D. Liguoro

Université Victor Segalen Bordeaux 2, Burdeos, Aquitaine, France

Are you D. Liguoro?

Claim your profile

Publications (80)77.93 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate short- and mid-term level of imbalance after vestibular schwannoma (VS) microsurgery by the transpetrosal approach, to search for factors predictive of vestibular compensation, and to determine which patient categories need a postoperative vestibular rehabilitation program. Prospective cohort study at a tertiary referral center. Between 2010 and 2011, patients aged 18 to 75 operated on for VS by transpetrosal approaches were included. VS was characterized by its size (Koos classification) and the presence or not of a cystic component. Hearing was classified according to the Gardner Robertson grading. The preoperative workup included an audiogram, computerized video nystagmography (VNG) with caloric testing, gaze study, rotatory tests, click-evoked cervical vestibular evoked myogenic potential measurements (cVEMPs), and subjective visual vertical test. Patients were asked to complete a Dizziness Handicap Inventory (DHI). Postoperatively, patients were reevaluated on D7 (clinical status), D90 (VNG and DHI), and D180 (DHI). Timing and duration of vestibular rehabilitation were also recorded. Forty-eight patients were included. Preoperatively, 77% experienced mild instability problems with a mean DHI score of 14.1 (range 4-32). Postoperatively, 71% reported stable or even improved perceived stability. Mean DHI scores were 28.1 on D90 and 19.8 on D180. Serviceable hearing, cystic transformation, normal cVEMPs, diplopia, and vestibular syndrome on D7 were found to be predictive of worse equilibrium outcome than when absent. A preoperative caloric deficit greater than 75% seemed to be a good prognostic factor. Vestibular rehabilitation was conducted in 56% of patients. Starting it early (<1 mo) seemed to be beneficial for final equilibrium outcome. VS microsurgery provides good stability results. Some preoperative parameters may be predictive of worse or improved balance recovery, as is clinical status on D7.
    No preview · Article · Mar 2015 · Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim of the Study: 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. Study Design and Setting: Retrospective review of all patients having undergone removal of FNS/VS and needing intraoperative FN repair between 2001 and 2011. Intervention: FN was rehabilitated using great auricular nerve cable graft and fibrin glue (Tisseal) without stitching suture. Main Outcome Measures: 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. Results: 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. Conclusion: 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.
    No preview · Article · Mar 2015 · Otology & Neurotology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: 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). Methods: Following institutional review board approval, patients who underwent MSS were assessed in the postanesthesia care unit after extubation. A laptop containing the HRV software was connected to the ECG monitor. The low-frequency band (LF: 0.04 to 0.5 Hz) denoted both sympathetic and parasympathetic activities, whereas the high-frequency band (HF: 0.15 to 0.4 Hz) represented parasympathetic activity. LF/HF was the sympathovagal balance. Pain was quantified by the NRS ranging from 0 (no pain) to 10 (worst imaginable pain). Simultaneously, HRV parameters were noted. Optimal thresholds were calculated using receiver operating characteristic curves with NRS>3 as cutoff. The correlation between HRV and NRS was assessed using the Spearman rank test. Results: We included 120 patients (64 men and 56 women), mean age 51±14 years. The optimal pain threshold values were 298 ms for LF and 3.12 for LF/HF, with no significant change in HF. NRS was correlated with LF (r=0.29, P<0.005) and LF/HF (r=0.31, P<0.001) but not with HF (r=0.09, NS). Conclusions: This study suggests that, after MSS, values of LF>298 m and LF/HF>3.1 denote acute pain (NRS>3). These HRV parameters are significantly correlated with NRS.
    No preview · Article · Aug 2014 · Journal of neurosurgical anesthesiology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · May 2014 · Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Apr 2014

  • No preview · Article · Dec 2013 · Neurochirurgie
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Feb 2013 · Neurochirurgie
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jan 2013 · Acta Neurochirurgica
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Dec 2012 · Archives of Oto-Rhino-Laryngology
  • V. Darrouzet · D. Liguoro · V. Franco-Vidal · J. Maire

    No preview · Article · Oct 2012 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale

  • No preview · Article · Oct 2012 · Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Apr 2012 · European Journal of Orthopaedic Surgery & Traumatology

  • No preview · Article · Sep 2011 · Neurochirurgie

  • No preview · Article · Sep 2011 · Neurochirurgie
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2011 · American journal of otolaryngology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Dec 2010 · Neurochirurgie
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nous rapportons dans ce chapitre les résultats de l’activité d’un certain nombre de services de neurochirurgie, dédiée à la prise en charge des tumeurs de l’orbite et la comparons à celle d’un service neurochirurgical parisien dont les liens et l’implication avec un service d’ophtalmologie étaient très étroits. L’activité des différents centres intéressés est relativement faible et est constituée principalement par le traitement des méningiomes sphéno-orbitaires, les autres types tumoraux étant traités de façon inégale et sporadique.
    No preview · Article · Apr 2010 · Neurochirurgie
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Mar 2010 · Neurochirurgie

  • No preview · Article · Oct 2009

Publication Stats

477 Citations
77.93 Total Impact Points

Institutions

  • 2007-2015
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 2002-2014
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
  • 1994-2014
    • University of Bordeaux
      Burdeos, Aquitaine, France
  • 2009
    • Centre Hospitalier de la Côte Basque
      Bayona, Aquitaine, France