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Biomedical subjects

C Raftopoulos

Publications and source records attributed to C Raftopoulos.

At least 19 recordsLinked to original sources
PubMed2006

Neurosurgical management of inadequately embolized intracranial aneurysms: a series of 17 consecutive cases.

OBJECTIVE: Inadequately embolized aneurysms (IEA) are coiled aneurysms with a significant remnant (>5%), initially or after recanalisation, or with a coil extrusion deemed too thrombogenic or threatening the blood flow in the parent vessel. Our objective is to report our experience with the surgical clipping (SC) of a consecutive series of 17 IEA considered as not appropriate for an additional endovascular procedure. METHODS: Between February 1996 and April 2006, we evaluated 523 ICA in 380 patients of whom 192 underwent coil embolisation (CE), 117 with complete occlusion (61%), 47 with near complete occlusion (> or = 95%), 9 with partial occlusion (<95%), and 19 without any coil delivery (attempted embolisation). Of the 173 ICA embolized one or two times, at their radiological follow-up 15 (8.6%) were considered as IEA and not appropriate for an additional CE. Two IEA treated endovascularly before February 1996 were added to this series. The female/male ratio was 0.47 with an average age of 54 years (range, 37-65). All cases were located on the anterior circulation except the last one. The 17 IEA were treated by SC either because of an aneurysm remnant deemed not accessible to a further CE and large enough for direct clipping or because the risks of a thromboembolic event related to extruded coils was too high. RESULTS: SC was complete in all 17 cases, confirmed angiographically. Postoperatively, the clinical status of two patients deteriorated slightly but transiently. Our surgical experience with this series led us to classify IEA into five types, in three groups: group A (with one type: type A) was the most important group (n = 11) with IEA characterized by an aneurysm residue allowing direct SC, as assessed preoperatively; group B (n = 4) comprised aneurysms with a residue smaller than predicted and showing parent vessel stenosis when a clip was applied to the neck residue requiring the fundus full of coils to be removed followed by either clip application to the neck residue (type B1, n = 3) or suture if the remnant was too small (type B2, n = 1); and group C (n = 2) grouping cases requiring coil extraction through the parent vessel (type C2, n = 1) or through the fundus (type C2, n = 1). CONCLUSIONS: With this series of IEA, we observed that open surgery of type A and C aneurysms can be a straightforward procedure. Our experience with type B IEA encourages us to wait for a sufficient aneurysm residue before performing SC because of the potential difficulties that may be encountered by the surgeon, particularly in type B2. SC of IEA was very effective with complete occlusion and no permanent morbidity in all 17 cases.

Adult↗
PubMed2006

Unusual CT/MR features of putative ligamentum flavum ossification in a North African woman.

To display the unusual spinal CT and MR findings in a 48-year-old North African woman presenting with two adjacent intracanalar mineralized epidural outgrowths exhibiting mature bone organization with "cortical" and "trabecular" areas and pseudoarthritic changes at their interface. An unusual form of ligamentum flavum ossification (LFO) was speculated, of which features are discussed under the light of the available literature.

Female↗
PubMed2005

Microsurgical results with large vestibular schwannomas with preservation of facial and cochlear nerve function as the primary aim.

OBJECTIVE: To evaluate our microsurgical results in dealing with vestibular schwannomas (VS) greater than or equal to 30 mm when preservation of cranial nerve function was considered more important than total tumour removal. METHODS: Sixteen consecutive cases were operated on by the same neurosurgeon according to a prospective protocol using intraoperative neuro-monitoring (IONM) based on electromyographic and brain stem auditory evoked potential recordings. Facial nerve function was evaluated on the House-Brackmann Scale and cochlear nerve function on the Gardner-Robertson Scale. Someone not involved in the clinical management of our patients collected all data. RESULTS: Fifteen patients showed facial nerve (FN) function of House-Brackmann grade (HBG) I or II at one year postoperatively and one kept the HBG IV she had preoperatively. Two patients of four maintained a cochlear nerve function of Gardner-Robertson grade (GRG) II. The tumour excision rates were: total, 68.7%; near total, 6.3%; subtotal, 18.7%, and partial, 6.3%. The average follow-up was 55 months (1-106). Three patients underwent radiotherapy later with growth stabilisation and no additional morbidity. CONCLUSION: When dealing with VS greater than or equal to 30 mm, microsurgery guided by IONM, with a rate of total or near-total tumour excision of about 75%, can retain socially acceptable facial nerve function (HBG I or II) in all cases and serviceable hearing (GRG I or II) in two cases out of four. Maintaining serviceable cranial nerve function should take precedence over total tumour excision.

Adult↗
PubMed2005

Is surgical clipping becoming underused?

Coil embolization is a treatment for intracranial aneurysms with a particular appeal for posterior circulation aneurysms. However, although this procedure is effective in well-selected intracranial aneurysms, it has a series of limitations that may be overlooked as a result of its rapid technological evolution and its minimally invasive appearance. The author analyses the data that lead him to consider that since the introduction of coil embolisation in 1991 and its progressive diffusion, the technique of surgical clipping risks being underused as a therapeutic procedure for intracranial aneurysms because of the shortage of vascular neurosurgeons trained and experienced in its use.

Clinical Trials as Topic↗
PubMed2000

Spinal neurenteric cyst presenting in infancy with chronic fever and acute myelopathy.

The authors describe the clinical, radiologic, and pathologic features of a neonatal spinal neurenteric cyst (NC) presenting with long-lasting fever and acute myelopathy, and compare this observation with other infants reported in the literature. This observation shows that NC must be considered in the differential diagnosis of acute myelopathy with persistent fever in infancy. Fever is attributed to degenerative changes in the NC, triggering inflammatory cell infiltration and tumor necrosis factor alpha secretion.

Consanguinity↗
PubMed2000

Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option.

OBJECT: The aim of this study was to evaluate prospectively the results of treating cerebral aneurysms with coil embolization (CE) or with surgical clipping when CE was considered the first option. METHODS: Whenever an aneurysm was to be treated, CE was first considered by our neurovascular team. Surgical clipping was reserved for cases excluded from CE or cases in which CE failed. The study consisted of 103 consecutive patients with 132 aneurysms, of which 127 were treated. Coil embolization was performed using Guglielmi detachable coils, and surgery was performed using Zeppelin clips. Three groups were defined: Group A consisted of 64 aneurysms that were treated by CE (neck/sac ratio < 1:3); Group B, 63 aneurysms that were surgically clipped; and Group C, 12 aneurysms that failed to be satisfactorily (> or = 95%) embolized and were subsequently clipped. The percentages of residual aneurysm were 31.2% in Group A, 1.6% in Group B, and 0% in Group C. The percentages of patients with poor Glasgow Outcome Scale (GOS) scores (GOS Scores 1-3) were 13.3% in Group A, 6.1% in Group B, and 8.3% in Group C. The percentages of poor outcome (GOS Scores 1-3) in patients with good clinical status before treatment were 10.7% in Group A, 0% in Group B, and 8.3% in Group C. CONCLUSIONS: Even with preselection, CE remains associated with a significant number of treatment failures and poor outcomes, even in patients with good preoperative clinical status. Surgical clipping can offer better results than CE, even for more complex aneurysms of the anterior circulation, especially for those involving the middle cerebral artery cases. However, because CE can be effective and causes less stress and invasiveness for the patient, it should be considered first in aneurysms strictly selected by a neurovascular team.

Adult↗
PubMed1999

Diffusion-weighted MRI postoperative assessment of an epidermoid tumour in the cerebellopontine angle.

Cerebellopontine angle epidermoid tumour generally has a typical appearance with conventional MRI sequences. The lesion is irregular in shape and gives slightly higher signal than cerebrospinal fluid on T1- and T2-weighted images, with a characteristic marbled inner pattern on T1-weighted images. Diffusion-weighted imaging (DWI) can be useful for the diagnosis of an atypical epidermoid tumour. Our case report illustrates the usefulness of DWI for postoperative assessment of residual foci of tumour. The specific appearance of an epidermoid tumour is illustrated, with emphasis on apparent diffusion coefficient (ADC) measurements.

Adult↗
PubMed1999

Coronary heart disease risk factors in male adolescents, with particular reference to smoking and blood lipids.

PURPOSE: To examine coronary heart disease (CHD) risk factors, particularly blood lipids and smoking, in adolescent boys in the Sydney Metropolitan area, and to investigate possible differences between boys from English-speaking (ESB) and non-English-speaking backgrounds (NESBs). METHODS: Male volunteers aged 15-18 years were recruited from the senior years of four secondary schools in different geographical areas of Sydney. Body mass index (BMI), waist-hip ratio (WHR), blood lipids, and percent body fat were measured. Behavioral variables were estimated by questionnaire. RESULTS: A total of 110 boys were recruited; 74% were from an ESB. Mean WHR (0.836 +/- 0.045), waist circumference (80.6 +/- 9.4 cm), and percent body fat (21.0 +/- 6.3) were similar across age groups. Atherogenicity of the lipid profile, as measured by the ratio of total cholesterol to high-density lipoprotein cholesterol (TC:HDL-C), was lower in boys aged 15 years than in any other age group (p < .05). TC:HDL-C was strongly associated with BMI (r = .57; p < .0001) and WHR (r = .35; p < .01). Smokers had higher BMI, were less active and had lower HDL-C (p < .001) and higher TC:HDL-C (p < .0001) than nonsmokers. Smoking, even of short duration, and quite moderate consumption of cigarettes (6/day) were associated with a deterioration of the lipid profile. Boys from NESBs had a higher degree of risk in all of the factors examined. CONCLUSIONS: Regular smoking of short duration has an appreciable impact on lipid and lipoprotein concentrations in this sample of Australian adolescent boys. Boys from an NESB appear to be at greater risk of developing CHD in later life.

Adolescent↗
PubMed1999

Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients.

Cabergoline is a new long-acting dopamine agonist that is very effective and well tolerated in patients with pathological hyperprolactinemia. The aim of this study was to examine, in a very large number of hyperprolactinemic patients, the ability to normalize PRL levels with cabergoline, to determine the effective dose and tolerance, and to assess the effect on clinical symptoms, tumor shrinkage, and visual field abnormalities. We also evaluated the effects of cabergoline in a large subgroup of patients with bromocriptine intolerance or -resistance. We retrospectively reviewed the files of 455 patients (102 males and 353 females) with pathological hyperprolactinemia treated with cabergoline in 9 Belgian centers. Among these patients, 41% had a microadenoma; 42%, a macroadenoma; 16%, idiopathic hyperprolactinemia; and 1%, an empty sella. The median pretreatment serum PRL level was 124 microg/L (range, 16-26,250 microg/L). A subgroup of 292 patients had previously been treated with bromocriptine, of which 140 showed bromocriptine intolerance and 58 showed bromocriptine resistance. Treatment with cabergoline normalized serum PRL levels in 86% of all patients: in 92% of 244 patients with idiopathic hyperprolactinemia or a microprolactinoma and in 77% of 181 macroadenomas. Pretreatment visual field abnormalities normalized in 70% of patients, and tumor shrinkage was seen in 67% of cases. Side effects were noted in 13% of patients, but only 3.9% discontinued therapy because of side effects. The median dose of cabergoline at the start of therapy was 1.0 mg/week but could be reduced to 0.5 mg/week once control was achieved. Patients with a macroprolactinoma needed a higher median cabergoline dose, compared with those with idiopathic hyperprolactinemia or a microprolactinoma: 1.0 mg/week vs. 0.5 mg/week, although a large overlap existed between these groups. Twenty-seven women treated with cabergoline became pregnant, and 25 delivered a healthy child. One patient had an intended abortion and another a miscarriage. In the patients with bromocriptine intolerance, normalization of PRL was reached in 84% of cases, whereas in the bromocriptine-resistant patients, PRL could be normalized in 70%. We confirmed, in a large-scale retrospective study, the high efficacy and tolerability of cabergoline in the treatment of pathological hyperprolactinemia, leaving few patients with unacceptable side effects or inadequate clinical response. Patients with idiopathic hyperprolactinemia or a microprolactinoma, on average, needed only half the dose of cabergoline as those with macroprolactinomas and have a higher chance of obtaining PRL normalization. Cabergoline also normalized PRL in the majority of patients with known bromocriptine intolerance or -resistance. Once PRL secretion was adequately controlled, the dose of cabergoline could often be significantly decreased, which further reduced costs of therapy.

Adenoma↗
PubMed1998

Visual sensations produced by optic nerve stimulation using an implanted self-sizing spiral cuff electrode.

A blind volunteer with retinitis pigmentosa was chronically implanted with a self-sizing spiral cuff electrode around an optic nerve. Electrical stimuli applied to the nerve produced localized visual sensations that were broadly distributed throughout the visual field and could be varied by changing the stimulating conditions. These results demonstrate the potential for constructing a visual prosthesis, based on electrical stimulation of the optic nerve, for blind subjects who have intact retinal ganglion cells.

Electric Stimulation↗
PubMed1998

Pre- and peroperative misdiagnosed sellar tumour.

We describe the case of a 76-year old woman complaining of headaches and progressive sight loss. Cerebral CT scan and MRI disclosed a large sellar tumour. Endocrine evaluation showed no evidence of pituitary hypersecretion, but a slight hyperprolactinemia related to stalk compression. A non-functioning pituitary adenoma was suspected. The pathological diagnosis was however a meningioma. In the literature, about 5% of sellar tumours are not pituitary adenomas and this is an alternate diagnosis to consider in the presence of non-secreting macroadenomas.

Adenoma↗
PubMed1996

Slow increase of homovanillic acid in cerebrospinal fluid after levodopa administration.

Concentrations of major catabolites of dopamine were followed in the ventricular cerebrospinal fluid (CSF) in five patients undergoing intracranial pressure monitoring for chronic hydrocephalus. Determinations were made every 2 h following the administration of carbidopa/levodopa 25/250 mg (one Sinemet capsule) given 8 h apart. The rise of homovanillic acid (HVA) concentrations was slow and progressive, reaching the level of statistical significance (p < or = 0.01) only 8 h after the second administration of Sinemet. The rise in 3,4-dihydroxyphenylacetic acid (DOPAC) was faster than the rise in HVA, with the peak value detected 4 h after the first administration of Sinemet. These data are interpreted as a confirmation, in humans, of a slow pool of exogenous levodopa, previously demonstrated in animal studies.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1996

Cranial disjunction and visual failure in a slit ventricle syndrome with patent shunt.

A 6.5-year-old child who received a shunt at 3 weeks of age for triventricular hydrocephalus related to his congenital toxoplasmosis developed symptoms of intracranial hypertension and papilloedema. Computed tomographic scan demonstrated slit ventricles. The shunt device was shown to be patent on isotope transit study. Spontaneously the cranial sutures widened and headaches disappeared, but loss of vision occurred and did not reverse despite optic nerve sheath fenestration. We suspect that a rapid drop in intracranial pressure played a role in the pathogenesis of our patient's blindness. This possible complication should be taken into account when calvarial expansion is planned in a patient with an intracranial hypertension syndrome with papilloedema in the presence of slit ventricles and a patent shunt.

Blindness↗
PubMed1996

Anterior fontanelle pressure monitoring for the evaluation of asymptomatic infants with increased head growth rate.

We studied non-invasive intracranial pressure monitoring in 20 asymptomatic infants with increased head growth rate. Both basal anterior fontanelle pressure (AFP) traces and occurrence of pressure waves were analysed and compared with normal range values previously established. Eight recordings were classified as pathological; cerebral imaging showed subdural collections or ventricular dilatation in all cases. Five out of these eight infants further developed neurological deficits and/or increase of the ventricular size, and required neurosurgical procedures. Twelve infants had normal AFP traces; six of these had normal cerebral imaging and six showed enlargement of subarachnoid spaces with normal ventricles. All of these 12 patients normalised their head growth rate and remained asymptomatic. This observation suggests that AFP monitoring may be helpful in asymptomatic infants with increased head growth rate to identify a progressive intracranial process and the potential need for a neurosurgical procedure.

Child Development↗
PubMed1996

Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus.

From 1986 to 1989, 23 adult patients (average age, 70 yr) with idiopathic chronic hydrocephalus received shunts with medium-pressure Pudenz-Schulte valves for suspected normal pressure hydrocephalus. Prospective clinical and computed tomographic monitoring was continued for at least 5 years. We observed the formation of a hypodense subdural collection in each of 10 patients (43%). Those collections that occurred early, i.e., within the first 9 postoperative days, evolved differently from those that occurred late; only early hypodense collections became subdural hematomas (three cases). In one case, a subdural hematoma was already present 9 days after surgery, so that four patients (17%) presented a subdural hematoma within the first 2 postoperative months. Our long-term follow-up revealed three patients (13%) with hypodense subdural collections, which appeared more than 2 months after surgery. None of the collection evolved into a subdural hematoma. Thirteen patients (57%) died between 9 and 68 months (average, 20 mo) after surgery, most often of an ischemic stroke. During the 1st postoperative year, there was improvement in the condition of 22 patients (96%) who had received a ventricular shunt; 21 of these patients (91%) remained improved until death or for at least 5 years.

Aged↗
PubMed1995

Peripheral and central pharmacokinetics of apomorphine and its effect on dopamine metabolism in humans.

Apomorphine is a dopamine receptor agonist increasingly used in the treatment of Parkinson's disease (PD). In the present study, we examined the plasma and ventricular cerebrospinal fluid (CSF) pharmacokinetics of apomorphine as well as its effects on dopamine metabolism in six patients (one woman and five men, mean age 79.5 years) without evidence of PD who underwent 48-h intracranial pressure monitoring for suspected normal pressure hydrocephalus. Maximal plasma apomorphine concentration (25.04 ng/ml) is found 20 min after subcutaneous injection (50 micrograms/kg), and the mean area under the curve is 1,439.37 ng/ml for 120 min. In contrast to plasma values, the maximal ventricular CSF apomorphine concentration (1.08 ng/ml) is found 30 min after injection and the mean area under that curve is 7% of that of plasma (96.69 ng/ml for 120 min). Apomorphine administration causes a significant reduction in ventricular CSF concentrations of dopamine and of its major metabolites sulfoconjugated dopamine, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA). This effect starts 10 min after the injection of apomorphine, is maximal after 30 min (free dopamine, -30%; sulfoconjugated dopamine, -28%; HVA, -21%; DOPAC, -31%) and is still present, although to a lesser extent (-5 to -10%), 120 min after the injection of apomorphine. This study shows that in humans a dose of apomorphine commonly used in PD causes significant inhibition of dopamine metabolism lasting > 120 min. In addition to their symptomatic effects, dopamine agonists such as apomorphine may play a role in preventing or slowing the neurodegeneration in PD by autoreceptor-mediated inhibition of dopamine metabolism.

3,4-Dihydroxyphenylacetic Acid↗