[Resection of a retroperitoneal schwannoma by a combined approach]. / Résection d'un schwannome rétropéritonéal en sablier par abord combiné.

BACKGROUND AND PURPOSE: We report a remarkable case of retroperitoneal schwannoma with significant spinal growth illustrating the effectiveness of a combined surgical approach. METHODS: A 41-year-old man presented with a long history of back pain and unexplained weight loss. An abdominal mass was found in the right upper quadrant. The CT-scan revealed a partially cystic lesion located in the right psoas muscle. Spinal extension was noticed through the L1-L2 neural foramen. MRI better showed the wide rostro-caudal extension in the spinal canal. RESULTS: Bilateral L1 and L2 laminectomy was performed to remove the spinal portion of the tumor. It was extradural but attached to the dura. The roots were not infiltrated. The retroperitoneal mass was removed by an anterior transperitoneal approach. The histological examination did not reveal criteria of malignancy. CONCLUSIONS: Retroperitoneal schwannomas are rare and their preoperative diagnosis remains difficult. In case of significant spinal growth, a combined surgical exposure should be preferred to allow total removal of the lesion and control of the neurological structures.

Inhibition of epidural fibrosis with ADCON-L: effect on clinical outcome one year following re-operation for recurrent lumbar radiculopathy.

In a prospective multicenter study, 20 patients underwent re-operation for recurrent radiculopathy after lumbo-sacral discectomy, and were treated with ADCON-L (Adhesion Control in a Barrier Gel) to inhibit epidural fibrosis following secondary surgery. Outcomes after re-operation were assessed at six and 12 months using: Visual Analog Scales to measure radicular and back pain, straight leg raising exams, and self-assessment of activity-related radicular pain. Each parameter was compared to baseline values, obtained immediately prior to the re-operation. The long term clinical results at 12 months after re-operation (summarized below) demonstrate a significant improvement of all clinical parameters, and correlated with the results seen at six months. Radicular pain, measured when most severe, was reduced from an average pre-operative score of 8.1-3.7 (p < 0.005). The straight leg raising angle increased from an average pre-operative value of 41 degrees-67 degrees (p < 0.005). Activity-related pain mean score was 4.6, vs. 17.0 pre-operatively (p < 0.005). Low back pain, measured when most severe, was reduced from an average pre-operative score of 6.1 to 3.1 (p < 0.012). These clinical findings compare very favorably with data reported in the literature. There were no adverse events or complications related to the use of ADCON-L.

Iliopsoas bursitis and pseudogout of the knee mimicking L2-L3 radiculopathy: case report and review of the literature.

We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain. As a CT scan showed multiple herniated intervertebral discs and spinal stenosis at the L3-L4 level, she was referred to a neurosurgical unit with the tentative diagnosis of L2-L3 radicular pain. Investigations (MR, myelography with CT scan) showed severe acquired lumbar canal stenosis. Decompression surgery was finally postponed because of the patient's serious cardiac medical history and she was referred to us for conservative treatment. She was found to have iliopsoas bursitis with chondrocalcinosis of the knee. Local steroid injections of the two sites abolished her symptoms. We draw attention to the possible pitfalls that the radiographic appearance and one of the multiple clinical presentations of this unrare pathology may represent. Whenever a patient comes walking with crutches, avoids putting weight on his or her leg, and radicular pain is suspected, we advise consideration of other extra-spinal causes for the pain.

Solitary osteochondroma presenting as a neck mass with spinal cord compression syndrome.

Osteochondromas are a rare cause of spinal pathology and neurological dysfunction. A case of cervical osteochondroma with spinal cord compression is reported and the pathological, clinical, and radiological features are discussed with a brief review of the literature.

Acute subfrontal epidural hematoma: report of two cases.

Two cases of acute subfrontal epidural hematoma are reported. Both were diagnosed by computed tomography scan and successfully removed via a frontal craniotomy.

[Craniocerebral trauma and skiing: the ABC of the general surgeon]. / Traumatismes cranio-cérébraux et ski: l'ABC du chirurgien généraliste.

This paper describes the classical encephalic lesions due to ski accidents, after a short review of the normal cerebral physiology. It analyses the main steps of the management of the head injury patient by the general surgeon taking history, general and neurologic state, diagnosis, first aid, initial medication, transport conditions and information of the neurosurgical center.

CT in thrombosed dilated posterior epidural vein.

The authors report a case of thrombosis of the distal end of an enlarged right posterior epidural vein. The patient had a markedly narrow lumbar canal due to 1.5 spondylolisthesis. The dilated vein and the thrombosis were displayed by computed tomography but remained unrecognized until surgery. Pathogenesis of this condition is discussed. A review of the english, french and german literature revealed no prior radiological reports of a similar condition.

[Treatment of post-traumatic cerebrospinal fluid rhinorrhea with lumbar drainage (author's transl)]. / Die Problematik der Behandlung der Liquorfistel bei frontobasalem Schädel-Hirntrauma mittels Lumbaldrainage.

Three patients with CSF-rhinorrhea following frontobasal skull and brain injury were treated with lumbar CSF drainage. Rhinorrhea was successfully stopped in one patient few hours after onset of the drainage while a pneumatocephalus developed in each of the remaining patients during the first post-trauma week. We believe that this latter occurrence was due to depression of intra-cranial pressure as a result of the drainage. As a further consequence of this, risk of intracranial infection increased in association with a hypoliquorrhea, and led to a tentorial pressure cone in one of the patients.

[Cerebellar abscess as an intracranial complication of otogenic origin (author's transl)]. / Der Kleinhirnabszess als endokranielle Komplikation otologischer Erkrankungen.

Three cases of otogenic cerebellar abscesses, treated between 1976 and 1978, are reviewed. Early diagnosis is the most important factor in the successful management of these lesions. In localising subtentorial intracranial abscesses, computed axial tomography appears superior to other neuroradiological methods. Lumbar puncture is both inaccurate in diagnosis and dangerous to the patient, when increased intracranial pressure exists.

Angiography of the spinal cord after vertebral trauma.

Angiography of the spinal cord after trauma to the spine is reported in 14 new cases with neurological signs. Three types of angiographic signs are demonstrated: (1) arterial interruption of the anterior spinal artery, the ascending branch of the radiculomedullary arteries or the extravertebral arteries; (2) displacement of the anterior spinal artery without interruption; (3) hyperemia. The mechanism and significance of these signs are discussed.

The microsurgical removal of intramedullary spinal hemangioblastomas. Report of twelve cases and a review of the literature.

From 1969 to 1975, 12 patients were operated upon at the Kantonsspital Zürich by the senior author (MGY) for intramedullary spinal hemangioblastoma with the help of microtechnique. The purpose of this paper is to describe in detail the surgical technique and the results, and to comment on the historical, clinical, pathological, and radiological aspects of spinal hemangioblastoma and the complex of von Hippel-Lindau's Disease (multiple angiomatosis of retina, central nervous system, and viscera) with which it is associated.

[Microsurgical experiments in 12 cases of intramedullary hemangioblastomas]. / Expériences microchirurgicales dans 12 cas d'hémangioblastomes intramédullaires

12 patients (8 males and 4 females) operated on for intramedullary hemangioblastomas, using microsurgical techniques are presented. Special consideration is given to the clinical and pathological aspects. The results of surgery are discussed. The family history is positive in 4 cases. Clinical aspect : a) the initial symptoms is usually pain (9 patients) motor deficits were present in 2 cases. Only 1 patient presented visual disturbances at the beginning of the disease. b) the interval of time between the first symptom and the fully developped clinical picture is shorter than 1 year in 4 patients and longer (up to 18 years) in 8 patients. c) the full clinical picture consists of motor deficit, sensory disturbances (especially dorsal columns), cerebellar signs, raised intracranial pressure, sphincter disturbances, retinal angiomas, arterial hypertension and psychoorganic syndrome in decreasing order of frequence. Pathological findings at opsurgery : There are. a) 3 cases of hemangioblastomas at the bulbo-cervical junction b) 5 cases of cerebello-medullary hemangoblastomas. c) 4 cases of medullary hemangioblastomas. 1 patient had renal and pancreatic cysts. 2 patients had pheochromocytomas with arterial hypertension. Operative technique. Microsurgical techniques, bipolar coagulation, and continuous irrigation of the operative field are of primordial importance. The tumor must be approached from the periphery and never from the center. One should coagulate the afferent vessels first and the efferent vessels only at the end. Results of surgery. In 1 case, only a partial removal was possible and the patient did not improve. A complete removal was possible in 11 patients with the following results : -- 4 patients are in excellent condition and have a normal socio-professional life. -- 5 patients improved and are independant. The are able to perform partial time-work. -- 1 patient, with bulbar extension of the tumor improved from the motor point of view, but he presents a permanent. deficit of the IX, X, XI cranial nerves. He has a permanent tracheal canula. -- 1 patient improved following surgery, but he died 12 months later (stress ulcer and cardiac decompensation). The autopsy revealed a recurrence of the cerebellar tumor.