H. Person

The place of decompressive surgery in the treatment of uncontrollable post-traumatic intracranial hypertension in children.

The authors report two cases of post-traumatic uncontrollable intracranial hypertension in children (120 torr in case 1; 90 torr in case 2) who were treated within the first 12 h after trauma by surgery including decompressive craniectomy. The outcome was favourable in both children. Intracranial pressure (ICP) was recorded during the pre-, intra-and postoperative periods and during each specific step of the surgical procedure. Craniectomy alone induced a decrease in ICP of 45% (40 torr) in case 1 and 30% (35 torr) in case 2. Although this method remains controversial, given the lack of controlled trials, it can offer a salvage procedure in children with rapidly worsening intracranial hypertension, allowing survival without disabling neurological sequelae.

Delayed cerebral pseudo-tumoral radionecrosis following scalp-tumour irradiation. Case report and review of literature

SummaryA case of delayed radionecrosis of the brain is reported, following irradiation of a scalp dermatofibrosarcoma. Signs and symptoms were those of an intracranial neoplasm and appeared 5 years after an irradiation dosage of 1890 rets. Twenty-seven similar cases were gathered from a survey of the literature. Surgical excision was the treatment of choice and led to cure or improvement in 20 cases. Analysis of doses and fractionation revealed excessive irradiation in all but one of the cases.

Arthrodèses lombaires par voie antérieure dans le traitement des lombalgies et lomboradiculalgies récidivantes postchirurgicales : étude rétrospective de 46 cas ☆

BACKGROUND AND PURPOSE Anterior lumbar interbody fusion (ALIF) has gained popularity for the treatment of degenerative disease of the lumbar spine. In this report, we present our experience with the ALIF procedure for treatment of failed back surgery syndrome following lumbar discectomy in a noncontrolled retrospective cohort. METHODS From 1st January to 31 December 2005, we performed an ALIF in 46 patients presenting with low back pain with or without radiculopathy. All patients had a history of intractable pain resistant to conventional medical treatment and failed posterior lumbar surgery. Clinical and radiological outcomes were recorded. Neurological pain and functional outcomes were measured postoperatively (at 1, 3 and 12 months). Operative data, intraoperative complications, and the fusion rate were recorded. RESULTS Forty-six patients with a preoperative diagnosis of failed back surgery syndrome underwent ALIF. The mean follow-up was 21 months. Back pain and leg pain completely disappeared in 60.9% of patients, decreased but required occasional medication in 28.3%, and 10.8% declared no benefit from ALIF surgery. CONCLUSION On the basis of our results, we found ALIF to be a safe and effective procedure for the treatment of failed back surgery syndrome.

Hémangioblastome « en sablier » de la huitième racine cervicale

Resume Les hemangioblastomes radiculaires cervicaux « en sablier » avec une composante a la fois extra- et intra-durale sont exceptionnellement rencontres puisqu’un seul cas a ete decrit dans la litterature. Nous rapportons une seconde observation d’un patient de 33 ans ayant une tumeur cervicale inferieure « en sablier », responsable d’une nevralgie cervico-brachiale depuis 6 mois. L’aspect en IRM evoquait un schwannome et l’angiographie du tronc thyro-bicervico-scapulaire montrait une hyper-vascularisation non specifique, si bien que le diagnostic d’hemangioblastome n’a ete precise que par l’examen histologique.L’exerese complete de cette lesion tres vascularisee peut necessiter un abord chirurgical combine (anterieur et posterieur), ainsi qu’une embolisation pre-operatoire.

Traitement des chondrosarcomes de la base du crâne

BACKGROUND AND PURPOSE Skull base chondrosarcomas are rare. Gross total removal is the treatment of choice, but can be difficult depending on the closeness of noble structures. Proton beam therapy can be associated in most cases. METHODS Retrospective study of five cases treated in 13 years and study of the literature. RESULTS Median age of patients was 34 years [28-46]. Cranial nerve palsy was the common clinical presentation. Tumor location was variable but always off midline. Treatment was surgical in all patients with a maximal resection and proton beam therapy associated for two cases. Surgical complications were rare with cranial nerve palsy as the main side effect. Outcomes were good with a median follow-up of 12.4 years [4.3-16.2]. DISCUSSION The review of the literature showed that chondrosarcomas of skull base are rare. The best outcome is achieved with total surgical resection. Medical imaging can only give clues to the diagnosis. Pathology is required to obtain a precise immunohistochemistry diagnosis. Multidisciplinary treatment using proton beam therapy and surgical removal enables a good local control (90-100%) at 5 years with good quality-of-life. It is difficult to determine how many cases have been published (around 220 cases in the literature) since many surgical or radiotherapy series included the same patients.