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Biomedical subjects

T Civit

Publications and source records attributed to T Civit.

29 records · Page 2Linked to original sources
PubMed1997

[Meningiomas of the sellar diaphragm. Apropos of 4 cases].

Since 1987, we have treated four patients with diaphragma sellae meningioma. Tuberculum sellae meningiomas with intrasellar extension were strictly excluded from this retrospective study. A complete tumor removal was performed in two patients. The two other patients underwent post-operative radiotherapy. According to the Kinjo's classification, the four meningiomas were classified as follows: one type A (supradiaphragmatic-prepituitary), one type B (supradiaphragmatic-retropituitary), one type C (subdiaphragmatic), one type not described in this classification characterized by sub and supradiaphragmatic extension. Based on our experience and data in the literature, the clinical and neuroradiological features of the diaphragma sellae meningiomas are reviewed. Diaphragma sellae visualization at MRI, which is not always possible, allows to localize the tumor on a supra- or infra- diaphragmatic position and to decide the optimal surgical approach. The diaphragma sellae is more visible on protonic density, or T2-weighted sequences, but can be located on T1-weighted images. Appropriate surgical approaches are the sub-fronto-pterional route for supradiaphragmatic meningiomas and the transsphenoidal approach for subdiaphragmatic meningiomas.

Adult↗
PubMed1997

[Waldenström's macroglobulinemia and cerebral lymphoplasmocytic proliferation: Bing and Neel syndrome. Apropos of a new case].

Waldenström's disease is a B-cell, low grade lymphoma, secreting an immunoglobulin M, and is called immunocytoma. Neurological complications are frequent, but encephalopathies due to lymphoplasmocytoid infiltration are rare (Bing-Neel syndrome). Tumors, probably arising from confluence of infiltrative areas, are exceedingly rare. The authors report the case of a 70-year-old man, suffering from a Waldenström's immunoglobulinemia, who underwent surgery for a right sided rolandic tumor involving the vault, the dura-mater, and the cortex. On the CT scan, the tumor mimicked a meningioma. Histological study and immunohistologic stains confirmed the monoclonal nature of the tumor. Based on the review of the literature, clinical and neuroradiological features of these infiltrative and tumoral rare lesions, as well as their histopathogenesis and treatment, are discussed.

Aged↗
PubMed1997

[Chordoid meningiomas. Clinical, neuroradiological and anatomopathological aspects. Apropos of a new case and review of the literature].

A 21-year old woman underwent surgery in December 1996 for the removal of a presumed tuberculum sellae meningioma. However, some radio-clinical findings were proved somewhat intriguing:the patient's age, the presence of inflammatory and febrile syndromes together with the diagnosis of aseptic meningitis associated with perilesional edema intensity (an unusual feature in such cases) made us challenge the initial neuroradiological diagnosis evoked in connection with the tumoral location and dural attachment pattern. A right sub-fronto-temporal approach allowed complete tumor resection (confirmed with a postoperative MRI) and clinical recovery of the patient. But while pathological examination suggested a chordoma, the study of immunohistochemical stains revealed a meningioma. The final diagnosis was chordoid meningioma. Our review of the literature has shown that chordoid meningiomas display several areas of physaliferous cells which give the tumor a chordoma-like aspect. However, the results of immunohistochemical studies along with the location of the tumor were not consistent with the diagnosis of chordoma. Eight cases of chordoid meningiomas are reviewed in the literature. They are described as inducing systemic symptoms, particularly anemia. They could also be linked to Castleman's syndrome according to Kepes et al. After careful evaluation, we retained the hypothesis of a cause and effect relationship between the local and generalised inflammatory syndrome and chordoid meningioma.

Adult↗
PubMed1996

[Isolated invasive sphenoid aspergillosis].

Isolated aspergillosis of the sphenoid sinus is a difficult diagnosis because the often misleading clinical manifestations of this rare disease develop late. We report a case of invasive aspergillosis uniquely involving the sphenoid sinus revealed by clinical features suggesting pseudotumor of the pituitary in an immunocompetent man. A 71-year-old man presented sudden onset palsy of the abductor nerve of the left eye. Neuroimaging suggested a pseudotumor of the pituitary. Sphenoid sinusitis was discovered at surgery. The diagnosis of aspergillosis was provided by the histology examination of the sphenoid mucosa. Despite medical treatment with itraconazol alone then in combination with amphotericine B, the infectious process progressed to the pituitary, the cavernous sinus, the upper orbital fissue and the optic canal. Cure was finally achieved after a second surgical procedure to drain and aerate the sphenoid sinus. Aspergillosis of the sphenoid sinus is usually discovered due to neurological signs such as a cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intraoperatively or at histology examination. Invasive forms almost always are seen in immunosuppressed subjects. In our case, the patient was immunocompetent and had no past history of sinusitis. The invasive sphenoid aspergillosis invaded bone tissue, the cavernous sinus and the meninges.

Aged↗
PubMed1996

Aneurysm clipping after endovascular treatment with coils: a report of eight patients.

Between January 1990 and December 1994, patients with subarachnoid hemorrhage related to ruptured aneurysms who were referred to our institution were treated by neurosurgical and neuroradiological teams. In each patient, the respective indications for neurosurgical or endovascular treatment were discussed, taking into consideration patients' age and the morphological and topographical aneurysm features. We report eight cases of patients with subarachnoid hemorrhage who underwent operations after primary endovascular procedures (Hunt and Hess scores III, IV, and V). The indications for surgical treatment were as follows. First, deliberate partial occlusion of the aneurysm (two aneurysms of the internal carotid artery and one aneurysm of the anterior communicating artery) was performed to obtain only partial clotting of the aneurysm sac by free coils. However, this procedure was discontinued in favor of the use of Guglielmi detachable coils. The second indication was partial occlusion after an endovascular procedure (two aneurysms of the middle cerebral artery and one internal carotid artery aneurysm). The third indication was re-expansion of the aneurysm 1 year after the endovascular treatment (one middle cerebral artery aneurysm). The final indication was secondary rupture of the aneurysm sac and false aneurysm around the migrating coil (one aneurysm of the pericallosal artery). During surgery, the aneurysm sac appeared translucent. The coils bulged out and stretched the aneurysm sac. One ruptured the membrane leading to a subarachnoid hemorrhage during the endovascular procedure. No hemorrhage occurred during the surgical clipping. Aneurysm obliteration was easily performed, especially when the packing was partial, but was very difficult when the complete aneurysm closure led to a stenosis of the parent vessel. A giant sylvian aneurysm rest, visible only with angiography, was left untreated. This series illustrates an original experience, which led us to conclude that aneurysm surgery with coils in place is not as difficult as is often thought.

Adult↗
PubMed1996

[Lipogranuloma of the orbit. Apropos of a case].

We present a case of orbital lipogranuloma with a supero-nasal retrobulbar localisation associated with axial proptosis and major choroidal thickening. No clinical sign of inflammation, neither orbital nor in the posterior segment, was revealed. The systemic work-up as well as paraclinical data were within normal limits. The diagnosis was made after histopathologic examination of the biopsy taken via superior orbit. Outcome was favorable following long-term systemic corticotherapy. Orbital lipogranuloma is a rare particular form of orbital pseudotumour of unknown etiology. It is characterized, histologically, by orbital fat necrosis. Pathogenesis remains controversial. The differential diagnosis includes iatrogenic lipogranulomas secondary to sinus surgery (paraffinoma), orbital granulomas in sarcoidosis and Wegener's disease and orbital lymphomas. The prognosis is usually good following treatment with steroids.

Adult↗
PubMed1995

Mitral valve tumor revealed by stroke.

Valvular tumors are uncommon and usually benign lesions, discovered accidentally or when neurological or cardiological complications occur. We report a case of mitral valve papillary fibroelastoma measuring less than 1 cm and revealed by stroke. Transesophageal echocardiography was the best method to establish the diagnosis as it provided higher discriminative power than the transthoracic echocardiography or nuclear magnetic resonance. The embolic risks justify the surgical treatment of these lesions while anticoagulation therapy can be suggested as a substitute to surgery for the high risk patients.

Adult↗
PubMed1994

Transsphenoidal surgery for pituitary adenomas in children.

The authors have reviewed the results of transsphenoidal surgery for pituitary adenomas done on 66 children (younger than 16 yr of age) between 1966 and 1992. Ninety-four percent (62 of 66) showed clinical evidence of pituitary hormonal hypersecretion. The most common type was the adrenocorticotropic hormone-secreting adenoma (n = 36), followed by the prolactinoma (n = 18) and the growth hormone-secreting types (n = 8). There were four cases of nonfunctioning adenomas. Adrenocorticotropic hormone-secreting tumors in children had presentations and surgical results similar to those seen in adults. Twenty-three of 33 patients with Cushing's disease had simple adenomectomy or subtotal hypophysectomy without symptomatic recurrence. Four of 10 initial treatment failures had subsequent successful surgical intervention, resulting in an overall cure rate of 78%. Postoperative hypocortisolism was suggestive of surgical success but was not absolute. Of three patients with Nelson syndrome, none were successfully treated with surgery alone and two developed invasive disease. Prolactin-secreting and growth hormone-secreting tumors in children occurred more commonly with suprasellar expansion than did their adult counterparts. Transsphenoidal surgery was capable of controlling disease in only 12% (1 of 8) of growth hormone-secreting tumors, and 67% (12 of 18) of prolactin-secreting tumors required postoperative medical therapy or radiotherapy for persistently elevated prolactin levels. Special difficulty was noted in boys with prolactinomas and in girls with primary amenorrhea. As in adults, preoperative prolactin levels correlated with ultimate surgical success rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1994

Functioning ectopic supradiaphragmatic pituitary adenomas.

Pituitary adenomas arising far from the pituitary gland occur rarely as a result of defects in embryological migration. Likewise, there have been reports of isolated suprasellar adenomas (clinically nonfunctioning), presumably derived from cells of the pars tuberalis. In this report, we present four cases of functional pituitary adenomas (three adrenocorticotrophic hormone, one prolactin) confined to the supradiaphragmatic region. In each case, the tumors were initially treated unsuccessfully by operations via the transsphenoidal route because of expected intrasellar processes with suprasellar extension.

Adenoma↗
PubMed1992

[Asymptomatic giant thoracic dumbbell neurinoma. Apropos of a case].

Giant thoracic dumbbell neurinomas are usually revealed by neurological or mediastinal signs. The case we are reporting was discovered accidentally and allow us to add some accuracy to the current diagnostic criteria for these tumors. MRI provides the most interesting information. The surgical exeresis of these tumors must use a double approach: first laminectomy then thoracotomy.

Adult↗