Stereotactic CT localization and biopsy of brain tumours using the Leksell frame. A study of 45 cases.

The authors have explored 45 patients presenting with clinical and CT evidence of space-occupying process in the brain. They endeavoured to determine the nature of the processes by performing stereotactic biopsy after localization by CT in 43 cases, by magnetic resonance imaging in 2 cases and by angiography in 1 case. The method proved reliable: the quality of the biopsy specimens obtained enabled the pathologist to make a satisfactory diagnosis by light microscopy after freezing in almost every case. Moreover, the orifice of penetration of the Leksell-Sedan needle provided a very accurate localization of the lesion when surgery was needed. Several specimens were taken during each session, since histological findings may vary according to the site of biopsy. All explorations were carried out under local anaesthesia. Two cases of haemorrhage were recorded; they were without long-term consequences but required surgery.

Anatomo-radiological considerations about lumbar discography. An experimental study.

An experimental study was undertaken to determine the origin of lumbar pain associated with degeneration of lumbar intervertebral disc by examining their innervation, vascularization, and stages of evolution. The study included the comparison of discography on patients with an experimental reproduction of this examination on cadavers.

[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.

[The spine in Recklinghausen's neurofibromatosis]. / Le rachis dans la neurofibromatose de Recklinghausen

The authors have studied the various spinal manifestations of Rechlinghausen's disease. They observed static disorders, such as progressive and non progressive kyphoscoliosis, tumours outside the spinal cord but within the vertebral column of neurinoma type or meningiomas and intraspinal glial tumours. Pseudo-tumoral dystrophic malformations, together with diffuse osteo-dystrophy the skeleton were also observedmthe most interesting and rarest manifestation, as there are to date only 23 published cases, is festooning or vertebral scalloping, which may be demonstrated by tomographic examination and completed by the use of contrast media, e.g. opaque myelography giving the pitted appearance and gas myelography showing the integrity of the spinal cord. The physiopatholoty of the latter form is not clearly established. This may be either of meningeal origin or bony origin, with a dystrophic character.