Neurochirurgie
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The aim of this study in patients with traumatic brain injury (TBI) was to assess the effectiveness of continuous cerebrospinal fluid (CSF) drainage in controlling intracranial pressure (ICP) and minimizing the use of other ICP-lowering interventions potentially associated with serious adverse events. ⋯ CSF drainage may not only lower ICP levels, but also decreases treatment intensity during the 24 hours following EVD placement in TBI patients. Because EVD placement may be associated with adverse event, the exact role for each of the available ICP-lowering interventions remains open to discussion.
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Deep brain stimulation (DBS) is an effective treatment of movement disorders and psychiatric diseases. However, this surgery is still time consuming and associated with complications, among which we aimed to identify non-stimulo-induced adverse effects. Hence, we retrospectively systematically analyzed patients operated on, at our institution, using magnetic resonance imaging (MRI) direct anatomic mapping. ⋯ DBS efficiency is recognized however the significant incidence of adverse effects should prompt us to improve the procedures.
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Seizures can occur in patients who have surgery for a chronic subdural hematoma. However, the incidence of seizures and their impact on the clinical course of patients in the perioperative period is not well known. ⋯ We have shown that patients suffering from seizures may have worse outcome. The benefit of a systematic perioperative prophylaxis using antiepileptic drugs has to be evaluated.
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The supply for diagnosis and treatment is inadequate in France for epileptic patients eligible for surgery. Our institution includes a Video-electroencephalography (v-EEG) unit and a general neurosurgery department. Our objective was to evaluate the efficacy and morbidity of the surgery performed in a center non-dedicated to epilepsy surgery. ⋯ Despite the small number of operated patients, the surgical treatment keeps its efficiency without adding morbidity. v-EEG centers combined with non-specialists neurosurgical teams can contribute to improve care without reducing their quality.
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Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. ⋯ After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered.