1
|
Stan A, Dragos H, Strilciuc S, Ilut S, Vacaras V, Cozma A, Panaitescu PS, Stan H, Muresanu DF. Circadian Rhythm and Risk of Hemorrhagic Transformation after Acute Ischemic Stroke Treated with Intravenous Thrombolysis - A Systematic Review. CNS Neurol Disord Drug Targets 2023; 22:1493-1506. [PMID: 36200200 DOI: 10.2174/1871527322666221004113752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A circadian pattern for the onset of acute ischemic stroke (AIS) has been described, with a higher risk in the early morning and a lower risk during nighttime. However, data assessing the circadian distribution of hemorrhagic transformation after intravenous thrombolysis (ivT) are still incongruent. OBJECTIVES This review aimed to evaluate whether the time interval based on AIS onset or ivT time could influence the occurrence of intracranial hemorrhage (ICH) related to ivT and if the circadian rhythm of endogenous production of tissue plasminogen activator (t-PA) favors ICH occurrence. METHODS We conducted a systematic review following the PRISMA guidelines, searching PubMed and Embase for articles in English using the keywords: 'stroke', 'thrombolysis', and 'circadian'. Articles investigating the AIS onset or ivT time effects on circadian variations of ICH in AIS adult patients treated with ivT were included. Based on ICH's incidence and odds ratio, time intervals associated with higher risk and time intervals associated with lower risk were defined. The Newcastle-Ottawa Scale was used to assess the risk of bias. The resulting data were reported in a qualitative narrative synthesis. RESULTS From the 70 abstracts returned by electronic literature search, six studies with 33,365 patients fulfilled the inclusion criteria, out of which three were retrospective analysis studies, one case-control study, one prospective study, and one post hoc analysis of a multicentre trial. Some studies assessed the relationship between ICH occurrence and circadian rhythm depending on AIS onset time (n = 2), treatment time (n = 2), or both (n = 4). All studies investigated the patients' comorbidities as confounding variables for the circadian pattern of symptomatic ICH (sICH). Two studies found no association between AIS onset or ivT time and patient risk factors, but the other four found several differences and used multivariate logistic regression models to balance these covariates. The overall score of the Newcastle- Ottawa scale was 83.3%, which might be interpreted as overall high quality. CONCLUSION ICH occurred after ivT seems to follow a circadian pattern; the 18:00-00:00 time frame was the safest one, and patients with AIS onset or ivT time between these hours had the lowest incidence of any ICH, including sICH. The 06:00-12:00 block was associated with the highest incidence of ICH and sICH. However, the analysis is limited by the small number of included studies and the heterogeneous findings reported. Further homogenized studies using comparable time frames and sICH definitions are needed to demonstrate this circadian pattern. The review protocol was registered in the OSF database under reference UHNF, doi:10.17605/OSF.IO/UHNF6.
Collapse
Affiliation(s)
- Adina Stan
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
- Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj- Napoca, Romania
| | - Hanna Dragos
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
- Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj- Napoca, Romania
| | - Stefan Strilciuc
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
| | - Silvina Ilut
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
- Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj- Napoca, Romania
| | - Vitalie Vacaras
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
- Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj- Napoca, Romania
| | - Angela Cozma
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
- Department 5 Internal Medicine, 4th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
| | - Paul Stefan Panaitescu
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
| | - Horatiu Stan
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
| | - Dafin F Muresanu
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
- Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj- Napoca, Romania
| |
Collapse
|
2
|
Stan A, Ilut S, Dragos HM, Bota C, Hanghicel PN, Cristian A, Vlad I, Mocanu D, Strilciuc S, Panaitescu PS, Stan H, Muresanu DF. The Burden of Cerebral Venous Thrombosis in a Romanian Population across a 5-Year Period. Life (Basel) 2022; 12:life12111825. [PMID: 36362980 PMCID: PMC9693190 DOI: 10.3390/life12111825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/28/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Health policies in transitioning health systems are rarely informed by the social burden and the incidence shifts in disease epidemiology. Cerebral venous thrombosis (CVT) is a type of stroke more often affecting younger adults and women, with higher incidences being reported in recent studies. A retrospective, hospital-based population study was conducted at Cluj-Napoca Emergency County Hospital across a 5-year period between 2017 and 2021. The overall incidence and the rates in distinctive gender and age groups were assessed. Length of hospital stay (LHS), modified Rankin score (mRS) and mortality at discharge and at 3 months were calculated. Fifty-three patients were included. The median age was 45 years, and 64.2% were women. In our population of 3,043,998 person-years, 53 CVT cases resulted in an incidence of 1.74 per 100,000 (95% CI 1.30–2.27). CVT incidence was higher in women (2.13 per 100,000, 95% CI 1.47–2.07). There was a statistically significant difference in LHS between patients with different intracranial complications (Kruskal–Wallis, p = 0.008). The discharge mRS correlated with increasing age (rs = 0.334, p = 0.015), transient risk factors (Fisher’s exact test, p = 0.023) and intracranial complications (Fisher’s exact test, p = 0.022). In addition, the mRS at 3 months was statistically associated with increasing age (rs = 0.372, p = 0.006) and transient risk factors (Fisher’s exact test, p = 0.012). In-hospital mortality was 5.7%, and mortality at follow up was 7.5%, with higher rates in women (5.9% and 8.8%, respectively). Our findings may provide insight regarding the epidemiological features of certain patient groups more prone to developing CVT and its complications, informing local and central stakeholders’ efforts to improve standards of care.
Collapse
Affiliation(s)
- Adina Stan
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Silvina Ilut
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Hanna Maria Dragos
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-773991273
| | - Claudia Bota
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Patricia Nicoleta Hanghicel
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Alexander Cristian
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Irina Vlad
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
| | - Diana Mocanu
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Stefan Strilciuc
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
| | - Paul Stefan Panaitescu
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Horatiu Stan
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Dafin F. Muresanu
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
- Neurology Department, Emergency County Hospital Cluj-Napoca, 400347 Cluj-Napoca, Romania
| |
Collapse
|
3
|
|
4
|
Muresanu DF, Ciurea AV, Gorgan RM, Gheorghita E, Florian SI, Stan H, Blaga A, Ianovici N, Iencean SM, Turliuc D, Davidescu HB, Mihalache C, Brehar FM, Mihaescu AS, Mardare DC, Anghelescu A, Chiparus C, Lapadat M, Pruna V, Mohan D, Costea C, Costea D, Palade C, Bucur N, Figueroa J, Alvarez A. A retrospective, multi-center cohort study evaluating the severity- related effects of cerebrolysin treatment on clinical outcomes in traumatic brain injury. CNS Neurol Disord Drug Targets 2016; 14:587-99. [PMID: 25924999 DOI: 10.2174/1871527314666150430162531] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/21/2015] [Accepted: 03/22/2015] [Indexed: 11/22/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability for which there is currently no effective drug therapy available. Because drugs targeting a single TBI pathological pathway have failed to show clinical efficacy to date, pleiotropic agents with effects on multiple mechanisms of secondary brain damage could represent an effective option to improve brain recovery and clinical outcome in TBI patients. In this multicenter retrospective study, we investigated severity-related efficacy and safety of the add-on therapy with two concentrations (20 ml/day or 30 ml/day) of Cerebrolysin (EVER Neuro Pharma, Austria) in TBI patients. Adjunctive treatment with Cerrebrolysin started within 48 hours after TBI and clinical outcomes were ranked according to the Glasgow Outcome Scale and the Modified Rankin Disability Score at 10 and 30 days post-TBI. Analyses of efficacy were performed separately for subgroups of patients with mild, moderate or severe TBI according to Glasgow Coma Scale scores at admission. Compared to standard medical care alone (control group), both doses of Cerebrolysin were associated with improved clinical outcome scores at 10 days post-TBI in mild patients and at 10 and 30 days in moderate and severe cases. A dose-dependent effect of Cerebrolysin on TBI recovery was supported by the dose-related differences and the significant correlations with treatment duration observed for outcome measures. The safety and tolerability of Cerebrolysin in TBI patients was very good. In conclusion, the results of this large retrospective study revealed that early Cerebrolysin treatment is safe and is associated to improved TBI outcome.
Collapse
Affiliation(s)
- Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hatieganu", Victor Babeș Street No. 8, 400012 Cluj-Napoca, Romania.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Georgescu CE, Ilie I, Moldovan F, Stan H, Albu S, Duncea I. Thunderclap headache caused by a pituitary non-functioning tumour presenting as spontaneous pituitary apoplexy. Ro J Neurol 2010. [DOI: 10.37897/rjn.2010.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hemorrhagic or ischemic pituitary apoplexy is a rare neuro-endocrine emergency, potentially leading to coma. Neuro-ophthalmic symptoms or complications are amongst the most prevalent clinical features at onset, especially in previously asymptomatic patients. Usually, permanent pituitary insufficiency of various degrees follows, implying long-term hormone substitutive therapy. Rarely, the association of pituitary apoplexy with diabetes insipidus has been noticed. We report the case of a young, apparently healthy 32-year-old man presenting with thunderclap headache, fever, optic chiasm compression, central diabetes insipidus and central thyro-gonadic insufficiency. Magnetic resonance imaging and neurosurgery revealed a clinically non-functioning macro-adenoma developing pituitary hemorrhage. One year after the apoplectic episode, complete recovery of diabetes insipidus and pituitary function was confirmed.
Collapse
|
6
|
Georgescu CE, Ilie I, Moldovan F, Stan H, Albu S, Duncea I. Thunderclap headache caused by a pituitary non-functioning tumour presenting as spontaneous pituitary apoplexy. Ro J Neurol 2009. [DOI: 10.37897/rjn.2009.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hemorrhagic or ischemic pituitary apoplexy is a rare neuro-endocrine emergency, potentially leading to coma. Neuro-ophthalmic symptoms or complications are amongst the most prevalent clinical features at onset, especially in previously asymptomatic patients. Usually, permanent pituitary insufficiency of various degrees follows, implying long-term hormone substitutive therapy. Rarely, the association of pituitary apoplexy with diabetes insipidus has been noticed. We report the case of a young, apparently healthy 32-yearold man presenting with thunderclap headache, fever, optic chiasm compression, central diabetes insipidus and central thyro-gonadic insufficiency. Magnetic resonance imaging and neurosurgery revealed a clinically non-functioning macro-adenoma developing pituitary hemorrhage. One year after the apoplectic episode, complete recovery of diabetes insipidus and pituitary function was confirmed.
Collapse
|
7
|
Rotaru H, Bǎciuţ G, Stan H, Schumacher R, Zeilhofer H, Chezan H, Hurubeanu L, Bǎciuţ M, Dinu C, Rotaru A, Kim S, Moldovan I, Bran S, Rotaru O. Reconstruction of craniofacial bone defects with three-dimensional custom-made implants. A five year experience. Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Stan H, Popa C, Iosif A, Nistor S. Combined Endoscopically Guided Third Ventriculostomy with Prepontine Cistern Placement of the Ventricular Catheter in a Ventriculo-Peritoneal Shunt: Technical Note. ACTA ACUST UNITED AC 2007; 50:247-50. [DOI: 10.1055/s-2007-985374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
9
|
Rotar H, Stan H, Chezan H, Bran S, Kim SG, Rotar A, Munteanu D, Bačiut G, Berce P, Dinu C. O.067 Silicone-rubber moulding of custom-made cranioplasty plates. J Craniomaxillofac Surg 2006. [DOI: 10.1016/s1010-5182(06)60096-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
10
|
Rotaru H, Baciut M, Stan H, Bran S, Chezan H, Iosif A, Tomescu M, Kim SG, Rotaru A, Baciut G. Silicone rubber mould cast polyethylmethacrylate-hydroxyapatite plate used for repairing a large skull defect. J Craniomaxillofac Surg 2006; 34:242-6. [PMID: 16644233 DOI: 10.1016/j.jcms.2006.01.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 01/17/2006] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Reconstruction of the cranial vault is performed for various reasons and precise repair of the defect is important. A modified method of cranioplasty is presented using three-dimensional (3D) models and polyethylmethacrylate mixed with hydroxyapatite, cast in a silicone rubber mould. PATIENT AND METHOD A large custom made cranial implant was produced using data acquired from 3D computer tomography, rapid prototyping and cast in a silicone rubber mould. This plate was then applied to a 53 year-old man who had undergone a decompressive fronto-parieto-temporo-occipital craniotomy. The bone flap had been lost due to infection. The cranioplasty was performed at 1 year after the initial operation. RESULTS The cranial plate fitted precisely into the defect and needed no correction at the time of surgery. The stability of the reconstruction plate was increased by the presence of thin margins allowed by silicone rubber elasticity. No complications occurred and the final functional and aesthetic results were good. CONCLUSION The use of 3D imaging and rapid prototyping allow precise repair of large skull defects, with good aesthetic and functional results. At the same time, silicone rubber moulds permit the production of very thin details needed not only for cosmetic reasons but for reconstruction plate stability as well.
Collapse
Affiliation(s)
- Horatiu Rotaru
- Department of Cranio-Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Bret P, Stan H, Streichenberger N, Sebban C, Guyotat J. [Solitary plasmacytoma of the sphenoid. A case report]. Neurochirurgie 2002; 48:431-5. [PMID: 12483122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
A rare case of sphenoidal plasmacytoma in a 79 year-old male patient is reported. The diagnosis was preoperatively considered because of associated dysproteinemia and it was histopathologically confirmed on a transphenoidal biopsy specimen. Initial evaluation disclosed no systemic dissemination of the disease and a solitary plasmacytoma was diagnosed. Radiotherapy was delivered with subsequent clinical improvement and significant tumor reduction was illustrated on follow-up imaging studies. Twenty-two months after diagnosis, the patient remains asymptomatic without evidence of transformation to multiple myeloma. Only 7 comparable cases have been reported in the literature. The diagnostic, pathological and nosographic features of sphenoid plasmacytomas are discussed.
Collapse
Affiliation(s)
- Ph Bret
- Service de Neurochirurgie B, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, 59 boulevard Pinel, BP Lyon-Montchat, 69394 Lyon Cedex 03, France.
| | | | | | | | | |
Collapse
|
12
|
Mottolese C, Stan H, Hermier M, Berlier P, Convert J, Frappaz D, Lapras C. Intracystic chemotherapy with bleomycin in the treatment of craniopharyngiomas. Childs Nerv Syst 2001; 17:724-30. [PMID: 11862438 DOI: 10.1007/s00381-001-0524-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2001] [Indexed: 11/28/2022]
Abstract
OBJECT Since bleomycin has not yet been used very frequently in the treatment of patients with craniopharyngioma, it seemed important to document the course of a series of such patients treated with this preparation. METHODS AND RESULTS Local chemotherapy with bleomycin was performed in 24 patients (20 children and 4 adults), 16 of whom presented with cystic or mixed (solid/cystic) craniopharyngioma and 8, with recurrent cystic craniopharyngioma. The drug was administered through an Ommaya reservoir, which was placed either by using a direct surgical approach (6 patients) or a stereotactic approach (16 patients), or with endoscopic assistance in patients with hydrocephaly (2 patients). Injection of bleomycin was always preceded by a water-tightness test. Each patient received a 3-mg dose of bleomycin every other day. The total dose of bleomycin injected ranged from 28 mg to 150 mg. Most patients (17, or 70%) were treated only with intracystic chemotherapy. Chemotherapy was followed by surgery in 7 patients. Five were operated on at the beginning of our study, and 2 required surgery because chemotherapy yielded poor results. A toxic dose was injected in 1 patient only: a severe complication, i.e. blindness, was observed. The follow-up period ranged from 2 years to 10 years. CONCLUSION Our results show that bleomycin can be an alternative in the treatment of cystic craniopharyngiomas or cystic recurrences, as it reduces surgical morbidity and improves clinical results.
Collapse
Affiliation(s)
- C Mottolese
- Pediatric Neurosurgery, Pierre Wertheimer Hospital, 59 Boulevard Pinel, Lyon Cedex 3, France,
| | | | | | | | | | | | | |
Collapse
|
13
|
Guyotat J, Signorelli F, Isnard J, Stan H, Mohammedi R, Schneider F, Bret P. [Perioperative cortical stimulation of language fields under local anesthesia in preparation to excision of tumors of the dominant hemisphere]. Neurochirurgie 2001; 47:523-32; discussion 533. [PMID: 11915611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES The aim of this study is to demonstrate the accuracy of direct cortical stimulation of language areas preparatory to the removal of infiltrating tumors of dominant hemisphere. MATERIAL AND METHODS From June 1998 to March 2000 we included in our study 15 patients, aged from 30 to 75 years, harboring gliomas (14 high grades and 1 low grade) close to language-specific cortex. All patients had slight inaugural phasic troubles. They underwent craniotomy under local anesthesia for cortical stimulation language mapping, in conjunction with electrocorticography to identify the after-discharge threshold. Stimulation mapping covered the entire macroscopically tumor involved area, extending up to 3 cm away from the margins of the lesion, without searching to identify systematically the language areas. Therefore, the lesion was removed as completely as possible, respecting a security margin of at least 1 cm from the recognized language sites. RESULTS We identified from 1 to 6 language sites for 14 of our patients, in different locations. A radical removal was achieved for all high grade gliomas, while the low grade was only partially removed. A patient died on the 16th postoperative day from pulmonary embolism; 2 patients deteriorated from peri- or immediate postoperative complications; 9 showed a transient neurological worsening that receded by the 2nd postoperative month, while 3 did not present any postoperative aggravation. At a follow-up of 1 month to 2 years (mean 8 months), 6 patients died and the 9 survivors maintain a good life quality. CONCLUSIONS Cortical stimulation for language mapping is an accurate technique that allows the surgical morbidity of lesions in proximity to language areas to decrease and become comparable to the surgical morbidity for lesions in non eloquent areas.
Collapse
Affiliation(s)
- J Guyotat
- Service de Neurochirurgie B, Hôpital Neurologique, 59, boulevard Pinel, BP Lyon-Montchat, 69394 Lyon.
| | | | | | | | | | | | | |
Collapse
|
14
|
Mottolese C, Stan H, Giordano F, Frappaz D, Alexei D, Streichenberger N. Metastasis of clear-cell renal carcinoma to cerebellar hemangioblastoma in von Hippel Lindau disease: rare or not investigated? Acta Neurochir (Wien) 2001; 143:1059-63. [PMID: 11685614 DOI: 10.1007/s007010170012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A new case of metastatic hypernephroma to cerebellar hemangioblastoma is described in a patient affected by von Hippel-Lindau disease. To our knowledge this is the third reported case of metastasis of renal carcinoma to intracranial hemangioblastoma associated with Von Hippel-Lindau disease. The real frequency of this pathological entity and its management are not well defined.
Collapse
Affiliation(s)
- C Mottolese
- Service de Neurochirurgie B, Hôpital Neurologique et Neurochirurgical, Pierre Wertheimer, Lyon, France
| | | | | | | | | | | |
Collapse
|
15
|
Mottolese C, Hermier M, Stan H, Jouvet A, Saint-Pierre G, Froment JC, Bret P, Lapras C. Central nervous system cavernomas in the pediatric age group. Neurosurg Rev 2001; 24:55-71; discussion 72-3. [PMID: 11485241 DOI: 10.1007/pl00014581] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pediatric CNS cavernomas still are diagnostically and therapeutically challenging lesions. With the help of magnetic resonance imaging, the natural history of cavernomas now guiding therapeutic strategies is well documented in adults but remains poorly known in the pediatric age group, since most previous studies dealt with adult and pediatric patients together. This paper focuses on clinical, imaging, and therapeutic features and differential diagnosis of CNS cavernomas with an emphasis on their specificities in the pediatric age group. It is based upon a critical review of the literature and our single-center experience with 36 children (35 with cerebral cavernomas and one with spinal cord cavernoma) operated on during the period of 1985-1999 as well as with seven additional unoperated pediatric cases. Our experience resembles that of other authors regarding the high hemorrhagic risk in children compared to adults. These angiographically occult vascular malformations are often revealed by the sudden onset of intracerebral hematoma with acute focal neurologic deficits, concomitant manifestations, and/or signs of raised intracranial pressure. True epilepsy is less common and may be related to chronic or recurrent microbleeding. Evocative imaging findings are also somewhat different in the two age groups, and we propose here an imaging classification of cerebral cavernomas based on both morphological and signal characteristics that is applicable to the pediatric age group. A sharply demarcated spherical intracerebral hematoma or heterogeneous lesion should always make one consider the hypothesis of a cavernoma. For symptomatic lesions and most rapidly growing asymptomatic lesions, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. Improvements in surgical techniques and anesthesiology over recent years have brought good results in most operated children. The limited role of radiosurgery in the management of pediatric cerebral cavernomas is discussed. There is still a need for well-conducted specific evaluation of the natural history of these lesions in the pediatric age group to aid in systematic research, follow-up, and therapeutic strategies for asymptomatic cavernomas.
Collapse
Affiliation(s)
- C Mottolese
- Department of Pediatric Neurosurgery, Université Claude-Bernard Lyon-I, Hĵpital Neurologique et Neurochirurgique P. Wertheimer, France
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Hypothalamic hamartoma are rare lesions. We report a new series of eight patients treated for precocious puberty (six cases) or gelastic seizures (two cases). Surgical resection was total in four cases (three pediculated and one sessile). Precocious puberty was controlled by surgical treatment in all cases. Gelastic seizures were controlled by medical treatment, but the patients did not become seizure free. We observed no mortality and no endocrinological or visual morbidity. The fact that a vascular "rete mirabilis" was observed on the surface of the lesion in our surgical material is an argument favoring a vascular mechanism in precocious puberty. Coagulation of this vascular structure can help control precocious puberty. Our series confirms that the hypothalamic hamartoma can be surgically treated when patients fail to respond to medical treatment, when the length of the treatment cannot be tolerated by the chidren and their families, and when there are uncontrolled gelastic seizures
Collapse
Affiliation(s)
- C Mottolese
- Service de Neurochirurgie B, Hĵpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | | | | | | | | |
Collapse
|