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1.
Neurochirurgie ; 68(1): 117-122, 2022 Jan.
Article in English | MEDLINE | ID: mdl-33667532

ABSTRACT

Cerebral venous sinus thrombosis (CVST) following brain surgery is a feared complication, commonly described after direct injury to the sinus. However, distant CVST occurring away from the operative area are unexpected. Yet, there is a strong physio-pathological rational supporting the role of intracranial hypotension as a risk factor of CVST. Here, we report the case of a frontal arachnoid cyst depletion followed by an extensive contralateral CVST. Given the major prognostic consequences observed in this clinical illustration, we further investigated the hypothesis of intracranial hypotension as an etiology of CVST by carrying out a systematic review of the literature.


Subject(s)
Intracranial Hypotension , Sinus Thrombosis, Intracranial , Humans , Intracranial Hypotension/diagnosis , Intracranial Hypotension/etiology , Sinus Thrombosis, Intracranial/diagnostic imaging , Sinus Thrombosis, Intracranial/etiology
2.
Neurochirurgie ; 67(4): 301-309, 2021 Jul.
Article in English | MEDLINE | ID: mdl-33667533

ABSTRACT

BACKGROUND: Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE: To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS: Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION: Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.


Subject(s)
Craniotomy/standards , Durapatite/standards , Plastic Surgery Procedures/methods , Prostheses and Implants/standards , Prosthesis Implantation/standards , Skull/surgery , Adult , Autografts/transplantation , Craniotomy/adverse effects , Craniotomy/methods , Durapatite/administration & dosage , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Prostheses and Implants/adverse effects , Prosthesis Implantation/adverse effects , Plastic Surgery Procedures/adverse effects , Reproducibility of Results
3.
Eur Spine J ; 30(6): 1574-1584, 2021 06.
Article in English | MEDLINE | ID: mdl-33635376

ABSTRACT

BACKGROUND: C1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population. METHODS: A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. RESULTS: A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. CONCLUSIONS: C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.


Subject(s)
Pseudarthrosis , Spinal Fractures , Spinal Fusion , Adult , Aged , Aged, 80 and over , Cervical Vertebrae/injuries , Female , Fracture Healing , Humans , Male , Middle Aged , Neck , Prospective Studies , Spinal Fractures/surgery , Treatment Outcome
4.
Neurochirurgie ; 66(4): 212-218, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32623059

ABSTRACT

OBJECTIVE: The medical world is continuously evolving, with techniques being created or improved almost daily. Immersive virtual reality (VR) is a technology that could be harnessed to develop tools that meet the educational challenges of this changing environment. We previously described the immersive tutorial, a 3D video (filmed from the first-person point of view), displayed on a VR application. This tool offers access to supplementary educational data in addition to the video. Here we attempt to assess improvement in learning a technique using this new educational format. MATERIAL AND METHODS: We selected a single neurosurgical technique for the study: external ventricular drainage. We wrote a technical note describing this procedure and produced the corresponding immersive tutorial. We conducted a prospective randomized comparative study with students. All participants read the technical note, and one group used the immersive tutorial as a teaching supplement. The students completed a multiple-choice questionnaire immediately after the training and again at six months. RESULTS: One hundred seventy-six fourth-year medical students participated in the study; 173 were included in assessing the immediate learning outcomes and 72 were included at the six-month follow-up. The VR group demonstrated significantly better short-term results than the control group (P=0.01). The same trend was seen at six months. CONCLUSION: To our knowledge, this study presents one of the largest cohorts for VR. The use of the immersive tutorial could enable a large number of healthcare professionals to be trained without the need for expensive equipment.


Subject(s)
Neurosurgery/education , Virtual Reality , Adult , Cerebral Ventricles , Clinical Competence , Drainage/methods , Educational Measurement , Female , Humans , Male , Problem-Based Learning , Prospective Studies , Simulation Training , Students, Medical , Surveys and Questionnaires , Video Recording
5.
Neurochirurgie ; 63(1): 1-5, 2017 Mar.
Article in English | MEDLINE | ID: mdl-28233530

ABSTRACT

OBJECTIVE: To improve surgical practice, there are several different approaches to simulation. Due to wearable technologies, recording 3D movies is now easy. The development of a virtual reality headset allows imagining a different way of watching these videos: using dedicated software to increase interactivity in a 3D immersive experience. The objective was to record 3D movies via a main surgeon's perspective, to watch files using virtual reality headsets and to validate pedagogic interest. MATERIAL AND METHODS: Surgical procedures were recorded using a system combining two side-by-side cameras placed on a helmet. We added two LEDs just below the cameras to enhance luminosity. Two files were obtained in mp4 format and edited using dedicated software to create 3D movies. Files obtained were then played using a virtual reality headset. Surgeons who tried the immersive experience completed a questionnaire to evaluate the interest of this procedure for surgical learning. RESULTS: Twenty surgical procedures were recorded. The movies capture a scene which is extended 180° horizontally and 90° vertically. The immersive experience created by the device conveys a genuine feeling of being in the operating room and seeing the procedure first-hand through the eyes of the main surgeon. All surgeons indicated that they believe in pedagogical interest of this method. CONCLUSIONS: We succeeded in recording the main surgeon's point of view in 3D and watch it on a virtual reality headset. This new approach enhances the understanding of surgery; most of the surgeons appreciated its pedagogic value. This method could be an effective learning tool in the future.


Subject(s)
Computer Simulation , Imaging, Three-Dimensional , Surgery, Computer-Assisted , User-Computer Interface , Humans , Imaging, Three-Dimensional/instrumentation , Imaging, Three-Dimensional/methods , Operating Rooms/methods , Software , Surgery, Computer-Assisted/methods
6.
Orthop Traumatol Surg Res ; 101(7): 845-9, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26526092

ABSTRACT

OBJECT: Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. METHODS: This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). RESULTS: One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. CONCLUSION: Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method.


Subject(s)
Hospital Information Systems/statistics & numerical data , Infection Control/methods , Orthopedic Procedures , Spine/surgery , Surgical Wound Infection/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Cohort Studies , Data Collection , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Young Adult
7.
Orthop Traumatol Surg Res ; 101(1): 5-10, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25583235

ABSTRACT

BACKGROUND: In France, attempts to define common ground during spine surgery meetings have revealed significant variability in clinical practices across different schools of surgery and the two specialities involved in spine surgery, namely, neurosurgery and orthopaedic surgery. OBJECTIVES: To objectively characterise this variability by performing a survey based on a fictitious spine trauma case. Our working hypothesis was that significant variability existed in trauma practices and that this variability was related to a lack of strong scientific evidence in spine trauma care. METHODS: We performed a cross-sectional survey based on a clinical vignette describing a 31-year-old male with an L1 burst fracture and neurologic symptoms (numbness). Surgeons received the vignette and a 14-item questionnaire on the management of this patient. For each question, surgeons had to choose among five possible answers. Differences in answers across surgeons were assessed using the Index of Qualitative Variability (IQV), in which 0 indicates no variability and 1 maximal variability. Surgeons also received a questionnaire about their demographics and surgical experience. RESULTS: Of 405 invited spine surgeons, 200 responded to the survey. Five questions had an IQV greater than 0.9, seven an IQV between 0.5 and 0.9, and two an IQV lower than 0.5. Variability was greatest about the need for MRI (IQV=0.93), degree of urgency (IQV=0.93), need for fusion (IQV=0.92), need for post-operative bracing (IQV=0.91), and routine removal of instrumentation (IQV=0.94). Variability was lowest for questions about the need for surgery (IQV=0.42) and use of the posterior approach (IQV=0.36). Answers were influenced by surgeon specialty, age, experience level, and type of centre. CONCLUSION: Clinical practice regarding spine trauma varies widely in France. Little published evidence is available on which to base recommendations that would diminish this variability.


Subject(s)
Attitude of Health Personnel , Decision Making , Practice Patterns, Physicians'/statistics & numerical data , Spinal Fractures/surgery , Surgeons , Adult , Age Factors , Aged , Clinical Competence , Cross-Sectional Studies , Female , France , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Professional Practice Location , Specialties, Surgical , Spinal Fusion , Surveys and Questionnaires
8.
Orthop Traumatol Surg Res ; 101(1): 11-5, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25596983

ABSTRACT

INTRODUCTION: Recent epidemiological data for spinal trauma in France are sparse. However, increased knowledge of sagittal balance and the development of minimally invasive techniques have greatly improved surgical management. OBJECTIVES: To describe the epidemiology and management of traumatic vertebral fracture, and to analyze evolution and risk factors for poor functional outcome at 1 year's follow-up. MATERIALS AND METHODS: A prospective multicenter French cohort study was performed over a 6-month period in 2011, including all cases of vertebral fracture surgery. Data were collected by online questionnaire over the Internet. Demographic characteristics, lesion type and surgical procedures were collected. Clinical, functional and radiological assessment was carried out at 1 year. RESULTS: Five hundred and eighteen patients, with a mean age of 47 years, were included. Sixty-seven percent of fractures involved the thoracic or lumbar segment. Thirty percent of patients had multiple fractures and 28% neurological impairment. A minimally invasive technique was performed in 20% of cases and neurological decompression in 25%. Dural tear was observed in 42 patients (8%). Seventy percent of patients were followed up at 1 year. Functionally, SF-36 scores decreased on all dimensions, significantly associated with age, persistent neurological deficit and previous spine imbalance. Thirty-eight percent of working patients had returned to work. Radiologically, sagittal balance was good in 74% of cases, with fracture consolidation in 70%. DISCUSSION: Despite progress in management, spinal trauma was still a source of significant morbidity in 2011, with pronounced decrease in quality of life. Conserved sagittal balance appeared to be associated with better functional outcome.


Subject(s)
Quality of Life , Spinal Fractures/epidemiology , Spinal Fractures/surgery , Age Factors , Decompression, Surgical , Disability Evaluation , Female , Follow-Up Studies , France/epidemiology , Humans , Male , Middle Aged , Orthopedic Procedures/statistics & numerical data , Prospective Studies , Radiography , Return to Work/statistics & numerical data , Spinal Fractures/diagnostic imaging
9.
Orthop Traumatol Surg Res ; 100(5): 475-80, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25106100

ABSTRACT

PURPOSE: The morphological and biomechanical features of the thoracic spine, together with its close proximity to the spinal cord, set it apart from other spinal segments. Management of thoracic spine injuries consists of achieving a reduction and an immediate and long-lasting stabilization of the spine while constantly protecting the central and peripheral nervous system. The aim of this study was to determine the best treatment for surgical thoracic spine fractures. MATERIALS AND METHODS: We studied the baseline characteristics of 68 patients admitted to our neurosurgical department for one or several thoracic spine fractures between 2008 and 2010. We analysed on this group of patient the surgical management, complications and functional outcomes. We detailed the 2-years radiological outcome on 50 patients (23 months mean follow-up). RESULTS: The majority of patients underwent an extensive posterior arthrodesis bridging, on average, 5.3 vertebrae. The median time between diagnosis and surgery was 2 days and the median length of stay in hospital was 13.5 days. About 94% of hooks and 80% of pedicle screws were considered stable. Mean values of reduction and correction loss were similar (about 4.5°). We concluded to the superiority of extensive procedures and of pedicle screws fixation for the reduction and the maintenance of the correction by the end of follow-up. Functional data indicated daily discomfort and moderate pain. CONCLUSION: A prospective study comparing the different procedures and instrumentations is needed to better define guidelines for the management of thoracic spine injuries. LEVEL OF EVIDENCE: Level IV.


Subject(s)
Fracture Fixation, Internal/instrumentation , Spinal Fractures/surgery , Spinal Fusion , Thoracic Vertebrae/surgery , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Kyphosis/etiology , Kyphosis/surgery , Length of Stay/statistics & numerical data , Male , Middle Aged , Patient Outcome Assessment , Pedicle Screws , Postoperative Complications , Reoperation/statistics & numerical data , Retrospective Studies , Thoracic Vertebrae/injuries , Time-to-Treatment , Young Adult
10.
Orthop Traumatol Surg Res ; 100(6 Suppl): S305-9, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25129704

ABSTRACT

INTRODUCTION: Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. OBJECTIVE: To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. MATERIAL AND METHOD: A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years' follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. RESULTS: Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16-73 years). Mean follow-up was 14.5 years (12-18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI (P=0.02). DISCUSSION: Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. LEVEL OF EVIDENCE: IV - Multicenter retrospective study.


Subject(s)
Brachial Plexus Neuritis/epidemiology , Cervical Vertebrae/surgery , Diskectomy/adverse effects , Intervertebral Disc Degeneration/epidemiology , Intervertebral Disc/surgery , Spinal Fusion/adverse effects , Adolescent , Adult , Aged , Cervical Vertebrae/diagnostic imaging , Diskectomy/methods , Female , Follow-Up Studies , Humans , Incidence , Intervertebral Disc/diagnostic imaging , Longitudinal Studies , Male , Middle Aged , Radiography , Reoperation , Retrospective Studies , Risk Factors , Spinal Fusion/methods , Surveys and Questionnaires , Time Factors , Treatment Outcome , Young Adult
11.
Neurochirurgie ; 59(4-5): 187-90, 2013.
Article in English | MEDLINE | ID: mdl-24367799

ABSTRACT

Glomus tumors are rare benign neoplasms usually arising from soft tissues. Surgical removal seems to be the best treatment. Here, we report the case of a 52-year-old female patient referred for chronicback pain, revealing a thoracic paravertebral tumor with no osseous extension. After surgical removal,this tumor turned out to be a glomangioma. Differential diagnosis with other more frequent tumors,such as schwannoma, is particularly difficult. A review of the relevant literature will be presented. A better knowledge of the natural history of those tumors, as well as the therapeutic options available, are necessary for spinal surgeons who may encounter such presentations.


Subject(s)
Diagnosis, Differential , Glomus Tumor/diagnosis , Glomus Tumor/surgery , Neurilemmoma/diagnosis , Spinal Neoplasms/surgery , Female , Glomus Tumor/pathology , Humans , Middle Aged , Neurilemmoma/pathology , Spinal Neoplasms/diagnosis , Treatment Outcome
12.
Orthop Traumatol Surg Res ; 99(8): 983-6, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24210294

ABSTRACT

As spinal surgery in elderly patients is becoming increasingly frequent, comorbidities likely to be decompensated after such procedures must be kept in mind. We report here the case of an 82-year-old woman who presented rapidly progressive spinal cord compression following lumbar surgery for radiculopathy. Investigations showed a thoracic intradural extramedullary compressive lesion, which after removal turned out to be a meningioma. We suggest that radiculopathy and non-specific degenerative modifications partially masked this lesion, and that lumbar surgery caused this acute neurological deterioration. Therefore, we advice caution in older patients among whom such ambiguous clinical presentation is frequent.


Subject(s)
Meningeal Neoplasms/complications , Meningioma/complications , Spinal Cord Compression/etiology , Spinal Cord Neoplasms/complications , Aged, 80 and over , Diskectomy , Female , Humans , Magnetic Resonance Imaging , Meningeal Neoplasms/diagnosis , Meningioma/diagnosis , Osteoarthritis, Spine/diagnostic imaging , Spinal Cord Neoplasms/diagnosis , Thoracic Vertebrae , Tomography, X-Ray Computed
13.
Orthop Traumatol Surg Res ; 99(5): 607-13, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23911134

ABSTRACT

INTRODUCTION: Ninety percent of the lesions resulting from diving injuries affect the cervical spine and are potentially associated with spinal cord injuries. The objective is to determine the most frequent lesion mechanisms. Evaluate the therapeutic alternatives and the biomechanical evolution (kyphotic deformation) of diving-induced cervical spine injuries. Define epidemiological characteristics of diving injuries. MATERIALS AND METHODS: A retrospective analysis over a period of 10 years was undertaken for patients admitted to the Department of Neurosurgery of Montpellier, France, with cervical spinal injuries due to a diving accident. Patients were re-evaluated and clinical and radiological evaluation follow-ups were done. RESULTS: This study included 64 patients. Cervical spine injuries resulting from diving predominantly affect young male subjects. They represent 9.5% of all the cervical spine injuries. In 22% of cases, patients presented severe neurological troubles (ASIA A, B, C) at the time of admission. A surgical treatment was done in 85% of cases, mostly using an anterior cervical approach. DISCUSSION: This is a retrospective study (type IV) with some limitations. The incidence of diving injuries in our region is one of the highest as compared to reports in the literature. Despite an increase of our surgical indications, 55% of these cases end up with a residual kyphotic deformation but there is no relationship between the severity of late vertebral deformity and high Neck Pain and Disability Scale (NPDS) scores. LEVEL OF EVIDENCE: Level IV, retrospective study.


Subject(s)
Cervical Vertebrae/injuries , Diving/injuries , Fracture Fixation/methods , Spinal Fractures/epidemiology , Spinal Fractures/surgery , Adolescent , Adult , Age Factors , Bone Transplantation/methods , Cohort Studies , Decompression, Surgical/methods , Female , Follow-Up Studies , Fracture Fixation/adverse effects , Fracture Healing/physiology , France , Humans , Injury Severity Score , Magnetic Resonance Imaging/methods , Male , Pain, Postoperative/physiopathology , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Retrospective Studies , Risk Assessment , Spinal Fractures/diagnosis , Spinal Fusion/methods , Spinal Injuries/etiology , Spinal Injuries/physiopathology , Spinal Injuries/surgery , Time Factors , Treatment Outcome , Young Adult
14.
Neurochirurgie ; 59(1): 30-4, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23395186

ABSTRACT

BACKGROUND AND PURPOSE: To evaluate the incidence, clinical presentation, operative techniques and long-term outcome of spinal meningiomas following surgery. METHODS: Fifteen patients harboring spinal meningiomas were treated between 1998 and 2005 in our department. Diagnosis was made on magnetic resonance imaging and confirmed histologically. Microsurgical resection was carried out through a posterior approach in all cases. RESULTS: Follow-up extended from 60 to 156 months (mean: 99 and median 105 months). The most common site of spinal meningiomas was the thoracic region. Tumors were strictly intradural and extramedullary in 14 patients (93%) and macroscopic resection was considered as complete in all cases. Neurological improvement was observed in 13 patients (87%). There was no operative mortality and morbidity was low (20%). No patient underwent radiotherapy and the recurrence rate is 8%. CONCLUSION: Spinal meningiomas are benign tumors for which advances in imaging tools and microsurgical techniques have yielded better results. The goal of surgery should be the total resection, which significantly reduces the risk of recurrence with an acceptable morbidity.


Subject(s)
Fecal Incontinence/etiology , Gait Disorders, Neurologic/etiology , Meningeal Neoplasms/surgery , Meningioma/surgery , Paraparesis/etiology , Postoperative Complications/etiology , Spinal Cord Neoplasms/surgery , Urinary Incontinence/etiology , Aged , Aged, 80 and over , Back Pain/epidemiology , Back Pain/etiology , Fecal Incontinence/epidemiology , Female , Follow-Up Studies , Gait Disorders, Neurologic/epidemiology , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/complications , Meningioma/complications , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Paraparesis/epidemiology , Postoperative Complications/epidemiology , Prognosis , Recovery of Function , Retrospective Studies , Sensation Disorders/epidemiology , Sensation Disorders/etiology , Spinal Cord Neoplasms/complications , Treatment Outcome , Urinary Incontinence/epidemiology
15.
Neurochirurgie ; 58(5): 293-9, 2012 Oct.
Article in French | MEDLINE | ID: mdl-22959585

ABSTRACT

OBJECTIVE: Specify the epidemiological data on the acute spinal cord injuries and define a group of patients that could benefit from cellular transplantation therapy designed with the aim of repair and regeneration of damaged spinal cord tissues. MATERIAL AND METHODS: Five years monocentric (Gui-de-Chauliac Hospital, Montpellier, France) retrospective analysis of patients suffering from spinal cord injury (SCI). Spinal cord injured-patients, defined as sensory-motor complete, underwent a clinical evaluation following American Spinal Injury Association (ASIA) and functional type 2 Spinal Cord Independence Measure (SCIM2) scorings as well as radiological evaluation through spinal cord magnetic resonance imaging (MRI). RESULTS: One hundred and fifty-seven medical records were reviewed and we selected and re-examined 20 patients with complete thoracic spinal cord lesion. Clinical and radiological evaluations of these patients demonstrated, in 75 % of the cases, an absence of clinical progression after a mean of 49months. Radiological abnormalities were constantly present in the initial (at the admission to hospital) and control (re-evaluation) MRI and no reliable predictive criteria of prognosis had been found. DISCUSSION/CONCLUSION: We compare our results to the literature and discuss advantages and limits of cellular transplantation strategies for these patients.


Subject(s)
Spinal Cord Injuries/diagnostic imaging , Spinal Cord Injuries/epidemiology , Acute Disease , Cell Transplantation , Humans , Magnetic Resonance Imaging , Prognosis , Radiography , Recovery of Function/physiology , Retrospective Studies , Spinal Cord Injuries/therapy , Treatment Outcome
16.
Neurochirurgie ; 58(6): 364-8, 2012 Dec.
Article in French | MEDLINE | ID: mdl-22683208

ABSTRACT

Odontoid fractures have been classified by Anderson and D'Alonzo into three main categories. The most unstable injuries, type II fractures involve the base of the odontoid peg at the junction with the C2 body. Due to the proximity of vital neural structures, fracture of the odontoid process may result in instability and fatal neurological damage. Treatment aims to re-establish stability of the atlanto-axial complex by restoring the odontoid process. This may be achieved by conservative or surgical treatment. Anterior screw fixation of the odontoid peg is an interresting alternative surgical option but this technique has a significant complication rate. However, vascular injury is very rare with three case reported in the literature: one case of an intracranial vertebral artery (VA) injury, one case of a cervical internal carotid artery (ICA) injury and one case of anterior pseudoaneurysm of the spinal artery branch. We report a new case of long term vascular injury after screw fixation revealed by a subarachnoid hemorrhage. We discuss the incidence, the mechanisms of injury and the conditions necessary for the occurrence of this complication.


Subject(s)
Bone Screws/adverse effects , Fracture Fixation, Internal/instrumentation , Odontoid Process/injuries , Postoperative Complications/etiology , Spinal Fractures/surgery , Subarachnoid Hemorrhage, Traumatic/etiology , Accidents, Traffic , Chronic Disease , Device Removal , Disease Management , Fractures, Closed/surgery , Fractures, Ununited/surgery , Headache/etiology , Humans , Male , Middle Aged , Odontoid Process/surgery , Postoperative Complications/surgery , Subarachnoid Hemorrhage, Traumatic/surgery , Vertebral Artery/injuries
17.
Cell Death Dis ; 2: e218, 2011 Oct 13.
Article in English | MEDLINE | ID: mdl-21993394

ABSTRACT

Serotonergic innervation of the spinal cord in mammals has multiple roles in the control of motor, sensory and visceral functions. In rats, functional consequences of spinal cord injury at thoracic level can be improved by a substitutive transplantation of serotonin (5-HT) neurons or regeneration under the trophic influence of grafted stem cells. Translation to either pharmacological and/or cellular therapies in humans requires the mapping of the spinal cord 5-HT innervation and its receptors to determine their involvement in specific functions. Here, we have performed a preliminary mapping of serotonergic processes and serotonin-lA (5-HT(1A)) receptors in thoracic and lumbar segments of the human spinal cord. As in rodents and non-human primates, 5-HT profiles in human spinal cord are present in the ventral horn, surrounding motoneurons, and also contact their presumptive dendrites at lumbar level. 5-HT(1A) receptors are present in the same area, but are more densely expressed at lumbar level. 5-HT profiles are also present in the intermediolateral region, where 5-HT(1A) receptors are absent. Finally, we observed numerous serotonergic profiles in the superficial part (equivalent of Rexed lamina II) of the dorsal horn, which also displayed high levels of 5-HT(1A) receptors. These findings pave the way for local specific therapies involving cellular and/or pharmacological tools targeting the serotonergic system.


Subject(s)
Receptor, Serotonin, 5-HT1A/metabolism , Serotonergic Neurons/cytology , Spinal Cord/anatomy & histology , Adolescent , Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Rats , Serotonergic Neurons/metabolism , Spinal Cord/metabolism , Young Adult
18.
J Biomech ; 44(15): 2685-91, 2011 Oct 13.
Article in English | MEDLINE | ID: mdl-21924427

ABSTRACT

BACKGROUND AND PURPOSE: Individual rupture risk assessment of intracranial aneurysms is a major issue in the clinical management of asymptomatic aneurysms. Aneurysm rupture occurs when wall tension exceeds the strength limit of the wall tissue. At present, aneurysmal wall mechanics are poorly understood and thus, risk assessment involving mechanical properties is inexistent. Aneurysm computational hemodynamics studies make the assumption of rigid walls, an arguable simplification. We therefore aim to assess mechanical properties of ruptured and unruptured intracranial aneurysms in order to provide the foundation for future patient-specific aneurysmal risk assessment. This work also challenges some of the currently held hypotheses in computational flow hemodynamics research. METHODS: A specific conservation protocol was applied to aneurysmal tissues following clipping and resection in order to preserve their mechanical properties. Sixteen intracranial aneurysms (11 female, 5 male) underwent mechanical uniaxial stress tests under physiological conditions, temperature, and saline isotonic solution. These represented 11 unruptured and 5 ruptured aneurysms. Stress/strain curves were then obtained for each sample, and a fitting algorithm was applied following a 3-parameter (C(10), C(01), C(11)) Mooney-Rivlin hyperelastic model. Each aneurysm was classified according to its biomechanical properties and (un)rupture status. RESULTS: Tissue testing demonstrated three main tissue classes: Soft, Rigid, and Intermediate. All unruptured aneurysms presented a more Rigid tissue than ruptured or pre-ruptured aneurysms within each gender subgroup. Wall thickness was not correlated to aneurysmal status (ruptured/unruptured). An Intermediate subgroup of unruptured aneurysms with softer tissue characteristic was identified and correlated with multiple documented risk factors of rupture. CONCLUSION: There is a significant modification in biomechanical properties between ruptured aneurysm, presenting a soft tissue and unruptured aneurysms, presenting a rigid material. This finding strongly supports the idea that a biomechanical risk factor based assessment should be utilized in the to improve the therapeutic decision making.


Subject(s)
Aneurysm, Ruptured , Hemodynamics , Intracranial Aneurysm , Models, Cardiovascular , Stress, Physiological , Aneurysm, Ruptured/pathology , Aneurysm, Ruptured/physiopathology , Aneurysm, Ruptured/surgery , Female , Humans , Intracranial Aneurysm/pathology , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/surgery , Male , Risk Assessment
19.
Spinal Cord ; 49(3): 472-9, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20838405

ABSTRACT

STUDY DESIGN: Cell transplantation strategies are gaining increasing interest for spinal cord injury (SCI) with the objective of promoting spinal cord repair. To avoid allogenic graft rejection, an adequate immune suppression is required, and one of the most potent and commonly used immunosuppressives is cyclosporin A (CsA). In SCI, permanent sensory motor loss is combined with modifications of drug absorption, distribution and elimination. OBJECTIVES: The objectives of this study were to thoroughly explore histological and functional outcomes of CsA treatment in a rat model of spinal cord compression. SETTING: Experiments were carried out at the Institute for Neurosciences of Montpellier (France), the Integrative Biology of Neurodegeneration Laboratory (Spain) and in the Novartis Institutes for BioMedical Research (Switzerland) for CsA blood concentration determination. METHODS: We first evaluated histological outcomes of CsA treatment on kidneys and spinal cord after SCI. We then investigated whether SCI modified CsA blood concentration. Finally, using behavioral analysis, we assessed the potential CsA impact on functional recovery. RESULTS: When spinal-cord-injured rats were treated with a CsA dose of 10 mg kg(-1) per day, we observed deleterious effects on kidneys, associated with modifications of CsA blood concentration. Adding an antibiotic treatment reduced kidney alteration without modifying CsA blood concentration. Finally, we showed that CsA treatment per se modified neither functional recovery nor lesion extension. CONCLUSION: This study pinpoints the absolute requirement of careful CsA monitoring in the clinical setting for patients with SCI to minimize potential unexpected effects and avoid therapeutic failure.


Subject(s)
Cell Transplantation/methods , Cyclosporine/toxicity , Graft Rejection/drug therapy , Kidney Diseases/physiopathology , Spinal Cord Injuries/physiopathology , Animals , Cell Transplantation/adverse effects , Cyclosporine/blood , Cyclosporine/therapeutic use , Disease Models, Animal , Drug Therapy, Combination/methods , Graft Rejection/physiopathology , Graft Rejection/prevention & control , Immunosuppressive Agents/blood , Immunosuppressive Agents/therapeutic use , Immunosuppressive Agents/toxicity , Kidney Diseases/chemically induced , Male , Rats , Rats, Wistar , Spinal Cord Injuries/surgery , Treatment Outcome
20.
Neurochirurgie ; 56(6): 449-54, 2010 Dec.
Article in French | MEDLINE | ID: mdl-20870253

ABSTRACT

Glioblastoma is found preferentially in men (1.5/1), nearing age 60, but all ages can be concerned. Clinical symptoms are intracranial mass without specificity, intracranial hypertension and localization signs. From the clinical history, the essential prognosis factors are: age, Karnofsky score and cognitive dysfunction. Conventional MRI sequences, including T1-FSE with and without contrast injection and T2-FSE or Flair-weighted sequences, provide the diagnosis in most cases, showing an intraparenchymal mass with a heterogeneous, irregularly enhanced signal. Other sequences define the tumor more precisely. Diffusion sequences provide the differential diagnosis with an abscess or a highly cellular tumor such as lymphoma. Perfusion sequences allow appreciation of tumor microvascularization outlining the tumor's most active areas. Magnetic resonance spectroscopy (SRM) sequences allow noninvasive exploration of tumor metabolism. Beyond its diagnostic role, imagery assists the surgical procedure itself, particularly with functional MRI, allowing a precise preoperative mapping of functional cortical areas. Biopsy can also be guided toward the most active areas of the tumor. In the postoperative period, MRI completes the surgeon's impression on whether or not there is residual tumor. Finally, this exam has become essential in follow-up to diagnose recurrence, radionecrosis, or pseudoprogression.


Subject(s)
Brain Neoplasms/diagnosis , Glioblastoma/diagnosis , Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Neuroradiography
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