One-year survival of aneurysmal subarachnoid hemorrhage after airplane transatlantic transfer - a monocenter retrospective study.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is preferentially treated by prompt endovascular coiling, which is not available in Guadeloupe. Subsequently, patients are transferred to Paris, France mainland, by commercial airplane (6751 km flight) after being managed according to guidelines. This study describes the characteristics, management and outcomes related to these patients. METHODS: Retrospective observational cohort study of 148 patients admitted in intensive care unit for a suspected aSAH and transferred by airplane over a 10-year period (2010-2019). RESULTS: The median [interquartile range] age was 53 [45-64] years and 61% were female. On admission, Glasgow coma scale was 15 [13-15], World Federation of Neurological Surgeons (WFNS) grading scale was 1 [1-3] and Fisher scale was 4 [2-4]. External ventricular drainage and mechanical ventilation were performed prior to the flight respectively in 42% and 47% of patients. One-year mortality was 16% over the study period. By COX logistic regression analysis, acute hydrocephalus (hazard ratio [HR] 2.34, 95% confidence interval [CI] 0.98-5.58) prior to airplane transfer, WFNS grading scale on admission (HR 1.53, 95% CI 1.16-2.02) and age (OR 1.03, 95% 1.00-1.07) were associated with one-year mortality. CONCLUSION: When necessary, transatlantic air transfer of patients with suspected aSAH after management according to local guidelines seems feasible and safe.

Radiological analysis of minimally invasive treatment of type A thoracolumbar fractures based on a series of 135 fractures.

INTRODUCTION: Although the reduction of traumatic fractures of the thoracolumbar spine is of good quality during conventional so-called open procedures, the alternative minimally invasive approach also appears to confer good results. The aim of this study was to measure the radiological parameters before and after minimally invasive surgery, in order to assess the quality of the reduction of thoracolumbar compression fractures. MATERIALS AND METHODS: This retrospective, monocentric study included 112 patients with a mean age of 48.9years, presenting with 135 type A thoracolumbar compression fractures treated by a posterior minimally invasive surgical approach comprising vertebral augmentation or posterior osteosynthesis or a mixed procedure. RESULTS: The parameters analyzed were significantly lower whatever the procedure in the immediate postoperative period. Mean regional and local kyphosis, posterior wall displacement, and mean vertebral height were significantly lower (p<0.01). Fracture reduction was better when osteosynthesis was associated with vertebral augmentation. In the osteosynthesis subgroup with osteosynthesis hardware removal but without vertebral augmentation, we found a significant worsening of the regional kyphosis (p<0.05). CONCLUSION: The management of thoracolumbar compression fractures by a posterior minimally invasive approach allows excellent fracture reduction with a restoration of the spinal canal, vertebral height and kyphosis. LEVEL OF EVIDENCE: IV.

[Ogilvie´s syndrome as a rare complication of lumbar stenosis surgery: report of two cases and literature review]. / Syndrome d'Ogilvie, une complication rare de la chirurgie du canal lombaire étroit: à propos de deux cas et revue de la littérature.

Ogilvie´s syndrome is an acute colonic pseudo-obstruction, characterized by massive colonic distension in the absence of mechanical cause. It is a very rare pathology after spinal surgery. We report two cases in the neurosurgery department of the University Hospital of Guadeloupe. A 79-year-old woman overweight (BMI= 27kg/m2) and a 56-year-old man experienced history of non-systematized bilateral lumbar and sciatic pain with reduction in walking perimeter for few months. MRI of lumbar spine had revealed a lumbar stenosis with disc herniation. They had undergone decompression surgery with laminectomy. The surgical intervention was uneventful perioperatively. By 48 hours after surgery, they had complained of constipation with cessation of fecal and flatus with resultant abdominal distension. Abdominal CT scan and X-rays showed significant bowel distension with no mechanical obstruction, suggestive of Ogilvie´s syndrome. Conservative treatment had been sufficient to treat this syndrome and the patients completely recovered. In the occurrence of Ogilvie´s syndrome, the most frequent pathology is the lumbar disc herniation. The clinical presentation is typical with a cessation of fecal and gas elimination, and abdominal distension. Conservative treatment remains the treatment of choice when diagnosis is made early.

An unusual presentation of a lumbar synovial cyst: case report.

STUDY DESIGN: A case of intraforaminal synovial cyst is reported. OBJECTIVES: To stress the importance of the way intraforaminal synovial cyst, a very rare condition, causes a peculiar position of the nerve root in the foramen and to describe the required surgical approach. SUMMARY OF BACKGROUND DATA: Intraforaminal synovial cyst is a highly unusual finding. The existence of this rare entity raises the problem of differential diagnosis with other space-occupying lesions of the neural foramen, such as herniated disc, neurinoma, neurofibroma, and metastatic lesions METHODS AND RESULTS: A 64-year-old woman suffered a right L4 radiculopathy with motor deficit. Computed tomography showed a space-occupying lesion in the L4-L5 foramen isodense with the disc. Magnetic resonance images showed a right intraforaminal cystic lesion at the L4-L5 level with no enhancement after intravenous infusion of gadolinium. A 3-cm cystic lesion, which appeared to arise from the L4-L5 facet joint without direct communication, was excised from the L4-L5 foramen. In contrast with intraforaminal disc herniation, downward displacement of the L4 nerve root was observed. Two months after surgery, the patient was pain-free and neurologic examination revealed no motor deficit. CONCLUSIONS: An unusual intraforaminal presentation of a lumbar synovial cyst demonstrates the importance of considering this entity and of adapting the surgical technique to avoid injury to the nerve root.