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Biomedical subjects

M Djindjian

Publications and source records attributed to M Djindjian.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Prevention of wound infections in neurosurgery].

Post-operative wound infections are a serious complication in neurosurgery. The average wound infection without antibiotics ranges between 5-11% in C.S.F. shunts, 2-5% in clean and clean contaminated patients; 11-38% in C.S.F. fistula. In C.S.F. shunt procedures, common skin commensals are responsible for most post-operative infections, mainly coagulase negative and positive staphylococci. Contradictory results of the studies evaluating the efficacy of antibioprophylaxis make it impossible to conclude whether antibiotics have any impact on the incidence of infections. Neverless the decision to adopt antibioprophylaxis must be left to each surgeon and based on their own experience (mean level of infection dropped from 5-11% to 1% with ABP in France). In clean and clean contaminated patients, the weight of evidence based on some large, prospective, randomized studies, suggest that ABP exert a protective effect, for which an antistaphylocci antibiotic would be appropriate. In case of Methi-R organisms, a second generation cephalosporin is an alternative candidate. Association of Vancomycin-Gentamycin is not recommanded routinely because of the risk of development of resistance. In skull fracture and C.S.F. fistula, the results of studies does not favour the routine administration of antibiotics.

Anti-Bacterial Agents↗
PubMed1992

Multiple vertebral hemangiomas with neurological signs. Case report.

A case of multiple vertebral hemangiomas with progressive neurological deficit is presented. Successful treatment was accomplished using preoperative embolization, palliative surgical decompression, and postoperative radiation therapy. The patient has remained asymptomatic for 6 years. The authors review the role of current imaging modalities and options for therapeutic intervention. Preoperative embolization, palliative surgical decompression, and postoperative radiotherapy appear to provide a satisfactory outcome in patients with multiple hemangiomas and may represent an effective alternative to more aggressive surgical intervention.

Adult↗
PubMed1991

[Pseudo-oligodendrogliomatous meningioma. Report of 2 cases and review of the literature].

We report two cases of oligodendroglioma-like meningioma revealed by symptoms of increased intracranial pressure, progressive hemiparesia and partial epileptic seizures. Brain CT-scan or scintigraphy and carotid arteriography were suggestive of a convexity meningioma. One patient had received radiation treatment for scalp tinea capitis 25 years previously. In spite of complete surgical removal, the tumor recurred in both cases respectively 17 years and 18 months later. The two patients were operated again, and one underwent a complementary radiotherapy. Pathologic diagnosis was particularly difficult in the first case where the pattern at conventional histologic technics was that of oligodendroglioma. On the occasion of recurrence, immuno-histochemistry and ultrastructural studies were performed. The tumor was positive for epithelial membrane antigen (E.M.A) and cytokeratin, but was negative for glial fibrillary acidic (G.F.A.) protein, S 100 protein (S 100), neuron-specific enolase (N.S.E.), vimentin, anti-LEU-7 (N.H.K.1), and neurofilaments (N.F.). Electron microscopy showed closely adjacent cells with tonofilaments and numerous desmosomes. These findings permitted to establish the diagnosis of oligodendroglioma-like meningioma instead of oligodendroglioma. In the second case, the histologic pattern was also reminiscent of oligodendroglioma, but presence of few cellular whorls in some part of the tumor permitted the correct diagnosis. The pathogenesis of this atypical form of meningioma, its tendency for recurrence, and usefulness of radiotherapy are discussed and literature is reviewed.

Adult↗
PubMed1990

[Optimal length of antibiotic therapy in aspirated cerebral abscess].

Between 1983 and 1988, 22 patients with brain abscess were admitted to our neurosurgery department; 2 patients deeply comatose on admission and who died on the first day were excluded from this study. Treatment consisted of needle aspiration of the abscess and antibacterial therapy initially using a broad-spectrum antibiotic later replaced, in all cases, by an antibiotic found to be active in vitro against the organism(s) isolated. The portal of entry was eradicated as early as possible. The duration of antibiotic therapy was determined according to the changes observed on computerized tomography images classified as cavitary, nodular, hypodense or normal. Nodular images were taken as reflecting an inflammatory state in the healing process, and hypodense images as sequelae, so that antibiotics were withdrawn in patients with such images. Altogether, 62 per cent of the patients received antibiotics for 60 days and 95 per cent for 90 days. There was no recurrence. In some patients with deep or, chiefly, multiple abscesses, treatment was pursued. In any case, antibiotics should not be given for more than 90 days if the initial treatment has proved effective, since cure is achieved in 45 to 60 days on average.

Anti-Bacterial Agents↗
PubMed1990

Antibiotic prophylaxis during prolonged clean neurosurgery. Results of a randomized double-blind study using oxacillin.

The efficacy of oxacillin as a prophylaxis for infection was analyzed in a 27-month randomized double-blind study of 400 patients who had undergone clean neurosurgical interventions lasting longer than 2 hours. Four neurosurgeons took part in the study and 356 patients were eligible for final analysis. Among the 171 patients treated with oxacillin, there was one case of infection (0.6%), compared to nine (4.9%) of the 185 patients given a placebo. The difference between the two groups was statistically significant (p = 0.0398). This study, together with others (randomized or not), clearly demonstrates the efficacy of antibiotic prophylaxis in prolonged clean neurosurgery.

Adolescent↗
PubMed1990

Giant gangliocytic paraganglioma of the filum terminale. Case report.

The clinical and pathological features of a giant cauda equina paraganglioma arising from the intradural filum terminale is described. Scattered mature large neurons characterized the tumor as a gangliocytic paraganglioma. Histologically, these neoplasms have considerable similarity with ependymoma and the diagnosis can be easily missed unless special techniques are employed.

Adult↗
PubMed1990

[Correlations between anatomy and computerized tomography findings in transtentorial cerebral herniation].

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

Brain↗
PubMed1989

Sacral lipoma of the filum terminale with dural arteriovenous fistula. Case report.

A patient presenting with progressive paraparesis was found to have a dural sacral arteriovenous (AV) fistula. His condition deteriorated abruptly after thoracolumbar angiography. Embolization of the fistula improved the patient's status so that he was able to walk with crutches. One year later his neurological condition worsened. He was treated via an enlarged laminectomy because of uncertainty concerning a lipoma noted on the initial computerized tomography scan. The lesion consisted of an intradural filum terminale lipoma associated with an AV fistula, both of which were excised. The patient's condition was unchanged 6 months later. The different types of spinal lipomas and spinal AV malformations are reviewed, and mechanisms are proposed to explain the clinical deterioration in this patient. Venous hypertension seems to be the most likely possibility. The lipoma may have produced local hypervascularization of the dura mater with a subsequently acquired AV fistula.

Arteriovenous Fistula↗
PubMed1989

[The role of surgery and low molecular weight heparin in the treatment of cerebral venous thrombosis. Apropos of 2 cases].

For one case of thrombosis of sinus sagittalis superior joint haemorrhagic cerebral softening necessitates surgical draining of haemorrhagic focus grown to a true intracranial haematoma; for the another case direct low molecular weight heparin treatment obtained a mere evolution. Authors are of the opinion that early low molecular weight heparin treatment is able to avoid massive haemorrhage.

Adult↗
PubMed1989

[Radiotherapy of vertebral hemangioma with neurologic complications].

The interest of radiotherapy in the treatment of compressive vertebral hemangiomas (H.V.C.) is discussed from a literature review. Recent advances in imaging permit to precisely define the target-volume. The dose of 35 grays with standard fractioning affords optimal results on H.V.C. with no risk of spinal cord damage.

Hemangioma↗
PubMed1989

[Vertebral hemangioma with neurologic signs. Therapeutic results. Survey of the French Society of Neurosurgery].

45 cases of vertebral hemangiomas with neurologic involvement are reported. This series corresponds to the french experience between 1969 to 1988 (series of the "Société Française de Neuro-Chirurgie" (S.F.N.)). In this report, the therapeutic results are detailed. 16 patients were treated by a simple laminectomy, 6 by laminectomy associated with radiotherapy, 4 by radiotherapy alone. In 9 patients, a large removal of the hemangioma was performed by mean of a lamino-arthrectomy (7 cases) or a corporectomy (2 cases). 7 patients were treated by embolization or vertebroplasty. Both techniques were used alone or in association with surgery or radiotherapy. 3 patients had no therapy. Results of the S.F.N. series demonstrated that 75.5% of the patients had a long term favorable clinical course. 13.4% of the patients were not improved. Mortality was of 11.1%. The mean follow up time was of 51.6 months. Recurrence was encountered in 13 cases. It was mainly observed in the first two years. In cases of total involvement of the vertebrae by hemangioma, laminectomy associated with radiotherapy was the best mean of therapy: 93% of recovery without recurrence. Treatment of body localization appeared to be difficult. Corporectomy could be unefficient if a complete removal of the hemangioma could not be performed. In contrast, posterior arch localization was successfully treated by a simple laminectomy without radiotherapy, even in cases of incomplete removal of the hemangioma: all such cases (10 cases) had a complete recovery without recurrence.

Combined Modality Therapy↗
PubMed1989

Anatomy-computerized tomography correlations in transtentorial brain herniation.

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal plane was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

Autopsy↗
PubMed1989

[Vertebral hemangioma with neurologic signs. Clinical presentation, results of a survey by the French Society of Neurosurgery].

45 cases of vertebral hemangiomas with neurologic involvement are reported. This series corresponds to the french experience between 1969 and 1988 (series of the "Société Française de Neurochirurgie" (S.F.N.)). In this report the clinical presentation and the results of the radiological examination are detailed. Local vertebral pain was present in half of the cases. The neurological symptoms were related to spinal cord compression in 33/45 of the patients and to radicular suffering in the other cases. Evolution of the neurological symptoms appeared to be slow: the mean evolution time before diagnosis was of 10 months. Hemangioma involved the thoracic column in 73% of the cases. Neurologic symptoms was due to a diffuse narrowing of the spinal canal in 28.8% of the cases, to a local bony expansion in 60% of the cases. Hemangioma was found to involve the whole vertebra in 44.4% of the cases, the vertebral body alone in 24.4% of the cases and the posterior arch alone in 22.2% of the cases. An incomplete involvement of both vertebral body and posterior arch was found in 6.6% of the cases. 2.2% of the cases corresponded to pure epidural hemangioma. Preoperative diagnosis was established in 58% of the patients. In these cases, the diagnosis was based on standard radiography and CT datas. Results of the S.F.N. serie are compared with those of the main series of the literature.

Adolescent↗
PubMed1989

[Sciatica and nerve root anomalies. Apropos of a series of 20 cases].

We present 20 operative cases of lumbar nerve root anomalies, divided into 6 anatomical types: nerve roots with common dural emergence (4 cases), contiguous dural emergence (6 cases), with common dural sheath (4 cases), splited nerve roots (2 cases), anastomosis between roots (3 cases) and plexiform nerve roots (1 case). 14 cases are associated with a discal hernia. 10 cases presented with unilateral but biradicular sciatica. The asymmetry of emergence is the best symptom of the pre-operative radiological evaluation on the CT scan, moreover on the myelography. The management led to an enlargement of the surgical field by hemilaminectomy to recognize the anomaly and make easier the discectomy. In 3 cases, the anomaly was recognized in patients who had been previously operated on. There are only 53% of satisfactory final results. We present a review of the main publications concerning this subject.

Adult↗
PubMed1988

Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases.

The decision to operate on a patient older than 70 years for an intracranial meningioma is always difficult. Therefore a series of meningiomas treated surgically in 30 cases older than 70 years has been reconsidered and studied according to the following parameters: Karnofsky's rating scale, physiological status of the patient (A.S.A. criteria), perifocal oedema and mass effect. The locations of the meningiomas were: convexity 13, parasagittal 6, falx 2, pterion (sphenoid ridge) 5, orbito-cranial 3, jugum sphenoidale 1, tentorium (occipital) 1. Postoperative survival at day 30 shows a mortality rate of 23% which increases to 37% at day 90 including causes like decubitus ulcers and 3 cases of fatal pulmonary embolism. In a comparable series of 31 cases from 60 to 70 years, mortality rate was only 16% at day 90. Two parameters seem essential for quantifying surgical risk: clinical status, oedema and mass effect, evaluated by CT scan. The best conditions seem combined when Karnofsky rating scale is higher than or equal to 50 with no or only limited perifocal hypodensity and without mass effect. Although meningiomas may remain dormant for many years or can be kept under control medically for some time, their development is unpredictable. We think therefore that a reasonable surgical risk can be taken on patients with good physical status and favourable parameters at the time of diagnosis, particularly if the meningioma is located at the convexity where the risk of recurrence is minimal. On the other hand, patients with unfavourable parameters are not recommended for surgery.

Aged↗
PubMed1988

Correlation between anatomy and computed tomography in the occipito-temporal plane: application to cerebral lobectomy.

Identification of the anatomic limits of cerebral lobectomies has for long been based on the indirect data provided by ventriculography, arteriography and the statistical anatomic details of the stereotactic atlases. Today, it is simple to identify the cerebral anatomic structures directly on scanner sections, to assess the limits of a required lobectomy and to monitor the outcome. This appears to be just as valid in clinical conditions where the anatomic structures remain near-normal (surgery of epilepsy) as in those where they may be deformed (such as the surgery of malignant gliomata). In order to establish precise correlations between the anatomy and the computed tomographic findings, a study in the occipito-temporal plane used regularly in CT was carried out in 18 brains. Frontal, temporal and occipital lobectomies were performed on these brains using the anatomic landmarks commonly accepted in neurosurgery. The practical import of these theoretic lobectomies studied in the OT plane is illustrated by some examples of surgical excision of lobar cerebral lesions.

Brain↗