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J Brotchi

Publications and source records attributed to J Brotchi.

At least 127 records · Page 7Linked to original sources
PubMed1992

Morphological quantitative analysis of intracranial pressure waves in normal pressure hydrocephalus.

This work presents a prospective morphological and quantitative analysis of 43 intracranial pressure recordings performed on normal pressure hydrocephalic patients. This analysis led us to separate Lundberg's B waves into different subtypes and to refine the definition of the 'Plateau' wave. Two B wave subtypes named Great Symmetrical wave and Intermediate wave appeared correlated with the surgical improvement. In addition, the degree of post-operative improvement was correlated with the frequency of Intermediate wave. An extended quantitative classification of intracranial pressure waves is proposed that can be used alone to determine which patients should undergo a shunting procedure and which one should the most improve.

Aged↗
PubMed1992

Endoscopic cure of a giant sacral meningocele associated with Marfan's syndrome: case report.

An unusual anterior sacral meningocele associated with Marfan's syndrome, with demonstrated dural anomalies related to Marfan's syndrome is reported. Endoscopy enabled complete exploration of the meningocele, its morphological description, and ultimate cure. The meningocele resembled an hourglass made up of intrasacral and anterior sacral components. The communication of this bilobed malformation with the dural sac was so small that only the intrathecal injection of a colored solution allowed its localization. The closure of this communication was accomplished under endoscopic view by a single stitch. The postoperative course of the patient was characterized by immediate disappearance of the preoperative clinical signs. Computed tomographic scans demonstrated progressive complete collapse of the anterior sacral meningocele and partial resolution of the intrasacral component. Dural anomalies of Marfan's syndrome are described, and their relationship to the formation of the meningocele is discussed.

Adult↗
PubMed1992

Positron emission tomography-guided stereotactic brain biopsy.

We describe a technique that allows target definition for stereotactic brain biopsy using coordinates calculated on stereotactic positron emission tomographic (PET) images. In this study, PET images were obtained using [18F]-labeled fluorodeoxyglucose, a marker for glucose metabolism. The difference between PET-calculated and actual stereotactic coordinates of simulated targets is within PET spatial resolution. Combined computed tomography- and PET-guided stereotactic biopsies were performed in 11 patients with brain tumors. In this report, we describe two representative patients who underwent stereotactic brain biopsy using the present technique. Because of the complementary role of PET and computed tomography, their integration in multimodality planning might optimize the target selection for stereotactic brain biopsies.

Astrocytoma↗
PubMed1992

A patient with two upper lumbar disc herniations.

Of all lumbar disc herniations, less than 5% occur in the upper lumbar area. Though protrusions are common at all levels, truly extruded disc herniations in the upper lumbar area from L1 to L3 are rare. Even more unusual is the multilevel occurrence of herniations in this area. The authors stress the importance of accurate diagnosis and clinically directed medical imaging work-ups.

Humans↗
PubMed1991

Invading meningiomas of sphenoid wing. What must we know before surgery?

Sphenoid wing meningiomas are very invasive tumours. The only permanent treatment is total eradication. But quality of life should also be taken into account. Several surgical approaches have been proposed with more and more aggressivity. We have raised a list of 9 questions which is not exhaustive. We recommend solving them before surgery and to be sure to have an answer before a surgical decision is made. This would be of great benefit for more efficacious results with less sequelae.

Humans↗
PubMed1991

Three-quarter prone approach to the pineal-tentorial region. Report of seven cases.

We report our preliminary results (seven cases) with a three-quarter prone approach to the pineal-tentorial region using an opening beneath the midline. The technique we have used eliminates the risk of air embolism because the head is just over the right atrium, the table remaining in an horizontal plane. Using the natural effect of gravity, it is no more necessary to use retraction on the occipital lobe. So, hemianopsia is eliminated. We confirm the results of other teams who have used this approach which seems to us to be the best way to treat any lesion in the pineal-tentorial area.

Adult↗
PubMed1991

Sarcoidosis presenting as an isolated intramedullary tumor.

We report a case of isolated intramedullary sarcoidosis. The patient developed progressive signs that indicated a spinal tumor, which were investigated with contrast-enhanced magnetic resonance imaging scans. Magnetic resonance imaging clearly revealed an intramedullary lesion, but the diagnosis of sarcoidosis was made on the pathological analysis of the surgical specimen. Magnetic resonance imaging with contrast enhancement is reported in a histologically proven case of intramedullary sarcoidosis. Only 12 other cases of isolated intramedullary sarcoidosis have been reported. We review and discuss these cases according to their clinical presentation, the segmental location of the granulomas in the spinal cord, preoperative and operative diagnoses, and signs for systemic sarcoidosis. In none of the cases was the diagnosis of intramedullary sarcoidosis made before surgery. We think that surgical therapy for intramedullary lesions is the best way to diagnose rare instances of benign lesions like sarcoidosis and to treat them in an appropriate manner.

Contrast Media↗
PubMed1991

[Subarachnoid hemorrhage of unknown origin. Apropos of 59 cases].

Fifty-nine subarachnoid hemorrhage with normal panangiography were reviewed (1982-1989). The mean age is 50 + 10. The grades at admission are compared following the Hunt and Hess and the World Federation Classification. Fifty cases (Hunt and Hess) or 45 (W.F.N.S.) are grade I or II. Compared with 278 cases of subarachnoid hemorrhage of aneurysmal etiology, 76% were in good grades versus 55% only for the aneurysms. Hypertension was present in 21 cases (35%) and represented a factor of gravity. Hydrocephaly is a rare complication in these cases and only 2 cases were shunted. The repetition of angiographic exploration seems to be unnecessary: all the examens remained negatives. The aspect on C.T. Scan was the same that the subarachnoid hemorrhage of aneurysmal origin. Angiography of 4 pedicles were performed in all cases and in the late 15 cases, external carotid explorations were added for exclusion of dural malformations. Seven suspected cases had had a secondary exploration between 12 days. The other cases were reexamined at 3 months. Three cases deceased from a second hemorrhage without aneurysm at autopsy. These cases confirm that subarachnoid hemorrhage of unknown etiology is of good prognosis. Low grades, rare complications, few rebleeding and good outcome scale are common. Etiology remains hypothetic.

Adult↗
PubMed1991

[Lesions of the pineal and tentorial region. Occipito-parietal approach in three-quarter prone position with infrasagittal craniotomy].

Surgical treatment of pineal-tentorial region lesions remains a challenge. The difficulty in approaching the pineal region can be verified with the number of operative plans that have been proposed to reach this area: transcallosal, occipital transtentorial, infratentorial supracerebellar approaches and sitting, prone or Concorde positions. This emphasizes the surgeon's dissatisfaction with the surgical techniques described. Recently, a three-quarter prone position with the bone flap placed under the midline has been described (1, 3, 8). We have decided to test this approach that we have slightly modified and we report our results on 13 cases: 2 arachnoid cysts, 3 vascular malformations and 8 tumors (3 brainstem gliomas, 2 dysgerminomas, 1 quadrigeminal plate metastasis and 1 meningioma plus 1 metastasis of the falx). Keeping the table in a horizontal plane, risks of air embolus are eliminated. Using the natural effect of gravity, traction on the occipital lobe is no more necessary and hemianopsia no more occurs. We recommand the parieto-occipital route which is the shortest way to reach epiphysis and falco-tentorial notch. We confirm the results of american colleagues (1, 3, 8, 15) and we advise to use this approach which seems to us the best way to treat pineal-tentorial lesions.

Adult↗
PubMed1991

[Brain grafts: ethical and scientific aspects].

Neural grafting will dramatically modify the treatment of major cerebral and medullary illnesses. This new approach has already been used in Parkinson's disease, perhaps too early according to our knowledge in that field. Ethical problems are numerous with brain grafting but one may hope in next future a better understanding of the mechanisms involved in these procedures and a solution to most of ethical objections to perform that treatment.

Adrenal Medulla↗
PubMed1991

[Protective effect of intrastriatal grafts in an experimental model of Huntington's disease. Behavioral and morphological correlation].

The intrastriatal injection of the excitotoxin quinolinic acid (Q.A.) in rats produces neuroanatomical and neurochemical changes mimicking those appearing in the striatum in Huntington's disease (H.D.). Although its cause is unknown, it has been hypothesized that the neurodegenerative changes seen in H.D. may result from the action of an endogenous toxin. Therefore, the development of new strategies for limiting or preventing Q.A.-or other neurotoxic-induced degeneration may be of therapeutic interest for neurodegenerative disorders. Accordingly, we tested the ability of various tissue transplants to protect the rat striatum against a subsequent Q.A. insult. Using a "unilateral model", i.e. unilateral intrastriatal grafts followed by an ipsilateral intrastriatal injection of Q.A., we were able to quantify a behavioral protective effect of the grafts in recording the apomorphine-induced rotational behavior that normally appears after the striatal Q.A.-induced lesion. Our results show that one of the tested tissue, fetal striatum, protects the recipients against the lesioned-induced rotational behavior that appeared in non-grafted lesioned animals. The other grafted tissues (adrenal medulla, peripheral nerve, adipose tissue) seemed to provide a less dramatic protection than fetal striatum; however, this difference did not reach significance. Quantification of the striatal neuronal loss showed that the behavioral protection is significantly correlated with a better neuronal survival in the grafted animals. These results suggest that intracerebral grafts can protect the host brain against a toxin-induced damage, like the one resulting from Q.A. intrastriatal injection. Though fetal striatal grafts seem to exert an optimal protection, this protective effect may at least partially result from a host-mediated response to the transplantation procedure. The mechanism underlying this protective effect is unclear, but the present data suggest that it might be related to a transplantation-induced astroglial reaction resulting in an increased neuronotrophic activity that could protect against the toxic effect of Q.A. The results of this study also support the concept that the effect of transplantations could occur through processes other than a direct restoration of deficient transmitters or a reconstruction of damaged pathways. Further characterization of the factors implicated in the present paradigm might conceivably open avenues for possible therapeutic preventive interventions in neurodegenerative disorders.

Animals↗
PubMed1991

[Ethics and research in neurosurgery].

Ethical issues related to neural grafting are numerous. Experimental research on animals give much hope to get in next future a treatment in favour of numerous neurological disorders which are incurable at present. We must follow ethical recommendations of the NIH human fetal tissue transplantation research panel. According to the rapidity of knowledge growing in this field, so as in others, it would not be adequate to favour any law project on this subject, which does not mean that we could have something to hide. On the contrary, we would like to favour the diffusion of the works made by all ethical committees in our country. This could be one of the aims of the future National Bioethical Committee.

Animals↗
PubMed1991

A survey of 65 tumors within the spinal cord: surgical results and the importance of preoperative magnetic resonance imaging.

Between January 1984 and December 1990, 65 intramedullary spinal cord tumors were diagnosed and operated on. In this series, all patients underwent magnetic resonance imaging investigations and were operated on with the Cavitron ultrasonic surgical aspirator whenever necessary. Major surgical difficulties have been found in patients previously treated by radiotherapy with or without biopsy. We found magnetic resonance imaging to be a highly sensitive imaging procedure and the method of choice for visualizing tumors within the spinal cord. Nevertheless, accurate diagnosis may only be suggested by magnetic resonance imaging, rather than made definitively. Surgery is necessary in every case in order to obtain a definite diagnosis. Radical surgery can be performed when a plane exists between the tumor and the normal spinal cord: biopsy or debulking with the Cavitron ultrasonic surgical aspirator should be performed when the tumor is infiltrative. We have performed 33 so-called total resections, 22 partial resections, and 10 biopsies, among which 5 were performed on lipomas. Surgical results were assessed at 3 months after surgery, showing 35 improvements (53%), 24 stabilizations (37%), and 6 deteriorations (10%).

Adolescent↗
PubMed1990

Paraganglioma of the cauda equina. Report of 2 cases and review of 59 cases from the literature.

Paragangliomas of the cauda equina are not so rare as said in the literature. Two additional cases are presented with a global analysis of the 59 cases from the literature. The diagnosis of this pathology greatly benefit of the use of immunostainings as the cells are often neuron-specific enolase, neurofilament protein and somatostatin positive so that electron microscopy is thus no longer mandatory for establishing the diagnosis. In addition, we report the first magnetic resonance images of this tumor at this location.

Adult↗
PubMed1990

[Long-term survival after surgery of solitary cerebral metastasis of lung cancer. Clinical case and review of the literature].

In cases of solitary brain metastasis of lung cancers other than small cell lung carcinoma, which has an even poorer prognosis, long-term patient survival over 1.2 years is rare. One case with a 12 year survival is presented. The authors review the other 18 cases with a minimum 5 year survival described in the literature. It is concluded that surgical aggressivity is justified in these cases.

Brain Neoplasms↗