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Coll G, Arrighi M, Berton Q, Coste A, de Schlichting E, Chazal J, Sakka L, Abed Rabbo F. Mechanical Complications of Sophysa SM8 Shunt in Adult Hydrocephalus: A Monocentric Experience. Oper Neurosurg (Hagerstown) 2022; 23:318-325. [PMID: 36001762 DOI: 10.1227/ons.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sophysa SM8 is widely used by neurosurgeons in France. Published studies report shunt malfunction rates in adults between 18% and 29%. However, these studies included multiple valve types and thus entailed a serious confounding factor. OBJECTIVE To ascertain the incidence the Sophysa SM8 cerebrospinal fluid (CSF) shunt malfunctions in adults. METHODS We present a retrospective series of adult patients who underwent CSF shunt placement between 2000 and 2013 with Sophysa SM8. RESULTS In total, 599 patients (329 males and 270 females) were included. The mean age at surgery was 64.15 years (19-90) (SD 16.17; median 68.0). The causes of hydrocephalus were normal pressure hydrocephalus (49%), traumatic hemorrhages (26.5%), tumors (15.7%), cerebral aqueduct stenoses (3%), and arachnoid cysts (2%). The mean follow-up was 3.9 years (0-16) (SD 4.10; median 3 years). The rate of complications was 22.04% (132 of 599). Most frequent causes of complications were disconnection (25%), migration (12.9%), overdrainage (9.1%), and proximal obstruction (6.8%). In 17 cases (12.9%), no failure was diagnosed during revision. Seven infections (5.3%) were reported. The mean delay for the first revision was 1.70 years (0-13.93) (SD 2.67, median 0.35). The risk of shunt failure was 36% at 10 years. Seventeen percent of revisions occurred during the first year after shunt placement. CONCLUSION Disconnections are a very frequent complication of Sophysa SM8 valve. They are related to the 2-connector system of this valve. Based on these results, we recommend using 1-piece valves.
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Affiliation(s)
- Guillaume Coll
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marta Arrighi
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Quentin Berton
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Coste
- Service de Neurochirurgie, CHU Grenoble-Alpes, Grenoble, France
| | | | - Jean Chazal
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Sakka
- Département d'Anatomie et d'Organogenèse, NeuroDol UMR INSERM 1107 CNRS, UFR de Médecine et des Professions Paramédicales, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Francis Abed Rabbo
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Coll G, Abed Rabbo F, de Schlichting E, Coste A, Chazal J, Garcier JM, Peyre H, Sakka L. Mechanical complications of cerebrospinal fluid shunt. Differences between adult and pediatric populations: myths or reality? Childs Nerv Syst 2021; 37:2215-2221. [PMID: 33768313 DOI: 10.1007/s00381-021-05125-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Shunt malfunctions seem more frequent in children (44 to 81%) than in adults (18 to 29%). Because of discrepancies between studies, it is not possible to affirm this disparity. The objective was to verify whether the incidence of cerebrospinal fluid (CSF) shunt malfunctions is higher in children than adults. METHODS We present a retrospective series of child and adult patients who underwent CSF shunt placement between 2000 and 2013 with a Sophysa SM8® valve. RESULTS 599 adults and 98 children (sex ratio 1.28) underwent CSF shunt placement. Age at first surgery ranged between 1 day of life and 90 years (mean of 55.8 years, SD 25.8, median 64.8 years). The mean follow-up was 4 years (SD 4.264, 0-16; median 3 years). The cumulative complication rate was 25.5% (178/697). Mechanical complications were disconnection (25.1%), migration (11.8%), intracranial catheter obstruction (8.9%) and malposition (8.4%). The mean delay for the first revision was 1.90 years (0-13.9), (SD 2.73, median 0.5). The probability of shunt failure was 65% at 10 years in the child group and 36% at 10 years in the adult group. Moreover, in the child group, 33% of revisions occurred during the first year after shunt placement versus 17% in the adult group. Thus, the probability of shunt failure was higher in children than in adults (log-rank test, p < 0.001). CONCLUSIONS This is the first retrospective study, comparing children and adults undergoing CSF shunt using the same valve, able to confirm the higher rate of complications in children.
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Affiliation(s)
- Guillaume Coll
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France
| | - Francis Abed Rabbo
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France. .,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France.
| | | | - Aurélien Coste
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France
| | - Jean Chazal
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France.,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Jean-Marc Garcier
- Service de Radiologie Pédiatrique, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Hugo Peyre
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75005, Paris, France
| | - Laurent Sakka
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France.,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
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Claus D, Coudeyre E, Chazal J, Irthum B, Mulliez A, Givron P. An evidence-based information booklet helps reduce fear-avoidance beliefs after first-time discectomy for disc prolapse. Ann Phys Rehabil Med 2017; 60:68-73. [DOI: 10.1016/j.rehab.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/26/2022]
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Bouvier D, Duret T, Abbot M, Stiernon T, Pereira B, Coste A, Chazal J, Sapin V. Utility of S100B Serum Level for the Determination of Concussion in Male Rugby Players. Sports Med 2016; 47:781-789. [DOI: 10.1007/s40279-016-0579-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sakka L, Chomicki A, Gabrillargues J, Khalil T, Chazal J, Avan P. Validation of a noninvasive test routinely used in otology for the diagnosis of cerebrospinal fluid shunt malfunction in patients with normal pressure hydrocephalus. J Neurosurg 2016; 124:342-9. [DOI: 10.3171/2015.1.jns142142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Ventriculoperitoneal shunting is the first-line treatment for normal pressure hydrocephalus. Noninvasive auditory tests based on recorded otoacoustic emissions were assessed, as currently used for universal neonatal hearing screenings, for the diagnosis of cerebrospinal fluid shunt malfunction. The test was designed based on previous works, which demonstrated that an intracranial pressure change induces a proportional, characteristic, otoacoustic-emission phase shift.
METHODS
Forty-four patients with normal pressure hydrocephalus (23 idiopathic and 21 secondary cases) were included in this prospective observational study. The male:female sex ratio was 1.44, the age range was 21–87 years (mean age 64.3 years), and the range of the follow-up period was 1–3 years (mean 20 months). Patients were implanted with a Sophy SU8 adjustable-pressure valve as the ventriculoperitoneal shunt. The phase shifts of otoacoustic emissions in response to body tilt were measured preoperatively, immediately postoperatively, and at 3–6 months, 7–15 months, 16–24 months, and more than 24 months postoperatively. Three groups were enrolled: Group 1, 19 patients who required no valve opening-pressure adjustment; Group 2, 18 patients who required valve opening-pressure adjustments; and Group 3, 7 patients who required valve replacement.
RESULTS
In Group 1, phase shift, which was positive before surgery, became steadily negative after surgery and during the follow-up. In Group 2, phase shift, which was positive before surgery, became negative immediately after surgery and increasingly negative after a decrease in the valve-opening pressure. In Group 3, phase shift was positive in 6 cases and slightly negative in 1 case before revision, but after revision phase shift became significantly negative in all cases.
CONCLUSIONS
Otoacoustic emissions noninvasively reflect cerebrospinal fluid shunt function and are impacted by valve-opening pressure adjustments. Otoacoustic emissions consistently diagnosed shunt malfunction and predicted the need for surgical revision. The authors’ diagnostic test, which can be repeated without risk or discomfort by an unskilled operator, may address the crucial need of detecting valve dysfunction in patients with poor clinical outcome after shunt surgery.
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Affiliation(s)
- Laurent Sakka
- 1Service de Neurochirurgie, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand
- 2Equipe IGCNC, EA 7282, ISIT, UMR 6284, CNRS, Université d’Auvergne
| | - Alexandre Chomicki
- 4Laboratoire de Biophysique Sensorielle, Faculté de Médecine, Université d’Auvergne; and
| | - Jean Gabrillargues
- 3Service de Neuroradiologie, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Toufic Khalil
- 1Service de Neurochirurgie, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand
- 2Equipe IGCNC, EA 7282, ISIT, UMR 6284, CNRS, Université d’Auvergne
| | - Jean Chazal
- 1Service de Neurochirurgie, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand
- 2Equipe IGCNC, EA 7282, ISIT, UMR 6284, CNRS, Université d’Auvergne
| | - Paul Avan
- 4Laboratoire de Biophysique Sensorielle, Faculté de Médecine, Université d’Auvergne; and
- 5Biophysique Médicale, Centre Jean Perrin, Clermont-Ferrand, France
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Coll G, Combes JD, Isfan F, Rochette E, Chazal J, Lemaire JJ, de Schlichting E, Kanold J. Incidence and survival of childhood central nervous system tumors: A report of the regional registry of childhood cancers in Auvergne-Limousin. Neurochirurgie 2015; 61:237-43. [PMID: 26123613 DOI: 10.1016/j.neuchi.2015.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Central nervous system tumors (CNST) are the most lethal of solid tumors in childhood cancer. PATIENTS AND METHODS We report incidence and survival data for all CNST (International Classification of Diseases for Oncology third edition, category III or Xa) recorded in children under 15 years of age by the Auvergne-Limousin cancer registry for the period 1986-2009. RESULTS Annual incidence of all CNST was 3.27 per 100,000 and the male to female ratio was 0.95. Over 45.0% of CNST were glial. Astrocytomas (36.2%) showed the highest incidence for each age group except between 1 and 4 years where embryonal tumors were more common. For all CNST, no significant variation in incidence over time was observed for the evaluated period of 23 years (annual percent change: -0.4%, 95% CI, [-2.8-2.1]). Globally, 5 years overall survival was 67% [59-73] and had increased by more than 16% between 1986-1999 and 2000-2009, mainly due to better survival for astrocytomas, other gliomas, ependymomas and choroid plexus tumors (P=0.01). CONCLUSION We report that the incidence of CNST in Auvergne-Limousin is similar to that in the literature and did not increase between 1986 and 2009. In addition, 5 years overall survival increased after 1999, especially for surgically treatable tumors.
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Affiliation(s)
- G Coll
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 58, rue Montalembert, 63001 Clermont-Ferrand, France; Université Clermont Auvergne, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France.
| | - J-D Combes
- International Agency for Research on Cancer, 69372 Lyon, France
| | - F Isfan
- Centre régional de cancérologie et thérapie cellulaire pédiatrique, hôpital Estaing, CHU de Clermont-Ferrand, 63001 Clermont-Ferrand, France; Unité CRECHE Inserm-CIC 1405, 63003 Clermont-Ferrand, France
| | - E Rochette
- Centre régional de cancérologie et thérapie cellulaire pédiatrique, hôpital Estaing, CHU de Clermont-Ferrand, 63001 Clermont-Ferrand, France; Unité CRECHE Inserm-CIC 1405, 63003 Clermont-Ferrand, France
| | - J Chazal
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 58, rue Montalembert, 63001 Clermont-Ferrand, France; Université Clermont Auvergne, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France
| | - J-J Lemaire
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 58, rue Montalembert, 63001 Clermont-Ferrand, France; Université Clermont Auvergne, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France
| | - E de Schlichting
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 58, rue Montalembert, 63001 Clermont-Ferrand, France
| | - J Kanold
- Centre régional de cancérologie et thérapie cellulaire pédiatrique, hôpital Estaing, CHU de Clermont-Ferrand, 63001 Clermont-Ferrand, France; Unité CRECHE Inserm-CIC 1405, 63003 Clermont-Ferrand, France; Université Clermont Auvergne, université d'Auvergne, BP 10448, 63000 Clermont-Ferrand, France
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Lemaire JJ, Delom C, Coste A, Khalil T, Jourdy JC, Pontier B, Gabrillargues J, Sinardet D, Chabanne A, Achim V, Sakka L, Coste J, Chazal J, Salagnac A, Coll G, Irthum B. [Medico-economic analysis of a neurosurgery department at a university hospital]. Neurochirurgie 2015; 61:2-15. [PMID: 25665774 DOI: 10.1016/j.neuchi.2014.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/29/2014] [Accepted: 11/11/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Economic and societal constraints require to take into account the economic dimension and medical performance of hospital departments. We carried out a self-assessment study, which we thought could be useful to share with the neurosurgical community. MATERIAL AND METHODS Care and research activities were assessed from 2009 to 2013. We used institutional and assessment-body parameters in order to describe activities and perform a financial evaluation. It was a retrospective descriptive study based on the guidelines of the DHOS/O4 circular No. 2007/390 of October 29, 2007. RESULTS The average annual, analytic income statement was +1.39 millions euros, for 63 beds with a 92% occupancy rate, including 6.7 full-time equivalent neurosurgeons (and assistants), for 2553 patients and 1975 surgeries. The average mortality rate was 2.74%. The annual mean length of stay was 6.82 days. Per year, on average 15.6% of patients were admitted in emergency and 76.9% returned home. The annual, act-related-pricing and publication-related incomes represented 77% and 0.6%, respectively of the total funding. Difficulties to find downstream beds for the most severe patients induced 1401 "waiting days" in 2012. CONCLUSION Medico-economic analysis of a neurosurgery department at a university hospital was useful in order to take into account the care, teaching and research activities, as well as its related financial value.
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Affiliation(s)
- J-J Lemaire
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France.
| | - C Delom
- Direction des finances, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - A Coste
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J-C Jourdy
- Département d'information médicale, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - B Pontier
- Coordination soins de suite et réadaptation, agence régional de santé - Auvergne, 63057 Clermont-Ferrand, France
| | - J Gabrillargues
- Unité de neuroradiologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - D Sinardet
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - A Chabanne
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - V Achim
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - L Sakka
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J Coste
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J Chazal
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - A Salagnac
- Délégation à la recherche clinique & à l'innovation, direction générale adjointe, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - G Coll
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - B Irthum
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
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Botella C, Chaix R, Coste A, Chazal J, Lemaire JJ, Irthum B. Méningiomatose et cyprotérone. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Batisse M, Raverot G, Maqdasy S, Durando X, Sturm N, Montoriol PF, Kemeny JL, Chazal J, Trouillas J, Tauveron I. Aggressive silent GH pituitary tumor resistant to multiple treatments, including temozolomide. Cancer Invest 2013; 31:190-6. [PMID: 23477586 DOI: 10.3109/07357907.2013.775293] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Temozolomide (TMZ) has been proposed as a therapeutic option in aggressive pituitary tumors. Among the published cases, GH expressing tumors were rare. We describe a patient with initially benign silent GH adenoma that transformed into an aggressive GH secreting tumor resistant to usual therapy. MGMT expression was high and the MGMT promoter was unmethylated. Before this aggressive course, patient received three cycles of TMZ; no response was observed. Four cases of GH aggressive tumor treated by TMZ have been reported. Response to TMZ was observed in one of these four patients. Predictive factors of failure of TMZ remain unclear.
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Affiliation(s)
- Marie Batisse
- Department Endocrinologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.
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Tardy MM, Galvaing G, Sakka L, Garcier JM, Chazal J, Filaire M. [Embryology of the heart walls]. Morphologie 2013; 97:2-11. [PMID: 23414788 DOI: 10.1016/j.morpho.2012.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 10/12/2012] [Accepted: 11/19/2012] [Indexed: 11/16/2022]
Abstract
Although anatomically simple structures, the atrial septum and the ventricular septum have complex embryological origins. Recent findings in molecular biology allowed better comprehension of their formation. As soon as the heart tube is formed, cells migrate from several cardiogenic fields to take part in the septation. Elongation, ballooning, and later inflexion of the heart tube create chamber separating grooves, facing the future septa. The systemic venous tributaries conflate at the venous pole of the heart; it will partially involute while contributing to the atrial septum. The primary atrial septum grows from the atrial roof towards the atrioventricular canal. It fuses there with the atrioventricular cushions, while its upper margin breaks down to form the ostium secundum. Then a deep fold develops from the atrial roof and partly covers the ostium secundum, leaving a flap-like interatrial communication through the oval foramen. It will close at birth. The interventricular septum has three embryological origins. The ventricular septum primum, created during the ballooning process, origins from the primary heart tube. It will form the trabecular septum and the inlet septum. The interventricular ring, surrounding the interventricular foramen, will participate in the inlet septum and also form the atrioventricular conduction axis. The outflow cushions will separate the outflow tract in the aorta and pulmonary artery, and grow to create the outlet septum. After merging with the atrioventricular cushions, they will also be part of the membranous septum.
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Affiliation(s)
- M-M Tardy
- Laboratoire d'anatomie, faculté de médecine, BP 38, 28, place Henri-Dunant, 63001 Clermont-Ferrand cedex 1, France.
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Khalil T, Lemaire JJ, Dedieu V, Donnarieix D, Béatrice C, Lapeyre M, Kemeny JL, Pereira B, Thalami A, Chazal J, Verrelle P. MRI tumor response and clinical outcomes after LINAC radiosurgery on 50 patients with recurrent malignant gliomas. J Radiosurg SBRT 2013; 2:291-305. [PMID: 29296372 PMCID: PMC5658838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 06/24/2013] [Indexed: 06/07/2023]
Abstract
BACKGROUND The place of radiosurgery (RS) as an option in the treatment of recurrent malignant glioma is still debated on in the absence of prospective randomized trials. OBJECTIVE To assess the clinical outcome and MRI response after radiosurgery of recurrent malignant glioma. METHODS We evaluated 50 consecutive patients treated in a single institution. Between 2001 and 2008, 34 glioblastoma (GBM) and 16 anaplastic oligodendroglioma (AO) patients were treated with linear accelerator (Linac) RS for recurrence. RESULTS The median marginal dose was 15 Gy and the median gross tumor volume (GTV) was 6.64 ml. No patient had acute (< 3 months) neurological morbidity after RS. Ten patients (20%) were reoperated on after RS, histopathological findings included necrosis alone in 3 cases (6%). The median overall survival was 21.5 months for GBM and 57.9 months for AO. The median survival after RS was 9.5 months for GBM and 32.9 months for AO. The median progression-free survival after RS was 6.7 months for GBM and 18 months for AO. MRI volume modifications after RS showed a transitory reduction or stabilization of disease linked to significantly improved survival in 58.8% of patients with GBM, 81.1% of patients with AO. Pathological subtype (AO versus GBM), MRI response, KPS >70, marginal dose > 13 Gy, largest diameter of GTV < 25 mm and GTV < 7 ml were the main prognostic factors, associated with improved survival or PFS from RS. CONCLUSION The magnitude of the survival increase compared to historical RPA classes may not be due to selection bias alone. Linac RS in selected patients with recurrent malignant glioma was well tolerated, effective and can be considered as one of several re-treatment options.
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Affiliation(s)
- Toufic Khalil
- Service de neurochirurgie A, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France
| | - Jean Jacques Lemaire
- Service de neurochirurgie A, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France
| | - Véronique Dedieu
- Département de Radiothérapie, Centre Jean Perrin, 63 000 Clermont-Ferrand, France
| | - Denise Donnarieix
- Département de Radiothérapie, Centre Jean Perrin, 63 000 Clermont-Ferrand, France
| | - Claise Béatrice
- Service de radiologie A, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France
| | - Michel Lapeyre
- Département de Radiothérapie, Centre Jean Perrin, 63 000 Clermont-Ferrand, France
| | - Jean Louis Kemeny
- Service d'anatomie pathologique, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France
| | - Bruno Pereira
- Direction à la recherche clinique, biostatistiques, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France
| | - Aurélie Thalami
- Direction à la recherche clinique, biostatistiques, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France
| | - Jean Chazal
- Service de neurochirurgie A, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France
| | - Pierre Verrelle
- Département de Radiothérapie, Centre Jean Perrin, 63 000 Clermont-Ferrand, France
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12
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Sakka L, Coll G, Chazal J. Anatomy and physiology of cerebrospinal fluid. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:309-16. [PMID: 22100360 DOI: 10.1016/j.anorl.2011.03.002] [Citation(s) in RCA: 382] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 03/28/2011] [Indexed: 12/21/2022]
Abstract
The cerebrospinal fluid (CSF) is contained in the brain ventricles and the cranial and spinal subarachnoid spaces. The mean CSF volume is 150 ml, with 25 ml in the ventricles and 125 ml in subarachnoid spaces. CSF is predominantly, but not exclusively, secreted by the choroid plexuses. Brain interstitial fluid, ependyma and capillaries may also play a poorly defined role in CSF secretion. CSF circulation from sites of secretion to sites of absorption largely depends on the arterial pulse wave. Additional factors such as respiratory waves, the subject's posture, jugular venous pressure and physical effort also modulate CSF flow dynamics and pressure. Cranial and spinal arachnoid villi have been considered for a long time to be the predominant sites of CSF absorption into the venous outflow system. Experimental data suggest that cranial and spinal nerve sheaths, the cribriform plate and the adventitia of cerebral arteries constitute substantial pathways of CSF drainage into the lymphatic outflow system. CSF is renewed about four times every 24 hours. Reduction of the CSF turnover rate during ageing leads to accumulation of catabolites in the brain and CSF that are also observed in certain neurodegenerative diseases. The CSF space is a dynamic pressure system. CSF pressure determines intracranial pressure with physiological values ranging between 3 and 4 mmHg before the age of one year, and between 10 and 15 mmHg in adults. Apart from its function of hydromechanical protection of the central nervous system, CSF also plays a prominent role in brain development and regulation of brain interstitial fluid homeostasis, which influences neuronal functioning.
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Affiliation(s)
- L Sakka
- Laboratoire d'anatomie, faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, 63001 Clermont-Ferrand cedex 1, France.
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Laurent-Vannier A, Nathanson M, Quiriau F, Briand-Huchet E, Cook J, Billette de Villemeur T, Chazal J, Christophe C, Defoort-Dhellemmes S, Fortin G, Rambaud C, Raul JS, Rey-Salmon C, Sottet F, Vieux E, Vinchon M, Willinger R. A public hearing "Shaken baby syndrome: guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff". Guidelines issued by the Hearing Commission. Ann Phys Rehabil Med 2011; 54:600-25. [PMID: 22118914 DOI: 10.1016/j.rehab.2011.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- A Laurent-Vannier
- Service de rééducation des pathologies neurologiques acquises de l'enfant, hôpitaux de Saint-Maurice, 14, rue du val d'Osne, 94415 Saint-Maurice cedex, France.
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14
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Laurent-Vannier A, Nathanson M, Quiriau F, Briand-Huchet E, Cook J, Billette de Villemeur T, Chazal J, Christophe C, Defoort-Dhellemmes S, Fortin G, Rambaud C, Raul JS, Rey-Salmon C, Sottet F, Vieux E, Vinchon M, Willinger R. A public hearing. "Shaken baby syndrome: guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff". Scoping report. Ann Phys Rehabil Med 2011; 54:533-99. [PMID: 22118913 DOI: 10.1016/j.rehab.2011.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Laurent-Vannier
- Service de rééducation des pathologies neurologiques acquises de l'enfant, hôpitaux de Saint-Maurice, 14, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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15
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Glace B, Dubost JJ, Ristori JM, Irthum B, Chazal J, Soubrier M. [Transversal fractures in spinal ankylosis: a case series of 17 patients]. Rev Med Interne 2010; 32:283-6. [PMID: 21146904 DOI: 10.1016/j.revmed.2010.10.356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 10/20/2010] [Accepted: 10/24/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE Transverse fractures of the spine are rare. They occur in ankylosed spine and may lead to neurological complications. We report a series of 18 cases observed in 17 patients with ankylosing spondylitis (AS). The objective of this study were to describe the clinical, diagnostic and therapeutic features of our series and to compare our results with those of the literature. METHODS We conducted a retrospective study from 1975 to 2008 in the neurosurgery and rheumatology departments of the university hospital (CHU) of Clermont-Ferrand. RESULTS Eighteen transverse spine fractures were documented in 17 patients (one female patient had two fractures of the lumbar vertebrae). The 13 male and four female patients included in this series had a mean age of 57.4 ± 17.2 years and AS for a mean time of 21.3 ± 12 years (5-40). All patients had spinal ankylosis with a "bamboo" spine appearance. The reasons for hospital admission were suspicion of AS flare (n=10) and suspected traumatic fracture (n=8). Trauma, in most cases minor, was noted in 15 patients. Fourteen patients presented with mechanical spinal pain and three had both mechanical and inflammatory pain. Three patients experienced severe pain on mobilization. Two patients had pyramidal syndrome. The mean time to diagnosis of the fracture was 6.8 ± 8.4 weeks (0-22). The fracture was located in cervical spine (n=2), dorsal spine (n=8) and lumbar spine (n=8). It was transdiscal and transcorporeal in nine cases each. Standard radiographs (n=18) identified the fracture in nine cases. The fracture was demonstrated in all CT-scan (n=13). Magnetic resonance imaging (MRI) (n=6) showed the fracture in five cases and epidural hematoma in one. Eleven patients had orthopedic treatment and six underwent surgery. Outcome was favorable in 16 patients. One paraplegic patient died of pulmonary embolism. CONCLUSION Transverse fractures of the spine are rare and diagnosis should be considered in a patient with AS and ankylosed spine who presented mechanical spine pain following even minor trauma. If standard radiographs are normal, further investigations should be performed using MRI, CT-scan, or both.
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Affiliation(s)
- B Glace
- Service de rhumatologie, CHU Gabriel-Montpied, Clermont-Ferrand, France.
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16
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André M, Guettrot-Imbert G, Delèvaux I, Mom T, Chazal J, Kémény JL, Blay JY, Rousset H, Aumaitre O. Ostéomalacie oncogénique : chercher la tumeur et la traiter. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Khalil T, Lemaire JJ, Donnarieix D, Dedieu V, Pereira B, Thalami A, Kemeny JL, Chazal J, Verrelle P. Réponse tumorale et survie après radiochirurgie Linac de 50 gliomes malins intracrâniens récidivants. Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Duclos C, Bonnin N, Merlin E, Viorel A, Lacombe P, Dalens H, Chiambaretta F, Deméocq F, Chazal J, Kanold J. Hypertension intracrânienne bénigne, mais pas anodine. À propos d’un cas. Arch Pediatr 2010; 17:1677-81. [DOI: 10.1016/j.arcped.2010.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 01/21/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
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19
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Sakka L, Chomicki A, Avan P, Chazal J. Test non invasif du fonctionnement d’une dérivation du liquide cérébro-spinal (LCS). Apport des oto-émissions acoustiques (OEA). Neurochirurgie 2009. [DOI: 10.1016/j.neuchi.2009.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Mom T, Chazal J, Montalban A, Gabrillargues J, Gilain L, Avan P. Disturbances of Auditory Function during Vestibular Schwannoma Surgery: Insights from Intraoperative Distortion-Product Otoacoustic Emissions. Skull Base 2009. [DOI: 10.1055/s-2009-1222249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Le Guérinel C, Sindou M, Auque J, Blondet E, Brassier G, Chazal J, Cuny E, Devaux B, Fontaine D, Finiels PJ, Fuentes JM, D'Haens J, Massager N, Mercier P, Mooij J, Nuti C, Rousseaux P, Serrie A, Stecken J, de Waele L, Keravel Y. [Cranial nerve functional neurosurgery: evaluation of surgical practice]. Neurochirurgie 2009; 55:282-90. [PMID: 19328504 DOI: 10.1016/j.neuchi.2009.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 02/12/2009] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- C Le Guérinel
- Service de neurochirurgie, hôpital Henri-Mondor, 94000 Créteil, France.
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22
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Hermet M, Delévaux I, Trouillier S, André M, Chazal J, Aumaître O. [Pituitary metastasis presenting as diabetes insipidus: a report of four cases and literature review]. Rev Med Interne 2009; 30:425-9. [PMID: 19231038 DOI: 10.1016/j.revmed.2008.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pituitary metastases are a rare cause of central diabetes insipidus and usually complicate advanced cancers. CASE REPORTS We report four cases in which diabetes insipidus revealed a metastatic stage of a lung (two cases) or a breast (two cases) cancer. One patient presented with a panhypopituitarism, three had diabetes insipidus including one with corticotroph insufficiency. In one case, the cerebrospinal fluid analysis showed a lymphocytic meningitis. On brain magnetic resonance imaging there was an absence of high intensity signal in the posterior pituitary lobe (one case) or an infiltration of the posterior lobe (three cases). CONCLUSION Breast and lung malignancies are the most frequent causes of metastasis of the pituitary gland. In most cases there are often other metastatic locations; however insipidus diabetes can reveal the metastatic stage of the cancer. A pituitary biopsy may be necessary to obtain the diagnosis.
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Affiliation(s)
- M Hermet
- Service de médecine interne, CHU Gabriel-Montpied, 63003 Clermont-Ferrand cedex 1, France
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23
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Abstract
Benign intracranial hypertension (BIH) is a rare condition in which the pathophysiology remains unclear. Multiple theories have been proposed in the past to explain BIH. Today it is widely accepted that the condition occurs in situations where alteration of cerebrospinal fluid (CSF) reabsorption is encountered. The venous system is therefore involved and may be the common denominator of the pathophysiological theories. A distinction must be made between idiopathic benign intracranial hypertension and BIH resulting from drugs, other pathological conditions, or toxics (secondary BIH), which are reported in this paper. We emphasize the crucial role of exhaustive clinical, biological, and neuroradiological investigations aiming to establish the diagnosis of BIH.
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Affiliation(s)
- J Chazal
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex, France.
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Mendes Martins V, Khalil T, Verelle P, Donnarieix D, Dedieu V, Irthum B, Chazal J, Lemaire JJ. Radiochirurgie par LINAC des schwannomes vestibulaires : résultats sur 38 patients consécutifs. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Proust F, Gérardin E, Chazal J. Anévrisme intracrânien non rompu et exclusion microchirurgicale : justification d’une étude randomisée chirurgie versus histoire naturelle. J Neuroradiol 2008; 35:109-15. [DOI: 10.1016/j.neurad.2008.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lemaire JJ, Mendes-Martins V, Sakka L, Vassal F, Caire F, Coste J, Khalil T, Chazal J. Étude anatomique du thalamus en IRM à 4,7 Tesla et apport pour la segmentation manuelle des noyaux intra-thalamiques en chirurgie stéréotaxique. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Coste A, Khalil T, Lemaire JJ, Tao Y, Donnarieix D, Chazal J, Verrelle P. Radiochirurgie par Linac des métastases cérébrales d'origine rénale: résultats sur 19 patients consécutifs. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khalil T, Lemaire JJ, Chazal J, Verrelle P. [Role of radiosurgery in the management of intracranial cavernomas. Review of the literature]. Neurochirurgie 2007; 53:238-42. [PMID: 17498754 DOI: 10.1016/j.neuchi.2007.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 03/27/2007] [Indexed: 10/19/2022]
Abstract
From a review of the literature dealing with radiosurgery of cavernous malformations, we have analyzed its impact on hemorrhagic risk, epilepsy, histological modifications, morbidity and potential indications of treatment. Radiosurgery could significantly reduce the hemorrhagic risk, in a selected population with a high risk of hemorrhage, after an interval of about 2 years, but cannot provide protection against rebleeding. As for epilepsy related to the lesion, a significant reduction of seizures has been observed in certain cases, with better control in case of recent evolution and simple seizures linked to the site of the vascular malformation. Histologic lesions are vascular fibrosis, fibrinoid necrosis and ferrugination, without good correlation with results of CT scan or MRI. Morbidity of radiosurgery seems higher compared to other diseases with similar doses and target volumes. The rate of transient complications was about 25%, with permanent sequelae in 5 to 10% of patients. This would be due to a radiosensitizing effect of the hemosiderin halo around the lesion. Radiosurgery can be proposed for non-surgical lesions with a high risk of hemorrhage, nevertheless the superiority of the technique over conservative treatment has to be proven. Without long-term prospective studies, the efficiency of RS for cavernomas remains questionable and subject to debate. New imaging methods proving the obstruction of the cavernous malformation are needed.
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Affiliation(s)
- T Khalil
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU, 63003 Clermont-Ferrand cedex, France.
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29
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Chomicki A, Sakka L, Avan P, Khalil T, Lemaire JJ, Chazal J. Dérivation du liquide cérébrospinal avec valve: ses conséquences sur la biomécanique de l'oreille interne chez les patients atteints d'hydrocéphalie chronique de l'adulte. Neurochirurgie 2007; 53:265-71. [PMID: 17559890 DOI: 10.1016/j.neuchi.2007.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 04/10/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Patients suffering from hydrocephalus are often treated by the surgical placement of a shunt, directing the excess of cerebrospinal fluid towards another body compartment. However, the degree of clinical improvement is variable and the dynamics of cerebrospinal fluid pressure in shunted hydrocephalus is poorly understood. A recently developed noninvasive technique makes it possible to follow pressure variations: it is based on otoacoustic emissions, sounds naturally emitted by the cochlea and routinely detected in audiology. When cerebrospinal fluid pressure changes, emissions undergo a phase shift while crossing the oval window. The goal of this work is to study how this shift is affected by shunt placement. METHOD Otoacoustic emissions were recorded repeatedly in 22 adult patients who suffered from chronic hydrocephalus. Their phase shifts were measured, in sitting and recumbent positions, before and after surgical placement of a ventriculo-peritoneal shunt (Sophysa SM8). RESULTS Postural shift in normal subjects is a phase lead, and this outcome was found in 17 of 22 patients preoperatively. After shunt placement, the postural effect became a phase lag in 18 patients of 20. In a given posture, sitting or recumbent, phase shifts changed from pre to postoperative measurements in a systematic manner. CONCLUSION Otoacoustic emissions respond in a characteristic way to posture changes in normal adults, and having received a shunt for chronic hydrocephalus reverses the effect, presumably in relation to the existence of a "vacuum" in the inner ear.
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Affiliation(s)
- A Chomicki
- Laboratoire de biophysique sensorielle (EA 2667), faculté de médecine, université d'Auvergne, CHU de Clermont-Ferrand, PO Box 38, 63000 Clermont-Ferrand, France
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30
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Lemaire JJ, Coste J, Ouchchane L, Hemm S, Derost P, Ulla M, Siadoux S, Gabrillargues J, Durif F, Chazal J. MRI anatomical mapping and direct stereotactic targeting in the subthalamic region: functional and anatomical correspondence in Parkinson’s disease. Int J Comput Assist Radiol Surg 2007. [DOI: 10.1007/s11548-007-0124-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Lemaire JJ, Coste J, Ouchchane L, Caire F, Nuti C, Derost P, Cristini V, Gabrillargues J, Hemm S, Durif F, Chazal J. Brain mapping in stereotactic surgery: a brief overview from the probabilistic targeting to the patient-based anatomic mapping. Neuroimage 2007; 37 Suppl 1:S109-15. [PMID: 17644002 DOI: 10.1016/j.neuroimage.2007.05.055] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 05/18/2007] [Accepted: 05/22/2007] [Indexed: 11/23/2022] Open
Abstract
In this article, we briefly review the concept of brain mapping in stereotactic surgery taking into account recent advances in stereotactic imaging. The gold standard continues to rely on probabilistic and indirect targeting, relative to a stereotactic reference, i.e., mostly the anterior (AC) and the posterior (PC) commissures. The theoretical position of a target defined on an atlas is transposed into the stereotactic space of a patient's brain; final positioning depends on electrophysiological analysis. The method is also used to analyze final electrode or lesion position for a patient or group of patients, by projection on an atlas. Limitations are precision of definition of the AC-PC line, probabilistic location and reliability of the electrophysiological guidance. Advances in MR imaging, as from 1.5-T machines, make stereotactic references no longer mandatory and allow an anatomic mapping based on an individual patient's brain. Direct targeting is enabled by high-quality images, an advanced anatomic knowledge and dedicated surgical software. Labeling associated with manual segmentation can help for the position analysis along non-conventional, interpolated planes. Analysis of final electrode or lesion position, for a patient or group of patients, could benefit from the concept of membership, the attribution of a weighted membership degree to a contact or a structure according to its level of involvement. In the future, more powerful MRI machines, diffusion tensor imaging, tractography and computational modeling will further the understanding of anatomy and deep brain stimulation effects.
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Affiliation(s)
- Jean-Jacques Lemaire
- CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Service de Neurochirurgie A, Clermont-Ferrand, F-63003, France.
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Abstract
We describe the therapeutic indications for central nervous system cavernomas based on three criteria: 1) Single and multiple lesions: indications are the same, considering that in multiple lesions, one location can be symptomatic; 2) locations: indications are easy to define for exophytic cavernomas close to the hemisphere, brain stem or cerebellum pial surface, or to the ventricular ependyma; 3) symptomatic and non symptomatic presentations: usually, symptomatic forms require surgery except deep lesions located in functional zones distant from the ependyma or the pia matter, unless life prognosis is compromised. Treatment of a symptomatic forms remains debatable, opinion being divided between therapeutic abstention and surgery (in case of cavernomas close to the pia matter or the ependyma). Scientific data strongly support surgical indication for lesions presenting with epilepsy specially when drug-resistant; 4) natural history: prevention against hemorrhage is an argument in favor of surgery for the lesions located in non functional zones or where the risk of bleeding is higher, especially in the brain stem. Discrepancy in the risk of bleeding reported in the literature tends to temper this attitude. Radiosurgery is exceptionally reserved for technically inoperable cavernomas. Partial protection for two years can be expected. Epileptic seizures decrease but few prospective randomised studies are available. The rate of complication appears to be higher than in other affections.
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Affiliation(s)
- J Chazal
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
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Chazal J, Brunon J. [Conclusions]. Neurochirurgie 2007; 53:262-3. [PMID: 17806210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- J Chazal
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
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Ghannane H, Khalil T, Sakka L, Chazal J. Analyse d'une série de cavernomes du système nerveux central: 39 cas non opérés, 39 cas opérés et un cas décédé. Neurochirurgie 2007; 53:217-22. [PMID: 17475289 DOI: 10.1016/j.neuchi.2007.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 03/21/2007] [Indexed: 10/19/2022]
Abstract
Cavernomas are vascular malformations frequently localized in the central nervous system. Debate remains open concerning proper treatment. We reviewed a series of cavernomas in order to collect information concerning the natural history. This retrospective study concerned 79 patients seen over a 15-year period. The epidemiologic, clinical, radiological, therapeutic and follow-up data were analyzed. The cavernomas were encephalic (including brain stem and cerebellum) in 74 patients, and in the spinal cord in 5 patients. Average age was 40.08 years, without sex predominance. The most frequent clinical sign was a focal neurological deficit. The cavernoma was solitary in 71 patients. The subtentorial localization was most frequent (44 cases). Bleeding was observed in 31 patients giving a hemorrhagic risk of 0.013%/patient/year. One patient died at admission, 39 were operated and surgical abstention with clinical and radiological follow up was decided for 39 patients (no bleeding in 64.2%). The course in these patients was marked by bleeding in six during 29.5 months follow-up of (rate of hemorrhagic risk 6.27%/patient/year). These results are not in total agreement with the literature. They demonstrate the difficulties for an exact evaluation of the hemorrhagic risk in cavernomas of the central nervous system. So, it is very important to meticulously discuss surgical indications.
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Affiliation(s)
- H Ghannane
- Service de neurochirurgie A, hôpital Gabriel-Montpied, Clermont-Ferrand, France.
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Chazal J, Ghannane H, Sakka L. [Surgical anatomy of the brain stem]. Neurochirurgie 2007; 53:168-81. [PMID: 17498753 DOI: 10.1016/j.neuchi.2007.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 03/21/2007] [Indexed: 10/19/2022]
Abstract
We reviewed the literature on brain stem anatomy, to identify possible and non-hazardous entry zones with a minimum of functional risks. Using the reticular formation defined as a median structure in a coronal plane, we determined six anatomic zones, 3 ventral, 3 dorsal (mesencephalic, pontic, medulla-oblongata). Considering the functional structures surrounding each zone, the possible penetration points are described. There are ventral, one for the mesencephale, one for the pons, one for the medulla oblongata; and dorsal, one for the mesencephale, two for the floor of the 4th ventricle, one for the medulla oblongata.
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Affiliation(s)
- J Chazal
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
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Affiliation(s)
- J Brunon
- Service de neurochirurgie, hôpital de Bellevue, CHU, 17 boulevard Pasteur, 42055 Saint-Etienne cedex 02, France
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Chazal J, Brunon J. [Comments on intramedullary cavernomas]. Neurochirurgie 2007; 53:202. [PMID: 17475288 DOI: 10.1016/j.neuchi.2007.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 02/28/2007] [Indexed: 11/18/2022]
Affiliation(s)
- J Chazal
- Service de neurochirurgie A, hôpital Gabriel-Montpied, BP 69, Clermont-Ferrand cedex, France.
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Liétin B, Mom T, Avan P, Llompart X, Kemeny JL, Chazal J, Russier M, Gilain L. [Adenocarcinomas of the ethmoid sinus: retrospective analysis of prognostic factors]. ACTA ACUST UNITED AC 2007; 123:211-20. [PMID: 17185918 DOI: 10.1016/s0003-438x(06)76670-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Determinate the different prognostic factors of survival in ethmoidal sinus adenocarcinomas (ADK). MATERIAL AND METHODS 60 patients with ethmoidal sinus ADK. 59 men and one woman. Average of 62.2 years (41-82). Retrospective study between 1985 and 2005. The following data were analyzed: exposure time to wood dust, disease incidence, primary clinical symptoms and ASA score. Radiological data were recovered by tomodensitometry and magnetic resonance imaging. Histological groups were described. TNM classification according to UICC 2002 and Roux/Brasnu was established on clinical and radiological constatations. Different treatments used were analyzed. Estimate of survival rate and impact of different prognostic factors were based on Kaplan-Meier actuarial method and multivariate analysis. RESULTS Incidence rate was 2.86 patients a year. Exposure average time to wood dust was 25.6 years (2-44). T3/T4 stages were predominant (66.7%). the survival rate was 46.5% at 5 years. The survival rate was significantly superior respectively in T1 and T2 stages than in T3 and T4 stages, and in T4a than in T4b stages. Extension of the lesion to the sphenoid sinus was revealed as a significant bad prognostic factor. The ASA score and the exposure time to wood dust were not identified as statistically significant prognosis factors. CONCLUSION Survival factors of ethmoïd sinus ADK were T stage and the extension of the tumor to the sphenoid sinus. On the results of this study, we consider that extension in sphenoïd sinus could be include in TNM classification of ethmoïd sinus adenocarcinomas.
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Affiliation(s)
- B Liétin
- Service d'ORL et de Chirurgie de la face et du cou, Centre hospitalier universitaire, BP 69 63003 Clermont-Ferrand Cedex 1
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Abstract
We report the case of a hemorrhagic lumbar juxta facet cyst (L2-L3), revealed by a chronic right lumbocruralgia, in a 77-year-old woman treated by anticoagulants for cardiac arrhythmia. Computerized tomography and magnetic resonance imaging suggested the diagnosis of benign tumor. During surgical removal of the whole lesion, a hemorrhagic synovial cyst was evoked. The operation dramatically relieved the symptoms. The diagnosis was confirmed by the histopathological analysis confronted with the clinical and the radiological findings. This uncommon observation allows the discussion of the pathogenic mechanism and of the differential diagnosis.
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Affiliation(s)
- H Ghannane
- Service de Neurochirurgie A, Hôpital Gabriel Montpied, Centre Hospitalier et Universitaire de Clermont-Ferrand
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Durando X, Thivat E, Roché H, Bay JO, Lemaire JJ, Verrelle P, Lentz MA, Chazal J, Curé H, Chollet P. Cystemustine in recurrent high grade glioma. J Neurooncol 2006; 79:33-7. [PMID: 16575534 DOI: 10.1007/s11060-005-9096-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 12/06/2005] [Indexed: 10/24/2022]
Abstract
In this study, we have assessed the efficacy of a nitrosourea, cystemustine, in treating patients with recurrent high grade glioma with overall survival analysis as primary end-point. Forty-eight patients with recurrent high grade glioma (24 glioblastomas, 17 astrocytomas and 5 oligodendrogliomas) were treated every 2 weeks with 60 mg/m2 cystemustine by a 15 min-infusion. The median number of treatment cycles was 4 (range 1-17). The median overall survival was 8.3 months (range 1-97) and the 6- and 12-month overall survival rates were 55.3% (95% CI, 41.3-68.6%) and 29.8% (95% CI, 18.6-44.0%), respectively. The objective response rate was 18.8% (95% CI, 7.7-29.9%), and 54.2% of patients had stable disease (95% CI, 40.1-68.3%). Multivariate analysis showed that WHO performance status, histology and response to cystemustine were significant prognostic factors for survival of patients with recurrent glioma. In conclusion, cystemustine has encouraging activity for patients with recurrent high grade glioma.
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Affiliation(s)
- X Durando
- Centre Jean Perrin, 63011, Clermont-Ferrand Cédex, France
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Mendes-Martin V, Ghannane H, Kémény J, Chazal J, Lemaire J. Granulome intracrânien postopératoire secondaire à des microfibres de coton : à propos d’un cas. Neurochirurgie 2005. [DOI: 10.1016/s0028-3770(05)83627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chazal J. [Comments on the evolution of the human brain]. Neurochirurgie 2005; 51:197-204. [PMID: 16389908 DOI: 10.1016/s0028-3770(05)83478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J Chazal
- Service de Neurochirurgie A, Hôpital Gabriel-Montpied, CHU, BP 69, 63003 Clermont-Ferrand Cedex 01
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Abstract
The meninges correspond to an anatomical concept. For the morphologist, the microscopic organization, the hypothetical presence of a subdural space, the nature of the interface between the deep meningeal layer and the nervous parenchyma in the perivascular spaces are the central issues. For the clinician, dynamic aspects of cerebrospinal fluid flow, secretion, and resorption are essential factors with practical consequences in terms of disease and patient management. Comparative anatomy, embryology, and organogenesis provide an interesting perspective for the descriptive and functional anatomy of the meninges. Usually considered as protective membranes, the meninges play a prominent role in the development and maintenance of the central nervous system. The meninges are in constant evolution, from their formation to senescence. The meninges present three layers in children and adults: the dura mater, the arachnoid and the pia mater. The cerebrospinal fluid is secreted by the choroid plexuses, flows through the ventricles and the subarachnoid space, and is absorbed by arachnoid granulations. Other sites of secretion and resorption are suggested by comparative anatomy and human embryology and organogenesis.
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Affiliation(s)
- L Sakka
- Laboratoire d'Anatomie et Organogenèse, Faculté de Médecine, 28 Place Henri Dunant, BP 38, 63001 Clermont-Ferrand.
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Khalil T, Achim V, Bard J, Tao Y, Verrelle P, Chazal J, Lemaire J. Radiochirurgie dans les gliomes malins récidivants hémisphériques de l’adulte. À propos de 16 Patients traitées par LINAC. Neurochirurgie 2005. [DOI: 10.1016/s0028-3770(05)83428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chazal J. L’hydrocéphalie chronique de l’adulte : où en est le concept en 2005. Neurochirurgie 2005; 51:38-40. [PMID: 15851964 DOI: 10.1016/s0028-3770(05)83419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- J Chazal
- Société de Neurochirurgie de la Langue Française, Service de Neurochirurgie, CHU Gabriel-Montpied, Clermont-Ferrand
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Khalil T, Puget S, Lemaire JJ, Chazal J, Irthum B. [Spontaneous intrasphenoidal encephalocele. Report of two cases revealed by rhinorrhea]. Neurochirurgie 2003; 49:114-8. [PMID: 12746728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
We report two cases of spontaneous anteromedial temporo-sphenoidal meningo-encephalocele. The first patient was a 67-year-old man with a history of treated epiglotic cancer 6 years ago, was referred to us for CSF rhinorrhea. Lateral sphenoidal CSF fistula was confirmed by CT cisternography. Four lumbar taps were performed and rhinorrhea stopped for 2 years. At relapse of rhinorrhea, the patient was operated on via a subtemporal approach. The dural defect was filled by an intradural patch of pericranium. Four years later patient showed no evidence of cerebrospinal fluid leakage. The second patient was a 54-year-old woman referred to us after a one year history of CSF rhinorrhea. CT cisternography confirmed lateral sphenoidal CSF fistula. The patient was operated on via a subtemporal approach. The dural defect was filled by a patch of pericranium. Three years later the patient had no evidence of cerebrospinal fluid leakage. Twenty-one cases of anteromedial temporosphenoidal meningo-encephaloceles have been reported in the literature. They probably are of a developmental origin. Some cases have been successfully treated via a transsphenoidal route. However surgical failures related to this approach can be due to the lack of control of the lateral recess of the sphenoid sinus. Therefore, the frontotemporal approach seems more adequate but the transphenoidal endoscopic approach will probably be used in the future.
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Affiliation(s)
- T Khalil
- Service de Neurochirurgie, Hôpital Gabriel-Montpied, CHU, BP 69, 63003 Clermont-Ferrand Cedex 1.
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Durando X, Lemaire JJ, Tortochaux J, Van-Praagh I, Kwiatkowski F, Vincent C, Bailly C, Verrelle P, Irthum B, Chazal J, Bay JO. High-dose BCNU followed by autologous hematopoietic stem cell transplantation in supratentorial high-grade malignant gliomas: a retrospective analysis of 114 patients. Bone Marrow Transplant 2003; 31:559-64. [PMID: 12692621 DOI: 10.1038/sj.bmt.1703889] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Conventional treatment of high-grade glioma includes maximal surgical resection followed by external radiation therapy. Despite this treatment, the prognosis for patients is poor. High doses of chemotherapy might be another way to increase the response rate and median survival. Increasing doses of BCNU might be more effective, but also provokes unacceptable myelotoxicity. This dose-limiting toxicity can be circumvented by using autologous blood stem cell rescue. We report our experience of high-dose BCNU followed by transplantation of autologous hematopoietic stem cells in 114 patients with high-grade gliomas. Of the 114 gliomas, 78 were glioblastoma multiforme (GM) (68%), 24 anaplastic astrocytomas (AA) (21%), and 12 anaplastic oligodendrogliomas (OD) (11%). Complete surgical resection was performed for 22 patients (18 GM and 4 AA). The median age was 44 years (range 17-65). A total of 84 patients received autologous hematopoietic stem cells from bone marrow harvest, while 30 patients received granulocyte colony-stimulating factor followed by apheresis and received peripheral blood progenitor cells (PBPC). High dose of BCNU (800 mg/m(2)) was given at least 1 month after neurosurgery. Bone marrow or PBPC was transplanted 48-72 h after chemotherapy. Radiotherapy was started approximately 40 days after transplantation to a total of 60 Gy. Median follow-up was 89 months (19-163). The overall survival (OS) was, respectively, 12 months for GM, 37 months for OD and 81 months for AA. Histological type appeared to be the main discriminating factor, with a worse prognosis for GM. Within the GM population, age, completeness of surgery, and response appeared to be one important prognostic factors. The AA and OD populations were small to reliably assess prognostic factors. On multivariate analysis, the main prognostic factors were histologic type, quality of surgery, and age (P<0.005). Five of 114 patients had lethal complications from the procedure. Four of these patients had a Karnovsky performance score (KPS) of 60%. The protocol thus appears to be feasible but patients should be selected for KPS more than 70%. We observed long-term survivors, although the OS and the time to treatment failure seem to be comparable to that described for other treatment. Additional pilot studies are unlikely to reveal more than a modest benefit from this procedure and therefore a randomized study should be performed.
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Affiliation(s)
- X Durando
- Départment d'oncologie médicale, Centre Jean Perrin, Clermont-Ferrand cedex 01, France
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