[Intramedullary tumors. Results of a national investigation in private neurosurgery]. / Les tumeurs intramédullaires. Résultat d'une enquête nationale en neurochirurgie libérale.

UNLABELLED: The frequency of intramedullary tumors is 0.5 cases per year for 100,000 inhabitants. The study reported herein was a retrospective study conducted from January 1985 to September 2007. MATERIAL: Seventy-nine cases were distributed in the following manner: ependymomas, 38; astrocytomas, 22; oligodendrogliomas, four; gangliogliomas, two; hemangioblastomas, 10 (nine sporadic cases and one case of Von Hippel-Lindau disease); primitive melanoma, one; and intramedullary neurinomas, two. Three patients were lost to follow-up and 10 patients died. METHOD: All patients were explored using MRI and were operated using a microsurgical technique. Tumor removal was complete in the cases of ependymoma and hemangioblastoma and subtotal in the cases of astrocytoma. RESULTS: Ependymoma: 38 cases with three cases of ependymoblastoma. Mean age: 47 years (range, 17-74 years); 17 males and 21 females. Diagnostic delay: less than one year, 11; one year, 15 cases; two years, nine cases; three years, three cases. Seven recurrences with one 35 years after a prior removal. Localizations: cervical and cervicodorsal, 19; dorsal, ten; dorsolumbar, seven; holomedullary, one. Number of levels concerned: 5-12 (with the cysts associated). Mean follow-up was 10 years (range, two months to 35 years). Patients stabilized, 19; worse, six; improved, nine. Patients deceased: four, one by suicide, three cases of ependymoblastoma (survival, seven months). Astrocytomas: 22 cases, with 14 cases of astrocytoma, two pilocytic astrocytoma, four malignant astrocytoma, and two glioblastoma. Mean age: 44 years (range, 22-73 years); 14 males and eight females. Diagnostic delay: malignant tumors, one to nine months; low grades; three to six years (range, eight months to 25 years). Number of levels concerned: two to eight. Mean follow-up: seven years (range, six months to 10 years). Stabilized patients: 13; worse, five; deaths, four. Oligodendroglioma: four cases. Mean age: 58 years; two males and two females. Diagnostic delay: 10months. Localization: cervical, three; dorsal, one. Oligodendroglioma A, two; B, two. Results: two cases stabilized, one case with recurrence, and one patient deceased. Ganglioglioma: two. Both cases were associated with scoliosis. Recurrence in the eighth month and two years for the second case. One patient died. Hemangioblastoma: 10 cases, nine sporadic and one case of Von Hippel-Lindau disease. Nine cervical localizations, one on the medulla cone. Mean age: 45 years (range, 11-54 years); eight males and two females. Total removal in nine cases. One case of recurrence seven years after a prior surgery and operated a second time with no recurrence after 10 years of follow-up. Intramedullary neurinomas: two cases with a total removal and 15 years of follow-up. Primitive melanoma: one case with mediothoracic location. Treatment with surgery plus radiotherapy. Follow-up, seven years without recurrence. CONCLUSION: Total removal of the intramedullary tumors is a challenge. In cases of removal, the risk of worsening status is 18-19.5%. Subtotal or incomplete removal 27-40% risk of recurrence.

[Technical features of endoscopic surgery for lumbar disc herniation: 191 patients]. / Aspects techniques de la chirurgie endoscopique des hernies discales foraminales lombaires. A propos de 191 cas.

BACKGROUND: We analyzed the contribution of endoscopic surgery for lumbar foraminal disc herniation in a series of 191 patients. METHODS: All the patients underwent a posterior paramedian endoscopic procedure performed by the same operator. This prospective study concerned 191 consecutive patients included between April 1999 and March 2002. Outcome was assessed with a self-administered questionnaire. Prolo's criteria were used. RESULTS: Of the 191 patients, 144 questionnaires (75%) were returned showing results were excellent in 130 (90%), good in 1 (0.7%) and poor in 13 (9%). The complications observed were: aseptic discitis (n=1); approach of two levels due to incorrect fluoroscopic guidance (n=2); dural tear (n=1); partial nerve root lesion (n=3); a second operation was necessary in 4 patients but only once at the same level and on the same side. Of the 80 patients who were working before the operation, 77 were able to return to work with an average delay of 3 weeks, 2 did not return to work and one worked only part time. CONCLUSIONS: These good results associated with a high rate of patient satisfaction demonstrate that endoscopic surgery is an effective technique for the foramen. Endoscopy allow complete exposure decompression of the nerve root all along the foraminal canal.

A special device for endoscopic surgery of lumbar disc herniation.

We studied the use of an endoscopic technique for lumbar discectomy, the most frequent operation in spinal surgery. Minimal invasive procedures are cost effective and allow earlier resumption of activities, work and sports. Endoscopic procedures have become more frequent in surgery but rarely for spinal surgery. It is sometimes used in the disc itself but not in the spinal canal. The goal of this operation is to reach the disc herniation in the spinal canal through a small incision, using a special device with an endoscope. It is composed of three tubes: one for the endoscope, one for aspiration and the largest one for classical surgical instruments. A protected space is created at one end of the tubes by a special part of the device which looks like a speculum; there is also an included nerve retractor. One hundred patients were operated during the year 1993. In a follow-up, 91 patients were evaluated using Prolo's criteria. The results could be classified as excellent in 78 patients, good in nine and poor in four. Complications were rare: two discitis, four recurrences, one failure. This technique allows a smaller incision, less trauma to lumbar muscles, better identification of deep structures, soft manipulation and better release of neural structures, perfect hemostasis and no drain. Early post-operative mobilization is easy and special wound dressing allows immediate shower and intensive re-education. These excellent results must be confirmed by long term studies; nevertheless this minimal invasive technique can be considered as a safe and effective treatment of the lumbar disc herniation.

[Chronic subdural hematoma in adults. Prognostic factors of surgery. Apropos of 100 cases]. / Hématome sous-dural chronique de l'adulte. Facteurs pronostiques de la chirurgie. A propos de 100 cas.

One hundred chronic subdural haematomas in the adult are presented in a retrospective study, looking for correlations between results and aetiological, clinical, radiological and therapeutic elements. Only four parameters are correlated with results: headache and isodensity on C.T. Scan are good prognostic factors (p less than 0.02 and p less than 0.04 respectively); on the other hand chronic alcoholism (p less than 0.03) and even more postoperative pneumatocele (p less than 0.007) are correlated with a poor result. Pneumatocele is due to intracranial hypotension which is the major factor promoting formation and development of chronic subdural haematoma occurring in aged population.

An experimental study of traction on the cervical spinal nerves.

The authors present a study of experimental traction on 48 cervical spinal nerves obtained from fresh cadavers. 16 avulsions of the roots were produced, always after rupture of the dura mater. The different stages of traction and rupture are described, as well as the different specimens after rupture. Ways of protecting the spinal nerves against avulsion are discussed.

An approach to the functional anatomy of the sacroiliac joints in vivo.

This first part of this paper is a review of the literature on the functional anatomy of the sacroiliac joint followed by a preliminary biomechanical study of the fresh post mortem pelvis. The latter was done in order to determine the coefficients of the screw matrix and the position of the instantaneous centers of rotation during the symmetrical movements of nutation and contranutation simulated in the biomechanics laboratory. The main part of this work deals with the spatial analysis in vivo of the relative displacements of the iliac bones with respect to the sacrum in the course of dissymmetrical movements of the pelvis. In the different phases of movement, the roentgenographic observation of the position of the bony components with respect to a three-dimensional orthonormal reference system required the use of material based on the principles of photogrammetry. This technique was used to achieve spatial reconstruction of the data recovered from a series of orthogonal x-ray films of the sacroiliac joints. Data retrieval was carried out on a digital table linked to a computer with a graphic terminal so that the information could be displayed in the form of rectangular coordinates of defined points on the bone. Owing to the limited amplitude of articular displacement, a statistical study was required to retrieve the coordinates from the projection of these points on the X-ray film with an estimated threshold of significance of 0.1 and an error of +/- 0.1 mm.(ABSTRACT TRUNCATED AT 250 WORDS)