[Intra-spinal ganglioglioma. A case and review of the literature]. / Le gangliogliome intra-médullaire. Une observation, revue de la littérature.

A case of intra medullary ganglioglioma is reported in a 25 year old woman, who had presented an acute poliomyelitis when she was 2 years old. Since 7 years, new neurological signs occurred with spastic paraplegia, sensitive and sphincter disturbances. Cervical and lumbar myelography showed an intra medullary tumor, extending from C2-C3 to T7-T8. Macroscopically, the lesion was well circumscribed, except on the cervico-dorsal junction where it engulfed the anterior spinal artery. Histologically, the tumor was a ganglioglioma, grade I. Two years after surgery, the patient remains paraplegic. This case is compared with the 13 other cases of the literature.

["De novo" aneurysms. Apropos of a surgically treated case]. / Anévrysmes "de novo". A propos d'un cas opéré.

The authors report the case of a 26 years old woman who developed four "new" T aneurysms, ten years after the successful clipping of a vertebro-basilar system aneurysm. This observation is discussed in relation to the literature; current views supporting that aneurysms may result from a combination of inherent and acquired tissue weakness associated with hemodynamic effects are cited. Another twelve cases of "de novo" aneurysms developed in patients without previously carotid ligation and reported in the literature are reviewed. Their characteristics in relation to their localisation and their interval time discovery are discussed. The advisibility of repeated angiograms in some patients with aneurysm is discussed as these patients are at an increased risk of hemorrhage from another "new" aneurysm.

[Peroperative embolization of cerebral arteriovenous malformations with butylcyanoacrylate (18 cases)]. / Embolisation peropératoire des malformations artério-veineuses cérébrales par le butyl-cyanoacrylate (18 cas).

18 cases of cerebral Arterio-Venous malformations (AVM) are reported, treated by direct intra-operative embolisation. A 50% mixture of Butyl-2-Cyanoacrylate and Mono-Iodo-Stearate of Ethyl was used. The clinical history of the patients was a long history of seizures in 8 cases a sub-arachnoid or intra-cerebral hemorrhage in 9 cases, and a transient motor deficit in 1 case. The AVM site was supra-tentorial in 16 cases, and infra-tentorial in 2 cases. The AVM size was large with numerous feeders in 13 cases, and limited with a few feeders in 5 cases. Technically, after catheterisation of a cortical feeder, an intra-operative angiogram was performed (except for the first 6 cases) then the polymerizing mixture was pushed inside the feeder (from 1 cc to 3 cc routinely, depending of the AVM size; exceptionally 7 cc and 11 cc were used). In the immediate postoperative course, 1 patient died (case with the 11 cc embolization), 3 patients had a serious postoperative hemorrhage, 4 patients presented with a transient postoperative deficit, and in 10 patients the postoperative course was uneventful. The long term results are: 1 postoperative death, 1 death after recurrence of intra-cerebral hemorrhage (3 years postoperatively), 1 hemiplegia, 15 patients without long lasting complication. The embolization was performed as unique treatment in 14 cases, and was followed with the AVM removal in 4 cases (immediately in 1 case, delayed in 1 case, late after recurrence of intra-cerebral hemorrhage in 2 cases, respectively after 3 years and 2 years).(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of spondylolisthesis (stage I-II) by neurosurgical decompression without either osteosynthesis or reduction]. / Traitement du spondylolisthésis (stade I-II) par décompression neurochirurgicale sans ostéosynthèse ni réduction.

Between 1978 and 1982, 45 patients (44 adults, 1 child) with lumbar isthmic spondylolisthesis (SPL) were operated upon, through a classical posterior approach without setting or fixing. 46 SPL were at the L5-S1 level, 9 at the L4-L5, with 31 class I and 14 class II SPL, according to Meyerding. All the patients had experienced backache with radicular pain. A bilateral interlaminar way with preserving the posterior arch, allowed a large dural and radicular decompression. At the slipping level the wedge-shaped bone was removed while stripping off the disc together with its cartilaginous layer. Every possibility of root compression was cleared up: fibrosis, soft discs, osteophytic spurs, roof of the intervertebral foramina, with exploration of the adjacent levels. Neither bone graft or metallic devices were used. Apophyseal joints and their synovial membrane were denervated by coagulation. The postoperative course was uneventful. Bracing was needed for 2 months. X-ray postoperative follow-up demonstrated an important narrowing of the intervertebral space with constitution of a solid intersomatic fibrous joint without increase of slipping. Good and excellent results were obtained in 68% of cases, fair result in 20% with A 1 to 4 years follow-up. 80% of patients returned to their pre-operative occupation. After reviewing the data of the literature the authors ascertain that more complicated and sophisticated procedures do not bring out better results. They conclude that their safe and simple technique should be widely advocated for lumbar class I and II spondylolisthesis.

[Reliability of the results of the ultrasonic hemodynamic recording (Doppler effect) in the diagnosis of cerebral ishemic ischemia of carotid origin]. / Fiabilité des résultats du bilan hémodynamique ultrasonographique (effet Doppler) dans le diagnostic de l'ischémie cérébrale d'origine carotidienne.

The Doppler ultrasound diagnosis of carotid artery stenosis (asymetrical systolic and diastolic flows; elevated resistance index: ratio of flow pulse amplitude to systolic and diastolic values; flow reversal in the ophtalmic artery) is compared, in 52 patients, to the clinical, angiographic (40 patients) an surgical findings and to the peroperative measure of intra-arterial pressure and flow (30 patients). Its reliability is proved as a guide for angiographic exploration and for postoperative watching, but it is restricted to great vessels (cervical carotid artery) and is unable to detect ulcerated plate without stenosis.

[Pan-spinal ependymoma. Apropos of 2 cases with complete exeresis]. / L'épendymome pan-médullaire. A propos de deux cas d'exérèse compléte

Authors performed in two patients a macroscopically complete exeresis of a panspinal ependymoma. The first case concerns a 27 years old woman, submitted to surgery in 1971, soon after a delivery, who exhibited a tumor in all points identical to the one described by G. Horrax an D. Henderson (1939). The second case concerns a male subject submitted to surgery in May 1973 because of a lesion extending from C2 to L2 and corresponding to a dorsal fleshy ependymoma, surrounded by two voluminous pseudosyringomyelic cysts, with respectively cervical and dorsal-lumbar localization. Such cases rare, with sometimes difficult clinical and roentgenologic diagnosis, raise before all problems of surgical tactics. We are dealing here with benign ependymomas, few favourable to roentgentherapy. Their management is surgical, i.e. complete exeresis. The few common extent of some of these tumors to the totality of the spinal cord does not modify in any manner such a principle. The same may be said of some etiologic circumstances, such as pregnancy, that often enough constitute a postponing of diagnosis and mangement detrimental for the patient. Only, the march of the surgical procedure may be object of discussion. The here reported experience lets appear that, when necessary, complete exeresis may be performed in one session under the same conditions and with the same spinal risks than for a less extensive analogous tumor. At long term the problem of spasticity of lower extremities has to be considered. However, in spite of extensive laminectomy, no major deformity of the vertebral column is to be noted.