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This report describes two patients with medically intractable post-traumatique trigeminal neuralgia, who underwent bipolar coagulation of the pars caudalis of the trigeminal spinal nucleus. Follow-up examination--36 months and 7 months, respectively, after the procedure-showed that the patients were free of pain.

Between 1985 and 1989, 50 patients with trigeminal neuralgia were submitted for percutaneous gasserian ganglion compression, the procedure is the technic described by Mullan with some variants. The Fogarty catheter is introduced through a teflon catheter. The balloon is inflated to 0.5 cc during 8 minutes. So 46 patients were relieved of their pain; there were 7 (14%) recurrence for an interval of between 6 and 54 months (average 30 months). Dysesthesias were noted in two patients when the duration of compression was more prolonged. Two patients had transient oculomotor nerve palsy. The success rate after gasserian compression is similar to this obtained in the other percutaneous procedures. Despite the general anesthesia with intubation which is useful, the procedure is technically very easy and can be performed by a neurosurgeon who has not a long experience.

This series involves 29 patients treated for chronic pain (9 patients) or severe spasticity (20 patients). The surgical technique used was the microsurgical D.R.E.Z.-tomy technique as described by Sindou. In the first group, three patients had malignant pain, while the six others had deafferation pain. In the second group, spasticity involved the upper limb in 13 patients and the lower limbs in 7 patients. Out of 20 patients, one-third suffered from cerebral palsy. In the first group, results one year after surgery were excellent or good in 7 out of the 9 patients. In the group treated for spasticity, a significant decrease in spastic disorders was observed in 16 of the 20 patients over a 1 to 4 year follow-up period. There was also an improvement of voluntary movements in 11 patients and a decrease in pain in 15 patients belonging to this group. A number of complications were noted: cerebrospinal fluid leakage in two cases, painful anesthesia in the C5 to T1 territory in one case, transient paresis of the upper limb in six cases. One patient died as a result of an expansive pneumatocele (3.4% of cases).

During the fifteen past years, the treatment of trigeminal neuralgia resistant to medical therapy has benefited from several neurosurgical techniques, either with percutaneous methods (RF-thermorhizotomy, cisternal injection of glycerol, balloon compression of the gasserian ganglion) or direct approach (microsurgical selective section of pars major, microvascular decompression). The respective advantages and disadvantages of these techniques are presented, both from the authors' experience (609 thermocoagulations, 150 direct approaches in the cerebello-pontine angle) and a review of some important series of the literature.

The authors report a case of a primary intracranial yolk sac tumor which is a quite rare eventuality. The patient, an 18 months old girl was referred for severe intracranial hypertension. Neurological examination revealed a right hemiparesis, a left abducens nerve palsy and a bilateral papilledema. The serum and C.S.F. levels of alpha fetoprotein were at 2100 Ugr/l and 2500 Ugr/l, respectively. The computerized tomography showed a mass with a low density area in the left temporoparietal lobe and the carotid angiogram a highly hyper-vascular tumor. The child underwent a left temporo-parietal craniotomy and the friable vascular tumor was totally removed. A radiotherapy was associated to the surgical treatment. Histologically, glomerular like structures (Shiller Duval body), intra and extra cellular hyaline globules PAS positive were frequently seen. The tumor marker was demonstrated immunohistochemically.

A large number of patients suffering from various neurological diseases remain disabled because of spastic disorders in their foot. These disorders--which are responsible for abnormal postures and painful disturbances for walking and standing--can be corrected by an effective procedure: the so-called Selective Neurotomy of the Tibial Nerve (T.N.), developed in its modern form by Gros in 1972. The procedure aims at sectioning the T.N. branches corresponding to the muscles, the spasticity of which is considered harmful, i.e. the soleus (and/or gastrocnemius) nerves for equinus and ankle clonus, the posterior tibialis branch for varus, and the flexor fascicles for tonic flexion of the toes. After dissection of each T.N. branches at the lower part of the popliteal region and their identification with bipolar electro-stimulation, the selected nerves are sectioned partially (about two-third of their caliber) under the operative microscope. The present series consists of 37 operations--performed 25 times unilaterally and 6 bilaterally--in 31 patients, 17 to 68 year old (39 on average). In 11 patients spasticity was from spinal cord origin and in the 20 others from vascular or traumatic cerebral damages. The spastic disorders--installed for 2 to 17 years (4 on average)--were due to one, several or all the following components: equinus, ankle clonus, varus, flexion of the toes. Surgery obtained complete suppression of the disabling spastic components, total pain relief and consequently improvement of the residual voluntary movements by achieving balance between agonist and antagonist muscles, in 33 out of the 37 cases, i.e. in 91% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)