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H Boissonnet

Publications and source records attributed to H Boissonnet.

17 recordsLinked to original sources
PubMed2006

[Optic nerve sheath meningioma: diagnosis and new treatment options, a case study of monocular blindness during pregnancy].

Optic nerve sheath meningiomas are challenging lesions to manage. We report here a case of primary optic nerve sheath meningioma in a pregnant woman with sudden unilateral vision loss. Then we review the current literature on the subject, prognosis factors, and report the results of fractionated radiotherapy and current therapeutic guidelines. Pregnancy may accelerate growth of meningiomas and this diagnosis must be considered in all cases of optic neuropathy in pregnant woman.

Adult↗
PubMed2005

[Endovascular treatment of unruptured middle cerebral artery aneurysms].

INTRODUCTION: Middle cerebral artery aneurysms (MCA) often present an unusual anatomical feature for the endovascular treatment and are frequently sent to surgery. We report our experience in the endovascular treatment of unruptured MCA aneurysms and compare it with results from the neurosurgical literature. PATIENTS AND METHODS: In this retrospective study were included all patients with unruptured MCA aneurysms treated in our institution between November 1998 and December 2003. 3D imaging was performed in all cases to determine precisely the relationship between aneurysm and parent artery. The degree of occlusion of the aneurysms was estimated according to Raymond's classification. The neurological state was evaluated according to the Rankin scale and was re-evaluated at the time of each follow-up. RESULTS: Eighty four patients with 100 aneurysms were analysed. Ninety aneurysms were treated by endovascular approach. Nine aneurysms were sent to surgery, after 3D imaging analyses or failed endovascular treatment. In one patient, related to the aneurysm configuration, a conservative attitude has been adopted. Four giant aneurysms were treated by parent vessel occlusion and 86 aneurysms were selectively occluded. The remodelling technique with balloon was performed in 58.1% of cases. Eight patients presented a new neurological deficit. The deficit was transient in six cases, and permanent in 2 cases. There was no mortality in this series. In 86 aneurysms selectively treated, there were 87.2% good results (grades A and B). Seventy one aneurysms (82.5%) treated were controlled between 3 and 58 months with a 19.6 months average. Recurrences were observed in 25.3% of cases. They were major in 9.8% and retreatment was performed. CONCLUSION: We report the feasibility of the endovascular treatment of MCA aneurysms previously estimated untreatable. Per procedural 3D imaging and remodelling technique were fundamental tools in the management of these aneurysms.

Adult↗
PubMed2001

[Surgical removal of radio-induced lesions after radiosurgery of cerebral arteriovenous malformations].

Radioinduced lesions after radiosurgery of cerebral arteriovenous malformations may be associated with an increased signal on T2-weighted and gadolinium enhancement on T1-weighted MR images. They do not have necessarily a poor prognosis. These lesions are mostly asymptomatic. But in a few cases they can be associated with severe clinical symptoms which can become corticodependant or corticoresistant. We present the 5 cases of such cerebral arteriovenous malformations treated by radiosurgery, out of our series of 705 patients. The removal was easier than that of untreated cerebral arteriovenous malformations, and led to a complete recovery of symptoms and progressive decrease of imaging abnormalities. Such surgery should be proposed in case of symptomatic radioinduced lesions which fail to respond to steroids.

Adult↗
PubMed2001

Pilocytic astrocytoma: unusual feature.

Juvenile pilocytic astrocytoma is a well-defined brain tumor. It most often occurs in children and young adults. It is located in the posterior fossa and has typical imaging features, associating cystic and strongly contrast enhancing mural nodule. After complete surgical removal, its prognosis is excellent. Adult cases are seldom observed. They develop almost exclusively within the cerebral hemispheres and share the same imaging and prognostic characteristics as the pediatric forms. We describe the case of a 42-years-old man presenting with a huge heterogenous posterior fossa lesion. Histopathological analysis of the lesion after surgical resection diagnosed a juvenile pilocytic astrocytoma. These peculiar location and imaging features in an adult patient may be misdiagnosed for infectious lesions and must be recognized.

Adult↗
PubMed2000

Experimental vertebroplasty using osteoconductive granular material.

STUDY DESIGN: Osteoporotic human cadaveric thoracic vertebral bodies and vertebral bodies from mature sheep were used as model systems to assess coral resorption and new bone formation after injection of coral granules. OBJECTIVE: To evaluate the use of natural coral exoskeleton, an osteoconductive material, for the filling of vertebral bodies. SUMMARY OF BACKGROUND DATA: Percutaneous injection of polymethylmetacrylate (PMMA) is often proposed for prophylactically stabilizing osteoporotic vertebral bodies at risk for fracture or augmentation of vertebral bodies that have already fractured. Recently, the possibility of using osteoconductive materials in granular formulation was assessed in pilot studies. METHODS: As a first step, the possibility of injecting coral granules percutaneously within osteoporotic human cadaveric thoracic vertebral bodies was assessed. As a second step, cavities were drilled into vertebral bodies of 10 mature ewes and were either left empty (control group) or filled with coral alone (CC) or coral supplemented with fibrin sealant (CC+FS). Quantitative evaluation of coral resorption and new bone formation was made 2 months and 4 months after implantation. RESULTS: The distribution of coral granules injected into human cadaveric thoracic vertebral bodies was homogenous as assayed radiographically. In the experimental animal model, osteogenesis was increased in cavities filled with coral in comparison with cavities left empty at both 2 months and 4 months (P < 0.005 and P < 0.02, respectively). Surprisingly, supplementation of coral with a fibrin sealant had no positive influence on osteogenesis (P < 0.0008 at 2 months; P < 0.002 at 4 months). In addition, it led to an increase in coral resorption by as soon as 2 months (P < 0.0008). CONCLUSION: These results demonstrate the osteoconductivity of coral in granular form for vertebral filling. Interestingly, interconnectivity between adjacent bone trabeculae and newly formed bone was restored; however, its mechanical significance remains to be determined. Further investigations are needed to evaluate the efficacy of coral in osteopenic animals and in relieving pain.

Aged↗
PubMed2000

So-called malignant and extra-ventricular neurocytomas: reality or wrong diagnosis? A critical review about two overdiagnosed cases.

Central neurocytoma (CN) is described as a rare intra-ventricular benign neuronal tumor of the brain. Two primary tumors first diagnosed as malignant and extra-ventricular neurocytomas are reported here. Histologically, the tumor of the first patient, a forty-one-year-old man, consisted of monotonous cells with round nuclei, but no fibrillar background. The second tumor, in a nineteen-year-old girl, showed areas of moderately pleomorphic round cells, with numerous rosettes and ganglion cell differentiation, in an abundant fibrillary network. Both presented calcifications. Mitoses were more frequent in recurrences and spinal locations than in the primaries. All tumors stained strongly for synaptophysin, and GFAP was partly positive in the first case only. Patients received post-surgical radiotherapy and were still alive eight and six years, respectively, after initial surgery. The interpretation of atypical cases, such as ours is not easy: the diagnoses finally retained were oligodendroglioma in the first case and ganglioneuroblastoma in the second case. Furthermore, neurocytomas atypical either by their unusual topographical or histological presentation or by their poor prognosis, have been frequently entitled in this way on synaptophysin positivity. So, we were prompted to reassess the entity of CN, seventeen years after the first description, to re-appreciate the reality of anatomo-clinical variants and to discuss the value of synaptophysin positivity in these tumors. In conclusion, it seems preferable to individualize true classical CN, which has a favorable outcome, from so-called extra-ventricular, atypical and anaplastic, clinically malignant neurocytomas for which complementary treatment is required.

Adolescent↗
PubMed1997

[Cerebromeningeal hemorrhages in Rendu-Osler disease. 2 cases treated by embolization].

BACKGROUND: Treatment for cerebral vascular malformations in patients with hereditary hemorrhagic telangiectasia, also called Osler-Weber Rendu disease, has been greatly improved with advances in interventional neuroradiology. CASE REPORTS: Two patients with Osler-Weber Rendu disease experienced intracranial hemorrhage. In the first case, the disease was diagnosed at the age of 60 years in a man with recurrent epistaxis and numerous angiomas on the face and trunk as well as in the buccal cavity. The first neurological signs appeared seven years later and brain MRI revealed a 2-3 cm temporo-occipital arteriovenous malformation. Six months later sudden onset headache following exertion led to a CT-scan which showed tetraventricular hemorrhage. The second case was a 63-year-old man referred to neurosurgery for cerebromeningeal hemorrhage. Clinical examination and history taking found several small skin angiomas and a family and personal history of epistaxis. CT-scan revealed a dural fistula in the posterior fossa. Good clinical outcome was obtained in both cases by endovascular embolisation. DISCUSSION: Intracranial hemorrhage is observed in 2 to 3% of patients with Osler-Weber Rendu disease. Telangiectasia is not a pathognomonic sign and non-specific vascular malformations may be observed, particularly arteriovenous malformations or arterial aneurysms. Most can be reached by endovascular catheterism. Most of these usually unique malformations can be successfully treated by first-line embolisation.

Cerebral Hemorrhage↗
PubMed1997

Meningioma of the foramen magnum: a series of 40 cases.

BACKGROUND: Surgical treatment of foramen magnum meningiomas (FM meningiomas) has been improved by the recently developed posterolateral and anterolateral approaches. The choice of these approaches and the extent of bone resection, however, need to be defined according to the tumor location. METHODS: Over a short period (1980-1993), 40 cases of FM meningiomas were treated either by the posterolateral (N = 31), the anterolateral (N = 5), or the midline posterior approaches (N = 4). The choice of surgical technique (surgical approach, extent of bone drilling, and dural opening) was made according to the tumor location, which is defined by three parameters: the horizontal plane (anterior N = 18, lateral N = 21, and posterior N = 1); the vertebral artery (above N = 4, below N = 20, and on both sides N = 16); the dura mater (intradural N = 24, extradural N = 2, and intraextradural N = 4). RESULTS: Intradural anterior and lateral FM meningiomas were operated by the posterolateral approach. The bone drilling was limited either to the occipital condyle or to the lateral mass of the atlas, depending on whether the tumor location is above or below the vertebral artery, respectively. Intradural posterior meningiomas were treated by the midline posterior approach. FM meningiomas with an extradural component were resected by the anterolateral approach alone or combined with a midline posterior approach. The rate of complete resection was 94% for intradural FM meningiomas and 50% for the extradural ones. FM meningiomas with an extradural component generally have aggressive features invading the adjacent bone and soft tissues; this explains the difficulty of performing a complete resection. The clinical condition improved in 90%, worsened in 7.5%, and did not change in 2.5%. The worsened group consisted of three deaths (one case of air embolism, one case of pulmonary embolism, and one case with preoperative coma and tetraplegia). Similar results were obtained in both anterior and lateral locations. CONCLUSION: FM meningiomas can be completely and safely removed in most cases, using an appropriate surgical technique. The technique must be chosen after precise and correct analysis of the tumor location. The lateral approaches are very effective in the treatment of lateral and anterior FM meningiomas.

Adolescent↗
PubMed1997

[Malignant tumors of the ethmoid sinuses. A homogeneous series of 41 cases operated on by mixed approaches].

A series of 41 malignant tumors including 31 adenocarcinomas invading the ethmoid sinuses were treated by a combined transcranial-transfacial approach. Management, by the same team, of these consecutive cases permitted to analyze the technical problems and the carcinologic results. Chemotherapy was given to 21 patients pre-operative followed by surgical resection by a combined transbasal and paralateronasal routes and then, by a post-operative radiotherapy. Post-operative complications were more frequent (52%) in case of reconstruction of the anterior skull base and especially with madroporic corals. In the other cases where the double dural closure was only packed with abdominal subcutaneous fat, the rate of post-operative problems was only 20%. Noticeably, infection at the cranial base was observed in 6 cases (4 cases needing a reoperation) with bone reconstruction and in none without reconstruction. Actuarial survival rate was 84% at 1 year, 53% at 3 years and 36% at 5 years whatever the pathology (whole series or subgroup of adenocarcinomas). Mortality is related to incidental problems (3 cases), another malignant primary disease (3 cases), metastasis (8 cases) and local recurrence (4 cases). A longer survival was observed in the group of patients without skull base invasion (survival rate 100%, 83%, 50% at 1, 3 and 5 years respectively).

Combined Modality Therapy↗
PubMed1992

Intra-operative monitoring of the facial nerve with an air inflated balloon. Technical note.

A simple, reliable and cheap device for intra-operative monitoring of the facial nerve during surgery for cerebellopontine angle tumours is presented. It consists of a single use tracheostomy tube with a low pressure air inflatable cuff placed in the mouth of the patient on the side of the tumour, connected by a pressure transducer to a monitoring unit. It records any pressure changes in the patient's mouth induced by muscular contractions as a result of excitation of the inferior parts of the facial nerve.

Equipment Failure↗
PubMed1992

[Cisternal cysticercosis of the cerebellopontine angle. A surgically-treated case and review of the literature].

Most neurocysticercosis (N.C.C.) cases reported occur in undeveloped countries where contaminated food by Taenia solium gives rise to human infection. People of developed countries are exposed by migrations and travels. We report a case of a 36 years old french woman living at La Reunion. Her symptomatology consisted of left unilateral hypoacusis progressing over a two years period accompagnied by intermittent headaches. CT scan showed a hypodense mass with a ring enhancement in the left cerebello pontine angle (C.P.A.). M.R.I. showed multicystic arrangement of vesicles in a racemous fashion that spread out to peduncular and carotid cisterns. Parenchymatous or ventricular involvement was not observed. A lateral suboccipital craniectomy was carried up in the sitting position. After division of a thickened arachnoid in the C.P.A., the vesicles were dissected an pulled out easily because the membranes had not any adhesions. Progressive improvement of hearing was observed in the next week. Primary cisternal involvement of N.C.C. is rare and, in literature, there is not any other reported case in the C.P.A. Different mechanisms of invasion to the C.N.S. are discussed.

Adult↗
PubMed1991

[Value of the measurement of cerebral blood flow before and after diamox injection in predicting clinical vasospasm and final outcome in aneurysmal subarachnoid hemorrhage].

The timing for surgery on ruptured intracranial aneurysms remains a difficult question and the choice of the day of operation depends greatly from the occurrence of a vasospasm. On a previous paper, the value of the cerebral blood flow (CBF) measurement by intravenous injection of Xenon 133 was demonstrated to be efficient for the prediction of vasospasm only when done between day 4 and day 8 after bleeding. Moreover the efficiency of the measurement was much greater if the evolution of the CBF values between D0 and D8 was considered, but this method was incompatible with early surgery. It suggested the interest of a dynamic study of the CBF by the same method. On a series of 43 patients, the comparison between basal CBF values and reactivity of CBF values to intravenous injection of 1 gram of acetazolamide for the prediction of clinical vasospasm is presented. The series comprises 32 early admitted patients (74%) and 31 operated patients (16 of them between D0 and D3 after bleeding, 15 others after D4). The efficiency of the CBF reactivity study for the prediction of the clinical vasospasm appears much greater than that of the basal CBF value, even during the first three days after bleeding, but not for the prediction of the final clinical outcome. The method is immediate and compatible with early surgery. What precisely is evaluated by this method on the physiopathology of the vasospasm remains disputable, but the operability of the patients seems to be explored.

Acetazolamide↗
PubMed1987

[Suboccipital Pott's disease].

A new case of sub-occipital Pott's disease is reported: a 26 year old, coloured male patient from Senegal was admitted for: cervical pain of 6 month duration, neck stiffness, dysphagia, left XII paralysis and left hemiparesis. The radiological study found an anterior atlanto-axial subluxation, basilar impression, and increased thickness of the retropharyngeal soft tissue, lysis of the left occipital condyle and the left lateral mass. CT scan study revealed a retropharyngeal mass and an epidural contrast-enhanced lesion at the C2 C3 C4 levels. Chest-X ray showed one tuberculous lesion at the right apex. The research of Acid Fast Bacilli in gastric secretion samples and the results of the retropharyngeal mass puncture were positive. An antituberculous trichemotherapy was started. After early reduction by skull tongs traction, an occipito-cervical arthrodesis by Roy Camille plates was performed, followed by the wearing of a minerva plaster jacket and then a plastic collar. Each one for a 5 month period. One year later, there remained only a left XII paralysis, but the bony reconstruction was not yet obvious on tomography. A survey of the literature of 70 cases of sub-occipital Pott's disease has pointed out these findings: cervical pain (98%), neck stiffness (82%), Atlantoaxial subluxation (68%), thickened prevertebral soft tissue shadow (77%), lateral mass lysis (48%) other tuberculous focus (29%). The main therapeutic trends are: early and long-lasting antituberculous poly-chemotherapy, early reduction of subluxations, prolonged contention for slight osteolytic lesions and for major: lytic lesions, a posterior surgical procedure either by bone graft combined with wires or preferably fusion by means of occipito-cervical plates. The removal of abscess is discussed.

Adult↗
PubMed1986

[A new promotor of nerve growth: naftidrofuryl].

20 day-old rat thoracic dorsal root ganglia were grown for 48 hrs. in Iscove's medium supplemented with 8% fetal calf serum and 600 mg/100 ml glucose. Naftidrofuryl was added at 10(-6), 10(-7), 10(-8) and 10(-9) M concentrations to the culture medium. The 10(-7) and 10(-8) M concentrations induced a statistically significant increase of the number (30 to 40%; p = .0054 and .0016, respectively) and length (20 to 30%; p = .0012 and .001, respectively) of neurites of the outgrowth measured after Bodian's protargol impregnation. The width of the cell spread in the outgrowth was also enlarged at the 10(-7) and 10(-8) M concentrations (18 to 26%; p = .0012; p less than .0001, respectively).

Animals↗
PubMed1982

[Bacteriologic monitoring of external ventricular drainage in children].

The authors report 27 cases of external ventricular drainage employed in children. The usage of this technique caused neither infection nor surinfection in any of the cases. It is difficult to interpret the analysis of the cerebrospinal fluid thus obtained. Decisive criteria for recovery or non infection can be derived by studying the isozymatic profile of the L.D.H. (lactic dehydrogenase).

Adolescent↗