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Biomedical subjects

P Dhellemmes

Publications and source records attributed to P Dhellemmes.

At least 19 recordsLinked to original sources
PubMed2005

[Functional status, scholastic placement after rehabilitation and follow-up of children with traumatic brain injury: a retrospective study of 48 patients].

OBJECTIVE: To evaluate the follow-up of children with traumatic brain injury (TBI). POPULATION AND METHODS: A retrospective study during 4.5 years of 48 children with TBI. We measured GOS during admission and after rehabilitation and where children were placed after hospitalisation. RESULTS: Most patients were males; the mean age was 9.4 years (range 14 months to 16.5 years). The rehabilitation length was 11.4 months. Most children (77%) had a good functional outcome. For 23%, placement was in establishments for severely handicapped people, for 35.4%, an environment with specific support, and for 37.5%, an environment without specific support. After 2 years, 43.7% of infants were lost to follow up. CONCLUSION: Rehabilitation and functional results have improved for children with TBI, but some improvements must be made.

Adolescent↗
PubMed2002

[Outcome and quality of life after three years in a cohort of patients with severe traumatic brain injury].

OBJECTIVES: The late outcome of patients with severe traumatic brain injury (STBI) has been investigated by measuring deficits, disability and social handicap, but their quality of life (QOL) has been less evaluated, and not by a direct analysis of the subjective patient "and relatives" QOL. The aim of this study was to investigate this outcome and the QOL, with its predictive factors, 3 years after STBI, in a homogeneous cohort of patients. MATERIAL AND METHODS: We selected all adult patients from the Lille area (north of France) admitted in the CHU in 1995 following STBI. Each was evaluated at home, in the presence of a close relative, using the EBIS document. This one investigates the medical history, initial status and late outcome, as well as the subjective QOL of patients (evaluated by the patient and by a close relative: 0-10 on an analogical visual scale) and close relatives. Relationships between possible explanatory factors and QOL were analysed using correlation tests. RESULTS: Among the 33 patients, 23 survived at three years. The mean initial GCS score was of 5,6/15 and the mean coma duration of 18.5 days. At three years, physical deficits were usually discrete, intellectual deficits more important and the emotional and behavioural problems even more severe. The GOS was of 6 in one patient, 4-5 in seven, 2-3 in seven and 0-1 in eight. Dependence in advanced activities was more sever than in elementary activities. The subjective QOL of patients was discretely lower (m = 5,48/10) than that estimated by close relatives (m = 5,91). The relatives QOL was similarly reduced (m = 5,45). The factors most influencing the patients QOL were the cognitive and behavioural problems and the dependence in the advanced activities and the GOS for the patients QOL, and the behavioural problem and the dependence in advanced activities for the relatives QOL. CONCLUSION: The reduction of the patients "and relatives" QOL was parallel at three years. Emotional and behavioural problem as well as the dependence in advanced activities mainly explained these QOL.

Activities of Daily Living↗
PubMed2002

[Surgery for craniosynostosis: timing and technique].

Craniosynostoses are a group of diseases, the presentation of which differs markedly on account of the cranial suture involved. Their impact is cosmetic, cerebral, and ophthalmologic. Syndromic craniosynostoses associate a more or less pronounced faciostenosis, which requires surgical correction as well, because of cosmetic, ophthalmologic or airway problems. Surgical treatment depends on the type of the craniosynostosis and the patient's age; ideally, the child should be operated between 3 and 12 months. This surgery requires a perfect collaboration between neurosurgeon, plastic surgeon, and anaesthesiologist. Surgical correction allows in large measures the preservation of intellect, sight, and body image.

Anesthesia↗
PubMed2002

[Follow-up study of head-injured children].

The authors reviewed in a retrospective study 61 cases of severely head injury children who where admitted in the rehabilitation centre to evaluate the outcome 1 and 5 years after the brain injury. Neurologic and neuropsychologic status of children was assessed ad admission, 1 and 5 years later. Duration on intubation and age at time of head trauma were the worst functional prognosis.

Adolescent↗
PubMed2002

[Chiari type I malformation in children: presentation in 34 cases].

UNLABELLED: Incidental diagnoses of Chiari I malformation are more and more frequent in pauci or asymptomatic children. The value of neurophysiological investigations for surgical indications is discussed. OBJECTIVE: To determine clinical presentations of Chiari I malformation and relative frequencies of severe and incidental forms, and to evaluate the usefulness of neurophysiological investigations for surgical indications. METHODS: This retrospective study included 34 patients admitted from 1984 to 2000, with Chiari I malformation diagnosis in different pediatric (intensive care, neurology and neurosurgery) units of a university hospital. RESULTS: The clinical presentation was severe (two children died) in four cases (12%). Signs of brain stem compression were found in 41% of cases, scoliosis in 21%, and incidental diagnosis in 26%. The polysomnography, performed in 12 cases, showed sleep-apneas in six cases. One child with an incidental diagnosis of Chiari I malformation had many sleep-apneas which required a surgical treatment. A surgical decompression was performed in 69% of cases, with clinical improvement in 77%. CONCLUSION: The high incidence (12%) of severe forms revealing Chiari I malformations justifies systematic neurophysiological investigations for the initial evaluation and the follow-up of Chiari 1 malformations, including the less symptomatic forms.

Adolescent↗
PubMed2002

Late shunt infection: incidence, pathogenesis, and therapeutic implications.

Shunt infections (SI) are a major concern in pediatric neurosurgery. Although SI occurs generally shortly after surgery, it can be very delayed in a number of cases. The incidence of late shunt infection (LSI) is not established, and the sources of contamination are poorly understood. We reviewed 1,793 pediatric cases from our database, with a mean follow-up of 9.12 years. We selected 40 cases of SI occurring more than one year after the previous shunt operation. These represented 12.7 % of SI, and the annual incidence of LSI was 0.28 % in our series. Peritonitis, generally due to appendicitis, was the cause of LSI in 11 cases. Hematogenous contamination was diagnosed in eight cases, because the germ was Haemophilus,Pneumococcus, or Listeria, or an ENT infection had preceded SI; the incidence of purulent meningitis was significantly higher in shunted patients than in the general population. LSI was due in seven cases to bowel perforation, and in four to direct inoculation, after abdominal surgery or traumatic exposure of the shunt. In the remaining 10 cases, no potential cause of infection was identified, and persistence of a germ since the previous shunt operation was suspected. SI represents a life-long threat after shunting, and may be unrelated to shunt surgery.

Adolescent↗
PubMed2001

Cerebellar gliomas in infants: specificity, pathology, and outcome.

Cerebellar gliomas (CGs) in children are generally associated with a favorable outcome; however, data regarding these tumors in very young children are scarce. We report on our experience with CGs in children less than 3 years old at surgery, compared with a second group older than 3 years. From 1991 to 1996, we operated on 7 children with CGs in the first group and 43 in the second. Psychomotor delay and regression were the first symptoms in 3 cases, and 3 had macrocrania. The tumor was totally removed in all cases. One child died intraoperatively of air embolism and subdural bleeding. Three had malignant tumors (grade 3 or 4). There was no operative mortality or malignancy in the second group of patients. With a mean follow-up of 33 months, all survivors in the first group are disease-free, with no or minimal symptoms, and attend normal schools. The clinical, surgical, and pathological features suggest that children under 3 years of age represent a specific subgroup of CGs.

Adolescent↗
PubMed2001

[Mid-facial distraction without osteotomy with a trans-facial pin. Report of 4 clinical cases].

After the publications of Mulhbaüer, Raposo do Amaral and mainly the one of Toth and Chin, it has been proved that midfacial distraction was an effective procedure for the treatment of cranio-facial dysostosis. First attempts to distract (in human) the midface without osteotomies has given poor results because devices acting on the zygomatic bone had failed to draw forward the maxilla through a thin maxillo-zygomatic suture which had been dislocated. With the help of a transfacial pin and an external device, we have obtained in four patients an important advancement of the maxilla. We report here the surgical procedure and preliminary results.

Child, Preschool↗
PubMed2001

Early treatment of posthemorrhagic hydrocephalus in low-birth-weight infants with valveless ventriculoperitoneal shunts.

The surgical treatment of posthemorrhagic hydrocephalus (PHH) in low-birth-weight infants (LBWI) is debated. In a few cases, hydrocephalus progresses rapidly and requires early drainage, but valves and ventriculostomy have a high rate of complications in the early phase. Temporary valveless shunt (VLS) is proposed as an alternative treatment of acute PHH in LBWI. Thirteen infants with PHH, weighing less than 2,000 g at birth, were treated with VLS, which was systematically converted into a valve-regulated shunt (VRS) after a few weeks; during the same period, 27 others were treated with VRS initially. The use of VLS presented significantly more shunt obstructions, but not more shunt infections, than VRS. Although placement of VLS was performed earlier, and in smaller babies than VRS, the outcome after a mean 9.1-year follow-up period was comparable in both groups, and only shunt infection was correlated with a poor outcome. We conclude that VLS is a valuable treatment of rapidly evolving PHH in LBWI.

Cerebral Hemorrhage↗
PubMed2001

Supratentorial ependymoma in children.

The clinical and pathological characteristics of supratentorial ependymomas (STE) in children are not well identified in the literature, because most series deal with ependymomas regardless of their location or the age of the patient. As a result, the pathological description of the disorder is still debated. We therefore reviewed our cases of children operated for STE and compared them with cases of infratentorial ependymomas (ITE) to provide a better characterization of STE and suggest guidelines for treatment. From 1985 to 1999, we operated 18 children for STE, almost half of which developed with no connection to the ventricular system. Intraoperative bleeding and infiltration of the basal ganglia prevented total removal in 4 cases and were the main causes of operative mortality and morbidity. The 5-year overall survival and recurrence-free survival rates were 54 and 37%, respectively, and were highly affected by the extent of resection, but not by histological grade. Because of the high recurrence rate, we recommend systematic postoperative irradiation limited to the tumor site for all high-grade tumors in older children, and reoperation after subtotal removal and for recurrences.

Adolescent↗
PubMed2001

Occipital dermal sinuses: report of nine pediatric cases and review of the literature.

Occipital dermal sinuses (ODS) are rare dysraphic lesions resulting from defective separation of the ectoderm and neuroderm. These lesions are often diagnosed at birth and should be treated early because of potentially life-threatening complications. However, the pathogenesis of these rare lesions is still poorly understood, and there is no consensus about the optimal timing of surgery. We reviewed 9 pediatric cases of ODS operated in our department since 1982 and 79 other cases published in the literature during the last 50 years. Thirty-eight percent of these had neurological infection (meningitis or abscess), 22% had purely local infection and 40% were uncomplicated at the time of diagnosis. The incidence of infection was low during the first year of life. MRI was highly valuable to study the extent of the sinus and the content of the cyst. The outcome was regularly favorable after surgery. Surgery should however be undertaken with caution on account of the intimate relationship with venous structures, aggravated by postinfectious scarring when the patient is operated late. Considering the risks associated with surgery in neonates and the low incidence of infection during the first year, we advise performing surgery at around 6 months.

Brain Neoplasms↗
PubMed2001

Subduroperitoneal drainage for subdural hematomas in infants: results in 244 cases.

OBJECT: Subduroperitoneal drainage (SDPD) is commonly used in the treatment of infantile subdural hematomas (SDHs). Few studies have focused on this technique and most series have included SDHs of various origins in children of different ages. The surgical procedure is not standardized and results achieved using this technique have not been well documented. The authors reviewed their cases of traumatic SDH treated with SDPD in infants (< 2 years of age). Their standard technique includes bilateral SDPD whenever the SDH is bilateral, placement of a free shunt, and systematic removal of the drainage unit after a few months. METHODS: The authors performed SDPD in 244 infants with traumatic SDH. The patients' SDHs were controlled by SDPD in 241 cases, and 78.9% of the patients recovered to live a normal life. Complications of SDPD occurred in 38 patients (15.6%): obstruction in 22 cases (9%), infection in eight cases (3.28%), and internal hydrocephalus in eight cases (3.28%). Early complications could be ascribed to surgical technique, delayed complications were associated with the severity of the initial clinical presentation, and late complications were time dependent and unrelated to initial clinical severity. Poor clinical outcome was correlated to the severity of the initial presentation, but not to complications of surgery. CONCLUSIONS: Because of its efficacy and low complication rate, SDPD is the procedure of choice when subdural taps fail to control SDH. The authors prefer bilateral drainage because of the low rate of complications. Drains should be systematically removed after a few months to prevent long-term complications.

Arteriovenous Shunt, Surgical↗
PubMed2001

[Cerebellar pilocytic astrocytomas in children. Report of 72 cases].

BACKGROUND AND PURPOSE: Cerebellar pilocytic astrocytoma (CPA) bears a well-deserved reputation of benignity. However, these tumors infiltrate the brainstem in a number of cases, and total removal may cause morbidity, whereas subtotal removal can lead to recurrence. MATERIAL AND METHODS: To define guidelines for tumor removal, management of tumor remnants and recurrence, we reviewed 72 cases of CPA of childhood operated on in our department since the introduction of CT. RESULTS: Surgical removal was total in 57 cases, had to be withheld because of brainstem infiltration in nine cases, and was revealed subtotal by postoperative imaging in six cases. Two of the latter were reoperated on; six had only radiological controls and did not progress. Early in the series, eight children had external irradiation because of subtotal removal or recurrence. Three children were reoperated on for tumor recurrence, between six and eight years after complete removal. We had no tumor-related mortality; long-term disability could be related to previous mental retardation, the severity of clinical state at presentation, and complications of surgery and irradiation. CONCLUSION: The goal of surgery is to cure the patient with minimal morbidity, however, total removal is not always possible. In our experience: i) tumor remnants can be surveyed radiologically, and reoperated only in case of progression; ii) the indications for radiotherapy should be the exception; iii) clinical and radiological follow-up should be protracted beyond entry into adulthood.

Adolescent↗
PubMed2000

Cerebellar gliomas in children with NF1: pathology and surgery.

Cerebellar gliomas associated with NF1 (CGNF1) are rarely reported in the literature, and they are considered to be malignant in a high proportion of cases. In an attempt to improve the definition of this disease and clarify its management, we reviewed our patients with CGNF1 and compared their tumors with sporadic cerebellar gliomas (SGC). We operated on six children with CGNF1, all but one of whom were asymptomatic. They represented one-tenth of all pediatric cerebellar gliomas, and one third of NF1-associated gliomas seen in our institution. CGNF1 appeared at a later age than SCG. They are seated near the roof of the IV ventricle and are not related to white matter hypersignal hamartomas. Most of these tumors showed radiological progression. They were four pilocytic astrocytomas, one ganglioglioma, and one malignant astrocytoma. One patient had tumor recurrence after 8 years, and the others are still disease free. The overall outcome appeared to be better for GCNF1 than for SCG. On account of the regular growth, uncertain pathology, and good surgical outcome, we advocate systematic resection of these tumors.

Adolescent↗
PubMed2000

Sinus pericranii: advantages of MR imaging.

Sinus pericranii is a rare vascular anomaly involving an abnormal communication between the extracranial and intracranial circulations. A 3-year-old girl presented with a 2 x 2-cm, midline soft-tissue mass at the vertex. Plain skull films and CT using bone windows showed erosion of the parietal bones. MRI confirmed the clinical diagnosis by identifying communication of the vascular mass with the intracranial dural venous sinus. The advantages of MRI are discussed.

Child, Preschool↗
PubMed2000

[Third ventricle tumors in children].

Tumors of the third ventricle in children raise specific problems, owing to their clinical presentation, pathology, treatment, and outcome. The clinical presentation is often unspecific at that age, many cases presenting with isolated macrocrania or delayed milestones. Some histological types are specific of the pediatric group, such as the pilocytic astrocytoma or hypothalamic hamartoma, and others types which are exceptional in adults are relatively common in children, such as choroid plexus tumors. Surgery is especially dangerous in young children, because of the blood loss, and the hemispheric collapse associated with the large hydrocephalus which is the rule in these patients. External irradiation is associated with a high rate of complications, above all a progressive intellectual delay, and endocrine disorders. Chemotherapy has reduced the indication of irradiation, and, in some cases, can be performed preoperatively to reduce tumor volume and intraoperative blood loss. The therapeutic approach to these patients is thus pluridisciplinar, and should be tailored for each case, with a follow-up protracted well into the adult age.

Cerebral Ventricle Neoplasms↗
PubMed1998

Prognostic factors in pediatric spinal cord astrocytoma.

BACKGROUND: Factors that could optimize the management of pediatric spinal cord astrocytoma remain unclear and controversial. METHODS: To determine the factors that influence the prognosis of pediatric patients with spinal cord astrocytomas, a series of 73 consecutive patients at 13 French treatment centers with histologically proven spinal cord astrocytomas was retrospectively reviewed. Hospital records, operative records, and results of radiologic investigations were available in all cases. Follow-up was achieved in 94% of cases. RESULTS: Seventy percent of the patients had low grade (1 or 2) tumors. Total or subtotal surgical resection was achieved in 43%. Thirty-six patients were irradiated following surgery. Fifty-one patients were alive at a median follow-up of 54 months. Twenty-three patients relapsed. Univariate analysis showed that good outcome was correlated with male gender, age younger than 7 years, duration of presenting symptoms longer than 2 months, the presence of spinal deformities, and low grade histology, whereas sensory loss was associated with decreased survival. Multivariate analysis using the Cox proportional hazards model confirmed that histology (relative risk [RR] = 7.69) and the interval between first symptoms and diagnosis (RR = 4.93) were significant independent prognostic factors. The extent of surgery or radiotherapy had no clear influence on survival. CONCLUSIONS: This review sheds light on the prognoses of pediatric patients with spinal cord astrocytomas and may help to determine therapeutic strategies based on patients' clinical, radiologic, and pathologic features.

Adolescent↗