Biomedical subjects

Ph Métellus

Publications and source records attributed to Ph Métellus.

5 recordsLinked to original sources

PubMed2006

[Idiopathic acute obstructive hydrocephalus. Case report].

Acute hydrocephalus is rarely encountered in adults without venticuloperitoneal or venticuloatrial shunts. The purpose of this report is to describe a case of acute hydrocephalus due to no identifiable cause. A 40-year-old man developed a typical clinical picture of intracranial hypertension within a 24-hours period. On the morning of hospitalization, the patient consulted his physician for severe headache followed quickly by nausea and vomiting. After cerebral CT-scan, the patient was referred to our department. His condition rapidly worsened, with confusion, then drowsiness. Magnetic resonance imaging (MRI) demonstrated quadri-ventricular hydrocephalus with a Chiari I malformation. In view of his rapidly deteriorating clinical condition, emergency endoscopic third ventriculostormy was performed. The patient recovered rapidly and was discharged 8 days after the procedure. Diagnostic work-up included lumbar puncture showing normal cerebrospinal fluid (thereby eliminating multiple sclerosis, low-grade intracranial hemorrhage, and meningitis (bacterial, viral, fungal)), spinal MRI depicting no medullary lesions, and brain angiography revealing no vascular abnormalities. Follow-up brain MRI carried out at six months after hospitalization demonstrated normal ventricles and complete disappearance of the Chiari I malformation. No conclusion can be drawn as to whether the Chiari I malformation was the consequence or cause of hydrocephalus. The explanation of this acute hydrocephalus is the acute decompensation without identifiable cause of idiopathic stenosis of the foramen of Magendie and Luschka. Treatment with endoscopic third ventriculostomy is effective.

Acute Disease↗

PubMed2005

[Endovascular treatment of benign intracranial hypertension by stent placement in the transverse sinus. Therapeutic and pathophysiological considerations illustrated by a case report].

We report a case of benign intracranial hypertension in a 31-year-old man treated by endovascular stent placement in the right transverse sinus. The patient presented with a typical benign intracranial hypertension syndrome. Ophthalmologic findings showed bilateral papilledema with a 7/10 loss visual acuity loss in the right eye and 2/10 in the left eye. At lumbar puncture, cerebrospinal fluid (CSF) pressure was 40 mmHg. Magnetic resonance imaging (MRI) showed slit ventricles and dilatation of optic nerve sheaths. optiques. After failure of medical treatment, the patient was referred to our neurosurgical department for therapeutic decision. Direct retrograde cerebral venography showed predominant cerebral venous drainage via the right transverse sinus which exhibited stenosis in its proximal third. Mamometry revealed a 25 mmHg pressure gradient across the point of stenosis. Due to possible venogenic benign intracranial hypertension, endovascular stent placement was proposed and accepted by the patient. At 3 months follow-up, the patient was symptoms free, papilledema had disappeared and visual acuity was 10/10 on both eyes. CSF pressure on lumbar puncture was 11 mmHg. The pathophysiological aspects and therapeutic management of this pathology illustrated by this are discussed along with a careful and exhaustive review of the literature.

Adult↗

PubMed2005

[Transsacral approach to lumbosacral extraforaminal disc herniations].

INTRODUCTION: The lateral approach is classically used for surgical treatment of extraforminal disc herniations (EDH). However, its use at the level of the L5-S1 space can require more or less extensive resection of the facet joint. This study reports our experience in the treatment of L5-S1 EDH using the transsacral approach described by Muller and Reulen in 1998. MATERIAL AND METHODS: From February 2002 to October 2004, 12 patients presenting EDH at the L5-S1 level underwent treatment using the transsacral approach. There were 8 men and 4 women. Mean age was 55 years (range: 36 to 75 years). All patients presented lumbalgia and L5radiculalgia. Only one patient had dysesthesia. Five patients presented motor deficits and 3 presented sensory deficits. Surgical treatment was proposed after failure of medical treatment and two L5 corticoids infiltrations. RESULTS: All patients were re-examined two months after the procedure. Mean follow-up was 15 months. Complete resolution of radiculalgia with no paresthesia was achieved in all patients. Patients presenting preoperative motor deficit recovered fully after treatment. All patients resumed normal activity. CONCLUSION: The transsacral approach is a valid alternative to the lateral approach for treatment of L5-S1 EDH. The amount of operative exposure achieved using this technique is sufficient to avoid joint injury that can result in chronic postoperative lumbalgia. Another advantage is that excision of the protruding disc fragment can be achieved without mobilization of the nerve root or dorsal root ganglion, thus avoiding postoperative dysesthesia.

Adult↗

PubMed2004

[Hydroxyurea treatment for unresectable meningioma].

BACKGROUND: Management of unresectable progressive meningioma remains controversial and constitutes a major challenge since therapeutic options including chemotherapy and hormone modulation are limited. Recent data have suggested that hydroxyurea treatment may have an antitumoral effect. The purpose of this prospective phase II study was to evaluate the efficacy of hydroxyurea treatment for unresectable progressive meningioma. METHODS: From 1997 to 1999, consecutive patients presenting unresectable meningioma with clinically and/or neuroradiologically documented progression were considered for entry into this protocol. Previous radiotherapy was not a mandatory inclusion criteria. Treatment consisted of continuous oral administration of hydroxyurea at a dose of 20 mg/kg per day. Follow-up assessment included physical examination, computed tomography (CT), and magnetic resonance imaging (MRI) performed every three months, as well as regular blood testing. The primary endpoint was documentation of objective response by MRI or CT. RESULTS: The intent-to-treat population was 43 patients with at least 18 months follow-up. Median age was 60.4 years. Twenty-eight patients had undergone surgery following initial diagnosis. The meningioma was located in the skull base in 67% of patients. Histology was benign in 18 and atypical in 10. The eligible population included 36 patients with documented progressive disease at the time of inclusion; with progression documented clinically in 29 (67.5%) and/or radiologically in 20 (46%). In 7 patients, clinical or radiological progression could not be confirmed. The intent-to-treat analysis at median 26 months follow-up revealed objective response to hydroxyurea in only 3 patients (7%) including one on the basis of improvement in visual symptoms and two on MRI analysis. Progressive disease was observed clinically or radiologically in 26 patients (60.5%). Of the eligible population (n=36), 2 achieved an objective response and 13 (36%) exhibited stabilization under hydroxyurea therapy, while 21 (58%) progressed under treatment. Overall tolerance was good but anemia (grade I-II) and asthenia (grade I-II) were observed in 28% and 23.5% respectively. Treatment was discontinued in 3 patients because of chronic skin toxicity in one and anemia and asthenia in two. CONCLUSION: Hydroxyurea treatment is of marginal efficacy for meningioma and must not be considered as an alternative if radiotherapy or surgery is feasible. New efficient medical treatments are still required for progressive meningiomas.

Adult↗

PubMed2003

[Intracranial aneurysm revealed by panhypopituitarism. Considerations on therapeutic management based on a case report and review of the literature].

We report a case of an unruptured intracranial aneurysm in paraclinoidal location which was a unmasked by severe panhypopituitarism. An ipsilateral internal carotid artery (ICA) clamp test was performed in the pretreatment stage. The test was well tolerated and the aneurysm could be embolized with GDC (Guglielmi detachable coils) without necessitating an occlusion of the ICA. The postoperative course was uneventful and the patient was discharged after 48 hours. At one year, cerebral angiograms confirmed complete obliteration of the aneurysm. Therapeutic management of this rare entity is discussed along with a careful and exhaustive review of the literature.

Adult↗