WHO grade II and III meningiomas: a study of prognostic factors.

Meningiomas represent one of the largest subgroups of intracranial tumors. They are generally benign, but may show a histological progression to malignancy. Grades II and III meningiomas have been less well studied and are not well controlled because of their aggressive behaviour and recurrences.

[Spinal dural arteriovenous fistula with peri-medullary venous drainage: analysis of a series from a single centre and review of the literature].

Introduction: The optimal diagnosis and therapeutic managements of spinal dural arteriovenous fistulae, a rare disease, is discussed.

Material And Methods: We report a series of 10 patients seen in a 7-year period, treated by embolization.

Results: There were 6 males and 4 females, with an average age of 58.

Regrowth of residual ruptured aneurysms treated by Guglielmi's Detachable Coils which demanded further treatment by surgical clipping: report of 7 cases and review of the literature.

Object: The management of intracranial aneurysms has truly evolved after the introduction of endovascular treatment by Guglielmi Detachable Coils (GDC). In our department, for every case (ruptured or unruptured aneurysm) we discuss in the first place endovascular treatment. When coiling is feasible, it is done as a first choice.

Computer-assisted resection of supra-tentorial cavernous malformation.

Introduction: Resection of cerebral tumors or vascular lesions requires a precise localization to minimize the skin, bone and cerebral approach. The image-guided surgery is currently considered to be of undisputed value in microneurosurgical technique.

Methods: Between 1998 and 2000, 13 patients were operated in our service for resection of a cavernous malformation deeply located using the MRI assisted image guidance (Sofamor-Danek Neuronavigation Cranial 3 System).

[Comparative study for ruptured aneurysms treated by surgery and endovascular method].

The management of intracranial aneurysms has truly evolved after the introduction of the endovascular treatment. In this paper we compare patients that were operated or embolized for intracranial aneurysms. Between 1995 and 1999, 78 grade I to III ruptured aneurysms were treated in our service: 52 patients were operated, 21 were embolized and 5 were submitted to combinated endovascular and surgical treatment.

[Multiple intracranial and intraspinal meningiomas successively discovered in the absence of neurofibromatosis: 2 cases].

Multiple meningiomas in different neuroaxial compartments are quite rare. We describe the case of a 44-year-old woman who developed three intracranial meningiomas and 8 years later a T3 dorsal meningioma. Histologically, the frontal and dorsal tumors appeared as benign psammomatouss meningiomas.

Recurrent lumbosacral metastases from intracranial meningioma. Report of a case and review of the literature.

We report a case of a 31 year-old woman who in 1991 presented a clinical history of headaches, nausea and vomiting. CT scan showed a right frontotemporal meningioma. The first operation achieved a macroscopically complete resection.

Lack of evidence of osteo-medullary metastases at diagnosis in patients with high grade gliomas.

High grade gliomas usually show a transient response to standard therapy by radiation. A local evolution leads to patient death in most of the cases. Necropsic series suggest that metastatic evolution is rather frequent in lungs, lymph nodes, bones or bone marrow.

[Central nervous system neurocytomas: clinicopathological analysis of tree cases].

Central nervous system neurocytoma is a rare benign tumor of neuronal origin. Because of some clinical and radiological findings CNS neurocytomas were confused with other intraventricular lesions (ependymomas, choroid plexus papilloma, oligodendrogliomas, subependymal astrocytomas). Pathological diagnosis improved with immunohistochemical and electron microscopic studies.

[Moyamoya disease: advantage of early diagnosis and survival treatment. Review of three cases].

A diagnosis of moyamoya disease was made in three children aged five, eight and 13 years (including two Turkish sisters). Clinical presentation was recurrent episodes of cerebral ischemia and stroke. CT scans and MRI showed infarcts in various distributions.

Reflections on the management of cerebral arteriovenous malformations.

Background: The authors report their personal experience in the management of cerebral arteriovenous malformations (AVMs), using the three techniques now available: surgical resection, endovascular embolization, and radiosurgery. They review the recent literature on this topic and present their current management algorithm based on this experience.

Methods: A series of 90 patients treated for cerebral AVMs is reported (68% Grade I-III and 32% Grade IV-V, Spetzler scale).

The role of Linac radiosurgery in multidisciplinary management for cerebral arteriovenous malformations: personal experience.

The authors analyze their personal series of 90 patients with cerebral arteriovenous malformations (AVMs) concerning the place of radiosurgery (RS). Out of the 90 patients, 34 undervent Linac RS-RS was used as single treatment (17%) or in combination with embolization or surgery (21%.) Eradication rate assessed angiographically after 2 years was 89%.

Stereotactic radiosurgery for arteriovenous malformations of the brain using a standard linear accelerator: the Lyon experience.

Radiosurgery (RS) was initiated in Lyon in October 1989. The technique was adapted from that described by Lutz and Saunders in Boston (BRW stereotactic frame). Irradiation is delivered with 18-MV photons produced by a LINAC.

Management of unruptured cerebral aneurysms.

A series of 62 patients treated surgically for one or several unruptured intracranial aneurysms is reported. 83 aneurysms were treated in 65 operations. The main locations of the aneurysms were: MCA 35%, ICA (posterior communicating) 22%, carotido-ophthalmic segment 12%, carotid bifurcation 11%, anterior communicating artery 11%, verterbro basilar artery 5%.

[Therapeutic risk in multidisciplinary approach of cerebral arteriovenous malformations].

Patients And Techniques: A series of 67 patients treated for cerebral AVMs using a multidisciplinary approach is reported, paying special attention to the complications due to treatment. The malformations were classified according to the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique).

Complications after multidisciplinary treatment of cerebral arteriovenous malformations.

Patients And Techniques: A series of 67 patients treated for cerebral AVMs with a multidisciplinary approach is reported, with special attention for the complications due to treatment. The malformations were classified after the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique).

Multidisciplinary treatment of cerebral arteriovenous malformations.

A series of 67 patients treated for cerebral AVM with a multidisciplinary approach is reported. The malformations were classified after the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique).

Level of consciousness and age as prognostic factors in aneurysmal SAH.

The prognostic value of the level of consciousness and the patient's age for the outcome of aneurysmal subarachnoid haemorrhage (SAH) is studied in 74 patients admitted on day (D) 0 to D3 after aneurysm rupture. For the level of consciousness three groups of patients are compared: grade I+II (alert patients), grade III+IV (drowsy patients), and grade V (comatose patients). For the age, two groups are compared: patients aged under 50, and patients aged 50 and over.

The use of Teflon as wrapping material in aneurysm surgery.

Even if clipping is the ideal and only complete treatment of the intracranial aneurysm, wrapping is a well-known alternative technique when aneurysm clipping is not feasible, or is not completely satisfactory. We present a technique of wrapping using fibres of Teflon material shaped in strings or in pledgets, arranged on or around the area to be treated and fixed by fibrin glue. This Teflon technique was used during the years 1990 to 1992, in 44 treated aneurysms (33% or all aneurysms treated during the same period), and in 3 situations: 1) to reinforce a residual or additional ectasia next to the clipped aneurysm, usually proximal to the clip (25 cases, i.

Long term outcome after treatment of the ruptured intracranial aneurysm: 73 cases admitted from day 0 to day 3 after subarachnoid haemorrhage.

73 patients admitted from day 0 to day 3 (D0 to D3) after a subarachnoid haemorrhage and being in Hunt and Hess grades I to IV after aneurysm rupture, were studied. All admitted patients were operated upon. The timing of surgery was neither systematic early nor systematic late surgery, but modulated surgery.

Prognostic value of the Spetzler's grading system in a series of cerebral AVMs treated by a combined management.

The prognostic value of the Spetzler's grading system is studied in a series of 52 AVMs treated by a combined management, using one or several of the 3 available techniques: surgical resection, endovascular embolization, radiosurgery. The symptoms at the time of treatment were haemorrhage 50%, seizures 31%, headache and deficit 19%. Three grade groups were considered: I and II (31%), III (33%), IV and V (36%).

Medulloblastoma in adults: survival and prognostic factors.

The authors report a series of 30 adults with medulloblastoma treated after surgery between 1975 and 1990. Half the patients presented a classical medulloblastoma and the other half presented desmoplastic medulloblastoma. Brainstem infiltration was noted in 3 patients, cerebellar peduncle infiltration in 6 cases and 4 patients had cerebrospinal fluid (CSF) involvement.

[Teflon wrapping in cerebral aneurysm surgery. A technical note].

Wrapping is a well-known alternative technique when clipping the aneurysm is by no means possible or when it seems necessary to complete an imperfect clip. In 22 operated cases of intracranial aneurysm, we recently experienced pledgets of Teflon arranged and then fixed by drops of fibrin sealant. We used this technique in the following operative circumstances: to reinforce the ectatic base of the clipped aneurysm (11 cases); to wrap a pre-aneurysmal ectasia distant from the ruptured aneurysm (5 cases); to minimize the compression due to the clip to an adjacent cranial nerve or artery (6 cases).

The combined management of cerebral arteriovenous malformations. Experience with 100 cases and review of the literature.

A series of 100 patients treated for a cerebral arteriovenous malformation (AVM) is presented. Patients were admitted between 1985 and April 1992. Two groups are considered: the first group including 52 patients treated before the availability of radiosurgery (1985-1988), and the second group including 48 patients treated after the availability of radiosurgery (1989-1992).