Neurochirurgie
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Incidentally discovered diffuse low-grade gliomas progress in a fashion similar to their symptomatic counterparts. Their early detection allows more effective pre-emptive and individualized oncological treatment. We assessed the safety and efficacy of maximal safe resection according to functional boundaries for incidental diffuse low-grade gliomas in eloquent areas. ⋯ These results suggest the reproducibility, safety, and effectiveness of an early maximal functionally based resection within cortico-subcortical functional boundaries for incidental diffuse low-grade gliomas in adults in centres hyperspecialized in surgical neuro-oncology.
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Awake craniotomy for brain tumor resection is usually well-tolerated and most of the patients are satisfied. However, in studies reporting the patients' postoperative perception of the awake craniotomy procedure, about half of them have experienced some degree of intraoperative pain. Pain was mild (intensity between 1 and 2 on the visual analogical score) short lasting in most cases, and did not challenge the procedure. Pain was reported as moderate in about 25% and exceptionally severe. ⋯ Strategies to deal with these causes included focusing the patient on the intraoperative functional tests to distract their attention away from the pain, and avoiding contacts with the pain-sensitive intracranial structures during the awake phase. Adequate preoperative patient information and preparation, trained anesthesiologists and application of recommendations for awake craniotomy procedures as well as adaptation of surgical technique to avoid contact with pain-sensitive intracranial structures are key factors to prevent intraoperative pain and ensure patient's postoperative satisfaction.
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Dysembryoplastic neuroepithelial tumors and gangliogliomas are developmental glioneuronal tumors usually revealed by partial epilepsy. High epileptogenicity, childhood epilepsy onset, drug-resistance, temporal location, and seizure freedom after complete resection are common characteristics of both tumors. We report the specificity of surgical management, functional results and seizure outcome in cases of a tumor location in eloquent areas. ⋯ Epilepsy surgery for benign glioneuronal tumors in eloquent areas provides acceptable results regarding the functional risks. Complete tumor resection is crucial for long-term favorable outcome.
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Review Case Reports
Partial cauda equina syndrome after an uneventful minimally invasive microdiscectomy in a patient with Crohn's disease.
Cauda equina syndrome is a serious condition resulting from dysfunction of the lumbosacral nerve roots and characterized by impairment of bladder, bowel, sexual and lower limb functions. We report the case of a 48-year-old woman who had Crohn's disease for more than twenty years. ⋯ A postoperative magnetic resonance imaging examination showed root clumping but no compressive lesion. We discuss a possible relationship between the cauda equina syndrome and the patient's active Crohn's disease, treatment and surgery.
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Case Reports
Impact of surgical correction of a U-shaped sacral fracture on sagittal spino-pelvic alignment: Regarding one case.
U-shaped sacral fractures are uncommon and are mostly the consequence of a high-energy kinetic trauma. The sacrum is a crucial element for sagittal alignment in a standing position as it determines the value of the pelvic incidence, which is a fixed and unchanging parameter for a given individual. We report the case of a 21-year-old man who underwent corrective surgery for a type II U-shaped fracture of the sacrum (according to the Roy-Camille classification), associated with a S1-S2 dislocation and sacral kyphosis that modified the patient's pelvic incidence. ⋯ The surgery was managed for neurological decompression, stabilization of the fracture and correction of sacral kyphosis. The restoration of the theoretical pelvic incidence depended on the estimated lumbar lordosis. The aim of this study was to highlight the particularities in the management of a sacral U-shaped fracture and their relationship with the sagittal alignment.