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Biomedical subjects

P Frerebeau

Publications and source records attributed to P Frerebeau.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Contribution of 99m Tc-HMPAO single-photon emission-computed tomography to the perioperative evaluation of subarachnoid hemorrhage caused by ruptured aneurysms].

Twenty one cases of proven subarachnoid hemorrhage (S.A.H.) have been analysed in a protocol especially including transcranial doppler (T.C.D.) and 88mTc-H.M.P.A.O. single photon emission tomography (H.M.P.A.O.-S.P.E.C.T.). Seventeen patients were intraoperatively studied. All data were compared with clinical grading, computerized tomography (C.T.) and angiography. S.P.E.C.T. is a quite recent method of measuring and three-dimensional imaging of brain perfusion. It provides important information for the diagnosis of ischemic syndromes in S.A.H. Sixty-two S.P.E.C.T.-scans were performed in twenty one patients. Fifty-eight were abnormal and showed significant abnormalities of brain perfusion varying in extent and severity. In this preliminary study, we set out to validate the clinical use of H.M.P.A.O.-S.P.E.C.T. for the diagnosis of "vapospasm" comparing S.P.E.C.T. data with classical criteria. We propose a classification which allowed us to quantify the ischemic risk in an attempt to adapt the global therapeutic management to hemodynamic data. This method appears to be very sensitive and reliable in this field. It will introduce, if these first results are confirmed, important criteria for the evaluation of patients presenting with S.A.H. as far as prognosis and treatment are concerned, especially in regard to timing of surgery and institution of medical hemodynamic therapy.

Aneurysm, Ruptured↗
PubMed1992

[Modalities and delays in the resoration of consciousness after brain injury].

We studied the modalities and delays of restructuring of consciousness in a series of 89 consecutive survival cases, ranging over a large variety of age and severity and leading to any degree of awareness and results. We used the Glasgow coma scale, the study of brain-stem reflexes, and the Glasgow outcome scale. The recovery of awareness (eye opening to pain and fronto-orbicular reflex) was obtained mainly on the 9th day, with a limited variance. Recovery of a basic responsiveness to pain was concomittant of spontaneous eye opening mainly on the 15th day. A true relationship obeying orders was noticed on the 21st day, and a verbal response ranging mainly from the 30th day (confused) to the 60th (oriented). There was not any significative correlation of the delays with other early indicators of prognosis (Initial Glasgow score, C.T. scann lesions). Relating to the used sedation the effect was significant for the delays of eye opening only, with a possible analyse of the relationship. An inter-relationship between the steps and delays, leading to define an optimum for eye opening before day 15, for a motor response localizing pain before day 21, and for the item "obey to orders" before day 30 can be define as related to G.O.S. 4 and 5. A final analysis gave 79% of positive correlation with good results. We find a correlation between the delays of restructuring of consciousness and the functional results.

Adolescent↗
PubMed1991

[Peroperative monitoring of the facial nerve in surgery for acoustic neuroma].

This paper reports our experience about intraoperative facial nerve monitoring carried out in 97 patients operated on by a retrosigmoid approach. Intra-operative facial nerve monitoring was performed using a pneumatic sensor which transforms into acoustic signals contractions of facial muscles elicited by mechanical, electrical or thermal stimulations of facial nerve. Long term results showed that a normal facial function (grade I) was achieved in 90.5% of patients, 4 patients were grade II, 2 patients grade III, a total paralysis (grades V and VI) was persistent in 3 patients. Our experience with facial nerve monitoring suggests a modification of the strategy of dissection based upon a preservation of the arachnoid veil and a medial to lateral direction of dissection.

Electric Stimulation↗
PubMed1991

[Effects of ultrasonic aspiration on the sciatic nerve of rats. Experimental study].

We report the effects of induced ultrasonic lesions on the sciatic nerve of the rat. Using different level of intensity (5 to 35%) and time exposure (5 to 60 seconds) for each application, we study the effects by action potential recording, microphotography and histological study. The nerve remains unaltered for low intensity (5 to 10%) until a time exposure of 20 seconds. Beyond that level, a progressive severity of the lesion is documented from oedema to contusion. A safe use of the surgical ultrasonic aspiration in the vicinity of nerves and roots must have a low intensity level, reducing the risks of direct contact between nerve and sonoprobe.

Action Potentials↗
PubMed1989

[Materials for osteo-dural reconstruction in the cranium. An update].

Materials available for repair of a bony or dural defect at the cranial level are reviewed with particular attention stressed on their qualities and drawbacks for neurosurgical purposes. These materials include autologous or heterologous bone graft and biologically stable or biodegradable implants. No material can demonstrate ideal qualities of biocompatibility and biofunctionality. It should be either perfectly stable biologically and inert or perfectly biodegradable allowing simultaneous new bone reconstruction; moreover, it should be sterilizable, disposable, easy to handle and of low cost. Autologous grafts (iliac bone, split bone flap, pericranium...) have the best features but irradiated heterologous bone can be used instead; the latter needs a particular organization (bone graft bank) to fill the strict conditions of safety, especially regarding the risks of virus transmission. Implants have more recently been developed (acrylic, coral, B.O.P., ceramic, collagen-vicryl...) and present some drawbacks: generally high cost and not well established or insufficient biological properties. The experience of French neurosurgeons is reported from a questionnaire (102 answers) on the most frequently used materials. Autologous bone grafts, and acrylic as bone substitutes and pericranium for dural repair are preferentially used. Some materials, including coral, B.O.P. and collagen-vicryl, have a decreasing utilisation because of poor results especially with regards to bone incorporation and water tightness. Particular techniques (acrylic + teflon, acrylic with pre-op external casting and even non-repair of bone defects) are proposed by some neurosurgeons. New materials still under experimentation are finally presented (lyophilized bovine pericardium, collagen IV, polylactic acid).

Biocompatible Materials↗
PubMed1988

[Intracranial arterial aneurysm in children. A cooperative study. Apropos of 43 cases].

This joint study describes 43 cases of intracranial arterial aneurysms in children diagnosed on the basis of clinical symptoms. In the pediatric age group, this malformation is notable because of the marked sex predilection in males (70%) and an unequal topographic incidence in the circle of Willis, where carotid artery (39.3%) and anterior communicating artery lesions (30%) predominate. The most frequent clinical sign was subarachnoid hemorrhage (81%), although symptoms caused by compression revealed the abnormality in 2.3% of patients. In this series, 11% of the patients suffered a head injury at the time of the hemorrhagic accident; this finding has been reported previously in the literature. Today, treatment is always surgical, consisting in removal of the aneurysmal sac. Surgical results are encouraging; all grade lesions considered together, 63.4% of the children were cured without any sequelae, 19.5% lost one school year but were able to lead a normal life, and 4.8% remained severely handicapped; overall postoperative mortality was 12.3%. Cerebral plasticity and tolerance of spasm in children are fundamental features of this aneurysmal pathology which partially explain the favorable results obtained with surgery.

Adolescent↗
PubMed1988

[Treatment of vasospasm in aneurysmal meningeal hemorrhage using intravenous nimodipine. Multicenter cooperative study].

We present a multicentric randomized double-blind study of the curative effect of intravenous Nimodipine on the post hemorrhagic vasospasm after aneurysmal rupture. On 122 validated cases out of 188 analyzed patients, the study demonstrates a significative effect on the mortality and severe morbidity related to vasospasm: the reduction of the risk is appreciated to 72%. The major effect is obtained on the mortality risk. A selective effect can be demonstrate on the isolated vasospasm.

Double-Blind Method↗
PubMed1987

Hearing preservation after acoustic neurinoma operation.

Between 1981 and 1984, 44 patients underwent acoustic neurinoma removal by a posterior cranial fossa approach with an attempt to preserve hearing. Seven tumors were small (less than 20 mm), 28 were medium (20 to 40 mm), and 9 were large (greater than 40 mm). Preoperatively, 4 patients had normal hearing, 15 had serviceable hearing, 10 had poor hearing, and 15 had no hearing. Postoperative hearing was preserved in 11 cases. Of the 19 patients with normal or serviceable hearing, 8 (42%) had serviceable hearing preserved postoperatively. Hearing preservation was achieved in 43% of the patients with small tumors, 25% of those with medium tumors, and 11% of those with large tumors. This study confirms the value of the suboccipital approach, which can be used in an attempt to preserve hearing whenever the patient has serviceable hearing preoperatively and whenever the tumor size makes it feasible.

Adult↗
PubMed1987

[Intraventricular hemorrhage in the newborn infant at term: thalamic origin].

Four observations of intraventricular hemorrhage in full term neonates without perinatal asphyxia are reported. The clinical pictures were remarkably similar in the four infants: neurological symptoms developed several days after birth with sunsetting and eye deviation and symptoms of cranial hypertension. Ultrasonography and CT scan showed a thalamic hemorrhage.

Cerebral Hemorrhage↗
PubMed1987

[Brain abscess in the neonatal period].

Cerebral abscess is considered as a rare lesion with severe prognosis in neonates. The present means of cerebral imaging allow for a better estimation of its frequency, a more precise diagnosis of the evolutive stage and the estimation of the efficacy of the treatments. Incision-drainage associated with antibiotic treatment was successful in children. Two cases of neonatal cerebral abscesses treated and cured according to this protocol are reported.

Anti-Bacterial Agents↗
PubMed1987

[Preservation of hearing in surgery of acoustic neuroma].

Between 1981 and 1984, 44 patients underwent acoustic neuroma removal by a posterior cranial fossa approach in an attempt to preserve hearing. 7 tumors were small (less than 20 mm), 28 were medium (20 to 40 mm) and 9 large (greater than 40 mm). Of these 44 patients, 4 had normal hearing preoperatively, 15 had serviceable hearing, 10 poor hearing and 15 no hearing. Postoperative hearing was preserved in 11 cases. Of the 19 patients with normal or serviceable hearing, 8 (42%) had serviceable hearing preserved postoperatively. Hearing preservation was achieved in 43% of the cases of small tumors, 25% of those medium tumors and 11% with large tumors. This study confirms the value of the suboccipital approach, which can be used in an attempt to preserve hearing whenever the patient has serviceable hearing preoperatively and whenever the tumor size makes in feasible.

Adult↗
PubMed1986

[Possibilities of preserving hearing in the surgery of acoustic neurinoma].

Between 1981 and 1984, 44 patients underwent acoustic neurinoma removal by a posterior cranial fossa approach in an attempt to preserve hearing. 7 tumors were small (less than 20 mm), 28 were medium (20 to 40 mm) and 9 large (greater than 40 mm). Of these 44 patients, 4 had normal hearing preoperatively, 15 had serviceable hearing, 10 non-serviceable hearing and 15 anacousis. Postoperative hearing was preserved in 11 cases. Of the 19 patients with normal or serviceable hearing, 8 (42%) had serviceable hearing preserved postoperatively. Hearing preservation was achieved in 43% of small tumors, 25% of medium tumors and 11% of large tumors. This study stress the importance of the suboccipital approach which can be used in an attempt of hearing preservation whenever the patients have serviceable hearing preoperatively and whenever the tumor size makes it feasible.

Adult↗
PubMed1985

[Functional neurosurgery of cerebral palsy].

In 1983, approximately 40 000 patients in France and 5 760 patients in Switzerland suffered from cerebral palsy, representing more than 0.1% of their respective populations. The functional disability of these patients is particularly impressive and emphasizes the medical, social and economic importance of this problem. The term cerebral palsy is restricted to non-progressive disorders of motor function, already observed at an early age and due to cerebral lesions. These motor disorders can be of paretic, dystonic and dyskinetic nature. Their epidemiology, classification, etiology, pathology, early diagnosis and evolution are extensively reviewed by Th. Deonna. The difficulty in evaluation of treatment is the absence of a generally accepted rating scale. G. Broggi has proposed one on the basis of a large experience which could serve in the future for more objective evaluation. This monograph is devoted to the functional neurosurgical treatment of cerebral palsy. Physiotherapy and rehabilitation are part of the basic treatment of cerebral palsy, and must be continued after any neurosurgical treatment. Various conservative methods of treatment and their neurophysiological rationale are mentioned by P. Claverie. Some technical devices which improve the neurological deficits and facilitate rehabilitation are presented. Radiculotomies and neurotomies are probably the oldest neurosurgical operations for the treatment of spasticity. The neurophysiological and neuroanatomical basis of this therapeutic approach are treated in the review of the material from the neurosurgical department of Montpellier. Sixty cases were collected and the results analysed according to the type of operation (posterior radiculotomy, anterior radiculotomy, mixed) performed. Stereotactic thalamotomies and subthalamotomies are believed to be the best neurosurgical method to treat the tremor and improve other dyskinesias and hyperkinesias. The technique and a personal review of 49 cases of cerebral palsy are presented. The long-term follow-up in this study demonstrates that this type of operation markedly improves the functional disability of patients with moderate hyperkinesias, moderately improves patients severely affected, but also demonstrates that possible side effects cannot be ignored. Review of the literature indicates the difficulty in interpretation of results due to a lack of objective evaluation. Nevertheless, stereotactic thalamotomy can still be recommended when tremor and rigidity are the most prominent symptoms. Stereotactic dentatotomies in the treatment of spasticity were very popular 20 years ago, but have been largely forgotten for nearly a decade.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

[Spinal intradural arachnoid cyst].

The authors report the case of a 13 year-old boy who presented after minor cranial trauma with severe gastrointestinal symptoms (acute hemorrhage) followed by neurologic signs evoking a spinal compression. Gastro-intestinal hemorrhage was related to a duodenal lesion induced by acetylsalicylic acid. Neurologic symptoms were related to an intra dural cervical arachnoid cyst. After surgical resection of this congenital malformation outcome was favorable.

Adolescent↗
PubMed1984

Possible influence of cerebrospinal fluid pressure on the growth of a third ventricle choroid plexus papilloma.

A case of histologically proven benign choroid plexus papilloma of the third ventricle in a 4-month-old male child is reported. The clinical symptoms and the neuroradiologic findings were those of a supratentorial hydrocephalus. A shunting procedure was performed after refusal by the family of a direct surgical approach. Subsequently there was a four- to fivefold increase in volume of this tumor in less than 4 months under decreased cerebrospinal fluid pressure. The purpose of this report is first to add a case to 27 cases of papilloma of the choroid plexus of third ventricle reported in the medical literature. Secondly to underline a possible influence of intraventricular pressure on the growth of a histologically benign intraventricular papilloma. Subsequently, the question of radiation therapy may be raised, if total removal of the papilloma is not obtained, especially in view of decreased cerebrospinal fluid pressure provided by the previous shunting procedure.

Cerebral Ventricle Neoplasms↗