La trépanation : aspects historiques, techniques et éthiques
Scientific conference (2008, January 23)Detailed reference viewed: 4 (0 ULg)
Mucormycose invasive du poumon et du rachis dorsal.
De Pasqual, Aurelie ; Deprez, Manuel ; Ghaye, Benoît et al
in Revue Médicale de Liège (2008), 63
Nous rapportons le cas d'un patient de 67 ans atteint d'un syndrome myélodysplasique et qui a développé une mucormycose pulmonaire avec extension tout à fait exceptionnelle vers le rachis dorsal ... [more ▼]
Nous rapportons le cas d'un patient de 67 ans atteint d'un syndrome myélodysplasique et qui a développé une mucormycose pulmonaire avec extension tout à fait exceptionnelle vers le rachis dorsal responsable d'un paraplégie aiguë. Après échec d'un traitement probabiliste anti-aspergillaire, c'est finalement l'analyse des prélèvements obtenus lors de la laminectomie décompressive qui a fourni le diagnostic mycologique. En raison d'une altération majeure de l'état général, la lobectomie prévue n'a pu être réalisée et malgré l'adaptation du traitement antifongique (Abelcet, Posaconazole), le patient est décédé. La mucormycose (ou zygomycose) pulmonaire est une infection fongique peu commune qui touche essentiellement les patients immuno-déprimés. Le champignon pathogène fait partie des zygomycètes dont la caractéristique principale est la capacité d'angio-invasion. L'invasion périneurale est une autre voie de propagation récemment mise en évidence. Les difficultés thérapeutiques associées à cette pathologie sont liées au terrain d'immunodépression, aux difficultés d'obtenir rapidement un diagnostic précis ainsi qu'à l'absence de sensibilité du Mucor aux antifongiques récemment introduits (V-Fend, Cancidas). Ceci souligne le risque inhérent à un traitement antifongique empirique par ces agents et la nécessité d'un prélèvement biopsique précoce en cas de non-réponse au traitement. [less ▲]Detailed reference viewed: 201 (12 ULg)
IRM interventionnelle : vers une neuronavigation en temps réel.
Martin, Didier ; Nguyen Khac, Minh-Tuan ; Scholtes, Félix et al
in Revue Médicale de Liège (2008), 63
La neuronavigation est un outil neurochirurgical qui peut être comparé au GPS. Elle sert à guider la procédure neurochirurgicale en visualisant les déplacements des instruments chirurgicaux sur les images ... [more ▼]
La neuronavigation est un outil neurochirurgical qui peut être comparé au GPS. Elle sert à guider la procédure neurochirurgicale en visualisant les déplacements des instruments chirurgicaux sur les images préopératoires. En augmentant la précision du geste, elle permet d’atteindre des lésions parfois très petites ou difficiles d’accès tout en réduisant la morbidité et en augmentant l’efficacité. Elle présente cependant un écueil majeur. L’image utilisée par le système de navigation est obtenue avant l’intervention et ne peut être corrigée durant celle-ci. En raison des modifications anatomiques inhérentes à l’opération (modification du volume du liquide céphalo-rachidien, résection de la tumeur,…), il apparaît progressivement une discordance entre la réalité chirurgicale et l’imagerie. Les informations pertinentes se périment ainsi peu à peu et la précision se perd. L’IRM interventionnelle est le moyen de réactualiser la neuronavigation par des images de haute définition. De plus, elle permet de réaliser des contrôles intra-opératoires de la qualité du geste chirurgical. [less ▲]Detailed reference viewed: 132 (2 ULg)
Rapid, postmortem 9.4 T MRI of spinal cord injury: correlation with histology and survival times.
Scholtes, Félix ; Phan-Ba, Rémy ; et al
in Journal of Neuroscience Methods (2008), 174(2), 157-67
High field magnetic resonance imaging (MRI) has been increasingly used to assess experimental spinal cord injury (SCI). In the present investigation, after partial spinal cord injury and excision of the ... [more ▼]
High field magnetic resonance imaging (MRI) has been increasingly used to assess experimental spinal cord injury (SCI). In the present investigation, after partial spinal cord injury and excision of the whole spine, pathological changes of the spinal cord were studied in spinal cord-spine blocks, from the acute to the chronic state (24 h to 5 months). Using proton density (PD) weighted imaging parameters at a magnetic field strength of 9.4 tesla (T), acquisition times ranging from <1 to 10 h per specimen were used. High in-plane pixel resolution (68 and 38 microm, respectively) was obtained, as well as high signal-to-noise ratio (SNR), which is important for optimal contrast settings. The quality of the resulting MR images was demonstrated by comparison with histology. The cord and the lesion were shown in their anatomical surroundings, detecting cord swelling in the acute phase (24 h to 1 week) and cord atrophy at the chronic stage. Haemorrhage was detected as hypo-intense signal. Oedema, necrosis and scarring were hyper-intense but could not be distinguished. Histology confirmed that the anatomical delimitation of the lesion extent by MRI was precise, both with high and moderate resolution. The present investigation thus demonstrates the precision of spinal cord MRI at different survival delays after compressive partial SCI and establishes efficient imaging parameters for postmortem PD MRI. [less ▲]Detailed reference viewed: 159 (13 ULg)
Absence d'hypogonadisme chez un patient masculin avec prolactinome géant : un paradoxe clinique
; Daly, Adrian ; Deprez, Manuel et al
in Annales d'Endocrinologie (2008), 69(1), 47-52
Background Impotence and decreased libido are the cardinal features of prolactinomas in males. We describe the unusual clinical, pathological and biochemical features in a male patient with a giant ... [more ▼]
Background Impotence and decreased libido are the cardinal features of prolactinomas in males. We describe the unusual clinical, pathological and biochemical features in a male patient with a giant prolactinoma and normal gonadal function. Case Report A 57 year-old man presented with visual symptoms related to a 30 × 25 × 60 mm tumor of the sella and skull base. Biopsy revealed a pituitary adenoma and subsequent hormone profiles demonstrated grossly elevated serum prolactin (131,412 ng/ml), LH at the upper limit of normal and normal testosterone. The patient had no symptoms of decreased libido or impotence related to this giant prolactinoma. Immunohistochemistry revealed a tumor that was positive for prolactin, alpha-subunit and LH. Cabergoline greatly reduced prolactin levels but these remained above normal. LH, testosterone and alpha-subunit levels were decreased in parallel. Loss of libido and impotence became apparent when testosterone fell below normal, a situation that resolved with further cabergoline treatment and prolactin inhibition and testosterone therapy. Conclusions Sexual dysfunction is a hallmark of prolactinomas in males. Tumors that co-secrete prolactin and LH are extremely rare and this is the first such case reported in an adult male. In this case, normal testosterone was maintained by intact LH levels even in the face of the highest prolactin level reported to date. [less ▲]Detailed reference viewed: 90 (5 ULg)
Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience.
; Scholtes, Félix ; et al
in Neurosurgery (2008), 62(2), 463-9469-71
OBJECTIVE: The management of cerebrospinal fluid (CSF) fistulae after anterior cranial base fracture remains a surgical challenge. We reviewed our results in the repair of CSF fistulae complicating ... [more ▼]
OBJECTIVE: The management of cerebrospinal fluid (CSF) fistulae after anterior cranial base fracture remains a surgical challenge. We reviewed our results in the repair of CSF fistulae complicating multiple anterior cranial base fractures via a combined intracranial extradural and intradural approach and describe a treatment algorithm derived from this experience. METHODS: We retrospectively reviewed the files of 209 patients with an anterior cranial base fracture complicated by a CSF fistula who were admitted between 1980 and 2003 to Liege State University Hospital. Among those patients, 109 had a persistent CSF leak or radiological signs of an unhealed dural tear. All underwent the same surgical procedure, with combined extradural and intradural closure of the dural tear. RESULTS: Of the 109 patients, 98 patients (90%) were cured after the first operation. Persistent postoperative CSF rhinorrhea occurred in 11 patients (10%), necessitating an early complementary surgery via a transsphenoidal approach (7 patients) or a second-look intracranial approach (4 patients). No postoperative neurological deterioration attributable to increasing frontocerebral edema occurred. During the mean follow-up period of 36 months, recurrence of CSF fistula was observed in five patients and required an additional surgical repair procedure. CONCLUSION: The closure of CSF fistulae after an anterior cranial base fracture via a combined intracranial extradural and intradural approach, which allows the visualization and repair of the entire anterior base, is safe and effective. It is essentially indicated for patients with extensive bone defects in the cranial base, multiple fractures of the ethmoid bone and the posterior wall of the frontal sinus, cranial nerve involvement, associated lesions necessitating surgery such as intracranial hematomas, and post-traumatic intracranial infection. Rhinorrhea caused by a precisely located small tear may be treated with endoscopy. [less ▲]Detailed reference viewed: 48 (1 ULg)
Acquired tonsillar herniation and syringomyelia after pleural effusion aspiration: case report.
Scholsem, Martin ; Scholtes, Félix ; Belachew, Shibeshih et al
in Neurosurgery (2008), 62(5), 1172-31173
OBJECTIVE: We present a case of brachial plexus avulsion and reconstructive surgery with cerebrospinal fluid leak between the cervical subarachnoid space and the pleural cavity responsible for tonsillar ... [more ▼]
OBJECTIVE: We present a case of brachial plexus avulsion and reconstructive surgery with cerebrospinal fluid leak between the cervical subarachnoid space and the pleural cavity responsible for tonsillar herniation and syringomyelia. CLINICAL PRESENTATION: A 17-year-old man presented with headaches when he was positioned upright, simultaneously with a persistent right pleural effusion for about 4 months after reconstructive surgery for a right brachial plexus avulsion. In addition, the headaches had worsened considerably after two aspirations of the pleural effusion. Magnetic resonance imaging (MRI) demonstrated signs of chronic intracranial hypotension and tonsillar herniation with a presyrinx cavity from vertebral level C1 to C7. None of those abnormalities were seen on the MRI scan obtained a few days after the initial trauma 7 months previously. Plexus brachial MRI confirmed the presence of a cerebrospinal fluid leak between the avulsed root of C8 and the pulmonary apex. INTERVENTION: The leak was treated by surgical closure of the dural tear of the C8 root. Postoperatively, the patient's headaches immediately resolved, and MRI 4 months later showed resolution of cerebellar tonsil herniation and regression of the syrinx. CONCLUSION: Resolution of acquired tonsillar herniation and syringomyelia can be achieved by closure of the dural tear responsible of the cerebrospinal fluid leak. [less ▲]Detailed reference viewed: 214 (17 ULg)
TGF-1 and TGF-2 expression after traumatic human spinal cord injury
; ; et al
in Spinal Cord (2008), 46
TGF-beta1 and TGF-beta2 expression after traumatic human spinal cord injury.Detailed reference viewed: 17 (0 ULg)
Table ronde : «Mort et résurrection de la moelle spinale».
Conference (2007, November 25)Detailed reference viewed: 1 (1 ULg)
Les lésions médullaires post-traumatiques : aspects fondamentaux.
Conference (2007, September 26)
State of the Art in Spinal Cord Injury – Research and Clinical Application
Conference (2007, September 06)Detailed reference viewed: 2 (0 ULg)
Growth-modulating molecules are associated with invading Schwann cells and not astrocytes in human traumatic spinal cord injury
; ; et al
in Brain (2007), 130(Part 4), 940-953
Despite considerable progress in recent years, the underlying mechanisms responsible for the failure of axonal regeneration after spinal cord injury (SCI) remain only partially understood. Experimental ... [more ▼]
Despite considerable progress in recent years, the underlying mechanisms responsible for the failure of axonal regeneration after spinal cord injury (SCI) remain only partially understood. Experimental data have demonstrated that a major impediment to the outgrowth of severed axons is the scar tissue that finally dominates the lesion site and, in severe injuries, is comprised of connective tissue and fluid-filled cysts, surrounded by a dense astroglial scar. Reactive astrocytes and infiltrating cells, such as fibroblasts, produce a dense extracellular matrix (ECM) that represents a physical and molecular barrier to axon regeneration. In the human situation, correlative data on the molecular composition of the scar tissue that forms following traumatic SCI is scarce. A detailed investigation on the expression of putative growth-inhibitory and growth-promoting molecules was therefore performed in samples of post-mortem human spinal cord, taken from patients who died following severe traumatic SCI. The lesion-induced scar could be subdivided into a Schwann cell dominated domain which contained large neuromas and a surrounding dense ECM, and a well delineated astroglial scar that isolated the Schwann cell/ECM rich territories from the intact spinal parenchyma. The axon growth-modulating molecules collagen IV, laminin and fibronectin were all present in the post-traumatic scar tissue. These molecules were almost exclusively found in the Schwann cell-rich domain which had an apparent growth-promoting effect on PNS axons. In the astrocytic domain, these molecules were restricted to blood vessel walls without a co-localization with the few regenerating CNS neurites located in this region. Taken together, these results favour the notion that it is the astroglial compartment that plays a dominant role in preventing CNS axon regeneration. The failure to demonstrate any collagen IV, laminin or fibronectin upregulation associated with the astroglial scar suggests that other molecules may play a more significant role in preventing axon regeneration following human SCI. [less ▲]Detailed reference viewed: 6 (0 ULg)
International Foundation for Research in Paraplegia
Conference (2007, February 20)Detailed reference viewed: 1 (0 ULg)
La pression intracrânienne normale et pathologique
Conference (2007, January 22)Detailed reference viewed: 6 (2 ULg)
Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma
; ; Seidel, Laurence et al
in Radiotherapy & Oncology (2007), 82(1), 83-89
AIM: The long-term effects of radiosurgery of vestibular schwannomas were investigated in a group of consecutively treated patients. METHODS AND MATERIALS: Between 1995 and 2001, 26 patients (median age ... [more ▼]
AIM: The long-term effects of radiosurgery of vestibular schwannomas were investigated in a group of consecutively treated patients. METHODS AND MATERIALS: Between 1995 and 2001, 26 patients (median age: 67, range: 30-82) with a vestibular schwannoma were treated by Linac-based stereotactic radiosurgery (SRS). The median follow-up was 49 months (16-85 months). Only progressive tumours were treated. The median size of tumours was 18 mm (range 9-30 mm). Before SRS, 11 patients had a useful hearing (Gardner-Robertson classes 1 and 2). Single doses of 10-14 Gy were prescribed at the 80% isodose at the tumour margin. The follow-up consisted of regular imaging with MRI the first 3-6 months after the intervention, followed by additional yearly MRIs, a hearing test and a neurological examination. RESULT: The 5-year-probability of tumour control (defined as stabilization or decrease in size) was 95%. Five-year-probability of preservation of hearing and facial nerve function was 96% and 100%, respectively. Hearing was preserved in 10 out of 11 patients who had a normal or useful hearing at the time of treatment. Mild and transient trigeminal toxicity occurred in 2 (8%) patients. It appeared to be significantly correlated to the dose used (p=0.044). However, only a tendency to significance could be demonstrated in the relationship between the two factors when using the Cox analysis (hazard ratio=1.7; 95% CI: 0.7-3.9; p=0.23). CONCLUSIONS: With the doses used, our study demonstrates that SRS provides an equivalent tumour control rate when compared to surgery, as well as on a long-term basis, an excellent preservation of the facial and the acoustic nerves. Although no permanent trigeminal toxicity was observed, our data confirm that doses below 14 Gy can avoid transient dysesthesias. [less ▲]Detailed reference viewed: 35 (2 ULg)