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Biomedical subjects

M Sindou

Publications and source records attributed to M Sindou.

At least 145 records · Page 8Linked to original sources
PubMed1987

[Intrapetrous neurinoma of the facial nerve. Removal by the oto-neurologic route].

A case of a 33 year-old woman presenting an intrapetrous facial nerve neurinoma is reported. The neurological finding was a quickly progressive facial nerve palsy without hearing loss which the initial diagnosis was a Bell's palsy. The radiological findings showing an petrous bone erosion located at the third portion of the facial nerve gave the diagnosis. It was confirmed by CT scan and arteriography that allows a pre-operative embolisation. A one stage operation performed by a triple retromastoid, transpetrous and retroparotid approach, allowed a complete removal. The post-operative course was uneventful and a reconstructive facial surgery was performed to restore a facial symmetry six months later. The authors review the literature about this tumor which remains rare and point out two facts: --A non regressive or recurrent or atypical facial nerve palsy had to be checked up by neuroradiology and even by surgical exploration. --The triple retromastoid, transpetrous and retroparotid approach is very interesting, allowing a one stage complete removal of the tumor and a check up of the facial nerve repair possibilities.

Adult↗
PubMed1986

Selective posterior rhizotomy in the dorsal root entry zone for treatment of hyperspasticity and pain in the hemiplegic upper limb.

The authors report a series of 16 hemiplegic patients suffering from harmful spasticity in the upper limb and treated with selective posterior rhizotomy (SPR) in the dorsal root entry zone (DREZ). This severe spasticity was associated with irreducible abnormal postures in flexion in 11 cases and painful manifestations in 12. The method was introduced in 1972 on the basis of anatomical studies of the DREZ in humans, in which a topographical segregation of the root afferents, according to their anatomicofunctional destinations, has been shown. It consists of a DREZ microsurgical lesion 1 to 2 mm in depth and directed at a 45 degree angle, performed ventrolaterally in the posterolateral sulcus of the spinal cord and into the internal part of the Lissauer's tract. The procedure is carried out in each rootlet of the posterior roots considered to be responsible for the harmful spasticity. SPR interrupts selectively the (lateral) nociceptive and (central) myotactic afferent fibers connecting the motor neurons, while sparing most of the (medial) lemniscal fibers and the inhibitory circuitry of Lissauer's tract and the dorsal horn. The results were evaluated after a 1- to 12-year follow-up. There were no deaths and no general complications; in 1 case a loss of motility in the leg ipsilateral to the procedure occurred. The excess of spasticity was slightly diminished (2 cases), markedly reduced (9 cases), or totally abolished (5 cases), making possible an improvement in voluntary movements in 8 patients and at least a good passive mobilization in 7 further cases. In 1 case only, a marked tendency for spasticity to return was observed. Of the 12 patients with painful manifestations, 9 were completely relieved and 3 improved. These beneficial effects on both spasticity and pain led to a gain in functional status in 93% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Microsurgical treatment of trigeminal neuralgia. Results and prognostic factors of microsurgical vascular decompression].

The authors have reviewed 100 cases of trigeminal neuralgia operated upon at the cerebello-pontine angle using microsurgical techniques, i.e. 20% of their total series of 513 patients with tic douloureux, 413 of them having been submitted to percutaneous R.F.--thermocoagulation. In 10 of the above 100 patients, a tumour or an angioma have been found and with its removal a total relief of pain has been obtained. In all but three of the other 90 patients, a neurovascular conflict has been revealed. In 17 of them a selective section of the trigeminal root had to be performed, as its cross-compression could not be eliminated. A total cure was achieved in all but three cases in which the result was only partial. In 70 patients a microvascular decompression (MVD) was performed and in 68 of them a follow-up of 1 to 5 years has been analyzed. In 82.4% the results were excellent. Further 7.3% thought to be benefited by the operation; although they still had some pain, they were well controlled by medical treatment. In 10.3% an unsatisfactory improvement, failure or recurrence were noted. Then a critical study of the whole material has been made in search for the causes of unsatisfactory results and for the possibilities of making the efficacity of MVD ascertained in a higher percentage of patients. The results of this study lead to definite conclusions, a part of which is quoted below: Some of clinical findings showed to be of paramount importance for the prognosis. The most evident has been a highly significant difference in the percentage of a total cure in patients with attacks of tic douloureux only (94.5%) and in those with the same type of attacks, but associated with permanent pain (58.3%). The analysis of the operative findings and of the details of the surgical procedure indicated to a necessity of restitution of the normal shape and course of the trigeminal root from the petrous ridge up to the entry-zone and of an adequate root protection (for instance with Dacron), after the Vth nerve had been detached from the conflicting vessel. A correlation of the above findings with the angiographic ones has been made. A measurable method has been used to make available data which could be informative as to the presence of a conflict, as well as to its anatomical cause. But this still needs a further critical elaboration.

Adult↗
PubMed1986

[Complications related to the seated position of the aged patient in neurosurgery].

The advantages of the sitting position for neurosurgery of the posterior fossa are evident and universally admitted. However, respiratory and haemodynamic consequences make this position uncommon and even exceptional for the old patient whose existing physiological cardiovascular and pulmonary disturbances may result in greater risks. In this study, the complications observed during and after surgery in twenty-two patients over 65 years are analysed. These patients underwent functional neurosurgical procedures in sitting position. According to the results, old age does not appear to be an absolute contra-indication of the sitting position for this type of surgery.

Aged↗
PubMed1986

[Dural arteriovenous fistulas of the posterior cerebral fossa and thrombosis of the lateral sinus. Discussion of their relations and treatment apropos of 2 cases].

Two cases of a posterior fossa dural arteriovenous malformation associated with a lateral sinus thrombosis are reported. In the first case, a right tentorial meningioma develops at the end of the superior sagittal sinus and on the transverse sinus which are occluded. A cranial bruit, heard by the patient four months after the surgical removal of the tumour, brings up a dural fistula supplied by the occipital, middle meningeal and pharyngeal arteries and drained away by cervical and cortical veins. Many attempts of extirpation and radiological embolization stop the bruit. In the second case, an increased intracranial pressure mixes up with an aphasia. A continuous emission doppler examination and a CT scan make likely a dural fistula. The malformation, which is associated to a left sigmoid sinus thrombosis, is fed by the occipital and middle meningeal arteries and drained by cortical veins to the cavernous sinus. The occipital artery ligation and a by-pass between the lateral sinus and the internal jugular vein cure the patient with a very good patency of the venous graft that holds up two years after. A few cases of the literature show the succession of the two vascular lesions and prove the primitive occurrence, either of the sinus occlusion, or of the dural fistula. A venous thrombosis might cause a fistula by the opening of physiological shunts of the dura-mater which consequently deviates the blood into the cortical veins, brings down the increased intracranial pressure and stops the thrombosis to spread.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Microsurgical selective procedures in peripheral nerves and the posterior root-spinal cord junction for spasticity.

This review deals with the long-term results of selective peripheral neurotomy (SPN) of the tibial nerve and selective posterior rhizotomy (SPR) in 123 cases of severe spastic syndromes in the limbs. The microtechniques and preoperative electrostimulation for identification of the nervous structures responsible for the spastic components give to these methods an advantage of a substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory functions. The results were effective, with a 1- to 13-year follow-up, in 89% of 47 SPN of the tibial nerve for spastic foot, in 92% of 53 SPR for paraplegia and in 87% of 23 SPR for hemiplegia.

Adolescent↗
PubMed1985

Prognostic factors in microvascular decompression for trigeminal neuralgia.

The results of microvascular decompression (MVD) in 68 patients with trigeminal neuralgia followed for 1 to 5 years were compared with the clinical and operative findings and with the surgical modalities. Among 20 factors analyzed, the mode of pain manifestation proved to be the only factor significantly related to prognosis (p less than 0.001). In patients with paroxysmal pain only, a cure was obtained in 95%, whereas in those with paroxysmal and permanent pain, 58% were cured. None of the remaining factors showed any unfavorable influence on the results of MVD in cases of paroxysmal pain only. Some factors seemed to be related to prognosis in patients with a permanent pain component, and the following conclusions concern this group of patients only. Two factors proved to be statistically significant. First, patients with pain extending to two or three branches responded to MVD less favorably than those with pain in one branch only. The interposition of a piece of periosteum to separate a conflicting artery from the root led to worse results than the use of a square of Dacron. Other conclusions were based on small numbers and should be verified. A sensory deficit extending to two or three branches was related to worse results that a sensory deficit in one branch or its absence; a prior surgical procedure plays an additional unfavorable role. The patients with the least advanced degree of vasculonervous conflict (VNC) responded to MVD less favorably than those with severe cross compression; a posterosuperior site of VNC seems to play an additional unfavorable role. The distribution of some factors among types of pain manifestation showed marked differences, which seem to relate to results. The clinical and operative findings indicate that the sensory deficit corresponds to the extent of compression by the conflicting vessel. The necessity of distinguishing various clinical forms of trigeminal neuralgia for practical and cognitive reasons is emphasized.

Follow-Up Studies↗
PubMed1985

[Treatment of spastic foot by selective neurotomy of the tibial nerve. Results of a series of 31 cases].

A large number of patients suffering from various neurological diseases remain disabled because of spastic disorders in their foot. These disorders--which are responsible for abnormal postures and painful disturbances for walking and standing--can be corrected by an effective procedure: the so-called Selective Neurotomy of the Tibial Nerve (T.N.), developed in its modern form by Gros in 1972. The procedure aims at sectioning the T.N. branches corresponding to the muscles, the spasticity of which is considered harmful, i.e. the soleus (and/or gastrocnemius) nerves for equinus and ankle clonus, the posterior tibialis branch for varus, and the flexor fascicles for tonic flexion of the toes. After dissection of each T.N. branches at the lower part of the popliteal region and their identification with bipolar electro-stimulation, the selected nerves are sectioned partially (about two-third of their caliber) under the operative microscope. The present series consists of 37 operations--performed 25 times unilaterally and 6 bilaterally--in 31 patients, 17 to 68 year old (39 on average). In 11 patients spasticity was from spinal cord origin and in the 20 others from vascular or traumatic cerebral damages. The spastic disorders--installed for 2 to 17 years (4 on average)--were due to one, several or all the following components: equinus, ankle clonus, varus, flexion of the toes. Surgery obtained complete suppression of the disabling spastic components, total pain relief and consequently improvement of the residual voluntary movements by achieving balance between agonist and antagonist muscles, in 33 out of the 37 cases, i.e. in 91% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗