Grade 1 Spetzler and Martin cerebral ruptured arteriovenous malformations treated by microsurgery: Poor functional outcome is related to injury from haemorrhage.

INTRODUCTION: Ruptured arteriovenous malformations (rAVM) are life-threatening diseases. OBJECTIVE: To evaluate the outcome of patients with grade 1 SPM rAVM after microsurgical treatment. MATERIALS AND METHOD: We retrospectively included 64 consecutive operated patients with a grade 1 SPM rAVM in our institution between 2002 and 2012. Complications related to the surgical procedure were recorded. All patients were re-evaluated 3months after treatment using the modified Rankin Scale score (mRS). Persistent neurological disorders were evaluated 1year after bleeding. Conventional cerebral angiography was performed for each patient immediately after surgical treatment and 1year later. RESULTS: The mean age at diagnosis was 30.8 years. Initial WFNS score was grade 1 in 25 patients, grade 2 in 11 patients, grade 3 in 10 patients, grade 4 in 9 patients and grade 5 in 9 patients. No remnant was left and a new surgery was performed only in a single patient who was initially operated-on under emergency conditions with limited preoperative investigations due to a poor clinical grade. Early postoperative complications related to the surgical procedure were recorded in 7 patients. The mRS score 3months after treatment was ≤2 in 53 patients (83%). Persistent neurological disorders were recorded in 40 patients (62.5%). High initial WFNS score (>2) and the hydrocephalus were significantly associated (P<0.05) to a bad functional outcome (mRS>2). CONCLUSION: Grade 1 rAVM is a life-threatening disease concerning in most cases young patients. Long-term morbidity is often related to the hemorrhagic brain damage and rarely to the AVM resection.

A dissecting aneurysm of a basilar perforating artery.

We report an additional case of a ruptured basilar trunk perforator aneurysm, for which an endovascular treatment was initially planned, but aborted due to the spontaneous regression of the aneurysm. Thus, a conservative management consisting on a close follow-up was decided that confirmed the favorable radiological outcome. Spontaneous regression of such aneurysm should be well-known by neurosurgeons and neuroradiologists in order to prevent the potential iatrogenic effects of the related treatment modalities.

[Assessment of the surgeon radiation exposure during a minimally invasive TLIF: Comparison between fluoroscopy and O-arm system]. / Évaluation de l'exposition aux radiations du chirurgien lors d'un TLIF mini-invasif: comparaison entre fluoroscopie et navigation O-arm.

INTRODUCTION: Transforaminal lumbar interbody fusion with a minimally invasive approach (MIS TLIF) has become a very popular technique in the treatment of degenerative diseases of the lumbar spine, as it allows a decrease in muscle iatrogenic. However, iterative radiological controls inherent to this technique are responsible for a significant increase in exposure to ionizing radiation for the surgeon. New techniques for radiological guidance (O-arm navigation-assisted) would overcome this drawback, but this remains unproven. OBJECTIVES: To analyze the exposure of the surgeon to intraoperative X-ray during a MIS TLIF under fluoroscopy and under O-arm navigation-assisted. MATERIALS AND METHODS: This prospective study was conducted at the University Hospital of Lille from February to May 2013. Twelve patients underwent a MIS TLIF for the treatment of low-grade spondylolisthesis; six under standard fluoroscopy (group 1) and six under O-arm system (group 2). Passive dosimeters (rings and glasses) and active dosimeters for thorax were used to measure the radiation exposure of the surgeon. RESULTS: For group 1, the average time of fluoroscopy was 3.718 minutes (3.13-4.56) while no radioscopy was perform on group 2. For the first group, the average exposure dose was 12 µSv (5-20 µSv) on the thorax, 1168 µSv (510-2790 µSv) on the main hand and 179 µSv (103-486 µSv) on the lens. The exposure dose was measured zero on the second group. CONCLUSION: The maximum recommended doses can be reached, mainly for the lens. In addition to the radioprotection measures, O-arm navigation systems are safe alternatives to significantly reduce surgeon exposure.