Brain glycoprotein in tumours of the nervous system.

We studied various tumours of the nervous system by the immunofluorescence technique using an anti-brain specific alpha 2 glycoprotein antiserum (anti-NSA3 antiserum). We found the antigen in 24/27 astrocytomas and 4/4 oligodendrogliomas but in none of the 8 meningiomas tested. There was an identity between the astrocytoma/oligodendroglioma antigen and that of normal brain as shown by the immunoprecipitation technique. By the immunofluorescence technique using inhibition of the antiserum we demonstrated that the tumour antigen is devoid of some specific nervous system determinants present in normal brain.

Hyaluronan and hyaluronectin in the extracellular matrix of human brain tumour stroma.

Hyaluronan (HA) and the hyaluronan-binding glycoprotein hyaluronectin (HN) were measured in 23 gliomas and 8 meningiomas and their location was revisited in 35 tumours. A clear-cut difference was found in the HN/HA ratio values of glioblastomas (below 0.5) and that of astrocytomas (above 0.5 P < 0.001). Besides their location in the intercellular part of gliomas, HA and HN displayed a perivascular location in 1/3 astrocytomas, 17/24 glioblastomas, and 3/7 meningiomas, suggesting they could be produced also by the vascular stroma of tumours and that they would characterise the neoangiogenesis. All cultivated glioma cells tested produced HA in vitro, whereas only 1/11 cell lines produced HN, at a low level. The results obtained suggest that glioma HA and HN are produced by both cancer cells and vascular stroma cells, which contribute to the edification of the extracellular matrix. In meningiomas only the stroma would be responsible for HA and HN production.

Establishment and characterisation of a human glioma cell line.

A new cell line, CB109, has been established from a human glioblastoma multiforme. The cytoskeleton was positive for glial fibrillary acidic protein, vimentin and fibronectin. Hyaluronan (HA) and the HA-binding protein hyaluronectin (HN) were expressed in the cell cytoplasm and in the extracellular matrix of spheroids and plated cells. Hyaluronidase did not prevent spheroid formation suggesting that HA was not involved in the cell-cell adhesion. HA precoating prevented cell adherence to the plates and favoured spheroid formation. HA was secreted in relatively large amounts into the culture medium. High performance liquid chromatography demonstrated that HA was in the high molecular weight form. The rate of HN secretion by cells was very low. Basic fibroblast growth factor significantly increased the proliferation in vitro and tumour growth after grafting into nude mice. The epidermal growth factor receptor was not expressed on cultivated CB109 cells. Cytogenetic analysis showed polysomy 7, structural rearrangement of chromosome 10 short arm and a translocation 13q13-q14 without detectable alteration of the RB gene.

[Vasospasm and ischemia in a series of 60 aneurysms treated quickly surgically]. / Le vasospasme et l'ischémie dans une série de 60 anévrismes opérés tôt.

Sixty patients with ruptured cerebral aneurysms were operated during the first 3 days after the onset of bleeding. In all cases the following investigations were performed: before surgery and 10 days after surgery angiography and CTScan, two months later a control CTScan. The first CTScans have been classified according to the staging defined by Fisher. Vasospasms (VS) were assessed comparing the arteriographies before and after surgery and classified as narrow or moderate; ischemia were assessed on post surgical CTScans. VS were found in any of the Fisher grades but were more frequent in grade 4; they occurred in 50% of cases (30 cases). Narrow VS were found 17 times in any Fisher grade. Ischemia occurred in 7 cases (1 death); following narrow VS in 6 cases. The high incidence of VS demonstration is emphasized: it is probably due to the lag time between bleeding and angiography and to the fact that angiographic controls were systematically performed. On the other hand ischemia occurred in 7 patients: the respective role of normalized intracranial pressure, hypervolemia, drug use and surgical procedure are discussed as candidate factors of this low incidence.

[Treatment of colloid cysts of the third ventricle by cerebrospinal fluid shunt]. / Traitement des kystes colloïdes du 3e ventricule par dérivation ventriculaire.

The authors report 6 cases of colloid cyst of the third ventricle treated with unilateral ventriculo-atrial shunt and followed up 14 to 3 years. Today the diagnostic of these cysts is safer with C.T.-Scan and M.R.I.; in the 6 cases hydrocephalus was reduced and the volume of the cysts did not increase on C.T.-Scan controls. Nowadays the stereotactic approach seems to be safer than direct surgery but is not always a radical treatment and can be insufficient to treat hydrocephalus. We think that ventricular shunt can be a good alternative as a first and definitive treatment.

[Compression of the cauda equina by osteoarthritic pseudo-spondylolisthesis, with overlying signs of deficit. The possible role of a venous mechanism]. / Compression de la queue de cheval par un pseudo-spondylolisthesis arthrosique, avec signes déficitaires sus-jacents. Rôle possible d'un mécanisme veineux.

The authors report the case of a patient suffering from paraparesis where a venous pathology seemed to be responsible, and the literature is reviewed. A cauda-equina compression by L4/L5 arthrosic pseudo-spondylolisthesis caused troubles of the spinal cord venous drainage, seen at the myelography. There was a neurological deficit above the L4/L5 compression with a psoas and quadriceps deficit. After a L4/L5 laminectomy the neurological signs improved rapidly.

[Aneurysms with severe clinical manifestations (Hunt and Hess grade IV and V). A series of 66 cases]. / Les anévrismes à expression clinique grave d'emblée (grades IV et V de Hunt et Hess). Une série de 66 cas.

Among 250 patients consecutively admitted in our center with a ruptured intracranial aneurysm, 66 patients (24.4%) were initially classified in Hunt and Hess clinical grade IV (37 cases) or grade V (29 cases). All patients were studied as following: --The severity of subarachnoid haemorrhage was evaluated on the pre-operative C.T. scan using Fisher's criteria. Quantification of the intracerebral haematoma or the intraventricular associated haemorrhage or a subdural haematoma was estimated as well. --The arterial diameter, aneurysm size and location, and the eventual presence of intra-arterial embolus were noted on the pre-operative angiography. Aneurysm location was: anterior artery 27 cases, internal carotid artery 9 cases, middle cerebral artery 27 cases, posterior cerebral artery 2 cases, and 1 case on the basilar artery. In this series, a poor clinical condition on admission was related to the direct effect of the initial haemorrhage in 84.9% of the patients. Early seizures (7.6%) acute hydrocephalus (1.5%), multiple emboli (3%) and apparently early diffuse vasospasm (1.5%) were the other documented causes explaining the initial poor clinical condition. One case remained completely unexplained. Sixteen patients admitted with bilateral fixed dilated pupils or a major intracerebral haematoma from a ruptured anterior artery aneurysm were not operated on and subsequently died. Operative treatment (aneurysm clipping in all cases, and haematoma evacuation on demand) was performed in the remaining 50 cases within 12 hours after their admission. Thus, these patients underwent surgery on Day 0 in 31 cases, on Day 1 in 11 cases, and on Day 2 in 8 cases. A post-operative C.T. scan was performed in 46 cases. Post-operative angiographic control was only performed in 29 cases. Changes on the post-operative C.T. scan or the angiographic control were strictly compared to the neuroradiological information previously available. Final outcome was assessed at least two months after the onset. According to the Glasgow Outcome Score, the results were: good recovery 12 patients (18.2%); moderate disability 1 patient; severe disability 4 patients (6%); vegetative state 4 patients; death 45 patients (68.2%). Excluding the patients admitted in poor clinical grade but presenting with early seizures or minor initial haemorrhage, the mortality rate was 74.2%. According to the initial clinical grade, the initial C.T. scan findings, the eventual post-operative angiographic presence of an arterial thrombosis or vasospasm, it was obvious that the final bad outcome was mainly related to the severity of the initial haemorrhage. However, in 7 patients, post-operative disability or death can be explained by other complications, principally an arterial thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of therapeutic management of vesico-urethral and anorectal disorders in 20 patients with cauda equina syndrome]. / Résultats de la prise en charge thérapeutique des troubles vésico-sphinctériens et ano-rectaux de 20 patients ayant un syndrome de la queue de cheval.

Twenty patients (7 females and 13 males) with cauda equina lesions (12 herniated lumbar disks, 4 tumours, and 4 compression fractures of the lumbar spine), were treated according to a standardized management of their urinary and digestive symptoms, after surgery. The bladder emptying inability was managed by Crédé manoeuver facilitated by appropriate drugs completed by self intermittent catheterization. The constipation was treated by non irritant osmotic laxatives, and defecation obtained by abdominal straining, was facilitated by a suppository. All the patients recovered a sphincteric autonomy, without invalidating incontinence. Within 3 to 6 months, eleven patients improved enough bladder emptying to stop drugs and self-catheterization. None presented urinary incontinence. Within the same time, 14 had a stool daily, but medical treatment of the constipation had to be carried on in all of the 20 patients. None of the patients had incontinence for the solid stools, but only the patients who improved (spontaneously or after biofeedback therapy) the voluntary anal sphincter contraction were continent for the gaz, and liquid stools. The intermittent self-catheterization release (a complete emptying of the bladder being achieved) was more frequent after tumor treatment than after herniated disk, or compressive fracture treatment; the same release happened in case of immediate management if compared with delayed management of the urinary symptoms. Adversely, the digestive recovering was not influenced by either the etiology of the cauda equina lesions or the therapeutic management delay. Defecography demonstrated anatomical disturbances of the rectoanal apparatus such as perineal descent and/or mucosal prolapse, which could be secondary to the abdominal straining necessary to complete bladder and rectum emptying.

[Intracranial hematoma in ruptured aneurysms. Apropos of 57 cases]. / Les hématomes intracrâniens des anévrysmes rompus. A propos de 57 cas.

In 200 consecutive cases of ruptured aneurysms volume of resulting hematomas exceeded 5 ml in 57 patients (28.5%) and 50 ml in 25 patients (12.5%). We have studied the radio anatomical and clinical datas of these 57 cases: In most of them (90%) the aneurysm situation appears to determine hematomas characteristic features. Fatal issues are related to hematoma volume when above 50 ml and to vasospasm in other cases. Results in the 48 operated cases lead to advise neurosurgeons against surgical procedure when volume is greater than 60 ml in grade V patients (unless operation could take place immediately after rupture onset), and when severe intra ventricular hemorrhage is present. Death in ruptured aneurysms is a consequence of hematomas volume in at least 10% cases. Hematomas or vasospasm are responsible for sequellae or fatal issues which still occurs in 15-20% of overall population of patients with ruptured aneurysms, despite improvement in management and timing. Cases finding and preventive surgery of non incidental aneurysms should be a matter of concern.

[Intraspinal epidural hematoma in the hemophiliac]. / L'hématome épidural intrarachidien chez l'hémophile.

The authors report a series of 11 epidural haematoma in hemophilia. Of these, one case is observed in the department of Neurosurgery at the CHRU. From this study, main points results: a mechanic etiology was found in four cases; the main clinical and radiological signs are those of epidural haematoma; the indication to operate is required and the hemophiliacs should receive a "substitutive" treatment as soon as possible.

[Nervous system tumour proteins. G.F.A. and hyaluronectin (author's transl)]. / Les proteéines des tumeurs du système nerveux. G.F.A. et hyaluronectine.

G.F.A. (gliofibrillary acid protein) and hyaluronectin studied here are two antigens defined by the heteroantibodies which appear in the serum of the immunised animal. G.F.A. is associated with gliofilaments and is considered as an astrocyte marker, either normal or tumoral. Hyaluronectin, is found in the Ranvier nodes and at the periphery of neurones. It is not specific to the nervous system. It is found in all tissues and tumors, and in particular marks the intercellular spaces of gliomas, where it is associated with hyaluronic acid for which it has a great affinity. Serum estimation of these Proteins is being undertaken with the view to a clinical application.

[A model for intracranial vasospasm in subarachnoid hemorrhage]. / Etude d'un modèle de vasospasme intra-crânien dans les hémorragies méningées expérimentales.

Cerebral vasospasm (V.S.P.) is a major complication of subarachnoid hemorrhage. In order to investigate this cerebral vasospasm, an intracisternal injection of autologous blood and topical application around the internal carotid artery was performed in the dog model. Thirty dogs were divided into five groups and a cerebral angiography was performed on D0, D2, D5, D7 and D9. In comparison with the control group (group 1), the angiography in group 2 (12 dogs) systematically exhibited severe V.S.P. In group 3 (intracisternal injection of venous blood: 5 dogs), the angiography exhibited no vasospasm at all. In group 4, a left frontoparietal flap was opened, allowing us to deposit blood around the carotid bifurcation. In these cases, a severe narrowing of cortical arteries was demonstrated. In group 5 (intracisternal injection of heparinated blood), no vasospasm was observed. These findings suggest that the vasospasm involves the circle of Willis' as well as the cortical arteries.

[Diagnosis of vasospasm: comparison between arteriography and transcranial Doppler. A series of 112 comparative tests]. / Diagnostic du vasospasme: comparison artériographie-Doppler transcrânien. Une série de 112 examens comparatifs.

56 consecutive patients with ruptured aneurysm (An) were studied. The An localisation were: anterior communicating artery (ACoA) 26 cases, internal carotid artery (I.C.A.) 13 cases, Middle cerebral artery (M.C.A.) 11 cases, Pericallosal artery (P.C.A.) 4 cases, anterior cerebral artery (A.C.A.) 2 cases. Nimodipine infusion was started as soon as the diagnostic was established. Transcranial Doppler (T.C.D.) and angiography (A degrees) were performed at the arrival and 10 to 12 days after surgery. Surgery was performed in the 72 first hours after S.A.H. in 79% of the cases. 112 comparisons A degrees-T.C.D. were available. An A degrees vasospasm (V.S.) was assessed if the reduction of calibre was 25% or more, on T.C.D. V.S. was assessed if mean cerebral flow (M.C.F.) was equal to or more than 130 cm/sec. There were 15 cases of A degrees V.S. in 14 patients: 2 cases before surgery, 1 case before and after surgery in the same patient and 11 cases after surgery. D.T.C. exhibited 11 cases of V.S. at the level of M.C.A.; there were 11 true positive, 0 false positive, 97 true negative and 4 false negative. The diagnosis of V.S. was always correct with T.C.D. when A degrees V.S. was present at the level of M.C.A., it was not made when A degrees V.S. was restricted to the initial part of A.C.A. (A1) uni or bilaterally: 3/6 cases of ACoA. An rupture or to I.C.A.: 1/4 case of I.C.A. An. rupture.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vasospasm, early surgery and nimodipine. A series of 120 consecutive cases of surgically treated ruptured aneurysm]. / Vasospasme, chirurgie précoce et nimodipine. Une série de 120 cas consécutifs d'anévrismes rompus opérés.

A total of 120 consecutive ruptured aneurysms (An) were managed according to a radio clinical investigation protocol. Preoperative evaluation included clinical grading (Hunt & Hess classification) (3 patients were Gr. I, 62 Gr. II, 27 Gr. III, 13 Gr. IV, 15 Gr. V) angiography (A degree) and C.T.Scan grading. Nimodipine infusion was started before surgery (1 mg/Kg/h). Surgery was performed from Day 0 to Day 3--Control A degrees and C.T.Scan were performed 10 to 12 days after surgery. Post operative C.T.Scan hypodensities were evaluated according to preoperative C.T.scan anc control A degrees. The outcome was evaluated according to the Glasgow Outcome Score (G.O.S.) and the causes of sequelae and decreases were listed according to vasospasm (V.S.), initial hemorrhage and post operative thrombosis (T.H.R.). The outcome was good or excellent in 95.4% of 65 Gr. I.II cases, in 85.9% of 92 Gr. I.II.III cases. Among the causes of disability or death only one case of diffuse severe V.S. was noted; besides that and according to our experience V.S. incidence was lower in this series (25%) than in our previous experience. It is stated that nowadays with Nimodipine treatment and early surgery V.S. is no more a problem.

[Multiple cerebral aneurysms disclosed by subarachnoid hemorrhage. Apropos of 60 cases]. / Les anévrysmes multiples découverts à l'occasion d'une hémorragie méningée. A propos de 60 cas.

In a series of 60 consecutive patients, 137 multiple aneurysms (An) were discovered after subarachnoid hemorrhage. Multiple An were mostly double (83 % of the patients). The incidence of middle cerebral artery An was 42 %, internal carotid artery An 25.5 %, anterior communicating artery An 15 %. Both angiography (A degree) and CT scan could identify the ruptured An in 56 cases or at least the side of the ruptured An in the remaining 4 cases. Among the routine A degree criteria used to determine which one of the An had bled the most reliable ones appears to be: the existence of vasospasm of the parent artery, the bigger size of the sac, the irregular wall of the sac. The incidence of rupture is the highest in anterior communicating artery An (16/21). When an An located on the polygon of Willis is associated to a distal An, the former ruptures in 17 cases/18. All ruptured An were treated during the first operative session. In 47 patients (78.3%) all the An, ruptured and asymptomatic, were treated during the first procedure or in one or two additional surgical sessions. In 13 patients (22.7%) for several reasons only ruptured An and asymptomatic An that could be reached via the same craniotomy were treated. There was no morbidity or mortality related to the surgical treatment of asymptomatic An.

[Vasospasm after rupture of aneurysms of the anterior communicating artery. Sensitivity and specificity of transcranial Doppler]. / Vasospasme après rupture des anévrismes de l'artère communicante antérieure. Sensibilité et spécificité du Doppler transcrânien.

This study was undertaken to determine the sensitivity and specificity of the transcranial Doppler (TCD) for diagnosis of vasospasm after rupture of anterior communicating artery (CoA) aneurysm. Results provided by 164 carotid angiograms and TCD measures were compared in 40 patients with CoA ruptured aneurysm. Twelve patients demonstrated a vasospasm on 22 angiographies. The distribution of angiographic vasospasm was 95.5% anterior cerebral artery (A1), 77.3% pericallosal artery (A2) and 59.1% middle cerebral artery (M1). A TCD velocity value equal or superior to 120 cm/sec was the criterion for TCD vasospasm on M1. The sensitivity of TCD on M1 for diagnosing vasospasm on M1 with high specificity (96.4%) was only 66.7%. A TCD velocity value equal or superior to 80 cm/sec, or superior to the homolateral TCD value on M1, was the criterion for TCD vasospasm on A1. The association of TCD criteria on A1 and M1 increased sensitivity to 83.3%, but specificity decreased to 75%. These results demonstrate that TCD is not yet efficient enough to diagnose vasospasm accurately when it is limited to A1. Moreover, the fact that vasospasm limited to A1-A2 was symptomatic in three patients suggests that angiography is still necessary to diagnose VS after CoA ruptured aneurysm.

[Stress-induced pituitary apoplexy in 2 phases]. / Apoplexie pituitaire à l'effort en deux temps.

A case of pituitary apoplexy occurring in the context of physical effort is reported. A 47-year-old man presented headache after a foot-race. Secondary visual deficit developed. On admission, bilateral cavernous sinus syndrome with bitemporal hemianopia was observed. The CT scan showed an enlarged sella eroded by an intrasellar soft tissue mass. Magnetic resonance imaging (MRI) confirmed the presence of the mass with peripheral enhancement following gadolinium injection. Decompression was carried out by transsphenoidal surgery. The microscopic study demonstrated infarction of the anterior hypophysis with peripheral tissular scarring. The post-operative outcome was characterized by visual recovery and anterior hypophyseal insufficiency. The possible pathophysiological mechanisms are discussed.

[Comparative experimental study of nerve repairs by classical suture or biological adhesive]. / Etude expérimentale comparative des réparations nerveuses par suture classique ou par colle biologique.

The respective possibilities of nerve reparation with classical microsutures or biological glue (bioglue) were compared on experimental rat sciatic nerve lesions. Seventy rats were operated upon, and 69 results can be interpreted. 22 had a microsuture, 47 anastomosis with bioglue (Tissucol). The animals were followed for 120 days, and the results assessed on muscular testing, electrostimulation, optic microscopic histology, and morphometry. Five anastomosis dysjunctions occurred in the bioglue group, because of technical errors. All other animals improved from the 60th day. From the histological view point, the results with bioglue were more satisfactory, because of the absence of foreign body reaction to sutures; the authors conclude that because of the equivalent results on nerve function, and better histological results with bioglue, its use is preferable to repair nerves, especially when microsuture is technically difficult.

[Is it necessary to operate on asymptomatic aneurysms? Apropos of 114 surgically treated asymptomatic aneurysms]. / Faut-il opérer les anévrysmes asymptomatiques? A propos de 114 anévrysmes asymptomatiques opérés.

A six years retrospective analysis of asymptomatic aneurysms (A.A.) was done in 4 neurosurgical departments: 114 AA were clipped in 99 patients. In 44 patients (48 asymptomatic aneurysms) the surgical procedure was achieved in one step for both symptomatic and asymptomatic aneurysms. In 59 patients (66 asymptomatic aneurysms) the surgical procedure was delayed as it necessitated a second and elective craniotomy. As regard the treatment of asymptomatic aneurysms, there was no morbidity, and one death due to a massive pulmonary embolism. These surgical results are undoubtebly better than the risk of hemorrhage from unruptured aneurysm as emphasized in the literature.

[A series of 106 cases of ruptured aneurysms operated on during the 1st week]. / Une série de 106 cas d'anévrysmes rompus opéres pendant la première semaine.

The authors report 106 intracranial aneurysms operated on during the first 7 days post S.A.H. The résults according to grade and operative day are compared to the results of litterature, operative indications according to grades and spasms are given.