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Biomedical subjects

N de Tribolet

Publications and source records attributed to N de Tribolet.

At least 109 records · Page 6Linked to original sources
PubMed1993

Surgery of supratentorial tumors.

Neurosurgery may be the ultimate treatment of benign tumors, eg, certain meningiomas and acoustic neurinomas; however, for invasive and malignant tumors, it is just another part in a multimodality approach coupled with radiotherapy, chemotherapy, and possibly immunotherapy. Still heading for more efficiency, new surgical techniques and aids have been developed. Their multiplicity and precision should encourage the neurosurgeon to even more carefully plan the type of surgery by a thorough preoperative evaluation. Preoperative management now not only assesses the size and the extent of the tumor but tries to find hints of its degree of malignancy to understand the perilesional edema and to guide the surgeon's hand. Although surgical approaches have been improved over the past years by the introduction of microsurgery, the ultrasonic aspirator, laser, and perioperative ultrasound, computer-assisted stereotactic neuronavigation seems to be the major novelty, and its future developments may prove to be of great medical value. Finally, the postoperative evaluation of the patient also benefits from new standards in neuroimaging and radionuclide investigations, allowing better estimation of residual tumor and early diagnosis of recurrence.

Adult↗
PubMed1993

Total intravenous anesthesia with propofol for burst suppression in cerebral aneurysm surgery: preliminary report of 42 patients.

Forty-two patients underwent cerebral aneurysm clipping at our institution in 1991, 35 with a ruptured aneurysm and 7 with an unruptured aneurysm. Preoperatively, 22 patients with a ruptured aneurysm were graded I or II according to the World Federation of Neurosurgical Societies and 21 underwent an operation on the first day. All underwent a standard cerebral protective general anesthesia, combining propofol with fentanyl, arterial normotension (mild hypertension with volume loading and/or dopamine during temporary clipping and once the aneurysm was secured), normocarbia or slight hypocarbia, brain relaxation with lumbar drainage, mannitol and propofol, and electroencephalogram burst suppression when temporary clipping (> or = 2 min) was required. Propofol doses for induction were 1.8 +/- 0.1 mg/kg (mean +/- standard error); for maintenance, doses were 86 +/- 3.5 micrograms/kg per min; and for burst suppression doses were 500 micrograms/kg per min. After clipping, the propofol dose rate was reduced to allow early recovery and neurological examination in the operating room. In 21 patients, temporary clipping was required for a mean duration of 8.8 +/- 1.3 minutes (range, 2-29); none of these patients deteriorated as compared with their preoperative neurological state. Twenty-four of the 42 patients (57%) had a Glasgow Coma Outcome Scale (GOS) score of 1, 7 patients had a GOS score of 2, 8 had a score of 3, and 3 had a score of 5. Thirty-two patients were extubated in the operating room with a mean GOS Score of 13.2 +/- 0.5, and 10 were extubated later in the intensive care unit.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1993

Giant cell tumor of the orbit.

Giant cell tumors of the skull are very rare and usually occur in the sphenoid bone. The authors report the case of a 10-year-old boy with such a tumor involving exclusively the roof of the left orbit. He presented essentially with edema of the left superior eyelid and diplopia. Computed tomographic examination and magnetic resonance imaging delineated the lesion, which was radically removed via a left fronto-orbital craniotomy. Some aspects of this rare neoplasm are reviewed.

Cerebral Angiography↗
PubMed1993

[Neuroanesthesia. Some new aspects].

Major changes are becoming apparent among neuro-anesthetists and neurosurgeons in their attitude towards hypocarbia, blood volume, mean arterial pressure (MAP), cerebral perfusion pressure (CPP), anesthetic technique, and brain retraction pressure. These changes are related to the transfer from intensive care units to operating theaters of major new physiologic data regarding oxygen delivery to tissues (DO2) and oxygen consumption by tissues (VO2). These fundamental data have progressively, during the last five years, led to the concept of brain homeostasis based on four fundamental therapeutic principles: 1) The use of moderate hypocarbia (as opposed to deep hypocarbia which should stay exceptional). 2) The use of a normal mean arterial pressure (MAP) and thus cerebral perfusion pressure (CPP) by promoting a. normovolemia, b. a hematocrit around 30% and c. a light anesthesia technique allowing rapid recovery. 3) The use of appropriate crystalloids (NaCl 0.9% rather than Ringer-Lactate, and no DW5) taking into account measured osmolality. 4) The optimisation of brain relaxation by combining an appropriate anesthetic technique, mannitol, head up (and head straight) position, together with a lumbar drainage.

Anesthesia, General↗
PubMed1993

[Acoustic neuroma. A review of 50 cases].

A consecutive series of 50 patients undergoing acoustic neurinoma excision between 1985 and 1990 is reported. All patients were operated by the retrosigmoid approach. With no mortality, the most frequent complication was a leak of cerebrospinal fluid (12%). The facial nerve was preserved in 94% of cases and the cochlear nerve in 38% of cases. In our series, the size of the neurinoma is the most important predictive factor for the post-operative facial nerve function. The cochlear nerve could be preserved in 19 patients but only 4 patients retain some hearing after surgery, which represents 8% of the whole series and 21% of the preserved cochlear nerves. 4 patients had a subtotal excision. All 4 had a grade IV neurinoma. Only one patient had a recurrence that necessitated a second surgery. Complete excision is the goal in acoustic neurinoma surgery. However the dilemma can sometimes arise between a complete removal necessitating the sacrifice of the facial nerve and a subtotal extirpation with regular control CT-scans in the follow-up.

Adult↗
PubMed1992

Interleukin-8 is produced in neoplastic and infectious diseases of the human central nervous system.

The presence of interleukin-8 (IL-8), a leukocyte chemotactic factor, was examined in primary and metastatic central nervous system tumors and in nonneoplastic acute meningoencephalitides. In vitro: (a) 11 of 12 glioblastoma cell lines constitutively expressed IL-8 mRNA; (b) 5 of 6 of these cell lines secreted IL-8 protein as detected by enzyme-linked immunosorbent assay and a glucosaminidase release bioassay; and (c) IL-1 beta or tumor necrosis factor was able to augment both IL-8 mRNA steady state levels and protein secretion of all cell lines tested except IN-319. IL-8 was also found in vivo. (a) IL-8 poly A+ mRNA was detected in 2 of 2 low grade astrocytomas, 1 of 2 anaplastic astrocytomas, and 6 of 6 glioblastomas. (b) IL-8 protein was present in the cyst fluid of 1 of 4 low grade astrocytomas, 1 anaplastic astrocytoma, 2 of 2 glioblastomas, 1 oligodendroglioma grade III, and one central nervous system cervical carcinoma metastasis. (c) The cerebrospinal fluid of 3 of 4 metastatic lymphomas, 2 of 16 glioblastomas, 1 of 2 low grade astrocytomas, but none of 3 anaplastic astrocytomas and none of 9 meningiomas contained IL-8. The presence of IL-8 was not restricted to central nervous system tumors as 2 of 2 bacterial meningitis and 5 of 5 acute viral meningitis patients contained considerable IL-8 levels in the cerebrospinal fluid. (d) Immunohistochemical analysis showed IL-8 immunoreactivity in perivascular tumor cells in 11 of 15 glioblastoma sections. These data suggest that IL-8 secretion could be a key factor involved in the determination of the lymphoid infiltrates observed in brain tumors and the development of cerebrospinal fluid pleocytosis in meningoencephalitides.

Astrocytoma↗
PubMed1992

Granulocyte-macrophage colony-stimulating factor (GM-CSF) production by glioblastoma cells. Despite the presence of inducing signals GM-CSF is not expressed in vivo.

One of the morphologic hallmarks of human gliomas are inflammatory infiltrates with accumulation of macrophages in the tumor site. The signals leading to the macrophage response are only at the beginning of being understood. Novel chemotactic factors that have recently been characterized as secretory products of glioblastoma cells may attract mononuclear cells from the blood. Within the tumor tissue blood-derived monocytes and macrophages of the brain tissue, the microglial cells, may increase in cell numbers due to tumor-derived growth factors. Both astrocytoma cell lines and cultured astrocytes have been shown recently to produce granulocyte-macrophage (GM)-CSF. We show that in vitro not only astrocytoma but also glioblastoma cell lines secrete GM-CSF when stimulated with TNF-alpha or IL-1. However, there is no evidence for GM-CSF production by glioblastoma cells in vivo: fresh tumor samples lack the mRNA for GM-CSF and the protein is not detectable in the tumor cyst fluids or the cerebrospinal fluids of glioblastoma patients. This contrasts IL-1 and IL-6 that are detectable in the tumor cyst fluids and IL-6 also in the cerebrospinal fluids of the patients. Unlike GM-CSF, transforming growth factor-beta 2 mRNA is expressed in ex vivo tested glioblastoma tissues. Absence of GM-CSF in vivo may be explained by the presence of tumor-derived inhibitory factors, such as transforming growth factor-beta 2 and PGE which suppress GM-CSF production by glioblastoma cells in vitro. The accumulation of macrophages at the tumor site may be due to local elaboration of chemoattractants and/or not yet defined growth factors rather than due to GM-CSF production.

Chemotactic Factors↗
PubMed1992

Differential expression of the CD44 molecule in human brain tumours.

Expression of the CD44 molecule was examined in a variety of human brain tumours, brain metastases and normal brain. Immunohistological staining with several CD44 antibodies demonstrated differential expression of the CD44 molecule among different brain tumour types. CD44 was strongly expressed in high-grade gliomas and weakly expressed in meningiomas, medulloblastomas and normal brain. Northern blot analysis revealed the presence of 3 major CD44 mRNAs of 1.6, 2.2, and 5.0 kb in glioblastomas and a mRNA of 5.6 kb in meningiomas. CD44 expression was also detected by flow cytometric analysis on cultured cells derived from a variety of human brain tumours including glioblastomas and meningiomas.

Brain Neoplasms↗
PubMed1992

Sedatives and antagonists in the management of severely head-injured patients.

Continuous intravenous sedation is often prescribed during the intensive treatment of severe head injury. It is known that intravenous hypnotics may prevent or treat the brief intracranial hypertension episodes associated with nociceptive stimuli, like tracheal intubation. However there is yet no clear evidence in the literature showing beneficial effects of sedation in severely head-injured patients on intracranial pressure control or outcome. Sedation should be primarily administered in neurotraumatology to allow good conditions for intensive treatment, while avoiding any depressive cardiovascular action. The abrupt reversal of sedation by means of specific antagonists may induce significant elevation of both cerebral blood flow and intracranial pressure and should be avoided.

Brain↗
PubMed1992

Osseous metastases from a benign intraventricular meningioma. Case report.

The authors report a case of a 6 month-old male presenting with increasing head circumference and a large benign intraventricular meningioma which was grossly removed at the initial surgery. Twenty-four months later, the patient returned with subcutaneous and osseous metastatic lesions at the site of the previous craniotomy, revealing the same histology as the original tumour. The presentation, pathology and management of this unique case are discussed.

Cerebral Ventricle Neoplasms↗
PubMed1992

Expression of cALLa/NEP on gliomas: a possible marker of malignancy.

First described on pre-B leukemia cells, the common acute lymphoblastic leukemia antigen (cALLa) is also expressed on glioma cells in vitro. Its identity to neutral endopeptidase (NEP) (E.C.3.24.11) was corroborated by our finding that cALLa positive glioma cells had NEP activity. To study cALLa/NEP distribution on glial tumours in vivo, we examined 76 brain tumour biopsies by immunostaining techniques on frozen tissue sections using anti-cALLa (FAH99) and anti-NEP (135 A 3) monoclonal antibodies. We found that 96% of grade 4 gliomas (25/26) expressed NEP. Whereas only 45% (4/9) of grade 3 or anaplastic astrocytomas did. In low grade gliomas, we found 2 positive tumours out of 21 tested (10%). Double immunostaining procedures revealed that NEP was co-expressed with GFAP. However no NEP could be detected on non-glial brain tumours nor on reactive astrocytes. These results suggest that cALLa/NEP expression could be linked to malignant progression of gliomas.

Adolescent↗
PubMed1992

Microsurgical anatomy and operative technique for extreme lateral lumbar disc herniations.

The anatomy of the lateral aspect of the lumbar spine and our lateral microsurgical technique for extreme lateral lumbar disc herniations (ELLDH) is described. This study was based on the microdissection of 4 cadavers, on the morphometric evaluation of these as well as 6 dried cadaver spines and 8 lumbar CT scans, and on the use of this technique on over 200 cases. Level dependent changes in the posterior arch cause a shift of the disc space distally relative to the facet joint, an increasing amount of bone to overlie the intervertebral foramen, and a decreasing amount of working space within the exposure in the caudal direction. Therefore, more bone removal from the lateral aspect of the pars interarticularis and supero-lateral aspect of the facet joint is required in the lower lumbar spine. When the exposed ligamentum flavum is resected, the dorsal root ganglion is seen and access to the herniation and disc space is achieved. Level dependent changes in the pedicles and transverse processes lead to an alteration in the course and relationships of the nerves, thereby influencing the pathophysiology of and surgical technique for the ELLDH. The operative target is the lateral aspect of the pars interarticularis and not the intertransverse space as has been previously described. Our techniques allows for the early identification of the nerve with minimal risks of injury to it, to the adjacent vessels and to the structural integrity of the facet joint and pars interarticularis.

Humans↗
PubMed1992

Herald facial numbness.

Three unusual patients who developed subacute facial numbness as the heralding symptom of an expanding tumor that involved the trigeminal nerve fibers are reported. The first patient had clinical and electrophysiological evidence of an isolated mental neuropathy as a result of metastatic lesions with bone destruction from a renal cell carcinoma. The second patient had a sensorimotor trigeminal neuropathy caused by a direct compression of the semilunar ganglion by a cavernous hemangioma of Meckel's cave. The last patient experienced facial numbness as the unusual presenting manifestation of a primary brainstem lymphoma. Patients 1 and 3 died a few weeks after the admission, whereas patient 2 poorly recovered. Despite the availability of new techniques for early diagnosis, this report demonstrates how difficult it can initially be to differentiate a 'benign' trigeminal neuropathy from serious conditions and underscores the poor prognosis of fifth nerve fibers involvement by an expanding mass. Early referral with clinical and electrophysiological evaluation appears to be of crucial importance.

Adult↗
PubMed1992

Adhesion molecules and malignant gliomas: implications for tumorigenesis.

Adhesion molecules, a family of cell-surface molecules, are likely to be of central importance in mediating cell-extracellular matrix and specific cell-cell interactions within both neoplastic and inflammatory sites. The recently discovered expression of adhesion molecules on glioma cells, tumor-infiltrating lymphocytes, and endothelial cells within the tumor offers insight into the molecular basis of the interactions both between the glioma cell and surrounding heterologous cell types within the tumor environment, and between the tumor cell and the extracellular matrix. Such interactions suggest that these molecules may play roles in the homing of immune cells to these tumors and in regulating the extent of local tumor invasion. The ability to modulate adhesion molecule expression on either immune cells or their respective ligands on gliomas provides an approach to modify cell-cell interactions that may be used to increase tumor kill by the immune system. A similar approach in the modulation of adhesion molecules involved in tumor cell adhesion to the extracellular matrix or endothelial cells may be a method to limit local invasion in these lesions.

Cell Adhesion Molecules, Neuronal↗
PubMed1992

[Cerebral metastases. A study of a surgical series of 81 cases].

In this retrospective study, 81 patients operated by craniotomy for a brain metastasis are reviewed. Mean age is 56.3 years and most of the patients are male (71.6%). Clinically, 79% of the patients present a focal semiology, most frequently with neuropsychologic disturbances (43%); epilepsy is found in 31% of the cases. Symptoms related to intracranial hypertension (vomiting and headache) are present in 43% of the patients. On C.T.-scan, there is a solitary metastasis in 89% and the most common intracranial location is the frontal lobe (33.3%). The most frequent primary neoplasms are: bronchial adenocarcinoma in 19%, squamous carcinoma of the lung in 11%, melanoma in 12% and unknown origin in 18%. The surgical removal (as judged by the surgeon) is total in 70%, subtotal in 19% and partial in 11%. Standard operative mortality (30 days after craniotomy) is 7.4%. The postoperative course (till the patients leave our department) is excellent in 58% (complete neurologic recovery), steady in 20% (stability of symptoms and neurologic examination) and bad in 22%, with worsening of the neurological deficits. Most of the patients (84% of the patients who survive more than 30 days after the craniotomy) had postoperative whole brain radiotherapy with a hypofractionned schedule (total doses of 15 to 40 Gy with fractions of 200 to 650 cGy). Ten patients had surgery alone. Mean survival is 10.2 months with a follow-up of 12 months to 10 years. Ten patients survived over 18 months and one is still alive almost 4 years after his craniotomy. In this study, the survival is not modified by the primary lesion's histology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Delayed intracranial hematomas following cranio-cerebral trauma].

We present a retrospective study of 30 cases of delayed intracranial hematoma, of which 28 were intracerebral, 5 epidural and 2 subdural. Follow-up of the neurologic and radiologic evolution aimed at determining the risk factors capable of predicting the occurrence of delayed intracranial hematoma. 14 patients had a Glasgow score of 15 on admission. 11 patients were neurologically entirely normal and did not undergo an initial CT-scan. In the 19 cases where it was performed the initial CT-scan showed contusion in 9 cases, edema in 6 and epidural hematoma in 7. A skull fracture was diagnosed in 22 patients. The most significant prognostic factor was the level of the Glasgow score on admission. Of the 14 patients who had a score of 15, 7 made good recoveries, 4 had a minor handicap, 1 a severe handicap and 2 died. Delayed intracerebral hematomas are highly unpredictable and can occur in any age group, in patients who are fully conscious on admission, and in patients with a normal CT-scan, with or without fracture. Our current policy is the following: no concussion but normal neurological findings: discharge home; concussion but normal neurological findings on admission: plain skull films; if fracture, 24 hours' hospital supervision; if no fracture, discharge home; abnormal neurological findings on admission: CT-scan; repeat CT if there is secondary neurological deterioration, secondary rise in intracranial pressure, or lack of improvement after 24 hours, and in all sedated and hyperventilated patients after 24 hours.

Adolescent↗
PubMed1991

Tuberothalamic infarct after division of a hypoplastic posterior communicating artery for clipping of a basilar tip aneurysm: case report.

The authors present a case of a tuberothalamic infarct subsequent to division of the posterior communicating artery for clipping of a high-lying aneurysm of the basilar bifurcation using the pterional approach. In view of this clinical observation and some particular aspects of the microsurgical anatomy of the perforating vessels of the posterior communicating artery, we conclude that interrupting this parent vessel carries a significant risk of infarction.

Aged↗