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D Le Gars

Publications and source records attributed to D Le Gars.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Tumors of the third ventricle: review of 262 cases].

The data from 262 cases of third ventricle (V3) tumors treated in 21 Departments of Neurosurgery in France between 1980 and 1995 were collected in this series. These tumors were frequent in young adults, and 17.5% of the patients were children. Colloid cysts (55%) and gliomas (19%) were the most frequent lesions. Other tumors were rare, or exceptional. CLINICAL PRESENTATION: The duration of symptoms was short in time, despite these lesions were usually benign. Most of cases were revealed by intracranial hypertension (63%), sometimes with a paroxystic or positional evolution. Neuropsychological signs (48 %) were undoubtedly under-estimated, revealing the disease in only 10% of cases. Ophthalmologic signs and endocrine disorders were infrequent. This feature is related to the selection of patients in this series, as tumors arising from the floor of the third ventricle or from the optic chiasm were excluded. Endocrine disorders were frequent with gliomas (30 %). THERAPEUTIC MANAGEMENT: In half of the patients, hydrocephalus was absent or mild and was ruled out after the treatment of the ventricular lesion. However, 12% of patients required a shunt procedure after the treatment of the ventricular lesion. A stereotactic procedure was performed in 63 patients, 12 had ventriculoscopy, and a direct surgical approach to the V3 was performed in 200 patients, sometimes after the failure of stereotactic or endoscopic procedures. Thirty six patients received no treatment. The patients were operated on via a transcortical approach (159 cases), or via the anterior transcallosal route (35 patients). Postoperative course was uneventful in 67% of the patients, complications were recorded in 24% of patients. MORTALITY AND MORBIDITY: The overall mortality in the national series is 13.7 % (36/262 died). The death occurred before any treatment (4 patients), or was directly correlated to the surgical procedure (13 cases), to long-term complications of hydrocephalus (2 patients), to general complications (7 patients), or to recurrence of the tumor (10 cases). The final outcome analysis recorded neurological impairment in 29% of cases, neuropsychological deficit in 50% of patients, and residual endocrine disorders in 19%. Social independence was recovered by 86% of patients, 76% of them returned to work, 72% of students returned to normal school attendance. The long-term neurological outcome was better with the transcallosal approach. No conclusion was possible concerning neuropsychological outcome, as postoperative neuropsychological assessment was not available for most of the patients operated on with the transcortical approach. PROGNOSIS: The results of treatment were evaluated only for the most frequent lesions (colloid cysts and gliomas). The outcome was worse for gliomas when compared to colloid cysts, considering mortality (13% vs 8%), neurological impairment (36% vs 21%), residual endocrine disorders (34% vs 0%), and ability to return to work (83% vs 56%).

Adolescent↗
PubMed2000

[Tumors of the third ventricle: review of the literature].

In this chapter, the authors compared the results of the national series (262 patients) with the relevant data from the literature, in order to establish the optimal therapeutic management. Colloid cysts represent the main tumor encountered within the third ventricle (145 cases). Sudden death from colloid cysts is documented in this series, but neurosurgeons should also be aware of the increasing number of fortuitous diagnosis of such lesions. The liquid consistency of the content of the cyst is the major argument to choose the surgical procedure. Liquid colloid cysts usually associate isodense appearance on CT Scan, hypo-intensity on T1 weighted MRI images, and hyperintensity on T2-weighted MRI images. Endoscopy now appears as an accurate surgical procedure. A surgical strategy is proposed. Among glial tumors, pilocytic astrocytomas are poorly documented in the literature. Low grade astrocytomas, ependymomas, subependymomas and giant cell subependymal astrocytomas, gangliogliomas, and oligodendrogliomas were reviewed with the relevant literature. Other tumors are rare in the third ventricle, except for choroid plexus papilloma and craniopharyngioma. The reality of purely intraventricular craniopharyngioma is confirmed by the experience of this series. Other lesions such as meningioma, cavernoma, germ-cell tumors, lymphomas, metastasis, epidermoid cysts, and exceptionnal lesions were also reviewed.

Cerebral Ventricle Neoplasms↗
PubMed2000

[Tumors of the third ventricle in children: review of 46 cases].

In the national series, 46 patients out of 262 (17.5%) were children under 15 years of age. Most of them presented with gliomas (50 %), choroid plexus tumors were recorded in 8 cases (17%). Intracranial hypertension revealed the tumor in 80% of children, endocrine disorders were recorded in 8 patients. A stereotactic procedure was performed in 7 patients, 1 had ventriculoscopy, and a direct surgical approach to the third ventricle was performed in 37 patients, in one case after the failure of the endoscopic procedure. Two patients with a radiological appearance of hamartoma received no treatment. Most of patients were operated on via a transcortical approach (27 cases). The overall mortality in this series is 9%. The death was directly correlated to the surgical procedure (1 case), or to recurrence of the tumor (3 cases). The final outcome analysis recorded neurological impairment in 50% of cases, neuropsychological deficit in 58 % of patients, and residual endocrine disorders in 41%. Social independence was recovered by 82% of the children, and 68% returned to normal school attendance.

Adolescent↗
PubMed2000

[MR diffusion and perfusion imaging in clinical practice].

MR functional imaging, due to the improvement in ultra-speed imaging technology such as echo-planar imaging, has become a very powerful technique since the beginning of the nineties. This imaging technique is divided into diffusion imaging, perfusion imaging and cerebral activation. Diffusion imaging probes the mobility of water molecules characterized by a diffusion coefficient called the apparent diffusion coefficient (ADC) for biological tissues. Perfusion imaging gives hemodynamic information due to the regional cerebral blood volume by the use of contrast agents such as chelates of gadolinium carrying strong magnetic susceptibility. Both imaging techniques can provide information in a wide nosological range : cerebral ischemia, in the acute phase and in case of intracranial tumors, contributing to tumoral grading, localizing the site of biopsy, and assessing response to therapy (after radiotherapy for example). Nevertheless, a wide range of domains remains incompletely studied, for example cerebral white matter diseases and neurodegenerative diseases. For clinical applications, a precise knowledge of the potentials of both techniques and their limitations is needed. Limitations result from the large number of often patient-related parameters, imaging technique (perfusion) and data analysis. Powerful software has been developed in the workstation environment. Thus this imaging technique requires up-to-date equipment and close collaboration between clinical and research teams for optimal efficiency.

Brain Ischemia↗
PubMed1998

Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results.

Percutaneous vertebroplasty with acrylic cement consists of injecting polymethylmethacrylate into vertebral bodies destabilized by osseous lesions. The aim is to obtain an analgesic effect by reinforcing lesions of the spine. The major indications are vertebral angiomas, osteoporotic vertebral crush syndromes, and malignant spinal tumors. The clinically significant complications occur predominantly in patients with spinal metastatics, but in the great majority of cases they resolve with medical treatment.

Anesthesia, General↗
PubMed1997

Outcome in 43 patients with distal anterior cerebral artery aneurysms.

BACKGROUND AND PURPOSE: The aim of this retrospective multicenter study was to evaluate the outcome of distal anterior cerebral artery (DACA) aneurysms and to determine the incidence, causes, and consequences of unfavorable outcomes. METHODS: 43 patients with 50 DACA aneurysms (27 females and 16 males, mean age 49 years) were studied retrospectively. Forty-four DACA aneurysms were treated surgically (83% with an interhemispheric approach), and 2 were embolized. At postoperative day 10, all patients underwent routine angiography. The outcome at 6 to 12 months was scored according to the Glasgow Outcome Scale (GOS). RESULTS: 35 DACA aneurysms were ruptured. Among the 26 "good"-grade patients (Hunt and Hess grades I through III), 18 (69.2%) were in GOS 1, 2 in GOS 2 (7.7%), 2 in GOS 3 (7.7%), and 4 in GOS 5 (15.4%); among the 9 "poor"-grade patients (Hunt and Hess grades IV and V), 1 (11.1%) was in GOS 1, 2 in GOS 2 (22.2%), 2 in GOS 3 (22.2%), and 4 in GOS 5 (44.5%). The initial intracerebral hemorrhage (ICH) (40%) induced neurological aftereffects in 8 patients. An operative rupture occurred in 40%, with a temporary occlusion in 28.6% that was responsible for mediocre results in 3 patients (8.7%). A postoperative thrombosis was observed in 4 patients (11.4%) and an aneurysmal remnant in 1 (2.8%). Ten DACA unruptured aneurysms were clipped without operative rupture or thrombosis. CONCLUSIONS: The authors suggest that the proportion of ruptured DACA aneurysms evolving to a GOS 1 or 2 was similar to that of aneurysms found in other locations, after early surgery. Endovascular treatment should be considered in the management of uncommon ruptured fusiform DACA aneurysms.

Adolescent↗
PubMed1987

[Pseudotumoral amyloidosis of the orbit].

A case of orbital amyloid pseudotumour is reported; this rare condition typically present as a ptosis followed by slowly growing orbital neoplasm, in middle-aged women. CT-scan disclose an extra-conal, extra-osseous, calcified mass; preoperative diagnosis of this rare condition might help in avoiding recurrence, probably due to incomplete excision. Pathophysiology of these amyloid deposits remain unknown.

Amyloidosis↗
PubMed1987

[The cranio-spinal joint: apropos of some anomalies].

The occipitocervical region settles down around the rostral extremity of the chorda, from components coming from the parachordal cartilage, the occipital somites and the first cervical somites. The evolution of the ossification points may be defective. This explains the malformations of this region, and their eventual mechanical repercussions. These malformations may be associated with malformations of the nervous system.

Atlanto-Axial Joint↗
PubMed1987

[Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

Findings in several cases are used to demonstrate that certain vertebral angiomas may not be congenital and can ultimately provoke medullary or radicular neurologic complications. Radiotherapy is the usual treatment but is not always accepted unconditionally close to spinal cord. Destruction of angioma and consolidation of vertebral column can be obtained by percutaneous intrasomatic injection of acrylic cement. The preoperative radiologic examination includes direct phlebography with insertion of trocar, the vertebroplasty being performed under television screen surveillance. Results in seven patients treated are very encouraging but the current 2-year follow up requires extension. However, the method appears to be able to be included amongst treatment for an affection of sometimes seriously questioned benign nature.

Adult↗
PubMed1986

[Venous vascularization of the ilium].

The authors have tried to render visible the venous network of the ilium in order to understand the technique of high flow intra iliac infusion. To that aim, they have injected in each ilium of corpses, not previously embalmed, a coloured resin plastic transfused within two minutes. The corpses have then been dissected. The authors have remarked: 1. the whole vena cava inferior system was quickly and completely filled, 2. the filling-up of a dense network of periosteal small veins on the ilium, spreading to the muscular intra and extra-pelvic veins.

Adult↗
PubMed1986

[Multiple intracranial aneurysms. A very peculiar case of 8 sylvian aneurysms].

Reports vary with respect to frequency of multiple aneurysm but they are observed in an average of 13% of intracranial aneurysm cases. Multiple aneurysms generally involve several intracranial vascular trunks but those affecting the vertebrobasilar system and middle cerebral artery are the most common combinations. It is rare for more than two lesions to be located on the trunk of a same vessel. These data emphasize the exceptional nature of the clinical case presented. The eight aneurysms detected in this patient were all situated on the left sylvian artery and its proximal collaterals. Rupture of one of the aneurysms had provoked haemorrhage into sylvian fissure. All eight aneurysms were treated by eleven clamps during the course of a one-stage operation. Full recovery, with completely normal clinical and review arteriographic results, was obtained despite the postoperative onset of a right hemiplegia with aphasia.

Adult↗
PubMed1983

[Painful sciatic rubbing caused by benign synovioma of the spinal joints. Apropos of 4 cases].

Synovioma, a benign neoplasm arising from pigmented villonodular synovium or synovitis, is uncommon. It involves the tendons and joints of the finger, ankle and foot. In this study four cases of villonodular synovioma of spinal joints are reported. The authors studied 555 cases of patients operated for sciatica due to herniated disk. Histopathology showed that in four out of 555 cases sciatica was found to be due to synoviomas of the spinal joints. The patients, three women and one man, were between 54 and 70 years of age and each had had a long history of low back pain with episodes of sciatica. Clinical evaluation at the time of surgery showed moderate severity of signs and symptoms. Roentgenographic studies of all four cases revealed osteoarthritic changes of vertebral apophyses, with two cases of spondylolisthesis. The pathogenesis of synovioma remains controversial and its histopathological characterization -hyperplasia VS/true tumours- has not yet been determined. It is possible that the number of recorded cases of sciatica due to synoviomas is small because surgical and pathological studies in patients with sciatica associated with osteoarthritic changes have not been adequately performed. Surgery consists of a large resection of the capsule and ligament including resection of intraspinal extension. Because this study involves only four cases, the first of which occurred in 1977, the possibility of recurrence cannot be evaluated.

Aged↗
PubMed1981

[Management of the non traumatic dissecting aneurysm of the cervical portion of the internal carotid artery (author's transl)].

The spontaneous dissecting aneurysms of the internal cervical carotid artery are renowned unusual, as about fifty cases only are reported in the literature. About 18 cases of dissecting aneurysms, 5 of which operated on and 13 clinically and radiologically followed, the authors try to draw a management. This one is resolutely conservative because: 1. It is possible to expect the spontaneous evolution according to the radiological form of the dissection which becomes in the great majority of cases toward repermeability. 2. The exceptional cases evolving to the thrombosis can later have an extra-intracranial anastomosis. 3. The cases justifying a direct surgical approach are exceptional and the operatory decision is easily taken according to the radiological aspect. On the whole, this pathology seems less unusual than the literature leads to suppose and the spontaneous evolution is worth to be well known because it conditions the management.

Adult↗
PubMed1979

[Functional anatomy of the pisiform bone].

The pisiform is the only moving structure of the canalis carpi. In the power grip, it undergoes a posterior and medial movement, limited by the pisohamate ligament. This motion is indispensable for a good prehension. The strength of the pisohamate ligament effectively balances the dislocation tendency the flexors carpi ulnaris exert on the pisiform.

Biomechanical Phenomena↗