[Prevention of late post-traumatic epilepsy by phenytoin in severe brain injuries. 2 years' follow-up]. / Prévention de l'épilepsie post-traumatique tardive par phénytoïne dans les traumatismes crâniens graves. Suivi durant 2 ans.

The high incidence rate and the invalidating nature of post-traumatic epilepsy after severe brain injury have encouraged the authors to review the prophylactic treatment of this type of epilepsy. Thirty-four out of 86 randomised patients with brain injuries admitted into a neurotraumatology intensive care unit were treated prophylactically, immediately after the injury, with an intravenous hydantoin injection in a dose sufficient to provide stable and effective blood levels. This was followed by dose-adjusted oral administration maintained for a minimum period of 3 months. After a 2 years' follow-up, there was a significant difference between treated and untreated patients, since only 6 per cent of the patients treated suffered from post-traumatic epilepsy, as against 42 percent in the untreated group.

[Atlanto-occipital luxation and syringomyelia: 2 rare complications of cervical injury. Diagnostic and therapeutic effects. Apropos of a case]. / Luxation occipito-atloïdienne et syringomyélie: deux complications rares de la traumatologie cervicale. Incidences diagnostiques et thérapeutiques. A propos d'un cas.

The authors report the case of a 19 years old patient with an undiagnosed traumatic atlanto-occipital dislocation complicated after two years by a rapidly evolutive syringomyelia. This clinical case which associates two rare complications of cervical traumatology allows to discuss the problems of both pathologies especially on the following points: --The early diagnosis of the dislocation by tomography and CT scan is the only mean to treat totally these lesions and perhaps to avoid the complications like syringomyelia. --In case of delayed diagnosis, when the dislocation is "fixed" the complete decompressive surgery both by a posterior and a trans-oral way is for the authors the treatment of choice.

[Diagnosis and surgical strategy in 3 cases of benign and unusual tumors of the occipito-cervical skeleton]. / Diagnostic et stratégie opératoire dans trois cas de tumeurs bénignes et rares du squelette occipito-cervical.

The authors report three cases of benign tumours of the occipito-cervical skeleton, remarkable for their rarity and especially by their unusual, even exceptional anatomic site: an osteoid osteoma, a pre-medullary chondroma and an extra-dural exostosis developing within a hereditary multiple disease. This presentation which allows to recall a few epidemiological and diagnostic problems is essentially focused on operative strategy and particularly on the choice of the best way to cope with surgical difficulties to be met. The osteoid osteoma whose diagnosis is difficult raises two surgical problems: the relation with the vertebral artery and the preservation of the atlanto-occipital joint. An approach through limited occipital craniotomy has allowed a perfect control of the vertebral artery and a complete removal without joint damage. Pre-medullary chondroma: a complete removal has been performed through the anterior way as described in rare observations of the literature. Post operatively, the patient had a complete neuro-orthopedic recovery. The antero-lateral exostosis has been removed through the posterior way by first resecting the basis of implantation, which has allowed the mobilization of the lesion without cord damage. Results have been good in the three cases both from neurological and orthopedic points of view.

[Computer-assisted measurement of intracranial pressure. The Pic Part system]. / Mesure de la pression intra-cranienne assistée par ordinateur. Le système Pic Part.

In this article the authors describe a computer assisted pressure measuring equipment: the PIC PART system which allows real time visualisation of intracranial and possibly arterial pressure, and above all the automatic analysis of measures after long casting recording (24 hours).

[Acute post-traumatic tetraparesis: a developmental complication of cervical arthrosis. Physiopathology, clinical study, prognosis. Apropos of 6 cases]. / Tétraparésie aiguë post-traumatique: accident évolutif de l'arthrose cervicale. Physiopathologie, étude clinique, pronostic. A propos de 6 cas.

After dealing with the anatomo-pathology of arthrosis, and then the physio-pathology of cervico-arthrotic myelopathy, the authors describe just now six cases of acute post-traumatic tetraplegia happening as a complication of cervical arthrosis. They do insist on the circumstances of that unexpected coming of such neurologic accidents, on their prognosis very often pejorative, on the necessity of a preventive surgical treatment at the stage of cervico-arthrosis myelopathy not very evolved, which is the only one accurate device to avoid the acute decompensation, insisting at last on the functional sequela most often severe of these complications.

[Diagnostic and therapeutic problems of osteomeningeal defects and traumatic cerebrospinal fluid defects of the anterior floor of the base of the skull. Apropos of 95 cases]. / Problèmes diagnostiques et thérapeutiques des brèches ostéoméningées et des fistules liquidiennes traumatiques de l'étage antérieur de la base du crâne. A propos de 95 cas.

The authors here report teaching drawn from the latest ninety five cases of osteo-dural defects in basilar skull fractures they have surgically treated. They particularly insist on the following points: Difficulties in establishing a clinical diagnosis when the traumatism is in its acute stage: initially 55% of patients do not show any symptom of rhinorrhea, so that the diagnosis is only based on X-ray data. Previous to any surgical treatment the number of serious septic meningitis is rather high in as much as it reaches 10.55% in this series. Risk of infection together with bone damages incite the authors to suggest a surgical treatment of dural defects in their acute stage, namely within the two weeks following the accident. The study of results shows that due to treatment complications, are not insignificant. The authors then tackle the problems of technics and osteo-dural restoration. They, at last, explain, in this series, the interest of preventive antiepileptic treatment by hydantoins during and after the operation. Despite complications due to treatment the results in this series appear to be significant enough to allow the authors to place the indication of the surgical treatment of traumatic osteo-dural defects in basilar skull at the acute stage of their evolution.

[Prospective trial of treating aneurysmal meningeal hemorrhage by delayed operation under cover of antifibrinolytic therapy]. / Essai prospectif de traitement des hémorragies méningées anévrysmales par intervention différée sous couvert d'un traitement antifibrinolytique.

Seventy patients with subarachnoid haemorrhage due to ruptured intracranial aneurysms were managed by delayed intervention (third week) along with the prescription of antifibrinolytic drugs (tranexamic acid 6 g/daily). During the pre-operative period, 41 patients stayed in the same clinical status as on admission or improved, whereas 29 deteriorated due to rebleeding (4 cases), vasospasm (18 cases), large hematoma (4 cases), hydrocephalus (2 cases) and postarteriographic accident (1 case). Clipping the aneurysm was finally achieved in 42 patients only; with 3 deaths, 3 severe sequellae, 8 light handicaps, and 28 patients considered as cured with returning to previous occupations. As far as the whole series is concerned, these results yield a 38.5% rate of mortality, 20% morbidity, and 41.5% recovery. It is concluded that 1) Tranexamic acid was effective in reducing the risk or rebleeding, 2) Third week delayed intervention associated with this drug significantly reduced the operative mortality, but probably favoured vasospasm, and finally had no beneficial effect on the overall results concerning the entire series of patients.