Biomedical subjects

Jean-Marc Vital

Publications and source records attributed to Jean-Marc Vital.

2 recordsLinked to original sources

PubMed2004

Surgical treatment of greater occipital neuralgia by neurolysis of the greater occipital nerve and sectioning of the inferior oblique muscle.

OBJECTIVES: To evaluate a new surgical treatment consisting of neurolysis of the great occipital nerve and section of the inferior oblique muscle. DESIGN.: A retrospective study of 10 patients operated for greater occipital neuralgia. SUMMARY AND BACKGROUND DATA: This technique is based on a previous anatomic cadaver study. The greater occipital nerve is stretched by the inferior oblique muscle of the head during flexion of the cervical spine. Sectioning this muscle relaxes the greater occipital nerve. With this procedure, the authors systematically associate release of the nerve down to the inferior edge of the inferior oblique muscle. METHODS: A retrospective study was conducted of 10 patients operated on from January 1998 to December 1999 for greater occipital neuralgia. All the patients had pain exacerbated by flexion of the cervical spine. The average age of the patients was 62 years. The mean follow-up of the series was 37 months. The results of the treatment were assessed according to three criteria: 1) degree of pain on a Visual Analogue Scale before surgery, at 3 months, and at last follow-up; 2) consumption of analgesics before surgery and at follow-up; and 3) the degree of patient satisfaction at follow-up. RESULTS: In three cases, anatomic anomalies were found. One patient had hypertrophy of the venous plexus around C2. In another, the nerve penetrated the inferior oblique muscle. The third had degenerative C1-C2 osteoarthritis requiring associated C1-C2 arthrodesis. The mean Visual Analogue Scale score was 80/100 before surgery and 20/100 at last follow-up. Consumption of analgesics decreased in all patients. Seven of the 10 patients were very satisfied or satisfied with the operation. CONCLUSION: This surgical technique gives good results on greater occipital neuralgia if patients are well chosen. Nerve release is justified by the frequency of associated anatomic abnormalities.

Adult↗

PubMed2003

Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy.

PURPOSE: To evaluate diffusion-weighted magnetic resonance (MR) imaging in patients with cervical spondylosis and/or myelopathy. MATERIALS AND METHODS: A multishot echo-planar imaging sequence with calculation of apparent diffusion coefficient (ADC) and apparent diffusion tensor (ADT) was applied in 36 patients with symptomatic cervical spondylosis. Diffusion-weighted images read by two neuroradiologists were compared with T2-weighted fast spin-echo images read independently by three neuroradiologists with regard to clinical status (n = 36). MR findings in a selected subgroup of 20 patients whose clinical status was confirmed by electrophysiologic examination also were compared. Sensitivity, specificity, positive predictive value, and negative predictive value of both T2-weighted imaging and diffusion-weighted imaging (ADC and ADT) were calculated and compared. RESULTS: Patients with myelopathy had abnormal ADC (17 of 21) and ADT (15 of 19) maps with increased ADC and ADT values and decreased anisotropy. For the detection of myelopathy, diffusion-weighted ADC maps had a sensitivity of 80% (17 of 21), while T2-weighted images had a sensitivity of 61% (13 of 21). The negative predictive value was 63% (seven of 11) and 60% (12 of 20) for ADC maps and T2-weighted images, respectively. Conversely, the specificity of diffusion-weighted images (53%; seven of 13) was lower than that of T2-weighted images (92%; 12 of 13). In patients with myelopathy confirmed at electrophysiologic examination, the sensitivity of diffusion-weighted images increased to 92% (12 of 13) and the negative predictive value increased to 75% (three of four), while T2-weighted images had a 53% (seven of 13) sensitivity and a 50% (six of 12) negative predictive value. CONCLUSION: Diffusion weighting improved the sensitivity of imaging in cervical spondylotic myelopathy.

Adult↗