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  • 1
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    German Medical Science; Düsseldorf, Köln
    In:  56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC); 20050507-20050511; Strasbourg; DOCP132 /20050504/
    Publication Date: 2005-05-05
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
    ISSN: 0942-0940
    Keywords: Cavernous angioma ; angiographically occult vascular malformation ; haemorrhage ; rebleeding
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Although intracranial cavernomas are known to cause haemorrhage, data concerning the frequency, severity and delay of recurrent bleedings are controversial. We report a series of 6 patients with histologically proven cavernoma, presenting with early clinical signs and radiological proof of rebleeding, that is occuring in the first month after initial overt haemorrhage. These 6 cases have been selected from a series of 142 patients seen between 1980 and 1995 in our department with cavernous angiomas or so-called AOVMs, of whom 93 presented with clinical symptoms of haemorrhage (34 patients presented symptoms of one or more rebleeding, but only 6 had radiological proof). All patients suffered neurological worsening due to the rebleeding, with an increase of the size of the haematoma on the CT scan. Five MRIs were performed at the acute stage: 3 showed evidence of cavernoma (60%). All patients underwent surgery at the acute stage of the rebleeding, with 5 improvements and 1 stabilization. A cavernous angioma was found in 5 cases at first surgery, but a further operation was necessary in the last patient to find and remove the cavernoma, after a second rebleeding following the first intervention. Our series reveals a high frequency of rebleeding after a first intracranial haemorrhage from a cavernous angioma, and highlights the precocity of such rebleedings. Therefore, we advocate early aggressive surgical management: in cases of cavernoma revealed by a first clinical overt haemorrhage, when there is strong radiological suspicion at the acute stage; and in all cases of rebleeding, even without radiological evidence of malformation, in the absence of vascular risk factors. Surgical indication must be discussed in particular cases of cavernomas of the brain stem when neither the haematoma nor the cavernoma reach the surface, and in deep supratentorial cavernomas, when the neurological status is good, because of the therapeutic risk.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the course of hydrocephalus treated by ventriculoatrial shunt revision operations are often necessary mostly for elongation of the catheter. After several revisions it may became difficult or even impossible to introduce the catheter into the auricle through the jugular vein. The authors report on 19 direct cardiac implantations using a medial sternotomy. Operative technique, complications and results are described. This approach proved to be very safe and useful and seems to be superior to the thoracotomy already recommended by other neurosurgical teams. But it is not recommended for children under the age of 3 years.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Keywords: Electrical stimulations; functional mapping; language; sensorymotor.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ Indications of surgical treatment for lesions in the central nervous system depend on the risk of a definitive neurological deficit, related to the benefit of resection. Detection of eloquent areas is then necessary because of major individual variability. Neuro-imaging functional techniques are in development and are beginning to be efficient for cortical sensorymotor mapping, but still lack sensitivity and specificity for language mapping, and remain unable to give real-time data during surgery and to perform sub-cortical mapping. The more precise and reliable method of functional mapping is represented by the intra-operative direct electrical stimulations (DES), which allow identification and preservation of essential pathways for motricity, sensibility and language, at each level of the central nervous system (cortico-subcortical). We report our experience of DES in the surgery of tumours and vascular malformations located in supra-tentorial brain eloquent areas, with a consecutive series of 60 patients operated on under general or local anaesthesia, from November 1996 until May 1999 in our department at La Salpêtrière Hospital.  Presenting symptoms in the 60 subjects (39 males, 21 females, mean age: 45 years) were seizures in 37 cases with normal clinical examination, and mild neurological deficit in 29 cases. MRI showed 60 supra-tentorial brain lesions: 30 precentral, 12 postcentral, 14 perisylvian in the dominant hemisphere, 4 deep-seated. All subjects underwent surgical resection using DES, with supratentorial cortico-subcortical mapping under general anaesthesia for motor areas detection in 43 cases and under local anaesthesia for sensori-motor and/or language tasks in 17 cases. The final histological diagnosis was 44 gliomas (31 low-grade and 13 high-grade), 9 metastasis, 3 cavernomas, 4 arteriovenous malformations (AVM). Resection was total or subtotal in 52 cases (87%) and partial in 8 cases (13%). 29 patients had no post-operative deficit, while the other 31 patients were impaired post-operatively, with in all cases, except 3, a complete recovery delayed for 15 days to 3 months (overall morbidity: 5%). The median follow up was 14 months.  Intra-operative direct electrical stimulations of the central nervous system constitute a reliable, precise and safe method, allowing the realization of a functional mapping useful for all operations of lesions located in eloquent areas. This technique allows a minimization of definitive post-operative neurological deficit, and concurrently an improvement in the quality of resection.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary When the ventricular fluid pressure has reached a level of 120 to 150 mm H2O, there is a risk of rapid internal herniation. The effects of corticoids and hyperosmolar drugs on this are not as striking as they are on brain oedema. The only efficient therapy is the establishment of an external ventricular drainage system proposed for the first time in 1941 by Ingraham and Campbell and regulated with a valve system by Whiteet al. 1967. From our experience of 202 cases we review the technique, the indications, and the complications of ED.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0942-0940
    Keywords: Glioblastomas ; Chemotherapy ; Intracranial hypertension ; Pseudocysts
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 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.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The rupture of a saccular aneurysm during a direct attack can led to a disastrous result unless deep hypotension has been induced before the dissection. If the mean pressure recorded through a microcatheter introduced into the radial artery is at 30 mm Hg level or below the rupture remains circumscribed and the operative field can be dried easily with adjustable suction wherever the situation of the rupture may be. This technique was used in 52 cases with the operative microscope which enables, a clear vision of the lesion and of its vicinity. The mortality was 2, or 3.8%, in spite of 34 operative ruptures.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1920
    Keywords: Pituitary adenomas ; Angiotomography ; Empty sella ; Carotid angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The supra sellar extension of even small sized pituitary adenomas can be delineated with accuracy by angiotomography. This technique avoids the discomfort of pneumoencephalography in many patients. Angiotomography is also useful for the differential diagnosis of empty sellae.
    Type of Medium: Electronic Resource
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