Paratrigonal choroid plexus papilloma presenting with satellite multiple supra- and infratentorial hemorrhages. Neuroanatomical basis and pathological hypothesis.

INTRODUCTION: Choroid plexus papillomas (CPP) are rare tumors arising from the neuroepithelium of the choroid plexus. PRESENTATION OF CASE: We report a case of a patient operated for a paratrigonal hemorrhagic WHO class I CPP presenting with multiple satellite supra- and infratentorial hemorrhages. Clinical presentation was characterized by sudden hemiparesis, speech impairment and consciousness deterioration; neuroradiological imaging showed a huge contrast-enhanced solid hemorrhagic left paratrigonal lesion along with others multifocal right occipital and vermian hemorrhages. The patient underwent urgent intervention for excision of the paratrigonal lesion, whose histological analysis led to the diagnosis of CPP. A few days later due to failure of conservative treatment of the satellite hemorrhages the patient underwent a second-time surgery for their evacuation; interestingly histological examination of the tissue probe did not reveal any neoplastic features confirming their sole hemorrhagic nature. Patient's conditions slowly improved despite severe neurological deficits, without any further tumor recurrence. DISCUSSION: A thorough revision of the literature is provided including previous reported cases of spontaneous bleeding CPPs and other underlying causes that could lead to multifocal hemorrhages. CONCLUSION: Due to the rarity of these events, this case remains still open to speculative hypotheses drawn to explain the neuroanatomical and pathogenetic basis behind this case report.

[Peritraumatic distress prospectively predicts PTDS symptoms in assault victims]. / L'intensité de la détresse péritraumatique prédit la survenue des symptômes post-traumatiques parmi des victimes d'agressions.

INTRODUCTION AND OBJECTIVES: Among the peritraumatic reactions after a traumatic event, one best identifies dissociation as a predictor of serious post-traumatic problems. The dimension of emotional distress is recent in the literature and we have attempted to identify how it may contribute to the prediction of the evolution of post-traumatic symptoms. METHOD: 1. Population. Victims of individual aggression and those of a hold-up were recruited consecutively in the Paris area from five consulting centers. Individuals who had lost consciousness, had psychotic or dementia problems, or had a serious somatic patho-logy were excluded. Overall, we included 101 individuals with a traumatic experience (DSM IV criteria) that took place in the past 12 months. Two evaluations with a six-month interval were made. The first involved a face-to-face consultation with a clinician and the second required the individuals to complete self-reports. 2. Instruments. The Peritraumatic Distress Inventory (PDI) was administered to measure peritraumatic emotional distress, in the first phase. The Peritraumatic Dissociative Experience Questionnaire (PDEQ) was used to measure the intensity of the trauma and the dissociation, in this first phase. The Impact of Event Scale Revised (IES-R) was administered to assess the severity of the PTSD symptoms, in the first phase and at six months. The Mini International Neuropsychiatry Interview (MINI) was used in diagnosing depression and PTSD. RESULTS: Among the 63 subjects who were followed-up after the initial meeting and completed the second half of the study, 29 were victims of physical assault, 20 of a hold-up, 7 of a robbery, and 5 were confronted with another menacing situation; thus 40 were victims of aggression. According to the first consultation, 46 individuals presented symptoms of PTSD and 22 presented an episode of major depression. Between those who were followed-up for the whole study and those who dropped out after the initial consultation there were no significant differences with regards to gender, type of aggression, initial PDI scores (t=0.38, df=96, p=.7), PDEQ scores (t=0.7, df=96, p=0.94), or IES-R scores (t=0.23, df=97, p=0.082). Individuals who were victims of physical or sexual assault showed higher scores on the IES-R than individuals who claimed no such assault. The scores for peritraumatic dissociation were correlated with the initial IES-R scores with a correlation coefficient of 0.50. The scores from the PDEQ and the initial PDI were correlated with the IES-R scores at six months with a coefficient of 0.63. Using a multi-hierarchical linear regression controlling for type of experience, it appeared that the score of peritraumatic distress improved the variance by 14% in predicting the IES-R score at six months, compared to the prediction of the score of the initial IES-R. DISCUSSION: This is the first study using a prospective inquiry to demonstrate the power of the peritraumatic emotional distress score. Our results suggest that the type of trauma is a strong predictor of prognosis at six months. Despite our small sample size, the absence of significant differences between the drop-out group and our subjects reduces the probability of a bias in our selection criteria to explain our results. This study points to the fact that the measurement of peritraumatic emotional distress (PDI) is a good predictor of PTSD symptoms six months down the road. This study underlines the importance of an initial psychotraumatic consultation to identify the type of trauma and to measure the intensity of the peritraumatic symptoms in order to predict the severity of the evolution.

Binge eating behaviours, depression and weight control strategies.

The aim of this paper was to explore the relationships between depressive symptoms and weight control strategies in DSM-IV eating disordered patients with binge eating behaviours. We hypothesised that weight control strategies characterised by a loss of control, such as vomiting and purging, may be clinically associated with increased levels of depression. The study population consisted of 402 consecutive outpatients: 27 with binge eating/purging anorexia nervosa (AN-BN), 213 with purging bulimia nervosa (BN-P), 73 with non-purging bulimia nervosa (BN-NP), and 89 with binge eating disorder (BED). The severity of depression was measured using the Beck Depression Inventory (BDI), and binge eating behaviours were investigated using the self-report scale for bulimic behaviours. In the sample as a whole, the severity of depression significantly correlated with the severity of binge eating behaviours, but no significant differences were found in the severity of depression by diagnostic sub-types. In order to avoid the confounding erasing effect of time, a smaller sample of patients with a short history of binge eating behaviours was further explored. Furthermore, because weight control strategies and the eating disorder diagnostic sub-types overlapped imperfectly, the patients were compared on the basis of presence or absence of strategies reflecting an active attempt to master the weight gain due to bingeing behaviours. The patients adopting active control strategies (N = 14) had significantly less severe depressive symptoms than those adopting non-active weight control strategies (N = 39). Finally, the Authors discuss some hypotheses concerning the defensive role of weight control strategies and the impact of illness duration on the clinical expression of depression in eating disordered patients.

Involvement of cytokines in eating disorders: a critical review of the human literature.

A number of findings from clinical and animal studies indicate that pro-inflammatory cytokines may play roles in eating disorders. The measurement of pro-inflammatory cytokines (IL-1, IL-6, TNFalpha), which are known to decrease food intake, provides highly variable data from which firm conclusions cannot be drawn. In most of the longitudinal studies where pro-inflammatory cytokines have been shown to be impaired in anorexia or bulimia nervosa, a return to normal values was observed after renutrition. However these findings do not exclude the possibility that pro-inflammatory cytokines might be overproduced in specific brain areas and act locally without concomitantly increased serum or immune production. It was also pointed out that the production of the major type-1 cytokines (especially IL-2) was depressed in anorexia nervosa. It remains unclear whether this is due to undernutrition or to a specific underlying cause common to eating disorders. The impaired cytokine profile observed in eating disorders could be related to several factors including impaired nutrition, psychopathological and neuroendocrine factors. More particular attention should be devoted to the deregulation of the anti/pro-inflammatory balance. Deregulation of the cytokine network may be responsible for medical complications in eating disorder patients who are afflicted with chronic underweight.

Suicide attempts in women with bulimia nervosa: frequency and characteristics.

OBJECTIVE: This study aimed to estimate the lifetime frequency of suicide attempts in a large referred population of women with DSM-IV bulimia nervosa (BN), and to compare demographic and clinical characteristics of those who had attempted suicide and those who had not. METHOD: A total of 295 women (202 with BN purging type, 68 with BN non-purging type and 25 with anorexia nervosa binge/eating purging type) were assessed using a semi-structured interview and self-rated questionnaires. RESULTS: Suicide attempts were frequent (27.8% of women), often serious and/or multiple. Women who had attempted suicide differed significantly from those who had not for earlier onset of psychopathology, higher severity of depressive and general symptoms, and more impulsive disordered conducts, but not for the core symptoms or severity of BN. CONCLUSION: Interventions targeting depressive and impulsive features associated with BN are essential to reduce the risk of suicide attempt in women with this disorder.

[French validation study of the levels of emotional awareness scale]. / Validation de la version française de l'échelle des niveaux de conscience émotionnelle.

According to a thesis based on the idea of an influence of cognitions in the structuring of internal reality, emotional awareness, ie the capacity of representing your own emotional experience and that of others, is a cognitive process that goes into maturation. Defining this concept, Lane and Schwartz present a cognitivo-developmental model in five stages of the processes of symbolization, accounting for the differences in levels of emotional awareness observed in individuals. The organization of these cognitive processes would thus be structured in well differentiated stages, in which the development of the emotions would be inseparable from the development of ego and of the relation to others. These authors focus on the capacity of representing in a conscious way the emotional experience and consider that verbal representations used to describe the contents of what is experience constitute a good reflection of the organization structural of the emotional awareness. Therefore, they worked out an instrument of evaluation: the Levels of Emotional Awareness Scale (LEAS), which measures the capacity to describe your own emotional experience and the one you allow to others, in an emotional situation. The system of quotation of this scale is based on the analysis of the verbal contents of the provided answers, in direct reference to the authors' theory of the levels of differentiation and integration of the emotional experience. It is therefore an empirical measurement which is centered specifically on the structural organization of the emotional experience. The various studies of validation of this instrument show that it presents solid metrological properties. This work presents the validation of the French version of Lane and Schwartz's LEAS. Validity and fidelity were studied in a group of 121 healthy subjects. This setting is part of a larger clinical evaluation, also including a collection of socio-demographic and clinical data, and other instruments of self-evaluation (Beck Depression Inventory, BDI, Hospital Anxiety and Depression Scale, HAD, and Toronto Alexithymia Scale, TAS). The face validity appears correct: the questionnaire was well accepted and seemed easy to complete. A principal components analysis of the correlation matrix of the set of items was used as the method of extraction of the various factors and made it possible to confirm the unidimensionality of the instrument. The number of factors to be retained was given according to Kaiser and Cattell criteria. The internal consistency was evaluated through computation of the Cronbach coefficient, whose value is 0.75 for the scale's global score. The confidence interval of the margin of error of LEAS scores was also measured; for the global score it is IC=[m 6.1]. The measure given by this rating scale may therefore be considered sufficiently accurate, since this interval is weak. A study of the frequency of quotation of each item of the instrument was carried out, in order to check the homogeneity and the uniformity of quotations, as well as a diagram of distribution of the score, showing that it follows a law which is close to a normal law. The concurrent validity could only be studied via the similar concept of alexithymia, measured with the TAS, for there is not other instrument validated in French evaluating the levels of emotional awareness, and these two instruments seem to measure different notions, because none of the correlations between the scores of these two questionnaires are significant. Concerning discriminant validity, the Pearson correlation coefficients between the global score for the LEAS, the BDI score and the HAD sub-scores for depression and anxiety were measured; it is clear that the level of emotional awareness is independent from negative affects. Furthermore, the study of the reliability made it possible to highlight excellent intra-class correlation coefficients (r=0.993). The French version of the Levels of Emotional Awareness Scale thus appears to be valid and accurate and should allow the study of levels of emotional awareness on psychopathology. It is about an easily acceptable and simple questionnaire of use in varied clinical circumstances.

Psychosocial factors at work, personality traits and depressive symptoms. Longitudinal results from the GAZEL Study.

BACKGROUND: An association between stressful job conditions and depressive symptoms has been reported. This association could be explained by personality traits. AIMS: To examine the relationship between psychosocial factors at work and changes in depressive symptoms, taking into account personality traits. METHOD: The role of occupational characteristics, psychosocial stress and personality traits in predicting an increase of depressive symptoms was evaluated in 7729 men and 2790 women working at the French National Electricity and Gas Company, with a 3-year follow-up. RESULTS: In men, high decision latitude was predictive of a decrease in the Centre for Epidemiologic Studies - Depression scale (CES-D) scores. In both genders, high job demands and low social support at work were predictive of increased scores, irrespective of personality traits and covariates. CONCLUSIONS: Adverse psychosocial work conditions are predictors of depressive symptom worsening, independent of personality traits.

Cytokines and anorexia nervosa.

OBJECTIVE: Recent studies have indicated that the inflammatory cytokines could be implicated in anorexia nervosa and in its complications. To determinate the potential role of interleukins (IL-1, IL-2, IL-4, IL-6, IL-10), interferon (IFN gamma), tumor necrosis factor (TNF-alpha), and transforming growth factor (TGF-beta2) in anorexia nervosa, serum concentrations of these cytokines were measured in patients suffering from anorexia nervosa in comparison to healthy subjects. METHOD: Twenty-nine anorexic women according to DSM-IV criteria participated in the study. The control group consisted of 20 healthy women without eating disorders, mood disorders, and immunological disorders. RESULTS: We find that serum IL-2 and TGF-beta2 concentrations were both significantly decreased in anorexic patients, although the other cytokines did not differ significantly between the two groups. CONCLUSION: Our results show that in patients with anorexia nervosa, there are lower levels of specific cytokines (especially IL-2 and TGF-beta2). These levels may reflect the combination of impaired nutrition and weight loss, therefore, the dysregulation of these cytokines may contribute in anorexia's complications. Follow-up studies should examine the effects of parameters such as starvation, psychopathologic factors, and psychoneuroendocrinological perturbation which could affect interplay between cytokines, neuropeptides, and neurotransmitters.

Sustained anxiety and 4-year progression of carotid atherosclerosis.

Several studies have shown that anxiety disorders are associated with a higher risk of coronary artery disease. However, the relationship between anxiety disorders and atherosclerosis has been studied to a lesser extent. The goal of this study was to examine whether high and stable trait anxiety was associated with the progression of atherosclerosis. The study group consisted of 726 subjects (297 men and 429 women), aged 59 to 71 years, recruited from the electoral rolls of the city of Nantes. The subjects had no history of coronary artery disease at baseline evaluation and or at the 2-year follow-up. Two follow-up examinations were conducted 2 and 4 years after the baseline evaluation. Trait anxiety was evaluated by means of the French translation of the Spielberger Inventory (a 20-item trait inventory, form X-2). The "sustained anxiety" group consisted of men and women with the highest Spielberger Inventory scores at baseline and at the 2-year follow-up examination. Each ultrasound examination included measurement of intima-media thickness and the sites of plaque in the extracranial carotid arteries. Men with sustained anxiety showed a higher 4-year increase of common carotid intima-media thickness than did men without sustained anxiety (adjusted means 0.08 versus 0.04 mm, respectively; P=0.05) and a higher risk of 4-year plaque occurrence (adjusted OR 3.5, 95% CI 1.4 to 8.5). Among women, sustained anxiety was associated with a higher 4-year increase of common carotid intima-media thickness (0.07 versus 0.04 for women with versus women without sustained anxiety, respectively; P=0.07). These results suggest that chronically high levels of anxiety may contribute to accelerating the evolution of carotid atherosclerosis.

[Prospective study of post-traumatic stress in victims of terrorist attacks]. / Etude prospective de l'état de stress post-traumatique parmi des victimes d'un attentat terroriste.

In 1995-96 several terrorist attacks struck Paris. After that, the French government decided to optimize the service claimed to treat psychological repercussions of attacks victims. For this reason we need to better understand the psychopathology developing after these traumatic events in order to adjust the various steps of the treatment. In December 1996, a terrorist attack occurred in a Paris subway. Medical and medico-psychological teams intervened immediately on the site to help victims. Among 115 victims, 4 persons died and 35 were seriously injured. The aim of our study was to evaluate the psychological impact among a population of terrorist attacks victims by a prospective study and to identify predictive factors of posttraumatic stress disorder (PTSD). We evaluated PTSD rates at 6 and 18 months, the relationship between coping style and PTSD, and whether PTSD increased health care utilization. Two follow up evaluations were performed in the 6th and 7th month respectively, by means of self-questionnaires sent by mail. Among 115 victims of the bombing attack occurred in December 1996, the 111 survivors were asked to participate to the study. The subjects who accepted and could use French questionnaires were considered eligible for the inclusion: the main criteria of the Watson's PTSD Inventory for the specific post-traumatic symptoms were used; the Goldberg's General Health Questionnaire was used to measure the general psychopathology; to identify coping styles we used the questionnaire "Ways of Coping Check List" of Vitaliano at 6 months and the "Coping Inventory for Stressful Situations (CISS)" by Endler at 18 months; a small questionnaire was proposed to evaluate injuries, hospitalization and specific treatment immediately or after the event. Among 70 subjects who accepted to participate, 56 (33 females) could be evaluated at 6 months and 32 (14 females) subjects at 18th months. The mean age at 6 months was 38.4 years: 41% of participants met PTSD criteria at 6 months, 34.4% still had PTSD at 18 months; at 18th months, 50% subjects presented GHQ scores higher than 3, corresponding to the cut-off revealing mental suffering; people hospitalized more than two days immediately after the event presented significantly lower PTSD scores at 6 months. General characteristics of risks factors for PTSD were: at 6 and 18 months, women and younger people presented significantly higher PTSD scores; for the CISS at 18 months Emotion-oriented coping correlated significantly with PTSD (r = 0.49, p = 0.007), while task-oriented coping and PTSD correlated negatively (r = -0.39; p = 0.04). Avoidance coping's styles were not correlated with PTSD. About predictive factors: the GHQ-12 and PTSD-I scores at 6 months were significantly correlated with PTSD-I scores at 18 months (respectively r = 0.73, p = 0.018 and r = 0.75, p = 0.0029); by a multiple regression we observed that PTSD-I score at 6 months predicted the PTSD-I score at 18 months, adjusted on sex and age. The others characteristics at 18 months were: medication use increased significantly at 18 months; people who lived another traumatic event since December 1996 presented a 18 month PTSD score higher than the other victims. In spite of the small size of this sample, the principal interest of this study is the prospective data in a population exposed by the same traumatic event. We note the high score of PTSD at 18 months. Terrorism exposure resulted in persisting PTSD in a significant proportion of victims; this was related to coping style. Moreover PTSD increased health care utilization. We discuss these results comparing with other similar populations in France, Israel and USA. We discuss overall the role of coping styles during the time after an attack; we insist on considering this aspect in the therapeutic strategies. These data contribute to inform that people with a high PTSD score at 6 months presented a high risk to suffer PTSD at 18 months. These results underline the importance of early diagnosis to propose early medical and psychological help to the victims.

Early psychopathological signs in bulimia nervosa. A retrospective comparison of the period of puberty in bulimic and control girls.

While bulimia nervosa (BN) typically begins in girls during late adolescence, puberty and associated developmental changes have been linked to negative body image and onset of a variety of psychological problems. This study aimed to identify early psychopathological signs, which could have marked the period of puberty in subjects whom later developed BN. In a case control study, we compared 49 girls with BN according to DSM-IV, aged between 18 and 20 years, to 49 girls of the same age, who were free of any past or current psychiatric diagnosis. Psychiatrists or clinical psychologists, using a semi-structured clinical interview including retrospective assessment of the emotional and behavioural changes that had occurred in puberty evaluated both groups. Before the onset of a clinical eating disorder, the subjects with BN presented significantly more often than controls weight related concerns, attitudes of withdrawal and social isolation, and negative changes in their body image and self-image, as well as in their relationships with siblings and peers. The results suggest that early psychological distress precedes the onset of an eating disorder in many cases, and that prevention efforts should be directed towards peripubertal psychopathology.

Low blood pressure and risk of depression in the elderly. A prospective community-based study.

BACKGROUND: The relationship between depression and low blood pressure in unclear. AIMS: To examine the temporal relation between low blood pressure and depression in a two-year follow-up. METHOD: The study group consisted of 1389 subjects aged 59-71 years; 1272 (92%) were examined after two years. Subjects completed the Center for Epidemiological Studies-Depression (CES-D) and the Spielberger inventory scales to assess depressive and anxiety symptoms respectively. Data were collected on socio-demographic characteristics, smoking and drinking habits, medical history, drug use and blood pressure measures. RESULTS: Among 1112 subjects who were considered as non-depressed at baseline, logistic regression models showed that low diastolic blood pressure (DBP) and decrease of blood pressure were predictors of high depressive symptomatology at follow-up. Baseline high CES-D scores did not predict low blood pressure two years after. CONCLUSIONS: In our study, low blood pressure was a risk factor for, but not a consequence of, high depressive symptomatology.

Alexithymia and depression in eating disorders.

We compared alexithymia and depression ratings for non-hospitalized women meeting DSM-IV criteria for anorexia nervosa (n=32) and bulimia nervosa (n=32) to ratings for healthy women (n=74). Alexithymia was evaluated by the Toronto Alexithymia Scale (TAS-20) and depression by the Hospital Anxiety and Depression Scale (HAD). TAS and HAD scores were significantly higher in anorexic compared to bulimic patients, although these two scales were significantly and positively correlated (r=0.53, P=0.001). After taking depression into account as a confounding variable, rates of alexithymia did not vary according to the type of eating disorder (anorexia or bulimia).

[Alexithymia and depression in eating disorders]. / Alexithymie et dépression dans les troubles des conduites alimentaires.

Patients suffering from eating disorder show elevated rates of alexithymia and depression. We compared alexithymia and depression ratings for non-hospitalized women meeting DSM IV criteria for anorexia nervosa (n = 32) and bulimia nervosa (n = 32) to healthy women (n = 74). Alexithymia was evaluated by the Toronto Alexithymia Scale (TAS-20) and depression by the Hospital Anxiety and Depression Scale (HAD). We found that TAS and HAD scores were significantly higher in anorexic compared to bulimic patients, although alexithymia and depression, as evaluated, were significantly and positively correlated with each other (r = 0.53, p = 0.001). Finally, a logistic regression with alexithymia and depression as independent variables showed a strong correlations between the HAD ratings and anorexia, but no correlations between TAS score and the eating disorder subgroups. In eating disorder patients, alexithymia, as evaluated by the Toronto Alexithymia Scale, seems to exhibit a thymo-dependent component which could be secondary to concurrent depression. Through recent studies and results of our research, we analyze and give several interpretations which may explain this correlation between alexithymia and depression.

Anxiety, depression, psychotropic drug use and cognitive impairment.

BACKGROUND: Numerous studies have shown that anxiety and depression are related to cognitive impairment, but the concomitant association between anxious symptoms, depressive symptoms and cognitive function has not been investigated, and, most studies have not considered psychotropic drug use as a possible confounding factor. METHODS: We assessed the independent association between depression, anxiety, psychotropic drug use and cognitive performance in 457 men and 659 women, aged 59-71 years living in the community. Data on demographic background, occupation, medical history, drug use and personal habits were obtained using a standardized questionnaire. The Spielberger Inventory Trait and the Center for Epidemiologic Study-Depression (CES-D) scales were used to evaluate anxious and depressive symptomatology respectively. Cognitive assessment included six traditional tests covering the main areas of cognitive functioning. RESULTS: In men, anxious and depressive symptomatologies had independent significant associations with most cognitive abilities, independent of psychotropic drug use. In women, the association between anxiety or depression and cognitive functioning was less strong and disappeared after adjustment for psychotropic drug use. Psychotropic drug use was associated with lower cognitive scores in both sexes. In men with high CES-D scores, we found positive correlations between anxiety level and cognitive scores. CONCLUSIONS: The study showed that anxiety, depression and psychotropic drug use were significantly and independently associated with cognitive functioning in elderly men. The high prevalence of psychotropic drug use in women with or without psychological disorders may explain its major effect in women. Results suggested that anxiety may partly compensate for some negative effects of depression on cognitive functioning.

Anxiety but not depression is associated with elevated blood pressure in a community group of French elderly.

OBJECTIVE: This study examined whether anxiety and depression were independently associated with elevated blood pressure in elderly persons. METHOD: The study group consisted of 1389 subjects aged 59 to 71 years recruited from the electoral rolls of the city of Nantes (France). Subjects completed the Center for Epidemiologic Studies-Depression scale (CES-D) and the Spielberger Inventory scales to assess depressive symptoms and anxiety symptoms, respectively. Data were collected on sociodemographic characteristics, smoking and drinking habits, medical history, and drug use. Two measures of systolic and diastolic blood pressure were taken after a 10-minute rest. Body mass index was computed from weight and height measurements. Subjects taking antihypertensive drugs (N = 281) were excluded from the present analysis. RESULTS: Depression and anxiety scores were significantly correlated (r = .61 in men; r = .65 in women; p<.001). In univariate analyses, anxiety scores were correlated with systolic and diastolic blood pressure in men, but not in women; blood pressure was not associated with depressive symptoms in either sex. Multivariate logistic regressions, controlling for possible confounders, showed that in both men and women, the risk of high blood pressure increased with increasing anxiety scores; odds ratios for high blood pressure were less than 1 in subjects with depressive symptomatology. CONCLUSIONS: This study suggested that anxiety but not depression was independently associated with an increased risk for high blood pressure.

Venous saving in olfactory meningioma's surgery.

Bifrontal craniotomy and interhemispherical approach, usually used to remove olfactory groove meningioma, does not allow a view of posterior pole, which is very important in the surgical management of this neoplasm, and, provides for an anatomical sacrifice of frontal bridging veins, not without complications as a result of venous infarction. From 1975 the pterional approach was performed on 20 patients with olfactory meningioma, with good results in 90% of cases. This approach presents several advantages over bifrontal craniotomy and, in order to minimise surgical damage, it avoids planned sacrifice of venous vessels.

Basal meningiomas. A retrospective study of 139 surgical cases.

BACKGROUND: Basal meningiomas represent a significant group of intracranial tumours. Their surgical treatment presents still today several difficulties since these tumours, as it is well known, may involve critical neurovascular structures. METHODS: This is a retrospective study of 139 consecutive cases of basal meningioma operated on in our institution during the last two decades. Meningiomas location: olfactory groove 20 cases; suprasellar region 22; anterior cranial fossa 6; sphenoid wing 37; cerebellopontine angle/clivus 21; tentorium 26. In most cases the meningioma was larger than 5 cm. The tumour was completely removed (grade I-II of Simpson classification) in 111 cases (79.9%). The authors dwell upon some clinical and surgical aspects of prevailing groups (olfactory, suprasellar, sphenoidal, petroclival and tentorial meningiomas); regarding to operative procedures, the authors in particular emphasise the usefulness of the pterional approach to remove olfactory groove meningiomas and of the combined supra- and infratentorial approach, with preservation of transverse and sigmoid sinuses, to remove petroclival meningiomas. RESULTS: The surgery was followed by excellent or good results in 115 cases (82.7%): patients having a normal life with a score 80-100 of Karnofsky scale; poor outcome occurred in 5.8% of cases, postoperatively died 16 patients (mortality rate 11.5%). Tumour recurrence occurred in 7 cases. CONCLUSIONS: Based on their experience and on analysis of the reviewed literature, the authors conclude that advances in microsurgical techniques and in neuroradiological imaging have radically improved the outcome so that today basal meningiomas can be successfully treated in most cases.

Is the size of an epidural haematoma related to outcome?

Recently we treated 54 patients with acute epidural haematoma, diagnosed by early CT scan and operated on quickly, within 6 hours after trauma. In 18 cases the volume of the haematoma, calculated by three different methods, was more than 150 cc, and GCS score was equal to or less than 8. In all 18 patients, as well as in another 36, we obtained good results: all patients survived and 17 fully recovered (only one was left with moderate neurological disability). Our experience leads us to the conclusion that even volumes of over 150 cc can be compatible not only with survival but also with very low morbidity, if rapid surgical treatment is performed.