Biomedical subjects

A Fichten

Publications and source records attributed to A Fichten.

7 recordsLinked to original sources

PubMed2006

[Intracranial facial nerve schwannomas. Seven cases reviewed].

BACKGROUND AND PURPOSE: Intracranial facial nerve schwannomas are rare neoplasms. Preoperative diagnosis is difficult because of non-specific clinical presentations (deafness, facial paralysis sudden or progressive) and radiological differential diagnosis (petrous bone tumor, vestibular schwannoma). Treatment depends on localization and has to be discussed for each case. METHODS: Seven cases (four men and three women) of intracranial facial nerve schwannomas were retrospectively studied. RESULTS: Before treatment, we found deafness in six cases (two sudden and four progressive), a facial palsy in five cases (three sudden and two progressive). Five patients had deafness and facial palsy. One patient had only headache. Three schwannomas were supra and intra-petrous, two in the cerebello-pontine angle, and two were plurifocal (petrous bone, internal auditive canal and cerebellopontine angle). Six patients were operated on with an oto-neurosurgical procedure. After treatment, facial palsy always worsened (requesting secondary hypoglosso-facial anastomosis in cinq cases). Only one case of transmission deafness improved after ossiculoplasty. One patient is still under clinical and radiological observation. CONCLUSION: Diagnosis is difficult and made operatively in half of patients. A large tumor requires surgery, but surveillance can be a good option for a small one, considering the risk of postoperative facial palsy.

Adult↗

PubMed2006

Lhermitte-Duclos disease and Cowden's syndrome. Report of two cases.

OBJECTIVE AND IMPORTANCE: Lhermitte-Duclos disease, or dysplastic cerebellar gangliocytoma is a rare entity characterized by a hamartomatous lesion in the posterior fossa. Cowden's syndrome, or hamartoma-neoplasia syndrome is a rare underdiagnosed autosomal dominant genodermatosis with high incidence of malignant tumors. Several recent reports suggest that Lhermitte-Duclos disease may be a component of Cowden's syndrome. CLINICAL PRESENTATION: We report two cases of Lhermitte-Duclos and Cowden disease occurring in adult patients. A 40-year-old woman had symptoms of raised intracranial pressure and macrocephaly. She displayed the stigmata of fibrocystic breast disease, thyroid goitre. Clinical examination showed mucocutaneous lesions. Her mother, brother and uncle had manifestations of Cowden's disease. An asymptomatic 38-year-old male had bilateral optic nerve drusen related to a cerebellar neoplasm. He exhibited manifestations of Cowden's syndrome and his familial history confirmed this hypothesis. INTERVENTION: The first patient was operated on for Lhermitte-Duclos disease. A conservative strategy was performed for the second patient and the clinical and imaging follow-ups were uneventful over 5 years. CONCLUSION: We stress the possibility that Lhermitte-Duclos and Cowden disease might be a peculiar form of phakomatosis. A conservative strategy can be chosen without neurological signs because of slow tumor growth. However, these patients should be carefully examined and followed up because of the risk of future malignancy.

Adult↗

PubMed2004

[Target-controlled infusion with propofol for neuro-anesthesia].

Propofol is an intravenous anaesthetic agent, which presents interesting features for its use in neuro-anaesthesia: it is a powerful hypnotic that does not increase the intracranial pressure. The delay of recovery is short even after several hours of continuous infusion. This is essential for a fast neurologic examination. Continuous infusion should be preferred to bolus in order to prevent hypotension and decrease of the cerebral perfusion pressure. Target-controlled infusion models based on effect site concentrations are now available through several softwares. This technique appears especially useful for awake craniotomy and functional neurosurgery. The level of consciousness is easily fixed between deep anaesthesia and light sedation permitting to ask the patient to move following orders. A sedation controlled by the patient himself is even possible.

Anesthesia, Intravenous↗

PubMed2002

Symptomatic vasospasm after subarachnoid haemorrhage: assessment of brain damage by diffusion and perfusion-weighted MRI and single-photon emission computed tomography.

Our purpose was to assess the usefulness of diffusion- and perfusion-weighted MRI for the detection of ischaemic brain damage in patients with suspected vasospasm after subarachnoid haemorrhage (SAH). We studied 11 patients admitted with a ruptured aneurysm of the anterior circulation and suspected of intracranial vasospasm on clinical examination and transcranial Doppler sonography (TCD). All were investigated by technetium-hexamethyl-propylene amine oxime (Tc-HMPAO) single photon emission computed tomography (SPECT) and diffusion and perfusion-weighted MRI (DWI, PWI) within 2 weeks of their SAH. Trace images and TTP maps were interpreted by two examiners and compared with clinical and imaging follow-up. PWI revealed an area of slowed flow in seven patients, including four with major and three with minor hypoperfusion on SPECT. In two patients, PWI did not demonstrate any abnormality, while SPECT revealed major hypoperfusion in one and a minor deficit hypoperfusion in the other. Two patients with high signal on DWI had a permanent neurological deficit.

Adult↗

PubMed2002

[Frontal sinus osteomas: neuro-ophthalmological complications].

Osteomas are the most frequent benign tumors of the paranasal sinuses. They often grow in the frontal sinus near the nasofrontal duct. They remain frequently asymptomatic and they tend to be an incidental finding on radiographic studies. Rarely, they extend out of the sinus limits. Two cases with neuro-ophthalmological complications are reported and discussed. A 19-year-old female presented with a progressive left visual impairment and orbital bone deformity. A CT-scan revealed a large calcified mass in both frontal sinuses, with left intraorbital and frontobasal extension. A 21-year-old man suffered from acute frontoethmoidal sinusitis. Radiological exams revealed a right frontal sinus osteoma with bilateral nasofrontal ducts obstruction. The frontal sinus cavities were filled with a large mucocele with intracranial extension. Both patients were successfully treated using frontobasal craniotomy with complete osteoma and mucocele removal and cranio facial bone reconstruction. Neuro-ophthalmological or intrasinusal complications of osteomas lead to radical treatment. CT-scan and MRI analysis for surgical purpose and strategy are emphased.

Adult↗

PubMed2001

[Diagnostic problems in brain abscess: 45 cases].

BACKGROUND AND PURPOSE: We analysed the difficulties encountered in the differential diagnosis between brain abscess and brain tumor and their influence on treatment and outcome. METHODS: - Forty-five adults with brain abscess operated on between 1993 and 1999 were retrospectively reviewed. We studied preoperative diagnosis, clinical, radiological, bacteriological findings, surgical procedure, primary sources of infection and outcome. RESULTS: Preoperative diagnosis was right in 55.6% (25/45), wrong in 22.2% (10/45) and doubtful in 22.2% (10/45). Diffusion-weighted MR imaging was successfully used in 4 doubtful cases to make the differential diagnosis between abscess and tumor. When the preoperative diagnosis was right, the surgical procedure was a burr-hole aspiration in 73.3% (22/25) whereas when it was wrong, an excision was performed in 60% (6/10) of the cases. Aspiration was the last diagnostic investigation in 80% (8/10) of doubtful cases. Microbacterial organisms were identified in 75.5% (34/45) of the cases and primary cause of infection in 62.2% (28/45). The outcome depended on clinical status on admission, preoperative diagnosis and surgical procedure. In four cases, diffusion-weighted MRI allowed differential diagnosis between brain abscess and tumor through calculation of the Apparent Diffusion Coefficient which is low in abscess and high in cystic tumor. CONCLUSION: The diagnosis of brain abscess remains difficult in certain patients. Correct preoperative diagnosis influences the decision on the appropriate surgical procedure and helps improve outcome.

Adult↗

PubMed1999

[Chronic subdural hematoma in patients over 80 years of age].

Eighty cases of chronic subdural haematomas (SDH) in elderly patients (over 80 year-old) are reported retrospectively. The estimated incidence of the disease is 17 cases per 10(5) per year. The main presenting symptoms were confusion and impaired mentation. Surgical treatment was performed in all patients. Biological disorders deserved particular attention in the elderly SDH population. Complications occurred in 10% of patients, and recurrence of SDH was noted in 5% of patients. After their hospital discharge, 85% of patients returned to their previous neurological status. In this study, the age of patients did not appear to be a poor prognostic factor.

Accidental Falls↗