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Söderlund ME, Benisty S, Gaston A, Djindjian M, Cesaro P, Créange A. Les myélopathies secondaires aux fistules durales artério-veineuses peuvent-elles être aggravées par la corticothérapie intraveineuse ? Rev Neurol (Paris) 2007; 163:235-7. [PMID: 17351543 DOI: 10.1016/s0035-3787(07)90395-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 10/22/2022]
Abstract
Dural fistulas are the most common vascular malformations of the spinal cord. They are of unknown origin but constitute a recognized cause of myelopathy. Aggravation of the clinical manifestations, either spontaneously or after invasive procedures, has been described. We report the case of a patient with a four-month history of myelopathic syndrome involving the lower limbs. Intravenous corticosteroid steroid treatment (1g) given for a suspected inflammatory disorder, induced a dramatic flare-up of the neurological symptoms which were reversible within 48 hours after corticosteroid withdrawal. The causal effect of the steroid treatment is discussed.
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Affiliation(s)
- M E Söderlund
- Service de Neurologie, Centre Hospitalier Universitaire Henri-Mondor, AP/HP, Université Paris XII, Créteil
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Decq P, Charadio P, Vargas A, Djindjian M, Le Guerinel C, Palfi S, Moubarak K, Hattou M, Nguyen J, Keravel Y. Traitement endoscopique des kystes colloïdes du troisième ventricule. Résultats d’une série consécutive de 40 cas. Neurochirurgie 2005. [DOI: 10.1016/s0028-3770(05)83549-0] [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: 10/22/2022]
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3
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Detante O, von Raison F, Brugières P, Palfi S, Le Guerinel C, Djindjian M, Degos JD. [Early diagnosis of bacterial brain abscesses: interest of diffusion-weighted MRI]. Rev Neurol (Paris) 2003; 159:421-4. [PMID: 12773871] [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: 03/02/2023]
Abstract
Three cases of bacterial brain abscesses, in immunocompetent patients, are reported. In all these cases, the diffusion-weighted magnetic resonance (MRI) with apparent diffusion coefficient (ADC) map has permitted an early diagnosis and a rapid treatment. This emergency MRI showed in the three cases a low signal on TI-weighted images, a high signal on T2-weighted and echo-planar images, and a decrease of ADC (0.36- 0.49 x 10(-3) mm2/s). So, this new MRI technique provides an available and rapid element in the brain abscess diagnosis which often remains a complex clinical and radiological diagnosis.
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Affiliation(s)
- O Detante
- Service de Neurologie, Hôpital Henri Mondor, Créteil
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4
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Decq P, Le Guérinel C, Sol JC, Brugières P, Djindjian M, Nguyen JP. Chiari I malformation: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy. J Neurosurg 2001; 95:783-90. [PMID: 11702868 DOI: 10.3171/jns.2001.95.5.0783] [Citation(s) in RCA: 52] [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] [Indexed: 02/07/2023]
Abstract
OBJECT Hydrocephalus associated with Chiari I malformation is a rare entity related to an obstruction in the flow of cerebrospinal fluid (CSF) in the foramen of Magendie. Like all forms of noncommunicating hydrocephalus. it can be treated by endoscopic third ventriculostomy (ETV). The object of this study is to report a series of five cases of hydrocephalus associated with Chiari I malformation and to evaluate the use of ETV in the treatment of this anomaly. METHODS Five patients (four women and one man with a mean age of 29.6 years) underwent ETV for hydrocephalus associated with Chiari I malformation between April 1991 and February 1997. All patients had presented with paroxysmal headaches, which in two cases were associated with visual disorders. All patients had also presented with hydrocephalus (mean transverse diameter of the third ventricle 12.79 mm; mean sagittal diameter of the fourth ventricle 18.27 mm) with a mean herniation of the cerebellar tonsils at 13.75 mm below the basion-opisthion line. Surgery was performed in all patients by using a rigid endoscope. No complications occurred either during or after the procedure, except in one patient who experienced a wound infection that was treated by antibiotic medications. The mean duration of follow up in this study was 50.39 months. Four patients became completely asymptomatic and remained stable throughout the follow-up period. One patient required an additional third ventriculostomy after I year, due to secondary closure, and has remained stable since that time. Postoperative magnetic resonance images demonstrated a significant reduction in the extent of hydrocephalus in all patients (mean transverse diameter of the third ventricle 6.9 mm [p = 0.0035]; mean sagittal diameter of the fourth ventricle 10.32 mm [p = 0.007]), with a mean ascent of the cerebellar tonsils from 13.75 mm below the basion-opisthion line to 7.76 mm below it (p = 0.01). In addition, CSF flow was identified on either side of the orifice of the third ventriculostomy in all patients postoperatively. CONCLUSIONS Results in this series confirm the efficacy of ETV in the treatment of hydrocephalus associated with Chiari I malformation. It is a reliable, minimally invasive technique that also provides a better understanding of the pathophysiology of this malformation.
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Affiliation(s)
- P Decq
- Service de Neurochirurgie et de Neuroradiologie, Hôpital Henri Mondor, Créteil, France.
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5
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Djindjian M. [Pathologic vascular malformations of the spinal cord]. Rev Prat 2001; 51:1191-6. [PMID: 11503488] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Like for the intracranial level, spinal cord vascular malformations can be classified, according to their radiological (particularly arteriographic) and histological aspects, as: arteriovenous malformations, cavernomas and so-called malformations, arterial aneurysms, and venous malformations. This classification should also include the involvement of the surrounding envelopes. Clinical manifestations are not always typical. Magnetic resonance imaging is useful for diagnosis, and angiography is not always necessary nowadays. Arteriovenous malformations are the most frequent vascular malformations; they are equally represented by arteriovenous fistulas of the dura mater and intradural arteriovenous malformations. Intradural cavernomas are rare as compared to arteriovenous malformations. Intradural arterial aneurysms are a rare, owing to local haemodynamic conditions. Venous malformations are exceptional; some intramedullar forms have been recently reported.
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Affiliation(s)
- M Djindjian
- Service de neurochirurgie Hôpital Henri-Mondor 94010 Créteil
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6
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Boulay C, Hamonet C, Galaup N, Djindjian M, Montagne A, Vivant R. [Belated diagnosis of medullar compression in a case of post-polio syndrome]. Ann Readapt Med Phys 2001; 44:150-2. [PMID: 11587662 DOI: 10.1016/s0168-6054(01)00077-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The physiatrist observes about his practice individuals with sequela of old poliomyelitics. A part of them have unusual fatigue and muscular pains and weakness. The hypothesis of an evolution of neuro-biological mechanism suggested by few authors isn't, actually, demonstrated. More probably, the modifications of lesional and, functional changes with disability observed are the consequence of elderly effects and decreasing of physical activites. We report a case of spinal cord compression by intramedullar tumor, associated with a post-polio syndrome.
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Affiliation(s)
- C Boulay
- Service de réadaptation médicale, CHU Henri-Mondor, 51, avenue du Maréchal de Lattre-de-Tassigny, 94010, Créteil, France
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7
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Djindjian M. [Head injuries in the acute phase]. Rev Prat 2000; 50:2015-8. [PMID: 11192971] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Half of patients with traumatic head injuries are comatose (Glasgow coma scale < or = 8); motor vehicle accidents among young people are the predominant mode of injury. CT scanner reveals a large variety of lesions such as extracerebral hematomas, focal or diffuse hematomas, deep lesions. Surgery is performed in one quarter of these patients and indications are extracerebral hematomas, depressed fracture or craniofacial wounds. Indications for surgery in focal intracerebral lesions are difficult and depend on patient age, evolutivity and delayed intracranial hypertension; shift on CT scanner and compression of basal cisterns are the predictors of developing intracranial hypertension. Medical treatment depends on patient severity state; with comatose patient, intensive care unit is required with intubation, ventilation and intracranial pressure measurement by ventricular drain. If the pressure is greater than 20 mmHg, barbiturate therapy is indicated.
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Affiliation(s)
- M Djindjian
- Service de neurochirurgie, Hôpital Henri-Mondor, 94010 Créteil.
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8
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Abstract
Since its description by Dandy in 1922, several techniques have been used to perform third ventriculostomy under endoscopic control. Except for the blunt technique, in which the endoscope is used by itself to create the opening in the floor of the third ventricle, the other techniques require more than one instrument to perforate the floor of the ventricle and enlarge the ventriculostomy. The new device described is a sterilizable modified forceps that allows both the opening of the floor and the enlargement of the ventriculostomy in a simple and effective way. The new device has the following characteristics: 1) the tip of the forceps is thin enough to allow the easy perforation of the floor of the ventricle; 2) the inner surface of the jaws is smooth to avoid catching vessels of the basal cistern; and 3) the outer surface of the jaws has indentations that catch the edges of the opening to prevent them from slipping along the instrument's jaws. The ventricle floor is opened by gentle pressure of the forceps, which is slowly opened so that the edges of the aperture are caught by the distal outer indentation of the jaws, leading to an approximately 4-mm opening of the floor. This device has been used successfully in 10 consecutive patients. This new device allows surgeons to perform third ventriculostomy under endoscopic control in a very simple, quick, and effective way, avoiding the need for additional single-use instruments.
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Affiliation(s)
- P Decq
- Service de Neurochirurgie, Hôpital Henri Mondor, Créteil, France.
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9
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Decq P, Le Guerinel C, Sol JC, Palfi S, Djindjian M, Nguyen JP. [Endoscopic anatomy of the third ventricle]. Neurochirurgie 2000; 46:203-8. [PMID: 10854980] [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: 02/16/2023]
Abstract
According to the development of neurosurgical endoscopy (and especially for third ventriculostomy), the endoscopic anatomy in hydrocephalus should be well known and utilized for orientation. The endoscopic pictures are obtained with a 30; telescope, acquired by a digitalized camera and visualized on a video monitor. The pictures are then numerized on a DKR system. Endoscopic anatomy of the third ventricle is described with a particular focus on the anatomical landmarks and their variations around the foramen of Monro, the anterior and posterior walls of the third ventricle. The knowledge of this anatomy is essential for the safety and the reliability of intraventricular endoscopic procedures.
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Affiliation(s)
- P Decq
- Service de Neurochirurgie, Hôpital Henri-Mondor. 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil Cedex
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10
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Abstract
INTRODUCTION Idiopathic normal pressure hydrocephalus is a disease that most frequently concerns subjects of an advanced age. It is not easy to establish a definitive diagnosis, and the practitioner frequently encounters decision-making problems regarding the following question: should a shunt be performed, or not? Opinions remain contradictory, even though the available scientific data is increasingly precise. The aim of this review is to analyze the physiopathogenic, clinical, paraclinical and therapeutic data associated with this type of hydrocephalus. CURRENT KNOWLEDGE AND KEY POINTS If the clinical triad is determinant, no other investigation is in fact necessary to confirm the diagnosis, although it should always be questioned in the case of ventricular enlargement determined by tomodensitometry. The decision to perform the only efficient procedure, i.e., a ventricular shunt operation, depends upon a number of established arguments in favor of that procedure. Clinical improvement, which is often spectacular, can then confirm the diagnosis. FUTURE PROSPECTS AND PROJECTS The efficacy of surgical treatment has been confirmed by clinical studies, and there is a reduced tendency as regards post-operative complications. However, each case should be considered individually and with the cooperation of and coordination between the family, the physician and the neurosurgeon.
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Affiliation(s)
- O Louletzian
- Service de gériatrie, CHI Poissy-Saint-Germain, Saint-Germain-en-Laye, France
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11
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Brugières P, Malapert D, Adle-Biassette H, Fuerxer F, Djindjian M, Gaston A. Idiopathic spinal cord herniation: value of MR phase-contrast imaging. AJNR Am J Neuroradiol 1999; 20:935-9. [PMID: 10369369 PMCID: PMC7056135] [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: 02/12/2023]
Abstract
We report two patients with an idiopathic transdural spinal cord herniation at the thoracic level. Phase-contrast MR imaging was helpful in showing an absence of CSF flow ventral to the herniated cord and a normal CSF flow pattern dorsal to the cord, which excluded a compressive posterior arachnoid cyst.
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Affiliation(s)
- P Brugières
- Department of Neuroradiology, Henri Mondor Hospital, Créteil, France
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12
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Abstract
OBJECTIVE Several surgical approaches have been proposed for the treatment of colloid cysts, which still remains controversial. The most recent technique used is endoscopy. By its nature, endoscopy cannot offer complete removal, as compared to microsurgical techniques, but can do more than puncture. To evaluate the usefulness of endoscopy for colloid cyst surgery, a series of 15 patients who were operated on for colloid cysts under endoscopic control since 1994 was reviewed. METHODS The presenting symptoms of our patients (10 men and 5 women) were intermittent headache (10 patients), nausea (3 patients), short-term memory loss (4 patients), coma (2 patients), gait disturbance (3 patients), blurred vision (2 patients), and mental status changes (3 patients). The sizes of the cysts ranged from 4 to 50 mm (median, 22.93 mm). Depending on the radiological appearance, the procedure was performed via a right (10 patients) or left (5 patients) precoronal burr hole. A rigid neuroendoscope was used. Initial stereotactic placement of the neuroendoscope was used in two patients who had moderate hydrocephalus. In the other patients, hand-guided endoscopy was performed using an articulated arm. The cysts were perforated with a needle. The opening was enlarged with microscissors. The cyst material was aspirated, and the remaining capsule was coagulated. RESULTS The average follow-up was 15.26 months (range, 1-28 mo). Total aspiration of the cysts was achieved in 12 patients, as revealed by normal postoperative magnetic resonance imaging. Control magnetic resonance imaging revealed residual cysts in three patients. One patient presented with an asymptomatic recurrence at 1 year. Resolution of the symptoms was obtained in all patients except for two of the four patients with preoperative memory deficit (improvement without complete recovery). There was no mortality or morbidity. CONCLUSION These results show that endoscopy is a safe and promising percutaneous technique for the treatment of colloid cysts of the third ventricle. Longer follow-up is, however, still required.
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Affiliation(s)
- P Decq
- Service de Neurochirurgie, Hôpital Henri Mondor, Créteil, France
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13
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Djindjian M. [Non-traumatic meningeal hemorrhage. Etiology, diagnosis, disease outcome]. Rev Prat 1998; 48:987-9. [PMID: 11767359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- M Djindjian
- Service de neurochirurgie, CHU Henri-Mondor, 51, av. du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil
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14
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Decq P, Filipetti P, Feve A, Djindjian M, Saraoui A, Kéravel Y. Peripheral selective neurotomy of the brachial plexus collateral branches for treatment of the spastic shoulder: anatomical study and clinical results in five patients. J Neurosurg 1997; 86:648-53. [PMID: 9120629 DOI: 10.3171/jns.1997.86.4.0648] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 02/04/2023]
Abstract
A new type of peripheral selective neurotomy involving the collateral branches of the brachial plexus has been perfected for treatment of the spastic shoulder. Anatomical study of six cadaveric shoulders led to the specification of a surgical approach to the pectoralis major and teres major nerves, which innervate the main muscles implicated in shoulder spasticity. Between August 1994 and September 1995, five patients (four men and one woman) underwent two to four associated neurotomies of the upper limb, which included neurotomies of the pectoralis major (all five patients) and the teres major (two patients). The average follow-up period was 11 months, during which there were no local or general complications. The spasticity of the treated muscles resolved in all five patients (Held score range 3-0). The neurotomies led to statistically significant average amplitude increases in shoulder mobility, especially in abduction (+30 degrees), antepulsion (+50 degrees), retropulsion (+20 degrees), and external rotation (+20 degrees). The functionally useful active amplitude scores increased from 2.66 to 5.16/6. This functional improvements mainly involved the standing position and walking stability, as well as improvement in the range of motion of the lower limb. These results encourage the increasing use of this new type of neurotomy in treatment of the spastic upper limb.
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Affiliation(s)
- P Decq
- Anatomy Laboratory, University of Paris, France
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15
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Decq P, Brugieres P, Le Guerinel C, Djindjian M, Keravel Y, Nguyen JP. Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy? Technical note. J Neurosurg 1996; 84:696-701. [PMID: 8613867 DOI: 10.3171/jns.1996.84.4.0696] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.1] [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: 01/31/2023]
Abstract
The use of an endoscope in the treatment of suprasellar arachnoid cysts provides an opening of the upper and lower cyst walls, thereby allowing the surgeon to perform a ventriculocystostomy (VC) or a ventriculocystocisternostomy (VCC). To discover which procedure is appropriate, magnetic resonance (MR)-imaged cerebrospinal fluid (CSF) flow dynamics in two patients were analyzed, one having undergone a VC and the other a VCC using a rigid endoscope. Magnetic resonance imaging studies were performed before and after treatment, with long-term follow-up periods (18 months and 2 years). The two patients were reoperated on during the follow-up period because of slight headache recurrence in one case and MR-imaged CSF flow dynamics modifications in the other. In each case surgery confirmed the CSF flow dynamics modifications appearing on MR imaging. In both cases, long-term MR imaging follow-up studies showed a secondary closing of the upper wall orifice. After VCC, however, the lower communication between the cyst and the cisterns remained functional. The secondary closure of the upper orifice may be explained as follows: when opened, the upper wall becomes unnecessary and tends to return to a normal shape, leading to a secondary closure. The patent sylvian aqueduct aids the phenomenon, as observed after ventriculostomy when the aqueduct is secondarily functional. The simplicity of the VCC performed using endoscopic control, which is the only procedure to allow the opening in the cyst's lower wall to remain patent, leads the authors to advocate this technique in the treatment of suprasellar arachnoid cysts.
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Affiliation(s)
- P Decq
- Department of Neurosurgery, Hopital Henri Mondor, Creteil, France
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16
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Khalil A, Ricolfi F, Debray MP, Djindjian M, Gaston A. A common bronchial arterial trunk arising from a left subclavian artery: a rare anatomic variant. Surg Radiol Anat 1995; 17:171-2, 27-8. [PMID: 7482156 DOI: 10.1007/bf01627579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/25/2023]
Abstract
The origin of the bronchial arteries is very variable. An exceptional case is reported of a common bronchial arterial trunk arising from a left subclavian artery discovered incidentally during angiography in a patient without any pulmonary disease. An embryologic explanation is proposed for this anatomic variant.
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Affiliation(s)
- A Khalil
- Service de Neuroradiologie, Hôpital Henri Mondor, Créteil, France
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17
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Abstract
Postoperative wound infections are a serious complication in neurosurgery. The average infection rate without antibiotics ranges between 5-11% in CSF shunts, between 2-5% in craniotomies and spinal surgery in clean and clean contaminated patients, and 11-38% in CSF fistulas. In CSF shunt procedures as well as in craniotomies, common skin commensals, mainly coagulase negative and positive staphylococci are responsible for most postoperative infections. Contradictory results of the studies evaluating the efficacy of prophylactic antibiotics (PA) make it impossible to conclude whether antibiotics have any impact on the incidence of infections or not. Nevertheless the decision to use PA must be left to each surgeon and based on own experience (the mean rate of infection decreased from 5-11% to 1% with PA in France). In clean and clean contaminated surgery, the weight of evidence based on some large, prospective, randomized studies, suggests that PA exerts a protective effect, for which an antistaphylococci antibiotic would be appropriate. In case of methi-R organisms, a second generation cephalosporin is an alternative. Association of vancomycin-gentamicin is not recommended routinely because of the risk of development of resistance.
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Affiliation(s)
- M Djindjian
- Service de Neurochirurgie, Hôpital Henri-Mondor, Créteil
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18
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Abstract
A case of multiple vertebral hemangiomas with progressive neurological deficit is presented. Successful treatment was accomplished using preoperative embolization, palliative surgical decompression, and postoperative radiation therapy. The patient has remained asymptomatic for 6 years. The authors review the role of current imaging modalities and options for therapeutic intervention. Preoperative embolization, palliative surgical decompression, and postoperative radiotherapy appear to provide a satisfactory outcome in patients with multiple hemangiomas and may represent an effective alternative to more aggressive surgical intervention.
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Affiliation(s)
- M Djindjian
- Department of Neurosurgery, Hôpital Henri Mondor, Créteil, France
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19
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Djindjian M. Masson's vegetant intravascular hemangioendothelioma. J Neurosurg 1992; 76:890. [PMID: 1564554 DOI: 10.3171/jns.1992.76.5.0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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20
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Brugières P, Djindjian M, Revel MP, Chakir N, Gaston A. Anterior cervical spinal artery originating from a right vertebral artery with a bifid origin. Neuroradiology 1990; 32:506-7. [PMID: 2287381 DOI: 10.1007/bf02426465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 12/31/2022]
Abstract
A case of an anterior cervical spinal artery originating from a right vertebral artery with a bifid origin is presented. Such an origin may have important surgical consequences, and must be evokated when the vertebral artery enters the cervical canal at an unusual level.
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Affiliation(s)
- P Brugières
- Department of Neuroradiology, Henri Mondor Hospital, Creteil, France
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21
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Nguyen JP, Djindjian M, Brugières P, Badiane S, Melon E, Poirier J. [Correlations between anatomy and computerized tomography findings in transtentorial cerebral herniation]. J Radiol 1990; 71:671-9. [PMID: 2290147] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The diagnosis of transtentorial brain herniation has long relied on encephalography, then arteriography. Computerized tomography (CT) is a safer method which permits a more precise and earlier visualization of temporal and central herniations and herniation of the culmen cerebelli, which are the three varieties of transtentorial herniation. In an attempt to evaluate the reliability of CT images of herniation, the authors have conducted a study of anatomy-CT correlations, using autopsy specimens of brains with these three types of transtentorial herniation. Temporal herniation was well studied, irrespective of the CT reference plane. Direct visualization of temporal uncus herniation and filling of the homolateral perimesencephalic cistern was regularly obtained. Central herniation was better visualized when the occipito-temporal was used as reference. The disappearance of perimesencephalic cisterns on CT sections through the widest part of the tentorial incisura is the best element of diagnosis. Herniation of the culmen is easily studied on the conventional orbito-meatal plane. Provided CT scans are performed with the technique they recommend, the authors consider that this examination is reliable for the diagnosis of transtentorial herniation. Some variations in the anatomy of the incisura may explain why the clinical consequences of herniation are varied. CT perfectly shows the configuration of this notch and therefore may be helpful in predicting the prognosis.
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Affiliation(s)
- J P Nguyen
- Département de Neurosciences, Hôpital Henri-Mondor, Faculté de Médecine Paris, XII, Créteil
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22
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Abstract
The clinical and pathological features of a giant cauda equina paraganglioma arising from the intradural filum terminale is described. Scattered mature large neurons characterized the tumor as a gangliocytic paraganglioma. Histologically, these neoplasms have considerable similarity with ependymoma and the diagnosis can be easily missed unless special techniques are employed.
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Affiliation(s)
- M Djindjian
- Department of Neurosurgery, Hôpital Henri Mondor, Créteil, France
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Djindjian M, Lepresle E, Homs JB. Antibiotic prophylaxis during prolonged clean neurosurgery. Results of a randomized double-blind study using oxacillin. J Neurosurg 1990; 73:383-6. [PMID: 2117055 DOI: 10.3171/jns.1990.73.3.0383] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [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: 12/30/2022]
Abstract
The efficacy of oxacillin as a prophylaxis for infection was analyzed in a 27-month randomized double-blind study of 400 patients who had undergone clean neurosurgical interventions lasting longer than 2 hours. Four neurosurgeons took part in the study and 356 patients were eligible for final analysis. Among the 171 patients treated with oxacillin, there was one case of infection (0.6%), compared to nine (4.9%) of the 185 patients given a placebo. The difference between the two groups was statistically significant (p = 0.0398). This study, together with others (randomized or not), clearly demonstrates the efficacy of antibiotic prophylaxis in prolonged clean neurosurgery.
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Affiliation(s)
- M Djindjian
- Neurosurgery Service, Hôpital Henri Mondor, Créteil, France
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Lepresle E, Djindjian M, Nguyen JP, Goujon C. [Optimal length of antibiotic therapy in aspirated cerebral abscess]. Presse Med 1990; 19:405-6. [PMID: 2138760] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Between 1983 and 1988, 22 patients with brain abscess were admitted to our neurosurgery department; 2 patients deeply comatose on admission and who died on the first day were excluded from this study. Treatment consisted of needle aspiration of the abscess and antibacterial therapy initially using a broad-spectrum antibiotic later replaced, in all cases, by an antibiotic found to be active in vitro against the organism(s) isolated. The portal of entry was eradicated as early as possible. The duration of antibiotic therapy was determined according to the changes observed on computerized tomography images classified as cavitary, nodular, hypodense or normal. Nodular images were taken as reflecting an inflammatory state in the healing process, and hypodense images as sequelae, so that antibiotics were withdrawn in patients with such images. Altogether, 62 per cent of the patients received antibiotics for 60 days and 95 per cent for 90 days. There was no recurrence. In some patients with deep or, chiefly, multiple abscesses, treatment was pursued. In any case, antibiotics should not be given for more than 90 days if the initial treatment has proved effective, since cure is achieved in 45 to 60 days on average.
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Affiliation(s)
- E Lepresle
- Département d'Anesthésie-Réanimation III, Hôpital Henri Mondor, Créteil
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25
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Bénichou J, Djindjian M, DiDio LJA. Books received. Surg Radiol Anat 1989. [DOI: 10.1007/bf02098702] [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: 10/25/2022]
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26
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Abstract
A patient presenting with progressive paraparesis was found to have a dural sacral arteriovenous (AV) fistula. His condition deteriorated abruptly after thoracolumbar angiography. Embolization of the fistula improved the patient's status so that he was able to walk with crutches. One year later his neurological condition worsened. He was treated via an enlarged laminectomy because of uncertainty concerning a lipoma noted on the initial computerized tomography scan. The lesion consisted of an intradural filum terminale lipoma associated with an AV fistula, both of which were excised. The patient's condition was unchanged 6 months later. The different types of spinal lipomas and spinal AV malformations are reviewed, and mechanisms are proposed to explain the clinical deterioration in this patient. Venous hypertension seems to be the most likely possibility. The lipoma may have produced local hypervascularization of the dura mater with a subsequently acquired AV fistula.
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Affiliation(s)
- M Djindjian
- Department of Neurosurgery, Hôpital Henri Mondor, Créteil, France
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27
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Nguyen JP, Lepresle E, Homs JB, Djindjian M, Goujon C. [The role of surgery and low molecular weight heparin in the treatment of cerebral venous thrombosis. Apropos of 2 cases]. Agressologie 1989; 30:351-2. [PMID: 2552856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
For one case of thrombosis of sinus sagittalis superior joint haemorrhagic cerebral softening necessitates surgical draining of haemorrhagic focus grown to a true intracranial haematoma; for the another case direct low molecular weight heparin treatment obtained a mere evolution. Authors are of the opinion that early low molecular weight heparin treatment is able to avoid massive haemorrhage.
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28
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Abstract
The arterial and venous blood-supply of the intradural filum terminale was studied microscopically in 18 fresh cadavers after removing the dorsolumbar spinal cord in one piece, with the roots and the filum in their dural sheath. The arteries were examined after manual injection of the artery of the lumbar enlargement, while study of the veins was made without injection since their bluish-black color made them easily identifiable. After gross examination, each specimen was fixed and then sectioned at 12 different levels from the medullary conus to the bottom of the dural sac for histologic study. The distribution of the vascularization of the filum terminale appeared constant. A single artery, the artery of the filum, arises from the termination of the anterior spinal axis, either by trifurcation or from the proximal part of one of the 2 branches of the anastomotic ansa of the conus. The artery travels in front of the filum, with rapidly diminishing caliber; rarely, it can be followed into the sacral canal. The vein of the filum travels in front of that structure but behind the artery, as in the cord; its caliber is uniform but varies from subject to subject. It traverses the dura below and is continuous with the anterior spinal vein above. No vessels were found on the dorsal aspect of the filum. While the artery of the filum is of a caliber proportional to that of the filum and appears to be a nutrient vessel, the vein has a caliber unrelated to that of the filum and appears rather as an intradural drainage route continuous with the anterior spinal vein.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Djindjian
- Neurosurgery Departement, Hôpital Henri Mondor, Faculté de Médecine, Créteil, France
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29
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Djindjian M, Caron JP, Athayde AA, Février MJ. Intracranial meningiomas in the elderly (over 70 years old). A retrospective study of 30 surgical cases. Acta Neurochir (Wien) 1988; 90:121-3. [PMID: 3354358 DOI: 10.1007/bf01560565] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.9] [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: 01/05/2023]
Abstract
The decision to operate on a patient older than 70 years for an intracranial meningioma is always difficult. Therefore a series of meningiomas treated surgically in 30 cases older than 70 years has been reconsidered and studied according to the following parameters: Karnofsky's rating scale, physiological status of the patient (A.S.A. criteria), perifocal oedema and mass effect. The locations of the meningiomas were: convexity 13, parasagittal 6, falx 2, pterion (sphenoid ridge) 5, orbito-cranial 3, jugum sphenoidale 1, tentorium (occipital) 1. Postoperative survival at day 30 shows a mortality rate of 23% which increases to 37% at day 90 including causes like decubitus ulcers and 3 cases of fatal pulmonary embolism. In a comparable series of 31 cases from 60 to 70 years, mortality rate was only 16% at day 90. Two parameters seem essential for quantifying surgical risk: clinical status, oedema and mass effect, evaluated by CT scan. The best conditions seem combined when Karnofsky rating scale is higher than or equal to 50 with no or only limited perifocal hypodensity and without mass effect. Although meningiomas may remain dormant for many years or can be kept under control medically for some time, their development is unpredictable. We think therefore that a reasonable surgical risk can be taken on patients with good physical status and favourable parameters at the time of diagnosis, particularly if the meningioma is located at the convexity where the risk of recurrence is minimal. On the other hand, patients with unfavourable parameters are not recommended for surgery.
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Affiliation(s)
- M Djindjian
- Department of Neurosurgery, Hôpital Henri Mondor, Créteil, France
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30
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Djindjian M, Ribeiro A, Ortega E, Gaston A, Poirier J. La vascularisation normale du filum terminale intradural chez l'homme. Surg Radiol Anat 1988. [DOI: 10.1007/bf02087009] [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: 11/29/2022]
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31
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Djindjian M, Nguyen JP. Correlation between anatomy and computed tomography in the occipito-temporal plane: application to cerebral lobectomy. Surg Radiol Anat 1988; 10:61-9. [PMID: 3131900 DOI: 10.1007/bf02094072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Identification of the anatomic limits of cerebral lobectomies has for long been based on the indirect data provided by ventriculography, arteriography and the statistical anatomic details of the stereotactic atlases. Today, it is simple to identify the cerebral anatomic structures directly on scanner sections, to assess the limits of a required lobectomy and to monitor the outcome. This appears to be just as valid in clinical conditions where the anatomic structures remain near-normal (surgery of epilepsy) as in those where they may be deformed (such as the surgery of malignant gliomata). In order to establish precise correlations between the anatomy and the computed tomographic findings, a study in the occipito-temporal plane used regularly in CT was carried out in 18 brains. Frontal, temporal and occipital lobectomies were performed on these brains using the anatomic landmarks commonly accepted in neurosurgery. The practical import of these theoretic lobectomies studied in the OT plane is illustrated by some examples of surgical excision of lobar cerebral lesions.
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Affiliation(s)
- M Djindjian
- Department of Neurosurgery, Hôpital Henri-Mondor, Faculté de Médecine Paris XII, Créteil, France
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32
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Djindjian M, Nguyen JP. Corrélations anatomo-tomodensitométriques dans le plan occipito-temporal: application aux lobectomies cérébrales. Surg Radiol Anat 1988. [DOI: 10.1007/bf02345734] [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: 11/30/2022]
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33
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Abstract
The authors report and discuss some clinical, radiological, histological and ultrastructural aspects of an intracranial foreign body granuloma. This granuloma, which simulated a cavernoma, was due to a surgical swab forgotten during a previous neurosurgical evacuation of an intracerebral hematoma.
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Affiliation(s)
- M Djindjian
- Service de Neurochirurgie, Hôpital Henri Mondor, Créteil, France
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34
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Djindjian M, Nguyen JP, Lepresle E, Melon E, François Y, Royand F. [Cranial traumatology. Recent statistical data]. Presse Med 1987; 16:991-4. [PMID: 2955319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The authors describe a one-year prospective study carried out in Créteil from October, 1983 to October, 1984 in 155 selected patients admitted for at least 24 hours with traumatic head injury. Patients with gunshot wounds of the head were excluded from the study. 30% of the patients were infants, 60% were adults aged between 15 and 60, and 5% were over 60; 48% were not comatose (initial Glasgow symptomatic score [GSC] greater than or equal to 8) and 36% were free of any neurological symptom. Prognosis was related to the initial neurological status, to the patient's age and to underlying diseases, such as alcoholism. 10 out of 11 patients with an initial GSC of 4 or less died, against 12 out of 144 with a GSC above 5. At the first CT scan, 10% were found to have an extradural haematoma, but the examination was normal in 20% of patients with neurological symptoms and/or coma; 22% of the CT scans were abnormal without any clinical symptom, as was the case, in particular, with 4 extradural haematomas. Surgery was performed in 24% of all patients and in 17.4% of infants, whereas the percentage reached 30% in alcoholic patients, due to the frequency of intracerebral haematomas in this population. In 16% of the 155 cases, barbiturates were used to treat uncontrolled intracranial pressure higher than 20 mmHg. 15% of the 155 patients deteriorated; a second operation was necessary in 9 cases. The final outcome on discharge was: 112/155 patients with good recovery or moderate disability, 22 with severe disability, 5 with persistent vegetative state and 21 deaths.
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35
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Nguyen JP, Djindjian M, Gaston A, Gherardi R, Benhaiem N, Caron JP, Poirier J. Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol 1987; 27:391-7. [PMID: 3824146 DOI: 10.1016/0090-3019(87)90020-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Six cases of spinal hemangiomas with neurologic symptoms are reported. In three of them the diagnosis was obtained before surgery using plain x-rays and spinal computed tomography scan or biopsy. In the other cases the diagnosis was not done before surgery. In two cases preoperative embolization had minimized blood loss during surgery. Laminectomy was performed in three cases. Large removal and/or vertebrectomy was carried out in the other cases. Our results and a review of the literature about the investigations and treatment of vertebral hemangiomas led us to propose a stereotypical management of spinal hemangiomas with neurologic symptoms.
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36
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Djindjian M, Fevrier MJ, Otterbein G, Soussy JC. Oxacillin prophylaxis in cerebrospinal fluid shunt procedures: results of a randomized open study in 60 hydrocephalic patients. Surg Neurol 1986; 25:178-80. [PMID: 3510475 DOI: 10.1016/0090-3019(86)90290-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A 27-month open randomized trial (October 1981-January 1984) was carried out to study the prophylactic efficacy of antibiotics in 60 hydrocephalic patients being shunted for the first time. The treatment group received oxacillin at a dosage of 200 mg/kg/day by six bolus intravenous injections, beginning with anesthetic induction and continuing for 24 hours after the operations. The minimum postoperative observation was 6 months. Six patients in the control group developed cerebrospinal fluid infections (20%) as compared with only a single patient in the oxacillin group (3.3%); this difference was statistically significant (p less than 0.05). Time of development of cerebrospinal fluid infection was brief (86% at 6 weeks), and as usual staphylococci were the pathogens most frequently implicated. This study would appear to confirm the choice of oxacillin for prevention of meningitis. Nevertheless, the frequency of methicillin-resistant staphylococci, which account for 20% of nosocomial staphylococcal infections, constitutes a limiting factor for such prevention.
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37
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Abstract
This is the report of the surgical removal of a solitary hemangioblastoma that had developed in the left nucleus cuneatus of the medulla oblongata. The surgical intervention was simple and no technical or anesthetic problems were encountered. In spite of the patient's extremely serious neurological state before the operation, his nervous functions reverted virtually to normal.
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38
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Melon E, Bonnet F, Lepresle E, Fevrier MJ, Djindjian M, François Y, Gray F, Debras C. Altered capillary permeability in neurogenic pulmonary oedema. Intensive Care Med 1985; 11:323-5. [PMID: 4086709 DOI: 10.1007/bf00273546] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.
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39
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Cordonnier C, Bernaudin JF, Djindjian M, Jouault H. Localized meningeal blast crisis revealing chronic myeloid leukaemia. Br J Haematol 1984; 56:176-9. [PMID: 6584169 DOI: 10.1111/j.1365-2141.1984.tb01287.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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40
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Djindjian M, Veyrac A, Royan F, Otterbein G. [Risk of meningitis from the placement of shunts in neurosurgery. 1st results of an open randomized series of patients treated with oxacillin compared to a control series]. Agressologie 1983; 24:175-7. [PMID: 6638291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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41
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Louarn F, Brun B, Lebourgeois JP, Djindjian M, Claude C, Barbizet J. [Treatment of malignant glioma. Apropos of 39 cases]. Sem Hop 1983; 59:438-43. [PMID: 6302881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thirty-nine patients with malignant gliomas (36 glioblastomas, 3 astrocytomas grade III; age median 52.5) were treated after surgery by combination chemotherapy followed by irradiation. The median survival on the actuarial curve is 7 months. An attempt is made to evaluate each therapeutic modality by analysis of clinical and CT parameters.
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42
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François Y, Veyrac A, Lefoll D, Nore O, Djindjian M. [Initial results of anesthesia treatment using thiopental in combination with sodium gamma-hydroxybutyrate on patients with severe head injuries]. Agressologie 1982; 23:49-50. [PMID: 7180968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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43
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Riché MC, Modenesi-Freitas J, Djindjian M, Merland JJ. Arteriovenous malformations (AVM) of the spinal cord in children. A review of 38 cases. Neuroradiology 1982; 22:171-80. [PMID: 7035995 DOI: 10.1007/bf00341245] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The cases of 38 children with AVM seen at the Lariboisière Hospital since 1962 are reviewed. The clinical picture was often of sudden onset with impairment of motor function and/or subarachnoid hemorrhage. The diagnosis was usually made by myelography, but spinal arteriography is the key examination, since it confirms the diagnosis and is essential to determine the exact location of the angioma: whether it is extramedullary, intramedullary, or mixed. Angiotomography and angiomyelography with magnification are necessary to determine if the lesion is median, compact, and if it has long sulco-commissural arteries, details which have an important bearing on the prognosis. Operation should be performed as soon as possible after its feasibility has been demonstrated angiographically. But embolization with new materials has also been effective, either associated with operation or as an alternative.
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44
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Nebout T, Romano P, Abbou C, Comoy J, Keravel Y, Djindjian M, Auvert J, Caron JP, Huguenard P, Mannoni P, Weil B. [Removal of kidneys for transplantation. Experience in a French general teaching hospital (author's transl)]. Nouv Presse Med 1981; 10:481-4. [PMID: 7015282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A law issued on december 22, 1976 and aimed at increasing the number of kidney transplantations in France authorizes the removal of kidneys from deceased persons of full age provided they had not expressed refusal while still alive; for decreased persons under age, removal is subject to written consent of the legal representative. In a general teaching hospital of whose than 1 000 beds, 21 kidneys donors were operated upon between January 1, 1971 and December 31, 1975 (an average of 4.2 per year). A kidney transplantation team was developed in 1976. Between January 1, 1976 and August 31, 1979, 83 kidneys donors were operated, an average of 22.6 per year. Ninety-five per cent (59/62) of the kidneys removed and transplanted in the hospital began to function (diuresis greater than 2 ml/min) within minutes of releasing the clamp, no matter how long cold ischaemia had lasted. The increase in kidney removal and transplantation may be attributed to the fact that motivation was maintained among the various units concerned (anaesthesia and intensive care, neurosurgery, neuroradiology) by sustained information and teaching.
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45
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Djindjian M, Djindjian R, Hurth M, Lougnon J, Houdart R. [Spinal meningeal hemorrhage due to tumors: a report on 5 cases with arteriography (author's transl)]. Rev Neurol (Paris) 1978; 134:685-92. [PMID: 751161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Meningeal hemorrhages in 5 patients with tumors of the cauda equina are reported. In each case there were signs from the brain area which led to a false diagnosis of ruptured intracranial aneurism, before attention was drawn to the cauda equina by a relapse with hemorrhage or other signs. The value of medullary arteriography for positively diagnosing cauda equina tumors, and their differential diagnosis from medullary arteriovenous malformations--principal cause of spinal meningeal hemorrhages--is discussed, as well as the necessity for systematically evoking this topography in children and young adults when arteriographic exploration is negative.
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46
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Rey A, Bacourt F, Djindjian M, Georges B. [Neurogenic claudication and claudication by arteritis of the lower limbs]. Phlebologie 1978; 31:389-94. [PMID: 217030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intermittent claudication of neurogenic origin can be traced to three basic causes: --either a chronic circulatory deficiency in the arteries leading to the spinal cord, whether these arteries be the site of an atheroma of the ostia, an inflammation or a loco-regional compression. In such cases, the claudication is painless which differentiates it from the arteritis claudication of the lower limbs. --or to a compression of the roots of the cauda equina and to a lesser degree of the spinal cord, through a narrow rachidian canal that is hereditary or acquired, and relative or absolute. --or finally to a sheathing peripheral neuropathy of the lower limbs. The two latter causes are accompanied by pain, and make it necessary to widen the classical notion of the intermittent claudication (Dejerine's non painful intermittent claudication of the spinal cord).
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47
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Djindjian M, Djindjian R, Hurth M, Houdart R, Rey A. Steal phenomena in spinal arteriovenous malformations. J Neuroradiol 1978; 5:187-201. [PMID: 755097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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48
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Djindjian R, Merland JJ, Djindjian M, Houdart R. [Embolization in the treatment of medullary arteriovenous malformations in 38 cases (author's transl)]. Neuroradiology 1978; 16:428-9. [PMID: 745728 DOI: 10.1007/bf00395323] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A Group of 38 medullary arterio-venous malformations have been embolized with solid emboli: 12 retromedullary, 22 intramedullary and four mixed AVM. Indications, contraindications, and long-term results are described.
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49
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Djindjian M, Djindjian R, Hurth M, Rey A, Houdart R. [Medullary angiomas and the Klippel-Trenaunay-Weber syndrome]. Rev Neurol (Paris) 1977; 133:609-19. [PMID: 203014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
5 cases of an association of Klippel-Trenaunay-Weber syndrome and of spinal cord angiomas are reported amongst a series of 150 cases of malformation of the cord. The hypertrophic element, arterial dilatations and varices were found to be constant, in constant to cutaneous angiomatosis which was found in only 2 cases. There were intraspinal angiomas in all cases. The relationship between Klippel-Trenaunay-Weber syndrome and regional angiomatous phacomatoses are discussed.
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50
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Djindjian M, Djindjian R, Hurth M, Rey A, Houdart R. Spinal cord arteriovenous malformations and the Klippel-Trenaunay-Weber syndrome. Surg Neurol 1977; 8:229-37. [PMID: 197652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Five cases in which the Klippel-Trenaunay-Weber syndrome was associated with a spinal cord arteriovenous malformation are reported: they formed part of a series of 150 spinal arteriovenous malformations. Hypertrophic lesions, dilated arteries and varicose veins were present in every case, but cutaneous angiomatosis was found in only two. In each case, there was an intramedullary AVM. The relationship of the Klippel-Trenaunay-Weber syndrome to the regional angiomatous phacomatoses is discussed.
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