Experimental bypass for sagittal sinus repair. Preliminary report.

Bypasses of the sagittal sinus, 2.5 mm in diameter, were carried out in 25 dogs with venous (13 cases) and arterial (12 cases) autogenous grafts, by classical microtechniques. Animals were sacrificed 10 to 75 days after the operation, average 40 days. The patency rate was 54% in the venous autograft group; in all cases, thrombosis occurred early and was due to technical factors. The immediate postoperative patency rate was 100% in the arterial graft group, but this type of graft showed a tendency to progressive occlusion because of extensive fibrosis of the arterial wall; thus the patency rate was 75% at the time of autopsy. This preliminary work demonstrates the technical feasibility of bypass procedure which could be used for sagittal sinus repair.

Revascularization of the spinal cord by micro-anastomoses in dogs.

The severity of ischemic lesions in the spinal cord justifies attempts at its surgical revascularization. The experiments consisted of: (1) creating devascularization of the conus medullaris by ligation of all the lumbo-sacral collaterals of the aorta, and (2) revascularizing the lumbo-sacral rachidian circulation by performing an end-to-side anastomosis between the caudal mesenteric artery and the 5th left lumbar artery (from which in the dog the Adamkiewicz artery generally arises). After two-months, the patency rate of the 20 cases was 85%. Such a procedure of revascularization could be useful in man in cases of interruption of the arterial supply of the spinal cord.

Florid cemento-osseous dysplasia: Report of a case documented with computed tomography and 3D imaging.

Florid cemento-osseous dysplasia is an uncommon disease of the jaws. This article reports the case of a 49-year-old black woman who was diagnosed with florid cemento-osseous dysplasia on the basis of conventional radiographic findings. Computed tomography and three-dimensional imaging of the mandible were performed, and they enabled detailed localization of the bone defects. The role of computed tomography in the evaluation of cemento-osseous lesions is discussed.

[Cortical thrombophlebitis and developmental venous anomalies]. / Thrombophlébite corticale et anomalie veineuse du développement.

Abnormal intracranial venous drainage called cerebral venous angioma is usually asymptomatic. Hemorrhages and seizures may however occur. The malformation may rarely be revealed by thrombosis. We report the case of a 25-year-old right-handed woman who developed cortical thrombophlebitis subsequent to developmental venous anomalies. After a course of anticoagulant therapy, outcome was good, demonstrating that anticoagulant therapy may be indicated in spite of the high risk of hemorrhage.

[Treatment of osteoid osteoma with percutaneous resection under computerized tomography control. Apropos of 5 cases]. / Traitement de l'ostéome ostéoïde par résection percutanée sous contrôle tomodensitométrique. A propos de 5 cas.

Osteoid osteoma is a benign tumor requiring a surgical resection. An original technique is reported: the nidus was first located by computed tomography and then reached and resected through a small percutaneous approach. A special device, similar to those of knee arthroscopy or percutaneous discotomy has been designed. Five patients have been thus treated successfully (1 femoral neck, 1 trochanter, 1 femur, 2 tibias). Recent progress in radiology for management of bone tumors (scintigraphy, angiography) have given greater accuracy in the preoperative diagnosis of osteoid osteoma. It is thus possible to dispense with an histological proof in case of destruction of the nidus. However a new device is now designed to achieve true "en bloc" resection of the nidus.

[Lumbar venography in the diagnosis of disc herniation (author's transl)]. / Apport de la phlébographie lombaire dans le diagnostic des hernies discales.

The authors have performed lumbar venography on 120 occasions in patients with low back pain. In 58 patients in whom the herniated disc was confirmed, the result of venography was positive and the localisation was precise in 67 cases. It is concluded that the method is safe, reliable and allows precision in diagnosis to allow better selection for surgical treatment. The examination is particularly useful in recurrent sciatica, fractures of the lumbar spine, recent or old, and in spinal stenosis. It may be associated with discography when the result is not clear cut.

[Experimental intracranial venous microsurgery. Bypass of the sagittal sinus for arterial or venous repair and preoperative measurement of the cerebral impedance in the dog]. / Microchirurgie veineuse intracranienne expérimentale. Pontage du sinus sagittal par autogreffe artérielle ou veineuse et mesures peropératoires de l'impédance cérébrale, chez le chien

By-passes of the sagittal sinus-which is 2,5 mm in diameter-were carried out with autogenous arterial or venous grafts, in 34 dogs, using the classical microtechniques (operative microscope, micro-instruments, micro-sutures...). Controls were done both 1 degree by angiography (direct sinography was the only convenient procedure to visualize the sinus and the by-pass) during survival, and 2 degrees by anatomical and histological examination after sacrifying the animals, on an average the 40th post-operative day (from the 10th to the 75th day). The early patency rate (within the first post-operative month) was 76 p. 100. All cases of early thromboses, which affected especially venous autografts, were related to technical insufficiencies. The late patency rate (after a one month follow-up) was only 64 p. 100, because of the secondary occlusion of some arterial autografts. All these late thromboses were related to an extensive fibrosis of the arterial wall.

Osteoid osteoma: CT-guided percutaneous treatment.

Seven patients with presumed osteoid osteoma were treated with percutaneous destruction or drill resection with computed tomographic (CT) guidance. The diagnosis of osteoid osteoma was made on the basis of findings in the clinical history and results at plain radiography, bone scintigraphy, and CT. In four patients, histologic confirmation was obtained. Hospital stay lasted from 1 to 3 days. After 11-38 months of follow-up examinations, all patients were asymptomatic. The authors report this simple procedure as an alternative to the more traditional open surgery technique.

[A thoracic "stealing" vascular syndrome (author's transl)]. / Un syndrome vasculaire voleur thoracique.

The authors report quite a remarkable observation of a thoracic "stealing" vascular syndrome, apparently a sequela of a previous pleural involvement. It was a patient with fainting fits in effort related to severe hemo-diversion of the sub-pleural vascular laci fed by several vascular pedicles coming from the internal mammary artery and several broncho-intercostal arterial vessels. Selective bronchial arteriography revealed these pedicles, enabling an important blood derivation in effort without corresponding venous return, with a phenomenon of low cerebral outflow; a series of embolisms in these pedicles enabled to obtain a valuable obliteration of the main ones with a complete disappearance of the clinical signs. The syndrome mentioned in this observation is related to the "stealing" vascular ones described in the level of the subclavian artery.