Neurochirurgie
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To determine factors influencing ultimate visual outcome following surgical decompression of pituitary adenoma and suprasellar meningioma, the authors analyse the post-operative visual function of 19 patients with pituitary tumors and of 11 with meningiomas encroaching upon the anterior visual pathways. Their data indicate that : visual impairment tended to be worse and of larger duration with meningiomas than with adenoma. No pre-operative data were of prognostic value for visual outcome with meningioma; for adenoma, younger age, a short duration of symptoms and transsphenoidal approach all positively influenced ultimate visual recovery. Even with minimal visual deficits, eyes tended not to recover completely.
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A series of 180 patients with painful neurological disorders were treated with TENS. The findings most frequently encountered when the treatment was successful are analyzed. ⋯ In all other cases the percentage of pain relief decreased with follow-up. In this series the likelyhood of good results was associated with the following objective data : 1) Pain is generally secondary to deafferentation. 2) Pain is localized. 3) TENS application in close contact with the nervous structure innervating the painful area is more productive. 4) A relative preservation of lemniscal fibers to superior centers must be present so that stimulation can be transmitted.
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Meralgia paresthetica although it does not produce intensive pain is a cause of chronic disability, usually barely improved by medical treatment. From the report of two cases of neurolysis the authors stress on the possibility of entrapment neuropathy of the lateral femoral cutaneous nerve in its way through the femoral canal, between the inguinal ligament and the fascia-iliaca. ⋯ The compression is due to a thickening of the fascia-iliaca as it forms the postero inferior wall of this canal; the nerve is squeezed between the fascia and the inguinal ligament. In 60% of cases of meralgia paresthetica where this mechanism is involved, the funicular neurolysis appears to be a radical treatment.
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A rare anomaly of the A1 portion of both ACA associated with a saccular aneurysm of the basilar bifudcation is presented. Based upon this case and eigth other cases in the literature, the anatomical and radiological features of the anomaly are precised : the anomalous artery comes from the internal carotid artery right over the cavernous sinus, very close to the origin of the ophtalmic artery; it rums medailly below the inferior aspect of the optic nerve, thus being projected under the plane of the optic canal on oblique angiograms; finally, it crosses the anterior edge of the optic chiasm up to the interhemispheric fissure. By itself the anomaly is asymptomatic but it should not be considered as a mere curiosity since it has most often been found associated with a variety of cerebral vasculature anomalies and in particular with encor more saccular aneurysms of the circle of Willis.