Biomedical subjects
Publications and source records attributed to F Lesoin.
The authors report two cases of chiasmatic tuberculomas. They emphasize that diagnosis is still difficult despite CT scan if a picture of tuberculous meningitis is lacking. Surgical approach may be justified when diagnosis remains uncertain, especially as tuberculoma is sometimes responsible for recurrent meningitis.
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On the grounds of studies carried out in the last ten years, the authors criticize the usual classification of comas and question the Glasgow scale (opening of eyes, verbal answer, motor response). Their description of brain stem injury by axial herniation and explanation of the role of diffuse encephalic lesions causing intracranial hypertension is based upon anatomo-clinical findings and results of investigations in comatose patients with head injury. For prognostic purposes, a simple and fairly reliable classification of post-traumatic comas is proposed. Comas are divided into five stages of rostro-caudal destructuration (cortico-sub-cortical, diencephalic, meso-diencephalic, mesencephalic and pontic) by studying the response to pain (unadapted, adapted, absent) and four brain stem reflexes (fronto-orbicular, vertical and horizontal oculocephalic, light reflexes).
Twenty-three cases of acute spinal epidural infection due to common pathogens were retrospectively studied. Pain is not always present initially and usually appears 15 to 32 days after the primary infection, which is only found in one-half of the cases. When established, the condition is characterized by spinal rigidity, signs of infection, and compression of the cord or cauda equina. The diagnosis is confirmed by surgery, radiology (myelographic blockade, spondylodiscitis) or the finding of pus in the epidural space at lumbar puncture. A frequently delayed diagnosis explains the poor prognosis of these infections. Treatment should always include an antibiotic active against staphylococci, which are by far the most common pathogens. The indications for surgery are discussed in the light of published data compared to the authors' own experience.
Severe head injury often produces complex intracranial displacements of the brain, resulting in widespread, often microscopic lesions. These are responsible for two types of edema: vasogenic edema, with outflow of molecules and fluid into the extracellular spaces by rupture of the blood-brain barrier and vasoplegia, and cytotoxic edema, with swelling of astrocytes due to membrane lesions. The connexions between these two types of edema are still obscure. Alterations in membrane phospholipids may impede function of Na-K pump enzymes, causing accumulation of water in the cell. Cerebral edema is responsible for intracranial hypertension and tentorial herniation, which in turn increase edema through venous compression, ischemia, and hypoxia. The least controversial anti-edema therapeutic measures include relative fluid and salt restriction, mannitol if called for, neuroplegia, in particular with diazepam and Gamma-OH, and assisted ventilation.
Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.
The authors report on their experience with the use of a reinforced acrylic prosthesis in cervical spine pathology. The study of their own 45 cases enables the advantages and disadvantages of the technique to be demonstrated. A discussion of possible improvements in the technique and its indication completes the report.
The case report here deals with an intracavernous arterial aneurysm spontaneously developing into a carotid-cavernous fistula. The etiopathology of these fistulas is discussed.
Based on the study of 10 cases of post traumatic spinal arachnoid cysts (SAC), acute and chronic clinical variants are individualized. A physiopathological hypothesis is advanced to explain their mechanism of formation. Acute SACs should be operated upon immediately although the differential diagnosis with spinal epidural haematomas is difficult. Even more difficult is the diagnosis of the chronic SAC. Rare though it may be, the Neurosurgeon must be aware of the possibility of its occurrence, especially when treating rather vague and stubborn cases.
We describe the use of a transcervical-transclival approach in the treatment of an ascending luxation of the odontoid by rheumatoid arthritis. We favor this approach and use of methylmethacrylate in this rare condition. Other applications of this route which gives access to the craniocervical junction are discussed.
Chemonucleolysis is widely used in the treatment of disease of the lumbar intervertebral disk. From a series of 28 patients, the authors report their experience using this technique at the cervical level using aprotinin instead of chymopapain.
Between 1949 and 1982, 290 patients were operated on for lesions of the lower cervical spine. Since 1970 the combined use of the anterior approach and more and more sophisticated osteosynthesis equipment has led us to revise our therapeutic policy with regard to 160 patients. The results, advantages, and disadvantages of this policy are discussed hereafter.
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Spinal dysraphia with stretching of the spinal cord is usually diagnosed in the adolescent or young-adult patient. Two types of the condition are distinguished: a stretched spinal cord with an intradural lipoma, and a stretched spinal cord with both an intra- and extradural lipoma. The pathogenesis of the condition and mechanical role of the lipoma and the late appearing neurological signs are presented.
Based on a series of 500 operated intracranial aneurysms in 486 patients, we have analyzed the results of current neurosurgical treatment. The overall results (75% cures, 13% poor results, 12% deaths) depend on several factors, which have all to be analyzed: the age and general condition of the patient; the topography and mode of rupture of the aneurysm; and the timing of the surgical intervention.
A case of post traumatic retrograde amnesia is described. The patient presented after an initial coma a global amnesia, but the fixation deficit rapidly disappeared, and a severe retrograde amnesia dating back to childhood experience and learning remained the main symptom. Amnesia for remote events was associated with didactic memory deficit and, at a lesser degree, with a verbal memory deficit. Recovery of fixation allowed a progressive relearning. This pattern of impairment was recently related to mesencephalic lesions, but we think that the role of temporal lobe involvement cannot be neglected.
A case of giant intrasacral schwannoma is reported. This tumour was revealed by a lumbosacral pain without any neurological deficit. It appears that the lesion is surrounded by a dense layer of nucleated cells which resemble immature cells. This corona of young cells could explain the tremendous size of this tumour.
A case of hemangiopericytic meningioma of the pineal region is reported. We discuss the origin of meningiomas in this region and their histological nature. The rapid recurrence in situ of the tumor in this particular case seems to confirm the need to complement surgery with radiation therapy.