A scanographic study of asymmetry of the frontal process of zygoma in unilateral coronal synostosis.

Introduction: Unilateral coronal synostosis (UCS) is a complex craniosynostosis, combining malformations of the upper (frontal bone, orbito-naso-frontal bandeau (ONFB) ) and the middle thirds of the face. In our centre, the surgical correction consists in the repositioning of the ONFB in front of the zygomaticofrontal suture on the affected side. Defects in the corrections have been observed post-operatively for some patients with a persistent asymmetry in the side walls of the orbits.

Surgical guide for the remodelling of the orbito-naso-frontal bandeau in craniosynostosis surgery.

Introduction: Craniosynostoses affecting the forehead sutures can not only cause brain damage, but can also have an esthetic impact, because of the associated orbito-naso-frontal deformations. Reshaping the orbito-naso-frontal bandeau (ONFB) is difficult to appreciate perioperatively and should ideally be customized to each child. The aim of this study was to develop a template to guide the surgeon preoperatively towards an ideal customized remodelling of the ONFB.

[Study of the normality of the orbito-naso-frontal bandeau].

Introduction: Craniosynostoses are cranio-facial malformations affecting about 1/2100 newborns in France. The involvement of anterior sutures (coronal and metopic) leads to orbito-frontal deformities. The treatment calls upon surgery the goal being, on an esthetic point of view, to restore a normal anatomy.

TCF12 microdeletion in a 72-year-old woman with intellectual disability.

Heterozygous mutations in TCF12 were recently identified as an important cause of craniosynostosis. In the original series, 14% of patients with a mutation in TCF12 had significant developmental delay or learning disability. We report on the first case of TCF12 microdeletion, detected by array-comparative genomic hybridization, in a 72-year-old patient presenting with intellectual deficiency and dysmorphism.

[Thoracic spine pseudarthrosis treated by transpleural corporectomy and bone morphogenic protein].

Background And Purpose: Traumatic thoracic spine instability is a rare but difficult-to-treat entity, particularly above T5 where pedicle screwing is widely regarded as an unsatisfactory option and anterior surgery is considered difficult because of the anatomic relationship with the shoulder and large vessels.

Methods: A case of T4 and T5 pseudarthrosis after posterior fixation is reported. It was treated with transpleural corpectomy and fixation, with bone morphogenic protein used to obtain rapid arthrodesis between T3 and T6.

Frontosphenoidal synostosis: a rare cause of unilateral anterior plagiocephaly.

Introduction: When a child walks in the clinic with a unilateral frontal flattening, it is usually associated in our minds with unilateral coronal synostosis. While the latter might be the most common cause of anterior plagiocephaly, it is not the only one. A patent coronal suture will force us to consider other etiologies, such as deformational plagiocephaly, or synostosis of another suture.

Predicting the outcome of shunt surgery in normal pressure hydrocephalus.

We studied retrospectively the effectiveness of the repeated lumbar CSF tap test (RTT), lumbar external CSF drainage (LED) and radioisotope cisternography (RIC) in predicting the outcome of shunt surgery, as well as the diagnostic and prognostic value of periventricular hyperintensity (PVH) and of the classic clinical triad in normal pressure hydrocephalus. Two hundred and seventy patients were referred to the Departments of Neurosurgery, in Nancy, France and in Istanbul, Turkey. The decision to perform surgery was based on the clinical presentation (all patients had at least two symptoms of the classic clinical triad), neuroimaging examinations and the results of the RTT (taps were performed on three consecutive days and at each tap a minimum of 30 to 40 cc of CSF was removed), the LED (drainage was performed for 3 days and the volume of CSF drained daily was a minimum of 150 to 250 cc) or the RIC.

[Prenatal diagnosis and management of a case of rapidly involuting congenital hemangioma. Review of literature].

Rapidly involuting congenital hemangioma (RICH) is a rare vascular lesion, identified in 1996, of elective localization in the dermal-hypodermic tissue. Its name comes from its particular natural course: it is fully developed at birth and then completely involutes, usually in the first year. We present a case of a RICH of the scalp discovered with a screening ultrasonography in the 31st week of gestation.

[Use of polyester urethane (Neuro-Patch) as a dural substitute. Prospective study of 70 cases].

Between October 1995 and March 1998, 70 patients were treated with a microporous polyester urethane dura substitute (Neuro-Patch), after brain or spinal surgery. These patients were assessed clinically and radiologicaly 10 days, 6 weeks and 1 year after surgery. Radiological evaluation used CT scan or MRI.

Hypervascular intracisternal acoustic neuroma.

The diagnosis of acoustic neuroma is usually evoked in a patient presenting with a long history of hearing disturbance in whom an enhancing lesion within the internal auditory canal and/or the cerebellopontine angle is found on MRI. Hypervascularity with arteriovenous shunting and early filling of enlarged veins is a common feature of malignancy and has been reported very rarely in benign acoustic neuroma. We present the case of a patient without hearing disturbance, who showed a highly vascular lesion with no component in the internal auditory canal, making the preoperative diagnosis of acoustic neuroma very challenging.

[Intramedullary spread of a cerebral oligodendroglioma. Two case reports].

We report two cases of leptomeningeal metastatic dissemination to the spinal cord of a grade B oligodendroglioma. Diagnosis was suspected on MRI but imaging findings were nonspecific. The pathways by which the intramedullary part of the spinal is reached by metastatic cells remains controversial.

Primary intracerebral hemorrhages in the Besançon stroke registry. Initial clinical and CT findings, early course and 30-day outcome in 350 patients.

The purpose of this study was to estimate the risk factors, early course, outcome and neuroimaging patterns in primary intracerebral hemorrhages (PIH). Using the Besançon Stroke Registry, 350 patients with first PIH documented by computed tomography (CT) between 1987 and 1993 were included in the present study. Patients with hemorrhage secondary to traumatism, brain tumor, thrombolytic treatment, vascular malformation or with hemorrhagic infarction were excluded.

[Results of cervical interbody fusion with coral grafts].

Objectives: We present the long term clinical and radiological results of a retrospective series of 46 cervical interbody fusions using coral grafts performed in 38 patients.

Material And Methods: The patients were treated for prolapsed discs (19 cases) or cervical spondylosis (19 cases) with a clinical presentation of either radiculopathy (31 cases) or myelopathy (7 cases). We have done a post-operative clinical analysis of cervicoscapulalgia and radiculo-medullary symptoms and a radiological comparison of the change of the cervical spine angulation, the loss of height and the fusion rate at the graft site.

[The posterior cranium and its dysmorphisms].

The deformation of the posterior part of the skull (occipito-vertebral region) induced directly, occurs in numerous pathological situations. Its significance is frequently overlooked. Lesions of the cranial content, alterations of the lambdoid suture or other premature synostosis, abnormal constraint related to posture or to muscular activity can modify the posterior curvature of the skull, generally flattening it.

[Advances in the understanding of the etiopathogenesis of non syndromic craniostenoses and therapeutic approaches].

The treatment of craniostenoses has not been revolutionized over the last decade, but the methods of investigation, particularly 3D CT scan, histological studies, and refinement of techniques, have allowed substantial progress in the understanding of the aetiopathogenesis and treatment of craniostenoses. The deformities of the components of the base of the skull can now be more precisely analysed. The authors present these elements for each of the various types of craniostenosis.

[The posterior part of the skull. Classification of dysmorphism. Original treatment: turned biparietal flap transposition].

The deformation of the posterior part of the skull (occipito-vertebral region), induced directly or indirectly, occurs in numerous pathological situations. Its significance is frequently overlooked. Lesions of the cranial content, alterations of the lambdoid suture or other premature synostosis, abnormal constraint related to posture or to muscular activity can modify the posterior curvature of the skull, generally flattening it.

[Torticollis and C1-C2 rotation subluxation. Apropos of a case. The value of a dynamic scanner and of a 3-dimensional scanner].

The authors report the rare and complex case of a girl who had been followed since the age of 3 years for hydrocephalus the cause of which was found only when she was 6-year old. The causative agent was a pilocytic astrocytoma of the cerebellum. On April 10, 1990, she underwent subtotal excision of the tumour, associated with radiotherapy.

[Cranial asymmetries. Reflexions on plagiocephalies. Premature sutural synostosis or extracranial origin?].

The authors relate a clinical and radiological (X Ray and TDM tridimensional) study with an anthropological (dry skulls) study of plagiocephaly. The aim is to find with the aid of a physical examination, some anatomic parameters which permit to differentiate cranial asymmetry with coronal premature synostotic suture from functional deformation with extracranial outset. The term plagiocephaly is used to define forehead asymmetry.

[Papilloma of the choroid plexus. Apropos of 11 cases].

The authors report 11 cases of choroid plexus papillomas in children operated on from 1979 until 1993. The age ranges from 2 months to 14 years old. The most frequent location occurred in the lateral ventricles (7 cases) followed by the locations in the third ventricle (3 cases) and the fourth ventricle (1 case).