[Cerebral tumors and pregnancy. Apropos of 8 cases].

Pregnancy is an aggravating factor for brain tumours on which it acts by three mechanism: acceleration of tumour growth, increase of peritumoral oedema and the immunotolerance to foreign tissue antigens that is proper to pregnancy. Histologically, the brain tumour most frequently encountered is glioma, usually revealed during the third trimester. Brain tumours is pregnant women have no special clinical features, and their diagnosis rests on computerized tomography or nuclear magnetic resonance completed, if required, by stereotactic biopsy.

[Natural history and spontaneous prognosis of cerebral arteriovenous malformations].

Eight large series of patients presenting with untreated cerebral arterio-venous malformations (A.V.M.

[Hydrocephalus with cerebrospinal fluid shunts and pregnancy: 2 cases].

During pregnancy 50% of all cases with a ventriculo-peritoneal shunt malfunction. This is because of anatomo-physiological changes associated with the pregnant state, and shows itself as a rise in intracranial tension. There were no acute neurological complications at term; with the malfunction of the shunt distally, vaginal delivery is preferable.

[Cerebral aneurysms and pregnancy: 4 cases].

Haemorrhagic cerebral accidents are the commonest neurosurgical diagnoses made in pregnancy. The state of pregnancy makes it more likely that an arterial or an arteriovenous aneurysm will rupture and this is the principal cause of most haemorrhages. They occur more often in primiparae in the third trimester of pregnancy.

[Importance of the study of the cytology and proteins of the spinal fluid in lumbago].

In the cerebrospinal fluid (C.S.F.

[Management of meningeal hemorrhage for angiographic evaluation].

Perfect immobilization of the patient is mandatory when performing cerebral angiography. It allows good analysis and diagnosis of arterial or arterio-venous malformations. Neuroleptanalgesia or general anesthesia are currently used.

[Stereotaxic technics in expanding lesions of the brain stem].

Stereotactic biopsies, according to the Talairach's system, define the histopathological data (nature, grading, spatial delimitation, evolutive potential) of brain stem lesions, precisely localized by computerized tomography scanner and magnetic resonance imaging. They are the more valued complement of the modern neuro-imaging and they prove the extreme polymorphism of theses lesions. According to this histological analysis and the volume of the lesions, it's possible to choose the best therapeutic procedure.

Management of focal intracranial infections: is medical treatment better than surgery?

Three groups of patients with single hemispheric brain abscesses or subdural empyemas, from 1 to 5 cm large, with similar initial prognosis, have been treated either by medical treatment alone (20), aspiration (21), or excision (15). Differences in survival were not found, but medical treatment alone was better for long term sequelae. Surgical procedures (either aspiration or excision) were better for both isolation of the organism and the hospital stay before discharge.

[Clinical course after surgery of aneurysms of the anterior communicating artery].

The evolution and correlations between initial state and outcome (one year) are analysed in 81 patients with anterior cerebral artery aneurysm. The age and initial evaluations are seldomly correlated with late evaluations, Jennett and Holbook scales, frontal syndrome, amnesia. The evaluations at one month are very significantly correlated to the late evaluations.

[Natural history and current surgical prognosis of intracranial arterial aneurysms].

The abrupt flow of blood in the meninges or in the brain after fissure or rupture of an arterial aneurysm still remains a medico-surgical emergency which includes the mobilisation of important technical and financial means which justifies itself by the reduction of the occurrence of a more severe accident and to give the patient its best chances. The cure of a cerebral aneurysm and its intracranial consequences must not be dissociated from its clinical context. Surgical indication must take into account the cause of the vascular lesion, the background on which it has evoked, its natural outcome which is characterised by rebleeding and vasospasm.

[Cellular kinetics of cerebral glioma: study of the proliferative activity using monoclonal antibody Ki 67. Apropos of 60 cases].

The monoclonal antibody Ki 67 is able to detect a nuclear antigen expressed by proliferating cells during the cellular cycle (phase G1, G2, S and M). It is used as a marker of the proliferative activity of 60 cerebral gliomas including 41 biopsied under stereotaxic conditions. The immunocytochemical study performed with the peroxidase antiperoxidase technique on crushed and smeared fresh tumors, permit to define a nuclear marking index for each tumor.

[Rhythmical myoclonus and tremor at rest disclosing mesencephalic metastasis].

We report a case in which rhythmical myoclonus and tremor at rest revealed a thalamo-subthalamic metastasis from a bronchial carcinoma. Tremor of the upper limbs and face (4 Hz) disappeared with sustained posture and action. A cogwheel phenomenon, hypotonia and disorders of automatic and voluntary movements were also present.

[Surgical treatment of lumbar foraminal disk herniation. Value and indications for an interlaminar and extra-articular combined approach].

From 62 foraminal herniations seen over 2 years, the authors present a series of 22 lumbar foraminal disc herniations operated on by a combined interlaminar and extra-articular approach. After describing the technique the results are analysed. The objective of the combined approach is to provide satisfactory foraminal liberation without damage to the articular structures.

[Automatized percutaneous nucleotomy in lumbar disc pathology].

The authors report on percutaneous automated lumbar discectomy for lumbar diks herniations. They discuss its advantages and inconvenients in front of non automated technics.

[Secondary and late development of hematoma of the brain stem].

The functional and social outcome in 15 patients with brainstem hematomas surviving on the 15th day is reported. At the end of the first year post stroke, the main neurological deficits were sensory, postural and paresis of the 6th and 7th cranial nerves. This resulted from the preferential location of the lesions in the lateral and posterior pons.

[Problem of the preservation of hearing in acoustic neuroma. Value of the mixed supra petrous and retrosigmoid approach].

The authors described their experience of the possibilities of preservation of hearing on the basis of a series including approximately 180 acoustic neurinomas. Whilst the initial experimental approach involving the use of a sub-occipital approach in seated position was abandoned, in view of the risk of complications inherent to the use of this approach, the authors progressively developed the possibility of the preservation of hearing by a retro-sigmoid approach in horizontal position as described in France by Bremond, Magnand and Garcin, and taken up subsequently by Sterkers. Currently, a retro-sigmoid approach is used combined with a classical supra petral approach which can be used in all cases to assess the tumour at the base of the internal auditory meatus and identify the position of the facial nerve.

[Anterior decompression and spinal stabilization in the treatment of dorsolumbar metastatic compression].

The authors report their experience of the postero-lateral approach for the treatment of thoraco-lumbar spinal metastasis with anterior decompression and osteosynthesis. They stress the progress in the surgical technique which is designed to have a direct effect on osseous posterior wall compression with a more effective osteosynthesis to allow an immediate mobilization.

Discectomies of the lower cervical spine using interbody biopolymer (B.O.P.) implants. Advantages in the treatment of complicated cervical arthrosis. A review of 150 cases.

The authors report their experience with 150 cases of discectomies performed with interbody grafts using a copolymer (Biocompatible Orthopedic Polymer or BOP). Made of N-Vinylpyrrolidone-Methylmethacrylate monomers, polyamide fibres and calcium gluconate. BOP is a biocompatible, biodegradable, osteoconductive matrix, easy to use and quite safe.

[Recurrent meningitis, hydrocephalus and tegmen tympani dehiscence].

Cerebrospinal fluid (CSF) otorrhea is the usual presenting symptom of spontaneous tegmen tympani defects. A case associated with recurrent meningitis and CSF rhinorrhea without otorrhea is described. The coexistence of an hydrocephalus had led initially to ventriculoperitoneal shunting, which did not prevent meningitis recurrence.

[Treatment of severe postoperative infections in head surgery. 20 cases].

The authors report the management and follow-up of 20 patients with severe postoperative intracranial infections, abscesses and/or empyemas. Clinical neurological diagnosis was difficult in patients with deficits resulting from the first operation but over half the cases had an inflammatory reaction in the operated zone. CT scan showed that the infection was not limited to a single site (e.

[Treatment of osteo-dural injuries of the anterior segment of the skull base through the trans-lesion approach. Apropos of 25 cases surgically treated by a dual neurosurgical and maxillofacial team].

The authors describe a technique of mobilisation of the frontal sinus using the fractures of anterior and posterior walls. The translesional approach is adapted to cranio-facial borders surgery of traumatisms. It's a skull base approach which minimizes the cerebral retraction and enables or perfect viewing of the top of the ethmoid.

[Cervical melanotic neurofibroma. Apropos of a case and a review of the literature].

The authors report a case of cervical melanotic neurofibroma hour glass shaped, growing in the extra and intradural spaces. Melanotic aspect of spinal neurofibroma are rarely reported in the literature. Various etiopathologies have already been discussed.