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N de Tribolet

Publications and source records attributed to N de Tribolet.

At least 55 records · Page 3Linked to original sources
PubMed1997

Low grade glioma in intractable epilepsy: lesionectomy versus epilepsy surgery.

In approximately 30% of patients with intractable partial epilepsy, an intra-axial cerebral lesion is the aetiology of the seizure disorder. Lesions adjacent to mesiotemporal structures often result in secondary epileptogenicity in the same region. The authors present 22 cases of low-grade gliomas associated with intractable epilepsy. In 15 cases the location was temporal (8 extra-hippocampal and 7 with invasion of the amygdalo-hippocampus), 7 cases were extratemporal in eloquent areas. The eight extra-hippocampal tumours were originally treated with lesionectomy. The seizure outcome was class 1 in only 4 cases, the remaining 4 were class 4 according to Engel's classification. The 4 cases with class 4 outcome required additional temporal lobectomy associated with amygdalo-hippocampectomy for seizure control. The 2 cases with associated hippocampal atrophy at MRI after lobectomy had outcome class 1. The 2 cases without hippocampal atrophy at MRI presented outcome class 2. The 7 cases with invasion of amygdala and hippocampus were treated with selective lesionectomy+amygdalo-hippocampectomy. In all these cases convergence of focal structural abnormality, ictal onset of epileptiform EEG abnormality and interictal epileptiform EEG abnormality provided powerful evidence of focal epileptogenicity. All these patients had a favourable epilepsy outcome (class 1-2). In the seven extratemporal cases the first step was lesionectomy. In 1 case located in the parietal region intraoperative mapping was required. 5 had class 1 outcome, one case had outcome class 2 and one case had an outcome class 4. The last patient required a second step operation with intraoperative strip and deep electrode monitoring that led subsequently to a frontal lobectomy. This patient is seizure free 2 years after surgery. There was no perioperative mortality and post-operative morbidity was 3/22. This study indicates that lesionectomy may be the first step procedure if the structural abnormality is localized to extra-temporal eloquent cortex and concordance is documented. Patients may subsequently be candidates for a cortical resection as a second step procedure if the lesionectomy does not provide an adequate reduction in seizure tendency. Since MRI identified hippocampal atrophy was predictive in this study of an unsatisfactory seizure outcome after lesionectomy, MRI defined dual pathologies consisting of a temporal lesion plus hippocampal atrophy necessitate temporal lobectomy+amygdalo-hippocampectomy. In patients with negative MRI findings of hippocampal atrophy and temporal lobe lesions, intraoperative electrocorticography and deep electrode monitoring are indicated for planning the surgical strategy.

Adolescent↗
PubMed1997

Jugular venous bulb oxygen saturation monitoring in arteriovenous malformation surgery.

We describe a case in which jugular venous bulb oxygen saturation (SjvO2) monitoring proved useful during the surgical resection of an intracranial arteriovenous malformation (AVM). Surgical resection of large intracranial AVMs may be followed by normal perfusion pressure breakthrough with brain swelling, hyperemia, and subsequent problems in achieving hemostasis. SjvO2 monitoring during AVM embolization by interventional radiology has been shown to help in deciding whether embolization is sufficient to avoid such postresection hyperemia, but its use during surgical resection has not been described. In the case discussed, SjvO2 monitoring enabled assessment of the risk of postresection hyperemia preoperatively and permitted the degree and completeness of surgical AVM resection to be followed intraoperatively. During the normal perfusion pressure breakthrough bleeding which followed complete AVM resection, SjvO2 monitoring helped with safe management of the controlled hypotension that finally permitted hemostasis to be achieved.

Adult↗
PubMed1997

Management of malignant brain tumors.

This review is made up of two parts. The first section describes techniques and methods used in the treatment of malignant brain tumors, stressing the most recent developments. The second part reviews the therapeutic modalities in malignant gliomas, where an attempt is made to consider separately glioblastomas, anaplastic astrocytomas and oligodendrogliomas, low-grade glioma, medulloblastoma, primary brain lymphoma, and brain metastases. A decision making algorithm is suggested for each tumor type.

Algorithms↗
PubMed1997

Synovial cyst and degeneration of the transverse ligament: an unusual cause of high cervical myelopathy. Case report.

A case of cystic degeneration of the transverse ligament located posteriorly to the dens and causing compression to the lower medulla and upper cervical spinal cord is reported. The clinical, pathological, and radiological findings are described and compared to the literature to characterize this syndrome more fully. The advantages of a posterolateral surgical approach are stressed.

Aged↗
PubMed1997

Management of primary intracranial germinomas: diagnostic surgery or radical resection?

Because intracranial germinomas are readily curable with radiation and chemotherapy or radiation therapy alone, the role of radical surgery has become debatable. This study assesses the optimum degree of surgical resection for intracranial germinomas. Twenty-nine patients who underwent surgery for germinoma were retrospectively analyzed (male/female ratio 27:2, median age 18 years). Among these 29 patients there were 10 solitary pineal, seven solitary neurohypophyseal/hypothalamic, and 12 multifocal or disseminated tumors. Biopsy samples were obtained in 16 patients (stereotactically in eight, transsphenoidally in four, and via frontotemporal craniotomy in four). Partial resection was attained in five patients (via a frontotemporal approach in three and occipitotranstentorially in two). Gross-total resection was achieved via an occipitotranstentorial route in eight patients with pineal masses. After surgery, 10 patients were treated with radiotherapy alone, and 19 received radiation and chemotherapy; complete remission was achieved in all 29 patients. The overall tumor-free survival rate was 100% at a median follow-up period of 42 months. There was no significant difference in outcome related to the extent of surgical resection. Postoperative neurological improvement was seen in only two patients, whereas transient postoperative complications, mainly upgaze palsy, were observed in six. One patient experienced a slight hemiparesis, bringing the surgical morbidity rate to 3% (one of 29). It is concluded that radical resection of intracranial germinomas offers no benefit over biopsy. The primary goal of surgery should be to obtain a sufficient volume of tumor tissue for histological examination. If there is strong evidence of germinoma on radiological studies, biopsy samples should be obtained. When a perioperative histological diagnosis of pure germinoma is made during craniotomy, no risk should be taken in continuing the resection.

Adolescent↗
PubMed1997

A case in favor of aneurysmographic studies: a perforating artery originating from the dome of a basilar tip aneurysm.

A posterior perforating artery originating from the dome of a basilar tip aneurysm is reported. The exact origin of this perforator was identified by selective aneurysmography only. This observation provides an argument favoring the consideration of aneurysmographic studies before treatment of large aneurysms located in proximity to areas of normal perforating arteries.

Adult↗
PubMed1997

[Cognitive sequelae following rupture of aneurysms of the anterior communicating artery and the anterior cerebral artery. Retrospective study of 56 cases].

The neuropsychological records of 56 patients operated for clipping were studied. Almost every patient remained autonomous and without invalidating motor defect. The present study was aimed at specifying the type and frequency of neuropsychological sequelae and, to a lesser extent, the role of various pathophysiological factors. A main concern was to examine to what extent and at what post-operative interval the neuropsychological assessment can predict the intellectual and socioprofessional outcome of each individual patient. The neuropsychological assessment performed beyond the acute phase showed evidence of intellectual sequelae in about two thirds of the patients. Only one case of permanent anterograde amnesia was observed, probably due to unavoidable inclusion of a hypothalamic artery in the clip during surgery. Transient anterograde amnesia and confabulations were occasionally observed, generally for less than three weeks. A common finding was impaired performance on memory and/or executive tests. In a minority of patients, language disorders, visuoperceptive and visuoconstructive disabilities were found, probably in relation with hemodynamic changes at distance from the aneurysm. Global impairment of intellectual function was not uncommon in the acute post-operative phase but it evolved in most cases towards a more selective impairment, for instance restricted to executive and memory functions, in the chronic phase. The neuropsychological investigation carried out 4 to 15 weeks post-operatively provided satisfactory information about possible long-lasting intellectual disturbances and professional resumption. In particular, persistent global intellectual impairment, persistent amnesia and confabulations 4-15 weeks post-operative were associated with cessation of professional activity; executive and memory impairment, behavioral disturbances such as those encountered in patients with frontal lobe damage were associated with a decreased probability of full-time employment. Pre- and post-operative angiography were not good predictors of long-term cognitive outcome: normal angiography was not necessarily followed by normal neuropsychological outcome, conversely abnormal angiography could be found together with normal neuropsychological outcome. By contrast, there was a relationship between left-lateralised abnormalities on post-operative angiography and occurrence of language disorders; similarly, there was a relationship between side of craniotomy and type of deficits, that is language disorders versus visuoperceptive-visuoconstructive impairments.

Adult↗
PubMed1996

Phantom face: conscious correlate of neural reorganization after removal of primary sensory neurones.

A patient in whom mandibular and maxillary parts of right trigeminal ganglion were removed experienced referred sensations after stimulation of the right hand and right forehead. She described them either as parallel to the perception at the actual stimulation site or as coming uniquely from a (non-existent) stimulation of denervated territory. The latter occurred in 6-19% of stimulations performed on the right forehead and on digits 1, 3 and 4 of the right hand. Thumb stimulations were localized on the right side of the face, stimulations of right forehead, middle and ring fingers more precisely on right cheek. Referred sensations were present on postoperative day 7 and had a more real-like quality than 5 days later.

Brain Mapping↗
PubMed1996

Lack of postdiscectomy adhesions following application of ADCON-L: a case report.

STUDY DESIGN: This case study focused on findings in two patients who underwent repeat discectomy following reherniation. OBJECTIVES: The cases are presented to show that use of ADCON-L Anti-Adhesion Barrier Gel can limit the extent of peridural adhesions subsequent to discectomy. Peridural fibrosis has been implicated as one of the principal causes of failed back surgery syndrome following lumbar discectomy. SUMMARY OF BACKGROUND DATA: Accurate assessment of the extent of scarring following lumbar discectomy has been made possible by the use of MR1; however, the only direct means of assessing adhesions is during reoperations to treat reherniations or other causes of surgical failure. METHODS: Both of the initial operations were performed using standard microsurgical procedures. At the end of surgery, one patient received ADCON-L Anti-Adhesion Barrier Gel and the other did not. RESULTS: During the repeat operation, extensive peridural adhesions were found in the patient who did not receive ADCON-L during the initial discectomy procedure. In contrast, essentially neither scar nor adhesions were found in the patient who received ADCON-L. CONCLUSION: ADCON-L effectively inhibits the development of peridural fibrosis following lumbar discectomy. This finding could have implications for the rate of occurrence of failed back surgery syndrome.

Diskectomy↗
PubMed1996

Leptomeningeal cyst in newborns due to vacuum extraction: report of two cases.

Two new cases of leptomeningeal cysts subsequent to vacuum extraction are reported. Both children presented with a huge, nonpulsating, transilluminating subgaleal collection over the anterior fontanel that appeared soon after instrument delivery. Plain X-rays, computed tomography, and magnetic resonance imaging confirmed that the subgaleal collection was cerebrospinal fluid and showed the presence of a diastatic coronal suture in both cases. Treatment consisted of duraplasty with periosteal flaps and application of fibrin glue. In one case, an associated porencephalic cyst was treated with a cystoperitoneal shunt. Surgical treatment of leptomeningeal cyst due to vacuum extraction is simple and should not be postponed, despite the tendency for the extracranial cyst to regress, because of the potential risk of continuous growth of an underlying porencephalic cyst and risk of neurological damage.

Arachnoid Cysts↗
PubMed1996

Cavernous haemangioma of the pineal region.

Cavernous haemangiomas rarely occur in the pineal region, only eight histologically verified cases have been reported to date. Clinically and radiographically, they are often confused with other tumours of the pineal region, particularly germ cell tumours. When radiotherapy is performed without the benefit of biopsy, cavernous haemangiomas as well as other radioresistant neoplasms may be unnecessarily treated. We report two surgically treated cases of cavernous haemangioma of the pineal region, and comment upon one treated by shunt placement alone. Two cases were associated with an adjacent venous malformation. In all instances, magnetic resonance imaging (MRI) permitted a correct pre-operative diagnosis. We conclude that surgical exploration and total resection is the treatment of choice when the diagnosis of cavernous haemangioma is suspected on the basis of neuro-imaging. A conservative attitude is justifiable in the case of elderly patients with a higher surgical risk.

Adult↗
PubMed1996

Three- to five-dimensional biomedical multisensor imaging for the assessment of neurological (dys) function.

This report describes techniques and protocols implemented at the Geneva Canton University Hospitals (HUG) for the combination of various biomedical imaging modalities and sensors including electromagnetic tomography, to study, assess, and localize neurological (dys) function. The interest for this combination stems from the broad variety of information brought out by (functional) magnetic resonance imaging, magnetic resonance spectroscopy, computed tomography, single-photon emission tomography, positron emission tomography, and electromagnetic tomography. Combining these data allows morphology, metabolism, and function to be studied simultaneously, the complementary nature of the information from these modalities becoming evident when studying pathologies reflected by metabolic or electrophysiologic dysfunctions. Compared with other current multimodality approaches, the one at the HUG is totally compatible with both clinical and research protocols, and efficiently addresses the multidimensional registration and visualization issues. It also smoothly integrates electrophysiology and related data as fully featured modalities.

Computer Graphics↗
PubMed1996

Immunoisolated xenogenic chromaffin cell therapy for chronic pain. Initial clinical experience.

BACKGROUND: Chromaffin cells from the adrenal gland secrete a mixture of compounds that have a strong analgesic effect, especially when administered intrathecally. Many studies in animal models have shown that discordant xenogeneic cell isolates, including chromaffin cells, can survive and have biologic effects when transplanted within a semipermeable membrane capsule. METHODS: To evaluate the clinical potential of encapsulated cell therapy, a human-scale implant containing bovine chromaffin cells was developed, characterized, and implanted in the subarachnoid space of seven patients with severe chronic pain not satisfactorily managed with conventional therapies. Patients received no pharmacologic immunosuppression. Cell devices were implanted during minimally invasive surgery, and device design allowed retrieval. All devices were recovered after implant periods of 41 to 176 days. RESULTS: Postexplant histologic analysis, immunostaining, and secretory function all confirmed survival and biochemical function of the encapsulated cells. Reductions in morphine intake and improvement in pain ratings were observed in several patients. CONCLUSIONS: This study represents the first successful trial of encapsulated xenogeneic cells in humans. The preliminary findings of pain reduction warrant the initiation of a randomized, double-blind phase II study to evaluate the potential efficacy of the procedure.

Adult↗
PubMed1996

Epilepsy in patients with central nervous system tumors.

Seizure is often the first manifestation of a central nervous system tumor; such tumors are often responsible for pharmacologically refractory seizures. The treatment of tumor-associated epilepsy should, on one hand, follow sound neuro-oncological principles and, on the other hand, control the epilepsy.

Astrocytoma↗