✓ A technique for the removal of sphenoid blocks from cadavers and for selective injection of the hypophyseal arteries of these specimens is described. Results of such injections are presented, with emphasis on the role of the inferior hypophyseal artery (IHA). The IHA was found to be the most important artery supplying the pituitary gland, and in particular, the structures involved in production, transportation, and storage of the antidiuretic hormone. The literature pertinent to the arterial blood supply of the normal pituitary gland is reviewed.
An anatomical study
Toussaint A. Leclercq and Francois Grisoli
Stéphane Fuentes, Phillipe Metellus, Henry Dufour and François Grisoli
A modified technique of selective hypophysectomy
Toussaint A. Leclercq and Francois Grisoli
✓ A modified transsphenoidal microsurgical technique of selective hypophysectomy is described. By preserving the posterior lobe, the pituitary stalk, and the blood supply from the inferior hypophyseal arteries, diabetes insipidus was avoided.
Pablo Bouillot, Stéphane Fuentes, Henry Dufour, Luis Manera and François Grisoli
✓ The authors report a new case of combined atlantoaxial and occipitoatlantal rotatory subluxation in a 17-year-old girl. They describe the clinical and imaging features of this rare entity. An occiput—C2 arthrodesis was performed.
Giuseppe Caruso, François Vincentelli, Gérard Giudicelli, François Grisoli, Tao Xu and André Gouaze
✓ The perforating branches of the upper basilar artery and of the first (P1) segment of the posterior cerebral artery were studied in 50 fixed brains obtained from human cadavers. No vertical branches arose from the basilar bifurcation. The upper basilar artery gave rise to horizontal branches, which were studied with reference to their angle of origin. Perforating arteries arising from P1 segments were found in all specimens. Rare branches were found to come from the inferior and anterior surfaces of P1 segments. The anatomical patterns of these branches are discussed in the light of previous reports. Preoperative knowledge of some anatomical aspects (the position of the basilar apex, the angle between the right P1 and left P1 segments, and relationships to the dorsum sellae and the mammillary bodies) can help in the selection of a neurosurgical approach and may improve the operative results in the surgical treatment of basilar apex aneurysms.
Marie-Dominique Piercecchi-Marti, Hicham Mohamed, Agnes Liprandi, Daniele Gambarelli, Francois Grisoli and Jean-François Pellissier
✓ In this report, the authors review the case of a man with a neurocutaneous syndrome. He presented with an intracerebral melanocytoma associated with a blue nevus of the scalp; its location and its appearance during childhood supported the diagnosis of a nevus of Ota.
Meningeal melanocytomas are increasingly being diagnosed, but remain rare. Primary meningeal malignant melanoma is the first differential diagnosis to eliminate.
Despite their common embryonic origin, the association of a melanocytoma with a nevus of Ota is rare. A nevus of Ota exhibits the same melanocytic proliferation and affects the trigeminal nerve territory. An ocular effect is not always observed. In contrast to an ocular lesion, a nevus of Ota rarely transforms into a malignant melanoma. It is found only among caucasians.
During 4 years of follow-up review after surgery, the patient remained asymptomatic. Other than antiepileptic therapy, he received no complementary treatment and cerebral imaging revealed no evidence of recurrence.
Report of four cases
François Vincentelli, François Grisoli, Toussaint A. Leclercq, Bernard Ardaud, Pedro Diaz-Vasquez and Jacques Hassoun
✓ Cylindromas are rarely encountered in the neurosurgical field. Four cases of this rare tumor are presented. Conventional and computerized tomography scanning were most useful in establishing the diagnosis; angiography did not provide any further information. Because these tumors are well demarcated from surrounding structures, even in cases of recurrence, surgery is the treatment of choice. Radiation therapy is useful in the postoperative management. Long survival times with multiple recurrences are the rule.
Stéphane Fuentes, Phillipe Métellus, Grégoire Pech-Gourg, Tarek Adetchessi, Henri Dufour and François Grisoli
Elderly patients in poor general health frequently suffer vertebral body (VB) fractures due to osteoporosis or vertebral metastatic lesions. Kyphoplasty and vertebroplasty have become the standard treatment for these types of fractures. In certain conditions that cause local kyphosis, such as spinal cord compression due to a metastatic epidural tumor or the shortening of the spinal canal secondary to vertebral compression, the surgical treatment should provide decompression and stabilization during a short intervention. In this study the authors evaluated a surgical technique that frequently combines a same-session surgical decompression, such as a laminectomy, and posterior instrumentation-assisted stabilization during the same open intervention in which the VB is stabilized by kyphoplasty.
During an 18-month period, the authors treated 18 patients with VB fractures according to this protocol: 14 patients with vertebral metastatic lesions and four with osteoporosis. The patients' mean age was 60 years. All suffered severe pain preoperatively (mean visual analog scale [VAS] score of 7). Fourteen of the 18 patients suffered a neurological deficit. Twenty-three vertebral levels were treated; in 15 patients it was necessary to place posterior instrumentation. The mean duration of the intervention was 90 minutes.
Pain in all patients improved 3 days after the intervention, and the mean VAS score decreased to 2. Patients with a neurological dysfunction improved. The mean quantity of injected cement for the kyphoplasty procedure was 7 ml. The mean duration of hospitalization was 7 days. Neuroimaging revealed cement leaks in two cases: one into the disc interspace and one anteriorly into the fractured part of the vertebra. After the intervention, most patients with metastatic lesions underwent radiotherapy. No procedure-related complications occurred.
This procedure allows decompression of the spinal cord, consolidation of the VB and thus a stabilization of the vertebral column, and may provide an alternative treatment to invasive VB excision in patients in poor general health.
Dominique Figarella-Branger, Miguelina Perez-Castillo, Louise Garbe, François Grisoli, Danielle Gambarelli and Jacques Hassoun
✓ What is apparently the first reported case of spontaneous malignant transformation of a benign osteoblastoma of the skull is described. The initial lesion was completely removed surgically and showed the histological features typical of a benign osteoblastoma. No radiotherapy was performed. Eleven years later the patient developed an osteosarcoma of the skull. Review of the literature showed that malignant transformation of benign osteoblastomas is extremely rare and could take place spontaneously. However, the risk of this occurring seems higher after inadequate initial treatment (curettage or partial excision). Follow-up monitoring of patients with osteoblastoma of the cranial vault is suggested.