[Limits of laparoscopic surgery of adrenal glands. Apropos of 17 cases and a review of the literature]. / Limites de la résection coelio-chirurgicale des surrénales. Dix-sept observations et revue de la littérature.

OBJECTIVES: To review own cases of laparoscopic adrenalectomy in order to better ascertain limits therapeutic management and indications, compared with the literature data. PATIENTS-METHODS: Medical files of 15 patients after 17 laparoscopic adrenalectomies in the Dupuytren hospital of Limoges from February 1994 to November 1996, were analyzed 10 women and 5 men mean aged 59.4 years (22-77) were operated. Transperitoneal laparoscopic adrenal resection indications were: Conn adenoma (3), Cushing discase (2 bilateral resection), adrenal incidentaloma (9) and adrenal metastasis (1). RESULTS: Mean (range) of adrenal tumor size was 4 cm (0.8-7.5 cm). Operating times mean (range) was: 3 hours 40 minutes (1 h 50-6 h). Mean (range) of hospital stay was 3.4 day (3-6), marquedly reduced than open traditional adrenal surgery. Neither complication nor mortality per- or post-operative were present. But the laparoscopic operation required conversion to an open adrenal resection in 3 cases (18%). COMMENTS: Laparoscopic adrenalectomy offer real advantages: effectiveness and safety with a reduced time hospital discharge. Indications and adrenal size limits need to be precised on largest studies.

[Oculomotor nerve paralysis secondary to dural carotido-cavernous sinus fistula]. / Paralysies oculomotrices secondaires aux fistules carotido-caverneuses durales.

Carotid-cavernous sinus fistulas are an uncommon cause of oculomotor nerve palsies. These fistulas are fed by meningeal branches of the internal carotid and/or external carotid arteries. They occur spontaneously, and have symptoms less severe than those of direct carotid-cavernous sinus fistulas. The authors report 5 observations of oculomotor nerve palsy consecutive to these fistulas; diagnostic, physiopathogenic and therapeutic problems are discussed.