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International audience; INTRODUCTION: There is a growing interest in personality evaluation in Parkinson's disease (PD), following observations of specific temperaments in PD patients. Therefore, our objective was to evaluate personality dimensions from the Temperament and Character Inventory (TCI) in a cohort of fluctuating PD patients considered for deep brain stimulation. METHODS: Fluctuating PD patients from the PREDISTIM cohort were included. Description of TCI dimensions and comparison with a French normative cohort were performed. Pearson correlations between TCI dimensions and motor, behavioral and cognitive variables were investigated. Structural and internal consistency analysis of the TCI were further assessed. RESULTS: The 570 PD patients presented significant higher scores in Harm Avoidance, Reward Dependence, Persistence, Self-Directedness and Cooperativeness and significant lower scores in Self-Transcendence compared to the French normative cohort; only Novelty Seeking scores were not different. Harm Avoidance and Self-directedness scores were correlated with PDQ-39 total, HAMD, HAMA scores, and anxiolytic/antidepressant treatment. Novelty Seeking scores were correlated with impulsivity. Pearson correlations between TCI dimensions, principal component analysis of TCI sub-dimensions and Cronbach's alpha coefficients showed adequate psychometric proprieties. CONCLUSION: The TCI seems to be an adequate tool to evaluate personality dimensions in PD with good structural and internal consistencies. These fluctuating PD patients also have specific personality dimensions compared to normative French population. Moreover, Harm Avoidance and Self-Directedness scores are associated with anxio-depressive state or quality of life and, and Novelty Seeking scores with impulsivity.

Objectives The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the hip joint and the distribution of sensory receptors within its capsule. Methods Five electronic databases were queried, with the search encompassing articles published between January 1945 and June 2019. Twenty-one original articles providing a detailed description of sensory receptors around the hip joint capsule (n=13) and its articular branches (n=8) were reviewed. Results The superior portions of the anterior capsule and the labrum were found to be the area of densest nociceptive innervation. Similar to the distribution of nociceptors, mechanoreceptor density was found to be higher anteriorly than posteriorly. Hip joint capsular innervation was found to consistently involve the femoral and obturator nerves, which supply the anterior capsule, and the nerve to the quadratus femoris, which supplies the posterior capsule. The femoral, obturator, and superior gluteal nerves supply articular branches to the most nociceptor-rich region of the hip capsule. Conclusions The femoral and obturator nerves and the nerve to the quadratus femoris were found to consistently supply articular branches to both the anterior and posterior capsule of the hip joint. The anterior capsule, primarily supplied by the femoral and obturator nerves, and the superior labrum appear to be the primary pain generators of the hip joint, given their higher density of nociceptors and mechanoreceptors. Level of Evidence Anatomy study, literature review.

Iron plays an important role in many neurobiological processes, especially in the basal ganglia, the brain structures with the highest concentration. Composed of the pallidum and putamen, the lentiform nucleus plays a key role in the basal ganglia circuitry. With MRI advances, iron-based sequences such as R2* and quantitative susceptibility mapping (QSM) are now available for detecting and quantifying iron in different brain structures. Since their validation using classic iron detection techniques (histology or physical techniques), these sequences have attracted growing clinical attention, especially in the field of extrapyramidal syndromes that particularly affect the basal nuclei. Accurate mapping of iron in these nuclei and their connections is needed to gain a better understanding of this specific anatomy, before considering its involvement in the physiopathological processes. We performed R2* and QSM along with Perls histology, to gain new insights into the distribution of iron in the lentiform nucleus and its surrounding structures, based on four specimens obtained from voluntary donors. We found that iron is preferentially distributed in the anterior part of the globus pallidus externus and the posterior part of the putamen. The lateral wall of the putamen is iron-poor, compared with the lateral medullary lamina and intraputaminal fibers. The relevance of perivascular iron concentration, along with pallido- and putaminofugal iron-rich fibers, is discussed.

Objectif La connaissance precise de la vascularisation arterielle des fosses nasales est un prerequis indispensable a l’utilisation de lambeaux locaux en chirurgie rhinosinusienne et basicrânienne ainsi qu’a la gestion des epistaxis severes notamment par embolisation arterielle. L’objectif de notre etude etait de preciser la participation de l’artere faciale et de proposer une classification de la variabilite de celle-ci. Materiel et methode Nous avons injecte 10 mL de latex colore dans les deux arteres faciales apres reperage et catheterisme en regard du bord basilaire de la mandibule, de 15 cadavres frais. Une endoscopie des fosses nasales etait alors realisee. Pour chaque sujet injecte nous avons repertorie les territoires muqueux vascularises par une branche terminale de l’artere faciale. Resultats Un total de 24 arteres faciales a ete injecte. Dans 8 cas (33 %) aucune vascularisation ou une simple coloration du vestibule narinaire etait notee. Dans 5 cas (20 %) il existait une participation classique, limitee au vestibule narinaire homolateral, a la partie anterieure du septum jusqu’a la tâche vasculaire, a la tete du cornet inferieure et a la cloison inter-sinusonasale. On retrouvait une coloration atteignant la choane dans 10 cas (41 %), associee a une coloration complete du plancher des fosses nasales pour 8 d’entre elles. Conclusion La vascularisation des fosses nasales par l’artere faciale peut se reveler bien plus importante que celle couramment decrite dans la litterature. La grande variabilite de sa participation doit etre prise en compte avant la realisation de lambeau de couverture de base du crâne, ou dans le traitement des epistaxis severes.

ObjectiveTo investigate predictors for improvement of disease-specific quality of life (QOL) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) with early motor complications.MethodsWe performed a secondary analysis of data from the previously published EARLYSTIM study, a prospective randomized trial comparing STN-DBS (n = 124) to best medical treatment (n = 127) after 2 years follow-up with disease-specific QOL (39-item Parkinson's Disease Questionnaire summary index [PDQ-39-SI]) as the primary endpoint. Linear regression analyses of the baseline characteristics age, disease duration, duration of motor complications, and disease severity measured at baseline with the Unified Parkinson’s Disease Rating Scale (UPDRS) (UPDRS-III “off” and “on” medications, UPDRS-IV) were conducted to determine predictors of change in PDQ-39-SI.ResultsPDQ-39-SI at baseline was correlated to the change in PDQ-39-SI after 24 months in both treatment groups (p < 0.05). The higher the baseline score (worse QOL) the larger the improvement in QOL after 24 months. No correlation was found for any of the other baseline characteristics analyzed in either treatment group.ConclusionImpaired QOL as subjectively evaluated by the patient is the most important predictor of benefit in patients with PD and early motor complications, fulfilling objective gold standard inclusion criteria for STN-DBS. Our results prompt systematically including evaluation of disease-specific QOL when selecting patients with PD for STN-DBS.Clinicaltrials.gov identifierNCT00354133.

Introduction Le putamen est une structure profonde du cerveau multipliant les connexions reciproques avec toutes les zones du cerveau et du tronc cerebral devolues a la planification, l’execution et le controle du mouvement. Comme la plupart des noyaux gris centraux il est riche en fer. Ce fer se revele etre une mine d’information pour les neuroscientifiques. En effet, les progres constants de l’imagerie par resonance magnetique (IRM) permettent de visualiser in vivo de maniere indirecte la repartition du fer et de le quantifier approximativement a partir d’abaques. Pour completer le lien entre les sequences dites du fer (R2* et Quantitative susceptibility mapping) et les reelles concentrations de fer intraparenchymateuses, nous avons tente de correler des sequences IRM ex-vivo avec des coupes histologiques servant de reference sur des putamens. Materiel et methodes A partir de prelevements cerebraux humains, nous avons realise des sequences IRM T2* nous permettant de calculer les sequences du fer. Puis un putamen a ete analyse par des colorations de Perls, Perls + DAB et par une immunohistochimie de la ferritine. Les images issues des deux modalites ont ete confrontees de maniere visuelle puis quantitative en faisant correler pixel a pixel les deux types d’images. Resultats Quatre putamens ont ete etudies. L’analyse pixel a pixel entre les deux modalites s’est revelee infructueuse. Les raisons sont de trop grandes differences d’acquisition entre les deux modalites. L’analyse qualitative a revele des heterogeneites de repartition du fer avec une plus grande concentration au sein de la substance blanche et en zone perivasculaire, une faible concentration au niveau du bord lateral et un gradient de fer anteroposterieur au sein du putamen. Conclusion L’etude ex-vivo analysant conjointemant l’histologie et l’IRM est prometteuse mais presente des contraintes. L’IRM du fer est une technique prometteuse tant au plan anatomique que clinique.

Introduction Le nerf suprascapulaire (NSS) est le principal nerf assurant l’innervation sensitive de la face posterieure et superieure de l’epaule. Cependant, la distribution des branches sensitives du NSS reste encore debattue. L’objectif de cette etude etait de permettre une description consensuelle de l’anatomie des branches sensitives du NSS. L’hypothese etait que le NSS donnait trois branches sensitives permettant l’innervation de la capsule gleno-humerale posterieure, de la bourse sous acromiale, et des ligaments acromio- et coraco-claviculaires. Methodes Les divisions, les courses, et la distribution des branches sensitives du NSS innervant les structures de l’epaule ont ete examinees macroscopiquement par la dissection de 37 epaules de 19 cadavres frais âges en moyenne de 83 ans (74–89). Resultats Les 37 NSS donnaient 1 branche sous acromiale mediale (bSAM) et 1 branche sous acromiale laterale (bSAL), et une branche gleno-humerale posterieure (bGHP) a l’epaule. Cette distribution permet une innervation bipolaire - mediale (bSAM) et laterale (bSAL) - de la bourse sous acromiale, des ligaments acromio- et coraco-claviculaire (bSAM), et de la capsule gleno-humerale posterieure (bGHP). Conclusion Le NSS donne deux branches sous acromiales et une branche gleno-humerale posterieure a l’epaule. Cette distribution permet une innervation bipolaire - mediale et laterale - de la bourse sous acromiale, des ligaments acromio- et coraco-claviculaire, et de la capsule gleno-humerale posterieure.

Facial-nerve palsy is the most common complication during facial surgery. However, there are few detailed reports on the distribution of the terminal branches of the facial nerve to the mimetic muscles. This also applies to the communicating branches. The aim of our study was to assess the variability of communicant and terminal branches of the facial nerve in humans. This prospective study involved anatomical dissections and intraoperative electric stimulation of facial nerves. We first performed 30 dissections to define the branching patterns of the extracranial facial nerve, with particular focus on the penetrating points into the mimetic muscles. We then studied and compared these preliminary data with 14 operative facial stimulations conducted during parotidectomies. Each trunk and branch received systematic electrostimulation. The electrostimulation and facial-and-neck movements were analyzed by two independent reviewers. The peripheral branching and intercommunication of the facial branches were highly variable. Combining electrostimulation and dissections, the frontalis muscle, the depressor labii inferioris and the platysma showed little nerve recuperation whereas the sphincter muscles (orbicularis ori and oculi) were anatomically protected. Facial-muscle innervation differed among individuals. We found complex variations in the facial branching mode. Our study highlights the branches and corresponding areas that could be considered anatomically risky. Clin. Anat. 32:169-175, 2019. © 2018 Wiley Periodicals, Inc.

Cone-beam computed tomography (CBCT) is an imaging technique, first developed for use during oral and pre-implant surgery. In sinonasal surgery, CBCT might represent a valuable tool for anatomical research given its high spatial resolution and low irradiation dose. However, clinical and anatomical evidence pertaining to its efficacy is lacking. This study assessed the morphological concordance between CBCT and multislice detector computed tomography (MDCT) in the context of sinonasal anatomy. We performed an anatomical study using 15 fresh cadaver heads. Each head underwent both CBCT and MDCT. Two independent reviewers evaluated 26 notable anatomical landmarks. The primary outcome was the overall morphological concordance between the two imaging techniques. Secondary objectives included assessment of inter-rater agreement and comparison of the radiation doses received by different parts of the anatomy. Overall morphological concordance between the two imaging techniques was excellent (>98 %); the inter-rater agreement for CBCT was approximately 97 %, which is highly similar to MDCT, but achieved using a significantly decreased irradiation dose. Our preliminary study indicates that CBCT represents a valid, reproducible, and safe technique for the identification of relevant sinonasal anatomical structures. Further research, particularly in pathological contexts, is required.

The temporal branch of the facial nerve, a particularly important branch in facial expression, is commonly exposed to surgical trauma. The frontal branch is the most important branch of the temporal branch in the clinical point of view. However, it does not really define in the international nomenclature. The objective of this study was to clearly identify this branch, to perform a cartography of the crossing areas of this branch; and therefore to define statistically a zone of safety within the fronto-temporal region. We used 12 fresh cadavers to perform 24 facial nerve dissections. After the identification of the facial nerve, the branches of the temporofacial trunk were identified, dissected and followed till their penetration. We measured the relationship of the frontal branch with the zygomatic arch, temporal vessels and lateral border of the orbit. We conducted a statistical study to assess the risk of injury of this branch within the temporal region. We observed an important variability in the distribution of this branch in the temporal region. We defined three zones of decreasing safety at the level of three interest landmarks: at the level of the inferior part of the zygomatic arch, we estimated an elevated risk of nerve injury (>85 %) from 22.6 to 26.06 mm in front of the tragus; at the level of the superior part of the zygomatic arch, we estimated an elevated risk of nerve injury (>85 %) from 27.46 to 30.43 mm in front of the tragus; at the level of the lateral border of the orbit, we estimated an elevated risk of nerve injury (>85 %) from 16.20 to 19.17 mm behind this landmark. There exists no real area of anatomical safety in the temporal region. It seems, however, possible to define areas of relative safety that would be of great help for the surgeon or the morphologist wishing to approach pathologies of this region.

Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone.We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only.Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral subthalamic stimulation plus medical therapy and was increased by 21% (245·8 mg/day [40·4]) in those assigned medical therapy alone (p0·0001). Neuropsychiatric fluctuations decreased with bilateral subthalamic stimulation plus medical therapy during 2-year follow-up (mean change -0·65 points [SE 0·15]) and did not change with medical therapy alone (-0·02 points [0·15]); the between-group difference in change from baseline was significant (p=0·0028). At 2 years, the Ardouin scale subscore for hyperdopaminergic behavioural disorders had decreased with bilateral subthalamic stimulation plus medical therapy (mean change -1·26 points [SE 0·35]) and had increased with medical therapy alone (1·12 points [0·35]); the between-group difference was significant (p0·0001). Mean change from baseline at 2 years in the Ardouin scale subscore for hypodopaminergic behavioural disorders, the Starkstein Apathy Scale score, and the Beck Depression Inventory score did not differ between treatment groups. Antidepressants were stopped in 12 patients assigned bilateral subthalamic stimulation plus medical therapy versus four patients allocated medical therapy alone. Neuroleptics were started in nine patients assigned medical therapy alone versus one patient allocated bilateral subthalamic stimulation plus medical therapy. During the 2-year follow-up, two individuals assigned bilateral subthalamic stimulation plus medical therapy and one patient allocated medical therapy alone died by suicide.In a large cohort with Parkinson's disease and early motor complications, better overall behavioural outcomes were noted with bilateral subthalamic stimulation plus medical therapy compared with medical therapy alone. The presence of hyperdopaminergic behaviours and neuropsychiatric fluctuations can be judged additional arguments in favour of subthalamic stimulation if surgery is considered for disabling motor complications.German Federal Ministry of Education and Research, French Programme Hospitalier de Recherche Clinique National, and Medtronic.

The cervical spine is an anatomically complex structure whose essential roles are to orient the head and the sensory system and to protect the spinal cord. In developed countries, sports related accidents constitute the fourth most common cause of spinal cord trauma. They are the second most frequent case of spinal cord injuries for those under the age of 30. All sports are potentially affected even though it would seem that highly kinetic physical activities or contact sports would be the most concerned. In this chapter, we will first review the anatomy of the cervical spine and then describe the biomechanical basis of the protective effect of the cervical musculature and the neurophysiological aspects of trauma prevention. We will describe how cervical muscles can be evaluated and close with a brief overview of preventative strategies of the French Rugby Federation will be described.

Epistaxis constitutes a significant proportion of the Otolaryngologist’s emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoidal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.

Introduction Le sphincter superieur de l’œsophage est defini comme une zone de « haute pression » situee au niveau de l’extremite superieure de l’œsophage. Il est responsable de diverses pathologies notamment d’episodes de dysphagie en cas d’hypertonie. D’un point de vue anatomique, sa definition reste abstraite et il est souvent confondu avec le faisceau cricopharyngien du muscle constricteur du pharynx. L’objectif de notre etude etait de realiser une cartographie micro-architecturale des elements musculaires de la jonction pharyngo-œsophagienne. Methode Cinq pharyngo-œsophagectomies ont ete realisees sur cadavres frais. Le bord superieur du cartilage cricoide (CC) etait systematiquement repere. Nous avons realise sur chaque piece trois coupes longitudinales : posterieure, laterale gauche et laterale droite. La zone d’interet s’etendait de 1 cm au-dessus du bord superieur du cartilage cricoide a 2 cm en dessous. L’orientation des fibres musculaires, le type de fibre musculaire ainsi que l’epaisseur musculaire etaient mesures tous les 500 microns. Resultats Les resultats confirment l’existence d’un epaississement musculaire predominant au niveau des coupes laterales. Cet epaississement est maximal 5 mm au-dessus du CC (moy : 2200, min. : 1800, max. : 2544) sur les coupes laterales droites. Il apparait maximal en regard du CC (moy : 2496, min. : 2120, max. : 2832) sur les coupes laterales gauches. Sur la ligne mediane, nous ne notons aucun epaississement particulier, mais plutot une tendance a une rarefaction des cellules musculaires 5 mm sous le bord superieur du cartilage cricoide. La grande majorite des cellules musculaires observees etaient striees. Conclusion Il existe bel et bien un epaississement musculaire lateral en regard du bord superieur cartilage cricoide. Celui-ci semble correspondre macroscopiquement au faisceau cricopharyngien du constricteur inferieur. Les caracteristiques morphologiques des cellules musculaires a ce niveau ne semblent pas differees des autres localisations pharyngo-œsophagiennes.

Objectif Justifier la voie d’abord transvaginale (VATV) en chirurgie mini-invasive (CMI) par une etude anatomique, clinique et anatomo-pathologique. Methode Une etude anatomique a ete realisee : 10 cadavres frais de femmes adultes ont ete macroscopiquement disseques avec mise en evidence de la voie d’abord transvaginale. Parallelement, une etude anatomo-pathologique a ete menee par l’analyse du cul de sac vaginal posterieur (site de l’incision de la VATV) sur pieces operatoires de patientes ayant beneficie d’une hysterectomie avec colpectomie partielle, mais egalement sur les colpectomies realisees lors du travail anatomique de dissections. Enfin, une etude clinique a ete menee par le suivi postoperatoire des patientes ayant beneficie de la VATV. Resultats L’etude anatomique a mis en evidence une voie d’abord situee dans un « triangle de securite » [1] dans la majorite des cas. Des lesions d’endometriose pelvienne profonde et la presence d’adherences pelviennes compliquaient l’acces au cul de sac vaginal posterieur. Les resultats preliminaires de l’etude anatomopathologique du cul de sac vaginal posterieur mettent en evidence l’absence de structure contre indiquant la VATV. Egalement l’etude macroscopique semble privilegier l’abord du cul de sac vaginal posterieur par rapport a l’abord du cul de sac vaginal anterieur. Concernant l’etude clinique, nos resultats sont concordants avec ceux de la litterature [2] , [3] , [4] : la VATV ne presente pas plus de complications que la laparotomie. Une diminution des douleurs postop., une rehabilitation precoce et l’absence de dysfonction sexuelle ont ete mises en evidence. Conclusion La VATV, de facon exclusive ou complementaire dans la CMI, reste peu exploitee. Notre etude met en evidence le caractere securitaire sur le plan anatomique, anatomo-pathologique et fonctionnel de cette voie d’abord mini invasive.

Background In Parkinson's disease (PD), chronic pain is a common symptom which markedly affects the quality of life. Some physiological arguments proposed that Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) could improve pain in PD. Methods We investigated in 58 PD patients the effect of STN-DBS on pain using the short McGill Pain Questionnaire and other pain parameters such as the Bodily discomfort subscore of the Parkinson's disease Questionnaire 39 and the Unified Parkinson's Disease Rating Scale section II (UPDRS II) item 17. Results All pain scores were significantly improved 12 months after STN-DBS. This improvement was not correlated with motor improvement, depression scores or l -Dopa reduction. Conclusions STN-DBS induced a substantial beneficial effect on pain in PD, independently of its motor effects and mood status of patients.

Introduction Les voies lymphatiques et les territoires de drainage de l’ovaire sont mal connus alors qu’ils sont directement concernes dans le traitement chirurgical du cancer de l’ovaire. Buts de l’etude L’objectif principal de notre travail anatomique etait de mettre en evidence les territoires et les voies physiologiques de drainage lymphatique de l’ovaire. L’objectif secondaire etait d’etudier la faisabilite d’une technique inedite d’injection et de visualisation des vaisseaux lymphatiques. Materiel et methodes Vingt-six ovaires de cadavres frais ont ete injectes a l’aide de bleu patente. Les vaisseaux lymphatiques colores ont ete reperes et disseques, apres observation puis selon les territoires de lymphadenectomies pelvienne et lombo-aortique recommandees. Resultats Nous avons retrouve une coloration lymphatique du territoire lombo-aortique dans 35 % des cas, du territoire iliaque commun dans 35 % des cas, du territoire ilio-obturateur dans 81 % des cas et du territoire inguinal dans 4 % des cas. Le territoire lombo-aortique semble se drainer via le ligament suspenseur de l’ovaire, colore dans 77 % des injections. Le ligament large, colore dans 69 % des cas, semble etre un veritable carrefour lymphatique anastomotique, entre l’ovaire, l’uterus et la trompe. L’atteinte du territoire inguinal pourrait se faire via les vaisseaux lymphatiques du ligament large puis du ligament rond. Nous n’avons pas observe de drainage controlateral dans les territoires de lymphadenectomie. La faisabilite de notre methode est probante, 92 % de nos injections ont permis la coloration d’au moins un territoire lymphatique. Conclusion Notre etude contribue a une meilleure comprehension du drainage lymphatique de l’ovaire. Celle-ci est indispensable au developpement de techniques orientees de prelevement ganglionnaire, plus contributives dans la stadification et moins morbides que les lymphadenectomies etendues recommandees.

Introduction Le tronc cerebral reste un element anatomique difficile a bien mettre en evidence avec les sequences IRM classiques utilisees en routine. Le prelevement post-mortem de troncs cerebraux analyses frais avec des sequences d’acquisitions longues sur IRM 3 Tesla permet des images de qualite inatteignables in vivo. Notre etude consiste en la mise en evidence des elements anatomiques constituant le tronc cerebral par IRM apres correlation aux coupes histologiques. Materiel et methodes Trois troncs cerebraux humains sont extraits de corps frais. Chaque tronc est immerge dans une solution saline au sein d’une boite fermee hermetiquement. Differentes sequences d’acquisition sont alors recueillies (T1, T2, sequences de diffusion, sequences de susceptibilite). Resultats Les images sont en cours de traitement et seront disponibles au moment du congres. Discussion L’analyse IRM ex vivo du tronc cerebral permet un niveau d’information incomparable avec les IRM realisees en routine a destinee clinique. Duvernoy et al. avaient deja propose un atlas du tronc cerebral humain en IRM 9,4Tesla. Cependant, les IRM d’une telle puissance ne sont encore utilisees en routine. Cette presentation est un prelude a la realisation d’un Atlas du tronc cerebral et nous esperons pouvoir appliquer sur de l’in vivo la qualite des acquisitions recueillies ici.

Objectif Evaluer la devascularisation pelvienne et perineale chez la femme apres cystectomie totale pour cause neuro-urologique et ses consequences fonctionnelles. Materiel et methode Il s’agit d’une etude anatomique, clinique et radiologique prospective. Nous avons realise 25 dissections de pelvis de cadavres frais de femmes adultes de facon bilaterale afin d’identifier les branches de division de l’artere ombilicale et ainsi montrer que l’artere ombilicale conserve chez certaines patientes son statut embryonnaire qui est d’etre a l’origine de la vascularisation pelvienne [1] , [2] . Nous avons compare les examens d’imagerie realises en pre- et postoperatoire (angio IRM) de 11 patientes devant beneficier d’une cystectomie. Nous avons ainsi quantifie l’amputation de la vascularisation pelvienne sur l’imagerie postoperatoire. Egalement le questionnaire Female Sexual Function Index (FSFI) a ete analyse dans le but de mettre en evidence un eventuel retentissement fonctionnel sexuel. Resultats L’etude anatomique met en evidence une grande variabilite de la distribution des branches de division de l’artere iliaque interne dont certaines naissent de l’artere ombilicale : l’artere uterine dans la majorite des cas, et l’artere pudendale interne (qui vascularise le clitoris et les petites levres). L’etude radiologique montre une devascularisation pelvienne et perineale consequente dependante de la topographie de la ligature chirurgicale (lors de la ligature de l’artere ombilicale a son origine). Les resultats preliminaires de l’analyse comparative du questionnaire FSFI en pre- et postoperatoire ne semblent pas mettre en evidence de majoration des troubles sexuels. Conclusion La ligature non selective prive le perinee d’une partie de sa vascularisation. Il est donc licite au vu des possibles consequences fonctionnelles engendrees, notamment sexuelles, de discuter le benefice d’une ligature chirurgicale plus selective. L’etude preliminaire des consequences fonctionnelles chez ces patientes traitees pour cause neuro-urologique pourrait etre biaisee par l’atteinte perineale neurologique associee.

ERMA; International audience; BACKGROUND: The purposes of this study were to identify the presence of the anterior intermeniscal ligament of the knee (AIL), to study its attachment patterns and relationships to other anatomic structures within the knee and to evaluate the potential association of its rupture with other pathology of the knee. METHODS: Ten human cadaver knees were dissected excluding knees with surgical scars. Fifty-one MR examinations were performed in symptomatic patients. Arthroscopic observations were carried out on ten patients. RESULTS: AIL was found in nine dissected knees with type I insertion in six cases, type II insertion in three cases. The average length was 31.2 mm (25-45 mm). The average distance between AIL and insertion of the anterior cruciate ligament was 12 mm (11-15 mm). Concerning MR study, AIL was found in 34 cases (82.9%). Four (9.75%) ruptures of the AIL were encountered. Where AIL was intact, 14 patients presented meniscal lesions (46.6%). Where AIL was ruptured, three patients presented meniscal lesions (75%). CONCLUSION: The present study demonstrates through anatomical and MR studies that AIL is present in more than 80% of the cases with predominant type I insertion. The association of meniscal and AIL lesions was highlighted demonstrating that AIL is not only an anatomical point of interest but also a clinical and surgical reality.

We report the case of a young patient, presenting with total bilateral vulvar necrosis after reduction of a femoral neck fracture. This report describes the management of this complication, its mechanism of injury and the associated means of prevention. We present an investigation of the vulvar vasculature in order to understand the mechanism of injury. The study of the vulvar vasculature rejects the anatomical hypothesis of selective damage to the internal and external arteries. Instead, it suggests intraoperative impingement of the terminal blood vessels caused by compression against the perineal post prompting discussion on the use of moulded countertraction posts during orthopaedic surgery.

OBJECTIVE: The veins draining the posterior wall all of the third ventricle and its adjacent structures and the posterior part of the midbrain have been the most neglected of the intractanial vascular structres in both the anatomic and neumsurgical literature. During our dissections of the prineal region and the quadrigeminal cistern, we did not always encounter topographic anatomy as described in previous articles. The purpose of this study is to describe the topographic anatomy and normal variations of the of this study is to describe the topographic anatom and normal variations of the specific veins that drain the collicular plate and the pineal body and their adjacent structures with a view to better defining neurosurgical approaches to the pineal region. METHODS: The deep cerebral veins draining the pineal body, the collicular plate, and their surrounding neural structures were examined on both sides of 25 adult cadaveric brains, in all specimens, the carotid and vertebral arteries and the jugular veins were perfused with red or blue silicone, respectively, to facilitate dissection und ×3 to ×40 magnification. RESULTS: The venous plexus on the dorsal aspect of the collicular plate drains via collicular veins according to three different patterns. These types of drainage are closely related to the existence or absence of the basal vein on one or both sides. CONClUSION: The veins draining the superior and inferior aspects of the pineal body form a superior and an inferior pineal vein that usually drain into the internal or great cerebral vein.

Objectif Evaluer la devascularisation pelvienne et perineale chez la femme apres cystectomie totale. Materiel et methode Il s’agit d’une etude anatomique et radiologique. Nous avons realise 15 dissections de pelvis de cadavres frais de femmes adultes de facon bilaterale afin d’identifier et de quantifier les branches de division de l’artere ombilicale et ainsi montrer que l’artere ombilicale conserve chez certaines patientes son statut embryonnaire qui est notamment d’etre a l’origine de la vascularisation pelvienne [1] , [2] , [3] . Parallelement nous avons analyse et compare les examens d’imagerie realises en pre- et postoperatoire des patientes devant beneficier d’une cystectomie radicale. Nous avons ainsi evalue l’amputation de la vascularisation pelvienne sur l’imagerie postoperatoire. En effet, lorsque le chirurgien realise une cystectomie, la technique chirurgicale consiste a lier l’artere ombilicale a son origine [4] . Resultats Nos resultats preliminaires sont concordants avec ceux de la litterature. Nous avons constate une variabilite non negligeable concernant la naissance des branches viscerales de division de l’artere iliaque interne. En effet, certaines naissent de l’artere ombilicale : l’artere uterine dans la majorite des cas, mais egalement l’artere pudendale interne assurant la vascularisation du clitoris et des petites levres. Parallelement, l’etude des premiers examens realises en postoperatoire met en evidence une devascularisation pelvienne et perineale consequente. Conclusion Cette ligature non selective est donc susceptible de lier des arteres a destinee pelvienne, privant ainsi le perinee d’une partie de sa vascularisation. Il est donc licite au vu des possibles consequences fonctionnelles engendrees de discuter du benefice d’une ligature chirurgicale plus selective.

Objectif Realiser une etude anatomique du drainage lymphatique de l’ovaire. Materiel et methode En se basant sur les travaux de Hidden, nous avons realise 8 dissections de pelvis de cadavres frais de femmes adultes indemnes de cicatrice abdominale. Apres realisation d’une laparotomie mediane xypho-pubienne, une injection de colorant chimique de couleur bleue avec ajout de catalyseur, a ete effectuee au niveau du cortex ovarien par un point de ponction unique de facon bilaterale. L’injection a ete debutee sous pression afin de voir apparaitre les vaisseaux collecteurs. La pression etait poursuivie a pression moderee afin d’eviter la rupture des vaisseaux lymphatiques. Une fois l’injection achevee, le temps de diffusion etait compris entre trente minutes et quelques heures. L’evaluation du marquage etait dans un premier temps observationnelle par la recherche de coloration visible avant toute dissection. Puis une incision du peritoine a ete realisee suivant les axes ilio-obturateurs et lombo-aortique. Les lymphatiques et ganglions colores ont ete preleves et notes sur un schema. L’ouverture et la dissection du peritoine ont ete poursuivies selon la coloration observee. Resultats Nos resultats sont concordants avec ceux de la litterature dans le cancer de l’ovaire [1] . Nous avons mis en evidence une voie de drainage majeure et immediate au niveau du peritoine du cul de sac de douglas de facon constante. Nous avons observe des voies de drainage preferentielles : la principale etant le drainage le long des veines ovariennes en para-aortique et para-cave jusqu’aux hiles renaux ; la seconde au niveau des chaines ilio-obturatrices selon la classification de Rouviere [2] , et la troisieme le long des ligaments ronds au niveau inguinal. Notre etude a egalement mis en evidence un drainage supra-cœliaque. Conclusion Cette etude experimentale et de faisabilite montre une bonne concordance avec la litterature du cancer de l’ovaire.

Several neuropeptide FF (NPFF)-related peptides, known as modulators of the opioid system, have been previously characterized in bovine and rodent brain. Reverse-phase high pressure liquid chromatography (HPLC) fractions of a human with normal pressure hydrocephalus cerebrospinal fluid (CSF), co-migrating with NPFF-related synthetic peptides, were characterized by capillary HPLC coupled on-line to nanospray ion trap tandem mass spectrometry. Two peptides present in the pro-NPFFA precursor, NPAF (AGEGLNSQFWSLAAPQRF-NH2) and NPSF (SLAAPQRF-NH2), were identified. The monitoring of NPFF-related peptides in human CSF can be helpful to understand their roles in pain sensitivity.

Introduction Brain midline shift (MLS) is a life-threatening condition that requires urgent diagnosis and treatment. We aimed to validate bedside assessment of MLS with Transcranial Sonography (TCS) in neurosurgical ICU patients by comparing it to CT. Methods In this prospective single centre study, patients who underwent a head CT were included and a concomitant TCS performed. TCS MLS was determined by measuring the difference between the distance from skull to the third ventricle on both sides, using a 2 to 4 MHz probe through the temporal window. CT MLS was measured as the difference between the ideal midline and the septum pellucidum. A significant MLS was defined on head CT as >0.5 cm. Results A total of 52 neurosurgical ICU patients were included. The MLS (mean ± SD) was 0.32 ± 0.36 cm using TCS and 0.47 ± 0.67 cm using CT. The Pearson’s correlation coefficient (r2) between TCS and CT scan was 0.65 (P

Objectif L’imagerie cone beam s’est progressivement developpee au cours des dix dernieres annees notamment en stomatologie. Elle presente de nombreux avantages comme sa facilite d’utilisation, son moindre cout ou encore sa faible irradiation. L’objectif de notre etude etait d’analyser sur piece anatomique la concordance morphologique entre cone beam et tomodensitometrie dans l’analyse de l’anatomie naso-sinusienne. Methode Nous avons realise une etude prospective cadaverique portant sur 15 sujets ; Chaque piece anatomique a beneficie d’une imagerie cone beam et d’une imagerie scanner standard. Vingt-six reperes remarquables prealablement definis ont ete analyses par deux lecteurs independants. Nous avons analyse la concordance morphologique globale entre les deux examens, la concordance inter-lecteur pour chaque examen. Nous avons par ailleurs compare les niveaux de dose utilises pour chaque technique. Resultats La concordance morphologique globale entre les deux examens etait excellente (> 98 %). La concordance inter-lecteur pour le cone beam etait de 97 % tres proche de celle du scanner. L’utilisation du cone beam permettait de diviser la dose d’irradiation d’un facteur 3. Conclusion Le cone beam semble une technique fiable et reproductible en imagerie naso-sinusienne. Des analyses complementaires sur sujets sains et pathologiques nous semblent cependant necessaires.

Objectif La graisse peri-prostatique (GPP) est peu decrite et son implication dans le drainage lymphatique de la prostate peu connue. L’objet de cette etude est de decrire ses rapports anatomiques et d’evaluer son infiltration ganglionnaire lors de la prostatectomie totale. Materiel et methode Les rapports anatomiques ont ete etudies par une revue de la litterature associee a des dissections toujours en cours de cadavres frais. La dissection de la GPP est realisee en routine lors des prostatectomies car elle permet de visualiser l’apex prostatique pour eviter les marges positives [1] . Afin d’evaluer son infiltration ganglionnaire, une analyse anatomopathologique systematique de la GPP a ete conduite chez 375 patients ayant une prostatectomie robot-assistee pour cancer de la prostate (CaP). Resultats La GPP siege a la face anterieure de la prostate dans l’espace retro pubien. Elle recouvre la partie inferieure du fascia ombilico-prevesical, puis le fascia prostatique et le ligament pubo-prostatique. Elle est centree par le plexus veineux retropubien, son epaisseur est en moyenne de 5,0 ± 2,0 mm [2] . Elle est en continuite sur ses faces laterales avec la graisse ilio-obturatrice [3] . Parmi les 375 patients, 29 (7,7 %) avaient des ganglions lymphatiques dans la GPP, la mediane des ganglions retrouves dans la graisse etait de 1 (rang 1–6). Deux patients (0,53 %) presentaient 1 ganglion metastatique dans leur GPP avec un curage pelvien extensif sain. Un patient avait un ganglion metastatique dans son curage pelvien mais les 2 ganglions retrouves dans sa GPP etaient sains. Les 2 patients metastatiques dans la GPP avaient un franchissement capsulaire prostatique avec une infiltration du col vesical. Conclusion La GPP ne doit pas etre negligee, son analyse histologique peut retrouver des ganglions metastatiques malgre un curage pelvien sain. La GPP est un territoire de drainage lymphatique de la prostate et probablement du col vesical.

In this cadaveric study we assessed the level of the emergence of the musculocutanous nerve (MCN) relative to needle insertion site during infraclavicular block.Forty brachial plexi from 20 embalmed adult cadavers were dissected. The MCN was exposed from its origin on the lateral cord to its penetration into the coracobrachialis muscle. The point of emergence of the MCN from the lateral cord relative to a line drawn directly caudad from the anteromedial tip of the coracoid process was measured. A needle was placed predissection using our previously described technique, and the distance from the needletip to the emergence of the MCN was measured.MCN often emerged distal to the coracoid process. At the needle insertion site, 80% of MCN had already emerged from the lateral cord. The distance of emergence ranged from 8.5 cm proximal to 12 cm distal to the coracoid process.This anatomical study suggests that MCN may be one of the factors explaining MCN block failure for the single-injection technique of infraclavicular block using lateral needle trajectory.

The primary intracranial development of olfactory neuroblastomas, outside olfactory epithelium, is rare. We report a case of primary sellar neuroblastoma without any aggressive histopathological features, managed solely surgically without adjuvant therapy, with good outcomes at 3 years. Primary sellar neuroblastomas mostly occur in women in the 4th decade with a context of a non-secreting pituitary tumour. Diagnosis is made on histopathological examination (small cells, fibrillary intercellular background, strong immunoreactivity for neurons markers, negative immunoreactivity for anterior pituitary hormones). Management is based on surgery. Adjuvant treatment is not consensual, largely depends on patient's conditions and aggressive histopathological features.

International audience; Objective: to characterize subthalamic neuronal activity in obsessive compulsive disorder (OCD) patients, in comparison to patients with Parkinson's disease (PD), and its relationship to the severity of obsessions and compulsions.Background: modifications in the function and connectivity of the brain's corticostriatal systems have been reported in patients with OCD. However changes in the basal ganglia neuronal activity in the relation of severity of OCD have never been adequately elucidated.Design/Methods: twelve patients with OCD and 12 patients with PD operated for subthalamic stimulation were included. Resting-state subthalamic single unit neuronal activity was recorded during surgery. Recorded neurons were located with precision and mapped according to the motor, associative and limbic subdivisions of the subthalamic nucleus. Discharge frequency, pattern, bursting and oscillatory activities were characterized for each recorded neuron and compared between OCD and PD patients. Correlations with the severity of symptoms in OCD patients were explored.Results: one hundred and thirty-seven subthalamic neurons were isolated and recorded in OCD patients and 173 subthalamic neurons in PD patients. Between groups, OCD patients had lower STN neuronal discharge frequency, with a similar fraction of subthalamic neurons exhibiting burst-type activity. Significant oscillatory activity was present in 46% and 68% of neurons in OCD and PD patients, respectively; predominantly in the low frequency band (1-8 Hz). In the OCD patients, abnormal neuronal activity was mainly observed in the associative-limbic part of the subthalamic nucleus. Additionally, OCD patients with more severe symptoms exhibited oscillatory activity. Conclusions: heightened burst and low frequency oscillatory activities in the associative limbic subthalamic subdivision demonstrate its involvement in the pathophysiology of OCD.

International audience; Functional and connectivity changes in corticostriatal systems have been reported in the brains of patients with obsessive-compulsive disorder (OCD); however, the relationship between basal ganglia activity and OCD severity has never been adequately established. We recently showed that deep brain stimulation of the subthalamic nucleus (STN), a central basal ganglia nucleus, improves OCD. Here, single-unit subthalamic neuronal activity was analysed in 12 OCD patients, in relation to the severity of obsessions and compulsions and response to STN stimulation, and compared with that obtained in 12 patients with Parkinson's disease (PD). STN neurons in OCD patients had lower discharge frequency than those in PD patients, with a similar proportion of burst-type activity (69 vs 67%). Oscillatory activity was present in 46 and 68% of neurons in OCD and PD patients, respectively, predominantly in the low-frequency band (1-8 Hz). In OCD patients, the bursty and oscillatory subthalamic neuronal activity was mainly located in the associative-limbic part. Both OCD severity and clinical improvement following STN stimulation were related to the STN neuronal activity. In patients with the most severe OCD, STN neurons exhibited bursts with shorter duration and interburst interval, but higher intraburst frequency, and more oscillations in the low-frequency bands. In patients with best clinical outcome with STN stimulation, STN neurons displayed higher mean discharge, burst and intraburst frequencies, and lower interburst interval. These findings are consistent with the hypothesis of a dysfunction in the associative-limbic subdivision of the basal ganglia circuitry in OCD's pathophysiology.

International audience; BACKGROUND: Severe, refractory obsessive-compulsive disorder (OCD) is a disabling condition. Stimulation of the subthalamic nucleus, a procedure that is already validated for the treatment of movement disorders, has been proposed as a therapeutic option. METHODS: In this 10-month, crossover, double-blind, multicenter study assessing the efficacy and safety of stimulation of the subthalamic nucleus, we randomly assigned eight patients with highly refractory OCD to undergo active stimulation of the subthalamic nucleus followed by sham stimulation and eight to undergo sham stimulation followed by active stimulation. The primary outcome measure was the severity of OCD, as assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), at the end of two 3-month periods. General psychopathologic findings, functioning, and tolerance were assessed with the use of standardized psychiatric scales, the Global Assessment of Functioning (GAF) scale, and neuropsychological tests. RESULTS: After active stimulation of the subthalamic nucleus, the Y-BOCS score (on a scale from 0 to 40, with lower scores indicating less severe symptoms) was significantly lower than the score after sham stimulation (mean [+/-SD], 19+/-8 vs. 28+/-7; P=0.01), and the GAF score (on a scale from 1 to 90, with higher scores indicating higher levels of functioning) was significantly higher (56+/-14 vs. 43+/-8, P=0.005). The ratings of neuropsychological measures, depression, and anxiety were not modified by stimulation. There were 15 serious adverse events overall, including 1 intracerebral hemorrhage and 2 infections; there were also 23 nonserious adverse events. CONCLUSIONS: These preliminary findings suggest that stimulation of the subthalamic nucleus may reduce the symptoms of severe forms of OCD but is associated with a substantial risk of serious adverse events. (ClinicalTrials.gov number, NCT00169377.)

We sought to define the influence of ageing in clinical, cognitive, and quality-of-life outcomes after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD). We performed motor assessment (UPDRS), mood tests, cognitive, and quality of life evaluation (PDQ-39) on PD patients before surgery, and 12 and 24 months after, and we recorded adverse events. The variations of these parameters after surgery were correlated with age using regression statistical tests. Cerebral bleeding risk was evaluated by a nonparametric test. We enrolled 45 patients (mean age 60 +/- 9 years, range 40-73). No significant correlation was found between age and motor scores and PDQ-39 improvements at 12 months. At 24 months, there was a significant negative correlation between age and the improvement of three dimensions of PDQ 39 (mobility, activities of daily life, and cognition). Cognitive impairment showed no correlation, but apathy and depression were positively correlated with age. Significant statistical difference was observed between cerebral bleeding and age. STN-DBS is an effective treatment for elderly patients with advanced PD. A longer follow-up duration and a larger population seem necessary to better assess the quality of life perception in elderly patients and to determinate the real risk of hemorrage.

The increasing trend toward performing minimally invasive neurosurgery may benefit from recent progress in using neuroendoscopic techniques to reduce trauma in patients who have undergone operations. Arterial and venous vessels, especially loops, may compress the central segment and cause hyperactive dysfunction of the nerves. Relationships of the anterior inferior cerebellar artery to the facial and vestibulocochlear nerves and the anterior inferior, and superior cerebellar arteries to the trigeminal nerve were studied. The authors report findings from an endoscopic study performed in cadaver heads via the retrosigmoid and retrolabyrinthine approaches. Arteries and veins were colored by injection of red and blue silicon rubber. The cerebellopontine angle (CPA) was examined using 2.7-mm and 4-mm-diameter rigid endoscopes at viewing angles of 0s degrees , 30s degrees , and 70s degrees . Well-known structures could be identified endoscopically without prior dissection, and the entire CPA could be explored. However, with a retrosigmoid or a retrolabyrinthine approach, the cerebellum had to be retracted to some extent to view the CPA. Moreover, wide dural exposure was required to maneuver the endoscope freely in the CPA. Use of the rigid fiberoptic endoscope is not yet superior to standard surgical techniques for approaching and exploring the CPA.

But de la presentation La faisabilite technique du cone beam est reconnue sans avoir ete demontree de facon comparative dans l’imagerie sinusienne, alors qu’elle pourrait permettre une reduction significative des doses d’irradiation. L’objectif principal etait d’evaluer la concordance morphologique globale entre le cone beam et le scanner dans l’imagerie de sinus. Nos objectifs secondaires etaient d’evaluer la concordance interlecteur, et le rapport dosimetrique entre ces deux examens. Materiel et methodes Nous avons realise une etude sur 15 pieces anatomiques. Pour chaque piece, nous avons realise un scanner, et un cone beam en protocole sinus. Chaque examen a ete interprete selon une grille de lecture en double lecture. Le critere principal evaluant la concordance morphologique inter-methode d’imagerie etait la proportion de reponses concordantes, La concordance morphologique de chaque critere a ete evaluee separement en utilisant un coefficient Kappa. La concordance interlecteurs des 26 structures a ete evaluee par un coefficient de Kappa, ainsi que par le pourcentage de valeurs concordantes. Resultats Nous avons demontre une excellente concordance morphologique inter-methodes d’imagerie puisque, d’une part, les deux relecteurs possedait de 97 a 100 % de reponses concordantes concernant les criteres principaux ou secondaires. Nous avons egalement retrouve une bonne concordance interlecteur du cone beam par rapport au scanner, dans l’identification de reperes et variations anatomiques cles. De plus, le cone beam delivre une dose de 3,95 mGy en moyenne contre 12,5 mGy pour le scanner. Conclusion En conclusion, d’apres ces donnee precliniques le cone beam represente un examen pertinent dans l’exploration des cavites nasosinusiennes, de part ces caracteristiques techniques. Nous avons debute une etude clinique comparative, dont les resultats preliminaires tendent a valider cette equivalence morphologique. Les resultats definitifs permettront d’analyser la concordance diagnostique entre ces deux examens.

✓ Extramedullary hematopoiesis (EMH) is a compensatory mechanism occurring in patients with chronic anemia, which occurs most frequently with thalassemia. The authors report the case of a 57-year-old man, with no history of clinical or hematological disease, presenting with spinal cord compression. Magnetic resonance (MR) imaging demonstrated a homogeneous posterior epidural mass extending from T-3 to T-6. Following decompressive surgery, the patient's symptoms improved. Histological analysis showed features consistent with a diagnosis of EMH. Subsequent workup was remarkable for an asymptomatic spherocytosis without anemia. There was no family history of anemia. An EMH-related presentation of mild spherocytosis has been described in the literature, but its epidural location led to spinal cord compression. The MR imaging features were suggestive of EMH, but in the presence of spinal cord compression and in the absence of a history of chronic anemia, the authors did not believe that nonsurgical management would have been reasonable.

Though intraoperative neurophysiology is essential to precisely define the definitive target, little is known regarding its predictive value in defining the most effective contact for chronic deep brain stimulation. In this retrospective study, we reviewed the correlation between intraoperative neurophysiology and contacts selected for chronic stimulation. Twenty consecutive patients implanted for subthalamic nucleus (STN) stimulation were reviewed. There was no significant correlation between the electrophysiologically defined STN and the most effective contact for chronic stimulation at 3 months or at 6 months. Furthermore, there was a discrepancy between the most effective contact for rigidity versus akinesia or tremor at 3 months. Interestingly, at 3 months, the same electrode contact was maximally efficient for rigidity, akinesia and tremor in only 13 of the 39 cases. This lack of correlation did not affect the global improvement.

Object. The deep cerebral veins may pose a major obstacle in operative approaches to deep-seated lesions, especially in the pineal region where multiple veins converge on the great cerebral vein of Galen. Because undesirable sequelae may occur from such surgery, the number of veins and branches to be sacrificed during these approaches should kept to a minimum. The purpose of this study was to examine venous drainage into the vein of Galen with a view to surgical approaches. If a vein hampering surgical access must be sacrificed, it can therefore be selected according to the smallest draining territory. Methods. The deep cerebral veins and their surrounding neural structures were examined in 50 cerebral hemispheres from 25 adult cadavers in which the arteries and veins had been perfused with red and blue silicone, respectively. Special consideration was given to the size and location of drainage of the vein of Galen and its tributaries. Conclusions. When a surgeon approaches the pineal region, several veins may hamper the access route. From posterior to anterior, these include the following: the superior vermian and the precentral or superior cerebellar veins, which drain into the posteroinferior aspect of the vein of Galen; and the tectal and pineal veins, which drain into its anterosuperior aspect. The internal occipital vein is the main vessel draining into the lateral aspect of the vein of Galen. It may be joined by the posterior pericallosal vein, and in that case has an extensive territory. To avoid intraoperative venous infarction, it is important to use angiography to determine the venous organization before surgery and to estimate the permeability and size of the branches of the deep venous system.

Introduction la prise de poids des patients parkinsoniens apres stimulation du STN SCP STN pourrait resulter d’un mecanisme peripherique (diminution de la depense energetique) et/ou central (trouble du comportement alimentaire). Objectifs Etudier ce mecanisme central et identifier en tomographie par emission de positons (TEP- 18 FDG) les aires cerebrales impliquees dans le comportement alimentaire des patients parkinsoniens apres SCP STN. Methodes Comparer l’effet de la SCP STN sur l’activation cerebrale evaluee en TEP, chez des parkinsoniens avec prise de poids > 10 % (PP) et sans prise de poids Resultats 10 patients PP (âge moyen 60 ± 10 ans ; variation de poids : + 25 ± 6 %) et 6 patients NP (âge moyen 60 ± 9 ans ; variation de poids : - 4 ± 11 %) ont ete inclus. Chez les Parkinsoniens PP, l’activation cerebrale etait significativement augmentee dans le tronc cerebral (hypothalamus, substance noire) et dans le cortex occipital (BA 18) et etait diminuee au niveau du cortex pre frontal droit (BA 9-10) comparativement aux patients NP (p Discussion Cette etude pilote montre que la SCP-STN modifie l’activation de plusieurs aires cerebrales impliquees dans les troubles du comportement alimentaire (hypothalamus et cortex occipital). Conclusion la prise de poids observee chez les patients parkinsoniens avec SCP STN pourrait resulter d’un dysfonctionnement des circuits du comportement alimentaire.