Resolution of traumatic hypertrophic periodontoid cicatrix after posterior cervical fusion: case report.

The case of a 38-year-old man with delayed myelopathy 19 years after a nontreated odontoid type II fracture is reported. Magnetic resonance imaging of the craniocervical region revealed a periodontoid cicatrix. The clinical syndrome improved, and complete resolution of the retro-odontoid mass was achieved 9 months after posterior cervical fixation. The implications of this unique case for the management of myelopathy associated with nonunion of odontoid fractures are discussed.

Surgical treatment for cervical spondylitic myelopathy.

The long-term outcome of cervical spondylitic myelopathy after surgical treatment was retrospectively reviewed and critically evaluated in 100 patients with documented cervical myelopathy treated between 1978 and 1988 at our institution. Eighty-four patients were available for long-term study. The median duration of follow up was 7.35 years (range 3 to 9.5 years). There were 67 men and 17 women; their ages ranged from 27 to 86 years. The duration of preoperative symptoms ranged from 1 month to 10 years. Preoperative functional grade as evaluated with the Nurick Scale for the group was 2.1. Thirty-three patients with primarily anterior cord compression, one- or two-level disease, or a kyphotic neck deformity were treated by anterior decompression and fusion. Fifty-one patients with primarily posterior or cord compression and multiple-level disease were treated by posterior laminectomy. There was no difference in the preoperative functional grade in these two groups. The patients in the posterior treatment group were older (59 vs 55 years). There was no surgical mortality from the operative procedures; morbidity was 3.6%. Of the 33 patients undergoing anterior decompression and fusion, 24 showed immediate functional improvement and nine were unchanged. Of the 51 patients who underwent posterior laminectomy, 35 demonstrated improvement, 11 were unchanged, and five were worse. Six patients, one in the anterior group and five in the posterior group, demonstrated early deterioration. Late deterioration occurred from 2 to 68 months postoperatively. Four (12%) patients who had undergone anterior procedures had additional posterior procedures, and seven (13.7%) patients who had undergone posterior procedures had additional decompressive surgery. The final functional status at last follow-up examination for the 33 patients in the anterior group was improved in 18, unchanged in nine, and deteriorated in six. Of the 51 patients who underwent posterior decompression, 19 benefited from the surgery, 13 were unchanged, and 19 were worse at last follow up than before their initial surgical procedure. Age, severity of disease, number of levels operated, and preoperative grade were not predictive of outcome. The only factor related to potential deterioration was the duration of symptoms preoperatively. The results indicate that with anterior or posterior decompression, long-term outcome is variable, and a subgroup of patients, even after adequate decompression and initial improvement, will have late functional deterioration.

The neurogenic origin of hypertension in SHR may be mediated by angiotensin II through a receptor different from AT1 and AT2.

In spontaneously hypertensive rats (SHR) 15-18 weeks old, the intracerebroventricular (icv) administration of peptide angiotensin II (Ang) antagonists results in a short (30-60 min) decrease (15-25 mmHg) of blood pressure (BP). Both EXP-3174, a known metabolite of Losartan and AT1 selective, and PD-123177, a receptor AT2 specific compound, do not affect SHR BP following icv administration. The receptor AT1 selective non-peptide Ang antagonists, Losartan and L-158809, induce long-lived (days) significant BP reductions (< or = 40 mmHg) in SHR, but only 18 h after icv injection. The slow development of BP reduction and its persistence might be due to the formation of an active metabolite, different from EXP-3174, a Losartan metabolite. In older SHR (25-28 weeks), the hypotensive effect of Losartan and L-158809 is not significant. These results suggest that in the CNS of the young SHR, an active Renin-Ang-System is implicated in the establishment of the hypertensive state, and that the receptor for this function is different from AT1 and AT2, since it has a selectivity profile different from AT1 and AT2 receptor types.

[Surgical treatment of arteriovenous malformations in eloquent zones of the brain. Apropos of eleven cases]. / Traitement chirurgical des malformations artério-veineuses en zones "éloquentes" du cerveau. A propos de onze cas.

The site of a cerebral arteriovenous malformation, particularly in an eloquent area of the brain, is a significant factor that may influence the therapeutic approach. In these cases, surgery is often viewed as a contraindication. We report our experience of eleven consecutive cases of cerebral arterio-venous malformation in an eloquent area of the brain treated surgically. The resection was complete as confirmed by post-operative angiogram in ten patients. There were no post-operative mortality. One patient had a mild neurological deterioration and all patients have resumed their normal activities. The technical aspects which allowed these results are discussed.