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M Djindjian

Publications and source records attributed to M Djindjian.

At least 19 recordsLinked to original sources
PubMed1996

Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note.

The use of an endoscope in the treatment of suprasellar arachnoid cysts provides an opening of the upper and lower cyst walls, thereby allowing the surgeon to perform a ventriculocystostomy (VC) or a ventriculocystocisternostomy (VCC). To discover which procedure is appropriate, magnetic resonance (MR)-imaged cerebrospinal fluid (CSF) flow dynamics in two patients were analyzed, one having undergone a VC and the other a VCC using a rigid endoscope. Magnetic resonance imaging studies were performed before and after treatment, with long-term follow-up periods (18 months and 2 years). The two patients were reoperated on during the follow-up period because of slight headache recurrence in one case and MR-imaged CSF flow dynamics modifications in the other. In each case surgery confirmed the CSF flow dynamics modifications appearing on MR imaging. In both cases, long-term MR imaging follow-up studies showed a secondary closing of the upper wall orifice. After VCC, however, the lower communication between the cyst and the cisterns remained functional. The secondary closure of the upper orifice may be explained as follows: when opened, the upper wall becomes unnecessary and tends to return to a normal shape, leading to a secondary closure. The patent sylvian aqueduct aids the phenomenon, as observed after ventriculostomy when the aqueduct is secondarily functional. The simplicity of the VCC performed using endoscopic control, which is the only procedure to allow the opening in the cyst's lower wall to remain patent, leads the authors to advocate this technique in the treatment of suprasellar arachnoid cysts.

Adult↗
PubMed1995

[Intra-extracranial meningioma in the cranial vault].

Between 1982 and 1993, 11 cases of intra-extracranial vault meningiomas were treated in Créteil, by the same multidisciplinary team. The average age was 53.5 years and the Karnofsky rating was high (> 80 in 7 cases). Ten of the 11 cases had medial tumours with venous sinus thrombosis occurring in 9 of these. The location of the tumour was frontal in 6 and parietal in 4 patients. Of the medial tumours, 5 (half) were bilateral intracranial lesions. The average duration of symptoms was more than 10 years in four cases, between 1 and 3 years in five, and the diagnosis was made immediately in two patients. MRI coronal sections, after venous contrast injection, allowed diagnosis of the lesion and visualisation of the sinus thrombosis. Embolisation was performed pre-operatively in all cases scheduled to have surgery, resulting in safe excision of the tumour. Surgery was performed in 9 patients with complete tumour removal achieved in 8. Of those who did not undergo surgery, one received radiotherapy and the other died before treatment. The bony defect was covered with cadaveric bone, autogenous bone, coral and methyl-methacrylate in one, two, two and two patients respectively. Complications occurred in 2 cases: extradural secondary infection and CSF rhinorrhea treated with a lumbo-peritoneal shunt. The post-operative Karnofsky rating was greater than 90 in seven cases, 70 in one, and 50 in two cases. After an average follow-up of 4 years, 3 patients had tumor recurrence at 4, 7, and 8 years; the first having a locally malignant character, the second showing radiological recurrence in a case of subtotal removal, and the third a marginal recurrence. Two of the 3 patients underwent further surgery. The malignant case, received radiotherapy but unfortunately a new recurrence occurred 14 months later. As radiotherapy was used in only 3 cases, statistically significant conclusions concerning efficacy cannot be drawn.

Adult↗
PubMed1994

[Antibiotic prophylaxis in neurosurgery].

Postoperative wound infections are a serious complication in neurosurgery. The average infection rate without antibiotics ranges between 5-11% in CSF shunts, between 2-5% in craniotomies and spinal surgery in clean and clean contaminated patients, and 11-38% in CSF fistulas. In CSF shunt procedures as well as in craniotomies, common skin commensals, mainly coagulase negative and positive staphylococci are responsible for most postoperative infections. Contradictory results of the studies evaluating the efficacy of prophylactic antibiotics (PA) make it impossible to conclude whether antibiotics have any impact on the incidence of infections or not. Nevertheless the decision to use PA must be left to each surgeon and based on own experience (the mean rate of infection decreased from 5-11% to 1% with PA in France). In clean and clean contaminated surgery, the weight of evidence based on some large, prospective, randomized studies, suggests that PA exerts a protective effect, for which an antistaphylococci antibiotic would be appropriate. In case of methi-R organisms, a second generation cephalosporin is an alternative. Association of vancomycin-gentamicin is not recommended routinely because of the risk of development of resistance.

Anti-Bacterial Agents↗
PubMed1994

[Neurosurgical endoscopy. Diagnostic and therapeutic indications].

An historical review of neurosurgical endoscopy is evocated. The characteristics of the endoscopic material are discussed: flexible or rigid?, length?, diameter?, irrigation?, free-hand manipulation or fixed arm? A rigid neurosurgical endoscope (STORZ) is described which characteristics are the following: 5 mm/3.7 mm ovale diameter, working length of 21 cm (allowing its use under stereotactic conditions), 5F working channel and articulated arm for solid immobilization in the desired position. All the indications of endoscopy are described and illustrated with a series of 48 patients. Indications for diagnosis are rare and summarised in exceptional help for conventional surgery. 80% of the usual indications of endoscopy were represented by third ventriculostomy. The endoscopic guidance brings safety and allows an increasing of the ventriculostomy's indications. Endoscopic fenestrations of arachnoid cyst are described with a particular interest on suprasellar cysts. The other indications are rare: unilateral hydrocephalus, biopsies of intraventricular tumors, puncture of colloid cysts.

Brain Diseases↗
PubMed1994

[Neuro-aggressive dorsal vertebral hemangioma and vertebrectomy. Apropos of 2 cases. Review of the literature].

PURPOSE OF STUDY: Vertebral hemangioma is a benign and relatively frequent lesion. It is rarely associated with medullary compression. Two cases of vertebral hemangioma with progressive neurologic deficit are presented. METHODS AND RESULTS: Successful treatment was accomplished using pre-operative embolization and vertebrectomy. The tumor was resected by an antero-lateral transthoracic and posterior approach. DISCUSSION: The technique of operative management and complications are discussed. Based on these two patients and a review of the literature, the authors recommend that management of patients with progressive neurological deficit should include pre-operative angiography and embolization, decompressive surgery with the approach determined by the degree of vertebral involvement and site of spinal compression.

Adolescent↗
PubMed1993

[Prevention of wound infections in neurosurgery].

Post-operative wound infections are a serious complication in neurosurgery. The average wound infection without antibiotics ranges between 5-11% in C.S.F. shunts, 2-5% in clean and clean contaminated patients; 11-38% in C.S.F. fistula. In C.S.F. shunt procedures, common skin commensals are responsible for most post-operative infections, mainly coagulase negative and positive staphylococci. Contradictory results of the studies evaluating the efficacy of antibioprophylaxis make it impossible to conclude whether antibiotics have any impact on the incidence of infections. Neverless the decision to adopt antibioprophylaxis must be left to each surgeon and based on their own experience (mean level of infection dropped from 5-11% to 1% with ABP in France). In clean and clean contaminated patients, the weight of evidence based on some large, prospective, randomized studies, suggest that ABP exert a protective effect, for which an antistaphylocci antibiotic would be appropriate. In case of Methi-R organisms, a second generation cephalosporin is an alternative candidate. Association of Vancomycin-Gentamycin is not recommanded routinely because of the risk of development of resistance. In skull fracture and C.S.F. fistula, the results of studies does not favour the routine administration of antibiotics.

Anti-Bacterial Agents↗
PubMed1992

Multiple vertebral hemangiomas with neurological signs. Case report.

A case of multiple vertebral hemangiomas with progressive neurological deficit is presented. Successful treatment was accomplished using preoperative embolization, palliative surgical decompression, and postoperative radiation therapy. The patient has remained asymptomatic for 6 years. The authors review the role of current imaging modalities and options for therapeutic intervention. Preoperative embolization, palliative surgical decompression, and postoperative radiotherapy appear to provide a satisfactory outcome in patients with multiple hemangiomas and may represent an effective alternative to more aggressive surgical intervention.

Adult↗
PubMed1991

[Pseudo-oligodendrogliomatous meningioma. Report of 2 cases and review of the literature].

We report two cases of oligodendroglioma-like meningioma revealed by symptoms of increased intracranial pressure, progressive hemiparesia and partial epileptic seizures. Brain CT-scan or scintigraphy and carotid arteriography were suggestive of a convexity meningioma. One patient had received radiation treatment for scalp tinea capitis 25 years previously. In spite of complete surgical removal, the tumor recurred in both cases respectively 17 years and 18 months later. The two patients were operated again, and one underwent a complementary radiotherapy. Pathologic diagnosis was particularly difficult in the first case where the pattern at conventional histologic technics was that of oligodendroglioma. On the occasion of recurrence, immuno-histochemistry and ultrastructural studies were performed. The tumor was positive for epithelial membrane antigen (E.M.A) and cytokeratin, but was negative for glial fibrillary acidic (G.F.A.) protein, S 100 protein (S 100), neuron-specific enolase (N.S.E.), vimentin, anti-LEU-7 (N.H.K.1), and neurofilaments (N.F.). Electron microscopy showed closely adjacent cells with tonofilaments and numerous desmosomes. These findings permitted to establish the diagnosis of oligodendroglioma-like meningioma instead of oligodendroglioma. In the second case, the histologic pattern was also reminiscent of oligodendroglioma, but presence of few cellular whorls in some part of the tumor permitted the correct diagnosis. The pathogenesis of this atypical form of meningioma, its tendency for recurrence, and usefulness of radiotherapy are discussed and literature is reviewed.

Adult↗
PubMed1990

[Optimal length of antibiotic therapy in aspirated cerebral abscess].

Between 1983 and 1988, 22 patients with brain abscess were admitted to our neurosurgery department; 2 patients deeply comatose on admission and who died on the first day were excluded from this study. Treatment consisted of needle aspiration of the abscess and antibacterial therapy initially using a broad-spectrum antibiotic later replaced, in all cases, by an antibiotic found to be active in vitro against the organism(s) isolated. The portal of entry was eradicated as early as possible. The duration of antibiotic therapy was determined according to the changes observed on computerized tomography images classified as cavitary, nodular, hypodense or normal. Nodular images were taken as reflecting an inflammatory state in the healing process, and hypodense images as sequelae, so that antibiotics were withdrawn in patients with such images. Altogether, 62 per cent of the patients received antibiotics for 60 days and 95 per cent for 90 days. There was no recurrence. In some patients with deep or, chiefly, multiple abscesses, treatment was pursued. In any case, antibiotics should not be given for more than 90 days if the initial treatment has proved effective, since cure is achieved in 45 to 60 days on average.

Anti-Bacterial Agents↗
PubMed1990

Antibiotic prophylaxis during prolonged clean neurosurgery. Results of a randomized double-blind study using oxacillin.

The efficacy of oxacillin as a prophylaxis for infection was analyzed in a 27-month randomized double-blind study of 400 patients who had undergone clean neurosurgical interventions lasting longer than 2 hours. Four neurosurgeons took part in the study and 356 patients were eligible for final analysis. Among the 171 patients treated with oxacillin, there was one case of infection (0.6%), compared to nine (4.9%) of the 185 patients given a placebo. The difference between the two groups was statistically significant (p = 0.0398). This study, together with others (randomized or not), clearly demonstrates the efficacy of antibiotic prophylaxis in prolonged clean neurosurgery.

Adolescent↗
PubMed1990

Giant gangliocytic paraganglioma of the filum terminale. Case report.

The clinical and pathological features of a giant cauda equina paraganglioma arising from the intradural filum terminale is described. Scattered mature large neurons characterized the tumor as a gangliocytic paraganglioma. Histologically, these neoplasms have considerable similarity with ependymoma and the diagnosis can be easily missed unless special techniques are employed.

Adult↗
PubMed1990

[Correlations between anatomy and computerized tomography findings in transtentorial cerebral herniation].

The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.

Brain↗
PubMed1989

Sacral lipoma of the filum terminale with dural arteriovenous fistula. Case report.

A patient presenting with progressive paraparesis was found to have a dural sacral arteriovenous (AV) fistula. His condition deteriorated abruptly after thoracolumbar angiography. Embolization of the fistula improved the patient's status so that he was able to walk with crutches. One year later his neurological condition worsened. He was treated via an enlarged laminectomy because of uncertainty concerning a lipoma noted on the initial computerized tomography scan. The lesion consisted of an intradural filum terminale lipoma associated with an AV fistula, both of which were excised. The patient's condition was unchanged 6 months later. The different types of spinal lipomas and spinal AV malformations are reviewed, and mechanisms are proposed to explain the clinical deterioration in this patient. Venous hypertension seems to be the most likely possibility. The lipoma may have produced local hypervascularization of the dura mater with a subsequently acquired AV fistula.

Arteriovenous Fistula↗
PubMed1989

[The role of surgery and low molecular weight heparin in the treatment of cerebral venous thrombosis. Apropos of 2 cases].

For one case of thrombosis of sinus sagittalis superior joint haemorrhagic cerebral softening necessitates surgical draining of haemorrhagic focus grown to a true intracranial haematoma; for the another case direct low molecular weight heparin treatment obtained a mere evolution. Authors are of the opinion that early low molecular weight heparin treatment is able to avoid massive haemorrhage.

Adult↗
PubMed1989

[Radiotherapy of vertebral hemangioma with neurologic complications].

The interest of radiotherapy in the treatment of compressive vertebral hemangiomas (H.V.C.) is discussed from a literature review. Recent advances in imaging permit to precisely define the target-volume. The dose of 35 grays with standard fractioning affords optimal results on H.V.C. with no risk of spinal cord damage.

Hemangioma↗