Lestumeurs de la fosse cereabrale posterieuea [FCP]: [a propos de 150 cas]

The authors have reported the experiment of the neurosurgical department at the "Specialised Hospital" about the tumoral pathology of the posterior cranial fossa concerning 150 cases encountered between 1983 and 1990. In about 56% cases, the patients were young, less than 20. Their clinical aspect was dominated by intracranial hypertension [I.C.H.] syndrome [78%]. Due to the patients delay in consulting, there is blindess in most of the cases [16%]. The CT. scan, carried out systematically in all our patients has amliowed us to distinguish the tumor and to find out an associate hydrocephaly in 62% cases. The main anatomo-pathological types encountered in our series are medulloblastoma in 34 cases, astrocytomas in 30 cases, and neurinoma in 23 cases. The dreadful prognosis of this affection is death in 25% of the cases in the pen-operating period. It is reduced gradually year after year thanks to an early management of the patients, to the progress we have achieved, and to a better multidisciplinary collaboration

Traitement neurochirurgical de la nevralgie faciale essentielle A propos de 46 cas

We report here a study of 46 essential facial neuralgia cases, mainly managed by thermocoagulation [36 case], neurovascular decompression [6 cases] and balloon compressor [4 cases]. These therapeutical methods were crowned with immediate success [disappearance of pain] in 34 thermocoagulation cases [94,5%] in the 6 neurovascular decompression cases and in the 4 balloon compression cases. Their remote results were excellent or satisfying in 26 cases [72%] of thermocoagulation and 4 cases of neurovascular decompression However, we noted 8 cases [22%] of recurrence after thermocoagulation after a periode oscillating between 3 months and 5 years and complications lying in embarrassing or painful sensitive disorders in 9 cases [119]. No death results from this innocuous method. As for the neurovascular decompression we noted 2 recurrence case after 6 - 16 months period, two patients presented later a facial paralysis whose course led to progressive recovery. For the balloon compression, the period is not too sufficient to analyse the results. The results, achieved in this series, are similar to those reported, in literature, more Particularly for thermocoagulation but for the neurovascular decompression and the compression by balloon, the number of our cases is limited and does not allow a comparaison with literature data. The Physiopathology of this affection is still a contreversial question, and only a good understanding of the pain mechanism can lead to a standard and generalized therapeutical attitude

stereotaxie dans le diagnostic et le traitement des processus expansifs intracraniens A propos de 50 cas

The authors report that their experience in stereotactic surgery is based on 50 cases of brain tumors from 1989 to 1991. There are 33 males and 7 females. The median age is 38 years old. The main symptom was intracranial hypertension. The C.T. scan. demonstrated a process deep seated in the hemisphere in 60% of the cases, in the pineal region and the brain stemb in 18% of the cases, and in suprasellar region in 22% of the cases. The procedure was simple, quick conservative and performed under only local anesthesia and sedative drugs. We were able to perform 38 biopsies by stereotactic surgery, biopsy with drainage of the cyst in 8 cases. A drainage of the cyst alone was done in 3 cases, and in one case drainage of a hematoma in the thalamic region was performed. No major complications were seen after surgery. The pathological results of biopsies were dominated by malignant gliomas. However, other types of lesions were seen such as lymphoma, tuberculoma, and Metastasis. In, 4 cases the pathological result was negative. we regret two deaths post operatively 4% one after hemmor, hage and the other after brain edema

Traitement neurochirurgical des douleurs chroniques

A neurosurgical treatment must be considered whenever there is a permanent pain which is rebellions to important antalgics. At the moment, a wide range of techniques is available. Some of them are destructive, aiming at cutting the tracts taken by the painful message. Among them, the most used are posterior radicotomy, dorsal root entry zone lesion [DREZ-tomie] and commissural myelotomy. The two last ones are used only when the pain has cancerous origin. The other techniques are conservative, aiming at strenghtening the mecanism of checking pain. We point out: electric neurostimulation used when the sort of pain is a sensitive deafferenta tion [peripheral nerve trauma, amputation stamp pain]. Intrathecal morphine are conservative technique of the present used more for diffuse cancerous pain with a weak life expectancy. The choice of an adequate takes into account the type of pain and its mechanism as well as it site. We do our best to choose the most conservative technique and the least impairing

Etude de la configuration anatomique du polygone arteriel de Willis chez le foetus humain par les techniques d'injections vasculaire et morphometrie cranio cerebrale foetale: a propos de 50 cerveaux de foetus

60 f'tuses aged from four to nine months were taken from the Rabat C. H. U. mortuary and injected through different arteries the aorta, the carotid and the umbilical using in so doing two different products. After the product was fixed, samples were taken from 50 brains and studied by means of micro-dissection under binocular lens; at the same time, measurements were taken. On one hand, we have studied the f'tal cranio cerebral,morphometry which showed with age a gradual increase of the different diameters in both the vault and the brain. On the other hand, the study of each segment of the injected arterial circle of Willis showed the existence of great anatomical variations as far as "filiform arteries" and "non developped arteries" are concerned with a clear predominance of these variations in the medium and anterior segments. No anomalies were observed in the coverying arteris. As to the anterior communication presents variations and complex aspects in the f'tus. We have thus isolated 8 morphological types of the fcetal arterial circle whose ideal type [all the segments are similar as to caliber is concerned, without being "filiform" represents 60% of the cases. These results show, above the congenital factors the part played by the progressive modeling of the arterial circle of Willis [already acquired theory] to explain, on one hand, the different anatomical variations of the arterial circle of Willis in the adult and, on the other hand, the physiopathogeny of these arteries

Compression modullaire par hernie discale dorsale

We report a case of acute medullary compression by thoracic disc-herniation. This uncommon entity require surgical decompression without delay. The discussion concerns the important information provides by the TDM and RMN and they concerns too, the different surgical approaches