Astereognosis and amyotrophy of the hand with neurinoma of the second cervical nerve root.

A case of astereognosis and amyotrophy of the right hand is reported, which was caused by a large extradural neurinoma of the C2 nerve root. The quick and complete recovery which followed surgery suggested a vascular mechanism as the cause of the neurological deficits.

Bilateral spontaneous dissection of extracranial vertebral arteries.

A previously healthy 35-year-old man suddenly developed vertebrobasilar ischaemia while playing tennis. Cerebral arteriography revealed a dissecting aneurysm of the cervical portion of both vertebral arteries. The neurological deficit and the angiographic features resolved with anticoagulant treatment alone. Only 15 patients with non-traumatic extracranial vertebral artery dissection have been previously reported. It is necessary to recognize the condition very quickly, because the authors consider that anticoagulation is required as an emergency.

[Balint syndrome as a result of a biparietal infarct. Neuropsychological analysis]. / Syndrome de Balint par infarctus biparietal analyse neuropsychologique.

A case of Balint syndrome with bilateral parietal infarction is presented. Analysis shows the tight intrication of visual inattention and psychic gaze palsy. The deficit of visuo-manual adjustment is characterized by a fixed divergence between the target and the point where the patient places his hand, either in ballistic movements (classical optic ataxia), either in pursuit movements; for this reason, a simple disconnexion should not explain the classic optic ataxia. The discretion of aphasia allows the individualization of an anterograde and partially retrograde amnesia.

[Post-traumatic retrograde amnesia]. / Amnesie retrograde post traumatique.

A case of post traumatic retrograde amnesia is described. The patient presented after an initial coma a global amnesia, but the fixation deficit rapidly disappeared, and a severe retrograde amnesia dating back to childhood experience and learning remained the main symptom. Amnesia for remote events was associated with didactic memory deficit and, at a lesser degree, with a verbal memory deficit. Recovery of fixation allowed a progressive relearning. This pattern of impairment was recently related to mesencephalic lesions, but we think that the role of temporal lobe involvement cannot be neglected.

[Evaluation of the amnesia caused by restricted thalamic infarcts--6 cases]. / Bilan de l'amnesie des infarctus thalamiques restreints--6 cas.

The amnesic syndrome is analysed in 6 infarctions restricted to the thalamic area. Bilateral lesions were linked to more definite deficits; the anterograde forgetting was unequivocal at the initial stage and affected both verbal and visual memory. In unilateral lesions, deficits were far more discrete and there was no evidence enough for assuming a strict hemispheric specialisation, left for verbal memory, and right for visual memory. These cases and others from the literature suggested that amnesia is more important and pure in infarctions of the anterior part of the thalamus.

Foraminal cervical herniated disc treated by anterior discoforaminotomy.

The authors report their experience with cervical foraminal disc herniation. The importance of the computed tomographic scan in its diagnosis is emphasized, and discoforaminotomy is described.

Anterior approach and osteosynthesis for recent fractures of the pedicles of the axis.

The authors report their experiences using the anterior approach and osteosynthesis for recent fractures of the pedicles of the axis in eight patients. They describe the transcervical transclival approach and osteosynthesis and discuss the advantages of and indications for this approach.

"Pseudotumoral" cystic cerebellar infarction with slow evolution.

A 63-year-old female patient presented with cerebellovestibular symptoms and posterior headaches. The onset of the symptoms was sudden, and the neurological condition slowly worsened over a 5-month period. It was found that she suffered from a cystic infarction of the cerebellar lobe, with subsequent hydrocephalus. This case and two others discovered in the literature argue for the recognition of a slowly evolving, cystic form of cerebellar infarction that calls for a direct surgical approach.

An intramedullary ependymal cyst in a 71-year-old woman.

An intraspinal ependymal cyst of the thoracolumbar spinal cord was found in a 71-year-old woman with a history of right side abdominal pain since the age of 18. The late discovery of the cyst is related to the extremely slow evolution of this type of cyst in the absence of spinal trauma. Etiopathogenic problems are discussed after a review of the literature.

Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas.

Seven cases of frontotemporosphenoid meningioma are reported. The principles of the orbitofrontomalar approach and of reconstruction of the orbital cone and of the frontomalar region with an orbitotemporal prop are discussed.

Intradural rupture of lumbar intervertebral disc: report of three cases with review of the literature.

The intradural herniated disc is a rare complication of disc herniation. A study of the literature shows that this location is often responsible for severe neurological deficit with loss of sphincter control and a complete block shown on the myelogram. We report three cases to demonstrate the radioclinical interpretation of intradural herniated disc and the possibility of definite and misleading symptoms.

Developments in the treatment and prognosis of multiple cerebral abscesses.

Multiple cerebral abscesses have been recognized with increasing frequency because of the use of computed tomography and have been the subject of various therapeutic proposals. Their prognosis has been considerably improved thanks to high dose antibiotic therapy. However, diagnostic and therapeutic problems persist.

Anterointernal approach to the lumbar spine: technical note.

Lumbar surgery is currently benefiting from the development of anterior approaches to the spine and the possibilities of anterior arthrodesis. The transperitoneal approach is being replaced more often by an extraperitoneal approach that enables anterior access to the spine. The authors report an anterointernal approach to the lumbar spine.

Use of Harrington rods with segmental wiring for spinal pathology. Technical note.

The Authors report their experience using Harrington rods with segmental wiring for spinal pathology. They describe the advantages of this technical point in neoplastic and traumatological dorsal compression.

Direct microsurgical approach to intracavernous tumors.

Tumors that are strictly intracavernous remain rare and their management is a subject of controversy. The authors describe the direct surgical approach to these lesions and consider this approach necessary to determine the exact nature of the intracavernous process. The subsequent treatment, radiotherapy in particular, will depend on this assessment.

Posterolateral approach to thoracic disk herniations through transversoarthropediculectomy.

The authors describe an approach by transversoarthropediculectomy in three cases of herniation of thoracic disks. The technique permits the initial approach to locate the vasculoneural elements and leaves these intact. We underline certain rules: osteotomy of the vertebral bodies located above and below, possible laminectomy after excision of the herniated disk fragment, and posterior osteosynthesis.

Prognosis with 500 ruptured and operated intracranial arterial aneurysms.

Based on a series of 500 operated intracranial aneurysms in 486 patients, we have analyzed the results of current neurosurgical treatment. The overall results (75% cures, 13% poor results, 12% deaths) depend on several factors, which have all to be analyzed: the age and general condition of the patient; the topography and mode of rupture of the aneurysm; and the timing of the surgical intervention.

Prognosis for arteriovenous malformations of the brain in adults based on 150 cases.

Arteriovenous malformations of the brain generally make their presence felt before the age of 40 through cerebromeningeal hemorrhage (83 cases) or epilepsy (47 cases). In our series, 128 patients were operated upon and total resection of the malformation was performed on 119 occasions. The operative mortality rate was 12.5% and there were 70.3% good results from a long-term point of view. The essential benefit from surgical treatment is the elimination of the risk of hemorrhage. The effect on epilepsy is much less, and the natural development of nonhemorrhagic forms is not unfavorable over the long term. The prognosis for surgical treatment is linked to the size and the topography of the malformation, the number and the origin of the arterial afferent vessels, and, above all, to the mode of drainage into the venous system that may be malformed.

Transcervical approach and screw fixation for upper cervical spine pathology.

The authors report on the use of transcervical approach and screw fixation for upper cervical spine pathology. They describe the direct osteosynthesis for odontoid fractures and atlantoaxial fixation using a screw fixation of the articular processes. The surgical technique is described and its advantages and disadvantages are discussed as are its indications.

A transsternal biclavicular approach to the upper anterior thoracic spine.

A transsternal biclavicular approach to the anterior face of the upper thoracic spine (T-1 to T-4) is described, and the advantages, disadvantages, and indications of the technique are discussed.