Anterior skull base reconstruction after tumour resection using the posterior wall of the frontal sinus.

INTRODUCTION: The authors describe their experience of surgical closure of the anterior skull base after tumour resection, using the posterior wall of the frontal sinus. MATERIAL AND METHOD: The authors describe their anterior skull base closure technique performed in three patients after tumour resection. Tumour resection via a transglabellar approach resulted in an anterior skull base defect. Reconstruction consisted of direct implantation of the posterior wall of the frontal sinus without using a bone substitute (except when nasofrontal duct obstruction is required). RESULTS: Three patients were operated by this surgical procedure with complete tumour resection in every case and no infectious complications. This technique was easy to perform, despite one case of persistent CSF leak. Follow-up imaging showed no displacement of the onlay bone graft. CONCLUSION: Anterior skull base reconstruction after tumour resection using autologous frontal sinus bone graft is easy to perform with a low complication rate.

Reconstruction of cranioplasty using medpor porouspolyethylene implant.

INTRODUCTION: We describe our experience of cranioplasty after a calvarial defect, following an external decompressive craniectomy, with the Medpor® (Stryker®) porous polyethylene implant for cosmetic cranioplasty and reconstruction. METHODS: A retrospective chart review was performed on 23 consecutive patients who underwent cranioplasty at a single institution between January 2013 and January 2016: 9 patients after head injury and 14 patients after vascular event (ruptured aneurysm, intraprenchymal haematoma, malignant cerebrovascular accident). All patients with cranioplasties after oncological resection or infection were excluded. These cranioplasties were performed using porous polyethylene sheet (Medpor®) and contoured with a burr or scissors in the sterile field, and fixed to the calvarial bone with screws. RESULTS: Porous polyethylene sheet (Medpor®) is a proven material used for cranial reconstruction in neurosurgery and maxillofacial surgery with a biocompatibility advantage. The implant can be directly used in an emergency context. The average operating time was 72minutes. An average delay of 527 days (1 year and 5months) with a median of 985 days (43; 4206) occurred between craniectomy and the cranioplasty. There was only one set back implant due to scalp necrosis with infection for a recovery-unit patient. CONCLUSION: Porous polyethylene is an excellent restorative material for the reconstruction of large sized cranial defects and can be also used safely in reconstruction of the cranium. The cosmetic results are good, easy to perform, with a low complication rate.

Is spinal cord stimulation safe? A review of 13 years of implantations and complications.

OBJECTIVE: The aim of this review was to evaluate the complications of spinal cord stimulation (SCS) for chronic pain. METHODS: This was a retrospective case series of 212 patients treated with SCS for chronic lower-limb neuropathic pain between March 2002 and February 2015 in a Reims academic hospital. All patients received a surgically implanted paddle-type electrode. Complications with this technique are here described and analyzed, and other treatment and preventative methods proposed. RESULTS: The major indication was 'failed back surgery syndrome', and 74 (35%) patients experienced complications, of which 57% were benign, while 42% required invasive treatment. Most frequent complications (n=22, 10%) were hardware malfunctions. There were two cases (0.9%) of postoperative neurological deficit and nine (4.2%) with postoperative infections. All patients received the appropriate treatment for their complication. CONCLUSION: Despite the presence of complications, SCS is still a safe technique, although careful patient selection and proper surgical technique can help to avoid major complications.

Spontaneous epidural hematoma due to cervico-thoracic angiolipoma.

Epidural angiolipomas are uncommon benign tumors of the spine. Their clinical presentation is usually a progressive spinal cord compression. We report the case of a 22-year-old patient who presented with an acute paraparesis and a spontaneous epidural hematoma, which revealed a epidural angiolipoma which extended from C7 to T3. The patient underwent a C7-T3 laminectomy, in emergency, with evacuation of the hematoma and extradural complete resection of a fibrous epidural tumor bleeding. The postoperative course was favorable with regression of neurological symptoms. Epidural angiolipomas can be revealed by spontaneous intratumoral hemorrhage without traumatism. The standard treatment is total removal by surgery.

Advantages and limitations of endoscopic endonasal odontoidectomy. A series of nine cases.

INTRODUCTION: Transoral odontoidectomy is the treatment of choice in cases of anterior bulbo-medullary compression. The development of endoscopic procedures has made it possible to perform odontoidectomy via a minimally invasive endoscopic endonasal approach. We discuss the feasibility, advantages, and limitations of this surgical approach. MATERIALS AND METHODS: We report a two-center retrospective series of patients who underwent endoscopic endonasal odontoidectomy between September 2011 and February 2013. Preoperative characteristics, intraoperative data, clinical course, and postoperative complications were studied. The patients were followed for a minimum of 6 months. Cervico-occipital posterior fusion was performed during the same hospital stay in cases of preoperative instability. RESULTS: Nine patients underwent decompressive odontoidectomy, for rheumatoid pannus in five cases and basilar impression in four cases. All had progressive neurological symptoms. Seven patients also underwent posterior fusion. In six patients, the C1 anterior arch was preserved. Decompression was achieved satisfactorily in all nine cases. The patients were able to resume oral feeding the day after the intervention. No patient required tracheostomy. We observed no dural fistulae or infectious complications. One patient died 2 months after the intervention of a pulmonary embolism. All patients improved in terms of their preoperative neurological status. CONCLUSION: This short series shows the feasibility of the endoscopic endonasal approach for resection of the dens. This approach allows optimal viewing when using angulated instrumentation and seems to result in low morbidity. In some cases, this approach makes it possible to preserve the C1 anterior arch, thus limiting the risk of cranial settling. LEVEL: IV retrospective study.

[Management of WHO grade II and II meningiomas: retrospective study of surgical series of 36 cases at a single institution]. / Prise en charge des méningiomes OMS grade II et III : étude rétrospective monocentrique d'une série chirurgicale de 36 cas.

INTRODUCTION: Atypical and malignant meningiomas are a rare disease whose histological definition is still recent. Their management is not consensual. The aim of this study was to review the outcome, prognostic factors and the role of complementary therapies. PATIENTS AND METHODS: Between 1999 and 2007, 36 patients with atypical or malignant meningiomas were managed in our hospital. All surgical specimens were reviewed according to the 2007 WHO classification system. The sex ratio was 1.25 male, the median age was 59 years. The median follow-up was 55 months. Thirty meningiomas were atypical and six were malignant. RESULTS: Five and 10 years overall survival rate are respectively 72 and 41%, whereas 5 and 10 years progression free survival rate are 61 and 23%. We only identify female sex, age over 70 years and Karnofsky status under 70% as negative prognostic factors. CONCLUSION: Atypical and malignant meningiomas are difficult to manage and have high recurrence and poor survival rates. The prognostic of OMS II meningiomas is heterogeneous. Adjuvant radiation therapy is recommended in case of malignant menigioma or in case of atypical meningioma if incomplete surgical excision is performed.

[Adjunctive use of endoscopy during microvascular decompression in the cerebellopontine angle: 27 case reports]. / Apport de l'endoscopie pour la décompression microvasculaire dans l'angle ponto-cérébelleux: à propos de 27 cas.

Microvascular decompression is an important procedure for the management of microvascular compression syndromes in the cerebellopontine angle (CPA) like trigeminal neuralgia or hemifacial spasm. The ability to identify the offending vessel is the key to success. Can the endoscope help surgeons to identify and understand the responsible conflict in order to treat them? Our series concerns 27 consecutive patients who underwent microvascular decompression systematically using an endoscope with an angulation of 30° at the beginning and the end of the intervention. The decompression procedure was done under microscope. Endoscopic exploration was successful for all patients. Endoscopy improved visualization of the cranial nerves and allowed to see and understand the neurovascular conflicts, which were not able to be observed using the microscope alone for two of the 27 patients. The endoscope is a useful adjunct to microscopic exploration of the cranial nerves in the CPA avoiding significant cerebellar or brainstem retraction.

Spinal cord compression due to C4 vertebral arch osteochondroma.

Osteochondromas are usually benign bone tumors found on the metaphysis of long bones. These tumors are rarely located on the spine especially at cervical level. This report presents the case of a 23-year-old man who had previously developed tetraparesis at the age of 13 after infectious myelitis. Recent severe clinical neurological deterioration revealed the diagnosis of osteochondroma arising in the C4 vertebral arch compressing the spinal cord and associated with syringomyelia. Of note in his past history was a treated hip localization. The patient underwent complete surgical excision of the osteochondroma. Postoperative outcome was good with slow clinical recovery from the spinal cord compression. We report this rare cause of spinal cord compression and other cases reported in the literature.

[Intradiploic cavernous hemangioma of the calvaria: case report and review of the literature]. / Hémangiome caverneux intradiploïque du vertex: à propos d'un cas et revue de la littérature.

We report the case of a 31-year-old patient who had had frontal cephalalgias for several years. CT and MRI anatomical imaging objectified a frontal osteolytic tumor respecting the osseous external table but compressing the superior sagittal sinus. Total en bloc resection of the tumor associated with titan cranioplasty was performed. The postoperative course was uneventful. Three months after surgery the patient no longer reported headache. The anatomical and pathological results concluded in intradiploic cavernous hemangioma. We discuss this case and others described in the literature.

[Primitive malignant rhabdoid tumor of the central nervous system in an adolescent. A case study]. / Tumeur rhabdoïde du système nerveux central chez une adolescente de 16ans : à propos d'un cas.

Primitive malignant rhabdoid tumors of the central nervous system are rare and have a poor prognosis. Adult and adolescent cases are exceptional. We report the case of a 16-year-old girl who presented an intratumoral hemorrhage in a rhabdoid tumor. She was treated with surgery, followed by intravenous and intrathecal chemotherapy. Despite intensive treatment, she died 5 months after diagnosis. We discuss the different therapeutic options for this patient and review the literature on this kind of tumor.

[Feasibility of auditory cortical stimulation for the treatment of tinnitus. Three case reports]. / Protocole de prise en charge neurochirurgicale des acouphènes invalidants: à propos de trois cas.

UNLABELLED: Tinnitus is a public health issue in France. Around 1 % of the population is affected and 30,000 people are handicapped in their daily life. The treatments available for disabling tinnitus have until now been disappointing. We report our experience on the treatment of these patients in neurosurgery. PATIENT AND METHODS: Between 2006 and 2008, transcranial magnetic stimulation (rTMS) was performed following several supraliminal and subliminal protocols in 16 patients whose mean age was 47 years (range, 35-71). All patients underwent anatomical and functional MRI of the auditory cortex before and 18 h after rTMS, to straddle the primary and secondary auditory cortices. All patients underwent audiometric testing by an ENT physician. RESULTS: Nine patients responded with rTMS. After these investigations, two quadrapolar electrodes (Resume), connected to a stimulating device implanted under the skin (Synergy, from Medtronic), were extradurally implanted in three patients. The electrodes were placed between the primary and secondary auditory cortices. The mean follow-up was 25 months and significant improvement was found in these patients. CONCLUSION: The feasibility of cortical stimulation in symptomatic treatment of tinnitus was demonstrated by this preparatory work. The intermediate- and long-term therapeutic effects remain to be evaluated.

[Spinal cord compression caused by idiopathic dorsal epidural lipomatosis: Case report and critical review of the literature]. / Compression médullaire lente par lipomatose épidurale thoracique idiopathique : cas clinique et revue de la littérature.

We report the case of a patient with spinal cord compression evolving over 36 months with spastic paraparesis. Anatomic imagery showed epidural lipomatosis. No predisposing factors were found. Surgical treatment was decided. A T1-T10 laminectomy with excision of the surplus epidural fat was performed. Immediate and medium-term postsurgical follow-up was favorable with the disappearance of the pyramidal syndrome. Other cases found in literature and the principal predisposing factors are discussed.

[Clostridial brain abscess after glioblastoma resection: case report and critical review of the literature]. / Abcès cérébral àClostridium perfringens après chirurgie d'exérèse d'un glioblastome: à propos d'un cas et revue de la littérature.

Clostridium perfringens is rare in neurosurgery. The source of clostridial brain abscess is usually a penetrating head injury. We report the case of a 57-year-old man who had parietal glioblastoma resection with local carmustine chemotherapy and who presented a clostridial brain abscess three weeks later. Progression was especially brutal, leading to patient's death in few hours. We discuss the etiology and progression of this case compared to the data reported in the literature.