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Biomedical subjects

P Freger

Publications and source records attributed to P Freger.

At least 19 recordsLinked to original sources
PubMed2005

Embryology of the internal carotid artery dural crossing: apropos of a continuous series of 48 specimens.

The aim of this study was to describe the embryologic and foetal development of the anterior paraclinoid region and more precisely the relationship of the internal carotid artery to the dura mater. This has been done by examining a collection of histological sections, representing a continuous series of 48 embryologic and foetal specimens, covering the period of the first 6 months of intra-uterine life. Neurological and vascular elements develop during the embryologic period; the internal carotid artery is recognizable in the various sections of its course and acquires a histological adult parietal constitution. The foetal period corresponds to the development of the meningeal structures. The superior, medial and lateral walls appear on the fifteenth week of amenorrhoea and do not change after that. The internal carotid artery enters subarachnoid space accompanied by a sleeve of mesenchymatous cells, which fixes it to the anterior clinoid process. The constitution of this sleeve, arising from the superior wall of the lateral sellar compartment, remained independent of the principle vascular part, which allows the formation of a plan of cleavage. The foetal relations of the dura mater and the internal carotid artery were seen to be different from those of adult subjects described in the literature, suggesting an existence of period of maturation postnatally.

Carotid Artery, Internal↗
PubMed2004

[Ruptured anterior communicating artery aneurysm. Therapeutic options in 119 consecutive cases].

BACKGROUND AND PURPOSE: The respective roles of endovascular and surgical treatment must be clearly defined in the management of ruptured anterior communicating artery (AcoA) aneurysm. The aim of our study was to report our results, using the aneurysm direction as the main morphological argument to choose between microsurgery and endovascular embolization. Morbidity and mortality, causes of unfavorable outcome and morphological results were also assessed. PATIENTS AND METHODS: Our prospective study included 119 patients: 89 treated by microsurgery and 30 undergoing embolization with Guglielmi Detachable Coils (GDC). When the aneurysm had an anterior direction (fundus of the aneurysm in front of the pericallosal arteries), we attempted microsurgery. If the fundus of the aneurysm was behind the pericallosal arteries, we selected the most adapted procedure after discussion with the neurovascular team, taking into account the physiological status, treatment risk and neck size. Preoperative status of the patients was assessed according to the Hunt and Hess (HH) classification. Cerebral CT-scan and angiograms were routinely performed after treatment to determine causes of unfavorable outcome (GOS>1) and the morphological results. RESULT: Overall clinical outcome was excellent (GOS1) for 63.0% of patients, good (GOS2) for 10.1%, fair (GOS3) for 13.4%, poor (GOS4) for 2.5%. The mortality rate was 10.9%. Among the 82 patients in good preoperative grade (HH III), 8 (21.6%) achieved an excellent outcome. However permanent morbidity or death occurred in 15 patients (78.4%). Permanent disability and death were related to initial subarachnoid hemorrhage and were observed 21.3% of patients in the microsurgical group and 30.0% in the endovascular group [Fisher's Exact Test; p=0.33]. Procedure-related permanent disability and death rates were 9.0% for the microsurgical group and 23.3% for the endovascular group (p=0.06) respectively. In the microsurgical group, the only morphologic characteristic which significantly correlated with the occurrence of vessel occlusion was the fundus direction (p=0.03). The difference between endovascular and microsurgical procedures in the achievement of complete occlusion was considered significant (p=0.04). CONCLUSION: In our experience, the direction of the aneurysm was the main morphological criterion in choosing between microsurgery or endovascular procedure for the treatment of AcoA aneurysm. We propose that microsurgical clipping should be preferred for AcoA aneurysms with anterior direction, and depending on morphological criteria, endovascular packing for those with posterior direction.

Adolescent↗
PubMed2004

[Atlantoaxial synovial cyst. A case report].

The case of a 62-year-old patient with an atlanto-axial synovial cyst is presented. The narrowing of the spinal canal was associated with anterior medullar compression and neurological deficit. A transoral approach with odontoid resection was performed. The diagnostic of synovial cyst was histologically confirmed. Secondary atlanto-axial instability required posterior fixation completed by C1-C2 transarticular screw fixation. The follow-up showed an improvement of the neurological deficit. Similar cases reported in the literature are reviewed and discussed.

Atlanto-Axial Joint↗
PubMed2003

Embryology of the walls of the lateral sellar compartment: apropos of a continuous series of 39 embryos and fetuses representing the first six months of intra-uterine life.

The aim of this study was a continuous and rather exhaustive description of the embryological development of the lateral sellar compartment. The histological sections of 39 embryos and fetuses were studied, and represent the first six months of intra-uterine life. The embryological period showed the organization of the content of the compartment. The medial and lateral walls appeared during the 15th week of amenorrhoea, and did not modify later. The medial wall was constituted in its rostral part by the hypophyseal lodge and in its caudal part by the periosteum of the sphenoid bone. Two layers formed the lateral wall: the superficial layer was an expansion of the dura mater that surrounded the oculomotor nerves along their course to the superior orbital fissure; the deep layer was weaker, and surrounded and joined the nerves together. The results of this study advocate the evolution of the nomenclature of this region, as the term "inter-periosto-dural space" would better reflect the real pattern of the lateral sellar compartment. Furthermore, the presence of a communication between the two lateral sellar compartments has led to a discussion of the previous hypothesis about the development of the lateral sellar compartment. The venous network was located on both the medial and lateral sides of the internal carotid artery, but expanded in the lateral wall of the lateral sellar compartment. That is of interest to surgeons and radiologists because it could explain some hemorrhagic complications.

Carotid Artery, Internal↗
PubMed2003

[Bilateral chronic subdural hematoma: spontaneous intracranial hypotension?].

We report a case of bilateral chronic subdural hematoma (SDH) in a 48-year-old man, who presented with postural headaches, tinnitus and progressive confusion without intoxication, head trauma or abnormal hemostasis. Magnetic resonance imaging revealed cerebellar tonsillar herniation in the foramen magnum and a deformation of the brainstem. Outcome was normal after surgery. We discuss about the rare causes of SDH in young adults.

Confusion↗
PubMed2000

[A case of primitive meningeal rhabdomyosarcoma. Histological, immunohistochemical and ultrastructural study].

A 64 year-old patient, complained of headache and neurological disorders. CT scan found a voluminous solitary tumor of the posterior part of the left cavernous sinus. Removal of tumor was followed by a rapid recurrence and by the patient's death. Histologic study found a malignant undifferentiated tumoral proliferation, with strap-like cells. Immunohistochemical stains were positive for conjunctival and muscular differentiation. Ultrastructural study revealed intracytoplasmic filamentous striated structure. The primary meningeal rhabdomyosarcoma is an exceptional tumor, generally affecting young patients. Its prognosis is poor and its histogenesis remains unclear.

Fatal Outcome↗
PubMed1999

Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia.

PURPOSE: Pudendal neuralgia caused by nerve compression may be improved by surgical decompression of the pudendal nerve. This study was undertaken to determine if clinical symptoms, electrophysiological investigations, and the efficacy of preoperative pudendal nerve blocks could be used to predict the efficacy of surgery. METHODS: Twelve consecutive patients complaining of anal pain, genital pain, or both, exacerbated in the sitting position and unsuccessfully treated by analgesic drugs before referral were studied. In these 12 patients decompression of the pudendal nerve was performed after unsuccessful CT-guided injection of corticosteroids in the pudendal nerve at the ischial spine or after pain relapse following successful injections. Nineteen nerves were decompressed by surgery, and the compressed area was located between the sacrospinal and sacrotuberal ligaments for 18 nerves. RESULTS: Three months after surgery, four patients were totally relieved, and three were only partially improved. After 21 months of follow-up, three patients were cured, one was slightly improved, and eight remained in pain. In the three patients cured by surgery, pain completely disappeared for at least two weeks after a nerve block repeated twice before surgery, whereas pain relief was observed in only one of the nine other patients (P = 0.018). None of the three patients cured by surgery were being treated for depression, whereas six of the nine remaining patients were receiving antidepressants or were followed by a psychiatrist (P = 0.09). Results of surgery did not depend on other preoperative clinical or electrophysiological data. CONCLUSIONS: This preliminary study suggests that complete disappearance of pain for at least two weeks after a nerve block repeated twice before surgery may be the best criterion to predict success. Based on this criterion, surgery would have been performed in four patients in this study, of whom three would have been cured.

Aged↗
PubMed1998

[Embryology of the human carpal bones (triangular cartilage, central carpal bone, morphogenesis of the scaphoid)].

Wax reconstructions according to Born's methods were performed from serial 10-micron sections of the wrists of human embryos (B. Tardif) to study the triangular cartilage and central bone of the carpus. A subsequent morphological study of the adult scaphoid bone was conducted in the light of embryological data. The triangular cartilage was observed in 4 of 38 carpi of embryos with a craniocaudal length of 40 to 69 mm, flatten between the ulna and triquetrum, on the inferior surface of the mesenchymal bud of the triangular ligament. The central bone of the carpus is constant in the embryo, between the inferior surface of the radial chondrification centre, capitatum, trapezium and trapezoid. In one case, the two wrists of the same embryo presented two central nuclei, leading to the distinction of two different formations:--the constant C2 embryonic central bone, trapped between capitatum, trapezoid and trapezium, which participates in the constitution of the scaphoid by fusion with the radial chondrification centre;--the C1 central bone, a rare supernumerary bone in adults, close to the inferolateral angle of the lunatum, on the dorsal surface of the carpus. These embryological data support. Westoll's theory concerning the filiation of the thoracic limb since the fin of crossopterygians, with deviation of the mechanical axis related to the development of weightbearing on the ground. The scaphoid bone must to be assimilated to a cube, but to an irregular tetrahedron, composed of two inverted pyramids joined by their bases. The inferior pyramid, articulating with he trapezium, trapezoid and capitatum, is concerned by morphological variations of the bone, which can present variable configurations between the two extreme morphotypes: the massive type and the strangulated type. The inferior pyramid, constituting the scaphoid, is derived from the central cartilage and presents the same relations. Variations of the volume of this inferior part of the bone are related to the more or less marked regression of this chondrification centre of the embryonic carpus. These variations of the bone can be expressed in terms of a scaphoid index, by calculating the relationship between the greatest dimension and the width of the narrowed portion.

Adult↗
PubMed1997

Anatomical basis of the variable aspects of injuries of the axillary nerve (excluding the terminal branches in the deltoid muscle).

The course of the axillary n. is complex with three points of angulation that may be used to delineate four segments and a fifth segment that corresponds to the intramuscular ending of the nerve in the deltoid m. The purpose of this study was to determine the precise anatomy of the nerve and of its branches, and some morphologic features for each segment. Thirty-two shoulders from embalmed adult cadavers have been studied. The axillary n. was divided in five segments: 1) from its origin to the inferior border of the subscapularis m., 2) from the subscapularis m. to the anterolateral border of the tendon of the long head of the triceps brachii m., 3) from the triceps to the posteromedial part of the surgical neck of the humerus, 4) from the humerus to the entry into the deltoid m., 5) the intramuscular distribution of the nerve in the deltoid m. In each segment from 1 to 4 were noted the origins of the branches to the subscapularis and teres minor mm. and to the scapulohumeral joint, and the origins of the lateral cutaneous branchial n. and of the terminal motor branches to the deltoid m. The length and the diameter of the nerve in the segments and the distance from the segment S1 to the musculotendinous junction of the subscapularis m. were measured. The results showed that the mean diameters were about 4.1 mm in segment 1, 4.1 mm in segment 2 and 3.4 mm in segment 3. The mean distance to the musculotendinous junction was 7.7 mm. Many variations in the levels of origin of the different muscular, articular or cutaneous branches were found without symmetry between the right and left sides. The lateral cutaneous brachial n. was absent in four cases. The results are compared with those in the literature. The division into five segments is proposed to radiologists and surgeons for evaluation or operative procedures on the axillary n., and to provide a hypothesis about the variable aspects of injuries of the nerve.

Adult↗
PubMed1997

Anatomic basis of the transgluteal approach to the hip-joint by anterior hemimyotomy of the gluteus medius.

The authors present a study of the intrinsic anatomy of the gluteus medius m, and of its innervation through the caudal branch of the superior gluteal n. The existence of an intramuscular tendon in the thickness of the gluteus medius was constantly prooved in 40 muscles. The relations of the intrinsic fibrous structure of the muscle and its innervation were studied. The authors deduce from that the topography of a gluteus medius incision, with respect to a safety area towards its innervation, which leads to an exposure of the acetabulum that is satisfying and gives opportunities of a sound repair after the surgery of the hip joint through the transgluteal approach. They propose the "anterior hemimyotomy of the gluteus medius m" designation.

Buttocks↗
PubMed1995

Causes of morbidity and mortality after ruptured aneurysm surgery in a series of 230 patients. The importance of control angiography.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the causes of morbidity and mortality after surgery for ruptured aneurysms. METHODS: Two hundred thirty consecutive patients were studied. Initial hemorrhage volume and vasospasm were evaluated preoperatively with CT, transcranial Doppler ultrasonography, and angiography. Nimodipine infusion was started before surgery. Preoperative clinical status was evaluated according to Hunt and Hess grading criteria. Surgery was performed early in 186 patients (81%). Control angiography, transcranial Doppler ultrasonography, and CT were performed routinely after surgery. Hypodense areas revealed by control CT were related to intracerebral initial hematoma, vasospasm, postoperative thrombosis, or spatula hyperpressure. RESULTS: Clinical outcome was excellent or good (Glasgow Outcome Scale [GOS] scores of 1 or 2) in 176 patients (77%), 17 (7%) were disabled (GOS score of 3), and 37 (16%) were vegetative or dead. In patients in good condition (grades I to III) preoperatively (n = 200), 38 had an unfavorable outcome (GOS score of 2, 3, 4, or 5). The major cause of complication was postoperative thrombosis (42%). In patients in poor condition (grade IV or V) (n = 30), 27 had an unfavorable outcome. The major cause of complication was initial bleeding (66%). Vasospasm was responsible for delayed ischemic deficit in 9 patients (3.9% of the total population). CONCLUSIONS: Systematic angiography remains by far the best means for determining the cause of a poor postoperative course.

Adolescent↗
PubMed1992

[Diagnosis of vasospasm: comparison between arteriography and transcranial Doppler. A series of 112 comparative tests].

56 consecutive patients with ruptured aneurysm (An) were studied. The An localisation were: anterior communicating artery (ACoA) 26 cases, internal carotid artery (I.C.A.) 13 cases, Middle cerebral artery (M.C.A.) 11 cases, Pericallosal artery (P.C.A.) 4 cases, anterior cerebral artery (A.C.A.) 2 cases. Nimodipine infusion was started as soon as the diagnostic was established. Transcranial Doppler (T.C.D.) and angiography (A degrees) were performed at the arrival and 10 to 12 days after surgery. Surgery was performed in the 72 first hours after S.A.H. in 79% of the cases. 112 comparisons A degrees-T.C.D. were available. An A degrees vasospasm (V.S.) was assessed if the reduction of calibre was 25% or more, on T.C.D. V.S. was assessed if mean cerebral flow (M.C.F.) was equal to or more than 130 cm/sec. There were 15 cases of A degrees V.S. in 14 patients: 2 cases before surgery, 1 case before and after surgery in the same patient and 11 cases after surgery. D.T.C. exhibited 11 cases of V.S. at the level of M.C.A.; there were 11 true positive, 0 false positive, 97 true negative and 4 false negative. The diagnosis of V.S. was always correct with T.C.D. when A degrees V.S. was present at the level of M.C.A., it was not made when A degrees V.S. was restricted to the initial part of A.C.A. (A1) uni or bilaterally: 3/6 cases of ACoA. An rupture or to I.C.A.: 1/4 case of I.C.A. An. rupture.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm, Ruptured↗
PubMed1992

[Vasospasm, early surgery and nimodipine. A series of 120 consecutive cases of surgically treated ruptured aneurysm].

A total of 120 consecutive ruptured aneurysms (An) were managed according to a radio clinical investigation protocol. Preoperative evaluation included clinical grading (Hunt & Hess classification) (3 patients were Gr. I, 62 Gr. II, 27 Gr. III, 13 Gr. IV, 15 Gr. V) angiography (A degree) and C.T.Scan grading. Nimodipine infusion was started before surgery (1 mg/Kg/h). Surgery was performed from Day 0 to Day 3--Control A degrees and C.T.Scan were performed 10 to 12 days after surgery. Post operative C.T.Scan hypodensities were evaluated according to preoperative C.T.scan anc control A degrees. The outcome was evaluated according to the Glasgow Outcome Score (G.O.S.) and the causes of sequelae and decreases were listed according to vasospasm (V.S.), initial hemorrhage and post operative thrombosis (T.H.R.). The outcome was good or excellent in 95.4% of 65 Gr. I.II cases, in 85.9% of 92 Gr. I.II.III cases. Among the causes of disability or death only one case of diffuse severe V.S. was noted; besides that and according to our experience V.S. incidence was lower in this series (25%) than in our previous experience. It is stated that nowadays with Nimodipine treatment and early surgery V.S. is no more a problem.

Adolescent↗
PubMed1990

[Aneurysms with severe clinical manifestations (Hunt and Hess grade IV and V). A series of 66 cases].

Among 250 patients consecutively admitted in our center with a ruptured intracranial aneurysm, 66 patients (24.4%) were initially classified in Hunt and Hess clinical grade IV (37 cases) or grade V (29 cases). All patients were studied as following: --The severity of subarachnoid haemorrhage was evaluated on the pre-operative C.T. scan using Fisher's criteria. Quantification of the intracerebral haematoma or the intraventricular associated haemorrhage or a subdural haematoma was estimated as well. --The arterial diameter, aneurysm size and location, and the eventual presence of intra-arterial embolus were noted on the pre-operative angiography. Aneurysm location was: anterior artery 27 cases, internal carotid artery 9 cases, middle cerebral artery 27 cases, posterior cerebral artery 2 cases, and 1 case on the basilar artery. In this series, a poor clinical condition on admission was related to the direct effect of the initial haemorrhage in 84.9% of the patients. Early seizures (7.6%) acute hydrocephalus (1.5%), multiple emboli (3%) and apparently early diffuse vasospasm (1.5%) were the other documented causes explaining the initial poor clinical condition. One case remained completely unexplained. Sixteen patients admitted with bilateral fixed dilated pupils or a major intracerebral haematoma from a ruptured anterior artery aneurysm were not operated on and subsequently died. Operative treatment (aneurysm clipping in all cases, and haematoma evacuation on demand) was performed in the remaining 50 cases within 12 hours after their admission. Thus, these patients underwent surgery on Day 0 in 31 cases, on Day 1 in 11 cases, and on Day 2 in 8 cases. A post-operative C.T. scan was performed in 46 cases. Post-operative angiographic control was only performed in 29 cases. Changes on the post-operative C.T. scan or the angiographic control were strictly compared to the neuroradiological information previously available. Final outcome was assessed at least two months after the onset. According to the Glasgow Outcome Score, the results were: good recovery 12 patients (18.2%); moderate disability 1 patient; severe disability 4 patients (6%); vegetative state 4 patients; death 45 patients (68.2%). Excluding the patients admitted in poor clinical grade but presenting with early seizures or minor initial haemorrhage, the mortality rate was 74.2%. According to the initial clinical grade, the initial C.T. scan findings, the eventual post-operative angiographic presence of an arterial thrombosis or vasospasm, it was obvious that the final bad outcome was mainly related to the severity of the initial haemorrhage. However, in 7 patients, post-operative disability or death can be explained by other complications, principally an arterial thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[The value of a computer tomography scanner and controlled arteriography in the study of the results of aneurysm surgery. A series of 100 consecutive cases].

A total of 100 consecutive patients, (93 with ruptured aneurysms, 7 with asymptomatic aneurysms) were managed following a radio clinical investigation protocol. Preoperative evaluation included clinical grading (Hunt and Hess) (20 patients were GR I, 43 GR II, 19 GR III, 9 GR IV and 9 GR V) angiography and CTScan grading. The timing of surgery was determined according to angiographic, clinical and CTScan data: 73.2% of ruptured aneurysms were operated on between Day 0 and Day 3. Control angiography and control CT were performed 10-12 days after surgery (earlier in case of clinical deterioration). Post operative CTScan hypodensities were evaluated according to preoperative CT, preoperative angiography and post operative angiography: 32 hypodensities (8 without any symptom) were related to initial hemorrhage, vasospasm or post surgical thrombosis. In five cases the etiology was dobble. Angiographic control data showed 18 cases of vasospasm and 12 cases of post surgical thrombosis. We did not find any complication due to the control angiography. The outcome was classified according to the Glasgow Outcome Score (GOS): of 82 GR I.II.III (H & H) cases, the outcome was 73 GOS 1-2 cases, 3 GOS 3 Cases, 1 GOS 4 case and 5 GOS 5 cases. of 18 GR IV.V (H & H) cases, the outcome was 4 GOS 1-2 cases, 1 GOS 3 case, 1 GOS 4 case and 12 GOS 5 cases. In 28 GOS 2-3-4-5 cases, the cause of disability or death was under the main responsibility of the initial hemorrhage 13 times, of a thrombosis 11 times, of the vasospasm 4 times with associated non neurological problems in seven cases. When the control angiography is not performed and when the thrombosis is unrecognized sequellae or death can be erroneously attributed in many cases to the sole vasospasm or to the initial hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Treatment of colloid cysts of the third ventricle by cerebrospinal fluid shunt].

The authors report 6 cases of colloid cyst of the third ventricle treated with unilateral ventriculo-atrial shunt and followed up 14 to 3 years. Today the diagnostic of these cysts is safer with C.T.-Scan and M.R.I.; in the 6 cases hydrocephalus was reduced and the volume of the cysts did not increase on C.T.-Scan controls. Nowadays the stereotactic approach seems to be safer than direct surgery but is not always a radical treatment and can be insufficient to treat hydrocephalus. We think that ventricular shunt can be a good alternative as a first and definitive treatment.

Brain Diseases↗