D. Liguoro

Centre Hospitalier Universitaire de Bordeaux, Burdeos, Aquitaine, France

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Publications (71)55.2 Total impact

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    ABSTRACT: L’accesso chirurgico del forame giugulare è complesso. La sua profondità e la sua vicinanza con il nervo faciale e l’arteria carotide interna sono critiche. La presenza, all’interno di questo orifizio, di nervi misti di alta importanza funzionale e di notevole fragilità complica molto il compito del chirurgo. Quella del bulbo giugulare, essenziale per il drenaggio venoso cerebrale e facilmente invaso, è al centro del rischio chirurgico. L’accesso al forame giugulare si può prendere in considerazione attraverso delle vie d’accesso otologiche, di cui la più utilizzata è la via infratemporale tipo A descritta da Ugo Fisch. Questa via ha dimostrato la sua efficacia nel corso del tempo. Il suo inconveniente principale è di sacrificare poco o molto l’udito e di richiedere una deviazione del nervo faciale. Altre vie d’accesso otologiche più rispettose della posizione del canale facciale e dell’orecchio medio sono state descritte più recentemente per la rimozione di tumori di dimensioni da piccole a medie. Tuttavia, il forame giugulare può essere controllato anche attraverso vie d’accesso puramente neurochirurgiche, rispettando la rocca, la posizione del nervo faciale e l’integrità dell’orecchio medio. Questi accessi, descritti per raggiungere il forame magno, sono in grado di portare il chirurgo a delle lesioni che dipendono dal forame giugulare. Lo scopo di questo lavoro è di fare una descrizione quanto più completa possibile di questi due tipi di accessi, precisando le rispettive indicazioni. Sono evocati i problemi posti dai diversi tumori che possono occupare questo spazio. I paragangliomi timpanogiugulari servono da base di descrizione, ma sono anche specificate le particolarità tecniche sollevate dai meningiomi e dai neurinomi.
    EMC - Tecniche Chirurgiche - Chirurgia ORL e Cervico-Facciale. 10/2014; 18(1):1–15.
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    ABSTRACT: The autonomic nervous system is influenced by many stimuli including pain. Heart rate variability (HRV) is an indirect marker of the autonomic nervous system. Because of paucity of data, this study sought to determine the optimal thresholds of HRV above which the patients are in pain after minor spinal surgery (MSS). Secondly, we evaluated the correlation between HRV and the numeric rating scale (NRS).
    Journal of neurosurgical anesthesiology. 08/2014;
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    ABSTRACT: To evaluate the results of facial nerve (FN) grafting using great auricular cable graft and fibrin glue without suturing to palliate FN disruption after removal of large cerebellopontine angle (CPA) vestibular schwannoma (VS) or facial nerve schwannoma (FNS). To assess whether tumor size and origin influenced the results. Retrospective review of all patients having undergone removal of FNS/VS and needing intraoperative FN repair between 2001 and 2011. FN was rehabilitated using great auricular nerve cable graft and fibrin glue (Tisseal) without stitching suture. All data recorded were reviewed to access age, sex, tumor type, and tumor size according to the Koos classification and presenting symptoms. FN function was evaluated preoperatively and at 18 months using the House-Brackmann (HB) grading system. Among the 595 patients operated for CPA schwannomas in this period, 15 patients (2.5%) underwent FN repair, including 7 cases of FNS and 8 cases of VS. Tumor removal was total in all cases. FN recovery was HB3 in 13 cases (86.7%) and HB4 in 2. The mean time to the first clinical signs of facial reinnervation was 10 months (6-12 mo). No significant relation was found between postoperative facial function and tumor size or type, even if all cases of preoperative FP were noted in FNS. Immediate FN reconstruction with fibrin glue-aided greater auricular nerve graft can effectively restore FN function with excellent outcomes. The results seem better than those observed by other authors using sutured grafts or delayed hypoglossal-facial nerve anastomosis.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 05/2014; · 1.44 Impact Factor
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    ABSTRACT: El acceso quirúrgico del agujero yugular es complejo. Su profundidad y su proximidad con el nervio facial y la arteria carótida interna son críticas. La presencia en el seno de este agujero de nervios mixtos con una importancia funcional muy elevada y de gran fragilidad complica mucho la tarea del cirujano, mientras que la presencia del bulbo yugular, esencial para el drenaje venoso cerebral y cuya invasión es fácil, es un elemento central del riesgo quirúrgico. El acceso al agujero yugular puede plantearse a través de vías otológicas, de las que la más utilizada es la vía infratemporal tipo A descrita por Ugo Fisch. Esta vía ha demostrado su eficacia a lo largo del tiempo. Su inconveniente principal es que sacrifica en mayor o menor grado la audición y que requiere una transposición del nervio facial. Recientemente, se han descrito otras vías de acceso otológicas más respetuosas con la posición del conducto facial y del oído medio para la resección de tumores de tamaño pequeño o intermedio. Sin embargo, el agujero yugular también se puede controlar a través de vías de acceso puramente neuroquirúrgicas, respetando el peñasco, la posición del nervio facial y la integridad del oído medio. Estos accesos, descritos para alcanzar el agujero magno, pueden llevar al cirujano a lesiones dependientes del agujero yugular. El objetivo de este artículo es realizar una descripción lo más completa posible de estos dos tipos de acceso, precisando sus indicaciones respectivas. Se detallarán los problemas que plantean los distintos tumores que pueden ocupar este espacio. Los paragangliomas timpanoyugulares sirven de base para la descripción, pero las particularidades técnicas que plantean los meningiomas y los neurinomas también se expondrán.
    EMC - Cirugía Otorrinolaringológica y Cervicofacial. 01/2014; 15(1):1–16.
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    ABSTRACT: Antithrombotic (anticoagulants and antiplatelets) are responsible for iatrogenic accidents, with a specific impact in neurosurgery. Bleeding complications are the most common and best-known. But the link to antiplatelet or to dual association of antithrombotic treatment with intracranial haemorrhage is not complete yet. We studied the proportion of patients under antithrombotic treatment, when an intracranial hemorrhage occurred, as well as the morbi-mortality of each group of patients (with or without antithrombotic treatment). Finally, we studied the proportion of off-label prescriptions. We conducted a monocentric and comprehensive prospective study on a group of patients. All patients that had been admitted for intracranial hemorrhage to our hospital, in a 5-month period were included in the study. One hundred and sixty patients admitted for an intracranial hemorrhage were included during 70days of call. Seventy-four of these patients (46.25%) were under antithrombotic treatment: 40 under antiplatelet treatment (54%), 29 under anticoagulant treatment (39.2%), four under dual antithrombotic treatment (5.4%), and one under Arixtra. Half of the patients under antithrombotic treatment had poor prognosis as compared to 40% of patients without antithrombotic treatment. Off-label antithrombotic therapy was estimated at 27.3% of all prescriptions. The prevalence of antithrombotic therapy in patients is high when intracranial hemorrhage occurs. Some complications could be avoided by decreasing the number of off-label prescriptions and by better controlling their use (using standardized INR). Antiplatelet treatments and new antithrombotic therapies require better drug monitoring which could be part of the establishment of a specific register.
    Neurochirurgie 02/2013; 59(1):17-22. · 0.32 Impact Factor
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    ABSTRACT: BACKGROUND: Intracranial lipomas are extremely rare tumors, with certain clinical and radiological characteristics. METHODS: We considered the diagnostic evaluation and treatment options of seven patients presenting with lipoma in the cerebellopontine angle or internal acoustic meatus in our department. RESULTS: Mean age was 51, with four out of seven cases being women. Balance disorders (vertigo, dizziness) were the predominant symptoms (in six out of seven patients), followed by hearing loss. The diagnosis of intracranial lipomas was based on the results of imaging studies, especially on magnetic resonance imaging. The management of lipomas of the CPA and of the IAM should initially be conservative, including close follow-up of the patient and evaluation of a potential change in tumor size. Surgical management of CPA lipomas should be reserved for patients with intractable clinical symptoms due to tumor overgrowth. CONCLUSIONS: Diagnosis of CPA and IAM lipomas is considered to be a clinical and imaging challenge. As the complete resection of such lipomas is a risky choice and taking into account the benign course of such tumors, the only absolute surgical indication should be uncontrolled tumor growth.
    Acta Neurochirurgica 01/2013; · 1.55 Impact Factor
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    ABSTRACT: OBJECTIVES: To describe the clinical features, radiological findings, treatment and outcomes of three cases of endolymphatic sac tumors (ELST). METHODS: Retrospective analysis of three cases of ELST. RESULTS: The first patient had a large ELST invading the labyrinth after a long history of vertigo. He was recurrence-free 1 year after retrolabyrinthine surgical removal. In the second case, an acute peripheral facial nerve paralysis associated with ipsilateral sensorineural hearing loss led to the diagnosis. A translabyrinthine approach was used to remove the tumor, which recurred three times over 10 years. The third patient was a young woman suffering from von Hippel-Lindau (VHL) disease and referred for a sudden sensorineural hearing loss due to an intralabyrinthine hemorrhage secondary to a 2 mm-large endolymphatic sac-confined ELST. Her hearing was totally lost after the deafness recurred 1 month after this first episode. MRI demonstrated a small bilateral ELST. The patient refused surgery on the deaf side. CONCLUSION: ELST are difficult to diagnose due to the wide variety of their presentations. Patients with ELST should be screened for VHL disease. Dural invasion and tumor hypervascularization increase the risk of local recurrences after surgery. Early surgical resection may lead to complete tumor removal and inner ear preservation.
    Archives of Oto-Rhino-Laryngology 12/2012; · 1.29 Impact Factor
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    ABSTRACT: Spinal ligaments play a very important role in the mechanics of the spine. Curiously the ligamentum flavum (LF) has been the object of few specific studies. First a study on LF of foetuses has been carried out with anatomical, histological (classic staining techniques, immunohistochemistry and ultrastructural study) and radiological techniques. The LF is very different from the other spinal ligaments. It derives very early from a mesenchymeal tissue and not from the primitive muscular structures. Its development, its relations are very closed with lamina, capsules and tendons of spinal muscles. It is quickly an innervated and vascularized ligament with a predominance of elastic fibres. It is from a structural and functional point of view, by its two layers, the equivalent of a capsule and an articular ligament. Second, an ultrastructural and immunohistochemical study has been realized on adult LF to specify the kind of its innervation. It is innervated by fibres of great diameter, with myelin sheath. The positive immunomarking with neuropeptid Y is in favour of the proprioceptive type of this innervation. The LF has a specific and active role within the vertebral building, at the level of the spinal joints. Its characteristics described above confirm its neurological role especially for proprioceptive control. On the whole, this ligament is both mobilizing, stabilizing and adviser. The implications in spinal physiopathology are numerous. Les ligaments rachidiens jouent un rôle important dans la biomécanique du rachis. Le ligamentum flavum (LF) a été peu étudié alors qu’il est très particulier. Après des travaux rapportés au préalable (32) sur le LF adulte, une étude anatomique, histologique, ultrastructurale et radiologique (RMI) a été réalisée sur le foetus; et une étude ultrastructurale et immunohistochimique sur des LF prélevés en per-opératoire pour préciser le type d’innervation de ce ligament. Le LF est très tôt formé à partir d’un tissu mésenchymateux et non à partir des structures musculaires primitives comme les autres ligaments. Son développement se fait en synergie avec les structures voisines avec lesquelles il est en relation étroite: capsules articulaires, tendons des muscles érecteurs du rachis. Il devient rapidement un ligament à prédominance de fibres élastiques, organisé en deux couches, innervé et vascularisé. L’étude de sa morphogenèse indique qu’il est d’un point de vue structurel et fonctionnel, par ses 2 couches, à la fois l’équivalent d’une capsule et d’un ligament articulaire. Sa structure histologique particulière lui confère des propriétés biomécaniques spécifiques. Chez l’adulte, les études réalisées indiquent que ce ligament innervé contient des fibres myélinisées de gros diamètre, immunoréactives pour le Neuropeptide Y, et non pour l’isolectine et la galanine, et donc en faveur de fibres de signification proprioceptive. Mais il est possible que certaines lésions induisent de nouveaux phénotypes vis à vis des molécules synthétisées (nociception secondaire éventuelle). Le LF est donc un ligament actif au sein de l’édifice vertébral, prenant part au complexe articulaire. Il est mobilisateur, stabilisateur et informateur au niveau intersegmentaire. Les implications en physiopathologie rachidienne sont nombreuses.
    European Journal of Orthopaedic Surgery & Traumatology 04/2012; 10(2):77-83. · 0.18 Impact Factor
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    ABSTRACT: Malignant transformation of vestibular schwannoma is considered a rare clinical entity. Radiotherapy, as a treatment option for vestibular schwannoma, is regarded as a potential risk factor for secondary malignancy. Recently, radiotherapy with dose fractionation has been proposed, intended to diminish the risk of radiation-induced neuropathy. The aim of the present study is to report the first case, to the best of our knowledge, of malignant transformation of a residual vestibular schwannoma 19 years after fractionated radiotherapy, describing its characteristics with regard to those previously reported in the literature. The main purpose of the present work is to state that the knowledge of the iatrogenic potential pitfalls of any technique of radiotherapy in clinical oncology is becoming a necessity. Finally, our report demonstrates that the irradiated patients must be monitored for life because a secondary malignancy may appear after a very long delay.
    American journal of otolaryngology 06/2011; 33(1):168-73. · 0.77 Impact Factor
  • Neurochirurgie. 01/2011; 57(s 4–6):278.
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    ABSTRACT: In this chapter, we report the results of orbital tumor management in a few neurosurgical departments and compare it to a Paris neurosurgical department that has developed a close relation with an ophthalmological department. These departments' activity is quite low, treating mainly sphenoorbital meningiomas. Other tumor groups are unequally and sporadically managed.
    Neurochirurgie 03/2010; 56(2-3):213-6. · 0.32 Impact Factor
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    ABSTRACT: In this chapter, we report the results of orbital tumor management in a few neurosurgical departments and compare it to a Paris neurosurgical department that has developed a close relation with an ophthalmological department. These departments’ activity is quite low, treating mainly sphenoorbital meningiomas. Other tumor groups are unequally and sporadically managed.
    Neurochirurgie. 01/2010; 56(2):213-216.
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    ABSTRACT: Background and purposeAntithrombotic (anticoagulants and antiplatelets) are responsible for iatrogenic accidents, with a specific impact in neurosurgery. Bleeding complications are the most common and best-known. But the link to antiplatelet or to dual association of antithrombotic treatment with intracranial haemorrhage is not complete yet. We studied the proportion of patients under antithrombotic treatment, when an intracranial hemorrhage occurred, as well as the morbi-mortality of each group of patients (with or without antithrombotic treatment). Finally, we studied the proportion of off-label prescriptions.Methods We conducted a monocentric and comprehensive prospective study on a group of patients. All patients that had been admitted for intracranial hemorrhage to our hospital, in a 5-month period were included in the study.ResultsOne hundred and sixty patients admitted for an intracranial hemorrhage were included during 70 days of call. Seventy-four of these patients (46.25%) were under antithrombotic treatment: 40 under antiplatelet treatment (54%), 29 under anticoagulant treatment (39.2%), four under dual antithrombotic treatment (5.4%), and one under Arixtra®. Half of the patients under antithrombotic treatment had poor prognosis as compared to 40% of patients without antithrombotic treatment. Off-label antithrombotic therapy was estimated at 27.3% of all prescriptions.ConclusionsThe prevalence of antithrombotic therapy in patients is high when intracranial hemorrhage occurs. Some complications could be avoided by decreasing the number of off-label prescriptions and by better controlling their use (using standardized INR). Antiplatelet treatments and new antithrombotic therapies require better drug monitoring which could be part of the establishment of a specific register.RésuméIntroductionLes antithrombotiques sont à l’origine d’accidents iatrogènes responsables de problèmes spécifiques en neurochirurgie. Les accidents hémorragiques associés aux anti-vitamine K (AVK) sont les plus connus et les plus fréquents. La documentation est incomplète sur l’implication des antiagrégants plaquettaires (AAP) dans la survenue d’une hémorragie intracrânienne (HIC). Nous nous proposons d’étudier la proportion de patients traités par antithrombotiques, lors de la survenue d’une HIC, ainsi que le pronostic à un mois pour chaque groupe de patients (avec ou sans antithrombotique). Enfin, on estimera la proportion d’utilisation hors AMM de ces médicaments.Population et méthodesLe schéma d’étude retenu est celui d’une cohorte observationnelle prospective, monocentrique et exhaustive. Tous les patients majeurs présentant une HIC (hors rupture d’anévrisme), pour lesquels un avis spécialisé a été requis, sur une période de cinq mois, ont été inclus dans l’étude.RésultatsCent-soixante patients présentant une HIC ont été inclus dans l’étude en 70 jours de garde. Parmi eux, 74 patients (46,3 %) étaient sous traitement antithrombotique (AT) : 40 sous traitement AAP (soit 54 %), 29 sous AVK seul (soit 39,2 %), quatre avec un traitement combinant AVK et AAP (soit 5,4 %), et un sous Arixtra®. Cinquante pour cent des patients sous AT ont un mauvais pronostic contre 40,7 % des patients sans AT et 27,3 % des prescriptions d’AT sont hors AMM.Conclusion La prévalence de patients sous traitement AT est élevée lors de la survenue d’une HIC. Un certain nombre de complications pourraient être évitable en diminuant le nombre de prescriptions hors AMM, et en contrôlant leur meilleur usage (contrôle d’une INR standardisée). Les AAP et les nouveaux AT nécessitent une meilleure pharmacovigilance pouvant s’inclure dans la constitution d’un registre spécifique.
    Neurochirurgie. 01/2010; 56(6):539-540.
  • Neurochirurgie. 01/2009; 55(4):535-535.
  • Neurochirurgie. 01/2009; 55(4):535-535.
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    ABSTRACT: The cerebral venous system is poorly known and is best appreciated based on macroscopic anatomical considerations. We present an anatomical and immunohistochemical study to better define the morphological characteristics of the junction between the inferior cortical veins and the transversal sinuses. Sixteen cadaveric specimens from the anatomy laboratory of the University Victor-Segalen of Bordeaux were studied. The venous junctions with the transversal sinuses were observed under the operating microscope. Thirty vein-sinus junctions were immunohistochemically stained with smooth muscle actin. Ten venous junctions were observed under the electronic microscope. The inferior cortical veins drain into the transverse sinus either directly or through a tentorial sinus. The venous orifices in the transverse sinuses share the same characteristics. They are oval with semicircular superior dural reinforcement and follow an orientation opposite venous flow in the transversal sinus. The histologic study showed that the walls of the cortical veins contained smooth muscle cells as well as the dural reinforcement of the transversal sinuses. The venous orifices of the inferior cortical veins have the anatomical features of true sphincters. Their function in the regulation of the cerebral blood flow needs further exploration.
    Neurochirurgie 01/2009; 55(1):19-24. · 0.32 Impact Factor
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    ABSTRACT: The aim of this study was to determine the apoptotic and cytotoxic effects induced on glioblastoma cells by various anticancer agents that possess different mechanisms of action (alkylating drugs, anti-EGFR (Epidermal Growth Factor receptor), proteasome inhibitor). Primary cell cultures were obtained from patients who underwent surgery for their glioblastoma. The cytotoxic effects of drugs were determined by MTT (dimethylthiazolyl diphenyl tetrazolium bromide) assay and apoptosis was evaluated by measuring mitochondrial potential by flow cytometry. Biological markers (EGFR, bcl-2) were studied by a immunoblotting technique to find out predictive markers of response. We found a large interindividual sensitivity, thus confirming the interest of the primary cultures. New proteasome inhibitor bortezomib had considerable cytotoxic and apoptotic potential in glioblastoma, even at very low concentrations. Moreover, the characterization of patients' cells for EGFR and bcl-2 status could constitute an interest, with the evaluation of other markers, in the study of expected chemotherapy response.
    Journal of Experimental Therapeutics and Oncology 01/2009; 8(2):105-16.
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    ABSTRACT: IntroductionThe cerebral venous system is poorly known and is best appreciated based on macroscopic anatomical considerations. We present an anatomical and immunohistochemical study to better define the morphological characteristics of the junction between the inferior cortical veins and the transversal sinuses.
    Neurochirurgie. 01/2009; 55(1):19-24.
  • Neurochirurgie. 01/2009; 55(4):513-513.
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    ABSTRACT: Peritumoral brain edema (PTBE) is often associated with meningiomas. PTBE is probably implicated in the complications occurring in intracranial meningiomas. The goal of this study was to determine the exact implication of PTBE in prognosis. Thirty consecutive patients who underwent surgery for intracranial meningiomas were investigated over a 1-year period. We focused on the clinical and radiological status before and after surgery, and postoperative complications. Multiple regression analysis revealed a close correlation (p<0.05) between PTBE and symptoms, type of arterial supply, difficulty of surgical removal, and postoperative complications. PTBE is likely implicated in the morbidity of intracranial meningiomas. We suggest predictive factors for difficult surgical resection, and emphasise the importance of medical preoperative management and post-operative follow-up.
    Journal of Clinical Neuroscience 08/2008; 15(7):764-8. · 1.25 Impact Factor

Publication Stats

252 Citations
55.20 Total Impact Points

Institutions

  • 2001–2014
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
  • 2013
    • Aristotle University of Thessaloniki
      Saloníki, Central Macedonia, Greece
  • 2007–2013
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
    • Assistance Publique Hôpitaux de Marseille
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1994–2008
    • University of Bordeaux
      Burdeos, Aquitaine, France