Etude Irm Des Sequelles Lesionnelles Post - Traumatisme Cranien

Introduction Dans les pays industrialisés les déficiences cérébrales sont souvent dues aux séquelles des traumatismes crâniens. L\'IRM est une technique d\'imagerie cérébrale pouvant préciser les types de lésions à long terme. Matériel et Méthode Dans une étude rétrospective, en 2003 et 2004, nous avons analysé 75 dossiers d\'expertise post - traumatique à l\'Université Libre de Bruxelles (ULB). Les séquelles cérébrales ont été explorées à l\'IRM . Ont été exclus les patients qui ont subi une intervention chirurgicale cérébrale. Résultats 75 cas de traumatisés cérébraux ont été répertoriés ; 64,4% sont de sexe masculin, l\'âge moyen était de 35 ans (7 à 80 ans) ; 40 cas avait une lésion séquellaire cérébrale. Les lésions axonales diffuses ont été retrouvées dans 11 cas dont 5 cas en région péricalleuse, 2 cas avaient une atteinte des pédoncules cérébelleux. La plupart de ces lésions étaient situées dans l\'interface substance blanche/substance grise. Des lésions focales de la base du cerveau étaient observées dans 10 cas. Les séquelles cortico-sous corticales étaient les plus fréquentes, 26 cas . L\'hémosidérine est un indicateur à long terme de l\'atteinte cérébrale. Conclusion Nous concluons que l\'IRM est une excellente technique pour étudier les séquelles cérébrales traumatiques et permet d\'établir leur pronostic. Background Disabilities are frequent in western countries and may be due to cerebral traumatic sequella. MRI with high resolution is an excellent technique to visualise cerebral sequella. Materials and Method In a retrospective study, we reviewed 75 cases of traumatic sequella at the Université Libre de Bruxelles (ULB), in 2003 and 2004 explorated with MRI. We excluded patients who underwent cerebral surgery. Results Focal sequellea cortical and cortico-sub cortical are most frequent, 26 patients. Hemosiderin and encephalomalacia atrophy are common signs. Diffuse Axonal Injury were found in 11 cases, focal sequella of brain sterm in 10 cases. Conclusion We concluded that RMI is an excellent technic of imaging cerebral sequella. Keywords: Brain trauma, Head injuries, Head trauma, Cerebral sequella, MRI.African Journal of Neurological Sciences Vol. 25 (1) 2006: pp. 12-2

A patient with two upper lumbar disc herniations

Of all lumbar disc herniations, less than 5% occur in the upper lumbar area. Though protrusions are common at all levels, truly extruded disc herniations in the upper lumbar area from L1 to L3 are rare. Even more unusual is the multilevel occurrence of herniations in this area. The authors stress the importance of accurate diagnosis and clinically directed medical imaging work-ups

Lésions de la région pinéale et falco-tentorielle. Abord occipito-pariétal en trois-quarts ventral avec volet infra-sagittal [Lesions of the pineal and tentorial region. Occipito-parietal approach in three-quarter prone position with infrasagittal craniotomy].

Surgical treatment of pineal-tentorial region lesions remains a challenge. The difficulty in approaching the pineal region can be verified with the number of operative plans that have been proposed to reach this area: transcallosal, occipital transtentorial, infratentorial supracerebellar approaches and sitting, prone or Concorde positions. This emphasizes the surgeon's dissatisfaction with the surgical techniques described. Recently, a three-quarter prone position with the bone flap placed under the midline has been described (1, 3, 8). We have decided to test this approach that we have slightly modified and we report our results on 13 cases: 2 arachnoid cysts, 3 vascular malformations and 8 tumors (3 brainstem gliomas, 2 dysgerminomas, 1 quadrigeminal plate metastasis and 1 meningioma plus 1 metastasis of the falx). Keeping the table in a horizontal plane, risks of air embolus are eliminated. Using the natural effect of gravity, traction on the occipital lobe is no more necessary and hemianopsia no more occurs. We recommand the parieto-occipital route which is the shortest way to reach epiphysis and falco-tentorial notch. We confirm the results of american colleagues (1, 3, 8, 15) and we advise to use this approach which seems to us the best way to treat pineal-tentorial lesions

The Zeiss-MKM system for frameless image-guided approach in epidural motor cortex stimulation for central neuropathic pain.

OBJECT: Twelve patients (seven female, and five male, mean age 55.6 years) suffering from refractory central (ischemic/traumatic [eight cases]) and neuropathic pain (trigeminal neuropathy [four cases]) underwent surgery for the implantation of an epidural motor cortex stimulation (MCS) device in which the authors used a frameless neuronavigation system, the Zeiss-MKM microscope. METHODS: The authors assessed the spatial accuracy of the neuronavigation system and its potential contribution to improve the quality of targeting pain. In these patients, the positions of the central sulcus, defined by stereotactic magnetic resonance MR imaging, intraoperative somatosensory evoked potentials (SSEPs) and subdural visual verification, were correlated into the stereotactic neuronavigation planning procedure. The mean spatial accuracy of distance between (MR) imaging-defined and actual central sulcus was 2.4 mm (range 5-10 mm). The intraoperative SSEPdefined central sulcus was close to that defined by MR imaging (mean distance 6.4 mm). Although very precise, intraoperative SSEP recordings were impaired by artifacts and wave attenuation in six of the 12 patients. Stereotactic correlations between anatomical and functional data in the navigation system corrected final targeting in 10 of 12 cases. Pain relief was obtained in eight patients. Indeed, inappropriate targeting probably explains the reported variable success rate of MCS and certainly underestimates the actual efficacy. CONCLUSIONS: Since intraoperative SSEP monitoring has, for many years, been considered the standard procedure to approach motor target, the development of an accurate stereotactic image guidance system could help to increase the efficacy of MCS on the alleviation of pain. The excellent spatial accuracy provided by the Zeiss-MKM navigation system allows precise data correlations that represent a remarkable means to validate functional MR imaging as an alternative to SSEP. The authors believe that developing stereotactic image guidance with such a navigation system could improve the success rate of MCS

Positron emission tomography for the early postsurgical evaluation of pediatric brain tumors.

OBJECT: The object was to study the value of postoperative positron emission tomography (PET) to assess the extension of brain tumor resection. METHODS: Twenty children operated on for total resection of a glial tumor (18 low-grade, 2 anaplastic) presented a signal on postoperative magnetic resonance (MR) images raising the question of a possible tumor residue. PET was performed early ((18)F-Fluoro-deoxyglucose in 1, (11)C-methionine in 16, both in 3) to further characterize the nature of the abnormal MR signal in order to consider second-look surgery. An increased tracer uptake found in 14 children led to reoperation on 11 of them, confirming the tumor histologically. No (11)C-methionine uptake led to a conservative attitude in 6 children in whom MR imaging follow-up showed no tumor progression. CONCLUSIONS: The early postoperative PET, especially with (11)C-methionine, appears to be a valid basis for complementary therapeutic decisions, especially second-look surgery, in glial tumors for which a radical resection is a key factor for prognosis