[Sacrifice was an art: the voice of the castrato]. / L'art du sacrifice: la voix du castrat.

Introduced in Europe through the mozarabic civilization during the IXth century, the castrato will reign on Baroc Opera theaters in Europe in the XVllth and XVlllth century and will progressively disappear in the XIXth century. Castration is responsible pour morphologic changes not only of the larynx, but also of the skeleton and visceral tissues. These anatomic particularities mixed with a stupefying vocal technic, will create one of the most extraordinary vocal phenomenon of the history of singing, but the price to pay was so high.

[Callas or the trajectory of the meteor]. / Callas ou la trajectoire du météore.

The lyric career of Maria Callas, though exceptional, is also noteworthy for its brevity. The first signs of downturn appeared at the age of 36 and her voice fell silent at only 40. Though the literature has massively commented on this premature worsening, few analyses of its characteristics have been made public so far The purpose of our study was to realise a perceptual and acoustical analysis of recorded arias by the artist at the climax to the fall. The audible impairments were first verbally described, and then compared to acoustical observations based on spectrographic analyses and fundamental-frequency measurements.

[Partiturogram: (new) tool in the evaluation of an opera roles]. / Le partiturogramme: (nouvel) outil dans l'évaluation du profil vocal des rôles d'opéra.

The partiturogram is a tool that was defined in the 1990s by Franco Fussi. It aims to display all the music notes of an opera role as a histogram. Several parameters are then calculated in order to define the vocal profile of the role, as well as help the singer choose from various options. We have decided to use this tool to study Norma and Sonnambula, two roles which were specifically written for the same singer described as a dramatic soprano. Over time, both roles have been allocated to radically different voices. The partiturogram confirms the similarity of the vocal types of both roles, but gives no explanation as to the differences in the casting decisions. We have therefore established its limits, and we have submitted a study including new parameters in order to refine the characterization of roles.

[Recurrent acoustic neurinoma after complete surgical resection]. / Les récidives des neurinomes de l'acoustique après exérèse chirurgicale.

BACKGROUND: Mortality of acoustic neurinoma surgery is currently very low, well below the figures reported by the first surgeons. Morbidity has also declined with attempts at preserving the facial function and more recently hearing function. Long-term follow-up has demonstrated the well-known risk of recurrence after partial resection, but also evidenced a risk after complete resection. PATIENTS AND METHODS: We reviewed two series of patients, the first including 40 patients treated and followed at the Timone Hospital since 1975 and the second including 97 operated patients who were followed by the ENT Federation over 8 to 16 years. We studied recurrence after partial and complete resection. RESULTS: Recurrence rate was 20% after partial resection and 9.2% after complete resection. DISCUSSION: The 20% recurrence rate after partial resection was similar to that reported in the literature. After total extirpation, our 9.2% recurrence rate appears well above the 1% reported by others. Although our series could have a bias due to the large number of patients lost to follow-up, the large population size and the fact that we had a majority of large tumors would suggest that recurrence rate is generally underestimated. An 8 to 10% rate appears to be closer to reality. Most recurrences were late, with a peak around 8 years. We did however observe recurrences as early as 1 year and as late as 20 years. Delay appears to be shorter after partial removal. A wide range of localizations were observed but two areas predominated: the internal auditory canal and the components of the acousticofacial pedicle, and to a lesser degree the brain stem. Most patients were asymptomatic. The principal manifestations were balance disorders or trigeminal nerve lesions, more rarely facial palsy. But these clinical signs came late and generally signaled a bulky tumor measuring more than 3 cm. CONCLUSION: These findings lead us to insist on the need for radiological monitoring of all operated neurinomas irrespective of the initial surgery. MRI appears to be more accurate than computed tomography. Images must be interpreted carefully due to possible postoperative remodeling. For us, these observations point to the need for prolonged follow-up of at least 8 years, longer for young subjects, for all patients undergoing surgical resection of an acoustic neurinoma.

[Essential parathyroid cysts: a misleading lesion]. / Le kyste parathyroïdien essentiel: une affection trompeuse.

Though a rare lesion, non-functioning parathyroid cyst is of clinical significance because it usually mimics a thyroid nodule. The cyst can be ectopic in location and therefore constitutes a differential diagnosis to a bronchial or thymic cyst. Two recent cases of non-functioning parathyroid assay are reported. Needle puncture with estimation of the level of parathyroid hormone in the aspirate allows the diagnosis to be made before surgery.

[Endolymphatic sac tumors]. / Tumeur du sac endolymphatique.

Tumors of the endolymphatic sac are rare and can be found in patients with Von Hippel Lindau disease. They most often develop within the intrapetrosal part of the sac but can sometimes be located in the distal part. Their growth is slow and they spread in two directions: laterally toward the external and middle ear and in the direction of the jugular foramen and medially into the ponto-cerebellar angle. The symptoms are usually auditive, with a constant neurosensorial deafness of sudden onset in 50 % of cases and sometimes associated with a tinnitus and dizziness. The varieties with medial extension result in a cerebellopontine angle syndrome. Diagnosis is made by imaging (CT scan and MRI) that reveals a heterogeneous tumor between the lateral sinus and the internal auditory meatus, hypervascularized showing contrast, with cystic zones and associated with bone lysis. Histological examination of a papillary cystadenoma is performed and the differential diagnosis is essentially made with a papillary of the choroïd plexus. They require total surgical excision in order to avoid possible recurrence and can be performed by retrosigmoïd approach, or more ideally, by transpetrosal approach.

Preservation of hearing in acoustic neuromas treated by gamma knife surgery.

138 acoustic schwannomas were treated by Gamma Knife surgery from July 1992 to May 1994. Cases with neurofibromatosis were excluded because of differences in the patterns of growth and development of tumors in these cases. Hearing was evaluated by tonal and vocal audiometry and classified using the Gardner and Robertson score. 104 patients were observed at 3 years after treatment. Hearing studies, the relation of tumor volume to hearing, central and marginal dose, number of shots and preoperative brain-stem-evoked responses (BER) were all recorded. 70% of patients with normal hearing maintained a useful hearing, and 50% of patients with useful hearing maintained serviceable hearing. No correlation was found between hearing preservation and tumor volume, central and marginal dose and number of shots. Gamma Knife surgery seems to be superior to microsurgery with regard to preservation of useful hearing.

[Neuro-vascular decompression in hemifacial spasm: anatomical, electrophysiological and therapeutic results apropos of 100 cases]. / Décompression neuro-vasculaire dans le spasme de l'hémiface: résultats anatomiques, électrophysiologiques et thérapeutiques à propos de 100 cas.

Hemifacial spasm is a neurological disorder due to abnormal hyperactivity of the facial nerve. The most common cause of hemifacial spasm is a neuro-vascular conflict in the cerebellopontine angle between a vascular loop and the root of the facial nerve (96% of cases). Tumors are the cause of hemifacial spasm in only 1% of cases). The authors present their results in 100 patients who underwent microvascular decompression for essential hemifacial spasm between 1990 and 1995. They used microsurgical and endoscopic procedures by a minimal retrosigmoid approach in all cases. The most common offending vessels were the posterior inferior cerebellar artery (70%), the vertebral artery (41%) and the anterior inferior cerebellar artery (28%). An aberrant vein was found in 2 cases. There were 38% of multiple artery-nerve conflicts. Physiopathology of hemifacial spasm is explained by two principal theories: in the ephaptic theory, hyperactivity and an abnormal nervous impulse pathway are due to a short demyelinated area on the nerve trunk caused by the offending vessel, inducing short circuiting between adjacent nerve fibers. In the nuclear theory, hyperactivity of the facial nerve is due to an abnormal and automatic activity of the facial nerve nucleus itself, induced by the vessel. The authors used pre and postoperative electromyographic tests and intraoperative electromyographic tests. Their results tend to prove the nuclear theory. Ninety per cent of the patients had a good result, with a mean follow-up time of 30 months in 60 cases. In 82% of the cases, there was a total recovery after a single procedure. There was no mortality and no facial palsy. Hearing loss occurred in less than 5%.

[Surgical treatment of subglottic angioma in infants. Technique and indications]. / Le traitement chirurgical des angiomes sous-glottiques du nourrisson. Technique et indications.

Subglottic angiomas, frequently observed in new-borns, can have an unfavourable course due to laryngeal dyspnea. Although the natural course is towards spontaneous involution, different therapeutic approaches depend upon the lesion's sensitivity to corticotherapy. The authors report 24 cases of angioma observed over the last six years at the Hôpital d'Enfants de la Timone in Marseille, France. The relative importance of corticotherapy, intubation, laser and tracheotomy were analyzed and the role of surgical exeresis was analyzed with precision. Four observations were presented in detail. Based on the data in the literature, indications for this therapeutic method would be rather limited, but could offer rapid curative care without complications.