Endoscopic endonasal surgery complication: new methods of intracavernous internal carotid artery injury treatment.

OBJECTIVES: To present new interventional neuroradiology methods of management of an ICA injury during functional endoscopic sinus surgery (FESS). CASE: The authors report the case of a patient who presented an ICA injury during a FESS and who could undergo an embolization. This embolization stopped the epistaxis and saved the patient from a lethal issue without any aftereffect. DISCUSSION: After a review of the literature the authors describe the circumstances of occurrence, the urgent management and the modern treatment of an ICA injury. Along with the progress in neuroradiology, the embolization represents a top grade treatment of this complication. Embolization with stent keeps permeable the ICA axis which represents a major progress in the management. CONCLUSION: The success of the management of an ICA injury relies on the close collaboration between anesthesist, otorhinolaryngologist surgeon and interventional neuroradiologist. Since 2004, modern techniques of interventional neuroradiology using new stents allow to keep permeable the ICA axis.

[Preoperative mixed embolization of a paraganglioma using Onyx]. / Embolisation préopératoire par abord mixte d'un paragangliome à l'aide d'Onyx.

Paragangliomas, or glomus tumors, are highly vascular benign tumors of the head and neck. Clinical symptoms are essentially progressive and neurological, involving infiltration of the regional cranial nerves. The usual treatment is surgery, which itself is a challenge because of the close proximity of vital structures and the considerable blood loss. Preoperative embolization can reduce morbidity, and several techniques have been described using arterial injection of particles or of cyanoacrylate directly into the tumor. This case report is of a patient treated by surgery using a new technique-preoperative embolization involving both the arteries and veins, and injection of Onyx, resulting in complete devascularization of the tumor's arteriovenous network.

[Neuroradiological investigations in mild brain injuries: state of the art and practical recommendations]. / La neuro-imagerie après traumatisme crânien léger: mise au point et recommandations pratiques.

OBJECTIVES: To clarify the contribution of each technique of neuroradiological and nuclear medicine investigations after mild brain injuries. To analyze the pathophysiological mechanisms of the lesions. To update indications for imaging techniques in the short or long term management. To define the practical recommendations. METHOD: The international databases were consulted for each neuroradiological technique; the most valuable articles were retained for study (PubMed, ). RESULTS AND DISCUSSION: Standard skull X-rays are obsolete. Craniofacial (bony windows) and brain CT-scan (parenchymal windows) is the most efficient diagnosis tool in the acute phase because of its accessibility. Brain MRI is less accessible in the emergency setting but is feasible in some centers. It is the best choice in the first weeks following mild brain injury but may be normal. Taking into account the limitations of morphological imaging, functional imaging techniques (SPECT, fMRI, PET-scan) are necessary as they may show axonal damage or brain atrophy. There is however the problem of availability. SPECT is the most accessible. Spectro-MRI is promising. In spite of progress in neuroradiological investigation methods, the neuropsychological evaluation and multi-disciplinary treatment of these patients by a skilled team remains of utmost importance.

[Gastroduodenal intussusception complicating Menetrier's disease]. / Maladie de Ménetrier révélée par une invagination gastro-duodénale.

The authors report a very rare case of gastroduodenal intussusception complicating Menetrier's disease. This uncommon condition of unknown aetiology is characterized by hyperplasia of the gastric mucosal folds. Computed Tomography (CT) in high resolution mode can be helpful for diagnosis by showing the cerebriform surface of the giant mucosal folds. Filling the gastoduodenal tract with water is useful in non complicated cases.

[Subacute combined degeneration of the spinal cord: contribution of MRI]. / Sclérose combinée médullaire: apport de l'IRM.

The authors report a case of subacute combined degeneration of the cervicothoracic spinal cord involving the dorsal and lateral spinal columns, extending to the brainstem, due to cobalamin deficiency in an elderly patient. Symptoms of this subacute myelopathy are potentially reversible with early diagnosis. Presenting symptoms of this myelopathy, involvement of the lateral columns and brainstem have rarely been documented by magnetic resonance imaging (MRI) studies. MRI showed increased T2-weighted signal in the spinal cord. The patient's background and history and the posterior location of the abnormalities increased the specificity of MRI, and the resolution of clinical symptoms with vitamin supplementation confirmed the diagnosis.

[Bowel obstruction in pregnancy: value of Single Shot Fast Spin Echo MR sequence (SS-FSE)]. / Occlusion digestive de la femme enceinte: intérêt de la séquence Single Shot Fast Spin Echo (SS-FSE).

Bowel obstruction is a rare but serious complication of pregnancy for both the mother and the developing fetus. The authors report a case of small bowel obstruction in an early pregnant patient. Increasing delay between the onset of symptoms and the diagnosis remains a significant contributing factor to the high morbidity and mortality in the pregnant patient population. So, prompt diagnosis and therapy are essential. Single Shot Fast Spin Echo MR sequence confirmed the presence of bowel obstruction and identified the zone of transition.