Prolactin secreting adenoma in 22 men.

The authors report on 22 men with a prolactin secreting adenoma. Clinical symptomatology included associated signs of tumoral compression with varying degrees of hypogonadism. Endocrinological evaluation disclosed hyperprolactinemia in all cases but one, and hypopituitarism in 10 of 22 cases. Of the 22 patients, 21 underwent transsphenoidal microsurgery (two of whom underwent a second procedure by the infrafrontal approach) and in one case surgery was performed by the infrafrontal route. Diagnosis was confirmed by immunocytochemical evaluation of tumoral tissue. Prolactin levels returned to normal in 32% of cases after operation and became normal after complementary bromocriptine therapy in 54.5% of cases. However, normal prolactin secretion was not consistently accompanied by a return to normal of gonadotropin regulation. In three patients radiotherapy was not effective. The latter treatment should be limited to the very rare cases of postoperative resistance to bromocriptine.

[Hemichorea in acquired immunodeficiency syndrome. Toxoplasmosis abscess in the striatum]. / Hémichorée au cours du syndrome d'immunodéficience acquise. Abcès toxoplasmiques dans le striatum.

Three HIV seropositive patients presented with cerebral toxoplasmosis which was treated by anti-infectious agents. After partial improvement, they developed hemichorea related to striatal infectious lesions. In AIDS patients with cerebral toxoplasmosis, autopsy series have reported a high incidence of basal ganglia abscesses, explaining the occurrence of involuntary movements such as hemichorea.

[Angiographic study of cerebral convolutions and their area of vascularization]. / Etude angiographique des circonvolutions cérébrales et de leur territoire de vascularisation

The authors demonstrate the facility with which the principal fissures and sulci of the brain can be angiographically localized by reference to characteristic loops and bends in the courses of the branches of the anterior, middle, and posterior cerebral arteries. The study is based upon dissections of 150 human brains in which the arteries of interest were selectively injected. A propos to this anatomic-angiographic correlation the authors also describe the vascular territories of each cortical branch and propose a simple procedure for the evaluation of these territories during cerebral angiography.

[Paralytic pontine exotropia disclosing endocarditis]. / Exotropie pontique paralytique révélatrice d'une endocardite.

A case of bacterial endocarditis complicated by paralytic pontine exotropia is reported. Magnetic resonance imaging clearly showed a rostral lesion of the paramedial pontine reticular formation and the medial longitudinal fasciculus. The occurrence of paralytic pontine exotropia is suggestive of ischaemia, and patients with this so-called "one-and-a-half syndrome" associated with signs of infection should be investigated for endocarditis.

[Preoperative approach to the histologic diagnosis of cerebral tumors by combination of clinical and paraclinical examinations (EEG, computerized cerebral tomography, scintigraphy, and angiography)]. / L'approche préopératoire du diagnostic histologique des tumeurs cérébrales par la conjonction des examens cliniques et paracliniques (E.E.G., tomographie cérébrale avec ordinateur, scintigraphie, angiographie). A propos de 100 observations de sujets adultes opérés.

The authors present their last series of one hundred operated cerebral tumors (19 meningiomas, 16 benign gliomas, 38 malignant gliomas, 20 isolated metastasis, 8 diversified tumors) studied on the clinical, E.E.G., isotopic scanner, computorized tomographies and angiographic point of view. The comparison of these multiple exams, permits one to determinate the malignant of benign nature of a tumor in 86 p. 100 of the cases and the precise histological nature in 56 p. 100 of the cases. The biopsy effectuated in stereotaxic conditions permits to solve the problem in uncertain cases. The interest of computorized tomography is emphasized (discovery or confirmation of a suspected tumor, definition of its extension in depth), but this recent technic is incapable of constant confirmation of the histological diagnosis; it cannot replace other confirmed methods of diagnosis. The angiography remains necessary to guide the surgical gesture.

Value of MRI in the morphological evaluation of tumors of the third ventricle.

The detection or suspicion of a tumoral expansive process in the third ventricule is usually performed by MRI. The contribution of MRI to the diagnosis is unquestionable in view of its accuracy in the topographical characterization of these lesions and in the detection of small formations. The great histological variety of tumours in that region may result in different treatments which can be associated. MRI, therefore, plays an important role in pretherapeutic morphological evaluation. Fifteen patients with tumour of the third ventricle were examined by MRI before treatment. The results of these examinations were compared with the pathological data and the therapeutic procedures: ventricular shunting, stereotactic needle biopsy, radio- or chemotherapy and surgery. MRI cannot provide a formal histological characterization, but it can individualise some categories of tumours, give details on the walls of the third ventricle (notably in the case of bifocal pineal and suprassellar lesions), visualize the paths of CSF flow and predict the need for cisternoventriculostomy, and detect venous structures in the vicinity of the great cerebral vein which might result in post-biopsy and post-surgery complications.

[Stereotaxic guidance in open surgery of the brain]. / Guidage stéréotaxique de certaines interventions à crâne ouvert.

The authors describe the technique used to precisely locate, before surgical ablation, small superficial or deep seated intracerebral lesions. When they are superficial, a burrhole is placed above the lesional site, that is reconstructed by superimposing the CT image onto a plain film radiogram taken during stereotaxy. Deep seated lesions are localized by inserting a guide under stereotaxy, prior to open surgery, which will lead the neurosurgeon without error from the cortex to the lesion. 37 observations are reported where this technique lead to a greatly simplified intervention with minimal cortical damage.

[Modern imaging and stereotaxy]. / Imagerie moderne et stéréotaxie.

The authors present their technique of utilization in stereotaxic neurosurgery of CT and IRM documents realized in standard condition. Besides, they present an original apparatus that allows to combine the advantages of Leksell and Talairach's stereotaxic system.

[The role of stereotaxic biopsy in the therapeutic approach to malignant gliomas (author's transl)]. / Place de la biopsie en condition stéréotaxique dans la tactique thérapeutique des gliomes malins.

Analysis of 770 biopsies of intra-cerebral neoplasms under stereotaxic conditions and performed in Bordeaux, Rennes and Marseilles. The study emphasized the relative benign nature of this examination (1% deaths, 1.4 % severe sequellae) bearing in mind the severity of the underlying disease. In a very large number of cases (from 7 to 38% according to Schools) the diagnosis made before biopsy was fundamentally altered by this examination. The quasi-certitude of the nature of the lesion, and the possible facilitation of surgery by the precision of the lesional topography, and finally the possibility of a therapeutic gesture of evacuation in certain cases, is felt to justify intra-cranial biopsy performed under stereotaxic conditions.

[Colloid cysts of the third cerebral ventricle. Computed x-ray tomography, MRI and stereotaxic puncture. Apropos of 9 cases]. / Kystes colloïdes du 3e ventricule. Scanner, I.R.M. et ponction stéréotaxique. A propos de 9 observations.

The authors report their experience with Colloid Cysts of the third ventricle (9 cases treated between 1983 and 1989). Eight of them were punctured using stereotactic approach; five cysts were completely evacuated and the patients are free of recurrence. In three cases, tapping was impossible or the cyst insufficiently evacuated and the patients were secondary operated on (open microsurgical approach). The last case was directly operated on. Colloid cysts cured by stereotactic puncture were all hypo or iso-dense at C.T. scan and had a diameter of more than 1 cm. All these cases have had a M.R.I. exploration and the image of the cyst was always the same increased T1 and T2 signal. Unfortunately, we did not have the opportunity to realize M.R.I. in colloid cysts of a small size and hyperdense at C.T. scan. These results can help to the indication of a stereotactic puncture at the first attempt in some well defined colloid cysts.

[Advances in the contributions of imaging to stereotaxic localization of cerebral arteriovenous malformations for radiosurgery ]. / Evolution des données d'imagerie dans le repérage stéréotaxique pour la radiochirurgie des malformations artério-veineuses cérébrales.

Historically, angiography was one of the first diagnostic methods to allow for visualization of neurovascular structures. It has been and still is very useful for precise evaluation of vascular pathology and is one of the main elements in treatment planning for radiosurgical targets. It is the only imaging method that gives insight into the angioarchitecture of a cerebral arteriovenous malformation, possibly reducing the target volume. Construction of frames (Leksell, Fisher) that are compatible with cross-sectional imaging methods, such as CT and MRI allowed there use for planning of stereotactical treatment for brain cerebral arteriovenous malformations. The advantages of these methods are given by the fact, that they are less invasive and that they allow visualization of neurovascular structures and surrounding cerebral structures. Further evolution of the cross-sectional imaging techniques allowed reconstruction of the image data in different planes and segmentation of structures such as vessels. Use of special algorithms allow visualization of the image data, i.e. surface rendering with 3D images of vascular structures. However, such images allow no detailed insight into the angioarchitecture of a cerebral arteriovenous malformation and give rather a view of the whole volume, i.e. a "tumor" aspect of the cerebral arteriovenous malformation. Similar images are currently also obtained with digital substraction angiography using rotational image acquisitions and image postprocessing allowing 3D reconstruction of angiographical image data. The different image evaluation methods are thus complementary all giving useful information for treatment planning. Therefore it would be useful to develop the possibility to integrate the information obtained by these modalities. Image fusion require identification of fiducial marks, what can be performed with application of external marks or by using internal anatomical marks. Recent developments allow now use of vascular structures as fidiucial marks to obtain image fusion. This paper reports on the evolution of stereotactical planning, performed on 541 patients over a period of eight years.

[Surgical results in prolactin-secreting pituitary adenomas (a propos of 40 personal observations)]. / Résultats chirurgicaux dans les adénomes hypophysaires à prolactine (à propos de 40 observations personnelles).

The authors present a serie of 40 histologically verified prolactin secreting adenomas. Thirty-four women and six men were explored using the usual techniques and operated by the transphenoidal approach with biological follow-up 3, 6 and 12 months post-operatively. Results were a function of tumor size and invasive potential. Although amelioration of the tumoral syndrome always resulted, fonctional and biological normalization were inconstant. Complementary anti-prolactin treatment (C.B. 154) was begun in the non-normalized patients, especially in the cases of invasive adenoma. --Normalization was achieved in 95% of enclosed adenomas, --In 61% of invasion adenomas. In those patients normalized following surgery a return to normal rythmic prolactin secretion was observed.

[Stereotaxic biopsies (SB) of intracranial neoplasms. Considerations apropos of 3,052 cases]. / Les biopsies stéréotaxiques (BS) des néoformations intra-crâniennes. Réflexions à propos de 3 052 cas.

On May 12th 1984 a meeting on stereotactic biopsies of intraencephalic lesions has been held in Marseilles. All French Neurosurgeons and Neuropathologists involved with this technique were present. This report presents, in one hand, the result of an investigation on 3 052 BS and, in the other hand, the synthesis of discussions held on the limits and dangers of the BS, morphology of the biopsy instrument, means of the definition of the target and the microscopic histologic technics and results.

[Gamma-knife radiosurgery for brainstem arteriovenous malformations. Preliminary results]. / Traitement radiochirurgical gamma-knife des malformations artério-veineuses du tronc cérébral. Résultats préliminaires.

BACKGROUND AND PURPOSE: Microsurgical resection have the advantage to be immediately effective according to bleeding risk and is the reference treatment for cerebral arteriovenous malformations. For cerebral arteriovenous malformations located in the brainstem gamma-knife radiosurgery due to its low invasivity is classically a first line treatment. We reviewed the Marseilles experience to assess the efficacy and safety of gamma-knife radiosurgery for brain stem arteriovenous malformations. METHODS: We analyzed retrospectively data of 45 patients with an arteriovenous malformation located in the brain stem treated in Marseilles by gamma-knife radiosurgery by between 07/92 and 12/99. Mean age was 42 years, there were 5 children. Arteriovenous malformations were located in the pons or midbrain for the majority of the patients. Intraaxial lesion was found in 82% of patients. Hemorrhage prior to radiosurgery occurred in 75% of the patients. Gamma-knife procedure was the first treatment of the arteriovenous malformations for 29 patients (65%); previous surgery was performed in 34 patients (15%). Mean nidus volume was 550 mm(3) (32-14 196 mm(3)). Mean margin dose was of 23 Gy (range 15-30 Gy). Follow up was available for 25 patients (mean 18 months). RESULTS: One patient presented a transient worsening of his neurological status, and 2 patients developed a fixed deficit. Two patients underwent rebleeding at an interval of 12 to 36 months after the gamma-knife procedure. At last angiographic follow-up (13 patients), the obliteration rate was 82% of the arteriovenous malformations. A second procedure was proposed to a patient with only partial occlusion at 3 years. CONCLUSIONS: Gamma-knife radiosurgery can achieve good obliteration rate of brain stem arteriovenous malformations with low morbidity and may be a valuable first-choice therapy for such arteriovenous malformations. A larger population and longer follow up are mandatory in order to confirm these preliminary results.

[Craniopharyngioma in children: MRI study of 43 cases]. / Les crAniopharyngiomes de l'enfant.

BACKGROUND AND PURPOSE: Craniopharyngiomas are intra-cranial tumors, relatively frequent in children, expanding in the pituitary stalk axis, from the third ventricle to the sphenoid body. Plain films and CT scan generally show a calcified lesion, deforming the sella turcica. MRI improves tumor description and topographic and structural analysis of the lesion. The aim of this study is to analyze the MRI aspect of craniopharyngiomas in a pediatric population and to correlate findings with surgical data. METHODS: MR and CT studies of 43 pediatric cases of histology-proven craniopharyngiomas were reviewed retrospectively. Tumor emergence, extensions and signal on different sequences were recorded. We searched for radio-surgical correlations. RESULTS: Craniopharyngiomas can be classified into two groups: intra-sellar tumors and third ventricle floor tumors (infundibulum and tuber cinereum). Preferential routes of extension are observed in each group correlated with consistency (cystic and/or solid). Surgical data confirmed these results. CONCLUSIONS: MRI is crucial for the pre-therapeutic evaluation of craniopharyngiomas allowing not only a detailed description of the tumor but also guiding therapeutic decisions. This series demonstrated that craniopharyngiomas exhibit two different types of localization and behavior. Embryonic development of the tumor explains the topographical differences.