[Extracranial internal carotid artery aneurysm]. / Anévrysme de l'artère carotide interne dans sa portion extracrânienne.

INTRODUCTION: Extracranial aneurysm of the internal carotid artery is an exceptional finding. CASE REPORT: An 89-year-old woman consulted for a peritonsillar mass. Physical examination revealed a parapharyngeal pulsatile mass in the oropharynx. Computed tomography (CT) provided the diagnosis of extracranial internal carotid artery aneurysm. Endovascular or surgical treatment were declined. Anticoagulation medication was given. DISCUSSION: We reviewed the CT and magnetic resonance imaging findings and the clinical manifestations of extracranial internal artery aneurysm. Endovascular treatment is an alternative to open surgery.

[Image-guided epidural blood patch as effective treatment of intracranial hypotension. A case report]. / Le blood-patch épidural thoracique radioguidé: un traitement efficace du syndrome d'hypotension intracrânienne.

We report the case of a patient with postural headache. A CT scan revealed bilateral subdural hygroma. Brain MRI showed diffuse pachymeningeal enhancement. A diagnosis of intracranial hypotension was therefore made. Thoracic cerebrospinal fluid leak was proved by radionuclide cisternography and contrast myelography. Conservative medical treatment was ineffective. Two thoracic epidural blood patches with radiographic control were made. We think the blood patch is the most important element for success.

[Therapeutic strategies in somatotroph adenomas with extrasellar extension: role of the medical approach, a consensus study of the French Acromegaly Registry]. / Stratégies thérapeutiques dans les adénomes somatotropes avec extension extrasellaire. Place du traitement médical. Etude consensus du Répetoire français de l'Acromégalie.

UNLABELLED: From the first 198 patient files included into the French Acromegaly Registry, we analyzed 68 patients harboring a somatotroph adenoma with extrasellar extension, after exclusion of those treated by stereotactic or conventional radiotherapy. In these patients (including 37 women), aged 21-77 yr. (45.7 +/- 13.3), GH concentrations ranged from 2-260 microg/L (38.6 +/- 44.3), and IGF I from 86-967% of age-matched upper limit of normal (303 +/- 164). Maximal diameter of the adenoma at MRI was 11-36.5 mm (20.4 +/- 6.5), with cavernous sinus involvement in 68% of cases. Three subgroups were defined: 20 patients treated by long-acting somatostatin analogs only (group M), for a mean duration of 3 yr. (extremes 1-7 yr.), 48 patients initially treated by transsphenoidal surgery (group C), of whom 21 were secondarily treated by long-acting somatostatin analogs (group CM) for a mean duration of 1.2 yr. (extremes 0.2-2 yr.). All 3 groups were not statistically different in terms of tumor mass and initial levels of GH and IGF-1. Patients from group M were significantly older than those of the other groups (p<0.05). RESULTS: 46% of patients from group C after surgery vs. 45% of patients from group M had a mean GH below 2.5 microg/L. Biochemical remission (GH<2.5 microg/L and normal IGF1 normal) was obtained in 31% of cases in group C, vs. 25% in group M. In this group, a decrease of the largest tumor diameter was observed in 10 patients (71.5%), ranging from 10-25% in 7 (50%) and exceeded 50% in 3 (21.5%). In group CM, the biochemical remission rate (42%) and final GH or IGF1 values were not significantly different from group M. In conclusion, these data suggest that surgery or long-acting somatostatin analogs have a comparable efficacy in terms of remission rates in somatotroph macroadenomas with extrasellar extensions.

[Hemangiopericytoma of the infratemporalis fossa: a multi-operated patient]. / Hémangiopéricytome de la fosse infra-temporale.

Hemangiopericytoma (HPC) was diagnosed in a 65-year-old man in 1991. Initially the tumor was located in the maxillary sinus. Resection was followed by multiple recurrences involving the infratemporalis fossa (ITF), the nasopharyngeal region, and the right tonsillar region. Over a 10-year-old period, the histology pattern remained unchanged. Multiple approaches, as described in the literature, were used for resection depending on the site of the recurrence. To data, no malignant structure has been identified. Pain and cranial nerve deficits (V2, V3) have been the main squeleae. This case points out the limitations of radical resection because of the difficulty of the approach to this anatomic region. CT scan must be performed to choose the best access route depending on the primary site of the tumor and its extension.

[Tracheocele: a rare cause of pharyngeal disorders]. / Trachéocèle: une cause rare de gêne pharyngée.

A 40-year-old woman with an uneventful history consulted for an episode of cervical swelling and pharyngeal disorders with sensation of a foreign body. Cervical and ENT examination was normal. The barium swallow showed a normal esophagus and the CT scan showed an air image in the right side of the trachea. The diagnosis of tracheocele was made at surgery and was confirmed by histology. Clinical, endoscopic, and radiologic outcome was favorable three months after surgical resection of the diverticulum. Tracheocele is rarely reported in the literature. It results from a congenital or acquired weakness of the tracheal wall. The right side is involved more frequently. No specific signs or symptoms have been identified. Diagnosis is often based on CT findings. Surgery confirms the diagnosis and allows resection.