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S Malca

Publications and source records attributed to S Malca.

15 recordsLinked to original sources
PubMed1999

[Lumbar canal stenosis caused by amyloidosis of the yellow ligament].

Symptomatic lumbar canal stenosis without bony stenosis has previously been described. We describe the pathological modifications of ligamentum flavum among such operated patients. Ten patients were prospectively included in this study. Their mean age was 74, ranges: from 52-90. Clinical manifestation was a radicular claudication (sciatic or crural). Neuroradiology confirmed in all cases the ligamentum flavum thickness as the main cause of the symptomatology. This feature was also confirmed operatively and complete resection of the ligamentum flavum was performed. Resolution of the radicular pain was obtained in all cases at last follow-up. Pathological examination of the ligamentum flavum displayed characteristic features of degenerative modifications and elastic fibers fragmentation caused by numerous amorphous deposits. The deposits were studied using red Congo staining, polarized light and immunostaining methods. Such technique showed evidence of amyloid origin of the deposits. Immunodetection was positive for the P component in the amyloid deposits and for beta-2-microglobulin in one case (chronic renal failure and hemodialysis). The deposits did not express antitransthyretin antibodies. In parallel, control ligamentum flavum were obtained from 10 operated patients affected by bony lumbar stenosis. Moderate degenerative features were observed but small amounts of amyloid deposits were found in only 3 of those cases, without thickening of the ligamentous structure. This study correlates the presence of thickened ligamentum flavum caused by amyloid deposition, with symptomatic non-osseous lumbar canal stenosis. Association with degenerative modifications of the spine in the studied cases is suggestive of a microtraumatic origin.

Aged↗
PubMed1999

[Dural metastases mimicking meningioma. Report of a case].

We report a case of dural metastasis, detailing the neuroradiologic and therapeutic aspects. The clinical presentation was limited to a progressive left hemiparesis. Post-contrast CT scan revealed a heterogeneous high-density mass of the right fronto-parietal convexity. MRI demonstrated dural involvement mimicking meningioma. Chest X-ray showed a right lung opacity, suggesting the diagnosis of dural metastasis. Surgical resection was performed. Histology confirmed the diagnosis of dural metastasis from a poorly differentiated carcinoma. Treatment was completed with radiotherapy and chemotherapy. Dural metastases are rarely reported. A review of the literature revealed principally 2 radiological aspects: hemorrhagic effusion and tumor mass. The pathophysiology of dural metastases is still a subject of debate. Two mechanisms have been put forward involving venous and arterial dissemination. As radiological aspects are confusing, the diagnosis of dural metastasis should be evoked in patients with spontaneous hemorrhagic subdural effusion or a tumor mass involving the dura mater.

Diagnosis, Differential↗
PubMed1997

[Primary spinal osteosarcomas].

The rarity of primary osteosarcoma of the spine led us to index the 66 reported cases published in literature. From this analysis a difference was found between spinal osteosarcoma and osteosarcoma of the extremities. Tumors of the spine appear to be two times more frequent in the male population in their thirties. The average period between the beginning of the symptoms and the first consultation is seven months. Back pain is permanent and localized to the affected vertebra. In 80 percent of the cases, neurological symptoms already exist at the stage of the diagnosis. Magnetic resonance imaging (MRI), computed tomography and standard X-ray remain complementary in the morphological analysis of this tumor. All the aspects from the lytic to sclerotic forms are noted, although the lytic form is common. Among spinal osteosarcoma, the lumbar vertebrae are the most frequently affected. Diagnosis can only be established by pathology, even though this may also lead to some errors. In all the reported cases surgery is used, but carcinological methodology is not possible and a complete removal of affected tissue is difficult, with this being achieved in only a quarter of the cases. Radiation therapy, when used, requires doses of 70 Gy to 80 Gy without any certitude of controlling the tumour and with high risks of post-radiation complications. Chemotherapy on its own, despite the use of high-dose methotrexate, only has a temporary effect due to partial action on the primary center. Twenty years ago, only twenty percent of all patients suffering from osteosarcoma lived beyond two years, with worse prognosis for spinal osteogenic sarcoma. Today, the therapeutic approach for spinal tumors uses techniques developed in the treatment of osteosarcoma of the extremities, which can now expect more than seventy percent of all patients to live beyond five years. Present day methods recommend a rapid confirmation of the diagnosis, and then a neoadjuvant chemotherapy followed by surgery to remove all the affected area. This strategy allows an evaluation of the tumor chemosensitivity and to adapt the treatment in consequence. The latest results of this treatment on spinal osteosarcoma appear to be encouraging.

Humans↗
PubMed1997

[Primary spinal osteosarcoma. Apropos of a case].

We report a case of primary osteogenic sarcoma of the third lumbar vertebra, detailing the neuroradiologic and therapeutic aspects. The clinical presentation was limited to low back pain which radiated to the left thigh for 5 months. Lumbosacral spine roentgenograms revealed a sclerotic lesion of the left part of the body of the third lumbar vertebra. Treatment consisted of total vertebrectomy, chemotherapy completed with radiotherapy. Fourteen months after a complex combined treatment no recurrence was observed. A review of the literature highlighted the rarity of this tumor. Usually, patients with vertebral osteogenic sarcoma do poorly. Today, the therapeutic approach for these spinal tumors should use techniques developed in the treatment of osteosarcoma of the extremities because of their encouraging results.

Adult↗
PubMed1997

[Acoustico-facial cavernomas. Apropos of 2 surgically treated cases].

BACKGROUND: Acousticofacial cavernomas are rare lesions. Only 4 cases with a cerebellopontine extension have been reported previously whereas intrapetrous facial nerve cavernomas are well described in the otologic literature. In this paper, we describe two additional cases of acousticofacial cavernomas. METHOD AND RESULTS: The two patients were operated via a translabyrinthine route with a preoperative diagnosis of vestibular schwannoma. In the first case, the lesion was confined in the internal auditory canal whereas the cavernoma extended into the cerebellopontine angle in the latter. CONCLUSIONS: Diagnosis is suspected when facial nerve deficit strikingly reveals a small cerebellopontine angle lesion. MRI examination is not specific enough when the lesion is confined to the internal auditory canal. Treatment is based upon surgical removal although facial nerve impairment is often described as the main cause of postoperative morbidity.

Adult↗
PubMed1995

Giant central neurocytoma with tetraventricular and extra-axial extension. Case report.

The central neurocytoma is a recently recognized benign intraventricular tumour of young adults. The authors report a unique case of a panventricular neurocytoma with extension to the interpeduncular and prepontique cisterns which developed in a 35-year-old woman with a 7-year history of headaches and amenorrhea. They review the different pathological and topographical patterns of previously published neurocytomas and discuss the histogenesis of this rare tumour.

Adult↗
PubMed1994

[Anatomic problems involved in the approach to the internal carotid artery].

The portion of the internal carotid artery (ICA) located above the line joining the tip of the mastoid and the angle of the mandible is in close relation with cranial nerves VII, IX, X, XI and XII as well as the middle ear at the beginning of its intrapetrous course. Several procedures have been described for exposure of the ICA at the base of the skull. Extension of the conventional sternocleidomastoid approach by mandibular subluxation associated with division of the posterior belly of the digastric muscle and the styloid apophysis or its attached muscles allows exposure of most of the ICA. To access the last centimeter of the ICA it is necessary ot drill through the mastoid apophysis and the vaginal apophysis of the tympanic bone. This approach preserves the middle ear and the facial nerve.

Aged↗
PubMed1992

[Perioperative remote infections in neurosurgery. Role of antibiotic prophylaxis].

We report the results of a randomized, prospective study devised to assess the effectiveness of perioperative cefamandole prophylaxis on the remote infections rate in neurosurgery. Only two kinds of neurosurgical procedures were studied: shunt placement and craniotomy for brain tumour. In the treated patients cefamandole 1.5 g was given one hour before surgery, then repeated twice eight hourly. When the surgical procedure lasted more than three hours cefamandole 1.5 g was administered throughout the operation. No case of local infection was observed in either group, and the percentage of patients with remote infections was the same in both groups. Leucocytosis and temperature were measured during 15 days following the surgical procedure, and there were no differences between the treated and untreated groups in the evolution of these parameters. This study does not suggest that routine perioperative antibiotic prophylaxis is mandatory in neurosurgery.

Adolescent↗
PubMed1992

[Giant cholesterol cysts of the petrous apex].

In connection with their two own cases, the authors deal about the giant cholesterol cysts of the petrous apex. The lesions which are to be differentiated from epidermoid cysts are cholesterol granulomas. Their petrous apex location explains their characteristic large appearance. As each cholesterol granuloma, they occur when a bony cell is obstructed. This chronic obstruction induces mucosal edema then bleedings which lead to the formation and, by the lack of drainage, to the accumulation of cholesterol crystals. These crystals initiate a non specific reaction to foreign bodies, a granuloma, which also can bleed. Thus, a continuous cycle perpetuates the growth of the lesion. This lesion, when it is localized in the petrous apex, can reach a big size before the appearance of some signs. Usually, these are otologic (sensorineural hearing loss, tinnitus, vertigo) and/or cranial nerve palsies (V, VI, VII). C.T. scan (well defined, sharply marginated bony expansible lesion with isodense to the brain central part) and M.R.I. (central region of increased intensity on both T1 and T2 weighted images and peripheral rim of markedly decreased signal intensity in all instances) features are characteristic enough to allow diagnose with other petrous apex lesions (cholesteatoma, mucocele, epithelial cyst, histiocytosis X, ...). Surgical treatment must try to evacuate and to aerate the cavity or perhaps to obliterate it with fatty pieces in order to prevent the recurrence.

Adult↗
PubMed1991

[Aneurysmal temporal bone cyst. Apropos of 2 new cases].

Aneurysmal bone cyst is a well known lesion on the metaphyse of lung tubular bones or on the spine. Unusually, it is detected on the skull and more rarely again on the temporal bone. The authors, talking about the eleven cases they have found in the literature and two recent personal cases, try to describe the main diagnostic dates of this temporal lesion which one has never known if it is a real tumor or a reactional dystrophic pseudotumor secondary to an intrabone circulatory incident, perhaps a phlebitis. As for all other locations, these temporal bone forms are more frequently encountered among adolescents or young adults and, because their blowing bone effect, give clinical signs which directly result from their aggressive behavior on the surrounding structures, in this particular location: temporal fossa swelling, otologic, ophthalmologic or stomatologic symptoms, facial or trigeminal nerves troubles and rarely central neurological signs. On CT-scan, it appears as a space-occupying lesion located in the temporal fossa, with a blowing bone aspect, with intracranial and infratemporal expansions. This CT scan lesion is heterogeneous and contrast enhanced except in its center which is hypodense, as a cyst. The MRI shows comparable pictures. Its total excision, made easier by a preoperative embolization, gives a total and definitive recovery.

Adolescent↗
PubMed1991

[Screwing the odontoid process. A functional operation].

The authors describe a case of direct screw fixation of the odontoid process via an anterolateral retropharyngeal subhyoid pre-sternomastoid approach and discuss the indications for this operation. In this particular case, immobilization by a cervical collar or a halo vest was not chosen because of its constraining character and the risk of secondary displacement and pseudarthrosis. C1-C2 or occipitospinal arthrodesis, whether performed via a posterior, lateral or anterior approach, is difficult to perform and always leads to a functional handicap. The transoral approach does not allow direct screw fixation of the dens. Dens screwing via an anterior pre-sternomastoid subhyoid approach is the most logical and least disabling technique. The subhyoid approach is much simpler than the suprahyoid approach. This technique is used in fractures of the odontoid process with an ablique downward and backward fracture line, with or without arch fracture of C1, and allows screwing perpendicular to the fracture line. Considering the present results and the literature, the double screw fixation does not seem to be justified.

Adult↗