Tudor Racaru

Centre Hospitalier Universitaire de Liège, Luik, Walloon Region, Belgium

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Publications (15)12.51 Total impact

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    Skeletal Radiology 11/2012; · 1.74 Impact Factor
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    ABSTRACT: The main emphasis of the chapter on skeletal radiology is CAT scanning and its use in the diagnosis of neoplasms. Other topics that are discussed include infections, arthritis, trauma, and metabolic and endocrine diseases as they relate to skeletal radiology. (KRM)
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    ABSTRACT: BACKGROUND AND PURPOSE: Paralysing lumbar disc herniation (LDH): what and when to do? Few studies have analyzed the optimal timing of surgery in case of paralysing LDH. METHODS: Twenty-four charts were retrospectively reviewed of patients suffering of LDH with severe motor deficit. RESULTS: There were 16 men and eight women. Mean age was 45.1years. Seventeen patients suffered of lumbar pain, 15 of radicular pain and all of a severe motor deficit, implying mostly the ankle flexion (17 patients). LDH was most frequently located at L4/L5 or L5/S1 level. Surgery was proposed to all patients at the end of the consultation. Nine patients were operated within 48hours. The mean interval between onset of motor deficit and operation was 20days. The statistical analysis did not reveal any significant difference among different prognostic factors between the 17 patients with good motor recovery and the seven patients with poor motor recovery. In particular the operative delay did not appear to influence the degree of motor recovery. Literature review on paralysing LDH provides five published series since 1996, including 28 to 116 patients. Two series, including the single prospective one, conclude that the degree of recovery of motor function is inversely related to the degree and duration of motor deficit. CONCLUSIONS: Our retrospective series of 24 operated paralysing LDH did not reveal any prognostic factor for motor recovery. There is no evidence based medicine data in the literature about the optimal timing of decompressive surgery. A relative consensus exists among spine surgeons for paralysing LDH: since operative indication is obvious, surgery should be done as soon as possible.
    Neurochirurgie 11/2012; · 0.32 Impact Factor
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    ABSTRACT: To evaluate the clinical presentation, diagnostic and therapeutic management and outcome of 27 cases of post-traumatic thoracic outlet syndrome (PT TOS). Retrospective chart analysis. Nineteen women and eight men were included in this study. Involvement in a traffic accident was the most common scenario. Fracture of either the first rib or the clavicle was reported in eight patients at the time of injury; in others, the diagnosis was cervical or shoulder soft tissue trauma. Upon presentation at our clinic at a mean 41 months after injury, four patients had bilateral symptoms and 17 reported decreased function of either the arm or hand. Two patients presented with severe lower trunk deficits including one who had received surgical intervention at both the cervical spine and elbow before diagnosis of TOS was made. Sixteen and 15 patients were suffering from some degree of anxiety and/or depression. Upon diagnosis of neurogenic TOS, the two patients with atrophy of the hand musculature were treated surgically. Conservative treatment was applied to all other patients. Six months after presentation to our clinic, nine patients demonstrated a significant improvement. The remainder that reported incapacitating symptoms were offered surgical treatment. Three patients declined the latter. Fifteen patients received surgical treatment via an anterior supraclavicular approach with resection of the anterior scalene muscles. Eleven patients had resection of the middle scalene muscle while five had resection of an osseous structure (partial claviculectomy, C7 transverse process or a cervical rib). The two patients with atrophy of the hand only slightly improved their motor deficit but had a notable relief of symptoms of pain. Postoperative improvement occurred in 80% of surgically treated patients. The majority of patients suffering from a post-traumatic TOS present a neurogenic, usually subjective syndrome. Prompt therapeutic management is necessary, addressing both physical and psychological complaints. Most patients are cured or well improved by conservative and/or surgical treatment.
    Acta Neurochirurgica 03/2012; 154(3):517-26. · 1.55 Impact Factor
  • World Neurosurgery 01/2012; 77(1):206. · 1.77 Impact Factor
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    Skeletal Radiology 06/2011; · 1.74 Impact Factor
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    Skeletal Radiology 05/2011; 40(10):1361-2, 1387-8. · 1.74 Impact Factor
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    ABSTRACT: The clinical picture of hand atrophy related to a cervical rib or elongated C7 transverse process was well described in the modern literature by Gilliatt and Sumner; in 1970, they reported a series of nine patients whose motor status was stabilized following brachial plexus decompression. We report here seven patients suffering from thoracic outlet syndrome (TOS), who developed hand atrophy, sometimes because of diagnostic delay. The patient's charts were analysed retrospectively. The seven patients were all female; the mean age was 43 years. The first complaints were arm pain and paresthesias lasting six months to 5 years. Three patients were treated with C56/C67 discectomy plus disc prosthesis (one patient), ulnar neurolysis at the elbow (the same patient), carpal tunnel release (one patient), and intravenous immunoglobulins (one patient) before TOS diagnosis. Hand atrophy, severe in five patients, was present at presentation. All patients underwent brachial plexus decompression by the anterior (four), posterior (two), or transaxillary (one) approach. This last approach was completed 18 months later by brachial plexus neurolysis via the anterior approach. Postoperatively, motor deficit was improved in two patients and stabilized in five patients. Physicians' unfamiliarity with TOS diagnosis or their reluctance to accept the diagnosis without electrical confirmation can lead to hand atrophy. Brachial plexus decompression at this stage usually stabilizes the deficit.
    Neurochirurgie 02/2011; 57(1):9-14. · 0.32 Impact Factor
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    ABSTRACT: Background and purposeThe clinical picture of hand atrophy related to a cervical rib or elongated C7 transverse process was well described in the modern literature by Gilliatt and Sumner; in 1970, they reported a series of nine patients whose motor status was stabilized following brachial plexus decompression. We report here seven patients suffering from thoracic outlet syndrome (TOS), who developed hand atrophy, sometimes because of diagnostic delay.Methods The patient's charts were analysed retrospectively.ResultsThe seven patients were all female; the mean age was 43 years. The first complaints were arm pain and paresthesias lasting six months to 5 years. Three patients were treated with C56/C67 discectomy plus disc prosthesis (one patient), ulnar neurolysis at the elbow (the same patient), carpal tunnel release (one patient), and intravenous immunoglobulins (one patient) before TOS diagnosis. Hand atrophy, severe in five patients, was present at presentation. All patients underwent brachial plexus decompression by the anterior (four), posterior (two), or transaxillary (one) approach. This last approach was completed 18 months later by brachial plexus neurolysis via the anterior approach. Postoperatively, motor deficit was improved in two patients and stabilized in five patients.ConclusionsPhysicians’ unfamiliarity with TOS diagnosis or their reluctance to accept the diagnosis without electrical confirmation can lead to hand atrophy. Brachial plexus decompression at this stage usually stabilizes the deficit.RésuméDescription et objectifLe tableau clinique d’atrophie de la main en relation avec une côte cervicale ou transversomégalie de C7 a été bien décrit dans la littérature moderne par Gilliatt et Sumner ; ces auteurs rapportèrent en 1970 une série de neuf patients dont l’état moteur fut stabilisé après la décompression du plexus brachial. Nous rapportons sept patients qui, souffrant de syndrome de défilé cervicothoracique (SDCT), développèrent progressivement une atrophie de la main. Des retards diagnostiques sont parfois incriminés.MéthodesNous avons analysé rétrospectivement les dossiers des patients.RésultatsLes sept patients sont toutes des femmes, âgées en moyenne de 43 ans. Les plaintes initiales comprenaient douleurs et paresthésies brachiales évoluant pendant six mois à cinq ans. Trois patientes ont été traitées par discectomie C56/C67 plus prothèses discales (une patiente), neurolyse du nerf ulnaire au coude (même patiente), libération du canal carpien (une patiente), immunoglobulines intraveineuses (une patiente) avant le diagnostic de SDCT. Une atrophie de la main, sévère chez cinq patientes, est présente au moment de notre prise en charge. Les patientes sont opérées pour décompression plexuelle par abord antérieur (quatre), postérieur (deux) ou transaxillaire (une). Cette dernière approche a été complétée 18 mois plus tard d’une neurolyse plexuelle par voie antérieure. En postopératoire, le déficit moteur est amélioré chez deux patientes et stabilisé chez cinq patientes.Conclusions La méconnaissance du diagnostic de SDCT ou la réticence à accepter le diagnostic sans confirmation électrique peut conduire à une atrophie de la main. La décompression plexuelle à ce stade ne permet souvent qu’une stabilisation du déficit.
    Neurochirurgie. 01/2011; 57(1):9-14.
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    ABSTRACT: Acute traumatic orbital encephalocele is a rare entity, with less than 25 cases reported. We hereby describe the first bilateral orbital encephalocele through a blow-in orbital fracture after a blunt cranial traumatism. Early treatment of the orbital traumatic encephalocele is necessary in order to avoid the increase of the intra orbital pressure that might damage the optic nerve. Repairing the orbital roof has to be performed in a rigid manner in order to avoid the transmission of the intracranial pressure variation to the orbit. In the present case, the reconstruction of orbital roof was performed using a subfrontal approach supported by a titanium mesh fixed with screws and a mixture of bone powder mixed and fibrin glue.
    Revue médicale de Liège 02/2010; 65(2):59-61.
  • Neurochirurgie. 01/2010; 56(6):552-552.
  • Surgical Neurology 11/2009; 72(5):519. · 1.67 Impact Factor
  • Surgical Neurology 11/2009; 72(5):516–517. · 1.67 Impact Factor
  • Surgical Neurology - SURG NEUROL. 01/2009; 71(1):149-149.