Clinical and radiological evaluation of cervical disc arthroplasty with 5-year follow-up: a prospective study of 384 patients.

BACKGROUND: Cervical total disc replacement was developed to avoid known complications of cervical fusion. The purpose of this paper was to provide 5-year follow-up results of an ongoing prospective study after implantation of cervical disc prosthesis. METHODS: Three hundred and eighty-four patients were treated using Mobi-C cervical disc (Zimmer Biomet, Troyes, France) and included in a prospective multicentre study. Routine clinical and radiological examinations were reported preoperatively and postoperatively with up to 5-year follow-up. Complications and revision surgeries were also explored. RESULTS: Results at 5 years showed significant improvement in all clinical outcomes (NDI, VAS for arm and neck pain, SF-36 PCS and MCS). Motion at index level increased significantly from 6.0° preoperatively to 8.0°, and 72.1% of the implanted segments were still mobile (referring to threshold of ROM > 3°). Proximal and distal adjacent discs showed no significant change in average motion 5 years after surgery compared to baseline. Ossification resulting in complete fusion was observed in 16.4% of the implanted segments. Distal and proximal adjacent disc degeneration occurred in 42.2% and 39.1% of patients, respectively. Complications rate was 8.9%, and 1.5% of the patients had reoperation at the index level. Surgery rate of adjacent discs was 2.9%. An increased percentage of working patients and a decrease in medication consumption were observed. At 5 years, 93.3% patients were satisfied regarding the overall outcome. CONCLUSIONS: In this study, favourable 5-year follow-up clinical and radiological outcomes were observed with a low rate of adjacent level surgery. These slides can be retrieved under Electronic Supplementary Material.

Comparison between single- and multi-level patients: clinical and radiological outcomes 2 years after cervical disc replacement.

In cervical multi-level degenerative pathology, considering the morbidity of the extensive fusion techniques, some authors advocate for the multilevel disc replacement. This study compared the safety and efficacy of disc replacement with an unconstrained prosthesis in multi- versus single-level patients. A total of 231 patients with cervical degenerative disc disease (DDD) who were treated with cervical disc replacement and completed their 24 months follow-up were analyzed prospectively: 175 were treated at one level, 56 at 2 levels or more. Comparison between both groups was based on usual clinical and radiological outcomes [Neck Disability Index (NDI), Visual Analog Scale (VAS), Range of Motion, satisfaction]. Safety assessments, including complication and subsequent surgeries, were also documented and compared. Mean NDI and VAS scores for neck and arm pain were improved in both groups similarly. Improvement of mobility at treated segments was also similar. Nevertheless, in the multi-level group, analgesic use was significantly higher and occurrence of Heterotopic Ossification significantly lower than in the single-level group. Subject satisfaction was nearly equal, as 94.2% of single-level group patients would undergo the surgery again versus 94.5% in the multi-level group. The overall success rate did not differ significantly. Multi-level DDD is a challenging indication in the cervical spine. This study showed no major significant clinical difference between the two groups. We need further studies to know more about the impact of multi-level arthroplasty, especially on the adjacent segments, but these results demonstrate initial safety and effectiveness in this patient sample.

Two level Anterior Lumbar Interbody Fusion (ALIF) in a patient with a rare vascular malformation, a duplication of the inferior vena cava.

BACKGROUND: Anterior Lumbar Interbody Fusion is now a well-established procedure to treat degenerative lumbar disease. This approach has its own risks and each spine surgeon must understand the pitfalls that can be encountered when dealing with an anatomy variation of the vessels in order to be able to perform the safest possible procedure. CASE DESCRIPTION: We report the case of a 48 years old man with a rare vascular anatomy variation undergoing a two-levels L4-L5 and L5-S1 ALIF procedure through a right-sided retroperitoneal approach. The preoperative imaging planning revealed a duplication of the Inferior Vena Cava (IVC) located on each side of the aorta. CONCLUSION: Preoperative Imaging evaluation and a detailed knowledge of the anatomy is the key of a safe and successful procedure as any variation can complicate the anterior approach. We believe that teaming up with a vascular surgeon for junior surgeons during the first anterior procedures and especially in the context of anatomical variation is recommended.

Intermediate clinical and radiological results of cervical TDR (Mobi-C) with up to 2 years of follow-up.

The interest in cervical total disc replacement (TDR) as an alternative to the so-far gold standard in the surgical treatment of degenerative disc disease (DDD), e.g anterior cervical discectomy and fusion (ACDF), is growing very rapidly. Many authors have established the fact that ACDF may result in progressive degeneration in adjacent segments. On the contrary, but still theoretically, preservation of motion with TDR at the surgically treated level may potentially reduce the occurrence of adjacent-level degeneration (ALD). The authors report the intermediate results of an undergoing multicentre prospective study of TDR with Mobi-C prosthesis. The aim of the study was to assess the safety and efficacy of the device in the treatment of DDD and secondary to evaluate the radiological status of adjacent levels and the occurrence of ossifications, at 2-year follow-up (FU). 76 patients have performed their 2-year FU visit and have been analyzed clinically and radiologically. Clinical outcomes (NDI, VAS, SF-36) and ROM measurements were analyzed pre-operatively and at the different post-operative time-points. Complications and re-operations were also assessed. Occurrences of heterotopic ossifications (HOs) and of adjacent disc degeneration radiographic changes have been analyzed from 2-year FU X-rays. The mean NDI and VAS scores for arm and neck are reduced significantly at each post-operative time-point compared to pre-operative condition. Motion is preserved over the time at index levels (mean ROM = 9 degrees at 2 years) and 85.5% of the segments are mobile at 2 years. HOs are responsible for the fusion of 6/76 levels at 2 years. However, presence of HO does not alter the clinical outcomes. The occurrence rate of radiological signs of ALD is very low at 2 years (9.1%). There has been no subsidence, no expulsion and no sub-luxation of the implant. Finally, after 2 years, 91% of the patients assume that they would undergo the procedure again. These intermediate results of TDR with Mobi-C are very encouraging and seem to confirm the efficacy and the safety of the device. Regarding the preservation of the status of the adjacent levels, the results of this unconstrained device are encouraging, but longer FU studies are needed to prove it.

Traumatic atlanto-axial rotatory subluxation after surgical correction of prominent ears: Case report and review of the literature.

Corrective surgery of prominent ears may be justified for social or aesthetic reasons during childhood or adulthood. Post-operative complications occur in approximately 0 to 8.4% of cases. This case describes a rare atlanto-axoid rotatory subluxation after bilateral surgical correction of prominent ears under general anesthesia. Orthopedic treatment was done after two months of medical roaming outside of our center. The one-year post-operative clinic consultation and radiological exam were normal. Only the psychological impact of the episode remained. Traumatic atlanto-axial rotatory subluxation is a rare complication but should be considered after post-operative torticollis in order to aid with diagnosis and allow doctors to implement the appropriate course of treatment.

[Anesthesia for video-assisted surgery of the thoracic and lumbar spine: a survey of 44 patients]. / Anesthésie pour chirurgie vidéoassistée du rachis thoracolombaire.

INTRODUCTION: The development of video-assisted surgery of the dorsolumbar spine has led to the need for adaptations for appropriate anesthetic management. Data concerning anesthesia for such surgery is very sparse in the literature. AIM OF THE STUDY: The aim of this retrospective study of 44 patients was to learn more about anesthesia practices used for patients undergoing this type of surgery. PATIENTS AND METHOD: The files of 44 patients were studied retrospectively. Epidemiologic data and the perioperative phase were analysed. RESULTS: The preoperative phase was not specific with preoperative assessment adapted to each patient. Similarly, monitoring practices during the surgical procedure were not specific. The choice of the anesthetic agents depended on the patient's clinical status. For tracheal intubation, care was taken to enable lung exclusion, even if not often used. Thoracic drainage at the end of the surgery was required in the event of imperfect hemostasis and in selected patients was replaced by pneumothorax exsufflation during closure. The postoperative period was uneventful and did not require admission to intensive care; non-specific analgesia was used. DISCUSSION: Adaptations of anesthetic practices are required each time a new surgical technique is developed. Excepting lung exclusion, anesthesia for video-assisted dorsolumbar spine surgery is not specific.

Comparison between total disc replacement and hybrid construct at two lumbar levels with minimum follow-up of two years.

INTRODUCTION: Lower back pain due to degenerative disc disease is a therapeutic challenge in young patients. Although arthrodesis is currently the gold standard for surgical treatment, improvement in total disc replacement techniques makes it possible to preserve segmental mobility with good results in one-level surgery. Nevertheless, the French National Health Authority does not recommend total disc replacement for multilevel surgery. Thus, hybrid constructs that combine one-level disc replacement with arthrodesis have been developed for multilevel indications. HYPOTHESIS: The outcome of two-level lumbar disc arthroplasty does not differ from hybrid constructs. METHODS: The clinical and radiographic outcomes of disc arthroplasty were compared to hybrid constructs for two-level degenerative disc disease in 72 patients after a continuous follow-up of at least 2 years. The patients were divided into two groups that were similar for the indication and type of implants. RESULTS: There was no statistical difference in pain relief (-3.9 points versus -3.5 points for lumbar VAS) or reduction in ODI (-29.5% versus -27.0%) between TDR and hybrid constructs, respectively. There was no statistical difference in range of motion at the level of arthroplasty (8.4° versus 7.6°) and no kinematic dysfunction was identified. The re-operation rate at two years for persistent lumbar pain was respectively 6.7% for two-level disc arthroplasty and 4.3% for hybrid constructs. The complication rate was 4.8% and 8.7% respectively. DISCUSSION: No difference was found in this comparison of two homogeneous series between two-level disc arthroplasty and hybrid constructs for the treatment of degenerative disc disease after two years of follow-up. Two-level disc arthroplasty may be an alternative for young patients depending on an evaluation of long-term results. LEVEL OF EVIDENCE: Cohort observational study level III.

Assessment of the effectiveness of SFCR patient information sheets before scheduled spinal surgery.

INTRODUCTION: Patient information is an essential component of any surgical procedure as it allows the surgeon to collect informed consent. This is a legal obligation in the civil code and a professional obligation in the code of medical ethics. As a result, the French spinal surgery society (SFCR) decided to make a model information sheet available on the Internet. The goal of this prospective study was to evaluate the impact of this information sheet when given to patients before scheduled spinal surgery. METHODS: This was a single-centre prospective study performed between November 2014 and February 2015. Seventy patients filled out two questionnaires. The first was about the quality of the medical information given orally by the surgeon; it was administered to patients after the preoperative consultation. The second was about the quality of the medical information contained in the information sheet; it was administered after patients had read this sheet. For each of the questions, patients could either select "yes" if they found the information to be correct/useful (1 point) or "no" if not (0 point). RESULTS: The mean patient age was 56.7 years (range: 28-86). The average number of "yes" answers was 7.07 (out of 12) in the first questionnaire. The average number of "yes" answers was 10.3 (out of 12) after reading the information sheet. This indicates that patients were significantly better informed after reading the SFCR sheet. The written document was deemed to be understandable (mean: 8/10). It answered the patients' questions (mean: 6.7/10) and helped them understand how the surgical procedure would be carried out (mean: 7.3/10). The patients' level of education did not significantly alter these findings. CONCLUSION: Adding a written SFCR information sheet to the preoperative consultation improved patients' understanding before scheduled spine surgery. LEVEL OF EVIDENCE: Low-powered prospective study.

Aim and indications of spinal angiography for spine and spinal cord surgery: Based on a retrospective series of 70 cases.

AIM: For spinal surgery, computerized tomography (CT scan) and magnetic resonance imaging (MRI) have clear indications and are easily accessible. In contrast, the indications and the use of spinal angiograms (SA) remain unclear, and many centres performing spinal surgery do not have an access to SA. Based on a retrospective study, the role of SA in spinal surgery is assessed and their indications are discussed. MATERIAL AND METHODS: A retrospective series of 72 SA in 70 patients is presented. No procedural accident occurred. SA was performed under general anaesthesia in 57 cases (82%). In 61 patients, locating the radiculomedullary arteries (RMA) was obligatory and performed in all cases: for 14 patients (21%), RMA were identified using the forecasted surgical approach (4 patients with degenerative disc disease out of 10 in the entire series were included), and modified. No ischaemic complications were observed in the series. Thirty-nine patients were treated for a tumour that was considered hypervascular (based on a histological hypothesis or the MRI data): 20 of them (51%) were preoperatively embolised and in only 8 cases was the operation considered "haemorrhagic" by the surgeon (among which, 3 intramedullary hemangioblastomas were included). No accident was observed during the embolisations. Thirteen patients presented with a vascular or haemorrhagic lesion (4 arteriovenous malformations, 6 dural arteriovenous fistulas, 3 intramedullary cavernomas): in all these cases, the SA was indispensable for the diagnosis and the decision-making process. Seven patients were treated by embolisation. In the last 8 cases, SA was considered for the diagnosis of a clinical worsening myelopathy with a non-contributive MRI, but it was not useful in providing a positive diagnosis. CONCLUSIONS: SAs were performed with different goals: (i) localization of RMA when a surgical approach between T4 and L2 involved the intervertebral foramen, or when an anterior approach was considered in order to avoid severe ischaemic complications (40% of the degenerative disc patients and 33% of the extramedullary tumour patients in this series); (ii) preoperative embolisation in cases of extramedullary tumours probably considered hypervascular (51% of the cases in the series) or in cases of arteriovenous shunt lesions (7 of 13 patients were treated by embolisation); (iii) as a diagnostic tool, SA is indispensable when MRI can reveal vascular abnormalities; it also provides information about the vascularisation as well as the endovascular possibilities in extramedullary tumours. In contrast, SA was not useful for intramedullary tumours because the RMA preoperative localisation is not mandatory (posterior approach), and embolisation seemed ineffective. SA was also not useful for the diagnosis of myelopathy with normal MRI. In the future, angiograms and MR angiography of the spinal cord may be useful in order to avoid general anaesthesia for a diagnostic procedure, but not practical to obtain access for endovascular treatment.

Preliminary observations of metabolic characterization of bilateral temporal epileptic focus, using proton magnetic resonance spectroscopy. Three cases.

The authors report the case of 3 patients with bilateral temporal lobe epilepsy demonstrated by EEG and sphenoïdal electrodes. Two out of the 3 patients presented with childhood febrile convulsions. Their neurological and mental examination was normal. EEG showed spikes within the anterior part of the 2 temporal lobes. CT scan and MRI showed no atrophic lesion within the 2 temporal lobes. Proton magnetic resonance spectroscopy, performed within a cube of 8 cube-centimetres localized in the anterior part of the 2 temporal lobes showed a significant decrease of N-acetyl-aspartate in the 2 temporal lobes of the 3 cases, compared with controls matched with age, sex and laterality. Because N-acetyl-aspartate is a marker of the neuronal cells, the decreased level of NAA in the temporal area with spikes, may be related to a decreased number of neuronal cells, developing an abnormal tendency to seizures.

Hippocampal formations imaging with axial sections parallel to their longitudinal axis.

The complex shape of hippocampal formation (HF) and its obliquity make its morphological analysis difficult using brain imaging techniques. Adapted planes of section are required. The hippocampal axial plane (HAP) parallel to the hippocampus long axis is able to provide a complete and comprehensive view of the structure. HF has a rostrocaudal extent and is divided into three parts, head, body, and tail. Histological sections in the HAP display very well the pattern of the cell layers, with their transversal folding at the head and the tail. At more ventral levels, HF sections consist of parts of the CA1 field and the subicular complex. These are completely embedded in the temporal lobe and separated from its medial surface by the white matter and the cortical plate of the parahippocampal gyrus. More dorsal sections allow the study of the amygdala, uncus and fimbria. Functional images of HF can be accurately defined by combining magnetic resonance imaging (MRI), positron emission tomography (PET), or single photon emission computed tomography (SPECT) in this plane. According to the small dorsal-ventral dimension of the structures, a few slices can cover the whole HF and precise regions of interest may be outlined.

[N-acetyl-aspartate abnormalities in internal-temporal epileptic foci using proton magnetic resonance spectroscopy]. / Anomalies du N-acétyl-aspartate observées dans les foyers epileptiques temporaux internes par spectroscopie de résonance magnétique nucléaire du proton.

The aim of this study was to characterize the neurochemical abnormalities related to N-acetyl-aspartate which is a neuronal marker, within an epilepticus focus located in the internal-temporal area, using proton magnetic resonance spectroscopy. Eleven patients with a mono-hippocampal epileptics focus on clinical and per-critical electroencephalographical criteria, were matched with 11 controls by age, sex and laterality. Proton spectroscopy of a volume of 8 cm3 was performed within the ipsilateral and the contralateral internal-temporal area and within the 2 hippocampus of controls. Volumetry of the ipsilateral and the contralateral hippocampus and of the 2 hippocampus of controls was performed using resonance magnetic imaging. All these measurements were performed during the interictal stage. The results were concordant to show a decrease of the ratio N-acetyl-aspartate/choline and N-acetyl-aspartate/creatine within the epilepticus focus, in relation with a hippocampal atrophy. This study finds similar results to those of other previous works. The decrease of N-acetyl-aspartate levels within the epilepticus focus could be related to a decrease of the neuronal cell density. This procedure is able to show a decrease of the levels of this metabolite within an internal temporal epilepticus focus and associated with a hippocampal atrophy.

[Predictive factors of short-term mortality in patients with severe head injury]. / Facteurs prédictifs de mortalité à court terme chez le patient traumatisé crânien grave.

OBJECTIVES: To define hazard factors of early mortality in severe brain injured patients. PATIENTS AND METHODS: An open prospective study was conducted in 125 brain injured patients with initial Glasgow coma score below 8. Different vital parameters were recorded daily during the first 10 days of resuscitation. Computed tomography (CT) scan classification of the Traumatic Coma Data Bank, the Glasgow coma score, the SAPS score and the influence of neurosurgery were assessed. RESULTS: In exclusive parameters analysis, a Glasgow coma score below 6, the presence of a midline shift of more than 5 mm on the initial brain CT scan, high or mixed density lesion of more than 25 cc, as well as mean blood pressure below 90 mm Hg were respectively correlated with early death. Low mean blood pressure led to low brain perfusion pressure in patients with intracranial hypertension. CONCLUSION: We defined 3 independent predictive factors of early mortality: the Glasgow coma scale, CT scan classification and mean blood pressure below 90 mm Hg. The main goal of the resuscitation in severe brain insult patients must be to obtain a sufficient brain perfusion pressure. This often requires the use of vasoactive drugs.

Adjacent segment disease after anterior cervical interbody fusion: a multicenter retrospective study of 288 patients with long-term follow-up.

INTRODUCTION: Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. OBJECTIVE: To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. MATERIAL AND METHOD: A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years' follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. RESULTS: Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16-73 years). Mean follow-up was 14.5 years (12-18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI (P=0.02). DISCUSSION: Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. LEVEL OF EVIDENCE: IV - Multicenter retrospective study.

Minimally invasive management of thoraco-lumbar fractures: combined percutaneous fixation and balloon kyphoplasty.

STUDY DESIGN: Retrospective review of prospectively collected data. BACKGROUND: There is no consensus regarding the ideal treatment of thoraco-lumbar spine fractures without neurological compromise. Many surgical techniques have been described but none has proved its definite superiority. The main drawback of these procedures is directly related to the morbidity of the approach. As minimally invasive fixation combined with balloon kyphoplasty for treatment of thoraco-lumbar fractures is gaining popularity, its efficacy has yet to be established. PURPOSE: The purpose of this study is to report operative data, clinical and radiological outcomes of patients undergoing minimally invasive management of thoraco-lumbar fracture at our institutions. METHODS: Forty-one patients underwent percutaneous kyphoplasty and stabilization for treatment of single-level fracture of the thoracic or lumbar spine. All patients were neurologically intact. There were 20 males and 21 females with an average age of 50 years. RESULTS: The mean follow-up was 15 months (3-90 months). The mean operative time was 102 minutes (range 35-240 minutes) and the mean blood loss was <100mL. VAS was significantly improved from 6.7 to 0.7 at last follow-up. Vertebral kyphosis decreased by 16° to 7.8° postoperatively (P<0.001). Local kyphosis and percentage of collapse were also significantly improved from 8° to 5.6° and from 35% to 16% at last follow-up. Fifteen leaks have been identified, three of which were posterior; all remained asymptomatic. No patient worsened his or her neurological condition postoperatively. CONCLUSION: Percutaneous stabilization plus balloon kyphoplasty seems to be a safe and effective technique to manage thoraco-lumbar fractures without neurological impairment.

Hypopituitarism after surgical clipping of a ruptured cerebral aneurysm.

OBJECTIVE: The causes of hypopituitarism in adult life are most frequently cerebral tumors, pituitary infarction, head trauma, pituitary surgery, or irradiation. We report a case of hypopituitarism after surgical clipping of a ruptured cerebral aneurysm. Two previous cases after the rupture of a cerebral aneurysm have been reported. DESIGN: Case report. PATIENTS: One 42-yr-old man. MEASUREMENTS AND MAIN RESULTS: A 42-yr-old man was admitted as an emergency for unconsciousness. The computed tomography showed a massive subarachnoid hemorrhage, and specific angiography showed an aneurysm in the internal carotid. The aneurysm was successfully clipped through craniotomy. The patient's hospital course was marked by a few episodes of pulmonary infection, and a tracheotomy was performed. The patient was transferred to the rehabilitation unit; he received a rating of 9 on the Glasgow Coma Scale. Seven months after rupture of the aneurysm, the patient was readmitted to the intensive care unit for septic shock, with pulmonary infection associated with vomiting and diarrhea. Despite standard therapy and inotropic support, there was no improvement of his clinical condition. Adrenal failure was then suspected. Treatment was started immediately with hydrocortisone (50 mg) four times a day. Within hours, his clinical condition improved. The following month, the patient was weaned off his tracheotomy and had nearly recovered. Endocrine tests confirmed the cortisol insufficiency but also hypothyroidism and hypogonadotropic hypogonadism secondary to hypopituitarism. CONCLUSION: Our case is the first one reported of hypopituitarism after surgical clipping of a ruptured cerebral aneurysm.

[Morphometric and radioautographic study of neuronal loss and gliosis in sclerosis of the hippocampus associated with temporal lobe epilepsy]. / Etude morphométrique et radio-autographique de la perte neuronale et de la gliose dans la sclérose de l'hippocampe associée à l'épilepsie du lobe temporal.

Hippocampal sclerosis is a complex combination of neuronal and glial changes. It is frequently associated with temporal lobe epilepsy. Six hippocampal specimen were obtained from patients operated on for intractable mesial temporal lobe epilepsy. Comparisons were made with six autopsy controls. The neuronal and glial cells populations were studied by morphometric quantitative analysis. The glial cell types were identified by immunohistochemistry procedures. Distribution of the central (neuronal location) and the peripheral (glial location) benzodiazepine (BZ) binding sites was studied by quantitative autoradiography using [3H]-flumazénil and [3H]-PK11195 as respective ligands. Neuronal death and glial proliferation with the usual HS pattern were confirmed in all cases. Microglial cells, labelled with KP1 antibody (resident component) and with HLA-DR alpha (reactive component) were qualitatively similar in patients and controls. Particular radial organization of numerous, long and thin astrocytic processes, as labelled with GFAP antibody, was observed in the molecular layer of the dentate gyrus in 5 cases. These fibrillary processes were intermingled with the granule cells, which were markedly dispersed in 4 of the cases. In comparison with control group, all the epileptic cases had significant selective decreased central-type and increased peripheral-type BZ receptor. These results were respectively correlated with neuronal loss and glial proliferation. Morphologic results suggest that a specific configuration of astrocytic cell processes may be associated with some of the neuronal changes of human HS. Such aspect has not been reported in the astroglial growth observed in animal models of limbic epilepsy. The lack of reactive microglia suggested the absence of recent cell death.(ABSTRACT TRUNCATED AT 250 WORDS)