[Chondrosarcomas of skull base treatment]. / Traitement des chondrosarcomes de la base du crâne.

BACKGROUND AND PURPOSE: Skull base chondrosarcomas are rare. Gross total removal is the treatment of choice, but can be difficult depending on the closeness of noble structures. Proton beam therapy can be associated in most cases. METHODS: Retrospective study of five cases treated in 13 years and study of the literature. RESULTS: Median age of patients was 34 years [28-46]. Cranial nerve palsy was the common clinical presentation. Tumor location was variable but always off midline. Treatment was surgical in all patients with a maximal resection and proton beam therapy associated for two cases. Surgical complications were rare with cranial nerve palsy as the main side effect. Outcomes were good with a median follow-up of 12.4 years [4.3-16.2]. DISCUSSION: The review of the literature showed that chondrosarcomas of skull base are rare. The best outcome is achieved with total surgical resection. Medical imaging can only give clues to the diagnosis. Pathology is required to obtain a precise immunohistochemistry diagnosis. Multidisciplinary treatment using proton beam therapy and surgical removal enables a good local control (90-100%) at 5 years with good quality-of-life. It is difficult to determine how many cases have been published (around 220 cases in the literature) since many surgical or radiotherapy series included the same patients.

[Anatomic study and CT angiography with 3D reconstructions of the pulmonary arterial tree]. / Etude anatomique et angioscanographique avec reconstructions 3D de l'arbre artériel pulmonaire.

AIM OF THE STUDY: To prove in vivo and on cadaveric lungs, the constancy of the collateral type of distribution for the right and left pulmonary arteries as described in classical books and modern studies; to estimate the frequency of the main branches observed and define an arterial tree of reference set up with the most common branches for reading the CT pulmonary angiographies. PATIENTS AND METHODS: Sixty three-dimensional reconstructions of pulmonary arterial trees (right: 30; left: 30) using the Volume Rendering Technique (VRT) performed from CT angiographic studies of 30 patients without bronchial, arterial or pulmonary pathology. Dissection of 16 pulmonary arteries from eight fresh cadavers injected with latex. Finally, 76 pulmonary arteries (right: 38; left: 38) were examined. RESULTS: The most common division of the pulmonary artery is a collateral distribution but in seven cases from 38 (18.4%) at right and one case from 38 (2.6%) at left the artery ended in two or three terminal lobar trunks which provided the segmental arteries. The mediastinal artery for the upper right lobe was always found, with a complementary scissural artery in 89.5% of cases; a middle lobar trunk was observed in 22 of the 38 right lungs (57.9%). On the left tree, four different but usually not coexisting mediastinal arteries were identified for the upper lobe, three for the culmen and one for the lingula; six various scissural arteries were noted, three for the culmen and three for the lingula; the segment 6 received one or two segmental arteries, exceptionally three. An arterial tree of reference could be defined for both sides. CONCLUSION: The division in terminal lobar trunks of the pulmonary arteries is a variation demonstrated for the first time. The data obtained from 3D reconstruction imaging in vivo are in conformity with the results of studies performed on injected cadaveric lungs for this point and to define the arterial tree of reference.

[Anterior lumbar interbody fusion for treatment of failed back surgery syndrome: a retrospective study of 46 cases]. / Arthrodèses lombaires par voie antérieure dans le traitement des lombalgies et lomboradiculalgies récidivantes postchirurgicales : étude rétrospective de 46 cas.

BACKGROUND AND PURPOSE: Anterior lumbar interbody fusion (ALIF) has gained popularity for the treatment of degenerative disease of the lumbar spine. In this report, we present our experience with the ALIF procedure for treatment of failed back surgery syndrome following lumbar discectomy in a noncontrolled retrospective cohort. METHODS: From 1st January to 31 December 2005, we performed an ALIF in 46 patients presenting with low back pain with or without radiculopathy. All patients had a history of intractable pain resistant to conventional medical treatment and failed posterior lumbar surgery. Clinical and radiological outcomes were recorded. Neurological pain and functional outcomes were measured postoperatively (at 1, 3 and 12 months). Operative data, intraoperative complications, and the fusion rate were recorded. RESULTS: Forty-six patients with a preoperative diagnosis of failed back surgery syndrome underwent ALIF. The mean follow-up was 21 months. Back pain and leg pain completely disappeared in 60.9% of patients, decreased but required occasional medication in 28.3%, and 10.8% declared no benefit from ALIF surgery. CONCLUSION: On the basis of our results, we found ALIF to be a safe and effective procedure for the treatment of failed back surgery syndrome.

Chondrosarcoma of the skull base in Maffucci's syndrome.

We report a new case of skull base chondrosarcoma in Maffucci's syndrome. Maffucci's syndrome combining enchondromatosis with cutaneous haemangioma is rarely associated with chondrosarcoma. The review of literature highlights a small number of this pathological association.

[Transmaxillary approach to the skull base: surgical anatomy and guidelines]. / Voie d'abord transmaxillaire de la base du crâne : anatomie chirurgicale et repères.

BACKGROUND: A surgical and anatomic approach to the skull base using the transmaxillary route is presented. This route is well-known and used for a long time for sinus conditions. METHOD: This study was performed on injected cadavers. This study describes step by step this approach in microsurgical conditions following a vital lead: the infraorbital nerve. RESULTS: Anatomical landmarks are located in order to avoid complications. These complications are on one hand, hemorrhages by vascular lesions and on the other, definitive nerve palsy. CONCLUSION: Several skull base approaches exist, transfacial routes produce cosmetic damages. This route preserves the functional anatomy of the nose because it preserves the integrity of the lateral wall of the nasal cavity.

[Dumbell hemangioblastoma of the eighth cervical nerve root]. / Hémangioblastome "en sablier" de la huitième racine cervicale.

Hemangioblastomas involving cervical nerve roots are extremely rare. Only one case has been previously reported in the literature. We report the case of a 33-year-old man presenting with a 6-month history of upper limb pain. MRI and cervical angiography demonstrated the presence of a dumbell (intra and extradural) and highly vascularized tumor of the right C7-T1 foramina. Histological examination eventually confirmed the diagnosis of hemangioblastoma. Total removal of such a lesion may require combined (anterior and posterior) approaches and preoperative embolization.

[Intrathyroid parathyroid adenoma]. / Adénome parathyroïdien intrathyroïdien.

Parathyroid adenomas are embedded within thyroid tissue in about 2-5% of cases. Intrathyroid parathyroid adenomas are easily detected at US. As such, US should be performed prior to surgical intervention.

[Chronic hematoma in Dandy-Walker cyst]. / Hématome chronique dans un kyste de Dandy Walker.

A rare case is reported of Dandy-Walker cyst of the posterior fossa with intracystic chronic hemorrhage. The serial computed tomography scans without contrast showed only the increase of the cyst. Only a C.T. Scan with contrast was the most helpful in making the correct diagnosis.

[Turned biparietal transposition. A new technic for correcting back of the skull dysmorphisms]. / La transposition bipariétale retournée. Nouvelle technique de correction des dysmorphies de l'arrière crâne.

The authors describe a new surgical technique for the deformities of the back of the skull vault. They use a biparietal flap which is turned upside down in order to extend the back of the skull. They use this technique for the correction of craniosynostosis (posterior plagiocephaly, pachycephaly). 12 children have been operated with this technique since 24 month.

[The posterior part of the skull. Classification of dysmorphism. Original treatment: turned biparietal flap transposition]. / L'arrière-crâne. Classification des dysmorphies. Thérapeutique originale: la transposition bipariétale retournée.

The deformation of the posterior part of the skull (occipito-vertebral region), induced directly or indirectly, occurs in numerous pathological situations. Its significance is frequently overlooked. Lesions of the cranial content, alterations of the lambdoid suture or other premature synostosis, abnormal constraint related to posture or to muscular activity can modify the posterior curvature of the skull, generally flattening it. The authors propose a classification based on three points: -Intracranial pathology: alterations of the brain or CSF fluid can induce either insufficient (microencephaly) or excessive (hydrocephalus, Dandy Walker or Arnold Chiari malformations) expansion. -Bone pathology: craniosynostosis: sagittal synostosis (scaphocephaly) induces a bulging and coronal synostosis a flatness of the posterior skull. Bilateral premature lambdoid synostosis (pachycephaly) produces total flatness of the back of the skull. -Extrinsic pathology: dysmorphism is often asymmetrical and results from extracranial mechanical application dysfunction such as inborn torticollis, cervical spine pathology (Klippel-Feil syndrome), or prolonged decubitus during the first year of life. The authors describe a personal technique for correcting this dysmorphism: the turned biparietal flap transposition. The back of the skull is remodelled (either asymmetrical or bilateral flatness), and patients with no need for a helmet can lie on their backs immediately after the operation.

[Triangular skull. Apropos of trigonocephaly]. / Les crânes triangulaires. A propos de 87 cas de trigonocéphalies.

The authors present 87 patients with trigonocephaly who were operated on. They take an interest in the consequence of the early synostosis of the metopic suture. The metopic suture combine with the sagittal sutural system, but his spot of manifestation is unambiguous. Its manage the dimension of the frontal bone which himself has repercussions on the set of the orbits. Thereby the fronto-orbito-facial dysmorphy has two component parts. One direct with little frontal bone and a thick sutural spot which extend more or less to the bregma and a second indirect with early deformation of the orbits and late deformation of the parietal bones. Three clinical patterns are described: micro-frontal shape, medio-frontal shape and orbito-frontal shape. In the pure shapes there is no direct impact on the encephalon but the venous stasis is high and probably liable for the encephalic damage when they exist. A single surgical proceeding does not meet the many varieties of deformations. Resection of fused metopic suture from a bifrontal flap; confection of orbito-fronto-nasal band which is opened by greenstick fracture on the metopic site; transposition of an hemicoronal suture between the two hemifrontal valves lateraly translated; foreward mobilisation and interventing temporal flaps. To finish the modeling it is necessary to open the periosteum sheet in order to translate temporal muscles then to overlay with interparietal pedicularly periosteum the anterior step. Metopic synostosis is ordinarily only an aesthetic deformity infrequently associated with intracranial pathology. The treatment must be required for pronounced deformities to prevent significant psychosocial consequences.

[Lumbar disk hernia in children. Apropos of 12 cases]. / Les hernies discales lombaires de l'enfant. A propos de 12 cas.

Lumbar disc herniation in young adolescent is uncommon. Twelve patients of 13 to 16 years old (4 boys and 8 girls) are reported. Traumatic history is encountered only in 1/3 of cases and any spinal abnormality is noted in this series. The rapidity in clinical course is the main difference compared with the lumbosciatalgia of the adult. The mean interval of time between the beginning of clinical signs and surgery is 5 months and a half. A positive straight leg raising test is always present as well as antalgic pseudo-scoliosis. The radiculalgia without lumbalgia is the essential sign in on fourth of cases. The myelography and C.T. scan revealed lumbar disc herniation 5 times in L4-L5 intervertebral space and 7 times in L5-S1 space. The intervertebral disc is reached by unilateral interlaminal approach. The complete removal of the disc is always difficult as the disc is not dehydrated at this age. The radiculalgia disappears immediately in the postoperative period as well as the lumbalgia. The back pain persist some months following the surgery. Up the date any response is noted but the authors think that some prudence is necessary in the evaluation of the results especially because of the incomplete removal of disc in young patients. The authors think also that well hydrated and simply protruded disc of young adolescent may constitute an excellent indication for chemonucleolysis.

[Cranial asymmetries. Reflexions on plagiocephalies. Premature sutural synostosis or extracranial origin?]. / Asymétries craniennes réflexions sur les plagiocéphalies. Synostose suturaire prématurée ou origine extra-crânienne?

The authors relate a clinical and radiological (X Ray and TDM tridimensional) study with an anthropological (dry skulls) study of plagiocephaly. The aim is to find with the aid of a physical examination, some anatomic parameters which permit to differentiate cranial asymmetry with coronal premature synostotic suture from functional deformation with extracranial outset. The term plagiocephaly is used to define forehead asymmetry. It is necessary to study orbital rim, nasal root, malar eminence, ear and chin mid point position. The morphology of the skull is important to look: frontal flattering and also occipital flattering or bulging, contra-lateral frontal and pterional aera bulging. The authors conclude that a single parameter is necessary to differentiate the two kinds of plagiocephaly: the petrous bone position on the flattened frontal side: sagittalisation: fonctionnal plagiocephaly; frontalisation: synostotic plagiocephaly.

[Scaphocephaly. Treatment and complications apropos of 115 cases]. / Scaphocéphalies. Traitement et complications à propos de 115 cas.

The authors report, concerning 115 cas of scaphocephaly, the clinical (spheno., lepto., bathmo., clino., the kinds without dolichocephaly) radiological characteristics (temporal curve without dolichocephaly), orbito-sphenoidal obliquity regressing after treatment). They discuss the accepted ideas of the merely morphological problems of this type of craniostenosis, about their clinical and X-ray findings of encephalic disorder. The therapeutic methods are stated, so are the complications met during the surgical treatment. They suggest the craniectomy, taking away the sagittal suture associated with the linear coagulation of the dura mater. To the median sagittal craniectomy, one can add retrocoronal, pre lambdoid or metopic craniectomies according to the type of scaphocephaly. This treatment is simple, efficient and not very dangerous during the first year.

[Plagiocephaly. Craniofacial asymmetry with variable curling-up]. / La plagiocéphalie. Asymétrie cranio-faciale à enroulement variable.

The plagiocephaly syndrome is an asymmetrical cranial deformity due to premature synostosis of a coronal hemi-suture. The predominant alteration is at the spheno-frontal suture. The classification is attempted between the isolated plagiocephaly (P) an plagiocephaly with hypertelorism, on one side, that are to be distinguished from complex asymmetrical cranio-facial deformities. The frontal P. are differentiated from occipital P (pachycephaly) and from mixed hemi-cranial P. The deformity affects the fronto-orbital region situated anterior to the synostosis. The coronal suture incurves around a pivot formed by the lateral orbital pillar and the pterion, giving rise to a set of facial and cranial deformities, variable according to the precocity and the topography of the synostosis. Investigating the syndrome is clinical and radiological. The deformity reveals itself in 88% of cases, the affects are mainly orbital and ophthalmologic. The authors insist on the necessity of a bilateral orbito-fronto-nasal osteotomy, as a therapeutic act that gives better harmony on short and long term; on the other hand, they draw the attention to the importance of abolishing the synostocic lock by the resection of the lesser wing of the sphenoid extended till the superior orbital fissure and the resection of the outher periosteal layer of the dura matter which allows a remodeling effect the growing brain. The results and complications are evaluated on 44 operated children.

[Persistence of the stapedial artery: three cases]. / Persistance de l'artère stapédienne: à propos de trois observations.

The authors report three cases of persistence of the stapedial artery, discovered by computed tomography examination. For two cases, a clinical symptomatology was present but probably related to the association with an aberrant carotid artery in the middle ear; the only case of isolated persistence of the stapedial artery was asymptomatic. Direct visualisation of the abnormal artery was possible on the C. T. scans in two cases and a collateral sign as a larger tympanic part of the facial canal was found in the third case inducing a MRI. The incidence of this anomaly is 0.48 per cent from 1,045 dissections of temporal bones but it is generally clinically unrecognized. The hyoïdo-stapedial artery appears and develops at the 7-18 mm embryonic stages. Partial or complete persistence have been described associated with no regression or no division of the ventral pharyngeal artery.

[Vertex aplasia cutis congenita with bone defect: Management synthesis and review of the literature]. / Aplasia cutis congenita du vertex avec atteinte osseuse : synthèse sur la prise en charge et revue de la littérature.

Aplasia cutis congenita (ACC) of the vertex is a rare and potentially severe malformation. We report the case of a newborn boy presenting ACC of the vertex with a skull defect. Surgical closure of the skin was performed 5 days following birth, which allowed skin healing. The skull spontaneously remodelled perfectly 6 months later. When associated with skull defect, this rare malformation characterized by the absence of skin carries the risk of severe complications such as rupture of the superior sagittal sinus or infections. Based on a review of the literature, we purpose an overview of the medical and surgical management of vertex ACC, which depends on the size of the skin defect and the presence of a skull defect.

Split cervical spinal cord malformation and vertebral dysgenesis.

We report a case of vertebral malformation associated with diplomyelia believed to be a type II split cord malformation. Cervicothoracic level cases are exceptional. This article reports the case of an 11-year-old boy with no neurological symptoms who had not undergone surgery. The diagnosis was made during pregnancy by prenatal screening with ultrasound and MRI. Several embryological theories have been offered to provide an explanation for this syndrome. Close follow-up is mandatory. Surgery must only be considered if neurological deterioration occurs.

Spontaneous resolution of arachnoid cysts: review and features of an unusual case.

Most intra-cranial arachnoid cysts are quiescent and remain asymptomatic throughout life. Within the natural course of arachnoid cyst evolution, spontaneous resolution has been known to occur rarely, but its frequency is probably underestimated due to lack of systematic detection and long-term observation. We illustrate the spontaneous regression of arachnoid cysts with a patient which was conjointly diagnosed with an arachnoid cyst and a post-traumatic epidural haematoma. Cyst regression was observed 16 months later, upon examination following a second benign cranial trauma. Mechanisms underlying the resolution of the arachnoid cyst are discussed.