Search Results

You are looking at 1 - 8 of 8 items for

  • Author or Editor: Fabrice Parker x
Clear All Modify Search
Full access

Steven Knafo, Charles Court and Fabrice Parker

Object

Spinal deformity after surgery for intramedullary tumors is a potentially serious complication that may require subsequent fusion. The aim of this study was to determine whether there were risk factors that could be used to predict postoperative sagittal deformity.

Methods

The authors conducted a retrospective study of patients harboring an intramedullary tumor who had undergone surgery at a single center between 1985 and 2011. The main outcome of interest was the difference, at the last follow-up, between post- and preoperative measures of the Cobb angle formed by the superior and inferior limits of the laminectomy (ΔCobb).

Results

Sixty-three patients were eligible for inclusion in the study. The mean sagittal deformity, measured as described above, was 15.9° (range 0°–77°) at a mean follow-up of 85.4 months (range 4–240 months). Univariate analysis showed increased sagittal deformity in patients 30 years old or younger (21.9° vs 13.7°, p = 0.04), undergoing a laminectomy involving 4 or more levels (19.3° vs 12.1°, p = 0.04), and undergoing a laminectomy that included a spinal junction (20.8° vs 12.4°, p = 0.02). Multivariate analysis showed that only age (p = 0.01) and the number of spinal levels involved in the laminectomy (p = 0.014) were significant and independent predictors of postoperative sagittal deformity. The linear regression equation drawn from this model allows one to quantitatively predict sagittal deformity for any follow-up time point after surgery.

Conclusions

Authors of this study developed a statistical tool that could be used to plan surgery and follow-up as regards the risk of sagittal spinal deformity in patients undergoing surgery for intramedullary tumors.

Restricted access

Raphaël Vialle, Fabrice Parker, Jean-François Lepeintre, Georges Rodesch, Jean-Louis Tassin and Marc Tadié

Restricted access

Steven Knafo, Fabrice Parker, Anne Herbrecht, Charles Court and Guillaume Saliou

Subarachnoid-pleural fistula is a well-described complication after anterior surgery for thoracic disc herniation, but is difficult to treat by means of traditional chest and lumbar drains due to interference by positive ventilation pressures that may keep the fistula open and prevent proper closure. Current treatment strategies include surgical repair, which is technically challenging, and noninvasive positive pressure ventilation, which can take several weeks to be effective. In this report, the authors describe a novel treatment for subarachnoid-pleural fistula using percutaneous obliteration with Onyx.

Surgery for removal of a T7–8 disc herniation associated with ossification of the posterior longitudinal ligament was performed in a 56-year-old woman via an anterior transthoracic transpleural approach. Ten days after surgery, she presented with diplopia due to a subarachnoid-pleural fistula that was confirmed by CT myelography. Percutaneous injection of Onyx was performed under local anesthesia. Postprocedure CT showed complete obliteration of the fistula with no adverse events. A CT scan obtained 1 month later showed complete resolution of the pleural effusion. Neurological examination at 3 months postsurgery was normal. Clinical and radiological follow-up at 1 year showed complete recovery and no sign of fistula recurrence. Percutaneous treatment for subarachnoid-pleural fistula is an easy, safe, and effective strategy and can therefore be proposed as a first-line option for this challenging complication.

Restricted access

Serge Blond, Dominique Caparros-Lefebvre, Fabrice Parker, Richard Assaker, Henri Petit, Jean-Daniel Guieu and Jean-Louis Christiaens

✓ The authors report on the long-term results of chronic stereotactic stimulation of the ventralis intermedius thalamic nucleus performed in 14 cases of disabling and intractable tremor. There were 10 patients with parkinsonian tremor and four with essential tremor. Three of the 10 parkinsonian patients had previously undergone contralateral thalamotomy. Tremor was assessed by clinical evaluation, surface electromyography, accelerometer, and videotape recordings before and after stimulation. The deep-brain electrode was implanted in the ventralis intermedius nucleus according to stereotactic procedure and connected to a subcutaneous pulse generator after a stimulation test period. Tremor suppression or reduction was obtained in all cases with high-frequency (130 Hz) stimulation. Marked functional improvement was maintained in 11 patients with a mean follow-up interval of 17 months. Levodopa-induced dyskinesias observed in five parkinsonian patients prior to surgery were improved or suppressed in four cases by thalamic stimulation. Stimulation was continued during the day and stopped at night in eight cases. Six patients were stimulated night and day to avoid a rebound effect which appeared as soon as the pulse generator was stopped. The only side effects were hand tonic posture in one case and persistent paresthesia in another case. The mechanism of action of this attractive treatment may be a functional alteration of the thalamic discharging area. The authors conclude that this technique is a good alternative to thalamotomy, especially when the risks of high-frequency coagulation are severe in frail and older patients.

Restricted access

Constantin Tuleasca, Yohan Ducos, Marc Levivier, Fabrice Parker and Nozar Aghakhani

Restricted access

Nozar Aghakhani, Philippe Durand, Laurent Chevret, Fabrice Parker, Denis Devictor, Marc Tardieu and Marc Tadié

Object

In this study, the authors investigated the clinical efficacy of decompressive craniectomy treatments for nontraumatic intracranial hypertension in children.

Methods

Seven patients with nontraumatic refractory high intracranial pressure (ICP) were enrolled in the study between 1995 and 2005; there were 2 boys and 5 girls with a mean age of 9 years (range 4–14). Decompressive craniectomy was performed in all patients after standard medical therapy had proven insufficient and ICP remained > 50 mm Hg. All patients had a Glasgow Coma Scale score < 8 at admission and a mean Pediatric Risk of Mortality Scale score of 20 (range 10–27).

Results

One patient died of persistent high ICP and circulatory failure 48 hours after surgery. Six months later, according to their Glasgow Outcome Scale scores, 3 patients had adequate recoveries, 2 patients recovered with moderate disabilities, and 1 patient had severe disabilities. According to the Pediatric Overall Performance Category Scale, 4 patients received a score of 2 (mild disability), 1 a score of 3 (moderate disability), and 1 a score of 4 (severe disability). Five patients returned to school and normal life.

Conclusions

The authors found decompressive craniectomy to be an effective and lifesaving technique in children. This procedure should be included in the arsenal of treatments for nontraumatic intracranial hypertension.

Restricted access

Oral Presentations

2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010