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Intracranial meningiomas are sometimes located anteriorly to the foramen magnum and can cause disabling long tract symptoms. The far-lateral approach has been developed to provide an extensive view over the bulbopontine junction and the surrounding lower cranial nerves and upper spinal nerves with a good control on the vertebral artery, allowing the safe resection of such tumors. It is the report of a case with anatomical study before and after the removal of the meningioma. The use of the far-lateral approach allowed us to (1) control the vertebral artery in its V3 (Atlantic extradural) and V4 (intradural) portion (2) have an optimal visibility on the lower cranial nerves, the upper spinal nerves, and the bulbopontine junction, and (3) perform a Simpson 2 resection of the tumor that was inserted between the lower clivus and the upper odontoid process. Beyond its interest for the safe resection of tumors located anteriorly to the foramen magnum, the far-lateral approach is of particular anatomical interest. It allowed us to review the anatomy of the craniocervical junction.

Introduction Deformity associating coronal and sagittal malalignment can severely impair quality of life in Parkinson's disease (PD). Realignment using patient-specific rods (PSRs) is useful for achieving alignment goals. Methods This was a retrospective single-center analysis of a prospectively maintained database of all PD patients who underwent surgery between January 2013 and January 2017. Clinical evaluation, preoperatively and at 1 year's follow-up, used the Oswestry Disability Index (ODI). Radiological evaluation used systematic preoperative and 1-year postoperative full-spine radiographs. Results Twelve patients were included: 6 female, 6 male; mean age, 68.4 years. Mean follow-up was 40.8 months [range 12–70]. On average, 14 levels were fused [range 10–18]. Unplanned revision surgery was necessary for 8 patients at a mean 15.625 months after index surgery. Mean preoperative ODI score was 64% preoperatively [range 56–70] versus 52% [range 28–64] at 1 year's follow-up (P = 0.004). Lumbar lordosis improved significantly, from −16.7° preoperatively to −41.4° at 1 year (P = 0.006). Pelvic tilt was the least effectively corrected parameter, with a mean preoperative value of 31.6° vs. 27.8° at 1 year (P = 0.19). Mean preoperative sagittal vertical axis was 149.7 mm versus 73.6 mm at 1 year (P = 0.013). Mean preoperative coronal tilt was 68.2 mm versus 22.9 mm at 1 year (P = 0.007). Conclusion Parkinson's disease is a degenerative disease frequently associated with major spine malalignment. The severity of the postural disorders in these patients needs special precautions to avoid complications.

Purpose: Each summer, many vacationers enjoy the Mediterranean Sea shores. Among the recreational nautical activities, motorboat cruise is a popular choice that leads to a significant number of thoracolumbar spine fractures at our clinic. This phenomenon seems to be underreported, and its injury mechanism remains unclear. Here, we aim to describe the fracture pattern and propose a possible mechanism of injury. Methods: We retrospectively reviewed the clinical, radiological, and contextual parameters of all motorboat-related spinal fracture cases during a 14-year period (2006–2020) in three French neurosurgical level I centers bordering the Mediterranean Sea. Fractures were classified according to the AOSpine thoracolumbar classification system. Results: A total of 79 patients presented 90 fractures altogether. Women presented more commonly than men (61/18). Most of the lesions occurred at the thoracolumbar transition region between T10 and L2 (88.9% of the levels fractured). Compression A type fractures were seen in all cases (100%). Only one case of posterior spinal element injury was observed. The occurrence of neurological deficit was rare (7.6%). The most commonly encountered context was a patient sitting at the boat’s bow, without anticipating the trauma, when the ship’s bow suddenly elevated while crossing another wave, resulting in a “deck-slap” mechanism hitting and propelling the patient in the air. Conclusions: Thoracolumbar compression fractures are a frequent finding in nautical tourism. Passengers seated at the boat’s bow are the typical victims. Some specific biomechanical patterns are involved with the boat’s deck suddenly elevating across the waves. More data with biomechanical studies are necessary to understand the phenomenon. Prevention and safety recommendations should be given before motorboat use to fight against these avoidable fractures.

Objective The aim of this study was to describe progestin-associated meningiomas’ characteristics, outcome and management. Material and methods We included 53 patients operated on and/or followed in the department for meningioma with progestin intake longer than one year and with recent drug discontinuation. Results Cyproterone acetate (CPA), nomegestrol acetate (NomA), and chlormadinone acetate (ChlA) were involved in most cases. Mean duration of progestin drugs intake was 17.5 years. Tumors were multiple in 66% of cases and were located in the anterior and the medial skull base in 71% of cases. Transitional subtype represented 16/25 tumors; 19 meningiomas were WHO grade I and 6 were grade II. The rate of transitional subtype and skull base location was significantly higher compared to matched operated meningioma general population. No difference was observed given WHO classification. But Ki67 proliferation index tends to be lower and 5/6 of the WHO grade II meningiomas were classified as WHO grade II because of brain invasion. Strong progesterone receptors expression was observed in most cases. After progestin discontinuation, a spontaneous visual recovery was observed in 6/10 patients. Under CPA (n = 24) and ChlA/NomA (n = 11), tumor volume decreased in 71% and 18% of patients, was stabilized in 25% and 64% of patients, and increased in 4% and 18% of patients, respectively. Volume outcome was related to meningioma location. Conclusions Outcome at progestins discontinuation is favorable but different comparing CPA versus ChlA-NomA and comparing tumor location. Long-term follow-up is required. In most cases, simple observation is recommended and surgery should be avoided.

International audience; BackgroundAccurate screw placement remains challenging, especially in the cervical spine. We present our first experience of minimally invasive posterior cervical and upper thoracic pedicle screw fixation in the lower cervical spine.MethodsThis study reports a case series of patients, undergoing posterior percutaneous pedicle fixation using Cirq robotic assistance coupled to the Airo intraoperative computed tomography scan and Brainlab navigation system. Routine computed tomography was performed on postoperative day 2 to evaluate pedicle screw placement. The effective dose was calculated.ResultsBetween February 2020 and December 2020, 7 patients (4 men and 3 women) were treated. The mean age was 58.8 years (range, 29–75 years). Fixation was performed with a cannulated PASS OCT Reconstruction System (Medicrea). Overall, 28 screws were placed within cervical and upper thoracic pedicles. According to the Neo and Heary classification, 85.7% were rated as acceptable and 14.3% as poor. The radiation dose received by the patient was 9.1 mSv (range, 7.7–10.6 mSv). The radiation dose received by the surgical staff was 0 mSv. The postoperative course was excellent.ConclusionsPosterior miniopen fixation using Cirq robotic assistance coupled with an intraoperative computed tomography navigation system is a major innovation that can improve the accuracy of pedicle screw positioning, with acceptable patient radiation and reduced surgical team exposure.

Introduction Complex spinal surgery is known to be at risk of complications. Surgical site infection is a serious complication in spine surgery and its frequency is significantly increased in adult spinal deformity correction. The aim of this study is to identify patients’ characteristics and risk factors of surgical site infection (SSI) following an osteotomy. Methods This is a single-center retrospective study of patients who underwent an osteotomy between January 2015 and December 2017. Surgical site infection diagnosis was based upon patient's clinical evidence of infection, biologic parameters, microbiological criteria and/or image findings. Results In total, 102 patients were eligible and 70 were women (68.6%). Mean age was 65 years old (27–83 years) and mean body mass index (BMI) was 26.14 kg.m−2 (18.4–44.1). Eleven patients were in the SSI group and 91 in the No-SSI group. The mean Schwab grade was 1.5 (1–4) in the SSI group vs. 1.4 (1–5) in the No-SSI group (P = 0.435). The mean operative time was on 201.9 minutes (67–377). Mean length of stay was 20.6 days (10–73) in the SSI group vs. 15 days (5–44) in the No-SSI group (P = 0.041). Favorable outcome was found in 10 patients (90.9%) in the SSI group. Conclusion Correction surgery for adult spinal deformity with osteotomies carries a high risk of complications specially SSI. Identification of risk factors, prevention and medical management of SSI should be well assessed.

Traumatic fractures of the thoracolumbar spine are common. Their management considers the fracture type according to the various classifications in existence, as well as the patient's background and age. In some cases, the occurrence of a fracture on a spine with an unoperated scoliotic deformity can be observed. This entity, not described in the literature, can pose a therapeutic challenge and is not present in any existing treatment algorithm. The main objective of this work was to describe the characteristics and management of vertebral fractures in patients with unoperated idiopathic scoliosis.We carried out a monocentric retrospective study in all patients operated on for a spinal fracture between May 2011 and August 2020, with a history of unoperated adolescent idiopathic scoliosis. We collected epidemiological data including the surgical course of each patient and the final result. The patients were categorized according to the surgical strategy (extensive fusion and correction of the deformity, short osteosynthesis without considering the scoliosis, vertebroplasty, orthopedic treatment) and the final clinical and radiological result evaluated at the last follow-up.Ten patients were included in this study with a total number of 16 fractured vertebrae. The population was 80% female, with an average age of 36.3 years. The majority of fractures were type A, at the thoracolumbar junction. The curves were classified as Lenke 1A in 5 cases, 1B in 2 cases, 1C in 1 case and 5C for 2 patients. Ultimately, 3 patients underwent extended fusion with correction of scoliosis, 6 localized osteosynthesis and 1 percutaneous vertebroplasty. In 50% of cases, a change of surgical strategy had to be made, due to worsening of the deformity or hyperalgesia. The last follow-up was at 19.7 months on average. Five patients had a good final clinical result, 5 patients had persistence of significant pain (lower back pain or cruralgia).This is the first study investigating the association of vertebral fractures and the presence of unoperated idiopathic scoliosis. The results of our study highlight the management challenges and difficulties in therapeutic decision making. The presence of a pre-existing curve is thus an important parameter to consider, and should lead to the discussion of performing an extended fusion secondarily in view of the risk of poor results from localized surgery.IV.

Resume Introduction Les fractures-eclatement de L5 representent un faible pourcentage de l’ensemble des fractures de la colonne vertebrale dont la strategie de traitement n’est pas encore standardisee. Les caracteristiques anatomiques et biomecaniques lombo-sacrees creent des types de fractures qui different de celles de la jonction thoraco-lombaire. L’objectif de cette etude etait d’evaluer les resultats du traitement chirurgical des fractures-eclatement de L5 apres stabilisation posterieure et reconstruction de la colonne anterieure. Patients et methodes Six patients avec une fracture instable de L5 isolee ont ete inclus. Les dossiers medicaux, les radiographies et des scores cliniques etaient analyses. Les resultats portaient sur la restauration de la hauteur du corps vertebral, de la lordose/cyphose vertebrale, la stenose canalaire et les parametres de l’equilibre sagittal a differentes phases de la prise en charge. Resultats Aucun patient n’a presente d’aggravation neurologique. La hauteur vertebrale anterieure mediane preoperatoire etait de 41 mm vs 48 mm en postoperatoire. La cyphose traumatique moyenne preoperatoire, mesuree par l’angle de Cobb (local et regional), etait de 21,5 degres et 33 degres avec une amelioration respective de 7,5 et 5,5 degres apres instrumentation. La stenose canalaire moyenne, liee a la retropulsion du fragment osseux dans le canal, etait mesuree a 67 % en preoperatoire et a 35 % en postoperatoire. Au dernier recul, une fusion anterieure etait obtenue dans tous les cas et il etait note une restauration de l’equilibre sagittal. Cliniquement, tous les patients avaient une incapacite minimale a moderee en utilisant l’indice d’Oswestry. La capacite de retour au travail montrait des resultats a long terme consideres comme bon a excellent. Discussion Les resultats du traitement des fractures instables de L5 avec stabilisation posterieure et reconstruction de la colonne anterieure montrent un benefice sur le resultat fonctionnel a long terme, la stabilisation de la colonne vertebrale et les parametres radiologiques. Niveau de preuve IV, etude retrospective.

Introduction L5 burst fractures represent a small percentage of all spine fractures. Treatment strategy has not yet been standardized. Anatomical features and their biomechanical characteristics create fracture patterns which differ from those at the thoracolumbar junction. The objective of this study was to evaluate L5 burst fracture surgical treatment outcomes after posterior stabilization and reconstruction of the anterior column. Patients and methods Six patients with fifth lumbar isolated unstable burst fractures were analyzed. Medical records, radiographs, and clinical scores were obtained. The results were evaluated based on restoration of vertebral body height, spinal lordosis/kyphosis, canal compromise and sagittal alignment at several phases of treatment. Results No patient showed neurologic deterioration, regardless of treatment. The median preoperative anterior vertebral height was 41 mm and postoperative was 48 mm. The median preoperative kyphotic angle as measured by Cobb angle (local and regional) was 21.5 degrees and 33 degrees which improved respectively by 7.5 and 5.5 degrees following instrumentation. The median amount of backward protrusion of bony fragment into the canal was measured at 67% preoperatively and at 35% postoperatively. There were no pseudarthrosis and anterior arthrodesis solid fusion was visible in all cases. There were a sagittal alignment restoration. At one year of follow up, fusion was obtained in all the cases, all patients had minimal to moderate disability using Oswestry Disability Index. The ability to return to work revealed a good-to-excellent long-term result. Discussion The results of treatment of 5th lumbar unstable burst fractures with posterior stabilization and reconstruction of the anterior column show benefit on durable functional outcome, spine stabilization and radiologic parameters. Level of evidence IV, retrospective study.

Ventriculoperitoneal shunt (VPS) is an adequate treatment for congenital hydrocephalus or chronic hydrocephalus in adults. Yet, it is a surgery associated with a significant rate of complications amongst neurosurgical procedures, with frequent shunt obstructions and infections. We report the first-ever case of peritonitis caused by Roseomonas mucosa, shortly after the revision of a VPS ventricular catheter. Hardware removal and proper antibiotic therapy led to the patient's recovery. Roseomonas mucosa is an opportunistic skin pathogen with an antibiotic resistance profile to many beta-lactamines and a tropism for indwelling catheters and post-operative period. Nowadays, it should be taken into account in case of infection of indwelling catheters and for some implantable medical devices.

Background Odontoid fractures are the most common lesions of the upper cervical spine in patients >70 years old. These fractures are associated with frequent comorbidities, and minimally invasive techniques might have the potential to reduce postoperative complications while ensuring better precision. The aim of this study was to report an innovative technique and preliminary results of minimally invasive atlantoaxial fixation using a three-dimensional intraoperative navigation system and percutaneous approach. Methods This retrospective study included 5 consecutive patients with an acute traumatic odontoid type II fracture managed using a percutaneous Harms fixation under three-dimensional intraoperative navigation guidance. Results C1 lateral mass screws and C2 isthmus screws were successfully placed in all patients. In all cases (100%), adequate screw positioning with no medial breach and no transverse foramen obstruction was observed. No intraoperative complications, such as injury of the vertebral artery, spinal nerve root, or spinal cord, occurred. None of the 5 patients received blood transfusion during or after the procedure. During the follow-up period (mean, 11.2 months; range, 5-16 months), 4 patients (80%) demonstrated a favorable clinical recovery, and only 1 patient required occasional medication for moderate pain. Mean radiation exposure was 4.83 mSV for each patient and 0 mSv for surgical staff. Conclusions Minimally invasive atlantoaxial fixation using an intraoperative three-dimensional navigation system is a safe and effective alternative to the conventional approach that reduces postoperative morbidity.

Purpose Nocardia farcinica is an opportunistic pathogen causing mainly pneumonia in immunocompromised patients, complicated in almost one-third of the cases by a thick-walled multiloculated cerebral abscess which induces significant morbidity and mortality. This review aims to assess the optimal treatment strategy for N. farcinica cerebral abscess. Methods Report of a case. Medline database was used to conduct a systematic review from inception to January 2020 looking for English-language articles focused on N. farcinica cerebral abscess, in accordance with the PRISMA guidelines. Results The research yielded 54 articles for a total of 58 patients. N. farcinica cerebral abscess displayed three different neuroimaging patterns: a single multiloculated abscess in half of the cases, multiple cerebral abscesses, or a small paraventricular abscess with meningitis. The patients who benefited from surgical excision of the abscess showed a trend towards a lower risk of surgical revision (8% versus 31%, P = 0.06) and a lower mortality rate (8% versus 23%, P = 0.18) than patients who benefited from needle aspiration. Twenty-two percent of the patients benefited from microbiological documentation from another site with a mortality rate of 23%. Conclusion Urgent multimodal MRI is necessary in face with clinical suspicion of cerebral nocardiosis. In case of single or multiple small cerebral abscesses, microbiological documentation can be obtained with puncture of pseudotumoral visceral lesions. In case of large or symptomatic cerebral abscess, an aggressive surgical excision seems a reliable option and can be preferred over needle aspiration. Long-term antibiotic therapy with cotrimoxazole is necessary thereafter.

Sacral fractures are underdiagnosed and often undertreated. We report the second case of presentation and surgical management of a 56-year-old man with traumatic sacral U-shape fracture secondary to a grand mal epileptic seizure. We then discuss risk factors and mechanism of such fracture in epileptic patients.

Secondary empty sella syndrome (SESS) following pituitary surgery remains a diagnostic and therapeutic challenge. The aim of this study was to specify the diagnostic criteria, surgical indications and results of chiasmapexy in the SESS. Three cases from two experienced neurosurgical centers were collected and the available literature was reviewed. The 3 patients were operated for a giant non-functioning pituitary adenoma, a cystic macroprolactinoma, and an arachnoid cyst respectively. Postoperative visual outcome was initially improved, and then worsened progressively. At the time of SESS diagnosis, visual field defect was severe in all cases with optic nerve (ON) atrophy in 2 cases. Patients were operated via an endoscopic endonasal extradural approach. One patient was re-operated because of early fat reabsorption. Visual outcome improved in 1 case and stabilized in 2 cases. Statistical analyses performed on 24 cases from the literature review highlighted that patient age and severity of the preoperative visual defect were respectively significant and nearly significant prognostic factors for visual outcome, unlike the surgical technique. T2-weighted or CISS/FIESTA sequence MRI is mandatory to visualize adhesions, ON kinking and neurovascular conflict. TS approach is the most commonly used approach. The literature review could not conclude on the need for an intra or extradural approach suggesting case by case adapted strategy. Intrasellar packing with non-absorbable material such as bone should be considered. Severity of the visual loss clearly decreases the visual outcome suggesting early chiasmapexy. In case of severe and long standing symptoms before surgery, benefits and surgical risks should be carefully balanced.

Background Odontoid fracture is a common injury in the upper cervical spine that can sometimes be managed by anterior odontoid screw fixation. Case description We report the first case of iatrogenic postero-inferior cerebellar artery (PICA) injury while performing anterior odontoid screw fixation for a type II odontoid fracture in a 22-year-old man. Fisher grade 4 subarachnoid hemorrhage secondary to iatrogenic pseudoaneurysm formation was managed by the endovascular neuroradiologist. Odontoid fracture was then managed posteriorly using Harm's technique. Postoperative 12-month follow-up revealed good clinical and radiological results. CT scan showed fusion. Complete exclusion of the pseudo aneurysm with a mild stroke in the inferior left cerebellar hemisphere were noted on the MRI. There were no cerebellar ataxia or swallowing disorders. Conclusion To the best of our knowledge, this is the first case report of iatrogenic PICA injury in anterior odontoid screw fixation. The patient was well managed in our institution within a multidisciplinary team. We recommend that surgical management of odontoid fractures should be performed in expert centres.

International audience; Recent discoveries of multiple driver mutations open promising perspectives for targeted therapies in meningioma. Nevertheless, iterative recurrences of most aggressive meningiomas as extended skull base meningiomas are not systematically operated and histologically documented. This suggests the interest and the relevance of liquid biopsy in meningiomas. In a proof-of-concept study, we detected the NF2 mutation in 2 of 6 cell-free plasma DNAs and 1 of 1 cerebrospinal fluid (CSF) from high-grade recurrent cases, suggesting that identification of the driver mutation in blood and CSF is today feasible. Liquid biopsy could be an interesting tool to adapt the targeted therapy in meningiomas in the near future.

Study Design: Observational study.Purpose: The actual sanitary crisis led to a massive mobilization of the sanitary system toward intensive care units and management of coronavirus disease 2019 (COVID-19) patients. However, some patients still require spinal interventions. The present study aimed to assess the impact of the COVID-19 pandemic on spine surgical in a moderate COVID-19 cluster region.Overview of Literature: Previous studies have reported screening and management of patients with spinal conditions during the COVID-19 pandemic. However, to date, knowledge, no observational study on spine surgeries during the pandemic has not been reported.Methods: Between March 17, 2020 and April 17, 2020, information on spine surgical activity was prospectively collected at our institution. This surgical activity related to the first month of confinement in France was compared to the activity during the same period in 2019 to evaluate the impact of the COVID-19 pandemic on surgical activities.Results: In order to reduce the contamination rate of patients and medical staff during hospitalization, the spine department was completely reorganized. Non-urgent elective spine surgeries were cancelled. When considering the global amount of surgeries procedures during the first month of confinement, a decrease of almost 50% was observed in the number of surgical procedures. During the study period, 62 patients were eligible for spine surgery. The numbers of patients managed for tumor and infectious cases were stable, while a considerable reduction was observed in the number of trauma and degenerative cases. During the follow-up period, two patients were tested as COVID+ during the postoperative course, and no cases of medical or paramedical staff contamination were reported using polymerase chain reaction-testing.Conclusions: During the COVID-19 pandemic, it is possible to maintain spine surgical activity. Each surgical procedure must be discussed and organized with all the caregivers involved. Indications for surgery must be in line with the scientific guidelines and adapted to each healthcare facility.

Background. Although lumbar isthmic spondylolisthesis is frequent in the Caucasian population, its association with spondylodiscitis is extremely rare. Case Description. The authors reported the case of a 44-year-old patient affected by pyogenic spondylodiscitis on previously documented isthmic spondylolisthesis at the L5-S1 level. The patient was surgically treated by circumferential arthrodesis combining anterior lumbar interbody fusion (ALIF), followed by L4-S1 percutaneous osteosynthesis using the same anesthesia. Appropriate antibiotherapy to methicillin-susceptible Staphylococcus aureus, found on the intraoperative samplings, was then delivered for 3 months, allowing satisfactory evolution on the clinical, biological, and radiological levels. Discussion. This is the first case report of spondylodiscitis affecting an isthmic spondylolisthesis surgically treated by circumferential arthrodesis. In addition to providing large samplings for analysis, it confirms the observed evolution over the past 30 years in modern care history of spondylodiscitis, increasingly including surgical treatment with spinal instrumentation, thus avoiding the need of an external immobilization. Care must nonetheless be exercised in performing the ALIF because of the inflammatory tissue increasing the risk of vascular injury. Conclusion. Spondylodiscitis occurring on an L5-S1 isthmic spondylolisthesis can be safely managed by circumferential arthrodesis combining ALIF then percutaneous osteosynthesis in the same anesthesia, obviously followed by appropriate antibiotherapy.

Minimally invasive approaches for lumbar fusion are aimed at reducing soft tissue injury in order to minimize surgical morbidity and facilitate recovery. Applied to lumbar fusion, such an approach is described as a mini-open transforaminal lumbar interbody fusion (TLIF). Important anatomical landmarks are reviewed. Indications, advantages, and limitations are discussed, and a step-by-step description of the procedure is presented. Decompression, fixation, and bone grafting can be achieved efficiently through this approach with lesser blood loss, shorter hospital stay, reduced rate of general complications, and infections as well as a lower readmission rate. The mini-open TLIF technique, as presented here, is a safe and efficient procedure to achieve lumbar fusion with a reduced rate of complications related to surgery.

Background: Percutaneous kyphoplasty is a minimally-invasive techniques that aim to provide pain relief and bone stabilization by the injection of cement. Metastatic lesions of the atlas treated by this technique has been described in only few articles. Objective: We describe the use of kyphoplasty in a painful osteolytic lesion located in the left mass lateral of C1 with a postero lateral approach using 3D CT-scann intraoperative navigation system and fluoroscopy. Methods: A 58 year-old woman with metastastic breast neoplastic which admitted for treatment severe left-sided suboccipital exacerbated by head rotation and neck pain refractory to conventional medical treatment painkillers. CT scan and magnetic resonance imaging of the cervical spine revealed osteolytic destruction the left lateral mass of C1 . The patient underwent a percutaneous kyphoplasty managed using polymethylmetacrylate bone cement. Results: The patient reported post operative substantial pain relief . CT scan showed adequate filling of the osteolytic lesion without the obvious leakage of bone cement. the patient showed no clinical complications, while Clinical follow-up at 3 months revealed that this pain condition was improved and maintained. Conclusion: Minimally invasive percutaneous kyphoplasty using an intraoperative 3D navigation system and fluroscopy with postero lateral approach is a safe and effective alternative reducing post-operative morbidity and effective possibility in selected patients with C1 metastasis

Background Infectious aneurysm is a rare complication in intracranial aneurysm. Moreover, giant aneurysm is a rare entity in intracranial aneurysm. In the great majority of infectious intracranial aneurysms, vasculitis and/or endocarditis is associated. Case Description Here, we report the case of an 83-year-old man who developed a giant infectious intracranial aneurysm on the anterior communicating artery. This patient had never shown any intracranial bleeding. A surgery was performed, and purulent liquid and aneurysm wall were removed during procedure. The bacteriologic analyses reported Campylobacter fetus. Conclusions This bacterium seems to be more and more frequent in North America and Europe, according to the current literature. Moreover, cases of mycotic extracranial aneurysm were reported. Here we report the first case of intracranial giant infectious aneurysm in an adult patient, without any endocarditis or vasculitis. This new entity could be the cause of a bacterial graft on an asymptomatic giant preexisting intracranial aneurysm or a consequence of campylobacteriosis.

Epidermoid cysts are classical tumors in neurosurgery, but spinal locations are rare and intramedullary locations represent only approximately 80 cases in the literature. Intramedullary epidermoid cysts arise from ectodermic tissue inclusion during neural tube closure. Intramedullary epidermoid cysts are more frequent in young patients and in a thoracic location. We report the case of a 61-year-old patient consulting for bilateral asymmetrical progressive paraparesis and proprioceptive ataxia revealing a T3-T4 exophytic medullar epidermoid cyst. The tumor was surgically removed with a favorable outcome. The capsule was partially removed. The authors present an updated literature review of intramedullary epidermoid cyst diagnosis, management and recommendations.

Background Accurate screw placement remains very challenging especially in the upper cervical spine. Objective To present our first experience of a percutaneous posterior C1-C2 fixation for a traumatic fracture. Methods This is a case report of a non-neurological patient, harboring a type II odontoid fracture. She underwent a posterior percutaneous fixation using Cirq® Robotic Assistance coupled to the AIRO® intraoperative computed tomography (iCT)-scan and BrainLab® navigation system (all by BrainLab AG). Routine CT was performed on postoperative day 2 to evaluate pedicle screw placement. The effective dose was calculated. Results The C1-C2 posterior percutaneous fixation was performed with cannulated VERTEX® Reconstruction System (Medtronic). Overall, 4 screws were placed. All of them were rated as acceptable (100%). Radiation dose received by the patient was 4.13 mSv. Radiation dose received by the surgical staff was 0 mSv. Postoperative course was excellent. Conclusion Posterior percutaneous fixation using Cirq® Robotic Assistance coupled with iCT navigation system is a major innovation that can improve pedicle screw positioning's accuracy with acceptable patient radiation and reduced surgical team exposure.

Object In recent years, the classical vertebroplasty has tended to be replaced by vertebral augmentation procedures. This article discusses the reliability of vertebral augmentation procedures using balloon kyphoplasty or a spine jack system, with intraoperative CT scan control coupled with the neuronavigation system as a treatment option for cervical and upper thoracic spine lesions. Methods In our neurosurgical department, in the past two years, 11 patients underwent either a kyphoplasty or a vertebral augmentation by a Spine Jack via a transpedicular route, under perioperative 3D imaging, for a total of 15 cervical/upper thoracic lesions. For these patients, we evaluated the clinical symptoms before and after surgery, the intraoperative and postoperative complications as well as the radiation exposure and the duration of their hospitalisation. Results We noted for all of the patients an improvement of the mean Karnofsky index, which improved from 50 to 80, and of the VAS that decreased from a mean of 75 to 15, as they were clearly alleviated after the operation. The radiation was lower for patients that were treated for 2 or more vertebrae, and much lower for the medical staff. The intraoperative complications rate (4 cement leakages for 15 vertebrae, 26%), was low and completely asymptomatic in all cases. The radiological follow-up examinations were satisfactory for all the patients. Conclusions Our results suggest that percutaneous transpedicular vertebral augmentation techniques using intraoperative CT scan are a viable treatment for secondary lesions or traumatic compression fractures of the cervical and upper thoracic spine.

Introduction Le syndrome de selle vide secondaire (SSVS) apres chirurgie hypophysaire pose un reel probleme diagnostique et therapeutique. Nous avons collige 3 cas operes a l’hopital Lariboisiere et a l’hopital de La Timone, puis realise une revue de la litterature. Observations Les 3 patients ont ete operes d’un macroadenome hypophysaire non secretant, d’un macroprolactinome invasif et d’un kyste arachnoidien. L’atteinte visuelle preoperatoire etait severe dans les 3 cas avec une amelioration visuelle postoperatoire variable suivie par la suite d’une degradation visuelle. Les IRM ont confirme le diagnostic de SSVS. Les 3 patients avaient une atteinte visuelle severe avec atrophie d’un des 2 NO chez 2 patients. Ils ont ete operes par voie endoscopique endonasale essentiellement extradurale. Une patiente a du etre reoperee devant une resorption rapide de la graisse. 2 patients ont presente une stabilisation du bilan visuel, 1 patient a ete ameliore. Discussion Lors d’un SSVS, l’amelioration visuelle postoperatoire est le plus souvent modeste, mais permet le plus souvent au moins une stabilisation visuelle. L’âge du patient et la severite visuelle preoperatoire sont des criteres pronostiques significatifs quant au pronostic visuel a l’inverse de la technique chirurgicale. Nous recommandons l’utilisation de la voie endoscopique extradurale avec implantation d’un fragment osseux dans la majorite des cas, mais une voie intradurale transsphenoidale ou transcrânienne peut etre proposee au cas par cas, particulierement si des adherences ou un conflit vasculo-nerveux sont visualises a l’IRM. Il faut neanmoins prendre en compte un risque chirurgical superieur.

BACKGROUND The aim of this retrospective study was to evaluate the relevance of a systematic postoperative CT scan after neurosurgical craniotomy and to identify predictive factors of complications. METHODS This retrospective analysis included all the patients at our institution who benefited from a cerebral postoperative CT scan within 24 hours post-craniotomy. Patient characteristics and neuroimaging abnormalities were recorded. Predictive factors were identified using a recursive partitioning analysis. RESULTS A total of 633 patients were included. Of these, 17.9% of patients suffered from postoperative complications and 7.4% of them required a new surgery. The decision for reoperation was based on the neurological deterioration and the CT scan, but never on the CT scan alone. The mortality rate was 1.1%. The risk to be reoperated was correlated to the occurrence of a new postoperative neurological deficit (P

Introduction: The difficulty in treating of burst fracture is marked by secondary kyphosis. We expose our results in this challenge. Material and Methods: We retrospectively evaluated on preoperative, postoperative, and follow up scanners of 40 patients operated between 2007 and 2012 in the neurosurgery department of the CHU Grenoble these parameters: vertebral kyphosis (CV), regional kyphosis (CR), traumatic regional angulation (ART) and the inter-pedicular distance. The follow-up should be at least a year. Results: The mean age of patients was 39.2 years. Average postoperative distraction was 5.8 mm, and angular reduction was 8.5 ° on the CV and 9.8 ° on ART. At follow-up, the loss of correction was respectively 3.2 ° and 6.1 ° on CV and ART. The secondary compaction was 2.5 mm. Secondary regional kyphosis was higher in short instrumentation (7 ° against 5.2 °) as well as for patients with a BMI ≥ 25.

In general, children and adolescents in the WHO European Region today have better nutrition, health and development than ever before. There are striking inequalities in health status across the 52 countries in the Region, however, with over ten-fold differences in infant and child mortality rates. Inequalities are also growing within countries, and several health threats are emerging. Against this background, the WHO Regional Office for Europe has developed a European strategy for child and adolescent health and development. The purpose of the Strategy, together with a tool kit for implementation, is to assist member states in formulating their own policies and programmes.

In general, children and adolescents in the WHO European Region have better nutrition, health and development today than ever before. However, there are striking inequalities in health status across the 52 countries in the Region with over ten-fold differences in infant and child mortality rates. Inequalities are also growing within countries, and several health threats are emerging. To prevent this, the WHO Regional Office for Europe has developed a European strategy for child and adolescent health and development. The strategy, and its tool kit for implementation, aims to assist Member States in formulating their own policies and programmes.