Subject(s)
Spinal Cord Compression/surgery , Spinal Cord Neoplasms/surgery , Tuberculoma/surgery , Tuberculosis, Spinal/surgery , Adult , Antitubercular Agents/therapeutic use , Combined Modality Therapy , Decompression, Surgical , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Laminectomy , Magnetic Resonance Imaging , Spinal Cord/pathology , Spinal Cord Compression/drug therapy , Spinal Cord Neoplasms/diagnosis , Thoracic Vertebrae/pathology , Tomography, X-Ray Computed , Treatment Outcome , Tuberculoma/diagnosis , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Spinal/diagnosisABSTRACT
The authors present the French concept of a mobile neurosurgical unit (MNSU) as used to provide specific support to remote military medicosurgical units deployed in Africa, South America, Central Europe, and Afghanistan. From 2001 to 2009, 15 missions were performed, for 16 patients. All but 3 of these missions (those in Kosovo, French Guyana, and Afghanistan) concerned Africa. Eleven patients were French soldiers, 3 were civilians, and 2 were Djiboutian soldiers. The conditions that MNSUs were requested for included craniocerebral wounds (2 cases), closed head trauma (7 cases), spinal trauma (5 cases), and spontaneous intracranial hemorrhage (2 cases). In 5 of the 16 cases, neurosurgical treatment was provided on site. All French soldiers and 2 civilians were evacuated to France. The MNSU can be deployed for timely treatment when some delay in neurosurgical management is acceptable.
Subject(s)
Ambulances/organization & administration , Military Medicine/organization & administration , Neurosurgery/organization & administration , Transportation of Patients/organization & administration , Adult , Case Management/organization & administration , Child, Preschool , Craniocerebral Trauma/surgery , France , Humans , Male , Military Medicine/methods , Neurosurgery/methods , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Transportation of Patients/methods , WarfareABSTRACT
We report a case of associated vertebromedullary and ureteral lesions in a severely injured patient, a victim of a gunshot aggression in Africa. Urine extended from the ureteral fistula through the third lumbar vertebral body, blended with cerebrospinal fluid from the dural attrition, and flowed very slowly through the dorsal exit ballistic hole. This is to our knowledge the first such case described in the literature. Uro-computed tomography scan finally made the diagnosis of ureteral fistula after two neurosurgical procedures determined that initially presumed dural persistent fistula needed to be closed.
