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Biomedical subjects

D Brasnu

Publications and source records attributed to D Brasnu.

At least 91 records · Page 5Linked to original sources
PubMed1997

Laryngofissure and cordectomy for glottic carcinoma limited to the mid third of the mobile true vocal cord.

The objective of this study was to analyze the long-term results of laryngofissure with cordectomy for invasive glottic squamous cell carcinoma limited to the mid third of the mobile true vocal cord. The authors conducted a retrospective review of the medical charts and operative files of 33 patients with invasive glottic carcinoma limited to the mid third of the mobile true vocal cord managed with laryngofissure and cordectomy. A 10-year follow-up was achieved in 30 patients (90.9%). Kaplan-Meier actuarial analysis of survival, local control, nodal recurrence, distant metastasis, and second primary metachronous tumor was performed. The 5-year actuarial survival, local control, nodal recurrence, and distant metastasis estimates were 97%, 100%, 0%, and 0%, respectively. Tracheotomy was never performed. The overall laryngeal preservation rate was 100%. The 5- and 10-year actuarial metachronous second primary tumor estimates were 3% and 11.5%, respectively. The authors' experience suggested that laryngofissure and cordectomy should still be considered a valuable oncologic option for the management of invasive glottic carcinoma limited to the mid third of the mobile true vocal cord.

Adult↗
PubMed1997

Functional outcome and prognosis factors after supracricoid partial laryngectomy with cricohyoidopexy.

A retrospective analysis of the medical records and operative files of 124 patients who consecutively underwent supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) was undertaken. The objective of this study was to analyze the postoperative course and functional results of SCPL-CHP. The mean duration of follow-up was 7 years (range 1 to 20 years). The postoperative mortality was 1.6%. The average times until tracheostomy and nasogastric feeding tube removal were 8 and 22 days, respectively. All patients but 1 were decannulated. The rate of pneumonia from aspiration was 11.5%. Completion total laryngectomy and permanent gastrostomy were required in 2.5% and 2.5% of patients, respectively. Overall normal swallowing without permanent gastrostomy and respiration without tracheostomy were achieved by the first postoperative year in 91% and 99.1% of patients, respectively. Univariate analysis of the potential correlation between various variables and the duration of the tracheostomy and nasogastric feeding tube, the incidence and causes of mortality, the incidence and type of the various complications, the recovery of swallowing, and the length of hospitalization is presented. The report also discusses the management and follow-up care.

Adult↗
PubMed1997

Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncologic results with 112 patients.

The medical charts and operative files of 112 patients (combined inception cohort) with well to moderately differentiated invasive glottic squamous cell carcinoma presenting fixation (22) or impaired motion (90) of the true vocal cord (TVC) consecutively treated with cricohyoidoepiglottopexy (CHEP) at our institutions from 1972 to 1989 were retrospectively reviewed. A minimum 5-year follow-up was always achieved. The Kaplan-Meier 5-year actuarial survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate for the entire group of patients were 84.7%, 5.4%, 6.4%, 1.2%, and 10.8%, respectively. The 5-year absolute and cause-specific survival rates were 85.5% and 94.1% for patients with fixation of the TVC and 81.3% and 96% for patients with impaired motion of the TVC. The 5-year actuarial local control rates for patients with fixation or impaired motion of the TVC were 95.4% and 94.4%, respectively. Local recurrence was statistically more likely in patients with positive margins (p = .007). Nodal recurrence was statistically more likely in patients with local recurrence (p = .005). Permanent tracheostomy related to postoperative laryngeal stenosis was requested in 2 patients. Aspiration-related completion total laryngectomy and/or permanent gastrostomy were never requested. Overall, local control and laryngeal preservation were achieved in 97.3%, and 95.5% of patients, respectively. At our institutions, the change from the conservative treatment modalities of radiotherapy and vertical partial laryngectomy to CHEP has brought about an increase in long-term survival, local control, and laryngeal preservation rates when compared to historical controls using vertical partial laryngectomy or radiotherapy.

Adult↗
PubMed1997

[Trans-facial approaches of cancers of the ethmoid].

Lateral rhinotomy, midface degloving approach and medial maxillectomy are described. Lateral rhinotomy allows for a wide surgical approach, complete tumor removal with safe margins and satisfying cosmetic result. Lateral rhinotomy with medial maxillectomy is recommended for surgical resection of ethmoid sinus carcinoma. This surgical approach allows for a simultaneous neurosurgical subfrontal approach.

Ethmoid Sinus↗
PubMed1997

[Malignant tumors of the ethmoid region. Neurosurgical techniques].

We describe the main neurosurgical approaches in use for removing cancers of the ethmoid region: a) the classical subfrontal procedure usually combined with a transfacial approach, b) the sub-fronto-orbito-nasal approach (SFON) now performed in a majority of procedures as long as the tumor does not present with a large intra-cranial and/or maxillary extension. The advantages and drawbacks of both techniques are discussed. The progressive simplification of techniques for anterior cranial base reconstruction is explained and warranted.

Ethmoid Bone↗
PubMed1997

[Malignant ethmoid-sphenoidal tumors. 130 cases. Retrospective study].

We report on 130 ethmoidal cancers. 96 (74%) were adenocarcinomas (ADKE). 110 were operated upon between 1984 and 1996: 9.1% T1 + T2, 27.7% T3, 36.2% T4a, 27% T4b. Neoadjuvant chemotherapy was administered in 93 patients (76 ADKE). Combined surgical route was performed 103 times, sub-fronto-orbito-nasal (SFON) route 7 times. Post-operative radiotherapy was performed in 36 patients. Complete clinical and radiological response to chemotherapy was noted in 21.5% of cases (23% of ADKE). Post-operative mortality concerned one patient who died from a pulmonary embolism during the third post-operative week. Morbidity included: 3 transient clinical rhinorrheas, 5 meningitis (one of which was responsible for heavy psycho-intellectual disability), 4 deep suppurations associated with osteitis of the bone flap and two superficial suppurations. 44 patients had a local recurrence (10 ADKE). No recurrence appeared in complete chemoresponders. Systematic preservation of intra-orbital contents did not increase the risk of local failure. Eleven patients (4 ADKE) developed cervical nodes and/or systemic metastasis. Death occurred after a mean of three months following the diagnosis of metastasis. Survival rate was: 60% at 3 years, 51.5% at 5 years, 32.5% at 10 years. ADKE survival rate was: 55% at 3 years, 51.5% at 5 years, 23% at 10 years. Survival ws related to tumoral extension: 75% at 5 and 10 years for T3, 45% at 5 years and 38% at 10 years for T4a, 40% at 3 years and null at 5 years for T4b, 5 and 10 years survival rate of complete chemoresponders are 100% whatever the tumour. Prognosis remained poor for epidermoid carcinomas (survival rate: 36% at 3 years, 0% at 5 years) and for melanomas (mean survival: 19.6 months). Post-operative radiotherapy should be indicated for large tumors T3, T4a and T4b).

Adenocarcinoma↗
PubMed1996

Cisplatin-based neoadjuvant chemotherapy and combined resection for ethmoid sinus adenocarcinoma reaching and/or invading the skull base.

OBJECTIVE: To review our experience with cisplatin-based neoadjuvant chemotherapy before en bloc resection via a combined neurosurgical and transfacial approach for ethmoid sinus adenocarcinoma reaching and/or invading the skull base. DESIGN: Case series. SETTING: A tertiary care center and university teaching hospital. PATIENTS: Twenty-two patients with primary untreated ethmoid sinus adenocarcinoma reaching and/or invading the skull base consecutively treated between 1984 and 1992 with cisplatin-based neoadjuvant chemotherapy and combined neurosurgical and transfacial approach. MAIN OUTCOME MEASURES: Statistical analysis of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor incidence based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors, survival, and local recurrence. Clinical response, histological response, toxic effects of chemotherapy, and postoperative course were also reported. RESULTS: The Kaplan-Meier 3-year survival, local control, nodal recurrence, and distant metastasis estimates were 68.1%, 65.7%, 5.3%, and 10%, respectively. Metachronous second primary tumor was not encountered in our series. Survival was statistically more likely to be reduced in patients with intrasphenoidal tumor extent (P = .04) and local recurrence (P = .01). Local recurrence was statistically more likely in patients with intrasphenoidal tumor extent (P = .002) and no response to cisplatin-based neoadjuvant chemotherapy (P = .03). CONCLUSIONS: The results achieved suggest that cisplatin-based neoadjuvant chemotherapy before combined neurosurgical and transfacial approach should be further investigated for the treatment of ethmoid sinus adenocarcinoma reaching and/or invading the skull base.

Adenocarcinoma↗
PubMed1996

Glottic carcinoma with a fixed true vocal cord: outcomes after neoadjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

Twenty patients with glottic squamous cell carcinoma and a fixed true vocal cord underwent neoadjuvant chemotherapy followed by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Phonation, respiration, and deglutition were preserved. Local control was better than has been previously reported for either extended vertical partial laryngectomy or radiation therapy. All patients were monitored for at least 3 years or until death. The Kaplan-Meier 3-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary rates were 75%, 10.8%, 5%, 10.8%, and 10.8%, respectively. Overall local control was achieved in all cases, and laryngeal preservation in 90%. Our experience suggested that neoadjuvant chemotherapy with supracricoid partial laryngectomy with cricohyoidoepiglottopexy deserves further consideration in the treatment of glottic tumors with a fixed true vocal cord.

Adult↗
PubMed1996

Supracricoid partial laryngectomy after failed laryngeal radiation therapy.

Twelve patients managed with supracricoid partial laryngectomies (SCPLs) after failed laryngeal radiation therapy (RT) were evaluated. None of the recurrent tumors were amenable to vertical or horizontal partial laryngectomy. Results were analyzed for tracheostomy decannulation, oral alimentation, morbidity, local control, and survival. Major complications included perichondritis (2 patients), laryngeal stenosis (2 patients), and pneumonia from aspiration (1 patient). Mucocutaneous fistula and cricoarytenoid joint ankylosis were not encountered. Margins of resection were uninvolved in all cases. The Kaplan-Meier 3-year actuarial survival and local control estimate was 83.3%. Salvage total laryngectomy allowed for an overall 100% local control rate and a 75% laryngeal preservation rate. This preliminary report suggests that, in patients with failed laryngeal RT not amenable to vertical or horizontal partial laryngectomy, the SCPL procedures should be discussed before advocating salvage total laryngectomy. Further series analyzing the role and limitations of the various SCPL procedures after failed laryngeal RT are warranted.

Adult↗
PubMed1996

Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results.

A 20-year experience with end-to-end tracheal resection and anastomosis for isolated postintubation stenosis of the cervical trachea, in a consecutive series of 32 adult patients, has been reviewed. Surgical death was never encountered. The overall incidences for superficial wound infection, pneumonia, and inferior left laryngeal nerve paralysis were 6.2%, 3.1%, and 3.1%, respectively. One-, 3- and 5-year actuarial anastomosis success rates were 96.7%, 93.3%, and 93.3%, respectively. Successful revision tracheal end-to-end anastomosis was performed once, resulting in an overall 96.9% success rate in our series. None of the following variables-sex, age, cause for intubation, intubation type (laryngotracheal and/or tracheotomy) and duration, delay from initial injury, presence of an open stoma, number of tracheal rings resected, and type of sutures used-were statistically related to the anastomosis success rate or the incidence of complications.

Adult↗
PubMed1996

Cisplatin-fluorouracil exclusive chemotherapy for T1-T3N0 glottic squamous cell carcinoma complete clinical responders: five-year results.

PURPOSE: To evaluate cisplatin-fluorouracil exclusive chemotherapy (EC) for T1-T3N0 glottic squamous cell carcinoma complete clinical responders (CCR) after cisplatin-fluorouracil induction chemotherapy (IC). PATIENTS AND METHODS: A retrospective analysis was performed of 58 patients with T1-T3N0 glottic squamous cell carcinoma CCR after IC consecutively managed at our department between 1985 and 1992. Twenty-one CCR were managed with EC. Thirty-seven CCR were managed with IC and a conventional laryngeal-preservation modality. Analyses of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor were performed using the Kaplan-Meier actuarial life-table method. In CCR managed with EC, the independent factors of age, tumor classification, exact tumor location, true vocal cord motion, arytenoid cartilage motion, total dosage of drugs delivered, and number of courses received were tested for potential correlation with survival, local recurrence, nodal recurence, and distant metastasis. RESULTS: The 5-year survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor rates in CCR managed with EC were 95.2%, 70.7%, 0%, 0%, and 14.3%, respectively. The 5-year rates of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor in CCR managed with IC and a conventional laryngeal-preservation modality were 86.1%, 97%, 2.7%, 6%, and 14.5%, respectively. Local recurrence was statistically more likely in CCR managed with EC (P = .002). Local recurrence in CCR managed with EC was always salvaged with partial laryngectomy or radiation therapy, which resulted in an overall 100% local control and laryngeal-preservation rate within this group. In CCR managed with EC, none of the variables analyzed was statistically related to survival, local recurrence, nodal recurrence, or distant metastasis. CONCLUSION: The present retrospective studies demonstrated that within T1-T3N0 glottic squamous cell carcinoma CCR, there is clearly a significant subset of patients with chemocurable tumors who achieved both perfect preservation of structure-supporting voice and long-term survival after EC. Careful monthly follow-up evaluation allowed for timely successful salvage of local recurrence after EC without the need for total laryngectomy. Such management did not appear to increase the risk for subsequent nodal failure, subsequent distant metastasis, or reduced survival.

Adult↗
PubMed1996

The role of computed tomography and magnetic resonance imaging in planning for conservation laryngeal surgery.

Refined laryngeal conservation surgeries have been devised to maintain the voice while eradicating even extensive glottic and hypopharyngeal tumors. The role of diagnostic imaging is to adequately define the extent of disease in conjunction with endoscopy. Critical areas to be evaluated are the tongue base, vallecula, pre-epiglottic space, arytenoid cartilages, postcricoid region, hypopharynx, thyroid cartilage, and subglottis.

Humans↗
PubMed1996

[Supra-cricoid partial laryngectomy extended to the anterior arch of the cricoid with tracheo-crico-hyoido-epiglottopexy. Oncologic and functional results].

21 patients with glottic carcinoma presenting anterior infraglottic extent of tumor, classified T2-T4, were offered and extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy (TCHEP) between 1979 and 1994 at our department. The technique for the procedure, the duration of tracheotomy tube, naso-gastric feeding tube, and hospital stay are presented. Postoperative complications and management were described. The 5-year actuarial survival, local control, nodal recurrence, distant metastasis, and metachroneous second primary tumor estimate was 74.7%, 88.9%, 11.1%, 22.4% and 15%, respectively. Overall a 95.2% (20/21) local control rate was achieved with a 90.5% (19/21) laryngeal preservation rate.

Actuarial Analysis↗
PubMed1996

[Development of reconstruction techniques of the anterior skull base after tumor excision].

183 benign and malignant tumors of the anterior cranial base were operated in the department of neurosurgery at Ste Anne's hospital, from June 1982 to December 1993. The bone defect was repaired first with bone sheets taken from the inner table of the cranial flap. Then allografts of irradiated bone and madreporic coral blocks were used as reconstruction material. Since January 1992, no bone reconstruction was performed; the anterior base was just covered with a sheet of Vicryl Composit Mesh (VCM) which was secured bilateraly on the pterion, the temporalis pars squamosa and around the ethmoid defect. This sheet of VCM reinforces the dural plane, which is always lined with a pediculated galea flap. These technical changes and evolution were motivated by: i/- a desire to simplify the surgical technique: ii/- the risk of transmission of viral diseases such as Creutzfeld Jacob disease by allografts, iii/- the frequency of splits and/or falls of madreporic coral grafts. Whatever the material, the infection risks were identical: 8% of subcutaneous and/or deep suppurations, 5% of post-operative meningitis. One patient presented with a transient clinical rhinorrhea.

Bone Transplantation↗