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Biomedical subjects

B Vlahovitch

Publications and source records attributed to B Vlahovitch.

At least 19 recordsLinked to original sources
PubMed1997

[Symptomatic aneurysms of the postero-inferior cerebellar artery. A multicenter retrospective study of 29 cases].

A multicenter retrospective study of 29 cases of posterior inferior cerebellar artery is reported. Over a period of 21 years, the frequency of posterior inferior cerebellar artery aneurysm among all intracranial aneurysm was estimated to 1.38 p. 100 of cases of aneurysms followed by 3 University Hospitals. Frequency of rupture appeared to be very high (93 p. 100) in this series probably because of the type of selection. Average grade of presentation according to Hunt and Hess classification being < III in 3 fourth of the cases. Neither clinical presentation nor suspicious etiological factors were specific of this localization. Only two cases were of pseudotumoral appearance. Positive diagnosis of subarachnoid hemorrhage was made by CT scan. Angiograms gave diagnosis of localization of the malformation and its type. Intraventricular hemorrhage was found in 62 p. 100 of our cases: all had hemorrhage of the fourth ventricle. Hydrocephaly was more frequent as compared to supratentorial localizations, Vasospasm was less frequent as in supratentorial localizations. Nimodipin seems to be efficient. Therapeutic possibilities are primary dominated by surgery with good results when it is possible. Endovascular treatment is under evaluation.

Adult↗
PubMed1996

[Use of a transcutaneous neuro-stimulator as peroperative stimulator in neurosurgical treatment of spasticity and traumatic lesions of the peripheral nerves and brachial plexus].

We have had the opportunity to use a standard percutaneous stimulator as an intraoperative stimulator, with the use of sterile leads, in order to palliate the sudden failure of our usual surgical stimulator. The simplicity and the possibility of modulation of the device, brought us to use it several times in different purposes of surgical work for spasticity, neurotization of the brachial plexus and treatment of fresh wounds of the nerves. Important features of this new way of using this device are simplicity of programation (width and frequency rates), good stability of chosen parameters, low diffusion allowing selective stimulation, and above all low cost versus standard devices used for this purpose.

Brachial Plexus↗
PubMed1988

[Value of postoperative radiotherapy in various tumors of the pituitary gland].

Already advocated by Cushing to complement surgery of pituitary adenomas, radiotherapy remains useful in these benign tumours despite controversies concerning long-term results, pituitary cell resistance and potential harmful effects on the optic nerve, glands and skin. Radiotherapy was applied to 36.6 p. 100 of 150 patients with pituitary tumours operated upon by the same surgical team. Some very good results were obtained, notably in invasive and recurrent tumours. In a case of chromophobe adenoma operated twice at 1 year interval, radiotherapy (4,500 rads) after the second operation resulted in complete cure confirmed by computerized tomography 15 years later. Similarly, in an 8-year old girl reoperated upon for severe recurrent suprasellar craniopharyngioma 3 years after the initial excision, post-operative radiotherapy (5,000 rads) produced excellent remission which persists after 19 years. Thus, even with the modern diagnostic and microneurosurgical procedures, radiotherapy remains, for many authors, a useful and safe method to improve the prognosis of pituitary tumours.

Adenoma↗
PubMed1988

Treatment and recurrences in 135 pituitary adenomas.

In 135 operated pituitary adenomas of different histological nature, seen over 20 years, the initial treatment was surgical, by trans-sphenoidal or transcranial approach depending on the tumour extent, followed by radiotherapy if necessary. In spite of modern investigation methods, diagnosis is still often made late, so that 118 of our cases already had visual symptoms. After surgery alone (87 cases) made by the same team recurrences occurred in 16%. Reoperations (14 cases) were generally more difficult and could also be followed by new recurrences needing finally radiotherapy with still positive results. Two cases had initial radiotherapy, the other 46 cases were treated by surgery and radiotherapy with a recurrence level of 8.3%. These results indicate the need to use immediate postoperative radiotherapy in every pituitary adenoma showing even the slightest invasive potential because radical surgery is hypothetical and recurrences possible. The recurrence of pituitary adenomas remains a difficult problem of anticipation and of curative management. Our position in terms of these benign tumours is to adopt readily this therapeutic course: surgery followed by radiotherapy, which provides the best prognosis without major risks.

Adenoma↗
PubMed1987

[Brown-Séquard syndrome caused by foramen and calcified disk herniation, responsible for direct compression of Adamkiewicz's artery].

The thoracic discal hernia is a rare affection whose prognosis has been transformed by the present diagnostic means and the technical progress of surgery. A case history has been reported of a thoracic discal hernia, T9-T10, with Brown-Sequard Syndrome and vertebral CT Scanning showed a left lateral localization. A posterior access remains indicated in lateral localization of those hernias, and it confirms clinical and neuroradiological findings showing a direct compression of the Adamkiewicz artery in the intervertebral foramen.

Arterial Occlusive Diseases↗
PubMed1986

[Fracture-separation of the articular process of the lower cervical spine. Its relation to fracture-dislocation in hyperextension].

The authors have seen 13 cases of fracture-separation of the articular processes in the lower cervical spine with horizontal facets. This type of lesion was caused by trauma in hyperextension, compression and rotation. The mechanism appears to be similar to that of dislocations in hyperextension. Four types are defined according to the displacement and the association of disc and ligamentous lesions. Most of the cases were unstable and had to be fixed surgically. Eleven cases were treated in this way, twice by a posterior approach, 6 times by an anterior approach and 3 times by a combined anterior and posterior approach.

Adult↗
PubMed1985

Radiation necrosis of the brain: time of onset and incidence related to total dose and fractionation of radiation.

Clinical deterioration during or after brain irradiation may be due to progression of neoplasm or radiation induced necrosis of the neoplasm and/or of normal brain tissues, or a combination of all. Eight patients with histologically documented radiation induced lesions of the brain are included in this study. The radiation therapy included the fractional schedule, group A, who received 280 to 300 rads daily, to a total dose of 4500 to 5000 rads and weekly exposure did not exceed 900 rads. Group B patients were exposed to 850 rads, daily dose on day 1, 3, 21 and 23 to a total dose of 3400 rads. The incidence of radiation induced lesions of brain was 3.4% in patients group A and 8.7% in group B patients (without statistical significance). The median time of onset of these lesions after completion of radiation therapy was significantly shorter in group B patients (8.5 months) as opposed to group A patients (21 months).

Brain↗
PubMed1985

[Series of 17 cases of giant intracranial aneurysms. Long-term surgical follow-up and hemodynamic effects of arterial occlusions].

The authors report their experience of 17 cases of giant intracranial aneurysms some of them with particular forms and localisations: Giant serpentine aneurysms in 17.6%, carotid cavernous, carotid, Willis Circle and vertebral branches. 8 cases were operated, 2 by direct neck occlusion and 6 others by carotid or vertebral interruption. For the nine non operated cases 5 were in a very bad clinical condition and 4 had refused the operation. Aneurysmal neck occlusion gave uneventful results lasting more than 4 and 10 years. Carotid or vertebral branches occlusion showed 16.6% mortality. In one case, the post operative death happened after 8 days of well tolerated carotid occlusion and in spite of a functional extra-intra-cranial anastomosis. Very good surgical outcome was seen in the other cases for over 3 and 22 years. Arterial occlusion in giant aneurysm surgery can bring multiple complications as in one case iatrogenic aneurysmal formation like in experimental Hassler and Hashimoto's descriptions. Curiously in the same way can be explained the ruptured intra cranial aneurysmal formation in some ischemic cerebral disease like Moyamoya syndrome or Takayashu disease.

Adult↗
PubMed1985

[Osteosynthesis of the low lumbar spine and spondylolisthesis. Modification of the Scholner plate and pedicular screwing].

A modification of Roy Camille's Technic for better screw location into the pedicle of vertebra of the low lumbar column and lumbo-sacral junction is reported. A small 5 millimeters resection of the inferior articular process allows a more cranial drill-hole which is more steadily in the pedicle of the vertebra as confirmed by X rays controls and anatomic specimens. A 10 degree slope to a caudal direction is needed at the L5 level and a 30 degree slope to a caudal direction is required at S1 level. 50 millimeters length screw can be used for adult patients. Some modification of Scholner's plate are proposed in spondylolisthesis surgery.

Bone Plates↗
PubMed1985

[Is there currently a role for radical surgery of pain?].

Radical surgery of pain is destined for chronic and intolerable pain, resistant to causal treatment, and rebellious to the various medicinal therapeutics. Conventional neuro surgery by selective section of nociceptive fibers is very valuable for cancerous subjects with a limited life span. On the other hand, there has been skepticism concerning the real efficiency of neuro stimulation. The advance made in the knowledge of neurophysiologic and neurochemical mechanism of pain will allow a radical transformation as substitute for this invasive type surgery.

Central Nervous System↗
PubMed1985

[Iatrogenic carotid-cavernous fistulas, complications of carotid thrombectomy].

The authors report four cases of carotid cavernous fistula at the C5 segment of the internal carotid artery following embolectomy by a 3F Fogarty Catheter. All patients were operated on a carotid bifurcation stenosis (pre-occlusive) and a thrombectomy with a 3F Fogarty Catheter was carried out in the same time in 3 patients and during re-operation in 1 patient who had post operative thrombosis. The carotid-cavernous fistula occurred the day after surgery in 2 cases, 1 week after in 1 case, and 2 months later in 1 case. Spontaneous recovery occurred in two patients (1 occlusion--1 re-stenosis), 1 patient died from controlateral carotid occlusion, and 1 patient was lost for investigation. There were no relationship between the number of "repeated passages" of the Fogarty Catheter and the interval time where the fistula occurred. However the location of fistula was constant. Overtension on the internal wall of the artery by the balloon could be advocated rather than a collateral torn of the intra cavernous internal carotid. Endoluminal treatment of various vascular lesion is increasingly used and iatrogenic problems as reported here should be kept in mind. Age and atheromatous lesion of carotid siphon appear to be the main risk factors.

Aged↗
PubMed1984

[Brachial diplegia of traumatic origin as a result of injuries of the cervical cord].

Described by Dide and Lhermitte (1917) the brachial diplegia or bilateral paralysis of the upper limbs, is called since Schneider's data acute central spinal cord injury (1956). It is characterized by disproportionately more motor impairment of the upper than of the lower limbs, bladder dysfunction and variable sensory loss (pain and temperature) below the level of the cervical injury. For Richard C. Schneider the mechanism is a severe hyperextension injury and the anatomical finding indicate a central cord destruction with bleeding and hematomyelia. The pattern of the recovery is first return of the motor power in lower extremities; then bladder function and finally strength in the upper extremities reappears (finer finger movements coming back last). In our experience (28 cases) the incidence of the brachial diplegia is 20% of the cervical spinal cord injury and 31% of the incomplete cord lesions. The average age is 54 years. In the half of our cases hyperextension is the responsible mechanism and hyperflexion is present in one third of patients. Radiological findings indicate some vertebral displacement in 40% of cases and no patent loss of the bodies alignment in 28% of patients. Clinical investigations authorize the description of 4 clinical patterns: 1--Incomplete tetraplegia with more motor impairment of the upper extremities (57%), 2--Brachial diplegia (without loss of function of the lower limbs) 25%, 3--Brachial diparesis with total recovery (11%), 4--Incomplete cord lesions with Brown Sequard syndrome and brachial diplegia (7%). The review of the literature (Bohlman, Barraquer) and our anatomical findings show that central hematomyelia is not constant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Chance's fracture].

Described by Chance (1948) this fracture is induced by a mechanism of flexion distraction (seat belt fracture). The injury is characterized by the following (W.S. Smith, 1969): A disruption of the vertebral body by an horizontal splitting of this formation and neural arches through the pedicles, nor, or a minimum decrease in the anterior height of the involved vertebral body, no forward or lateral displacements of the superior vertebra, location of the disruption between the first and third lumbar vertebra in the majority of cases. Four patterns of Chance's fracture are isolated in this paper: First pattern: The osseous disruption cross the posterior arches, pedicles and vertebra. The fracture is unstable. Second pattern: horizontal fracture involves both pedicles with extension anteriorly through inferior third of the vertebral body (unstable). Third pattern: Chance's fracture with anterior vertebral extension through superior third of vertebra (unstable). Fourth pattern: fracture with anterior horizontal vertebral disruption in the posterior half of the body (stable).

Adult↗
PubMed1983

[Optochiasmatic diastasis in tumors with suprasellar extension and duplication of the chiasma].

The opto chiasmatic diastasis whose extreme form is a duplication of the chiasma, corresponds to a longitudinal cleavage, using the well known fasciculation of the optic fibres. It has been noticed four times in the sellar and para sellar expanding processes (two adenomas, one craniopharyngioma and one metastasis). Generally, this lesion of the chiasma goes with big tumors (grade II); it has been detected four times in frontal approaches (15%) while the rhinoseptal approach represents 85% of our cases. The diastasis of the optic fibers with tendency to form double chiasma, instead of being an exception, happens in 4% of sellars tumors. It is perfectly identified by the frontal surgical approach, but is really hard or impossible to be recognized by the rhinoseptal surgical way. The mechanisms and the prognosis of this lesion are discussed.

Adenoma, Chromophobe↗
PubMed1983

[Tear drop fractures. Contribution to the study of the mechanism of osteo-disco-ligamentous lesions].

Since the original description by Schneider (1956), the tear drop fracture is designated as a flexion fracture. The C.A.T. investigation proves the coexistence of two lines of fractures: a frontal fracture (by mechanism of flexion), a sagittal fracture (by compression). The sagittal fracture affects the body and the posterior arch in 48% of Lee's cases (1982) as Jefferson's fracture. The tear drop fracture is a fracture by mechanism of flexion-compression with sagittal sprain of the inter vertebral cervical disk. --In our experiences C5 is the level of the most frequent lesion. --4 types of tear drop fractures are described: an occult form (C.A.T. diagnosis), tear drop without displacement, tear drop with moderate displacement, tear drop with posterior dislocation and kyphosis greater than 20 degrees. --The spinal cord damage corresponds to displacement of the two half vertebral bodies and posterior dislocation. --In case with posterior dislocation and kyphosis greater than 20 degrees complete tetraplegia or anterior spinal cord injury are often presents. --In case with asymmetrical posterior displacement of an half vertebral body the syndrom of Brown Sequard is constant. --The tear drop fracture is unstable and cervical spine fusion necessary.

Biomechanical Phenomena↗