[Remodeling the cranial vault in anterior craniosynostoses. Our therapeutic experience of trigonocephaly and plagiocephaly]. / Le remodelage de la voûte du crâne des crâniosténoses antérieures. Techniques personnelles de traitement des trigonocéphalies et des plagiocéphalies.

The authors propose two simple techniques to improve the adaptation of the frontal vault after remodeling the orbito-naso-frontal flap in anterior craniostenosis. In trigonocephaly: the metopic suturectomy is enlarged by lateral translation of the two half frontal bones, then to fall the place the coronal suture is used. The temporal plates are moved forward and turned to fill the failure of fronto-temporal junction due to valgisation of orbito-naso-frontal band. In plagiocephaly: the frontal flattened flap is cut with oblique radial osteotomies starting at bregma so called "Daisy petal". The first internal petal is sacrificed. The others are rotated axially in a medial direction. Internal table corticotomies must be performed at two levels to recurve the flattening and to obtain a curve in the coronal plane. In this two techniques the pericranium and dura-mater must be carefully teated to obtain a better adaptation of the new bone shape and to permit the spontaneous reossification.

[Results of cervical interbody fusion with coral grafts]. / Résultats d'arthrodèses intersomatiques cervicales par greffons coralliens.

OBJECTIVES: We present the long term clinical and radiological results of a retrospective series of 46 cervical interbody fusions using coral grafts performed in 38 patients. MATERIAL AND METHODS: The patients were treated for prolapsed discs (19 cases) or cervical spondylosis (19 cases) with a clinical presentation of either radiculopathy (31 cases) or myelopathy (7 cases). We have done a post-operative clinical analysis of cervicoscapulalgia and radiculo-medullary symptoms and a radiological comparison of the change of the cervical spine angulation, the loss of height and the fusion rate at the graft site. RESULTS: The early clinical postoperative outcome showed that 10 out of 20 patients with excellent radiculo-medullary results had cervicoscapulalgia and 13 out of 18 patients with partial improvement had cervicoscapulalgia. No poor results according to our classification were noted. The late clinical outcome (average follow-up of 16 months) showed that 15 patients out of 31 had radiculo-medullary degradation and 24 presented with cervicoscapulalgia. Sixteen out of 20 patients had a loss of lordosis (range 6.2 degrees; SD 1.2) and 17 a loss of height (range 11.3%; SD 1.5). After 2 years, 13 out of 20 grafts were still hyperdense compared to the adjacent bone, and 8 had a hypodense peripheral edge. CONCLUSIONS: Coral grafts of this series have not been able to keep a physiological sagittal balance of the cervical spine, which is probably one of the essential factors to prevent postoperative cervicoscapulalgia. In the same way, the loss of height of the fused segments, by narrowing of the intervertabral foramen, may explain some further radiculo-medullary deterioration.

[Advances in the understanding of the etiopathogenesis of non syndromic craniostenoses and therapeutic approaches]. / Avancées dans la compréhension de l'étiopathogénie des craniosténoses non syndromiques et applications thérapeutiques.

The treatment of craniostenoses has not been revolutionized over the last decade, but the methods of investigation, particularly 3D CT scan, histological studies, and refinement of techniques, have allowed substantial progress in the understanding of the aetiopathogenesis and treatment of craniostenoses. The deformities of the components of the base of the skull can now be more precisely analysed. The authors present these elements for each of the various types of craniostenosis. The role of soft tissues has been more clearly defined; the dura mater, corresponding to an internal periosteum, has an osteogenic, but also directional role. The concept of the brain as the essential determinant of cranial morphology has led to the proposal of treatments adapted to each deformity. Specific craniectomies have been completed by mobilization of flaps, and segmentation of the vault allowing almost ideal reconstruction of the skull. In most treated cases, directed osteogenesis results in good consolidation after seven to eight months; partial non-ossification remains frequent in children treated after the age of eighteen months.

[Expression of mRNA, interleukin-1 beta, interleukin 6 and tumor necrosis factor-alpha during regeneration of the sciatic nerve in rats after tissue loss]. / Expression des ARNm de l'interleukine 1 beta, de l'interleukine 6 et du Tumor Necrosis Factor alpha au cours de la régénération du nerf sciatique de rat après perte de substance.

Within the family of proinflammatory cytokines, some exhibit a neurotrophic activity in addition to their proinflammatory functions. However, their role in peripheral nerve regeneration processes is still poorly understood. This study presents the kinetics of expression of mRNAs for different cytokines, IL-1 beta, IL-6, TNF alpha and that of NGF included as control. It was carried out on the rat sciatic nerve regeneration using two models of nerve transection with a 7 mm loss of substance. Nerve regeneration took place through an autologous nerve grafting in the first model, and through a collagenous cylinder in the second one. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to quantify each mRNA of cytokine and that of actin beta gene considered as an endogenous internal standard. The results showed a peak in the expression of IL-1 beta mRNAs in both models at D2 (second bay after operation). This D2-peak was also observed for TNF alpha and IL-6, but only in the model of the cylinder. The level of IL-6 D2-peak was very high compared to the nearly complete absence of IL-6 mRNAs expression in non operated control nerves. According to these results, proinflammatory cytokines and especially IL-6 may play a major role in promoting peripheral nerve regeneration.