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Medulloblastoma is classically a childhood tumor, but one third of the cases occurs in adulthood. 17 adult cases are reported here (12 men, 5 women). The average age was 26 years 6 m (from 16 to 47 years). Pre-surgical clinical course is shorter before 30 years (7 months) than after (up to 24 months). Initial symptoms were intracranial hypertension with signs of lateralisation in 2:3 of the cases (cranial nerve and pontocerebellar syndroms). Vertebral angiography, scintigraphy, tomodensitometry helped to the diagnosis. Morphologically, two variants of tumors were found: soft and infiltrative classical medulloblastoma (12 cases) and desmoplastic medulloblastoma which was firmer and better limited (5 cases). The treatment consisted of a surgical removal, as complete as possible, then of an entire neuraxis radiation. Three operated patients died before 6 weeks. Among the 14 other cases, six patients are still alive three years, four other, five years and one, 22 years after the operation. This histological type was of no influence on the post-operative course. Remote metastasis were noted in cauda equina (3 cases), in spinal cord (1 case), in bones and lymphatic nodes (3 cases).

The authors report 90 cases of space occupying lesions originating in the occipital lobe, including 58 primary (26 malignant gliomas, II "benign" gliomas, 19 meningiomas, I sarcoma nad I hémangioblastoma (and 32 secondary masses (i. e. 16 metastatic tumors, 15 abcesses and I hydatid cyst). The onset of clinical features was progressive (gradual increase of intracranial pressure : 59 p. 100) rather than acute (41 p. 100 mostly as a visual (II) or a non visual (10) epileptic seizure). The time elapsed between the first symptom and the surgical procedure in any case appeared to be much shorter than in masses with other hemispheric localisation. This is thought to be due to the precocity and the intensity of the increased intracranial pressure, in relation to the blocage of posterior venous drainage. Increased intracranial pressure : only 7,7 p. 100 of the patient were free of IIP. Fundal changes are of little value in excluding this finding since no less than 3 months of evolution are necessary for their appearence. Visual disturbances consisted of acute obscurations (7.7 p. 100), controlateral deviations of head and eyes (3.3 p. 100) and visual field defects = 10 p. 100 of the patients were comatose and unable to be examined, 16.6 p. 100 had normal visual field. All the others had visual field defects wich could be evaluated by campimetric examination in only 26.6 p. 100. These included 14 hemiopias (7 without macular sparing) and 10 quadranopsia, always with incongruence (4 superior and 6 inferior). When the mass was strictly occipital, the same disparity was observed. Finally these visual field defects appeared to be variable and could well recover after surgery. Visual hallucinations were mostly of elementary type (21 p. 100) and always controlateral in cases of strictly occipital lesions. Elaborate hallucinations were rare (2 patients with extensive lesions). 8.8 p. 100 suffered from visual illusions wich always were related to large and right-sided masses. Disturbances of higher functions : Alexia was seen in 33 p. 100 of the left-sided masses (24 p. 100 "agraphic", 9 p. 100 "pure word blindness") Space agnosias of different type was found in 10 p. 100 of the patients, sometimes with purely occipital tumors.

The authors report their experience of 84 patients with oligodendroglioma seen over a 34 year period. The low incidence of these brain tumors is underlined. Oligodendroglioma is the most epileptogenic of brain tumors. The clinical picture may resemble "essential" epilepsy. Normal EEG should be considered suspect in confirmed epileptic children and adolescents since oligodendroglioma is the most common of all tumors which induce long-standing epilepsy. Emphasis is put on the importance of computerized tomography and radionuclide scanning for early detection of these tumors. Both procedures are very helpful for deciding on the best operative approach and for determining whether the lesion is malignant or not. The authors advise tumorectomy, which should be as complete as possible, followed by systematic radiotherapy, even if histopathological criteria indicate a benign tumor. With this therapeutic regimen mean survival rates are significantly higher than those published previously.

✓ The results of the surgical treatment of cerebral hemorrhage in 250 cases are reported. Preoperative diagnosis, the selection of patients, and the favorable moment to operate are discussed.

In order to study the changes of consciousness associated with lesions of the posterior fossa it is necessary to define consciousness so that we may be ready to recognise the different mechanisms which may affect it. Many authors have attempted definition. We believe that the following proposition may be satisfactory: consciousness is a state which allows us to react at every moment to exteroceptive and proprioceptive stimuli and to know their respective values; this implies both vigilance and the confrontation with more or less precise memories. As G. Jefferson wrote, there are “two extreme meanings, the psychological and the physiological”.