Brain regional pharmacokinetics of 11C-labeled diphenylhydantoin: positron emission tomography in humans.

We used positron emission tomography to study the regional cerebral pharmacokinetics of 11C-labeled diphenylhydantoin (11C-DPH), which was given intravenously to 10 patients (8 intractable partial epileptics and 2 nonepileptics). In the nonaffected hemisphere, 11C-DPH concentration in gray matter reached equilibrium with blood within 20 minutes but was still rising at 60 minutes in white matter, where equilibrium was too slow to be detected owing to the fast physical decay of 11C. Brain-blood concentration ratios at 50 minutes were 1.37 and 1.06 in gray and white matter, respectively, similar but less variable than steady-state DPH ratios reported in human brain surgical samples. There was no indication that normal brain regions of medically resistant epileptics bind DPH less effectively than in nonepileptic patients. Brain and blood 11C-DPH concentrations were well correlated, confirming that the latter gives a reliable estimate of the former in unaffected brain regions.

Dysembryoplastic neuroepithelial tumors located in the caudate nucleus area: report of four cases.

OBJECTIVE AND IMPORTANCE: Dysembryoplastic neuroepithelial tumors (DNTs) histologically resemble gliomas but behave as stable lesions. These tumors initially were considered to be located exclusively within the supratentorial cortex. The four reported cases demonstrate that DNTs may also arise in the area of the caudate nuclei. Moreover, the peculiar topography of these lesions, which suggests a derivation from the subependymal plate, is in accordance with the putative origin of DNTs from secondary germinal layers. CLINICAL PRESENTATION: The patients experienced partial seizures (two patients), generalized seizures (one patient), or headaches (one patient). All patients were young (17-26 yr) at the onset of symptoms, and all had normal results from their neurological examinations. INTERVENTION: All lesions demonstrated a pseudocystic appearance on computed tomographic scans, were hypointense on T1-weighted magnetic resonance imaging scans, hyperintense on T2-weighted magnetic resonance imaging scans, and did not show contrast enhancement. The four tumors similarly lined the left or right caudate nuclei and expanded within the homolateral ventricle (three patients) or both lateral ventricles (one patient). In one patient, the tumor also involved the adjacent paraolfactory cortex. CONCLUSION: In all patients, stereotactic biopsies helped to identify a specific glioneuronal element of DNTs. None of the tumors was operated on. Radiotherapy was performed in only one patient. A long pre- and/or postbiopsy imaging follow-up, which was available in two nontreated patients (3 yr and 16 yr), demonstrated the perfect stability of the lesion. The occurrence of DNTs in this peculiar location needs to be considered to avoid misidentification as "ordinary" gliomas and prevent useless aggressive treatment.

Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases.

This report concerns the clinicopathological features of 39 cases of a morphologically unique and surgically curable group of neuroepithelial tumors associated with medically intractable partial complex seizures. All were supratentorial and characterized by intracortical location, multinodular architecture, and heterogeneity in cellular composition. The constituent cells included astrocytes, oligodendrocytes, and neurons. Because neuronal atypia was often inapparent, the tumors superficially resembled mixed oligoastrocytomas. The term "dysembryoplastic neuroepithelial tumor" (DNT) is proposed for these distinctive lesions, the clinicopathological features of which suggest a dysembryoplastic origin. With the exception of the occurrence of headaches in 2 patients, partial complex seizures were the exclusive symptom. Age at onset of symptoms ranged from 1 to 19 years (mean 9 years). In addition to the chronic nature of the seizures (range, 2 to 18 years; mean, 9 years), one-third of the patients showed radiological features, such as focal cranial deformity, indicating that the tumors had an early onset and were of long standing. In most cases, computed tomography showed a "pseudocystic," well-demarcated, low density appearance associated in some cases with focal contrast enhancement (18%) or calcific hyperdensity (23%). The tumor involved the temporal lobe in 24 patients (62%), the frontal lobe in 12 (31%), and the parietal and/or occipital lobe in 3 cases. Although tumor removal was considered incomplete or subtotal in 17 patients (44%), long term follow-up (range, 1 to 18 years; mean, 9 years) showed neither clinical nor radiological evidence of recurrence in any patient. Comparison of the survival data of the 13 subjects who had undergone postoperative radiotherapy with 26 who had not indicated that radiation therapy was of no obvious benefit. The identification of DNT has therapeutic and prognostic implications because aggressive therapy can be avoided, thus sparing these young patients the deleterious long term effects of radio- or chemotherapy.

Stereotactic endocavitary treatment of cysts and pseudocysts of glioma. Preliminary report.

The present study reports the results of the stereotactic treatment via endocavitary irradiation (Talaraich's method) of 50 gliomatous cysts (volume: 5-242 cm3; av.: 73 cm3) in 45 patients (M: 24; F: 21; age 3.5-57 yrs; av.: 22 yrs) in the period January 1973-January 1987. Twenty-four patients (27 cysts) were affected by a grade I glioma, 10 patients (12 cysts) by a grade II and 11 patients (11 cysts) by a grade III or IV glioma. The first step in the treatment was a neuroradiological stereotactic stereoscopical survey (tele-angiography, ventriculography, cystography) with serial biopsies and a cystic impermeability test (injection of 0.3-1 mCi of Re 186). One week later one therapeutic dose, ranging between 5 and 85 mCi of a beta-emitting colloidal radioisotope (Re 186, Au 198, Y 90), was stereotactically injected into the cyst. The stereotactic treatment was not followed by severe side effects. In high grade gliomas (grade III and IV) the benefit of the possible shrinkage and/or disappearance of the cyst was vanished by the solid tumor progression. In low grade gliomas (grade I and II) more than 50% of the cysts disappeared and 25% of them shrinked up to one third of the starting volume (follow-up: 5-168 mo.; av.: 54 mo.). At present almost only Re 186 is employed using a cyst wall dose of 400-500 Gys. The low surgical invasiveness, the absence of severe side effects and good therapeutical results induce us to propose this as a first choice treatment in inoperable low grade gliomatous expanding cysts.

Long term results of stereotactic endocavitary beta irradiation of craniopharyngioma cysts.

This study concerns 33 pts (age: 3-69 yrs; m: 22) with cystic craniopharyngiomas (36 cysts) treated with stereotactic beta endocavitary irradiation (TRT). Nine patients died (3 days to 36 months after TRT) and one was lost. In 23 the follow-up varied from 12 to 126 months (m: 45 months). The disappearance of 13 cysts was appreciated 5 to 24 months after TRT: no recurrence was observed after 22-126 months (m: 61). A greater than 70% reduction of the cyst volume occurred 3-36 months after TRT and persisted at 12-71 months (m: 35 m). In one patient, the cyst volume increased. Visual acuity improved in more than 50% of survivors, while endocrine disturbances did not change and memory troubles disappeared.

Diagnosis and treatment of colloid cysts of the third ventricle by stereotactic drainage. Report on eleven cases.

Between December 1979 and September 1986, 11 patients with colloid cysts of the third ventricle were operated on by a stereotactic procedure with Talairach's system. Stereoscopic angiography and ventriculographic study allowed for a percutaneous (twist-drill hole diameter: 2.5 mm) stereotactic aspiration of the cysts. The operations were successful, and there were no intraoperative or postoperative mortalities but just mild transient morbidity in three cases. Six cysts were evacuated completely, and five only partially. The mean residual volume was 19% of the initial one. Clinical and anatomical results are presented, and the advantages of this stereotactic procedure are discussed.

Effects of 1.32-micron Nd-YAG laser on brain thermal and histological experimental data.

Considering that the 1.32-microns Nd-YAG laser should have physicothermal properties close to those of the CO2 laser, a series of experiments were conducted on rat cortex (N = 51). Three laser wavelengths were compared: CO2 laser (10.6 microns), 1.06-microns Nd-YAG, and 1.32-microns Nd-YAG lasers. For each shot, temperature measurements were recorded with an infrared thermographic videocamera. The digitized signals were figured as thermal profiles and temperature developments. Ninety-five shots were correctly studied and analyzed: CO2, N = 29; 1.06-microns Nd-YAG, N = 20; 1.32-microns Nd-YAG, N = 46. The histological lesions produced by these three lasers were compared on animals killed 24 hours (N = 20), 8 days (N = 20), and 30 days (N = 5) after the laser impacts. For equivalent densities of energy, the depth of cortical necrosis was comparable for the CO2 laser (200-250 microns) and the 1.32-microns Nd-YAG laser (210-260 microns) whatever the date of death; the 1.06-microns Nd-YAG laser shots were responsible for much more important damage (400-550 microns). Because of its important absorption in water and nervous tissue, the authors consider the 1.32-microns Nd-YAG laser most suitable for neurosurgery, particularly because it is conducted through optic fibers, and therefore is easy to handle during neurosurgical procedures.

[The rolandic line: a simple baseline for the identification of the central region. An MRI study and functional validation]. / La ligne rolandique: une ligne de base simple pour le repérage de la région centrale. Etude IRM et validation fonctionnelle.

INTRODUCTION: The identification of the central region--i.e. the central sulcus, the pre- and post-central gyri, the paracentral lobule--on MRI and angiographic images may be necessary prior to stereotactic procedures such as biopsies or resection of centrally located tumors, depth electrode recordings for presurgical evaluation of drug-resistant epilepsies, or radiosurgery of arteriovenous malformations. Stereotactic methods, such as the Talairach's proportional grid based on the bicommissural system, demonstrated the statistical position of the central sulcus according to the Ac-Pc, Vac and Vpc baselines. However, the course and the spatial position of this sulcus have remarkable individual differences that sometimes make the sulcus difficult to identify on serial sagittal MRI or lateral angiographic images. In order to facilitate this identification, the authors propose a new oblique baseline, the rolandic (R) line. MATERIAL AND METHODS: The stereotactic MRI and angiography of 22 patients were reviewed for this study. Eleven of these patients had stereotactic biopsies for a low-grade tumor located in the central region, while eleven others had multiple intracerebral electrodes implantation and depth EEG recording (SEEG: stereoelectroencephalography) in the presurgical evaluation of drug-resistant partial epilepsy, prior to epileptogenic cortex resection. The Ac-Pc, Vac, Vpc baselines and segments of the central sulcus were drawn from the mid-sagittal and lateral T1-weighted MRI images and reported on an individual graph. Surface and deep margins as well as axis of the central sulcus were also reported along with corpus callosum baselines as defined by Olivier et al.: horizontal plane, anterior and posterior callosal planes. The rolandic line was then traced from the graph:it joined the intersection point between the anterior callosal plane and an orthogonal line passing through the floor of the temporal fossa, and the intersection point between posterior callosal plane and an orthogonal line passing through the top of the hemisphere. The rolandic line was then superimposed on any sagittal MRI image or lateral stereotactic angiographic film. Finally, the spatial position of electrode contracts through which electrical stimulations elicited motor and/or sensory responses, either from central electrode implanted for motor fibers identification prior to stereotactic biopsies or from SEEG electrodes implanted for epileptogenic zone identification and cortical mapping, was reported on the individual graph. Angular and linear measurements were taken from the graph, between the rolandic line, the central sulcus axis, the Ac-Pc and callosal baselines, and the central sulcus limits (top, bottom, anterior and posterior margins). RESULTS: Graph measurements indicated that the rolandic line was significantly closer to the inferior part of the central sulcus than to its superior part (average distance between the line and the inferior point of the sulcus: 1.86 +/- 1.87 mm; average distance between the line and the superior point of the sulcus: 4.5 +/- 2.3 mm; p < 0.001-t test); similarly, the rolandic line was closer to the deep margin of the sulcus rather than to its superficial border (average distance between the line and the most anterior point of the sulcus: 11.43 +/- 3.16 mm; average distance between the line and the most posterior point of the sulcus: 7.95 +/- 4.14 mm; p < 0.01-t test). In 90% of the cases, the rolandic line followed the deep or middle part of the sulcus, with an average angle of 4.18 degrees +/- 2.53 degrees between the line and the sulcus axis. The spatial position of the electrode contacts that elicited motor/or sensory responses to stimulations correlated topographically well in all cases with the position of the motor and sensory fibers defined according to the central sulcus, baselines and reference to stereotactic atlases. (ABSTRACT TRUNCATED)

[Intracranial tumors in mental patients (author's transl)]. / Tumeurs cérébrales des malades mentaux.

One hundred and fifty patients admitted consecutively to the same neurosurgical service in Paris were reviewed retrospectively. There is no definite difference between intracranial tumors in mental patients and those encountered in a normal population in terms of: frequency, anatomic localisation and histological distribution. All the patients had been referred previously to psychiatric hospitals for: confusional states, disturbed behaviour or pseudo-depression in 60% of the cases. Neurological localizing signs were present in 83% of the cases; EEG was abnormal in 96% of the patients recorded during their stay in psychiatric wards. Diagnosis of brain tumors in mental patients appears feasible if not always simple; it is based upon elementary neurological examination and routine investigations. In a near future, isotopic scan and CT scan should become a great help to reduce excessive diagnostic delays in order to improve the prognosis which remains poor.

[Craniopharyngioma in adults]. / A propos d'un craniopharyngiome de l'adulte.

Initial signs of a craniopharyngioma in a 58 years old woman were a decrease in visual acuity and suppression of the pupillary light reflex. Perimetric signs were: left: central scotoma with an inferior temporal defect of the peripheral field; right: superior temporal field defect. The CT scan showed an intrasellar tumor, extending into the suprasellar region, isodensity of the tumor being the main finding. The radiological diagnosis was adenoma, but all the perimetric defects disappeared spontaneously, and the post-operative diagnosis was craniopharyngioma. Variations of the visual field defect are one of the most typical signs of craniopharyngioma, and absence of calcification, with isodensity of the tumor on the CT scan may lead to a mistaken.

[Mucoceles of the sphenoid sinus and their ophthalmological manifestations]. / Les mucocèles du sphénoïde et leurs manifestations ophtalmologiques.

The authors describe two cases of sphenoïd sinus mucoceles, the first with a chiasmatic syndrome and the second with an oculomotor paralysis, and compare these cases with those described in the litterature. This rare benign tumor is revealed by ophthalmological complications which result from compression of adjacent structures. The main clinical findings are pain, decrease in visual acuity, proptosis, and diplopia. Plain X rays and pluridirectional tomographies are usually sufficient to make the diagnosis but CT scan is the procedure of choice for defining the extent of the lesion and thus assuring an appropriate surgical approach. The CT scan findings have been reviewed. Early and correct diagnosis is important to prevent permanent visual loss by optic nerve atrophy.

[The CO2 laser: a new instrument for intracranial neurosurgery]. / Le laser CO2: un nouvel instrument pour la neurochirurgie intracrânienne.

Since 1983 we have been using an 80 watts CO2 laser unit (Ercelas 80, Robert et Carrière Biomédical) routinely in some neurosurgical procedures. Fifty tumours (34 intracranial, 4 intraorbital and 12 intraspinal) have been operated upon with laser. The CO2 laser appears to be particularly useful to excise solid tumours, such as meningiomas and neurinomas. When these lesions are located in the posterior fossa or lying deeply near highly functional or vital supratentorial structures (e.g. carotid arteries, optic nerves, chiasma), the laser beam should be coupled with an operating microscope. Laser being a non-touch technique, the tumour can be removed with minimal trauma to healthy tissues. Depending on the output power, the laser beam coagulates, cuts or vaporizes the target lesion.

[Extradural hematoma in the Emergency Medical Assistance System and scanners. Comparison between 2 series at the Sainte-Anne Hospital Center]. / L'hématome extra-dural à l'ère du S.A.M.U. et du scanner. Comparaison de deux séries du Centre Hospitalier Sainte-Anne.

The authors compare two groups of intracranial epidural hematomas treated in the Neurosurgical department of Sainte-Anne Hospital in Paris: the first group includes 262 patients operated upon between 1965 and 1977; the second group concerns 124 patients operated during the period 1979-1984. The mortality rate has been progressively diminishing from 1969 (50%) to 1984 (12.5%). Among the survivors, functional sequellae are still frequent; some improvement in the functional prognosis has although been noted; in the first group, 41% of patients are cured and 56% of them returned to work; in the second group, 50% are cured, and 62% returned to their professional activities. The detailed analysis of those data emphasizes the importance of CT-Scan and of the improvement of specialized neurosurgical intensive care; on the other hand, the particular role of an emergency care organisation, such as the SAMU, appears rather discreet referring to this type of pathology.

[Cerebrovascular accidents and oral contraceptives (reflections a propos of 36 observations)]. / Accidents vasculaires cérébraux et contraceptifs oraux (réflexions a propos de 36 observations)

Thirty-six cases of cerebro-vascular accidents in young women using oral contraceptives have been studied and a survey of the literature devoted to the subject gives an opportunity to discuss a few problems related with these accidents. They occur with no evident relationship with the type of drug used, and the duration of treatment; in 66 p. 100 of the cases these patients have a definite and sometimes severe pathological history prior to the neurological accident. The cerebro-vascular accidents are of the ischemic type in more than 80 p. 100 of the cases. Angiographic studies demonstrate various types of lesion: stenosis or thrombosis of the arteries; in almost all of the cases the internal carotid artery or the sylvian artery or both of them are concerned; the angiogram appeared normal in 8 cases.

PIP: 36 original cases, 24 from the Hopital de Sainte-Anne in Paris and 12 from the surrounding region, of ischemic (30) or hemorrhagic (6) strokes in women taking oral contraceptives are reported. The patients were 20-55 years, half under 30; took various types of pills from 10 weeks to 10 years, mean 28 months; 30 of them for contraception but other for migraine, Reclus disease, amenorrhea, sterility, and endometri osis. 27 women had related history: ischemic vascular accident (5), hyp ertension (5), thromboembolism (4), Basedow disease (3), heavy smoking (3), essential comitiality (2), migraine (1), essential hyperlipidemia (1). The women with ischemic strokes were younger, 61% under 30. A 3rd had premonitory symptoms like headache, progressing rapidly to massive hemiplegia in 17, discrete hemiplegia in 11, loss of consciousness in 6, and convulsions in 3. The cerebrospinal fluid was clear in 11 cases tested. Angiography revealed lesions in the internal carotid in 4, sylvian arteries in 9, posterior cerebral in 1, but no anomaly in 8. Only 5 recovered completely: 3 died and 7 retained major neurologic dysfunction. 6 women had hemorrhagic strokes, 2 intracerebral hematomas, and 4 cerebromeningeal hemorrhages. 5 were operated on, 3 with good results and 2 were left with severe neurologic sequelae. The authors insisted that none of these women had been given any preliminary tests or followed with any attention to their related history while taki ng oral contraceptives.

[Neurosurgery with a CO2 laser. Evaluation of 61 operations]. / Neurochirurgie au laser CO2. Bilan de 61 interventions.

The authors present the results of their over two years experience with CO2 Laser neurosurgical unit. They explicit the indications and the technical data followed during intra-cranial (N = 44), intra-spinal (N = 12) and intra-orbital (N = 5) procedures. Meningiomas, neurinomas and adenomas are the best indications for tumoral CO2 Laser neurosurgery. In other respects sterilization and cranialization of aeric sinuses are simplified by the use of CO2 Laser: it assures vaporization of the mucosa and carbonization of the walls more easily than an electric coagulator. At last the use of CO2 Laser for dissection and removal of intra-orbital tumors is quite demonstrative. Thus owing to its physical and thermical qualities CO2 Laser is often a very useful, sometimes irreplaceable, apparatus: provided that its indications are precise and rigorous.

[Combined ORL and neurosurgical approach in adenocarcinoma of the ethmoid. Preliminary results apropos of 15 cases]. / La voie d'abord combinée ORL et neurochirurgicale dans les adénocarcinomes de l'ethmoïde. Résultats préliminaires à propos de 15 cas.

Fifteen cases of adenocarcinoma of the ethmoid sinus treated by a combined subfrontal and transfacial approach after induction chemotherapy are reported. The surgical technique is described precisely including a paralateronasal approach combined with a bifrontocoronal incision, a bilateral ethmoidectomy and reconstruction of the anterior base of the skull by one sheets taken-out from the inner surface of the frontal flap or more recently madreporic coralline grafts; the dura is hermetically sealed and it is lined with a large galea flap. Results were as following: one post-operative death, no clinical rhinorrhea, no recurrence from the anterior cerebral fossa, one orbital and one sphenoidal recurrences. Surgical indications are discussed according to the different extensions of the tumor and a frontal lobe extension is not a contraindication. This surgical procedure should be employed for the adenocarcinomas of the ethmoid invading the superior cells even in the absence of lysis of the cribriform plate in order to avoid the endocranial recurrences.

[Stereotaxic ventriculocisternostomy in the treatment of triventricular obstructive hydrocephalus. Apropos of 23 cases]. / La ventriculocisternostomie stéréotaxique dans le traitement de l'hydrocéphalie obstructive triventriculaire. A propos de 23 cas.

UNLABELLED: During the period January 1975-October 1987, we performed stereotactic ventriculocisternostomy (V.C.S.) on 23 patients (13 M., 10 F.; age: 11-73 years, m: 33). Sometimes used as an isolated therapeutic procedure, V.C.S. may also follow stereotactic biopsies using Talairach's methodology. Serial stereotactic biopsies were performed in 15 out of 23 patients showing 11 tumoral lesion, two arachnoïdal cysts and two cryptic vascular malformations. Eight patients presented with an isolated aqueductal stenosis. Among the 12 non tumoral patients, seven had very large triventricular hydrocephalus (6 with a retroclival dilatation of the third ventricle) and 5 showed significant dilatation. Of the 11 tumoral patients, 7 had significant ventricular dilatation (1 with a protrusion of the floor of the third ventricle) and 4 with modest dilation. V.C.S. is done by creating an opening (diameter: 5-6 mm) in the floor of third ventricle with a fine forceps introduced through a tubular guide (diameter: 2.45 mm). The percutaneous double oblique transfrontal trajectory (drill-hole: 2.5 mm of diameter) passing through the foramina of Monro, avoids superficial and deep vessels visualised on the previous Stereoscopic Tele-Angiographic and Ventriculographic study. A systematic verification of the V.C.S. patency is made intraoperatively by injection of iodine contrast medium into the third ventricle. RESULTS: (non tumoral patients: 12) (m follow-up: 4 years): two patients needed a ventricular shunt after 3 and 1 months respectively, the first one because of an associated communicant hydrocephalus, the second because of a post-operative meningeal infection. Long-term clinical and CT-Scan follow-up showed that complete resolution (7 cases) or partial (2 cases) improvement of symptoms and signs was not accompanied by normalization of ventricular size, even though the dilatation was significantly reduced in 8 cases and to a lesser extent in 2. RESULTS: (tumoral patients: 11) (m follow-up: 3 years). Hydrocephalus was reduced in 6 cases and remained unchanged in 5. Two patients needed a ventricular shunt 2 years after the V.C.S.: 1 patient, because of a tumoral recurrence involving the region of the fenestration, the second patient because of adhesive arachnoiditis following reoperation for suspicion of recurrence, though this was found to be granulomatous inflammation. Two patients died as a result of their tumors at 2 and 6 years. CONCLUSION: Stereotactic V.C.S. is the treatment of choice for triventricular obstructive hydrocephalus even when there is no retroclival dilatation of the floor of the third ventricle.

[Stereotaxic approach in extensive lesions of the septum-fornix-callosal region. Apropos of 14 cases]. / L'approche stéréotaxique des lésions expansives intéressant la région trigono-septo-calleuse. A propos de 14 observations.

Stereotactic approach of anterior midline lesions which involve the septum-fornix-callosal region is a logical alternative to open surgery as a first choice. It contributes to know anatomical relations--particularly vascular and ventricular--of the lesion; it provides an accurate neuro-pathological diagnosis, with grading and spatial configuration of the lesion, and therapy in some cases. In other cases, it is a guide for appropriate therapeutic choice.

[Ethmoidal adenocarcinoma surgically treated in one stage by transfacial and subfrontal approach after inductive chemotherapy. Preliminary results of a new therapeutic approach]. / Les adénocarcinomes ethmoïdaux opérés en un temps par voie transfaciale et sous-frontale après chimiothérapie d'induction. Résultats préliminaires d'une nouvelle approche thérapeutique.

The authors present a new therapeutic protocol for ethmo++idal adenocarcinomas. It includes a pre-operative chemotherapy based on a four days continued infusion of cis-platinum and 5 F.U. (three cures with 3 weeks-intervals); it is followed by a carcinologic removal realized through a combined transfacial and intra-cranial approach. They discuss the interest of combined surgery which should allow a limitation of intra-cranial recurrencies. The intra-cranial extension must not be a limit to the removal even in case of dural, or even sub-dural extension. The reconstruction of the anterior basis of the skull has been simplified as much as possible: it has been performed either with a bone graft removed from the frontal flap inner table, or with a precut madreporic coral graft. In all cases, the dura has been doubled with a large shred of galea. They emphasize the efficiency of pre-operative chemotherapy. Eleven patients underwent such a protocol; two were operated in a recurrence, 9 in first hand. The preliminary results seem to be promising: the one year and two years actuarial survival rates are 84%.

[Value of bifocal stereotaxic destruction in case of dyskinesia in patients with a motor deficit of cerebral origin]. / Intérêts de la destruction stéréotaxique bifocale en cas de dyskinésies chez des patients ayant une infirmité motrice d'origine cérébrale.

Authors report a study concerning 12 dyskinetic patients with cerebral palsy. The clinical pre-operative examination shows that many signs and symptoms are associated: volitional and postural dyskinesia, athetosis and dystonia, pyramidal deficit and spasticity. Talairach's stereotactic methodology has been used for bifocal (VPL thalamic nucleus and internal pallidum) Yttrium 90 implantation. After stereotactic bifocal lesions, involuntary movements have been reduced in 45.5% of cases and have disappeared in 27% of cases. Impairment of previous motor deficit has been observed in 3% of cases; volitional and postural dyskinesia seems to be the most curable symptomatology. Clinical results in athetoid involuntary movements and dystonia are less rewarding. Because of important anatomical modifications often observed cerebral palsy patients, the authors stress the interest of individual acute neurophysiological study and discuss about the stereotactic targets and the modalities of destruction. They insist upon the necessity of rigorous selection of indications based on acute clinical examination in the perspective of improvement of global functional capacities.