Neurochirurgie
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Acute traumatic central cord syndrome (ATCCS) is the most common type of incomplete spinal cord injury, characterized by predominant upper extremity weakness, and less severe sensory and bladder dysfunction. ATCCS is thought to result from post-traumatic centro-medullary hemorrhage and edema, or, as more recently proposed, from a Wallerian degeneration, as a consequence of spinal cord pinching in a narrowed canal. ⋯ Surgical management of ATCCS consists of posterior, anterior or combined approaches, in order to achieve spinal cord decompression, with or without stabilization. The benefits of early surgical decompression in the setting of ATCCS remain controversial due to the lack of clinical randomized trials; recent studies suggest that early surgery (less than 72hours after trauma) appears to be safe and effective, especially for patients with evidence of focal anatomical cord compression.
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Intracranial hypertension is an emergency suspected from clinical symptoms, imaging data and ophthalomologic signs. Intracranial hypertension is confirmed by invasive intracranial monitoring, which is the gold standard technique to measure intracranial pressure (ICP). ⋯ We have reviewed ONSD technique that detects intracranial hypertension related volume variations of subarachnoid space along the retro bulbar segment of the optic nerve. Technique, indications and prospects are discussed.
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Surgery for diffuse low-grade glioma (DLGG) was debated for a long time. Discrepancies in the classical literature are mainly due to the lack of objective radiological assessment of the extent of resection (EOR). Here, the goal is to review the recent data on oncological and functional outcomes. ⋯ These recent data strongly argue in favor of achieving a maximal resection of DLGG as the first therapeutic option. Biopsy should be considered only in very diffuse lesions (gliomatosis) or when a subtotal resection is not a priori possible. Thus, neurosurgeons should change their mind, by operating the brain involved by a chronic tumoral disease rather than by trying to remove a "tumor mass". The aim is not to achieve a simple "tumorectomy", but the most extensive resection of the brain invaded by DLGG, on the condition that this part of the brain is not crucial for cerebral functions. This new philosophy suggests to perform early and maximal resection according to functional (and not purely oncological or anatomical) boundaries in awake patients. This perspective is the best way to build a personalized "functional surgical neuro-oncology".
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Cortical spreading depolarization waves (CSD) are massive temporary neuronal depolarizations that slowly propagate through cerebral cortex from brain injured tissue. CSD waves cause temporary brain electrical silence, local tissue hemodynamic responses and metabolic increases required for cellular repolarization. Due to this metabolic imbalance in compromised tissue, CSD could participate in the extension of secondary insults after brain injury. From the analysis of the human literature, we aimed at determine the CSD incidences in brain injured patients. ⋯ When monitoring tools are available, CSD occur in more than 50% of brain injured patients. Today results come from clinical research. Future studies are necessary to determine the impact of CSD detection on care and potential therapeutics aimed at counteracting these adverse events.
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Review
[Surgery of high-grade gliomas guided by fluorescence: a retrospective study of 22 patients].
Optimal surgical resection improves the prognosis of glioblastomas. However, this goal is far from being achieved due to its invasive nature. Several studies have already shown the efficacy of fluorescence-guided surgery, in improving the quality of resection of glioblastoma. We report herein our experience through a retrospective serie and describe the principles, limitations and advantages of this technique. ⋯ Our study confirms the use of fluorescence as an effective method to allow optimal resection of glioblastoma. In addition to neuronavigation, surgical experience, vision and proprioception, fluorescence contributes to achieve a complete tumor resection.