Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group.

Primary orbital bone tumors account for 0.6-2% of all orbital tumors. This is a heterogeneous group of tumors arising from osseous, cartilaginous, fibrous, and vascular tissues. The two most commonly encountered lesions are fibrous dysplasia and osteoma. Treatment of the primitive orbital bone tumors is generally surgical. (C) 2010 Elsevier Masson SAS. All rights reserved.

Mesenchymal tumors grow from pluripotent mesenchymal cells that form the soft orbital tissue. Primary tumors of the orbital walls are discussed in another section. Tumors from muscle and adipose tissue are rare or exceptional, except rhabdomyosarcoma, described in the section dedicated to pediatric tumors. Most frequent tumors are fibrous histiocytomas and solitary fibrous tumors, which often have a retrobulbar location. Fibrous histiocytoma is benign in only 65% of cases. Fibrous solitary tumor is now better known (Ag CD34): this tumor is generally benign but frequently recurs. (C) 2010 Elsevier Masson SAS. All rights reserved.

Orbital metastases are uncommon, accounting for 4% of all adult orbital tumors. The mean age at time of presentation is 60 years. The primary tumor is most often a carcinoma involving the breast (40%), lung (11%), or prostate (8%). Proptosis is the main clinical sign at diagnosis and is often associated with visual impairment, pain or ptosis. Imaging features are not specific; nevertheless, an enhanced extraconal tumor with osteolysis suggests the diagnosis. From a pathological point of view, there are no differences between the metastasis and the primary tumor. Regarding the average survival, the gold standard treatment remains radiotherapy.

Orbital metastases are uncommon, accounting for 4% of all adult orbital tumors. The mean age at time of presentation is 60 years. The primary tumor is most often a carcinoma involving the breast (40%), lung (11%), or prostate (8%). Proptosis is the main clinical sign at diagnosis and is often associated with visual impairment, pain or ptosis. Imaging features are not specific; nevertheless, an enhanced extraconal tumor with osteolysis suggests the diagnosis. From a pathological point of view, there are no differences between the metastasis and the primary tumor. Regarding the average survival, the gold standard treatment remains radiotherapy. (C) 2010 Elsevier Masson SAS. All rights reserved.

Sphenoorbital meningiomas account for 20% of all orbital tumors treated by neurosurgeons. Proptosis is the main clinical sign but this can be reduced with accurate surgical management. Complete tumor removal is often difficult considering the frequent extensions of the meningioma to the superior orbital fissure, the cavernous sinus, and the periorbita.

Intraorbital schwannomas and solitary neurofibromas account for 2 to 5% of all operated intraorbital tumors. Without any known neurofibromatosis, their diagnosis is only suggested with the MRI data, which displays a heterogeneous signal that may mimic a cavernous angioma. Their treatment is solely surgical.

Orbital metastases are uncommon, accounting for 4% of all adult orbital tumors. The mean age at time of presentation is 60 years. The primary tumor is most often a carcinoma involving the breast (40%), lung (11%), or prostate (8%). Proptosis is the main clinical sign at diagnosis and is often associated with visual impairment, pain or ptosis. Imaging features are not specific; nevertheless, an enhanced extraconal tumor with osteolysis suggests the diagnosis. From a pathological point of view, there are no differences between the metastasis and the primary tumor. Regarding the average survival, the gold standard treatment remains radiotherapy. Les métastases orbitaires sont rares (4 % des tumeurs orbitaires) et concernent des patients âgés en moyenne de 60 ans. Les tumeurs primitives sont majoritairement des adénocarcinomes, les plus souvent mammaires (40 %), pulmonaires (11 %) ou prostatiques (8 %). Cliniquement, les métastases orbitaires se manifestent principalement par une exophtalmie. Un ptosis, une baisse de l’acuité visuelle ainsi que des douleurs peuvent s’y associer. L’imagerie est peu spécifique, mais la présence d’une lésion extraconique, prenant le contraste et envahissant les structures osseuses, est évocatrice. L’anatomopathologie est la même que celle de la tumeur primitive et n’est pas spécifique de la localisation orbitaire. Compte tenu des délais de survie faibles, la radiothérapie reste le traitement de référence.

Sphenoorbital meningiomas account for 20% of all orbital tumors treated by neurosurgeons. Proptosis is the main clinical sign but this can be reduced with accurate surgical management. Complete tumor removal is often difficult considering the frequent extensions of the meningioma to the superior orbital fissure, the cavernous sinus, and the periorbita. (C) 2010 Elsevier Masson SAS. All rights reserved.

Orbital tumors arising from paranasal sinuses comprise mucoceles and malignant ethmoidal tumors. Most often, anamnestic, clinical, and radiological data as well as endoscopic biopsy performed by an ENT surgeon provide the preoperative diagnosis. If the tumor is benign, surgery can cure the patient. It is associated with chemotherapy and radiotherapy if the tumor is malignant.

La espondilolistesis se define como el deslizamiento anterior o posterior de una vértebra respecto a las vértebras subyacentes. A veces se compensa de manera natural por una modificación postural que crea un nuevo equilibro. No obstante, este deslizamiento también puede causar una alteración de las funciones estáticas, dinámicas y de protección nerviosa del segmento raquídeo. El objetivo del tratamiento quirúrgico es restablecer estas tres funciones. Se han descrito múltiples técnicas quirúrgicas, vías de acceso anteriores, posteriores, combinadas, artrodesis asociadas o no a osteosíntesis, etcétera. Más allá de las preferencias de cada cirujano, estas técnicas presentan indicaciones, dificultades y también complicaciones propias. Por tanto, la fuerza de la costumbre debe dejar paso a la realidad del trastorno y cualquier cirujano de la columna debe conocer estos diferentes accesos para ser capaz de llevar a cabo el mejor tratamiento de la sintomatología.

INTRODUCTION:After diagnosis of an antenatal monoventricular hydrocephalus caused by a cystic lesion of the foramen of Monro, treatment modality and time frame may be difficult to assess. Previously, this type of hydrocephalus was often treated with internal shunting. The advent of neuroendoscopy has changed the surgical management of this pathology.MATERIALS AND METHODS:We report on two cases of cystic lesions of the foramen of Monro discovered on antenatal ultrasonography. A cavum veli interpositi in one case and a choroid plexus cyst in the other were responsible for unilateral hydrocephalus. In both cases, endoscopic treatment before 1 month of age was performed as the primary procedure with a successful outcome.CONCLUSIONS:We advise early endoscopic treatment for newborns presenting with progressive unilateral hydrocephalus caused by a cystic lesion of the foramen of Monro. It has been, in our hands, a safe and efficient procedure.

La spondilolistesi è definita come lo scivolamento anteriore o posteriore di una vertebra rispetto alle vertebre sottostanti. Talvolta essa è compensata naturalmente da una modificazione della postura, che crea quindi un nuovo equilibrio. Lo scivolamento può anche essere responsabile di un’alterazione delle funzioni statiche e dinamiche e di un interessamento midollare. L’obiettivo del trattamento chirurgico è quello di ripristinare tali funzioni. Molteplici sono le tecniche chirurgiche descritte: vie d’accesso anteriore, posteriore, combinate, artrodesi associate o meno a osteosintesi. Al di là delle preferenze del chirurgo, queste tecniche presentano indicazioni, difficoltà e complicanze proprie. È quindi importante che ogni chirurgo conosca i diversi approcci per trattare al meglio la sintomatologia.

Computer-assisted surgery has been more and more widely used in craniofacial surgery in recent years. It is useful in many situations: stereolithographic models, surgical simulations of osteotomies and bone repositioning, and cutting guides and customized implants. The present paper argues that computer-assisted surgery is particularly useful in complex cases such as rare malformations, or to address the sequelae of previous surgeries. The various advantages of the technique are emphasized from a surgical and from a teaching standpoint.Forty cases of various computer-assisted surgeries were analyzed, allowing a comprehensive review of outcomes in cases such as craniosynostosis, complex craniosynostosis, hypertelorism, craniosynostosis sequelae and cranio-facial and orbital trauma.Results were promising in all of the cases reviewed, except in a few cases for which computer-assisted surgery with cutting guides may not be necessary. In these specific cases, the pedagogical input is nevertheless interesting for residents and students.Computer-assisted surgery is revolutionizing the surgical approach to complex craniofacial malformations, as well as easing management of less complex ones. It is likely that in the years to come this technique will supersede previous ones. However, using this technique implies being willing to rely on a non-human device. We need to consider computer-assisted surgery as a tool that can change surgical practices. The surgeon can rely on it, yet nothing will replace his/her eye and experience. It is the combination of both this experience and the appropriate use of computer-assisted surgery that, ultimately, leads to successful surgery.

Le syringome chondroïde est une tumeur cutanée rare caractérisée par une double composante épithéliale et mésenchymateuse. Le diagnostic histologique morphologique peut être orienté par l’immuno-histochimie. Nous présentons 10 cas et leurs caractéristiques clinico-pathologiques.Dix cas de syringomes chondroïdes ont été inclus, entre janvier 2000 et août 2013, sur les CHU Louis-Mourier et de Fort-de-France. Ils ont tous été relus par un expert en pathologie cutanée et des compléments d’immuno-histochimie ont été réalisés. Les données cliniques et histologiques ont été colligées.Les lésions étaient surtout localisées au visage (3/10) et aux extrémités (3/10). La taille variait de 1,2 à 5,2 cm. Tous les cas ont été traités chirurgicalement, aucun cas de malignité n’a été diagnostiqué. L’histologie montrait un aspect de tumeur dermique limitée, avec une double différenciation syringo-chondroïde, et des cavités revêtues d’une à deux assises cellulaires évoquant une tumeur annexielle de type apocrine (5/10) ou eccrine (4/10). L’étude immuno-histochimique montrait une positivité de l’EMA, l’ACE et de la CK7 sur les cellules bordant les lumières, et une positivité de la PS100 et de la vimentine sur les cellules de la bordure externe.Le syringome chondroïde est caractérisé par une double composante épithéliale et mésenchymateuse au sein d’un stroma myxoïde ou chondroïde. Notre série a des particularités cliniques et histologiques (localisation aux extrémités, raccordement épidermique…). Les principaux diagnostics différentiels sont les autres lésions annexielles, dont l’immuno-histochimie ne serait pas caractéristique de celle des syringomes chondroïdes : les cellules bordant les lumières expriment les marqueurs épithéliaux (EMA, cytokératines et ACE), les cellules de la bordure externe les marqueurs mésenchymateux (PS100, vimentine). Le traitement est chirurgical.L’aspect histologique du syringome chondroïde est évocateur mais en cas de doute la réalisation d’une étude immuno-histochimique montrant une double composante cellulaire peut en faciliter le diagnostic.Chondroid syringoma (CS) is a rare cutaneous tumor characterized by mixte epithelial and mesenchymal component. The confident histological diagnosis can be obtained by immuno-histochemistry study. Here we present 10 new cases with their clinico-hystological characteristics.The 10 cases were observed between January 2000 and august 2013, in Fort-de-France and Louis-Mourier universitary hospitals. For all the cases a controlled histological study was performed by a dermatopathologist expert and immuno-histochemistry was added. Clinical and immuno-histological data were analyzed.The lesions were almost localized on the face (3/10) and the extremities (3/10). The size was about 1.2 to 5.2 cm. Every case was treated by surgery, no malignant case was diagnosed. Histologically, all the 10 cases presented as a well-limited dermic tumor with a mixte epithelial and mesenchymal component. The stroma was myxo-chondroid, and the epithelial component consisted in epithelial cavities lined by one or two cell layers with eccrine (4/10) or apocrine (5/10) features. Immuno-chemistry study reveals positivity for EMA, ACE and CK7 for the internal cells, and positivity for S100 protein and vimentin of the extern cell layer.Chondroid syringoma is characterized by a mixte epithelial with eccrine and apocrine cells and a myxo-chondroid stroma. Our study has some clinical and histological particularities (lesions on the extremities, epidermic connecting…). The main differentials diagnoses are the other annexial tumors. The treatment is surgical.The histological diagnosis of CS is quite easy, but in case of doubt, immuno-chemistry will help, showing a double mesenchymal and epithelial differentiation.