[The interest of CSF examinations in the etiological diagnosis of intracranial hypertension (author's transl)]. / Intérêt de l'examen cytologique du LCR dans le diagnostic étiologique de l'hypertension intra-crânienne.

The authors discuss the case of a 15-year-old girl suffering from intra-cranial hypertension. Neuroradiological examinations do not reveal any obstruction in the cerebral spinal fluid circulation. The CSF cylologic examination was the first to give etiological indications, showing the existence of malignant cells which the cerebral biopsy later enabled us to classify as glioblastoma. This case affords an opportunity to recall the three stages of the diagnosis: first, intra-cranial hypertension; secondly, chronic meningitis; thirdly, cytological difficulties in the examination of CSF in patients having undergone neuro-radiological examinations.

[Disabling segmental occlusion of the vertebral artery. Surgical treatment using a venous by pass from the external carotid to the C1-C2 portion if the vertebral artery (2 cases) (author's transl)]. / Les occlusions vertébrales segmentaires mal tolérées. Traitement par pontage veineux entre la carotide externe et le segment C1-C2 de l'artère vertébrale (2 observations).

The authors report the cases of two patients who were severely disabled due to signs and symptoms of vertebrobasilar insufficiency caused by unilateral segmental occlusion of one vertebral artery. The patency of the occluded vertebral artery beyond C3 was demonstrated by a faint angiographic injection through anastomic ascending cervical arteries which provided insufficient blood supply. The opposite vertebral artery was abnormal in both cases: a proximal kinking with intracranial atheromatous stenosis in the first and an atheromatous ostial stenosis in the second one. A venous by pass from the external carotid artery (end to end anastomosis) to the C1-C2 portion of the vertebral artery (en to side anastomosis) was performed through an incision from the tip of the mastoid process along the S.C.M. the division of which was unnecessary. Post operatively the signs and symptoms disappeared immediately. The stability of this result is attested by a follow up period of 13 months in the first case and 9 months in the second one. A control angiogram demonstrated a good supply to the vertebro-basilar system through the bypass, the excellent permeability of which was further confirmed by repeated Doppler ultrasound examinations. The indication of this technique is discussed.

[A rare anomaly of the circle of Willis : infra-optic course of both anterior cerebral arteries: associated aneurysm of the basilar bifurcation (author's transl)]. / Anomalie rare du polygone de Willis : trajet sous-optique des deux artères cérébrales antérieures--anévrysme associé de la bifurcation du tronc basilaire.

A rare anomaly of the A1 portion of both ACA associated with a saccular aneurysm of the basilar bifudcation is presented. Based upon this case and eigth other cases in the literature, the anatomical and radiological features of the anomaly are precised : the anomalous artery comes from the internal carotid artery right over the cavernous sinus, very close to the origin of the ophtalmic artery; it rums medailly below the inferior aspect of the optic nerve, thus being projected under the plane of the optic canal on oblique angiograms; finally, it crosses the anterior edge of the optic chiasm up to the interhemispheric fissure. By itself the anomaly is asymptomatic but it should not be considered as a mere curiosity since it has most often been found associated with a variety of cerebral vasculature anomalies and in particular with encor more saccular aneurysms of the circle of Willis.

Extra-dural hematoma of the posterior fossa (author's transl). / L'hématome extra-dural de la fosse postérieure. Problèmes diagnostiques (10 observations).

10 cases of posterior fossa extra-dural hematoma are reported and 100 other published cases reviewed. It appears that the sole clinical evaluation frequently leads to wrong or delayed diagnosis. In only one out of five cases the cerebellar signs and the palsy of one or several cranial nerves (VII, IX, X, XI, XII) are prominent. In contrast, all other cases do not present specific signs. Furthermore, the presence of a concomitant supratentorial traumatic lesion may contribute to prevent the finding of evidences for cerebellar extra-dural hematoma. The possibility for such hematoma must always been kept in mind when an occipital fracture is shown by radiography. Venous phases in carotid arteriography permit to ascertain the extradural hematoma if there is a displacement of the torcular Herophili or of the transverse sinus. Data from carotid arteriography may be normal and the lesion may be ascertained by vertebral arteriography which will demonstrate: anterior displacement of the basilar artery against the clivus--anterior displacement of posterior inferior cerebellar and posterior meningeal arteries--crescentic displacement of brain substance from the inner table--displacement of the venous sinuses.

[Carotid-cavernous fistulas by tearing or rupture of the meningo-hypophysial trunk or of one of its branches. Anatomo-radiologic study of 4 cases. Pathogenic hypotheses]. / Fistules carotido-caverneuses par arrachement ou rupture du tronc méningo-hypophysaire ou de l'une de ses branches. Etude anatomo-radiologique de 4 observations. Hypothèses pathogéniques

Thr authors report observations relative to four cases of traumatic carotid-cavernous fistulas for which angiographic pictures were similar. Autopsy examination permitted in two cases to establish that the tentorial branch of the meningo-hypophyseal trunk was involved in the genesis of both fistulas. One case was from a rupture, the other from tearing of that branch. Further examination of these two cases showed an absence of sphenoid bone fracture which suggested that any arterial perforation or shearing process could be excluded. Thus the pathogenic hypothesis of PARKINSON is further sustained. The authors suggest that the observed arterial lesions may be due to tensions occuring at the proximal part of branches of the meningo-hypophyseal trunk. Such tensions may be carried out through tractions on the posterior meningeal walls of the cavernous sinus when trauma occur on the posterior temporal area and the petrous bone. Such traction forces were shown to be real in one case where a fracture of the dorsum sellae and a bilateral caroti-cavernous fistula were caused by a bilateral temporo-petrous trauma.

[Selective ventriculography according to the Corrales technique. Its value in the diagnosis of tumors of the 3d ventricle and posterior fossa]. / La ventriculographie sélective selon la technique de Corrales. Son intérêt dans le diagnostic des tumeurs du 3e ventricule et de la fosse postérieure

The authors relate their experience of selective ventriculography. The methode previously described by CORRALES needs a small gold chain with fine links which can reach by gravity the cavity of the fourth ventricle through the third ventricle and the aqueduct of Sylvius. This small chain is used as a leader for a flexible catheter which permits selective clouding of median ventricular cavities. This technique was used in 18 patients. In one case only, the small chain went down without any difficulty into the cisterna magna. The ventricular system was normal. In the 17 other cases, the progression of the small chain was stopped at some point of the ventricular cavities. In each of those cases, the stopping of the small chain appeared to be linked with the presence of a growth directly obstructing or compressing the ventricular cavities and gave a first clue as to its location. Introduction of the catheter into the aqueduct of Sylvius was the only true difficulty; in 3 cases, anatomical (large massa intermedia) or pathological obstacle (right angle bending of the aqueduct of Sylvius) made it impossible. In those 3 cases a satisfactory selective clouding of the fourth ventricle was nevertheless obtained by injecting the dimer either into the posterior part of the 3rd ventricle or into the upper part of the aqueduct of Sylvius. In all cases the trouble some superpositions due to clouding of lateral ventricles were thus avoided and a tomographic investigation, specially useful for the diagnosis of expanding lesions of the third ventricle and posterior fossa was allowed.