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Anatomie Chirurgicale du Cou

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Spinal Nurse Course Depuy Synthes Belgium
Anatomie chirurgical du cou en neurochirurgie
Rappel anatomique et étiologies des complications en chirurgie de la colonne cervicale par abord antérieur et abord postérieur.
Cours destiné au personnel de salle d'opération

Publié dans : Santé
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Anatomie Chirurgicale du Cou

  1. 1. Spinal Nurse Course Depuy Synthes M Triffaux Neurochirurgie CHwapi Tournai Belgium 13 mai 2016
  2. 2. L’Anatomie Chirurgicale du Cou •  Les voies d’abords – Antérieure – Antérolatérale – Postérieure – Trans orale A P TsOr AL
  3. 3. L’anatomie par devant, par derrière
  4. 4. L’anatomie par devant, par derrière
  5. 5. L’anatomie par devant, par derrière
  6. 6. L’anatomie par devant
  7. 7. L’anatomie par devant •  Le plaJsma
  8. 8. L’anatomie par devant •  Le Sterno Cleïdo Mastoïdien •  Le Sterno Hyoidien, le Thyro Hyoïdien
  9. 9. L’anatomie par devant •  La thyroide, la trachée et l’œsophage
  10. 10. L’anatomie par devant •  Les veines External jugular Anterior jugular Internal jugular
  11. 11. L’anatomie par devant •  Les artères Artère vertébrale CaroJde
  12. 12. L’anatomie par devant •  Les nerfs: – Superficiels; Vagues, Récurrents – SNA sympathique et parasympathique
  13. 13. L’anatomie par devant •  Les nerfs: – Les récurrents Récurrent gauche
  14. 14. L’anatomie par devant •  Les lymphaJques
  15. 15. L’anatomie par devant •  Les muscles longs du cou
  16. 16. Les vertèbres cervicales
  17. 17. Transverse Process Transverse Foramen Anterior Tubercle Articular Facet for Dens Lateral Mass LaminaPosterior Tubercle Superior Articular Facet Superior View L’Atlas C1
  18. 18. L’axis C2 Odontoid Process (Dens) Body Transverse Process Inferior Articular Facet Superior Articular Facet Anterior View Posterior View Lateral Mass Spinous Process
  19. 19. De C3 à C7
  20. 20. •  Les ligaments Les vertèbres cervicales
  21. 21. •  Le contenu La moelle épinière Les racines cervicales Les vertèbres cervicales
  22. 22. •  Le contenu Les vertèbres cervicales
  23. 23. L’anatomie par derrière •  Les muscles
  24. 24. Les traitements chirurgicaux 1 niveau antérieur Discectomie / Cage / Plaque Cervicale Prothèse discale postérieur Séquestromie / Foraminotomie > 1 niveau antérieur Corporectomie (Somatotomie) / Cage / Plaque XlJples cages / plaque postérieur Laminectomie / LaminoplasJe / FixaJon postérieure Double abord Vertébrectomie
  25. 25. Anterior Cervical Disc Fusion
  26. 26. Corporectomie Schwannome C5
  27. 27. Corporectomie Schwannome C5
  28. 28. Corporectomie Schwannome C5
  29. 29. Corporectomie: métastase Technique du berceau
  30. 30. Corporectomie: métastase Technique du berceau
  31. 31. – à la pince – au moteur –  au bone scalpel La laminectomie
  32. 32. – à la pince – au moteur – au bone scalpel La laminectomie
  33. 33. •  La laminectomie – au bone scalpel La laminectomie
  34. 34. La laminoplasJe
  35. 35. La laminoplasJe
  36. 36. La laminoplasJe
  37. 37. La fixaJon postérieure C7 C3-C6 C2 pédiculaire massif arJc. pédiculaire
  38. 38. •  La fixaJon postérieure La fixaJon postérieure
  39. 39. •  La fixaJon postérieure La fixaJon postérieure
  40. 40. # C2 La pathologie traumaJque
  41. 41. FixaJon cervico-occipitale La pathologie traumaJque
  42. 42. FixaJon cervico-occipitale La pathologie traumaJque
  43. 43. C5 # discoligamentaire C5-C6 La pathologie traumaJque
  44. 44. La pathologie traumaJque
  45. 45. Les pathologies de la charnière •  MalformaJon d’Arnold Chiari •  Impression basilaire
  46. 46. Arnold Chiari Syringomyélie Les pathologies de la charnière
  47. 47. Impression basilaire Les pathologies de la charnière
  48. 48. Les pathologies de la charnière AblaJon de la dent C2
  49. 49. La pathologie tumorale •  Extradurale •  Intradurale – Extramédullaire – Intramédullaire
  50. 50. MENINGIOME La pathologie tumorale
  51. 51. La pathologie tumorale
  52. 52. La pathologie tumorale ReconstrucJon C6 Myélome
  53. 53. La pathologie tumorale CAVERNOME
  54. 54. La pathologie tumorale
  55. 55. CHORDOME CERVICAL La pathologie tumorale
  56. 56. CHORDOME CERVICAL post op La pathologie tumorale
  57. 57. ASTROCYTOME III La pathologie tumorale
  58. 58. •  Vertébrectomie C7 : Tumeur à Cellules Géantes La pathologie tumorale
  59. 59. Double abord
  60. 60. Double abord
  61. 61. Double abord
  62. 62. Les complicaJons •  de la voie d’abord antérieure – La dysphagie – Le nerf de la « barbe » – La dysphonie – Le Sd de Claude Bernard Horner – Lésion œsophage – L’hématome suffocant => risque vital – Lésion canal thoracique – Lesion a. vertébrale – Brèche Dure Mère
  63. 63. Les complicaJons •  de la voie d’abord antérieure
  64. 64. Les complicaJons •  de la voie d’abord postérieure – Akeinte visuelle •  ION: neuropathie opJque ischémique •  Occlusion artère réJenne centrale – Déplacement du tube en flexion – Artère vertébrale – Brèche DM – MalposiJon des implants
  65. 65. Les complicaJons •  les lésions neurologiques –  Akeinte C5: 5% –  Médullaire
  66. 66. Les complicaJons •  de l’arthrodèse •  du site de prélèvement de la greffe
  67. 67. Imagerie 3D per op
  68. 68. Imagerie 3D per op
  69. 69. Trouver l’info •  SlideShare: hkp://fr.slideshare.net/MichelTriffaux •  YouTube: hkps://www.youtube.com 25/03/16 Nech4you 04 69
  70. 70. L’info: 25/03/16 Nech4you 04 70
  71. 71. L’info: YouTube 25/03/16 Nech4you 04 71
  72. 72. •  La COMPLICATION à domicile Taux de complicaJons* inférieur en ambulatoire 5,39 % hospi > 3,45% ambulatoire (* tous types confondus) Si complicaJon, elle survient dans les 4-6 h post op. –  HDC: hématome suffocant +/- idem qu’en chirurgie thyroïde, CI 0 à 2,4 % pas de données pour simple HDC 1 niveau Facteurs de Risque: > 50 ans, tabagique, > 2 niveaux brèche durale: 0,1 % La HDC en chirurgie ambulatoire
  73. 73. Merci Dr A Bouras Staff du bloc opératoire Dorcas et Union Staff d’assistance Depuy Synthes Spine

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