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Biomedical subjects

M Sindou

Publications and source records attributed to M Sindou.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Intramedullary tuberculoma: a case report].

A fifty-year-old Portuguese man presented with a six-month history of low back pain, which initially was mechanical and slowly became inflammatory. Secondarily, he complained of right atypical sciatalgia. He did not report any fever, loss of weight, cough nor personal or familial history of tuberculosis. General examination was normal. Neurologic examination showed weakness of the extensors of the right leg, with a symmetric increased reflexes of the lower extremities suggesting a pyramidal syndrome without Babinski's sign. Laboratory data were normal as well as chest radiographs. Dorsolumbar gadolinium enhanced MRI revealed an intramedullary ringlike enhancing mass at T12 level. Lumbar puncture showed 11 WBC/mm3 (95 p. 100 lymphocytes), a normal protein and glucose content. PCR and culture for Mycobacterium tuberculosis were negative. Within a few days, he developed meningoencephalitis with fever, CSF examination revealed then 360 WBC/mm3 (65 p. 100 lymphocytes and 17 p. 100 neutrophils), a protein content of 7 g/l and a glucose level of 1.7 mmol/l. The clinical picture was then suggestive of tuberculosis and a specific therapy with rifampin, izoniazid, pyrazinamid, ethambutol and steroids was started. Clinical improvement and a second CSF culture that revealed one month later Mycobacterium tuberculosis complex confirmed this diagnosis. Ten months later, the patient was asymptomatic with a normal MRI. To our knowledge, this is the first total recovery of an intramedullary tuberculoma on medical therapy alone, confirmed by MRI normalization. We reviewed also 19 recent cases of tuberculomas in the literature, intending a therapeutic attitude when discovering an intramedullary ringlike enhancing mass on MRI.

Antitubercular Agents↗
PubMed1998

[Microsurgical drezotomy for the treatment of spasticity of the lower limbs].

Ablative functional neurosurgery can be useful in some selected patients for the treatment of harmful spasticity in the lower limbs. Microsurgical drezotomy was introduced in 1972, on the basis of anatomical studies of the human dorsal root entry zone (DREZ) showing a topographical segregation of the afferent fibers according to their size and thus functional destinations. It consists of a 3 mm deep microsurgical lesion directed at a 45 degree angle in the postero-lateral sulcus, penetrating the DREZ in its ventro-lateral aspect, at the level of all the rootlets considered as involved in spasticity (and pain). It destroys mainly the lateral (nociceptive) and central (myotatic) afferent fibers as well as the facilitatory medial part of the Lissauer tract, whilst sparing most of the medial (lemniscal) fibers and the inhibitor lateral part of the Lissauer tract. We report a series of 121 bedridden patients suffering from harmful spasticity in one (15) or both (106) lower limbs and treated with microsurgical drezotomy. Surgery was decided on because of abnormal postures in flexion in two-thirds of the patients and in hyperextension in one-third, additional pain in 75 of them, and hyperactive bladder in 38 cases. The post-operative results were evaluated after a mean follow-up time of 5 years and 6 months. Both spasticity and spasms were significantly decreased or suppressed respectively in 78% and 88% of the patients. When present, pain was relieved without abolition of sensation in 82%. These benefits resulted in either disappearance or marked reduction of the abnormal postures and articular limitation in 90% of the patients. When present preoperatively, urinary leakage disappeared in 85% of the cases. Mild to severe complications occurred in 32 patients and precipitated or were responsible for death in 6 cases (5%). This is explained by the fact that most of the patients, especially those affected by multiple sclerosis, were in very precarious general and neurological conditions. Microsurgical drezotomy has however enabled a large majority of these severely disabled patients to sit and lie comfortably, and allowed them to reach a significantly improved quality of life.

Adult↗
PubMed1997

Clinical use of polysynaptic flexion reflexes in the management of spasticity with intrathecal baclofen.

The aim of this study was to evaluate the clinical usefulness of lower limb flexion reflexes (FR) in the assessment of spinal excitability responsible for spontaneous or induced spasms. FR were recorded on the short head of biceps femoris, after electrical stimulation of the ipsilateral sural nerve at the ankle, in 17 spastic patients selected for chronic intrathecal administration of baclofen. The results obtained before and after treatment were compared with clinical scores commonly used to assess spasticity (Ashworth and spasm scores). Before intrathecal baclofen 15/17 patients (88%) had pathologically enhanced flexor reflexes in the lower limbs, which were associated to clinical spasms. Reflex enhancement was accompanied in 47% of cases by abnormal decrease of reflex threshold. No significant correlation appeared between the magnitude or threshold of FR in control conditions and either the hypertonia (Ashworth scale) or the number of clinical spasms per unit of time. Intrathecal baclofen attenuated flexor reflex amplitude and increased reflex threshold in all patients. Our results suggest that FR investigate the intrinsic features of the spasms (threshold, intensity and duration) not assessed clinically, and that therefore the information gathered from FR recordings is not redundant with, and adds significantly to, that obtained by clinical scales. In our experience, FR recordings appeared to be a useful tool for quantifying the benefit of antispastic treatment and might be used as an ancillary indicator to determine the minimal effective dose of intrathecal baclofen.

Adult↗
PubMed1997

Brain glucose metabolism with [18F]-fluorodeoxyglucose and positron emission tomography before and after surgical resection of epileptogenic cavernous angiomas.

Surgery of cavernous angiomas is often proposed due to the epileptogenic and hemorrhagic potential of this lesion. Little information is available on the impact of surgical resection on brain metabolism, locally or at a distance from the lesion. Fifteen patients presenting with a cavernoma and epileptic seizures underwent positron emission tomography examinations before and 1 year after surgical resection. We studied the quantitative cerebral metabolic rate of glucose (CMRGlu) with [18F]-fluorodeoxyglucose. The global brain CMRGlu remained unchanged after surgery. There was a significant decrease of metabolism in the lesion hemisphere, which remained unchanged after surgery. The perilesional regions were less metabolic than the contralateral ones and less metabolic than remote regions within the same hemisphere, before and after surgery. The absence of pre- to postsurgical variations suggests that the metabolic consequences of the lesion are maintained despite the surgical procedure during long-term follow-up studies.

Brain↗
PubMed1997

Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively.

OBJECTIVE: Effects of selective dorsal rhizotomy (SDR) were studied in children with spastic cerebral palsy in orthopaedic and functional fields. METHODS: In a prospective study, we compared the same population before SDR and 1 year after SDR. This population included children with spastic cerebral palsy, when spasticity was responsible for a halt in the motor skill acquisitions or for orthopaedic complications. All the children had intensive physiotherapy for 6 months postoperatively. We observed spasticity by a 4-point scale, isolation of movement by a 3-point scale, and orthopaedic status by the measure of range of motion, hip migration on the radiography, and function by Gross Motor Function Measure (GMFM) and Abbott scale. All the assessments were done by the same physiotherapist. We compared the results with a Wilcoxon statistic test. RESULTS: 18 quadriplegic children had spastic cerebral palsy; their mean age was 9 years (5.5-16.5 years). We observed a decrease in spasticity in all the muscular groups; increase in range of motion only on abduction and extension of the hips; no evolution of hip migration; an increase of 3.2% in the total GMFM score; 1 child was classified IV before SDR and V after SDR on the Abbott scale; 3 children had planned orthopaedic surgery in the year after SDR; 16 children and their families were highly satisfied with the result of the surgery. CONCLUSIONS: The decrease in spasticity does not entail prevention of orthopaedic problems in children with quadriplegic spastic cerebral palsy. However, we observed an improvement in qualitative function that is outside the scope of current assessment scales.

Cerebral Palsy↗
PubMed1997

Somatosensory evoked potentials following functional posterior rhizotomy in spastic children.

Ten children with cerebral palsy and severe lower limb spasticity were treated by functional posterior rhizotomy (FPR). Somatosensory evoked potential recordings were performed preoperatively, intraoperatively (directly on the surface of the spinal cord) and 6 months after surgery, to evaluate the effects of FPR on lower limb somatosensory function. Before surgery, 7/10 patients showed abnormal cortical responses after tibial stimulation. In all patients, intraoperative recordings showed a reduction in the amplitude of segmental responses (N22) (50 +/- 25% of reference value) after the section of a mean 50% of L2-S2 dorsal rootlets. The modifications of segmental responses (N22) were maintained 6 months after surgery, whereas reduction of cortical responses (P39) did not reach the significance level when compared with preoperative recordings.

Adolescent↗
PubMed1997

Positron emission tomography during motor cortex stimulation for pain control.

We studied regional changes in cerebral flood flow (rCBF) in 9 patients undergoing motor cortex stimulation (MCS) for pain control. Significant increase in rCBF was observed in the lateral thalamus ipsilateral to MCS probably reflecting corticothalamic connections from motor/premotor areas. Subsignificant increases were observed in the anterior cingulate, left insula and upper brainstem. Mean rCBF in the anterior cingulate increased during MCS in patients with good analgesic efficacy, while it decreased in those with poor clinical outcome; conversely, thalamic rCBF increased in the two groups, albeit to a greater extent in patients with good clinical results. Our results support a model of MCS action whereby activation of thalamic nuclei directly connected with motor and premotor cortices would entail a cascade of synaptic events in other pain-related structures, including the anterior cingulate and the periaqueductal gray. MCS could influence the affective-emotional component of chronic pain by way of cingulate activation, and lead to descending inhibition of pain impulses by activation of the brainstem. Such effects may be obtained only if thalamic activation reaches a 'threshold' level, below which the analgesic cascade would not be successfully triggered.

Adult↗
PubMed1997

Microsurgical DREZotomy for pain due to brachial plexus avulsion: long-term results in a series of 37 patients.

The authors analyzed the postoperative and long-term results of the microsurgical DREZotomy procedure performed in 37 patients suffering from chronic pain due to brachial plexus avulsion. The evaluation was based on clinical parameters. The immediate results consisted of good pain relief (pain relief > 75%) in 79% of the patients. A long-lasting good pain relief has been achieved in 66.5% of the patients with a mean follow-up of 60 months (range 12-120). The morbidity rate was 5%.

Adolescent↗
PubMed1997

Microvascular decompression for the treatment of hemifacial spasm. Retrospective study of a consecutive series of 75 operated patients--electrophysiologic and anatomical surgical analysis.

The authors report the results of a series of 75 patients operated on for hemifacial spasm by the same surgeon between October 1981 and January 1997. Microsurgical vascular decompression was performed through a retromastoid approach in contralateral position. The conflicting vessel was identified as the posterior inferior cerebellar artery in 41.3% of the cases, the anterior inferior artery in 38.6%, and the vertebrobasilar complex in 18.7%. Follow-up varied from 1 month to 13 years (with a mean duration of 5 years and 2 months). The outcome was excellent (total improvement) in 57 cases, good (> 75% improvement) in 11 cases, fair (< 75%) in 4 cases and poor in 3 cases. Neurological complications included deafness or hearing loss in 3 cases (2 occurred in the absence of intraoperative monitoring and the other during the first part of the series) and facial paralysis in 1 case. Brainstem auditory evoked potential (BAEP) intraoperative monitoring should be performed to avoid postoperative auditory complications; a marked auditory loss was observed in only 1.6% of the 60 patients of our series who underwent BAEP intraoperative monitoring.

Adult↗
PubMed1997

Percutaneous biopsy of cavernous sinus tumors through the foramen ovale.

OBJECTIVE: We present a new application to the widely used Hartel percutaneous route through the foramen ovale to the parasellar region to obtain aspiration biopsies of lesions arising from or invading the posterolateral part of the cavernous sinus. METHODS: Thirteen patients with cavernous sinus lesions that were diagnosed using imaging underwent aspiration biopsy by this route. Nine of them were subsequently operated on, and two will undergo surgery in the near future. For the remaining two, surgical removal of the tumor was not indicated. One of these two patients had a meningioma without any related symptoms and no growth revealed by repeated computed tomographic scans, and the other was diagnosed as having a nasopharyngeal carcinoma and consequently received radiotherapy. RESULTS: The accuracy of diagnosis with this technique was 84%. There was no complication related to the procedure. Having knowledge of the pathological diagnosis before determining the correct treatment helped to define the most appropriate strategy. CONCLUSION: We suggest that aspiration biopsy procedures through the foramen ovale be performed in cavernous sinus tumors before making any decision to indicate open surgical, radiosurgical, and/or radiotherapeutic treatments.

Adult↗
PubMed1997

[An experimental study of the treatment of aneurysms using an intravascular prosthesis].

Intracranial aneurysms occur frequently with the risk of major damage. Neurosurgery or endovascular techniques can be used for treatment. Current techniques are not well adapted for aneurysms with a wide implantation (or neck). The aim of this experimental work was to study a technique for treating aneurysms which can be used for wide neck aneurysms. A metal stent is implanted facing the neck of the aneurysm to allow occlusion. In the first part of the study, the stent was inserted alone. Ten aneurysms were created surgically in five dogs. The stents were positioned facing seven of the ten aneurysms. The stent led to immediate occlusion of the aneurysm in six of the cases. One aneurysm remained patent despite the correct position of the stent. One dog developed secondary thrombosis of the carotid. Three dogs have been followed for sixty days after insertion of the stent. Two aneurysms thrombosed and one was patent. Since these results were less than satisfactory, a second part of the study was undertaken to cover the stent with a fragment of the autologous vein. Results in five aneurysms, evaluated three and eight weeks after treatment, showed partial or total repermeabilization of the aneurysms. In the third part of the study, we associated stents and detachable coils. Twelve aneurysms of the carotid artery in pigs were thrombosed and two aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms remained patent despite the stent and treatment was then completed with a coil. Six of the animals have been followed for thirteen weeks. One carotid artery thrombosed. In the five other cases, the carotid arteries were patent and the aneurysms were occluded at the control angiogram. Histology results showed the presence of a fibromuscular endothelialized neointima at the neck of the aneurysm in four of the five cases. The technique described here could be proposed for the treatment of wide-neck aneurysms implanted low on the carotid artery in man. Improvements should render the system more flexible.

Aneurysm↗
PubMed1997

[Assessment of procarbazine, vincristine and lomustine association (PCV protocol) in oligodendroglioma and mixed glioma].

Effective chemotherapy using PCV (procarbazine, lomustine and vincristine) has been documented in anaplastic oligodendrogliomas and oligoastrocytomas. A pilot study using PCV was conducted for relapsing patients with anaplastic oligodendrogliomas and oligoastrocytomas. Preliminary results are reported. Fourteen patients were enrolled. All received at least two courses of PCV and were evaluable for response. Eleven patients (78%) responded to chemotherapy with complete responses in 2 patients. Response was more obvious regarding contrast enhanced areas than volumes changes (11 responses versus 7). A story of seizure was the main clinical prognostic factor for response. All toxicities were manageable and no treatment related death occurred. Chemotherapy is an effective treatment in aggressive oligodendrogliomas. Further studies must assess the role of chemotherapy in the multidisciplinary management of oligodendroglioma.

Adolescent↗
PubMed1997

[Postoperative arteriography in surgery for intracranial aneurysm. Prospective study in a consecutive series of 267 operated aneurysms].

OBJECTIVES: We present the results of a prospective study of post-operative angiographic data in a consecutive series of 267 intracranial aneurysms (in 217 patients) operated on by the same surgeon (M.S.). MATERIAL AND METHODS: All patients underwent a preoperative as well as a postoperative angiographic control. Besides, an analysis of the operative reports was done in order to correlate the surgical and angiographic data. RESULTS: Out of 267 operated aneurysms, 257 (96%) were located in the anterior circulation, and 10 (4%) in the posterior circulation. The surgical clipping was considered incomplete in 17 aneurysms (6.3%). Aneurysmal remnants were classified in 5 grades; grade I: remnant less than 50% of the neck size; grade II: remnant more than 50% of the neck size; grade III: remnant of a multilobed aneurysmal sac; grade IV: residual sac less than 75% of the aneurysmal size; and grade V: residual sac more than 75% of the aneurysmal size. The analysis of the operative reports helped in understanding the favoring factors of incomplete clipping: large neck and/or huge sized sac, insufficient exposure and dissection of the neck. The presence of a collateral artery with a large infundibulum in the vicinity of the neck-implantation zone on the parent artery. CONCLUSIONS: In most cases the surgeon can easily control peroperatively under the microscope, after puncture-evacuation of the sac, the watertightness of clipping and the absence of any residual neck or sac of the aneurysm. Therefore the remaining place for a postoperative arteriography can be limited to those cases when the surgeon has some doubt concerning the perfection of clipping, as well as for giant and/or "difficult" aneurysms. A re-operation or a complementary endovascular treatment can be discussed for remnants in graded III, IV or V. Knowledge concerning the percentages of aneurysm with neck remnant only and of aneurysms with sac remnant obtained by surgery is interesting at the present time when endovascular treatment is becoming popular. In our series they amounted at 4.1% and 2.2%, respectively. These percentages are those of a series comprising all types of aneurysms. Needless to say, that the percentage of incomplete occlusion will be less if only the aneurysms with small-sized neck were taken into account.

Adult↗
PubMed1996

Extraocular proprioception is required for spatial localization in man.

We studied the effect of extraocular muscle deafferentation on the performance of manual pointing to foveated visual targets at different craniotopic locations. Five patients who underwent unilateral thermocoagulation of the trigeminal nerve (V) for trigeminal neuralgia were tested before and after surgery. Only the group of patients with postsurgical corneal anaesthesia, attesting to involvement of the ophthalmic branch (which carries the ocular proprioceptive fibres), presented deficits in accuracy of pointing. The position of initial and final pointing was shifted toward the lesioned side predominantly in the ipsilateral hemispace. These data support a model in which balanced ocular proprioceptive inputs are required for accuracy of visually guided movements in egocentric space.

Afferent Pathways↗
PubMed1996

[Microsurgical vascular decompression in the treatment of facial hemispasm. A retrospective study of a series of 65 cases and review of the literature].

The results of a series of 65 consecutive patients operated on to relieve hemifacial spasm (HFS) at Pierre Wertheimer Hospital in Lyon and at Henri Mondor Hospital in Creteil, using the same microvascular decompression (MVD) method, are reported. MDV was performed through a retromastoid keyhole approach. A neurovascular conflict (NVC) was found in 62 cases (i.e., 95.5%). The conflicting vessel was the posterior inferior cerebellar artery (PICA) in 23 cases (35.4%), the anterior inferior cerebellar artery (AICA) in 22 cases (33.8%), the vertebro-basilar artery (VBA) with PICA and/or AICA in 13 cases (20%), and VBA alone in 4 cases (3.1%). The conflicting artery was maintained apart from the REZ of VII nerve by interposing a ball made of Teflon fibers and/or a plaque of Dacron. Forty-five patients (69.2%) were totally cured, 16 patients (24.6%) had only a partial (more than 50%) improvement, and in 4 patients (6.2%) surgery failed. Follow-up ranged from 1 month to 13 years (mean: 4 years and 8 months). Important was that in 9 patients, total relief of spasm occurred only secondarily with a delay sometimes as long as one year. Post-operative complications were dominated by: 1) facial nerve deficits in 16 cases (24.6%), of which 14 were transient and 2 were permanent; 2) hearing decrease in 10 cases (15.4%), of which 5 were transient and 5 were permanent. These complications were encountered at the start of the experience and at a time when monitoring of intraoperative brainstem auditory evoked potentials (BAEP) was not routinely done. Our data proved to be consistent with those published in the literature.

Adult↗
PubMed1995

Anatomical findings in microsurgical vascular decompression for trigeminal neuralgia. Correlations between topography of pain and site of the neuro-vascular conflict.

We here report on the anatomical findings in a series of 350 patients with trigeminal neuralgia (TN) and operated on using a microsurgical key-hole approach to the CPA. In 5.7% there was a tumour or a vascular malformation, in 2.3% a mega-vertebro-basilar-artery. Among the remaining 322 (= real idiopathic TN), only 3.1% had no visible compressive factor, whilst 96.9% had one (or several) conflicting vessel(s): SCA in 90%, AICA in 23.6%, a vein in 24.7%. In 35.7% of the patients, several neurovascular conflicts (NVC) were found. Beside the NVC(s), a global atrophy of the entire root was seen in 67% of the cases. Degree of severity of the NVC and its site along the root were studied. The site of the conflict was: anteriorly to the root when pain was in V1, anteriorly and superiorly when in V2, superiorly and posteriorly when in V3.

Adult↗
PubMed1995

Long-term clinical, electrophysiological and urodynamic effects of chronic intrathecal baclofen infusion for treatment of spinal spasticity.

Seventeen patients with severe disabling spinal spasticity were selected and treated by chronic intrathecal baclofen infusion using an implanted programmable pump. Nine patients were tetraparetic, seven were paraplegic and one paraparetic. Patients were regularly followed for 5 to 69 months (mean 37.5 months). The clinical efficacy of baclofen was estimated by means of evaluation of: hypertonia, spasms, pain and functional disability. All patients experienced significant amelioration of quality of life secondary to reduction of hypertonia, spasms and pain related to contractures. Neurogenic pain improved in 3 cases and remained unchanged in 3 others. In patients whose motor functions were partially preserved, various degrees of motor improvement were detected. Electrophysiological recordings of Polysynaptic flexion reflexes (FR) were obtained to control conditions, and under intrathecal baclofen, in order to quantify the spinal excitability responsible for spontaneous or induced spasms. Flexion reflex threshold was increased and amplitude proved to be very significantly reduced by chronic baclofen infusion in all our patients. Twelve patients with neurogenic bladder dysfunction were also evaluated by a clinically oriented questionnaire and by quantitative urodynamic recordings, before and after pump implantation. In patients with normal micturition, this was not changed by intrathecal baclofen. In patients with spastic bladder, intrathecal baclofen produced a decrease of detrusor hypertonia and hyperactivity in 50% of cases, with reduction of leakage and increase in functional bladder capacity.

Adolescent↗