Lipoma in the cerebellopontine angle.

A case of lipoma in the cerebellopontine angle is reported. Intracranial lipomas are very rare, especially in the cerebellopontine angle. To our knowledge, only four cases, including our own, have been operated upon. Until now, total extirpation has not been possible. The singular appearance on computed tomography scanning of this dysembryoplasia is presented together with a bibliography of this subject.

[Hand-Schüller-Christian disease with tumor localization in the posterior fossa]. / Maladie de Hand-Schüller-Christian avec localisation tumorale dans la fosse postérieure.

A 19-year-old girl had been suffering since the age of 4 from Hand-Schüller-Christian disease. The condition was diagnosed by biopsy of a cranial bone lacuna. Later on, she developed diabetes insipidus and bilateral exophthalmos, both being typical signs of Hand-Schüller-Christian disease. At the age of 14, an intracranial tumour in the posterior cerebral fossa was discovered by computerized tomography, but in view of her parent's refusal of surgery, she was operated upon only 4 years later for obstructive hydrocephalus with intracranial hypertension. Two years after this operation, she presented with neurological signs of compression of the medulla oblongata, including tetraparesis and respiratory disorders, and the tumour was resected. Following a brief improvement she died of major hydroelectrolytic disorders due to her irreducible unstable diabetes insipidus. A review of the literature on Hand-Schüller-Christian disease and its rare association with intracranial tumours is analysed. The occurrence of such tumours raise important therapeutic problems and make the prognosis considerably worse.

[Peroperative echography in neurosurgery. Its value and applications 10 years later]. / L'échographie peropératoire en neurochirurgie. Son intérêt et ses applications dix ans après.

Intraoperative ultrasound imaging has many advantages over other imaging methods. The authors present their experience from hundred patients over ultrasound scanning. A large iconography is exposed. Not only the intracerebral lesions such as gliomas or metastases but also abscess or cysts can be controlled or biopsied directly. Per-operative ultrasonography is interesting for spinal cord lesions and spinal traumas. Ten years from the first utilisation in neurosurgery, the method is always used, its cost is low and its practice is very easy.

[Glioblastoma of the cerebellum in a child. Apropos of a case. A review of the literature]. / Glioblastome du cervelet chez un enfant. A propos d'un cas. Revue de la littérature.

Authors present a case of glioblastoma of cerebellum in a 11-year old child. Symptoms and signs are those of other tumors of posterior fossa. Diagnosis was made by CT Scan and pathologist. In spite of radiotherapy, he died one year after craniotomy. Only twenty cases of glioblastoma of cerebellum in childhood were described in the literature.

[Cauda equina syndrome complicating cutaneous T-cell lymphoma (mycosis fungoides)]. / Compression de la queue de cheval compliquant un lymphome cutané à cellules T (mycosis fongoïde).

Authors present a case of a cutaneous T. cell lymphoma (mycosis fungoides) complicated by a cauda equina syndrome. Crural and sciatic radicular pain were due to epidural lumbar involvement by tumoral process. After surgical decompression completed by chemotherapy the evolution was uneventful. This case is the second one reported in the literature.

[Solitary plasmacytoma simulating pituitary adenoma]. / Plasmocytome solitaire simulant un adénome hypophysaire.

A case of solitary plasmocytoma of the sphenoid is reported, masquerading as pituitary adenoma. At the time of surgery, the patient had no findings of multiple myeloma. The tumor was removed by trans-sphenoidal route and radiotherapy delivered. The post-operative course was uneventful, and two years later, there is no sign of recurrency or extension of multiple myeloma.

[Intramedullary neurinoma. Apropos of a case. Review of the literature]. / Neurinome intramédullaire. A propos d'un cas. Revue de la littérature.

The authors present a case of intramedullary neurinoma. A 44 years old patient was admitted for lumbar pain and bilateral sciatica. Neurological examination was normal except for dysuria and diminution of Achilles tendon reflexes. Lumbar spine X-rays and spinal cord angiogram were normal, but myelogram and myelo-scan revealed a fusiform enlargement of the conus medullaris. MRI confirmed this aspect. Total removal of an intramedullary tumor was done, using ultrasonography, operating microscope and ultrasonic aspiration. The post-operative course was uneventful, with, as sequelae a perineal hypoesthesia. Histological examination of the excised tumor revealed a neurinoma. The epidemiology, clinical features, radiology, and surgical treatment of such rare intramedullary tumors are discussed.

[Cervical chordoma. Apropos of a case]. / Chordome cervical. A propos d'un cas.

The chordomas are malignant tumors arising from the remnants of the posterior spinal chord. The chordomas of the cervical spine are rare (5% of the spinal chordomas). A new case of spine chordoma at C5 level in a 76 years old woman is reported. The diagnosis depends on the results of the histological studies and especially the studies of the labelled elements as Protein S100 or Cytokeratin. Firstly a double osteosynthesis was realized by an anterior and posterior approach. There was no radiotherapy after this operation. A new operation for a fracture of odontoid process was necessary one year later. There was no recurrence. The patient was complaining from pains, two years after the first operation in relation to lateral recurrence. A third operation by an anterior approach was realized. A radiotherapy of 50 Gy was applied on the same level. The first osteosynthesis was with acrylic cement and the second one with an autologous bone graft and a plate after removing the cement without problem. Actually she is in good health, 78 years old.

[Large partially thrombosed pseudo-tumoral aneurysm of the aqueductal area]. / Volumineux anérisme pseudo-tumoral partiellement thrombosé du territoire de la sylvienne.

Authors are reporting a case of a giant sylvian aneurism partially thrombosed which had given some tumor like symptoms. The Peumography performed, just before an angiography showed the exact size and the malformation's relations with the lateral ventricle. During the operation, the complete removal of the aneurismatic mass had been done. The follow up was good.

[Traumatic quadriplegia and vertebral thrombosis (author's transl)]. / Quadriplégie traumatique et thrombose vertebrale.

The case of traumatic thrombosis of the vertebral artery in a 14 year old boy with quadriplegia is related. They were neither spinal fracture nor blockage at the Queckenstedt test and the spinal fluid was normal. The clinical recovery was poor but a partial revascularisation of the thrombosed vessel was observed. Physiopathological, clinical and therapeutic aspects of the traumatic thrombosis of the vertebral arteries and also literature data are under consideration.

[Sciatica and occult sacral meningocele]. / Sciatique et méningocèle sacrée occulte

The authors present the case of a 43-years-old man who had suffered from back pain for 7 to 8 years followed by sciatic. X-rays showed an abnormal sacral cavity extending from S1 to S3. Wtih the suspicion of an occult sacral meningocoele, Dimer X radiculography showed a cystic formation at S2 which only partially filled the sacral cavity. There was also an L5-S1 disc protrusion. At operation, after exploration of the roots on both sides, it was possible to remove a disc herniation at L5-S1 on the right. Laminectomy of S1 and opening of the posterior wall of the sacral canal at S2 and S3 revealed a large cyst of epidural location, touching both S1 roots superiorly and situated behind the communicating cystic cavity seen at radiculography. Histological examination of the sacral cyst showed it to be a dura mater structure, in fact anon-communicating meningocoele.

[Primary cerebral lymphoma. Diagnostic and therapeutic values. Apropos of 4 cases]. / Lymphomes primitifs cérébraux. Intérêts diagnostique et thérapeutique. A propos de 4 observations.

The authors report four recent cases, of primary cerebral Lymphoma discovered since the use of the C.T. scan. Even though rare, the incidence of this tumor seems to be in slowly increase. The lesions on the C.T. scan are too variables and the surgical biopsy is necessary for the diagnosis. The primary cerebral Lymphoma should be considered more and more like the others Lymphomas. For this reason, they have started the treatment after surgical biopsy, with chemotherapy followed by radiotherapy associated with corticotherapy. The two last patients, are still alive with a follow up of 36 months for one of them. The prognosis seems to us, better as much as the diagnosis and the treatment was started early.

[Nerve regeneration through a venous graft in the rat. Preliminary results]. / Régénérescence nerveuse à travers un greffon veineux chez le rat. Résultats préliminaires.

An experimental study of nerve regeneration in rats was realized after sectioning 8 mm of the sciatic nerve and interpositioning a vein-graft to replace the portion of nerve which has been removed. The vein-graft was taken at the neck level, far away from the point of suture between vein and nerve, a procedure which seems to prevent the problems of scabbing. A histological and electrophysiological analysis was carried out on 16 grafts, over periods ranging from 4 weeks to 4 months. The nerve and venous dissections were realized under a stereoscopic microscope. A certain degree of amyotrophy appeared in the external-posterior region of the thigh, directly related to the muscular dissection and the partial paralysis caused by the section of the common peroneal nerve. The electrophysiological recordings in vivo provide proof of nerve regeneration but reveal the absence of any correlation between the time of recovery and the time of induction. Examination under the light microscope confirms the regeneration of the nerve inside of the vein-graft, with an augmentation of myelin sheaths, which increase with time both in number and in thickness. The vein-wall acts as a guide but the passage of a few nervous filaments outside of the graft itself is observed. Examination under the electron microscope furnishes important information on myelin sheaths. The results are of excellent quality, but to better appreciate and evaluate them, we envisage a further study, this time to be carried out on another animal species.

[Germinoma (ectopic pinealoma) with double location : supra-sellar and the cerebellum without pineal tumour (author's transl)]. / Germinome (pinéalome ectopique) a double localisation : supra-sellaire et cérébelleuse sans tumeur pinéale.

The now nine years old girl with growth retardation, started to be ill with otitis and then diabetes insipidus of central origin at 1974. A treatment with lysin-vasopressin is prescribed. The PNEG in May 1976 shows a little, pea like, suspicious, supra-sellar nodule who is not surgically explored since they was no ophtalmologic symptoms and because a normal CT scan. Corticoid and thyroid substitutive therapy is added until September 1977 when the general status becomes impaired and vomiting starts. Also because some visual loss, a new neuroradiological study is performed showing a supra-sellar tumour and a fourth ventricle mass. The CT scan asserts the double intracranial expansive process and a posterior fossa craniotomy is done with subtotal resection of a vermian tumour and Torkildsen drainage. The histology is : Immature Dysembryoma (seminoma type) or germinoma. The follow-up was good under hormonal care. X Rays Therapy over the posterior fossa, the suprasellar region, the brain and the spinal channel was instaured. Four months later, the CT scan shows normal sized ventricles and no tumour mass at all. This case gives the authors opportunity for comments and to study the concerned literature.