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C Lapras

Publications and source records attributed to C Lapras.

At least 37 records · Page 2Linked to original sources
PubMed1994

Tectal plate gliomas. Part I: Microsurgery of the tectal plate gliomas.

A series of 12 patients with tectal plate gliomas, is presented treated by direct surgery. Mean age was 19 years. All patients presented with signs of raised intracranial pressure and supratentorial hydrocephalus on CT scan. Diplopia was the most common local sign. CT scan and MR imaging showed 4 intrinsic, 6 exophytic, and 2 ventrally infiltrating tectal tumours. The histological diagnosis was low-grade astrocytoma in 7, high-grade astrocytoma in 2, oligodendroglioma in one, oligo-astrocytoma in one, and ependymoma in one case. The suboccipital supra- and transtentorial approach was used in every cases. Tumour resection was generous at the level of the superior colliculi, but on the contrary, resection was limited at the level of inferior colliculi due to the auditory risk. Tumour removal was total (macroscopically) in 9 cases and partial in 3 cases. There were 4 surgical complications and one death related to surgery. Parinaud's syndrome was the most-common postoperative sequelae. Auditory hallucinations and the acoustic neglect syndrome were seen once. In three cases additional radiotherapy and chemotherapy were given once with severe sequelae. The treatment of tectal plate gliomas is controversial. The role of different therapeutic options remains open. We consider the tectal plate as a relatively safer territory for surgery than the ventral part of the midbrain. The brain stem auditory evoked potentials (BAEPs) and middle latency potentials (MLPs) monitoring can help to determine the appropriate limit of surgery.

Adolescent↗
PubMed1994

Tectal plate gliomas. Part II: CT scans and MR imaging of tectal gliomas.

CT scans and MR images were analyzed in 12 patients with histologically proved tectal plate gliomas. In an attempt to identify the nature of these lesions, their radiological characteristics were correlated with the histological results. In four of our patients CT scan failed to show the tumour. MR imaging demonstrated the tectal distortion in all cases. Contrast enhancement, calcification, cystic portions, exophytic nature were observed in both high and low-grade gliomas. We conclude that in the case of intrinsic tectal tumours, the most probable diagnosis is that of low-grade astrocytoma while in the case of exophytic tectal tumours, the differential diagnosis from pineal region tumour is required and a histological verification is necessary.

Adolescent↗
PubMed1994

Tectal plate gliomas. Part III: Apparent lack of auditory consequences of unilateral inferior collicular lesion due to localized glioma surgery.

The authors present one of their cases operated on for intrinsic tectal plate glioma. The complete resection of the right inferior colliculus (I.C.) had no apparent auditory consequences. The pre- and post-operative tonal and vocal auditory tests were normal. The brain-stem auditory evoked potentials (BAEPs) and middle latency potentials (MLPs) were recorded pre-, post- and intraoperatively. At the end of surgery all waves were present with a marked delay of wave V and a slight delay of the Pa component. The dichotic test showed a significant right ear extinction but admittedly much less important than expected. The role of inferior colliculus (I.C.) in hearing is discussed.

Astrocytoma↗
PubMed1994

Auditory early- and middle-latency evoked potentials in patients with quadrigeminal plate tumors.

Both early auditory evoked potentials (BAEPs) and middle-latency auditory evoked potentials (MLAEPs), were recorded in nine patients suffering from a quadrigeminal plate tumor. These recordings were performed before surgery in six cases and after surgery in three cases. The results of these examinations were correlated with impairments of the midbrain auditory pathways as shown by magnetic resonance imaging. BAEPs and MLAEPs were abnormal in five of nine cases and eight of nine cases, respectively. The two examinations yielded normal results in only one case. These data show that the functional evaluation of the midbrain should not be limited to the recording of BAEPs, routinely performed for brain stem functional evaluation, but should also include recording of MLAEPs, although the technique is a little more delicate. In the five patients with abnormal BAEPs, I-V conduction time was increased unilaterally (three patients) and bilaterally (two patients), and the I/V amplitude ratio was abnormal in two patients. In one of these two patients, isolated destruction of the right inferior colliculus was responsible for an abnormality affecting Wave V of the BAEP that was visible only after left ear stimulation. The most frequently observed MLAEP abnormality was a delay in the peaking of the Pa component, assumed to be of cortical origin. Therefore, a limited impairment of the midbrain may delay the peaking latency of Pa. Unilateral hypovoltage of Na-Pa was also observed. In only one case were Na and Pa components unilaterally abolished, in a patient suffering from a postoperative lesion extending from the right inferior colliculus to the right medial geniculate body.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Medulloblastoma in adults: survival and prognostic factors.

The authors report a series of 30 adults with medulloblastoma treated after surgery between 1975 and 1990. Half the patients presented a classical medulloblastoma and the other half presented desmoplastic medulloblastoma. Brainstem infiltration was noted in 3 patients, cerebellar peduncle infiltration in 6 cases and 4 patients had cerebrospinal fluid (CSF) involvement. Tumor resection was achieved in all patients except 1, and in 5 surgery was incomplete. All patients but 2 received postoperative cerebral radiotherapy. Six patients did not receive chemotherapy before radiotherapy, 7 patients received CCNU-Vincristine concomitantly with and after irradiation, 1 patient was given a CHOP regimen, and the remaining 16 patients received the 8 drugs in a 1-day (8/1) regimen before irradiation. The median follow-up time was 104 months. The 5- and 10-year overall survival rates were 58.5% and 41%, respectively. Two toxic deaths occurred under the 8/1 regimen, and no better survival was observed for this group of patients in comparison with those receiving other regimens. Persistence of malignant cells in the CSF, brainstem involvement, cerebellar peduncle infiltration, non-radical surgery and a postoperative performance status (PS) of more than 2 were significantly correlated with an adverse outcome for overall survival in adult patients with medulloblastoma.

Adolescent↗
PubMed1993

[S. aureus neuromeningeal infection in 3 children with ventricular shunts without cytochemical changes in the lumbar cerebrospinal fluid].

The authors report on three cases of staphylococcal cerebrospinal fluid (CSF) infection with normal white blood cell count and normal CSF glucose level in repeated lumbar CSF examination. All three children (2 months, 17 months and 4 years old) have been operated for neonatal hydrocephalus with setting of a ventriculo-peritoneal shunt one to two months before. Infection was suspected because of fever without evocative clinical signs. In two cases plasma C reactive protein level was increased, and in all three cases a leucocytosis was present. The diagnosis was made by bacteriological examination of the ventricular CSF. Both surgical and medical management were required and the bacteriological outcome was favourable. Since neurological sequellae may occur if the treatment is delayed such atypical infection needs to be promptly assessed.

Fever↗
PubMed1993

[Hemodynamic study of acute neurogenic pulmonary edema in children].

Acute neurogenic pulmonary edema (NPE) can dramatically complicate a serious brain injury. From bibliographic data and four personal cases documented by and haemodynamical study, the authors analyse the pathophysiological mechanisms and the haemodynamical changes resulting from massive sympathic outflow, the main mechanism of NPE being haemodynamical rather than lesional. This rare complication needs to be recognized in order to undergo an intensive care treatment generally leading to a favourable evolution. This treatment lies on circulatory and ventilatory supports with positive and expiratory pressure in order to maintain an optimal oxygenation and an optimal cerebral perfusion pressure. With this treatment the outcome of NPE is usually favourable with complete recovery within 2 to 5 days.

Acute Disease↗
PubMed1992

M4 protocol for cerebellar medulloblastoma: supratentorial radiotherapy may not be avoided.

The main goal of the M4 protocol was to evaluate the efficacy of treatment excluding supratentorial radiation in patients with newly diagnosed medulloblastoma. All patients underwent surgical resection and received postoperative chemotherapy. Chemotherapy was adapted to the initial staging and prognostic factors (Group A: good-risk; Group B: poor-risk). Chemotherapy was started early after surgery, and consisted of two courses of the "eight drug in one day" regimen and two courses of high dose methotrexate. Radiotherapy was delayed until 5 (Group B) to 7 (Group A) weeks after the first course of chemotherapy. Radiotherapy was administered only to the posterior fossa and the spinal axis. Only 3/16 patients (18%) are alive and disease-free with a mean follow up of 6 years. The site of progression was supratentorial in 9 out of 13 patients and three patients had spinal and/or cerebrospinal fluid relapses. Only one patient had isolated posterior fossa relapse. The mean time to relapse was 484 days. We conclude that the chemotherapy regimens used in the M4 protocol do not allow the reduction of irradiation fields in patients with cerebellar medulloblastoma. In spite of long-term side effects on neurocognitive functions, supratentorial radiotherapy should remain a major component of medulloblastoma treatment.

Adolescent↗
PubMed1992

In vitro karyotypic and immunophenotypic characterisation of primitive neuroectodermal tumours: similarities to malignant gliomas.

Monoclonal antibody (Mab) mediated immunotherapy of brain tumours requires the identification of tumour-restricted cell surface antigens. We have characterised four primitive neuroectodermal tumours, which included pineoblastoma, medulloblastoma and ependymoblastoma cultures, that demonstrated in vitro evidence of malignant behaviour (anchorage-independent growth and nu/nu xenograft tumour formation). The cytogenetic findings ranged from normal G-banded and Q-banded karyotypes through mixed near-diploid/hyperdiploid. These cultures resembled the cell surface immunophenotypic spectrum of malignant gliomas. They were distinguished from normal glia in vitro by the expression of restricted fetal mesenchymal, neuronal, myoblastic, melanocytic, epidermal, chondrocytic, lymphoid and epithelial antigens. Certain antigens appeared sufficiently represented among central nervous system (CNS) neoplasms to afford potential targets for Mab-mediated immunotherapy.

Adolescent↗
PubMed1992

Results of surgical treatment for cervicobrachial neuralgia. A retrospective study of 122 patients with long-term follow-up.

Surgical nerve root decompression is rarely needed in the treatment of cervicobrachial neuralgia. In patients with prolonged and resistant pain or neurological deficits, or when signs of associated spinal cord suffering have been found, various surgical procedures can be used, but is most cases the disco-arthro-radicular conflict can be solved by the anterior approach with or without bone graft. This review of long-term résults in a series of 122 patients operated upon and re-examined more than 3 years later shows that the radicular symptoms were relieved in 95% of the cases. Evaluation of anatomical results did not reveal any instability or aggravation of discarthrosis at the site of surgery. However, in 30% of the cases disc degeneration was increased in the over- and underlying levels but without recurrence of clinical symptoms; 4% of the patients in this series were reoperated upon for this aggravated or de novo disc disease. The authors underline the importance of a thorough radioanatomical examination not only to decide whether or not a "soft hernia" or an arthrotic hypertrophy should be operated, but also to evaluate the extent of the decompressive operation to be performed.

Adult↗
PubMed1992

MRI in Sturge-Weber syndrome.

Five children (3 girls, 2 boys, aged from 1 to 18 years) presenting with Sturge-Weber syndrome were explored by MRI with contrast injection in 2 cases. The respective positions of CT and MRI are discussed: CT is the method of choice to display leptomeningeal calcifications. MRI seems to be more accurate than CT to determine the location of the lesions and to demonstrate the enhancement of the angioma after contrast injection.

Adolescent↗
PubMed1991

The carotid endarterectomy: experience with 260 cases and discussion of the indications.

During 1978 to 1989, 235 patients were operated upon with 260 procedures for cervical carotid endarterectomy. The patients were classified according to the presence or absence of ischaemic symptomatology, and for symptomatic patients, according to the reversibility or persistence of ischaemic symptoms. So the selection of patients was: reversible ischaemia 46%, stroke 29%, asymptomatic patients 25%. In the stroke group, no patient was operated on as an emergency, the endarterectomy was only performed after stabilization of the clinical state. Three subgroups were included in patients operated on for asymptomatic carotid stenosis: casual discovery 40%, treatment of the second carotid artery (previous endarterectomy for symptomatic contralateral stenosis) 34%, and treatment of the second carotid artery (previous ECIC by-pass for contralateral carotid occlusion) 26%. All patients were operated upon after angiographic exploration (femoral catheterisation in most cases), and after cerebral CT scan. The surgical technique included general anaesthesia, systematic shunting, endarterectomy after longitudinal arteriotomy, closure without patch. The operating microscope has been used since 1985. The surgical results were studied in terms of uneventful postoperative course (87%), reversible complications (8%) and long lasting complications (5%). The long lasting complications were of local origin (1%), of neurological origin (2%), of general origin (1%). Overall the operative outcome at 6 months was: return to previous clinical state 95%, neurological sequelae 2%, death 3%. In the patients operated on for asymptomatic carotid stenosis the overall outcome was: previous clinical state 97%, death 3%. The legitimacy of carotid endarterectomy procedure is discussed in relation to some recent pertinent literature.

Adult↗
PubMed1991

[Hemispheric tumors].

Despite great histological polymorphism, clinical features of supratentorial brain tumors are mainly limited to neurological deficit, and focal epilepsy and/or symptoms secondary to raised intracranial pressure. The treatment relies on surgery and radiotherapy; chemotherapy has not yet demonstrated its efficacy. Failures are explained by the limitation of neurosurgery, and by the toxicity of the radiotherapy that precludes the use of high dosages. Some good vital results are hampered by neuropsychic sequellae.

Brain Neoplasms↗
PubMed1991

[Cervical carotid endarterectomy. Evaluation of a 12 years' experience (260 operations)].

From 1978 to 1989, 235 patients were operated upon with 260 procedures for cervical carotid endarterectomy. The patients were classified according to the presence or absence of ischemic symptomatology, and for symptomatic patients, according to the reversibility or persistence of ischemic symptoms. So the selection of patients was: reversible ischemia 46%, stroke 29%, asymptomatic patients 25%. In the stroke group, no patient was operated on in emergency, the endarterectomy was performed after stabilization of the patients. Three subgroups were included in patients operated on for asymptomatic carotid stenosis: casual discovery 40%, treatment of the second carotid artery (previous endarterectomy for symptomatic controlateral carotid artery) 34%, and treatment of the second carotid artery (previous ECIC Bypass for controlateral occluded artery) 26%. All patients were operated upon after angiographic exploration (femoral catheterism in most cases), and after cerebral CT Scan. The surgical technique included general anesthesia, systematic shunting, endarterectomy after longitudinal arteriotomy, closure without patch. The operative microscope has been used since 1985. The operatives results were studied in terms of uneventful post-operative course (87.3%), reversible complications (8.1%) and long lasting complications (4.6%). The long lasting complications were of local origin (1.1%), of neurological origin (2.3%), of general origin (1.2%). Overall the operative results at 6 months were: return to previous clinical state 95.4%, neurological sequellae 1.5%, deaths 3.1%. In patients operated on for asymptomatic carotid stenosis the overall results were: previous clinical state 97%, death 3%. The legitimy of carotid endarterectomy procedure is discussed in view of some recent pertinent literature.

Adult↗
PubMed1989

[Brain tumors in infants].

In 76 of 575 children operated on for intracranial tumors during a 15 year period, symptoms had started during the first 2 years of life. Excision of the tumor was complete in 44, subtotal in 13, partial in 13, and in 6 only a biopsy was taken. Surgical mortality was 13% (10/76). 31 died later as their tumors progressed. The overall survival rate was 46% and 27 of the survivors are leading useful lives, with no signs of recurrence, 8 months to 14 years after operation. All of these had total or subtotal removal of the tumor. Only 3 required oncologic treatment. Despite radical surgery, the late neuropsychological results were good. However, 8 children who had had brain irradiation are severely handicapped. We conclude that in infancy functional recovery from a focal surgical lesion, even if extensive, is more complete than after diffuse damage to the immature central nervous system caused by irradiation. In this age group brain irradiation leads to severe handicapping in the great majority of cases. Radiotherapy should therefore be used only for highly malignant tumors, especially when surgical excision is incomplete. Radical surgery gives the best results in terms of survival and satisfactory neuropsychological state.

Brain↗