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Background: Intracranial hemorrhage due to arteriovenous malformation or intracranial aneurysm is a rare but severe complication of pregnancy with maternal and fetal mortality of 20% and 33% respectively. Whether to deliver the patient first, or to treat the aneurysm first is still controversial, but an emergency cesarean section followed by aneurismal treatment appears to be a widely accepted strategy in pregnant women with cerebral aneurysmal complications., Case: A 38-year-old patient, G3P2A0, presented at 36 gestational weeks with a diffuse bilateral subarachnoid hemorrhage with fourth ventricle bleeding and hydrocephalus. She had a cerebral aneurysm of the left posterior communicating artery on arteriography. A cesarean section was performed on the first day of admission, and an external ventricular derivation with clipping of the aneurysm on the left posterior communicating artery were done immediately after the cesarean section. Mother and newborn were discharged from hospital in a good health status except Broca's aphasia in the mother., Conclusion: In the absence of categorical recommendations, we stress the role of combined care by both neurosurgeons and obstetricians, on a case to case basis according to gestational age, mother neurological status and experience of caregivers.

Background and Purpose: Lumbar disc herniation frequently affects young patients and is responsible for high rate of worker's compensation claims. The aim of this study is to evaluate at short and long-term the results of microdiscectomy in terms of pain control, quality of life and patient's satisfaction., Methods: In this prospective study, 28 patients were enrolled and operated on by microdiscectomy for lumbar disc herniation. Three questionnaires were administered preoperatively. They evaluated the pain, the quality of life and the expectation of the patients. Four questionnaires were administered at six months and two years postoperatively evaluating pain, quality of life, results and satisfactions., Results: A 62.3% and 53.2% improvement of low back pain at 6 months and 2 years respectively, and a 91.7% and 88.4% improvement of radicular pain were reported. A 73.2% and 79.8% improvement in quality of life was recorded respectively. Patient's expectation was evaluated at 3.85 and results estimated 3.24. Patient's satisfaction was 93.3% and 88.3% respectively. It was positively correlated to radicular pain, and inversely correlated to patient's expectations., Conclusion: Microdiscectomy for lumbar disc herniation offers a marked improvement in back and radicular pain. Quality of life is much improved. Although satisfaction is high, it is somewhat decreased for patients with high expectations.

Objectives: To study the efficacy of surgery on the postoperative control of epilepsy in patients operated for brain tumors., Methods: Forty patients operated for supratentoriel cerebral tumors with epilepsy, at Hotel-Dieu de France (HDF) hospital center, between 1983 and 2005, were included in this study. Clinical, paraclinical and surgical information were collected. The extent of the tumor resection was based on the postoperative MRI results., Results: The mean duration of the follow-up was 52 +/- 6 months (from 6 months to 10 years). 62.5% of our patients have had acute seizures (< 1 year) and 37% had experienced chronic seizures (> or = 1 year). The histopathologic exam revealed 2 DNET, 3 pilocytic astrocytomas, 2 diffuse astrocytomas, 6 A oligodendrogliomas, 7 B oligodendrogliomas, 7 anaplastic astrocytomas and glioblastomas and 13 meningiomas. Twenty-two patients had a complete resection, whereas the postoperative MRI of 18 patients have shown a tumoral remnant. After one year of follow-up, a complete remission was noted in 57.5% of the patients (Engel I). The prognostic factors of good outcome were: low-grade glial tumors (I +/- II), meningiomas, and complete tumor resection., Conclusion: The efficacy of surgery for epilepsy associated to cerebral tumors, established by the majority of articles, matched the results obtained for the patients operated at HDF, with complete seizures control in 57.5% of patients. This control depended essentially on the extent of tumor resection and on tumor's nature.

Objectives: The purpose of this study is to discuss the clinical and radiological aspects as well as the controversies in the management of lumbar synovial cysts., Methods: We report a retrospective analysis of a series of 6 cases of lumbar synovial cysts. Patients presented with unilateral radicular pain mimicking a disc herniation. An MRI (magnetic resonance imaging) was performed in all patients. A computerized tomography scan was performed in one case and X rays in 2 cases. All patients were operated on and the cyst resected. Arthrodesis was not performed in any of our patients., Results: Functional outcome was marked by a significant improvement. Excellent results were found in 4 patients. Three patients who presented with a motor deficit recovered after the surgery., Conclusions: Lumbar synovial cysts should be considered in the differential diagnosis of any radicular compression. MRI is the examination of choice. Surgical resection is the definitive treatment with low rates of complications and recurrences.

Purpose: The results of a series of 8 patients with hemifacial spasm (HFS), treated with microsurgical vascular decompression (MVD) are reported., Method: A magnetic resonance imaging (MRI) of the brain was performed in all patients prior to surgery. The presence of arterial hypertension (HT) was noted. MVD was performed through a retromastoid approach, and Gortex was interposed between the nerve and the conflicting vessel., Results: The offending vessels found were: the antero-inferior cerebellar artery in 50% of the cases, the postero-inferior cerebellar artery in 25% and the vertebral artery in 25%. These findings were positively correlated with MRI in only 50% of cases. The surgical results were the following: total and immediate relief in 62.5% of cases, delayed relief in 25%, and partial relief in 12.5%. Neither failure, nor recurrence were noted. In terms of complications, two cases of persisting hearing loss, one case of transient hearing loss, and two cases of persisting facial palsy. Hypertension improved in 20% of cases., Conclusion: This study shows the success of MVD in the treatment of HFS. Intraoperative monitoring is helpful in reducing the complication rate. In our practice, the correlation between MRI findings and surgery was poor, as opposed to the results found in literature.

Objective: The objective of this work is to evaluate the results of a draining valve of the cerebrospinal fluid, whose opening pressure is transcutaneously adjustable, in the treatment of intracranial collections., Material and Methods: A series of 50 operated patients is retrospectively reviewed. Forty-four patients are treated for hydrocephalus of variable causes and six patients for arachnoidal cysts. Offering eight opening pressures, the adjustable valve Sophy was used in all these patients. The mean follow-up is of 48 months., Results: Nineteen patients (38%) needed an adjustment of their valve's opening pressure. This adjustment was achieved to higher levels in seven patients presenting with overdrainage and to lower levels in twelve patients presenting with underdrainage. In 4 patients a subdural collection was observed and treated. Six patients underwent a second surgery for infection or obstruction. Taking all etiologies into consideration, and after the adjustment of the valve's opening pressure, 40 patients had a positive clinical result (obvious amelioration of the symptomatology), ten patients did not improve., Conclusion: The valve Sophy provides a simple solution for the patients in whom it is difficult to choose an adapted opening pressure, it particularly allows to avoid a reintervention when this is rendered necessary by a hypo or a hyper drainage programmable valve.

The authors report a series of 46 patients operated for an intracranial aneurysm from January 92 to January 96 in Hôtel-Dieu de France. There were 28 males and 18 females ranging from 22 to 69 years. Forty-four patients presented a typical clinical pattern of subarachnoid haemorrhage. In 20 cases (45%), correct diagnosis was not made at the time of bleeding but at another outpatient visit or at a bleeding recurrence. Cerebral angiography was performed in all our patients. The most frequent aneurysmal location was at the anterior communicating artery (n = 20). Surgical total exclusion of the aneurysm was possible in 45 patients. Forty-one patients had a favourable outcome but three presented important neurological sequelae. We encountered 2 postoperative deaths due to irreversible arterial vasospasm. These results suggest that the preoperative neurological state and the occurrence of an arterial vasospasm are the main prognostic factors of the intracranial aneurysm. Early diagnosis and treatment allow to avoid rebleeding, mostly responsible of the poor neurological status, and to better manage the arterial vasospasm in order to improve the outcome.

The authors report a retrospective study (April 92-April 95) of 60 CT guided stereotactic biopsies. The procedure offered accurate histological diagnosis in 56 cases. There were 38 glial tumors, the majority being of high grade (III-IV). Five abscesses were evacuated and medically treated. Complications occurred in 5% of cases. These results are compatible with those reported in the literature. The simplicity and accuracy of stereotactic procedure are confirmed, making it an imperative step in the management of intraxial space occupying lesion when surgical resection is negotiable. The other applications of the stereotactic procedure are exposed.

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at Hôtel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satisfactory in twenty patients (90.9%) who became asymptomatic. No major complication was noticed. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia.