Intra-operative neuromonitoring of the vagus nerve during thyroidectomy. A prospective study.

OBJECTIVES: To determine whether intra-operative neuromonitoring (IONM) of the vagus nerve during thyroidectomy can predict postoperative vocal fold palsy. DESIGN: A single-centre, prospective study. SETTING: University Hospital. PARTICIPANTS: A total of 95 patients underwent thyroid surgery. A total of 160 vagus nerves were studied. The amplitude of the action potential of vocal muscles was recorded intra-operatively by indirect supramaximal stimulation of the vagus nerve. All patients underwent flexible fibre-optic laryngoscopy on postoperative day 1 to detect the presence of vocal fold palsy. MAIN OUTCOME MEASURES: The primary outcome measure was the difference of the action potential amplitude of the vagus nerve before and after resection of the thyroid lobe. Statistical analysis determined the amplitude variation cut-off able to accurately predict postoperative vocal fold palsy. RESULTS: Transient vocal fold palsy was observed in 4.375% of cases, and permanent fold palsy was observed in 1.25% of cases. A decrease of the action potential amplitude by more than 61% was statistically significantly associated with postoperative vocal fold palsy. A greater than 87% decrease of the amplitude of the action potential was correlated with permanent postoperative vocal fold palsy. CONCLUSION: IONM of the vagus nerve during thyroidectomy may accurately predict postoperative vocal fold palsy.

[Diffuse cervical cellulitis and descending mediastinitis]. / Cellulites cervicales diffuses et cellulites cervico- médiastinales.

PURPOSE OF THE STUDY: The principal objective is to evaluate the circumstances of diagnosis and the treatment of cervical cellulitis and descending mediastinitis. MATERIAL AND METHOD: It is about a retrospective study concerning ten patients, hospitalized between January 2000 and July 2011 in the University Hospital of Amiens for cervical cellulitis and descending mediastinitis, included according to Estrera's criterion. RESULTS: The starting point was oropharyngeal (tonsillitis) in 70% of the cases. The three main germs were Streptococcus spp, Streptococcus milleri and Prevotella spp. The diffusion of the infection was done mainly by retropharyngeal way. 70% presented a mediastinitis associated to cellulitis. All the patients were operated by cervical approach, two profited from an associated thoracic way. Only four patients did not have any complication of their cellulitis. One patient died. CONCLUSION: The early diagnosis of this pathology proves to be of primary importance. The treatment must be "aggressive". The drainage of mediastinitis proves to be sufficient by trans-cervical way in the event of the involvement of the higher part of the mediastinum (mediastinitis Endo type I) whereas a thoracotomy appears essential in the event of involvement beyond the carina (mediastinitis Endo type II).

The circumstances in which recurrent laryngeal nerve palsy occurs after surgery for benign thyroid disease: a retrospective study of 1026 patients.

OBJECTIVE: To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery. METHODS: This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study. RESULTS: With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors. CONCLUSION: Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.

[Sinonasal cavities: CT imaging features of anatomical variants and surgical risk]. / Cavités sinusiennes de la face: aspect scanographique des variantes anatomiques et leur risque chirurgical.

Anatomical variants of the sinonasal cavities are common. About 15 major variants are described (nasal septal deviation is present in up to 62% of the population). Because the may lead to complications at the time of endovascular procedures or endoscopic sinonasal surgery (vascular, nervous, or osseous injury), there detection has medicolegal implications. Knowledge of anatomical variants by radiologists and ENT surgeons is thus required. We will describe these variants, their imaging features, frequency, implications and associated risk of potential complication.

[Cervical lymph node tuberculosis: diagnosis and treatment]. / Tuberculose lymphonodale cervicale: prise en charge diagnostique et thérapeutique.

OBJECTIVES: The purpose of this study was to evaluate the advantages of surgery for diagnosis and treatment of cervical lymph node tuberculosis. MATERIAL AND METHODS: This was a retrospective study from 1st January 1998 to 31st December 2007 including 30 patients with cervical lymph node tuberculosis. The population included 60% autochthones with a mean age of 47.1 years and a female predominance (73.33%). RESULTS: The lymph nodes were most often supraclavicular, unilateral, firm, and a mean 3 cm at its largest span. Lymph nodes were excised for diagnosis in 22 patients, which demonstrated specific granulomatous and giant cell lesions with caseous necrosis in 21 patients out of 22. Five abscessed adenopathies required surgical drainage, and three cases required repeated lymph node cleaning after well-conducted medical treatment. CONCLUSION: Surgery retains an important place in the diagnosis and treatment of cervical lymph node tuberculosis.

[Postoperative complications in total thyroidectomy for Graves disease: comparison with multinodular benign goiter surgery]. / Complications postopératoires dans la thyroïdectomie totale pour maladie de Basedow: comparaison avec la chirurgie des goitres non basedowiens.

OBJECTIVES: To study and compare postoperative complications of total thyroidectomy for Graves disease and multinodular benign goiters. MATERIAL AND METHODS: A retrospective study on 176 patients (37 with Graves disease and 139 with multinodular benign goiters) over a period of 41 months was conducted. Postoperative calcemia and laryngeal palsy as well as hemorrhagic and infectious complications were studied and statistically compared using the Kruskal-Wallis test. RESULTS: There was no statistical difference concerning the occurrence of postoperative laryngeal palsy, hypoparathyroidism or hemorrhagic complications between these two groups of patients. Only a more frequent immediate postoperative hypocalcemia (day 1) in the Graves disease group was found. CONCLUSION: Total thyroidectomy in the surgical management of Graves disease, after a cautious medical preoperative preparation, appears to be a safe technique. Total thyroidectomy must be performed instead of subtotal thyroidectomy in order to avoid recurrences.

[Scintigraphy in staging upper aerodigestive tract epidermoid carcinomas]. / Scintigraphie osseuse dans le bilan d'extension des carcinomes épidermoïdes des voies aérodigestives supérieures.

OBJECTIVES: To determine the value of technetium-99m bone scintigraphy in the screening of bone metastases in the systematic initial extension assessment of upper aerodigestive tract suamous cell carcinomas; to identify risk factors of these bone metastases for better screening. MATERIAL AND METHODS: In this prospective study, the initial assessment of tumoral extension was systematically associated with bone scintigraphy. Only patients with no malignant tumors were included in the study. Any skeletal fixation identified was then analyzed with standard radiography and/or tomodensitometry and with the patient's clinical progression to confirm whether or not the fixation was metastatic. The sensitivity and specificity of bone scintigraphy was then calculated. A correlation between bone pain or hypercalcemia and confirmed bone metastases was also systematically sought to determine whether these factors were predictive of bone metastases so as to better target the screening. RESULTS: Among the 55 patients included in the study, three had confirmed bone metastases. All were detected by the bone scintigraphy, with a sensitivity of 100%. However, the 20 false-positive results gave a low specificity of 62%. Bone pain was described by two patients, but they were among the three metastatic patients. Specificity was 100%, but the sensitivity was only 67%. Three patients had hypercalcemia: the three metastatic patients. The sensitivity and specificity were 100%. In the tumoral status of the three patients with bone metastasis, tumors were small, classified as T1 or T2, but with substantial node involvement, classified N3, and with invasion of the internal jugular vein in two cases. CONCLUSION: The incidence of bone metastases in the initial extension assessment was low; consequently, they are not sought systematically. However, their presence radically changes the prognosis and the therapeutic management, raising the question of screening. The technetium-99m bone scintigraphy has limits, with many false-positive resulting the need for additional investigations. Defining the risk factors for bone metastases would improve screening. Two questions remain: what factors are involved? The bone pain and the hypercalcemia must be analyzed with a larger number of cases, but they seem to be nonspecific. The node involvement stage could be a more reliable parameter, in particular in cases of jugular vein invasion; what method should be used? In the future, the PET scan could be the key procedure not only in the locoregional extension assessment, but also for general extensions, in a single procedure investigating the whole body.

[Post-operative complications and predictive factors in a series of 117 total thyroidectomies for substernal goiter]. / Complications post-opératoires et facteurs prédictifs dans une série de 117 thyroïdectomies totales pour goitre cervico-thoraciques.

OBJECTIVE: The recurrential nerve palsy (RNP), the hypocalcemy and bleeding are traditional complications of the thyroid surgery. The objective is to bring back the postoperative rates of complications and to compare them with the patient's history and the goiter features (CT-scan extensions and weight) in order to identify predictive factors of these complications. PATIENTS AND METHOD: One hundred and seventeen patients with a goiter below the subclavicular vessels on the cervicothoracic CT-scan and with a benign extemporane histopathology were operated between february 1997 and January 2004 and included in this retrospective study. The initial clinical assessment reports the respiratory and digestive functional signs, researches a palpable mass and studies the mobility of the vocal folds. The post-operative complications rates (RNP hypocalcemy and bleeding) are analyzed according to the patient's history and the goiter extensions in order to correlate these factors with the complications occurence. RESULTS: Five unilateral RNP occurred and two of them remained permanent, particularly for patients with thyroid surgery history (NS). The right/left or anterior/posterior extensions did not seem determining factors. Nevertheless the volume of the goiter suspected by the tracheal latero-deviation seems to play a role but without statistical confirmation. Among the thirty-four hypocalcemies, six were defined like permanent, without correlations with the surgical history nor the systematic identification of parathyroid glands. The volume and the younger age of the patient tend nevertheless to support the hypocalcemy. Three post-operative bleeding cases were reported, which one needed a reoperation, with a correlation with thyroid surgical history. None the factors among volume, extension or the age of the patient seem to play a role. CONCLUSION: The cervico-thoracic CT-scan is essential since echography does not manage to identify the lower pole of the gland. It helps to define the goiter and to analyze its extensions, very usefull to predict surgical difficulties in the preoperative information of the patient. Complications occurrence seems related on the volume and the thyroid surgical history.

[The emergency in the management of sudden hearing loss; still of present interest? A study of 109 cases of sudden deafness]. / L'urgence dans la surdité brusque, est-elle toujours d'actualité? Etude a propos de 109 surdités brusques.

UNLABELLED: The emergency in the treatment of sudden hearing loss. A controversial dogma? OBJECTIVE: Does the delay in instigation of treatment in cases of sudden hearing loss affect the outcome? MATERIAL AND METHOD: 109 patients were included in this study. Sudden hearing loss is a much discussed subject in the literature. The authors agree on the concept of therapeutic emergency. This retrospective study aims to analyze the value of precocity in starting treatment on hearing improvement. RESULTS: The therapeutic time delay does not appear to be a significant factor and sheds doubt on the rule of therapeutic emergency. CONCLUSION: The authors remain nevertheless prudent on these conclusions. A larger number of cases should be studied. The question of a national versus placebo study is also laid.

Cardiovascular risk and severity factors in patients admitted to hospital for spontaneous epistaxis.

OBJECTIVES: To assess the role of cardiovascular risk factors, intake of drugs altering hemostasis and severity signs in patients admitted with spontaneous epistaxis. MATERIAL AND METHODS: A single-center retrospective study covering a 7-year period in a university hospital center included 205 patients admitted with spontaneous epistaxis. Study variables comprised: cardiovascular risk factors (cardiovascular disease or history of cardiovascular disease with hemorrhagic or thromboembolic risk, high blood pressure, type-2 diabetes, dyslipidemia), intake of drugs altering hemostasis, blood pressure and minimum hemoglobin level during hospital stay. Groups of serious and non-serious epistaxis were distinguished. RESULTS: There were no significant inter-group differences for mean age, sex ratio, history of high blood pressure or number of cardiovascular risk factors. Serious epistaxis was associated with significantly lower blood pressure and hemoglobinemia. Number of cardiovascular risk factors correlated with probability of blood transfusion. CONCLUSION: The real influence of the various study factors, including severity factors, on onset of spontaneous epistaxis remains to be elucidated.

Subjective voice assessment after thyroid surgery: a prospective study of 395 patients.

BACKGROUND: Total thyroidectomy has become a routine surgical procedure. However, postoperative complications are not rare and can lead to voice disorders. AIM: To study voice quality after total thyroidectomy. SETTINGS AND DESIGN: Prospective study over a period of 5 years in 395 surgical patients undergoing total thyroidectomy. MATERIALS AND METHODS: The voice quality of patients was based on systematic preoperative and postoperative laryngeal and voice examination. Voice assessment was performed by means of a voice quality questionnaire and recovery time within 12 months postoperatively. Patients who had inferior laryngeal nerve palsy were excluded from the study. RESULTS: Preoperative subjective voice disorders were found in 21% of patients and 49% had voice impairment after surgery. The recovery time was less than 1 month for one-half of the patients with impaired voices and 85% of the patients had recovered their voice after 5 months. At the 1-year postoperative examination, the permanent impaired voice rate was 1.26%. CONCLUSION: Voice impairment is common after thyroidectomy but usually transient and less than 20% persist at 6 months. Patients must be informed about the risk of voice impairment after thyroid surgery. An objective voice assessment is desirable to monitor the presence and progress of voice disorders.

[Informing patients in otorhinolaryngology: legislation, jurisprudence, and incidences in practice]. / L'information des patients en ORL: législation, jurisprudence et incidences sur les pratiques.

The law of March 4, 2002 is the pedestal of legal responsibility in medicine in France. This law resumed data stemming from the jurisprudence but innovated also by establishing for example the "confidant" person and the direct access of the patient to his medical file. This law established or strengthened the rights of the patients: respect for dignity, respect for refusal of care, right to end-of-life care, right to adequate analgesia, right to the respect for professional confidentiality but also right to the information. The obligation of information is justified by the respect for the autonomy of the patient and by the necessity of obtaining a free and lit assent. Information is not only a preliminary to the medical act; it has to be done before, during and after. In case of complication, it will be reinforced. The information has to deal with the necessity of the medical act, the expected benefits, the possible urgency, the consequences, the normally predictable frequent or severe complications, the alternatives and the predictable consequences in case of refusal. The oto-laryngologist can refuse to perform an act prescribed by a colleague that he considers useless or too dangerous as compared to the benefit expected. The surgical oto-laryngologist in private practice has to prove that he informed his patient and it is his (compulsory) malpractice insurance that financially compensates the patient in case insufficient information leads the patient to lose his or her chance to refuse treatment. If the surgical oto-laryngologist practices in a public hospital, the establishment has to bring this proof of sufficient information, and in case of litigation, the hospital must provide compensation. One will note that the more difficult it is to justify the medical act, the less the judges tend to tolerate insufficient patient information. If the indication of the act is indisputable from a medical standpoint, then legally there is usually no ground for litigation due to insufficient information except possibly emotional damage.

[Peritonsillar abscesses (quincy)]. / Phlegmons péritonsillaires.

OBJECTIVES: To study the circumstances of diagnosis, the supporting factors, the bacteriology, and the therapeutic management of peritonsillar abscesses (quinsy). MATERIAL AND METHODS: This was a retrospective study over a period of 10 years in 98 patients hospitalized in an ENT and Head and Neck Surgery department for peritonsillar abscess. RESULTS: Ninety percent of cases of peritonsillar abscesses complicated angina. Forty-nine percent of patients had no previous antibiotic therapy, 9% had a previous history of peritonsillar abscess, 62% were treated in the emergency department, and fever was present in 64% of cases. The diagnosis was clinical in 98% of cases. The average hospitalization stay lasted 2 days. Sixty-five percent of patients had one needle aspiration of the abscess, 35% had surgical drainage with local anaesthesia. The needle aspiration was negative in 14% of cases. In 29% of cases one bacterium was identified. The patients were completely cured in 10 days. Forty-five percent of patients underwent tonsillectomy at a later date. CONCLUSION: The progression of peritonsillar abscess is favorable in 2-3 days since a local therapeutic act (needle aspiration or drainage) is done associated with an antibiotic and corticoid treatment that is initially intravenous. An emergency tonsillectomy can be proposed in cases of recurrent tonsillitis or peritonsillar abscess.

Evaluation of cardiovascular risks and recovery of idiopathic sudden sensorineural hearing loss in hospitalised patients: comparison between complete and partial sudden sensorineural hearing loss.

OBJECTIVE: To evaluate the presence of cardiovascular risk factors and recovery of idiopathic sudden sensorineural hearing loss in hospitalised patients. METHODS: A single-centre retrospective study of 80 patients hospitalised for idiopathic sudden sensorineural hearing loss was conducted over a 6-year period. Mean pure tone hearing thresholds were assessed by pure tone audiometry. RESULTS: Twenty-three of 80 patients (28.75 per cent) initially had no cardiovascular risk factors. Forty-five patients had hyperlipidaemia, 22 patients had hypertension, 7 patients had diabetes mellitus and 7 patients were obese. No statistically significant difference was observed between patients with complete versus partial sudden sensorineural hearing loss (p = 0.0708) concerning the cardiovascular risk factors. At long-term follow up, the hearing recovery rate was not significantly different between the two groups of patients (p = 0.7541). CONCLUSION: The lack of a clear relationship between idiopathic sudden sensorineural hearing loss and cardiovascular risk factors suggests that sudden sensorineural hearing loss has a predominantly multifactorial disease profile regardless of hearing impairment severity.

Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients.

OBJECTIVE: To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre. METHODS: This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia. RESULTS: Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032). CONCLUSION: Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

[Clinical signs and correlation with radiological extent in a series of 117 retrosternal goitre]. / Signes cliniques et corrélations radiocliniques dans une série de 117 goitres cervico-thoraciques.

OBJECTIVES: To report, compare the clinical signs and the radiological signs of retrosternal goitre (cervico-thoracic goitre) and try to establish a correlation between clinical signs and radiological extent. PATIENTS AND METHOD: One hundred and seventeen patients with a goitre beyond the sub-clavian vessels in cervico-thoracic CT-scan and with a benign histopathology examination after thyroid surgery in the head and neck department, University Hospital, Amiens, France between February 1997 and January 2004 were included in this retrospective study. The initial clinical assessment includes the respiratory and swallowing functional signs, palpable mass and mobility of the vocal cords. A correlation is analyzed between the extent of the goitre, the anatomic relations with the trachea and oesophagus and clinical signs. RESULTS: Dyspnea is the commonest of the functional signs (39.3%) for young subjects (p < 0.05), due to tracheal compression regardless of the side of extension of the goitre. Dysphagia (16.2%) is not correlated with the extent of the goitre in this series. A cervical palpable mass is present in 69.2% of cases. CONCLUSION: The cervico-thoracic CT-scan is the key examination of the assessment of a retrosternal goitre making it possible to appreciate its features, its anatomic relations and its tracheal involvement sometimes announced by respiratory disorders, the presence of a dysphagia should alert to the possibility of posterior extension which can not be felt during the cervical palpation.

A radiologic and anatomic study of the superior semicircular canal.

OBJECTIVES: The present study sought to determine whether there is a correlation between the prevalence of superior semicircular canal (SSC) dehiscence (SSCD) on temporal CT and population age. The secondary objective was to identify anatomic factors for SSCD by studying SSC diameter and its protrusion into the middle cranial fossa. The aim was to determine the acquired or congenital origin of SSCD (Minor's syndrome). MATERIAL AND METHOD: A single-center retrospective radiological and anatomic study included 180 CT scans of 354 petrous parts of the temporal bone taken between January and December 2011 in a university hospital center. Bone thickness above the SSC was measured and classified in 4 grades: grade 1, >2.5mm; grade 2, <2.5mm: grade 3, predehiscent; grade 4, dehiscent. SSC diameter was also measured, as was the height of SSC protrusion into the middle cranial fossa. RESULTS: SSCD was found in 0.8% of cases and predehiscence in 12%. Patients with dehiscence were older; patients with grade 3 or 4 were significantly older than those free of dehiscence (P<0.05). There was no significant difference in SSC diameter according to grade. In grade 1, protrusion was greater than in other subjects, with a significant correlation between age and reduced protrusion (P<0.05). CONCLUSION: The study demonstrated a correlation between aging and SSCD prevalence. Reduced SSC roof height with age suggests that SSCD may be an acquired phenomenon, related in some way to aging of the base of the skull.

Therapeutic management of laryngeal cancer. Results of a study of 356 patients from the Cancer Registry of the Somme, France.

CONCLUSIONS: The global survival rate was low compared to those reported in the literature, in which the analyzed populations were selected according to the tumor stage or treatment. This study should be prolonged and should also involve other cancer registries in France in order to increase the number of patients and to analyze tumors of comparable stage and therapeutic management. OBJECTIVE: To analyze the survival rate of a non-selected laryngeal cancer population from the Cancer Registry of the Somme, a French region. MATERIAL AND METHODS: A total of 356 patients were included in a retrospective study covering the period 1987-1997. Survival and prognostic factors were analyzed. Statistical analysis was performed using the Kaplan-Meier method, the Cox model and the chi2 test. RESULTS: The 5-year global survival rate was 42% for males and 55% for females. Tumor localization, T, N and M stages and surgery were found to be significant prognostic factors. Sex and age were not statistically significant factors. For stage I tumors, surgery alone gave better results than radiotherapy alone in terms of global survival. No difference occurred in terms of local recurrence. A similar comparison was not possible for stage II-IV tumors owing to the small number of cases.

[A rare case of nasal and buccal obstruction in a child: the antrochoanal polyp of Killian]. / Un cas rare d'obstruction nasale et buccale chez l'enfant: le polype antrochoanal de Killian.

Nasal obstruction is a frequent symptom of consultation in paediatric otorhinolaryngology. Usually, adenoid hypertrophy is the cause. Sometimes the examination reveals the presence of polyps in the nose. The antrochoanal polyp of Killian is particularly frequent in childhood. The obstruction is usually unilateral, but the posterior extension of a bulky polyp to the oropharynx can cause a major discomfort, sometimes a respiratory distress. We report the observation of a 10-year-old patient presenting a bulky polyp of Killian, visible in the oropharynx and then discuss the features of this polyp in the literature.

[Intra cranial abscess and empyemas from E.N.T. origin]. / Abcès et empyèmes intracrâniens d'origine O.R.L.

OBJECTIVES: The purpose of this study was to evaluate the diagnosis criteria, the bacteriology and the evolution after adapted treatment of intracranial abscess of ENT origin. MATERIAL AND METHODS: It was a retrospective study from 1985 to 2003 concerning 22 patients who had brain abscesses secondary to an ENT infection. RESULTS: The infectious origin was sinusoid in 32% of cases, otologic in 32% of cases, pharyngeal or dental in 27% of cases and cutaneous in 9% of cases. The clinical symptoms were: fever in 55% of cases, headache in 73% of cases (Intra cranial hypertension syndrome in 23% of cases), epilepsy in 32% of cases and various other neurologic symptoms. Bacteria were identified in 82% of cases. In 50% of cases multibacterial associations were found. All the patients had bi antibiotherapy associated to surgical excision of the abscess (16 cases) or single (or more) punction (stereotaxic guided or not) of the abscess. 3 patients (14%) died and 50% are alive and well. CONCLUSION: The diagnosis of cerebral abscess is often difficult. The "classical" intracranial hypertension associated to high fever is usually incomplete and sometimes absent. There is no predominant bacteria involved and multibacterial infections are frequent. Despite abscesses are serious and potentially lethal, an early diagnosis, a medical (antibiotics) and surgical treatment (punction and/or surgical excision) may completely be cured in more than 50% of cases.