Neurosurgery
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The development of new devices, especially controlled detachable coils, has made the endovascular approach one of the modalities for the treatment of intracranial aneurysms. We describe the treatment and present the results of 35 patients treated by selective occlusion of basilar artery aneurysms in our department during a period of 2 years (November 1992-November 1994). This period of time was chosen to analyze a homogeneous population treated since the introduction of controlled detachable coils and also to be able to have as many follow-up angiographic controls of the treated aneurysms as possible. ⋯ In this study, the morbidity-mortality rate of the endovascular technique is low (3%). If we include complications related to the subarachnoid bleeding, the morbidity-mortality rate remains low (8.8%) Regarding basilar artery aneurysms, endovascular treatment (selective occlusion by controlled detachable coils) is now useful for some patients, especially those with small aneurysms. However, long-term anatomic follow-up is needed to accurately evaluate the role of this treatment modality in the management of basilar aneurysms.
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We report 43 consecutive surgically treated patients with pyogenic (37 patients) and tuberculous (6 patients) osteomyelitis of the thoracic and lumbar spine encountered within an 8-year period, including 1 with late recurrence after 15 months. There were 24 men and 18 women, ranging in age from 21 to 83 years. Twenty-six patients were in poor general condition because of associated illnesses, especially diabetes mellitus. ⋯ Two patients required further surgery because of postoperative epidural hematoma and pedicle screw malpositioning. In conclusion, most patients with thoracic and lumbar osteomyelitis can be successfully treated by combined débridement and internal fixation using only a posterior approach. Autogenous interbody bone grafting can be simultaneously performed and allows early mobilization of the patient.
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In 99 patients with mass lesions in and around the central region, the central sulcus was intraoperatively localized with the use of somatosensory evoked potential (SEP) phase reversal. In 33 of these patients, the motor cortex was directly stimulated and electromyographic responses were recorded from the forearm flexor, thenar, and hypothenar muscles. An additional 25 patients, with subcortical lesions or lesions directly located at the pyramidal tract, were continuously monitored during surgery by motor evoked potentials (MEPs). ⋯ Concerning the safety of stimulation, the exact localization of the central sulcus by the noninvasive SEP method, compared with direct electrical stimulation, offered more safety for the patient. The modified technique of direct motor cortex stimulation needed much less charge density than did the common technique. The recording of electromyographic responses instead of movements made objective documentation possible, and the analysis of amplitudes and latencies will supply quantitative information about the motor system.
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Between January 1990 and December 1994, patients with subarachnoid hemorrhage related to ruptured aneurysms who were referred to our institution were treated by neurosurgical and neuroradiological teams. In each patient, the respective indications for neurosurgical or endovascular treatment were discussed, taking into consideration patients' age and the morphological and topographical aneurysm features. We report eight cases of patients with subarachnoid hemorrhage who underwent operations after primary endovascular procedures (Hunt and Hess scores III, IV, and V). ⋯ Aneurysm obliteration was easily performed, especially when the packing was partial, but was very difficult when the complete aneurysm closure led to a stenosis of the parent vessel. A giant sylvian aneurysm rest, visible only with angiography, was left untreated. This series illustrates an original experience, which led us to conclude that aneurysm surgery with coils in place is not as difficult as is often thought.
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Historical Article
The development of neurological surgery at the Salpétrière Hospital.
The development of neurological surgery at the Salpétrière Hospital is traced from its beginning, at the end of the 19th century, with reference to the historical aspect of the hospital itself, going back over 300 years. Early leading neurological surgeons and their achievements are described, and a summary of the present department of neurosurgery and its future plans is presented.