Neurochirurgie
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Case Reports
Chiasmatic cavernoma haemorrhage: To treat or not to treat? Concerning a clinical case.
We present the case of a 43-year-old man with acute visual loss due to an optic chiasm cavernoma. Our clinical and imaging findings quickly led us to this diagnosis. ⋯ The visual evolution was satisfactory and, to date after a 36-months follow-up, no clinical worsening has been reported. We present this clinical case regarding our approach, primarily a close follow-up, as well as a review of the literature.
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Minimally invasive surgery has expanded over the past two decades and was initially used for the treatment of lumbar disc herniation. Later, this approach was used to treat other spine pathologies, as well as to perform spinal fusion and extended spinal decompression. In this study, we report our experience regarding the use of a minimal surgical approach in the treatment of intradural extramedullary spinal cord tumours. ⋯ A minimal surgical approach using a tubular retractor permits an effective resection of intradural extramedullary tumours. This procedure may be a useful tool to decrease the risk of secondary spine instability and postoperative kyphosis, and could also be used for spinal junctions and in fragile patients.
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Persistent traumatic peroneal nerve palsy, following nerve surgery failure, is usually treated by tendon transfer or more recently by tibial nerve transfer. However, when there is destruction of the tibial anterior muscle, an isolated nerve transfer is not possible. In this article, we present the key steps and surgical tips for the Ninkovic procedure including transposition of the neurotized lateral gastrocnemius muscle with the aim of restoring active voluntary dorsiflexion. ⋯ Early clinical results after neurotized lateral gastrocnemius muscle transfer appear excellent; however, they still need to be compared with conventional tendon transfer procedures. Clinical studies are likely to be conducted in this area largely due to the frequency of persistant peroneal nerve palsy and the limitations of functional options in cases of longstanding peripheral nerve palsy, anterior tibial muscle atrophy or destruction.
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Comparative Study
[Assessment of the surgeon radiation exposure during a minimally invasive TLIF: Comparison between fluoroscopy and O-arm system].
Transforaminal lumbar interbody fusion with a minimally invasive approach (MIS TLIF) has become a very popular technique in the treatment of degenerative diseases of the lumbar spine, as it allows a decrease in muscle iatrogenic. However, iterative radiological controls inherent to this technique are responsible for a significant increase in exposure to ionizing radiation for the surgeon. New techniques for radiological guidance (O-arm navigation-assisted) would overcome this drawback, but this remains unproven. ⋯ The maximum recommended doses can be reached, mainly for the lens. In addition to the radioprotection measures, O-arm navigation systems are safe alternatives to significantly reduce surgeon exposure.
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Hemifacial spasm (HFS) is a chronic facial nerve disorder characterized by spontaneous muscle contractions. Microvascular decompression (MVD) is the neurosurgical treatment of choice. Intraoperative neurophysiologic monitoring (IOM) during MVD can help determine when adequate decompression is performed. ⋯ Evaluation of the LSR by monitoring of two lower facial muscles provides valuable neurosurgical guidance during MVD for HFS. This simple modification of intra-operative monitoring may improve prediction of satisfactory MVD and HFS resolution.