Many studies have shown that women who begin childbearing as teenagers tend to have a larger number of children than, and have them at shorter intervals than, women who postpone childbearing. However, most of the reported studies were done in developed countries, while similar data from the less developed and Asian countries are limited. This paper attempts to present data on the relationship of the age at mothers' first birth and subsequent family size and birth interval in Singapore. The study group, comprising women who had their first birth below the age of 20 years, was compared with a control group, whose age of first birth was between 20 and 29 years. An attempt was made to control for the socio-economic status of the two groups, and they were found to be similar.Findings reveal that the group of teenage mothers had an average of 3·18 pregnancies,while that of the control group was 2·54 pregnancies. The mean number of living children was 2·94 among the former and 2·44 in the latter group. Of the teenage mothers, 37·5% (compared with 14·6% of the older mothers) had children with average birth interval less than 24 months. The differences in the results between the two groups are statistically significant at the P=0·01 level.

Chondromyxoid fibroma is an uncommon benign bone tumor of cartilaginous origin. It is often located in long bone metaphysis. We report a case involving the left frontotemporal cranial vault in a 44-year-old woman. Fifteen cranial vault cases have been reported in the international literature. Surgical resection of the lesion with tumor-free margins is the key factor to cure it and avoid local recurrence.

We report the results of an investigation carried out on the activity of functional neurosurgery of the cranial nerves in the French-speaking countries, based on the analysis of a questionnaire addressed to all the members of the SNCLF. Eighteen centers responded to this questionnaire, which showed that activities and indications varied greatly from one unit to another. The results appear homogeneous and comparable with those reported in the literature. The questionnaire sought to provide a global perspective, open to the comments and questions of all responders on the various techniques raised, with the objective of establishing a common decisional tree for these pathologies and providing if possible to a consensus for better dissemination of these therapies.

Tuberculomas of the spinal cord are rare. The objective of this study was to illustrate the diagnosis and treatment of tuberculomas of the conus medullaris. They must be suspected in patients with a clinical context and a typical spinal cord mass lesion. Treatment is primarily medical. Surgery is reserved for cases of rapid neurological deterioration or doubts concerning the diagnosis. We report a case of intramedullary tuberculoma of the conus in a 27-year-old woman with paresthesias and weakness of the lower limbs who had been treated for pulmonary tuberculosis. The spinal MR showed a characteristic intramedullary ring-enhancing lesion. She improved neurologically one month after the beginning of the antituberculous drugs and a laminectomy. Seven months later, the patient is asymptomatic and the lesion has nearly completely disappeared completely.

PURPOSE:Few reliable prognostic molecular markers have been characterized for glioblastoma multiforme (GBM), considered the deadliest of human cancers. We hypothesized that genetic polymorphisms in chemokines and their receptors, which together control microglial cell mobilization, may influence survival.METHODS:Distributions of one polymorphism of the chemokine CCL2 (-2518A<G) and two polymorphisms of the chemokine receptor CX3CR1 (termed V249I and T280M) were determined in a prospective series of 230 patients with GBM and correlated with overall survival. The replication study used data from a retrospective series of 106 additional patients with GBM. The extent of microglial cell infiltration was assessed by immunochemistry in 102 tumor specimens.RESULTS:Survival analysis showed that the common CX3CR1-I249 allele was an independent favorable prognostic factor in both groups, prospective and retrospective, with hazard ratios of 0.619 (95% CI, 0.451 to 0.850; P = .0031) and 0.354 (95% CI, 0.217 to 0.580; P < .0001), respectively. This beneficial effect was observed only in patients who underwent surgery. Patients with only this CX3CR1-I249 allele had a substantially longer mean survival (23.5 v 14.1 months; P < .0001). The CCL2-2518G allele was not associated with patient survival. Immunohistochemical analysis of primary tumor biopsies showed that the common CX3CR1 variant allele was associated with reduced microglial cell infiltration.CONCLUSION:The common CX3CR1 allelic variant was associated with increased GBM survival and with reduced tumor infiltration by microglia. The CX3CR1 polymorphism does not seem to be a risk factor for GBM but may prove useful in predicting survival.

European Journal of PainVolume 11, Issue S1 p. S114-S115 259 LONG-TERM RESULTS OF THE MICROSURGICAL DREZ-TOMY FOR NEUROPATHIC PAIN DUE TO BRACHIAL PLEXUS AVULSION: ANATOMICAL LEARNING AND CLINICAL DISCREPANCY E. Blondet, E. Blondet Department of Neurosurgery, HIA Percy, Clamart, FranceSearch for more papers by this authorM. Sindou, M. Sindou Department of Neurosurgery, Hopital P. Wertheimer, Lyon, FranceSearch for more papers by this author E. Blondet, E. Blondet Department of Neurosurgery, HIA Percy, Clamart, FranceSearch for more papers by this authorM. Sindou, M. Sindou Department of Neurosurgery, Hopital P. Wertheimer, Lyon, FranceSearch for more papers by this author First published: 16 January 2012 https://doi.org/10.1016/j.ejpain.2007.03.274Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume11, IssueS1June 2007Pages S114-S115 RelatedInformation

European Journal of PainVolume 11, Issue S1 p. S141-S141 318 THE TRIGEMINAL NEURALGIA: WHEN ESSENTIAL CRITERIA MEET COMPRESSIVE ETIOLOGY E. Blondet, E. Blondet Department of Neurosurgery, HIA Percy, Clamart, FranceSearch for more papers by this authorT. Briche, T. Briche Department of ENT Surgery, HIA Percy, Clamart, FranceSearch for more papers by this authorD. Vandershooten, D. Vandershooten Department of Psychiatry, HIA Percy, Clamart, FranceSearch for more papers by this authorV. Prudon, V. Prudon Department of Medical Imagery, HIA Percy, Clamart, FranceSearch for more papers by this authorM. Sindou, M. Sindou Department of Neurosurgery, Hopital P. Wertheimer, Lyon, FranceSearch for more papers by this author E. Blondet, E. Blondet Department of Neurosurgery, HIA Percy, Clamart, FranceSearch for more papers by this authorT. Briche, T. Briche Department of ENT Surgery, HIA Percy, Clamart, FranceSearch for more papers by this authorD. Vandershooten, D. Vandershooten Department of Psychiatry, HIA Percy, Clamart, FranceSearch for more papers by this authorV. Prudon, V. Prudon Department of Medical Imagery, HIA Percy, Clamart, FranceSearch for more papers by this authorM. Sindou, M. Sindou Department of Neurosurgery, Hopital P. Wertheimer, Lyon, FranceSearch for more papers by this author First published: 16 January 2012 https://doi.org/10.1016/j.ejpain.2007.03.333Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume11, IssueS1June 2007Pages S141-S141 RelatedInformation

European Journal of PainVolume 11, Issue S1 p. S179-S180 405 LONG-TERM RESULTS OF THE MICROSURGICAL DREZ-TOMY FOR NEUROPATHIC PAIN DUE TO BRACHIAL PLEXUS AVULSION: CLINICAL LEARNING ABOUT PAIN MECHANISM E. Blondet, E. Blondet Department of Neurosurgery, HIA Percy, Clamart, FranceSearch for more papers by this authorM. Sindou, M. Sindou Department of Neurosurgery, Hopital P. Wertheimer, Lyon, FranceSearch for more papers by this author E. Blondet, E. Blondet Department of Neurosurgery, HIA Percy, Clamart, FranceSearch for more papers by this authorM. Sindou, M. Sindou Department of Neurosurgery, Hopital P. Wertheimer, Lyon, FranceSearch for more papers by this author First published: 16 January 2012 https://doi.org/10.1016/j.ejpain.2007.03.420Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume11, IssueS1June 2007Pages S179-S180 RelatedInformation

To the Editor: Chronic subdural hematoma (CSH) is a common pathology encountered in neurosurgical practice, with an annual incidence of 8.2 per 100,000 for people aged 65 and older,1 but its diagnosis is not always easy to establish, especially in older people, with an often poor and sometimes misleading clinical presentation.2 We report the case of a 79-year-old patient with bilateral CSH revealed by distant diplopia in relation with bilateral abducens nerve palsy and papilledema. A previously healthy 79-year-old Lebanese man was admitted with a 2-week history of isolated distant diplopia. Medical history was uneventful except essential hypertension treated with beta-blocking agents. There were no other associated signs, including headache. Clinical examination revealed paresis of lateral rectus on both eyes. Because the patient presented no impairment of gaze and following movements, the diagnosis of divergence palsy (abducens nerve palsy) was made. Funduscopic examination showed bilateral papilledema. An emergency computerized tomography (CT) scan revealed bilateral CSH with a symmetrical thickness of 1.5 cm (Figure 1). A thorough questioning of the patient's son uncovered a history of benign cranial trauma 2 months before of nonelucidated origin, with no loss of consciousness. Emergency burr hole evacuation was performed. Bilateral concomitant opening of the dura and outer membrane permitted evacuation of the hematoma under high pressure. The brain returned quickly to the cranial wall, preventing irrigation of the cavity and subdural drainage. Postoperative course was uneventful, with total recovery of previous diplopia 1 month after surgery. Further arterial tension controls showed significant hypotension with the previous antihypertensive treatment. Beta-blocking agents were progressively carefully stopped with no ischemic complication. A control CT scan performed 2 months later revealed no recurrence of the hematoma. Cerebral computed tomography scan. Bilateral chronic subdural hematoma. The association between bilateral CSH and bilateral abducens nerve palsy is rarely mentioned in the literature. Cases reported with diplopia are generally related to unilateral VI palsy, creating a true localizing sign with ipsilateral bleeding or revealing bilateral hematoma.3, 4 A review reported no patient with bilateral CSH presenting with diplopia.5 One study seems to describe the first case in a 75-year-old woman during the CT era.6 This case is similar to ours, with a recent history of distant diplopia without headache, although ophthalmological examination did not indicate the existence of papilledema. Cranial nerve VI has the longest intracranial course and is thus vulnerable to variations of the intracranial pressure. It may be damaged between its emergence from the belly of the pons and Dorello's canal where it enters the cavernous sinus.7, 8 The association between diplopia and bilateral CSH may correspond to two distinct physiopathological mechanisms. There may be bilateral abducens nerve damage because of the development of intracranial hypertension caused by posttraumatic subdural bleeding. Alternatively, it may be secondary to intracranial hypotension, with downward displacement of the brain, which leads to tearing of dural veins with subsequent subdural bleeding. This could explain the development of diplopia, with a possible secondary subdural hematoma in spontaneous or acquired intracranial hypotension.4, 9, 10 Nevertheless, the association between bilateral abducens nerve palsy and bilateral CSH is rare. The fact that bilateral CSH is predominantly encountered in older people, whose symptoms in relation to the acute pathology are not always in the foreground and can mislead the clinician, may explain this. The frequency of diplopia may therefore be underestimated. Moreover, CSH is not always correlated with intracranial hypertension. Normal to low pressure rates are reported in 30% to 50% of patients presenting with CSH. The relative slowness of the development of the hematoma, with progressive adaptation of intracranial pressure at the expense of cerebral and liquid compartments, in patients with cerebral atrophy can explain this.9 This was not the case in our patient, who presented with papilledema related to intracranial hypertension. The hematomas were evacuated under pressure, with a rapid subdural space collapse, which is not the general rule with bilateral CSH.5 Finally, hypotension was supposed to be the origin of the cranial trauma, and antihypertensive treatment was stopped. This case of bilateral CSH, bilateral VI nerve palsy, and papilledema is rarely mentioned in the literature. Intracranial hypertension was diagnosed with funduscopic examination. Special care must be reported for a thorough history and examination in such patients, often presenting a poor symptomatology that sometimes does not lead directly to the main diagnosis. Financial Disclosure: No author declares any financial support from research, consultantships, or speakers forums. Author Contributions: Lydie Dulou and Renaud Dulou wrote the manuscript. Corinne Leduc, ophthalmologist, confirmed abducens nerve palsy and found funduscopic abnormalities. Arnaud Dagain and Renaud Dulou operated on the patient. Eric Blondet helped with the final form of the letter. Sponsor's Role: None.

Nous présentons les cas de deux patientes ayant une compression médullaire par kystes arachnoïdiens. Pour l’une d’entre elles, plusieurs interventions ont été nécessaires, à différentes étapes de l’évolution de sa maladie. À la lumière des difficultés rencontrées pour traiter cette dernière patiente, il nous a paru intéressant d’étudier les particularités de cette entité peu fréquente de compression médullaire, au travers d’une revue de la littérature.

Spinal arachnoid cysts are considered to be rare entities, intradural locations are even less common. We report two cases of patients (two women aged 77- and 21-year-old) who presented spinal cord compression by intradural arachnoid cysts. For the second patient, repeated surgical procedures were necessary to improve the neurological status. After presenting the case reports, we expose the pathophysiological mechanisms and clinical features, and the surgical difficulties of treating this rare cause of spinal cord compression.

OBJECT Most patients with preganglionic lesions after brachial plexus injuries suffer pain that is hard to control through medication or neuromodulation. Lesioning in the dorsal root entry zone (DREZ) is undeniably effective. Fifty-five patients who had undergone the so-called microsurgical DREZotomy (MDT) procedure were studied with the two following objectives: 1) to describe the anatomical lesions observed during MDT in correlation with sensory deficits and pain features; and 2) to analyze the results in the 44 patients who were followed for more than 1 year (mean 6 years). METHODS The observed lesions were severe: 79.6% of ventral and 78.2% of dorsal roots from C5-T1 were impaired. Damage extended to all five roots in 42% of patients. Strong arachnoiditis was present in 38.2%, pseudomeningoceles in 31%, spinal cord distortion and/or atrophy in 49%, and abundant gliotic tissue and/or microcavitations within the dorsal horn at the avulsed segments in 36.4% of cases. Sensory deficit corresponded to the entire territory of the dorsal root lesions in 52% of patients, but was larger in 30% most certainly due to the associated extrarachidian lesions. At the last evaluation after MDT, 66% of patients showed excellent (total relief without medication) or good (total relief with medication) pain relief and 71% experienced an improvement in activity level. CONCLUSIONS Apart from other indications not addressed in this article, MDT can be performed to treat refractory pain due to brachial plexus avulsions. The long-term efficacy of this procedure strongly indicates that pain after brachial plexus avulsion originates from the deafferented (and gliotic) dorsal horn.

La radiothérapie stéréotaxique en séance unique ou radiochirurgie cérébrale est une technique non invasive qui permet de créer des lésions focales dans le cerveau de façon très précise et localisée. Elle peut ainsi permettre de traiter des troubles fonctionnels cérébraux en cas d’inefficacité médicamenteuse et d’inopérabilité. L’indication la plus décrite et connue est la radiochirurgie pour névralgie du nerf trijumeau. D’autres indications se développent comme la radiochirurgie pour tremblements, épilepsie réfractaire, troubles obsessionnels compulsifs (TOC) ou syndrome dépressif majeur. Nous présentons dans cette revue de la littérature les indications actuelles et futures de la radiochirurgie cérébrale fonctionnelle, ainsi que leur niveau de preuve. Ces traitements doivent être strictement encadrés, dans des équipes entraînées, avec une excellente collaboration entre radiothérapeutes, physiciens médicaux, neurochirurgiens, voire neuroradiologues, neurologues et/ou psychiatres selon les indications.Stereotactic radiosurgery (SRS) is a non-invasive technique that enables to create brain focal lesions with a high precision and localization. Thus, functional brain disorders can be treated by SRS in case of pharmacoresistance or inoperability. To date, treatment of trigeminal neuralgia is the most described and known indication. Other indications will be developed in the future like movement disorders, refractory epilepsy, obsessive compulsive disorder and severe depression. We present here a review of actual and future indications of functional brain SRS with their level of evidence. All these SRS treatments have to be strictly conducted by trained teams with an excellent collaboration between radiation physicists, medical physicists, neurosurgeons, neurologists, psychiatrists and probably neuroradiologists.

Primary central nervous system lymphoma is an invasive disease in both HIV-positive and HIV-negative patients. Atypical presentations, including leptomeningeal involvement often described in cases with aggressive histology, have been reported but primary meningeal B-cell lymphoma appears to be very rare. A 40-year-old immunocompetent man developed a voluminous frontoparietal cranial vault tumor. The neurology examination demonstrated a large extra-axial mass involving the anterior part of the superior longitudinal sinus. The tumor extended through the cranial vault, without osteolysis, and grew in the subcutaneous tissue. Craniotomy was performed and the entire mass was resected without neurological deterioration. Pathology reported B-cell lymphoma. No other localization was found. Primary B-cell meningeal lymphoma, as illustrated in this case, can be another atypical presentation of CNS lymphoma.

The authors present the results of neuronavigation as a help to open neurosurgery for the tumors of the third ventricle. From January, 1995 to August, 1999, six image-guided surgical procedures were performed to remove third ventricle lesions : 4 colloïd cysts, 1 ependymoma, and 1 craniopharyngioma. The operative approach was transcortical in 5 cases, and transcallosal in 1 case. The use of neuronavigation allows a decrease of the surgical trauma during the surgical approach. The procedure secures the neurosurgeon in the choice and execution of his pathway to the target. It becomes however less accurate after opening the ventricle, because of the brainshift induced by the loss of cerebrospinal fluid becomes important. Nevertheless, neuronavigation is useful in the surgery of the third ventricle, especially if it is used with neuroendoscopy.

The authors analyzed the postoperative and long-term results of the microsurgical DREZotomy procedure performed in 37 patients suffering from chronic pain due to brachial plexus avulsion. The evaluation was based on clinical parameters. The immediate results consisted of good pain relief (pain relief > 75%) in 79% of the patients. A long-lasting good pain relief has been achieved in 66.5% of the patients with a mean follow-up of 60 months (range 12-120). The morbidity rate was 5%.