[Cerebellar hemorrhage. Clinico-topographic correlations and therapeutic indications]. / Hémorragies cérébelleuses. Confrontations clinico-topographiques et indications thérapeutiques.

Spontaneous cerebellar hemorrhages are more easily recognized since the large use of CT scanner. In this series of 28 cases, they represent 9% of all spontaneous intra-cranial hemorrhages. Three main categories may be described. Small hematomas (less than 3 cm) are located in the postero-medial part of the cerebellum (9 cases): they are difficult to recognize, due to their limited clinical signs; their evolution is spontaneously favorable. Larger hematomas (more than 3 cm) represent two thirds of our clinical cases. When situated near the midline (7 cases) stupor or coma are quite constant, as neurovegetative signs; differentiating this type of case from brain-stem hemorrhages is difficult; prognosis is severe as even with surgery; there is a high mortality rate. When located more laterally (12 cases), their evolution is less acute: consciousness disturbances do not generally occur at the onset, whereas cerebellar disfunction is quite obvious; contrary to midline cases, these, when operated upon at an early stage, show a high success rate. If operation is delayed, the prognosis is much more serious due to the mass effect of this lesion in the posterior fossa. This is clearly demonstrated by CT scan which consistently shows displacement of the 4th ventricle with hydrocephalus of the lateral ventricles.

[Computed tomography of the head in gunshot wounds. Thirty-three cases (author's transl)]. / Le pronostic des plaies crâniocérébrales par balle en pratique civile. Série de trente-trois cas étudiés par la tomodensitométrie.

The authors report a series of 33 cases of craniocerebral lesions secondary to projectiles injuries studied by means of CT scan. Ct scans demonstrate the path of the missile, destructions of deep cerebral parenchyma, dissections of with matter (intra-cerebral bubble) and reactive oedema. Prognostic incidence of CT is discussed. CT scan helps to choose the best therapeutic approach as regards each particular case.

[Tumoral medullary compressions in malignant hemopathy (a 28 cases review (author's transl)]. / Compressions médullaires tumorales dans les hémopathies malignes. A propos de 28 observations.

The authors reviewed 28 cases of tumoral medullary compressions in malignant hemopathy. At once they point out 2 groups according to the fact that this compression is or not the revealing symptom of the disease. With regard to different data, that is to say, preoperative clinical examination with complementary investigations, and then results obtained from decompressive laminectomy followed or not with complementary therapy; the elements of the functional prognosis are analysed. They insist on frequency of medullary compression in a neuro surgical environment, as the revealing symptom of the hematologic disease and its immediate decompressive therapy is emphasized.

[Simplified technic for stereotaxic biopsy of hemispheric tumors]. / Technique simplifiée de biopsie stéréotaxique dans les tumeurs hémisphériques.

Stereotaxic biopsy of cerebral tumors has been considerably facilitated by the use of CT scanner. A new method is described using the CT section in the horizontal or oblique plan of biopsy. When this has been determined, it is possible to define a trajectory, calculated by the CT scan computer, with external landmarks marked on the skin. This method is possible with any kind of CT apparatus; the surgical biopsy is performed in the operating room with a simple stereotaxic frame square-shaped and fixed in the plan of the CT section. The biopsy needle may be oriented in an antero-posterior or medio-lateral direction. This method has been used in 33 patients, leading to as precise histological diagnosis in 30 cases. No complications have been noted, except for transient neurological deterioration in two cases, due to local edema. Hemorrhage have not been observed. The topographical precision of the method was verified by the injection of lcc of air followed by a post-biopsy CT scan. This technique seems particularly valuable for the diagnosis of deep or wide spread hemispheric tumors, non indicated for open surgery.

[Gasserian differential thermocoagulation in trigeminal neuralgia: a medium-term follow up (author's transl)]. / La thermacoagulation gassérienne dans la névralgie essentielle du trijumeau. Résultats à moyen terme (2 à 6 ans).

The results of thermo-coagulation have been evaluated in a series of 50 patients followed up from two to six years (average three years). Neuralgia disappeared in nearly 80 p. 100 of the cases (however this was obtained with a second operation in nine cases). The frequency of recurrences increase with time: 20 p. 100 during the first two years reaching 40 p. 100 after three years. They were more likely to occur if the post-operative sensory deficit is moderate. Complications directly related to the surgical technique were rare: some faded away relatively quickly (oculo-motor palsies less than 1 p. 100, masseter weakness 20 p. 100 in the first weeks). The only residual problems were related to sensory deficits: in general they were limited to a small cutaneous area and total anesthesia was never been observed. Although paresthesias were noted in 12 p. 100 of the cases, these usually were not really troublesome. Our conclusion, therefore, is that differential thermocoagulation appears to be the best surgical treatment for trigeminal neuralgia.

[Recurrency of intracranial tumors operated. Diagnosis (author's transl)]. / Valeur respective des explorations tomodensitométrique, scintigraphique et angiographique pour le diagnostic des récidives tumorales intra-craniennes post-opératoires.

The records of 123 patients who had previously be operated upon for intra-cranial tumors are studied to find symptoms of recurrency. 82 of these patients underwent a second operation. The value of CT Scan, cinegammagraphy and angiography are compared. CT Scan yields the best results to detect recurrency and its place. Using both CT Scan and cinegammagraphy increases reliability for difficult cases, mainly in the cases of multiple lesions. Angiography is no longer used to detect recurrencies but only just before operation.

[Preoperative diagnosis of posterior fossa tumors (author's transl)]. / Approche diagnostique pré-opératoire des tumeurs de la fosse postérieure de l'adulte.

The wide-scale use of the CT Scanner has completely modified the radiological approach in the diagnosis of infratorial tumors. In the cerebello pontine angle tumors, computerized tomography offers enough information for surgery (at least in those cases where enlargement of porus is noticeable on the skull film). On the other hand, if clinical picture is incomplete or CT scann atypical (spontaneous hyperdensity), a vertebral angiography is necessary to recognize a meningioma or a neurinoma of the firth nerve. A low density suggesting a cyst (epidermoid or other) is a good indication for pneumoencephalography. In cerebellar tumors of the hemispheres, vertebral angiography should be performed in the case of multiple tumors (except if there is a good chance of metastases) and also with a single tumor showing a high enhancement with contrast; in a solitary cyst, angiography is recommanded when clinical signs suggest hemangioblastoma. Isotopic scanning is only indicated when there is a suspicion of metastases. In midline tumors, one has to consider the relationship with the 4th ventricle; no other radiological exams are necessary if tumor is likely located in the cerebellar vermis; on the contrary, if the ventricular cavity is barely visible positive ventriculography is helpful. In the anteriorly located neoplasms, pneumoencephalography with tomography may precise the exact situation in relation with the brain stem. Regardless of the anteroposterior location, a highly contrasted tumor should be explored by angiography.

CT follow-up studies in postoperative craniopharyngiomas.

Thirty patients with histologically proved craniopharyngiomas were controlled by CT after surgical excisions. Recurrence occurred in 70%. Of these tumours 33% were cystic, 30% were solid, and 12% were calcified. The ventricles were dilated in 67%, and postoperative cavities were found in 33%. The effectiveness of various forms of therapy has been monitored by CT. The purpose of our study is to investigate the value of early and long term CT scanning in craniopharyngiomas after surgical excision.

[Computerized tomography of craniopharyngiomas. Therapeutic consequences]. / Analyse tomodensitométrique des craniopharyngiomes. Incidences thérapeutiques.

An analysis was made of the results of C.T. scanning in 43 patients with craniopharyngiomas. Filling of the suprasellar cisternae was observed in most cases, together with dilatation of the lateral ventricles. The appearances of the tumor before and after intravenous injection of the contrast medium are described and the frequency with wich calcification, cysts, and lipid densities were noted is reported. Regular C.T. scanning can define operative indications for craniopharyngiomas as a function of the results obtained.

[The value of computerized tomography in the exploration and surveillance of diencephalic tumours (4 cases) (author's transl)]. / La tomodensitométrie dans l'exploration et la surveillance des tumeurs diencéphaliques. 4 cas.

Computerized tomography has transformed the protocol of exploration and surveillance of diencephalic tumours. It gives information concerning their structure, extension and all associated pathology. In addition, the examination is non-traumatic for the patient which in most cases makes it possible to avoid classical neuroradiological procedures with contrast medium, and may be repeated in order to observe the course of these tumours after radiotherapy. Four cases are reported to illustrate the different contributions of CT scanning.