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Julie Dubourg


Journal articles

Julie Dubourg, Moncef Berhouma, Michael Cotton, Mahmoud Messerer (2012)  Meta-analysis of diagnostic test accuracy in neurosurgical practice.   Neurosurg Focus 33: 1. Jul  
Abstract: Comparative effectiveness research (CER) allows evidence to be evaluated on the effectiveness, benefits, and detriments of management options, diagnostic tests, or ways to deliver health care. This process can be achieved in different ways, such as with well-designed randomized controlled trials or by meta-analyses. Several medical subspecialties are increasingly using CER, but CER remains underused by the neurosurgical community. Meta-analysis is a highly accurate method that permits results from multiple well-designed research studies to be quantitatively compared. Meta-analysis can be performed in many settings, such as the evaluation of treatment or of a diagnostic test or prognostic factor. Meta-analyses of randomized controlled treatment trials are well known, but there is a paucity of papers describing the ways to perform a meta-analysis of a diagnostic test. The aim of this paper is to improve neurosurgeons' familiarity with the meta-analysis of diagnostic test accuracy by describing and detailing each stage leading to publication.
Mahmoud Messerer, Julie Dubourg, Ghislaine Saint-Pierre, Emmanuel Jouanneau, Marc Sindou (2012)  Percutaneous biopsy of lesions in the cavernous sinus region through the foramen ovale: diagnostic accuracy and limits in 50 patients.   J Neurosurg 116: 2. 390-398 Feb  
Abstract: The cavernous sinus and surrounding regions-specifically the Meckel cave, posterior sector of the cavernous sinus itself, and the upper part of the petroclival region-are the location of a large variety of lesions that require individual consideration regarding treatment strategy. These regions may be reached for biopsy by a percutaneous needle inserted through the foramen ovale. The aim of this retrospective study was to evaluate the diagnostic accuracy of percutaneous biopsy in a consecutive series of 50 patients referred for surgery between 1991 and 2010.
Mahmoud Messerer, Julie Dubourg, Sylma Diabira, Thomas Robert, Abderrahmane Hamlat (2012)  Spinal epidural hematoma: not always an obvious diagnosis.   Eur J Emerg Med 19: 1. 2-8 Feb  
Abstract: Spinal epidural hematoma (SEH) is a rare neurosurgical emergency. SEH is characterized by an archetypal clinical presentation including abrupt spinal pain followed more or less rapidly by various degrees of neurological deficit. The diagnosis of SEH, often based on a clinical presumption, represents a clinical challenge. Several reports have outlined missed or delayed diagnosis due to unusual and confusing onsets or unawareness of this diagnosis by physicians. Therefore, physicians should keep in mind the possibility of SEH in their differential diagnosis when confronted with patients complaining of sudden onset of acute spinal pain with or without neurological sign, because the impact of a delayed diagnosis can be disabling catastrophic neurological sequelae. We suggest that SEH is a dynamic disease, which occurs in patients with an abnormal vasculature structural degenerative change. The bleeding is probably of multifactorial origin incriminating veins as well as arteries. Therefore, we proposed a classification of SEH, according to the most probable etiology whatever the associated factors, in six groups: spontaneous, secondary, iatrogenic, traumatic, recurrent, and idiopathic SEH.
Mahmoud Messerer, Juan Carlos De Battista, Gérald Raverot, Sebouh Kassis, Julie Dubourg, Veronique Lapras, Jacqueline Trouillas, Gilles Perrin, Emmanuel Jouanneau (2011)  Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal.   Neurosurg Focus 30: 4. Apr  
Abstract: Because of their size and lateral extension, total removal of nonfunctioning pituitary adenomas (NFPAs) remains a challenge and postoperative tumor remnants are frequent. Endoscopy has improved the surgeon's view; however, its superiority in terms of surgical outcome remains undetermined. The authors' aim in this study was to compare the clinical results and morbidity between microscopic and endoscopic techniques in 164 patients with NFPAs.
Julie Dubourg, Etienne Javouhey, Thomas Geeraerts, Mahmoud Messerer, Behrouz Kassai (2011)  Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis.   Intensive Care Med 37: 7. 1059-1068 Jul  
Abstract: To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter (ONSD) for assessment of intracranial hypertension.
Julie Dubourg, Mahmoud Messerer (2011)  Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction.   Neurosurg Focus 31: 5. Nov  
Abstract: Traumatic brain injury (TBI) is recognized as a cause of hypopituitarism even after mild TBI. Although over the past decade, a growing body of research has detailed neuroendocrine changes induced by TBI, the mechanisms and risk factors responsible for this pituitary dysfunction are still unclear. Around the world, sports-especially combative sports-are very popular. However, sports are not generally considered as a cause of TBI in most epidemiological studies, and the link between sports-related head trauma and hypopituitarism has not been investigated until recently. Thus, there is a paucity of data regarding this important concern. Because of the large number of young sports participants with near-normal life expectancy, the implications of undiagnosed or untreated postconcussion pituitary dysfunction can be dramatic. Understanding the pathophysiological mechanisms and risk factors of hypopituitarism caused by sports injuries is thus an important issue that concerns both medical staff and sponsors of sports. The aim of this paper was to summarize the best evidence for understanding the pathophysiological mechanisms and to discuss the current data and recommendations on sports-related head trauma as a cause of hypopituitarism.
Julie Dubourg, Emmanuel Jouanneau, Mahmoud Messerer (2011)  Pituitary surgery: legacies from the past.   Acta Neurochir (Wien) 153: 12. 2397-2402 Dec  
Abstract: Pituitary surgery is a recent development in neurosurgery and most of the surgical techniques concerned have been described within the last century. We provide a historical perspective by reviewing the major steps in the development of this neurosurgical subspecialty through the ages. We concentrate on the most important figures whose advances in the study of the physiology and anatomy of the pituitary are most significant. This journey into the past will demonstrate that our current knowledge is the summation of a long road of investigation.
Julie Dubourg, Mahmoud Messerer (2011)  State of the art in managing nontraumatic intracerebral hemorrhage.   Neurosurg Focus 30: 6. Jun  
Abstract: Nontraumatic intracerebral hemorrhage constitutes a major public health problem worldwide. Intracerebral hemorrhage leads to a high rate of morbidity and mortality. To date, no medical or surgical trials have clearly attested to the benefit of a particular therapy. The aim of this review was to summarize the best evidence for management decision-making in intracerebral hemorrhage.

Conference papers

E Jouanneau1, M Messerer, G Raverot, J Dubourg, G Perrin, J Trouillas (2011)  Improving the removal of the lateral and suprasellar extensions of Non Functioning Pituitary Adenomas using Endonasal Endoscopic Surgery   EANS Roma, Italia: Acta Neurochirurgica  
Abstract: Background and aims: Total removal of nonfunctioning pituitary adenoma (NFPAs) remains a challenge for neurosurgeons. Endoscopy has improved the surgeon's view. However, its superiority in terms of quality of resection remains unclear. The aim of this study was to compare the clinical results and morbidity between microscopic and endoscopic techniques in 164 patients with NFPAs operated on by the same author. Methods: Tumoral (3D MR imaging), endocrinological, and ophthalmological results and morbidity were compared between 2 groups of 82 patients with newly diagnosed NFPAs surgically treated via either a sublabial microscopic approach (Group B) or a fully endonasal endoscopic technique (Group A). The results were judged at 12 months. Results: Endoscopy significantly improved the quality of resection in group A with greater control of lateral extension (Knosp Grade 2: Gross total removal (GTR) 88% vs 47.8% in group B,p = 0.02;Knosp grade 3: 67.9% vs 16.7% in group B,p < 0.001) and suprasellar extension (tumor height 20-30mm : GTR 76% vs 53% in group B, p=0.01). Endocrinological outcome in patients with a partial deficiency in anterior pituitary function preoperatively was significantly better in Group A (improvement 56% vs 25% in Group B, stabilization 22% vs 46%, and aggravation 22% vs 29%;p = 0.01). No significant difference was found regarding morbidity. Conclusions: In this series of 164 NFPAs, endoscopy significantly improved the quality of resection and endocrinological outcome, especially regarding tumors with lateral and suprasellar extension. We recommend that endoscopy should be considered as the choice technique for NFPAs removal.
M Messerer, J Dubourg, G Raverot, J Trouillas, M Berhouma, E Jouanneau (2011)  RESULTS OF PURE ENDONASAL ENDOSCOPIC TRANSSPHENOIDAL SURGERY (PEETS) FOR PITUITARY ADENOMAS INVADING THE CAVERNOUS SINUS   Edited by:Acta Neurochirurgica. EANS, Roma, Italia  
Abstract: Background and aims: Endoscopy, improving the lateral vision, may allow a better resection of the lateral part of pituitary adenomas (PA). The aim of this study was to evaluate the quality of resection of PA, suspected of invading the cavernous sinus, operated on by PEETS. Methods: Tumoral (3D MRI), endocrinological, ophthalmological results and morbidity were retrospectively analyzed in a series of 112 patients bearing PA invading the cavernous sinus (grade II, III or IV of the Knosp's classification) and operated on between 2007 and 2010. For all, authors tried to remove as much as feasible the lateral extension of tumors remaining nevertheless medial with regard to the internal carotid. The quality of resection to the Knosp's grading was judged on MRI for Non Functioning Pituitary Adenomas (NFPA) and on endocrinological criteria of cure for Functioning Pituitary Adenomas (FPA). Results: They were 76 NFPA (grade II:25;III:42;IV:9) and 36 FPA including 26 somatotropic adenomas (II:14;III:11;IV:1), 6 prolactinomas (II:4;III:2) and 4 corticotropic adenomas (II:1;III:2;IV:1). Gross total removal (GTR) or cure was achieved in 69.7% of NFPA (II:88%;III:73.8%;IV:0%;p< 0.001), 57.7% of somatotropic adenomas (II:78.6%;III:36.4%;IV:0%;p=0.04), 33.3% of prolactinomas (II:50%;III:0%;p>0.05) and 50% of corticotropic adenomas (II:100%;III/IV:0%;p>0;05). No difference was observed regarding ophthalmological and endocrinological results as well as regarding morbidity according to the grade. Conclusions: Due to a better visualization, the removal of the cavernous sinus extension can be attempt with endoscopy without additional morbidity. This allows a GTR or cure in 73.8% and 36.4% of grade III NFPA and somatotrophic adenomas respectively.
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