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Resume Une dizaine d'observations d'anevrysmes arteriels cerebraux a Aspergillus fumigatus figurent dans la litterature. Nous rapportons ici le cas d'un patient immunodeprime presentant un anevrysme aspergillaire de l'artere sylvienne au cours d'une aspergillose pulmonaire.

Eight large series of patients presenting with untreated cerebral arterio-venous malformations (A.V.M.) were reviewed. Data were gathered on 1134 patients who were followed for 20 years or more. The risk of rupture and the rate of other complications were estimated, in relation with other factors like age of patient, size of A.V.M., or hemodynamic stresses. The prevalence of A.V.M. at autopsy is 14 per 10,000 population. Fifty percent of A.V.M.s remain asymptomatic during the whole patient's life. The risk of hemorrhage from rupture of an A.V.M. is 2% per year and per patient. Hemorrhage is more frequent from small-sized A.V.M.s, mostly under certain hemodynamic factors. The risk of hemorrhage is also higher in children between 5 and 10 years of age, and in women to the end of pregnancy. The incidence of seizures and neurological impairment is approximately 1% per year and per patient, and these symptoms mostly occur in elder patients with large A.V.M.s. If the A.V.M. has not been revealed by hemorrhage, the risk of rupture is 1% per year and per patient. The incidence of complications from fortuitously diagnosed A.V.M.s seems very low, and even nil in some series. The risks of therapeutic procedures could not be determined, but in some A.V.M.s, the association of different therapeutic means seems mor advisable than isolated therapy. The analysis of natural history of A.V.M.s is desirable to provide a better information to the patient, and to define the limits of therapeutic indications.

Pregnancy is an aggravating factor for brain tumours on which it acts by three mechanism: acceleration of tumour growth, increase of peritumoral oedema and the immunotolerance to foreign tissue antigens that is proper to pregnancy. Histologically, the brain tumour most frequently encountered is glioma, usually revealed during the third trimester. Brain tumours is pregnant women have no special clinical features, and their diagnosis rests on computerized tomography or nuclear magnetic resonance completed, if required, by stereotactic biopsy. Following a review of the literature, the authors present an updated description of the neurological and obstetrical actions to be taken, illustrated by a report of eight personal cases. The indications for surgery depend on the site and histological nature of the tumour. As regards obstetrical measures, induced therapeutic abortion and caesarean section, no longer routinely performed, are now being replaced by vaginal delivery with systematic instrumental extraction. In both mother and foetus the prognosis has improved over the last ten year, but it remains very sombre.

During pregnancy 50% of all cases with a ventriculo-peritoneal shunt malfunction. This is because of anatomo-physiological changes associated with the pregnant state, and shows itself as a rise in intracranial tension. There were no acute neurological complications at term; with the malfunction of the shunt distally, vaginal delivery is preferable. It is not necessary routinely to carry out instrumental delivery.

Haemorrhagic cerebral accidents are the commonest neurosurgical diagnoses made in pregnancy. The state of pregnancy makes it more likely that an arterial or an arteriovenous aneurysm will rupture and this is the principal cause of most haemorrhages. They occur more often in primiparae in the third trimester of pregnancy. The clinical picture is classical. The conformation of the diagnosis is made by scanning and angiography. The main differential diagnosis is eclampsia. Neurosurgical treatment should be carried out immediately whenever possible in order to avoid the two great risks that follow, namely recurrence of haemorrhage and secondly ischaemia. As far as the obstetric side is concerned, Caesarean section would only be indicated if: the clinical state of the mother is severe with coma and brain stem damage when the child is viable, if there is symptomatic vascular malformation diagnosed at term, if there is haemorrhagic arteriovenous malformation which is highly liable to occur and cannot be operated on without risks for the child if viable, if, finally, the interval between the surgical treatment of the condition and labour is less than 8 days. In all other cases a vaginal delivery is preferable under epidural anaesthetic which should be given if medical induction is carried out, and where instrumental delivery is being carried out systematically, unless radical treatment is being performed. The prognosis which is, in spite of all steps that may be taken, poor, depends on the initial neurosurgical stage and the nature of the causes of lesion and the possibilities of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Perfect immobilization of the patient is mandatory when performing cerebral angiography. It allows good analysis and diagnosis of arterial or arterio-venous malformations. Neuroleptanalgesia or general anesthesia are currently used. Most common complications are due, either to induced arterial hypertension or to arterial catheterism (vasospasm or embolism). Early diagnosis and adequate treatment are necessary.

Stereotactic biopsies, according to the Talairach's system, define the histopathological data (nature, grading, spatial delimitation, evolutive potential) of brain stem lesions, precisely localized by computerized tomography scanner and magnetic resonance imaging. They are the more valued complement of the modern neuro-imaging and they prove the extreme polymorphism of theses lesions. According to this histological analysis and the volume of the lesions, it's possible to choose the best therapeutic procedure.

The abrupt flow of blood in the meninges or in the brain after fissure or rupture of an arterial aneurysm still remains a medico-surgical emergency which includes the mobilisation of important technical and financial means which justifies itself by the reduction of the occurrence of a more severe accident and to give the patient its best chances. The cure of a cerebral aneurysm and its intracranial consequences must not be dissociated from its clinical context. Surgical indication must take into account the cause of the vascular lesion, the background on which it has evoked, its natural outcome which is characterised by rebleeding and vasospasm. Surgical cure of intracranial aneurysm is one of the great achievement of modern surgery. A better understanding of the malformation, the improvement of neuro-anesthesia and intensive care, and the use of pre-operatoire adjuvants have considerably improved the surgical results over the years. At the moment, alternative treatment start to emerge such as selective vascular catheterism with ejectable balloon which become more feasible and seductive.

The monoclonal antibody Ki 67 is able to detect a nuclear antigen expressed by proliferating cells during the cellular cycle (phase G1, G2, S and M). It is used as a marker of the proliferative activity of 60 cerebral gliomas including 41 biopsied under stereotaxic conditions. The immunocytochemical study performed with the peroxidase antiperoxidase technique on crushed and smeared fresh tumors, permit to define a nuclear marking index for each tumor. The index Ki 67 is correlated with the degree of tumor malignancy. The maximum values are found in astrocytomas IV (20%) and malignant ependymomas (18%), with a mean index at 11% in the 25 high-grade gliomas and 1.7% in low-grade gliomas. The minimum values are observed in pilocytic astrocytomas and low-grade oligodendrogliomas. Marked variations of the index Ki 67 are found in homogeneous tumor classes regrouping tumors of identical nature and grade: grade IV astrocytomas (5 to 20%), grade III astrocytomas (8 to 18%). These marking differences reflect the heterogeneous nature of the proliferative activity of morphologically similar gliomas. The nuclear marking index with antibody Ki 67 complements the findings of the standard histological examination of cerebral gliomas. This is an additional diagnostic mean to evaluate the proliferative potential and the prognosis of these tumors.

We report a case in which rhythmical myoclonus and tremor at rest revealed a thalamo-subthalamic metastasis from a bronchial carcinoma. Tremor of the upper limbs and face (4 Hz) disappeared with sustained posture and action. A cogwheel phenomenon, hypotonia and disorders of automatic and voluntary movements were also present. Surface electromyographic recordings showed a rhythmical, synchronous activity of the biceps brachialis and triceps muscles at rest. Pathology disclosed lesions of the red nucleus and neighbouring area and severe compression of the substantia nigra which were likely to be the cause of the signs and symptoms.

Three cases of extraneural metastases of pineal tumors are reported from a series of 81 cases collected between 1949 and 1982. The diagnostic, etiopathic and therapeutic problems arising from these ca

Polygraphic studies were performed over periods of 14 to 76 hours in 30 patients with reccent closed cranial injuries. Correlations between ICP and EEG findings were rarely found (3/16) in cases of cerebral dysfunction of mesodiencephalic or lower levels, where both ICP and EEG were usually stable. Correlations are regularly found in diencephalic or higher (10/14) levels and their presence is of favourable prognostic significance. Generally, delta waves at 1,5-2 cs, high in amplitude (type A) accompany reduced or low ICP levels,while a rapid and low voltage tracing (type B) is associated with raised or high levels of ICP. In the latter cases, a very slow (0.5 cs) and low in amplitude tracing (type C) can progressively replace the type B. The classical periodic or alternating tracing associates alternate sequences of type A and B and is observed simultaneously with type B pressure waves. These correlations are analogous with those observed during the evolution of intracranial tumors or hydrocephalus. The EEG modifications are probably related more to the pathological lesion than to a direct action of fluctuations in ICP.

A case of hemangiopericytic meningioma of the pineal region is reported. We discuss the origin of meningiomas in this region and their histological nature. The rapid recurrence in situ of the tumor in this particular case seems to confirm the need to complement surgery with radiation therapy.

The authors report on percutaneous automated lumbar discectomy for lumbar diks herniations. They discuss its advantages and inconvenients in front of non automated technics.

The authors describe the use of orbito-fronto-temporo-malar for sphenoidal meningiomas. The resection is followed by bone reconstruction. They discuss the advantages and indications for this approach and reconstruction.

Twelve cases of Scheuermann's disease associated with neurological disorders are reported. The relation between the two conditions can be established through herniated disc, kyphotic angulation or spinal cyst. A more interventionist attitude is justified by the progress and results of neuroradiological investigations and surgical techniques.

We present a multicentric randomized double-blind study of the curative effect of intravenous Nimodipine on the post hemorrhagic vasospasm after aneurysmal rupture. On 122 validated cases out of 188 analyzed patients, the study demonstrates a significative effect on the mortality and severe morbidity related to vasospasm: the reduction of the risk is appreciated to 72%. The major effect is obtained on the mortality risk. A selective effect can be demonstrate on the isolated vasospasm.

Between 1960 and 1980 the authors have observed 67 cases of spinal traumatism for children under 15 years old. Neurological deficit was present for 25 of these patients. At the first examination for 17 and after for 8. 5 children have total paraplegia without osteoligamentary lesions. The cervical traumatisms were without other injuries and were the result of minor trauma. The thoracolumbar traumatisms were accompanied by other injuries and were the result of violent trauma. Most of these lesions have been reduced by orthopedic method; only 4 children were operated because the dislocation was incoercible. The 15 children who presented total paraplegia had no recovery. For all the others, the recuperation was good.

Twenty-three cases of acute spinal epidural infection due to common pathogens were retrospectively studied. Pain is not always present initially and usually appears 15 to 32 days after the primary infection, which is only found in one-half of the cases. When established, the condition is characterized by spinal rigidity, signs of infection, and compression of the cord or cauda equina. The diagnosis is confirmed by surgery, radiology (myelographic blockade, spondylodiscitis) or the finding of pus in the epidural space at lumbar puncture. A frequently delayed diagnosis explains the poor prognosis of these infections. Treatment should always include an antibiotic active against staphylococci, which are by far the most common pathogens. The indications for surgery are discussed in the light of published data compared to the authors' own experience.

The Authors report their experience using Harrington rods with segmental wiring for spinal pathology. They describe the advantages of this technical point in neoplastic and traumatological dorsal compression.

The authors report their experience of the postero-lateral approach for the treatment of thoraco-lumbar spinal metastasis with anterior decompression and osteosynthesis. They stress the progress in the surgical technique which is designed to have a direct effect on osseous posterior wall compression with a more effective osteosynthesis to allow an immediate mobilization.

On the grounds of studies carried out in the last ten years, the authors criticize the usual classification of comas and question the Glasgow scale (opening of eyes, verbal answer, motor response). Their description of brain stem injury by axial herniation and explanation of the role of diffuse encephalic lesions causing intracranial hypertension is based upon anatomo-clinical findings and results of investigations in comatose patients with head injury. For prognostic purposes, a simple and fairly reliable classification of post-traumatic comas is proposed. Comas are divided into five stages of rostro-caudal destructuration (cortico-sub-cortical, diencephalic, meso-diencephalic, mesencephalic and pontic) by studying the response to pain (unadapted, adapted, absent) and four brain stem reflexes (fronto-orbicular, vertical and horizontal oculocephalic, light reflexes).

A 35 year-old caucasian man suffered from paroxysmal nocturnal haemoglobinuria (PNH) or Marchiafava-Micheli's disease diagnosed in 1976 and complicated by several thrombotic episodes. He developed a benign intracranial hypertension. A digitalized intravenous angiography showed occlusion of both lateral sinuses. Partial improvement followed lombo-peritoneal shunting and steroid therapy. Cerebral venous thrombosis is a well-known complication of PNH but only a few cases have been radiologically and/or pathologically proven. It usually involves the superior longitudinal sinus and/or cortical veins resulting in hemorrhagic infarction of poor outcome. Benign intracranial hypertension due to a venous occlusion is rare. In 3 published cases, as in our own, the neurologic outcome was good. Steroid therapy seems useful. The risks of anticoagulant therapy are discussed.

The authors report their experience of the antero-lateral bilateral approach for the treatment of inferior spinal cervical metastasis. They underline the effect of osseous posterior wall compression.

The authors report the use of the antero-external approach for the intrapetrous and skull base portion of the carotid artery. They underline its advantages and limits and report its indications.

A case of hemangiopericytic meningioma of the pineal region is reported. We discuss the origin of meningiomas in this region and their histological nature. The rapid recurrence in situ of the tumor in this particular case seems to confirm the need to complement surgery with radiation therapy.

A technique is proposed for the anterior approach to the cervicothoracic intervertebral joint which allows access to the first four thoracic vertebrae and is based on the insertion of a sterno-biclavicular piece respecting insertion of sternocleidomastoid muscles.

The authors report a new approach of the intervertebral foramen using a conservative hemi-transverso-arthro-pediculotomy. It allows to remove one half of the posterior neural arch and to follow the nervous bundle from its origin to the extra-foraminal space. Removal of the foraminal disc herniation is easy and safe. The monobloc is replaced to prevent any instability.

In a 52 years old man a backward epilepsy revealed a left fronto parietal tumor. The histopathological study shows that it is a meningial tumor composed around by meningocytic proliferation with a metastasis of lung cancer in the middle. This fact was proved only two months after neurosurgical intervention. Thirty three cases of cancer with metastasis in an intracranial primitive tumor have been collected in the literature. The authors study the clinical aspects and etiopathogenic hypothesis of this surprising anatomopathological fact.

The authors report their experience of the posterolateral approach for the treatment of spinal dorsolumbar metastasis. They underline the effect of osseous posterior wall compression. In this way the classical laminectomy is not indicated.

Intermediate filaments represent a class of identical ultra-structure (intracellular filaments 70–100 Angstrom in diameter), yet biologically different according to their cell of origin, thus allowing the production of specific sera and monoclonal antibodies for their identification by histoimmunological technique (LAZARIDES E. 1980).