[Natural history and current surgical prognosis of intracranial arterial aneurysms]. / Histoire naturelle et pronostic chirurgical actuel des anévrysmes artériels intracrâniens.

The abrupt flow of blood in the meninges or in the brain after fissure or rupture of an arterial aneurysm still remains a medico-surgical emergency which includes the mobilisation of important technical and financial means which justifies itself by the reduction of the occurrence of a more severe accident and to give the patient its best chances. The cure of a cerebral aneurysm and its intracranial consequences must not be dissociated from its clinical context. Surgical indication must take into account the cause of the vascular lesion, the background on which it has evoked, its natural outcome which is characterised by rebleeding and vasospasm. Surgical cure of intracranial aneurysm is one of the great achievement of modern surgery. A better understanding of the malformation, the improvement of neuro-anesthesia and intensive care, and the use of pre-operatoire adjuvants have considerably improved the surgical results over the years. At the moment, alternative treatment start to emerge such as selective vascular catheterism with ejectable balloon which become more feasible and seductive.

[Spinal cord ependymoma: contribution of MRI using gadolinium]. / Ependymome pan-médullaire: apport de l'IRM avec gadolinium.

In a case of panmedullary ependymoma, a rare tumour, MRI was performed before and after gadolinium injection. The latter clearly demonstrated the borders of the tumour. Throughout the procedure, neurophysiological exploration was carried out with recording of motor and somatosensory evoked potentials.

[Surgical treatment of lumbar foraminal disk herniation. Value and indications for an interlaminar and extra-articular combined approach]. / Le traitement chirurgical des hernies discales foraminales lombaires. Intérêts et indications de la voie combinée interlamaire et extra-articulaire.

From 62 foraminal herniations seen over 2 years, the authors present a series of 22 lumbar foraminal disc herniations operated on by a combined interlaminar and extra-articular approach. After describing the technique the results are analysed. The objective of the combined approach is to provide satisfactory foraminal liberation without damage to the articular structures. They also define the indications. These are based on precise analysis of the topography of the hernia, provided by CAT scan examination. Three major topographical types may thus be defined.

[Automatized percutaneous nucleotomy in lumbar disc pathology]. / La nucléotomie percutanée automatisée en pathologie discale lombaire.

The authors report on percutaneous automated lumbar discectomy for lumbar diks herniations. They discuss its advantages and inconvenients in front of non automated technics.

[Anterior decompression and spinal stabilization in the treatment of dorsolumbar metastatic compression]. / Décompression antérieure et stabilisation rachidienne dans le traitement des compressions métastatiques dorso-lombaires.

The authors report their experience of the postero-lateral approach for the treatment of thoraco-lumbar spinal metastasis with anterior decompression and osteosynthesis. They stress the progress in the surgical technique which is designed to have a direct effect on osseous posterior wall compression with a more effective osteosynthesis to allow an immediate mobilization.

[Treatment of severe postoperative infections in head surgery. 20 cases]. / Traitement des infections post-opératoires sévères en chirurgie cranio-cérébrale. Vingt cas.

The authors report the management and follow-up of 20 patients with severe postoperative intracranial infections, abscesses and/or empyemas. Clinical neurological diagnosis was difficult in patients with deficits resulting from the first operation but over half the cases had an inflammatory reaction in the operated zone. CT scan showed that the infection was not limited to a single site (e.g. the subdural area) but was more diffuse in the majority of cases. Antibiotics were given alone in 10 patients and in association with empyema aspiration or reoperation in the other 10 patients. There were two fatalities but the other patients made a generally good functional recovery.

[Autostatic lumbar retractor]. / Ecarteur lombaire auto-statique.

The authors present an autostatic lumbar retractor. Its advantages are: one side dissection, stability, possibility for a restricted and elective approach for lumbar microsurgery.

[Screw fixation of the odontoid process]. / Le vissage de l'odontoïde.

Fractures of the odontoid process of the axis create problems of specific osteosynthesis. The different techniques described so far require an external support and limit the movements of the cranio-cervical joint. These 2 drawbacks are avoided by direct screw fixation of the odontoid process in cases where conditions are favourable to this procedure.

[Panmedullary ependymoma. A case report]. / Ependymome pan medullaire. Une observation.

Panmedullary ependymoma is an unusual disease last reported by Fuentes in 1986. The present case is the first to have been studied by magnetic resonance, using gadolinium. The findings indicated a panmedullary lesion rather than a tumour. Histopathological investigation confirmed the hypothesis.

[Choice of a technic of stabilization in surgical treatment of recent fractures of the odontoid process. 90 cases]. / Choix d'une technique de stabilisation lors du traitement chirurgical des fractures récentes de l'odontoïde. 90 observations.

The objective of this study is to analyse the advantages and disadvantages of different surgical technics of odontoid process fracture stabilization. We try to find the best indications for each of them. We won't consider stable odontoid fractures which haven't treated by surgical therapy. A review of ninety acute dens fractures since 1979 has been analysed before 1985, the most of our injured person had a surgical stabilization by posterior approach. The analysis of our results had incited us, since that date, to vary our indications, by taking possibilities of anterior approach into consideration. So, have been realized 55 C1-C2 lacings, 20 of which with bone graft, 12 occipito-cervical arthrodesis, 10 screw fixations of odontoid process, 9 atlanto-axial arthrodesis by screw fixations, 2 posterior fixations by CD pediatric instrumentation, 1 Knodt instrumentation, 1 osteosynthesis by trans-oral exposure. Patients have been seen again, 1 month, 3 month, 6 month, 1 year later. Results have been estimated: Clinically by cervical mobility study in rotation and by local pain (16 excellent results, 24 good results, 27 middle results, and 23 bad results); Radiologically by analysis of specific complications of each technic (8 secondary removing, 6 incomplete deplacement corrections, 4 excessive corrections, 3 pseudarthrosis). We have regrouped global results technic by technic. We propose a therapeutic planning in which each technic can find the best result. The objective is to assure an effective retention by preserving movings of superior cervical spine.

[Post-traumatic intracavernous aneurysms. 2 cases]. / Anévrysmes intracaverneux post-traumatiques. Deux observations.

The authors describe two cases of post-traumatic aneurysms of the intracavernous carotid artery. They analyze the difficulties they have encountered during direct approach. Direct cure was impossible for the first patient because of the arterial wall dilaceration. In the second case, the aneurysm has been treated upon by stitching. A second operation with injection of biological glue into the cavernous sinus was required because of the secondary formation of a carotido-cavernous fistula in front of a second metal fragment.

[Percutaneous surgery of the lumbar disk]. / La chirurgie percutanée du disque lombaire.

Percutaneous discectomy is performed with an equipment which has proved reliable in urological surgery, namely dilators and optic fibers. Carried out under local anaesthesia, it empties the intervertebral disc by an extra-spinal route, thus reducing the risk of fibrosis which is almost constant when the interlaminar route is used. Its indications must be discussed with those of chemonucleolysis.

Transcervical approach and screw fixation for upper cervical spine pathology.

The authors report on the use of transcervical approach and screw fixation for upper cervical spine pathology. They describe the direct osteosynthesis for odontoid fractures and atlantoaxial fixation using a screw fixation of the articular processes. The surgical technique is described and its advantages and disadvantages are discussed as are its indications.

[Treatment of the neurological complications of kyphosis and kyphoscoliosis by spinal cord transposition]. / Traitement des complications neurologiques des cyphoses et cyphoscolioses par transposition radiculomédullaire.

The authors report their experience of radiculomedullary transposition for the treatment of neurological complications by kyphosis or kyphoscoliosis. They use a posterolateral approach by transversoarthropediculectomy. They underline the necessity to treat all etiopathological aspects.

Usefulness of the bilateral anterolateral approach in operations on the cervical spine.

The authors report on their experience with the bilateral anterolateral approach to the cervical spine, emphasizing its advantages and disadvantages and discussing its indications.

[Surgical prognosis of unruptured intracranial arterial aneurysms. 50 cases]. / Pronostic chirurgical des anévrysmes artériels intracrâniens non rompus. Cinquante observations.

The authors have reviewed a series of 53 patients with unruptured intracranial arterial aneurysm. Out of 50 patients operated upon, 2 died post-operatively, 5 remained with neural deficits that were present before surgery, and 43 were cured without subsequent cerebral or meningeal haemorrhage. None of the 3 unoperated patients developed cerebral vascular accidents. In 25 cases the aneurysm was asymptomatic and was discovered accidentally during angiography; it varied in size from 3 to 6 mm. In 28 cases, the aneurysm gave rise to various symptoms, including headache or facial pain (9 cases), ischaemic vascular accident (7 cases), ocular symptoms (8 cases), seizures (4 cases); its size ranged from 7 to 10 mm. The clinical and post-mortem series available in the literature show the usefulness of surgery in patients presenting with factors that increase the risk of rupture, i.e.: age comprised between 40 and 65 years, history of arterial hypertension, aneurysm located on the anterior segment of Willis' circle and about 10 cm in diameter, which is the critical size for rupture.