Neurochirurgie
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Ewing's sarcoma is found exceptionally as a primary epidural tumor of the spine. Four cases of extraosseous Ewing's sarcoma of the spinal epidural space are presented. Another 17 cases were found in the pertinent literature and are discussed. ⋯ Most patients received radiation therapy and chemotherapy. Twelve patients died, 1 to 54 months (mean, 18) after diagnosis. Even though the number of patients was too small in this series for statistical analysis, partially resected tumors do appear to be associated with a higher mortality.
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We report an unusual case of epidermoid cyst located in the cavernous sinus. Only two cases of epidermoid cyst of the cavernous sinus have been reported in the literature. In 1995, a 61-year-old man experienced diplopia, which resolved spontaneously. ⋯ The patient was discharged on day 5 after surgery. These techniques provided a good view of the tumor without orbitozygomatic or zygomatic osteotomy. The 30 neuroendoscope allowed visual control of tumor removal that was better than a direct microscope view.
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We report long-term results of posterior sacral root rhizotomies in combination with Finetech-Brindley anterior sacral root stimulators implanted intradurally in 20 spinal cord injury patients. ⋯ Sacral anterior root stimulation combined with sacral posterior rhizotomy is a valuable method to restore bladder functions in spinal cord injured patients suffering from hyperactive bladder refractory to medical therapy.
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We report two cases of leptomeningeal metastatic dissemination to the spinal cord of a grade B oligodendroglioma. Diagnosis was suspected on MRI but imaging findings were nonspecific. ⋯ Chemotherapy after radiotherapy appears to improve outcome. Nevertheless, prognosis remains very poor.
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Review Clinical Trial
[Management of intractable cancer pain: from intrathecal morphine to cell allograft].
The durable effectiveness of intrathecal morphine administration is well established for the management of intractable cancer pain, after failure of systemic opioids, secondary to the persistence of non-reversible undesirable side effects. Many patients are referred to late in the disease course. This conservative method to control pain of malignant origin must not be reserved for last resort treatment for terminal patients. ⋯ Convincing evidence will require controlled studies. The limitations of this innovative cell therapy and especially the lack of human adrenal gland availability point to the need for new sources of cells. Perspectives include xenogenic or engineered cell lines.