Hyperostosing meningiomas of the sphenoid ridge--clinical features, surgical therapy, and long-term observations: review of 49 cases.

Thirty-three patients with en plaque, 9 with en masse (but with extensive bone involvement), and 7 with recurrent hyperostosing meningiomas of the sphenoid ridge were operated on. All patients underwent large extradural resection of the base of the skull as well as extirpation of the intradural tumors or adjacent plaques. The periorbita was involved in 13 patients (26.5%). Seventeen patients (34.7%) needed reconstruction of the base of the skull. This was achieved with autogenous bone grafts. In all but 3 patients, invasion of the bone by meningiomatous tissue was demonstrated histologically. Operative mortality was 4%. Total removal was possible in 91% of the patients with meningiomas located at the pterion or middle third of the sphenoid ridge. More difficult was the total removal of meningiomas of the inner third or of the entire sphenoid ridge (47%). However, long-term results have proved to be satisfying. Early surgical therapy should always be considered as the treatment of choice for such meningiomas.

Acromegaly: analysis of 132 cases treated surgically.

The surgical treatment of 132 acromegalics is analyzed. There was an equal sex distribution among patients between the ages of 30 and 59. In the younger patients there was a preponderance of males, and the opposite situation occurred in patients older than 59 years. The overall cure rates were 58% (growth hormone (GH) less than 5 ng/ml) and 78% (GH less than 10 ng/ml). Endocrinological evidence of cure was observed most commonly in patients who exhibited preoperative GH values below 70 ng/ml.

[Long-term outcome of surgery for myelopathy due to cervical arthrosis. 35 cases (author's transl)]. / Devenir lointain des malades opérés pour myélopathie cervicarthrosique. 35 observations.

The authors report on 57 patients operated upon for myelopathy secondary to cervical arthrosis, 56 of whom underwent posterior laminectomy. The clinical symptoms were those reported in the literature for such cases. During the first post-operative year 66% of the patients improved, 5% became worse and 28% remained unchanged. Among 35 patients seen more than 5 years after the operation (mean: 8.5 years), improvement was observed in 75%, deterioration in 17% and no change in 8%. The significant difference (p < 0.02) between short-term and long-term results suggests that the disease continues to evolve, one way or the other, long after surgery. Altogether, changes occurred in 31% of the patients.

Endocrine outcome after transsphenoidal adenomectomy for prolactinoma: prolactin levels and tumor size as predicting factors.

The level of prolactin in the serum was determined pre- and postoperatively in 90 patients who were operated upon transsphenoidally for prolactin-secreting pituitary adenomas. Twenty-three had microadenomas and 67 had macroadenomas. Those patients who were cured had a distinctly lower mean prolactin level (about 200 ng/ml or less) than those who were not cured. Of those patients whose adenomas were larger than 10 mm in diameter, only 39% were cured. The relationship between prolactin levels and tumor size and the return of menses and cure is discussed.

[Endocrine prognosis of PRL-secreting pituitary adenomas. In 90 female cases (author's transl)]. / Pronostic endocrinien des adénomes à prolactine chez la femme. Quatre-vingt-dix cas.

This study based upon 90 cases of prolactinomas where hormonal and clinical results have been compared demonstrates: 1) a good correlation between a normal postoperative plasma PRL level (less than 30 ng/ml) and the cure of the amenorrhea galactorrhea syndrome (90% of the cases); 2) a good correlation between the cure of the patients and the preoperative plasma PRL level: below 200 ng/ml, 85% of the patients are cured compared to 24% only when the preoperative PRL plasma level is above 200 ng/ml.

[Prolactin secreting adenomas: surgical treatment and results. 120 female cases, 30 males cases (author's transl)]. / Adénomes à prolactine: résultats du traitement chirurgical. 120 cas féminins, 30 cas masculins.

Twenty one per cent of the female cases concerned microadenomas discovered because of amenorrhea with or without galactorrhea. Sixty two per cent of these cases were cured by surgery alone, against 40% of the other types of prolactin (Prl) -- secreting tumors with extra-sellar extensions which were not cured. With men, no microadenomas was discovered (although one case demonstrated their possible existence) and in the most frequent cases, tumors exhibited extra-sellar extensions sometimes very large (giant tumors). In these cases, tumoral symptoms were cured by surgery while only 5 out of 30 men recovered a normal plasma Prl. level (30 ng/ml). In all cases the prognosis was established taking into account the volume and invasive characters (at the surgical and histopathological level) of the tumors. The different therapeutical approaches of these tumors (i.e. medical treatment by CB 154, surgery of Rxtherapy) were evaluated. Anyway the necessity of an earlier diagnosis is pointed out allowing the possibility of a selective adenomectomy by a microsurgical approach.

Thalamic spatial variability and the surgical results of lesions placed with neurophysiologic control.

One hundred stereotactic thalamotomies performed for upper extremity tremor were reviewed and the spatial positions of the anterior limit of ventralis posterior (VP), the thalamic-internal capsular boundary and somatotopic areas within VP plotted with respect to the midline and the place of the anterior comissure. Considerable variability was noted as to the location of these points. The surgical results following 97 of the 100 thalamotomies were evaluated at least three months after the procedure. Fifty-six of 70 patients with Parkinsonian tremor had complete abolition of their upper extremity tremor, as did 20 out of 27 patients with intention tremon. Plotting the spatial positions of the lesions in those cases in which the tremor was abolished and those cases in which tremor continued revealed little difference. However, in all of the cases in which upper extremity tremor was totally abolished, the lesion site was situated in ventralis lateralis anterior to the VP representation of the buccal commissure, thumb, or index finger. This study not only demonstrates the wide range of individual spatial variability in thalamic structures, and the necessity for neurophysiologic corroboration of radiologic information during stereotactic surgery if optimal results are to be obtained, but also suggests a somatotopic organization within ventralis lateralis.

[10 cases of giant lumbo-sacral neurinoma]. / Dix cas de neurinomes géants lombo-sacrés

Among giant tumours of the cauda equina, apart from ependymomas, neurinomas merit a special place. Depending on their site, they give rise to severe lumbar pain or root pain, with, almost constantly, aggravation during the night. X ray suggests the diagnosis when one finds displacement of the bone without inflammation, a regular bony defect, well-limited and asymmetric, and when the tumour is frequently prolonges in several directions across the bony orifices, sometimes giving a very large paravertebral mass which requires a double approach during surgery. The prognosis of isolated neurinomas is excellent, with disappearance of the pain immediately after operation, regression of the neurological signs or, at any rate, stabilisation when the latter are important. As far as the problem of spinal stability is concerned, this has been solved by sufficient spontaneous bony reconstruction.

Afterdischarges elicited by electrical thalamic stimulation in the hemicerebellectomized baboon.

Electrical stimulation of the ventrolateral (VL) nucleus of the thalamus was performed on hemicerebellectomized baboons. Stimulation was delivered in volleys of 40 to 60 Hz lasting 5 to 25 sec, and at intensities ranging from 1 to 6 mA (width of shock 0.5 to 5 msec). Similar parameters of stimulation produced asymmetrical motor and electrocortical responses. When the normal VL nucleus was stimulated, these responses were tonic or tonic-clonic. When the VL nucleus deprived of its cerebellar afferents was stimulated, the tonic-clonic responses were followed by afterdischarges appearing in the EEG which persisted after cessation of stimulation. The role of the cerebellum in the lowering of the excitability threshold of some structures, particularly the VL nucleus, is discussed, as are the systems likely to play a role in producing various clinical responses.