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Chabert E, Hugonnet E, Kastler A, Sakka L, Rabbo FA, Zerroug A, Coudeyre E, Pereira B, Coll G. Vertebroplasty versus bracing in acute vertebral compression fractures: A prospective randomized trial. Ann Phys Rehabil Med 2023; 66:101746. [PMID: 37030247 DOI: 10.1016/j.rehab.2023.101746] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 11/21/2022] [Accepted: 12/17/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND The treatment of stable vertebral compression fractures remains controversial. OBJECTIVE To compare the efficacy of vertebroplasty and bracing for acute vertebral compression fractures. METHODS We conducted a prospective, randomized, non-blinded, single-center study. Adult participants were randomized to undergo vertebroplasty or bracing. Both groups were stratified by age. The primary outcome was functional disability (Roland-Morris disability questionnaire [RMDQ]). Secondary outcomes were pain intensity (Visual Analogue Scale [VAS]), and change in vertebral body height and kyphosis angle. Outcomes were assessed on day 2, and 1, 3 and 6 months after treatment. RESULTS Ninety-nine people were included, 51 in the vertebroplasty group and 48 in the brace group. Treatment was performed within 2 weeks of the trauma. On day 2 post-treatment, pain was lower in the vertebroplasty group (mean [SD] 2.3 [1.5] versus 3.4 [2.1], p = 0.004) but the difference was no longer significant at 6 months. Functional disability was significantly lower in the vertebroplasty than brace group at all time-points (RMDQ score 7.5 [5.7] vs 11.4 [5.3], p<0.001 at 1 month). At 6 months, the increase in kyphosis angle was smaller in the vertebroplasty than the brace group (+1.5°versus +4°, p<0.001). CONCLUSION In people with acute vertebral compression fractures, the immediate effect of vertebroplasty was greater than that of bracing on pain and function, and for restoring sagittal balance. At 6 months, the superiority of vertebroplasty decreased, except for the maintenance of sagittal balance. DATABASE REGISTRATION ClinicalTrials.gov number, NCT01643395.
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Affiliation(s)
- Emmanuel Chabert
- Service de Neuroradiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France
| | - Eulalie Hugonnet
- Service de Radiologie, Hôpital de Vichy, Boulevard Denière, 03200 Vichy, France
| | - Adrian Kastler
- Service de Neuroradiologie, Centre Hospitalier Universitaire de Grenoble-Alpes, Avenue des Maquis du Grésivaudan, 38700 La Tronche, France
| | - Laurent Sakka
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France
| | - Francis Abed Rabbo
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France
| | - Abderrahim Zerroug
- Service de Neuroradiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de médecine physique et réadaptation, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation à La Recherche Clinique et à L'Innovation, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France
| | - Guillaume Coll
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France; INSERM, CIC 1405, unité CRECHE, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63 000 Clermont-Ferrand, France.
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Passemard L, Hida S, Barrat A, Sakka L, Barthélémy I, Dang NP. Eyelid and periorbital necrotizing fasciitis, a severe preseptal infection, a systemic review of the literature and anatomical illustrations. J Stomatol Oral Maxillofac Surg 2023:101498. [PMID: 37178871 DOI: 10.1016/j.jormas.2023.101498] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
In necrotizing fasciitis, aggressive surgical debridement and broad-spectrum antibiotics are the cornerstone of treatment but cannot be proposed for the eyelid and periorbital area because of the risk of blindness, eyeball exposure and disfiguration. The aim of this review was to determine the most effective management of this severe infection while preserving eye function. A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to March 2022; 53 patients were included. Management was probabilistic, combining antibiotic therapy with skin (+/- orbicularis oculi muscle) debridement in 67.9 % of cases, and probabilistic antibiotic therapy alone in 16.9% of cases. Radical surgery with exenteration was performed in 11.1% of patients; 20.9% of patients had complete loss of vision, and 9.4% died of the disease. Aggressive debridement was rarely necessary possibly because of the anatomical particularities of this region.
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Affiliation(s)
- Léa Passemard
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Sarah Hida
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Antoine Barrat
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Laurent Sakka
- Laboratoire d'anatomie, Faculté de Médecine, Université d'Auvergne, 28, place Henri-Dunant, 63001 Clermont-Ferrand cedex 1, France..
| | - Isabelle Barthélémy
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France.; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, 63003, France..
| | - Nathalie Pham Dang
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France.; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, 63003, France..
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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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Coll G, de Schlichting E, Sakka L, Garcier JM, Peyre H, Lemaire JJ. Assessment of Maturational Changes in White Matter Anisotropy and Volume in Children: A DTI Study. AJNR Am J Neuroradiol 2020; 41:1726-1732. [PMID: 32816761 DOI: 10.3174/ajnr.a6709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Anisotropy is a good indicator of white matter fascicle macrostructure and organization but the interpretation of its changes with age remains difficult. The increase of WM fascicle fractional anisotropy with time and its relationship with WM fascicle volume have never been examined during childhood. We studied the maturation of associative WM fascicles during childhood using MR imaging-based DTI. We explored whether the fractional anisotropy increase of the main WM fascicles persists beyond the period of brain growth and is related to WM fascicle volume increase. MATERIALS AND METHODS In a series of 25 healthy children, the fractional anisotropy and volume of 15 associative WM fascicles were calculated. Several regression linear mixed models were used to study maturation parameters (fractional anisotropy, volume, and total telencephalon volume) considered as dependent variables, while age and sex were independent variables (the variable identifying the different WM fascicles was considered as a repeated measure). RESULTS In children older than 8 years of age, WM fascicle fractional anisotropy increased with age (P value = .045) but not its volume (P value = .7) or the telencephalon volume (P value = .16). The time course of WM fascicle fractional anisotropy and volume suggested that each WM fascicle might follow a specific pattern of maturation. CONCLUSIONS The fractional anisotropy increase of several WM fascicles after 8 years of age may not result from an increase in WM fascicle volume. It might be the consequence of other developmental processes such as myelination.
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Affiliation(s)
- G Coll
- Service de Neurochirurgie (G.C.), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France .,Centre National de la Recherche Scientifique (G.C.), SIGMA Clermont, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
| | - E de Schlichting
- Service de Neurochirurgie (E.d.S.), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - L Sakka
- Service de Neurochirurgie (L.S.), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,Laboratoire d'anatomie et d'organogenèse, laboratoire de biophysique sensorielle (L.S.), NeuroDol, faculté de médecine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - J-M Garcier
- Service de Radiologie Pédiatrique (J.M.-G.), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle (J.M.G.), NeuroDol, Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - H Peyre
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Robert Debré (H.P.), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J-J Lemaire
- Service de Neurochirurgie (J.-J.L.), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.,Centre National de la Recherche Scientifique (J.-J.L.), SIGMA Clermont, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
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Abed Rabbo F, Kouyoumdjian P, Coste N, Coll G, Sakka L, Dupeyron A. Pelvic parameters and sagittal alignment in people with chronic low back pain and active discopathy (Modic 1 changes): A case-control study. Ann Phys Rehabil Med 2020; 64:101400. [PMID: 32535168 DOI: 10.1016/j.rehab.2020.05.007] [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: 04/21/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Francis Abed Rabbo
- Service de Neurochirurgie B. Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Clermont-Ferrand, France; Département d'Anatomie, UFR de Médecine et des Professions Paramédicales, Université Clermont-Auvergne, Clermont-Ferrand, France.
| | - Pascal Kouyoumdjian
- Service de chirurgie Orthopédique et de la Colonne Vertébrale, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France
| | - Nicolas Coste
- Service de Médecine physique et réadaptation. Centre Hospitalo-Universitaire (CHU) de Clermont-Ferrand, INRA, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Guillaume Coll
- Service de Neurochirurgie B. Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Clermont-Ferrand, France
| | - Laurent Sakka
- Service de Neurochirurgie B. Centre Hospitalo-Universitaire (CHU) de Clermont Ferrand, Clermont-Ferrand, France; Département d'Anatomie, UFR de Médecine et des Professions Paramédicales, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Arnaud Dupeyron
- Service de Médecine Physique & de Réadaptation, CHU Nîmes, Université de Montpellier, Montpellier France
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Coll G, El Ouadih Y, Abed Rabbo F, Jecko V, Sakka L, Di Rocco F. Hydrocephalus and Chiari malformation pathophysiology in FGFR2-related faciocraniosynostosis: A review. Neurochirurgie 2019; 65:264-268. [PMID: 31525395 DOI: 10.1016/j.neuchi.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/25/2019] [Accepted: 09/03/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with syndromic faciocraniosynostosis due to the mutation of the fibroblast growth factor receptor (FGFR) 2 gene present premature fusion of the coronal sutures and of the cranial base synchondrosis. Cerebrospinal fluid (CSF) circulation disorders and cerebellar tonsil prolapse are frequent findings in faciocraniosynostosis. OBJECTIVE We reviewed the medical literature on the pathophysiological mechanisms of CSF disorders such as hydrocephalus and of cerebellar tonsil prolapse in FGFR2-related faciocraniosynostosis. DISCUSSION Different pathophysiological theories have been proposed, but none elucidated all the symptoms present in Apert, Crouzon and Pfeiffer syndromes. The first theory that addressed CSF circulation disruption was the constrictive theory (cephalocranial disproportion): cerebellum and brain stem are constricted by the small volume of the posterior fossa. The second theory proposed venous hyperpressure due to jugular foramens stenosis. The most recent theory proposed a pressure differential between CSF in the posterior fossa and in the vertebral canal, due to foramen magnum stenosis.
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Affiliation(s)
- G Coll
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, SIGMA, Institut Pascal, Clermont-Ferrand, France.
| | - Y El Ouadih
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - F Abed Rabbo
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - V Jecko
- Service de Neurochirurgie, CHU Bordeaux, Bordeaux, France
| | - L Sakka
- Service de Neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, Faculté de Médecine, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - F Di Rocco
- Service de Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Lyon, France; Université Claude Bernard, INSERM 1033, Lyon, France
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El Ouadih Y, Coll G, Jean B, Coste A, Chaix R, Sakka L, Lemaire JJ. A rare complication of flow diverter: delayed migration causing aneurysm expansion and brainstem compression. Br J Neurosurg 2019:1-4. [PMID: 31130025 DOI: 10.1080/02688697.2019.1617406] [Citation(s) in RCA: 1] [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] [Indexed: 10/26/2022]
Abstract
Flow-diverting stents (FD) are admitted therapeutic devices for challenging aneurysms. Delayed migrations of FD remain exceptional, particularly with brainstem compression. We report a case of delayed migration of pipeline embolization device (PED) responsible of medulla oblongata compression due to expansion of posterior inferior cerebellar artery (PICA) aneurysm. This is the first report of brainstem compression due to delayed migration of FD. Among the seven previously reported cases of FD delayed migration, two led to death. Our case illustrates the importance of technical issues of stenting and the role of surgery facing the clinical emergency of vascular compression of lower brainstem. We wanted to warn neurosurgeons of this rare and delayed complication, which likely could become less exceptional with the increase of indications and utilizations of FD.
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Affiliation(s)
- Youssef El Ouadih
- a Service de Neurochirurgie , CHU Gabriel Montpied , Clermont-Ferrand , France
| | - Guillaume Coll
- a Service de Neurochirurgie , CHU Gabriel Montpied , Clermont-Ferrand , France
| | - Betty Jean
- a Service de Neurochirurgie , CHU Gabriel Montpied , Clermont-Ferrand , France
| | - Aurélien Coste
- a Service de Neurochirurgie , CHU Gabriel Montpied , Clermont-Ferrand , France
| | - Rémi Chaix
- a Service de Neurochirurgie , CHU Gabriel Montpied , Clermont-Ferrand , France
| | - Laurent Sakka
- a Service de Neurochirurgie , CHU Gabriel Montpied , Clermont-Ferrand , France
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Sakka L, Delétage N, Chalus M, Aissouni Y, Sylvain-Vidal V, Gobron S, Coll G. Assessment of citalopram and escitalopram on neuroblastoma cell lines. Cell toxicity and gene modulation. Oncotarget 2018; 8:42789-42807. [PMID: 28467792 PMCID: PMC5522106 DOI: 10.18632/oncotarget.17050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRI) are common antidepressants which cytotoxicity has been assessed in cancers notably colorectal carcinomas and glioma cell lines. We assessed and compared the cytotoxicity of 2 SSRI, citalopram and escitalopram, on neuroblastoma cell lines. The study was performed on 2 non-MYCN amplified cell lines (rat B104 and human SH-SY5Y) and 2 human MYCN amplified cell lines (IMR32 and Kelly). Citalopram and escitalopram showed concentration-dependent cytotoxicity on all cell lines. Citalopram was more cytotoxic than escitalopram. IMR32 was the most sensitive cell line. The absence of toxicity on human primary Schwann cells demonstrated the safety of both molecules for myelin. The mechanisms of cytotoxicity were explored using gene-expression profiles and quantitative real-time PCR (qPCR). Citalopram modulated 1 502 genes and escitalopram 1 164 genes with a fold change ≥ 2. 1 021 genes were modulated by both citalopram and escitalopram; 481 genes were regulated only by citalopram while 143 genes were regulated only by escitalopram. Citalopram modulated 69 pathways (KEGG) and escitalopram 42. Ten pathways were differently modulated by citalopram and escitalopram. Citalopram drastically decreased the expression of MYBL2, BIRC5 and BARD1 poor prognosis factors of neuroblastoma with fold-changes of -107 (p<2.26 10−7), -24.1 (p<5.6 10−9) and -17.7 (p<1.2 10−7). CCNE1, AURKA, IGF2, MYCN and ERBB2 were more moderately down-regulated by both molecules. Glioma markers E2F1, DAPK1 and CCND1 were down-regulated. Citalopram displayed more powerful action with broader and distinct spectrum of action than escitalopram.
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Affiliation(s)
- Laurent Sakka
- Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, Faculté de Médecine, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France.,Service de Neurochirurgie, Pole RMND, CHU de Clermont-Ferrand, Hôpital Gabriel-Montpied, 63003 Clermont-Ferrand Cedex, France
| | - Nathalie Delétage
- Neuronax SAS, Biopôle Clermont-Limagne, F-63360 Saint-Beauzire, France
| | - Maryse Chalus
- Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, Faculté de Médecine, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Youssef Aissouni
- Laboratoire de Pharmacologie Fondamentale et Clinique de la Douleur, NeuroDol, Faculté de Médecine, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | | | - Stéphane Gobron
- Neuronax SAS, Biopôle Clermont-Limagne, F-63360 Saint-Beauzire, France
| | - Guillaume Coll
- Service de Neurochirurgie, Pole RMND, CHU de Clermont-Ferrand, Hôpital Gabriel-Montpied, 63003 Clermont-Ferrand Cedex, France
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Coll G, Lemaire JJ, Di Rocco F, Barthélémy I, Garcier JM, De Schlichting E, Sakka L. Human Foramen Magnum Area and Posterior Cranial Fossa Volume Growth in Relation to Cranial Base Synchondrosis Closure in the Course of Child Development. Neurosurgery 2017; 79:722-735. [PMID: 27341342 DOI: 10.1227/neu.0000000000001309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To date, no study has compared the evolution of the foramen magnum area (FMA) and the posterior cranial fossa volume (PCFV) with the degree of cranial base synchondrosis ossification. OBJECTIVE To illustrate these features in healthy children. METHODS The FMA, the PCFV, and the ossification of 12 synchondroses according to the Madeline and Elster scale were retrospectively analyzed in 235 healthy children using millimeter slices on a computed tomography scan. RESULTS The mean FMA of 6.49 cm in girls was significantly inferior to the FMA of 7.67 cm in boys (P < .001). In both sexes, the growth evolved in a 2-phase process, with a phase of rapid growth from birth to 3.75 years old (yo) followed by a phase of stabilization. In girls, the first phase was shorter (ending at 2.6 yo) than in boys (ending at 4.33 yo) and proceeded at a higher rate. PCFV was smaller in girls (P < .001) and displayed a biphasic pattern in the whole population, with a phase of rapid growth from birth to 3.58 yo followed by a phase of slow growth until 16 yo. In girls, the first phase was more active and shorter (ending at 2.67 yo) than in boys (ending at 4.5 yo). The posterior interoccipital synchondroses close first, followed by the anterior interoccipital and occipitomastoidal synchondroses, the lambdoid sutures simultaneously, then the petro-occipital and spheno-occipital synchondroses simultaneously. CONCLUSION The data provide a chronology of synchondrosis closure. We showed that FMA and PCFV are constitutionally smaller in girls at birth (P ≤ .02) and suggest that a sex-related difference in the FMA is related to earlier closure of anterior interoccipital synchondroses in girls (P = .01). ABBREVIATIONS AIOS, anterior interoccipital synchondrosesFMA, foramen magnum areaLS, lambdoid suturesOMS, occipitomastoidal synchondrosesPCFV, posterior cranial fossa volumePIOS, posterior interoccipital synchondrosesPOS, petro-occipital synchondrosesSOS, spheno-occipital synchondrosisyo, years old.
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Affiliation(s)
- Guillaume Coll
- *Service de Neurochirurgie, Hôpital Gabriel Montpied, Clermont-Ferrand, France;‡Laboratoire d'anatomie, Université Clermont Auvergne, Université d'Auvergne, Clermont-Ferrand, France;§Université Clermont Auvergne, Université d'Auvergne, EA 7282, Image Guided Clinical Neurosciences and Connectomics, Clermont-Ferrand, France;¶Unité de Chirurgie Craniofaciale, Service de Neurochirurgie Pédiatrique, Centre de Référence National des Dysostoses Crâniofaciales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France;‖Service de Chirurgie Maxillo-Faciale, Hôpital Estaing, Clermont-Ferrand, France;#Service de Radiologie Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France
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11
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Giraudet F, Longeras F, Mulliez A, Thalamy A, Pereira B, Avan P, Sakka L. Noninvasive detection of alarming intracranial pressure changes by auditory monitoring in early management of brain injury: a prospective invasive versus noninvasive study. Crit Care 2017; 21:35. [PMID: 28219399 PMCID: PMC5319090 DOI: 10.1186/s13054-017-1616-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/24/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND In brain-injured patients intracranial pressure (ICP) is monitored invasively by a ventricular or intraparenchymal transducer. The procedure requires specific expertise and exposes the patient to complications such as malposition, hemorrhage or infection. As inner-ear fluid compartments are connected to the cerebrospinal fluid space, ICP changes elicit subtle changes in the physiology of the inner ear. Notably, we previously demonstrated that the phase of cochlear microphonic potential (CM) generated by sound stimuli rotates with ICP. The aim of our study was to validate the monitoring of CM as a noninvasive method to follow ICP. METHODS Non-invasive measure of CM-phase was compared to ICP recorded invasively in a prospective series of patients with acute brain injury managed in a neuro-intensive care unit. The study focused on patients with varying ICP and normal middle-ear function. RESULTS In the 24 patients with less than 4 days of endotracheal ventilation and whose ICP fluctuated (50-hour data), we demonstrated close correlation between CM-phase rotation and ICP (average 1.26 degrees/mmHg). As a binary classifier, CM phase changes of 7-10 degrees signaled 7.5-mmHg ICP increases with a sensitivity of 83% and 19% fallout. CONCLUSION Reference methods to measure ICP require the surgical placement of a pressure transducer. Noninvasive CM-based monitoring of ICP might be beneficial to early management of brain-injured patients with initially preserved consciousness and to the diagnosis of neurological conditions, whenever invasive monitoring cannot be performed. TRIAL REGISTRATION ClinicalTrials.gov NCT01685476 , registered on 30 August 2012.
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Affiliation(s)
- Fabrice Giraudet
- University Clermont Auvergne, Laboratory of Neurosensory Biophysics, UMR INSERM 1107, Clermont-Ferrand, France
| | - François Longeras
- Department of Anesthesiology and Intensive Care, University Hospital, rue Montalembert, Clermont-Ferrand, 63000, France
| | - Aurélien Mulliez
- Department of Biostatistics, University Hospital, PO Box 69, Clermont-Ferrand, 63003, France
| | - Aurélie Thalamy
- Department of Clinical Research and Innovation, University Hospital, PO Box 69, Clermont-Ferrand, 63003, France
| | - Bruno Pereira
- Department of Biostatistics, University Hospital, PO Box 69, Clermont-Ferrand, 63003, France
| | - Paul Avan
- University Clermont Auvergne, Laboratory of Neurosensory Biophysics, UMR INSERM 1107, Clermont-Ferrand, France. .,Centre Jean Perrin, 30 rue Montalembert, Clermont-Ferrand, 63000, France. .,School of Medicine, 28 Place Henri Dunant, Clermont-Ferrand, 63000, France.
| | - Laurent Sakka
- University Clermont Auvergne, Laboratory of Neurosensory Biophysics, UMR INSERM 1107, Clermont-Ferrand, France
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12
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d'ostrevy N, Ardellier FD, Cassagnes L, Ouchchane L, Azarnoush K, Camilleri L, Sakka L. The apex of the aortic arch backshifts with aging. Surg Radiol Anat 2016; 39:703-710. [PMID: 27921138 DOI: 10.1007/s00276-016-1792-9] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Only a few studies, involving small numbers of patients, have globally assessed the curvature of the thoracic aorta but without any details concerning the location of the supra-aortic trunks. OBJECTIVES Using CT to describe normal aortic-arch morphology and its changes with age and sex. METHODS 344 CT scans were studied. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch, that of the segment, including bifurcations of supra-aortic vessels, and the angle, height, and shift of the arch. RESULTS In men, the arch was significantly longer (146.2 vs 122.8 mm; p < 0.001), higher (49.3 vs 40.1 mm, p < 0.001), and wider transversely (83.6 vs 73.3 mm; p < 0.001) than in women. The average men's arch also had a more acute angle at the apex (79.7° vs 83.7° p < 0.001). Neither morphology nor age influenced the winding angle around the mediastinum. Aging was accompanied by deflection and extension of the aortic arch, which grew more anteroposteriorly (6.1 mm/10 years in men) than vertically (2.5 mm/10 years in men), while the apex moved towards the rear of the arch. The ascending aorta was the only curvilinear length unaffected by age, whereas the supra-aortic trunks parted from each other. CONCLUSION We believe that all these original observations could lead to a better assessment of normal aging of the aorta and guide technical choices during surgical or hybrid procedures.
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Affiliation(s)
- N d'ostrevy
- Heart Surgery Department, Clermont-Ferrand University Hospital, Place H. Dunant, 63000, Clermont-Ferrand, France. .,ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France.
| | - F D Ardellier
- Radiology Department, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France
| | - L Cassagnes
- Radiology Department, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France.,ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France
| | - L Ouchchane
- ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France.,Laboratoire de Biostatistique Informatique Médicale et Technologies de Communication, University Clermont1, 63000, Clermont-Ferrand, France
| | - K Azarnoush
- Heart Surgery Department, Clermont-Ferrand University Hospital, Place H. Dunant, 63000, Clermont-Ferrand, France.,INRA, UMR 1019 Nutrition Humaine, 63122, Saint Genès Champanelle, France
| | - L Camilleri
- Heart Surgery Department, Clermont-Ferrand University Hospital, Place H. Dunant, 63000, Clermont-Ferrand, France.,ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France
| | - L Sakka
- Laboratoire d'anatomie, University Clermont1, 63000, Clermont-Ferrand, France
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13
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Zerroug A, Gabrillargues J, Coll G, Vassal F, Jean B, Chabert E, Claise B, Khalil T, Sakka L, Feschet F, Durif F, Boyer L, Coste J, Lemaire JJ. Personalized mapping of the deep brain with a white matter attenuated inversion recovery (WAIR) sequence at 1.5-tesla: Experience based on a series of 156 patients. Neurochirurgie 2016; 62:183-9. [PMID: 27236731 DOI: 10.1016/j.neuchi.2016.01.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/29/2015] [Accepted: 01/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Deep brain mapping has been proposed for direct targeting in stereotactic functional surgery, aiming to personalize electrode implantation according to individual MRI anatomy without atlas or statistical template. We report our clinical experience of direct targeting in a series of 156 patients operated on using a dedicated Inversion Recovery Turbo Spin Echo sequence at 1.5-tesla, called White Matter Attenuated Inversion Recovery (WAIR). METHODS After manual contouring of all pertinent structures and 3D planning of trajectories, 312 DBS electrodes were implanted. Detailed anatomy of close neighbouring structures, whether gray nuclei or white matter regions, was identified during each planning procedure. We gathered the experience of these 312 deep brain mappings and elaborated consistent procedures of anatomical MRI mapping for pallidal, subthalamic and ventral thalamic regions. We studied the number of times the central track anatomically optimized was selected for implantation of definitive electrodes. RESULTS WAIR sequence provided high-quality images of most common functional targets, successfully used for pure direct stereotactic targeting: the central track corresponding to the optimized primary anatomical trajectory was chosen for implantation of definitive electrodes in 90.38%. CONCLUSION WAIR sequence is anatomically reliable, enabling precise deep brain mapping and direct stereotactic targeting under routine clinical conditions.
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Affiliation(s)
- A Zerroug
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - J Gabrillargues
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - G Coll
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - F Vassal
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France
| | - B Jean
- Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - E Chabert
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - B Claise
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - T Khalil
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - L Sakka
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - F Feschet
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France
| | - F Durif
- Service of neurology, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - L Boyer
- Service of radiology, CHU de Clermont-Ferrand, 63003 Clemront-Ferrand, France
| | - J Coste
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J-J Lemaire
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
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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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Abstract
Abstract
BACKGROUND
The spinal meninges have received less attention than the cranial meninges in the literature, although several points remain debatable and poorly understood, like their phylogenesis, their development, and their interactions with the spinal cord. Their constancy among the chordates shows their crucial importance in central nervous system homeostasis and suggests a role far beyond mechanical protection of the neuraxis.
OBJECTIVE
This work provides an extensive study of the spinal meninges, from an overview of their phylogenesis and embryology to a descriptive and topographic anatomy with clinical implications. It examines their involvement in spinal cord development, functioning, and repair.
METHODS
This work is a review of the literature using PubMed as a search engine on Medline.
RESULTS
The stages followed by the meninges along the phylogenesis could not be easily compared with their development in vertebrates for methodological aspects and convergence processes throughout evolution. The distinction between arachnoid and pia mater appeared controversial. Several points of descriptive anatomy remain debatable: the functional organization of the arterial network, and the venous and lymphatic drainages, considered differently by classical anatomic and neuroradiological approaches. Spinal meninges are involved in neurodevelopment and neurorepair producing neural stem cells and morphogens, in cerebrospinal fluid dynamics and neuraxis functioning by the synthesis of active molecules, and the elimination of waste products of central nervous system metabolism.
CONCLUSION
The spinal meninges should be considered as dynamic functional formations evolving over a lifetime, with ultrastructural features and functional interactions with the neuraxis remaining not fully understood.
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Affiliation(s)
- Laurent Sakka
- Laboratoire d'Anatomie, Université Clermont Auvergne, Université d'Auvergne, Clermont-Ferrand, France
- Service de Neurochirurgie, Pole RMND, CHU Gabriel Montpied, Clermont-Ferrand, France
- Neurosensory Biophysics, INSERM Unit 1107, University of Auvergne, France
| | - Jean Gabrillargues
- Service de Neuroradiologie, Pole RMND, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Guillaume Coll
- Laboratoire d'Anatomie, Université Clermont Auvergne, Université d'Auvergne, Clermont-Ferrand, France
- Service de Neurochirurgie, Pole RMND, CHU Gabriel Montpied, Clermont-Ferrand, France
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16
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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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Veziant J, Sakka L, Galvaing G, Tardy MM, Cassagnes L, Filaire M. Lymphovenous anastomosis for recurrent swelling syndrome and chylous effusion due to cervical thoracic duct cyst. J Vasc Surg 2014; 62:1068-70. [PMID: 24745943 DOI: 10.1016/j.jvs.2014.02.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Abstract
Thoracic duct (TD) cyst is an uncommon abnormality that can be manifested as a cervical swelling. Pathogenesis includes congenital or degenerative weakness of the wall of the TD and obstruction of the lymphoid flow. Diagnosis is crucial to eliminate malignant disease or vein thrombosis and can be established by imaging and needle aspiration. We report a case of recurrent cervical swelling with spontaneous chylothorax and chyloperitoneum. A TD cyst with a terminal obstruction of the TD was diagnosed on lymphangiography. Treatment by microsurgical lymphovenous anastomosis was successful, and the patient was free of symptom 3 years later.
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Affiliation(s)
- Julie Veziant
- Service de Chirurgie Thoracique, Centre Jean Perrin, Clermont-Ferrand, France; Laboratoire d'Anatomie, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Laurent Sakka
- Laboratoire d'Anatomie, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Géraud Galvaing
- Service de Chirurgie Thoracique, Centre Jean Perrin, Clermont-Ferrand, France; Laboratoire d'Anatomie, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Marie M Tardy
- Service de Chirurgie Thoracique, Centre Jean Perrin, Clermont-Ferrand, France
| | - Lucie Cassagnes
- Service de Radiologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Filaire
- Service de Chirurgie Thoracique, Centre Jean Perrin, Clermont-Ferrand, France; Laboratoire d'Anatomie, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France; Unité de Nutrition Humaine, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.
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Lemaire JJ, Nezzar H, Sakka L, Boirie Y, Fontaine D, Coste A, Coll G, Sontheimer A, Sarret C, Gabrillargues J, De Salles A. Maps of the adult human hypothalamus. Surg Neurol Int 2013; 4:S156-63. [PMID: 23682342 PMCID: PMC3654779 DOI: 10.4103/2152-7806.110667] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 01/14/2023] Open
Abstract
The human hypothalamus is a small deeply located region placed at the crossroad of neurovegetative, neuroendocrine, limbic, and optic systems. Although deep brain stimulation techniques have proven that it could be feasible to modulate these systems, targeting the hypothalamus and in particular specific nuclei and white bundles, is still challenging. Our goal was to make a synthesis of relevant topographical data of the human hypothalamus, under the form of magnetic resonance imaging maps useful for mastering its elaborated structure as well as its neighborhood. As from 1.5 Tesla, Inversion-Recovery sequence allows locating the hypothalamus and most of its components. Spotting hypothalamic compartments is possible according to specific landmarks: the anterior commissure, the mammillary bodies, the preoptic recess, the infundibular recess, the crest between the preoptic and the infundibular recesses, the optical tract, the fornix, and the mammillo-thalamic bundle. The identification of hypothalamus and most of its components could be useful to allow the quantification of local pathological processes and to target specific circuitry to alleviate severe symptoms, using physical or biological agents.
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Affiliation(s)
- Jean-Jacques Lemaire
- Univ Clermont 1, UFR Médecine, EA 7282, Image-Guided Clinical Neuroscience and Connectomics, Clermont-Ferrand, F-63001, France ; Service de Neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
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19
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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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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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Lemaire JJ, Pontier B, Coste J, Gillart T, Sakka L, Feschet F, Gabrillargues J, Coudeyre E, Luauté J. Comportements conscients après cérébrolésions : support anatomofonctionnel et perspectives thérapeutiques. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.373] [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: 10/17/2022]
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Lemaire JJ, Pontier B, Coste J, Gillart T, Sakka L, Feschet F, Gabrillargues J, Coudeyre E, Luauté J. Conscious behavior after traumatic brain injury: Anatomo-functional support and therapeutic prospects. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.387] [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: 10/17/2022]
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23
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Lemaire JJ, Sakka L, Ouchchane L, çois Caire F, Gabrillargues J, Bonny JM. Anatomy of the Human Thalamus Based on Spontaneous Contrast and Microscopic Voxels in High-Field Magnetic Resonance Imaging. Oper Neurosurg (Hagerstown) 2010; 66:161-72. [DOI: 10.1227/01.neu.0000365617.41061.a3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background:
Since the pioneering studies of human thalamic anatomy based on histology and binding techniques, little new work has been done to bring this knowledge into clinical practice.
Objective:
With the advent of magnetic resonance imaging (MRI) we hypothesized that it was possible, in vitro, to make use of high spontaneous MRI contrasts between white and grey matter to directly identify the subcompartmentalisation of the thalamus.
Methods:
An anatomic specimen was imaged at high field (4.7 T) (basal ganglia plus thalamus block; 3-dimensional (3D) T1-weighted spin echo sequence; matrix, 256 × 256 × 256; isotropic voxel, 0.250 mm/edge; total acquisition time, 14 hours 30 minutes). Nuclei were manually contoured on the basis of spontaneous contrasted structures; labeling relied on 3D identification from classic knowledge; stereotactic location of centers of nuclei was computed.
Results:
Almost all intrathalamic substructures, nuclei, and white matter laminae were identified. Using 3D analysis, a simplified classification of intrathalamic nuclei into 9 groups was proposed, based on topographic MRI anatomy, designed for clinical practice: anterior (oral), posterior, dorsal, intermediate, ventral, medial, laminar, superficial, and related (epi- and metathalamus). The overall 4.7-T anatomy matches that presented in the atlases of Schaltenbrand and Bailey (1959), Talairach et al (1957), and Morel et al (1997).
Conclusion:
It seems possible to identify the subcompartments of the thalamus by spontaneous MRI contrast, allowing a tissue architectural approach. In addition, the MRI tissue architecture matches the earlier subcompartmentalization based on cyto- and chemoarchitecture. This true 3D anatomic study of the thalamus may be useful in clinical neuroscience and neurosurgical applications.
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Affiliation(s)
- Jean-Jacques Lemaire
- Medical Imagery Research Team, Unité de Formation et de Recherche Médecine, University of Clermont 1, and Neurosurgery Service A, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Sakka
- Medical Imagery Research Team and Anatomy Laboratory, Unité de Formation et de Recherche Médecine, University of Clermont 1, and Neurosurgery Service A, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Medical Imagery Research Team, Unité de Formation et de Recherche Médecine, and Laboratory of Biostatistics, Telematics, and Imaging, Faculty of Medicine, University of Clermont 1, Clermont-Ferrand, France
| | - Fran çois Caire
- Medical Imagery Research Team, Unité de Formation et de Recherche Médecine, University of Clermont 1, Clermont-Ferrand, France, and Neurosurgery Service, Hôpital Dupuytren, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Jean Gabrillargues
- Medical Imagery Research Team, Unité de Formation et de Recherche Médecine, University of Clermont 1, and Neuroradiology Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-Marie Bonny
- STIM UR370, Animal Products Quality Unit, French National Institute for Agricultural Research, Saint-Genès-Champanelle, France
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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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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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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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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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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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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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Abstract
The vestibular system is a complex system involving not only posterior labyrinth but also central structures such as cerebellum, striatum, thalamus, frontal and prefrontal cortex to assure balance, movements and walking. Information reaching the vestibular complex are not purely vestibular but also from visual, somatosensory and cerebellar origins. The equilibrium is also a complex physiological function needing concordance of vestibular, visual and somatosensory information or either central compensation after an injury but also an integrity of the central nervous system.
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Affiliation(s)
- L Sakka
- Laboratoire d'Anatomie, Service de Neurochirurgie, Clermont-Ferrand
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Nguyen JP, Lefaucheur JP, Le Guerinel C, Fontaine D, Nakano N, Sakka L, Eizenbaum JF, Pollin B, Keravel Y. [Treatment of central and neuropathic facial pain by chronic stimulation of the motor cortex: value of neuronavigation guidance systems for the localization of the motor cortex]. Neurochirurgie 2000; 46:483-91. [PMID: 11084480] [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: 02/18/2023]
Abstract
Thirty two patients with refractory central and neuropathic pain of peripheral origin were treated by chronic stimulation of the motor cortex between May 1993 and January 1997. The mean follow-up was 27. 3 months. The first 24 patients were operated according to the technique described by Tsubokawa. The last 13 cases (8 new patients and 5 reinterventions) were operated by a technique including localization by superficial CT reconstruction of the central region and neuronavigator guidance. The position of the central sulcus was confirmed by the use of intraoperative somatosensory evoked potentials. The somatotopic organisation of the motor cortex was established peroperatively by studying the motor responses at stimulation of the motor cortex through the dura. Ten of the 13 patients with central pain (77%) and nine of the 12 patients with neuropathic facial pain had experienced substantial pain relief (75%). One of the 3 patients with post-paraplegia pain was clearly improved. A satisfactory result was obtained in one patient with pain related to plexus avulsion and in one patient with pain related to intercostal herpes zoster. None of the patients developed epileptic seizures. The position of the stimulating poles effective on pain corresponded to the somatotopic representation of the motor cortex. The neuronavigator localization and guidance technique proved to be most useful identifying the appropriate portion of the motor gyrus. It also allowed the establishment of reliable correlations between electrophysiological-clinical and anatomical data which may be used to improve the clinical results and possibly to extend the indications of this technique.
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Affiliation(s)
- J P Nguyen
- Département de Neurosciences, Service des Explorations Fonctionnelles, CHU Henri-Mondor, 94010 Créteil, France
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Decq P, Le Guerinel C, Sakka L, Roujeau T, Sol J, Palfi S, Nguyen J. [Endoscopic surgery of third ventricle lesions]. Neurochirurgie 2000; 46:286-94. [PMID: 10854986] [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: 02/16/2023]
Abstract
The endoscopic approach of the tumors of the third ventricle interests mainly the colloid cysts but also offers the possibilities of biopsies. Twenty two patients (16 men and 6 women, average age 41 years) presenting with hydrocephalus related to a tumor of the pineal area were treated by a ventriculostomy with attempt at biopsy : they are outside of the limits of this report. Twenty two other patients (15 men, 7 women, average age 39 years) were operated on from 1994 to 1999 for a colloid cyst, and 2 of them were admitted in emergency in sudden coma. The CT scan showed a colloid cyst (hyperdense in 16 patients) associated with an hydrocephalus, except for a patient previously shunted. The diameter of the cyst varied from 4 to 50 mm (average of 20 mm). All the patients were operated on using a rigid endoscope. Among the 20 patients presenting a tumor of the pineal area, a biopsy was possible only in 4 cases (20%). There were no hemorrhage nor neurological disorders. In all the cases, the size and the number of the specimens were sufficient to allow the histological diagnosis. For the patients presenting with colloid cyst, the average follow-up is 2 years. All the preoperative symptoms disappeared except for the memory disorders which were improved. The post-operative Evans index decreased significantly. No residual cyst was observed on the post-operative MRI in 14 patients (63%). Among these patients, an asymptomatic recurrence was observed and remained stable after 44 months of follow-up. A residual cyst was observed in 8 patients (36%), with a diameter from 5 to 25 mm (average 9 mm). No patient required a shunt procedure, and no patient presented hemorrhagic complication. Endoscopy is especially useful in the first line treatment of the colloid cysts of the third ventricle.
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Affiliation(s)
- P Decq
- Service de Neurochirurgie, Hôpital Henri-Mondor, 51, avenue du Maréchal de-Lattre-de-Tassigny, 94010 Créteil Cedex
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Vuong PN, Wanji S, Sakka L, Klager S, Bain O. The murid filaria Monanema martini: a model for onchocerciasis. Part I. Description of lesions. Ann Parasitol Hum Comp 1991; 66:109-20. [PMID: 1776782 DOI: 10.1051/parasite/1991663109] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A study of the anatomo-pathological lesions induced by Monanema martini, a filaria with skin-dwelling microfilariae, was performed using 65 Lemniscomys striatus fixed from 30 minutes to 36 months after inoculation of the infective larvae, 5 Arvicanthis niloticus and 3 Meriones unguiculatus fixed during the patent phase, and controls. Attempts at quantification of lesions in L. striatus was made. Approximately 20% of L. striatus had microfilariae in the eyeballs, and many more presented ocular lesions. The delay of the patent period seems to have more effects on the gravity of lesions than repeated inoculations. The location of the lesions and parasites presuppose that microfilariae enter the eyeball through the lymphatic capillaries of the irido-corneal angles. Cutaneous lesions were often severe: there is a parallel between the importance of lesions and the abundance of microfilariae. Larvae are responsible for damage to various structures of the lymphatic system (thrombo-lymphangitis, acute or granulomatous lymphadenitis...) into which they migrate, explaining the mechanism of elephantiasis. These rodent lesions appear similar to those observed in human onchocerciasis and lymphatic filariasis. Whatever the M. martini stage and the organ examined, major lesions belonged to the inflammatory process. Various types of inflammatory reaction (acute, subacute, or chronic inflammation, scarring sclerosis etc.) can co-exist within a single tissue area. The accidental escape of a microfilaria from a lymphatic capillary into the connective tissue (including the corneal stroma) induces an inflammatory reaction. Thus M. martini, as human Onchocerca species, causes a chronic disease, associating recent lesions to old ones.
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Affiliation(s)
- P N Vuong
- Département d'Anatomie et de Cytologie Pathologiques, Hôpital Saint-Michel, Paris
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