Biomedical subjects
R van Effenterre
Publications and source records attributed to R van Effenterre.
[Optochiasmal cavernoma: a rare cause of unilateral visual loss].
INTRODUCTION: Optic pathways cavernomas are rare vascular hamartomas that can present either with an acute chiasmal syndrome or slowly progressive visual loss. OBSERVATION: A 29-year-old patient presented with mild unilateral visual loss of rapid onset and monocular left temporal hemianopia. MRI disclosed a heterogenous enhancing optochiasmal lesion. Work-up found no evidence for an inflammatory, infectious or tumoral disease and therefore a neurosurgical approach of the lesion allowed diagnosis of cavernoma, confirmed by pathological examination. Successful resection resulted in partial recovery of the visual field. CONCLUSION: Optochiasmal cavernomas are rare, removal can improve visual outcome.
Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients.
The objective of this study was to evaluate incidence and risk factors of postoperative infections, with emphasis on antibiotic prophylaxis, in a series of 4578 craniotomies. A prospective database was implemented for surveillance of postcraniotomy infections. During period A, no antibiotic prophylaxis was prescribed for scheduled, clean craniotomies, lasting less than 4 h, whereas emergency, clean-contaminated or long-lasting craniotomies received cloxacillin or amoxicillin-clavulanate. During period B, prophylaxis was given to every craniotomy. The effect of prophylaxis on craniotomy infections, independently of other risk factors, was studied by multivariate analysis. The overall infection rate was 6.6%. CSF leak, male gender, surgical diagnosis, surgeon, early re-operation, surgical duration and absence of prophylaxis were independent risk factors. CSF leak had the highest odds ratio. Antibiotic prophylaxis decreased infection rate from 9.7% down to 5.8% in the entire population (p<0.0001) mainly by decreasing rates in low risk patients from 10.0% down to 4.6% (p<0.0001). Antibiotic prophylaxis in craniotomy is effective in preventing surgical site infections even in low-risk patients.
Primary intracranial myopericytoma: report of three cases and review of the literature.
Myopericytoma is a benign tumour generally arising in the subcutaneous and superficial soft tissues of the extremities. Very few cases have been reported in other locations and intracranial examples are exceptional. We now report on three cases of primary intracranial myopericytoma and review the literature on that rare entity. The patients were women in their fifties who presented with decreased visual acuity in two cases and raised intracranial pressure in one case. The tumour involved, respectively, the anterior cranial fossa, the orbital apex and the pineal region. Gross total resection was achieved in all three cases. Histological analysis revealed oval-to-spindle shaped myoid-appearing cells with a striking tendency for concentric perivascular growth. The lesional cells showed apparent differentiation towards perivascular myoid cells as witnessed by smooth muscle actin expression. In one case, an epithelioid differentiation was also present. None of the patients received adjuvant therapy. One patient died of unrelated causes 6 months after surgery. The other two are alive and well at 9 and 12 month follow-up respectively. Myopericytoma is a recently described neoplasm, and it is likely that reappraisal of intracranial haemangiopericytoma with which it shares many histopathologic features will lead to more case reports of primary intracranial myopericytoma.
Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy.
OBJECTIVE: With the aim to better evaluate the role of the insula in seizures and the therapeutic implications, we analyzed the rate of insular low-grade gliomas (LGG) presenting with medically refractory epilepsy, detailed their ictal symptoms, and described the epileptological results following their surgical resection. METHODS: Eleven patients (8 men, 3 women, mean age: 35 years) harboring an insular LGG generating intractable seizures, underwent tumor removal and perilesional opercular cortex resection (lesionectomy "plus") using intraoperative functional electrical mapping, combined with ultrasonography and/or neuronavigation. RESULTS: Despite the occurrence of five postoperative deficits, the patients recovered in all cases. The epileptological results showed improvement in all cases: 9 Engel's Class I (82%), 1 Class II and 1 Class III. Ten lesionectomies were total [3] or subtotal [7], while one resection was partial (the patient in Engel's III). CONCLUSION: The high rate of pharmacologically intractable seizures associated with insular LGG, and the favorable epilepsy outcome following surgical resection of these tumors seemingly indicate that the insular cortex itself may induce chronic seizures when injured. These results suggest, taking account of the technical surgical progress allowing now to minimize the morbidity after surgery in this region, that there is another indication than the sole oncological reason for surgery in patients with diffuse insular glioma -- even if total tumor removal is not systematically possible.
[Intracranial cholesterol granulomas. Report of 2 cases].
Two cases of cholesterolic granuloma, one intraorbital and the other of the petrous apex, are reported. The xanthogranulomatous and/or cystic process localized in the intracranial cavities or in the brain parenchyma are discussed. A simple topographical and histological classification is attempted in answer to a rather ambiguous terminology.
Craniopharyngiomas in two consanguineous siblings: case report.
OBJECTIVE AND IMPORTANCE: We describe a double case of craniopharyngioma in consanguineous siblings, suggesting the disease is sometimes genetic. CLINICAL PRESENTATION: Two typical adamantine craniopharyngiomas were observed in two consanguineous siblings. The brother and the sister, whose parents were first cousins, developed the tumors at the same age. INTERVENTION: The male patient was operated on using a frontopterional approach, and the tumor was completely resected. The patient remained free from recurrence 9 years after surgery. His older sister died after tumor removal was attempted at another institution. CONCLUSION: To our knowledge, such a connection has never been reported in the literature. It suggests that craniopharyngioma, which is usually sporadic, can also be transmitted in an autosomal recessive manner.
[Tumors and injuries of the optic nerve].
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[Opto-chiasmatic glioma: radiological signs].
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[Tumoral medullary compressions in malignant hemopathy (a 28 cases review (author's transl)].
The authors reviewed 28 cases of tumoral medullary compressions in malignant hemopathy. At once they point out 2 groups according to the fact that this compression is or not the revealing symptom of the disease. With regard to different data, that is to say, preoperative clinical examination with complementary investigations, and then results obtained from decompressive laminectomy followed or not with complementary therapy; the elements of the functional prognosis are analysed. They insist on frequency of medullary compression in a neuro surgical environment, as the revealing symptom of the hematologic disease and its immediate decompressive therapy is emphasized.
[Superior external orbitotomy. A variant of the neurosurgical approach to orbital tumors].
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High energy radiotherapy in the treatment of meningiomas of the cavernous sinus.
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Computerized tomography in parasellar space-occupying lesions and therapeutic decision.
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Angiotomography in the diagnosis of parasellar lesions.
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Management of postoperative diabetes insipidus after removal of craniopharyngioma.
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[Discussion of terminology concerning disorders of the optic nerve and disc (author's transl)].
Progress over the past few years in knowledge concerning disorders of the optic nerve and disc leads to changes in their classification. A new terminology is proposed. It uses a minimum of terms, their very general sense being understandable by any nonophthalmologist physician. It is based upon clinical symptoms and signs, thus being immediately applicable in clinical practice.
Cerebral pseudocysts following chemotherapy of glioblastomas.
Three cases of pseudocysts following surgery and chemotherapy for glioblastomas are reported. Their clinical picture was similar, consisting of intracranial hypertension without primary modification of focal signs. CT scanning has been able to detect the cystic aspect and to eliminate a true tumour recurrence. Medical treatment (steroids or Mannitol) seems inefficient. Evacuation of the cyst is the only efficient method of treatment.
[Oedematous optic neuropathy from Perhexilline maleate associated with peripheral polyneuropathy (author's transl)].
The authors report on a polyradiculoneuropathy related to long-term treatment with Perhexiline maleate (a drug used in France since 1973 for coronary insufficiency) whose presenting sign is a bilateral aedematous optic neuropathy. The mechanism of this effect on the optic nerves and on papilloedema is discussed; it seems not to be caused by a direct toxic action on the optic fibres but by the existence of chronic intracranial hypertension.