Françoise LAPIERRE, Bernadette STILHART, The First Two Female Big Bosses in French Neurosurgery.

We believe it is crucial to discuss the roles of women in medicine, specifically in surgery and neurosurgery. Despite society's progress towards gender equality in surgery and neurosurgery, these fields remain predominantly male. Recognizing and supporting these talented women allows them to bring attention to their contributions in their respective fields. Two notable French neurosurgeons, Françoise Lapierre, and Bernadette Stilhart have played significant roles in their field for several decades. Françoise Lapierre, the second head of neurosurgery at Poitiers since its creation, was one of the first female heads of neurosurgery in France. In addition to her departmental role, she has also conducted training missions in the Far East, specifically in Vietnam and Cambodia. She also served as the editor-in-chief of the journal Neurochirurgie for several years. Bernadette Stilhart, with a career spanning almost 50 years, has trained multiple generations of neurosurgeons from France and around the world. She has also been the head of one of France's oldest neurosurgery departments in Colmar, Alsace for 20 years.

Alice ROSENSTEIN(1898-1991) First German female Neurosurgeon.

Gender inequality has been a long-standing issue throughout history, with limited progress despite the rise of women in the workforce. Historically, women were deemed inferior to men, including within the medical profession, due to perceived bodily differences. This perception was reinforced in religious texts, depicting women as bearing the burden of the first woman's transgressions. Such attitudes also influenced the treatment of women's health, with menstruation viewed as a natural source of suffering. Nevertheless, a thorough examination of medical history unveils a deep-rooted bias against women.This antiquated and discriminatory notion lacks any foundation in scientific truth. Indeed, an examination of the contributions made by female physicians reveals that they deliver equivalent levels of care, attentiveness, preventive measures, and therapeutic efficacy as their male counterparts (1-2). The narratives of female trailblazers in the medical field, like Alice Rosenstein, the first female neurosurgeon in Germany, provide compelling evidence of this phenomenon. This paper delves into her professional journey and the significant influence she has had on the field of neurosurgery.

Aimée Redondo, the First Female Neurosurgeon Professor in France.

It is crucial to promote the role of women in surgery, particularly in the field of neurosurgery, which is still predominantly male-dominated. Without recognition and support, these talented and pioneering women may continue to be overlooked, despite their significant contributions to the field. One such remarkable woman is Professor Aimée Redondo, the first female neurosurgeon professor in France. She was born in 1944 during the last years of World War II to immigrant parents from Spain. Thanks to grants and scholarships from the French government, Aimée Redondo was able to continue her education. She excelled in high school and even passed the entrance exam for medical school on her first attempt - a rare achievement at the time. In 1975, at the young age of 31, she became the first female professor of neurosurgery in France. After completing her residency, she worked as a senior neurosurgeon at the Salpêtrière Hospital in Paris and then joined the newly established department of neurosurgery at Beaujon Hospital. For over thirty years, she was a crucial member of this department and served as its head from 2004 until her retirement. Sadly, she passed away in 2022 at the age of 78.

New minimally-invasive approach in adult for Chiari I malformation.

BACKGROUND: Chiari I malformation is defined by tonsillar herniation through the foramen magnum. There is no consensus on the treatment of Chiari malformation. A simple follow-up is recommended for asymptomatic cases. The classic approach is the midline sub-occipital craniotomy. METHODS: For four years, we operated on six patients with Chiari malformation I using our endoscopic minimally invasive sub-occipital approach. We compared the results with six other patients operated by the classical sub-occipital approach. RESULTS: Patients operated by endoscopic approach had shorter hospital stays, and wounds healed faster and smoother. Mid-term results were similar in the two groups. CONCLUSION: This paper proposes a new endoscopic Minimally invasive paramedian sub-occipital approach for Chiari malformation I. Although the number of cases is limited, the results look promising. We need to gather more cases to have significant numbers to perform a global comparison between the two approaches and assess the advantages and disadvantages of each technique.

Noninfectious skin fistulization as a delayed complication of lumbar interlaminar device implantation: a report of two cases.

INTRODUCTION: Delayed wound healing is one reason for readmission after spine surgery. The main cause of delayed wound healing is infection. Infection rates after initial instrumented spine surgery reportedly range from 0.7% to 11.9%. However, there are noninfectious reasons for wound problems as well. MATERIALS AND METHODS: This report presents 2 cases of noninfectious fistulization, 1 which occurred 11 months and 1 which occurred 2 years after surgery for implantation of a lumbar interlaminar device. RESULTS: Although no sign of infection was found in either patient, in both cases it was necessary to remove the interlaminar device. CONCLUSIONS: These 2 cases of delayed noninfectious fistulization following instrumented spine surgery are the first seen by the authors of the current report, and as of the time of this writing, no such cases have been documented in the medical literature.

A comparison between different suture techniques in lumbar spine surgery.

As a result of solicited muscles, strong friction, and tensile force on cutaneous tissue, the difference in closure procedure and management strategies and complications of surgical incision healing is a real challenge in lumbar spine surgery. We performed a retrospective study to compare different types of wound closure in lumbar spine surgery. 4383 patients were included in this study. Wound dehiscence was more common in the intracutaneous suture group than in the far- near-near-far suture group. Delayed wound healing occurred more in the far-near near-far suture group than intracutaneous suture group. Also, the far-near near-far interrupted point suture group showed a higher ratio of delayed wound healing compared with crossover suture. The superficial wound infection rate was roughly the same in all types of sutures with an average value of 0.79% with 0.81% SD. This is a preliminary study to compare different types of operative wounds showing the pros and cons related to each option.

Modified anterior retropharyngeal approach for C2-C3 disc herniation.

Background: C2-C3 disc herniations are rare, but occur more frequent in the elderly population. As the classical anterior Cloward approach to these lesions is not optimal, we propose an alternative modified retropharyngeal approach to these disc herniations that were successfully utilized in two patients. Methods: Two patients with C2-C3 disc herniations underwent anterior cervical surgery utilizing the modified retropharyngeal approach. Results: Surgery was successful is two cases with C2-C3 disc herniation and no patient sustained a perioperative complication. Conclusion: Our modified anterior retropharyngeal approach for C2-C3 disc herniations resulted in good outcomes without perioperative complications.

Minimally Invasive Surgical Approach for Treatment of Chronic Subdural Hematoma, Outcome in 1079 Patients.

AIM: To present the authors' experience in treatment of chronic subdural hematoma (CSDH) by a minimally surgical percutaneous approach. MATERIAL AND METHODS: We relate our experience of mini-invasive evacuation of chronic subdural hematoma. Between May 2006 and December 2017, 1079 patients have been operated for percutaneous evacuation of chronic subdural hematoma. Prior to operation, the volume of hematoma was measured quantitatively by using a software for CT scan. RESULTS: From May 2006 to December 2017, 1079 patients underwent mini-invasive percutaneous evacuation (MIPE). Of the 1079 patients, 994 (92.12%) became asymptomatic or improved clinically. Six weeks later, the scan revealed the hematoma had wholly disappeared in 699 (64.78%) of the cases. We had one postoperative abscess. CONCLUSION: Treatment of CSDH using our MIPE technique is a safe method with satisfactory outcome and a good therapeutic alternative to the craniostomy.

A comparison of sciatica in young subjects and elderly person.

BACKGROUND: Sciatica is a common symptom for many people with degenerative lumbar spine diseases. It is by far the most common symptom of disc herniation. However, disc herniation is not the only cause of sciatica. Other degenerative lumbar spine diseases can provoke Sciatica. To date, few studies have analysed the cause of sciatica in particularly in elderly patients. MATERIAL AND METHODS: We analysed retrospectively records of patients aged between 35 and 55 (first group) and between 65 and 85 (second group) visited in our departments for sciatica between December 2009 and November 2018. RESULTS: In elderly patients, disc herniation from upper levels (L2-L3 and L3-L4) is more common than younger people. Sciatica as a result of exclusive disc herniation reduces with age. Foramen stenosis produces sciatica in elderly patients more than twice as high in younger patients. Statistically, more patients needed to surgery in elderly patients in comparison with younger population. CONCLUSION: Sciatica in elderly patients takes a different clinical aspect in comparison with younger population. The clinical picture associates pain less severe but more persistent, more resistant to treatment. It is caused in less than 50% by disc herniation.

Cervicothoracic junction disc herniation: Our experience, technical remarks, and outcome.

BACKGROUND: C7-D1 disc herniation is rare in comparison with other cervical levels. The incidence rates are between 3.5% and 8%. The cervicothoracic junction disc herniation can be operated posteriorly or anteriorly. The anterior approach can be challenging because of the difficulty of access resulted from the manubrium. In this article, we present our experience about cervicothoracic junction disc herniation (C7-T1) surgery. MATERIALS AND METHODS: Between January 2008 and December 2017, 21 patients have been operated for solitary C7-T1 disc herniation. We operated 12 male patients and 9 female patients. Eight patients have been operated by the anterior approach, and 13 patients underwent surgery by the posterior approach. The mean symptoms duration was 11.4 months. RESULTS: All patients had C8 cervicobrachial neuralgia. Other clinical presentations were numbness, tingling sensation, and weakness. All patients improved after surgery. We had no significant complication. CONCLUSION: We did not find a great difference between the clinical features of cervicothoracic herniated disc and other cervical levels. The anterior approach seems more difficult to carry out in particularly in large patients with the short neck. The posterior approach can be used for all types of patients except in the case of medial disc herniation.

Proposal of a new anatomical landmark to identify the disc space in endoscopic lumbar discectomy.

INTRODUCTION: In endoscopic lumbar discectomy for posterolateral disc herniation, we determined some anatomical landmarks for improved disc space access. These landmarks are based on the beginning of the insertion of the ligamentum flavum (LF) to vertebral lamina. MATERIALS AND METHODS: In 978 patients operated by posterolateral disc herniation, we measured prospectively the distance between the beginning of the insertion of the LF and space disc rostrally. RESULTS: The distance between the beginning of the insertion of the LF and space disc was broader at the level of L3-L4, with an average of 14 mm. At L4-L5, the average distance was 13.5. At L5-S1, the average distance was 12 mm. CONCLUSION: Knowing the accurate distance between the insertion of LF and disc space contributes to reducing the average duration of the surgical procedure to avoid empirical search of disc space by a surgeon and avoiding unnecessary and excessive LF and bone removal.

Interlaminar lumbar device implantation in treatment of Baastrup disease (kissing spine).

BACKGROUND: Baastrup disease (BD) is characterized by the degenerative changes of spinous processes and interspinous soft tissues. It is more common among aged persons. This disorder is a relatively common cause of low back pain. Its incidence is underestimated. A few studies have investigated BD epidemiology and proposed treatment efficacy. The aim of this paper is to establish impact and outcome evaluations of managing the patients with Baastrup disease who have been treated by implementing of floating interlaminar device (FID). MATERIALS AND METHODS: Between January 2015 and September 2017, 47 patients have been operated by implementing of FID for BD in our Department of Neurosurgery. RESULTS: Of the 47 patients, 20 were female and 27 were male with an average age of 51.78. On average, we followed the cases up to 11 months. The most frequent level of disorder was L4"L5 followed by L3"L4 level. The condition of 45 patients improved after surgery according to Oswestry low back pain score and 39 patients could return to their work. CONCLUSION: The results from our study corroborate that implementing of FID is a good alternative treatment for patient chronic low back pain due to BD This technique contributes to improving a better living situation for the patients given the correct indications.

Late appearance of low back pain relating to Modic change after lumbar discectomy.

BACKGROUND: In practice of neurosurgery, we find that a wide number of patients referred for refractory low back pain have a history of lumbar discectomy. In a large number of them, magnetic resonance imaging (MRI) studies detect Modic changes (MCs). The aim of this study is to determine the relationship between emergence of MC and low back after lumbar discectomy. MATERIALS AND METHODS: Three hundred and fifty-eight patients with a medical history of discectomy had a MC at the level of the operated disc without any other discopathy. They have been selected from among the 1154 patients operated for lumbar disc herniation over 5 years. RESULTS: Two hundred and fourteen patients (67.30%) had not presented MCs on preoperative MRI. CONCLUSION: Our study awakens a strong presumption about the relationship between emergence of MC after lumbar discectomy.

The reliability of LERI's sign in L4 and L3 radiculalgia.

Although not as frequent as sciatica, cruralgia remains one of the most frequent reasons why people consult a neurosurgeon. It should be kept in mind, however, that every anterior leg pain is not cruralgia and thus several diagnoses must be discarded, such as of musculoskeletal diseases of hip, pelvis and femur. In the last years of the 19th century, André Léri, a French neurologist, described Leri's sign as it is used widely even today in everyday clinical practice. We studied retrospectively files of those patients who were seen in Neurosurgery by the authors for L3 and L4 nerve root compression to evaluate the reliability and accuracy of this sign. Between October 1998 and September 2017, 38,654 patients were examined in our department of Neurosurgery. Among them, 1698 patients presented pain as cruralgia and meralgia. In total, 1545 patients were included in the study. The data analysis showed that the sensitivity of LS was 0.9333 and the specificity 0.7974. The results of the study show a reliable diagnostic accuracy of Leri's sign.

Preliminary results of lumbar disk herniation surgery by Endoscopic Destandau Method.

BACKGROUND: The incidence of Disc herniation is about 2-3% of population. Each year 300,000 procedures performed in USA. The aim of this paper is to describe the utility of endoscopic procedure in treatment of lumbar disc herniation. METHODS: We operated 359 patients from September 2013 to December 2016 for lumbar disk herniation by Endoscopic DESTANDAU method (EDM). The average length of surgery was 47 min. We operated 211 male and 148 female patients. In average, patients had pain for 4.3 months before surgery. RESULTS: 310 patients became pain free in six weeks and 332 after 3 months. We had 7 recurrent herniation. Among these patients 4 have been operated for the second time with success. Three patients refused to be operated. And had infiltration. We had 1 deep infection and 3 cutaneous infections. We have 7 two SCF fluid leak. Among them 3 needed second operation. CONCLUSIONS: The patients are admitted the day of surgery and are discharged the day after surgery. EDM is a good alternative surgery for lumbar disk herniation in comparison with classical surgery. The duration of hospitalization is shorter and recovery is faster.

Lumbar disk herniation: How far should efforts go to minimally invasive procedure?

BACKGROUND: Minimally invasive surgery (MIS) of lumbar disk herniation allows avoiding less of a mess in crossing structures, reducing muscular and cutaneous scarring, postoperative pain, lengthy recovery times, and the rate of infection. The aim of this study is to explain our experience in MIS of disc herniation. We compare the outcome of three different surgical techniques used for the treatment of lumbar disc herniation. MATERIALS AND METHODS: A total of 1147 patients have been operated from July 2008 to December 2015 for lumbar disk herniation by posterior endoscopic approach. Three hundred and seventy-nine patients underwent discectomy and herniectomy (DH), 557 patients have been operated by herniectomy (H), and 211 patients underwent only bone decompression (BD). RESULTS: The results show 80.10%, 82.06%, and 84.02% excellent outcome, respectively, in BD, DH, and BD techniques. CONCLUSION: Analysis of the data demonstrates that the results obtained are equivalent and comparable in different used techniques for the treatment of disc herniation, we do not need to perform discectomy in all cases in a systematic way.

Preliminary results of anterior cervical arthroplasty by porous alumina ceramic cage for cervical disc herniation surgery.

OBJECTIVE: Anterior cervical arthroplasty (ACA) is the gold standard surgery in severe or unresponsive cases of cervical disc herniation, uncarthrosis, and foraminal stenosis. The aim of this study is to establish the impact and outcome evaluations of managing the patients operated for cervical arthroplasty by the intersomatic porous alumina ceramic cervical cages (PACC). The authors describe their experience in the area to allow the comparison of effectiveness of ceramic cages versus other interbody fusion cages. MATERIALS AND METHODS: Between April 2015 and September 2018, we operated 118 for ACA by using PACC. Among them, 52 were female and 66 were male, with an average age of 46.78 years. RESULTS: The mean symptoms duration was 14.1 months. The most frequent level of the disorder was C5-C6 followed by C6-C7 level. Mean follow-up was 3.3 years. The Neck Disability Index (NDI) and the visual analog scale (VAS) were used to evaluate the patients status. No significant differences were observed between our results and literature data regarding operative time, duration of hospitalization, and NDI; however, we observed a shorter period and higher rate of bony fusion. CONCLUSION: The results from the present study corroborate that implementing of PACC is a good alternative treatment for the patient operated by ACA for cervical disc herniation or foraminal cervical stenosis.

Surgical treatment of bilateral nondisplaced isthmic lysis by interlaminar fixation device.

STUDY DESIGN: Spondylolysis is a defect in the portion of pars interarticularis. The latter affects approximately 6% of the population. It is caused by repetitive trauma in hyperextension. Low back pain is the most common symptom. METHODS: We implanted interspinous process devices in 12 patients with isthmic lysis without spondylolisthesis for low back pain. The purpose of the surgery was to conduct a minimally invasive procedure. RESULTS: In eight cases, patients became asymptomatic. In two cases, there has been a considerable improvement. In two cases, no change had been noted. CONCLUSION: This good result motivates us to consider this approach a part of therapeutic arsenal for some cases of spondylolysis.

Secondary communicating hydrocephalus management by implantation of external ventricular shunt and minimal gradual increase of cerebrospinal fluid pressure.

BACKGROUND: This paper presents a new management strategy explaining the process used by implantation of external ventricular drainage (EVD) and very gradual increase of intracranial pressure for treatment of acute hydrocephalus. During the last 30 years' experience in professional practice, the senior author (M.S.) discovered that there are some options of regulations between cerebral spinal fluid (CSF) production and resorption. This theory shows that minimal continuous increase of the CSF pressure as long as the patient general neurological condition is unchanged and appears as normal can lead to definitive treatment of hydrocephalus without needing to set a shunt. Gradual weaning from EVD is used in some neurosurgical centers related to aneurismal subarachnoid hemorrhage only in a way to treat hydrocephalus in the acute phase, but not as an alternative curative treatment for hydrocephalus, and as far as we know this procedure has not been presented to date in medical literature in this form and this purpose. MATERIALS AND METHODS: Between July 2000 and November 2012, 16 patients suffering from acute secondary hydrocephalus were treated by the method described in the International Neurosciences Institute in Hannover (Germany). RESULTS: The causes of hydrocephalus were brain tumors (12), arteriovenous malformations (2), one cavernoma, and one polytrauma. In 11 patients (68.75%), the procedure led to a complete cure and surgical treatment has been excluded after EVD removal without any risk to the patients. CONCLUSIONS: Minimal gradual increase of CSF pressure by EVD implantation for the treatment of secondary acute communicating hydrocephalus used by senior author as an option is a safe alternative treatment of hydrocephalus and may obviate the need for surgical procedures.

Endoscopic Anatomy and Features of Anterior Cervical Foraminotomy by Destandau Technique.

BACKGROUND: Minimally invasive spine surgery limits surgical trauma and avoids traditional open surgery so in the majority of cases, recovery is much quicker and patients have less pain after surgery. AIM: The authors describe an endoscopic approach to anterior cervical foraminotomy (ACF) by Destandau's method. MATERIAL AND METHODS: Anterior cervical foraminotomy by Destandau's method is carried out under general anaesthesia. A 3 cm transverse skin incision is used just slightly past the anterior border of the sternocleidomastoid's muscle laterally. After exposing and dissecting superficial cervical fascia, platysma muscle, and deep cervical fascia, Endospine material designed by Destandau will be inserted. As from this moment, the procedure will continue using endoscopy. RESULTS: the Endoscopic approach to anterior cervical foraminotomy by Destandau's method offers a convenient access to the cervical foraminal stenosis with fewer complications and negligible morbidity and gives maximum exposure to discal space with the goal of minimising cutaneous incision. CONCLUSION: Contrary to the other minimally invasive approaches, the visual field in foraminotomy by Destandau technique is broad and depending on the workability of Endospine an adequate access to cervical disc is possible.