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Intraoperative imaging, in particular intraoperative MRI, is a developing area in neurosurgery and its role is currently being evaluated. Its role in epilepsy surgery has not been defined yet and its use has been limited. In our experience with a compact and mobile low-field intraoperative MRI system, a few epilepsy surgeries have been performed using this technique. As the integration of imaging and functional data plays an important role in the planning of epilepsy surgery, intraoperative verification of the surgical result may be highly valuable. Therefore, teams that have access to intraoperative MRI should be encouraged to use this technique prospectively to evaluate its current relevance in epilepsy surgery.

Intramedullary cavernomas are rare, but with routinely use of MRI detection has improved, raising the problem of choosing the adequate management approach: conservative or surgical. Cavernomas are vascular malformations, but, as hemangioblastomas they appear as vascular tumors of the spinal cord. They can be durably asymptomatic. The symptoms are a progressive clinical deterioration or acute spinal dysfunction (tetra or paraplegia) in case of hemorrhage. Cavernomas have a typical aspect with MRI in contrast with intramedullary gliomas. The lesion is often superficial, covered by the pia-mater, visible immediately after opening the dura, the approach is direct; but in few cases the cavernoma is deep seated in the spinal cord and not visible, the approach is through the midline. It is recommended to perform a complete "en bloc" resection. A yearly MRI control is necessary to search possible "de novo" cases.

Optimal treatment for low-grade glioma remains controversial. Moreover, though surgery is recommended for disease management, evidence is lacking concerning the appropriate extent of surgery and the use of adjunctive therapy. Available data is basically retrospective, coming from series with substantial limitations. We reviewed our institution's series in order to evaluate the efficiency of surgical management and the influence of the extent of surgical removal for patients with low-grade glioma.Data were collected from a series of 201 patients who underwent first-intention therapy for low-grade glioma, the standard practice in our institution between 1994 and 2005. After applying certain exclusion criteria, we retained for analysis 123 patients with grade II glioma (WHO classification). We compared progression-free survival curves for the three surgical treatment groups defined as biopsy, partial removal, or total removal.Statistical evaluation of the progression free survival shows a benefit in total surgery as a first intention treatment. No statistical significance was demonstrated between partial surgery and stereotactic biopsy.For patients with low-grade glioma we recommend total surgical removal as first intention management.

A brief history of the most current scales of aneurysmal subarachnoid hemorrhage and follow-up is presented. Advantages and inaccuracies of these scales are discussed. The World Federation of Neurological Surgeons (WFNS) classification is recommended as the most objective and reliable although some critics exist about its use in particular conditions. The grading of the follow-up is also analyzed. Here, the Glasgow Outcome Scale (GOS) is the most common employed and promoted in a first approach in spite of its briefness. Secondary functional and neuropsychological examination at 6 or 12 months is to be recommended to enable a more accurate evaluation. In conclusion, the WFNS scales for subarachnoid hemorrhage and follow-up is proposed as the best way to allow comparison between work of different centers.

Appropriate evaluation of resection remains one of the major difficulties of surgical treatment of pituitary adenoma. The transsphenoidal approach does not allow direct visual control. Endoscopy provides useful information but may no distinguish well residual adenoma from the pituitary gland. Intraoperative MRI offers new perspectives for assessing the quality of resection. We report our experience with low field intraoperative MRI in surgical treatment of pituitary adenoma.Intraoperative MRI (Polestar N10, 30 patients and Polestar N20, 17 patients) was performed in 45 consecutive patients undergoing surgery for pituitary adenoma. Thirty-seven patients had a macroadenoma. Patients were in the prone position with the head fixed with a three-pin MRI-compatible headholder.Coronal T1 MRI scans with enhancement were acquired pre and per operatively. We compared scans and surgical filling (complete removal). If there was a difference, a surgical control was undertaken.Intraoperative images were unavailable for two patients due to small size of the neck and the pituitary glands which were not in the middle in the field of view. For the others, the pituitary glands were in the field of view and the intraoperative scans could be used for comparison. For four patients, there was a discrepancy between surgeon filling and the intraoperative MRI. A control showed no residual adenoma but hemostatic tissue.Low field intraoperative MRI is an excellent technique for controlling the size of pituitary adenoma resection.

Management of patients with low-grade glioma is a major challenge for the neurosurgeon. When is neurosurgery indicated? Should chemotherapy or radiotherapy be used? Many questions without an answer. We reviewed our experience with 65 patients treated for low-grade glioma who had preoperative PET images (FDG or/and MET). We examined the prognostic value of PET and also determined the sensitivity and the specificity of PET images to predict outcome.Sixty-five patients with a FDG or MET PET images were analyzed. We used two visual scales and had complete follow-up data for 63 patients. The free interval was the principal criterion for statistical analysis. The sensitivity and the specificity of PET images was determined.Strong FDG uptake was correlated with a short free interval (p=0.001). Similar results were found with the MET analysis (p=0.0076). We had a PET with MET and FDG for 36 patients. The sensitivity was 66% and the specificity 94% for FDG PET. Sensitivity was 100% and specificity 53% for MET PET.PET imaging provides a prognostic factor independent from histology. MET PET is the best exam for the follow-up of patients with low-grade glioma and is helpful for separating aggressive from low-grade glioma.

Some WHO grade I intracranial meningiomas resected from the same sites and with the same quality of resection (Simpson's grading scale) recur, while others do not. The reasons for this variability in occurrence of recurrence have not yet been determined. We therefore investigated the prognostic recurrence value of seven biological markers on a series of completely resected WHO grade I meningiomas. For this purpose, we analysed a series of 33 WHO grade I meningiomas totally resected between 1980 and 1990 (a follow-up of 10 years), including 14 cases of recurrence. The fixed tumour material from each meningioma was submitted to histochemical analyses targeting galectin-3 and its binding sites, the S100A5, S100A6 and S100B proteins, and cathepsin-B and -D. The levels of expression were assessed semi-quantitatively (in terms of the staining intensity and the labelling index) and submitted to uni- and multivariate analyses. Of all the markers investigated, only S100A5 expression can be associated with any significant prognostic value in the matter of recurrence. More particularly, the meningiomas with high levels of S100A5 staining intensity either did not recur, or recurred later than those with a low immunopositive S100A5 intensity (P = 0.004). Cox regression analyses demonstrated that this latter marker was associated with significant prognostic values independent of the patients' ages. Furthermore, the combination of the patients' ages and S100A5 staining intensity permitted the identification of a group with a particularly high risk of recurrence, that is, the patients younger than 55 and with meningiomas exhibiting low S100A5 intensities (P = 0.001). In conclusion, the S100A5 protein could play a role in the recurrence of totally resected WHO grade I meningiomas.

Parkinson's disease (PD) is a neurodegenerative disease characterised by a progressive loss of the dopaminergic neurones in the substantia nigra pars compacta. Accumulating evidence indicates that apoptosis contributes to neuronal cell death in PD patients' brain. Excitotoxicity, oxidative stress, and mitochondrial respiratory failure are thought to be the key inducers of the apoptotic cascade. Even though the initial cause and the mechanism of degeneration are poorly understood, neuroprotection can be achieved by interfering with neuronal cell death either directly or by preventing neuronal dysfunction. Potential agents for neuroprotection are neurotrophic factors, inhibitors of apoptosis or anti-oxidative agents. However, the existence of the blood-brain barrier precludes systemic delivery of these factors. In situ gene delivery provides strategies for local and sustained administration of protective factors at physiologically relevant doses. Viral vectors mediating stable gene expression in the central nervous system exist and are still under development. Efficacy of these vectors has repeatedly been demonstrated in the animal models both ex vivo and in vivo. Ex vivo gene delivery could furthermore be combined with cell replacement therapies by transplanting genetically modified cells compensating for the lost neuronal cell population in order to provide neuroprotection to both the grafted cells and degenerating host neurones. However, several aspects of gene transfer, such as uncontrolled diffusion, axonal transport, unpredictable site of integration and immunological responses, still raise safety concerns and justify further development of viral and non-viral vectors as well as genetic elements with tightly controlled gene expression. Various relevant animal models for Parkinson's disease are available for the evaluation of gene therapy strategies. These include induction of cell death in specific neurone population through administration of toxins either directly in the brain or systemically, as well as transgenic mice expressing human disease-associated mutations.

Different approaches to the pineal region are described in the literature with high mortality and morbidity. We report our experience with two different approaches (occipitoparietal or infratentorial supracerebellar approaches) for pineal region.Between 1986 and 1997, 25 operations were performed in 22 patients. Preoperative work-up included a CT-scan with conventional angiography (for older patients), magnetic resonance imaging with angiographic study (angio-MRI) for the others. Two different approaches, the occipitoparietal (n=14) or the infratentorial supracerebellar (n=8) ones, were used. Three patients had a stereotactic biopsy, followed by a total resection for one of them.The mortality and morbidity induced by the approaches were low compared to the series of the literature. Only 2 patients were worsened by the surgery: Patient 4 developed hemianopsia after an occipitoparietal approach and patient 21 temporary Parinaud syndrome after resection of a teratoma by supracerebellar infratentorial approach. One patient improved his neurological status but died on the 10th postoperative day from pulmonary embolism.Total or partial resection of well-defined pineal region lesions by direct neurosurgical approaches can be achieved in most cases with low morbidity. The choice among the two surgical occipitoparietal or infratentorial supracerebellar approaches depends on the size and the location of the lesion in the pineal area, its relation to the ventricular system, the median line and the splenium. Angiographic sequences in magnetic resonance with study of the deep veins are helpful in this respect.

The prognostic value of the metabolic status of cerebral gliomas determined by positron emission tomography with [18F]-fluoro-deoxy-D-glucose (FDG-PET) has been established in populations with a mixture of grades 2, 3 and 4 gliomas, but remains uncertain when only malignant gliomas are considered (grade 3 and 4).FDG-PET performed in 30 patients with anaplastic astrocytoma (grade III) and 61 patients with glioblastoma (grade 4) were classified according to a metabolic grading. The uptake of FDG was lower in the tumor compared to white matter (WM) in grade 1 (4 glioblastoma, 4 anaplastic astrocytoma), it was intermediate between WM and cortex in grade 2 (20 glioblastoma, 22 anaplastic astrocytoma), and it was superior to cortex in grade 3 (38 glioblastoma, 4 anaplastic astrocytoma).Kaplan-Meier survival curves were similar in patient with grades 1 and 2, but were significantly worse (p = 0.007) in grade 3. In multivariate analysis considering age, pathological grade (anaplastic astrocytoma versus glioblastoma), and metabolic grades, the metabolic grade did not appear to be an independent prognostic factor. When anaplastic astrocytomas and glioblastomas were considered separately, metabolic grade is of predictive value only in the group of glioblastomas.In malignant gliomas, metabolic grading determined by FDG-PET was not superior to the pathological grading for survival prediction. Still, it remains of predictive value when applied to malignant gliomas histologically classified as glioblastoma.

Postoperative cerebellar hemorrhage after a supratentorial craniotomy represents a rare event. We report a case of a patient with a meningioma of the jugum who developed suddenly after surgery a neurological deterioration due to a cerebellar hemorrhage detected on the CT scan. An occipital craniectomy and an external ventricular drainage were performed in emergency. A complete neurological recovery was observed after surgery. Nineteen similar other cases are found in the literature. Pre- and postoperative high blood pressure, lowered intracranial pressure and mispositioning of the head during surgery could be at the origin of the hemorrhage. Size of the hemorrhage, time between diagnosis and treatment represent two prognostic factors. All patients, who present a neurological deterioration in postoperative course, must have CT scan including posterior fossa.

The computer-assisted microscopic analysis of Feulgen-stained nuclei enabled us to identify two subgroups of astrocytomas (WHO grade II) and two subgroups of anaplastic astrocytomas (WHO grade III) with significantly distinct clinical outcomes (Decaestecker et al. Brain Pathol 1998; 8: 29-38). The astrocytomas labelled in the present study as typical (TYP-ASTs) behaved clinically like real astrocytomas while atypical astrocytomas (ATYP-ASTs) behaved similarly to anaplastic astrocytomas. The anaplastic astrocytomas that we labelled as typical (TYP-ANAs) behaved clinically like anaplastic astrocytomas while atypical ones (ATYP-ANAs) behaved like glioblastomas. In the present study, we investigate whether some biological characteristics could be evidenced across these four groups of TYP- and ATYP-ASTs and TYP- and ATYP-ANAs. The data show that the levels of expression (immunohistochemically assayed and quantitatively determined by means of computer-assisted microscopy) of vimentin, the glial fibrillary acidic protein and the platelet-derived growth factor-alpha did not differ significantly across these four groups of astrocytic tumours. The level of cell proliferation (determined by means of both the anti-proliferating cell nuclear antigen and the anti-MIB-1 antibodies; P0.001 to P0.0001) differed very significantly between the astrocytomas and anaplastic astrocytomas, but not between the typical and atypical variants identified in each group. In sharp contrast, the levels of expression of the S100A3 and S100A5 proteins differed markedly in the solid tumour tissue in relation to the astrocytic tumour types and grades. In addition, while the levels of expression of S100A6 did not change in the astrocytic tumour tissue in relation to histopathological grade, the levels of expression of this S100 protein (but not those of S100A3 and S100A5) differed markedly in the blood vessel walls according to whether these vessels originated from low- or high-grade astrocytic tumours.

Primitive malignant rhabdoid tumor of the central nervous system are extremely rare. Less than 70 cases are reported in the literature. This tumor grows during the first months of life and prognosis is very poor. We report a case of primitive malignant rhabdoid tumor in a 17-year-old young adult. To our knowledge it is the first such case reported in the literature. We review the clinical feature, the neuradiological and therapeutical aspects.

Using a reliable non-invasive technique for ICP monitoring, we realized 93 continuous anterior fontanelle pressure (AFP) recordings in 86 healthy infants aged from 29 to 85 post-conceptional (PC) weeks. For each recording, we calculated the mean and extremes values of AFP, cerebral pulse amplitude, and pressure waves rate and amplitude. We observed the occurrence of plateau-waves of relatively low amplitude and duration in most infants aged of more than 49 PC weeks. We postulate that PW represents a physiological phenomenon which is amplified under pathological conditions. All AFP parameters are correlated to PC age and vary during early infancy according to an ascending sigmoidal relation (this variation may be explained by a connection between several cranio-cerebral characteristics of the young infant). We conclude that the interpretation of AFP recordings must take into account [1] PC age rather than postnatal age, [2] variation of AFP parameters with age, and [3] occurrence of physiological plateau-waves.

Ectopic pituitary adenomas are rare. Only 29 cases are reported in the literature. The clivus was involved in some cases but sella turcica was occasionally involved.Headache was the first symptom of a 47-year-old woman. Radiological examination diagnosed a clivus tumour. No connection with the pituitary gland was observed. Pre-operative diagnosis was metastasis of an unknown cancer.By a transphenoidal approach, we removed a haemorrhagic tumour. No connection between the normal pituitary gland and the tumour was observed. Neuropathological analysis showed a prolactinoma.We report a rare case of an ectopic prolactinoma in the clivus unrelated to the pituitary gland. Only one other case has been reported in the literature.

A prospective, multicenter, randomized, double-blind, controlled study of ADCON-L Anti-Adhesion Barrier Gel (a medical device by Gliatech Inc, Cleveland, OH) was conducted in 298 patients undergoing first-time lumbar discectomy to evaluate the safety and effectiveness of ADCON-L in preventing postoperative peridural fibrosis and in improving patient clinical outcome. After lumbar discectomy, patients were randomized to receive either ADCON-L gel or nothing (control group) at the conclusion of the surgical procedure. Six months after surgery, peridural scar was evaluated by magnetic resonance imaging, and postoperative pain and straight-leg-raise angle were assessed. No statistically significant differences between the ADCON-L and control groups were observed in terms of adverse events or wound healing characteristics. ADCON-L gel was shown to be safe and to significantly inhibit peridural scar compared with the control group (P = 0.002). That peridural scarring was reduced with ADCON-L gel was further supported by direct visualization of scar tissue at reoperation in both groups. ADCON-L-treated patients had better clinical outcomes than did control patients. The incidence of activity-related pain was significantly reduced (P = 0.013), straight-leg-raise examination scores were significantly improved (P = 0.024 on the operative side and P = 0.015 on the nonoperative side), and ADCON-L reduced low back pain when it was most severe (P = 0.047) and at the end of the day (P = 0.044).

We report a 25-year old immunocompetent woman with a high grade primary non-Hodgkin's lymphoma of the central nervous system (PNHL-CNS) in whom the administration of dexamethasone alone during three months produced a complete clinical and radiological response lasting over four years. If complete remission of PNHL-CNS induced by glucocorticoids are well known, the opportunity to observe glucocorticoid-induced remission for a long period of time without radio- and chemotherapy is rare. Only nine other cases of PNHL-CNS with complete remission induced by glucocorticoids lasting from 6 to 60 months, were found in the literature and are summarized here. Duration of glucocorticoids therapeutic effect in PNHL-CNS is probably underestimated. Glucocorticoids cannot be recommended as sole initial treatment for PNHL-CNS. However, we suggest standard therapies to be delayed in those patients responding completely to glucocorticoids where radio- and chemotherapy should be contraindicated (kidney, liver, bone marrow failure, pregnancy).

A few cases of brain metastasis from gynecological cancer have been reported. This tumor usually dissaminates via the blood stream, normally through surface implantation or lymphatic spread.We report four cases of brain metastases from gynecological cancer (2 from ovarian cancer and 2 from endometrial cancer).Several months later, three patients developed brain metastases without any other location elsewhere. For the other patient, brain metastasis was the first sign of her malignant disease.In brain metastases from gynecological cancer, treatment should consist in surgical resection, radiation therapy and chemotherapy.

The diagnostic and prognostic value of the DNA ploidy level (nuclear DNA content) was studied in a series of 847 tumours of the nervous system. This series included 93 nerve sheath tumours, 224 meningiomas, 389 neuro-epithelial tissue tumours, 46 primitive neuroectodermal tumours (retinoblastomas, medulloblastomas, neuroblastomas, etc.) and 95 brain metastases. The DNA ploidy level determination was carried out by means of the computer-assisted microscope analysis (digital cell image analysis) of Feulgen-stained nuclei. The results show that the DNA ploidy level does not contribute significant diagnostic information when tumours are analyzed individually. Indeed, some tumours which are definitely benign like certain schwannomas and meningiomas can exhibit very high levels of aneuploidy, while some highly malignant tumours like certain glioblastomas and neuroblastomas can be diploid. In contrast to its weak diagnostic value, the DNA ploidy level appears to be a powerful prognostic factor with respect to the supratentorial astrocytic tumours of the adult. Indeed, patients with hypertriploid astrocytic tumours exhibit a survival period which is significantly longer when compared to that of patients with non-hypertriploid astrocytic tumours. These hypertriploid astrocytic tumours could be involved in a process of biological degeneration when reference is made to their proliferation activity which is significantly weaker than that of non-hypertriploid tumours.

For this study, we reviewed a series of 564 consecutive SAH among which 72 cases (12.7%) were older than 65 years. Etiology of SAH was: arterial aneurysms (65), arteriovenous malformations (1), unknown origin (6). Among the 65 aneurysms, 28 operated cases were between 65-69 years old. One year after surgery, the results are: GOS 1 and 2: 22 cases (57%); GOS 3: 4 cases; GOS 5: 13 cases. In the non operated group, 19 cases died (73%) and among the alive patients, one was GOS 2 (4%), 5 GOS 3 and 1 GOS 4. In the operated group, mortality is similar to other published series. In the non operated group, mortality is unsurprisingly higher (73%) than in the operated group, but also than in the literature. An explanation could be found with analyses of the income of our patient whose many are not referred cases from other hospital. Our analysis confirmed that the severity of SAH after 65 years is increasing. The raise of anterior communicating aneurysms location is demonstrated. Operative indication and timing are dependent of neurological grading, general condition and secondarily of the location and anatomy of the aneurysm.

Traumatic aneurysms constitute a very small percentage of all intracranial aneurysms. A high mortality results of a catastrophic rupture and they run an unpredictable course. Traumatic aneurysms usually involve the large basal arteries or the middle meningeal arteries. We report a case of an association of a traumatic aneurysm with a congenital aneurysm located on the same middle cerebral artery. At our knowledge, it is the first described case of the literature.

A rare case of sphenoid sinus osteoma associated with a mucocele is presented. Progressive unilateral amaurosis is the only clinical sign. Subtotal resection of the tumor had been realised through a frontal extra-dural approach. The operative indications are discussed.

Anterior sacral meningocele is a not rare entity. Treatment is usually surgical and consists in a transacral posterior approach with patching of the communication between the malformation and the dural sac. But surgery can be difficult and require multiple procedures. We report the first case of a giant anterior sacral meeningocele rapidly cured by a simple endoscopic procedure. We believe that more attention should be used in the diagnosis of such cases as they can be so easily cured. We have reviewed the literature about anterior sacral meningocele and particularly its treatment and its association either with Marfan syndrome or a familial occurrence.

PURPOSE: To evaluate the use of postembolization gadolinium-enhanced MR imaging as a means to judge the efficacy of tumor embolization. METHODS: Fifteen patients with meningiomas were prospectively studied. The following data were evaluated for each tumor: the percentage of vascular supply to the tumor arising from the internal and external carotid arteries; the percentage of the tumor embolized as judged by angiography, by MR imaging, and by CT scanning; the estimated blood loss according to the surgeon; and histologic evidence of necrosis as seen by the neuropathologist. RESULTS: The data reveal an excellent correlation between the amount of tumor embolized as estimated by MR and both the estimated blood loss at time of surgery and the presence of histological necrosis in the specimen. CONCLUSIONS: Postembolization gadolinium-enhanced MR is an excellent means to evaluate the efficacy of an embolization and offers certain advantages over CT and angiography. One important advantage of this technique lies in the fact that it can be performed immediately postembolization.

An unusual anterior sacral meningocele associated with Marfan's syndrome, with demonstrated dural anomalies related to Marfan's syndrome is reported. Endoscopy enabled complete exploration of the meningocele, its morphological description, and ultimate cure. The meningocele resembled an hourglass made up of intrasacral and anterior sacral components. The communication of this bilobed malformation with the dural sac was so small that only the intrathecal injection of a colored solution allowed its localization. The closure of this communication was accomplished under endoscopic view by a single stitch. The postoperative course of the patient was characterized by immediate disappearance of the preoperative clinical signs. Computed tomographic scans demonstrated progressive complete collapse of the anterior sacral meningocele and partial resolution of the intrasacral component. Dural anomalies of Marfan's syndrome are described, and their relationship to the formation of the meningocele is discussed.

Ethical issues related to neural grafting are numerous. Experimental research on animals give much hope to get in next future a treatment in favour of numerous neurological disorders which are incurable at present. We must follow ethical recommendations of the NIH human fetal tissue transplantation research panel. According to the rapidity of knowledge growing in this field, so as in others, it would not be adequate to favour any law project on this subject, which does not mean that we could have something to hide. On the contrary, we would like to favour the diffusion of the works made by all ethical committees in our country. This could be one of the aims of the future National Bioethical Committee.

Fifty-nine subarachnoid hemorrhage with normal panangiography were reviewed (1982-1989). The mean age is 50 + 10. The grades at admission are compared following the Hunt and Hess and the World Federation Classification. Fifty cases (Hunt and Hess) or 45 (W.F.N.S.) are grade I or II. Compared with 278 cases of subarachnoid hemorrhage of aneurysmal etiology, 76% were in good grades versus 55% only for the aneurysms. Hypertension was present in 21 cases (35%) and represented a factor of gravity. Hydrocephaly is a rare complication in these cases and only 2 cases were shunted. The repetition of angiographic exploration seems to be unnecessary: all the examens remained negatives. The aspect on C.T. Scan was the same that the subarachnoid hemorrhage of aneurysmal origin. Angiography of 4 pedicles were performed in all cases and in the late 15 cases, external carotid explorations were added for exclusion of dural malformations. Seven suspected cases had had a secondary exploration between 12 days. The other cases were reexamined at 3 months. Three cases deceased from a second hemorrhage without aneurysm at autopsy. These cases confirm that subarachnoid hemorrhage of unknown etiology is of good prognosis. Low grades, rare complications, few rebleeding and good outcome scale are common. Etiology remains hypothetic.

Paragangliomas of the cauda equina are not so rare as said in the literature. Two additional cases are presented with a global analysis of the 59 cases from the literature. The diagnosis of this pathology greatly benefit of the use of immunostainings as the cells are often neuron-specific enolase, neurofilament protein and somatostatin positive so that electron microscopy is thus no longer mandatory for establishing the diagnosis. In addition, we report the first magnetic resonance images of this tumor at this location.

In cases of solitary brain metastasis of lung cancers other than small cell lung carcinoma, which has an even poorer prognosis, long-term patient survival over 1.2 years is rare. One case with a 12 year survival is presented. The authors review the other 18 cases with a minimum 5 year survival described in the literature. It is concluded that surgical aggressivity is justified in these cases.

Acute subdural hematoma of the posterior fosa (ASDH-PF) is a clinical rarity with a poor prognosis in teenagers or adults (mortality rate: 71%). We report the third case operated upon with success. The relevant literature is analysed and the characteristics of ASDH-PF are discussed, particularly in connection with the patient's age.

Purpose of study: Complete spinal cord injury is a devastating and, until now, almost untreatable condition. Experiments showing central nervous system regeneration and partial functional recovery in rats [1] served as proof of principle. Safety and efficacy have been demonstrated in extensive preclinical experiments that continue to produce promising results. Methods used : A phase 1 clinical trial is underway, involving eight patients with acute complete spinal cord injury (ASIA A). The treatment consists of activating autologous macrophages derived from the patient's peripheral blood and administering them into the parenchyma of the spinal cord within 14 days of injury. The follow-up consists of neurological, electrophysiological, rehabilitation and quality-of-life assessments. The patient outcomes are compared with historical controls. of findings: Eight patients have been followed for up to 30 months, depending on the date of treatment. In none of them short- or long-term side effects that could be linked to the experimental treatment were detected. Of these eight patients, the three patients who have been followed for more than 6 months exhibit partial recovery of sensory and motor function and have upgraded their ASIA classification from ASIA A to ASIA C. These clinical findings are also supported by elctrophysiological examinations. Relationship between findings and existing knowledge: This phase 1 also proves that the results in rats (as described by Rapalino et al. [1]) can be mimicked in human. Overall significance of findings: Based on the interim results of this small sample, it is proposed that autologous activated macrophage therapy can be an effective treatment for complete spinal cord injury. Disclosures: Device or drug: activated macrophage. Status: investigational. Conflict of interest: Nachshon Knoller, grant research support for study initiation: and consultant.