The aim of this study was to investigate somatosensory and motor cortical activity with functional MRI (fMRI) in a hand-grafted patient with early clinical recovery. The patient had motor fMRI examinations before transplantation, and motor and passive tactile stimulations after surgery. His normal hand and a normal group were studied for comparison. A patient with complete brachial plexus palsy was studied to assess the lack of a fMRI signal in somatosensory areas in the case of total axonal disconnection. Stimulating the grafted hand revealed significant activation in the contralateral somatosensory cortical areas in all fMRI examinations. The activation was seen as early as 10 days after surgery; this effect cannot be explained by the known physiological mechanisms of nerve regeneration. Although an imagination effect cannot be excluded, the objective clinical recovery of sensory function led us to formulate the hypothesis that a connection to the somatosensory cortex was rapidly established. Additional cases and fundamental studies are needed to assess this hypothesis, but several observations were compatible with this explanation. Before surgery, imaginary motion of the amputated hand produced less intense responses than executed movements of the intact hand, whereas the normal activation pattern for right-handed subjects was found after surgery, in agreement with the good clinical motor recovery.
Osteoid osteoma is uncommonly located at the ankle joint level. Arthroscopic resection is an unusual treatment modality in this tumour situation. We report the case of a young man presenting with an osteoid osteoma of his talus neck. Diagnosis was made by MRI. Since the tumour was intraarticular and subperiosteal, it was arthroscopically removed. Pathological examination confirmed the diagnosis of osteoid osteoma. Recovery was uneventful; immediate and complete pain relief followed surgery and the patient remains asymptomatic several months after his operation. Arthroscopic techniques allow complete exploration of the joint and total excision of the tumour. This minimally invasive approach reduces infectious and functional risks (joint stiffness). Less invasive resection techniques should be advocated, when applicable, to achieve pathological diagnosis of the surgical specimen.
The modern neurodiagnostic techniques of MR imaging, CT scanning and angiography provide valuable morphological information that, although highly sensitive to tumour localisation, still lacks comparable specificity as to the exact histological nature of those lesions demonstrated. Biopsy remains necessary. To patients with potentially inoperable lesions or lesions best treated by chemotherapy or irradiation, modern techniques of neurosurgery now offer the option of precise stereotactic biopsy through small twist-drill burr holes as opposed to open biopsy. The interrelationships between MR, CT, angiography and stereotactic biopsy and their respective roles in the establishment of a definitive diagnosis are discussed.
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