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The surgical management of deep brain tumors is often challenging due to the limitations of stereotactic needle biopsies and the morbidity associated with transcortical approaches. We present a novel microscopic navigational technique utilizing the Viewsite Brain Access System (VBAS) (Vycor Medical, Boca Raton, FL, USA) for resection of a deep parietal periventricular high-grade glioma as well as another glioma and a cavernoma with no related morbidity. The approach utilized a navigational tracker mounted on a microscope, which was set to the desired trajectory and depth. It allowed gentle continuous insertion of the VBAS directly to a deep lesion under continuous microscopic visualization, increasing safety by obviating the need to look up from the microscope and thus avoiding loss of trajectory. This technique has broad value for the resection of a variety of deep brain lesions.

Atypical lipomatous tumors occur predominantly in middle-aged patients and often present as painless, slow-growing masses in the extremities. The clinical outcomes of surgically treated superficial or deep atypical lipomas of the extremities were reviewed. Thirty-one patients were included in this study. There were 16 men and 15 women, with an average age of 57 years (range, 32-87 years). The mean followup was 7 years (range, 1-28.8 years). Twenty-five tumors occurred in the lower extremity and six in the upper extremity. Sixteen patients (52%) had a recurrence at an average of 4.7 years after resection. Twelve (39%) patients required additional surgical procedures to treat their tumor. Occurrence of a deep lesion and positive margins at the time of the initial surgery correlated closely with the rate of recurrence and need for additional surgical treatment. Dedifferentiation to high-grade liposarcoma developed in four (13%) patients. Atypical lipomas have a high propensity for local recurrence and a potential for malignant dedifferentiation. Patients with atypical lipomas require careful evaluation, complete surgical excision when possible, and close clinical followup extending beyond 5 years.

Background: Neurofibromatosis may present with different skin lesions. Disfiguring lesions on the face might be challenging for the surgeon or clinician to correct and may have adverse effects on patients' social lives, especially in young women. Objective: To present the dermabrasion technique combined with serial excisions of a deeper accompanying lesion to treat superficial facial lesions in a young neurofibromatosis patient. Methods: Dermabrasion was applied to superficial lesions on the face, and staged excision was applied to the deeper lesion located on the forehead. Results: We obtained high patient satisfaction with the result. The deep lesion was excised totally, and superficial lesions were decreased with dermabrasion. Conclusion: Dermabrasion may become a good alternative in cases of neurofibromatosis with superficial facial lesions.

We introduced the procedure and the technique of percutaneous microwave coagulation therapy (PMCT) for small liver cancer. PMCT with a microwave electrode for deep lesion was done by an ultrasonic guide under local anesthesia. PMCT may be utilized simply and safely for the treatment of small liver cancer, and also be a useful treatment in combination with conventional palliative managements for recurrent tumors after hepatectomy.

To determine the clinical usefulness of gadolinium-DPTA-enhanced MRI in identifying recent small, deep infarcts we prospectively studied 91 patients with first-ever stroke and presenting with a lacunar syndrome. In 78 patients (85.7%), plain MRI revealed possibly appropriate infarcts, classified as deep (n = 69), internal borderzone (n = 1), and cortical (n = 8 patients). Enhancement was seen in 38 (80.9%) of 47 patients with only one possibly relevant deep lesion on plain MRI, and in 14 (63.6%) out of 22 patients with multiple lesions. MRI with gadolinium-DPTA facilitates identification of the relevant lesion in patients with presumed lacunar infarcts.

Two hundred and twenty three right-handed patients consecutively admitted to the wards in a 21-month period for a left-sided cerebrovascular disease were examined 15 to 30 days after the stroke for the presence of aphasia. Twenty-seven of them could not be assessed. Of the remaining 196, 108 (55.1%) were aphasic. The incidence of global aphasia (43%) in the latter group was higher than in previous studies. Based on CT-scan data it was associated in 32% of patients with a deep lesion and only in 53% with an antero-posterior cortical-subcortical lesion, contrary to what is traditionally assumed. There was no sex difference in the incidence and distribution of aphasia.

The contralateral corneal reflex may be absent in patients with a deep lesion of the parietal lobe. Frontal and temporal lobe lesions apparently do not interfere with this reflex.

Hemorragie de la tete du noyau caude gauche et de la partie contigue du bras de la capsule interne

A neuropsychological analysis of a deep echinococcus cyst of the left temporal lobe where the hippocampus system suffers and the cortical structures of the Wernicke zone is preserved gives important data on the comparative role of both structures in memory processes. A syndrome of specific disturbance of acoustic-verbal memory and no defects in phonematic analysis is described and the neurodynamic disturbances underlying the defect are analysed. A comparative analysis of differential symptoms of memory deficit in cases of a deep lesion of the left temporal lobe is presented.