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Introduction. Delayed wound healing is one reason for readmission after spine surgery. The main cause of delayed wound healing is infection. Infection rates after initial instrumented spine surgery reportedly range from 0.7% to 11.9%. However, there are noninfectious reasons for wound problems as well. Materials and Methods. This report presents 2 cases of noninfectious fistulization, 1 which occurred 11 months and 1 which occurred 2 years after surgery for implantation of a lumbar interlaminar device. Results. Although no sign of infection was found in either patient, in both cases it was necessary to remove the interlaminar device. Conclusions. These 2 cases of delayed noninfectious fistulization following instrumented spine surgery are the first seen by the authors of the current report, and as of the time of this writing, no such cases have been documented in the medical literature.

As a result of solicited muscles, strong friction, and tensile force on cutaneous tissue, the difference in closure procedure and management strategies and complications of surgical incision healing is a real challenge in lumbar spine surgery. We performed a retrospective study to compare different types of wound closure in lumbar spine surgery. 4383 patients were included in this study. Wound dehiscence was more common in the intracutaneous suture group than in the far- near-near-far suture group. Delayed wound healing occurred more in the far-near near-far suture group than intracutaneous suture group. Also, the far-near near-far interrupted point suture group showed a higher ratio of delayed wound healing compared with crossover suture. The superficial wound infection rate was roughly the same in all types of sutures with an average value of 0.79% with 0.81% SD. This is a preliminary study to compare different types of operative wounds showing the pros and cons related to each option.

Background: C2-C3 disc herniations are rare, but occur more frequent in the elderly population. As the classical anterior Cloward approach to these lesions is not optimal, we propose an alternative modified retropharyngeal approach to these disc herniations that were successfully utilized in two patients. Methods: Two patients with C2-C3 disc herniations underwent anterior cervical surgery utilizing the modified retropharyngeal approach. Results: Surgery was successful is two cases with C2-C3 disc herniation and no patient sustained a perioperative complication. Conclusion: Our modified anterior retropharyngeal approach for C2-C3 disc herniations resulted in good outcomes without perioperative complications.

Background: C7-D1 disc herniation is rare in comparison with other cervical levels. The incidence rates are between 3.5% and 8%. The cervicothoracic junction disc herniation can be operated posteriorly or anteriorly. The anterior approach can be challenging because of the difficulty of access resulted from the manubrium. In this article, we present our experience about cervicothoracic junction disc herniation (C7-T1) surgery. Materials and Methods: Between January 2008 and December 2017, 21 patients have been operated for solitary C7-T1 disc herniation. We operated 12 male patients and 9 female patients. Eight patients have been operated by the anterior approach, and 13 patients underwent surgery by the posterior approach. The mean symptoms duration was 11.4 months. Results: All patients had C8 cervicobrachial neuralgia. Other clinical presentations were numbness, tingling sensation, and weakness. All patients improved after surgery. We had no significant complication. Conclusion: We did not find a great difference between the clinical features of cervicothoracic herniated disc and other cervical levels. The anterior approach seems more difficult to carry out in particularly in large patients with the short neck. The posterior approach can be used for all types of patients except in the case of medial disc herniation.

Background: Baastrup disease (BD) is characterized by the degenerative changes of spinous processes and interspinous soft tissues. It is more common among aged persons. This disorder is a relatively common cause of low back pain. Its incidence is underestimated. A few studies have investigated BD epidemiology and proposed treatment efficacy. The aim of this paper is to establish impact and outcome evaluations of managing the patients with Baastrup disease who have been treated by implementing of floating interlaminar device (FID). Materials and Methods: Between January 2015 and September 2017, 47 patients have been operated by implementing of FID for BD in our Department of Neurosurgery. Results: Of the 47 patients, 20 were female and 27 were male with an average age of 51.78. On average, we followed the cases up to 11 months. The most frequent level of disorder was L4–L5 followed by L3–L4 level. The condition of 45 patients improved after surgery according to Oswestry low back pain score and 39 patients could return to their work. Conclusion: The results from our study corroborate that implementing of FID is a good alternative treatment for patient chronic low back pain due to BD This technique contributes to improving a better living situation for the patients given the correct indications.

Objective: Anterior cervical arthroplasty (ACA) is the gold standard surgery in severe or unresponsive cases of cervical disc herniation, uncarthrosis, and foraminal stenosis. The aim of this study is to establish the impact and outcome evaluations of managing the patients operated for cervical arthroplasty by the intersomatic porous alumina ceramic cervical cages (PACC). The authors describe their experience in the area to allow the comparison of effectiveness of ceramic cages versus other interbody fusion cages. Materials and Methods: Between April 2015 and September 2018, we operated 118 for ACA by using PACC. Among them, 52 were female and 66 were male, with an average age of 46.78 years. Results: The mean symptoms duration was 14.1 months. The most frequent level of the disorder was C5–C6 followed by C6–C7 level. Mean follow-up was 3.3 years. The Neck Disability Index (NDI) and the visual analog scale (VAS) were used to evaluate the patients status. No significant differences were observed between our results and literature data regarding operative time, duration of hospitalization, and NDI; however, we observed a shorter period and higher rate of bony fusion. Conclusion: The results from the present study corroborate that implementing of PACC is a good alternative treatment for the patient operated by ACA for cervical disc herniation or foraminal cervical stenosis.

Aim Chronic subdural hematoma(CSDH) is a commonly encountered entity in neurosurgery in particular in elderly patients. It likely to occurs over 65 years of age. Bleeding may be spontaneous or caused by benign or minimal head trauma that often goes unnoticed. Types of presentation of CSDH are extremely variable, so that we can call it "the great imitator"! There is a high variance in the treatment in literature but at any rate, surgery is still the primary therapy. Material and methods We relate our experience of mini-invasive evacuation of chronic subdural hematoma. Between May 2006 and December 2017, 1079 patients have been operated for percutaneous evacuation of chronic subdural hematoma. Prior to operation, the volume of hematoma was measured quantitatively by using a software for CT scan Results: From May 2006 to December 2017, 1079 patients underwent mini-invasive percutaneous evacuation(MIPE). 994 of the 1079 patients (92.12%) became asymptomatic or improved clinically. Six weeks later, the scan revealed the hematoma had wholly disappeared in 699 (64.78%) of the cases. We had one postoperative abscess. Conclusion Treatment of chronic subdural hematoma using our mini-invasive technique (MIPE) is a safe method with satisfactory outcome and a good therapeutic alternative to the craniostomy.

Background Sciatica is a common symptom for many people with degenerative lumbar spine diseases. It is by far the most common symptom of disc herniation. However, disc herniation is not the only cause of sciatica. Other degenerative lumbar spine diseases can provoke Sciatica. To date, few studies have analysed the cause of sciatica in particularly in elderly patients. Material and methods We analysed retrospectively records of patients aged between 35 and 55 (first group) and between 65 and 85 (second group) visited in our departments for sciatica between December 2009 and November 2018. Results In elderly patients, disc herniation from upper levels (L2-L3 and L3-L4) is more common than younger people. Sciatica as a result of exclusive disc herniation reduces with age. Foramen stenosis produces sciatica in elderly patients more than twice as high in younger patients. Statistically, more patients needed to surgery in elderly patients in comparison with younger population. Conclusion Sciatica in elderly patients takes a different clinical aspect in comparison with younger population. The clinical picture associates pain less severe but more persistent, more resistant to treatment. It is caused in less than 50% by disc herniation.

Background: This paper presents a new management strategy explaining the process used by implantation of external ventricular drainage (EVD) and very gradual increase of intracranial pressure for treatment of acute hydrocephalus. During the last 30 years' experience in professional practice, the senior author (M.S.) discovered that there are some options of regulations between cerebral spinal fluid (CSF) production and resorption. This theory shows that minimal continuous increase of the CSF pressure as long as the patient general neurological condition is unchanged and appears as normal can lead to definitive treatment of hydrocephalus without needing to set a shunt. Gradual weaning from EVD is used in some neurosurgical centers related to aneurismal subarachnoid hemorrhage only in a way to treat hydrocephalus in the acute phase, but not as an alternative curative treatment for hydrocephalus, and as far as we know this procedure has not been presented to date in medical literature in this form and this purpose. Materials and Methods: Between July 2000 and November 2012, 16 patients suffering from acute secondary hydrocephalus were treated by the method described in the International Neurosciences Institute in Hannover (Germany). Results: The causes of hydrocephalus were brain tumors (12), arteriovenous malformations (2), one cavernoma, and one polytrauma. In 11 patients (68.75%), the procedure led to a complete cure and surgical treatment has been excluded after EVD removal without any risk to the patients. Conclusions: Minimal gradual increase of CSF pressure by EVD implantation for the treatment of secondary acute communicating hydrocephalus used by senior author as an option is a safe alternative treatment of hydrocephalus and may obviate the need for surgical procedures.

Background: Minimally invasive surgery (MIS) of lumbar disk herniation allows avoiding less of a mess in crossing structures, reducing muscular and cutaneous scarring, postoperative pain, lengthy recovery times, and the rate of infection. The aim of this study is to explain our experience in MIS of disc herniation. We compare the outcome of three different surgical techniques used for the treatment of lumbar disc herniation. Materials and Methods: A total of 1147 patients have been operated from July 2008 to December 2015 for lumbar disk herniation by posterior endoscopic approach. Three hundred and seventy-nine patients underwent discectomy and herniectomy (DH), 557 patients have been operated by herniectomy (H), and 211 patients underwent only bone decompression (BD). Results: The results show 80.10%, 82.06%, and 84.02% excellent outcome, respectively, in BD, DH, and BD techniques. Conclusion: Analysis of the data demonstrates that the results obtained are equivalent and comparable in different used techniques for the treatment of disc herniation, we do not need to perform discectomy in all cases in a systematic way.

Background The incidence of Disc herniation is about 2–3% of population. Each year 300,000 procedures performed in USA. The aim of this paper is to describe the utility of endoscopic procedure in treatment of lumbar disc herniation. Methods We operated 359 patients from September 2013 to December 2016 for lumbar disk herniation by Endoscopic DESTANDAU method (EDM). The average length of surgery was 47 min. We operated 211 male and 148 female patients. In average, patients had pain for 4.3 months before surgery. Results 310 patients became pain free in six weeks and 332 after 3 months. We had 7 recurrent herniation. Among these patients 4 have been operated for the second time with success. Three patients refused to be operated. And had infiltration. We had 1 deep infection and 3 cutaneous infections. We have 7 two SCF fluid leak. Among them 3 needed second operation. Conclusions The patients are admitted the day of surgery and are discharged the day after surgery. EDM is a good alternative surgery for lumbar disk herniation in comparison with classical surgery. The duration of hospitalization is shorter and recovery is faster.

Although not as frequent as sciatica, cruralgia remains one of the most frequent reasons why people consult a neurosurgeon. It should be kept in mind, however, that every anterior leg pain is not cruralgia and thus several diagnoses must be discarded, such as of musculoskeletal diseases of hip, pelvis and femur. In the last years of the 19th century, Andre Leri, a French neurologist, described Leri's sign as it is used widely even today in everyday clinical practice. We studied retrospectively files of those patients who were seen in Neurosurgery by the authors for L3 and L4 nerve root compression to evaluate the reliability and accuracy of this sign. Between October 1998 and September 2017, 38,654 patients were examined in our department of Neurosurgery. Among them, 1698 patients presented pain as cruralgia and meralgia. In total, 1545 patients were included in the study. The data analysis showed that the sensitivity of LS was 0.9333 and the specificity 0.7974. The results of the study show a reliable diagnostic accuracy of Leri's sign.

Background Studies toward the end of the 20th century and in the first decade of the millennium show that meningioma represents the most common brain tumor of all types. There are no data available regarding meningiomas in the French West Indies and French Guiana. The author aimed to determine clinical and epidemiological features and provide data of meningiomas in French West Indies and French Guiana. Material and Methods I reviewed the files of 358 patients who underwent surgery between January 2000 and December 2008. Results I found a sex ratio of 2.5 to 1—256 (71.5%) female to 102 (28.5%) male. Meningiomas were encountered mostly in the sixth decade of life and the most common anatomical location was cerebral convexities (29.32% of patients) followed by parasagittal and parafalcine (20.11%). The third most common was sphenoid wing meningioma. The incidence of meningiomas was 6.31 per 100,000 inhabitants. Conclusion The current study attempts to estimate frequency and peculiarities of meningiomas in the French West Indies and French Guiana and is the first of its kind.

BACKGROUND: Minimally invasive spine surgery limits surgical trauma and avoids traditional open surgery so in the majority of cases, recovery is much quicker and patients have less pain after surgery.AIM: The authors describe an endoscopic approach to anterior cervical foraminotomy (ACF) by Destandau's method.MATERIAL AND METHODS: Anterior cervical foraminotomy by Destandau’s method is carried out under general anaesthesia. A 3 cm transverse skin incision is used just slightly past the anterior border of the sternocleidomastoid's muscle laterally. After exposing and dissecting superficial cervical fascia, platysma muscle, and deep cervical fascia, Endospine material designed by Destandau will be inserted. As from this moment, the procedure will continue using endoscopy.RESULTS: the Endoscopic approach to anterior cervical foraminotomy by Destandau's method offers a convenient access to the cervical foraminal stenosis with fewer complications and negligible morbidity and gives maximum exposure to discal space with the goal of minimising cutaneous incision.CONCLUSION: Contrary to the other minimally invasive approaches, the visual field in foraminotomy by Destandau technique is broad and depending on the workability of Endospine an adequate access to cervical disc is possible.

The incidence of cervical disc herniation is estimated about 5.5/100,000, and they lead to surgical intervention in 26 %. Cervical disc herniation causes radiculopathy, which defines by radicular pain and sensory deficit and maybe weakness following the path of the affected nerves. Classically, cervical radiculopathy is expected to follow its specific dermatome-C4, C5, C6, C7 and C8. We investigate patients who present with discrepancy between classical radiculopathy and imaging findings in the daily practice of our profession.We reviewed the medical records of 102 patients with cervical radiculopathy, caused by cervical disc herniation. All patients had surgery.We found an apparent discrepancy between clinical and radiological findings, patients complained of radiculopathy on one side, and magnetic resonance imaging (MRI) scan or CT scan finding on the other side in ten patients (10.2 %). We did not found any other abnormalities in preoperative and post-operative period. All patients underwent cervical diskectomy via anterior approach. Six weeks after surgery eight patients (80 %) recovered completely, and 3 months after all ten patients (100 %) had been relieved totally.The aim of this paper is review of this medical concept and management of radiculopathy in patients with this discrepancy. As far as we know, the subject has not yet been touched in this light in medical literature.The discrepancy between clinical radiculopathy and disc herniation level on MRI or on CT scan is not rare. Management of this discrepancy requires further investigation to avoid missing diagnosis and treatment failure.

Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid after papillary carcinoma. Skull metastasis of thyroid carcinoma is rare and only about 1.7% of patients with differentiated thyroid carcinoma present bone metastasis. We present a very rare case of skull and soft tissue metastasis from an occult FTC in a 60-year-old female with 4 years follow-up.

Focal cortical dysplasia is a malformation caused by abnormalities of cortical development. It is characterized by no dysmorphic or ballon cells (type I), dysmorphic neurons witout or with ballon cells (type II). It is the main cause of pharmacoresistant epilepsy. The combination of clinical and neurophysiological findings provided by VEEG and MRI had lead to an improvement in the diagnosis and outcome of FCD. This paper describes our experience in the form of a retrospective study conducted on the patients affected by FCD who were treated in the Clinical Neurophysiology Service at University Hospital of Lille in France.

Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature.We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients.From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection.Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.

Neurocutaneous melanosis represents a rare congenital but nonheritable phakomatosis defined as the association of giant or multiple congenital nonmalignant melanocytic nevi with leptomeningeal melanosis or melanoma of the central nervous system.We describe the case of an adolescent with a giant congenital bathing trunk melanocytic nevus who developed progressive intracranial hypertension due to leptomeningeal melanosis confirmed by surgical biopsy. Brain and spine magnetic resonance images showed posterior fossa malformation compatible with the Dandy-Walker complex, hydrocephalus, and extensive enhancement of posterior fossa then spine. Shunt placement, corticotherapy, and chemotherapy were attempted leading to transient relief but the boy died 12 months after the onset of primary neurological symptoms.We discuss diagnosis, pathogenesis, management, and prognosis in the light of data from the recent literature.Neurocutaneous melanosis is considered to follow from neurulation disorders which could account for associated developmental malformations as the so-called Dandy-Walker complex. Cutaneous lesions are usually recognized at birth whereas neurological manifestations develop later. Numerous neurological symptoms have been reported according to extent of leptomeningeal and parenchymal infiltration. Whether magnetic resonance imaging of the neuroaxis represents the choice radiological exam, definite diagnosis relies upon the histological data obtained by mean of biopsy. Once symptomatic, surgical and medical measures remain palliative since death occurs within 3 years.

Background: Massive ischemic cerebellar infarct (MICI) is a main source of stroke, which can lead to severe morbidity and mortality. There is no consensus in medical literature for the management of MICI. The choice is made between placing an external ventricular drainage, suboccipital decompressive craniectomy, and removal of necrotic tissue or conservative treatment. There are not many prospective studies, done on this subject. Methods: We retrospectively analyzed the clinical features, and imaging studies of 53 patients with MICI who had been treated by surgery or conservative treatment between January 2000 and December 2008 at the Department of Neurosurgery of the general hospital of Fort de France in Martinique. A total of 25 patients underwent surgery and 28 were treated medically. Results: The results show significantly better outcomes in the operated patients compared with the patients treated medically; Operated comatose patients demonstrated significant improvement in their Glasgow coma score (GCS) score with only two deaths. Whereas, nonoperated comatose patients lost points in their GCS with four deaths. Conclusion: The results of our study suggest that surgery may be an effective procedure and quite helpful for MICI in majority of cases.