OBJECTIVEThe purpose of this study is to explore the feasibility of reconstructing the APB with a pedicled PQ flap, and to report results in a child presenting with bilateral radial deficiency. ...METHODSTwenty-one injected cadaver upper extremities were dissected. The muscle was pedicled distally on the transverse carpal artery, and reinnervated with the flexor digiti minimi (FDM) motor branch. The transfer was evaluated on 3 parameters: surgical feasibility, length of the distal pedicle and distance from the coaptation site to the muscle entry of recipient nerve. A bilateral PQ pedicled transfer was accomplished in a 17-month old child with bilateral radial deficiency. RESULTSIn the cadaver study, transfer of PQ to the APB was feasible and the distal end of the PQ transfer was reaching the radial side of the first metacarpophalangeal joint in all cases. The length of the distal pedicle on the transverse carpal artery was 38.5±0.20mm. The distance from coaptation of the FDM to the PQ muscle entry was 43.0±3.77mm. At 7 months, there was a cosmetic improvement of the thenar eminence, a bilateral M3 abduction of the thumb and a functional improvement from bilateral PQ pedicled transfer. CONCLUSIONSReconstruction of the APB may be achieved with a PQ pedicled transfer reinnervated, improving the function and the cosmetic aspect of the thenar eminence without sacrificing any function of the hand.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Retrospective observational survey-based study.
In France, intracranial aneurysm (IA) patients are managed by neurosurgeons and by interventional neuroradiologists. The growth of endovascular ...treatment led us to reflect on the role of neurosurgeons in the management of patients with IA. The present study aimed to highlight the current organization of IA management in France.
A 60-question survey was sent to the neurosurgeons in 34 hospitals managing IA patients. Thirty-three questions dealt with standards of care, follow-up procedures and the involvement of the specific specialist.
Twenty-seven centers (79.4%) responded to the survey. A Vascular Multidisciplinary Discussion Team was organized, including both surgeons and neuroradiologists, in 92% of responding centers. There were department protocols in 66% of centers, a local registry in 33% and clinical trials in IA in 60%. Patients with unruptured IA were first seen by a neurosurgeon or by an interventional neuroradiologist, with different practices. For ruptured IA, the neurosurgeons were contacted first in 93% of cases, and were systematically involved in initial intensive care unit management. The patients were hospitalized in the neurosurgery department in 89% of the centers. The neurosurgeons took care of initial follow-up in 85% of the centers, and of lifetime follow-up in 36%. In most centers, radiological monitoring of IA was based on MRI angiography for patients who were embolized or under surveillance, and on CT angiography after microsurgery.
Despite the growth of endovascular treatments, the present survey and the literature highlight a major role of neurosurgeons in treatment, follow-up and care coordination.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Observational retrospective survey-based study.
Intracranial aneurysms (IA) can be treated with microsurgery or by endovascular treatments (EVT). EVT have taken an increasingly important part in IA ...management; the ability of neurosurgical teams to perform such surgery as well as the quality of their training is being questioned. We therefore wanted to assess the proportion of IA treated by microsurgery in France, the demography and caseload of surgeons trained in vascular neurosurgery.
A 60-question survey was sent to the 34 French neurosurgical centers treating IA. Twenty-seven questions dealt with the demography of neurovascular surgeons and caseload. Descriptive data are reported here.
Twenty-seven centers answered, giving us a response rate of 79.4%. A total of 209 neurosurgeons worked in these centers. Forty-six neurosurgeons were designated as referents in vascular neurosurgery, 47% of them were under 45 years old. Among the centers, 96.3% had at least one surgeon that was a referent in neurovascular surgery. A total of 88 surgeons performed IA surgery, but only 11 operated more than 20 IA per year. Two thousand four hundred and thirty seven unruptured IA were treated every year in these centers, 25% of which by microsurgery. A total of 2727 ruptured IA were treated in these centers, of which 15% were treated by microsurgery. The most common indications for microsurgical treatment of IA were: middle cerebral artery aneurysms, wide-neck intracranial aneurysms, and giant intracranial aneurysms, as well as aneurysms associated with a hematoma for the ruptured ones.
Demography of vascular neurosurgeons remains favorable, with a referent neurosurgeon in most centers, who, in half of the cases, is a young practitioner. The percentage of microsurgery in the treatment of IA is low, especially for ruptured ones. The most frequently operated types of intracranial aneurysm correspond to good practice recommendations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
La voie endoscopique endonasale transphénoïdale est la voie préférentielle de la chirurgie de l’adénome hypophysaire. Cette voie traverse la muqueuse sphénoïdale (MS). Peu de données existent dans la ...littérature concernant son éventuelle atteinte dans ce contexte. L’objectif de ce travail a été d’établir la fréquence de l’atteinte de la MS par analyse histologique, et de son intérêt sur le plan clinique. Méthodes Étaient comme suit : – étude prospective observationnelle ; patients opérés par voie transphénoïdale ; – données démographiques, type d’adénome (taille, sécrétion) étudiés ; – histologie : présence d’une inflammation ou d’une infiltration de la MS, d’une infiltration de la dure-mère, du caractère complet ou non de la chirurgie ; – guérison à 3 mois, si absence de récidive sur l’IRM et d’hypersécrétion. Résultats Étaient comme suit : – quarante-cinq patients inclus ; âge 56,4 ans (22–86) ; sex-ratio 0,53 ; 91 % macro-adénomes ; 5 cas d’apoplexie ; – sécrétion : gonadotropes 49 %, somatotropes 27 %, corticotropes 13 %, lactotrope 2 %, mixtes 6 % ; – anatomopathologie : inflammation de la MS dans 89 % des cas (80 % des apoplexies), infiltration dans 9 % (toujours avec inflammation), infiltration de la dure-mère dans 51 %. Exérèse complète dans 38 % ; – Guérison dans 33 % ; – Corrélation entre infiltration de la MS et infiltration de la dure-mère en histologie ( p = 0,04 ; test de Pearson-Chi2 ). Absence de corrélation avec les autres critères étudiés. Conclusion L’atteinte de la MS semble fréquente : son infiltration, contrairement à celle de la dure-mère, apporte peu d’intérêt sur le plan clinique. D’autres études sont nécessaires pour déterminer l’éventuel rôle pronostique de son inflammation, notamment dans l’apoplexie hypophysaire comme suggéré par ailleurs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Highlights • We examine surgical site infection risk in doing two procedures in the same time. • We recorded patients in intensive care unit. • Tracheotomy and ventriculoperitoneal shunt were ...studied. • We report the feasibility of both procedures with different contamination class.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Most intra-cranial arachnoid cysts are quiescent and remain asymptomatic throughout life. Within the natural course of arachnoid cyst evolution, spontaneous resolution has been known to occur rarely, ...but its frequency is probably underestimated due to lack of systematic detection and long-term observation. We illustrate the spontaneous regression of arachnoid cysts with a patient which was conjointly diagnosed with an arachnoid cyst and a post-traumatic epidural haematoma. Cyst regression was observed 16 months later, upon examination following a second benign cranial trauma. Mechanisms underlying the resolution of the arachnoid cyst are discussed.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Hours attributed to teaching anatomy have been reduced in medical curricula through out the world. In consequence, changes in anatomical curriculum as well as in teaching methods are becoming ...necessary. New methods of teaching are being evaluated. We present in the following paper an example of interactive anatomical teaching associating topographic anatomy with ultrasonographic radiological anatomy. The aim was to explicitly show anatomical structures of the knee and the ankle through dissection and ultrasonography.
One cadaver was used as an ultrasonographic model and the other was dissected. Anatomy of the knee and ankle articulations was studied through dissection and ultrasonography.
The students were able to simultaneously assimilate both anatomical aspects of radiological and topographic anatomy. They found the teaching very helpful and practical.
This body of work provides example of a teaching method combining two important aspects of anatomy to help the students understand both aspects simultaneously.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Introduction Inferolateral pontine infarcts are well-described lesions of the anterior inferior cerebellar artery territory with a wide variety of clinical presentations. We report the case ...of isolated unilateral hearing loss and contralateral sensation of coldness due to a dorsolateral lower pontine infarct. Case description We describe the case of a 48-year-old female patient who developed isolated selective high-frequency hearing loss on the left side, and contralateral hemibody sensation of coldness. MRI showed a left-sided dorsolateral lower pontine ischemic lesion. A subsequent angiogram revealed the lesion to result from the spontaneous dissection of a long circumferential branch of the basilar artery. Conclusion To our knowledge, this is the first reported case of a vascular alternating syndrome consisting of isolated ipsilateral hearing loss and contralateral thermal dysesthesia from a dorsolateral lower pontine infarct. Occlusion of a long perforating branch of the basilar artery and consequent posterolateral lower pontine infarct may result in an alternating syndrome with subtle clinical symptoms. Knowledge of this type of syndrome may direct physicians towards the diagnosis of a dorsolateral lower pontine infarct, despite vague clinical complaints.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
