325,17.5286447 18.4630656,8.77285509 12,3 M3.5,12 L20.5,12\"\/><\/svg><span class=\"font-weight-bold \" >En savoir plus - Site Neurochirurgie<\/span><\/a>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-970472d\" data-id=\"970472d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-74acf13 elementor-widget elementor-widget-pix-accordion\" data-id=\"74acf13\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"accordion w-100 accordion-card\" id=\"accordion-74acf13\"><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-74acf13-972f147\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-74acf13-972f147\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-74acf13-972f147\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-statistics-board-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M19.5,3 L4.5,3 C3.67157288,3 3,3.67157288 3,4.5 L3,15.5 C3,16.3284271 3.67157288,17 4.5,17 L19.5,17 C20.3284271,17 21,16.3284271 21,15.5 L21,4.5 C21,3.67157288 20.3284271,3 19.5,3 Z M6,14 L6,9 M9,14 L9,12 M12,14 L12,6 M15,14 L15,9 M12,17 L8,21 M12,17 L17,21 M18,14 L18,11\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indication<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-74acf13-972f147\" class=\"collapse \" aria-labelledby=\"headingpix-tab-74acf13-972f147\">\n                 <div class=\"card-body\"><p class=\"p1\">(pos\u00e9es en RCP et\/ou staff)<\/p>\n<p class=\"p1\">Pas de conflit vasculo-nerveux ou indication chirurgicale r\u00e9cus\u00e9e en fonction de l\u2019\u00e2ge, du terrain..<\/p>\n<p class=\"p1\">Douleur r\u00e9sistante au traitement m\u00e9dical ou \u00e0 la thermocoagulation<\/p>\n<p class=\"p1\">Traitement m\u00e9dical mal support\u00e9<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-74acf13-a4718a3\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-74acf13-a4718a3\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-74acf13-a4718a3\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-information-circle-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C16.9705627,21 21,16.9705627 21,12 C21,7.02943725 16.9705627,3 12,3 C7.02943725,3 3,7.02943725 3,12 C3,16.9705627 7.02943725,21 12,21 Z M11.85,16.525 L11.85,16.975 L12.15,16.975 L12.15,16.525 L11.85,16.525 Z M12,7 L12,13.5 L12,13.5 L12,7 Z\" transform=\"matrix(1 0 0 -1 0 24)\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Modalit\u00e9s<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-74acf13-a4718a3\" class=\"collapse \" aria-labelledby=\"headingpix-tab-74acf13-a4718a3\">\n                 <div class=\"card-body\"><p class=\"p1\">Cible\u00a0: tronc du nerf trijumeau dans la citerne, cible minimale, \u00e0 distance du tronc c\u00e9r\u00e9bral<\/p>\n<p class=\"p1\">(alternative\u00a0: ganglion de Gasser o\u00f9 il existe une syst\u00e9matisation)<\/p>\n<p class=\"p1\">Monofractionn\u00e9<\/p>\n<p class=\"p1\">Dose \u00a0: l\u2019\u00e9l\u00e9ment important est la Dmax qui doit \u00eatre de 80 Gy, correspondant souvent \u00e0 une Dmin de 60 Gy<\/p>\n<p class=\"p1\">Contraintes sur le tronc c\u00e9r\u00e9bral (&lt; 12 Gy) et la cochl\u00e9e (&lt; 4 Gy)<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-74acf13-72eeed4\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-74acf13-72eeed4\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-74acf13-72eeed4\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-clipboard-edit-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M15,5 L17,5 C18.1045695,5 19,5.8954305 19,7 L19,19 C19,20.1045695 18.1045695,21 17,21 L7,21 C5.8954305,21 5,20.1045695 5,19 L5,7 C5,5.8954305 5.8954305,5 7,5 L9,5 L9,5 M15.0417831,10.7273336 C15.3155532,11.0124282 15.3109771,11.4641391 15.0314873,11.7436288 L10.3437661,16.4313501 C10.233161,16.5419552 10.0977768,16.6245928 9.94884481,16.6724075 L8.70710678,17.0710678 L8.70710678,17.0710678 L9.11701829,15.7992422 C9.16488611,15.6507236 9.24739564,15.5157214 9.35773405,15.405383 L14.0458727,10.7172443 C14.3181556,10.4449615 14.7596133,10.4449615 15.0318962,10.7172443 C15.0352258,10.7205739 15.0385216,10.7239372 15.0417831,10.7273336 Z M13.2091945,11.5539226 L14.1948091,12.5803071 M11,3 L13,3 C14.1045695,3 15,3.8954305 15,5 C15,6.1045695 14.1045695,7 13,7 L11,7 C9.8954305,7 9,6.1045695 9,5 C9,3.8954305 9.8954305,3 11,3 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Suivi<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-74acf13-72eeed4\" class=\"collapse \" aria-labelledby=\"headingpix-tab-74acf13-72eeed4\">\n                 <div class=\"card-body\"><p class=\"p1\">Conjoint avec l\u2019\u00e9quipe douleur<\/p>\n<p class=\"p1\">Modalit\u00e9s\u00a0: clinique + IRM FLAIR et 3D gado<\/p>\n<p class=\"p1\">Ryhtme\u00a0: 3, 6, 12 mois puis annuel<\/p>\n<p class=\"p1\">Dur\u00e9e\u00a0: minimum de 5 ans<\/p>\n<\/div>\n               <\/div>\n             <\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-853d199 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"853d199\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4ba454e\" data-id=\"4ba454e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9ba4bca elementor-widget elementor-widget-pix-heading\" data-id=\"9ba4bca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div  class=\"pix-heading-el text-left \"><h3 class=\"text-gradient-primary font-weight-bold h3 heading-text el-title_custom_color mb-12\" style=\"\" data-anim-type=\"\" data-anim-delay=\"\">Algies vasculaires de la face<\/h3><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7633d14 elementor-widget elementor-widget-pix-text\" data-id=\"7633d14\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"pix-el-text w-100 text-left \" ><p class=\"text-20 resp-option text-dark-opacity-5 text-left \" >Protocoles de prise en charge<\/p><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-b713aab\" data-id=\"b713aab\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0fa49f9 elementor-widget elementor-widget-pix-accordion\" data-id=\"0fa49f9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pix-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"accordion w-100 accordion-card\" id=\"accordion-0fa49f9\"><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-0fa49f9-972f147\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-0fa49f9-972f147\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-0fa49f9-972f147\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-lock-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M7,10 L17,10 C18.1045695,10 19,10.8954305 19,12 L19,19 C19,20.1045695 18.1045695,21 17,21 L7,21 C5.8954305,21 5,20.1045695 5,19 L5,12 C5,10.8954305 5.8954305,10 7,10 Z M8,10 L8,7 C8,4.790861 9.790861,3 12,3 C14.209139,3 16,4.790861 16,7 L16,10\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Indication<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-0fa49f9-972f147\" class=\"collapse \" aria-labelledby=\"headingpix-tab-0fa49f9-972f147\">\n                 <div class=\"card-body\"><p class=\"p1\">(pos\u00e9es en RCP et\/ou staff)<\/p>\n<p class=\"p1\">Douleur r\u00e9sistante au traitement m\u00e9dical<\/p>\n<p class=\"p1\">Pas de conflit vasculo-nerveux<\/p>\n<p class=\"p1\">Traitement m\u00e9dical mal support\u00e9<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-0fa49f9-a4718a3\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-0fa49f9-a4718a3\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-0fa49f9-a4718a3\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-information-circle-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M12,21 C16.9705627,21 21,16.9705627 21,12 C21,7.02943725 16.9705627,3 12,3 C7.02943725,3 3,7.02943725 3,12 C3,16.9705627 7.02943725,21 12,21 Z M11.85,16.525 L11.85,16.975 L12.15,16.975 L12.15,16.525 L11.85,16.525 Z M12,7 L12,13.5 L12,13.5 L12,7 Z\" transform=\"matrix(1 0 0 -1 0 24)\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Modalit\u00e9s<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-0fa49f9-a4718a3\" class=\"collapse \" aria-labelledby=\"headingpix-tab-0fa49f9-a4718a3\">\n                 <div class=\"card-body\"><p class=\"p1\">2 Cibles\u00a0:<\/p>\n<ul class=\"ul1\">\n<li class=\"li1\">tronc du nerf trijumeau dans la citerne, cible minimale, \u00e0 distance du tronc c\u00e9r\u00e9bral<\/li>\n<li class=\"li1\">ganglion sph\u00e9no-palatin dans la fosse pt\u00e9rygo-palatine<\/li>\n<\/ul>\n<p class=\"p1\">Monofractionn\u00e9<\/p>\n<p class=\"p1\">Dose \u00a0: l\u2019\u00e9l\u00e9ment important est la Dmax qui doit \u00eatre de 80 Gy pour chacune des cibles , correspondant souvent \u00e0 une Dmin de 60 Gy<\/p>\n<p class=\"p1\">Contraintes sur le tronc c\u00e9r\u00e9bral (&lt; 12 Gy) et la cochl\u00e9e (&lt; 4 Gy)<\/p>\n<\/div>\n               <\/div>\n             <\/div><div class=\"card\">\n               <div class=\"card-header pix-mb-10 shadow-sm rounded-lg bg-custom\" id=\"headingpix-tab-0fa49f9-72eeed4\" style=\"background:#F8F9FA !important\">\n                   <button class=\"btn btn-link d-flex text-left\" type=\"button\" data-toggle=\"collapse\" data-target=\"#collapsepix-tab-0fa49f9-72eeed4\" aria-expanded=\"true\" aria-controls=\"collapsepix-tab-0fa49f9-72eeed4\"><span class=\"d-inline-flex align-self-center text-primary svg-202 text-20 pix-mr-10\"><svg class=\"pixfort-icon \" width=\"24\" height=\"24\"  data-name=\"Line\/pixfort-icon-clipboard-edit-1\" viewBox=\"2 2 20 20\"><path fill=\"none\" stroke=\"var(--pf-icon-color)\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"var(--pf-icon-stroke-width)\" d=\"M15,5 L17,5 C18.1045695,5 19,5.8954305 19,7 L19,19 C19,20.1045695 18.1045695,21 17,21 L7,21 C5.8954305,21 5,20.1045695 5,19 L5,7 C5,5.8954305 5.8954305,5 7,5 L9,5 L9,5 M15.0417831,10.7273336 C15.3155532,11.0124282 15.3109771,11.4641391 15.0314873,11.7436288 L10.3437661,16.4313501 C10.233161,16.5419552 10.0977768,16.6245928 9.94884481,16.6724075 L8.70710678,17.0710678 L8.70710678,17.0710678 L9.11701829,15.7992422 C9.16488611,15.6507236 9.24739564,15.5157214 9.35773405,15.405383 L14.0458727,10.7172443 C14.3181556,10.4449615 14.7596133,10.4449615 15.0318962,10.7172443 C15.0352258,10.7205739 15.0385216,10.7239372 15.0417831,10.7273336 Z M13.2091945,11.5539226 L14.1948091,12.5803071 M11,3 L13,3 C14.1045695,3 15,3.8954305 15,5 C15,6.1045695 14.1045695,7 13,7 L11,7 C9.8954305,7 9,6.1045695 9,5 C9,3.8954305 9.8954305,3 11,3 Z\"\/><\/svg><\/span><span class=\"d-inline-flex font-weight-bold secondary-font text-heading-default\" >Suivi<\/span><\/button>\n               <\/div>\n\n               <div id=\"collapsepix-tab-0fa49f9-72eeed4\" class=\"collapse \" aria-labelledby=\"headingpix-tab-0fa49f9-72eeed4\">\n                 <div class=\"card-body\"><p class=\"p1\">Conjoint avec l\u2019\u00e9quipe douleur<\/p>\n<p class=\"p1\">Modalit\u00e9s\u00a0: clinique + IRM FLAIR et 3D gado<\/p>\n<p class=\"p1\">Ryhtme\u00a0: 3, 6, 12 mois puis annuel<\/p>\n<p class=\"p1\">Dur\u00e9e\u00a0: minimum de 5 ans<\/p>\n<\/div>\n               <\/div>\n             <\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Procedure radiochirurgie metastases cerebrales de melanome Protocoles de prise en charge par pathologies Indications pour Metastase cerebrale unique de melanome 1\u00b0) URGENCE, d\u00e9gradation neurologique rapide, m\u00e9tastase volumineuse\u00a0: Chirurgie 2\u00b0) Urgence relative\u00a0: m\u00e9tastase mena\u00e7ante asymptomatique ou pauci symptomatique BRAF mut\u00e9\u00a0: traitement&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":18411,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-18404","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/pages\/18404","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/comments?post=18404"}],"version-history":[{"count":6,"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/pages\/18404\/revisions"}],"predecessor-version":[{"id":18586,"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/pages\/18404\/revisions\/18586"}],"up":[{"embeddable":true,"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/pages\/18411"}],"wp:attachment":[{"href":"https:\/\/www.radiochirurgiezapx-lariboisiere.com\/en\/wp-json\/wp\/v2\/media?parent=18404"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}