How I do it: Selective femoral neurotomy.

Background: Quadriceps spasticity is responsible for a gait disturbance characterized by stiff knee with reduced knee flexion during the swing phase. Selective Femoral Neurotomy induces long-term muscle relaxation via a decrease of the stretch reflex.

Method: Femoral nerve trunk is dissected just below the femoral crease.

Microstructural Characteristics of Cervical Spinal Cord Using High Angular Resolution Diffusion Imaging (HARDI) and Tractography in Healthy Subjects.

Purpose: This study aimed to characterize spinal cord microstructure in healthy subjects using high angular resolution diffusion imaging (HARDI) and tractography.

Methods: Forty-nine healthy subjects (18-50 years, divided into 2 age groups) were included in a prospective study. HARDI of the cervical spinal cord were acquired using a 3T MRI scanner with: 64 directions, b‑value: 1000s/mm, reduced field-of-view (zonally magnified oblique multi-slice), and opposed phase-encoding directions.

Value of Spinal Cord Diffusion Imaging and Tractography in Providing Predictive Factors for Tumor Resection in Patients with Intramedullary Tumors: A Pilot Study.

This pilot study aimed to investigate the interest of high angular resolution diffusion imaging (HARDI) and tractography of the spinal cord (SC) in the management of patients with intramedullary tumors by providing predictive elements for tumor resection. Eight patients were included in a prospective study. HARDI images of the SC were acquired using a 3T MRI scanner with a reduced field of view.

The Impact of Neurophysiological Monitoring during Intradural Spinal Tumor Surgery.

Surgery for spinal cord tumors poses a significant challenge due to the inherent risk of neurological deterioration. Despite being performed at numerous centers, there is an ongoing debate regarding the efficacy of pre- and intraoperative neurophysiological investigations in detecting and preventing neurological lesions. This study begins by providing a comprehensive review of the neurophysiological techniques commonly employed in this context.

Evaluation of the long-term effect of selective tibial neurotomy for the treatment of spastic foot using a personal goal-centered approach.

Objective: The objective of this study was to evaluate the long-term effectiveness of selective tibial neurotomy (STN) for the treatment of the spastic foot using a goal-centered approach.

Methods: Between 2011 and 2018, adult patients with a spastic foot (regardless of etiology) who received STN followed by a rehabilitation program were included. The primary outcome was the achievement of individual goals defined preoperatively (T0) and compared at 1-year (T1) and 5-year (T5) follow-up by using the Goal Attainment Scaling methodology (T-score).

Locked-in syndrome after central pontine myelinolysis, an outstanding outcome of two patients.

Objective: Central pontine myelinolysis (CPM) is a rare demyelinating disease that affects the pons and which can cause extreme disabilities such as locked-in syndrome (LIS) in the initial phase. The aim of the study was to describe the evolution over a 12-month period of two patients with CPM causing an initial LIS.

Method: We retrospectively report the unexpected clinical outcome of these two patients in relation with the anatomical damages documented by brain MRI, associated with diffusion tensor imaging and reconstruction of corticospinal tracts in tractography.

Spinal cord tractography and neuromonitoring-based surgical strategy for intramedullary ependymoma.

Because the spinal cord contains a rich concentration of longitudinal and transversal fibers in a very small area, intramedullary surgery could result in a high likelihood of morbidity. In this video, the authors demonstrate the microsurgical technique and surgical skills used to perform excision of an intramedullary ependyma. The authors also present tools (electrophysiology and neuroimaging) that are useful for surgical decision-making and planning, and thus are used intraoperatively, that allow safer and more effective resection of an intramedullary tumor.

Evaluation of Selective Tibial Neurotomy for the Spastic Foot Treatment Using a Personal Goal-Centered Approach: A 1-Year Cohort Study.

Background: Selective tibial neurotomy (STN) has already demonstrated its effectiveness to reduce foot deformities and spasticity, but assessment according to a goal-centered approach is missing.

Objective: To evaluate the effectiveness of STN associated with a postoperative rehabilitation program for the treatment of the spastic foot, according to a goal-centered approach.

Methods: Interventional study (before-after STN and rehabilitation program) with observational design including consecutive adult patients with spastic foot, who received STN followed by a rehabilitation program, was performed.

Full cervical cord tractography: A new method for clinical use.

Despite recent improvements in diffusion-weighted imaging, spinal cord tractography is not used in routine clinical practice because of difficulties in reconstructing tractograms, with a pertinent tri-dimensional-rendering, in a long post-processing time. We propose a new full tractography approach to the cervical spinal cord without extensive manual filtering or multiple regions of interest seeding that could help neurosurgeons manage various spinal cord disorders. Four healthy volunteers and two patients with either cervical intramedullary tumors or spinal cord injuries were included.

Predictors of functional outcome after spinal cord surgery: Relevance of intraoperative neurophysiological monitoring combined with preoperative neurophysiological and MRI assessments.

Objectives: To assess the accuracy of intraoperative neurophysiological monitoring (IONM) in predicting immediate and 3-month postoperative neurological new deficit (or deterioration) in patients benefiting from spinal cord (SC) surgery; and to identify factors associated with a higher risk of postoperative clinical worsening.

Methods: Consecutive patients who underwent SC surgery with IONM were included. Pre and postoperative clinical (modified McCormick scale), radiological (lesion-occupying area ratio), and electrophysiological features were collected.

Minimally Invasive Approach for Dorsal Arachnoid Web: 2-Dimensional Operative Video.

A 67-yr-old patient presented with severe paraparesis and lower limb spasticity. The spinal cord magnetic resonance imaging (MRI) revealed the "scalpel sign" 1,2 at the T7 level, suggesting a diagnosis of a dorsal arachnoid web. This video demonstrates a microsurgical technique for the excision of a dorsal arachnoid web with a minimally invasive approach.

Microsurgical DREZotomy for Treatment of Brachial Plexus Avulsion Pain.

A 63-year-old man with a history of motorcycle accident 42 years ago suffered a left brachial plexus avulsion (BPA). Neuropathic pain in his left upper limb was felt in the C6-C7-C8 dermatomes. The rationale for performing "DREZotomy" is to preferentially interrupt the nociceptive inputs in the lateral part of the dorsal root entry zone (DREZ).

Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population.

Purpose: Thoracolumbar fractures are the most common kind of spine injury in children. Several types of spine injury can occur, and for this reason, treatment algorithms have been put in place for the management of these patients. At present, the thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AOSpine injury score (AOSpine score) aimed at providing treatment recommendations.

Effect of distortion corrections on the tractography quality in spinal cord diffusion-weighted imaging.

Purpose: To assess the impact of a different distortion correction (DC) method and patient geometry (sagittal balance) on the quality of spinal cord tractography rendering according to different tractography approaches.

Methods: Forty-four adults free of spinal cord diseases underwent cervical diffusion-weighted imaging. The phase-encoding direction was head→foot.

How I do it: selective tibial neurotomy.

Background: Selective neurotomy is known as an effective method to reduce focal spasticity when medical treatment including botulinum toxin is not sufficient. The tibial nerve can be targeted to treat spastic equinovarus foot with (or without) claw toes.

Method: Tibial nerve trunk is dissected in the popliteal fossa.

Overcoming challenges of the human spinal cord tractography for routine clinical use: a review.

The spinal cord (SC) is a dense network of billions of fibers in a small volume surrounded by bones that makes tractography difficult to perform. We aim to provide a review collecting all technical settings of SC tractography and propose the optimal set of parameters to perform a good SC tractography rendering. The MEDLINE database was searched for articles reporting "spinal cord" "tractography" in "humans".

Stereoscopic three-dimensional visualization: interest for neuroanatomy teaching in medical school.

Purpose: The anatomy of both the brain and the skull is particularly difficult to learn and to teach. Since their anatomical structures are numerous and gathered in a complex tridimensional (3D) architecture, classic schematical drawing or photography in two dimensions (2D) has difficulties in providing a clear, simple, and accurate message. Advances in photography and computer sciences have led to develop stereoscopic 3D visualization, firstly for entertainment then for education.

How I do it: dorsolateral approach for ventrolateral intramedullary cavernoma.

Background: For small and lateral lesions, in order to avoid postoperative sequelae related to dorso-median myelotomy, we propose to describe the use of a ventrolateral approach for intramedullary lesions.

Method: Performing this approach entails that the denticulate ligament is cut from its dural attachment and retracted. Rotation of the spinal cord must be achieved with great caution and under electrophysiological monitoring.

Cysts associated with intramedullary ependymomas of the spinal cord: clinical, MRI and oncological features.

Purpose: Few published articles have explicitly focused on cysts associated with intramedullary (IM) ependymomas. The objective was to assess the clinical, MRI, and oncological results of patients operated for an IM ependymoma associated with a cystic portion.

Methods: During the study period, 23 IM tumors resected were cystic ependymomas.

Anatomy of the human spinal cord arachnoid cisterns: applications for spinal cord surgery.

Objective: The goal in this study was to describe the overall organization of the spinal arachnoid mater and spinal subarachnoid space (SSAS) as well as its relationship with surrounding structures, in order to highlight spinal cord arachnoid cisterns.

Methods: Fifteen spinal cords were extracted from embalmed adult cadavers. The organization of the spinal cord arachnoid and SSAS was described via macroscopic observations, optical microscopic views, and scanning electron microscope (SEM) studies.

Surgical Management of Pediatric Spine Trauma: 12 Years of Experience.

Objective: Spine trauma management in children varies from one team to another, and to date, no clear consensus has been reached. The goal of this study was to describe the epidemiology of spine trauma in children and evaluate the timing and techniques of surgery when it was required.

Methods: A retrospective review of all patients admitted to our pediatric trauma center for spine traumas that required surgical management, between 2005 and 2016, was performed.