Stereotactic open craniotomy and laser resection of brain tumours. A five years experience.

In 23 cases of deep-seated brain tumours stereotactically guided laser vaporization has been done, using a 60 watts CO2 laser. The experiences and results of the 18 first cases with a follow-up of 10 months to 5 years are presented. The technique is described.

[Abdominal metastasis of a pineal germinoma in a child with a ventriculo-peritoneal shunt]. / Metástasis abdominales de germinoma pineal en niño con derivación ventriculoperitoneal.

We present a case of germinal tumor of the pineal gland, treated with a ventriculo-atrial shunt, cytostatics and radiotherapy. Two and a half years later, in Spite of the clinical remission of the cerebral tumor a metastasis appeared in the abdominal cavity. After reviewing the current literature, the necessity of using millipore filters in the CSF derivation systems when dealing with malignant cerebral tumors to avoid the spreading of malignant cells through the CSF.

[Aneurysm of the vein of Galen with neonatal cardiac insufficiency. Success of early neurosurgical treatment]. / Anévrisme de la veine de Galien avec insuffisance cardiaque néo-natale. Succès du traitement neurochirurgical précoce.

The vein of Galen malformation is a rarely recognized cause of congestive heart failure in the newborn. This report describes a newborn who developed severe cardiac failure in the second week of life. An aneurysm of the vein of Galen was noted on the computerized tomography scan, confirming the clinical diagnosis of cerebral arteriovenous fistula. The vascular abnormality was well shown by cerebral arteriography. At the age of four weeks, surgery was carried out by clipping the afferent arteries. The patient is non a three years old infant with moderate developmental delay and hypotonia.

Surgical experience with arteriovenous malformations in children.

The authors report their surgical experience with 15 cases of arteriovenous malformations in children operated on in the last decade. Subarachnoid hemorrhage was the main clinical manifestation in 12 patients. Epilepsy was a secondary feature in 3 of these. Cortical areas were involved in 7 cases while the other 8 had the malformation in medial or deep structures of the brain. No mortality occurred from surgery. A radical excision was achieved in 12 cases, while in 3 cases remnants of the lesion were shown by postoperative angiography. Nine patients recovered from surgery without neurological impairment. Two children with left-sided arteriovenous malformations showed mild speech disturbances and 2 others with midline lesions suffered from hypotonus and ataxia.

Surgical treatment of an aneurysm of the vein of Galen in a newborn with heart failure.

Congestive heart failure is the usual complaint and cause of death in neonates with aneurysms of the great vein of Galen. Direct surgical obliteration of the feeding arteries cures the heart failure, but few such newborns survive the operation. The authors report a case of primary aneurysm of the great vein of Galen treated successfully by clipping the afferent arteries and reduction of the bulk of the aneurysm by bipolar coagulation. Five months after the operation the child's development is normal.

[Intradural lumbar disk hernia. Contribution of 2 cases]. / Hernie discale lombaire intradurale. Apport de deux cas.

Two new cases of intradural herniated disks are added to those previously reported in the literature. It's frequency in our casuistry is of 0.27%, similar to that of other series. Predisponent factors and incidence at different levels are reviewed. Acute or subacute clinical on-set, level of lesion and an early surgical treatment seems to influence the evolution of these patients. Recent observations with C.T. with metrizamide and cytological study of L.C.R. with Cytospin suggest a more precise preoperative diagnosis than the myelography. The final diagnosis has been casual after intradural exploration when there were no correlation between the extradural exploration and the clinical and radiological picture. The pathological study of the intradural herniated disk don't differ from the usual extradural herniated disk.

[Intrasellar abscess into a cyst of the Rathke's pouch (authors' translation)]. / Abcès intrasellaire au sein d'un kyste de la poche de rathke.

The authors report a case of abscessified cyst the pouch of Rathke similar to that published by Obenchain in 1972 and Menault in 1979. The clinical picture was determined for recurrent meningeal burst without signs of intracraneal pressure nor optochiasmatic involvement. The spinal fluid showed pleocitosis and hyperprotein. No bacterial growth was demonstrated. Antibiotic therapy had no effect on the clinical follow-up. C.T. was unable to show the location of the lesion evidenced by pneumocisternography. Though a subfrontal approach was emptied an abscess in the sella turcica, with walls formed for tissue of he Rathke's pouch. A few months later a new meningeal burst occurred and a recurrence of the abscess was confirmed at operation. The follow-up was of progressive neurological deterioration with exitus letalis a few days later. Abscessified sella tumors ahd been rarely reported in the literature : chromophobe adenoma appeared most frequently and only in 3 cases within craniopharyngiomas. Diagnostic difficulties arise from the lack of focal symptoms and from the failure of some neuroradiological procedures to demonstrate the lesion. The high risk of recurrence and the poor prognosis of these abscess will be discused. Although a similar embryological origin the cyst the Rathke's cleft and the craniopharingiomas present pathological aspects that made each other differenciable.