[What treatment for which patient? Organisation of a strategy (author's transl)]. / Quel traitement pour quel malade? Organisation d'une stratégie.

Therapeutic indications vary in patients with a malignant glioma of the brain and must be envisaged differently according to whether the patients is operable or not. These are the following possibilities according to previously defined criteria:

[Surgical posterior approach in spondylolisthesis (author's transl)]. / Opérations des spondylolisthesis par voie postérieure.

The authors report their experience about 60 patients who suffered of a spondylolisthesis and who were treated by a surgical procedure. A posterior approach has been used for all the patients. After a brief review of the clinical and radiological features of the disease, the authors emphazise the advantages of the posterior approach; only this technique allows a correct access both to the bone and the nerve roots lesions. Two types of operations are proposed:--the ablation of the posterior arch of the concerned vertebra (Gill's operation).--a posterior arthrodesis by mean of an homograft, using one of the following technique: an Albee grafting a Bosworth grafting an ilio-transversary grafting. The results are considered from a clinical, and an anatomo-radiological point of view.

[Arterio-veinous malformations located within the occipito-cerebello-mesencephalic dihedral (author's transl)]. / A propos des malformations artério-veineuses du diedre occipito-cérébello-mésencéphalique.

About 4 cases of arterio-veinous malformations located within the occipito-cerebello-mesencephalic dihedral (which is this region of the brain including the cistern of Galen and the surrounding formations : the quadrigeminal bodies forwards, the splenium of the corpus callosum upwards, the upper face of the cerebellum and the pedonculus cerebellaris superior below) the authors related their own experience. These 4 cases are detailed from a clinical point of view. Them, a synthetic study is undertaken in which a comparison is done between the literature and the clinical features encountered : headache, sub-archnoid hemorrhage, impairment of consciousness, clinical features such as cranial nerve impairment, nystagmus motor impairment, cerebellar deficit, hydrocephaly. The value of angiography, ventriculography and CAT is discussed. All these patients have been operated upon as far as the authors think that a better chance can thus be offered to them. The choice of the technique is discussed. For one patient, the sub-temporal route was performed ; but it seems worth using the posterior inter-occipital route : this allows a better view on the lesion and an easier treatment of the malformation. These 4 patients suffered post operatively of a visual defect. The control angiography revealed no more arterio-venious malformation in two patients, a mild one in two others.

[Value of computerized axial tomography in cranio-cerebral injuries]. / Intérêt de la tomographie axiale commandée par ordinateur (tacographie) dans les traumatismes crânio-cérébraux

Since May 1975 was have been working in the field of C.A.T. and its application to study head injuries. We are presenting differents groups of patients studied by C.A.T. I. -- DATA OF C.A.T. IN THE CASES OF EMERGENCY AND IMMEDIATE POST-OPERATIVE FOLLOW-UP OF HEAD INJURIES A) EMERGENCY STATE As soon as the clinical state of an head injured patient was supposed to need an operation, C.A.T. was realized; so differents abnormal scanners may be observed: 1. epidural hematoma, 2. subdural hematoma, 3. intra-cerebral hematoma, 4. acute subdural hematoma or contusion. We must do some comments: -- The Emi-scanner is pre-eminent in showing the exact topography of the lesion : so, the flap is easier to realise. -- In most cases the Emi-scanner is easier to interpret than angiogram for example contusion and hematoma. We know the goods results in hematomas and the poors results in surgery of contusions. -- But the senior advantage of C.A.T. is to provide all the informations in the totality of skull content. Emi-scanner shows bilateral lesions, ipsilateral lesion. C.A.T. is pre-eminent in showing the presence of this two lesions, more accurately than senior methods of investigations, so C.A.T. permits emergency neurosurgical treatment. B) C.A.T. AND FOLLOW-UP Repeated studies at post-intervals can be accomplished without risk to the patient, thus making follow-up simpler and more effective to the neurosurgical attitude. C) POST-OPERATIVE CONTROL AND C.A.T. Post-operative complications are always hard to diagnosis. C.A.T. is painless, quick and safe, and easier to interpret than an angiogram. II -- SEQUELLAE STADE AND C.A.T. In this field certains advantages of C.A.T. are immediatly apparents. In most cases the C.A.T. is the best screening method. Patients carried out are: -- psychiatric troubles, -- post-traumatic epilepsy. The results are not reliable. There is no anatomical-clinical relation in most cases. Differents pictures are observed: -- asymetrical ventricle enlargment, -- global ventricule enlargment, -- partial cerebral atrophy. III -- DISCUSSION 1. We are at the beginning of our study. 2. This not always possible to obtain a C.A.T. in emergency for a head injury, especialy at night. 3. Patients investigated following head trauma are among the most difficult to study with C.A.T. These invididuals send to be restless and uncooperative. Numerous artefacts produced by patient motion may lead to erroneous negative or positive diagnosis, so general anesthesia is often helpful. It is hoped that as a more rapid scanners become available this problem will be obviated. The C.A.T. alone is not capable, to provide all the necessary date concerning head injury. The C.A.T. is, however, re-adjusting our total investigation (E.E.G., angiograms) philosophy and practice rather than replacing the standard neuroradiological technique, except, may be, with epidural hematoma.

[Intraosseous meningioma in a child]. / Méningiome intra-osseux chez un enfant

The authors present a case of intra-osseous meningioma in a 10 years old boy, located on the level of the vertex in the fronto-interparietal region, with the shape of a hand mass, painless, free from all neurological, ophtalmological and angiographic signs. The x-rays examination permit a diagnosis of an osteoma of the cranial vault. The surgery enables the exeresis of a large tumor of the vault 3 cm thick, without any attachment to the dura-matter. The histological examination reveals that it is, in fact, an intra-osseous meningioma. From this observation the authors carried out a review of all litterature in this field, only 12 observations are found again, and none of them deal with children. These intra-osseous meningioma develop from Pacchioni granulations included in the diploic region. They bring about handly any clinical signs and the x-rays findings do not enable us to put forward or suggest the diagnostic of intra-osseous meningioma.

[Diagnostic and prognostic value of the EEG in the immediate aftermath of cranial trauma]. / Valeur diagnostique et pronostique de l'E.E.G. dans les suites immédiates des traumatismes craniens

The authors studied the EGGs of 262 cases of post-traumatic coma and drew the following conclusions: 1. If the EEG shows sleep activity immediately after cranial trauma, the prognosis is generally good. 2. The existence of electrical reactivity to sensory stimulation is a favourable sign and examination of the symmetry of reactions often demonstrates a focal lesion which is not otherwise apparent. However, the absence of localizing signs in the EEG does not necessarily preclude the existence of an intracranial focal lesion; nor do signs of focalization necessarily confirm the existence of a lesion. 3. In equivocal cases, the echo-EG and arteriography should be contemplated. 4. Focal irritative abnormalities in an elderly patient suggest a very poor prognosis. 5. A recording which implies mtabolic disorder should prompt the immediate search for the causal disturbance. If correction of the metabolic disturbance is not followed by rapid improvement of the EEG, the prognosis is very unfavourable. 6. A focal lesion associated with the coma will affect the prognosis but surgical correction of the lesional effects may also get rid of the disturbances of consciousness.