[Coexistence of a disc herniation and psoas hematoma revealed by L3 deficiency]. / Le cas clinique du mois. Coexistence d'une hernie discale et d'un hématome du psoas révélé par un déficit de L3.

Radiculopathy is a constellation of symptoms secondary to a pathology affecting the nerve root, the most frequent cause of which is a herniated intervertebral disc. We report a case of a 58-year-old man under anticoagulant admitted to the neurosurgery department of Lariboisière hospital (Paris) for an L3 motor deficit that occurred progressively over a period of 24 hours with an L3-L4 disc herniation on the MRI. However, a psoas hematoma was also noted. Biological assessments revealed a hemostasis disorder. The final clinical diagnosis was a spontaneous hematoma caused by anticoagulant overdose. Psoas hematomas usually occur in patients with coagulopathy.

Un déficit radiculaire est une symptomatologie secondaire à un conflit radiculaire dont la cause la plus fréquente est une hernie discale. Nous rapportons le cas d'un homme de 58 ans sous anticoagulant admis dans le service de neurochirurgie de l'hôpital Lariboisière (Paris) pour un déficit de L3 d'apparition brutale en 24h avec une hernie discale L3-L4 à l'IRM. Par ailleurs, un hématome du psoas est également mis en évidence. Les bilans biologiques révèlent un trouble de l'hémostase. Le diagnostic retenu fut celui d'un hématome spontané par surdosage d'un anticoagulant. L'hématome du psoas survient généralement chez un patient qui a une coagulopathie.

[Chordoma]. / Les chordomes.

PURPOSES: To review in the literature, all the epidemiological, clinical, radiological, histological and therapeutic data regarding chordomas as well as various notochordal entities: ecchordosis physaliphora, intradural and intraparenchymatous chordomas, benign notochordal cell tumors, parachordomas and extra-axial chordomas. To identify different types of chordomas, including familial forms, associations with tuberous sclerosis, Ollier's disease and Maffucci's syndrome, forms with metastasis and seeding. To assess the recent data regarding molecular biology and progress in targeted therapy. To compare the different types of radiotherapy, especially protontherapy and their therapeutic effects. To review the largest series of chordomas in their different localizations (skull base, sacrum and mobile spine) from the literature. MATERIALS: The series of 136 chordomas treated and followed up over 20 years (1972-2012) in the department of neurosurgery at Lariboisière hospital is reviewed. It includes: 58 chordomas of the skull base, 47 of the craniocervical junction, 23 of the cervical spine and 8 from the lombosacral region. Similarly, 31 chordomas in children (less than 18 years of age), observed in the departments of neurosurgery of les Enfants-Malades and Lariboisière hospitals, are presented. They were observed between 1976 and 2010 and were located intracranially (n=22 including 13 with cervical extension), 4 at the craniocervical junction level and 5 in the cervical spine. METHODS: In the entire Lariboisière series and in the different groups of localization, different parameters were analyzed: the delay of diagnosis, of follow-up, of occurrence of metastasis, recurrence and death, the number of primary patients and patients referred to us after progression or recurrence and the number of deaths, recurrences and metastases. The influence of the quality of resection (total, subtotal and partial) on the prognosis is also presented. Kaplan-Meier actuarial curves of overall survival and disease free survival were performed in the entire series, including the different groups of localization based on the following 4 parameters: age, primary and secondary patients, quality of resection and protontherapy. In the pediatric series, a similar analysis was carried-out but was limited by the small number of patients in the subgroups. RESULTS: In the Lariboisière series, the mean delay of diagnosis is 10 months and the mean follow-up is 80 months in each group. The delay before recurrence, metastasis and death is always better for the skull base chordomas and worse for those of the craniocervical junction, which have similar results to those of the cervical spine. Similar figures were observed as regards the number of deaths, metastases and recurrences. Quality of resection is the major factor of prognosis with 20.5 % of deaths and 28 % of recurrences after total resection as compared to 52.5 % and 47.5 % after subtotal resection. This is still more obvious in the group of skull base chordomas. Adding protontherapy to a total resection can still improve the results but there is no change after subtotal resection. The actuarial curve of overall survival shows a clear cut in the slope with some chordomas having a fast evolution towards recurrence and death in less than 4 years and others having a long survival of sometimes more than 20 years. Also, age has no influence on the prognosis. In primary patients, disease free survival is better than in secondary patients but not in overall survival. Protontherapy only improves the overall survival in the entire series and in the skull base group. Total resection improves both the overall and disease free survival in each group. Finally, the adjunct of protontherapy after total resection is clearly demonstrated. In the pediatric series, the median follow-up is 5.7 years. Overall survival and disease free survival are respectively 63 % and 54.3 %. Factors of prognosis are the histological type (atypical forms), localization (worse for the cervical spine and better for the clivus) and again it will depend on the quality of resection. CONCLUSIONS: Many different pathologies derived from the notochord can be observed: some are remnants, some may be precursors of chordomas and some have similar features but are probably not genuine chordomas. To-day, immuno-histological studies should permit to differentiate them from real chordomas. Improving knowledge of molecular biology raises hopes for complementary treatments but to date the quality of surgical resection is still the main factor of prognosis. Complementary protontherapy seems useful, especially in skull base chordomas, which have better overall results than those of the craniocervical junction and of the cervical spine. However, we are still lacking an intrinsic marker of evolution to differentiate the slow growing chordomas with an indolent evolution from aggressive types leading rapidly to recurrence and death on which more aggressive treatments should be applied.

Skull bone flap fixation - reliability and efficacy of a new grip-like titanium device (Skull Grip) versus traditional sutures: a clinical randomized trial.

BACKGROUND: After completing a craniotomy, it is important to replace the removed bone flap in its natural position in order to guarantee brain protection as well as improve cosmesis. A skull defect can expose the brain to accidental damage, and in cases of larger defects it may also cause the patients psychosocial problems. The ideal fixation device should provide reliable attachment of the flap to the skull and promote fast bony healing to avoid possible pseudo-arthrosis and/or osteolytic changes. MATERIALS AND METHODS: This is a pilot randomized clinical trial on a series of 16 patients undergoing different craniotomies for benign brain lesions in which the bone flaps were replaced using traditional sutures (Prolene 0.0) in 8 cases and with a new skull fixation device (Skull Grip) in the other 8 (randomly allocated). All patients underwent CT scans of the head with 3D reconstruction at day 1 and day 90 postoperatively to evaluate bone flap position and fusion. These scans were independently reviewed by a neuroradiologist. Cosmesis was also evaluated clinically by the surgeon and radiologically by the neuroradiologist in the 2 patient groups. RESULTS: The new "Skull Grip" device has shown stronger fixation qualities with optimal bone flap fusion and increased cosmetic healing features vs. traditional sutures. CONCLUSION: The "Skull Grip" has shown to be a reliable, effective and stronger bone flap fixation device when compared to traditional sutures.

Primary malignant rhabdoid tumour of the brain in adults.

Malignant rhabdoid tumour (MRT) was described for the first time in the kidney, and is rarely reported in the brain. Most rhabdoid tumours affect infants and young children and there have been only isolated adult patients reported. The optimal treatment for this very aggressive tumour has not yet been established. We describe the clinical and pathological features of a rare primary malignant rhabdoid tumour of the brain in a 27-year-old pregnant female. The literature is reviewed briefly and the role of the INI1 gene in adult MRTs and the also possible interactions between MRTs and pregnancy are discussed.

Pediatric primary pilocytic astrocytoma of the cerebellopontine angle: a case report.

INTRODUCTION: We describe a rare case of pediatric pilocytic astrocytoma presented as a right cerebellopontine angle (CPA) mass, completely separated from the brain stem and arising from the proximal VIII nerve portion. CASE REPORT: A 12-year-old boy, with no evidence of neurofibromatosis type 2, presented with progressive hearing loss at the right ear and headache. An initial enhanced magnetic resonance examination suggested the diagnosis of schwannoma. The tumor was resected by a suboccipital retrosigmoid approach. DISCUSSION: Our case seems to be the first report of a primary pediatric CPA pylocitic astrocytoma arising from the VIII nerve complex and presenting internal auditory canal enlargement. It represents the third reported case of a primary CPA pilocytic astrocytoma (the second pediatric case with the first arising from V nerve) and the eighth report of primary CPA glioma, overall. We discuss the clinical, neuroradiological, and intraoperative findings, and we review the different hypothesis about the origin of these rare tumors.

[Is arterial hypertension in women different from that in men? Example of the relationship between arterial pressure and left ventricular mass]. / L'HTA de la femme est-elle différente de celle de l'homme? Exemple de la relation pression artérielle-masse ventriculaire gauche.

In the Bordeaux cohort of never treated, uncomplicated hypertensive patients with office BP > 140/90 on at least 2 occasions, we selected those with good quality 24 H ambulatory BP measurement and LVM measured with M mode echo before any antihypertensive treatment. In this group, we studied the relationships between LVM and average 24 h systolic BP in males and females in univariate and multivariate analysis, taking into account age, weight and height. The population studied included 531 patients whose main characteristics are summarized in the table. The slope of the relationship between LVM and 24 h SBP is significantly steeper in males than in females (1.73 vs 0.58, p < 0.01). In multivariate analysis, the variable showing the higher correlation to LVM is 24 h SBP in males, weight in females. For a similar increase in BP, males hypertensive show a higher increase in LVM than females.

Quantum Number Dependence of Lineshift Coefficients Induced by Collisions with Noble Gas Perturbers in the nu(3) Band of NO(2).

To complete our study concerning lineshift in the rovibrational spectrum of (14)N(16)O(2), a pulse-driven three-channel lead salt diode laser spectrometer was applied to record high-resolution spectra at room temperature in the 6.2-µm region corresponding to the nu(3) band at low NO(2) concentrations. The shift was studied for collisions with the noble gases He, Ne, Ar, Kr, and Xe. This paper extends our recently published data in order to analyze the quantum number dependence of the shift effect more precisely. Therefore, in this paper, additionally eight unresolved NO(2) doublets covering an enlarged quantum number range (10

Determination of the Line-Shift and Line-Broadening Coefficients in the nu(3) Band of ()NO(2) Perturbed by ()O(2), N(2), H(2), D(2), and CO(2).

A high-resolution three-channel diode-laser spectrometer was used to record a large number of spectra with (14)N(16)O(2) and foreign gas pressures ranging from 0.1 to 0.4 and 20 to 150 Torr, respectively, at room temperature. The 6.2-µm region corresponding to the nu(3) band of NO(2) was analyzed and the broadening and shift coefficients were derived in the case of collisions between NO(2) and H(2), D(2), O(2), N(2), CO(2), and SO(2) for 13 lines with 18

Pressure shifts of O(3) broadened by N(2) and O(2).

High resolution infrared spectra of O(3) have been recorded with an FT spectrometer at Reims University with a resolution of 0.002 cm(-1) and a SNR of the order of 800. The 2100-cm(-1) region corresponding to the v(1) + v(3) band has been analyzed. A large number of spectra, with ozone pressure varying from 5 to 50 Torr and foreign gas from 80 to 700 Torr, were recorded. The CO lines were recorded simultaneously and used as the standard to obtain the shifts, which have been measured for about 150 lines. We note a linear variation of the shifts with the J quantum number.