Sitting position for pineal surgery: Some anaesthetic considerations.

INTRODUCTION: The sitting position for pineal tumour removal remains controversial as regards the number of potential complications despite good surgical conditions. METHOD: A systematic review of the literature was conducted in order to record the most frequent complications observed in this position, their incidence and prevention. RESULTS: Venous air embolism, hypotension, pneumocephalus, macroglossia, quadriplegia and nerve injuries are the most frequent complications observed. Their incidence can be dramatically decreased with an accurate anesthesiological and neurosurgical management. CONCLUSION: In training teams, the sitting position remains the gold standard for pineal tumour removal.

Delayed rupture of traumatic aneurysm after civilian craniocerebral gunshot injury in children.

BACKGROUND: There are few published large series on civilian craniocerebral gunshot injuries in children. Traumatic intracranial aneurysms (TICAs) are rare and highly unstable lesions. They represent less than 1% of all aneurysms and can either rupture within minutes after formation or remain quiescent for several weeks or years, manifesting with delayed hemorrhage and neurologic deterioration. CASE HISTORY: We report the case of a 10-year-old girl who was referred for coma after high-velocity craniocerebral gunshot wound and neurological deterioration 7 days after the initial injury. A massive right posterior occipital hematoma caused by the rupture of an unsuspected right posterior cerebral artery TICA was discovered. TICA was treated by coil embolization, with a good neurological recovery at 6-month follow-up. DISCUSSION: We discuss the pathogenesis and the management of TICA in a child after civilian craniocerebral gunshot injuries. CONCLUSIONS: TICAs should be suspected in patients with civilian craniocerebral gunshot injuries, presenting with secondary neurological deterioration, to carry out emergent CT scan and angiographic exploration before contemplating definitive endovascular treatment. Endovascular management may be a prompt safe-to-use technique and a valuable option, especially when surgery is highly risky.

Craniocerebral injury resulting from transorbital stick penetration in children.

OBJECTS: Two children were admitted to hospital for treatment of craniocerebral injury with transorbital penetration. METHODS: One child aged 6 years and 6 months had poked a chopstick in his orbit. There was no report of either a palpebral or an ocular wound. He had subsequently developed a meningeal syndrome with a cerebral abscess managed by needle aspiration biopsy and intravenous antibiotics. The other child, aged 4, had fallen onto a metal rod. He presented with a palpebral wound, motor disorders and coma, all due to a frontal intracerebral hematoma. There was an improvement in outcome without complications of an infectious nature or motor sequelae. CONCLUSIONS: Such head injuries are rare. Clinical, radiological and ophthalmological investigations must be performed, including computed tomography (CT) scan or cerebral magnetic resonance imaging (MRI) with antibiotic treatment for suspected microorganisms.

[Ventriculostomy of the third ventricle and diabetes insipidus]. / Ventriculostomie du troisième ventricule et diabète insipide.

We report the case of a 2-year-old child who sustained a permanent diabetes insipidus following a third ventriculostomy for hydrocephalus from a Dandy-Walker syndrome. Ventriculostomy, used for therapy of non-communicating hydrocephalus, can cause complications such as diabetes insipidus. The latter has rarely been reported and is usually transient. Following ventriculostomy, a close postoperative surveillance is essential, especially in children.

[Cerebral deep vein thrombosis: three cases]. / Thrombose des veines cérébrales profondes: trois observations.

Cerebral internal venous thrombosis are rare and diagnosis is difficult. We report three cases in male adults. Clinical data were headaches, vomiting, dizziness and coma, in relation with an intracranial hypertension, or in a case, cardiocirculatory arrest. Cerebral internal veinous thrombosis was diagnosed by a CT scan and cerebral angiography twenty four hours after the admission in neurosurgical intensive care. CT scan showed hemorrhagic and ischemic lesions of thalami in two cases, diffuse cerebral edema in two patients, early or delayed hydrocephaly in two cases. No patient survived despite intensive treatment including heparinotherapy, ventricular CSF drainage, osmotherapy, dehydration, barbiturate, other antiepileptic drugs and mechanical ventilation. In two cases, general or local illness was found, sickle cell disease or radiotherapy for pineal tumor, and in case 3 clinical signs evoked autoimmune disease, not demonstrated by biological samples.

[Prevention of arterial hypotension during spinal anesthesia using intramuscular ephedrine in older people]. / Prévention de l'hypotension artérielle au cours de la rachianesthésie par l'éphédrine intramusculaire chez la personne âgée.

OBJECTIVE: To assess the efficacy of intramuscular ephedrine for prevention of hypotension following subarachnoid block (SB) in the elderly. STUDY DESIGN: Prospective, randomized double blind study vs placebo. PATIENTS: Twenty patients, aged 60 years or more, of physical class ASA 2 or 3, scheduled for surgical fixation of fractured neck of femur under SB, allocated into two groups of ten each. METHODS: After oral premedication with hydroxyzine 50 mg, 90 min before surgery, and preloading with cristalloid solution 10 mL.kg-1, the subarachnoid space was punctured with the patient in lateral position using a 22 Gauge spinal needle at the L3-L4 or L4-L5 interspace. Patients were given 0.5% hyperbaric bupivacaine intrathecally, according to body weight. Patients in ephedrine group received intramuscular ephedrine 30 mg immediately after SB. Patients in placebo group received 1 mL of intramuscular saline immediately after SB. When blood pressure decreased below 100 mmHg repeated bolus of ephedrine 6 mg were given intravenously. RESULTS: Patients in both groups experienced a significant decrease in systolic pressure after SB, the decrease being significantly greater in the placebo group. CONCLUSION: Prophylactic intramuscular ephedrine is effective to prevent hypotension associated with SB in the elderly.

[Sickle cell anemia and internal cerebral vein thrombosis]. / Drépanocytose et thrombose des veines cérébrales internes.

Cerebrovascular disorders are frequently associated with sickle cell disease, mainly in homozygous children. We report the case a 25-old-patient with known sickle cell disease who presented with coma inaugurated by manifestations of intracranial hypertension. CT revealed bilateral thalamic infarcts and angiography confirmed the thrombosis of internal cerebral veins. Treatment included heparin and blood transfusion. Severe cerebral oedema resulted in the lethal outcome three days later.

[Thrombolytic therapy with rt-PA of recurrent thrombosis in tricuspid valve prosthesis during pregnancy]. / Traitement thrombolytique par rt-PA d'une thrombose récidivante de prothèse valvulaire tricuspidienne durant la grossesse.

The authors report a case of a woman who had two episodes of a tricuspid Saint-Jude prosthesis thrombosis treated with fibrinolysis using rt-PA, during the fourth month of pregnancy. A first course of thrombolytic therapy was successful with normal valve function despite threatening abortion and uterine bleeding. An early rethrombosis of the prosthetic valve and a failure of a second course of thrombolysis required the interruption of pregnancy with a replacement of the tricuspid valve prosthesis.