Ph. Mercier

Réparation médullaire des avulsions radiculaires du plexus brachial: vers de nouvelles stratégies chirurgicales ?

Resume Description et objectif de l’etude Les avulsions radiculaires du plexus brachial sont des lesions dramatiques dont le pronostic fonctionnel reste tres mauvais. Regardees comme des lesions du systeme nerveux central, elles sont toujours considerees comme irreparables. Pourtant de nombreuses experiences chez l’animal ont montre que si la continuite est retablie entre la moelle cervicale et un muscle denerve ou l’extremite distale de son nerf, les axones des motoneurones spinaux peuvent repousser a travers un greffon de nerf peripherique avec recuperation fonctionnelle. Une premiere experience a ete realisee chez l’homme par une equipe anglaise avec de modestes resultats. Malgre les controverses issues de ces premiers travaux, nous avons voulu demontrer que la repousse axonale apres reimplantation intra-spinale d’une racine avulsee est une realite chez l’homme, qu’elle s’accompagne d’une recuperation fonctionnelle, et qu’elle devrait pouvoir constituer la base de nouvelles strategies chirurgicales. Methode Nous avons dans un premier temps etudie l’anatomie du compartiment intra-dural et developpe l’abord posterieur du plexus brachial pour une implantation dans le cordon ventro-lateral de la moelle. Le caractere non permissif a la repousse axonale de la substance blanche du systeme nerveux central nous a ensuite conduit a demontrer l’interet d’implanter directement le greffon dans le sillon ventro-lateral pour atteindre la corne anterieure de la substance grise. Dans ce but, nous avons developpe au laboratoire l’abord chirurgical direct de la corne anterieure, et applique cette technique chez des patients qui presentaient des avulsions radiculaires multiples et etagees. Resultats et conclusions La reimplantation medullaire n’a entraine aucune complication neurologique. Aucun des patients ne presente de co-contraction musculaire. Une re-innervation partielle des muscles triceps et biceps, et a ete obtenue selon le type de lesion et de greffe. La supplementation neurotrophique constitue une voie de recherche parallele qui pourrait permettre d’ameliorer les resultats fonctionnels de la reparation spinale des avulsions radiculaires.

La neurochirurgie fonctionnelle des nerfs crâniens

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.Abstract We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.

[Cranial nerve functional neurosurgery: evaluation of surgical practice].

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.Abstract We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.

Cranial nerve functional neurosurgery

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.Abstract We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.

La neurochirurgie fonctionnelle des nerfs crâniens. Évaluation de l'activité

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.Abstract We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.