Hypoglossal-facial anastomosis, tricks and trade

Total removal of difficult tumours at the skull base left behind a traumatized facial nerve previously aggressed by the tumour. Reanimation of the nerve was mandatory in order to recover functional and cosmetic results. Despite an additional XII[th] cranial nerve morbidity, hypoglossal-facial nerve anastomosis was still a gold standard to reach this goal. The authors present their experience in managing 11 cases of facial nerve reanimation after skull base tumour resection by using the descending branch of the hypoglossal nerve as axon donator for direct facial anastomosis. Outcome of facial reanimation according to House-Brackmann classification was good [grade I, II and III] in 5 cases, mild [grade IV] in 3 cases and bad [grade IV and V] in 3 cases. Hemi tongue atrophy occurred in none of our patients. Hypoglossal-facial nerve anastomosis using the descending branch of the XII[th] cranial nerve is an effective procedure to reanimate the facial nerve without additional morbidity. Early reanimation of the facial nerve is the key to offer resumption of normal life for these patients who had already undergone a major neurosurgical procedure

Kyphoplasty: state of the art

During the last decade, technological advances for the treatment of osteoporotic vertebral compression fractures have provided quick pain reduction and prevention of further damage, through repair of kyphotic deformity. This entity is the major cause of additional vertebral deterioration and even in some cases can end in death. The substantial pain relief, reinstatement without inertia stiffness and restoration of kyphotic deformities are the major parameters of a successfiul treatment. Kyphoplasty offers successful treatment of this pathology

rare aetiology of myelopathy: Spinal dural arteriovenous fistula: Report of 6 cases

The authors describe 6 cases of spinal dural arteriovenous fistula [5 males and one female patient, with a mean age of 64 years [range 49 - 77 years]]. Four of the spinal arteriovenous fistulas were located at the thoracic level, one at the lumbar and one at the sacral level. Clinically, symptoms were divided between radiculopathy and myelopathy. Diagnosis was made using magnetic resonance imaging and confirmation attained with angiography, excluding one case which was incidentally found. A fistula between the radicular and the corresponding radicular vein within the dural sheath, at the level of the spinal root foramina, was visually confirmed intraoperatively and clipping of the fistula was done in 3 cases, whereas 3 fistulas were closed by endovascular embolization. All patients totally recovered with no neurological deficit/so Spinal dural arteriovenous fistulas are rare because of myelopathy but sometimes because of radiculopathy. Diagnosis is the key in prevention of irreversible neurological damage. Treatment consists of closure of fistula through clipping or embolization