Cervical Hyperextension Deformity After Sagittal Balance Correction in Patient with Congenital Limb-Girdle Myopathy: Surgical Technique and Review of Literature.

BACKGROUND: There is no gold standard surgical treatment for cervical hyperextension deformity, especially in case of muscular dystrophy. Special considerations and caution should be taken as they carry a high risk of early mortality and spinal cord injury. Only a few case reports are available in the literature. CASE DESCRIPTION: We report a case of surgical correction of an iatrogenic cervical hyperextension deformity following sagittal balance correction in a patient with congenital limb-girdle myopathy. The patient was successfully treated by posterior cervical release and fusion after verification of the range of motion, reducibility of the deformity, and absence of any positional spinal cord compression with dynamic radiographic examination and preoperative magnetic resonance imaging in the desired postoperative position. CONCLUSIONS: We suggest posterior cervical release and fusion in case of a radiologically and clinically reducible cervical hyperextension deformity under both motor and sensory spinal evoked potential monitoring. In cases of longstanding, rigid, nonreducible cervical hyperextension, laminectomy and concomitant duroplasty could be considered.

Fibroblastic and myofibroblastic tumors of the head and neck: comprehensive imaging-based review with pathologic correlation.

Fibroblastic and myofibroblastic tumors of the head and neck are a heterogeneous group of disorders characterized by the proliferation of fibroblasts, myofibroblasts, or both. These tumors may be further subclassified on the basis of their behavior as benign, intermediate with malignant potential, or malignant. There are different types of fibroblastic and myofibroblastic tumors that can involve the head and neck including desmoid-type fibromatosis, solitary fibrous tumor, myofibroma/myofibromatosis, nodular fasciitis, nasopharyngeal angiofibroma, fibrosarcoma, dermatofibrosarcoma protuberans, fibromatosis coli, inflammatory myofibroblastic tumor, ossifying fibroma, fibrous histiocytoma, nodular fasciitis, fibromyxoma, hyaline fibromatosis and fibrous hamartoma. Although the imaging characteristics of fibroblastic and myofibroblastic tumors of the head and neck are nonspecific, imaging plays a pivotal role in the noninvasive diagnosis and characterization of these tumors, providing information about the constitution of tumors, their extension and invasion of adjacent structures. Correlation with the clinical history may help limit the differential diagnosis and radiologists should be familiar with the imaging appearance of these tumors to reach an accurate diagnosis.

[Prospective study of microdiskectomy for lumbar disc herniation: evolution of pain, quality of life and satisfaction of Lebanese patients at short and long-term follow-up]. / Etude prospective á court et long terme de la microdiscectomie lombaire. Evaluation de la douleur, qualité de vie et satisfaction des patients libanais.

BACKGROUND AND PURPOSE: Lumbar disc herniation frequently affects young patients and is responsible for high rate of worker's compensation claims. The aim of this study is to evaluate at short and long-term the results of microdiscectomy in terms of pain control, quality of life and patient's satisfaction. METHODS: In this prospective study, 28 patients were enrolled and operated on by microdiscectomy for lumbar disc herniation. Three questionnaires were administered preoperatively. They evaluated the pain, the quality of life and the expectation of the patients. Four questionnaires were administered at six months and two years postoperatively evaluating pain, quality of life, results and satisfactions. RESULTS: A 62.3% and 53.2% improvement of low back pain at 6 months and 2 years respectively, and a 91.7% and 88.4% improvement of radicular pain were reported. A 73.2% and 79.8% improvement in quality of life was recorded respectively. Patient's expectation was evaluated at 3.85 and results estimated 3.24. Patient's satisfaction was 93.3% and 88.3% respectively. It was positively correlated to radicular pain, and inversely correlated to patient's expectations. CONCLUSION: Microdiscectomy for lumbar disc herniation offers a marked improvement in back and radicular pain. Quality of life is much improved. Although satisfaction is high, it is somewhat decreased for patients with high expectations.

[Brain tumors and epilepsy: postoperative evaluation of surgical procedures]. / Evolution postopératoire de l'epilepsie chez les patients opérés de tumeurs cérébrales.

OBJECTIVES: To study the efficacy of surgery on the postoperative control of epilepsy in patients operated for brain tumors. METHODS: Forty patients operated for supratentoriel cerebral tumors with epilepsy, at Hotel-Dieu de France (HDF) hospital center, between 1983 and 2005, were included in this study. Clinical, paraclinical and surgical information were collected. The extent of the tumor resection was based on the postoperative MRI results. RESULTS: The mean duration of the follow-up was 52 +/- 6 months (from 6 months to 10 years). 62.5% of our patients have had acute seizures (< 1 year) and 37% had experienced chronic seizures (> or = 1 year). The histopathologic exam revealed 2 DNET, 3 pilocytic astrocytomas, 2 diffuse astrocytomas, 6 A oligodendrogliomas, 7 B oligodendrogliomas, 7 anaplastic astrocytomas and glioblastomas and 13 meningiomas. Twenty-two patients had a complete resection, whereas the postoperative MRI of 18 patients have shown a tumoral remnant. After one year of follow-up, a complete remission was noted in 57.5% of the patients (Engel I). The prognostic factors of good outcome were: low-grade glial tumors (I +/- II), meningiomas, and complete tumor resection. CONCLUSION: The efficacy of surgery for epilepsy associated to cerebral tumors, established by the majority of articles, matched the results obtained for the patients operated at HDF, with complete seizures control in 57.5% of patients. This control depended essentially on the extent of tumor resection and on tumor's nature.

[Microsurgical facial nerve decompression for hemifacial spasm]. / Etude de huit cas de spasme hémifacial traités par décompression microchirurgicale.

PURPOSE: The results of a series of 8 patients with hemifacial spasm (HFS), treated with microsurgical vascular decompression (MVD) are reported. METHOD: A magnetic resonance imaging (MRI) of the brain was performed in all patients prior to surgery. The presence of arterial hypertension (HT) was noted. MVD was performed through a retromastoid approach, and Gortex was interposed between the nerve and the conflicting vessel. RESULTS: The offending vessels found were: the antero-inferior cerebellar artery in 50% of the cases, the postero-inferior cerebellar artery in 25% and the vertebral artery in 25%. These findings were positively correlated with MRI in only 50% of cases. The surgical results were the following: total and immediate relief in 62.5% of cases, delayed relief in 25%, and partial relief in 12.5%. Neither failure, nor recurrence were noted. In terms of complications, two cases of persisting hearing loss, one case of transient hearing loss, and two cases of persisting facial palsy. Hypertension improved in 20% of cases. CONCLUSION: This study shows the success of MVD in the treatment of HFS. Intraoperative monitoring is helpful in reducing the complication rate. In our practice, the correlation between MRI findings and surgery was poor, as opposed to the results found in literature.

[Lumbar synovial cysts : six case studies]. / Les kystes synoviaux lombaires: étude de six cas.

OBJECTIVES: The purpose of this study is to discuss the clinical and radiological aspects as well as the controversies in the management of lumbar synovial cysts. METHODS: We report a retrospective analysis of a series of 6 cases of lumbar synovial cysts. Patients presented with unilateral radicular pain mimicking a disc herniation. An MRI (magnetic resonance imaging) was performed in all patients. A computerized tomography scan was performed in one case and X rays in 2 cases. All patients were operated on and the cyst resected. Arthrodesis was not performed in any of our patients. RESULTS: Functional outcome was marked by a significant improvement. Excellent results were found in 4 patients. Three patients who presented with a motor deficit recovered after the surgery. CONCLUSIONS: Lumbar synovial cysts should be considered in the differential diagnosis of any radicular compression. MRI is the examination of choice. Surgical resection is the definitive treatment with low rates of complications and recurrences.