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Biomedical subjects

J Brunon

Publications and source records attributed to J Brunon.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Anterior and anterolateral surgery of the lower cervical spine (25 years after H. Verbiest). I: Technical bases].

The anterior approach to the cervical spine is currently a worldwide traditional surgical technique used by neurosurgeons or orthopedists in the treatment of traumatic, degenerative or tumoral cervical spinal lesions. Many original rules of these techniques were raised by pioneers as R. Cloward and H. Verbiest, and are still valid. Advances in the surgical armentarium and in bio-materials markedly improved the original technique and subsequently improved the clinical results. The present course was organized for the neurosurgery trainees by the French Speaking Neurosurgical Society, and was helded during the winter meeting in December 1995. The aim of this course is to recall the basic technical principles of the microsurgical anterior cervical approach, and to discuss the main indications of this surgical treatment. Many theoretical points are strengthened by the author's personal experience and comments. Part I presents the different anterior or antero-lateral approaches which any surgeon involved in cervical spine surgery actually needs to know. Secondly, the materials and technical basis needed to achieve an interbody graft or fusion or fixation are described. Lastly, some practical applications are detailed as a microdiscectomy, a medial or lateral cervical spine decompression, and the use of acrylic plastic or prothesis for a cervical vertebral replacement.

Bone Transplantation↗
PubMed1996

When is spinal fusion warranted in degenerative lumbar spinal stenosis?

This study, conducted by a group of neurosurgeons who devote a large portion of their professional time to the treatment of degenerative lumbar spine lesions, was prompted by the dramatic increase in the number of lumbar spinal fusion procedures performed over the last few years in a broad spectrum of disorders ranging from chronic incapacitating low back pain to lumbar spinal stenosis. In the authors' experience, lumbar spinal fusion is rarely warranted and often of dubious efficacy. To investigate this contradiction, the authors reviewed the medical literature on lumbar spinal fusion for the treatment of degenerative spinal stenosis. They have defined lumbar instability as objectively as possible, reviewed clinical and roentgenographic features, described spinal fusion techniques with the drawbacks of each, and evaluated outcomes of surgery for degenerative lumbar spinal stenosis with or without fusion. Findings demonstrate that spinal fusion is a technique of unproven benefit that should be used only in carefully selected patients until results of reliable, prospective, comparative clinical trials become available. In the authors' opinion lumbar spinal fusion should be used as the first-line treatment only in young patients with clinical manifestations directly related to lumbar instability as defined in this study, when decompression requires removal of both facet joints and of the disk (which is rarely the case) or when simple decompression is followed by a recurrence of symptoms ascribable to worsening vertebral slippage.

Adult↗
PubMed1996

[Anterior and antero-lateral surgery of the lower cervical spine (25 years after H. Verbiest). 2: Indications, results, complications)].

The present course on the anterior and antero-lateral surgical approach of the lower cervical spine was organized for the neurosurgery trainees by the French Speaking Neurosurgical Society, and was held during the winter meeting in December 1995. The aim of this course was to recall the basic technical principles of the microsurgical anterior cervical approach, and to discuss the main indications of this surgical treatment. Many theoretical points were strengthened by the author's personal experience and comments. In Part I, the technical bases of the different anterior or antero-lateral approaches were presented (1996, 42 : 105-122). In the present Part II, the main indications of the anterior surgical approach to the cervical disk or the vertebral body are detailed, and the requirement of a bone graft and/or an osteosynthesis are discussed with their consequences on the final results. Secondly, variants of the surgical technics in use in case of cervical spinal instability are commented. Then various approaches to the cervical spinal tumors and to the vertebral artery are detailed and commented. Lastly, general and specific complications of the anterior cervical approach are listed with their rate of occurrence, and their prevention and management are discussed.

Cervical Vertebrae↗
PubMed1995

Gonadotropic pituitary carcinoma: case report.

A 37-year-old man developed multiple intracranial, intraspinal, and general metastases from an invasive nonfunctioning pituitary adenoma after surgery and radiation therapy. This is the first gonadotropic pituitary carcinoma reported in literature.

Adenoma↗
PubMed1994

Cervical root compression by a loop of the vertebral artery: case report.

A case of an abnormal loop of the extracranial vertebral artery enlarging the intervertebral foramen at C5-C6 and the transverse foramen at C5 is reported. This occurrence is rare and was associated with cervicobrachial neuralgia caused by neurovascular compression of the C6 root. The patient was cured by microvascular decompression.

Adult↗
PubMed1994

[Anterior osteosynthesis of the cervical spine by phusiline bioresorbable screws and plates. Initial results apropos of 5 cases].

The authors have designed a biocompatible and bioresorbable plate (1) in Phusilines* for anterior cervical interbody stabilization. Phusilines* are polymer of alpha hydroxyacid (poly lactic acid), and their in vivo degradation (in lactic acid and via the Krebs circle, in water and carbon dioxide), is complete within 18 months. Screws are available in the same material. Phusilines* are radiotransparent and do not interfere with MRI. The size and shape of the plate have been determined with three dimensional computed tomography, their thickness and their molecular weight and chemical structure have been determined to obtain the best compromise in mechanical properties and time of resorption. Biomechanical studies have been performed in cadaver, and have showed a good quality of the osteosynthesis. Five patients with anterior cervical disco-ligamental instability were operated on according the french law of bioethic (Huriet Law). In these five cases the operation was performed via antero lateral approach, and it consisted in a interbody xenograft with Surgibone (2) and interbody osteosynthesis with a plate and four screws of 16 mm of length and 4 mm of diameter. Clinical and radiological examinations were realised during 18 months. In all cases, clinical results in rachialgia and neurological signs were excellent, in four case the tolerance was excellent, in a case inflammatory phenomens were observed the 8th and the 14th month successfully treated with non steroid anti-inflammatories. Anatomical results were excellent in two cases, good in two cases and incomplete in one case. Reasons of these incomplete results are discussed. These preliminary results are sufficient to continue these implantations.

Adult↗
PubMed1994

[Stereotaxic biopsies of pineal tumors. Comments on their risk and implication apropos of 370 cases].

370 stereotactic biopsies of pineal region tumors, from 15 neurosurgical centers in France have been reviewed with the goal to evaluate the mortality/morbidity rates and diagnostic yield of this procedure. The impact of neuroradiological means of localisation, the probe trajectory, the type of biopsy instrument, the time of shunting are discussed in order to maximize the diagnostic yield and minimize the mortality/morbidity rates. Stereotactic biopsy contribution, as compared to other diagnostic methods, in pineal region tumors was evaluated. The mortality rate was 1.3 % (5 patients of 370), 3 patients suffered severe neurological complication. In relation to the large number of patients in this study, we can assess that the mortality rate of stereotactic biopsy in this region doesn't significantly exceed that of stereotactic brain tumor biopsies in general.

Adolescent↗
PubMed1993

[Familial aneurysms, multiple aneurysms and "de novo" aneurysms. Apropos of 2 cases].

The authors report the case of two sisters: each suffered from two intracranial hemorrhages caused by aneurysmal rupture at an interval of respectively 8 and 5 years. In the first case, the first subarachnoid hemorrhage (SAH) was related to a left middle cerebral artery aneurysm and the second, 8 years later, to the rupture of one of three right aneurysms (anterior communicating, supraclinoid internal carotid and middle cerebral arteries). But the "de novo" character of the right aneurysms could not be established. In the second case, the first SAH was related to an aneurysm of the right middle cerebral artery, with the left one appearing normal on the initial angiography. The second SAH, 5 years later, was related to a "de novo" left aneurysm. These two observations of familial, multiple and "de novo" intracranial aneurysms suggest a genetic basis for the pathogenesis of the arterial dysplasia. As in the literature, these hypothetical congenital factors could not be identified in both cases, but their probability justifies further investigations. If this factor exists, can we hope for a total recovery of the aneurysmal disease?

Adult↗
PubMed1992

[Primary cerebromeningeal hemorrhages in children (except newborn infants)].

The authors report their experience on 22 children admitted for spontaneous subarachnoid hemorrhages, to the pediatric and neurosurgery units of the University-Hospital of Saint-Etienne. There were seven cases of subarachnoid hemorrhages (five ruptured arterial aneurysms and one angioma) and 15 cases with associated intracranial hematomas (eight angiomas, one cavernoma, one aneurysm). Seven of 15 children with hematoma died, compared to two of seven children with subarachnoid hemorrhage. Half of the patients with hematomas and 20% of those with subarachnoid hemorrhage had sequellae. This rare pathology should be diagnosed in emergency, since brain damage occurs secondary to raised intracranial pressure. The respective roles of tomodensitometry, lumbar puncture and arteriography are discussed. The surgery should be performed in emergency, because the most frequent etiology is a vascular malformation, and because there is a risk of unexpected deterioration. When an underlying cause cannot be found neither by arteriography not by surgery, the follow-up should include a tomodensitometry and/or magnetic imaging.

Adolescent↗
PubMed1992

[Skin aplasia of the vertex. Report of a familial form].

The authors report about a familial case of skin aplasia of the vertex cranii, of which they present a form that required emergent surgical repair with a favorable outcome. The investigation allowed tracing two relatives with minor forms expressed as alopecia of the vertex. Skin aplasia of the vertex cranii is an exceptional condition, which consists in the congenital absence of cutaneous, bony and/or dural tissue in the cranium. The various etiopathogenetic, clinical, diagnostic, evolutive and therapeutic aspects are reviewed.

Congenital Abnormalities↗
PubMed1991

[Cerebral nocardiosis cured by repeated stereotaxic punctures and antibiotic therapy].

We report the case of a 58-year old man who had been on corticosteroid therapy for several months and presented with cerebral nocardiosis. Computerized tomography showed multiple brain abscesses. As the neurological status was getting worse, several stereotactic needle aspirations were performed, resulting in decompression of the brain and permitting bacteriological examination of the pus. Antibiotic therapy based on sensitivity tests was administered, and cure was obtained in the 4th month of treatment.

Anti-Bacterial Agents↗
PubMed1991

[Takayasu's disease and post-traumatic scalp necrosis].

This relates the case of a 19-years old female suffering from Takayasu's disease, who sustained injury with extradural hematoma formation calling for emergent evacuation thereof. The immediate postoperative period in this neurosurgical patient was characterized by extended necrosis of the scalp and underlying bone, due to low blood supply to the head in connection with her disease. The authors review the main characteristics of this rare inflammatory arteriopathy, and point out to the multidisciplinary collaboration which prompted healing of the patient's loss of substance.

Adult↗
PubMed1991

[Growth factors and oncogenes in brain tumors: the model of glioblastoma and medulloblastoma].

Glioblastomas and medulloblastomas are models for studying the implication of growth factors and oncogenes in tumor development. Amplification and/or hyperexpression of oncogenes result in products that may mimic growth factors and/or their receptors; cells may demonstrate autocrine and/or paracrine activity. Prognostic implications of such findings are suggested.

Brain Neoplasms↗
PubMed1991

[Chromosome anomalies in brain tumors].

The authors review the literature concerning chromosomal abnormalities in childhood brain tumors: medulloblastomas, ependymomas, and gliomas of low and high grade. Though these technics require further development, they highlight the role of cytogenetic modification in oncogenesis of brain tumors.

Astrocytoma↗
PubMed1991

[Treatment of chronic hydrocephalus in adults by lumboperitoneal shunt. Results and indications apropos of 82 cases].

Patients with chronic hydrocephalus are most often aged people and in bad general condition. It seems that treatment may be more simplest possible and the less iatrogenic. Furthermore, the diagnosis of chronic hydrocephalus is not often certain, and can be generally assert after the good result of the CSF shunting. Since 1985, when hydrocephalus appears communicant, a lumboperitoneal shunt was systematically implanted in the aim to decrease the number of complications due to ventricular shunts. The operation can be performed on neuroloptanalgesia and/or local anesthesia. Post-operative orthostatic intracranial hypotension can be prevented by using valves with opening pressure varying with the position or valves with a flow depending of the opening pressure. Our clinical series includes 82 patients (51 males and 31 females), aged from 27 to 88 years (average 55 years). In 47 cases, hydrocephalus was idiopathic and in 35 cases hydrocephalus was secondary to an identified aetiology: subarachnoid or intracranial hemorrhage (20 cases), post-traumatic (11 cases), post meningitic (1 case) and post anoxic (1 case). In this last case, physiopathological mechanism was unclear. The middle delay between the first symptom and the operation was greater than 6 months for the majority of observations, but in few cases, precoce shunting was performed (between 1 to 3 months) in post S.A.H. and post traumatic hydrocephalus when C.T. Scan shows increasing ventricular size. Clinical results are evaluated after 2 months and at long term, and complications analysed. The lumbo-peritoneal shunt gives same results on the clinical symptoms, and less iatrogenic complications than ventricular shunts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Apparently primary cerebrospinal rhinorrhea. Apropos of 4 cases].

While rhino-liquorrhea is a severe condition, its incidence is not exceptionally rare, and it raises problems, namely etiopathogenic, diagnostic and therapeutical ones, which call for the close collaboration of ENT doctors, neuroradiologists and neurosurgeons. 4 relatively recent cases are reported here, whereby the diversity of the problems encountered is made apparent. ENT specialists must be aware of those when faced with refractory aqueous rhinorrhea, often triggered by forward head motion, Valsalva's maneuver... Screening for rhinorrhea is readily achieved by biochemical tests, or simply using a Labstix-type diagnostic strip. Rhinoscopic examination should be accurate and carried out optically to check for any congenital malformation (meningocele). Most of the times, but not always, a thorough radio-neurological workup (isotopic analysis, CT-scan with contrast medium, MR imaging) will provide precise data regarding the infraction site and its possible cause, invariably warranting surgical management. Surgery should be case-adapted (CSF derivation, filling of the gap via the extra- or intracranial approach).

Adolescent↗