Jacques Noterman

Lower clivus and foramen magnum anterolateral meningiomas: surgical strategy.

Lower clivus and anterolateral foramen magnum meningiomas are rare but challenging tumors. Indeed, all access routes to their intradural anterolateral implantation appear unsafe since highly-functional local structures may not be sacrified or even retracted. Anterior and posterior surgical approaches have specific advantages and limitations. Different lateral extensions of the posterior approach have been described. They include a transposition of the vertebral artery, a partial occipital condylectomy and even the exposure and the section of the sigmoid sinus. Such posterolateral approaches offer the optimal access to anterolateral foramen magnum meningiomas and allow a total removal with a minimal morbidity. We report the surgical strategy that we applied for the last 6 anterolateral foramen magnum meningiomas in our department.

Thoracic spinal epidural cysts

Two cases of spinal cord compression by thoracic epidural cysts are reported. The first case, associated with a lipoma, is of a congenital type, while the second illustrates a rare mechanism of spinal cord compression caused by a post-traumatic cyst after stretching of the brachial plexus and tearing of the meningeal sheaths of nerve roots. Computed tomography of the spine is helpful in disclosing the cyst and associated malformation, particularly in congenital cases. The prognosis is good after removing the cyst and closing the fistula communicating with the subarachnoid space. Further surgical treatment may be required in complex congenital malformations.

Petite histoire et quelques réflexions à propos des échelles de grades des hémorragies sous-arachnoïdiennes d’origine anévrismale et des échelles de suivi

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.

De la ligature de carotide aux techniques endovasculaires ou un siècle de traitement des anévrismes intracrâniens. Historique du traitement des anévrismes

Intracranial aneurysm treatment began in the 20th century. Treatment remained anecdotal for a long time because these lesions could not be visualized. This was the period of hunterian ligation of the carotid and trapping. After the discovery of the carotid angiography at the end of the 1920s, a new direct clipping approach started. Other techniques were used, such as wrapping and coating. Finally, in the 1980s, endovascular procedures appeared and are now in constant progress. The advantages, problems and improvements of these treatments are briefly reviewed.

De la ligature de carotide aux techniques endovasculaires ou un siècle de traitement des anévrismes intracrâniens

Intracranial aneurysm treatment began in the 20th century. Treatment remained anecdotal for a long time because these lesions could not be visualized. This was the period of hunterian ligation of the carotid and trapping. After the discovery of the carotid angiography at the end of the 1920s, a new direct clipping approach started. Other techniques were used, such as wrapping and coating. Finally, in the 1980s, endovascular procedures appeared and are now in constant progress. The advantages, problems and improvements of these treatments are briefly reviewed.

Pseudomembranous colitis associated with oxacillin therapy

Received for publication Dec 11,1973; accepted Jan 30, 1974. From the Edward Mallinckrodt Department of Pediatrics (Drs. Keating, Frank, and Barton); the Division of Gastroenterology, Department of Internal Medicine (Dr. Tedesco), Washington University School of Medicine; and the Division of Gastroenterology, St. Louis Childrens Hospital (Dr. Keating). Reprint requests to St. Louis Childrens Hospital, 500 Kings Hwy, St. Louis, MO 63110 (Dr. Keating). Fig 1.—Intensely hyperemic, friable rectal mucosa with patchy, adherent membrane.