French mobile neurosurgical unit: a retrospective analysis of 22 years of mission.

INTRODUCTION: The French mobile neurosurgical unit (MNSU) is used to provide specific support to remote military medicosurgical units deployed in foreign theatres. If a neurosurgical casualty is present, the Role 2 team may request the MNSU to be deployed directly from France. The deployed neurosurgeon can then perform surgery in Role 2 or decide to evacuate the casualty and perform surgery in Role 4 in France. We provide an epidemiological analysis of MNSU missions between 2001 and 2023 and investigate the value of the MNSU for the French Armed Forces. METHODS: We conducted a retrospective case series that included patients managed by the MNSU from 1 January 2001 to 31 January 2023. We collected epidemiological data (eg, age, military or civilian status, delay between transmission and takeoff, origin of the injury and mission location), clinical records (aetiologies of the injury and disease), data on surgical intervention (operator nature and type of surgery) and data on postoperative outcomes recorded at the time of discharge from hospital. RESULTS: 51 patients were managed by the MNSU. 36 (70.5%) and 3 (5.8%) patients underwent surgery on Role 2 and Role 4, respectively. 39 (76.9%) interventions were due to traumatic injury, 4 (7.8%) due to hydrocephalus, 4 (7.8%) due to vascular causes, 3 (5.9%) due to tumour and 1 (2%) due to spine degeneration. In 30 (76.9%) of these cases, the first operator was a neurosurgeon from the MNSU, whereas in the remaining 9 (23.1%) cases, procedures were initially performed by a non-neurosurgeon. CONCLUSION: The MNSU contribution to D1 casualties' strategic evacuation (STRATEVAC) is important. The MNSU provides additional support for STRATEVAC during the reorganisation of French Armed Forces engaged in several fronts. With the return of high-intensity wars, the French MNSU must develop and adjust for the management of massive influxes of casualties.

Awake surgery for isolated parenchymal degenerating neurocysticercosis - Case report and focused review of misdiagnosis of neurocysticercosis.

Differential diagnosis of isolated single neurocysticercosis can be difficult, and management is controversial. We report here an original surgical strategy, and review previous studies reporting misdiagnosis, using the PRISMA guidelines. A 24-year-old man was admitted to our hospital for recent memory impairment, hypoesthesia of the right hand, and recurrent focal seizures without loss of consciousness. Brain MRI revealed a single ring-enhancing parenchymal lesion in the left superior postcentral gyrus, with large perilesional edema. Since exhaustive systemic exploration was negative, surgical resection of the lesion was decided on in a multidisciplinary team meeting. To preserve eloquent brain areas, surgery was performed in awake condition. It allowed complete resolution of clinical manifestations. The diagnosis of neurocysticercosis was confirmed on pathology. This case illustrates the utility of awake surgery in degenerating neurocysticercosis in functional areas, and emphasizes the importance of including it in differential diagnosis of cystic ring-enhancing brain lesions.

Coagulopathy and transfusion requirements in war related penetrating traumatic brain injury. A single centre study in a French role 3 medical treatment facility in Afghanistan.

INTRODUCTION: Traumatic brain injury associated coagulopathy is frequent, either in isolated traumatic brain injury in civilian practice and in combat traumatic brain injury. In war zone, it is a matter of concern because head and neck are the second most frequent site of wartime casualty burden. Data focusing on transfusion requirements in patients with war related TBI coagulopathy are limited. MATERIALS AND METHODS: A descriptive analysis was conducted of 77 penetrating traumatic brain injuries referred to a French role 3 medical treatment facility in Kabul, Afghanistan, deployed on the Kabul International Airport (KaIA), over a 30 months period. RESULTS: On 77 patients, 23 died during the prehospital phase and were not included in the study. Severe traumatic brain injury represented 50% of patients. Explosions were the most common injury mechanism. Extracranial injuries were present in 72% of patients. Traumatic brain injury coagulopathy was diagnosed in 67% of patients at role 3 admission. Red blood cell units (RBCu) were transfused in 39 (72%) patients, French lyophilized plasma (FLYP) in 41 (76%), and fresh whole blood (FWB) in 17 (31%). CONCLUSION: The results of this study support previous observations of coagulopathy as a frequent complication of traumatic brain injury. The majority of patients with war related penetrating traumatic brain injury presented with extracranial lesions. Most of them required a high level of transfusion capacity.

[Assessment of surgical teleconsultations in a developing country: two years of experience in Djibouti]. / Évaluation de la télé-expertise en chirurgie dans un pays en développement: une expérience de deux ans à Djibouti

OBJECTIVE: Our objective was to assess the influence of teleconsultations on patient management and clinical outcomes in a developing country. MATERIALS AND METHODS: All the surgical teleconsultations by a single surgeon (orthopedist) between November 2009 and November 2011 were recorded. RESULTS: Neurosurgery and pediatric orthopedics were the two most important specialities most often concerned, accounting for 67% of the 157 teleconsultations for 138 patients. The teleconsultations resolved the diagnostic uncertainties in 29 of 37 cases (78%). Advice from the expert modified management in 69% cases. Clinical outcomes were good or very good in 86% of the treated patients. CONCLUSIONS: This study establishes the feasibility and usefulness of surgical teleconsultations in Djibouti.

[Recurrent giant cystic vestibular schwannomas: role of cystoperitoneal shunt]. / Schwannomes vestibulaires kystiques géants: intérêt du drainage kystopéritonéal.

INTRODUCTION: Surgical removal of giant cystic vestibular schwannomas is difficult because of adherences between the cyst membrane, brainstem, and the VII-VIII nerve complex. The recurrence of the cyst is frequent and requires reoperation. The aim of this study was to analyze the role of the palliative cystoperitoneal shunt in giant cystic vestibular schwannomas. MATERIALS AND METHODS: Eighty-eight patients with a diagnosis of stage III or IV vestibular schwannoma were managed surgically from January 2000 to December 2005 in our department. Six schwannomas were deemed to be cystic according to the following criteria: a voluminous cystic component with mass effect causing symptoms as well as radiological and intraoperative identification of cystic elements. RESULTS: Complete tumor removal was achieved in two patients. After a follow-up of 5 and 7 years, these patients were asymptomatic. In four cases, we performed cyst drainage. For three patients, we implanted a permanent cystoperitoneal shunt. These patients were asymptomatic with a mean follow-up of 19.7 months. CONCLUSIONS: The cystoperitoneal shunt with no valve is a valid palliative surgical solution to remove brain stem compression. Neuronavigation allows proper positioning of the drain and secures the procedure.

[Extradural spinal meningioma: case report]. / Méningiome rachidien extradural. A propos d'un cas et revue de la littérature.

OBJECTIVES: We report a case of purely extradural spinal meningioma and discuss the potential pitfalls in differential diagnosis. BACKGROUND: Spinal meningiomas account for 20-30% of all spinal neoplasms. Epidural meningiomas are infrequent intraspinal tumors that can be easily confused with malignant neoplasms or spinal schwannomas. CASE: A 62-year-old man with a previous history of malignant disease presented with back pain and weakness of the lower limbs. Magnetic resonance imaging revealed a well-enhanced T4 intraspinal lesion. The intraoperative histological examination showed a meningioma (confirmed by postoperative examination). Opening the dura mater confirmed the purely epidural location of the lesion. The postoperative course was uneventful with no recurrence 12 months after surgery. CONCLUSION: Purely extradural spinal meningiomas can mimic metastatic tumors or schwannomas. Intraoperative histology is mandatory for optimal surgical decision making.

[Study of the junction between the cortical bridging veins and basal cranial venous sinus]. / Etude anatomique du drainage des veines corticales inférieures dans le sinus transverse.

INTRODUCTION: The cerebral venous system is poorly known and is best appreciated based on macroscopic anatomical considerations. We present an anatomical and immunohistochemical study to better define the morphological characteristics of the junction between the inferior cortical veins and the transversal sinuses. MATERIAL AND METHODS: Sixteen cadaveric specimens from the anatomy laboratory of the University Victor-Segalen of Bordeaux were studied. The venous junctions with the transversal sinuses were observed under the operating microscope. Thirty vein-sinus junctions were immunohistochemically stained with smooth muscle actin. Ten venous junctions were observed under the electronic microscope. RESULTS: The inferior cortical veins drain into the transverse sinus either directly or through a tentorial sinus. The venous orifices in the transverse sinuses share the same characteristics. They are oval with semicircular superior dural reinforcement and follow an orientation opposite venous flow in the transversal sinus. The histologic study showed that the walls of the cortical veins contained smooth muscle cells as well as the dural reinforcement of the transversal sinuses. CONCLUSION: The venous orifices of the inferior cortical veins have the anatomical features of true sphincters. Their function in the regulation of the cerebral blood flow needs further exploration.

Junction between the great cerebral vein and the straight sinus: an anatomical, immunohistochemical, and ultrastructural study on 25 human brain cadaveric dissections.

The cerebral venous system is poorly understood, and best appreciated under macroscopic anatomical considerations. We present an anatomical and immunohistochemical studies to better define the morphological characteristics of the junction between the great cerebral vein and the straight sinus. Twenty-five cadaveric specimens from the anatomy laboratory of the University Victor Segalen of Bordeaux were studied. The observation of the venous junctions with the straight sinus was performed under an operating microscope. The smooth muscular actin immunohistochemical staining was performed for 18 veno-sinosal junctions. Five venous junctions were observed using an electron microscope. We observed 3 different anatomic aspects: type 1 was a junction with a small elevation in its floor and a posterior thickening (14 cases); type 2 was a junction with an outgrowth on the floor like a cornice (7 cases); and type 3 was a junction presenting a nodule. Microscopic study of type 1 and 2 junctions showed a positive coloration to orceine attesting the presence of elastic fibers. Immunohistochemistry revealed the presence of smooth muscular actin and S 100 protein attesting the presence of smooth muscular fibers and nervous fibers. We observed in the ultrastructural study, a morphological progression of the endothelium. The venous orifice of the great cerebral vein into the straight sinus could be anatomically assimilated as a true "sphincter." Its function in the regulation of the cerebral blood flow needs further exploration.

[Surgical management of synovial cyst of the lumbar spine: retrospective study of 52 patients]. / Prise en charge chirurgicale des kystes synoviaux lombaires: étude rétrospective concernant 52 patients.

PURPOSE OF THE STUDY: Lumbar synovial cysts are an uncommon cause of radiculopathy, low back pain and neurogenic claudication. We report a retrospective analysis of the clinical presentation, radiological studies, operative findings and outcome in 52 patients surgically treated for symptomatic lumbar synovial cysts. MATERIAL AND METHODS: Retrospective data from 52 consecutive patients treated from January 1996 to February 2006 were analyzed. We studied the clinical symptoms, diagnostic methods and radiological findings in all patients, reviewed the types of conservative therapy applied, the surgical findings and techniques, as well as the immediate and long-term results. Surgical outcomes were evaluated according to the Friedberg scale. RESULTS: There were 35 women and 17 men with an average age of 63.2 years (range 36-84 years). The most common symptoms were radiculopathy (65,4%) and neurogenic multiroot claudication (34,6%). Forty-seven patients had back pain and 22 paresthesia. Preoperative neurological examination demonstrated motor weakness (5.7%), sensory loss (7.6%). The radiological work-up consisted in CT-scan and/or MRI for all patients. The correct preoperative diagnosis was established in 44 patients. A total of 56 cysts were found. Five patients had bilateral cysts. The L4-L5 level was affected in 66%. Total resection of the synovial cyst was possible for 46 patients. No fusion was performed as a first line procedure. However, subsequent fusion was necessary in one patient who developed delayed symptomatic spondylolisthesis. Mean follow up period was 14 months ranging from six to 24 months. Three recurrences occurred during the follow-up period. Functional outcome was excellent in 61.6%, good in 34.6% and poor in 3.8%. CONCLUSION: Surgery should be proposed when synovial cysts fail to respond to conservative therapy. Recurrence and surgical complication rates are low. The usefulness of systematic fusion procedure is questionable.

[A rare primary tumor of the cerebellopontine angle: melanotic schwannoma, a pigmented tumor with unpredictable prognosis]. / Une tumeur primitive rare de l'angle pontocérébelleux: le schwannome mélanocytique, une tumeur pigmentée au pronostic réservé

Schwannomas are common ubiquitous benign tumours of the nervous sheaths. Among the various histopathological types, the pigmented schwannoma has to be distinguished from melanoma. We report a case of melanotic schwannoma of the cerebellopontine angle in a 52-year-old man with a slowly progressive cerebellar syndrome since 1978, who presented with a posterior cerebral fossa bleeding. Melanotic schwannoma is a rare form of schwannoma. The diagnosis remains difficult and melanotic schwannoma has been described as a part of the Carney complex. Distinguishing melanotic schwannoma from malignant melanoma is of paramount importance in planning the management, but these two tumours are probably sharing the same origin. It must be distinguished from classic schwannoma because its behaviour is unpredictable, requiring long-term follow-up.

[Spinal cord compression by arachnoid cysts]. / Compression médullaire par kystes arachnoïdiens.

Spinal arachnoid cysts are considered to be rare entities, intradural locations are even less common. We report two cases of patients (two women aged 77- and 21-year-old) who presented spinal cord compression by intradural arachnoid cysts. For the second patient, repeated surgical procedures were necessary to improve the neurological status. After presenting the case reports, we expose the pathophysiological mechanisms and clinical features, and the surgical difficulties of treating this rare cause of spinal cord compression.

[Pulsating exophtalmos and contralateral carotid-cavernous fistula]. / Exophtalmie pulsatile contralatérale à une fistule carotido-caverneuse résolutive après traitement médical.

A rare case of spontaneous carotid-cavernous fistula with contralateral clinical signs (ocular discomfort, pulsating exophthalmos, chemosis, ptosis) is reported. It was associated with partial thrombosis of the ipsilateral cavernous sinus. It was cured with conservative treatment after six months. Anatomical knowledge of the cavernous sinus remains essential for better understanding of this original clinical presentation.

[Primary dural lymphoma. A case report]. / Lymphome méningé primitif.

Primary central nervous system lymphoma is an invasive disease in both HIV-positive and HIV-negative patients. Atypical presentations, including leptomeningeal involvement often described in cases with aggressive histology, have been reported but primary meningeal B-cell lymphoma appears to be very rare. A 40-year-old immunocompetent man developed a voluminous frontoparietal cranial vault tumor. The neurology examination demonstrated a large extra-axial mass involving the anterior part of the superior longitudinal sinus. The tumor extended through the cranial vault, without osteolysis, and grew in the subcutaneous tissue. Craniotomy was performed and the entire mass was resected without neurological deterioration. Pathology reported B-cell lymphoma. No other localization was found. Primary B-cell meningeal lymphoma, as illustrated in this case, can be another atypical presentation of CNS lymphoma.

[Intramedullary spinal cord metastasis: is there a place for surgery? Case report and review of literature]. / Métastases intramédullaires de cancers viscéraux: quelle place pour la chirurgie? Revue de la littérature à propos d'un cas.

BACKGROUND AND PURPOSE: The usual onset of intramedullary spinal cord metastases at an advanced stage of cancer disease explains that surgical removal of such lesions is rarely performed. We tried to define the place for surgery in the management of such lesions. METHODS: We report the observation of a 52-year-old male patient presenting with a metastasis of the conus medullaris revealing a lung cancer. Surgical excision of the lesion led to pain relief and improvement of bladder dysfunction. We present a review of pertinent literature. RESULTS: Surgery allows histological diagnosis in case of isolated, revealing tumor. In other selected cases, radical removal of intramedullary metastases could improve the quality and comfort of life although it does not seem to affect the duration of survival.

[Neuronavigation in third ventricle tumors]. / Tumeurs du troisième ventricule et neuronavigation.

The authors present the results of neuronavigation as a help to open neurosurgery for the tumors of the third ventricle. From January, 1995 to August, 1999, six image-guided surgical procedures were performed to remove third ventricle lesions : 4 colloïd cysts, 1 ependymoma, and 1 craniopharyngioma. The operative approach was transcortical in 5 cases, and transcallosal in 1 case. The use of neuronavigation allows a decrease of the surgical trauma during the surgical approach. The procedure secures the neurosurgeon in the choice and execution of his pathway to the target. It becomes however less accurate after opening the ventricle, because of the brainshift induced by the loss of cerebrospinal fluid becomes important. Nevertheless, neuronavigation is useful in the surgery of the third ventricle, especially if it is used with neuroendoscopy.