PubMed Health⌕ Search

Biomedical subjects

Y Keravel

Publications and source records attributed to Y Keravel.

At least 19 recordsLinked to original sources
PubMed1992

A technique for stereotactic aspiration of deep intracerebral hematomas under computed tomographic control using a new device.

A new device, modified from the Nucleotome (Surgical Dynamics, Alameda, CA), was used for stereotactic aspiration of deep brain hematomas. Real-time monitoring by computed tomography allows a very safe procedure, and the risk of aspirating the surrounding brain is avoided. The technique was applied in 13 cases of deep brain hematomas. The intraoperative computed tomographic scan demonstrated that the mass effect was always immediately improved. Aspiration was stopped when the midline shift disappeared or was dramatically reduced. For most of the cases, a total aspiration of the hematoma was not needed (mean value of the aspiration rate of 71, 5%). No rebleeding and no complication related to the technique was observed. This technique was easily performed in emergency conditions.

Activities of Daily Living↗
PubMed1992

[Neurosurgical treatment of essential facial neuralgia].

The authors describe the neurosurgical techniques currently available for the treatment of essential trigeminal neuralgia refractory to the usual medical treatments. They compare the advantages and disadvantages of percutaneous techniques (particularly thermocoagulation of the trigeminal ganglion) and open techniques (especially microsurgical treatment of neurovascular conflict in the cerebellopontine angle.

Electrocoagulation↗
PubMed1991

[Intracerebral hematoma surgically treated under x-ray computed tomography with Backlund's needle. A series of 15 cases].

15 cases of supratentorial intracerebral hematomas (12 cases of primary hematomas and 3 post-traumatic cases) were operated under C.T. scan control, using the screw and suction technique (Backlund's needle). 10 cases of primary hematomas were operated early, before the 24th hour. The patients were selected for intervention on the following criteria: 1) Patients aged less than 70 years old; 2) initial Glasgow coma scale between 6 and 10; 3) cases with involvement of the mesencephalon by the hematoma were excluded. In the 3 cases of post-traumatic hematomas, intervention was decided in reference to the clinical course. The volume of the hematomas ranged from 40 to 160 cc. Putaminal or thalamic hematomas were observed in 9 cases. The percentage of aspirated hematoma volume ranged from 50 to 91%, the average being 70.5%. Dramatic improvement of the consciousness was observed in all cases. Improvement of the motor deficit was incomplete, for the most part. 1 patient rebled and 1 patient died (6.6% mortality). In 26% of the cases (4 patients) the development of a brain oedema, in the surrounding of the residual hematoma site, was observed during the post operative follow up. There was no post operative infection. Intervention under direct C.T. control allows an accurate guidance of the needle. Efficacity of the evacuation is attested by an immediate improvement of the mass effect on C.T. scan. Under C.T. control the risk to aspirate the adjacent brain is avoided. The technique proposed here has been easily performed in emergency condition.

Adult↗
PubMed1989

[Phrenic stimulation in C1-C2 tetraplegia. Apropos of a case].

The authors report a case of post traumatic tetraplegia at the C1-C2 level in a young man of 16 with total respiratory paralysis treated with mechanical ventilation and a tracheotomy. Thirty months after the accident, an Avery S 232(1) diaphragmatic pacemaker was surgically implanted by the mediastinal approach. The technique was rapidly successful and enabled satisfactory ventilation and phonation two months after the implantation. The patient is currently treated at home with no signs of diaphragmatic fatigue 20 months after the implantation of the stimulator.

Adolescent↗
PubMed1989

[Materials for osteo-dural reconstruction in the cranium. An update].

Materials available for repair of a bony or dural defect at the cranial level are reviewed with particular attention stressed on their qualities and drawbacks for neurosurgical purposes. These materials include autologous or heterologous bone graft and biologically stable or biodegradable implants. No material can demonstrate ideal qualities of biocompatibility and biofunctionality. It should be either perfectly stable biologically and inert or perfectly biodegradable allowing simultaneous new bone reconstruction; moreover, it should be sterilizable, disposable, easy to handle and of low cost. Autologous grafts (iliac bone, split bone flap, pericranium...) have the best features but irradiated heterologous bone can be used instead; the latter needs a particular organization (bone graft bank) to fill the strict conditions of safety, especially regarding the risks of virus transmission. Implants have more recently been developed (acrylic, coral, B.O.P., ceramic, collagen-vicryl...) and present some drawbacks: generally high cost and not well established or insufficient biological properties. The experience of French neurosurgeons is reported from a questionnaire (102 answers) on the most frequently used materials. Autologous bone grafts, and acrylic as bone substitutes and pericranium for dural repair are preferentially used. Some materials, including coral, B.O.P. and collagen-vicryl, have a decreasing utilisation because of poor results especially with regards to bone incorporation and water tightness. Particular techniques (acrylic + teflon, acrylic with pre-op external casting and even non-repair of bone defects) are proposed by some neurosurgeons. New materials still under experimentation are finally presented (lyophilized bovine pericardium, collagen IV, polylactic acid).

Biocompatible Materials↗
PubMed1989

[Sciatica and nerve root anomalies. Apropos of a series of 20 cases].

We present 20 operative cases of lumbar nerve root anomalies, divided into 6 anatomical types: nerve roots with common dural emergence (4 cases), contiguous dural emergence (6 cases), with common dural sheath (4 cases), splited nerve roots (2 cases), anastomosis between roots (3 cases) and plexiform nerve roots (1 case). 14 cases are associated with a discal hernia. 10 cases presented with unilateral but biradicular sciatica. The asymmetry of emergence is the best symptom of the pre-operative radiological evaluation on the CT scan, moreover on the myelography. The management led to an enlargement of the surgical field by hemilaminectomy to recognize the anomaly and make easier the discectomy. In 3 cases, the anomaly was recognized in patients who had been previously operated on. There are only 53% of satisfactory final results. We present a review of the main publications concerning this subject.

Adult↗
PubMed1988

Pericallosal aneurysms.

The authors report a series of 19 patients with one (17 cases) or two (2 cases) pericallosal aneurysms referred during the past 10 years. Of the 19 patients, 18 had a ruptured pericallosal aneurysm and one was asymptomatic. On admission two were graded I, four graded II, six graded III, and six graded IV. Of the latter group two patients died from rebleeding, and the asymptomatic patient would not undergo surgery. The 16 operated patients underwent surgery after a delay ranging from 6 to 90 days after hemorrhage (25 days on average). The delayed surgery allowed the patients to be operated on in better neurological status: seven were graded I or Ia, six graded II, three graded III, and none graded IV. The results were excellent (with resumption of their previous activity) in 11 cases (69%), good (autonomous but with a slight deficit) in 4 cases (25%), and bad in 1 case (6%). There was no operative mortality or morbidity.

Adult↗
PubMed1988

Microsurgical procedures in the peripheral nerves and the dorsal root entry zone for the treatment of spasticity.

When spasticity becomes severe and harmful, in spite of physical and medical therapy, neurosurgery can give functional improvement. This paper deals with the long term results of Selective Peripheral Neurotomies of the Tibial Nerve and Selective Posterior Rhizotomies in the Dorsal Root Entry Zone, in 123 patients with spastic disorders localized to the limbs. The micro-techniques and intra-operative electro-stimulation for identification of the nervous structures responsible for the spastic components, can give a substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory functions. The results were effective, with a 1 to 13 year follow-up (5 on average), in 89% of 47 Selective Peripheral Neurotomies of the tibial nerve for spastic foot, in 92% of 53 Selective Posterior Rhizotomies for paraplegia and in 87% of 23 Selective Posterior Rhizotomies for hemiplegia. In the most severe situations ("comfort" indications), correction of the abnormal postures and relief of pain facilitated nursing and physiotherapy. Sometimes there was reappearance of some useful voluntary movements. In the less affected patients ("functional" indications), the suppression of the harmful spastic components made the persistant capacities more effective.

Adolescent↗
PubMed1987

[Neurosurgical treatment of trigeminal neuralgia. Direct approach of percutaneous method?].

During the fifteen past years, the treatment of trigeminal neuralgia resistant to medical therapy has benefited from several neurosurgical techniques, either with percutaneous methods (RF-thermorhizotomy, cisternal injection of glycerol, balloon compression of the gasserian ganglion) or direct approach (microsurgical selective section of pars major, microvascular decompression). The respective advantages and disadvantages of these techniques are presented, both from the authors' experience (609 thermocoagulations, 150 direct approaches in the cerebello-pontine angle) and a review of some important series of the literature.

Cerebellopontine Angle↗
PubMed1987

[Occipital intraosseous epidermoid cyst producing a clinical picture simulating benign intracranial hypertension. A clinical case].

The authors describes a 17 years old woman with a small occipital intradiploic epidermoid cyst simulating a benign intracranial hypertension on an initial CT scanner. Digital angiography showed torcular compression by the tumor. Intracranial pressure and sagittal sinus pressure were analysed and implicated the epidermoid cyst as the cause of the intracranial hypertension.

Adolescent↗
PubMed1986

[Cerebral cavernoma: a rare vascular malformation].

The authors have observed 7 cases of intracranial cavernous haemangioma. A review of the literature shows that the diagnosis is suggested by the occurrence of epileptic seizures, signs of expansive process or meningeal haemorrhage. Computerized tomography displays an area of hyperdensity enhanced by injections of a contrast medium. Surgical excision is mandatory. The post-operative mortality varies with the site of the malformation.

Adolescent↗
PubMed1985

Extradural and hourglass cervical neurinomas: the vertebral artery problem.

Eleven cases of cervical neurinomas with an extradural component were operated on with control of the vertebral artery as the first step of the surgical procedure. The lateral anterior approach was used first in each case with excellent results. In the case of hourglass tumors (seven cases), a complementary posterior approach was performed to remove the intradural portion. Primary control of the vertebral artery in cases of extradural or hourglass neurinoma is a logical and safe procedure in the attempt to achieve complete and bloodless tumor removal.

Adult↗