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Biomedical subjects

C Sainte-Rose

Publications and source records attributed to C Sainte-Rose.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Hydrocephalus of venous origin].

The relationship between intracranial pressure and superior sagittal venous pressure has been often debated. On one side, the observation of patients with achondroplasia or hydrocephalus associated with craniostenosis suggest that the venous hyperpressure could be the cause of the enlarged ventricles; on the other side, reports have demonstrated that an increased superior sagittal venous pressure could be the consequence of increased intracranial pressure. Therefore, the authors undertook a study to determine if there was a test that could distinguish between rare instances of increased superior sagittal venous pressure caused by structural and irreversible narrowing of the sinus, and those caused by increased intraranial pressure. This test is based on the study of venous pressure variation during cerebrospinal fluid withdrawal as compared to simultaneous intracranial pressure variations. The relationship between a sinus venous hyperpressure and an enlargement of the ventricles, the pathology of pericerebral collection occurring in such cases of hydrocephalus are discussed.

Blood Pressure Monitors↗
PubMed1989

[Treatment of chronic subdural collection in infants by subdural peritoneostomy].

Between 1980 and 1987, 50 chronics bilateral subdural collections in infants were treated by means of a subdural peritoneal shunt (unilateral in 48 cases, bilateral in 2 cases). In 2 patients with huge macrocranium the drains were left in situ. In the 48 others, the drains were removed after an average of 10 months. In these 48 cases, the drainages either bilateral (2 cases) or unilateral (46 cases) led to the disappearance of the collections; however, in 1 of these 48, a drain had to be reinserted due to the reproduction of the collection following the removal of the initial drainage. High level of C.S.F. protein content did not alter the peritoneal resorption. Obstruction of the catheter by a clot occurred in 3 cases with grossly bloody collections. Unilateral subdural peritoneal drainage for bilateral pericerebral collection is an efficient and safe treatment. The authors should advocate temporary external drainage only in the cases where the collection is grossly bloody.

Chronic Disease↗
PubMed1988

Prenatal hydrocephalus: outcome and prognosis.

The clinical records of 108 infants presenting with hydrocephalus at birth and operated on from 1971 to 1981 were reviewed in order to evaluate the functional results. Premature newborns and spina bifida patients were excluded. Communicated hydrocephalus (39 cases) and aqueductal stenosis (32 cases, excluding 6 X-linked hydrocephalus and 4 toxoplasmoses) were the two main types of hydrocephalus in this series. Eighty-four percent of the infants were operated on before the age of 3 months. The mean follow-up time was 7 years (range 1 to 14 years). The survival rate, calculated by the life table method, was 62% at 10 years. The functional results were evaluated according to intellectual performance, academic level, and psychological status. Of the 75 surviving children, 28% have an I.Q. over 80 and 50% an I.Q. under 60. The mean I.Q. is 54 (range 0 to 130). Of the 52 children who have now reached school age, only 29% have reached a normal academic level. The psychological status is normal or borderline in 46% of the patients. The importance of head enlargement at birth, ventricular size, and the age at the time of surgery are not related to late functional results. The results were best when there were no associated malformations, no shunt infection, when hydrocephalus was due to aqueductal stenosis (excluding X-linked hydrocephalus and toxoplasmosis), or when the first developmental quotient measured at 6 months was over 80.

Age Factors↗
PubMed1988

[Treatment of craniopharyngiomas in children. Retrospective analysis of 50 cases].

In order to evaluate the results of surgery and radiotherapy upon craniopharyngiomas in children, the authors review their own series of 50 cases treated from 1968 to 1985 and the literature. After subtotal removal, the recurrence-free survival rate, 10 years postoperatively, was 37%. This rate was significantly higher (72%) when the subtotal removal was followed by irradiation with a dose of 50 to 55 grays: however, deafness and severe neuro-psychological and intellectual sequelae were frequent in these patients. After radical excision the rate of recurrence was the lowest, with a 10 year-recurrence-free survival rate of 88%. The postoperative mortality was low in case of pre-chiasmatic craniopharyngiomas, but high in case of retro-chiasmatic ones. Nevertheless, it appears from the recent literature data that impressive surgical improvements are to be expected from new surgical routes, associated with the use of the most recent technologies. The conclusions of this study are: 1. Radical excision is the treatment of choice; 2. If radical excision is not possible, surgery should be followed by irradiation to lower the risk of recurrence; 3. However, in view of the dangers of radiotherapy to the growing brain, it should be delayed as long as possible, particularly in the case of young children, and used only when tumor recurrence has been demonstrated.

Adolescent↗
PubMed1987

A new approach in the treatment of hydrocephalus.

To date, most patients suffering from hydrocephalus have been treated by insertion of differential-pressure valves that have fairly constant resistance. Since intracranial pressure (ICP) is a variable parameter (depending on such factors as patient's position and rapid eye movement sleep) and since cerebrospinal fluid (CSF) secretion is almost constant, it may be assumed that some shunt complications are related to too much or too little CSF drainage. The authors suggest a new approach to treating hydrocephalus, the aim of which is to provide CSF drainage at or below the CSF secretion rate within a physiological ICP range. This concept has led the authors to develop a three-stage valve system. The first stage consists of a medium-pressure low-resistance valve that operates as a conventional differential-pressure valve until the flow through the shunt reaches a mean value of 20 ml/hr. A second stage consists of a variable-resistance flow regulator that maintains flow between 20 and 30 ml/hr at differential pressures of 80 to 350 mm H2O. The third stage is a safety device that operates at differential pressures above 350 mm H2O (inducing a rapid increase in CSF flow rate) and therefore prevents hyper-elevated ICP. An in vitro study is described that demonstrates the capability of this system to maintain flow rates close to CSF production under a range of pressures similar to those observed under various human physiological and postural conditions. Promising clinical results in 19 patients shunted with this valve are summarized.

Adolescent↗
PubMed1986

Acute intracranial hematomas in term neonates.

Acute intracranial hematomas in 17 term neonates are reported: 3 were subdural in the posterior fossa; 14 supratentorial, either subdural, intracerebral (1 frontal, 4 occipital) or intraventricular. The hematomas were aspirated in 3 cases and surgically evacuated in 10. In the remaining 4, the effusion was left in situ. Three patients died: 2 due to dramatic preoperative deterioration and 1 to hemostatic difficulties during surgery. In the 14 survivors, neurological sequellae are major in 3, nil or minor in 11. Comparison of these cases to the 110 others already published allows the following conclusions: the cause of such hematomas is usually multifactorial, combining obstetrical trauma, anoxia and/or coagulation disorders; early diagnosis of the hematoma requires early echography and/or tomodensitometry; when the hematoma causes a midline shift, the authors advocate its early evacuation by aspiration, or craniotomy if it is clotted; the prognosis is poor when there is associated severe perinatal anoxia; if there is no anoxia, the prognosis seems good, but as the follow-up is usually short, definite conclusions are difficult; in our series hydrocephalus requiring treatment occurred in 2 of the 14 survivors.

Cerebral Hemorrhage↗
PubMed1986

Intraspinal lipomas with spina bifida. Prognosis and treatment in 73 cases.

The authors present a series of 73 cases of intraspinal lipomas in the lumbosacral region. Sixty-four patients were operated on, 43 of these under intraoperative monitoring of neural function. The results of this series and of major series published in the past 10 years demonstrate both the potential severity of these lesions (which are responsible for progressive neurological deficits in 56% of affected cases) and the benignity of their surgical treatment. The authors emphasize the usefulness of systematic early surgical treatment of these lesions.

Adolescent↗
PubMed1984

Intracranial venous sinus hypertension: cause or consequence of hydrocephalus in infants?

From a previous study of achondroplasia as well as from the observation of patients with hydrocephalus associated with craniostenosis, the authors have concluded that an increased superior sagittal sinus venous pressure (SSVP) could be the cause of the enlarged ventricles. However, other workers have demonstrated that an increased SSVP could be the consequence of increased intracranial pressure (ICP). Therefore, the authors undertook a study to determine if there was a physiological test that could distinguish between rare instances of increased SSVP caused by structural and irreversible narrowing of the sinus and those caused by increased ICP. In 20 hydrocephalic infants and children, pressure was simultaneously measured in the lateral ventricle, the superior sagittal sinus, and the jugular vein. Stable baseline pressures were recorded, as well as the variations observed after the withdrawal of an amount of cerebrospinal fluid (CSF) sufficient to lower ICP to zero. Similar recordings were taken after reinjection of an equal quantity of CSF. In all of the patients, SSVP was increased, but not as much as the ICP. In the cases of hydrocephalus without any associated cranial malformation, and therefore without any likely anatomical interruption of the sinus, CSF withdrawal induced a simultaneous decrease of ICP and SSVP. However, whereas ICP could be lowered to zero, SSVP never fell below the jugular venous pressure, which remained stable (around 5 mm Hg) throughout the recording session. Results were different when sinography demonstrated an anatomical interruption of the sinus, as in cases of hydrocephalus associated with achondroplasia or craniostenosis. In these cases, although ICP was normally lowered by CSF withdrawal, SSVP remained nearly unchanged, usually greater than the jugular venous pressure. The present study demonstrated that SSVP recording during ICP variations induced by CSF withdrawal permits differentiation between a reversible collapse of the sigmoid sinus due to increased ICP and a fixed obstructive lesion of the sinuses. Based upon this test and the results of sinography, the authors inserted a venous bypass between the lateral sinus and a jugular vein in three patients.

Achondroplasia↗
PubMed1984

The Dandy-Walker malformation. A review of 40 cases.

Forty cases of Dandy-Walker malformation referred to the Hôpital Necker Enfants-Malades between 1969 and 1982 have been reviewed. The incidence of the malformation in hydrocephalus was 2.4%. There was a slight, statistically insignificant, female prevalence. Hydrocephalus should not be included in the definition of the syndrome. In 80% of the cases, it was actually a post-natal complication of the malformation and most often developed within 3 months after birth. In 80% of the cases, a communication, although insufficient, was found between the dilated 4th ventricle and the subarachnoid space. Since this communication is probably established through the foramina of Luschka, the definition of the Dandy-Walker malformation should only include atresia of the foramen of Magendie. Associated brain and systemic malformations were numerous. Among facial anomalies, facial angiomas were found in 10% of our cases. The association of facial and cardiovascular anomalies favors the hypothesis that the onset of the malformation occurs between the formation and the migration of the cells of the neural crest (that is, between the 3rd and the 4th post-ovulatory week, earlier than previously thought). Except in selected patients, membrane excision has a high rate of failure and should be abandoned. Cyst-peritoneal shunting avoids the risk of an entrapped fourth ventricle and is presently the best surgical procedure. The overall mortality in this series was 12.5%. Intelligence quotients were over 80 in 60% of the patients. Other studies will be necessary to understand why the communication between the fourth ventricle and the subarachnoid spaces, sufficient in utero, usually becomes insufficient for a normal cerebrospinal fluid (CSF) circulation in the first months following birth. Two hypotheses are discussed: a change in CSF circulation, or bleeding in the dilated fourth ventricle during delivery.

Brain↗
PubMed1984

Factors causing acute shunt infection. Computer analysis of 1174 operations.

A series of 1174 operations performed on 802 hydrocephalic children was analyzed in an effort to find the factors causing acute postoperative infection. Culture of the cerebrospinal fluid (CSF) samples during the operation was positive in 33 cases. These cases were excluded from the series. Ninety infections were observed in the remaining 1141 operations, an overall rate of 7.9%. Most of these infections were meningitis (56 cases). Staphylococcus epidermidis was the bacterium most frequent identified (44%). Statistically significant relationships were found between shunt infection and the following factors: 1) age: infection was 2.6 times as frequent before 6 months than after 1 year of age (p = 0.03); 2) poor condition of the skin; 3) presence of intercurrent seats of infection at the time of surgery; 4) type of operation: the rate of infection was 8.4% in primary shunt insertions, 5% in shunt revisions, and 17.5% in reinsertions following shunt removal for infection (p = 0.0001); 5) end of the shunt requiring revision: an infection rate of 7.7% followed revision of the ventricular catheter alone, and 2.6% followed revision of the other end alone (p = 0.012); and 6) postoperative wound dehiscence or scalp necrosis. The surgical team involved was poorly correlated with the rate of infection (p = 0.12). No statistically significant relationships have been found between infection and 1) etiology of hydrocephalus: 2) sex; 3) recent neurosurgical operation before the shunt procedure; 4) preoperative presence of an external drainage tube or CSF fistula; 5) lumbar or ventricular taps, or ventriculography; 6) number of previous operations performed on the shunt; 7) time (month and year) of operation; or 8) sugar level and cell count in the CSF.

Cerebrospinal Fluid Shunts↗
PubMed1983

Intracranial ependymomas in childhood. Survival and functional results of 47 cases.

A pediatric series of 47 intracranial ependymomas (15 supra- and 32 infratentorial) is presented. All children were operated upon between 1969 and 1979. Among these children, 35 completed the treatment with radiotherapy. The irradiation was usually limited to the intracranial content but in 7 patients, it was extended to the spinal axis as well. Malignant ependymomas represented 69% of the whole series (86% of the supratentorial and 53% of the infratentorial ependymomas). The operative mortality rate was 17%. The 5-year survival rate was 39% in the whole series and 51% when excluding postoperative mortality. Recurrences developed in 41% of cases and metastases in 20%. The study of this series and of the literature points out that: (1) metastases from supratentorial ependymomas are not frequent, almost always supratentorial and secondary to a malignant ependymoma, and (2) metastases from infratentorial ependymomas are almost always intraspinal and occur in one third of these tumors. The rate of seeding is especially high in the case of malignant infratentorial ependymomas (50%) but is also 15% in the case of benign tumors. These data lead the authors to propose a craniospinal irradiation in the case of infratentorial ependymomas whether benign or malignant, an irradiation of only the brain in the case of malignant supratentorial ependymoma, an irradiation of only the tumoral bed when ependymomas are benign and supratentorial.

Brain Neoplasms↗
PubMed1983

[Lumbosacral lipomas with spina bifida. Anatomo-clinical correlations. Therapeutic results].

From 1971 to 1982, the authors saw 41 patients who presented lumbo sacral lipomas with spina bifida; 9 remained outpatients and had regular clinical follow up; the other 32 were operated on; 1 was lost sight of, shortly after the operation. 40 patients were then regularly followed; of these, 15 (37%) developed neurological deficits (14 before and 1 long after surgery). Intraspinal lipomas were classified into 2 groups: group I (18 cases), when the lipomas displaced but did not include the lumbo sacral roots; group II (14 cases) when it included most or all of these roots. Despite an inevitably less satisfactory liberation of the spinal cord in the group II, post operative results were not significantly different in the 2 groups. Comparing the post operative results of this series to others in the literature, the authors come to the following 3 conclusions: 1) these operations are benign; 2) they are all the more effective when the neurological deficits are either recent or evolutive, and 3) they protect most of the patients from eventual neurological deterioration. Therefore the authors agree that patients with lumbo sacral lipomas should be operated on at the onset of neurological deficits but also recommend early intervention, even in the absence of any neurological disturbance.

Adolescent↗
PubMed1983

[Intracranial ependymoma in children. Prognosis and therapeutic perspectives].

The authors report 47 cases of intracranial ependymomas occurring in children less than 15 years of age, who were operated on from 1969 to 1979. The aim of the study was to study the incidence of intraspinal metastases and to suggest a logical protocol for postoperative radiotherapy. The operative mortality rate was 17%. The 5 year survival rate, after exclusion of postoperative mortality, was 51%. Recurrences developed in 41% of cases and metastases in 20%. Among these, intraspinal metastases occurred in 14.5% and were found only in infratentorial ependymomas, whether benign or malignant. The results and those in the literature suggest that a protocol of irradiation adapted to the site and the histological grading of these tumors should be discussed with the teams of radiotherapy; in infratentorial ependymomas, the irradiation should include the whole craniospinal axis.

Adolescent↗
PubMed1983

Brain abscess in childhood. A study of 34 cases treated by puncture and antibiotics.

During the last 15 years, 34 children were treated for a brain abscess. 13 (38%) had cyanotic heart disease; 12 (35%) had an ENT infection. The standardized treatment protocol included puncture of the abscess and administration of antibiotic and antiedematous drugs. Postoperative permanent epidural monitoring of intracranial pressure and, in the last 5 years, repeated CT scans indicated if retapping the abscess or reinforcing the antiedematous treatment was necessary. In 7 out of these 34 cases the abscess had to be excised. Postoperative mortality rate was 6%. Overall mortality rate was 12%. Neurological sequelae were slight. Epilepsy frequency was 10%. Mental retardation (18%) was found only in cyanotic congenital heart disease to which it is related. Repeated CT scans demonstrated the progressive disappearance of the capsule within a few months. This study shows an improvement in the results when brain abscesses in children are punctured rather than excised.

Adolescent↗
PubMed1982

Intracranial pressure in craniostenosis.

In this study, intracranial pressure (ICP) was recorded with an epidural sensor for periods of 12 to 24 hours in 92 cases of craniosynostosis. Pre- and postoperative recordings were performed in 23 patients, and 55 children underwent preoperative psychometric testing. The ICP was found to be normal in one-third of the cases, was obviously elevated in one-third, and was borderline in one-third. Waves of increased ICP were recorded during rapid eye movement (REM) sleep. After surgery, ICP decreased progressively and returned to normal in several weeks. A significant statistical relationship was found between the patients' ICP and their mental level: the higher the ICP the lower the mental level. The regression curve of ICP as a function of age shows that ICP is maximal at the age of 6 years and decreases later. The significance of these results is discussed. The authors recommend that ICP be recorded in cases of craniosynostosis since it is of some help in deciding whether patients should undergo surgery.

Adolescent↗
PubMed1982

[Intra-cranial abscesses and congenital heart disease in children (author's transl)].

The authors report on 13 cerebral abscesses developed in children with cyanogenic heart disease. The abscesses have been treated by one or several punctures and by a general antibiotherapy adjusted to the germ when it was isolated. C.T. Scan and epidural Intra-cranial pressure monitoring have defined the Therapeutic tactics. The mortality rate is 7.7%. 60% of the survivors lead a normal life; 40% are mentally retarded; however this mental retardation is not directly related to the abscess; it appears to be a consequence of the cyanogenic cardiopathy. The neurological sequelae are one epilepsy and two visual defects compatible with normal life. Successive C.T. Scans in the months following treatment have shown the progressive disappearance of the abscess membranes. The conclusions of this study are under antibiotherapy, it is better to tap abscesses than to remove them and that their prophylaxy is the suppression of the shunt responsible of the cyanosis.

Adolescent↗