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1.
Article in French | MEDLINE | ID: mdl-26513838

ABSTRACT

OBJECTIVES: We evaluated the postoperative facial nerve function after vestibular schwannoma (VS) surgery and analyzed factors causing it. MATERIAL AND METHODS: We included 89 consecutive patients undergoing surgical excision of unilateral VS. Patient and tumor characteristics, surgical approaches, facial nerve function, extent of tumor resection and complications were analyzed. RESULTS: Complete tumor resection was achieved in 85% of cases. Anatomic preservation of the facial nerve was achieved in 96% of patients. In all tumor stages, 88.2% of patients, have a normal or subnormal facial function within one year of the intervention, the rate was 100% in patients carrying a VS stage I or II. No severe complication or death was reported. CONCLUSION: Short- and long-term facial nerve outcome was comparable with results of other recent series reported in literature. The facial nerve function after surgery was better with small VS compared to large VS. The intraoperative decision of near-total excision of the tumor followed by adjuvant radiotherapy, in some cases, can prove to be a good option in the interest of better preservation of the facial nerve function. The adhesion of the facial nerve and its complex relationship with the tumor remain mysterious; RMI can bring significant refinements, helping to get the best preservation offacial function rate, in the coming years.


Subject(s)
Facial Nerve/physiology , Neuroma, Acoustic/surgery , Female , Humans , Male , Middle Aged , Treatment Outcome
2.
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
4.
Neurochirurgie ; 58(5): 275-81, 2012 Oct.
Article in French | MEDLINE | ID: mdl-22425580

ABSTRACT

INTRODUCTION: Atypical and malignant meningiomas are a rare disease whose histological definition is still recent. Their management is not consensual. The aim of this study was to review the outcome, prognostic factors and the role of complementary therapies. PATIENTS AND METHODS: Between 1999 and 2007, 36 patients with atypical or malignant meningiomas were managed in our hospital. All surgical specimens were reviewed according to the 2007 WHO classification system. The sex ratio was 1.25 male, the median age was 59 years. The median follow-up was 55 months. Thirty meningiomas were atypical and six were malignant. RESULTS: Five and 10 years overall survival rate are respectively 72 and 41%, whereas 5 and 10 years progression free survival rate are 61 and 23%. We only identify female sex, age over 70 years and Karnofsky status under 70% as negative prognostic factors. CONCLUSION: Atypical and malignant meningiomas are difficult to manage and have high recurrence and poor survival rates. The prognostic of OMS II meningiomas is heterogeneous. Adjuvant radiation therapy is recommended in case of malignant menigioma or in case of atypical meningioma if incomplete surgical excision is performed.


Subject(s)
Meningeal Neoplasms/surgery , Meningioma/surgery , Adult , Aged , Aged, 80 and over , Disease Progression , Disease-Free Survival , Female , Humans , Karnofsky Performance Status/statistics & numerical data , Male , Meningeal Neoplasms/mortality , Meningeal Neoplasms/radiotherapy , Meningioma/mortality , Meningioma/radiotherapy , Middle Aged , Neoplasm Grading , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/radiotherapy , Neoplasm Recurrence, Local/surgery , Retrospective Studies , Survival Rate , Treatment Outcome , World Health Organization
5.
Neurochirurgie ; 57(2): 68-72, 2011 Apr.
Article in French | MEDLINE | ID: mdl-21530987

ABSTRACT

Microvascular decompression is an important procedure for the management of microvascular compression syndromes in the cerebellopontine angle (CPA) like trigeminal neuralgia or hemifacial spasm. The ability to identify the offending vessel is the key to success. Can the endoscope help surgeons to identify and understand the responsible conflict in order to treat them? Our series concerns 27 consecutive patients who underwent microvascular decompression systematically using an endoscope with an angulation of 30° at the beginning and the end of the intervention. The decompression procedure was done under microscope. Endoscopic exploration was successful for all patients. Endoscopy improved visualization of the cranial nerves and allowed to see and understand the neurovascular conflicts, which were not able to be observed using the microscope alone for two of the 27 patients. The endoscope is a useful adjunct to microscopic exploration of the cranial nerves in the CPA avoiding significant cerebellar or brainstem retraction.


Subject(s)
Cerebellopontine Angle/blood supply , Cerebrovascular Disorders/surgery , Decompression, Surgical/methods , Endoscopy , Adult , Aged , Combined Modality Therapy , Endovascular Procedures , Humans , Microsurgery , Middle Aged , Retrospective Studies , Vascular Surgical Procedures/methods , Young Adult
6.
Neurochirurgie ; 57(1): 42-5, 2011 Feb.
Article in French | MEDLINE | ID: mdl-20870256

ABSTRACT

We report the case of a 31-year-old patient who had had frontal cephalalgias for several years. CT and MRI anatomical imaging objectified a frontal osteolytic tumor respecting the osseous external table but compressing the superior sagittal sinus. Total en bloc resection of the tumor associated with titan cranioplasty was performed. The postoperative course was uneventful. Three months after surgery the patient no longer reported headache. The anatomical and pathological results concluded in intradiploic cavernous hemangioma. We discuss this case and others described in the literature.


Subject(s)
Hemangioma, Cavernous, Central Nervous System/surgery , Neurosurgical Procedures/methods , Skull Neoplasms/surgery , Skull/surgery , Adult , Craniotomy , Endothelium/pathology , Headache/etiology , Hemangioma, Cavernous, Central Nervous System/pathology , Humans , Magnetic Resonance Imaging , Male , Skull/pathology , Skull Neoplasms/pathology , Superior Sagittal Sinus/pathology , Tomography, X-Ray Computed
8.
Orthop Traumatol Surg Res ; 97(1): 94-7, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21094109

ABSTRACT

Osteochondromas are usually benign bone tumors found on the metaphysis of long bones. These tumors are rarely located on the spine especially at cervical level. This report presents the case of a 23-year-old man who had previously developed tetraparesis at the age of 13 after infectious myelitis. Recent severe clinical neurological deterioration revealed the diagnosis of osteochondroma arising in the C4 vertebral arch compressing the spinal cord and associated with syringomyelia. Of note in his past history was a treated hip localization. The patient underwent complete surgical excision of the osteochondroma. Postoperative outcome was good with slow clinical recovery from the spinal cord compression. We report this rare cause of spinal cord compression and other cases reported in the literature.


Subject(s)
Cervical Vertebrae , Osteochondroma/complications , Spinal Cord Compression/etiology , Spinal Neoplasms/complications , Diagnosis, Differential , Humans , Laminectomy/methods , Magnetic Resonance Imaging , Male , Osteochondroma/diagnosis , Osteochondroma/surgery , Spinal Cord Compression/diagnosis , Spinal Cord Compression/surgery , Spinal Neoplasms/diagnosis , Spinal Neoplasms/surgery , Young Adult
9.
Neurochirurgie ; 56(5): 404-7, 2010 Oct.
Article in French | MEDLINE | ID: mdl-20594960

ABSTRACT

Primitive malignant rhabdoid tumors of the central nervous system are rare and have a poor prognosis. Adult and adolescent cases are exceptional. We report the case of a 16-year-old girl who presented an intratumoral hemorrhage in a rhabdoid tumor. She was treated with surgery, followed by intravenous and intrathecal chemotherapy. Despite intensive treatment, she died 5 months after diagnosis. We discuss the different therapeutic options for this patient and review the literature on this kind of tumor.


Subject(s)
Brain Neoplasms , Rhabdoid Tumor , Adolescent , Brain Neoplasms/diagnosis , Brain Neoplasms/therapy , Fatal Outcome , Female , Humans , Rhabdoid Tumor/diagnosis , Rhabdoid Tumor/therapy
11.
Neurochirurgie ; 56(4): 303-8, 2010 Aug.
Article in French | MEDLINE | ID: mdl-20427063

ABSTRACT

UNLABELLED: Tinnitus is a public health issue in France. Around 1 % of the population is affected and 30,000 people are handicapped in their daily life. The treatments available for disabling tinnitus have until now been disappointing. We report our experience on the treatment of these patients in neurosurgery. PATIENT AND METHODS: Between 2006 and 2008, transcranial magnetic stimulation (rTMS) was performed following several supraliminal and subliminal protocols in 16 patients whose mean age was 47 years (range, 35-71). All patients underwent anatomical and functional MRI of the auditory cortex before and 18 h after rTMS, to straddle the primary and secondary auditory cortices. All patients underwent audiometric testing by an ENT physician. RESULTS: Nine patients responded with rTMS. After these investigations, two quadrapolar electrodes (Resume), connected to a stimulating device implanted under the skin (Synergy, from Medtronic), were extradurally implanted in three patients. The electrodes were placed between the primary and secondary auditory cortices. The mean follow-up was 25 months and significant improvement was found in these patients. CONCLUSION: The feasibility of cortical stimulation in symptomatic treatment of tinnitus was demonstrated by this preparatory work. The intermediate- and long-term therapeutic effects remain to be evaluated.


Subject(s)
Auditory Cortex/physiology , Tinnitus/therapy , Transcranial Magnetic Stimulation , Adult , Aged , Audiometry , Depressive Disorder/complications , Electrodes, Implanted , Female , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Middle Aged , Tinnitus/surgery , Treatment Outcome
12.
Neurochirurgie ; 56(2-3): 132-6, 2010.
Article in French | MEDLINE | ID: mdl-20227092

ABSTRACT

Optic nerve sheath meningiomas account for one-third of optic nerve tumors, 1-2 % of all meningiomas, and 2-3.5 % of all orbital tumors. Loss of vision is the main clinical sign. Diagnosis is easily made after the neuroradiological evaluation. Fractionated stereotactic radiotherapy (RSF) is now the gold standard treatment for controlling tumor volume and preserving visual acuity.


Subject(s)
Meningioma/surgery , Optic Nerve Neoplasms/surgery , Radiosurgery/methods , Disease Progression , Dose Fractionation, Radiation , Female , Humans , Meningioma/diagnostic imaging , Meningioma/epidemiology , Meningioma/pathology , Optic Nerve/pathology , Optic Nerve Neoplasms/diagnostic imaging , Optic Nerve Neoplasms/pathology , Radiography , Visual Acuity
13.
Neurochirurgie ; 56(2-3): 213-6, 2010.
Article in French | MEDLINE | ID: mdl-20299066

ABSTRACT

In this chapter, we report the results of orbital tumor management in a few neurosurgical departments and compare it to a Paris neurosurgical department that has developed a close relation with an ophthalmological department. These departments' activity is quite low, treating mainly sphenoorbital meningiomas. Other tumor groups are unequally and sporadically managed.


Subject(s)
Neurosurgical Procedures/methods , Orbital Neoplasms/surgery , Age Factors , Exophthalmos/etiology , Female , France , Functional Laterality , Glioma/surgery , Hospitals , Humans , Lacrimal Apparatus/surgery , Lacrimal Apparatus Diseases/surgery , Male , Neurosurgical Procedures/statistics & numerical data , Paris , Vision Disorders/etiology
14.
Neurochirurgie ; 56(1): 55-8, 2010 Feb.
Article in French | MEDLINE | ID: mdl-20074758

ABSTRACT

We report the case of a patient with spinal cord compression evolving over 36 months with spastic paraparesis. Anatomic imagery showed epidural lipomatosis. No predisposing factors were found. Surgical treatment was decided. A T1-T10 laminectomy with excision of the surplus epidural fat was performed. Immediate and medium-term postsurgical follow-up was favorable with the disappearance of the pyramidal syndrome. Other cases found in literature and the principal predisposing factors are discussed.


Subject(s)
Epidural Space/pathology , Lipomatosis/complications , Lipomatosis/pathology , Spinal Cord Compression/etiology , Epidural Space/surgery , Humans , Laminectomy/methods , Lipomatosis/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Spinal Cord Compression/surgery
15.
Acta Neurochir (Wien) ; 152(3): 481-3, 2010 Mar.
Article in English | MEDLINE | ID: mdl-19652905

ABSTRACT

Spinal neurenteric cyst is a rare congenital lesion that may occur either alone or in the context of a complex malformative disorder. Our case is unusual because of its rare intramedullary location, the association with an important intrathoracic development, and the age of the child at presentation (1 month). An anterior approach through a right-sided lateral thoracotomy was performed for a total resection of the intrathoracic part and a subtotal resection for the intramedullar portion. During 2 years of follow-up, the child presented no neurological deficit and post-operative magnetic resonance imaging found a small residue fixed on the anterior spinal cord without progression.


Subject(s)
Neural Tube Defects/pathology , Neural Tube Defects/surgery , Spinal Cord/abnormalities , Spinal Cord/surgery , Spinal Dysraphism/pathology , Spinal Dysraphism/surgery , Cervical Vertebrae/abnormalities , Cervical Vertebrae/surgery , Humans , Infant, Newborn , Magnetic Resonance Imaging , Male , Neural Tube Defects/complications , Neurosurgical Procedures/methods , Spinal Canal/pathology , Spinal Canal/surgery , Thoracotomy/methods , Thorax/abnormalities , Thorax/pathology , Treatment Outcome
16.
Neurochirurgie ; 55(2): 282-90, 2009 Apr.
Article in French | MEDLINE | ID: mdl-19328504

ABSTRACT

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.


Subject(s)
Cranial Nerve Diseases/pathology , Cranial Nerve Diseases/surgery , Cranial Nerves/pathology , Cranial Nerves/surgery , Neurosurgery/statistics & numerical data , Neurosurgical Procedures/statistics & numerical data , Data Collection , Hemifacial Spasm/surgery , Humans , Surveys and Questionnaires , Trigeminal Neuralgia/surgery
17.
Neurochirurgie ; 55(6): 569-72, 2009 Dec.
Article in French | MEDLINE | ID: mdl-19095271

ABSTRACT

Clostridium perfringens is rare in neurosurgery. The source of clostridial brain abscess is usually a penetrating head injury. We report the case of a 57-year-old man who had parietal glioblastoma resection with local carmustine chemotherapy and who presented a clostridial brain abscess three weeks later. Progression was especially brutal, leading to patient's death in few hours. We discuss the etiology and progression of this case compared to the data reported in the literature.


Subject(s)
Brain Abscess/etiology , Brain Abscess/microbiology , Brain Neoplasms/surgery , Clostridium Infections/etiology , Clostridium Infections/microbiology , Glioblastoma/surgery , Postoperative Complications/microbiology , Antineoplastic Agents, Alkylating/adverse effects , Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/complications , Brain Neoplasms/therapy , Carmustine/adverse effects , Carmustine/therapeutic use , Combined Modality Therapy , Fatal Outcome , Glioblastoma/complications , Glioblastoma/therapy , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Postoperative Complications/etiology , Tomography, X-Ray Computed
18.
Rev Neurol (Paris) ; 165(1): 52-62, 2009 Jan.
Article in French | MEDLINE | ID: mdl-18829055

ABSTRACT

BACKGROUND AND PURPOSE: Nocardia species is an aerobic soil-saprophyte bacterium, responsible for rare opportunistic infections, mainly reported in immunocompromised patients. Nocardia brain abscess accounts for 1 to 2% of cerebral abscesses. Prognosis is poor. METHODS: We describe clinical, radiological and bacteriological findings along with therapeutic aspects for five patients and review the literature on Nocardia cerebral abscess. RESULTS: The clinical features of Nocardia brain abscess are insidious and nonspecific, occurring frequently with a medical background of obvious or latent immunodeficiency; fever, if any, is observed subordinate to extracerebral nocardiosis. Computerized tomography scan and conventional magnetic resonance (MR) scan show lesions with a necrotic core and multilobed thick walls enhancing after injection of gadolinium or iodine. Abscesses are mainly located in the brain stem, basal ganglia and cerebral cortex of the frontal, parietal and occipital lobes; cerebellar and spinal locations are uncommon. MR diffusion-weighted imaging with calculation of apparent diffusion coefficient and proton MR spectroscopy can provide additional data for accurate differential diagnosis between abscess and other necrotic lesions, such as tumor and cyst formations. Bacteriological identification has progressed with advances in molecular microbiology: 16S rRNA sequencing, allowing a more rapid routine identification of Nocardia strains from clinical samples. Clinical management of patients with a Nocardia brain abscess relies upon early use of intravenous antibiotics adapted to the strains identified and their susceptibility. Most Nocardia strains display susceptibility to cotrimoxazol, amikacin and linezolid, but develop beta-lactamase activity. CONCLUSIONS: Early pus samples, obtained by biopsy or surgical resection, are needed to establish a certain bacteriological diagnosis and initiate appropriate intravenous antibiotics.


Subject(s)
Brain Abscess/pathology , Nocardia Infections/pathology , Aged , Anti-Bacterial Agents/therapeutic use , Apraxias/etiology , Brain/microbiology , Brain Abscess/drug therapy , Brain Abscess/microbiology , Female , Gout/complications , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Middle Aged , Neurosurgical Procedures , Nocardia Infections/drug therapy , Nocardia Infections/surgery , Sarcoidosis, Pulmonary/complications , Silicosis/complications , Smoking , Tomography, X-Ray Computed , Treatment Outcome
19.
Neurochirurgie ; 54(2): 85-8, 2008 Apr.
Article in French | MEDLINE | ID: mdl-18329051

ABSTRACT

BACKGROUND AND PURPOSE: Lumbar puncture is a common procedure highly contributive to neurological diagnosis. It can also cause serious adverse side effects including subdural hematoma and intracranial hypotension as illustrated by this case report. CASE REPORT: A 38-year-old women presented severe intracranial hypotension after a lumbar puncture. Magnetic resonance imaging was compatible with intracranial hypotension and revealed an acute subdural hematoma with midline deviation. A first blood patch was unsuccessful. Symptom relief was achieved with a second patch. The patient was, then, discharged but developed recurrent headache subsequent to the transformation from acute to chronic subdural hematoma. Surgical drainage was required. The postoperative imaging and physical examination returned to normal and the patient was discharged with no recurrence. CONCLUSION: The serious adverse effects of lumbar puncture is an easy and common medical procedure that must be kept in mind.


Subject(s)
Hematoma, Subdural/etiology , Intracranial Hypotension/etiology , Spinal Puncture/adverse effects , Adult , Blood Patch, Epidural , Drainage , Female , Headache/etiology , Hematoma, Subdural/diagnostic imaging , Hematoma, Subdural/surgery , Humans , Intracranial Hypotension/diagnostic imaging , Intracranial Hypotension/surgery , Magnetic Resonance Imaging , Neurosurgical Procedures , Radionuclide Imaging
20.
AJNR Am J Neuroradiol ; 28(8): 1567-72, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17846214

ABSTRACT

BACKGROUND AND PURPOSE: We conducted a retrospective evaluation of the results of endovascular treatment (EVT) of middle cerebral artery aneurysms (MCAAs) in a center where embolization is the first treatment option considered. MATERIALS AND METHODS: Ninety-two MCAAs were diagnosed in 87 patients between September 2001 and January 2006. The strategy of treatment (endovascular versus surgical), the clinical and angiographic results of embolization, and the ensuing complications are described. RESULTS: Initially, 59 aneurysms (64.1%) in 55 patients were embolized, 18 (19.6%) were clipped, and 15 (16.3%) were not treated. Four endovascular procedures failed (7.3%), and 55 aneurysms in 51 patients were finally treated by embolization. During the procedure, complications occurred in 13 patients (25.5%) comprising 3 ruptures and 10 thromboembolisms. In the follow-up, 4 patients having a preoperative complication had a modified Rankin scale more than 2 (3 patients [5.9%]) or died (1 patient [2.0%]). Of the 55 embolized aneurysms, according to the Raymond scale, 23 (41.8%) were completely occluded, 24 (43.6%) retained a residual neck, and 8 (14.6%) were residual at the end of the first procedure. No bleeding was detected during the follow-up period in the embolized patients. CONCLUSION: EVT of MCAA is effective for preventing rebleeding episodes within the first year of treatment judging by historical controls. The real question is whether clipping or coiling of MCAAs is better in terms of reducing rebleeding rates and complications rates in the long term, and such a determination would require a far larger number of patients over a much longer observation period.


Subject(s)
Embolization, Therapeutic , Intracranial Aneurysm/therapy , Adult , Aged , Aneurysm, Ruptured/etiology , Cerebral Angiography , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/methods , Female , Follow-Up Studies , Humans , Intracranial Aneurysm/diagnostic imaging , Male , Middle Aged , Retreatment , Retrospective Studies , Thromboembolism/etiology , Treatment Failure , Treatment Outcome
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