The seizures of frontal lobe epilepsy. A study of clinical manifestations.

We describe ictal clinical manifestations of frontal lobe epileptic seizures in 22 patients. After examination of all ictal clinical data, 14 catergories of signs and symptoms were established. The validity of the ictal clinical data used was confirmed on the basis of 99 frontal lobe seizures recorded by tele-electroencephalogram or tele-stereo-electroencephalogram. The main conclusion is that the frontal lobe appears to be partially connected with motor acitivity.

In vivo localization of brain sulci by arteriography: a stereotactic anatomoradiological study.

The authors studied the course of the cortical arteries using the Talairach stereotactic system (orthogonal 4.8 m teleradiography, with rigid fixation of the skull in the stereotactic frame) in both anatomical specimens and normal bilateral carotid angiographies of epileptic patients. Anatomoradiological correlations between arterial patterns and underlying brain surface were identified by detailed 3-dimensional analysis of brain-skull preparations, where gyri and injected arteries were dissected progressively with stereotactic X-ray and photographic pictures taken at each step. The vascular landmarks so identified were studied in stereoscopic arteriographies that give a direct visualization of the spatial relationships of the arterial tree moulding the cortical surface thus allowing the recognition of the localization of the principal gyri and sulci. The latter were drawn on stereotactic diagrams. The basic sulcal pattern as shown by the arteries is strikingly symmetrical in both hemispheres of the same individual, in spite of variability in branching of the arterial tree. The disposition of the vascular landmarks in the retroinsular region reflects the left-right asymmetry of the planum temporale that can be recognized in vivo. This can give a clue to the study of anatomofunctional correlations with regard to speech dominance. A limited first series studied in this respect strongly suggests a close relationship between anatomical and functional asymmetry of the human cerebral hemispheres. Generally speaking, the authors feel that 3- dimensional, anatomical interpretation of angiography permits a direct localization of brain structures including the cortex, that can be used instead of indirect localization landmarks in stereotactic explorations, and further, that the wealth of anatomical information that can be drawn from angiography with their method may be helpful in diagnosis or for planning surgery.

Distribution of growth hormone and thyroid-stimulating hormone in cerebrospinal fluid and pathological compartments of the central nervous system.

Human growth hormone (HGH) radio-immunoassay (RIA) was adapted for an accurate measurement of immunoreactive HGH concentrations in the CSF in different cases of hypothalamic-somatotropin dysfunctions. In control subjects (n = 43) mean HGH levels were 0.35 +/- 0.03 ng/ml in CSF and 1.95 +/- 0.2 ng/ml in plasma with a CSF/plasma ratio of 17%. The thyroid-stimulating hormone (TSH) RIA gave in controls mean basal levels of 2.65 +/- 0.2 muU/ml in CSF and 5.95 +/- 0.3 muU/ml in plasma with a CSF/plasma ratio of 44%. HGH and TSH concentrations in CSF and plasma show a very good correlation; but the regression curves for both hormones are distinctly different and appear specific for each polypeptide hormone. Hypothalamic-somatotropin hyperreactivity was reported in diabetic retinopathy (DR). CSF and plasma HGH concentrations in a group of diabetic patients with progressing retinopathy (n = 27) were not different from those in normal subjects (respectively 0.35 +/- 0.05 in CSF and 2.10 +/- 0.25 ng/ml in plasma with a CSF/plasma ratio of 16%). The HGH regression curve obtained in diabetics is similar to that of controls. These data do not substantiate the hypothesis of an HGH hyperreactivity in diabetic retinopathy. In somatotropin hypersecretion (acromegaly) without adenoma suprasellar extension, higher HGH concentrations recorded in CSF than in plasma cannot be attributed to an anatomical break-down of the CSF blood-brain barrier and suggest an active transport process of pituitary hormones to the CNS. HGH and TSH concentrations were measured in the cystic fluid of CNS tumors. In 1 case of a cystic dysembryoma, the HGH and TSH of CF were considerably increased. In gliomas (n = 8) the HGH and TSH cystic fluid concentrations were more elevated (respectively 0.72 +/- 0.2 ng/ml and 3.6 +/- 0.7 muU/ml) than in the CSF of controls.

Interstitial gamma irradiation by 198Au of the pituitary in diabetic retinopathy. Selective growth hormone blockade and ocular results.

Pituitary interstitial irradiation by stereotaxic implantation of a gamma pointemitter was performed in 110 patients with progressing diabetic retinopathy. Reduction of growth hormone secretion peaks was delayed, but was consistent and selective in all cases controlled by somatotropin stimulation test, while other pituitary secretions remianed unchanged in all but five cases. In 31 patients who had no associated photocoagulation, long-term postoperative assessment showed significant improvement of hemorrhages and intrarentinal new vessels with preservation of visual acuity. Preretinal vascular proliferation (except when treatable by photocoagulation), extensive retinitis proliferans, and macular deterioration are contraindications. This technique represents a new approach in the functional pituitary neurosurgical treatment of diabetic retinopathy and differs from all other procedures that result in a more or less complete hypophysectomy.

Surgical therapy for frontal epilepsies.

We have described our 25 years experience concerning 100 patients operated on for frontal epilepsy. Results show that 55% of patients are practically cured of their seizures and that 76% benefited from cortectomy (reduction of more than 75% of seizures). These results are the worst in the total series of St. Anne. Reasons for success and especially failure were analyzed in detail: 1. SEEG methods gave good indications along three dimensions of the limits and borders of the cortical excision. 2. When clinical semiology and organization of ictal discharges give evidence for rapid bilateral discharge, with involvement of axial musculature and generalized tonic-clonic manifestations, experience shows that it is necessary to combine cortectomy with a section of the adjacent cortico-subcortical fibers of the corona radiata, as if propagation of ictal discharges were impeded if not interrupted by sectioning such fibers and the primary site were incapable of expressing itself clinically. 3. If the characteristics of seizures suggest the quasisimultaneous involvement of the two frontal lobes and the existence of bilateral multifocal epilepsy, we suggest that a systematized anterior callosotomy might lead to useful results. 4. Finally, we propose general criteria for indications and contraindications for surgery.

[Acute transient Korsakoff's syndrome caused by hematoma of the floor of the 3rd ventricle]. / Syndrome de Korsakoff aigu et transitoire par hématome du plancher du 3e ventricule.

A forty four year-old woman had had an amenorrhea-galactorrhea syndrome for 3 months when a Korsakoff's syndrome with headache suddenly appeared. Neuroradiological investigations revealed a hematoma involving the anterior part of the IIIrd ventricle. After a short period of neurogenic hypernatremia the lesion disappeared with the development of a spontaneous ventriculocisternostomy. Simultaneously, the Korsakoff's syndrome decreased until it went off almost completely, but a diabetes insipidus appeared and the hyperprolactinemia remained unchanged. Four years later, those are the only symptoms which are still present. This case, particular by its aetiology and evolution, illustrates well the possibility of functional Korsakoff's syndromes.

[Definition of limits and 3D configuration of cerebral gliomas. Histological data, therapeutic incidences (author's transl)]. / Délimitation et configuration spatiale des gliomes cérébraux. Données histologiques, incidences thérapeutiques.

In neurosurgical common practice, the only histological informations usually taken into account for the treatment of gliomas are the histological type and degree of malignancy. Nevertheless, from a therapeutic point of view the spatial development of the tumor should be considered as a point of paramount importance. This spatial development can be evaluated in vivo with the help of C.T. scan and stereotaxic biopsic exploration. From the study of 150 astrocytic, oligodendrocytic or composed which have been explored by serial stereotactic biopsies, we tried to codify the histological informations so as to express, in a simple and practical way, both the histological type and malignancy together with the 3 D configuration of the tumor. This codification is a useful contribution to the choice of therapy, further more, it helps to assess and to compare therapeutic protocols on homogeneous tumor groups.

[Reliability of a simplified method of localization of CT images. Correlation with stereotaxic results in 30 cases]. / Fiabilité d'une méthode simplifiée de transposition des images TDM. Corrélations au repérage stéréotaxique dans 30 cas.

A simplified method of localization of cerebral lesions by reference to CT Scan images was compared systematically in 30 cases, with localization obtained under stereotaxic conditions. The comparison was made in reference to the pineal gland and certain ventricular landmarks. The uncertainty of the method in an angular plane is less than or equal to 2,5 degrees; it is less than or equal to 3 mm in a linear plane in more than 90% of the cases.

[Current experience of stereotaxic irradiations in the treatment of hemispheric gliomas (author's transl)]. / L'expérience actuelle des irradiations stéréotaxiques dans le traitement des gliomes hémisphériques.

Authors present a short review of the techniques and results of the stereotactic focal irradiations (S.I.) used at present in France for the treatment of small "active" gliomas localized in high risk areas (functional and vital) of the brain. These techniques include the temporary interstitial implantation of 192Ir wires, possibly associated with external irradiation and the treatment of active glioma cysts by intracystic injection of colloidal beta emitters such as 90Y and 186Re. The risk of immediate (surgical) and late (radiation) functional loss is low and the overall results at 3 years are satisfactory in particular with small well delimited astrocytomas. Such treatments can be associated to surgical reduction of the tumor volume or to other forms of irradiation according to the data of stereotactic localization studies including biopsy.

[Indications and results of interstitial hypophyseal stereo-gammatherapy in the treatment of diabetic retinopathy]. / Indications et résultats de la stéréo-gammathérapie interstitielle hypophysaire freinatrice (stéréo-GIHF) dans le traitement de la rétinopathie diabétique.

New interest for pituitary neurosurgery in diabetic retinopathy is based on several data: long-term efficacy of various medical therapeutic agents is still unproved, ocular treatment by photocoagulation remains symptomatic, growth-hormone (HGH) has a permissive or supportive role in the development of diabetic retinopathy. Stereo-GIHF performs the pituitary interstitial irradiation by stereotaxic implantation of a gamma point emitter (198Au) and results in the selective blockade of HGH secretion peaks. Different from all other procedures achieving a more or less complete hypophysectomy, Stereo-GIHF introduces a new trend for the functional neurosurgical treatment of diabetic retinopathy.

[Familial forms of intracranial cavernous hemangioma. Apropos of 5 cases in 2 families]. / Formes familiales des hémangiomes caverneux intracrâniens. A propos de 5 cas dans deux familles.

The authors report five cases of cavernous hemangioma belonging to two families. In the first family, an 8 year old child was operated on in 1970 for a left frontal location. His mother, aged 39, was operated on in december, 1981, with stereotaxic approach, for two locations: one was frontal location, the other one was in the pineal region. Among the second family, a 21 year old woman was operated on in december 1976, for a cerebellar cavernous hemangioma. Her sister, aged 18, presented with subarachnoid hemorrhage in january 1980. C.T. scan showed a right temporal high attenuation area. This patient was not operated on. The aunt to those two sisters was operated on in october, 1981, for a left temporal cavernous hemangioma. Those five cases represent about half of the intracranial cavernous hemangiomas operated on in the Lille Neurosurgery Department since 1967. Even, unusual, the familial occurrence of this affection must be admitted. It shows a nosological interest, but also allows prevention by searching and surveying the asymptomatic cases, or genetic evaluation of disease risk.