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D Renier

Publications and source records attributed to D Renier.

At least 127 records · Page 7Linked to original sources
PubMed1987

[Brain abscess in the newborn infant (27 cases: initial electroclinical study, course].

The authors studied 27 brain abscesses in neonates. The neonates were divided in two groups: neonates with seizures and neonates without seizures. The authors tested the diagnostic and predictive value of the initial EEG aspect. They noted the absence of correlation between EEG focal abnormalities and localizations shown by the CT scan. They observed a severe electroclinical evolution in more than fifty percent of the cases presented.

Brain Abscess↗
PubMed1987

Treatment of craniosynostosis in infancy.

Craniosynotosis affects approximately one infant out of 1000. The increase of intracranial pressure and the risks of functional problems are more frequent than usually estimated, especially in monosutural synostosis. Frontocranial remodeling will correct both functional and aesthetic consequences of craniosynostosis. The best operative period is the first year of life, 2 to 3 months of age for the brachycephalies, and 6 to 9 months of age for the other craniosynostoses. Not only does growth not adversely affect the results of the forehead remodeling, but the adjacent orbitonasal areas improve with time. In Crouzon's disease and Apert's syndrome, early frontal advancement does not prevent the midface retrusion, and a radical frontofacial advancement may be indicated in very severe cases.

Child↗
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↗
PubMed1986

[Ophthalmologic complications of craniofacial stenoses. Apropos of 244 cases].

The authors present a review of the most commonly observed ophthalmological troubles in 244 cases of children affected by cranio-facio stenoses and hospitalized for a first examination. The fundus examination shows that nearly all types of cranio-facio stenoses can be complicated by intracranial hypertension with potential damage on the optic nerve. The hyper and hypotelorisms, particularly frequent, carry along aesthetic prejudice and effect on the ocular motility. In the most severe forms of the diseases (Alport), pseudo-exophthalmy by retrusion of the face can justify preventive surgical procedures in emergency. Squint is frequent (36.5%). All types can be found. Finally, the authors certify the frequency and the seriousness of ocular repercussion, even in so called benign types of cranio-stenoses, such as plagiocephaly, trigonocephaly, and scaphocephaly.

Acrocephalosyndactylia↗
PubMed1985

Craniofacial surgery for craniosynostosis improves facial growth: a personal case review.

An evaluation of 220 cases of frontocranial remodeling for craniosynostosis is reported. The follow-up period was 10 years for children, 7 years for infants. The principles of the craniofacial techniques described in 1974 [4] and 1978 [3] were not modified; only variations were added. The floating forehead [5] concept has also remained basically unchanged. Intracranial pressure recordings have been used continually to help evaluate borderline indications and to assess results [9]. Our results show that 14% of cases of craniosynostosis affecting only one suture, usually considered as merely aesthetic problems, in fact were accompanied by increased intracranial pressure. The postoperative recordings have shown a return to normal pressures. Growth has not deteriorated the initially satisfactory results at the level of the forehead. At the midface level, improvement has been observed after surgery, especially for plagiocephalics. Their orbitonasal asymmetry has nearly completely disappeared. Patients with bilateral faciocraniosynostosis show an improvement of midface development compared with non-operated patients, but in severe cases an inverted bite still develops and further facial osteotomies remain necessary. The Apert's patients remain the most difficult to improve.

Child↗
PubMed1985

[Statural growth following irradiation of the central nervous system for medulloblastoma of the posterior fossa. Retrospective analysis of 45 cases].

Treatment of medulloblastoma in children with head and spinal irradiation causes growth hormone deficiency and growth retardation. The present study deals with 45 patients presenting a follow-up time superior to 4 years; some of them having reached their final height. The mean final height is 3 standard deviations below normal mean. Growth retardation which occurred in 42 of 45 children, appears to be due to two major factors: 1) GH deficiency in 42 cases as assessed by the arginine insulin tolerance test. 2) Spinal lesions due to irradiation, causing early growth retardation and a reduced trunk length in most of these children. The response to hGH treatment (10 mg/kg/yr) was not sufficient in this group of patients.

Body Height↗
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↗
PubMed1984

[Primary bone tumors of the spine in children. Apropos of 66 cases].

Primary tumours of the spine in children are infrequent. The authors have studied 60 benign and 6 malignant tumours in 4 orthopaedic centres. These tumours have been diagnosed in 3 different ways - in the study of cord compression, as a finding in the course of a previously known disease, or as an isolated tumour. In most cases, the diagnosis could be made even before biopsy whose technique and indications are discussed. The treatment is based on the pathology but in all cases, it must avoid any loss of stability of the spine such as may occur after extensive resection.

Adolescent↗
PubMed1984

[Abdominal complications of ventriculo-peritoneal shunts in children. 65 cases].

From 1971 to 1982, among 1 200 children with hydrocephalus cured by ventriculo-peritoneal shunt, 65 have presented an abdominal complication. Some of them are rare and easily explainable: 2 intra-operative viscus perforations, 1 intestinal obstruction, 3 extrusions of the catheter into an inguinal hernia. Also rare, C.S.F. ascites (5 cases) et C.S.F. pseudocysts (3 cases) presented with typical symptomatology easily diagnosed, but their etiology is not clear. The main complications are peritonitis without perforation (32 cases) and migrations of the catheter in the colon (19 cases): their etiology is an intra-operative bacterial contamination, they happen during the following weeks or months after the shunt procedure. They are associated with 8 among 9 deaths of our data by gram negative germ meningitis. Removal of the peritoneal catheter and temporary external shunt are their main treatment.

Ascites↗
PubMed1984

[Orbitopalpebral neurofibromatosis: orbital enlargement by an intracranial approach and palpebral correction].

Exophthalmos with lowering of the globe, eyelid enlargement and canthal displacement are the usual consequences of orbitopalpebral neurofibromatosis. A cerebral hernia into the orbit may be seen on the CT scan. An intracranial approach allows for pushing back the brain with a bone graft to create an enlarged orbital cavity, lifting the globe with a graft on the orbital floor, and fixing the canthi in proper position. An eyelid radical resection is performed in the same stage or later. This approach is discussed in the treatment of 17 cases of orbito-palpebral neuro-fibromatosis.

Adult↗
PubMed1984

[Use of Ommaya reservoirs in the treatment of meningeal relapse of acute lymphoblastic leukemia].

We report our experience in the treatment of meningeal relapses in acute lymphoblastic leukemia (ALL) with intraventricular chemotherapy via an Ommaya reservoir. We treated 5 children in this way with some complications secondary to the use of the reservoir: methotrexate leukoencephalopathy, bacterial meningitis, reservoir malfunction. But patient comfort homogeneous drug distribution when injected via the Ommaya reservoir and the possibility of long term meningeal remission justify the discussion of the use of an Ommaya reservoir use in meningeal relapses in ALL.

Adolescent↗
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↗