Biomedical subjects

F Nataf

Publications and source records attributed to F Nataf.

61 records · Page 4Linked to original sources

PubMed1997

[Stereotaxic radiotherapy of cerebral arteriovenous malformations: the role of neuroradiology].

The therapeutic approach to cerebral arteriovenous malformations has been modified with the availability of stereotactic radiosurgery, initially, the main indications of radiosurgery were limited, non surgical arteriovenous malformations. Indications are now much more diverse. Imaging plays an important role in the radiosurgical management of arteriovenous malformations and its evaluation. In this review, the different roles of neuroimaging are discussed; characterization of malformations, choice of the best indications, role of embolization, delimitation of the target, evaluation of results and complications of radiosurgery.

Cerebral Angiography↗

PubMed1996

Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management.

INTRODUCTION: Intraspinal meningiomas account for 25%-46% of primary spinal cord tumors. Technical advances in magnetic resonance imaging (MRI) and surgical procedures (ultrasonic cavitation aspirators [CUSA], lasers) have brought about better clinical results. In spite of these new techniques, a small percentage of patients still present with poor postoperative results and/or a recurrence. The authors tried to determine which data could influence clinical outcome and what therapeutic modalities could limit recurrence rate. MATERIALS AND METHODS: We reviewed 54 patients who from 1963 to 1994, each had surgery for an intraspinal meningioma. There were 43 females and 11 males, aged 8 to 85 years old. Thirty-six (66.6%) patients were ambulatory on admission; only 2 presented with a paraplegia. Tumor location was cervical in 10 cases, thoracic in 43 cases, lumbar in 1 case. Forty-seven tumors were intradural, 5 epidural, 2 epidural and intradural. Thirty patients underwent a myelography, 10 a computed tomography (CT) scan, and 14 an MRI. Twenty-three spinal angiographies were performed before surgery. Complete removal was achieved in 50 patients (92.6%). Ultrasonic cavitation was used 10 times for debulking the tumor, and laser was used in 12 surgical procedures to perform hemostasis of the meningioma and to coagulate the dural attachment. RESULTS: The majority of the neoplasms were meningothelial (N = 24) or psammomatous (N = 11). No mortality was noted. Morbidity concerned five patients: two pulmonary embolisms, one definitive paraplegia, one transient deficit, and one epidural suppuration, which necessitated a second operation. Mean follow-up was 28 months. Final functional results were very good in 85% and good in 13%; one patient (2%) worsened. Two recurrences were noted: one with clinical signs and the other with only CT-scan modifications. Both patients underwent complementary radiotherapy. DISCUSSION AND CONCLUSION: The authors discuss factors influencing functional results. Sex, pregnancy, pathologic diagnosis, and recurrence do not seem to have any influence. Calcification of the meningioma, as well as an anterior dural attachment, are pejorative factors. They insist on preoperative angiography and point out the advantage of using a CUSA and/or a laser to debulk and coagulate the tumor itself and its dural attachment. They propose radiation therapy as an adjuvant treatment or an alternative to reoperation, which could be hazardous for some patients when, for instance, a recurrence is located in a critical area or when the patient's general status is fragile.

Adolescent↗

PubMed1996

[Intracavernous invagination of pituitary macro-adenomas].

Depending on authors, intra-cavernous invasion by a pituitary adenoma is found in 9% to 40% of cases. In the light of our own experience, we think that such an invasion is probably much less frequent than usually evoked on CT-scan and MRI. In our study, it was confirmed in only one case over 125 (0.80%), though radiological data suspected an intra-cavernous invasion 17 times. An anatomical study on 20 cadavers showed that 30% of normal pituitary glands present with a lateral expansion into one or both cavernous sinuses (CS). These natural invaginations were already evoked by Harris and Rhoton in 1976. They can resemble an intra-cavernous extension or invasion on MRI views, moreover when an adenoma increases the volume of this expansion, and in the absence of any rupture of the medial wall of the CS. The medial wall of the CS is, in fact, constituted by a dural pouch which close-fits the pituitary gland and its expansions; it invaginates more or less in the CS, depending on the importance of the pituitary lateral expansion. In case of a large adenoma, the finger-glove lateral distension of the pouch disappears progressively during the tumoral removal. Finally the dura returns to its normal place back, at the end of the procedure. This concept of invagination of the CS medial wall, as opposed to that of invasion and therefore of rupture of the dural plane, explains the wide range of figures concerning the frequency of intracavernous invasion by pituitary adenomas, in the literature. These figures are all the more variable as there is no absolute criteria of intra-cavernous invasion on CT-scan nor MRI views. In the same way, no clinical criteria can be retained to assume the existence of such an invasion. So, an ophthalmoplegia seems to be usually linked to a compression of occulomotors nerves; it recovers in a large majority of cases, after the adenoma is removed. In conclusion we emphasize the necessity of interpreting with great care radiological imaging when it evokes' a possible intra-cavernous invasion of a pituitary adenoma. The indication of an eventual radiotherapy should be retained with as much care as possible, since complete removal of an adenoma and its lateral expansion(s) is almost always feasible through a trans-sphenoidal route.

Adenoma↗

PubMed1996

[The Codman Medos programmable shunt valve. Evaluation of 53 implantations in 50 patients].

Fifty three Codman Medos programmable valves were implanted in 50 patients (28 men and 22 women) aged 5 to 77 years, from April 1992 to February 1994. They presented with a hydrocephalus 43 times, an arachnoid cyst three times and a CSF leakage four times. The aims of this study were: a) to test the reliability of this equipment, in current use as well as its eventual advantages, inconveniences and restraints, b) to determine its best indications. Follow-up ranged from 12 to 36 months (average = 22 months). Five patients were lost for follow-up. One patient died from a post-operative sepsis. Four died from their disease. Infectious complications concerned 6 patients (11%). A radio-clinical overdrainage syndrome appeared in 9 patients with slit-ventricles, 5 of them associated with sub-dural collections. All these cases were treated with shunt reprogrammings. While 43 pressure settings over 53 were satisfactory in the immediate post-operative period, it appeared that only 38% of shunts had required one only setting when the study period was over. A certain number of pressure adjustments malfunctioned: 6 times, post-operative X-ray controls showed pressures significantly different from the figures which had been selected (difference from -30 mm H2O to + 70 mm H2O); pressure readjustments were effective and accurate for five of them, but one shunt had to be changed; 15 deprogrammings were detected during long term follow-up, 9 of them after MR1. Pressure programming was readjusted only on patients presenting with clinical signs, i-e mainly for those having a pressure difference > +/-30 mm H2O. As a conclusion, the authors consider that such a shunt can be very useful in some precise indications as: NPH, multioperated hydrocephalus, arachnoid and porencephalic cysts, some spontaneous or iatrogenic CSF leakages, temporary shunts necessitating a progressive withdrawal. Because of a) the cost of this equipment, b) the specific restraints (X-rays controls, programmer), and c) the specific incidents (spontaneous and/or post-MR1 deprogramming), it seems difficult to generalize indications to all cases of hydrocephalus. On the other hand, these shunts have the great advantage of simplifying the treatment of overdrainage by avoiding, in all cases, a reoperation for changing the shunt and/or removing a subdural hematoma. Consequent economies due to a significant diminution of the duration of hospitalisation, could justify an enlargement of indications.

Adolescent↗

PubMed1993

[Sphenocavernous localization of meningeal neurosarcoidosis. Apropos of a case and review of the literature].

The authors report on the case of a 32 year old woman treated with prednisone and diphenylsulfon for a multi-visceral sarcoidosis; headache and progressive oculomotor paralysis revealed an expansive lesion of the left cavernous sinus extending to the temporal fossa. C.T. scan, M.R.I., and angiographic data as well as the intra-operative findings evoked the diagnosis of meningioma. Pathological findings showed an epithelioid and gigantocellular granuloma without caseous necrosis, corresponding to a sarcoidosic lesion. After the operation, the increase of steroid doses was followed by a complete regression of the tumoral remnants, and total clinical recovery. In a patient having a previously diagnosed sarcoidosis with evidence of an intracranial tumor mimicking a meningioma, steroids should be first prescribed. Efficacy of steroids on sarcoid granulomas is often dramatic; surgical approach would be discussed in case of ineffective steroid therapy, of persisting questionnable diagnosis, and of tumoral threatening compression.

Adrenal Cortex Hormones↗

PubMedDate not supplied

[Radioanatomy of cerebral arteriovenous malformations].

New imaging modalities permit detailed knowledge of the anatomy of cerebral arteriovenous malformations. Magnetic resonance imaging (MRI) provides morphological data, size and topography of the nidus, anatomic relationship, as well as dynamic information particularly with the use of MR angiography. Selective and hyperselective cerebral angiography provide information about the angioarchitecture and search for associated vascular abnormalities such as aneurysms. It is therefore possible to distinguish malformations associated with a high risk of hemorrhage and to define the indications for radiosurgery.

Cerebral Angiography↗

PubMedDate not supplied

[Cerebral cavernomas followed by epileptic seizures: clinical picture, diagnosis, and treatment].

The clinical features of epilepsy associated with cerebral cavernomas and the results of different types of its surgical treatment: cavernonectomy, extended cavernomectomy, and epileptic focus resection were analyzed. The clinical, radiological, and electrophysiological data were studied in 48 patients with epileptic seizures associated with cerebral cavernomas who had been admitted to the Unit of Neurosurgery, Saint Anna Hospital (Paris, France) in 1982-2001. According to the severity of epileptic manifestations, the patients were divided into 2 groups: 1) 21 patients with single and rare seizures and 2) 27 patients with drug-resistant epilepsy. All the patients received medical antiepileptic therapy. Twelve patients from Group 1 underwent cavernomectomy or "extended" cavernomectomy. In Group 2, 23 patients were operated on and 3 types of operations (cavernomectomy, "extended" cavernomectomy, and corticoectomy) were performed. Statistically significant differences were found in anatomic, clinical, and electrophysiological parameters. Criteria associated with the development of drug-resistant epilepsy were established. These included: the early onset of seizures, temporal cavernoma, and a combination of partial and generalized seizures in one patient. The paper shows it necessary to choose a surgical intervention in relation to the duration of seizures, their frequency, and a response to medical antiepileptic therapy. The advantages of surgical treatment over medical one were not found in single and rare seizures (Group 1), while in drug-resistant epilepsy, surgical treatment yielded much better epileptological results than did medical treatment. The volume of a surgical intervention depends on the sizes of an epileptic focus detected by an in-depth preoperative study and on the site of a cavernoma.

Adult↗