Spinal dysraphia and elongated spinal cord in adults.

Spinal dysraphia with stretching of the spinal cord is usually diagnosed in the adolescent or young-adult patient. Two types of the condition are distinguished: a stretched spinal cord with an intradural lipoma, and a stretched spinal cord with both an intra- and extradural lipoma. The pathogenesis of the condition and mechanical role of the lipoma and the late appearing neurological signs are presented.

[Lumbosacral dysraphia and "long spinal cord" of delayed appearance (9 cases)]. / Dysraphie lombo-sacrée et "moelle longue" de révélation tardive (neuf observations).

Urinary disorders, deformities of the feet, and sensory of trophic disturbances appearing during, or increasing in severity at adolescence, were observed in 9 patients. In seven cases there appeared to be an abnormality of the teguments of the lumbosacral region, and in all cases, as shown by straight radiological examination of a spina bifida of L5 or S1, a sacral dehiscence and wide sacral canal, and a subjacent nervous tissue abnormality was suspected. Radiculography showed the presence of a "long spinal cord" terminating in the sacrum by a tumor mass. Examination of this mass in the seven operated cases demonstrated that the tumor was an intradural lipoma with a wedge-shaped penetration into the end of the medulla, fixing the cord in the sacrococcygial region, in the absence of the filum terminale and cauda equina. The etiology of this "long spinal cord" is discussed, and it appears to be the consequence of a dysraphia, which is also the cause of the lipoma. Mechanical factors appear later and produce neurological signs.

[Evaluation of bone density of the calcaneum using ultrasound attenuation in menopausal women]. / Evaluation de la densité osseuse du calcanéum par mesure de l'atténuation des ultrasons chez les femmes ménopausées.

The results of bone density of the calcaneum measured with ultrasound in 107 menopaused women were compared with reference values provided by the manufacturer of the Walker Sonics machine and with the results of quantitative densitometry obtained with computed tomography of the calcaneum and lumbar vertebrae. The coefficient of correlation was 0.57 for the calcaneum and 0.45 for the vertebrae and was confirmed by the kappa index which was 0.58 and 0.54 respectively, indicating that bone density measurement with ultrasound attenuation is a simple non-invasive non-radiating technique which is a promising method for exploring osteoporosis in menopaused women.

[Traumatic otoliquorrhoea. Fifty patients treated surgically (author's transl)]. / Les otoliquorrhées traumatiques. A propos de 50 malades opérés.

After a fracture in the petrous bone responsible for CSF otorrhea, the discharge continues no more than a few days and ceases spontaneously, but if prolonged, meningitis becomes a considerable risk. During the past five years, we operated on 50 cases of cerebral spinal fluid otorrheas after head injury. The surgical procedures were settled after an agreement between neurosurgeons, oto-rhino-laryngologists and neuroradiologists. 6 patients had a neurosurgical approach because of an associated brain lesion, 32 patients were operated only by otologists, 12 patients had presented an early or late meningitis. In most cases (41/50) a microsurgical exploration of the middle ear was performed: CSF was seen to be coming through the internal meatus acusticus into the middle ear, on account of a fracture, a luxation or a disinsertion of the annular ligament of the stirrup bone. The closing of the gap with muscle tissue, from the temporalis, gave good results, without recurrence of otorrhea or meningitis. This procedure may be performed easily and rapidly as soon as the CSF discharge does not cease after few days. This attitude, even if considered as preventive, is safer for the patient.

[Use of radiology in the diagnosis of posttraumatic otoliquorrhea. A report on 33 operated cases (author's transl)]. / Apport de la radiologie dans le diagnostic des otoliquorrhées d'origine post-traumatique. A propos de 33 cas opérés.

The association of standard radiography and tomography can enable the origin of the fistula to be established with reasonable precision : complementary contrast cisternography should permit direct localization. Treatment is essentially the concern of the E.N.T. surgeon, but the problem cannot be resolved without a perfect understanding between the neurosurgeon, surgeon, E.N.T. specialist, and the radiologist.

[Carotid dolichosiphon. One case (author's transl)]. / Dolicho-siphon carotidien. A propos d'un cas

A report of the case of a 68 year old patient with a 9,5 cm long ectasia of the cisternal portion of the left internal carotid. On the basis of this case, the authors review the pathology due to such dolichomega-arteries and the aetiology of arteriectasia which are partly dysplasic in origin.