[Intramedullary tumors. Results of a national investigation in private neurosurgery]. / Les tumeurs intramédullaires. Résultat d'une enquête nationale en neurochirurgie libérale.

UNLABELLED: The frequency of intramedullary tumors is 0.5 cases per year for 100,000 inhabitants. The study reported herein was a retrospective study conducted from January 1985 to September 2007. MATERIAL: Seventy-nine cases were distributed in the following manner: ependymomas, 38; astrocytomas, 22; oligodendrogliomas, four; gangliogliomas, two; hemangioblastomas, 10 (nine sporadic cases and one case of Von Hippel-Lindau disease); primitive melanoma, one; and intramedullary neurinomas, two. Three patients were lost to follow-up and 10 patients died. METHOD: All patients were explored using MRI and were operated using a microsurgical technique. Tumor removal was complete in the cases of ependymoma and hemangioblastoma and subtotal in the cases of astrocytoma. RESULTS: Ependymoma: 38 cases with three cases of ependymoblastoma. Mean age: 47 years (range, 17-74 years); 17 males and 21 females. Diagnostic delay: less than one year, 11; one year, 15 cases; two years, nine cases; three years, three cases. Seven recurrences with one 35 years after a prior removal. Localizations: cervical and cervicodorsal, 19; dorsal, ten; dorsolumbar, seven; holomedullary, one. Number of levels concerned: 5-12 (with the cysts associated). Mean follow-up was 10 years (range, two months to 35 years). Patients stabilized, 19; worse, six; improved, nine. Patients deceased: four, one by suicide, three cases of ependymoblastoma (survival, seven months). Astrocytomas: 22 cases, with 14 cases of astrocytoma, two pilocytic astrocytoma, four malignant astrocytoma, and two glioblastoma. Mean age: 44 years (range, 22-73 years); 14 males and eight females. Diagnostic delay: malignant tumors, one to nine months; low grades; three to six years (range, eight months to 25 years). Number of levels concerned: two to eight. Mean follow-up: seven years (range, six months to 10 years). Stabilized patients: 13; worse, five; deaths, four. Oligodendroglioma: four cases. Mean age: 58 years; two males and two females. Diagnostic delay: 10months. Localization: cervical, three; dorsal, one. Oligodendroglioma A, two; B, two. Results: two cases stabilized, one case with recurrence, and one patient deceased. Ganglioglioma: two. Both cases were associated with scoliosis. Recurrence in the eighth month and two years for the second case. One patient died. Hemangioblastoma: 10 cases, nine sporadic and one case of Von Hippel-Lindau disease. Nine cervical localizations, one on the medulla cone. Mean age: 45 years (range, 11-54 years); eight males and two females. Total removal in nine cases. One case of recurrence seven years after a prior surgery and operated a second time with no recurrence after 10 years of follow-up. Intramedullary neurinomas: two cases with a total removal and 15 years of follow-up. Primitive melanoma: one case with mediothoracic location. Treatment with surgery plus radiotherapy. Follow-up, seven years without recurrence. CONCLUSION: Total removal of the intramedullary tumors is a challenge. In cases of removal, the risk of worsening status is 18-19.5%. Subtotal or incomplete removal 27-40% risk of recurrence.

[X-ray computed tomographic aspects of benign primary cerebral melanomas. Apropos of 4 cases]. / Aspects tomodensitométriques des mélanomes bénins primitifs cérébraux. A propos de 4 observations.

Benign primitive melanomas are rare tumours usually involving the leptomeninges. Four cranial localizations are reported: 2 tumours of the foramen magnum, 1 of the cerebellopontine angle and 1 supratentorial. The clinical symptomatology is variable according to the level. Slow medullary compression is frequent. One can emphasize the special and difficult problem of foramen magnum tumours that present with a very variable clinical status frequently simulating a non surgical disease of the central nervous system. The benign and primitive appearance of these tumours is evocated by the slow and favourable evolution and by the absence of extraneurologic melanotic tumour. Our purpose is essentially to emphasize the radiological and particularly the computed tomographic (CT) findings poorly described in the literature. Benign melanomas have resemblance with meningiomas: osseous or meningeal relationship, homogeneity and high density. On the other hand the angiography shows poor vascularization. One can think that a tumor simulating a meningioma by CT but not by angiography is perhaps a benign melanoma. The special problem of the radiological diagnosis of foramen magnum tumours is evocated: Computed myelography, tridimensional imaging by NMR.

[Transtentorial central impaction in traumatic cranio-cerebral pathology (author's transl)]. / L'engagement transtentoriel de type central en pathologie cranio-cérébrale traumatique.

On the basis of a series of 255 severe head injuries, the authors present a clinical, radiological and anatomical study of central transtentorial impaction. Anatomical examination reveals the frequency of central impaction which affects from above downwards and in succession all of the axial structures in their median part. Clinically, these lesions fall into three categories in terms of signs: homogeneous and corresponding to the anatomical lesions. Scanner findings confirm the anatomoclinical data and provide important information in the assessment of prognosis.

[Levels of axial lesion in severe head injuries (author's transl)]. / Les niveaux de souffrance axiale du traumatisme cranien grave. Etude critique.

Over the past few years considerable amount of clinical syndromes describing brain stem levels of lesion were reported. This work was undertaken to establish, if possible, a simplification of criterions of axial lesions in head injuries. 125 patients with severe head injuries were strictly selected. Statistical analysis of careful examination of clinical pattern was performed and correlated, when possible, with anatomical lesions. Only four homogeneous groups were isolated:--group I represents the cortico-sub-cortical level,--group II représents the diencéphalie level,--group III represents the upper brain stem level with two subdivisions dependent upon the mechanism of herniation : central or uncus,--group IV represents the lower brain stem level.