Chromosomes in gliomatosis cerebri.

Gliomatosis cerebri is a rare brain tumor which histologically resembles a diffuse cerebral astrocytoma. It can simultaneously infiltrate multiple sites in the cerebrum, cerebellum, brainstem, and spinal cord. This remarkable diffuseness has led to the idea that gliomatosis cerebri does not derive from a solitary focus but must arise from a broad field of glial cells. We studied the chromosomes from gliomatosis cerebri in a 12-year-old boy by conventional cytogenetics and fluorescence in situ hybridization (FISH). Aside from normal cells, we found a majority of cells with the karyotype 44,XY,del(6)(q25),del(14)(q21), der(15;21)(q10;q10),add(18)(q22),del(19)(p12),add(20)(p13),-21. A smaller proportion of cells had 88 chromosomes with a doubling of this abnormal karyotype. These findings are consistent with a clonal neoplasm stemming from a single cell. The chromosome changes we observed, with the possible exception of the chromosome 6 deletion, did not resemble those frequently found in astrocytomas. Gliomatosis cerebri may therefore belong to a separate category of brain tumors.

[Single cerebral metastasis of bronchopulmonary cancers]. / Métastases cérébrales uniques des cancers broncho-pulmonaires.

The most frequent brain metastasis originates from a lung cancer. About half of them are unique. We report a series of 36 patients with lung cancer, operated for a single brain lesion. The mean age was 57.6 years, most (83.3%) were male. Most of the metastases originated from a primary adenocarcinoma (52.8%), in 10 patients (27.8%) from an epidermoid carcinoma, in 4 patients (11.1%) from a small cell carcinoma and in 3 patients from a mixed lesion. The metastatic lesion was detected before the primary lesion in 20 cases (55.5%). The mean post-operative survival was 9.6 months. 36% were alive one year after surgical treatment. We evaluated our clinical findings, histopathological studies and the type of surgical and medical post-operative management, at the cerebral and pulmonary level, in order to make a possible prognosis. In our series we found that only post-operative clinical status (Karnofsky score) and the post-operative neurological grading (Order classification) were significant factors (p < 0.001) to determine survival time.

[Intracranial cavernoma. 30 cases]. / Les cavernomes intracrâniens. 30 observations.

During the last few years, as a result of improved neurodiagnostic procedure there has been an increase in the number of intracranial cavernous angioma. We present 30 cases totalling 32 cavernous angiomas. Twenty-one received a successful surgical treatment. Twenty-four angiomas were supratentorial (75 percent) and 8 subtentorial (25 percent). Cavernous angiomas are congenital vascular malformations, usually of small size, with multiple vascular cavities surrounded by fibrous walls. They are often found in young adults (mean age 35 years in our series), most frequently located in the supratentorial white matter. The presenting symptoms were epilepsy, haemorrhage and an expanding mass syndrome. In this series, 16 patients had epilepsy (53 percent), 7 had haemorrhage (23.5 percent) and 7 had a mass syndrome (23.5 percent). The diagnosis of this lesion, usually obtained with angiography, has been dramatically improved by CT scan and, particularly, MRI. The natural history of cavernous angiomas is still poorly understood: the major complication is haemorrhage. Total surgical excision is the treatment of choice: it avoids a possible haemorrhage and is effective in relieving epileptic seizures. The indication for surgery depends on the clinical symptom and the location of the lesion. The post-operative morbidity in our 21 operated cases was fairly low due to minor sequelae. In only 2 of the 16 patients who had epilepsy the clinical seizures persisted after surgery, but they were less frequent. The literature is reviewed.

[Primary lymphoma of the cranial vault. Apropos of a case]. / Lymphome primitif de la voûte. A propos d'un cas.

Primary lymphomas of the cranial vault are most unusual lesions. Only six cases have been described in the literature. We report a case of a 71 year old female who was admitted with an occipital mass. A C.T. scan revealed a mainly extra cranial tumor with an osteolysis of the cranial vault and a small intracranial component. It was diagnosed as a phenotype B centroblastic lymphoma. Half of the patients reported in the literature had a subcutaneous mass as the main symptom. These neoplasms are usually highly malignant tumors. The treatment realized is neurosurgical excision followed by chemotherapy and radiotherapy.

[Extradural intracavernous epidermoid cyst. Apropos of 2 cases]. / Kyste épidermoïde intra-caverneux extra-dural. A propos de deux observations.

The authors report two cases of intracranial, extradural, intracavernous epidermoid cyst. In one case the cyst was ruptured into the subarachnoid space and in the substance of the temporal lobe. The two cysts had to be subtotally resected because of dense adherences with the internal carotid artery. In both cases the post-operative periods were uneventful.

Evidence for CSF accumulation of 5-methyltetrahydrofolate during repeated courses of methotrexate plus folinic acid rescue.

In the first part of this study the availability of folinic acid (FA) and its main active circulating metabolite, 5-methyltetrahydrofolate (5-MTHF), were studied in plasma and cerebrospinal fluid (CSF) from normal subjects after i.v. administration of 100 and 250 mg of FA. 5-MTHF rapidly appeared in plasma, the maximum value being reached at the first observation time point (1 h). FA was eliminated in plasma more slowly than 5-MTHF. Between the two doses, there was no evidence of modification in pharmacokinetic parameters (terminal half-life, clearance) for either FA or 5-MTHF in plasma and CSF; 5-MTHF was the only product detectable in CSF. Considering FA plus 5-MTHF together, the AUC (area under the curve) ratios between CSF and plasma were close to 1%. 5-MTHF was cleared very slowly from CSF (t 1/2 = 85 h). This finding suggested possible accumulation of 5-MTHF in CSF during repeated administration of FA combined with medium or high dose MTX. In the second part of the study, dealing with a group of eight children treated by such protocols, an increase in CSF 5-MTHF was detected from cycle to cycle in five (r = 0.91, P less than 0.01) with a maximum at 5 x 10(-8) M. This progressive accumulation of 5-MTHF in CSF may have a negative effect on the local action of MTX and should be taken into account for therapeutic strategies designed for the management of meningeal leukaemia.

[Intracranial arterial aneurysm in children. A cooperative study. Apropos of 43 cases]. / L'anévrysme artériel intra-cranien chez l'enfant. Etude coopérative. A propos de 43 observations.

This joint study describes 43 cases of intracranial arterial aneurysms in children diagnosed on the basis of clinical symptoms. In the pediatric age group, this malformation is notable because of the marked sex predilection in males (70%) and an unequal topographic incidence in the circle of Willis, where carotid artery (39.3%) and anterior communicating artery lesions (30%) predominate. The most frequent clinical sign was subarachnoid hemorrhage (81%), although symptoms caused by compression revealed the abnormality in 2.3% of patients. In this series, 11% of the patients suffered a head injury at the time of the hemorrhagic accident; this finding has been reported previously in the literature. Today, treatment is always surgical, consisting in removal of the aneurysmal sac. Surgical results are encouraging; all grade lesions considered together, 63.4% of the children were cured without any sequelae, 19.5% lost one school year but were able to lead a normal life, and 4.8% remained severely handicapped; overall postoperative mortality was 12.3%. Cerebral plasticity and tolerance of spasm in children are fundamental features of this aneurysmal pathology which partially explain the favorable results obtained with surgery.

[Statistical EEG detection of subjects with intracranial tumors. Study of a sample of 40 quantified recordings]. / Détection statistique des EEG de sujets porteurs d'une tumeur intracrânienne. Etude sur un échantillon de 40 enregistrements quantifiés.

Spectral analysis of 16 channel EEG recordings was applied to 40 normal subjects (N) and 40 patients with supratentorial intracranial tumor (T). A set of 22 spectral parameters was computed from each lead. This study tries to evaluate if univariate and multivariate scoring techniques of quantified EEG data can achieve good separation of the two groups. A reference profile of data is derived from the standardized data of the group N. The 40 patients as well as the 40 normal subjects are compared to the reference data profile. Scorings from 264 univariate features do not separate the two groups. Scorings from a smaller number of multivariate features proved to be more powerful and distinguished 90% of patients. Badly classified subjects are discussed.

[Epidermoid cysts of the cranial vault in children. Apropos of 6 cases]. / Les kystes épidermoïdes de la voûte crânienne chez l'enfant. A propos de 6 cas.

Six observations of epidermoid cysts of the cranial vault in children are reported. The main clinical sign is a cranial tumefaction; the radiological data consist in an edged osseous gap; the surgical extraction of this evolutional tumor is indicated.

[Cystic dilatations of the subarachnoid space at the lumbo-sacral level. Clinical and therapeutic aspects]. / Dilatations kystiques de l'espace sous-arachnoïdien à l'étage lombo-sarcré Aspects cliniques et thérapeutiques.

The cystic dilation of the sub-arachnoidal space individualised by Tarlov in 1938, may be integrated in the diagnosis of non discal surgical sciatica. The classification proposed by Lazorthes sumes up the eventualities encountered at the lombo-sacral level. The clinical study of five personal observations and the analysis of literature enable the establishment of a clinical picture evoking the anomaly. It would appear that the affection is characterised by lumbago or lumbo-sciatica, the attacks separated by free intervals. In an acute period the algia lessens in the Trendelenbourg position. A significant sign would be the pain on moving the sacrum. Among the complementary examination the radiographic study of the sacrum with tomographies is indisplusable, the diagnosis is based on the radiography of spinal nerve roots with late time in a vertical position. Medico-surgical treatment is in order, it gives a favorable result when surgical criteria have respected: invalidating evolutive algia with or without a clear sign of deficiency. The surgical result is essentially conditioned by a strict indication.

[Radio-anatomical study of the main trunk of the middle cerebral artery (author's transl)]. / Etude radio-anatomique du segment basal de l'artère sylvienne.

This work corroborates anatomical data well known since G. Lazorthes about the main trunk of the middle cerebral artery. The data are interesting in various fields: Sylvian aneurysms, big sphenoïd ridge meningiomas, extra-intra cranial micro neurosurgical anastomoses. This work is based upon 280 angiographic pictures, 20 dissections of brain arteries and 12 plastic injections of the brain arterial vascular tree. The most important data to point out are variations of length and of division (no division, simple bifurcation, trifurcation or multiple divisions), variability in the central arteries and some rare anomalies like accessory middle cerebral arteries and duplication.