Biomedical subjects
Publications and source records attributed to F Lesoin.
Surgery of the dorsolumbar spine is currently benefiting from diverse approaches and the advent of computed tomography. This report describes a bilateral posterolateral approach with transversoarthropediculectomy and corporectomy. The advantages and disadvantages of this approach and its indications are discussed.
Surgeons are increasingly required to resect disk herniations. Methods for preoperative or perioperative localization of such lesions require precision. This is difficult to achieve using the usual methods. We propose the use of a preoperative invasive technique: needle and marker wire. Its precision has been proved for preoperative localization of nonpalpable breast lesions.
A transsternal biclavicular approach to the anterior face of the upper thoracic spine (T-1 to T-4) is described, and the advantages, disadvantages, and indications of the technique are discussed.
A syringoperitoneal shunt is a one-way drain that empties cerebrospinal fluid from the pathological syringomyelic cavity into the abdomen. This treatment technique is based on the principle that the signs and symptoms of syringomyelia are caused by insidious interference with the condition of nerve signals in the spinal cord tracts due to either tearing or compression of the tracts by the distended cavity. A series of eight patients suffering from this disorder were operated upon using a syringoperitoneal shunt. The initial results seem to indicate that this technique is especially useful when pain, atrophy, or both dominate the clinical picture. Clinical signs, diagnostic studies, and surgical considerations are discussed.
The amnesic syndrome is analysed in 6 infarctions restricted to the thalamic area. Bilateral lesions were linked to more definite deficits; the anterograde forgetting was unequivocal at the initial stage and affected both verbal and visual memory. In unilateral lesions, deficits were far more discrete and there was no evidence enough for assuming a strict hemispheric specialisation, left for verbal memory, and right for visual memory. These cases and others from the literature suggested that amnesia is more important and pure in infarctions of the anterior part of the thalamus.
A case of Balint syndrome with bilateral parietal infarction is presented. Analysis shows the tight intrication of visual inattention and psychic gaze palsy. The deficit of visuo-manual adjustment is characterized by a fixed divergence between the target and the point where the patient places his hand, either in ballistic movements (classical optic ataxia), either in pursuit movements; for this reason, a simple disconnexion should not explain the classic optic ataxia. The discretion of aphasia allows the individualization of an anterograde and partially retrograde amnesia.
Most spiral neurinomas are intradural extramedullary tumours. Intramedullary neurinomas are rare: only 20 cases have been published. The authors report a new case of solitary intramedullary dorsal neurinoma and review the main diagnostic and therapeutic problems raised by this type of tumour.
Two cases of retroclival arachnoid cyst are presented. The clinical symptoms, putting aside the hydrocephalus, are dominated by pyramidal signs, oculomotor disorders and ataxia. In both cases, a posterior suprasellar extension was found as in the previous descriptions in the literature. This shows the close pathological relations of these cysts to the more classic suprasellar cysts.
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The authors report their experiences using the anterior approach and osteosynthesis for recent fractures of the pedicles of the axis in eight patients. They describe the transcervical transclival approach and osteosynthesis and discuss the advantages of and indications for this approach.
Chemonucleolysis is widely used in the treatment of disease of the lumbar intervertebral disk. From a series of 34 patients the authors report their experience using this technique at the cervical level using aprotinin instead of chymopapain in cervical soft disk protrusion. They underline the technique, mechanism of aprotinin and indications.
13 cases of severe intracranial postoperative infections, abscesses and/or empyema, are reported. These lesions, whose clinical diagnosis is often difficult, have benefited from C.T. scan. The diffusion of the infectious process in operatory focus, the frequency of Staphylococcal origin and the importance of high doses antibiotherapy must be underlined. This one is, of course, an indispensable complement to reintervention, but it may be utilized alone with success in selected cases, or insure the definitive cure when reintervention is partial.
A case of septo-optic dysplasia, presenting with focal epileptic fits in a 29 year old man, is described. Gas encephalography and CT scan demonstrated the main features of the malformation: a single ventricle overhanging a narrowed third ventricle, abnormal mass in the basal forebrain corresponding to an embryonic cyst, optic atrophy. Angiography revealed deep venous anomalies, and, in particular, absence or hypoplasia of the sinus recti.
Cerebral blood flow measurements with single photon emission tomography and 133Xe inhalation was performed in 18 patients with hematomas, 14 thalamo-capsular, 4 capsulo-lenticular. In thalamo-capsular cases and in standard conditions, ipsilateral hemispheric C.B.F. and contralateral cerebellar C.B.F. were decreased; a concomitant depression of frontal and temporal C.B.F. was often noted. A similar change was found in capsulo-lenticular cases, the frontal C.B.F. being however less depressed. An attenuation of interhemispheric asymmetry was often found after acetazolamide intravenous injection. A significant correlation was demonstrated between interhemispheric asymmetry index (AI) and frontal and temporal AI.
The authors describe the use of orbito-fronto-temporo-malar for sphenoidal meningiomas. The resection is followed by bone reconstruction. They discuss the advantages and indications for this approach and reconstruction.
Treatment of chronic subdural haematomas is subject to controversies. The progressive, continuous closed system drainage may progressively restore++ intracranial pressure unbalance, linked to disequilibrium between subdural collection and collapsed brain.
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The approach of thoracocervical spine junction is sometimes difficult. The authors expose a technique to realize the exposition of the lower cervical spine and upper thoracic vertebrae (T1 to T4). An anatomical reconstruction is performed. Advantages and inconveniences of this approach are exposed before underline its indications.