[Predictive value of postural and dynamic walking parameters after high-volume lumbar puncture in normal pressure hydrocephalus]. / Intérêt prédictif de l'évolution des facteurs posturaux et locomoteurs après ponction lombaire soustractive dans l'hydrocéphalie chronique de l'adulte.

INTRODUCTION: Normal pressure hydrocephalus (NPH) was described by Adams et al. (1965). The common clinical presentation is the triad: gait disturbance, cognitive decline and urinary incontinence. Although these symptoms are suggestive, they are not specific to diagnosis. The improvement of symptoms after high-volume lumbar puncture (hVLP) could be a strong criterion for diagnosis. We tried to determine a specific pattern of dynamic walking and posture parameters in NPH. Additionally, we tried to specify the evolution of these criteria after hVLP and to determine predictive values of ventriculoperitoneal shunting (VPS) efficiency. PATIENTS AND METHODS: Sixty-four patients were followed during seven years from January 2002 to June 2009. We identified three periods: before (S1), after hVLP (S2) and after VPS (S3). The following criteria concerned walking and posture parameters: walking parameters were speed, step length and step rhythm; posture parameters were statokinesigram total length and surface, length according to the surface (LFS), average value of equilibration for lateral movements (Xmoyen), anteroposterior movements (Ymoyen), total movement length in lateral axis (longX) and anteroposterior axis (longY). RESULTS: Among the 64 patients included, 22 had VPS and 16 were investigated in S3. All kinematic criteria are decreased in S1 compared with normal values. hVLP improved these criteria significantly (S2). Among posture parameters, only total length and surface of statokinesigram showed improvement in S1, but no improvement in S2. A gain in speed greater or equal to 0.15m/s between S1 and S2 predicted the efficacy of VPS with a positive predictive value (PPV) of 87.1% and a negative predictive value (NPV) of 69.7% (area under the ROC curve [AUC]: 0.86). CONCLUSION: Kinematic walking parameters are the most disruptive and are partially improved after hVLP. These parameters could be an interesting test for selecting candidates for VPS. These data have to be confirmed in a larger cohort.

[Intracranial primary epidermoid carcinoma]. / Carcinome épidermoïde primitif intracrânien.

We report a case of intracranial primitive epidermoid carcinoma localized in the right temporal fossa in a 40-year-old man. The patient was submitted to surgical removal of his tumor and radiotherapy. Unfortunately, the survival time was six weeks after the operation. Clinical, radiological, anatomopathological features and the interest of the radiotherapy are discussed.

Intraspinal cervical degenerative cyst. Report of three cases.

The authors report three cases of cervical degenerative cysts causing medullary or radiculomedullary compression. Anatomicopathological examination confirmed the fibrous nature of the cyst wall and the absence of a synovial layer. One of the cysts was embedded in the ligamentum flavum, whereas the other two were most lateral and adherent to the facet joint. The physiopathogenesis of these cysts is discussed.

[Mature lumbar multi-tissue dysembryoma of the spinal cord with sacral spina bifida occulta]. / Dysembryome pluritissulaire mature médullaire lombaire avec spina bifida occulta sacré.

The authors report the case of a 28-year-old woman who presented with L5 bilateral sciatica associated with perineal sensory disorders. During surgery, a mature pluritissular dysembryoma originating in a tethered spinal cord was discovered at the level of the L2-L3 intervertebral space. Following removal of the lesion, all symptoms disappeared. Mature pluritissular dysembryomas of the spinal cord result from the inclusion of neuroectodermal and mesodermal tissue which has not followed normal evolutive embryonic organization.

Treatment of severe traumatic lesions of the dorsolumbar spine using Roy-Camille's apparatus. A clinical study of 121 cases together with technical considerations.

The authors report 121 cases of surgically treated severe lesions of the dorsolumbar spine. One single technique has been used: posterior osteosynthesis using Roy-Camille's plates.

Odontoid process fracture osteosynthesis with a direct screw fixation technique in nine consecutive cases.

The authors present their experience with surgical treatment of odontoid process fractures using a direct screw fixation technique via an anterolateral retropharyngeal approach. Nine consecutive patients have been operated on with this technique. There were two deaths unrelated to the surgery, and anatomical union with conservation of the craniospinal hinge mobility was achieved in the remaining seven patients. The direct screw fixation technique appears feasible, efficient, and logical.

[Cervical Pott's disease. Technical considerations apropos of a surgically treated case]. / Mal de Pott cervical. Considérations techniques à propos d'un cas opéré.

The authors report one case of cervical Pott's disease located in C5 and associated with neurological disorders. Following corrections of the spinal disaxation, they advocate a per priman posterior fixation which will ensure spinal stability. This will be followed secondarily by an operation through an anterior approach.

Treatment of severe lesions of the lower cervical spine (C3-C7). A clinical study and technical considerations in 102 cases.

The authors report 102 cases of severe lesions of the lower cervical spine, in which operation was mandatory. The characteristics of these fractures are discussed, together with the different operative procedures. Posterior osteosynthesis using Roy-Camille's plates was preferred.

[Osteosynthesis of fractures of the odontoid process by direct screwing. Preliminary reflections on 2 surgically treated cases]. / Ostéosynthèse des fractures de l'odontoïde par vissage direct Réflexions préliminaires à propos de 2 cas opérés.

Following surgical treatment of 2 cases of odontoïd base fracture, the authors describe the direct screw fixation technique through an anterolateral approach. This technique allows for good access and is very efficient. It results in an anatomical union with conservation of the craniospinal hinge mobility.

Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique.

The authors report 18 cases of pedicular fractures of C-2. The characteristics of these fractures are discussed, and the authors conclude that these lesions are more correctly called "pedicular-isthmus" fractures. A technique of screw fixation of the pedicle is presented. This was found to be a simple and safe method of repair, giving consistently good anatomical and functional results.

[Cervical spine injuries in children]. / Les traumatismes du rachis cervical chez l'enfant.

Cervical spine injuries in children are usually benign, severe traumatism being exceptional. The authors report 4 observations of severe traumatisms, 2 of which have required surgical treatment. Moreover they insist on the interest of acupuncture in the treatment of torticollis and of pain in the cervical spine after injury. The authors also point out the frequent aspect of anterior pseudo-subluxation C2-C3 which corresponds to a genuine medio-cervical physiological hinge.

[Traumatic bitemporal hemianopsia (author's transl)]. / L'hémianopsie bi-temporale traumatique.

The authors report a case of traumatic bitemporal hemianopsia, without any macroscopic lesion in the chiasma. At this juncture, they argue about the different mechanisms which may occur in the pathogenesis of these lesions, and they dwell on the indirect mechanism of the quartering of the optic nerves, which is responsible for a tear in the chiasma.

[A clinical study in neurosurgical diseases. A report on eighty cases (author's transl)]. / Essai thérapeutique en neurochirurgie. A propos de quatre-vingts observations.

The authors describe 80 patients with neurosurgical disorders treated with tiapride, either during neurosurgical investigations including radiological examinations after removal of cerebrospinal fluid, or for agitation following alcoholism or meningeal haemorrhage. The authors stress the value of tiapride for patients undergoing radiculography and especially gas myelography procedures. The effect of tiapride on the various manifestations of agitation was also spectacular and rapid, and the authors confirm the excellent tolerance of the product.

[Diagnostic problems in the disseminated intraparenchymatous form of cerebral cysticercosis. A report on two cases (author's transl)]. / Problèmes diagnostiques posés par la forme intraparenchymateuse disséminée de la cysticercose cérébrale. A propos de deux cas.

The authors report 2 cases of brain localisation of cysticercosis due to Cysticercus cellulosae. In both cases epilepsy was found but only later was its origin proved by the finding of caracteristic ellipsoidal calcifications of cysticerci on the roentgenogram. The authors also recall the various possible symptoms; insist on the fact that early positive diagnosis is difficult and that the mode of treatment by surgery is exceptional. Though cysticercosis is rare in France, it should be remembered when a diagnosis of epilepsy is made and no apparent cause is found: further research of etiology should thus be made in such cases.

[Large aneurysms of the internal carotid artery in its infraclinoidal intracranial portion (author's transl)]. / Les anévrismes géants de la carotide interne, intra-cranienne infra-clinoidienne.

Two new cases of large aneurysms of the infraclinoidal intracranial portion of the internal carotid artery are reported. After a survey of the literature, the authors emphasize the rarity of these malformations, their particular clinical picture with involvement of the cranial nerves. Among the various surgical techniques which were suggested for the management of these large aneurysms, the ligation of the internal carotid artery in the neck is favoured by the authors as the best procedure.

[Cerebral cysticercosis. About two cases of brain localisation (author's transl)]. / La cysticercose cérébrale: à propos de 2 cas d'infestation intra-parenchymateuse disséminée.

The authors report 2 cases of brain localisation of cysticercosis due to Cysticercus cellulosae. In both cases epilepsy was found but only later was its origin proved by the finding of characteristic ellipsoidal calcifications of cysticerci on the roentgenogram. The authors also recall the various possible symptoms ; insist on the fact that early positive diagnosis is difficult and that the mode of treatment by surgery is exceptional. Though cysticercosis is rare in France, it should be remembered when a diagnosis of epilepsy is made and no apparent cause is found : further research of etiology should thus be made in such cases.

[Carotid-cavernous fistulas by tearing or rupture of the meningo-hypophysial trunk or of one of its branches. Anatomo-radiologic study of 4 cases. Pathogenic hypotheses]. / Fistules carotido-caverneuses par arrachement ou rupture du tronc méningo-hypophysaire ou de l'une de ses branches. Etude anatomo-radiologique de 4 observations. Hypothèses pathogéniques

Thr authors report observations relative to four cases of traumatic carotid-cavernous fistulas for which angiographic pictures were similar. Autopsy examination permitted in two cases to establish that the tentorial branch of the meningo-hypophyseal trunk was involved in the genesis of both fistulas. One case was from a rupture, the other from tearing of that branch. Further examination of these two cases showed an absence of sphenoid bone fracture which suggested that any arterial perforation or shearing process could be excluded. Thus the pathogenic hypothesis of PARKINSON is further sustained. The authors suggest that the observed arterial lesions may be due to tensions occuring at the proximal part of branches of the meningo-hypophyseal trunk. Such tensions may be carried out through tractions on the posterior meningeal walls of the cavernous sinus when trauma occur on the posterior temporal area and the petrous bone. Such traction forces were shown to be real in one case where a fracture of the dorsum sellae and a bilateral caroti-cavernous fistula were caused by a bilateral temporo-petrous trauma.

[Selective ventriculography according to the Corrales technique. Its value in the diagnosis of tumors of the 3d ventricle and posterior fossa]. / La ventriculographie sélective selon la technique de Corrales. Son intérêt dans le diagnostic des tumeurs du 3e ventricule et de la fosse postérieure

The authors relate their experience of selective ventriculography. The methode previously described by CORRALES needs a small gold chain with fine links which can reach by gravity the cavity of the fourth ventricle through the third ventricle and the aqueduct of Sylvius. This small chain is used as a leader for a flexible catheter which permits selective clouding of median ventricular cavities. This technique was used in 18 patients. In one case only, the small chain went down without any difficulty into the cisterna magna. The ventricular system was normal. In the 17 other cases, the progression of the small chain was stopped at some point of the ventricular cavities. In each of those cases, the stopping of the small chain appeared to be linked with the presence of a growth directly obstructing or compressing the ventricular cavities and gave a first clue as to its location. Introduction of the catheter into the aqueduct of Sylvius was the only true difficulty; in 3 cases, anatomical (large massa intermedia) or pathological obstacle (right angle bending of the aqueduct of Sylvius) made it impossible. In those 3 cases a satisfactory selective clouding of the fourth ventricle was nevertheless obtained by injecting the dimer either into the posterior part of the 3rd ventricle or into the upper part of the aqueduct of Sylvius. In all cases the trouble some superpositions due to clouding of lateral ventricles were thus avoided and a tomographic investigation, specially useful for the diagnosis of expanding lesions of the third ventricle and posterior fossa was allowed.