Treated Pathologies
Neurosurgery
1. Brain tumours
2. Intracranial aneurysm
3. Hydrocephaly
4. Subdural hematoma
1. Brain tumours
There are many types of brain tumours and their classification is complex. When they are derived from cells originally present in brain tissue or its envelopes, they are called primitive. If they develop in the brain at a distance from an initial cancer (lung, liver, breast, lymph nodes,…), they are secondary tumours.
The symptoms
Symptoms vary and depend on the affected area: headaches, nausea, seizures, aphasia, apraxia, hemiplegia, visual disorders, sensitivity disorders, mental impairment…
The diagnosis
A radiological assessment (CT, MRI, scintigraphy, angiography,…) will make it possible to analyse the tumour, clarify the diagnosis and propose a therapeutic strategy.
The treatment
Multidisciplinary management will be required to develop optimal treatment. The latter will depend on the type of tumour, its size, its location, its degree of aggressiveness, the physical and psychological condition of the patient. If surgical treatment is possible, it will consist of partial or total removal of the tumour. Radio surgery, radiotherapy, chemotherapy, or a combination of approaches may also be considered depending on the type of tumour.
2. Intracranial aneurysm
An aneurysm is a malformation of the arterial wall. Usually in the form of bags in which blood circulates under pressure, they can be located on intracranial arteries. As their volume increases, the wall becomes weak and can break. The origins are diverse (congenital, degenerative, infectious, traumatic, inflammatory,…) and remain poorly known.
The symptoms
When the aneurysm is not ruptured, the patient is usually asymptomatic. If the aneurysm is large, some nerve structures can be compressed and cause vision or speech disorders.
The rupture of an aneurysm causes a hemorrhage around the brain that will increase intracranial pressure. This usually manifests itself in severe headaches, sudden settling in, which can lead to unconsciousness (coma).
The diagnosis
An angioscanner or an angio-MRI will show the bleeding and determine the location and characteristics of the aneurysm.
The treatment
When the aneurysm has been accidentally discovered and is not ruptured, the main focus will be on preventing bleeding and radiological follow-up. Management should be considered on a case-by-case basis, depending on the size and topography of the aneurysm, age and patient history. Neurosurgical treatment will consist of placing a “clip” (small tweezers) at the base of the aneurysm, after craniectomy. Endovascular treatment is also possible, in which case catheters are introduced, usually into the femoral artery, and followed the path of the arteries to the aneurysm. A tube is then placed in the aneurysm to fill it with a platinum wire (coil), so that it can be plugged.
Once the aneurysm is ruptured, it is a medical emergency.
3. Hydrocephaly
When cerebrospinal fluid accumulates in the ventricles of the brain, dilation occurs, this is called hydrocephalus. This dilation will increase intracranial pressure and interfere with proper brain function. Hydrocephalus can occur at any age and its causes are multiple: congenital (malformation), infectious (meningitis), vascular (stroke, aneurysm rupture), traumatic or tumor.
The symptoms
Intracranial hypertension can cause various symptoms depending on its origin, degree and speed of onset: headache, walking imbalance, incontinence, vision disorders, mental confusion…
The diagnosis
Clinical diagnosis is difficult and will need to be confirmed by medical imaging. An MRI examination will observe the dilation of the cerebral ventricles.
The treatment
Symptoms can be temporarily improved by an evacuating lumbar puncture. Most often, the surgical treatment will consist of the installation of a ventriculoperitoneal diversion. This valve will drain excess cerebrospinal fluid from the cerebral ventricles to the peritoneal cavity.
4. Subdural hematoma
The subdural hematoma is a localized blood effusion between the dura mater (the outermost membrane of the three meninges that protect the brain) and the arachnoid (the meninge in the middle). It usually occurs following a head injury, or in elderly patients with weakened vessels.
The symptoms
The subdural hematoma may go undetected for a relatively long time. The volume of the hematoma will gradually compress the brain tissue and increase the internal pressure of the skull, usually causing headaches. Symptoms vary, sometimes psychic disorders, speech, walking, loss of consciousness, epilepsy and more rarely paralysis or coma.
The diagnosis
A brain scan will assess the size, location and consequences of the hematoma on brain structures.
The treatment
This will generally involve monitoring the neurological and radiological evolution of the hematoma. If the neurological disorders caused by the hematoma are significant, surgery may be considered. A drill hole in the skull will allow the hematoma to be evacuated.
Spinal surgery
1. Narrow cervical canal
2. Narrow lumbar canal
3. Cervical disc herniation
4. Lumbar disc herniation
5. Spondylolisthesis
6. Spinal fractures
7. Tumours of the spine
1. Narrow cervical canal
The canal containing the spinal cord of the cervical spine may gradually become too narrow and compress its contents, referred to as a narrow cervical canal. This pathology may be congenital, but it is generally of a degenerative type (osteoarthritis).
The symptoms
A narrow cervical canal does not necessarily cause discomfort, but it can cause cervical pain of varying intensity. Motor disorders (decreased strength, difficulty using arms, hands, etc.), walking disorders, as well as burning, tingling and tingling sensations, may also occur.
The diagnosis
An MRI examination will visualize the narrow cervical canal and compression of the spinal cord, the extent of the lesions and possible signs of neurological severity.
The treatment
A drug prescription can provide relief in the event of a painful episode. But if the pain is stabilized, the narrow cervical canal will continue to evolve, causing, in the more or less long term, a worsening of the pain.
In the treatment of the narrow cervical canal, recent medical studies have shown the superiority of surgical management. Indeed, by widening the canal, the surgical intervention will allow to give more space to the spinal cord of the cervical spine and stop the evolution of the pathology.
2. Narrow lumbar canal
A narrow lumbar canal is a narrowing of the cavity in the centre of the lumbar vertebrae through which the various nerves pass to the lower limbs. This narrowing of the canal therefore causes nerve compression. It is generally a degenerative type of disease (osteoarthritis).
The symptoms
Nerve compression usually manifests itself as lumbar or sciatic pain. Sensitivity disorders: tingling, dysesthetics, numbness, claudication, limited walking distance may also occur. These pains gradually end up hindering the patient in his daily activities.
The diagnosis
An MRI examination will define the level, intensity and extent of root canal narrowing.
The treatment
It consists primarily of the use of analgesics, combined with non-steroidal anti-inflammatory drugs. Re-educational care is desirable, as walking maintenance and mobilization can relieve pain and promote independence. Spinal infiltration is sometimes practiced.
In case of failure of these treatments, a surgical procedure can be considered. The surgical procedure will consist in freeing up space for the nerves in the spine.
3. Cervical disc herniation
Disc herniation is a common spinal pathology that occurs frequently. Most often, it is due to osteoarthritis in the cervical vertebrae, but trauma or intense effort can also be the cause.
The symptoms
If no nerves are compressed, it may be asymptomatic. Otherwise, the hernia usually manifests itself in stiff neck, pain in the shoulder and arm, tingling sensations, burns, dysesthetics… these pains can appear suddenly or gradually. In a few rare cases, the hernia can even lead to paralysis of the arm.
The diagnosis
The diagnosis is suspected by a specialist following the clinical examination. An MRI examination will show whether an intervertebral disc or osteophyte compresses the nervous elements.
The treatment
The first step will be to set up a conservative analgesic treatment (painkillers, anti-inflammatory drugs, physiotherapy sessions, possibly one or more infiltrations). For most patients, this treatment is sufficient to relieve pain.
If after one to two months of disabling pain persists, a surgical procedure may be proposed. It is then a question of decompressing the root by removing the intervertebral disc in question. The latter is replaced by a cage or in some cases by a mobile disc prosthesis. The procedure can be performed anteriorly (neck) or posteriorly (neck).
4. Lumbar disc herniation
The spine is made up of vertebrae separated from each other by a kind of damping pad, called intervertebral discs. In the centre, the lumbar canal allows the spinal cord, nerve roots and cerebrospinal fluid to pass through. When an intervertebral disc is worn out, it can move, protrude into the spinal canal and conflict with nerve roots, this is called a herniated disc. Disc hernias are therefore the result of the natural aging of the intervertebral disc.
The symptoms
The lumbar disc herniation does not necessarily cause pain, more than 50% of the population would be carriers of an asymptomatic disc herniation.
The reasons why a herniated disc becomes symptomatic are not well known. Most of the time, patients will experience low back pain and sensations of burning, tingling or numbness along the path of the affected nerve in the lower limb. Depending on the lumbar level involved, the pain will appear in the anterior thigh (cruralgia) or in the posterior surface of the leg, up to the foot (sciatic).
In rare cases, the disc herniation can be bulky and compress the spinal cord, causing anaesthesia or even paralysis of the lower limb or urinary or genital disorders. This is a serious neurological condition, so urgent consultation is required.
The diagnosis
The doctor who examines a patient with lower limb pain will have to carry out a number of tests to determine whether it is actually root pain caused by a herniated disc or not. The doctor will also look for signs of loss of superficial sensitivity and especially signs of weakness in certain muscle groups important for walking. He will try to determine the severity of the loss of strength. In general, a loss of more than 50% of the force requires special attention. The clinical diagnosis can be confirmed by CT and/or MRI.
The treatment
Rest and analgesic and anti-inflammatory treatment generally allow a large majority of patients to recover from disability and pain after six weeks. If the pain persists, rheumatological advice may be offered, as well as rehabilitation and epidural infiltration.
Surgical treatment is considered when there is a motor and sensory deficit or resistance to medical treatment.
An incision in the back, usually quite small, will allow the herniated disc to be removed under the control of a microscope. Patients are encouraged to mobilize on the day of the intervention. Hospitalization time varies according to the institutions and countries in which patients are treated, but there is a general trend towards outpatient surgery. Patients are also encouraged to return to work as soon as possible, depending on their profession.
5. Spondylolisthesis
From the Greek spondylos (vertebra) and olisthesis (slip), spondylolisthesis is a condition of the spine characterized by the sliding of a vertebra forward. The causes of this slip can be genetic, degenerative (osteoarthritis) or more rarely traumatic (vertebral fracture).
The symptoms
The lumbar level is the most frequently affected. The sliding causes a displacement of the centre of gravity of the spine and the nervous elements can be
tablets. The symptoms will depend on the origin of the spondylolisthesis. Generally, they consist of lumbar pain, which may be associated with root pain (sciatica, cruralgia). The evolution is progressive and the pain can become very disabling.
The diagnosis
The clinical examination must be supplemented by radiological examinations. The condition of the intervertebral discs and the degree of compression of the nervous elements can be evaluated by an MRI. An EOS scanner will calculate pelvic parameters and sagittal balance.
The treatment
First, an analgesic and anti-inflammatory treatment is put in place. Physiotherapy sessions can also be prescribed to strengthen the dorsolumbar and abdominal muscles. In some cases, corticosteroid-based infiltrations may also provide relief to patients.
In case of resistance to treatment, and when the spinal disc is seriously affected or the risk is high, it will be necessary to discuss surgical management. The purpose of the procedure will be to decompress the affected nerves and limit vertebral slippage by welding the vertebrae (fusion) using bone grafting and implanted equipment (screws, rods, cages). The approach can be posterior (back) or anterior (belly), depending on the patients. Minimally invasive surgical techniques reduce incision, limit bleeding loss and improve recovery time.
6. Spinal fractures
The spine can be affected by fractures at any point: cervical, thoracic (dorsal), lumbar or even sacral. They are mainly related to a traumatic event (traffic accident, sport,…), but in elderly subjects, they can be facilitated by osteoporosis and they sometimes occur following a simple fall.
The symptoms
These fractures usually cause pain at the level concerned. Deformations of the spine can occur and create functional disorders (balance disorders, breathing difficulties,…). If a nerve is directly compressed as a result of the trauma, neurological pain may also occur. Cases of complete or incomplete paralysis occur in a few severe cases, when the spinal cord is heavily compressed.
The diagnosis
The type of fracture can be assessed through standard radiographs and scans. MRIs are used to determine if there is evidence of neurological damage.
The treatment
The management of fractures following trauma is most often done in an emergency context. Treatment will then depend on a number of factors (age of the patient, number of lesions, type of fracture, clinical and neurological manifestations) and should be tailored to each patient.
In general, fractures can be treated either conservatively or surgically. External orthopaedic support (corset, neck brace) more or less rigid and more or less large can be put in place for a few weeks or even several months. The surgical treatment will aim to consolidate the fracture and remedy the deformities sometimes caused (nerves or compressed marrow). Arthrodesis will allow the vertebrae to be welded together by means of bone grafting and mechanical equipment (screws, rods, plates). The surgical technique to be adopted and the approach (back, neck, chest, abdomen) will depend on specialized criteria. Minimally invasive (small scars) or percutaneous (through the skin) techniques are increasingly being used. During a kyphoplasty, for example, cement is percutaneously injected into the injured vertebrae to consolidate it.
7. Tumours of the spine
Tumours sometimes affect the spine in a primary or secondary way (metastases). Secondary lesions, which appear at a distance from an initial cancer, particularly affect the lungs, liver and bones. The spine is therefore frequently affected.
The symptoms
The lesion will cause almost constant pain in the spine. Located at the level of the tumour, this pain is of variable intensity but generally increasing.
The diagnosis
A complete radiological assessment (CT, MRI, scintigraphy, myelography, etc.) will confirm the diagnosis, devalue the tumour (its expansion, its degree of compression on the nervous elements) and search for possible multiple locations.
The treatment
Depending on the patient, the cancerous disease, the location of the disease, different therapeutic possibilities are possible. A multidisciplinary approach is necessary for optimal care.
If surgical treatment is considered, it will consist of partial or complete removal of the tumour. The affected vertebrae can be replaced by prostheses or reinforced, either by screws or rods or by cement injected percutaneously into the vertebra.
Chemotherapy and/or radiotherapy treatment often complements surgical treatment.