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Spontaneous obliteration of cerebral arteriovenous malformations (AVMs) is a rare phenomenon. Hereditary Hemorrhagic Telangiectasia (HHT) is a predisposal genetic condition for AVMs development in all organs.We report the case of a 34 years old woman with HHT family history. After radiosurgical treatment of a symptomatic evolving cerebellar AVM, late control subtracted digital angiography (DSA) demonstrated the complete obliteration of this AVM but also spontaneous obliteration of 3 fronto-parietal AVMs without any hemorrhagic sign on MRI.To our knowledge, this is the first report of spontaneous obliteration of multiple and unruptured AVMs in a HTT case.

Objective. - Our study aimed to identify predictive factors for malignant post-treatment edema and hem-orrhage in patients who underwent microsurgical treatment of arteriovenous malformation (AVM) in our institution.Methods. - The study included 72 patients treated by microsurgery for cerebral symptomatic and/or ruptured AVM between 2010 and 2020. Six patients developed postprocedural malignant edema and hemorrhage (group M); the other 66 patients had no malignant edema and hemorrhage (group NM). In each patient, flow was assessed indirectly by summing the diameters of all feeding arteries to obtain an overall diameter (ODA), and similarly for draining veins (ODV). High-flow was defined as a delay between feeding artery injection and draining vein injection (DAV) < 1 second on dynamic digital subtraction angiography. Univariate analysis was performed. Results. - Mean ODA and ODV were respectively 11 mm (+/- 8.2) and 11 mm (+/- 5.3) in group M and 2.9 mm (+/- 1.4) and 3.7 mm (+/- 1.3) in group NM (P = 0.001). High-flow AVM was demonstrated in 4 out of 5 patients (85%) in group M and in 14 out of 55 (25%) in group NM (P = 0.02). Associated aneurysm was seen in 5 patients in group M (83%) and in 11 in group NM (17%) (P = 0.001).Conclusion. - High-flow AVM may be associated with higher risk of postoperative edema and hemorrhage. Multidisciplinary discussion is mandatory in these cases, to define a pre-therapeutic plan for progressive staged vascular malformation occlusion.(c) 2022 Elsevier Masson SAS. All rights reserved.

Gliomas are diffuse intra-axial lesions, which can be accessed by multiple surgical corridors for a same location depending on the surgeon's preference. 5-Aminolevulinic Acid use facilitates the extend of resection in case of high-grade gliomas, especially when differentiating normal brain from tumor periphery is challenging.Complete resection of glioblastoma via a supraorbital transciliary approach with 5-Aminolevulinic Acid use was performed without any complications, as demonstrated on postoperative MRI.Patient was discharged on the third postoperative day. Wound follow-up shows good cosmetic result. Patient underwent concomitant chemo-radiation (Temozolomide- 60Gy) and adjuvant chemotherapy (Temozolomide). No tumor recurrence was noted at six months follow-up.In selected cases, supraorbital transciliary approach could be proposed as primary approach as it provides the advantage of full control over all the vasculo-nervous structures at skull base without the necessity of protective brain retractor use while the 5-Aminolevulinic Acid use allows a gross total resection.

Resume La decouverte fortuite d’anomalies lors d’une exploration en imagerie par resonance magnetique (IRM) est observee 1 fois toutes les 37 IRM si l’on exclue les anomalies de la substance blanche, les infarctus silencieux et les micro-saignements. Cette proportion augmente avec l’injection de gadolinium, des sequences angiographiques, et l’âge des personnes. Les consequences sont parfois benefiques pour le patient lorsqu’elles permettent un traitement (par exemple d’une tumeur), ou la surveillance d’une lesion a risque evolutif (syndrome radiologique isole susceptible de representer un stade precoce de sclerose en plaques). Elles sont plus souvent deleteres par les consequences psychologiques et sociales qu’elles induisent, et les strategies therapeutiques auxquelles elles exposent, soient en traitant des anomalies qui ne devraient pas l’etre (par exemple certaines malformations arterioveineuses), ou en privant par exces de prudence le patient d’un traitement (thrombolyse intraveineuse en presence d’un anevrisme silencieux). Dans la plupart des cas l’incertitude prevaut et la decision necessite, en l’absence d’essais randomises, une analyse multidisciplinaire du risque spontane et du traitement, et la preference du patient. Un medecin qui demande la realisation d’une IRM doit avoir a l’esprit le risque de decouverte d’une anomalie fortuite qui ne rendra qu’exceptionnellement service au patient. Cette decouverte peut generer de l’anxiete chez les patients et leurs proches, et les exposer a des refus d’assurances, et une consommation excessive et souvent injustifiee de ressources medicales. Une telle eventualite doit etre anticipee, ce qui serait plus aise si l’acces a l’IRM etait reserve aux specialistes du sujet.

Traumatic subarachnoid hemorrhage (SAH) has an annual incidence of 9 per 100 000 people. It is a rare but serious event, with an estimated mortality rate of 40% within the first 48hours. In 85% of cases, it is due to rupture of an intracranial aneurysm. In the early phase, during the first 24hours, cerebral CT, combined with intracranial CT angiography is recommended to make a positive diagnosis of SAH, to identify the cause and to investigate for an intracranial aneurysm. Cerebral MRI may be proposed if the patient's clinical condition allows it. FLAIR imaging is more sensitive than CT to demonstrate a subarachnoid hemorrhage and offers greater degrees of sensitivity for the diagnosis of restricted subarachnoid hemorrhage in cortical sulcus. A lumbar puncture should be performed if these investigations are normal while clinical suspicion is high.

Resume L’hypertension intracrânienne idiopathique se developpe sur le terrain particulier des patientes jeunes en surcharge ponderale et se manifeste par des cephalees et un œdeme papillaire. Les causes sont multiples et leurs mecanismes restent inconnus. Ils conduisent a un dereglement de l’equilibre entre la pression intracrânienne, la compression des sinus veineux intracrâniens et la resorption du liquide cerebrospinal, en un cercle vicieux que la derivation du LCS ou le stenting d’un sinus lateral peut interrompre. Dans la majorite des cas, le traitement medical et la reduction ponderale reussissent a controler l’evolution qui reste benigne.

Isolated optic nerve sheath meningocele is a rare affection defined as the cystic enlargement of the optic nerve sheath filled with cerebrospinal fluid. We report the case of a 39-year-old woman presenting with bilateral meningocele uncovered during a routine examination for headache complaints. A 5-year follow-up validated the lesion’s clinical and imaging stability. Magnetic resonance imaging (MRI) is an essential tool in the diagnosis of this pathology, alongside characteristic symptoms indicating that the meningocele might have progressively expanded into the orbit. In this case we present a therapeutic approach based on pathophysiological hypotheses and review of the literature.

Glioblastomas are the most aggressive of the brain tumors occurring in adults and children. Currently available chemotherapy prolongs the median survival time of patients by only 4 months. The low efficiency of current treatments is partly owing to the blood-brain barrier, which restricts the penetration of most drugs into the central nervous system. Locoregional treatment strategies thus become mandatory. In this context, viral tools are of great interest for the selective delivery of genes into tumoral cells. Gliomas express high levels of type 2 somatostatin receptors (sstr2A), pinpointing them as suitable targets for the improvement of transduction efficiency in these tumors. We designed a new adenoviral vector based on the introduction of the full-length somatostatin (SRIF (somatotropin release-inhibiting factor)) sequence into the HI loop of the HAdV fiber protein. We demonstrate that (i) HAdV-5-SRIF uptake into cells is mediated by sstr2A, (ii) our vector drives high levels of gene expression in cells expressing endogenous sstr2A, with up to 65-fold enhancement and (iii) low doses of HAdV-5-SRIF are sufficient to infect high-grade human primary glioblastoma cells. Adenoviral vectors targeting SRIF receptors might thus represent a promising therapeutic approach to brain tumors.

We report a new case of giant cell ependymoma (GCE) of the thoracic spinal cord. Ependymomas predominate in children and young adults and are frequently intracranial and infra-tentorial. However, a second age peak at 30–40 years is reported for spinal tumours. Microscopically, ependymomas show a large variety of histological features, among which a rare variant with giant cells. This 59-year-old woman presented with a 6-month history of numbness and burning sensation affecting the left lower limb and hemi-trunk. A cervico-thoracic MRI revealed a solid intra-medullary tumour at the level of T1–T3, slightly T1-hypointense, T2-hyperintense and contrast enhancing. A complete surgical resection was carried out through a C7 to T4 laminectomy. Recovery was complete with no sign of recurrence at 18-month follow-up. The initial histological diagnosis of glioblastoma was challenged on the basis of the imaging and operative findings of a well-circumscribed tumour. The case was sent to us for second opinion and we diagnosed a GCE, WHO grade II, with a biphasic pattern including a predominant giant cell component (>90%), with genetic evidence of polyploidy, and a very limited classic component, showing a characteristic loss of chromosome 22. Our report adds to the clinical, imaging, pathological and genetic characterisation of GCE and brings the first genetic evidence that these rare tumours are at least bi-clonal. It also suggests that GCE have a good prognosis after complete surgical resection.

Objective: The paraclinoid region has a complex anatomy. The purpose of this study was to depict in details its anatomical landmarks and their radiological translations with magnetic resonance imaging (MRI). Material and method: Ten anatomical specimens (20 paraclinoid regions) were prepared, then dissected and further analyzed with MRI in order to describe their important radio-anatomical structures (dural folds, osseous surfaces, arteries and nerves) along with their course and measurements, and the reference points of the carotid distal dural ring. The paraclinoid MR protocol consisted in a T2 high-resolution sequence with thin and contiguous slices acquired in a coronal (diaphragmatic) and sagittal oblique (carotid) plane. Reproducibility in living subjects was evaluated on 15 patients (30 paraclinoid regions). Statistical comparison was made between laboratory and MR measurements obtained on cadavers. Results: A detailed description of paraclinoid anatomy and structures was provided. Its landmarks were satisfactorily identified with the dedicated MR protocol. Reproducibility in living subjects was obtained. No statistical difference was found between laboratory and MR measurements. Conclusion: This study provides a precise description of paraclinoid anatomical structures and their radiological correlations. This paraclinoid MR protocol allows locating paraclinoid lesions in comparison with the cavernous sinus roof, which is of paramount importance for the management of paraclinoid carotid artery aneurysms.

Summary Reasons for performing study: Intense physical exercise can induce the degranulation of neutrophils leading to an increase in plasma concentration of the neutrophil marker enzymes myeloperoxidase (MPO) and elastase (ELT). These enzymes have pro-oxidative and pro-inflammatory properties and may play a role in the exercised-induced muscular damage. Objectives: To measure MPO and ELT concentrations in plasma and muscles of endurance horses and to correlate them to the extent of exercise-induced muscular damage. Methods: Seven endurance horses qualified on 120 km races were tested in this study. Neutrophil count, serum creatine kinase (CK), plasmatic and muscular MPO and ELT concentrations were measured before and 2 h after a 120 km endurance race. Results: The race produced a significant increase of neutrophils, CK, and plasma MPO and ELT levels. A significant correlation was observed between the MPO and ELT values in plasma (r2= 0.92, P

Summary Reasons for performing study: Intensive exercise induces a systemic inflammatory response characterised by an increase of blood neutrophil count and myeloperoxidase (MPO) release. Neutrophil elastase (NE) could also contribute to tissues lesions by its proteinase activities. Objective: To compare plasmatic NE concentrations before and after different forms of intensive exercise. Materials and methods: EDTA blood samples were taken from 51 eventing horses (EvH) and 32 endurance horses (EndH) were sampled before the race (T0). Blood sampling was performed 2 h (T1) after completing either phase D of a one or 2 star eventing competition (n = 51), or a 120 or 160 km endurance race (n = 32). Plasmatic NE and MPO were measured by a specific equine ELISA. Neutrophil counts and creatine kinase (CK) levels were also measured. A Wilcox on test for paired samples was used to compare mean values of neutrophils, CK, MPO and NE at T0 and T1 in EvH and in EndH. Correlations were calculated between all the 4 parameters in EvH and EndH. Results: At T0, mean NE levels were 14.43 ± 3.63 ng/ml for EvH and 11.7 ± 2.11 ng/ml for EndH. The competition induced a significant increase of NE levels in (58.57 ± 24.06 ng/ml) EvH and (95.74 ± 22.70 ng/ml) EndH (P

The authors report the results of a multicenter retrospective series with a long-term follow-up and the analysis of clinical, radiological, surgical data as well as the complementary treatments in patients with intramedullary astrocytomas (IA).We performed a retrospective analysis of all the patients with IA operated on between 1984 and 2011 at 7 French centers (Kremlin-Bicêtre, Lille, Lyon, Marseille, Montpellier, Nice, and Nîmes). The minimum follow-up was 12 months. The clinical evaluation was based on the McCormick scale (MCS) results from the pre- and postoperative period.Data from 95 patients with a pathologically confirmed diagnosis of IA were considered: 54 patients were treated at the Neurosurgical Department of Kremlin-Bicêtre Hospital, 8 were treated at Lille and 33 were treated in the south region of France. The epidemiological analysis was performed on the whole cohort of patients while follow-up considerations were made solely on the 54 patients managed at Kremlin-Bicêtre Hospital to obtain homogeneous data. The average age at diagnosis was 35.6 years without significant gender difference (47 % men for 53 % women). The age at first clinical manifestation was 33.7 years. The average duration of the symptoms before the diagnosis was 22.9 months. Neuropathic pain was the principal revealing symptom (76 % of cases). The localization of IA was thoracic in 40 %, purely cervical in 28.4 %. Complete removal was achieved in 29.5 % of cases when considering the whole cohort and in 38 % of cases treated at Bicêtre Hospital. The histological distribution recorded was: grade 1 in 35 %; grade 2 in 35 %; grade 3 in 22 % and grade 4 in 8 %. During the early postoperative period (3 months) a worsening of functional capacity was observed with an increase in the frequencies of ranks 3 and 4 of MCS in 18.4 %. At 5 years follow-up, the frequencies of ranks 1 and 2 were increased. The application of a Cox model for the determination of the relative risk of death for IA grade 1 and 2 (66 patients) showed a probability of survival at 5 years of 78.6 % (CI 95 %: 68.6 %-87.6 %). Survival at 10 years is to 76.8 % (CI 95 %: 62.3 %-84.2 %).Surgery is indicated if the patient is symptomatic or the tumor increases in size. A radical excision remains the mainstay of treatment, while searching to preserve the motor function. A total resection was however only possible in 38 % of cases. A regular postoperative follow-up is compulsory and the adjuvant treatment is based on chemotherapy and radiotherapy according to the histological type.

Introduction: Osteochondrosis (OC) is a developmental disease in horses which has a significant impact on the horse's welfare and performance. The early disturbance in the process of endochondral ossification progresses to inflammatory and repair processes in older horses. Previously, differentially expressed genes in leukocytes of OC-affected horses have been identified. The aim of the present study is to detect age-related changes in these differentially expressed genes. Materials and Methods: The expression of OC-related genes was analysed by real-time PCR and subsequent statistical analysis (ΔΔCT) in the leukocytes of 135 Belgian Warmblood horses divided into three different age groups: 30 months (n=38). Results: Relative expression of genes of horses less than 12 months of age showed significant induction of the genes MGAT4A, PRKCG, MHCI, ApoB, ApoB3G, B4GALT6 and a significantly lower expression of the genes OAS3. Horses of 18–24 months of age, showed a significantly higher expression of the genes TBC1D9, MGAT4A, IFIH1, MHCIIa and MMP1. Horses of more than 30 months of age showed a significantly higher expression of the genes MGAT4A, HP, SECTM1 compared with their age-matched control groups. Conclusions: The study demonstrates that OC-related genes are differentially expressed in horses of different ages compared with their age-matched controls. Some of the genes may be implicated in cell signalling and differentiation as well as carbohydrate and lipid metabolism and inflammation. However, the causal relationship between the differentially expressed genes and the development and progression of the OC lesions needs to be determined.

In the exercising horse, the oxygen delivery to the muscle enables the regeneration of high-energy phosphates (ATP) which are necessary for sustaining an effort and for subsequent recovery. For a fixed and constant level of submaximal exercise, the pulmonary oxygen uptake (VO2) reflects a balance between the energy required by the working muscles and ATP production via the aerobic metabolism. In horses performing

Behavioral disorders were a prominent clinical feature after the surgical treatment of an anterior communicating artery aneurysm rupture in a 44-year-old man. Callosal apraxia was associated with an alien hand. The latter remained 1 year after surgery while diagonistic apraxia disappeared after 3 months. Other callosal signs included left agraphia, tactile anomia and auditory suppression. MRI revealed posterior callosal infarction and a right frontal infarct. The association of diagonistic apraxia and alien hand is rarely reported.

Evaluation of the proliferation activity of neuromas has a practical meaning when there are doubts about the complete resection of the tumor. Evaluation of the clinical aspects connected with increased proliferation activity may have a much broader application. The aim of this study was to correlate selected clinical and radiologic aspects of vestibular schwannomas with the results of the Ki-67 index. The studied group included 23 males and 20 females. Unilateral neuromas were stated in 38 cases (mean age, 52.2 years) and bilateral tumors in 5 cases (mean age, 44.2 years). The immunohistochemical tests (Ki-67) were performed on the specimens preserved in formalin and stored in paraffin. The Ki-67 index was estimated in a semiquantitative study. The mean value of Ki-67 index was 1.86%. In case of unilateral neuromas (n = 38), the average Ki-67 index was 1.74%. In 5 cases of bilateral tumors, the index amounted to 2.79% (P = 0.278). No significant correlation was found by comparing the value of the Ki-67 index with the age of patients (P = 0.410: r = 0.128). Significant differences in the value of the Ki-67 index were noted in the sub-groups of tumors that were evaluated radiologically as growing and stable. The mean value of Ki-67 index was 3.17% in the first subgroup; in stable neuromas, it was significantly lower, amounting to 1.11% (P = 0.020). Such results may confirm that the growth rate of vestibular schwannomas varies and may explain the difficulties in estimating the growth of neuromas on the basis of clinical aspects only. (Otolaryngol Head Neck Surg 2000;123:779-83.)

Osteochondrosis (OC) is the most common developmental orthopaedic disease in horses and represents a major problem to the horse industry. The complete mechanism of this multifactorial disease is not yet elucidated, but it is accepted that OC lesions are the result of intrinsic genetic and external factors. The aim of the present work was to evaluate the relationship between breeding management and OC. Breeding conditions were recorded, and a radiological examination was performed in 223 foals. Feeding practice and housing management were analysed in a multivariate model to determine risk factors for OC in three periods: gestation, birth to weaning and weaning to one-year-old. The major breakthrough of this study is the significant relationship between OC development and (1) the maternal nutrition during gestation and (2) the type of housing of the foals during their first year. It appears that mares fed with concentrates during gestation are more likely to produce foals that are subsequently affected by OC compared with other mares (P

The hearing level is a major point to take into account for managing a patient with an acoustic neuroma. The Gardner-Robertson classification is the most frequently reported as well as the AAO-HNS classification. It combines the use of pure tone audiometry and speech audiometry. The goal of this study is to determine the effect of the level of presentation for the speech material and the effect of the type of list selected for the determination of the speech discrimination score.The speech determination score has been determined for 94 patients with different type of lists of 20 items: sentences, bi and monosyllabic words at two levels of presentation: at speech recognition threshold level plus 35dB and at the most comfortable level. The impact of the choice of the frequencies selected to determine the pure tone average, especially 3000Hz or 4000Hz has been also evaluated.There is a statistical difference when the frequency 4000Hz is selected rather than 3000Hz in the determination of the pure tone average. The speech discrimation score obtained with the use of monosyllabic word lists is statistically different than those obtained with bisyllabic words.To classify a patient's hearing whatever the classification, the speech discrimination score should be determined using monosyllabic word lists. Any other type of lists (sentences, spondees) leads to a significantly different score.

Central nervous system (CNS) hemangioblastomas (HGB) are rare vascular tumors. The goal of this study was to analyze their epidemiology, treatment and prognosis in association with von Hippel-Lindau (VHL) disease.We retrospectively reviewed a series of patients treated in our department for a CNS HGB with VHL disease between 1996 and 2008. We analyzed pre- and postoperative clinical and radiological characteristics, number of visceral lesions (fundoscopy, abdomino-pelvian CT, metanephrines), clinical course (modified Rankin Scale and McCormick scale) and late prognosis (Kaplan-Meier survival curves).We studied 19 cases (sex-ratio 0.9, mean age 36). The mean time to diagnosis was 61days. The main symptom was intracranial hypertension for cerebellar lesions (7/15) and a sensitive-motor deficit for medulla oblongata (2/5) or spinal lesions (5/11). Preferred locations were cerebellum (15/31), often nodulo-cystic appearance, followed by spinal cord (11/31), frequently coming with adjacent syringomyelia. Multiple locations and visceral lesions were found in two-third of the cases. Surgical removal was complete in more than three-quarter of the cases. Mean follow-up duration was 9years. Postoperative mortality rate was 16%. In cerebellar and medulla oblongata locations together, final mRS was ≤1 in 17 of the 20 cases. In spinal cord locations, final McCormick score was ≤2 in all the cases. After delayed follow-up, about two-third of patients experienced recurrence or new progressive CNS lesions.HGB are rare CNS tumors. VHL disease should be considered when an HGB is diagnosed before 30, is located at the spinal cord, comes with multiple other CNS lesions or with typical peripheral lesions. Microsurgical removal is the gold standard treatment and can offer good functional results.

Metastases of lateral ventricle (LV) are attached to choroidal plexus. Primary source is cancer of kidney. Two thirds of patients are male. Oligodendrogliomas occur in young females. Signs of increased intracranial pressure are a constant feature. These tumors are found in anterior portion of the LV with severe enhancement and clumped calcifications. Treatment is surgical. Cavernomas have a preponderance of rapid growth with a bleeding revelation. Seizures are rare. Rebleeding is frequent and justifies a surgical treatment. Schwannomas are a rare entity in which the majority of patients are very young. MRI shows calcifications, cystic components and a strong enhancement. They are limited to sporadic cases, never associated with neurofibromatosis. Arachnoid cysts are located in the atrium and/or in the occipital horn. Patients are young (mean age40 years). MRI demonstrates an intracystic lesion with signal intensity similar to the CSF. Best treatment is an endoscopic fenestration. Epidermoid cysts occur in third decade. These pearly tumors appear isointense or a little hyperintense on T1-weighted imaging, very characteristic. They are enhanced after gadolinium injection and appear strongly hyperintense on T2-weighted imaging. An incomplete removal with a thorough long-term follow-up is necessary. Cavernomas of LV are hyperintense on T1- and T2-weighted imaging. They have a bleeding risk of 25 to 45%. Therefore, they must be operated.

Central neurocytoma is the second most frequent tumor in our series of 284 lateral ventricle tumors (12%). Mean age was 32.6 years. There was a male predominance (20/35). Most frequent clinical signs were neuropsychological disturbances and intracranial hypertension. On imaging, these tumors concentrate central calcifications in more than half of cases. Main locations were frontal horn and corpus of lateral ventricle (82%). Uneventful postoperative course was recorded in 52% of cases. Immunoreactivity against neuron-specific enolase (NSE), synaptophysin, S100 protein, Microtubul Associated Protein de type 2 (MAP2) and calcineurin confirms the neuronal nature of the neoplasm. This tumor has a good prognosis. Local control after surgery is obtained in 68% of cases. Gamma knife surgery seems to be useful in cases of little volume with tumoral remnants or recurrence, when radiological appearance is well circumscribed and round-shaped.

This series reports 40 cases of meningiomas of the lateral ventricle treated in France between 1995 and 2010. The mean age was 52 years. The revelation was incidental in 23% of cases. 36 patients underwent surgery with uneventful postoperative course in 75% of them. Visual field deficits were the most frequent sequelae. In six cases, recurrences occurred during the follow-up period. The relevant series of the literature were discussed in order to precise the therapeutic strategies and the outcome.

Twenty-seven cases of ependymoma were collected in the French multicentric study dedicated to lateral ventricle tumors. The mean age of patients was 31,5 years. All patients underwent surgery, with complete resection of the tumor in 76% of cases. Histologic examination disclosed 23 grade 2 ependymomas and four grade 3 ependymomas. Postoperative mortality was 7%. Four patients underwent radiotherapy, and five chemotherapy. Local recurrence of the tumor occurred in seven cases, with a mean delay of 48 months. Disseminated disease within the central nervous system was found in only one patient. Median survival in all the 27 patients was 181 months, and median progression-free survival was 106 months. The relevant series of the literature are reviewed in order to precise the prognostic factors of ependymomas and therapeutic strategies.

The lateral ventricle (LV) has a deep position within the cerebral hemisphere. The LV is covered by white matter with important functional role in the dominant hemisphere. Lateral wall of the frontal horn is covered by the inferior occipitofrontal fasciculus (IOFF) and its roof by the corpus callosum (CC). The body of the LV has the same cranial relationship and is covered laterally by fibers of internal capsula and arcuate fasciculus; its lower part is in relationship with the body of the fornix. The atrium of the LV is covered by the arcuate fasciculus and its lower part is covered by the IOFF and optic radiations. The inferior horn or temporal horn is covered by optic radiations in depth of middle temporal gyrus (T2). The auditive radiations crossed the optic radiations at the level of the roof of the inferior horn.

Subependymoma is a benign lesion, slow-growing neoplasm, representing 0.2 to 0.7 % of intracranial tumors. They are often clinically silent, incidentally discovered at autopsy. These symptoms are related to big volume. They are attached to the septum pellucidum, leading to hydrocephalus by Monro foramen obstruction. Overall mean age at diagnosis is 39 years with more males than females. At CT-scan, subependymoma shows a slightly low attenuation compared to gray matter. There is no or mild enhancement following contrast injection. On MR T1-weighted imaging, subependymoma is isointense and hyperintense on MR T2-weighted imaging. Intramural calcifications and cystic components are noted in 20 to 30 % of patients. Peritumoral oedema is absent. Immunohistochemicals studies show intense positivity for S-100 and GFAP. The treatment is surgical with an excellent prognosis.

Tumors of the frontal horn of the lateral ventricle (LV) are only supplied by the posteromedial choroidal artery. Tumors of the body of the LV are supplied by the same artery. Tumors of the atrium of the LV with anterior extension are supplied by both posteromedial choroidal and posterolateral arteries. Tumors of the atrium with inferior extension are supplied by both anterior choroidal artery and posterolateral choroidal arteries. Tumors of the inferior horn are only supplied by anterior choroidal artery. The tumoral venous drainage is organized with three main groups of veins: a medial group, a lateral group and a choroidal group.

The data from 284 cases of lateral ventricle (VL) tumors treated in 18 departments of Neurosurgery in France between 1995 and 2010 were collected in this series. The mean age was 33 years with a large proportion of children (79/284).The mean duration of symptoms was short in time (2 months). The revelation was incidental in 10% of the cases; for symptomatic lesions, raised intracranial pressure (ICP, due to hydrocephalus) and neuropsychological signs were the most frequent. Only one third of the patients had no CSF disorder.The two most frequent tumors were meningiomas (40 cases, 15%) and neurocytomas (35 cases, 13%). The sub-ependymal giant cells astrocytomas, the ependymomas and sub-ependymomas were also common (11, 10 and 9% respectively).A surgical procedure was performed in 258 patients, with the help of neuronavigation in one third of cases. The patients were most frequently operated with a transfrontal approach (40%). The resection was complete in 73%, which was a statistical factor of global survival. The postoperative mortality rate was 4.9%.Neuropsychological deficits were the most frequent sequelae (22.8%) due to raised ICP. Campimetric deficits (19%), seizures (19%), hemiparesis (15%) and language disorders (12%) were then found. The mean follow-up was 52 months with good evolution for 58% of patients. Fifteen percent of patients had a handicap and, finally, 12.9% will die. At last, two third of living patients had no tumoral residue or re-evolution.

The lateral ventricles are the C-shaped cavities of the telencephalon. Embryology of theses cavities is recalled as well as the immediate relationship of the frontal horn, the body, the atrium and the temporal and occipital horns.

Chronic hydrocephalus is a classic and recognized complication that affects 6 to 37% of patients with aneurysmal subarachnoid haemorrhage. The diagnosis is often mentioned due to the delayed onset of gait disturbance and slower psychomotor performance. The CT-scan confirms the diagnosis by showing an enlargement of the ventricles. In case of symptomatic hydrocephalus, a ventriculo-peritoneal shunt is often required. The authors report a rare case of chronic hydrocephalus presenting with visual symptoms, due to the delayed mobilisation of a surgical clip with direct mass effect over the anterior optic pathways. The treatment of hydrocephalus led to a rapid and complete regression of symptoms.

The paraclinoid region has a complex anatomy. The purpose of this study was to depict in details its anatomical landmarks and their radiological translations with magnetic resonance imaging (MRI).Ten anatomical specimens (20 paraclinoid regions) were prepared, then dissected and further analyzed with MRI in order to describe their important radio-anatomical structures (dural folds, osseous surfaces, arteries and nerves) along with their course and measurements, and the reference points of the carotid distal dural ring. The paraclinoid MR protocol consisted in a T2 high-resolution sequence with thin and contiguous slices acquired in a coronal (diaphragmatic) and sagittal oblique (carotid) plane. Reproducibility in living subjects was evaluated on 15 patients (30 paraclinoid regions). Statistical comparison was made between laboratory and MR measurements obtained on cadavers.A detailed description of paraclinoid anatomy and structures was provided. Its landmarks were satisfactorily identified with the dedicated MR protocol. Reproducibility in living subjects was obtained. No statistical difference was found between laboratory and MR measurements.This study provides a precise description of paraclinoid anatomical structures and their radiological correlations. This paraclinoid MR protocol allows locating paraclinoid lesions in comparison with the cavernous sinus roof, which is of paramount importance for the management of paraclinoid carotid artery aneurysms.

But de la presentation La Neurofibromatose de type deux est marquee par la survenue de schwannomes vestibulaires bilateraux. L’evolution ultime est la perte bilaterale d’audition dont la rehabilitation repose sur l’implantation cochleaire ou du tronc cerebrale. Des solutions alternatives pour ralentir l’evolution audiometrique sont en cours d’evaluation parmi lesquelles la decompression du conduit auditif interne. L’objectif de l’etude est d’evaluer les resultats auditifs de la decompression du conduit auditif interne proposee au cours de la prise en charge d’une neurofibromatose de type 2. Materiel et methodes Parmi une base de donnee de 110 patients atteints de Neurofibromatose de type 2 et suivis regulierement dans un unique centre hospitalo-universitaire, nous avons identifie les patients operes d’une decompression du conduit auditif interne entre 2010 et 2013. Les resultats auditifs sont donnes selon les criteres identifies pour l’echelle AAO-HNS et la fonction faciale selon la classification House & Brackmann. Les informations concernant le genotype et le phenotype ont ete colligees parallelement a la croissance tumorale suivie par IRM volumetrique. Resultats Dix patients ont ete inclus dont 7 hommes et 3 femmes (S.R. = 2,3). Sept patients sont porteurs d’une mutation germinale identifiee, 3 sont suspects de mosaicisme. L’âge moyen au diagnostic de NF2 est de 17,9 ans (5–49), et de 26 (9–53) au moment de la chirurgie. Le suivi moyen apres decompression est de 12 mois (4–31). Le seuil tonal moyen pre-operatoire est de 34,6 dBHL (14–60), le seuil d’intelligibilite (SI) de 35,7 (17–60) et le score de discrimination maximum en liste monosyllabique mesure 35 dBHL au dela du SI (SDS) de 76 % (0–100). Deux patients ont ameliores leur SI au dela de 5dBHL (18 et 7). Le SDS est reste a 100 % pour 7, ameliore chez 2 (0 a 40 % et 90 a 100 % respectivement). Enfin l’ecriture de potentiels evoques auditifs a ete amelioree chez 2 avec meme une reapparition des ondes I, III et V pour un. Ces reponses ont ete observees independamment l’une de l’autre soulignant des mecanismes multiples a la perte d’audition. Le score H&B est reste a 1 pour tous et aucune complication n’a ete notee. Conclusion La decompression du CAI est une solution chirurgicale interessante chez les patients NF2 non eligibles a une chirurgie d’exerese avec preservation auditive et/ou presentant des criteres d’evolutivite auditive. Les resultats presentes soulignent l’importance du suivi de la discrimination en liste monosyllabique et par PEA pour la selection des patients.

But de la presentation Les tumeurs intracrâniennes peuvent s’exprimer de maniere variable au cours des grossesses. Certaines deviennent plus frequemment symptomatiques pouvant augmenter de taille (meningiomes, hemangioblastome, adenomes pituitaires, schwannomes). Si l’influence de facteurs hormonaux a ete demontre pour des tumeurs telles que les meningiomes, celle-ci reste hypothetique en ce qui concerne les schwannomes en particulier dans un contexte de neurofibromatose de type 2. Materiel et methodes Nous rapportons ici le cas d’une jeune femme nee en 1982 chez qui furent decouverts des schwannomes vestibulaires bilateraux dans le cadre du bilan remnographique d’un syndrome vertigineux atypique. Le diagnostique de neurofibromatose de type II fut rapidement confirme par une analyse genetique orientee. La prise en charge decidee fut celle d’une surveillance bi-annuelle de ces lesions par IRM des angles ponto-cerebelleux et conduits auditifs internes associee a un bilan audiometrique (tonal et vocal) et electrophysiologique (potentiels evoques auditifs precoces (PEAs), potentiels evoques otolithiques myogeniques). Resultats L’IRM initiale montrait donc des schwannomes vestibulaires bilateraux limites aux conduits auditifs internes n’envahissant pas les fossettes cochleaires et vestibulaires. Au debut de la surveillance, les examens audiometriques etaient normaux, on retrouvait des PEAs symetriques sans retard des latences des ondes III et V. D’octobre 2008 a mai 2009 la patiente a vecu une premiere grossesse au cours de laquelle la surveillance montra une stabilite de l’etude volumetrique des 2 schwannomes vestibulaires. En octobre 2012 la patiente debuta une nouvelle grossesse. Pendant celle-ci, la patiente decrivit une perte auditive avec trouble d’intelligibilite a droite. A ce moment, l’audiometrie tonale de l’oreille droite demeurait normale et l’audiometrie vocale montrait un seuil d’intelligibilite a 25 dBHL. Les PEA de ce cote etait absents a 90 dB. Cette aggravation audiometrique a ete associee a une croissance acceleree du schwannome vestibulaire droit passant de 160 mm 3 avant la grossesse a 465 mm 3 apres. Enfin, en post-partum, on observa un retour des ondes I, III, V individualisables sur les PEAs a droite. Et ce en coherence avec une sensation subjective d’amelioration de la fonction auditive droite chez la patiente en quelques semaines post-partum. Conclusion Ce cas clinique richement documente presente l’influence de la grossesse sur l’evolution d’un schwannome vestibulaire developpe dans le cadre d’une NF2 par mutation germinale. L’atteinte auditive retrocochleaire marquee par l’aggravation de la discordance tonale-vocale et des PEA, a ete reversible temoignant d’un phenomene local affectant le nerf cochleaire. Cette observation souligne l’importance du facteur compressif du conduit auditif interne.

Intense physical exercise can induce the degranulation of neutrophils leading to an increase in plasma concentration of the neutrophil marker enzymes myeloperoxidase (MPO) and elastase (ELT). These enzymes have pro-oxidative and pro-inflammatory properties and may play a role in the exercised-induced muscular damage.To measure MPO and ELT concentrations in plasma and muscles of endurance horses and to correlate them to the extent of exercise-induced muscular damage.Seven endurance horses qualified on 120 km races were tested in this study. Neutrophil count, serum creatine kinase (CK), plasmatic and muscular MPO and ELT concentrations were measured before and 2 h after a 120 km endurance race.The race produced a significant increase of neutrophils, CK, and plasma MPO and ELT levels. A significant correlation was observed between the MPO and ELT values in plasma (r(2) = 0.92, P0.01) and in muscles (r(2) = 0.89, P0.01) while plasmatic concentrations of MPO and ELT were not significantly correlated to muscular ones. An increase of mean concentrations (± s.e.) of MPO (T0: 9.85 ± 3.9, T1: 228.9 ± 95.9 ng/mg proteins) and ELT (T0: 8.4 ± 2.4, T1: 74.5 ± 39.7 ng/mg proteins) in the muscles were observed after the race. Interestingly, the individual data showed large differences between the horses. Muscular MPO and ELT concentrations were significantly correlated to plasma CK levels. The coefficient of correlation (r(2)) was 0.69 (P0.01) for MPO and 0.66 (P0.01) for ELT, respectively.Results underline the possible role of MPO and ELT in exercise-induced muscular damage.Further studies should investigate the effect of exercise type and intensity, as well as the role of the training state on MPO and ELT involvement in muscular damage. The assessment of the intensity of exercise-induced neutrophilic degranulation may have a potential role in the monitoring of the athletic career.

Intensive exercise induces a systemic inflammatory response characterised by an increase of blood neutrophil count and myeloperoxidase (MPO) release. Neutrophil elastase (NE) could also contribute to tissues lesions by its proteinase activities.To compare plasmatic NE concentrations before and after different forms of intensive exercise.EDTA blood samples were taken from 51 eventing horses (EvH) and 32 endurance horses (EndH) were sampled before the race (T0). Blood sampling was performed 2 h (T1) after completing either phase D of a one or 2 star eventing competition (n = 51), or a 120 or 160 km endurance race (n = 32). Plasmatic NE and MPO were measured by a specific equine ELISA. Neutrophil counts and creatine kinase (CK) levels were also measured. A Wilcox on test for paired samples was used to compare mean values of neutrophils, CK, MPO and NE at T0 and T1 in EvH and in EndH. Correlations were calculated between all the 4 parameters in EvH and EndH.At T0, mean NE levels were 14.43 ± 3.63 ng/ml for EvH and 11.7 ± 2.11 ng/ml for EndH. The competition induced a significant increase of NE levels in (58.57 ± 24.06 ng/ml) EvH and (95.74 ± 22.70 ng/ml) EndH (P0.05). NE was significantly (P0.0001) correlated to MPO in EvH (r = 0.293) and EndH (r = 0.594) and to CK (r = 0.297) in EndH (P0.0001). Neutrophils, CK and MPO were significantly increased between T0 and T1 in both types of horses.Significant increase of NE (EndH) was observed after intense exercise with a significant correlation between NE and MPO. The huge variability in MPO and NE indicates that not all horses show the same intensity of systemic inflammatory response.

Whereas the effect of heel configuration on the tension of the suspensory apparatus is well documented in the literature, there are few reports of joint contact force components in the equine distal forelimb.To improve understanding of the effect of heel configuration on equine digit joint loading, a sensitivity analysis was performed to compare the effect of a raised heel on joint contact force components in the coffin and fetlock joints during the stance phase of the trot.Four Warmblood horses were used. An inverse dynamic analysis was carried out using kinematic and kinetic data. Taking into account the tendon wrapping forces (WF) around the sesamoid bones in the calculations, the joint contact forces (CF) were estimated for the coffin and fetlock joints during the trot stance phase (4 m/s). To test the sensitivity of the results to heel configuration changes, calculations were performed repeatedly for different heel configurations (raised by 0, 6 and 12°). A one-way ANOVA with repeated measures was used to test the effect of heel configuration (at the 3 levels) (α = 0.05; P0.05; post hoc testing: Bonferroni).For heel configurations raised from 0-12°: whereas the tension of the deep digital flexor tendon decreased and the tension of the superficial digital flexor tendon increased, for the coffin joint the peak WF (1.4 ± 0.25 bwt; 1.2 ± 0.2 bwt; 0.95 ± 0.1 bwt) and the peak CF (2.45 ± 0.25 bwt; 2.2 ± 0.2 bwt; 2 ± 0.1 bwt) decreased significantly (P0.05). For the fetlock joint, the peak WF (3.8 ± 0.7 bwt; 4.1 ± 0.3 bwt; 4.4 ± 0.25 bwt) and the peak CF (4.35 ± 0.7 bwt; 4.7 ± 0.35 bwt; 5 ± 0.3 bwt) increased, but not significantly.This analysis suggests that the coffin joint loading and fetlock joint loading are strongly connected. The heel configuration may influence both coffin joint and fetlock joint contact force components.

This study focuses on the surgical approaches to intraventricular tumors which have developed within the cavity of the lateral ventricle. The first section is dedicated to embryology and describes the wrapping of the telencephalic vesicles around the thalamus and the morphogenesis of basal nuclei and commissures. In the second section, the anatomy of the lateral ventricles is described, along with their arterial and venous vasculature, their relationship with the eloquent cortical areas and cortical sulci, and their relationship with white matter fascicles, especially the optic radiations. In the third part, the main surgical approaches to the frontal horn, to the ventricular atrium and to the temporal horn are detailed.

The prevalence of cerebral cavernomas is about 0.5% in the general population. In contrast, spinal cord cavernomas are considered as rare. The objective of this study was to determine the natural history of spinal cord cavernomas in a multicentric study.Clinical and neuroradiological findings were retrospectively collected. Diagnosis was based on pathological criteria or magnetic resonance (MR) findings.Fifty-three patients were included (26 males, 27 females). Mean age at onset of symptoms was 40.2 years (range: 11-80). Initial symptoms were progressive (32) and acute myelopathy (20). One patient was asymptomatic. Clinical symptoms were related to spinal cord compression (24) and hematomyelia (19). Cavernoma location was dorsal (41) and cervical (12.). MR findings consisted of hyperintense signal on T1 and T2 sequences (19 cases), mixed hyperintense and hypointense signal (33 cases), and hypointense signal on T1 and T2 sequences in 1 case. Mean size was 16.3 mm (range: 3-54). Forty patients underwent surgical resection. Improvement was observed in 20 patients and worsening of neurological symptoms in 11. Length of follow up was 7.1 years. At the end of the study, 26 patients were autonomous, 18 handicapped and 1 bedridden.This study provided precise data on the clinical and MR patterns of these lesions. The natural history is associated with a higher risk of hemorrhage recurrence, but is favorable in many operated patients. Microsurgery is the treatment of choice for most of these lesions.

Intracranial dural arteriovenous fistulas (DAVF) with cortical venous drainage are vascular malformations with high hemorrhagic risk. Their treatment may be complex and requires a multidisciplinary approach.We retrospectively report 38 observations of dural arteriovenous fistulas with cortical venous drainage from 1990 to 2001. There were 28 men and 10 women with a mean age of 57 years. Hemorrhage revealed the malformation in 24 cases (63%). The other patients had headache, neurological deficit, seizure or pulsating mass of the scalp. One patient was asymptomatic. All the patients had DAVF with cortical venous drainage and decision of treatment was in each case multidisciplinary.Of the 38 patients, seven had no treatment for the following reasons: spontaneous occlusion of the malformation after hemorrhage, refusal of treatment, or poor neurological status at the admission. Thirty-one patients were treated and complete exclusion of the fistula was obtained in 30 cases. Endovascular occlusion of the fistula was performed in 14 patients, surgical clipping of the origin of the draining vein in 12 and combined treatment (surgical clipping after embolization of feeding arteries) in four. One patient had an untreated fistula despite several procedures.Complete exclusion of these malformations is mandatory because of the potential risk of hemorrhagic complications. The best treatment is the occlusion of the origin of the draining vein (endovascular or surgical) and requires multidisciplinary discussion.