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Biomedical subjects

J Brotchi

Publications and source records attributed to J Brotchi.

At least 109 records · Page 6Linked to original sources
PubMed1994

PET in stereotactic conditions increases the diagnostic yield of brain biopsy.

We have recently described a technique allowing routine integration of PET scan data in the planning of stereotactic brain biopsy [Levivier et al:, Neurosurgery, 1992; 31:792-797]. We now report our results in a consecutive series of 38 patients that underwent combined FDG-PET and CT-guided stereotactic biopsy between June 1991 and January 1993. Stereotactic procedures were performed according to a standard protocol in which two biopsy trajectories were used whenever possible. This yielded to a total of 78 trajectories. In 31 patients, at least 1 trajectory was defined using an abnormality visualized on PET. The histological diagnosis was obtained in all cases. The diagnostic yield of each trajectory according to the FDG uptake of PET and contrast enhancement on CT showed that most low-grade tumors were found in hypometabolic/hypodense areas, glioblastomas were all diagnosed in areas with increased FDG uptake and contrast enhancement on CT while data for anaplastic astrocytomas were heterogeneously distributed. In the present series, 6 targets defined on CT were nondiagnostic; this never occurred when targets were defined on FDG-PET. In one case of anaplastic astrocytoma, the diagnosis was only made using a target defined on PET in a normal CT area; the second trajectory was made in a contrast-enhanced area on CT and was nondiagnostic. Because only structural images such as CT or MRI are available preoperatively, we analyzed separately the benefit of FDG-PET-guided biopsy in patients who have either an enhanced- or a nonenhanced lesion on CT. CT-enhanced lesions were found in 27 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study.

Idiopathic normal-pressure hydrocephalus remains difficult to treat. Controversy exists as to whether or not shunting can really improve cognitive functions and whether quantified intracranial pressure monitoring (ICP-Mo) can predict postoperative improvement rates. Several studies have drawn attention to the lack of a prospective study concerning the surgical outcome of this condition. We have performed such a study on idiopathic normal-pressure hydrocephalus patients shunted on the basis of ICP-Mo when "high" waves (amplitude > 9 mm Hg) were present. Twenty-three patients underwent surgery. The preoperative and postoperative clinical states were assessed by a quantitative procedure blind to the ICP-Mo results. A clear postshunting improvement was seen in 96% of the patients at 1 year with a statistically significant correlation between high wave relative frequency and the grade of improvement (P < 0.05). At the same time, 66.6% of shunted patients showed a significant improvement in cognitive functions. Complications of shunting were successfully managed without residual deficits in this series. We recommend the use of quantitative ICP-Mo as a criterion for surgery and to predict the improvement grade.

Aged↗
PubMed1994

Prognostic scoring in adult astrocytic tumors using patient age, histopathological grade, and DNA histogram type.

High-grade astrocytic tumors constitute the most serious as well as the most common group of primary brain tumors. Although several prognostic factors have been proposed, little is known about the prognostic value of deoxyribonucleic acid (DNA) ploidy in adult astrocytic tumors. In a series of 146 adult patients, aged 16 to 82 years, the individual prognostic values of six variables were studied, namely: tumor histopathological grade, treatment, patient age, extent of tumor, ploidy level, and DNA histogram type. Cox's proportional hazard model was then applied to the data to ascertain which factors might independently determine patient survival. Univariate analyses revealed that histopathological grade, age, and DNA histogram type were very powerful prognostic factors. The statistical significance of the influence of adjuvant radiotherapy and chemotherapy was at a borderline level, and the two remaining variables (tumor extent and ploidy level) had no prognostic relevance. Multivariate analyses showed that age, histopathological grade, and DNA histogram type were independent, statistically significant prognostic factors. A prognostic score was calculated from Cox's polynomial function in which those factors were introduced. The best score corresponded to a patient aged 16 years with a hypertriploid low-grade astrocytoma, while the worst score corresponded to a patient aged 82 years with a diploid high-grade astrocytoma. The worst score:best score ratio revealed a risk 71 times higher for a bad prognosis. It is concluded that patient age, histopathological grade, and DNA histogram type are very powerful prognostic factors for adult astrocytic tumors. A prognostic score including those factors could be used to characterize astrocytic tumor aggressiveness presurgically on fine-needle aspirates, and to monitor the patient's postsurgical evolution to define the appropriate therapy.

Adolescent↗
PubMed1994

[Intramedullary spinal cord tumors. Report. French Society of Neurosurgery. 45th annual congress. Angers, June 12-15 1994].

Since Guidetti and Slooff's masterbooks (1964), numerous papers have been devoted to intramedullary spinal cord tumors (IMT) and their treatment, most of them were focused on ependymomas and astrocytomas. Informed opinion was that these tumors were difficult to cure and that biopsy plus radiotherapy was the treatment of choice. Thanks to microsurgery and bipolar coagulation surgeons grew bolder and more efficient as illustrated by the contributions from Hurth or Resche on hemangioblastomas, Fischer on ependymomas, Epstein on childhood astrocytomas and Guidetti, Malis, Stein on IMT in general. Meanwhile, in the eighties, Magnetic Resonance Imaging (MRI) and Cavitron Ultrasonic Surgical Aspirator (CUSA) drastically modified diagnostic and therapeutic strategies of IMTs, as may be judged by the significant increase in the number of publications on this topic in current medical literature. However, no updated work of synthesis is currently available. This prompted us to publish our common experience based on 171 patients and 200 surgical procedures. Thanks to the collaboration of many colleagues of the "Société de Neurochirurgie de Langue Française" (SNCLF) who completed a questionnaire sent to them, we are now in the position to give an epidemiological estimation based on 1117 cases. This work is divided in three main parts. The first part deals with considerations common to all IMTs, the second with particular aspects specific of each tumoral type, the third with the results and concluding recommendations.

Humans↗
PubMed1993

Lipomyeloschisis associated with thoracic syringomyelia and Chiari I malformation.

Co-existence of Chiari I malformation and myelomeningocele is uncommon. Syringomyelia, when associated with a Chiari I malformation, classically involves the cervical spinal cord. Intramedullary extension of lipoma is unusual in lipomyeloschisis. A patient with lumbar lipomyelomeningocele with tethered cord, lower thoracic syringomyelia and Chiari I malformation, shown by MRI is reported.

Arnold-Chiari Malformation↗
PubMed1993

Gadolinium enhancement of vertebral endplates following lumbar disc surgery.

Gadolinium enhancement may be normal in the vertebral endplates adjacent to previously operated intervertebral discs. To determine the frequency of this finding and to differentiate this normal healing process from early lesions due to focal infection, we studied 135 patients who had undergone surgery for herniated lumbar disc, and compared them with 249 unoperated patients with radicular symptoms and 15 with known spondylodiscitis. Hypointense foci which enhanced with gadolinium were identified in the endplates of 25 (18.5%) of the operated patients, 9 of whom required a second operation for recurrent disc herniation, at which time the absence of infection was confirmed. Gadolinium enhancement within the endplates adjacent to the operated disc occurs during normal healing after surgery. Care should be taken before invoking a diagnosis of focal infection or secondary spondylodiscitis.

Adult↗
PubMed1993

Hydrosyringomyelia-Chiari I complex. Prospective evaluation of a modified foramen magnum decompression procedure: preliminary results.

A modified foramen magnum decompression procedure, designed to respect the subarachnoid spaces as much as possible, was prospectively evaluated in eight consecutive patients with a progressive clinical syndrome related to hydrosyringomyelia-Chiari I complex. This evaluation included quantitative clinical and magnetic resonance follow-up of at least 1 year in the first six patients and 6 months for the last two. Magnetic resonance scans at 6 months or more confirmed a persistent reduction of the hydrosyringomyelic cavity in all cases, which was associated with obvious subjective improvement. All patients have maintained this improvement. The operative technique and methods of clinical and radiological follow-up are discussed.

Adolescent↗
PubMed1993

Cylindrical spinal meningioma. A case report.

A case of cylindrical spinal meningioma is reported. This most unusual morphology suggested a preoperative diagnosis of either lymphoma, metastatic epidural tumor, or meningioma. At operation, the tumor was found to be hard and extremely adherent to the cord, so its anterior part had to be left in place. Transient paraplegia was observed postoperatively, but the patient recovered normal stance and gait within 6 months. Three years after the operation, magnetic resonance imaging demonstrated a very slow progression of the remaining tumor with an estimated increase of 5%. The differential diagnosis of this lesion by magnetic resonance, its clinical postoperative evolution, and the surgical strategy are discussed.

Aged↗
PubMed1993

Characterization of nuclear DNA content, proliferation index, and nuclear size in a series of 181 meningiomas, including benign primary, recurrent, and malignant tumors.

The characterization of nuclear area, the proliferation index, and nuclear DNA content was carried out by means of digital cell image analysis, which makes it possible to compute morphometric and densitometric features on Feulgen-stained nuclei from archival, that is, formalin-fixed, paraffin-embedded materials. The 181 meningiomas studied included 173 classic (41 meningotheliomatous, 27 fibroblastic, 82 transitional, nine psammomatous, eight angiomatous and six hemangioblastic tumors) and eight malignant meningiomas (three hemangiopericytomas and five tumors that we labeled HFM, that is, tumors exhibiting evidence of histological features of malignancy). The results reveal a strong relationship between incomplete surgical resection and recurrence on the one hand and between the probability of recurrence and histopathological type on the other. Whereas neither nuclear area nor nuclear DNA content assessments were helpful in distinguishing the six classic and the two malignant meningioma subgroups, a statistically significant increase in proliferative activity was observed in the malignant meningiomas as compared with classic ones, excepting hemangioblastomas that proliferate at the same rate as the malignant meningiomas. Furthermore, the multiple meningiomas definitely proliferated more actively than the single ones, but a similar proliferative activity was observed in the nonrecurrent and recurrent meningiomas. Proliferation analyses might be therefore helpful for determining aggressive meningiomas and for planning adjuvant therapy in these cases.

Adult↗
PubMed1993

DNA histogram typing in a series of 707 tumors of the central and peripheral nervous system.

The diagnostic value of ploidy level was investigated in a series of 707 tumors (from 707 patients) of the central and peripheral nervous system. The series contained 91 nerve sheath tumors (NSTs), 222 meningiomas (MNGs), 37 primitive neuroectodermal tumors (PNETs), 293 glial tumors of the adult (ATTs), and 64 brain metastases (MTTs). The ploidy level of each tumor was obtained by means of its DNA histogram type (DHT), which was computed (digital cell image analysis) on Feulgen-stained nuclei from archival formalin-fixed paraffin-embedded materials. The data reveal that the measurement of the ploidy level showed a diagnostic value in some of these tumor cases. Indeed, the proportion of highly aneuploid cases significantly (p < 0.05-0.01) decreased according to the sequence PNETs (72%)-->MTTs (64%)-->ATTs (40%)-->NSTs (23%)-->MNGs (9%). Nevertheless, this significant diagnostic value in terms of a distinction between benignity and malignancy only appears when all the tumors are taken into consideration. Indeed, at the level of one individual patient, our study shows that, like traumatic neuromas, schwannomas, or classical meningiomas, completely benign tumors can exhibit a high aneuploidy level. In contrast, some tumors from histopathological groups like brain metastases or PNETs, which are known to be clinically aggressive, could be completely diploid.

Astrocytoma↗
PubMed1993

Assessment of nuclear size, nuclear DNA content and proliferation index in stereotaxic biopsies from brain tumours.

In this paper we study the feasibility of measuring the diverse biological parameters in stereotaxic biopsies from human brain lesions. These biological parameters are the nuclear area (NA), the proliferation index (PI) and the ploidy level, the latter of which was evaluated by means of the DNA index (DI) and histogram type (DHT). These parameters were assessed by means of the digital cell image analysis of Feulgen-stained nuclei. This analysis was performed on 124 samples from 22 computed tomography (CT)-guided stereotaxic biopsies. The data show that the methodology used here enables the above parameters to be assessed on small samples without limiting the classical anatomopathological diagnosis. The data also reveal that the DHT corresponded more accurately to the ploidy level in the sample analysed than the DI. Lastly, it appears that supratentorial astrocytic tumours of the adult, which constituted the majority of the cases analysed here, are strongly heterogeneous at a biological level.

Biopsy↗
PubMed1993

Receptors for pituitary adenylate cyclase activating peptides in human pituitary adenomas.

The presence of pituitary adenylate cyclase activating polypeptide (PACAP) receptors coupled to adenylate cyclase was investigated in four types of human pituitary adenomas: three null adenomas and five gonadotropin-, three ACTH-, four GH-, and four PRL-producing adenomas. In all samples, except in prolactinomas, PACAP(1-27) and PACAP(1-38) stimulated adenylate cyclase activity equally well and potently (K(act) around 3 nmol). Vasoactive intestinal polypeptide (VIP) was systematically 100- to 300-fold less potent than both PACAPs. In prolactinomas, PACAP(1-27), PACAP(1-38), and VIP were inactive despite a response of the enzyme to guanosine 5'-triphosphate, Gpp(NH)p, forskolin, and fluoride. [125I-AcHis1]PACAP(1-27) binding was detected in all samples except in prolactinomas. In addition, a detailed analysis of receptors was feasible in all five gonadotropin- and in two ACTH-producing adenomas, confirming the existence of selective PACAP receptors that recognized PACAP(1-27) and PACAP(1-38) with similar high affinity (IC50 0.8-1.5 nmol) and VIP with a low affinity (IC50 100 nmol/L).

Adenoma↗
PubMed1993

First year experience using the Fischer ZD-Neurosurgical Localizing Unit with particular reference to the development of PET-guided stereotactic biopsy.

Initial experience using the Fischer ZD-Neurosurgical Localizing Unit is reviewed. During the first year, 26 stereotactic procedures were performed in 25 patients. Twenty-two patients underwent imaging-guided stereotactic biopsy. Among them, 20 were included in the protocol we have developed for combined positron emission tomography (PET)- and computerized tomography (CT)-guided stereotactic biopsy. The technique is briefly described and preliminary results are reported. Most low-grade tumors were found in hypometabolic/hypodense areas, glioblastomas were all diagnosed in areas with increased FDG uptake and contrast enhancement on CT while data for anaplastic astrocytomas were heterogeneous. Some of the biopsic trajectories performed in areas were there was no increased FDG uptake or in areas with increased FDG uptake but without contrast enhancement on CT were non diagnostic. This never occurred in areas with both increased FDG uptake and contrast enhancement. Other stereotactic procedures performed include 2 catheter placement for drainage of cystic lesions, 3 stereotactically guided open neurosurgical procedures and 1 third ventriculostomy. Procedural objectives were accomplished in all cases. From our experience, we found stereotactic procedures using this system safe, accurate, easy to handle and allowing a wide range of applications. Because the system is designed to be readily used in conjunction with modern planar imaging techniques (i.e. CT and magnetic resonance imaging), it allowed us to develop a technique for PET-guided biopsy which might increase the diagnostic yield of stereotactic biopsy of intracranial neoplasms.

Adolescent↗
PubMed1992

Histopathologic grading and DNA ploidy in relation to survival among 206 adult astrocytic tumor patients.

BACKGROUND: The authors studied the benefit of performing histopathologic grading and DNA ploidy characterization with respect to patient survival in a series of 206 astrocytomas (AST) for which they obtained 134 complete clinical follow-ups. METHODS: The material analyzed came from archival material, i.e., formalin-fixed paraffin-embedded tissues. DNA ploidy was assessed by means of a cell image processor computing the integrated optical density (IOD) on Feulgen-stained nuclei. RESULTS: Results showed that histopathologic diagnosis in three grades, i.e., AST, anaplastic astrocytoma (ANA), and glioblastoma multiforme (GBM), had a significant prognostic value. Patients with AST showed a mean survival time (between histopathologic diagnosis and death) of more than 36 +/- 6 months (AST versus ANA or GBM) (P less than 0.001). Patients with ANA and GBM showed a mean survival time of 15 +/- 2 and 10 +/- 1 months, respectively, (ANA versus GBM) (P less than 0.05). Patient age strongly correlated with survival. Patients younger than 40 years of age had a mean survival time of 20 +/- 4 months. Patients between 41 and 60 years of age had a mean survival time of 12 +/- 2 months, and patients older than 60 years of age had a mean survival time of 11 +/- 1 months. CONCLUSIONS: Considering DNA ploidy characterization, the authors noticed that aneuploid ANA (DNA index [DI] more than 1.30) were associated with a significantly higher mean patient survival time compared with that associated with euploid ANA. In contrast, the authors did not find this in either of the groups with AST and GBM. Recognizing six DNA histogram types (diploid, triploid, tetraploid, hyperdiploid, hypertriploid, and polymorphic), the authors observed that hypertriploid tumors were associated with greater patient survival compared with what happened in the cases of the five other DNA histogram types. This was true with respect to the three AST histopathologic types. Thus, DNA ploidy determination seemed helpful in characterizing aggressiveness in adult AST.

Adolescent↗
PubMed1992

Traumatic brain edema induced by ventricular puncture. A study by magnetic resonance imaging.

Magnetic resonance imaging demonstrates after ventricular catheterization a focal brain hypersignal corresponding to a parenchymal edema along the drain track. In the course of our daily clinical activity, this hypersignal extension seemed more pronounced when catheterizing the frontal area than the junctional parieto-temporo-occipital parenchyma (or trigonal area). In order to confirm this impression, we prospectively studied ten consecutive patients with normal pressure hydrocephalus in whom both of these brain regions were successively catheterized first by a frontal puncture for intracranial pressure monitoring and then by a trigonal one for a ventricular shunt. Each patient was evaluated by serial magnetic resonance imaging. The extension of the hypersignal induced by both catheterizations was estimated on a scale of five grades (0 to 4) of hypersignal extension. A statistically significant more important hypersignal extension was demonstrated at the level of frontal area when compared to the trigonal one. We discuss the likely underlying mechanisms of this phenomenon.

Adolescent↗
PubMed1992

Surgery of intramedullary spinal cord tumours.

MRI and Cusa have significantly modified the diagnosis and the treatment of intramedullary tumours. Our experience, based on 66 cases, is in favour of surgery performed when the patient's neurological status is still good. Radical surgery, whenever possible, is the best treatment and can be achieved for many histological diagnoses, even in gliomas where we succeeded in 36% of the cases. Surgery is the only way to be sure of the exact histological diagnosis of the lesion which can be suggested in 70% of the cases but not confirmed by MRI.

Astrocytoma↗