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Biomedical subjects

G Nohra

Publications and source records attributed to G Nohra.

16 recordsLinked to original sources
PubMed2006

[Etiologic spectrum of intracerebral hemorrhage in young patients].

INTRODUCTION: Hemorrhagic stroke is uncommon in young patients. The etiologic spectrum is very wide in the literature. The purpose of this study was to determine the range of etiology in a group of patients completely investigated and to study the relation with a history of high blood pressure. PATIENTS AND METHODS: We reviewed study database, clinical and diagnostic records of 130 patients identified in a population based study, aged 18 to 55 years presenting with hemorrhagic stroke. There were divided into two groups: 67 patients treated at Hotel-Dieu Hospital in Beirut, Lebanon, and 63 patients reviewed at Yale New Haven Hospital, Connecticut, USA. Patients presenting with selective subarachnoidal or intraventricular hemorrhage were excluded. Diagnostic evaluation was assessed for completeness (based on prospectively articulated evidence based criteria) and for identifiable etiology of hemorrhagic stroke and its relation to high blood pressure. RESULTS: There were 84 cases (64%) with complete diagnostic workup. The most common cause of incomplete investigations in remaining cases was death, poor neurological condition and incomplete follow up. Hematoma was superficially located (lobar) in 59.2%, deep seated (thalamo-capsulo-lenticular) in 26%, within the brain stem in 8.7% and cerebellar in 6.1%. An etiology was established in 70.4% of cases (pial AVM 16.7%, aneurysms 15.5%, hematological disorders 13%, cavernous malformations 10.7%, tumors 4.8%, bleeding within ischemic area 3.8%, vasculitis 2.3%, venous thrombosis 1.2% and venous angioma 1.2%. 29.6% of patients remained with undetermined etiology despite complete investigations. In a subgroup of 45 patients, a history of high blood pressure was found in 46.7%. In this cohort, an underlying etiology was established in 71% of cases. CONCLUSION: Complete investigation can establish an etiology in 70% of young patients who survived hemorrhagic stroke, independently from the presence of a history of high blood pressure.

Adolescent↗
PubMed2004

[Central neurocytoma. Four patients].

We report four cases of central neurocytoma we operated on at our institution, between 1994 and 2002. This uncommon lesion occurred in young patients, was located in the lateral ventricules and was revealed by signs of intracranial hypertension. The tumor was totally removed in three cases and subtotally in one. Immunohistochemistry provided useful information to distinguish neurocytoma from other nervous system tumors. Prognosis was excellent in two patients. One patient developed tumor recurrence seven years after surgery, without any progression on further follow up evaluation. In the last patient, the tumor showed a more aggressive progression requiring the adjunction of radiosurgery.

Adolescent↗
PubMed2003

[Anterior cervical discectomy with or without bone graft placement in the treatment of cervical radiculopathy. Long-term results].

BACKGROUND AND PURPOSE: Anterior approach for cervical radiculopathy is a frequently performed operation in neurosurgery. The goal of this study is to evaluate the short and long-term results of anterior cervical discectomy with and without fusion. METHODS: Between 1984 and 1999, we operated on 101 patients presenting with cervical radiculopathy by an anterior approach. The operation consisted of one-level discectomy in 74 cases, two-level discectomy in 25 cases and three-level discectomy in 2 cases. Eighty-four out of 130 levels operated on were fused. Evaluation was done following a consultation with dynamic cervical X-rays and by telephone using a detailed questionnaire. Follow-up was obtained in 91 cases with a mean of 54 months in fused patients, and a mean of 45 months in the non-fused patients. RESULTS: Post-operative results were good in 95% in the 2 groups of patients. We encountered 8 complications, all in patients operated with bone graft placement. Five patients were reoperated on at an adjacent level, 4 being fused previously. CONCLUSIONS: The 2 techniques are comparable in term of goods results at short and long-term follow-up. Anterior discectomy without fusion is associated with less complications, less post-operative pain, and less operative time cost.

Adult↗
PubMed2002

[Subcranial subfrontal approach for the treatment of extensive cerebrospinal fluid leaks].

BACKGROUND AND PURPOSE: Over the time, the management of cerebrospinal fluid (CSF) rhinorrhea has been a major surgical challenge. In this paper, we will describe our experience using the extended anterior subcranial approach for the repair of extensive or previously treated CSF leaks. This approach consists of a nasoorbitofrontal bony flap, then an ethmoidectomy and sphenoidectomy are performed and the empty space is filled with subcutaneous fat, a pediculated periostal flap is dissected and layed extradurally at the base of the anterior cranial fossa. METHODS: Between January 1994 and December 1999, we reviewed the charts of 7 men and 3 women with a mean age of 36.5 years. The etiology was traumatic in 8 cases. One patient had a spontaneous CSF leak, the other had a macroprolactinoma. RESULTS: The average duration of surgery was 5 hours. Patients were kept in the Intensive Care unit for an average period of 36 hours. The mean follow-up period was 30 months. The success rate was 100%. Postoperatively, all of our patients were anosmic, four of them had anosmia as a preoperative finding. Cosmetically, the skin incisions are limited to the bicoronal incision. CONCLUSION: Knowing that the classical subfrontal and endoscopic approaches have their definite indications, our experience with the extended anterior subfrontal approach in the treatment of extensive or multiple anterior fossa defects suggests that it is a reliable procedure, giving an excellent access with low morbidity, provided that the patients are selected properly.

Adipose Tissue↗
PubMed2002

[Infections after missile head injury. Experience during the Lebanese civilian war].

OBJECTIVE: Establish the risk factors for infection following missile head injuries (MHI). METHODS: Between 1975 and 1990, 500 cases of MHI were admitted, with only 272 responding to inclusion criteria. After initial evaluation including CT scan for 177 patients, all underwent craniectomy with debridement and duroplasty. A retrospective study was undertaken in order to identify the risk factors that increase the infection rate. RESULTS: The global infection rate was 11.39%. Among the studied factors, those increasing the infection rate were: coma on admission (17.6% vs 7.6%), penetrating wounds (12.93% vs 7% for tangential wounds), intracerebral trajectory length over 6 cm (18.42% vs 6.32%), air sinuses effraction (25.8% vs 9.54%), a surgical delay over 72 hours (41.6% vs 10.6%), inadequate duroplasty (28% vs 7.33%), cerebrospinal fluid (CSF) fistulae (58.62% vs 5.76%). The presence of postoperative bone fragments did not increase the infection rate (11.4% vs 11.2%). DISCUSSION AND CONCLUSION: Adequate duroplasty and aggressive treatment of CSF fistulae decrease the infection rate. There is no need to reoperate on residual bone fragments after adequate debridment. A delay of 24 to 48 hours should be considered, to facilitate the procedure without increasing the infection risk.

Adolescent↗
PubMed1999

[Temporary occlusion in surgical management of intracranial aneurysm. Report of 54 cases].

Temporary arterial occlusion (TAO) is commonly used in the surgery of intracranial giant aneurysms. Its usefulness and safety in the surgical management of all cases of aneurysms remains to be proved. We report a series of 54 patients operated on for an intracranial aneurysm with the use of TAO. Among the 27 patients, admitted before the 4th day following post subarachnoid hemorrhage with I or II on WFNS score clinically, 24 had early aneurysm surgery. The size of the aneurysm was small in 16 cases, medium in 22, large in 13 and giant in 3 cases. The protocol proposed by Batjer in 1988 for large and giant aneurysms (etomidate, normotention and hypervolemia) was used without any electrophysiological monitoring. All patients underwent a post-operative cerebral CT scan to evaluate the incidence of a cerebral ischemia. Serial transcranial doppler was used to evaluate the severity of vasospasm. Clinical results were assessed using the GOS. TAO was elective in 51 patients and done after peroperative aneurysm rupture in 3 patients. The duration of TAO was less than 5 mn in 25 patients, between 5 and 10 min in 12, between 10 and 15 in 11, between 15 and 20 in 5 and more than 20 min in one patient. The last one developed a reversible neurological deficit secondary to ischemia attribuated to TAO. Intracranial aneurysm peroperative rupture was noted in 3 patients, clinical vasospam in 13 patients. These results allow us to recommend the routine use of TAO in the surgery of intracranial aneurysm. When application time is limited and cerebral protection used, TAO is safe. It decreases the risk of intraoperative rupture from a 18% rate in literature to 4.2% in our present experience and the risk of symptomatic vasospasm is not increased.

Adult↗
PubMed1999

[Growing fracture of the orbital roof. A case report].

We report a case of growing fracture of the orbital roof in a 5-year-old child. The presenting sign was a pulsatile orbital mass. This child had a history of a minor head injury with orbital impact 2 years ago. Cerebral CT scan revealed a diastatic fracture of the right orbital roof. On MRI a leptomeningeal cyst extending in the orbital cavity was shown. Frontal craniotomy with direct repair of the dural and bone defects was performed. The outcome was excellent. In the literature the exact pathophysiology of the growing fractures is still debated but a dural laceration along the fracture line is noted in all the cases. They are mostly located in the cranial convexity, and rarely affect the skull base. Only 5 similar cases were found in the relevant literature. Growing fracture of the orbital roof should be suspected if ocular symptoms appears in childs who have sustained a head injury several months or years ago.

Accidental Falls↗
PubMed1996

[Thermocoagulation in the treatment of facial neuralgia. Preliminary results in 22 cases].

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at Hôtel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satisfactory in twenty patients (90.9%) who became asymptomatic. No major complication was noticed. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia.

Adult↗
PubMed1995

Madreporic coral for cranial base reconstruction. 8 years experience.

The authors, since 1985, have used 587 Madreporic Coral grafts as bone substitute in a total of 183 patients, among them in 80 cases for repair of cranial base bone defects. They report their long-term results. Partial resorption to about 40% of the initial volume occurred in almost all cases within 8 to 10 months, with complete resorption after about one year. 20% of the coral blocks moved spontaneously or split into pieces, but could easily be withdrawn rhinoscopically through the nostrils. No CSF leakage was noticed afterwards. The local infection rate was only 4%, always close to the basal coral graft. This is lower than the infection rate after using autologous bone harvested from the inner table of the bone flap (20%). Infections were cured by removal of the coral graft. Despite the mentioned draw backs, Madreporic Coral graft implants can be recommended as bone substitute in cranial base surgery: 1. The material simplifies the surgical procedure; 2. Harvesting of autologous bone is no longer necessary; 3. Transmission of infections like AIDS, Hepatitis C or Creutzfeld-Jacob-disease can be avoided with certainty.

Biocompatible Materials↗
PubMed1994

[Multiple cavernoma of delayed appearance].

The authors report on a right fronto-singular cavernous angioma which appeared, in a 46 year-old woman, four years after the excision of a right rolandic localization. Diagnosis suggested on radiological findings was confirmed by histological examination. After a review of the literature the authors discuss possible mechanisms of such delayed appearance of intra-cerebral cavernous angiomas. They suggest the possibility of infraradiologic stage corresponding to a micro-malformation characterized by abnormal capillaries, which has not been yet histologically modified by hemorrhages, thrombosis, fibrosis, gliosis and calcifications.

Brain Neoplasms↗
PubMed1992

[Combined CO2 and Nd-YAG laser in neurosurgical practice. A 1st experience apropos of 40 intracranial procedures].

The authors present their experience concerning the use of Combolaser (Lasermatic, Finland), in neurosurgery. This laser-unit combines two wavelengths (CO2 and 1.06 Nd-YAG) which are emitted simultaneously and coaxially. During the last 12 months, 40 patients harbouring an intracranial tumor were operated upon with such a combolaser unit: 8 infra-tentorial, 32 supra-tentorial, 17 were meningiomas. The mean output power used during the procedures was 3-5 w for both CO2 and Nd-YAG beams. The authors discuss the advantages and inconveniences of such a laser; and they compare it with the other laser-units they have been using for the last 10 years: CO2-Laser, 1.06 Nd-YAG and 1.32 Nd-YAG laser. The main inconvenience of this unit is linked to the utilization of the articulated arm which conducts the CO2 laser beam. This drawback should be avoided or limited by the use of a fiber microguide, which will conduct both CO2 and Nd-YAG beams simultaneously. The principal contribution of a combined-laser unit is the quality of the haemostasis associated to a very good vaporization and cutting effect. When both wavelengths are synchronized, the combined laser beams penetrate into the nervous parenchyma more deeply than the only CO2 laser beam would with the same parameters. The vaporization effect is identical to that obtained with the isolated CO2 laser; the quality of haemostasis is limited to the effects of the Nd-YAG laser. Another advantage must be emphasized: the possibility of utilizing separately the CO2 laser and the 1.06 Nd-YAG.

Adolescent↗
PubMedDate not supplied

[Stereotaxic approach in deep cerebral lesions].

The authors report a retrospective study (April 92-April 95) of 60 CT guided stereotactic biopsies. The procedure offered accurate histological diagnosis in 56 cases. There were 38 glial tumors, the majority being of high grade (III-IV). Five abscesses were evacuated and medically treated. Complications occurred in 5% of cases. These results are compatible with those reported in the literature. The simplicity and accuracy of stereotactic procedure are confirmed, making it an imperative step in the management of intraxial space occupying lesion when surgical resection is negotiable. The other applications of the stereotactic procedure are exposed.

Adolescent↗
PubMedDate not supplied

[Intracranial arterial aneurysm: from diagnosis to treatment. A retrospective study of 46 surgically treated cases].

The authors report a series of 46 patients operated for an intracranial aneurysm from January 92 to January 96 in Hôtel-Dieu de France. There were 28 males and 18 females ranging from 22 to 69 years. Forty-four patients presented a typical clinical pattern of subarachnoid haemorrhage. In 20 cases (45%), correct diagnosis was not made at the time of bleeding but at another outpatient visit or at a bleeding recurrence. Cerebral angiography was performed in all our patients. The most frequent aneurysmal location was at the anterior communicating artery (n = 20). Surgical total exclusion of the aneurysm was possible in 45 patients. Forty-one patients had a favourable outcome but three presented important neurological sequelae. We encountered 2 postoperative deaths due to irreversible arterial vasospasm. These results suggest that the preoperative neurological state and the occurrence of an arterial vasospasm are the main prognostic factors of the intracranial aneurysm. Early diagnosis and treatment allow to avoid rebleeding, mostly responsible of the poor neurological status, and to better manage the arterial vasospasm in order to improve the outcome.

Adult↗
PubMedDate not supplied

[Endocrinologic recovery after treatment of an intrasellar aneurysm].

OBJECTIVE: Cavernous intrasellar aneurysms are rare, but may be clinically mistaken for an hypophyseal tumor, thus the need for a preoperative diagnosis. CLINICAL PRESENTATION: We report on a 60-year-old woman suffering from retroorbital headache, diplopia and decreased visual acuity, along with hyperprolactinemia and both gonadotropic and thyreotropic deficencies. Computed tomography revealed a sellar mass with superior extension, but MR raised the possibility of a cavernous aneurysm, that was confirmed by arteriography, avoiding a disastrous transsphenoidal surgery. DISCUSSION: Intracavernous aneurysms are known having a benign course, but serious meningeal hemorrhage can occur in 1.4% of cases and carotid-cavernous fistulae in 8% of patients, warranting treatment. Medial development is rare and may be responsible for endocrinologic manifestations. Neurosurgical approach remains hazardous, and endovascular occlusion represents the method of choice. CONCLUSION: Intracavernous aneurysm must be taken into consideration in the differential diagnosis of pituitary masses because it has a completely different management.

Angiography↗