Appearance and vanishing of a spinal intradural arachnoid cyst after multiple epidural corticosteroid injections. A spontaneously resolving cause of symptomatic lumbar stenosis.

BACKGROUND: Spinal intradural arachnoid cyst is a rare lesion, sometimes acquired. PURPOSE: To describe the appearance and later spontaneous disappearence of a lumbar intradural arachnoid cyst, following perineural corticoid injections. METHOD: Review of the clinical data and imaging, with final spontaneous return to initial state. DISCUSSION: Atypical intradural arachnoid cysts can be related to perineural injections and can cause symptoms of spinal stenosis. Its spontaneous vanishing is a very rare event, up to now unreported.

MR diagnosis of transdural disc herniation causing cauda equine syndrome.

Intradural disc herniation is very rare. We describe a case of anterior transdural L4-L5 disc herniation presenting as a partial cauda equina syndrome without related back pain or history of back pain. MRI allowed presurgical diagnosis showing an irregular intradural mass that did not enhance. That lack of enhancement could be related to the fact that the disc herniation was relatively recent.

[Alternative site of implantation of pulse generator for spinal cord stimulation]. / Site alternatif d'implantation du boîtier de neurostimulation cordonale postérieure.

INTRODUCTION: Neurostimulation is now a well-accepted treatment for neuropathic pain. The system is composed of an electrode and a battery-powered stimulator generally implanted in the abdominal wall or subclavicular space according to the location of electrodes. One of the complaints of the patients is the discomfort due to the site and the volume of the battery, particularly with the largest model used for dual channel stimulation. To reduce the frequency of this discomfort we propose an alternative site of implantation of the generator. MATERIAL AND METHODS: From January 2001 to February 2002, 17 of our patients chose the buttock area for implantation of the generator. After introduction of the electrodes in the epidural space and tunnelisation has been made to buttock, a pocket is performed in the subcutaneous area to lodge the generator. RESULTS: Ninety-four percent of our patients were very satisfied with this alternative site. One of the 17 patients complained of pain when he was in a reclining position. Otherwise, this technique enable us to perform simultaneously the implantation of the electrodes and the generator facilitating the surgery.

Treatment of failed back surgery syndrome patients with low back and leg pain: a pilot study of a new dual lead spinal cord stimulation system.

Objective. Treatment of pain associated with failed back surgery syndrome was evaluated in a pilot clinical study of a new dual lead spinal cord stimulation (SCS) system. Methods. The following data was retrospectively sought from 20 non-randomized patients at 2 centers treated by the new SCS system, instead of an implantable drug pump: 1) prior back surgeries, 2) pain and paresthesia mapping, 3) VAS ratings, 4) medication use, 5) sleep patterns, 6) physical abilities, 7) hardware problems, and 8) willingness to repeat the procedure. Two-year follow-up was sought from all patients. Results. The new dual lead SCS system provided good low back and leg paresthesia coverage. Patients reported having less pain and using fewer analgesics and narcotics during follow-up, compared to their preimplant experience. These improvements were statistically significant. Patients also improved their sleep and physical abilities during follow-up. While external hardware problems occurred, 65% of dual lead SCS patients were willing to repeat the SCS implant procedure. Conclusions. Dual lead stimulation proved beneficial for patients with low back and leg pain associated with failed back surgery syndrome.

[Chemonucleolysis. A therapeutic alternative in extra-canalicular lumbar disk hernias]. / La chemonucleolyse. Une alternative thérapeutique des hernies discales lombaires extra-canalaires.

Between 1% and 13% of lumbar disk hernias lie in a very lateral position outside the canal. Diagnosis of the disease is based mainly on CT scan with x-ray. Once conservative therapy has failed, surgery has hitherto been the only treatment proposed, but this generally requires sacrifice of an articular mass. The authors report their experience with chemonucleolysis with chymopapain in five patients presenting this type of hernia. Cure was obtained in four cases. The main advantage of the technique is that osteo-articular structures are preserved.

Clinical and radiological aspects of dysplastic gangliocytoma (Lhermitte-Duclos disease): a report of two cases with review of the literature.

Two cases of Lhermitte-Duclos disease confirmed by biopsy are reported. Review of the 58 published cases shows that the disease can manifest itself only by signs of increased intracranial pressure. Cerebellar symptoms are not constant. Computed tomographic (CT) scans suggest the diagnosis by showing a posterior fossa lesion, iso- and hypodense, partially calcified, and not enhanced by contrast medium. Magnetic resonance imaging (MRI) seems to define limits of the lesion better than CT scanning and could improve the surgical approach. Surgical excision of the lesion is the only satisfactory treatment. The postoperative prognosis is usually favorable.

[Cervico-arthrotic myelopathies. Treatment and prognosis]. / Médullopathies cervicarthrosiques. Traitement et pronostic.

The authors present 50 cases of cervical spondylotic myelopathy treated by anterior or posterior approach. To assess the severity of the pre- and postoperative neurological symptoms, they define an original ten-point classification scale taking into account gait and urinary disturbance, ability to manipulate objects and pain. With C2-C7 laminectomy, 60% of the patients are improved, essentially for walk. A few cases only (14%) are upgraded for upper limbs function. The authors conclude that this surgical treatment should be applied only when there is a multi-level narrowed canal and predominant lower limbs deficits. The efficacy of the anterior approach depends on complete removal of osteophytes. In cases with complete osteophytectomy, this surgical treatment can improve both the upper and lower limbs function and 77.8% good results are obtained. In a few cases it may be necessary to use both approach successively. Discriminant analysis applied to 12 factors shows that pre-operative scores of upper and lower limbs and sagittal diameter of spinal canal are the most important factors for neurological prognosis.

[Skull injury. Arteriovenous shunt. Limitations of cerebral x-ray computed tomography]. / Traumatisme crânien. Shunt artérioveineux. Limites du CT scan cérébral.

The authors report the case of a patient suffering from a head trauma after dizziness followed by a loss of consciousness. In the hours following the admission, he developed drowsiness and a left hemiparesis. CT scanner showed an intracerebral haematoma. Due to the dizziness a carotid angiography has been realized and has demonstrated an intracerebral avascular mass, an arteriovenous shunt and an epidural haematoma at the vertex. Two aspects of the case seem to be important: the first one is the limit of CT scanner; the second one is the relationship between the three lesions.

[Incidence and treatment of subdural hygroma in severe head injuries]. / Incidence et traitement des hygromes sous-duraux chez le traumatisé crânien grave.

In a population of 109 subjects with severe head injury (Liège score less than or equal to 12) we observed secondary development of subdural hygroma in sixteen patients. These liquefying processes were mostly secondary to the entry of CSF in the subdural space from tears in the arachnoid. Half the accumulations were accompanied by increased subdural pressure. Drainage of the subdural fluid brought clinical improvement in patients with elevated subdural pressure (greater than 15 torr).

Creatine kinase isoenzymes in severe head injury.

Brain-type creatine kinase (CK) isoenzyme (CK-BB) was found in the ventricular cerebrospinal fluid (CSF) and the serum in a series of 35 patients within 13 hours following severe head injury. There was a good correlation between total CK and CK-BB activities in CSF only. The values found in the CSF appear to be a quantitative index of brain dysfunction at admission, and did not correlate with intracranial pressure activity. High levels of CK-BB in the CSF correlated with a poor outcome, and thus offer a reliable criterion for the assessment of the severity of head injury.

[Practical assessment of brain dysfunction in severe head trauma (author's transl)]. / Evaluation pratique du dysfonctionnement encéphalique chez le traumatisé crânien.

Assessment of brain dysfunction in head injured patients is important as an index of severity of brain damage and forms the basis of monitoring. . The Glasgow Coma scale (G.C.S.) is a practical scale for nurses. The Liege Coma scale contains the three variables of the G.C.S. and provides informations concerning the brain stem reflexes. In a series of 60 head-injured patients, recovery rates were calculated on the basis of either Glasgow scores or Liege scores. The Liege Coma scale provides a more sensitive index of clinical course and a better prognosis.

[Creatine kinase isoenzymes in severe head injury (author's transl)]. / Etude isoenzymatique de la créatine kinase chez les traumatisés crâniens en coma.

We measured the c.s.f. and serum creatine kinase activities in the first hours following the trauma, for 24 severe head injury patients. We found a good correlation between total CK and CKBB isoenzymes levels in the c.s.f. only. The c.s.f. values are a quantitative index of brain dysfunction assessed by the Liège coma scale, associating the Glasgow coma scale and the study of the brain stem reflexes. There is no relationship between CK activity and intracranial pressure.