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Biomedical subjects

F X Roux

Publications and source records attributed to F X Roux.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Multiple cortical photolesions and penicillin epileptogenic focus. Study of a model in rabbits].

Inactivation of an epileptogenic focus by dividing it into sub-unities unable to maintain epileptic activity has been demonstrated in animals. Based on these experiments, multiple subpial transections have been performed in patients suffering from partial drug-resistant epilepsies when resection of the epileptogenic cortex was not possible. In order to develop a new surgical technique for such epilepsies, the authors present an initial study of multiple cortical laser photolesions on the rabbit brain. The aim of this study is to assess the histological lesions created on the cortex with a laser at a chronic stage, and to compare the electrical paroxysmal activity of a penicillin focus on the laser irradiated cortex and on the non radiated cortex in the same animal. Twenty-five adult albino rabbits were used for this study. Both hemispheres of 19 rabbits have been exposed; 14 to 35 photolesions in a network were performed on one hemisphere using a 1.064 microns wavelength Nd-YAG laser. Six to twenty-one days later, a penicillin-induced focus was created on both hemispheres, a corticographic study was performed, and each animal was sacrificed for histological study of the brain. For the 6 last animals a high-power 0.805 micron wavelength diode laser was used with the same protocol. Histological study was solely performed in order to compare the effects of both lasers. In 11 animals electrocorticographic control was reliable. Time to first spike occurrence after penicillin application was significantly increased on the treated hemisphere as compared to the untreated one (1' to 14'30" and 10" to 6', respectively; p < 0.01) and the number of spikes per minute at early and late counts was significantly smaller on the treated hemisphere as compared to the untreated one (1 to 29 and 2 to 70, respectively; p < 0.02). Histologically the lesions appeared as cone-shaped coagulation necrosis surrounded by an area of macrophagic reaction, angiogenesis and gliosis. With the diode laser, some lesions included ischemic changes extended in the white matter. This study demonstrated the possibility of creating limited and reproducible photolesions using the laser light energy, without extensive destruction of the cortex. These lesions were reaching from one third to the totality of the cortical depth, depending on laser exposure parameters. This study also demonstrated that these photolesions arranged in a network and at a chronic stage were associated with a significantly reduced paroxysmal activity of a penicillin focus when compared to intact cortex. Since such lesions did not totally isolate cortical sub-unities, spiking was still recorded from the irradiated cortex, but at a lower rate, suggesting a disorganization of the local neuronal network responsible for paroxysmal activity.

Animals↗
PubMed1995

Madreporic coral for cranial base reconstruction. 8 years experience.

The authors, since 1985, have used 587 Madreporic Coral grafts as bone substitute in a total of 183 patients, among them in 80 cases for repair of cranial base bone defects. They report their long-term results. Partial resorption to about 40% of the initial volume occurred in almost all cases within 8 to 10 months, with complete resorption after about one year. 20% of the coral blocks moved spontaneously or split into pieces, but could easily be withdrawn rhinoscopically through the nostrils. No CSF leakage was noticed afterwards. The local infection rate was only 4%, always close to the basal coral graft. This is lower than the infection rate after using autologous bone harvested from the inner table of the bone flap (20%). Infections were cured by removal of the coral graft. Despite the mentioned draw backs, Madreporic Coral graft implants can be recommended as bone substitute in cranial base surgery: 1. The material simplifies the surgical procedure; 2. Harvesting of autologous bone is no longer necessary; 3. Transmission of infections like AIDS, Hepatitis C or Creutzfeld-Jacob-disease can be avoided with certainty.

Biocompatible Materials↗
PubMed1995

[Secondary intraspinal localizations of glioblastoma. Apropos of a case].

Metastasis of intracranial glioblastomas have been described for the first time more than fifty years ago. They are exceptional and seem to develop clinically in less than 2% of cases. In fact, microscopic metastasis (necropsic series) of such glioblastomas are much more frequent: from 6% for supratentorial glioblastomas to 60% in infratentorial ones; but patients usually die before clinical symptoms appear. The authors report on an intraspinal metastasis which appeared clinically four years after the removal of a frontal glioblastoma. The metastasis was subdural, T3. Preoperative radiological data (CT-scan, MRI) evoked a meningioma, while surgical findings favoured the diagnosis of neurinoma. The diagnosis of glioblastoma metastasis was suggested by intra-operative pathological findings, and confirmed a few days later on smears and stains studies.

Brain Neoplasms↗
PubMed1994

Ethmoid sinus carcinomas: results and prognosis after neoadjuvant chemotherapy and combined surgery--a 10-year experience.

From June 1982 to June 1992, 144 ethmoido-sphenoido-orbital tumors have been referred to the neurosurgical department of Ste Anne Hospital. One hundred five of them were malignant lesions, among which 83 were included into our therapeutic protocol (1) neo-adjuvant chemotherapy (CDDP + 5-FU), (2) combined surgical procedure (subfrontal and transfacial), (3) postoperative radiotherapy. Fifty nine percent of the patients had no response to chemotherapy; 19% had a partial response (reduction of the tumoral volume > 50% and < 100%), 22% had a complete response. One patient had an immediate and transient postoperative rhinorrhea responsible for meningitis (acinetobacter) that was cured after a 3-day treatment. Four patients had postoperative meningitis without any cerebrospinal fluid leakage; they were also cured. Five patients had a local suppuration that was treated by subcutaneous drainage (n = 1) or the removal of the cranial basis graft (n = 4). Oncologic results are presented for only adenocarcinomas (n = 63) because they represent the only population of this series large enough to assure significant statistical figures. The global actuarial survival rate was 53% at 3 years and 42.5% at 5 years. The 5-year actuarial survival rate was 80% for T1 tumors, 60% for T2, 40% for T3, and 25% for T4. Patients with an intracranial extension had a 3-year survival rate of 19%; none survived after 4-year follow-up. Neo-adjuvant chemotherapy seemed to influence the survival: 100% survival rate at 5 and 10 years for the complete responders. We discuss the opportunity of intraorbital exenteration, the indications, and the limits of combined surgery. We emphasize the importance of neo-adjuvant chemotherapy and of combined surgical procedures, even when the patients are complete responders to chemotherapy: complete responders who had only a transfacial approach have a 5-year actuarial survival rate of 80% (instead of 100% when a combined procedure was performed). Those who were not operated primarily recurred within 3 years and then had to be operated. We propose to follow such a combined surgery for all large ethmoidal cancers (T3 and T4) and for small tumors (T1 and T2) developed superiorly and posteriorly. Anterior T1 and T2 tumors should be operated through a single transfacial route.

Actuarial Analysis↗
PubMed1994

[Multiple cavernoma of delayed appearance].

The authors report on a right fronto-singular cavernous angioma which appeared, in a 46 year-old woman, four years after the excision of a right rolandic localization. Diagnosis suggested on radiological findings was confirmed by histological examination. After a review of the literature the authors discuss possible mechanisms of such delayed appearance of intra-cerebral cavernous angiomas. They suggest the possibility of infraradiologic stage corresponding to a micro-malformation characterized by abnormal capillaries, which has not been yet histologically modified by hemorrhages, thrombosis, fibrosis, gliosis and calcifications.

Brain Neoplasms↗
PubMed1993

Erythropoietin synthesis by tumor cells in a case of meningioma associated with erythrocytosis.

While secondary erythrocytosis is often associated with tumors arising from the kidney, other tumors have been described to originate in the liver, uterus, ovary, adrenal gland, and central nervous system, among which cerebellar hemangioblastomas are involved in most instances. Two cases of meningioma associated with erythrocytosis have already been reported. We observed a 59-year-old female patient who had developed a frontal meningioma associated with erythrocytosis. Before surgery, she had a significantly elevated total red blood cell volume with a normal plasma volume. Serum erythropoietin (Epo) dosage assessed by radioimmunoassay was within the normal range. The tumor was removed and the pathologic study found a meningotheliomatous meningioma. Total RNA from the tumor was hybridized to a monkey cDNA Epo probe. A strong 1.6-kb messenger RNA (mRNA) signal was observed, which is the expected size of human Epo mRNA. In situ hybridization with the 35S-labeled Epo probe was performed on frozen tumor tissue sections. A significant hybridization was observed in all the tumor cells, whereas the stroma was negative. Therefore, in this meningioma associated with erythrocytosis, Epo was produced by the tumor cells themselves.

Erythropoietin↗
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↗
PubMed1992

Characterization of the 5-hydroxytryptamine receptor modulating the release of 5-[3H]hydroxytryptamine in slices of the human neocortex.

In the rat brain, the presynaptic 5-hydroxytryptamine (5-HT) autoreceptors located on 5-HT terminals correspond to the 5-HT1B subtype. The presence of a 5-HT receptor probably located on 5-HT nerve endings and modulating transmitter release in the human neocortex has been reported, but its detailed pharmacological characterization is not yet available. On the other hand, receptor binding and autoradiographic results indicate that the 5-HT1B receptor subtype is not present in the human brain. We, therefore, studied the modulation of the electrically evoked release of [3H]5-HT by various 5-HT receptor agonists and antagonists in preloaded slices of human neocortex obtained from 18 patients undergoing neurosurgery. The nonselective 5-HT1A/1B/1D receptor agonist 5-carboxamidotryptamine produced a potent inhibition (70% at 0.03 microM) of the electrically evoked release of [3H]5-HT which was blocked by 5-HT receptor antagonists with the following relative order of potency: methiothepin greater than metergoline = methysergide greater than propranolol. The selective 5-HT1A receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin at 0.1 microM did not modify the electrically evoked release of [3H]5-HT. The 5-HT1A/1B receptor agonist RU 24969 was 10 times more potent at inhibiting [3H]5-HT overflow in the rat frontal cortex than in the human neocortex. The potent 5-HT1B receptor antagonist cyanopinodolol did not modify the 5-carboxamidotryptamine-induced inhibition of the electrically evoked release of [3H]5-HT in slices of the human neocortex, but produced by itself a small inhibition of [3H]5-HT overflow.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Meningeal sarcoidosis, pseudo-meningioma, and pachymeningitis of the convexity.

Two cases of meningeal sarcoidosis with unusual and misleading presentations are reported. In the first case, CT scan, angiographic, and MRI findings were indistinguishable from those of meningioma. CSF pleiocytosis may help in diagnosing sarcoid pseudo-meningioma. The second patient had transient focal deficits and pachymeningitis of the convexity. The transient deficits were probably of epileptic origin based on their response to antiepileptic treatment. The diagnosis of neurosarcoidosis was made only after meningeal biopsy, despite thorough investigations.

Adult↗
PubMed1992

[YAG laser in neurosurgery].

The authors try to answer to some practical questions concerning Yag Lasers in neurosurgery. The aim of this work is to determine the main data useful for the choice of a YAG-Laser. Are considered: the wavelengths which can be bought on the international market (1.06 microns or 1.32 microns for instance), the peripherics at disposal, the tissular effects due to the different lasers, the surgical applications and indications. The Laser unit which will be chosen should be a compromise between the different advantages and inconveniences of a particular laser, its tissular effects, its price. The multi-wavelengths units appear to be, at the present time, interesting compromises (such as 1.32 + 1.06 microns, CO2 + 1.06 microns).

Humans↗
PubMed1992

[Combined CO2 and Nd-YAG laser in neurosurgical practice. A 1st experience apropos of 40 intracranial procedures].

The authors present their experience concerning the use of Combolaser (Lasermatic, Finland), in neurosurgery. This laser-unit combines two wavelengths (CO2 and 1.06 Nd-YAG) which are emitted simultaneously and coaxially. During the last 12 months, 40 patients harbouring an intracranial tumor were operated upon with such a combolaser unit: 8 infra-tentorial, 32 supra-tentorial, 17 were meningiomas. The mean output power used during the procedures was 3-5 w for both CO2 and Nd-YAG beams. The authors discuss the advantages and inconveniences of such a laser; and they compare it with the other laser-units they have been using for the last 10 years: CO2-Laser, 1.06 Nd-YAG and 1.32 Nd-YAG laser. The main inconvenience of this unit is linked to the utilization of the articulated arm which conducts the CO2 laser beam. This drawback should be avoided or limited by the use of a fiber microguide, which will conduct both CO2 and Nd-YAG beams simultaneously. The principal contribution of a combined-laser unit is the quality of the haemostasis associated to a very good vaporization and cutting effect. When both wavelengths are synchronized, the combined laser beams penetrate into the nervous parenchyma more deeply than the only CO2 laser beam would with the same parameters. The vaporization effect is identical to that obtained with the isolated CO2 laser; the quality of haemostasis is limited to the effects of the Nd-YAG laser. Another advantage must be emphasized: the possibility of utilizing separately the CO2 laser and the 1.06 Nd-YAG.

Adolescent↗
PubMed1992

[Stereotaxic laser interstitial thermotherapy. A new alternative in the therapeutic management of some brain tumors].

Laser Interstitial Thermo Therapy (ITT) is a new procedure which has been performed only a few times in our department as well as in foreign services. The aim of an ITT is to increase the temperature of a tumoral target which has been perfectly determined stereotactically. In the center of the target, i-e at the extremity of the laser fibre, temperature reaches 80 degrees 90 degrees C and creates a coagulation necrosis. At the periphery of the target, temperature must be 41 degrees-43 degrees C so as to create a selective lesion of the pathological tissue due to proteinic and enzymatic denaturation. The authors present their experience based on 8 patients who underwent an ITT between June 1990 and October 1991. A stereotactic determination of the tumor is first performed; then two routes are determined for the laser-fibre (Nd-YAG 1.06 microns, fiber diameter: 400 mu) and for the thermic electrode. The ITT itself is performed a few days later (P = 3-5w, time: 800-1200 seconds). Laser heat effects are monitored with MRI controls (H5, H24, D8 then monthly). The authors insist on the importance of a long follow-up so as to be sure of the complete inocuity of such a treatment. It is the only way to broaden and develop laser-ITT procedures as therapeutic alternatives for certain deep-seated intracerebral tumors.

Brain Neoplasms↗
PubMed1992

[Use of Nd-YAG laser in intracranial endoscopy. An initial experience in stereotaxy].

The authors report on four cases of intra-ventricular lesions surgically treated by endoscopic laser-therapy in stereotactic conditions. Two colloid cysts of the third ventricle, one arachnoidal cyst responsible for with an intracranial hypertension and an intraventricular meningioma were treated with such a procedure. The laser beam was used as a surgical knife on cystic lesions and to vaporize the meningioma. The laser coupled with an endoscope add to the comfort given by direct visualization the precision of surgical instrument the effects of which are perfectly controllable in areas where surgical traumatism must be avoided as much as possible.

Arachnoid Cysts↗
PubMed1992

[A rare case of intramedullary epidermoid cyst diagnosed by MRI].

Intramedullary epidermoid cysts are rare entities. A case recently seen on MRI led us to review the literature on the subject. A 9 year old boy developed in a four month-time a spastic paraparesis with a T7-T8 sensitive level. The MRI showed a widening of the spinal cord at the T6 level with an area of decreased signal on T1 weighted images, and a homogeneous round shaped area of increased signal on T2 weighted images. The authors discuss the contribution of MRI to the diagnosis of this lesion. The number of cases of intramedullar epidermoid cysts, like dermoid cysts, diagnosed with this neuroradiological method, is still very limited and the literature only mentions isolated cases.

Child↗
PubMed1991

[Combined approach to malignant tumors of the ethmoid and other paranasal sinuses. Principles and results].

The authors present their experience concerning combined transfacial and neurosurgical procedures in the treatment of carcinomas of the ethmoid sinuses. 109 ethmoid-spheno-orbital tumors were treated at our department from 1982 to 1990: 85 were located into the ethmoidal and/or sphenoidal sinuses; 78 of these were malignant. Among the 65 ethmoidal carcinomas which were operated through a combined route, 48 underwent an induction chemotherapy and 19 a post-operative radiotherapy. The surgical technique is detailed, mostly the intra-cranial approach and the reconstruction of the cranial basis. Clinical results, and particularly the actuarial survival rates are discussed. The 5-year actuarial survival rate is 40% for all first hand ethmoidal adenocarcinomas. The figure reaches 52% for the patients without intra-cranial extension. At last, the 5-year actuarial survival rate is 100% for patients having a complete clinical response to induction chemotherapy.

Actuarial Analysis↗
PubMed1991

[Terson's syndrome and intraocular complications in meningeal hemorrhages (26 cases)].

The Terson syndrome was described in the early 1900's as the association of an intra-vitreous humor bleeding and a subarachnoidal hemorrhage (SAH). The high jeopardy of blindness of such a syndrome emphasizes the importance of evaluating as soon as possible the presence of blood in the posterior chamber of patients presenting with a SAH. 250 patients admitted in the Neurosurgical Department of Ste Anne Hospital with a SAH were evaluated between January 1984 and February 1990. 26 had an intra-ocular hemorrhage (10.5%). In those cases the mortality rate was not increased (15.4%) but the morbidity rate was higher (42%). Concerning the intra-ocular bleeding, 4 patients underwent a vitrectomy (2 had a complementary photocoagulation). Only one patient had a visual sequela (partial decrease of visual acuity). These data emphasize the visual risk which has to be considered; a specific treatment (vitrectomy and/or photocoagulation) must be performed as quickly as possible so as to save the vision. In some particular instances, the ophthalmological treatment might even be necessary before the intracranial procedure itself.

Adolescent↗