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Duerinck J, Van Der Veken J, Schuind S, Van Calenbergh F, van Loon J, Du Four S, Debacker S, Costa E, Raftopoulos C, De Witte O, Cools W, Buyl R, Van Velthoven V, D'Haens J, Bruneau M. Randomized Trial Comparing Burr Hole Craniostomy, Minicraniotomy, and Twist Drill Craniostomy for Treatment of Chronic Subdural Hematoma. Neurosurgery 2022; 91:304-311. [PMID: 35593710 DOI: 10.1227/neu.0000000000001997] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The mainstay of treatment for symptomatic or large chronic subdural hematoma (CSDH) is surgery, but controversy still exists regarding the best surgical technique. Three different techniques are commonly used: burr hole craniostomy (BHC), minicraniotomy (MC), and twist drill craniostomy (TDC). OBJECTIVE To determine which surgical technique for drainage of CSDH offers best results. METHODS We set up a multicenter prospective randomized trial (Comparison of Chronic Subdural Hematoma Treatment [COMPACT] trial) comparing BHC, MC, and TDC for the surgical treatment of CSDH. The primary end point was reoperation rate, and secondary end points included complication rates and clinical outcome. Patients were considered to have good outcome when they did not undergo reoperation, suffered no surgical or medical complication, and had no related mortality. Clinical outcome was also evaluated by evolution of the Markwalder score and the modified Rankin score. RESULTS Two-hundred forty-five patients were included in the final analysis: 79 BHC, 84 MC, and 82 TDC. Mean duration of surgery was shorter for TDC than for BHC and MC (P < .001). Reoperation rate was 7.6% for BHC, 13.1% for MC, and 19.5% for TDC (P = .07). This trend toward better results for BHC was not statistically significant in logistic regression analysis. The proportion of patients with good outcome was 78.5% for BHC group, 76.2% for MC, and 69.5% for TDC (P = .4). Evolution of the Markwalder score and modified Rankin score were not significantly different between treatment groups. CONCLUSION All 3 techniques are effective at treating patients with CSDH with eventual 6-month outcome being similar. Although not reaching statistical significance in our study, BHC offers the lowest recurrence rate combined with manageable complication rate.
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Affiliation(s)
| | - Jorn Van Der Veken
- Department of Neurosurgery, UZ Brussel, Brussels, Belgium.,Current affiliation: Department of Neurosurgery, Flinders Medical Centre, Adelaide, Australia
| | - Sophie Schuind
- Department of Neurosurgery, ULB Erasme, Brussels, Belgium
| | | | | | | | - Servaes Debacker
- Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emmanuel Costa
- Department of Neurosurgery, UCL Saint-Luc, Brussels, Belgium
| | | | | | - Wilfried Cools
- Interfaculty Center Data Processing and Statistics, UZ Brussel/Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Jean D'Haens
- Department of Neurosurgery, UZ Brussel, Brussels, Belgium
| | - Michaël Bruneau
- Department of Neurosurgery, ULB Erasme, Brussels, Belgium.,Current affiliation: Department of Neurosurgery, UZ Brussel, Brussels, Belgium
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Vermeulen E, D'Haens J, Stadnik T, Unuane D, Barbe K, Van Velthoven V, Gläsker S. Predictors of dopamine agonist resistance in prolactinoma patients. BMC Endocr Disord 2020; 20:68. [PMID: 32429916 PMCID: PMC7236128 DOI: 10.1186/s12902-020-0543-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical resection of prolactinomas resistant to dopamine agonists is frequently incomplete due to fibrotic changes of the tumour under pharmacological therapy. In order to identify a subgroup of patients who may benefit from early surgery, we thought to investigate possible predictive factors of pharmacological resistance of prolactinomas to dopamine agonists. METHODS We retrospectively analyzed a database of a Belgian tertiary reference center for patients with pituitary tumours from 2014 to 2016. The groups of interest were patients with dopamine agonist responsive and resistant prolactinomas. The possible predictive factors, including MRI findings, endocrinological parameters, response of tumour and patient factors for dopamine agonist resistance were investigated. RESULTS We included 69 patients of whom 52 were women (75,4%) and 17 were men (24,6%). Rate of dopamine agonist resistance was 15.9%. We identified four significant predictors of dopamine agonist resistance: male gender, a large tumour volume, prolonged time to prolactin normalization and presence of a cystic, hemorrhagic and/or necrotic component. In addition, symptoms due to mass effect, high baseline prolactin level and a high contrast capture on MRI are factors that can be taken into consideration. CONCLUSION We identified predictive factors for pharmacological resistance and developed a scoring system for patient specific prediction of resistance to dopamine agonists. This scoring system may have impact on the timing and decision of surgery in prolactinoma patients after further prospective evaluation.
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Affiliation(s)
- Elle Vermeulen
- Department of Neurosurgery, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Jean D'Haens
- Department of Neurosurgery, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Tadeusz Stadnik
- Department of Radiology, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - David Unuane
- Department of Endocrinology, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Kurt Barbe
- Department of Statistics, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Vera Van Velthoven
- Department of Neurosurgery, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Sven Gläsker
- Department of Neurosurgery, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium.
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Bourgonjon B, Duerinck J, Moens M, D'Haens J. Comparison of the effect of anterior and posterior neurosurgical treatment for cervical spondylotic myelopathy: a clinical outcome. Acta Neurol Belg 2019; 119:585-593. [PMID: 31309455 DOI: 10.1007/s13760-019-01184-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/31/2018] [Accepted: 07/02/2019] [Indexed: 11/30/2022]
Abstract
Cervical degenerative disease is the most common cause of acquired disability in patients over the age of 50. The incidence of cervical spondylotic myelopathy (CSM) is increasing with aging of the population. Surgical decompression is indicated for severe CSM. There is, however, insufficient evidence to prefer anterior over posterior surgical decompression technique for CSM. Our purpose was to identify groups of patients that would benefit from a chosen surgical approach with a better clinical outcome. We conducted a retrospective analysis of patients operated for CSM between 2007 and 2011. Patients were assessed according to the Nurick grading system. Preoperative and postoperative clinical details and MR imaging were analyzed. Treatment consisted of either anterior cervical discectomy with fusion (ACDF) or laminectomy without fusion. Over a period of 4 years, 90 patients were included. The mean age of patients was 64.5 ± 1.3 years. Of 90 included patients, 42 patients were treated with ACDF and 48 with laminectomy. Mean total Nurick grade recovery rate (NGRR) was 29.6% with 31.2% in ACDF and 27.7% in laminectomy. Mid-sagittal diameter of the cervical canal measured on MRI-T2 increased significantly more with laminectomy (4.4 mm) than ACDF (2.2 mm) (p < 0.001). The presence of preoperative spasticity or quadriparesis or a multilevel compression indicated a higher recovery on the Nurick scale. Surgical treatment of CSM leads to a significant improvement of the functional neurological status of the patient as well as an increase in the diameter of the cervical canal. No significant difference in Nurick recovery was found between ACDF and laminectomy indicating that clinical decision-making in our series was adequate. We were able to demonstrate that even severely disabled patients have a good chance of neurologic recovery after surgical treatment for CSM.
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Affiliation(s)
- B Bourgonjon
- Department of Anesthesiology, UZ Brussel, Brussels, Belgium.
| | - J Duerinck
- Department of Neurosurgery, UZ Brussel, Brussels, Belgium
| | - M Moens
- Department of Neurosurgery, UZ Brussel, Brussels, Belgium
| | - J D'Haens
- Department of Neurosurgery, UZ Brussel, Brussels, Belgium
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Ismail M, Fares AA, Abdelhak B, D'Haens J, Michel O. Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation. Ger Med Sci 2016; 14:Doc07. [PMID: 27408609 PMCID: PMC4928027 DOI: 10.3205/000234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/22/2016] [Indexed: 11/30/2022]
Abstract
Objectives: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing. Methods: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A – with no intrasellar packing, Group B – with haemostatic materials packing, and Group C – with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome. Results: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. Conclusions: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our preferred technique, at least if no intraoperative CSF leakage is evident.
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Affiliation(s)
- Mostafa Ismail
- Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium; Department of Otorhinolaryngology, Minia University Hospital, Minia University, Minya, Egypt
| | - Abd Alla Fares
- Department of Radiology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium
| | - Balegh Abdelhak
- Department of Otorhinolaryngology, Minia University Hospital, Minia University, Minya, Egypt
| | - Jean D'Haens
- Department of Neurosurgery, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium
| | - Olaf Michel
- Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussels, Brussels, Belgium
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Dereymaeker L, Brouns R, Herregodts P, Mariën P, De Smedt A, Huylebrouck M, Duerinck J, D'Haens J, Moens M. Disc Fragment Herniectomy Through a Facet Joint Quadrantectomy for Extraforaminal Lumbar Herniation: Technique and Results. World Neurosurg 2016; 85:228-35. [DOI: 10.1016/j.wneu.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
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Steenbeke F, Gevaert T, Engels B, Poels K, D'Haens J, Van Tussenbroek F, Verellen D, Storme G, De Ridder M. Analysis of the targeting uncertainty of a stereotactic frameless radiosurgery technique for arteriovenous malformation. Radiother Oncol 2014; 113:371-3. [PMID: 25454170 DOI: 10.1016/j.radonc.2014.10.003] [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: 03/21/2014] [Revised: 10/03/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
In order to target arteriovenous malformations (AVM) in a frameless approach, registration of two-dimensional (2D) digital-subtracted-angiographs (DSA) with three-dimensional (3D) computed tomography (CT) is required. Targeting accuracy and delineation of a frameless 2D-DSA and 3D-CT image registration tool based on bony anatomy of the skull was evaluated. This frameless approach assures accurate target localization and can be used in a clinical setting.
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Affiliation(s)
- Femke Steenbeke
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | - Thierry Gevaert
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium.
| | - Benedikt Engels
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | - Kenneth Poels
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | - Jean D'Haens
- Department of Neurosurgery, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | | | - Dirk Verellen
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | - Guy Storme
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | - Mark De Ridder
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium
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Michotte A, Van Der Veken J, Huylebrouck M, Duerinck J, D'Haens J, Hoorens A. Expression of thyroid transcription factor 1 in a chordoid glioma. J Neurol Sci 2014; 346:362-3. [PMID: 25248954 DOI: 10.1016/j.jns.2014.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/24/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- A Michotte
- Department of Neurology and Pathology (Neuropathology), UZ Brussel, Belgium.
| | | | | | - J Duerinck
- Department of Neurosurgery, UZ Brussel, Belgium
| | - J D'Haens
- Department of Neurosurgery, UZ Brussel, Belgium
| | - A Hoorens
- Department of Pathology, UZ Brussel, Belgium
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Steenbeke F, Gevaert T, Poels K, Verellen D, D'Haens J, Van Tussenbroek F, De Ridder M. EP-1739: Analysis of a stereotactic frameless radiosurgery technique fortargeting arteriovenous malformation. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31857-0] [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: 10/23/2022]
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9
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Van Der Veken J, Van Rompaey K, Duerinck J, Ampe B, D'Haens J. Spinal Epidural Hematoma Misdiagnosed as Myocardial Infarction. World Neurosurg 2013. [DOI: 10.1016/j.wneu.2013.07.051] [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: 10/26/2022]
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10
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Unuane D, D'Haens J, Van Rompaey K, Halewyck S, Poppe K, Velkeniers B. Cushing's disease: diagnosis through the nose. A case report. Acta Clin Belg 2013. [PMID: 23189551 DOI: 10.2143/acb.67.5.2062697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In Cushing's disease clinical symptoms are usually related to the ACTH hypersecretion. On diagnosis these secreting tumours tend to be small due to their ability to reach clinical detection early. However, symptoms may also be caused by mass-related effects such as the depression of secretion of other pituitary hormones. Furthermore growth related symptoms may occur due to the invasion of the suprasellar region with compression of the visual system. As we illustrate in a case report, when spreading of pituitary adenoma occurs to the infrasellar region, Cushing disease may manifest itself by rather atypical initial symptoms that are more related to ear-nose-throat (ENT) complaints. In these invasive macro adenomas multimodal therapy is usually required to achieve control of hypersecretion and mass related symptoms.
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Affiliation(s)
- D Unuane
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Belgium.
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Cattrysse E, Moens M, Schaillée E, D'Haens J, Van Roy P. Changed cervical kinematics after fusion surgery. Eur Spine J 2012; 21:1353-9. [PMID: 22173609 PMCID: PMC3389115 DOI: 10.1007/s00586-011-2112-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 10/11/2011] [Accepted: 12/04/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Analyzing and comparing the range of motion and movement pattern of subjects who underwent an anterior cervical fusion using trabecular metal with control subjects. METHODS Three-dimensional kinematics of planar active axial rotation and active lateral bending of 50 experimental and 41 control subjects were registered by means of an electromagnetic tracking system. RESULTS Comparing the experimental group with the control group reveals that the range of the main motion component differs significantly (p < 0.01) during the active axial rotation and lateral bending movement. During active axial rotation, the coupled lateral bending motion component also differs between both groups. The root mean square value of the jerkiness (derivative of the acceleration) and de deviation from the 6-polynomial smoothed function of the main as well as the coupled motion component express the qualitative aspects of kinematics and are significantly different between the experimental and the control group for both movements (p < 0.05). CONCLUSIONS Subjects who have an anterior cervical fusion with trabecular metal show significant quantitative as well as qualitative differences in cervical kinematics during active axial rotation and lateral bending compared to control subjects.
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Affiliation(s)
- E Cattrysse
- Faculty of Medicine and Pharmacy, Department of Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, Building B, 1090 Brussels, Belgium.
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Gevaert T, Boussaer M, Engels B, Litré C, Prieur A, Verellen D, D'Haens J, Collin P, De Ridder M. Evaluation of the clinical usefulness for using verification images during frameless radiosurgery. Phys Med 2012. [DOI: 10.1016/j.ejmp.2012.08.038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Moens M, De Smedt A, Brouns R, Spapen H, Droogmans S, Duerinck J, D'Haese J, D'Haens J, Nuttin B. Retrograde C0-C1 Insertion of Cervical Plate Electrode for Chronic Intractable Neck and Arm Pain. World Neurosurg 2011; 76:352-4; discussion 268-9. [DOI: 10.1016/j.wneu.2011.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 12/27/2010] [Accepted: 03/17/2011] [Indexed: 11/29/2022]
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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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Van Rompaey K, Michotte A, Ampe B, Moens M, Ates R, Chaskis C, D'Haens J. Malignant transformation of a vestibular schwannoma after radiosurgery. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.surneu.2008.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ampe B, Massie A, D'Haens J, Ebinger G, Michotte Y, Sarre S. NMDA-mediated release of glutamate and GABA in the subthalamic nucleus is mediated by dopamine: an in vivo microdialysis study in rats. J Neurochem 2007; 103:1063-74. [PMID: 17727638 DOI: 10.1111/j.1471-4159.2007.04847.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/30/2022]
Abstract
The present study investigated the effects of N-methyl-D-aspartic acid.H2O (NMDA) on the dopamine, glutamate and GABA release in the subthalamic nucleus (STN) by using in vivo microdialysis in rats. NMDA (100 micromol/L) perfused through the microdialysis probe evoked an increase in extracellular dopamine in the STN of the intact rat of about 170%. This coincided with significant increases in both extracellular glutamate (350%) and GABA (250%). The effect of NMDA perfusion on neurotransmitter release at the level of the STN was completely abolished by co-perfusion of the selective NMDA-receptor antagonist MK-801 (10 micromol/L), whereas subthalamic perfusion of MK-801 alone had no effect on extracellular neurotransmitter concentrations. Furthermore, NMDA induced increases in glutamate were abolished by both SCH23390 (8 micromol/L), a selective D1 antagonist, and remoxipride (4 micromol/L), a selective D2 antagonist. The NMDA induced increase in GABA was abolished by remoxipride but not by SCH23390. Perfusion of the STN with SCH23390 or remoxipride alone had no effect on extracellular neurotransmitter concentrations. The observed effects in intact animals depend on the nigral dopaminergic innervation, as dopamine denervation, by means of 6-hydroxydopamine lesioning of the substantia nigra, clearly abolished the effects of NMDA on neurotransmitter release at the level of the STN. Our work points to a complex interaction between dopamine, glutamate and GABA with a crucial role for dopamine at the level of the STN.
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Affiliation(s)
- Ben Ampe
- Department of Pharmaceutical Chemistry, Drug Analysis and Drug Information, Research Group Experimental Neuropharmacology, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
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Fomekong E, Hernalsteen D, Godfraind C, D'Haens J, Raftopoulos C. Pituitary stalk hemangioblastoma: The fourth case report and review of the literature. Clin Neurol Neurosurg 2007; 109:292-8. [PMID: 17187928 DOI: 10.1016/j.clineuro.2006.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 09/11/2006] [Revised: 11/20/2006] [Accepted: 11/23/2006] [Indexed: 11/22/2022]
Abstract
Supratentorial hemangioblastomas (HBL) have been rarely described in the literature. Herein we report the fourth case of pituitary stalk HBL diagnosed concurrently with cerebellar HBLs in a 51-year-old woman with von Hippel-Lindau disease. Complete resection of the lesion was achieved using left frontopterional craniotomy and no recurrence was observed after 8 years of follow-up. The clinical presentation, radiological features, pathological findings, and the management of this particular case are discussed in the light of the available literature. To our knowledge, this case is the only pituitary stalk HBL with total resection, and a long follow-up fully documented.
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Affiliation(s)
- Edward Fomekong
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Chaskis C, Stadnik T, Michotte A, Van Rompaey K, D'Haens J. Prognostic value of perfusion-weighted imaging in brain glioma: a prospective study. Acta Neurochir (Wien) 2006; 148:277-85; discussion 285. [PMID: 16421765 DOI: 10.1007/s00701-005-0718-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [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: 06/26/2005] [Accepted: 11/23/2005] [Indexed: 11/28/2022]
Abstract
OBJECT Biopsy targeting based on MR imaging alone may fail to identify malignant areas in brain gliomas. Considering the differences in relative Cerebral Blood Volume (rCBV) ratios reported among tumour grades, we evaluated whether perfusion-weighted MR imaging (PWI) could usefully implement the routine preoperative imaging by detecting those areas bearing a higher yield for malignancy to guide the stereotactic biopsy or the surgical removal. CLINICAL MATERIAL AND METHODS We studied a series of 55 consecutive patients with newly diagnosed brain glioma using both conventional MR imaging and PWI in the preoperative assessment. The pathological diagnosis was established by stereotactic biopsy in 29 cases and by craniotomy in 24 cases. We evaluated the patient survival to detect undergrading. DISCUSSION Independent from contrast-enhancement, perfusion-weighted MR imaging improved the target selection in stereotactic biopsy guidance and the removal of malignant areas in tumours amenable to surgery. Particularly sensitive to the perfused part of the tumour as to small regional changes, rCBV maps allowed a better detection of malignant areas. The rCBV ratios correlated significantly to the tumour grade and the final outcome (p < 0.01). CONCLUSIONS We found PWI valuable in the preoperative assessment of brain gliomas, discriminating high from low-grade gliomas. PWI can easily be performed on widely available MR imaging systems as part of the routine imaging of gliomas.
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Affiliation(s)
- C Chaskis
- Department of Neurosurgery, Academic Hospital, Vrije Universiteit Brussel, Belgium.
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Affiliation(s)
- Cristo Chaskis
- Department of Neurosurgery, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium.
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20
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Chaskis C, Buisseret T, Michotte A, D'Haens J. Meningioma of the fourth ventricle presenting with intermittent behaviour disorders: a case report and review of the literature. J Clin Neurosci 2001; 8 Suppl 1:59-62. [PMID: 11386828 DOI: 10.1054/jocn.2001.0879] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/18/2022]
Abstract
Intraventricular meningiomas are rare, representing 0.5-5% of all intracranial meningiomas. They arise mostly within the lateral ventricles and more rarely in the third ventricle. Meningiomas of the fourth ventricle are exceptional. They are clearly defined as meningiomas arising from the choroid plexus and lying strictly within the fourth ventricle. We report a 76 year old male patient presenting with a 2-week history of headache and cognitive disorders with agitation and restlessness particularly exacerbated at night or when lying down. CT scan and MR imaging showed a contrast-enhancing lesion located purely within the whole fourth ventricle, with slight ventricular enlargement. At surgery, we totally removed a well-vascularised, greyish encapsulated mass attached to the choroid plexus. Pathological examination revealed a WHO grade I fibroblastic meningioma. We reviewed the literature concerning this unusual meningioma location.
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Affiliation(s)
- C Chaskis
- Department of Neurosurgery, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium.
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21
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Abstract
We present a case of subarachnoid hemorrhage due to a ruptured cerebral aneurysm of the right internal carotid artery in a patient at 34 weeks of gestation (G2P1). A combined surgical procedure (cesarean section followed by clipping of the aneurysm) was performed with good maternal and fetal outcome. The differential diagnosis, the timing of neurosurgery, and the anesthetic techniques used are discussed.
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Affiliation(s)
- J D'Haese
- Department of Anesthesiology, University Hospital-V.U.B., Brussels, Belgium
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22
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Chaskis C, Michotte A, Geffray F, Vangeneugden J, Desprechins B, D'Haens J. Cervical intramedullary lipoma with intracranial extension in an infant. Case illustration. J Neurosurg 1997; 87:472. [PMID: 9285619 DOI: 10.3171/jns.1997.87.3.0472] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C Chaskis
- Department of Neurosurgery, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium
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23
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Noppen M, Dendale P, Hagers Y, Herregodts P, Vincken W, D'Haens J. Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis. J Auton Nerv Syst 1996; 60:115-20. [PMID: 8912261 DOI: 10.1016/0165-1838(96)00034-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Essential hyperhidrosis (EH) is caused by an unexplained overactivity of the sympathetic fibers which pass through the upper dorsal sympathetic ganglia D2 and D3. Since the D2 and D3 ganglia are also involved in the sympathetic cardiac innervation, cardiocirculatory autonomic function may also be abnormal in EH. In order to study the function of the sympathetic nervous system in EH, and to assess the effects of thoracoscopic sympathiocolysis, cardiocirculatory autonomic function tests were performed in 13 consecutive patients with EH, before (baseline) and 6 weeks after the thoracoscopic intervention. Baseline data were also compared with data obtained from 13 matched healthy volunteers: EH patients showed an increased heart rate at rest, but only in the standing position (94 +/- 18.5 vs 78 +/- 10.9 bpm, P < 0.01), as well as an increased ratio of low to high frequency power of the heart rate variability in the standing position (5.92 +/- 4.4 vs 2.8 +/- 2.5, P < 0.05). Exercise tests were normal in every EH patient. After sympathiocolysis, heart rate at rest (sitting on the cycloergometer) had decreased (75.4 +/- 13 vs 90.4 +/- 16.5 bpm, P < 0.05), as well as heart rate at maximal exercise (165.2 +/- 14.8 vs 180 +/- 10 bpm, P < 0.05). Exercise capacity and the cardiorespiratory responses to exercise were, however, unchanged after sympathicolysis. Resting heart rate in the lying (66 +/- 10 vs 76 +/- 15 bpm, P < 0.05) and standing positions (82 +/- 13.8 vs 94 +/- 18.5 bpm, P < 0.05), and the diastolic blood pressure reaction to a handgrip test (73.6 +/- 8.6 vs 84.7 +/- 11.6 mmHg, P < 0.05) were also lowered after sympathicolysis. In conclusion, patients with EH show an overfunctioning of the sympathetic system which is characterised by an increased reaction to stress (standing, exercise), whereas resting sympathetic tone is unaffected. Thoracoscopic D2-D3 sympathicolysis corrects this hyperfunction and has a partial beta-blocker-like activity, which results in a decrease in heart rate at rest and during maximal exercise, and in the diastolic blood pressure response to the handgrip test. Further studies are needed to assess the long-term consequences of this procedure.
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Affiliation(s)
- M Noppen
- Respiratory Department of the University Hospital AZ-VUB, Free University, Brussels, Belgium
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24
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Noppen M, Herregodts P, D'Haese J, D'Haens J, Vincken W. A simplified T2-T3 thoracoscopic sympathicolysis technique for the treatment of essential hyperhidrosis: short-term results in 100 patients. J Laparoendosc Surg 1996; 6:151-9. [PMID: 8807515 DOI: 10.1089/lps.1996.6.151] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A simplified one-time bilateral thoracoscopic T2-T3 sympathicolysis technique using single-lumen endotracheal intubation with high frequency jet ventilation and electrocautery destruction ("sympathicolysis") of the sympathetic ganglia was applied in 100 consecutive patients with severe essential hyperhidrosis (EH). Providing a pleural space can be created, this technique was proven simple and safe, and short-term clinical results were excellent: palmar hyperhidrosis was cured in 98% of patients, and axillar and plantar improvement was achieved in 62 and 65% of patients, respectively. Side-effects and complications were minor (compensatory hyperhidrosis) or self-limiting (pain). These data confirm the safety and efficacy of thoracoscopic sympathetic interventions for the treatment of EH, and support the evolution toward simplified methodologies.
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Affiliation(s)
- M Noppen
- Respiratory Department, Academic Hospital A.Z.-V.U.B., Free University of Brussels, Belgium
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25
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Abstract
Spinal epidural abscess is an uncommon site of infection, resulting in back pain, fever, weakness and loss of sensibility. These signs should suggest the diagnosis, and quick confirmation by MRI should be performed. Immediate surgical decompression and antibiotherapy is necessary, because this is the base of a possible successful functional recovery. Empiric therapy consisting of high dose of penicillinase-resistant antibiotics is advised because most often an epidural abscess is caused by Staphylococcus aureus. However, because other bacteria can be involved, an aminoglycoside or a cephalosporin should be added to the empiric treatment, until the results of the cultures are known. When diagnosis and therapy are delayed, permanent paralysis and death are common.
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Affiliation(s)
- I Colle
- Department of Internal Medicine, Academisch Ziekenhuis, Vrije Universiteit Brussel (VUB), Belgium
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26
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Noppen M, Herregodts P, Dendale P, D'Haens J, Vincken W. Cardiopulmonary exercise testing following bilateral thoracoscopic sympathicolysis in patients with essential hyperhidrosis. Thorax 1995; 50:1097-100. [PMID: 7491560 PMCID: PMC475025 DOI: 10.1136/thx.50.10.1097] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [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: 01/25/2023]
Abstract
BACKGROUND Essential hyperhidrosis is characterised by an overactivity of the sympathetic fibres passing through the upper dorsal sympathetic ganglia D2-D3. Anatomical interruption at the D2-D3 level is a highly effective treatment for essential hyperhidrosis but also causes (partial) cardiac denervation and, after surgical sympathicolysis, important impairment of cardiopulmonary exercise function has been observed. The purpose of this study was to compare the results of cardiopulmonary exercise testing between patients with essential hyperhidrosis and a normal control population, and to examine the effects of thoracoscopic D2-D3 sympathicolysis on cardiopulmonary exercise capacity in patients with essential hyperhidrosis. METHODS maximal, symptom limited incremental exercise tests were performed in 26 patients with severe essential hyperhidrosis one week before and one month after D2-D3 thoracoscopic sympathicolysis, and in 14 age and sex matched healthy volunteers. D2-D3 thoracoscopic sympathicolysis was performed using a simplified one stage bilateral procedure. RESULTS Palmar hyperhidrosis was relieved in every patient, confirming the D2-D3 denervation. A higher peak heart rate (7%) was seen in the patient group than in the normal subjects, but ll other cardiovascular, metabolic, and respiratory parameters were similar. After D2-D3 thoracoscopic sympathicolysis, heart rate at rest (13%) and at peak exercise (7%) were reduced, together with an increase in oxygen pulse. All other parameters remained unchanged. CONCLUSIONS Sympathetic overactivity relevant to cardiovascular function in essential hyperhidrosis is evident only during sympathetic stimulation. D2-D3 thoracoscopic sympathicolysis causes a small and asymptomatic reduction in maximal and resting heart rate and is not associated with a decrease in exercise capacity, in contrast with the detrimental effects on exercise capacity of open surgical sympathectomy.
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Affiliation(s)
- M Noppen
- Respiratory Division, Academic Hosptial AZ-VUB, Free University of Brussels, Belgium
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27
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Herregodts P, Stadnik T, De Ridder F, D'Haens J. Cortical stimulation for central neuropathic pain: 3-D surface MRI for easy determination of the motor cortex. Acta Neurochir Suppl 1995; 64:132-5. [PMID: 8748601 DOI: 10.1007/978-3-7091-9419-5_29] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Motor cortex electric stimulation has been reported to be effective for the treatment of central post-stroke pain and trigeminal neuropathic pain. Five patients with pain due to injury of the trigeminal nerve and with abnormalities of facial sensibility, as well as two patients suffering of a post-stroke thalamic pain, were subjected to stimulation applied epidurally on the motor cortex. Quadripolar electrodes were implanted under local anaesthesia and the precise location of the motor cortex was determined on three-dimensional surface MRI the day prior to surgery. In our experience, correct topographic localization of the electrode on the motor cortex seems to be crucial to obtain pain reduction.
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Affiliation(s)
- P Herregodts
- Department of Neurosurgery, University Hospital Free University of Brussels (AZ-VUB), Belgium
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28
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Woussen-Colle MC, Gourlet P, Vandermeers A, Vandermeers-Piret MC, D'Haens J, Velkeniers B, Robberecht P. Identification of a new chromogranin B fragment (314-365) in endocrine tumors. Peptides 1995; 16:231-6. [PMID: 7784254 DOI: 10.1016/0196-9781(94)00176-6] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A rabbit antiserum was raised against the fragment (350-365) of human chromogranin B corresponding to the C-terminal end of a putative proteolytic fragment generated by the cleavage of a dibasic doublet located in position 366-367 of the precursor. A radioimmunoassay was developed. Chromatographic analysis of 10 endocrine tumor extracts (one liver metastasis of a gastrinoma, one liver metastasis of a medullary carcinoma of the thyroid, one VIPoma, one insulinoma, one nonsecreting pancreatic endocrine tumor, one local recurrence of a gut carcinoid, two pituitary gonadotropinoma, and two non-secreting pituitary adenomas) revealed the presence of two forms of immunoreactive material. The most abundant form had an apparent molecular weight of 4500 and was purified to homogeneity by successive reverse-phase HPLC chromatographies and partially sequenced. The N-terminal sequence of the peptide, established by automated Edman degradation, was A-S-E-E-E-P-E-Y-G-E-E-I-K-G-Y-P-V-Q and corresponded to the 314-332 sequence of human chromogranin B. Taking into account the specificity of the antiserum used for peptide identification, we deduced that the purified peptide was chromogranin B(314-365) and represented a new form generated by limited proteolysis of chromogranin B.
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Affiliation(s)
- M C Woussen-Colle
- Department of Biochemistry and Nutrition, Medical School, Université Libre de Bruxelles, Belgium
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29
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Stadnik T, D'Haens J, Luypaert R, Osteaux M. The value of three-dimensional turbo-FLASH and spin-echo sequences in the detection of pituitary microadenomas following gadolinium administration. Neuroradiology 1994; 36:598-601. [PMID: 7862272 DOI: 10.1007/bf00600416] [Citation(s) in RCA: 3] [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] [Indexed: 01/27/2023]
Abstract
Our purpose was the comparison of T1-weighted spin-echo (SE) and three-dimensional (3D) Turbo-fast low-angle shot (FLASH) (3DTFL) in detection of 14 pituitary microadenomas following intravenous gadolinium (Gd). 3DTFL represents an important improvement in the diagnosis of pituitary microadenomas. In two cases, the site of the tumour was correctly identified only by Gd-enhanced Turbo-FLASH. Nevertheless, in two other cases, the Gd-enhanced 3DTFL gave false negative (FN) results while the T1-weighted SE images enabled correct localisation. Replacement of T1-weighted SE by 3DTFL cannot therefore be advocated and use of both contrast-enhanced sequences offers the highest detection capability for microadenomas.
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Affiliation(s)
- T Stadnik
- Department of Radiology and Medical Imaging, University Hospital V.U.B., Brussels, Belgium
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30
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Velkeniers B, Vergani P, Trouillas J, D'Haens J, Hooghe RJ, Hooghe-Peters EL. Expression of IL-6 mRNA in normal rat and human pituitaries and in human pituitary adenomas. J Histochem Cytochem 1994; 42:67-76. [PMID: 8263325 DOI: 10.1177/42.1.8263325] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cells expressing IL-6 mRNA were detected by in situ hybridization in normal pituitaries. In normal untreated rat pituitary the expression was very low. Within hours after IP administration of liposaccharide, IL-6 mRNA accumulated in the anterior lobe of the pituitary. Production of IL-6 was monitored after dissociation and culture of pituitary cells. High levels (8000 pg/ml) were recovered after 72 hr in culture. In normal human pituitaries, less than 1% of cells expressed IL-6 mRNA or IL-6 receptor mRNA (IL-6-R mRNA). In gonadotropinomas, prolactinomas, and non-functioning adenomas, only rare, scattered positive cells were found for either IL-6 or IL-6-R. In contrast, both genes were highly expressed in ACTH- and GH-secreting tumors at the junction of adenoma and infiltrating fibrous tissue and around blood vessels. The combined expression of IL-6 and IL-6-R suggests that IL-6 acts in an autocrine or in a paracrine way in ACTH and GH adenomas.
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Affiliation(s)
- B Velkeniers
- Department of Pharmacology, University of Brussels, Belgium
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31
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Herregodts P, Stadnik T, D'Haens J. Easy preoperative planning of deeply located brain lesions using external skin reference and 3-dimensional surface MRI. Stereotact Funct Neurosurg 1994; 63:26-30. [PMID: 7624644 DOI: 10.1159/000100286] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Open skull surgery of deeply located intracerebral lesions requires precise determination of the treatment area in 3-dimensional (3-D) space. 3-D MRI can give important additional information in presurgical determination of the surgical approach to the target, taking into account highly functional brain areas and important vascular structures. The day before surgery, a grid composed of 9 tubings intersecting at 90 degrees at 1 cm intervals and filled with a CuSO4 solution is firmly attached to the skin of the patient's head in the presumed region of the craniotomy. A 3-D turbo-FLASH sequence is then performed in the sagittal plane after intravenous Gd-DOTA injection on a 1T Magneton. 3-D surface reconstruction of the cortical gyri and sulci is performed. Once the gyri are identified, the 3-D program is then implemented in order to perform a color display of the cortical veins and of the tumor boundaries. The surgical access is then chosen by the surgeon, taking into account highly functional areas. Finally, the boundaries of the tumor are projected on the cortex reconstruction and on the external reference placed on the skin. The entry place for surgery as well as the size of craniotomy are drawn on the skin and the tubed grid is removed. The accuracy of this method tested in 9 patients with deeply located brain tumors or arteriovenous malformations was very satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Herregodts
- Department of Neurosurgery, University Hospital, Free University of Brussels (AZ-VUB), Belgium
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32
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Vincken W, Meysman M, Verbeelen D, Lauwers S, D'Haens J. Intraventricular rifampicin in severe tuberculous meningo-encephalitis. Eur Respir J 1992. [DOI: 10.1183/09031936.93.05070891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a patient acutely ill from severe tuberculous meningo-encephalitis, in whom acute hepatic and renal failure, due to intercurrent septic shock, precluded the administration of full systemic dosage of antituberculous drugs. Daily direct intraventricular administration of 5 mg rifampicin, via a subcutaneous Ommaya reservoir connected to a catheter placed in the right lateral cerebral ventricle, resulted in rapid improvement without neurological sequelae. Intraventricular rifampicin administration for 50 consecutive days was well-tolerated without local or systemic side-effects. In well-selected patients with severe tuberculous meningo-encephalitis, intraventricular rifampicin may safely and highly effectively be added to systemic antituberculous therapy.
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33
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Vincken W, Meysman M, Verbeelen D, Lauwers S, D'Haens J. Intraventricular rifampicin in severe tuberculous meningo-encephalitis. Eur Respir J 1992; 5:891-3. [PMID: 1499716] [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: 12/27/2022]
Abstract
We present a patient acutely ill from severe tuberculous meningo-encephalitis, in whom acute hepatic and renal failure, due to intercurrent septic shock, precluded the administration of full systemic dosage of antituberculous drugs. Daily direct intraventricular administration of 5 mg rifampicin, via a subcutaneous Ommaya reservoir connected to a catheter placed in the right lateral cerebral ventricle, resulted in rapid improvement without neurological sequelae. Intraventricular rifampicin administration for 50 consecutive days was well-tolerated without local or systemic side-effects. In well-selected patients with severe tuberculous meningo-encephalitis, intraventricular rifampicin may safely and highly effectively be added to systemic antituberculous therapy.
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Affiliation(s)
- W Vincken
- Dept. of Pneumology, Academic Hospital, University of Brussels, Belgium
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34
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Vloeberghs M, Herregodts P, Stadnik T, Goossens A, D'Haens J. Spinal arachnoiditis mimicking a spinal cord tumor: a case report and review of the literature. Surg Neurol 1992; 37:211-5. [PMID: 1536026 DOI: 10.1016/0090-3019(92)90233-d] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report on an unusual case of idiopathic arachnoiditis mimicking a spinal cord tumor in a 50-year-old man with progressive paraparesis. The medical imaging work-up showed an enlarged terminal cone with adjacent cysts. Although there was no enhancement of the terminal cone or the surrounding structures, the diagnosis of spinal cord tumor was maintained and surgery was carried out. Exploration of the cauda equina and the tissue surrounding the terminal cone did not reveal a tumor. The patient improved dramatically after surgery but the symptoms recurred 1 year later. We review arachnoiditis, its pathology, and its treatment with special attention drawn to the primary form of spinal arachnoiditis.
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Affiliation(s)
- M Vloeberghs
- Department of Neurosurgery, Radiology, and Pathology, Free University of Brussels, Belgium
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35
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D'Haens J. [Neurosurgical approach to orbital tumors]. Bull Soc Belge Ophtalmol 1992; 245:15-8. [PMID: 1344741] [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] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The transcranial approach to the orbital tumors consists of a subfrontal route after frontal or frontotemporal craniotomy to allow epidural access to the orbital roof. This approach is used for all tumors with intracranial extension as well as for tumors located in the apex of the orbit or medial to the optic nerve in the posterior part of the orbit.
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Affiliation(s)
- J D'Haens
- A.Z.-V.U.B., Service de Neurochirurgie, Brussels, Belgium
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36
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Abstract
A case of solitary dorsal intramedullary schwannoma diagnosed by magnetic resonance imaging and treated surgically is reported. The authors review the previously published cases. The possible etiology of the tumor as well as some difficulties encountered in the diagnostic procedure and treatment are discussed.
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Affiliation(s)
- P Herregodts
- Department of Neurosurgery, Vrije Universiteit Brussel, Belgium
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37
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Vervaeck M, De Keyser J, Pauwels P, Frecourt N, D'Haens J, Ebinger G. Sudden hypotonic paraparesis caused by tophaceous gout of the lumbar spine. Clin Neurol Neurosurg 1991; 93:233-6. [PMID: 1660379 DOI: 10.1016/s0303-8467(05)80010-1] [Citation(s) in RCA: 18] [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] [Indexed: 12/28/2022]
Abstract
Gouty arthritis of the axial skeleton is rare, and neurological complications due to spinal cord or nerve root compression secondary to tophaceous deposits have been seldom reported. We describe a patient with chronic gouty arthritis who developed an acute paraparesis caused by tophaceous cauda equina compression. Surgical removal of the mass resulted in complete recovery.
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Affiliation(s)
- M Vervaeck
- Department of Neurology, University Hospital, Vrije Universiteit Brussel, Belgium
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38
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Rodesch G, Parizel PM, Farber CM, Lalmand B, Przedborski S, D'Haens J, van Calck M, Vanderhofstadt A, Taelman H, Baleriaux D. Nervous system manifestations and neuroradiologic findings in acquired immunodeficiency syndrome (AIDS). Neuroradiology 1989; 31:33-9. [PMID: 2717002 DOI: 10.1007/bf00342027] [Citation(s) in RCA: 14] [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] [Indexed: 01/02/2023]
Abstract
We report a series of thirteen patients with nervous system complications out of a total of thirty AIDS patients admitted to our hospital over the last two years for which CT and/or MRI have been performed. Five were homosexual men and eight patients (5 men, 3 women) were of African origin (Zaïre and Rwanda) (n = 5) or had had sexual intercourse with the local African population (n = 3). The nervous system complications encountered included: toxoplasma gondii brain abscess (2 patients); cryptococcus neoformans meningitis + toxoplasmosis (1 patient); toxoplasmosis + lymphoma (2 patients); progressive multifocal leucoencephalopathy (1 patient); lymphocytic meningitis or encephalitis (3 patients); lymphoma (1 patient); polyradiculoneuritis (3 patients). Three of thirteen patients had multiple intracranial abnormalities: one had concomitant intraparenchymal toxoplasma abscess and cryptococcal meningitis; in one patient a lymphoma developed after the successful medical treatment of a toxoplasma abscess; conversely, one patient developed a toxoplasma abscess two years after mediastinal radiotherapy for a systemic non-Hodgkin lymphoma. In conclusion, in our experience, nervous system toxoplasmosis is the most frequent AIDS related CNS complication. Our series demonstrates the high frequency of a second neurological disease occurring either concomitantly or separately. In these cases, while CT may readily identify the intracranial abnormalities, it contributes little towards an etiological diagnosis. Finally, our series illustrates the importance of a central African endemic focus for AIDS.
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Affiliation(s)
- G Rodesch
- Department of Neuroradiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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39
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Abstract
The Gd-DTPA-enhanced magnetic resonance findings in two patients with herniated thoracic intervertebral discs are reported. The first patient was a 56-year-old woman with a small subligamentous T6-7 disc herniation, slightly lateralized to the right. The second patient was a 51-year-old man with a central and right posterolateral disc herniation, including a large calcified fragment, at the T8-9 level. The nonenhanced MR examination revealed the presence of an extradural mass lesion in both patients, impinging upon the dural sac and compressing and displacing the spinal cord posteriorly. The lesion was slightly hypointense on both T1- and T2-weighted spin echo sequences. Following intravenous injection of Gd-DTPA in a dosage of 0.1 mmol/kg body weight, enhancement of the posterior longitudinal ligament was noted and triangular areas of contrast uptake were seen to occur in the epidural space above and below the herniated disc. At surgery, they were found to correspond to dilated and congested epidural veins.
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Affiliation(s)
- P M Parizel
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Belgium
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40
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Brotchi J, Noterman J, D'Haens J. [At what point should one operate on a ruptured intracranial arterial aneurysm?]. Bull Acad Natl Med 1988; 172:45-52. [PMID: 3293715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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41
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Abstract
Two cases of spinal cord compression by thoracic epidural cysts are reported. The first case, associated with a lipoma, is of a congenital type, while the second illustrates a rare mechanism of spinal cord compression caused by a post-traumatic cyst after stretching of the brachial plexus and tearing of the meningeal sheaths of nerve roots. Computed tomography of the spine is helpful in disclosing the cyst and associated malformation, particularly in congenital cases. The prognosis is good after removing the cyst and closing the fistula communicating with the subarachnoid space. Further surgical treatment may be required in complex congenital malformations.
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42
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Noterman J, D'Haens J, Brotchi J. [3-year evaluation of the surgical treatment of intracranial aneurysms. Apropos of 100 surgically treated aneurysms]. Acta Neurol Belg 1986; 86:243-59. [PMID: 3766113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors present the results of surgical treatment of a consecutive series of 100 cases of intra cranial aneurysm. The results are analysed in relation to various factors such as the pre-operative delay, the clinical status, the location of the aneurysm and the age of the patient. Altogether, the percentage of excellent and good results is 83%. Bad results account for 10% of the total and deaths represent 7%. Shunted postoperative hydrocephalus was recorded in 10% of cases and half were due to aneurysm of the anterior communicating artery. Postoperative spasm (16%) was the severest complication, responsible for more than half the deaths.
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43
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Brion JP, Couck AM, Flament-Durand J, D'Haens J, Mockel J. Demonstration of prolactin at the ultrastructural level in a pituitary adenoma by the use of colloidal gold labelling. J Submicrosc Cytol 1984; 16:555-560. [PMID: 6471148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A prolactin-secreting pituitary adenoma was removed in a 38-year-old man. The tumor was classified as a chromophobe adenoma on the basis of tinctorial staining, but immunocytochemistry revealed that cells reacted with anti-PRL serum. Electron microscopy showed secretory granules and evidence of high metabolic activity (well developed Golgi apparatus and rough endoplasmic reticulum). Immunoelectron microscopy by the immunogold staining method allowed a clear definition of prolactin containing granules.
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44
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De Mol J, D'Haens J, Brihaye J. [Pseudo-Hakim-Adams syndrome. Neuropsychological study of 23 cases of misdiagnosed Hakim-Adams syndrome]. Acta Neurol Belg 1982; 82:197-208. [PMID: 7136480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The authors study the characteristics of a group of 23 patients for whom an initial tentative diagnosis of Hakim-Adams syndrome (H-A syndrome) was eventually rejected. On account of several factors distinguishing these patients from the true H-A group, the authors propose using the term "pseudo Hakim-Adams syndrome". The distinguishing factors include: the grounds for admission, i.e. mental or mnesic deterioration, associated with radiological images of ventricular dilatation; a clinical picture dominated by mental disorders with only rare disorders of gait and sphincter control (several neurological defects were direct consequences of previous cerebral disease); no antecedents of spontaneous meningeal hemorrhage or meningitis in the case history; neuropsychological examination showing fewer disorders of concentration and less dyscalculia and constructive dyspraxia than in true HA, and far more atypical signs of the aphasic and anxio-depressive type. The authors think that various pathological processes may be responsible for this pseudo H-A syndrome in which a predominant mental picture is associated with ventricular dilatation.
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45
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D'Haens J, Brihaye J, Dupont M. [Cervical spondylotic myelopathy and radiculopathy (author's transl)]. Rev Med Brux 1982; 3:161-6. [PMID: 7079645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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46
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Van der Auwera P, D'Haens J, Noterman J. Pseudomembranous colitis associated with oxacillin therapy. Acta Clin Belg 1982; 37:116-7. [PMID: 7113571 DOI: 10.1080/22953337.1982.11718850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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47
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Christiaens JL, Combelles G, Bousquet C, D'Haens J, Dhellemmes P, Lesoin F, Jomin M. [Intracranial and intraspinal hemorrhage in patients on anticoagulant treatment. Apropos of 33 cases]. Lille Med 1980; 25:178-82. [PMID: 7392767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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48
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Nubourgh Y, Noterman J, D'Haens J, Colle H. [Intracranial hypertension and continuous monitoring of the intracranial pressure in neurosurgical practice (author's transl)]. Rev Med Brux 1980; 1:175-91. [PMID: 7008128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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49
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Ploncard P, Dang T, D'Haens J, Nubourgh Y, Sadeghi B. [The surgery of peripheral nerves. New perspectives in treatment by the microsurgical techniques (author's transl)]. Acta Chir Belg 1979; 78:47-56. [PMID: 433509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The author describes the different techniques of reconstructive surgery of peripheral nerves and the failures that marked these trials until the advent of microsurgical techniques. After stressing the importance of the biology and physiopathology of a traumatized nerve and its stem cells, the author detailes the regeneration stages of the nerve cell when ideal conditions of axonal alignment are established by microtechniques. Considering the different notions of biology and pathology in relation to the time delay between the traumatism and referral to the surgeon, the author insists on the absolute necessity of operating during the period of full regeneration of the nerve cell, i.e. within the first 6 months.
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50
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Noterman J, Dor P, D'Haens J, Baleriaux-Waha D. [Radical resection by combined cranio-facial method for invasive neoplasm of the maxillary sinus. Surgical and tomodensitometric aspects]. Ann Otolaryngol Chir Cervicofac 1978; 95:603-7. [PMID: 371487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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