Biomedical subjects
Publications and source records attributed to F Lesoin.
The authors describe the technique of orbito-fronto-temporo-pterional bone flap in block. They underline its interest for the treatment of aneurysms at an early stage because its angle is very tangential.
The authors describe the surgical technique of atlanto-axial fixation using a transcervical anterior approach. The cartilage of the articular processes of C1 and C2 are excised. A screw fixation of the articular processes is performed with two spongious screws. These are perpendicular to the articular surfaces. The trend is to obtain a bilateral articular fusion. The indications are discussed.
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A 23 year-old man, with a two month-history of back pain, presented with spastic paraplegia and hypesthesia of both lower limbs. A myelo C.T. revealed a spinal epidural dumb bell-shaped mass extending in the intra and extra vertebral spaces through the enlarged intervertebral foramen. Total recovery was observed three months after surgery. Pathological examination of the tumor showed it to be a cavernous angioma. Primary epidural angioma is rare: in 2 reported dumb bell-shaped spinal epidural cavernous angiomas, radiological findings were also suggesting a spinal neurinoma.
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Surgeons are increasingly requested to resect dorsal disk herniation. The methods for pre- or peroperative localization of such lesions require a precision that is difficult to obtain with the usual methods. We suggest the needle and marker wire technique, a preoperative invasive technique the accuracy of which has been proven for preoperative localization of non-palpable breast lesions.
A case of astereognosis and amyotrophy of the right hand is reported, which was caused by a large extradural neurinoma of the C2 nerve root. The quick and complete recovery which followed surgery suggested a vascular mechanism as the cause of the neurological deficits.
The authors report 165 cases of thoraco-lumbar lesions with neurological dysfunction. All the patient were operated. They analyze the neurological and mechanical results and indicate the use of different osteosynthesis apparatus according to the type and level of lesions. Harrington's rods seem to give more precise repositioning while Roy Camille's plates give more stability. When the posterior wall of the spinal canal is intact, Kempf's compression rods can be used. Thoraxic spine injuries seem to be an indication for Harrington's rods, while lumbar injuries seem to call for Camille's plates.
The authors describe an orbito-zygomatic-malar bone flap approach which gives lateral extra-cerebral access to the internal base of the skull. The technique is described, and some of the situations in which it has been used are discussed.
Over a period of 18 years the authors have collected together 230 cases of herniation cervical discs. Multifactor analysis of the results of the various therapies is given. Surgical decompression has been done, mostly using an anterior approach, and it effectively treats the radicular damage; it stabilizes and improves spinal cord deficits whether the herniation is spontaneous or traumatic, acute or chronic. Computed tomography facilitates its anatomical identification and the decision regarding the therapy to apply.
Tumours of the spine occasionally also present with an intra-thoracic extension. The authors report on a technique which permits the complete removal of these hourglass lesions at a single operation by transversoarthropediculocostectomy. Its advantages and disadvantages are discussed and the results in 6 patients presented.
The authors outline the possible approaches to vertebromedullary tumours of the thoraco-lumbar spine using unilateral or bilateral transverso-arthro-pediculectomy and corporectomy. In a personal series of 20 cases. The technique and indications are described and the results.
The authors described the monobloc fronto-temperal-pterional flap bone technique. They underline its usefulness in the treatment of aneurysms at an early stage on account of the highly tangential approach used.
Neurinomas of the trigeminal nerve are rare. Based on an analysis of the published cases and on six additional cases of our own classification into three types is proposed: Type I: neurinoma of the roots in the posterior fossa, Type II: neurinoma of the Gasserian ganglion, Type III: neurinoma of the trigeminal branches. This classification allows a better adaptation of the surgical procedure to the individual case. The trigeminal nerve originates from a sensory root and a motor root which emerge from the pons and gain the middle cranial fossa floor over the apex of the petrousrigde before forming the Gasserian ganglion. The three branches of the trigeminal nerve originate at the Gasserian ganglion. Neurinomas of this nerve are relatively rare, as there are only 183 published cases. A study of the literature reveals that their incidence among brain tumours is from 0.2 to 0.4% according to the authors. Based on the published material and six personal cases and also on the anatomical, clinical and neuroradiological findings three major types of neurinomas of the trigeminal nerve can be distinguished according to their origin: neurinomas developed in the posterior fossa (type I) on the nerve roots, neurinomas of the Gasserian ganglion (type II) developed in the temporal fossa and neurinomas of the branches of the trigeminal nerve (type III). Transitional forms between the various types are possible and express special conditions of development. Each of these topographical forms has a specific clinical and radiological picture and each requires specific surgical treatment. This will be demonstrated by analysing our own six cases and the cases reported in the literature.
Between 1960 and 1 June 1985, 21 patients were operated for thoracic disc herniations. The advent of new operative techniques (with transverso-arthropediculectomy) has brought about new indications in the management of such disorders. These new indications are important because such protrusions may be abruptly complicate by compression of blood vessels, which may produce abrupt and irreversible neurological deficit. The progress in the radiological examinations allows a more precise study of the topography and density of the hernia. Furthermore, the use of a surgical microscope and microsurgical techniques allow a surgical treatment without preoperative medullary angiography.
The transclival-transcervical approach to lesions of the craniocervical junction is described. It gives reasonable access to the lower part of the clivus and to C1 and C2 for removal to tumours and stabilization of fractures and otherwise caused dislocations of this region. Because an opening of the pharynx can be avoided, reconstruction work can be done using bone graft or reinforced methyl-methacrylate without risk of infectious contamination. The results obtained in 6 cases are presented.