Arteries and Veins of the Sylvian Fissure and Insula: Microsurgical Anatomy

International audienceWe present a vascular anatomical study of the arteries and veins of the sylvian fissure and insula.A good knowledge of the sylvian fissure, the insula, and their vascular relationship would seem mandatory before performing surgery in this area, whatever the type of surgery (aneurysms, arteriovenous malformations, insular tumors).We start with the sylvian fissure and insula morphology, followed by the MCA description and its perforators, with special attention paid to the insular perforators. We demonstrate that the long insular perforators penetrating in the superior part of the posterior short gyrus and long gyri vascularize, respectively, the corticonuclear and corticospinal fasciculi. We particularly insist too on three anatomical constants regarding the vascularization of the insula, already described in the literature: The superior periinsular sulcus is the only sulcus on the lateral surface of the brain without an artery along its axis; the superior branch of the MCA supplies the anterior insular pole and both the anterior and middle short gyri in 100 % of cases; in at least 90 % of cases, the artery that supplied the central insular sulcus continued on to become the central artery.We end with the anatomical study of the veins and cistern

Création d'outils d'auto-évaluation pour une formation médicale continue en ligne. Modélisation à propos d'une formation

ERMAInternational audienc

Validation de la Segmentation des Ganglions de la Base sur un Template IRM 3 Tesla

National audienc

Impact of surgical site infection surveillance in a neurosurgical unit.

International audienceThis article describes a two-year surveillance of neurosurgical site infections and an outbreak of infections in deep brain stimulation (DBS) cases. From April to December 2008, six patients had a DBS surgical site infection (SSI). Audits of hygiene practices, infection control of the healthcare environment, and preoperative antimicrobial prophylaxis characteristics were carried out. The results of surgical audits showed that skin preparation and antimicrobial prophylaxis were not being performed adequately. In 2008, the general SSI rate was 1.8% (27 SSIs/1471 patients). Length of preoperative stay was significantly longer among infected patients (2.7 ± 2.9 months) compared with uninfected patients (2.2 ± 4.6 months) (P=0.01). Based on these results, skin preparation and antimicrobial prophylaxis were reviewed with the neurosurgery team. In 2009, the general SSI rate was reduced to 1.1% (16 SSI in 1410 patients), a reduction from 2008 (P=0.12). Although the overall incidence of SSI in 2008 (1.8%) was within the range of published data, this surveillance of SSIs permitted identification of site operative infected patients surgically treated for DBS. A set of actions was then taken to reduce SSI risk. This work demonstrates how an active surveillance programme can successfully change clinical care practice

SPECT and PET analysis of subthalamic stimulation in Parkinson's disease: analysis using a manual segmentation.

International audienceThe subthalamic nucleus (STN) has become an effective target of deep-brain stimulation (DBS) in severely disabled patients with advanced Parkinson's disease (PD). Clinical studies have reported DBS-induced adverse effects on cognitive functions, mood, emotion and behavior. STN DBS seems to interfere with the limbic functions of the basal ganglia, but the limbic effects of STN DBS are controversial. We measured prospectively resting regional cerebral metabolism (rCMb) with 18-fluorodeoxyglucose and PET, and resting regional cerebral blood flow (rCBF) with HMPAO and SPECT in six patients with Parkinson's disease. We compared PET and SPECT 1 month before and 3 months after STN DBS. On cerebral MRI, 13 regions of interest (ROI) were manually delineated slice by slice in frontal and limbic lobes. We obtained mean rCBF and rCMb values for each ROI and the whole brain. We normalized rCBF and rCMB values to ones for the whole brain volume, which we compared before and following STN DBS. No significant difference emerged in the SPECT analysis. PET analysis revealed a significant decrease in rCMb following STN DBS in the superior frontal gyri and left and right dorsolateral prefrontal cortex (p < 0.05). A non-significant decrease in rCMb in the left anterior cingulate gyrus appeared following STN DBS (p = 0.075). Our prospective SPECT and PET study revealed significantly decreased glucose metabolism of the two superior frontal gyri without any attendant perfusion changes following STN DBS. These results suggest that STN DBS may change medial prefrontal function and therefore the integration of limbic information, either by disrupting emotional processes within the STN, or by hampering the normal function of a limbic circuit

Une plateforme logicielle de neurochirurgie assistée par l'image

National audienc

Intramedullary spinal cord tumors.

Since Guidetti and Slooff's masterbooks (1964), numerous papers have been devoted to intramedullary spinal cord tumors (IMT) and their treatment, most of them were focused on ependymomas and astrocytomas. Informed opinion was that these tumors were difficult to cure and that biopsy plus radiotherapy was the treatment of choice. Thanks to microsurgery and bipolar coagulation surgeons grew bolder and more efficient as illustrated by the contributions from Hurth or Resche on hemangioblastomas, Fischer on ependymomas, Epstein on childhood astrocytomas and Guidetti, Malis, Stein on IMT in general. Meanwhile, in the eighties, Magnetic Resonance Imaging (MRI) and Cavitron Ultrasonic Surgical Aspirator (CUSA) drastically modified diagnostic and therapeutic strategies of IMTs, as may be judged by the significant increase in the number of publications on this topic in current medical literature. However, no updated work of synthesis is currently available. This prompted us to publish our common experience based on 171 patients and 200 surgical procedures. Thanks to the collaboration of many colleagues of the "Société de Neurochirurgie de Langue Française" (SNCLF) who completed a questionnaire sent to them, we are now in the position to give an epidemiological estimation based on 1117 cases. This work is divided in three main parts. The first part deals with considerations common to all IMTs, the second with particular aspects specific of each tumoral type, the third with the results and concluding recommendations.CongressesEnglish Abstractinfo:eu-repo/semantics/publishe