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Biomedical subjects

F X Roux

Publications and source records attributed to F X Roux.

At least 91 records · Page 5Linked to original sources
PubMed1987

[Spontaneous dissection of the exocranial internal carotid artery. Therapeutic aspects].

Spontaneous dissection of the extracranial internal carotid artery is uncommon and has been first described in 1959. Since then, 250 cases have been published. The authors report on 5 recent cases and on that occasion, they review the literature and discuss the different therapeutic possibilities. This pathology can be envisaged when a middle-aged adult, free of any previous pathology or trauma, presents with latero-cervical pain followed by cerebral ischemic stroke. The angiographic findings are of three types: regular or irregular extensive stenosis, pseudo-aneurysmal dilatation followed by luminal stenosis, funnel-like tapering of the vessel. The spontaneous course of such a dissection most often (80%) leads to an almost complete resolution of clinical and angiographic signs. Treatment, therefore, should essentially be based on anticoagulant and antiaggregant therapy, so as to prevent ischemic attacks or carotid thrombosis. Surgical indications should remain exceptional.

Adult↗
PubMed1987

[Ethmoidal adenocarcinoma surgically treated in one stage by transfacial and subfrontal approach after inductive chemotherapy. Preliminary results of a new therapeutic approach].

The authors present a new therapeutic protocol for ethmo++idal adenocarcinomas. It includes a pre-operative chemotherapy based on a four days continued infusion of cis-platinum and 5 F.U. (three cures with 3 weeks-intervals); it is followed by a carcinologic removal realized through a combined transfacial and intra-cranial approach. They discuss the interest of combined surgery which should allow a limitation of intra-cranial recurrencies. The intra-cranial extension must not be a limit to the removal even in case of dural, or even sub-dural extension. The reconstruction of the anterior basis of the skull has been simplified as much as possible: it has been performed either with a bone graft removed from the frontal flap inner table, or with a precut madreporic coral graft. In all cases, the dura has been doubled with a large shred of galea. They emphasize the efficiency of pre-operative chemotherapy. Eleven patients underwent such a protocol; two were operated in a recurrence, 9 in first hand. The preliminary results seem to be promising: the one year and two years actuarial survival rates are 84%.

Adenocarcinoma↗
PubMed1987

[Combined ORL and neurosurgical approach in adenocarcinoma of the ethmoid. Preliminary results apropos of 15 cases].

Fifteen cases of adenocarcinoma of the ethmoid sinus treated by a combined subfrontal and transfacial approach after induction chemotherapy are reported. The surgical technique is described precisely including a paralateronasal approach combined with a bifrontocoronal incision, a bilateral ethmoidectomy and reconstruction of the anterior base of the skull by one sheets taken-out from the inner surface of the frontal flap or more recently madreporic coralline grafts; the dura is hermetically sealed and it is lined with a large galea flap. Results were as following: one post-operative death, no clinical rhinorrhea, no recurrence from the anterior cerebral fossa, one orbital and one sphenoidal recurrences. Surgical indications are discussed according to the different extensions of the tumor and a frontal lobe extension is not a contraindication. This surgical procedure should be employed for the adenocarcinomas of the ethmoid invading the superior cells even in the absence of lysis of the cribriform plate in order to avoid the endocranial recurrences.

Adenocarcinoma↗
PubMed1986

[Extradural hematoma in the Emergency Medical Assistance System and scanners. Comparison between 2 series at the Sainte-Anne Hospital Center].

The authors compare two groups of intracranial epidural hematomas treated in the Neurosurgical department of Sainte-Anne Hospital in Paris: the first group includes 262 patients operated upon between 1965 and 1977; the second group concerns 124 patients operated during the period 1979-1984. The mortality rate has been progressively diminishing from 1969 (50%) to 1984 (12.5%). Among the survivors, functional sequellae are still frequent; some improvement in the functional prognosis has although been noted; in the first group, 41% of patients are cured and 56% of them returned to work; in the second group, 50% are cured, and 62% returned to their professional activities. The detailed analysis of those data emphasizes the importance of CT-Scan and of the improvement of specialized neurosurgical intensive care; on the other hand, the particular role of an emergency care organisation, such as the SAMU, appears rather discreet referring to this type of pathology.

Adolescent↗
PubMed1986

[Management of cranial-injured patients in the era of the Emergency Medical Service and the scanner. Comparative epidemiologic study with a 12-year interval in the same department of neurosurgery, in the Paris region].

The authors present an analysis of the different data concerning the emergencies admitted in the Neurosurgical department of Sainte-Anne Hospital in Paris, during the one year-period extending from 1st June 1983 to 1st June 1984. These data have been compared to the corresponding findings established during 1972 in the same department. Traumatology appears to be a more and more limited activity among neurosurgical emergencies: 55% of admissions in 1972, 43% in 1983-84. The main characteristics of injured patients on admission have not changed: 65% are in a coma, 1.25 are operated in emergency, age distribution and types of lesion are identical. The sorting of the patients has improved: 25% of them were operated upon in 1972, 37% in 1983-84. Conveyance of injured patients has undoubtedly improved in quality during the last years; yet the duration of transport is still important, too important, even in Paris: 2 h 30 as an average-time. Another favorable factor has been the coming out of CT-Scan; it is of course of great help for diagnosis, but it must not let forget basic and fundamental therapeutic decisions.

Adolescent↗
PubMed1986

[Real-time ultrasonography in neurosurgery. Puncture of an intracranial hypoechogenic cavity].

The authors have been using real time echography in neurosurgical procedures since 1981: either for detection of a small sub-cortical tumor during a surgical operation, either for biopsy-guidance, or for puncturing a cavity (abscess, cyst or hematoma). The imaging is performed with a CGR SONEL 100 apparatus and two different frequency transducer elements: 3.5 MHz and 5 MHz. 56 patients underwent this technique; 22 times the lesion was hypoechoic: abscess give homogeneous, round hypoechoic image, often surrounded by a fine hyperechoic line; intracerebral hematoma produces an hypoechoic image after a 10 to 15 days evolution: compared to an abscess it then has a more hyperechoic irregular wave-like limit; tumoral-cyst echogenicity is very low; it can even be anechoic. If a stereotaxic structure exists, indication of real time echography must be limited to such stereotaxy contraindications: threatening intracranial hypertension, suppurated lesion, fragile patient. The technique has its limit: that is the small volume of the target-lesion (inferior to 10 mm); advantages must be emphasized: light procedure, satisfying confidence when considering the probe progression, sometimes better information than that of a CT-Scan examination especially for tumoral and cystic lesions.

Brain Abscess↗
PubMed1985

[The CO2 laser: a new instrument for intracranial neurosurgery].

Since 1983 we have been using an 80 watts CO2 laser unit (Ercelas 80, Robert et Carrière Biomédical) routinely in some neurosurgical procedures. Fifty tumours (34 intracranial, 4 intraorbital and 12 intraspinal) have been operated upon with laser. The CO2 laser appears to be particularly useful to excise solid tumours, such as meningiomas and neurinomas. When these lesions are located in the posterior fossa or lying deeply near highly functional or vital supratentorial structures (e.g. carotid arteries, optic nerves, chiasma), the laser beam should be coupled with an operating microscope. Laser being a non-touch technique, the tumour can be removed with minimal trauma to healthy tissues. Depending on the output power, the laser beam coagulates, cuts or vaporizes the target lesion.

Brain Neoplasms↗
PubMed1985

Intracranial haemostasis with a neurosurgical CO2-laser unit.

The authors have been using CO2-laser radiation routinely for more than 2 years. After having recalled the basic thermal properties of this beam, they present their experience. The goal of this work is to point out the particular benefit of CO2-laser cautery to perform tumoral haemostasis. The technical data of this CO2-laser haemostasis are detailed for 3 main indications: In cases of a precise origin of the haemorrhage, the coagulation of small intratumoural vessel necessitates a low output power: 2-4 watts in continued emission; 10-15 watts in the pulsed mode. The beam must be defocussed so as to be as large as the aimed vessel. A micro-manipulatotor is necessary for deeply located tumours. Basal meningiomas, neurinomas, giant adenomas are the best indications. If a diffuse bleeding is encountered in the operative cavity the output must be a little higher: 3-8 watts in continuous mode or 15-30 watts in the pulsed mode; first the cavity is swept with a defocussed CO2-laser ray; then the few larger vessels which have not been cauterized are coagulated one by one either by laser or by bipolar coagulation. The insertion zone of a meningioma can be efficiently coagulated by CO2-laser: a 150-200 watts output in the pulsed mode is necessary if the attachment is dural, a 300-400 watts pulsed output in the case of bony infiltration.

Adolescent↗
PubMed1985

[Regional hemodynamic and metabolic consequences of temporo-sylvian anastomosis. Study of 15 patients by positron emission tomography].

Cerebral Blood Flow (CBF), Oxygen Extraction Fraction, and Oxygen utilization (CMRO2) have been studied in 15 patients before and After Extra-Intracranial Arterial bypass (EIAB), using PET and 150 steady-State Inhalation technique. Fourteen patients had carotid artery obstructive lesions and the last one a middle cerebral artery occlusion. In the whole group of patients, both CBF and CMRO2 increased significantly on both cerebral hemispheres after the EIAB. This effect was more marked in patients with extensive occlusive disease of neck vessels. This metabolic improvement afforded by EIAB in our patients suggests that long-standing hemodynamic failure may induce a metabolic depression that's still potentially reversible by surgical revascularization. On the other hand, improvement of focal CBF abnormalities depends, in our patients, upon the preoperative coupling of CBF-CMRO2 (mainly misery perfusion syndrome) as reported earlier.

Adult↗
PubMed1985

[Physical and technical bases of tumor hemostasis with a CO2 laser in neurosurgery].

The particular thermal properties of CO2 laser make it an useful instrument for neurological surgery. Necrosis and carbonization zones, as well as its thermal diffusion in the nervous tissue are dramatically less important with a CO2-laser unit than with other lasers (Nd-Yag or Argon) and moreover with the electrical mono--or bipolar coagulator. That is why the authors chosed this instrumentation for achieving a good hemostasis. It was particularly useful during removal of intracranial tumors situated close to the functional structures of the basis of the brain and the brainstem. The authors present their experience with the french CO2-laser unit Ercelas 80 (Robert et Carrière Biomedical) that they have been using routinely since 1983 in 60 neurosurgical procedures. They present the technical standards necessary to perform such an hemostasis either with the hand-piece or using the micromanipulator. In all cases the output power must be much lower for hemostasis than for tumoral cutting or vaporization. Depending on the type of tumor, radiation power should vary from 2 to 10 watts if a linear emission is used, and from 10 to 30 watts in case of pulsed emission. On the other hand, CO2-laser beam must be unfocussed so as to avoid cutting the vessels less than 0.5 mm in diameter before coagulating them properly.

Carbon Dioxide↗
PubMed1985

[Neurosurgery with a CO2 laser. Evaluation of 61 operations].

The authors present the results of their over two years experience with CO2 Laser neurosurgical unit. They explicit the indications and the technical data followed during intra-cranial (N = 44), intra-spinal (N = 12) and intra-orbital (N = 5) procedures. Meningiomas, neurinomas and adenomas are the best indications for tumoral CO2 Laser neurosurgery. In other respects sterilization and cranialization of aeric sinuses are simplified by the use of CO2 Laser: it assures vaporization of the mucosa and carbonization of the walls more easily than an electric coagulator. At last the use of CO2 Laser for dissection and removal of intra-orbital tumors is quite demonstrative. Thus owing to its physical and thermical qualities CO2 Laser is often a very useful, sometimes irreplaceable, apparatus: provided that its indications are precise and rigorous.

Adolescent↗
PubMed1984

[Value and limitations of the use of CO2 laser in neurosurgery. Reflexions from a French experience].

The authors have been using routinely since February 1983 a french 80W. CO2 Laser unit. They discuss the advantages and limits of this technic in the light of the first 26 intracranial and intraspinal operations carried on with it. The main and wellknown qualities of CO2 Laser are: the easiness of the hemostasis of the tumor and of the surgical cavity; and the absence of traction on the same tissue. The coupling of CO2 Laser with the operating microscope appeared very useful and made safer deep tumor excision, particularly that of the posterior fossa such as neurinomas and meningiomas. It was also quite efficient for intra-orbital tumors. The maniability of the hand piece was increased by the use of oblique mirror (45 degrees and 60 degrees) fixed at its extremity. The incision of skin, subcutaneous and muscular layers was not simplified by CO2 Laser; indeed this apparatus increased the operatory duration and was responsible of a healing time extension.

Adolescent↗
PubMed1984

[Efficacy of medical treatment (isoproterenol + aminophylline) of aneurysm rupture spasm].

Efficiency against spasm of a combined therapy by Isoproterenol Aminophylline is discussed from 97 operated cases (118 aneurysms) and 30 non operated cases (32 aneurysms). This treatment seems efficient and best results are achieved when therapy is started as soon as possible or systematically after surgery. Analysis of spasm and of its treatment is based on criterions which vary from one author to another, and comparison between different series is difficult. In the series here reported, one group with treatment is compared to another one without treatment. This method seems the most reliable. This treatment cannot be considered as the lone efficient therapy against spasm and is usually used beside other techniques such as ICP and Arterial pressure management or early surgery.

Aminophylline↗