in this discipline has been limited due to an incomplete knowledge of the functional anatomy of the brain. This highly integrated organ does not lend itself easily to study, as its morphology does not translate to its function 1 . This caveat was quickly acknowledged by the early neuro-anatomists such as Brodmann, who stated in 1909: "One thing must be stressed quite firmly: henceforth functional localization of the cerebral cortex without the lead of anatomy is utterly impossible in man as in animals… so, first anatomy, and then physiology; but if first physiology, then not without anatomy" 2 . Furthermore, there is now mounting evidence that the brain has the capacity to reorganize its functional networks in the face of an injury, or a ABSTRACT: Background: The brain functions as an integrated multi-networked organ. Complex neurocognitive functions are not attributed to a single brain area but depend on the dynamic interactions of distributed brain areas operating in large-scale networks. This is especially important in the field of neurosurgery where intervention within a spatially localized area may indirectly lead to unwanted effects on distant areas. As part of a preliminary integrated work on functional connectivity, we present our initial work on diffusion tensor imaging tractography to produce in vivo white matter tracts dissection. Methods: Diffusion weighted data and high-resolution T1-weighted images were acquired from a healthy right-handed volunteer (25 years old) on a whole-body 3 T scanner. Two approaches were used to dissect the tractography results: 1) a standard region of interest technique and 2) the use of Brodmann's area as seeding points, which represents an innovation in terms of seeds initiation. Results: Results are presented as tri-dimensional tractography images. The uncinate fasciculus, the inferior longitudinal fasciculus, the inferior fronto-occipital fasiculus, the corticospinal tract, the corpus callosum, the cingulum, and the optic radiations where studied by conventional seeding approach, while Broca's and Wernicke's areas, the primary motor as well as the primary visual cortices were used as seeding areas in the second approach. Conclusions: We report state-of-the-art tractography results of some of the major white matter bundles in a normal subject using DTI. Moreover, we used Brodmann's area as seeding areas for fiber tracts to study the connectivity of known major functional cortical areas.RÉSUMÉ: La tractographie dans l'étude du cerveau humain : perspective neurochirurgicale. Contexte : Le cerveau fonctionne comme un organe constitué en multiréseaux intégrés et les fonctions neurocognitives complexes ne sont pas restreintes à une seule zone du cerveau. Elles dépendent d'interactions dynamiques de différentes régions du cerveau opérant en réseaux de grande envergure. Ceci est particulièrement important dans le domaine de la neurochirurgie où une intervention à l'intérieur d'une zone très localisée peut provoquer indirectement des effets indésirables à distance. Nous présent...

Background:Prompt physical and occupational therapy is crucial in managing nonsurgical candidates with obstetrical brachial plexus injuries (OBPI). The objective of our study was to identify newborns suffering from nonoperative OBPI in need of a “fast-track” evaluation by a multidisciplinary team.Methods:This is a retrospective review of patients with OBPI from June 1995 to June 2015. All nonsurgical candidates (Narakas class 1) were included in the study. The Gilbert score and the Medical Research Council grading system were used to measure shoulder and elbow function, respectively. The relationship between shoulder and elbow functional outcomes and time delay to consultation was studied using analysis of variance and Welch’s tests. Various subgroups were studied based on OBPI risk factors: maternal diabetes, birth weight >4 kg, use of forceps, asphyxia, multiple comorbidities, and Apgar score at 1 and 5 minutes.Results:A total of 168 patients were included in this study. Mean follow-up time was 313.8 weeks (minimum: 52; maximum: 1072; SD: 228.1). A total of 19 patients had an Apgar scores <7 at 5 minutes. Time delay between birth and the first consult to our clinic had an impact on shoulder outcome in the subgroup of newborns with Apgar scores <7 at 5 minutes.Conclusions:The subgroup of newborns with an Apgar score <7 at 5 minutes shows improved long-term shoulder function when promptly examined by an OBPI clinic. We recommend a “fast-track” referral for this time-sensitive population.

Neisseria animaloris is a rare pathogen in humans primarily associated with dog and cat bites. Fourteen cases have been documented in the literature related to the difficulty in identifying this bacterium in the laboratory. We present a patient case demonstrating a prolonged treatment course, which is often seen as the result of misdiagnosis, and subsequent nonhealing wound requiring multiple surgeries and eventual wide excision with staged graft coverage. We discuss the clinical course, laboratory identification techniques, surgical treatment, and patient outcome.

OBJECTIVEThe purpose of this study was to compare shoulder abduction and external rotation (ER) after single-nerve repair of the upper trunk alone versus dual-nerve repair of both the upper trunk and the suprascapular nerve.METHODSA retrospective chart review of a single surgeon’s experience repairing obstetrical brachial plexus injuries between June 1995 and June 2015 was performed. Eight patients underwent repair of the upper trunk alone, and 10 patients underwent repair of the upper trunk and the suprascapular nerve. Shoulder abduction and ER ranges of motion (ROMs) (in degrees) were recorded preoperatively and postoperatively. Postoperative ROM and the difference in ROM gained after surgery were compared by independent t-test analysis.RESULTSThe mean follow-up time was 161.4 weeks (range 62–514 weeks, SD 124.0 weeks). The mean patient age at the time of surgery was 31.3 weeks (range 19.9–47.0 weeks, SD 6.9 weeks). The mean postoperative shoulder abduction ROMs were 145.0° (range 85°–180°, SD 39.4°) after single-nerve repair and 134.0° (range 90°–180°, SD 30.3°) after dual-nerve repair (p = 0.51). The mean postoperative shoulder ER ROMs were 67.5° (range 10°–95°, SD 28.8°) after single-nerve repair and 72.0° (range 10°–95°, SD 31.3°) after dual-nerve repair (p = 0.76).CONCLUSIONSThe authors found no difference in shoulder abduction and ER between patients who underwent single-nerve repair of the upper trunk alone and those who underwent dual-nerve repair of both the upper trunk and the suprascapular nerve.

Treatment of isolated complete tear of the scapholunate ligament is challenging. The purpose of this study was to determine (1) whether delayed repair of only scapholunate ligament is an option without other reconstruction procedures and (2) whether functional outcomes are possible despite radiographic presence of arthritis. This study included patients who had complete ligament tear at exploration and underwent only scapholunate ligament repair without capsulodesis or tenodesis. Fifteen patients returned for clinical and radiographic examinations. Preoperatively, mean scapholunate gap was 2.9 mm and 4.58 mm on posteroanterior and tangential posteroanterior views, respectively. Postoperatively, the final mean gap was 2.5 mm and 3.9 mm on the posteroanterior and tangential posteroanterior views, respectively. The mean preoperative and final scapholunate angles were 74° and 72.6°, respectively. Seven patients had radiographic arthritis at final follow-up. Delayed scapholunate repair is possible after complete ligament tear. At long-term follow-up, clinical functional outcomes may not correlate with radiographic presence of degenerative arthritis. [ Orthopedics . 2021;44(3):e446–e453.]

The authors present a rare case of nontraumatic medial orbital wall fracture in an 11-year-old girl. Fractures of the orbital wall secondary to nose blowing have not been previously described in the pediatric population. The patient reported a history of chronic forceful nose blowing, followed by periorbital swelling after an episode of vigorous nose blowing. Erroneous diagnoses of sinusitis and periorbital cellulitis lead to unnecessary antibiotic treatment. The authors hypothesize that repeated and aggressive nose blowing is analogous to stress fractures, leading to weakening and eventual fracture of the medial orbital wall.

No abstract

No abstract