Biomedical subjects
Publications and source records attributed to J Goffin.
A case of hemangioblastoma of the right lateral ventricle is presented. Only five other cases of intraventricular hemangioblastoma have been reported. The literature on supratentorial intraventricular hemangioblastoma is reviewed.
A case of meningeal cyst of the spinal canal in the lumbosacral region is described. A CT scan showed a soft tissue mass associated with bone erosion. Myelography and computerised tomographic myelography revealed a cyst filling with contrast and thus CSF containing. The diagnosis of meningeal cyst was confirmed in a non-invasive way by MRI showing a mass with the same signal intensities as CSF on both T1 and T2 weighted images. Final characterisation of meningeal cysts in one of the three categories comprising spinal extradural meningeal cyst without spinal nerve root fibers (type I), spinal extradural meningeal cyst with spinal nerve root fibers (type II) and intradural meningeal cyst (type III) is impossible without operative inspection and histological examination.
Glossopharyngeal neurinomas are rare entities. Only 16 cases have been described so far in the literature. Our experience with 2 cases demonstrates the non-specific and discrete clinical presentation of the ninth nerve neurinoma, but illustrates also some typical radiological aspects, enabling a more precise preoperative diagnosis. Two cases are presented and a survey of the literature is given.
Balloon embolization was attempted in 7 patients with posttraumatic carotid-cavernous fistulas. The procedure was successful in 4 patients and failed in 3 other. Two of these fistulas showed spontaneous regression after failed embolization. In one patient, premature detachment of the balloon led to cerebral infarction, but with total clinical recovery. One patient showed temporary palsy of the VIth cranial nerve after embolization.
Outpatient myelography with iohexol (Omnipaque) was performed in 150 patients. Side effects were noted in 28 patients (19%), with only 3 (2%) major complaints. It concerned 2 patients with severe and prolonged headache and one patient with seizures. Side effects were not more frequent in outpatient myelography than in reported series of hospitalized patients. The frequency of side effects was significantly lower with the use of iohexol than in comparable studies with metrizamide. Headache was the most frequent side effect, followed by an increase or exacerbation of ischiatiform pain, nausea and vomiting. Side effects were slightly more frequent in cervical myelography than in lumbar myelography and were not related to underlying pathology. It is concluded that outpatient myelography is feasable for as far as iohexol is used and patient surveillance is carefully organized.
Between June 1984 and April 1988, 41 patients with severe posttraumatic lesions of the cervical spine between the C2-C3 and the C7-T1 level seen consecutively were treated by an anterior cervical fusion and osteosynthetic stabilization according to Caspar. These patients were prospectively studied. Seven patients had a bilateral facet dislocation, 5 a unilateral facet dislocation, 9 an anterior subluxation, 9 an anterior compression fracture, 5 a hangman's fracture, and 6 a hyperextension injury at a lower cervical level. From a neurological point of view, there were 12 patients with an initial complete transverse lesion and 14 with an incomplete transverse lesion, and the remaining 15 patients did not have any deficit initially. Four patients died during the first 3 months after the operation. In 38 patients good anatomical position was obtained, generally by the intraoperative use of the vertebral distractor of Caspar. In all patients excellent immediate postoperative stability of the spine was obtained, although in 2 patients a second operation was necessary a few days after the first one. Postoperatively all patients were "immobilized" by a soft collar for 3 months. Four patients with an initial complete transverse lesion showed some neurological recovery in the postoperative period, and all patients with an incomplete transverse lesion improved. There were no postoperative neurological disturbances in the group of patients who were neurologically normal from the beginning. The mean postoperative hospitalization time was 13.6 days. These results were compared to the results from the literature, concerning other conservative and operative treatments for posttraumatic lesions of the cervical spine.
In 7 patients with a brain tumor and intracranial hypertension treated by ventriculosubcutaneous drainage, intracranial pressure and cerebral perfusion pressure were continuously monitored during induction of anesthesia with fentanyl 1.5 micrograms/kg, propofol 2.5 mg/kg and vecuronium 0.1 mg/kg. End-tidal pCO2 was kept constant by manual ventilation and arterial pCO2 was verified before induction and before and after intubation. Five minutes after induction the patients were intubated and measurements continued for five more minutes. Mean arterial pressure decreased from 102 (+/- 9.8) mmHg to 57 (+/- 11.6) mmHg (p less than 0.01). Intracranial pressure did not change significantly before intubation. However in two patients intracranial pressure increased before intubation due to a significant rise in arterial pCO2. In 4 of the 7 patients an important increase to 25 (+/- 4.6) mmHg in intracranial pressure was observed during intubation. Cerebral perfusion pressure decreased from 88 (+/- 4.6) to 45 (+/- 9.8) mmHg (p less than 0.01) before intubation, but did not differ from the baseline during and after intubation. It is concluded that propofol 2.5 mg/kg in a bolus injection does not increase ICP but can produce a significant decrease of the cerebral perfusion pressure due to a marked decrease in mean arterial pressure in patients with a brain tumor.
A method for subtotal cervical vertebral body replacement in cases of tear drop fractures or burst compression fractures is presented, using a C-shaped iliac crest graft in combination with the trapezial osteosynthetic plate technique according to Caspar.
Different types of anomalies of the lumbosacral nerve roots were documented in the literature. The present report is the first description of a combination of conjoined and anastomosed nerve roots, at the same level and unilaterally, in the lumbar region.
Different types of anomalies of the lumbosacral nerve roots are documented in the literature. However, combinations of anomalies in one single person appear to occur very seldom. This report describes a unique combination of adjacent, conjoined and anastomosed lumbosacral nerve roots.
Since 1979 much attention has been payed in the literature to the presence and importance of estrogen- and progesterone-receptors in meningiomas. The existence of these receptors seems to be proven, but the question about their biological activity is not solved conclusively. If the hypothesis of a biological activity of the estrogen- and progesterone-receptors in meningiomas is confirmed, some patients could benefit from a hormonal therapy.
Explore the source record for details and available documents.
The authors report a case of tension pneumocephalus in association with a ventriculoperitoneal shunt for obstructive hydrocephalus, due to the presence of a pineal tumour. In this unique form of tension pneumocephalus, air from the middle ear must have penetrated into the brain parenchyma and later on into the ventricular system through pre-existing congenital defects in the bony tegmen tympani and the covering dura mater. The possible pathogenetic mechanisms of this kind of tension pneumocephalus are discussed.
A method for multiparametric quantitative cerebral angioscintigraphy is described. For the evaluation of the symmetry of hemispherical bolus transit the following parameters were used: the cumulative L/R hemispheric ratios expressed in arctangent values and the sequential hemispheric activity difference. Both the sensitivity and specificity of this technique for detection of proven stenosis of carotid or cerebral arteries (25 cases) were 80%, in comparison with 60% for computerized axial tomography. A few clinical examples illustrate the diagnostic utility of quantitative cerebral angioscintigraphy. The value of the different quantitative parameters is discussed and compared with other similar studies. With regard to the complementary role of computerized axial tomography and serial cerebral scintigraphy the results of other authors were confirmed. Considering the broad field of application for dynamic brain scintigraphy and the fact that both sensitivity and specificity of this exploration are comparable to, or even better than, CT, it is our opinion that isotopic exploration remains a reliable detection method for cerebrovascular disease.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
PURPOSES: Intracranial haemorrhage (ICH) is a rare but potentially devastating complication of oral anticoagulants (OAC). This raises the difficult clinical choice between either permanent cessation of OAC, or continuing OAC and if so, when to restart. To make this choice, one needs to balance the thrombo-embolic risk after cessation of OAC against the risk of recurrent intracranial haemorrhage when OAC are restarted. There are few published data to base this difficult clinical decision on. METHODS: We present an observational study of a consecutive series of 108 patients, collected prospectively and admitted to our department, with an OAC-related intracranial haemorrhage, in whom we assessed the thrombotic event rate and the recurrent intracranial bleeding rate during follow-up. RESULTS: In the 25 patients in whom OAC were reinstituted no new thrombo-embolic events occurred (0/506 unprotected patient-days). In the group of patients in whom OAC were not restarted (n = 81), the thrombo-embolic event rate was 8/11590 unprotected patient-days, of which only 2 were cerebrovascular thrombo-embolisms. The overall risk of a thrombo-embolic complication can be estimated to be 0.66 events/1000 patient-days at risk (95% exact confidence limits of 0.3 to 1.3 events/1000 patient-days at risk). In three patients the thrombo-embolic event was fatal. We saw recurrent intracranial bleeding in eight patients, 2 of which were fatal. Seven of these occurred before the restarting of the OAC. CONCLUSIONS: In OAC-related intracranial haemorrhages, OAC can be stopped safely for a considerable period, with a very low overall thrombotic event rate. The recurrent bleeding risk after restarting OAC is low. Recurrent bleeding mostly occurred before restarting OAC and is probably caused by insufficient or unsustained correction of the initial coagulation deficit. Immediate reversal of anticoagulation provides the patient with the best possible treatment options including surgery. OAC-related intracranial haemorrhages can therefore be actively treated.
Magnetic resonance was performed in five patients with obstructive hydrocephalus due to surgically proven colloid cyst of the third ventricle. On T1-weighted images two lesions were homogeneously hyperintense and another homogeneously isointense with the surrounding brain parenchyma. On T2-weighted images these three lesions were strongly hypointense except for a hyperintense rim at the periphery. At surgery in these patients the cyst was thin walled and filled with viscous colloidal material. In two patients the content of the lesion was composed of two layers. The outer layer was hyperintense and the inner layer hypointense in one patient. In the other patient the periphery of the lesion was isointense with central hypointensity. On T2-weighted images the content of both lesions was hyperintense at the periphery with central hypointensity. In these last two patients at surgery the cyst was thin walled too. However, two clearly different components could be found in the cyst content: an outer component composed of amorphous material and cellular debris and an inner component consisting of viscous material.