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Biomedical subjects

C Raftopoulos

Publications and source records attributed to C Raftopoulos.

At least 37 records · Page 2Linked to original sources
PubMed1995

Evaluation of endoscopy in the treatment of rare meningoceles: preliminary results.

BACKGROUND: Endoscopy is used on different occasions-for instance, to open the floor of the third ventricule in triventricular hydrocephalus, to open a cyst into the cerebrospinal fluid circulation, for biopsy or for partial resection of some tumors, or to insert a shunt in hydrocephalus or syringohydromyelia. However, the use of endoscopes for evaluating and treating meningoceles remains to be assessed. METHODS: Five different kinds of rare meningoceles are presented. In each, neuroendoscopy was used as the main tool for exploration and treatment. RESULTS: Two sacral meningoceles and one oral cephalocele were cured through a keyhole opening under endoscopic control. One posterior sacral meningocele was explored and no communication with normal subarachnoid spaces was observed, allowing a simple suture of the posterior to the anterior walls. And, last, a complex case with three intrasacral meningocles was explored and partially treated. CONCLUSIONS: Meningocles with very small communication within the normal subarachnoid spaces appeared the most suitable to be cured by an endoscopic procedure. In case of a larger communication, the meningocele could be treated, or at least the morphology can be better understood, by using a keyhole procedure under endoscopic control. In all cases the surgery was of short duration (less than 1 hour) and very well tolerated.

Adolescent↗
PubMed1995

[Subarachnoid hemorrhage in patients over 65 years of age. Retrospective study of 72 patients including 65 cases of aneurysmal origin].

For this study, we reviewed a series of 564 consecutive SAH among which 72 cases (12.7%) were older than 65 years. Etiology of SAH was: arterial aneurysms (65), arteriovenous malformations (1), unknown origin (6). Among the 65 aneurysms, 28 operated cases were between 65-69 years old. One year after surgery, the results are: GOS 1 and 2: 22 cases (57%); GOS 3: 4 cases; GOS 5: 13 cases. In the non operated group, 19 cases died (73%) and among the alive patients, one was GOS 2 (4%), 5 GOS 3 and 1 GOS 4. In the operated group, mortality is similar to other published series. In the non operated group, mortality is unsurprisingly higher (73%) than in the operated group, but also than in the literature. An explanation could be found with analyses of the income of our patient whose many are not referred cases from other hospital. Our analysis confirmed that the severity of SAH after 65 years is increasing. The raise of anterior communicating aneurysms location is demonstrated. Operative indication and timing are dependent of neurological grading, general condition and secondarily of the location and anatomy of the aneurysm.

Age Factors↗
PubMed1994

Total recuperation in a case of sudden total paraplegia due to an aneurysmal bone cyst of the thoracic spine.

A 3-year-old girl developed sudden complete paraplegia because of an aneurysmal bone cyst of the fourth thoracic vertebra. We performed a two-step surgical procedure resulting in complete neurological recuperation and no cyst recurrence within 2.5-year follow-up. Although the literature shows the prognosis of such a condition to be poor, this case reveals the positive effect of rapid surgical decompression and of postponing assessment by magnetic resonance imaging until before the second surgical stage. Furthermore, this case is an example of cure with neither interbody fusion nor postoperative radiotherapy, despite the total involvement of the vertebrae by the lesion.

Bone Cysts, Aneurysmal↗
PubMed1994

Upper cervical spinal cord compression due to bony stenosis of the spinal canal.

Compression of the upper cervical spinal cord due to stenosis of the bony spinal canal is infrequent. In the first case reported here, stenosis was due to acquired extensive, unilateral osteophytes centered on the left apophyseal joints of C1-C2 in an elderly professional violinist. In the second case, stenosis was secondary to isolated congenital hypertrophy of the laminae of C1 and C2.

Adult↗
PubMed1994

Brain oedema induced by ventricular puncture. A study by magnetic resonance on a series of forty-one normal-pressure hydrocephalic patients.

After ventricular catheterization magnetic resonance (MR) imaging very often demonstrates a focal area of high signal along the drain track which corresponds to parenchymal oedema. This high signal seemed to be more pronounced when the frontal area was catheterized than when the junctional parieto-temporo-occipital parenchyma (or trigonal area) was catheterized. In order to confirm this impression, we prospectively studied 41 consecutive patients with normal-pressure hydrocephalus in whom both of these brain regions were catheterized for intracranial pressure monitoring. Each patient was evaluated by serial MR. The extent of the MR hypersignal induced by both catheterizations was computed from digitized MR masks. The extent of the MR high signal area was significantly greater when the frontal area was catheterized compared to the trigonal area suggesting that the frontal area could be more prone to injury.

Adult↗
PubMed1994

Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study.

Idiopathic normal-pressure hydrocephalus remains difficult to treat. Controversy exists as to whether or not shunting can really improve cognitive functions and whether quantified intracranial pressure monitoring (ICP-Mo) can predict postoperative improvement rates. Several studies have drawn attention to the lack of a prospective study concerning the surgical outcome of this condition. We have performed such a study on idiopathic normal-pressure hydrocephalus patients shunted on the basis of ICP-Mo when "high" waves (amplitude > 9 mm Hg) were present. Twenty-three patients underwent surgery. The preoperative and postoperative clinical states were assessed by a quantitative procedure blind to the ICP-Mo results. A clear postshunting improvement was seen in 96% of the patients at 1 year with a statistically significant correlation between high wave relative frequency and the grade of improvement (P < 0.05). At the same time, 66.6% of shunted patients showed a significant improvement in cognitive functions. Complications of shunting were successfully managed without residual deficits in this series. We recommend the use of quantitative ICP-Mo as a criterion for surgery and to predict the improvement grade.

Aged↗
PubMed1994

Endoscopic treatment of an oral cephalocele. Case report.

This report describes an unusual cephalocele originating in the temporobasal region and protruding through the sphenopetral area into the oral cavity. A rapid and nonaggressive endoscopic procedure was performed. The relationship between this type of cephalocele, spontaneous anteroinferior temporal encephaloceles, and nasopharyngeal brain heterotopia is discussed.

Cranial Sutures↗
PubMed1994

[Paretic syndrome of spinal stenosis].

We report a case of painless progressive leg amyotrophy without intermittent claudication due to spinal lumbar stenosis. Our attention was drawn to the lumbar region because of the discrepancy between normal leg sensory potentials and altered somatosensory evoked potentials, prompting us to perform a myelography. The rapid though partial, clinical improvement following decompressive surgery suggested that some of the symptoms may have been due to a reversible nerve conduction block.

Aged↗
PubMed1993

MRI in seven cases of Rathke's cleft cyst in infants and children.

Seven MRI observations of presumed Rathke's cleft cysts in infants and children are reported. Age ranged between 6 months and 13 years. Size of the cysts ranged between 4 and 20 mm. While 3 small cysts were detected incidentally, 4 were large enough to cause symptoms secondary to compression of the pituitary gland and suprasellar components. The MRI appearance of the Rathke's cleft cysts varied according to their nature. MRI provides a major contribution to the diagnosis of these lesions; nevertheless, it often remains difficult to differentiate complex Rathke's cleft cysts from cystic craniopharyngiomas. The difficulties related to this differentiation are discussed.

Adolescent↗
PubMed1993

Hydrosyringomyelia-Chiari I complex. Prospective evaluation of a modified foramen magnum decompression procedure: preliminary results.

A modified foramen magnum decompression procedure, designed to respect the subarachnoid spaces as much as possible, was prospectively evaluated in eight consecutive patients with a progressive clinical syndrome related to hydrosyringomyelia-Chiari I complex. This evaluation included quantitative clinical and magnetic resonance follow-up of at least 1 year in the first six patients and 6 months for the last two. Magnetic resonance scans at 6 months or more confirmed a persistent reduction of the hydrosyringomyelic cavity in all cases, which was associated with obvious subjective improvement. All patients have maintained this improvement. The operative technique and methods of clinical and radiological follow-up are discussed.

Adolescent↗
PubMed1993

Cylindrical spinal meningioma. A case report.

A case of cylindrical spinal meningioma is reported. This most unusual morphology suggested a preoperative diagnosis of either lymphoma, metastatic epidural tumor, or meningioma. At operation, the tumor was found to be hard and extremely adherent to the cord, so its anterior part had to be left in place. Transient paraplegia was observed postoperatively, but the patient recovered normal stance and gait within 6 months. Three years after the operation, magnetic resonance imaging demonstrated a very slow progression of the remaining tumor with an estimated increase of 5%. The differential diagnosis of this lesion by magnetic resonance, its clinical postoperative evolution, and the surgical strategy are discussed.

Aged↗
PubMed1993

Non-invasive measurement of intracranial pressure in the newborn and the infant: the Rotterdam teletransducer.

Knowledge of intracranial pressure may be important in many clinical situations in neonates and young infants. The best way to obtain this information would be a non-traumatic procedure. In order to test the reliability of a new fontanometer, the Rotterdam teletransducer, 25 simultaneous measurements of cerebrospinal fluid (CSF) pressure and anterior fontanelle pressure (AFP) were performed. Mean (SD) difference between CSF pressure and AFP was -0.2 (1.8) mm Hg (95% confidence interval from -0.48 to -0.88 mm Hg). The AFP was also measured in 60 healthy children (15 premature, 30 term newborn babies, and 15 infants). The different aspects of AFP were analysed and normal values computed. These results suggest that the Rotterdam teletransducer gives reliable continuous information about intracranial pressure and can be used in clinical practice. Interpretation of AFP plots must take the influence of postconceptional age and the physiological occurrence of pressure waves into account.

Aging↗
PubMed1993

Receptors for pituitary adenylate cyclase activating peptides in human pituitary adenomas.

The presence of pituitary adenylate cyclase activating polypeptide (PACAP) receptors coupled to adenylate cyclase was investigated in four types of human pituitary adenomas: three null adenomas and five gonadotropin-, three ACTH-, four GH-, and four PRL-producing adenomas. In all samples, except in prolactinomas, PACAP(1-27) and PACAP(1-38) stimulated adenylate cyclase activity equally well and potently (K(act) around 3 nmol). Vasoactive intestinal polypeptide (VIP) was systematically 100- to 300-fold less potent than both PACAPs. In prolactinomas, PACAP(1-27), PACAP(1-38), and VIP were inactive despite a response of the enzyme to guanosine 5'-triphosphate, Gpp(NH)p, forskolin, and fluoride. [125I-AcHis1]PACAP(1-27) binding was detected in all samples except in prolactinomas. In addition, a detailed analysis of receptors was feasible in all five gonadotropin- and in two ACTH-producing adenomas, confirming the existence of selective PACAP receptors that recognized PACAP(1-27) and PACAP(1-38) with similar high affinity (IC50 0.8-1.5 nmol) and VIP with a low affinity (IC50 100 nmol/L).

Adenoma↗
PubMed1993

[Monitoring of fontanelle pressure in neonates and infants. Evaluation of a new measuring technique, determination of normal values and clinical usefulness].

The experience with 200 measurements of anterior fontanelle pressure with the Rotterdam Teletransducer in newborns and infants is reported. Statistical analysis of 25 comparative measurements between anterior fontanelle pressure and invasive cerebrospinal fluid pressure showed an excellent correlation (rs = 0.95). Measurements were reproducible and the plot quality allowed visualisation of pulse pressure and pressure waves. Normal values of the anterior fontanelle pressure, pulse pressure amplitude and pressure wave maximal amplitude were established in 15 prematures, 27 term newborns and 10 infants. Anterior fontanelle pressure monitoring was performed in 19 term newborns with post-asphyxial encephalopathy, 18 newborns and infants with hydrocephalus, 8 preterm and term newborns with respiratory distress and 19 patients with subdural haematomas, metabolic diseases, meningitis, subarachnoidal haemorrhage, head trauma, post cardiac arrest encephalopathy and abnormal head growth or bulging fontanelle. Abnormal patterns of anterior fontanelle pressure monitoring were found in moderate or severe neonatal post-asphyxial encephalopathy, evolutive hydrocephalus, subdural haematomas, metabolic diseases with hyperammoniemia and other clinical situations. In contrast, anterior fontanelle pressure monitoring yielded normal values in mild post-asphyxial encephalopathy, arrested hydrocephalus, well functioning ventriculo-peritoneal derivation, and in normal infants with rapid head growth or bulging fontanelle. The Rotterdam Teletransducer provides thus accurate and reproducible values of intracranial pressure. Anterior fontanelle pressure monitoring may be of value in many situations in clinical practice.

Asphyxia Neonatorum↗