Biomedical subjects

Jacques Philippon

Publications and source records attributed to Jacques Philippon.

5 recordsLinked to original sources

PubMed2005

["Normal pressure" hydrocephalus].

Normal pressure hydrocephalus (NPH) or, more precisely, chronic adult hydrocephalus, is a complex condition. Even if the basic mechanism is found in an impediment to CSF absorption, the underlying pathology is heterogeneous. In secondary NPH, the disruption of normal CSF pathways, following meningitis or sub-arachnoid haemorrhage, is responsible for ventricular dilatation. However, in about half of the cases, the etiology remains obscure. NPH is more frequently found in elderly people, probably in relation with the increased incidence of cerebrovascular disease. The diagnosis of NPH is based upon a triad of clinical symptoms. The main symptom is gait disturbances, followed by urinary incontinence and various degree of cognitive changes. The latter two symptoms are not prerequisites for the diagnosis. Radiological ventricular dilatation without cortical sulcal enlargement is a key factor, as well as substantial clinical improvement after CSF withdrawal (CSF tap test). Other CSF dynamic studies and various imaging investigations have been proposed to improve diagnostic accuracy, but no simple test can predict the results of CSF drainage. The current treatment is ventriculo-peritonial shunting, ideally using an adjustable valve. Results are directly dependent upon the accuracy of the preoperative diagnosis. Post-surgical complications may be observed in about 10% of cases.

Algorithms↗

PubMed2004

[Brain tumors in the elderly].

The incidence of brain tumors in the elderly has been questioned, but recently several studies have tended to confirm its increase. This may be partially due to the improvement of diagnostic methods and progress in the collection of epidemiological data. However, should this increase be confirmed by further studies, the possible role of specific risk factors in the elderly should not be neglected. Metastases are three times more frequent than primary brain tumors. Depending on the state of the primitive cancer, local control of brain localization may be achieved by surgery or, more recently, by radio surgery. Among primary brain tumors, gliomas have the worst prognosis with a survival not exceeding 6-8 months, regardless of the type of treatment used. However, half of the primary tumors are benign, meningioma representing the most frequent variety. In function of their clinical impact and their localization, surgery may be proposed, if the physical condition of the patient so allows. Conformational radiotherapy is indicated if a remnant of the tumor is detected as growing post-operatively. Pituitary adenomas should be treated surgically if they are responsible for compression of the visual pathways; in case of a secreting tumor (mainly prolactinomas) a medical treatment can be proposed.

Aged↗

PubMed2004

[Place of surgery in the treatment of adult temporal lobe epilepsy].

Surgery for temporal lobe epilepsy has made significant progress during the past twenty years: in addition to traditional factors (frequency of partial seizures and relative resistance to medical treatment), the possibilities offered by MRI in a large number of cases to detect the responsible lesion (hippocampal sclerosis in the majority of cases) has led to an increase in the use of surgical methods. Furthermore, other examinations (EEG-video, SPECT Depth-electrode recording) now permit precise localization of the epileptic focus. Surgical techniques have likewise been considerably modified: in parallel to classical temporal lobectomy, new surgical methods offer more restricted resection of the lateral cortex. The results are, on the whole, quite satisfactory, as three-quarters of patients can be considered cured or greatly improved. The length of post-operative follow-up does not seem to influence the quality of the results, as observed by the end of the second year.

Electroencephalography↗

PubMed2003

[Operability of intracranial meningiomas].

Intracranial meningiomas are lesions which generally can be removed radically by surgery. However, because of their location, the extension of the dural attachment, the inclusion of the main arteries of the circle of Willis or of cranial nerves, total removal carries a high risk of morbidity. In a review of a personal series of 500 cases, the limits of surgery are discussed and different groups of tumors are defined corresponding to their surgical operability. Although surgery appears indisputable on the convexity of the brain, para-sagittal and anterior basal meningiomas, total removal remains questionable for tumors of the inner part of the sphenoid ridge, of the petrous bone and of the falco-tentorial junction. In a few other cases, surgery is either unnecessary (asymptomatic meningioma) or inefficient in that there is no clear benefit for the patient (cavernous sinus meningioma). In the cases where surgery does not offer a complete cure, radiotherapy may be considered.

Adult↗

PubMed2002

[Cerebro-vascular emergencies: cerebral and meningeal hemorrhage].

Intracerebral haemorrhage is the most dramatic, even if not the most frequent among cerebrovascular emergencies. However the improved treatment of arterial hypertension has decreased its frequency. Modern neuroradiological methods have led to an easier diagnosis, but the best choice for treatment (medical or surgical) is still debated. Decision must be based upon different factors, the most important of which are clinical condition volume, and location of haemorrhage. If the general prognosis has been improved by the transfer to specialized Units, wherein such are available, the benefit of surgery, while indispensable in some cases, has yet to be demonstrated by prospective studies. The problem is far different in subarachnoïd haemorrhage due to rupture of a vascular malformation: the necessity of a rapid treatment by surgery or embolization is largely admitted except for those patients in a bad clinical conditions.

Cerebral Hemorrhage↗