Biomedical subjects

Michaël Bruneau

Publications and source records attributed to Michaël Bruneau.

10 recordsLinked to original sources

PubMed2006

Microsurgical cervical nerve root decompression by anterolateral approach.

OBJECTIVE: Cervical radiculopathy caused by a posterolateral soft disc herniation or spondylosis is a common pathology. METHODS: Decompression of a stressed cervical nerve root is a routine neurosurgical procedure. Most of the time it is achieved through an anterior approach and, less frequently, through a posterior approach in specific indications. RESULTS: According to the principles that an anterolateral compression must directly be reached and that working in the vicinity of the vertebral artery is safe under visual control, we developed the anterolateral approach to the cervical intervertebral foramen and the nerve root using a minimally invasive technique to remove the offending process. CONCLUSION: Microsurgical cervical nerve root decompression by anterolateral approach is a minimally invasive technique, permitting one to remove the offending process staightforwardly. The disc and bone resections are minimal. This method avoids osteoarthrodesis or arthroplasty with disc prosthesis. This technique is efficient with good results and low morbidity.

Cervical Vertebrae↗

PubMed2006

Antero-lateral approach to the V3 segment of the vertebral artery.

OBJECTIVE: We describe our surgical technique of exposure, control, and transposition of the third segment of the vertebral artery (VA V3 segment). METHODS: The VA V3 segment extends from the C2 transverse foramen to the dura mater of the foramen magnum. It initially courses vertically between the C2 and C1 transverse foramens, then runs horizontally over the atlas groove, and finally obliquely upwards before piercing the dura mater. Exposure of the VA V3 segment through an antero-lateral approach is performed by passing medially to the sternomastoid muscle. After exposure and protection of the spinal accessory nerve, the C1 transverse process is identified below and in front of the mastoid tip. The small muscles that insert on it are cut to expose the C1-C2 portion. The inferior aspect of the horizontal portion is safely separated from the atlas groove by elevating the subperiosteal plane and the superior aspect is freed by a cut a few millimeters above the VA on the occipital condyle. Complete unroofing of the C1 transverse foramen is achieved by resecting the bone while leaving intact the subperiosteal plane. The VA then can be transposed. Venous bleedings during the dissection from periosteal sheath tearing can be controlled by direct bipolar coagulation. RESULTS: The control of the VA V3 segment is essentially used for lesions in the VA vicinity and to improve the surgical exposure at the craniocervical junction level. Indications therefore are tumoral removal, VA decompression, and rarely, nowadays, VA revascularization. CONCLUSION: Perfect knowledge of the anatomy and the surgical technique permits a safe exposure, control, and transposition of the VA V3 segment. This is the first step of many surgical procedures.

Cerebral Arteries↗

PubMed2006

Anterolateral approach to the V1 segment of the vertebral artery.

OBJECTIVE: We describe the normal anatomy, variations, and the surgical technique to expose and control the V1 segment of the vertebral artery (VA). METHODS: The VA V1 segment extends classically from the subclavian artery to the C6 transverse foramen. It courses obliquely upwards and posteriorly in the cervical fat tissue, at a distance of 5 to 10 mm from the C7 vertebral body. Along its course, the VA V1 segment is crossed by the inferior thyroid artery, the thoracic duct, and the sympathetic chain. For neurosurgeons, the safest approach is to expose the distal part of the V1 segment at the C6 transverse foramen level through an antero-lateral approach. Otherwise, direct exposure of the subclavian artery requires vascular surgery expertise. RESULTS: Surgical exposure of the VA V1 segment can be indicated on approaching the C6-C7 intervertebral disc space for degenerative disease or on treating tumoral processes in its vicinity. With developments of endovascular techniques, revascularization procedures are more rarely indicated nowadays. CONCLUSION: Perfect knowledge of the anatomy and of the surgical technique permits a safe exposure and control of the VA V1 segment.

Anatomy, Artistic↗

PubMed2006

Anatomical variations of the V2 segment of the vertebral artery.

OBJECTIVE: Our goal was to evaluate the incidence of anatomic variations of the V2 segment (from its entrance into the transverse canal to C2) of the vertebral artery. Ignoring such variations during anterior or lateral approach to the cervical spine can lead to inadvertent injury and potentially serious complications. METHODS: We studied the course of 500 vertebral arteries on 200 magnetic resonance imaging and 50 contrast-enhanced computed tomographic scans. RESULTS: The vertebral artery entered the C6 transverse foramen in 93.0% of all specimens. An abnormal level of entrance was observed in 7.0% of specimens (35 courses), with a level of entrance into the C3, C4, C5, or C7 transverse foramen, respectively, in 0.2% (n = 1; 2.9% of all anomalies), 1.0% (n = 5; 14.3% of all anomalies), 5.0% (n = 25; 71.4% of all anomalies), and 0.8% (n = 4; 11.4% of all anomalies) of all specimens. Seventeen (48.6%) abnormalities were right-sided and 18 (51.4%) were left-sided. Thirty-one out of 250 patients (12.4%) had a unilateral anomaly and two had a bilateral anomaly (0.8%). In cases of abnormal entrance into the transverse foramen on computed tomographic images (n = 6), the area of the unfilled transverse foramens was significantly smaller than the contralateral filled foramen (P < 0.0001) and was significantly smaller than the filled foramen of all patients at the same level (P < 0.0001). In five patients (2.0%), the vertebral artery formed a medial loop either into an unusually large transverse foramen whose internal border was medial to the uncovertebral joint or into the intervertebral foramen. CONCLUSION: The incidence of anatomic variations of the vertebral artery V2 segment is high. Potentially dangerous conditions can be detected on preoperative imaging.

Anthropometry↗

PubMed2005

Osteoid osteomas and osteoblastomas of the occipitocervical junction.

STUDY DESIGN: We describe our surgical experience to remove osteoid osteomas and osteoblastomas of the occipitocervical junction. In this location, vertebral artery vicinity requires special consideration. OBJECTIVES: We illustrate our surgical approaches to remove lesions confidently, while minimizing bone resection to preserve stability. SUMMARY OF BACKGROUND DATA: Up until now, osteoid osteomas and osteoblastomas of the occipitocervical junction are reported as case reports. Several treatment methods have been described to treat osteoid osteomas. Nevertheless, surgery is the treatment of choice for lesions located in the C0-C2 region. METHODS: A retrospective review of 7 patients, including 5 men and 2 women, with a mean age of 21.0 years (range 3.0-38.0) was conducted. Clinical outcomes were evaluated immediately and after a mean follow-up of 27.6 months. RESULTS: There were 6 and 1 patients who underwent surgery with the anterolateral and posterolateral approaches, respectively. In osteoid osteomas, the nidus was removed, and the peripheral condensation was drilled up to normal bone (n = 4) or partially resected (n = 2). One osteoblastoma was removed extensively up to soft tissues. No osteo-arthrodesis was performed. Before surgery, all patients complained of pain, 3 presented with neck stiffness, and 2 with a torticollis. Immediately after surgery, all complaints disappeared. One patient underwent repeat surgery 15 months later for a recurrence. At the end of the follow-up, all patients were symptom-free, and partially resected peripheral condensations were stable on computerized tomography. CONCLUSIONS: Removal of osteoid osteomas and osteoblastomas of the occipitocervical junction is safe and efficient. Stability is preserved if more than half the joints are preserved with a proper surgical approach that minimizes bone resection.

Adolescent↗

PubMed2005

Lateral sacral artery aneurysm: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: We report the third case of an aneurysm of the lateral sacral artery (AnLSA). In all cases, because of an incorrect preoperative diagnosis, the surgeons were confronted with severe and unexpected hemorrhaging, and surgery was aborted without effective treatment. Our purpose is to present the preoperative features of AnLSA and its treatment modalities. CLINICAL PRESENTATION: A 54-year-old man had a medical history of renal transplantation on his left external iliac artery. He complained of acute lumbar pain associated with cauda equina syndrome, which resolved within a few hours. At that time, a magnetic resonance imaging (MRI) scan revealed an intracanal hematoma extending from S1 to T12. Six weeks later, a second MRI scan demonstrated an oval-shaped intracanal mass behind the vertebral body of S1 with intense gadolinium enhancement. INTERVENTION: An anterior epidural mass was found. An incision into this mass resulted in significant arterial hemorrhaging. Transparietal embolization with a cotton compress and closure of the aneurysm wall were performed. The postoperative clinical status was stable, and a delayed angiographic study suggested a diagnosis of aneurysm of the right LSA, a branch of the internal iliac artery. Its pathophysiology was explained by the development of a high-flow transpelvic shunt from the right iliac artery territory to the left, to maintain the renal graft blood flow that had initially been reduced by stenosis of the left common iliac artery. Six weeks later, a new MRI scan demonstrated that the AnLSA had increased in size. The lesion was then excluded endovascularly by injection of glue. CONCLUSION: A medical history of renal transplantation with MRI scans showing an anterior epidural mass behind S1 or a spontaneous spinal epidural hematoma are features that must evoke a diagnosis of AnLSA. Treatment is mandatory and is best achieved by embolization. Surgery based on angiographic findings is indicated if the lesion is responsible for a compressive hematoma.

Aortic Dissection↗

PubMed2005

Anterolateral approach to the V2 segment of the vertebral artery.

OBJECTIVE: We describe our surgical technique of exposure and control of the second segment of the vertebral artery (VA V2 segment). Our basic principle is that working in the VA vicinity is more confident under visual control. METHODS: The VA V2 segment extends classically in and between the transverse processes from C6 to C2. This segment can be exposed through an anterolateral approach, passing medially to the sternocleidomastoid muscle and laterally to the internal jugular vein. Except in case of anatomic variation, the VA V2 segment is protected by the transverse processes bone, even if a pathological process displaces the VA along its course between them. The safest technique to expose the VA V2 segment then is to reach first the transverse process by cutting the longus colli muscle. Afterward, dividing intertransversary muscles permits exposure of and safely controls the VA by following its course. If required, the VA V2 segment can even be freed by opening the transverse process as far as the dissection is performed in the subperiosteal plane. In fact, the VA V2 segment is surrounded by a venous plexus and a periosteal sheath. This sheath gives a plane out of which the dissection is safe, avoiding troublesome venous bleeding or VA damage. RESULTS: This technique is very efficient for degenerative disorders, hour glass tumors, and vascular surgeries. CONCLUSION: Exposure and control of the VA V2 segment is safe if anatomy and variations are perfectly known, and if a rigorous step-by-step surgical technique is followed.

Angiography↗

PubMed2005

Progression of an osteoid osteoma to an osteoblastoma. Case report.

The authors report the unusual case of a 25-year-old man with occipitocervical pain related to a lesion of the C-1 lateral mass. Initially this lesion measured 8 mm and exhibited radiological features of an osteoid osteoma. Seven years later, as pain increased and became unresponsive to antiinflammatory drugs, computerized tomography scanning demonstrated progression to a 16-mm lesion, highly suspicious of an osteoblastoma. After mobilization of the vertebral artery from the C-1 groove, the lesion was completely resected via an anterolateral approach. Complete symptomatic relief, restoration of cervical range of motion and preservation of cervical stability were achieved immediately after surgery, and the results were confirmed at the 4-year follow-up examination. Pathological examination of tissue samples confirmed the diagnosis of osteoblastoma. Osteoid osteoma rarely evolves to osteoblastoma. Deterioration of a patient's ability to control pain is a warning sign. Insight into such cases underlines the importance of close long-term radiological follow-up examination in patients with conservatively treated osteoid osteomas.

Adult↗

PubMed2004

Surgical treatment of a syringomyelia associated with an idiopathic arachnoid malformation disclosed by preoperative MRI.

BACKGROUND: We describe the very rare condition of an idiopathic spinal arachnoid malformation associated with syringomyelia (SM) and depicted on preoperative magnetic resonance imaging (MRI) whose features were confirmed at surgery. CASE DESCRIPTION: A 34-year-old female suffered from progressive gait impairment because of lower limb palsy and sensory disturbances. MRI demonstrated a bulging membrane at the T6 level that was transversely stretched between the dorsal aspect of the spinal cord and the posterior dura mater. At this level, the spinal cord appeared atrophic and pushed anteriorly against the dura with enlargement of the posterior subarachnoid spaces (SAS) and focal collapse of an associated panmedullar SM. Surgery consisted in releasing the arachnoid malformation and opening the inferior segment of the syringomyelic cavity. Pathological examination revealed a fibro-sclerotic tissue with cellular areas of meningo-endothelial cells. Postoperative neurological status progressively improved but slightly. Three-months and 1 year postoperatively, MRI showed the collapse of the whole SM and restoration of cerebrospinal fluid (CSF) flow at the treated T6 level. CONCLUSION: Spinal arachnoid malformations associated with SM are very rare and have never been described up to now on MRI. Surgical removal of the causative malformation allows spinal cord decompression and prevents the recurrence of the SM by restoring normal CSF circulation.

Adult↗

PubMed2002

Traumatic false aneurysm of the middle meningeal artery causing an intracerebral hemorrhage: case report and literature review.

BACKGROUND: Traumatic false aneurysms of the meningeal arteries are rare. We report an unusual case of an intracerebral hematoma caused by the rupture of a traumatic aneurysm of the middle meningeal artery. CASE DESCRIPTION: A 64-year-old woman suffered a massive spontaneous intracerebral fronto-temporal hemorrhage. Cerebral angiogram revealed a pseudoaneurysm of the middle meningeal artery. At operation, a skull fracture was discovered in the vicinity of the aneurysm. The patient died the day after surgery. CONCLUSION: Although rare, traumatic meningeal aneurysms should be considered as a possible cause of cerebral hematoma. Because of their potential morbidity and mortality, they must be detected and treated rapidly.

Aneurysm, False↗