Biomedical subjects
Publications and source records attributed to P Creissard.
Aneurysmal bone cyst occurring within the calvarium is uncommon. We report a case presenting as an intracranial space-occupying lesion. Fluid levels within a lesion on CT is very suggestive but inconstant. The theory of a pre-existing lesion is noted.
Sixty patients with ruptured cerebral aneurysms were operated during the first 3 days after the onset of bleeding. In all cases the following investigations were performed: before surgery and 10 days after surgery angiography and CTScan, two months later a control CTScan. The first CTScans have been classified according to the staging defined by Fisher. Vasospasms (VS) were assessed comparing the arteriographies before and after surgery and classified as narrow or moderate; ischemia were assessed on post surgical CTScans. VS were found in any of the Fisher grades but were more frequent in grade 4; they occurred in 50% of cases (30 cases). Narrow VS were found 17 times in any Fisher grade. Ischemia occurred in 7 cases (1 death); following narrow VS in 6 cases. The high incidence of VS demonstration is emphasized: it is probably due to the lag time between bleeding and angiography and to the fact that angiographic controls were systematically performed. On the other hand ischemia occurred in 7 patients: the respective role of normalized intracranial pressure, hypervolemia, drug use and surgical procedure are discussed as candidate factors of this low incidence.
Forty-six out of a series of 76 patients with intracranial metastases from lung cancer underwent a surgical operation for complete macroscopic resection. 44 cases presented with a single metastasis. In 2 cases, there were 2 cerebral metastases. Most of the lesions were situated in the frontal lobe (41%). In more than one half of cases, the primary lung cancer was squamous carcinoma. The mean survival was 9 months. It was shorter in the case of anaplastic cancers (6 months) and adenocarcinomas (8 months) than in the squamous carcinomas (12 months). The five patients still alive 2 years after surgery all belong to this histological group. The results suggest that surgical treatment of single cerebral metastases from lung cancer, in the absence of extracranial dissemination, allows a considerable improvement in the quality and duration of the survival.
A six years retrospective analysis of asymptomatic aneurysms (A.A.) was done in 4 neurosurgical departments: 114 AA were clipped in 99 patients. In 44 patients (48 asymptomatic aneurysms) the surgical procedure was achieved in one step for both symptomatic and asymptomatic aneurysms. In 59 patients (66 asymptomatic aneurysms) the surgical procedure was delayed as it necessitated a second and elective craniotomy. As regard the treatment of asymptomatic aneurysms, there was no morbidity, and one death due to a massive pulmonary embolism. These surgical results are undoubtebly better than the risk of hemorrhage from unruptured aneurysm as emphasized in the literature.
In 200 consecutive cases of ruptured aneurysms volume of resulting hematomas exceeded 5 ml in 57 patients (28.5%) and 50 ml in 25 patients (12.5%). We have studied the radio anatomical and clinical datas of these 57 cases: In most of them (90%) the aneurysm situation appears to determine hematomas characteristic features. Fatal issues are related to hematoma volume when above 50 ml and to vasospasm in other cases. Results in the 48 operated cases lead to advise neurosurgeons against surgical procedure when volume is greater than 60 ml in grade V patients (unless operation could take place immediately after rupture onset), and when severe intra ventricular hemorrhage is present. Death in ruptured aneurysms is a consequence of hematomas volume in at least 10% cases. Hematomas or vasospasm are responsible for sequellae or fatal issues which still occurs in 15-20% of overall population of patients with ruptured aneurysms, despite improvement in management and timing. Cases finding and preventive surgery of non incidental aneurysms should be a matter of concern.
The authors report the case of a patient suffering from paraparesis where a venous pathology seemed to be responsible, and the literature is reviewed. A cauda-equina compression by L4/L5 arthrosic pseudo-spondylolisthesis caused troubles of the spinal cord venous drainage, seen at the myelography. There was a neurological deficit above the L4/L5 compression with a psoas and quadriceps deficit. After a L4/L5 laminectomy the neurological signs improved rapidly.
The authors report a series of 11 epidural haematoma in hemophilia. Of these, one case is observed in the department of Neurosurgery at the CHRU. From this study, main points results: a mechanic etiology was found in four cases; the main clinical and radiological signs are those of epidural haematoma; the indication to operate is required and the hemophiliacs should receive a "substitutive" treatment as soon as possible.
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110 patients with ruptured aneurysms were operated on within 4 to 96 hours after subarachnoid hemorrhage. Clinical grades (Hunt) were: 1-2-3 in 93 cases and 4-5 in 17 cases. Among the patients grades 1-2-3, 81% had a good out come without any neurological abnormality, among the patients graded 4-5, only 27% had a fair out come. Cerebral ischemia has been noted (CTS can + neurological deficits) in 7 cases only among patients graded 1-2-3 (93 cases). The results, concerning ischemia, are better than the natural course of ruptured aneurysms and better than the course in series with delayed operation. Probably vasospasm is not alone to create ischemia.
The authors report 106 intracranial aneurysms operated on during the first 7 days post S.A.H. The résults according to grade and operative day are compared to the results of litterature, operative indications according to grades and spasms are given.
G.F.A. (gliofibrillary acid protein) and hyaluronectin studied here are two antigens defined by the heteroantibodies which appear in the serum of the immunised animal. G.F.A. is associated with gliofilaments and is considered as an astrocyte marker, either normal or tumoral. Hyaluronectin, is found in the Ranvier nodes and at the periphery of neurones. It is not specific to the nervous system. It is found in all tissues and tumors, and in particular marks the intercellular spaces of gliomas, where it is associated with hyaluronic acid for which it has a great affinity. Serum estimation of these Proteins is being undertaken with the view to a clinical application.
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We studied various tumours of the nervous system by the immunofluorescence technique using an anti-brain specific alpha 2 glycoprotein antiserum (anti-NSA3 antiserum). We found the antigen in 24/27 astrocytomas and 4/4 oligodendrogliomas but in none of the 8 meningiomas tested. There was an identity between the astrocytoma/oligodendroglioma antigen and that of normal brain as shown by the immunoprecipitation technique. By the immunofluorescence technique using inhibition of the antiserum we demonstrated that the tumour antigen is devoid of some specific nervous system determinants present in normal brain.
The authors present a new method of lumbar phlebology without catheterism by direct venous puncture of the femoral veins. An analysis of 300 contrast tests maked it possible to identify different types of pathological images characterized by disappearance and displacement of epidural veins corresponding as a rule to discal hernia when the uncharacteristic shadowy images do not allow one to make a precise conclusion or to determine whether an operation is needed. With equal reliability (96 percent), lumbar phlebography without catheterism is, by its simplicity and harmlessness and the absence of minor and major venous complications, preferable to phlebography by catheterism. Carried out in all subjects, whatever their age, without special precautions, it seems to us to now be the most desirable test to be used in the radiological investigation of lumbar discal hernias.
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