[Symptomatic aneurysms of the postero-inferior cerebellar artery. A multicenter retrospective study of 29 cases]. / Anévrysmes symptomatiques de l'artère cérébelleuse postéro-inférieure. Etude rétrospective multicentrique de 29 cas.

A multicenter retrospective study of 29 cases of posterior inferior cerebellar artery is reported. Over a period of 21 years, the frequency of posterior inferior cerebellar artery aneurysm among all intracranial aneurysm was estimated to 1.38 p. 100 of cases of aneurysms followed by 3 University Hospitals. Frequency of rupture appeared to be very high (93 p. 100) in this series probably because of the type of selection. Average grade of presentation according to Hunt and Hess classification being < III in 3 fourth of the cases. Neither clinical presentation nor suspicious etiological factors were specific of this localization. Only two cases were of pseudotumoral appearance. Positive diagnosis of subarachnoid hemorrhage was made by CT scan. Angiograms gave diagnosis of localization of the malformation and its type. Intraventricular hemorrhage was found in 62 p. 100 of our cases: all had hemorrhage of the fourth ventricle. Hydrocephaly was more frequent as compared to supratentorial localizations, Vasospasm was less frequent as in supratentorial localizations. Nimodipin seems to be efficient. Therapeutic possibilities are primary dominated by surgery with good results when it is possible. Endovascular treatment is under evaluation.

[Value of postoperative radiotherapy in various tumors of the pituitary gland]. / Intérêt de la radiothérapie postopératoire dans certaines tumeurs de l'hypophyse.

Already advocated by Cushing to complement surgery of pituitary adenomas, radiotherapy remains useful in these benign tumours despite controversies concerning long-term results, pituitary cell resistance and potential harmful effects on the optic nerve, glands and skin. Radiotherapy was applied to 36.6 p. 100 of 150 patients with pituitary tumours operated upon by the same surgical team. Some very good results were obtained, notably in invasive and recurrent tumours. In a case of chromophobe adenoma operated twice at 1 year interval, radiotherapy (4,500 rads) after the second operation resulted in complete cure confirmed by computerized tomography 15 years later. Similarly, in an 8-year old girl reoperated upon for severe recurrent suprasellar craniopharyngioma 3 years after the initial excision, post-operative radiotherapy (5,000 rads) produced excellent remission which persists after 19 years. Thus, even with the modern diagnostic and microneurosurgical procedures, radiotherapy remains, for many authors, a useful and safe method to improve the prognosis of pituitary tumours.

[Fracture-separation of the articular process of the lower cervical spine. Its relation to fracture-dislocation in hyperextension]. / La fracture-séparation du massif articulaire du rachis cervical inférieur. Ses rapports avec la fracture-dislocation en hyperextension.

The authors have seen 13 cases of fracture-separation of the articular processes in the lower cervical spine with horizontal facets. This type of lesion was caused by trauma in hyperextension, compression and rotation. The mechanism appears to be similar to that of dislocations in hyperextension. Four types are defined according to the displacement and the association of disc and ligamentous lesions. Most of the cases were unstable and had to be fixed surgically. Eleven cases were treated in this way, twice by a posterior approach, 6 times by an anterior approach and 3 times by a combined anterior and posterior approach.

[Brown-Séquard syndrome caused by foramen and calcified disk herniation, responsible for direct compression of Adamkiewicz's artery]. / Syndrome de Brown-Séquard par hernie discale foraminale et calcifiée, responsable d'une compression directe de l'artère d'Adamkiewicz.

The thoracic discal hernia is a rare affection whose prognosis has been transformed by the present diagnostic means and the technical progress of surgery. A case history has been reported of a thoracic discal hernia, T9-T10, with Brown-Sequard Syndrome and vertebral CT Scanning showed a left lateral localization. A posterior access remains indicated in lateral localization of those hernias, and it confirms clinical and neuroradiological findings showing a direct compression of the Adamkiewicz artery in the intervertebral foramen.

[Results of selective posterior radiculetomy at the lumbar and cervical level]. / Résultats de la radicellotomie sélective postérieure à l'étage lombaire et cervical

At the light of authors' present experience, radicletomy appears as an excellent antalgic operative procedure in the case of roots with high functional risk (brachial plexus and lumbar plexus). In the absence of any motor deficiency or ataxia, it appears that radicletomy is of help in the cure of severe hypertonies of the extremities (sequelae of cerebral stem contusions). Conversely, in the spastic sequelae of hemi- or paraparesias, lumbar-sacral posterior selective radicotomy is a sure procedure that procures results nearly super-imposable to radicletomy with an appreciable gain in time. At last, for what concerns the motor involvements of the upper extremity ending in spasticity, selective radicletomy recovers its rights and has to be preferred to S.P.R. The indications may be summarized as follows: -- At the level of the lower extremities: in the case of paraparetic sequelae or of sequelae due to spastic paraplegia, a S.P.R. has to be performed; for what concerns antalgic surgery, in the absence of motor deficiency, the best indication is radicletomy. -- At the level of the upper extremities: in the case of dystonic sequeale of the cerebral stem, spastic pain bound with hemiplegia or with carcinoma etc. (herpes zoster..), radicletomy constitutes the ideal surgical procedure.

[Contribution of Doppler angiography to the study of sub-millimeter cortical arteries]. / Apport du Doppler per-opératoire dans l'étude des artères corticales sub-millimétriques.

Intra operative Doppler has been already used especially during cerebral vascular malformations surgery. The systematic practice of this method, in 15 cases, for the blood flow study of the sub millimetric cortical vessels is helpful, very simple, and harmless. The investigation has been achieved by the direct application of a sterilized 8 MHZ, 5 mm Doppler probe on a small cortical artery. As the diameter has been exactly measured (0,8 mm +/- 0,2 in 15 cases) it is easy to calculate the blood flow from the recorded curve diagrams. The normal cortical flow of the sub millimetric arteries is about 2,52 cm3/mn +/- 1,16 confirming the previous data obtained with other methods of approach. The study of contused brains, points out, the disastrous effect of edema on cerebral blood flow, which before a complete arrest, looses its continuous diastolic pattern. Deep seated angiomas can be accurately located together with the flow direction in their feeding vessels. This method is also of fair interest for extra intra-crânial anastomosis, the choice of the cortical artery for bypass and its functional appreciation.

[Brachial diplegia of traumatic origin as a result of injuries of the cervical cord]. / La diplégie brachiale d'origine traumatique consécutive aux atteintes de la moelle cervicale.

Described by Dide and Lhermitte (1917) the brachial diplegia or bilateral paralysis of the upper limbs, is called since Schneider's data acute central spinal cord injury (1956). It is characterized by disproportionately more motor impairment of the upper than of the lower limbs, bladder dysfunction and variable sensory loss (pain and temperature) below the level of the cervical injury. For Richard C. Schneider the mechanism is a severe hyperextension injury and the anatomical finding indicate a central cord destruction with bleeding and hematomyelia. The pattern of the recovery is first return of the motor power in lower extremities; then bladder function and finally strength in the upper extremities reappears (finer finger movements coming back last). In our experience (28 cases) the incidence of the brachial diplegia is 20% of the cervical spinal cord injury and 31% of the incomplete cord lesions. The average age is 54 years. In the half of our cases hyperextension is the responsible mechanism and hyperflexion is present in one third of patients. Radiological findings indicate some vertebral displacement in 40% of cases and no patent loss of the bodies alignment in 28% of patients. Clinical investigations authorize the description of 4 clinical patterns: 1--Incomplete tetraplegia with more motor impairment of the upper extremities (57%), 2--Brachial diplegia (without loss of function of the lower limbs) 25%, 3--Brachial diparesis with total recovery (11%), 4--Incomplete cord lesions with Brown Sequard syndrome and brachial diplegia (7%). The review of the literature (Bohlman, Barraquer) and our anatomical findings show that central hematomyelia is not constant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Optochiasmatic diastasis in tumors with suprasellar extension and duplication of the chiasma]. / Le diastasis opto-chiasmatique dans les tumeurs à extension supra-sellaire avec duplication du chiasma.

The opto chiasmatic diastasis whose extreme form is a duplication of the chiasma, corresponds to a longitudinal cleavage, using the well known fasciculation of the optic fibres. It has been noticed four times in the sellar and para sellar expanding processes (two adenomas, one craniopharyngioma and one metastasis). Generally, this lesion of the chiasma goes with big tumors (grade II); it has been detected four times in frontal approaches (15%) while the rhinoseptal approach represents 85% of our cases. The diastasis of the optic fibers with tendency to form double chiasma, instead of being an exception, happens in 4% of sellars tumors. It is perfectly identified by the frontal surgical approach, but is really hard or impossible to be recognized by the rhinoseptal surgical way. The mechanisms and the prognosis of this lesion are discussed.

[Contrast medium turnover in discography (author's transl)]. / Valeur diagnostique de la durée du contraste dans la discographie lombaire.

Discography seems to have lost some interest for diagnosis in froomt of the new methods of myelo and radiculography with Metrizamide. But it remains still usefull before operation in some cases of lumbo-sciatic and cervico brachial pains. Beside the already known morphological disturbances of the disks it appeared very important to follow up the turnover of the contrast medium in the vertebral interspace. The turnover study of the contrast was performed by successives X ray views taken 12 hours, 24 hours and 48 hours after discography and also in some cases by the analysis of the half-life curve of a radioactive isotope (Technetium) injected jointly with the contrast in the disk. In the normal lumbar disk the contrast medium remains still visible after a delay of 24 hours, while it disappears completely at this time in cases of discopathy. This fact was also confirmed by isotope turnover. In cervical disk this information remains valuable but with a little shorter delay. This radiological sign remains trusty for the great majority of operated discopathies.

[Enlarged operations for atypical lombo-sciatic pain from disk origin (author's transl)]. / Interventions élargies pour lombo-sciatiques discales atypiques.

In certain forms of atypical sciatic pain the surgical treatment of the affection cannot be accomplished exclusively upon the disk. This study was done on 120 patients operated upon during a two year period. The major technics used had an action upon the articular processes and facets with or without removal of the disk. In 60 cases a desensibilisation of the region was equally done. The principal reason of the surgical treatment remains still to permit the decompression of the sick root. In certain circumstances a more important surgical treatment is required: laminectomy is performed in cases of stenosis or in other cases an inter body fusion by posterior approach (60 patients). The term atypical lombo-sciatic pain is applied essentially when there exists discordancy in the clinical and neuroradiological examination. Surgical cure is applied when the medical treatment has failed. The best results have been obtained in atypical sciatic pain when facet rhizolysis has been associated with root decompression. However great care was taken to prevent the act from being destructive.

[Use of a transcutaneous neuro-stimulator as peroperative stimulator in neurosurgical treatment of spasticity and traumatic lesions of the peripheral nerves and brachial plexus]. / Utilisation d'un neuro-stimulateur transcutané comme stimulateur per-opératoire dans le traitement neurochirurgical de la spasticité et des lésions traumatiques des nerfs périphériques et du plexus brachial.

We have had the opportunity to use a standard percutaneous stimulator as an intraoperative stimulator, with the use of sterile leads, in order to palliate the sudden failure of our usual surgical stimulator. The simplicity and the possibility of modulation of the device, brought us to use it several times in different purposes of surgical work for spasticity, neurotization of the brachial plexus and treatment of fresh wounds of the nerves. Important features of this new way of using this device are simplicity of programation (width and frequency rates), good stability of chosen parameters, low diffusion allowing selective stimulation, and above all low cost versus standard devices used for this purpose.

[Chance's fracture]. / La fracture de Chance.

Described by Chance (1948) this fracture is induced by a mechanism of flexion distraction (seat belt fracture). The injury is characterized by the following (W.S. Smith, 1969): A disruption of the vertebral body by an horizontal splitting of this formation and neural arches through the pedicles, nor, or a minimum decrease in the anterior height of the involved vertebral body, no forward or lateral displacements of the superior vertebra, location of the disruption between the first and third lumbar vertebra in the majority of cases. Four patterns of Chance's fracture are isolated in this paper: First pattern: The osseous disruption cross the posterior arches, pedicles and vertebra. The fracture is unstable. Second pattern: horizontal fracture involves both pedicles with extension anteriorly through inferior third of the vertebral body (unstable). Third pattern: Chance's fracture with anterior vertebral extension through superior third of vertebra (unstable). Fourth pattern: fracture with anterior horizontal vertebral disruption in the posterior half of the body (stable).

[Osteosynthesis of the low lumbar spine and spondylolisthesis. Modification of the Scholner plate and pedicular screwing]. / Ostéosynthèse du rachis lombaire bas et des spondylolisthésis. Modification de la plaque de Scholner et de la visée pédiculaire.

A modification of Roy Camille's Technic for better screw location into the pedicle of vertebra of the low lumbar column and lumbo-sacral junction is reported. A small 5 millimeters resection of the inferior articular process allows a more cranial drill-hole which is more steadily in the pedicle of the vertebra as confirmed by X rays controls and anatomic specimens. A 10 degree slope to a caudal direction is needed at the L5 level and a 30 degree slope to a caudal direction is required at S1 level. 50 millimeters length screw can be used for adult patients. Some modification of Scholner's plate are proposed in spondylolisthesis surgery.

[Series of 17 cases of giant intracranial aneurysms. Long-term surgical follow-up and hemodynamic effects of arterial occlusions]. / Série de 17 cas d'anévrysmes géants intra-crâniens. Suites chirurgicales éloignées et effets hémodynamiques des occlusions artérielles.

The authors report their experience of 17 cases of giant intracranial aneurysms some of them with particular forms and localisations: Giant serpentine aneurysms in 17.6%, carotid cavernous, carotid, Willis Circle and vertebral branches. 8 cases were operated, 2 by direct neck occlusion and 6 others by carotid or vertebral interruption. For the nine non operated cases 5 were in a very bad clinical condition and 4 had refused the operation. Aneurysmal neck occlusion gave uneventful results lasting more than 4 and 10 years. Carotid or vertebral branches occlusion showed 16.6% mortality. In one case, the post operative death happened after 8 days of well tolerated carotid occlusion and in spite of a functional extra-intra-cranial anastomosis. Very good surgical outcome was seen in the other cases for over 3 and 22 years. Arterial occlusion in giant aneurysm surgery can bring multiple complications as in one case iatrogenic aneurysmal formation like in experimental Hassler and Hashimoto's descriptions. Curiously in the same way can be explained the ruptured intra cranial aneurysmal formation in some ischemic cerebral disease like Moyamoya syndrome or Takayashu disease.

[Tear drop fractures. Contribution to the study of the mechanism of osteo-disco-ligamentous lesions]. / La tear drop fracture. Contribution à l'étude du mécanisme et des lésions ostéo-disco-ligamentaires.

Since the original description by Schneider (1956), the tear drop fracture is designated as a flexion fracture. The C.A.T. investigation proves the coexistence of two lines of fractures: a frontal fracture (by mechanism of flexion), a sagittal fracture (by compression). The sagittal fracture affects the body and the posterior arch in 48% of Lee's cases (1982) as Jefferson's fracture. The tear drop fracture is a fracture by mechanism of flexion-compression with sagittal sprain of the inter vertebral cervical disk. --In our experiences C5 is the level of the most frequent lesion. --4 types of tear drop fractures are described: an occult form (C.A.T. diagnosis), tear drop without displacement, tear drop with moderate displacement, tear drop with posterior dislocation and kyphosis greater than 20 degrees. --The spinal cord damage corresponds to displacement of the two half vertebral bodies and posterior dislocation. --In case with posterior dislocation and kyphosis greater than 20 degrees complete tetraplegia or anterior spinal cord injury are often presents. --In case with asymmetrical posterior displacement of an half vertebral body the syndrom of Brown Sequard is constant. --The tear drop fracture is unstable and cervical spine fusion necessary.

[Complementary procedures to the Sjoqvist operation in cancerous cervico-facial pain]. / Gestes complémentaires à l'opération de Sjoqvist dans les algies cancéreuses cervico-facilaes

The trigeminal spinal tractotomy of Sjoqvist can be enlarged and give a very good result on cancer pain of face and throat. When pain is also cervical, it is usefull to associate with the Sjoqvist operation two important procedures: 1 degree--Instead of a simple posterior cervical radicotomy it seems best to practise a selective posterior radicellotomy. This technic has the advantage to preserve the sensory proprioceptive capacity of the superior limb, while being perform even until C6 and C7 roots. Also in case of recurrence of cervico brachial pain, it remains easy to apply a posterior spinal stimulation. 2--The spinal nerve has not only a motor function but also a sensory one. The sensory fibers travelling through small anastomosis between "LARUELLE Ganglion" and cervical roots must be separated to obtain a more complete analgesia.

[Inseparable prognostic value of spinothalamic and corticospinal functions in severe spinal cord injuries]. / Valeur pronostique indissociable des fonctions spinothalamique et corticospinale dans les traumatismes médullaires graves.

In severe spinal cord trauma with initial complete paraplegia or tetraplegia, even the smallest recovery of sensibility to pain or motor function has an obvious prognostical value as it results from the study of 112 spinal injuries. For the motor aspect it is well known from experimental work and in man that even a small part of a single pyramidal tract in the spinal cord can take in charge the bilateral motricity of the limbs. It remains exceptional in severe spinal cord injury that recovery of motricity is not followed by a return of pain sens. In the lateral funiculus of the cord the sensitive and pyramidal tracts belongs to a same anastomotic vascular area between the central and peripherical circulatory streams. In physiological conditions this intermediate circulatory stream is poorly functional. But in severe spinal cord trauma with reduction of central blood flow the adjacent spinothalamic and corticospinal tracts survive in couple on the basis of the same anastomotic vascular area: from this results the prognostical unity that belongs to pain sens and motricity.

[Iatrogenic carotid-cavernous fistulas, complications of carotid thrombectomy]. / Les fistules carotido-caverneuses iatrogènes, complications de la thrombectomie carotidienne.

The authors report four cases of carotid cavernous fistula at the C5 segment of the internal carotid artery following embolectomy by a 3F Fogarty Catheter. All patients were operated on a carotid bifurcation stenosis (pre-occlusive) and a thrombectomy with a 3F Fogarty Catheter was carried out in the same time in 3 patients and during re-operation in 1 patient who had post operative thrombosis. The carotid-cavernous fistula occurred the day after surgery in 2 cases, 1 week after in 1 case, and 2 months later in 1 case. Spontaneous recovery occurred in two patients (1 occlusion--1 re-stenosis), 1 patient died from controlateral carotid occlusion, and 1 patient was lost for investigation. There were no relationship between the number of "repeated passages" of the Fogarty Catheter and the interval time where the fistula occurred. However the location of fistula was constant. Overtension on the internal wall of the artery by the balloon could be advocated rather than a collateral torn of the intra cavernous internal carotid. Endoluminal treatment of various vascular lesion is increasingly used and iatrogenic problems as reported here should be kept in mind. Age and atheromatous lesion of carotid siphon appear to be the main risk factors.

[Prognostic elements at early stapes of severe spinal cord injuries (value of pain sensitivity]. / Eléments de pronostic à la phase précoce des traumatismes vertébro-médullaires graves (valeur de la sensibilité à la douleur

The prognosis in serious spinal cord injury remains difficult. The neurologist has a large number of elements at his disposal, but their reliability is uncertain. Clinical information, experimental work and recent data on medullar vascularization makes it possible to isolate diagramatically in the spinal cord a medium layer which contains the pyramidal and spino-thalamic tracts. The neighbourhood of these two fasciculi confers them a similar vulnerability to severe injury. Thus when an injured tetraplegic or paraplegic patient recovers his sensitivity to pain, he finally must recover his motor function and on the contrary, the recovery of motility is impossible without a return of pain sens. Clinical observation is in consequence of major importance as it shows that the recovery of sensitivity to pain, in the case of a patient with a serious spinal cord injury, is an argument for a favourable prognosis, whereas the recovery of an isolated tact perception does not in itself makes it possible to hope for eventual recovery of motor power.

[Is there currently a role for radical surgery of pain?]. / Y'a-t-il une place aujourd'hui pour la chirurgie radicale de la douleur?

Radical surgery of pain is destined for chronic and intolerable pain, resistant to causal treatment, and rebellious to the various medicinal therapeutics. Conventional neuro surgery by selective section of nociceptive fibers is very valuable for cancerous subjects with a limited life span. On the other hand, there has been skepticism concerning the real efficiency of neuro stimulation. The advance made in the knowledge of neurophysiologic and neurochemical mechanism of pain will allow a radical transformation as substitute for this invasive type surgery.