[Cerebro-meningeal hemorrhage secondary to ruptured vascular malformation during pregnancy and post-partum]. / Hémorragies cérébro-méningées par rupture d'une malformation vasculaire en cours de grossesse ou de post-partum.

Thirty two new cases of vascular malformations discovered during pregnancy were reviewed in a multicentric retrospective study and compared to the literature. The authors studied both the influence of pregnancy and post-partum on cerebral vascular malformations and the corresponding neurosurgical and obstetrical management. The relative frequencies of arteriovenous malformations (AVMs) and arterial aneurysms (AAs) is the same for pregnant and non-pregnant women. Pregnancy does not increase the risk of first bleeding of vascular malformations but the risk of re-bleeding is increased for AVMs. The bleeding of a vascular malformation is more strongly correlated to age than to parity. The mean maternal age at the time of rupture is greater for AAs than for AVMs, as it is in the general population. The bleeding of a vascular malformations occurs more frequently during the second and third trimesters of pregnancy than in the first one and in the post-partum. Labor and delivery are not great-risk-periods. Management of vascular malformation in pregnant woman is proposed as follow : --a ruptured AA or AVM is managed as it is in non-pregnant woman, whatever the gestational age; no fetal extraction needs to be performed except ed if the rupture occurs at the very end of the pregnancy;--an non-ruptured AVM discovered during pregnancy is treated after delivery; an non-ruptured AVM that never bled before pregnancy is managed in the same way that an non-ruptured AA.

[Dermoid cyst of the lateral ventricle associated with ethmoidal dermal sinus. Report of a case]. / Kyste dermoïde des ventricules latéraux associé à un sinus dermique ethmoïdal. A propos d'un cas.

We report a case of a ventricular dermoid cyst associated with a dermal sinus connected with the ethmoidal cells in a patient who developed rapid symptoms of raised intracranial pressure. Computed tomography showed a cystic mass in the right lateral ventricle with a hydrolipidic image in the left frontal horn of the ventricle and associated hydrocephalus. Magnetic resonance imaging showed a heterogeneous T1 hyperintense mass with a fistulous tract communicating with the ethmoid cells. A cerebrospinal fluid ventriculo-peritoneal shunt was initially established, which required further revision. A right sided transventricular approach was undertaken in a second stage, allowing resection of a dermoid cyst. Obliteration of the dermal sinus tract was obtained using pericranial duraplasty. Clinical and imaging features are discussed. The need for total resection including the tumor capsule and occlusion of the fistula are emphasized if recurrence and infection are to be prevented.

[Central neurocytoma. A report of 4 cases]. / Le neurocytome central. A propos de 4 observations.

We report 4 cases of central neurocytoma removed by a transfrontal approach with no recurrence after a mean follow up of 3 years. This uncommon lesion of the supratentorial ventricles (150 cases reported) occurs in young adults, and often induces intracranial hypertension secondary to an obstructive hydrocephalus. The CT scan, MRI and histopathological features are related. This neuronal origin tumor is difficult to distinguish from other intraventricular processes as oligodendroglioma or ependymoma. However, the immunopositivity for the neuronal markers as synaptophysin, calcineurin and microtubul associated protein 2, and the negativity for the glial fibrillary acidic protein, allow the diagnosis of this neuropathological entity. The prognosis is favorable though some cases of recurrence (14 cases) and cerebrospinal dissemination (2 cases) has been reported in the literature.

Reactivation of herpes virus after surgery for epilepsy in a pediatric patient with mesial temporal sclerosis: case report.

OBJECTIVE: This case report is presented to raise the awareness of the potential risk of reactivation of herpes simplex virus (HSV) encephalitis after intracranial surgery. CLINICAL PRESENTATION: The case of an 8-year-old male patient who suffered a reactivation of HSV encephalitis after undergoing amygdalohippocampectomy for complex partial seizures is reported. This patient had previously contracted HSV 1 meningoencephalitis at the age of 16 months. Six years later, a left amygdalohippocampectomy was proposed after the development of intractable partial epilepsy associated with left mesial temporal lesions. During the postoperative period, the patient suffered severe clinical deterioration with partial status epilepticus, aphasia, and hyperthermia, which resolved after intensive antiepileptic treatment supported by acyclovir. CONCLUSION: We advise prophylactic pre-, peri-, and postoperative treatment with acyclovir for patients with known histories of HSV encephalitis who undergo intracranial procedures.

[Intra-orbital dacryops. Report of a case]. / Dacryops intra-orbitaire. A propos d'un cas.

We report a case of intra-orbital Dacryops in a 7-year-old child. The presenting sign was progressive exophtalmus. The patient was operated via a lateral approach allowing total removal of the cyst without recurrence after one year. The clinical, radiological (CT Scan and MRI) and therapeutical aspects are discussed.

[Chronic subdural hematoma in utero. Case report with literature review]. / Hématome sous-dural chronique in utero. A propos d'un cas, revue de la littérature.

We present a case of chronic subdural hematoma diagnosed in utero by ultrasonography, and MRI at 31 weeks gestation. No cause of usual intracranial hemorrhage was found. There was no trauma. The child was operated after induced vaginal delivery at 37 weeks gestation, with good results and normal neuropsychological development after one year. We discuss the symptomatology and the therapeutic attitude in such cases.

[Trauma-induced arterial aneurysm in childhood. Report of a case and review of the literature]. / Anévrisme post-traumatique de l'enfant. A propos d'un cas, revue de la littérature.

We report a case of calloso-marginal artery aneurysm in a 3 year old child, revealed 3 weeks after a craniocerebral trauma with frontal embarrure, by a sudden subarachnoidal hemorrhage syndrome with loss of consciousness and coma. The CT scan confirmed the subarachnoid hemorrhage in all the basal cisterns, with an interhemispheric subdural hematoma. The carotid angiography showed a right calloso-marginal aneurysm. The child has been operated (coagulation of the artery and excision of the false aneurysm. We studied the mechanism of pediatric post-traumatic aneurysm, the histological and clinical presentation emphasizing the necessity of a complete neuroradiological exploration when new neurological symptoms develop after head trauma. Neurosurgical and/or endovascular neuroradiological treatment is mandatory.

Subdural sarcoma associated with chronic subdural hematoma. Report of two cases and review of the literature.

The authors report the cases of two children who presented in the first months of life with progressive macrocrania related to chronic pericerebral fluid collection. This condition resolved spontaneously without treatment after a few months in the first case, whereas it required several aspirations of blood-stained fluid via the fontanel in the second case. Both patients developed normally without evidence of disease in the earliest years of life and presented at the ages of 3 1/2 and 4 1/2 years, respectively, with symptoms and signs of rapidly progressing intracranial hypertension. In both cases contrast-enhanced computerized tomography and magnetic resonance imaging revealed masses in the subdural space of the skull base and the cranial vault associated with significant subdural fluid collections. In the first case the lesion was misdiagnosed in the initial phase and treated, by means of multiple craniotomies, as an organized subdural hematoma. After a diagnosis of liposarcoma had been made, the patient was treated with chemotherapy, which resulted in a good resolution of the lesions at 3-month follow-up review. In the second case a biopsy allowed the diagnosis of fibrohistiocytic sarcoma and the patient was treated with chemotherapy. The authors review the literature of the few reported cases and discuss the possible pathophysiological association between pericerebral fluid collection and the subsequent development of a subdural sarcoma.

Insidious craniosynostosis and chronic papilledema in childhood.

PURPOSE: We studied a case of chronic papilledema in a 5-year-old child with visual loss who presented no obvious cosmetic abnormalities. METHODS: Neuroradiologic investigations were suggestive of craniosynostosis. The child underwent decompressive cranial surgery. Postoperatively, the papilledema totally regressed, and visual acuity recovered to 20/20 in both eyes. RESULTS: The chronic papilledema was confirmed to be related to harmonious oxycephaly. CONCLUSION: Insidious craniosynostosis is an unusual cause of chronic papilledema in childhood. The papilledema may be resolved and visual loss prevented by surgery.

[Spinal epidural cavernous angioma. Apropos of 2 cases. Review of the literature]. / L'angiome caverneux épidural rachidien. A propos de 2 observations. Revue de la littérature.

We report 2 cases of spinal epidural cavernous angiomas revealed by paraplegia, and present the main cases reported in the literature since 1895. The diagnosis of this uncommon affection seems to be difficult to establish only upon clinical and radiological features. In spite of recent advances in neuroradiological imaging, these kinds of angiomas still remain an operative and histopathological discovery. A laminectomy was performed revealing a vascular lesion which was totally extirpated. Functional recovery was achieved in both cases.

[Spontaneous spinal epidural hematoma. Apropos of 2 new cases]. / L'hématome épidural rachidien spontané. A propos de 2 nouvelles observations.

The authors report on two cases of spontaneous spinal epidural hematomas. The clinical and radiological (CT, MRI) features as well as the pathogenesis of this rare disease are discussed in comparison with the literature. The authors emphasize the necessity for early diagnosis and treatment as the condition can compromise the functional and even vital prognosis of the patient.

[Papilloma of the choroid plexus. Apropos of 11 cases]. / Papillomes des plexus choroides de l'enfant. A propos de 11 observations.

The authors report 11 cases of choroid plexus papillomas in children operated on from 1979 until 1993. The age ranges from 2 months to 14 years old. The most frequent location occurred in the lateral ventricles (7 cases) followed by the locations in the third ventricle (3 cases) and the fourth ventricle (1 case). A complete resection was performed in all the cases. Hydrocephalus induced by the tumors was always present. An internal and permanent shunting procedure was carried out in the pre-operative period in 5 cases, in the post-operative course in 1 case. 3 cases underwent an external CSF shunting before surgery. This external CSF drainage has been taken out a few days after the surgical resection and no further permanent internal shunting was required in the long-term outcome. In 2 cases, no CSF drainage was performed either before or after surgery. Choroid plexus papillomas (CPP) require surgical management. The hypervascularisation of these tumors can give rise to important bleeding and generate surgical difficulties particularly in children under one year. The best way to remove these tumors would be to reach the arterial feeder(s) in first place, but it is not always possible. It's also difficult to forecast wether or nor the hydrocephalus will require further permanent CSF drainage, so we have chosen to carry on an external and transient CSF shunting.