Search

Objective: This study was a randomized, multicenter Phase II trial comparing the effect of perioperative implantation of 5-fluorouracil-releasing microspheres followed by early radiotherapy (Arm A) and early radiotherapy alone (Arm B) in patients with gross total resection of high-grade glioma., Methods: Patients were randomized on clinical and radiological assumption of supratentorial high-grade glioma. All patients underwent surgery, and after resection and histological confirmation, patients randomized to Arm A received multiple injections of microsphere suspension (130 mg of 5-fluorouracil). Conventional fractionated radiotherapy (59.4 Gy) was initiated between the second and the seventh day after surgery for both arms., Results: A total of 95 patients were randomized. Seventy-seven patients were treated and analyzed in intention to treat for efficacy and safety. Overall survival was 15.2 months in Arm A and 13.5 months in Arm B. In the subpopulation of patients with complete resection, overall survival was 15.2 months in Arm A versus 12.3 months in Arm B. However, these differences were not significant. Safety was acceptable with prophylactic high doses of corticosteroids., Conclusion: It may be hypothesized that the implantation of 5-fluorouracil-loaded microspheres in the wall of the cavity resection did increase the overall survival, but the present study was not designed and sufficiently powered to demonstrate this.

In an effort to extend the potential relationship between the methylation status of MGMT promoter and response to CENU therapy, we examined the methylation status of MGMT promoter in 44 patients with glioblastomas. Tumor specimens were obtained during surgery before adjuvant treatment, frozen and stored at -80 degrees C until for DNA extraction process. DNA methylation patterns in the CpG island of the MGMT gene were determined in every tumor by methylation specific PCR (MSP). These results were then related to overall survival and response to alkylating agents using statistical analysis. Methylation of the MGMT promoter was detected in 68% of tumors, and 96.7% of methylated tumors exhibited also an unmethylated status. There was no relationship between the methylation status of the MGMT promoter and overall survival and response to alkylating agents. Our observations do not lead us to consider promoter methylation of MGMT gene as a prognostic factor of responsiveness to alkylating agents in glioblastomas.

In Parkinson's patients, swallowing difficulties may result in inhalation pneumonia, with a potentially serious prognosis. They may be revealed by withdrawal of L-dopa, especially after deep brain stimulation surgery. The following two cases illustrate the usefulness of apomorphine.

In view of its localization, brain abscess (BA) usually requires medical and surgical care. A broad spectrum of bacteria is involved. Recent reports stress the increasing frequency of anaerobes, but their impact has not been well evaluated. A retrospective review was conducted of all episodes of documented BA admitted in a tertiary-care hospital over a 10 y period. BA due to anaerobic bacteria (group A) were compared with other cases (group B) to determine the frequency and eventual characteristics of BA with isolated anaerobic bacteria. Between 1991 and 2000, BA were diagnosed in 42 patients (28M, 14F, mean age 54.6 y). No differences in clinical features and laboratory findings were found between patients with BA caused by anaerobic (n = 22) and only aerobic (n = 20) bacteria. Using appropriate microbiological techniques, 41 anaerobic bacteria strains were isolated in 22 of 42 patients (52.4%) with BA. Anaerobic bacteria were associated with aerobic strains in 5 patients (12%), whereas in 17 patients (40.5%) only anaerobic strains were isolated in cerebral puncture cultures. The most frequently isolated species were Fusobacterium nucleatum (n = 14), Prevotella sp. (n = 8), Actinomyces sp. (n = 6) and Bacteroides sp. (n = 4). Compared with group B, group A had more cases of a single abscess (p = 0.03) and ear, nose and throat (ENT) as a source of infection (p = 0.04), and seemed to have a better outcome (p = 0.07). These results emphasize the important role that anaerobic bacteria play in BA. The presence of such pathogens must be evoked when faced with a single abscess, an ENT infection, or both. Therapy should take into account this high frequency.

A 45-year-old man presented with headaches and extraocular muscle palsy due to a sellar mass extending into the right cavernous sinus. Hormonal determinations revealed a gonadotrophic insufficiency. A transsphenoidal surgical removal revealed a lymphocytic hypophysitis with fibrosis and necrosis. Rapid growth of the pseudotumor was noted despite a high dose steroid therapy (1 mg/kg/d) for a month. Further biological and histopathological investigations were performed. They showed a high cerebrospinal fluid (CSF) B-human chorionic gonadotropin (ss-HCG) level of 12 UI/L (normal<5 UI/L), normal plasma BHCG level, and undetectable CSF and plasma alpha-fetoprotein levels. The tumors cells showed a positive reactivity for placental alkaline phosphatase and for vimentin. These findings were consistent with an inflammatory lymphocytic process caused by an intrasellar germinoma. Chemotherapy was ill-tolerated and external radiotherapy was ineffective.

Large series of cauda equina tumors in adults are seldom reported. This French series retrospectively reviews 231 cases collected for the congress of the Societe Francaise de Neurochirurgie in 1996. The authors first analyze this series and then discuss the pertinent literature. Schwannoma was the most frequent benign tumor in this series, followed by ependymoma. Very few malignant tumors were recorded; these were usually malignant neurinomas nearly always in neurofibromatosis patients. Some other rare tumors were also recorded, including paragangliomas. This series confirms the importance of the pretherapeutic neurological status in functional prognosis. All schwannomas can be cured, while ependymomas and paragangliomas may recur after a very long delay. Surgery must be as complete as possible, since adjuvant therapies are proven to have little efficacy. This type of tumor requires very long follow-up. Prognosis is good for hemangioblastomas. Sphincter dysfunctions carries a poor prognosis and may appear after primary surgery, more often after treatment of recurrences.

Experimental factorial designs were built to investigate the effects of five parameters on production yields and moisture contents of spray-dried products. These factors concerned both the solution feed (drug concentration, colloidal silica concentration and polymer/drug ratio) and the spray dryer (inlet temperature and feed rate). Three formulations containing cellulose derivatives and acetaminophen were tested. The aim of the study was to optimize the operating conditions to maximize production yields while minimizing moisture contents. First screening experiments consisting of fractional factorial designs revealed the most significant factors to be inlet temperature, feed rate and their interaction for both formulations containing sodium carboxymethylcellulose and feed rate and colloidal silica concentration for the formulation containing microcrystalline cellulose. Then, the optimal operating conditions were estimated by response surface methodology. Central rotational composite designs showed quadratic models were adequate. New assays were carried out using these last conditions to evaluate both the repeatability and reproducibility of the spray-drying technique. Yields above 80% and moisture content of approximately 1% were reached. The characterization of microparticles revealed the poor flowability of the spray-dried products due to significant cohesiveness and very small size (less than 55 microm).

Radiculopathy resulting from ossification of the ligamentum flavum (OLF) is extremely rare and concerns only intercostal neuralgias. We describe a 37-year-old Caucasian woman with a lumbar radiculopathy revealing an OLF. Her symptoms were completely and definitively relieved by surgery.

Object: The authors present a retrospective analysis of 248 immunocompetent patients with primary intracerebral lymphoma treated at 19 French and Belgian medical centers between January 1980 and December 1995., Methods: This study involved 127 female and 121 male patients with a median age of 61 years (range 2-88 years). All tumors available for review were classic diffuse non-Hodgkin's lymphoma, for which the phenotype was determined in 220 patients: 212 (96.4%) were B-cell and eight (3.6%) were T-cell type tumors. According to the Revised European-American classification of lymphoid neoplasms, most lesions were diffuse large cell tumors (62%). A total of 196 tumors were reviewed in 127 patients for whom preoperative computerized tomography and magnetic resonance studies were available. There was a single lesion in 66% of the cases, with a supratentorial location in 87%. Tumor location in the basal ganglia, corpus callosum, or fornix, infiltration of the periventricular ependyma, or a mirror pattern, were strongly suggestive of a lesion of lymphomatous origin. The histological diagnosis was obtained after surgical resection in 116 patients, with the remainder undergoing biopsy sampling only. Of the 248 patients studied, 129 (52%) received chemotherapy plus radiation therapy, 60 (24%) received radiation therapy alone, 35 (14%) received chemotherapy alone, and 24 (10%) received no postsurgical treatment., Conclusions: Using univariate analysis, the authors determined prognostic factors that were significantly associated with a favorable impact on survival including age younger than 60 years, radiation therapy (without evidence of a dose-response relationship), radiation therapy combined with chemotherapy, and chemotherapy consisting of anthracycline. Partial surgical resection was an unfavorable prognostic factor. Multivariate analysis was used to confirm the independent prognostic value of radiation therapy, age, chemotherapy consisting of anthracyclines or methotrexate, and partial surgical resection. This European survey provides a reasonable basis for the treatment of primary intracerebral lymphoma with the following sequence: stereotactic biopsy sampling, chemotherapy with a methotrexate- and anthracycline-based regimen, followed by cranial irradiation.

Extraneural relapses of medulloblastoma are associated with a very poor outcome. We present two cases of young adults who developed bone marrow metastases after treatment of medulloblastoma. A very good response to a sequentially scheduled combination of carboplatin and etoposide was observed. Then, high-dose chemotherapy was delivered consisting of busulfan and thiotepa followed by infusion of autologous hematopoietic stem cells. Toxicity of the conditioning regimen was acceptable. The patients remained free of disease 20 and 27 months from the time of relapse, respectively. Further studies are needed to evaluate the impact of high-dose chemotherapy in terms of survival of such patients.

Large series of cauda equina tumors in adults are seldom reported. This study was based on the 231 cases collected in the French neurosurgery units for the congress of the Société Française de Neurochirurgie in October 1996. Schwannomas were the most frequent benign tumor in this series, followed by ependymomas. Very few malignant tumors were recorded, usually malignant neurinomas nearly always arising in patients with neurofibromatosis. Some other rare tumors were also observed including paragangliomas. This series confirms the contribution of pre-therapeutic neurological status to functional prognosis. All schwannomas can be cured while ependymomas and paragangliomas may recur after a very long delay. Surgery must be as complete as possible since adjuvant therapies have proven to have little efficacy. This type of tumor requires a very long follow-up. Prognosis is good for hemangioblastoma. When present, abnormal sphincter function is an argument for poor prognosis. It may appear after primary surgery or more often after treatment of recurrence.

Effective treatment in primary central nervous system lymphoma remains elusive. Usually high dose methotrexate and/or cytosine arabinoside may improve survival. We report the results of multimodality therapy in 248 patients (SFNC series). The addition of chemotherapy to radiation therapy and high dose methotrexate increased the duration of survival. We demonstrate that the use of anthracyclines in addition to radiation therapy had a significantly favorable impact on survival which is not reported in the literature. Survival was not longer in patients receiving intrathecal chemotherapy. The efficacy of chemotherapy alone has not been clearly defined.

Therapeutic results of 248 patients with primary central nervous system lymphoma reported in the SFNC series between 1980 and 1995 were analyzed. Clinical, biological and radiological prognostic factors were found to have a favorable impact on survival: a) age < 60 years; b) radiation therapy but without evidence of a dose-response relationship; c) radiation therapy in addition to chemotherapy; d) the use of systemic chemotherapy consisting of anthracyclines. In multivariate analysis, we identified 4 independent factors: a) radiotherapy (RR = 3), b) age (RR = 2.31), c) the use of chemotherapy consisting of anthracyclines (RR = 2.53), d) partial surgical resection but as an unfavourable prognostic factor (RR = 1.45).

In the SFNC series (248 patients), the histological diagnosis was obtained after surgical resection in 116 patients (46%). Mortality was 3.4%, 54% had stereotactic biopsies which is the most safe and efficient diagnostic procedure. Our results suggest that surgical resection should be reserved for tissue diagnosis.

In the SFNC series (248 patients), extension of surgical resection provided no increase in survival (p = 0.04). One hundred and twenty nine patients (52.2%) receive chemotherapy in addition to radiation therapy; 60 patients (24.3%) received radiation therapy alone, and 35 patients (14.2%) chemotherapy alone. One hundred seventeen patients (48.3%) were in remission at the conclusion of the treatment. The median survival was 12 months. Actuarial survival rates for the 248 patients at 1, 2 and 5 years after diagnosis were 48%, 37% and 27%, respectively. Treatment method provided increase in survival, and radiation therapy in addition to chemotherapy significantly enhanced the duration of survival.

Among primary nerve sheath tumors, schwannomas and neurinomas are the most common. While the schwannomas (neurilemomas) originate in schwann cells, neurofibromas arise from all the constitutive parts of the nerve. The behavior of each tumor is quite different and only neurofibromas may present malignant transformation, especially when arising in patients with Von Recklinghausen disease (NF1 with multiple neurofibromas).

One hundred eighty three patients (73.8%) in the SFNC series received radiation therapy alone, for 60 patients and with additional chemotherapy for 129 patients. From this review, a dose-response relationship with an improved survival time with doses greater than 50 Gy could not be demonstrated (p = 0.97). The multivariate risk analysis identified the radiation therapy as one of the factors which has the most favorable impact on survival. Radiation therapy remains the treatment method of choice. These results are compared with data from the literature.

A 24-year-old woman with Rendu-Osler-Weber disease presented an intracranial hematoma during pregnancy. The main localizations of the Rendu-Osler-Weber disease, an inborn disease, are discussed. Neurological complications are rare. Vascular malformations are more fragile during pregnancy. The obstetrical attitude depends on the organ involved and the severity of the complications.

Background: Spinal tuberculosis is now rare in developed countries; its appearance in sacral vertebrae is exceptional., Case Report: A 6 year-old boy was admitted because he had suffered from lumbar pain and rigidity for 24 hours, limiting anterior flexion. X-rays of the spine was normal, but a CT-scan showed lytic lesions of the sacrum. Bone scintigraphy showed no inflammatory lesions. Ewing sarcoma was diagnosed: surgical biopsy showed a cold abscess containing many bacilli that where resistant to decoloration with acid-alcohol. They were cultured for 12 days and identified as Mycobacterium tuberculosis. The boy had been given a BCG vaccination at the age of 2 years and was not immunodeficient. He was treated with isoniazid, rifampin and pyrazinamide for 2 months followed by isoniazid plus rifampin for 1 year. A cold abscess in the presacral area rupturing into the sacro-iliac articulation pointed above the left iliac wing during treatment and was treated by surgical debridement. Eighteen months later, the boy is well but still avoids bending., Conclusion: A sacrally located bone tuberculosis is difficult to diagnose. Careful therapy is necessary to avoid sequelae that may lead to spinal curvature.

The authors report two cases of brain metastasis of a testicular cancer in two young men. In the first case the histology was an embryonal carcinoma, in the second the association of a seminoma and a teratocarcinoma. The first patient was submitted to chemotherapy, neurosurgery and radiotherapy. The second one to chemotherapy alone. The survival time was respectively of 16 and 58 months. It looked interesting to review the different treatments and their indications in this extremely severe pathology to define the interest of surgery and radiotherapy, and the different prognostic factors. In the literature, among the various treatment, the role of chemotherapy is widely emphasized. The prognosis remains desperately bad when several brain metastasis exist, or if a brain metastasis develops during chemotherapy.

The authors report a case of a 5 year old child suffering from isolated sacral tuberculosis which presented as sudden and total loss of function of the left leg. The rarity of this bony site, and the recurrence at nine months of a presacral abscess after 9 months of anti-tuberculous treatment in an HIV negative child, vaccinated with BCG, justify the presentation of this observation.

This 67 year-old man experienced the sudden onset of generalized headache followed by visual troubles. Examination showed a poor visual acuity of the right eye with a palsy of the right third nerve and signs of panhypopituitarism confirmed by endocrinologic testing. CT- scan and MRI showed a large sellar tumor with a necrotic portion in the middle, so that the pre-operative diagnosis was: pituitary adenoma. The tumor was removed through a trans-sphenoïdal approach. The pathologic diagnosis was benign schwannoma. A review of the literature showed that this was the second reported case of an intra sellar schwannoma mimicking a pituitary adenoma clinically as well as radiologically. Surgical removal of these lesions by a trans-sphenoïdal approach seems to be more difficult than for an adenoma. The histopathogenic origin of such tumors could be either ectopic schwann cells of peri-vascular schwann cells in the sellar region.

The object of this study is a scientific research in human and compared anatomy of the cavernous sinus and Meckel's cave. The observations made in the foetus and human adult are compared to these made in non human primates and domestic mammals, the cavernous sinus and the Meckel's cave contribute to realize a entirety that we call "a morphological and functional anatomical system". The human cavernous sinus and Meckel's cave are described as an indissociable parasellar space representing a heavy traffic area for vascular and nervous structures. In the human and non human primates, the authors observe a parasellar space which agreed with the concept of "trigeminal-cavernous anatomical system". In the cat, the same observations are made and an osseous outline closing the roof of the parasellar space is observed; this is the evidence of a more ancient osseous or cartilaginous wall. The authors demonstrate in the last part of this study that the morphogenesis of this trigeminal-cavernous system is in relation with the phylogenic development of its morphological and functional environment, that we call the "externation". This study is of interest: to a best understanding of the tumors involving the cavernous sinus, to a semantic point of view: an attempt to a review of the terminology applied to the cavernous sinus and Meckel's cave.

Radiologic effects of the surgery for lumbar disc herniation: a study with MRI at the end of the third post-operative month. The results of patients operated for lumbar disc herniation are good in 83%, fair in 10% and poor in 7. The poor results are considered to be the consequence of post operative fibrosis. A prospective study in 67 patients has been performed to study the post operative appearance of the operated lumbar spine, three months after surgery. 45 days after surgery the recovery of patients was assessed by the score of Staufer and Coventry and patients were entered in the study independently of their clinical state. The MRI was performed at the end of the third month postoperatively and patient recovery assessed according to the score of Senegas and Lavignolle. All the clinical and radiologic data were statistically analysed... the chi-square test, a p. value less than 0.05 was considered statistically non significant. The correlation between the clinical recovery and the MRI was realized.

We report 6 cases of corticotroph macroadenomas which show heterogeneity of clinical and biological features (from Cushing's syndrome to silent adenoma) and heterogeneity of immunocytochemical staining. One patient reported on had skin hyperpigmentation and ACTH hypersecretion without clear abnormal adrenocortical function; we believe that this patient's plasma contained ACTH with very low bioactivity.

A retrospective study of thromboembolic complications after lumbar disc surgery has been performed. It included 16,656 patients from fifty neurosurgical units, operated on over the year 1989. The average number of operations was 333 +/- 19.5 in each unit, their average duration 55.2 +/- 20 minutes, and the hospital care 6.2 +/- 1.7 days. Surgery was performed using the genupectoral position in 64% of the cases, the supine position in 28%, and the lateral position in 8%. Two groups of patients have been individualized: a first group of patients with no preventive antithrombic treatment (46% of the units) including 10,351 patients, a second group (54% of the units) including 6,305 patients and receiving a systematic treatment with low molecular weight heparin (4,304 patients) or calciparin (1,001 patients) or antiplatelet agents or pentosane polysulfate (1,000 patients). 0.63% of the patients (105) had a thromboembolic accident: 0.65% in the first group (68 cases) and 0.58% in the second (37 cases). No statistically significant difference was noticed between the two groups concerning pulmonary embolism and/or lower-limb thrombophlebitis. Nevertheless, a prospective randomized study would be usefull to corroborate this first data.

From the minigranules of the theophylline-based that prepared by extrusion-spheronization, the authors have envisaged the study of one of the parameters of operation (spheronizer speed) on the physical properties and lyoavailability of the active ingredient. It emerges that there is a clear influence of that parameters on the particle size distribution, the hardness, the friability, the density and the lyoavailability.

Spheroids are prepared from microcrystalline cellulose in binary and compound combination with lactose and theophylline, in certain fixed conditions of extrusion and of spheronisation. The present work envisages the influence of combinated raw materials upon the physical-technique characteristic of the made spheroids. Besides a variation in the granulometric distribution a statical study through analysis of variance brings to the fore that the parameters of formulation contribute to modify the properties of hardness and of friability of the minigranules.

The stability of anaesthesia and the quality of recovery obtained with low doses of enflurane were studied. Two groups of 20 patients operated for lumbar slipped disc were compared. The mean age and weight distribution of the two groups were not statistically different. Induction was the same in the two groups (diazepam, fentanyl, pancuronium and nitrous oxide). In one group, enflurane (0.4%) was added with controlled ventilation. Thiopentone was added if some spontaneous movements were observed, if arterial pressure and heart rate increased, and if the digital plethysmograph curve decreased. The quality of recovery was assessed by number-connection tests 1 and 2 h after the end of anaesthesia. Thiopentone was required five times in the group without enflurane, whilst it was never used in the group with enflurane. This difference was statistically significant (p less than 0.01) and showed a more important stability of anaesthesia when enflurane (0.4%) was used. No statistically significant difference was found in the recovery scores between the two groups 1 and 2 h after the end of anaesthesia. It was proposed that low doses of enflurane were sufficient to increase the effects of the other anaesthetic drugs without any residual effect on recovery. Low doses of enflurane could be used during anaesthesia induced with fentanyl and diazepam, giving better stability during anaesthesia without any pernicious effects on recovery.

A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.

Intraspinal tumors with subarachnoid hemorrhage are exceptional. They are most often localized at the cauda equina. Ependymoma is the most common tumor. Low back pain followed by headache (Fincher syndrome) should suggest hemorrhage originating from a low lesion.

A 22 year old woman had a seizure, and the skull X-ray showed an intracranial arched calcification. CT scan permitted diagnosis of dermoid cyst. Rupture of the cyst was testified by low density areas disseminated on the cortical surface and intra-ventricular fat level. Surgical removal confirmed dermoid cyst with rupture and fat fluid inside. Authors underline infrequency of such intra-ventricular fat level. CT scan, with low density of lipidic origin promote considerably such diagnosis both of the real nature of the cyst and of its rupture.

Three cases of spinal cord tumor, revealed by hydrocephalus, are reported. Two patients showed symptoms of increased intracranial pressure and the third one presented himself with ataxic gait without intellectual impairment nor incontinence. In two cases ventriculo atrial shunt was initially inserted and the correct diagnosis was made only later on myelogram because lombosciatalgia or syndrome of the cauda equina. Clinical outcome was satisfying after surgical removal of the tumor. The nature of which was a neurinoma of the cauda equina; a lumbar intradural granuloma and an ependymoma of the cauda equina. The mechanism by which spinal cord tumors raised intracranial hypertension is discussed.

The case is reported of an 18 year old patient who developed a peripheral neuropathy after being given 1.5 g ornidazole daily for 6 days and 2 g daily for 16 days (total dose: 41 g). Bilateral radial paralysis was noted clinically, whilst electrical investigations showed diffuse motor and sensitive anomalies. Three months after the drug had been stopped, all symptoms and signs had disappeared. The pathogenesis of this complication is discussed. The part played by ornidazole is suggested but cannot be proved because of the multiple disorders presented by the patient.

A 31-year old primigravida was admitted at 31 week gestation for subarachnoid haemorrhage. Cerebral angiography revealed an aneurysm on the left middle cerebral artery. Eleven days later, the aneurysm was clipped off. General anaesthesia was induced with thiopentone, pancuronium and fentanyl, and maintained with fentanyl (40 micrograms.kg-1) and isoflurane in air/O2 with a non-rebreathing circuit. The patient was mechanically ventilated to maintain mild hypocapnia. Arterial hypotension was induced by increasing the inspired isoflurane concentration from 1 to 3 vol%. The response was immediate and a mean arterial pressure of 60 mmHg was maintained for 80 min with an inspired isoflurane concentration of 2.5 vol%. Foetal heart rate was monitored before, during and after general anaesthesia. Loss of beat to beat variation was observed after induction, and foetal heart rate slowly decreased from 150 to 115 b.min-1 at the end of the operation. Postoperative state was good, except for transitory aphasia. At 35 week gestation, the patient went into premature labour, with hypothermia of 39.5 degrees C; an emergency caesarean section was performed. The 2,340 g female infant had a 10 min Apgar score of 8. One month later, clinical examination of the mother and daughter was quite normal. The precautions and anaesthetic management of patients suffering from ruptured cerebral aneurysm during the end of pregnancy are reviewed. Hypotensive agents are discussed.

The authors report on the case of a young woman, seven months gone, with an history of sudden onset of successive lobar intracerebral hematomas. They revealed a Rendu-Osler-Weber disease. The mechanism is discussed.

The authors report the case of an isolated supratentorial hemangioblastoma occurring in a woman operated on for a cerebellar hemangioblastoma twenty years before. The data furnished by immunohistochemical technics don't seem to be deciding and don't work out the problem of hemangioblastoma histogenesis.

Third, fourth and sixth cranial nerve palsy is a less common complication of giant cell arteritis than ischemic optic neuritis. Nevertheless, it occurs in at least 10% of cases. A case of giant cell arteritis with third nerve palsy which resolved under corticosteroid therapy is reported. The incidence of ocular complications is assessed from a review of the cases previously seen in the department and of data from the medical literature. The authors believe that the index patient has ischemic neuritis rather than myositis. It is concluded that giant cell arteritis should be considered at an early reversible stage.

The appearance observed with CT during and following eclampsia seem to be related to edema, hemorrhagic lesions and ischemic lesions. The authors report on a reversible appearance of hypodense central grey nuclei and of the calcarine cortex fitting into this new context.

Brainstem auditory evoked responses were recorded in a neurosurgical intensive care unit in 38 patients who had all the clinical criteria for brain death. Of the brain-dead patients, 65.8% never showed a response. 3.42% showed a type I wave, which was unilateral in 26.3% and bilateral in the other 7.9%. Types II to VII waves were never seen. An increase in latency of type I waves (2.25 +/- 0.24 ms) was noted. The interest and the limits of this non invasive electrophysiologic technique for the diagnosis of brain death are discussed.

A mixed ENT and neurosurgical approach is employed widely at present for exeresis of malignant ethmoidal tumors. The stability of the reconstruction of the anterior stage by bone graft is satisfactory in the long term even after radiotherapy. The transfacial approach, with or without conservation of the maxillonasal bone flap, procures a remarkable opening allowing in most cases a monobloc excision.

This report based on a series of 8 cases deals with the appearance of cerebral venous angiomas with computed tomography (CT), arteriography and magnetic resonance imaging (MRI). The CT data are not conclusive, and venous involvement is demonstrated by arteriography, as well as the site of involvement. Magnetic resonance imaging seems to be useful owing to the morphological information and data on flow phenomena it provides.

The authors report a case of L4-L5 foraminal disc herniation revealed by symptoms of bi-radicular and medullary lesions. Anatomical study allows to understand such association of symptoms.