Biomedical subjects
Publications and source records attributed to M Jomin.
The authors report the use of bilateral posterolateral approach by transversoarthropediculectomy with corporectomy in dorso lumbar rachidian pathology. They discuss the advantages and inconvenience of this approach before propose its indications.
The association of a meningioma and an arachnoid cyst is one of the many association of cyst and meningioma. The diagnosis could be difficult by CT scan. We report three cases of parameningiomal cysts and discuss their different mechanism of formation before stressing practical problems.
SEP contribution to diagnosis is interesting but limited to hardly examined complete syndromes in an emergency care unit. The predictive value of SEP is high if electrophysiological data are correlated the 10th. day with the clinical status. A good prognostic value is shown when the clinical posterior column and pyramidal tract dysfunctions are equal in intensity and distribution, i.e. in complete syndromes or central spinal cord syndromes or Brown-Sequard's ones. However, not any correlation exists in cases of anterior spinal cord syndromes. Dg.EMG. is an easy, atraumatic useful tool for the clinician. It must be a systematic approach of the brain stem and cervical spinal cord phrenic centers vitality that may be involved by the trauma. When a respiratory deficiency occurs, it allows the diagnosis of a "peripheral" or "neurological" etiology. Its high prognostic value for m tor diaphragmatic function (increase or decrease) must be discussed before any therapeutic decision.
An aneurysm of the superficial artery, developing after surgical removal of a frontal meningioma is described. This case shows an other topographic possibility to post operatory aneurysm, mainly developed on the intracranial internal carotid artery or her branches.
Three cerebellar hematomas induced by a tumor are reported. A metastasis was present in two cases, but the lesion was unique on CT scan, vertebral angiography did not reveal abnormal vessels, and general investigations were normal. The third case was a medulloblastoma. The first two patients were treated medically or with ventricular shunting. In both cases the primary tumor was lately discovered. These cases show that a CT scan follow up is necessary when the patient is not operated, and a pathological examination of the hematoma must be done where there has been surgical intervention.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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.
Explore the source record for details and available documents.
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.