Operability of intracranial meningiomas. Personal series of 353 cases.

The senior author's experience has been reviewed in 353 operated meningiomas; so called "malignant meningiomas" have been discarded. The whole series has been split into two groups: the first (A) includes 273 cases operated before the CT era, the second (B) consists of 80 cases the operability of which was based mainly on the CT. In addition, during the time elapsed to constitute the second series surgery has been refused to 15 patients which were considered for CT and clinical reasons as surgically incurable when one wants to reduce the risk of mortality and morbidity. Therefore, we have reviewed in series B indisputable, questionable and incurable cases with respect to operability in the present condition of our technical possibilities including arterial hypotension, the operative microscope and the CUSA. Considering localization, we have made technical observations with respect to the principles on which operations have been based since 1958 when general anaesthesia became available in La Pitié. Among the patients of the whole series, 14 were admitted for a recurrence. The time interval between surgery and readmission has been given as well as the primary location of the meningiomas. The mortality rate has been 26 out of 353 (7%), and the main causes have been reviewed especially in series B. With regard to series B, we have been able to get in touch with 53 patients out of 80; 90% of them returned to work or family without sequelae. Intracranial meningiomas remain the most curable tumours, nevertheless some of them must be considered incurable like in meningiomatosis or when the dural attachment is extensive. For those cases surgery is not the final answer and we must accept the fact that in the future other kinds of treatment will develop.

[Ruptured intracranial saccular aneurysm. Conduct to apply before direct surgical intervention (stabilization of arterial pressure with diazepam]. / Anévrysme sacculaire intra-crânien rompu. Conduite à tenir durant la période précédent l'abord direct (stabilisation de la pression artérielle par le diazépam).

The 250 patients of this series, whatsoever was the location of the aneurysm, were operated radically on the 6th and 7th day following the rupture. That is to say at the end of the brain swelling period and before the rebleeding period. During these 5 or 6 days the blood pressure was stabilized by a daily intake of diazepam (15 to 30 millig); 10% only of the patients were resistant; in these cases clonidine was used. During this period antifibrinolitic agents were not given as well as antioedematous therapy. No case of rebleeding was observed in this series under this therapy.

[Total removal through the ventricle in 2 cases of pallidocaudal arteriovenous abnormalities under deep hypotension]. / Exérèse totale par voie ventriculaire de deux malformations aftério-veineuses pallido-caudées sous hypotension profonde

Two cases of A.V.M. situated in the pallido-caudal area and directly nourrished by the anterior perforated space arteries have been investigated using three angiographic techniques: selective internal carotid angiography, angiotomography including pneumoencephalography and angiography under deep hypotension at 30 mm Hg (mean pressure) induced by sodium nitroprusside. These investigations led to the conclusion that the A.V.M. could be removed through the lateral ventricle. Both were radically removed using the retrograde technique under deep hypotension and the operative microscope. Both patients are alive without additional neurological deficit.