[Continuous CSF aspiration. An alternative in the management of acute hydrocephalus]. / Aspiration continue du L.C.R. Une alternative dans la prise en charge de l'hydrocéphalie aiguë.

As proposed by Marmarou in 1976, in case of acute hydrocephalus high intracranial pressure (I.C.P.) can be controlled by withdrawing the ventricular cerebrospinal fluid (C.S.F.) at a constant rate equal to the rate of C.S.F. formation. We experienced this procedure since 1989 in 17 patients presenting with acute hydrocephalus consecutive to aneurysmal subarachnoid hemorrhage (11 cases) or infratentorial mass (6 cases). A ventricular catheter was connected to an electrical syringe of which the motor driving direction has been inverted. Using an outflow rate ranging from 0.15 to 0.20 ml/mn, i.e. lower than the physiological C.S.F. rate formation, this controlled continuous mechanical ventricular C.S.F. drainage has serious advantages compared to a traditional external ventricular C.S.F. drainage. These advantages are mainly the better control of intracranial pressure (fiability of I.C.P. monitoring, lowered risk of hyperdrainage), more comfort for the patient and the nursing staff and lower cost.

[Clinical incidence of thromboembolism in neurosurgery]. / Incidence clinique de la maladie thrombo-embolique en neurochirurgie.

Deep vein thrombosis and pulmonary embolism are known complications in neurosurgical patients, but prophylactic treatment is not commonly used in neurosurgical units. However the incidence of thromboembolism is comparable to general surgical patients, when reliable tests are applied. This retrospective study examines the clinical incidence of thromboembolism in 1378 neurosurgical patients. A thromboembolic complication is found in 2.6% of the patients, 1.4% of them shows pulmonary embolism. Clinical incidence seems to be small, but adjustment of heparin treatment is always difficult in neurosurgical patients and it is often insufficient. Partial inferior vena cava interruption is indicated in nearly half of the patients. Prospective studies are necessary to appreciate the incidence of deep vein thrombosis in neurosurgical patients with a reliable test. The efficiency and security of the prophylactic methods must be evaluated.

[Clinical, neuroradiologic and developmental aspects of idiopathic benign subarachnoid hemorrhage (subarachnoid hemorrhage of unknown cause). Retrospective study of 65 cases]. / Aspects cliniques, neuroradiologiques et évolutifs du syndrome d' "hémorragie méningée bénigne idiopathique" (hémorragie méningée sans cause reconnue). Etude rétrospective de 65 patients.

Sixty-five patients with a mean age of 50.2 +/- 10.9 were admitted with a subarachnoid hemorrhage and a subsequent normal cerebral panangiography. On admission, 69% of the patients were graded I or II on the Hunt and Hess scale, versus 14% of them admitted on grade IV or V. Fifty-one patients (78%) were submitted to a second angiography between day 10 and day 132 after their hemorrhage (average day 29). A third angiography was performed on twenty-six patients (40%). Angiographic vasospasm was present on 52% of the first angiograms and affected predominantly the vertebro-basilar arterial system. On the second angiography, the vasospasm was still present on 26 out of 32 angiograms performed before day 30, and was only noted on 2 out of 19 angiograms performed later. No rebleeding was recorded in this group of patients who were followed-up for an average of 49 +/- 23 months. Complication as acute hydrocephalus affected 17% of the patients. In two patients (3%), symptomatic vasospasm was judged responsible of a delayed neurological deficit with concomitant hypodensity on the CT scan. Angiographic explorations were complicated by a transient ischemic deficit in 3 cases and by a fatal stroke in one case (4 cases out of 65 procedures, or 6%). As another patient died with bronchopneumonia during the hospitalization, the initial mortality rate was 3%. During the period of follow-up, two patients died from medical causes unrelated to their initial hemorrhage. Finally, 92% of the patients were alive and in an excellent or good clinical condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Adventitial cysts of the popliteal artery.

Adventitial cysts of the popliteal artery are rare. Their pathogenesis is debated. In one of the two cases reported here, there was a communication between the arterial cyst and the articulation of the knee. This supports the embryonic theory that the articular synovium and adventitial cysts have the same mesenchymal origins. Treatment is surgical, with simple evacuation of the contents of the cyst in uncomplicated cases, excision and reconstruction in the others.

[Changes in intracranial pressure in severe head injured patients in hemodialysis]. / Variations de la pression intracrânienne chez le traumatisé crânien grave en hémodialyse.

Two cases of acute post-traumatic renal failure in severely head injured patients are reported. An increase in intracranial pressure (ICP) was shown up by continuous monitoring during haemodialysis: it was more important during conventional haemodialysis than during continuous arteriovenous haemofiltration. Although this effect is well known experimentally, few cases of continuous ICP pressure monitoring have been reported in head injury patients undergoing haemodialysis. The increase in ICP is explained in the dog as a result of blood-brain differences in urea concentration and osmolality leading to an increase in cerebral spinal fluid volume and cerebral tissue swelling. If dialysis is necessary in these patients, it should be carried out early and progressively, the patient's ICP being monitored continuously.