Cerebral aneurismal rupture with subarachnoid hemorrhage during pregnancy: a case report

Background: Intracranial hemorrhage due to arteriovenous malformation or intracranial aneurysm is a rare but severe complication of pregnancy with maternal and fetal mortality of 20% and 33% respectively. Whether to deliver the patient first, or to treat the aneurysm first is still controversial, but an emergency cesarean section followed by aneurismal treatment appears to be a widely accepted strategy in pregnant women with cerebral aneurysmal complications

Case: A 38-year-old patient, G3P2A0, presented at 36 gestational weeks with a diffuse bilateral subarachnoid hemorrhage with fourth ventricle bleeding and hydrocephalus. She had a cerebral aneurysm of the left posterior communicating artery on arteriography. A cesarean section was performed on the first day of admission, and an external ventricular derivation with clipping of the aneurysm on the left posterior communicating artery were done immediately after the cesarean section. Mother and newborn were discharged from hospital in a good health status except Broca's aphasia in the mother

Conclusion: In the absence of categorical recommendations, we stress the role of combined care by both neurosurgeons and obstetricians, on a case to case basis according to gestational age, mother neurological status and experience of caregivers

Interest of the adjustable opening pressure valve in the treatment of hydrocephalus and arachnoid cysts. Analysis of a series of 50 cases

Objective: The objective of this work is to evaluate the results of a draining valve of the cerebrospinal fluid, whose opening pressure is transcutaneously adjustable, in the treatment of intracranial collections. Material and methods A series of 50 operated patients is retrospectively reviewed. Forty-four patients are treated for hydrocephalus of variable causes and six patients for arachnoidal cysts. Offering eight opening pressures, the adjustable valve Sophy was used in all these patients. The mean follow-up is of 48 months. Results: Nineteen patients [38%] needed an adjustment of their valve's opening pressure. This adjustment was achieved to higher levels in seven patients presenting with overdrainage and to lower levels in twelve patients presenting with underdrainage. In 4 patients a subdural collection was observed and treated. Six patients underwent a second surgery for infection or obstruction. Taking all etiologies into consideration, and after the adjustment of the valve's opening pressure, 40 patients had a positive clinical result [obvious amelioration of the symptomatology], ten patients did not improve. Conclusion: The valve Sophy provides a simple solution for the patients in whom it is difficult to choose an adapted opening pressure, it particularly allows to avoid a reintervention when this is rendered necessary by a hypo or a hyper drainage programmable valve

La thermocoagulation dans le traitement de la nevralgie faciale. Resultats preliminaires de 22 cas

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at Hotel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satifactory in twenty patients [90.9%] who became asymptomatic. No major complication was notice. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia