[Extra-intracranial anastomosis: radio-clinical correlations]. / L'anastomose extra-intracrânienne: corrélations radio-cliniques

25 patients have been operated on by means of extra-intracranial anastomosis (22 with STA-MCA anastomosis, 3 with occipital-MCA anastomosis). 23 patients underwent an angiographic study early after surgery (two weeks). The patency rate is 14 out of 23 (13 STA, 1 occipital anastomosis). In comparison of its pre-operative size, the afferent artery has enlarged in the most cases, particularly in patients with complete obliteration, either of the carotid artery, or of the middle cerebral artery. In every case, only a limited part of the MCA territory is visualized through the anastomosis. In no case was the complete MCA field visualized; the frontal branches, particularly, are not supplied through a temporal anastomosis. In the case of occipital anastomosis, both upper and lower branches of MCA are supplied through the new channel. 11 patients underwent a second angiographic study, from one year through 28 months after the first one. In three patients with no patency on the first angiography the anastomosis remained non patent. So, in this series, no anastomosis was seen to became patent secondarily. In 8 patients with patency on the first control, the anastomosis remained patent on the second angiography. In patients with a pre-operative stenosis, no increasing of the size of the vessel could be noticed. The filling of the MCA branches is difficult to be discussed, for in these cases, the angiographies were not performed selectively through the external carotid artery. In patients with a pre-operative thrombosis, an enlarging of the vessels was seen, as well as an extension of the intra-cranial filling through the anastomosis. Clinical correlations are the following ones: the most patients with TIA's had a stenosis. They presented no increasing of the size of the vessels. They were doing well after operation, as if a little more of blood supply was sufficient to improve the general blood perfusion. Every patient with stroke had a pre-operative thrombosis and presented an enlarging of the vessels with a better filling on the second angiography, as if a great deal of additional blood supply was required; the clinical improvement is slow (3 out of 5) and remains often incomplete.

[Microsurgical treatment of a series of intracranial subtentorial arterial aneurysms]. / Traitement microchirurgical d'une série d'anévrysmes artériels intra-crâniens sus-tentoriels

A series of 60 arterial aneurysms is reported, pateints pre-operatively being from grade I to grade IV of the classification of Botterell. Microsurgical technique is emphasized : patients are operated on through the fronto-lateral approach described by Yasargil. The most patients with anterior communicating artery aneurysm are operated on from the right side, except for patients with only one left anterior cerebral artery. Middle cerebral artery aneurysms are approached by the proximal way, along the internal carotid artery and then following the main trunk of middle cerebral artery. Concerning the internal carotid artery aneurysms, the carotid bifurcation aneurysms, the true posterior communicating artery aneurysms, dissection is generally performed without particular difficulty, except for the low internal carotid artery aneurysms (carotido-ophtalmic aneurysms); in these latter, the anterior clinoid process and the internal part of sphenoidal ridge must be removed. In case of intra-cerebral hematoma, only a part of hematoma is at first sucked away, up to a sufficient view of the chiasmatic cistern; then, releasing of cerebro-spinal fluid allows the management of the aneurysm and the remaining part of hematoma is totally evacuated after clipping of aneurysm. Reduction of the neck and sometimes of the whole aneurysm is performed with bipolar forceps. Every aneurysm was treated with metal clip (Yasargil, Scoville, Heifetz, Sundt's clip-graft). In no case a silk ligature was used...

[Intraspinal meningiomas. A series of 60 cases]. / Les méningiomes intra-rachidiens. Réflexions ã propos d'une série de 60 observations

The authors present and compare two consecutive series of spinal meningioma, a total of 60 cases. From the aetiological point of view, the meningioma were more frequent than neurinoma. This study confirms its predominance in the female after the fifth decade. A traumatic factor was sometimes implicated. Anatomically, its localisation predominated in the dorsal region (78.3 p. cent), specially in the first three vertebral segments, and most commonly laterally placed. The strictly epidural meningioma, the multiplicity and the association with a neurinoma were less frequent. On the clinical level, the comparison between the two series illustrated a considerable diminution of the pre-operative evolution of the disease, taking into consideration the existence of spinal deficit less apparent in patients operated after 1963. 54.5 p. cent presented at diagnosis, a total or partial impotence against 81.5 p. cent in the old series. Among the laboratory examinations, the C.D.F. study confirmed slight or even absent cyto-albuminous dissociation, which contrasted markedly with the figures obtained in cases of neurinoma. Plain spinal radiography was usually negative. The radio-opaque myelography revealed a block, sometimes a partial one, very suggestive when bossulated, but which might sometimes mimic a neurinoma or even an epidural lesion. The presence of an arachnoid cyst may give a false level. Surgery was always indicated, regardless of the patients' age. The tumour should be completly removed in a piece-meal fashion with the preservation of the radiculo-medullary elements, which was facilitated by the use of the microscope. To prevent a recurrence, the base of the tumour should be well coagulated or resected followed by a plastic reconstruction of the dura mater. The mortality rate including the late mortality has diminished from 24 p. cent to 11 p. cent. This is essentially due to decubitus in patients who did not improve. The percentage of complete functional recovery rose from 40 p. cent to 66 p. cent of those who survived. The percentage of recovery with sequellae compatible with an autonomous physical activity was stable. The percentage of completly handicaped survivals fell from 28 p. cent to 5 p. cent. The authors conclude that the prognosis for patients with intraspinal menigioma has improved, however the diagnosis is still difficult in the old subject, and there is a serious risk to life when the lesion is in the cervical region.

[Cranial traumatism following a fall in children under 4 years of age (author's transl)]. / Les traumatismes crâniens par chute chez les enfants de moins de 4 ans: analyse de 706 observations recueillies sur une période d'un an

This survey was carried out on 706 cases chosen at random, of cranial traumatism following a fall in children under 4; it underlines the fact that in most cases there is a favourable evolution. However, complications may always occur, even in apparently slight accidents. A clinical examination, although difficult to carry out, reveals important information for the detection and treatment of complications, which are mainly intracranial collections which are not always immediately detectable; this entails a constant observation for at least one week. Complementary tests give information which must be interpreted according to clinical situation.