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1.
Neurochirurgie ; 68(3): 323-326, 2022 Apr.
Article in English | MEDLINE | ID: mdl-33989640

ABSTRACT

Meningiomas are the most common tumors of the central nervous system. Most meningiomas are benign and occur mainly in middle-aged women. Only a few cases of meningiomas in identical twins have been reported. Cyproterone acetate (Androcur® Bayer Healthcare SAS) (CPA) is an antiandrogenic progestin used to treat female hirsutism in some countries including France. We report a case of identical twin sisters who developed multiple, atypically located meningiomas in the setting of long-term CPA use. Eighteen-month follow-up showed spontaneous decrease of meningiomas after cessation of CPA. This case illustrates CPA's ability to induce development of atypically located meningiomas that differ even between identical twins, confirms benefit of surgical abstention, and raises questions regarding security of use of CPA.


Subject(s)
Meningeal Neoplasms , Meningioma , Cyproterone/pharmacology , Cyproterone Acetate/adverse effects , Female , Humans , Meningeal Neoplasms/chemically induced , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/pathology , Meningioma/chemically induced , Meningioma/pathology , Middle Aged , Progestins , Twins, Monozygotic
2.
Rev Neurol (Paris) ; 172(11): 689-695, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27776893

ABSTRACT

OBJECTIVE: The aim of this review was to evaluate the complications of spinal cord stimulation (SCS) for chronic pain. METHODS: This was a retrospective case series of 212 patients treated with SCS for chronic lower-limb neuropathic pain between March 2002 and February 2015 in a Reims academic hospital. All patients received a surgically implanted paddle-type electrode. Complications with this technique are here described and analyzed, and other treatment and preventative methods proposed. RESULTS: The major indication was 'failed back surgery syndrome', and 74 (35%) patients experienced complications, of which 57% were benign, while 42% required invasive treatment. Most frequent complications (n=22, 10%) were hardware malfunctions. There were two cases (0.9%) of postoperative neurological deficit and nine (4.2%) with postoperative infections. All patients received the appropriate treatment for their complication. CONCLUSION: Despite the presence of complications, SCS is still a safe technique, although careful patient selection and proper surgical technique can help to avoid major complications.


Subject(s)
Chronic Pain/therapy , Electrodes, Implanted , Postoperative Complications/etiology , Spinal Cord Stimulation/adverse effects , Adolescent , Adult , Aged , Chronic Pain/epidemiology , Electric Stimulation Therapy/adverse effects , Electric Stimulation Therapy/instrumentation , Electric Stimulation Therapy/methods , Electrodes, Implanted/adverse effects , Electrodes, Implanted/statistics & numerical data , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Spinal Cord Stimulation/instrumentation , Spinal Cord Stimulation/statistics & numerical data , Treatment Outcome , Young Adult
3.
J Fr Ophtalmol ; 39(4): 387-99, 2016 Apr.
Article in French | MEDLINE | ID: mdl-27017475

ABSTRACT

Orbital tumors are a rather frequent pathology. Their diagnosis and treatment may be difficult. They can be benign or malignant. All the tissues of the orbit can give rise to a tumor, resulting in their large number. Among the benign tumors, we have meningiomas and cavernous hemangiomas, and for the malignant tumors, lymphomas, metastasis, ENT tumors and lacrimal gland tumors in the adult. Usually the signs are nonspecific, with proptosis, oculomotor disturbance, inflammatory signs, pain and sometimes a mass. Imaging (CT, MRI and color Doppler ultrasound) shows the tumor, its location, extent and possible metastases. Biopsy and anatomic and cytopathologic examination confirm the type of benign or malignant tumor. Based on these three elements: clinical appearance, imaging and histology, the tumor will be treated, usually by a surgical approach according to the recommendations of a multidisciplinary tumor conference. Radiation therapy and chemotherapy may supplement the treatment.


Subject(s)
Orbital Neoplasms , Adult , Age of Onset , Diagnostic Techniques, Ophthalmological , Hemangioma, Cavernous/diagnosis , Hemangioma, Cavernous/epidemiology , Humans , Magnetic Resonance Imaging , Orbit/pathology , Orbital Neoplasms/diagnosis , Orbital Neoplasms/epidemiology , Orbital Neoplasms/therapy , Tomography, X-Ray Computed
4.
Neurochirurgie ; 59(4-5): 191-4, 2013.
Article in English | MEDLINE | ID: mdl-24367800

ABSTRACT

We report the case of a patient diagnosed with a pathological fracture of the odontoid dens related to a renal carcinoma metastasis and treated by an original technique. In order to achieve correct stabilization of the fracture and to preserve rotational neck mobility, an anterior approach combining an odontoid screw fixation and a balloon kyphoplasty was performed. This minimal invasive strategy provided satisfactory clinical and radiological results for this unstable lesion. To our knowledge, this technique has not been previously reported and could be a valuable alternative approach in the management of craniocervical metastatic lesions for these fragile patients.


Subject(s)
Bone Neoplasms/secondary , Fracture Fixation, Internal , Kyphoplasty , Odontoid Process/surgery , Spinal Fractures/surgery , Bone Screws , Fracture Fixation, Internal/methods , Humans , Kidney Neoplasms/pathology , Kyphoplasty/methods , Male , Middle Aged , Odontoid Process/diagnostic imaging , Postoperative Complications , Spinal Fractures/diagnosis , Spinal Fractures/diagnostic imaging , Spinal Fractures/etiology , Tomography, X-Ray Computed , Treatment Outcome
5.
AJNR Am J Neuroradiol ; 34(7): 1395-400, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23391837

ABSTRACT

BACKGROUND AND PURPOSE: The treatment of cerebral AVMs is complex, reliant on interventions such as embolization, surgery, and radiosurgery, or a combination of these modalities. To date, treatment with the embolic agent Onyx, followed by radiosurgery, has not been evaluated. The goal of this study was to evaluate the safety and efficacy of this combination in a homogeneous, monocentric series. MATERIALS AND METHODS: From April 2003 to June 2008, a total of 20 patients (11 women and 9 men; age range, 10-55 years) were treated for AVMs with Onyx embolization followed by radiosurgery. AVM sizes were <3 cm in 7 patients and ≥3 cm in 13 patients. Modalities and complications of the procedure were analyzed as well as the long-term clinical and anatomic outcomes (2-5 years after treatment). RESULTS: Of 17 patients evaluated by DSA after radiosurgery, 10 (58.8%) were observed to have complete occlusion of the AVM nidus. Complete occlusion was observed in 5 (71.4%) of 7 Spetzler-Martin grade I-II AVMs and in 5 (50.0%) of 10 Spetzler-Martin grade III-IV AVMs. Complete occlusion was observed in 4 (80.0%) of 5 AVMs of <3 cm and 6 (50.0%) of 12 AVMs of >3 cm. One of 20 patients had significant worsening of clinical status (mRS ≥2) at long-term follow-up. CONCLUSIONS: In this preliminary series, the safety and efficacy of combined treatment by Onyx embolization followed by radiosurgery are quite satisfactory, with a low rate of clinical complications (5.0%) and a 58.8% rate of complete obliteration of the AVM.


Subject(s)
Dimethyl Sulfoxide/therapeutic use , Embolization, Therapeutic/methods , Intracranial Arteriovenous Malformations/therapy , Polyvinyls/therapeutic use , Radiosurgery/methods , Adolescent , Adult , Angiography, Digital Subtraction/methods , Aphasia/etiology , Child , Child, Preschool , Combined Modality Therapy , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/instrumentation , Enbucrilate/therapeutic use , Female , Follow-Up Studies , Humans , Intracranial Arteriovenous Malformations/classification , Intracranial Arteriovenous Malformations/surgery , Intraoperative Complications , Longitudinal Studies , Male , Middle Aged , Paresis/etiology , Postoperative Complications , Prospective Studies , Radiosurgery/adverse effects , Rupture, Spontaneous , Safety , Treatment Outcome , Young Adult
6.
Childs Nerv Syst ; 19(10-11): 756-9, 2003 Nov.
Article in English | MEDLINE | ID: mdl-12908116

ABSTRACT

OBJECT: The object of this study is to demonstrate the delayed occurrence of aqueductal stenosis in preterm infants who have suffered from intraventricular hemorrhage (IVH) and to try to explain the mechanisms of this stenosis. METHOD: From January 1996 to June 2002, 1,046 premature infants were admitted to our institution. Thirty-six neonates suffered from grade 3 or 4 intraventricular hemorrhage (Papile grading), of whom 16 died. Twenty patients survived and a ventriculoperitoneal shunt was inserted in 7 infants. Four patients underwent a neuroendoscopic third ventriculostomy. Follow-up was carried out, twice a month during the first 2 months and subsequently twice a year. CONCLUSION: In 2 children NTV was an effective treatment for hydrocephalus with an average follow-up of 29 months. The specific pattern concerning these patients is the long delay before obstructive hydrocephalus and the visualization of de novo obstruction with MRI. The biological explanation must be investigated.


Subject(s)
Cerebral Aqueduct/abnormalities , Cerebrospinal Fluid Shunts , Constriction, Pathologic/surgery , Cerebral Aqueduct/surgery , Cerebral Ventricles , Child, Preschool , Constriction, Pathologic/physiopathology , Endoscopy , Female , Follow-Up Studies , Humans , Hydrocephalus/etiology , Hydrocephalus/surgery , Infant , Infant, Newborn , Infant, Premature , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/surgery , Magnetic Resonance Imaging , Male , Obstetric Labor, Premature/complications , Obstetric Labor, Premature/physiopathology , Obstetric Labor, Premature/surgery , Postoperative Complications , Pregnancy , Tomography, X-Ray Computed , Ventriculostomy/adverse effects , Ventriculostomy/methods
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